Improving Walking Energy Efficiency in Transtibial Amputees Through the Integration of a Low-Power Actuator in an ESAR Foot.

Reducing energy consumption during walking is a critical goal for transtibial amputees. The study presents the evaluation of a semi-active prosthesis with five transtibial amputees. The prosthesis has a low-power actuator integrated in parallel into an energy-storing-and-releasing foot. The actuator is controlled to compress the foot during the stance phase, supplementing the natural compression due to the user's dynamic interaction with the ground, particularly during the ankle dorsiflexion phase, and to release the energy stored in the foot during the push-off phase, to enhance propulsion. The control strategy is adaptive to the user's gait patterns and speed. The clinical protocol to evaluate the system included treadmill and overground walking tasks. The results showed that walking with the semi-active prosthesis reduced the Physiological Cost Index of transtibial amputees by up to 16% compared to walking using the subjects' proprietary prosthesis. No significant alterations were observed in the spatiotemporal gait parameters of the participants, indicating the module's compatibility with users' natural walking patterns. These findings highlight the potential of the mechatronic actuator in effectively reducing energy expenditure during walking for transtibial amputees. The proposed prosthesis may bring a positive impact on the quality of life, mobility, and functional performance of individuals with transtibial amputation.

Continuous Phase Estimation in a Variety of Locomotion Modes Using Adaptive Dynamic Movement Primitives.

Accurate gait phase estimation algorithms can be used to synchronize the action of wearable robots to the volitional user movements in real time. Current-day gait phase estimation methods are designed mostly for rhythmic tasks and evaluated in highly controlled walking environments (namely, steady-state walking). Here, we implemented adaptive Dynamic Movement Primitives (aDMP) for continuous real-time phase estimation in the most common locomotion activities of daily living, which are level-ground walking, stair negotiation, and ramp negotiation. The proposed method uses the thigh roll angle and foot-contact information and was tested in real time with five subjects. The estimated phase resulted in an average root-mean-square error of 3.98% ± 1.33% and a final estimation error of 0.60% ± 0.55% with respect to the linear phase. The results of this study constitute a viable groundwork for future phase-based control strategies for lower-limb wearable robots, such as robotic prostheses or exoskeletons.

Decoding Upper-Limb Movement Intention Through Adaptive Dynamic Movement Primitives: A Proof-of-Concept Study with a Shoulder-Elbow Exoskeleton.

This work presents an intention decoding algorithm that can be used to control a 4 degrees-of-freedom shoulder-elbow exoskeleton in reaching tasks. The algorithm was designed to assist the movement of users with upper-limb impairments who can initiate the movement by themselves. It relies on the observation of the initial part of the user's movement through joint angle measures and aims to estimate in real-time the phase of the movement and predict the goal position of the hand in the reaching task. The algorithm is based on adaptive Dynamic Movement Primitives and Gaussian Mixture Models. The performance of the algorithm was verified in robot-assisted planar reaching movements performed by one healthy subject wearing the exoskeleton. Tests included movements of different amplitudes and orientations. Results showed that the algorithm could predict the hand's final position with an error lower than 5 cm after 0.25 s from the movement onset, and that the final position reached during the tests was on average less than 4 cm far from the target position. Finally, the effects of the assistance were observed in a reduction of the activation of the Biceps Brachii and of the time to execute the reaching tasks.

A Locomotion Mode Recognition Algorithm Using Adaptive Dynamic Movement Primitives.

