A modified passive-dynamic ankle-foot orthosis:can it prevent amputation and arthrodesis in patients with ankle-foot trauma?

Introduction High-energy lower extremity trauma (HELET) may cause severe damage within the foot-ankle complex. Occasionally, arthrodesis or amputation are the only remaining options to increase activity levels. The modified passive dynamic ankle-foot orthosis (PDAFO) may prove to be a nonsurgical alternative. This study evaluated the effect of a modified PDAFO with a 6-week training program on pain and performance in patients after HELET. Materials and methods A retrospective cohort study was conducted on seventeen patients who considered an arthrodesis or an amputation after HELET. In an attempt to avoid surgery, the modified PDAFO with a 6-week training program was provided. Pain scores was measured with the Numeric Rating Scale and administered at the start of testing, immediately after the two performance tests and at the end of the day of testing. Performance was evaluated with the 6-min walk test (6MWT) and the Comprehensive high-level activity mobility predictor (CHAMP). Results A significant pain reduction was achieved after the treatment procedure. At the start of the test days (p = 0.002), after the 6MWT (p = 0.001), after the CHAMP (p < 0.001) and at the end of the day (p < 0.001). In addition, a significant improvement on performance was observed in the 6MWT (p < 0.001) and the CHAMP (p = 0.01). None of the patients considered a surgical intervention anymore. Conclusions Patients after HELET show a decrease in pain and an improvement in performance after a 6-week training program with modified PD-AFO. The results suggest that the modified PDAFO is an effective alternative for a surgical approach

A proposed bare tether experiment on board a sounding rocket

A sounding rocket experiment is proposed to carry out two experiments by the conductive bare-tether; 1) the test of the OML (Orbital-Motion-Limited) theory to collect electron, and II) the test of techniques to determine (neutral) density profile in critical E-layer. The main driver of the mission is provide a space tether technology experiment in low-Earth-Orbit (LEO) deploying a long tape tether in space and verify the performance of the bare electrodynamic tape tether. The sounding rocket experiment will show no danger to other satellites as the tether missions YES1, SEDSAT, and ProCEDS, which is cancelled just for afraid of collision with the ISS orbit. Also, the sounding rocket mission is possible to demonstrate the bare tether technology in low cost, simple mission concept, fast realization for space structures. The present sounding rocket experiment is expected to be the first conductive bare tether experiment

Outcomes after Surgical Treatment of Metastatic Disease in the Adrenal Gland; Valuable for the Patient?

SIMPLE SUMMARY: Adrenal glands are common dissemination sites for metastases of various solid tumors. The rapid development of new treatment strategies, such as targeted therapy and immunotherapy for different cancer types, has led to increased metastatic adrenalectomies. Therefore, clear communication between oncologists and adrenal gland specialists has become increasingly important to outweigh surgical risks versus oncological advantages of adrenalectomies in these patients. This study assesses trends in diagnosis, type of surgery, and short-term and long-term surgical outcomes of patients who underwent metastatic adrenalectomy. We included a total of 95 patients with an adrenal metastasis of non-adrenal primary tumors, most often colorectal or lung cancer, who underwent (minimal invasive) adrenalectomy. 37.9% of the patients experienced one or more complications after adrenalectomy. Within our patient cohort, an increased demand for metastatic adrenalectomy was observed over the past years, which might be associated with the rise of targeted- and immunotherapy. Our data aims to assist multidisciplinary teams with weighing the pros and cons of resection of the metastasized adrenal gland of cancer patients. ABSTRACT: The adrenal glands are common dissemination sites for metastasis of various solid tumors. Surgical treatment is often recommended because targeted therapies and immunotherapy are frequently ineffective for adrenal metastasis. We report the experience with short-term and long-term surgical outcomes of patients undergoing surgery for adrenal metastasis in two hospitals. A retrospective, multicenter study was performed to analyze patient characteristics, tumor-related data, perioperative outcomes, and oncological outcomes. Postoperative complications that occurred within 30 days were scored according to the Clavien Dindo classification. Metastatic adrenalectomy was performed in 95 patients. We observed an increase from an average of 3 metastatic adrenalectomies per year between 2001–2005 to 10 between 2015–2019. The most frequent underlying malignancies were colorectal and lung cancer. In 55.8%, minimal invasive adrenalectomy was performed, including six conversions to open surgery. A total of 37.9% of patients had postoperative complications, of which ileus or gastroparesis, wound problems, pneumonia, and heart arrhythmias were the most occurring complications. Improved cancer care has led to an increased demand for metastatic adrenalectomy over the past years. Complication rates of 37.9% are significant and cannot be neglected. Therefore, multidisciplinary teams should weigh the decision to perform metastatic adrenalectomy for each patient individually, taking into account the drawbacks of the described morbidity versus the potential benefits

