Combined immunosuppressive therapy including a TNF-alpha blocker induces remission in a difficult to treat patient with Takayasu arteriitis and coronary involvement.

A 40 year old woman presented with symptoms of a systemic inflammatory disease and obstruction of the left subclavian artery. Takayasu arteriitis (TA) was clinically diagnosed and confirmed by MR angiography and FDG-PET scan showing inflammation of the aortic arch and the left subclavian artery. Immunosuppression with glucocorticoids and methotrexate resulted in immediate clinical improvement and normalization of systemic markers of inflammation. Despite that the patient developed chest pain on exertion suggesting coronary involvement, which was confirmed by dobutamine stress echocardiography. After adding the TNF-alpha blocker infliximab coronary symptoms gradually improved and a clinically stable situation could be achieved for more than 6 months. Coronary angiography and aortography showed an occluded main stem of the left coronary artery, an occluded left subclavian artery, and stenoses of the brachiocephalic trunk and the left common carotid artery. Revascularization of the coronary artery and the aortic arch and its branches was performed. The patient returned to work two months after the operation. Immunosuppressive therapy with infliximab and methotrexate is continued, glucocorticoids were stopped after one year of treatment. This case shows that vascular progress in TA patients may occur even when systemic inflammation is controlled, therefore patients have to be carefully observed for new vascular manifestations. TNF-alpha blockers may be an additional treatment option in otherwise difficult to treat TA patients allowing to perform revascularization after a stable disease state has been achieved.

Design and Implementation of a Wireless Medical Robot for Communication Within Hazardous Environments.

The huge spreading of COVID-19 viral outbreak to several countries motivates many of the research institutions everywhere in numerous disciplines to try decreasing the spread rate of this pandemic. Among these researches are the robotics with different payloads and sensory devices with wireless communications to remotely track patients' diagnosis and their treatment. That is, it reduces direct contact between the patients and the medical team members. Thus, this paper is devoted to design and implement a prototype of wireless medical robot (MR) that can communicate between patients and medical consultants. The prototype includes the modelling of a four-wheeled MR using systems' identification methodology, from which the model is utilized in control design and analysis. The required controller is designed using the proportional-integral-derivative (PID) and Fuzzy logic (FLC) techniques. The MR is equipped onboard with some medical sensors and a camera to acquire vital signs and physical parameters of patients. The MR model is obtained via an experimental test with input/output signals in open-loop configuration as single-input-single-output from which the estimation and validation results demonstrate that the identified model possess about 89% of the output variation/dynamics. This model is used for controllers' design with PID and FLC, the response of which is good for heading angle tracking. Concerning the medical measurements, more than two thousand real recorded Photo-plethysmography (PPG) signals and Blood Pressure (BP) are used to find the appropriate BP estimation model. Towards this objective, some experiments are designed and conducted to measure the PPG signal. Finally, the BP is estimated with mean absolute error of about 4.7 mmHg in systolic and 4.8 mmHg in diastolic using Artificial Neural Network.

The C-Port xV® vascular anastomosis system: results from an animal trial.

BACKGROUND: In this study, facilitated anastomosis using an anastomotic device was compared to conventional hand-sewn (HS) vascular anastomosis in an animal model. METHODS: A pig carotid bypass model was employed. C-Port xV® (xV) and HS anastomoses were compared by evaluating intraoperative performance, midterm graft patency, and histology. RESULTS: All animals survived; none developed early/late neurological deficits. Mean graft blood flow was comparable between groups (HS group: 161 ± 61 ml/min; xV group: 143 ± 44 ml/min). All anastomoses were patent at necropsy (at 111 ± 6 postoperative days). Histologically, no significant inflammation was found around the fasteners or in the vessel wall. Neointimal overgrowth on the lumen surface appeared organized and covered with endothelium. There was no adherence of fibrin, platelets, or inflammatory cells to the surface. The neointimal tissue appeared normal without any inflammation, hemorrhage, calcification, or necrosis. CONCLUSION: Facilitated vascular anastomosis using the xV anastomotic device is safe and effective in the pig carotid bypass model. Further studies should evaluate the efficacy of this device when used in confined spaces to define its potential role in minimally invasive procedures.