Therapists and patients perceptions of a mixed reality system designed to improve trunk control and upper extremity function.

A prototype system aimed at improving arm function and trunk control after stroke has been developed that combines mixed-reality (MR) feedback with a mobile seat system (Holoreach). The purpose of this study was to assess the usability of Holoreach in a rehabilitation setting from both the patient and therapist perspective. Ten therapists (eight physiotherapists and two occupational therapists) used the device in their regular therapy programs for fifteen stroke patients with trunk control issues. Each patient received four individual therapy sessions with the device performed under the supervision of the therapist. Therapists and patients kept therapy diaries and used customized questionnaires. At the end of the study two focus groups were conducted to further assess usability. Generally, the prototype system is suitable for training trunk and arm control. The therapists expressed overall positive views on the impact of Holoreach. They characterized it as new, motivating, fresh, joyful, interesting, and exciting. All therapists and 80% of the patients agreed with the statement that training with Holoreach is beneficial for rehabilitation. Nonetheless, improvements are required in the hardware and software, and design. The prototype system contributes at various levels to the rapidly evolving advances in neurorehabilitation, particularly regarding the practical aspect of exercise delivery.

Deep Learning-Based Image Registration in Dynamic Myocardial Perfusion CT Imaging.

Registration of dynamic CT image sequences is a crucial preprocessing step for clinical evaluation of multiple physiological determinants in the heart such as global and regional myocardial perfusion. In this work, we present a deformable deep learning-based image registration method for quantitative myocardial perfusion CT examinations, which in contrast to previous approaches, takes into account some unique challenges such as low image quality with less accurate anatomical landmarks, dynamic changes of contrast agent concentration in the heart chambers and tissue, and misalignment caused by cardiac stress, respiration, and patient motion. The introduced method uses a recursive cascade network with a ventricle segmentation module, and a novel loss function that accounts for local contrast changes over time. It was trained and validated on a dataset of n = 118 patients with known or suspected coronary artery disease and/or aortic valve insufficiency. Our results demonstrate that the proposed method is capable of registering dynamic cardiac perfusion sequences by reducing local tissue displacements of the left ventricle (LV), whereas contrast changes do not affect the registration and image quality, in particular the absolute CT (HU) values of the entire CT sequence. In addition, the deep learning-based approach presented reveals a short processing time of a few seconds compared to conventional image registration methods, demonstrating its application potential for quantitative CT myocardial perfusion measurements in daily clinical routine.

A novel assistive therapy chair to improve trunk control during neurorehabilitation: Perceptions of physical therapists and patients.

A prototype assistive therapy chair (T-Chair) that induces exercise stimuli to improve trunk control and standing and walking early after stroke has been developed. The aim of this study was to assess its usability in a rehabilitation setting. Eleven physical therapists (PTs) integrated the T-Chair into the therapy programs of 15 patients post stroke. Each patient performed on average four individual therapy sessions on the T-Chair under the PTs' supervision. Usability was assessed using questionnaires, therapy diaries and focus group interviews with PTs'. Among PTs', 64% had generally a positive view on the T-Chair. Physical therapists recognized the potential for unsupervised therapy. Generally, patients reacted positively and enjoyed training. The T-Chair has the potential to become an adequate training tool for patients with an intermediate trunk control after stroke. Further development and usability testing are required to provide a therapeutic device allowing for an intensive therapy early post stroke.

Determination of a sagittal plane axis of rotation for a dynamic office chair.

