Quantification of Age-Related Differences in Reaching and Circle-Drawing using a Robotic Rehabilitation Device

Background: Although robotic therapy is at the forefront of upper limb rehabilitation, there is limited information about the importance of selecting age-matched subjects to evaluate recovery of arm movement during rehabilitation

The ENPP1 Q121 Variant Predicts Major Cardiovascular Events in High-Risk Individuals: Evidence for Interaction With Obesity in Diabetic Patients

Insulin resistance (IR) and cardiovascular disease may share a common genetic background. We investigated the role of IR-associated ENPP1 K121Q polymorphism (rs1044498) on cardiovascular disease in high-risk individuals

Rationale and design of an independent randomised controlled trial evaluating the effectiveness of aripiprazole or haloperidol in combination with clozapine for treatment-resistant schizophrenia

<p>Abstract</p> <p>Background</p> <p>One third to two thirds of people with schizophrenia have persistent psychotic symptoms despite clozapine treatment. Under real-world circumstances, the need to provide effective therapeutic interventions to patients who do not have an optimal response to clozapine has been cited as the most common reason for simultaneously prescribing a second antipsychotic drug in combination treatment strategies. In a clinical area where the pressing need of providing therapeutic answers has progressively increased the occurrence of antipsychotic polypharmacy, despite the lack of robust evidence of its efficacy, we sought to implement a pre-planned protocol where two alternative therapeutic answers are systematically provided and evaluated within the context of a pragmatic, multicentre, independent randomised study.</p> <p>Methods/Design</p> <p>The principal clinical question to be answered by the present project is the relative efficacy and tolerability of combination treatment with clozapine plus aripiprazole compared with combination treatment with clozapine plus haloperidol in patients with an incomplete response to treatment with clozapine over an appropriate period of time. This project is a prospective, multicentre, randomized, parallel-group, superiority trial that follow patients over a period of 12 months. Withdrawal from allocated treatment within 3 months is the primary outcome.</p> <p>Discussion</p> <p>The implementation of the protocol presented here shows that it is possible to create a network of community psychiatric services that accept the idea of using their everyday clinical practice to produce randomised knowledge. The employed pragmatic attitude allowed to randomly allocate more than 100 individuals, which means that this study is the largest antipsychotic combination trial conducted so far in Western countries. We expect that the current project, by generating evidence on whether it is clinically useful to combine clozapine with aripiprazole rather than with haloperidol, provides physicians with a solid evidence base to be directly applied in the routine care of patients with schizophrenia.</p> <p>Trial Registration</p> <p><b>Clincaltrials.gov Identifier</b>: NCT00395915</p

Riabilitazione robotica della postura in Pediatria; progettazione, sviluppo, implementazione del sistema di controllo e sensorizzazione di un robot riabilitativo e sua utilizzazione nella routine clinica

