Manipulability Optimization of a Rehabilitative Collaborative Robotic System

The use of collaborative robots (or cobots) in rehabilitation therapies is aimed at assisting and shortening the patient's recovery after neurological injuries. Cobots are inherently safe when interacting with humans and can be programmed in different working modalities based on the patient's needs and the level of the injury. This study presents a design optimization of a robotic system for upper limb rehabilitation based on the manipulability ellipsoid method. The human-robot system is modeled as a closed kinematic chain in which the human hand grasps a handle attached to the robot's end effector. The manipulability ellipsoids are determined for both the human and the robotic arm and compared by calculating an index that quantifies the alignment of the principal axes. The optimal position of the robot base with respect to the patient is identified by a first global optimization and by a further local refinement, seeking the best alignment of the manipulability ellipsoids in a series of points uniformly distributed within the shared workspace

New tools in percutaneous minimally invasive chronic subdural hematomas evacuation

Background: Incidence of chronic subdural hematomas (cSDH) is expected to progressive rise in the next decades. There is no univocal indication of the approach to be used. Furthermore, there is no data about the efficacy of twist drill craniostomy (TDC) in hematomas with membranes. Objective: To describe our modified technique for TDC in patients affected by cSDH with membranes and in treatment with antiplatelets. Methods: We analyzed a group of 37 patients, affected by cSDH with membrane (type D laminar membrane and type G trabecular membrane according to Nakaguchi classification), treated with mushroom TDC using a modified technique. Results: After surgery the average maximum thickness of the common postoperative liquoral subdural collection decreased from 18.8 to 6.21 mm. We documented one acute subdural hematoma (2.7%), asymptomatic and not treated, and one recurrence of cSDH (2.7%) after 2 months that needed re-intervention with single burr hole. Conclusions: We presented a modified twist drill technique, characterized by the introduction of an application of a new device that optimizes both surgical results, clinical outcome and surgical procedure time. The presence of membrane type D and G does not affect the efficacy of drainage, that is negatively related to the presence of clots or acute hematoma. This modified technique is safe, fast, effective and represents a valid first line treatment of an unstable and unpredictable pathology such as cSDH. We suggest performing such technique on a larger patients’ cohort to further validate its effectiveness

Safety of treatments for inflammatory bowel disease: Clinical practice guidelines of the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD)

Inflammatory bowel diseases are chronic conditions of unknown etiology, showing a growing incidence and prevalence in several countries, including Italy. Although the etiology of Crohn's disease and ulcerative colitis is unknown, due to the current knowledge regarding their pathogenesis, effective treatment strategies have been developed. Several guidelines are available regarding the efficacy and safety of available drug treatments for inflammatory bowel diseases. Nevertheless, national guidelines provide additional information adapted to local feasibility, costs and legal issues related to the use of the same drugs. These observations prompted the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD) to establish Italian guidelines on the safety of currently available treatments for Crohn's disease and ulcerative colitis. These guidelines discuss the use of aminosalicylates, systemic and low bioavailability corticosteroids, antibiotics (metronidazole, ciprofloxacin, rifaximin), thiopurines, methotrexate, cyclosporine A, TNFα antagonists, vedolizumab, and combination therapies. These guidelines are based on current knowledge derived from evidence-based medicine coupled with clinical experience of a national working group

Collaborative Robotics for Rehabilitation: A Multibody Model for Kinematic and Dynamic Analysis

Human-Robot Collaboration is increasing in industrial settings because of the robot’s accuracy and repeatability join perfectly with human’s problem solving to enhance the industrial productivity. Collaborative robots share the workspace with operators in order to reduce human workload and guarantee performances. The reliability and safety of these robots allow their application in the health care sector (e.g. neuromuscular rehabilitation). The cobot-assisted therapy is becoming a significant supplement to the traditional one aimed at providing intensive and repetitive rehabilitating tasks to improve the patient’s recovery. The human-robot system presented in this paper is a closed kinematic chain composed of a robotic arm attached to the human forearm through a custom handle system. The handle, designed with simple components, is used for primary rehabilitation exercises. The kinematic models of human and robotic arms presented in this study are applied to develop trajectory planning algorithm in the joint space. Robot joints torques needed for guiding the patient limb are obtained by multibody dynamic simulations, assessing the capability of the manipulator to perform the task at given speeds and loads. The tools and methods proposed in this work allow for a preliminary study on cobot-assisted-therapy by different human-cobot-working modalities

A Framework for the Study of Human-Robot Collaboration in Rehabilitation Practices

Collaborative robots and humans can cooperate in different industrial processes by combining their peculiar skills: the accuracy and repeatability of the manipulators can be exploited in synergy with human intelligence and flexibility. Since the cobots are safe and reliable, they can be adopted in the health sector, in particular in rehabilitation: the cobots allow the three-dimensional manipulation of the limbs and can be easily adapted to different anthropometric parameters. The kinematic models of the human-robot system presented in this paper can be exploited to develop motion planning algorithms for rehabilitation exercises. Furthermore, the estimation of the interaction forces in the human-robot interface can be obtained by multibody dynamic simulations. The proposed methodology is a starting point for the study of the integration of cobots into current rehabilitation practices, evaluating the feasibility and providing useful ideas in order to plan different man-robot working modalities

A systematic review of FOLFOXIRI chemotherapy for the first-line treatment of metastatic colorectal cancer: improved efficacy at the cost of increased toxicity.

AIM: The simultaneous administration of irinotecan, 5-fluorouracil, folinic acid and oxaliplatin (FOLFOXIRI) has been compared with standard 5-fluorouracil, folinic acid and irinotecan (FOLFIRI) in randomized trials in metastatic colorectal cancer patients. A superior efficacy of FOLFOXIRI has been reported by some authors, but others have failed to show any differences and do not recommend its use because of greater cost and toxicity. We performed a systematic review of the literature to analyse efficacy and toxicity of FOLFOXIRI. METHOD: Odds ratios (OR) with 95% confidence intervals (CI) were used to analyse dichotomous variables. Hazard ratios (HR) for progression and death were combined with an inverse variance method based on logarithmic conversion. A fixed-effect model and Mantel-Haenszel's method were used. Heterogeneity was tested with Cochrane's Q test and I(2) test. RESULTS: A significant increase in response rate (OR 2.04; P < 0.01) was associated with treatment by FOLFOXIRI and a benefit was also shown by the HR for progression (HR 0.72; P < 0.01) and death (HR 0.71; P < 0.01). Analysis for toxicity found a significant increase associated with FOLFOXIRI except for anaemia, fatigue and febrile neutropenia. CONCLUSION: FOLFOXIRI confers significant benefit in progression-free survival, survival, response and R0 resection rates but is more toxic compared with FOLFIRI