Development of the Italian version of the knee injury and osteoarthritis outcome score for patients with knee injuries: cross-cultural adaptation, dimensionality, reliability, and validity

OBJECTIVE

Translating, culturally adapting and validating an Italian version of the Knee injury and Osteoarthritis Outcome Score (KOOS-I) to allow its use with Italian-speaking patients with knee complaints.

DESIGN

The KOOS-I was developed by means of forward-backward translation, a final review by an expert committee, and a test of the pre-final version to establish its correspondence with the original English version. The psychometric testing included analysis of dimensionality using item-scale correlation after correction for overlap, reliability by means of internal consistency (Cronbach's alpha) and test-retest reliability (Intraclass Correlation Coefficients), and construct validity using an a priori hypothesised Pearson correlations with a Numerical Rating Scale (NRS) and the Short-Form 36 Health Survey (SF-36).

RESULTS

The questionnaire was administered to 224 subjects with knee injuries and proved to be acceptable. Hypothesised item-to-domain correlations were observed for all of the items. The questionnaire showed good internal consistency (0.782-0.977), and a high level of test-retest reliability (0.850-0.949). Construct validity was supported by the confirmation of the a priori hypothesised correlations.

CONCLUSIONS

The KOOS outcome measure was successfully translated into Italian, and proved to have good psychometric properties that replicated the results of existing versions. Its use is recommended for clinical and research purposes in patients with knee injuries.

Effectiveness and safety of dolutegravir two-drug regimens in virologically suppressed people living with HIV: a systematic literature review and meta-analysis of real-world evidence

Objectives

Dolutegravir (DTG) is widely recommended within three‐drug regimens. However, similar efficacy and tolerability have also been achieved with DTG within two‐drug regimens in clinical trials. This study evaluated the real‐world effectiveness and discontinuations in people living with HIV‐1 (PLHIV) switching to DTG with lamivudine (3TC) or rilpivirine (RPV).

Methods

This was a one‐arm meta‐analysis utilizing data from a systematic literature review. Data from real‐world evidence studies of DTG + RPV and DTG + 3TC were extracted, pooled and analysed. The primary outcome was the proportion of patients with viral failure (VF; ≥ 50 copies/mL in two consecutive measurements and/or ≥ 1000 copies/mL in a single measurement) at week 48 (W48) and week 96 (W96). Other outcomes included virological suppression (VS; < 50 copies/mL) and discontinuations (W48 and W96). Estimates were calculated for VF, VS as per snapshot (VSS) and on treatment analysis (VSOT), and discontinuations.

Results

Pooled mean estimates of VF for DTG + 3TC and DTG + RPV were 0.8% [95% confidence interval (CI): 0.4–1.3] and 0.6% (95% CI: 0.0–1.6), respectively, at W48. VSS rate at W48 was 85.0% (95% CI: 82.3–87.5) for DTG + 3TC regimen and 92.4% (95% CI: 85.0–97.7) in the DTG + RPV regimen. The DTG + 3TC and DTG + RPV regimens led to discontinuations in 13.6% (95% CI: 11.1–16.2) and 7.2% (95% CI: 2.1–14.4) of patients, respectively, at W48. Similar results were observed at W96.

Conclusions

Treatment with DTG + 3TC or DTG + RPV in clinical practice provides a low rate of VF and a high rate of VS when initiated in virologically suppressed PLHIV with diverse backgrounds.

Automatic speech analysis to early detect functional cognitive decline in elderly population

This study aimed at evaluating whether people with a normal cognitive function can be discriminated from subjects with a mild impairment of cognitive function based on a set of acoustic features derived from spontaneous speech. Voice recordings from 90 Italian subjects (age >65 years; group 1: 47 subjects with MMSE>26; group 2: 43 subjects with 20≤ MMSE ≤26) were collected. Voice samples were processed using a MATLAB-based custom software to derive a broad set of known acoustic features. Linear mixed model analyses were performed to select the features able to significantly distinguish between groups. The selected features (% of unvoiced segments, duration of unvoiced segments, % of voice breaks, speech rate, and duration of syllables), alone or in addition to age and years of education, were used to build a learning-based classifier. The leave-one-out cross validation was used for testing and the classifier accuracy was computed. When the voice features were used alone, an overall classification accuracy of 0.73 was achieved. When age and years of education were additionally used, the overall accuracy increased up to 0.80. These performances were lower than the accuracy of 0.86 found in a recent study. However, in that study the classification was based on several tasks, including more cognitive demanding tasks. Our results are encouraging because acoustic features, derived for the first time only from an ecologic continuous speech task, were able to discriminate people with a normal cognitive function from people with a mild cognitive decline. This study poses the basis for the development of a mobile application performing automatic voice analysis on-the-fly during phone calls, which might potentially support the detection of early signs of functional cognitive decline.

