Microbial electrosynthesis: opportunities for microbial pure cultures.

Microbial electrosynthesis (MES) is an emerging technology that couples renewable electricity to microbial production processes. Although advances in MES performance have been driven largely by microbial mixed cultures, we see a great limitation in the diversity, and hence value, of products that can be achieved in undefined mixed cultures. By contrast, metabolic control of pure cultures and genetic engineering could greatly expand the scope of MES, and even of broader electrobiotechnology, to include targeted high-value products. To leverage this potential, we advocate for more efforts and activities to develop engineered electroactive microbes for synthesis, and we highlight the need for a standardized electrobioreactor infrastructure that allows the establishment and engineering of electrobioprocesses with these novel biocatalysts.

Microbial electrosynthesis with Clostridium ljungdahlii benefits from hydrogen electron mediation and permits a greater variety of products.

Microbial electrosynthesis (MES) is a very promising technology addressing the challenge of carbon dioxide recycling into organic compounds, which might serve as building blocks for the (bio)chemical industry. However, poor process control and understanding of fundamental aspects such as the microbial extracellular electron transfer (EET) currently limit further developments. In the model acetogen Clostridium ljungdahlii, both direct and indirect electron consumption via hydrogen have been proposed. However, without clarification neither targeted development of the microbial catalyst nor process engineering of MES are possible. In this study, cathodic hydrogen is demonstrated to be the dominating electron source for C. ljungdahlii at electroautotrophic MES allowing for superior growth and biosynthesis, compared to previously reported MES using pure cultures. Hydrogen availability distinctly controlled an either planktonic- or biofilm-dominated lifestyle of C. ljungdahlii. The most robust operation yielded higher planktonic cell densities in a hydrogen mediated process, which demonstrated the uncoupling of growth and biofilm formation. This coincided with an increase of metabolic activity, acetate titers, and production rates (up to 6.06 g L-1 at 0.11 g L-1 d-1). For the first time, MES using C. ljungdahlii was also revealed to deliver other products than acetate in significant amounts: here up to 0.39 g L-1 glycine or 0.14 g L-1 ethanolamine. Hence, a deeper comprehension of the electrophysiology of C. ljungdahlii was shown to be key for designing and improving bioprocess strategies in MES research.

Assistance Robotics and Sensors.

In recent years, the exploitation of assistive robotics has experienced significant growth, mostly based on the development of sensor and processing technologies with the increasing interest in improving the interactions between robots and humans and making them more natural [...].

Electro-fermentation: Sustainable bioproductions steered by electricity.

The market of biobased products obtainable via fermentation processes has steadily increased over the past few years, driven by the need to create a decarbonized economy. To date, industrial fermentation (IF) employs either pure or mixed microbial cultures (MMC), whereby the type of the microbial catalysts and the used feedstock affect metabolic pathways and, in turn, the type of product(s) generated. In many cases, especially when dealing with MMC, the economic viability of IF is still hindered by factors such as the low attained product titer and selectivity, which ultimately challenge the downstream recovery and purification steps. In this context, electro-fermentation (EF) represents an innovative approach, based on the use of a polarized electrode interface to trigger changes in the rate, yield, titer or product distribution deriving from traditional fermentation processes. In principle, the electrode in EF can act as an electron acceptor (i.e., anodic electro-fermentation, AEF) or donor (i.e., cathodic electro-fermentation, CEF), or simply as a means to control the oxidation-reduction potential of the fermentation broth. However, the molecular and biochemical basis underlying EF are still largely unknown. This review provides a comprehensive overview of recent literature studies including both AEF and CEF examples using pure or mixed microbial cultures. A critical analysis of biochemical, microbiological, and engineering aspects which presently hamper the transition of the EF technology from the laboratory to the market is also presented.

Management of NF-1 dystrophic scoliosis associated with rib heads dislocation into the spinal canal in neurological intact patients: a systematic literature review.

