The SÖderberg Socket 2.0: A Technical Note.

BACKGROUND: Transtibial prosthesis socket trim lines have remained fairly consistent over the past decade, and based on methods such as a supracondylar cuff suspension. However, with vacuum suspension methods, trim lines can change. OBJECTIVE: An objective of this technical note was to inform practitioners how to fabricate a socket in a better way. A step-by-step fabrication guide is provided for the prosthetist. METHODS: A unilateral transtibial amputee was selected for this technical note. We provide a detailed description of the different steps of fabrication as well as patient feedback. The fabrication involved fabrication of a vacuum socket using Pre-preg carbon fiber and anti-bacterial Ethylene-Vinyl-Acetate (EVA), as a proximal flexible brim. FINDINGS: The properties of EVA and Pre-preg carbon fiber allow for fabrication of a transtibial socket with a flexible proximal brim. The new design resulted in greater comfort and increased range of motion in the patient studied. The patient subjectively noted enhanced squatting and cycling capabilities while using the updated socket and flexible proximal brim. CONCLUSION: This technical note presented a fabrication guide for a new style of socket and preliminary patient feedback. Clinical studies evaluating functional and biomechanical effects of this new socket design are needed.

Pelvic motion in trans-femoral amputees in the frontal and transverse plane before and after special gait re-education.

Using a special gait re-education programme, combining methods in physiotherapy with a psychological therapeutic approach to integrate the prosthesis with normal movements and to increase body awareness, the authors studied unilateral trans-femoral amputees aged 16-60 years with trauma or tumour as causes. In their service area they found 16 such current prosthetic users with at least 2 years of prosthetic experience and 9 who could complete the programme. Gait was measured before and after treatment and at 6 months follow-up with a three-dimensional motion analysis system and was compared to a reference group of 18 healthy volunteers of similar age. Results showed normalised gait speed and increased symmetry in step length after treatment, but reduced symmetry in pelvic motion. The reference group had a pelvic rotation of + 4 degrees both in the frontal and transverse planes. In the frontal plane, pelvic obliquity increased after treatment to a similar amplitude to the reference group, but with a different timing. Pelvic internal rotation on the amputated side increased to about 8 degrees in the beginning of stance. The amputated and the intact side before treatment were more symmetrical than afterwards and also when compared with the reference group. In spite of this, gait appeared to be more symmetrical, probably due to more efficient pelvic motion and more symmetrical upper-body movements. This was probably an effect of increased work with the intact side to compensate for the lack of power on the amputated side. These results remained at follow-up.

Kinematic and kinetic gait analysis in the sagittal plane of trans-femoral amputees before and after special gait re-education.

A special gait-training programme, combining a psychological therapeutic approach with methods in physiotherapy and body awareness, was used to re-educate nine unilateral trans-femoral amputees. All were rehabilitated trauma or tumour amputees with an age of 16-60 years. They had worn prostheses for more than 18 months. The re-education aimed at integrating the prosthesis in normal movements and increasing body awareness. Gait was measured before and after treatment and at 6 months follow-up with a three-dimensional motion analysis system. Results showed almost normalised gait speed and increased symmetry in the hip joints with increased muscle work on the amputated side both immediately and at follow-up. At follow-up there were significant differences in almost all parameters between the two legs of the subjects and when compared to a reference group of 18 healthy volunteers of similar age. Thus, the intact leg compensates for loss of function in the amputated leg and thereby works differently compared to the reference group. For example, during shock absorption the extension moment in the intact knee increased from 0.6 Nm/kg before to 1.0 Nm/kg after treatment and at follow-up compared to 0.4 Nm/kg in the reference group. The eccentric power of quadriceps increased from 0.6 w/kg before to 1.8 w/kg after treatment and 1.7 w/kg at follow-up compared to 0.4 w/kg in the reference group. The limp of amputees is usually observed in the frontal plane, but the authors' special focus on the sagittal plane here illustrates gait propulsion influences. The positive training results remained after six months.

