Design and real-time control of a robotic system for fracture manipulation.

This paper presents the design, development and control of a new robotic system for fracture manipulation. The objective is to improve the precision, ergonomics and safety of the traditional surgical procedure to treat joint fractures. The achievements toward this direction are here reported and include the design, the real-time control architecture and the evaluation of a new robotic manipulator system. The robotic manipulator is a 6-DOF parallel robot with the struts developed as linear actuators. The control architecture is also described here. The high-level controller implements a host-target structure composed by a host computer (PC), a real-time controller, and an FPGA. A graphical user interface was designed allowing the surgeon to comfortably automate and monitor the robotic system. The real-time controller guarantees the determinism of the control algorithms adding an extra level of safety for the robotic automation. The system's positioning accuracy and repeatability have been demonstrated showing a maximum positioning RMSE of 1.18 ± 1.14mm (translations) and 1.85 ± 1.54° (rotations).

Intra-operative 3D imaging system for robot-assisted fracture manipulation.

Reduction is a crucial step in the treatment of broken bones. Achieving precise anatomical alignment of bone fragments is essential for a good fast healing process. Percutaneous techniques are associated with faster recovery time and lower infection risk. However, deducing intra-operatively the desired reduction position is quite challenging due to the currently available technology. The 2D nature of this technology (i.e. the image intensifier) doesn't provide enough information to the surgeon regarding the fracture alignment and rotation, which is actually a three-dimensional problem. This paper describes the design and development of a 3D imaging system for the intra-operative virtual reduction of joint fractures. The proposed imaging system is able to receive and segment CT scan data of the fracture, to generate the 3D models of the bone fragments, and display them on a GUI. A commercial optical tracker was included into the system to track the actual pose of the bone fragments in the physical space, and generate the corresponding pose relations in the virtual environment of the imaging system. The surgeon virtually reduces the fracture in the 3D virtual environment, and a robotic manipulator connected to the fracture through an orthopedic pin executes the physical reductions accordingly. The system is here evaluated through fracture reduction experiments, demonstrating a reduction accuracy of 1.04 ± 0.69 mm (translational RMSE) and 0.89 ± 0.71 ° (rotational RMSE).

Immediate loading rehabilitation of a severe oligodontia: minimum impact on a young patient's social life.

The purpose of this work was to illustrate the treatment of a severe oligodontia on a patient at the end of the growth through the use of immediately loaded dental implants. Deciduous teeth from 7.4 to 8.3 were extracted in a young patient suffering this severe oligondontia. In the same session five conical implants were inserted by the use of Piezosurgery inserts and traditional burs. The impression for the temporary restoration was then taken and an acrylic temporary restoration stabilized with a laser-welded titanium bar was delivered two days after. One year after loading the impression for the final restoration was taken and the screw retained final rehabilitation was then given to the patient. The radiographic, phonetic and esthetic tests showed an accurate fitting and very satisfactory esthetic integration. The functional and esthetic deficits that could possibly occur with a delayed function different method were minimized with an immediate loading technique. Probably the young patient received a less psycho-esthetic-functional impact then a delayed technique, that in a young age could heavily affect his social life. Although this work considers a single case is interesting how today it's possible to overcome a problem that has to be evaluated with a relational global view, not only dental or esthetic one.

Mobile laminar air flow screen for additional operating room ventilation: reduction of intraoperative bacterial contamination during total knee arthroplasty.

BACKGROUND: Surgical site infections are important complications in orthopedic surgery. A mobile laminar air flow (LAF) screen could represent a useful addition to an operating room (OR) with conventional turbulent air ventilation (12.5 air changes/h), as it could decrease the bacterial count near the operating field. The purpose of this study was to evaluate LAF efficacy at reducing bacterial contamination in the surgical area during 34 total knee arthroplasties (TKAs). MATERIALS AND METHODS: The additional unit was used in 17 operations; the LAF was positioned beside the operating table between two of the surgeons, with the air flow directed towards the surgical area (wound). The whole team wore conventional OR clothing and the correct hygiene procedures and rituals were used. Bacterial air contamination (CFU/m(3)) was evaluated in the wound area in 17 operations with the LAF unit and 17 without the LAF unit. RESULTS: The LAF unit reduced the mean bacterial count in the wound area from 23.5 CFU/m(3) without the LAF to 3.5 CFU/m(3) with the LAF (P < 0.0001), which is below the suggested limit for an OR with ultraclean laminar ventilation. There were no significant differences in the mean bacterial count in the instrument table area: 28.6 CFU/m(3) were recorded with the LAF (N = 6) unit and 30.8 CFU/m(3) (N = 6) without the LAF unit (P = 0.631). During six operations with LAF and six without LAF, particle counts were performed and the number of 0.5 µm particles was analyzed. The particle counts decreased significantly when the LAF unit was used (P = 0.003). CONCLUSION: When a mobile LAF unit was added to the standard OR ventilation, bacterial contamination of the wound area significantly decreased to below the accepted level for an ultraclean OR, preventing SSI infections.

