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Aging-related muscle dysfunction has been conceptualized through the model of sarcopenia, but it embraces several other characteristics, e.g., dynapenia, myosteatosis, and powerpenia. Our perspective reframes muscle aging from a different point of view, the Skeletal Muscle Function Deficit (SMFD), a unifying approach that integrates muscle quality and mass into a single functional definition. An SMFD score has been adopted in the InCHIANTI study against many geriatric outcomes, such as risk of disability, physical performance, hospitalizations and falls, and incidence of major diseases, highlighting its potential value as a primary indicator of muscle failure and/or of healthy aging. At the core of SMFD lies inflammaging, the chronic, low-grade, age-related inflammation, linking functional outcomes to muscular and neural aging. Inflammatory mediators alter the anabolic/catabolic balance, accelerate myosteatosis, impair neuromuscular junction, and influence denervation. These findings support the idea of a common pathway that links neuro-muscular deficit and inflammation, which simultaneously targets cortical motor circuits, spinal motor neurons, peripheral nerves, and muscle fibers. The SMFD approach facilitates early detection, risk stratification, and possible intervention for muscle deterioration with aging.

Multiple sclerosis (MS) is a chronic neurological disease often resulting in motor and autonomic dysfunction. This case report investigates the acute and subacute effects of the EXOPULSE Mollii Suit (EMS), a wearable device capable of delivering transcutaneous electrical nerve stimulation to multiple anatomical regions, in a 43-year-old woman with MS. The patient underwent a clinical evaluation before the EMS treatment, during which central nervous system (CNS) and autonomic nervous system (ANS) responses were monitored using electroencephalography (EEG), heart rate variability (HRV), and infrared thermography (IRT). Immediately after the first EMS application, the clinical evaluation was repeated. The intervention continued at home for one month, followed by a post-treatment evaluation similar to the pre-intervention assessment. Functional evaluations showed improvements in sit-to-stand performance (from 8 s to 6 s), muscle tone (MAS scale for the right side from 3 to 2 and for the left side from 2 to 1), clonus, and spasticity (from 3 to 2). EEG results revealed decreased θ-band power (on average, from 0.394 to 0.253) and microstates’ reorganization. ANS activity modifications were highlighted by both HRV (e.g., RMSSD from 0.118 to 0.0837) and IRT metrics (e.g., nose tip temperature sample entropy from 0.090 to 0.239). This study provides the first integrated analysis of CNS and ANS responses to EMS in an MS patient, combining functional scales with multimodal instrumental measurements, emphasizing the possible advantages EMS for MS treatment. Although preliminary, these results demonstrated the potentiality of the EMS to deliver effective and personalized rehabilitative interventions for MS patients.

Purpose This paper introduces the Research Articles in Simplified HTML (or RASH), which is a Web-first format for writing HTML-based scholarly papers; it is accompanied by the RASH Framework, a set of tools for interacting with RASH-based articles. The paper also presents an evaluation that involved authors and reviewers of RASH articles submitted to the SAVE-SD 2015 and SAVE-SD 2016 workshops. Design RASH has been developed aiming to: be easy to learn and use; share scholarly documents (and embedded semantic annotations) through the Web; support its adoption within the existing publishing workflow. Findings The evaluation study confirmed that RASH is ready to be adopted in workshops, conferences, and journals and can be quickly learnt by researchers who are familiar with HTML. Research Limitations The evaluation study also highlighted some issues in the adoption of RASH, and in general of HTML formats, especially by less technically savvy users. Moreover, additional tools are needed, e.g., for enabling additional conversions from/to existing formats such as OpenXML. Practical Implications RASH (and its Framework) is another step towards enabling the definition of formal representations of the meaning of the content of an article, facilitating its automatic discovery, enabling its linking to semantically related articles, providing access to data within the article in actionable form, and allowing integration of data between papers. Social Implications RASH addresses the intrinsic needs related to the various users of a scholarly article: researchers (focussing on its content), readers (experiencing new ways for browsing it), citizen scientists (reusing available data formally defined within it through semantic annotations), publishers (using the advantages of new technologies as envisioned by the Semantic Publishing movement). Value RASH helps authors to focus on the organisation of their texts, supports them in the task of semantically enriching the content of articles, and leaves all the issues about validation, visualisation, conversion, and semantic data extraction to the various tools developed within its Framework.

