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Bahrami F, Psikuta A, Rossi RM, Dommann A, Defraeye T. Exploring the thermally-controlled fentanyl transdermal therapy to provide constant drug delivery by physics-based digital twins. Eur J Pharm Sci 2024; 200:106848. [PMID: 38986719 DOI: 10.1016/j.ejps.2024.106848] [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: 04/05/2024] [Revised: 06/20/2024] [Accepted: 07/07/2024] [Indexed: 07/12/2024]
Abstract
Transdermal drug delivery is suitable for low-molecular-weight drugs with specific lipophilicity, like fentanyl, which is widely used for cancer-induced pain management. However, fentanyl's transdermal therapy displays high intra-individual variability. Factors like skin characteristics at application sites and ambient temperature contribute to this variation. In this study, we developed a physics-based digital twin of the human body to cope with this variability and propose better adapted setups. This twin includes an in-silico skin model for drug penetration, a pharmacokinetic model, and a pharmacodynamic model. Based on the results of our simulations, applying the patch on the flank (side abdominal area) showed a 15.3 % higher maximum fentanyl concentration in the plasma than on the chest. Additionally, the time to reach this maximum concentration when delivered through the flank was 19.8 h, which was 10.3 h earlier than via the upper arm. Finally, this variation led to an 18 % lower minimum pain intensity for delivery via the flank than the chest. Moreover, the impact of seasonal changes on ambient temperature and skin temperature by considering the activity level was investigated. Based on our result, the fentanyl uptake flux by capillaries increased by up to 11.8 % from an inactive state in winter to an active state in summer. We also evaluated the effect of controlling fentanyl delivery by adjusting the temperature of the patch to alleviate the pain to reach a mild pain intensity (rated three on the VAS scale). By implementing this strategy, the average pain intensity decreased by 1.1 points, and the standard deviation for fentanyl concentration in plasma and average pain intensity reduced by 37.5 % and 33.3 %, respectively. Therefore, our digital twin demonstrated the efficacy of controlled drug release through temperature regulation, ensuring the therapy toward the intended target outcome and reducing therapy outcome variability. This holds promise as a potentially useful tool for physicians.
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Affiliation(s)
- Flora Bahrami
- Swiss Federal Laboratories for Materials Science and Technology, Laboratory for Biomimetic Membranes and Textiles, Empa, Lerchenfeldstrasse 5, CH-9014St. Gallen, Switzerland; ARTORG Center for Biomedical Engineering Research, University of Bern, Mittelstrasse 43, Bern CH-3012, Switzerland
| | - Agnes Psikuta
- Swiss Federal Laboratories for Materials Science and Technology, Laboratory for Biomimetic Membranes and Textiles, Empa, Lerchenfeldstrasse 5, CH-9014St. Gallen, Switzerland
| | - René Michel Rossi
- Swiss Federal Laboratories for Materials Science and Technology, Laboratory for Biomimetic Membranes and Textiles, Empa, Lerchenfeldstrasse 5, CH-9014St. Gallen, Switzerland
| | - Alex Dommann
- ARTORG Center for Biomedical Engineering Research, University of Bern, Mittelstrasse 43, Bern CH-3012, Switzerland
| | - Thijs Defraeye
- Swiss Federal Laboratories for Materials Science and Technology, Laboratory for Biomimetic Membranes and Textiles, Empa, Lerchenfeldstrasse 5, CH-9014St. Gallen, Switzerland.
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Chaki C, De Taboada L, Tse KM. Three-dimensional irradiance and temperature distributions resulting from transdermal application of laser light to human knee-A numerical approach. JOURNAL OF BIOPHOTONICS 2023; 16:e202200283. [PMID: 37261434 DOI: 10.1002/jbio.202200283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 05/02/2023] [Accepted: 05/02/2023] [Indexed: 06/02/2023]
Abstract
The use of light for therapeutic applications requires light-absorption by cellular chromophores at the target tissues and the subsequent photobiomodulation (PBM) of cellular biochemical processes. For transdermal deep tissue light therapy (tDTLT) to be clinically effective, a sufficiently large number of photons must reach and be absorbed at the targeted deep tissue sites. Thus, delivering safe and effective tDTLT requires understanding the physics of light propagation in tissue. This study simulates laser light propagation in an anatomically accurate human knee model to assess the light transmittance and light absorption-driven thermal changes for eight commonly used laser therapy wavelengths (600-1200 nm) at multiple skin-applied irradiances (W cm-2 ) with continuous wave (CW) exposures. It shows that of the simulated parameters, 2.38 W cm-2 (30 W, 20 mm beam radius) of 1064 nm light generated the least tissue heating -4°C at skin surface, after 30 s of CW irradiation, and the highest overall transmission-approximately 3%, to the innermost muscle tissue.
