Enhancing Walking Performance With a Bilateral Hip Exoskeleton Assistance in Individuals With Above-Knee Amputation.

Transfemoral amputation is a debilitating condition that leads to long-term mobility restriction and secondary disorders that negatively affect the quality of life of millions of individuals worldwide. Currently available prostheses are not able to restore energetically efficient and functional gait, thus, recently, the alternative strategy to inject energy at the residual hip has been proposed to compensate for the lack of energy of the missing leg. Here, we show that a portable and powered hip exoskeleton assisting both the residual and intact limb induced a reduction of walking energy expenditure in four individuals with above-knee amputation. The reduction of the energy expenditure, quantified using the Physiological Cost Index, was in the range [-10, -17]% for all study participants compared to walking without assistance, and between [-2, -24]% in three out of four study participants compared to walking without the device. Additionally, all study participants were able to walk comfortably and confidently with the hip exoskeleton overground at both their self-selected comfortable and fast speed without any observable alterations in gait stability. The study findings confirm that injecting energy at the hip level is a promising approach for individuals with above-knee amputation. By reducing the energy expenditure of walking and facilitating gait, a hip exoskeleton may extend mobility and improve locomotor training of individuals with above-knee amputation, with several positive implications for their quality of life.

Posterior wall as atypical localization of left atrial myxoma : Diagnosis and management.

Atrial myxomas are the most common benign cardiac neoplasms. Although the majority occur in the left atrium (LA) and are attached to the interatrial septum (75-80 % of cases), they can arise from any part of the LA and the cardiac chambers. We report the case of a 65-year-old woman who presented with features of worsening dyspnea and persistent headache. During transthoracic echocardiography, a suspected cardiac myxoma was found arising from the posterior wall of the LA.

Metastatic liposarcoma of the heart. Case series and brief literature review.

Secondary cardiac tumors are 20-40 times more frequent than primary lesions. Primary cardiac lesions are represented by myxomas when related to benign tumors, and by sarcomas in terms of malignant disease. Metastases to the heart from liposarcomas are very rare. We present three cases of secondary liposarcomas involving the left atrium, the right atrium, and the pericardium.

Diagnostic accuracy of 320-row computed tomography as compared with invasive coronary angiography in unselected, consecutive patients with suspected coronary artery disease.

Noninvasive coronary angiography with multislice computed tomography (CT) scanners is feasible with high sensitivity and negative predictive value. The radiation exposure associated with this technique, however, is high and concerns in the widespread use of CT have arisen. We evaluated the diagnostic accuracy of coronary angiography using 320-row CT, which avoids exposure-intensive overscanning and overranging. We prospectively studied 118 unselected consecutive patients with suspected coronary artery disease (CAD) referred for invasive coronary angiography (ICA). All patients had 320-row CT within 1 week of ICA, which, together with quantitative analysis, served as the reference standard. Of the 65 out of 118 patients who were diagnosed as having CAD by ICA, 64 (98 %) were correctly identified at 320-row CT. Noteworthy, 320-row CT correctly detected CAD in 3 patients with atrial fibrillation and ruled out the disease in the other 8 patients. From 151 significant coronary stenoses detected on ICA, 137 (91 %) were correctly identified with 320-row CT. In the per-patient analysis, sensitivity and specificity of 320-row CT were 98 and 91 %, respectively. In the per-vessel analysis, sensitivity and specificity of 320-row CT were 93 and 95 %, respectively. In the per segment analysis, sensitivity and specificity of 320-row CT were 91 and 99 %, respectively. Diameter stenosis determined with the use of CT showed good correlation with ICA (P < 0.001, R = 0.81) without significant underestimation or overestimation (-3.1 ± 24.4 %; P = 0.08). Comparison of CT with ICA revealed a significantly smaller effective radiation dose (3.1 ± 2.3 vs. 6.5 ± 4.2 mSv; P < 0.05) and amount of contrast agent required (99 ± 51 vs. 65 ± 42 ml, P < 0.05) for 320 row CT. The present study in an unselected population including patients with atrial fibrillation demonstrates that 320-row CT may significantly reduce the radiation dose and amount of contrast agent required compared with ICA while maintaining a very high diagnostic accuracy.

Cigarette smoking and ambulatory blood pressure: a case-control study in normotensives.

The aim of our study was the evaluation of the effects of cigarette smoking on ambulatory blood pressure (ABP) in normotensive subjects participating to a cardiovascular prevention program. All subjects were followed up for an average time of 97+/-42 months to assess the event of hypertension development. Prevalence of hypertension development was higher in smokers even if regression logistic analysis was not able to predict hypertension development.