SensAA-Design and Verification of a Cloud-Based Wearable Biomechanical Data Acquisition System.

Exoskeletons designed to assist patients with activities of daily living are becoming increasingly popular, but still are subject to research. In order to gather requirements for the design of such systems, long-term gait observation of the patients over the course of multiple days in an environment of daily living are required. In this paper a wearable all-in-one data acquisition system for collecting and storing biomechanical data in everyday life is proposed. The system is designed to be cost efficient and easy to use, using off-the-shelf components and a cloud server system for centralized data storage. The measurement accuracy of the system was verified, by measuring the angle of the human knee joint at walking speeds between 3 and 12 km/h in reference to an optical motion analysis system. The acquired data were uploaded to a cloud database via a smartphone application. Verification results showed that the proposed toolchain works as desired. The system reached an RMSE from 2.9° to 8°, which is below that of most comparable systems. The system provides a powerful, scalable platform for collecting and processing biomechanical data, which can help to automize the generation of an extensive database for human kinematics.

NTRK fusion events and targeted treatment of advanced radioiodine refractory thyroid cancer.

PURPOSE: Pathogenic fusion events involving neurotrophic receptor tyrosine kinase (NTRK) have been described in ~ 2% of differentiated thyroid cancer (DTC). The selective tropomyosin receptor kinase (TRK) inhibitors entrectinib and larotrectinib have been approved in a tumor agnostic manner based on phase 1/2 clinical trials. In a real-world setting at five referral centers, we aimed to describe the prevalence of NTRK gene fusions and the efficacy and safety of TRK inhibitor treatment for non-medullary, advanced thyroid cancer (TC). METHODS: A total of 184 TC patients with testing for NTRK gene fusions were included. Progression-free survival (PFS) and overall survival (OS) probabilities were estimated using the Kaplan-Meier method in six patients with NTRK fusion-positive TC who underwent TRK inhibitor therapy. RESULTS: 8/184 (4%) patients harbored NTRK gene fusions. Six patients with radioiodine (RAI)-refractory TC harboring NTRK1 (n = 4) and NTRK3 (n = 2) gene fusions were treated with larotrectinib. Five patients (83%) had received ≥ 1 prior systemic therapy and one patient did not receive prior systemic therapy. All patients had morphologically progressive disease before treatment initiation. Objective response rate was 83%, including two complete remissions. Median PFS from start of TRK inhibitor treatment was 23 months (95% confidence interval [CI], 0-57.4) and median OS was not reached (NR) (95% CI, NR). Adverse events were of grade 1-3. CONCLUSION: The prevalence of NTRK gene fusions in our cohort of RAI-refractory TC is slightly higher than reported for all TC patients. Larotrectinib is an effective treatment option in the majority of NTRK gene fusion-positive advanced TC patients after prior systemic treatment and has a favorable safety profile.

A Podcast Discussion on the Current Treatment Landscape for Renal Cell Carcinoma.

During the last 15 years, tremendous efforts have been made in the medical treatment of metastatic renal cell carcinoma (mRCC). Immune-oncological (IO) combinations are the current standard of care in the first-line setting of mRCC. Here, the current phase 3 trials CM214 (nivolumab/ipilimumab vs. sunitinib), KN426 (axitinib/pembrolizumab vs. sunitinib), Javelin-ren-101 (axitinib/avelumab vs. sunitinib), CM9ER (cabozantinib/nivolumab vs. sunitinib), and CLEAR (lenvatinib/pembrolizumab vs. sunitinib) were discussed. In the mentioned phase 3 trials, primary and secondary endpoints were discussed. Strengths and weaknesses of each trial were reflected in terms of overall survival, progression-free survival, objective remission, health quality of life, and safety. Reflecting on the data, as well as the current ESMO guidelines, we discuss choosing the appropriate medical treatment for patients' individualized treatment journey and relay the strength and weaknesses of each combination-starting with the appropriate first-line therapy.

First Line Medical Treatment of Metastatic Renal Cell Carcinoma: A Podcast on Choosing Wisely and Managing Safely.

During the last 15 years, tremendous efforts have been made toward medical treatment of metastatic renal cell carcinoma (mRCC). Checkpoint inhibitors (CPI) and tyrosine kinase inhibitors (TKI) dominate the therapeutic armamentarium, as a combination of either CPIs or CPI/TKI, while the value of TKI monotherapy is decreasing. With increasing efficiency, however, toxicity also increases. Appropriate management of adverse events is therefore pivotal. Recognizing adverse events, judging their etiology and appropriate management, and sometimes expanding the diagnostics of adverse events are mandatory and demand experience and vigilance. Ultimately, appropriate safety management achieves optimal oncological outcomes and maintains patient quality of life.

SenGlove-A Modular Wearable Device to Measure Kinematic Parameters of The Human Hand.

