Órteses e próteses de membro superior impressas em 3D: uma revisão integrativa / Upper limbs orthesis and prostheses printed in 3D: an integrative review

Resumo Introdução A impressão tridimensional (3D) é capaz de confeccionar produtos físicos avançados e especializados por meio de tecnologia computadorizada e softwares específicos. Alguns desses produtos são as órteses e próteses, que podem favorecer a funcionalidade do sujeito em seu cotidiano. Objetivo Identificar o tipo, o uso e a aplicabilidade da impressão 3D na confecção de órteses e próteses para membro superior. Método Revisão integrativa realizada nas bases de dados PubMed, LILACS, Web of Science, Scopus e Science Direct, sem delimitação de tempo, na língua portuguesa, inglesa ou espanhola, seguindo os critérios de elegibilidade: estudos do tipo experimental, observacional e relatos de casos, cujo objeto de estudo foram as órteses e próteses impressas em 3D, com pacientes de qualquer idade e qualquer diagnóstico de comprometimento do membro superior. Resultados Foram incluídos nove artigos, sete referentes ao uso da impressão 3D na confecção de prótese e dois referentes à confecção de órteses. Muitos dos estudos foram direcionados ao público infantil e os materiais mais utilizados para confecção foram o PLA e o ABS. A equipe multidisciplinar foi apresentada como fundamental no processo de avaliação, criação e testagem dos dispositivos. Conclusão Apesar dos estudos analisados tangenciarem fases iniciais de desenvolvimento e investigação da aplicabilidade da impressão 3D na criação de órteses e próteses, observou-se que já existem melhorias do custo-benefício gerado pelo uso desta tecnologia, bem como a possibilidade de gerar produtos mais versáteis. Apontando-se como um campo promissor para ampliar a aplicação da impressão 3D como recurso facilitador do processo de reabilitação.

Abstract Introduction Three-dimensional (3D) printing is capable of making advanced and specialized physical products using computerized technologies and specific software. Some of these products are orthosis and prostheses which can support patients' functionality in their daily lives. Objective To identify the type, the usage, and the applicability of 3D printing on the development of upper limbs' orthosis and prostheses. Method Integrative review carried out on the following databases: Pubmed, LILACS, Web of Science, Scopus e Science Direct, with no specific publication period, written in English, Spanish or Portuguese. It also had to fit the following criteria: experimental and observational studies and case reports which had 3D printed orthosis and prosthesis as the object of study with patients of any age or diagnosis of upper limb damage. Results Nine studies were included. Seven referred to the use of 3D printing to make prosthesis and 2 to make orthosis. Many studies were directed to children and the most used materials were PLA and ABS. The multidisciplinary team was fundamental in the process of evaluation, creation, and testing of the devices. Conclusion Despite the analyzed studies mention initial phases of development and investigation of the applicability of 3D printing in the creation of orthosis and prostheses, it was observed that cost-benefit improvements generated by the use of this technology already exist, as well as the possibility of generating more versatile products. It's a promising field to amplify the applicability of 3D printing as a resource facilitating the rehabilitation process.

Preventive role of metformin on peripheral neuropathy induced by diabetes.

Metformin is the first line drug in the treatment of type 2 diabetes, however, little is known about its therapeutic potential to prevent or delay damage to the peripheral nerve. Thus, the aim of this study was to investigate whether metformin is able to attenuate the neuroinflammatory response in sciatic nerve of insulin-dependent diabetic mice. Swiss Webster mice were divided into four groups: Control, Diabetic (STZ), Diabetic +100 mg/kg/day of metformin (STZ + M100) and Diabetic +200 mg/kg/day of metformin. Diabetes was induced by streptozotocin (90 mg/kg, i.p.). Only animals with glycemia ≥270 mg/dl were considered diabetics. Metformin prevented atrophy of myelinated axons, and reduced expression of inflammatory mediators (interleukin-1ß, inducible nitric oxide synthase and nitric oxide). However, treatment with 200 mg of metformin was more effective in increasing neurotrophic (myelin basic protein and neural growth factor), angiogenic (vascular endothelial growth factor) and anti-inflammatory (inhibitor kappa B-alpha and interleukin 10) factors. Thus, metformin treatment, especially at the dose of 200 mg, protected the nerve from damages related to chronic hyperglycemia.