Smart Devices for Health and Wellness Applied to Tele-Exercise: An Overview of New Trends and Technologies Such as IoT and AI

This descriptive article explores the use of smart devices for health and wellness in the context of telehealth, highlighting rapidly evolving technologies such as the Internet of Things (IoT) and Artificial Intelligence (AI). Key innovations, benefits, challenges, and opportunities related to the adoption of these technologies are outlined. The article provides a descriptive and accessible approach to understanding the evolution and impact of smart devices in the tele-exercise reality. Nowadays, technological advances provide solutions that were unthinkable just a few years ago. The habits of the general population have also changed over the past few years. Hence, there is a need to investigate this issue and draw the attention of the scientific community to this topic by describing the benefits and challenges associated with each topic. If individuals no longer go to exercise, the exercise must go to their homes instead.

Chronic Effects of Asymmetric and Symmetric Sport Load in Varsity Athletes across a Six Month Sport Season

The relation between specific sport practice and possible spine modifications is unclear. The aim of this study was to investigate the effects of different sports on the spine in adult varsity athletes across a six month sports season. Forty-four athletes (24.5 ± 3 years) were divided into two groups according to the typology of the sport practiced: the symmetric sports group (S, 22 athletes: track and field running, n = 14; cycling, n = 8), and the asymmetric sports group (A, 22 athletes: tennis, n = 22). The participants' spines were evaluated with Formetric^® 4D rasterstereographic analysis at the beginning (BL), in the middle (INT), and at the end (FIN) of the season. Twenty-five parameters were measured in an average 4D modality. The results showed that the intervention factor (BL vs. FIN) had a significant effect on dimple distance (p < 0.05) and on left lateral deviation (BL vs. FIN and INT vs. FIN, p < 0.01 and p < 0.01, respectively). Statistical differences were found for the sport typology factor for pelvic antero-retroversion and right lateral deviation. For left lateral deviation, no modulation was found for the sport typology. Asymmetric versus symmetric sport loads showed small statistical differences in a non-professional sample of adult athletes. The practice of asymmetric sports should also be encouraged without exceeding the total number of hours per week.

Automatic Detection of Aerobic Threshold through Recurrence Quantification Analysis of Heart Rate Time Series

During exercise with increasing intensity, the human body transforms energy with mechanisms dependent upon actual requirements. Three phases of the body's energy utilization are recognized, characterized by different metabolic processes, and separated by two threshold points, called aerobic (AerT) and anaerobic threshold (AnT). These thresholds occur at determined values of exercise intensity(workload) and can change among individuals. They are considered indicators of exercise capacities and are useful in the personalization of physical activity plans. They are usually detected by ventilatory or metabolic variables and require expensive equipment and invasive measurements. Recently, particular attention has focused on AerT, which is a parameter especially useful in the overweight and obese population to determine the best amount of exercise intensity for weight loss and increasing physical fitness. The aim of study is to propose a new procedure to automatically identify AerT using the analysis of recurrences (RQA) relying only on Heart rate time series, acquired from a cohort of young athletes during a sub-maximal incremental exercise test (Cardiopulmonary Exercise Test, CPET) on a cycle ergometer. We found that the minima of determinism, an RQA feature calculated from the Recurrence Quantification by Epochs (RQE) approach, identify the time points where generic metabolic transitions occur. Among these transitions, a criterion based on the maximum convexity of the determinism minima allows to detect the first metabolic threshold. The ordinary least products regression analysis shows that values of the oxygen consumption VO₂, heart rate (HR), and Workload correspondent to the AerT estimated by RQA are strongly correlated with the one estimated by CPET (r > 0.64). Mean percentage differences are <2% for both HR and VO₂ and <11% for Workload. The Technical Error for HR at AerT is <8%; intraclass correlation coefficients values are moderate (≥0.66) for all variables at AerT. This system thus represents a useful method to detect AerT relying only on heart rate time series, and once validated for different activities, in future, can be easily implemented in applications acquiring data from portable heart rate monitors.

