Feasibility Study for Monitoring an Ultrasonic System Using Structurally Integrated Piezoceramics.

This paper presents a new approach to monitoring ultrasonic systems using structurally integrated piezoceramics. These are integrated into the sonotrode at different points and with different orientations. The procedure for integrating the piezoceramics into the sonotrode and their performance is experimentally investigated. We examine whether the measured signal can be used to determine the optimal operating frequency of the ultrasonic system, if integrating several piezoceramics enables discernment of the current vibration shape, and if the piezoceramics can withstand the high strains caused by the vibrations in a frequency range of approximately 20-25 kHz. The signals from the piezoceramic sensors are compared to the real-time displacement at different points of the sonotrode using a 3D laser scanning vibrometer. To evaluate the performance of the sensors, different kinds of excitation of the ultrasonic system are chosen.

Cardinal Composition.

The thesis of Weak Unrestricted Composition says that every pair of objects has a fusion. This thesis has been argued by Contessa (Analysis 72(3):455-457, 2012) and Smith (Erkenntnis 84(1):41-55, 2019) to be compatible with the world being junky and hence to evade an argument against the necessity of Strong Unrestricted Composition proposed by Bohn (Analysis 69(1):27-31, 2009a, Philos Q 59(235):193-201, 2009b). However, neither Weak Unrestricted Composition alone nor the different variants of it that have been proposed in the literature can provide us with a satisfying answer to the special composition question, or so we will argue. We will then go on to explore an alternative family of purely mereological rules in the vicinity of Weak Unrestricted Composition, Cardinal Composition: A plurality of pairwise non-overlapping objects composes an object iff the objects in the plurality are of cardinality smaller than κ. As we will show, all the instances for infinite κs determine fusion and are compatible with junk, and every instance for a κ>ℵ0 is furthermore compatible with gunk and dense chains of parthood.

Functional reconstruction of the unilateral supraglottis and piriform sinus with a triple chimeric superficial circumflex iliac artery perforator flap after supraglottic laryngectomy: A case report.

Preservation of laryngeal functions after supraglottic laryngectomy depends on both the extent of surgical resection and the type of reconstruction. Any reconstructive modality faces the challenges of preserving voice and swallow function due to the complex and dynamic anatomy of the larynx. In this report, we present a case in which the entire affected unilateral supraglottis and piriform sinus were functionally reconstructed using a triple chimeric superficial circumflex iliac artery perforator (SCIP) free flap. An extended unilateral supraglottic laryngectomy and neck dissection were performed in a 78-year-old male patient presenting with a supraglottic cT4a cN0 cM0 laryngeal cancer. The resulting defect was reconstructed using a triple chimeric SCIP flap from the right inguinal region intended to reconstruct the different affected compartments. It was based on three perforators and consisted of a 4 cm × 3 cm fascial flap from the external oblique muscle and two fasciocutaneous paddles measuring 6 cm × 2 cm and 3 cm × 4 cm. The arterial and venous vessels were anastomosed to the superior thyroid artery and internal jugular vein. The fascial flap was used to reconstruct the aryepiglottic fold. The smaller fasciocutaneous paddle was utilized to reconstruct the affected piriform sinus and former thyroid cartilage compartment, while the larger fasciocutaneous paddle served as a monitor skin flap. The postoperative recovery was uneventful. Laryngeal functions including voice and deglutition were well-preserved after 4 months of rehabilitation. The patient showed no signs of chronic aspiration or tumor recurrence 6 and 12 months postoperatively. The pliable and versatile triple chimeric SCIP flap provides a useful free flap option for a tailored functional reconstruction after an extended supraglottic laryngectomy. Restoration of larynx elevation and mobility with the presented technique substantially improves swallow rehabilitation while preserving the voice.

Comparison of Structural Integrated Piezoceramics, Piezoelectric Patches and Strain Gauges for Condition Monitoring.

This paper presents a new approach to the structural integration of piezoceramics into thin-walled steel components for condition-monitoring applications. The procedure for integrating the sensors into metal components is described, and their functionality is experimentally examined with a 2 mm-thick steel sheet. The signal quality of the produced sensors is investigated in a frequency range from 100 Hz to 50,000 Hz and is compared with the results of piezo patches and strain gauges under the same conditions. The results show that due to a higher signal-to-noise ratio and a better coherence, the structurally integrated piezoceramics and the piezo patches are more qualified sensors for vibration measurement in the examined frequency range than the strain gauges. The measurements also indicate that the patches provide higher amplitudes for the frequency range up to 20 kHz. Beyond that, up to 40 kHz, the integrated sensors supplied higher amplitudes. The better signal quality in different frequency ranges as well as the different manufacturing and application methods can be interpreted as an advantage or disadvantage depending on the boundary conditions of the condition-monitoring system. In summary, structural integrated piezoceramics extend the options of monitoring technology.

