Real-Time Management of Multimodal Streaming Data for Monitoring of Epileptic Patients

This is the Accepted Manuscript version of the following article: I. Mporas, D. Triantafyllopoulos, V. Megalooikonomou, “Real-Time Management of Multimodal Streaming Data for Monitoring of Epileptic Patients”, Journal of Medical Systems, Vol. 40(45), December 2015. The final published versions is available at: https://link.springer.com/article/10.1007%2Fs10916-015-0403-3 © Springer Science+Business Media New York 2015.New generation of healthcare is represented by wearable health monitoring systems, which provide real-time monitoring of patient’s physiological parameters. It is expected that continuous ambulatory monitoring of vital signals will improve treatment of patients and enable proactive personal health management. In this paper, we present the implementation of a multimodal real-time system for epilepsy management. The proposed methodology is based on a data streaming architecture and efficient management of a big flow of physiological parameters. The performance of this architecture is examined for varying spatial resolution of the recorded data.Peer reviewedFinal Accepted Versio

Ερμηνευτικά αρχαιολογικά ζητήματα της βυζαντινής Εύβοιας

Keynote lectureΤhe aim of this paper is to present the current status of the study of the Christian monuments in Euboea and to summarize current issues for future researchers. We should take into consideration the lack of monuments from certain periods, the sometimes obscure chronological terminology, the shortage of a critical overview of the material already published, as well as the tendency for damnatio memoriae. Finally, there is also a great volume of unpublished material. In view of these facts, one can easily understand why Early Christian and Byzantine Euboea represents almost a blank page in our knowledge of Byzantine Greece, with the exception of the period of Venetian dominion over the island (1204-1470). The absence of a local Ephorate for Byzantine Monuments before 2005 has played a not-insignificant role in this defective situation. The Early Christian Period (4th century AD-AD 565) is characterized by the lack of archaeological evidence for the majority of its Christian centres (Chalkis, Oreoi, Porthmos), with Karystos being an exception. Concerning the Early Byzantine Period (7th-9th century), it seems certain that Euboea remained relatively unaffected by the disastrous effects of the so-called ‘Slavic invasions’. During the Mid-Byzantine Period (9th-12th century), the island was considerably favoured by local and other saints, which had an obvious impact on the architecture and art of Euboea. The following Late Byzantine Period (1204-1470) is marked by the Latin Dominion on Negroponte that ended to the fatal Ottoman occupation. The prevailing view that Euboea remained religiously and politically a rather peaceful, indifferent place has to be reconsidered, since a more detailed examination of the religious and secular architecture and the iconographical settings of the churches reveal a vigorous confessionalism against the Latin Church of the conquerors. The appendix enumerates open issues on various topics

Impact of iliac crest bone graft harvesting on fusion rates and postoperative pain during instrumented posterolateral lumbar fusion

This study aims to evaluate the influence of bone harvesting on postoperative pain and fusion rates. Group 1 patients received iliac crest bone graft (ICBG) either alone or augmented with local bone. Group 2 received only local bone. No statistical significance was found in radiological union or in the Oswestry Disability Index scores. Visual Analogue Scale scores showed less pain in group 2. Logistic regression showed no correlation between residual pain and occurrence of fusion. Harvesting ICBG did not appear to increase fusion rates and no relation was found between radiological non-union and pai

Posterolateral lumbar spine fusion using a novel demineralized bone matrix: a controlled case pilot study

