Cardiovascular risk and dyslipidemia among persons living with HIV: A review

Background: Aim of this review is to focus the attention on people living with HIV infection at risk of developing a cardiovascular event. What is or what would be the most suitable antiretroviral therapy Which statin or fibrate to reduce the risk How to influence behavior and lifestyles Discussion: Prevention of cardiovascular disease (CVD) risk remains the first and essential step in a medical intervention on these patients. The lifestyle modification, including smoking cessation, increased physical activity, weight reduction, and the education on healthy dietary practices are the main instruments. Statins are the cornerstone for the treatment of hypercholesterolemia. They have been shown to slow the progression or promote regression of coronary plaque, and could also exert an anti-inflammatory and immunomodulatory effect. However the current guidelines for the use of these drugs in general population are dissimilar, with important differences between American and European ones. The debate between American and European guidelines is still open and, also considering the independent risk factor represented by HIV, specific guidelines are warranted. Ezetimibe reduces the intestinal absorption of cholesterol. It is effective alone or in combination with rosuvastatin. It does not modify plasmatic concentrations of antiretrovirals. A number of experimental new classes of drugs for the treatment of hypercholesterolemia are being studied. Fibrates represent the first choice for treatment of hypertriglyceridemia, however, the renal toxicity of fibrates and statins should be considered. Omega 3 fatty acids have a good safety profile, but their efficacy is limited. Another concern is the high dose needed. Other drugs are acipimox and tesamorelin. Current antiretroviral therapies are less toxic and more effective than regimens used in the early years. Lipodistrophy and dyslipidemia are the main causes of long-term toxicities. Not all antiretrovirals have similar toxicities. Protease Inhibitors may cause dyslipidemia and lipodystrophy, while integrase inhibitors have a minimal impact on lipids profile, and no evidence of lipodystrophy. There is still much to be written with the introduction of new drugs in clinical practice. Conclusions: Cardiovascular risk among HIV infected patients, interventions on behavior and lifestyles, use of drugs to reduce the risk, and switch in antiretroviral therapy, remain nowadays major issues in the management of HIV-infected patients

Cardio-respiratory monitoring in archery using a smart textile based on flexible fiber bragg grating sensors

In precision sports, the control of breathing and heart rate is crucial to help the body to remain stable in the shooting position. To improve stability, archers try to adopt similar breathing patterns and to have a low heartbeat during each shot. We proposed an easy-to-use and unobtrusive smart textile (ST) which is able to detect chest wall excursions due to breathing and heart beating. The sensing part is based on two FBGs housed into a soft polymer matrix to optimize the adherence to the chest wall and the system robustness. The ST was assessed on volunteers to figure out its performance in the estimation of respiratory frequency (fR) and heart rate (HR). Then, the system was tested on two archers during four shooting sessions. This is the first study to monitor cardio-respiratory activity on archers during shooting. The good performance of the ST is supported by the low mean absolute percentage error for fR and HR estimation (≤1.97% and ≤5.74%, respectively), calculated with respect to reference signals (flow sensor for fR, photopletismography sensor for HR). Moreover, results showed the capability of the ST to estimate fR and HR during different phases of shooting action. The promising results motivate future investigations to speculate about the influence of fR and HR on archers’ performance

Assessment of intuitiveness and comfort of wearable haptic feedback strategies for assisting level and stair walking

Nowadays, lower-limb prostheses are reaching real-world usability especially on ground-level walking. However, some key tasks such as stair walking are still quite demanding. Providing haptic feedback about the foot placement on the steps might reduce the cognitive load of the task, compensating for increased dependency on vision and lessen the risk of falling. Experiments on intact subjects can be useful to define the feedback strategies prior to clinical trials, but effective methods to assess the efficacy of the strategies are few and usually rely on the emulation of the disability condition. The present study reports on the design and testing of a wearable haptic feedback system in a protocol involving intact subjects to assess candidate strategies to be adopted in clinical trials. The system integrated a sensorized insole wirelessly connected to a textile waist belt equipped with three vibrating motors. Three stimulation strategies for mapping the insole pressure data to vibrotactile feedback were implemented and compared in terms of intuitiveness and comfort perceived during level and stair walking. The strategies were ranked using a relative rating approach, which highlighted the differences between them and suggested guidelines for their improvement. The feedback evaluation procedure proposed could facilitate the selection and improvement of haptic feedback strategies prior to clinical testing

Endoscopic Tactile Capsule for Non-Polypoid Colorectal Tumour Detection

An endoscopic tactile robotic capsule, embedding miniaturized MEMS force sensors, is presented. The capsule is conceived to provide automatic palpation of non-polypoid colorectal tumours during colonoscopy, since it is characterized by high degree of dysplasia, higher invasiveness and lower detection rates with respect to polyps. A first test was performed employing a silicone phantom that embedded inclusions with variable hardness and curvature. A hardness-based classification was implemented, demonstrating detection robustness to curvature variation. By comparing a set of supervised classification algorithms, a weighted 3-nearest neighbor classifier was selected. A bias force normalization model was introduced in order to make different acquisition sets consistent. Parameters of this model were chosen through a particle swarm optimization method. Additionally, an ex-vivo test was performed to assess the capsule detection performance when magnetically-driven along a colonic tissue. Lumps were identified as voltage peaks with a prominence depending on the total magnetic force applied to the capsule. Accuracy of 94 % in hardness classification was achieved, while a 100 % accuracy is obtained for the lump detection within a tolerance of 5 mm from the central path described by the capsule. In real application scenario, we foresee our device aiding physicians to detect tumorous tissues

A multi-parametric wearable system to monitor neck movements and respiratory frequency of computer workers

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 ≤6.09% and ≤1.90%, during quiet breathing and tachypnea, respectively

[Intranuclear particles in chronic non-A, non-B hepatitis: what diagnostic significance?].