MR889, a neutrophil elastase inhibitor, in patients with chronic obstructive pulmonary disease: a double-blind, randomized, placebo-controlled clinical trial.

We investigated whether MR889, a synthetic cyclic thiolic elastase inhibitor, administered for a period of 4 weeks to chronic obstructive pulmonary disease (COPD) patients, is well-tolerated, and whether it modifies biochemical indices of lung destruction. The study was a double-blind, randomized, placebo-controlled clinical trial in COPD patients. Thirty subjects were administered MR889 orally at a dose of 500 mg b.i.d. for 4 weeks, and 30 received placebo following the same schedule. In addition to safety parameters, MR889 efficacy was checked by a pretreatment/postreatment evaluation of levels of plasma elastin-derived peptides and urinary desmosine. There were no statistically significant differences between pretreatment and posttreatment efficacy parameter levels either in the control group or in the treated group. However, in a subset of treated patients with a short disease duration, the level of urinary desmosine dropped significantly with respect to pretreatment values (p = 0.004). We conclude that MR889 is safe to administer to COPD patients for a period of at least 4 weeks. During this time, MR889 does not modify biochemical markers of lung destruction in unselected COPD patients. Nevertheless, a subset of treated patients with fairly short disease duration showed a post-treatment reduction of desmosine urine levels, thus justifying the need for further studies to prove the efficacy of MR889 in modulating indices of lung destruction in COPD.

[Phlebology and podiatry]. / Phlébologie et podologie.

By their tensing and relaxation, the muscles of the leg are thought to be responsible for compressing and relaxing the vascular walls and the lumen of vessels. In order to study the way the muscle structure of the lower limb (in particular the leg and the foot) functions, it is necessary to understand the step and break down its components. The weight of the body is transmitted to the ground by the astralagus which distributes the different forces throughout the fives systems of ossei trabeculae of the astralagus and the heel. The valgus heel determines a continuous traction on the tendon and the hind leg muscle which determines with time a dragging of the foot. When the body goes forward, the weight levels the transverse fore arch. The flexor muscles of the toes bend the phalanxes, gripping them to the ground, they avoid the falling forward of the body with the proximal insertion on the tibia. The sesamoids increase the muscles power as well as that of the kneecap on the quadriceps. The internal curvature of the foot on the ground is furthered by the decreasing length of the metatarsal bones. This is counterbalanced by the long fibular muscle which lowers the medial axis and raises the external axis. The supination of the forefoot depends only in part on the varus valgus of the rear of the foot. The plantar aponeurosis and the flexor tendons have an impact on the metatarsi because they increase the power and bring the insert closer. The complex articular system of the feet depends on the extrinsic and intrinsic muscle structure which, at the same time as a position variation can also play an important part in the venous alteration.

[Ethics committees: international experience and of the National Institute for cancer research of Genoa]. / Comitati etici: esperienze internazionali e dell'Istituto Nazionale per la ricerca sul cancro di Genova.

The aim of the present study is to describe the constitutions and functions of Ethics Committees and Institutional Review Boards. In particular, the experience of the National Institute for Cancer Research of Genoa in which the Authors carry out their activity is presented.

[Scientific institutions for treatment and care: purpose, characteristics and specific role in the oncologic sector]. / Istituti di ricovero e cura a carattere scientifico: finalità, caratteristiche e ruolo specifico nel settore oncologico.