Control systems of robotic prostheses should be designed to decode the users' intent to start, stop, or change locomotion; and to select the suitable control strategy, accordingly. This paper describes a locomotion mode recognition algorithm based on adaptive Dynamic Movement Primitive models used as locomotion templates. The models take foot-ground contact information and thigh roll angle, measured by an inertial measurement unit, for generating continuous model variables to extract features for a set of Support Vector Machines. The proposed algorithm was tested offline on data acquired from 10 intact subjects and 1 subject with transtibial amputation, in ground-level walking and stair ascending/descending activities. Following subject-specific training, results on intact subjects showed that the algorithm can classify initiatory and steady-state steps with up to 100.00% median accuracy medially at 28.45% and 27.40% of the swing phase, respectively. While the transitory steps were classified with up to 87.30% median accuracy medially at 90.54% of the swing phase. Results with data of the transtibial amputee showed that the algorithm classified initiatory, steady-state, and transitory steps with up to 92.59%, 100%, and 93.10% median accuracies medially at 19.48%, 51.47%, and 93.33% of the swing phase, respectively. The results support the feasibility of this approach in robotic prosthesis control.

The effect of Liv-52 on liver ischemia reperfusion damage in rats.

BACKGROUND: Liver ischemia reperfusion (I/R) damage which is frequently seen in clinical hepatobiliary surgeries has no effective treatment for it. Liv-52, known to have hepatoprotective effects, is a natural antioxidant drug licensed by the Ministry of Health of India. The aim of our study is to investigate the effect of Liv-52 on liver damage induced by I/R in rats. METHODS: Albino Wistar male rats were divided into three groups; liver I/R (IR), 20 mg/kg Liv-52 + liver ischemia reperfusion (LIR) and sham operation applied to control group (HG). Liv-52 was administered to the LIR group (n = 6) 1 h prior to I/R application and distilled water was given orally to IR (n = 6) and HG (n = 6) groups as a solvent. Ischemia was determined as 1 h, and reperfusion was identified as 6 h in animals. RESULTS: Increased levels of alanine aminotransferase, aspartate aminotransferase and lactate dehydrogenase, malondialdehyde, myeloperoxidase, and decreased levels of superoxide dismutase, and glutathione related enzymes caused by I/R application have been converged to healthy group level with Liv-52 treatment and the damage in liver tissue has been improved histopathologically. CONCLUSIONS: Liv-52 may be beneficial for preventing liver I/R damage in pre-surgery application.

Effect of taxifolin on oxidative gastric injury induced by celiac artery ligation in rats.

PURPOSE: To examine the effect of taxifolin on I/R induced gastric injury in rats using biochemical and histopatholohical methods. METHODS: Eighteen albino Wistar male rats equally grouped as; gastric I/R (I/R), 50 mg/kg taxifolin + gastric I/R (TAX+ I/R) and sham operation applied (SHAM). Ischemia induced for 1 hour, and reperfusion induced for 3 hours. RESULTS: Oxidant parameters like, Malondialdehyde (MDA) and Hydroxyguanine (8-OHdG) were higher, whereas total glutathione (tGSH) was lower in the I/R group according to SHAM group, histopathological findings such as marked destruction, edema, and proliferated dilated congested blood vessels were observed severely in the I/R group, whereas there was not any pathological finding except mild dilated congested blood vessels in the TAX+ I/R group. CONCLUSION: The taxifolin can be clinically beneficial in the treatment of gastric injury due to I/R procedure.

Effect of taxifolin on oxidative gastric injury induced by celiac artery ligation in rats

Abstract Purpose: To examine the effect of taxifolin on I/R induced gastric injury in rats using biochemical and histopatholohical methods. Methods: Eighteen albino Wistar male rats equally grouped as; gastric I/R (I/R), 50 mg/kg taxifolin + gastric I/R (TAX+ I/R) and sham operation applied (SHAM). Ischemia induced for 1 hour, and reperfusion induced for 3 hours. Results: Oxidant parameters like, Malondialdehyde (MDA) and Hydroxyguanine (8-OHdG) were higher, whereas total glutathione (tGSH) was lower in the I/R group according to SHAM group, histopathological findings such as marked destruction, edema, and proliferated dilated congested blood vessels were observed severely in the I/R group, whereas there was not any pathological finding except mild dilated congested blood vessels in the TAX+ I/R group. Conclusion: The taxifolin can be clinically beneficial in the treatment of gastric injury due to I/R procedure.