OBJECTIVE: This study investigated the location of the axis of rotation in sagittal plane movement of the spine in a free sitting condition to adjust the kinematics of a mobile seat for a dynamic chair. BACKGROUND: Dynamic office chairs are designed to avoid continuous isometric muscle activity, and to facilitate increased mobility of the back during sitting. However, these chairs incorporate increased upper body movement which could distract office workers from the performance of their tasks. A chair with an axis of rotation above the seat would facilitate a stable upper back during movements of the lower back. The selection of a natural kinematic pattern is of high importance in order to match the properties of the spine. METHOD: Twenty-one participants performed four cycles of flexion and extension of the spine during an upper arm hang on parallel bars. The location of the axis of rotation relative to the seat was estimated using infrared cameras and reflective skin markers. RESULTS: The median axis of rotation across all participants was located 36 cm above the seat for the complete movement and 39 cm for both the flexion and extension phases, each with an interquartile range of 20 cm. CONCLUSION: There was no significant effect of the movement direction on the location of the axis of rotation and only a weak, non-significant correlation between body height and the location of the axis of rotation. Individual movement patterns explained the majority of the variance. APPLICATION: The axis of rotation for a spinal flexion/extension movement is located above the seat. The recommended radius for a guide rail of a mobile seat is between 36 cm and 39 cm.

[Automated two-point discrimination (TPD) for phantom pain : Effect of a 3­week automated therapy based on TPD for a transtibial amputee with phantom pain]. / Automatisierte Zweipunktdiskrimination bei Phantomschmerzen : Effekt einer 3­wöchigen automatisierten Therapie auf der Basis der Zweipunktdiskrimination (ZPD) bei einem unterschenkelamputierten Patienten mit Phantomschmerzen.

There is preliminary evidence that phantom pain is associated with disturbed organization of the sensory cortex and that this organization can be normalized with two-point discrimination (TPD) training. In this case study, a reduction in phantom pain and painful phantom sensation during a test period of 19 days, was achieved using an automated TPD procedure. In a patient with a transtibial amputation, pain levels decreased from a mean of 2.3/10 on the visual analog scale (VAS) to 1.3/10 (VAS) and the painful phantom sensation level decreased from a mean 3.7/10 (VAS) to 2.0/10 (VAS). These results show a positive trend, but are (except of the nocturnal pain attacks) rather of limited clinical relevance.

Inclination-dependent changes of the critical shoulder angle significantly influence superior glenohumeral joint stability.

BACKGROUND: The critical shoulder angle combines the acromion index and glenoid inclination and has potential to discriminate between shoulders at risk for rotator cuff tear or osteoarthritis and those that are asymptomatic. However, its biomechanics, and particularly the role of the glenoid inclination, are not yet fully understood. METHODS: A shoulder simulator was used to analyze the independent influence of glenoid inclination during abduction from 0 to 60°. Spindle motors transferred tension forces by a cable-pulley on human cadaveric humeri. A six-degree-of-freedom force transducer was mounted directly behind the polyethylene glenoid to measure shear and compressive joint reaction force and calculate the instability ratio (ratio of shear and compressive joint reaction force) with the different force ratios of the deltoid and supraspinatus muscles (2:1 and 1:1). A stepwise change in the inclination by 5° increments allowed simulation of a critical shoulder angle range of 20° to 45°. FINDINGS: Tilting the glenoid to cranial (increasing the critical shoulder angle) increases the shear joint reaction force and therefore the instability ratio. A balanced force ratio (1:1) between the deltoid and the supraspinatus allowed larger critical shoulder angles before cranial subluxation occurred than did the deltoid-dominant ratio (2:1). INTERPRETATION: Glenoid inclination-dependent changes of the critical shoulder angle have a significant impact on superior glenohumeral joint stability. The increased compensatory activity of the rotator cuff to keep the humeral head centered may lead to mechanical overload and could explain the clinically observed association between large angles and degenerative rotator cuff tears.

The validation and application of a finite element human head model for frontal skull fracture analysis.