Live Streaming vs. Pre-Recorded Training during the COVID-19 Pandemic in Italian Rhythmic Gymnastics

The SARS-CoV-2 outbreak led to an inevitable and drastic transition to online training systems. This study aimed to analyze the differences between live-streaming and pre-recorded training modalities in rhythmic gymnastics (RG) with coaches and gymnasts of different technical levels. A total of 238 coaches and 277 athletes affiliated with the Italian Gymnastics Federation (FGI) participated in the study. The data collection tool was a self-collected questionnaire structured in three sections: participant's information, characteristics of live-streaming training, and characteristics of pre-recorded training. A 2 × 2 ANOVA was used for each numeric variable. A Pearson's chi-squared test was used for each categorical variable. For the athletes, training frequency, motivation, and efficacy were significantly higher (p < 0.05) with live streaming (3.7 ± 1.5 day/week, 3.8 ± 0.9 score and 3.8 ± 0.8 score, respectively) than with a pre-recorded modality (2.2 ± 1.7 day/week, 3.1 ± 1.2 score and 3.7 ± 0.9 score, respectively), while for coaches, significant differences (p < 0.005) were found between the two modalities only for training frequency (live streaming, 3.6 ± 1.8 days/week vs. pre-recorded, 2.1 ± 1.7 days/week). The adherence (number of No:Yes) was significantly higher (p < 0.05) for the live-streaming modality than for the pre-recorded modality in gold athletes (1:74 vs. 14:61, respectively), silver athletes (12:190 vs. 28:174, respectively), and gold coaches (3:63 vs. 11:55, respectively), but it was not for silver coaches. Physical preparation was performed significantly (p < 0.005) more often (number of No:Yes) for live streaming than for the pre-recorded modality by gold athletes (9:66 vs. 34:41, respectively), silver athletes (25:177 vs. 77:125, respectively), gold coaches (8:58 vs. 37:29), and silver coaches (33:139 vs. 85:87, respectively). Free body technical preparation was performed significantly (p < 0.005) more often (number of No:Yes) for live streaming than for the pre-recorded modality by gold athletes (15:60 vs. 39:36, respectively), silver athletes (84:118 vs. 121:81, respectively), gold coaches (10:56 vs. 38:28), and silver coaches (60:112 vs. 105:67, respectively), while no differences were found for silver athletes' and coaches' technical preparations for apparatus training between the two modalities. In conclusion, live streaming had greater positive effects on RG training during home confinement. However, pre-recorded training could be more effective for some types of training, depending on the technical level of the athletes.

Detecting Metabolic Thresholds from Nonlinear Analysis of Heart Rate Time Series: A Review

Heart rate time series are widely used to characterize physiological states and athletic performance. Among the main indicators of metabolic and physiological states, the detection of metabolic thresholds is an important tool in establishing training protocols in both sport and clinical fields. This paper reviews the most common methods, applied to heart rate (HR) time series, aiming to detect metabolic thresholds. These methodologies have been largely used to assess energy metabolism and to identify the appropriate intensity of physical exercise which can reduce body weight and improve physical fitness. Specifically, we focused on the main nonlinear signal evaluation methods using HR to identify metabolic thresholds with the purpose of identifying a method which can represent a useful tool for the real-time settings of wearable devices in sport activities. While the advantages and disadvantages of each method, and the possible applications, are presented, this review confirms that the nonlinear analysis of HR time series represents a solid, robust and noninvasive approach to assess metabolic thresholds.

Detection of hearing losses (HL) via transient-evoked otoacoustic emissions: towards an automatic classification

Transiently evoked otoacoustic emissions (TEOAEs) are routinely used in the hearing assessment of the auditory periphery. The major contribution of TEOAEs is the early detection of hearing losses in neonates, children, and adults. The evaluation of TEOAE responses by specific signal decomposition techniques offers numerous advantages for current and future research. One methodology, based on recurrence quantification analysis (RQA), can identify adult subjects presenting sensorineural hearing impairments. In two previous papers, the RQA-based approach was succesfully applied in identifying and classifying cases presenting noise and age related hearing losses. The current work investigates further two aspects of the previously proposed RQA-based analysis for hearing loss detection: (i) the reliability of a Training set built from different numbers of ears with normal hearing, and (ii) the threshold set of values of the key hearing loss detecting parameter RAD2D. Results: The Training set built from 158 healthy ears was found to be quite reliable and a similar but slightly minor performance was observed for the training set of 118 normal subjects, used in the past; the proposed ROC-curve method, optimizing the values of RAD2D, shows improved sensibility and specificity in one class discrimination. Conclusions: A complete and simplified procedure, based on the combined use of the traditional TEOAE reproducibility value and on values from the RQA-based RAD2D parameter, is proposed as an improved automatic classifier, in terms of sensitivity and specificity, for different types of hearing losses.

