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Peritoneal metastases (PM) are a form of metastatic spread affecting approximately 5-15% of colon cancer patients. The attitude towards management of peritoneal metastases has evolved from therapeutic nihilism towards a more comprehensive and multidisciplinary approach, in large part due to the development of cytoreductive surgery (CRS), usually coupled with heated intraperitoneal chemotherapy (HIPEC), along with the constant improvement of systemic chemotherapy of colorectal cancer. Several landmark studies, including 5 randomized controlled trials have marked the development and refinement of surgical approaches to treating colorectal cancer peritoneal metastases. This review article focuses on these landmark studies and their influence in 4 key areas: the evidence supporting surgical resection of peritoneal metastases, the identification and standardization of important prognostic variables influencing patient selection, the role of surgery and intraperitoneal chemotherapy in prevention of colorectal PM and the role of intraperitoneal chemotherapy as an adjuvant to surgical resection. These landmark studies indicate that surgical resection of colorectal PM should be considered as a therapeutic option in appropriately selected patients and when adequate surgical expertise is available. Standardized prognostic variables including the Peritoneal Cancer Index and the Completeness of Cytoreduction Score should be used for evaluating both indications and outcomes. Current evidence does not support the use of second look surgery with oxaliplatin HIPEC or prophylactic oxaliplatin HIPEC in patients with high risk colon cancer nor the use of oxaliplatin HIPEC with CRS of colorectal PM. more...

Gastrointestinal complications, predominantly anastomotic leak (AL), are the most frequent source of severe morbidity after cytoreductive surgery (CRS). The aim of this study was to present the technical standards for colorectal anastomoses developed and systematically applied to all patients undergoing CRS in a high-volume tertiary center, and the associated AL rates. This was a descriptive study reporting the technical characteristics of a standardized protocol for three types of colorectal anastomoses (colorectal, ileorectal, and ileocolic) in CRS with heated intraperitoneal chemotherapy (HIPEC), and a retrospective analysis of prospectively collected data on anastomotic outcomes. All patients (1172) undergoing CRS with HIPEC from September 2006 to September 2020 were included. The anastomotic complications were classified according to the International Study Group of Rectal Cancer Surgery (ISGRCS) classification. Overall, 1172 patients underwent 1300 procedures and 1359 gastrointestinal anastomoses. An ileocolic anastomosis was performed in 408 patients, colorectal anastomosis in 469 patients, and ileorectal anastomosis in 16 patients, none with diverting ileostomy; 345 other gastrointestinal reconstructions and 82 urinary reconstructions were performed in these patients. The AL rate was 1% (4/408) for the ileocolic anastomosis, 0.85% (4/469) for the colorectal anastomosis, and 0% (0/16) for the ileorectal anastomosis. One patient died postoperatively due to AL. Systematic application of standardized techniques adapted to ensure optimal tissue healing (stapled anastomoses avoiding overlap, accurate staple deployment, and hand-sewn reinforcement) are associated with a very high level of anastomotic safety in a large cohort of patients undergoing CRS and HIPEC. more...

Background Colorectal cancer (CRC) treatment in patients with peritoneal metastases is complex. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are under debate. The aim of this study was to assess the consensus among international experts for decision-making regarding CRS/HIPEC in CRC patients. Materials and methods Twelve of 15 experts provided their decision algorithms for CRS/HIPEC for patients with or at high risk for peritoneal metastases from CRC. Based on the objective consensus methodology, the results were transformed into decision trees, which then provided information on the consensus and discordance. Results There was only one scenario in which the consensus on performing HIPEC reached 100%, which was when treating young patients with complete cytoreduction and a peritoneal carcinomatosis index (PCI) of less than 16 in the presence of certain risk factors (RFs). Five major decision criteria were identified and displayed: age, PCI, completeness of cytoreduction (CC), extent of extraperitoneal metastases (EoM) and, in the case of nonverified extraperitoneal metastases, further RFs. There was consensus to refrain from using HIPEC in older patients with a high PCI, and the consensus further increased when addressing incomplete cytoreduction and extensive EoM. Conclusion A definite consensus concerning the use of HIPEC was only determined for very selected scenarios. These findings can be used for general guidance, but due to the heterogeneity of each individual situation and the impracticality to present this information through decision trees, as well as the unclear future of the role of HIPEC in the adjuvant setting, a one-on-one transfer to daily clinical practice cannot be achieved. more...

Purpose To evaluate the effect of cementation protocols on the bonding interface stability and pull-out forces of temporary implant-supported crowns bonded on a titanium base abutment (TiB) or on a temporary titanium abutment (TiA). Materials and methods A total of 60 implants were restored with PMMA-based CAD/CAM crowns. Five groups (n = 12) were created: Group 1 = TiB/SRc: crown conditioned with MMA-based liquid (SR Connect, Ivoclar Vivadent); Group 2 = TiB/50Al-MB: crown airborne particle-abraded with 50-μm Al2O3 and silanized (Monobond Plus, Ivoclar Vivadent); Group 3 = TiB/30SiOAl-SRc: crown airborne particle-abraded with 30-μm silica-coated Al2O3 (CoJet, 3M ESPE) and conditioned with MMA-based liquid (SR Connect); Group 4 = TiB/30SiOAl-MB: crown airborne particle-abraded with 30- μm silica-coated Al2O3 (CoJet) and silanized (Monobond Plus); and Group 5 = TiA/TA-PMMA: crown manually enlarged, activated, and rebased with PMMA resin (Telio Lab, Ivoclar Vivadent). Specimens in the TiB groups were cemented using a resin cement (Multilink Hybrid Abutment, Ivoclar Vivadent). After aging (120,000 cycles, 49 N, 1.67 Hz, 5°C to 55°C, 120 seconds), bonding interface failure was analyzed (50x). Pull-out forces (N) (0.5 mm/minute) and modes of failure were registered. Chi-square and Kruskal-Wallis tests were used to analyze the data (α = .05). Results Bonding failure after aging varied from 0% (Group 5) to 100% (Groups 1, 2, and 4) (P .05). Conclusion The cementation protocol had an effect on the bonding interface stability and pull-out forces of PMMA-based crowns bonded on a titanium base. Airborne particle abrasion of the crown internal surface and conditioning it with an MMA-based liquid may be recommended to improve retention of titanium base temporary restorations. Yet, for optimal outcomes, conventional temporary abutments might be preferred. more...

