Studio sperimentale delle proprietà meccaniche di tessuti cardiaci fetali

A partire dalla diciottesima settimana di gestazione, con diagnosi definitiva dalla ventesima alla ventiduesima settimana, le attuali tecniche diagnostiche permettono di rilevare patologie di diverse gravità, su cui è possibile intervenire con tempistiche e modalità differenti. Alcune patologie consentono di operare con successo il bambino nei primi anni d’età, ripristinando completamente le funzioni compromesse. Altre patologie di più grave entità non consentono invece di intervenire sul bambino in modo risolutivo. In molti di questi casi sarebbe opportuno intervenire sul feto non appena effettuata la diagnosi. Un’alternativa a cui purtroppo si ricorre attualmente nella quasi totalità dei casi è l’aborto terapeutico. Mancano infatti sia le metodiche chirurgiche, che lo strumentario necessario per condurre interventi su feti così piccoli con ragionevole probabilità di successo. Nell’ambito della ricerca finalizzata allo studio di procedure chirurgiche attuabili sul feto durante il periodo gestazionale, il presente lavoro di tesi si colloca nel settore della caratterizzazione meccanica dei tessuti molli, avendo come argomento principale l’analisi sperimentale di tessuti fetali cardiaci. Tale tipo di informazione non è attualmente presente in letteratura e può essere di fondamentale importanza sia nella progettazione, che nella sperimentazione clinica di strumenti chirurgici dedicati alla correzione di difetti cardiaci in regime fetale. Tale studio è stato eseguito su campioni tissutali di cuore di agnello a gestazione programmata, utilizzando un banco di prova specifico, realizzato presso il laboratorio CRIM della Scuola Superiore Sant’Anna. Tale stazione sperimentale è stata progettata per la caratterizzazione dei tessuti molli e consente di ricavare informazioni sperimentali da prove meccaniche multiple di trazione, compressione e taglio. L’analisi dei dati raccolti dalle prove meccaniche è stata svolta utilizzando algoritmi implementati in linguaggio Matlab, tramite i quali sono state ricavate curve sforzo-deformazione, fondamentali per la caratterizzazione del tessuto biologico

Searching for the perfect wave: the effect of radiofrequency electromagnetic fields on cells

There is a growing concern in the population about the effects that environmental exposure to any source of "uncontrolled" radiation may have on public health. Anxiety arises from the controversial knowledge about the effect of electromagnetic field (EMF) exposure to cells and organisms but most of all concerning the possible causal relation to human diseases. Here we reviewed those in vitro and in vivo and epidemiological works that gave a new insight about the effect of radio frequency (RF) exposure, relating to intracellular molecular pathways that lead to biological and functional outcomes. It appears that a thorough application of standardised protocols is the key to reliable data acquisition and interpretation that could contribute to clear the picture for scientists and lay public. Moreover, specific tuning of experimental and clinical RF exposure might lead to health beneficial effects

Design, Realization, and Assessment of a High-Fidelity Physical Simulator for the Investigation of Childbirth-Induced Pelvic Floor Damage

Vaginal delivery is one of the main causes of pelvic floor damage, which can lead to short- and long-term clinical consequences called pelvic floor dysfunctions. The number of women affected by this pathology is continuously rising, representing both a medical issue and an important financial burden. Prevention represents the best strategy of care, but it requires a deep understanding of the injury mechanisms, which is currently lacking. Simulation can help to identify the main factors affecting a clinical event, reducing the need for in vivo investigations. However, current simulators poorly mimic the pelvic structures and do not provide any feedback. These limitations led to the development of an innovative high-fidelity physical simulator to study the mechanisms behind pelvic floor damage caused by vaginal delivery. Anatomically correct gynecological structures were realized using soft materials able to resemble human tissue behavior. Ad hoc stretch sensors were realized with conductive fabric and integrated into the simulator to evaluate tissue elongation caused by the passage of the fetal head. Evaluation of the simulator was carried out both in laboratory conditions and by involving expert clinicians. Gynecologists determined that the simulator is a valid teaching and training tool that is able to provide feedback on instantaneous pelvic floor elongation, thus potentially preventing induced tissue damage

Toward a Variable Stiffness Surgical Manipulator Based on Fiber Jamming Transition

Soft robots have proved to represent a new frontier for the development of intelligent machines able to show new capabilities that can complement those currently performed by robots based on rigid materials. One of the main application areas where this shift is promising an impact is minimally invasive surgery. In previous works, the STFF-FLOP soft manipulator has been introduced as a new concept of using soft materials to develop endoscopic tools. In this paper, we present a novel kind of stiffening system based on fiber jamming transition that can be embedded in the manipulator to widen its applicability by increasing its stability and with the possibility to produce and transmit higher forces. The STIFF-FLOP original module has been re-designed in two new versions to incorporate the variable stiffness mechanism. The two designs have been evaluated in terms of dexterity and variable stiffness capability and, despite a general optimization rule did not clearly emerge, the study confirmed that fiber jamming transition can be considered an effective technological approach for obtaining variable stiffness in slender soft structures

Toward the design of a tailored training course for birth assistance: an Ethiopian experience.

