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Background: The level of spinal cord injury affects the severity of respiratory impairment and the alteration of respiratory pattern and gas exchanges. Lesions at the C3-C5 level (phrenic nerve nucleus) cause disruption of descending input with paralysis of the main inspiratory muscle, often requiring tracheostomy and prolonged mechanical ventilation. Oxygen therapy is essential to switch from ventilatory support to removal of the endotracheal tube to correct residual difficulties in oxygenation management. Case Presentation: A 58-year-old man had tracheostomy and tetraparesis as complication of tonsillectomy and adenoidectomy treatment for a history of obstructive sleep apnea. A respiratory rehabilitation program with protocol of oxygen therapy with high flow cannula alternated with a low-flow system by Venturi mask during daytime hours only was started. The patient was constantly monitored with capillary partial oxygen saturation to obtain adequate oxygenation (> 94%) and registered every 15 minutes in the clinical chart. There was gradual improvement of respiratory function. Oxygen by Venturi mask was gradually reduced due to improvement of partial pressure oxygen values. Over the course of days, the optimal results of respiratory parameters led to a gradual weaning from the Venturi mask until the complete discontinuation of the low-flow system during daytime and decreased of the high-flow fraction of inspired oxygen to the maximal tolerated level during nighttime. Conclusions: Implementing a combined protocol of nighttime oxygen with high flow cannula and daytime Venturi mask improves intensive motor training of patients by promoting the acquisition of ability to perform chair/bed transitions and to be able to achieve standing and begin gait training. More research is needed whether or noted to determine the role of this promising approach in patients with severe SCI and in other critically ill patients.

Arctic seabirds are key bio-indicators of marine plastic pollution due to their transient movement and large populations. Although many studies have quantified the ingestion of microplastic particles (100 µm in size), 19 of which were analyzed for material composition using Fourier Transform Infrared Spectroscopy and Raman micro-spectroscopy. Of these, 13 particles were successfully matched to materials, with five as plastic. This produced an average concentration of 0.08 ± 0.28 microplastic particles per fecal sample, with no difference of occurrence between chicks and adults. Particle lengths ranged from 113 - 751 µm. The presence of microplastics larger than our lower limit of detectability of 100-µm suggests a need for analysis of smaller particles and microfibers in this species. We contribute to understanding how microplastics pass through little auks and characterize how this species interacts with the plastic pathways.

Abstract Urinary tract infections (UTIs) are the most common bacterial infections and uropathogenic Escherichia coli (UPEC) is the main etiological agent of UTIs. UPEC can persist in bladder cells protected by immunological defenses and antibiotics and intracellular behavior leads to difficulty in eradicating the infection. The aim of this paper is to design, prepare and characterize surfactant-based nanocarriers (niosomes) able to entrap antimicrobial drug and potentially to delivery and release antibiotics into UPEC-infected cells. In order to validate the proposed drug delivery system, gentamicin, was chosen as “active model drug” due to its poor cellular penetration. The niosomes physical–chemical characterization was performed combining different techniques: Dynamic Light Scattering Fluorescence Spectroscopy, Transmission Electron Microscopy. Empty and loaded niosomes were characterized in terms of size, ζ-potential, bilayer features and stability. Moreover, Gentamicin entrapped amount was evaluated, and the release study was also carried out. In addition, the effect of empty and loaded niosomes was studied on the invasion ability of UPEC strains in T24 bladder cell monolayers by Gentamicin Protection Assay and Confocal Microscopy. The observed decrease in UPEC invasion rate leads us to hypothesize a release of antibiotic from niosomes inside the cells. The optimization of the proposed drug delivery system could represent a promising strategy to significatively enhance the internalization of antimicrobial drugs.

Background/Objectives: Neuronal Ceroid Lipofuscinosis type 2 is a rare pathology affecting mainly the central nervous system (CNS) and retina, and is caused by variants in the gene encoding the lysosomal enzyme tripeptidyl peptidase 1. Therapy with enzyme replacement through the brain infusion of the orphan drug cerliponase alfa, a recombinant human tripeptidyl peptidase 1 enzyme replacement therapy delivered via intracerebroventricular infusion, has been approved for Neuronal Ceroid Lipofuscinosis type 2 disease. The safety profile of cerliponase alfa has been established based on pre-authorization studies; currently, no post-marketing investigation has been performed to confirm it. Here, a descriptive analysis of real-world spontaneous reporting data of suspected adverse reactions (SARs) to cerliponase alfa in the EudraVigilance database was performed to compile clear information on the safety profile. Methods: Suspected adverse reactions to cerliponase alfa reported in the data system EudraVigilance were analyzed for age, sex of the patient, adverse reactions, and the indication for use. Results: Cases with suspected adverse reactions to cerliponase alfa were found to be more frequent in female patients (58.1%) and in children aged 3–11 years. The most common adverse reactions were, in decreasing order, fever/pyrexia, device-related infection, vomiting, seizures/convulsions, pleocytosis, irritability, ventriculitis, and respiratory disorders. Conclusions: The results confirm the safety profile of cerliponase alfa established with pre-registration clinical studies but suggest the need for further studies to investigate the occurrence of adverse reactions, as possible predictive prognostic markers, in more depth.

