Efficacy and safety of trabeculectomy vs nonpenetrating surgical procedures: a systematic review and meta-analysis

To date, only a few studies have directly compared nonpenetrating surgery (NPS) and trabeculectomy (TE). Therefore, there is no strong evidence as to which surgical technique leads to the best results in terms of ocular hypotensive effect and safety

Pilot scale validation campaign of gel dosimetry for pre-treatment quality assurance in stereotactic radiotherapy

Purpose: Complex stereotactic radiotherapy treatment plans require prior verification. A gel dosimetry system was developed and tested to serve as a high-resolution 3D dosimeter for Quality Assurance (QA) purposes.Materials and Methods: A modified version of a polyacrylamide polymer gel dosimeter based on chemical response inhibition was employed. Different sample geometries (cuvettes and phantoms) were manufactured for calibration and QA acquisitions. Irradiations were performed with a Varian Trilogy linac, and analyses of irradiated gel dosimeters were performed via MRI with a 1.5 T Philips Achieva at 1 mm3 or 2 mm3 isotropic spatial resolution. To assess reliability of polymer gel data, 54 stereotactic clinical treatment plans were delivered both on dosimetric gel phantoms and on the Delta4 dosimeter. Results from the two devices were evaluated through a global gamma index over a range of acceptance criteria and compared with each other.Results: A quantitative and tunable control of dosimetric gel response sensitivity was achieved through chemical inhibition. An optimized MRI analysis protocol allowed to acquire high resolution phantom dose data in time -frames of approximate to 1 h. Conversion of gel dosimeter data into absorbed dose was achieved through internal calibration. Polymer gel dosimeters (2 mm3 resolution) and Delta4 presented an agreement within 4.8 % and 2.7 % at the 3 %/1 mm and 2 %/2 mm gamma criteria, respectively.Conclusions: Gel dosimeters appear as promising tools for high resolution 3D QA. Added complexity of the gel dosimetry protocol may be justifiable in case of small target volumes and steep dose gradients

Complications associated with transobturator sling procedures: analysis of 233 consecutive cases with a 27 months follow-up

<p>Abstract</p> <p>Backround</p> <p>The transobturator tape procedure (TOT) is an effective surgical treatment of female stress urinary incontinence. However data concerning safety are rare, follow-up is often less than two years, and complications are probably underreported. The aim of this study was to describe early and late complications associated with TOT procedures and identify risk factors for erosions.</p> <p>Methods</p> <p>It was a 27 months follow-up of a cohort of 233 women who underwent TOT with three different types of slings (Aris^®, Obtape^®, TVT-O^®). Follow-up information was available for 225 (96.6%) women.</p> <p>Results</p> <p>There were few per operative complications. Forty-eight women (21.3%) reported late complications including <it>de novo </it>or worsening of preexisting urgencies (10.2%), perineal pain (2.2%), <it>de novo </it>dyspareunia (9%), and vaginal erosion (7.6%). The risk of erosion significantly differed between the three types of slings and was 4%, 17% and 0% for Aris^®, Obtape^®and TVT-O^®respectively (P = 0.001). The overall proportion of women satisfied by the procedure was 72.1%. The percentage of women satisfied was significantly lower in women who experienced erosion (29.4%) compared to women who did not (78.4%) (RR 0.14, 95% CI 0.05-0.38, P < 0.001).</p> <p>Conclusion</p> <p>Late post operative complications are relatively frequent after TOT and can impair patient's satisfaction. Women should be informed of these potential complications preoperatively and require careful follow-up after the procedure. Choice of the safest sling material is crucial as it is a risk factor for erosion.</p

Sport-therapy effects on cardiorespiratory functionality in patients with spinal cord injury

