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Zhang X, Fei F. Effects of long-term oxygen therapy on the mental state of patients with chronic obstructive pulmonary disease: A systematic review. Chronic Illn 2023:17423953231187169. [PMID: 37448234 DOI: 10.1177/17423953231187169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
OBJECTIVES This systematic review aimed to examine the effects of long-term oxygen therapy on the mental state of patients with chronic obstructive pulmonary disease. METHODS Web of Science, Medline, CINAHL, EMBASE, ProQuest, and Cochrane Library were selected to search for relevant studies. We followed the Cochrane Handbook for Systematic Reviews of Interventions, adopted the Cochrane risk-of-bias tool and Risk Of Bias In Non-randomized Studies of Interventions tool, and synthesized the outcomes narratively with Grading of Recommendations, Assessment, Development and Evaluations evidence profile. RESULTS Six studies were included. Moderate quality of evidence supported no effects of long-term oxygen therapy on the mental state in patients with severe resting hypoxemia and moderate resting hypoxemia (or exertional desaturation) at follow-up of 6 to 12 months; however, adverse effects on mental state among patients with moderate resting or exertional desaturation were reported at the follow-up of 36 to 48 months. DISCUSSION Nurses should focus on the mental state of patients treated with long-term oxygen therapy, especially those who use it for a prolonged time. Due to ethical constraints in this study, a quasi-experimental study with faithful consideration of internal validity can be commenced in the future.
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Affiliation(s)
- Xiaohan Zhang
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- School of Nursing and Midwifery, Jiangsu College of Nursing, Huai'an, Jiangsu, PR China
| | - Fei Fei
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- School of Medical and Health Engineering, Changzhou University, Changzhou, Jiangsu, PR China
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Hamada S, Handa T, Tanabe N, Sato S, Tanizawa K, Sato A, Morita S, Chin K, Hirai T. Evaluation of respiratory rate monitoring performance using a home oxygen monitoring device among patients with interstitial lung disease and chronic obstructive pulmonary disease. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2022; 39:e2022007. [PMID: 35494164 PMCID: PMC9007031 DOI: 10.36141/svdld.v39i1.12133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 01/06/2022] [Indexed: 11/11/2022]
Abstract
Background Home monitoring devices have been developed to measure adherence to home oxygen therapy. In this study, we evaluated the performance of TeleOx®, a commercially available remote monitoring device, in comparison with polysomnography (PSG) in patients with interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD) and the factors that affected TeleOx® correct use. Methods TeleOx® was connected on the patient or concentrator side. The oxygen flow rates were set at 1, 3, and 5 L/min. Intraclass correlation coefficient (ICC) (2,1) was used to determine the agreement between respiratory rate measured using TeleOx® and that measured using PSG, and the minimum acceptable level of reliability was >0.7. Results In total, 22 patients (16 with ILD and 6 with COPD) were assessed. In patients with ILD, the detection rate of patients' respiration assessed using TeleOx® did not change according to the device's position. It increased from 53.5% to 79.0% by changing the position from the concentrator to the patient side in patients with COPD. The ICC (2,1) value indicated that TeleOx® had acceptable reliability at oxygen flow rates of 1 and 3 L/min regardless of the device's position in patients with ILD (the concentrator side: 0.9 and 0.82, respectively; the patient side: 0.95 and 0.82, respectively), whereas that did only at the oxygen flow rate of 1 L/min and in connecting TeleOx® on the patient side in patients with COPD (0.73). Conclusion The monitoring performance of TeleOx® differed according to its position, oxygen flow rates, and patients' diseases.