Background: Pediatric aortic root dilatation is a life-threatening condition that lacks guidelines for surgical management. We aimed to analyze the data on aortic valve interventions during root surgery to guide decision-making. Methods: A search was performed of MEDLINE, Embase, CENTRAL, ClinicalTrials.gov , and WHO ICTRP. Citations were screened in duplicate and independently to identify randomized controlled trials, cohorts, and case series involving populations aged 0 to 18 years, who received valve-sparing and valve-replacing aortic root surgeries between 1999 and 2019. Outcomes considered included mortality (perioperative, one year, five year), reintervention rates. Results: After duplicate removal, 689 citations were screened through abstract and full text review, identifying five eligible studies. All five were observational studies evaluating valve-sparing procedures. There were 81 patients with a mean study age range of 9.9 to 13.9 years. Both reimplantation (74%) and remodeling (26%) subtypes were done. Range of mean duration of follow-up was 1.2 to 4.4 years. There was no mortality reported until the one-year follow-up period. The long-term mortality rate was calculated as 0.02 per patient-year (95% CI: 0.01-0.05). The long-term reintervention rate was 0.08 per patient-year (95% CI: 0.05-0.13). Conclusions: There is limited experience on aortic valve intervention during aortic root surgery in children. Single-arm studies on valve-sparing surgeries show excellent survival up to one year. Mortality and reintervention rates increase in the longer term. The small sample size and lack of controlled studies do not allow for direct comparisons between procedure types. more...

Diffuse malignant peritoneal mesothelioma (DMPM) is a rare malignancy associated with poor outcomes. Recent reports have shown longer survival with radical surgery, usually combined with intraperitoneal chemotherapy. However, surgical interventions in these patients have not been extensively studied at a population level. The objective of this retrospective cohort study is to assess the prevalence of surgical and nonsurgical interventions for DMPM patients, the influence of surgery on survival outcomes, and the associations between demographic and clinical factors with treatments and outcomes. This study included adult patients diagnosed with DMPM from 2003 to 2014 and registered in the National Cancer Database (NCDB). The primary outcome was overall survival. Histologically confirmed mesothelioma was defined using International Classification of Diseases (ICD)-3 codes 9050/3, 9051/3, 90523, and 9053/3 and peritoneum as primary affected organ using ICD codes C17-19, C22-24, C26, C42, C48, and C76. Relationships between demographic and clinical variables, surgical treatments, and survival outcomes were evaluated using logistic and Cox modeling and log-rank tests. A total of 2062 patients were identified, of whom 1055 (51%) did not receive any surgery while 701 (34%) received radical surgery. Patients receiving radical surgery had overall survival of 38.4 months compared with 7.1 months for patients without surgery (p more...

Background: Diabetes is a metabolic disease that is taking an epidemic proportion around the world. The occurrence of microvascular complications and diabetic foot ulcer is associated with an increased mortality and morbidity incidence, which is the most serious complication of this disease, which significantly reduce the quality of patient life. Objective. The aim of the study was to determine the correlation of extracutaneous microvascular complications with diabetic foot ulcer in patients with type 2 diabetes. Method. The study was prospective, and included 160 patients with type 2 diabetes. It was conducted at the University Clinical Center of the Republic of Srpska in the period from January 2016 until December 2019. The respondents were adults, of both sexes, suffering from type 2 diabetes, in whom complications of this disease are present. Glycemic control was established based on a target HbA1c value of 7%. Results. Of the 160 patients in the study, 53.8% were men and 46.2% were women. The average age of the patients was 70.11%±10.05 years. Extracutaneous microvascular complications were present in 85 patients (53.1%); of which 30.2% had well-regulated glycemia (HbA1c≤7.0%), while 61.5% (p more...

Introduction: According Type 2 diabetes mellitus is a chronic metabolic disease with a high prevalence characterized by elevated blood glycemic values and with progressive development of micro and macrovascular complications. Glycemia control is a very important factor in the process of „delaying“ the onset of complications by glycated hemoglobin (HbA1c) analysis. Aim: The aim of the study is to determine the association of obesity, microvascular complications with glycemic control in patients with type 2 diabetes. Methods: The study was prospective, involving 105 patients with type 2 diabetes. It was conducted at the University Clinical Center of the Republic of Srpska from January 2016 to January 2018. The patients were adults, of both sexes, suffering from type 2 diabetes, in whom complications of this disease are present. Glycemic control was evaluated based on a target HbA1c value of 7%. Results: Out of the 105 patients in the study, 45.8% were male, 54.2% female. The mean age of the patients was 68.3%±10.7 years. The mean HbA1c level was 8.32±1.57%. Of the total number of patients, in 25.7% the HbA1c levels were ≤7.0%, while in 74.3% the HbA1c were ≥7.0% (p more...

Uterine leiomyosarcoma in a prior myomectomy site is a rare phenomenon. We report an unusual case of a leiomyosarcoma arising six months post myomectomy in a 16-year old female., Graphical Abstract Radiographic images (A) starting with the CT of mass on day 0 followed by the CT abdomen/pelvis of second pelvic mass leiomyosarcoma on day 185, the MRI prior to staging surgery on day 317, and finishing up with the MRI of the recurrence of malignancy. Timeline of patient events (B). Our patient initially underwent a diagnostic laparoscopy with pelvic mass biopsies showing leiomyoma which was followed by an abdominal myomectomy. She re-presented to the hospital on Day 190 and urgently underwent an exploratory laparotomy for resection of a pelvic mass which revealed a leiomyosarcoma. The patient subsequently received neoadjuvant chemotherapy (NACT) with ifosamide and doxorubicin and pelvic radiation. On day 316 she underwent surgical staging including hysterectomy and bilateral salpingo-oophorectomy which showed no residual disease. Patient received adjuvant chemotherapy with ifosamide and doxorubicin. On Day 490 patient diagnosed with recurrence of disease and on day 500 underwent exploratory laparotomy with resection of three recurrent abdominal tumors, greater omentectomy, small bowel resection, and heated intraperitoneal chemotherapy (HIPEC) with cisplatin and doxorubicin. For microscopic recurrent and persistent disease the patient will receive gemcitabine and docetaxel. Histological images (C) starting of the pelvic mass biopsy on day 0 followed by the myomectomy on day 8, the primary tumor resection on day 190, the staging surgery showing no residual leiomyosarcoma on day 316, and end with the recurrent abdominal tumor debulking surgery on day 500.Unlabelled Image, Highlights • Malignant transformation of a leiomyoma to a leiomyosarcoma is a rare phenomenon. • Leiomyosarcomas can be extremely aggressive when they present in an adolescence. • Multidisciplinary team needed to treat an adolescent with a leiomyosarcoma. more...

