A motor learning-based postural intervention with a robotic trunk support trainer to improve functional sitting in spinal cord injury: case report.

STUDY DESIGN: Single-subject-research-design. OBJECTIVES: To improve seated postural control in a participant with spinal cord injury (SCI) with a robotic Trunk-Support-Trainer (TruST). SETTING: Laboratory. METHODS: TruST delivered "assist-as-needed" forces on the participant's torso during a motor learning-and-control-based intervention (TruST-intervention). TruST-assistive forces were progressed and matched to the participant's postural trunk control gains across six intervention sessions. The T-shirt test was used to capture functional improvements while dressing the upper body. Kinematics were used to compute upper body excursions (cm) and velocity (cm2), and sitting workspace area (cm2). Functional trunk dynamometry was used to examine muscle force (Kg). Surface electromyography (sEMG) was applied to measure trunk muscle activity. The Borg Rating of Perceived Exertion (RPE) was used to monitor physical exertion during TruST-intervention. A two-standard-deviation bandwidth method was adopted for data interpretation. RESULTS: After TruST-intervention, the participant halved the time needed to don and doff a T-shirt, increased muscle force of trunk muscles (mean = 3 kg), acquired a steadier postural sitting control without vision (mean excursion baseline: 76.0 ± 2 SD = 5.25 cm and post-intervention: 44.1 cm; and mean velocity baseline: 3.0 ± 2 SD = 0.2 cm/s and post-intervention: 1.8 cm/s), and expanded his sitting workspace area (mean baseline: 36.7 ± 2 SD = 36.6 cm2 and post-intervention: 419.2 cm2). The participant increased his tolerance to counteract greater TruST-force perturbations in lateral and posterior directions. Furthermore, abdominal muscle activity substantially augmented after completion of TruST-intervention across all perturbation directions. CONCLUSIONS: Our data indicate a potential effectiveness of TruST-intervention to promote functional sitting in SCI.

Antimicrobial resistance in neonates with suspected sepsis.

SETTING: Nobel Medical College and Teaching Hospital, Biratnagar, Nepal. OBJECTIVE: To determine the pattern of antimicrobial resistance and hospital exit outcomes in neonates with suspected sepsis in a tertiary neonatal intensive care unit (NICU). DESIGN: This hospital-based cohort study was conducted to follow patients from January to December 2019. All identified cases of suspected sepsis were enlisted from hospital records. RESULTS: Sepsis was suspected in 177 (88%) of the 200 cases admitted in the NICU; 52 (29%) were culture-positive. Pseudomonas was the predominant organism isolated (n = 40; 78%), followed by coagulase negative staphylococcus (n = 12, 23%). Nine (17%) of the 52 isolates were resistant to the Access and Watch group of antibiotics, including some resistance to Reserve group drugs such as imipenem and linezolid. Most treated cases (n = 170, 96%) improved, although 7 (4%) left against medical advice. CONCLUSION: Most of the pathogens were resistant to WHO Access and Watch antibiotics and occasional resistance was observed to Reserve group drugs. Most sepsis was caused by Gram-negative bacilli. Improving turnaround times for antibiotic sensitivity testing using point-of-care testing, and a greater yield of culture-positive results are needed to enhance the management of neonatal sepsis.

LIEU: Hôpital Universitaire Nobel Medical College, Biratnagar, Népal. OBJECTIF: Déterminer le profil de résistance antimicrobienne et les résultats au moment de la sortie d'hôpital chez des nouveau-nés avec suspicion de sepsis dans une unité néonatale de soins intensifs tertiaires (NICU). MÉTHODE: Cette étude de cohorte hospitalière a été réalisée pour suivre les patients de janvier à décembre 2019. Tous les cas identifiés de suspicion de sepsis ont été inclus à partir des dossiers hospitaliers. RÉSULTATS: Une suspicion de sepsis a été observée chez 177 (88%) des 200 cas admis en NICU ; 52 (29%) étaient positifs par culture. Pseudomonas était le micro-organisme prédominant (n = 40 ; 78%), suivi des staphylocoques à coagulase négative (n = 12, 23%). Neuf (17%) des 52 isolats étaient résistants aux groupes d'antibiotiques « dont l'utilisation est essentielle ¼ et « à utiliser sélectivement ¼, avec certaines résistances aux antibiotiques « de réserve ¼ comme l'imipénème et le linézolide. L'état de la plupart des cas traités (n=170, 96%) s'est amélioré, mais sept (4%) nouveau-nés sont sortis contre avis médical. CONCLUSION: La plupart des pathogènes étaient résistants aux antibiotiques des groupes OMS « dont l'utilisation est essentielle ¼ et « à utiliser sélectivement ¼, et quelques résistances ont été observées à certains « antibiotiques de réserve ¼. La plupart des sepsis ont été causés par des bacilles à Gram négatif. L'amélioration des délais d'exécution des tests de sensibilité aux antibiotiques à l'aide de tests au point de service et un meilleur rendement des résultats positifs par culture sont nécessaires pour renforcer la prise en charge du sepsis néonatal.

