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1. A characterization of varieties of algebras of proper central exponent equal to two

Author

Benanti, F. S. and Valenti, A.

Subjects
Mathematics - Rings and Algebras
Abstract

Let $F$ be a field of characteristic zero and let $ \mathcal V$ be a variety of associative $F$-algebras. In \cite{regev2016} Regev introduced a numerical sequence measuring the growth of the proper central polynomials of a generating algebra of $ \mathcal V$. Such sequence $c_n^\delta(\mathcal V), \, n \ge 1,$ is called the sequence of proper central polynomials of $ \mathcal V$ and in \cite{GZ2018}, \cite{GZ2019} the authors computed its exponential growth. This is an invariant of the variety. They also showed that $c_n^\delta(\mathcal V)$ either grows exponentially or is polynomially bounded. The purpose of this paper is to characterize the varieties of associative algebras whose exponential growth of $c_n^\delta(\mathcal V)$ is greater than two. As a consequence, we find a characterization of the varieties whose corresponding exponential growth is equal to two., Comment: 12 pages

Published
2024

3. *-Graded Capelli Polynomials and their Asymptotic

Author

Benanti, F. S. and Valenti, A.

Subjects
Mathematics - Rings and Algebras
Abstract

Let $F\langle Y \cup Z, \ast \rangle$ be the free $\ast$-superalgebra over a field $F$ of characteristic zero and let $ \Gamma^\ast_{M^{\pm}, L^{\pm}} $ be the $T^\ast_{\mathbb{Z}_2}$-ideal generated by the set of the $\ast$-graded Capelli polynomials $Cap^{(\mathbb{Z}_2, \ast)}_{M^+} [Y^+,X]$, $Cap^{(\mathbb{Z}_2, \ast)}_{M^-} [Y^-,X]$, $Cap^{(\mathbb{Z}_2, \ast)}_{L^+} [Z^+,X]$, $Cap^{(\mathbb{Z}_2, \ast)}_{L^-} [Z^-,X]$ alternating on $M^+$ symmetric variables of homogeneous degree zero, on $M^-$ skew variables of homogeneous degree zero, on $L^+$ symmetric variables of homogeneous degree one and on $L^-$ skew variables of homogeneous degree one, respectively. We study the asymptotic behavior of the sequence of $\ast$-graded codimensions of $\Gamma^\ast_{M^{\pm}, L^{\pm}}.$ In particular we prove that the $\ast$-graded codimensions of the finite dimensional simple $\ast$-superalgebras are asymptotically equal to the $\ast$-graded codimensions of $\Gamma^\ast_{M^{\pm}, L^{\pm}}$, for some fixed natural numbers $M^+, M^-, L^+$ and $L^-$.

Published
2021

6. Asymptotics for Capelli Polynomials with Involution

Author

Benanti, F. S. and Valenti, A.

Subjects
Mathematics - Rings and Algebras
Abstract

Let $F\langle X, \ast \rangle$ be the free associative algebra with involution $\ast$ over a field $F$ of characteristic zero. We study the asymptotic behavior of the sequence of $\ast$-codimensions of the T-$\ast$-ideal $\Gamma_{M+1,L+1}^\ast$ of $F\langle X, \ast \rangle$ generated by the $\ast$-Capelli polynomials $Cap^\ast_{M+1} [Y,X]$ and $Cap^\ast_{L+1} [Z,X]$ alternanting on $M+1$ symmetric variables and $L+1$ skew variables, respectively. It is well known that, if $F$ is an algebraic closed field of characteristic zero, every finite dimensional $\ast$-simple algebra is isomorphic to one of the following algebras: \begin{itemize} \item [$\cdot$]$(M_{k}(F),t)$ the algebra of $k \times k$ matrices with the transpose involution; \item [$\cdot$]$(M_{2m}(F),s)$ the algebra of $2m \times 2m$ matrices with the symplectic involution; \item [$\cdot$]$(M_{h}(F)\oplus M_{h}(F)^{op}, exc)$ the direct sum of the algebra of $h \times h$ matrices and the opposite algebra with the exchange involution. \end{itemize} We prove that the $\ast$-codimensions of a finite dimensional $\ast$-simple algebra are asymptotically equal to the $\ast$-codimensions of $\Gamma_{M+1,L+1}^\ast$, for some fixed natural numbers $M$ and $L$. In particular: $$ c^{\ast}_n(\Gamma^{\ast}_{\frac{k(k+1)}{2} +1,\frac{k(k-1)}{2} +1})\simeq c^{\ast}_n((M_k(F),t)); $$ $$ c^{\ast}_n(\Gamma^{\ast}_{m(2m-1)+1,m(2m+1)+1})\simeq c^{\ast}_n((M_{2m}(F),s)); $$ and $$ c^{\ast}_n(\Gamma^{\ast}_{h^2+1,h^2+1})\simeq c^{\ast}_n((M_{h}(F)\oplus M_{h}(F)^{op},exc)). $$

Published
2019

7. A Potent and Effective Suicidal Listeria Vaccine Platform

Author

Hanson, William G, Benanti, Erin L, Lemmens, Edward E, Liu, Weiqun, Skoble, Justin, Leong, Meredith L, Rae, Chris S, Fassò, Marcella, Brockstedt, Dirk G, Chen, Chen, Portnoy, Daniel A, Dubensky, Thomas W, and Lauer, Peter

Subjects
Medical Microbiology, Biomedical and Clinical Sciences, Biological Sciences, Immunology, Digestive Diseases, Emerging Infectious Diseases, Biodefense, Prevention, Immunization, Biotechnology, Vaccine Related, Infectious Diseases, Foodborne Illness, 3.4 Vaccines, 5.1 Pharmaceuticals, Infection, Good Health and Well Being, Animals, Bacterial Vaccines, Female, Immunotherapy, Listeria monocytogenes, Mice, Mice, Inbred BALB C, Mice, Inbred C57BL, T-Lymphocytes, Vaccines, Attenuated, Virulence, biotechnology, cell-mediated immunity, immunotherapy, vaccines, Agricultural and Veterinary Sciences, Medical and Health Sciences, Microbiology, Medical microbiology
Abstract

Live-attenuated Listeria monocytogenes has shown encouraging potential as an immunotherapy platform in preclinical and clinical settings. However, additional safety measures will enable application across malignant and infectious diseases. Here, we describe a new vaccine platform, termed Lm-RIID (L. monocytogenes recombinase-induced intracellular death), that induces the deletion of genes required for bacterial viability yet maintains potent T cell responses to encoded antigens. Lm-RIID grows normally in broth but commits suicide inside host cells by inducing Cre recombinase and deleting essential genes flanked by loxP sites, resulting in a self-limiting infection even in immunocompromised mice. Lm-RIID vaccination of mice induces potent CD8+ T cells and protects against virulent challenges, similar to live L. monocytogenes vaccines. When combined with α-PD-1, Lm-RIID is as effective as live-attenuated L. monocytogenes in a therapeutic tumor model. This impressive efficacy, together with the increased clearance rate, makes Lm-RIID ideal for prophylactic immunization against diseases that require T cells for protection.