BackgroundRecent clinical practice changes in neonatal care resulted in higher, narrower oxygen saturation target ranges for preterm infants. The effect of targeting higher or lower oxygen saturations on respiratory outcomes of preterm infants and duration of hospitalization has not been extensively reviewed in the context of current care, but could have significant implications.MethodsA multicentre retrospective cohort of 145 preterm infants was conducted; 105 had lower oxygen saturation targets (88 to 92%), 40 had higher targets (90 to 95%). The primary outcome was bronchopulmonary dysplasia (BPD). Secondary outcomes included duration of invasive/noninvasive respiratory support, oxygen therapy, and hospitalization. The primary outcome was compared using Fisher’s exact test. Secondary outcomes were evaluated with survival analysis and Wilcoxon rank sum test.ResultsThe difference in incidence of BPD in the lower (N=56, 53.3%) and higher saturation groups (N=14, 35.0%) was not statistically significant (relative risk [RR]=0.66 [0.41, 1.04], P=0.06). The difference in duration of mechanical ventilation in the lower (median 7.8 days, interquartile range [IQR] 3.7 to 15.9) and higher saturation groups (median 4.5, IQR 1.9 to 12.3) approached statistical significance (P=0.05). There were no statistically significant differences in the durations of other respiratory supports or hospital stay between the two groups.ConclusionsThe results of this study approached statistical significance and suggest that higher, narrower oxygen saturation targets may result in a clinically important reduction in BPD incidence and duration of mechanical ventilation. These results require validation in a larger sample to refine optimal targets. more...

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is an innovative drug delivery technique invented to be used for the treatment of peritoneal metastasis. Its application gained popularity over the past years. Several prospective clinical trials are being conducted to determine efficacy and safety. At this moment, there remain many challenges to overcome before PIPAC can be widely adopted in clinical practice. See related article by Kim et al., p. 1875 more...

Adverse weather conditions, including snow, rain, and fog, pose a major challenge for both human and computer vision. Handling these environmental conditions is essential for safe decision making, especially in autonomous vehicles, robotics, and drones. Most of today's supervised imaging and vision approaches, however, rely on training data collected in the real world that is biased towards good weather conditions, with dense fog, snow, and heavy rain as outliers in these datasets. Without training data, let alone paired data, existing autonomous vehicles often limit themselves to good conditions and stop when dense fog or snow is detected. In this work, we tackle the lack of supervised training data by combining synthetic and indirect supervision. We present ZeroScatter, a domain transfer method for converting RGB-only captures taken in adverse weather into clear daytime scenes. ZeroScatter exploits model-based, temporal, multi-view, multi-modal, and adversarial cues in a joint fashion, allowing us to train on unpaired, biased data. We assess the proposed method on in-the-wild captures, and the proposed method outperforms existing monocular descattering approaches by 2.8 dB PSNR on controlled fog chamber measurements., Comment: 2021 IEEE Conference on Computer Vision and Pattern Recognition (CVPR), project page available at https://light.princeton.edu/publication/zeroscatter/ more...

This paper presents the early results of research aiming to develop a novel system for unobtrusive and intuitive electrotactile feedback for first responders. The system leverages the multi-pad stimulation technology based on spatiotemporal modulation of the stimuli. Two-point discrimination threshold mapping was performed in potential electrode placement locations, defined from the usability perspective by the first responders in initial co-development sessions. Based on these results a custom electrode design was proposed and validated in six healthy volunteers. Psychometric testing was conducted to determine spatial discrimination between stimuli produced by the multi-pad electrode. The average success rate of 80% indicates that the proposed approach is feasible. The work presented in this paper was funded by the European Union’s Horizon 2020 research and innovation programme under grant agreement No 883315. more...

Gastrointestinal complications are the main source of severe morbidity after cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC), mainly in the form of anastomotic leak. Reducing the rate of anastomotic leaks is of paramount importance and should be approached both through risk factor understanding and reduction, as well as optimization of surgical team performance. We performed a study that describes the details of a technical protocol for the creation of anastomoses after colorectal resections in CRS and HIPEC and the anastomotic outcomes associated with its systematic application in a high-volume peritoneal surface malignancy center. An extremely low, near-zero anastomotic leak rate (0.85% in colorectal anastomoses, 1% in ileo-colic anastomoses, and 0% in ileo-rectal anastomoses) was observed among 1172 patients. Extremely low, near-zero rates of anastomotic leak after colorectal resections in CRS and HIPEC could be achievable in high-volume peritoneal malignancy centers. The described techniques could be adopted and validated in other high-volume peritoneal malignancy centers. more...

BACKGROUND: Foot drop is common gait impairment after stroke. Functional electrical stimulation (FES) of the ankle dorsiflexor muscles during the swing phase of gait can help correcting foot drop. OBJECTIVE: To evaluate efficacy of additional novel FES system to conventional therapy in facilitating motor recovery in the lower extremities and improving walking ability after stroke. METHODS: Sixteen stroke patients were randomly allocated to the FES group (FES therapy plus conventional rehabilitation program) (n=8), and control group (conventional rehabilitation program) n=8. FES was delivered for 30min during gait to induce ankle plantar and dorsiflexion. Main outcome measures: Gait speed using 10 Meter Walk Test (10 MWT), Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS) and modified Barthel Index (MBI). RESULTS: Results showed a significant increase in gait speed in FES group (p more...

Although superficial spreading melanomas (SSM) are diagnosed as thinner lesions, nodular melanomas (NM) have a more rapid growth rate and are biologically more aggressive compared with other histologic subtypes.To determine the difference in 5-year relative survival in patients with NM and SSM at the same Breslow depth and TNM stage.A population-based cross-sectional analysis compared the 5-year relative survival of patients with NM and SSM using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER)∗Stat software (version 8.2.1-8.3.5). Chi-square tests compared the proportions, and Kaplan-Meier method with Z-score compared 5-year relative survival.For patients receiving a diagnosis between 2004 and 2009, 5-year relative survival was lower in NM compared with SSM (53.7% vs 87.3%; Z score, -41.35; P .001). Similarly, for patients receiving a diagnosis between 2010 and 2015, 5-year relative survival was lower in NM compared with SSM (61.5% vs 89.7%; Z score, -2.7078; P .01). Subgroup analyses showed inferior survival in NM in T1b, and survival differences remained significant after excluding patients with nodal or distant metastases.Five-year relative survival is worse in NM compared with SSM especially in T1b, T2a, and T2b melanomas. Melanoma subtype should be taken into consideration when making treatment recommendations. more...

Hearing loss is an important health concern in Canada's Arctic. The objective of this research was to provide information on the prevalence of childhood hearing loss in Nunavut.This cross-sectional study involved comprehensive audiologic assessments of school-aged children in six communities to determine overall and community-specific prevalence of hearing loss. Data were collected about hearing aid use and factors affecting use through a parent questionnaire.Assessments were completed for 644 children in kindergarten to grade 6.124 (19.3%) children had hearing loss of ≥ 30 dB HL at one or more frequencies in at least one ear (93.5% conductive loss). Applying a Canadian prevalence study definition, 148 (23.5%) children had hearing loss. Tympanic membrane perforations were present in 36.8% (The prevalence of hearing loss in Canada's North was almost three times that reported for non-indigenous children. One in five school-aged children was found to have hearing loss that is likely to affect classroom learning and social/emotional development. A hearing health strategy tailored to this population is critically needed. more...