Aim: People with spinal cord injury (SCI) have limited maximum oxygen uptake (VO2max) because of a change in respiratory pattern, reduction in pulmonary compliance and heart rate (HR) adaptation to exercise. Sport activity is known to provide beneficial effects on stabilized SCI however, the effects of sport-therapy on patient with recent lesion is still not documented. Therefore, aim of this study was to evaluate the acute and long-term cardiorespiratory adaptation to a physical training program in people with recent SCI. Methods: 28 patients (age: 34.3\ub111.9 yrs.; body mass: 69.1\ub111.9 kg; stature: 175\ub19 cm; mean\ub1standard deviation, SD) with a recent spinal cord lesion (T6, LOW). Participants underwent a 3 months of sport-therapy (resistance activity on adapted ergometers + aerobic sport activity, 3-4 sessions/wk). Maximal load (Wpeak), VO2max, VE, HR and VO2vsHR relationship were assessed at admission in the rehabilitation center (PRE), after 3 months of sport-therapy (POST) and 6 months after the end of the therapy (F_UP). Results: Training significantly increased Wpeak in both groups (+58% e +26%, respectively. P<0.05 vs PRE). VO2, VE and HR vs load relationships improved more efficiently in LOW group. 6 months after the discharge, improvements induced by training were maintained in LOW and lost in HIGH group. Conclusion: Sport activity is strongly suggested in the early phases of SCI therapy to improve cardiorespiratory functionality. After the discharge a constant monitoring of people with SCI, especially when lesion level is higher than T6, is recommended to motivate practice over time. References: Hopman M.T. et al. The effects of training on cardiovascular responses to arm exercise in individuals with tetraplegia. Eur J Appl Physiol 74: 172-179, 1996 Hoffman, M.D. Cardiorespiratory fitness and training in quadriplegics and paraplegics. Sports Med. 3, 312-330 (1986)

Sport-therapy effects on cardiorespiratory functionality in patients with spinal cord injury

Aim: People with spinal cord injury (SCI) have limited maximum oxygen uptake (VO2max) because of a change in respiratory pattern, reduction in pulmonary compliance and heart rate (HR) adaptation to exercise. Sport activity is known to provide beneficial effects on stabilized SCI however, the effects of sport-therapy on patient with recent lesion is still not documented. Therefore, aim of this study was to evaluate the acute and long-term cardiorespiratory adaptation to a physical training program in people with recent SCI. Methods: 28 patients (age: 34.3\ub111.9 yrs.; body mass: 69.1\ub111.9 kg; stature: 175\ub19 cm; mean\ub1standard deviation, SD) with a recent spinal cord lesion (T6, LOW). Participants underwent a 3 months of sport-therapy (resistance activity on adapted ergometers + aerobic sport activity, 3-4 sessions/wk). Maximal load (Wpeak), VO2max, VE, HR and VO2vsHR relationship were assessed at admission in the rehabilitation center (PRE), after 3 months of sport-therapy (POST) and 6 months after the end of the therapy (F_UP). Results: Training significantly increased Wpeak in both groups (+58% e +26%, respectively. P<0.05 vs PRE). VO2, VE and HR vs load relationships improved more efficiently in LOW group. 6 months after the discharge, improvements induced by training were maintained in LOW and lost in HIGH group. Conclusion: Sport activity is strongly suggested in the early phases of SCI therapy to improve cardiorespiratory functionality. After the discharge a constant monitoring of people with SCI, especially when lesion level is higher than T6, is recommended to motivate practice over time. References: Hopman M.T. et al. The effects of training on cardiovascular responses to arm exercise in individuals with tetraplegia. Eur J Appl Physiol 74: 172-179, 1996 Hoffman, M.D. Cardiorespiratory fitness and training in quadriplegics and paraplegics. Sports Med. 3, 312-330 (1986)

Mechanical Arm for Soft Exoskeleton Testing

Soft robotic exoskeletons offer multiple advantages in the field of motor rehabilitation and assistance with activities of daily living This paper reports the design process of a mechanical arm for upper-limb soft exoskeleton testing. The main requirement of the test bench was to simulate five degrees of freedom (DOF) of the human arm, and in particular i) shoulder flexion/extension, ii) shoulder adduction/abduction, iii) shoulder medial rotation/lateral rotation, iv) elbow flexion/extension and v) forearm supination/pronation. An additional requirement included the possibility to alternatively lock each DOF. The final concept was designed using Autodesk Inventor and it is composed of 32 parts, 18 of which were particularly designed for this application. Topological optimisation and Finite Element Method (FEM) analysis were performed to some custom components to obtain the final design. The final concept was manufactured by means of additive manufacturing of PLA (polylactic acid) and laser cutting of PMMA (poly methyl methacrylate) sheets. After testing and validation, the prototype was able to meet the desired requirements and it can be used for soft-exoskeleton testing