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Affiliation(s)
- Satoshi Hamada
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomohiro Handa
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoya Tanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Susumu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kiminobu Tanizawa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsuyasu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuo Chin
- Department of Sleep Medicine and Respiratory Care, Division of Sleep Medicine, Nihon University of Medicine, Tokyo, Japan, Department of Human Disease Genomics, Center for Genomic Medicine, Graduate School Medicine, Kyoto University, Kyoto, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Perez-Malagon CD, Barrera R. Lack of Medical Criteria for Long-Term Oxygen Therapy Usage According to International Guidance in Outpatients With Chronic Hypoxemia. Cureus 2021; 13:e19634. [PMID: 34956760 PMCID: PMC8675795 DOI: 10.7759/cureus.19634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 11/12/2022] Open
Abstract
Background Benefits of long-term oxygen therapy (LTOT) have been observed in hypoxemic respiratory patients. Reports have shown the lack of observance among healthcare professionals of LTOT. Thus, this study aimed to determine the demographic characteristics and observance of the medical indication of LTOT according to the international guidelines. Methodology A cross-sectional study was conducted on patients who attended the Medical Unit in Aguascalientes, Mexico to re-evaluate the need for LTOT. Data are presented as mean ± standard deviation. Statistical analyses were performed using the chi-square test or unpaired t-tests. P-values of <0.05 were considered statistically significant. Results From 813 outpatients attended to re-evaluate whether they met the medical criteria to use LTOT, 93 outpatients were excluded, and the remaining 714 outpatients were enrolled. The mean age of the patients was 70.0 ± 15.1 years, with a female gender predominance (59.1 %). The mean PaO2 level in room air was 7.9 ± 2.3 kPa. Hemoglobin and hematocrit levels were 14.9 ± 4.1 g/dL and 44.7 ± 8.4%, respectively. The mean levels of PaO2 were higher in female patients (8.1 ± 2.5 kPa vs. 7.6 ± 1.9 kPa; p = 0.01). The most common diagnosis was chronic obstructive pulmonary disorder (60.5%). Moreover, the specialty that most indicated the use of LTOT was pulmonology (57.8%); however, 36.8% of patients who used LTOT did not have any criteria according to international guidelines. Conclusions Although a significant percentage of patients do not use LTOT correctly, the most important finding is that the medical indication of LTOT by physicians is not always correct, leading to an excessive prescription of oxygen.
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Affiliation(s)
- Carlos David Perez-Malagon
- Centro de Ciencias Biomedicas, Universidad Autónoma de Aguascalientes, Aguascalientes, MEX.,Clinical Service Rotation, Unidades Médicas de Atención Ambulatoria, Instituto Mexicano del Seguro Social, Aguascalientes, MEX
| | - Raul Barrera
- Autoimmunity, National Institute of Respiratory Diseases, Mexico City, MEX
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Azevedo FMD, Oliveira CC, Evangelista DG, Cabral LF, Malaguti C. Adherence to long-term home oxygen therapy in patients with chronic respiratory disease in two cities in the state of Minas Gerais, Brazil. J Bras Pneumol 2021; 47:e20210055. [PMID: 34190863 PMCID: PMC8332717 DOI: 10.36416/1806-3756/e20210055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Felipe Meirelles de Azevedo
- . Programa de Pós-Graduação em Ciências de Reabilitação e Desempenho Físico-Funcional, Faculdade de Fisioterapia, Universidade Federal de Juiz de Fora, Juiz de Fora (MG) Brasil
| | - Cristino Carneiro Oliveira
- . Programa de Pós-Graduação em Ciências de Reabilitação e Desempenho Físico-Funcional, Faculdade de Fisioterapia, Universidade Federal de Juiz de Fora, Juiz de Fora (MG) Brasil
| | - Deborah Gollner Evangelista
- . Programa de Pós-Graduação em Ciências de Reabilitação e Desempenho Físico-Funcional, Faculdade de Fisioterapia, Universidade Federal de Juiz de Fora, Juiz de Fora (MG) Brasil
| | - Leandro Ferracini Cabral
- . Programa de Pós-Graduação em Ciências de Reabilitação e Desempenho Físico-Funcional, Faculdade de Fisioterapia, Universidade Federal de Juiz de Fora, Juiz de Fora (MG) Brasil
| | - Carla Malaguti
- . Programa de Pós-Graduação em Ciências de Reabilitação e Desempenho Físico-Funcional, Faculdade de Fisioterapia, Universidade Federal de Juiz de Fora, Juiz de Fora (MG) Brasil