Remyelination is a key aspect in multiple sclerosis pathology and a special effort is being made to promote it. However, there is still no available treatment to regenerate myelin and several strategies are being scrutinized. Myelination is naturally performed by oligodendrocytes and microRNAs have been postulated as a promising tool to induce oligodendrocyte precursor cell differentiation and therefore remyelination. Herein, DSPC liposomes and PLGA nanoparticles were studied for miR-219a-5p encapsulation, release and remyelination promotion. In parallel, they were compared with biologically engineered extracellular vesicles overexpressing miR-219a-5p. Interestingly, extracellular vesicles showed the highest oligodendrocyte precursor cell differentiation levels and were more effective than liposomes and polymeric nanoparticles crossing the blood&ndash, brain barrier. Finally, extracellular vesicles were able to improve EAE animal model clinical evolution. Our results indicate that the use of extracellular vesicles as miR-219a-5p delivery system can be a feasible and promising strategy to induce remyelination in multiple sclerosis patients. more...

Objectives: Resource limitations and low rates of follow-up with primary care providers currently limit the impact of emergency department (ED)-based preventative strategies for children with asthm... more...

Cracked endodontically treated molars (ETMs) are commonly treated with full crowns. Less invasive techniques could include fiber-reinforced composite (FRC) base and adhesively bonded endocrowns. The purpose of this study was to assess the fatigue resistance of ETMs restored with CAD/CAM resin composite endocrowns and reinforced with different FRC bases. Cracks were simulated in fifty mandibular molars by cutting the teeth longitudinally and reassembling the two parts. After performing endodontic treatments and preparing cavities, teeth were restored in one of the following methods (n = 10). In Group 1, cavity floors were lined with 0.5 mm of flowable composite (Universal Injectable; GUI, shade A2). In Groups 2 and 3, the cavity floors were covered with one and three layers of FRC-net (ES Net) respectively, whereas in Groups 4 and 5 with 1 mm and 2 mm of flowable FRC-resin (EverX Flow Dentin; EXFD) respectively. Endocrowns (Cerasmart 270; CE, A2 HT) with 5 mm thickness were adhesively luted with preheated composite and all specimens were subjected to cyclic loading in water at 5 Hz, starting with a load of 600 N (5000 cycles), followed by stages of 1000, 1300, 1600, 1900, 2200 and 2500 at a maximum of 20 000 cycles each. Results were analyzed using Kaplan-Meier survival analysis and the Log-Rank test (p = 0.05). The fatigue failure load of ES Net applied in three layers (1617 N ± 371) or in one layer (1499 N ± 306), as well as EXFD applied in 2 mm (1496 N ± 264) or in 1 mm (1434 N ± 372) did not differ significantly (p > 0.05). Control teeth fractured at 1255 N ± 350 (p > 0.05). In the fiber-reinforced groups, restorable fractures were observed in 50%-80%, with only 30% deemed restorable in the control group. The fractures originated mainly at the occlusal contact points and the main crack propagated in the corono-apical direction. No crack origin (primary or secondary) starting from the artificial pre-existing crack was observed in fractured specimens. FRC bases did not improve the fatigue resistance of cracked ETMs, but favorably influenced the failure mode. more...

This study evaluated several fiber- and matrix related factors and investigated different mechanical properties of discontinuous i.e. short fiber-reinforced composite (SFRC) (everX Posterior, eXP). These were compared with three conventional composites, microfilled G-ænial Anterior (GA), nanofilled Supreme XTE (SXTE) and bulk-fill Filtek Bulk-Fill (FBF).Fracture toughness (KIC), flexural strength (FS), flexural modulus (FM), compressive strength (CS), diametral tensile strength (DTS), apparent horizontal shear strength (AHSS) and fracture work (Wf) were determined for each composite (n=8) stored dry or in water. SEM analysis of the fiber diameter (df) (n=6) and orientation (n=6) were performed. The theoretical critical fiber length (lfc) and the aspect ratio (l/d) of SFRC were calculated and the volume fraction of discontinuous fibers (Vf%) and the fiber length (lf) of SFRC were evaluated. The results were statistically analyzed with two-way ANOVA (α=0.05).The mechanical properties of SFRC (eXP) were generally superior (p0.05) compared with conventional composites. GA had the highest FM (p0.05), whereas FBF had the highest AHSS (p0.05). The fiber related properties Vf%, l/d, lf, lfc and df of eXP were 7.2%, 18-112, 0.3-1.9mm, 0.85-1.09mm and 17μm respectively. SEM results suggested an explanation to several toughening mechanisms provided by the discontinuous fibers, which were shown to arrest crack propagation and enable a ductile fracture. Water exposure weakened the mechanical properties regardless of material type. Wf was unaffected by the water storage.The properties of this high aspect ratio SFRC were dependent on the fiber geometry (length and orientation) and matrix ductility.The simultaneous actions of the toughening mechanisms provided by the short fibers accounted for the enhanced toughness of this SFRC, which toughness value matched the toughness of dentin. Hence, it could yield an inherently uniform distribution of stresses to the hard biological tissues. more...

Breast cancer in African-American females (AAF) has a less favorable outcome than that in Caucasians. More information is needed regarding its biology. We evaluated gene expression in tumors from AAF presenting with early stage or locally advanced breast cancer using MammaPrint(®), BluePrint (®) (molecular subtype) and TargetPrint (®) [estrogen receptor (ER), progesterone receptor, and Human Epidermal Growth Factor Receptor 2 (HER2) mRNA levels]. Genomic information was correlated with clinical and pathologic characteristics and Oncotype DX(®) Recurrence Score(®) (RS). One hundred Patients were enrolled, 1 not evaluable by BluePrint. The median age was 60 years (range 22-98), and eighty-four (84 %) patients had stage I or II disease. High Risk MammaPrint was present in 66 % of patients and in 52 % of patients with stage I disease. High Risk MammaPrint was associated with young age (p = 0.02), high grade (p 0.0001), HER2 expression (p = 0.016), and triple-negative phenotype (p 0.001). Sixty-four tumors (65 %) were Luminal type (47 % of these were classified as High Risk), 26 (26 %) were Basal type, and 9 (9 %) HER2 type. Twenty-two cancers were triple negative (TN) by IHC and 19 (90 %) Basal type. Among the 15 tumors HER2 positive by IHC/FISH, 8 (53 %) were HER2 type by BluePrint. Eleven tumors with ER expression of 1-9 % were ER negative by TargetPrint and none of these was Luminal type. None of the seven tumors HER2 positive by IHC/FISH but negative by TargetPrint was HER type. RS results were available in 29 patients: two had High Risk both by RS and MammaPrint; eight had intermediate RS, with four High Risk by MammaPrint; 19 had a low RS, with eight High Risk by MammaPrint. AAF with stage I to III breast cancer often present with High Risk disease. Molecular heterogeneity is present within TN, HER2-positive, and ER-positive breast cancer. RS and MammaPrint offer different prognostic information. more...

