Harnessing the Power of Artificial Intelligence in Neuromuscular Disease Rehabilitation: A Comprehensive Review and Algorithmic Approach

Neuromuscular diseases present profound challenges to individuals and healthcare systems worldwide, profoundly impacting motor functions. This research provides a comprehensive exploration of how artificial intelligence (AI) technology is revolutionizing rehabilitation for individuals with neuromuscular disorders. Through an extensive review, this paper elucidates a wide array of AI-driven interventions spanning robotic-assisted therapy, virtual reality rehabilitation, and intricately tailored machine learning algorithms. The aim is to delve into the nuanced applications of AI, unlocking its transformative potential in optimizing personalized treatment plans for those grappling with the complexities of neuromuscular diseases. By examining the multifaceted intersection of AI and rehabilitation, this paper not only contributes to our understanding of cutting-edge advancements but also envisions a future where technological innovations play a pivotal role in alleviating the challenges posed by neuromuscular diseases. From employing neural-fuzzy adaptive controllers for precise trajectory tracking amidst uncertainties to utilizing machine learning algorithms for recognizing patient motor intentions and adapting training accordingly, this research encompasses a holistic approach towards harnessing AI for enhanced rehabilitation outcomes. By embracing the synergy between AI and rehabilitation, we pave the way for a future where individuals with neuromuscular disorders can access tailored, effective, and technologically-driven interventions to improve their quality of life and functional independence.

一种评估非接触水下爆炸对海军复合船体影响的设计方法

Despite the non-contact underwater explosion phenomena(UNDEX)have been studied for decades and several numerical methods have been proposed in literature,its effects on military structures,especially composite ones,are even nowadays matter of research.In early design phases,it is not always possible to verify the shock resistance of hull structures modelling the whole phenomenon,in which fluid,gas and solid properties must be properly set in a fully coupled fluid-structure interaction(FSI)numerical model.These ones are extremely complex to set,computationally demanding and certainly not suitable for everyday design practice.In this paper,a simplified finite element(FE)model,easy to use in an early design phase,is proposed.Both,the structure and the fluid are simulated.In this approximation,the fluid behaviour is simplified,using special finite elements,available in a commercial software environment.This choice reduces the computational time and numerical efforts avoiding the problem of combining computational fluid dynamics(CFD)and FE domains and equations in a fully coupled fluid-structure interaction model.A typical parallel body block of a minesweeper is modelled,using two-dimensional multi-layered shell elements to properly account for the composite materials behaviour.For the fluid instead,three dimensional volumetric elements,directly coupled to the structural elements,are placed.In addition,the same calculation is performed,modelling separately fluid in the CFD environment and structures in the finite element one.Thus,realizing a fully coupled fluid-structure interaction model.The results obtained by applying both numerical models are compared with the structural response measured on board of a composite ship during a full-scale shock test.The simplified proposed procedure provides results in satisfactory agreement with experiments,allowing the validation of the model.Approximations are discussed and differences with the real phenomenon and fully coupled CFD+FE method are shown,providing a better understanding of the phenomena.Eventually,the modelling strategy has been considered a valuable and cost-effective tool for the concept and preliminary design of composite structures subject to underwater explosions.

Use of bone morphogenetic proteins in mesenchymal stemcell stimulation of cartilage and bone repair

The extracellular matrix-associated bone morphogenetic proteins(BMPs) govern a plethora of biological processes. The BMPs are members of the transforming growth factor-β protein superfamily, and they actively participate to kidney development, digit and limb formation, angiogenesis, tissue fibrosis and tumor development. Since their discovery, they have attracted attention for their fascinating perspectives in the regenerative medicine and tissue engineering fields. BMPs have been employed in many preclinical and clinical studies exploring their chondrogenic or osteoinductive potential in several animal model defects and in human diseases. During years of research in particular two BMPs, BMP2 and BMP7 have gained the podium for their use in the treatment of various cartilage and bone defects. In particular they have been recently approved for employment in non-union fractures as adjunct therapies. On the other hand, thanks to their potentialities in biomedical applications, there is a growing interest in studying the biology of mesenchymal stem cell(MSC), the rules underneath their differentiation abilities, and to test their true abilities in tissue engineering. In fact, the specific differentiation of MSCs into targeted celltype lineages for transplantation is a primary goal of the regenerative medicine. This review provides an overview on the current knowledge of BMP roles and signaling in MSC biology and differentiation capacities. In particular the article focuses on the potential clinical use of BMPs and MSCs concomitantly, in cartilage and bone tissue repair.

