Complete Immobility Research Articles

Enhancing regenerative potential: A comprehensive review of stem cell transplantation for sports-related neuronal injuries, with a focus on spinal cord injuries and peripheral nervous system damage

Neuronal injuries, as one of the consequences of sports-related incidents, exert a profound influence on the athletes' future, potentially leading to complete immobility and impeding their athletic pursuits. In cases of severe damage inflicted upon the spinal cord (SC) and peripheral nervous systems (PNS), the regenerative process is notably compromised, rendering it essentially inefficient. Among the pivotal therapeutic approaches for the enhancement and prevention of secondary SC injuries (SCI), stem cell transplantation (SCT) stands out prominently. Stem cells, whether directly involved in replacement and reconstruction or indirectly through modification and secretion of crucial bioenvironmental factors, engage in the intricate process of tissue regeneration. Stem cells, through the secretion of neurotrophic factors (NTFs) (aiming to modulate the immune system), reduction of inflammation, axonal growth stimulation, and myelin formation, endeavor to facilitate the regeneration of damaged SC tissue. The fundamental challenges of this approach encompass the proper selection of suitable stem cell candidates for transplantation and the establishment of an appropriate microenvironment conducive to SC repair. In this article, an attempt has been made to explore sports-related injuries, particularly SCI, to comprehensively review innovative methods for treating SCI, and to address the existing challenges. Additionally, some of the stem cells used in neural injuries and the process of their utilization have been discussed.

Restricted cusp motion in newly implanted tricuspid bioprostheses: Incidence, predictors, and impact on survival

ObjectiveTo investigate the occurrence of restricted cusp motion (RCM) at the time of bioprosthetic tricuspid valve replacement (TVR) and analyze associated risk factors and outcomes. MethodsThis study involved adult patients who underwent TVR with a bioprosthesis at our institution between 2012 and 2022. Bioprosthetic cusp motion was analyzed de novo through a detailed review of intraoperative transesophageal echocardiograms (TEE). Two models of porcine valves were implanted: the Medtronic Hancock II bioprosthesis and the St Jude Medical Epic bioprosthesis. ResultsAmong the 476 patients who met the inclusion criteria, RCM was identified on immediate post-bypass TEE in 150 (31.5%); there was complete immobility of the cusp in 63 patients (13.2%) and limited movement of a cusp in 87 patients (18.3%). In a multivariable logistic regression analysis, the Hancock II model (odds ratio [OR], 6.15; P < .001), a larger orifice area (per IQR increase: OR, 1.58; P = .017), a smaller body surface area (per IQR increase: OR, .68; P = .040), and a lower ejection fraction (per IQR increase: OR, .60; P = .033) were independently associated with having RCM. Cox regression adjusting for 15 covariates revealed that RCM at the time of TVR was independently associated with an increased risk of mortality (hazard ratio, 1.35; P = .049). ConclusionsThis study revealed a high incidence of RCM in bioprosthetic valves in the tricuspid position detected shortly postimplantation, which was associated with increased late mortality. To reduce the probability of RCM, it is important to select the appropriate prosthesis model and size, particularly in small patients.

Tongue flicking heralds flight behaviour following passive antipredator displays in dice snakes

AbstractWhen captured, many prey respond by biting the predator or struggling to get free. However, one indirect escape option is death feigning (DF), in which complete immobility supposedly “tricks” the predator into abandoning its meal. But lying motionless and exposed to a predator is dangerous; therefore, individuals should optimize DF occurrence and duration. We captured colour polymorphic dice snakes (Natrix tessellata, Natricidae) (N = 271) in the field and measured two behavioural responses: (1) the occurrence and duration of immobility/DF; (2) the number of tongue‐flicking sequences (TF). Tongue flicking is an essential component of a key sensory mechanism to check the safety of the environment before attempting escape. We experimentally assessed the relationship between these two behaviours and the effects of phenotypic characteristic of snakes on the occurrence and duration of immobility and of TF. Snake phenotype had multiple effects. Gravid females avoided DF and displayed more TF sequences during the tests compared to non‐gravid females and males. Blotched snakes stayed immobile longer than green and melanistic snakes. Larger individuals remained in DF for longer and showed fewer TF sequences than smaller individuals. Snakes burdened with a recent meal postponed fleeing and displayed more TF sequences than snakes without food. Finally, snakes showing more TF sequences postponed fleeing, which suggests that dice snakes assessed predatory risks and adapted escape behaviour to their risk status. Future studies should examine how individuals estimate the appropriate timing to shift from immobility to escape.