PURPOSE: The management of scoliosis and kyphoscoliosis in patients with Type 1 Neurofibromatosis (NF-1) among spinal surgeons is still challenging due to the severity of the deformity especially in dystrophic deformity types. This rapid and progressive condition is likely to be associated with dislocated rib heads into the spinal canal, hence representing a real dilemma on the decision making between its resection versus not resection during the corrective surgery, especially in patients with normal neurological status. The objective of this publication is to discuss the management options in this patient population through a literature review. METHODS: A comprehensive systematic literature search was performed for relevant studies using PubMed, Web of Science, and Scopus databases. Previous publications depicting neurologically intact patients with NF-1 and rib dislocation into the canal were reviewed. Articles reporting individual cases or case series/cohorts with patient-discriminated findings were included. RESULTS: The data collection retrieved a total of 55 neurologically intact patients with NF-1 dystrophic scoliosis and rib penetration into the canal who underwent spinal surgery. Among them, 37 patients underwent surgery without head rib resection and 18 patients with rib excision. No patient presented postoperative neurological deficit except for one case of late postoperative neurological deterioration reported in a patient within situ fusion in which the surgeons ignored the presence of previous spinal cord compression. CONCLUSION: Corrective surgery for patients with NF-1 and rib penetration into the canal in neurologically intact patients can be safely performed without the resection of the dislocated rib heads without a higher risk of neurological compromise.

Glucocorticoides en hemorragia alveolar por leptospira / Glucocorticoids in leptospira alveolar hemorrhage

Resumen Se presentan los casos clínicos de dos pacientes que ingresaron en la guardia de Emergencias del HIGA San Martín de La Plata con un cuadro clínico compatible con leptospirosis, que evolucionaron con insuficiencia respiratoria y hemorragia alveolar. En ambos se administraron glucocorticoides con buena evolución. Se realizó una búsqueda bibliográfica de artículos publicados desde 2005 en castellano e inglés y la revisión del tema. Basada en la evidencia actual no se puede hacer una clara recomendación para el uso de corticoides en la leptospirosis grave. La bibliografía publicada es escasa y de baja calidad. Aparentemente habría un beneficio en el uso de corticoides en los casos de afectación pulmonar por leptospirosis grave. Se necesitan estudios de alta calidad para realizar recomendaciones con evidencia científica, para verificar la dosis adecuada de corticoides, tiempo de inicio, duración del tratamiento y los casos en los que se debería administrar esta terapéutica.

Abstract We present the clinical cases of two patients who were admitted to the HIGA San Martín de La Plata emergency ward with a clinical picture compatible with leptospirosis, who evolved with respiratory failure and alveolar hemorrhage. In both, glucocorticoids were administered with good evolution. A bibliographic search of articles published since 2005 in Spanish and English and a review of the topic was carried out. Based on the current evidence, no clear recommendation can be made for the use of corticosteroids in severe leptospirosis. The published bibliography is scarce and of low quality. There would appear to be a benefit in the use of corticosteroids in cases of pulmonary involvement due to severe leptospirosis. High-quality studies are needed to make recommendations with scientific evidence, to verify the adequate dose of corticosteroids, time of initiation, duration of treatment and the cases in which this therapy should be administered.

[Glucocorticoids in leptospira alveolar hemorrhage]. / Glucocorticoides en hemorragia alveolar por leptospira.

We present the clinical cases of two patients who were admitted to the HIGA San Martín de La Plata emergency ward with a clinical picture compatible with leptospirosis, who evolved with respiratory failure and alveolar hemorrhage. In both, glucocorticoids were administered with good evolution. A bibliographic search of articles published since 2005 in Spanish and English and a review of the topic was carried out. Based on the current evidence, no clear recommendation can be made for the use of corticosteroids in severe leptospirosis. The published bibliography is scarce and of low quality. There would appear to be a benefit in the use of corticosteroids in cases of pulmonary involvement due to severe leptospirosis. High-quality studies are needed to make recommendations with scientific evidence, to verify the adequate dose of corticosteroids, time of initiation, duration of treatment and the cases in which this therapy should be administered.

Se presentan los casos clínicos de dos pacientes que ingresaron en la guardia de Emergencias del HIGA San Martín de La Plata con un cuadro clínico compatible con leptospirosis, que evolucionaron con insuficiencia respiratoria y hemorragia alveolar. En ambos se administraron glucocorticoides con buena evolución. Se realizó una búsqueda bibliográfica de artículos publicados desde 2005 en castellano e inglés y la revisión del tema. Basada en la evidencia actual no se puede hacer una clara recomendación para el uso de corticoides en la leptospirosis grave. La bibliografía publicada es escasa y de baja calidad. Aparentemente habría un beneficio en el uso de corticoides en los casos de afectación pulmonar por leptospirosis grave. Se necesitan estudios de alta calidad para realizar recomendaciones con evidencia científica, para verificar la dosis adecuada de corticoides, tiempo de inicio, duración del tratamiento y los casos en los que se debería administrar esta terapéutica.