Space demostration of bare electrodynamic tape-tether technology on the sounding rocket S520-25

A spaceflight validation of bare electro dynamic tape tether technology was conducted. A S520-25 sounding rocket was launched successfully at 05:00am on 31 August 2010 and successfully deployed 132.6m of tape tether over 120 seconds in a ballistic flight. The electrodynamic performance of the bare tape tether employed as an atmospheric probe was measured. Flight results are introduced through the present progressive report of the demonstration and the results of flight experiment are examined as the premier report of the international cooperation between Japan, Europe, USA and Australia. Future plans for maturing space tether technology, which will play an important role for future space activities, are also discussed

Circulating adrenomedullin and B-type natriuretic peptide do not predict blood pressure fluctuations during pheochromocytoma resection:a cross-sectional study

Background: Despite adequate presurgical management, blood pressure fluctua tions are common during resection of pheochromocytoma or sympathetic paraganglioma (PPGL). To a larg e extent, the variability in blood pressure control during PPGL resection remains unexplained. Adrenomedullin and B -type natriuretic peptide, measured as MR-proADM and NT-proBNP, respectively, are circulating biomarkers of card iovascular dysfunction. We investigated whether plasma levels of MR-proADM and NT-proBNP are associated with bl ood pressure fluctuations during PPGL resection. Methods: Study subjects participated in PRESCRIPT, a randomized control led trial in patients undergoing PPGL resection. MR-proADM and NT-proBNP were determined in a single plasma sample drawn before surgery. Multivariable linear and logistic regression analyses were used to explore associations between these biomarkers and blood pressure fluctuations, use of vasoconstrictive agents duri ng surgery as well as the occurrence of perioperative cardiovascular events. Results: A total of 126 PPGL patients were included. Median plasma conc entrations of MR-proADM and NT-proBNP were 0.51 (0.41-0.63) nmol/L and 68.7 (27.9-150.4) ng/L, respec tively. Neither MR-proADM nor NT-proBNP were associated with blood pressure fluctuations. There was a positiv e correlation between MR-proADM concentration and the cumulative dose of vasoconstrictive agents (03B2 0.44, P = 0.001). Both MR-proADM and NT-proBNP were significantly associated with perioperative cardiovascular events (OR: 5.46, P = 0.013 and OR: 1.54, P = 0.017, respectively). Conclusions: Plasma MR-proADM or NT-proBNP should not be considered as biom arkers for the presurgical risk assessment of blood pressure fluctuations during PPGL resection. Future studies are needed to explore the potential influence of these biomarkers on the intraoperative requirement of vasoconstrictive agents and the perioperative cardiovascular risk

TP53 outperforms other androgen receptor biomarkers to predict abiraterone or enzalutamide outcome in metastatic castration-resistant prostate cancer

Purpose: To infer the prognostic value of simultaneous androgen receptor (AR) and TP53 profiling in liquid biopsies from patients with metastatic castration-resistant prostate cancer (mCRPC) starting a new line of AR signaling inhibitors (ARSi). Experimental Design: Between March 2014 and April 2017, we recruited patients with mCRPC (n = 168) prior to ARSi in a cohort study encompassing 10 European centers. Blood samples were collected for comprehensive profiling of Cell Search-enriched circulating tumor cells (CTC) and circulating tumor DNA (ctDNA). Targeted CTC RNA sequencing (RNA-seq) allowed the detection of eight AR splice variants (ARV). Low-pass whole-genome and targeted gene-body sequencing of AR and TP53 was applied to identify amplifications, loss of heterozygosity, mutations, and structural rearrangements in ctDNA. Clinical or radiologic progression-free survival (PFS) was estimated by Kaplan-Meier analysis, and independent associations were determined using multivariable Cox regression models. Results: Overall, no single AR perturbation remained associated with adverse prognosis after multivariable analysis. Instead, tumor burden estimates (CTC counts, ctDNA fraction, and visceral metastases) were significantly associated with PFS. TP53 inactivation harbored independent prognostic value [HR 1.88; 95% confidence interval (CI), 1.18-3.00; P = 0.008], and outperformed ARV expression and detection of genomic AR alterations. Using Cox coefficient analysis of clinical parameters and TP53 status, we identified three prognostic groups with differing PFS estimates (median, 14.7 vs. 7.51 vs. 2.62 months; P < 0.0001), which was validated in an independent mCRPC cohort (n = 202) starting first-line ARSi (median, 14.3 vs. 6.39 vs. 2.23 months; P < 0.0001). Conclusions: In an all-comer cohort, tumor burden estimates and TP53 outperform any AR perturbation to infer prognosis. See related commentary by Rebello et al., p. 169