Introduction: Intertransverse posterolateral fusion along with instrumentation is a common technique used for spinal fusion. Iliac crest bone graft (ICBG) offers good fusion success rates with a low risk for disease transmission but is, however, linked with certain morbidity. In an effort to eliminate or reduce the amount of iliac graft needed, bone substitutes including demineralized bone matrix (DBM) have been developed. This study evaluates a novel DBM (Accell Connexus®) used in one or two-level instrumented posterolateral lumbar fusion. Materials and methods: A total of 59 consecutive patients were studied as two groups. Group 1 consisted of 33 patients having Accell Connexus® used to augment either ICBG or local decompression material. Group 2 consisted of 26 consecutive patients, operated prior to the introduction of this novel DBM, having either ICBG alone or local decompression material. Fusion was assessed by two independent observers, blinded to graft material, using standardized criteria found in the literature. All adverse events were recorded prospectively. Results: The results show no statistically significant differences between the two groups in fusion rates, complications, surgery duration, ODI, or pain on VAS. Logistical regression showed no relation between fusion and age, smoking status or comorbidities. Furthermore, no adverse events related to the use of the novel DBM were observed. Conclusion: The results from this study demonstrate that the novel DBM presented performs equally as well as that of autologous bone, be it either ICBG or a local decompression material, and can therefore be used as a graft extende

Study of trunk asymmetry in normal children and adolescents

The scoliometer readings in both standing and sitting position of 2071 children and adolescents (1099 boys and 972 girls) aged from 5 to 18 years old were studied. The angle of trunk rotation (ATR) was measured, in order to quantify the existing trunk asymmetry. Children and adolescents were divided in two groups according to the severity of trunk asymmetry. In the first group asymmetry was 1 to 6 degrees and in the second group was 7 or more degrees. Radiographic and leg length inequality evaluation were also performed in a number of children. The mean frequency of symmetric (ATR = 0 degrees) boys and girls was 67.06% and 65.01% for the standing screening position and 76.5% and 75.1% for the sitting position, respectively. The mean difference of frequency of asymmetry (ATR > 0 degrees) at standing minus sitting forward bending position for boys and girls was 10.22% and 9.37%, respectively. The mean frequency of asymmetry of 7 or more degrees was 3.23% for boys and 3.92% for girls at the standing forward bending position and 1.62% and 2.21% at the sitting, respectively. Girls are found to express higher frequency of asymmetry than boys. Right trunk asymmetry was more common than left. The sitting position is the preferred screening position for examining the rib or loin hump during school screening as it demonstrates the best correlation with the spinal deformity exposing the real trunk asymmetry

Implementing frailty assessment into a healthcare system: a clinical opinion paper.

Frailty is a multifactorial medical syndrome characterized by reduced endurance and decreased physiological ability. The aim of this narrative literature review is to present the frailty diagnostic instruments that are already used in most Western countries and provide recommendations for use in clinical practice. Among the numerous available frailty instruments identified in current literature, the Frailty Index and the Physical Frailty Phenotype are most commonly used. There are large differences in each instrument design, ease of use by healthcare teams and also significant heterogeneity in the design of the studies based on these instruments. Therefore, future studies should be designed to properly address the discrepancy in the comparison of the existent instruments and consider their validity and feasibility of implementation in different healthcare settings with different healthcare providers

A Systematic Approach for Stronger Documentation of Anterior Cruciate Ligament Graft Choice.

Numerous studies have focused on determining the optimal choice between the two most used anterior cruciate ligament (ACL) reconstruction autografts. In order to address this matter, we performed a systematic review of every meta-analysis published on the PubMed platform between 2001 and 2020, comparing the functional outcomes, the static stability parameters, as well as the postoperative and long-term complications of the patellar tendon (BPTB) autograft and hamstrings (HT). We retrieved a total of 26 meta-analyses that met our criteria, and the characteristics and outcomes of every meta-analysis, as well as subgroup analysis regarding the type of the study design, number of strands of HT autograft, and fixation method, were extensively recorded. The majority of the meta-analyses showed that there were no significant differences between BPTB and HT in terms of functional outcomes and static stability parameters while HT autografts seem to be superior to BPTB regarding kneeling pain and anterior knee pain. Other outcomes seem to be affected by the number of strands of the HT autograft, the fixation technique, and the type of study design, indicating superiority of the four-strand HT autograft with the use of an extra-cortical button fixation. Overall, there is no clear superiority of BPTB over HT autografts for ACL reconstruction, as both types present similar outcomes in the majority of postoperative parameters. Autograft selection should be individualized according to each patient's needs and more RCTs are warranted in order to reach safer results on the appropriate autograft type

