3D Printing-A "Touch-Button" Approach to Manufacture Microneedles for Transdermal Drug Delivery.

Microneedles (MNs) represent the concept of attractive, minimally invasive puncture devices of micron-sized dimensions that penetrate the skin painlessly and thus facilitate the transdermal administration of a wide range of active substances. MNs have been manufactured by a variety of production technologies, from a range of materials, but most of these manufacturing methods are time-consuming and expensive for screening new designs and making any modifications. Additive manufacturing (AM) has become one of the most revolutionary tools in the pharmaceutical field, with its unique ability to manufacture personalized dosage forms and patient-specific medical devices such as MNs. This review aims to summarize various 3D printing technologies that can produce MNs from digital models in a single step, including a survey on their benefits and drawbacks. In addition, this paper highlights current research in the field of 3D printed MN-assisted transdermal drug delivery systems and analyzes parameters affecting the mechanical properties of 3D printed MNs. The current regulatory framework associated with 3D printed MNs as well as different methods for the analysis and evaluation of 3D printed MN properties are outlined.

Comparison of Results of Measurement of Dimensions of the Placed Dental Implants on Cone Beam Computed Tomography with Dimensions of the Producers of the Implants.

INTRODUCTION: One of the most frequently used method for scanning patients with indication for dental implantation in dentistry is cone beam computed tomography. Implantation, CBCT imaging and implant programme are inevitable when planning a successful replacement of lost teeth. CBCT offers exact information about available bone and its density, adjacent tooth roots, the place of mandibular canal and maxillary sinus and adjacent anatomical structure. AIM: The goal of this study is to estimate accuracy of measurements on CBCT images ofpatients who have implants of different producers and determine if there is any statistically significant correlation between four test groups regardless of the alloy of which implants are made. MATERIAL AND METHODS: The study was a prospective-comparative, and included fifteen patients with hundred dental implants divided in four groups depending on the producer. RESULTS: Over dimensioning in the gained measurements of the whole sample on CBCT images in relation to dimensions of producers is between 0.1006mm and 0.368mm. Even though over dimensioning is measured in millimetres, it has to be taken into consideration in clinical practice when planning an implant placement, and we can recommend safety zone of 0.5mm. There have been no statistically significant differences in the gained results in over dimensioning of implants of different alloys for horizontal and vertical measurements on CBCT images of Astra Tech, Brendet titanium implants and Straumann titanium-zirconium implants. Based on the goals of the study there have been confirmed statistically significant correlations of great value (from 0.841 to 0.936) of high level of importance between manufactured value of dimensions and average dimensions values gained through CBCT imaging in four types of implants (four test groups). The total exactness of measurements on CBCT scan in this research is 96.66% for horizontal measuring and 96.92% for vertical measuring. Therefore, we can conclude that CBCT as radiological method has an unavoidable importance in planning and successful realisation of dental implant procedure. CONCLUSION: Cone Beam Computed Tomography provides exact measurements of dimensions of placed dental implant in relation to dimensions of the producers of the implant because the material from which dental implants have been made does not significantly affect the precision of the measurement.

Importance of Early Detection of Potentially Malignant Lesions in the Prevention of Oral Cancer.

OBJECTIVE: The aim of this study was to assess the importance of early diagnosis of potentially malignant lesions in the prevention of oral cancer. MATERIAL AND METHODS: In order to achieve the set objectives, we selected our participant pool. Of the 340 patients who came to the initial examination at the Clinic for Oral Medicine and Periodontology, we selected 40 patients with potentially malignant oral lesions (PMOL) of both sexes and of different ages. After an extensive anamnesis and a clinical examination of all mucous membranes, we documented potentially malignant lesions, their localization, subjective and objective symptoms, duration of pathological lesion, and bad habits (smoking and alcohol). All lesions were colored with Toluidine blue, which indicates malignancy in 75% of cases. Patients who had a positive Toluidine blue staining test were sent to biopsy and pathohistological analysis. RESULTS: The most common potentially malignant lesions are Lichen reticularis (25%), Lichen erosivus (20%), and Leukoplakia (15%). The most common localization of lesions is the buccal mucosa bilaterally (26%), buccal mucosa unilaterally (10%), and the lower lip (10%). The staining test with Toluidine blue was positive at 23% PMOLs. In patients with positive Toluidine staining findings, biopsy and pathohistological analysis were performed, which showed that 20% of all lesions are carcinoma (CIS, Baseocellular Carcinoma, Squamocellular Carcinoma), while 14% are mucosal epithelial dysplasia. Statistical analysis confirmed the significance of positive staining of Toluidine blue and Leukoplakia (Spearman's coefficient = 0.427, p = 0.006, N = 40), and statistically significant positive association of Squamocellular Carcinoma and Toluidine blue staining (Spearman's coefficient = 0.619, p = 0.000, N = 40). CONCLUSION: Most oral cancers are caused by potentially malignant lesions, which is why a very detailed clinical examination with the visualization of pathological lesions is very important. Toluidine blue test can be an auxiliary tool for clinical diagnosis but does not replace the pathohistological finding. Biopsy and pathohistological findings are the gold standard in the diagnosis of oral cancers, as confirmed in our research.

