Novel mixed active hand exoskeleton and assistive arm device for intensive rehabilitative treatment for stroke patients

This paper presents a novel rehabilitative platform designed to provide a functional upper-limb task specific training for hemiparetic chronic stroke patients. The system provides arm weight support and robotic assistance of the hand closing/opening skill. A graphical interface allows clinicians to administer different virtual reality scenarios and to customize training tasks providing progressive complexity based on patients motor skills. In order to assess motor function recovery along the whole treatment, objective performance metrics have been extracted and analyzed, showing an overall improvement of upper limb motor function after the treatment period

A novel approach for upper limb robotic rehabilitation for stroke patients

This paper presents a novel neuro-rehabilitation system for recovery of arm and hand motor functions involved in reaching and grasping. The system provides arm weight support and robotic assistance of the hand closing/opening within specific exercises in virtual reality. A user interface allows the clinicians to perform an easy parametrization of the virtual scenario, customizing the exercises and the robotic assistance to the needs of the patient and encouraging training of the hand with proper recruitment of the residual motor functions. Feasibility of the proposed rehabilitation system was evaluated through an experimental rehabilitation session, conducted by clinicians with 4 healthy participants and 2 stroke patients. All subjects were able to perform the proposed exercises with parameters adapted to their specific motor capabilities. All patients were able to use the proposed system and to accomplishing the rehabilitation tasks following the suggestion of the clinicians. The effectiveness of the proposed neuro-rehabilitation will be evaluated in an imminent prolonged clinical study involving more stroke patients

Real-life therapeutic effects of beclomethasone dipropionate/formoterol fumarate/glycopyrronium combined triple therapy in patients with chronic obstructive pulmonary disease

Background: The small airway disease has been recognized as a central feature of chronic obstructive pulmonary disease (COPD). Triple fixed combination beclomethasone dipropionate/formoterol fumarate/glycopyrronium (BDP/FF/G) is provided as a pressurized single-dose inhaler based on an extra-fine formulation, which has been approved for patients with COPD experiencing frequent disease exacerbations. Methods: The aim of our real-life single-center observational study was to investigate, in 22 patients with COPD, the effects of BDP/FF/G on lung function, respiratory symptoms, health status, and exacerbation rate. Several clinical and lung functional parameters were evaluated at baseline and after 12 months of treatment with combined inhaled triple therapy. Results: With respect to baseline, after 12 months of treatment with BDP/FF/G, significant changes were recorded with regard to forced expiratory flow at 75% of forced vital capacity (FVC) ( p  < 0.01), forced expiratory flow at 50% of FVC ( p  < 0.01), forced expiratory flow at 25% of FVC ( p  < 0.05), and forced mid-expiratory flow between 25% and 75% of FVC ( p  < 0.01). Moreover, we observed reductions of total resistance ( p  < 0.01), effective resistance ( p  < 0.01), and effective specific resistance ( p  < 0.01). In the same period, residual volume diminished ( p  < 0.01) and forced expiratory volume in 1 s increased ( p  < 0.01). Moreover, in a subgroup of 16 patients, an enhancement of diffusion lung capacity ( p  < 0.01) was also detected. These functional results were paralleled by concomitant clinical effects, as evidenced by the improvements of modified British Medical Research Council (mMRC) dyspnea scale ( p  < 0.001), COPD Assessment Test (CAT) score ( p  < 0.0001), and COPD exacerbations ( p  < 0.0001). Conclusion: In conclusion, the valuable findings of our observational study consist in the corroboration in a real-life context of the therapeutic effects evidenced by randomized controlled trials with regard to the use of the triple inhaled BDP/FF/G therapy in patients with COPD

Anti-tumor Activity and Epigenetic Impact of the Polyphenol Oleacein in Multiple Myeloma

