Publications by authors named "Luca Padua"

351 Publications

Challenges of Prevention for a Sustainable Personalized Medicine.

J Pers Med 2021 Apr 16;11(4). Epub 2021 Apr 16.

Department of Woman and Child Health and Public Health-Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.

The development and implementation of the approaches of personalized medicine for disease prevention are still at infancy, although preventive activities in healthcare represent a key pillar to guarantee health system sustainability. There is an increasing interest in finding informative markers that indicate the disease risk before the manifestation of the disease (primary prevention) or for early disease detection (secondary prevention). Recently, the systematic collection and study of clinical phenotypes and biomarkers consented to the advance of Rehabilomics in tertiary prevention. It consents to identify relevant molecular and physiological factors that can be linked to plasticity, treatment response, and natural recovery. Implementation of these approaches would open avenues to identify people at high risk and enable new preventive lifestyle interventions or early treatments targeted to their individual genomic profile, personalizing prevention and rehabilitation. The integration of personalized medicine into prevention may benefit citizens, patients, healthcare professionals, healthcare authorities, and industry, and ultimately will seek to contribute to better health and quality of life for Europe's citizens.
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http://dx.doi.org/10.3390/jpm11040311DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8073054PMC
April 2021

Personalized Clinical Phenotyping through Systems Medicine and Artificial Intelligence.

J Pers Med 2021 Apr 2;11(4). Epub 2021 Apr 2.

Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.

Personalized Medicine (PM) has shifted the traditional top-down approach to medicine based on the identification of single etiological factors to explain diseases, which was not suitable for explaining complex conditions. The concept of PM assumes several interpretations in the literature, with particular regards to Genetic and Genomic Medicine. Despite the fact that some disease-modifying genes affect disease expression and progression, many complex conditions cannot be understood through only this lens, especially when other lifestyle factors can play a crucial role (such as the environment, emotions, nutrition, etc.). Personalizing clinical phenotyping becomes a challenge when different pathophysiological mechanisms underlie the same manifestation. Brain disorders, cardiovascular and gastroenterological diseases can be paradigmatic examples. Experiences on the field of Fondazione Policlinico Gemelli in Rome (a research hospital recognized by the Italian Ministry of Health as national leader in "Personalized Medicine" and "Innovative Biomedical Technologies") could help understanding which techniques and tools are the most performing to develop potential clinical phenotypes personalization. The connection between practical experiences and scientific literature highlights how this potential can be reached towards Systems Medicine using Artificial Intelligence tools.
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http://dx.doi.org/10.3390/jpm11040265DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8065854PMC
April 2021

"United we stand, divided we fall": The multidimensional evaluation of neurotmesis. A specific case and literature review based on graph theory.

Neurophysiol Clin 2021 Apr 5. Epub 2021 Apr 5.

Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Orthopaedics and Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy.

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http://dx.doi.org/10.1016/j.neucli.2021.03.003DOI Listing
April 2021

Neuropathic Pain in the Elderly.

Diagnostics (Basel) 2021 Mar 30;11(4). Epub 2021 Mar 30.

Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.

Neuropathic pain due to a lesion or a disease of the somatosensory system often affects older people presenting several comorbidities. Moreover, elderly patients are often poly-medicated, hospitalized and treated in a nursing home with a growing risk of drug interaction and recurrent hospitalization. Neuropathic pain in the elderly has to be managed by a multidimensional approach that involves several medical, social and psychological professionals in order to improve the quality of life of the patients and, where present, their relatives.
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http://dx.doi.org/10.3390/diagnostics11040613DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066049PMC
March 2021

Parkinson's disease and virtual reality rehabilitation: cognitive reserve influences the walking and balance outcome.

Neurol Sci 2021 Mar 4. Epub 2021 Mar 4.

Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy.

Introduction: Parkinson's disease (PD) is a neurodegenerative pathology characterized by motor and non-motor symptoms that often lead to several impairments. Many studies show the efficacy of different rehabilitation protocols aimed to improve balance and gait functions in PD patients. However, multiple factors may influence rehabilitation outcome. Recently, it has been observed as the cognitive reserve (CR) may influence the rehabilitation outcome, helping to address the patient toward technological or conventional rehabilitation. Our study investigated how CR may affect motor rehabilitation outcomes in PD patients who undergo virtual reality (VR) rehabilitation, aimed at improving walking and balance.

Materials And Methods: Thirty patients affected by idiopathic PD were enrolled. Patients underwent 12 sessions VR training, over 6 weeks (45 min). Six-Minute Walk Test (6MWT) and Berg Balance Scale (BBS) were used to assess walking and balance, respectively. CR was assessed by Cognitive Reserve Index questionnaire (CRIq).

