scholarly journals Human Permanent Denervated Muscles Recovery

2020 ◽  
Author(s):  
Ugo Carraro ◽  
Paolo Gargiulo ◽  
Jorgelina Ramos ◽  
Romain Aubonnet ◽  
Helmut Kern
Keyword(s):  
Motor Neurons ◽  
Cauda Equina ◽  
Clinical Value ◽  
Case Scenario ◽  
Worst Case ◽  
Leg Muscles ◽  
Cord Injury ◽  
Life Threatening ◽  
Aging Muscle ◽  
Denervated Muscles

We demonstrated the long-term clinical value of co-activating thigh muscles through hbFES strategy using high currents and large surface electrodes. This Vienna Strategy is able to reverse, at clinically relevant levels, the adverse effects of Spinal Cord Injury (SCI), even in the worst-case scenario of complete lesion of lower motor neurons, as it may occur in complete conus and cauda equina syndrome. Continued regularly, hbFES for denervated, degenerating muscles helps to maintain healthier leg muscles and skin, reducing the risks of life-threatening SCI complications. By products of these studies are new approaches for counteracting aging muscle atrophy, new color clinical imaging of muscle tissue and Machine Learning Predictive Systems for skeletal muscle diagnostics and managements.

scholarly journals Home-Based Functional Electrical Stimulation of Human Permanent Denervated Muscles: A Narrative Review on Diagnostics, Managements, Results and Byproducts Revisited 2020

Diagnostics ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. 529 ◽  
Author(s):  
Helmut Kern ◽  
Ugo Carraro
Keyword(s):  
Electrical Stimulation ◽  
Functional Electrical Stimulation ◽  
Cauda Equina ◽  
Quadriceps Muscle ◽  
Ultrastructural Organization ◽  
Force Output ◽  
Case Scenario ◽  
Worst Case ◽  
Home Based ◽  
Cord Injury

Spinal cord injury (SCI) produces muscle wasting that is especially severe after complete and permanent damage of lower motor neurons, as can occur in complete conus and cauda equina syndrome. Even in this worst-case scenario, mass and function of permanently denervated quadriceps muscle can be rescued by surface functional electrical stimulation using a purpose designed home-based rehabilitation strategy. Early diagnostics is a key factor in the long-term success of this management. Function of quadriceps muscle was quantitated by force measurements. Muscle gross cross-sections were evaluated by quantitative color computed tomography (CT) and muscle and skin biopsies by quantitative histology, electron microscopy, and immunohistochemistry. Two years of treatment that started earlier than 5 years from SCI produced: (a) an increase in cross-sectional area of stimulated muscles; (b) an increase in muscle fiber mean diameter; (c) improvements in ultrastructural organization; and (d) increased force output during electrical stimulation. Improvements are extended to hamstring muscles and skin. Indeed, the cushioning effect provided by recovered tissues is a major clinical benefit. It is our hope that new trials start soon, providing patients the benefits they need.

scholarly journals Functional electrical stimulation of permanently denervated muscles, updated 2020

2020 ◽  
Vol 97 (3) ◽  
pp. 130-136 ◽  
Author(s):  
U. Carraro ◽  
H. Kern ◽  
G. Albertin G. ◽  
S. Masiero ◽  
A. Pond ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Functional Electrical Stimulation ◽  
Cauda Equina ◽  
Quadriceps Muscle ◽  
Ultrastructural Organization ◽  
Force Output ◽  
Case Scenario ◽  
Cross Sectional ◽  
Worst Case ◽  
Cord Injury

Spinal cord injury produces muscle wasting, which is especially severe after the complete and permanent damage of lower motor neurons that occurs in complete Cauda Equina Syndrome. Even in this worst-case scenario, we have shown that permanently denervated Quadriceps muscle can be rescued by surface Functional Electrical Stimulation and a purpose designed home-based rehabilitation regime. Here, our aim is to show that the effects are extended to both antagonist muscles and the skin of the thighs. Before and after 2 years of electrical stimulation, mass and structure of Quadriceps and Hamstrings muscles were quantitated by force measurements. Muscle gross cross section were evaluated using color computed tomography, muscle and skin biopsies by quantitative histology and immunohistochemistry. The treatment produced: a) an increase in cross-sectional area of stimulated muscles; b) an increase in muscle fiber mean diameter; c) improvements in ultrastructural organization; and d) increased force output during electrical stimulation. The recovery of Quadriceps muscle force was sufficient to allow 25% of the compliant subjects to perform stand-up and step-in place trainings. Improvements are extended to hamstring muscles and skin. Indeed, the cushioning effect provided by recovered tissues is a major clinical benefit. It is our hope that, with or without our advice, trials may start soon in Europe and Russia to provide persons-in-need the help they deserve.

