Population Pharmacokinetic Modeling to Inform Sertraline Dosing Optimization in Patients with Depression.

Sertraline is one of the most prescribed antidepressants, but its pharmacokinetic (PK) properties are still not completely characterized. Using nonlinear mixed-effects modeling, we examined factors influencing sertraline PK variability in outpatients with major depressive disorder. Blood samples from 53 male and female adults treated with sertraline orally were collected at a steady state. Various demographic and clinical covariates were tested by stepwise regression procedure. We found that sertraline clearance is significantly influenced by serum concentrations of its main metabolite N-desmethylsertraline, whereas clearance of N-desmethylsertraline is affected by both creatinine clearance and drug daily dose. These results were confirmed by the reduction of points dispersion in goodness-of-fit plots for their predicted versus measured concentrations and with bootstrapping analyses. This finding can serve to inform sertraline dosing optimization, especially when changes in kidney function occur in treated individuals, to prevent adverse drug reactions and maximize therapeutic benefits.

The hepatoprotective effect of aminoguanidine in acute liver injury caused by CCl4 in rats.

In this study, the hepatoprotective effect of aminoguanidine in acute liver damage caused by carbon tetrachloride-CCl4 at a dose of 1 mL/kg, i.p. was investigated in experimental rats. Ten days of preventive treatment with aminoguanidine before exposure to toxic CCl4, at a dose of 150 mg/kg, i.p., led to significant reduction in biochemical markers of acute liver injury-AST(p < 0.001), ALT (p < 0.01), SDH (p < 0.05) and reduction in pro-oxidative markers-H2O2 (p < 0.05), TOS (p < 0.01), TBARS, and LOOH (p < 0.001) in relation to rats treated only CCl4. Treatment with aminoguanidine resulted in a significant reduction in the consumption of antioxidant-GR (p < 0.01), GST, GPx, GSH (p < 0.001), and a decrease in pro-inflammatory-TNF-α (p < 0.01), IL-1ß, IL-6, NO and NGAL (p < 0.001) markers relative to animals exposed to CCl4 alone. Also, aminoguanidine pre-treatment leads to an increase in arginase activity (p < 0.001), and a decrease in citrulline concentration (p < 0.01), as well as polyamine catabolism enzyme activity-putrescin oxidase and spermine oxidase (p < 0.001) in comparison to the CCl4 group. Aminoguanidine led to a striking reduction of the necrotic field (p < 0.001), and a significant increase in the number of apoptotic hepatocytes (p < 0.001), as well as the proapoptotic markers-BAX and Caspase-3 (p < 0.05), compared to CCl4. The hepatoprotective mechanisms in CCl4 induce hepatotoxicity of aminoguanidine are based on the strong antioxidant effects, inhibition of pro-oxidative and pro-inflammatory mediators, as well as induction of damaged hepatocytes into apoptosis.

New scale for assessing spasticity based on the pendulum test.

Quantified assessment of spasticity is essential for the rehabilitation of persons with paralysis. We introduce the new SPAsticity Scale (SPAS), which we found highly correlated with the Modified Ashworth Score (MAS); yet, with a delicate gradation of spasticity compared to the MAS. The parameters defining the SPAS show the level and the type of spasticity (flexion or extension). The SPAS is based on a complex model of the pendulum type oscillations of the lower leg, which includes the spastic torques. The data to calculate SPAS were collected by a wearable instrument with two inertial measurement units and two EMG recording units in subjects with a complete chronic spinal cord injury.

A principal component analysis (PCA) based assessment of the gait performance.

The gait assessment is instrumental for evaluating the efficiency of rehabilitation of persons with a motor impairment of the lower extremities. The protocol for quantifying the gait performance needs to be simple and easy to implement; therefore, a wearable system and user-friendly computer program are preferable. We used the Gait Master (instrumented insoles) with the industrial quality ground reaction forces (GRF) sensors and 6D inertial measurement units (IMU). WiFi transmitted 10 signals from the GRF sensors and 12 signals from the accelerometers and gyroscopes to the host computer. The clinician was following in real-time the acquired data to be assured that the WiFi operated correctly. We developed a method that uses principal component analysis (PCA) to provide a clinician with easy to interpret cyclograms showing the difference between the recorded and healthy-like gait performance. The cyclograms formed by the first two principal components in the PCA space show the step-to-step reproducibility. We suggest that a cyclogram and its orientation to the coordinate system PC1 vs. PC2 allow a simple assessment of the gait. We show results for six healthy persons and five patients with hemiplegia.