Simulation in healthcare has already demonstrated extraordinary potential in high-income countries. However, to date, few authors have explored the possibility of applying simulation-based training in African settings, highlighting the necessity of need-based training protocols capable of addressing economic, social, and cultural aspects. In this framework, this research investigates the main features a simulation training course on umbilical cord care and placenta management should have to be considered effective and sustainable in an African healthcare environment. Local facilitators were identified as the best resources for defining course contents and providing technical lectures to mitigate cultural, linguistic, and social issues. For the training program, the design of a new low-cost medium-fidelity simulator was explored and a preliminary evaluation was performed. Finally, the propensity of 25 students to attend a simulation training course was investigated using a questionnaire. The attitude of the enrolled students was positive, endorsing the future introduction of simulation training into the educational offers of Ethiopian colleges

Neonatal intubation: what are we doing?

: How and when the forces are applied during neonatal intubation are currently unknown. This study investigated the pattern of the applied forces by using sensorized laryngoscopes during the intubation process in a neonatal manikin. Nine users of direct laryngoscope and nine users of straight-blade video laryngoscope were included in a neonatal manikin study. During each procedure, relevant forces were measured using a force epiglottis sensor that was placed on the distal surface of the blade. The pattern of the applied forces could be divided into three sections. With the direct laryngoscope, the first section showed either a quick rise of the force or a discontinuous rise with several peaks; after reaching the maximum force, there was a sort of plateau followed by a quick drop of the applied forces. With the video laryngoscope, the first section showed a quick rise of the force; after reaching the maximum force, there was an irregular and heterogeneous plateau, followed by heterogeneous decreases of the applied forces. Moreover, less forces were recorded when using the video laryngoscope.    Conclusions: This neonatal manikin study identified three sections in the diagram of the forces applied during intubation, which likely mirrored the three main phases of intubation. Overall, the pattern of each section showed some differences in relation to the laryngoscope (direct or video) that was used during the procedure. These findings may provide useful insights for improving the understanding of the procedure. What is Known: • Neonatal intubation is a life-saving procedure that requires a skilled operator and may cause direct trauma to the tissues and precipitate adverse reactions. • Intubation with a videolaryngoscope requires less force than with a direct laryngoscope, but how and when the forces are applied during the whole neonatal intubation procedure are currently unknown. What is New: • Forces applied to the epiglottis during intubation can be divided into three sections: (i) an initial increase, (ii) a sort of plateau, and (iii) a decrease. • The pattern of each section shows some differences in relation to the laryngoscope (direct or videolaryngoscope) that is used during the procedure

Applied forces with direct versus indirect laryngoscopy in neonatal intubation: a randomized crossover mannequin study

Purpose: In adult mannequins, videolaryngoscopy improves glottic visualization with lower force applied to upper airway tissues and reduced task workload compared with direct laryngoscopy. This trial compared oropharyngeal applied forces and subjective workload during direct vs indirect (video) laryngoscopy in a neonatal mannequin. Methods: We conducted a randomized crossover trial of intubation with direct laryngoscopy, straight blade videolaryngoscopy, and hyperangulated videolaryngoscopy in a neonatal mannequin. Thirty neonatal/pediatric/anesthesiology consultants and residents participated. The primary outcome measure was the maximum peak force applied during intubation. Secondary outcome measures included the average peak force applied during intubation, time needed to intubate, and subjective workload. Results: Direct laryngoscopy median forces on the epiglottis were 8.2 N maximum peak and 6.8 N average peak. Straight blade videolaryngoscopy median forces were 4.7 N maximum peak and 3.6 N average peak. Hyperangulated videolaryngoscopy median forces were 2.8 N maximum peak and 2.1 N average peak. The differences were significant between direct laryngoscopy and straight blade videolaryngoscopy, and between direct laryngoscopy and hyperangulated videolaryngoscopy. Significant differences were also found in the top 10th percentile forces on the epiglottis and palate, but not in the median forces on the palate. Time to intubation and subjective workload were comparable with videolaryngoscopy vs direct laryngoscopy. Conclusions: The lower force applied during videolaryngoscopy in a neonatal mannequin model suggests a possible benefit in reducing potential patient harm during intubation, but the clinical implications require assessment in future studies. Registration: ClinicalTrials.gov (NCT05197868); registered 20 January 2022

Wireless Robotic Capsule for Releasing Bioadhesive

A novel, miniature wireless robotic capsule for releasing bioadhesive patches in the gastrointestinal (GI) tract was designed, fabricated, and preliminarily tested. In particular, the assembled prototype was successfully navigated in a GI phantom, up to a target site where the release mechanism was verified. Then, deployment of a bioadhesive patch onto ex vivo porcine tissue was accomplished, and patch adhesion strength was verified. The main application of the present system is the deployment of anchoring patches for miniature robotic modules to be operated in the targeted anatomical domain. Such an innovative application stems from the wise blend of robotics and bioadhesion. Obtained results, which are consistent with previous investigations by the group, confirm the viability of the adopted bioadhesives for the envisaged anchoring tasks. The present feasibility study complies with the spirit of minimally invasive, wireless diagnosis, and therapy, and provides a preliminary contribution for their advancement