Search Results (538)

Axial truncal dystonia can present as either flexion or extension, often with a tendency toward lateral movement. Flexion dystonia is more common and may represent a clinical spectrum associated with parkinsonism. In contrast, extensor trunk dystonia is less frequent and exhibits a diverse range of causes. In this paper, we reviewed the literature on axial extensor trunk dystonia. We identified 11 studies involving 49 patients, of which only 10 had idiopathic trunk dystonia. Treatment with botulinum neurotoxin A (BoNT/A) emerged as the most effective therapy; however, many studies did not provide detailed descriptions of the treatment (4/11) and follow-up periods were not specified or short term (up to one–two years). We present four new, well-documented patients with the idiopathic form of extensor trunk dystonia who were treated with BoNT/A with moderate to significant effect according to Global Clinical Impression scale (GCI) and Burke-Fahn-Marsden (BFM) dystonia scale. These cases include long-term follow-up for three patients, all without any adverse events. While the diagnostic process and treatment can be challenging, we recommend using BoNT/A with adjusted doses tailored to the appropriate muscle groups as a first-line treatment. Full article

Background: Inflammasomes regulate the activation of caspases resulting in inflammation; inflammasome activation is dysregulated in Alzheimer’s disease (AD) and plays a role in the pathogenesis of this condition. Glibenclamide, an anti-inflammatory drug, could be an interesting way to down-modulate neuroinflammation. Methods: In this pilot study we verified with ex vivo experiments whether a glibenclamide-loaded nanovector (GNV) could reduce the NLRP3-inflammasome cascade in cells of AD patients. Monocytes isolated from healthy controls (HC) and AD patients were cultured in medium, alone or stimulated with LPS + nigericin in presence/absence of GNV. ASC-speck positive cells and inflammasome-related genes, proteins, and miRNAs expressions were measured. The polymorphisms of ApoE (Apolipoprotein E), specifically rs7412 and rs429358, as well as those of NLRP3, namely rs35829419, rs10733113, and rs4925663, were also investigated. Results: Results showed that ASC-speck+ cells and Caspase-1, IL-1β, and IL-18 production was significantly reduced (p < 0.005 in all cases) by GNV in LPS + nigericin-stimulated cells of both AD and HC. Notably, the NLRP3 rs10733113 AG genotype was associated with excessive inflammasome-related gene and protein expression. GNV significantly down-regulates inflammasome activation in primary monocytes, at least at protein levels, and its efficacy seems to partially depend on the presence of the NLRP3 rs10733113 genotype. Conclusions: All together, these results showed that GNV is able to dampen inflammation and NLRP-3 inflammasome activation in an ex vivo monocyte model, suggesting a possible role for GNV in controlling AD-associated neuroinflammation. Full article

Obstructive sleep apnea (OSA) is a prevalent and heterogeneous sleep disorder associated with significant health and societal burdens. While continuous positive airway pressure (CPAP) remains the gold standard treatment, its limitations in adherence and patient tolerance have highlighted the need for alternative therapies. Positional therapy (PT), which targets apneas that occur predominantly in the supine position, has emerged as a promising option for individuals with positional OSA (POSA). This narrative review synthesizes the current literature on PT, examining its clinical indications, typologies, comparative efficacy with CPAP, oral appliances, and hypoglossal nerve stimulation, as well as data on adherence and barriers to long-term use. Traditional methods such as the tennis ball technique have largely been replaced by modern vibrotactile devices, which demonstrate improved comfort, adherence, and comparable short-term outcomes in selected POSA subjects. While PT remains inferior to CPAP in reducing overall AHI and oxygen desaturation, it performs favorably in terms of mean disease alleviation (MDA) and sleep continuity. Importantly, treatment effectiveness is influenced by both anatomical and non-anatomical traits, underscoring the need for accurate phenotyping and individualized care. PT should be considered within a broader patient-centered model that incorporates preferences, lifestyle, and motivational factors. Further research is needed to validate long-term efficacy, optimize selection criteria, and integrate PT into personalized OSA management strategies. Full article

Promoting sustainable lifestyles through early interventions in schools is increasingly recognized as a critical component of public health and educational policy. Sustainable development, as outlined by the United Nations Sustainable Development Goals (SDGs), particularly Goal 3 (Good Health and Well-being) and Goal 4 (Quality Education), calls for integrating health-promoting behaviors into all aspects of life, including school settings. Active breaks (ABs) could represent a promising strategy to counteract these effects. This study assessed the impact of ABs on the attention of fifth-grade children, aiming to promote both immediate cognitive benefits and long-term health. A total of 32 primary children (age, 9.34 ± 0.77 years old), divided into an experimental group (AB sessions) and a control group, participated in this study. Attention and concentration were measured using the D2-R Test, while processing speed and distraction-related behaviors were tracked. Additionally, questionnaires assessed children’s and teachers’ perceptions. After five weeks, the experimental group demonstrated significant improvements in attention (p < 0.05), especially after high intensity ABs at 12:00. This study suggested the effectiveness of ABs as a tool for improving children’s attention and behavior in primary schools. The findings suggest that integrating physical activity breaks not only enhances cognitive function but also contributes to sustainable educational practices by fostering better learning environments and supporting children’s health and well-being. Full article