SUMMARY Objective: This study aimed to evaluate the original (OR) and repair (RR) fracture resistance of a semi-interpenetrating polymer network (semi-IPN)–based short fiber–reinforced composite compared to dimethacrylate-based composite materials by means of the V-notch test. Methods and Materials: Circular specimens (5×2 mm) with a centrally machined 90° V-shaped notch were prepared. Four bulk fill (Filtek Bulk Fill, Venus Bulk Fill, TetricEvo Ceram Bulk Fill, SDR), three microfilled hybrid (GC-Anterior, GC-Posterior, Z250), one nanofilled (SupremeXTE), and two short fiber–reinforced (Alert, everX Posterior) composites were selected. EverX Posterior was the semi-IPN material. Specimens (n=12/group) were either dry or water stored for 7 and 30 days, respectively, at 37°C and then loaded in two-point load until fracture. One-half of each tested specimen was used for the repair procedure. Repairing surfaces were diamond-bur ground, etched, and treated with silane containing universal adhesive (Scotchbond Universal) before repair. Results: Three-way analysis of variance revealed a significant statistical difference between the groups (p0.05). The everX Posterior preserved the specimens' integrity at the final fracture load (ductile fracture), whereas all other materials fractured into two halves at the interface (adhesive failure). Conclusions: The only material that provided enhanced repair strength that was close to the original cohesive strength of the material was everX Posterior. The endurance of repaired restorations can be improved by using semi-IPN-based filling material. more...

The aim of this study was to assess the chewing fracture resistance of compromised molars restored with direct composite resin (CR) restorations, with and without a short-fiber reinforcing (short-FRC) base. Wide extension of MOD cavities with removed palatal cusps preparations were simulated on 48 extracted maxillary molars. Five groups (n = 12) were designed: 1. control (intact teeth), 2. non-endodontically treated and 3. endodontically treated teeth with direct CR restorations (GC-Posterior), and 4. non-endodontically treated and 5. endodontically treated teeth with direct biomimetic bilayered restorations. Groups 4 and 5 included an anatomically shaped short-FRC base (everX Posterior), covered with a 2 mm CR layer (GC-Posterior). Restorations were subjected to chewing in water (1.5 Hz), with load of 85 N. Specimens were loaded until fracture or to a maximum of 120 000 cycles. Restorations that survived the chewing cycle were submitted to static load test (post-chewing test). The data were statistically analyzed using two-way ANOVA (p = 0.05) and fracture types with the chi-square test (p = 0.05). Fractures were classified into reparable, possibly reparable or non-reparable. All specimens survived the chewing cycle. The chewing fracture resistance of the direct biomimetic restorations prepared on non-endodontically treated teeth (2889 N) was statistically significantly higher than the direct CR counterparts (1966 N) (p = 0.00015), which was not the case for the groups with endodontically treated teeth (p = 0.257). Inclusion of a short-FRC base also influenced the fracture type resulting in most reparable fractures (67–75% versus 25% for biomimetic and CR groups respectively) (p = 0.054). Anatomically shaped i.e. a cusp-supporting design made of short-FRC base (everX Posterior) improved the chewing fracture resistance and fracture manner of compromised molars regardless of whether they were endodontically treated or not. more...

OBJECTIVE Determine whether higher targeted oxygen levels are associated with reduced incidence of pulmonary hypertension (PH) and elevated pulmonary vascular resistance (PVR) in extremely premature infants. STUDY DESIGN Retrospective chart review of 252 extremely preterm infants ( more...

Cycling masticatory loads decrease the strength of particulate filler composites (PFCs) and initiate the failure process by fatigue. The life expectancy of a composite resin restoration under stress remains difficult to predict.The purpose of this study was to determine the fracture resistance and the compressive fatigue limits (CFL) of anterior crown restorations made of a short-fiber reinforced composite resin (SFC), to investigate selected mechanical properties of the material following standard test methods, and to observe their correlation with the CFL.Specimens (n=10) were fabricated either from SFC (everX Posterior, GC Corp) or PFC (G-ænial anterior, GC Corp). The properties investigated were flexural strength (FS), compression strength (CS), diametral-tensile strength (DTS), and single-edge-notched-bend fracture toughness (FT) following ISO standards. Fracture resistance was determined by static load (n=10) and the CFL at 10000 cycles was determined using a staircase approach (n=20), both on anterior composite resin crowns. The results were analyzed with 1-way ANOVA (α=.05) or 2-way ANOVA (α=.05) followed by a Tukey B post hoc test and the Pearson-correlation analysis.The SFC crowns had higher fracture resistance (954 ±121 N) than the PFC crowns (415 ±75 N) (P.001) and higher CFL (267 ±23 N) than the PFC crowns (135 ±64 N) (P.001). SFC revealed also higher FT (2.6 ±0.6 MPa·m(1/2)) than the PFC (1.0 ±0.2 MPa·m(1/2)) (F=69.313, P.001). A significant correlation was observed only between the FT and the CFL (r(2)=0.899; P.001).SFC crowns showed good performance under static and fatigue loading. FT was the only in vitro test method that filtered as a clinically relevant parameter. more...

BackgroundCytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) is a treatment option for patients with peritoneal metastases shown to provide improved overall survival for appropriately selected patients. However, the availability and utilization of this treatment remains limited. The aim of this survey-based study was to evaluate factors influencing physician treatment choices for peritoneal metastases.MethodsSurveys were mailed to medical oncologists and surgeons in Virginia, Maryland, and Washington, D.C. Survey questions evaluated access to HIPEC centers, prior experience with referral to HIPEC centers, opinions regarding efficacy, and knowledge regarding outcomes of CRS and HIPEC.ResultsSurveys were mailed to 2279 physicians; 116 eligible surveys were returned. Seventy-five percent of respondents would consider referral to a HIPEC center for appendiceal peritoneal metastasis, while only 50% would consider it for colon cancer and peritoneal mesothelioma. The most common reason for never referring a patient to a HIPEC center was lack of access to a HIPEC specialist (47%) followed by perceived lack of evidence for the treatment modality (31%). Five-year survival after CRS and HIPEC was underestimated while 30-day mortality was overestimated by more than half of respondents.ConclusionsReferral to HIPEC centers is underutilized among community physicians in practice. Limited access to HIPEC experts is the most common cause for lack of referral, followed by a perception of insufficient evidence for this treatment approach. Lack of familiarity with data regarding outcomes impacts referral patterns and treatment choices. Possible actions to increase awareness and appropriate utilization of CRS and HIPEC are suggested. more...