A Unified Genomic Mechanism of Cell-Fate Change

The purpose of our studies is to elucidate the nature of massive control of the whole genome expression with a particular emphasis on cell-fate change. The whole genome expression is coordinated by the emergence of a critical point (CP: a peculiar set of biphasic genes) with the genome acting as an integrated dynamical system. In response to stimuli, the genome expression self-organizes into local sub-, near-, and super-critical states, each exhibiting distinct collective behaviors with its center of mass acting as a local attractor, coexisting with the whole genome attractor (GA). The CP serves as the organizing center of cell-fate change, and its activation makes local perturbation to spread over the genome affecting GA. The activation of CP is in turn elicited by genes with elevated temporal variance (oscillating-mode genes), normally in charge to keep genome expression at pace with microenvironment fluctuations. When oscillation exceeds a given threshold, the CP synchronizes with the GA driving genome expression state transition. The expression synchronization wave invading the entire genome is fostered by the fusion-splitting dynamics of silencing pericentromere-associated heterochromatin domains and the consequent folding-unfolding transitions of transcribing euchromatin domains. The proposed mechanism is a unified step toward a time-evolutional transition theory of biological regulation.

Recurrence quantification analysis of heart rate variability to detect both ventilatory thresholds

Aims of this study were: to verify if Recurrence Quantification Analysis (RQA) of Heart Rate Variability (HRV) time series could determine both ventilatory thresholds in individuals with different fitness levels, and to assess the validity of RQA method compared to gas-exchange method (GE). The two thresholds were estimated in thirty young individuals during incremental exercise on cycle-ergometer: Heart rate (HR), Oxygen consumption (VO₂) and Workload were measured by the two methods (RQA and GE). Repeated measures ANOVA was used to assess main effects of methods and methods-by-groups interaction effects for HR, VO₂ and Workload at aerobic (AerT) and anaerobic (AnT) thresholds. Validity of RQA at both thresholds was assessed for HR, VO₂ and Workload by Ordinary Least Products (OLP) regression, Typical Percentage Error (TE), Intraclass Correlation Coefficients (ICC) and the Bland Altman plots. No methods-by-groups interaction effects were detected for HR, VO₂ and Workload at AerT and AnT. The OLP analysis showed that at both thresholds RQA and GE methods had very strong correlations (r >0.8) in all variables (HR, VO₂ and Workload). Slope and intercept values always included the 1 and the 0, respectively. At AerT the TE ranged from 4.02% (5.48 bpm) to 10.47% (8.53 Watts) (HR and Workload, respectively) and in all variables ICC values were excellent (≥0.85). At AnT the TE ranged from 2.53% (3.98 bpm) to 6.64% (7.81 Watts) (HR and Workload, respectively) and in all variables ICC values were excellent (≥0.90). Therefore, RQA of HRV time series is a new valid approach to determine both ventilatory thresholds in individuals with different physical fitness levels, it can be used when gas analysis is not possible or not convenient.

Self-organization of whole-gene expression through coordinated chromatin structural transition

The human DNA molecule is a 2-m-long polymer collapsed into the micrometer space of the cell nucleus. This simple consideration rules out any "Maxwell demon"-like explanation of regulation in which a single regulatory molecule (e.g., a transcription factor) finds autonomously its way to the particular target gene whose expression must be repressed or enhanced. A gene-by-gene regulation is still more contrasting with the physical reality when in the presence of cell state transitions involving the contemporary expression change of thousands of genes. This state of affair asks for a statistical mechanics inspired approach where specificity arises from a selective unfolding of chromatin driving the rewiring of gene expression pattern. The arising of "expression waves" marking state transitions related to chromatin structural reorganization through self-organized critical control of whole-genome expression will be described in the present paper. We adopt as a model system the gene expression time course of a cancer cell (MCF-7) population exposed to an efficient stimulus causing a state transition in comparison with an ineffective stimulus. The obtained results will be put into the perspective of biological adaptive systems living on the edge of chaos.