An information-based neural approach to constraint satisfaction.

A novel artificial neural network approach to constraint satisfaction problems is presented. Based on information-theoretical considerations, it differs from a conventional mean-field approach in the form of the resulting free energy. The method, implemented as an annealing algorithm, is numerically explored on a testbed of K-SAT problems. The performance shows a dramatic improvement over that of a conventional mean-field approach and is comparable to that of a state-of-the-art dedicated heuristic (GSAT+walk). The real strength of the method, however, lies in its generality. With minor modifications, it is applicable to arbitrary types of discrete constraint satisfaction problems.

Aneurysm of the membranous septum in critical pulmonary stenosis: spontaneous rupture after balloon dilatation.

We report a case of critical pulmonary valve stenosis in which congenital aneurysm of the membranous septum ruptured spontaneously after balloon dilatation of the pulmonary valve. It is considered that the chronic mechanical trauma with phasic protrusion and collapse of the aneurysm during the cardiac cycles was responsible for an aneurysm rupture.

Narrative interpretations for clinical laboratory evaluations: an overview.

As the clinical laboratory test menu has significantly expanded in volume and complexity, there is a rapidly growing need by clinicians for narrative interpretations of complex studies that resemble those provided in anatomic pathology and radiology. In this report, the impact of advice on laboratory test selection and interpretation is presented with regard to providing adequate quality of care, reducing medical error, and reducing the cost for health care. In addition, past and current attempts to address the physician's need for advice on laboratory test selection and interpretation are also described. These include curbside consultations, intelligent laboratory information systems, and medical information from the Internet. Each is presented with examples from the literature and with its advantages and disadvantages for practicing clinicians confronting large, expensive test menus and the results of esoteric assays.

Regulations regarding reflexive testing and narrative interpretations in laboratory medicine.

The use of reflexive test selection and patient-specific narrative interpretations in laboratory medicine is associated with a host of compliance issues and government regulations. Reflexive testing is associated with many advantages for patients and their physicians, but if not adequately organized it has the potential for inefficient test ordering and abuse by physicians and laboratories. Patient-specific narrative interpretations in laboratory medicine, much more than fixed comments generated by a computer with a specific test result, also provide clinical and financial benefit when done effectively. Regulations exist to ensure that the physician-provided information has clinical value. This report describes the compliance and billing regulations regarding reflex testing and narrative interpretations. The codes used for narrative interpretations in laboratory medicine are also presented, as well as the use of those codes to obtain payment for the interpretation provided.

The generation of narrative interpretations in laboratory medicine: a description of service-specific sign-out rounds.

The logistical details for organizing effective interpretive rounds in a laboratory medicine subspecialty must be carefully established so that expert opinions are provided in a timely fashion in a patient-specific report, rather than as a collection of fixed comments associated with a particular laboratory result generated by a computer This report describes the test batteries for interpretations, the billing for interpretations, clinical examples of interpretations, and interpretations for which billing is not typically performed in several clinical or laboratory areas in our institution. These include coagulation disorders, hemoglobin and anemia evaluations, autoimmune disorders, serum protein analysis, toxicology, molecular diagnostics, and transfusion medicine. The information in this report should provide sufficient detail to allow development of interpretive services with successful billing for the areas in laboratory medicine described.

Local routing algorithms based on Potts neural networks.

A feedback neural approach to static communication routing in asymmetric networks is presented, where a mean field formulation of the Bellman-Ford method for the single unicast problem is used as a common platform for developing algorithms for multiple unicast, multicast and multiple multicast problems. The appealing locality and update philosophy of the Bellman-Ford algorithm is inherited. For all problem types the objective is to minimize a total connection cost, defined as the sum of the individual costs of the involved arcs, subject to capacity constraints. The methods are evaluated for synthetic problem instances by comparing to exact solutions for cases where these are accessible, and else with approximate results from simple heuristics. In general, the quality of the results are better than those of the heuristics. Furthermore, the computational demands are modest, even when the distributed nature of the the approach is unexploited numerically.

