Prosthesis development has taken big strides recently. Research has shown that targeted reinnervation enhance the capabilities of prosthetic arms  to allow the amputee to “feel” temperature, texture, etc.

Todd Kuiken is the doctor/engineer behind the concept.

Here is a video where he talks about future of the prosthetic arm

Click here to view the embedded video.

Quite an interesting presentation with demo

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The Robot Is Claimed To Adapt To Individual in Minutes,

The system comes from the collaboration of Barrett Technology‘s robotic WAM arms and NAIST‘s advanced computer intelligence. The robot will potentially help older people or those disabled with maintaining a level of personal independence.

The device aims at older people who require assistance with basic activities, but also want the dignity of independence but often require assistance.

The official press release mentions

According to the team’s leader, Associate Professor Tomohiro Shibata of the Mathematical Informatics Laboratory, “Barrett’s robots are unique in the world for their ability to react to subtle physical interactions, enabling our algorithms to learn to dress people.

Taking clothes on and off are essential activities in daily life, but for elderly and physically challenged people this can be difficult due to limited mobility in the upper limbs. At the same time, there is a key technical problem. Specifically, it’s difficult to calculate the optimal robot motions for manipulating a soft, floppy material like clothing, while in contact with a person of unique shape and constantly changing posture.

This is definitely a breakthrough making many people comfortable.

What do you think about having a robot in your life?

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The device is called AdaptiveStim With RestoreSensor and built by Medtronic. It uses an implantable pacemaker-like device to interrupt pain signals, transforming them into a tingling sensation instead of pain.

The manufacturer says in a press release

Neurostimulation systems consist of an implantable medical device similar to a pacemaker to interrupt pain signals from reaching the brain.

The treatment has become a mainstay of chronic pain management; however, a change in body position (e.g., sitting up or lying down) can result in an increase or decrease in the intensity of stimulation as a patient’s spinal cord moves closer or further away from the stimulation site.

As a result, patients may need to make frequent manual adjustments to their stimulation levels as they move, using a handheld patient programmer, that the device automatically tailors the level of stimulation to the needs of people with chronic back and/or leg pain by adjusting stimulation to accommodate changes in body position.

AdaptiveStim with RestoreSensor reduces the need for manual programming changes by automatically adapting stimulation levels to the needs of people with chronic back and/or leg pain by recognizing and remembering the correlation between a change in body position and the level of stimulation needed.

It also records and stores the frequency of posture changes, providing objective feedback to clinicians to help them understand how a patient’s individual stimulation requirements are changing over time.

AdaptiveStim with RestoreSensor is approved by the FDA for use in MRI head scan.

In a clinical trial, 64 out of 74 patients included in an intent-to-treat analysis reported more pain relief with no loss of convenience, or improving convenience with no loss of pain relief.

In addition, more than 90% of participants indicated that they would keep the device turned on all or most of the time, and 80.3% reported functional improvements.

Use of the device was not associated with an increase in adverse events.

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The study has been published online on Oct 13 in Journal of Pediatrics was conducted by Sabatini and colleagues.

For study, 50 randomly selected orthopedic practices were contacted twice with an identical scenario to request an appointment for a fictitious child with an arm fracture. Once it was told that the child had private insurance and once with Medicaid,the government-run health insurance program.

Access to appointments on the basis of insurance was compared with rates 10 years earlier.

Forty-five practices were contacted successfully. The children with private insurance had a better rate of approval. Nineteen out of forty five physicians offered appointment within 7 days to a child with private insurance [42%].

However only one out of 45 offered treatmentto a child with Medicaid[2%].

The authors noticed big decline in timely access for children with private insurance in the past decade [42% (19/45) in this study, compared with 100% (50/50) 10 years ago]

Conclusion

When his team did a similar study 10 years ago, most practices also wouldn’t see kids on Medicaid  but all of them scheduled appointments for those with private insurance.

Thus half the doctors were not seeing children anymore.

The authors noted that there has been a substantial decrease in the last decade in the willingness, availability, or both of orthopedic surgeons in Los Angeles to care for children with fractures whose families have private insurance.

The authors noted that even though these children are insured,they really don’t have access to medical care.

Journal of Pediatrics, online September 13, 2011.

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Growth factor augmentation has been proposed to boost the healing the rotator cuff after its reinsertion on the humerus and researchers wanted to assess the efficacy and safety of growth factor augmentation during rotator cuff repair.

The trial included 88 patients with a rotator cuff tear. They  were randomly assigned two groups by a computer-generated sequence. One group of 45 patients was to receive arthroscopic rotator cuff repair without  augmentation with autologous platelet-rich fibrin matrix whereas other group consisting of 43 patients received augumentation in addition to arthroscopic repair.

The primary end point was the postoperative difference in the Constant score between two groups.

The secondary end point was the integrity of the repaired rotator cuff, as evaluated by magnetic resonance imaging.

Follow up period was 16 months and all patients completed the follow up.

The researchers found no statistically significant difference in total Constant score between two groups.  Similarly  no statistically significant difference was highlighted by magnetic resonance imaging.

The authors concluded that study has found no evidence in use of  autologous platelet rich for augmentation of a double-row repair of a small or medium rotator cuff tear to improve the healing of the rotator cuff in  small and medium rotator cuff tears.

The authors, though did not rule out the possibility that the procedure might be beneficial for large and massive rotator cuff tears and that preparations of plasma rich fluid, other than they used may be more effective.

Am J Sports Med December 15, 2010, doi: 10.1177/036354651039078

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With an objective  to study the efficacy and safety of daily oral alendronate  in children with osteogenesis imperfecta, Dr Ward et al conducted a multicenter, double-blind, randomized, placebo-controlled study.