The combined action of a passive exoskeleton and an EMG-controlled neuroprosthesis for upper limb stroke rehabilitation: First results of the RETRAINER project

The combined use of Functional Electrical Stimulation (FES) and robotic technologies is advocated to improve rehabilitation outcomes after stroke. This work describes an arm rehabilitation system developed within the European project RETRAINER. The system consists of a passive 4-degrees-of-freedom exoskeleton equipped with springs to provide gravity compensation and electromagnetic brakes to hold target positions. FES is integrated in the system to provide additional support to the most impaired muscles. FES is triggered based on the volitional EMG signal of the same stimulated muscle; in order to encourage the active involvement of the patient the volitional EMG is also monitored throughout the task execution and based on it a happy or sad emoji is visualized at the end of each task. The control interface control of the system provides a GUI and multiple software tools to organize rehabilitation exercises and monitor rehabilitation progress. The functionality and the usability of the system was evaluated on four stroke patients. All patients were able to use the system and judged positively its wearability and the provided support. They were able to trigger the stimulation based on their residual muscle activity and provided different levels of active involvement in the exercise, in agreement with their level of impairment. A randomized controlled trial aimed at evaluating the effectiveness of the RETRAINER system to improve arm function after stroke is currently ongoing.

Biomimetic NMES controller for arm movements supported by a passive exoskeleton

The European Project MUltimodal Neuroprosthesis for Daily Upper limb Support (MUNDUS) aims at the development of an assistive platform for recovering direct interaction capability during daily life activities based on arm reaching and hand functions. Within this project the present study is focused on the design of a biomimetic controller able to modulate the neuromuscular electrical stimulation needed to perform reaching movements supported by a commercial passive exoskeleton for weight relief. Once defined the activities of daily life to be supported by the MUNDUS system, an experimental campaign on healthy subjects was carried out to identify the repeatable kinematics and muscular solution adopted during the target movements. The kinematics resulted to be highly stereotyped, a root mean squared error lower than 5° was found between all the trajectories obtained by healthy subjects in the same movement. A principal component analysis was performed on the EMG signals: less than 5 components explained more than the 85% of the signal variance. This result suggested that the muscular strategy adopted by healthy subjects was stereotyped and can be replicated by a biomimetic NMES controller. The controller was based on a time-delay artificial neural network which mapped the dynamic and non-linear relationship between kinematics and EMG activations to determine the stimulation timing. The stimulation levels reproduced the same scaling factors found between muscles in the stereotyped strategy. The controller was tested on 2 healthy subjects and though it was a feedforward controller, it showed good accuracy in reaching the desired target positions. The integration of a feedback controller is foreseen to ensure the complete accomplishment of the task and to compensate for unpredictable conditions such as muscular fatigue.

Neuro-mechanics of muscle coordination during recumbent pedaling in post-acute stroke patients

Motor impairment after stroke has been hypothesized to be related, among others, to impairments in the modular control of movement. In this study we analyzed muscle coordination and pedal forces during a recumbent pedaling exercise from a sample of post-acute stroke patients (n=5) and a population of age-matched healthy individuals (n=4). Healthy subjects and the less impaired patients showed a shared modular organization of pedaling based on 4 similar muscle synergies. The most impaired patient, characterized by a Motricity Index of 52/100, showed a reduced complexity (only 2 muscle synergies for the affected side). Differences between healthy subjects and post-stroke patients in the execution of the task were identified in terms of unbalance in mechanical work production, which well corresponded to the level of impairment. This pedaling unbalance could be traced back to different activation strategies of the 4 identified modules. Investigation on a more representative sample will provide a full characterization of the neuro-mechanics of pedaling after stroke, helping our understandings of the disruption of motor coordination at central level after stroke and of the most effective solutions for functional recovery.