Preanalytical variables affecting the quantification of fatty acid ethyl esters in plasma and serum samples.

BACKGROUND: Fatty acid ethyl esters (FAEEs) are cytotoxic nonoxidative ethanol metabolites produced by esterification of fatty acids and ethanol. FAEEs are detectable in blood up to 24 h after ethanol consumption. The objective of this study was to assess the impact of gender, serum or plasma triglyceride concentration, time and temperature of specimen storage, type of alcoholic beverage ingested, and the rate of ethanol consumption on FAEE concentrations in plasma or serum. METHODS: For some studies, subject were recruited volunteers; in others, residual blood samples after ethanol quantification were used. FAEEs were isolated by solid-phase extraction and quantified by gas chromatography-mass spectrometry. RESULTS: For weight-adjusted amounts of ethanol intake, FAEE concentrations were twofold greater for men than women (P /=24 h. The type of alcoholic beverage and rate of consumption did not affect FAEE concentrations. CONCLUSION: These studies advance plasma and serum FAEE measurements closer to implementation as a clinical test for ethanol intake.

A Potts Neuron Approach to Communication Routing.

A feedback neural network approach to communication routing problems is developed, with emphasis on multiple shortest path problems, with several requests for transmissions between distinct start and end nodes. The basic ingredients are a set of Potts neurons for each request, with interactions designed to minimize path lengths and prevent overloading of network arcs. The topological nature of the problem is conveniently handled using a propagator matrix approach. Although the constraints are global, the algorithmic steps are based entirely on local information, facilitating distributed implementations. In the polynomially solvable single-request case, the approach reduces to a fuzzy version of the Bellman-Ford algorithm. The method is evaluated for synthetic problems of varying sizes and load levels, by comparing to exact solutions from a branch-and-bound method, or to approximate solutions from a simple heuristic. With very few exceptions, the Potts approach gives high-quality legal solutions. The computational demand scales merely as the product of the numbers of requests, nodes, and arcs.

Structure of oxidized bacteriophage T4 glutaredoxin (thioredoxin). Refinement of native and mutant proteins.

The structure of wild-type bacteriophage T4 glutaredoxin (earlier called thioredoxin) in its oxidized form has been refined in a monoclinic crystal form at 2.0 A resolution to a crystallographic R-factor of 0.209. A mutant T4 glutaredoxin gives orthorhombic crystals of better quality. The structure of this mutant has been solved by molecular replacement methods and refined at 1.45 A to an R-value of 0.175. In this mutant glutaredoxin, the active site residues Val15 and Tyr16 have been substituted by Gly and Pro, respectively, to mimic that of Escherichia coli thioredoxin. The main-chain conformation of the wild-type protein is similar in the two independently determined molecules in the asymmetric unit of the monoclinic crystals. On the other hand, side-chain conformations differ considerably between the two molecules due to heterologous packing interactions in the crystals. The structure of the mutant protein is very similar to the wild-type protein, except at mutated positions and at parts involved in crystal contacts. The active site disulfide bridge between Cys14 and Cys17 is located at the first turn of helix alpha 1. The torsion angles of these residues are similar to those of Escherichia coli thioredoxin. The torsion angle around the S-S bond is smaller than that normally observed for disulfides: 58 degrees, 67 degrees and 67 degrees for wild-type glutaredoxin molecule A and B and mutant glutaredoxin, respectively. Each sulfur atom of the disulfide cysteines in T4 glutaredoxin forms a hydrogen bond to one main-chain nitrogen atom. The active site is shielded from solvent on one side by the beta-carbon atoms of the cysteine residues plus side-chains of residues 7, 9, 21 and 33. From the opposite side, there is a cleft where the sulfur atom of Cys14 is accessible and can be attacked by a nucleophilic thiolate ion in the initial step of the reduction reaction.