Development of clinical sign-based scoring system for assessment of omphalitis in neonatal calves

Omphalitis contributes significantly to morbidity and mortality in neonatal calves. Diagnosis of omphalitis is based on the local signs of inflammation—pain, swelling, local heat and purulent discharge. An abattoir trial identified an optimal, sign-based, scoring system for diagnosis of omphalitis. A sample of 187 calves aged between 7 and 15 days old were clinically examined for signs of umbilical inflammation and compared with postmortem examination of navels. On postmortem findings, 64 calves (34.2 per cent) had omphalitis. In the examined omphalitis cases, the most commonly affected umbilical structure was the urachus (78.1 per cent). Multivariable logistic regression revealed that thickening of the umbilical stump over 1.3?cm (P<0.001), discharge (P<0.001), raised local temperature (P=0.003) and the presence of umbilical hernia (P=0.024) were correlated and positive predictors of omphalitis. Discharge from the umbilical stump was associated with intra-abdominal inflammation (P=0.004). Assigning weights based on the multivariable logistic regression coefficients, a clinical scoring algorithm was developed. The cumulative score ranged from 0 to 9. Using this scoring system, calves were categorised as positive if their total score was =2. This scoring method had a sensitivity of 85.9 per cent, specificity of 74.8 per cent and correctly classified 78.6 per cent of all calves

Recognizing myofascial pelvic pain in the female patient with chronic pelvic pain.

Myofascial pelvic pain (MFPP) is a major component of chronic pelvic pain (CPP) and often is not properly identified by health care providers. The hallmark diagnostic indicator of MFPP is myofascial trigger points in the pelvic floor musculature that refer pain to adjacent sites. Effective treatments are available to reduce MFPP, including myofascial trigger point release, biofeedback, and electrical stimulation. An interdisciplinary team is essential for identifying and successfully treating MFPP

A Clinical Study of the Pulse Wave Characteristics at the Three Pulse Diagnosis Positions of Chon, Gwan and Cheok

In this work, we analyze the baseline, signal strength, aortic augmentation index (AIx), radial AIx, time to reflection and P_T2 at Chon, Gwan, and Cheok, which are the three pulse diagnosis positions in Oriental medicine. For the pulse measurement, we used the SphygmoCor apparatus, which has been widely used for the evaluation of the arterial stiffness at the aorta. By two-way repeated measures analysis of variance, we tested two independent measurements for repeatability and investigated their mean differences among Chon, Gwan and Cheok. To characterize further the parameters that were shown to be different between each palpation position, we carried out Duncan's test for the multiple comparisons. The baseline and signal strength were statistically different (P < .05) among Chon, Gwan and Cheok, respectively, which supports the major hypothesis of Oriental medicine that all of the three palpation positions contain different clinical information. On the other hand, aortic AIx and time to reflection were found to be statistically different between Chon and the others, and radial AIx and P_T2 did not show any difference between pulse positions. In the clinical sense, however, the aortic AIx at each palpation position was found to fall within the 90% confidence interval of normal arterial compliance. The results of the multiple comparisons indicate that the parameters of arterial stiffness were independent of the palpation positions. This work is the first attempt to characterize quantitatively the pulse signals at Chon, Gwan and Cheok with some relevant parameters extracted from the SphygmoCor apparatus

Morphological and functional adaptations of the abdominal wall during pregnancy and in the postpartum period.