Fracton Self-Statistics.

Fracton order describes novel quantum phases of matter that host quasiparticles with restricted mobility and, thus, lies beyond the existing paradigm of topological order. In particular, excitations that cannot move without creating multiple excitations are called fractons. Here, we address a fundamental open question-can the notion of self-exchange statistics be naturally defined for fractons, given their complete immobility as isolated excitations? Surprisingly, we demonstrate how fractons can be exchanged and show that their self-statistics is a key part of the characterization of fracton orders. We derive general constraints satisfied by the fracton self-statistics in a large class of Abelian fracton orders. Finally, we show the existence of nontrivial fracton self-statistics in some twisted variants of the checkerboard model and Haah's code, establishing that these models are in distinct quantum phases as compared to their untwisted cousins.

Rheumatoid Arthritis Has Won the Battle but Not the War: How Many Joints Will We Save Tomorrow?

Rheumatoid arthritis refers to joint diseases of unclear etiology whose final stages can lead to unbearable pain and complete immobility of the affected joints. As one of the most widely known diseases of the joints, it serves as a study target for a large number of research groups and pharmaceutical companies. Modern treatment with anti-inflammatory drugs, including janus kinase (JAK) inhibitors, monoclonal antibodies, and botanicals (polyphenols, glycosides, alkaloids, etc.) has achieved some success and hope for improving the course of the disease. However, existing drugs against RA have a number of side effects which push researchers to elaborate on more selective and effective drug candidates. The avant-garde of research, which aims to develop treatment of rheumatoid arthritis using antisense oligonucleotides along with nonsteroidal drugs and corticosteroids against inflammation, increases the chances of success and expands the arsenal of drugs. The primary goal in the treatment of this disease is to find therapies that allow patients with rheumatoid arthritis to move their joints without pain. The main purpose of this review is to show the victories and challenges for the treatment of rheumatoid arthritis and the tortuous but promising path of research that aims to help patients experience the joy of freely moving joints without pain.

Similarly slow diffusion of BAM and SecYEG complexes in live E. coli cells observed with 3D spt-PALM

The β-barrel assembly machinery (BAM) complex is responsible for inserting outer membrane proteins (OMPs) into the Escherichia coli outer membrane. The SecYEG translocon inserts inner membrane proteins into the inner membrane and translocates both soluble proteins and nascent OMPs into the periplasm. Recent reports describe Sec possibly playing a direct role in OMP biogenesis through interactions with the soluble polypeptide transport-associated (POTRA) domains of BamA (the central OMP component of BAM). Here we probe the diffusion behavior of these protein complexes using photoactivatable super-resolution localization microscopy and single-particle tracking in live E. coli cells of BAM and SecYEG components BamA and SecE and compare them to other outer and inner membrane proteins. To accurately measure trajectories on the highly curved cell surface, three-dimensional tracking was performed using double-helix point-spread function microscopy. All proteins tested exhibit two diffusive modes characterized by “slow” and “fast” diffusion coefficients. We implement a diffusion coefficient analysis as a function of the measurement lag time to separate positional uncertainty from true mobility. The resulting true diffusion coefficients of the slow and fast modes showed a complete immobility of full-length BamA constructs in the time frame of the experiment, whereas the OMP OmpLA displayed a slow diffusion consistent with the high viscosity of the outer membrane. The periplasmic POTRA domains of BamA were found to anchor BAM to other cellular structures and render it immobile. However, deletion of individual distal POTRA domains resulted in increased mobility, suggesting that these domains are required for the full set of cellular interactions. SecE diffusion was much slower than that of the inner membrane protein PgpB and was more like OMPs and BamA. Strikingly, SecE diffused faster upon POTRA domain deletion. These results are consistent with the existence of a BAM-SecYEG trans-periplasmic assembly in live E. coli cells.

Safety and effectiveness of the combination of remimazolam tosilate and propofol in gastroscopy: a multicenter, randomized controlled, single-blind clinical trial.

