Upper limb robotic rehabilitation for patients with cervical spinal cord injury: a comprehensive review

The upper extremities limitation represents one of the essential functional impairments in patients with cervical spinal cord injury. Electromechanics assisted devices and robots are increasingly used in neurorehabilitation to help functional improvement in patients with neurological diseases. This review aimed to systematically report the evidence-based, state-of-art on clinical applications and robotic-assisted arm training (RAT) in motor and functional recovery in subjects affected by cervical spinal cord injury. The present study has been carried out within the framework of the Italian Consensus Conference on "Rehabilitation assisted by robotic and electromechanical devices for persons with disability of neurological origin" (CICERONE). PubMed/MEDLINE, Cochrane Library, and Physiotherapy Evidence Database (PEDro) databases were systematically searched from inception to September 2021. The 10-item PEDro scale assessed the study quality for the RCT and the AMSTAR-2 for the systematic review. Two different authors rated the studies included in this review. If consensus was not achieved after discussion, a third reviewer was interrogated. The five-item Oxford CEBM scale was used to rate the level of evidence. A total of 11 studies were included. The selected studies were: two systematic reviews, two RCTs, one parallel-group controlled trial, one longitudinal intervention study and five case series. One RCT was scored as a high-quality study, while the systematic review was of low quality. RAT was reported as feasible and safe. Initial positive effects of RAT were found for arm function and quality of movement in addition to conventional therapy. The high clinical heterogeneity of treatment programs and the variety of robot devices could severely affect the generalizability of the study results. Therefore, future studies are warranted to standardize the type of intervention and evaluate the role of robotic-assisted training in subjects affected by cervical spinal cord injury

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

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

Acute Delta Hepatitis in Italy spanning three decades (1991–2019): Evidence for the effectiveness of the hepatitis B vaccination campaign

Updated incidence data of acute Delta virus hepatitis (HDV) are lacking worldwide. Our aim was to evaluate incidence of and risk factors for acute HDV in Italy after the introduction of the compulsory vaccination against hepatitis B virus (HBV) in 1991. Data were obtained from the National Surveillance System of acute viral hepatitis (SEIEVA). Independent predictors of HDV were assessed by logistic-regression analysis. The incidence of acute HDV per 1-million population declined from 3.2 cases in 1987 to 0.04 in 2019, parallel to that of acute HBV per 100,000 from 10.0 to 0.39 cases during the same period. The median age of cases increased from 27 years in the decade 1991-1999 to 44 years in the decade 2010-2019 (p < .001). Over the same period, the male/female ratio decreased from 3.8 to 2.1, the proportion of coinfections increased from 55% to 75% (p = .003) and that of HBsAg positive acute hepatitis tested for by IgM anti-HDV linearly decreased from 50.1% to 34.1% (p < .001). People born abroad accounted for 24.6% of cases in 2004-2010 and 32.1% in 2011-2019. In the period 2010-2019, risky sexual behaviour (O.R. 4.2; 95%CI: 1.4-12.8) was the sole independent predictor of acute HDV; conversely intravenous drug use was no longer associated (O.R. 1.25; 95%CI: 0.15-10.22) with this. In conclusion, HBV vaccination was an effective measure to control acute HDV. Intravenous drug use is no longer an efficient mode of HDV spread. Testing for IgM-anti HDV is a grey area requiring alert. Acute HDV in foreigners should be monitored in the years to come

Access to Social Justice: the Intersection of Homelessness and Migration in Europe. A Multiple Case Study of Italy and Sweden

This study maps the intersection of homelessness and migration in Europe by focusing on Italy and Sweden; in the study, ‘Europe’ is defined by the Schengen Common Area Agreement, by the Common European Asylum System and by the Dublin Regulation. Using Kimberlé Crenshaw’s Intersectionality as one of its main theoretical reference points, the study argues that different dimensions of power relations may combine to create unique modes of discrimination that apply specifically to homeless migrants in Italy and Sweden. Moreover, with reference to Nancy Fraser’s Scales of Justice and the principles of Recognition and Redistribution, in order to eradicate the homelessness that different social groups suffer from, we must recognise differences and redistribute wealth more equally. Based on fieldwork among migrants, NGOs workers and professionals, all of whom are dealing with immigration procedures and homeless migrants’ (lack of) access to housing, healthcare and employment, the study finds that there are significant obstacles to social justice. In both Italy and Sweden most of the research participants became homeless upon migrating. The same migrants, in both countries, face all the harmful effects of homelessness, lack of access to healthcare and employment, which in turn drive some individuals toward addiction and substance abuse. The study main finding suggests that the absence of a permanent abode is the migrant’s gravest limitation because for those suffering of a pre-existing medical or psychological condition the situation is aggravated further. Additionally, upon becoming homeless migrants can rely solely on NGOs for support (shelter, healthcare and food)

How do young and senior cytopathologists interact with digital cytology?

Today thanks to the technological advances in information technology the scenario of utilization of digital cytology has radically changed. New competitive systems, such as client-server architectures are now available in digital cytology. Their application in telemedicine should be investigated. A new interactive tool designed for the final destination user (the cytopathologist) has been proposed. Taking into account the different expertise of the subjects of the study, the investigation was focused both on the senior cytopathologist and on the younger student pathologist. The methodology was tested on 10 students of a Master in cytopathology and on 3 senior cytopathologists. The study showed that the use of digital cytology applications is effective and feasible for telediagnosis. In particular, the study on younger and senior expert investigators showed that, although they interacted with the novel technology of the virtual slide in a different manner, all of them reached the objective of a "correct diagnosis". This investigation, in consideration of the effectiveness of the digital cytology, also showed other indirect and tangible cost-beneft and quantitative advantages. In particular for the learning methodologies for the students of the Master itself and for the biomedical personnel involved in diagnosis