Traumatic head injuries can result from vehicular accidents, sports, falls or assaults. The current advances in computational methods and the detailed finite element models of the human head provide a significant opportunity for biomechanical study of human head injuries. The biomechanical characteristics of the human head through head impact scenarios can be studied in detail by using the finite element models. Skull fracture is one of the most frequent occurring types of head injuries. The purpose of this study is to analyse the experimental head impacts on cadavers by means of the Strasbourg University Finite Element Head Model (SUFEHM). The results of the numerical model and experimental data are compared for validation purpose. The finite element model has also been applied to predict the skull bone fracture in frontal impacts. The head model includes the scalp, the facial bone, the skull, the cerebral spinal fluid, the meninges, the cerebrum and the cerebellum. The model is used to simulate the experimental frontal head impact tests using a cylindrical padded impactor. Results of the computational simulation shows that the model correlated well with a number of experimental data and a global fracture pattern has been predicted well by the model. Therefore the presented numerical model could be used for reconstruction of head impacts in different impact conditions also the forensic application of the head model would provide a tool for investigation of the causes and mechanism of head injuries.

Marfan syndrome--a diagnostic challenge caused by phenotypic and genetic heterogeneity.

OBJECTIVES: Marfan syndrome (MFS) is an autosomal dominant inherited connective tissue disorder caused by mutations in the fibrillin-1 (FBN1) gene with variable clinical manifestations in the cardiovascular, musculoskeletal and ocular systems. METHODS: Data of moleculor genetic analysis and a catalogue of clinical manifestations including aortic elastic parameters were mined in order to (i) assess aortic abnormality before and during medical treatment, and to (ii) identify novel correlations between the genotype and phenotype of the disease using hierarchical cluster analysis and logistic regression analysis. A score measure describing the similarity between a patient's clinical symptoms and a characteristic phenotype class was introduced. RESULTS: A probabilistic model for monitoring the loss of aortic elasticity was built on merely aortic parameters of 34 patients with classic MFS and 43 control subjects showing a sensitivity of 82% and a specificity of 96%. The clinical phenotypes of 100 individuals with classical or suspected MFS were clustered yielding four different phenotypic expressions. The highest correlation was found between FBN1 missense mutations, which manifested as ectopia lentis, skeletal major and skin minor criteria, and two out of four clustered phenotypes. The probability of the presence of a missense mutation in both phenotype classes is approximately 70%. CONCLUSIONS: Monitoring of aortic elastic properties during medical treatment may serve as additional criterion to indicate elective surgical interventions. Genotype-phenotype correlation may contribute to anticipate the clinical consequences of specific FBN1 mutations more comprehensively and may be helpful to identify MFS patients at risk at on early stage of disease.

Supervised machine learning techniques for the classification of metabolic disorders in newborns.

MOTIVATION: During the Bavarian newborn screening programme all newborns have been tested for about 20 inherited metabolic disorders. Owing to the amount and complexity of the generated experimental data, machine learning techniques provide a promising approach to investigate novel patterns in high-dimensional metabolic data which form the source for constructing classification rules with high discriminatory power. RESULTS: Six machine learning techniques have been investigated for their classification accuracy focusing on two metabolic disorders, phenylketo nuria (PKU) and medium-chain acyl-CoA dehydrogenase deficiency (MCADD). Logistic regression analysis led to superior classification rules (sensitivity >96.8%, specificity >99.98%) compared to all investigated algorithms. Including novel constellations of metabolites into the models, the positive predictive value could be strongly increased (PKU 71.9% versus 16.2%, MCADD 88.4% versus 54.6% compared to the established diagnostic markers). Our results clearly prove that the mined data confirm the known and indicate some novel metabolic patterns which may contribute to a better understanding of newborn metabolism.

Opportunities for sustainable riverine management in the Queensland Murray-Darling Basin.

The RiverReach program has provided significant material, planning and educational resources to communities throughout the QMDB over the last three years. The devolved granting process has proven to be a valuable mechanism for the initiation of on-ground works and as a platform for the delivery of educational and awareness raising activities. The range of riverine management projects developed among riparian communities reflects both the socio-economic and the environmental circumstances. An increasing knowledge of riverine management issues among both the community and practitioners and a growing acceptance of the need for riverine management within the community has increased opportunities for sustainable riverine management in the region. While the range of riverine management issues is diverse, and their integration complex, the combination of all three aspects (financial assistance, technical advice, and awareness raising) has enabled significant management outcomes to be achieved.