Results: Significant correlations between CR and change from baseline in walking and balance measures were found, with a significant positive correlation between CRIq and 6MWT (r=0.50, p=0.01) and between CRIq and BBS (r=0.41, p=0.04).

Discussion: Our results showed that PD patients with higher CR treated with VR improved significantly more in their balance and walking distance than those with lower CR. The current study suggests that VR when aimed to improve balance and walking in PD patients is more effective in patients with higher CR.
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http://dx.doi.org/10.1007/s10072-021-05123-3DOI Listing
March 2021

Peripheral Neuropathies Seen by Ultrasound: A Literature Analysis through Lexical Evaluation, Geographical Assessment and Graph Theory.

Brain Sci 2021 Jan 16;11(1). Epub 2021 Jan 16.

UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.

(1) Background: Ultrasound is a well-known tool used for the diagnosis and management of many diseases, including peripheral neuropathies. The main aim of this study was the lexical analysis of the literature on this topic considering the most cited words and the relationship between the words and the papers. Furthermore, a geographical analysis was performed to evaluate the worldwide prevalence. (2) Methods: We performed a literature search on PubMed, and we calculated the occurrence of the words indicating nerves and the body parts. Furthermore, we calculated the number of papers for each country, considering the affiliation of the first author. Finally, to describe the relationships between the words and the papers, we used the 30 most cited words, and we built a matrix describing in which papers a word was cited. This matrix was used to create a network based on the graph theory using Gephi 0.9.2 software. (3) Results: The most cited nerves were median and ulnar ones, and the most cited body parts were hand, wrist and elbow. The United States of America was the most productive country, with 80 papers. The graph of the network showed the importance of ultrasound as support for therapy. (4) Conclusions: The study represents a lexical analysis of the literature and shows information about subjects, authors and relationships of the papers. This may be helpful for better understanding and evaluation of the situation of the current literature.
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http://dx.doi.org/10.3390/brainsci11010113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7829799PMC
January 2021

Nerve ultrasonography features in hereditary transthyretin amyloidosis with V30M mutation and polyneuropathy.

Neurol Sci 2021 Jan 7. Epub 2021 Jan 7.

Department of Neuroscience, University of Padova, via Giustiniani 5, 35128, Padova, Italy.

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http://dx.doi.org/10.1007/s10072-020-05033-wDOI Listing
January 2021

Deprescribing in older adults during COVID-19 pandemic; Opportunity or risk?

Res Social Adm Pharm 2021 05 1;17(5):1024-1025. Epub 2020 Dec 1.

Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy.

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http://dx.doi.org/10.1016/j.sapharm.2020.11.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7704332PMC
May 2021

Homotopic reduction in laser-evoked potential amplitude and laser-pain rating by abdominal acupuncture.

Eur J Pain 2021 03 12;25(3):659-667. Epub 2020 Dec 12.

Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Background: The neural mechanism underlying the analgesic effect of acupuncture is largely unknown. We aimed at investigating the effect of abdominal acupuncture (AA) on the laser-evoked potential (LEP) amplitude and laser-pain rating to stimulation of body parts either homotopic or heterotopic to the treated acupoint.

Methods: Laser-evoked potentials were recorded from 13 healthy subjects to stimulation of the right wrist (RW), left wrist (LW) and right foot (RF). LEPs were obtained before, during and after the AA stimulation of an abdominal area corresponding to the representation of the RW. Subjective laser-pain rating was collected after each LEP recording.

Results: The amplitude of the N2/P2 LEP component was significantly reduced during AA and 15 min after needle removal to both RW (F = 4.14, p = .02) and LW (F = 5.48, p = .008) stimulation, while the N2/P2 amplitude to RF stimulation (F = 0.94, p = .4) remained unchanged. Laser-pain rating was reduced during AA and 15 min after needle removal only to RW stimulation (F = 5.67, p = .007).

Conclusion: Our findings showing an AA effect on LEP components to both the ipsilateral and contralateral region homotopic to the treated area, without any LEP change to stimulation of a heterotopic region, suggest that the AA analgesia is mediated by a segmental spinal mechanism.

Significance: Although abdominal acupuncture has demonstrated to be effective in the reduction in laser-evoked potential (LEP) amplitude and laser-pain rating, the exact mechanism of this analgesic effect is not known. In the current study, we found that treatment of an area in the "turtle representation" of the body led to a topographical pattern of LEP amplitude inhibition that can be mediated by a segmental spinal mechanism.
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http://dx.doi.org/10.1002/ejp.1701DOI Listing
March 2021

The reaching movement in breast cancer survivors: Attention to the principles of rehabilitation.