Initial validation of the Italian version of the Volition in Exercise Questionnaire (VEQ-I)

The purpose of this study was to validate the Volition in Exercise Questionnaire in Italian language (VEQ-I). The translation and cultural adaptation of the VEQ-I was conducted using the forward-backward translation method. VEQ-I eighteen items correspond to the six-factors structure of the original version. The construct validity was verified by the confirmatory factor analysis (CFA) (CFI = 0.960; TLI = 0.943; RMSEA = 0.039; and SRMR = 0.040). The eighteen items were well distributed in six subscales and the six-factors structure of the questionnaire was supported. Internal Consistency value of the questionnaire was investigated for each subscale of the VEQ-I. Cronbach’s alpha and Omega values of the Reasons, Postponing Training, Unrelated Thoughts, Self-Confidence, Approval from Others and Coping with Failure subscales were 0.76 (α) and 0.76 (ω), 0.76 (α) and 0.76 (ω), 0.87 (α) and 0.88 (ω), 0.85 (α) and 0.85 (ω), 0.70 (α) and 0.72 (ω) and 0.74 (α) and 0.74 (ω), respectively. They were acceptable in all the six subscales. The concurrent validity was assessed using the correlation among the subscales of VEQ-I measures and those contained in two questionnaires: Psychobiosocial States in Physical Education (PBS-SPE) and Exercise Motivations Inventory (EMI-2).

Differences between Pressurized and Non-Pressurized Transient-Evoked Otoacoustic Emissions in Neonatal Subjects

INTRODUCTION

Recently, Interacoustics presented a new otoacoustic emission protocol where the probe pressurizes the ear cavity, thus eliminates the risk of non-assessment (REFER outcome) due to a negative middle ear pressure. This study evaluated the characteristics and the performance of this new protocol on a newborn well-baby population.

METHODS

One hundred sixty-three newborns (age 2.7 ± 1.1 days) for a total of 294 ears were assessed randomly. Transiently evoked otoacoustic responses were acquired by the Titan device (Interacoustics), using the default and a pressurized TEOAE protocol. The data were analyzed in terms of signal to noise ratios (S/Ns) at 5 frequencies, namely, 0.87, 1.94, 2.96, 3.97, and 4.97 kHz. To assess any possible gestational age (GE) effects on the TEOAE variables, the responses were subdivided in 4 different age subgroups.

RESULTS

There were no significant differences between the left and right ear TEOAE responses, for age (in days), GE (in weeks), weight (in grams), and S/N at all 5 frequencies. Considering the pooled 294 ears, paired t tests between the default and the pressurized TEOAE data showed significant differences across all 5 frequencies (p < 0.01). The pressurized protocol generated TEOAE responses presenting larger S/Ns, and a positive additive effect of approximately 2.31 dB was observed at all tested frequencies. There were no significant GE effects on the pressurized TEOAE responses. In terms of performance, both protocols performed equally (same number of PASSes).

CONCLUSION

The pressurized TEOAE protocol generates responses with higher S/Ns which might be useful in borderline cases where the middle ear status might cause a REFER screening outcome.

Efficacy of Denosumab Therapy Following Treatment with Bisphosphonates in Women with Osteoporosis: A Cohort Study

Denosumab is a human monoclonal antibody that neutralizes RANKL, a cytokine able to interact with the RANK receptor on preosteoclasts and osteoclasts, decreasing their recruitment and differentiation, leading to a decreased bone resorption. The aim of this observational real-life study was to analyze adherence to denosumab therapy and assess its efficacy in increasing bone mineral density (BMD) and modulating biochemical skeletal markers following previous treatments with bisphosphonates in a group of post-menopausal women with osteoporosis. Women were recruited in the specialized center from March 2012 to September 2019. Biochemical markers were recorded at baseline and every six months prior to subsequent drug injection. Dual X-ray absorptiometry was requested at baseline and after 18/24 months. Comparing BMD at baseline and after denosumab therapy in naive patients and in those previously treated with bisphosphonates, a positive therapeutic effect was observed in both groups. The results of our real-life study demonstrate, as expected, that BMD values significantly increased upon denosumab treatment. Interestingly, denosumab showed an increased efficacy in patients previously treated with bisphosphonates. Moreover, biochemical markers data indicate that osteoporotic patients, without other concomitant unstable health conditions, could be evaluated once a year, decreasing the number of specialistic center access.

