Adaptable Poly-Articulated Bionic Hands EnhanceBoth Performance and User's Perception in Bilateral Amputation: A Case Study.

This article evaluates and compares the performance and perception of prosthetic devices based on different design principles, a traditional rigid gripper and an adaptable poly-articulated hand, in a pre- and post-training protocol with an individual with bilateral amputation. As a representative of the first class, we use commercial hands (Ottobock's MyoHand VariPlus Speed), which is a widely adopted model by prosthesis users worldwide. We compare these with two SoftHand Pro hands, which are experimental prototypes exhibiting 19 articulations actuated by one single motor, and are inspired by human hand motor control models. Results show that the individual with bilateral amputation, who was a non-expert myoelectric user, achieved better performance with adaptive poly-articulated hands. Furthermore, the acceptation, satisfaction and perceived functionality of the user were considerably higher for the SoftHand Pro. An observational analysis of the patient's behaviour by experienced therapists suggests that adaptable poly-articulated hands reduced compensatory movements and cognitive load. Using soft technologies may be especially advantageous for individuals with bilateral amputation, who present a very limited residual mobility and can largely benefit from the active use of their artificial arms in everyday life.

Flow-mediated vasodilatation of the brachial artery and intima-media thickness of carotid artery in never-treated subjects.

AIM: Data on the association between brachial artery flow-mediated dilatation (FMD) and common carotid intima-media thickness (IMT) are contrasting. The present study investigated the relationship between FMD and IMT and carotid atherosclerosis in never treated subjects. METHODS: Seventy-seven subjects were investigated: 46 had no coronary heart disease (CHD) risk factors, 21 had only one, and 10 had more than one risk factor. IMT of the common carotid was measured by ultrasonography and FMD was evaluated according to standardized methods. RESULTS: IMT increased with increasing number of risk factors (0.66+/-0.12, 0.69+/-0.12 and 0.8+/-0.17 mm, respectively, ANOVA P<0.05). FMD decreased with increasing number of risk factors (10.44+/-5.2, 6.52+/-7.11 and 7.35+/-4.42%, respectively, P<0.05). Endothelium-independent vasodilatation was similar in the 3 groups. IMT and FMD did not correlate neither in subjects without risk factors (r=-0.151, P=0.3), nor in those with 1 (r=-0.196, P=0.4) or with 2 or more risk factors (r=-0.387, P=0.2), while in the group as a whole the correlation was borderline significant (r=-0.217, P=0.058). Eleven subjects had carotid atherosclerosis and higher values of IMT, but not reduced FMD. In multiple regression analysis, diabetes and IMT, but not FMD, were associated with carotid atherosclerosis. CONCLUSIONS: The present findings indicate that, in never treated subjects, FMD is not strictly associated with IMT or atherosclerosis of the carotid arteries.

Manual lymphatic drainage for chronic post-mastectomy lymphoedema treatment.

BACKGROUND: The authors evaluated the chronic post-mastectomy lymphoedematous tissue and the effects of manual lymphatic drainage (Leduc method) with and without compressive bandage. METHODS: The arms were measured before and after physical therapy and the results were expressed as a percentage decrease. Physical therapy was performed first by manual lymphatic drainage only and after by manual lymphatic drainage plus compressive bandage. RESULTS: We observed that during manual lymphatic drainage plus compressive bandage the total percentage decrease of whole limb was the highest: 41.1 +/- 12.2% versus 30.4 +/- 15.8% (p < 0.05). Clinical and physiopathological implication are discussed.

Speech lateralisation in callosal agenesis assessed by the dichotic fused words test.

Child patients with left-hemisphere damage (n = 2), with total callosal agenesis (n = 2), and with partial callosal agenesis or hypotrophy (n = 3) were submitted to dichotic verbal stimulation by the Fused Words Test. The controls were nine normal children, right-, left-, and mixed-handed. As expected, the left-injured patients presented a massive advantage of the ear contralateral to the intact hemisphere. Among the controls the right-handers showed a significant right-ear prevalence, whereas left-and mixed-handers exhibited rather inconsistent earasymmetries. The major finding of this study is the striking difference in perceptual asymmetry between partial and total acallosals. Based on the notion that the dichotic verbal asymmetry is an effect of the underlying functional asymmetry for language, these findings are interpreted as an indication that development of the unilateral speech control is influenced by the presence, during ontogenesis, of callosal connections.

[Viral hepatitis B. Seroepidemiological study in Veneto]. / Epatite virale B. Indagine sieroepidemiologica nel Veneto.

