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

The expression of uridine diphosphate glucuronosyltransferase gene is a major determinant of bilirubin level in heterozygous beta-thalassaemia and in glucose-6-phosphate dehydrogenase deficiency

We evaluated the effect of Gilbert's syndrome, the most common defect of bilirubin conjugation, on the bilirubin levels of subjects with inherited haematological disorders which cause increased bilirubin production. 57 patients heterozygous for beta-thalassaemia, 21 with G6PD deficiency and 44 controls were examined by typing the TATA-box in the promoter of the gene uridine diphosphate glucuronosyltransferase 1A. Nearly 80% of patients with increased bilirubin levels were heterozygous or homozygous for the UGT1A TA(7) variant associated with Gilbert's syndrome. These findings indicate that Gilbert's syndrome accounts for a large proportion of the variability of bilirubin levels in beta-thalassaemia and G6PD deficiency

Early cardiac rehabilitation: could it improve functional outcomes and reduce length of stay and sanitary costs in patients aged 75\ua0years or older? A retrospective case\u2013control study

Background: Cardiac rehabilitation (CR) is considered as a cornerstone in improving physical function in older people after cardiac procedures; however, its effects in patients aged more than 75\ua0years are still debated. Aims: To assess the effectiveness of early CR in improving functional outcomes and reducing the length of stay (LOS) and sanitary costs in patients aged 65 75\ua0years. Methods: We retrospectively analysed data from medical records of patients aged 65 75\ua0years performed CR after cardiac procedures. Patients were divided into two groups according to the median timing lasting from the cardiac procedure and CR start: \u2018early rehabilitation\u2019 (< 8\ua0days) and \u2018delayed rehabilitation\u2019 ( 65 8\ua0days). Six-minutes walking test (6MWT), left ventricular ejection fraction (LVEF), LOS, and sanitary costs were assessed. Results: The 160 patients (mean aged 79.18 \ub1 3.13\ua0years) included were divided into two groups: \u2018early rehabilitation\u2019 (n = 80) and \u2018delayed rehabilitation\u2019 (n = 80). Both groups showed a significant improvement (p < 0.0001) in 6MWT and LVEF but there were no differences between groups in all clinical outcomes. On the other hand, the \u2018early rehabilitation\u2019 group showed significantly lower LOS (25.8 \ub1 5.3 vs 34.1 \ub1 10.8\ua0days; p < 0.0001) and sanitary costs (22,282.08 \ub1 3242.68 euros vs. 44,954.03 \ub1 22,160.11 euros; p < 0.0001). Discussion: Beginning CR in the first week seems to be effective in improving physical performance after cardiac procedures in patients aged 65 75\ua0years, reducing LOS and sanitary costs. Conclusions: Our findings suggest that early CR could be performed with positive effects on functional outcomes, leading to a reduction in LOS and sanitary costs in elderly

Multidisciplinary Rehabilitation after Hyaluronic Acid Injections for Elderly with Knee, Hip, Shoulder, and Temporomandibular Joint Osteoarthritis

Osteoarthritis (OA) is a prevalent degenerative joint condition characterized by cartilage deterioration, joint inflammation, and functional limitations, particularly impacting the elderly population. Rehabilitation and hyaluronic acid (HA) injections are common therapeutic approaches routinely used in clinical practice, but their synergistic potential is far from being fully characterized. Thus, the aim of this narrative review was to elucidate the multilevel benefits and synergies of integrating these two approaches in multidisciplinary OA rehabilitation. This narrative review follows the scale for the assessment of narrative review articles (SANRA) criteria and involves a comprehensive literature search from July to August 2023. Two independent reviewers screened studies, including those involving human subjects with OA, rehabilitation strategies, and outcomes following HA injection, published in English. Results: HA injections might improve joint biomechanics, reducing friction, absorbing shocks, and potentially regulating inflammation. Rehabilitation plays a pivotal role in strengthening muscles, increasing the range of motion, and enhancing overall function. Optimizing rehabilitation following HA injection might provide additional benefits in joint health. OA management requires a multidisciplinary approach integrating HA injections, rehabilitation, and personalized care. Challenges in patient adherence and healthcare resources currently exist, but emerging technologies offer opportunities to enhance patient engagement and monitoring optimizing sustainability and outcomes of patients with knee, hip, shoulder, and temporomandibular joint OA

