Towards a Soft Robotic Skin for Autonomous Tissue Palpation

Manual palpation is commonly used to localize tumors and other features buried deep inside organs during open surgery. This approach is not feasible in minimally invasive or robotic surgery, as the contact with the tissue is mediated by instruments. To address this problem, we propose a soft robotic skin (SRS) that can be deployed from a small incision and create a stiffness map in a single step. Such a skin is composed of a matrix of soft robotic tactile elements (SRTEs), each one able to expand and record the tissue response during expansion. In this paper, we firstly prove the feasibility of palpation using a single SRTE. Then, we present and test a soft-suction based anchoring mechanism able to keep the SRS in the desired position in contact with the tissue, allowing surgeons to palpate different sides of the organ. Finally, we detail a calibration method for the SRTE, and assess the feasibility of identifying lumps buried inside a soft tissue phantom, and then inside a chicken liver during an ex-vivo trial. Experimental results show that the SRTE was able to differentiate simulated lumps (up to 3.25 mm deep) from healthy tissue in both the phantom and the ex-vivo trials. These results, added to the ability of the suction gripper to compensate for the expansion forces of each SRTE, are paving the way for soft robotic autonomous tools that can be used for intraoperative mapping of tissue cancers

CONTRIBUTION OF EMPIRICAL METHODS AND SATELLITE DATA USE FOR ESTIMATING DAILY REFERENCE EVAPOTRANSPIRATION

Στην παρούσα εργασία χρησιμοποιούνται επίγεια και δορυφορικά μετεωρολογικά δεδομένα του έτους 2014 από την περιοχή της Βοιωτίας. Τα επίγεια δεδομένα προέρχονται από τον αυτόματο αγρομετεωρολογικό σταθμό (ΑΑΣ) μέτρησης της εξατμισοδιαπνοής αναφοράς (ΕΤο) του Γεωπονικού Πανεπιστημίου Αθηνών (ΓΠΑ). Τα μετεωρολογικά δορυφορικά δεδομένα (SAT) αντιστοιχούν σε πολύγωνο 0.25οΧ0.25ο εντός του οποίου λειτουργεί και ο ΑΑΣ. Χρησιμοποιώντας τα επίγεια αλλά και τα δορυφορικά δεδομένα, υπολογίσθηκε η ΕΤο με τη μέθοδο FAO-56 PM, αλλά και με τρεις εμπειρικές μεθόδους (Copais, Valiantzas και Hargreaves-Samani) και πραγματοποιήθηκαν συγκρίσεις με σκοπό να αξιολογηθεί η αξιοπιστία των μοντέλων. Ως βάση των συγκρίσεων υιοθετήθηκε η μέθοδος FAO-56 PM με χρήση επίγειων δεδομένων. Από την εργασία προκύπτει ότι τόσο για τα επίγεια όσο και για τα δορυφορικά δεδομένα η μέθοδος Copais δίνει τις καλύτερες εκτιμήσεις ακολουθούμενη από την μέθοδο Valiantzas και με σοβαρή υπερεκτίμηση η Hargreaves-Samani. In the present study we used ground and satellite meteorological data of the year 2014 from the region of Viotia-Greece. The ground data were obtained from the automatic grass reference evapotranspiration station (AAS) of the Agricultural University of Athens. The satellite data (SAT) cover an area of 0,25ο x 0,25ο that includes the AAS. By using the ground and the satellite data we calculated the reference evapotranspiration, ΕΤο, with the method FAO-56 PM and with three empirical methods (Copais, Valiantzas and Hargreaves-Samani). The FAO-56 PM was used as a benchmark method to compare and validate the performances of the others methods. The results show that for both the ground and the satellite data, Copais method is the most accurate followed by Valiantzas and Hargreaves-Samani, indicated by serious overestimation

Comparative effectiveness and safety of non-vitamin K antagonists for atrial fibrillation in clinical practice: GLORIA-AF Registry

Background and purpose: Prospectively collected data comparing the safety and effectiveness of individual non-vitamin K antagonists (NOACs) are lacking. Our objective was to directly compare the effectiveness and safety of NOACs in patients with newly diagnosed atrial fibrillation (AF). Methods: In GLORIA-AF, a large, prospective, global registry program, consecutive patients with newly diagnosed AF were followed for 3 years. The comparative analyses for (1) dabigatran vs rivaroxaban or apixaban and (2) rivaroxaban vs apixaban were performed on propensity score (PS)-matched patient sets. Proportional hazards regression was used to estimate hazard ratios (HRs) for outcomes of interest. Results: The GLORIA-AF Phase III registry enrolled 21,300 patients between January 2014 and December 2016. Of these, 3839 were prescribed dabigatran, 4015 rivaroxaban and 4505 apixaban, with median ages of 71.0, 71.0, and 73.0 years, respectively. In the PS-matched set, the adjusted HRs and 95% confidence intervals (CIs) for dabigatran vs rivaroxaban were, for stroke: 1.27 (0.79–2.03), major bleeding 0.59 (0.40–0.88), myocardial infarction 0.68 (0.40–1.16), and all-cause death 0.86 (0.67–1.10). For the comparison of dabigatran vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 1.16 (0.76–1.78), myocardial infarction 0.84 (0.48–1.46), major bleeding 0.98 (0.63–1.52) and all-cause death 1.01 (0.79–1.29). For the comparison of rivaroxaban vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 0.78 (0.52–1.19), myocardial infarction 0.96 (0.63–1.45), major bleeding 1.54 (1.14–2.08), and all-cause death 0.97 (0.80–1.19). Conclusions: Patients treated with dabigatran had a 41% lower risk of major bleeding compared with rivaroxaban, but similar risks of stroke, MI, and death. Relative to apixaban, patients treated with dabigatran had similar risks of stroke, major bleeding, MI, and death. Rivaroxaban relative to apixaban had increased risk for major bleeding, but similar risks for stroke, MI, and death. Registration: URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01468701, NCT01671007. Date of registration: September 2013

