The absence of tactile perception limits the dexterity of a prosthetic hand and its acceptance by amputees.Recreating the sensing properties of the skin using a flexible tactile sensor could have profound implications...The absence of tactile perception limits the dexterity of a prosthetic hand and its acceptance by amputees.Recreating the sensing properties of the skin using a flexible tactile sensor could have profound implications for prosthetics,whereas existing tactile sensors often have limited functionality with cross-interference.In this study,we propose a machine-learning-assisted multifunctional tactile sensor for smart prosthetics,providing a human-like tactile sensing approach for amputations.This flexible sensor is based on a poly(3,4-ethylenedioxythiophene):poly(styrene sulfonate)(PEDOT:PSS)-melamine sponge,which enables the detection of force and temperature with low cross-coupling owing to two separate sensing mechanisms:the open-circuit voltage of the sensor as a force-insensitive intrinsic variable to measure the absolute temperature and the resistance as a temperature-insensitive extrinsic variable to measure force.Furthermore,by analyzing the unsteady heat conduction and characterizing it using real-time thermal imaging,we demonstrated that the process of open-circuit voltage variation resulting from the unsteady heat conduction is closely correlated with the heatconducting capabilities of materials,which can be utilized to discriminate between substances.Assisted by the decision tree algorithm,the device is endowed with thermal conductivity sensing ability,which allows it to identify 10 types of substances with an accuracy of 94.7%.Furthermore,an individual wearing an advanced myoelectric prosthesis equipped with the above sensor can sense pressure,temperature,and recognize different materials.We demonstrated that our multifunctional tactile sensor provides a new strategy to help amputees feel force,temperature and identify the material of objects without the aid of vision.展开更多
Digit amputations are the most common amputation worldwide.This manuscript describes the impairments imposed by digit loss and the potential benefits of digit prosthetics.This review of the literature is designed to p...Digit amputations are the most common amputation worldwide.This manuscript describes the impairments imposed by digit loss and the potential benefits of digit prosthetics.This review of the literature is designed to provide a reference for healthcare workers and patients for identifying and selecting prosthetic options for digit amputees.展开更多
Locomotor intent classification has become a research hotspot due to its importance to the development of assistive robotics and wearable devices.Previous work have achieved impressive performance in classifying stead...Locomotor intent classification has become a research hotspot due to its importance to the development of assistive robotics and wearable devices.Previous work have achieved impressive performance in classifying steady locomotion states.However,it remains challenging for these methods to attain high accuracy when facing transitions between steady locomotion states.Due to the similarities between the information of the transitions and their adjacent steady states.Furthermore,most of these methods rely solely on data and overlook the objective laws between physical activities,resulting in lower accuracy,particularly when encountering complex locomotion modes such as transitions.To address the existing deficiencies,we propose the locomotion rule embedding long short-term memory(LSTM)network with Attention(LREAL)for human locomotor intent classification,with a particular focus on transitions,using data from fewer sensors(two inertial measurement units and four goniometers).The LREAL network consists of two levels:One responsible for distinguishing between steady states and transitions,and the other for the accurate identification of locomotor intent.Each classifier in these levels is composed of multiple-LSTM layers and an attention mechanism.To introduce real-world motion rules and apply constraints to the network,a prior knowledge was added to the network via a rule-modulating block.The method was tested on the ENABL3S dataset,which contains continuous locomotion date for seven steady and twelve transitions states.Experimental results showed that the LREAL network could recognize locomotor intents with an average accuracy of 99.03%and 96.52%for the steady and transitions states,respectively.It is worth noting that the LREAL network accuracy for transition-state recognition improved by 0.18%compared to other state-of-the-art network,while using data from fewer sensors.展开更多
With the continuous advancement of technology,the application of 3D printing technology in the field of dental medicine is becoming increasingly widespread.This article aims to explore the current applications and fut...With the continuous advancement of technology,the application of 3D printing technology in the field of dental medicine is becoming increasingly widespread.This article aims to explore the current applications and future potential of 3D printing technology in dental medicine and to analyze its benefits and challenges.It first introduces the current state of 3D printing technology in dental implants,crowns,bridges,orthodontics,and maxillofacial surgery.It then discusses the potential applications of 3D printing technology in oral tissue engineering,drug delivery systems,personalized dental prosthetics,and surgical planning.Finally,it analyzes the benefits of 3D printing technology in dental medicine,such as improving treatment accuracy and patient comfort,and shortening treatment times,while also highlighting the challenges faced,such as costs,material choices,and technical limitations.This article aims to provide a reference for professionals in the field of dental medicine and to promote the further application and development of 3D printing technology in this area.展开更多
This study aimed to comprehensively investigate the essential considerations in designing adaptive clothing for women with lower limb prostheses in Saudi Arabia. Employing a qualitative methodology, the research entai...This study aimed to comprehensively investigate the essential considerations in designing adaptive clothing for women with lower limb prostheses in Saudi Arabia. Employing a qualitative methodology, the research entailed semi-structured, in-depth interviews with women utilizing lower limb prostheses and prosthetic specialists. This approach was selected to unearth pivotal design prerequisites and comprehend the specific challenges these women encounter within the realm of clothing. The utilization of selective sampling facilitated the collection of intricate and valuable insights. A Functional, Expressive, and Aesthetic (FEA) User Needs model was utilized to scrutinize participant feedback. Functional requisites encompass ease of dressing and undressing, accessibility to the prosthetic limb, comfort, mobility with the prosthesis, and appropriate fit. Additionally, participants highlighted various expressive needs, including privacy preservation, modesty, camouflaging disability appearances, maintaining alignment with non-disabled women’s fashion, and considerations about the aesthetic aspects of garments.展开更多