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Naranjo-Rojas A, Perula-de-Torres LÁ, Cruz-Mosquera FE, Molina-Recio G. Mobile application for monitoring patients under home oxygen therapy: a protocol for a randomized controlled trial. BMC FAMILY PRACTICE 2021; 22:104. [PMID: 34039277 PMCID: PMC8157712 DOI: 10.1186/s12875-021-01450-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/04/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Mobile technologies have become capable of changing the paradigm of healthcare services. A clear example is that, nowadays, these technologies are an important instrument for data collection processes, epidemiologic surveillance, health promotion and disease prevention. Therefore, technological tools should be exploited to optimize the monitoring of patients with chronic diseases, including patients who require home oxygen therapy. PURPOSE The purpose of this study is to determine the efficacy of a mobile application in the clinical monitoring of patients under home oxygen therapy. METHODS This is a randomized controlled trial includes subjects of 18 years or older diagnosed with Chronic Obstructive Pulmonary Disease (COPD) who are under home oxygen therapy. Subjects will be divided into two arms: the intervention group will include patients who will be monitored with a mobile application, and the control group will include patients monitored by conventional follow-up methods (periodic visits of a respiratory therapist). The following outcome variables will be considered to measure the effect of the intervention: identification of dyspnea self-management, number of acute exacerbations associated with oxygen therapy, and the occurrence of oxygen supply underuse. DISCUSSION This study is expected to assess the efficacy of a mobile application in the follow up of patients under home oxygen therapy. It will also determine whether the monitoring of a six-month intervention by a team comprising a physician, a nurse and respiratory therapists can decrease acute exacerbations, determine the most appropriate oxygen dose, and identify the underuse of oxygen systems and supplies. TRIAL REGISTRATION The study has been registered at ClinicalTrials.gov ( NCT04820790 ; date of registration: March 29, 2021).
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Affiliation(s)
- Anisbed Naranjo-Rojas
- School of Medicine, GINEYSA - GISI. USC Research Groups, Universidad Santiago de Cali, Cali, Colombia.
| | - Luis Ángel Perula-de-Torres
- Multiprofessional teaching unit for Family and Community Care of the Córdoba and Guadalquivir District. Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Hospital Universitario Reina Sofia, Universidad de Córdoba, Cordoba, Spain
| | | | - Guillermo Molina-Recio
- Nursing, Pharmacology and Physiotherapy Department, University of Cordoba. Lifestyles, Innovation and Health (GA-16). Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
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Isokääntä S, Honkalampi K, Kokki H, Sintonen H, Kokki M. Resilience and health-related quality of life in patients with pulmonary diseases receiving ambulatory oxygen therapy. BMC Pulm Med 2021; 21:144. [PMID: 33933036 PMCID: PMC8088314 DOI: 10.1186/s12890-021-01515-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 04/26/2021] [Indexed: 11/11/2022] Open
Abstract
Background Pulmonary diseases affect health-related quality of life (HRQoL), but there are few data on patients’ adaptation to a serious illness. This study assessed resilience and its associations with HRQoL, life satisfaction, anxiety and depression in patients with pulmonary diseases receiving ambulatory oxygen therapy. Methods In this prospective cohort study, we enrolled 42 patients with pulmonary diseases receiving ambulatory oxygen therapy. The patients completed the following questionnaires at baseline and after one and three months; the Resilience Scale-25, the Life Satisfaction Scale-4, the 15D instrument of HRQoL, the Hospital Anxiety and Depression Scale (HADS) and the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0). To compare HRQoL, we recruited age- and gender-matched controls from the general population (n = 3574). The primary outcome was the proportion of patients with low resilience. Results Half (42–48%) of the patients had low resilience, which was correlated with low HRQoL, low levels of life satisfaction and higher levels of anxiety and depression. Patients had very low HRQoL compared to controls. Dissatisfaction with life increased during the 3-months follow-up, but only a few patients had anxiety or depression. Patient satisfaction with assistive technology was high; the median QUEST 2.0 score (scale 1–5) was 4.00 at baseline, 3.92 at one month and 3.88 at three months. Conclusions Resilience was low in half of the patients with pulmonary diseases receiving ambulatory oxygen therapy. Higher resilience was positively correlated with HRQoL and life satisfaction and negatively correlated with anxiety and depression. Trial registration: ClinicalTrials.gov Protocol Record 507A023. Registered 17 September 2020—Retrospectively registered, https://clinicaltrials.gov/ct2/results?cond=&term=NCT04554225&cntry=&state=&city=&dist=.
