Use of a 3D reconstruction model in a patient with severe atresia auris for optimal placement of Bonebridge transcutaneous bone conduction implant.

PURPOSE: Patients affected by severe atresia auris (AA) can be a challenge during hearing restoration surgery due to the abnormal position of vascular and nervous structures in the bone. A 3D reconstruction model of malformed temporal bones can be helpful for planning surgery and optimizing intra-, peri-, and post-operative results. METHOD: A 5-year-old girl with severe AA on the right side was implanted with a Bonebridge transcutaneous bone conduction implant (tBCI). 3D printing was used to reproduce the malformed temporal bone, find a good position for the tBCI and plan out the surgical details in advance. Hearing tests were performed before and after surgery and information about intra-, peri-, and post-operative outcomes were collected. RESULTS: The patient did not show any negative outcomes and, thanks to the Bonebridge, completely recovered hearing on the right side. CONCLUSIONS: 3D printing is a useful tool for planning surgery in AA patients and for preventing possible risks related to the unknown malformed anatomy.

Application of data mining in a cohort of Italian subjects undergoing myocardial perfusion imaging at an academic medical center.

INTRODUCTION: Coronary artery disease (CAD) is still one of the primary causes of death in the developed countries. Stress single-photon emission computed tomography is used to evaluate myocardial perfusion and ventricular function in patients with suspected or known CAD. This study sought to test data mining and machine learning tools and to compare some supervised learning algorithms in a large cohort of Italian subjects with suspected or known CAD who underwent stress myocardial perfusion imaging. METHODS: The dataset consisted of 10,265 patients with suspected or known CAD. The analysis was conducted using Knime analytics platform in order to implement Random Forests, C4.5, Gradient boosted tree, Naïve Bayes, and K nearest neighbor (KNN) after a procedure of features filtering. K-fold cross-validation was employed. RESULTS: Accuracy, error, precision, recall, and specificity were computed through the above-mentioned algorithms. Random Forests and gradients boosted trees obtained the highest accuracy (>95%), while it was comprised between 83% and 88%. The highest value for sensitivity and specificity was obtained by C4.5 (99.3%) and by Gradient boosted tree (96.9%). Naïve Bayes had the lowest precision (70.9%) and specificity (72.0%), KNN the lowest recall and sensitivity (79.2%). CONCLUSIONS: The high scores obtained by the implementation of the algorithms suggests health facilities consider the idea of including services of advanced data analysis to help clinicians in decision-making. Similar applications of this kind of study in other contexts could support this idea.

Using gait analysis' parameters to classify Parkinsonism: A data mining approach.

INTRODUCTION: Parkinson's disease (PD) is the second most common neurodegenerative disorder in the world, while Progressive Supranuclear Palsy (PSP) is an atypical Parkinsonism resembling PD, especially in early stage. Assumed that gait dysfunctions represent a major motor symptom for both pathologies, gait analysis can provide clinicians with subclinical information reflecting subtle differences between these diseases. In this scenario, data mining can be exploited in order to differentiate PD patients at different stages of the disease course and PSP using all the variables acquired through gait analysis. METHODS: A cohort of 46 subjects (divided into three groups) affected by PD patients at different stages and PSP patients was acquired through gait analysis and spatial and temporal parameters were analysed. Synthetic Minority Over-sampling Technique was used to balance our imbalanced dataset and cross-validation was applied to provide different training and testing sets. Then, Random Forests and Gradient Boosted Trees were implemented. RESULTS: Accuracy, error, precision, recall, specificity and sensitivity were computed for each group and for both algorithms, including 16 features. Random Forests obtained the highest accuracy (86.4%) but also specificity and sensitivity were particularly high, overcoming the 90% for PSP group. CONCLUSION: The novelty of the study is the use of a data mining approach on the spatial and temporal parameters of gait analysis in order to classify patients affected by typical (PD) and atypical Parkinsonism (PSP) based on gait patterns. This application would be helpful for clinicians to distinguish PSP from PD at early stage, when the differential diagnosis is particularly challenging.

An alternative to plaster cast treatment in a pediatric trauma center using the CAD/CAM technology to manufacture customized three-dimensional-printed orthoses in a totally hospital context: a feasibility study.