Printed Multilayer Piezoelectric Transducers on Paper for Haptic Feedback and Dual Touch-Sound Sensation.

With a growing number of electronic devices surrounding our daily life, it becomes increasingly important to create solutions for clear and simple communication and interaction at the human machine interface (HMI). Haptic feedback solutions play an important role as they give a clear direct link and response to the user. This work demonstrates multifunctional haptic feedback devices based on fully printed piezoelectric transducers realized with functional polymers on thin paper substrate. The devices are flexible; lightweight and show very high out-of-plane deflection of 213 µm at a moderate driving voltage of 50 Vrms (root mean square) achieved by an innovative multilayer design with up to five individually controllable active layers. The device creates a very clear haptic sensation to the human skin with a blocking force of 0.6 N at the resonance frequency of 320 Hz, which is located in the most sensitive range of the human fingertip. Additionally the transducer generates audible information above two kilohertz with a remarkable high sound pressure level. Thus the paper-based approach can be used for interactive displays in combination with touch sensation; sound and color prints. The work gives insights into the manufacturing process; the electrical characteristics; and an in-depth analysis of the 3D deflection of the device under variable conditions.

Preservation of laryngeal function through reconstruction of the supraglottis and thyrohyoid membrane with a chimeric anterolateral thigh flap after supraglottic laryngectomy: A case report and literature review.

Supraglottic laryngectomy offers a treatment option in laryngeal cancer confined to the supraglottis with the aim to preserve laryngeal functions. Current reconstruction modalities face the challenges of restoring swallow function and preventing chronic aspiration. In this report, we present for the first time a case in which the thyrohyoid membrane and supraglottis were reconstructed using a chimeric anterolateral thigh (ALT) flap. Horizontal supraglottic laryngectomy was performed in a 70-year-old male patient with recurrent supraglottic laryngeal cancer after primary radiotherapy. The chimeric ALT flap used for reconstruction measured 7 x 20 cm and was based on two perforators, allowing it to be divided in two parts. The larger deepithelialized fasciocutaneous paddle was used for the reconstruction of the supraglottic defect and the smaller skin paddle was utilized as monitor flap and for neck resurfacing. The chimeric ALT flap was anastomosed to the superior thyroid artery and to a branch of the internal jugular vein. The postoperative recovery was uneventful. Laryngeal functions, including an unimpaired voice, could be preserved. Six months postoperatively, the patient showed no signs of chronic aspiration or tumor recurrence. Using a chimeric ALT free flap for reconstruction after horizontal supraglottic laryngectomy may prevent chronic aspiration through restoration of larynx elevation, mobility, and thus airway protection during deglutition due to increased supraglottic bulk.

Hip and groin time-loss injuries decreased slightly but injury burden remained constant in men's professional football: the 15-year prospective UEFA Elite Club Injury Study.

BACKGROUND: Hip and groin injuries are common in men's professional football, but the time-trend of these injuries is not known. AIM: To investigate hip and groin injury rates, especially time-trends, in men's professional football over 15 consecutive seasons. STUDY DESIGN: Prospective cohort study. SETTING: Men's professional football. METHODS: 47 European teams were followed prospectively for a varying number of seasons between 2001/2002 and 2015/2016, totalling 268 team seasons. Time-loss injuries and individual player exposure during training and matches were recorded. Injury rate was defined as the number of injuries/1000 hours and injury burden as the number of lay-off days/1000 hours. Time-trends for total hip and groin injuries and adductor-related injury rates were analysed using Poisson regression, and injury burden was analysed using a negative binomial regression model. RESULTS: Hip and groin injuries contributed 1812 out of 12 736 injuries (14%), with adductor-related injury as the most common of hip and groin injuries (n=1139, 63%). The rates of hip and groin injury and adductor-related injury were 1.0/1000 hours and 0.6/1000 hours, and these rates decreased significantly with on average 2% (Exp(b)=0.98, 95% CI 0.97 to 0.99, P=0.003) and 3% (Exp(b)=0.97, 95% CI 0.95 to 0.99, P<0.001) per season (year on year), respectively. The seasonal trend of hip and groin injury burden did not improve (Exp(b)=0.99, 95% CI 0.97 to 1.01, P=0.40). CONCLUSIONS: Hip and groin injuries constitute a considerable part of all time-loss injuries in men's professional football. Although there was a promising slight decreasing trend in the rates of hip and groin injury (as a category) and adductor-related injury (as a specific diagnosis), the injury burden remained at a consistent level over the study period.

