International Journal of Endovascular Treatment and Innovative Techniques

Toward the Development of a Hybrid Active and Measuring Exoskeleton for Upper Limbs of Heavy-duty Harbor Workers

Guido Danieli — 2024-03-22

The paper presents the study of a novel exoskeleton designed for the upper limbs of heavy-duty port operators responsible for lashing containers. This exoskeleton is designed to measure initially its configuration and operational times, once positioned on the workers, to pass to a partial activeness introducing motors for the shoulder, the intra-extra rotation of the forearm, and the elbow. The key concept revolves around the shoulder joint, with particular emphasis on the scapula and its motion. The scapula plays a fundamental role in moving the center of rotation of the humerus, contributing to its exceptional mobility. The fundamental objective is to develop a system that provides support for the vertical motion of the operator's arms, with a specific focus on allowing initially the vertical motion of the scapula to remain unrestricted. This approach aims to collect essential data, which, in a subsequent phase, will likely enable the addition of vertical support to the scapula, possibly with the assistance of AI. Meanwhile, the horizontal motion will consistently be left unrestricted. This exoskeleton design is inspired by previous work that conceptualized a fully measuring exoskeleton, and a corresponding patent application has been presented.

ROSES: The most Complete System for Endovascular Surgery

Guido Danieli — 2024-04-10

ROSES, an innovative Robotic System for Endovascular Surgery, features a unique mechanism that continuously measures the resistance encountered by catheters and guide wires as they advance within the body. This feature operates seamlessly without the need for additional specialized components. The system is comprised of a series of robotic actuators (up to three) arranged linearly on slides running along a rail, inclined toward the patient. Another slide, housing a pair of step motors, facilitates the adjustment of relative positions between the actuators, with the proximal actuator affixed to the motor slide by a lateral bar. A force transducer, linked to the motor slide via a wire, is responsive to the gravitational component of any object on the rail. Importantly, this force remains constant even as the actuators move. However, the force dynamically changes if an external obstruction hinders the progress of catheters and guide wires, serving as an alert to the attending physician. The system, uniquely, is also capable of guiding the introduction of the first catheter, even if it is pre-curved. This capability facilitates the complete separation of the doctor from the patient throughout the entire surgical procedure. The system employs compact, purely mechanical disposables designed for a wide range of interventions utilizing commercially available catheters and guide wires, including angioplasty, brain and carotid surgery (for aneurysms or thrombi), TAVI, and various lower and upper limb procedures. Future developments include the incorporation of animated catheters capable of altering their shape configuration under console control. As the system also records the penetration length of each device and transmits this data to a workstation along with X-ray images, it effectively becomes the "black box" of endovascular surgeries. This functionality allows for a complete separation between physicians and patients throughout the entire surgical procedure. The system is safeguarded by multiple pending international patent applications.

Lymphocele Management: A Pictorial Review of Lymphocele Treatment

Lorenzo Steri — 2024-04-29

Lymphocele represents a quite frequent complication of surgical treatments that involve kidneys, lymphadenectomy, and pelvic organs. It can also arise after pelvic trauma, or due to infectious diseases. Aim of this review is to give a pictorial evaluation on current epidemiology, pathophysiology, clinical presentation, diagnosis of lymphocele, with particular attention to possible treatments, considering the standard management, but also the new available alternatives, which arose in the last years. All studies were identified by searching from electronic databases of Pubmed. We used the following keywords to search the database: lymphocele, symptoms, pathophysiology, infection, treatment. All the articles chosen were in English.

Appraisal of Olezarsen for Treatment of Hypertriglyceridemia

Nasser Mikhail — 2024-06-28

Olezarsen is antisense antinucleotide under investigation that inhibits synthesis of apolipoprotein C3 (ApoC3) resulting in reduction of plasma triglycerides levels. In a phase 3 clinical trial of patients having familial chylomicronemia syndrome (FCS) with extreme hypertriglyceridemia at baseline (mean plasma triglycerides 2,630 mg/dl), olezarsen 80 mg administered subcutaneously every 4 weeks decreased triglycerides by 43.5 percentage points (95% CI, 69.1 to 17.9; P<0.001) after 6 months compared with placebo. By 53 weeks, 1 episode of acute pancreatitis occurred in olezarsen group versus 11 episodes in the placebo group, rate ratio (RR) 0.12 (95% CI, 0.02 TO 0.66). Two phase 2 trials evaluated olezarsen in patients with moderately elevated triglycerides (<500 mg/dl) and high cardiovascular (CV) risk recorded similar magnitude of reduction of triglycerides. Olezarsen reduced levels of atherogenic lipoproteins such as ApoC3 by 73%, non-high-density lipoprotein cholesterol (non-HDL-C) by 17-23% and increased high-density lipoprotein cholesterol (HDL-C) levels by 30-40%. Meanwhile, olezarsen increased mean values of low-density lipoprotein (LDL-C) from 22.8 to 37.6 mg/dl in patients with FCS but had no significant effects in patients with high CV risk having higher baseline LDL-C levels. Discontinuation rates due to adverse effects of olezarsen were 9-12% versus 0% with placebo. The most common adverse effects of olezarsen were elevation of liver enzymes, mostly below 3 times the upper limit of normal, and injection-site reactions. Platelet count < 140,000/µl occurred in 18% in patients receiving olezarsen versus 3% with placebo (risk ratio 6.8; 95% CI, 0.91 to 51.3; P=0.03). No patient had severe thrombocytopenia with platelet number < 75,000/µl. Overall, olezarsen is a promising new therapy for hypertriglyceridemia and for prevention of hypertriglyceridemia-induced pancreatitis. Long-term randomized trials are urgently needed to examine the effects of olezarsen on CV events and mortality and establish its long-term safety.