The myokinetic control interface: tracking implanted magnets as a means for prosthetic control.

Upper limb amputation deprives individuals of their innate ability to manipulate objects. Such disability can be restored with a robotic prosthesis linked to the brain by a human-machine interface (HMI) capable of decoding voluntary intentions, and sending motor commands to the prosthesis. Clinical or research HMIs rely on the interpretation of electrophysiological signals recorded from the muscles. However, the quest for an HMI that allows for arbitrary and physiologically appropriate control of dexterous prostheses, is far from being completed. Here we propose a new HMI that aims to track the muscles contractions with implanted permanent magnets, by means of magnetic field sensors. We called this a myokinetic control interface. We present the concept, the features and a demonstration of a prototype which exploits six 3-axis sensors to localize four magnets implanted in a forearm mockup, for the control of a dexterous hand prosthesis. The system proved highly linear (R2 = 0.99) and precise (1% repeatability), yet exhibiting short computation delay (45 ms) and limited cross talk errors (10% the mean stroke of the magnets). Our results open up promising possibilities for amputees, demonstrating the viability of the myokinetic approach in implementing direct and simultaneous control over multiple digits of an artificial hand.

Primary headache pathophysiology in children: the contribution of clinical neurophysiology.

Although primary headaches are very prevalent also in pediatric age, most neurophysiologic studies in these diseases concerned only the adulthood. The neurophysiologic investigation of the pathophysiological mechanisms subtending migraine and tension-type headache in children and adolescents could be particularly interesting, since during the developmental age the migrainous phenotype is scarcely influenced by many environmental factors that can typically act on adult headache patients. The neurophysiologic abnormality most frequently found in adult migraineurs, that is the reduced habituation of evoked potentials, was confirmed also in migraine children, although it was shown to involve also children with tension-type headache. Some studies showed abnormalities in the maturation of brain functions in migraine children and adolescents. While the visual system maturation seems slowed in young migraineurs, the psychophysiological mechanisms subtending somatosensory spatial attention in migraine children are more similar to those of healthy adults than to those of age-matched controls. There are some still unexplored fields that will have to be subjects of future studies. The nociceptive modality, which has been investigated in adult patients with primary headaches, should be studied also in pediatric migraine. Moreover, the technique of transcranial magnetic stimulation, not yet used in young migraineurs, will possibly provide further elements about brain excitability in migraine children.

Correlation between abnormal brain excitability and emotional symptomatology in paediatric migraine.

We investigated a possible correlation between brain excitability in children with migraine and tension-type headache (TTH) and their behavioural symptomatology, assessed by using the Child Behaviour Checklist (CBCL). The mismatch negativity (MMN) and P300 response were recorded in three successive blocks to test the amplitude reduction of each response from the first to the third block (habituation). MMN and P300 habituation was significantly lower in migraineurs and TTH children than in control subjects (two-way ANOVA: P < 0.05). In migraineurs, but not in TTH patients, significant positive correlations between the P300 habituation deficit and the CBCL scores were found (P < 0.05), meaning that the migraineurs with the most reduced habituation showed also the worst behavioural symptomatology. To the best of our knowledge, this is the first study showing a correlation between neurophysiological abnormality and emotional symptomatology in migraine, suggesting a role of the latter in producing the migrainous phenotype.

Headache and recurrent abdominal pain: a controlled study by the means of the Child Behaviour Checklist (CBCL).

Headache and recurrent abdominal pain (RAP) are common disorders in children and adolescents, frequently referred to paediatricians. Both disorders show similarities in trigger and comorbid factors, their burden on family and individual life, and a paroxysmal trend with risks of chronicization over time. However, very few studies have compared directly headache and RAP. The main aim of this study was to compare the psychological profile of headache and RAP patients vs. healthy controls. A total of 210 children and adolescents [99 boys, 111 girls; age range 4-18 years; mean age (m.a.) = 11.04, SD 4.05] were assessed: 70 headache patients (m.a. 12.4 years; SD 2.9; F = 35, M = 35), 70 RAP patients (m.a. 9 years; SD 3.6; F = 30, M = 40) and 70 controls (m.a. 11.7 years; SD 4.6; F = 46, M = 24). The diagnoses had been made according to international systems of classification both for headache (ICHD-II criteria) and RAP (Rome II criteria). The psychological profile had been made according to the Child Behaviour Checklist 4-18 (CBCL). anova one-way analysis was used to compare CBCL scales and subscales between groups. Headache and RAP showed a very similar trend vs. control for the main scales of the CBCL, with a statistically significant tendency to show problems in the Internalizing scale (anxiety, mood and somatic complaints) and no problems in the Externalizing (behavioural) scale. Only for the Attention Problems subscale migraineurs showed a significant difference compared with RAP. In conclusion, headache and RAP show a very similar psychological profile that should be considered not only for diagnostic and therapeutic purposes, but also from the aetiological aspect.