For technical or medical applications, the knowledge of the exact kinematics of the human hand is key to utilizing its capability of handling and manipulating objects and communicating with other humans or machines. The optimal relationship between the number of measurement parameters, measurement accuracy, as well as complexity, usability and cost of the measuring systems is hard to find. Biomechanic assumptions, the concepts of a biomechatronic system and the mechatronic design process, as well as commercially available components, are used to develop a sensorized glove. The proposed wearable introduced in this paper can measure 14 of 15 angular values of a simplified hand model. Additionally, five contact pressure values at the fingertips and inertial data of the whole hand with six degrees of freedom are gathered. Due to the modular design and a hand size examination based on anthropometric parameters, the concept of the wearable is applicable to a large variety of hand sizes and adaptable to different use cases. Validations show a combined root-mean-square error of 0.99° to 2.38° for the measurement of all joint angles on one finger, surpassing the human perception threshold and the current state-of-the-art in science and technology for comparable systems.

Lessons from Building a Sustainable Healthcare Exchange between the Netherlands and Cuba.

Over the past ten years, seven Dutch Universities have built a sustainable exchange with seven institutes in Cuban healthcare. The exchange was initiated by the Leiden University Medical Centre and the University of Medical Sciences of Havana. Cooperation with Cuba was chosen as Cuba has excellent primary healthcare and has a strong focus on prevention and public health. These were considered important due to the major contribution of non-communicable diseases to morbidity and mortality in the Netherlands. Exchanges have occurred with Dutch health professionals and students visiting Cuban healthcare institutions and Cuban postgraduate students studying in the Netherlands. There has been an increased awareness of the importance of public health and prevention in Dutch professional organizations following the exchange. The exchange has also helped to break the scientific and economic US blockade of Cuba and resulted in joint publications. In this review we described the process, key aspects, results and lessons learned in this process. Collaboration between Cuba (a middle income) and the Netherlands (a high-income country) is possible.

Negativity Spreads More than Positivity on Twitter After Both Positive and Negative Political Situations.

What type of emotional language spreads further in political discourses on social media? Previous research has focused on situations that primarily elicited negative emotions, showing that negative language tended to spread further. The current project extends existing knowledge by examining the spread of emotional language in response to both predominantly positive and negative political situations. In Study 1, we examined the spread of emotional language in tweets related to the winning and losing parties in the 2016 US elections, finding that increased negativity (but not positivity) predicted content sharing in both situations. In Study 2, we compared the spread of emotional language in two separate situations: the celebration of the US Supreme Court approval of same-sex marriage (positive) and the Ferguson unrest (negative), finding again that negativity spread further. These results shed light on the nature of political discourse and engagement. Supplementary Information: The online version contains supplementary material available at 10.1007/s42761-021-00057-7.

Pedobarographic changes during first month after subtalar extra-articular screw arthroereisis (SESA) operation of juvenile flexible flatfoot.

BACKGROUND: Juvenile flexible flatfoot deformity is a common problem in childhood. In severe cases, the subtalar extra-articular screw arthroereisis (SESA) according to De Pellegrin is a viable and effective option. There are just a few retrospective studies showing long-term outcomes, but the interval right after the surgery has not been described so far, even though the short time of healing is one of the great benefits of this technique. In this study, we examined if the pedobarographic measurements are able to demonstrate functional changes in the month after surgery. METHODS: Data were analyzed for seven patients (13 feet). Measurements were performed before surgery, as well as 3, 14 and 28 days after. For analysis, the foot was comparted in six areas-fore-, mid- and hindfoot, each split in their lateral and medial parts. Plantar forces and contact area were measured under static and dynamic conditions. Time-dependent changes of plantar acting forces and the contact area were compared. RESULTS: During bipedal stance, the ground force increased significantly in lateral foot areas (p < 0.001) and decreased in medial areas (p < 0.001). While the force in the medial midfoot remained reduced, in the medial forefoot, the force increased 14 days after surgery (p < 0.05) CONCLUSION: The functional changes after SESA can be accurately assessed using pedobarography. The results indicate morphologic changes of the foot, in particular the development of a longitudinal arch. Post-surgical progression can be monitored and success of the surgery can be verified.

Are there benefits of a 2D gait analysis in the evaluation of the subtalar extra-articular screw arthroereisis? Short-term investigation in children.

BACKGROUND: A juvenile flexible flatfoot is a common abnormality during growth. For children with a pathological manifestation, subtalar extra-articular screw arthroereisis is a popular operative technique. Although this minimally invasive operation technique has been performed for >45 years, complications still occasionally occur. For this reason, we created this pilot study to investigate whether a two-dimensional (2D) gait analysis is able to identify functional movement deficits after surgery. METHODS: Fourteen children (27 ft) with a mean age of 12.38 years (SD, 1.40 years) were analyzed. Biomechanics were examined before and 4 weeks after surgery using a 2D gait analysis. For this purpose, the patients were filmed on a treadmill. In focus were static and dynamic recordings of the heel angle, rearfoot angle, and the leg axis angle. In addition, the step length and self-selected speed were measured. FINDINGS: After surgery rearfoot angle showed significant reduction (p < 0.001) from 12.49° to 3.63° under static conditions and from 12.65° to 4.58° under dynamic conditions. Heel angle responded similar (p < 0.001). There were no significant differences in self-selected speed or step length. Undoubtedly, gait analysis was able to identify intraindividual deficits, leading to a closer monitoring of five patients and an adjustment of the screw in one foot. INTERPRETATION: By means of the 2D gait analysis, we were able to show functional improvement after subtalar extra-articular screw arthroereisis. Nonetheless, we identified a few children who still had functional abnormalities. Certainly, it is unclear whether this additional examination is able to reveal all complications that would have occurred later.