Remimazolam tosilate (RT) is a new short-acting γ-aminobutyric acid A (GABAA) receptors agonist. However, its optimal use mode and dosage still remain unclear. This study aimed to examine the safety and effectiveness of the combination of RT and propofol in gastroscopy. This was a prospective, single-blind, randomized, multicenter, parallel-group study. All eligible 256 patients were randomized into the following 3 groups. Patients were anesthetized with propofol (Group P), RT (Group R) or the combination of RT and propofol (Group RP). The primary efficacy endpoints were: body movement score; satisfaction of gastroscopy doctors; success rate of sedation and effects on sleep status. Sedation induction time, time to be fully alert and adverse events were also recorded. The probability of complete immobility was lower in group R (33.73%) than in group P (86.67%) and RP (83.13%). The rate of doctors' satisfaction was much lower in group R (28.92%) than in group P (77.78%) and RP (72.29%). The success rate of sedation and sleep outcome score has no difference in the three groups. The time to adequate sedation was longer in group RP (77.27 ± 18.63s) than in group P (64.47 ± 24.36s), but much shorter than that in group R (102.84 ± 46.43s). The time to be fully alert was shorter in group R (6.30 ± 1.52min) and RP (6.54 ± 1.13min) than in group P (7.87 ± 1.08min). The proportion of sedative hypotension was significantly higher in group P (41.11%) than in group R (1.20%) and group RP (3.61%) (p < 0.001). The incidence of respiratory depression was much higher in group P (17.78%) than in group R (no patient) and group RP (1.2%). The incidence of adverse events was lower in groups R (4.82%) and RP (9.64%) than in group P (31.11%). The combination of RT and propofol takes effect quickly, makes patients alert quickly, provides a sufficient depth of sedation, reduces body movement, does not inhibit circulation and respiratory function, does not affect sleep, and is the preferred mode for gastroscopy doctors and anesthesiologists.

Uloga gena modifikatora na klinički tok Dišenove mišićne distrofije

Duchenne muscular dystrophy is the most common inherited muscle disease in childhood, which has a progressive clinical course with a fatal outcome that most often occurs between the second and fourth decade of life. The disease is inherited X-linked, recessively, and in two-thirds of patients, it is transmitted from the mother, while in the remaining third of patients, it is a de novo mutation. Mutations in the dystrophin gene (DMD gene) such as deletions, duplications and small mutations can be found throughout the entire length of the gene. The disease begins between the third and fifth year of life, and the initial muscle weaknesses are clinically manifested as slower running, difficulty climbing stairs or difficulty getting up from squats. Sometimes, accidentally discovered, elevated keratin kinase values or delayed early psychomotor development milestones in a child with hypertrophic calves can initiate a diagnostic procedure in the direction of Duchenne muscular dystrophy. The disease usually has a uniform clinical course and implies a clear time sequence of events. Muscle weakness leads to loss of ambulation, then the function of the upper extremities, to complete immobility, with the evolution of dilated cardiomyopathy and respiratory insufficiency, which are the main causes of death. Certain patients show deviations from the above in terms of longer functionality and later loss of independent ambulation, later cardiomyopathy and respiratory insufficiency and vice versa. It is believed that in addition to the application of modern standards of care and treatment of patients, the clinical course is influenced by genes independent of the causal DMD gene, which affects processes in dystrophic muscle, primarily inflammation, fibrosis and fatty infiltration, through specific signaling pathways. So far, six genes have been described whose variants modify the course of Duchenne muscular dystrophy. The secreted phosphoprotein 1 (SPP1) is the first described gene whose G allele in the variant rs28357094 is associated with an earlier age of gait loss. In addition, variants in the genes described are LTBP4 (latent transforming growth factor-b binding protein 4), CD40, ACTN3 (actinin 3), THBS1 (thrombospondin 1) and TCTEX1D1 (Tctex1 domain containing 1). The aim of this paper is to present already-known genes that modify Duchenne muscular dystrophy and their influence on the clinical course of the disease.

Oral health and oral health-related quality of life in patients with chronic peripheral facial nerve palsy with synkineses-A case-control-study.