Anticoagulant selection in relation to the SAMe-TT2R2 score in patients with atrial fibrillation. the GLORIA-AF registry

Aim: The SAMe-TT2R2 score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA) and those with scores >2 might be better managed with a target-specific oral anticoagulant (NOAC). We hypothesized that in clinical practice, VKAs may be prescribed less frequently to patients with AF and SAMe-TT2R2 scores >2 than to patients with lower scores. Methods and results: We analyzed the Phase III dataset of the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF), a large, global, prospective global registry of patients with newly diagnosed AF and ≥1 stroke risk factor. We compared baseline clinical characteristics and antithrombotic prescriptions to determine the probability of the VKA prescription among anticoagulated patients with the baseline SAMe-TT2R2 score >2 and ≤ 2. Among 17,465 anticoagulated patients with AF, 4,828 (27.6%) patients were prescribed VKA and 12,637 (72.4%) patients an NOAC: 11,884 (68.0%) patients had SAMe-TT2R2 scores 0-2 and 5,581 (32.0%) patients had scores >2. The proportion of patients prescribed VKA was 28.0% among patients with SAMe-TT2R2 scores >2 and 27.5% in those with scores ≤2. Conclusions: The lack of a clear association between the SAMe-TT2R2 score and anticoagulant selection may be attributed to the relative efficacy and safety profiles between NOACs and VKAs as well as to the absence of trial evidence that an SAMe-TT2R2-guided strategy for the selection of the type of anticoagulation in NVAF patients has an impact on clinical outcomes of efficacy and safety. The latter hypothesis is currently being tested in a randomized controlled trial. Clinical trial registration: URL: https://www.clinicaltrials.gov//Unique identifier: NCT01937377, NCT01468701, and NCT01671007

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Fouling Issues in Membrane Bioreactors (MBRs) for Wastewater Treatment: Major Mechanisms, Prevention and Control Strategies

Membrane fouling is one of the most important considerations in the design and operation of membrane systems as it affects pretreatment needs, cleaning requirements, operating conditions, cost and performance. Given that membrane fouling represents the main limitation to membrane process operation, it is unsurprising that the majority of membrane material and process research and development conducted is dedicated to its characterization and amelioration. This work presents the fundamentals of fouling issues in membrane separations, with specific regard to membrane fouling in Membrane Bioreactors (MBRs) and the most frequently applied preventive-control strategies. Feed pretreatment, physical and chemical cleaning protocols, optimal operation of MBR process and membrane surface modification are presented and discussed in detail. Membrane fouling is the major obstacle to the widespread application of the MBR technology and, therefore, fouling preventive-control strategies is a hot issue that strongly concerns not only the scientific community, but industry as well

Immunotherapy for hepatocellular carcinoma: A 2021 update

Hepatocellular carcinoma (HCC) is one of one of the most frequent liver cancers and the fourth leading cause of cancer-related mortality worldwide. Current treatment options such as surgery, neoadjuvant chemoradiotherapy, liver transplantation, and radiofrequency ablation will benefit only a very small percentage of patients. Immunotherapy is a novel treatment approach representing an effective and promising option against several types of cancer. The aim of our study is to present the currently ongoing clinical trials and to evaluate the efficacy of immunotherapy in HCC. In this paper, we demonstrate that combination of different immunotherapies or immunotherapy with other modalities results in better overall survival (OS) and progression-free survival (PFS) compared to single immunotherapy agent. Another objective of this paper is to demonstrate and highlight the importance of tumor microenvironment as a predictive and prognostic marker and its clinical implications in immunotherapy response. © 2020 by the authors. Licensee MDPI, Basel, Switzerland

Immunotherapy for pancreatic cancer: A 2020 update

Pancreatic adenocarcinoma (PAC) is associated with extremely poor prognosis and remains a lethal malignancy. The main cure for PAC is surgical resection. Further treatment modalities, such as surgery, chemotherapy, radiotherapy and other locoregional therapies provide low survival rates. Currently, many clinical trials seek to assess the efficacy of immunotherapeutic strategies in PAC, including immune checkpoint inhibitors, cancer vaccines, adoptive cell transfer, combinations with other immunotherapeutic agents, chemoradiotherapy or other molecularly targeted agents; however, none of these studies have shown practice changing results. There seems to be a synergistic effect with increased response rates when a combinatorial approach of immunotherapy in conjunction with other modalities is being exploited. In this review, we illustrate the current role of immunotherapy in PAC. © 2020 Elsevier Lt

BlogForever D4.8: Final BlogForever Platform

This report presents the integration of the two components, the nal weblog Spider and the final webblog digital Repository, fully functional and communicating optimally with each other, resulting in the Final BlogForever Platform. The implementation activities carried out during the last period as well as a detailed documentation of both components are provided