Objective: Several symptoms are common to knee osteoarthritis and Baker’s cyst. To what extent each condition contributes to the patient’s discomfort is still a matter of debate. The aim of the present study was twofold: first, to compare the burden of symptoms in patients with isolated knee osteoarthritis and patients with knee osteoarthritis associated with Baker’s cyst; second, to assess the outcomes after conservative treatments. Subject and Methods: Patients suffering from monolateral idiopathic knee osteoarthritis were enrolled. Demographic, anthropometric and clinical data (KOOS scale) were collected. Ultrasound evaluation was performed according to standard protocols. On the basis of the clinical presentation different therapeutic options were used (fluid withdrawal, hyaluronic acid and/or steroids injections). Results: One-hundred and thirty patients were included in the study (97 with isolated knee osteoarthritis, 33 with knee osteoarthritis and Baker’s cyst). In basal conditions, lower scores in KOOS sub-scales were observed in patients with knee osteoarthritis associated with Baker’s cyst and in patients with effusion compared with patients without effusion. At 3 months after therapy significant higher scores were observed in both groups. At 6 months the scores were unchanged in the patients without Baker’s cyst, but worsened in those with Baker’s cyst. Conclusions: The study shows that Baker’s cysts associated with knee osteoarthritis contribute to the burden of symptoms. The conservative treatment of both conditions allows significant improvements, but in the medium term (6 months) the efficacy of the therapy declines in patients with knee osteoarthritis associated with Baker’s cyst.

Background Rotator cuff (RC) tendinopathy is a common shoulder pain condition. Extracorporeal shockwave therapy (ESWT) and hyaluronic acid peritendinous injection are viable treatment options for RC tendinopathy. The aim of this study is to evaluate the response in two different therapeutic rehabilitative approaches, the combined treatment ESWT plus hyaluronic acid injections (E + Hy) compared to ESWT alone (ESWT-al), in a cohort of patients with RC tendinopathy according to gender differences. Methods This is a retrospective longitudinal cohort study of patients with painful RC tendinopathy. Patients that had received a clinical evaluation, a shoulder ultra sound examination, as well as the Shoulder Pain and Disability Index (SPADI) questionnaire, and the Numerical Rating Scale (NRS) for pain at baseline, 1-month (T1) and 2-month follow-ups (T2) were included. Results Medical records of 53 patients were analyzed. In the comparison between baseline to T1 and similarly from baseline to T2, a statistically significant reduction has been reported in the NRS ( p  < 0.001) and in the SPADI ( p  < 0.001) in the entire study group. At T1, patients in the E + Hy compared to ESWT-al group, showed a slight but statistically significant reductions in both NRS and SPADI score, while these changes were more evident at T2 ( p  < 0.001). Interestingly, a gender dimorphism in NRS and in SPADI was found, with female patients that apparently responded better to the combined E + Hy compared to ESWT-al approach. Conclusion This retrospective cohort study suggests that the combination of ESWT plus HyA injections seems to be more effective than ESWT alone in RC tendinopathy in both genders. Moreover, in ESWT alone treatment, male patients reported better outcomes compared to females. However, further randomized controlled trials should be structured to confirm and enforce these conclusions.

Background: Brain-Computer Interface (BCI) is becoming more reliable, thanks to the advantages of Artificial Intelligence (AI). Recently, hybrid Deep Learning (hDL), which combines different DL algorithms, has gained momentum over the past five years. In this work, we proposed a review on hDL-based BCI starting from the seminal studies in 2015. Objectives: We have reviewed 47 papers that apply hDL to the BCI system published between 2015 and 2020 extracting trends and highlighting relevant aspects to the topic. Methods: We have queried four scientific search engines (Google Scholar, PubMed, IEEE Xplore and Elsevier Science Direct) and different data items were extracted from each paper such as the database used, kind of application, online/offline training, tasks used for the BCI, pre-processing methodology adopted, type of normalization used, which kind of features were extracted, type of DL architecture used, number of layers implemented and which optimization approach were used as well. All these items were then investigated one by one to uncover trends. Results: Our investigation reveals that Electroencephalography (EEG) has been the most used technique. Interestingly, despite the lower Signal-to-Noise Ratio (SNR) of the EEG data that makes pre-processing of that data mandatory, we have found that the pre-processing has only been used in 21.28% of the cases by showing that hDL seems to be able to overcome this intrinsic drawback of the EEG data. Temporal-features seem to be the most effective with 93.94% accuracy, while spatial-temporal features are the most used with 33.33% of the cases investigated. The most used architecture has been Convolutional Neural Network-Recurrent Neural Network CNN-RNN with 47% of the cases. Moreover, half of the studies have used a low number of layers to achieve a good compromise between the complexity of the network and computational efficiency. Significance: To give useful information to the scientific community, we make our summary table of hDL-based BCI papers available and invite the community to published work to contribute to it directly. We have indicated a list of open challenges, emphasizing the need to use neuroimaging techniques other than EEG, such as functional Near-Infrared Spectroscopy (fNIRS), deeper investigate the advantages and disadvantages of using pre-processing and the relationship with the accuracy obtained. To implement new combinations of architectures, such as RNN-based and Deep Belief Network DBN-based, it is necessary to better explore the frequency and temporal-frequency features of the data at hand.