Comparison of Bone-Patella Tendon-Bone Four-Strand Hamstring Tendon Grafts for Anterior Cruciate Ligament Reconstruction: A Prospective Study

Introduction To date, the proper choice of graft for anterior cruciate ligament (ACL) reconstruction remains a matter of conflict. We aimed to compare the clinical and functional outcomes of the two most commonly utilized autografts, bone-patella tendon-bone (BPTB) and four-strand hamstring tendon (HT) graft, at 6 and 12 months after surgery. Methods In a prospective randomized study, we included a total of 60 patients undergoing ACL reconstruction, thirty in BPTB and thirty in HT group. All patients were amateur athletes and were evaluated at 6 and 12 months after surgery for: (a) postoperative functionality of the operated knee by the Thgner, the Lysholm and the International Knee Documentation Committee (IKDC) scoring scales, (b) anterior cruciate ligament (ACL) instability of the operated knee compared to the healthy contralateral knee by the KT-1000 arthrometer and (c) the extension and flexion muscle strength of the operated knee by a CYBEX isokinetic dynamometer. Results Patients in the two groups did not differ regarding demographics, and pre-injury functionality status. Significantly more patients in the HT group (n=6) compared to the BPTB group (n=1) experienced ACL re-rupture and underwent revision surgery before follow-up end (p=0.044). All patients, regardless of graft, showed significant improvement within each group of functional assessments by Lysholm, Thgner and IKDC scores, as well as of Cybex measurements -with an increase of peak torque at 60 degrees extension and 180 degrees extension and 60 degrees flexion and 180 degrees flexion- at 12 months compared to 6 months follow-up (p<0.05). However, there was no difference between the two groups regarding knee function improvement or extension measurements neither at 6 nor 12 months. Contrarily, the BPTB graft group had higher values of peak torque (Nm) at 60 degrees and 180 degrees flexion compared to the HT group, both at 6 (p=0.014 and 0.029, respectively) and 12 months (p=0.033 and 0.030, respectively). Postoperative stability was similar between the two groups at 12 months (p=0.519). Conclusion Both BPTB and HT grafts present with benefits and drawbacks and remain viable autograft options for primary ACL reconstruction as each has, although HT grafts seem to be more susceptible to re-rupture. The graft selection should be based on the needs and activities of each patient

HOW I DO IT Total Scapulectomy and Constrained Reverse Total Shoulder Reconstruction for a Ewing's Sarcoma

Background: Total scapulectomy and intra-articular resection of the glenohumeral joint indicates the Malawer Type III shoulder girdle resection. Materials and Methods: The modified Tikhoff-Linberg total scapulectomy and constrained reverse total shoulder reconstruction for a Ewing’s sarcoma of the scapula is presented. A combined approach has been used. The deltoid, trapezius, rhomboids, levator scapulae, latissimus dorsi, and serratus anterior were preserved. the tumor was removed en bloc by disarticulation of the acromioclavicular and the glenohumeral joints. The scapular prosthesis was suspended by the muscles. A constrained reverse humeral prosthesis was implanted after osteotomy of the humeral head. Results: There were no intraoperative or postoperative complications; surgical margin, were clear. At 12 months postoperatively, the patient has a stable and painless shoulder. Conclusion: The goal of shoulder reconstructions is to provide a stable and painless joint that allows positioning of the arm and hand in space. Compared to those patients left without a scapula reconstruction, prosthetic replacement of the scapula and shoulder partially restores abduction and external rotation and improves cosmesis. J. Surg. Oncol. 2009;100:611-615. (C) 2009 Wiley-Liss, Inc