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Affiliation(s)
- Siiri Isokääntä
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Puijonlaaksontie 2, PO Box 100, 70029, Kuopio, Finland.,School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Kirsi Honkalampi
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Hannu Kokki
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Merja Kokki
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Puijonlaaksontie 2, PO Box 100, 70029, Kuopio, Finland.
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Batista DR, Coelho LS, Tanni SE. November 18: World COPD Day 2020. Is it a date to celebrate? J Bras Pneumol 2021; 46:e20200575. [PMID: 33439927 PMCID: PMC7909999 DOI: 10.36416/1806-3756/e20200575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Diane Rezende Batista
- . Disciplina de Pneumologia, Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
| | - Liana Sousa Coelho
- . Disciplina de Pneumologia, Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
| | - Suzana Erico Tanni
- . Disciplina de Pneumologia, Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
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Hussain T, Saman HT, Yousaf Z. Identification of Exertional Hypoxia and Its Implications in SARS-CoV-2 Pneumonia. Am J Trop Med Hyg 2020; 103:1742-1743. [PMID: 32851969 PMCID: PMC7543840 DOI: 10.4269/ajtmh.20-1012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Lima CDAD, Oliveira RCD, Oliveira SAGD, Silva MASD, Lima ADA, Andrade MS, Pinho CM. Quality of life, anxiety and depression in patients with chronic obstructive pulmonary disease. Rev Bras Enferm 2020; 73 Suppl 1:e20190423. [PMID: 32667477 DOI: 10.1590/0034-7167-2019-0423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/23/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to assess quality of life, anxiety and depression in patients with Chronic Obstructive Pulmonary Disease. METHOD a cross-sectional, quantitative study, conducted in a reference hospital for the treatment of pulmonary diseases. Seventy patients were assessed, using a sociodemographic and clinical questionnaire, Beck's anxiety and Depression Inventories and the SF-36 Quality of Life Scale. RESULTS the participants had better quality of life in the vitality, mental health and social role functioning domains (median=50.0) and worse in limitation by physical and emotional role functioning (median=0.0 points). Anxiety, depression and oxygen dependence were associated with poorer results in the quality of life domains. CONCLUSION all patients were classified with severe anxiety level and moderate depression predominance. Patients had low quality of life scores in all domains.
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Zhang Y, Xu CB. The roles of endothelin and its receptors in cigarette smoke-associated pulmonary hypertension with chronic lung disease. Pathol Res Pract 2020; 216:153083. [PMID: 32825951 DOI: 10.1016/j.prp.2020.153083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/03/2020] [Accepted: 06/22/2020] [Indexed: 01/23/2023]
Abstract
Chronic exposure to cigarette smoke is the major risk factor for the development of pulmonary hypertension (PH) with chronic lung disease (i.e. PH group III). The pathogenesis of smoke-associated PH group III in chronic obstructive pulmonary disease (COPD) involves cigarette smoke exposure-induced damage to lung tissue and dysfunction of pulmonary system with increased synthesis and release of endothelin-1 (ET-1), hypoxia, inflammation, pulmonary vascular remodeling. Many studies have demonstrated that cigarette smoke exposure induces activation of mitogen-activated protein kinase (MAPK) signal pathway that leads to up-regulation of ET-1 and its receptors with the receptor-mediated enhanced contraction, proliferation of pulmonary vascular smooth muscle cells, pulmonary vascular remodeling, elevated pulmonary arterial pressure and finally PH group III. This mini-review article aims to summarize the current state of understanding on the roles of cigarette smoke-induced up-regulation of ET-1 and its receptors in the development of PH group III. Understanding the underlying molecular mechanisms that cigarette smoke exposure leads to PH group III may provide a novel strategy for the treatment.
