A meta-analysis of amputation versus limb salvage in mangled lower limb injuries--the patient perspective

This meta-analysis evaluates the quality of life in post-traumatic amputees in comparison with limb salvage. Studies included in this meta-analysis had a minimum of 24 months of follow-up and used a validated quality-of-life outcome assessment scale (Short Form-36 or Sickness Impact Profile) for physical and psychological outcomes. Two reviewers performed the search and data extraction independent of each other. A total of 214 studies were identified; 11 fulfilled the inclusion criteria; thus, 1138 patients were available for meta-analysis (769 amputees and 369 cases of reconstruction). The meta-analysis demonstrated that lower limb reconstruction is more acceptable psychologically to patients with severe lower limb trauma compared with amputation, even though the physical outcome for both management pathways was more or less the same.

Patient-specific spine models. Part 1: Finite element analysis of the lumbar intervertebral disc--a material sensitivity study

If patient-specific finite element models of the spine could be developed, they would offer enormous opportunities in the diagnosis and management of back problems. Several generic models have been developed in the past, but there has been very little detailed examination of the sensitivity of these models' characteristics to the input parameters. This relationship must be thoroughly understood if representative patient-specific models are to be realized and used with confidence. In particular, the performance of the intervertebral discs are central to any spine model and need detailed investigation first. A generic non-linear model of an intervertebral disc was developed and subjected to compressive, flexion and torsional loading regimes. The effects of both material and geometric non-linearities were investigated for the three loading schemes and the results compared with experimental data. The basic material properties of the fibres, annulus and nucleus were then varied and the effects on the stiffness, annulus bulge and annulus stresses analysed. The results showed that the non-linear geometry assumption had a significant effect on the compression characteristics, whereas the non-linear material option did not. In contrast, the material non-linearity was more important for the flexural and torsional loading schemes. Thus, the inclusion of non-linear material and geometry analysis options in finite element models of intervertebral discs is necessary to predict in vivo load-deflection characteristics accurately. When the influence of the material properties was examined in detail, it was found that the fibre properties did not have a significant effect on the compressive stiffness of the disc but did affect the flexural and torsional stiffnesses by up to +/-20 per cent. All loading modes were sensitive to the annulus properties with stiffnesses varying by up to +/-16 per cent. The model also revealed that for a particular compressive deformation or flexural or torsional rotation, the disc bulge was not sensitive to any of the material properties over the range of properties considered. The annulus stresses did differ significantly as the material properties were varied (up to 70 per cent under a compressive load and 60 per cent during disc flexion).

Finite element analysis in spine research

Finite element analysis is a widely accepted tool used in many industries and research activities. It allows new designs to be thoroughly 'tested' before a prototype is even manufactured, components and systems which cannot readily be experimented upon to be examined, and 'diagnostic' investigations to be undertaken. Finite element models are already making an important contribution to our understanding of the spine and its components. Models are being used to reveal the biomechanical function of the spine and its behaviour when healthy, diseased or damaged. They are also providing support in the design and application of spinal instrumentation. The spine is a very complex structure, and many of the models are simplified and idealized because of the complexity and uncertainty in the geometry, material properties and boundary conditions of these problems. This type of modelling simplification is not peculiar to spinal modelling problems. Indeed, the idealization is often a strength when there is such uncertainty and variation between one individual and another, allowing cause-effect relationships to be isolated and fully explored, and the inherent variability of experimental tests to be eliminated. This paper reviews the development of finite element analysis in spinal modelling. It shows how modelling provides a wealth of information on our physiological performance, reduces our dependence on animal and cadaveric experiments and is an invaluable complement to clinical studies. It also leads to the conclusion that, as computing power and software capabilities increase, it is quite conceivable that in the future it will be possible to generate patient-specific models that could be used for patient assessment and even pre- and inter-operative planning.