J Bodyw Mov Ther 2020 Oct 30;24(4):102-108. Epub 2020 Jun 30.

Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Italy. Electronic address:

Introduction: Breast-cancer is leading cause of morbidity and mortality in women. The prognosis and survival rate of women with breast-cancer have significantly improved worldwide; more attention needs to be paid to rehabilitative interventions after surgery. This paper describes use of reaching movement to assess upper limb motorcontrol and functional ability after breast-cancer surgery (BC).

Material And Methods: We conducted a cross-sectional observational study consisting of biomechanical evaluation of upper limb limitations in women BC, versus a controlgroup (CG). Thirty breast-cancer survivors and thirty healthy women participated in this study. Both groups were subjected to clinical evaluation of the shoulder joint ROM on the operated side, as an assessment of the muscular-strength of the shoulder with the MRC-scale. The Functional-Assessment was evaluated by the DASH and Constant-Murley-Score. The EORTC QLQ-C30 and VAS were used to measure the quality of life assessment and pain respectively. A Biomechanical evaluation was performed, using Reaching-Task and Surface-EMG.

Results: Normal Jerk for BC was higher than CG. Target approaching velocity and movement duration BC was lower than CG. Synergy Anterior Deltoid/Triceps Brachii muscles in CG was higher than BC.
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http://dx.doi.org/10.1016/j.jbmt.2020.06.039DOI Listing
October 2020

Pregnancy in Charcot-Marie-Tooth disease: Data from the Italian CMT national registry.

Neurology 2020 12 14;95(24):e3180-e3189. Epub 2020 Sep 14.

From the Fondazione IRCCS Istituto Neurologico Carlo Besta (C. Pisciotta, D.C., I.T., P.S., D.P.), Milan; Department of Neurosciences, Reproductive Sciences and Odontostomatology (L.S., F.M., S.T.), Federico II University of Naples; Department of Neuroscience, Biomedicine and Movement Sciences (G.M.F., T.C.), University of Verona; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal Infantile Sciences (A.S., M.G.), University of Genoa; IRCCS Ospedale Policlinico San Martino (A.S., M.G.), Genoa; Division of Neuroscience and INSPE (S.C.P.), IRCCS Ospedale San Raffaele, Milan; A.O. di Parma (I.A., M.C.T.), U.O. Neurologia; Università Cattolica del Sacro Cuore (L.P.); Fondazione Policlinico Universitario A. Gemelli IRCCS (L.P., C. Pazzaglia), Rome; Neuroscience Centre (A.Q.), Magna Graecia University and Neuroimaging Research Unit, IBFM-CNR, Germaneto, Catanzaro; Department of Medical Sciences (P.V.), Magna Graecia University, Catanzaro; Unit of Neurology and Neuromuscular Diseases (L.G., M.R., A.M., G.V.), Department of Clinical and Experimental Medicine, University of Messina; and Department of Woman, Newborn and Child (F.P.), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, and University of Milan, Italy.

Objective: To collect information on frequency of pregnancy and delivery complications in Charcot-Marie-Tooth (CMT) disease and on CMT course during pregnancy.

Methods: Through an ad hoc online questionnaire, we investigated pregnancy and neuropathy course in women with CMT adhering to the Italian CMT Registry. Data were compared to those of controls (recruited among friends and unaffected relatives) and the Italian (or other reference) population.

Results: We collected data on 193 pregnancies from 86 women with CMT (age 20-73 years) with 157 deliveries (81.4%) after a mean of 38.6 gestational weeks. In women with CMT, there were no differences compared to controls (59 pregnancies and 46 deliveries from 24 controls) and the reference population for miscarriages (11.4%) and planned (21.0%) and emergency (14.0%) cesarean sections. We found a significantly higher frequency of placenta previa (1.6% vs 0.4%), abnormal fetal presentations (8.4% vs 4.5%), and preterm deliveries (20.3% vs 6.9%; most in week 34-36 of gestation) compared to reference populations. Excluding twins, newborn weight did not differ from the reference population. Postpartum bleeding rate in patients with CMT (2.1%) was similar to that of the general population (2.4%). CMT status worsened during 18 of 193 pregnancies (9.3%) with no recovery in 16 of them and with similar figures in the CMT1A and non-CMT1A subtypes.

Conclusions: We observed higher rates of placenta previa, abnormal presentations, and preterm deliveries in CMT, but pregnancy outcome and newborn weight and health were similar to those of the reference populations. Worsening of CMT is not infrequent and occurs not only in CMT1A. Pregnant women with CMT should be monitored with particular care.
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http://dx.doi.org/10.1212/WNL.0000000000010860DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836663PMC
December 2020

Relationship Between Sensory Symptoms, Mulder's Sign, and Dynamic Ultrasonographic Findings in Morton's Neuroma.