Doutoramento em Motricidade Humana na especialidade de BiomecânicaA diástase dos retos abdominais (DRA) carateriza-se pela separação dos músculos rectos abdominais, sendo que o incremento da distância inter-rectos (DIR) se inicia durante a gravidez e prolonga-se pelo puerpério. A fiabilidade dos instrumentos de registo desta condição é reduzida sendo escasso o conhecimento sobre a prevalência e factores de risco que lhe estão associados. Adicionalmente existe pouca evidência sobre o efeito na prevenção e/ou agravamento da DIR induzida pelos trabalho abdominal. Assim, foram objetivos desta tese 1) o desenvolvimento de uma metodologia fiável de avaliação da morfologia da parede abdominal feminina; 2) descrição da prevalência da DIR, factores de risco e relação com dor lombo-pélvica aos 6 meses no pós-parto; 3) e avaliar a resposta imediata da DIR ao exercício, nomeadamente no crunch abdominal e no drawing-in. Cento e oitenta e sete mulheres participaram nos cinco estudos apresentados na tese. Os resultados dos três estudos metodológicos demonstraram a fiabilidade da medição da DIR com base na ultrassonografia, nomeadamente face à palpação. Nos dois estudos longitudinais foi avaliada a prevalência e potenciais fatores de risco da DRA a par da associação do incremento de DIR com a incidência de dor lombo-pélvica assim como o efeito imediato dos exercícios crunch e drawing-in. Os resultados revelaram que aos 6 meses de pós-parto a DRA tem uma prevalência de 39% não apresentando relação significativa com a dor lombo pélvica. A resposta imediata produzida pelo exercício drawing-in foi um aumento da DIR, enquanto o crunch induziu a redução imediata da DIR, tanto na gravidez como no pós-parto.ABSTRACT - Diastasis recti abdominis (DRA) or increased inter rectus distance (IRD) is characterized by the separation of the rectus abdominis muscles. It has its onset during pregnancy and the first weeks following childbirth. The reliability of the instruments used to assess this condition is unclear. There is scant knowledge on the prevalence and risk factors for development of the condition. There is little evidence on which exercises are most effective in reduction of DRA. The aims of the present thesis were to establish a reliable method for the assessment of the morphology of the abdominal wall, describe the natural recovery of IRD from late pregnancy till 6 months postpartum and evaluate IRD during drawing in and abdominal crunch exercises. One hundred and eighty-seven women participated in the different studies comprising this thesis. The results of the three methodological studies showed ultrasound imaging to be a reliable method for measuring IRD. Palpation has sufficient reliability to be used in clinical practice. However, ultrasound is a more accurate and valid method. The ultrasound transducer can be held relatively stationary in a clinical setting, to evaluate IRD. DRA is prevalent at 6 months postpartum, with a prevalence rate of 39% but is not linked with lumbo-pelvic pain. The drawing in exercise widened the IRD in postpartum women while the abdominal crunch narrowed the IRD compared to rest both during pregnancy and in the postpartum period.Fundação para a Ciência e a Tecnologia - FCT ; International Society of Biomechanics Dissertation Grant- IS

Emergency abdominal surgery

This study guide contains information about basic principles of diagnostics and treatment of patients with acute surgical abdominal diseases

Cable-driven parallel mechanisms for minimally invasive robotic surgery

Minimally invasive surgery (MIS) has revolutionised surgery by providing faster recovery times, less post-operative complications, improved cosmesis and reduced pain for the patient. Surgical robotics are used to further decrease the invasiveness of procedures, by using yet smaller and fewer incisions or using natural orifices as entry point. However, many robotic systems still suffer from technical challenges such as sufficient instrument dexterity and payloads, leading to limited adoption in clinical practice. Cable-driven parallel mechanisms (CDPMs) have unique properties, which can be used to overcome existing challenges in surgical robotics. These beneficial properties include high end-effector payloads, efficient force transmission and a large configurable instrument workspace. However, the use of CDPMs in MIS is largely unexplored. This research presents the first structured exploration of CDPMs for MIS and demonstrates the potential of this type of mechanism through the development of multiple prototypes: the ESD CYCLOPS, CDAQS, SIMPLE, neuroCYCLOPS and microCYCLOPS. One key challenge for MIS is the access method used to introduce CDPMs into the body. Three different access methods are presented by the prototypes. By focusing on the minimally invasive access method in which CDPMs are introduced into the body, the thesis provides a framework, which can be used by researchers, engineers and clinicians to identify future opportunities of CDPMs in MIS. Additionally, through user studies and pre-clinical studies, these prototypes demonstrate that this type of mechanism has several key advantages for surgical applications in which haptic feedback, safe automation or a high payload are required. These advantages, combined with the different access methods, demonstrate that CDPMs can have a key role in the advancement of MIS technology.Open Acces