Chance fracture after pedicle screw fixation. A case report.

STUDY DESIGN: A case of a Chance fracture through an instrumented pedicle is presented. The radiographic and intraoperative findings and management of this complication are reported. OBJECTIVE: To increase awareness of the complications of transpedicular screw fixation and to suggest a form of management of this unusual complication. SUMMARY OF BACKGROUND DATA: To the authors' knowledge, this is the first reported case of such a vertebral fracture occurring after pedicle screw fixation. METHODS: A 44-year-old man with athetoid cerebral palsy and a progressive thoracic kyphosis sustained a Chance fracture at the caudal end of the segmental instrumentation construct. RESULTS: Surgical intervention, including fracture reduction and extension of the instrumented fusion to the pelvis, provided effective restoration of physiologic sagittal alignment. CONCLUSION: Chance fracture after pedicle screw fixation can be successfully managed with surgical intervention.

Ultrasound screening for deep venous thrombosis after total knee arthroplasty. 2-year reassessment.

The efficacy of ultrasound compared with ascending venography for the detection of deep venous thrombosis immediately after total knee arthroplasty was assessed after a 2-year interval. One hundred thirty-seven patients were eligible for the study; however, 31 patients received only one of the screening methods and a color Doppler examination was inconclusive in six patients. Therefore, 100 patients had a Doppler examination and a venogram. Overall, the sensitivity of ultrasound was 85%, the specificity 97%, the positive predictive value 85%, the negative predictive value 97%, and the accuracy 95%. The sensitivity in the calf was 83%, in the popliteal vein 86%, and in the femoral vein 100%. Two years ago, the initial assessment of ultrasound for the detection of deep venous thrombosis after surgery in patients who had total joint arthroplasty revealed a 75% sensitivity, 99% specificity, 91% positive predictive value, 97% negative predictive value, and 97% accuracy. The sensitivity in the calf was 83%; the sensitivity in the popliteal vein was 40%; and the sensitivity in the femoral vein was 50%. After 2 years of using this screening test with one technician and one radiologist, an improvement with this noninvasive technique was shown. However, it was found that Doppler imaging is not as sensitive as venography for detecting calf thrombi. Any imaging technique should be validated by each institution to determine the validity of the instrument and the learning curve of the technician administering the examination.

Who's the patient here? Inpatient psychiatric rehabilitation in a state hospital setting.

1. The primary focus of psychiatric rehabilitation is on improving the competencies of persons with psychiatric disabilities. 2. Both patients and staff must change their ideas about themselves and each other before the work of rehabilitation could move forward. 3. Institutional rigidity works against psychiatric rehabilitation, with its value on individual growth and self-sufficiency.

[Ulcerative rectocolitis: review of clinical characteristics in patients with distal colitis and extended colitis]. / Rettocolite ulcerosa: revisione delle caratteristiche cliniche nei pazienti con colite distale e colite estesa.

Ulcerative colitis is an inflammatory disease which, starting from the rectum, affects more or less extended tracts of the colon. Given that distal and extended forms are generally described as a single nosological entity, the authors aimed to verify whether there are any clinical differences between the two groups of patients with varying extents of disease. A retrospective review was made of data relating to 189 patients suffering from ulcerative colitis observed over a 90-months period. Only 111 cases were included in the study: all patients had undergone an endoscopic and histological diagnosis with a follow-up of over one year. Seventy-eight patients (41.26%) were excluded from the study because they had been lost during follow-up, or follow-up had lasted less than one year, or it had not been possible to perform pancolonoscopy. The 111 patients examined were subdivided into 2 groups: one (39 patients) with distal colitis, namely involving the rectum or recto-sigmoid, and the other (72 patients) with more extended disease. The extension of disease was evaluated on the basis of histological findings. The mean follow-up was 5 years and 11 months. The two groups were comparable for age, sex, number of annual attacks, maximum duration of disease-free periods, clinical evolution, predominant symptoms, extraintestinal symptoms and surgical treatment. Results were processed using Student's t test and the chi-square test.(ABSTRACT TRUNCATED AT 250 WORDS)

[Body Image Index in the Rorschach test in ulcerative proctocolitis]. / Body-Image Index al test di Rorschach nella rettocolite ulcerosa.

