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Article: A Multiaxial Rehabilitation Programme for Workers with COVID-19 Sequelae Using a Conventional and Technological-Robotic Approach: The Proposal of INAIL and Fondazione Don Carlo Gnocchi.

Aprile, Irene / Bramante, Lucia / La Russa, Chiara / Germanotta, Marco / Barletta, Valeria Teresa / Falchini, Francesca / Brambilla, Lorenzo / Guglielmelli, Eugenio / Rossi, Patrizio

Healthcare (Basel, Switzerland)

2023 Volume 11, Issue 11

Abstract: The COVID-19 sequelae have been shown to affect respiratory and cardiological functions as well as neuro-psychological functions, and, in some cases, metabolic/nutritional aspects. The Italian National Institute for Insurance against Accidents at Work ( ... ...

Abstract	The COVID-19 sequelae have been shown to affect respiratory and cardiological functions as well as neuro-psychological functions, and, in some cases, metabolic/nutritional aspects. The Italian National Institute for Insurance against Accidents at Work (Istituto Nazionale Assicurazione Infortuni sul Lavoro, INAIL) recorded that, until December 2022, 315,055 workers were affected by COVID-19; therefore, there is a need to identify an effective approach to treat such patients. Robotic and technological devices could be integrated into the rehabilitation programme of people with long COVID conditions. A review of the literature showed that telerehabilitation may improve functional capacity, dyspnoea, performance, and quality of life in these patients, but no studies were found evaluating the effects of robot-mediated therapy or virtual reality systems. Considering the above, Fondazione Don Carlo Gnocchi and INAIL propose a multi-axial rehabilitation for workers with COVID-19 sequelae. To accomplish this goal, the two institutions merged the epidemiological information gathered by INAIL, the expertise in robotic and technological rehabilitation of Fondazione Don Carlo Gnocchi, and the literature review. Our proposal aims to facilitate a multi-axial rehabilitation approach customized to meet the unique needs of each individual, with a particular emphasis on utilizing advanced technologies to address the current and future challenges of patient care.
Language	English
Publishing date	2023-05-30
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2721009-1
ISSN	2227-9032
ISSN	2227-9032
DOI	10.3390/healthcare11111593
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Article ; Online: Shaping the Neurovascular Unit Exploiting Human Brain Organoids.

Rizzuti, Mafalda / Melzi, Valentina / Brambilla, Lorenzo / Quetti, Lorenzo / Sali, Luca / Ottoboni, Linda / Meneri, Megi / Ratti, Antonia / Verde, Federico / Ticozzi, Nicola / Comi, Giacomo Pietro / Corti, Stefania / Abati, Elena

Molecular neurobiology

2024

Abstract: Brain organoids, three-dimensional cell structures derived from pluripotent stem cells, closely mimic key aspects of the human brain in vitro, providing a powerful tool for studying neurodevelopment and disease. The neuroectodermal induction protocol ... ...

Abstract	Brain organoids, three-dimensional cell structures derived from pluripotent stem cells, closely mimic key aspects of the human brain in vitro, providing a powerful tool for studying neurodevelopment and disease. The neuroectodermal induction protocol employed for brain organoid generation primarily gives rise to the neural cellular component but lacks the vital vascular system, which is crucial for the brain functions by regulating differentiation, migration, and circuit formation, as well as delivering oxygen and nutrients. Many neurological diseases are caused by dysfunctions of cerebral microcirculation, making vascularization of human brain organoids an important tool for pathogenetic and translational research. Experimentally, the creation of vascularized brain organoids has primarily focused on the fusion of vascular and brain organoids, on organoid transplantation in vivo, and on the use of microfluidic devices to replicate the intricate microenvironment of the human brain in vitro. This review summarizes these efforts and highlights the importance of studying the neurovascular unit in a forward-looking perspective of leveraging their use for understanding and treating neurological disorders.
Language	English
Publishing date	2024-02-09
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	645020-9
ISSN	1559-1182 ; 0893-7648
ISSN (online)	1559-1182
ISSN	0893-7648
DOI	10.1007/s12035-024-03998-9
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Article ; Online: Quadriceps muscle group function and after total knee arthroplasty-asystematic narrative update.