Published
2019

8. Algor-ethics: charting the ethical path for AI in critical care

Author

Montomoli, J, Bitondo, M, Cascella, M, Rezoagli, E, Romeo, L, Bellini, V, Semeraro, F, Gamberini, E, Frontoni, E, Agnoletti, V, Altini, M, Benanti, P, Bignami, E, Montomoli J., Bitondo M. M., Cascella M., Rezoagli E., Romeo L., Bellini V., Semeraro F., Gamberini E., Frontoni E., Agnoletti V., Altini M., Benanti P., Bignami E. G., Montomoli, J, Bitondo, M, Cascella, M, Rezoagli, E, Romeo, L, Bellini, V, Semeraro, F, Gamberini, E, Frontoni, E, Agnoletti, V, Altini, M, Benanti, P, Bignami, E, Montomoli J., Bitondo M. M., Cascella M., Rezoagli E., Romeo L., Bellini V., Semeraro F., Gamberini E., Frontoni E., Agnoletti V., Altini M., Benanti P., and Bignami E. G.

Abstract

The integration of Clinical Decision Support Systems (CDSS) based on artificial intelligence (AI) in healthcare is groundbreaking evolution with enormous potential, but its development and ethical implementation, presents unique challenges, particularly in critical care, where physicians often deal with life-threating conditions requiring rapid actions and patients unable to participate in the decisional process. Moreover, development of AI-based CDSS is complex and should address different sources of bias, including data acquisition, health disparities, domain shifts during clinical use, and cognitive biases in decision-making. In this scenario algor-ethics is mandatory and emphasizes the integration of ‘Human-in-the-Loop’ and ‘Algorithmic Stewardship’ principles, and the benefits of advanced data engineering. The establishment of Clinical AI Departments (CAID) is necessary to lead AI innovation in healthcare, ensuring ethical integrity and human-centered development in this rapidly evolving field.

Published
2024

10. Virulent Burkholderia Species Mimic Host Actin Polymerases to Drive Actin-Based Motility

Author

Benanti, Erin L, Nguyen, Catherine M, and Welch, Matthew D

Subjects
Vaccine Related, Prevention, Biodefense, Emerging Infectious Diseases, Infectious Diseases, 2.2 Factors relating to the physical environment, Aetiology, Infection, Actins, Amino Acid Sequence, Animals, Burkholderia, Burkholderia Infections, COS Cells, Cell Adhesion Molecules, Cell Fusion, Cell Line, Tumor, Chlorocebus aethiops, HEK293 Cells, Humans, Microfilament Proteins, Molecular Sequence Data, Phosphoproteins, Sequence Alignment, Biological Sciences, Medical and Health Sciences, Developmental Biology
Abstract

Burkholderia pseudomallei and B. mallei are bacterial pathogens that cause melioidosis and glanders, whereas their close relative B. thailandensis is non-pathogenic. All use the trimeric autotransporter BimA to facilitate actin-based motility, host cell fusion, and dissemination. Here, we show that BimA orthologs mimic different host actin-polymerizing proteins. B. thailandensis BimA activates the host Arp2/3 complex. In contrast, B. pseudomallei and B. mallei BimA mimic host Ena/VASP actin polymerases in their ability to nucleate, elongate, and bundle filaments by associating with barbed ends, as well as in their use of WH2 motifs and oligomerization for activity. Mechanistic differences among BimA orthologs resulted in distinct actin filament organization and motility parameters, which affected the efficiency of cell fusion during infection. Our results identify bacterial Ena/VASP mimics and reveal that pathogens imitate the full spectrum of host actin-polymerizing pathways, suggesting that mimicry of different polymerization mechanisms influences key parameters of infection.

Published
2015

11. Computing with rational symmetric functions and applications to invariant theory and PI-algebras

Author

Benanti, Francesca, Boumova, Silvia, Drensky, Vesselin, Genov, Georgi K., and Koev, Plamen

Subjects
Mathematics - Rings and Algebras, Mathematics - Commutative Algebra, Mathematics - Combinatorics, 05A15, 05E05, 05E10, 13A50, 15A72, 16R10, 16R30, 20G05
Abstract

Let the formal power series f in d variables with coefficients in an arbitrary field be a symmetric function decomposed as a series of Schur functions, and let f be a rational function whose denominator is a product of binomials of the form (1 - monomial). We use a classical combinatorial method of Elliott of 1903 further developed in the Partition Analysis of MacMahon in 1916 to compute the generating function of the multiplicities (i.e., the coefficients) of the Schur functions in the expression of f. It is a rational function with denominator of a similar form as f. We apply the method to several problems on symmetric algebras, as well as problems in classical invariant theory, algebras with polynomial identities, and noncommutative invariant theory., Comment: 37 pages

Published
2012

12. Rad53 Downregulates Mitotic Gene Transcription by Inhibiting the Transcriptional Activator Ndd1

Author

Edenberg, Ellen R, Vashisht, Ajay, Benanti, Jennifer A, Wohlschlegel, James, and Toczyski, David P

Subjects
Biochemistry and Cell Biology, Biological Sciences, Genetics, 1.1 Normal biological development and functioning, Animals, Cell Cycle Proteins, Checkpoint Kinase 2, DNA Damage, Down-Regulation, Gene Expression Regulation, Fungal, Humans, Mitosis, Promoter Regions, Genetic, Saccharomyces cerevisiae, Saccharomyces cerevisiae Proteins, Transcription Factors, Transcription, Genetic, Medical and Health Sciences, Developmental Biology, Biological sciences, Biomedical and clinical sciences, Health sciences
Abstract

The 33 genes in the Saccharomyces cerevisiae mitotic CLB2 transcription cluster have been known to be downregulated by the DNA damage checkpoint for many years. Here, we show that this is mediated by the checkpoint kinase Rad53 and the dedicated transcriptional activator of the cluster, Ndd1. Ndd1 is phosphorylated in response to DNA damage, which blocks recruitment to promoters and leads to the transcriptional downregulation of the CLB2 cluster. Finally, we show that downregulation of Ndd1 is an essential function of Rad53, as a hypomorphic ndd1 allele rescues RAD53 deletion.

Published
2014

13. Defining Relations of Minimal Degree of the Trace Algebra of $3 \times 3$ Matrices

Author

Benanti, Francesca and Drensky, Vesselin

Subjects
Mathematics - Rings and Algebras, Primary: 16R30, Secondary: 16S15, 13A50, 15A72
Abstract

The trace algebra C(n,d) over a field of characteristic 0 is generated by all traces of products of d generic nxn matrices, n,d>1. Minimal sets of generators of C(n,d) are known for n=2 and n=3 for any d as well as for n=4 and n=5 and d=2. The defining relations between the generators are found for n=2 and any d and for n=3, d=2 only. Starting with the generating set of C(3,d) given by Abeasis and Pittaluga in 1989, we have shown that the minimal degree of the set of defining relations of C(3,d) is equal to 7 for any d>2. We have determined all relations of minimal degree. For d=3 we have also found the defining relations of degree 8. The proofs are based on methods of representation theory of the general linear group and easy computer calculations with standard functions of Maple.

