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ABSTRACT: This paper reports on an ongoing research collaboration between the University of Padua and the University of California Irvine, on the use of continuous auditory-feedback in robot-assisted neurorehabilitation of post-stroke patients. This feedback modality is mostly underexploited in current robotic rehabilitation systems, that usually implement very basic auditory feedback interfaces. The results of this research show that generating a proper sound cue during robot assisted movement training can help patients in improving engagement, performance and learning in the exercise.
IEEE ... International Conference on Rehabilitation Robotics : [proceedings]. 06/2011; 2011:5975373.
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In Proc. of the Int. Symp. on Application of Biomedical Control Systems to Precision Eng. ISAB 2010, Fukushima, Japan; 01/2010
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ABSTRACT: Patient engagement and effort are thought to be important for maximizing the therapeutic benefit of robot-assisted movement exercise after neurologic injury, but little is understood about how the audio-visual feedback presented during training affects engagement and effort. For the study reported here, we hypothesized that visual distraction would decrease engagement during robot-assisted movement training, but that appropriate auditory feedback would counteract this effect. Non-disabled participants (n = 10) participated in a common therapeutic exercise in which they attempted to track a moving target presented on a computer screen as a robotic exoskeleton compliantly assisted their arm movement. Introducing a simple visual distractor significantly increased both tracking error and the interaction forces between the participants and the robot. Introducing auditory feedback of tracking error reduced the effect of the visual distractor, decreasing tracking error and interaction forces toward normative values. If tracking error is taken as a surrogate measure of participant engagement, these results indicate that the presence of even a modest level of visual distraction in the training environment may decrease engagement, and thus present a hazard to the effectiveness of training. However, providing appropriate task feedback through the auditory system can reduce the effect of visual distractors. Therefore, an integrated design of the audio, visual, and haptic environment is important for optimizing robot-assisted movement training.
Haptic Audio visual Environments and Games, 2009. HAVE 2009. IEEE International Workshop on; 12/2009
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ABSTRACT: Analysing the effectiveness of a surgical procedure is mandatory in every modern health-care system. The aging of the population stresses the need for a good standard of care. This study tests the hypothesis that porthsmouth-physiologic operative severity score for enumeration of morbidity and mortality (P-POSSUM) and colorectal-POSSUM (CR-POSSUM) would be useful clinical auditing tools in colorectal cancer surgery for aged patients.
One hundred and seventy-seven consecutive patients over 70 years of age underwent emergency or elective surgery from January 2003 to December 2005. Demographic, clinical and surgical information, score systems' prediction, complications and 30-day mortality data were prospectively entered in a comprehensive database. The observed over expected morbidity and mortality rate was calculated.
Thirty-day observed mortality was 10.3% (19/177) while P-POSSUM and CR-POSSUM expected mortality were, respectively, 11.21% (P = NS) and 13.08% (P = NS). Overall observed morbidity was 42.7%, P-POSSUM prediction was 59.3% (P = 0.002). Morbidity and mortality data were analysed for specific subgroups of patients (resection and anastomosis/resection and stoma/palliative; emergency/elective).
P-POSSUM and CR-POSSUM are useful tools to predict mortality in elderly patients. P-POSSUM significantly overestimated the risk of complications. A more accurate tool for preoperative assessment for aged patients is probably needed to predict the post-surgical outcome.
Colorectal Disease 10/2009; 11(7):750-5. · 2.93 Impact Factor
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ABSTRACT: Acute pouchitis, an idiopathic inflammatory condition of the ileal pouch anal anastomosis, is the most frequent complication after proctocolectomy for ulcerative colitis.
To test the hypothesis that sulfasalazine (SASP) might have a synergistic beneficial effect in acute pouchitis, by combining the anti-inflammatory activity of 5-aminosalicylic Acid and the bacteriostatic effect of sulphapyridine.
