Valutazione della stabilità motoria in soggetti post-stroke tramite misure inerziali

I test clinici e i questionari generalmente non sono in grado di fornire una valutazione predittiva e quantitativa della stabilità motoria. Permettono al clinico di esaminare la forza muscolare del paziente, il grado di spasticità, la funzionalità motoria e l'autonomia nello svolgimento delle normali attività, ma non di capire quanto il soggetto sia stabile. Sono stati esaminati diciotto pazienti con esiti di stroke in fase post acuta ed il 38% ha affermato di essere caduto almeno una volta nell'arco degli ultimi dodici mesi. Adottando una politica di prevenzione delle cadute si potrebbero limitare questi eventi che vanno ad aggravare un quadro clinico già compromesso. Per tale motivo sono attualmente oggetto di studio misure biomeccaniche, eseguite in laboratorio, atte a definire metodi con alta sensibilità e specificità per la valutazione della stabilità del cammino. Nel presente lavoro le misure strumentali sono state ottenute partendo dal segnale di accelerazione del centro di massa corporeo. Servendosi di un'unità inerziale munita di accelerometro triassiale è stato possibile, durante il cammino, ricavare l'andamento delle accelerazioni antero-posteriore, medio-laterale e verticale. Grazie ad un algoritmo, messo a punto nel Laboratorio di Bioingegneria della Facoltà di Cesena dall'Ing. Federico Riva, sono stati estrapolati gli indici strumentali. Il corpo centrale di questa tesi consiste nell'analisi statistica condotta tramite modelli di regressione lineare che mettono in correlazione parametri clinici (acquisiti per mezzo di test e questionari) abitualmente usati in ospedale e indici strumentali

Studio e sviluppo di un metodo per il monitoraggio della posizione dell'esofago durante l'ablazione transcatetere

Lo scopo del presente lavoro di tesi è l’implementazione di un metodo per la detezione automatica dei contorni dell’esofago in immagini ecografiche intracardiache acquisite durante procedure di ablazione transcatetere per il trattamento della fibrillazione atriale. Il progetto si è svolto in collaborazione con il laboratorio di elettrofisiologia, Unità Operativa di Cardiologia, Dipartimento Cardiovascolare, dell’ospedale ‘’ S. Maria delle Croci ’’ di Ravenna, Azienda Unità Sanitaria Locale della Romagna e si inserisce in un progetto di ricerca più ampio in cui sono stati sviluppati due differenti metodi per il tracciamento automatico della parete posteriore dell’atrio sinistro. L’obiettivo è consentire al clinico il monitoraggio della posizione dell’esofago rispetto all’atrio sinistro per ridurre il rischio di lesioni della parete esofagea. L’idea di base dell’algoritmo è di lavorare sull’immagine per linee di scansione orizzontali, valutando la distribuzione dei livelli di intensità di grigio. Una volta individuati i punti appartenenti alle pareti anteriore e posteriore dell’esofago, sono stati utilizzati dei polinomi rispettivamente del quarto e secondo ordine per interpolare i dati. Per assicurarsi che la detezione sia corretta è stato introdotto un check aggiuntivo che consente la correzione del risultato qualora il clinico non sia soddisfatto, basandosi su input manuale di due punti richiesto all’operatore. L’algoritmo è stato testato su 15 immagini, una per ogni paziente, e i contorni ottenuti sono stati confrontati con i tracciamenti manuali effettuati da un cardiologo per valutare la bontà del metodo. Le metriche di performance e l’analisi statistica attestano l’accuratezza del metodo. Infine sono state calcolate delle misure di interesse clinico, quali la distanza tra parete posteriore dell’atrio sinistro e parete anteriore dell’esofago e la larghezza media di quest’ultimo che risulta comparabile con quanto riportato in letteratura

Automatic Dynamic Quantification of Oesophagus Position from Intra:cardiac Echocardiography During Atrial Fibrillation Ablation

