Actuation and stiffening in fluid-driven soft robots using low-melting-point material

Soft material robots offer a number of advantages over traditional rigid robots in applications including human-robot interaction, rehabilitation and surgery. These robots can navigate around obstacles, elongate, squeeze through narrow openings or be squeezed - and they are considered to be inherently safe. The ability to stiffen compliant soft actuators has been achieved by embedding various mechanisms that are generally decoupled from the actuation principle. Miniaturisation becomes challenging due to space limitations which can in turn result in diminution of stiffening effects. Here, we propose to hydraulically actuate soft manipulators with low-melting-point material and, at the same time, be able to switch between a soft and stiff state. Instead of allocating an additional stiffening chamber within the soft robot, one chamber only is used for actuation and stiffening. Low Melting Point Alloy is integrated into the actuation chamber of a single-compartment soft robotic manipulator and the interfaced robotic syringe pump. Temperature change is enabled through embedded nichrome wires. Our experimental results show higher stiffness factors, from 9-12 opposing the motion of curvature, than those previously found for jamming mechanisms incorporated in separate additional chambers, in the range of 2-8 for the same motion

Myocardial Work in Patients Hospitalized With COVID‐19:Relation to Biomarkers, COVID‐19 Severity, and All‐Cause Mortality

BACKGROUND: COVID‐19 infection has been hypothesized to affect left ventricular function; however, the underlying mechanisms and the association to clinical outcome are not understood. The global work index (GWI) is a novel echocardiographic measure of systolic function that may offer insights on cardiac dysfunction in COVID‐19. We hypothesized that GWI was associated with disease severity and all‐cause death in patients with COVID‐19. METHODS AND RESULTS: In a multicenter study of patients admitted with COVID‐19 (n=305), 249 underwent pressure‐strain loop analyses to quantify GWI at a median time of 4 days after admission. We examined the association of GWI to cardiac biomarkers (troponin and NT‐proBNP [N‐terminal pro‐B‐type natriuretic peptide]), disease severity (oxygen requirement and CRP [C‐reactive protein]), and all‐cause death. Patients with elevated troponin (n=71) exhibited significantly reduced GWI (1508 versus 1707 mm Hg%; P=0.018). A curvilinear association to NT‐proBNP was observed, with increasing NT‐proBNP once GWI decreased below 1446 mm Hg%. Moreover, GWI was significantly associated with a higher oxygen requirement (relative increase of 6% per 100–mm Hg% decrease). No association was observed with CRP. Of the 249 patients, 37 died during follow‐up (median, 58 days). In multivariable Cox regression, GWI was associated with all‐cause death (hazard ratio, 1.08 [95% CI, 1.01–1.15], per 100–mm Hg% decrease), but did not increase C‐statistics when added to clinical parameters. CONCLUSIONS: In patients admitted with COVID‐19, our findings indicate that NT‐proBNP and troponin may be associated with lower GWI, whereas CRP is not. GWI was independently associated with all‐cause death, but did not provide prognostic information beyond readily available clinical parameters. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04377035

The PROFOUND Database for evaluating vegetation models and simulating climate impacts on European forests

Process-based vegetation models are widely used to predict local and global ecosystem dynamics and climate change impacts. Due to their complexity, they require careful parameterization and evaluation to ensure that projections are accurate and reliable. The PROFOUND Database (PROFOUND DB) provides a wide range of empirical data on European forests to calibrate and evaluate vegetation models that simulate climate impacts at the forest stand scale. A particular advantage of this database is its wide coverage of multiple data sources at different hierarchical and temporal scales, together with environmental driving data as well as the latest climate scenarios. Specifically, the PROFOUND DB provides general site descriptions, soil, climate, CO2, nitrogen deposition, tree and forest stand level, and remote sensing data for nine contrasting forest stands distributed across Europe. Moreover, for a subset of five sites, time series of carbon fluxes, atmospheric heat conduction and soil water are also available. The climate and nitrogen deposition data contain several datasets for the historic period and a wide range of future climate change scenarios following the Representative Concentration Pathways (RCP2.6, RCP4.5, RCP6.0, RCP8.5). We also provide pre-industrial climate simulations that allow for model runs aimed at disentangling the contribution of climate change to observed forest productivity changes. The PROFOUND DB is available freely as a "SQLite" relational database or "ASCII" flat file version (at https://doi.org/10.5880/PIK.2020.006/; Reyer et al., 2020). The data policies of the individual contributing datasets are provided in the metadata of each data file. The PROFOUND DB can also be accessed via the ProfoundData R package (https://CRAN.R- project.org/package=ProfoundData; Silveyra Gonzalez et al., 2020), which provides basic functions to explore, plot and extract the data for model set-up, calibration and evaluation.Peer reviewe