A computer assisted orthopaedic surgical system for distal locking of intramedullary nails

This paper presents a prototype system for computer assisted surgery, the purpose of which is to assist orthopaedic surgeons when performing distal locking of intramedullary nails. This system comprises three components, namely: an Intelligent Image Intensifier, a Trajectory Tactician and an Intelligent Trajectory Guide. The Intelligent Image Intensifier is an X-ray vision system that provides accurate X-ray images. Such images enable the Trajectory Tactician software to analyse the operation site and calculate the trajectory required for a screw to lock an intramedullary nail. This involves the capture of two X-ray images from which are extracted the projections of the nail's edge boundaries and its distal locking holes. Using an analytical mathematical model of the nail, the position and orientation of the nail is determined. The trajectory is then implemented by the surgeon using the Intelligent Trajectory Guide. Evaluation in the laboratory suggests that the system is capable of reliably inserting a locking screw into an intramedullary nail. The rapidity with which this computer assisted method achieves locking should benefit both patient and surgeon by reducing radiation dosage and the length of time required to lock a nail.

Cubosomes as a Potential Oral Drug Delivery System for Enhancing the Hepatoprotective Effect of Coenzyme Q10

Coenzyme Q10 (CoQ10) acts as an antioxidant that protects the cells by preventing lipid peroxidation. Owing to its low solubility, CoQ10 has shown poor delivery properties and poor bioavailability. The aim of this study is to develop CoQ10 loaded cubosomes in order to enhance its oral delivery and hepatoprotective activity. Cubosomes are cubic nanostructured systems resulting from the colloidal dispersion of cubic liquid crystalline structure in water. CoQ10 loaded cubosomes were prepared using poloxamer 407 and glyceryl monooleate at three weight ratios (1:2.5, 1:5 and 1:7.5) and were further characterized. They were investigated for their hepatoprotective effect in thioacetamide (TAA) induced hepatotoxicity in Wistar rats. The developed CoQ10 cubosomes exhibited moderate to high entrapment efficiency percentages (44.69-75.96%), nanometric dimensions (132.4-223.2 nm), and negatively charged zeta potential values (<-21.3). In-vitro release profiles showed a sustained release of CoQ10 from the developed cubosomes up to 48 h. In-vivo study revealed an improved hepatoprotective effect of CoQ10 cubosomes via reducing liver enzymes, nitric oxide and malondialdehyde as well as elevating phosphoinositide 3-kinase, catalase and glutathione peroxidase, compared to plain drug. These results were in good agreement with histopathological investigations. Consequently, the developed cubosomes showed a potential effect in enhancing the hepatoprotective activity of CoQ10.

Fabrication of All-Trans Retinoic Acid loaded Chitosan/Tripolyphosphate Lipid Hybrid Nanoparticles as a Novel Oral Delivery Approach for Management of Diabetic Nephropathy in Rats

The present study aims to formulate all-trans retinoic acid (ATRA) loaded chitosan/tripolyphosphate lipid hybrid nanoparticles (CTLHNs) for enhancing its solubility and oral delivery. This is to improve ATRA therapeutic effect on diabetic nephropathy (DN). CTLHNs were prepared by o/w homogenization, employing stearic acid, to form lipid nanoparticles coated with chitosan that is stabilized against acidic pH via sodium tripolyphosphate crosslinking. Chitosan coated (F7) and naked lipid nanoparticles (F6) were also prepared for comparison with CTLHNs. In vitro characterization for the prepared formulations was performed comprising entrapment efficiency, particle size, zeta potential, transmission electron microscopy, FT-IR spectroscopy and x-ray diffraction. Stability of chitosan coat in GI fluid revealed that CTLHNs were more stable than F7. In vitro release indicated an enhanced release of ATRA from the developed formulations. In vitro mucoadhesion study proved a notable mucoadhesive property for CTLHNs. In DN rat model, serum levels of creatinine and urea were elevated, over expression of tumor necrosis factor alpha (TNF-α), granulocyte macrophage colony-stimulating factor (GM-CSF), vascular endothelial growth factor (VEGF) and intercellular adhesion molecule-1 (ICAM-1) were observed. In addition, adenosine monophosphate activated protein kinase (AMPK) and liver kinase B1 (LKB1) expressions were decreased in DN rats. Treatment with free ATRA and the selected formulations led to a significant amelioration of DN by reducing of creatinine, urea, TNF-α, ICAM-1, GM-CSF, VEGF levels as well as elevating AMPK and LKB1 levels. The order of activity was: CTLHNs > F7 > F6 > free ATRA, as proved by histopathological examination.

