Peripheral nerve injuries resulting in a nerve defect require surgical repair. The gold standard of autograft (AG) has several limitations, and therefore, new alternatives must be developed. The main ...objective of this study was to assess nerve regeneration through a long gap nerve injury (50 mm) in the peroneal nerve of sheep with a decellularized nerve allograft (DCA).
A 5-cm long nerve gap was made in the peroneal nerve of sheep and repaired using an AG or using a DCA. Functional tests were performed once a month and electrophysiology and echography evaluations at 6.5 and 9 months postsurgery. Nerve grafts were harvested at 9 months for immunohistochemical and morphological analyses.
The decellularization protocol completely eliminated the cells while preserving the extracellular matrix of the nerve. No significant differences were observed in functional tests of locomotion and pain response. Reinnervation of the tibialis anterior muscles occurred in all animals, with some delay in the DCA group compared with the AG group. Histology showed a preserved fascicular structure in both AG and DCA; however, the number of axons distal to the nerve graft was higher in AG than in DCA.
The decellularized graft assayed supported effective axonal regeneration when used to repair a 5-cm long gap in the sheep. As expected, a delay in functional recovery was observed compared with the AG because of the lack of Schwann cells.
Objective. Interfacing the peripheral nervous system can be performed with a large variety of electrode arrays. However, stimulating and recording a nerve while having a reasonable amount of channels ...limits the number of available systems. Translational research towards human clinical trial requires device safety and biocompatibility but would benefit from design flexibility in the development process to individualize probes. Approach. We selected established medical grade implant materials like precious metals and Parylene C to develop a rapid prototyping process for novel intrafascicular electrode arrays using a picosecond laser structuring. A design for a rodent animal model was developed in conjunction with an intrafascicular implantation strategy. Electrode characterization and optimization was performed first in saline solution in vitro before performance and biocompatibility were validated in sciatic nerves of rats in chronic implantation. Main results. The novel fabrication process proved to be suitable for prototyping and building intrafascicular electrode arrays. Electrochemical properties of the electrode sites were enhanced and tested for long-term stability. Chronic implantation in the sciatic nerve of rats showed good biocompatibility, selectivity and stable stimulation thresholds. Significance. Established medical grade materials can be used for intrafascicular nerve electrode arrays when laser structuring defines structure size in the micro-scale. Design flexibility reduces re-design cycle time and material certificates are beneficial support for safety studies on the way to clinical trials.
En el contexto educativo y social es frecuente encontrarse con niños con algún tipo de trastorno autista, que presentan diversas alteraciones y afectan a sus habilidades comunicativas. El presente ...trabajo investigativo tuvo como finalidad diseñar una guía metodológica basada en el Sistema de Comunicación por Intercambio de Imágenes (PECS) para desarrollar la comunicación verbal en el entorno educativo de un niño con trastorno del espectro autista. La investigación se abordó desde un enfoque cualitativo bajo un diseño metodológico de estudio de caso único, apoyado en técnicas como la observación participante y entrevistas semiestructuradas, que permitieron diagnosticar las limitaciones que presenta el caso que se estudió. Los resultados del diagnóstico evidenciaron las principales limitaciones que tiene el niño, como la escasa comunicación verbal y la no interacción dentro del entorno educativo, que son características comunes de su condición de desarrollo. Además, los signos de exclusión educativa que generaron pocas mejoras en sus competencias comunicativas. Se propuso como contribución al problema, el diseño de una guía metodológica fundamentada en el sistema PECS, cuyos resultados diagnósticos pronosticaron que es un buen potenciador para la comunicación verbal del niño, para su interacción y su relación con las personas de su entorno educativo y social.
Los problemas distributivos tienen un tratamiento extenso en diversos campos del conocimiento. Sin embargo, el Derecho Procesal Civil en Chile ha quedado ajeno a tales problemáticas. Lo anterior, a ...pesar que las consecuencias de tener poco (dinero) son relevantes y cruzan todo el proceso. La escasa bibliografía sobre el tema se concentra en las dificultades de acceso a la justicia, pero no a las consecuencias que las desigualdades tienen en el ámbito probatorio, en la ejecución, y en la producción de precedentes. Este artículo busca identificar esos problemas y dar algunas luces de cómo en general deben ser solucionados.
Monoclonal antibodies constitute important and useful tools in clinical practice and biotechnology for diagnosing and treating infectious, inflammatory, immunological and neoplastic diseases. This ...article reviews evidence on the different acute adverse effects of monoclonal antibodies, specifically infusion-related reactions (IRRs), and on the measures that should be taken before and during crises. A literature search using key terms relating to IRRs produced by monoclonal antibodies was undertaken to generate a comprehensive narrative review of the information available. Immunomodulatory monoclonal antibodies may produce IRRs and hypersensitivity-related reactions. Strategies to avoid or minimize the appearance of IRRs depend on the monoclonal antibody and type of patient and reaction (pre-medication, slowing infusion rates, infusion interruption or desensitization, etc.). Considering the great number of available monoclonal antibodies in current practice and those which will soon be authorized, it is mandatory to have clear guidelines that can give support to practitioners and nurses to help them respond quickly and safely to the different IRRs related to the use of these therapeutic drugs.
