Open-source design of low-cost sensorised elastic actuators for collaborative prosthetics and orthotics.

Collaborative robots, or cobots, have become popular due to their ability to safely operate alongside humans in shared environments. These robots use compliant actuators as a key design element to prevent damage during unintended collisions. In prosthetic and orthotic applications, compliant actuators are crucial for ensuring user safety and comfort. However, most compliant cobots for these applications are excessively expensive and complex to construct. Our study introduces an innovative, cost-effective, and sensorised elastic actuator design tailored for prosthetics and orthotics. The design uses a modular approach and leverages 3D printing technology for rapid customisation, enabling efficient and affordable fabrication. Both hardware and software components are open-source, facilitating unrestricted access for students, researchers, and practitioners. Our design supports impedance and admittance control techniques, enhancing the system's capabilities. Validation results show a standard deviation of 9.67 Nm between calculated and measured torque in impedance control and 0.2563 radians between calculated and measured angles in admittance control. This allows for improved adaptability to varying operational requirements in prosthetics and orthotics. By introducing this educational framework encompassing a low-cost, sensorised elastic actuator design, we aim to address the need for accessible solutions in the field of collaborative robotics for prosthetics and orthotics.

Modelling and Control of a 2-DOF Robot Arm with Elastic Joints for Safe Human-Robot Interaction.

Collaborative robots (or cobots) are robots that can safely work together or interact with humans in a common space. They gradually become noticeable nowadays. Compliant actuators are very relevant for the design of cobots. This type of actuation scheme mitigates the damage caused by unexpected collision. Therefore, elastic joints are considered to outperform rigid joints when operating in a dynamic environment. However, most of the available elastic robots are relatively costly or difficult to construct. To give researchers a solution that is inexpensive, easily customisable, and fast to fabricate, a newly-designed low-cost, and open-source design of an elastic joint is presented in this work. Based on the newly design elastic joint, a highly-compliant multi-purpose 2-DOF robot arm for safe human-robot interaction is also introduced. The mechanical design of the robot and a position control algorithm are presented. The mechanical prototype is 3D-printed. The control algorithm is a two loops control scheme. In particular, the inner control loop is designed as a model reference adaptive controller (MRAC) to deal with uncertainties in the system parameters, while the outer control loop utilises a fuzzy proportional-integral controller to reduce the effect of external disturbances on the load. The control algorithm is first validated in simulation. Then the effectiveness of the controller is also proven by experiments on the mechanical prototype.

Patient creates filtering bleb: hypotony following traumatic rupture of an old scleral incision for intracapsular cataract surgery.

An 86-year-old woman presented with symptomatic hypotony on the left eye since a few weeks, blurry vision and a very sensitive eye. She had a history of bilateral intracapsular cataract extraction (ICCE) in 1982 and secondary intraocular lens implantation in 1988. The patient mentioned a fall on the left side of the head 6 months earlier. The diagnosis of a superior scleral fistula was made, confirmed by gonioscopy and anterior segment optical coherence tomography. Direct surgical repair of the fistula led to a favourable outcome. This case demonstrates the occurrence of symptomatic hypotony due to the traumatic creation of a scleral fistula with an inadvertent filtering bleb many years after ICCE, and the resolution of signs and symptoms after surgical repair. Conventional as well as contemporary modalities can be valuable in the assessment of such fistulae. Management depends on the clinical course and the mechanism and extent of fistulation.

Pralatrexate in relapsed/refractory T-cell lymphoma: a retrospective multicenter study.

We present a retrospective multicenter study of pralatrexate treatment outcomes in an Australian practice setting for patients with relapsed/refractory T-cell lymphoma who had failed 1+ systemic therapies, treated via a compassionate access program. Endpoints assessed included response rates, toxicities, and subsequent therapies. Progression-free survival (PFS), time to next treatment (TTNT), event-free survival (EFS), overall survival (OS), and time to best response, were assessed by Kaplan-Meier analysis. The study included 31 patients, with median age 69 years. We demonstrated ORR of 35.5% (n = 11), including 4 complete responses (13%) and 7 partial responses (23%). The predicted median OS was 10 months, with EFS of 9 months, and PFS of 9 months. Median TTNT was 8 months. Mucositis was the most commonly observed toxicity. This study - the second largest real-world cohort reported to date - underscores the importance of pralatrexate in relapsed/refractory T-cell lymphoma, as well as its acceptable toxicity profile.

Fifteen years of IOL exchange: indications, outcomes, and complications.