BACKGROUND Septic arthritis,whether native or prosthetic,poses a significant challenge in clinical practice due to its potentially devastating consequences.Despite its clinical importance,there remains a dearth of com...BACKGROUND Septic arthritis,whether native or prosthetic,poses a significant challenge in clinical practice due to its potentially devastating consequences.Despite its clinical importance,there remains a dearth of comprehensive studies and standardized diagnostic criteria,particularly in the Kingdom of Saudi Arabia.AIM To investigate the epidemiology,microbiological profiles,and clinical characteristics of native and prosthetic septic joints in the Saudi Arabian population.METHODS Medical records of patients diagnosed with septic arthritis between January 1,2015,and December 31,2022,were retrospectively reviewed.Data regarding patient demographics,clinical presentation,microbiological cultures,treatment modalities,and outcomes were analyzed.RESULTS In a retrospective review of 52 cases of septic arthritis,a balanced gender distribution was observed(1:1 ratio),with the knee being the most commonly affected joint(80.8%).Methicillin-resistant Staphylococcus aureus predominated in native joints(24.2%),while Brucella spp.was more prevalent in prosthetic joints(21.1%).Joint preservation was achieved in most cases(84.6%),with no significant difference in clinical features between native and prosthetic joints.However,certain comorbidities were more common in native joint cases,including renal impairment(P=0.002),hemodialysis(P=0.004),heart disease(P=0.013),and chronic liver disease(P=0.048).At the same time,osteoarthritis was more prevalent in prosthetic joint cases(P=0.013).Vancomycin was the most frequently used antibiotic(26.9%),and most patients received antibiotics before joint aspiration(57.7%).Surgical intervention,predominantly arthrotomy,was required in most cases(32.7%).Notably,a significant association was found between joint type and mortality(odds ratio=0.587,P=0.048),as well as the Charlson comorbidity index and mortality(P=0.001).CONCLUSION This study highlighted distinctive microbiological profiles and etiological factors in septic arthritis cases in the Saudi Arabian population.展开更多
BACKGROUND Advances in implant material and design have allowed for improvements in total knee arthroplasty(TKA)outcomes.A cruciate retaining(CR)TKA provides the least constraint of TKA designs by preserving the nativ...BACKGROUND Advances in implant material and design have allowed for improvements in total knee arthroplasty(TKA)outcomes.A cruciate retaining(CR)TKA provides the least constraint of TKA designs by preserving the native posterior cruciate ligament.Limited research exists that has examined clinical outcomes or patient reported outcome measures(PROMs)of a large cohort of patients undergoing a CR TKA utilizing a kinematically designed implant.It was hypothesized that the studied CR Knee System would demonstrate favorable outcomes and a clinically significant improvement in pain and functional scores.AIM To assess both short-term and mid-term clinical outcomes and PROMs of a novel CR TKA design.METHODS A retrospective,multi-surgeon study identified 255 knees undergoing a TKA utilizing a kinematically designed CR Knee System(JOURNEY™II CR;Smith and Nephew,Inc.,Memphis,TN)at an urban,academic medical institution between March 2015 and July 2021 with a minimum of two-years of clinical follow-up with an orthopedic surgeon.Patient demographics,surgical information,clinical outcomes,and PROMs data were collected via query of electronic medical records.The PROMs collected in the present study included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement(KOOS JR)and Patient-Reported Outcomes Measurement Information System(PROMIS■)scores.The significance of improvements in mean PROM scores from preoperative scores to scores collected at six months and two-years postoperatively was analyzed using Independent Samples t-tests.RESULTS Of the 255 patients,65.5%were female,43.8%were White,and patients had an average age of 60.6 years.Primary osteoarthritis(96.9%)was the most common primary diagnosis.The mean surgical time was 105.3 minutes and mean length of stay was 2.1 d with most patients discharged home(92.5%).There were 18 emergency department(ED)visits within 90 d of surgery resulting in a 90 d ED visit rate of 7.1%,including a 2.4%orthopedic-related ED visit rate and a 4.7%non-orthopedic-related ED visit rate.There were three(1.2%)hospital readmissions within 90 d postoperatively.With a mean time to latest follow-up of 3.3 years,four patients(1.6%)required revision,two for arthrofibrosis,one for aseptic femoral loosening,and one for peri-prosthetic joint infection.There were significant improvements in KOOS JR,PROMIS Pain Intensity,PROMIS Pain Interference,PROMIS Mobility,and PROMIS Physical Health from preoperative scores to six month and two-year postoperative scores.CONCLUSION The evaluated implant is an effective,novel design offering excellent outcomes and low complication rates.At a mean follow up of 3.3 years,four patients required revisions,three aseptic and one septic,resulting in an overall implant survival rate of 98.4%and an aseptic survival rate of 98.8%.The results of our study demonstrate the utility of this kinematically designed implant in the setting of primary TKA.展开更多
Background: Tuberculous endocarditis is a rare but serious complication of heart valve replacement surgery. We report the case of a 24-year-old patient, who presented with tuberculous endocarditis after mechanical mit...Background: Tuberculous endocarditis is a rare but serious complication of heart valve replacement surgery. We report the case of a 24-year-old patient, who presented with tuberculous endocarditis after mechanical mitral valve replacement, with a favorable clinical course following anti-tuberculosis treatment. Case Presentation: We report a 24-year-old male patient, admitted to the cardiac surgery department of the Fann Hospital (Dakar, Senegal), for the management of severe mixed (rheumatic and endocarditic) mitral insufficiency with associated tricuspid insufficiency. He had a history of recurrent angina and polyarthralgia in childhood, was hospitalized several times for refractory global cardiac decompensation, and for a suspected infective endocarditis a month before his admission. On admission, the clinical examination revealed signs suggestive of mitral and tricuspid insufficiency. Transthoracic echocardiography revealed severe post-endocarditic mitral insufficiency with A3 amputation, highly mobile 15 mm vegetations on the free edge of the large valve, moderate tricuspid insufficiency, and severe pulmonary artery hypertension. Mechanical mitral valve replacement and tricuspid valve annuloplasty using autologous pericardial strip were performed via median sternotomy. After ten days, the patient presented with global cardiac decompensation associated with a clinico-biological infectious syndrome, and tans-oesophageal echography revealed an abscess at the sinotubular junction, communicating with the aorta. A thoraco-abdomino-pelvic CT scan was done, which revealed a bilateral alveolar-interstitial syndrome with mediastinal lymphadenopathy. Anti-tuberculosis treatment with RHZE was initiated for 06 months. The clinical course was favorable. Conclusion: Tuberculous endocarditis in prostheses is a serious complication of heart valve replacement surgery, which may evolve favorably under medical treatment.展开更多
Objective:To explore the effect of observation of oral care in implant denture restoration of chronic periodontitis.Methods:80 patients with chronic periodontitis implant denture restoration admitted from March 2022 t...Objective:To explore the effect of observation of oral care in implant denture restoration of chronic periodontitis.Methods:80 patients with chronic periodontitis implant denture restoration admitted from March 2022 to March 2023 in the hospital were selected.They were randomly divided into an observation group and a control group,with 40 cases in each group.Both groups of patients received routine treatment and care.The patients in the control group used routine oral care methods to carry out oral care,the patients in the observation group carried out oral care on the basis of the control group,observation and analysis of the patients'mastery of oral knowledge,as well as the depth of the probing and the level of clinical attachment.Results:The oral knowledge mastery of the observation group was 72.31±6.98 after the nursing intervention,which was significantly higher than the score of 86.12±7.36 of the patients in the control group who used conventional oral care,and the difference was statistically significant at P<0.05;the depth of probing and the clinical attachment level of the observation group were 2.43±0.58 and 4.31±0.86 respectively,which were significantly better than those of the control group.The depth of probing and clinical attachment level scores of the observation group were 2.99±0.54 and 5.36±1.02 respectively,and P<0.05 was considered statistically significant.Conclusion:The combination of conventional treatment and oral care can effectively improve the treatment effect of implant denture prosthesis for chronic periodontitis.However,it is necessary to pay attention to the psychological counseling of the patients in the specific clinical application to ensure that the patients can actively cooperate with the clinical treatment.展开更多