The ability to maintain postural control is a complex task and, although it is natural for healthy subjects, it is often disrupted in stroke patients. The control of posture, in fact, results from the integration of several sensory inputs, both from the body and the external environment; these inputs are real-time processed to implement a dynamic equilibrium configuration for the entire musculoskeletal system. Postural rehabilitation has grown remarkably in the neuro-rehabilitation field and has met new challenges in the so-called cortical plasticity¬, which is also the rationale for rehabilitation robotics. This principle, in fact, states the ability of the CNS to reorganize itself, even after a cerebrovascular accident. This reason led to the introduction, during the last years, of a huge number of robotic platforms to improve the postural rehabilitation process, both in the fields of Research and clinical routine. The lack, in the literature, of a motorized, 2 DOFs platform, able to interact with the subjects standing upon it, led to the design of a device with these requirements, intended for use by the pediatric patients of the MARlab (Movement Analysis and Robotics laboratory, Ospedale Pediatrico “Bambino Gesù”, Palidoro, RM). After the dimensioning of the selected components, the platform has been designed in a CAD environment. The final layout is a Cartesian robot with a 15x15 cm2 workspace and a low profile (170 mm), and it is ideal to be installed, in the future, below the floor. Two linear induction motors are used to power the two motion axis and, in order to make the platform compliant with the patient, each motor slider was sensorized with a 1DOF load cell. A study was then conducted to evaluate the influence of the inertial forces over the load cell output. The goal of this project was to design and realize a robot prototype, called SlideBiT2D, with an open, evolvable architecture. For this reason we chose to install the network of sensors and actuators over a CAN fieldbus; we also selected, as the network master node, a PCI card CANopen-compliant, which could be programmed in LabVIEW environment. As regards the software, it has been designed on a three-level structure, two of which has already been developed. In this way it is not mandatory to have a good knowledge of the CANopen protocol in order to develop the user interface. To make the platform a real haptic interface, ie able to respond to the external forces imposed by the patient, we used, for both motors, the speed control mode; in addition, a superior control loop was imposed to simulate a 2DOFs spring, placed in parallel with a damper of coefficient C. The control thus produced was tested first with a test bench, along a single dimension, and was then successfully implemented in 2D, over the platform. Since the platform is a medical device, some special attentions were used throughout the design activities. As regards the requirements for electrical safety, the development of the electrical panel was demanded to a certified company (MPD Ltd – Induno Olona, VA). The use of the platform before its installation under the floor will be conducted in combination with the use of the overhead crane installed in the MARlab of Santa Marinella. Finally, the platform commissioning/start-up will require further calibration phase for motors and load cells, in order to assure quality measurements and safe interaction of the robot with the patient.Il mantenimento della postura è un compito complesso, pur nella sua apparente naturalezza, ed è spesso compromesso in pazienti con patologie a carico del Sistema Nervoso Centrale (SNC). Questo compito è, infatti, frutto dell’integrazione di numerosi input sensoriali, propriocettivi ed esterocettivi, da parte del SNC; tali input vengono elaborati per attuare, in ogni istante, durante tutte le attività quotidiane, una configurazione di equilibrio per l’intero apparato muscoloscheletrico. La riabilitazione del mantenimento della postura ha acquistato importanza sempre crescente nel campo della neuro-riabilitazione ed ha conosciuto nuovi stimoli nel razionale della terapia mediata da robot, la quale si fonda sul concetto della plasticità corticale, ossia sulla capacità del SNC di riorganizzarsi anche a seguito di accidenti cerebrovascolari. Per questo motivo, gli ultimi decenni hanno visto l’introduzione di numerose piattaforme robotiche sia in Ricerca che in Clinica, allo scopo di migliorare il processo di recupero dell’equilibrio e la sua oggettivazione. L’assenza, in letteratura, di una piattaforma motorizzata a 2 gdl (gradi di libertà), e in grado di interagire con i soggetti posti al di sopra di essa, hanno portato alla progettazione di un dispositivo con queste caratteristiche, destinato all’utilizzo da parte dei pazienti pediatrici del MARlab (Movement Analysis and Robotics laboratory) dell’OPBG (Ospedale Pediatrico “Bambino Gesù”) di Palidoro (RM). Dopo l’individuazione delle specifiche di progetto, la scelta e il dimensionamento dei componenti, la piattaforma è stata disegnata in ambiente CAD, risultando un robot cartesiano con un workspace di 15x15 cm2 ed un basso profilo (170 mm), ideale per essere in futuro installata al di sotto del pavimento. Il cuore del dispositivo è costituito dai due motori lineari a induzione elettromagnetica LinMot, che consentono di attivare ciascuno una direzione del moto. Al fine di rendere la piattaforma interattiva, è stato necessario sensorizzare ciascun motore con una cella di carico, così da rilevare la volontà esterna di muovere il robot. Inoltre, trattandosi di un dispositivo destinato a pazienti pediatrici, aventi cioè massa corporea confrontabile con quella della piattaforma, è stato condotto uno studio per valutare la possibilità di compensare in accelerazione le uscite delle celle di carico, depurandole dalla forza di inerzia associata proprio al moto della piattaforma. La filosofia di approccio alla costruzione di questo prototipo, denominato SlideBiT2D, è quella di un sistema aperto ed evolvibile, sia dal punto di vista dell’hardware che del software, pronto ad accogliere nuove necessità espresse da parte del personale medico. Per questo, si è scelto di installare la rete di sensori e attuatori su bus di campo CAN, scegliendo come master della rete un nodo CANopen-compliant, programmabile però in ambiente LabVIEW. Il software è stato concepito come articolato su tre livelli e ne sono stati sviluppati i due più bassi, in modo da svincolare la creazione di una interfaccia utente da qualsiasi conoscenza del CANopen, protocollo molto efficiente ma anche complesso da apprendere. Per rendere la piattaforma una vera e propria interfaccia aptica, in grado cioè di rispondere alle sollecitazioni imposte dall’esterno, i motori sono stati controllati in velocità e, in più, è stato sviluppato un controllore di livello superiore per simulare una molla a 2 gdl, di rigidezza variabile K, posta in parallelo ad uno smorzatore con coefficiente C. Il controllo così realizzato è stato testato dapprima con un banco di prova, lungo una sola dimensione, ed è stato poi implementato con successo in 2D sulla piattaforma. Avere a che fare con un prototipo di un dispositivo medico ha richiesto alcune attenzioni particolari durante tutta la attività di progettazione. Anzitutto, per ciò che riguarda la sicurezza elettrica, il quadro elettrico è stato sviluppato da una ditta certificata (MPD srl – Induno Olona, VA). L’utilizzo stesso della piattaforma, in attesa che essa sia interrata, sarà auspicabilmente condotto in combinazione con l’utilizzo di un carroponte in dotazione al MARlab dell’OPBG di Santa Marinella. Infine, come si conviene ad ogni dispositivo di misura, la messa in opera del robot richiederà una ulteriore fase di taratura dei motori e delle catene di misura presenti, al fine di garantire la qualità delle misure e la sicurezza nella interazione per il paziente.. Infine, come si conviene a un qualsiasi dispositivo di misura, la messa in opera del robot richiederà una ulteriore fase di taratura dei motori e delle catene di misura presenti, al fine di garantire la qualità delle misure e la sicurezza nella interazione per il paziente

