Search Results (127)

Due to its portability, non-invasiveness, and real-time capabilities, ultrasound imaging has been widely adopted for liver disease detection. However, conventional ultrasound examinations heavily rely on operator expertise, leading to high workload and inconsistent imaging quality. To address these challenges, we propose a Robotic Ultrasound Scanning System (RUSS) based on reinforcement learning to automate the localization of standard liver planes. It can help reduce physician burden while improving scanning efficiency and accuracy. The reinforcement learning agent employs a Deep Q-Network (DQN) integrated with LSTM to control probe movements within a discrete action space, utilizing the cross-sectional area of the abdominal aorta region as the criterion for standard plane determination. System performance was comprehensively evaluated against a target standard plane, achieving an average Peak Signal-to-Noise Ratio (PSNR) of 24.51 dB and a Structural Similarity Index (SSIM) of 0.70, indicating high fidelity in the acquired images. Furthermore, a mean Dice coefficient of 0.80 for the abdominal aorta segmentation confirmed high anatomical localization accuracy. These preliminary results demonstrate the potential of our method for achieving consistent and autonomous ultrasound scanning. Full article

Background and Objectives: Stroke and hemiplegia disrupts symmetrical activation of skeletal and abdominal muscles, impairing trunk control and functional movement. Although asymmetry is also present in healthy adults, its magnitude and patterns differ with neurological impairment. Understanding trunk muscle symmetry across functional tasks in healthy individuals and patients with stroke is essential for targeted rehabilitation strategies. Materials and Methods: A comparative cross-sectional study was conducted including healthy adults and patients with stroke. Muscle activation symmetry of the rectus abdominis, external oblique, internal oblique, and multifidus was analyzed across four trunk movements: flexion, extension, and lateral flexion to the dominant or non-dominant side. A two-way repeated measures ANOVA examined main and interaction effects of condition, muscle, and group. Results: Trunk muscle symmetry was significantly influenced by the movement conditions, and patterns of change differed between groups. While no consistent differences were observed across muscles, specific interactions revealed condition-dependent variations, particularly between abdominal and deep spinal muscles. Lateral flexion elicited the greatest asymmetry, with distinct response patterns in healthy individuals compared with patients with stroke. Conclusions: This study highlights the importance of addressing movement-specific demands in trunk rehabilitation. Rather than focusing on isolated muscles, interventions should consider the dynamic and condition-dependent nature of symmetry to optimize functional recovery in patients with stroke. Full article

Background/Objectives: Archery is a technical sport involving repetitive and asymmetrical movements that requires trunk stability to enable good performance of the upper extremities. Being an asymmetrical sport, imbalances between sides might appear in the abdominal and back muscles. To assess trunk muscle function and symmetry in young competitive archers. Methods: Analyzing pre-season screening evaluation tests from medical files. This included an ultrasound examination of back and abdominal muscles (transverse abdominus and internal oblique) during rest and contraction and trunk muscle clinical strength tests. Results: Data on 15 elite archery athletes (mean age 17.2 (±2.7) years) were included. No athletes reported low back pain. No differences were found between the dominant and non-dominant sides in all outcome measurements (absolute thickness and percentage difference). Internal oblique muscle thickness during rest and contraction for the dominant side was higher in males compared with females (p < 0.05). The back muscles were more symmetrical than the abdominal muscles. Conclusions: Despite the asymmetrical functional demands of sport archery, young athletes displayed trunk muscle symmetry, particularly in their back muscles. While some variability in abdominal muscle asymmetry was observed, these differences were not statistically significant. Full article

Crohn’s disease is a chronic inflammation affecting the gastrointestinal tract. To date, patients are commonly treated with corticosteroids or more aggressive biologics for high-risk subjects. Stem Cell Educator therapy has been successfully utilized to treat patients with type 1 diabetes and other autoimmune conditions. A 78-year-old patient with long-standing Crohn’s disease received one treatment with the Stem Cell Educator therapy, followed by clinical, radiographic, pathological examinations and immune marker testing by flow cytometry. After the treatment with Stem Cell Educator therapy, the patient’s clinical symptoms were quickly improved with normal bowel movements, without abdominal pain or rectal bleeding. Flow cytometry analysis revealed a marked decline in inflammatory markers, such as the percentage of monocyte/macrophage-associated cytokine interleukin-1 beta (IL-1β)⁺ cells, which reduced from 94.98% at the baseline to 18.21%, and down-regulation of the percentage of chemokine CXCL16⁺ cells from 91.92% at baseline to 42.58% at 2-month follow-up. Pathologic examination of the biopsy specimens from colonoscopy five weeks and six months post-treatment showed ileal mucosa with no specific abnormality and no significant inflammation or villous atrophy; no granulomas were identified. A follow-up CT scan four and one-half months post-treatment showed no evidence of the previously seen stenosis of the ilio-colonic anastomosis with proximal dilatation. Stem Cell Educator therapy markedly reduced inflammation in the subject with Crohn’s disease, leading to durable clinical, immunological, radiographic, and pathological improvements. Full article

Continuous monitoring of respiratory patterns is essential for disease diagnosis and daily health care. Contact medical devices enable reliable respiratory monitoring, but can cause discomfort and are limited in some settings. Radar offers a noncontact respiration measurement method for continuous, real-time, high-precision monitoring. However, it is difficult for a single radar to characterize the coordination of chest and abdominal movements during measured breathing. Moreover, motion interference during prolonged measurements can seriously affect accuracy. This study proposes a dual radar system with customized narrow-beam antennas and signals to measure the chest and abdomen separately, and an adaptive dynamic time warping (DTW) algorithm is used to effectively suppress motion interference. The system is capable of reconstructing respiratory waveforms of the chest and abdomen, and robustly extracting various respiratory parameters via motion interference. Experiments on 35 healthy subjects, 2 patients with chronic obstructive pulmonary disease (COPD), and 1 patient with heart failure showed a high correlation between radar and respiratory belt signals, with correlation coefficients of 0.92 for both the chest and abdomen, a root mean square error of 0.80 bpm for the respiratory rate, and a mean absolute error of 3.4° for the thoracoabdominal phase angle. This system provides a noncontact method for prolonged respiratory monitoring, measurement of chest and abdominal asynchrony and apnea detection, showing promise for applications in respiratory disorder detection and home monitoring. Full article

Background/Objectives: Prostate cancer is the most frequent cancer in men, for which Radiotherapy (RT) is used as a radical or post-surgical treatment. Actinic proctitis is one of the most disabling side effects of RT. Intestinal microbiome studies have highlighted the importance of short-chain fatty acids, in particular butyric acid, for their beneficial effects over intestinal epithelial cells. The aim of this prospective study is to evaluate if treatment with micro-encapsulated sodium butyrate (MESB) can reduce the incidence of actinic proctitis during RT in prostate cancer patients. Methods: In total, 122 consecutive patients with prostate cancer treated in Radiotherapy Unit, Centro di Riferimento Oncologico, IRCCS Aviano, were enrolled. Patients received MESB (3 tablets/day) from one week before until four weeks after RT. They completed a diary, tracking daily bowel movements, rectal bleeding, abdominal pain, and perceived health status before, at the end, and one month after RT. Results: Although an improvement in symptoms was observed, when comparing interpatient data before RT vs. one month after the end of RT, statistically significant differences emerged only regarding abdominal pain (94.2% vs. 81.6% vs. 81.6%) (McNemar’s test p < 0.002). Conclusions: MESB appears effective in reducing radiation-induced bowel toxicity during RT, minimizing stool changes, incontinence, and abdominal pain. Although patients’ health perception declined at RT completion, it improved after one month, suggesting MESB may support clinical recovery post-treatment. Full article

Depression, anxiety, and perceived stress are common comorbidities in patients with inflammatory bowel disease (IBD) and may negatively influence the disease course. Likewise, severe IBD may contribute to the development or worsening of psychiatric symptoms. Despite the established relevance of the gut–brain axis and frequent use of psychotropic medications in IBD patients, limited evidence exists regarding the effects of psychiatric treatments on gastrointestinal disease activity. Therefore, the aim of this systematic review is to evaluate the effectiveness of psychiatric therapies on gastrointestinal symptoms and disease activity in patients with IBD. The work was conducted in accordance with PRISMA guidelines. Searches were performed across PubMed, Web of Science, and Scopus up to July 2024. Eligible studies evaluated the effectiveness of psychiatric medications—including antidepressants, antipsychotics, anxiolytics, sedative-hypnotics, mood stabilizers, anticonvulsants, and others—on at least one gastrointestinal outcome in patients with IBD. Outcomes included changes in commonly used clinical and endoscopic scores for Crohn’s disease (CD) and ulcerative colitis (UC), number of bowel movements, stool consistency, presence of blood in stool, severity of abdominal pain, as well as in surrogate markers of disease activity following treatment. Out of 8513 initially identified articles, 22 studies involving 45,572 IBD patients met the inclusion criteria. Antidepressants, particularly bupropion, tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), venlafaxine, and duloxetine, were associated with improvements in IBD activity scores, including Crohn’s Disease Activity Index (CDAI) and Simple Endoscopic Score for Crohn’s Disease (SES-CD) for CD, Mayo score and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) for UC. Case reports highlighted potential benefits of pregabalin and lithium carbonate, respectively, showed by the reduction in clinical and endoscopic score of disease activity for pregabalin and improvement of UC symptoms for lithium carbonate, while topiramate showed limited efficacy. Clonidine and naltrexone determined the reductions in clinical and endoscopic score of disease activity, including CDAI and Crohn’s disease endoscopy index severity score (CDEIS) for CD and Disease Activity Index (DAI) for UC. Despite the limited data and study heterogeneity, antidepressants, naltrexone, and clonidine were associated with improvements in IBD activity. Larger, prospective studies are needed to confirm the therapeutic potential of psychiatric medications in modulating IBD activity and to guide integrated clinical management. Full article

Background and Clinical Significance: Prader–Willi syndrome (PWS) is a rare genetic disease caused by imprinted gene dysfunction, typically involving deletion of the chromosome 15q11.2-q13 region, balanced translocation, or related gene mutations in this region. PWS presents with complex and varied clinical manifestations. Abnormalities can be observed from the fetal stage and change with age, resulting in growth, developmental, and metabolic issues throughout different life stages. Case Presentation: We report the prenatal characteristics observed from the second to third trimester of pregnancy in a neonate with PWS. Prenatal ultrasound findings included a single umbilical artery, poor abdominal circumference growth from 26 weeks, normal head circumference and femur length growth, increased amniotic fluid volume after 30 weeks, undescended fetal testicles in the third trimester, small kidneys, and reduced fetal movement. The male infant was born at 38 weeks of gestation with a birth weight of 2580 g. He had a weak cry; severe hypotonia; small eyelid clefts; bilateral cryptorchidism; low responsiveness to medical procedures such as blood drawing; and poor sucking, necessitating tube feeding. Blood methylation-specific multiple ligation-dependent probe amplification (MS-MLPA) showed paternal deletion PWS. Notably, this case revealed two previously unreported prenatal features in PWS: a single umbilical artery and small kidneys. Conclusions: Through literature review and our case presentation, we suggest that a combination of specific sonographic features, including these newly identified markers, may aid clinicians in the early diagnosis of PWS. Full article

Background: Patients with Crohn’s disease (CD) suffer from a relevant burden of abdominal pain and psychological distress that can aggravate postoperatively. While systematic strategies for postoperative pain management are lacking, the potential benefit of perioperative epidural analgesia (EDA) in CD patients is unclear. Methods: All patients receiving an ileocecal resection due to CD at a tertiary hospital were included. The impact of epidural versus non-epidural analgesia on postoperative pain perception was evaluated by analyzing the numeric rating scale (NRS), analgesic consumption, and clinical outcomes. Results: In this monocentric study, 172 patients receiving ileocecal resection due to CD were included, with 122 receiving EDA. The epidural pain catheters were kept for an average of 4.4 days (±1.3) before being removed. EDA resulted in significantly decreased pain as well as a decreased amount of analgesic consumption (adjuvant analgesics: 16.4% vs. 32%, p = 0.021; strong opioids: 30.3% vs. 72.0%, p < 0.001) at the early postoperative course (1 vs. 3 at rest and 2 vs. 4 movement-evoked, p < 0.001). No difference in pain perception was detected on day 5 between EDA and non-EDA patients. Patients with EDA had a significantly longer length of hospital stay (7.5 versus 6 days, p = 0.002) and an increased intake of weak opioids at discharge (p = 0.024). Conclusions: While EDA in CD patients resulted in significantly decreased pain and decreased amounts of analgesic adjuvants and strong opioids at the early postoperative course, intravenous and oral analgesia provide sufficient postoperative pain control after surgery and earlier patient autonomy. Full article

Background and Clinical Significance: Pylephlebitis is a suppurative thrombophlebitis of porto-mesenteric veins. It is a rare complication of intraabdominal infection or inflammation. Case Presentation: A 46-year-old female patient presented to the Emergency Department (ED) with a three-day history of subfebrile body temperature (37.5 °C) and dull pain in the right lower abdominal quadrant propagating to the left lower quadrant, with frequent bowel movements and liquid stool consistency. Inflammatory markers were elevated. Following transabdominal ultrasound, possible diagnoses were inflammatory changes of the appendix or sigmoid colon. She was given oral antibiotics and discharged home with a surgical follow-up the next morning. The next day, due to the worsening of the symptoms, surgery was performed with no additional imaging studies. Intraoperative findings were diverticulitis of the sigmoid colon with perforation and peritoneal inflammation, and primary anastomosis with a diverting ileosotomy was performed. The patient was discharged from the hospital after seven days with completed antibiotic treatment. Twelve days later, the patient presented to the ED with a two-day fever (38 °C), elevated inflammatory markers and imaging findings consistent with pylephlebitis: complete left portal vein thrombosis, partial thrombosis of the segmental branch of the right portal vein and thrombosis of the inferior mesenteric vein. The administration of anticoagulants and antibiotics started and after nine days she was discharged home. Conclusions: Timely treatment is a necessity in patients with diverticulitis to prevent complications. Furthermore, clinicians and radiologists should be familiar with vascular complications of diverticulitis because their detection and the following treatment can prevent more extensive disease. Full article

Reduced fetal movement (RFM) can indicate that a fetus is at risk, but current monitoring methods provide only a “snapshot in time” of fetal health and require trained clinicians in clinical settings. To improve antenatal care, there is a need for continuous, objective fetal movement monitoring systems. Wearable sensors, like inertial measurement units (IMUs), offer a promising data-driven solution, but distinguishing fetal movements from maternal movements remains challenging. The potential benefits of using linear acceleration and angular rate data for fetal movement detection have not been fully explored. In this study, machine learning models were developed using linear acceleration and angular rate data from twenty-three participants who wore four abdominal IMUs and one chest reference while indicating perceived fetal movements with a handheld button. Random forest (RF), bi-directional long short-term memory (BiLSTM), and convolutional neural network (CNN) models were trained using hand-engineered features, time series data, and time–frequency spectrograms, respectively. The results showed that combining accelerometer and gyroscope data improved detection performance across all models compared to either one alone. CNN consistently outperformed other models but required larger datasets. RF and BiLSTM, while more sensitive to signal noise, offered reasonable performance with smaller datasets and greater interpretability. Full article

Obstructive sleep apnea (OSA) is common among older populations and individuals with cardiovascular diseases. OSA diagnosis is primarily conducted using polysomnography or recommended home sleep apnea test (HSAT) devices. Wireless wearable devices have emerged as promising tools for OSA screening and follow-up. This study introduces a novel automated algorithm for detecting OSA using abdominal movement signals and acceleration data collected by a wireless abdomen-worn sensor (Soomirang). Thirty-seven subjects underwent overnight monitoring using an HSAT device and the Soomirang system simultaneously. Normal and apnea events were classified using an MLP-Mixer deep learning model based on Soomirang data, which was also used to estimate total sleep time (ST). Pearson correlation and Bland–Altman analyses were conducted to evaluate the agreement of ST and the apnea–hypopnea index (AHI) calculated by the HSAT device and Soomirang. ST demonstrated a correlation of 0.9 with an average time difference of 7.5 min, while AHI showed a correlation of 0.95 with an average AHI difference of 3. The accuracy, sensitivity, and specificity of the Soomirang for detecting OSA were 97.14%, 100%, and 95.45% at AHI ≥ 15, respectively. The proposed algorithm, utilizing data from a wireless abdomen-worn device exhibited excellent performance in detecting moderate to severe OSA. The findings underscored the potential of a simple device as an accessible and effective tool for OSA screening and follow-up. Full article

Background/Objectives: Although cultural heritage conservators and restorers face consistent exposure to a multifaceted range of occupational hazards, research on their health remains limited. This systematic review aims to explore and synthesize the prevalence and types of occupational diseases among conservators and restorers of cultural heritage. It also intends to map populations, interventions, contexts and other relevant information to assess the current state of knowledge and identify gaps in the literature on the occupational health of conservation and restoration professionals. Methods: The systematic review followed PRISMA 2020 guidelines and the Cochrane handbook. Eligible studies were identified through comprehensive searches of databases, and inclusion criteria were applied to select relevant articles. The protocol was designed according to PRISMA 2020, Prisma-ScR guidelines and the Cochrane handbook. The searches were conducted on 23 May 2024 in PubMed, Scopus and Web of Science (core collection). The risk-of-bias assessment was performed using the Cochrane method for non-randomized studies (RoBANS). Results: Respiratory symptoms were the most prevalent occupational health issue, affecting 28% of cases. General symptoms and abdominal issues each accounted for 20% and 18%, respectively, while musculoskeletal disorders were reported in 14% of cases, primarily affecting the neck, back, shoulders and wrists due to prolonged static postures and repetitive movements. Dermatological and irritation manifestations were reported in 10% of cases. Additionally, 10% of cases involved specific diseases such as pneumonia and cancer. The risk-of-bias assessment revealed significant methodological heterogeneity, with notable gaps in exposure assessment and disease outcome reporting across studies. Conclusions: This analysis highlights the different health risks faced by conservators and restorers of cultural heritage, underscoring the need for standardized methodologies and prospective studies to increase the data on occupational risks. Full article

Background and Objectives: The aim of this study was to compare the effects of pelvic floor muscle contraction training (PFMCT) using verbal education, digital vaginal palpation (DVP), or perineometer on the common errors made during pelvic floor muscle contraction (PFMC) in women. Materials and Methods: A total of 48 women participated, and they were randomly assigned to three groups (Group I: PFMCT with verbal education, n = 16; Group II: PFMCT with DVP, n = 16; and Group III: PFMCT with perineometer, n = 16). Participants who had not previously received PFMCT were evaluated for pelvic floor muscle strength using the Modified Oxford Scale (MOS), and pelvic floor muscle activation was assessed with electromyographic biofeedback (EMG-BF). Possible errors during pelvic floor muscle contraction (gluteal, adductor and/or abdominal muscle contractions, stop breathing (breath holding), enhanced inhaling, and straining) were evaluated through inspection, palpation, or EMG-BF. After pre-training evaluations, all participants received training on pelvic floor. After this general training, each group received PFMCT using the specific training method for their group. After the training, the same evaluations were repeated. The sessions were conducted one-on-one and lasted for an average of one hour. Results: After the training, MOS values increased in Group II and Group III, while EMG-BF values only increased in Group II (p < 0.05). The number of incorrect movements during PFMC decreased after the training in all three groups (p < 0.05). The abdominal muscle contraction value monitored by EMG-BF only decreased in Group II (p < 0.05). Conclusions: Our study demonstrated that the PFMCT applied using the DVP method was more effective in creating more accurate and stronger muscle contractions and reducing common errors when compared to pre- and post-training values. Significant differences were observed between the groups in terms of performance improvements, with Group II showing the most notable progress. These results support the potential for DVP to yield better outcomes when used in PFMT. Full article

Knowledge of realistic loads is crucial in the engineering design process of medical devices and for assessing their interaction with the spinal system. Depending on the type of modeling, current numerical spine models generally either neglect the active musculature or oversimplify the passive structural function of the spine. However, the internal loading conditions of the spine are complex and greatly influenced by muscle forces. It is often unclear whether the assumptions made provide realistic results. To improve the prediction of realistic loading conditions in both conservative and surgical treatments, we modified a previously validated forward dynamic musculoskeletal model of the intact lumbosacral spine with a muscle-driven approach in three scenarios. These exploratory treatment scenarios included an extensible lumbar orthosis and spinal instrumentations. The latter comprised bisegmental internal spinal fixation, as well as monosegmental lumbar fusion using an expandable interbody cage with supplementary posterior fixation. The biomechanical model responses, including internal loads on spinal instrumentation, influences on adjacent segments, and effects on abdominal soft tissue, correlated closely with available in vivo data. The muscle forces contributing to spinal movement and stabilization were also reliably predicted. This new type of modeling enables the biomechanical study of the interactions between active and passive spinal structures and technical systems. It is, therefore, preferable in the design of medical devices and for more realistically assessing treatment outcomes. Full article