Olive oil contains different biologically active polyphenols, among which oleacein, the most abundant secoiridoid, has recently emerged for its beneficial properties in various disease contexts. By using in vitro models of human multiple myeloma (MM), we here investigated the anti-tumor potential of oleacein and the underlying bio-molecular sequelae. Within a low micromolar range, oleacein reduced the viability of MM primary samples and cell lines even in the presence of bone marrow stromal cells (BMSCs), while sparing healthy peripheral blood mononuclear cells. We also demonstrated that oleacein inhibited MM cell clonogenicity, prompted cell cycle blockade and triggered apoptosis. We evaluated the epigenetic impact of oleacein on MM cells, and observed dose-dependent accumulation of both acetylated histones and &alpha;-tubulin, along with down-regulation of several class I/II histone deacetylases (HDACs) both at the mRNA and protein level, providing evidence of the HDAC inhibitory activity of this compound; conversely, no effect on global DNA methylation was found. Mechanistically, HDACs inhibition by oleacein was associated with down-regulation of Sp1, the major transactivator of HDACs promoter, via Caspase 8 activation. Of potential translational significance, oleacein synergistically enhanced the in vitro anti-MM activity of the proteasome inhibitor carfilzomib. Altogether, these results indicate that oleacein is endowed with HDAC inhibitory properties, which associate with significant anti-MM activity both as single agent or in combination with carfilzomib. These findings may pave the way to novel potential anti-MM epi-therapeutic approaches based on natural agents

Oleil Hydroxytyrosol (HTOL) Exerts Anti-Myeloma Activity by Antagonizing Key Survival Pathways in Malignant Plasma Cells

Polyphenols from olive oil are endowed with several biological activities. Chemical modifications have been recently applied to these compounds to improve their therapeutic activity in different pathological settings, including cancer. Herein, we describe the in vitro effects on multiple myeloma (MM) cells of oleil hydroxytyrosol (HTOL), a synthetic fatty ester of natural hydroxytyrosol with oleic acid. HTOL reduced the viability of various human MM cell lines (HMCLs), even when co-cultured with bone marrow stromal cells, triggering ER stress, UPR and apoptosis, while it was not cytotoxic against healthy peripheral blood mononuclear cells or B lymphocytes. Whole-transcriptome profiling of HTOL-treated MM cells, coupled with protein expression analyses, indicate that HTOL antagonizes key survival pathways for malignant plasma cells, including the undruggable IRF4–c-MYC oncogenic axis. Accordingly, c-MYC gain- and loss-of-function strategies demonstrate that HTOL anti-tumor activity was, at least in part, due to c-MYC targeting. Taken together, these findings underscore the anti-MM potential of HTOL, providing the molecular framework for further investigation of HTOL-based treatments as novel anti-cancer agents

Clinical characteristics and predictors of mortality associated with COVID-19 in elderly patients from a long-term care facility

Since December 2019, coronavirus disease 2019 (COVID-19) pandemic has spread from China all over the world and many COVID-19 outbreaks have been reported in long-term care facilities (LCTF). However, data on clinical characteristics and prognostic factors in such settings are scarce. We conducted a retrospective, observational cohort study to assess clinical characteristics and baseline predictors of mortality of COVID-19 patients hospitalized after an outbreak of SARS-CoV-2 infection in a LTCF. A total of 50 patients were included. Mean age was 80 years (SD, 12 years), and 24/50 (57.1%) patients were males. The overall in-hospital mortality rate was 32%. At Cox regression analysis, significant predictors of in-hospital mortality were: hypernatremia (HR 9.12), lymphocyte count &lt; 1000 cells/µL (HR 7.45), cardiovascular diseases other than hypertension (HR 6.41), and higher levels of serum interleukin-6 (IL-6, pg/mL) (HR 1.005). Our study shows a high in-hospital mortality rate in a cohort of elderly patients with COVID-19 and hypernatremia, lymphopenia, CVD other than hypertension, and higher IL-6 serum levels were identified as independent predictors of in-hospital mortality. Given the small population size as major limitation of our study, further investigations are necessary to better understand and confirm our findings in elderly patients