Left atrium posterior wall (LAPW) is an essential target for transcatheter radiofrequency ablation (RFA) of atrial fibrillation (AF), but poses problems due to retro-atrial structures potentially damaged by RF. Intracardiac echocardiography (ICE) can be integrated with the 3D electro-anatomical map and can give unique real-time anatomical information about all closely-located peri-cardiac structures. The present study aimed to automatically detect dynamic oesophagus position and its spatial relationship from the LAPW by ICE during RFA. A fast algorithm based on the evaluation of gray-level intensity distribution in the image and was developed to detect distal and proximal oesophagus boundaries. The algorithm was tested in 15 ICE acquisitions. The detected oesophagus boundaries and those manually traced (MT) were compared and in 5 ICE sequences, dynamic tracking of proximal oesophagus boundary was performed. Mean analysis time was 4.5 sec/frame. Detected oesophagus wall positions were in good agreement with MT. Mean minimum dynamic distance between LAPW and oesophagus proximal wall during acquisition was 0.3\ub10.2mm (range: 0.0-0.6mm). This technique allows automated and accurate dynamic detection of LAPW and oesophagus position in ICE sequences. It represents a first step for dynamic quantification of oesophagus real-time position\u2019 changes and its distance from the LAPW to prevent oesophagus injuries

Facial approximation: Soft tissue thickness values for Caucasian males using cone beam computer tomography

The aim of this study was to obtain soft tissue thickness (STTs) of Caucasian males starting from 12 bone landmarks, to allow facial reconstruction and assign an identity to skeletal remains. When a skeleton is found without any circumstantial evidence of identity, through anthropological investigations it is possible to estimate age, sex, and race studying specific characteristics of bones. This first step of identification process helps investigators to narrow down the identity suppositions, but not always forensic analysis guarantees a final positive identification. Moreover, it is possible to rely on facial reconstruction trying to reproduce the likely features of the face from the skull. The obtained images could be used as a support in recognition by relatives who could provide photos and other data to carry out a comparative analysis. Furthermore, identity can be confirmed by conventional identification methods such as DNA profiling, odontological identification, and radiological comparison.Forensic facial reconstruction (FFR) is based on the bone surface that conditions the facial physiognomy. Analyzing cone beam CT (CBCT) scans of 30 Caucasian males, average STTs values were obtained. CBCT, compared with the conventional spiral CT, has much lower radiation doses, lower costs, high spatial resolution and focuses on head and neck. The obtained results were compared with existing literature and databases and were analyzed by descriptive statistics. Two researchers repeated measurements in different times to assess the reliability of the method

DNA extraction from sternum bone for identification of a saponified body: use of a modified protocol

This paper discusses our approach and results obtained when attempting to identify a saponified human body recovered from the sea, without arms and legs. Bones, especially the long ones, are the only sources of DNA available in several cases involving unidentified bodies in advanced state of putrefaction. In this case, since the body was found without limbs, attempts were made to extract DNA from the sternum bone. The DNA was extracted using a modified version of the NucleoSpin® DNA Trace Kit (Macherey Nagel™) protocol and an STR analysis was performed. Thanks to this modified protocol a complete DNA profile was obtained from the sternum bone, while only partial results were obtained from blood and teeth. The DNA profile obtained from the sternum was compared with the DNA of the putative son searching for a genetic match. Five incompatibilities were detected so it was possible to exclude the kinship. In conclusion this could be a useful technique in personal identification through DNA analysis in case of poor quality and quantity of bone.This paper discusses our approach and results obtained when attempting to identify a saponified human body recovered from the sea, without arms and legs. Bones, especially the long ones, are the only sources of DNA available in several cases involving unidentified bodies in advanced state of putrefaction. In this case, since the body was found without limbs, attempts were made to extract DNA from the sternum bone. The DNA was extracted using a modified version of the NucleoSpin® DNA Trace Kit (Macherey Nagel™) protocol and an STR analysis was performed. Thanks to this modified protocol a complete DNA profile was obtained from the sternum bone, while only partial results were obtained from blood and teeth. The DNA profile obtained from the sternum was compared with the DNA of the putative son searching for a genetic match. Five incompatibilities were detected so it was possible to exclude the kinship. In conclusion this could be a useful technique in personal identification through DNA analysis in case of poor quality and quantity of bone