The Helping Hand (HH) system is a novel grasp rehabilitation platform aimed at simplifying the clinical usage of wearable electrode arrays for neuromuscular electrical stimulation (NMES). In a randomized dose-matched, clinical study we evaluate usability and effectiveness of the HH treatment, and of other enriched upper limb rehabilitation treatments, and compare the outcomes. This paper shows the preliminary clinical results of the trial on 5 chronic stroke patients throughout a 9 weeks, 3 hours per week, hand preshaping training. more...

Introduction Scientific studies show that many factors related to lifestyles affect the reduction of bone mineral density and osteoporosis in postmenopausal women. Goal The goal of this study was to determine whether smoking, drinking coffee and alcohol in menopausal women contribute to the reduction of bone mass and osteoporosis, as well as the impact of physical activity on bone mass. Material and methods The study was carried out as case study and matched controls. The group of cases consisted of 100 females in postmenopausal age, in which by the DEXA method was newly diagnosed osteoporosis at the Clinic of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center of RS during 2015-2016, while the control group consisted of 100 females in a postmenopausal age without diagnosed osteoporosis. The groups were matched by age (±2 years). In order to collect demographic data and information on risk factors for osteoporosis and lifestyle of patients was used the questionnaire Bone Mineral Density Questionnaire- Female of the Irish Association for osteoporosis. Results Testing the significance of differences in terms of smoking showed that the studied groups are statistically significantly different in terms of smoking (χ2=24.025, p=0.000). In terms of consumption of coffee, a statistically significant difference was found between the group of cases and control group (χ2=0.615, p=0.735). When observing the obtained information about the consumption of alcohol, we find that this preventable risk factor in the present study did not show as significant for osteoporosis in postmenopausal women (χ2=4.35, p=0.114). Statistical analysis shows that there are significant differences between the group of cases and control group in terms of physical activity (χ2=7.30, p=0.026). Analysis of the data of our study by univariate logistic regressions showed that smoking (p=0.000) was statistically significantly associated with osteoporosis, while physical activity is a protective factor for bone mass (p=0.036). Results of multivariate logistic regression showed that the independent risk factors for osteoporosis in postmenopausal women is smoking (OR=1.665; p=0.006). Conclusion The results of our study show that smoking is an independent risk factor for osteoporosis in postmenopausal women, and physical activity is a protective factor for bone mass retention. Through education and certain preventive measures should be stressed the importance of these factors on bone health from the earliest period. more...

Background: Functional electrical stimulation (FES) can be applied as an assistive and therapeutic aid in the rehabilitation of foot drop. Transcutaneous multi-pad electrodes can increase the selectivity of stimulation; however, shaping the stimulation electrode becomes increasingly complex with an increasing number of possible stimulation sites. We described and tested a novel decision support system (DSS) to facilitate the process of multi-pad stimulation electrode shaping. The DSS is part of a system for drop foot treatment that comprises a customdesigned multi-pad electrode, an electrical stimulator, and an inertial measurement unit. Methods: The system was tested in ten stroke survivors (3-96 months post stroke) with foot drop over 20 daily sessions. The DSS output suggested stimulation pads and parameters based on muscle twitch responses to short stimulus trains. The DSS ranked combinations of pads and current amplitudes based on a novel measurement of the quality of the induced movement and classified them based on the movement direction (dorsiflexion, plantar flexion, eversion and inversion) of the paretic foot. The efficacy of the DSS in providing satisfactory pad-current amplitude choices for shaping the stimulation electrode was evaluated by trained clinicians. The range of paretic foot motion was used as a quality indicator for the chosen patterns. Results: The results suggest that the DSS output was highly effective in creating optimized FES patterns. The position and number of pads included showed pronounced inter-patient and inter-session variability; however, zones for inducing dorsiflexion and plantar flexion within the multi-pad electrode were clearly separated. The range of motion achieved with FES was significantly greater than the corresponding active range of motion (p < 0.05) during the first three weeks of therapy. Conclusions: The proposed DSS in combination with a custom multi-pad electrode design covering the branches of peroneal and tibial nerves proved to be an effective tool for producing both the dorsiflexion and plantar flexion of a paretic foot. The results support the use of multi-pad electrode technology in combination with automatic electrode shaping algorithms for the rehabilitation of foot drop. The research has been supported in part by grants of the Basque Government (PI2013-10), the ERA-NET EU/MINECO project (INDIGO-DBT2-051) and by the Ministry of Education, Science and Technological Development of Serbia (Project no. 175016). more...

Functional Electrical Stimulation (FES) is used for activation of nerves and muscles in order to restore their normal functions after an injury or stroke. Taking into consideration that electrical stimulation does not directly activate neural tissues, our intention was to show how this power is distributed in the tissues. In order to estimate the power (energy) distribution in the natural multilayer system of different tissues (skin, fat, muscle, and bone) we considered their respective geometries and electrical properties. Simulation was performed using a tissue model based on a finite element method. We present the energy distribution for each layer, and show that the largest portion of the energy is lost in the top skin layer, and that only a fraction reaches the targeted neural tissue. [Projekat Ministarstva nauke Republike Srbije, br. 175016] more...

Introduction. Ileostomy represents a necessary procedure to solve various surgical diseases in children. As the result of increased fluid loss and colonic exclusion in its regulation, it is often followed, particularly during the first months after birth, by chronic dehydration and failure to thrive. Objective. The aim of the paper was to present our experience related to the application of oral rehydration solution (ORS) to compensate the intestinal loss of water and electrolytes in infants with ileostomy. Methods. Treatment was performed with ORS containing 65 mmol/L of sodium in five infants aged 1.5-8 months (3.8?2.46 months) with dehydration and undernutrition after ileostomy performed in the first five days after birth. Results. After rehydration, the continual application of ORS in the daily dosage of 63.90?25.03 ml/kg, i.e. approximately matching the volume of intestinal content elimination (57.00?19.23 ml/kg), resulted in all infants in optimal water and electrolyte homeostasis, and in further course also in the improvement of their nutritional status (p=0.023). Conclusion. Our experience indicates that continual application of reduced sodium content of ORS in the approximate equal quantity of intestinal content loss represents the method of choice in water and electrolyte homeostasis maintenance in infants with ileostomy. more...

The aim of this study was to investigate the ability of the amputees to understand and identify proprioceptive feedback information presented by a set of dynamic stimulation patterns. The feedback relied on spatial coding of electrotactile stimuli, provided by a multichannel electrical stimulator, over custom designed array electrodes. Four stimulation patterns representing opening, closing, pronation and supination of a prosthetic hand were defined to mimic the change of the corresponding prosthesis degree of freedom. The psychometric evaluation on three amputee subjects confirmed that the four proposed dynamic stimulation patterns can be distinguished successfully after a short training. more...

