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Cusato J, Manca A, Palermiti A, Mula J, Antonucci M, Chiara F, De Nicolò A, Lupia T, Stroffolini G, Boglione L, D'Avolio A. Pharmacogenetics of tenofovir drug transporters in the context of HBV: Is there an impact? Biomed Pharmacother 2024; 175:116678. [PMID: 38713940 DOI: 10.1016/j.biopha.2024.116678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/19/2024] [Accepted: 04/29/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND Current treatments for chronic hepatitis B management include orally administered nucleos(t)ide analogues, such as tenofovir (TDF), which is an acyclic adenine nucleotide analogue used both in HBV and human immune deficiency virus (HIV). The course of HBV infection is mainly dependent on viral factors, such as HBV genotypes, immunological features and host genetic variables, but a few data are available in the context of HBV, in particular for polymorphisms of genes encoding proteins involved in drug metabolism and elimination. Consequently, the aim of this study was to evaluate the potential impact of genetic variants on TDF plasma and urine concentrations in patients with HBV, considering the role of HBV genotypes. METHODS A retrospective cohort study at the Infectious Disease Unit of Amedeo di Savoia Hospital, Torino, Italy, was performed. Pharmacokinetic analyses were performed through liquidi chromatography, whereas pharmacogenetic analyses through real-time PCR. FINDINGS Sixty - eight patients were analyzed: ABCC4 4976 C>T genetic variant showed an impact on urine TDF drug concentrations (p = 0.014). In addition, SLC22A6 453 AA was retained in the final regression multivariate model considering factors predicting plasma concentrations, while ABCC4 4976 TC/CC was the only predictor of urine concentrations in the univariate model. INTERPRETATION In conclusion, this is the first study showing a potential impact of genetic variants on TDF plasma and urine concentrations in the HBV context, but further studies in different and larger cohorts of patients are required.
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Affiliation(s)
- J Cusato
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, Corso Svizzera, 164, Turin 10149, Italy
| | - A Manca
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, Corso Svizzera, 164, Turin 10149, Italy
| | - A Palermiti
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, Corso Svizzera, 164, Turin 10149, Italy.
| | - J Mula
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, Corso Svizzera, 164, Turin 10149, Italy.
| | - M Antonucci
- Amedeo di Savoia Hospital, ASL Città di Torino, Turin, Italy
| | - F Chiara
- University of Turin, Department of Clinical and Biological Sciences, Laboratory of Clinical Pharmacology San Luigi A.O.U., Orbassano, TO, Italy
| | - A De Nicolò
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, Corso Svizzera, 164, Turin 10149, Italy
| | - Tommaso Lupia
- Department of Medical Sciences, Infectious Diseases, University of Turin, Italy
| | - Giacomo Stroffolini
- Department of Medical Sciences, Infectious Diseases, University of Turin, Italy
| | - L Boglione
- University of Eastern Piedmont, Department of Translational Medicine, Novara, Italy
| | - A D'Avolio
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, Corso Svizzera, 164, Turin 10149, Italy
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Mendes D, Machira Krishnan S, O'Brien E, Padgett T, Harrison C, Strain WD, Manca A, Ustianowski A, Butfield R, Hamson E, Reynard C, Yang J. Modelling COVID-19 Vaccination in the UK: Impact of the Autumn 2022 and Spring 2023 Booster Campaigns. Infect Dis Ther 2024; 13:1127-1146. [PMID: 38662331 PMCID: PMC11098993 DOI: 10.1007/s40121-024-00965-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/21/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION The delivery of COVID-19 vaccines was successful in reducing hospitalizations and mortality. However, emergence of the Omicron variant resulted in increased virus transmissibility. Consequently, booster vaccination programs were initiated to decrease the risk of severe disease and death among vulnerable members of the population. This study aimed to estimate the effects of the booster program and alternative vaccination strategies on morbidity and mortality due to COVID-19 in the UK. METHOD A Susceptible-Exposed-Infectious-Recovered (SEIR) model was used to assess the impact of several vaccination strategies on severe outcomes associated with COVID-19, including hospitalizations, mortality, National Health Service (NHS) capacity quantified by hospital general ward and intensive care unit (ICU) bed days, and patient productivity. The model accounted for age-, risk- and immunity-based stratification of the UK population. Outcomes were evaluated over a 48-week time horizon from September 2022 to August 2023 considering the actual UK autumn 2022/spring 2023 booster campaigns and six counterfactual strategies. RESULTS The model estimated that the autumn 2022/spring 2023 booster campaign resulted in a reduction of 18,921 hospitalizations and 1463 deaths, compared with a no booster scenario. Utilization of hospital bed days due to COVID-19 decreased after the autumn 2022/spring 2023 booster campaign. Expanding the booster eligibility criteria and improving uptake improved all outcomes, including averting twice as many ICU admissions, preventing more than 20% additional deaths, and a sevenfold reduction in long COVID, compared with the autumn 2022/spring 2023 booster campaign. The number of productive days lost was reduced by fivefold indicating that vaccinating a wider population has a beneficial impact on the morbidities associated with COVID-19. CONCLUSION Our modelling demonstrates that the autumn 2022/spring 2023 booster campaign reduced COVID-19-associated morbidity and mortality. Booster campaigns with alternative eligibility criteria warrant consideration in the UK, given their potential to further reduce morbidity and mortality as future variants emerge.
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Affiliation(s)
| | | | - Esmé O'Brien
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | | | - Cale Harrison
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | | | | | - Andrew Ustianowski
- Manchester University Foundation Trust, University of Manchester, Manchester, UK
| | | | | | | | - Jingyan Yang
- Pfizer Inc, New York, USA
- Institute for Social and Economic Research and Policy, Columbia University, New York, USA
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Mazuquin B, Moffatt M, Realpe A, Sherman R, Ireland K, Connan Z, Tildsley J, Manca A, Gc VS, Foster NE, Rees J, Drew S, Bateman M, Fakis A, Farnsworth M, Littlewood C. Clinical and cost-effectiveness of individualised (early) patient-directed rehabilitation versus standard rehabilitation after surgical repair of the rotator cuff of the shoulder: protocol for a multicentre, randomised controlled trial with integrated Quintet Recruitment Intervention (RaCeR 2). BMJ Open 2024; 14:e081284. [PMID: 38580365 PMCID: PMC11002397 DOI: 10.1136/bmjopen-2023-081284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/08/2024] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION Despite the high number of operations and surgical advancement, rehabilitation after rotator cuff repair has not progressed for over 20 years. The traditional cautious approach might be contributing to suboptimal outcomes. Our aim is to assess whether individualised (early) patient-directed rehabilitation results in less shoulder pain and disability at 12 weeks after surgical repair of full-thickness tears of the rotator cuff compared with current standard (delayed) rehabilitation. METHODS AND ANALYSIS The rehabilitation after rotator cuff repair (RaCeR 2) study is a pragmatic multicentre, open-label, randomised controlled trial with internal pilot phase. It has a parallel group design with 1:1 allocation ratio, full health economic evaluation and quintet recruitment intervention. Adults awaiting arthroscopic surgical repair of a full-thickness tear are eligible to participate. On completion of surgery, 638 participants will be randomised. The intervention (individualised early patient-directed rehabilitation) includes advice to the patient to remove their sling as soon as they feel able, gradually begin using their arm as they feel able and a specific exercise programme. Sling removal and movement is progressed by the patient over time according to agreed goals and within their own pain and tolerance. The comparator (standard rehabilitation) includes advice to the patient to wear the sling for at least 4 weeks and only to remove while eating, washing, dressing or performing specific exercises. Progression is according to specific timeframes rather than as the patient feels able. The primary outcome measure is the Shoulder Pain and Disability Index total score at 12-week postrandomisation. The trial timeline is 56 months in total, from September 2022. TRIAL REGISTRATION NUMBER ISRCTN11499185.
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Affiliation(s)
- Bruno Mazuquin
- Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Maria Moffatt
- School of Allied Health Professios and Nursing, University of Liverpool, Liverpool, UK
| | - Alba Realpe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Rachelle Sherman
- Derby Clinical Trials Support Unit, Royal Derby Hospital, Derby, UK
| | - Katie Ireland
- Derby Clinical Trials Support Unit, Royal Derby Hospital, Derby, UK
| | - Zak Connan
- Derby Clinical Trials Support Unit, Royal Derby Hospital, Derby, UK
| | - Jack Tildsley
- Derby Clinical Trials Support Unit, Royal Derby Hospital, Derby, UK
| | - Andrea Manca
- Centre for Health Economics, York University, York, UK
| | - Vijay Singh Gc
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Nadine E Foster
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Saint Lucia, Queensland, Australia
| | - Jonathan Rees
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Steven Drew
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Marcus Bateman
- Derby Shoulder Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Apostolos Fakis
- Derby Clinical Trials Support Unit, Royal Derby Hospital, Derby, UK
| | | | - Chris Littlewood
- Allied Health, Social Work & Wellbeing, Faculty of Health Social Care and Medicine, Edge Hill University, Ormskirk, UK
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Morrone M, Boi A, Meloni M, Martinez G, Ventura L, Pusole M, Ghiani G, Crisafulli A, Bandiera P, Cugusi L, Deriu F, Manca A. Physiological adaptations of active postmenopausal women and matched men to the multi-day Sardinia Selvaggio Blu wild trek: a gender-comparative pilot study. Eur J Appl Physiol 2024; 124:1063-1074. [PMID: 37819614 PMCID: PMC10954930 DOI: 10.1007/s00421-023-05330-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE To evaluate the effects of wild trekking by examining, in postmenopausal women, the physiological adaptations to an intensive 5-day wild trek and comparing their responses to those displayed by a group of men of comparable age, training status and mountaineering skills. METHODS Six healthy, active postmenopausal women in their sixth decade of life participated in the study. Six men of comparable age and training status were also enrolled for gender-based comparisons. The participants traversed the Selvaggio Blu wild trek (Sardinia, Italy) completing a total of 56 km, for an overall height differential of 14,301 m. During all 5-day trek, subjects were supervised by two alpine guides. Changes in body composition, cardiorespiratory fitness, and metabolic patterns of energy expenditure were evaluated before and after the intervention. RESULTS Total energy expenditure during the trek was significantly higher (p = 0.03) in women (12.88 ± 3.37 kcal/h/kg) than men (9.27 ± 0.89 kcal/h/kg). Extracellular (ECW) and intracellular water (ICW) increased significantly following the trek only in women (ECW: - 3.8%; p = 0.01; ICW: + 3.4%; p = 0.01). The same applied to fat-free mass (+ 5.6%; p = 0.006), fat mass (- 20.4%; p = 0.006), skeletal muscle mass (+ 9.5%; p = 0.007), and appendicular muscle mass (+ 7.3%; p = 0.002). Peak VO2/kg (+ 9.4%; p = 0.05) and fat oxidation (at 80 W: + 26.96%; p = 0.04; at 100 W: + 40.95%; p = 0.02; at 120 W: + 83.02%; p = 0.01) were found increased only in women, although no concurrent changes in partial pressure of end-tidal CO2 (PETCO2) was observed. CONCLUSIONS In postmenopausal women, a 5-day, intensive and physically/technically demanding outdoor trekking activity led to significant and potentially relevant changes in body composition, energy balance and metabolism that are generally attained following quite longer periods of training.
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Affiliation(s)
- Marco Morrone
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy
| | - Anna Boi
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy
| | - Martina Meloni
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy
| | - Gianluca Martinez
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy
| | - Lucia Ventura
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy
| | - Maurizio Pusole
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy
| | - Giovanna Ghiani
- Sports Physiology Lab, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Crisafulli
- Sports Physiology Lab, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Pasquale Bandiera
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy
| | - Lucia Cugusi
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy.
- Unit of Endocrinology, Nutrition, and Metabolic Disorders, AOUSS, Sassari, Italy.
| | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy
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Chalkou K, Hamza T, Benkert P, Kuhle J, Zecca C, Simoneau G, Pellegrini F, Manca A, Egger M, Salanti G. Combining randomized and non-randomized data to predict heterogeneous effects of competing treatments. Res Synth Methods 2024. [PMID: 38501273 DOI: 10.1002/jrsm.1717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/26/2024] [Accepted: 02/16/2024] [Indexed: 03/20/2024]
Abstract
Some patients benefit from a treatment while others may do so less or do not benefit at all. We have previously developed a two-stage network meta-regression prediction model that synthesized randomized trials and evaluates how treatment effects vary across patient characteristics. In this article, we extended this model to combine different sources of types in different formats: aggregate data (AD) and individual participant data (IPD) from randomized and non-randomized evidence. In the first stage, a prognostic model is developed to predict the baseline risk of the outcome using a large cohort study. In the second stage, we recalibrated this prognostic model to improve our predictions for patients enrolled in randomized trials. In the third stage, we used the baseline risk as effect modifier in a network meta-regression model combining AD, IPD randomized clinical trial to estimate heterogeneous treatment effects. We illustrated the approach in the re-analysis of a network of studies comparing three drugs for relapsing-remitting multiple sclerosis. Several patient characteristics influence the baseline risk of relapse, which in turn modifies the effect of the drugs. The proposed model makes personalized predictions for health outcomes under several treatment options and encompasses all relevant randomized and non-randomized evidence.
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Affiliation(s)
- Konstantina Chalkou
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Tasnim Hamza
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Pascal Benkert
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Multiple Sclerosis Centre, Neurologic Clinic and Policlinic, Department of Head, Spine and Neuromedicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Multiple Sclerosis Centre, Neurologic Clinic and Policlinic, Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Multiple Sclerosis Centre, Neurologic Clinic and Policlinic, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital, University of Basel, Basel, Switzerland
| | - Chiara Zecca
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | | | | | - Andrea Manca
- Centre for Health Economics, University of York, York, UK
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Georgia Salanti
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Peek N, Stockton-Powdrell C, Casson A, Sperrin M, Parsia B, Manca A, Iglesias C, Habli I, Hassan L, Antrobus S, Machin M. Applying Team Science to Collaborative Digital Health Research: Learnings from the Wearable Clinic. Stud Health Technol Inform 2024; 310:374-378. [PMID: 38269828 DOI: 10.3233/shti230990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Collaboration across disciplinary boundaries is vital to address the complex challenges and opportunities in Digital Health. We present findings and experiences of applying the principles of Team Science to a digital health research project called 'The Wearable Clinic'. Challenges faced were a lack of shared understanding of key terminology and concepts, and differences in publication cultures between disciplines. We also encountered more profound discrepancies, relating to definitions of "success" in a research project. We recommend that collaborative digital health research projects select a formal Team Science methodology from the outset.