A smart ink pen for spiral drawing analysis in patients with Parkinson's disease

Handwriting skills could be highly impaired in patients affected by Parkinson's disease (PD), and for this reason its analysis had always been considered relevant. In handwriting assessment, Archimedes spiral drawing is one of the most proposed tasks, due to its peculiar shape and ease of execution. In the last decades, digitizing tablets had been widely employed for the evaluation of the spiral performance, providing a cheap and non-invasive way to gather quantitative information, to be combined with the classical clinical examination. Despite this advantage, such approach cannot easily be adopted in an unsupervised scenario and lacks the natural feel of the traditional pen-and-paper approach. This work aims at overcoming these limitations by employing a smart ink pen, designed to write on paper and instrumented with inertial and force sensors, to automatically collect data related to spiral drawing execution of PD patients (n=30) and age-matched healthy controls (n=30). From the raw data, several time and frequency domains features were extracted and compared between the groups. The statistical analysis revealed some significant differences, showing less smooth acceleration and force profiles for PD patients. However, given the heterogeneous symptoms presented by the PD cohort, a detailed analysis of exemplifying PD patients was conducted, showing the ability of Archimedes spiral drawing to capture and quantify PD characteristic features.Clinical Relevance- Among the first clinical manifestations of the pathology, handwriting impairment appears in PD patients. It is often underestimated and not investigated properly. This easy-to-use tool could be very useful as a large-scale screening, but also for treatment efficacy evaluation and for the identification of PD subgroups.

Development and validation of an automated tool to scan scientific literature for the use of specific technologies in the field of cardiology

Background

Review of scientific literature is a time consuming but fundamental step in any kind of scientific research. A consistent manual filtering of papers is always necessary in order to evaluate their relevance with respect to the topic of interest, as the sorting provided by most common research engines is rarely efficient in terms of matching with the desired contents.

Purpose

The aim of this study was to develop, and validate versus manual analysis, an automated tool for performing an efficient search through medical scientific literature, according to keywords relevant to the application of specific technologies in the field of cardiology.

Methods

Using this multiplatform tool implemented in Python, PyQt5 library, the user is required to insert a list of keywords, from which all the possible search strings were built by connecting them with logical operators. The algorithm automatically queries the on-line database PubMed (NCBI) and downloads all the resulting abstracts, with titles and keywords. Results related to the field of cardiology are identified counting the occurrences of “marker” words collected in a dedicated dictionary, developed on the base of the Unified Medical Language System (U.S. NLM). Then, a search-specific dictionary is automatically developed according to the statistical distribution of words in the texts of abstracts, titles and keywords and weighting them according to their relative frequency (ratio between occurrences and number of considered papers). Finally, for each paper the occurrences of these “marker” words are counted and a matching-probability score is assigned, providing a sorting of the results according to expected matching with the topic of interest, together with a threshold-based binary classification.

In order to validate the algorithm, three different technologies with potential applications in cardiology were considered: smartphone applications (App), machine learning (ML) and virtual reality (VR). The related dictionaries were developed with the dedicated function embedded in the tool, while, for the validation of the results, a dataset of 461 manually-classified abstracts was considered, and algorithm thresholds were iteratively adjusted on the base of validation results.

Results

The algorithm applied to the validation dataset showed an overall accuracy (acc) of 88.5% (sensitivity (se) 85.78%, specificity (sp) 91.27%) in the identification of cardiology papers, while the results for the three inspected technologies were:

App: acc 90.89% (se 92.16%, sp 90.53%)

ML: acc 82.65% (se 94.06%, sp 79.44%)

VR: acc 91.54% (se 96%, sp 90.3%)

The algorithm can process 5000 abstracts in around 2 hours.

Conclusions

Results of the validation revealed that the proposed approach is highly valuable in speeding-up any search of medical literature focused on a specific technology or application, enabling a quick overview regarding its diffusion and maturity in a specific scientific domain.

