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

Management of pneumatosis cystoides intestinalis with pneumoperitoneum: 5-years systematic review.

SummaryBackground: Pneumatosis Cystoides Intestinalis (PCI) is a rare condition, characterized by gas-filled cysts in the intestinal wall. Rarely, it may also involve other places, such as the mesentery. It is classified as primary and secondary and associated with multiple predisposing factors. Its differential diagnosis is mesenteric ischemia.Methods: We conducted a systematic literature review according to PRISMA statement. PubMed and LILACS databases were searched for articles published between January 2015 and December 2020. The subject headings were "Pneumatosis cystoides intestinalis" and "pneumoperitoneum", "pneumatosis intestinalis" and "pneumoperitoneum" or "mesenteric pneumatosis".Results: 51 articles with 58 patients with PCI and pneumoperitoneum were included. Most patients were male and the average age was 64.9 years. The idiopathic etiology was recorded in 29.31% and the most common predisposing factor were immune dysfunction (28.3%). 24.13% were asymptomatic and the most commons symptoms were abdominal pain (43.1%), nausea and vomiting (41.37%) and abdominal distention (37.93%). Diagnostic surgery was performed in 26 patients (44.8%). Just one patient underwent to surgery with treatment intent.Conclusion: PCI is a benign disease that can be confused with a potentially fatal condition, mesenteric ischemia. Treatment is conservative, with periodic clinical evaluations. Surgical procedure is usually not necessary for the diagnosis or management of PCI.

On the management of nature-based solutions in open-air laboratories: new insights and future perspectives

202

Nature-based solutions efficiency evaluation against natural hazards: modelling methods, advantages and limitations

Nature-based solutions (NBS) for hydro-meteorological risks (HMRs) reduction and management are becoming increasingly popular, but challenges such as the lack of well-recognised standard methodologies to evaluate their performance and upscale their implementation remain. We systematically evaluate the current state-of-the art on the models and tools that are utilised for the optimum allocation, design and efficiency evaluation of NBS for five HMRs (flooding, droughts, heatwaves, landslides, and storm surges and coastal erosion). We found that methods to assess the complex issue of NBS efficiency and cost-benefits analysis are still in the development stage and they have only been implemented through the methodologies developed for other purposes such as fluid dynamics models in micro and catchment scale contexts. Of the reviewed numerical models and tools MIKE-SHE, SWMM (for floods), ParFlow-TREES, ACRU, SIMGRO (for droughts), WRF, ENVI-met (for heatwaves), FUNWAVE-TVD, BROOK90 (for landslides), TELEMAC and ADCIRC (for storm surges) are more flexible to evaluate the performance and effectiveness of specific NBS such as wetlands, ponds, trees, parks, grass, green roof/walls, tree roots, vegetations, coral reefs, mangroves, sea grasses, oyster reefs, sea salt marshes, sandy beaches and dunes. We conclude that the models and tools that are capable of assessing the multiple benefits, particularly the performance and cost-effectiveness of NBS for HMR reduction and management are not readily available. Thus, our synthesis of modelling methods can facilitate their selection that can maximise opportunities and refute the current political hesitation of NBS deployment compared with grey solutions for HMR management but also for the provision of a wide range of social and economic co-benefits. However, there is still a need for bespoke modelling tools that can holistically assess the various components of NBS from an HMR reduction and management perspective. Such tools can facilitate impact assessment modelling under different NBS scenarios to build a solid evidence base for upscaling and replicating the implementation of NBS

Effectiveness and Consequences of Direct Access in Physiotherapy: A Systematic Review

Background. Direct access in physiotherapy (DAPT) occurs when a patient has the ability to self-refer to physical therapy without physician referral. This model of care in musculoskeletal diseases (MSDs) has shown better outcomes than the traditional-based medical model of care that requires physician referral to access physiotherapist services. This traditional physician referral often results in a delay in care. Unfortunately, DAPT is still not permitted in many countries. Objectives. The primary objective of this systematic review was to compare the effectiveness, safety, and the accuracy of DAPT compared to the physician-led model of care for the management of patients with musculoskeletal disorders. The secondary objective of the present study is to define the physiotherapists’ characteristics or qualifications involved in DAPT. Materials and methods. Databases searched included: Medline, Scopus and Web of Science. Databases were searched from their inception to July 2022. Research strings were developed according to the PICO model of clinical questions (patient, intervention, comparison, and outcome). Free terms or synonyms (e.g., physical therapy; primary health care; direct access; musculoskeletal disease; cost-effectiveness) and when possible MeSH (Medical Subject Headings) terms were used and combined with Boolean operators (AND, OR, NOT). Risk of bias assessment was carried out through Version 2 of the Cochrane risk-of-bias tool (ROB-2) for randomized controlled trials (RCTs) and the Newcastle Ottawa Scale (NOS) for observational studies. Authors conducted a qualitative analysis of the results through narrative analysis and narrative synthesis. The narrative analysis was provided for an extraction of the key concepts and common meanings of the different studies, while the summary narrative provided a textual combination of data. In addition, a quantitative analysis was conducted comparing the analysis of the mean and differences between the means. Results. Twenty-eight articles met the inclusion criteria and were analyzed. Results show that DAPT had a high referral accuracy and a reduction in the rate of return visits. The medical model had a higher use of imaging, drugs, and referral to another specialist. DAPT was found to be more cost-effective than the medical model. DAPT resulted in better work-related outcomes and was superior when considering patient satisfaction. There were no adverse events noted in any of the studies. In regard to health outcomes, there was no difference between models. ROB-2 shows an intermediate risk of bias risk for the RCTs with an average of 6/9 points for the NOS scale for observational studies. Conclusion. DAPT is a safe, less expensive, reliable triage and management model of care that results in higher levels of satisfaction for patients compared to the traditional medical model. Prospero Registration Number: CRD42022349261