Foot Ankle Int 2020 Dec 28;41(12):1474-1479. Epub 2020 Aug 28.

Valdisieve Hospital, Ponteassieve, Florence, Italy.

Background: Morton's neuroma (MN) is often a diagnostic dilemma lacking a gold standard set of diagnostic criteria. Advanced imaging of MN is evolving including ultrasonography. The current study aimed to analyze the relationship between ultrasonographic findings and symptoms, clinical data, and operative findings in a subgroup of patients.

Methods: We evaluated physical examination, ultrasonographic findings, symptoms, and in a subgroup, the operative findings for Morton's neuroma. We analyzed the symptoms, the findings on physical examination, and ultrasonography data and performed a statistical correlation between them. A total of 175 patients were seen for suspected Morton's neuroma during the last 7 years.

Results: Neuropathic pain of the toes was reported in 63% of patients. Presence of ultrasonographic findings suggesting Morton's neuroma was observed in 77% of cases. A mild significant relationship between neuropathic pain and positive ultrasonographic findings was observed. We found a strong correlation between ultrasonographic and clinical evaluation, but more than half with clinical negative Morton's neuroma had positive findings at ultrasonography. In the subgroup of operatively treated patients (n = 44) surgery confirmed Morton's neuroma in all patients who had positive ultrasonography findings.

Conclusions: The current study suggests that the association of ultrasonographic evaluation and clinical evaluation can be very useful for the management of Morton's neuroma. Our study could help with the development of a multiperspective approach in the diagnosis of Morton's neuroma.

Level Of Evidence: Level II, prospective cohort survey study.
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http://dx.doi.org/10.1177/1071100720946748DOI Listing
December 2020

Health profiles and socioeconomic characteristics of nonagenarians residing in Mugello, a rural area in Tuscany (Italy).

BMC Geriatr 2020 08 15;20(1):289. Epub 2020 Aug 15.

Department of Geriatrics, Neurosciences and Orthopaedics, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy.

Background: Health, as defined by the WHO, is a multidimensional concept that includes different aspects. Interest in the health conditions of the oldest-old has increased as a consequence of the phenomenon of population aging. This study investigates whether (1) it is possible to identify health profiles among the oldest-old, taking into account physical, emotional and psychological information about health, and (2) there are demographic and socioeconomic differences among the health profiles.

Methods: Latent Class Analysis with covariates was applied to the Mugello Study data to identify health profiles among the 504 nonagenarians residing in the Mugello district (Tuscany, Italy) and to evaluate the association between socioeconomic characteristics and the health profiles resulting from the analysis.

Results: This study highlights four groups labeled according to the posterior probability of determining a certain health characteristic: "healthy", "physically healthy with cognitive impairment", "unhealthy", and "severely unhealthy". Some demographic and socioeconomic characteristics were found to be associated with the final groups: older nonagenarians are more likely to be in worse health conditions; men are in general healthier than women; more educated individuals are less likely to be in extremely poor health conditions, while the lowest-educated are more likely to be cognitively impaired; and office or intellectual workers are less likely to be in poor health conditions than are farmers.

Conclusions: Considering multiple dimensions of health to determine health profiles among the oldest-old could help to better evaluate their care needs according to their health status.
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http://dx.doi.org/10.1186/s12877-020-01689-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429096PMC
August 2020

Reply to Letter to the Editor: 'Comparison of virtual reality rehabilitation and conventional rehabilitation in Parkinson's disease: a randomised controlled trial'.

Physiotherapy 2021 Mar 13;110:88-89. Epub 2020 Jul 13.

Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Geriatrics, Neurosciences and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address:

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http://dx.doi.org/10.1016/j.physio.2020.07.001DOI Listing
March 2021

Nerve ultrasound in hereditary transthyretin amyloidosis: red flags and possible progression biomarkers.

J Neurol 2021 Jan 4;268(1):189-198. Epub 2020 Aug 4.

Department of Neurosciences, University of Padova, Via Giustiniani 5, 35128, Padova, Italy.

Background: Diagnostic delay of hereditary transthyretin amyloidosis (ATTRv, v for variant) prevents timely treatment and, therefore, concurs to the mortality of the disease. The aim of the present study was to explore with nerve ultrasound (US) possible red flags for early diagnosis in ATTRv patients with carpal tunnel syndrome (CTS) and/or polyneuropathy and in pre-symptomatic carriers.