Rehabilitation of lower limb amputation in developing countries is quite challenging.Though there are basic to highly advanced prostheses available in India,the set-up is still facing difficulties in developing countr...Rehabilitation of lower limb amputation in developing countries is quite challenging.Though there are basic to highly advanced prostheses available in India,the set-up is still facing difficulties in developing countries.Prosthetic management is difficult due to lack of availability of prostheses and reduced affordability among low income populations.In this review we highlighted the lower limb amputation and prosthetic rehabilitation status in India.Currently,India is advancing well in the rehabilitation field,but further studies are required to provide more evidence and recommendation.展开更多
Gripping devices help patients carry out everyday tasks and increase their independence.However,there seems to be a lack of bionic gripping technologies that can fully adapt to any possible shape,as the use of artific...Gripping devices help patients carry out everyday tasks and increase their independence.However,there seems to be a lack of bionic gripping technologies that can fully adapt to any possible shape,as the use of artificial fingers and predetermined grip settings limits the operating space.The development of a more agile device,which is operated by a simple control paradigm,could greatly benefit users.An electrorheological(ER)fluid system should be able to adapt to the shape of an object and then hold that configuration.The aim of this study was to explore if a conceptual prototype of an ER system could hold a geometric shape when it is activated.A test rig was constructed with a moving part(set in different silicone oils)that could be displaced using a tensometer.Silica particles were dispersed in the silicone oils,and a field with a voltage of 4 kV mm?1 was generated to activate the fluid.The results show that the developed system can support an increased force when activated and hold a simple geometric position without any noticeable delay.This outcome provides an initial proof of concept for a possible new(gravity-assisted)gripping approach using smart fluids,which could be developed with materials that are biocompatible and widely available.展开更多
To assist an amputee in regaining his or her daily quality of life,based on analysis of the motion characteristics of the human hip,a 2-UPR/URR parallel mechanism with a passive limb was designed.The inverse kinematic...To assist an amputee in regaining his or her daily quality of life,based on analysis of the motion characteristics of the human hip,a 2-UPR/URR parallel mechanism with a passive limb was designed.The inverse kinematics of this mechanism was analyzed based on a closed-loop vector method.The constrained Jacobian matrix and kinematic Jacobian matrix of each limb were then analyzed,and a 6×6 fully Jacobian matrix was constructed.Based on this,kinematic performances were analyzed and summarized.Finally,the dynamic model of the mechanism was constructed based on the virtual work principle,and its theoretical solution was compared with the numerical results,which were obtained in a simulation environment.Results showed that the prosthetic mechanism had a larger rotating workspace and better mechanical performance,which accorded a range of motion and bearing capacity similar to that of the human hip in multiple gait modes.Moreover,the validity of the dynamic model and inverse kinematics were verified by comparing the theoretical and simulation results.Furthermore,with flexion and extension,the torque change in the hip prosthetic mechanism was similar to that of the human hip,which demonstrated the feasibility of the hip prosthetic mechanism and its good dynamic performance.展开更多
AIM:To summarize our experience in the application of Crurasoft for antireflux surgery and hiatal hernia(HH)repair and to introduce the work of Chinese doctors on this topic.METHODS:Twenty-one patients underwent HH re...AIM:To summarize our experience in the application of Crurasoft for antireflux surgery and hiatal hernia(HH)repair and to introduce the work of Chinese doctors on this topic.METHODS:Twenty-one patients underwent HH repair with Crurasoft reinforcement.Gastroesophageal reflux disease(GERD)and HH-related symptoms including heartburn,regurgitation,chest pain,dysphagia,and abdominal pain were evaluated preoperatively and 6mo postoperatively.A patient survey was conducted by phone by one of the authors.Patients were asked about"recurrent reflux or heartburn"and"dysphagia".An internet-based Chinese literature search in this field was also performed.Data extracted from each study included:number of patients treated,hernia size,hiatorrhaphy,antireflux surgery,follow-up period,recurrence rate,and complications(especially dysphagia).RESULTS:There were 8 typeⅠ,10 typeⅡand 3 typeⅢHHs in this group.Mean operative time was 119.29min(range 80-175 min).Intraoperatively,length and width of the hiatal orifice were measured,(4.33±0.84and 2.85±0.85 cm,respectively).Thirteen and eight Nissen and Toupet fundoplications were performed,respectively.The intraoperative complication rate was9.52%.Despite dysphagia,GERD-related symptoms improved significantly compared with those before surgery.The recurrence rate was 0%during the 6-mo follow-up period,and long-term follow-up disclosed a recurrence rate of 4.76%with a mean period of 16.28mo.Eight patients developed new-onset dysphagia.The Chinese literature review identified 12 papers with213 patients.The overall recurrence rate was 1.88%.There was no esophageal erosion and the rate of dysphagia ranged from 0%to 24%.CONCLUSION:The use of Crurasoft mesh for HH repair results in satisfactory symptom control with a low recurrence rate.Postoperative dysphagia continues to be an issue,and requires more research to reduce its incidence.展开更多
A grasping force control strategy is proposed in order to complete various free manipulations by using anthropomorphic prosthetic hand. The position-based impedance control and force-tracking impedance control are use...A grasping force control strategy is proposed in order to complete various free manipulations by using anthropomorphic prosthetic hand. The position-based impedance control and force-tracking impedance control are used in free and constraint spaces, respectively. The fuzzy observer is adopted in transition in order to switch control mode. Two control modes use one position-based impedance controller. In order to achieve grasping force track, reference force is added to the impedance controller in the constraint space. Trajectory tracking in free space and torque tracking in constrained space are realized, and reliability of mode switch and stability of system are achieved. An adaptive sliding mode friction compensation method is proposed. This method makes use of terminal sliding mode idea to design sliding mode function, which makes the tracking error converge to zero in finite time and avoids the problem of conventional sliding surface that tracking error cannot converge to zero. Based on the characteristic of the exponential form friction, the sliding mode control law including the estimation of friction parameter is obtained through terminal sliding mode idea, and the online parameter update laws are obtained based on Lyapunov stability theorem. The experiments on the HIT Prosthetic Hand IV are carried out to evaluate the grasping force control strategy, and the experiment results verify the effectiveness of this control strategy.展开更多