Published
2007

14. Defining Relations of Noncommutative Trace Algebra of Two $3 \times 3$ Matrices

Author

Benanti, Francesca and Drensky, Vesselin

Subjects
Mathematics - Rings and Algebras, 16R30, 16S15
Abstract

The noncommutative (or mixed) trace algebra $T_{nd}$ is generated by $d$ generic $n\times n$ matrices and by the algebra $C_{nd}$ generated by all traces of products of generic matrices, $n,d\geq 2$. It is known that over a field of characteristic 0 this algebra is a finitely generated free module over a polynomial subalgebra $S$ of the center $C_{nd}$. For $n=3$ and $d=2$ we have found explicitly such a subalgebra $S$ and a set of free generators of the $S$-module $T_{32}$. We give also a set of defining relations of $T_{32}$ as an algebra and a Groebner basis of the corresponding ideal. The proofs are based on easy computer calculations with standard functions of Maple, the explicit presentation of $C_{32}$ in terms of generators and relations, and methods of representation theory of the general linear group., Comment: 19 pages

Published
2005
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15. F-box protein specificity for G1 cyclins is dictated by subcellular localization

Author

Toczyski, David, Landry, BD, Doyle, JP, Toczyski, DP, and Benanti, JA

Abstract

Levels of G1 cyclins fluctuate in response to environmental cues and couple mitotic signaling to cell cycle entry. The G1 cyclin Cln3 is a key regulator of cell size and cell cycle entry in budding yeast. Cln3 degradation is essential for proper cell cycle

Published
2012

16. Sensitivity of yeast strains with long G-tails to levels of telomere-bound telomerase.

Author

Vega, Leticia R, Phillips, Jane A, Thornton, Brian R, Benanti, Jennifer A, Onigbanjo, Mutiat T, Toczyski, David P, and Zakian, Virginia A

Subjects
Telomere, Saccharomyces cerevisiae, DNA Helicases, Ubiquitin-Protein Ligase Complexes, Telomerase, Saccharomyces cerevisiae Proteins, Anaphase-Promoting Complex-Cyclosome, Genetics, Developmental Biology
Abstract

The Saccharomyces cerevisiae Pif1p helicase is a negative regulator of telomere length that acts by removing telomerase from chromosome ends. The catalytic subunit of yeast telomerase, Est2p, is telomere associated throughout most of the cell cycle, with peaks of association in both G1 phase (when telomerase is not active) and late S/G2 phase (when telomerase is active). The G1 association of Est2p requires a specific interaction between Ku and telomerase RNA. In mutants lacking this interaction, telomeres were longer in the absence of Pif1p than in the presence of wild-type PIF1, indicating that endogenous Pif1p inhibits the active S/G2 form of telomerase. Pif1p abundance was cell cycle regulated, low in G1 and early S phase and peaking late in the cell cycle. Low Pif1p abundance in G1 phase was anaphase-promoting complex dependent. Thus, endogenous Pif1p is unlikely to act on G1 bound Est2p. Overexpression of Pif1p from a non-cell cycle-regulated promoter dramatically reduced viability in five strains with impaired end protection (cdc13-1, yku80Delta, yku70Delta, yku80-1, and yku80-4), all of which have longer single-strand G-tails than wild-type cells. This reduced viability was suppressed by deleting the EXO1 gene, which encodes a nuclease that acts at compromised telomeres, suggesting that the removal of telomerase by Pif1p exposed telomeres to further C-strand degradation. Consistent with this interpretation, depletion of Pif1p, which increases the amount of telomere-bound telomerase, suppressed the temperature sensitivity of yku70Delta and cdc13-1 cells. Furthermore, eliminating the pathway that recruits Est2p to telomeres in G1 phase in a cdc13-1 strain also reduced viability. These data suggest that wild-type levels of telomere-bound telomerase are critical for the viability of strains whose telomeres are already susceptible to degradation.

Published
2007

17. A treatment algorithm for hyaluronic acid filler related complications of the face.

Author

Zaccaria, Giovanna, Dotti, Alessandro, Benanti, Elisa, Vigliarolo, Camilla, and Vaienti, Luca

Abstract

Throughout the last decade, a notable increase in HA-filler-related complications have been observed, owing to the increase in demand for filler injections and availability of multiple products. The aim is to provide practical advice on the best way to prevent and treat HA-filler-related complications. Thirty patients who experienced visible and/or symptomatic complications localized within the facial area were treated according to our algorithm. Patients with inflammatory lesions underwent antibiotic and anti-inflammatory therapy, followed by hyaluronidase injections. Patients with abscesses were treated with antibiotics, incision, and drainage. Each patient completed the dermatology-specific quality of life questionnaire (DLQI) at the first and last examinations. Among the 29 patients who received antibiotic therapy, 3 healed without further treatment. However, 18 received hyaluronidase injections, 9 underwent incision and drainage, and 5 presented with fistulas and developed retracted scars. Moreover, 80% of the patients were completely healed, 13% significantly improved, and 3% did not show any improvement. The DLQI scores analysis showed a notable impact of patients' diseases on their quality of life, mainly in the terms of personal relationships and symptoms, with minor impacts on intimate relationships, ability to work, and study. We demonstrated that our algorithm resulted in a significant improvement in the overall quality of life at the last follow-up (p < 0.001). The use of filler injections requires caution and specific training because they can lead to serious complications. If these complications are recognized promptly, healing can be optimized. Our treatment algorithm demonstrated high rate of healing and significant improvement in the patients' quality of life. [ABSTRACT FROM AUTHOR]

Published
2024
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18. Effectiveness of robot-assisted arm therapy in stroke rehabilitation: An overview of systematic reviews

Author

Straudi S., Baluardo L., Arienti C., Bozzolan M., Lazzarini S. G., Agostini M., Aprile I., Paci M., Casanova E., Marino D., La Rosa G., Bressi F., Sterzi S., Giansanti D., Perrero L., Battistini A., Miccinilli S., Filoni S., Sicari M., Petrozzino S., Solaro C. M., Gargano S., Benanti P., Boldrini P., Bonaiuti D., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzoleni S., Mazzon S., Molteni F., Petrarca M., Picelli A., Posteraro F., Senatore M., Turchetti G., Morone G., Palomba A., Cinnera AM, Desilvestri M., Bravi M., Bruno D., Santacaterina F., Pecchioli C., Gandolfi M., Russo EF, Boetto V., Straudi, S., Baluardo, L., Arienti, C., Bozzolan, M., Lazzarini, S. G., Agostini, M., Aprile, I., Paci, M., Casanova, E., Marino, D., La Rosa, G., Bressi, F., Sterzi, S., Giansanti, D., Perrero, L., Battistini, A., Miccinilli, S., Filoni, S., Sicari, M., Petrozzino, S., Solaro, C. M., Gargano, S., Benanti, P., Boldrini, P., Bonaiuti, D., Castelli, E., Draicchio, F., Falabella, V., Galeri, S., Gimigliano, F., Grigioni, M., Mazzoleni, S., Mazzon, S., Molteni, F., Petrarca, M., Picelli, A., Posteraro, F., Senatore, M., Turchetti, G., Morone, G., Palomba, A., Cinnera, Am, Desilvestri, M., Bravi, M., Bruno, D., Santacaterina, F., Pecchioli, C., Gandolfi, M., Russo, Ef, and Boetto, V.