Susceptibility of boar spermatozoa to heat stress using in vivo and in vitro experimental models.

Induction of heat stress as an experimental procedure in animals is commonly used to examine heat-related impacts on sperm quality. This study aimed to develop potential heat stress models that could be used at any time of the year, to advance the study of seasonal infertility in the pig under controlled conditions. Heat stress was induced by either housing boars (n = 6) at 30 °C inside a hot room for 42 days (55-65% humidity; LD 12:12 h; in vivo), or by heating boar semen (n = 7) for 30 min at various temperatures (35.5, 38.8, 40, 42, 46, 50, 54 and 60 °C; in vitro). Sperm motility was then characterized by computer-assisted sperm analysis (CASA; IVOS version 10: Hamilton Thorne, USA), and DNA integrity was evaluated by terminal deoxynucleotidyl transferase dUTP nick-end labelling (TUNEL) and flow cytometry. Our in vivo hot room model induced biologically meaningful levels of DNA damage in boar spermatozoa (10.1 ± 1.9 hot room vs. 6.7 ± 1.7% control; P > 0.05), although not statistically significant from controls. Moreover, sperm concentration and motility parameters did not differ between treatments (P > 0.05). Compared to the 38.8 °C control, our in vitro heat shock model significantly increased sperm DNA damage after incubation at 54 and 60 °C (3.0 ± 1.0, 2.9 ± 1.0, 1.2 ± 0.3, 2.5 ± 0.7, 9.0 ± 3.7, 16.2 ± 7.1, 14.2 ± 5.8 and 41.8 ± 18.6% respectively; P ≤ 0.05). However, these temperatures rendered sperm completely immotile or dead, with most motility parameters declining rapidly to zero above 40 or 42 °C. In conclusion, our results suggest that temperature combined with individual factors may contribute to a boar's overall susceptibility to heat stress. Refinement of these models particularly of the in vitro heat shock model could be further pursued to overcome environmental variability, reduce whole animal experiments and provide a putative diagnostic fertility screening tool to evaluate heat tolerance in the boar.

Patients' and rheumatologists' perspectives on the efficacy and safety of low-dose glucocorticoids in rheumatoid arthritis-an international survey within the GLORIA study.

OBJECTIVE: To evaluate the current perspectives of patients and health professionals regarding the efficacy and safety of low-dose glucocorticoids (GCs) in RA. METHODS: Two online surveys were disseminated to patients and health professionals, in their native language, through national patient organizations and national rheumatology medical societies, respectively. SurveyMonkey®, MediGuard.org and the Glucocorticoid Low-dose Outcome in RA Study (GLORIA) website were used to offer and deliver these surveys. RESULTS: A total of 1221 RA patients with exposure to GCs, and 414 rheumatologists completed the surveys. Patients and rheumatologists reported high levels of agreement regarding the efficacy of low-dose GCs: at least 70% considered that they are very rapid and effective in the control of signs and symptoms of RA. However, half of the patients also reported having suffered serious adverse events with GCs, and 83% described concerns about safety. The majority of rheumatologists estimated that endocrine, ophthalmologic and cutaneous adverse events affect >4% of all patients treated with low-dose GCs for 2 years, based on a heat map. CONCLUSIONS: RA patients with self-reported exposure to GCs express high levels of satisfaction with low-dose GCs efficacy, as do rheumatologists. However, both expressed excessive concerns regarding the safety of GCs (greatly exceeding the published evidence data), which may compromise the optimal use of this medication. This study indicates that there is an unmet need for appropriately designed prospective trials that shed light on the real risk associated with low-dose GCs, as well as a need for renovated educational programs on the real benefits and harms of low-dose GCs, for both patients and physicians.

Acute Effect of Drop-Set, Traditional, and Pyramidal Systems in Resistance Training on Neuromuscular Performance in Trained Adults.