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Affiliation(s)
- Niels Peek
- Division of Informatics, Imaging and Data Sciences, University of Manchester, UK
| | | | - Alexander Casson
- Department of Electrical & Electronic Engineering, University of Manchester, UK
| | - Matthew Sperrin
- Division of Informatics, Imaging and Data Sciences, University of Manchester, UK
| | - Bijan Parsia
- Department of Computer Science, University of Manchester, UK
| | - Andrea Manca
- Centre for Health Economics, University of York, UK
| | | | - Ibrahim Habli
- Department of Computer Science, University of York, UK
| | - Lamiece Hassan
- Division of Psychology and Mental Health, University of Manchester, UK
| | - Steven Antrobus
- Division of Informatics, Imaging and Data Sciences, University of Manchester, UK
| | - Matthew Machin
- Division of Informatics, Imaging and Data Sciences, University of Manchester, UK
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Morano T, Lancia F, Di Marco A, Viscioni G, Bucci I, Grossi S, Pellegrino R, Cugusi L, Grassadonia A, Manca A, Bullo V, Di Giminiani R, Izzicupo P, Di Baldassarre A, Fusco A, Cortis C, Napolitano G, Di Blasio A. Flexibility and Strength Effects of Adapted Nordic Walking and Myofascial Exercises Practice in Breast Cancer Survivors and Analysis of Differences. Healthcare (Basel) 2024; 12:222. [PMID: 38255109 PMCID: PMC10815343 DOI: 10.3390/healthcare12020222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/07/2024] [Accepted: 01/13/2024] [Indexed: 01/24/2024] Open
Abstract
Breast cancer treatments can elicit negative kinesiological side effects concerning both the posture and functional status of breast cancer survivors. As our body is functionally organized in myofascial meridians, physical exercise practice should favor a whole-body approach rather than a local one. The aim of the study was to investigate and compare the effects of two whole-body disciplines, i.e., adapted Nordic Walking and myofascial exercise, on the flexibility and strength performances in BCS. One hundred and sixty breast cancer survivors were trained three times per week for 12 weeks through adapted Nordic Walking or myofascial exercise. Handgrip, sit and reach, back scratch, and single leg back bridge tests and body composition were assessed at the beginning and completion of the training period. Linear mixed models showed no significant changes in body composition, whereas flexibility (p < 0.001), strength (p < 0.001), and muscle quality index (p = 0.003) changed independently from the treatment. When data modification has been analyzed according to sub-sample membership, no significant differences have been observed. Age, radiation therapy, and chemotherapy seem to have independent effects on several investigated variables. Twelve weeks of adapted myofascial exercise and Nordic Walking led to significant changes in flexibility, strength, and muscle quality in breast cancer survivors, with no apparent superiority of one approach over the other.
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Affiliation(s)
- Teresa Morano
- Department of Medicine and Aging Sciences, “G. d’Annunzio” University of Chieti-Pescara, Via Polacchi L. 11, 66100 Chieti, Italy; (T.M.); (F.L.); (A.D.M.); (I.B.); (P.I.); (A.D.B.); (G.N.)
| | - Federica Lancia
- Department of Medicine and Aging Sciences, “G. d’Annunzio” University of Chieti-Pescara, Via Polacchi L. 11, 66100 Chieti, Italy; (T.M.); (F.L.); (A.D.M.); (I.B.); (P.I.); (A.D.B.); (G.N.)
| | - Alessandra Di Marco
- Department of Medicine and Aging Sciences, “G. d’Annunzio” University of Chieti-Pescara, Via Polacchi L. 11, 66100 Chieti, Italy; (T.M.); (F.L.); (A.D.M.); (I.B.); (P.I.); (A.D.B.); (G.N.)
| | - Gianluca Viscioni
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro L.A. 10, 37124 Verona, Italy;
| | - Ines Bucci
- Department of Medicine and Aging Sciences, “G. d’Annunzio” University of Chieti-Pescara, Via Polacchi L. 11, 66100 Chieti, Italy; (T.M.); (F.L.); (A.D.M.); (I.B.); (P.I.); (A.D.B.); (G.N.)
| | - Simona Grossi
- Eusoma Breast Center, “G. Bernabeo” Hospital, ASL02 Lanciano-Vasto-Chieti, c.da S. Liberata, 66026 Ortona, Italy;
| | - Raffaello Pellegrino
- Department of Scientific Research, Campus Ludes, Off-Campus Semmelweis University, 6912 Lugano, Switzerland;
| | - Lucia Cugusi
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/B, 07100 Sassari, Italy; (L.C.); (A.M.)
| | - Antonino Grassadonia
- Department of Innovative Technologies in Medicine and Dentistry, “G. d’Annunzio” University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy;
| | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/B, 07100 Sassari, Italy; (L.C.); (A.M.)
| | - Valentina Bullo
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy;
| | - Riccardo Di Giminiani
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio, 67100 L’Aquila, Italy;
| | - Pascal Izzicupo
- Department of Medicine and Aging Sciences, “G. d’Annunzio” University of Chieti-Pescara, Via Polacchi L. 11, 66100 Chieti, Italy; (T.M.); (F.L.); (A.D.M.); (I.B.); (P.I.); (A.D.B.); (G.N.)
| | - Angela Di Baldassarre
- Department of Medicine and Aging Sciences, “G. d’Annunzio” University of Chieti-Pescara, Via Polacchi L. 11, 66100 Chieti, Italy; (T.M.); (F.L.); (A.D.M.); (I.B.); (P.I.); (A.D.B.); (G.N.)
| | - Andrea Fusco
- Department of Human Sciences, Society and Health, University of Cassino and Lazio Meridionale, Via S. Angelo, 03043 Cassino, Italy; (A.F.); (C.C.)
| | - Cristina Cortis
- Department of Human Sciences, Society and Health, University of Cassino and Lazio Meridionale, Via S. Angelo, 03043 Cassino, Italy; (A.F.); (C.C.)
| | - Giorgio Napolitano
- Department of Medicine and Aging Sciences, “G. d’Annunzio” University of Chieti-Pescara, Via Polacchi L. 11, 66100 Chieti, Italy; (T.M.); (F.L.); (A.D.M.); (I.B.); (P.I.); (A.D.B.); (G.N.)
| | - Andrea Di Blasio
- Department of Medicine and Aging Sciences, “G. d’Annunzio” University of Chieti-Pescara, Via Polacchi L. 11, 66100 Chieti, Italy; (T.M.); (F.L.); (A.D.M.); (I.B.); (P.I.); (A.D.B.); (G.N.)
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Vassányi I, Szakonyi B, Loi D, Mantur-Vierendeel A, Quintas J, Solinas A, Blažica B, Raffo L, Guicciardi M, Manca A, Gaál B, Rárosi F. Impact of information technology supported serious leisure gardening on the wellbeing of older adults: The Turntable project. Geriatr Nurs 2024; 55:339-345. [PMID: 38159476 DOI: 10.1016/j.gerinurse.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE The study presented in this paper aimed to assess the effect of an Information Technology enabled community gardening program for older adults, developed by an international consortium. METHODS We have executed a quantitative, pre- and post-test field trial with older adult volunteers to test the proposed programme in two European countries, Italy and Belgium (n=98). We used standardized and ad hoc questionnaires to measure changes in the volunteers' mental and psychological state during the trial. The statistical data analysis sought for differences in the pre- and post-test values of the key scores related to the perceived quality of life and benefits of gardening via paired-samples t-tests, and also tried to identify the important factors of significant changes via logistic regression. RESULTS We found significant improvements in the perceived benefits of gardening and also in the scores computed from the WHO Quality of Life instruments, especially in the social sub-domains. The improvements were associated with the country, age, marital state and education of the volunteers. Higher age or being widow, divorced or single increased the odds of a significant improvement in the scores in more than one sub-domains. CONCLUSION Though the two trial settings were different in some aspects, the observed significant improvements generally confirmed the positive effects of gardening concerning the perceived quality of life and benefits of gardening.
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Affiliation(s)
- István Vassányi
- Medical Informatics R&D Centre, University of Pannonia, Veszprém, Hungary.
| | - Benedek Szakonyi
- Medical Informatics R&D Centre, University of Pannonia, Veszprém, Hungary
| | - Daniela Loi
- Department of Electrical and Electronic Engineering, University of Cagliari, Cagliari, Italy
| | | | - Joăo Quintas
- Laboratory for Automation and Systems, Instituto Pedro Nunes, Coimbra, Portugal
| | | | - Bojan Blažica
- Jožef Stefan Institute, Ljubljana, Slovenia/Proventus d.o.o., Ajdovščina, Slovenia
| | - Luigi Raffo
- Department of Electrical and Electronic Engineering, University of Cagliari, Cagliari, Italy
| | - Marco Guicciardi
- Department of Education, Psychology, Philosophy, University of Cagliari, Cagliari, Italy
| | - Andrea Manca
- Department of Education, Psychology, Philosophy, University of Cagliari, Cagliari, Italy
| | | | - Ferenc Rárosi
- Bolyai Institute, University of Szeged, Szeged, Hungary
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9
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Andrushko JW, Carr JC, Farthing JP, Lepley LK, DeFreitas JM, Goodall S, Hendy AM, Howatson G, Grooms DR, Zult T, Hortobagyi T, Harput G, Papandreou M, Nosaka K, Carson RG, Manca A, Deriu F, Behm DG, Kidgell DJ, Clark NC, Boyd LA. Potential role of cross-education in early-stage rehabilitation after anterior cruciate ligament reconstruction. Br J Sports Med 2023; 57:1474-1475. [PMID: 37821207 DOI: 10.1136/bjsports-2023-107456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Justin W Andrushko
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Joshua C Carr
- Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA
- School of Medicine, Department of Medical Education, Texas Christian University, Fort Worth, Texas, USA
| | - Jonathan P Farthing
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lindsey K Lepley
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jason M DeFreitas
- Applied Neuromuscular Physiology Laboratory, College of Education and Human Sciences, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Stuart Goodall
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Ashlee M Hendy
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Glyn Howatson
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Dustin R Grooms
- Division of Athletic Training, School of Rehabilitation and Communications Science, College of Health Sciences and Professionals, & Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, Ohio, USA
| | - Tjerk Zult
- Vision and Eye Research Institute, School of Medicine, Faculty of Health, Education, Medicine, and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Tibor Hortobagyi
- Kinesiology, Hungarian University of Physical Education, Budapest, Hungary
- Institute of Sport Sciences and Physical Education, University of Pécs, Pécs, Hungary
| | - Gulcan Harput
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Maria Papandreou
- Physiotherapy, University of West Attica, Egaleo, Attica, Greece
| | - Kazunori Nosaka
- School of Medical and Health Science, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Richard G Carson
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
- Unit of Endocrinology, Nutritional and Metabolic Disorders, AOU Sassari, Sassari, Italy
| | - David George Behm
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Dawson J Kidgell
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Clayton, Victoria, Australia
| | - Nicholas C Clark
- School of Sport, Rehabilitation, and Exercise Sciences, University of Essex, Colchester, UK
| | - Lara A Boyd
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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10
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Littlewood C, Moffatt M, Beckhelling J, Davis D, Burden A, Pitt L, Lalande S, Maddocks C, Stephens G, Tunnicliffe H, Pawson J, Lloyd J, Manca A, Wade J, Foster NE. Physiotherapist-led exercise versus usual care (waiting-list) control for patients awaiting rotator cuff repair surgery: A pilot randomised controlled trial (POWER). Musculoskelet Sci Pract 2023; 68:102874. [PMID: 37926065 DOI: 10.1016/j.msksp.2023.102874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Once a decision to undergo rotator cuff repair surgery is made, patients are placed on the waiting list. It can take weeks or months to receive surgery. There has been a call to move from waiting lists to 'preparation' lists to better prepare patients for surgery and to ensure it remains an appropriate treatment option for them. OBJECTIVE To evaluate the feasibility, as measured by recruitment rates, treatment fidelity and follow-up rates, of a future multi-centre randomised controlled trial to compare the clinical and cost-effectiveness of undertaking a physiotherapist-led exercise programme while waiting for surgery versus usual care (waiting-list control). DESIGN Two-arm, multi-centre pilot randomised controlled trial with feasibility objectives in six NHS hospitals in England. METHOD Adults (n = 76) awaiting rotator cuff repair surgery were recruited and randomly allocated to a programme of physiotherapist-led exercise (n = 38) or usual care control (n = 38). RESULTS Of 302 eligible patients, 76 (25%) were randomised. Of 38 participants randomised to physiotherapist-led exercise, 28 (74%) received the exercise programme as intended. 51/76 (67%) Shoulder Pain and Disability Index questionnaires were returned at 6-months. Of 76 participants, 32 had not received surgery after 6-months (42%). Of those 32, 20 were allocated to physiotherapist-led exercise; 12 to usual care control. CONCLUSIONS A future multi-centre randomised controlled trial is feasible but would require planning for variable recruitment rates between sites, measures to improve treatment fidelity and opportunity for surgical exit, and optimisation of follow-up. A fully powered, randomised controlled trial is now needed to robustly inform clinical decision-making.