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Affiliation(s)
- Chironjeet Chaki
- Department of Mechanical and Product Design Engineering, Swinburne University of Technology, Melbourne, Australia
| | | | - Kwong Ming Tse
- Department of Mechanical and Product Design Engineering, Swinburne University of Technology, Melbourne, Australia
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Dawit H, Zhang Q, Li Y, Islam SR, Mao J, Wang L. Design of Electro-Thermal Glove with Sensor Function for Raynaud's Phenomenon Patients. MATERIALS 2021; 14:ma14020377. [PMID: 33466727 PMCID: PMC7828797 DOI: 10.3390/ma14020377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/29/2020] [Accepted: 01/12/2021] [Indexed: 12/19/2022]
Abstract
Raynaud’s phenomenon (RP) is a disease that mainly affects human fingertips during cold weather. It is difficult to treat this disease using medicine, apart from keeping the body in a warm environment. In this research, conductive knitted fabrics were fabricated to help relax the vessels of the patient’s fingertips by providing proper heat, and also serving as a sensor to detect finger motion after relaxation of the blood vessels of patients. Four different structures, termed plain, purl, interlock, and rib were produced using conductive silver/PE (polyethylene) yarn and wool yarn, with a computerized flat knitting machine. The effect of knitted structure on the electro-thermal behavior, sensitivity, and stability of resistance change (∆R/R) under different tensile forces was investigated. By comprehensive comparison, the purl structure was identified as the preferred structure for the heating glove for RP patients, owing to superior electro-thermal behavior. Additionally, the purl structure had a greater capacity to detect different motions with stable resistance change. This potential electro-thermal glove could be used for functional, as well as aesthetic (fashion) purposes, and could be worn at any time and occasion with complete comfort.
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Affiliation(s)
- Hewan Dawit
- Key Laboratory of Textile Science & Technology of Ministry of Education and College of Textiles, Donghua University, 2999 North Renmin Road, Songjiang District, Shanghai 201620, China; (H.D.); (Q.Z.); (Y.L.); (S.R.I.)
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Qian Zhang
- Key Laboratory of Textile Science & Technology of Ministry of Education and College of Textiles, Donghua University, 2999 North Renmin Road, Songjiang District, Shanghai 201620, China; (H.D.); (Q.Z.); (Y.L.); (S.R.I.)
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Yimeng Li
- Key Laboratory of Textile Science & Technology of Ministry of Education and College of Textiles, Donghua University, 2999 North Renmin Road, Songjiang District, Shanghai 201620, China; (H.D.); (Q.Z.); (Y.L.); (S.R.I.)
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Syed Rashedul Islam
- Key Laboratory of Textile Science & Technology of Ministry of Education and College of Textiles, Donghua University, 2999 North Renmin Road, Songjiang District, Shanghai 201620, China; (H.D.); (Q.Z.); (Y.L.); (S.R.I.)
| | - Jifu Mao
- Key Laboratory of Textile Science & Technology of Ministry of Education and College of Textiles, Donghua University, 2999 North Renmin Road, Songjiang District, Shanghai 201620, China; (H.D.); (Q.Z.); (Y.L.); (S.R.I.)
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
- Correspondence: (J.M.); (L.W.)
| | - Lu Wang
- Key Laboratory of Textile Science & Technology of Ministry of Education and College of Textiles, Donghua University, 2999 North Renmin Road, Songjiang District, Shanghai 201620, China; (H.D.); (Q.Z.); (Y.L.); (S.R.I.)
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
- Correspondence: (J.M.); (L.W.)
