143,763 research outputs found

    Fully Integrated Biochip Platforms for Advanced Healthcare

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    Recent advances in microelectronics and biosensors are enabling developments of innovative biochips for advanced healthcare by providing fully integrated platforms for continuous monitoring of a large set of human disease biomarkers. Continuous monitoring of several human metabolites can be addressed by using fully integrated and minimally invasive devices located in the sub-cutis, typically in the peritoneal region. This extends the techniques of continuous monitoring of glucose currently being pursued with diabetic patients. However, several issues have to be considered in order to succeed in developing fully integrated and minimally invasive implantable devices. These innovative devices require a high-degree of integration, minimal invasive surgery, long-term biocompatibility, security and privacy in data transmission, high reliability, high reproducibility, high specificity, low detection limit and high sensitivity. Recent advances in the field have already proposed possible solutions for several of these issues. The aim of the present paper is to present a broad spectrum of recent results and to propose future directions of development in order to obtain fully implantable systems for the continuous monitoring of the human metabolism in advanced healthcare applications

    Optic nerve sheath diameter ultrasound evaluation in intensive care unit. possible role and clinical aspects in neurological critical patients' daily monitoring

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    Background. The increase of the optic nerve sheath diameter (ONSD) is a reliable, noninvasive sonographic marker of intracranial hypertension. Aim of the study was to demonstrate the efficacy of ONSD evaluation, when monitoring neurocritical patients, to early identify malignant intracranial hypertension in patients with brain death (BD). Methods. Data from ultrasound ONSD evaluation have been retrospectively analyzed in 21 sedated critical patients with neurological diseases who, during their clinical course, developed BD. 31 nonneurological controls were used for standard ONSD reference. Results. Patients with neurological diseases, before BD, showed higher ONSD values than control group (CTRL: RT  cm; LT  cm; pre-BD: RT  cm; LT  cm; ) even without intracranial hypertension, evaluated with invasive monitoring. ONSD was further significantly markedly increased in respect to the pre-BD evaluation in neurocritical patients after BD, with mean values above 0.7 cm (RT  cm; LT  cm; ), with a corresponding dramatic raise in intracranial pressure. Logistic regression analysis showed a strong correlation between ONSD and ICP ( 0,895, ). Conclusions. ONSD is a reliable marker of intracranial hypertension, easy to be performed with a minimal training. Routine ONSD daily monitoring could be of help in Intensive Care Units when invasive intracranial pressure monitoring is not available, to early recognize intracranial hypertension and to suspect BD in neurocritical patients

    Combining local- and large-scale models to predict the distributions of invasive plant species

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    Habitat-distribution models are increasingly used to predict the potential distributions of invasive species and to inform monitoring. However, these models assume that species are in equilibrium with the environment, which is clearly not true for most invasive species. Although this assumption is frequently acknowledged, solutions have not been adequately addressed. There are several potential methods for improving habitat-distribution models. Models that require only presence data may be more effective for invasive species, but this assumption has rarely been tested. In addition, combining modeling types to form ‘ensemble’ models may improve the accuracy of predictions. However, even with these improvements, models developed for recently invaded areas are greatly influenced by the current distributions of species and thus reflect near- rather than long-term potential for invasion. Larger scale models from species’ native and invaded ranges may better reflect long-term invasion potential, but they lack finer scale resolution. We compared logistic regression (which uses presence/absence data) and two presence-only methods for modeling the potential distributions of three invasive plant species on the Olympic Peninsula in Washington State, USA. We then combined the three methods to create ensemble models. We also developed climate-envelope models for the same species based on larger scale distributions and combined models from multiple scales to create an index of near- and long-term invasion risk to inform monitoring in Olympic National Park (ONP). Neither presence-only nor ensemble models were more accurate than logistic regression for any of the species. Larger scale models predicted much greater areas at risk of invasion. Our index of near- and long-term invasion risk indicates that \u3c4% of ONP is at high near-term risk of invasion while 67-99% of the Park is at moderate or high long-term risk of invasion. We demonstrate how modeling results can be used to guide the design of monitoring protocols and monitoring results can in turn be used to refine models. We propose that by using models from multiple scales to predict invasion risk and by explicitly linking model development to monitoring, it may be possible to overcome some of the limitations of habitat-distribution models

    The Use of Audio in Minimal Access Surgery

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    In minimal access surgery (MAS) (also known as minimally invasive surgery), operations are carried out by making small incisions in the skin and inserting special apparatus into potential body cavities through those incisions. Laparoscopic MAS procedures are conducted in the patient’s abdomen. The aim of MAS is faster recovery, shorter hospitalisation and fewer major post-operative complications; all resulting in lower societal cost with better patient acceptability. The technique is markedly dependent on supporting technologies for vision, instrumentation, energy delivery, anaesthesia, and monitoring. However, in practice, much MAS continues to take longer and be associated with an undesirable frequency of unwanted minor (or occasionally major) mishaps. Many of these difficulties result precisely from the complexity and mal-adaptation of the additional technology and from lack of familiarity with it. A survey of South East England surgeons showed the two main stress factors on surgeons to be the technical difficulty of the procedure and time pressures placed on the surgeon by third parties. Many of the problems associated with MAS operations are linked to the control and monitoring of the equipment. This paper describes work begun to explore ergonomic enhancements to laparoscopic operating technology that could result in faster and safer laparoscopic operations, less surgeon stress and reduce dependence on ancillary staff. Auditory displays have been used to communicate complex information to users in a modality that is complementary to the visual channel. This paper proposes the development of a control and feedback system that will make use of auditory displays to improve the amount of information that can be communicated to the surgeon and his assistant without overloading the visual channel. Control of the system would be enhanced by the addition of voice input to allow the surgeon direct control