An underactuated finger structure actuated by tendon-driven system is presented.Kinematics and static analysis of the finger is done,and the results indicate that the prosthetic finger structure is effective and feasi...An underactuated finger structure actuated by tendon-driven system is presented.Kinematics and static analysis of the finger is done,and the results indicate that the prosthetic finger structure is effective and feasible.Based on the design of finger,a prosthetic hand is designed.The hand is composed of 5 independent fingers and it looks more like humanoid.Its size is about 85% of an adult's hand and weights about 350 g.Except the thumb finger,each finger is actuated by one DC motor,gear head and a tendon,and has three curling/extension joints.The thumb finger which is different from other existing prostheses is a novel design scheme.The thumb finger has four joints including three curling/extension joints and a joint which is used to realize the motion of the thumb related to the palm,and these joints are also driven by one DC motor,harmonic drive and a tendon.The underactuation and adaptive curling/extension motion of the finger are realized by joint torsion springs.A high-powered chip of digital signal processing(DSP)is the main part of the electrical system which is used for the motors control,data collection,communication with external controlling source,and so on.To improve the reliability of the hand,structures and sensors are designed and made as simply as possible.The hand has strong manipulation capabilities that have been verified by finger motion and grasping tests and it can satisfy the daily operational needs and psychological needs of deformities.展开更多
Dear editor,Fungal endocarditis is a rare disease with a poor prognosis,suboptimal diagnostic tools responsible for long diagnostic delays in most cases,and poorly defined activity of most antifungal agents in endocar...Dear editor,Fungal endocarditis is a rare disease with a poor prognosis,suboptimal diagnostic tools responsible for long diagnostic delays in most cases,and poorly defined activity of most antifungal agents in endocarditis.^([1])The burden of diagnosis still lies with clinicians:they need a展开更多
Soon after the introduction of the modern prosthetic joint,it was recognized that radionuclide imaging provides useful information about these devices.The bone scan was used extensively to identify causes of prostheti...Soon after the introduction of the modern prosthetic joint,it was recognized that radionuclide imaging provides useful information about these devices.The bone scan was used extensively to identify causes of prosthetic joint failure.It became apparent,however,that although sensitive,regardless of how the images were analyzed or how it was performed,the test was not specific and could not distinguish among the causes of prosthetic failure.Advances in anatomic imaging,notably cross sectional modalities,have facilitated the diagnosis of many,if not most,causes of prosthetic failure,with the important exception of infection.This has led to a shift in the diagnostic paradigm,in which nuclear medicine investigations increasingly have focused on diagnosing infection.The recognition that bone scintigraphy could not reliably diagnose infection led to the development of combined studies,first bone/gallium and subsequently leukocyte/bone and leukocyte/marrow imaging.Labeled leukocyte imaging,combined with bone marrow imaging is the most accurate(about90%)imaging test for diagnosing joint arthroplasty infection.Its value not withstanding,there are significant disadvantages to this test.In-vivo techniques for labeling leukocytes,using antigranulocyte antibodieshave been explored,but have their own limitations and the results have been inconsistent.Fluorodeoxyglucose(FDG)-positron emission tomography(FDG-PET)has been extensively investigated for more than a decade but its role in diagnosing the infected prosthesis has yet to be established.Antimicrobial peptides bind to bacterial cell membranes and are infection specific.Data suggest that these agents may be useful for diagnosing prosthetic joint infection,but large scale studies have yet to be undertaken.Although for many years nuclear medicine has focused on diagnosing prosthetic joint infection,the advent of hybrid imaging with singlephoton emission computed tomography(SPECT)/electronic computer X-ray tomography technique(CT)and the availability of fluorine-18 fluoride PET suggests that the diagnostic paradigm may be shifting again.By providing the anatomic information lacking in conventional radionuclide studies,there is renewed interest in bone scintigraphy,performed as a SPECT/CT procedure,for detecting joint instability,mechanical loosening and component malpositioning.Fluoride-PET may provide new insights into periprosthetic bone metabolism.The objective of this manuscript is to provide a comprehensive review of the evolution of nuclear medicine imaging of joint replacements.展开更多
Prosthetic valve obstruction(PVO) is a rare but feared complication of mechanical valve replacement. Diagno-stic evaluation should focus on differentiating prosthetic valve thrombosis(PVT) from pannus formation,as the...Prosthetic valve obstruction(PVO) is a rare but feared complication of mechanical valve replacement. Diagno-stic evaluation should focus on differentiating prosthetic valve thrombosis(PVT) from pannus formation,as their treatment options differ. History of sub-optimal anti-coagulation and post-op time course to development of PVO are useful clinical characteristics in differentiating thrombus from pannus formation. Treatment of PVT is influenced by the patient's symptoms,valve location,degree of obstruction and thrombus size and may include thrombolysis or surgical intervention. Alternatively,pannus formation requires surgical intervention. The purpose of this article is to review the pathophysiology,epidemiology,diagnostic approach and treatment options for aortic and mitral valve PVO.展开更多
AIM: To investigate the correlation between preoperative measurement in total knee arthroplasty and the prosthetic size implanted. METHODS: A prospective double-blind study of 50 arthroplasties was performed. Firstly,...AIM: To investigate the correlation between preoperative measurement in total knee arthroplasty and the prosthetic size implanted. METHODS: A prospective double-blind study of 50 arthroplasties was performed. Firstly, the reliability and correspondence between the size of said measurement and the actual implant utilized was determined. Secondly, the existing correlation between the intra- and interobserver determinations with the intraclass correlation coefficient was analyzed. RESULTS: An overall correspondence of 54%, improving up to 92% when the measured size admitted a difference of one size, was found. Good intra- and interobserver reliability with an intraclass correlation coefficient greater than 0.90(P < 0.001) was also discovered. CONCLUSION: Agreement between the preoperative measurement with standardized acetate templates and the prosthetic size implanted can be considered satisfactory. We thus conclude it is a reproducible technique.展开更多
基金the funding support from the National Key R&D Program of China(2020YFB2008501)the National Science Fund for Distinguished Young Scholars of China(62125112)+4 种基金the National Natural Science Foundation of China(62071462,62071463)the Youth Promotion Association of Chinese Academy of Sciences(2020320)the Jiangxi Provincial Natural Science Foundation(20224ACB212001)the Foundation Research Project of Jiangsu Province(BK20201195)the Suzhou Key Industrial Technology Innovation Project(SYG202029).