scholarly journals An Odontoid Fracture Causing Apnea, Cardiac Instability, and Quadriplegia

2012 ◽  
Vol 2012 ◽  
pp. 1-2
Author(s):  
Christian A. Bowers ◽  
Gregory F. Jost ◽  
Andrew T. Dailey
Keyword(s):  
Traumatic Injury ◽  
Odontoid Fracture ◽  
Spine Injury ◽  
Case Scenario ◽  
Worst Case ◽  
Cardiovascular Instability ◽  
Anatomical Basis ◽  
Cord Injury ◽  
High Cervical ◽  
C2 Fracture

Odontoid fractures are typically associated with low rates of acute neurologic deficit and morbidity/mortality in nonelderly patients. In the patient in this case, traumatic injury triggered by a syncopal event led to a combined C1-C2 fracture and a fatal spinal cord injury with apnea, quadriplegia, and cardiovascular instability. We briefly review the anatomical basis for the pathophysiology of cardiac dysfunction following high-cervical spine injury and present an example of a worst-case scenario.

Home-Based Functional Electrical Stimulation Rescues Permanently Denervated Muscles in Paraplegic Patients With Complete Lower Motor Neuron Lesion

2010 ◽  
Vol 24 (8) ◽  
pp. 709-721 ◽  
Author(s):  
Helmut Kern ◽  
Ugo Carraro ◽  
Nicoletta Adami ◽  
Donatella Biral ◽  
Christian Hofer ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Muscle Mass ◽  
Functional Electrical Stimulation ◽  
Cauda Equina ◽  
Ultrastructural Organization ◽  
Mass Force ◽  
Cross Sectional ◽  
Home Based ◽  
Cord Injury ◽  
Denervated Muscles

Background. Spinal cord injury causes muscle wasting and loss of function, which are especially severe after complete and permanent damage to lower motor neurons. In a previous cross-sectional study, long-standing denervated muscles were rescued by home-based functional electrical stimulation (h-bFES) training. Objective. To confirm results by a 2-year longitudinal prospective study of 25 patients with complete conus/cauda equina lesions. Methods. Denervated leg muscles were stimulated by h-bFES using a custom-designed stimulator and large surface electrodes. Muscle mass, force, and structure were determined before and after 2 years of h-bFES using computed tomography, measurements of knee torque during stimulation, and muscle biopsies analyzed by histology and electron microscopy. Results. Twenty of 25 patients completed the 2-year h-bFES program, which resulted in ( a) a 35% cross-sectional increase in area of the quadriceps muscle from 28.2 ± 8.1 to 38.1 ± 12.7 cm 2 ( P < .001), a 75% increase in mean diameter of muscle fibers from 16.6 ± 14.3 to 29.1 ± 23.3 μm ( P < .001), and improvements of the ultrastructural organization of contractile material; and ( b) a 1187% increase in force output during electrical stimulation from 0.8 ± 1.3 to 10.3 ± 8.1 N m ( P < .001). The recovery of quadriceps force was sufficient to allow 25% of the subjects to perform FES-assisted stand-up exercises. Conclusions. Home-based FES of denervated muscle is an effective home therapy that results in rescue of muscle mass and tetanic contractility. Important immediate benefits for the patients are the improved cosmetic appearance of lower extremities and the enhanced cushioning effect for seating.

Reducing Probabilistic Weather Forecasts to the Worst Case Scenario: Anchoring Effects

2008 ◽  
Author(s):  
Sonia Savelli ◽  
Susan Joslyn ◽  
Limor Nadav-Greenberg ◽  
Queena Chen
Keyword(s):  
Case Scenario ◽  
Worst Case ◽  
Weather Forecasts ◽  
Worst Case Scenario ◽  
Anchoring Effects

EXPEDITION TO MALI, 2020

2020 ◽  
pp. 12-28
Author(s):  
D. V. Vaniukova ◽  
◽  
P. A. Kutsenkov ◽  
Keyword(s):  
Mass Murder ◽  
The State ◽  
Case Scenario ◽  
Worst Case ◽  
Traditional Art ◽  
Peter The Great ◽  
State Museum ◽  
Bobo Dioulasso ◽  
Oriental Studies ◽  
The Village