Hybrid Tongue - Myoelectric Control Improves Functional Use of a Robotic Hand Prosthesis.

OBJECTIVE: This study aims at investigating the functional performance of a novel prosthesis control scheme integrating an inductive tongue interface and myoelectric control. The tongue interface allowed direct selection of the desired grasp while myoelectric signals were used to open and close the robotic hand. METHODS: The novel method was compared to a conventional sequential on/off myoelectric control scheme using functional tasks defined by Assistive Hand Assessment protocol. Ten able-bodied participants were fitted with the SmartHand on their left forearm. They used both the conventional myoelectric control and the Tongue and Myoelectric Hybrid interface (TMH) to accomplish two activities of daily living (i.e., preparing a sandwich and gift wrapping). Sessions were video recorded and the outcome measure was the completion time for the subtasks as well as the full tasks. RESULTS: The sandwich task was completed significantly faster, with 19% decrease in the completion time, using the TMH when compared to the conventional sequential on/off myoelectric control scheme (p < 0.05). CONCLUSION: The results indicate that the TMH control scheme facilitates the active use of the prosthetic device by simplifying grasp selection, leading thereby to faster completion of challenging and relevant tasks involving bimanual activities.

Xanthine Oxidase/Dehydrogenase Activity as a Source of Oxidative Stress in Prostate Cancer Tissue.

Prostate cancer (PC) is one of the most frequent malignancies. Better biomarkers are constantly wanted, such as those which can help with the prediction of cancer behavior. What is also needed is a marker which may serve as a possible therapeutic target. Oxidative stress (OS), which is a hallmark of cancer, is included in the pathogenesis and progression of PC. We have conducted the present study to determine whether xanthine oxidase/dehydrogenase activity is the source of OS in prostate tissue. We have also determined the concentration of TBA-reactive substances (TBARS) and advanced oxidation protein products (AOPP), as well as the activity of catalase. Xanthine oxidase (XO) activity is significantly higher (p < 0.001) in tumor tissue when compared to the control healthy tissue. The concentration of TBARS (p < 0.001) and AOPP (p < 0.05) are also higher in tumor tissue. Catalase has raised its activity (p < 0.05) versus the control. There is also a strong correlation between XO activity and prostate-specific antigen (PSA) levels in the serum. These results indicate a significant role of XO activity in OS in prostate carcinogenesis, and it could be a possible theranostic biomarker, which can be important for a better understanding of the disease, its evolution, and prognosis. A promising treatment may be using XO inhibitors such as allopurinol as adjuvant therapy.

Unusual Clinical Presentation of Giant Extragenital Condyloma.