Algorithm schema

Funding Acknowledgement

Type of funding source: None

17: OBESE ADIPOCYTE-DERIVED EXOSOMAL MIRNAS TARGETING TGF-β SIGNALING ARE ASSOCIATED WITH POOR ASTHMA CONTROL

Purpose of Study

Obesity is a major risk factor for difficult-to-control asthma. We reported obese visceral adipose-derived exosomes contain miRNAs capable of impairing TGF-β signaling, a pathway involved in airway remodeling, associated with poor asthma clinical outcomes. We hypothesized that adipose-derived exosomal miRNAs from obese youth with asthma would be associated with poor asthma control.

Methods Used

AsthMaP-2 Subjects (youth with physician-diagnosed asthma) were selected at extremes of obesity (n=10) and leanness (n=10). We profiled RNA from adipose-derived exosomes from serum and urine and identified significant correlations (p≤0.05) between obese adipose-derived exosomal miRNAs and Asthma Control Test (ACT) scores. Ingenuity Pathway Analysis generated predicted mRNA targets and pathways.

Summary of Results

Obese subjects had a BMI≥98th percentile and lean subjects had a BMI≤13th percentile for age and sex. Serum adipose-derived exosomes contained 12 ACT-correlated miRNAs predicted to target 2,963 mRNAs with TGF-β Signaling as the top pathway (ratio=36/87; p=3×10−9). Urinary adipose-derived exosomes contained 7 ACT-correlated miRNAs predicted to target 2,387 mRNAs with TGF-β Signaling among the top pathways (ratio=18/87; p=0.01). The serum exosomal miRNAs were predicted to target TGF-β signaling mediators' mRNAs: downregulation of ACVR2B, SMAD3, SMAD5, and SMAD7 by miR-15a-5p (Fold Change (FC)=1.5; p=0.039) and upregulation of TGFB2 and TGFBR2 by miR-153-3p (FC=−1.7; p=0.041). The urinary exosomal miRNAs were also predicted to target TGF-β signaling mediators' mRNAs, the net effects were the opposite direction: upregulation of ACVR2B and SMAD4 by miR-138-5p (FC=−1.2; p=0.033) and downregulation of TGFB2 and TGFBR2 by miR-153-3p (FC=1.6; p=0.026) and SMAD6 by miR-3187-5p (FC=2.3; p=0.008).

Conclusions

Poor asthma control in obese youth is associated with adipose-derived exosomal miRNAs in both serum and urine, in particular those that are predicted to affect TGF-β signaling. Due to anatomic considerations, visceral adipose-derived exosomes are expected to predominate in urine, while serum will contain a mix of both visceral and subcutaneous adipose-derived exosomes. Therefore, adipose-derived exosomes derived from urine may be useful biomarkers in obese subjects with asthma.

Martha Rogers' model in associate degree education

This article describes the first associate degree nursing program in the country to adopt Martha Rogers' science of unitary humans as the conceptual model for the program. The authors discuss the rationale for choosing the model, the curriculum design, the special challenges to implementation, and student and faculty reactions to the model.

Continuous nebulization: a treatment modality for pediatric asthma patients

Asthma is the most common of the chronic lung diseases diagnosed in children and accounts for a large percentage of emergency department/hospital admissions. Recently, the use of continuous administration of Beta-adrenergic agents has been found to be a safe and effective method of therapy for the pediatric patient experiencing severe asthma. An understanding of equipment, monitoring parameters, and nursing implications can help prepare pediatric nurses to provide care for children receiving continuous nebulization. An urban hospital in the northeastern United States organized a multidisciplinary team to investigate the use of continuous nebulization of Beta 2 agonists in the care of the pediatric patient experiencing an acute asthma episode.

Cycling induced by functional electrical stimulation improves the muscular strength and the motor control of individuals with post-acute stroke. Europa Medicophysica-SIMFER 2007 Award Winner

AIM

The aim of this study was to investigate the effectiveness of cycling induced by functional electrical stimulation (FES) in patients with postacute stroke.

METHODS

Twenty postacute inpatients were recruited and were randomly shared in a control group (56+/-9.2 years old, 50.8+/-24.5 days post-stroke) performing the standard rehabilitation (SR) and a FES group (51+/-12 years old, 56.1+/-22.8 days post-stroke) performing FES cycling in addition to SR. Both the groups performed 3 hours of rehabilitation per day for 4 weeks. The FES cycling was applied daily for 35 minutes and quadriceps, hamstring, gluteus maximus and tibialis anterior of both the legs were stimulated. The two groups were compared by the following outcome measurements before and after treatment: maximum isometric voluntary contraction (MVC) of quadriceps, walking and sit-to-stand ability, motricity index, upright motor control test and trunk control test.