As artificial intelligence (AI) becomes ubiquitous across various fields, understanding people’s acceptance and trust in AI systems becomes essential. This review aims to identify quantitative measures used to measure trust in AI and the associated studied elements. Following the PRISMA guidelines, three databases were consulted, selecting articles published before December 2023. Ultimately, 45 articles out of 1283 were selected. Articles were included if they were peer-reviewed journal publications in English reporting empirical studies measuring trust in AI systems with multi-item questionnaires. Studies were analyzed through the lenses of cognitive and affective trust. We investigated trust definitions, questionnaires employed, types of AI systems, and trust-related constructs. Results reveal diverse trust conceptualizations and measurements. In addition, the studies covered a wide range of AI system types, including virtual assistants, content detection tools, chatbots, medical AI, robots, and educational AI. Overall, the studies show compatibility of cognitive or affective trust focus between theorization, items, experimental stimuli, and level of anthropomorphism of the systems. The review underlines the need to adapt measurement of trust in the specific characteristics of human–AI interaction, accounting for both the cognitive and affective sides. Trust definitions and measurement could be chosen depending also on the level of anthropomorphism of the systems and the context of application. Full article

Traumatic brain injury (TBI) affects millions of people worldwide and often results in long-term disabilities. Clinical outcomes vary widely even among patients with similar injury severity, partly due to systemic neuroinflammatory responses mediated by pro- and anti-inflammatory cytokines. Genetic polymorphisms in cytokine-coding genes may influence cytokine expression, thereby affecting rehabilitation and prognosis. We analyzed genetic polymorphisms in the TNF-α, IL-6, IL-6 receptor, IL-1β, and IL-10 genes in 28 subacute TBI patients undergoing rehabilitation. Clinical outcomes were assessed using the Glasgow Outcome Scale Extended (GOSE) and domain-specific scales for cognitive, motor, and functional recovery. Results were correlated with genetic profiles to identify potential predictive biomarkers. The IL-6-174 (GG) and IL-6R 1073 (AA) genotypes correlated with worse GOSE scores (p = 0.02 and p = 0.01, respectively). Co-segregation of IL-6-174 - IL-6R 1073 G-A alleles was linked to poorer outcomes (p = 0.01). Patients with the TNF-α-308 (GA) genotype showed less improvement in Barthel and Mobility scores (p = 0.001 and p = 0.01, respectively) and had a higher incidence of post-traumatic confusional state after rehabilitation (p = 0.03). Overall, the TNF-α-308(GA), IL-6 -174(GG), and IL-6R 1073(AA) genotypes negatively impact rehabilitation outcomes, likely due to their role in enhancing neuroinflammation. Larger studies are needed to develop personalized therapies tailored to genetic profiles, aiming to improve rehabilitation outcomes for TBI patients. Full article

Spinal cord injury (SCI) represents a complex pathological event, which requires continuous and highly specialized territorial interventions. The literature highlights disadvantages faced by people with SCI in accessing local services. This study aimed to investigate the concept of territorial continuity for SCI, reconstructing patients and healthcare professionals’ perspectives, to identify facilitators, barriers and opportunities. Methods: a Focus Group (FG) qualitative study was conducted at Piacenza Ausl; four FGs were carried out; a research team member moderated FGs using thematic guides, while an observer was responsible for noting non-verbal aspects. Meetings lasted between 90 and 120 min and were audio-recorded. Transcript analysis involved the identification of units of meaning, which were grouped into general themes. Results: Final analysis highlighted 435 verbatim, grouped into 21 initial themes, that converged into 5 emerging themes: “SCI continuity as multidisciplinary teamwork”; “The need for rehabilitation as a driver of territorial continuity”; “Reinventing everyday life after SCI”; “Barriers and facilitators”; and “The future of territorial care”. Discussion: Patients and healthcare professionals highlighted the absence of a defined treatment path and the lack of reference points, thus generating disorientation and need for information. Among the proposals, telemedicine, empowering the case manager’s role, promoting specific training courses and rethinking community hospitals were supported. Full article

