Clinical experience and complications with limited pleural dissection combined with a novel, simplified technique for thoracic Redon-like drain in vertebral body tethering.

PURPOSE: To report on our experience with a simplified, suction-bottle-drain technique of thoracic drain (Redon-like) combined with fully thoracoscopic vertebral body tethering (VBT) and a limited pleural approach, with particular focus on the rate of pulmonary complications. METHODS: A retrospective study was performed on all consecutive patients who underwent VBT for adolescent idiopathic scoliosis. For all subjects, a 10G Redon drain, an active drain system consisting of a perforated tube and a suction bottle, was placed intrathoracically and tunneled under the skin. All drains were removed on the first postoperative day. Perioperative and postoperative data such as type of access, length of surgery, amount of fluid collection in the drain, and length of hospital stay were collected. The type and number of pulmonary complications occurring in the first 3 months after surgery, along with their symptoms and management, were recorded. RESULTS: One Hundred eighty-two patients were included in the analysis. The mean length of surgery was 97 min (75-120). The average fluid collection in the drain was 30 ml (5-50), the mean length of hospital stay was 3 days (2-4). During the observation period, pulmonary complications occurred in five patients (2%). Two patients presented an aseptic right pleural effusion; for two patients, a residual pneumothorax was diagnosed on the X-rays in the recovery room and one patient developed a chylothorax. All patients recovered without sequelae. CONCLUSION: The simplified, Redon-like drain combined with a fully thoracoscopic VBT and limited pleural approach seems a safe and effective alternative to the chest drain. This technique allows to remove the drain on the first postoperative day, thus simplifying the management of the patients and improving their comfort.

Multi-Modal Data Correspondence for the 4D Analysis of the Spine with Adolescent Idiopathic Scoliosis.

Adolescent idiopathic scoliosis is a three-dimensional spinal deformity that evolves during adolescence. Combined with static 3D X-ray acquisitions, novel approaches using motion capture allow for the analysis of the patient dynamics. However, as of today, they cannot provide an internal analysis of the spine in motion. In this study, we investigated the use of personalized kinematic avatars, created with observations of the outer (skin) and internal shape (3D spine) to infer the actual anatomic dynamics of the spine when driven by motion capture markers. Towards that end, we propose an approach to create a subject-specific digital twin from multi-modal data, namely, a surface scan of the back of the patient and a reconstruction of the 3D spine (EOS). We use radio-opaque markers to register the inner and outer observations. With respect to the previous work, our method does not rely on a precise palpation for the placement of the markers. We present the preliminary results on two cases, for which we acquired a second biplanar X-ray in a bending position. Our model can infer the spine motion from mocap markers with an accuracy below 1 cm on each anatomical axis and near 5 degrees in orientations.

Comparison of Trunk Motion between Moderate AIS and Healthy Children.

Analysis of kinematic and postural data of adolescent idiopathic scoliosis (AIS) patients seems relevant for a better understanding of biomechanical aspects involved in AIS and its etiopathogenesis. The present project aimed at investigating kinematic differences and asymmetries in early AIS in a static task and in uniplanar trunk movements (rotations, lateral bending, and forward bending). Trunk kinematics and posture were assessed using a 3D motion analysis system and a force plate. A total of fifteen healthy girls, fifteen AIS girls with a left lumbar main curve, and seventeen AIS girls with a right thoracic main curve were compared. Statistical analyses were performed to investigate presumed differences between the three groups. This study showed kinematic and postural differences between mild AIS patients and controls such as static imbalance, a reduced range of motion in the frontal plane, and a different kinematic strategy in lateral bending. These differences mainly occurred in the same direction, whatever the type of scoliosis, and suggested that AIS patients behave similarly from a dynamic point of view.

Nutrient status and growth in vegan children.