The qualities of Comprehensive Health Care Institutes facilities established to foster, carry out and coordinate activities of scientific research and assistance in the field of biomedicine are described. At present there are 23 centers, their activity being based on two fundamental features: 1) topical research in specific themes characterizing the role these Institutes continuously play; 2) specialized research concerning subjects of particular interest and/or urgency suggested by the Ministry of Health.

The surgical treatment of valgus flat foot in the adolescent by osteotomy of calcaneum associated with tenodesis of tibialis anterior and posterior.

In the treatment of valgus flat foot in adolescent patients, when growth has nearly ceased (about 13 years in the female and 15 in the male) the operation of choice is varus osteotomy of the calcaneum, stabilised by a homoplastic bone wedge, together with tenodesis of tibialis anterior and posterior. At this age, skeletal growth is not sufficient to guarantee corrective evolution of the deformity after repositioning of the calcaneo-talar joint by any surgical technique. Varising osteotomy of the calcaneum offers the advantage of avoiding sacrifice of the calcaneo-talar joint, as in the Grice-Green arthrodesis, which although indicated for the paralytic valgus flat foot, is not appropriate in the idiopathic variety.

Pes cavus: treatment by naviculo-cuboid osteotomy.

The treatment of pes cavus in the adult by the V osteotomy of Japas has several advantages if performed before the onset of secondary arthritic degeneration. The correction is carried out at the apex of the cavus and is technically simple. Consolidation is rapid, and correction is achieved with no significant sacrifice of movement. The authors describe a modification of the medial part of the osteotomy line which was devised because of the difficulty of controlling the various fragments of navicular and cuboid during reduction in the original technique, as well as a significant incidence of osteonecrosis in some of these fragments. This modification involves only the naviculo-cuboid joint and spares the other joints, thus reducing postoperative articular stiffness to a minimum.

Allosteric inhibition as a model to explain flatter displacement curves in binding experiments: application to "heterogeneous" serotonin receptors.

Flattened or biphasic inhibition curves are usually interpreted by postulating the presence of two sites which are labelled with the same affinity by the ligand and can be recognized using the appropriate inhibitor with different selective affinities. We found that a priori this type of curve, can be equally fitted by another model, the allosteric model, on account of the mathematical equivalence of the two model functions when the 3H-ligand concentration is kept constant (i.e. inhibition experiments). A new approach consisting of three-dimensional analysis of the experimental data (3H-ligand binding as a function of ligand and inhibitor concentrations, simultaneously) permitted a statistical discrimination between the two models. The examples, used as tool for the present study, are the flattened or biphasic inhibition curves obtained by displacing 3H-serotonin with the neuroleptic spiperone. The results are discussed in relation to the general interpretation of this type of "anomalous" binding data and to the specific field of serotonergic receptor subtypes.

[Neurologic diseases, mental retardation and reduction in work capacity]. / Malattie neurologiche, ritardo mentale e riduzione della capacità di lavoro.

The reduction of working ability, because of disease, was considered in 1,053 subjects. 21 groups of maladies were found; the neurological disease and mental retardation (MR) caused various degrees of working inability in 416 subjects, i.e. in the 39.51% of the examined population; orthopaedic changes affected the 15.57% of the patients; psychic disorders determined some inability in 8.93% of the persons. The subjects unable to work receive, by Law, an economic help. This study was limited to neurological patients and to subjects mentally retarded. The working ability was reduced by 5 types of disturbances: neuromotor pathology, mental retardation, mental deterioration and dementia, epilepsy, other neurological diseases. The neuromotor pathology affected 163 subjects; the types of symptomatology: hemiplegia; it was found in 71 patients; 62 times it was the result of cerebrovascular disease; in 4 patients it was caused by a hypoxic-ischaemic pre-perinatal encephalopathy. 43 patients affected by cerebrovascular disease lost their personal autonomy, i.e. they could no longer do the activities of daily living (ADL); 7 patients lost their working ability; 12 subjects kept some ability to work. The hemiplegias which struck after 50 years of age were caused by cerebrovascular disease; paraplegia: 28 paraplegic patients have been seen; the aetiology was: poliomyelitis in 8 subjects; MS in 5 patients; ALS in 2 patients; in 13 patients the aetiology was unknown. 6 patients resulted unable to work; 8 persons kept some working ability; 14 patients lost the ability to do the ADL; tetraplegia, or double/bilateral hemiplegia, was found in 20 patients; the aetiology: poliomyelitis in 4 patients; pre-perinatal hypoxic ischaemic encephalopathy in 4 patients; 3 patients of MS; lesion of the cervical spinal cord because of breech delivery in 2 patients; the aetiology was not known in 7 persons. The ability to do the ADL was lost in 17 patients; 3 subjects kept some working ability. Double or bilateral hemiplegia (Little disease) was the model of neuromotor deficit subsequent natal encephalopathy (Infantile Cerebral Palsy, PCI); brachial plexus paralysis was only found from obstetrical (i.e. natal) origin; poliomyelitis and PKU resulted prevented as of 10 years. Mental Retardation (MR) was considered a borderline pathology between neurology and psychiatry; it included 162 subjects: in patients with severe MR a pre-perinatal hypoxic-ischaemic encephalopathy was found in 40.4% of the cases; in patients affected by moderate or light MR the same encephalopathy was found in the 11.3% of the subjects.(ABSTRACT TRUNCATED AT 400 WORDS)