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Affiliation(s)
- Chris Littlewood
- Faculty of Health, Social Care & Medicine, Edge Hill University, St Helen's Road, Ormskirk, Lancashire, L39 4QP, UK.
| | - Maria Moffatt
- Faculty of Health, Social Care & Medicine, Edge Hill University, St Helen's Road, Ormskirk, Lancashire, L39 4QP, UK
| | - Jacqueline Beckhelling
- Derby Clinical Trials Support Unit, University Hospitals Derby & Burton NHS Foundation Trust, Royal Derby Hospital, Derby, DE22 3NE, UK
| | - Daniel Davis
- Derby Clinical Trials Support Unit, University Hospitals Derby & Burton NHS Foundation Trust, Royal Derby Hospital, Derby, DE22 3NE, UK
| | | | - Lisa Pitt
- University Hospitals Derby & Burton NHS Foundation Trust, Royal Derby Hospital, Derby, DE22 3NE, UK
| | - Stacey Lalande
- Airedale NHS Foundation Trust, Airedale General Hospital, Skipton Rd, Steeton, Keighley, BD20 6TD, UK
| | - Catrin Maddocks
- Robert Jones & Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry, SY10 7AG, UK
| | - Gareth Stephens
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
| | - Helen Tunnicliffe
- University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Infirmary Square, LE1 5WW, UK
| | - Jessica Pawson
- Barts Health NHS Trust, Royal London Hospital, Whitechapel, E1 1FR, UK
| | - James Lloyd
- Barts Health NHS Trust, Royal London Hospital, Whitechapel, E1 1FR, UK
| | - Andrea Manca
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Julia Wade
- Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Nadine E Foster
- STARS Education and Research Alliance, Surgical, Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Queensland, QLD 4029, Australia
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11
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Bellizzi S, Pichierri G, Manca A, Panu Napodano CM. The cost of climate disasters: an additional call for health emergency preparedness. Public Health 2023; 223:e5-e6. [PMID: 36858882 PMCID: PMC9970845 DOI: 10.1016/j.puhe.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/13/2023] [Accepted: 01/20/2023] [Indexed: 03/03/2023]
Affiliation(s)
| | - G Pichierri
- Microbiology, Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - A Manca
- Candiolo Cancer Institute, FPO-IRCCS, 10060, Torino, Italy
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12
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Sandhu HK, Booth K, Furlan AD, Shaw J, Carnes D, Taylor SJC, Abraham C, Alleyne S, Balasubramanian S, Betteley L, Haywood KL, Iglesias-Urrutia CP, Krishnan S, Lall R, Manca A, Mistry D, Newton S, Noyes J, Nichols V, Padfield E, Rahman A, Seers K, Tang NKY, Tysall C, Eldabe S, Underwood M. Reducing Opioid Use for Chronic Pain With a Group-Based Intervention: A Randomized Clinical Trial. JAMA 2023; 329:1745-1756. [PMID: 37219554 PMCID: PMC10208139 DOI: 10.1001/jama.2023.6454] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/31/2023] [Indexed: 05/24/2023]
Abstract
Importance Opioid use for chronic nonmalignant pain can be harmful. Objective To test whether a multicomponent, group-based, self-management intervention reduced opioid use and improved pain-related disability compared with usual care. Design, Setting, and Participants Multicentered, randomized clinical trial of 608 adults taking strong opioids (buprenorphine, dipipanone, morphine, diamorphine, fentanyl, hydromorphone, methadone, oxycodone, papaveretum, pentazocine, pethidine, tapentadol, and tramadol) to treat chronic nonmalignant pain. The study was conducted in 191 primary care centers in England between May 17, 2017, and January 30, 2019. Final follow-up occurred March 18, 2020. Intervention Participants were randomized 1:1 to either usual care or 3-day-long group sessions that emphasized skill-based learning and education, supplemented by 1-on-1 support delivered by a nurse and lay person for 12 months. Main Outcomes and Measures The 2 primary outcomes were Patient-Reported Outcomes Measurement Information System Pain Interference Short Form 8a (PROMIS-PI-SF-8a) score (T-score range, 40.7-77; 77 indicates worst pain interference; minimal clinically important difference, 3.5) and the proportion of participants who discontinued opioids at 12 months, measured by self-report. Results Of 608 participants randomized (mean age, 61 years; 362 female [60%]; median daily morphine equivalent dose, 46 mg [IQR, 25 to 79]), 440 (72%) completed 12-month follow-up. There was no statistically significant difference in PROMIS-PI-SF-8a scores between the 2 groups at 12-month follow-up (-4.1 in the intervention and -3.17 in the usual care groups; between-group difference: mean difference, -0.52 [95% CI, -1.94 to 0.89]; P = .15). At 12 months, opioid discontinuation occurred in 65 of 225 participants (29%) in the intervention group and 15 of 208 participants (7%) in the usual care group (odds ratio, 5.55 [95% CI, 2.80 to 10.99]; absolute difference, 21.7% [95% CI, 14.8% to 28.6%]; P < .001). Serious adverse events occurred in 8% (25/305) of the participants in the intervention group and 5% (16/303) of the participants in the usual care group. The most common serious adverse events were gastrointestinal (2% in the intervention group and 0% in the usual care group) and locomotor/musculoskeletal (2% in the intervention group and 1% in the usual care group). Four people (1%) in the intervention group received additional medical care for possible or probable symptoms of opioid withdrawal (shortness of breath, hot flushes, fever and pain, small intestinal bleed, and an overdose suicide attempt). Conclusions and Relevance In people with chronic pain due to nonmalignant causes, compared with usual care, a group-based educational intervention that included group and individual support and skill-based learning significantly reduced patient-reported use of opioids, but had no effect on perceived pain interference with daily life activities. Trial Registration isrctn.org Identifier: ISRCTN49470934.
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Affiliation(s)
- Harbinder K. Sandhu
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Katie Booth
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Andrea D. Furlan
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Work & Health, Toronto, Ontario, Canada
| | - Jane Shaw
- Department of Pain Medicine, James Cook University Hospital, Middlesbrough, United Kingdom
- now with Boston Scientific, Hemel Hempstead, United Kingdom
| | - Dawn Carnes
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Stephanie J. C. Taylor
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Charles Abraham
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Sharisse Alleyne
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Shyam Balasubramanian
- Department of Anaesthesia and Pain Medicine, University Hospital Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Lauren Betteley
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Kirstie L. Haywood
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Cynthia P. Iglesias-Urrutia
- Department of Health Sciences, University of York, York, United Kingdom
- Danish Centre for Healthcare Improvements, Aalborg University, Aalborg, Denmark
| | - Sheeja Krishnan
- Department of Health Sciences, University of York, York, United Kingdom
| | - Ranjit Lall
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Andrea Manca
- Centre for Health Economics, University of York, York, United Kingdom
| | - Dipesh Mistry
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- now with Statistics and Decision Sciences, Janssen Pharmaceuticals Research & Development, High Wycombe, United Kingdom
| | - Sian Newton
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Jennifer Noyes
- Department of Pain Medicine, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Vivien Nichols
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Emma Padfield
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- now with IQVIA, Reading, Berkshire, United Kingdom
| | - Anisur Rahman
- Centre for Rheumatology Research, University College London, London, United Kingdom
| | - Kate Seers
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Nicole K. Y. Tang
- Department of Psychology, University of Warwick, Coventry, United Kingdom
| | - Colin Tysall
- University/User Teaching and Research Action Partnership, University of Warwick, Coventry, United Kingdom
- Service User and Carer Engagement, Coventry University, Coventry, United Kingdom
| | - Sam Eldabe
- Department of Pain Medicine, James Cook University Hospital, Middlesbrough, United Kingdom
- Hôpital de Morges, Morges, Switzerland
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
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13
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Manca A, Fiorito G, Morrone M, Boi A, Mercante B, Martinez G, Ventura L, Delitala AP, Cano A, Catte MG, Solinas G, Melis F, Ginatempo F, Deriu F. A novel estimate of biological aging by multiple fitness tests is associated with risk scores for age-related diseases. Front Physiol 2023; 14:1164943. [PMID: 37228822 PMCID: PMC10203437 DOI: 10.3389/fphys.2023.1164943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/25/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction: Recent research highlights the need for a correct instrument for monitoring the individual health status, especially in the elderly. Different definitions of biological aging have been proposed, with a consistent positive association of physical activity and physical fitness with decelerated aging trajectories. The six-minute walking test is considered the current gold standard for estimating the individual fitness status in the elderly. Methods: In this study, we investigated the possibility of overcoming the main limitations of assessing fitness status based on a single measure. As a result, we developed a novel measure of fitness status based on multiple fitness tests. In 176 Sardinian individuals aged 51-80 years we collected the results of eight fitness tests to measure participants' functional mobility, gait, aerobic condition, endurance, upper and lower limb strength, and static and dynamic balance. In addition, the participants' state of health was estimated through validated risk scores for cardiovascular diseases, diabetes, mortality, and a comorbidity index. Results: Six measures contributing to fitness age were extracted, with TUG showing the largest contribution (beta = 2.23 SDs), followed by handgrip strength (beta = -1.98 SDs) and 6MWT distance (beta = -1.11 SDs). Based on fitness age estimates, we developed a biological aging measure using an elastic net model regression as a linear combination of the results of the fitness tests described above. Our newly developed biomarker was significantly associated with risk scores for cardiovascular events (ACC-AHA: r = 0.61; p = 0.0006; MESA: r = 0.21; p = 0.002) and mortality (Levine mortality score: r = 0.90; p = 0.0002) and outperformed the previous definition of fitness status based on the six-minute walking test in predicting an individual health status. Discussion: Our results indicate that a composite measure of biological age based on multiple fitness tests may be helpful for screening and monitoring strategies in clinical practice. However, additional studies are needed to test standardisation and to calibrate and validate the present results.
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Affiliation(s)
- A. Manca
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - G. Fiorito
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - M. Morrone
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - A. Boi
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - B. Mercante
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - G. Martinez
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - L. Ventura
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - A. P. Delitala
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - A. Cano
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - M. G. Catte
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - G. Solinas
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - F. Melis
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - F. Ginatempo
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - F. Deriu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
- Unit of Endocrinology, Nutritional and Metabolic Disorders, AOU Sassari, Sassari, Italy
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14
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Chalkou K, Vickers AJ, Pellegrini F, Manca A, Salanti G. Decision Curve Analysis for Personalized Treatment Choice between Multiple Options. Med Decis Making 2023; 43:337-349. [PMID: 36511470 PMCID: PMC10021120 DOI: 10.1177/0272989x221143058] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 11/03/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Decision curve analysis can be used to determine whether a personalized model for treatment benefit would lead to better clinical decisions. Decision curve analysis methods have been described to estimate treatment benefit using data from a single randomized controlled trial. OBJECTIVES Our main objective is to extend the decision curve analysis methodology to the scenario in which several treatment options exist and evidence about their effects comes from a set of trials, synthesized using network meta-analysis (NMA). METHODS We describe the steps needed to estimate the net benefit of a prediction model using evidence from studies synthesized in an NMA. We show how to compare personalized versus one-size-fit-all treatment decision-making strategies, such as "treat none" or "treat all patients with a specific treatment" strategies. First, threshold values for each included treatment need to be defined (i.e., the minimum risk difference compared with control that renders a treatment worth taking). The net benefit per strategy can then be plotted for a plausible range of threshold values to reveal the most clinically useful strategy. We applied our methodology to an NMA prediction model for relapsing-remitting multiple sclerosis, which can be used to choose between natalizumab, dimethyl fumarate, glatiramer acetate, and placebo. RESULTS We illustrated the extended decision curve analysis methodology using several threshold value combinations for each available treatment. For the examined threshold values, the "treat patients according to the prediction model" strategy performs either better than or close to the one-size-fit-all treatment strategies. However, even small differences may be important in clinical decision making. As the advantage of the personalized model was not consistent across all thresholds, improving the existing model (by including, for example, predictors that will increase discrimination) is needed before advocating its clinical usefulness. CONCLUSIONS This novel extension of decision curve analysis can be applied to NMA-based prediction models to evaluate their use to aid treatment decision making. HIGHLIGHTS Decision curve analysis is extended into a (network) meta-analysis framework.Personalized models predicting treatment benefit are evaluated when several treatment options are available and evidence about their effects comes from a set of trials.Detailed steps to compare personalized versus one-size-fit-all treatment decision-making strategies are outlined.This extension of decision curve analysis can be applied to (network) meta-analysis-based prediction models to evaluate their use to aid treatment decision making.
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Affiliation(s)
- Konstantina Chalkou
- Institute of Social and Preventive Medicine,
University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University
of Bern, Switzerland
| | - Andrew J. Vickers
- Department of Epidemiology and Biostatistics,
Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Andrea Manca
- Centre for Health Economics, University of
York, York, UK
| | - Georgia Salanti
- Institute of Social and Preventive Medicine,
University of Bern, Bern, Switzerland
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15
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Prat-Luri A, Moreno-Navarro P, Carpena C, Manca A, Deriu F, Barbado D, Vera-Garcia FJ. Smartphone accelerometry for quantifying core stability and developing exercise training progressions in people with multiple sclerosis. Mult Scler Relat Disord 2023; 72:104618. [PMID: 36931076 DOI: 10.1016/j.msard.2023.104618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/10/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Core stability exercise programs have become popular in recent years for preserving balance and functional independence in people with multiple sclerosis (PwMS); however, their real impact is not well-known as the main intervention target (i.e., core stability) theoretically responsible for balance or functional improvements is not measured. The objective of this study was to test the reliability of accelerometers integrated into smartphones for quantifying core stability and developing exercise progressions in PwMS. METHODS Twenty participants with MS [age: 47.5±8.0 years; height: 1.62±0.07 m; mass: 63.4±10.9 kg; EDSS: 3.0 (1.5-6)] participated voluntarily in this study. CS was assessed in different variations of the front, side, and back bridges and bird-dog exercises by measuring the mean lumbopelvic acceleration in two testing sessions, separated by one week. Relative and absolute reliability of lumbopelvic acceleration of those exercise variations performed by more than 60% of the participants was analyzed by the intraclass correlation coefficient (ICC3,1), and the standard error of measurement (SEM) and the minimal detectable change (MDC), respectively. Repeated measures ANOVAs were performed to detect a potential learning effect between test-retest assessments. Statistical significance was set at p < 0.05. RESULTS Reliability analyses revealed that good to excellent relative and absolute scores (0.85<ICC<0.96; 7.8%≤SEM≤19.2%; 21.6%≤MDC≤53.2%) for the mean lumbopelvic acceleration obtained during 10 of the 12 CS exercise variations performed by more than 60% of the participants. A non-significant between-session learning effect was detected in all the variables considered (all p values >0.05). CONCLUSION Smartphone accelerometry seems a low cost, portable and easy-to-use tool to objectively and reliably track core stability changes in PwMS through. However, in spite of the popularity of bridging and bird-dog exercises, only the short and long bridges and the three-point bird-dog positions proved feasible for most participants. Overall, this study provides useful information to evaluate and guide the prescription of core stability exercise programs in PwMS with mild-to-moderate impairment.
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Affiliation(s)
- Amaya Prat-Luri
- Department of Sport Science, Sports Research Centre, Miguel Hernández University of Elche, Elche, Alicante, Spain
| | - Pedro Moreno-Navarro
- Department of Sport Science, Sports Research Centre, Miguel Hernández University of Elche, Elche, Alicante, Spain
| | - Carmen Carpena
- Department of Sport Science, Sports Research Centre, Miguel Hernández University of Elche, Elche, Alicante, Spain
| | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - David Barbado
- Department of Sport Science, Sports Research Centre, Miguel Hernández University of Elche, Elche, Alicante, Spain; Institute for Health and Biomedical Research (ISABIAL Foundation), Miguel Hernández University of Elche, Alicante, Spain.
| | - Francisco J Vera-Garcia
- Department of Sport Science, Sports Research Centre, Miguel Hernández University of Elche, Elche, Alicante, Spain; Institute for Health and Biomedical Research (ISABIAL Foundation), Miguel Hernández University of Elche, Alicante, Spain
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16
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Hamza T, Chalkou K, Pellegrini F, Kuhle J, Benkert P, Lorscheider J, Zecca C, Iglesias-Urrutia CP, Manca A, Furukawa TA, Cipriani A, Salanti G. Synthesizing cross-design evidence and cross-format data using network meta-regression. Res Synth Methods 2023; 14:283-300. [PMID: 36625736 DOI: 10.1002/jrsm.1619] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 10/28/2022] [Accepted: 12/01/2022] [Indexed: 01/11/2023]
Abstract
In network meta-analysis (NMA), we synthesize all relevant evidence about health outcomes with competing treatments. The evidence may come from randomized clinical trials (RCT) or non-randomized studies (NRS) as individual participant data (IPD) or as aggregate data (AD). We present a suite of Bayesian NMA and network meta-regression (NMR) models allowing for cross-design and cross-format synthesis. The models integrate a three-level hierarchical model for synthesizing IPD and AD into four approaches. The four approaches account for differences in the design and risk of bias (RoB) in the RCT and NRS evidence. These four approaches variously ignoring differences in RoB, using NRS to construct penalized treatment effect priors and bias-adjustment models that control the contribution of information from high RoB studies in two different ways. We illustrate the methods in a network of three pharmacological interventions and placebo for patients with relapsing-remitting multiple sclerosis. The estimated relative treatment effects do not change much when we accounted for differences in design and RoB. Conducting network meta-regression showed that intervention efficacy decreases with increasing participant age. We also re-analysed a network of 431 RCT comparing 21 antidepressants, and we did not observe material changes in intervention efficacy when adjusting for studies' high RoB. We re-analysed both case studies accounting for different study RoB. In summary, the described suite of NMA/NMR models enables the inclusion of all relevant evidence while incorporating information on the within-study bias in both observational and experimental data and enabling estimation of individualized treatment effects through the inclusion of participant characteristics.