文摘The absence of tactile perception limits the dexterity of a prosthetic hand and its acceptance by amputees.Recreating the sensing properties of the skin using a flexible tactile sensor could have profound implications for prosthetics,whereas existing tactile sensors often have limited functionality with cross-interference.In this study,we propose a machine-learning-assisted multifunctional tactile sensor for smart prosthetics,providing a human-like tactile sensing approach for amputations.This flexible sensor is based on a poly(3,4-ethylenedioxythiophene):poly(styrene sulfonate)(PEDOT:PSS)-melamine sponge,which enables the detection of force and temperature with low cross-coupling owing to two separate sensing mechanisms:the open-circuit voltage of the sensor as a force-insensitive intrinsic variable to measure the absolute temperature and the resistance as a temperature-insensitive extrinsic variable to measure force.Furthermore,by analyzing the unsteady heat conduction and characterizing it using real-time thermal imaging,we demonstrated that the process of open-circuit voltage variation resulting from the unsteady heat conduction is closely correlated with the heatconducting capabilities of materials,which can be utilized to discriminate between substances.Assisted by the decision tree algorithm,the device is endowed with thermal conductivity sensing ability,which allows it to identify 10 types of substances with an accuracy of 94.7%.Furthermore,an individual wearing an advanced myoelectric prosthesis equipped with the above sensor can sense pressure,temperature,and recognize different materials.We demonstrated that our multifunctional tactile sensor provides a new strategy to help amputees feel force,temperature and identify the material of objects without the aid of vision.
文摘Digit amputations are the most common amputation worldwide.This manuscript describes the impairments imposed by digit loss and the potential benefits of digit prosthetics.This review of the literature is designed to provide a reference for healthcare workers and patients for identifying and selecting prosthetic options for digit amputees.
基金funded by the National Natural Science Foundation of China(Nos.62072212,62302218)the Development Project of Jilin Province of China(Nos.20220508125RC,20230201065GX,20240101364JC)+1 种基金National Key R&D Program(No.2018YFC2001302)the Jilin Provincial Key Laboratory of Big Data Intelligent Cognition(No.20210504003GH).
文摘Locomotor intent classification has become a research hotspot due to its importance to the development of assistive robotics and wearable devices.Previous work have achieved impressive performance in classifying steady locomotion states.However,it remains challenging for these methods to attain high accuracy when facing transitions between steady locomotion states.Due to the similarities between the information of the transitions and their adjacent steady states.Furthermore,most of these methods rely solely on data and overlook the objective laws between physical activities,resulting in lower accuracy,particularly when encountering complex locomotion modes such as transitions.To address the existing deficiencies,we propose the locomotion rule embedding long short-term memory(LSTM)network with Attention(LREAL)for human locomotor intent classification,with a particular focus on transitions,using data from fewer sensors(two inertial measurement units and four goniometers).The LREAL network consists of two levels:One responsible for distinguishing between steady states and transitions,and the other for the accurate identification of locomotor intent.Each classifier in these levels is composed of multiple-LSTM layers and an attention mechanism.To introduce real-world motion rules and apply constraints to the network,a prior knowledge was added to the network via a rule-modulating block.The method was tested on the ENABL3S dataset,which contains continuous locomotion date for seven steady and twelve transitions states.Experimental results showed that the LREAL network could recognize locomotor intents with an average accuracy of 99.03%and 96.52%for the steady and transitions states,respectively.It is worth noting that the LREAL network accuracy for transition-state recognition improved by 0.18%compared to other state-of-the-art network,while using data from fewer sensors.
文摘With the continuous advancement of technology,the application of 3D printing technology in the field of dental medicine is becoming increasingly widespread.This article aims to explore the current applications and future potential of 3D printing technology in dental medicine and to analyze its benefits and challenges.It first introduces the current state of 3D printing technology in dental implants,crowns,bridges,orthodontics,and maxillofacial surgery.It then discusses the potential applications of 3D printing technology in oral tissue engineering,drug delivery systems,personalized dental prosthetics,and surgical planning.Finally,it analyzes the benefits of 3D printing technology in dental medicine,such as improving treatment accuracy and patient comfort,and shortening treatment times,while also highlighting the challenges faced,such as costs,material choices,and technical limitations.This article aims to provide a reference for professionals in the field of dental medicine and to promote the further application and development of 3D printing technology in this area.