Methods: Patients and pre-symptomatic carriers with a TTR gene mutation were enrolled from seven Italian centers. Severity of CTS was assessed with neurophysiology and clinical evaluation. Median nerve cross-section area (CSA) was measured with US in ATTRv carriers with CTS (TTR-CTS). One thousand one hundred ninety-six idiopathic CTS were used as controls. Nerve US was also performed in several nerve trunks (median, ulnar, radial, brachial plexi, tibial, peroneal, sciatic, sural) in ATTRv patients with polyneuropathy and in pre-symptomatic carriers.

Results: Sixty-two subjects (34 men, 28 women, mean age 59.8 years ± 12) with TTR gene mutation were recruited. With regard to CTS, while in idiopathic CTS there was a direct correlation between CTS severity and median nerve CSA (r = 0.55, p < 0.01), in the subgroup of TTR-CTS subjects (16 subjects, 5 with bilateral CTS) CSA did not significantly correlate with CTS severity (r = - 0.473). ATTRv patients with polyneuropathy showed larger CSA than pre-symptomatic carriers in several nerve sites, more pronounced at brachial plexi (p < 0.001).

Conclusions: The present study identifies nerve morphological US patterns that may help in the early diagnosis (morpho-functional dissociation of median nerve in CTS) and monitoring of pre-symptomatic TTR carriers (larger nerve CSA at proximal nerve sites, especially at brachial plexi).
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http://dx.doi.org/10.1007/s00415-020-10127-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815618PMC
January 2021

Metabolic syndrome is associated with better quality of sleep in the oldest old: results from the "Mugello Study".

Diabetol Metab Syndr 2020 24;12:46. Epub 2020 May 24.

Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Background And Aims: Reduced sleep quality is common in advanced age. Poor sleep quality is associated with adverse outcomes, chiefly cardiovascular, in young and middle-aged subjects, possibly because of its association with metabolic syndrome (MetS). However, the correlates of sleep quality in oldest populations are unknown. We evaluated the association of sleep quality with MetS in a cohort of subjects aged 90+.

Methods And Results: We analysed data of 343 subjects aged 90+ living in the Mugello area (Tuscany, Italy). Quality of sleep was assessed using the Pittsburgh Sleep Quality Assessment Index (PSQI). Good quality of sleep was defined by a PSQI score < 5. MetS was diagnosed according to the National Cholesterol Education Program's ATP-III criteria; 83 (24%) participants reported good quality of sleep. MetS was diagnosed in 110 (24%) participants. In linear and logistic models, MetS was inversely associated with PSQI score ((B = - 1.04; 95% CI - 2.06 to - .03; P = .044), with increased probability of good sleep quality (OR = 2.52; 95% CI 1.26-5.02; P = .009), and with a PSQI below the median (OR = 2.11; 95% CI 1.11-3.40, P = .022), after adjusting. None of the single components of MetS were associated with PSQI (all P values > .050). However, an increasing number of MetS components was associated with increasing probability of good quality of sleep (P for trend = .002), and of PSQI below the median (P for trend = .007). Generalized Additive Model analysis documented no smoothing function suggestive of nonlinear association between PSQI and MetS.

Conclusion: Our results confirm a high prevalence of poor sleep quality in oldest age; however, in these subjects, MetS seems to be associated with better sleep quality. Additional larger, dedicated studies are required to confirm our results, and, if so, to identify the subsystems involved and the potential therapeutic implications of such an association.
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http://dx.doi.org/10.1186/s13098-020-00554-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7386243PMC
May 2020

The impact of diagnostic ultrasound in clinical medicine and in nerve evaluation: PubMed and Google Ngram Viewer compared.

Neurophysiol Clin 2020 09 26;50(4):305-307. Epub 2020 Jun 26.

UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Geriatrics, Neurosciences and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy.

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http://dx.doi.org/10.1016/j.neucli.2020.05.003DOI Listing
September 2020

Exoskeleton-assisted gait in chronic stroke: An EMG and functional near-infrared spectroscopy study of muscle activation patterns and prefrontal cortex activity.

Clin Neurophysiol 2020 08 18;131(8):1775-1781. Epub 2020 May 18.

Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore, Rome, Italy; Neurorehabilitation Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy.

Objectives: Gait impairment dramatically affects stroke patients' functional independence. The Ekso™ is a wearable powered exoskeleton able to improve over-ground gait abilities, but the relationship between the cortical gait control mechanisms and lower limbs kinematics is still unclear. Our aims are: to assess whether the Ekso™ induces an attention-demanding process with prefrontal cortex activation during a gait task; to describe the relationship between the gait-induced muscle activation pattern and the prefrontal cortex activity.