The aim of this study is to implement the clinical use of the three-dimensional (3D) design and printing technology in pediatric pathologies requiring immobilization. We describe the manufacturing process of the 3D device in place of the plaster cast usually applied to a child 48/72 h after the access to the Trauma Center Traumatology Hub. This procedure had already been performed at Level II, Trauma Center, Campania Region, Orthopaedic Division of Santobono Children's Hospital, Naples, Italy. The operative phase was performed by two 3D printers and a scanner in the bioengineering laboratory of the hospital's outpatient area. The phase of software elaboration requires close cooperation among physicians and engineers. We decided to use a model with a double-shell design and holes varying in width to ensure complete ventilation and lightness of the device. We chose to treat nondisplaced metaphyseal distal fractures of the radius in 18 patients enrolled from January 2017 to November 2017. The flow chart includes clinical and radiological examinations of every enrolled child, collecting information required by the program and its elaboration by bioengineers, and then transfer of the results to 3D printers. The child, immobilized by a temporary splint, wore his 3D device after 12/24 h. Then, he underwent serial check-ups in which the effectiveness and appropriateness of the treatment were clinically monitored and evaluated using subjective scales: visual analogue scale and patient-rated wrist evaluation. All the fractures consolidated both radiologically and clinically after the treatment, with no complications reported. Only one partial breakage of the device happened because of an accidental fall. The statistical analysis of the visual analogue scale and patient-rated wrist evaluation data shows that children's activities of everyday life improved during the immobilization thanks to this treatment. This first study shows that using a 3D device instead of a traditional plaster cast can be an effective alternative approach in the treatment of pediatric nondisplaced metaphyseal distal radius fractures, with high overall patient satisfaction. We believe that 3D technology could be extended to the treatment of more complex fractures; this will be the subject of our second study.

Step length predicts executive dysfunction in Parkinson's disease: a 3-year prospective study.

Cognition and gait appear to be closely related. The chronological interplay between cognitive decline and gait dysfunction is not fully understood. The aim of the present prospective study is investigating whether the dysfunction of specific gait parameters, during specific task and medication conditions, may predict subsequent cognitive impairment in Parkinson's disease (PD). We evaluated cognition and gait in 39 Parkinsonian patients at an initial assessment and after 3 years. Cognitive performance was evaluated with a neuropsychological battery designed to assess memory, executive/attention, and visuospatial domains. Gait was investigated using a gait analysis system during both the off and on states in the following conditions: (1) normal gait; (2) motor dual task; and (3) cognitive dual task. We used regression models to determine whether gait predicts subsequent cognitive dysfunction. Overall, the cognitive test scores were stable over time with the exception of the executive/attention scores, whereas all gait parameters declined. The step length during the cognitive dual task during the on state at the initial evaluation was the only significant predictor of executive/attention domain dysfunction at follow up. The results were confirmed when executive/attention dysfunction at the initial assessment evaluation was included in the regression model as a covariate. Our longitudinal study offers additional insight into the progression of gait dysfunction, and its chronological relationship with cognitive dysfunction in PD patients. In particular, the present study indicates that step length during a cognitive task when on medication is an independent predictor of future executive/attention decline.

On the Power Spectrum of Motor Unit Action Potential Trains Synchronized With Mechanical Vibration.

This study provides a definitive analysis of the spectrum of a motor unit action potential train (MUAPT) elicited by mechanical vibratory stimulation via a detailed and concise mathematical formulation. Experimental studies demonstrated that MUAPs are not exactly synchronized with the vibratory stimulus but show a variable latency jitter, whose effects have not been investigated yet. Synchronized action potential train was represented as a quasi-periodic sequence of a given MU waveform. The latency jitter of action potentials was modeled as a Gaussian stochastic process, in accordance to the previous experimental studies. A mathematical expression for power spectrum of a synchronized MUAPT has been derived. The spectrum comprises a significant continuous component and discrete components at the vibratory frequency and its harmonics. Their relevance is correlated to the level of synchronization: the weaker the synchronization the more relevant is the continuous spectrum. Electromyography (EMG) rectification enhances the discrete components. The derived equations have general validity and well describe the power spectrum of actual EMG recordings during vibratory stimulation. Results are obtained by appropriately setting the level of synchronization and vibration frequency. This paper definitively clarifies the nature of changes in spectrum of raw EMG recordings from muscles undergoing vibratory stimulation. Results confirm the need of motion artifact filtering for raw EMG recordings during stimulation and strongly suggest to avoid EMG rectification that significantly alters the spectrum characteristics.

Efficacy of the Regent Suit-based rehabilitation on gait EMG patterns in hemiparetic subjects: a pilot study.