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Affiliation(s)
- Tasnim Hamza
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Konstantina Chalkou
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | | | - Jens Kuhle
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland.,Departments of Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Pascal Benkert
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Johannes Lorscheider
- Departments of Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Chiara Zecca
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | | | - Andrea Manca
- Centre for Health Economics, University of York, York, UK
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan.,Department of Clinical Epidemiology, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Georgia Salanti
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Russo P, Zanuzzi M, Carletto A, Sammarco A, Romano F, Manca A. Role of Economic Evaluations on Pricing of Medicines Reimbursed by the Italian National Health Service. Pharmacoeconomics 2023; 41:107-117. [PMID: 36434415 PMCID: PMC9813158 DOI: 10.1007/s40273-022-01215-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 05/10/2023]
Abstract
OBJECTIVE The main objective of this study was to explore the extent to which the incremental cost-effectiveness ratio (ICER), alongside other factors, predicts the final outcome of medicine price negotiation in Italy. The second objective was to depict the mean ICER of medicines obtained after negotiation. METHODS Data were extracted from company dossiers submitted to the Italian Medicines Agency (AIFA) from October 2016 to January 2021 and AIFA's internal database. Beta-based regression analyses were used to test the effect of ICER and other variables on the outcome of price negotiation (ΔP), defined as the percentage difference between the list price requested by manufacturers and the final price paid by the Italian National Health Service (INHS). RESULTS In our dataset of 48 pricing and reimbursement procedures, the ICER before negotiation was one of the variables with a major impact on the outcome of negotiation when ≥ 40,000€/QALY. As resulting from multiple regression analyses, the effect of the ICER on ΔP seemed driven by medicines for non-onco-immunological and non-rare diseases. Overall, the negotiation process granted mean incremental costs of €64,688 and mean incremental QALYs of 1.96, yielding an average ICER of €33,004/QALY. CONCLUSIONS This study provides support on the influence of cost-effectiveness analysis on price negotiation in the Italian context, providing an estimate of the mean ICER of reimbursed medicines, calculated using net confidential prices charged by the INHS. The role and use of economic evaluations in medicines pricing should be further improved to get the best value for money.
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Affiliation(s)
| | - Matteo Zanuzzi
- Italian Medicines Agency, Via del Tritone 181, Rome, Italy
| | | | | | | | - Andrea Manca
- Centre for Health Economics, University of York, Heslington, York, UK
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18
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Ventura L, Martinez G, Aiello E, Dvir Z, Deriu F, Manca A. Isokinetic Resistance Training for Ankle Plantarflexor Spasticity and Muscle Weakness in People With Multiple Sclerosis: A Proof-of-Concept Case Series. Phys Ther 2022; 103:pzac146. [PMID: 36222464 DOI: 10.1093/ptj/pzac146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/24/2022] [Accepted: 08/19/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To the best of the authors' knowledge, no data are available about the use of isokinetic resistance training for managing ankle plantarflexor spastic hypertonia in people with multiple sclerosis (MS). The aim of this proof-of-concept study was to explore the feasibility and effects of concentric contractions on spasticity-related resistance to passive motion, strength, and mobility in people with MS and ankle plantarflexor spasticity. METHODS In this pretest/posttest case series, 5 people with MS (mean age = 53.6 [SD = 8.8] years; median Expanded Disability Status Scale score = 5; Modified Ashworth Scale range = 1-4) received 6 weeks of isokinetic resistance training of the spastic plantarflexors. Before and after the intervention, the following outcomes were assessed: average peak torque during passive robotic mobilization, isometric strength, surface electromyography (sEMG) from the spastic muscles, time to complete the 10-m Walk Test, and the Timed "Up & Go" Test. The standardized effect size was used to test pretest and posttest effects at the individual level. Group-level analyses were also performed. RESULTS Following the training, the average peak torque recorded from the plantarflexors during passive motion at a velocity of 150 degrees per second was found to be decreased by at least 1 SD in all participants but 1, with a significant reduction at the group level of 23.8%. Conversely, no changes in sEMG activity were detected. Group-level analyses revealed that the maximal strength of the trained plantarflexors increased significantly (31.4%). Fast walking speed increased and time to complete the Timed "Up & Go" Test decreased in 4 participants, although not significantly at the group level. CONCLUSION Isokinetic resistance training proved safe and feasible in people who had MS and ankle plantarflexor spasticity. The observed reductions in resistance to passive motion from the spastic plantarflexors in the absence of sEMG changes might suggest a mechanical rather than a neural effect of the training. IMPACT Based on these preliminary findings, isokinetic resistance training does not exacerbate hypertonia in people with MS and ankle plantarflexor spasticity and could be safely used to manage muscle weakness in this population.
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Affiliation(s)
- Lucia Ventura
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Gianluca Martinez
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Elena Aiello
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Zeevi Dvir
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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Tramice A, Paris D, Manca A, Guevara Agudelo FA, Petrosino S, Siracusa L, Carbone M, Melck D, Raymond F, Piscitelli F. Analysis of the oral microbiome during hormonal cycle and its alterations in menopausal women: the "AMICA" project. Sci Rep 2022; 12:22086. [PMID: 36543896 PMCID: PMC9772230 DOI: 10.1038/s41598-022-26528-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
The maintenance of human health is dependent on a symbiotic relationship between humans and associated bacteria. The diversity and abundance of each habitat's signature microbes vary widely among body areas and among them the oral microbiome plays a key role. Significant changes in the oral cavity, predominantly at salivary and periodontal level, have been associated with changes in estrogen levels. However, whether the oral microbiome is affected by hormonal level alterations is understudied. Hence the main objective pursued by AMICA project was to characterize the oral microbiome (saliva) in healthy women through: profiling studies using "omics" technologies (NMR-based metabolomics, targeted lipidomics by LC-MS, metagenomics by NGS); SinglePlex ELISA assays; glycosidase activity analyses and bioinformatic analysis. For this purpose, thirty-nine medically healthy women aged 26-77 years (19 with menstrual cycle and 20 in menopause) were recruited. Participants completed questionnaires assessing detailed medical and medication history and demographic characteristics. Plasmatic and salivary levels of sexual hormones were assessed (FSH, estradiol, LH and progesteron) at day 3 and 14 for women with menstrual cycle and only once for women in menopause. Salivary microbiome composition was assessed through meta-taxonomic 16S sequencing and overall, the salivary microbiome of most women remained relatively stable throughout the menstrual cycle and in menopause. Targeted lipidomics and untargeted metabolomics profiling were assessed through the use of LC-MS and NMR spectroscopy technologies, respectively and significant changes in terms of metabolites were identified in saliva of post-menopausal women in comparison to cycle. Moreover, glycosyl hydrolase activities were screened and showed that the β-D-hexosaminidase activity was the most present among those analyzed. Although this study has not identified significant alterations in the composition of the oral microbiome, multiomics analysis have revealed a strong correlation between 2-AG and α-mannosidase. In conclusion, the use of a multidisciplinary approach to investigate the oral microbiome of healthy women provided some indication about microbiome-derived predictive biomarkers that could be used in the future for developing new strategies to help to re-establish the correct hormonal balance in post-menopausal women.
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Affiliation(s)
- A. Tramice
- grid.473581.c0000 0004 1761 6004CNR Istituto Di Chimica Biomolecolare, Pozzuoli (NA), Italy
| | - D. Paris
- grid.473581.c0000 0004 1761 6004CNR Istituto Di Chimica Biomolecolare, Pozzuoli (NA), Italy
| | - A. Manca
- CNR Istituto di Ricerca Genetica e Biomedica (IRGB), Sassari, Italy
| | | | - S. Petrosino
- grid.473581.c0000 0004 1761 6004CNR Istituto Di Chimica Biomolecolare, Pozzuoli (NA), Italy ,Epitech Group SpA, Saccolongo (PD), Italy
| | - L. Siracusa
- grid.473581.c0000 0004 1761 6004CNR Istituto Di Chimica Biomolecolare, Pozzuoli (NA), Italy
| | - M. Carbone
- grid.473581.c0000 0004 1761 6004CNR Istituto Di Chimica Biomolecolare, Pozzuoli (NA), Italy
| | - D. Melck
- grid.473581.c0000 0004 1761 6004CNR Istituto Di Chimica Biomolecolare, Pozzuoli (NA), Italy
| | - F. Raymond
- grid.23856.3a0000 0004 1936 8390Université Laval, Québéc City, Canada
| | - F. Piscitelli
- grid.473581.c0000 0004 1761 6004CNR Istituto Di Chimica Biomolecolare, Pozzuoli (NA), Italy
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Loi N, Ginatempo F, Carta M, Melis F, Manca A, Deriu F. Face emotional expressions influence interhemispheric inhibition. Psychophysiology 2022; 60:e14234. [PMID: 36523139 DOI: 10.1111/psyp.14234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 12/23/2022]
Abstract
The processing of face expressions is a key ability to perform social interactions. Recently, it has been demonstrated that the excitability of the hand primary motor cortex (M1) increases following the view of negative faces expressions. Interhemispheric interactions and sensory-motor integration are cortical processes involving M1, which are known to be modulated by emotional and social behaviors. Whether these processes may mediate the effects of face emotional expressions on M1 excitability is unknown. Therefore, the aim of this study was to investigate the influence of the passive viewing of face emotional expressions on M1 interhemispheric connections and sensory-motor integration using standardized transcranial magnetic stimulation (TMS) protocols. Nineteen healthy subjects participated in the study. Interhemispheric inhibition (IHI) and short-afferent inhibition (SAI) were probed in the right first dorsal interosseous (FDI) muscle 300 ms after the randomized presentation of seven different face expressions (neutral, sadness, fear, disgust, surprise and happiness). Results showed a significantly reduced IHI following the passive viewing of fearful faces compared to neutral (p = .001) and happy (p = .035) faces and following the view of sad faces compared to neutral faces (p = .008). No effect of emotional faces was detected on SAI. Data suggest that sensory-motor integration process does not mediate the increased excitability of M1 induced by the view of negative face expressions. By contrast, it may be underpinned by a depression of IHI, which from a functional point of view may promote symmetrical avoiding movements of the hands in response to aversive stimuli.
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Affiliation(s)
- Nicola Loi
- Department of Biomedical Sciences University of Sassari Sassari Italy
| | | | - Miriam Carta
- Department of Biomedical Sciences University of Sassari Sassari Italy
| | - Francesco Melis
- Department of Biomedical Sciences University of Sassari Sassari Italy
| | - Andrea Manca
- Department of Biomedical Sciences University of Sassari Sassari Italy
| | - Franca Deriu
- Department of Biomedical Sciences University of Sassari Sassari Italy
- Unit of Endocrinology, Nutritional and Metabolic Disorders AOU Sassari Sassari Italy
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21
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Hortobágyi T, Vetrovsky T, Balbim GM, Sorte Silva NCB, Manca A, Deriu F, Kolmos M, Kruuse C, Liu-Ambrose T, Radák Z, Váczi M, Johansson H, Dos Santos PCR, Franzén E, Granacher U. The impact of aerobic and resistance training intensity on markers of neuroplasticity in health and disease. Ageing Res Rev 2022; 80:101698. [PMID: 35853549 DOI: 10.1016/j.arr.2022.101698] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the effects of low- vs. high-intensity aerobic and resistance training on motor and cognitive function, brain activation, brain structure, and neurochemical markers of neuroplasticity and the association thereof in healthy young and older adults and in patients with multiple sclerosis, Parkinson's disease, and stroke. DESIGN Systematic review and robust variance estimation meta-analysis with meta-regression. DATA SOURCES Systematic search of MEDLINE, Web of Science, and CINAHL databases. RESULTS Fifty studies with 60 intervention arms and 2283 in-analyses participants were included. Due to the low number of studies, the three patient groups were combined and analyzed as a single group. Overall, low- (g=0.19, p = 0.024) and high-intensity exercise (g=0.40, p = 0.001) improved neuroplasticity. Exercise intensity scaled with neuroplasticity only in healthy young adults but not in healthy older adults or patient groups. Exercise-induced improvements in neuroplasticity were associated with changes in motor but not cognitive outcomes. CONCLUSION Exercise intensity is an important variable to dose and individualize the exercise stimulus for healthy young individuals but not necessarily for healthy older adults and neurological patients. This conclusion warrants caution because studies are needed that directly compare the effects of low- vs. high-intensity exercise on neuroplasticity to determine if such changes are mechanistically and incrementally linked to improved cognition and motor function.
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Affiliation(s)
- Tibor Hortobágyi
- Center for Human Movement Sciences, University of Groningen Medical Center, Groningen, the Netherlands; Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary; Department of Sport Biology, Institute of Sport Sciences and Physical Education, University of Pécs, Hungary; Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Potsdam, Germany; Hungarian University of Sports Science, Department of Kinesiology, Budapest, Hungary.
| | - Tomas Vetrovsky
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Guilherme Moraes Balbim
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Nárlon Cássio Boa Sorte Silva
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy; Unit of Endocrinology, Nutritional and Metabolic Disorders, AOU Sassari, Sassari, Italy
| | - Mia Kolmos
- Neurovascular Research Unit, Department of Neurology, Herlev Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christina Kruuse
- Neurovascular Research Unit, Department of Neurology, Herlev Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Zsolt Radák
- Research Center of Molecular Exercise Science, Hungarian University of Sport Science, Budapest, Hungary
| | - Márk Váczi
- Department of Sport Biology, Institute of Sport Sciences and Physical Education, University of Pécs, Hungary
| | - Hanna Johansson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden; Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | | | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden; Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Urs Granacher
- Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Potsdam, Germany
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22
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Ginatempo F, Loi N, Manca A, Rothwell JC, Deriu F. Is it possible to compare inhibitory and excitatory intracortical circuits in face and hand primary motor cortex? J Physiol 2022; 600:3567-3583. [PMID: 35801987 PMCID: PMC9544430 DOI: 10.1113/jp283137] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract Face muscles are important in a variety of different functions, such as feeding, speech and communication of non‐verbal affective states, which require quite different patterns of activity from those of a typical hand muscle. We ask whether there are differences in their neurophysiological control that might reflect this. Fifteen healthy individuals were studied. Standard single‐ and paired‐pulse transcranial magnetic stimulation (TMS) methods were used to compare intracortical inhibitory (short interval intracortical inhibition (SICI); cortical silent period (CSP)) and excitatory circuitries (short interval intracortical facilitation (SICF)) in two typical muscles, the depressor anguli oris (DAO), a face muscle, and the first dorsal interosseous (FDI), a hand muscle. TMS threshold was higher in DAO than in FDI. Over a range of intensities, resting SICF was not different between DAO and FDI, while during muscle activation SICF was stronger in FDI than in DAO (P = 0.012). At rest, SICI was stronger in FDI than in DAO (P = 0.038) but during muscle contraction, SICI was weaker in FDI than in DAO (P = 0.034). We argue that although many of the difference in response to the TMS protocols could result from the difference in thresholds, some, such as the reduction of resting SICI in DAO, may reflect fundamental differences in the physiology of the two muscle groups.