Methods: We enrolled 22 chronic stroke patients and 15 matched controls. We registered prefrontal cortex (PFC) activity with functional Near-Infrared Spectroscopy (fNIRS) and muscle activation with surface-electromyography (sEMG) during an over-ground gait task, performed with and without the Ekso™.

Results: We observed prefrontal cortex activation during normal gait and a higher activation during Ekso-assisted walking among stroke patients. Furthermore, we found that muscle hypo-activation and co-activation of non-paretic limb are associated to a high prefrontal metabolism.

Conclusions: Among stroke patients, over-ground gait is an attention-demanding task. Prefrontal activity is modulated both by Ekso-assisted tasks and muscle activation patterns of non-paretic lower limb. Further studies are needed to elucidate if other Ekso™ settings induce different cortical and peripheral effects.

Significance: This is the first study exploring the relationship between central and peripheral mechanisms during an Ekso-assisted gait task.
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http://dx.doi.org/10.1016/j.clinph.2020.04.158DOI Listing
August 2020

Muscle strength is related to mental and physical quality of life in the oldest old.

Arch Gerontol Geriatr 2020 Jul - Aug;89:104109. Epub 2020 May 15.

Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore di Roma, Rome, Italy.

Purpose Of The Study: Quality of life represents the principal outcome of health interventions for the oldest old. However, little is known about the determinants of quality of life in this population stratum. We evaluated the association between health-related quality of life (HRQoL) and handgrip strength in a cohort of 331 participants aged 90+ with a living in the Mugello area (Tuscany, Italy).

Design And Methods: HRQoL was assessed using the Medical Outcomes Study Short Form 12 (SF12), considering the Physical Composite Score (PCS) and the Mental Composite Score (MCS) of the SF-12. Muscle strength was tested by hand grip dynamometry.

Results: The median MCS was 46.9, while the median PCS was 43.0. According to logistic regression, muscle strength was associated with increased probability of better PCS (OR = 1.05; 95 % CI = 1.01-1.10, P = .042), and better MCS (OR = 1.05; 95 % CI = 1.01-1.10, P = .036), after adjusting.

Implication: Muscle strength is associated with both physical and mental HRQoL among nonagenarians. Further studies are needed to explore the subsystems involved in this association, and whether improving muscle performance might improve global mental and physical quality of life in the most advanced age.
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http://dx.doi.org/10.1016/j.archger.2020.104109DOI Listing
November 2020

The hyperchoic rim of the normal nerve in ultrasound: how significant is it?

Neurol Sci 2020 Oct 1;41(10):2985-2987. Epub 2020 May 1.

Riabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy.

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http://dx.doi.org/10.1007/s10072-020-04405-6DOI Listing
October 2020

AANEM - IFCN glossary of terms in neuromuscular electrodiagnostic medicine and ultrasound.

Clin Neurophysiol 2020 07 27;131(7):1662-1663. Epub 2020 Apr 27.

Department of Neurology, Indiana University, 362 W 15th St, Suite 3200, Indianapolis, IN 46202, USA. Electronic address:

Modern neuromuscular electrodiagnosis (EDX) and neuromuscular ultrasound (NMUS) require a universal language for effective communication in clinical practice and research and, in particular, for teaching young colleagues. Therefore, the AANEM and the IFCN have decided to publish a joint glossary as they feel the need for an updated terminology to support educational activities in neuromuscular EDX and NMUS in all parts of the world. In addition NMUS has been rapidly progressing over the last years and is now widely used in the diagnosis of disorders of nerve and muscle in conjunction with EDX. This glossary has been developed by experts in the field of neuromuscular EDX and NMUS on behalf of the AANEM and the IFCN and has been agreed upon by electronic communication between January and November 2019. It is based on the glossaries of the AANEM from 2015 and of the IFCN from 1999. The EDX and NMUS terms and the explanatory illustrations have been updated and supplemented where necessary. The result is a comprehensive glossary of terms covering all fields of neuromuscular EDX and NMUS. It serves as a standard reference for clinical practice, education and research worldwide.
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http://dx.doi.org/10.1016/j.clinph.2020.03.014DOI Listing
July 2020

AANEM - IFCN Glossary of Terms in Neuromuscular Electrodiagnostic Medicine and Ultrasound.

Muscle Nerve 2020 07 26;62(1):10-12. Epub 2020 Apr 26.

author for the AANEM.