BACKGROUND: The recovery of the functional limb mobility of patients with cerebral damages can take great benefit of the role offered by proprioceptive rehabilitation. Recently have been developed a special Regent Suit (RS) for rehabilitative applications. Actually, there are preliminary studies which describes the effects of RS on gait recovery of stroke patients in acute stage, but none in chronic stage. Moreover, it is known that motor recovery does not always reflect improvements of the muscle activity and coactivity. AIM: To investigate the effects of proprioceptive stimulation induced by the Regent Suit (RS) on the EMG patterns during gait in post-stroke chronic patients. DESIGN: Randomized controlled trial. SETTING: S. Maugeri Foundation, Telese Terme (BN), Italy. POPULATION: Patients have been randomly assigned into two equal groups of 20 patients: experimental group and traditional group. Further, a control group of 20 healthy subjects have been enrolled. METHODS: The traditional group attended a rehabilitation program composed by neuro-motor exercises without the RS, the experimental group performed the same rehabilitation program while wearing the RS. The NIH Stroke Scale (NIHSS), the Barthel Index (BI), the Functional Independent Measure (FIM) and the Berg Balance Scale (BBS) have been evaluated. EMG analysis has been performed considering the muscle activation timing over the gait of the soleus, tibialis anterior, semitendinosus and vastus lateralis muscles by decomposing the EMG signals into Gaussian pulses. Then, the symmetry of muscle activation and the muscle synergy patterns over the gait cycle have been assessed. RESULTS: The proprioceptive stimulation of the RS-based treatment induces higher and remarkable restoration of the normal muscle activation timing, also increasing the muscle symmetry and reducing the pathological muscle coactivation on both affected and non-affected sides. CONCLUSIONS: These results suggest confirm that a RS-based treatment is more effective than usual care in improving the EMG patterns during locomotion and daily living activities in chronic post-stroke subjects. CLINICAL REHABILITATION IMPACT: The proprioceptive rehabilitation Regent Suit based has an impact on motor function in stroke patients during gait.

Laser Speckle Imaging of Rat Pial Microvasculature during Hypoperfusion-Reperfusion Damage.

The present study was aimed to in vivo assess the blood flow oscillatory patterns in rat pial microvessels during 30 min bilateral common carotid artery occlusion (BCCAO) and 60 min reperfusion by laser speckle imaging (LSI). Pial microcirculation was visualized by fluorescence microscopy. The blood flow oscillations of single microvessels were recorded by LSI; spectral analysis was performed by Wavelet transform. Under baseline conditions, arterioles and venules were characterized by blood flow oscillations in the frequency ranges 0.005-0.0095 Hz, 0.0095-0.021 Hz, 0.021-0.052 Hz, 0.052-0.150 Hz and 0.150-0.500 Hz. Arterioles showed oscillations with the highest spectral density when compared with venules. Moreover, the frequency components in the ranges 0.052-0.150 Hz and 0.150-0.500 were predominant in the arteriolar total power spectrum; while, the frequency component in the range 0.150-0.500 Hz showed the highest spectral density in venules. After 30 min BCCAO, the arteriolar spectral density decreased compared to baseline; moreover, the arteriolar frequency component in the range 0.052-0.150 Hz significantly decreased in percent spectral density, while the frequency component in the range 0.150-0.500 Hz significantly increased in percent spectral density. However, an increase in arteriolar spectral density was detected at 60 min reperfusion compared to BCCAO values; consequently, an increase in percent spectral density of the frequency component in the range 0.052-0.150 Hz was observed, while the percent spectral density of the frequency component in the range 0.150-0.500 Hz significantly decreased. The remaining frequency components did not significantly change during hypoperfusion and reperfusion. The changes in blood flow during hypoperfusion/reperfusion caused tissue damage in the cortex and striatum of all animals. In conclusion, our data demonstrate that the frequency component in the range 0.052-0.150 Hz, related to myogenic activity, was significantly impaired by hypoperfusion and reperfusion, affecting cerebral blood flow distribution and causing tissue damage.

Validity and reliability of textile system Sensoria for posturographic measurements.

OBJECTIVES: Smart fabrics and interactive textiles are a relatively new area of research, with many potential applications in the field of biomedical engineering. The ability of smart textiles to interact with the body provides a novel means to sense the wearer's physiology and respond to the needs of the wearer. Physiological signals, such as heart rate, breathing rates, and activity levels, are useful indicators of health status. These signals can be measured by means of textile-based sensors integrated into smart clothing which has the ability to keep a digital record of the patient's physiological responses since his or her last clinical visit, allowing doctors to make a more accurate diagnosis. Similarly, in rehabilitation, it is difficult for therapists to ensure that patients are complying with prescribed exercises. Smart garments sensing body movements have the potential to guide wearers through their exercises, while also recording their individual movements and adherence to their prescribed programme. METHODS: In this paper, we present the new wireless textile system Sensoria, with pressure sensing capability for static posturography. The gold standard for static posturography is currently the use of a pressure or force plate but, due to their very complexity and expensiveness, the applicability outside laboratories is extremely limited. RESULTS: This paper focuses on the agreement between the static computed posturography assessed by means of a traditional stabilometric platform and the Sensoria system, in twenty subjects with Parkinson's Disease (PD). CONCLUSIONS: Preliminary results showed a significant agreement between the two methods, suggesting a clinical use of Sensoria for low cost home care based balance impairment assessments.