Feasibility and tolerance of a robotic postural training to improve standing in a person with ambulatory spinal cord injury.

An ambulatory elder with SCI, AIS C, balance deficits, and right ankle-foot-orthosis participated. RobUST-intervention comprised six 90 min-sessions of postural tasks with pelvic assistance and trunk perturbations. We collected three baselines and two 1 week post-training assessments-after the first four sessions (PT1) and after the last two sessions (PT2). We measured Berg Balance Scale (BBS), four-stage balance test (4SBT)-including a 30 s-window with and without vision-standing workspace area, and reactive balance (measured as body weight%). Kinematics, center-of-pressure (COP), and electromyography (EMG) were analyzed to compute root-mean-square-COP (RMS-COP), the margin of stability (MoS), ankle range of motion, and integrated EMG (iEMG) normalized to baseline. The Borg Rating of Perceived Exertion (BRPE), and change in the Mean Arterial Pressure (MAP) and heart rate (HR) compared with baseline were collected to address training tolerance. A 2SD-bandwidth method was selected for data interpretation. The maximum BBS was achieved (1-point improvement). In the 4SBT, the participant completed 30 s (baseline = 20 s) with reduced balance variability during semi-tandem position without vision (RMS-COP baseline = 50.32 ± 2 SD = 19.64 mm; PT1 = 21.29 mm; PT2 = 19.34 mm). A trend toward increase was found in workspace area (baseline = 996 ± 359 cm2; PT1 = 1539 cm2; PT2 = 1138 cm2). The participant tolerated higher perturbation intensities (baseline mean = 25%body weight, PT2 mean = 44% body weight), and on average improved his MoS (3 cm), ankle range of motion (4°), and gluteus medius activity (iEMG = 10). RobuST-intervention was moderate-sort of hard (BRPE = 3-4). A substantial reduction in MAP (9%) and HR (30%) were observed. In conclusion, RobUST-intervention might be effective in ambulatory SCI.

Current status of periodontitis and its association with tobacco use amongst adult population of Sunsari district, in Nepal.

BACKGROUND: Tobacco products are considered significant, but preventable factors related to initiation and progression of periodontal diseases. We assessed the prevalence of periodontitis and evaluated its association with tobacco use and other factors amongst the adult population of Sunsari district in eastern Nepal. METHODS: A community-based, cross-sectional study was conducted in rural municipalities in the province one of eastern Nepal. A total of 440 adults were interviewed with a set of a pre-tested semi-structured questionnaire. Data on social demographics, adverse oral habits followed by periodontal clinical examination were recorded. Prevalence of periodontitis was assessed by a case definition provided by CDC-AAP. Univariate and multivariate logistic regression analysis was done to measure the association between tobacco use and other factors with periodontitis. RESULTS: The overall prevalence of periodontitis was found to be 71.6%. Majority (85.4%) of tobacco users had periodontitis and they were significantly associated with the disease and its severity. The study identified age groups, 45-65 years (AOR = 7.58, 95% CI 3.93-14.61), plaque accumulation (AOR = 1.01, 95% CI 1.00-1.02), smoking (AOR = 3.14, 95% CI 1.36-7.27), khaini users (smokeless tobacco, AOR = 2.27, 95% CI 1.12-4.61) and teeth loss (AOR = 2.02, 95% CI 1.21-3.38) as the significant factors associated with periodontitis. CONCLUSION: The prevalence of periodontitis is high in the surveyed rural adult population. Cigarette smoking along with the use of smokeless tobacco in the form of khaini were identified as significant factors associated with periodontitis.