Calvarial "doughnut lesions": clinical spectrum of the syndrome, report on a case, and review of the literature.

Many pathologic fractures, lumps on the head, elevated serum alkaline phosphatase (ALP) levels, and dental caries are the main characteristics of the rare autosomal dominantly inherited calvarial "doughnut lesions" (MIM 126550). We report the sporadic case of a 16-year-old patient who has had 10 pathologic fractures between age 6 weeks and 15 years. An elevated serum ALP level was found at age 11 and skull lumps at age 15; radiography showed frontal and parietal round radiolucencies surrounded by sclerotic bone comparable to doughnuts. Magnetic resonance imaging (MRI) showed skull lesions at an early stage. Because the findings are reminiscent of osteogenesis imperfecta (OI), collagen types I, III, and V were analyzed in fibroblasts and shown to be normal in terms of quantities, proportions, electrophoretic mobility, and thermostability. Thus, this rare syndrome can be distinguished from OI by collagen analysis and MRI of the skull at an early stage, even before palpable skull lesions appear.

Bioaccumulation of selenium (Se) in the Cienega de Santa Clara wetland, Sonora, Mexico.

The Cienega de Santa Clara, on the east side of the Colorado River delta, is a brackish wetland supported by agricultural drainage water from the United States that provides habitat for endangered fish and bird species. Bioaccumulation of selenium has created toxicity problems for wildlife in similar wetlands in the United States. This is the first selenium survey in the Cienega de Santa Clara. Ten sites were selected to collect water (dissolved), sediments (total), plants, invertebrates, and fish. Samples were collected from October 1996 to March 1997. Selenium was detected in all samples. Concentrations in water ranged from 5 to 19 microg/L and increased along a salinity gradient. Although water levels of selenium exceeded EPA criterion for protection of wildlife, levels in sediments (0.8-1.8 mg/kg), aquatic plants (0.03-0.17 mg/kg), and fish (2.5-5.1 mg/kg whole body, dry wt) did not exceed USFWS recommended levels. It is concluded from this study that the levels of selenium in water did not affect the overall health of the fish sampled. Therefore, it is important to maintain or improve the water quality entering this wetland to continue to have normal levels of Se in the food chain components.

[Improvement of agitation and anxiety in dementia patients after psychoeducative training of their caregivers]. / Verbesserung von Unruhezuständen und Angst bei Demenzkranken nach psychoedukativer Gruppenarbeit mit pflegenden Angehörigen.

It has been convincingly demonstrated that in dementia psycho-educative training of caregivers positively impacts on motivation for care and satisfaction of the caregivers. It has, however, been neglected to examine the effect of psycho-educative training on the behavioural and psychological symptoms of dementia sufferers. In a three-month, expert-based and conceptualized group intervention with caregiving relatives of demented patients we investigated, whether functional impairment and behavioural and psychological symptoms may improve, which of a set of independent variables may predict improvement, and how the group intervention will be appreciated by the caregivers. The group intervention yielded a significant improvement of memory-related functions in daily living and a significant decrease of agitation and anxiety of the demented patients. The presence of an additional somatic disease predicted worse outcome of the intervention with respect to the impairment of memory-related functions in daily living and of agitation. Anonymous inquiry of the caregivers with respect to their judgement of the intervention revealed high acceptance and appreciation. This study demonstrated that a psycho-educative group intervention with caregiving relatives of dementia sufferers is helpful for both the caregivers and the demented patient. This evidence of a positive mediate effect of the group intervention on the functional and behavioural impairment of the demented patients underscores the importance of nonpharmacological strategies in the treatment plan of dementia.

Prandial lactate infusion inhibits spontaneous feeding in rats.