Background Neutrophils and lymphocytes represent the larger percentage of all white blood cells, they vary with age, with a progressive increase of the ratio in the first years of life, and then tend to remain at similar levels in steady state condition during adult age. Neutrophils to lymphocytes-ratio (NL-ratio) was proposed as an effective and low-cost marker to monitor and predict the evolution of several clinical conditions. The main objective of the study is to analyze its temporal trend variation, over twenty years’ follow-up, according to age, sex, and main clinical diagnosis, in a large representative Italian population. Methods The InCHIANTI study enrolled representative samples from the registry list of two towns in Tuscany, Italy. Baseline data were collected in 1998, and last follow-up visits were made in 2015-18. 1343 out of the 1453 participants enrolled were included, and consented to donate a blood sample. All subjects were assessed and followed for life-style, clinical condition, physical performance, and underwent an instrumental diagnostic session. Results The NL-ratio showed a statistically significant interaction between birth-cohort and time of the study (p-value = 0.005). A gender dimorphism was recognized in the neutrophils absolute count and in the NL-ratio. Moreover, in female participants only, those who reported CHF had lower neutrophil-count and NL-ratio; whereas an increase in creatinine clearance was directly associated with NL-ratio. In male subjects, an increase of BMI was inversely associated with both NL-ratio and neutrophils-count during the follow-up; a similar association but in the opposite direction was observed in female participants. Conclusion NL-ratio is a more reliable predictor of healthy aging than absolute lymphocytes and/or neutrophils counts. It is associated with the changes induced by disease, lifestyle, and environmental challenges in the immune system. NL-ratio confirms the gender dimorphism in the occurrence of inflammation-driven diseases, thus providing additional evidence for the necessity of tailored sex-specific measures to prevent and treat such diseases.

Delirium is an acute fluctuation in attention with reduced awareness, orientation, cognitive disturbances, sleep-wake cycle and emotional regulation. Psychomotor dysfunction represents a prominent feature defining three different delirium subtypes: hyperactive, marked by agitation, hypoactive, with lethargy and decreased motor activity, and mixed.1

Introduction: Diabetes mellitus (DM) is associated with a high risk of chronic degenerative Achilles (AT) and Patellar (PT) tendinopathies and ruptures. Growth factors (GFs) synthesis in diabetics is substantially decreased in human connective tissues, including in tendons. Platelet Rich Plasma (PRP), which is enriched in GFs, might prove of great help in tendon healing. The aim of the study was to assess whether pre-existent DM or Impaired Glucose Tolerance (IGT) could influence the clinical outcome in subjects undergoing PRP treatment. Methods: Sixty subjects with diabetes/pre-diabetes and sixty euglycemic controls, matched for sex and age, were enrolled. Patients suffering from proximal insertional PT and mid-portion AT, treated with PRP therapy, were included in the study. To assess the basal status and the efficacy of the therapy after 3 and 6 months, the Victorian Institute of Sport Assessment (VISA) questionnaire and the Ultrasound methodology study were used. Patient satisfaction was assessed by means of the Likert Scale. Results: In the population study at 6 months, the mean VISA-score increased (8.92 ± 0.67; p-value < 0.001). The improvement in the diabetic group was less evident compared to the controls (−2.76 ± 0.95; p-value = 0.003). Even though the improvement was poor, it was still significant. MCID analysis revealed that diabetics had higher risk of therapeutic unsuccess. Logistic regression analysis was applied to assess factors associated with unsatisfactory results (Likert-scale) of PRP treatment: AT (O.R.: 3.05; 95%CI: 1.40–6.64; p-value = 0.005), higher BMI values (O.R.: 1.02; 95%CI: 1.01–1.04; p-value = 0.01), and lower VISA score values at baseline (O.R.: 0.95; 95%CI: 0.90–0.99; p-value = 0.04). Conclusions: PRP treatment in AT and PT chronic tendinopathies resulted in less favorable results in subjects with diabetes compared with euglycemic subjects. Moreover, the subjects with PT showed better results than those with AT.

Natural antibodies (nAbs) against aggregation-prone proteins have been found in healthy normal subjects. These proteins likely have a pathogenetic role in neurodegenerative diseases of ageing. They include the amyloid β (Aβ) protein which may play an important role in Alzheimer’s dementia (AD), and α-synuclein, a major determinant of Parkinson’s disease (PD). We measured nAbs to Aβ in a group of Italian patients with AD, vascular dementia, non-demented PD patients and healthy elderly controls. We found that Aβ antibody levels in AD were similar to age- and sex-matched controls, but contrary to our expectations, they were significantly reduced in PD. This may identify patients that could be more prone to amyloid aggregation.