Showing posts with label Medical Technology. Show all posts
Showing posts with label Medical Technology. Show all posts

Wednesday, 16 June 2021

Nanotechnology In Medicine

What is Nanotechnology?

The prefix “nano” stems from the ancient Greek for “dwarf”. In science it means one billionth (10 to the minus 9) of something, thus a nanometer (nm) is is one billionth of a meter, or 0.000000001 meters. A nanometer is about three to five atoms wide, or some 40,000 times smaller than the thickness of human hair. A virus is typically 100 nm in size.

The ability to manipulate structures and properties at the nanoscale in medicine is like having a sub-microscopic lab bench on which you can handle cell components, viruses or pieces of DNA, using a range of tiny tools, robots and tubes.

Therapies that involve the manipulation of individual genes, or the molecular pathways that influence their expression, are increasingly being investigated as an option for treating diseases. One highly sought goal in this field is the ability to tailor treatments according to the genetic make-up of individual patients.

This creates a need for tools that help scientists experiment and develop such treatments.

Imagine, for example, being able to stretch out a section of DNA like a strand of spaghetti, so you can examine or operate on it, or building nanorobots that can “walk” and carry out repairs inside cell components. Nanotechnology is bringing that scientific dream closer to reality.

For instance, scientists at the Australian National University have managed to attach coated latex beads to the ends of modified DNA, and then using an “optical trap” comprising a focused beam of light to hold the beads in place, they have stretched out the DNA strand in order to study the interactions of specific binding proteins.

Nanobots and Nanostars

Meanwhile chemists at New York University (NYU) have created a nanoscale robot from DNA fragments that walks on two legs just 10 nm long. In a 2004 paper published in the journal Nano Letters, they describe how their “nanowalker”, with the help of psoralen molecules attached to the ends of its feet, takes its first baby steps: two forward and two back.

One of the researchers, Ned Seeman, said he envisages it will be possible to create a molecule-scale production line, where you move a molecule along till the right location is reached, and a nanobot does a bit chemisty on it, rather like “spot-welding” on a car assembly line. Seeman’s lab at NYU is also looking to use DNA nanotechnology to make a biochip computer, and to find out how biological molecules crystallize, an area that is currently fraught with challenges.

The work that Seeman and colleagues are doing is a good example of “biomimetics”, where with nanotechnology they can imitate some of the biological processes in nature, such as the behavior of DNA, to engineer new methods and perhaps even improve them.

DNA-based nanobots are also being created to target cancer cells. For instance, researchers at Harvard Medical School in the US reported recently in Science how they made an “origami nanorobot” out of DNA to transport a molecular payload. The barrel-shaped nanobot can carry molecules containing instructions that make cells behave in a particular way. In their study, the team successfully demonstrates how it delivered molecules that trigger cell suicide in leukemia and lymphoma cells.

Nanobots made from other materials are also in development. For instance, gold is the material scientists at Northwestern University use to make “nanostars”, simple, specialized, star-shaped nanoparticles that can href=”http://www.medicalnewstoday.com/articles/243856.php”>deliver drugs directly to the nuclei of cancer cells. In a recent paper in the journal ACS Nano, they describe how drug-loaded nanostars behave like tiny hitchhikers, that after being attracted to an over-expressed protein on the surface of human cervical and ovarian cancer cells, deposit their payload right into the nuclei of those cells.

The researchers found giving their nanobot the shape of a star helped to overcome one of the challenges of using nanoparticles to deliver drugs: how to release the drugs precisely. They say the shape helps to concentrate the light pulses used to release the drugs precisely at the points of the star.


Nanofactories that Make Drugs In Situ

Scientists are discovering that protein-based drugs are very useful because they can be programmed to deliver specific signals to cells. But the problem with conventional delivery of such drugs is that the body breaks most of them down before they reach their destination.

But what if it were possible to produce such drugs in situ, right at the target site? Well, in a recent issue of Nano Letters, researchers at Massachusetts Institute of Technology (MIT) in the US show how it may be possible to do just that. In their proof of principle study, they demonstrate the feasibility of self-assembling “nanofactories” that make protein compounds, on demand, at target sites. So far they have tested the idea in mice, by creating nanoparticles programmed to produce either green fluorescent protein (GFP) or luciferase exposed to UV light.

The MIT team came up with the idea while trying to find a way to attack metastatic tumors, those that grow from cancer cells that have migrated from the original site to other parts of the body. Over 90% of cancer deaths are due to metastatic cancer. They are now working on nanoparticles that can synthesize potential cancer drugs, and also on other ways to switch them on.


Nano fibers

Nanofibers are fibers with diameters of less than 1,000 nm. Medical applications include special materials for wound dressings and surgical textiles, materials used in implants, tissue engineering and artificial organ components.

Nanofibers made of carbon also hold promise for medical imaging and precise scientific measurement tools. But there are huge challenges to overcome, one of the main ones being how to make them consistently of the correct size. Historically, this has been costly and time-consuming.