The constellation fish, Valenciennellus tripunctulatus, is a small mesopelagic teleost typically found in equatorial and temperate waters worldwide, although the species has been also rarely recorded in the Mediterranean Sea (less than 20 specimens from the available literature since 1918). The Mediterranean records have been documented for the Strait of Messina, the southern Tyrrhenian Sea, the Ligurian Sea and the Adriatic Sea. The present paper offers an updated review on the occurrence of V. tripunctulatus in the Mediterranean basin and provides data on three new specimens, collected in the Strait of Messina between April 2010 and March 2024. Furthermore, we also report information from two individuals found in March 1992 and February 2017, respectively. Overall, the standard length of these specimens ranged from 24.1 to 28.2 mm, whereas weight varied from 0.18 g to 0.20 g. Morphometric and meristic data were reported, and this analysis revealed few differences between examined individuals in the number of PV (ventral series anterior to pelvic fin base) and AC (from anal fin origin to caudal fin base) photophore series. The relationship between total length and standard length (SL = 0.75 × TL + 2.98), total length and head length (HL = 0.17 × TL + 1.47) and standard length and head length (HL = 0.23 × SL + 0.88) showed high correlation values. Considering the lack of data on this species in the Mediterranean, updating morphometric, meristic, biological, ecological and distribution information is very important for taxonomic purposes and useful in understanding the characteristics of the regional population and eventual differences between Mediterranean stock(s) and those from other oceanic areas.

Introduction: Unlike the most common training approaches for bodybuilding, powerlifting programs are generally based on maximum and submaximal loads, putting enormous stresses on the lumbar spine. The flexion relaxation phenomenon evaluation is a clinical tool used for low back pain (LBP) assessment. This study aimed to evaluate the role of the flexion relaxation phenomenon in the analysis of LBP in the powerlifters. Methods: Healthy professional powerlifters participated in the study. In fact, we divided the participants into a LBP-low-risk group and a LBP-high-risk group, based on a prior history of LBP. Outcome measures included flexion relaxation ratio (FRR) and trough surface electromyography collected during trunk maximum voluntary flexion; furthermore, during a bench press lifting, we measured the height of the arched back (ARCH), using a camera and the Kinovea video editing software, to consider a potential correlation with the risk of LBP. Results: We included a group of 18 male (aged 24–39 y) powerlifters of 93 kg category. We measured a nonsignificant mean difference of ARCH between low-risk LBP group and high-risk LBP subjects. Curiously, maximum voluntary flexions were both above the threshold of 3.2 μV; therefore, with an absence of appropriate myoelectric silence, on the contrary, the FRR ratios were higher than 9.5, considering the presence of the phenomenon, exclusively for the low-risk group. The lumbar arched back measurement data did not report any association with the LBP risk, regarding the maximum voluntary flexion value, and even more than the FRR there is a relationship with the presence or the absence of LBP risk. Conclusions: FRR could be considered as a useful parameter for studying the risk of LBP in powerlifting. The FRR index not only refers to the possible myoelectric silence of the lumbar muscles in trunk maximum forward flexion but also takes into account the energy value delivered by the lumbar muscles during the flexion. Furthermore, we can indicate that the size of the powerlifter ARCH may not be a determining factor in the occurrence of LBP. [ABSTRACT FROM AUTHOR]

Scapular dyskinesia, glenohumeral internal rotation deficit, upper posterior labral anterior tears, and rotator cuff injuries are common in athletes who play “overhead” sports due to their repetitive excessive movements. The aims of this study are to propose a new protocol with kinematic analysis coupled with sEMG and to objectively analyze the effect of a specific prevention exercise protocol. Thirty-two subjects (age: 22 ± 4 years, height: 183 ± 3.2 cm, BMI: 23 ± 0.96 kg/m2), including sixteen healthy subjects (Group A) and sixteen male water polo athletes (Group B), underwent a three-dimensional motion analysis based on optoelectronic and sEMG systems. A functional evaluation was performed on Group A and Group B to assess the reliability of the operator-dependent tasks and collect a series of normative data, before starting the prevention protocol (T0) and after 8 weeks (T1). The athletes performed a specific exercise protocol to prevent shoulder injuries. In Group B, the movements of abduction (T0: 111° ± 24°; T1: 140° ± 13°) and extension (T0: 72°± 10°; T1: 84° ± 2.8°) of the glenohumeral joint and the scapulothoracic joint (T0: 33° ± 8.36°; T1: 40.5° ± 10.6°) significantly improved. A significant reduction (in %) in the maximum voluntary contraction (MCV) at T1 of the upper trapezius, teres minor, and pectoralis major was observed. This protocol provides objective data in a simple and reliable way for the functional assessment of the shoulder in water polo players during the sport season.

In the global context, advancements in technology and science have rendered virtual, augmented, and mixed-reality technologies capable of transforming clinical care and medical environments by offering enhanced features and improved healthcare services. This paper aims to present a mixed reality-based system to control a robotic wheelchair for people with limited mobility. The test group comprised 11 healthy subjects (six male, five female, mean age 35.2 ± 11.7 years). A novel platform that integrates a smart wheelchair and an eye-tracking-enabled head-mounted display was proposed to reduce the cognitive requirements needed for wheelchair movement and control. The approach’s effectiveness was demonstrated by evaluating our system in realistic scenarios. The demonstration of the proposed AR head-mounted display user interface for controlling a smart wheelchair and the results provided in this paper could highlight the potential of the HoloLens 2-based innovative solutions and bring focus to emerging research topics, such as remote control, cognitive rehabilitation, the implementation of patient autonomy with severe disabilities, and telemedicine.

Most clinical isolates of both Staphylococcus aureus and Staphylococcus epidermidis show the capacity to adhere to abiotic surfaces and to develop biofilms resulting in a contribution to chronic human skin infections. Antibiotic resistance and poor biofilm penetration are the main causes of ineffective therapeutic treatment in killing bacteria within biofilms. A possible strategy could be represented by drug delivery systems, such as nanoemulsions (composed of bioactive oil, surfactant and water phase), which are useful for enhancing the drug permeation of a loaded drug inside the biofilm and its activity. Phytochemical characterization of Pistacia lentiscus oil (LO) by direct infusion Fourier-transform ion cyclotron resonance mass spectrometry (FT-ICR MS) allowed the identification of bioactive compounds with antimicrobial properties, including fatty acids and phenolic compounds. Several monoterpenes and sesquiterpenes have been also detected and confirmed by gas chromatography–mass spectrometric (GC-MS) analysis, together providing a complete metabolomic profiling of LO. In the present study, a nanoemulsion composed of LO has been employed for improving Levofloxacin water solubility. A deep physical–chemical characterization of the nanoemulsion including hydrodynamic diameter, ζ-potential, morphology, entrapment efficiency, stability release and permeation studies was performed. Additionally, the antimicrobial/antibiofilm activity of these preparations was evaluated against reference and clinical Staphylococcus spp. strains. In comparison to the free-form antibiotic, the loaded NE nanocarriers exhibited enhanced antimicrobial activity against the sessile forms of Staphylococcus spp. strains.