Background and Objectives: This cross-sectional study investigates the association between fatigue and upper limb (UL) function in people with Multiple Sclerosis (PwMS). Methods: Adult PwMS were recruited from five Italian MS centers. Fatigue was evaluated using the Modified Fatigue Impact Scale (MFIS), while UL function was assessed through the Box and Block Test (BBT), Nine-Hole Peg Test (9HPT), and Hand-Grip Strength (HGS). Data analysis included Spearman rank correlations and Mann–Whitney U tests. Results: A total of 261 participants were involved. Significant correlations were found between fatigue severity, UL function, and patient-reported manual ability. Physical and cognitive aspects of fatigue were independently related to functional impairments. Participants with clinically relevant fatigue demonstrated lower subjective UL function, poorer BBT and HGS performance, and greater HGS asymmetry. Discussion: The study underscores the complex relationship between fatigue and functional impairments in MS. The findings suggest both strength and dexterity contribute to the perception of clinically relevant fatigue in PwMS, highlighting the importance of incorporating both domains to complement neurological assessment. Conclusion: Fatigue in PwMS is linked to both subjective and objective measures of UL function. Assessing strength and dexterity alongside fatigue may enhance clinical understanding and inform targeted rehabilitation strategies. Full article

Background: The variation in the body mass and height of players over time is called the secular trend. It has been analyzed in several team sports, but no similar studies have been conducted on female athletes playing water polo. The aim of this paper was to study the changes that have occurred in the body size and composition of female water polo athletes participating in the Olympic Games, from their first inclusion in the Olympics (2004) until today. Methods: Data were collected from the female water polo players of the National Team selected to participate in the Olympic Games from 2004 (Athens) until 2024 (Paris) and then analyzed. A total of 93 athletes were assessed, and we analyzed the data for each of the Olympics between 2004 and 2024. To evaluate the anthropometric characteristics of the athletes, their body mass and height were recorded and their Body Mass Index (BMI) was then calculated. The athletes’ Body Composition (BC) was assessed using bioelectrical impedance analysis (BIA). Results: The athletes’ average age decreases over time, while their body mass increases. Their body height does not vary significantly. The BMI confirmed that the athletes were always healthy and with a correct diet. With regard to BC, the Fat Free Mass (FFM) values exhibit an increasing trend. Conclusions: The water polo female athletes participating in the 2024 Olympic Games were younger and have different anthropometric and BC values than the athletes playing in the first women’s water polo tournament at the Olympics in 2004. The most likely explanation for this is the rapid evolution of the young female version of the sport, with improved recruitment and training strategies and greater attention paid to nutrition. Full article

Background/Objective: Stroke is one of the leading causes of death and disability worldwide, with older survivors (aged > 65 years) bearing significant health and economic impacts, particularly in industrialized countries. While gait rehabilitation is a cornerstone in post-stroke recovery and robotic technologies offer promising tools to enhance its effectiveness, the existing literature has largely overlooked elderly populations. Most studies on robot-assisted gait training (RAGT)—which uses exoskeleton or end-effector devices to support and guide movement—either exclude older adults or do not analyze their outcomes separately. This review aims to critically evaluate the current evidence on RAGT in elderly post-stroke patients, addressing a significant gap in the literature and providing novel insights into the effectiveness and adaptability of RAGT for this specific population. Methods: The search included databases such as PubMed, Scopus, Embase, Web of Science, and ClinicalTrials. The inclusion criteria covered studies published up to March 2025, focusing on post-stroke individuals aged >65 years, who underwent RAGT. Results: 25 studies were included in the review, 21 involving exoskeleton and 4 end-effector devices. The primary focus was on motor outcomes, such as gait independence, gait parameters, and balance control. Only a few studies examined non-motor aspects, including cognitive and emotional functions, fatigue, pain, and neuroplasticity. Moreover, data on the long-term effects on the elderly population remain scarce. Conclusions: RAGT is an effective strategy for promoting motor recovery and improving functional outcomes, from independence in daily activities to quality of life, in the post-stroke elderly population. Early and high-intensity interventions are particularly useful with positive effects on neuronal plasticity, cognitive function, and well-being. Full article