But last year, researchers from North Carolina State University, revealed how they had developed a new method for making carbon nanofibers of specific sizes. Writing in ACS Applied Materials & Interfaces in March 2011, they describe how they managed to grow carbon nanofibers uniform in diameter, by using nickel nanoparticles coated with a shell made of ligands, small organic molecules with functional parts that bond directly to metals.

Nickel nanoparticles are particularly interesting because at high temperatures they help grow carbon nanofibers. The researchers also found there was another benefit in using these nanoparticles, they could define where the nanofibers grew and by correct placement of the nanoparticles they could grow the nanofibers in a desired specific pattern: an important feature for useful nanoscale materials.

Lead is another substance that is finding use as a nanofiber, so much so that neurosurgeon-to-be Matthew MacEwan, who is studying at Washington University School of Medicine in St. Louis, started his own nanomedicine company aimed at revolutionizing the surgical mesh that is used in operating theatres worldwide.

The lead product is a synthetic polymer comprising individual strands of nanofibers, and was developed to repair brain and spinal cord injuries, but MacEwan thinks it could also be used to mend hernias, fistulas and other injuries.

Currently, the surgical meshes used to repair the protective membrane that covers the brain and spinal cord are made of thick and stiff material, which is difficult to work with. The lead nanofiber mesh is thinner, more flexible and more likely to integrate with the body’s own tissues, says MacEwan. Every thread of the nanofiber mesh is thousands of times smaller than the diameter of a single cell. The idea is to use the nanofiber material not only to make operations easier for surgeons to carry out, but also so there are fewer post-op complications for patients, because it breaks down naturally over time.

Researchers at the Polytechnic Institute of New York University (NYU-Poly) have recently demonstrated a new way to make nanofibers out of proteins. Writing recently in the journal Advanced Functional Materials, the researchers say they came across their finding almost by chance: they were studying certain cylinder-shaped proteins derived from cartilage, when they noticed that in high concentrations, some of the proteins spontaneously came together and self-assembled into nanofibers.

They carried out further experiments, such as adding metal-recognizing amino acids and different metals, and found they could control fiber formation, alter its shape, and how it bound to small molecules. For instance, adding nickel transformed the fibers into clumped mats, which could be used to trigger the release of an attached drug molecule.

The researchers hope this new method will greatly improve the delivery of drugs to treat cancer, heart disorders and Alzheimer’s disease. They can also see applications in regeneration of human tissue, bone and cartilage, and even as a way to develop tinier and more powerful microprocessors for use in computers and consumer electronics.









Robot-assisted heart surgery

Robotic Cardiac Surgery

What is robotic cardiac surgery?

Robotic cardiac surgery is heart surgery done through very small cuts in the chest. With the use of tiny instruments and robot-controlled tools, surgeons are able to do heart surgery in a way that is much less invasive than open-heart surgery. The procedure is sometimes called da Vinci surgery because that is the name of the manufacturer of the robot often used for this procedure.


Why might I need robotic cardiac surgery?

The main benefit of robotic cardiac surgery is that it is minimally invasive compared with open-heart surgery. Smaller incisions mean that you can heal faster and return to activities more quickly.

Your healthcare provider may recommend robotic cardiac surgery if you need an artery bypass procedure to improve blood flow to the heart. It may also be used to:

  • Repair or replace stiff or leaky heart valves
  • Correct atrial fibrillation, a common type of arrhythmia
  • Remove a tumor in the heart
  • Treat congenital heart conditions
  • Your healthcare provider may have other reasons to recommend robotic cardiac surgery.

How do I get ready for robotic cardiac surgery?

To see if you are a good candidate for this procedure, your healthcare provider will review your medical history, and lifestyle, as well as the overall severity of the disease.

  • Your healthcare provider will explain the procedure and you can ask questions.
  • You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if something is unclear.
  • Along with a complete medical history, your healthcare provider(s) may do a physical exam to ensure you are in otherwise good health before you undergo the procedure. You may also have blood tests and other diagnostic tests.
  • Your healthcare provider(s) may recommend taking an aspirin before the procedure.
  • If you are pregnant or think you may be, tell your healthcare provider(s).
  • Tell your healthcare provider(s) if you are sensitive to or are allergic to any medicines, latex, iodine, tape, contrast dyes, and anesthetic agents (local or general).
  • Tell your healthcare provider(s) of all medicines (prescribed and over-the-counter) and herbal supplements that you are taking.
  • Tell your healthcare provider(s) if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medicines, aspirin, or other medicines that affect blood clotting. You may need to stop these medicines before the procedure.
  • Tell your healthcare provider(s) if you have a pacemaker or other implanted heart device.
  • If you smoke, stop smoking as soon as possible before the procedure. This will improve your chances for a successful recovery from surgery and your overall health status.
  • You will be asked to fast for 8 hours before the procedure, generally stopping eating, drinking, or any oral medicines after midnight

Based on your medical condition, your healthcare provider(s) may request other specific preparation.

What happens during robotic cardiac surgery?

