Versatile vacuum-powered artificial muscles through replaceable external reinforcements.

Soft pneumatic artificial muscles are a well actuation scheme in soft robotics due to its key features for robotic machines being safe, lightweight, and conformable. In this work, we present a versatile vacuum-powered artificial muscle (VPAM) with manually tunable output motion. We developed an artificial muscle that consists of a stack of air chambers that can use replaceable external reinforcements. Different modes of operation are achieved by assembling different reinforcements that constrain the output motion of the actuator during actuation. We designed replaceable external reinforcements to produce single motions such as twisting, bending, shearing and rotary. We then conducted a deformation and lifting force characterization for these motions. We demonstrated sophisticated motions and reusability of the artificial muscle in two soft machines with different modes of locomotion. Our results show that our VPAM is reusable and versatile producing a variety and sophisticated output motions if needed. This key feature specially benefits unpredicted workspaces that require a soft actuator that can be adjusted for other tasks. Our scheme has the potential to offer new strategies for locomotion in machines for underwater or terrestrial operation, and wearable devices with different modes of operation.

Modeling the local biodiversity impacts of agricultural water use: case study of a wetland in the coastal arid area of Peru.

Global water use is dominated by agriculture and has considerable influence on people's livelihood and ecosystems, especially in semiarid and arid regions. Methods to address the impacts of water withdrawal and consumption on terrestrial and aquatic ecosystems within life cycle assessment are still sparse and very generic. Regionalized characterization factors (CFs) for a groundwater-fed wetland at the arid coast of Peru are developed for groundwater and surface water withdrawal and consumption in order to address the spatial dependency of water use related impacts. Several agricultural scenarios for 2020 were developed in a workshop with local stakeholders and used for calculating total biodiversity impacts. In contrast to assumptions used in top-down approaches (e.g., Pfister et al. Environ. Sci Technol. 2009, 43, 4098 ), irrigation with surface water leads in this specific region to benefits for the groundwater-fed wetland, due to additional groundwater recharge from surplus irrigation water. However, irrigation with groundwater leads to ecological damage to the wetland. The CFs derived from the different scenarios are similar and can thus be used as general CFs for this region, helping local decision-makers to plan future agricultural development, including irrigation technologies, crop choices, and protection of the wetland.

Use of lanreotide in combination with cabergoline or pegvisomant in patients with acromegaly in the clinical practice: The ACROCOMB study.

PURPOSE: To describe real-world use of lanreotide combination therapy for acromegaly. PATIENTS AND METHODS: ACROCOMB is a retrospective observational Spanish study of patients with active acromegaly treated with lanreotide combination therapy between 2006 and 2011. 108 patients treated at 44 Spanish Endocrinology Departments were analyzed separately: 61 patients received lanreotide/cabergoline (cabergoline cohort) and 47 lanreotide/pegvisomant (pegvisomant cohort). RESULTS: Patient median age was 50.8 years in the cabergoline cohort and 42.7 years in the pegvisomant cohort. Prior medical treatments were somatostatin analogue (SSA) monotherapy (40 [66%] patients) or dopamine agonists (7 [11%] patients) in the cabergoline cohort and SSA (29 [62%] patients) or pegvisomant monotherapy (16 [34%] patients) in the pegvisomant cohort. Across both cohorts 12 patients were previously untreated, and prior therapy was unknown/missing in 4 patients. Median duration of combined treatment was 1.6 years (0.1-6) and 2.1 years (0.4-6.3) in the cabergoline and pegvisomant cohorts, respectively. At baseline, median insulin growth factor (IGF)-I values were 149% upper limit of normal (ULN) (15-505%) in the cabergoline cohort and 156% ULN (15-534%) in the pegvisomant cohort, and decreased to 104% ULN (13-557%) p<0.001 and 86% ULN (23-345%) p<0.0001, respectively, at end of study (EOS). Normal age-adjusted values of IGF-I were obtained in 48% of lanreotide/cabergoline-treated patients and 70% of lanreotide/pegvisomant-treated patients at EOS. There were no significant changes in hepatic, cardiac or glycaemic parameters in either cohort. CONCLUSION: In clinical practice lanreotide treatment combinations are useful options for patients with acromegaly when monotherapy is insufficient; particularly, the combination of lanreotide and pegvisomant in patients not controlled with either SSA or pegvisomant alone has high efficacy and is well-tolerated.