This perspective explains why the lack of regulation around bioplastics remains a hurdle for the successful development and implementation of a legally binding agreement (the Global Plastics Treaty) by the United Nations Environment Assembly to curb plastic pollution by 2024. For example, bioplastics have been marketed to consumers as the panacea solution to our plastic waste crisis. Of the >400 million tonnes of plastics produced each year,

Spasticity is a very common sign in the neurological field. It can be defined as “a motor disorder marked by a velocity-dependent increase in muscle tone or tonic stretch reflexes” associated with hypertonia. It leads to a high risk of limb deformities and pain that prejudices residual motor function, impairing quality of life”. The treatment of spasticity depends on its severity and its location and, in general, it is based on rehabilitation, oral therapies (the gamma-aminobutyric acid b agonist baclofen) and injectable medications (i.e., botulin toxins, acting on polysynaptic reflex mechanisms). The botulin toxin type A (BoNT-A) injection has been effectively used to improve different types of spasticity. However, when BoNT-A is not sufficient, a combination of nonpharmacological approaches could be attempted. Therefore, additional intervention, such as conventional physical therapy by itself or further combined with robotic gait training, may be needed. Indeed, it has been shown that combination of BoNT-A and robotics has a positive effect on activity level and upper limb function in patients with stroke, including those in the chronic phase. The aim of this review is to evaluate the efficacy of pharmacological or nonpharmacological treatment in combination with BoNT-A injections on spasticity. The combined therapy of BoNT with conventional or adjunct activities or robot-assisted training, especially with end-effectors, is a valid tool to improve patients’ performance and outcomes. The combined strategies might rise the toxin’s effect, lowering its dosages of botulinum and reducing side effects and costs.

Although rehabilitation medicine emphasizes a holistic health approach, there is still a large gap of knowledge about potential interventions aimed at improving overall wellbeing through cosmetic interventions. Therefore, this narrative review investigates the role of different rehabilitative techniques in enhancing aesthetics, quality of life, and psychosocial wellbeing for patients with disabilities. The study follows the SANRA framework quality criteria for a narrative review. Literature searches across PubMed/Medline, Web of Science, and Scopus identified articles focusing on rehabilitation strategies within the aesthetic rehabilitation domain. The review identified evidence supporting injection procedures, such as Botulinum Toxin, Platelet-Rich Plasma, Hyaluronic Acid, Ozone, and Carboxytherapy, and assessing their applications in several disabling disorders. Additionally, physical therapies like Extracorporeal Shock Wave Therapy, Laser Therapy, Microcurrent Therapy, Tecar Therapy, and physical exercises were explored for their impact on cutaneous microcirculation, cellulite treatment, wound healing, and scar appearance improvement. Lastly, the manuscript underlines the role of manual therapy techniques in addressing both physical discomfort and aesthetic concerns, discussing their effectiveness in adipose tissue therapy, scar tissue mobilization, and regional fat thickness reduction. Taken together, this review emphasizes the role of a multidisciplinary approach, aiming to provide valuable insights into potential benefits for both functional and aesthetic outcomes.

Background: Evolocumab is a humanized immunoglobulin G2 monoclonal antibody, directed against Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9), prescribed in hypercholesterolemic patients. The safety profile of this drug is currently defined by the data of pre-authorization clinical trials. The purpose of this study is to update knowledge of the safety of evolocumab through an analysis of post-marketing real-world data on suspected adverse reactions (SARs), reported by the EudraVigilance database system. Methods: The public version of the EudraVigilance database has been used, and only serious SARs signals were included. Results: Musculoskeletal system disorders, flu-like symptoms, injection-site reactions, skin reactions, and metabolism and nutrition disorders are observed in the post-marketing surveillance, as well as being found in the pre-authorization studies. Not previously signaled in the pre-marketing studies, diarrhea was reported. Furthermore, signals related to cardiac adverse reactions, more frequently at the expense of adults in comparison to elders, were found. Conclusions: The post-marketing safety profile of evolocumab emerging from an analysis of the EudraVigilance data system indicates it is sufficiently safe but suggests the necessity for caution when it is prescribed to hyperlipidemic patients affected by heart diseases.

Background: Chronic post-surgical pain is a condition persisting for not less than 3 months after surgical intervention. It is evaluated that 25–60% of women who underwent breast cancer excision suffer from post-mastectomy pain syndrome, and anxiety, depression, sleep disturbance, and catastrophizing. Physical activity can reduce the risk of chronic diseases and has a good impact on mood and cognitive function. The aim of this study was to estimate the influence of physical activity on the intensity of pain, depression, and anxiety in women who underwent mastectomy for breast cancer removal. Methods: A prospective observational unicentric cohort study was performed. Patients were females who underwent unilateral or bilateral mastectomy. The Numerical Rating Scale (NRS) was used to measure pain intensity, Beck’s Depression Inventory (BDI) for depression, and Generalized Anxiety Disorders-7 (GAD-7) for anxiety evaluation. Physical activity was assessed by the International Physical Activity Questionnaire (IPAQ). Interleukin (IL)-17, IL-1β, cortisol, adrenocorticotropic hormone (ACTH), and brain-derived neurotrophic factor (BDNF) were also evaluated in the blood of patients. All evaluations were assessed 3 and 6 months after the surgery. Results: Adequate physical activity reduced the intensity of pain, depression, and anxiety symptoms in women affected by post-mastectomy pain syndrome. Moreover, adequately active women showed a reduction in biomarkers of inflammation, cortisol, ACTH, and an increase of BDNF. Conclusions: Our results suggest that physical activity can improve the quality of life, reduce the intensity of pain and inflammatory markers, and be useful in the reduction of associated anxiety and depression.