Früherkennung und ernährungsmedizinische Therapie von Mangelernährung bei Patienten mit chronischer Pankreatitis

Infolge des Verlustes von exokriner und endokriner Pankreasfunktion besteht bei Patienten mit chronischer Pankreatitis ein erhöhtes Mangelernährungsrisiko. Zu Früherkennung, Diagnostik und Therapie von Mangelernährung bei dieser Krankheitsentität liegen indes nur unzureichende Erkenntnisse vor. Ziel dieser Arbeit ist es daher, die bestehenden Wissenslücken hinsichtlich Risikofaktoren, Früherkennung und Behandlung von Mangelernährung bei chronischer Pankreatitis zu schließen. Zur Identifizierung von Behandlungsansätzen erfolgte mittels einer systematischen Übersichtsarbeit mit Metaanalyse eine Auswertung der Evidenz aus randomisierten kontrollierten Studien. Risikofaktoren, Phänotyp und gesundheitliche Folgen der Mangelernährung wurden in einer prospektiven multizentrischen Querschnittstudie untersucht. Schließlich erfolgte die Testung der Umsetzbarkeit und des Effekts einer intensivierten ernährungsmedizinischen Therapie im Rahmen einer einarmigen Machbarkeitsstudie. Die systematische Übersichtsarbeit mit Metaanalyse ergab, dass hinsichtlich der Behandlung von Mangelernährung bei chronischer Pankreatitis nur sehr begrenzt Daten aus hochwertigen randomisierten kontrollierten Studien vorliegen. Aktuelle Empfehlungen basieren daher in der Regel auf Erkenntnissen aus Beobachtungsstudien oder Expertenmeinungen. In der Querschnittstudie zeigte sich, dass eine Mangelernährung bei etwa zwei Dritteln der Patienten vorlag. Die mangelernährten Individuen wiesen häufiger eine kürzere Krankheitsdauer sowie eine höhere Krankheitsschwere auf. Der Phänotyp der Mangelernährung war insbesondere durch den Verlust von Muskelmasse nicht aber -funktion charakterisiert und trat bei Vorliegen einer schweren Mangelernährung ausgeprägter in Erscheinung als bei moderatem Schweregrad. Infolge der intensivierten Ernährungstherapie konnten diese pathologischen Veränderungen teilweise umkehrt werden. Neben einer Gewichtssteigerung resultierte die Intervention in einer Zunahme an Muskelmasse sowie einer Verbesserung des Krankheitsschweregrades. Hinsichtlich der Umsetzbarkeit konnte für die meisten Interventionskomponenten eine hohe Compliance beobachtet werden. Zudem ergab sich nur eine geringe Dropout-Rate im Interventionsverlauf. Mangelernährung stellt in der Tat eine häufige Komplikation der chronischen Pankreatitis dar und ist insbesondere durch eine verringerte Muskelmasse charakterisiert. Hierdurch ist die Muskelfunktion zwar kaum kompromittiert, allerdings geht dieser Zustand mit einer höheren Krankheitsschwere einher. Eine intensivierte ernährungsmedizinische Therapie bei mangelernährten Patienten mit chronischer Pankreatitis ist umsetzbar und verbessert effektiv den Ernährungszustand, aber auch funktionale und prognostische Parameter. Anschließende Untersuchungen sind indes erforderlich, um Früherkennung und Behandlung weiter zu optimieren und die notwendige Evidenz für starke Empfehlungen zu generieren.Due to the loss of pancreatic exocrine and endocrine function patients with chronic pancreatitis have an increased risk of malnutrition. However, there is only limited knowledge regarding the early detection, diagnosis, and therapy of malnutrition in this entity. This work aims to close these knowledge gaps with respect to risk factors, early detection, and treatment of malnutrition in chronic pancreatitis. To identify treatment modalities, a systematic review and meta-analysis evaluating the evidence from randomized controlled studies was performed. Risk factors, phenotype, and health outcome of malnutrition were investigated in a prospective, multi-center cross-sectional study. Eventually, the feasibility and the effect of an intensified nutritional intervention were tested in a single-arm feasibility study. The systematic review and meta-analysis showed that regarding the treatment of malnutrition in chronic pancreatitis there is only very limited available data from high-quality, randomized controlled trials. Hence, current recommendations are generally based on findings from observational studies or expert opinions. In the cross-sectional study, it turned out that malnutrition was prevalent in almost two-thirds of patients. Malnourished individuals commonly presented with shorter disease duration and higher disease severity. In particular, the phenotype of malnutrition was characterized by loss of skeletal muscle mass but absence of physical impairment and was more pronounced in severe than in moderate malnutrition. These pathologic changes could be partially reversed by an intensified nutritional therapy. Besides bodyweight gain, the intervention also resulted in increased muscle mass and an improved disease severity. With respect to feasibility, high compliance was observed for most components of the intervention. Moreover, there was only a low dropout rate during the intervention. In fact, malnutrition is a common complication of chronic pancreatitis and especially characterized by reduced muscle mass. Although muscle function is thereby hardly compromised, this condition is associated with higher disease severity. An intensified nutritional intervention in malnourished patients with chronic pancreatitis is feasible and effectively improves not only nutritional status but also functional and prognostic parameters. However, future investigations are necessary to further improve early detection and treatment and to generate the evidence required for strong recommendations