5th generation millimeter wave wireless communication propagation losses dataset for indian metro cities based on corresponding weather conditions.

In this paper, we present 5th generation (5G) millimeter wave (mmWave) wireless communication propagation losses dataset for four Indian major urban cities like Delhi, Mumbai, Kolkata and Chennai based on corresponding weather conditions. Weather effect on mmWave is calculated in terms of mmWave path losses by considering various atmospheric weather conditions. Propagation of mmWave is affected by weather impairments (WIs) and due to that mmWave attenuation takes place and Indian metro cities have variety in weather variations. 5G mmWave propagation attenuation is calculated due to WIs like water vapour, oxygen, rain and fog for frequencies 28 GHz, 37 GHz and 39 GHz. Individual WI effects during the season are calculated and shown suing graphs and tables.

Impact of Community Diagnosis Programme on Undergraduate Students at BP Koirala Institute of Health Sciences.

Background Community Diagnosis Programme (CDP) aims to demonstrate the importance of teamwork in health care to understand the comprehensive health needs of the rural people and conceive about the research. Objective To assess the impact of community diagnosis program on undergraduate students of BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. Method A cross sectional study with mixed design (quantitative and qualitative) was conducted among the undergraduate students of batch 2017 participating in community diagnosis programme of BP Koirala Institute of Health Sciences, Dharan, Nepal. Eight questions assessed the students' perceptions regarding their abilities about community diagnosis program using six point Likert Scale and four open ended questions were used to know the students' experience and perception of community diagnosis programme. Result Overall mean ± SD score for pre-exposure response was 30.47 ± 6.18 and for the post-exposure response was 40.49 ± 5.16. The overall mean ± SD score of the students categorized according to streams showed similar results in both pre-exposure response and post-exposure responses. Qualitative analysis revealed the themes like "Research, a reflection of community and new method of learning to medical students"; "method of developing confidence and good communication skills", "learning to work as a team" and "exposure to rural area"; "Research an adjunct to medical profession". Conclusion Community diagnosis programme had a positive impact on the students about basic survey process, learnt to communicate with rural people, understood the type of data and were willing to participate in similar projects in future. Qualitative analysis showed most of the students had positive experience with some negative experience of community diagnosis programme.

A novel functional calibration method for real-time elbow joint angles estimation with magnetic-inertial sensors.

Magnetic-inertial measurement units (MIMUs) are often used to measure the joint angles between two body segments. To obtain anatomically meaningful joint angles, each MIMU must be computationally aligned (i.e., calibrated) with the anatomical rotation axes. In this paper, a novel four-step functional calibration method is presented for the elbow joint, which relies on a two-degrees-of-freedom elbow model. In each step, subjects are asked to perform a simple task involving either one-dimensional motions around some anatomical axes or a static posture. The proposed method was implemented on a fully portable wearable system, which, after calibration, was capable of estimating the elbow joint angles in real time. Fifteen subjects participated in a multi-session experiment that was designed to assess accuracy, repeatability and robustness of the proposed method. When compared against an optical motion capture system (OMCS), the proposed wearable system showed an accuracy of about 4° along each degree of freedom. The proposed calibration method was tested against different MIMU mountings, multiple repetitions and non-strict observance of the calibration protocol and proved to be robust against these factors. Compared to previous works, the proposed method does not require the wearer to maintain specific arm postures while performing the calibration motions, and therefore it is more robust and better suited for real-world applications.

Robot-driven downward pelvic pull to improve crouch gait in children with cerebral palsy.

Children with cerebral palsy commonly exhibit an abnormality called crouch gait, which is characterized by excessive flexion of the hips/knees and weak plantar flexor muscles during the stance phase. One of the major reasons for this pathological gait is weakness in soleus muscles. During the mid-stance phase of gait when the toe and heel are both on the ground, the soleus keeps the shank upright and facilitates extension of the knee angle. It also provides propulsive forces on the body during the late stance phase of the gait cycle. We hypothesized that walking with downward pelvic pull will (i) strengthen extensor muscles, especially the soleus, against the applied downward force and (ii) improve muscle coordination during walking. We then tested a robotic training paradigm to improve both posture and gait of children with crouch gait. In this paradigm, participants with crouch gait were subjected to downward pelvic force when walking on a treadmill, provided by a cable-driven robot called Tethered Pelvic Assist Device. Electromyography of soleus and gastrocnemius muscles and walking kinematics of the participants showed the feasibility of this training, enhanced upright posture of the participants, and improved muscle coordination. In addition, walking features of these participants, such as increased step length, range of motion of the lower limb angles, toe clearance, and heel-to-toe pattern, improved. This robotic training method can be a promising intervention for children with cerebral palsy who have a crouch gait.