Background/Objectives: Neuronal Ceroid Lipofuscinosis type 2 is a rare pathology affecting mainly the central nervous system (CNS) and retina, and is caused by variants in the gene encoding the lysosomal enzyme tripeptidyl peptidase 1. Therapy with enzyme replacement through the brain infusion of the orphan drug cerliponase alfa, a recombinant human tripeptidyl peptidase 1 enzyme replacement therapy delivered via intracerebroventricular infusion, has been approved for Neuronal Ceroid Lipofuscinosis type 2 disease. The safety profile of cerliponase alfa has been established based on pre-authorization studies; currently, no post-marketing investigation has been performed to confirm it. Here, a descriptive analysis of real-world spontaneous reporting data of suspected adverse reactions (SARs) to cerliponase alfa in the EudraVigilance database was performed to compile clear information on the safety profile. Methods: Suspected adverse reactions to cerliponase alfa reported in the data system EudraVigilance were analyzed for age, sex of the patient, adverse reactions, and the indication for use. Results: Cases with suspected adverse reactions to cerliponase alfa were found to be more frequent in female patients (58.1%) and in children aged 3–11 years. The most common adverse reactions were, in decreasing order, fever/pyrexia, device-related infection, vomiting, seizures/convulsions, pleocytosis, irritability, ventriculitis, and respiratory disorders. Conclusions: The results confirm the safety profile of cerliponase alfa established with pre-registration clinical studies but suggest the need for further studies to investigate the occurrence of adverse reactions, as possible predictive prognostic markers, in more depth. [ABSTRACT FROM AUTHOR]

BACKGROUND: Glenohumeral degenerative joint disease may affect up to 20% of the population. There are several classification systems of this disease in the scientific literature. OBJECTIVE: The aim of this study is to determine the reliability and reproducibility of glenohumeral osteoarthritis classification systems. METHODS: We assessed glenohumeral plain radiographs performed in a University Hospital. These radiographs were graded into nine radiological classification systems by two observers on two evaluations. Patients who have performed CT/MRI scan were staged according to the Walch classification. The intra-observer and inter-observer reliability of the classification schemes were determined by using Cohen's weighted kappa coefficient. RESULTS: A total of 752 patients were included in the study (52.4% females and 47.6% males), mean aged 66.2 ± 16.3 years. The intra-observer and inter-observer reliabilities were 0.543 (observer 1), 0.630 (observer 2), and 0.760 (inter-observer) for the Weinstein grading system; 0.661, 0.706, and 0.761 for the Guyette grading system; 0.575, 0.679 and 0.704 for the Kellgren and Lawrence classification; 0.817, 0.816 e 0.871 for the Samilson and Prieto classification; 0.791, 0.811 and 0.847 for the Allain modification; 0.797, 0.842 and 0.860 for the Gerber modification; 0.773, 0.827 and 0.828 for the Buscayret modification; 0.584, 0.648 and 0.755 for the Hawkins and Angelo classification; 0.661, 0.749 and 0.764 for the Rosenberg classification. Intra-observer reliability for MRI was 0.757 (observer 1) and 0.675 (observer 2), while intra-observer reliability for CT was 0.811 (observer 1) and 0.653 (observer 2). Inter-observer reliabilities were 0.790 for MRI and 0.673 for CT. CONCLUSION: The classification systems according to Weinstein, Guyette, Hawkins and Angelo, Rosenberg and the modifications of the Samilson and Prieto classification according to Allain, Gerber and Buscayret showed a comparable reliability with the commonly used glenohumeral osteoarthritis grading systems, Samilson and Prieto and Kellgren and Lawrence. Thus, they are recommended for clinical and especially scientific purposes. [ABSTRACT FROM AUTHOR]

The constellation fish, Valenciennellus tripunctulatus, is a small mesopelagic teleost typically found in equatorial and temperate waters worldwide, although the species has been also rarely recorded in the Mediterranean Sea (less than 20 specimens from the available literature since 1918). The Mediterranean records have been documented for the Strait of Messina, the southern Tyrrhenian Sea, the Ligurian Sea and the Adriatic Sea. The present paper offers an updated review on the occurrence of V. tripunctulatus in the Mediterranean basin and provides data on three new specimens, collected in the Strait of Messina between April 2010 and March 2024. Furthermore, we also report information from two individuals found in March 1992 and February 2017, respectively. Overall, the standard length of these specimens ranged from 24.1 to 28.2 mm, whereas weight varied from 0.18 g to 0.20 g. Morphometric and meristic data were reported, and this analysis revealed few differences between examined individuals in the number of PV (ventral series anterior to pelvic fin base) and AC (from anal fin origin to caudal fin base) photophore series. The relationship between total length and standard length (SL = 0.75 × TL + 2.98), total length and head length (HL = 0.17 × TL + 1.47) and standard length and head length (HL = 0.23 × SL + 0.88) showed high correlation values. Considering the lack of data on this species in the Mediterranean, updating morphometric, meristic, biological, ecological and distribution information is very important for taxonomic purposes and useful in understanding the characteristics of the regional population and eventual differences between Mediterranean stock(s) and those from other oceanic areas. [ABSTRACT FROM AUTHOR]