![]() Key points Transcranial magnetic stimulation (TMS) single‐ and paired‐pulse protocols were used to investigate and compare the activity of facilitatory and inhibitory intracortical circuits in a face (depressor anguli oris; DAO) and hand (first dorsal interosseous; FDI) muscles. Several TMS intensities and interstimulus intervals were tested with the target muscles at rest and when voluntarily activated. At rest, intracortical inhibitory activity was stronger in FDI than in DAO. In contrast, during muscle contraction inhibitory activity was stronger in DAO than in FDI. As many previous reports have found, the motor evoked potential threshold was higher in DAO than in FDI. Although many of the differences in response to the TMS protocols could result from the difference in thresholds, some, such as the reduction of resting short interval intracortical inhibition in DAO, may reflect fundamental differences in the physiology of the two muscle groups.
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Affiliation(s)
- Francesca Ginatempo
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, Sassari, 07100, Italy
| | - Nicola Loi
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, Sassari, 07100, Italy
| | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, Sassari, 07100, Italy
| | - John C Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, Sassari, 07100, Italy.,Unit of Endocrinology, Nutritional and Metabolic Disorders, AOU Sassari, Sassari, Italy
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Kearns B, Stevenson MD, Triantafyllopoulos K, Manca A. Dynamic and Flexible Survival Models for Extrapolation of Relative Survival: A Case Study and Simulation Study. Med Decis Making 2022; 42:945-955. [PMID: 35769004 PMCID: PMC9459356 DOI: 10.1177/0272989x221107649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Extrapolation of survival data is a key task in health technology assessments (HTAs), which may be improved by incorporating general population mortality data via relative survival models. Dynamic survival models are a promising method for extrapolation that may be expanded to dynamic relative survival models (DRSMs), a novel development presented here. There are currently neither examples of dynamic models in HTA nor comparisons of DRSMs with other relative survival models when used for survival extrapolation. METHODS An existing appraisal, for which there had been disagreement over the approach to survival extrapolation, was chosen and the health economic model recreated. The sensitivity of estimates of cost-effectiveness to different model choices (standard survival models, DSMs, and DRSMs) and specifications was examined. The appraisal informed a simulation study to evaluate DRSMs with relative survival models based on both standard and spline-based (flexible) models. RESULTS Dynamic models provided insight into the behavior of the trend in the hazard function and how it may vary during the extrapolated phase. DRSMs led to extrapolations with improved plausibility for which model choice may be based on clinical input. In the simulation study, the flexible and dynamic relative survival models performed similarly and provided highly variable extrapolations. LIMITATIONS Further experience with these models is required to identify settings when they are most useful, and they provide sufficiently accurate extrapolations. CONCLUSIONS Dynamic models provide a flexible and attractive method for extrapolating survival data and facilitate the use of clinical input for model choice. Flexible and dynamic relative survival models make few structural assumptions and can improve extrapolation plausibility, but further research is required into methods for reducing the variability in extrapolations.
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Guicciardi M, Pazzona R, Manca A, Monni A, Scalas LF, Perra F, Leban B, Roberto S, Mulliri G, Ghiani G, Doneddu A, Crisafulli A. Executive Functions and Mood States in Athletes Performing Exercise Under Hypoxia. Front Psychol 2022; 13:906336. [PMID: 35712141 PMCID: PMC9196732 DOI: 10.3389/fpsyg.2022.906336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Hypoxia can impair cognitive performance, whereas exercise can enhance it. The effects of hypoxia on cognitive performance during exercise appear to be moderated by exercise duration and intensity and by severity and duration of hypoxia and cognitive task. In normal individuals, exercise under hypoxia can evoke adverse post-exercise mood states, such as tension and fatigue. However, little is known about the effects of hypoxia during exercise in trained athletes. The purpose of this study was to investigate how hypoxia affected executive functions and mood states, assessed, respectively, during and post-exercise and to explore the role of motivation moderators, such as inhibition and activation systems (BIS-BAS). Two different sessions of exercise in normoxia and hypoxia (FiO2 13%), each lasting 18 min, were randomly assigned in a counterbalanced order and administered to seventeen male athletes. During exercise bouts, participants performed a mental task (BST) aimed to produce cognitive interference and suppression. Reaction times and accuracy of responses were recorded. After 5 min, all participants completed two questionnaires assessing mood states (ITAMS) and incidence of symptoms potentially related to hypoxia (AMS-C). The results show that hypoxia impairs cognitive performance in terms of slower reaction times, but a high BAS attenuates this effect. Participants with high BAS show an equivalent cognitive performance under hypoxia and normoxia conditions. No effects were found on mood states. Further research is required to investigate the role of BAS, cognitive abilities, and mood states in prolonged hypoxic conditions.
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Affiliation(s)
- Marco Guicciardi
- Department of Education, Psychology, Philosophy, Faculty of Humanities, University of Cagliari, Cagliari, Italy
| | - Riccardo Pazzona
- Department of Education, Psychology, Philosophy, Faculty of Humanities, University of Cagliari, Cagliari, Italy
| | - Andrea Manca
- Department of Education, Psychology, Philosophy, Faculty of Humanities, University of Cagliari, Cagliari, Italy
| | - Alessandra Monni
- Department of Education, Psychology, Philosophy, Faculty of Humanities, University of Cagliari, Cagliari, Italy
| | - Laura Francesca Scalas
- Department of Education, Psychology, Philosophy, Faculty of Humanities, University of Cagliari, Cagliari, Italy
| | - Federica Perra
- Department of Education, Psychology, Philosophy, Faculty of Humanities, University of Cagliari, Cagliari, Italy
| | - Bruno Leban
- Department of Mechanical, Chemical and Materials Engineering, Faculty of Engineering and Architecture, University of Cagliari, Cagliari, Italy
| | - Silvana Roberto
- Sports Physiology Lab, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Gabriele Mulliri
- Sports Physiology Lab, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giovanna Ghiani
- Sports Physiology Lab, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Azzurra Doneddu
- Sports Physiology Lab, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Crisafulli
- Sports Physiology Lab, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Cano A, Ventura L, Martinez G, Cugusi L, Caria M, Deriu F, Manca A. Correction to: Analysis of sex-based differences in energy substrate utilization during moderate-intensity aerobic exercise. Eur J Appl Physiol 2022; 122:1749. [PMID: 35511302 PMCID: PMC9197811 DOI: 10.1007/s00421-022-04961-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Antonella Cano
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/b, 07100, Sassari, Italy
| | - Lucia Ventura
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/b, 07100, Sassari, Italy
| | - Gianluca Martinez
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/b, 07100, Sassari, Italy
| | - Lucia Cugusi
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/b, 07100, Sassari, Italy
| | - Marcello Caria
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/b, 07100, Sassari, Italy
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/b, 07100, Sassari, Italy.
- Unit of Endocrinology, Nutritional and Metabolic Disorders, AOU Sassari, Sassari, Italy.
| | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/b, 07100, Sassari, Italy
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Scano V, Fois AG, Manca A, Balata F, Zinellu A, Chessa C, Pirina P, Paliogiannis P. Role of EBUS-TBNA in Non-Neoplastic Mediastinal Lymphadenopathy: Review of Literature. Diagnostics (Basel) 2022; 12:diagnostics12020512. [PMID: 35204602 PMCID: PMC8871250 DOI: 10.3390/diagnostics12020512] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/13/2022] [Accepted: 02/14/2022] [Indexed: 02/01/2023] Open
Abstract
Mediastinal lymphadenopathy is a condition in which one or more mediastinal lymph nodes are enlarged for malignant or benign causes, generally more than 10 mm. For a long time, the only way to approach the mediastinum was surgery, while in last decades endoscopic techniques gained their role in neoplastic diseases. At the present time, EBUS is the technique of choice for studying the mediastinum in the suspicion of cancer, while there are not strong indications in guidelines for the study of benign mediastinal lymphadenopathy. We reviewed the literature, looking for evidence of the role of EBUS in the diagnostics of non-neoplastic mediastinal lymphadenopathy, with special regard for granulomatous disease, both infectious and non-infectious. EBUS is a reliable alternative to surgery in non-neoplastic mediastinal lymphadenopathy, even if more evidence is needed for granulomatous diseases other than tuberculosis and sarcoidosis.
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Affiliation(s)
- Valentina Scano
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.G.F.); (A.M.); (F.B.); (P.P.); (P.P.)
- Correspondence: ; Tel.: +39-340-926-5637
| | - Alessandro Giuseppe Fois
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.G.F.); (A.M.); (F.B.); (P.P.); (P.P.)
- Unit of Respiratory Diseases, University Hospital Sassari (AOU), 07100 Sassari, Italy
| | - Andrea Manca
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.G.F.); (A.M.); (F.B.); (P.P.); (P.P.)
| | - Francesca Balata
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.G.F.); (A.M.); (F.B.); (P.P.); (P.P.)
| | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Carla Chessa
- Postgraduate School in Hospital Pharmacy, University of Sassari, 07100 Sassari, Italy;
| | - Pietro Pirina
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.G.F.); (A.M.); (F.B.); (P.P.); (P.P.)
- Unit of Respiratory Diseases, University Hospital Sassari (AOU), 07100 Sassari, Italy
| | - Panos Paliogiannis
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.G.F.); (A.M.); (F.B.); (P.P.); (P.P.)
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Kearns B, Stevenson MD, Triantafyllopoulos K, Manca A. Comparing current and emerging practice models for the extrapolation of survival data: a simulation study and case-study. BMC Med Res Methodol 2021; 21:263. [PMID: 34837957 PMCID: PMC8627632 DOI: 10.1186/s12874-021-01460-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/08/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Estimates of future survival can be a key evidence source when deciding if a medical treatment should be funded. Current practice is to use standard parametric models for generating extrapolations. Several emerging, more flexible, survival models are available which can provide improved within-sample fit. This study aimed to assess if these emerging practice models also provided improved extrapolations. METHODS Both a simulation study and a case-study were used to assess the goodness of fit of five classes of survival model. These were: current practice models, Royston Parmar models (RPMs), Fractional polynomials (FPs), Generalised additive models (GAMs), and Dynamic survival models (DSMs). The simulation study used a mixture-Weibull model as the data-generating mechanism with varying lengths of follow-up and sample sizes. The case-study was long-term follow-up of a prostate cancer trial. For both studies, models were fit to an early data-cut of the data, and extrapolations compared to the known long-term follow-up. RESULTS The emerging practice models provided better within-sample fit than current practice models. For data-rich simulation scenarios (large sample sizes or long follow-up), the GAMs and DSMs provided improved extrapolations compared with current practice. Extrapolations from FPs were always very poor whilst those from RPMs were similar to current practice. With short follow-up all the models struggled to provide useful extrapolations. In the case-study all the models provided very similar estimates, but extrapolations were all poor as no model was able to capture a turning-point during the extrapolated period. CONCLUSIONS Good within-sample fit does not guarantee good extrapolation performance. Both GAMs and DSMs may be considered as candidate extrapolation models in addition to current practice. Further research into when these flexible models are most useful, and the role of external evidence to improve extrapolations is required.
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Affiliation(s)
- Benjamin Kearns
- School of Health and Related Research. Regent Court (ScHARR), The University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Matt D Stevenson
- School of Health and Related Research. Regent Court (ScHARR), The University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Kostas Triantafyllopoulos
- School of Mathematics and Statistics, The University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Andrea Manca
- Centre for Health Economics, The University of York, York, UK
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Crosetti E, Arrigoni G, Caracciolo A, Tascone M, Manca A, Succo G. VITOM-3D-assisted retroauricular neck surgery (RANS-3D): preliminary experience at Candiolo Cancer Institute. Acta Otorhinolaryngol Ital 2021; 41:419-431. [PMID: 34734577 PMCID: PMC8569660 DOI: 10.14639/0392-100x-n1293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/10/2021] [Indexed: 11/25/2022]
Abstract
Objective The recent introduction of 3D exoscopic surgery has engendered interesting technical improvements in head and neck surgery. The main goal of this study was to describe the application of 3D exoscopic technology on a wide range of pathologies of the neck, benign and malignant, through a minimally invasive retroauricular approach. Methods In the period January-December, 2019, 40 consecutive patients underwent neck surgery with a retroauricular approach, enhanced by using a 3D exoscope at the Head and Neck Oncological Unit of Candiolo Cancer Institute. Results Data regarding time to drain removal, length of hospitalisation, degree of pain experienced, need for opioid drugs during hospitalisation and after discharge, and intra-operative and post-operative complications were collected. All patients were followed for a minimum of 90 days with possible complications evaluated at each post-operative visit. Post-operative outcomes were evaluated at 3 months after surgery. Conclusions The current study indicates that VITOM-3D-assisted retroauricular neck surgery (RANS-3D) may be an interesting approach for neck surgery. The hybrid execution of neck dissection under direct and exoscopic vision represents a valid alternative to video-assisted endoscopic- and robot-assisted techniques.
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Affiliation(s)
- Erika Crosetti
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy
| | - Giulia Arrigoni
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy
| | - Alessandra Caracciolo
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy
| | - Martina Tascone
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy
| | - Andrea Manca
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy.,Department of Oncology, University of Turin, Orbassano (TO), Italy
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Kearns B, Stevenson MD, Triantafyllopoulos K, Manca A. The Extrapolation Performance of Survival Models for Data With a Cure Fraction: A Simulation Study. Value Health 2021; 24:1634-1642. [PMID: 34711364 DOI: 10.1016/j.jval.2021.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/21/2021] [Accepted: 05/25/2021] [Indexed: 05/25/2023]
Abstract
OBJECTIVES Curative treatments can result in complex hazard functions. The use of standard survival models may result in poor extrapolations. Several models for data which may have a cure fraction are available, but comparisons of their extrapolation performance are lacking. A simulation study was performed to assess the performance of models with and without a cure fraction when fit to data with a cure fraction. METHODS Data were simulated from a Weibull cure model, with 9 scenarios corresponding to different lengths of follow-up and sample sizes. Cure and noncure versions of standard parametric, Royston-Parmar, and dynamic survival models were considered along with noncure fractional polynomial and generalized additive models. The mean-squared error and bias in estimates of the hazard function were estimated. RESULTS With the shortest follow-up, none of the cure models provided good extrapolations. Performance improved with increasing follow-up, except for the misspecified standard parametric cure model (lognormal). The performance of the flexible cure models was similar to that of the correctly specified cure model. Accurate estimates of the cured fraction were not necessary for accurate hazard estimates. Models without a cure fraction provided markedly worse extrapolations. CONCLUSIONS For curative treatments, failure to model the cured fraction can lead to very poor extrapolations. Cure models provide improved extrapolations, but with immature data there may be insufficient evidence to choose between cure and noncure models, emphasizing the importance of clinical knowledge for model choice. Dynamic cure fraction models were robust to model misspecification, but standard parametric cure models were not.