文摘This study aimed to comprehensively investigate the essential considerations in designing adaptive clothing for women with lower limb prostheses in Saudi Arabia. Employing a qualitative methodology, the research entailed semi-structured, in-depth interviews with women utilizing lower limb prostheses and prosthetic specialists. This approach was selected to unearth pivotal design prerequisites and comprehend the specific challenges these women encounter within the realm of clothing. The utilization of selective sampling facilitated the collection of intricate and valuable insights. A Functional, Expressive, and Aesthetic (FEA) User Needs model was utilized to scrutinize participant feedback. Functional requisites encompass ease of dressing and undressing, accessibility to the prosthetic limb, comfort, mobility with the prosthesis, and appropriate fit. Additionally, participants highlighted various expressive needs, including privacy preservation, modesty, camouflaging disability appearances, maintaining alignment with non-disabled women’s fashion, and considerations about the aesthetic aspects of garments.
文摘BACKGROUND Septic arthritis,whether native or prosthetic,poses a significant challenge in clinical practice due to its potentially devastating consequences.Despite its clinical importance,there remains a dearth of comprehensive studies and standardized diagnostic criteria,particularly in the Kingdom of Saudi Arabia.AIM To investigate the epidemiology,microbiological profiles,and clinical characteristics of native and prosthetic septic joints in the Saudi Arabian population.METHODS Medical records of patients diagnosed with septic arthritis between January 1,2015,and December 31,2022,were retrospectively reviewed.Data regarding patient demographics,clinical presentation,microbiological cultures,treatment modalities,and outcomes were analyzed.RESULTS In a retrospective review of 52 cases of septic arthritis,a balanced gender distribution was observed(1:1 ratio),with the knee being the most commonly affected joint(80.8%).Methicillin-resistant Staphylococcus aureus predominated in native joints(24.2%),while Brucella spp.was more prevalent in prosthetic joints(21.1%).Joint preservation was achieved in most cases(84.6%),with no significant difference in clinical features between native and prosthetic joints.However,certain comorbidities were more common in native joint cases,including renal impairment(P=0.002),hemodialysis(P=0.004),heart disease(P=0.013),and chronic liver disease(P=0.048).At the same time,osteoarthritis was more prevalent in prosthetic joint cases(P=0.013).Vancomycin was the most frequently used antibiotic(26.9%),and most patients received antibiotics before joint aspiration(57.7%).Surgical intervention,predominantly arthrotomy,was required in most cases(32.7%).Notably,a significant association was found between joint type and mortality(odds ratio=0.587,P=0.048),as well as the Charlson comorbidity index and mortality(P=0.001).CONCLUSION This study highlighted distinctive microbiological profiles and etiological factors in septic arthritis cases in the Saudi Arabian population.
文摘BACKGROUND Advances in implant material and design have allowed for improvements in total knee arthroplasty(TKA)outcomes.A cruciate retaining(CR)TKA provides the least constraint of TKA designs by preserving the native posterior cruciate ligament.Limited research exists that has examined clinical outcomes or patient reported outcome measures(PROMs)of a large cohort of patients undergoing a CR TKA utilizing a kinematically designed implant.It was hypothesized that the studied CR Knee System would demonstrate favorable outcomes and a clinically significant improvement in pain and functional scores.AIM To assess both short-term and mid-term clinical outcomes and PROMs of a novel CR TKA design.METHODS A retrospective,multi-surgeon study identified 255 knees undergoing a TKA utilizing a kinematically designed CR Knee System(JOURNEY™II CR;Smith and Nephew,Inc.,Memphis,TN)at an urban,academic medical institution between March 2015 and July 2021 with a minimum of two-years of clinical follow-up with an orthopedic surgeon.Patient demographics,surgical information,clinical outcomes,and PROMs data were collected via query of electronic medical records.The PROMs collected in the present study included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement(KOOS JR)and Patient-Reported Outcomes Measurement Information System(PROMIS■)scores.The significance of improvements in mean PROM scores from preoperative scores to scores collected at six months and two-years postoperatively was analyzed using Independent Samples t-tests.RESULTS Of the 255 patients,65.5%were female,43.8%were White,and patients had an average age of 60.6 years.Primary osteoarthritis(96.9%)was the most common primary diagnosis.The mean surgical time was 105.3 minutes and mean length of stay was 2.1 d with most patients discharged home(92.5%).There were 18 emergency department(ED)visits within 90 d of surgery resulting in a 90 d ED visit rate of 7.1%,including a 2.4%orthopedic-related ED visit rate and a 4.7%non-orthopedic-related ED visit rate.There were three(1.2%)hospital readmissions within 90 d postoperatively.With a mean time to latest follow-up of 3.3 years,four patients(1.6%)required revision,two for arthrofibrosis,one for aseptic femoral loosening,and one for peri-prosthetic joint infection.There were significant improvements in KOOS JR,PROMIS Pain Intensity,PROMIS Pain Interference,PROMIS Mobility,and PROMIS Physical Health from preoperative scores to six month and two-year postoperative scores.CONCLUSION The evaluated implant is an effective,novel design offering excellent outcomes and low complication rates.At a mean follow up of 3.3 years,four patients required revisions,three aseptic and one septic,resulting in an overall implant survival rate of 98.4%and an aseptic survival rate of 98.8%.The results of our study demonstrate the utility of this kinematically designed implant in the setting of primary TKA.
文摘Background: Tuberculous endocarditis is a rare but serious complication of heart valve replacement surgery. We report the case of a 24-year-old patient, who presented with tuberculous endocarditis after mechanical mitral valve replacement, with a favorable clinical course following anti-tuberculosis treatment. Case Presentation: We report a 24-year-old male patient, admitted to the cardiac surgery department of the Fann Hospital (Dakar, Senegal), for the management of severe mixed (rheumatic and endocarditic) mitral insufficiency with associated tricuspid insufficiency. He had a history of recurrent angina and polyarthralgia in childhood, was hospitalized several times for refractory global cardiac decompensation, and for a suspected infective endocarditis a month before his admission. On admission, the clinical examination revealed signs suggestive of mitral and tricuspid insufficiency. Transthoracic echocardiography revealed severe post-endocarditic mitral insufficiency with A3 amputation, highly mobile 15 mm vegetations on the free edge of the large valve, moderate tricuspid insufficiency, and severe pulmonary artery hypertension. Mechanical mitral valve replacement and tricuspid valve annuloplasty using autologous pericardial strip were performed via median sternotomy. After ten days, the patient presented with global cardiac decompensation associated with a clinico-biological infectious syndrome, and tans-oesophageal echography revealed an abscess at the sinotubular junction, communicating with the aorta. A thoraco-abdomino-pelvic CT scan was done, which revealed a bilateral alveolar-interstitial syndrome with mediastinal lymphadenopathy. Anti-tuberculosis treatment with RHZE was initiated for 06 months. The clinical course was favorable. Conclusion: Tuberculous endocarditis in prostheses is a serious complication of heart valve replacement surgery, which may evolve favorably under medical treatment.