Impact of exercise training on muscle mitochondria modifications in older adults: a systematic review of randomized controlled trials

Background: Previous evidence showed that cellular aging is a multifactorial process that is associated with decline in mitochondrial function. Physical exercise has been proposed as an effective and safe therapeutical intervention to improve the mitochondria network in the adult myocytes. Aims: The aim of this systematic review of randomized controlled trials (RCTs) was to assess the exercise-induced muscle mitochondria modifications in older adults, underlining the differences related to different exercise modalities. Methods: On November 28th, 2021, five databases (PubMed, Scopus, Web of Science, Cochrane, and PEDro) were systematically searched for RCTs to include articles with: healthy older people as participants; physical exercise (endurance training (ET), resistance training (RT), and combined training (CT)) as intervention; other different exercise modalities or physical inactivity as comparator; mitochondrial modifications (quality, density and dynamics, oxidative, and antioxidant capacity) as outcomes. The quality assessment was performed according to the PEDro scale; the bias risk was evaluated by Cochrane risk-of-bias assessment tool. Results: Out of 2940 records, 6 studies were included (2 assessing ET, 2 RT, 1 CT, and 1 both ET and RT). Taken together, 164 elderly subjects were included in the present systematic review. Significant positive effects were reported in terms of mitochondrial quality, density, dynamics, oxidative and antioxidant capacity, even though with different degrees according to the exercise type. The quality assessment reported one good-quality study, whereas the other five studies had a fair quality. Discussion: The overall low quality of the studies on this topic indicate that further research is needed. Conclusion: RT seems to be the most studied physical exercise modality improving mitochondrial density and dynamics, while ET have been related to mitochondrial antioxidant capacity improvements. However, these exercise-induced specific effects should be better explored in older people

ALMA chemical survey of disk-outflow sources in Taurus (ALMA-DOT)

The chemical composition of planets is inherited from that of the natal protoplanetary disk at the time of planet formation. Increasing observational evidence suggests that planet formation occurs in less than 1−2 Myr. This motivates the need for spatially resolved spectral observations of young Class I disks, as carried out by the ALMA chemical survey of Disk-Outflow sources in Taurus (ALMA-DOT). In the context of ALMA-DOT, we observe the edge-on disk around the Class I source IRAS 04302+2247 (the butterfly star) in the 1.3 mm continuum and five molecular lines. We report the first tentative detection of methanol (CH3OH) in a Class I disk and resolve, for the first time, the vertical structure of a disk with multiple molecular tracers. The bulk of the emission in the CO 2−1, CS 5−4, and o–H2CO 31, 2 − 21, 1 lines originates from the warm molecular layer, with the line intensity peaking at increasing disk heights, z, for increasing radial distances, r. Molecular emission is vertically stratified, with CO observed at larger disk heights (aperture z/r ∼ 0.41−0.45) compared to both CS and H2CO, which are nearly cospatial (z/r ∼ 0.21−0.28). In the outer midplane, the line emission decreases due to molecular freeze-out onto dust grains (freeze-out layer) by a factor of > 100 (CO) and 15 (CS). The H2CO emission decreases by a factor of only about 2, which is possibly due to H2CO formation on icy grains, followed by a nonthermal release into the gas phase. The inferred [CH3OH]/[H2CO] abundance ratio is 0.5−0.6, which is 1−2 orders of magnitude lower than for Class 0 hot corinos, and a factor ∼2.5 lower than the only other value inferred for a protoplanetary disk (in TW Hya, 1.3−1.7). Additionally, it is at the lower edge but still consistent with the values in comets. This may indicate that some chemical reprocessing occurs in disks before the formation of planets and comets