Twenty two patients were investigated for acute pouchitis; the Pouchitis Disease Activity Index (PDAI) was calculated and 11 patients with acute pouchitis (PDAI >7) were included in an open study, after obtaining their informed consent. Patients were treated with SASP 500 mg tablets, two tablets three times per day (3000 mg daily), for 2 months. Pouch endoscopy with biopsies was performed at the entry and at the end of the study.
According to the PDAI score, 8/11 patients (73%) improved their clinical condition and 7/11 (63%) were in remission at the end of the treatment. At 8 weeks, the median PDAI index decreased from 11.2 +/- 2.3 to 6.6 +/- 4.7 P < 0.01. No adverse events or toxicity were reported and all patients completed the study.
Despite the limitations of the current study, sulfasalazine seems to be a potential treatment for acute pouchitis.
Alimentary Pharmacology & Therapeutics 10/2009; 31(2):228-32. · 3.77 Impact Factor
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ABSTRACT: Post-stroke robot-aided neurorehabilitation is an emerging research field, aiming to improve the intensity and the effectiveness of post-stroke rehabilitation protocols by using robotic technology and virtual reality. One classification that has been proposed for therapy robots is between exoskeletons and end-effector based machines. The latter are those devices whose interaction with the patient's arm takes place at the end-effector level. This paper presents the design of two novel end-effector based robots for upper-limb rehabilitation, named Sophia-4 and Sophia-3. Although the devices are based on a common concept (the cable-drive actuation over a planar workspace), the latter differs from the former by the number of employed cables (4 and 3, respectively), and, by several design solutions, such as the introduction of a moving pulley-block to enhance workspace and a tilting table to better target the patient's shoulder. Both mechanical and control system design are addressed and a comparison of performances is presented.
Rehabilitation Robotics, 2009. ICORR 2009. IEEE International Conference on; 07/2009
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ABSTRACT: Sarcomatoid carcinoma is a rare form of primitive carcinoma of the small bowel; it is considered a variant of adenocarcinoma, histologically characterized by a typical biphasic pattern with epithelial- and mesenchymal-like cells. Twenty-one cases have been described in the literature, presenting as small bowel obstructions (twenty cases) or superior vena cava syndrome (one case). The authors report the case of a 56 year-old man on immunosuppressive therapy for a heart transplant, who underwent surgery after a history of repeated episodes of melena, anemization and bowel obstruction. The operation brought to light an intraluminal occlusive mass in the distal ileum, associated with other intraluminal neoplasms of different sizes throughout the small bowel. No evidence of mesenteric adenopathies or hepatic metastases were found. Histological examination and immunohistochemical stain showed an anaplastic sarcomatoid carcinoma. The tumor cells showed strong positivity for cytokeratin and vimentin, and negativity for CD117 and CD34, as well as for all other characteristic markers of mesenchymal tumors. Early diagnosis is usually very difficult, due to the lack of any stereotyped clinical expression and the difficult to study the small bowel. Small-bowel barium follow-through or video capsule endoscopy can be helpful. In most cases, an emergency surgical operation is performed without a clear preoperative diagnosis. The case report is completed by a review of the literature.
Minerva chirurgica 09/2008; 63(4):301-6. · 0.77 Impact Factor
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C Zucchini,
A Biolchi,
P Strippoli,
R Solmi, G Rosati,
M Del Governatore,
E Milano,
G Ugolini,
N Salfi,
A Farina,
A Caira,
S Zanotti,
P Carinci,
L Valvassori
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ABSTRACT: Anal cancer originates from a peculiar histological region and provides a useful model for investigating alterations in proliferation and/or differentiation of neoplastic keratinocytes. Epidermal differentiation complex (EDC) genes, which form one of the major gene clusters in the human genome, are involved in the terminal differentiation of epithelial cells and in many instances have been implicated in epithelial tumours. We constructed a DNA macroarray capable of characterising the expression profiles of the entire EDC gene complex in normal mucosa and anal cancer biopsies of seven unrelated patients. Brain tissue and cultured keratinocytes were used as controls. All anal cancer samples showed expression profiles in which none of the EDC genes was silent, as evaluated by phosphor-imager analysis. Variance analysis showed significantly lower expression of SPRR2 with respect to SPRR1 or SPRR3, and significantly higher expression of S100A8 than of other S100A subfamily members. At hierarchical clustering analysis, the four basaloid anal cancer cases conglomerated in the top five positions. The macroarray method used by us provides the first demonstration of the expression profile of the EDC gene family in anal cancer, and is capable of producing significant information on the subgrouping of epithelial tumours such as anal cancer.