Dear editor, Condylomata accuminatum (CA) is a human papillomavirus (HPV) related sexually transmitted infection (STI), clinically characterized by solitary or even clustered dark red or pink lesions solely affecting the anogenital area (1). CA involving the extragenital, non-mucosal skin has been sporadically reported (2-4). Diagnosis of CA is usually straightforward when the lesions are located on the anogenital area. However, involvement of extragenital skin may pose a diagnostic challenge. Herein, we report a rare case of giant linear extragenital CA without coexisting genital lesions, diagnosed with a synergic intervention of dermatoscopy and clinics. A 70-year-old Caucasian man was referred to our department for an atypical asymptomatic seborrheic keratosis presenting as a linear verrucous plaque (20 × 2 cm) with few solitary reddish satellite papules on the abdomen (Figure 1, a). No similar lesions were present in both cutaneous and mucosal districts. Medical history was unremarkable, and the patient denied having recent sexual intercourse or any history of condylomas. Remarkably, the patient underwent a diet in the last 8 months that resulted in a loss of 30 kg. We employed dermatoscopy to further assess the lesions, highlighting a finger-like pattern on the main lesion (Figure 1, c), while satellite lesions presented a mosaic pattern (Figure 1, b). The clinical appearance and these dermatoscopic findings were suggestive of condyloma acuminatum (CA), but due to its extraordinary presentation we also performed an incisional biopsy. Histopathological examination reviled features compatible with the diagnosis of CA (Figure 1, d, e). To better characterized the HPV genotype (high-risk and low-risk HPV) a polymerase chain reaction (PCR) from lesional tissue sample was performed and found HPV type 6 positivity. The lesions were successfully removed by electrosurgery. Regular follow-up was scheduled. Sexually transmitted infections (STIs) were also screened, namely syphilis, gonorrhea, chlamydia trachomatis, and HIV status. In addition, laboratory tests and imaging examinations (radiography of the chest and ultrasound examination of the abdomen) revealed no pathological findings. CA involving the extragenital skin has been reported within intertriginous areas, including the inframammary fold, the groin, and the axillary vault, as well as mucosal surface such as intraoral and conjunctival mucosa (1-5). In most cases, extragenital CA coexisted with genital lesions. Staples et al. reported three obese patients with extragenital CA on the skin of the abdominal pannus (3). However, all of the patients had involvement of the inguinal folds, from where the CA had extended. Generally, CA is acquired by genital, oral, or anal sexual contact. Among the wide spectrum of HPV genotypes, types 6 and 11 are responsible of 90% of CA (1). Our paradigmatic case allows us reflect on the concept of transitory immune dysregulation due to a significant amount of weight loss, and the position of the lesions in particular seems to suggest that frictional triggers may disrupt the barrier integrity, leading to higher probability of infection. Dermoscopy is a noninvasive diagnostic tool with a significant role in the assessment of melanocytic and non-melanocytic skin tumors. Furthermore, the utility of dermatoscopy has expanded to the field of inflammatory and infectious skin disease, where dermoscopy enhances the differential diagnosis between them. Seborrheic keratosis, as the most common benign epithelial tumor, can occur anywhere in the skin excluding the palms, soles, and mucosa (6). In the anogenital area, seborrheic keratosis usually resembles CA. However, dermatoscopically, seborrheic keratosis can be immediately identified by the presence of milia-like cysts, comedo-like openings, fissures, finger-print structures, and sharply demarcated borders (6). In contrast, reports of CA dermoscopy suggested four different dermoscopic patterns: fingerlike, mosaic, knoblike, and the most commonly, an unspecific pattern (7). Our case showed that dermoscopy of extragenital CA presented a mosaic pattern in an early stage of CA, while fully developed lesions revealed a fingerlike pattern, as has previously been reported by Dong et al. (7), where two different stages of clinical development of CA exhibit distinctive dermoscopic patterns, which correlates with our case. We did not observe the typical dermoscopic features of seborrheic keratosis. CA arising in an extragenital area is very rare and perhaps also underestimated. Thus, dermatologists should be aware of this unusual presentation even in the absence of genital HPV involvement. Moreover, dermoscopy may facilitate CA recognition in a such uncommon location. To our knowledge, this is the first report of extragenital condyloma acuminatum documented dermoscopically.

Anthocyanins Protect Hepatocytes against CCl4-Induced Acute Liver Injury in Rats by Inhibiting Pro-inflammatory mediators, Polyamine Catabolism, Lipocalin-2, and Excessive Proliferation of Kupffer Cells.