Nanotechnology Advanced Strategies for the Management of Diabetes Mellitus

Background:

Medications currently available for the management of diabetes mellitus are inconvenient and have some limitations. Thus, investigations for novel approaches are needed to deliver and target antidiabetics safely to the site of action.

Objective:

The present review emphasizes the limitations of conventional antidiabetics and provides the recent progresses of nanotechnology in the treatment of diabetes mellitus with a special highlight on the novel nanocarriers methodologies employed as antidiabetic drug delivery systems.

Methods:

The potential nanocarriers employed for the treatment of diabetes comprise liposomes, niosomes, self-nanoemulsifying drug delivery systems, polymeric nanoparticles, gold nanoparticles, dendrimers and micelles. Herbal nanomedicine has also emerged to be a promising way for adequate delivery of herbal compounds. Other nanotechnology approaches involve the usage of oral insulin, inhalable insulin, artificial pancreas, and nanopump.

Results:

Nanocarriers have proved to lead a successful delivery of antidiabetic medications, aiming at drug targeting for enhanced efficacy and safety.

Conclusion:

These innovative generations of drug delivery systems have important benefits over conventionally existing ones. The future of nanotechnology in the management of diabetes is still open with several prospects and will be of pronounced significance.

Cationic Polymeric Nanoparticles for Improved Ocular Delivery and Antimycotic Activity of Terconazole

Terconazole (TCZ) is a broad-spectrum antifungal triazole that is particularly active against Candida species, but its poor water solubility hinders its ocular absorption and restricts its application. This study aims to fabricate TCZ-loaded cationic polymeric nanoparticles to enhance the ocular delivery and antimycotic activity of terconazole. TCZ-loaded nanoparticles were developed by nanoprecipitation method employing Eudragit RLPO®. They were characterized by entrapment efficiency (EE%), particle size (PS), zeta potential (ZP), morphology, Fourier transform infrared spectroscopy (FT-IR), and X-ray powder diffraction (XRPD). In-vitro antimycotic activity was evaluated by measuring zone of inhibition (ZI), minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC). The developed nanoparticles were spherical with moderate to high EE% (44.03-71.14%), a nanometric PS (49.41-78.72 nm), and a positively charged ZP (≥ +21.47). In-vitro release studies revealed sustained release of drug up to 24 h. FT-IR of TCZ-loaded nanoparticles revealed distinctive peaks for Eudragit RLPO® and Poloxamer-188, with disappearance of the TCZ characteristic peaks. XRPD revealed the amorphous state of TCZ within the polymer matrix. Mucoadhesive studies proved the mucoadhesive property of the developed TCZ nanoparticles. In-vitro antimycotic studies, assessed by ZI, MIC and MFC, revealed enhanced antimycotic activity of TCZ-loaded nanoparticles against Candida albicans, relative to plain TCZ. No irritation or abnormal changes to the rabbits' eyes for plain and medicated polymeric nanoparticles were found by the in-vivo Draize test. These findings reveal that the cationic polymeric nanoparticles can be regarded as a potential drug delivery system for enhancing the ocular antimycotic activity of TCZ.

