Movement therapy in lung transplantation candidates assisted by a lightweight wearable robot

The aim of this pilot-study was to investigate the safety, feasibility and tolerability of an assisted mobilization of patients with advanced pulmonary diseases, using a lightweight, exoskeleton-type robot (Myosuit, MyoSwiss AG, Zurich, Switzerland). Ten patients performed activities of daily life (ADL) both with and without the device. The mean age was 53.6 (±5.6) years; 70% were male. The assessment of outcome included the evaluation of vital signs, adverse events, rates of perceived exertion and dyspnea (PRE, PRD), the ability to perform ADL and the individual acceptability. Robotic-assisted mobilization was feasible in all patients. No adverse events occurred. RPE and RPD showed no significant difference with or without the Myosuit (mean difference in RPE -1.7, 95%-confidence interval (CI) -1.16, 4.49; p = 0.211; mean difference in RPD 0.00, 95%-CI -1.88, 1.88; p = 0.475). 80% of patients were interested to participate in a robotic-assisted training on a regular basis. A robotic exoskeleton-assisted mobilization is safe, feasible, well-tolerated and well-accepted. The results are highly encouraging to further pursue this highly innovative approach.

Validity of the 6-Minute Walk Test in Patients with End-Stage Lung Diseases Wearing an Oronasal Surgical Mask in Times of the COVID-19 Pandemic

BACKGROUND AND OBJECTIVES

The 6-minute walk test (6MWT), as a clinical assessment tool for functional exercise capacity, is an integral component of lung allocation scores (LASs). In times of the coronavirus disease (COVID-19) pandemic, patients underwent 6MWTs wearing a surgical mask in ambulatory care. We investigated the impact of wearing a mask on 6-minute walk distances (6MWDs).

METHOD

6MWDs of 64 patients with end-stage lung diseases wearing an oronasal surgical mask were retrospectively compared to previously investigated 6MWDs of the same cohort, in a pre-COVID-19 pandemic era, without wearing a mask. Four patients were excluded due to a primary vascular disease, 29 patients due to clinically unstable pulmonary functions, and 1 patient due to a psychiatric disorder.

RESULTS

The median age of the patients included was 55 (46-58) years; 15 (48%) were male. Ten (32.2%) were on the Eurotransplant lung transplant waiting list with a median LAS of 34.3 (31.9-36.2). Twenty (64.5%) patients had chronic obstructive pulmonary diseases, 7 (22.6%) had interstitial lung diseases, and 4 (12.9%) had other end-stage lung diseases. The mean 6MWD without versus with wearing a mask was 306.9 (101.9) versus 305.7 (103.8) m, with a mean difference of -1.19 m (95% confidence interval -13.4 to 11.03). The observed difference is statistically equivalent to zero (p < 0.001). No significant differences in 6MWDs were observed between the clinical groups.

CONCLUSION

Wearing an oronasal surgical mask did not affect the 6MWDs of patients with advanced lung diseases. Therefore, a masked 6MWT appears to provide a reliable examination of functional exercise capacity in this cohort.

Ambient habitat noise and vibration at the Georgia Aquarium

Underwater and in-air noise evaluations were completed in performance pool systems at Georgia Aquarium under normal operating conditions and with performance sound tracks playing. Ambient sound pressure levels at in-pool locations, with corresponding vibration measures from life support system (LSS) pumps, were measured in operating configurations, from shut down to full operation. Results indicate noise levels in the low frequency ranges below 100 Hz were the highest produced by the LSS relative to species hearing thresholds. The LSS had an acoustic impact of about 10 dB at frequencies up to 700 Hz, with a 20 dB re 1 μPa impact above 1000 Hz.

Clinical, haemodynamic and echocardiographic features of early cardiac graft dysfunction

BACKGROUND

The main cause of early death after heart transplantation (HTx) is so-called early primary or secondary graft failure (GF). The risk of profound GF has not declined in the past decade, as the consequence of the liberalisation of donor acceptance criteria because of the scarcity of donors. It is therefore important to try to diagnose graft failure and recognise the mechanisms of early graft dysfunction.

AIM

To establish haemodynamic and echocardiographic criteria of early GF to define patients who should be considered for assist device support or re-transplantation.

METHODS

Between January 2000 and March 2009, 116 HTx patients were studied. On the basis of echocardiography and continuous invasive monitoring, three groups were identified: (1) The true graft failure group (GF) consisted of 46 patients; (2) The latent right ventricular (RV) dysfunction group (RV-D) consisted of 25 patients with small left ventricular (LV) chamber (〈 39 mm) and RV ejection fraction (RVEF) 〈 50%; (3) The control group consisted of 45 consecutive HTx patients without any haemodynamic complications.