文摘Objective:To explore the effect of observation of oral care in implant denture restoration of chronic periodontitis.Methods:80 patients with chronic periodontitis implant denture restoration admitted from March 2022 to March 2023 in the hospital were selected.They were randomly divided into an observation group and a control group,with 40 cases in each group.Both groups of patients received routine treatment and care.The patients in the control group used routine oral care methods to carry out oral care,the patients in the observation group carried out oral care on the basis of the control group,observation and analysis of the patients'mastery of oral knowledge,as well as the depth of the probing and the level of clinical attachment.Results:The oral knowledge mastery of the observation group was 72.31±6.98 after the nursing intervention,which was significantly higher than the score of 86.12±7.36 of the patients in the control group who used conventional oral care,and the difference was statistically significant at P<0.05;the depth of probing and the clinical attachment level of the observation group were 2.43±0.58 and 4.31±0.86 respectively,which were significantly better than those of the control group.The depth of probing and clinical attachment level scores of the observation group were 2.99±0.54 and 5.36±1.02 respectively,and P<0.05 was considered statistically significant.Conclusion:The combination of conventional treatment and oral care can effectively improve the treatment effect of implant denture prosthesis for chronic periodontitis.However,it is necessary to pay attention to the psychological counseling of the patients in the specific clinical application to ensure that the patients can actively cooperate with the clinical treatment.
文摘Rehabilitation of lower limb amputation in developing countries is quite challenging.Though there are basic to highly advanced prostheses available in India,the set-up is still facing difficulties in developing countries.Prosthetic management is difficult due to lack of availability of prostheses and reduced affordability among low income populations.In this review we highlighted the lower limb amputation and prosthetic rehabilitation status in India.Currently,India is advancing well in the rehabilitation field,but further studies are required to provide more evidence and recommendation.
文摘Gripping devices help patients carry out everyday tasks and increase their independence.However,there seems to be a lack of bionic gripping technologies that can fully adapt to any possible shape,as the use of artificial fingers and predetermined grip settings limits the operating space.The development of a more agile device,which is operated by a simple control paradigm,could greatly benefit users.An electrorheological(ER)fluid system should be able to adapt to the shape of an object and then hold that configuration.The aim of this study was to explore if a conceptual prototype of an ER system could hold a geometric shape when it is activated.A test rig was constructed with a moving part(set in different silicone oils)that could be displaced using a tensometer.Silica particles were dispersed in the silicone oils,and a field with a voltage of 4 kV mm?1 was generated to activate the fluid.The results show that the developed system can support an increased force when activated and hold a simple geometric position without any noticeable delay.This outcome provides an initial proof of concept for a possible new(gravity-assisted)gripping approach using smart fluids,which could be developed with materials that are biocompatible and widely available.
基金Supported by Beijing Natural Science Foundation(Grant No.L172021)National Natural Science Foundation of China(Grant No.51875033).
文摘To assist an amputee in regaining his or her daily quality of life,based on analysis of the motion characteristics of the human hip,a 2-UPR/URR parallel mechanism with a passive limb was designed.The inverse kinematics of this mechanism was analyzed based on a closed-loop vector method.The constrained Jacobian matrix and kinematic Jacobian matrix of each limb were then analyzed,and a 6×6 fully Jacobian matrix was constructed.Based on this,kinematic performances were analyzed and summarized.Finally,the dynamic model of the mechanism was constructed based on the virtual work principle,and its theoretical solution was compared with the numerical results,which were obtained in a simulation environment.Results showed that the prosthetic mechanism had a larger rotating workspace and better mechanical performance,which accorded a range of motion and bearing capacity similar to that of the human hip in multiple gait modes.Moreover,the validity of the dynamic model and inverse kinematics were verified by comparing the theoretical and simulation results.Furthermore,with flexion and extension,the torque change in the hip prosthetic mechanism was similar to that of the human hip,which demonstrated the feasibility of the hip prosthetic mechanism and its good dynamic performance.
文摘AIM:To summarize our experience in the application of Crurasoft for antireflux surgery and hiatal hernia(HH)repair and to introduce the work of Chinese doctors on this topic.METHODS:Twenty-one patients underwent HH repair with Crurasoft reinforcement.Gastroesophageal reflux disease(GERD)and HH-related symptoms including heartburn,regurgitation,chest pain,dysphagia,and abdominal pain were evaluated preoperatively and 6mo postoperatively.A patient survey was conducted by phone by one of the authors.Patients were asked about"recurrent reflux or heartburn"and"dysphagia".An internet-based Chinese literature search in this field was also performed.Data extracted from each study included:number of patients treated,hernia size,hiatorrhaphy,antireflux surgery,follow-up period,recurrence rate,and complications(especially dysphagia).RESULTS:There were 8 typeⅠ,10 typeⅡand 3 typeⅢHHs in this group.Mean operative time was 119.29min(range 80-175 min).Intraoperatively,length and width of the hiatal orifice were measured,(4.33±0.84and 2.85±0.85 cm,respectively).Thirteen and eight Nissen and Toupet fundoplications were performed,respectively.The intraoperative complication rate was9.52%.Despite dysphagia,GERD-related symptoms improved significantly compared with those before surgery.The recurrence rate was 0%during the 6-mo follow-up period,and long-term follow-up disclosed a recurrence rate of 4.76%with a mean period of 16.28mo.Eight patients developed new-onset dysphagia.The Chinese literature review identified 12 papers with213 patients.The overall recurrence rate was 1.88%.There was no esophageal erosion and the rate of dysphagia ranged from 0%to 24%.CONCLUSION:The use of Crurasoft mesh for HH repair results in satisfactory symptom control with a low recurrence rate.Postoperative dysphagia continues to be an issue,and requires more research to reduce its incidence.