Intranuclear particles of 23-27 nm diameter have been repeatedly demonstrated in the nuclei of hepatocytes of patients with non-A, non-B hepatitis and of experimentally infected chimpanzees; however, their specificity has been challenged since they have also been observed in other pathological conditions and in healthy volunteers. We have conducted an ultrastructural study of liver biopsies from 10 patients with chronic active non-A, non-B hepatitis. The intranuclear particles, which were observed in all patients, were classified according to the aggregation patterns described by De Vos. Eight patients (80%) had particles of type 2. A reevaluation our proceeding data on Delta hepatitis demonstrated that no particles of type 2 were present. These results support the hypothesis that only type 2 particles are markers of non-A, non-B hepatitis

Soft large area FBG tactile sensors for exteroception and proprioception in a collaborative robotic manipulator

Interest in tactile sensing technologies is advancing due to the growing adoption of robots in daily life activities. Human-machine interaction has thus to be safe, and collaborative robotics is becoming increasingly important. The present work features the design, development and preliminary validation of a soft large area sensor for tactile and proprioceptive sensing in a collaborative robotic manipulator. Such a manipulator is shaped to resemble the human hand and within this paper we focused on the index finger. The finger architecture has a design which allows setting up a structured 3D model, with flexible parametrization and fast prototyping. An optical fiber embedding 12 Fiber Bragg Gratings (FBGs) has been integrated in a soft polymeric matrix to mimic human sense of touch abilities of a whole finger. In order to assess the sensorized robotic manipulator, a mechatronic validation platform has been developed and employed. Preliminary results show a mechanical decoupling between exteroceptive and proprioceptive functions, and among the spatially distributed outputs of the sensor array. These results demonstrate the potential of the proposed approach towards achieving dexterous and fine capabilities in the manipulation of objects

Design and Development of Large-Area FBG-Based Sensing Skin for Collaborative Robotics

Advancements in the field of collaborative robotics have led to a closer cooperation between humans and machines. Sharing the same environment, safety and adaptive control becomes of paramount importance in human-robot interaction. Thus, tactile feedback technologies are crucial to perceive contacts. This work presents the design and development of a polymeric artificial skin, mimicking the human sense of touch in perceiving and localizing pressure over a large area, and its integration on a custom human-like robotic forearm. The sensing system consisted of a curved soft matrix embedding an optical fiber equipped with 16 distributed Fiber Bragg Gratings (FBGs). To estimate the sensitivity of the tactile sensor array, a preliminary mechanical characterization was performed by means of force-controlled indentations. Results show a high correlation between the applied load and the corresponding output of the sensors. In particular, the median value of the sensitivity resulted in 0.26 nm.N-1, with 0.08 nm.N-1 interquartile range. These promising results call for further investigation on spatial sensitivity and force range, contact localization and calibration of the presented artificial skin

Blood in saliva of HIV seropositive drug abusers: possible implication in AIDS transmission.

We have studied hemoglobin concentration in saliva of anti-HIV positive and anti-HIV negative intravenous drug abusers (IVDA) and normal controls and the relationship between hemoglobin concentration in saliva and number of CD4+ cells and clinical status of AIDS in anti-HIV positive IVDA. 120 anti-HIV positive IVDA, 112 anti-HIV negative IVDA and 116 normal healthy subjects not belonging to any risk group for HIV infection completed the study. Saliva was collected at awakening before brushing teeth and the concentration of hemoglobin was determined. Hemoglobin concentration in saliva in basal conditions is higher in anti-HIV positive IVDA with respect to anti-HIV negative IVDA (p less than 0.05) and controls (p less than 0.01). In anti-HIV positive IVDA hemoglobin concentration in saliva is higher in subjects with CD4+ cells less than 200/10(6) l with respect to subjects with CD4+ greater than 200/10(6) l (p less than 0.05) and in subjects with ARC/AIDS with respect to subjects with PGL or who are asymptomatic (p less than 0.01). Subjects with ARC/AIDS have a mean concentration of hemoglobin of 19 micrograms/0.1 ml saliva (range 0-153) which corresponds to 1.3 microliters of blood/ml saliva. If 10 ml of saliva are exchanged during kissing an average of 13 microliters of blood are transferred (110 microliters of whole blood at extreme range). Blood of symptomatic patients has an HIV titer of 7 TCID/microliters which for 10 ml saliva containing an average of 1.3 microliters blood/ml saliva corresponds to an average of 90 TCID (770 TCID at the extreme range).(ABSTRACT TRUNCATED AT 250 WORDS

Design and Development of Large-Area FBG-Based Sensing Skin for Collaborative Robotics

Advancements in the field of collaborative robotics have led to a closer cooperation between humans and machines. Sharing the same environment, safety and adaptive control becomes of paramount importance in human-robot interaction. Thus, tactile feedback technologies are crucial to perceive contacts. This work presents the design and development of a polymeric artificial skin, mimicking the human sense of touch in perceiving and localizing pressure over a large area, and its integration on a custom human-like robotic forearm. The sensing system consisted of a curved soft matrix embedding an optical fiber equipped with 16 distributed Fiber Bragg Gratings (FBGs). To estimate the sensitivity of the tactile sensor array, a preliminary mechanical characterization was performed by means of force-controlled indentations. Results show a high correlation between the applied load and the corresponding output of the sensors. In particular, the median value of the sensitivity resulted in 0.26 nm·N-1, with 0.08 nm·N-1 interquartile range. These promising results call for further investigation on spatial sensitivity and force range, contact localization and calibration of the presented artificial skin