The surgical treatment of mobile valgus flat foot in children.

The indications for surgical intervention in the treatment of mobile valgus flat foot in children are based on the age of the patient and the severity of the lesion. This depends on an accurate pre-operative assessment based on many clinical and radiographic signs and is the only way of deciding when orthotic treatment and physiokinesotherapy should be replaced by surgery.

Structure reactivity relationships in the microsomal oxidation of tertiary amines.

Apparent kinetic parameters Vmax and KM have been measured for the oxidative N-demethylation of twelve para-substituted N, N-dimethylanilines catalysed by rat liver microsomes. Vmax was enhanced by pretreatment of the rats with phenobarbital, whereas pretreatment with beta-naphthoflavone gave no appreciable enhancement. In the case of phenobarbital pretreatment the kinetic parameters could be expressed in terms of lipophilic and electronic effect of the substituents. Kinetic parameters from control and beta-naphthoflavone microsomes gave no statistically meaningful correlation.

The cardiorespiratory impairment in cirrhosis and sepsis. An experimental interpretation using octopamine infusion.

The effects of octopamine on systemic and pulmonary circulation and on respiratory parameters have been studied in ten O2 100% breathing pigs. A rise in cardiac index (CI) due to an increase in the dynamics of the left ventricle and a progressive hypoxemia, notwithstanding the hyperventilation, was found. The decrease in arterial O2 tension was due to a rise in the pulmonary shunt fraction (QS/QT). The statistical analysis of cardiorespiratory parameters demonstrated that the high flow state linked with a non-Starling mechanism was the causing factor of a ventilation: perfusion ratio (VA/QT) decrease, which led to the rise in QS/QT. Also, a decrease in the lung compliance simultaneous to the increased blood flow was observed. It is suggested that octopamine may play a role in the pathogenesis of the cardiorespiratory hemodynamic impairment of cirrhosis and sepsis where high levels of this false neurotransmitter were observed.

Influence of adriamycin on growth kinetics of Lewis lung carcinoma and its lung metastases.

Using a Gompertzian pharmacodynamic model, we have studied the changes induced by graded doses of adriamycin (AM) on the growth of intramuscular Lewis lung carcinoma (3LL) and its lung metastases in C57Bl/6 mice. An interpretation of the drug's effects on free growth of the tumor cells is given in the Appendix. Unlike other tumors (1-6), in which AM treatment induces no long-term change in growth parameters, in the 3LL model after an initial phase of inhibited growth following treatment with AM, the theoretically attainable plateau value is lowered. This is dose dependent for the primary tumor and even more so for metastases. In order to investigate whether the drug effect was irreversible or whether the host's weakened condition was a factor in the altered growth conditions, the tumor and its metastases were removed from AM-treated mice and transplanted in healthy animals in which its growth was then observed over time. For transplants of the primary intramuscular tumor no differences could be seen between treated and nontreated mice, but for the metastases the growth was markedly slowed. However, after a 'lag' period, the tumors arising from metastases returned to a growth pattern whose kinetic parameters, analyzed statistically, were not different from controls.