Influence of Geographical Area and Living Setting on Children's Weight Status, Motor Coordination, and Physical Activity

This study was aimed (i) to examine the effect of living setting (rural vs. urban), geographical area (North vs. Center vs. South), and gender (boys vs. girls) on weight status, motor coordination, and physical activity (PA) level of Italian school-age children; (ii) to examine differences in the neighborhood walkability of different school areas from different geographical areas and living settings; and (iii) to examine whether motor coordination, PA level, geographical areas, living setting, neighborhood walkability, and gender could predict children's weight status. We assessed anthropometric parameters, gross motor coordination, and PA level in 1,549 children aged between 8 and 13 years. Results revealed that Central children had higher BMI than Northern and Southern children (η² = 0.01). Moreover, Northern children showed the highest motor quotient (η² = 0.148) and PA level (η² = 0.02), followed by Southern and Central children, respectively. Children from the South of Italy attended schools located in neighborhoods with the highest Walk Score®. Urban children attended schools located in neighborhoods with a higher Walk Score® than rural children. Lower motor quotient (MQ), lower PA level, and living in a rural setting and in a car-dependent neighborhood were associated with a higher relative risk for obesity. Being a girl was associated with a lower relative risk for obesity. The alarming high percentage of overweight and obesity in children as well as motor coordination impairments revealed the urgent need of targeted PA interventions in pediatric population.

Business cycle modeling between financial crises and black swans: Ornstein-Uhlenbeck stochastic process vs Kaldor deterministic chaotic model

Business cycles are oscillations in the economy because of recessions and expansions. In this paper we investigate the oscillation of the gross domestic product as a result of its relations with the other main macroeconomic variables such as capital, consumption, and investment. There is a long-standing debate about chaos and non-linear dynamics in economy and even the usefulness of those concepts has been questioned. Stochastic modeling has proven to be able to simulate reality fairly well. However, a stochastic behavior implies that reality is about exogenous randomness, while a chaotic behavior means that reality is deterministic and non-linearities are endogenous. Here we compare an Ornstein-Uhlenbeck stochastic process with a Kaldor-Kalecki deterministic chaotic model to understand which one fits better real data. We show that our chaotic model is able to represent reality as well as the stochastic model taken into consideration. Furthermore, our model may reproduce an extreme event (black swans).

Detection of Age-Related Hearing Losses (ARHL) via Transient-Evoked Otoacoustic Emissions

PURPOSE

The objective of the study was to identify subjects presenting hearing deficits, specifically age-related hearing losses (ARHL), via objective assessment methodologies.

MATERIALS AND METHODS

Initially, 259 subjects (165 men, 94 women) were enrolled in the study. After the application of inclusion criteria, the final number was reduced to 88 subjects (49.8 ± 19.1 ys) subdivided into 64 normal and 83 ARHL cases. The subjects were assessed with traditional audiometry tests and with transiently evoked otoacoustic emissions (TEOAEs). Since each ear has its own acoustic signature, the TEOAE analyses were conducted in terms of ears and not subjects. The TEOAE data were processed by traditional and recurrence quantification analyses, leading to the estimation of the WWR (whole waveform reproducibility) and the new RAD2D (2-dimensional radius) parameters. A plot of WWR vs RAD2D was used to optimize the classification of the cases presenting ARHL.

RESULTS

By using a WWR value of 70% as a classifier, the sensitivity of TEOAEs was estimated as 75.9% and the specificity as 89.1%. By using the RAD2D parameter (with a cut-off value of 1.78), a sensitivity value of 80.7% and a specificity value of 71.9% were obtained. When both parameters were used, a sensitivity value of 85.5% and a specificity value of 92.2% were estimated. In the latter classification paradigm, the number of false negatives decreased from 20 to 12 out of 83 ears (14%).

CONCLUSION

In adult hearing screening assessments, the proposed method optimizes the identification of subjects with a hearing impairment correlated to the presence of age-related hearing loss.

A time-dependent study of nano-mechanical and ultrastructural properties of internal limiting membrane under ocriplasmin treatment

Vitreomacular traction (VMT) syndrome has only been surgically treated for a long time. Recently, enzymatic vitreolysis with ocriplasmin has emerged as a possible option to release VMT and, in some cases, close full thickness macular holes (FTMHs). Despite its clinical relevance, gathering information about the ocriplasmin-induced alterations of the Inner Limiting Membrane (ILM) of the retina in a clinical study is a complex task, mainly because of the inter-individual variability among patients. To obtain more insights into the mechanism underlying the drug action, we studied in-vitro the mechanical and morphological changes of the ILM using Atomic Force Microscopy (AFM). To this aim, we measured the ILM average Young's modulus (YM), hysteresis (H) and adhesion work (A) over time under ocriplasmin treatment. Our data unveil a time-dependent increase in the membrane YM of 19% of its initial value, along with changes in its adhesive and dissipative behavior. Such modifications well correlate with the morphological alterations detected in the AFM imaging mode. Taken all together, the results here presented provide more insights into the mechanism underlying the ocriplasmin action in-vivo, suggesting that it is only able to alter the top-most layer of the vitreal side of the membrane, not compromising the inner ILM structure.