Micro-CT versus synchrotron radiation phase contrast imaging of human cochlea.

High-resolution images of the cochlea are used to develop atlases to extract anatomical features from low-resolution clinical computed tomography (CT) images. We compare visualization and contrast of conventional absorption-based micro-CT to synchrotron radiation phase contrast imaging (SR-PCI) images of whole unstained, nondecalcified human cochleae. Three cadaveric cochleae were imaged using SR-PCI and micro-CT. Images were visually compared and contrast-to-noise ratios (CNRs) were computed from n = 27 regions-of-interest (enclosing soft tissue) for quantitative comparisons. Three-dimensional (3D) models of cochlear internal structures were constructed from SR-PCI images using a semiautomatic segmentation method. SR-PCI images provided superior visualization of soft tissue microstructures over conventional micro-CT images. CNR improved from 7.5 ± 2.5 in micro-CT images to 18.0 ± 4.3 in SR-PCI images (p < 0.0001). The semiautomatic segmentations yielded accurate reconstructions of 3D models of the intracochlear anatomy. The improved visualization, contrast and modelling achieved using SR-PCI images are very promising for developing atlas-based segmentation methods for postoperative evaluation of cochlear implant surgery.

Characterization of cancer stem cells from different grades of human colorectal cancer.

Colorectal cancer (CRC) is one of the most common solid tumors worldwide. Recent evidence suggests that a population of cancer cells, called cancer stem cells (CSCs), is responsible for tumor heterogeneity, invasion, metastasis, therapeutic resistance, and recurrence of CRC. The isolation and characterization of CSCs using cell surface markers have been reported previously with varying results. In this study, we investigated a panel of four putative CSC markers, CD44, CD24, CD166, and EpCAM, to define CRC-CSC. Paraffin embedded tissue samples from different grades of primary, untreated CRC were analyzed for the expression of four CSC markers CD44, CD326, CD24, and CD166, using immunohistochemistry. Flow cytometric analysis of CRC-CSC from HT29 (low grade) and HCT116 (high grade) human colorectal cancer cell lines was done. Marker-based isolation of CSC and non-CSC-bulk-tumor cells from HT29 was done using FACS, and tumor sphere assay was performed. There was a statistically significant difference (p < 0.05) in the expression of CD44, CD326, and CD166 between cases and controls. A novel cutoff distribution of CD44 and CD166 was suggested to help for better immunohistochemical analysis of CRC. Higher prevalence of CSC was seen in high-grade CRC as compared to low-grade CRC. Sorted and cultured CD44 + CD166+ cells formed tumor spheres, suggesting that these cells, having properties of self renewal and anchorage independent proliferation, were in fact CSC. Hence, CD44 and CD166 may serve as good CRC-CSC markers when used together with novel cutoff immunohistochemistry (IHC) expression levels.

Iodine potassium iodide improves the contrast-to-noise ratio of micro-computed tomography images of the human middle ear.