The use of the Rorschach test allows the body image to be examined using the Body-Image Index formulated by Fisher-Cleveland. This index is obtained by calculating the responses to Penetration and Barrier. The hypothesis is that the diseases which affect the inside of the body are more greatly correlated to a high P score and a low B score (high P-low B type personality). The paper examines the Body-Image Index in a sample of 41 patients suffering from ulcerous rectocolitis comprising 24 males and 17 females with a mean age of 32 years. The personality profile obtained is of the "high P-low B" type with a P/R% ratio which is clearly higher than the central mean value (28.7% vs 8%) and a B/R% ratio which is clearly lower than the central mean value (4.2% vs 18%). The personality of the patients in this group was marked by a tendency to anxiety and a tendency to express aggression within their bodies (anger-in) which was field-dependent, difficulty in tolerating stress, a tendency to react somatically to conflicts, a low degree of body image stability and a constant need for an external holding object.

[Pathology of adaptation according to Sami-Ali and index of conformity to the Rorschach test in ulcerative rectocolitis]. / Patologia dell'adattamento secondo Sami-Ali e indice di conformismo al test di rorschach nella rettocolite ulcerosa.

According to Sami-Ali's theoretical model the psychosomatic personality is characterised by an adaptation pathology whose main elements are the repression of imaginative thought and conformity to socio-cultural standards. This study examines adaptation pathology using the Rorschach test. The Authors have formulated a conformity index by relating kinestheses (M) and banal perceptions (BAN). The study was carried out on a sample of 41 patients suffering from ulcerous rectocolitis comprising 24 males and 17 women with a mean age of 32 years. As expected in the hypothesis 97.6% of the sample showed M values below the norm, and 68.3% had Ban values higher than normal, whereas the conformity index was positive and tendentially positive in 65.9% of cases. These findings confirm Sami-Ali's theory. Subjects with ulcerous rectocolitis form part of the adaptation pathology which characterised the psychosomatic personality, with an inverse proportionality between imaginative activity (kinesthesia below normal) and conformism (banal perceptions above the norm).

Intrafollicular insemination for male factor infertility.

Intrafollicular insemination is a promising new development that may have a major impact on ART, notably in the treatment of male factor infertility. Reported is the first successful intrafollicular insemination in the United States and the first successful intrafollicular insemination for male factor infertility. Although the results are encouraging, further investigations are currently underway to critically evaluate intrafollicular insemination.

Regulation of insulin-like growth factor-binding proteins in the baboon (Papio anubis) uterus during early pregnancy.

The baboon uterus begins to synthesize insulin-like growth factor-binding protein-1 (IGFBP-1) in the deep glands of the late secretory endometrium, and this protein then becomes the major secretory product of the term decidua. We hypothesized that the placenta and/or conceptus may regulate the synthesis and secretion of IGFBP-1 by decidualized stromal cells during pregnancy. To test this hypothesis, tissue was obtained from pregnant baboons on days 18, 25, and 32 postovulation. The uterus was separated into three regions: RI (directly below the implantation site), RII (adjacent to the implantation site), and RIII (opposite the implantation site). Portions of the tissue were fixed in Bouin's solution for immunocytochemistry, and the remainder was subdivided into functionalis, basalis, and myometrium and subjected to organ explant culture. The placenta was fixed or cultured separately. Ligand blot analysis of functionalis medium showed that the major IGFBP had a mol wt (Mr) of 29,000-31,000; however, a doublet of 37,000-43,000 Mr and a band at 24,000 Mr were also present. The functionalis from all regions expressed the majority of the IGFBPs, but basalis from RI tissue also secreted the same array of IGFBPs on days 25 and 32. Ligand blot analysis of placental medium proteins revealed a doublet at Mr 37,000-43,000 on days 25 and 32, but not on day 18. Immunoprecipitation followed by ligand blot analysis of medium proteins using polyclonal antibodies to IGFBP-1 and IGFBP-2 and -3 confirmed that IGFBP-1 and -2 were the predominant products of the endometrium and decidua, while IGFBP-3 was synthesized by the placenta. Immunocytochemistry with a monoclonal antibody to IGFBP-1 demonstrated intense glandular epithelial staining in all regions on days 18, 25, and 32. Stromal staining for IGFBP-1 was first evident on day 25 and was only present in stromal cells in intimate contact with the trophoblastic tissue. By day 32, IGFBP-1 expression was not limited to the endometrial-trophoblastic junction, but extended to the deeper stromal cells and included the perivascular regions. IGFBP-1 staining was most intense in RI, but stromal cells at the luminal surface and those surrounding the spiral arteries also showed some staining in RII and RIII on day 32. These studies suggest that the baboon placenta and/or conceptus regulate IGFBP expression in the uterine endometrium during the initial stages of pregnancy.(ABSTRACT TRUNCATED AT 400 WORDS)

[Psychological disorders in patients with enterostomy. The influence of age]. / Disturbi psicologici in pazienti portatori di enterostomia. Influenza dell'età.