Vegan diets have risen in popularity over the past 9 years. However, few studies have examined nutrient status and the effect of a vegan diet on the growth of children. This study analysed the existing literature on the health impact and growth impact of selected nutrients in vegan children. We assessed the intake of calories and protein, as well as the nutrients iron, calcium, vitamin D, cobalamin and folate. With a small percentage of outliers, vegan children showed normal growth and were less often obese. We found limited evidence that children on a vegan diet can obtain all the examined nutrients. Furthermore, as proper planning and supplementation by caregivers is needed, it is currently unknown how often vegan children follow well-planned diets. Deficiencies in cobalamin, calcium, and vitamin D seem to be the biggest risks associated with a poorly planned vegan diet. For a more definitive assessment, data on the intake and nutrient status of omega-3 fatty acids, zinc, iodine, and selenium in vegan children are needed. Future research should account for demographic shifts in those following a vegan diet, and should discriminate between vegan sub-populations that are open or closed towards scientific approaches, towards health in general, and toward supplementation. Studies should assess the modes and dosages of supplementation and the use of fortified foods or drinks, as well as adherence to the diet itself. Plant ferritin as a source of iron and endogenous cobalamin synthesis warrants further scientific inquiry. In summary, the current literature suggests that a well-planned vegan diet using supplementation is likely to provide the recommended amounts of critical nutrients to provide for normal progression of height and weight in children, and can be beneficial in some aspects. However, data on 5 critical nutrients are still missing, hampering a more definitive conclusion.

Effects of a lower limb muscular fatigue on posture-movement interaction during a lower limb pointing task.

PURPOSE: The aim of the present study was to investigate the effects of muscular fatigue on the interaction between posture and movement during a lower limb pointing task. METHODS: Participants (n = 16), aged 18-30 years, kicked a ball toward a target in four conditions of fatigue: No muscular fatigue (NF), fatigue in the kicking (FM) or postural limb (FP) alone, and fatigue in both limbs (FMP). The mean amplitude and speed of the centre of foot pressure (CoP) and centre of mass (CoM) displacements were estimated through a force platform and an optoelectronic system, respectively. In addition, surface electromyography (EMG) of the biceps femoris, rectus femoris, medial gastrocnemius, and peroneus longus was recorded to investigate the anticipatory postural adjustments (APAs). RESULTS: Muscular fatigue yielded a decreased kicking accuracy (p < 0.001) and an increased time to perform the movement (p < 0.001), mainly during the backswing motion. In addition, significant increases in the mean amplitude and speed of the CoP and CoM displacement were found in the anteroposterior (AP) and mediolateral (ML) axes (ps < 0.001), especially when both limbs were fatigued. The EMG analysis confirmed that fatigue modified the way APAs were generated. During fatigue, postural muscle activity increased, but was delayed with respect to movement onset (ps < 0.001). This pattern of response was more consistent when both limbs were fatigued (p < 0.001). CONCLUSION: The present results suggested an additive effect of fatigue and a functional adaptation and subsequent decrease in the overall variability of APAs, indicating that postural and motor processes are interdependent.

Influence of dual-task constraints on the interaction between posture and movement during a lower limb pointing task.

One of the challenges regarding human motor control is making the movement fluid and at a limited cognitive cost. The coordination between posture and movement is a necessary requirement to perform daily life tasks. The present experiment investigated this interaction in 20 adult men, aged 18-30 years. The cognitive costs associated to postural and movement control when kicking towards a target was estimated using a dual-task paradigm (secondary auditory task). Results showed that addition of the attentional demanding cognitive task yielded a decreased kicking accuracy and an increased timing to perform the movement, mainly during the backswing motion. In addition, significant differences between conditions were found for COP and COM displacement (increased amplitude, mean speed) on the anteroposterior axis. However, no significant differences between conditions were found on the mediolateral axis. Finally, EMG analysis showed that dual-task condition modified the way anticipatory postural adjustments (APAs) were generated. More specifically, we observed an increase of the peroneus longus activity, whereas the temporal EMG showed a decrease of its latency with respect to movement onset. These results suggested a functional adaptation resulting in an invariance of overall APAs, emphasizing that cognitive, postural, and motor processes worked dependently.

Optimisation of aeration for activated sludge treatment with simultaneous nitrification denitrification.