: This study examined the hepatoprotective and anti-inflammatory effects of anthocyanins from Vaccinim myrtillus (bilberry) fruit extract on the acute liver failure caused by carbon tetrachloride-CCl4 (3 mL/kg, i.p.). The preventive treatment of the bilberry extract (200 mg anthocyanins/kg, orally, 7 days) prior to the exposure to the CCl4 resulted in an evident decrease in markers of liver damage (glutamate dehydrogenase, sorbitol dehydrogenase, malate dehydrogenase), and reduced pro-oxidative (conjugated dienes, lipid hydroperoxide, thiobarbituric acid reactive substances, advanced oxidation protein products, NADPH oxidase, hydrogen peroxide, oxidized glutathione), and pro-inflammatory markers (tumor necrosis factor-alpha, interleukin-6, nitrite, myeloperoxidase, inducible nitric oxide synthase, cyclooxygenase-2, CD68, lipocalin-2), and also caused a significant decrease in the dissipation of the liver antioxidative defence capacities (reduced glutathione, glutathione S-transferase, and quinone reductase) in comparison to the results detected in the animals treated with CCl4 exclusively. The administration of the anthocyanins prevented the arginine metabolism's diversion towards the citrulline, decreased the catabolism of polyamines (the activity of putrescine oxidase and spermine oxidase), and significantly reduced the excessive activation and hyperplasia of the Kupffer cells. There was also an absence of necrosis, in regard to the toxic effect of CCl4 alone. The hepatoprotective mechanisms of bilberry extract are based on the inhibition of pro-oxidative mediators, strong anti-inflammatory properties, inducing of hepatic phase II antioxidant enzymes (glutathione S-transferase, quinone reductase) and reduced glutathione, hypoplasia of Kupffer cells, and a decrease in the catabolism of polyamines.

EMG map image processing for recognition of fingers movement.

Electromyography (EMG) is the conventional noninvasive method for the estimation of muscle activities. We developed a new image processing method for the recognition of individual finger movements based on EMG maps. The maps were formed from the EMG recordings via an array electrode with 24 contacts connected to a multichannel wireless miniature digital amplifier. The task was to detect and quantify the high activity regions in the EMG maps in persons with no known motor impairment. The results show the temporal and spatial patterns within the images during well-defined finger movements. The average accuracy of the automatic recognition compared with the recognition by an expert clinician in persons involved in the tests was 97.87 ±â€¯0.92%. The application of the technique is foreseen for control for an assistive system (hand prosthesis and exoskeleton) since the interface is wearable and the processing can be implemented on a microcomputer.

Protective effects of anthocyanins from bilberry extract in rats exposed to nephrotoxic effects of carbon tetrachloride.

This study examined the nephroprotective effects of 15 different anthocyanins from the bilberry extract on the acute kidney injury caused by CCl4. The acute nephrotoxicity in rats was induced 24 h after the treatment with a single dose of CCl4 (3 mL/kg, i.p.).The nephroprotective effects of the anthocyanins were examined in the animals that had been given the bilberry extract in a single dose of 200 mg of anthocyanins/kg daily, 7 days orally, while on the seventh day, 3 h after the last dose of anthocyanins, the animals received a single dose of CCl4 (3 mL/kg, i.p.) and were sacrificed 24 h later. When the nephrotoxicant alone was administered, it resulted in a substantial increase of the pro-oxidative (TBARS, CD, H2O2, XO, and GSSG) and pro-inflammatory markers (TNF-α, NO, and MPO), as well as a noticeable reduction of the antioxidant enzymes (CAT, SOD, POD, GPx, GST, GR) and GSH when compared to the results of the control group. Moreover, the application of CCl4 significantly influenced a reduction of the renal function, as well as an increase in the sensitive and specific injury indicators of the kidney epithelial cells (ß2-microglobulin, NGAL, KIM1/TIM1) in the serum and urine of rats. The pretreatment of the animals poisoned with CCl4 with the anthocyanins from the bilberry extract led to a noticeable reduction in the pro-oxidative and pro-inflammatory markers with reduced consumption of the antioxidant defence kidney capacity, compared to the animals exposed to CCl4 alone. Anthocyanins have been protective for the kidney parenchyma, with an apparent absence of the tubular and periglomerular necrosis, severe degenerative changes, inflammatory mononuclear infiltrates and dilatation of proximal and distal tubules, in contrast to the CCl4-intoxicated animals. The nephroprotective effects of anthocyanins can be explained by strong antioxidant and anti-inflammatory effects achieved through the stabilization and neutralization of highly reactive and unstable toxic CCl4 metabolites.

Two different melatonin treatment regimens prevent an increase in kidney injury marker-1 induced by carbon tetrachloride in rat kidneys.