International Journal of Oncology 01/2002; 19(6):1133-41. · 2.40 Impact Factor
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C Zucchini,
P Strippoli, G Rosati,
M Del Governatore,
E Milano,
G Ugolini,
R Solmi,
G Mattei,
A Caira,
S Zanotti,
P Carinci,
L Valvassori
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ABSTRACT: To investigate whether ESE-1 gene abnormalities are involved in alterations of epithelial cell differentiation in squamous anal cancer ESE-1 expression and structure were screened in six patients by reverse transcriptase-polymerase chain reaction (RT-PCR) and automated sequence analysis. The complete cDNA of isoform ESE-1b was always expressed and correctly spliced, with single nucleotide polymorphism being observed in two cases. Presence of ESE-1b point mutations was excluded. Expression of SPRR2A and ENDOA/CK8, two epithelium-specific ESE-1 target genes, were revealed by RT-PCR in all cases. This first report of expression of ESE-1, and of SPRR2A and ENDOA/CK8 (both related to terminal differentiation in different types of epithelia lining) in anal cancer excludes the hypothesis that these genes influenced carcinogenesis in our patients. Despite selecting of patients without clinical evidence of HPV infection, PCR consistently revealed HPV-16 DNA, highlighting the importance of HPV infection in anal cancer.
International Journal of Oncology 09/2000; 17(2):265-70. · 2.40 Impact Factor
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ABSTRACT: The fistulous tracks and abscesses may be related anatomically to the anal sphincters and levator ani muscles. Defining the anatomical relationship between the fistulous lesion and the anal sphincters and/or adjacent organs is essential for correct management. Clinical examination can suggest possible sepsis or the direction of the fistulous track. We report the results of anal endosonography in the evaluation of 54 patients affected by perianal sepsis and fistula in ano. Anal endosonography has correctly identified 22 of 22 internal openings seen at the surgery, 14 of 16 intersphincteric tracts while only 7 of the 9 trans-sphincteric tracks described by anal endosonography were present at the surgery. All the abscesses were correctly identified. Anal endosonography provides a high-resolution image of the anatomy of anal canal and defines the anatomy of tracks and abscesses in relation to the sphincters, determines if there has been trans-sphincteric extension of the sepsis and assesses the state of the sphincters. We have observed a good correlation between the preoperative AES findings and those at surgery. We conclude that anal endosonography is a useful diagnostic procedure in patients with perianal sepsis.
Minerva chirurgica 10/1996; 51(9):653-9. · 0.77 Impact Factor
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ABSTRACT: Local therapy has been widely reported and accepted for benign tumours and carefully selected cancers of the rectum. Thirty-three patients with benign or malignant low rectal tumors have undergone a prospective evaluation after local resection with transanal electroresection as described by Faivre. Patients were divided in three groups: 1) local excision of benign tumours (12 patients), 2) curative resection for localised malignant tumours (7 patients) and 3) palliative local resection for malignant tumours (14 patients). The complications included transient incontinence and rectal bleeding. Patients have been followed for a mean period of 18 months (1-54). In group 3 there were four (28%) recurrences. The remainder of the patients with malignant tumours have been free of disease on follow-up. Although it is ideal for benign neoplasms, further follow-up is needed to determine its true indication in malignant lesions.
