Toward the Development of User-Centered Neurointegrated Lower Limb Prostheses.

The last few years witnessed radical improvements in lower-limb prostheses. Researchers have presented innovative solutions to overcome the limits of the first generation of prostheses, refining specific aspects which could be implemented in future prostheses designs. Each aspect of lower-limb prostheses has been upgraded, but despite these advances, a number of deficiencies remain and the most capable limb prostheses fall far short of the capabilities of the healthy limb. This article describes the current state of prosthesis technology; identifies a number of deficiencies across the spectrum of lower limb prosthetic components with respect to users' needs; and discusses research opportunities in design and control that would substantially improve functionality concerning each deficiency. In doing so, the authors present a roadmap of patients related issues that should be addressed in order to fulfill the vision of a next-generation, neurally-integrated, highly-functional lower limb prosthesis.

Anomalous Discharge of Endogenous Gas at Lavinio (Rome, Italy) and the Lethal Accident of 5 September 2011.

The Rome region contains several sites where endogenous gas is brought to the surface through deep reaching faults, creating locally hazardous conditions for people and animals. Lavinio is a touristic borough of Anzio (Rome Capital Metropolitan City) that hosts a country club with a swimming pool and an adjacent basement balance tank. In early September 2011, the pool and the tank had been emptied for cleaning. On 5 September, four men descended into the tank and immediately lost consciousness. On 12 August 2012, after a long coma the first person died, the second one reported permanent damage to his central nervous system, and the other two men recovered completely. Detailed geochemical investigations show that the site is affected by a huge release of endogenous gas (CO2 ≈ 96 vol.% and H2S ≈ 4 vol.%). High soil CO2 and H2S flux values were measured near the pool (up to 898 and 7.155 g·m-2·day-1, respectively), and a high CO2 concentration (23-25 vol.%) was found at 50-70 cm depth in the soil. We were able to demonstrate that gas had been transported into the balance tank from the swimming pool through two hubs connected to the lateral overflow channels of the pool. We show also that the time before the accident (60 hr), during which the balance tank had remained closed to external air, had been largely sufficient to reach indoor nearly lethal conditions (oxygen deficiency and high concentration of both CO2 and H2S).

[Malignant maxillary tumors involving the pterygo-maxillary and infratemporal fossae: a series of 200 cases]. / Resezione cranio-facciale anteriore per tumori maligni: esperienza di 200 casi.

At the Cranio-Maxillo-Facial Surgery Unit of the Istituto Nazionale per lo Studio e la Cura dei Tumori in Milan, Italy between 1987 and 1999 200 anterior cranio-facial resections were performed on malignant ethmoid tumors involving the anterior cranial base and extending to the nasal fossae and, at times to the orbit and maxillary and sphenoid sinuses. In the second portion of this case study the authors simplified their surgical technique. The frontal craniotomy was made rectangular and low, performed with an oscillating saw and scalpel, without drilling holes. The osteotomy of the cranial base was modulated according to tumor extension. Typically a paralateronasal facial incision was performed without opening the upper lip. Whenever the maxillary sinus and/or orbit were involved, the skin incision and osteotomy was consequently modified. Repair of the cranial base was performed with a pedicled pericranial flap. In this case study there were 6 post-operative deaths in the first 30 patients and only 2 in the remaining 170. The male/female ratio was 145/55, mean age 55 years (12-80) and average follow-up 38 months (2-117). There were 120 primary tumors while the remaining 80 patients presented recurrences from prior treatments. There were 96 adenocarcinomas, 42 spinocellular carcinomas, 21 esthesioneuroblastoma 15 adenoid-cystic carcinomas, 9 melanomas and 17 rare tumors. Our classification identified the following stages: 69 T2, 54 T3 and 77 T4 while the UICC-AJCC staging system indicated: 25 T1, 16 T2, 68 T3 and 91 T4. The NED survival according to tumor stage (INT classification) was: T262.3%, T3 44.4% and T4 29.9%. The NED survival for patients who had not previously undergone treatment was: T2 71.7%, T3 58.8% and T4 42.5%. On the other hand the NED survival for the cases of recurrence was: T2 43.5%, T3 20% and T4 16.2%. These results lead to the conclusion that the surgical technique currently used is valid and that the anterior cranio-facial resection should always be performed in patients with ethmoid tumors coming into contact with, or eroding, the cribriform plate. For all staging classes, the prognosis for those patients undergoing surgery for recurrence from prior, inadequate treatment was significantly worse than that for the primary tumors.