An Abdominal Phantom with Tunable Stiffness Nodules and Force Sensing Capability for Palpation Training

Robotic phantoms enable advanced physical examination training before using human patients. In this paper, we present an abdominal phantom for palpation training with controllable stiffness liver nodules that can also sense palpation forces. The coupled sensing and actuation approach is achieved by pneumatic control of positive-granular jammed nodules for tunable stiffness. Soft sensing is done using the variation of internal pressure of the nodules under external forces. This paper makes original contributions to extend the linear region of the neo-Hookean characteristic of the mechanical behavior of the nodules by 140% compared to no-jamming conditions and to propose a method using the organ level controllable nodules as sensors to estimate palpation position and force with a root-means-quare error (RMSE) of 4% and 6.5%, respectively. Compared to conventional soft sensors, the method allows the phantom to sense with no interference to the simulated physiological conditions when providing quantified feedback to trainees, and to enable training following current bare-hand examination protocols without the need to wear data gloves to collect data.This work was supported in part by the Engineering and Physical Sciences Research Council (EPSRC) MOTION grant EP/N03211X/2 and EP/N03208X/1, and EPSRC RoboPatient grant EP/T00603X/

Effects of Isolated Core Stability Training on Standing Static Postural Control, Recovery of Standing Postural Control and Kicking Velocity in Soccer Athletes

BACKGROUND: About 1/3 of injuries are non-contact in nature and half of these involve the LE’s. There are numerous anatomical and physiological mechanisms and systems involved in stabilizing the trunk for movement of the lower extremities. The ability of the trunk to maintain the position and motion of the trunk over the pelvis and LE’s is predominantly accomplished via quick postural responses to internal and external forces. These pre-programed postural responses are integrated within the neuromuscular system. It is theorized that poor core stability is a result of a failure in the neuromuscular system to support the trunk and pelvis over the lower extremities. Poor core stability has also been linked with an increased risk of lower extremity injuries. Poor core stability has also been linked to poor athletic performance via similar mechanisms. Current practice is to train the core in combination with the lower extremities. Improvements in athletic performance has been demonstrated. However, it is difficult to ascertain whether the improvements are due to changes in the trunk, the lower extremities or some combination thereof. Few studies have examined biomechanical measures of postural control following an integrated core stabilization training let alone an isolated approach to core stabilization. OBJECTIVE: To examine the reliability of the measurements and the effects of an 8-week isolated core stability program on trunk muscle activation, static and dynamic postural stability and kicking velocity in soccer athletes. DESIGN: Twenty division II and III soccer athletes (n=10 male, n=10 female) participated in a quasi-experimental randomized pre-post training study (n=10 control, n=10 experimental). The main outcomes were derivative of CoP and trunk muscle surface EMG normalized to %MVC for static postural control tasks TTS as a measure dynamic postural control and kicking velocity. STATISTICS: Reliability of the measures were assessed using ICC (2,K), MDC (95%CI) and SEM’s. Between and within group differences pre and post training were assessed using repeated measures MANOVA for static postural stability (CoP and EMG) and repeated measure ANOVA for dynamic recovery of balance and kicking velocity (p\u3c .05). RESULTS: Good to excellent ICC’s with relatively small MDC and SEM’s. Further, there was a reduction in CoP deviation and trunk muscle activation during postural control tasks, quicker TTS and increased kicking velocity following training as compared to controls. CONCLUSION: Static and dynamic postural control and kicking velocity improved in division II and III soccer athletes following an 8-week isolated core stabilization training. These results begin to elucidate to role of the core and the effects of core stabilization training on standing postural control and performance in athletes. These results have direct implications on clinical intervention for soccer athletes