ABSTRACT: Costa, BDV, Ferreira, MEC, Gantois, P, Kassiano, W, Paes, ST, de Lima-Júnior, D, Cyrino, ES, and Fortes, LS. Acute effect of drop-set, traditional, and pyramidal systems in resistance training on neuromuscular performance in trained adults. J Strength Cond Res 35(4): 991-996, 2021-The aim of this study was to analyze the acute effects of resistance training (RT) systems on lower- and upper-limb performance in trained adults. Eighteen male young adults with experience in RT aged from 18 to 26 years underwent the 3 experimental conditions (drop-set [DS], decrescent pyramid [DP], and traditional [TR]). The subjects performed 2 exercises (bench press and leg press 45°). In the DS condition, they underwent 2 sets of 10 repetitions at 12RM, followed by 5 additional repetitions with an intensity of 15RM with 6-minute interval rest between sets. In the DP, it was performed 3 sets of 10 repetitions at 10RM, 12RM, and 15RM, respectively, and the rest interval was 3 minutes between sets. In the TR, the subjects performed 3 sets of 10 repetitions at 12RM with 3 minutes of rest between sets. Countermovement jump, peak power (Wpeak), and force (Fpeak) in the bench press were evaluated in the baseline, before, and 30 minutes after the experimental sessions. Countermovement jump performance decreased significantly only after the DS and DP conditions (-6.7 and -1.9%, respectively). The groups were significantly different in the post-intervention; the DS condition presented lower values when compared with the DP (p = 0.01) and TR (p = 0.001). According to Fpeak and Wpeak, only DS condition significantly decreased the performance (-3.8 and -4.1%, respectively). The results indicate the DS and DP conditions impair the neuromuscular performance of the lower limbs, whereas for upper limbs, only DS condition negatively affect upper-limb performance.

How much of skin improvement over time in systemic sclerosis is due to normal ageing? A prospective study with shear-wave elastography.

BACKGROUND: Measurement of skin involvement is essential for the diagnosis and assessment of prognosis and disease progression in systemic sclerosis (SSc). The modified Rodnan skin score (mRSS) is the gold standard measure of skin thickness, but it has been criticised for the lack of objectivity, poor inter-observer reproducibility and lack of sensitivity to change. Recently, shear-wave elastography (SWE) emerged as a promising tool for the objective and quantitative assessment of the skin in SSc patients. However, no studies have evaluated its sensitivity to change over time. OBJECTIVE: To assess changes in skin stiffness in SSc patients using SWE during a 5-year follow-up. METHODS: Skin stiffness [i.e. shear-wave velocity values (SWV) in metres per second] was assessed by SWE ultrasound (using virtual touch image quantification) at the 17 sites of the mRSS, in each participant, at baseline and follow-up. mRSS was performed at both time points. Differences between groups were analysed using the related-samples Wilcoxon signed-rank test and the Mann-Whitney U test. RESULTS: We included 21 patients [85.7% females; mean age 56.3 (10.4) years at baseline, 57.1% with limited SSc] and 15 healthy controls [73.3% females; mean age 53.6 (14.1) years)]. The median follow-up was 4.9 (0.4) years. Skin stiffness decreased significantly at all Rodnan sites (p ≤ 0.001) (except in the fingers), in SSc patients, over time. The same phenomenon occurred in controls, but to a lesser degree, in terms of percentage change. The percentage reduction in skin stiffness varied in the different Rodnan sites and in different phases of the disease. In addition, SWV values also decreased significantly in 15/16 skin sites with local normal Rodnan at baseline, whereas local Rodnan skin score only changed significantly in the upper arm (p = 0.046) and forearm (p = 0.026). CONCLUSION: This study provides first-time evidence suggesting that skin SWV values are more sensitive to change over time than mRSS and reduce significantly over time in SSc and normal controls.

Assistance Robotics and Biosensors 2019.

This Special Issue is focused on breakthrough developments in the field of assistive and rehabilitation robotics. The selected contributions include current scientific progress from biomedical signal processing and cover applications to myoelectric prostheses, lower-limb and upper-limb exoskeletons and assistive robotics.

Boosting Heterologous Phenazine Production in Pseudomonas putida KT2440 Through the Exploration of the Natural Sequence Space.