The study included 139 children between  4–19 years of age having  with type I, III, or IV osteogenesis imperfecta.

They found that as compared to placebo, alendronate increases spine bone mineral density but long-bone fracture incidence, average midline vertebral height, iliac cortical width, bone pain, and physical activity were similar between groups. Bone turnover also decreased to a greater extent with alendronate.

The incidences of clinical and laboratory adverse experiences were also similar between the treatment and placebo groups.

The authors concluded that oral alendronate  for 2 years in pediatric patients with osteogenesis imperfecta significantly decreased bone turnover and increased spine areal bone mineral density but was not associated with improved fracture outcomes.

J Clin Endocrinol Metab    published November 24, 2010 as doi:10.1210/jc.2010-0636

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Zoledronic acid is a drug  that belongs to bisphosphonates group. Bisphosphonates have been used to reduce the risk of skeletal events in patients with malignant bone disease. The present study was a randomized controlled trial between zoledroninc acid and colodronic acid, another bisphosphonate.

In the study, patients of age 18 years or older with newly diagnosed multiple myeloma were enrolled from 120 centres in the UK. Computer-generated randomisation sequence was used to allocate patients equally, via an automated telephone service, to receive 4 mg zoledronic acid as an infusion every 3–4 weeks or 1600 mg oral clodronic acid daily.

There were 981 patients in the zoledronic acid group (555 on intensive chemotherapy, 426 on non-intensive chemotherapy) and 979 on clodronic acid (556 on intensive chemotherapy, 423 on non-intensive chemotherapy).

All patients received bisphosphonates for a median of 350 days, with a median of 3·7 years follow-up.

Zoledronic acid was found to reduce the  mortality by 16%  as compared to clodronic acid, and extended median overall survival by 5·5 months

Zoledronic acid also significantly improved progression-free survival by 12% more than  clodronic acid

Both bisphosphonates were generally well tolerated but zoledronic acid was associated with higher rates of confirmed 3% higher osteonecrosis of the jaw.

The authors concluded that  zoledronic acid has treatment benefits beyond bone health and recommend immediate treatment with zoledronic acid in patients with newly diagnosed multiple myeloma, not only for prevention of skeletal-related events, but also for potential antimyeloma benefits.

The Lancet, Volume 376, Issue 9757, Pages 1989 - 1999, 11 December 2010
doi:10.1016/S0140-6736(10)62051-X

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The study cohort consisted of 605 African American patients with rheumatoid arthritis and 255 healthy control participants to evaluate the associations of cigarette smoking with rheumatoid arthritis in African Americans and to examine the effect of the HLA-DRB1 shared epitope  on this association

An epitope, also known as antigenic determinant, is the part of an antigen that is recognized by the immune system, specifically by antibodies, B cells, or T cells

Participants were evaluated  to determine associations of smoking with RA and additive and multiplicative shared epitope  smoking interactions.

The researchers  found a two-fold increase in rheumatoid arthritis risk among African Americans who were heavy smokers, and this risk increased to more than four-fold in the presence of shared epitope.

Limitations of this study include those inherent to its case-control design, with possible recall bias and/or “healthy responder” bias among control participants, and inability to determine causality.

Despite these potential limitations of this study [case control study, recall bias possibility and inability to determine causality] this study represents the largest study to date examining the impact of smoking and gene-smoking interactions in rheumatoid arthritis in a African American population.

The authors further suggest that roughly one in six new cases of RA occurring in African Americans could be prevented through smoking cessation or by limiting cumulative smoking exposure..”

Arthritis Rheum. 2010;62:3560-3568.

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The study composed of randomly selected, population-based cohort enrolled in the Canadian Multicentre Osteoporosis Study, the investigators aimed to determine the association between dietary patterns and incident fracture and to evaluate whether body mass index (BMI), BMD, or falls affected this relationship.

In second year of the study (1997-1999), they used self-administered food frequency questionnaires to evaluate dietary patterns.

The main study endpoint was low-trauma fracture occurring before the 10th annual follow-up in 2005 to 2007.

Two dietary patterns were observed

• Nutrient dense, which emphasized intake of fruit, vegetables, and whole grains
• Energy dense, which had higher intake of soft drinks, potato chips, French fries, meats, and desserts.

Nutrient Dense Pattern was associated with lower rate of fractures occuring as a result of low trauma. These associations were independent of BMI, BMD, falls, and demographic factors.

No associations with fracture were identified for the energy-dense pattern.

Limitations of this study acknowledged by the study authors include

• Lack of assessment of possible intermediate factors such as weight or BMD change
• Limited scope and specified portion size of the food frequency questionnaire
• Underrepresentation of ethnic minorities
• Possible residual confounding.

The Canadian Multicentre Osteoporosis Study was funded by the Canadian Institutes of Health Research, Merck-Frosst Canada Ltd, Eli Lilly Canada Inc, Novartis Pharmaceuticals Inc, The Alliance for Better Bone Health, Sanofi-Aventis, Procter & Gamble Pharmaceuticals Canada Inc, The Dairy Farmers of Canada, and The Arthritis Society.

Am J Clin Nutr. Published online November 10, 2010.

Note:

It is time to drop that cola and throw those chips. Healthy eating habits can be cutivated and go long way in protecting our body from the sickness. The new study in fact emphasizes the importance of fruits, vegetables and wholegrains.

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The study included 89 patients who were put on infiximab and it was found that found obese patients improved less than leaner ones.

The study has been published in online November 8th in Arthritis & Rheumatism,

It is not clear why does this occur but  adipocytokines — inflammation-promoting proteins produced by fat tissue  are thought to play a role.

This may send an alert to the physicians that TNF blockers might be relatively less effective in obese people.

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