Cardiac toxicity of trastuzumab in elderly patients with breast cancer

乳癌(BC ) 在 &#x02265 被诊断；65 个岁女人在关于盒子的一半。专家们当前建议，那全身的治疗基于他们的全面条件和预期寿命与 BC 被提供给老病人，好处将超过治疗的风险，这能相当被期望。为年轻题目，相似对人的表皮的生长因素 receptor-2 (HER-2 ) 的 monoclonal 抗体， trastuzumab，代表一种有效治疗学的选择什么时候 BC 在表示上这受体。不幸地， trastuzumab 的管理与左室的机能障碍和长期的心失败(CHF ) 的出现被联系，因为有 homeostatic 的干扰，可能在心 HER-2 工作。基于登记的、回顾的分析在在没为 BC 给任何治疗的那些与 10%-15% 相比收到 trastuzumab 的老女人在 25% 附近报导了 CHF 的发生，并且 CHF 的风险被估计了在 &#x0003e 更高双重；60-65 岁 trastuzumab 用户对非用户。极其先进的年龄和先存在的心脏病被显示了预先安排到 trastuzumab cardiotoxicity。因此，为有 trastuzumab 的治疗的更老的病人的选择应该主要基于他们的一般地位和 comorbidities 的存在；特别与 anthracyclines，以前的化疗应该也被考虑。一旦治疗开始了，努力应该被作保证常规心脏的监视。选择 biomarkers 的角色，例如心脏的 troponin，或新成像技术(三尺寸，织物 Doppler echocardiography，磁性的回声成像) 是有希望的，但是必须进一步在特别被调查老。而且，另外的研究被需要以便更好理解 trastuzumab 由影响旧心的机制。

Outcome of nonerosive gastro-esophageal reflux disease patients with pathological acid exposure

AIM: To assess the management and outcome of nonerosive gastro-esophageal reflux disease (NERD) patients who were identified retrospectively, after a 5-year follow-up.METHODS: We included patients with gastro-esophageal reflux disease (GERD) symptoms who had a negative endoscopy result and pathological 24-h esophageal pH-monitoring while off therapy. We interviewed them after an average period of 5 years (range 3.5-7 years) by means of a structured questionnaire to assess presence of GERD symptoms, related therapy, updated en-doscopic data and other features. We assessed predictors of esophagitis development by means of univariate and multivariate statistical analysis.RESULTS: 260 patients (137 women) were included. Predominant GERD symptoms were heartburn andregurgitation in 103/260 (40%). 70% received a maintenance treatment, which was proton pump inhibitor (PPI) in 55% of cases. An average number of 1.5 symptomatic relapses per patient/year of follow-up were observed. A progression to erosive gastro-esophageal reflux disease (ERD) was found in 58/193 (30.0%) of patients undergoing repeat endoscopy; 72% of these were Los Angeles grade A-B. CONCLUSION: This study shows that progression to ERD occurs in about 5% of NERD cases per year, despite therapy. Only two factors consistently and independently influence progression: smoking and absence of PPI therapy.