Morelli, Ilaria / Maffulli, Nicola / Brambilla, Lorenzo / Agnoletto, Marco / Peretti, Giuseppe Maria / Mangiavini, Laura

British medical bulletin

2021 Volume 137, Issue 1, Page(s) 51–69

Abstract: Background: This article systematically summarizes the present evidences, published in the last 20 years, regarding the pre- and post-operative factors, which may influence recovery of the function of the quadriceps muscle group following total knee ... ...

Abstract	Background: This article systematically summarizes the present evidences, published in the last 20 years, regarding the pre- and post-operative factors, which may influence recovery of the function of the quadriceps muscle group following total knee arthroplasty (TKA). We following the PRISMA methodology, including meta-analyses and high-level evidence studies (prospective trials, and, when unavailable, retrospective studies). Sources of data: Pubmed and Cochrane databases: 582 articles were identified and 54 of them were selected. Areas of agreement: Tourniquets inflated at high pressure exert a detrimental effect on the quadriceps muscle group. Faster quadriceps recovery takes place using mini-invasive approaches, an eight-week rehabilitation period including balance training and the use of nutraceuticals. Areas of disagreement: Pre-habilitation and pre-operative factors, analgesic methods and different TKA implants. Growing points and areas timely for developing research: Telerehabilitation seems a cost-effective tool for rehabilitation after TKA. Patients' optimization protocols before TKA should include standardized nutraceuticals intake.
MeSH term(s)	Arthroplasty, Replacement, Knee ; Humans ; Prospective Studies ; Quadriceps Muscle/surgery ; Retrospective Studies ; Tourniquets
Language	English
Publishing date	2021-01-21
Publishing country	England
Document type	Journal Article ; Systematic Review
ZDB-ID	213294-1
ISSN	1471-8391 ; 0007-1420
ISSN (online)	1471-8391
ISSN	0007-1420
DOI	10.1093/bmb/ldaa041
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Article ; Online: Characteristics, Components, and Efficacy of Telerehabilitation Approaches for People with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

Isernia, Sara / Pagliari, Chiara / Bianchi, Luca Nicola Cesare / Banfi, Paolo Innocente / Rossetto, Federica / Borgnis, Francesca / Tavanelli, Monica / Brambilla, Lorenzo / Baglio, Francesca

International journal of environmental research and public health

2022 Volume 19, Issue 22

Abstract: Introduction: Chronic obstructive pulmonary disease (COPD) is at the top of the list of non-communicable diseases with related rehabilitation needs. Digital medicine may provide continuative integrated intervention, overcoming accessibility and cost ... ...

Abstract	Introduction: Chronic obstructive pulmonary disease (COPD) is at the top of the list of non-communicable diseases with related rehabilitation needs. Digital medicine may provide continuative integrated intervention, overcoming accessibility and cost barriers. Methods: We systematically searched for randomized controlled trials on telerehabilitation (TR) in people with COPD to profile the adopted TR strategies, focusing on TR models and the main rehabilitation actions: monitoring and assessment, decision, and feedback. Additionally, a meta-analysis was run to test the TR effect on functional capacity, dyspnea, and quality of life compared to no intervention (NI) and conventional intervention (CI). Results: Out of the 6041 studies identified, 22 were eligible for the systematic review, and 14 were included in the meta-analyses. Results showed a heterogeneous scenario in terms of the TR features. Furthermore, only a small group of trials presented a comprehensive technological kit. The meta-analysis highlighted a significant effect of TR, especially with the asynchronous model, on all outcomes compared to NI. Moreover, a non-inferiority effect of TR on functional capacity and quality of life, and a superiority effect on dyspnea compared to CI were observed. Finally, the studies suggested a high rate of TR adherence and high safety level. Conclusions: TR is an effective strategy to increase and maintain functional capacity, breath, and quality of life in people with COPD. However, a consensus on the essential elements and features of this approach needs to be defined, and the effect of long-term maintenance merits further investigation.
MeSH term(s)	Humans ; Telerehabilitation ; Quality of Life ; Pulmonary Disease, Chronic Obstructive ; Dyspnea
Language	English
Publishing date	2022-11-17
Publishing country	Switzerland
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph192215165
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Article ; Online: Outcome of total hip and total knee arthroplasty and vitamin D homeostasis.