Phenazine-1-carboxylic acid (PCA) and its derivative pyocyanin (PYO) are natural redox mediators in bioelectrochemical systems and have the potential to enable new bioelectrochemical production strategies. The native producer Pseudomonas aeruginosa harbors two identically structured operons in its genome, which encode the enzymes responsible for PCA synthesis [phzA1-G1 (operon 1), phzA2-G2 (operon 2)]. To optimize heterologous phenazines production in the biotech host Pseudomonas putida KT2440, we compared PCA production from both operons originating from P. aeruginosa strain PAO1 (O1.phz1 and O1.phz2) as well as from P. aeruginosa strain PA14 (14.phz1 and 14.phz2). Comparisons of phenazine synthesis and bioelectrochemical activity were performed between heterologous constructs with and without the combination with the genes phzM and phzS required to convert PCA to PYO. Despite a high amino acid homology of all enzymes of more than 97%, P. putida harboring 14.phz2 produced 4-times higher PCA concentrations (80 µg/mL), which resulted in 3-times higher current densities (12 µA/cm2) compared to P. putida 14.phz1. The respective PCA/PYO producer containing the 14.phz2 operon was the best strain with 80 µg/mL PCA, 11 µg/mL PYO, and 22 µA/cm2 current density. Tailoring phenazine production also resulted in improved oxygen-limited metabolic activity of the bacterium through enhanced anodic electron discharge. To elucidate the reason for this superior performance, a detailed structure comparison of the PCA-synthesizing proteins has been performed. The here presented characterization and optimization of these new strains will be useful to improve electroactivity in P. putida for oxygen-limited biocatalysis.

Antioxidant supplementation mitigates DNA damage in boar (Sus scrofa domesticus) spermatozoa induced by tropical summer.

Heat stress-induced sperm DNA damage has recently been demonstrated in boars during tropical summer; which could negatively impact early embryo survival and litter size in sows. Given the boar's inefficient capacity to sweat, non-pendulous scrotum and low antioxidant activity in seminal plasma, elevated endogenous levels of antioxidants are needed to combat reactive oxygen species induced during periods of heat stress. This should prevent the build-up of pathological levels of DNA damage in boar spermatozoa. Our aim was to investigate whether a combined antioxidant supplement could mitigate sperm DNA damage in boars exposed to tropical summer conditions. Terminal deoxynucleotidyl transferase dUTP nick end labelling and flow cytometry of 20,000 spermatozoa/boar/treatment revealed that boar diets supplemented with 100 g/day custom-mixed antioxidant during peak wet summer effectively reduced sperm DNA damage by as much as 55% after 42 and 84 days treatment respectively (16.1 ± 4.9 peak wet control vs. 9.9 ± 4.5 42 day vs. 7.2 ± 1.6% 84 day treatments; P ≤ 0.05). Supplementation did not improve sperm concentration beyond control levels for either season (P > 0.05); nor alter total motility, progressive motility or several other motion parameters measured by computer assisted sperm analysis of 20 x 106 sperm/mL at 38°C (P > 0.05). Antioxidant supplementation during tropical summer appears to mitigate the negative impact of heat stress on DNA integrity but not concentration nor motility of boar spermatozoa; which may provide one solution to the problem of summer infertility in the pig.

Tropical summer induces DNA fragmentation in boar spermatozoa: implications for evaluating seasonal infertility.

Summer infertility continues to undermine pig productivity, costing the pig industry millions in annual losses. The boar's inefficient capacity to sweat, non-pendulous scrotum and the extensive use of European breeds in tropical conditions, can make the boar particularly vulnerable to the effects of heat stress; however, the link between summer heat stress and boar sperm DNA damage has not yet been demonstrated. Semen from five Large White boars was collected and evaluated during the early dry, late dry and peak wet seasons to determine the effect of seasonal heat stress on the quality and DNA integrity of boar spermatozoa. DNA damage in spermatozoa during the peak wet was 16-fold greater than during the early dry and nearly 9-fold greater than during the late dry season. Sperm concentration was 1.6-fold lower in the peak wet than early dry whereas no difference was found across several motility parameters as determined by computer-assisted sperm analysis. These results demonstrate that tropical summer (peak wet season) induces DNA damage and reduces concentration without depressing motility in boar spermatozoa, suggesting that traditional methods of evaluating sperm motility may not detect inherently compromised spermatozoa. Boar management strategies (such as antioxidant supplementation) need to be developed to specifically mitigate this problem.