Providing somatosensory feedback to the user of a myoelectric prosthesis is an important goal since it can improve the utility as well as facilitate the embodiment of the assistive system. Most often, the grasping force was selected as the feedback variable and communicated through one or more individual single channel stimulation units (e.g., electrodes, vibration motors). In the present study, an integrated, compact, multichannel solution comprising an array electrode and a programmable stimulator was presented. Two co ding schemes (15 levels), spatial and mixed (spatial and frequency) modulation, were tested in able-bodied subjects, psychometrically and in force control with routine grasping and force tracking using real and simulated prosthesis. The results demonstrated that mixed and spatial coding, although substantially different in psychometric tests, resulted in a similar performance during both force control tasks. Furthermore, the ideal, visual feedback was not better than the tactile feedback in routine grasping. To explain the observed results, a conceptual model was proposed emphasizing that the performance depends on multiple factors, including feedback uncertainty, nature of the task and the reliability of the feedforward control. The study outcomes, specific conclusions and the general model, are relevant for the design of closed-loop myoelectric prostheses utilizing tactile feedback. more...

Introduction: Scientific studies indicate that there is a correlation between decreased bone mineral density and the age of the patient, especially in post menopausal women. Goal: The aim of our study was to assess the connection between osteoporosis and the age of respondents, based on the DEXA findings in patients with calcium urolithiasis. Material and methods: The study was prospectively and conducted in University Clinical Center Banja Luka, at the Urology Clinic and Clinic of Internal Medicine. In this study the respondents were divided into two groups: experimental group–subjects with calcium urolithiasis and control group without calcium urolithiasis. The study included 240 patients, in both groups of 120 patients who were divided into three age groups: 20-40 years, 40-60 years and more than 60 years. In both groups of respondents was conducted determination of bone mineral density in L2-L4 vertebra lumbar spine and hip by DEXA method. Results: Observing the whole sample of the experimental group, according to age groups it can be noticed that DEXA results are at 72.5% normal, 27.5% below expected value, more in women within older subgroups, 20% show signs of osteopenia and osteoporosis in 7.5 %. Share of patients with osteoporosis is statistically different (p0.05). The share of patients with normal DEXA values was significantly lower in the group over 60 years compared to the other two age groups (p more...

A new and frequently utilized treatment option for symptomatic uterine leiomyoma is laparoscopic resection with morcellation so the specimen can be extracted through a small abdominal incision or through the vagina. Some of these tumors (approximately 0.2 %) have malignant foci of uterine leiomyosarcoma (ULMS) that is widely disseminated in the process of resection. These patients are in need of effective additional treatments. Patients with ULMS were treated with a standardized cytoreductive surgery (CRS), hyperthermic perioperative chemotherapy (HIPEC), and early postoperative intraperitoneal chemotherapy (EPIC) specifically designed for sarcomatosis. Distribution of disease by Peritoneal Cancer Index was recorded by preoperative computed tomography or magnetic resonance imaging and at the time of CRS. Completeness of cytoreduction score was determined after completion of CRS. Morbidity and mortality, as well as interval to start systemic chemotherapy, were prospectively recorded. Six patients with disseminated ULMS after morcellation or slicing underwent CRS and HIPEC plus EPIC. All six patients had complete visible clearing of sarcoma prior to perioperative chemotherapy. Early intervention after morcellation was associated with a lesser extent of disease. No serious morbidity or mortality was observed in early referral patients, and patients eligible for systemic chemotherapy were treated with perioperative chemotherapy within 6 weeks of the CRS. The future use of laparoscopic resection of ULMS with morcellation is currently under debate. However, patients after laparoscopic resection and morcellation have CRS and HIPEC plus EPIC as a treatment option. Results regarding short-term benefit are suggested by these early data, especially with early referral. more...

We designed a 24-field array and an on-line control box that selects which and how many of 24 fields will conduct electrical charge during functional electrical stimulation. The array was made using a conductive microfiber textile, silver two-component adhesive, and the conductive ink imprint on the polycarbonate. The control box comprised 24 switches that corresponded one-to-one to the fields on the array. Each field could be made con- ductive or nonconductive by simple pressing of the corre- sponding push-button type switch on the control box. We present here representative results of the selectivity of the new electrode measured in three tetraplegic patients dur- ing functional electrical stimulation of the forearm. The task was to generate finger flexion and extension with min- imal interference of the wrist movement during lateral and palmar grasps. Therapists determined the appropriate pat- tern that lead to effective grasping, lasting on average 5 min per stimulation channel in the first session. This opti- mal conductive pattern (size and shape) provided effective finger flexion and extension with minimal wrist flexion/ extension and ulnar/radial deviations ( < 10 degrees). The optimal size and shape of the electrode in all cases had a branched pattern. The selection of the optimal stimulation site was achieved without moving the electrode. The size and shape were reproducible in the same subject from session to session, yet were different from subject to sub- ject. The optimal electrode size and shape changed when subjects pronated and supinated their forearm. The control box includes a program that can dynamically change the number and sites of the conductive fields; hence, it is fea- sible to use this during functional movements. Subjects learned how to determine the optimal electrode pattern; hence, these electrodes could be effective for home usage. Key Words: Electrical stimulation—Electrode— Selective—Surface—Conductive fields. more...

Introduction Duplicated ureter or Duplex Collecting System is a congenital condition in which the ureteric bud, the embryological origin of the ureter, arises twice, resulting in two ureters draining a single kidney. This congenital anomaly is rare, and even rarer when the duplex system with ectopic ureter is present. This type of congenital anomaly is even more rarely diagnosed and surgically treated in adulthood. Case report This case report presents a case of a 32-year-old male, who had a duplex collecting system with two ureters on the left side. Ectopic ureter, draining the upper pole of the left kidney, opened into the posterior urethra. In our patient, taking into account the clinical perspective, the renal tissue damaging of the upper pole which was not functional, partial nephrectomy and ureterectomy was successfully performed. more...

OBJECTIVES To compare the relative thickness change of the transversal abdominal (TrA) and lumbar multifidus (LM) muscles during activation in individuals with and without low back pain (LBP), and to establish a relationship between surface electromyography (sEMG) signal amplitude and the relative thickness change of the corresponding muscle during clinically relevant activity, with preferential activation of TrA/LM. MATERIALS AND METHODS Thirty-seven pain-free participants and 36 LBP patients were assessed by ultrasound for thickness changes of TrA and LM and by sEMG for changes of electrical activity of the same muscles. sEMG is done with wireless LUMBIA system. The position of the sEMG sensors and activation maneuvers were chosen carefully. RESULTS Significant group effect was found for relative thickness change of TrA (F1,142=60.69, P more...