Challenges In Early Glaucoma Detection.

INTRODUCTION: Glaucoma is the most common optic neuropathy which is characterized by progressive loss of retinal ganglion cells, the excavation of the optic nerve head, associated with defects in the visual field. It is not a disease, but the final result of united and yet completely unidentified cellular and subcellular processes and effects of many factors responsible for changes in retinal ganglion cells leading to their accelerated apoptosis. METHODS: This is a prospective-retrospective, comparative, randomized clinical trial that included 150 patients, 97 were female and 53 male. The age of patients ranged from 18 to 80 years. RESULTS: The highest degree of myopia in category of tilted optic discs had patients with large disc (4.05 + -0.65). Values of the degree of myopia have linearly declined in relation to the size of the oblique disc. The analysis of the results revealed that the subjects who had a higher degree of myopia associated with glaucoma had frequent parapapillar atrophy of alpha and beta zones. The highest percentage of subjects with parapapillar changes were in the group of patients who had other than glaucoma and myopia (62%), then in the group of patients with glaucoma only (56%). CONCLUSION: Previous studies on the relationship between myopia and open-angle glaucoma are based on the results of observational studies. However, according to recent findings, based on the available studies, the systematic approach to estimate the association between myopia and glaucoma does not exist. Disc Damage Likelihood Scale (DDLS) is a new system for assessing glaucomatous damage of the optic disc which strongly correlates with the degree of visual field loss.

Influence of the optic disc size on cup diameter in patients with glaucoma simplex chronicum.

INTRODUCTION: The relationship between the optic disc size, neuroretinal rim and cup diameter is the key in identifying glaucomatous changes in optic nerve head. Like some other biological characteristics, changes of the optic disc differ among healthy populations, thus hindering detection of pathological changes. MATERIAL AND METHODS: From the total number of 90 patients, we selected those that have optic disc diameter less than 1.30 mm, greater than 2.10 mm, as well as patients with a size of disc diameter ranging from 1.31mm to 2.09 mm. In all patients after anamnesis and standard ophthalmologic examination (best corrected visual acuity-BCVA, Goldman aplanatic tonometry, pachymetry, gonioscopy), we also performed the OCT analysis of the optic nerve head. RESULTS AND DISCUSSION: Glaucomatous changes in small optic discs may remain unnoticed unless there is a high degree of suspicion. The assesment of the optic disc size is an important, but often overlooked component of the diagnostic evaluation in glaucoma. There was a statistically significant strong positive correlation between the size of the optic disc diameter and cup diameter, larger optic disc diameter means greater cup diameter. Due to the large variation in the cup size in healthy subjects, the assessment of the morphology of the neuroretinal rim or cup diameter can be more helpful in evaluation of glaucomatous optic disc damage than the value of C/D ratio itself. CONCLUSION: Evaluation of the optic disc size and C/D ratio is an essential part in diagnostic procedure and management of glaucoma. OCT analysis in patients with small optic disc diameter showed the least sensitivity in all three categories (normal, abnormal and uncertain OCT results). The OCT results in the small optic disc diameter are the least reliable in the diagnosis of glaucoma. More complexed long-term study is needed to evaluate this complicated relations between optic disc diameter, C/D ratio, neuroretinal rim and other important clinical factors in emerging glaucoma disease.