Combined severe plastic deformation processing of commercial purity titanium enables superior fatigue resistance for next generation implants.

Commercial purity titanium (cp-Ti) is considered for replacing Ti64 as an implant material in various applications, due to the potential toxicity associated with the release of Al and V ions. However, the mechanical properties of cp-Ti, particularly fatigue resistance, are inadequate for this purpose. In this study, cp-Ti grade 4 rods were processed using a combination of equal channel angular pressing and rotary swaging (ECAP/RS). Tensile and fatigue tests were conducted, along with detailed microscopy and evaluation of corrosion resistance and biocompatibility. An average yield strength of 1383 MPa was obtained while maintaining moderate ductility of 10 %. This represents the highest strength ever recorded for cp-Ti, even exceeding that of Ti64. Additionally, fatigue endurance limit increased by 43 % up to 600 MPa, almost obtaining that of Ti64. Strengthening mechanisms were attributed to the ultrafine-grained (UFG) microstructure generated by ECAP/RS, along with strong crystallographic texture and formation of sub-grain structure. Furthermore, the corrosion resistance and biocompatibility of cp-Ti were largely unaffected, potentially easing regulatory transition in future medical devices. Thus, these results demonstrate high potential of combined ECAP/RS processing to manufacture UFG cp-Ti grade 4 materials that prospectively allow for the substitution of questionable alloys and downsizing of medical implants.

Use of Indocyanine Green Near-Infrared Imaging for Sentinel Lymph Node Biopsy in Early Oral Squamous Cell Carcinoma: A Pilot Study.

PURPOSE: The current established technique for sentinel lymph node (SLN) biopsy is preoperative injection of 99mtechnetium-labeled nanosized colloids (99mTc) followed by single photon emission computed tomography and standard computed tomography (SPECT/CT) with subsequent intraoperative gamma probe-guided excision of the SLN. It is however time and resource consuming, causes radiation exposure and morbidity for the patient as the injection is done in the awake patient. Recently near-infrared imaging with indocyanine green (ICG) gained importance in SLN biopsy as a faster and more convenient technique. The objective of our study was to investigate the feasibility of SLN biopsy using ICG-imaging in early oral squamous cell carcinoma (OSCC). METHODS: Single-centre pilot study of five patients with early-stage OSCC. For all patients, both techniques (99mTc and ICG) were performed. We injected 99mTc preoperatively in the awake patient, followed by SPECT/CT imaging. Intraoperatively ICG was injected around the primary tumor. Then the neck incision was performed according to the SPECT/CT images and SLN were detected by using a gamma probe and near-infrared fluorescence imaging of the ICG-marked lymph nodes intraoperatively. The excised lymph nodes were sent to histopathological examination according to the SLN dissection protocol. RESULTS: In all five patients sentinel lymph nodes were identified. A total of 7 SLN were identified after injection of 99mTc, imaging with SPECT/CT and intraoperative use of a gamma probe. All these SLN were fluorescent and visible with the ICG technique. In two patients, we could identify additional lymph nodes using the ICG technique. Pathological analysis demonstrated occult metastasis in two of the cases. CONCLUSIONS: Our study shows that ICG-guided SLN biopsy is a feasible technique, especially in combination with conventional radioisotope method and may help for intraoperative localization of SLN. Validation studies with bigger patient cohorts are needed to prove our results.

Localization of Brown Tumors With 18 F-Fluorocholine PET/CT Imaging in Severe Primary Hyperparathyroidism.

