Editor: Special Issue "Wearable & Soft Robotics Technologies and Beyond"

This Special Issue aims to bridge the gap between available technologies and application needs. The focus includes novel actuator mechanisms, biologically inspired and biomimetic designs, FES-based hybrid systems, intelligent controls, and user-based evaluations in real-world scenarios. Additionally, we seek research to assess the practical potential and impact of soft wearable robots on people with disabilities, athletes, workers, and others

COVID-19 Detection from Mass Spectra of Exhaled Breath

According to the World Health Organization, the SARS-CoV-2 virus generated a global emergency between 2020 and 2023 resulting in about 7 million deaths out of more than 750 million individuals diagnosed with COVID-19. During these years, polymerase-chain-reaction and antigen testing played a prominent role in disease control. In this study, we propose a fast and non-invasive detection system exploiting a proprietary mass spectrometer to measure ions in exhaled breath. We demonstrated that infected individuals, even if asymptomatic, exhibit characteristics in the air expelled from the lungs that can be detected by a nanotech-based technology and then recognized by soft-computing algorithms. A clinical trial was ran on about 300 patients: the mass spectra in the 10-351 mass-to-charge range were measured, suitably pre-processed, and analyzed by different classification models; eventually, the system shown an accuracy of 95% and a recall of 94% in identifying cases of COVID-19. With performances comparable to traditional methodologies, the proposed system could play a significant role in both routine examination for common diseases and emergency response for new epidemics.Comment: 15 page

Dopaminergic inhibition of human neutrophils is exerted through D1-like receptors and affected by bacterial infection

Dopamine (DA) affects immune functions in healthy subjects (HS) and during disease by acting on D1-like (D1 and D5) and D2-like (D2, D3 and D4) dopaminergic receptors (DR); however, its effects on human polymorphonuclear leukocytes (PMN) are still poorly defined. We investigated DR expression in human PMN and the ability of DA to affect cell migration and reactive oxygen species (ROS) production. Experiments were performed on cells from HS and from patients (Pts) with bacterial infections as well, during the acute phase and after recovery. Some experiments were also performed in mice knockout (KO) for the DRD5 gene. PMN from HS express both D1-like and D2-like DR, and exposure to DA results in inhibition of activation-induced morphological changes, migration and ROS production which depend on the activation of D1-like DR. In agreement with these findings, DA inhibited migration of PMN obtained from wild-type mice, but not from DRD5KO mice. In Pts with bacterial infections, during the febrile phase D1-like DRD5 on PMN were downregulated and DA failed to affect PMN migration. Both D1-like DRD5 expression and DA-induced inhibition of PMN migration were however restored after recovery. Dopaminergic inhibition of human PMN is a novel mechanism which is likely to play a key role in the regulation of innate immunity. Evidence obtained in Pts with bacterial infections provides novel clues for the therapeutic modulation of PMN during infectious disease

Quantitative and Qualitative Evaluation of Exoskeleton Transparency Controllers for Upper-Limb Neurorehabilitation

High transparency is a fundamental requirement for upper-limb exoskeletons to promote active patient participation. Although various control strategies have been suggested to improve the transparency of these robots, there are still some limitations, such as the need for precise dynamic models and potential safety issues when external forces are applied to the robot. This study presents a novel hybrid controller designed to tackle these limitations by combining a traditional zero-torque controller with an interaction torque observer that compensates for residual undesired disturbances. The transparency of the proposed controller was evaluated using both quantitative-e.g., residual joint torques and movement smoothness-and qualitative measures-e.g., comfort, agency, and perceived resistance-in a pilot study with six healthy participants. The performance of the new controller was compared to that of two conventional controllers: a zero-torque closed-loop controller and a velocity-based disturbance observer. Our preliminary results show that the proposed hybrid controller may be a good alternative to state-of-the-art controllers as it allows participants to perform precise and smooth movements with low interaction joint torques. Importantly, participants rated the new controller higher in comfort and agency, and lower in perceived resistance. This study highlights the importance of incorporating both quantitative and qualitative assessments in evaluating control strategies developed to enhance the transparency of rehabilitation robots.</p

Development and Validation of a Kinematically Accurate Upper-Limb Exoskeleton Digital Twin for Stroke Rehabilitation

Rehabilitation robotics combined with virtual reality using head-mounted displays enable naturalistic, immersive, and motivating therapy for people after stroke. There is growing interest in employing digital twins in robotic neurore-habilitation, e.g., in telerehabilitation for virtual coaching and monitoring, as well as in immersive virtual reality applications. However, the kinematic matching of the robot's visualization with the real robot movements is hardly validated, potentially affecting the users' experience while immersed in the virtual environment due to a visual-proprioceptive mismatch. The kinematic mismatch may also limit the validity of assessment measures recorded with the digital twin. We present the development and low-cost kinematic validation of a digital twin of a seven active degrees-of-freedom exoskeleton for stroke rehabilitation. We validated the kinematic accuracy of the digital twin end-effector by performing two tasks-a planar reaching task and a 3D functional task-performed by a single healthy participant. We computed the end-effector position and rotation from the forward kinematics of the robot, the digital twin, and data recorded from the real robot using a low-cost tracking system based on HTC VIVE trackers and compared them pair-wise. We found that the digital twin closely matches the forward kinematics and tracked movement of the real robot and thus provides a reliable platform for future research on digital twins for stroke rehabilitation.</p