ALMA chemical survey of disk-outflow sources in Taurus (ALMA-DOT). IV. Thioformaldehyde (H<SUB>2</SUB>CS) in protoplanetary discs: spatial distributions and binding energies

International audienceContext. Planet formation starts around Sun-like protostars with ages ≤1 Myr, but the chemical compositions of the surrounding discs remains unknown. Aims: We aim to trace the radial and vertical spatial distribution of a key species of S-bearing chemistry, namely H2CS, in protoplanetary discs. We also aim to analyse the observed distributions in light of the H2CS binding energy in order to discuss the role of thermal desorption in enriching the gas disc component. Methods: In the context of the ALMA chemical survey of disk-outflow sources in the Taurus star forming region (ALMA-DOT), we observed five Class I or early Class II sources with the o-H2CS(71,6-61,5) line. ALMA-Band 6 was used, reaching spatial resolutions ≃40 au, that is, Solar System spatial scales. We also estimated the binding energy of H2CS using quantum mechanical calculations, for the first time, for an extended, periodic, crystalline ice. Results: We imaged H2CS emission in two rotating molecular rings in the HL Tau and IRAS 04302+2247 discs, the outer radii of which are ~140 au (HL Tau) and 115 au (IRAS 04302+2247). The edge-on geometry of IRAS 04302+2247 allows us to reveal that H2CS emission peaks at radii of 60-115 au, at z = ±50 au from the equatorial plane. Assuming LTE conditions, the column densities are ~1014 cm-2. We estimate upper limits of a few 1013 cm-2 for the H2CS column densities in DG Tau, DG Tau B, and Haro 6-13 discs. For HL Tau, we derive, for the first time, the [H2CS]/[H] abundance in a protoplanetary disc (≃10-14). The binding energy of H2CS computed for extended crystalline ice and amorphous ices is 4258 and 3000-4600 K, respectively, implying thermal evaporation where dust temperatures are ≥50-80 K. Conclusions: H2CS traces the so-called warm molecular layer, a region previously sampled using CS and H2CO. Thioformaldehyde peaks closer to the protostar than H2CO and CS, plausibly because of the relatively high excitation level of the observed 71,6-61,5 line (60 K). The H2CS binding energy implies that thermal desorption dominates in thin, au-sized, inner and/or upper disc layers, indicating that the observed H2CS emitting up to radii larger than 100 au is likely injected in the gas phase due to non-thermal processes. Reduced datacubes are only available at the CDS via anonymous ftp to http://cdsarc.u-strasbg.fr (ftp://130.79.128.5) or via http://cdsarc.u-strasbg.fr/viz-bin/cat/J/A+A/644/A120</A

ALMA chemical survey of disk-outflow sources in Taurus (ALMA-DOT)

The chemical composition of planets is determined by the distribution of the various molecular species in the protoplanetary disk at the time of their formation. To date, only a handful of disks have been imaged in multiple spectral lines with high spatial resolution. As part of a small campaign devoted to the chemical characterization of disk-outflow sources in Taurus, we report on new ALMA Band 6 (~1.3 mm) observations with ~0.15′′ (20 au) resolution toward the embedded young star DG Tau B. Images of the continuum emission reveals a dust disk with rings and, putatively, a leading spiral arm. The disk, as well as the prominent outflow cavities, are detected in CO, H2CO, CS, and CN; instead, they remain undetected in SO2, HDO, and CH3OH. From the absorption of the back-side outflow, we inferred that the disk emission is optically thick in the inner 50 au. This morphology explains why no line emission is detected from this inner region and poses some limitations toward the calculation of the dust mass and the characterization of the inner gaseous disk. The H2CO and CS emission from the inner 200 au is mostly from the disk, and their morphology is very similar. The CN emission significantly differs from the other two molecules as it is observed only beyond 150 au. This ring-like morphology is consistent with previous observations and the predictions of thermochemical disk models. Finally, we constrained the disk-integrated column density of all molecules. In particular, we found that the CH3OH/H2CO ratio must be smaller than ~2, making the methanol non-detection still consistent with the only such ratio available from the literature (1.27 in TW Hya)