Emergency abdominal surgery in a patient anticoagulated with dabigatran.

Dabigatran is a newer oral anticoagulant, indicated for chronic atrial fibrillation anticoagulation. Experience with an emergent laparotomy in a patient on dabigatran is presented. Difficulties of this medication and strategies to deal with the coagulopathy from this direct thrombin inhibitor are described.

A case of obstruction due to jejunoileal diverticula.

OBJECTIVE: The objective of this study is to discuss the presentation and diagnosis of a complicated jejunoileal diverticuli. CASE REPORT: The case of a 94-year-old woman with small bowel obstruction secondary to an impacted enterolith from a jejunoileal diverticulum is presented to illustrate the clinical picture and radiographic findings of complicated small bowel diverticula.

Torsion of the cryptorchid testis--can it be salvaged?

PURPOSE: The literature concerning undescended testis mainly concentrates on the increased risks of infertility and development of germ cell tumors. Yet the UDT also appears to be at higher risk for torsion compared to the normally descended testis, and this issue is relatively poorly addressed. We reviewed all cases of torsion of UDTs operated on at our hospital during the last 20 years in an attempt to characterize better this condition and its salvageability. MATERIALS AND METHODS: In this retrospective clinical study we reviewed and analyzed all cases of testicular torsion involving UDT operated on at our hospital between 1984 and 2004. RESULTS: A total of 11 children were operated on at our hospital for torsion of undescended testis between 1984 and 2004. Patient age ranged from 1 month to 18 years (median 7.5 months). In all cases unilateral torsion of undescended testis was diagnosed, with 73% of cases involving the left side. Clinical symptoms included inguinal swelling and erythema associated with a tender, firm mass palpated in the groin area and an empty ipsilateral hemiscrotum. Doppler ultrasound examination was routinely performed in the last 7 patients to confirm the diagnosis. During inguinoscrotal exploration severe ischemia or overt necrosis of the testis was found in 5 of 11 cases. Three of these 5 cases were managed by orchiectomy, while in the other 2 cases the testis subsequently vanished. In the 6 patients who exhibited some improvement following detorsion and warming of the tissue the testes were preserved and orchiopexy was performed. Followup was available in only 5 patients, with vanishing of the torsed testis observed in 4 and a normal testicle detected 21 years postoperatively in 1 patient who was diagnosed early. CONCLUSIONS: This series clearly demonstrates poor rates of surgical salvage, which we mainly attribute to delays in parental response and in primary physician referral to the hospital. Parents, who have a pivotal role in early diagnosis, were usually unaware of this urological emergency, and some were surprisingly unaware of the presence of cryptorchidism. By increasing the awareness regarding this entity among members of the medical community and parents, we hope that torsion of the cryptorchid testis (literally, "hidden testis") will no longer necessarily be synonymous with "crypt-torsion" ("hidden torsion").

Late post-reimplantation ureteral obstruction during pregnancy: a transient phenomenon?

PURPOSE: Patients with a history of surgical correction of vesicoureteral reflux warrant surveillance for long-term complications. However, there are little data on long-term outcome, based mainly on small series and insufficient followup. Close followup is particularly indicated during pregnancy since these patients tend to have a dilated collecting system and frequent urinary tract infections. As part of a long-term postoperative assessment of patients who underwent ureteral reimplantations in childhood, we focused on late pregnancy related obstructive dilatation associated with renal failure. MATERIALS AND METHODS: Between 1970 and 1979, 322 children underwent ureteral reimplantation at our institution. A comprehensive retrospective study done to evaluate the long-term postoperative outcome, detected 2 cases of late gestational ureteral obstruction. Subsequently 2 additional cases were identified elsewhere. RESULTS: All 4 patients underwent successful Politano-Leadbetter ureteral reimplantation at ages 4 to 12 years. They presented during pregnancy 17 to 22 years postoperatively with progressive hydroureteronephrosis and renal failure, which required urinary drainage by percutaneous nephrostomies. Antegrade studies performed during pregnancy and in the early post-delivery period revealed severe obstruction of the distal ureters, which gradually subsided. CONCLUSIONS: Ureteral obstruction during pregnancy, in women who previously underwent Politano-Leadbetter ureteral reimplantation, may be attributed to high reimplantation syndrome and is likely to be a transient phenomenon. Awareness of this late and rare complication may enable us to detect this situation early, provide temporary adequate urinary drainage and prevent unnecessary surgical procedures.