The effect of metyrosine on oxidative gastric damage induced by ischemia/reperfusion in rats. Biochemical and histopathological evaluation.

PURPOSE: To investigate the effect of metyrosine against I/R induced gastric damage in rats. METHODS: Eighteen albino Wistar male rats were divided into groups; gastric I/R (GIR), 50 mg/kg metyrosine+gastric I/R (MGIR), and sham (SG) groups. 50 mg/kg metyrosine was given to the MGIR group, and distilled water was given to the GIR and SG groups by the oral gavage. After 30 minutes, 25 mg/kg thiopental sodium was injected intraperitoneally. Ischemia was achieved for 1 hour by clamping the celiac artery of the MGIR and GIR groups, then reperfusion was achieved for 3 hours. After that, animals were killed with 50 mg/kg thiopental. Biochemical and histopathological examinations performed on the gastric tissues. RESULTS: Metyrosine decreased the MDA and MPO and the increased the tGSH and SOD. In addition, it reduced inflammation by suppressing the decrease of COX-1 and the increase of COX-2. Histopathologically, metyrosine decreased symptoms caused by I/R such as mucosal necrosis, hemorrhage, edema, PMNL infiltration, and dilated congested blood vessels. CONCLUSIONS: Metyrosine prevented the I/R induced oxidative stress in the gastric tissue. Metyrosine may be beneficial for gastric I/R injury.

The effect of metyrosine on oxidative gastric damage induced by ischemia/reperfusion in rats. Biochemical and histopathological evaluation

Abstract Purpose: To investigate the effect of metyrosine against I/R induced gastric damage in rats. Methods: Eighteen albino Wistar male rats were divided into groups; gastric I/R (GIR), 50 mg/kg metyrosine+gastric I/R (MGIR), and sham (SG) groups. 50 mg/kg metyrosine was given to the MGIR group, and distilled water was given to the GIR and SG groups by the oral gavage. After 30 minutes, 25 mg/kg thiopental sodium was injected intraperitoneally. Ischemia was achieved for 1 hour by clamping the celiac artery of the MGIR and GIR groups, then reperfusion was achieved for 3 hours. After that, animals were killed with 50 mg/kg thiopental. Biochemical and histopathological examinations performed on the gastric tissues. Results: Metyrosine decreased the MDA and MPO and the increased the tGSH and SOD. In addition, it reduced inflammation by suppressing the decrease of COX-1 and the increase of COX-2. Histopathologically, metyrosine decreased symptoms caused by I/R such as mucosal necrosis, hemorrhage, edema, PMNL infiltration, and dilated congested blood vessels. Conclusions: Metyrosine prevented the I/R induced oxidative stress in the gastric tissue. Metyrosine may be beneficial for gastric I/R injury.

Necl 4 and RNase 5 Are Important Biomarkers for Gastric and Colon Adenocarcinomas.

BACKGROUND There is a need to identify new prognostic factors that may be used in addition to the known risk factors in gastrointestinal adenocarcinomas. In this study, we aimed to determine the expression of Necl 4 and RNase 5 biomarkers in gastric and colon adenocarcinomas, as well as the prognostic efficacy of these biomarkers in gastric and colon adenocarcinomas. MATERIAL AND METHODS Ninety-two cases resected due to stomach and colon adenocarcinoma were included in the study. The expression of Necl 4 and RNase 5 biomarkers was evaluated by immunohistochemical staining of the stomach and colon normal mucosa and adenocarcinoma areas. RESULTS In colon adenocarcinomas, there was a significant association between Necl 4 and lymphovascular invasion, vascular invasion, and perineural invasion (p<0.05). There was a significant association between RNase 5 and histological differentiation in colon adenocarcinomas (p<0.05). There was no association between RNase 5 and Necl 4 in gastric or colon adenocarcinomas. CONCLUSIONS Necl 4 may have prognostic value in colon adenocarcinomas, but it is difficult to ascertain in gastric adenocarcinomas.