Acute kidney injury is a frequent disorder that can be mimicked by the application of different nephrotoxic agents, including carbon tetrachloride (CCl4), where kidney injury marker-1 (KIM-1) has been recognized as a highly specific marker. Melatonin is one of the most powerful natural antioxidants and has numerous beneficial properties. We evaluated the nephroprotective potential of 2 melatonin treatment regimens (pre- and post-intoxication) in a CCl4-induced acute kidney injury model based on the standard serum parameters, kidney tissue antioxidative capacity, KIM-1 levels, and kidney tissue morphological changes. The two treatment regimens were found to preserve kidney function, as judged from the evaluated standard serum parameters. Only when administered after the intoxication, melatonin preserved total kidney antioxidant capacity; pre-treatment melatonin only preserved reduced glutathione levels. An increase in tissue KIM-1 level was found to be prevented by both treatment regimens, which correlated with the morphological changes seen in the kidney tissues of animals treated with melatonin and CCl4. The findings of our study are in agreement with the known actions of melatonin in relieving kidney tissue oxidative burden, but also contribute to the understanding of its action by preventing an increase in KIM-1.

Does galvanic vestibular stimulation decrease spasticity in clinically complete spinal cord injury?

The aim of this study was to determine changes in clinical and biomechanical measures of spasticity after administering galvanic vestibular stimulation in patients with a complete spinal cord injury (SCI). The spasticity in the lower limbs was assessed using the Modified Ashworth Scale and the pendulum test in seven SCI patients (grade A on the ASIA Impairment Scale) before (0), immediately after (0), and at 5 and 30 min after the real versus sham galvanic vestibular stimulation (15 s each, anode over the right mastoid). Overall, the changes in spasticity were not significantly different between the real and sham galvanic vestibular stimulation. However, the Modified Ashworth Scale and the pendulum test indicated a reduction in spasticity in two out of seven patients. The results suggest that galvanic vestibular stimulation may modify spasticity in some patients with complete SCI, presumably through the residual vestibulospinal influences. Future studies should determine clinical and neurophysiological profiles of responders versus nonresponders and optimize parameters of galvanic vestibular stimulation.

Assessment of Spasticity by a Pendulum Test in SCI Patients Who Exercise FES Cycling or Receive Only Conventional Therapy.

Increased muscle tone and exaggerated tendon reflexes characterize most of the individuals after a spinal cord injury (SCI). We estimated seven parameters from the pendulum test and used them to compare with the Ashworth modified scale of spasticity grades in three populations (retrospective study) to assess their spasticity. Three ASIA B SCI patients who exercised on a stationary FES bicycle formed group F, six ASIA B SCI patients who received only conventional therapy were in the group C, and six healthy individuals constituted the group H. The parameters from the pendulum test were used to form a single measure, termed the PT score, for each subject. The pendulum test parameters show differences between the F and C groups, but not between the F and H groups, however, statistical significance was limited due to the small study size. Results show a small deviation from the mean for all parameters in the F group and substantial deviations from the mean for the parameters in the C group. PT scores show significant differences between the F and C groups and the C and H groups and no differences between the F and C groups. The correlation between the PT score and Ashworth score was 0.88.

Posture in dentists: Sitting vs. standing positions during dentistry work--An EMG study.

INTRODUCTION: Adequate working posture is important for overall health. Inappropriate posture may increase fatigue, decrease efficiency, and eventually lead to injuries. OBJECTIVE: The purpose was to examine posture positions used during dentistry work. METHODS: In order to quantify different posture positions, we recorded muscle activity and positions of body segments. The position (inclination) data of the back was used to assess two postures: sitting and standing during standard dental interventions. RESULTS: During standard interventions, whether sitting or standing, a tilt of less than 20 degrees was most prevalent in the forward and lateral flexion directions. Amplitude of electromyography signals corresponding to the level of muscle activity were higher in sitting compared with the electromyography in standing position for all muscle groups on the left and right side of the body. Significant difference between muscle activity in two working postures was evident in splenius capitis muscle on the left (p = 0.032), on the right side of the body (p = 0.049) and in muscle activity of mastoid muscle on the left side (p = 0.029). CONCLUSION: These findings show that risk for increased fatigue and possible injures can be reduced by combining the sitting and standing occupational postures.

Stimulation map for control of functional grasp based on multi-channel EMG recordings.