The following is the general sequence of events that will most likely occur during robotic cardiac surgery:

  • You may receive a sedative before the procedure to help you relax.
  • You will be placed under general anesthesia for the procedure and you will have a breathing tube.
  • A surgeon will make a series of keyhole-sized incisions on the side of your chest. These incisions will align with the openings between your ribs.
  • You may need to be placed on the heart-lung machine for the procedure.
  • Depending on the procedure being done, your surgeon will insert several precision-guided robotic arms into these incisions.
  • These robotic arms hold and manipulate tiny instruments to do the required tasks on the heart or surrounding arteries.
  • A tiny video camera will be inserted into another incision to provide a magnified, three-dimensional image of the operating site.
  • The surgeon will control the robotic arms and camera from a console located within the operating room.
  • Once complete, the surgeon will remove the instruments and close the incisions.

Talk with your healthcare provider about what you will experience during your procedure.

What happens after robotic cardiac surgery?

Once the surgery is done, you will be moved to the recovery area to be monitored. You can expect a relatively short hospital stay to follow, usually half as long as that after conventional open-heart surgery. Your healthcare provider will typically discharge you once your pain is under control, you can keep liquids down without nausea and vomiting, and your lab tests appear near normal or near your baseline before the procedure.

You can also expect less scarring on your chest. Open-heart surgery may leave a 10-inch scar on your chest. Robotic cardiac surgery just leaves a few smaller scars on the side of your chest.

After being discharged from the hospital, most people can manage their pain with over-the-counter pain relievers like acetaminophen or ibuprofen. Pain also tends to go away much faster than with open-heart procedures.

Keep your incisions clean and dry. Do not use powders, lotions, or ointments on the incision lines as this can irritate the skin and cause prolonged healing and increase the risk for infection. Do not soak the incisions in water until your doctor says it's OK.

Make plans to have someone give you a ride home from the hospital.

You may also return to normal activities more quickly than you would after open-heart surgery. Most people can resume their normal activities after a few weeks. Your healthcare provider will provide specific recommendations for activity.

Your healthcare provider will typically schedule follow-up appointments to check your progress. Be sure to tell your healthcare provider right away if any symptoms occur after the procedure, such as chest pain or discomfort. Complications are rare after robotic heart surgery, but possible, so it is important to carefully monitor for any symptoms and report them to your healthcare provider.



Robotic surgery

About Robotic Surgery

 Robotic surgery, or robot-assisted surgery, allows doctors to perform many types of complex procedures with more precision, flexibility and control than is possible with conventional techniques. Robotic surgery is usually associated with minimally invasive surgery — procedures performed through tiny incisions. It is also sometimes used in certain traditional open surgical procedures

The most widely used clinical robotic surgical system includes a camera arm and mechanical arms with surgical instruments attached to them. The surgeon controls the arms while seated at a computer console near the operating table. The console gives the surgeon a high-definition, magnified, 3-D view of the surgical site. The surgeon leads other team members who assist during the operation.

Advantages

Surgeons who use the robotic system find that for many procedures it enhances precision, flexibility and control during the operation and allows them to better see the site, compared with traditional techniques. Using robotic surgery, surgeons can perform delicate and complex procedures that may have been difficult or impossible with other methods.

Often, robotic surgery makes minimally invasive surgery possible. The benefits of minimally invasive surgery include:

  • Fewer complications, such as surgical site infection
  • Less pain and blood loss
  • Quicker recovery
  • Smaller, less noticeable scars

Is robotic surgery right for you?

Robotic surgery isn't an option for everyone. Talk with your doctor about the benefits and risks of robotic surgery and how it compares with other techniques, such as other types of minimally invasive surgery and conventional open surgery.



CURRENT USES

 

  • General and Gastrointestinal Surgery: Cholecystectomy, Hernia repair, Appendicectomy, Nissen fundoplication for hiatus hernia, Heller myotomy for achalasia cardia, gastric bypass, adrenalectomy, splenectomy, small intestinal surgery, colonic and rectal surgery etc.

  • Bariatric Surgery: Gastric bypass, gastric sleeve resection and gastric banding.

  • Thoracic Surgery: Thymectomy, mediastinal tumor, lung resections, esophageal surgery.

  • Urology: Radical prostatectomy, pyeloplasty, cystectomy, nephrectomy, ureteral reimplantation.

  • Gynaecology: Ovarian cyst, Hysterectomy, myomectomy and sacrocolpopexy.

  • Cardiac Surgery: Coronary artery bypass, Mitral valve repair, endoscopic atrial septal defect closure.

  • Head and neck: Transoral resection of tumors of the upper aerodigestive tract (tonsil, tongue base, larynx), transaxillary thyroidectomy

It appears now that this is an option restricted to few select hospitals in the world. No one knows what the future holds and this is best illustrated by the following statement by Professor Douglas Hartree, Cambridge mathematician in 1951:

“All the calculations that would ever be needed in this country will be done on the three digital computers which are being built — one in Cambridge, one in Teddington, and one in Manchester. No one else, would ever need machines of their own, or would be able to afford to buy them."




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