Subjects
Stroke, robot-assisted arm therapy, exoskeleton device, exoskeleton devices, end-effector device, arm rehabilitation, end-effector devices
Abstract

BACKGROUND: Robot-assisted arm therapy (RAT) has been used mainly in stroke rehabilitation in the last 20 years with rising expectations and growing evidence summarized in systematic reviews (SRs). OBJECTIVE: The aim of this study is to provide an overview of SRs about the effectiveness, within the ICF domains, and safety of RAT in the rehabilitation of adult with stroke compared to other treatments. METHODS: The search strategy was conducted using search strings adapted explicitly for each database. A screening base on title and abstract was realized to find all the potentially relevant studies. The methodological quality of the included SRs was assessed using AMSTAR-2. A pre-determined standardized form was used to realize the data extraction. RESULTS: 18 SRs were included in this overview. Generally, positive effects from the RAT were found for motor function and muscle strength, whereas there is no agreement for muscle tone effects. No effect was found for pain, and only a SR reported the positive impact of RAT in daily living activity. CONCLUSION: RAT can be considered a valuable option to increase motor function and muscle strength after stroke. However, the poor quality of most of the included SRs could limit the certainty around the results.

Published
2022

19. Robot-assisted gait training in patients with Parkinson's disease: Implications for clinical practice. A systematic review

Author

Carmignano, S, Fundaro, C, Bonaiuti, D, Calabro, R, Cassio, A, Mazzoli, D, Bizzarini, E, Campanini, I, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Gazzotti, V, Mazzoleni, D, Mazzucchelli, M, Melegari, C, Merlo, A, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Andrenelli, E, Carmignano S. M., Fundaro C., Bonaiuti D., Calabro R. S., Cassio A., Mazzoli D., Bizzarini E., Campanini I., Cerulli S., Chisari C., Colombo V., Dalise S., Gazzotti V., Mazzoleni D., Mazzucchelli M., Melegari C., Merlo A., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., Andrenelli E., Carmignano, S, Fundaro, C, Bonaiuti, D, Calabro, R, Cassio, A, Mazzoli, D, Bizzarini, E, Campanini, I, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Gazzotti, V, Mazzoleni, D, Mazzucchelli, M, Melegari, C, Merlo, A, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Andrenelli, E, Carmignano S. M., Fundaro C., Bonaiuti D., Calabro R. S., Cassio A., Mazzoli D., Bizzarini E., Campanini I., Cerulli S., Chisari C., Colombo V., Dalise S., Gazzotti V., Mazzoleni D., Mazzucchelli M., Melegari C., Merlo A., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., and Andrenelli E.

Abstract

BACKGROUND: Gait impairments are common disabling symptoms of Parkinson's disease (PD). Among the approaches for gait rehabilitation, interest in robotic devices has grown in recent years. However, the effectiveness compared to other interventions, the optimum amount of training, the type of device, and which patients might benefit most remains unclear. OBJECTIVE: To conduct a systematic review about the effects on gait of robot-assisted gait training (RAGT) in PD patients and to provide advice for clinical practice. METHODS: A search was performed on PubMed, Scopus, PEDro, Cochrane library, Web of science, and guideline databases, following PRISMA guidelines. We included English articles if they used a robotic system with details about the intervention, the parameters, and the outcome measures. We evaluated the level and quality of evidence. RESULTS: We included twenty papers out of 230 results: two systematic reviews, 9 randomized controlled trials, 4 uncontrolled studies, and 5 descriptive reports. Nine studies used an exoskeleton device and the remainders end-effector robots, with large variability in terms of subjects' disease-related disability. CONCLUSIONS: RAGT showed benefits on gait and no adverse events were recorded. However, it does not seem superior to other interventions, except in patients with more severe symptoms and advanced disease.

Published
2022

20. Gait robot-assisted rehabilitation in persons with spinal cord injury: A scoping review

Author

Stampacchia, G, Gazzotti, V, Olivieri, M, Andrenelli, E, Bonaiuti, D, Calabro, R, Carmignano, S, Cassio, A, Fundaro, C, Companini, I, Mazzoli, D, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Mazzoleni, D, Melegari, C, Merlo, A, Boldrini, P, Mazzoleni, S, Posteraro, F, Mazzucchelli, M, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bizzarrini, E, Stampacchia G., Gazzotti V., Olivieri M., Andrenelli E., Bonaiuti D., Calabro R. S., Carmignano S. M., Cassio A., Fundaro C., Companini I., Mazzoli D., Cerulli S., Chisari C., Colombo V., Dalise S., Mazzoleni D., Melegari C., Merlo A., Boldrini P., Mazzoleni S., Posteraro F., Mazzucchelli M., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., Bizzarrini E., Stampacchia, G, Gazzotti, V, Olivieri, M, Andrenelli, E, Bonaiuti, D, Calabro, R, Carmignano, S, Cassio, A, Fundaro, C, Companini, I, Mazzoli, D, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Mazzoleni, D, Melegari, C, Merlo, A, Boldrini, P, Mazzoleni, S, Posteraro, F, Mazzucchelli, M, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bizzarrini, E, Stampacchia G., Gazzotti V., Olivieri M., Andrenelli E., Bonaiuti D., Calabro R. S., Carmignano S. M., Cassio A., Fundaro C., Companini I., Mazzoli D., Cerulli S., Chisari C., Colombo V., Dalise S., Mazzoleni D., Melegari C., Merlo A., Boldrini P., Mazzoleni S., Posteraro F., Mazzucchelli M., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., and Bizzarrini E.

Abstract

BACKGROUND: Many robots are available for gait rehabilitation (BWSTRT and ORET) and their application in persons with SCI allowed an improvement of walking function.OBJECTIVE: The aim of the study is to compare the effects of different robotic exoskeletons gait training in persons with different SCI level and severity.METHODS: Sixty-two studies were included in this systematic review; the study quality was assessed according to GRADE and PEDro's scale.RESULTS: Quality assessment of included studies (n = 62) demonstrated a prevalence of evidence level 2; the quality of the studies was higher for BWSTRT (excellent and good) than for ORET (fair and good). Almost all persons recruited for BWSTRT had an incomplete SCI; both complete and incomplete SCI were recruited for ORET. The SCI lesion level in the persons recruited for BWSTRT are from cervical to sacral; mainly from thoracic to sacral for ORET; a high representation of AIS D lesion resulted both for BWSTRT (30%) and for ORET (45%). The walking performance, tested with 10MWT, 6MWT, TUG and WISCI, improved after exoskeleton training in persons with incomplete SCI lesions, when at least 20 sessions were applied. Persons with complete SCI lesions improved the dexterity in walking with exoskeleton, but did not recover independent walking function; symptoms such as spasticity, pain and cardiovascular endurance improved.CONCLUSION: Different exoskeletons are available for walking rehabilitation in persons with SCI. The choice about the kind of robotic gait training should be addressed on the basis of the lesion severity and the possible comorbidities.