Transcutaneous activation of muscles with electrical stimulation has limited selectivity in recruiting paralyzed muscles in stroke patients. However, the selectivity could be increased by the application of smaller electrodes and their appropriate positioning on the skin. We developed a method for selecting the appropriate positions of the stimulating electrodes based on electromyography (EMG). The EMG activity maps were estimated from signals recorded with two electrode arrays and two 24-channel wearable amplifiers positioned on the nonparetic and paretic forearms. The areas where the difference between the EMG maps obtained from the nonparetic and paretic arms was significant were identified as the stimulation sites. The stimulation was applied through array electrodes with magnetic holders and two wearable stimulators with four output channels each. The measures of functionality included joint angles measured with goniometers (hand opening) and grasp force measured with a multi-contact dynamometer (grasping). The stimulation protocol comprised co-activation of flexors and extensors to stabilize the wrist joint and prevent pronation/supination.

Antioxidant and proapoptotic effects of anthocyanins from bilberry extract in rats exposed to hepatotoxic effects of carbon tetrachloride.

AIMS: The aim of this research was to determine the hepatoprotective effects of anthocyanins from bilberry extract in rats exposed to carbon tetrachloride (CCl4) by monitoring the parameters of oxidative stress and apoptosis, and by performing the histopathological and morphometric analyses. MAIN METHODS: Animals were divided into four groups: Group I (0.9% NaCl-10days), Group II (bilberry extract, 75mg/kg-10days), Group III (0,9% NaCl-9days, and on the tenth day CCl4-2ml/kg), Group IV (bilberry extract, 75mg/kg-10days and on the tenth day CCl4-2ml/kg). KEY FINDINGS: Bilberry extract led to a significant decrease in the activity of biochemical parameters in serum (AST, GGT, LDH, and ALT), the activity of pro-oxidative enzyme xanthine oxidase, as well as the level of lipid peroxidation in the liver in Group IV compared to Group III (p<0.01). Bilberry extract resulted in a significant increase in the activity of the antioxidant markers-catalase (p<0.05), superoxide dismutase, glutathione S-transferase and glutathione peroxidase (p<0.01), and the concentration of reduced glutathione (p<0.05) in Group IV in relation to Group III. The application of bilberry extract resulted in an increase in the number of apoptotic hepatocytes and the activity of caspase-3 in the liver tissue (p<0.01). The reduction of coagulation necrotic areas was proved (p<0.001) as well as the number of macrovesicular hepatocytes (p<0.01), along with an increased mitotic activity (p<0.01) in Group IV compared to Group III. SIGNIFICANCE: Anthocyanins from bilberry extract have strong antioxidant properties and therefore can be considered as powerful hepatoprotectives in natural products.

Control of a Robotic Hand Using a Tongue Control System-A Prosthesis Application.

OBJECTIVE: The aim of this study was to investigate the feasibility of using an inductive tongue control system (ITCS) for controlling robotic/prosthetic hands and arms. METHODS: This study presents a novel dual modal control scheme for multigrasp robotic hands combining standard electromyogram (EMG) with the ITCS. The performance of the ITCS control scheme was evaluated in a comparative study. Ten healthy subjects used both the ITCS control scheme and a conventional EMG control scheme to complete grasping exercises with the IH1 Azzurra robotic hand implementing five grasps. Time to activate a desired function or grasp was used as the performance metric. RESULTS: Statistically significant differences were found when comparing the performance of the two control schemes. On average, the ITCS control scheme was 1.15 s faster than the EMG control scheme, corresponding to a 35.4% reduction in the activation time. The largest difference was for grasp 5 with a mean AT reduction of 45.3% (2.38 s). CONCLUSION: The findings indicate that using the ITCS control scheme could allow for faster activation of specific grasps or functions compared with a conventional EMG control scheme. SIGNIFICANCE: For transhumeral and especially bilateral amputees, the ITCS control scheme could have a significant impact on the prosthesis control. In addition, the ITCS would provide bilateral amputees with the additional advantage of environmental and computer control for which the ITCS was originally developed.

A comparative study of virtual hand prosthesis control using an inductive tongue control system.