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Affiliation(s)
- Benjamin Kearns
- School of Health and Related Research, The University of Sheffield, Sheffield, England, UK.
| | - Matt D Stevenson
- School of Health and Related Research, The University of Sheffield, Sheffield, England, UK
| | | | - Andrea Manca
- Centre for Health Economics, The University of York, York, England, UK
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Loi N, Ginatempo F, Manca A, Melis F, Deriu F. Faces emotional expressions: from perceptive to motor areas in aged and young subjects. J Neurophysiol 2021; 126:1642-1652. [PMID: 34614362 DOI: 10.1152/jn.00328.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The role of age in perception and production of facial expressions is still unclear. Therefore, this work compared, in aged and young subjects, the effects of passive viewing of faces expressing different emotions on perceptive brain regions, such as occipital and temporal cortical areas and on the primary motor cortex (M1) innervating lower face muscles. Seventeen young (24.41 ± 0.71 yr) and seventeen aged (63.82 ± 0.99 yr) subjects underwent recording of event-related potentials (ERP), of motor potentials evoked by transcranial magnetic stimulation of face M1 in the depressor anguli oris muscle and reaction time assessment. In both groups, the P100 and N170 waves, as well as short-latency intracortical inhibition (SICI) and intracortical facilitation (ICF) were probed in face M1 after 300 ms from the presentation of images reporting faces expressing happy, sad, and neutral emotions. ERP data evidenced a major involvement of the right hemisphere in perceptual processing of faces, regardless of age. Compared with young subjects, the aged group showed a delayed N170 wave and a smaller P100 wave following the view of sad but not happy or neutral expressions, along with less accuracy and longer reaction times for recognition of the emotion expressed by faces. Aged subjects presented less SICI than young subjects, but facial expressions of happiness increased the excitability of face M1 with no differences between groups. In conclusion, data suggest that encoding of sad face expressions is impaired in the aged compared with the young group, whereas perception of happiness and its excitatory effects on face M1 remains preserved.NEW & NOTEWORTHY This study shows that aged subjects have less visual attention and impaired perception for sad, but not for happy, face expressions. Conversely, the view of happy, but not sad, faces increases excitability in face M1 bilaterally, regardless of age. The impaired attention for sad expressions, the preserved perception of faces expressing happiness, along with the enhancing effects of the latter on face M1 excitability, likely makes the aged subjects more motivated in approaching positive emotions.
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Affiliation(s)
- Nicola Loi
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | | | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Francesco Melis
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy.,Unit of Endocrinology, Nutritional and Metabolic Disorders, AOU Sassari, Sassari, Italy
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Cugusi L, Manca A, Fishback E, Secci C, Bergamin M, Gobbo S, DI Blasio A, Montella A, Bandiera P, Deriu F. Low back pain prevalence and risk factors in Italian adolescent male soccer players: results from an online survey. J Sports Med Phys Fitness 2021; 62:1088-1094. [PMID: 34498823 DOI: 10.23736/s0022-4707.21.12696-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The purpose of this retrospective survey was to analyse the prevalence of low back pain (LBP) among Italian adolescent soccer players, and to identify potential risk factors. METHODS Participants were requested to answer an online survey based on the standardized Nordic questionnaires for musculoskeletal symptoms. RESULTS Data were obtained from 204 male soccer players aged 14-17 years competing at the national and regional level. More than half of the players had experienced LBP in their lives. One-way ANOVA revealed that the players with LBP were taller, heavier and with a higher BMI (all p values<0.00001). When considering the playing position, ANOVA revealed that 14-15 years-old strikers displayed higher LBP scores than all other roles (all p values<0.05). Accordingly, strikers were exposed to a higher risk of LBP than midfielders (RR=1.48; 95%CI:1.10-2.01; p=0.01) and goalkeepers (RR=1.48; 95%CI:1.02-2.971; p=0.04), but not defenders (RR=1.23; 95%CI:0.93-1.63; p=0.15). Within the 14-15 age-class, strikers were, again, those most exposed to LBP risk (all p values<0.05). CONCLUSIONS Anthropometric and soccer-related features should be monitored to ensure early identification of potential risk factors for LBP. This information should be considered along with the specific playing position as strikers emerged as the roles most exposed to LBP risk.
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Affiliation(s)
- Lucia Cugusi
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy -
| | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Ernest Fishback
- Bachelor Degree Course in Physiotherapy, University of Cagliari, Cagliari, Italy
| | - Claudio Secci
- Bachelor Degree Course in Physiotherapy, University of Cagliari, Cagliari, Italy
| | - Marco Bergamin
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Stefano Gobbo
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Andrea DI Blasio
- Endocrine Section, Department of Medicine and Sciences of Aging, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Andrea Montella
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Pasquale Bandiera
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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Crosetti E, Arrigoni G, Manca A, Fantini M, Caracciolo A, Sardanapoli F, Succo G. VITOM-3D assisted neck dissection via a retroauricular approach (RAND-3D): a preclinical investigation in a cadaver lab. ACTA ACUST UNITED AC 2021; 40:343-351. [PMID: 33299224 PMCID: PMC7726639 DOI: 10.14639/0392-100x-n0757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 08/06/2020] [Indexed: 11/23/2022]
Abstract
Objective The recent introduction of 3D exoscopic surgery has allowed interesting technical improvements in head and neck surgery resulting in technical solutions that are also applicable to neck dissection. The aim is to replace robotic surgery while minimising the costs of the procedure. Methods Based on these considerations, we conducted a preclinical investigation in the cadaver lab focused on approaching conventional neck dissection using a retroauricular incision, and evalute the applications and usefulness of the Storz 3D Exoscopic System at different stages of the surgical procedure. The acronym RAND-3D (3D exoscopic surgery) was coined to describe the application of this optical tool in neck dissection. Results The current study in the cadaver lab indicates that RAND-3D is an acceptable alternative operating technique in performing neck dissection by a retroauricular approach. Technically feasible and safe, this technique assures a complete compartment-oriented dissection without damaging major vascular or nervous structures. Conclusions This approach can be used in selected cases with a clear cosmetic benefit and represents a valid alternative to endoscopic- and robotic-assisted neck dissection.
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Affiliation(s)
- Erika Crosetti
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy
| | - Giulia Arrigoni
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy
| | - Andrea Manca
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy
| | - Marco Fantini
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy
| | - Alessandra Caracciolo
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy
| | - Francesco Sardanapoli
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy
| | - Giovanni Succo
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy.,Department of Oncology, University of Turin, Orbassano (TO), Italy
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Manca A, Cano A, Ventura L, Martinez G, Frid L, Deriu F, Kalron A. Sex-Based Differences in Oxygen Cost of Walking and Energy Equivalents in Minimally Disabled People with Multiple Sclerosis and Controls. Int J MS Care 2021; 24:54-61. [DOI: 10.7224/1537-2073.2020-112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Abstract
Background: Elevated oxygen cost of walking and energy equivalents are reported for highly and moderately disabled people with multiple sclerosis (MS). However, less is known about minimally impaired individuals. Moreover, no sex-based data on the metabolic rates of people with MS are available. In this cross-sectional study, the metabolic rates and temporospatial parameters of gait during overground walking in minimally disabled people with MS versus matched controls were quantified and whether sex-based differences occur was examined.
Methods: Sixty-nine minimally impaired adults with MS (37, relapsing-remitting MS [RRMS]; 32, clinically isolated syndrome [CIS]) and 25 matched controls completed two 6-minute walking bouts at comfortable and fast speeds. The oxygen cost of walking, energy equivalents, and respiratory exchange ratio were recorded through breath-by-breath open-circuit spirometry. Gait analysis was performed via a portable electronic walkway.
Results: At comfortable but not at fast speed, men with RRMS showed higher oxygen cost of walking than men with CIS (+17.9%, P = .04) and male controls (+21.3%, P = .03). In the RRMS group, men showed higher oxygen cost of walking (+19.2%, P = .04) and energy equivalents (+19.2%, P = .02) than women. Elevated oxygen cost of walking and energy equivalents in men were paralleled by significantly larger base of support and step time asymmetry during walking.
Conclusions: Metabolic demands are elevated while walking in minimally disabled people with RRMS. Furthermore, higher energy demands occur in men, probably due to increased step symmetry and base of support. Clinicians are advised to follow energy expenditure metrics collected while walking because they can indicate a decrease in fitness, even in the early phase of MS.
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Affiliation(s)
- Andrea Manca
- From the Department of Biomedical Sciences, University of Sassari, Sassari, Italy (AM, AC, LV, GM, FD)
| | - Antonella Cano
- From the Department of Biomedical Sciences, University of Sassari, Sassari, Italy (AM, AC, LV, GM, FD)
| | - Lucia Ventura
- From the Department of Biomedical Sciences, University of Sassari, Sassari, Italy (AM, AC, LV, GM, FD)
| | - Gianluca Martinez
- From the Department of Biomedical Sciences, University of Sassari, Sassari, Italy (AM, AC, LV, GM, FD)
| | - Lior Frid
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel (LF)
| | - Franca Deriu
- From the Department of Biomedical Sciences, University of Sassari, Sassari, Italy (AM, AC, LV, GM, FD)
| | - Alon Kalron
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel (AK)
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Deriu F, Martinez G, Loi N, Ventura L, Ginatempo F, Dvir Z, Manca A. Reporting quality of TMS studies in neurological conditions: A critical appraisal of the main gaps, challenges and clinical implications. J Neurosci Methods 2021; 362:109293. [PMID: 34293408 DOI: 10.1016/j.jneumeth.2021.109293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/22/2021] [Accepted: 07/16/2021] [Indexed: 11/28/2022]
Abstract
Transparent reporting of study methods and findings can dramatically expand the reliability and impact of health research. Evidence-based reporting checklists and guidelines, such as those hosted by the EQUATOR network, provide a framework for summarizing statistics, methods and data presentation. While being increasingly used in several research fields, such trend toward better control seems in its infancy in the field of transcranial magnetic stimulation (TMS). By the present work we aimed at assessing the quality of methodological and statistical reporting of TMS-based investigations in individuals with neurological motor impairments. We completed a methodological survey of all the studies conducted in the last two decades on the application of TMS to evaluate motor impairments in individual with neurological conditions. The pre-planned literature search of three major biomedical databases resulted in 1109 articles retrieved, 571 of which satisfied the eligibility criteria. The survey revealed that most of the studies suffered from relevant methodological and statistical issues, which potentially affect data interpretation and usability. Among these, sample size calculation, indices of change other than p values, reproducibility and clinical relevance/responsiveness emerged as those elements most commonly neglected. To increase research reliability of TMS data, we recommend adhering to international initiatives like the EQUATOR, that can impact clinical research by promoting adequate reporting. In particular, we advocate an update of the submission policies of the journals active in this field in line with adjacent areas, such as neurorehabilitation, that require the uploading of completed checklists that rationalize reporting.
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Affiliation(s)
- Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
| | - Gianluca Martinez
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Nicola Loi
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Lucia Ventura
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | | | - Zeevi Dvir
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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Calcagno A, Cusato J, Ferrara M, De Nicolò A, Lazzaro A, Manca A, D'Avolio A, Di Perri G, Bonora S. Antiretroviral concentrations in the presence and absence of valproic acid. J Antimicrob Chemother 2021; 75:1969-1971. [PMID: 32211890 DOI: 10.1093/jac/dkaa094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES An unexpected drug-drug interaction has been recently reported between dolutegravir, an HIV integrase inhibitor, and valproic acid. Despite there being several potential underlying mechanisms, plasma protein displacement has been suggested. The aim of this study was to assess plasma concentrations of several antiretrovirals when administered with or without valproic acid. METHODS We performed a therapeutic drug monitoring registry analysis and identified patients concomitantly taking antiretrovirals and valproic acid and without clinical affecting conditions or interacting drugs. RESULTS One hundred and thirty-four patients were identified. Median (IQR) age and BMI were 49.7 years (45-56) and 23.4 kg/m2 (20.8-26.3) and 78 were male (58.2%). Despite small groups, we observed no major effect on antiretroviral exposure, even when considering highly protein-bound compounds (such as etravirine), with the exception of dolutegravir trough concentrations [median (IQR) = 132 ng/mL (62-227) in individuals on valproic acid versus 760 ng/mL (333-1407) in those not receiving valproic acid]. CONCLUSIONS Valproic acid does not have a major effect on antiretrovirals other than dolutegravir. The mechanism of this unexpected drug-drug interaction may be the combination of protein displacement, reduced absorption and CYP3A4 induction.
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Affiliation(s)
- A Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - J Cusato
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - M Ferrara
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - A De Nicolò
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - A Lazzaro
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - A Manca
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - A D'Avolio
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - G Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - S Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
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Chalkou K, Steyerberg E, Egger M, Manca A, Pellegrini F, Salanti G. A two-stage prediction model for heterogeneous effects of treatments. Stat Med 2021; 40:4362-4375. [PMID: 34048066 PMCID: PMC9291845 DOI: 10.1002/sim.9034] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 12/23/2022]
Abstract
Treatment effects vary across different patients, and estimation of this variability is essential for clinical decision‐making. We aimed to develop a model estimating the benefit of alternative treatment options for individual patients, extending a risk modeling approach in a network meta‐analysis framework. We propose a two‐stage prediction model for heterogeneous treatment effects by combining prognosis research and network meta‐analysis methods where individual patient data are available. In the first stage, a prognostic model to predict the baseline risk of the outcome. In the second stage, we use the baseline risk score from the first stage as a single prognostic factor and effect modifier in a network meta‐regression model. We apply the approach to a network meta‐analysis of three randomized clinical trials comparing the relapses in Natalizumab, Glatiramer Acetate, and Dimethyl Fumarate, including 3590 patients diagnosed with relapsing‐remitting multiple sclerosis. We find that the baseline risk score modifies the relative and absolute treatment effects. Several patient characteristics, such as age and disability status, impact the baseline risk of relapse, which in turn moderates the benefit expected for each of the treatments. For high‐risk patients, the treatment that minimizes the risk of relapse in 2 years is Natalizumab, whereas Dimethyl Fumarate might be a better option for low‐risk patients. Our approach can be easily extended to all outcomes of interest and has the potential to inform a personalized treatment approach.