The secondary composite temporoparietal lobe-modification.

Orbital defects after malignant tumor removal represent a major problem for satisfactory reconstruction. Treatment and surgical reconstruction according to the regular surgical protocol improves with each new case contributing to continuous improvement of surgical techniques in order to achieve better reconstruction of the defect. In our modification in 20 patients there was presented a new method of reconstruction of the defect where the orbits included also a part of the muscle (sternocleidomastoid muscle) for better stabilization at the desired position on the immediate ocular prosthesis installation site in order to quickly overcome the postoperative defect after orbital exenteration. Application of modified temporoparietal slice gives good functional and cosmetic results, and is recommended to be used for reconstruction of defects after orbital exenteration.

New method for maximum mobilization of temporalis muscle flap.

INTRODUCTION: Pedicled temporalis muscle flap presenting a good flap for closing large craniofacial defects. Careful surgeons usually do not mobilize temporalis muscle flap enough to make appropriate use, fully closure, especially if defect exceeds the median line. PATIENTS AND METHODS: Temporalis flap was used in 16 patients, ages ranged between 12 and 76. In all cases defect reconstruction was done by useing new method of extending standard temporal muscle flap. During surgical procedure it is very important to keep periosteal elevator in close contact with the bone. Then, there is no risk for pedicle injury. After vascular pedicle is identified elevating temporal muscle has to be continued by releasing the muscle insertion from the coronoid process. By this way, flap length and arc of rotation is increased. RESULTS: The flap remained viable in all instances. Most of the patients experienced no perioperative complications. There was no major complications or mortality as a result of performed procedures. CONCLUSION: With this division, flap length was increased at least 2 cm wich is enough for covering defects crossing the midline. Instead of using bilateral temporalis muscle flaps for defect closure, unilateral is sufficient. With this extension of the pedicle length now rotation point is not at the level of the zygomatic arch but lower part mandibular neck.

Modificiation of infrahyoid neuromyocutaneous flap with radical neck dissection.

INTRODUCTION: Understanding technique of flap surgery allow uncompromising tumor resection and operation of tumors previously considered inoperable. Infrahyoid neuro-myocutaneous flap (IHNMCF) is pedicled flap harvested from the anterior part of the neck. IHNMCF is a good solution for the moderated sized defects of the head and neck below the zygomatic arch. The objective of this article was to describe modified infrahyoid neuromyocutaneous flap used for reconstruction of tongue and mouth floor defects, immediate after removing neoplasm. CASE REPORT: A 63 year old patient were hospitalized with pathohistologically confirmed-squamocellular carcinoma. The tumor were in the region of the ventral part of the mouth. Magnetic resonance imaging (MRI) and ultrasound investigation of the head and neck showed detectable nodes in the right side of the neck and suspicious nodes in the left side of the neck. Through the transmandibular approach it was performed a wide local excision of the tumor. IHNMCF was harvested from the right side. It was performed meticulous microvascular procedure venous end-to-end anastomosis of the right superior thyroid vein to the left superior thyroid vein. Patient is during procedure subjected to the supraomohyoid neck dissection on the left side and radical neck dissection on the right side. DISCUSSION AND CONCLUSION: Disadvantage of this modified infrahyoid flap is the extremely limited arc of rotation. This seriously limits its applications to specific situations, where defects are located very close to the flap. Othervise, advantage of this modified flap is that radical neck dissection is not contraindication anymore. In this case flap was successful, without flap necrosis or complications in the donor side. Speech and swallow were without significant decrease. After radiation therapy flap remained sufficiently soft, trophic and mobile.

A giant cutaneous horn.

A cutaneous horn is a uncommon and rare lesion. It is a conical projection of hyperkeratotic epidermis. Vary from a few milimeters to a several centimeters in length. The cutaneous horn is a clinical diagnosis and different histologic lesions have been documented at the base of the keratin mound. We presented a 77 years old female with a large "horn" of 3 years duration, arising from her forehead. Excision was performed and defect was covered by split thickness skin graft. Hystopathology reported keratoacanthoma at the base of the horn. By reviewing cutaneous horns presented in literature we can declare that this is one of the biggest cutaneous horn recorded cases. Also it is important to mention that horn itself is not the most important issue, but rather the underlying condition, which may be malignant.