Analysis of reaching movements of upper arm in robot assisted exercises. Kinematic assessment of robot assisted upper arm reaching single-joint movements.

Robot-mediated therapy (RMT) has been a very dynamic area of research in recent years. Robotics devices are in fact capable to quantify the performances of a rehabilitation task in treatments of several disorders of the arm and the shoulder of various central and peripheral etiology. Different systems for robot-aided neuro-rehabilitation are available for upper limb rehabilitation but the biomechanical parameters proposed until today, to evaluate the quality of the movement, are related to the specific robot used and to the type of exercise performed. Besides, none study indicated a standardized quantitative evaluation of robot assisted upper arm reaching movements, so the RMT is still far to be considered a standardised tool. In this paper a quantitative kinematic assessment of robot assisted upper arm reaching movements, considering also the effect of gravity on the quality of the movements, is proposed. We studied a group of 10 healthy subjects and results indicate that our advised protocol can be useful for characterising normal pattern in reaching movements.

Frequency and Time Domain Analysis of Foetal Heart Rate Variability with Traditional Indexes: A Critical Survey.

Monitoring of foetal heart rate and its variability (FHRV) covers an important role in assessing health of foetus. Many analysis methods have been used to get quantitative measures of FHRV. FHRV has been studied in time and in frequency domain and interesting clinical results have been obtained. Nevertheless, a standardized definition of FHRV and a precise methodology to be used for its evaluation are lacking. We carried out a literature overview about both frequency domain analysis (FDA) and time domain analysis (TDA). Then, by using simulated FHR signals, we defined the methodology for FDA. Further, employing more than 400 real FHR signals, we analysed some of the most common indexes, Short Term Variability for TDA and power content of the spectrum bands and sympathovagal balance for FDA, and evaluated their ranges of values, which in many cases are a novelty. Finally, we verified the relationship between these indexes and two important parameters: week of gestation, indicator of foetal growth, and foetal state, classified as active or at rest. Our results indicate that, according to literature, it is necessary to standardize the procedure for FHRV evaluation and to consider week of gestation and foetal state before FHR analysis.

A new tool for foetal phonocardiography simulation.

Among diagnostic techniques for foetal monitoring, phonocardiography is gaining more and more interest for its low cost, passive nature and capability to detect some cardiac diseases. In spite of these characteristics, its use in clinical routine is still limited due to different troubles; for example, signals recorded through maternal abdomen show generally a quite low signal-to-noise ratio, so that detection and analysis of foetal heart sounds result very difficult. In this scenario, the availability of artificial phonocardiographic signals, simulated with conditions resembling different foetal conditions, week of gestation and noise amount, to name someone, can be a very useful tool to train medical staff. In this paper a software for phonocardiography simulation, updated to take account also of the split is presented. The software is completed with a user interface which allow to modify in a simple way simulation parameters. It is worth highlighting that this software can be useful also for testing performances of other analysis software and mathematical tools for recognising of valves components in the heart sounds.

Gait patterns in Parkinsonian patients with or without mild cognitive impairment.

Although in recent years the relationship between cognition and gait in Parkinson's disease (PD) has received increasing attention, the specific connections between gait patterns and cognitive features are not fully understood. The objective of this study was to describe the gait patterns in patients affected by PD with or without mild cognitive impairment (MCI+ and MCI-, respectively). We also sought to find an association between gait patterns and specific cognitive profiles. Using a gait analysis system, we compared the gait patterns among MCI+ patients (n = 19), MCI- patients (n - 24), and age- and sex-matched healthy subjects (HS; n = 20) under the following conditions: (1) normal gait, (2) motor dual task, and (3) cognitive dual task. In PD patients, gait parameters were evaluated in both the off and on states. Memory, executive, and visuospatial domains were assessed using an extensive neuropsychological battery. Compared with MCI- PD and HS, MCI+ PD patients displayed reduced step length and swing time and impairment of measures of dynamic stability; these dysfunctions were only partially reversed by levodopa. We also found that dual-task conditions affected several walking parameters in MCI+ PD in the off and on states relative to MCI- PD and HS. Factor analysis revealed 2 independent factors, namely, pace and stability. The latter was strongly and directly correlated to the visuospatial domain. In conclusion, dysfunctions on specific gait parameters, which were poorly responsive to levodopa and highly sensitive to dual-task conditions, were associated with MCI in PD patients. Importantly, visuospatial impairment was strongly associated with the development of instability and more generally with the progression of PD.