    Comparing open and minimally invasive surgical procedures for oesophagectomy in the treatment of cancer: the ROMIO (Randomised Oesophagectomy: Minimally Invasive or Open) feasibility study and pilot trial

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    Localised oesophageal cancer can be curatively treated with surgery (oesophagectomy) but the procedure is complex with a risk of complications, negative effects on quality of life and a recovery period of 6-9 months. Minimal-access surgery may accelerate recovery.The ROMIO (Randomised Oesophagectomy: Minimally Invasive or Open) study aimed to establish the feasibility of, and methodology for, a definitive trial comparing minimally invasive and open surgery for oesophagectomy. Objectives were to quantify the number of eligible patients in a pilot trial; develop surgical manuals as the basis for quality assurance; standardise pathological processing; establish a method to blind patients to their allocation in the first week post surgery; identify measures of postsurgical outcome of importance to patients and clinicians; and establish the main cost differences between the surgical approaches.Pilot parallel three-arm randomised controlled trial nested within feasibility work.Two UK NHS departments of upper gastrointestinal surgery.Patients aged ≥ 18 years with histopathological evidence of oesophageal or oesophagogastric junctional adenocarcinoma, squamous cell cancer or high-grade dysplasia, referred for oesophagectomy or oesophagectomy following neoadjuvant chemo(radio)therapy.Oesophagectomy, with patients randomised to open surgery, a hybrid open chest and minimally invasive abdomen or totally minimally invasive access.The primary outcome measure for the pilot trial was the number of patients recruited per month, with the main trial considered feasible if at least 2.5 patients per month were recruited.During 21 months of recruitment, 263 patients were assessed for eligibility; of these, 135 (51%) were found to be eligible and 104 (77%) agreed to participate, an average of five patients per month. In total, 41 patients were allocated to open surgery, 43 to the hybrid procedure and 20 to totally minimally invasive surgery. Recruitment is continuing, allowing a seamless transition into the definitive trial. Consequently, the database is unlocked at the time of writing and data presented here are for patients recruited by 31 August 2014. Random allocation achieved a good balance between the arms of the study, which, as a high proportion of patients underwent their allocated surgery (69/79, 87%), ensured a fair comparison between the interventions. Dressing patients with large bandages, covering all possible incisions, was successful in keeping patients blind while pain was assessed during the first week post surgery. Postsurgical length of stay and risk of adverse events were within the typical range for this group of patients, with one death occurring within 30 days among 76 patients. There were good completion rates for the assessment of pain at 6 days post surgery (88%) and of the patient-reported outcomes at 6 weeks post randomisation (74%).Rapid recruitment to the pilot trial and the successful refinement of methodology indicated the feasibility of a definitive trial comparing different approaches to oesophagectomy. Although we have shown a full trial of open compared with minimally invasive oesophagectomy to be feasible, this is necessarily based on our findings from the two clinical centres that we could include in this small preliminary study.Current Controlled Trials ISRCTN59036820.This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 48. See the NIHR Journals Library website for further project information

    The pitfalls and promise of liquid biopsies for diagnosing and treating solid tumors in children : a review

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    Cell-free DNA profiling using patient blood is emerging as a non-invasive complementary technique for cancer genomic characterization. Since these liquid biopsies will soon be integrated into clinical trial protocols for pediatric cancer treatment, clinicians should be informed about potential applications and advantages but also weaknesses and potential pitfalls. Small retrospective studies comparing genetic alterations detected in liquid biopsies with tumor biopsies for pediatric solid tumor types are encouraging. Molecular detection of tumor markers in cell-free DNA could be used for earlier therapy response monitoring and residual disease detection as well as enabling detection of pathognomonic and therapeutically relevant genomic alterations. Conclusion: Existing analyses of liquid biopsies from children with solid tumors increasingly suggest a potential relevance for molecular diagnostics, prognostic assessment, and therapeutic decision-making. Gaps remain in the types of tumors studied and value of detection methods applied. Here we review the current stand of liquid biopsy studies for pediatric solid tumors with a dedicated focus on cell-free DNA analysis. There is legitimate hope that integrating fully validated liquid biopsy-based innovations into the standard of care will advance patient monitoring and personalized treatment of children battling solid cancers

    Attitudes of surgeons to the use of postoperative markers of the systemic inflammatory response following elective surgery

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    Background: Cancer is responsible for 7.6 million deaths worldwide and surgery is the primary modality of a curative outcome. Postoperative care is of considerable importance and it is against this backdrop that a questionnaire based study assessing the attitudes of surgeons to monitoring postoperative systemic inflammation was carried out. Method: A Web based survey including 10 questions on the “attitudes of surgeons to the use of postoperative markers of the systemic inflammatory response following elective surgery” was distributed via email. Two cohorts were approached to participate in the survey. Cohort 1 consisted of 1092 surgeons on the “Association of Coloproctology of Great Britain and Ireland (ACPGBI)” membership list. Cohort 2 consisted of 270 surgeons who had published in this field in the past as identified by two recent reviews. A reminder email was sent out 21 days after the initial email in both cases and the survey was closed after 42 days in both cases. Result: In total 29 surgeons (2.7%) from cohort 1 and 40 surgeons (14.8%) from cohort 2 responded to the survey. The majority of responders were from Europe (77%), were colorectal specialists (64%) and were consultants (84%) and worked in teaching hospitals (54%) and used minimally invasive techniques (87%). The majority of responders measured CRP routinely in the post-operative period (85%) and used CRP to guide their decision making (91%) and believed that CRP monitoring should be incorporated into postoperative guidelines (81%). Conclusion: Although there was a limited response the majority of surgeons surveyed measure the systemic inflammatory response following elective surgery and use CRP measurements together with clinical findings to guide postoperative care. The present results provide a baseline against which future surveys can be compared
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