Clinical characteristics and prognostic impact of atrial fibrillation in patients with chronic heart failure

AIM To assess the prevalence, clinical characteristics and independent prognostic impact of atrial fibrillation(AF) in chronic heart failure(CHF) patients, and the potential protective effect of disease-modifying medications, particularly beta-blockers(BB). METHODS We retrospectively reviewed the charts of patients referred to our center since January 2004, and collected all clinical information available at their first visit. We assessed mortality to the end of June 2015. We compared patients with and without AF, and assessed the association between AF and all-cause mortality by multivariate Cox regression and Kaplan-Meyer analysis, particularly accounting for ongoing treatment with BB.RESULTS A total of 903 patients were evaluated(mean age 68 ± 12 years, 73% male). Prevalence of AF was 19%, ranging from 10% to 28% in patients ≤ 60 and ≥ 77 years, respectively. Besides the older age, patients with AF had more symptoms(New York Heart Association II-III 60% vs 44%), lower prevalence of dyslipidemia(23% vs 37%), coronary artery disease(28% vs 52%) and left bundle branch block(9% vs 16%). On the contrary, they more frequently presented with an idiopathic etiology(50% vs 24%), a history of valve surgery(13% vs 4%) and received overall more devices implantation(31% vs 21%). The use of disease-modifying medications(i.e., BB and ACE inhibitors/angiotensin receptor blockers) was lower in patients with AF(72% vs 80% and 71% vs 79%, respectively), who on the contrary were more frequently treated with symptomatic and antiarrhythmic drugs including diuretics(87% vs 69%) and digoxin(51% vs 11%). At a mean follow-up of about 5 years, all-cause mortality was significantly higher in patients with AF as compared to those in sinus rhythm(SR)(45% vs 34%, P value < 0.05 for all previous comparisons). However, in a multivariate analysis including the main significant predictors of allcause mortality, the univariate relationship between AF and death(HR = 1.49, 95%CI: 1.15-1.92) became not statistically significant(HR = 0.98, 95%CI: 0.73-1.32). Nonetheless, patients with AF not receiving BB treatment were found to have the worst prognosis, followed by patients with SR not receiving BB therapy and patients with AF receiving BB therapy, who both had similarly worse survival when compared to patients with SR receiving BB therapy.CONCLUSION AF was highly prevalent and associated with older age, worse clinical presentation and underutilization of disease-modifying medications such as BB in a population of elderly patients with CHF. AF had no independent impact on mortality, but the underutilization of BB in this group of patients was associated to a worse long-term prognosis.

Numerical Evaluation of Rudder Performance Behind a Propeller in Bollard Pull Condition

Correct evaluation of rudder performance is a key issue in assessing ship maneuverability.This paper presents a simplified approach based on a viscous flow solver to address propeller and rudder interactions.Viscous flow solvers have been applied to this type of problems,but the large computational requests limit(or even prevent)their application at a preliminary ship design stage.Based on this idea,a simplified approach to include the propeller effect in front of the rudder is considered to speed up the solution.Based on the concept of body forces,this approach enables sufficiently fast computation for a preliminary ship design stage,therebymaintaining its reliability.To define the limitations of the proposed procedure,an extensive analysis of the simplified method is performed and the results are compared with experimental data presented in the literature.Initially,the reported results show the capability of the body-force approach to represent the inflow field to the rudder without the full description of the propeller,also with regard to the complex bollard pull condition.Consequently,the rudder forces are satisfactorily predicted at least with regard to the lift force.However,the drag force evaluation ismore problematic and causes higher discrepancies.Nevertheless,these discrepancies may be accepted due to their lower influence on the overall ship maneuverability performance.