The Effect of Infliximab on Intestinal Anastomosis Healing in Rats.

Intestinal anastomosis healing is a complex physiological process in which many local and systemic factors play a role. One of the significant cytokines in this process is TNF-α. Infliximab is a chimeric monoclonal antibody which binds to TNF-α with high affinity. Although this agent is used in ulcerative colitis and Crohn's disease, intestinal surgery may be required in these patients. In this study it was aimed to determine whether or not there was any negative effect of preoperative single dose infliximab treatment on intestinal anastomosis healing. Two groups of 10 rats were formed. One of these groups was administered with a single dose of infliximab 8 mg/kg as a 20-minute intravenous infusion from the femoral vein. Four days after the infusion, a full layer incision was made to the colon and anastomosis was applied to all the rats. At 7 days after anastomosis, the subjects were sacrificed. The anastomosis segment was removed and the bursting pressure was measured. Tissue samples were taken from this segment for hydroxyproline concentration and histopathological examination. A blood sample was taken to measure TNF-α values. No statistically significant difference was determined between the groups in terms of bursting pressure, tissue hydroxyproline concentration or histopathological scoring. A single dose of 8 mg/kg infliximab administered 4 days preoperatively was not found to have any negative effect on intestinal anastomosis healing in rats.

Effects of Montelukast in an Experimental Model of Acute Pancreatitis.

BACKGROUND We evaluated the hematological, biochemical, and histopathological effects of Montelukast on pancreatic damage in an experimental acute pancreatitis model created by cerulein in rats before and after the induction of pancreatitis. MATERIAL AND METHODS Forty rats were divided into 4 groups with 10 rats each. The study groups were: the Cerulein (C) group, the Cerulein + early Montelukast (CMe) group, the Cerulein + late Montelukast (CMl) group, and the Control group. The pH, pO2, pCO2, HCO3, leukocyte, hematocrit, pancreatic amylase, and lipase values were measured in the arterial blood samples taken immediately before rats were killed. RESULTS There were statistically significant differences between the C group and the Control group in the values of pancreatic amylase, lipase, blood leukocyte, hematocrit, pH, pO2, pCO2, HCO3, and pancreatic water content, and also in each of the values of edema, inflammation, vacuolization, necrosis, and total histopathological score (P<0.05). When the CMl group and C group were compared, no statistically significant differences were found in any parameter analyzed. When the CMe group was compared with the C group, pancreatic amylase, lipase, pH, PO2, pCO2, HCO3, pancreatic water content, histopathological edema, inflammation, and total histopathological score values were significantly different between the groups (P<0.05). Finally, when the CMe group and the Control group were compared, significant differences were found in all except 2 (leukocyte and pO2) parameters (P<0.05). CONCLUSIONS Leukotriene receptor antagonists used in the late phases of pancreatitis might not result in any benefit; however, when they are given in the early phases or prophylactically, they may decrease pancreatic damage.

Bogota Bag Use in Planned Re-Laparotomies.