Facial nerve palsy (FP) is the most common cranial nerve lesion, leading to partial or complete immobility of the affected half of face. If food residues on tooth surfaces cannot be removed by natural self-cleaning mechanisms that this is likely to lead to an increase dental plaque formation and the risk of dental, periodontal and general diseases. It was the aim of this study to assess oral health, oral hygiene with the influence of handedness and oral health related quality of life in patients with chronic peripheral FP. This study included 86 people. Patients with FP (n = 43) in an FP-group (FPG) were matched with 43 participants without ever diagnosed FP in a control group (CG). Oral health and oral hygiene were assessed in a clinical examination performed in hospital. Decayed-missing-filled-teeth-index, periodontal-screening-index, approximal plaque index and sulcus bleeding index were used to evaluate dental caries and periodontal health status. Oral health-related quality of life data (OHQoL) was collected with the Oral health impact profile (Germany-14) by interview. Oral health parameters in the FPG were significantly worse than in the CG. The median revealed 14.3% more proximal plaque (p = 0.014), 20.8% more sulcus bleeding (p = 0.002) and more than twice as much caries (p = 0.024). The paretic side compared to the non-paretic side of patients was significantly more affected by inflammatory periodontal diseases (p = 0.032) and had a higher prevalence of caries (p = 0.163). Right-handed patients with right-sided FP performed worse than right-handed patients with left-sided FP (p = 0.004). Patients with FP described a greater limitation of OHQoL than patients without this disease (p &lt; 0.001). In conclusion, facial nerve palsy affects oral health, oral hygiene and OHQoL of patients while handedness influences oral hygiene and oral health.

The effects of red LED light on pig sperm function rely upon mitochondrial electron chain activity rather than on a PKC-mediated mechanism.

While irradiation with red LED light has been reported to modulate sperm function in different mammalian species, the mechanisms underlying their response are poorly understood. This work sought to provide new insights into whether this effect relies on a direct action upon mitochondrial electron chain and/or on PKC-linked mechanisms such as those related to opsins. For this purpose, pig semen was light-stimulated for 1, 5 or 10 min in the presence/absence of antimycin A, an inhibitor of the mitochondrial electron chain, or PKC 20–28® (PKCi), a PKC inhibitor. Antimycin A completely blocked the effects of light at all the performed irradiation patterns. This effect was linked to a complete immobility of sperm, which was accompanied with a significant (p < 0.05) drop in several markers of mitochondrial activity, such as JC-1 staining and O2 consumption rate. Antimycin A, however, did not affect intracellular ATP levels, intramitochondrial calcium, total ROS, superoxides or cytochrome C oxidase (CCO) activity. In the case of PKCi, it did also counteract the effects of light on motility, O2 consumption rate and CCO activity, but not to the same extent than that observed for antimycin A. Finally, the effects observed when sperm were co-incubated with antimycin A and PKCi were similar to those observed with antimycin A alone. In conclusion, red LED light acts on sperm function via a direct effect on mitochondrial electron chain. Additionally, light-activated PKC pathways have a supplementary effect to that observed in the electron chain, thereby modulating sperm parameters such as motility and CCO activity.

Clinical Predictors of Postintubation Bilateral Vocal Fold Immobility.

Introduction Iatrogenic bilateral vocal fold immobility (BVFI) often arises from posterior glottic stenosis (PGS) after endotracheal intubation, whereby posterior commissure mucosal disruption leads to fibrosis and ankylosis of the cricoarytenoid joints. Sequelae can be devastating, resulting in dyspnea, stridor, and death due to asphyxiation. Objectives We sought to review features associated with PGS to better understand how to prevent this condition. A secondary aim is to analyze factors correlating to tracheostomy dependence. Methods Charts from January 2010 to November 2020 were retrospectively reviewed, and adult patients with the diagnosis of BVFI after intubation were included. Data on comorbidities, duration of intubation, laryngoscopy, and decannulation status was analyzed. Results Out of the 68 patients included in the present study, 60.3% were male, and the mean duration of intubation 14.3 ± 8.5 days. A total of 94% of the patients were intubated for at least 7 days, diabetic, and/or obese. Although association with prolonged intubation >7 days was not significant ( p = 0.064), complete BVFI on fiberoptic exam ( n = 47) was significantly associated with tracheostomy dependence both in the entire cohort ( p = 0.036) and in the 56 patients with tracheostomy ( p = 0.0086). Patients without cardiovascular disease (CVD) were less likely to be tracheostomy dependent compared with those with CVD (odds ratio [OR]: 0.23 [0.053-0.79]; p = 0.028). Conclusions We identified duration of intubation, DM, and obesity as potential risk factors for PGS. Complete immobility and CVD were significantly associated with tracheostomy dependence. Our findings may have important implications for earlier tracheostomy in high-risk intubated patients, as well as for closer monitoring of disease progression and earlier intervention in those predisposed to tracheostomy dependence.