The Fourier Notation of the Geomagnetic Signals Informative Parameters

The paper discusses the quantitative definition of the s/n (signal to noise ratio) by means of new computational parameters derived (and computed) by the Fourier analysis. The theme is of great relevance when the geomagnetic observed field has high transient noise and high energy content (i.e.geomagnetic signal interfered by human activity magnetic band) and when the signal analysis action is oriented to the detection of magnetic sources characterized by quasi-punctiform size, low energy level and kinetic mechanical status (i.e.uw armed terrorist). The paper shows the results obtained introducing two new informative spectral parameters: the informative capability “C” and the enhanced informative capability “eC”. These parameters are depending on the comparison of the energy of the target signal with total field energy and they are characteristics of each elementary signal. C classifies the energy of the spectrum in two metrological bands: elementary signal informative energy EI (band or single signal) and passive energy EP. This metrological classification of the energy overtakes the concept of noise: each signal is part of the noise band when it is not under observation and becomes out of the band when it is under observation (numerical observation→computation). C (and eC) allows to compute the value of the “visibility” of the informative signals in a high energy geomagnetic field (or spectrum). C is a fundamental parameter for the evaluation of the effectiveness of singularity magnetic metrology in the passive detection of small magnetic sources in high noised magnetic field.

Impact of living with bipolar patients: Making sense of caregivers' burden

The aim of the present review was to examine objective and subjective burdens in primary caregivers(usually family members) of patients with bipolar disorder(BD) and to list which symptoms of the patients are considered more burdensome by the caregivers. In order to provide a critical review about caregiver's burden in patients with bipolar disorder, we performed a detailed Pub Med, Bio Med Central, ISI Web of Science, Psyc INFO, Elsevier Science Direct and Cochrane Library search to identify all papers and book chapters in English published during the period between 1963 and November 2011. The highest levels of distress were caused by the patient's behavior and the patient's role dysfunction(work, education and social relationships). Furthermore, the caregiving role compromises other social roles occupied by the caregiver, becoming part of the heavy social cost of bipolar affective disorder. There is a need to better understand caregivers' views and personal perceptions of the stresses and demands arising from caring for someone with BD in order to develop practical appropriate interventions and to improve the training of caregivers.

Prevalence and prognostic value of cardiac troponin in elderly patients hospitalized for COVID-19

BACKGROUND Increases in cardiac troponin(cTn)in coronavirus disease 2019(COVID19)have been associated with worse prognosis.Nonetheless,data about the significance of cTn in elderly subjects with COVID19 are lacking.METHODS From a registry of consecutive patients with COVID19 admitted to a hub hospital in Italy from 25/02/2020 to 03/07/2020,we selected those≥60 yearold and with cTnI measured within three days from the molecular diagnosis of SARSCoV2 infection.When available,a second cTnI value within 48 h was also extracted.The relationship between increased cTnI and allcause inhospital mortality was evaluated by a Cox regression model and restricted cubic spline functions with three knots.RESULTS Of 343 included patients(median age:75.0(68.0−83.0)years,34.7%men),88(25.7%)had cTnI above the upperreference limit(0.046μg/L).Patients with increased cTnI had more comorbidities,greater impaired respiratory exchange and higher inflammatory markers on admission than those with normal cTnI.Furthermore,they died more(73.9%vs.37.3%,P<0.001)over 15(6−25)days of hospitalization.The association of elevated cTnI with mortality was confirmed by the adjusted Cox regression model(HR=1.61,95%CI:1.06−2.52,P=0.039)and was linear until 0.3μg/L,with a subsequent plateau.Of 191(55.7%)patients with a second cTnI measurement,49(25.7%)had an increasing trend,which was not associated with mortality(univariate HR=1.39,95%CI:0.87−2.22,P=0.265).CONCLUSIONS In elderly COVID19 patients,an initial increase in cTn is common and predicts a higher risk of death.Serial cTn testing may not confer additional prognostic information.

Role of myelin sheath energy metabolism in neurodegenerative diseases

More than any other organs,brain energy demand is entirely dependent on glucose catabolism through the oxidative phosphorylation（OXPHOS）.Glucose is the major cerebral energy substrate in the nervous system（NS）.Ketone bodies can be utilized as an additional substrate,but in any case,neurons critically depend on oxygen supply.