PURPOSE: To report the indications, frequency, and outcomes regarding intraocular lens (IOL) exchange in 2 university hospital tertiary referral settings over a period of 15 years. SETTING: Ophthalmology departments of the University Hospital Antwerp and the University Hospital Leuven, Belgium. DESIGN: Retrospective cross-sectional study. METHODS: In this retrospective study, included were patients who underwent an IOL exchange between 2002 and 2017. Patient demographics, surgical indication, comorbidities, visual outcomes, and complications were reported. Patients who underwent IOL repositioning or add-on IOL implantation or extraction, and patients who were left aphakic, were excluded. RESULTS: Included in the study were 492 eyes. The mean age was 66.0 ± 13.3 years (range 19-91 years). The mean time between primary surgery and IOL exchange was 54.61 ± 67.07 months (range 0-343 months). Primary indication for explantation was IOL opacification, and the most common ophthalmic comorbidity was a previous history of vitreoretinal surgery. Preoperatively, the mean uncorrected visual acuity (UCVA) and corrected distance visual acuity (CDVA) were 0.47 ± 0.27 (range 0-1) and 0.61 ± 0.32 (range 0-1.2), respectively. Postoperative UCVA and CDVA was 0.7 ± 0.3 (range 0-1.2) and 0.8 ± 0.28 (range 0.05-1.6), respectively. The increase in both CDVA and UCVA was statistically significant (P < .001, paired t test). The most common complication perioperatively was vitreous prolapse, which occurred in 61 eyes (16%). CONCLUSIONS: IOL exchange is a challenging yet valuable treatment option for a wide spectrum of problematic IOL outcomes. The most common indication remains IOL opacification, although IOL dislocation and patient dissatisfaction are increasing as indications.

Donor-Related Nontuberculous Mycobacterial Interface Infection After Descemet Membrane Endothelial Keratoplasty.

PURPOSE: To describe the first reported case of Mycobacterium chelonae-related interface keratitis after Descemet membrane endothelial keratoplasty (DMEK), successfully treated with DMEK exchange. METHODS: A case of donor-related DMEK interface keratitis, treated with medical therapy and DMEK exchange, was studied retrospectively. RESULTS: A patient with Fuchs endothelial dystrophy developed infectious interface keratitis after DMEK. In cultures of the donor cornea transport medium, M. chelonae was isolated. Subsequent clinical investigation showed early signs of infectious keratitis with multiple infiltrates at the donor-graft interface. Cultures at the cornea bank of origin also showed M. chelonae, indicating a donor-related infection. Because of unsuccessful medical therapy, the DMEK graft was exchanged 4.5 months after initial DMEK. After 2 weeks, some interface precipitates appeared. These precipitates regressed over the following months with continued medical therapy. Antibiotic therapy was successfully ended 5 months after DMEK exchange. CONCLUSION: This case highlights the importance of early diagnosis and intensive treatment of nontuberculous mycobacterial interface keratitis. If intensive medical therapy is able to contain infection but fails to eradicate interface keratitis, DMEK exchange is a possible treatment option.

The role of the vitreous body in effective IOL positioning.

PURPOSE: To compare the effective lens position (ELP) after phaco surgery alone and after combined phacovitrectomy surgery. METHODS: Twenty patients who were scheduled for elective surgery in both eyes were included. In one eye, phacovitrectomy surgery was performed (without any tamponade), and in the fellow eye, only phaco surgery was performed using the same IOL type. Pre- and postoperative biometric measurements were performed using laser interference biometry. The postoperative anterior chamber depth (ACD) was measured to determine the ELP. The primary outcome measure was the difference in the postoperative ACD between both eyes. RESULTS: The postoperative ACD following phacovitrectomy showed a statistically significant increase compared with that following phaco surgery alone, indicating a more posterior position of the IOL. CONCLUSIONS: An adjusted ELP parameter to optimize IOL calculation may be useful in eyes undergoing combined phacovitrectomy sugergy.

Clinical Practice: A Proposed Standardized Ophthalmological Assessment for Patients with Cystinosis.