This study compares the time required to activate a grasp or function of a hand prosthesis when using an electromyogram (EMG) based control scheme and when using a control scheme combining EMG and control signals from an inductive tongue control system (ITCS). Using a cross-over study design, 10 able-bodied subjects used a computer model of a hand and completed simulated grasping exercises. The time required to activate grasps was recorded and analyzed for both control schemes. End session mean activation times (ATs; seconds) for the EMG control scheme grasps 1 -5 were 0.80, 1.51, 1.95, 2.93, and 3.42; for the ITCS control scheme grasps 1 ‒5 they were 1.19, 1.89, 1.75, 2.26, and 1.80. Mean AT for grasps 1 and 2 was statistically significant in favor of the EMG control scheme (p = 0.030; p = 0.004). For grasp 3 no statistical significance occurred, and for grasps 4 and 5 there was a statistical significance in favour of the ITCS control scheme (p = 0.048; p = 0.004). Based on the amount of training and the achieved level of performance, it is concluded that the proposed ITCS control scheme can be used as a means of enhancing prosthesis control.

Sensor fusion and computer vision for context-aware control of a multi degree-of-freedom prosthesis.

OBJECTIVE: Myoelectric activity volitionally generated by the user is often used for controlling hand prostheses in order to replicate the synergistic actions of muscles in healthy humans during grasping. Muscle synergies in healthy humans are based on the integration of visual perception, heuristics and proprioception. Here, we demonstrate how sensor fusion that combines artificial vision and proprioceptive information with the high-level processing characteristics of biological systems can be effectively used in transradial prosthesis control. APPROACH: We developed a novel context- and user-aware prosthesis (CASP) controller integrating computer vision and inertial sensing with myoelectric activity in order to achieve semi-autonomous and reactive control of a prosthetic hand. The presented method semi-automatically provides simultaneous and proportional control of multiple degrees-of-freedom (DOFs), thus decreasing overall physical effort while retaining full user control. The system was compared against the major commercial state-of-the art myoelectric control system in ten able-bodied and one amputee subject. All subjects used transradial prosthesis with an active wrist to grasp objects typically associated with activities of daily living. MAIN RESULTS: The CASP significantly outperformed the myoelectric interface when controlling all of the prosthesis DOF. However, when tested with less complex prosthetic system (smaller number of DOF), the CASP was slower but resulted with reaching motions that contained less compensatory movements. Another important finding is that the CASP system required minimal user adaptation and training. SIGNIFICANCE: The CASP constitutes a substantial improvement for the control of multi-DOF prostheses. The application of the CASP will have a significant impact when translated to real-life scenarious, particularly with respect to improving the usability and acceptance of highly complex systems (e.g., full prosthetic arms) by amputees.

Osteoporosis--a risk factor for cardiovascular diseases: a follow-up study.

INTRODUCTION: Cardiovascular (CV) diseases and bone fractures due to osteoporosis are the leading causes of death in the elderly. OBJECTIVE: The aim of this study was to demonstrate a correlation between the overall risk for CV events, and low bone density in postmenopausal women, and its impact on the incidence of serious CV events. METHODS: Our prospective study involved 300 postmenopausal women. All the examinees were divided into three groups based on their measured bone density: Group I--84 examinees with osteoporosis; Group II--115 examinees with osteopenia; and Group III--101 examinees with normal bone density. In all examinees the overall ten-year risk for a fatal CV event was calculated using the SCORE system tables. RESULTS: After a 36-month follow-up, CV events occurred in 19 (6.3%) examinees. Significant differences in the incidence of CV events were demonstrated between the patients with osteoporosis, osteopenia, and normal bone density (χ2 = 28.7; p < 0.001), as well as between those with a high and low CV risk (χ2 = 22.6; p < 0.001). Multivariate logistic regression analysis showed that smoking (OR: 2.23; 95% CI: 1.02 to 6.19; p = 0.035), and increase of overall CV score (OR: 1.36; 95% CI: 1.17 to 1.58; p < 0.001) are associated with increased CV event risk, while the increase of T score value is associated with decreased risk of CV event (OR: 0.42; 95% CI: 0.25 to 0.73; p = 0.002). CONCLUSION: Measurement of bone density with a standard assessment of the total CV risk could be useful for selecting women who need intensive prevention and treatment of atherosclerosis.