The loss of an upper limb significantly limits the functional activities of daily living. A huge emphasis is placed on the manipulation, shape, weight, and comfort of a prosthesis, to enable its use as an inherent body part. Even with technological advances, customized upper-extremity myoelectric prosthesis remain heavy and expensive. The high cost of upper-extremity prosthesis is an especially steep economic barrier for patients. Three-dimensional (3D) printing is a promising avenue for reducing the cost of prosthesis. We applied 3D-printed pressure-sensored prosthetics to a traumatic transradial amputee, and compared the hand functions with a customized myoelectric prosthesis. The 3D-printed pressure-sensored prosthetics showed low grip strength and decreased dexterity compared to the conventional myoelectric prosthesis. Although there were a few limitations, the fabrication of prosthesis with 3D printing technology can overcome previous problems such as high production cost, long fabrication period and heavy weight.
Activities of Daily Living ; Amputation ; Amputees ; Hand Strength ; Hand* ; Humans ; Printing, Three-Dimensional ; Prostheses and Implants ; Prosthesis Fitting ; Upper Extremity

Congenital anomalies, including limb deficiency, affect approximately 7.9 million newborns annually. Fitting the prosthesis at an early stage will aid the patient to achieve two-legged standing, to develop reciprocating gait and to attain an optimal body image. A 64-year-old female diagnosed with congenital limb deficiency, right, using a customized shoe was admitted for prosthetic management at the study hospital. Patient underwent inpatient prosthetic training with physical and occupational therapy. Psychological evaluation was done to assess for depression and anxiety and to determine the patient's response to the prosthesis. The Prosthesis Evaluation Questionnaire (PEQ), an instrument to measure prosthesis-related quality of life and functional outcome, was administered. 3D motion analysis was done to observe the temporospatial parameters of the patient's gait with and without the prosthesis. The patient had generally positive response towards her prosthesis based on PEQ administered 1 month after the provision of prosthesis. Psychological evaluation showed that the patient had improved general outlook after the provision of the prosthesis. Patient had slower self-selected walking speed compared to transtibial amputee using prosthesis. Early fitting and fabrication of prosthesis is recommended for the patient with congenital amputation. Studies showed that delayed fitting of prosthesis may decrease acceptance and use of prosthesis. However, provision of properly fitted prosthesis may still improve the quality of life of the patient who is already functionally independent without it. More than increase in physical activity, participation in leisurely activities that promote social interaction motivates elderly patients to use their prosthesis more often.
Lower Extremity ; Prosthesis Fitting

Size selection of the laryngeal mask airway (LMA) Classic based on actual body weight remains a common practice. However, ideal body weight might allow for a better size selection in obese patients. The purpose of our study was to compare the utility of ideal body weight and actual body weight when choosing the appropriate size of the LMA Classic by a randomized clinical trial. One hundred patients with age 20 to 70 yr, body mass index > or =25 kg/m2, and the difference between LMA sizes based on actual weight and ideal weight were allocated to insert the LMA Classic using either actual body weight or ideal body weight in a weight-based formula for size selection. After insertion of the device, several variables including insertion parameters, sealing function, fiberoptic imaging, and complications were investigated. The insertion success rate at the first attempt was lower in the actual weight group (82%) than in the ideal weight group (96%), even it did not show significant difference. The ideal weight group had significantly shorter insertion time and easier placement. However, fiberoptic views were significantly better in the actual weight group. Intraoperative complications, sore throat in the recovery room, and dysphonia at postoperative 24 hr occurred significantly less often in the ideal weight group than in the actual weight group. It is suggested that the ideal body weight may be beneficial to the size selection of the LMA Classic in overweight patients (Clinical Trial Registry, NCT 01843270).
Adult ; Aged ; *Body Weight ; Equipment Design ; Female ; Human Engineering/*methods ; Humans ; Ideal Body Weight/*physiology ; Laryngeal Masks/*classification ; Male ; Middle Aged ; Overweight/*physiopathology ; Prosthesis Fitting/*methods ; Reproducibility of Results ; Republic of Korea ; Sensitivity and Specificity ; Young Adult

Based on the investigation and analysis of the current situation for hearing aid fitting, some analysis results and suggestions for the development of the industry are presented, including manufacturer, association for medical devices industry and supervision division.
Health Care Sector ; Hearing Aids ; Prosthesis Fitting ; methods