RESULTS

After the treatment, the U-Mann-Whitney test demonstrated that the FES group produced a significantly higher increase of the muscular force produced by both the quadriceps during MVC with respect to the control group (P<0.05). Seventy percent of FES patients learned how to perform the sit to stand movement with three different rising speeds while no control patients develop the ability to perform the task properly.

CONCLUSION

Rehabilitation including FES cycling was more effective in promoting muscle strength and motor recovery of the lower extremity than therapist-assisted SR alone. Tests on an enlarged number of patients are necessary for generalization before proposing FES cycling in the clinical rehabilitation of post-acute stroke patients.

9: AN IN VIVO MODEL OF HUMAN AIRWAYS FOR INVESTIGATING FIBROSIS

Purpose of Study

Limited models exist to investigate the airway epithelium's role in repair, regeneration, and pathology of chronic obstructive lung diseases. We introduce a human asthmatic airway epithelial xenograft system integrating a proliferating and differentiating airway epithelium with an actively remodeling rodent mesenchyme in an immunocompromised murine host. We hypothesized that epithelial regeneration in asthma induces underlying matrix fibrosis.

Methods Used

Human airway epithelial cells from asthmatic and non-asthmatic donors (n=5 per group) were seeded into decellularized rat tracheas. Tracheas were ligated to a sterile tubing cassette and implanted subcutaneously in the flanks of athymic nude mice. Grafts were harvested at 2, 4, or 6 weeks for analysis of tissue histology, fibrillar collagen deposition, and TGFβ1 activation. Non-transplantable human lungs from asthmatic and non-asthmatic donor FFPE sections were analyzed using similar methods.

Summary of Results

Grafted epithelial cells generated a differentiated epithelium with basal, ciliated, and mucus cells. By 4 weeks post-engraftment, asthmatic-derived epithelia showed decreased numbers of ciliated cells and E-cadherin expression compared to non-asthmatic controls, similar to human lung biopsy tissue. While there was no evidence of matrix remodeling in acellular xenografts, grafts seeded with asthmatic-derived epithelial cells had 3 times as much fibrillar collagen at 6 weeks post-engraftment as non-asthmatic epithelial seeded grafts. This was accompanied by a >2-fold induction of matrix TGFβ1 [with evidence of pSMAD3 activity] in asthmatic grafts at 4 weeks (positive pixels/total field pixels=0.12±0.001 vs. 0.05±0.001; p=0.003) and 6 weeks (0.09±0.02 vs. 0.04±0.01; p=0.044) post-engraftment.

Conclusions

We show in this model that asthmatic epithelium alone is sufficient to drive aberrant mesenchymal remodeling, specifically with fibrillar collagen deposition in asthmatic-derived xenografts.These xenografts are a major advance over current animal models of asthma in that they permit direct assessment of the epithelial-mesenchymal trophic unit.

Cycling induced by functional electrical stimulation in children affected by cerebral palsy: case report

BACKGROUND

Recently, the efficacy of functional electrical stimulation (FES) cycling have been demonstrated on the improvement of strength and motor control in adults with stroke. FES-cycling, providing a repetitive goal-oriented task, could facilitate cortical reorganization and utilization of residual cortico-spinal pathways. These benefits could be more enhanced in children because of the greater plasticity and flexibility of their central nervous system.

AIM

The aim of the present case report study was to explore the feasibility of FES-cycling in children with cerebral palsy (CP) and to provide a set of instrumental measures able to evaluate the effects of this novel treatment on cycling and walking ability.

DESIGN

Interventional study.

SETTING AND POPULATION

Two ambulant outpatient children with diplegic CP were recruited by the "E. Medea" Scientific Institute.

METHODS

Patients followed a FES-cycling treatment for 30 minutes a day, 3 days a week for 7 weeks. Pre and post treatment tests were performed, namely clinical measures and electromyographic, kinematic and oxygen expenditure analysis during gait and cycling.