•Efficient transfer of information among epileptologists and neurosurgeons.•Scenegraph-based processing pipeline to drive registration of multiple datasets.•Graphics processing unit (GPU) based ...detection of vessels for a planned trajectory.•Specialized DWI tractography tools for SEEG.•Semi-automatic electrode segmentation tool.
We present SYLVIUS, a software platform intended to facilitate and improve the complex workflow required to diagnose and surgically treat drug-resistant epilepsies. In complex epilepsies, additional invasive information from exploration with stereoencephalography (SEEG) with deep electrodes may be needed, for which the input from different diagnostic methods and clinicians from several specialties is required to ensure diagnostic efficacy and surgical safety. We aim to provide a software platform with optimal data flow among the different stages of epilepsy surgery to provide smooth and integrated decision making.
The SYLVIUS platform provides a clinical workflow designed to ensure seamless and safe patient data sharing across specialities. It integrates tools for stereo visualization, data registration, transfer of electrode plans referred to distinct datasets, automated postoperative contact segmentation, and novel DWI tractography analysis. Nineteen cases were retrospectively evaluated to track modifications from an initial plan to obtain a final surgical plan, using SYLVIUS.
The software was used to modify trajectories in all 19 consulted cases, which were then imported into the robotic system for the surgical intervention. When available, SYLVIUS provided extra multimodal information, which resulted in a greater number of trajectory modifications.
The architecture presented in this paper streamlines epilepsy surgery allowing clinicians to have a digital clinical tool that allows recording of the different stages of the procedure, in a common multimodal 2D/3D setting for participation of different clinicians in defining and validating surgical plans for SEEG cases.
Stereoelectroencephalography (SEEG) consists of the implantation of microelectrodes for the electrophysiological characterization of epileptogenic networks. To reduce a possible risk of intracranial ...bleeding by vessel rupture during the electrode implantation, the stereotactic trajectories must follow avascular corridors. The use of digital subtraction angiography (DSA) for vascular visualization during planning is controversial due to the additional risk related to this procedure. Here we evaluate the utility of this technique for planning when the neurosurgeon has it available together with gadolinium-enhanced T1-weighted magnetic resonance sequence (T1-Gd) and computed tomography angiography (CTA).
Twenty-two implantation plans for SEEG were initially done using T1-Gd imaging (251 trajectories). DSA was only used later during the revision process. In 6 patients CTA was available at this point as well. We quantified the position of the closest vessel to the trajectory in each of the imaging modalities.
Two thirds of the trajectories that appeared vessel free in the T1-Gd or CTA presented vessels in their proximity, as shown by DSA. Those modifications only required small shifts of both the entry and target point, so the diagnostic aims were preserved.
T1-Gd and CTA, despite being the most commonly used techniques for SEEG planning, frequently fail to reveal vessels that are dangerously close to the trajectories. Higher-resolution vascular imaging techniques, such as DSA, can provide the neurosurgeon with crucial information about vascular anatomy, resulting in safer plans.
Opioid-induced constipation (OIC) can affect up to 63% of all patients with cancer. The objectives of this study were to assess quality of life as well as efficacy and safety of naloxegol, in ...patients with cancer with OIC.
An observational study was made of a cohort of patients with cancer and with OIC exhibiting an inadequate response to laxatives and treated with naloxegol. The sample consisted of adult outpatients with a Karnofsky performance status score ≥50. The Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL) and the Patient Assessment of Constipation Symptoms (PAC-SYM) were applied for 3 months.
A total of 126 patients (58.2% males) with a mean age of 61.3 years (range 34-89) were included. Clinically relevant improvements (>0.5 points) were recorded in the PAC-QOL and PAC-SYM questionnaires (p<0.0001) from 15 days of treatment. The number of days a week with complete spontaneous bowel movements increased significantly (p<0.0001) from 2.4 to 4.6 on day 15, 4.7 after 1 month and 5 after 3 months. Pain control significantly improved (p<0.0001) during follow-up. A total of 13.5% of the patients (17/126) presented some gastrointestinal adverse reaction, mostly of mild (62.5%) or moderate intensity (25%).
Clinically relevant improvements in OIC-related quality of life, number of bowel movements and constipation-related symptoms were recorded as early as after 15 days of treatment with naloxegol in patients with cancer and OIC, with a good safety profile.
The emergence of new devices to be used in low-power applications are expected to reach impressive performance compared to those obtained by equivalent CMOS counterparts. However, when used in ...lightweight security applications, these emerging paradigms are required to be reliable and safe enough during the task of protecting important and valuable data. In this work, the usage of HyperFET devices for security applications has been analyzed and new paradigms for enhancing security against Power Analysis attacks have been developed for the first time. To perform this analysis, classical dual-precharge logic primitives implemented with 14nm FinFET have been upgraded to incorporate HyperFET devices. The proposed primitives incorporating HyperFETs, as well as a 4-bit Substitution box of PRIDE algorithm as demonstrative example, have been designed and simulated using predictive models. Simulation-based Differential Power Analysis attacks demonstrate high improvements in security levels in a x25 factor at least, with negligible degradation in performance. This first approach could be easily extensible to other ciphers or crypto-circuits, where the incorporation of HyperFET devices will enhance security for most future applications.
PDF