Adenomyomatosis of the gallbladder in childhood: Report of a case and review of the literature

Adenomyomatosis of the gallbladder is considered an acquired pathologic condition that affects adults, with only 2 cases previously described in childhood. We report on a 5-year-old boy with incidental detection of this lesion by ultrasonography. Pathologic and clinical assessments are discussed in addition to treatment decision-making, including current insights into the relation between adenomyomatosis and malignancy of the gallbladder. The liberal use of ultrasonography in children with abdominal pain may result in detection of an increasing number of asymptomatic patients. Caregivers should be aware of this condition and its therapeutic implications in the pediatric population

How to choose and interpret similarity indices to quantify the variability in gait joint kinematics

Repeatability and reproducibility indices are often used in gait analysis to validate models and assess patients in their follow-up. When comparing joint kinematics, their interpretation can be ambiguous due to a lack of understanding of the exact sources of their variations. This paper studied four indices (Root Mean Square Deviation, Mean Absolute Variability, Coefficient of Multiple Correlation, and Linear Fit Method) in relation to five confusing-factors: joints’ range of motion, sample-by-sample amplitude variability, offset, time shift and curve shape. A first simulation was conducted to test the mathematics behind each index. A second simulation tested the influence of the curve shape on the indices using a Fourier’s decomposition. The Coefficient of Multiple Correlation and the Linear Fit method Coefficients were independent from the range of motion. Different Coefficients of Multiple Correlation were found among different joints, leading to misinterpretation of the results. The Linear Fit Method coefficients should not be adopted when time shift increases. Root Mean Square Deviation and Mean Absolute Variability were sensitive to all the confusing-factors. The Linear Fit Method coefficients seemed to be the most suitable to assess gait data variability, complemented with Root Mean Square Deviation or Mean Absolute Variability as measurements of data dispersion

Translational effects of robot-mediated therapy in subacute stroke patients: an experimental evaluation of upper limb motor recovery

Robot-mediated therapies enhance the recovery of post-stroke patients with motor deficits. Repetitive and repeatable exercises are essential for rehabilitation following brain damage or other disorders that impact the central nervous system, as plasticity permits to reorganize its neural structure, fostering motor relearning. Despite the fact that so many studies claim the validity of robot-mediated therapy in post-stroke patient rehabilitation, it is still difficult to assess to what extent its adoption improves the efficacy of traditional therapy in daily life, and also because most of the studies involved planar robots. In this paper, we report the effects of a 20-session-rehabilitation project involving the Armeo Power robot, an assistive exoskeleton to perform 3D upper limb movements, in addition to conventional rehabilitation therapy, on 10 subacute stroke survivors. Patients were evaluated through clinical scales and a kinematic assessment of the upper limbs, both pre- and post-treatment. A set of indices based on the patients’ 3D kinematic data, gathered from an optoelectronic system, was calculated. Statistical analysis showed a remarkable difference in most parameters between pre- and post-treatment. Significant correlations between the kinematic parameters and clinical scales were found. Our findings suggest that 3D robot-mediated rehabilitation, in addition to conventional therapy, could represent an effective means for the recovery of upper limb disability. Kinematic assessment may represent a valid tool for objectively evaluating the efficacy of the rehabilitation treatment

Hemoperitoneum caused by spontaneous rupture of hepatocellular carcinoma in noncirrhotic liver. A case report and systematic review

Hepatocellular carcinoma (HCC) is the sixth most common cancer. Spontaneous rupture of HCC is an acute complication with a high mortality rate. The HCC principally arises in the background of chronic liver disease and cirrhosis of the liver. In the last few years, the rising incidence of HCC in noncirrhotic liver suggests the presence of other factors that may play a role in liver carcinogenesis