A retrospective study of patients who had undergone enterostomy and subsequent follow-up in the past 9 years was carried out with the aim of identifying differences with relation to symptoms of depression, the deterioration of social relations and sexual disturbances between elderly (age greater than or equal to 65) and non-elderly patients (age less than 65). Depressive symptoms were present to a greater extent in elderly (48.6%) than in non-elderly patients (34.8%), whereas sexual disturbances were experienced more in non-elderly (34.8%) than elderly (21.6%) patients. No striking differences were noted with regard to the deterioration of social relations. The differences observed, although marked in terms of percentage, were not statistically significant given the relatively small number of cases examined.

[Disabling outcomes and psychological disorders in the patient with an enterostomy]. / Esiti invalidanti e disturbi psicologici nel paziente portatore di enterostomia.

The authors carried out a retrospective study of patients undergoing enterostomy during the past 9 years. From 1981 to present a total of 60 patients (39 males and 21 females) were operated and subsequently followed-up. The aim of the study was to examine the following factors: the diagnosis which led to operation, the type of stoma used, early and late complications, the behaviour of the alvus, psychological disorders and Karnofsky's Performance-Status Index. After having presented the findings, the surgical results obtained are discussed together with the patient's psychological reactions to stoma. All types of early surgical complications were absent in 66.6% of patients, whereas late complications were absent in 41.6%. Even in those cases where surgical techniques and prostheses permitted a satisfactory post-operative outcome, the sociopsychological and sexual problems relating to the wound and the perceived difference between the real and ideal Ego are highlighted.

[Prevention of duodenal ulcer recurrence by the use of anti H2. Comparison of continuous long-term and seasonal therapy]. / Prevenzione della recidiva di ulcera duodenale con anti H2. Confronto tra terapia a lungo termine continua e stagionale.

The Authors have assessed the incidence of ulcer recidivation in patients with cicatrized bulbar ulcers following anti H2 treatment using two maintenance therapy protocols: 1) 400 mg/day of cimetidine in a single evening dose for 1 year (continuous therapy); 2) the same dose of cimetidine administered at the same time but only for 4 months a year (February-March and September-October) (seasonal therapy). Ninety patients with cicatrized ulcers which had been diagnosed using endoscopy were randomly assigned to the two treatment protocols. Protocols were followed for a least one year with endoscopic controls every 6 months. There were no significant differences between continuous and seasonal therapy in relation to the recurrence of duodenal ulcers (Log Rank test p less than 0.05). Cox's proportional hazard model was used to assess the effect of the two treatment protocols on ulcer recurrence eliminating the influence of sex, age and smoking; it was seen that only smoking influenced the incidence of recidivation (p less than 0.05). These results suggest that seasonal maintenance therapy with anti H2 is as efficacious as continuous therapy in preventing the recurrence of ulcers.

[Chronic inflammatory diseases of the intestine. Extra-intestinal manifestations and perianal complications]. / Malattie infiammatorie croniche dell'intestino. Manifestazioni extraintestinali e complicanze perianali.

Extraintestinal manifestations and perianal complications were examined in 69 patients with ulcerative colitis (UC) and in 29 patients with Crohn's disease (CD). 17.5% of patients with UC presented an extraintestinal manifestation or a perianal disease against 48% of patients with CD. Over all, joint disease turned out to be the most frequent manifestation, but its frequency is significantly higher in patients with CD (27%) than in those with UC (3%). In the latter the most frequent disease is cholelithiasis (7%). This percentage is the same in both groups of patients. In 1.5% of patients with UC and in 14% of patients with CD perianal complications appeared; all patients with CD showed a colonic involvement.

Cholelithiasis after Billroth II gastric resection.

We evaluate whether Billroth II (BII) gastric resection is a predisposing condition in the formation of gallstones. In our department radiologic and echographic imaging is a routine examination before abdominal surgery. From 1980 to 1985, 202 patients underwent cholecystography or ultrasonography before BII gastric resections for peptic ulcers. The prevalence of cholelithiasis in a random sample of the population of the town near our institution was used to calculate the expected frequency of gallstones. The comparison of the expected and the observed frequencies of cholelithiasis in these patients did not show any statistically significant difference between men and women. All these patients were recalled for a follow-up of the long-term effects of gastric surgery, and 66% (133/202) returned and were examined. They underwent ultrasonography of the biliary tract. Again the observed and the expected (obtained as before) frequencies of cholelithiasis were compared. A statistically significant difference was apparent in male patients. We conclude that BII gastric resection could be a predisposing factor in the formation of gallstones in men.