Wearable robotic exoskeleton for overground gait training in sub-acute and chronic hemiparetic stroke patients: preliminary results

BACKGROUND: Recovery of therapeutic or functional ambulatory capacity in post-stroke patients is a primary goal of rehabilitation. Wearable powered exoskeletons allow patients with gait dysfunctions to perform over-ground gait training, even immediately after the acute event.AIM: To investigate the feasibility and the clinical effects of an over-ground walking training with a wearable powered exoskeleton in sub-acute and chronic stroke patients.DESIGN: Prospective, pilot pre-post, open label, non-randomized experimental study.SETTING: A single neurological rehabilitation center for inpatients and outpatients.POPULATION: Twenty-three post-stroke patients were enrolled: 12 sub-acute (mean age: 43.8\ub113.3 years, 5 male and 7 female, 7 right hemiparesis and 5 left hemiparesis) and 11 chronic (mean age: 55.5\ub115.9 years, 7 male and 4 female, 4 right hemiparesis and 7 left hemiparesis) patients.METHODS: Patients underwent 12 sessions (60 min/session, 3 times/week) of walking rehabilitation training using Ekso\u2122, a wearable bionic suit that enables individuals with lower extremity disabilities and minimal forearm strength to stand up, sit down and walk over a flat hard surface with a full weight-bearing reciprocal gait. Clinical evaluations were performed at the beginning of the training period (t0), after 6 sessions (t1) and after 12 sessions (t2) and were based on the Ashworth scale, Motricity Index, Trunk Control Test, Functional Ambulation Scale, 10-Meter Walking Test, 6-Minute Walking Test, and Walking Handicap Scale. Wilcoxon's test (P<0.05) was used to detect significant changes.RESULTS: Statistically significant improvements were observed at the three assessment periods for both groups in Motricity Index, Functional Ambulation Scale, 10-meter walking test, and 6-minute walking test. Sub-acute patients achieved statistically significant improvement in Trunk Control Test and Walking Handicap Scale at t0-t2. Sub-acute and chronic patient did not achieve significant improvement in Ashworth scale at t0-t2.CONCLUSIONS: Twelve sessions of over-ground gait training using a powered wearable robotic exoskeleton improved ambulatory functions in sub-acute and chronic post-stroke patients. Large, randomized multicenter studies are needed to confirm these preliminary data.CLINICAL REHABILITATION IMPACT: To plan a completely new individual tailored robotic rehabilitation strategy after stroke, including task-oriented over-ground gait training

Comparison of corneal morphologic parameters and high order aberrations in keratoconus and normal eyes

The aim of this study is evaluating the influence of corneal geometry in the optical system’s aberrations, and its usefulness as diagnostic criterion for keratoconus.159 normal eyes (normal group, mean age 37.8 ± 11.6 years) and 292 eyes with the diagnosis of keratoconus (keratoconus group, mean age 42.2 ± 17.6 years) were included in this study. All eyes received a comprehensive ophthalmologic examination. A virtual 3D model of each eye was made using CAD software and different anatomical parameters related with surface and volume were measured. Statistically significant differences were found for all anatomical parameters (all p < 0.001). AUROC analysis showed that all parameters reached values above 0.7, with the exception of the total corneal surface area (TCSAA-S). In conclusion, the methodology explained in this research, that bases in anatomical parameters obtained from a virtual corneal model, allow to analyze the diagnostic value of corneal geometry correlation with optical aberrations in keratoconus pathology.This publication has been carried out in the framework of the Thematic Network for Co-Operative Research in Health (RETICS), reference number RD16/0008/0012, financed by the Carlos III Health Institute–General Subdirection of Networks and Cooperative Investigation Centers (R&D&I National Plan 2013–2016) and the European Regional Development Fund (FEDER)

La territorializzazione del farmaco in epoca di PNRR: prospettive, opportunità e spunti di riflessione da un panel di esperti

This document illustrates the results of the work of two interdisciplinary and multistakeholder panels (resear-chers, public institutions, and industry representatives) on drug territorialization and digitalization, organized as part of a residential seminar held on 30 September and 1st October 2021. Arising from some considerations about the demand for health and the provisions of the National Recovery and Resilience Plan (PNRR), the discussion touched various aspects of managing the transition from current to future management models. The importance of identifying criteria for prioritizing interventions in the area emerged: different methods of drug delivery, scientific information and measurement, re-evaluation of pathologies that can be managed in this area. Finally, the role of digitization within this change was explored. The opinions provided by the experts move towards making the most of the opportunities arising from PNRR, in terms of investments in healthcare and data application, with a view to improve health system efficiency, patient care and related outcomes