Published
2022

21. Evidence-based improvement of gait in post-stroke patients following robot-assisted training: A systematic review

Author

Mazzucchelli, M, Mazzoleni, D, Campanini, I, Merlo, A, Mazzoli, D, Melegari, C, Colombo, V, Cerulli, S, Piscitelli, D, Perin, C, Andrenelli, E, Bizzarini, E, Calabro, R, Carmignano, S, Cassio, A, Chisari, C, Dalise, S, Fundaro, C, Gazzotti, V, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bonaiuti, D, Mazzucchelli M., Mazzoleni D., Campanini I., Merlo A., Mazzoli D., Melegari C., Colombo V., Cerulli S., Piscitelli D., Perin C., Andrenelli E., Bizzarini E., Calabro R. S., Carmignano S. M., Cassio A., Chisari C., Dalise S., Fundaro C., Gazzotti V., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., Bonaiuti D., Mazzucchelli, M, Mazzoleni, D, Campanini, I, Merlo, A, Mazzoli, D, Melegari, C, Colombo, V, Cerulli, S, Piscitelli, D, Perin, C, Andrenelli, E, Bizzarini, E, Calabro, R, Carmignano, S, Cassio, A, Chisari, C, Dalise, S, Fundaro, C, Gazzotti, V, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bonaiuti, D, Mazzucchelli M., Mazzoleni D., Campanini I., Merlo A., Mazzoli D., Melegari C., Colombo V., Cerulli S., Piscitelli D., Perin C., Andrenelli E., Bizzarini E., Calabro R. S., Carmignano S. M., Cassio A., Chisari C., Dalise S., Fundaro C., Gazzotti V., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., and Bonaiuti D.

Abstract

Background: The recovery of walking after stroke is a priority goal for recovering autonomy. In the last years robotic systems employed for Robotic Assisted Gait Training (RAGT) were developed. However, literature and clinical practice did not offer standardized RAGT protocol or pattern of evaluation scales. Objective: This systematic review aimed to summarize the available evidence on the use of RAGT in post-stroke, following the CICERONE Consensus indications. Methods: The literature search was conducted on PubMed, Cochrane Library and PEDro, including studies with the following criteria: 1) adult post-stroke survivors with gait disability in acute/subacute/chronic phase; 2) RAGT as intervention; 3) any comparators; 4) outcome regarding impairment, activity, and participation; 5) both primary studies and reviews. Results: Sixty-one articles were selected. Data about characteristics of patients, level of disability, robotic devices used, RAGT protocols, outcome measures, and level of evidence were extracted. Conclusion: It is possible to identify robotic devices that are more suitable for specific phase disease and level of disability, but we identified significant variability in dose and protocols. RAGT as an add-on treatment seemed to be prevalent. Further studies are needed to investigate the outcomes achieved as a function of RAGT doses delivered.

Published
2022

24. Effects of robotic upper limb treatment after stroke on cognitive patterns: A systematic review

Author

Bressi F., Cricenti L., Campagnola B., Bravi M., Miccinilli S., Santacaterina F., Sterzi S., Straudi S., Agostini M., Paci M., Casanova E., Marino D., La Rosa G., Giansanti D., Perrero L., Battistini A., Filoni S., Sicari M., Petrozzino S., Solaro C. M., Gargano S., Benanti P., Boldrini P., Bonaiuti D., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzoleni S., Mazzon S., Molteni F., Petrarca M., Picelli A., Posteraro F., Senatore M., Turchetti G., Morone G., Gallotti M., Germanotta M., Aprile I., Bressi, F., Cricenti, L., Campagnola, B., Bravi, M., Miccinilli, S., Santacaterina, F., Sterzi, S., Straudi, S., Agostini, M., Paci, M., Casanova, E., Marino, D., La Rosa, G., Giansanti, D., Perrero, L., Battistini, A., Filoni, S., Sicari, M., Petrozzino, S., Solaro, C. M., Gargano, S., Benanti, P., Boldrini, P., Bonaiuti, D., Castelli, E., Draicchio, F., Falabella, V., Galeri, S., Gimigliano, F., Grigioni, M., Mazzoleni, S., Mazzon, S., Molteni, F., Petrarca, M., Picelli, A., Posteraro, F., Senatore, M., Turchetti, G., Morone, G., Gallotti, M., Germanotta, M., and Aprile, I.

Subjects
Stroke, robotic, cognitive outcome, rehabilitation, robotic rehabilitation, systematic review, upper limb
Abstract

BACKGROUND: Robotic therapy (RT) has been internationally recognized for the motor rehabilitation of the upper limb. Although it seems that RT can stimulate and promote neuroplasticity, the effectiveness of robotics in restoring cognitive deficits has been considered only in a few recent studies. OBJECTIVE: To verify whether, in the current state of the literature, cognitive measures are used as inclusion or exclusion criteria and/or outcomes measures in robotic upper limb rehabilitation in stroke patients. METHODS: The systematic review was conducted according to PRISMA guidelines. Studies eligible were identified through PubMed/MEDLINE and Web of Science from inception to March 2021. RESULTS: Eighty-one studies were considered in this systematic review. Seventy-three studies have at least a cognitive inclusion or exclusion criteria, while only seven studies assessed cognitive outcomes. CONCLUSION: Despite the high presence of cognitive instruments used for inclusion/exclusion criteria their heterogeneity did not allow the identification of a guideline for the evaluation of patients in different stroke stages. Therefore, although the heterogeneity and the low percentage of studies that included cognitive outcomes, seemed that the latter were positively influenced by RT in post-stroke rehabilitation. Future larger RCTs are needed to outline which cognitive scales are most suitable and their cut-off, as well as what cognitive outcome measures to use in the various stages of post-stroke rehabilitation.

Published
2022

25. Robot-Assisted Upper Limb Training for Patients with Multiple Sclerosis: An Evidence-Based Review of Clinical Applications and Effectiveness

Author

Straudi S., Tramontano M., Russo E. F., Perrero L., Agostini M., Gandolfi M., Aprile I., Paci M., Casanova E., Marino D., La Rosa G., Bressi F., Sterzi S., Giansanti D., Battistini A., Miccinilli S., Filoni S., Sicari M., Petrozzino S., Solaro C. M., Gargano S., Benanti P., Boldrini P., Bonaiuti D., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzoleni S., Mazzon S., Molteni F., Petrarca M., Picelli A., Posteraro F., Senatore M., Turchetti G., Morone G., Palomba A., Arienti C., Baluardo L., Cinnera A. M., Desilvestri M., Bravi M., Bruno D., Santacaterina F., Pecchioli P., Boetto V., Straudi, S., Tramontano, M., Russo, E. F., Perrero, L., Agostini, M., Gandolfi, M., Aprile, I., Paci, M., Casanova, E., Marino, D., La Rosa, G., Bressi, F., Sterzi, S., Giansanti, D., Battistini, A., Miccinilli, S., Filoni, S., Sicari, M., Petrozzino, S., Solaro, C. M., Gargano, S., Benanti, P., Boldrini, P., Bonaiuti, D., Castelli, E., Draicchio, F., Falabella, V., Galeri, S., Gimigliano, F., Grigioni, M., Mazzoleni, S., Mazzon, S., Molteni, F., Petrarca, M., Picelli, A., Posteraro, F., Senatore, M., Turchetti, G., Morone, G., Palomba, A., Arienti, C., Baluardo, L., Cinnera, A. M., Desilvestri, M., Bravi, M., Bruno, D., Santacaterina, F., Pecchioli, P., and Boetto, V.

