A Review on Wearable Technologies for Tremor Suppression

Tremor is defined as a rhythmic, involuntary oscillatory movement of a body part. Although everyone exhibits a certain degree of tremor, some pathologies lead to very disabling tremors. These pathological tremors constitute the most prevalent movement disorder, and they imply severe difficulties in performing activities of daily living. Although tremors are currently managed through pharmacotherapy or surgery, these treatments present significant associated drawbacks: drugs often induce side effects and show decreased effectiveness over years of use, while surgery is a hazardous procedure for a very low percentage of eligible patients. In this context, recent research demonstrated the feasibility of managing upper limb tremors through wearable technologies that suppress tremors by modifying limb biomechanics or applying counteracting forces. Furthermore, recent experiments with transcutaneous afferent stimulation showed significant tremor attenuation. In this regard, this article reviews the devices developed following these tremor management paradigms, such as robotic exoskeletons, soft robotic exoskeletons, and transcutaneous neurostimulators. These works are presented, and their effectiveness is discussed. The article also evaluates the different metrics used for the validation of these devices and the lack of a standard validation procedure that allows the comparison among them.

Evaluation of Inherent Safety Strategies Using FAHP to Reduce Human Error

Inherent safety concept has been introduced to overcome the shortcoming of traditional hazard assessments by allowing modification to be made at any stage of lifecycle of a process plant. However, most of the proposed inherent safety modifications were suitable to prevent fire, explosion and toxic hazards assessment but less attention on human and organizational factor. Therefore, this paper introduces the inherently safer analysis for human and organizational factor to be implemented during design stage or process operation. Analytic Hierarchy Process model integrated with fuzzy logic and known as FAHP was employed to rank identified inherently safer strategies. The model was applied to select inherently safer strategies to reduce collision risk of a floating production, storage and offload and the authorized vessel. The result shows that minimization of hazardous procedure when the procedure is unavoidable is the best strategy to increase human performance. It is proven that the proposed methodology is capable to select the inherently safer strategy without requiring a bunch of precise information to transfer expert judgment in human performances perspective.

Iatrogenic rupture of the trachea caused by double Lumen tube intubation

Acute injuries of the tracheobronchial system are rare and life-threatening situations. Tracheal rupture most commonly occurs after blunt trauma to the chest. It is a rare but most concerning immediate complication of intubation. One-lung ventilation is required in lung surgery. Video assisted thoracoscopic procedures are an absolute indication for one-lung intubation. The double-lumen tube is the mainstay of one lung ventilation. Due to their larger size and rigidity, double lumen tubes are more difficult to insert, and complications are more common than with single lumen tubes. Opinions about the need for checking routinely the position of a double lumen tube by fiber optic bronchoscopy directly after intubation are divided. A 69-year-old woman with epidermoid lung carcinoma was scheduled for video assisted thoracoscopic left upper pulmonary lobectomy under general anaesthesia. The patient was prepared for the operation and itubated with the Carlens double lumen tube as usual. On introducing the camera into the thoracic cavity, the surgeon noted that the lungs were not completely collapsed. During blind adjustment the position of the tube the trachea was ruptured. The right-sided thoracotomy was performed and closed the greater part of the tracheal laceration. Only its upper 1.5-cm segment was surgically inaccessible because of the anatomical situation and thus remained unsutured. The patient received antibiotics, continuous airway humidification, analgesia with piritramide, and chest physiotherapy. She had no complications. In the literature, opinions about checking routinely the position of a double lumen tube by fiber optic bronchoscopy are divided.. Possibly, the very serious complication encountered in our patient could have been avoided, had the tube position been checked by bronchoscopy. The treatment strategy for post-intubation tracheal rupture depends on the size and location of the rupture, its clinical presentation, and the overall condition of the patient). Early surgical repair is the treatment of choice for most patients when a transmural tear with a length exceeding 2 cm. In our the combination of surgical and conservative treatment was performed. The uppermost part of the tear could not be sutured because of the anatomical situation, and so about 1.5 cm of the trachea remained open. The case is interesting from many perspectives. It shows that intubation with a Carlens tube is a potentially hazardous procedure, which should be performed only by experienced anaesthesiologists. Furthermore, our case report underscores the importance of checking routinely the position of a double lumen tube by fiber optic bronchoscopy. It provides evidence that minor tracheal lacerations can be successfully managed by conservative measures.

Central and peripheral nervous complications of dental treatment

This review outlines the complications involving the central or peripheral nervous system arising from dental procedures reported in the last decade. By far the commonest complications were related to intraoperative mechanical peripheral nerve injury. Trauma to branches of the mandibular nerve occuring during oral operations may potentially result in varying degrees of hypoesthesia, paresthesia, dysesthesia or in chronic pain syndromes. An increase in malpractice suits related to such a complication has been recognized in the late years. A warning of the possibility of occurrence of this complication should to be given to all patients undergoing risky procedures as part of the process of obtaining informed consent to operation. Mandibular third molar extraction seems to be alone the most hazardous procedure related to mechanical nerve injuries and also with anesthesiological accidents. Severe but rather infrequent infectious (meningitis, brain abscess and cavernous sinus thrombophlebitis) and anesthesiological complications (occular and facial palsies, optic nerve injury and complications related to general anesthesia) were also reported in this period.

Major complications of sinus surgery: a review of 1192 procedures

Based on this review of 1192 intranasal sinus procedures under endoscopic control with video assistance, the risk of major complications was estimated to be about 1.3 per cent. Ethmoidectomy was the most hazardous procedure. Operation by a right-handed surgeon standing on the right side of the patient was an added risk factor. We stress ways of achieving prevention, peroperative recognition of cerebrospinal fluid leaks and proper management of complications.

A study of safe entry zones via the floor of the fourth ventricle for brain-stem lesions

✓ Direct surgery for intra-axial lesions of the brain stem is considered a hazardous procedure, and morbidity of varying degrees cannot be avoided even with partial removal or biopsy. The main causes of morbidity relate to direct damage during removal of the lesion, selection of an entry route into the brain stem, and the direction of brain stem retraction. The authors examined the possibility of making a medullary incision and retracting the brain stem, taking into account the symptomatology and surgical anatomy, and found two safe entry zones into the brain stem through a suboccipital approach via the floor of the fourth ventricle. These safe entry zones are areas where important neural structures are less prominent. One is the “suprafacial triangle,” which is bordered medially by the medial longitudinal fascicle, caudally by the facial nerve (which runs in the brainstem parenchyma), and laterally by the cerebellar peduncle. The second is the “infrafacial triangle,” which is bordered medially by the medial longitudinal fascicle, caudally by the striae medullares, and laterally by the facial nerve. In order to minimize the retraction-related damage to important brain-stem structures, the brain stem should be retracted either laterally or rostrally in the suprafacial triangle approach and only laterally in the infrafacial triangle approach. Three localized intra-axial brain-stem lesions were treated surgically via the safe entry zones using the suprafacial approach in two and the infrafacial approach in one. The cases are described and the approaches delineated. Both approaches are indicated for focal intra-axial lesions located unilaterally and dorsal to the medial lemniscus in the lower midbrain to the pons. Magnetic resonance imaging is useful in selecting these approaches, and intraoperative ultrasonography is helpful to confirm the exact location of a lesion before a medullary incision is made. These approaches can also be used as routes for aspiration of brain-stem hemorrhage as well as for tumor biopsy.