PURPOSE: To investigate the biometric risk factors for corneal surface complications associated with hydrogel soft contact lens (SCL) fitting in myopic patients in Korea. METHODS: This is a retrospective case-control study. The records of 124 subjects (124 eyes) who wore SCLs on a daily basis were reviewed. Thirty-one patients (31 eyes) who were diagnosed with corneal neovascularization (NV) while wearing SCLs were included in the complication group. Ninety-three age- and sex-matched patients (93 eyes) who wore SCLs, who did not have corneal NV and who visited our clinic for correction of refractive errors were included in the control group. The degree of spherical equivalent, astigmatism and corneal base curve radius (BCR) were compared in both groups. RESULTS: Patients with NV exhibited poorer best corrected visual acuity and more myopia than controls (p = 0.008 and 0.006, respectively). In univariate analysis, highly myopic patients (-9 diopters [D] or higher) were more likely to experience NV (odds ratio [OR], 2.232; 95% confidence interval [CI], 1.602 to 3.105). High astigmatism (> or =2 D) increased the risk of complications (OR, 2.717; 95% CI, 1.141 to 6.451). Steep cornea, in which BCR was <7.5 mm, also raised the risk of complications (OR, 4.000; 95% CI, 1.661 to 9.804). Flat cornea was not a risk factor for the development of NV. CONCLUSIONS: High myopia, high astigmatism, and steep cornea seemed to be risk factors in the development of corneal NV in SCL wearers.
Adult ; Astigmatism/diagnosis ; Biometry ; Case-Control Studies ; Contact Lenses, Hydrophilic/*adverse effects ; Corneal Neovascularization/diagnosis/*etiology ; Female ; Humans ; Hydrogel ; Male ; Myopia/diagnosis/*therapy ; Prosthesis Fitting ; Retrospective Studies ; Risk Factors ; Visual Acuity

PURPOSE: Adequate passive-fitting of one-piece cast 3-element implant-supported frameworks is hard to achieve. This short communication aims to present an alternative method for section of one-piece cast frameworks and for casting implant-supported frameworks. MATERIALS AND METHODS: Three-unit implant-supported nickel-chromium (Ni-Cr) frameworks were tested for vertical misfit (n = 6). The frameworks were cast as one-piece (Group A) and later transversally sectioned through a diagonal axis (Group B) and compared to frameworks that were cast diagonally separated (Group C). All separated frameworks were laser welded. Only one side of the frameworks was screwed. RESULTS: The results on the tightened side were significantly lower in Group C (6.43 +/- 3.24 microm) when compared to Groups A (16.50 +/- 7.55 microm) and B (16.27 +/- 1.71 microm) (P<.05). On the opposite side, the diagonal section of the one-piece castings for laser welding showed significant improvement in the levels of misfit of the frameworks (Group A, 58.66+/-14.30 microm; Group B, 39.48+/-12.03 microm; Group C, 23.13+/-8.24 microm) (P<.05). CONCLUSION: Casting diagonally sectioned frameworks lowers the misfit levels. Lower misfit levels for the frameworks can be achieved by diagonally sectioning one-piece frameworks.
Axis, Cervical Vertebra ; Dental Implants ; Dental Prosthesis, Implant-Supported ; Dental Soldering ; Denture, Partial, Fixed ; Prostheses and Implants ; Prosthesis Fitting ; Prosthodontics ; Welding

OBJECTIVES: The stimulation levels programmed in cochlear implant systems are affected by an evolution since the first switch-on of the processor. This study was designed to evaluate the changes in stimulation levels over time and the relationship between post-implantation physiological changes and with the hearing experience provided by the continuous use of the cochlear implant. METHODS: Sixty-two patients, ranging in age from 4 to 68 years at the moment of implantation participated in this study. All subjects were implanted with the 12 channels COMBI 40+ cochlear implant at San Cecilio University Hospital, Granada, Spain. Hearing loss etiology and progression characteristics varied across subjects. RESULTS: The analyzed programming maps show that the stimulation levels suffer a fast evolution during the first weeks after the first switch-on of the processor. Then, the evolution becomes slower and the programming parameters tend to be stable at about 6 months after the first switch-on. The evolution of the stimulation levels implies an increment of the electrical dynamic range, which is increased from 15.4 to 20.7 dB and improves the intensity resolution. A significant increment of the sensitivity to acoustic stimuli is also observed. For some patients, we have also observed transitory changes in the electrode impedances associated to secretory otitis media, which cause important changes in the programming maps. CONCLUSION: We have studied the long-term evolution of the stimulation levels in cochlear implant patients. Our results show the importance of systematic measurements of the electrode impedances before the revision of the programming map. This report also highlights that the evolution of the programming maps is an important factor to be considered in order to determine an adequate calendar fitting of the cochlear implant processor.
Acoustics ; Cochlear Implants ; Electric Impedance ; Electric Stimulation ; Electrodes ; Hearing ; Hearing Loss ; Humans ; Otitis Media with Effusion ; Prosthesis Fitting ; Spain

OBJECTIVETo evaluate the long-term changes in the quality of life (QOL) scores in elderly patients after aortic valve replacement, and assess the impact of prosthesis-patient mismatch on the QQL of the patients.