Cubosome-based thermosensitive in situ gelling system for intranasal administration of lamotrigine with enhanced antiepileptic efficacy

Lamotrigine (LTG) is a second-generation antiepileptic drug that belongs to Biopharmaceutics Classification System (BCS) class II. LTG has a low probability of crossing the BBB if administered orally. This study was designed to fabricate LTG cubosomal dispersion that is further loaded in a thermosensitive in situ gel to increase nasal residence time and enhance drug absorption across the nasal mucosal membrane. LTG-loaded cubosomes exhibited an entrapment efficiency ranging from 24.83% to 60.13%, a particle size ranging from 116.2 to 197.6 nm, and a zeta potential ≤ -25.5 mV. The selected LTG-loaded cubosomal formulation was loaded in a thermosensitive in situ gel (cubogel) employing different concentrations of poloxamer 407. In vitro release study revealed sustained drug release from cubosomal and cubogel compared with free drug suspension. In vivo studies revealed enhanced antiepileptic efficacy of LTG cubogel and LTG cubosomes compared with free drug in rats with pilocarpine-induced epilepsy by stimulating the release of gamma-aminobutyric acid (GABA), total antioxidant capacity (TAC), and serotonin and by inhibiting the release of Ca²⁺, dopamine, acetylcholine (Ach), C-reactive protein (CRP), and glial fibrillary acidic protein (GFAP). LTG cubogel exhibited superior activity over LTG cubosomes. These findings reveal that the developed cubosomal thermosensitive in situ gel can enhance the antiepileptic efficacy of LTG via the intranasal route.

Day case treatment of delayed union of fracture of the shaft of the tibia with an external fixator

We report six cases of delayed union of fractures of the shaft of the tibia treated by the application of an external fixator on a day case basis. All fractures united within 12 weeks.

A technique for very high accuracy image intensifier calibration

Accurate characterisation of the image distortion within a fluoroscopic image intensifier is critical if it forms the vision component of an image guided surgical system. By considering non-linear dynamic distortion it is possible to greatly increase the accuracy of the image intensifier, although at the cost of some image quality.

Development of chitosan lipid nanoparticles to alleviate the pharmacological activity of piperine in the management of cognitive deficit in diabetic rats

The aim of the present study was to prepare and evaluate Piperine (PP) loaded chitosan lipid nanoparticles (PP-CLNPs) to evaluate its biological activity alone or in combination with the antidiabetic drug Metformin (MET) in the management of cognitive deficit in diabetic rats. Piperine was successfully loaded on CLNPs prepared using chitosan, stearic acid, Tween 80 and Tripolyphosphate (TPP) at different concentrations. The developed CLNPs exhibited high entrapment efficiency that ranged from 85.12 to 97.41%, a particle size in the range of 59.56-414 nm and a negatively charged zeta potential values (- 20.1 to - 43.9 mV). In vitro release study revealed enhanced PP release from CLNPs compared to that from free PP suspensions for up to 24 h. In vivo studies revealed that treatment with the optimized PP-CLNPs formulation (F2) exerted a cognitive enhancing effect and ameliorated the oxidative stress associated with diabetes. PP-CLNPs acted as an effective bio-enhancer which increased the potency of metformin in protecting brain tissue from diabetes-induced neuroinflammation and memory deterioration. These results suggested that CLNPs could be a promising drug delivery system for encapsulating PP and thus can be used as an adjuvant therapy in the management of high-risk diabetic cognitive impairment conditions.

A portable virtual environment knee arthroscopy training system with objective scoring

We have developed a Virtual Environment Knee Arthroscopy Training System (VE-KATS). Formative analysis indicated several features which surgical trainees indicated were necessary for a system to be useful. We have addressed this need by incorporating both rigid and deformable objects, simultaneous use of camera and surgical instrument, improved optical modeling, portability and low cost. A major advance has been the incorporation of automated objective scoring of performance. VE-KATS has now progressed to a viable training system which will be of practical benefit to trainee orthopaedic surgeons.