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Affiliation(s)
- Yaping Zhang
- Shaanxi Key Laboratory of Ischemic Cardiovascular Disease, Institute of Basic and Translational Medicine, Xi'an Medical University, Shaanxi, Xi'an, China
| | - Cang-Bao Xu
- Shaanxi Key Laboratory of Ischemic Cardiovascular Disease, Institute of Basic and Translational Medicine, Xi'an Medical University, Shaanxi, Xi'an, China.
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Paneroni M, Ambrosino N, Simonelli C, Bertacchini L, Venturelli M, Vitacca M. Physical Activity in Patients with Chronic Obstructive Pulmonary Disease on Long-Term Oxygen Therapy: A Cross-Sectional Study. Int J Chron Obstruct Pulmon Dis 2019; 14:2815-2823. [PMID: 31824146 PMCID: PMC6901041 DOI: 10.2147/copd.s228465] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/31/2019] [Indexed: 12/14/2022] Open
Abstract
Background and aim There are few studies evaluating physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD) on long-term oxygen therapy (LTOT). Aim To assess PA in hypoxemic COPD patients on LTOT. Methods In this cross-sectional study, we compared lung function, arterial blood gases, respiratory and peripheral muscle strength, 6-min walking distance (6MWD), daily energy expenditure and steps, and health-related quality of life (HRQL) in COPD patients on LTOT (LTOT group) versus two groups of control patients not needing LTOT: with (HYPOX) and without (COPD) exercise-induced desaturations. Results Groups did not differ as regards demographics, anthropometrics, peripheral or respiratory muscle strength. Compared to the other groups, LTOT patients had more severe airway obstruction and lung hyperinflation, greater number and severity of comorbidities, shorter 6MWD, as well as lower mean SpO2 during 6MWD and worse quality of life. LTOT patients had a lower daily energy expenditure, shorter time spent > 3.0 METs and longer sedentary time compared to the COPD group, and less daily steps compared to the other groups. No significant difference in any parameter of PA was found between COPD and HYPOX. In LTOT patients, daily steps showed a strong correlation with 6MWD, and a moderate correlation with airway obstruction, level of oxygenation, comorbidities and quality of life but not with peripheral and respiratory muscle strength. In COPD and HYPOX patients, daily steps were strongly correlated with 6MWD and level of oxygenation as assessed by PaO2/FiO2. There was no significant correlation between mean SpO2 and 6MWD in any group. Conclusion COPD patients on LTOT perform less physical activity than patients not needing LTOT, both with and without exercise-induced desaturations. Patients with exercise-induced desaturations do not perform less physical activity than those without.
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Affiliation(s)
- Mara Paneroni
- Respiratory Rehabilitation Division, ICS Maugeri SPA SB, Institute of Lumezzane, IRCCS, Brescia, Italy
| | - Nicolino Ambrosino
- Respiratory Rehabilitation Division, ICS Maugeri SPA SB, Institute of Montescano, IRCCS, Pavia, Italy
| | - Carla Simonelli
- Respiratory Rehabilitation Division, ICS Maugeri SPA SB, Institute of Lumezzane, IRCCS, Brescia, Italy
| | - Laura Bertacchini
- Respiratory Rehabilitation Division, ICS Maugeri SPA SB, Institute of Lumezzane, IRCCS, Brescia, Italy
| | - Massimo Venturelli
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Vitacca
- Respiratory Rehabilitation Division, ICS Maugeri SPA SB, Institute of Lumezzane, IRCCS, Brescia, Italy
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