Recurrence quantification analysis of heart rate variability during continuous incremental exercise test in obese subjects

The present paper concerns a new description of changing in metabolism during incremental exercises test that permit an individually tailored program of exercises for obese subjects. We analyzed heart rate variability from RR interval time series (tachogram) with an alternative approach, the recurrence quantification analysis, that allows a description of a time series in terms of its dynamic structure and is able to identify the phase transitions. A transition in cardiac signal dynamics was detected and it perfectly reflects the aerobic threshold, as identified by gas exchange during an incremental exercise test, revealing the coupling from the respiratory system toward the heart. Moreover, our analysis shows that, in the recurrence plot of RR interval, it is possible to identify a specific pattern that allows to identify phase transitions between different dynamic regimes. The perfect match of the occurrence of the phase transitions with changes observed in the VO₂ consumption, the gold standard approach to estimate thresholds, strongly supports the possibility of using our analysis of RR interval to detect metabolic threshold. In conclusion, we propose a novel nonlinear data analysis method that allows for an easy and personalized detection of thresholds both from professional and even from low-cost wearable devices, without the need of expensive gas analyzers.

The remarkable coherence between two Italian far away recording stations points to a role of acoustic emissions from crustal rocks for earthquake analysis

We observed a remarkable near-to-unity correlation between the time series of Acoustic Emissions (AEs) collected at two stations approximately 300 km apart from each other and located along the Apennine belt (Italy). This finding prompted us to verify the hypothesis that AE signals can carry with them an indication of anomalies in a crustal stress trend, possibly related to earthquake occurrences. Thus, we checked the ability of Recurrence Quantification Analysis and Fractal Analysis as applied to AE to identify signal phase transitions before the crisis occurs. The sharp drop of the Percent of Determinism after its maximum value, and simultaneously with minimum values of the Fractal Dimension (D), few days before some seismic events take place, seems to point to the relevance of the proposed approach as precursor detection.

Post-processing analysis of transient-evoked otoacoustic emissions to detect 4 kHz-notch hearing impairment--a pilot study

Background

To identify a parameter to distinguish normal hearing from hearing impairment in the early stages. The parameter was obtained from transient-evoked otoacoustic emissions (TEOAEs), overcoming the limitations of the usually adopted waveform descriptive parameters which may fail in standard clinical screenings.

Material/Methods

Audiometric examinations and TEOAE analysis were conducted on 15 normal ears and on 14 hearing-impaired ears that exhibited an audiometric notch around 4 kHz. TEOAE signals were analyzed through a multivariate technique to filter out the individual variability and to highlight the dynamic structure of the signals. The new parameter (named radius 2-dimension – RAD2D) was defined and evaluated for simulated TEOAE signals modeling a different amount of hearing impairment.

Results

Audiometric examinations indicated 14 ears as impaired-hearing (IH), while the TEOAE ILO92 whole reproducibility parameter (WWR) indicated as IH 7 signals out of 14 (50%). The proposed new parameter indicated as IH 9 signals out of 14 (64%), reducing the number of false negative cases of WWR.

Conclusions

In this preliminary study there is evidence that the new parameter RAD2D defines the topology and the quantification of the damage in the inner ear. The proposed protocol can be useful in hearing screenings to identify hearing impairments much earlier than conventional pure tone audiometry and TEOAE pass/fail test.

Effects of vestibular rehabilitation therapy on emotional aspects in chronic vestibular patients

OBJECTIVE

A strong relationship exists between vestibular dysfunction and anxiety disorders. The aim of this study was to assess the anxiety and depression levels in patients with chronic dizziness and to assess the effects of vestibular rehabilitation (VR) therapy, on the anxiety and depression levels, without a behavioural or pharmacological therapy.

METHOD

Two groups of 40 patients, each affected by chronic vestibular deficit, were studied. The first one underwent VR, and the latter did not. The psychometric tests used were the State-Trait Anxiety Inventory (STAI) and the Centre for Epidemiological Studies Depression Scale (CES-D).

RESULTS

Psychological factors influence the level of handicap experienced by chronic dizziness patients, and disequilibrium influences the anxiety and depression levels. STAI and CES-D scales significantly decrease after VR therapy (P<.001) and remain stable at follow-up.