We designed a new surface multi-pad electrode for the electrical stimulation of the forearm that is effective in controlling functional grasp in hemiplegic patients. The electrode shape and size were designed on the basis of the surface stimulation map of the forearm, determined from measurements in seven hemiplegic patients who had limited or absent voluntary movements of the fingers, thumb and wrist. The stimulation map for each patient was assessed with a conventional set of single pad Pals Platinum electrodes. Since the sites for the stimulation varied greatly between patients, the end result was a rather large multi-pad electrode. Modulating multi-pad electrode size, shape, position and individual pad stimulation parameters allows us to accommodate the diversity of the neural tissues in patients that need to be activated for functional grasp. This also allows asynchronous activation of different portions of the muscle and dynamic adaptation of the stimulation sites to appropriate underlying tissues during functional use. The validity of the determined stimulation map was tested in the same group of hemiplegic patients. The selected set of active pads resulted in fully functional and reproducible palmar and lateral grasps similar to healthy-like grasps. more...

This research is in line with an important comment from the first amputee who tried the prosthetic hand with tactile feedback developed within the Smarthand project [1]. While trying the system with tactile feedback the patient said: "It's a feeling I have not had in a long time. When I grab something tightly I can feel it in the fingertips. It's strange since I don't have them anymore! It's amazing." We describe here the instrumentation and methods for testing the abilities of humans to discriminate sensations generated by electrical stimulation applied to the skin on the forearm. The instruments allowed testing of electrical stimulation with various properties (pulse duration, intensity, and rate). We tested the perception and pain thresholds, with the emphasis that comfortable sensations are a must. During the tests subjects were asked to locate the point on the skin that was stimulated and describe their perception of the elicited sensation. Results of first tests with small concentric electrodes suggest that non-amputees can distinguish up to seven perceptual qualities (the most common one was vibration, followed by tingling and tickling). Certain sensations had a higher occurrence rate along one axial line of the forearm than another of the forearm. In terms of spatial acuity, the subjects had more difficulties in distinguishing between the positions in the axial direction of the forearm compared with the circumferential direction. These results guided the design of the new array electrode with multiple cathodes and anodes positioned circumferential to the forearm. The results of the tests conducted with this electrode design showed high location discernment accuracy, and demonstrated the ability to memorize and later accurately recall six different electrical “messages” created by delivering electrical stimulation onto three different electrode pads with two different stimulation parameters. [Projekat Ministarstva nauke Republike Srbije, br. TR35040] more...

We applied Agglomerative Hierarchical Clustering (AHC) technique on independent components of low back surface electromyography (sEMG) signals, in order to differ sitting and standing postures. Preliminary results from small group of healthy subjects, suggested that presented method might be used to distinguish between two postures in different conditions. Clustering accuracy varied from 60% to 70% due to variation of position properties, even when the muscle activity was very low: from 11% to 23% of Maximal Voluntary Contraction (MVC). more...

In this paper we present a method for optimization of spatial selectivity of multi-pad electrode during transcutaneous Functional Electrical Stimulation (FES). The presented method is based on measurent of individual muscle twitches using Micro-Electro-Mechanical Systems (MEMS) accelerometers positioned on hand, while stimulating with low frequency electrical stimulation via pads within multi-pad electrode. When elicited, wrist or fingers flexion/extension produce different, characteristic wave shapes of acceleration, by using trained Artificial Neural Network (ANN) we can detect these characteristic signals and detect correlation of each pad and activated muscle beneath. Results presented in this paper show high degree of accurate classification of the elicited movement in inter-subject testing. more...

Background A successful new treatment for a particular disease may change the natural history of that disease as patients go on to longer survival. The goal of this study was to investigate the porta hepatis as a site of recurrence of appendiceal mucinous neoplasms. Methods A prospective database on patients with peritoneal dissemination of mucinous appendiceal neoplasms has been maintained for 21 years. In patients with complete cytoreduction, disease progression/recurrence in and around the porta hepatis has been noted as a new manifestation of this disease. Results In 710 patients treated for mucinous appendiceal cancer with a complete cytoreduction, 140 developed recurrent disease. Seven patients (5%) had disease recurrence in and around the porta hepatis. Four of the seven had biliary obstruction and three had masses within the liver hilum not causing bile duct obstruction. Four of the seven patients were successfully palliated by surgical procedures within the liver and biliary tree. Two patients were successfully palliated using a biliary stent and one patient was not treated. Conclusions Progression of mucinous neoplasms within the porta hepatis may be related to imperfect cytoreduction technique. Reoperative surgical treatment and biliary stents were beneficial in some of these patients. more...

We present advantages of the “intelligent matrix electrode” for providing selective correction of drop-foot in hemiplegic individuals. The matrix electrode which integrates stimulating and sensing parts could allow the emulation of the appropriate electrode shape and size; thereby, provision of selective stimulation that leads to functional movement and online adaptation of the electrode during the application. The need for selective stimulation follows recent findings about therapeutic effects of electrical stimulation in neurorehabilitation. The matrix electrode comprises small fields that can be made conductive and a controller that allows computerized selection of the fields being conductive. Here we present results from a study in nine hemiplegics. The matrix electrode was positioned over the peroneal nerve and primary dorsiflexor muscles and we estimated the movement of the foot by measuring the ankle joint angle. We found that the branched tree type shape and size of the electrode vary substantially when stimulating over the dorsiflexor muscles individuals in the study. We confirmed very high sensitivity to the position of small electrode when stimulating over the nerve. more...

Background Functional electrical stimulation (FES) applied via transcutaneous electrodes is a common rehabilitation technique for assisting grasp in patients with central nervous system lesions. To improve the stimulation effectiveness of conventional FES, we introduce multi-pad electrodes and a new stimulation paradigm. Methods The new FES system comprises an electrode composed of small pads that can be activated individually. This electrode allows the targeting of motoneurons that activate synergistic muscles and produce a functional movement. The new stimulation paradigm allows asynchronous activation of motoneurons and provides controlled spatial distribution of the electrical charge that is delivered to the motoneurons. We developed an automated technique for the determination of the preferred electrode based on a cost function that considers the required movement of the fingers and the stabilization of the wrist joint. The data used within the cost function come from a sensorized garment that is easy to implement and does not require calibration. The design of the system also includes the possibility for fine-tuning and adaptation with a manually controllable interface. Results The device was tested on three stroke patients. The results show that the multi-pad electrodes provide the desired level of selectivity and can be used for generating a functional grasp. The results also show that the procedure, when performed on a specific user, results in the preferred electrode configuration characteristics for that patient. The findings from this study are of importance for the application of transcutaneous stimulation in the clinical and home environments. more...