Comparison of two pharmacokinetic–pharmacodynamic models of rocuronium bromide during profound neuromuscular block: analysis of estimated and measured post-tetanic count effect

BackgroundProfound neuromuscular block (NMB) is important in surgeries where complete immobility is considered essential to improve tracheal intubation and surgical conditions. Rocuronium bromide is a commonly used NMB agent. This work describes a noninvasive approach for estimation of post-tetanic count (PTC) based on two pharmacokinetic (PK) models, the Saldien and the De Haes models. The aim was to investigate the rocuronium bromide PK–pharmacodynamic (PD) relationship in estimating the PTC effect during profound NMB. MethodsIn this prospective, non-randomised, observational study, an induction bolus of rocuronium bromide was administered followed by continuous infusion for maintenance of a PTC of 1-2. measured every 3 min. Measurements were analysed as discrete categorical data and by applying the nonlinear mixed-effect modelling approach. Performance of the selected models was evaluated through simulation model-based diagnostics, further assessing the precision of the parameter estimates and the performance of the models at the individual level. ResultsData from 30 adult patients undergoing elective abdominal or neurosurgical procedures were included. Post-tetanic count response profiles during rocuronium bromide infusion were successfully characterised using the population PD analysis. The models showed a good performance for all PTC categories, albeit with a moderate over-prediction of PTC >6. ConclusionsOur findings indicate that using plasma concentrations of rocuronium bromide estimated with either of the two models, combined with a PD model, provides equal model performance when predicting PTC. These promising results may provide an important advance in guiding rocuronium bromide administration when profound NMB in routine clinical practice is desired.

Physiological Responses to In-Bed Cycle Ergometry Treatment in Intensive Care Unit Patients with External Ventricular Drainage.

PurposeEvidence suggests that early physical activity can be accomplished safely in the neurocritical care unit (NCCU); however, many NCCU patients are often maintained in a state of inactivity due to impaired consciousness, sensorimotor deficits, and concerns for intracranial pressure elevation or cerebral hypoperfusion in the setting of autoregulatory failure. Structured in-bed mobility interventions have been proposed to prevent sequelae of complete immobility in such patients, yet the feasibility and safety of these interventions is unknown. We studied neurological and hemodynamic changes before and after cycle ergometry (CE) in a subset of NCCU patients with external ventricular drains (EVDs).MethodsPatients admitted to the NCCU who had an EVD placed for cerebrospinal fluid drainage and intracranial pressure (ICP) monitoring underwent supine CE therapy with passive and active cycling settings. Neurologic status, ICP and hemodynamic parameters were monitored before and after each CE session.ResultsTwenty-seven patients successfully underwent in-bed CE in the NCCU. No clinically significant changes were recorded in neurologic or in physiological parameters before or after CE. There were no device dislodgements or other adverse effects requiring cessation of a CE session.ConclusionThese data suggest that supine CE in a heterogeneous cohort of neurocritical care patients with EVDs is safe and tolerable. Larger prospective studies are needed to determine the efficacy and optimal dose and timing of supine CE in neurocritical care patients.

Computer tomography‐assisted visualization of the movement triggered by frost in Ostrinia nubilalis overwintering in maize stalks

AbstractThe damage of the European corn borer, Ostrinia nubilalis (Hübner) (Lepidoptera: Crambidae), causes is mainly determined by the success of its overwintering. The aim of our study was to assess the consequences of the artificial cooling on the movement and survival ability of overwintering larvae of O. nubilalis by using computer‐assisted tomography. The in situ movement of the examined larvae in icy media of different thickness (5, 15, and 30 cm) and during freezing periods of 5, 10, 20, 40, and 60 min was determined in maize stalks using CT and the positioner‐laser of the CT apparatus. It has been found that the thickness of the ice had a significant effect on the displacement of the overwintering larvae, however, the impact of the duration of freezing on the moving of the larvae could not be proven statistically. Enhanced larvae activity due to thinner ice layers (5, 15 cm) were of exponential type, which was more pronounced just prior to the freezing point. In contrast, thicker ice covering (30 cm) caused complete immobility. According to our results, the diapausing larvae were still able to move and albeit it appeared to be capable of surviving the direct impact of extreme cold, it could even leave its overwintering place as a result of low temperature. Furthermore, the maize stalk tissue contributes to the survival‐success of the larvae as it seems to act as a temperature‐buffer moderating the severe impact that low temperature exerts on living tissue.