High-resolution imaging of middle-ear geometry is necessary for finite-element modeling. Although micro-computed tomography (microCT) is widely used because of its ability to image bony structures of the middle ear, it is difficult to visualize soft tissues - including the tympanic membrane and the suspensory ligaments/tendons - because of lack of contrast. The objective of this research is to quantitatively evaluate the efficacy of iodine potassium iodide (IKI) solution as a contrast agent. Six human temporal bones were used in this experiment, which were obtained in right-left pairs, from three cadaveric heads. All bones were fixed using formaldehyde. Three bones (one from each pair) were stained in IKI solution for 2 days, whereas the other three were not stained. Samples were scanned using a microCT system at a resolution of 20 µm. Eight soft tissues in the middle ear were segmented: anterior mallear ligament, incudomallear joint, lateral mallear ligament, posterior incudal ligament, stapedial annular ligament, stapedius muscle, tympanic membrane and tensor tympani muscle. Contrast-to-noise ratios (CNRs) of each soft tissue were calculated for each temporal bone. Combined CNRs of the soft tissues in unstained samples were 6.1 ± 3.0, whereas they were 8.1 ± 2.7 in stained samples. Results from Welch's t-test indicate significant difference between the two groups at a 95% confidence interval. Results for paired t-tests for each of the individual soft tissues also indicated significant improvement of contrast in all tissues after staining. Relatively large soft tissues in the middle ear such as the tympanic membrane and the tensor tympani muscle were impacted by staining more than smaller tissues such as the stapedial annular ligament. The increase in contrast with IKI solution confirms its potential application in automatic segmentation of the middle-ear soft tissues.

In vitro Cytotoxicity of Methanol Extract from Aerial Parts of Aralia cachemirica and Purified Continentalic Acid.

The present study was designed to evaluate the in vitro cytotoxic effect of methanol extract of aerial parts including stems, leaves and twigs of Aralia cachemirica and purified continentalic acid isolated from this extract against a panel of human cancer cell lines of varied tissues. Percentage of growth inhibition was evaluated by sulphorhodamine B assay. Purified continentalic acid showed moderate cytotoxicity against all the cell lines used. In contrast, the extract exhibited significant concentration dependant cytotoxicity against A-549 (lung), THP-1 (leukemia) and MCF-7 (breast) cell lines. This work highlights cytotoxic potential of this extract, which can further be explored for different constituents for their possible use autonomously or in combined manner in cancer therapy. The detailed analysis of their cytotoxicity has been presented in this paper.

Short-term Performance-based Error-augmentation versus Error-reduction Robotic Gait Training for Individuals with Chronic Stroke: A Pilot Study.

The success of locomotion training with robotic exoskeletons requires identifying control algorithms that effectively retrain gait patterns in neurologically impaired individuals. Here we report how the two training paradigms, performance-based error-augmentation versus error-reduction, modified walking patterns in four chronic post-stroke individuals as a proof-of-concept for future locomotion training following stroke. Stroke subjects were instructed to match a prescribed walking pattern template derived from neurologically intact individuals. Target templates based on the spatial paths of lateral ankle malleolus positions during walking were created for each subject. Robotic forces were applied that either decreased (error-reduction) or increased (error-augmentation) the deviation between subjects' instantaneous malleolus positions and their target template. Subjects' performance was quantified by the amount of deviation between their actual and target malleolus paths. After the error-reduction training, S1 showed a malleolus path with reduced deviation from the target template by 16%. In contrast, S4 had a malleolus path further away from the template with increased deviation by 12%. After the error-augmentation training, S2 had a malleolus path greatly approximating the template with reduced deviation by 58% whereas S3 walked with higher steps than his baseline with increased deviation by 37%. These findings suggest that an error-reduction force field has minimal effects on modifying subject's gait patterns whereas an error-augmentation force field may promote a malleolus path either approximating or exceeding the target walking template. Future investigation will need to evaluate the long-term training effects on over-ground walking and functional capacity.

Effect of sodium hydrosulphide after acute compression injury of spinal cord.

BACKGROUND: Early treatment of spinal cord white matter injury has been found beneficial. H2S, a neurotransmitter is neuroprotective at lower doses. PURPOSE: In the present study the effect of NaHS after clip compression injury of spinal cord white matter in vivo was studied. METHODS: The injury was induced in 8-10 weeks old Wistar rats by exposing the spinal cord at T8-T10 level by laminectomy and applying 35 g clip for 1 min. A dose of 50 µM NaHS was given intraperitoneally after 1h of injury. 0.5mm Spinal cord tissues were collected 8h after injury from both sides including epicenter and dorsal column was microdissected and used for further study. RESULTS: NaHS treatment decreases nitric oxide (NO) by 27% and lipid peroxide (LPO) by 18% as compared to injury, which are hallmark of attenuation in oxidative stress. Western blots shows significant changes in Myeloperoxidase (MPO) level went down by 10%. GSH contents increased 44% in treated group as compared to the injury group. NaHS treatment increased Nrf-2 expression 1.8 times. We found NaHS treatment reduced the GFAP expression 8%, there was no significant changes in NF-200 after treatment and no evident morphological changes with H and E staining. CONCLUSIONS: With the above data we conclude that NaHS at 50 µM dose at 1h after injury reduces the NO, LPO, GFAP and MPO level at injury site by increasing the expression of Nrf-2. We expect that a decrease in these parameters during acute phase of spinal cord injury would be helpful in neuroprotection and regeneration.