Use of lanreotide in combination with cabergoline or pegvisomant in patients with acromegaly in the clinical practice: the ACROCOMB study / Uso de lanreotida en combinación con cabergolina o pegvisomant en la práctica clínica en pacientes con acromegalia: el estudio ACROCOMB

PURPOSE: To describe real-world use of lanreotide combination therapy for acromegaly. PATIENTS AND METHODS: ACROCOMB is a retrospective observational Spanish study of patients with active acromegaly treated with lanreotide combination therapy between 2006 and 2011. 108 patients treated at 44 Spanish Endocrinology Departments were analyzed separately: 61 patients received lanreotide/cabergoline (cabergoline cohort) and 47 lanreotide/pegvisomant (pegvisomant cohort). RESULTS: Patient median age was 50.8 years in the cabergoline cohort and 42.7 years in the pegvisomant cohort. Prior medical treatments were somatostatin analogue (SSA) monotherapy (40 [66%] patients) or dopamine agonists (7 [11%] patients) in the cabergoline cohort and SSA (29 [62%] patients) or pegvisomant monotherapy (16 [34%] patients) in the pegvisomant cohort. Across both cohorts 12 patients were previously untreated, and prior therapy was unknown/missing in 4 patients. Median duration of combined treatment was 1.6 years (0.1–6) and 2.1 years (0.4–6.3) in the cabergoline and pegvisomant cohorts, respectively. At baseline, median insulin growth factor (IGF)-I values were 149% upper limit of normal (ULN) (15–505%) in the cabergoline cohort and 156% ULN (15–534%) in the pegvisomant cohort, and decreased to 104% ULN (13–557%) p<0.001 and 86% ULN (23–345%) p<0.0001, respectively, at end of study (EOS). Normal age-adjusted values of IGF-I were obtained in 48% of lanreotide/cabergoline-treated patients and 70% of lanreotide/pegvisomant-treated patients at EOS. There were no significant changes in hepatic, cardiac or glycaemic parameters in either cohort. CONCLUSION: In clinical practice lanreotide treatment combinations are useful options for patients with acromegaly when monotherapy is insufficient; particularly, the combination of lanreotide and pegvisomant in patients not controlled with either SSA or pegvisomant alone has high efficacy and is well-tolerated

PROPÓSITO: Describir el uso de lanreotida en combinación terapéutica en acromegalia en la práctica clínica. PACIENTES Y MÉTODOS: ACROCOMB es un estudio observacional, retrospectivo, de pacientes con acromegalia activa tratados en centros hospitalarios españoles con lanreotida en combinación con cabergolina o pegvisomant entre 2006 y 2011. Se revisaron los datos clínicos de 108 pacientes tratados en 44 departamentos de endocrinología: 61 pacientes recibieron lanreótido/cabergolina (cohorte cabergolina) y 47 lanreotida/pegvisomant (cohorte pegvisomant). RESULTADOS: La edad mediana de los pacientes fue de 50,8 años en la cohorte de cabergolina y 42,7 años en la de pegvisomant. Los tratamientos médicos previos a la combinación con lanreótido fueron análogos de somatostatina (SSA) en monoterapia (40 [66%] pacientes) o agonistas de la dopamina (7 [11%] pacientes) en la cohorte de cabergolina y SSA (29 [62%] pacientes) y pegvisomant en monoterapia (16 [34%] pacientes) en la de pegvisomant. Doce pacientes no habían recibido tratamiento previo y en 4 pacientes se desconocía la terapia previa. La mediana de duración del tratamiento fue de 1,6 años (0,1-6) y 2,1 años (rango 0,4 a 6,3) en las cohortes de cabergolina y pegvisomant, respectivamente. Al inicio del estudio el valor mediano del factor de crecimiento de insulina-I era 149% el límite superior normal (LSN) (15-505%) en la cohorte de cabergolina y 156% LSN (15-534%) en la de pegvisomant. Al final del estudio se redujeron a 104% LSN (13-557%) p < 0,001 y 86% LSN (23-345%) p < 0,0001, respectivamente. Al final del estudio, se reportaron valores normales de factor de crecimiento de insulina-I ajustados por edad en el 48% de los pacientes tratados con lanreotida/cabergolina y 70% de los tratados con lanreotida/pegvisomant. No hubo cambios significativos en los parámetros hepáticos, cardíacos o glucémicos. CONCLUSIÓN: En la práctica clínica las combinaciones con lanreotida son una opción útil en el tratamiento de pacientes con acromegalia que no está bien controlada en monoterapia, ya sea con SSA carbegolina o pegvisomant; particularmente, la combinación de lanreotida y pegvisomant tiene una alta eficacia y se tolera bien

Reconstrucción de segmento esofágico con intestino delgado libre vascularizado / Reconstruction of esophageal segment using free vascularized small bowel

Reportamos el primer caso en nuestro medio de reconstrucción exitosa de un segmento esofágico, usando injerto libre de intestino. Se describe la técnica de dicho procedimiento. Esta operación es considerada como la de elección para ciertos defectos esofágicos considerando las ventajas funcionales sobre los colgajos cutáneos o miocutáneos tradicionales. Se resalta la importancia de la participación de un equipo conformado por cirujanos generales y cirujanos especialistas en microcirugía. Estas consideraciones limitan la aplicación de éste método de reconstrucción a centros que tengan la infraestructura para desarrollar procedimientos microquirúrgicos