METHODSA prospective cohort study was conducted involving 100 consecutive elderly patients above 70 years of age, who underwent isolated aortic valve or simultaneous aortic valve-coronary artery bypass graft (CABG) procedures between August 10, 1995 and August 19, 1998. Patient-prosthesis mismatch (PPM) was defined as a prosthetic aortic valve EOAI of 0.85 cm2/m2 or less. The clinical follow-up examinations were carried out at 4 weeks and 6 months after the operation, and then annually afterwards. Cumulative and comparative analyses of the long-term outcomes and gradient pressure of the prosthetic valve were performed. The QOL of the patients was evaluated using the Short Form 36-Item Health Survey (SF-36) questionnaire.

RESULTSThe mean age of the patients at prosthesis implantation was 74.7-/+5.7 years (range 70-87 years). The patients were followed up for a mean of 7.3-/+4.5 years. The thirty-day mortality was 6.3% in the mismatch group, and 3.3% in the matching group. The freedom from death showed no significant difference between the two groups at the first, third and fifth years after the prosthetic implantation, but differed significantly at the seventh year. The echocardiographic data showed significant differences in the mean gradient pressure between the two groups at the first and fifth years postoperatively. At most of the time points for follow-up examination, the general health and energy/vitality of the patients all improved from the preoperative levels, but no significant improvement was found at the third, fifth, and seventh years in the role emotional, social role, or general mental health; at the first postoperative year, however, the role emotional, social role, and particularly mental health, presented with significant improvements in comparison with the preoperative levels. No obvious difference in the QOL was noted between the two groups at the time points of observation.

CONCLUSIONSAortic vale replacement improves the QOL of the elderly patients, but the degree of improvements do not seem to be influenced by PPM. The interpretation of the impact of PPM on the clinic outcome of the patients still remains controversial.

Aged ; Aged, 80 and over ; Aortic Valve ; physiopathology ; surgery ; Aortic Valve Insufficiency ; surgery ; Aortic Valve Stenosis ; surgery ; Bioprosthesis ; Female ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation ; methods ; Humans ; Male ; Postoperative Period ; Prospective Studies ; Prosthesis Design ; Prosthesis Fitting ; adverse effects ; Quality of Life ; Ventricular Dysfunction, Left ; physiopathology

Despite advances in surgical techniques and instrumentation, current intra-operative estimations of acetabular version in total hip arthroplasty are of limited accuracy. In the present study, two experienced orthopedic surgeons compared intra-operatively measured (using portable imaging) anteversions and vertical inclinations of acetabular components with those measured using standardized radiographs post-operatively in 40 patients. Of the all vertical inclinations measured from intra-operative radiographs, 72.5% (n=29) were within +/-2degrees, and 97.5% (n=39) were within +/-5degrees of those determined using post-operative radiographs, and for anteversion, 52.5% (n=21) were within +/-2degrees, and 97.5% (n=39) were within +/-5degrees. Post-operative radiographs demonstrated that 90.0% (n=36) of vertical inclinations and anteversions were within the adequate zone. Obviously, our method has its limitations, but the authors conclude that the method described in this article better allows surgeons to verify acetabular version intra-operatively. In particular, the described method is suitable in cases with a deformed acetabular anatomy and difficult revision surgery.
Acetabulum/radiography/*surgery ; Adult ; Aged ; Aged, 80 and over ; *Arthroplasty, Replacement, Hip ; Female ; Hip Joint/*radiography/surgery ; Hip Prosthesis ; Humans ; Imaging, Three-Dimensional/methods ; Intraoperative Care/*instrumentation/methods ; Male ; Middle Aged ; Prosthesis Fitting

At present, foreign standard knee joint prosthesis is mostly used in clinical practice; it can well represent the biological characteristic of knee joint on human being. So this paper adopts the reverse engineering technology in that connexion, presents novel positioning method of acquiring the point data on the surface of knee joint prosthesis, puts forward the algorithm of three-point angle method for removing the noise error and correcting the noise error based on the least squares plane to smooth point cloud. And then, the surface of knee joint prosthesis with better accuracy and smoothness can be generated. Finally, the knee joint prosthesis model can be generated. Thus, a basis is provided for the localization of knee joint prosthesis. This new algorithm is mainly used for the surface modeling based on point cloud smoothing, including the surface of knee joint prosthesis, the surface of regular shape, and the surface with gentle change in curvature.
Computer-Aided Design ; Humans ; Knee Joint ; anatomy & histology ; surgery ; Knee Prosthesis ; Prosthesis Design ; methods ; Prosthesis Fitting ; methods