The research expedition of the Institute of Oriental studies of the Russian Academy of Sciences has been working in Mali since 2015. Since 2017, it has been attended by employees of the State Museum of the East. The task of the expedition is to study the transformation of traditional Dogon culture in the context of globalization, as well as to collect ethnographic information (life, customs, features of the traditional social and political structure); to collect oral historical legends; to study the history, existence, and transformation of artistic tradition in the villages of the Dogon Country in modern conditions; collecting items of Ethnography and art to add to the collection of the African collection of the. Peter the Great Museum (Kunstkamera, Saint Petersburg) and the State Museum of Oriental Arts (Moscow). The plan of the expedition in January 2020 included additional items, namely, the study of the functioning of the antique market in Mali (the “path” of things from villages to cities, which is important for attributing works of traditional art). The geography of our research was significantly expanded to the regions of Sikasso and Koulikoro in Mali, as well as to the city of Bobo-Dioulasso and its surroundings in Burkina Faso, which is related to the study of migrations to the Bandiagara Highlands. In addition, the plan of the expedition included organization of a photo exhibition in the Museum of the village of Endé and some educational projects. Unfortunately, after the mass murder in March 2019 in the village of Ogossogou-Pel, where more than one hundred and seventy people were killed, events in the Dogon Country began to develop in the worst-case scenario: The incessant provocations after that revived the old feud between the Pel (Fulbe) pastoralists and the Dogon farmers. So far, this hostility and mutual distrust has not yet developed into a full-scale ethnic conflict, but, unfortunately, such a development now seems quite likely.

Alteraciones sistémicas y metabólicas producidas por lesión medular

2019 ◽  
Vol 1 (1) ◽  
pp. 59-75
Author(s):  
Gabriel Guízar Sahagún
Keyword(s):  
Spinal Cord ◽  
Daily Living ◽  
Autonomic Function ◽  
Clinical Presentation ◽  
Scientific Literature ◽  
International Standards ◽  
Therapeutic Approaches ◽  
Cord Injury ◽  
Life Threatening ◽  
The Impact

Besides the well-known loss of motor and sensory capabilities, people with spinal cord injury (SCI) experience a broad range of systemic and metabolic abnormalities including, among others, dysfunction of cardiovascular, respiratory, gastrointestinal, urinary, and endocrine systems. These alterations are a significant challenge for patients with SCI because such disorders severely interfere with their daily living and can be potentially life-threatening. Most of these disorders are associated with impairment of regulation of the autonomic nervous system, arising from disruption of connections between higher brain centers and the spinal cord caudal to the injured zone. Thus, the higher and more complete the lesion, the greater the autonomic dysfunction and the severity of complications.This article summarizes the medical scientific literature on key systemic and metabolic alterations derived of SCI. It provides information primarily focused on the pathophysiology and clinical presentation of these disorders, as well as some guides to prevent and alleviate such complications. Due to the impact of these alterations, this topic must be a priority and diffuse to those involved with the care of people with SCI, including the patient himself/herself. We consider that any collaborative effort should be supported, like the development of international standards, to evaluate autonomic function after SCI, as well as the development of novel therapeutic approaches.

Risk-Based Robust Bidding Strategies for EVs’ Aggregators in Day-ahead Markets with Uncertainty

2020 ◽  
Author(s):  
Ahmed Abdelmoaty ◽  
Wessam Mesbah ◽  
Mohammad A. M. Abdel-Aal ◽  
Ali T. Alawami
Keyword(s):  
Robust Optimization ◽  
Electricity Market ◽  
Real Life ◽  
Optimization Approach ◽  
Case Scenario ◽  
Worst Case ◽  
Bidding Strategies ◽  
Wind Generators ◽  
Proposed Model ◽  
Optimal Bidding

In the recent electricity market framework, the profit of the generation companies depends on the decision of the operator on the schedule of its units, the energy price, and the optimal bidding strategies. Due to the expanded integration of uncertain renewable generators which is highly intermittent such as wind plants, the coordination with other facilities to mitigate the risks of imbalances is mandatory. Accordingly, coordination of wind generators with the evolutionary Electric Vehicles (EVs) is expected to boost the performance of the grid. In this paper, we propose a robust optimization approach for the coordination between the wind-thermal generators and the EVs in a virtual<br>power plant (VPP) environment. The objective of maximizing the profit of the VPP Operator (VPPO) is studied. The optimal bidding strategy of the VPPO in the day-ahead market under uncertainties of wind power, energy<br>prices, imbalance prices, and demand is obtained for the worst case scenario. A case study is conducted to assess the e?effectiveness of the proposed model in terms of the VPPO's profit. A comparison between the proposed model and the scenario-based optimization was introduced. Our results confirmed that, although the conservative behavior of the worst-case robust optimization model, it helps the decision maker from the fluctuations of the uncertain parameters involved in the production and bidding processes. In addition, robust optimization is a more tractable problem and does not suffer from<br>the high computation burden associated with scenario-based stochastic programming. This makes it more practical for real-life scenarios.<br>