A significant proportion of children with Autism spectrum disorder (ASD) experience sleep issues, such as insomnia and other disorders, as assessed by the Sleep Disturbance Scale for Children. Our study investigated the link between six single nucleotide polymorphisms (SNPs) in the melatonin receptor genes MT1 and MT2 and ASD susceptibility, clinical severity and associated sleep problems. A total of 139 ASD children, 82 siblings, and 53 unrelated healthy controls, all of Sardinian ancestry, were studied; among them, 38 children with co-occurring sleep issues were assessed for the outcomes of a rehabilitative program, including behavioral therapy and sleep hygiene. The MT2 rs10830963 G allele is more prevalent in ASD children and their siblings compared to the healthy controls, while rs2119882 (MT1) and rs1562444 (MT2) are associated with DIMS, DA, and SHY. ASD Children carrying the rs2119882 T allele have higher scores for DIMS and DA compared to C allele carriers, and those carrying rs1562444 A allele have higher scores for SHY than G allele carriers. After rehabilitative treatment, homozygous TT carriers of rs2119882 showed less improvement in DIMS symptoms compared to CT and CC carriers. A similar result was observed for AA carriers of SNP rs1562444 about SHY. We may suggest that the MT1 and MT2 variants may serve as useful predictive genetic markers for the severity of sleep disorders in children with ASD, potentially informing the design of more targeted rehabilitative treatments. Full article

Drug delivery systems have revolutionized the clinical field by enabling the targeted, controlled, and sustained release of therapeutic agents, minimizing side effects and maximizing efficacy. Among the various drug delivery platforms, polymer-based systems have gained significant attention due to their versatility and biocompatibility. This study investigates the release of dexamethasone and clobetasol propionate from PLA (poly(lactic acid)) fibers in a cellular culture system. The release profiles were analyzed over 1, 6, and 24 h using high-performance liquid chromatography (HPLC), showing a gradual, continuous release, with clobetasol exhibiting slower release due to its poor water solubility. The presence of fibroblasts did not significantly affect the drug release, and the concentrations increased over time. An intracellular recovery test revealed that both drugs entered the cells, although their concentrations were below the limit of quantification (LOQ). Measurements of the remaining drug in the fibers confirmed a sustained release, with no significant difference between conditions with and without cells. These results highlight the potential of PLA fibrous membranes for controlled drug delivery, though further research is needed to optimize release and improve intracellular quantification for more effective therapeutic applications. Full article

Technologies for frail elderly individuals facilitate the integration of care services, support the post-discharge period, and enhance independence and quality of life while reducing isolation. However, the lack of methodological rigor in studies on technologies for diagnosing and treating geriatric syndromes limits applied research. This study aimed to develop and validate a checklist considering technical readiness, clinical needs, and context to support the use of technologies primary in clinical practice and also in research settings. To this aim, a Delphi procedure was conducted in four rounds, followed by a pilot test assessing the checklist’s practical effectiveness. Twenty-nine items were defined and discussed. Among them, no item was deleted, while a total of eight items were reformulated. At the end of the assessment steps, 73% of items showed a high median relevance rating. The pilot test showed the difficulty in finding relevant information to complete the checklist as the only critical issue. This tool represents the first validated checklist in the field of technology-based healthcare for elderly individuals and supports the application of technologies in the diagnosis and treatment of geriatric syndromes by clinicians and researchers. Full article

This paper presents a wearable, open-source system that combines electromyography (EMG) and functional electrical stimulation (FES) to restore hand function in individuals with disabilities caused by cervical spinal cord injuries or stroke. The device captures electrical signals produced during volitional muscle contractions and analyzes them to interpret the user’s intent to move. This information is then used to stimulate impaired muscles, promoting improved hand function and rehabilitation. We detail the design, prototyping, and testing of the system, emphasizing its modularity, affordability, and accessibility. Hardware and software, along with 3D-printable components, are shared via GitHub to enable replication and customization by professionals and makers. The system serves as both an orthotic device for enhancing grasping ability and a therapeutic tool for rehabilitating hemiparetic hands, with potential for broader applications. By addressing cost, customization, and accessibility barriers, this initiative promotes collaboration and further innovation in rehabilitation technologies, advancing the development of affordable, user-centered solutions for individuals with disabilities. Full article

Multifunctional reinforced polymer composites provide an ideal platform for next-generation smart materials applications, enhancing matrix properties like electrical and thermal conductivity. Reinforcements are usually based on functional metal alloys, inorganic compounds, polymers, and carbon nanomaterials. The latter have drawn significant interest in developing high-performance smart composites due to their exceptional mechanical, electrical, and thermal properties. The increasing demand for highly complex functional structures has led additive manufacturing to become a reference technology for the production of smart material components. In this study, laser sintering technology was adopted to manufacture nano-graphite/nylon-12 composites with a carbon-based particle reinforcement content of up to 10% in weight. The results showed that the addition of the filler led to the fabrication of samples that reached an electrical conductivity of around 4·10⁻⁴ S/cm, in contrast to the insulating behavior of a bare polymeric matrix (i.e., lower than 10⁻¹⁰ S/cm), while maintaining a low production cost, though at the expense of mechanical performance under both tensile and bending loads. Full article