Assistance Robotics and Biosensors.

This Special Issue is focused on breakthrough developments in the field of biosensors and current scientific progress in biomedical signal processing. The papers address innovative solutions in assistance robotics based on bioelectrical signals, including: Affordable biosensor technology, affordable assistive-robotics devices, new techniques in myoelectric control and advances in brain⁻machine interfacing.

Luxación anterior aislada e irreductible de la cúpula radial en un paciente pediátrico: un raro reporte de caso / Isolated irreducible anterior radial head dislocation in a child: a rare case report

La luxación de la cabeza radial suele asociarse a fractura o deformidad plástica cubital. La luxación aislada es rara. Sin tratamiento, puede evolucionar hacia deformidad cubital en valgo, lesión nerviosa, artrosis precoz y pérdida del rango de movilidad con limitación funcional. Se presenta a un paciente de 9 años que sufrió traumatismo de codo. Acudió a nuestra Institución a los 40 días y se diagnosticó luxación irreductible de la cabeza radial, primero desapercibida. La luxación era irreductible por un ojal en el ligamento anular y requirió ser reducida a cielo abierto. En ausencia de fractura, incluso sin evidencia de deformidad plástica del cúbito, debe sospecharse la luxación de la cabeza radial. La clínica, junto con el par radiográfico bilateral y el conocimiento de esta entidad poco frecuente, son el trípode necesario para alcanzar el diagnóstico y no demorar el tratamiento.

Anterior radial head dislocation in pediatric population is related to Monteggia fracture-dislocations. Isolated radial head dislocation is uncommon. Sometimes, radial head dislocation becomes irreducible. This entity can develop into chronic conditions such as nerve injuries, early osteoarthritis, limited range of motion and cubitus valgus. We describe a case of a 9-year-old patient who suffered elbow trauma. He was admitted to our institution 40 days after, where radial head dislocation was diagnosed. This condition was misdiagnosed at first stage. It was irreducible due to a tear in the annular ligament. He underwent open reduction. Radial head dislocation must be suspected even if there are no fractures or plastic deformity. Pure irreducible radial head dislocation is rare. Physical examination, together with plain bilateral radiographs and full acknowledgement of this rare condition are the basis to reach early diagnosis, which leads to proper non-delayed treatment.

[Isolated irreducible anterior radial head dislocation in a child: a rare case report]. / Luxación anterior aislada e irreductible de la cúpula radial en un paciente pediátrico: un raro reporte de caso.

Anterior radial head dislocation in pediatric population is related to Monteggia fracture-dislocations. Isolated radial head dislocation is uncommon. Sometimes, radial head dislocation becomes irreducible. This entity can develop into chronic conditions such as nerve injuries, early osteoarthritis, limited range of motion and cubitus valgus. We describe a case of a 9-year-old patient who suffered elbow trauma. He was admitted to our institution 40 days after, where radial head dislocation was diagnosed. This condition was misdiagnosed at first stage. It was irreducible due to a tear in the annular ligament. He underwent open reduction. Radial head dislocation must be suspected even if there are no fractures or plastic deformity. Pure irreducible radial head dislocation is rare. Physical examination, together with plain bilateral radiographs and full acknowledgement of this rare condition are the basis to reach early diagnosis, which leads to proper non-delayed treatment.

La luxación de la cabeza radial suele asociarse a fractura o deformidad plástica cubital. La luxación aislada es rara. Sin tratamiento, puede evolucionar hacia deformidad cubital en valgo, lesión nerviosa, artrosis precoz y pérdida del rango de movilidad con limitación funcional. Se presenta a un paciente de 9 años que sufrió traumatismo de codo. Acudió a nuestra Institución a los 40 días y se diagnosticó luxación irreductible de la cabeza radial, primero desapercibida. La luxación era irreductible por un ojal en el ligamento anular y requirió ser reducida a cielo abierto. En ausencia de fractura, incluso sin evidencia de deformidad plástica del cúbito, debe sospecharse la luxación de la cabeza radial. La clínica, junto con el par radiográfico bilateral y el conocimiento de esta entidad poco frecuente, son el trípode necesario para alcanzar el diagnóstico y no demorar el tratamiento.