Following a promising study at pilot scale a new aeration control law has been implemented at a full scale wastewater treatment plant displaying a conventional activated sludge process. The new control law is based on the direct measurements of ammonium and nitrate concentration in the biological tank by ion selective electrodes. This control law features a cascade of two Predictive Function Controls and calculates an optimal air flow rate to be provided to the biomass through fine bubble diffusers. The results obtained at the full scale plant confirmed the high performance of this control strategy allowing to substantially reduce the amount of diffused air while providing an easy means to manage the effluent quality to the plant operator.

Human treadmill walking needs attention.

BACKGROUND: The aim of the study was to assess the attentional requirements of steady state treadmill walking in human subjects using a dual task paradigm. The extent of decrement of a secondary (cognitive) RT task provides a measure of the attentional resources required to maintain performance of the primary (locomotor) task. Varying the level of difficulty of the reaction time (RT) task is used to verify the priority of allocation of attentional resources. METHODS: 11 healthy adult subjects were required to walk while simultaneously performing a RT task. Participants were instructed to bite a pressure transducer placed in the mouth as quickly as possible in response to an unpredictable electrical stimulation applied on the back of the neck. Each subject was tested under five different experimental conditions: simple RT task alone and while walking, recognition RT task alone and while walking, walking alone. A foot switch system composed of a pressure sensitive sensor was placed under the heel and forefoot of each foot to determine the gait cycle duration. RESULTS: Gait cycle duration was unchanged (p > 0.05) by the addition of the RT task. Regardless of the level of difficulty of the RT task, the RTs were longer during treadmill walking than in sitting conditions (p < 0.01) indicating that an increased amount of resources are required for the maintainance of walking performance on a treadmill at a steady state. No interaction (p > 0.05) was found between the attentional demand of the walking task and the decrement of performance found in the RT task under varying levels of difficulty. This finding suggests that the healthy subjects prioritized the control of walking at the expense of cognitive performance. CONCLUSION: We conclude that treadmill walking in young adults is not a purely automatic task. The methodology and outcome measures used in this study provide an assessment of the attentional resources required by walking on the treadmill at a steady state.

Preclinical Auger and gamma radiation dosimetry for fluorodeoxyuridine-enhanced tumour proliferation scintigraphy with [123I]iododeoxyuridine.

Animal experiments have shown that short blocking of thymidine (dThd) synthesis with fluorodeoxyuridine (FdUrd) results in significantly increased DNA incorporation of [(125)I]iododeoxyuridine ([(125)I]IdUrd) in tumour and rapidly cycling tissues. Based on these results, we give an Auger and gamma radiation dosimetry estimate for a scintigraphy study in glioblastoma patients using [(123)I]IdUrd. The Auger radiation dosimetry calculated for patients is based on measurement of DNA-incorporated [(125)I]IdUrd in rapidly dividing tissues in nude mice xenografted with human glioblastoma. Further data obtained 0.5, 6 and 24 h after injection of [(125)I]IdUrd allowed calculation of the additional gamma radiation exposure using MIRDOSE3.1. High gradients of radioactivity concentration between dividing and non-dividing tissues were observed 6 and 24 h after injection of [(125)I]IdUrd combined with FdUrd pretreatment. While the estimated Auger radiation absorbed doses of [(123)I]IdUrd in six rapidly cycling normal tissues in patients are low, the equivalent doses become significant with application of the recommended preliminary radiation weighting factor (W(R)) of 20 for stochastic effects of DNA-associated Auger radiation. Using the latter W(R), extrapolation of the animal results to the proposed patient injection with 300 MBq [(123)I]IdUrd combined with FdUrd pretreatment indicates that the effective dose will be 5.42 mSv, including 1.67 mSv from Auger and 3.75 mSv from gamma radiation. The predicted Auger radiation effective dose for patients undergoing [(123)I]IdUrd scintigraphy will be significant if the enhancement of DNA incorporation that is achieved by means of FdUrd pretreatment is similar to that obtained in animals.