scholarly journals Restoration of breathing after opioid overdose and spinal cord injury using temporal interference stimulation

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Michael D. Sunshine ◽  
Antonino M. Cassarà ◽  
Esra Neufeld ◽  
Nir Grossman ◽  
Thomas H. Mareci ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Motor Neurons ◽  
Drug Overdose ◽  
Cervical Spinal Cord ◽  
Opioid Overdose ◽  
Electrode Position ◽  
Spinal Motor Neurons ◽  
Cord Injury ◽  
Low Amplitude

AbstractRespiratory insufficiency is a leading cause of death due to drug overdose or neuromuscular disease. We hypothesized that a stimulation paradigm using temporal interference (TI) could restore breathing in such conditions. Following opioid overdose in rats, two high frequency (5000 Hz and 5001 Hz), low amplitude waveforms delivered via intramuscular wires in the neck immediately activated the diaphragm and restored ventilation in phase with waveform offset (1 Hz or 60 breaths/min). Following cervical spinal cord injury (SCI), TI stimulation via dorsally placed epidural electrodes uni- or bilaterally activated the diaphragm depending on current and electrode position. In silico modeling indicated that an interferential signal in the ventral spinal cord predicted the evoked response (left versus right diaphragm) and current-ratio-based steering. We conclude that TI stimulation can activate spinal motor neurons after SCI and prevent fatal apnea during drug overdose by restoring ventilation with minimally invasive electrodes.

scholarly journals A Thermally Conductive Pt/AAO Catalyst for Hydrogen Passive Autocatalytic Recombination

Catalysts ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 491
Author(s):  
Alina E. Kozhukhova ◽  
Stephanus P. du Preez ◽  
Aleksander A. Malakhov ◽  
Dmitri G. Bessarabov
Keyword(s):  
Electron Microscopy ◽  
Particle Size ◽  
Combustion Temperature ◽  
Volume Fraction ◽  
Morphological Characteristics ◽  
Al Alloy ◽  
Impregnation Method ◽  
Case Scenario ◽  
Worst Case ◽  
Thermal Distribution

In this study, a Pt/anodized aluminum oxide (AAO) catalyst was prepared by the anodization of an Al alloy (Al6082, 97.5% Al), followed by the incorporation of Pt via an incipient wet impregnation method. Then, the Pt/AAO catalyst was evaluated for autocatalytic hydrogen recombination. The Pt/AAO catalyst’s morphological characteristics were determined by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The average Pt particle size was determined to be 3.0 ± 0.6 nm. This Pt/AAO catalyst was tested for the combustion of lean hydrogen (0.5–4 vol% H2 in the air) in a recombiner section testing station. The thermal distribution throughout the catalytic surface was investigated at 3 vol% hydrogen (H2) using an infrared camera. The Al/AAO system had a high thermal conductivity, which prevents the formation of hotspots (areas where localized surface temperature is higher than an average temperature across the entire catalyst surface). In turn, the Pt stability was enhanced during catalytic hydrogen combustion (CHC). A temperature gradient over 70 mm of the Pt/AAO catalyst was 23 °C and 42 °C for catalysts with uniform and nonuniform (worst-case scenario) Pt distributions. The commercial computational fluid dynamics (CFD) code STAR-CCM+ was used to compare the experimentally observed and numerically simulated thermal distribution of the Pt/AAO catalyst. The effect of the initial H2 volume fraction on the combustion temperature and conversion of H2 was investigated. The activation energy for CHC on the Pt/AAO catalyst was 19.2 kJ/mol. Prolonged CHC was performed to assess the durability (reactive metal stability and catalytic activity) of the Pt/AAO catalyst. A stable combustion temperature of 162.8 ± 8.0 °C was maintained over 530 h of CHC. To confirm that Pt aggregation was avoided, the Pt particle size and distribution were determined by TEM before and after prolonged CHC.

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