CONCLUSIONS

The VR therapy positively influences the emotional condition of chronic vestibular deficit patients without pharmacological or psychotherapy treatments.

Vestibular rehabilitation and 6-month follow-up using objective and subjective measures

CONCLUSIONS

Vestibular rehabilitation improves quality of life by reducing the degree of handicap, improving the ability to perform everyday tasks and providing long-term rehabilitation stability (at 6 months). Recovery of the vestibulo-ocular reflex and the vestibulo-spinal reflex efficiency was proven by the objective results obtained in this study. Vestibular rehabilitation improves both subjective and objective parameters, although no significant correlation between these two indices was found.

OBJECTIVE

To determine the outcome of subjective and objective parameters and long-term rehabilitation stability after vestibular rehabilitation in 43 patients with vestibular disorders.

MATERIAL AND METHODS

The subjective tests used were the Medical Outcomes Study 36-item Short Form, the Dizziness Handicap Inventory and the Activity-specific Balance Confidence scale. The objective tests used were video-oculoscopy, dynamic visual acuity, the Equitest and the Dynamic Gait Index. All indices were evaluated before and after rehabilitation and at follow-up.

RESULTS

All patients showed an improvement in quality of life and a reduction in handicap due to dizziness. Improvement in objective test results was also seen. These results were stable at follow-up. A correlation was found between different subjective measures, but there was no correlation between subjective and objective measures.

Otoacoustic emissions at different click intensities: invariant and subject-dependent features

A study of click-evoked otoacoustic emissions (CEOAEs) elicited at stimulation intensities from 35 to >80 dB was carried out by recurrence quantification analysis on signals from both normal and hearing-impaired subjects. In normal subjects, a clear scaling of determinism with increasing stimulation intensity was observed in the click intensity range from 41 to 59 dB. Outside that range and, in particular, above its upper end, subject-dependent features appeared in the form of different maximal levels of determinism. A comparative analysis of responses from hearing-impaired subjects with conductive hearing losses and sensorineural hearing losses suggested that the principal contributor to this behavior is the middle ear and allowed us to discriminate the two pathologies solely on the basis of CEOAEs. These observations are consistent with a simple phenomenological model of the auditory periphery in which different functional modules are sequentially recruited at increasing stimulus intensities, with a consequent rise in CEOAE coherence.

Comparison of transient otoacoustic emission responses from neonatal and adult ears

Transient otoacoustic emission (TEOAE) responses from neonatal (age: 48 h) and adult subjects (age: 26.6 +/- 10.0 yr) were analyzed by the combined use of recurrence quantification analysis and singular value decomposition. The data from the two age groups showed significant differences and similarities. The neonatal responses presented less deterministic structures than those of the adults in terms of recurrent dynamic features. In both data sets, the same high level of individual specific dynamic features was observed. The results from the singular value decomposition analysis suggest that a large percentage of variability in all of the analyzed responses can be explained by four to five essential modes. This number is lower than that observed in simulated TEOAE responses generated by a five-component gammatone model. A possible explanation is presented, based on simple instrumental and morphoanatomic considerations.

Revealing deterministic structures in click-evoked otoacoustic emissions

Click-evoked otoacoustic emissions (CEOAEs) were studied by means of recurrence quantification analysis (RQA) and were found to be endowed with a relevant amount of deterministic structuring. Such a structure showed highly significant correlation with the clinical evaluation of the signal over a data set including 56 signals. Moreover, 1) one of the RQA variables, Trend, was very sensitive to phase transitions in the dynamical regime of CEOAEs, and 2) appropriate use of principal component analysis proved able to isolate the individual character of the studied signals. These results are of general interest for the study of auditory signal transduction and generation mechanisms.

The essential dynamics of Cu, Zn superoxide dismutase: suggestion of intersubunit communication

A 300-ps molecular dynamics simulation of the whole Cu, Zn superoxide dismutase dimer has been carried out in water, and the trajectory has been analyzed by the essential dynamics method. The results indicate that the motion is defined by few preferred directions identified by the first four to six eigenvectors and that the motion of the two monomers at each instant is not symmetrical. The vectors symmetrical to the eigenvectors are significantly sampled, suggesting that, on average, the motions of the two subunits will exchange. Large intra- and intersubunit motions involving different subdomains of the protein are observed. A mechanical coupling between the two subunits is also suggested, because displacements of the loops surrounding the active site in one monomer are correlated with the motion of parts of the second toward the intersubunit interface.