Resveratrol protects spinal cord dorsal column from hypoxic injury by activating Nrf-2.

Damage from oxidative stress plays a critical role in spinal cord injury. Nuclear factor erythroid 2-related factor (Nrf-2) signaling pathway can be activated by cellular oxidative stress. Resveratrol, a plant-derived polyphenolic compound found in red wine, has antioxidant properties. In the present study, we have examined the neuroprotective effect of resveratrol and the role of Nrf-2 in spinal cord hypoxic injury. The spinal cord was removed from adult male Wistar rats from T2-T10 and the dorsal column was used to induce hypoxic injury in vitro with and without treatment with resveratrol (50µM). Significant changes were found in the compound action potential (CAP) of spinal cord dorsal column, and hematoxyline and eosin (H&E) staining showed that resveratrol significantly improved neuronal injury. The biochemical assays showed significant changes in lipid peroxidase (LPO), reduced glutathione (GSH), superoxide dismutase (SOD), protein carbonyl (PC), mitochondrial ATP content, and mitochondrial Ca(++). Furthermore, using immunohistochemistry and Western blot, we found that after resveratrol treatment during hypoxic injury there was a significant activation of NrF-2 and down regulation of the glial fibrillary acidic protein (GFAP) content. The results show that resveratrol treatment has neuroprotective effects on CAP, Ca(++) loading, and biochemical parameters after hypoxic injury. The neuroprotective effect is likely to be exerted by increased activation of transcription factor Nrf-2 by resveratrol along with its direct antioxidant effect to ameliorate the oxidative damage and preserve mitochondrial function.

Training Toddlers Seated on Mobile Robots to Steer Using Force-Feedback Joystick.

The broader goal of our research is to train infants with special needs to safely and purposefully drive a mobile robot to explore the environment. The hypothesis is that these impaired infants will benefit from mobility in their early years and attain childhood milestones, similar to their healthy peers. In this paper, we present an algorithm and training method using a force-feedback joystick with an "assist-as-needed" paradigm for driving training. In this "assist-as-needed" approach, if the child steers the joystick outside a force tunnel centered on the desired direction, the driver experiences a bias force on the hand. We show results with a group study on typically developing toddlers that such a haptic guidance algorithm is superior to training with a conventional joystick. We also provide a case study on two special needs children, under three years old, who learn to make sharp turns during driving, when trained over a five-day period with the force-feedback joystick using the algorithm.

Reducing muscle effort in walking through powered exoskeletons.

This paper presents a novel assistive control for lower limb exoskeletons. The controller provides the user with a scaled version of the Winter's nominal torque profile, which is adapted online to the specific gait features of the user. The proposed assistive controller is implemented on the ALEX II exoskeleton and tested on two healthy subjects. Experimental results show that when assisted by the exoskeleton users can reduce the muscle effort compared to free walking.

Study of an upper arm exoskeleton for gravity balancing and minimization of transmitted forces.

An upper-arm wearable exoskeleton has been designed for the assistance and functional training of humans. One of the goals of this design is to provide passive assistance to a user by gravity balancing, while keeping the transmitted forces to the shoulder joints at a minimum. Consistent with this goal, this paper discusses: analytical gravity balancing design conditions for the structure of the exoskeleton; a possible implementation of these conditions into practical designs; the minimization of transmitted joint forces to the shoulder while satisfying the gravity balancing conditions; the numerical optimization of the system for gravity balancing and minimization of transmitted forces; and the effect of parameter variation on joint moments and joint forces via numerical optimization. An implementation of the design was undertaken using zero-free-length springs. The design idea presented in this paper may be useful in relieving the actuators effort of exoskeletons to support the weight of the arm and therefore the possibility of using small actuators and making the system light and portable or even a stand-alone passive support device can be developed based on these gravity balancing conditions.