To investigate the acute effects of lactate on spontaneous feeding, we infused lactate in the hepatic portal vein (0.5, 1.0, and 1.5 mmol lactate/meal) or in the vena cava (1.0 and 1.5 mmol lactate/meal) of ad libitum-fed rats during their first spontaneous nocturnal meal. Infusions (5 min, 0.1 ml/min) were remotely controlled, and a computerized feeding system recorded meal patterns. In separate crossover tests, meal size decreased independent of the infusion route after 1.0 and 1.5 mmol but not after 0.5 mmol lactate. The subsequent intermeal interval (IMI) tended to decrease only after vena cava infusion of 1.0 mmol lactate. The size of the second nocturnal meal increased after the 1.0 mmol lactate infusion. Hepatic portal infusion of 1.5 mmol lactate increased the satiety ratio [subsequent IMI (min)/meal size (g)] by 175%, which was higher than the insignificant 43% increase after vena cava infusion. Hepatic portal infusion of 1.5 mmol lactate also increased systemic plasma lactate but not glucose concentration at 1 min after the end of infusion. The results are consistent with the idea that meal-induced increases in circulating lactate play a role in the control of meal size (satiation). Moreover, the results suggest that lactate also contributes to postprandial satiety and that the liver is involved in this effect. The exact mechanisms of lactate's inhibitory effects on feeding and the site(s) where lactate acts to terminate meals remain to be identified.

Central nervous system-mediated hyperglycemic effects of NIK-247, a cholinesterase inhibitor, and MKC-231, a choline uptake enhancer, in rats.

We investigated the effects of intracerebroventricular administration of NIK-247 (9-amino-2,3,5,6,7,8-hexahydro-1H-cyclo-penta(b)-quinoline monohydrate hydrochloride; a cholinesterase inhibitor) or MKC-231 (2-(2-oxypyrrolidin-1-yl)-N-(2,3-dimethyl-5,6,7,8-tetrahydrofur o[2,3-b]quinolin-4-yl) acetoamide; a choline uptake enhancer) on plasma glucose level in comparison with that of neostigmine administration in rats. The extents of NIK-247- and MKC-231-induced hyperglycemia were considerably less than that by neostigmine, suggesting that the potencies of the drugs to produce the peripheral hyperglycemia may be pharmacologically negligible.

Centrally administered TRH-induced insulin secretion is impaired in the Otsuka-Long-Evans-Tokushima Fatty rats, a model of spontaneous non-insulin-dependent diabetes mellitus.

To investigate whether insulin secretion induced by stimulation of the vagus nerve is preserved or impaired in Otsuka-Long-Evans-Tokushima Fatty (OLETF) rats, we injected 10(-8) mol of thyrotropin-releasing hormone (TRH) into the third cerebral ventricle and determined the serum level of insulin in the unanesthetized, unrestrained rats. Intracerebroventricular (i.c.v.) injection increased the serum levels of glucose and insulin in both OLETF and Long-Evans-Tokushima-Otsuka (LETO) rats, a nondiabetic control strain, at 8-12 weeks of age. At 24-28 weeks of age, the increased level of glucose in OLETF rats was comparable to LETO rats but that of insulin was lower than control after the i.c.v. injection of TRH. Pretreatment with i.v. atropine had no significant effect on such hyperglycemia. However, the increases in the serum levels of insulin were suppressed in both OLETF and LETO rats. The plasma levels of epinephrine, norepinephrine, and glucagon rose significantly after TRH. There was no significant difference in the levels of any hormones between the two groups. In OLETF rats at 24-28 weeks of age, i.v. glucose load induced significantly higher serum levels of glucose and insulin than LETO rats. The results suggest that the vagus nerve-mediated insulin secretion is impaired in OLETF rats, similar to an autonomic diabetic neuropathy in the early stage of diabetes. This impairment may play some role in deteriorating glucose tolerance in this spontaneously developed diabetes model.

Comparison of two classification protocols in the evaluation of elbow dysplasia in the dog.