Purpose: Narrative Medicine complements the clinically centered approach, which focuses on the analytical and sanitary aspects, with the illness- and disorder- centered models, which deal respectively, with personal coping and social perception of a condition. Hypermobile Ehlers- Danlos Syndrome and Behçet's Disease are two rare multisystemic chronic disease experienced a myriad of clinical symptoms, psychological distress, and poor quality of life. The purpose of this report is to describe application of a multidisclipinary rehabilitation intervention according to the narrative medicine. Case description and Intervention: a 35-year-old woman with a 23-year history of Hypermobile Ehlers-Danlos Syndrome and Behçet's Disease was admitted. A multimodal rehabilitation approach was implemented and described through the patient's feelings and expected short-, medium-, and long- terms goals. Moreover, she reported her feeling with periodical interview by her therapist. History patient: The patient was seen for 32 weeks. A decreased pain, as well as improved function was recorded immediately post-intervention. Conclusion: Narration is not just an interpretation of the illness experience, but the result of reshaping the interpretations of the story that both patient and health professional. This discipline provides enrichment of care, especially when combined with rehabilitation in chronic disease, by paying attention to and using even in the therapeutic phase the stories of patients, family and health care personnel, giving the opportunity to define a tailored effectiveness rehabilitation approach at the light of the different points of view of the subjects. IMPLICATIONS FOR REHABILITATION: Narrative Medicine might play a key role in an interpretation of the illness experience to implement a multidisciplinary tailored rehabilitation approach. Narrative Medicine can help understand discomfort and difficulty associated with rehabilitation activities, thereby enhancing patient motivation and participation in interdisciplinary care. The Ehlers–Danlos Syndrome is a heterogeneous group of heritable connective tissue disorders representing a challenge in rehabilitation. Behçet's Disease is a rare multisystemic chronic disease experiencing an impaired function and a poor quality of life. A patient-oriented multimodal rehabilitation showed to be a useful approach in the case with both diseases, with a reduction of pain and an improvement of functioning. [ABSTRACT FROM AUTHOR]

BACKGROUND: Fibromyalgia is a debilitating condition marked by persistent pain and reduced functionality. Various therapeutic methods have been suggested to alleviate symptoms in individuals with fibromyalgia, yet the impact of diverse rehabilitation strategies remains unclear. OBJECTIVE: This systematic review and meta-analysis aimed at assessing the efficacy of rehabilitation interventions in improving functioning in fibromyalgia patients. METHODS: We conducted a comprehensive literature search of multiple international databases (PubMed, Scopus, and Web of Science) from their inception until November 22nd, 2023. We identified 23 randomized controlled trials (RCTs) assessing multiple rehabilitation strategies. The primary outcome was the Fibromyalgia Impact Questionnaire (FIQ). Study quality was assessed using the Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2). The study protocol was registered in PROSPERO (CRD42020197666). RESULTS: Our meta-analysis rehabilitation interventions significantly reduce FIQ scores (MD = - 11.74, 95% CI: - 16.88 to - 6.59, p < 0.0001). Notably, the subgroup analysis showed that different rehabilitation modalities seem to induce different therapeutic responses. CONCLUSIONS: Rehabilitation strategies hold promise in addressing the functional impairments and improving the overall well-being of individuals with fibromyalgia. The study underscores the need for further research to determine the optimal rehabilitation approach and its potential impact on the multilevel disability characterizing patients with fibromyalgia. [ABSTRACT FROM AUTHOR]

Featured Application: The proposed kinematic analysis protocol can play a role in detecting electromyographic and kinematic alterations of the shoulder for the pre-clinical detection of the risk factors for overuse pathologies. Moreover, the proposed exercise prevention protocol has shown valuable results in optimizing shoulder movement and can be proposed to overhead athletes as a part of their athletic preparation. Scapular dyskinesia, glenohumeral internal rotation deficit, upper posterior labral anterior tears, and rotator cuff injuries are common in athletes who play "overhead" sports due to their repetitive excessive movements. The aims of this study are to propose a new protocol with kinematic analysis coupled with sEMG and to objectively analyze the effect of a specific prevention exercise protocol. Thirty-two subjects (age: 22 ± 4 years, height: 183 ± 3.2 cm, BMI: 23 ± 0.96 kg/m2), including sixteen healthy subjects (Group A) and sixteen male water polo athletes (Group B), underwent a three-dimensional motion analysis based on optoelectronic and sEMG systems. A functional evaluation was performed on Group A and Group B to assess the reliability of the operator-dependent tasks and collect a series of normative data, before starting the prevention protocol (T0) and after 8 weeks (T1). The athletes performed a specific exercise protocol to prevent shoulder injuries. In Group B, the movements of abduction (T0: 111° ± 24°; T1: 140° ± 13°) and extension (T0: 72°± 10°; T1: 84° ± 2.8°) of the glenohumeral joint and the scapulothoracic joint (T0: 33° ± 8.36°; T1: 40.5° ± 10.6°) significantly improved. A significant reduction (in %) in the maximum voluntary contraction (MCV) at T1 of the upper trapezius, teres minor, and pectoralis major was observed. This protocol provides objective data in a simple and reliable way for the functional assessment of the shoulder in water polo players during the sport season. [ABSTRACT FROM AUTHOR]

The aim of our study is to inform the development of a rehabilitation program of care from the perspectives of those suffering from degenerative cervical radiculopathy (DCR). We conducted a qualitative study, purposefully recruiting individuals with DCR. Transcripts from virtual semi-structured interviews were iteratively analyzed using interpretative phenomenological methods. Eleven participants were recruited and depicted their ideal rehabilitation program of care. Participants described the importance of a patient centered-approach, health care providers who were validating, reassuring and attentive, easier access to health services, a supportive and collaborative team environment, and receiving peer support. Furthermore, participants expressed that they would expect the program of care to result in their symptoms being less intense and intermittent. In consideration of the participant perspectives, the ideal rehabilitation program of care can be conceptualized by the enactive-biopsychosocial model, which provides a theoretical framework for developing and implementing the program of care. We obtained valuable information from individuals living with DCR regarding their preferences and expectations of a rehabilitation program of care. The participant descriptions will provide the groundwork for its development to meet patient needs and expectations. Future research to guide implementation will also be explored. The lives of those suffering from cervical radiculopathy are significantly impacted. Incorporating patient perspectives in the development of care plans can lead to the inclusion of interventions considered patient-centered and may improve implementation, adherence, and outcomes. Participants described their preferences and expectations of a rehabilitation program of care that may assist in its future development to meet patient needs and expectations. From participants' perspectives, the ideal rehabilitation program of care would be framed by the enactive-biopsychosocial model, thus providing a theoretical context for its development and implementation. [ABSTRACT FROM AUTHOR]