Modern neuromuscular electrodiagnosis (EDX) and neuromuscular ultrasound (NMUS) require a universal language for effective communication in clinical practice and research and, in particular, for teaching young colleagues. Therefore, the AANEM and the IFCN have decided to publish a joint glossary as they feel the need for an updated terminology to support educational activities in neuromuscular EDX and NMUS in all parts of the world. In addition NMUS has been rapidly progressing over the last years and is now widely used in the diagnosis of disorders of nerve and muscle in conjunction with EDX. This glossary has been developed by experts in the field of neuromuscular EDX and NMUS on behalf of the AANEM and the IFCN and has been agreed upon by electronic communication between January and November 2019. It is based on the glossaries of the AANEM from 2015 and of the IFCN from 1999. The EDX and NMUS terms and the explanatory illustrations have been updated and supplemented where necessary. The result is a comprehensive glossary of terms covering all fields of neuromuscular EDX and NMUS. It serves as a standard reference for clinical practice, education and research worldwide. HIGHLIGHTS: Optimal terminology in neuromuscular electrodiagnosis and ultrasound has been revisited. A team of international experts have revised and expanded a standardized glossary. This list of terms serves as standard reference for clinical practice, education and research.
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http://dx.doi.org/10.1002/mus.26868DOI Listing
July 2020

Low Back Pain: Literature Review Based on Graph Theory.

Pain Pract 2020 11 7;20(8):946-947. Epub 2020 May 7.

Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

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http://dx.doi.org/10.1111/papr.12904DOI Listing
November 2020

Efficacy of electrical stimulation of denervated muscle: A multicenter, double-blind, randomized clinical trial.

Muscle Nerve 2020 06 24;61(6):773-778. Epub 2020 Apr 24.

Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy.

Background: This was a multicenter, double-blind, randomized clinical trial to investigate the efficacy of electrical stimulation of denervated muscle (ESDM) on recovery of patients with peripheral nerve injuries.

Methods: We enrolled 38 patients with traumatic peripheral nerve injuries with axonal damage and clinical impairment of two muscles, who were randomly treated with real or sham electrical stimulation (ES). Clinical and neurophysiological examinations were performed before treatment, at the end of treatment, and 3 mo posttreatment, by the same physician who was blinded to the ES allocation.

Results: All patients improved but there was no significant beneficial effect of ESDM compared with sham treatment.

Conclusions: This study failed to demonstrate the efficacy of ESDM for peripheral nerve injuries. However, given the large number of variables related to ES and the heterogeneity in disease etiologies and clinical manifestations, future studies on homogeneous populations using different stimulation protocols may be useful.
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http://dx.doi.org/10.1002/mus.26880DOI Listing
June 2020

Psychosocial impact of sport activity in neuromuscular disorders.

Neurol Sci 2020 Sep 4;41(9):2561-2567. Epub 2020 Apr 4.

Nemo Sud Clinical Centre for Neuromuscular Disorders, Messina, Italy.

Previous studies demonstrated the benefits of motor exercise and physical activity in neuromuscular disorders. However, very few papers assessed the effects of sport practise. The aim of this multicentre study was to assess the impact of sport activity on self-esteem and emotional regulation in a cohort of athletes with neuromuscular disorders. The 38 patients with Duchenne, Becker or other types of muscular dystrophy or spinal muscular atrophy practising sport (aged 13-49 years) and 39 age-, gender-, disability- and disease-matched patients not practising sport were enrolled. Testing procedures to assess self-esteem, anxiety and depression disorder, personality trait and quality of life (QoL) were used. Patients practising sport had a significantly higher self-esteem, lower level of depression, greater social own identity and adherence and QoL. Frequency of sport activity may represent a complementary therapy in neuromuscular disorders to improve mental and social well-being.
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http://dx.doi.org/10.1007/s10072-020-04345-1DOI Listing
September 2020

Global approaches for global challenges: The possible support of rehabilitation in the management of COVID-19.

J Med Virol 2020 10 8;92(10):1739-1740. Epub 2020 Apr 8.

Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

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http://dx.doi.org/10.1002/jmv.25829DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228366PMC
October 2020

Ultrasound evaluation of pupil: secrets of the "black hole" unveiled.

Brain Inj 2020 04 12;34(5):694-695. Epub 2020 Feb 12.

Neuroriabilitazione Ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

This Letter to the Editor is in response to Stevens and colleagues, who presented a study about pupillometry in patients with traumatic brain injury. They did not find any correlation between pupil diameter and intracranial pressure. We agree with the clinical importance of pupil assessment and we would like to suggest the application of transorbital ultrasound for this evaluation. This approach has been proposed in the past and, with our work, we show the possible quantification of symmetry of pupil diameter variation in response to a stimulus. This approach may represent a proficient and safe method for patients' supervision.
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http://dx.doi.org/10.1080/02699052.2020.1726467DOI Listing
April 2020

Ultrasound guidance increases diagnostic yield of needle EMG in plegic muscle.