A Parameter Identification Method for Static Cosserat Rod Models: Application to Soft Material Actuators with Exteroceptive Sensors

Soft material robotics is a rather young research field in the robotics and material science communities. A popular design is the soft pneumatic actuator (SPA) which, if connected serially, becomes a highly compliant manipulator. This high compliance makes it possible to adapt to the environment and in the future might be very useful for manipulation tasks in narrow and wound environments. A central topic is the modelling of the manipulators. While comparatively rigid continuum robots are build of metal or other materials, that conduct a linear behaviour, the material used in soft material robotics often exhibits a nonlinear stress-strain relationship. In this paper we contribute an identification method for material parameters and data-based approach within the constitutive equations of a Cosserat rod model. We target bending and extension stiffness, consider shear and neglect torsional strains. The proposed method is applicable to any continuum robot which can be modelled by the classic theory of special Cosserat rods, including constraint models, and shows great improvement in experimental results with mean position errors of 0.59% reference length

Associations of age, sex, and socioeconomic status with adherence to guideline recommendations on protein intake and micronutrient supplementation in patients with sleeve gastrectomy or Roux-en-Y gastric bypass

Introduction Patients with bariatric surgery often show poor long-term compliance to recommendations for prevention of nutrient deficiency but it is unclear which factors contribute. We investigated the associations of age, sex, and socioeconomic status (SES) with adherence to guideline recommendations on protein intake and micronutrient supplementation. Methods In a monocentric cross-sectional study we prospectively recruited patients with sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) and a minimum postoperative period of 6 months. Clinical and demographic data were obtained from the patients’ medical files and by questionnaire. Patients reported on supplement usage, recorded their dietary intake for seven days and underwent physical examinations including blood testing. Results We included 35 patients (SG: n = 25, RYGB: n = 10) with a mean (+SD) postoperative period of 20.2 (±10.4) months. Distributions of age, sex and SES were comparable between the SG and RYGB groups. Non-adherence to recommended protein intake was associated with age ≥ 50 years (p = 0.041) but not sex or SES. Protein intake inversely correlated with markers of obesity. There were no significant associations of age or sex with micronutrient supplementation. Only for vitamins A (p = 0.049) and B1 (p = 0.047) higher SES was associated with greater compliance. The only manifest deficiency associated with non-adherence to micronutrient supplementation was that for folic acid (p = 0.044). Conclusion In patients after bariatric surgery, those of older age and of lower SES might have a greater risk of unfavorable outcome and may require greater attention to micronutrient and protein supplementation

Infection of (Peri-)Pancreatic Necrosis Is Associated with Increased Rates of Adverse Events during Endoscopic Drainage: A Retrospective Study