Brambilla, Lorenzo / Peretti, Giuseppe Maria / Sirtori, Paolo / Maffulli, Nicola / Mangiavini, Laura

British medical bulletin

2020 Volume 135, Issue 1, Page(s) 50–61

Abstract: Background: Low levels of vitamin D are common in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA), but it is still unclear whether the outcome of such surgery is related to vitamin D levels.: Sources of data: ... ...

Abstract	Background: Low levels of vitamin D are common in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA), but it is still unclear whether the outcome of such surgery is related to vitamin D levels. Sources of data: Publicly available electronic databases were systematically reviewed to update knowledge about the role of vitamin D in THA and TKA patients, and to appraise the correlation between vitamin D levels before surgery and post-surgical outcomes. Eight studies were included in our review: six employed prospective observational designs, two reported retrospective database interrogations. Six prospective observational studies and two retrospective database interrogations matched inclusion and exclusion criteria. Areas of agreement: Patients undergoing THA and TKA have a high prevalence of hypovitaminosis D. Five of eight studies (62.5%) report a statistically significant association between low vitamin D status and worse outcomes after THA and TKA. Areas of controversy: Different explanations have been proposed for vitamin D insufficiency, but some authors have questioned the correctness of the methods used to measure the vitamin D levels. Growing points: A trial focusing on the role of vitamin D supplementation on safety and outcomes of patients undergoing THA and TKA with low vitamin D status is ongoing. Areas timely for developing research: Further studies should explore the possible causal relationship between vitamin D status and outcomes of THA and TKA and verify the laboratory methods to analyse it.
MeSH term(s)	Arthroplasty, Replacement, Hip/adverse effects ; Arthroplasty, Replacement, Knee ; Homeostasis ; Humans ; Retrospective Studies ; Vitamin D
Chemical Substances	Vitamin D (1406-16-2)
Language	English
Publishing date	2020-08-07
Publishing country	England
Document type	Journal Article ; Observational Study
ZDB-ID	213294-1
ISSN	1471-8391 ; 0007-1420
ISSN (online)	1471-8391
ISSN	0007-1420
DOI	10.1093/bmb/ldaa018
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Article ; Online: Genomic and transcriptomic advances in amyotrophic lateral sclerosis.

Rizzuti, Mafalda / Sali, Luca / Melzi, Valentina / Scarcella, Simone / Costamagna, Gianluca / Ottoboni, Linda / Quetti, Lorenzo / Brambilla, Lorenzo / Papadimitriou, Dimitra / Verde, Federico / Ratti, Antonia / Ticozzi, Nicola / Comi, Giacomo Pietro / Corti, Stefania / Gagliardi, Delia

Ageing research reviews

2023 Volume 92, Page(s) 102126

Abstract: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder and the most common motor neuron disease. ALS shows substantial clinical and molecular heterogeneity. In vitro and in vivo models coupled with multiomic techniques have provided ... ...

Abstract	Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder and the most common motor neuron disease. ALS shows substantial clinical and molecular heterogeneity. In vitro and in vivo models coupled with multiomic techniques have provided important contributions to unraveling the pathomechanisms underlying ALS. To date, despite promising results and accumulating knowledge, an effective treatment is still lacking. Here, we provide an overview of the literature on the use of genomics, epigenomics, transcriptomics and microRNAs to deeply investigate the molecular mechanisms developing and sustaining ALS. We report the most relevant genes implicated in ALS pathogenesis, discussing the use of different high-throughput sequencing techniques and the role of epigenomic modifications. Furthermore, we present transcriptomic studies discussing the most recent advances, from microarrays to bulk and single-cell RNA sequencing. Finally, we discuss the use of microRNAs as potential biomarkers and promising tools for molecular intervention. The integration of data from multiple omic approaches may provide new insights into pathogenic pathways in ALS by shedding light on diagnostic and prognostic biomarkers, helping to stratify patients into clinically relevant subgroups, revealing novel therapeutic targets and supporting the development of new effective therapies.
MeSH term(s)	Humans ; Amyotrophic Lateral Sclerosis/genetics ; Amyotrophic Lateral Sclerosis/therapy ; Transcriptome/genetics ; Gene Expression Profiling/methods ; MicroRNAs/genetics ; MicroRNAs/metabolism ; Biomarkers ; Epigenomics
Chemical Substances	MicroRNAs ; Biomarkers
Language	English
Publishing date	2023-11-14
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2075672-0
ISSN	1872-9649 ; 1568-1637
ISSN (online)	1872-9649
ISSN	1568-1637
DOI	10.1016/j.arr.2023.102126
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Article: Effects of Multidisciplinary Rehabilitation Enhanced with Neuropsychological Treatment on Post-Acute SARS-CoV-2 Cognitive Impairment (Brain Fog): An Observational Study.