Conductometric properties of human erythrocyte membranes: dependence on haematocrit and alkali metal ions of the suspending medium

The electrical properties of the cytoplasmatic membrane of human erythrocyte cells have been evaluated by means of dielectric spectroscopy measurements in the radiowave frequency range, using the so-called "suspension method". Measurements have been carried out at different volume fractions of the corpuscular phase (the cell haematocrit) in order to investigate the influence of the cell-cell interactions on the electrical parameters (the membrane permittivity epsilon and the membrane conductivity sigma) of the cell membrane and a set of new values are proposed. Moreover, the influence of different alkali metal ions (Na+, K+, Cs+, Li+) on the ion permeation properties of the membrane are investigated and the structural alterations in the membrane organized briefly discussed.

Use of low-frequency electrical impedance measurements to determine phospholipid content in amniotic fluid

In this report we propose a new method for an in vitro test of the foetal lung maturity based on the measurement of the electrical conductivity of the overall amniotic fluid obtained from transabdominal amniocentesis, since this quantity can be linked to a first approximation in a very simple way to the phospholipid content. We have carried out measurements of 85 different samples of amniotic fluid as a function of gestation weeks and we have observed a pronounced change of the electrical conductivity that reflects the increase in the phospholipid concentration occurring at the end of normal pregnancies. The method could be further developed to obtain similar information on in vivo experiments by means of bioelectric impedance tomography, taking advantage of the frequency dependence of the tissue electrical impedance.

Choreoathetosis in acquired immune deficiency syndrome patients with cerebral toxoplasmosis

The aim of our study was to evaluate both the incidence and the pathologic and clinical features of extrapyramidal disorders in a population of acquired immune deficiency syndrome (AIDS) patients with cerebral toxoplasmosis. Of 240 AIDS patients evaluated in the 1985-1994 period, 50 of them were diagnosed to have cerebral toxoplasmosis on the basis of the following criteria: occurrence of specific antibodies, computed tomography and/or magnetic resonance imaging (MRI), and regression of the symptoms after specific therapy. Three of 50 (6%) had hemichoreoathetosis. In the first case, the disorder began as a dyskinesia of the left hand that subsequently spread to the whole ipsilateral arm and assumed the features of choreic athetotic movements. The other two cases were characterized by left hemisomatic distal choreic movements. Therapy with pyrimethamine and sulfadiazine led to a complete recovery of the extrapyramidal signs in two cases and to improvement in the third. According to our observations, the onset of these movement disorders could not be related to the dimension of the lesion or to the edema, but to a specific localization in subthalamic nucleus, in subthalamic/pallidal, and pallidal/thalamic pathways. MRI seems the elective tool to perform a more accurate study of the anatomic areas involved in this pathway and to verify their integrity. Cerebral toxoplasmosis in AIDS can be considered as a new etiopathogenic cause of choreoathetosis.

A dielectric relaxation study on the effects of the antitumor drugs Lonidamine and Rhein on the membrane electrical properties of Ehrlich ascites tumor cells

The effects of the anti-tumor drugs lonidamine and rhein on the plasma membrane electrical properties of Ehrlich ascites tumor cells were investigated and compared. Dielectric relaxation measurements in the radiowave frequency range (10(4) to 10(8) Hz) as well as at higher frequencies (10(4) to 10(9) Hz) were performed and the data elaborated using a "single-shell" fitting procedure. The results obtained in both frequency ranges indicate that membrane conductivity and membrane permittivity are altered by 200 microM Lonidamine while 150 microM rhein induces only very slight variations in these two plasma membrane parameters. The usefulness of the dielectric relaxation technique described here in evaluating antitumor drugs and improving clinical protocols is discussed.

Anti-hepatitis C antibody prevalence among intravenous drug addicts in the Catanzaro area

A higher seroprevalence of anti-HCV antibodies (63.4%) was found in 41 intravenous drug addicts (IVDA) when compared to 220 controls (1.8%). Life style is an important risk factor for HCV transmission among IVDA.

[Myocardial infarct associated with arterial hypertension. Case studies]

An examination of cases of infarct with arterial hypertension in a total series of 173 cases of infarct showed that they more commonly presented as premonitory syndromes and tended to be sited anteriorly (p less than 0.05). Such cases are best treated by reducing sympathetic hypertonia.