RESULTS

Postoperatively, only the GF group required large doses of norepinephrine (〉 0.3 μmg/kg/min) and inhalative NO (40 ppm). Nevertheless, right and left filling pressures were significantly higher than in the controls (right 12 ± 3.6 vs. 9.0 ± 2 and left atrial pressure 13.0 ± 3.2 vs. 9.6 ± 2 mm Hg, both p 〈 0.001). Cardiac index was significantly smaller (2.9 ± 0.7 vs. 3.7 ± 0.9, p 〈 0.001) but neither pulmonary artery pressure (29.5 ± 6 vs. 29.7 ± 7 mm Hg) nor transpulmonary gradient (6 ± 5 vs. 5.1 ± 5 mm Hg) nor pulmonary vascular resistance (273 ± 97 vs. 287 ± 144 dyn × s × cm-5) differed significantly from those of the control group. In the GF group, LV end diastolic dimension (LVEDD) was significantly smaller and function poorer than in controls (39.8 ± 5 vs. 44.4 ± 5 mm, respectively, p = 0.001). RV function was also significantly worse (RVEF 42.2 ± 14% vs. 56.0 ± 9%), respectively, p = 0.001), whereas RV dimension did not differ significantly. Mechanical support after failure of the initial medical treatment was necessary in 37% of patients; 29 (63.0%) patients from the GF group died, the cause of death being sepsis with multi-organ failure. In the RV-D group, remodelling was quite similar but LVEF was excellent and maximal systolic velocity from the posterior wall was significantly higher than in GF. No death occurred.

CONCLUSIONS

True early GF represents a grave haemodynamic situation with high mortality. Bedside echocardiography helps to distinguish between latent RV dysfunction and true GF.

Spatial trade-offs in the digestive and reproductive systems of grape phylloxera

Trade-offs between reproduction and other energy-requiring activities are present in insects. However, feeding and reproduction are not often thought to be trade-offs, although in small insects space may be limiting for both ingestion of food and egg development. This study characterised the structure of the digestive system of radicicolae Daktulosphaira vitifoliae (Hemiptera: Phylloxeridae) to investigate how feeding and egg development occur in this species. Using light and electron microscopy, the midgut of D. vitifoliae was observed to be composed of anterior and posterior regions, separated by a hindgut connection. The midgut is compressed during the development of parthenogenetically produced eggs in adults; individual eggs are ~30% of the adult length and in volume internally occupy 3–5% of the body cavity. The midgut posterior chamber is suggested to be essential for the continual supply of energy during periods of reduced food intake. The presence of the hindgut and an anal opening indicated that waste excretion through the anus was physiologically possible, although honeydew excretion was not observed. The structure of the digestive system of radicicolae D. vitifoliae is atypical, containing adaptations that may assist the survival of the monophagous insect during dispersal events to a new Vitis food source.

Osteomyelitis of the sustentaculum tali in horses: 10 cases (1992-1998)

OBJECTIVE

To determine outcome of horses with osteomyelitis of the sustentaculum tali (ST), with or without associated tarsal sheath tenosynovitis, following surgical debridement and lavage.

DESIGN

Retrospective study.

ANIMALS

10 horses in which a diagnosis of osteomyelitis of the ST had been made on the basis of history, physical examination findings, and results of radiography.

PROCEDURE

Information on results of diagnostic testing, surgical findings, postoperative treatment, and short-term outcome was obtained from the medical records. Long-term follow-up information was obtained through reevaluation of horses at the teaching hospital and telephone conversations with referring veterinarians, owners, and trainers.

RESULTS

Treatment consisted of surgical debridement, intra- and postoperative lavage, and long-term antimicrobial and anti-inflammatory treatment. Eight horses had evidence of involvement of the tarsal sheath. One horse was euthanatized after surgery because of a lack of response to treatment; the other 9 were discharged from the hospital. Severity of lameness had improved, but all still had grade-1 or -2 lameness at the time of discharge. One horse was euthanatized after discharge because of contralateral hind limb laminitis, and another horse was lost to follow-up. Of the remaining 7 horses, 6 returned to their previous use, and 1 was sound but retired for breeding for unrelated reasons.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that horses with osteomyelitis of the ST, with or without concomitant tarsal sheath tenosynovitis, can have an excellent to good outcome and may return to their previous use after surgical debridement of affected tissues and lavage of the tarsal sheath.

[Therapy of dry eye disorders]

BACKGROUND

The treatment of dry eyes with artificial tears often fails. We differentiated the disturbances of the three layers of the tear film in 90 such patients. This showed that only 11.1% had aqueous deficiency, while 42.3% had combined disturbances of different layers of the tear film, and 76.7% had lipid deficiencies.