Subjects
robotics, Fluid Flow and Transfer Processes, Exoskeleton, Multiple sclerosis, Rehabilitation, Robotic devices, Technology, QH301-705.5, Process Chemistry and Technology, Physics, QC1-999, General Engineering, Multiple sclerosis, robotics, rehabilitation, exoskeleton, Engineering (General). Civil engineering (General), Computer Science Applications, NO, Chemistry, General Materials Science, Multiple sclerosi, TA1-2040, Biology (General), Instrumentation, QD1-999
Abstract

Upper extremities limitation is a common functional impairment in patients with Multiple Sclerosis (PwMS). Novel technological devices are increasingly used in neurorehabilitation to support motor function improvement and the quantitative assessment of motor performance during training in patients with neurological diseases. In this review, we systematically report the evidence on clinical applications and robotic-assisted arm training (RAT) in functional recovery in PwMS. PubMed/MEDLINE, the Cochrane Library, and the Physiotherapy Evidence Database (PEDro) databases were systematically searched from inception to March 2021. The 10-item PEDro scale assessed the study quality for the RCT, and the AMSTAR-2 was used to assess the quality of the systematic review. The 5-item Oxford CEBM scale was used to rate the level of evidence. A total of 10 studies (161 subjects) were included. The selected studies included one systematic review, four RCTs, one randomized crossover, and four case series. The RCTs were scored as high-quality studies, while the systematic review was determined to be of low quality. Shoulder range of motion, handgrip strength, and proximal arm impairment improved after RAT. Manual dexterity, arm function, and use in daily life also ameliorated arm function. The high clinical heterogeneity of treatment programs and the variety of robot devices affects the generalizability of the study results; therefore, we emphasize the need to standardize the intervention type in future studies that evaluate the role of robotic-assisted training in PwMS. Robot-assisted treatment seems safe and useful to increase manual dexterity and the quality of movement execution in PwMS with moderate to severe disability. Additional studies with an adequate sample size and methodological rigour are warranted to drive definite conclusions.

Published
2022

26. What does evidence tell us about the use of gait robotic devices in patients with multiple sclerosis? A comprehensive systematic review on functional outcomes and clinical recommendations

Author

Calabro, R, Cassio, A, Mazzoli, D, Andrenelli, E, Bizzarini, E, Campanini, I, Carmignano, S, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Fundaro, C, Gazzotti, V, Mazzoleni, D, Mazzucchelli, M, Melegari, C, Merlo, A, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Morone, G, Bonaiuti, D, Calabro R. S., Cassio A., Mazzoli D., Andrenelli E., Bizzarini E., Campanini I., Carmignano S. M., Cerulli S., Chisari C., Colombo V., Dalise S., Fundaro C., Gazzotti V., Mazzoleni D., Mazzucchelli M., Melegari C., Merlo A., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Petrarca M., Picelli A., Senatore M., Turchetti G., Morone G., Bonaiuti D., Calabro, R, Cassio, A, Mazzoli, D, Andrenelli, E, Bizzarini, E, Campanini, I, Carmignano, S, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Fundaro, C, Gazzotti, V, Mazzoleni, D, Mazzucchelli, M, Melegari, C, Merlo, A, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Morone, G, Bonaiuti, D, Calabro R. S., Cassio A., Mazzoli D., Andrenelli E., Bizzarini E., Campanini I., Carmignano S. M., Cerulli S., Chisari C., Colombo V., Dalise S., Fundaro C., Gazzotti V., Mazzoleni D., Mazzucchelli M., Melegari C., Merlo A., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Petrarca M., Picelli A., Senatore M., Turchetti G., Morone G., and Bonaiuti D.

Abstract

INTRODUCTION: There is growing evidence on the efficacy of gait robotic rehabilitation in patients with multiple sclerosis (MS), but most of the studies have focused on gait parameters. Moreover, clear indications on the clinical use of robotics still lack. As part of the CICERONE Italian Consensus on Robotic Rehabilitation, the aim of this systematic review was to investigate the existing evidence concerning the role of lower limb robotic rehabilitation in improving functional recovery in patients with MS. EVIDENCE ACQUISITION: We searched for and systematically reviewed evidence-based studies on gait robotic rehabilitation in MS, between January 1st, 2010 and December 31st, 2020, in the following databases: Cochrane Library, PEDro, PubMed and Google Scholar. The study quality was assessed by the 16-item assessment of multiple systematic reviews 2 (AMSTAR 2) and the 10-item PEDro scale for the other research studies. EVIDENCE SYNTHESIS: After an accurate screening, only 17 papers were included in the review, and most of them (13 RCT) had a level II evidence. Most of the studies used the Lokomat as a grounded robotic device, two investigated the efficacy of end-effectors and two powered exoskeletons. Generally speaking, robotic treatment has beneficial effects on gait speed, endurance and balance with comparable outcomes to those of conventional treatments. However, in more severe patients (EDSS >6), robotics leads to better functional outcomes. Notably, after gait training with robotics (especially when coupled to virtual reality) MS patients also reach better non-motor outcomes, including spasticity, fatigue, pain, psychological well-being and quality of life. Unfortunately, no clinical indications emerge on the treatment protocols. CONCLUSIONS: The present comprehensive systematic review highlights the potential beneficial role on functional outcomes of the lower limb robotic devices in people with MS. Future studies are warranted to evaluate the role of robot

Published
2021

27. robotic-assisted gait rehabilitation following stroke: A systematic review of current guidelines and practical clinical recommendations

Author

Calabro, R, Sorrentino, G, Cassio, A, Mazzoli, D, Andrenelli, E, Bizzarini, E, Campanini, I, Carmignano, S, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Fundaro, C, Gazzotti, V, Mazzoleni, D, Mazzucchelli, M, Melegari, C, Merlo, A, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bonaiuti, D, Calabro R. S., Sorrentino G., Cassio A., Mazzoli D., Andrenelli E., Bizzarini E., Campanini I., Carmignano S. M., Cerulli S., Chisari C., Colombo V., Dalise S., Fundaro C., Gazzotti V., Mazzoleni D., Mazzucchelli M., Melegari C., Merlo A., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., Bonaiuti D., Calabro, R, Sorrentino, G, Cassio, A, Mazzoli, D, Andrenelli, E, Bizzarini, E, Campanini, I, Carmignano, S, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Fundaro, C, Gazzotti, V, Mazzoleni, D, Mazzucchelli, M, Melegari, C, Merlo, A, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bonaiuti, D, Calabro R. S., Sorrentino G., Cassio A., Mazzoli D., Andrenelli E., Bizzarini E., Campanini I., Carmignano S. M., Cerulli S., Chisari C., Colombo V., Dalise S., Fundaro C., Gazzotti V., Mazzoleni D., Mazzucchelli M., Melegari C., Merlo A., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., and Bonaiuti D.

Abstract

Introduction: Stroke is the third leading cause of adult disability worldwide, and lower extremity motor impairment is one of the major determinants of long-term disability. although robotic therapy is becoming more and more utilized in research protocols for lower limb stroke rehabilitation, the gap between research evidence and its use in clinical practice is still significant. The aim of this study was to determine the scope, quality, and consistency of guidelines for robotic lower limb rehabilitation after stroke, in order to provide clinical recommendations. EVidEncE acQuisition: We systematically reviewed stroke rehabilitation guideline recommendations between January 1, 2010 and october 31, 2020. We explored electronic databases (n.=4), guideline repositories and professional rehabilitation networks (n.=12). two independent reviewers used the appraisal of Guidelines for research and Evaluation (aGrEE) ii instrument, and brief syntheses were used to evaluate and compare the different recommendations, considering only the most recent version. EVIDENCE SYNTHESIS: From the 1219 papers screened, ten eligible guidelines were identified from seven different regions/countries. Four of the included guidelines focused on stroke management, the other six on stroke rehabilitation. robotic rehabilitation is generally recommended to improve lower limb motor function, including gait and strength. unfortunately, there is still no consensus about the timing, frequency, training session duration and the exact characteristics of subjects who could benefit from robotics. conclusions: our systematic review shows that the introduction of robotic rehabilitation in standard treatment protocols seems to be the future of stroke rehabilitation. however, robot assisted gait training (raGt) for stroke needs to be improved with new solutions and in clinical practice guidelines, especially in terms of applicability.

