Smart Robotic Exoskeleton: Constructing Using 3D Printer Technique for Ankle-Foot Rehabilitation

Patients with spinal cord injury (SCI), stroke, and coronavirus patients must undergo a rehabilitation process involving programmed exercises to regain their ability to perform activities of daily living (ADL). This study focuses on the rehabilitation of the foot-ankle joint to restore ADL through the design and implementation of a rehabilitation exoskeleton with three degrees of freedom (abduction/adduction, inversion/eversion, and plantarflexion/dorsiflexion movements). increase the patients cause worker fatigue, emotional exhaustion, a lack of motivation, and feelings of frustration, all contributing to a decrease in work efficacy and productivity. The robotic exoskeleton was developed to overcome this limitation and support the medical rehabilitation section.   The main goal of this study is to develop a portable exoskeleton that is comfortable, lightweight, and has a range of motion (ROM) compatible with human anatomy to ensure that movements outside of this range are minimized, the anthropometric parameters of a typical human lower foot have been considered. In addition, it's a home-based rehabilitation device which means the exoskeleton can be used in any environment due to its lightweight and small size to accelerate the rehabilitation process and increase patient comfort.  The proposed autonomous exoskeleton structure is designed in Solid Works and constructed with polylactic acid (PLA) plastic, the reason PLA was chosen is its lightweight, available, stiff material, and low cost, using 3D printing technology the exoskeleton was manufacturing. Electromyography (EMG) and angle data were extracted using EMG MyoWare and gyroscope sensors, respectively, to control the exoskeleton. It was evaluated on its own then with 2 normal subjects and 17 patients with stroke, spinal cord injury (SCI), and coronavirus. The limitation that has been faced was that the sessions were limited due to the limited time provided for the study. According to the improvement rate, the exoskeleton has a significant impact on regaining muscle activity and improving the range of motion of foot-ankle joints for the three types of patients. The rate of improvement was 300%, 94%, and 133.3% for coronavirus, SCI, and stoke respectively. These results demonstrate that this exoskeleton can be utilized for physiotherapy exercises

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit