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BackgroundRotator cuff retear (RCR) is one of the main postoperative drawbacks. RCR can be considered a multifactorial issue, which causes are related either to biological than biomechanical factors. The aim of this study was to define the incidence of RCR after surgical treatment at different time points and to identify the main factors influencing the postoperative rotator cuff (RC) healing.MethodsA systematic review and meta-analysis were performed following the PRISMA guidelines. A comprehensive search of the literature was carried out in July 2020, using PubMed and Cochrane Library databases. Only level 1 and 2 clinical evidence studies were included. Studies were included if patients with preoperative repairable full-thickness RC tears were treated surgically, and if studies reported postoperative RCR confirmed by imaging diagnostic. The association between timing of retear and follow-up time points were investigated using an inverse-variance method of pooling data. A subgroup meta-analysis was performed using the DerSimonian and Laird method for the estimation of the between-study variance, i.e., τ2. The association between retear rate after surgery and patients’ age, preoperative tear size, fatty infiltration, postoperative rehabilitation protocol, surgical techniques, and RC repairs was determined by expressing the effect measure in terms of odds ratio (OR) with 95% confidence interval (CI). The Mantel-Haenszel method with 95% CIs was used.ResultsThirty-one articles were included in this study. The percentage of RCR after surgery was 15% at 3 months follow-up, 21% at 3–6 months follow-up, 16% at 6–12 months follow-up, 21% at 12–24 months follow-up, 16% at follow-up longer than 24 months. The main factors influencing RC healing are both patient-related (i.e., age, larger tear size, fatty infiltration) and not patient-related (i.e., postoperative rehabilitation protocol, surgical techniques, and procedures).ConclusionsPostoperative RC healing is influenced by patient-related and non-patient-related factors. Further high-level clinical studies are needed to provide highly relevant clinical results.

Systems for cardiorespiratory monitoring hold tremendous promise for many applications in clinical settings, harsh environments, sports science and telemonitoring. However, the translation in the real world is challenging because it is difficult to develop unobtrusive and comfortable systems with high metrological performance. Recent advances in fiber optic technology in the field of sensing and their application to instrument wearable systems can tackle the main issues in this field. In this work, we focused on the recent advances in cardiorespiratory monitoring of fiber Bragg grating (FBGs) sensors which are one of the most popular sensors based on fiber optic technology. We provide an overview of the FBGs working principle and performance. We also describe the most popular and promising configurations based on FBGs used for cardiorespiratory monitoring.

BackgroundThis study aims to compare conservative versus surgical management for patients with full-thickness RC tear in terms of clinical and structural outcomes at 1 and 2 years of follow-up.MethodsA comprehensive search of CENTRAL, MEDLINE, EMBASE, CINAHL, Google Scholar and reference lists of retrieved articles was performed since the inception of each database until August 2020. According to the Cochrane Handbook for Systematic Reviews of Interventions, two independent authors screened all suitable studies for the inclusion, extracted data and assessed risk of bias. Only randomised controlled trials comparing conservative and surgical management of full-thickness RC tear in adults were included. The primary outcome measure was the effectiveness of each treatment in terms of Constant-Murley score (CMS) and VAS pain score at different time points. The secondary outcome was the integrity of the repaired tendon evaluated on postoperative MRI at different time points. The GRADE guidelines were used to assess the critical appraisal status and quality of evidence.ResultsA total of six articles met the inclusion criteria. The average value of CMS score at 12 months of follow-up was 79.2 ± 13.7 in the surgery group and 72.7 ± 17.2 in the conservative group. The average value of CMS score at 24 months of follow-up was 80 ± 15 in the surgery group and 77 ± 15 in the conservative group. Results showed statistically significant differences between the CMS measured at one year of follow-up in favour of surgical RC repair compared with patients treated conservatively (P= 0.003). No significant differences were demonstrated in terms of CMS at 24 months of follow-up (P= 0.15). The mean of VAS pain score at 12 months of follow-up was 1.4 ± 1.6 in the surgery group and 2.4 ± 1.9 in the conservative group. Quantitative synthesis showed better results in favour of the surgical group in terms of VAS pain score one year after surgery (− 1.08, 95% CI − 1.58 to − 0.58;P ConclusionsAt a 2-year follow-up, shoulder function evaluated in terms of CMS was not significantly improved. Further high-quality level-I randomised controlled trials at longer term follow-up are needed to evaluate whether surgical and conservative treatment provide comparable long-term results.

BackgroundThis study aims (1) to estimate the yearly number of Achilles tendon (AT) surgeries in Italy from 2001 to 2015 based on official hospitalization records; (2) to investigate the eventual presence of geographical variation in equity in access to AT surgery between three macroregions of Italy (North, Center and South); (3) to perform statistical projections of the number of AT procedure volumes and rates based on these data.MethodsWe analysed the National Hospital Discharge records (SDO) maintained at the Italian Ministry of Health for a 15-year period, from 2001 through 2015. These data are anonymous and include the patient’s age (evaluated in the class of age), sex, census region, the region of hospitalization, length of the hospitalization, public or private reimbursement and diagnosis.ResultsDuring the 15-year study period, 118,652 AT repair were performed in Italy, whose peak of incidence was in 2010. More than half of AT repairs was performed in the North of Italy (52.1%), while 27.2% was performed in the South of Italy and 20.6% Center of Italy. The projection model predicted a slight growth of 2.65% in 2025 in comparison with 2015.ConclusionThe current study provides detailed information about the national population-weighted incidence of AT surgery, distribution and projection. The peak of average age was 35–45 year. The majority of AT procedures was performed in the North of Italy. The projection model predicts a slight growth of AT surgery by 2025. Furthermore, this 15-year nationwide registry study shows that the age of incidence of AT injuries shifted from 30 to 40 to 35–45 years compared to the available literature. The higher prevalence of AT surgery was found in men during the working age. Moreover, a low rate of procedures in pediatric and elder age classes was observed.

Low back pain represents a significant socioeconomic burden. Several nonsurgical medical treatments have been proposed for the treatment of this disabling condition. Epidural steroid injections (ESIs) are commonly used to treat lumbosacral radicular pain and to avoid surgery. Even though it is still not clear which type of conservative intervention is superior, several studies have proved that ESIs are able to increase patients’ quality of life, relieve lumbosacral radicular pain and finally, reduce or delay more invasive interventions, such as spinal surgery. The aim of this narrative review is to analyze the mechanism of action of ESIs in patients affected by low back pain and investigate their current application in treating this widespread pathology.

Inappropriate posture and the presence of spinal disorders require specific monitoring systems. In clinical settings, posture evaluation is commonly performed with visual observation, electrogoniometers or motion capture systems (MoCaps). Developing a measurement system that can be easily used also in non-structured environments would be highly beneficial for accurate posture monitoring. This work proposes a system based on three magneto-inertial measurement units (MIMU), placed on the backs of seventeen volunteers on the T3, T12 and S1 vertebrae. The reference system used for validation is a stereophotogrammetric motion capture system. The volunteers performed forward bending and sit-to-stand tests. The measured variables for identifying the posture were the kyphosis and the lordosis angles, as well as the range of movement (ROM) of the body segments. The comparison between MIMU and MoCap provided a maximum RMSE of 5.6° for the kyphosis and the lordosis angles. The average lumbo-pelvic contribution during forward bending (41.8 ± 8.6%) and the average lumbar ROM during sit-to-stand (31.8 ± 9.8° for sitting down, 29.6 ± 7.6° for standing up) obtained with the MIMU system agree with the literature. In conclusion, the MIMU system, which is wearable, inexpensive and easy to set up in non-structured environments, has been demonstrated to be effective in posture evaluation.

This study aims to compare conservative versus surgical management for patients with full-thickness RC tear in terms of clinical and structural outcomes at 1 and 2 years of follow-up.A comprehensive search of CENTRAL, MEDLINE, EMBASE, CINAHL, Google Scholar and reference lists of retrieved articles was performed since the inception of each database until August 2020. According to the Cochrane Handbook for Systematic Reviews of Interventions, two independent authors screened all suitable studies for the inclusion, extracted data and assessed risk of bias. Only randomised controlled trials comparing conservative and surgical management of full-thickness RC tear in adults were included. The primary outcome measure was the effectiveness of each treatment in terms of Constant-Murley score (CMS) and VAS pain score at different time points. The secondary outcome was the integrity of the repaired tendon evaluated on postoperative MRI at different time points. The GRADE guidelines were used to assess the critical appraisal status and quality of evidence.A total of six articles met the inclusion criteria. The average value of CMS score at 12 months of follow-up was 77.6 ± 14.4 in the surgery group and 72.8 ± 16.5 in the conservative group, without statistically significant differences between the groups. Similar results were demonstrated at 24 months of follow-up. The mean of VAS pain score at 12 months of follow-up was 1.4 ± 1.6 in the surgery group and 2.4 ± 1.9 in the conservative group. Quantitative synthesis showed better results in favour of the surgical group in terms of VAS pain score one year after surgery (- 1.08, 95% CI - 1.58 to - 0.58; P 0.001).At a 2-year follow-up, shoulder function evaluated in terms of CMS was not significantly improved. Further high-quality level-I randomised controlled trials at longer term follow-up are needed to evaluate whether surgical and conservative treatment provide comparable long-term results.

Monitoring scapular movements is of relevance in the contexts of rehabilitation and clinical research. Among many technologies, wearable systems instrumented by strain sensors are emerging in these applications. An open challenge for the design of these systems is the optimal positioning of the sensing elements, since their response is related to the strain of the underlying substrates. This study aimed to provide a method to analyze the human skin strain of the scapular region. Experiments were conducted on five healthy volunteers to assess the skin strain during upper limb movements in the frontal, sagittal, and scapular planes at different degrees of elevation. A 6 × 5 grid of passive markers was placed posteriorly to cover the entire anatomic region of interest. Results showed that the maximum strain values, in percentage, were 28.26%, and 52.95%, 60.12% and 60.87%, 40.89%, and 48.20%, for elevation up to 90° and maximum elevation in the frontal, sagittal, and scapular planes, respectively. In all cases, the maximum extension is referred to the pair of markers placed horizontally near the axillary fold. Accordingly, this study suggests interesting insights for designing and positioning textile-based strain sensors in wearable systems for scapular movements monitoring.

Epidural analgesia represents a clinical common practice aiming at pain mitigation. This loco-regional technique is widely used in several applications such as labor, surgery and lower back pain. It involves the injections of anesthetics or analgesics into the epidural space (ES). The ES detection is still demanding and is usually performed by the techniques named loss of resistance (LOR). In this study, we propose a novel soft system (SS) based on one fiber Bragg grating sensor (FBG) embedded in a soft polymeric matrix for LOR detection during the epidural puncture. The SS was designed to allow instrumenting the syringe’s plunger without relevant modifications of the anesthetist’s sensations during the procedure. After the metrological characterization of the SS, we assessed the capability of this solution in detecting LOR by carrying it out in silico and in clinical settings. For both trials, results revealed the capability of the proposed solutions in detecting the LOR and then in recording the force exerted on the plunger.

BackgroundThe purpose of this systematic review and meta-analysis is to compare the conservative and accelerated rehabilitation protocols in patients who underwent arthroscopic rotator cuff repair in terms of clinical outcomes and range of motions at 3, 6, 12, and 24-month follow-up.MethodsAccording to PRISMA guidelines, a systematic review of the literature was performed. For each included article, the following data has been extracted: authors, year, study design, level of evidence, demographic characteristics, follow-up, clinical outcomes, range of motions, and retear events. A meta-analysis was performed to compare accelerated versus conservative rehabilitation protocols after arthroscopic rotator cuff repair. The retear rate, postoperative Constant-Murley score and range of motions at 3, 6, 12, and 24 months of follow-up were the outcomes measured.ResultsThe search strategy yielded 16 level I-II clinical studies. A total of 1424 patients, with 732 patients and 692 in the accelerated and conservative group, were included. The average age (mean ± standard deviation) was 56.1 ± 8.7 and 56.6 ± 9 in the accelerated and conservative group. The mean follow-up was 12.5 months, ranging from 2 to 24 months. The meta-analysis showed no statistically significant differences in terms of retear rate between the groups (P = 0.29). The superiority of the accelerated group was demonstrated in terms of external rotation (P P P ConclusionsNo statistically significant differences in the retear rate among the accelerated and conservative group have been demonstrated. On the other hand, statistically and clinically significant differences were found in terms of external rotation at 3 and 6 months of follow-up in favour of the accelerated group. However, no differences between the two groups were detected at 24 months follow-up.

Strain sensors based on conductive and flexible textiles are gaining great relevance in research applications, rehabilitation, and sports medicine for monitoring human joints movements, thanks to their flexibility, negligible weight, and easy integration into substrates and wearable systems. The purpose of this work was twofold: i) to carry out the static characterization and to analyze the hysteresis of two textile-based strain sensors integrated into a polymeric matrix, and ii) to evaluate the feasibility of these sensors in monitoring scapular movements during bilateral arms abduction-adduction and flexion-extension. Results showed a comparable range of resistance variation at 0-20% strain during static characterization, with a mean absolute gauge factor of 2.65 (sensor A) and 2.12 (sensor B). The maximum hysteresis error was always lower than 31% for sensor A and lower than 27% for sensor B. Both sensors showed promising results in monitoring scapular motion during the two selected single-plane upper limb movements.

Epidural injection represents a widely accepted clinical practice in the management of pain relief caused by musculoskeletal disorders, labour and during surgery. The main purpose of this technique is to mitigate the painful feeling in the affected area by injecting anaesthetics and analgesics in the epidural space (the area between the ligamentum flavum and the dura mater). Correct epidural space detection is still challenging because of the small size, and the failure rate is not negligible. Including the existing techniques employed for identifying the epidural space, loss of resistance (LOR) is the most popular method used in clinical practice. It is based on the LOR feeling experienced by the anesthesiologist when the Tuohy needle moves from the ligamentum flavum to the epidural space due to the different density of these two tissues. In the last decades, several systems have been developed to support clinicians during the procedure. Recently, fiber Bragg grating sensors (FBG) have shown promising results for developing techniques able to detect the LOR. In this study, we proposed a novel FBG-based system for LOR detection during epidural puncture. We instrumented the syringe plunger with a flexible polymeric matrix. To assess its performance in LOR detection, we enrolled five users who performed the epidural procedure using a commercial simulator. The results obtained showed the ability of our system to detect LOR.

Wearable devices are finding their use from activities of daily living to clinical evaluations for monitoring different physiological parameters. Among others, estimation and tracking of limb movements are crucial especially in rehabilitation medicine and in supporting the worker's health. The purpose of this works is to develop and test a wearable system based on an encapsulated conductive sensor, able to track the elbow joint flexion-extension movements, to count the number of movement repetitions, and to estimate the elbow joint angles during the movement. The feasibility assessment of the proposed system has been carried out on 2 healthy volunteers mimicking a rehabilitation task and occupation setting one. A motion capture system has been used as reference system for the elbow movements. Results showed a good agreement between the data collected by the wearable system and the ones provided by the reference one. Indeed, the output of the two systems during the trials was similar, highlighting the capability of the wearable to follow the elbow flexion-extensions. In addition, the two systems tracked the same number of flexion-extensions. Finally, promising results were also obtained in the most challenging task, which is the estimation of the elbow angle. Indeed, the agreement, calculated in terms of mean absolute error, has been always lower than 7.5°.

Early diagnosis can be crucial to limit both the mortality and economic burden of cardiovascular diseases. Recent developments have focused on the continuous monitoring of cardiac activity for a prompt diagnosis. Nowadays, wearable devices are gaining broad interest for a continuous monitoring of the heart rate (HR). One of the most promising methods to estimate HR is the seismocardiography (SCG) which allows to record the thoracic vibrations with high non-invasiveness in out-of-laboratory settings. Despite significant progress on SCG, the current state-of-the-art lacks both information on standardized sensor positioning and optimization of wearables design. Here, we introduce a soft wearable system (SWS), whose novel design, based on a soft polymer matrix embedding an array of fiber Bragg gratings, provides a good adhesion to the body and enables the simultaneous recording of SCG signals from multiple measuring sites. The feasibility assessment on healthy volunteers revealed that the SWS is a suitable wearable solution for HR monitoring and its performance in HR estimation is strongly influenced by sensor positioning and improved by a multi-sensor configuration. These promising characteristics open the possibility of using the SWS in monitoring patients with cardiac pathologies in clinical (e.g., during cardiac magnetic resonance procedures) and everyday life settings.

AIMS: Real-time monitoring of tissue temperature during percutaneous tumor ablation improves treatment efficacy, leading clinicians in adjustment of treatment settings. This study aims at assessing feasibility of ultrasound thermometry during laser ablation of biological tissue using a specific ultrasound imaging techniques based on elastography acoustic radiation force impulse (ARFI). METHODS: ARFI uses high-intensity focused ultrasound pulses to generate ‘radiation force’ in tissue; this provokes tissue displacements trackable using correlation-based ultrasound methods: the sensitivity of shear waves velocity is able to detect temperature changes. Experiments were carried out using a Nd:YAG laser (power: 5 W) in three non-perfused ex vivo pig livers. In each organ, a thermocouple was placed close to the applicator tip (distance range 1.5–2.5 cm) used to record a reference temperature. Positioning of laser applicator and thermocouple was eco-guided. The organ was scanned by an echography system equipped with ARFI; propagation velocity was measured in a region of interest of 1 × 0.5 cm located close to thermocouple, to investigate influence of tissue temperature on shear waves velocity. RESULTS: Shear wave velocity has a very low sensitivity to temperature up to 55–60 °C, and in all cases, velocity is 55–60 °C, velocity shows a steep increment. The system measures a value “over limit”, meaning a velocity > 5 m s(−1). CONCLUSIONS: Ultrasound thermometry during laser ablation of biological tissue based on elastography shows an abrupt output change at temperatures > 55–60 °C. This issue can have a relevant clinical impact, considering tumor necrosis when temperature crosses 55 °C to define the boundary of damaged volume. GRAPHIC ABSTRACT: [Image: see text]

Rotator cuff (RC) disease is a common musculoskeletal disorder of the shoulder entailing pain, with reduced functionality and quality of life. The main objective of this study was to present a perspective of the current scientific evidence about personalized, predictive, participatory, precision, and preventive approaches in the management of RC diseases. The personalized, predictive, participatory, precision and preventive (P5) medicine model is an interdisciplinary and multidisciplinary approach that will provide researchers and clinicians with a comprehensive patrimony of knowledge in the management of RC diseases. The ability to define genetic predispositions in conjunction with the evaluation of lifestyle and environmental factors may boost the tailoring of diagnosis and therapy in patients suffering from RC diseases.

Cardiac radiofrequency ablation (RFA) has received substantial attention for the treatment of multiple arrhythmias. In this scenario, there is an ever-growing demand for monitoring the temperature trend inside the tissue as it may allow an accurate control of the treatment effects, with a consequent improvement of the clinical outcomes. There are many methods for monitoring temperature in tissues undergoing RFA, which can be divided into invasive and non-invasive. This paper aims to provide an overview of the currently available techniques for temperature detection in this clinical scenario. Firstly, we describe the heat generation during RFA, then we report the principle of work of the most popular thermometric techniques and their features. Finally, we introduce their main applications in the field of cardiac RFA to explore the applicability in clinical settings of each method.

BackgroundOur previous study on the 2016/2017 Serie A season showed that a greater likelihood of reaching the top positions in the Italian league “Serie A” seemed to be mainly related to sprint activity, goal attempts, total throws, target shots and assists. Therefore, we aim to evaluate the following season data in the same league to compare, confirm, and improve these results.MethodsThe data of all the matches played during the “Serie A” 2017–2018 season were obtained from the Italian soccer league. The teams’ analysis was performed in terms of total distance covered in km, jogging, running and sprint activities, average speed, and match statistics (total shots, shots on target, goal attempts, assists, turnovers, and steals).ResultsTeams that reached the first four positions revealed a lower percentage of running (65.98 ± 1.51 vs. 66.84 ± 2.18;p p = 0.037) and sprint activities (8.41 ± 1.04 vs. 7.86 ± 0.82;p R = 0.906;p R = 0.850;p ConclusionsOur results suggest that high-level teams have a lower running rate and a higher percentage of jogging and sprinting than other teams.

This work aims at selecting the number and the body location of piezoresistive sensors to instrument wearable systems for respiratory rate (RR) estimation. We tested a novel method based on Principal Component Analysis on 10 healthy male subjects, who were asked to perform six trials on a treadmill (at rest, during walking and low speed running). We monitored RR using both a smart garment composed of six piezoresistive sensors and a flowmeter, used as reference signal. On the basis of the results, we propose the following guidelines: i) breathing assessment at rest requires one sensor, placed on the lower thorax; ii) low speed walking assessment requires three sensors, placed on upper thorax, lower thorax and abdomen; iii) high speed walking and running assessment requires a four-sensor configuration (one sensor placed on the upper thorax, one on the lower thorax and two on the abdomen); iv) an effective assessment can be performed at all speeds using the above-mentioned four-sensor configuration, denoted as General Purpose Configuration.

Among the existing thermal ablation techniques, microwave ablation (MWA) is gaining momentum due to its great potentialities in the treatment of several organs. MWA effectiveness is influenced by several factors, such as ablation system design and patients' anatomical characteristics. The presence of large blood vessel in the proximity of tumor masses dissipates heat by convection (phenomenon known in the literature as heat sink effect). The potential consequence is the risk of incomplete tumor ablation. In this study, we experimentally investigated such phenomenon in ex vivo swine liver during MWA. The blood vessel was mimicked through a silicone tube inserted within the organ. To evaluate the influence of the heat sink effect on MWA, we measured the tissue temperature by fiber Bragg grating sensors (FBGs) in two different configurations (i.e., with and without blood vessel nearby the MW applicator). The notable differences in terms of temperature recorded in the two different scenarios demonstrated the cooling effect caused by blood vessel.

Purpose To assess the safety and efficacy of a two-step single-session procedure, combining transarterial embolization (TAE) and percutaneous microwave ablation (MWA), in the treatment of > 3 cm unresectable liver metastases. We also compared the final volume obtained by the two techniques (VE-T) and the expected ablation volume of the stand-alone MWA (VT). Methods From January 2015 to December 2017, 22 consecutive patients, with a total of 24 unresectable hepatic metastases >3 cm in diameter underwent a two-step single-session combined treatment of TAE and MWA. Follow-up computed tomography scans were performed at 1-, 3-, 6-, 12, and 24 months post-procedure. VE-T as final ablation volume induced by the combined treatment (TAE-MWA), VN as initial nodule volume, VT as expected ablation volume of MWA treatment alone were evaluated and compared. Results Tumor dimensions ranged from 32 to 73 mm. Technical success was achieved in all treated tumors with no local tumor recurrence. Final ablation volumes ranged from 50 to 450 cm3 and the short-axis diameter of the ablation zone ranged from 12 to 48 mm. The mean ΔV increment in the final ablation volume with respect to the stand-alone MWA was 196% (ranging from 25 cm3 − 210 cm3) (p 3 cm in diameter.

This study aims (1) to estimate the yearly number of Achilles tendon (AT) surgeries in Italy from 2001 to 2015 based on official hospitalization records; (2) to investigate the eventual presence of geographical variation in equity in access to AT surgery between three macroregions of Italy (North, Center and South); (3) to perform statistical projections of the number of AT procedure volumes and rates based on these data.We analysed the National Hospital Discharge records (SDO) maintained at the Italian Ministry of Health for a 15-year period, from 2001 through 2015. These data are anonymous and include the patient's age (evaluated in the class of age), sex, census region, the region of hospitalization, length of the hospitalization, public or private reimbursement and diagnosis.During the 15-year study period, 118,652 AT repair were performed in Italy, whose peak of incidence was in 2010. More than half of AT repairs was performed in the North of Italy (52.1%), while 27.2% was performed in the South of Italy and 20.6% Center of Italy. The projection model predicted a slight growth of 2.65% in 2025 in comparison with 2015.The current study provides detailed information about the national population-weighted incidence of AT surgery, distribution and projection. The peak of average age was 35-45 year. The majority of AT procedures was performed in the North of Italy. The projection model predicts a slight growth of AT surgery by 2025. Furthermore, this 15-year nationwide registry study shows that the age of incidence of AT injuries shifted from 30 to 40 to 35-45 years compared to the available literature. The higher prevalence of AT surgery was found in men during the working age. Moreover, a low rate of procedures in pediatric and elder age classes was observed.

Respiratory rate is a fundamental vital sign that is sensitive to different pathological conditions (e.g., adverse cardiac events, pneumonia, and clinical deterioration) and stressors, including emotional stress, cognitive load, heat, cold, physical effort, and exercise-induced fatigue. The sensitivity of respiratory rate to these conditions is superior compared to that of most of the other vital signs, and the abundance of suitable technological solutions measuring respiratory rate has important implications for healthcare, occupational settings, and sport. However, respiratory rate is still too often not routinely monitored in these fields of use. This review presents a multidisciplinary approach to respiratory monitoring, with the aim to improve the development and efficacy of respiratory monitoring services. We have identified thirteen monitoring goals where the use of the respiratory rate is invaluable, and for each of them we have described suitable sensors and techniques to monitor respiratory rate in specific measurement scenarios. We have also provided a physiological rationale corroborating the importance of respiratory rate monitoring and an original multidisciplinary framework for the development of respiratory monitoring services. This review is expected to advance the field of respiratory monitoring and favor synergies between different disciplines to accomplish this goal.

Background: Remote virtual rehabilitation aroused growing interest in the last decades, and its role has gained importance following the recent spread of COVID19 pandemic. The advantages of virtual reality (VR), augmented reality (AR), gamification, and telerehabilitation have been demonstrated in several medical fields. In this review, we searched the literature for studies using these technologies for orthopedic rehabilitation and analyzed studies’ quality, type and field of rehabilitation, patients’ characteristics, and outcomes to describe the state of the art of VR, AR, gamification, and telerehabilitation for orthopedic rehabilitation. Methods: A comprehensive search on PubMed, Medline, Cochrane, CINAHL, and Embase databases was conducted. This review was performed according to PRISMA guidelines. Studies published between 2015 and 2020 about remote virtual rehabilitations for orthopedic patients were selected. The Methodological Index for Non-Randomized Studies (MINORS) and Cochrane Risk-of-Bias assessment tool were used for quality assessment. Results: 24 studies (9 randomized controlled trials (RCTs) and 15 non-randomized studies) and 2472 patients were included. Studies mainly concern telerehabilitation (56%), and to a lesser extent VR (28%), AR (28%), and gamification (16%). Remote virtual technologies were used following knee and hip arthroplasty. The majority of included patients were between 40 and 60 years old and had a university degree. Remote virtual rehabilitation was not inferior to face-to-face therapy, and physical improvements were demonstrated by increased clinical scores. Orthopedic virtual remote rehabilitation decreased costs related to transports, hospitalizations, and readmissions. Conclusion: The heterogeneity of included studies prevented a meta-analysis of their results. Age and social context influence adaptability to technology, and this can modify compliance to treatment and outcomes. A good relationship between patient and physiotherapist is essential for treatment compliance and new technologies are useful to maintain clinical interactions remotely. Remote virtual technologies allow the delivery of high-quality care at reduced costs. This is a necessity given the growing demand for orthopedic rehabilitation and increasing costs related to it. Future studies need to develop specific and objective methods to evaluate the clinical quality of new technologies and definitively demonstrate advantages of VR, AR, gamification, and telerehabilitation compared to face-to face orthopedic rehabilitation.

BACKGROUND The detection of epidural space is usually performed by the technique of loss of resistance (LOR) without technological support, although there are few commercial options. In this work, we aimed to assess the feasibility of a new, non-invasive, mechatronic system for LOR detection in clinical settings. The system allows monitoring the pressure exerted on the syringe plunger by the clinician during the puncture. The LOR is related to the mentioned pressure. METHODS Pressure exerted on the syringe plunger by an expert anesthesiologist was monitored using the proposed system. 58 epidural punctures were performed on 34 patients using six configurations with different sensitivities and ranges of measurements. The system capability in LOR detection was evaluated comparing the LOR detected by the system with the feedback provided by the clinician. The procedure time was estimated using the system and without its use. RESULTS The detection of LOR is strongly related to the system configuration; it ranged from 93.3% to 27.7%, while 3 configurations never detected it. The procedure time showed a non-significant increase (p=0.56) using the proposed system (average time 71 s vs. 62 s). CONCLUSIONS The proposed mechatronic system successfully detected the LOR in the large part of cases using the configurations characterized by the best trade-off between system sensitivity and range of measurements. A non-significant increment of the procedure time is related to the use of the system.

Low back pain (LBP) is one of the musculoskeletal disorders that most affects workers. Among others, one of the working categories which mainly experiences such disease are video terminal workers. As it causes exploitation of the National Health Service and absenteeism in workplaces, LBP constitutes a relevant socio-economic burden. In such a scenario, a prompt detection of wrong seating postures can be useful to prevent the occurrence of this disorder. To date, many tools capable of monitoring the spinal range of motions (ROMs) are marketed, but most of them are unusable in working environments due to their bulkiness, discomfort and invasiveness. In the last decades, fiber optic sensors have made their mark allowing the creation of light and compact wearable systems. In this study, a novel wearable device embedding a Fiber Bragg Grating sensor for the detection of lumbar flexion-extensions (F/E) in seated subjects is proposed. At first, the manufacturing process of the sensing element was shown together with its mechanical characterization, that shows linear response to strain with a high correlation coefficient (R2 &gt, 0.99) and a sensitivity value (S&epsilon, ) of 0.20 nm∙m&epsilon, &minus, 1. Then, the capability of the wearable device in measuring F/E in the sagittal body plane was experimentally assessed on a small population of volunteers, using a Motion Capture system (MoCap) as gold standard showing good ability of the system to match the lumbar F/E trend in time. Additionally, the lumbar ROMs were evaluated in terms of intervertebral lumbar distances (&Delta, d L 3 &minus, L 1 ) and angles, exhibiting moderate to good agreement with the MoCap outputs (the maximum Mean Absolute Error obtained is ~16% in detecting &Delta, L 1 ). The proposed wearable device is the first attempt for the development of FBG-based wearable systems for workers&rsquo, safety monitoring.

Wearable stretchable sensors are gaining significant interest in application related to joint motion monitoring. Stretchable strain sensors are a promising technological solution to develop wearable systems for several applications (e.g., sports, rehabilitation, health science) thanks to their flexibility, lightweight, compliance, and ease to wear. The aim of this study is twofold: i) to perform the metrological characterization of a stretchable sensing element based on a conductive textile fabric for developing a wearable sensor intended for joint motion monitoring and ii) to provide a preliminary assessment of the developed sensor in shoulder motion monitoring. The static characterization and the hysteresis analysis at different speeds (i.e., 50 mm.min−1, 100 mm.min−1, 200 mm.min−1, 400 mm.min−1and 600 mm.min−1) were carried out to assess the sensor's characteristics to mechanical strain. An explorative test to assess the sensor feasibility in monitoring horizontal flexion-extension of the shoulder was performed on one healthy volunteer. Results showed that the sensor's resistance decreased from $75 k \Omega$ at 0% strain level to $52 k \Omega$ at 10% strain level during static characterization. Moreover, the maximum hysteresis error $e_{H}\%$ was always lower than 2.59% during loading-unloading hysteresis cycles at different speeds. The developed stretchable sensor seems to be a promising solution for monitoring shoulder range of motion in applications were unobtrusiveness and wearability are key factors.

Human gait is a significant health indicator used in a wide range of applications, including diagnosis, monitoring, rehabilitation, and sport. Among all the human joints movements, the knee flexion/extension is a crucial movement, and its evaluation may provide valuable information related to pathologies, walking disorders, to evaluate the efficiency of prescribed therapies and the rehabilitation of patients, and to improve performances of athletes. In this work, we designed, fabricated, and tested a wearable system (i.e., an instrumented knee brace) for monitoring knee movements under static and dynamic conditions. The system consists of a single fiber Bragg grating (FBG) sensor encapsulated in a soft and flexible polymer matrix in contact with the knee brace. The metrological characterization of two sensors (dimensions 50 mm × 30mm × 10mm and 40mm × 30mm × 10mm) has been performed by applying strains up to 2% which correspond to max length variations (ΔL MAX ) of 0.76 mm and 0.55 mm for the big and the small sensors, respectively. Additionally, pilot trials have been carried to preliminary test the instrumented knee brace for monitoring flexion/extension movements during walking at different speeds (i.e., 3 km/h, 4 km/h, 5 km/h). Both the sensors showed an approximately linear response in the range of interest and sensitivities up to 3.944 nm-mm−1, The wearable system was able to monitor the number of gait cycles and to discriminate the knee flexion and extension movements during walking.

Epidural blockade is a method often used in clinical practice to obtain pain relief during labor. Basically, the epidural puncture blocks the nerve impulses from the lower spinal segments with a consequent decrease of sensation in the lower half of the body. In this arena, the correct localization of the epidural space is crucial to perform the procedure. The loss of resistance (LOR) technique is the most popular approach to localize the epidural space. The LOR is caused by the fact that the ligamentum flavum is much harder than the epidural space, therefore when the needle tip pierces this ligamentum, there is an abrupt decrease of pressure (known as LOR). Although, there are several commercially available tools to support the clinicians in this task, the large part of epidural punctures is performed without any support. Our group of research has developed a novel and noninvasive tool to detect the LOR during epidural puncture. The aim of this study is to compare the output collected by the proposed system (i.e., the Epidural Space Management Tool, ESMT) with the output provided by a commercial system (i.e., CompuFlo®, Milestone Scientific, Inc.). Experiments were performed by an expert anesthesiologist (M.C.) on a simple simulator that allows mimicking the real scenario. Results showed a good agreement between the trends of the output of the two mentioned systems. Finally, the proposed system (ESMT), showed promising results in terms of LOR detection during all the five procedures performed on the simulator.

The COVID-19 pandemic has created an unprecedented need for remote patient monitoring. At the time of writing this article, the majority of countries worldwide are on lockdown to minimize the spread of the virus, and most of the patients who tested (or are suspected to be) positive for COVID-19 are in self-isolation at home. Even robust healthcare systems are facing a shortage of healthcare professionals, personal protective equipment, beds, and mechanical ventilators in intensive-care-units (ICU) (Kissler et al., 2020), thus highlighting the need for alternative medical solutions, including remote patient monitoring (Alwashmi, 2020; FDA, 2020; Ohannessian et al., 2020). New policies have therefore been introduced to promote the development of monitoring devices (FDA, 2020), thus creating favorable opportunities to improve the remote monitoring of some overlooked vital signs. This is especially the case for respiratory rate (RR), which is currently poorly recorded despite its relevance in the context of COVID-19. Current COVID-19 guidelines suggest measuring resting RR to inform triage decisions, diagnosis, prognosis, and as a criterion for ICU admission and for the early recognition of COVID-19 patient deterioration. The World Health Organization indicates that a resting value of RR > 30 breaths/min is a critical sign for the diagnosis of severe pneumonia in adults, while the cut-off value for children varies according to age (World Health Organization, 2020). At triage, RR values are used to support the assignment of patients to different categories and to make decisions on the use of supplemental oxygen (Ayebare et al., 2020; Italian Thoracic Society Italian Respiratory Society, 2020). The treatment of patients affected by acute respiratory insufficiency from COVID-19 is also tailored considering RR values (Italian Thoracic Society Italian Respiratory Society, 2020). Furthermore, RR helps with the timely recognition of COVID-19 patient deterioration, thus contributing to the implementation of early intervention strategies (Sun et al., 2020). Resting RR values also contribute to the prognosis of COVID-19 patients as ICU admission and mortality are associated with significantly higher RR values compared to non-ICU patients and survivors (Huang et al., 2020; Zhou et al., 2020). Besides, the normalization of resting RR is among the signs used to quantify the time to clinical recovery from COVID-19 infection (Al-Tawfiq et al., 2020). The clinical relevance of RR mandates the improvement of the accuracy of RR measurements in response to the COVID-19 pandemic. RR measurements too often rely on manual counting in the clinical setting and are often poorly performed out of the hospital. For instance, guidelines for telephone consultation of COVID-19 patients recognize the fundamental role of RR in the assessment of patients, but propose unsatisfying solutions for its remote assessment (Greenhalgh et al., 2020). Since patients usually have no direct access to respiratory devices, RR is self-reported by answering the question “Is your breathing faster, slower, or the same as normal?” (Greenhalgh et al., 2020). However, experimental data discourage the self-report of RR and highlight how measurement awareness affects resting RR values (Hill et al., 2018). On the other hand, several sensors and techniques can be used for the accurate remote monitoring of RR; some of these are ready-to-use in the face of the COVID-19 challenge, while others deserve further consideration in the future.

Unobtrusive and wearable technologies are gaining broad acceptance in the continuous monitoring of physiological parameters. Among others, the respiratory frequency is increasingly being considered as it allows to detect physiological abnormalities and health status changes, both in clinical and occupational scenarios and in sports science.The respiratory monitoring during physical activity is still challenging because of the artifacts caused by body movements. These breathing-unrelated movements may negatively affect the signal used for respiratory monitoring.This study aimed to investigate the influence of the torso movements that occur during walking and running activities on the signals recorded by a multi-sensor garment. The garment consists of three bands positioned at the level of upper and lower thorax and abdomen. Each band embeds two conductive sensors. The torso movements were recorded by a magneto-inertial measurement unit embedded into the garment.Experimental trials were carried out on four male volunteers during walking and running activities at selected speeds controlled by a treadmill. A flowmeter was used to retrieve reference respiratory frequency values. All the signals were analyzed in the frequency domain to investigate the frequency content.Results show that movements related to the torso rotation (arms and shoulders swing) cause motion artifacts on the garment sensors’ signals. Sensors positioned on the upper thorax and abdomen were found to be much more influenced by breathing-unrelated movements.Despite the influence of the torso movements on the conductive sensors, the garment can provide robust information about the average respiratory rate even during physical activities.

Background: This study intends to summarize the causes, clinical examination, and treatments of scapular dyskinesis (SD) and to briefly investigate whether alteration can be managed by a precision rehabilitation protocol planned on the basis of features derived from clinical tests. Methods: We performed a comprehensive search of PubMed, Cochrane, CINAHL and EMBASE databases using various combinations of the keywords “Rotator cuff”, “Scapula”, “Scapular Dyskinesis”, “Shoulder”, “Biomechanics” and “Arthroscopy”. Results: SD incidence is growing in patients with shoulder pathologies, even if it is not a specific injury or directly related to a particular injury. SD can be caused by multiple factors or can be the trigger of shoulder-degenerative pathologies. In both cases, SD results in a protracted scapula with the arm at rest or in motion. Conclusions: A clinical evaluation of altered shoulder kinematics is still complicated. Limitations in observing scapular motion are mainly related to the anatomical position and function of the scapula itself and the absence of a tool for quantitative SD clinical assessment. High-quality clinical trials are needed to establish whether there is a possible correlation between SD patterns and the specific findings of shoulder pathologies with altered scapular kinematics.

The desynchronisation between the rib cage and the abdomen known as thoraco-abdominal asynchrony (TAA) is an important parameter in the respiratory field. It can provide useful information about respiratory failures and work of breathing in different scenarios (e.g., clinical setting, sports science) and populations (e.g., neonates, athletes). The purpose of this work was to evaluate the capability of a multi-sensor smart garment to quantifity the TAA. The proposed garment is composed by three elastic bands embedding two conductive sensing element each. Experimental trials were carried out on five healthy volunteers who worn the elastic bands at the level of the upper rib cage, lower rib cage and abdomen. TAA was investigated by analysing the time shift between the rib cage and abdomen respiratory waveform. Data analysis demonstrated the ability of the garment to identify the thoracoabdominal time shift. This result is testified by the good agreement between the data of the proposed system and a commercial motion capture system used as gold standard: the Bland-Altman analysis showed a mean of difference of 170 ms.

In recent years, ever more workers are employed in sedentary jobs spending many hours sitting at video terminals. Discomfort office furniture and incorrect video screen positioning, as well as bad postural attitudes lead to the occurrence of back musculoskeletal disorders. Low back pain is one of the most widespread disease which causes a heavy socio- economic burden as it leads to absence from workplace and use of the National Health Service. In this scenario, being able to continuously evaluate poor postural attitudes may be beneficial to correct postural habits, and so to reduce the incidence of such a disease. For this purpose, many technologies capable to detect the spinal range of motions (ROMs) have been developed. Among others, the use of optical fiber sensors is gaining momentum, since these sensors allow the development of wearable, light and non-invasive monitoring systems. The present work aims at assessing the capability of a custom-made smart textile based on FBG sensors in detecting back dorsal flexion-extension (F/E) movements. Experimental results show high sensitivity to strain of the smart textile and confirm the system capability of monitoring back dorsal F/E movements in time.

Background: This study intends to summarize the causes, clinical examination, and treatments of scapular dyskinesis (SD) and to briefly investigate whether alteration can be managed by a precision rehabilitation protocol planned on the basis of features derived from clinical tests. Methods: We performed a comprehensive search of PubMed, Cochrane, CINAHL and EMBASE databases using various combinations of the keywords “Rotator cuff”, “Scapula”, “Scapular Dyskinesis”, “Shoulder”, “Biomechanics” and “Arthroscopy”. Results: SD incidence is growing in patients with shoulder pathologies, even if it is not a specific injury or directly related to a particular injury. SD can be caused by multiple factors or can be the trigger of shoulder-degenerative pathologies. In both cases, SD results in a protracted scapula with the arm at rest or in motion. Conclusions: A clinical evaluation of altered shoulder kinematics is still complicated. Limitations in observing scapular motion are mainly related to the anatomical position and function of the scapula itself and the absence of a tool for quantitative SD clinical assessment. High-quality clinical trials are needed to establish whether there is a possible correlation between SD patterns and the specific findings of shoulder pathologies with altered scapular kinematics.

Limited knowledge is accessible concerning the tendencies of hospitalization for skeletally immature patients with episodes of shoulder dislocation. Our research aim was to evaluate annual hospitalizations for shoulder dislocation in paediatric patients in Italy from 2001 to 2014, on the basis of the official data source as hospitalization reports. The second purpose was to investigate geographical diversification in hospitalization for shoulder dislocation in regions of Italy. The last aim was to make statistical predictions of the number of shoulder dislocation hospitalization volumes and rates in skeletally immature patients based on data from 2001 to 2014. An examination of the National Hospital Discharge records (SDO) kept at the Italian Ministry of Health regarding the 14 years of our study (2001 through 2014) was conducted. These data are anonymous and include patient&rsquo, s age, gender, domicile, region and time of hospitalization, and the kind of reimbursement (public or private). In the 14-year study time, 344 hospitalizations for shoulder dislocation of patients aged 0&ndash, 14 years took place in Italy. The male/female hospitalization ratio varied from a maximum of 3.0 (2001) to a minimum of 1.1 (2013), with a mean average ratio in the 2001&ndash, 2014 timespan of 2.0. Almost half of the hospitalizations (49.1%) were performed in the South. The mean incidence of hospitalizations in Italy for shoulder dislocation in patients with less than 14 years was 0.3 for every 100,000 inhabitants in the same class of age. The most common treatment was a closed reduction (60.8%), followed by open stabilization (16.6%) and arthroscopic procedures (13.7%). The present registry study shows a low incidence of hospitalization for shoulder dislocation in young patients. The most common treatment for a shoulder dislocation in paediatric patients is a closed shoulder reduction. Regions from the south and the centre of Italy are marked by an inferior number of operations and a higher number of hospitalization for closed shoulder reduction.

Musculoskeletal disorders are the most common form of occupational ill-health. Neck pain is one of the most prevalent musculoskeletal disorders experienced by computer workers. Wrong postural habits and non-compliance of the workstation to ergonomics guidelines are the leading causes of neck pain. These factors may also alter respiratory functions. Health and safety interventions can reduce neck pain and, more generally, the symptoms of musculoskeletal disorders and reduce the consequent economic burden. In this work, a multi-parametric wearable system based on two fiber Bragg grating sensors is proposed for monitoring neck movements and breathing activity of computer workers. The sensing elements were positioned on the neck, in the frontal and sagittal planes, to monitor: (i) flexion-extension and axial rotation repetitions, and (ii) respiratory frequency. In this pilot study, five volunteers were enrolled and performed five repetitions of both flexion-extension and axial rotation, and ten breaths of both quite breathing and tachypnea. Results showed the good performances of the proposed system in monitoring the aforementioned parameters when compared to optical reference systems. The wearable system is able to well-match the trend in time of the neck movements (both flexion-extension and axial rotation) and to estimate mean and breath-by-breath respiratory frequency values with percentage errors &le, 6.09% and &le, 1.90%, during quiet breathing and tachypnea, respectively.

Gold nanoparticles (GNPs)-based photothermal therapy (PTT) is a promising minimally invasive thermal therapy for the treatment of focal malignancies. Although GNPs-based PTT has been known for over two decades and GNPs possess unique properties as therapeutic agents, the delivery of a safe and effective therapy is still an open question. This review aims at providing relevant and recent information on the usage of GNPs in combination with the laser to treat cancers, pointing out the practical aspects that bear on the therapy outcome. Emphasis is given to the assessment of the GNPs' properties and the physical mechanisms underlying the laser-induced heat generation in GNPs-loaded tissues. The main techniques available for temperature measurement and the current theoretical simulation approaches predicting the therapeutic outcome are reviewed. Topical challenges in delivering safe thermal dosage are also presented with the aim to discuss the state-of-the-art and the future perspective in the field of GNPs-mediated PTT.

Although smart-textile solutions based on piezoresistive technology have emerged as a tool to assess unobtrusively breathing activity, their signals are affected by the artifacts related to the subjects' movements during common activities (e.g. walking or running). In order to remove such artifacts, we implemented a novel algorithm combining the information recorded by four piezoresistive textile sensors, which allowed to measure rib cage movements due to the breathing activity, with the data synchronously recorded by an inertial measurement unit. Specifically, by using an Independent Component Analysis (ICA), our algorithm allowed to blindly reduce movement artifacts from the signals recorded by the piezo sensors, leading to highlight the breathing activity. We tested our algorithm in a pilot study, in which we enrolled one healthy subject during a free-running task. In order to assess our approach, we compared the signal spectrum obtained applying our algorithm with the one computed after a standard band-pass filter at 0.05-3 Hz. To this aim, we compared the average amplitude of the Power Spectral Densities (PSDs), computed after both approaches, along three frequency ranges: i) [0–1] Hz, related to the breathing activity; ii) [1-2] Hz, related with the torso rotation, during a running a task; iii) [2-3] Hz, related with the pace, during a running a task. Although the study was performed on one single subject, the results obtained seem to be promising. Indeed, within the range [0–1] Hz, the average reduction of the Power Spectral Density (PSD) is only about 4%, while it is considerably higher within frequency range related to the walking/running activity. Specifically, considering the ranges [1-2] Hz and [2-3] Hz such a reduction is around 39% and 36% respectively.

Many minimally invasive thermal techniques, such as radiofrequency ablation, laser ablation, and microwave ablation (MWA) have gained substantial attention and broad clinical acceptance for the treatment of several tumors. All these treatments cause a high temperature increment, cytotoxic for the cells within the target organ. The knowledge of the ablation process effects in terms of temperature increment can be crucial to optimize the treatment settings and to avoid the occurrence of damages the healthy structures located around the tumor. During the last years, several feasibility studies on the use of MWA for bone tumor have been carried out, but an experimental analysis of the temperature reached within the bone during the treatment has not been performed. The aim of this work is to present a multi-point temperature measurement reached within the bone during MWA. Experiments were performed on an ex vivo bovine femur using a MWA system at a power of 75 W and a treatment time of 8 min. Femur temperature was measured in 30 points inside the bone and around the MW antenna, covering a large area. The measurements were performed by using three fiber optics embedding 10 fiber Bragg grating sensors each. Results of this pilot study showed the capability of the proposed approach for a multi-point temperature monitoring in bone undergoing MWA. Together, these experiments represent the first step towards the design of a system capable of understanding the effects of MWA on bone tumors, to rationally define the best MWA settings for the treatment of a specific tumor, and so to improve the treatment outcomes in this promising clinical application.

Background Wearable sensors are acquiring more and more influence in diagnostic and rehabilitation field to assess motor abilities of people with neurological or musculoskeletal impairments. The aim of this systematic literature review is to analyze the wearable systems for monitoring shoulder kinematics and their applicability in clinical settings and rehabilitation. Methods A comprehensive search of PubMed, Medline, Google Scholar and IEEE Xplore was performed and results were included up to July 2019. All studies concerning wearable sensors to assess shoulder kinematics were retrieved. Results Seventy-three studies were included because they have fulfilled the inclusion criteria. The results showed that magneto and/or inertial sensors are the most used. Wearable sensors measuring upper limb and/or shoulder kinematics have been proposed to be applied in patients with different pathological conditions such as stroke, multiple sclerosis, osteoarthritis, rotator cuff tear. Sensors placement and method of attachment were broadly heterogeneous among the examined studies. Conclusions Wearable systems are a promising solution to provide quantitative and meaningful clinical information about progress in a rehabilitation pathway and to extrapolate meaningful parameters in the diagnosis of shoulder pathologies. There is a strong need for development of this novel technologies which undeniably serves in shoulder evaluation and therapy.

Respiratory assessment and the biomechanical analysis of chest and abdomen motion during\ud breathing can be carried out using motion capture systems. An advantage of this methodology is\ud that it allows analysis of compartmental breathing volumes, thoraco-abdominal patterns,\ud percentage contribution of each compartment and the coordination between compartments. In the\ud literature, mainly, two marker models are reported, a full marker model of 89 markers placed on\ud the trunk and a reduced marker model with 32 markers. However, in practice, positioning and\ud post-process a large number of markers on the trunk can be time-consuming. In this study, the\ud full marker model was compared against the one that uses a reduced number of markers, in order\ud to evaluate i) their capability to obtain respiratory parameters (breath-by-breath tidal volumes)\ud and thoracoabdominal motion pattern (compartmental percentage contributions, and coordination\ud between compartments) during quiet breathing, and ii) their response in different groups such as\ud trained and untrained, male and female. Although tests revealed strong correlations of the tidal volume values in all the groups (R2\ud >0.93), the reduced model underestimated the trunk volume compared with the 89 marker model. The\ud highest underestimation was found in trained males (bias of 0.43 L). The three-way ANOVA test\ud showed that the model did not influence the evaluation of compartmental contributions and the\ud 32 marker model was adequate to distinguish thoracoabdominal breathing pattern in the studied\ud groups. Our findings showed that the reduced marker model could be used to analyse the\ud thoracoabdominal motion in both trained and untrained populations but performs poorly in\ud estimating tidal volume.

Purpose To validate a CT-navigation system during percutaneous lung biopsy (PLB). Methods Four hundred-ninety-six patients underwent low-dose CT-guided PLB. Lesion diameter (LD), procedural time (PT), histologic validity, lesion distance from pleural surface (DPS), needle distance travelled during procedure (DTP), complications and radiation exposure were recorded. Results Hysto-patological diagnosis was obtained in 96.2% cases. Mean PT, DPS, DTP, LD were respectively 29.5 min, 12.4 mm, 17.9 mm, 20.7 mm. In cases of major complications (4.6%), higher values of DTP were measured. Conclusions CT-navigation system allowed a good success in terms of diagnosis in small lesions and when a long DTP is required.

Distinction between treatment-related changes and tumour recurrence in patients who have received radiation treatment for brain metastases can be difficult on conventional MRI. In this study, we investigated the ability of dynamic susceptibility contrast (DSC) perfusion in differentiating necrotic changes from pathological angiogenesis and compared measurements of relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF) and K2, using a dedicated software. Twenty-nine patients with secondary brain tumors were included in this retrospective study and underwent DSC perfusion MRI with a 3-month follow-up imaging after chemo- or radiation-therapy. Region-of-interests were drawn around the contrast enhancing lesions and measurements of rCBV, rCBF and K2 were performed in all patients. Based on subsequent histological examination or clinico-radiological follow-up, the cohort was divided in two groups: recurrent disease and stable disease. Differences between the two groups were analyzed using the Student’s t test. Sensitivity, specificity and diagnostic accuracy of rCBV measurements were analyzed considering three different cut-off values. Between patients with and without disease, only rCBV and rCBF values were significant (p

Fiber Bragg grating (FBG) sensors have gained popularity in medicine for some valuable features, such as small size, immunity to electromagnetic interferences, and good metrological properties. Among several applications, this technology has been used in the analysis of gases in mechanical ventilation. In this field, in particular during invasive ventilation, the gas delivered by the ventilator must be warmed and humidified in order to reach the patients with optimal conditions (100% of relative humidity and 37 °C). The most popular device used to accomplish this task is the heated wire humidifiers (HWHs). Unfortunately, their performances are influenced by ventilatory settings (e.g., respiratory frequency) and environmental conditions. The aim of this paper is to fabricate a probe based on an FBG sensor able to monitor both the gas relative humidity and the respiratory frequency. This information can be used as a feedback to improve the performance of the HWHs. The probe consists of a needle, which houses an FBG sensor coated by hygroscopic material (i.e., agar). This solution allows an easy insertion of the probe within the ducts connecting the ventilator to the patient. The proposed system has been assessed during mechanical ventilation at different respiratory frequencies. Future testing will be focused on the development of a system able to monitor other parameters that influence the HWHs performances (e.g., gas temperature and minute volume).