Endoscopic mucosal resection of large hyperplastic polyps in 3 patients with Barrett’s esophagus

AIM: To report the endoscopic treatment of large hyperplastic polyps of the esophagus and esophago- gastric junction (EGJ) associated with Barrett’s esophagus (BE) with low-grade dysplasia (LGD), by endoscopic mucosal resection (EMR). METHODS: Cap fitted EMR (EMR-C) was performed in 3 patients with hyperplastic-inflammatory polyps (HIPs) and BE. RESULTS: The polyps were successfully removed in the 3 patients. In two patients, with short segment BE (SSBE) (≤ 3 cm), the metaplastic tissue was completely excised. A 2 cm circumferential EMR was performed in one patient with a polyp involving the whole EGJ. A simultaneous EMR-C of a BE-associated polypoid dysplastic lesion measuring 1 cm x 10 cm, was also carried out. In the two patients, histologic assessment detected LGD in BE. No complications occurred. Complete neosquamous re- epithelialization occurred in the two patients with SSBE. An esophageal recurrence occurred in the remaining one and was successfully retreated by EMR. CONCLUSION: EMR-C appears to be a safe and effective method for treating benign esophageal mucosal lesions, allowing also the complete removal of SSBE.

Feasibility of en bloc thulium laser enucleation of the prostate in a large case series. Are results enhanced by experience?

Objective:To provide the first large single-operator case series of patients who undergo“en bloc”thulium laser enucleation of the prostate(ThuLEP)and to demonstrate an improvement in enucleation efficacy with experience.Methods:We prospectively evaluated a cohort of patients with symptomatic benign prostatic hyperplasia(BPH)who underwent“en bloc”ThuLEP between May 2015 and November 2017.Association between dependent variables(delivered energy and operating time)and independent variables(adenoma volume and experience)were estimated with regression analysis.The experience was calculated as the time interval between the date of the first operation of the series and the date of the operation being considered.Results:A total of 100 patients were registered for the study.Median operative time was 56.5 min(interquartile range[IQR]:40-85 min).Median enucleation time was 17.4 min(IQR:15-21.5 min).Median enucleation index(enucleation time per adenoma gram)was 0.3 min/g(0.2-0.3 min/g).The overall operative time is not influenced by experience,but we registered a significant trend towards a reduction in the total amount of energy delivered energy normalized per adenoma gram(p=0.0148).Conclusion:We believe that further attention is needed for these new“en bloc”prostatic enucleation techniques,which can facilitate some surgical steps,leading to a widespread use of laser technology for BPH surgical treatment.

White matter abnormalities:Insights into the pathophysiology of major affective disorders

The presence of white matter hyperintensities(WMHs) has been commonly associated with poor outcome in subjects with major affective disorders. Unfortunately, WMHs may be frequently confounded by the use of psychoactive medications and duration of illness. Al-though findings from the current literature are quite conflicting, we proposed that subjects with WMHs may be at higher suicidal risk when compared to other sub-groups without. Based on the Fazekas modified scale, the severity of WMHs may serve as a trait marker of disease. Interestingly, the presence of WMHs may rep-resent a neurobiological marker between the underlying vulnerability and clinical presentation of major affective disorders.

The role of defects association in structural and transport properties of the Ce_(1-x)(Nd_(0.74)Tm_(0.26))_xO_(2-x/2) system

An experimental investigation of the crystallographic,Raman and transport properties of the Ce_(1-x)(Nd_(0.74)Tm_(0.26))_xO_(2-x/2)(0.1≤x≤0.6) doped ceria system was performed with the aim of setting out correlations between structural features and ionic conductivity of the material.The chosen composition ensures that the average size of the Nd^(3+) and Tm^(3+) doping ions coincides with the one of Sm^(3+);even so,the studied system presents larger cell parameters and a wider compositional extent of the CeO_(2)-based solid solution than Sm-doped ceria.Moreover,the occurrence of two different activation energies to ionic conduction below and above ~750 K determines the existence of two distinct conduction regimes.The described experimental results agree with the formation below the threshold temperature of1 V_O2 Tm'_(Ce) trimers,which promote the incorporation of Nd'_(Ce) isolated defects into the CeO_(2)-based solid solution.In the high temperature range the dissociation of trimers induces the appearance of a lower activation energy;the extrapolation of its value at infinite dilution provides a result in good accordance with the expected binding energy of 1 V_ORE'_(Ce) dimers,pointing at their stability even in the high temperature conduction regime.