T-REX: Bare electro-dynamic tape-tether technology experimetn on sounding rocket S520

The project to verify the performance of space tether technology was successfully demonstrated by the launch of the sounding rocket S520 the 25tu. The project is the space demonstration of science and engineering technologies of a bare tape electrodynamic tether (EDT) in the international campaign between Japan, USA, Europe and Australia. Method of "Inverse ORIGAMI (Tape tether folding)" was employed in order to deploy the bare tape EDT in a short period time of the suborbital flight. The deployment of tape tether was tested in a various experimental schemes on ground to show high reliability of tape tether deployment. The rocket was launched on the summer of 2010 and deployed a bare electro-dynamic tape tether with length 132.6 m, which is the world record of the length deployment of tape tether. The verification of tether technology has found a variety kind of science and technology results as the first in the humankind and will lead a large number of applications of space tether technologie

Value-Driven System Design of Utility-Scale Airborne Wind Energy

In the current auction-based electricity market, the design of utility-scale renewable energy systems has traditionally been driven by the levelised cost of energy (LCoE). However, the market is gradually moving towards a subsidy-free era, which will expose the power plant owners to the fluctuating prices of electricity. This paper presents a computational approach to account for the influence of time-varying electricity prices on the design of airborne wind energy (AWE) systems. The framework combines an analytical performance model, providing the power curve of the system, with a wind resource characterisation based on ERA5 reanalysis data. The resulting annual energy production (AEP) model is coupled with a parametric cost model based on reference prototype data from Ampyx Power B.V. extended by scaling laws. Ultimately, an energy price model using real-life data from the ENTSO-E platform maintained by the association of EU transmission system operators was used to estimate the revenue profile. This framework was then used to compare the performance of systems based on multiple economic metrics within a chosen design space. The simulation results confirmed the expected behaviour that the electricity produced at lower wind speeds has a higher value than that produced at higher wind speeds. To account for this electricity price dependency on wind speeds in the design process, we propose an economic metric defined as the levelised profit of energy (LPoE). This approach determines the trade-offs between designing a system that minimises cost and designing a system that maximises value

Value-Driven System Design of Utility-Scale Airborne Wind Energy

In the current auction-based electricity market, the design of utility-scale renewable energy systems has traditionally been driven by the levelised cost of energy (LCoE). However, the market is gradually moving towards a subsidy-free era, which will expose the power plant owners to the fluctuating prices of electricity. This paper presents a computational approach to account for the influence of time-varying electricity prices on the design of airborne wind energy (AWE) systems. The framework combines an analytical performance model, providing the power curve of the system, with a wind resource characterisation based on ERA5 reanalysis data. The resulting annual energy production (AEP) model is coupled with a parametric cost model based on reference prototype data from Ampyx Power B.V. extended by scaling laws. Ultimately, an energy price model using real-life data from the ENTSO-E platform maintained by the association of EU transmission system operators was used to estimate the revenue profile. This framework was then used to compare the performance of systems based on multiple economic metrics within a chosen design space. The simulation results confirmed the expected behaviour that the electricity produced at lower wind speeds has a higher value than that produced at higher wind speeds. To account for this electricity price dependency on wind speeds in the design process, we propose an economic metric defined as the levelised profit of energy (LPoE). This approach determines the trade-offs between designing a system that minimises cost and designing a system that maximises value