Published
2021

29. Comparison of Methicillin-Resistant Staphylococcus aureusNasal Screening Predictive Value in the Intensive Care Unit and General Ward

Author

Buckley, Mitchell S., Kobic, Emir, Yerondopoulos, Melanie, Sharif, Atefeh S., Benanti, Grace E., Meckel, Jordan, Puebla Neira, Daniel, Boettcher, Stormmy R., Khan, Abdul A., McNierney, Dakota A., and MacLaren, Robert

Abstract

Background: The clinical utility of methicillin-resistant Staphylococcus aureus(MRSA) nasal screening appears promising for antimicrobial stewardship programs. However, a paucity of data remains on the diagnostic performance of culture-based MRSA screen in the intensive care unit (ICU) for pneumonia and bacteremia.Objective: The objective of this study was to compare the predictive value of culture-based MRSA nasal screening for pneumonia and bacteremia in ICU and general ward patients.Methods: This multicenter, retrospective study was conducted over a 23-month period. Adult patients with MRSA nasal screening ≤48 hours of collecting a respiratory and/or blood culture with concurrent initiation of anti-MRSA therapy were included. The primary endpoint was to compare the negative predictive value (NPV) associated with culture-based MRSA nasal screening between ICU and general ward patients with suspected pneumonia.Results: A total of 5106 patients representing the ICU (n = 2515) and general ward (n = 2591) were evaluated. The NPV of the MRSA nares for suspected pneumonia was not significantly different between ICU and general ward patient populations (98.3% and 97.6%, respectively; P= 0.41). The MRSA nares screening tool also had a high NPV for suspected bacteremia in ICU (99.8%) and general ward groups (99.7%) (P= 0.56). The overall positive MRSA nares rates in the ICU and general ward patient populations were 9.1% and 8.2%, respectively (P= 0.283). Moreover, MRSA-positive respiratory and blood cultures among ICU patients were 5.8% and 0.8%, respectively.Conclusion and Relevance: Our findings support the routine use of MRSA nasal screening using the culture-based method in ICU patients with pneumonia. Further research on the clinical performance for MRSA bacteremia in the ICU is warranted.

Published
2023
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31. Robot-assisted arm therapy in neurological health conditions: Rationale and methodology for the evidence synthesis in the CICERONE Italian Consensus Conference

Author

Gimigliano, F., Palomba, A., Arienti, C., Morone, G., Perrero, L., Agostini, M., Aprile, I., Paci, M., Casanova, E., Marino, D., la Rosa, G., Bressi, F., Sterzi, S., Giansanti, D., Battistini, A., Miccinilli, S., Filoni, S., Sicari, M., Petrozzino, S., Solaro, C. M., Gargano, S., Benanti, P., Boldrini, P., Bonaiuti, D., Castelli, E., Draicchio, F., Falabella, V., Galeri, S., Grigioni, M., Mazzoleni, S., Mazzon, S., Molteni, F., Petrarca, M., Picelli, A., Posteraro, F., Senatore, M., Turchetti, G., Straudi, S., Baluardo, L., Boetto, V., Bravi, M., Bruno, D., Desilvestri, M., Gandolfi, M., Martino Cinnera, A., Pecchioli, C., Russo, E. F., Santacaterina, F., Gimigliano, F., Palomba, A., Arienti, C., Morone, G., Perrero, L., Agostini, M., Aprile, I., Paci, M., Casanova, E., Marino, D., la Rosa, G., Bressi, F., Sterzi, S., Giansanti, D., Battistini, A., Miccinilli, S., Filoni, S., Sicari, M., Petrozzino, S., Solaro, C. M., Gargano, S., Benanti, P., Boldrini, P., Bonaiuti, D., Castelli, E., Draicchio, F., Falabella, V., Galeri, S., Grigioni, M., Mazzoleni, S., Mazzon, S., Molteni, F., Petrarca, M., Picelli, A., Posteraro, F., Senatore, M., Turchetti, G., Straudi, S., Baluardo, L., Boetto, V., Bravi, M., Bruno, D., Desilvestri, M., Gandolfi, M., Martino Cinnera, A., Pecchioli, C., Russo, E. F., and Santacaterina, F.

Subjects
Upper extremity, Consensus, Robot, medicine.medical_treatment, Population, Psychological intervention, Physical Therapy, Sports Therapy and Rehabilitation, Context (language use), Consensu, Robotic surgical procedure, Consensus development conference, Neurological rehabilitation, Rehabilitation, Robotic surgical procedures, Arm, Humans, Italy, Disabled Persons, Robotics, NO, Nursing, medicine, education, Upper limb, education.field_of_study, Rehabilitation, Robotics, Upper extremity, Neurological rehabilitation, Consensus conference, business.industry, Consensus conference, Neurological health conditions, Data extraction, Electromechanical devices, Disabled Person, Working group, business, Evidence synthesis, Human
Abstract

BACKGROUND: Robot-assisted Arm Therapy (RAT) has been increasingly applied in the last years for promoting functional recovery in patients with disabilities related to neurological health conditions. Evidence of a knowledge-to-action gap for applying robot-assisted technologies in the rehabilitation of patients with neurological health conditions and the difficulty to apply and tailor the knowledge to the local contexts solicited the need for a national consensus conference on these interventions. AIM: The aim of this paper was to explain the methodology used by the working group dedicated to synthesizing evidence on the effectiveness of RAT in neurological health conditions in the context of the CICERONE Italian Consensus Conference. DESIGN: The methodological approach of the working group. SETTING: All rehabilitation settings. POPULATION: Patients with disability following a neurological health condition. METHODS: Following the indications proposed by the Methodological Manual published by the Italian National Institute of Health, a Promoting Committee and a Technical Scientific Committee have been set up. Six working groups (WGs) have been composed to collect evidence on different questions, among which WG2.2 was focused on the effectiveness of RAT in neurological health conditions. RESULTS: WG2.2 started its work defining the specific research questions. It was decided to adopt the ICF as the reference framework for the reporting of all outcomes. Literature search, data extraction and qualitative assessment, evidence analysis and synthesis have been performed. CONCLUSIONS: This paper summarized the methodological approaches used by the WG2.2 of the CICERONE Italian Consensus Conference to define the effectiveness of RAT in the management of patients with neurological health conditions. CLINICAL REHABILITATION IMPACT: WG2.2 synthesis might help clinicians, researchers, and all rehabilitation stakeholders to address the use of RAT in the Individualized Rehabilitation Plan, to guide the allocation of resources and define clinical protocols and indications for the management of patients with different neurological health conditions.