In the global context, advancements in technology and science have rendered virtual, augmented, and mixed-reality technologies capable of transforming clinical care and medical environments by offering enhanced features and improved healthcare services. This paper aims to present a mixed reality-based system to control a robotic wheelchair for people with limited mobility. The test group comprised 11 healthy subjects (six male, five female, mean age 35.2 ± 11.7 years). A novel platform that integrates a smart wheelchair and an eye-tracking-enabled head-mounted display was proposed to reduce the cognitive requirements needed for wheelchair movement and control. The approach's effectiveness was demonstrated by evaluating our system in realistic scenarios. The demonstration of the proposed AR head-mounted display user interface for controlling a smart wheelchair and the results provided in this paper could highlight the potential of the HoloLens 2-based innovative solutions and bring focus to emerging research topics, such as remote control, cognitive rehabilitation, the implementation of patient autonomy with severe disabilities, and telemedicine. [ABSTRACT FROM AUTHOR]

Most clinical isolates of both Staphylococcus aureus and Staphylococcus epidermidis show the capacity to adhere to abiotic surfaces and to develop biofilms resulting in a contribution to chronic human skin infections. Antibiotic resistance and poor biofilm penetration are the main causes of ineffective therapeutic treatment in killing bacteria within biofilms. A possible strategy could be represented by drug delivery systems, such as nanoemulsions (composed of bioactive oil, surfactant and water phase), which are useful for enhancing the drug permeation of a loaded drug inside the biofilm and its activity. Phytochemical characterization of Pistacia lentiscus oil (LO) by direct infusion Fourier-transform ion cyclotron resonance mass spectrometry (FT-ICR MS) allowed the identification of bioactive compounds with antimicrobial properties, including fatty acids and phenolic compounds. Several monoterpenes and sesquiterpenes have been also detected and confirmed by gas chromatography–mass spectrometric (GC-MS) analysis, together providing a complete metabolomic profiling of LO. In the present study, a nanoemulsion composed of LO has been employed for improving Levofloxacin water solubility. A deep physical–chemical characterization of the nanoemulsion including hydrodynamic diameter, ζ-potential, morphology, entrapment efficiency, stability release and permeation studies was performed. Additionally, the antimicrobial/antibiofilm activity of these preparations was evaluated against reference and clinical Staphylococcus spp. strains. In comparison to the free-form antibiotic, the loaded NE nanocarriers exhibited enhanced antimicrobial activity against the sessile forms of Staphylococcus spp. strains. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hemophilic arthropathy is a detrimental condition that crucially affects functional outcomes in hemophilic patients. In recent years, due to the advances in systemic therapies, growing attention has been raised in the rehabilitation field in order to improve functional outcomes of hemophilic patients. However, the optimal rehabilitation modalities in these patients are far from being fully characterized. OBJECTIVE: The present study aimed to assess the effects of different rehabilitation interventions on physical functioning and health-related quality of life of hemophilic arthropathic patients. METHODS: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Five databases were systematically searched for randomized controlled trials (RCTs) published until June 22nd, 2023. The selection criteria included adult patients with hemophilia A and B receiving rehabilitation interventions. The outcomes were muscle strength, physical function, pain intensity, physical performance, and health-related quality of life. RESULTS: Out of 1,743 identified records, 17 studies were included in the qualitative synthesis. Rehabilitation interventions were categorized into exercise intervention, fascial therapy, and multimodal intervention. The findings suggested positive outcomes in terms of muscle modifications, range of motion improvements, joint health enhancements, pain intensity reduction, and quality of life improvements. More in detail, meta-analyses showed significant improvements in pain intensity [ES: - 1.10 cm (- 1.37, - 0.82), p < 0.00001], joint health [ES: - 1.10 (- 1.38, - 0.82), p < 0.00001], In accordance, exercise interventions showed significant benefits in terms of joint health [ES: - 2.54 (- 3.25, - 1.83), p < 0.00001)] and quality of life [ES: 1.17 (0.48, 1.86), p < 0.0000)]. CONCLUSION: Rehabilitation interventions have a positive impact on functional outcomes and health-related quality of life of hemophilic arthropathic patients. Further studies are needed to better elucidate the role of a comprehensive intervention combining different rehabilitation approaches to treat hemophilic arthropathy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Vertebral fragility fractures (VFFs) commonly result from low bone mass and microarchitecture deterioration of bone tissue. spinal orthoses are common non-pharmacological options for managing vertebral fracture pain. However, the effects of spinal orthoses on pain, physical functioning, and quality of life (QoL) are still debated. OBJECTIVE: This survey aimed to investigate the patients-reported outcomes of a dynamic spinal orthosis prescribed in the routine clinical practice of VFFs management. METHODS: This multi-center national-wide prospective cohort study assessed older patients (aged > 60 years) diagnosed with acute VFFs and prescribed with a dynamic spinal orthosis (Spinfast®). A survey questionnaire was realized and included sections on patient characterization, osteoporosis characterization, spinal orthosis, clinical outcomes, pain medications, and osteoporosis medications. The questionnaire was administered at baseline and after three months. A total of 68 patients completed the questionnaire at three months. Most patients had one or two VFFs and were treated with pain medications and osteoporosis medications. Compliance and tolerability of the spinal orthosis were assessed, and clinical outcomes such as pain intensity, physical functioning, and QoL were measured. RESULTS: The results showed no significant differences in outcomes between age subgroups. Italian physical medicine and rehabilitation physicians were commonly involved in the management of VFFs patients. Sixty-six patients completed the questionnaire. The results showed that pain intensity, physical functioning and QoL improved after three months of spinal orthosis wearing (p < 0.0001). CONCLUSION: The correct management of VFFs is mandatory to improve pain and reduce disability, and our findings suggested a positive role of dynamic spinal orthosis to improve the comprehensive management of VFFs patients. However, high-quality research trials are warranted to provide clear recommendations for the correct clinical management of VFF. [ABSTRACT FROM AUTHOR]