Living in a pandemic: changes in mobility routines, social activity and adherence to COVID-19 protective measures

none7noNon-Pharmaceutical Interventions (NPIs), aimed at reducing the diffusion of the COVID-19 pandemic, have dramatically influenced our everyday behaviour. In this work, we study how individuals adapted their daily movements and person-to-person contact patterns over time in response to the NPIs. We leverage longitudinal GPS mobility data of hundreds of thousands of anonymous individuals to empirically show and quantify the dramatic disruption in people’s mobility habits and social behaviour. We find that local interventions did not just impact the number of visits to different venues but also how people experience them. Individuals spend less time in venues, preferring simpler and more predictable routines, also reducing person-to-person contacts. Moreover, we find that the individual patterns of visits are influenced by the strength of the NPIs policies, the local severity of the pandemic and a risk adaptation factor, which increases the people’s mobility regardless of the stringency of interventions. Finally, despite the gradual recovery in visit patterns, we find that individuals continue to keep person-to-person contacts low. This apparent conflict hints that the evolution of policy adherence should be carefully addressed by policymakers, epidemiologists and mobility experts.noneLucchini, Lorenzo; Centellegher, Simone; Pappalardo, Luca; Gallotti, Riccardo; Privitera, Filippo; Lepri, Bruno; De Nadai, MarcoLucchini, Lorenzo; Centellegher, Simone; Pappalardo, Luca; Gallotti, Riccardo; Privitera, Filippo; Lepri, Bruno; De Nadai, Marc

Case Report: Two Is Not (Always) Better Than One: Pyloric Gland Adenoma of the Gastric Cardia and Concurrent Neuroendocrine Cell Dysplasia Arising From Autoimmune Gastritis

Autoimmune gastritis is a chronic immune-mediated disorder characterized by varied clinical manifestations and that should be endoscopically managed over time, as the gastric atrophy contributes to microenvironmental alterations of the stomach milieu, and an increased cancer risk has been linked to this condition. Here, we report the unusual case of a woman who developed a cardiac high-grade pyloric adenoma in a context of previously undiagnosed autoimmune gastritis with synchronous neuroendocrine cell hyperplastic and dysplastic lesions

Management of pneumatosis cystoides intestinalis with pneumoperitoneum: 5-years systematic review.

SummaryBackground: Pneumatosis Cystoides Intestinalis (PCI) is a rare condition, characterized by gas-filled cysts in the intestinal wall. Rarely, it may also involve other places, such as the mesentery. It is classified as primary and secondary and associated with multiple predisposing factors. Its differential diagnosis is mesenteric ischemia.Methods: We conducted a systematic literature review according to PRISMA statement. PubMed and LILACS databases were searched for articles published between January 2015 and December 2020. The subject headings were "Pneumatosis cystoides intestinalis" and "pneumoperitoneum", "pneumatosis intestinalis" and "pneumoperitoneum" or "mesenteric pneumatosis".Results: 51 articles with 58 patients with PCI and pneumoperitoneum were included. Most patients were male and the average age was 64.9 years. The idiopathic etiology was recorded in 29.31% and the most common predisposing factor were immune dysfunction (28.3%). 24.13% were asymptomatic and the most commons symptoms were abdominal pain (43.1%), nausea and vomiting (41.37%) and abdominal distention (37.93%). Diagnostic surgery was performed in 26 patients (44.8%). Just one patient underwent to surgery with treatment intent.Conclusion: PCI is a benign disease that can be confused with a potentially fatal condition, mesenteric ischemia. Treatment is conservative, with periodic clinical evaluations. Surgical procedure is usually not necessary for the diagnosis or management of PCI.