International Journal of Colorectal Disease 02/1995; 10(2):112-6. · 2.38 Impact Factor
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S Rivetti,
M Lauriola,
M Voltattorni,
M Bianchini,
D Martini,
C Ceccarelli,
A Palmieri,
G Mattei,
M Franchi,
G Ugolini, G Rosati,
I Montroni,
M Taffurelli,
Rossella Solmi
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ABSTRACT: Cross-Reacting Material 197 (CRM197) is a diphtheria toxin non-toxic mutant that has shown antitumor activity in mice and humans. It is still unclear whether this anti-tumorigenic effect depends on its strong inflammatory-immunological property, its ability to inhibit heparin-binding epidermal growth factor (HB-EGF), or even its possible weak toxicity. CRM197 is utilized as a specific inhibitor of HB-EGF that competes for the epidermal growth factor receptor (EGFR), overexpressed in colorectal cancer and implicated in its progression. In this study we evaluate the effects of CRM197 on HT-29 human colon cancer cell line behaviour and, for CRM197 recognized ability to inhibit HB-EGF, its possible influence on EGFR activation. In particular, while HT-29 does not show any reduction of viability after CRM197 treatment (MTT modified assay), or changes in cell cycle distribution (flow cytometry), in EGFR localization, phospho-EGFR detected signals (immunohistochemistry) or in morphology (scanning electron microscopy, SEM) they show a change in the gene expression profile by microarray analysis (cDNA microarray SS-H19k8). The overexpression of genes like protein phosphatase 2, catalytic subunit, alpha isozyme (PPP2CA), guanine nucleotide-binding protein G subunit alpha-1(GNAI1) and butyrophilin, subfamily 2, member A1 (BTN2A1) has been confirmed with real-time-qPCR. This is the first study where the CRM197 treatment on HT-29 shows a possible scarce implication of endogenous HB-EGF on EGFR expression and cancer cell development. At the same time, our results show the alteration of a specific and selected number of genes.
International journal of immunopathology and pharmacology 24(3):639-49. · 2.99 Impact Factor
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ABSTRACT: We discuss a case of a giant renal angiomyolipoma. A 28 year-old woman presented with a history of a painless and swelling abdominal mass. A computerized tomography (CT) scan of the abdomen demonstrated a 27 x 13 x 11 cm tumor in the right retroperitoneum. At laparotomy, a wide excision of the mass was performed and the histopathological examination of the resected specimen revealed the presence of an angiomyolipoma. The clinical, radiological and pathological findings of this case are reported with a review of the literature.
Hepato-gastroenterology 46(25):182-4. · 0.66 Impact Factor
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ABSTRACT: Metastasis are the most common malignant lesions of the liver. Liver is the most common site of visceral metastasis from colo-rectal carcinoma. Only in few patients are the lesions surgically resectable for cure and standard intravenous chemotherapy produces a low response rate. An intrahepatic arterial device for regional chemotherapy is an effective and safe alternative for unresectable liver metastasis from colorectal carcinoma, with a significant improvement on response rates compared with conventional i.v. chemotherapy; a longer survival is also reported in patients receiving intrahepatic therapy, even if the difference is not statistically significant. The catheter is inserted through the gastro-duodenal artery and the reservoir is placed in a subcutaneous pocket on the anterior thoracic wall. The Authors discuss indications, implantation technique and complications. Intra-arterial chemotherapy is administered in ambulatorial regimen and scintigraphic scanning and/or epatic ultrasonography are performed every three months to evaluate response rate. Median survival is variable from 12 to 17 months in the different series with response rates (disappeared metastases or tumor-mass reduction over 50%) of 48%-62%. The increased tumor responses reported together with a lower systemic toxicity (compared with systemic therapy) suggest that intra-arterial chemotherapy is a reliable and well tolerated treatment.
Annali italiani di chirurgia 65(3):359-63. · 0.23 Impact Factor