The incidence of elbow disease based solely on arthrosis (ARTH) score was compared with a protocol using a combination of ARTH score plus a score for primary lesions (ED score). The population of dogs studied included 425 Bernese mountain dogs and 22 dogs of other breeds. The overall agreement between the two systems was high. However, 12 per cent of ARTH-score negative cases were positive using the ED score. This difference was statistically significant (P < 0.005). The female:male ratio of the dogs missed using the ARTH score was 2:1. The proportion of dogs affected with arthrosis increased with age, male dogs being affected more frequently. The development of arthrosis depends not only on age and breed, but probably also on gender. Thus, screening for elbow dysplasia should be based on at least two radiographic projections, including arthrosis and primary lesions. As the vast majority of dogs in this study were Bernese mountain dogs, conclusions are valid only for this breed.

Acetylcholine via muscarinic receptors inhibits histamine release from human isolated bronchi.

Human bronchi were incubated in organ baths to measure histamine release. The calcium ionophore A23187 (10 mumol/L; 1 min) stimulated histamine release by 148 +/- 28% (n = 11) above the prestimulation level but was ineffective in epithelium-denuded bronchi. Neither bradykinin (0.1 mumol/L) nor compound 48/80 (10 micrograms/ml) triggered the release of histamine from epithelium-intact bronchi. Acetylcholine did not affect spontaneous histamine release (about 2 nmol/g x 5 min) but inhibited A23187-evoked histamine release in an atropine-sensitive manner. Already a concentration as low as 0.1 nmol/L acetylcholine was effective, the maximal inhibition (by 89%) occurred at 100 nmol/L, whereas a concentration of 10 mumol/L acetylcholine was ineffective. Oxotremorine (1 nmol/L), a stable agonist at muscarinic receptors, suppressed stimulated histamine release completely. Physostigmine (0.1 mumol/L), an acetylcholinesterase inhibitor, reduced A23187-evoked histamine release by 58%. Antihuman IgE antibody stimulated histamine release by 127 +/- 30% (n = 6) above the prestimulation level. Acetylcholine (100 nmol/L) inhibited also the immunologically evoked histamine release by 70%. In conclusion, the present experiments provide a model to characterize mast cells that are localized in or close to the airway surface epithelium. Acetylcholine via muscarinic receptors strongly inhibits the releasability of these mucosal mast cells being among the first cells to interact with inhaled antigens and environmental agents. The inhibitory action of physostigmine indicates the involvement of endogenous, probably non-neuronal acetylcholine expressed in airway epithelial cells.

Metabolic effects of a fat- and carbohydrate-rich meal in rats.

To investigate meal-induced changes in hepatic fat and carbohydrate metabolism in rats, hepatic venous, portal venous, and aortal plasma levels of several metabolites as well as changes in hepatic glycogen and lactate content were measured during and after the first nocturnal meal following a 12-h fast. The rats were fed a diet with about 46%, 41%, and 13% of the total energy (approximately 16.5 kJ/g) derived from carbohydrates, fats, and protein, respectively. During the later part of the meal and thereafter, plasma triglyceride level increased in all blood vessels. After a transient initial decrease, portal venous and aortal nonesterified fatty acid (NEFA) levels, net hepatic NEFA uptake, and hepatic beta-hydroxybutyrate (BHB) production increased and reached fasting (meal onset) values by 30 min after the meal. Although liver glycogen did not change significantly, the liver released glucose continuously. The liver initially accumulated lactate and maintained a high lactate concentration despite switching from lactate uptake to net release of lactate around 10 min into the meal. Taken together, these data indicate that hepatic glycolysis, gluconeogenesis, and considerable fatty acid oxidation occur concurrently in rat liver during and after a fat- and carbohydrate-rich meal. The findings are relevant to contemporary hypotheses of the metabolic control of eating and, in particular, to hypotheses linking hepatic fatty acid oxidation to postprandial satiety.