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Affiliation(s)
- Konstantina Chalkou
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Ewout Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrea Manca
- Centre for Health Economics, University of York, York, UK
| | | | - Georgia Salanti
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Manca A, Hortobágyi T, Carroll TJ, Enoka RM, Farthing JP, Gandevia SC, Kidgell DJ, Taylor JL, Deriu F. Contralateral Effects of Unilateral Strength and Skill Training: Modified Delphi Consensus to Establish Key Aspects of Cross-Education. Sports Med 2021; 51:11-20. [PMID: 33175329 PMCID: PMC7806569 DOI: 10.1007/s40279-020-01377-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Background Cross-education refers to increased motor output (i.e., force generation, skill) of the opposite, untrained limb following a period of unilateral exercise training. Despite extensive research, several aspects of the transfer phenomenon remain controversial. Methods A modified two-round Delphi online survey was conducted among international experts to reach consensus on terminology, methodology, mechanisms of action, and translational potential of cross-education, and to provide a framework for future research. Results Through purposive sampling of the literature, we identified 56 noted experts in the field, of whom 32 completed the survey, and reached consensus (75% threshold) on 17 out of 27 items. Conclusion Our consensus-based recommendations for future studies are that (1) the term ‘cross-education’ should be adopted to refer to the transfer phenomenon, also specifying if transfer of strength or skill is meant; (2) functional magnetic resonance imaging, short-interval intracortical inhibition and interhemispheric inhibition appear to be promising tools to study the mechanisms of transfer; (3) strategies which maximize cross-education, such as high-intensity training, eccentric contractions, and mirror illusion, seem worth being included in the intervention plan; (4) study protocols should be designed to include at least 13–18 sessions or 4–6 weeks to produce functionally meaningful transfer of strength, and (5) cross-education could be considered as an adjuvant treatment particularly for unilateral orthopedic conditions and sports injuries. Additionally, a clear gap in views emerged between the research field and the purely clinical field. The present consensus statement clarifies relevant aspects of cross-education including neurophysiological, neuroanatomical, and methodological characteristics of the transfer phenomenon, and provides guidance on how to improve the quality and usability of future cross-education studies. Electronic supplementary material The online version of this article (10.1007/s40279-020-01377-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Manca
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, 07100, Sassari, Italy
| | - T Hortobágyi
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - T J Carroll
- Centre for Sensorimotor Performance, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - R M Enoka
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, USA
| | - J P Farthing
- University of Saskatchewan College of Kinesiology, Saskatoon, SK, Canada
| | - S C Gandevia
- Neuroscience Research Australia (NeuRA), The University of New South Wales, Sydney, Australia
| | - D J Kidgell
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia
| | - J L Taylor
- School of Medical and Health Sciences, Edit Cowan University, Joondalup, Australia
| | - F Deriu
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, 07100, Sassari, Italy.
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Moreno-Navarro P, Manca A, Martinez G, Ventura L, Barbado D, Vera-García FJ, Deriu F. Test-Retest Reliability and Known-Groups Validity of Trunk Muscle Tests in People With Multiple Sclerosis: A Cross-Sectional, Case-Control Study. Phys Ther 2021; 101:6128528. [PMID: 33538837 DOI: 10.1093/ptj/pzab049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 10/25/2020] [Accepted: 11/29/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Research on muscle performance testing reliability in people with multiple sclerosis (MS) has focused on limb performance while less is known about trunk strength and endurance. This work aims to 1) establish test-retest reliability of trunk flexion, lateral flexion, and extension strength tests, and plank, side bridge, and Biering-Sørensen endurance tests in people with MS and matched healthy controls (HCs); 2) analyze known-groups validity of these tests in people with MS and HCs; 3) to compare groups for side-to-side differences; and 4) to describe the relationships between trunk performance and functional mobility tests. METHODS Fifteen people with MS (median Expanded Disability Status Scale = 3) and 15 HCs underwent 2 trunk isometric strength and endurance testing sessions. Mobility was evaluated by Timed Up-and-Go test. Intraclass correlation coefficient, SEM, and minimal detectable change (MDC) were calculated. Between-group differences in trunk performance were tested using the t test for independent measures. Between-group differences in an asymmetry index were analyzed by independent t test. Bivariate correlations between trunk tests and mobility were also examined. RESULTS All trunk tests showed good-to-excellent relative reliability in both groups (intraclass correlation coefficient > 0.71). Regarding absolute reliability, strength tests were associated with low intersession variability in both groups (MDC: MS, 11.23%-36.45%; HCs, 26.60%-31.98%). Conversely, endurance tests showed higher variability scores in people with MS (MDC: MS, 69.55%-116.50%; HCs, 29.57%-54.40%). People with MS displayed significantly lower trunk performance. Likewise, the asymmetry index showed significantly higher scores in people with MS for endurance assessment but not in strength tests. Significant correlations were detected in people with MS between Timed Up-and-Go and several trunk tests (r = 0.63-0.70). CONCLUSIONS SEM and MDC scores revealed similar consistency and variability between groups for strength tests, whereas higher variability was observed for endurance tests in people with MS. Trunk strength tests are reliable and present discriminant validity to distinguish mildly disabled people with MS from HCs. Conversely, the high measurement error and variability of the endurance tests may hinder their application in intervention programs. IMPACT Determining the reliability and validity of the tests currently used to assess trunk function is of the greatest importance for people with MS (who show not only impaired trunk function but also wide fluctuations in performance), as it requires consistent and accurate measurements that are sensitive enough to detect minimal changes induced by rehabilitation.
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Affiliation(s)
- Pedro Moreno-Navarro
- Sports Research Centre, Department of Sport Sciences, Miguel Hernandez University of Elche, Alicante, Spain
| | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Italy
| | | | - Lucia Ventura
- Department of Biomedical Sciences, University of Sassari, Italy
| | - David Barbado
- Sports Research Centre, Department of Sport Sciences, Miguel Hernandez University of Elche, Alicante, Spain
| | - Francisco J Vera-García
- Sports Research Centre, Department of Sport Sciences, Miguel Hernandez University of Elche, Alicante, Spain
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Italy
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Mercante B, Nuvoli S, Sotgiu MA, Manca A, Todesco S, Melis F, Spanu A, Deriu F. SPECT imaging of cerebral blood flow changes induced by acute trigeminal nerve stimulation in drug-resistant epilepsy. A pilot study. Clin Neurophysiol 2021; 132:1274-1282. [PMID: 33867259 DOI: 10.1016/j.clinph.2021.01.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/17/2020] [Accepted: 01/19/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore the cortical areas targeted by acute transcutaneous trigeminal nerve stimulation (TNS) in patients with drug-resistant epilepsy (DRE) using single photon emission computed tomography (SPECT). METHODS Ten patients with DRE underwent brain SPECT at baseline and immediately after a 20-minute TNS (0.25 ms; 120 Hz; 30 s ON and 30 s OFF) applied bilaterally to the infraorbital nerve. The French Color Standard International Scale was used for qualitative analyses and z-scores were used to calculate the Odds Ratio (OR). RESULTS At baseline global hypoperfusion (mainly in temporo-mesial, temporo-parietal and fronto-temporal and temporo-occipital areas) was detected in all patients. Following TNS, a global increase in cortical tracer uptake and a significant decrease in median hypoperfusion score were observed. A significant effect favoring a general TNS-induced increase in cortical perfusion (OR = 4.96; p = 0.0005) was detected in 70% of cases, with significant effects in the limbic (p = 0.003) and temporal (p = 0.003) lobes. Quantitative analyses of z-scores confirmed significant TNS-induced increases in perfusion in the temporal (+0.59 SDs; p = 0.001), and limbic (+0.43 SDs; p = 0.03) lobes. CONCLUSION Short-term TNS is followed a global increase in cortical perfusion, namely in the temporal and limbic lobes. SIGNIFICANCE The TNS-induced perfusion increase may reflect neurons' activity changes in cortical areas implicated in the epilepsy network.
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Affiliation(s)
- Beniamina Mercante
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Susanna Nuvoli
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Science, University of Sassari, Sassari, Italy
| | - Maria A Sotgiu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Sara Todesco
- Neurology Unit, «A. Segni» Hospital, ASL n. 1, Sassari, Italy
| | - Francesco Melis
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Angela Spanu
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Science, University of Sassari, Sassari, Italy
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
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Fadda GL, Manca A, Testi F, Itri F, Nicoli P, Moratti G, Cavallo G, Guerrasio A. A Rare Case of Hodgkin Lymphoma of the Maxillary Sinus. Ear Nose Throat J 2021; 102:NP232-NP236. [PMID: 33734885 DOI: 10.1177/0145561321993599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hodgkin lymphoma (HL) is an uncommon B-cell malignant disease. It usually presents with mediastinal and/or laterocervical lymph node localization, while primary extranodal HL is a rare entity giving rise to diagnostic and therapeutic challenges. It rarely presents as just extranodal localization, so its presence within the maxillary sinus without any lymphadenopathy is exceptional. Given the rarity of this localization, there is no standard treatment for maxillary sinus HL. We present a case of a patient with extranodal HL of the right maxillary sinus treated with primary surgery followed by adjuvant sequential chemoradiation therapy.
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Affiliation(s)
- Gian Luca Fadda
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Andrea Manca
- FPO IRCCS, Head & Neck Oncology Unit, Candiolo Cancer Institute, Turin, Italy
| | - Francesca Testi
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Federico Itri
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Paolo Nicoli
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Giuseppe Moratti
- Department of Otorhinolaryngology, Galliera Hospital, Genova, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Angelo Guerrasio
- Departement of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
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Iglesias Urrutia CP, Erdem S, Birks YF, Taylor SJC, Richardson G, Bower P, van den Berg B, Manca A. People's preferences for self-management support. Health Serv Res 2021; 57:91-101. [PMID: 33634466 PMCID: PMC8763292 DOI: 10.1111/1475-6773.13635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective To identify and assess the preferences of people with long‐term health conditions toward generalizable characteristics of self‐management support interventions, with the objective to inform the design of more person‐centered support services. Data Sources Primary qualitative and quantitative data collected on a representative sample of individuals with at least one of the fifteen most prevalent long‐term conditions in the UK. Study Design Targeted literature review followed by a series of one‐to‐one qualitative semistructured interviews and a large‐scale discrete choice experiment. Data Collection Digital recording of one‐to‐one qualitative interviews, one‐to‐one cognitive interviews, and a series of online quantitative surveys, including two best‐worst scaling and one discrete choice experiment, with individuals with long‐term conditions. Principal Findings On average, patients preferred a self‐management support intervention that (a) discusses the options available to the patient and make her choose, (b) is individual‐based, (c) face to face (d) with doctor or nurse, (e) at the GP practice, (f) sessions shorter than 1 hour, and (g) occurring annually for two‐third of the sample and monthly for the rest. We found heterogeneity in preferences via three latent classes, with class sizes of 41% (C1), 30% (C2), and 29% (C3). The individuals’ gender [P < 0.05(C1), P < 0.01(C3)], age [P < 0.05(C1), P < 0.05(C2)], type of long‐term condition [P < 0.05(C1), P < 0.01(C3)], and presence of comorbidity [P < 0.01(C1), P < 0.01(C3), P < 0.01(C3)] were able to characterize differences between these latent classes and help understand the heterogeneity of preferences toward the above mentioned features of self‐management support interventions. These findings were then used to profile individuals into different preference groups, for each of whom the most desirable form of self‐management support, one that was more likely to be adopted by the recipient, could be designed. Conclusions We identified several factors that could be used to inform a more nuanced self‐management support service design and provision that take into account the recipient's characteristics and preferences.
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Affiliation(s)
| | - Seda Erdem
- Stirling Management School, University of Stirling, Stirling, UK
| | - Yvonne F Birks
- Social Policy Research Unit, University of York, York, UK
| | - Stephanie J C Taylor
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London (QMUL), London, UK
| | | | - Peter Bower
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Bernard van den Berg
- Department of Health Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Andrea Manca
- Centre for Health Economics, University of York, York, UK
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Hortobágyi T, Granacher U, Fernandez-Del-Olmo M, Howatson G, Manca A, Deriu F, Taube W, Gruber M, Márquez G, Lundbye-Jensen J, Colomer-Poveda D. Functional relevance of resistance training-induced neuroplasticity in health and disease. Neurosci Biobehav Rev 2020; 122:79-91. [PMID: 33383071 DOI: 10.1016/j.neubiorev.2020.12.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 01/13/2023]
Abstract
Repetitive, monotonic, and effortful voluntary muscle contractions performed for just a few weeks, i.e., resistance training, can substantially increase maximal voluntary force in the practiced task and can also increase gross motor performance. The increase in motor performance is often accompanied by neuroplastic adaptations in the central nervous system. While historical data assigned functional relevance to such adaptations induced by resistance training, this claim has not yet been systematically and critically examined in the context of motor performance across the lifespan in health and disease. A review of muscle activation, brain and peripheral nerve stimulation, and imaging data revealed that increases in motor performance and neuroplasticity tend to be uncoupled, making a mechanistic link between neuroplasticity and motor performance inconclusive. We recommend new approaches, including causal mediation analytical and hypothesis-driven models to substantiate the functional relevance of resistance training-induced neuroplasticity in the improvements of gross motor function across the lifespan in health and disease.
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Affiliation(s)
- Tibor Hortobágyi
- Center for Human Movement Sciences, University of Groningen, University Medical CenterGroningen, Groningen, Netherlands.
| | - Urs Granacher
- Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Potsdam, Germany
| | - Miguel Fernandez-Del-Olmo
- Area of Sport Sciences, Faculty of Sports Sciences and Physical Education, Center for Sport Studies, King Juan Carlos University, Madrid, Spain
| | - Glyn Howatson
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK; Water Research Group, North West University, Potchefstroom, South Africa
| | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Wolfgang Taube
- Department of Neurosciences and Movement Sciences, University of Fribourg, Fribourg, Switzerland
| | - Markus Gruber
- Human Performance Research Centre, Department of Sport Science, University of Konstanz, Konstanz, Germany
| | - Gonzalo Márquez
- Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, University of A Coruña, A Coruña, Spain
| | - Jesper Lundbye-Jensen
- Movement & Neuroscience, Department of Nutrition, Exercise & Sports Department of Neuroscience, University of Copenhagenk, Faculty of Health Science, Universidad Isabel I, Burgos, Spain
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Affiliation(s)
- Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Italy
| | - Lucia Cugusi
- Department of Biomedical Sciences, University of Sassari, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science, Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Italy
| | - Giulia Ingoglia
- Department of Surgical, Oncological and Oral Science, Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Italy
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Canada
- School of Epidemiology and Public Health, University of Ottawa, Canada
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Italy
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Vaira LA, Hopkins C, Sandison A, Manca A, Machouchas N, Turilli D, Lechien JR, Barillari MR, Salzano G, Cossu A, Saussez S, De Riu G. Olfactory epithelium histopathological findings in long-term coronavirus disease 2019 related anosmia. J Laryngol Otol 2020; 134:1123-1127. [PMID: 33190655 PMCID: PMC7729153 DOI: 10.1017/s0022215120002455] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Olfactory dysfunction represents one of the most frequent symptoms of coronavirus disease 2019, affecting about 70 per cent of patients. However, the pathogenesis of the olfactory dysfunction in coronavirus disease 2019 has not yet been elucidated. CASE REPORT This report presents the radiological and histopathological findings of a patient who presented with anosmia persisting for more than three months after infection with severe acute respiratory syndrome coronavirus-2. CONCLUSION The biopsy demonstrated significant disruption of the olfactory epithelium. This shifts the focus away from invasion of the olfactory bulb and encourages further studies of treatments targeted at the surface epithelium.