BACKGROUND Planned re-laparotomies are a series of surgical interventions that are rarely used and have a high mortality rate. The aim of this study was to investigate the factors affecting mortality and the effectiveness of the use of the Bogota bag for temporary closure of the abdomen in patients for whom re-laparotomy was planned. MATERIAL AND METHODS A retrospective examination was made of data of patients in whom a Bogota bag was used in planned re-laparotomies for various reasons in the General Surgery Department of Suleyman Demirel University Medical Faculty between June 2008 and April 2014. RESULTS Bogota bags were used in a total of 38 patients, comprising 23 (60.5%) males and 15 (39.5%) females, with a mean age of 58.94±17.89 years. The mean period of hospitalization was 14.5 days (range, 1-143 days) and the mean number of operations during that time was 3 (range, 1-11). The mean duration of intensive care unit stay was 6 days (range, 1-143 days). Malignancy was determined in 8 patients (21.1%). Indications were intra-abdominal sepsis in 23 patients (60.5%), mesenteric vascular disease in 10 patients (26.3%), and packing was required in 5 patients (13.2%). Mortality developed in 25 patients (65.8%). A significant relationship was determined between mortality and a diagnosis of mesenteric artery ischemia (p: 0.035). The mortality rate was 56% (n: 13) in patients diagnosed with intra-abdominal sepsis. A relationship was determined between mortality and age (p: 0.015), duration of hospital stay (p: 0.007), need for cardiac inotrope (p: 0.01), and need for mechanical ventilation (p: 0.01). The mean Apache II score was 26.4±5 for patients who died and 15.8±5.2 for surviving patients (p<0.001). In 5 (38.4%) of the 13 surviving patients, primary repair was applied to the abdomen, and in the remaining 8 patients abdominal wall repair was performed using dual mesh. CONCLUSIONS In patients in whom a Bogota bag was used, which is a cheap and easy method for temporary closure of the abdomen, the high mortality rates seen are related to diagnosis, Apache II score, age, and organ failure.

A giant ancient schwannoma mimicking an adnexal mass: Case report.

INTRODUCTION: Ancient schwannoma is a rare tumor of the peripheral nerve sheath. As degenerative properties are defined histologically, it can be wrongly interpreted as malignant. CASE PRESENTATION: The case presented here is of a giant ancient schwannoma with a pelvic retroperitoneal location, which was mimicking an adnexal mass. CONCLUSION: In the rarely seen cases in the retroperitoneum, it may reach very large dimensions.

Aggressive papillary adenocarcinoma on atypical localization: A unique case report.

INTRODUCTION: Aggressive digital papillary adenocarcinoma (ADPA) is a rare sweat gland tumor that is found on the fingers, toes, and the digits. To date, <100 cases have been reported in the literature. Apart from 1 case reported in the thigh, all of them were on digital or nondigital acral skin. CASE PRESENTATION: A 67-year-old Caucasian woman was admitted to the hospital due to a mass on the scalp. This lesion was present for almost a year. It was a semimobile cyctic mass that elevated the scalp. There was no change in the skin color. Its dimensions were 1.5 × 1 × 0.6 cm. The laboratory, clinic, and radiologic findings (head x-ray) of the patient were normal. It was evaluated as a benign lesion such as lipoma or epidermal cyst by a surgeon due to a small semimobile mass and no erosion of the skull. It was excised by a local surgery excision. The result of the pathologic examination was aggressive papillary adenocarcinoma. This diagnosis is synonymous with ADPA. CONCLUSION: In our case, localization was scalp. This localization is the first for this tumor in the literature. In addition, another atypical localization of this tumor (ADPA) is thigh in the literature. This case was presented due to both the rare and atypical localizations. That is why, in our opinion, revision of "digital" term in ADPA is necessary due to seem in atypical localizations like thigh and scalp.

Factors Affecting Morbidity in Solid Organ Injuries.