Presbyopia:Effectiveness of correction strategies

Presbyopia is a global problem affecting over a billion people worldwide. The prevalence of unmanaged presbyopia is as high as 50% of those over 50 years of age in developing world populations due to a lack of awareness and accessibility to affordable treatment, and is even as high as 34% in developed countries. Definitions of presbyopia are inconsistent and varied, so we propose a redefinition that states “presbyopia occurs when the physiologically normal age-related reduction in the eye's focusing range reaches a point, when optimally corrected for distance vision, that the clarity of vision at near is insufficient to satisfy an individual's requirements”. Presbyopia is inevitable if one lives long enough, but intrinsic and extrinsic risk factors including cigarette smoking, pregnancy history, hyperopic or astigmatic refractive error, ultraviolet radiation, female sex (although accommodation is similar to males), hotter climates and some medical conditions such as diabetes can accelerate the onset of presbyopic symptoms. Whilst clinicians can ameliorate the symptoms of presbyopia with near vision spectacle correction, bifocal and progressive spectacle lenses, monovision, translating or multifocal contact lenses, monovision, extended depth of focus, multifocal (refractive, diffractive and asymmetric designs) or ‘accommodating’ intraocular lenses, corneal inlays, scleral expansion, laser refractive surgery (corneal monovision, corneal shrinkage, corneal multifocal profiles and lenticular softening), pharmacologic agents, and electro-stimulation of the ciliary muscle, none fully overcome presbyopia in all patients. While the restoration of natural accommodation or an equivalent remains elusive, guidance is gives on presbyopic correction evaluation techniques

An analytical method for predicting the geometrical and optical properties of the human lens under accommodation

We present an analytical method to describe the accommodative changes in the human crystalline lens. The method is based on the geometry-invariant lens model, in which the gradient-index (GRIN) iso-indicial contours are coupled to the external shape. This feature ensures that any given number of iso-indicial contours does not change with accommodation, which preserves the optical integrity of the GRIN structure. The coupling also enables us to define the GRIN structure if the radii and asphericities of the external lens surfaces are known. As an example, the accommodative changes in lenticular radii and central thickness were taken from the literature, while the asphericities of the external surfaces were derived analytically by adhering to the basic physical conditions of constant lens volume and its axial position. The resulting changes in lens geometry are consistent with experimental data, and the optical properties are in line with expected values for optical power and spherical aberration. The aim of the paper is to provide an anatomically and optically accurate lens model that is valid for 3 mm pupils and can be used as a new tool for better understanding of accommodation

A virtual environment for modeling and analysis of human eye

The aim of this work is to develop a virtual environment for modelling and analyse individual virtual eyes which are able to integrate the modern imaging techniques input data. This environment is realized in 3D CAD software by means of specific plug-ins. The tools for analysing the virtual eye are based on ray-tracing and curvature analysis, while the shape of the eye is represented by NURBS or mesh surfaces. This thesis develops, and validates the use of, the plug-ins for the modelization of virtual eyes inside a 3D CAD environment; in particular a novel lens model whose shape is linked to geometrical and optical constraints was created. Shape was also tested on real crystalline images obtained with shadow photogrammetry. Moreover real eye topography was used for modelization of anterior cornea and preliminary results from ray tracing are shown. This model and the ray-tracing tools may be used in future works for design of ophthalmic, contact or intraocular lenses, specifically customised of a single ametropy.Lo scopo di questo lavoro è stato quello di sviluappare un ambiente virtuale per la modellazione e l’analisi di un occhio virtuale personalizzato, che fosse in grado di integrare le moderne tecniche di analisi ottica come dati di ingresso. Questo ambiente è stato sviluppato all’interno di un software CAD tramite l’ultilizzo di plug-in specifici. Gli strumenti utilizzati per analizzare l’occhio virtuale sono basati sul ray-tracing e sull’analisi di curvatura, mentre la geometria dell’occhio è stata modellizzata tramite l’utilizzo di superfici NURBS o mesh. La presente tesi sviluppa, e valida l’utilizzo, di codesti plug-in per la modellizzazione di un occhio virtuale in un ambiente CAD 3D; in particolare è stato creato un modello innovativo di lente, la cui forma è legata a vincoli geometrici ed ottici. La forma di tale lente è stata confrontata con cristallini reali le cui immagini sono state ottenute tramite fotografia ad ombra. Inoltre la topografia di un occho reale è state utilizzata per modellare la superficie anteriore della cornea e sono quindi riportati i risultati preliminari del ray-tracing. Questo modello e gli strumenti di ray-tracing utilizzati potranno essere utilizzati in futuro per la progettazione di lenti oftalmiche, a contatto o intraoculari specificatamente costumizzate sulle esigenze dell’ametrope

Perfume, Violence, and Symbolic Sacrifice

This article firstly analyzes a practical exercise of re-staging iconic violent images through actors and discusses the bodily reactions to being exposed to violent images. The article then presents a theoretical framework to understand the notion of the body as symbolic sacrifice. The text brings together these two notions (effects of violent images and symbolic sacrifice) and discusses the violence inherent in advertising images. Lastly, it claim that the clothing and perfume advertising industry, through the display of violence, attempts to commodify the sacrificed body

Multifractal analysis of human peripapillary atrophy

Multifractal characteristics of the retinal vascular networks in healthy patients and patients with peripapillary atrophy (PPA) are compared in the paper. Segmented and skeletonized fundus images from the DRIVE database were analyzed over the image region corresponding to the macular area and over the whole image. The regional and overall multifractal characteristics of fundi could serve as further clues in detecting human PPA and for quantifying the pathological stages of PPA cases