Rabaiotti, Paolo / Ciracì, Chiara / Donelli, Davide / Oggioni, Carlotta / Rizzi, Beatrice / Savi, Federica / Antonelli, Michele / Rizzato, Matteo / Moderato, Luca / Brambilla, Valerio / Ziveri, Valentina / Brambilla, Lorenzo / Bini, Matteo / Nouvenne, Antonio / Lazzeroni, Davide

Brain sciences

2023 Volume 13, Issue 5

Abstract: Concentration and memory impairment (named "brain fog") represents a frequent and disabling neuropsychological sequela in post-acute COVID-19 syndrome (PACS) patients. The aim of this study was to assess whether neurocognitive function could improve ... ...

Abstract	Concentration and memory impairment (named "brain fog") represents a frequent and disabling neuropsychological sequela in post-acute COVID-19 syndrome (PACS) patients. The aim of this study was to assess whether neurocognitive function could improve after a multidisciplinary rehabilitation program enhanced with individualized neuropsychological treatment. A prospective monocentric registry of PACS patients consecutively admitted to our Rehabilitation Unit was created. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive impairment at admission and discharge. A total of sixty-four (64) PACS patients, fifty-six (56) of them with brain fog, were treated with a day-by-day individualized psychological intervention of cognitive stimulation (45 min) on top of a standard in-hospital rehabilitation program. The mean duration of the acute-phase hospitalization was 55.8 ± 25.8 days and the mean in-hospital rehabilitation duration was 30 ± 10 days. The mean age of the patients was 67.3 ± 10.4 years, 66% of them were male, none had a previous diagnosis of dementia, and 66% of the entire sample had experienced severe COVID-19. At admission, only 12% of the patients had normal cognitive function, while 57% showed mild, 28% moderate, and 3% severe cognitive impairment. After psychological treatment, a significant improvement in the MoCA score was found (20.4 ± 5 vs. 24.7 ± 3.7;
Language	English
Publishing date	2023-05-12
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2651993-8
ISSN	2076-3425
ISSN	2076-3425
DOI	10.3390/brainsci13050791
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Article ; Online: The methodology of a "living" COVID-19 registry development in a clinical context.

Arienti, Chiara / Campagnini, Silvia / Brambilla, Lorenzo / Fanciullacci, Chiara / Lazzarini, Stefano Giuseppe / Mannini, Andrea / Patrini, Michele / Carrozza, Maria Chiara

Journal of clinical epidemiology

2021 Volume 142, Page(s) 209–217

Abstract: Objective: The aim of this study was to describe an innovative methodology of a registry development, constantly updated for the scientific assessment and analysis of the health status of the population with COVID-19.: Study design and setting: A ... ...

Abstract	Objective: The aim of this study was to describe an innovative methodology of a registry development, constantly updated for the scientific assessment and analysis of the health status of the population with COVID-19. Study design and setting: A methodological study design to develop a multi-site, Living COVID-19 Registry of COVID-19 patients admitted in Fondazione Don Gnocchi centres started in March 2020. Results: The integration of the living systematic reviews and focus group methodologies led to a development of a registry which includes 520 fields filled in for 748 COVID-19 patients recruited from 17 Fondazione Don Gnocchi centres. The result is an evidence and experience-based registry, according to the evolution of a new pathology which was not known before outbreak of March 2020 and with the aim of building knowledge to provide a better quality of care for COVID-19 patients. Conclusion: A Living COVID-19 Registry is an open, living and up to date access to large-scale patient-level data sets that could help identifying important factors and modulating variable for recognising risk profiles and predicting treatment success in COVID-19 patients hospitalized. This innovative methodology might be used for other registries, to be sure which the data collected is an appropriate means of accomplishing the scientific objectives planned. Clinical trial registration number: not applicable.
MeSH term(s)	COVID-19/epidemiology ; COVID-19/rehabilitation ; Evidence-Based Practice ; Focus Groups ; Health Status ; Humans ; Italy/epidemiology ; Registries ; Survivors/statistics & numerical data
Language	English
Publishing date	2021-11-14
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	639306-8
ISSN	1878-5921 ; 0895-4356
ISSN (online)	1878-5921
ISSN	0895-4356
DOI	10.1016/j.jclinepi.2021.11.022
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Article: Mortality and characteristics of older people dying with COVID-19 in Lombardy nursing homes, Italy: An observational cohort study.