ABSTRACT: We present the case of a 68-year-old woman with a painful tibial tumor and fatigue. Histology and laboratory studies were consistent with a brown tumor secondary to initially unrecognized, severe primary hyperparathyroidism. 18 F-fluorocholine PET/CT revealed a large hypermetabolic parathyroid mass and multiple bone foci considered as brown tumors. Unilateral neck exploration confirmed a large parathyroid adenoma. Serum calcium and parathyroid hormone levels normalized quickly, and symptoms subsided gradually after parathyroidectomy. Brown tumors are a rare complication of severe hyperparathyroidism. 18 F-fluorocholine PET/CT allows the localization of parathyroid adenomas and brown tumors, and can be used as a single imaging modality.

Investigation of TaC and TiC for Particle Strengthening of Co-Re-Based Alloys.

Cobalt-Rhenium (Co-Re)-based alloys are currently investigated as potential high-temperature materials with melting temperatures beyond those of nickel-based superalloys. Their attraction stems from the binary Co-Re phase diagram, exhibiting complete miscibility between Co and Re, whereby the melting temperature steadily increases with the Re-content. Thus, depending on the Re-content, one can tune the melting temperature between that of pure Co (1495 °C) and that of pure Re (3186 °C). Current investigations focus on Re-contents of about 15 at.%, which makes melting with standard equipment still feasible. In addition to solid solution strengthening due to the mixture of Co- and Re-atoms, particle strengthening by tantalum carbide (TaC) and titanium carbide (TiC) precipitates turned out to be promising in recent studies. Yet, it is currently unclear which of the two particle types is the best choice for high temperature applications nor has the strengthening mechanism associated with the monocarbide (MC)-precipitates been elucidated. To address these issues, we perform compression tests at ambient and elevated temperatures on the particle-free base material containing 15 at.% of rhenium (Re), 5 at.% of chromium (Cr) and cobalt (Co) as balance (Co-15Re-5Cr), as well as on TaC- and TiC-containing variants. Additionally, transmission electron microscopy is used to analyze the shape of the precipitates and their orientation relationship to the matrix. Based on these investigations, we show that TiC and TaC are equally suited for precipitation strengthening of Co-Re-based alloys and identify climb over the elongated particles as a rate controlling particle strengthening mechanism at elevated temperatures. Furthermore, we show that the Re-atoms are remarkably strong obstacles to dislocation motion, which are overcome by thermal activation at elevated temperatures.

The epidemiology of anterior cruciate ligament injury in football (soccer): a review of the literature from a gender-related perspective.

Football (soccer), the most popular sport worldwide, is associated with a high injury risk, and the knee joint is often affected. Several studies have found female players to be more susceptible to knee injury, anterior cruciate ligament (ACL) injury in particular, compared to their male counterparts. There is, however, some controversy regarding the magnitude of this risk increase and a few studies have found no differences. The influence of age and activity type on gender-related differences in injury risk is only scarcely investigated. In this paper, the literature reporting gender-specific ACL injury risk in football is reviewed. A literature search yielded 33 relevant articles that were included for review. These show that female players have a 2-3 times higher ACL injury risk compared to their male counterparts. Females also tend to sustain their ACL injury at a younger age than males, and a limiting factor in the existing literature is that age is not adjusted for in comparisons of ACL injury risk between genders. Furthermore, the risk increase in females is primarily evident during match play, but type of exposure is also rarely adjusted for. Finally, the studies included in this review share important methodological limitations that are discussed as a starting point for future research in the field.

Overall Neutrophil-to-Lymphocyte Ratio and SUVmax of Nodal Metastases Predict Outcome in Head and Neck Cancer Before Chemoradiation.

INTRODUCTION: This study investigates the pretherapeutic neutrophil-to-lymphocyte ratio (NLR) with markers of tumor metabolism in 18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) and their potential prognostic value in head and neck cancer patients prior to primary chemoradiation. MATERIALS AND METHODS: NLR and metabolic markers of primary tumor and nodal metastases including maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were retrospectively assessed in a consecutive cohort of head and neck squamous cell cancer patients undergoing primary chemoradiation. The main outcome measure was survival. RESULTS: The study included 90 patients of which 74 had lymph node metastases at diagnosis. Median follow-up time of nodal positive patients (n=74) was 26.5 months (IQR 18-44). The NLR correlated significantly with metabolic markers of the primary tumor (TLG: rs=0.47, P<0.001; MTV: rs=0.40, P<0.001; SUVmax: rs=0.34, P=0.003), but much less with FDG-PET/CT surrogate markers of metabolic activity in nodal metastases (TLG: rs=0.15, P=0.19; MTV: rs=0.25, P=0.034; SUVmax: rs=0.06, P=0.63). For nodal positive cancer patients, multivariate analysis showed that an increased NLR (HR=1.19, 95% CI=1.04-1.37, P=0.012) and SUVmax of lymph node metastasis (HR=1.09; 95% CI=0.99-1.19; P=0.081) are independently predictive of disease-specific survival. High NLR had a negative prognostic value for overall survival (HR=1.16, 95% CI=1.02-1.33, P=0.021). CONCLUSION: NLR correlates positively with metabolic markers of the primary tumor, suggestive of an unspecific inflammatory response in the host as a possible reflection of increased metabolism of the primary tumor. SUVmax of lymph node metastases and the NLR, however, show no correlation and are independently predictive of disease-specific survival. Therefore, their addition could be used to improve survival prediction in nodal positive head and neck cancer patients undergoing primary chemoradiation.