Histopathological landscape of rare oesophageal neoplasms

The landscape of neoplastic pathology of the oesophagus is dominated by malignancies of epithelial origin,in particular by oesophageal adenocarcinoma and oesophageal squamous cell carcinoma.However,several other histopathological variants can be distinguished,some associated with peculiar histopathological profiles and prognostic behaviours and frequently underrecognized in clinical practice.The aim of this review is to provide a comprehensive characterization of the main morphological and clinical features of these rare variants of oesophageal neoplastic lesions.

Design of a Centrifugal Compressor for Micro Gas Turbine: Investigation of Scaling and Tip Clearance Effects

The aim of this paper is to investigate the design in similarity of a centrifugal compressor for micro gas turbine and the related scaling effects on performance using CFD investigations. This work is part of a research project carried out by the Department DIME of the University of Genova, with the purpose of investigating the performance of a micro gas turbine in the change from 100 kW electrical output to 250 kW, while maintaining the compressor pressure ratio and geometry in similarity. The first part of the work focuses on the comparison between the original and the scaled machine, while the second part of the study deeply investigates the tip gap effect in the new configuration. The aim is to provide information about the performance of the compressor designed in geometrical similarity and to evaluate the tip gap height impact. From the efficiency point of view, the scaled-up machine has higher efficiency (up to 1.4% increment in design conditions) keeping the same technological limit for impeller manufacturing. However, the variation of tip gap height in the range 0 ÷ 1 mm strongly affects this parameter, leading to 10% alteration in design conditions between the ideal and worst case. The results, both in terms of overall performance and flow fields, are widely discussed in order to obtain simple yet reliable correlation for preliminary design.

Therapeutic termination of pregnancy and women’s mental health:Determinants and consequences

The therapeutic termination of pregnancy(TToP)is an induced abortion following a diagnosis of medical necessity.TToP is applied to avoid the risk of substantial harm to the mother or in cases of fetal unviability.This type of induced abortion is provided after the second semester of gestation if fetal illness or the pregnancy cause physical danger or pathological mental distress to the mother.Sociocultural and economic determinants could influence the desire for children and family planning in couples,as well as the use of effective contraception and the choice to perform an induced abortion.Also,pre-existing mental health problems could affect the decision between carrying on a problematic pregnancy or having TToP.Furthermore,the TToP is a reproductive event with an important traumatic burden,but also with an intrinsic therapeutic effect and it can produce different psychological and psychopathological effects on women and couples.The aim of this review is to evaluate what demographic,reproductive and psychopathological determinants are involved in the choice of undergoing a TToP in women.Also,we will examine both positive and negative consequences of this procedure on women’s mental health,underlying which factors are related to a worse outcome in order to provide the best clinical support to vulnerable groups.

Experimental Assessment of the Battery Lifetime in WSN Based on the <i>Duty</i>-<i>Cycle</i><i>Current</i><i>Average</i>Method

A great amount of work addressed methods for predicting the battery lifetime in wireless sensor systems. In spite of these efforts, the reported experimental results demonstrate that the duty-cycle current average method, which is widely used to this aim, fails in accurately estimating the battery life time of most of the presented wireless sensor system applications. The aim of this paper is to experimentally assess the duty-cycle current average method in order to give more effective insight on the effectiveness of the method. An electronic metering system, based on a dedicated PCB, has been designed and developed to experimentally measure node current consumption profiles and charge extracted from the battery in two selected case studies. A battery lifetime measurement (during 30 days) has been carried out. Experimental results have been assessed and compared with estimations given by using the duty-cycle current average method. Based on the measurement results, we show that the assumptions on which the method is based do not hold in real operating cases. The rationality of the duty-cycle current average method needs reconsidering.