Clin Neurophysiol 2020 02 9;131(2):446-450. Epub 2019 Nov 9.

Unit of High Intensity Neurorehabilitation, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; Department of Geriatrics, Neurosciences & Orthopaedics, Università Cattolica, Largo Agostino Gemelli n8, 00168 Rome, Italy.

Objectives: To increase the specificity of motor unit potential (MUPs) detection by using ultrasound guided electromyography (USG-EMG) in patients with muscle plegia due to traumatic nerve lesions.

Methods: Forty-six patients with recent nerve trauma underwent baseline standard EMG (ST-EMG) evaluation with evidence of absent MUPs. In 41 of them, ST-EMG was repeated after 2-3 months (T1) and the patients were accordingly divided in two groups: ST-EMG+ (if MUPs were detected) or ST-EMG- (MUPs not detected). Then, ST-EMG- patients underwent muscle ultrasound evaluation (M-US) and, if isles of muscular contractility were found, they also had USG-EMG. The same protocol was repeated 4-6 months after baseline (T2).

Results: At T1, 22/41 patients were ST-EMG+. While 19/41 were ST-EMG-; 9 of these patients had M-US consistent with residual muscular activity, for that reasons underwent USG-EMG with 7 of 9 demonstrating MUPs (at T2 all of these 7 patients resulted ST-EMG). In the other 2 patients, we found no MUPs at T1 but they became ST-EMG+ or USG-EMG positive at T2. The remaining 10 ST-EMG- patients had no EMG or US evidence of muscle contraction at T1, but at T2 2 of 10 became ST-EMG+ and 2 had USG-EMG showing MUPs. In the remaining 6 patients still M-US negative at T2, complete denervation was diagnosed. Concerning the 22 patients who were ST-EMG+ at T1, all but one showed increase of MUPs at T2.

Conclusions: In this study, we demonstrated the utility of US guidance when performing EMG evaluation in locating isles of muscular contractility in patients who have no detectable MUPs on EMG after nerve trauma.

Significance: USG-EMG significantly increases the specificity of needle EMG allowing earlier detection of MUPs.
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http://dx.doi.org/10.1016/j.clinph.2019.10.012DOI Listing
February 2020

Frailty Syndromes in Persons With Cerebrovascular Disease: A Systematic Review and Meta-Analysis.

Front Neurol 2019 29;10:1255. Epub 2019 Nov 29.

Department of Cardiovascular, Metabolic and Aging Diseases, Istituto Superiore di Sanità, Rome, Italy.

Frailty can change the prognosis and treatment approach of chronic diseases. Among others, frailty has been associated with cerebrovascular diseases such as stroke. However, the extent to which the two conditions are related is unclear, and no systematic review of the literature has been conducted. To conduct a systematic review and meta-analysis assessing the association of cerebrovascular diseases and frailty, as well as prefrailty, in observational studies. The project was carried out on behalf of the Joint Action ADVANTAGE WP4 group. The review was performed according to PRISMA guidelines. We searched PubMed, Web of Science, and Embase from 01/01/2002-26/05/2019. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Homogeneity was assessed with the I statistic. Publication bias was assessed with Egger's and Begg's tests. Of 1027 studies searched, 18 studies were included ( = 48,009 participants). Stroke was the only cerebrovascular disease studied in relation to frailty syndromes. All studies except one reported an association between stroke and prefrailty or frailty. However, most studies were not of high quality and there was heterogeneity between results. The pooled prevalence of prefrailty and frailty in stroke patients was 49% (95% CI = 42-57) and 22% (95% CI = 16-27), respectively. The prevalence of frailty was 2-fold in persons with stroke compared to those without stroke (pooled odds ratio = 2.32, 95% CI = 2.11-2.55). Only two studies longitudinally examined the association between stroke and frailty, producing conflicting results. Frailty and prefrailty are common in persons with stroke. These results may have clinical implications, as they identify the need to assess frailty in post-stroke survivors and assess how it may affect prognosis. Better quality, longitudinal research that examines the temporal relationship between stroke and frailty are needed, as well as studies on other types of cerebrovascular disease.
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http://dx.doi.org/10.3389/fneur.2019.01255DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6896936PMC
November 2019

Computer-based echotexture comparison of muscles. Exploring innovative analyses of ultrasound images.

Clin Neurophysiol 2020 02 22;131(2):583-585. Epub 2019 Nov 22.

Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of Sacred Heart, Rome, Italy.

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http://dx.doi.org/10.1016/j.clinph.2019.11.009DOI Listing
February 2020