Predictive Value of Pretherapeutic Maximum Standardized Uptake Value (Suvmax) In Laryngeal and Hypopharyngeal Cancer.

The aim of the study was to evaluate whether pretherapeutic metabolic tumor parameters from 18-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging could predict larynx preservation in laryngeal and hypopharyngeal cancer patients prior to primary chemoradiation. Tumor metabolic parameters [maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG)] were retrospectively assessed in a consecutive cohort of laryngeal and hypopharyngeal cancer patients undergoing primary (chemo-)radiation. Main outcome measures were larynx preservation and survival. The study included 97 patients with a median follow-up of 32 months (IQR 20-54.5). For hypopharyngeal cancer, multivariable analysis showed that patients with a primary tumor's SUVmax > 9.5 entailed a higher risk of undergoing salvage pharyngolaryngectomy after chemoradiation (HR = 8.64, 95% CI = 1.1-67.3, P = 0.040). In laryngeal cancer, SUVmax did not predict the need for salvage laryngectomy. The only predictor for larynx preservation in laryngeal cancer patients was T-classification at initial diagnosis (HR = 6.67, 95% CI = 0.82-53.9, P = 0.039). In conclusion, SUVmax of primary tumor could be used as a predictor of larynx preservation prior to primary chemoradiation in hypopharyngeal cancer patients. This information may be important for patient counseling, as high SUVmax was correlated with reduced probability of larynx preservation. However, in laryngeal cancer patients, SUVmax does not seem to be predictive of outcome.

Maximum Standardized Uptake Value (SUVmax) of Primary Tumor Predicts Occult Neck Metastasis in Oral Cancer.

The aim of this study was to investigate the predictability of occult lymph node metastasis using maximum standardized uptake value (SUVmax) in the primary tumor on pre-treatment 18-fluorodeoxyglucose positron emission tomography FDG-PET in oral squamous cell carcinoma (OSCC) patients who were clinically node negative (cN0) before surgery. A retrospective analysis of all patients treated at the University Hospital Zurich from 2007 to 2016 for OSCC with available pre-therapeutic FDG-PET was performed. We assessed the correlation of SUVmax of the primary tumors with the presence of occult nodal disease in the neck dissection specimen (pN+). The study included a total of 71 patients. In the nodal negative group (cN0/pN0), the median SUVmax of primary tumors was 9.0 (interquartile range (IQR) 7.4-13.9), while it was 11.4 (IQR 9.9-15.7) in the occult metastatic group (cN0/pN+). The difference was statistically significant (independent samples median test, P = 0.037). In a multivariable model, the only independent predictor of occult metastatic disease for cN0 patients was a SUVmax ≥ 9.5 (P = 0.028). Further, primary tumors with SUVmax ≥ 9.5 had a significantly higher risk of local recurrence (Log rank test, P = 0.020). In conclusion, we showed that higher SUVmax (≥9.5) of the primary tumor is associated with higher occurrence of occult metastatic nodal disease and worse local survival. High SUVmax of the primary tumor may encourage clinicians towards more aggressive treatment.

Serum levels of brain-derived neurotrophic factor (BNDF) in multiple sclerosis patients with Trichuris suis ova therapy.

We previously analysed clinical and immunological parameters under Trichuris suis ova (TSO) therapy in four patients with secondary progressive multiple sclerosis. The serum Brain-derived neurotrophic factor (BDNF) levels of these four patients were assessed before, during and after therapy with TSO and showed significant decrease of BDNF during TSO therapy (p < 0.05).