Chronic nonspecific low back pain (NSLBP) is a prevalent condition with socioeconomic and healthcare challenges. The flexion–relaxation phenomenon (FRP) evaluation is a valid clinical tool for low back pain (LBP) assessment. Yoga, a holistic mind–body practice, has been explored as an LBP intervention. This study aimed to evaluate the impact of yoga asanas on the FRP in women with NSLBP. The study included healthy and chronic NSLBP females who underwent an eight‐session yoga asanas program, with the first session conducted in‐clinic and the rest delivered with tele‐approach. Outcome measures included pain intensity, flexion–relaxation ratio (FRR), and trough surface electromyography collected during trunk maximum voluntary flexion (MVF). The study included 11 healthy and 10 NSLBP women. Repeated measures test in chronic NSLBP group showed a significant decrease in pain intensity after the 4 weeks follow‐up (visual analog scale [VAS]: 6.80 ± 1.48 vs. 3.30 ± 1.25; p < 0.001) and an FRR improvement after the intervention (5.12 ± 0.93 vs. 9.49 ± 0.92; p < 0.001). VAS and FRR effect sizes were 0.77 and 0.47, respectively. Therefore, we performed a Prophet evaluation to assess FRR trends, finding a growth rate (k) of 0.405 ± 0.448, with a forecast 1 month after the end of the intervention approaching the trend line of the control group. The findings suggested that tele‐yoga asana might have a positive impact on pain intensity and the FRP in chronic LBP. Further research is warranted to confirm the long‐term effects of yoga for managing LBP. [ABSTRACT FROM AUTHOR]

Spasticity is a very common sign in the neurological field. It can be defined as "a motor disorder marked by a velocity-dependent increase in muscle tone or tonic stretch reflexes" associated with hypertonia. It leads to a high risk of limb deformities and pain that prejudices residual motor function, impairing quality of life". The treatment of spasticity depends on its severity and its location and, in general, it is based on rehabilitation, oral therapies (the gamma-aminobutyric acid b agonist baclofen) and injectable medications (i.e., botulin toxins, acting on polysynaptic reflex mechanisms). The botulin toxin type A (BoNT-A) injection has been effectively used to improve different types of spasticity. However, when BoNT-A is not sufficient, a combination of nonpharmacological approaches could be attempted. Therefore, additional intervention, such as conventional physical therapy by itself or further combined with robotic gait training, may be needed. Indeed, it has been shown that combination of BoNT-A and robotics has a positive effect on activity level and upper limb function in patients with stroke, including those in the chronic phase. The aim of this review is to evaluate the efficacy of pharmacological or nonpharmacological treatment in combination with BoNT-A injections on spasticity. The combined therapy of BoNT with conventional or adjunct activities or robot-assisted training, especially with end-effectors, is a valid tool to improve patients' performance and outcomes. The combined strategies might rise the toxin's effect, lowering its dosages of botulinum and reducing side effects and costs. [ABSTRACT FROM AUTHOR]

Mosquito saliva plays a crucial physiological role in both sugar and blood feeding by helping sugar digestion and exerting antihemostatic functions. During meal acquisition, mosquitoes are exposed to the internalization of external microbes. Since mosquitoes reingest significant amounts of saliva during feeding, we hypothesized that salivary antimicrobial components may participate in the protection of mouthparts, the crop, and the gut by inhibiting bacterial growth. To identify novel potential antimicrobials from mosquito saliva, we selected 11 candidates from Anopheles coluzzii salivary transcriptomic datasets and obtained them either using a cell-free transcription/translation expression system or, when feasible, via chemical synthesis. Hyp6.2 and hyp13, which were predicted to be produced as propeptides and cleaved in shorter mature forms, showed the most interesting results in bacterial growth inhibition assays. Hyp6.2 (putative mature form, 35 amino acid residues) significantly inhibited the growth of Gram-positive (Staphylococcus aureus) and Gram-negative (Escherichia coli and Serratia marcescens) bacteria. Hyp13 (short form, 19 amino acid residues) dose-dependently inhibited E. coli and S. marcescens growth, inducing membrane disruption in both Gram-positive and Gram-negative bacteria as indicated with scanning electron microscopy. In conclusion, we identified two A. coluzzii salivary peptides inhibiting Gram-positive and Gram-negative bacteria growth and possibly contributing to the protection of mosquito mouthparts and digestive tracts from microbial infection during and/or after feeding. [ABSTRACT FROM AUTHOR]