Arienti, Chiara / Brambilla, Lorenzo / Campagnini, Silvia / Fanciullacci, Chiara / Giunco, Fabrizio / Mannini, Andrea / Patrini, Michele / Tartarone, Federica / Carrozza, Maria Chiara

Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences

2021 Volume 26, Page(s) 40

Abstract: Background: The aim of the study was to describe the epidemiological characteristics of Nursing Homes (NHs) residents infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to compute the related case-fatality rate.: ... ...

Abstract	Background: The aim of the study was to describe the epidemiological characteristics of Nursing Homes (NHs) residents infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to compute the related case-fatality rate. Materials and methods: The outcomes were mortality and case-fatality rate with related epidemiological characteristics (age, sex, comorbidity, and frailty). Results: During the COVID-19 outbreak lasted from March 1 to May 7, 2020, 330 residents died in Fondazione Don Gnocchi NHs bringing the mortality rate to 27% with a dramatic increase compared to the same period of 2019, when it was 7.5%. Naso/oropharyngeal swabs resulted positive for COVID-19 in 315 (71%) of the 441of the symptomatic/exposed residents tested. The COVID-19 population was 75% female, with a 17% overall fatality rate and sex-specific fatality rates of 19% and 13% for females and males, respectively. Fifty-six percent of deaths presented SARS-CoV-2-associated pneumonia, 15% cardiovascular, and 29% miscellaneous pathologies. Conclusion: Patients' complexity and frailty might influence SARS-CoV-2 infection case-fatality rate estimates. A COVID-19 register is needed to study COVID-19 frail patients' epidemiology and characteristics.
Language	English
Publishing date	2021-06-30
Publishing country	India
Document type	Journal Article
ZDB-ID	2513029-8
ISSN	1735-7136 ; 1735-1995
ISSN (online)	1735-7136
ISSN	1735-1995
DOI	10.4103/jrms.JRMS_1012_20
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Article ; Online: Multiscale sample entropy of heart rate and blood pressure: Methodological aspects.

Castiglioni, Paolo / Brambilla, Lorenzo / Bini, Matteo / Coruzzi, Paolo / Faini, Andrea

Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference

2017 Volume 2017, Page(s) 3134–3137

Abstract: The entropy of heart rate variability is one of the main features characterizing the complexity of the cardiovascular system. In order to take into account the multiscale nature of cardiovascular regulation, it was proposed to evaluate entropy with a ... ...

Abstract	The entropy of heart rate variability is one of the main features characterizing the complexity of the cardiovascular system. In order to take into account the multiscale nature of cardiovascular regulation, it was proposed to evaluate entropy with a multiscale approach, based on the estimation of Sample Entropy on progressively coarse-grained series (Multiscale Sample Entropy, MSE). Aim of this work is to investigate two methodological aspects related to MSE of cardiovascular signals. The first aspect regards the tolerance below which a couple of points are considered similar in a given embedding dimension, in particular how the way the tolerance is set at each level of coarse graining influences the MSE estimates. The second aspect regards whether heart rate and blood pressure (BP) signals are characterized by different MSE structures.To investigate these aspects, we analyzed 65 continuous BP recordings of more than 90-minute duration in healthy volunteers sitting at rest, and applied MSE estimators to beat-by-beat series of systolic BP, diastolic BP and pulse interval (inverse of heart rate). Results indicate that the way the tolerance is set during coarse graining influences substantially the MSE profile of cardiovascular signals, modifying the relative level of their unpredictability.
MeSH term(s)	Blood Pressure ; Blood Pressure Determination ; Entropy ; Heart Rate ; Rest
Language	English
Publishing date	2017-10-20
Publishing country	United States
Document type	Journal Article
ISSN	2694-0604
ISSN (online)	2694-0604
DOI	10.1109/EMBC.2017.8037521
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