RESULTS

The treatment was safe, feasible and well accepted by the 2 children. After treatment both patients achieved a more symmetrical muscular strategy during voluntary cycling and gait and a significant reduction of muscle co-contractions during cycling. These improvements were corroborated by a decrease in oxygen expenditure during the post test for one of the two children, the less impaired, implying a better exploiting of bi-articular muscles.

CONCLUSION AND CLINICAL REHABILITATION IMPACT

FES-cycling is feasible and safe and it may be an alternative rehabilitation method for diplegic CP patients. The set of instrumental measurements proposed seems to be a valuable tool for functional assessment to identify subclinical anomalies and improvements on cycling and gait in CP patients.

Evaluating the health and fitness benefits of a 6-month FES-cycling program on a recumbent trike for individuals with motor complete SCI: a pilot study

BACKGROUND

Spinal cord injury (SCI) severely affects physical function, leading to muscle atrophy and reduced bone density. Sport-therapy, incorporating recreational and competitive activities, has shown promise in enhancing recovery for individuals with SCI. Functional Electrical Stimulation (FES)-cycling combines exercise benefits with stimulation advantages, and recent integration with mobile recumbent trikes adds further potential. This study aimed to evaluate the effects of a 6-month FES-cycling sport therapy using a recumbent trike on individuals with motor complete SCI.

METHODS

Five participants engaged in bi-weekly FES-cycling sessions using an instrumented recumbent trike. A comprehensive assessment was conducted before training, at 3 and 6 months of training, and at 1-month follow-up. Outcome measures included maximal muscle Cross-Sectional Area (maxCSA) from Magnetic Resonance Images, bone mineral density, clinical scales, and questionnaires on spasticity, pain, bowel dysfunction, psychological well-being, and sport motivation. Additionally, maximal power output and cycling endurance were assessed.

RESULTS

The FES-cycling program led to a significant increase in muscle mass of 34% after 6 months of training, correlated to an improved cycling performance (maxCSA versus peak power). A slight decrease of muscle mass was observed as expected at follow-up. Participants reported high well-being and strong motivation throughout the training program. Bone health, spasticity, bowel dysfunction, and pain levels did not significantly change overall.

CONCLUSIONS

FES-cycling on a recumbent trike shows potential as a therapeutic and recreational activity for individuals with SCI. It significantly improved muscle mass and physical performance while positively impacting psychological well-being and motivation. Further research with larger cohorts is necessary to confirm these benefits and optimize protocols, establishing FES-cycling as a valuable sport-therapy model for SCI.

TRIAL REGISTRATION

The study protocol was retrospectively registered on clinicaltrials.gov (NCT06321172).

Ink-based textile electrodes for wearable functional electrical stimulation: A proof-of-concept study to evaluate comfort and efficacy

BACKGROUND

Functional Electrical Stimulation (FES) represents a promising technique for promoting functional recovery in individuals with neuromuscular diseases. Traditionally, current pulses are delivered through self-adhesive hydrogel Ag/AgCl electrodes, which allow a good contact with the skin, are easy-to-use and have a moderate cost. However, skin adherence decreases after a few uses and skin irritations can originate. Recently, textile electrodes have become an attractive alternative as they assure increased durability, easy integration into clothes and can be conveniently cleaned, improving the wearability of FES. However, as various manufacture processes were attempted, their clear validation is lacking. This proof-of-concept study proposes a novel set of ink-based printed textile electrodes and compares them to adhesive hydrogel electrodes in terms of impedance, stimulation performance and perceived comfort.

METHODS

The skin-electrode impedance was evaluated for both types of electrodes under different conditions. These electrodes were then used to deliver FES to the Rectus Femoris of 14 healthy subjects to induce its contraction in both isometric and dynamic conditions. This allowed to compare the two types of electrodes in terms of sensory, motor, maximum and pain thresholds, FES-induced range of motion during dynamic tests, FES-induced torque during isometric tests and perceived stimulation comfort.

RESULTS

No statistically significant differences were found both in terms of stimulation performance (Wilcoxon test) and comfort (Generalized Linear Mixed Model).

CONCLUSION

The results showed that the proposed ink-based printed textile electrodes can be effectively used as alternative to hydrogel ones. Further experiments are needed to evaluate their durability and their response to sterilizability and stretching tests.