Background and Aim. The aim of this study was to investigate the effects of demographic characteristics, biochemical parameters, amount of blood transfusion, and trauma scores on morbidity in patients with solid organ injury following trauma. Material and Method. One hundred nine patients with solid organ injury due to abdominal trauma during January 2005 and October 2015 were examined retrospectively in the General Surgery Department of Dicle University Medical Faculty. Patients' age, gender, trauma interval time, vital status (heart rate, arterial tension, and respiratory rate), hematocrit (HCT) value, serum area aminotransferase (ALT) and aspartate aminotransferase (AST) values, presence of free abdominal fluid in USG, trauma mechanism, extra-abdominal system injuries, injured solid organs and their number, degree of injury in abdominal CT, number of blood transfusions, duration of hospital stay, time of operation (for those undergoing operation), trauma scores (ISS, RTS, Glasgow coma scale, and TRISS), and causes of morbidity and mortality were examined. In posttraumatic follow-up period, intra-abdominal hematoma infection, emboli, catheter infection, and deep vein thrombosis were monitored as factors of morbidity. Results. One hundred nine patients were followed up and treated due to isolated solid organ injury following abdominal trauma. There were 81 males (74.3%) and 28 females (25.7%), and the mean age was 37.6 ± 18.28 (15-78) years. When examining the mechanism of abdominal trauma in patients, the following results were obtained: 58 (53.3%) traffic accidents (22 out-vehicle and 36 in-vehicle), 27 (24.7%) falling from a height, 14 (12.9%) assaults, 5 (4.5%) sharp object injuries, and 5 (4.5%) gunshot injuries. When evaluating 69 liver injuries scaled by CT the following was detected: 14 (20.3%) of grade I, 32 (46.4%) of grade II, 22 (31.8%) of grade III, and 1 (1.5%) of grade IV. In 63 spleen injuries scaled by CT the following was present: grade I in 21 (33.3%), grade II in 27 (42.9%), grade III in 11 (17.5%), and grade IV in 4 (6.3%). The mean length of hospital stay after trauma was 6.46 days in the medically followed patients. This ratio was 8.13 days in 22 patients with morbidity and 5.98 days in 78 patients without morbidity. There was a morbidity in 22 (22%) patients medically followed after trauma. In this study, nonoperative treatment was observed to be performed safely in solid organ injuries after trauma in case of absence of hemodynamic stability and peritoneal irritation. It has been emphasized that injury of both liver and spleen (p < 0.01), high respiratory rate (p < 0.01), trauma scores (GKS, ISS, RTS) (p < 0.0001), and elevation of ALT AST values (p < 0.01) are stimulants for morbidity that may occur during follow-up. Conclusion. Medical follow-up can be considered in patients with high grade injuries similar to patients with low-grade solid organ injury after trauma. The injury of both liver and spleen, high respiratory rate, high GCS and ISS, low RTS, and elevation of ALT AST values were found to increase morbidity again in the follow-up of these patients.

A Rare Case of Isolated Cystic Hydatid of Thyroid Gland.

Hydatid cysts are most frequently localized within the liver and lungs, although they can also be found in highly vascularized tissues such as the brain, muscle, heart, pancreas, adrenal, and thyroid glands.A 65-year-old female patient was admitted to our clinic with complaints of a progressively growing mass that was compressing the surrounding tissues and causing respiratory distress. The pathological result was obtained as cytic hydatid.In patients with diagnosed hydatid cysts in the liver, systemic evaluation is necessary to rule out involvement of other organs. Among patients presenting with growths located in the neck, primary hydatid cyst of the thyroid gland must be considered in endemic regions.

Giant Cutaneous Leiomyosarcoma Originating From the Abdominal Wall: A Case Report.

BACKGROUND: Leiomyosarcoma, a rare type of tumor, accounts for 5-10% of all soft tissue tumors. CASE REPORT: A 44-year-old male patient was admitted to the emergency service of our medical faculty with the complaints of fatigue and abdominal mass. CONCLUSIONS: The pathology result was leiomyosarcoma. Leiomyosarcoma of the skin is rare and our case is the largest such lesion reported in the literature.

Gossypiboma Mimicking a Mesenchymal Tumor: A Report of a Rare Case.

BACKGROUND: Gossypiboma is the term for a surgical complication resulting from foreign materials such as a surgical sponge or gauze that was accidentally left inside a patient's body. CASE REPORT: Here, we report the case of a 62-year-old woman with gossypiboma. She underwent surgery due to an abdominal mass that was preoperatively considered a tumor. Intra-postoperatively, it was diagnosed as gossypiboma. CONCLUSIONS: For the prevention of gossypiboma during the pre-operative and post-operative periods, counting sponges and surgical equipment must be done very carefully. If there is any doubt postoperatively, direct abdominal imaging may be helpful.