BACKGROUND: Muscle injuries are common traumatic events in the clinical practice of the rehabilitation field. There is still a gap in the scientific literature on the effectiveness of physical agent modalities in the management of muscle injuries in athletes. OBJECTIVE: The aim of this study was to assess the effectiveness of cryo plus ultrasound therapy com-pared to diathermy in combination with high-intensity laser therapy (HILT) for pain relief in professional footballers with muscle injuries. METHODS: A case-control study was conducted on 31 professional footballers with a muscle injury of the lower limbs. Of these, 17 patients, assigned to a Group A (AG), were treated with HILT and cryoultrasound therapy; the remaining 14 patients, assigned to a Group B (BG), underwent HILT and diathermy. We assessed the extent of the pain, the size of the muscle injury, frequency of recurrence and number of days to recovery, at the time of recruitment, at the end of the rehabilitation and 3 months after the injury. RESULTS: Group A athletes had a greater benefit on pain (4.65 ± 0.61 vs 3.24 ± 0.63; p < 0.05) and muscle injury recurrence. The return to play in the athletes of group A took place 4.73 days earlier. CONCLUSION: HILT and cryo plus ultrasound therapy, in combination with therapeutic exercise, rep-resent a valid strategy in the treatment of muscle injuries in professional footballers. [ABSTRACT FROM AUTHOR]

Although rehabilitation medicine emphasizes a holistic health approach, there is still a large gap of knowledge about potential interventions aimed at improving overall wellbeing through cosmetic interventions. Therefore, this narrative review investigates the role of different rehabilitative techniques in enhancing aesthetics, quality of life, and psychosocial wellbeing for patients with disabilities. The study follows the SANRA framework quality criteria for a narrative review. Literature searches across PubMed/Medline, Web of Science, and Scopus identified articles focusing on rehabilitation strategies within the aesthetic rehabilitation domain. The review identified evidence supporting injection procedures, such as Botulinum Toxin, Platelet-Rich Plasma, Hyaluronic Acid, Ozone, and Carboxytherapy, and assessing their applications in several disabling disorders. Additionally, physical therapies like Extracorporeal Shock Wave Therapy, Laser Therapy, Microcurrent Therapy, Tecar Therapy, and physical exercises were explored for their impact on cutaneous microcirculation, cellulite treatment, wound healing, and scar appearance improvement. Lastly, the manuscript underlines the role of manual therapy techniques in addressing both physical discomfort and aesthetic concerns, discussing their effectiveness in adipose tissue therapy, scar tissue mobilization, and regional fat thickness reduction. Taken together, this review emphasizes the role of a multidisciplinary approach, aiming to provide valuable insights into potential benefits for both functional and aesthetic outcomes. [ABSTRACT FROM AUTHOR]

Background: Evolocumab is a humanized immunoglobulin G2 monoclonal antibody, directed against Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9), prescribed in hypercholesterolemic patients. The safety profile of this drug is currently defined by the data of pre-authorization clinical trials. The purpose of this study is to update knowledge of the safety of evolocumab through an analysis of post-marketing real-world data on suspected adverse reactions (SARs), reported by the EudraVigilance database system. Methods: The public version of the EudraVigilance database has been used, and only serious SARs signals were included. Results: Musculoskeletal system disorders, flu-like symptoms, injection-site reactions, skin reactions, and metabolism and nutrition disorders are observed in the post-marketing surveillance, as well as being found in the pre-authorization studies. Not previously signaled in the pre-marketing studies, diarrhea was reported. Furthermore, signals related to cardiac adverse reactions, more frequently at the expense of adults in comparison to elders, were found. Conclusions: The post-marketing safety profile of evolocumab emerging from an analysis of the EudraVigilance data system indicates it is sufficiently safe but suggests the necessity for caution when it is prescribed to hyperlipidemic patients affected by heart diseases. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hip osteoarthritis (OA) is a chronic progressive disease that impresses a noticeable burden to society and healthcare systems. Physical exercise constitutes the first-line hip OA treatment approach, nevertheless, there is currently no gold standard method to treat this disease. OBJECTIVE: To evaluate the efficacy of proprioceptive neuromuscular facilitation (PNF) on functioning in patients with hip OA. METHOD: A pilot randomized controlled trial (RCT) was carried out on patients with painful bilateral hip OA with a body mass index (BMI) < 30 kg/m2. After the randomization, the experimental group was treated with PNF protocol and the control group with conventional physical therapy (10 sessions of manual therapy, 5 sessions/week for 2 weeks). The Harris Hip Score (HHS) was the primary outcome, whereas we assessed as secondary outcomes: pain, range of motion, and muscle strength of hip, physical performance, and quality of life. RESULTS: Twenty patients (40 hips) were enrolled and randomized into two groups: PNF group (mean age: 70.7 ± 8.07; BMI: 25.1 ± 3.07; 7 females and 3 males) and control group (mean age: 74.9 ± 10.72; BMI: 26.8 ± 3.78; 6 females and 4 males). The results showed a statistically significant improvement of HHS in the study group (T1: 90.6 ± 5.63) than in the control group (T1: 77.3 ± 10.9) (between-group p value < 0.001). Three months after the treatment we have statistically significant maintenance in the PNF group (T2:89.6 ± 6.32, within-group Δ T0-T2 p < 0.01) while the control group did not maintain the improvements recorded at T1 (T2: 71.4 ± 15.8). CONCLUSION: The results of this pilot RCT showed that incorporating PNF exercises into the rehabilitation program yielded notable enhancements in improving lower limb function, strength and ROM in hip OA patients. Nonetheless, further prospective studies including wider sample size are needed to implement scientific knowledge on this physical therapy approach, in patients with hip osteoarthritis. [ABSTRACT FROM AUTHOR]

Rehabilitation is a complex set of interventions involving the assessment, management, and treatment of injuries. It aims to support and facilitate an individual's recovery process by restoring a physiological function, e.g., limb movement, compromised by physical impairments, injuries or diseases to a condition as close to normal as possible. Innovative devices and solutions make the rehabilitation process of patients easier during their daily activities. Devices support physicians and physiotherapists in monitoring and measuring patients' physical improvements during rehabilitation. In this context, we report the design and implementation of a low-cost rehabilitation system, which is a programmable device designed to support tele-rehabilitation of the upper limbs. The proposed system includes a mechanism to acquire and analyze data and signals related to rehabilitation processes. [ABSTRACT FROM AUTHOR]