Development and Validation of a System for the Assessment and Recovery of Grip Force Control

The ability to finely control hand grip forces can be compromised by neuromuscular or musculoskeletal disorders. Therefore, it is recommended to include the training and assessment of grip force control in rehabilitation therapy. The benefits of robot-mediated therapy have been widely reported in the literature, and its combination with virtual reality and biofeedback can improve rehabilitation outcomes. However, the existing systems for hand rehabilitation do not allow both monitoring/training forces exerted by single fingers and providing biofeedback. This paper describes the development of a system for the assessment and recovery of grip force control. An exoskeleton for hand rehabilitation was instrumented to sense grip forces at the fingertips, and two operation modalities are proposed: (i) an active-assisted training to assist the user in reaching target force values and (ii) virtual reality games, in the form of tracking tasks, to train and assess the user’s grip force control. For the active-assisted modality, the control of the exoskeleton motors allowed generating additional grip force at the fingertips, confirming the feasibility of this modality. The developed virtual reality games were positively accepted by the volunteers and allowed evaluating the performance of healthy and pathological users

Retroperitoneal schwannoma during pregnancy: A case report and practice-based overview

The retroperitoneum is the rarest site for Schwannomas, tumors that originate from Schwann cells and usually present as benign, slowly growing masses. During pregnancy, the routine application of ultrasound for fetal assessment has led to an increased rate of detection of maternal asymptomatic masses, notably including the retroperitoneal ones. While most of these masses prove to be benign, it is imperative to consider the potential for malignancy. This report presents a rare case involving a woman diagnosed with bilateral adnexal cysts and a pre-sacral retroperitoneal mass during the first trimester of pregnancy. Surgical intervention was employed to remove ovarian tumors, and a biopsy was performed on the non-adnexal tumor to determine its nature. The histological examination revealed a bilateral borderline seromucinous tumor in the ovaries and identified a Schwannoma in the sacral mass. Despite the considerable size of the pre-sacral mass, which significantly impacted the patient's quality of life, successful measures were taken to achieve a near-term pregnancy, culminating in the delivery of a healthy baby. Subsequently the patient underwent neurosurgical treatment of the substantial pre-sacral Schwannoma. The discovery of a Schwannoma during pregnancy can evoke concerns among healthcare practitioners, touching upon potential malignancy risks, accelerated tumor growth, and impacts on fetal well-being. This paper provides a comprehensive, practice-based overview of these critical aspects

Restoring Activities of Daily Living Using an EEG/EOG-Controlled Semiautonomous and Mobile Whole-Arm Exoskeleton in Chronic Stroke

Stroke survivors with chronic paralysis often have difficulties to perform various activities of daily living (ADLs), such as preparing a meal or eating and drinking independently. Recently, it was shown that a brain/neural hand exoskeleton can restore hand and finger function, but many stroke survivors suffer from motor deficits affecting their whole upper limb. Therefore, novel hybrid electroencephalography/electrooculography (EEG/EOG)-based brain/neural control paradigms were developed for guiding a whole-arm exoskeleton. It was unclear, however, whether hemiplegic stroke survivors are able to reliably use such brain/neural-controlled device. Here, we tested feasibility, safety, and user-friendliness of EEG/EOG-based brain/neural robotic control across five hemiplegic stroke survivors engaging in a drinking task that consisted of several subtasks (e.g., reaching, grasping, manipulating, and drinking). Reliability was assumed when at least 75% of subtasks were initialized within 3 s. Fluent control was assumed if average “time to initialize” each subtask ranged below 3 s. System's safety and user-friendliness were rated using Likert-scales. All chronic stroke patients were able to operate the system reliably and fluently. No undesired side effects were reported. Four participants rated the system as very user-friendly. These results show that chronic stroke survivors are capable of using an EEG/EOG-controlled semiautonomous whole-arm exoskeleton restoring ADLs