Choice of anesthetic support components for children during MRI procedures

Introduction. An MRI-scan in early childhood requires anesthesia to create complete immobility of the patient due to the high incidence of artifacts with an MRI duration of 40 to 60 minutes. The purpose of the work is to select the components of anesthetic support in children from one month to three years old with MRI.&#x0D; Materials and methods. The object of the study was 33 patients aged one month to three years with congenital and acquired brain pathology. Anesthetic management intravenous general anesthesia without mechanical ventilation. Anesthesia in 11 (33.3%) patients of group 1 midazolam 0.5% 0.3 mg/kg, in 12 (36.4%) patients of group 2 midazolam 0.5% at a dose of 0.3 mg/kg + ketamine 5% 1.5 mg/kg, and in 10 (30.3%) patients of group 3 midazolam 0.5% at a dose of 0.3 mg/kg + propofol 2 mg/kg.&#x0D; Results. Group 1 patients achieved a sedation level on the RASS scale of 2.2 0.1 points with preservation of sound and tactile sensitivity, spontaneous involuntary movements limbs in 72.7% of cases. Group 2 patients had a lack of motor activity, consciousness - an assessment on the RASS scale 4.6 0.4 points, BIS 59.4 1%, increased in blood pressure by 7.3%, and normal without depression of respiratory function. Group 3 patients required careful titration of each subsequent dose, constant monitoring of breathing and hemodynamics, and, if necessary, maintaining adequate ventilation during the induction stage.&#x0D; Conclusion. The most rational components for anesthesia support in young children during MRI scanning are midazolam solutions at a dose of 0.3 mg/kg and ketamine at 1.5/kg.

Bilateral Temporomandibular Joint Ankylosis with Rare Finding of Odontogenic Keratocyst Extending into Ankylosed Segment: An Anomaly within Anomaly

Temporomandibular joint ankylosis is a pathological condition where the mandible fused to the glenoid fossa by bony and fibrotic tissues, which leads to a restriction of the mouth opening from partial reduction to complete immobility of the jaw. It is most commonly associated with trauma followed by local or systemic infection, tumors or systemic disease such as ankylosing spondylitis, rheumatoid arthritis, or psoriasis. This is a case report of an unusual presentation of bilateral Temporomandibular Joint (TMJ) ankylosis with rare finding of odontogenic keratocyst extending into the ankylosed segment. The CT scan revealed a welldefined with multicystic radiolucency appearance replaced the usual picture of TMJ ankylosis of a radio-opaque mass obliterating the normal architecture of the joint. Surgical exploration revealed cystic cavity filled with cheesy material within the ankylosed mass on right side of TMJ.

Smart Wheelchair Controls System Using Intelligent Algorithm and Biosensor Signal