Computer and robotic assisted osteotomy around the knee

The outcome variability and failures of conventional osteotomy have been attributed to lack of preoperative planning and inaccuracy in performing the correction. We present a computer and robotic assisted surgery system that can aid in accurate surgical planning for realignment, and in precisely implementing the plan in theatre. The approach seeks to avoid the cost and risks associated with the use of CT, and the insertion of fiducial markers, which are characteristic of existing computer assisted surgical systems. The paper details the architecture of the system as a whole, placing particular emphasis on planning technique. It is anticipated that the increased accuracy possible with the system will prove particularly useful for correcting multi-plane deformities, which are more problematic with conventional techniques.

Thymol-Loaded Eudragit RS30D Cationic Nanoparticles-Based Hydrogels for Topical Application in Wounds: In Vitro and In Vivo Evaluation

Natural medicines formulated using nanotechnology-based systems are a rich source of new wound-treating therapeutics. This study aims to develop thymol-loaded cationic polymeric nanoparticles (CPNPs) to enhance the skin retention and wound healing efficacy of thymol. The developed materials exhibited entrapment efficiencies of 56.58 to 68.97%, particle sizes of 36.30 to 99.41 nm, and positively charged zeta potential. In Vitro sustained release of thymol up to 24 h was achieved. Selected thymol CPNPs (F5 and C2) were mixed with methylcellulose to form hydrogels (GF5 and GC2). An In Vivo skin-retention study revealed that GF5 and GC2 showed 3.3- and 3.6-fold higher retention than free thymol, respectively. An In Vitro scratch-wound healing assay revealed a significant acceleration in wound closure at 24 h by 58.09% (GF5) and 57.45% (GC2). The potential for free thymol hydrogel, GF5, and GC2 to combat MRSA in a murine skin model was evaluated. The bacterial counts, recovered from skin lesions and the spleen, were assessed. Although a significant reduction in the bacterial counts recovered from the skin lesions was shown by all three formulations, only GF5 and GC2 were able to reduce the bacterial dissemination to the spleen. Thus, our study suggests that Eudragit RS30D nanoparticles-based hydrogels are a potential delivery system for enhancing thymol skin retention and wound healing activity.

Rutin loaded bilosomes for enhancing the oral activity and nephroprotective effects of rutin in potassium dichromate induced acute nephrotoxicity in rats

Rutin, a flavone glycoside, has shown to have a significant beneficial kidney protection effect in drug-induced nephropathy. However, its poor solubility and low oral bioavailability have limited its pharmacological applications. This study aimed at formulating rutin-loaded bilosomes to enhance the renal protective effect of rutin for oral application. Rutin-loaded bilosomes were developed using thin-film hydration technique. The prepared formulations were characterized by entrapment efficiency percentage (EE%), vesicular size (VS) and zeta potential (ZP) measurement. The developed formula exhibited moderate EE%, ranging from 20.02 ± 2.85 to 48.57 ± 3.57%, suitable VS results that ranged from 502.1 ± 36 to 665.1 ± 45 nm and high ZP values (≤ -41.4 ± 7.27 mV). Transmission electron microscopy revealed the spherical shape of the developed bilosomes. The in-vitro release study revealed prolonged release of rutin from bilosomes, relative to free drug. F2, prepared using the molar ratio span 60: cholesterol: sodium cholate 1:1:0.5, was selected for further investigations as it showed the highest EE%, smallest VS, optimum ZP, and persistent release profile. In-vivo studies were performed on drug-induced nephropathy in rats. Acute renal failure was induced using a single dose of potassium dichromate (PDC; 15 mg/kg; i.p). The selected formulation, F2, alleviated kidney dysfunction, oxidative stress and inflammation via decreasing MDA, TNF-α and TGF-β and increasing GSH. In addition, F2 promoted Akt/PI3K activation against PDC-induced acute renal failure. Histopathology results came in accordance with in-vivo results. Thus, bilosomes could be considered a potential delivery system for enhancing the oral delivery and kidney protection activity of rutin.