Cystinosis is a rare autosomal recessive disease with an incidence of approximately 1 case per 100,000-200,000 live births. Over the years, gaining in-depth knowledge of the disease has led to vast improvement in patient life expectancy. However, debilitating, extra-renal manifestations such as eye disease, in particular corneal crystal deposition and its associated photophobia, still occur frequently, regardless of patient age and notwithstanding the increased implementation of systemic therapy. Ophthalmological assessment has not yet been standardized. The aim of this article was to provide clear recommendations for ophthalmological assessment during follow-up of patients with cystinosis to improve quality and regularity of ophthalmological care and thereby minimize ophthalmological complications. A literature search was performed to assess previous and current recommendations on examinations to conduct during follow-up of patients with cystinosis. Multidisciplinary cystinosis clinics were set up in collaboration with the Department of Ophthalmology and the Department of Pediatric Nephrology to allow patients to be seen by a nephrologist, an ophthalmologist and other specialists on the same day. Based on the results of these multidisciplinary clinics the standardized clinical ophthalmological assessment was drafted. This is a protocol for follow-up, describing the approach taken regarding ophthalmological follow-up of patients with cystinosis, considering the different types of the disease and the time since diagnosis. Standard examination includes history, visual acuity, tonometry and slit-lamp examination, with fundus photography performed at diagnosis and annually thereafter. Confocal microscopy is the imaging modality of choice, while anterior segment optical coherence tomography (OCT) is a good alternative. Finally, posterior segment OCT for imaging of the macular region and optic nerve should be conducted on an annual basis.

Fracture types and risk factors in men with prostate cancer on androgen deprivation therapy: a matched cohort study of 19,079 men.

PURPOSE: Accumulating evidence shows that androgen deprivation therapy is associated with osteoporosis and fragility fractures of the spine, hip and wrist. One study suggested that androgen deprivation therapy may also be associated with nonfragility fractures in older men. Whether other clinical risk factors independently increase the risk of fractures is not certain. MATERIALS AND METHODS: Using linked administrative databases in Ontario, Canada, we matched 19,079 men 66 years old or older with prostate cancer with at least 6 months of continuous androgen deprivation therapy or bilateral orchiectomy with men with prostate cancer who had never received androgen deprivation. Matching variables were age, prior cancer treatment, diagnosis year, comorbidity, medication, prior fractures and socioeconomic variables. Primary outcomes were a typical fragility fracture of the spine, hip or wrist and any fracture. Independent predictors of fracture outcomes were assessed with Cox proportional hazards models. RESULTS: At a mean 6.47-year followup androgen deprivation therapy was associated with an increased risk of fragility fracture (HR 1.65, 95% CI 1.53-1.78) and any fracture (HR 1.46, 95% CI 1.39-1.54). Independent predictors of fragility and any fracture were increasing age, prior bone thinning medications, chronic kidney disease, prior dementia, prior fragility fracture and prior osteoporosis diagnosis or treatment (p <0.05). CONCLUSIONS: Continuous androgen deprivation therapy for at least 6 months is associated with an increased risk of fracture. Increasing age, prior osteoporotic fracture and dementia are important clinical factors that may warrant greater consideration of anti-osteoporotic therapy in these men.

Selective serotonin reuptake inhibitors and breast cancer mortality in women receiving tamoxifen: a population based cohort study.

OBJECTIVE: To characterise whether some selective serotonin reuptake inhibitor (SSRI) antidepressants reduce tamoxifen's effectiveness by inhibiting its bioactivation by cytochrome P450 2D6 (CYP2D6). DESIGN: Population based cohort study. PARTICIPANTS: Women living in Ontario aged 66 years or older treated with tamoxifen for breast cancer between 1993 and 2005 who had overlapping treatment with a single SSRI. MAIN OUTCOME MEASURES: Risk of death from breast cancer after completion of tamoxifen treatment, as a function of the proportion of time on tamoxifen during which each SSRI had been co-prescribed. RESULTS: Of 2430 women treated with tamoxifen and a single SSRI, 374 (15.4%) died of breast cancer during follow-up (mean follow-up 2.38 years, SD 2.59). After adjustment for age, duration of tamoxifen treatment, and other potential confounders, absolute increases of 25%, 50%, and 75% in the proportion of time on tamoxifen with overlapping use of paroxetine (an irreversible inhibitor of CYP2D6) were associated with 24%, 54%, and 91% increases in the risk of death from breast cancer, respectively (P<0.05 for each comparison). By contrast, no such risk was seen with other antidepressants. We estimate that use of paroxetine for 41% of tamoxifen treatment (the median overlap in our sample) would result in one additional breast cancer death within five years of cessation of tamoxifen for every 19.7 (95% confidence interval 12.5 to 46.3) patients so treated; the risk with more extensive overlap would be greater. CONCLUSION: Paroxetine use during tamoxifen treatment is associated with an increased risk of death from breast cancer, supporting the hypothesis that paroxetine can reduce or abolish the benefit of tamoxifen in women with breast cancer.