Sera from 3160 subjects without overt liver disease were tested for the presence of HBsAg, anti-HBs, anti-HBc. This group corresponds to a 4%, sample of the population resident in Padova and the surrounding district, selected according to sex and age distribution (in 5 to 5 year classes). The overall prevalence of HBV infection was 23%. The prevalence of HBsAg+ subjects was 3.2% higher in males than in females (3.8% v.s. 2.7%). Children under 5 years of age showed the maximum HBsAg carrier rate (7.3%), which was found to decrease with advancing age. Prevalence of anti-HBs is similar in both sexes (M 15.8% v.s. F 14.2%) and increases with age. Anti-HBc without HBsAg or anti-HBs was found in 4.6%, higher in males than in females (5.8% v.s. 3.6%). These result stress the importance of anti-HBc detection in HBV seroepidemiological surveys and suggest that HBV transmission within the household (both vertical and horizontal) plays a relevant role in HBV spread in our population.

[Viral hepatitis type A. Seroepidemiological study in Padova and its district]. / Epatite virale tipo A. Indagine sieroepidemiologica in Padova e provincia.

In order to ascertain the real frequency of HAV infection in North-East of Italy a seroepidemiologic survey was carried out on the population of Padova and its district. The serum samples obtained from 1812 subjects (approximately the 2% of registered people) subdivided according to sex and age (5 to 5 year groups), were tested for anti-HA by radioimmunoassay. The mean prevalence of anti-HA was 69.2%. Positive subjects' frequency of 50% was reached in 15-20 year-old group, whereas more than 90% of people over 35 years of age were positive. No significant differences were observed between the sexes or between town and country populations, while the increase of the anti-HA prevalence curve was delayed in the higher socioeconomic level group. These findings testify the relevant socioeconomic and public health levels improvement in the last decades, while, on the other hand, point out the increasing risk of adulthood HAV infection.

Fructose-induced hyperuricemia in essential hypertension.

A rapid intravenous fructose load was given to nine normouricemic essential hypertensive and eight control subjects. The following increase in plasma uric acid concentration was significantly higher in hypertensives than in controls. There was no significant difference in urinary excretion of urate between the two groups. Since the increase in uric acid concentration brought about by fructose is most probably due to an increased metabolism of preformed purine nucleotides, it is suggested that essential hypertensive patients have a higher than normal "pool" of purine nucleotides.

Renal histologic and ultrastructural findings in psychogenic polydipsia and diabetes insipidus.

The renal biopsies of 15 patients affected by polydipsia syndromes were examined under light and electron microscopes. The authors contend that the observed renal lesions (dilatation of the glomerular loops, tubular hypertrophy and vacuolization, and basal membrane swelling) are the morphologic result of tubular hyperfunction in the service of ion reabsorption. This, in turn, is secondary to the increased GFR.

Calcium and phosphorus metabolism in chronic uremia.

In chronic uremia, the clinical disorders o calcium and phosphorus metabolism are influenced by the following factors: (1) intestinal absorption of calcium and phosphate, resulting in a negative calcium and phosphate balance at normal dietary intakes; (2) renal handling of calcium and phosphate: the fractional transport of calcium (the isoosmotic reabsorption taking place in the proximal tubule) is not affected by GFR modifications, whereas the Tm-limited reabsorption is severely impaired; the external phosphate balance is kept, even in the presence of a reduced nephron population, by means of a proportional reduction in TmPO4 values; (3) physiochemical state and turnover of body calcium and phosphate: in uremic patients, the distribution spaces, turnover rate of calcium, and accretion rate of bones are increased in comparison with the controls; the calcium infusion test in patients with renal osteomalacia is followed by a regular increase in plasma [PO4], whereas a significant decrease is observed in patients with renal osteitis fibrosa, due to the extreme 'avidity' of bones for calcium phosphate; the role of hyperphosphatemia is critical in keeping the plasma [Ca] lower than the expected values for a given metabolic set; moreover, an increased cell uptake of phosphate could counteract to some extent the reduced renal clearance of phosphate; (4) structural and biochemical modifications of bone tissue: uremic osteodystrophy consists mainly of two components: (a) osteomalacia, with osteoid excess, disappearance of the calcification front, and diffuse pathologic mineralization, and (b) osteitis fibrosa, with severe resorption of normally mineralized bone, slight osteoid excess, and almost normal calcification front; (5) hormonal factors: chronic stimulation of parathyroid glands may result in suppressible or even autonomous hyperparathyroidism. As to vitamin D, it has been suggested that the uremic kidney is not able to synthesize the 1,25-di-OH-cholecalciferol, the active metabolite of vitamin D: this results in an impaired intestinal absorption of calcium. On the contrary, the role of calcitonin in chronic uremia is still uncertain, since low values of plasma [Ca] are usually observed.