A Vision-Driven Collaborative Robotic Grasping System Tele-Operated by Surface Electromyography.

This paper presents a system that combines computer vision and surface electromyography techniques to perform grasping tasks with a robotic hand. In order to achieve a reliable grasping action, the vision-driven system is used to compute pre-grasping poses of the robotic system based on the analysis of tridimensional object features. Then, the human operator can correct the pre-grasping pose of the robot using surface electromyographic signals from the forearm during wrist flexion and extension. Weak wrist flexions and extensions allow a fine adjustment of the robotic system to grasp the object and finally, when the operator considers that the grasping position is optimal, a strong flexion is performed to initiate the grasping of the object. The system has been tested with several subjects to check its performance showing a grasping accuracy of around 95% of the attempted grasps which increases in more than a 13% the grasping accuracy of previous experiments in which electromyographic control was not implemented.

Prognostic value of changes in brain tissue oxygen pressure before and after decompressive craniectomy following severe traumatic brain injury.

OBJECTIVE In severe traumatic brain injury (TBI), the effects of decompressive craniectomy (DC) on brain tissue oxygen pressure (PbtO2) and outcome are unclear. The authors aimed to investigate whether changes in PbtO2 after DC could be used as an independent prognostic factor. METHODS The authors conducted a retrospective, observational study at 2 university hospital ICUs. The study included 42 patients who were admitted with isolated moderate or severe TBI and underwent intracranial pressure (ICP) and PbtO2 monitoring before and after DC. The indication for DC was an ICP higher than 25 mm Hg refractory to first-tier medical treatment. Patients who underwent primary DC for mass lesion evacuation were excluded. However, patients were included who had undergone previous surgery as long as it was not a craniectomy. ICP/PbtO2 monitoring probes were located in an apparently normal area of the most damaged hemisphere based on cranial CT scanning findings. PbtO2 values were routinely recorded hourly before and after DC, but for comparisons the authors used the first PbtO2 value on ICU admission and the number of hours with PbtO2 < 15 mm Hg before DC, as well as the mean PbtO2 every 6 hours during 24 hours pre- and post-DC. The end point of the study was the 6-month Glasgow Outcome Scale; a score of 4 or 5 was considered a favorable outcome, whereas a score of 1-3 was considered an unfavorable outcome. RESULTS Of the 42 patients included, 26 underwent unilateral DC and 16 bilateral DC. The median Glasgow Coma Scale score at the scene of the accident or at the initial hospital before the patient was transferred to one of the 2 ICUs was 7 (interquartile range [IQR] 4-14). The median time from admission to DC was 49 hours (IQR 7-301 hours). Before DC, the median ICP and PbtO2 at 6 hours were 35 mm Hg (IQR 28-51 mm Hg) and 11.4 mm Hg (IQR 3-26 mm Hg), respectively. In patients with favorable outcome, PbtO2 at ICU admission was higher and the percentage of time that pre-DC PbtO2 was < 15 mm Hg was lower (19 ± 4.5 mm Hg and 18.25% ± 21.9%, respectively; n = 28) than in those with unfavorable outcome (12.8 ± 5.2 mm Hg [p < 0.001] and 59.58% ± 38.8% [p < 0.001], respectively; n = 14). There were no significant differences in outcomes according to the mean PbtO2 values only during the last 12 hours before DC, the hours of refractory intracranial hypertension, the timing of DC from admission, or the presence/absence of previous surgery. In contrast, there were significant differences in PbtO2 values during the 12- to 24-hour period before DC. In most patients, PbtO2 increased during the 24 hours after DC but these changes were more pronounced in patients with favorable outcome than in those with unfavorable outcome (28.6 ± 8.5 mm Hg vs 17.2 ± 5.9 mm Hg, p < 0.0001; respectively). The areas under the curve for the mean PbtO2 values at 12 and 24 hours after DC were 0.878 (95% CI 0.75-1, p < 0.0001) and 0.865 (95% CI 0.73-1, p < 0.0001), respectively. CONCLUSIONS The authors' findings suggest that changes in PbtO2 before and after DC, measured with probes in healthy-appearing areas of the most damaged hemisphere, have independent prognostic value for the 6-month outcome in TBI patients.