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Petrofsky J, Lohman E, Lee S, Cuesta ZDL, Labial L, Iouciulescu R, Moseley B, Korson R, Malty AA. The Effects of Aging on the Skin Blood Response to Warm, Cold, and Contrast Warm and Cold Baths. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2009. [DOI: 10.1080/j148v25n03_02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Vickers A. Acupuncture for hypertension: a tale of two trials. From the perspective of the statistician--Andrew Vickers, New York, NY, USA. Complement Med Res 2008; 14:371, 373-4. [PMID: 18219212 DOI: 10.1159/000109942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Andrew Vickers
- Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Lavery LA, Higgins KR, Lanctot DR, Constantinides GP, Zamorano RG, Athanasiou KA, Armstrong DG, Agrawal CM. Preventing diabetic foot ulcer recurrence in high-risk patients: use of temperature monitoring as a self-assessment tool. Diabetes Care 2007; 30:14-20. [PMID: 17192326 DOI: 10.2337/dc06-1600] [Citation(s) in RCA: 265] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effectiveness of a temperature monitoring instrument to reduce the incidence of foot ulcers in individuals with diabetes who have a high risk for lower extremity complications. RESEARCH DESIGN AND METHODS In this physician-blinded, randomized, 15-month, multicenter trial, 173 subjects with a previous history of diabetic foot ulceration were assigned to standard therapy, structured foot examination, or enhanced therapy groups. Each group received therapeutic footwear, diabetic foot education, and regular foot care. Subjects in the structured foot examination group performed a structured foot inspection daily and recorded their findings in a logbook. If standard therapy or structured foot examinations identified any foot abnormalities, subjects were instructed to contact the study nurse immediately. Subjects in the enhanced therapy group used an infrared skin thermometer to measure temperatures on six foot sites each day. Temperature differences >4 degrees F (>2.2 degrees C) between left and right corresponding sites triggered patients to contact the study nurse and reduce activity until temperatures normalized. RESULTS The enhanced therapy group had fewer foot ulcers than the standard therapy and structured foot examination groups (enhanced therapy 8.5 vs. standard therapy 29.3%, P = 0.0046 and enhanced therapy vs. structured foot examination 30.4%, P = 0.0029). Patients in the standard therapy and structured foot examination groups were 4.37 and 4.71 times more likely to develop ulcers than patients in the enhanced therapy group. CONCLUSIONS Infrared temperature home monitoring, in serving as an "early warning sign," appears to be a simple and useful adjunct in the prevention of diabetic foot ulcerations.
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Affiliation(s)
- Lawrence A Lavery
- Department of Surgery, Scott and White Hospital, Texas A&M University Health Science Center, Temple, Texas, USA.
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Perl T, Bräuer A, Timmermann A, Mielck F, Weyland W, Braun U. Differences among forced-air warming systems with upper body blankets are small. A randomized trial for heat transfer in volunteers. Acta Anaesthesiol Scand 2003; 47:1159-64. [PMID: 12969112 DOI: 10.1034/j.1399-6576.2003.00222.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Forced-air warming is known as an effective procedure in prevention and treatment of perioperative hypothermia. Significant differences have been described between forced-air warming systems in combination with full body blankets. We investigated four forced-air warming systems in combination with upper body blankets for existing differences in heat transfer. METHODS After approval of the local Ethics Committee and written informed consent, four forced-air warming systems combined with upper body blankets were investigated in a randomized cross-over trial on six healthy volunteers: (1) BairHugger trade mark 505 and Upper Body Blanket 520, Augustine Medical; (2) ThermaCare trade mark TC 3003, Gaymar trade mark and Optisan trade mark Upper Body Blanket, Brinkhaus; (3) WarmAir trade mark 134 and FilteredFlow trade mark Upper Body Blanket, CSZ; and (4) WarmTouch trade mark 5800 and CareDrape trade mark Upper Body Blanket, Mallinckrodt. Heat transfer from the blanket to the body surface was measured with 11 calibrated heat flux transducers (HFTs) with integrated thermistors on the upper body. Additionally, the blanket temperature was measured 1 cm above the HFT. After a preparation time of 60 min measurements were started for 20 min. Mean values were calculated over 20 min. The t-test for matched pairs with Bonferroni-Holm-correcture for multiple testing was used for statistical evaluation at a P-level of 0.05. The values are presented as mean+/-SD. RESULTS The WarmTouch trade mark blower with the CareDrape trade mark blanket obtained the best heat flux (17.0+/-3.5 W). The BairHugger trade mark system gave the lowest heat transfer (8.1+/-1.1 W). The heat transfer of the ThermaCare trade mark system and WarmAir trade mark systems were intermediate with 14.3+/-2.1 W and 11.3+/-1.0 W. CONCLUSIONS Based on an estimated heat loss from the covered area of 38 W the heat balance is changed by 46.1 W to 55 W by forced-air warming systems with upper body blankets. Although the differences in heat transfer are significant, the clinical relevance of this difference is small.
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Affiliation(s)
- T Perl
- Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Goettingen, Goettingen, Germany.
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