Published
2021

32. What is the impact of robotic rehabilitation on balance and gait outcomes in people with multiple sclerosis? A systematic review of randomized control trials

Author

Bowman, T., Gervasoni, E., Amico, A. P., Antenucci, R., Benanti, P., Boldrini, P., Bonaiuti, D., Burini, A., Castelli, E., Francesco, Draicchio, Falabella, V., Galeri, S., Gimigliano, F., Grigioni, M., Mazzon, S., Mazzoleni, S., Mestanza Mattos, F. G., Molteni, F., Morone, G., Petrarca, M., Picelli, A., Posteraro, F., Senatore, M., Turchetti, G., Crea, S., Cattaneo, D., Carrozza, M. C., Baricich, A., Bissolotti, L., Capecci, M., Cavalli, L., Di Stefano, G., Jonsdottir, J., Lentino, C., Massai, P., Morelli, S., Nardone, A., Panzeri, D., Taglione, E., Bowman, T., Gervasoni, E., Amico, A. P., Antenucci, R., Benanti, P., Boldrini, P., Bonaiuti, D., Burini, A., Castelli, E., Francesco, Draicchio, Falabella, V., Galeri, S., Gimigliano, F., Grigioni, M., Mazzon, S., Mazzoleni, S., Mestanza Mattos, F. G., Molteni, F., Morone, G., Petrarca, M., Picelli, A., Posteraro, F., Senatore, M., Turchetti, G., Crea, S., Cattaneo, D., Carrozza, M. C., Baricich, A., Bissolotti, L., Capecci, M., Cavalli, L., Di Stefano, G., Jonsdottir, J., Lentino, C., Massai, P., Morelli, S., Nardone, A., Panzeri, D., and Taglione, E.

Subjects
medicine.medical_specialty, medicine.medical_treatment, Physical Therapy, Sports Therapy and Rehabilitation, Context (language use), Walk Test, Cochrane Library, law.invention, Multiple sclerosis, Disability Evaluation, Physical medicine and rehabilitation, Gait training, Randomized controlled trial, law, Multiple Sclerosi, Neurologic, Medicine, Humans, Gait Disorders, Gait, Gait Disorders, Neurologic, Randomized Controlled Trials as Topic, Rehabilitation, Robotics, Combined Modality Therapy, Multiple Sclerosis, Exoskeleton Device, business.industry, Evidence-based medicine, Robotic, Berg Balance Scale, business, human activities, Human
Abstract

Introduction In recent years, robot-assisted gait training (RAGT) has been proposed as therapy for balance and gait dysfunctions in people with multiple sclerosis (PwMS). Through this systematic review, we aimed to discuss the impact of RAGT on balance and gait outcomes. Furthermore, characteristics of the training in terms of robots used, participants characteristics, protocols and combined therapeutic approaches have been described. Evidence acquisition As part of the Italian Consensus on robotic rehabilitation "CICERONE" a systematic search was provided in PubMed, the Cochrane Library and PEDro to identify relevant studies published before December 2019. Only randomized control trials (RCT) involving RAGT for PwMS were included. PEDro scale was used to assess the risk of bias and the Oxford Center for Evidence-Based Medicine (OCEBM) was used to assess level of evidence of included studies. Evidence synthesis The search on databases resulted in 336 records and, finally, 12 studies were included. RAGT was provided with Exoskeleton in ten studies (6-40 session, 2-5 per week) and with end-effector in two studies (12 sessions, 2-3 per week) with large variability in terms of participants' disability. All the exoskeletons were combined with bodyweight support treadmill and movement assistance varied from 0% to 100% depending on participants' disability, two studies combined exoskeleton with virtual reality. The end-effector speed ranged between 1.3 and 1.8 km/h, with bodyweight support starting from 50% and progressively reduced. In seven out of twelve studies RAGT was provided in a multimodal rehabilitation program or in combination with standard physical therapy. There is level 2 evidence that RAGT has positive impact in PwMS, reaching the minimally clinically importance difference in Berg Balance Scale, six-minute walking test and gait speed. Conclusions In available RCT, RAGT is mostly provided with exoskeleton devices and improves balance and gait outcomes in a clinically meaningful way. Considering several advantages in terms of safety, motor assistance and intensity of training provided, RAGT should be promoted for PwMS with severe disability in a multimodal rehabilitation context as an opportunity to maximize recovery.

Published
2021

40. Calcineurin promotes adaptation to chronic stress through two distinct mechanisms

Author

Flynn, Mackenzie J., Harper, Nicholas W., Li, Rui, Zhu, Lihua Julie, Lee, Michael J., and Benanti, Jennifer A.

Abstract

Adaptation to environmental stress requires coordination between stress-defense programs and cell cycle progression. The immediate response to many stressors has been well characterized, but how cells survive in challenging environments long term is unknown. Here, we investigate the role of the stress-activated phosphatase calcineurin (CN) in adaptation to chronic CaCl2stress in Saccharomyces cerevisiae.We find that prolonged exposure to CaCl2impairs mitochondrial function and demonstrate that cells respond to this stressor using two CN-dependent mechanisms—one that requires the downstream transcription factor Crz1 and another that is Crz1 independent. Our data indicate that CN maintains cellular fitness by promoting cell cycle progression and preventing CaCl2-induced cell death. When Crz1 is present, transient CN activation suppresses cell death and promotes adaptation despite high levels of mitochondrial loss. However, in the absence of Crz1, prolonged activation of CN prevents mitochondrial loss and further cell death by upregulating glutathione biosynthesis genes thereby mitigating damage from reactive oxygen species. These findings illustrate how cells maintain long-term fitness during chronic stress and suggest that CN promotes adaptation in challenging environments by multiple mechanisms.

Published
2024
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43. The Pope's AI adviser

Author

Benanti, Paolo and Lytton, Charlotte

Abstract

Franciscan monk Paolo Benantiis leading a global call for artificial intelligence developers to respect human dignity. He tells Charlotte Lyttonhow it is going

Published
2022
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44. Soft tissue coverage of the upper limb: A flap reconstruction overview

Author

Benanti, Elisa, De Santis, Giorgio, Leti Acciaro, Andrea, Colzani, Giulia, Baccarani, Alessio, and Starnoni, Marta

Abstract

Different opinions about the reconstructive choice for upper limb are described in literature: advancement or rotation flaps, regional flaps and free flaps are the most common reconstructive options. Local and regional flaps can be used to cover small defects while large wounds require the use of free flaps or distant pedicled flaps. The coverage of large wounds opens a discussion about when to use free flaps and when distant pedicled flaps. This review will describe the different methods used for the coverage of soft tissues injuries affecting hand and/or forearm (excluding fingers). The aim is to show all flap reconstructive options in order to support the inexperienced surgeon during the management of traumatic injuries of the upper limb.

Published
2020
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49. A balance of deubiquitinating enzymes controls cell cycle entry

Author

Mapa, Claudine E., Arsenault, Heather E., Conti, Michelle M., Poti, Kristin E., and Benanti, Jennifer A.

Abstract

The roles of deubiquitinating enzymes (DUBs) in the cell cycle are unclear. We found that Ubp10 stabilizes cell cycle regulators and controls cell cycle entry in yeast. Deletion of the proteasome-associated DUB Ubp6 reverses the cell cycle defects in cells lacking Ubp10, demonstrating that the balance of DUBs is important for accurate cell division.

Published
2018
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