基金Project(2009AA043803) supported by the National High Technology Research and Development Program of China Project (SKLRS200901B) supported by Self-Planned Task of State Key Laboratory of Robotics and System (Harbin Institute of Technology),ChinaProject (NCET-09-0056) supported by Program for New Century Excellent Talents in Universities of China
文摘A grasping force control strategy is proposed in order to complete various free manipulations by using anthropomorphic prosthetic hand. The position-based impedance control and force-tracking impedance control are used in free and constraint spaces, respectively. The fuzzy observer is adopted in transition in order to switch control mode. Two control modes use one position-based impedance controller. In order to achieve grasping force track, reference force is added to the impedance controller in the constraint space. Trajectory tracking in free space and torque tracking in constrained space are realized, and reliability of mode switch and stability of system are achieved. An adaptive sliding mode friction compensation method is proposed. This method makes use of terminal sliding mode idea to design sliding mode function, which makes the tracking error converge to zero in finite time and avoids the problem of conventional sliding surface that tracking error cannot converge to zero. Based on the characteristic of the exponential form friction, the sliding mode control law including the estimation of friction parameter is obtained through terminal sliding mode idea, and the online parameter update laws are obtained based on Lyapunov stability theorem. The experiments on the HIT Prosthetic Hand IV are carried out to evaluate the grasping force control strategy, and the experiment results verify the effectiveness of this control strategy.
基金Project(2008AA04Z203)supported by National High Technology Research and Development Program of China
文摘An underactuated finger structure actuated by tendon-driven system is presented.Kinematics and static analysis of the finger is done,and the results indicate that the prosthetic finger structure is effective and feasible.Based on the design of finger,a prosthetic hand is designed.The hand is composed of 5 independent fingers and it looks more like humanoid.Its size is about 85% of an adult's hand and weights about 350 g.Except the thumb finger,each finger is actuated by one DC motor,gear head and a tendon,and has three curling/extension joints.The thumb finger which is different from other existing prostheses is a novel design scheme.The thumb finger has four joints including three curling/extension joints and a joint which is used to realize the motion of the thumb related to the palm,and these joints are also driven by one DC motor,harmonic drive and a tendon.The underactuation and adaptive curling/extension motion of the finger are realized by joint torsion springs.A high-powered chip of digital signal processing(DSP)is the main part of the electrical system which is used for the motors control,data collection,communication with external controlling source,and so on.To improve the reliability of the hand,structures and sensors are designed and made as simply as possible.The hand has strong manipulation capabilities that have been verified by finger motion and grasping tests and it can satisfy the daily operational needs and psychological needs of deformities.
文摘Dear editor,Fungal endocarditis is a rare disease with a poor prognosis,suboptimal diagnostic tools responsible for long diagnostic delays in most cases,and poorly defined activity of most antifungal agents in endocarditis.^([1])The burden of diagnosis still lies with clinicians:they need a
文摘Soon after the introduction of the modern prosthetic joint,it was recognized that radionuclide imaging provides useful information about these devices.The bone scan was used extensively to identify causes of prosthetic joint failure.It became apparent,however,that although sensitive,regardless of how the images were analyzed or how it was performed,the test was not specific and could not distinguish among the causes of prosthetic failure.Advances in anatomic imaging,notably cross sectional modalities,have facilitated the diagnosis of many,if not most,causes of prosthetic failure,with the important exception of infection.This has led to a shift in the diagnostic paradigm,in which nuclear medicine investigations increasingly have focused on diagnosing infection.The recognition that bone scintigraphy could not reliably diagnose infection led to the development of combined studies,first bone/gallium and subsequently leukocyte/bone and leukocyte/marrow imaging.Labeled leukocyte imaging,combined with bone marrow imaging is the most accurate(about90%)imaging test for diagnosing joint arthroplasty infection.Its value not withstanding,there are significant disadvantages to this test.In-vivo techniques for labeling leukocytes,using antigranulocyte antibodieshave been explored,but have their own limitations and the results have been inconsistent.Fluorodeoxyglucose(FDG)-positron emission tomography(FDG-PET)has been extensively investigated for more than a decade but its role in diagnosing the infected prosthesis has yet to be established.Antimicrobial peptides bind to bacterial cell membranes and are infection specific.Data suggest that these agents may be useful for diagnosing prosthetic joint infection,but large scale studies have yet to be undertaken.Although for many years nuclear medicine has focused on diagnosing prosthetic joint infection,the advent of hybrid imaging with singlephoton emission computed tomography(SPECT)/electronic computer X-ray tomography technique(CT)and the availability of fluorine-18 fluoride PET suggests that the diagnostic paradigm may be shifting again.By providing the anatomic information lacking in conventional radionuclide studies,there is renewed interest in bone scintigraphy,performed as a SPECT/CT procedure,for detecting joint instability,mechanical loosening and component malpositioning.Fluoride-PET may provide new insights into periprosthetic bone metabolism.The objective of this manuscript is to provide a comprehensive review of the evolution of nuclear medicine imaging of joint replacements.
文摘Prosthetic valve obstruction(PVO) is a rare but feared complication of mechanical valve replacement. Diagno-stic evaluation should focus on differentiating prosthetic valve thrombosis(PVT) from pannus formation,as their treatment options differ. History of sub-optimal anti-coagulation and post-op time course to development of PVO are useful clinical characteristics in differentiating thrombus from pannus formation. Treatment of PVT is influenced by the patient's symptoms,valve location,degree of obstruction and thrombus size and may include thrombolysis or surgical intervention. Alternatively,pannus formation requires surgical intervention. The purpose of this article is to review the pathophysiology,epidemiology,diagnostic approach and treatment options for aortic and mitral valve PVO.
文摘AIM: To investigate the correlation between preoperative measurement in total knee arthroplasty and the prosthetic size implanted. METHODS: A prospective double-blind study of 50 arthroplasties was performed. Firstly, the reliability and correspondence between the size of said measurement and the actual implant utilized was determined. Secondly, the existing correlation between the intra- and interobserver determinations with the intraclass correlation coefficient was analyzed. RESULTS: An overall correspondence of 54%, improving up to 92% when the measured size admitted a difference of one size, was found. Good intra- and interobserver reliability with an intraclass correlation coefficient greater than 0.90(P < 0.001) was also discovered. CONCLUSION: Agreement between the preoperative measurement with standardized acetate templates and the prosthetic size implanted can be considered satisfactory. We thus conclude it is a reproducible technique.