Multi-modal human-machine control interfaces of upper limb motorized exoskeletons for severely impaired patients

Abstract: The aim of this study concerns the evaluation and comparison of different Human-Machine Interfaces for the control of an upper limb motorized exoskeleton for severely impaired patients. Different approaches (i.e. manual, vocal, visual control) are tested in a simulation environment on three subjects affected by muscular dystrophy with the aim of assessing the capability of the system to interact with the user and vice versa. A Graphical User Interface shows the simulated behavior of the exoskeleton to the user which has to perform reaching tasks in the space by moving the exoskeleton end-effector to defined virtual targets that are displayed on the screen. Specific assessment of the interaction of the user with each control interface is achieved, while a quantitative evaluation of the usability of all the three approaches is provided by a System Usability Scale (SUS) questionnaire. All patients were able to interact with all control interfaces without difficulties and to complete reaching tasks in simulation. SUS scores showed overall good usability of the Human-Machine Control Interfaces suggesting that the manual and the vocal control interfaces are preferred by the subjects

AGREE: an upper-limb robotic platform for personalized rehabilitation, concept and clinical study design

: Rehabilitation exoskeletons can supplement therapist-based training allowing post-stroke patients to perform functional, high-dosage, repetitive exercises. The use of robotic devices allows providing intense rehabilitation sessions and permits clinicians to personalize the therapy according to the patient's need. In this work, we propose an upper-limb rehabilitation system developed within the AGREE project. The platform relies on a four degrees-of-freedom arm exoskeleton, capable of assisting state-of-the-art rehabilitation exercises under different training modalities while behaving transparently to user-generated and therapist-applied forces. The system is provided with a LEDs-matrix mat to guide patients during reaching tasks with visual feedback, an EMG reader to evaluate the patient's involvement during the therapy, and several software tools to help clinicians customize the treatment and monitor the patient's progress. A randomized controlled pilot study aimed at evaluating the usability and the effectiveness of the AGREE rehabilitation platform to improve arm impairment after stroke is currently ongoing

High-dose dexamethasone treatment for COVID-19 severe acute respiratory distress syndrome: a retrospective study

Low-dose dexamethasone reduces mortality in patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS). We retrospectively analyzed the efficacy of high-dose dexamethasone in patients with COVID-19-related ARDS and evaluated factors affecting the composite outcome (death or invasive mechanical ventilation). From March 4th to April 1st 2020, 98 patients with COVID-19 pneumonia were included. Those who after at least 7 days from symptom onset presented a worsening of the respiratory function or of inflammatory biomarkers were started on intravenous high-dose dexamethasone (20 mg daily for 5 days, followed by 10 mg daily for 5 days). Most patients were males (62%) with a mean age of 69 years. Hypertension and cardiovascular disease (CVD) were prevalent. Following dexamethasone treatment, a significant improvement in PaO2/FiO2 (277.41 [178.5\u2013374.8] mmHg vs. 146.75 [93.62\u2013231.16] mmHg, p &lt; 0.001), PaO2 (88.15 [76.62\u2013112.0] mmHg vs. 65.65 [57.07\u201381.22] mmHg, p &lt; 0.001), and SpO2 (96 [95\u201398]% vs. 94 [90\u201396]%, p &lt; 0.001) was observed. A concomitant decrease in C-reactive protein and ferritin levels was found (132.25 [82.27\u2013186.5] mg/L vs. 7.3 [3.3\u201324.2] mg/L and 1169 [665\u20132056] ng/mL vs. 874.0 [569.5\u20131434] ng/mL, respectively; p &lt; 0.001 for both vs. baseline). CVD was found to increase the risk of the composite outcome (RR 7.64, 95% CI 1.24\u201347.06, p = 0.028). In hospitalized patients with COVID-19-related ARDS, high-dose dexamethasone rapidly improves the clinical status and decreases inflammatory biomarkers. CVD was found to increase the risk of the composite outcome. These data support the importance of randomized clinical trials with high-dose dexamethasone in COVID-19 patient

SYMPTOMATIC SARS-CoV-2 INFECTIONS AFTER FULL SCHEDULE BNT162b2 VACCINATION IN SEROPOSITIVE HEALTHCARE WORKERS: A CASE SERIES FROM A SINGLE INSTITUTION

AbstractWe report 11 cases of SARS-CoV-2 infection in healthcare workers (HCW) naive for COVID-19 and seropositive after the second dose of the BNT162b2 mRNA vaccine. Based on voluntary-based surveillance, they tested positive for different strains of SARS-CoV-2, as Spike gene sequencing showed. Five of them reported mild symptoms. Given the risk for SARS-CoV-2 introduction from asymptomatic vaccinees, this case series suggests the need to continue nasopharyngeal screening programs