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Affiliation(s)
- L A Vaira
- Maxillofacial Surgery Operative Unit, University Hospital of Sassari, Italy
- Biomedical Science Department, University of Sassari, Italy
| | - C Hopkins
- Department of ENT, King's College, London, UK
| | - A Sandison
- Department of Histopathology, Charing Cross Hospital and Imperial College Healthcare NHS Trust, London, UK
| | - A Manca
- Histopathology Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - N Machouchas
- Otorhinolaryngology Operative Unit, University Hospital of Sassari, Italy
| | - D Turilli
- Radiology Operative Unit, University Hospital of Sassari, Italy
| | - J R Lechien
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (‘YO-IFOS’), Belgium
- Department of Human and Experimental Oncology, Faculty of Medicine UMONS Research Institute for Health Sciences and Technology, University of Mons (‘UMons’), Belgium
| | - M R Barillari
- Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University, Naples, Italy
| | - G Salzano
- Maxillofacial Surgery Unit, University Hospital of Naples ‘Federico II’, Italy
| | - A Cossu
- Histopathology Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - S Saussez
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (‘YO-IFOS’), Belgium
- Department of Human and Experimental Oncology, Faculty of Medicine UMONS Research Institute for Health Sciences and Technology, University of Mons (‘UMons’), Belgium
| | - G De Riu
- Maxillofacial Surgery Operative Unit, University Hospital of Sassari, Italy
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Zanon D, Musazzi U, Manca A, De Nicolò A, D'Avolio A, Cilurzo F, Maximova N, Tomasello C, Clementi E, Minghetti P. Data on compounding lopinavir and ritonavir suspension for non-cooperative COVID-19 patients. Data Brief 2020; 33:106445. [PMID: 33110933 PMCID: PMC7582040 DOI: 10.1016/j.dib.2020.106445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 11/22/2022] Open
Abstract
The COVID-19 outbreak is now one of the most critical crises to manage for most of national healthcare systems in the world. The situation is complicated by the absence of vaccines and authorized pharmacological treatments, except for remdesivir. In this context, many medicaments, including different Ebola and HIV antivirals, are used off-label in the hospital wards as life-treating medicines for COVID-19 patients. Authorized medicaments manipulation is sometimes necessary because they are not always formulated to be administered to non-cooperative patients or they are in shortage. It is this the case of the fixed combination of lopinavir/ritonavir, which was extensively used in the first phase of the outbreak inducing a shortage of the oral solution available in the EU market. This work provides data on size distribution, osmolarity other than drug chemical stability of a lopinavir/ritonavir extemporaneous preparation made by using the solid dosage form (i.e., tablet) available on the market as drug source. The reported data indicate that such preparation is suitable to be delivered through a nasogastric tube, and enough stable for two weeks from the preparation at room temperature.
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Affiliation(s)
- D. Zanon
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - U.M. Musazzi
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Via Giuseppe Colombo, 71, 20133 Milan, Italy
| | - A. Manca
- Laboratory of Clinical Pharmacology and Pharmacogenetics, University of Turin, Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - A. De Nicolò
- Laboratory of Clinical Pharmacology and Pharmacogenetics, University of Turin, Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - A. D'Avolio
- Laboratory of Clinical Pharmacology and Pharmacogenetics, University of Turin, Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - F. Cilurzo
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Via Giuseppe Colombo, 71, 20133 Milan, Italy
| | - N. Maximova
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - C. Tomasello
- S.C. Farmacie Ospedaliere - Ospedale M. Vittoria - Asl Città di Torino, Turin, Italy
| | - E. Clementi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences “Luigi Sacco”, L. Sacco University Hospital, Università di Milano, Milan, Italy
| | - P. Minghetti
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Via Giuseppe Colombo, 71, 20133 Milan, Italy
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Manchira Krishnan S, Gc VS, Sandhu HK, Underwood M, Eldabe S, Manca A, Iglesias Urrutia CP. Protocol for an economic analysis of the randomised controlled trial of Improving the Well-being of people with Opioid Treated CHronic pain: I-WOTCH Study. BMJ Open 2020; 10:e037243. [PMID: 33444175 PMCID: PMC7682467 DOI: 10.1136/bmjopen-2020-037243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Over the last two decades, the use of opioids for the treatment of chronic pain in England has steadily increased despite lack of evidence of both long-term effectiveness in pain relief and significant, well-documented physical and mental adverse events. Guidelines recommend tapering when harms outweigh benefits, but the addictive nature of opioids hinders simple dose-reduction strategies. Improving the Well-being of people with Opioid Treated CHronic pain (I-WOTCH) trial tests a multicomponent self-management intervention aimed to help patients with chronic non-malignant pain taper opioid doses. This paper outlines the methods to be used for the economic analysis of the I-WOTCH intervention compared with the best usual care. METHODS AND ANALYSIS Economic evaluation alongside the I-WOTCH study, prospectively designed to identify, measure and value key healthcare resource use and outcomes arising from the treatment strategies being compared. A within-trial cost-consequences analysis and a model-based long-term cost-effectiveness analysis will be conducted from the National Health Service and Personal Social Service perspective in England. The former will quantify key parameters to populate a Markov model designed to estimate the long-term cost and quality-adjusted life years of the I-WOTCH intervention against best usual care. Regression equations will be used to estimate parameters such as transition probabilities, utilities, and costs associated with the model's states and events. Probabilistic sensitivity analysis will be used to assess the impact of parameter uncertainty onto the predicted costs and health outcomes, and the resulting value for money assessment of the I-WOTCH intervention. ETHICS AND DISSEMINATION Full ethics approval was granted by Yorkshire & The Humber-South Yorkshire Research Ethics Committee on 13 September 2016 (16/YH/0325). Current protocol: V.1.7, date 31 July 2019. Findings will be disseminated in peer-reviewed journals, scientific conferences, newsletters and websites. TRIAL REGISTRATION NUMBER International Standard Randomised Controlled Trial Number (49 470 934); Pre-result.
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Affiliation(s)
| | - Vijay Singh Gc
- Centre for Health Economics, University of York, York, UK
| | - Harbinder Kaur Sandhu
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Sam Eldabe
- Pain Department, James Cook University Hospital, Middlesbrough, UK
| | - Andrea Manca
- Centre for Health Economics, University of York, York, UK
| | - Cynthia P Iglesias Urrutia
- Department of Health Sciences, University of York, York, UK
- Danish Center for Healthcare Improvements, Aalborg University, Aalborg, Denmark
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Manca A, Cereatti A, Bar-On L, Botter A, Della Croce U, Knaflitz M, Maffiuletti NA, Mazzoli D, Merlo A, Roatta S, Turolla A, Deriu F. A Survey on the Use and Barriers of Surface Electromyography in Neurorehabilitation. Front Neurol 2020; 11:573616. [PMID: 33123079 PMCID: PMC7566898 DOI: 10.3389/fneur.2020.573616] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/25/2020] [Indexed: 11/13/2022] Open
Abstract
Historical, educational, and technical barriers have been reported to limit the use of surface electromyography (sEMG) in clinical neurorehabilitation settings. In an attempt to identify, review, rank, and interpret potential factors that may play a role in this scenario, we gathered information on (1) current use of sEMG and its clinical potential; (2) professional figures primarily dealing with sEMG; (3) educational aspects, and (4) possible barriers and reasons for its apparently limited use in neurorehabilitation. To this aim, an online 30-question survey was sent to 52 experts on sEMG from diverse standpoints, backgrounds, and countries. Participants were asked to respond to each question on a 5-point Likert scale or by ranking items. A cut-off of 75% agreement was chosen as the consensus threshold. Thirty-five invitees (67%) completed the electronic survey. Consensus was reached for 77% of the proposed questions encompassing current trends in sEMG use in neurorehabilitation, educational, technical, and methodological features as well as its translational utility for clinicians and patients. Data evidenced the clinical utility of sEMG for patient assessment, to define the intervention plan, and to complement/optimize other methods used to quantify muscle and physical function. The aggregate opinion of the interviewed experts confirmed that sEMG is more frequently employed in technical/methodological than clinical research. Moreover, the slow dissemination of research findings and the lack of education on sEMG seem to prevent prompt transfer into practice. The findings of the present survey may contribute to the ongoing debate on the appropriateness and value of sEMG for neurorehabilitation professionals and its potential translation into clinical settings.
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Affiliation(s)
- Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Andrea Cereatti
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Lynn Bar-On
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Alberto Botter
- Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Ugo Della Croce
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Marco Knaflitz
- Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | | | - Davide Mazzoli
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
| | - Andrea Merlo
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
| | | | - Andrea Turolla
- Laboratory of Rehabilitation Technologies, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Camillo Hospital, Venice, Italy
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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Manca A, Cugusi L, Behm D, Dvir Z, Ferber R, Deriu F. More on "listening to music while running alters ground reaction forces": why women and men pound the ground differently? Eur J Appl Physiol 2020; 121:351-352. [PMID: 32997258 DOI: 10.1007/s00421-020-04517-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 09/25/2020] [Indexed: 10/23/2022]
Affiliation(s)
- A Manca
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, 07100, Sassari, Italy
| | - L Cugusi
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, 07100, Sassari, Italy
| | - D Behm
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's Newfoundland, Canada
| | - Z Dvir
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Ferber
- Running Injury Clinic, University of Calgary, Calgary, AB, Canada
| | - F Deriu
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, 07100, Sassari, Italy.
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Manca A, Ventura L, Martinez G, Aiello E, Deriu F. Contralateral Strength Training as Preparation for Direct Strength Training in a Patient With Unilateral Foot-Drop Because of Multiple Sclerosis: A Case Report. Phys Ther 2020; 100:1816-1824. [PMID: 32691064 DOI: 10.1093/ptj/pzaa127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 12/13/2019] [Accepted: 05/05/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Direct strength training (DST) is effective in managing unilateral weakness in people with multiple sclerosis (MS). Its feasibility, however, is considerably reduced if one limb is too compromised to train. In this case, contralateral strength training (CST) of the unaffected side to induce a strength transfer to the untrained homologous muscles can help to establish a strength baseline in the weaker limb, eventually allowing direct training. Limited effects for CST, however, have been reported on patient functioning. We tested the effects on dynamometric, electromyographic, and functional outcomes of a sequential combination of CST and DST of the ankle dorsiflexors in a case of MS-related foot-drop. METHODS A 56-year-old man diagnosed with relapsing-remitting MS exhibited severe weakness of the right dorsiflexors impairing functional dorsiflexion. The intervention consisted of a 6-week CST of the unaffected dorsiflexors followed by 2 consecutive 6-week DST cycles targeting the weaker dorsiflexors. RESULTS At baseline, the participant could not dorsiflex his right ankle but could do so after CST. Maximal strength of the affected dorsiflexors increased by 80% following CST, by 31.1% following DST-1, and by a further 44.6% after DST-2. Neuromuscular recruitment was found progressively increased, with the largest changes occurring after DST-1. Improvements in mobility and walking speed were also detected, although plantar flexors' spasticity on the Modified Ashworth Scale increased from 1+ to 2. CONCLUSION In this case, the sequential combination of CST and DST proved a feasible approach to manage severe unilateral weakness in a patient who was not able, at least initially, to dorsiflex his weaker ankle. In this perspective, CST may prime a minimum gain in strength necessary to allow subsequent direct training.
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Affiliation(s)
- Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Lucia Ventura
- Department of Biomedical Sciences, University of Sassari
| | | | - Elena Aiello
- Department of Medical, Surgical, and Experimental Sciences, University of Sassari
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, Sassari 07100, Italy. Address all correspondence to Dr Deriu at:
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Cugusi L, Manca A, Sarritzu S, Bergamin M, Gobbo S, Di Blasio A, Massidda M, Cupisti A, Bandiera P, Deriu F. Risk factors associated with low back pain in competitive female gymnasts: A meta-analytic approach. J Sports Sci 2020; 38:2543-2552. [PMID: 32729788 DOI: 10.1080/02640414.2020.1793644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this meta-analysis was to aggregate data from studies investigating the risk factors associated with low back pain (LBP) in competitive gymnasts. Four databases were searched and studies reporting demographics, anthropometrics, functional, psychosocial and gymnastics-practice variables in competitive gymnasts with and without LBP were included. For continuous data, the weighted mean difference (MD) and confidence interval (95% CI) were calculated, while odds or risk ratio (OR, RR) were calculated for dichotomous data. Meta-analysis of six cross-sectional studies involving 284 competitive female gymnasts revealed that artistic were more likely to report LBP compared to rhythmic gymnasts (RR 1.4, 95% CI 1.04-2.0, Z=2.2, p=0.03). Data pooling revealed that age (MD 1.5 years, 95% CI 0.4-2.5, p=0.005) and body weight (MD 3.5 kg, 95% CI 0.1-6.8, p=0.04) were significantly higher in gymnasts with LBP compared to those without. Subgroup-analyses confirmed these differences in artistic but not in rhythmic gymnasts. Moreover, artistic gymnasts with LBP tended to display longer gymnastics-practice history (p=0.09) compared to those without. Increased age, body weight and, to a lesser extent, longer gymnastics-practice appear to differentiate artistic gymnasts with LBP from those without; conversely, these potential risk factors seem less relevant for rhythmic gymnasts.
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Affiliation(s)
- Lucia Cugusi
- Department of Biomedical Sciences, University of Sassari , Sassari, Italy
| | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari , Sassari, Italy
| | - Sara Sarritzu
- Bachelor Degree Course in Physiotherapy, University of Cagliari , Cagliari, Italy
| | - Marco Bergamin
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova , Padova, Italy
| | - Stefano Gobbo
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova , Padova, Italy
| | - Andrea Di Blasio
- Endocrine Section, Department of Medicine and Sciences of Aging, G. d'Annunzio University of Chieti-Pescara , Chieti, Italy
| | - Myosotis Massidda
- Department of Life and Environmental Sciences, University of Cagliari , Monserrato, Italy
| | - Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa , Pisa, Italy
| | - Pasquale Bandiera
- Department of Biomedical Sciences, University of Sassari , Sassari, Italy
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari , Sassari, Italy
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