PATIENTS AND METHODS

We now studied the efficacy of a therapeutic approach, which intended to stabilize each individual deficiency of the three layers of the tear film (follow-up > or = 6 months). The medical history, visual acuity, slit lamp examination, rose bengal stains and fluorescein stains, Schirmer test, break-up time (BUT), dye tests, impression cytology, and lid transillumination were analyzed.

RESULTS

Therapy was beneficial in all patients (n = 90) with regard to the symptoms and the objective parameters. Artificial tears applied strictly were without preservatives. Patients with toxic conjunctivitis induced by high dosages of eye drops were often stabilized through withdrawing the medication. The frequency of applying artificial tears was significantly tapered by punctum plugs and -coagulation. Tarsorrhapies were helpful in the most severe cases. Topical retinoids significantly reduced the symptoms and increased the goblet cell density. Treating chronic blepharitis was very sufficient, when initiated by topical steroids and Tetracycline, and systemical Doxycycline.

CONCLUSIONS

Differentiating the disturbances of the three tear film layers in "sicca syndrome", and stabilizing each component is more effective than artificial tears alone.

Comparative Radiation Death Kinetics of Clostridium botulinum Spores at Low-Temperature Gamma Irradiation

Spores of Clostridium botulinum 33A were irradiated with ⁶⁰Co gamma rays in 0.067 M Sorensen phosphate buffer (pH 7.0) at -196, -140, -80, -30, or 5 C and incubated in recovery broth for 30 days at 30 C, thus simulating an inoculated pack and eliciting "partial spoilage" data. Resistance of the spores decreased linearly with increasing temperature. A simple empirical equation was derived to predict D values for any desired temperature. An Arrhenius plot of the D value-radiation temperature profile indicated that the death kinetics is not first order. Comparison of the data in this model system with those previously observed in beef indicates a similar radiation death pattern, except that resistance of the spores was somewhat more (1.6-fold) temperature dependent, although significantly more resistant, in the beef. A comparison of the D value-temperature relationship of Streptoccus faecium a21, obtained earlier, with strain 33A in the same model system indicated that the spores were considerably less resistant below -20 C and much more resistant above this radiation temperature.

Comparative resistance of nonsporogenic bacteria to low-temperature gamma irradiation

A total of 36 microorganisms, comprising 19 species of 11 genera, were screened for radiation resistance with (60)Co gamma rays at a radiation temperatore of -80 +/- 2 C in phosphate buffer (pH 7.0) under vacuum. Micrococcus radiodurans was the most resistant organism. An initial population of 2.8 x 10(5) cells per dose of this species survived 2.4 but not 2.7 Mrad. Of the remaining 18 species with initial populations of about 10(6) cells per dose, Streptococcus faecium survived 0.9 to 1.5 Mrad, depending on the strain tested. S. faecalis QM survived 0.9 but not 1.2 Mrad. S. faecalis 1539 and Alcaligenes faecallis survived 0.6 but not 0.9 Mrad. Three species of Salmonella, one strain each of Escherichia coli, Streptococcus lactis, and Aerobacter aerogenes survived 0.3 but not 0.6 Mrad. The remaining 22 bacteria did not survive 0.3 Mrad, the lowest dose tested. Detailed survival curve determinations for four strains of S. faecium, the most resistant of the test bacteria of public health significance, indicated the following order of resistance at -80 C: alpha21 > theta12 = F(6) > FEC. Each strain produced two exponential survival curves with different slopes, the breaks occurring at 0.3 to 0.5 Mrad. The D values (doses which reduce the microbial population by 90%) of the more resistant cell fractions were two- to three-fold higher than the more sensitive cell fraction. The resistance of strain alpha21 was determined at different radiation temperature (+5, -30, -80, -140, -196 C). The D value-radiation temperature relationship followed a quadratic equation. Computations of E(a) and Q(10) values (activation energy and temperature coefficient, respectively) showed a very small thermodynamic effect on radiation death. An Arrhenius evaluation of the temperature effect on cell kill indicated that there was no simple physicochemical mechanism which might explain the change in D value as a function of temperature.

Production of types A and B spores of Clostridium botulinum by the biphasic method: effect on spore population, radiation resistance, and toxigenicity

Spores of three strains each of type A and type B Clostridium botulinum were produced both by a biphasic (solid medium overlaid with an aqueous phase) and by a "conventional" (deep broth culture) procedure. Sporogenesis by the biphasic system was more rapid, convenient, and economical, and yielded as many or more heat-resistant (80 C, 10 min) spores per milliliter as by the conventional technique. Of several aqueous phases [thiamine-hydrochloride, yeast extract, (NH(4))(2)SO(4)] tested with strain 62A, the highest spore colony counts were obtained with 2.0% (NH(4))(2)SO(4). The six strains formed maximum spore numbers in 5 to 6 days of incubation. Spores produced by the two methods had essentially equal radiation resistances (D and lag values), and their subcultures gave similar toxin titers (LD(50) values).