Pancreatic necroses are a major challenge in the treatment of patients with pancreatitis, causing high morbidity. When indicated, these lesions are usually drained endoscopically using plastic or metal stents. However, data on factors associated with the occurrence of failure or adverse events during stent therapy are scarce. We retrospectively analyzed all adverse events and their associated features which occurred in patients who underwent a first-time endoscopic drainage of pancreatic necrosis from 2009 to 2019. During the observation period, a total of 89 eligible cases were identified. Adverse events occurred in 58.4% of the cases, of which 76.9% were minor (e.g., stent dislocation, residual lesions, or stent obstruction). However, these events triggered repeated interventions (63.5% vs. 0%, p < 0.001) and prolonged hospital stays (21.0 [11.8–63.0] vs. 14.0 [7.0–31.0], p = 0.003) compared to controls without any adverse event. Important factors associated with the occurrence of adverse events during endoscopic drainage therapy were positive necrosis cultures (6.1 [2.3–16.1], OR [95% CI], p < 0.001) and a larger diameter of the treated lesion (1.3 [1.1–1.5], p < 0.001). Superinfection of pancreatic necrosis is the most significant factor increasing the likelihood of adverse events during endoscopic drainage. Therefore, control of infection is crucial for successful drainage therapy, and future studies need to consider superinfection of pancreatic necrosis as a possible confounding factor when comparing different therapeutic modalities

Identification of early predictors for infected necrosis in acute pancreatitis

Background In acute pancreatitis, secondary infection of pancreatic necrosis is a complication that mostly necessitates interventional therapy. A reliable prediction of infected necrotizing pancreatitis would enable an early identification of patients at risk, which however, is not possible yet. Methods This study aims to identify parameters that are useful for the prediction of infected necrosis and to develop a prediction model for early detection. We conducted a retrospective analysis from the hospital information and reimbursement data system and screened 705 patients hospitalized with diagnosis of acute pancreatitis who underwent contrast-enhanced computed tomography and additional diagnostic puncture or drainage of necrotic collections. Both clinical and laboratory parameters were analyzed for an association with a microbiologically confirmed infected pancreatic necrosis. A prediction model was developed using a logistic regression analysis with stepwise inclusion of significant variables. The model quality was tested by receiver operating characteristics analysis and compared to single parameters and APACHE II score. Results We identified a total of 89 patients with necrotizing pancreatitis, diagnosed by computed tomography, who additionally received biopsy or drainage. Out of these, 59 individuals had an infected necrosis. Eleven parameters showed a significant association with an infection including C-reactive protein, albumin, creatinine, and alcoholic etiology, which were independent variables in a predictive model. This model showed an area under the curve of 0.819, a sensitivity of 0.692 (95%-CI [0.547–0.809]), and a specificity of 0.840 (95%-CI [0.631–0.947]), outperforming single laboratory markers and APACHE II score. Even in cases of missing values predictability was reliable. Conclusion A model consisting of a few single blood parameters and etiology of pancreatitis might help for differentiation between infected and non-infected pancreatic necrosis and assist medical therapy in acute necrotizing pancreatitis

Systemic Bile Acids Affect the Severity of Acute Pancreatitis in Mice Depending on Their Hydrophobicity and the Disease Pathogenesis

Acute pancreatitis (AP) is a major, globally increasing gastrointestinal disease and a biliary origin is the most common cause. However, the effects of bile acids (BAs), given systemically, on the pancreas and on disease severity remains elusive. In this study, we have investigated the roles of different circulating BAs in animal models for AP to elucidate their impact on disease severity and the underlying pathomechanisms. BAs were incubated on isolated acini and AP was induced through repetitive injections of caerulein or L-arginine; pancreatic duct ligation (PDL); or combined biliopancreatic duct ligation (BPDL). Disease severity was assessed using biochemical and histological parameters. Serum cholecystokinin (CCK) concentrations were determined via enzyme immunoassay. The binding of the CCK1 receptor was measured using fluorescence-labeled CCK. In isolated acini, hydrophobic BAs mitigated the damaging effects of CCK. The same BAs further enhanced pancreatitis in L-arginine- and PDL-based pancreatitis, whereas they ameliorated pancreatic damage in the caerulein and BPDL models. Mechanistically, the binding affinity of the CCK1 receptor was significantly reduced by hydrophobic BAs. The hydrophobicity of BAs and the involvement of CCK seem to be relevant in the course of AP. Systemic BAs may affect the severity of AP by interfering with the CCK1 receptor