Introduction Quadriplegia caused by spinal cord injury can occur in people of any age range and can be caused by any etiology (traumatic or no traumatic) and directly affects both motor and sensory neurological functions. The aim of this research project is developing a control device for an electric wheelchair for mobility of people with spinal cord injury) in closed or controlled environments, with quadriplegia (very limited mobility or complete immobility of upper and lower limbs. Specifically, the system takes the head position data (head tracking) of the user supplied by a webcam and through an application developed on a Raspberry PI3 single board computer finally, the system generates the movement of the wheelchair depending on the position and movement of the user's head through an electromechanical system with servomotors using intelligent algorithm. The system was tested on 10 immobilized people with upper and lower limbs obtaining a learning response between 1 and 5 minutes, the device is fully portable and adaptable to any electric wheelchair with joystick control. The developed device worked successfully and was compared with other head control devices for electric wheelchairs in the current market, it is, economical and versatile non-invasive system as a solution for mobility autonomy for people with quadriplegia. Keywords: Quadriplegia, Spinal Cord Injurie, Head tracking, Raspberry PI3, Joystick, Servomotors, intelligent algorithm Method During the research process, the importance of the assistive devices has been evidenced as a fundamental component of the rehabilitation, autonomy and improvement of the quality of life. More than 90% of people with spinal cord injuries require some type of wheelchair. These chairs should be appropriate for the needs and limitations of patients and to navigate properly in their environment. Other possible needs for assistive technology are home modifications for home control and communication systems for people with quadriplegia.For the development of the prototype, a Raspberry PI3 with 7-inch LCD touch screen was used. The necessary peripherals for the correct operation are connect at development card for the operation of the electric wheelchair control, using algorithms that ensure the correct operation of the device in adverse conditions for the user. In the final phase of development, a user interface was programmed in Python. The software is user friendly and intuitive for quadriplegic users. The system sends the control signal to the motors according to the instructions indicated by the user. The algorithm process the instruction and signal to guarantees the integrity of the user in advance condition. Results and Conclusions Control system for translation devices using cephalic tracking used for mobility of people in tetraplegia or quadriplegia condition is an option for self-mobility and given to the user autonomy and better quality of life in closed or controlled spaces.The tests carried out during the current research resulted in a low rate crash on the way obstacles and low deviation from the original trajectory, less than 7% for a user learning time between 1 and 6 minutes.The proposed system differ from the other cephalic tracking developments reviewed in the state of the art, with effective autonomy by the use of control algorithms References Wolters Kluwer "ISCOS - Textbook on comprehensive management of spinal cord injuries ". Harvinder Singh Chhabra. New Delhi, India. ISBN: 9351294404. 2005.[2] D. J. Kupetz ; S. A. Wentzell ; B. F. BuSha "Head motion controlled power wheelchair". Proceedings of the 2010 IEEE 36th Annual Northeast Bioengineering Conference (NEBEC). 2016. ISSN: 00002013. doi: 10.1109/NEBC.2010.5458224.[3] J Aleksandar Pajkanović , Branko Dokić. "Wheelchair Control by Head Motion". SERBIAN JOURNALOF ELECTRICAL ENGINEERING. Vol. 10 N° 1, pp: 135-151. February 2015. ISSN: 14514869. doi:10.2298/SJEE1301135P[4] Vignesh S.N, Vivek Kumar. A, Bharathi Kannan.K. "Head Motion Controlled Robotic Wheel Chair". International Journal of Emerging Technology and Innovative Engineering. Vol. 1, Ussue 3, pp: 176-179. March 2015. ISSN: 2394 - 6598. Figure 1

Development of temporomandibular ankylosis after diagnosis of Jacob’s disease: clinical and tomographic assessment

Jacob's disease is a rare condition that consists of the formation of a pseudo joint structure between the mandibular coronoid process and the zygomatic bone, resulting in limited mouth opening. The disease is difficult to diagnose and etiology is uncertain. This article describes a clinical case of a 6-year-old child with limited mouth opening, which resulted in the formation of a temporomandibular ankylosis leading to complete immobility due to delayed diagnosis and treatment of the disease. A review of this pathology and the most precise imaging exams are discussed for the early and differential diagnosis of the disease.&#x0D; Descriptors: Ankylosis; Temporomandibular Joint; Temporomandibular Joint Disorders.&#x0D; Referências&#x0D; &#x0D; Wang WH, Xu B, Zhang BJ, Lou HQ. Temporomandibular joint ankylosis contributing to coronoid process hyperplasia. Int J Oral Maxillofac Surg. 2016;45(10):1229-33.&#x0D; Zhong SC, Xu ZJ, Zhang ZG, Zheng YH, Li TX, Su K. Bilateral coronoid hyperplasia (Jacob disease on right and elongation on left): report of a case and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Mar;107(3):e64-7.&#x0D; Coll-Anglada M, Acero-Sanz J, Vila-Masana I, Navarro-Cuéllar C, Ochandiano-Caycoia S, López de-Atalaya J, Navarro-Vila C. Jacob's disease secondary to coronoid process osteochondroma. A case report. Med Oral Patol Oral Cir Bucal. 2011;16(6):e708-10.&#x0D; Yesildag A, Yariktas M, Doner F, Aydin G, Munduz M, Topal U. Osteochondroma of the coronoid process and joint formation with zygomatic arch (jacob disease): report of a case. Eur J Dent. 2010;4(1):91-4. &#x0D; Çorumlu U, Kopuz C, Demir MT, Pirzirenli ME. Bilateral elongated mandibular coronoid process in an Anatolian skull. Anat Cell Biol. 2016;49(3):217-20.&#x0D; Choi JG, Kim SY, Perez-Atayde AR, Padwa BL. Bilateral coronoid process hyperplasia with pseudocartilaginous joint formation: Jacob disease. J Oral Maxillofac Surg. 2013;71(2):316–21.&#x0D; Losa-Muñoz PM, Burgueño-García M, González-Martín-Moro J, Sánchez-Burgos R. Osteochondroma of coronoid process: a rare etiology of jacob disease. Craniomaxillofac Trauma Reconstr. 2014;7(4):306-9. &#x0D; Escuder i de la Torre O, Vert Klok E, Marí i Roig A, Mommaerts MY, Pericot i Ayats J. Jacob's disease: report of two cases and review of the literature. J Craniomaxillofac Surg. 2001;29(6):372-76.&#x0D; Hernández-Alfaro F, Escuder O, Marco V. Joint formation between an osteochondroma of the coronoid process and the zygomatic arch (Jacob disease): report of case and review of literature. J Oral Maxillofac Surg. 2000;58(2):227-32.&#x0D; Sreeramaneni SK, Chakravarthi PS, Krishna Prasad L, Raja Satish P, Beeram RK. Jacob's disease: report of a rare case and literature review. Int J Oral Maxillofac Surg. 2011;40(7):753-57. &#x0D; D'Ambrosio N, Kellman RM, Karimi S. Osteochondroma of the coronoid process (Jacob's disease): an unusual cause of restricted jaw motion. Am J Otolaryngol. 2011;32(1):52-4.&#x0D; Shackelford RT, Brown WH. Restricted jaw motion due to osteochondroma of the coronoid process. J Bone Joint Surg Am. 1949;31A(1):107-14.&#x0D;

Giant Superelastic Piezoelectricity in Flexible Ferroelectric BaTiO3 Membranes

Mechanical displacement in commonly used piezoelectric materials is typically restricted to linear or biaxial in nature and to a few percent of the material dimensions. Here, we show that free-standing BaTiO3 membranes exhibit nonconventional electromechanical coupling. Under an external electric field, these superelastic membranes undergo controllable and reversible "sushi-rolling-like" 180° folding-unfolding cycles. This crease-free folding is mediated by charged ferroelectric domains, leading to giant >3.8 and 4.6 μm displacements for a 30 nm thick membrane at room temperature and 60 °C, respectively. Further increasing the electric field above the coercive value changes the fold curvature, hence augmenting the effective piezoresponse. Finally, it is found that the membranes fold with increasing temperature followed by complete immobility of the membrane above the Curie temperature, allowing us to model the ferroelectric domain origin of the effect.

Comparison of the Effects of Midazolam-Ketamine or Midazolam-Propofol Combinations on Hemodynamic Stability, Patient Comfort, and Post-anesthesia Recovery in Children Undergoing Sedation for Magnetic Resonance Imaging Procedures

BackgroundMagnetic resonance imaging (MRI) requires complete immobility of the subject during the acquisition of each sequence, which is highly important for image quality. MRI may necessitate sedation, particularly in young children and in some adolescent and adult patients, although the ideal sedation procedure leading to minimal side effects with the highest patient comfort in children undergoing MRI procedures remains controversial. The aim of this study was to compare the effects of midazolam-ketamine and midazolam-propofol combinations on hemodynamic stability, patient comfort, and post-anesthesia recovery in pediatric patients undergoing sedation for MRI and also to determine the ideal sedation procedure with minimal side effects.Materials and MethodsThe retrospective study included 40 pediatric patients aged between 2 and 12 years with normal growth and an American Society of Anesthesiology physical status (ASA-PS) 1-2 who were sedated with a combination of midazolam-ketamin or midazolam-propofol for the MRI procedure. The 40 patients were divided into two groups based on the drug combination used for sedation: (I) midazolam-ketamine (M-K) (n = 20) and (II) midazolam-propofol (M-P) (n = 20). Demographic characteristics, duration of MRI procedure, total duration of procedure, MRI image quality, family satisfaction, peripheral capillary oxygen saturation (SpO2), systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and Ramsay Sedation Score (RSS) scores were compared between the two groups.ResultsNo significant difference was detected between the groups with regard to gender, duration of MRI procedure, and total duration of procedure. The MRI scanning quality was very good in 14 (70%) and moderately good in 6 (30%) subjects in the M-K group, whereas the scanning quality was very good in 9 (45%) and moderately good in 11 (55%) subjects in the M-P group. There were significant differences between the two groups at different times in terms of SBP, DBP, and HR values. No complication was observed in any patient and no patient required additional sedation throughout the procedure.ConclusionThe midazolam-ketamine combination provided better hemodynamic stability than the midazolam-propofol combination, although the two combinations were similar with regard to patient comfort and post-anesthesia recovery.