Paolo Castiglioni

Fondazione Don Carlo Gnocchi | Don Gnocchi · Biomedical Technology Department

Background The role played by sympathetic and parasympathetic autonomic branches in patients with Parkinson's disease carrying variants in the GBA1 gene (GBA‐PD) is still elusive. Objectives To characterize cardiovascular autonomic function in GBA‐PD and I‐PD patients with early and mid‐stage disease. Methods These assessments were performed: car...

Individuals with Down Syndrome exhibit deficits in muscle strength and cardiovascular adaptation, which limit athletic performance. We compared a maximum-intensity 50 m front crawl test between competitive male swimmers with Down Syndrome (SDS; n = 11; 26.5 ± 5.6 years; m ± SD) and a control group of swimmers (CNT; n = 11; 27.1 ± 4.0 years) with si...

Little is known about the effect of using an attentional focus instruction on motor performance in people with intellectual disabilities. Therefore, this study explored the effects of different attentional focus instructions on gross motor skill performances in individuals with Down syndrome. Seven community-dwelling participants (age 25.2±3.2 yrs,...

Background: Multisystem Inflammatory Syndrome in Children (MIS-C) has emerged as a severe pediatric complication during the SARS-CoV-2 pandemic, with potential long-term cardiovascular repercussions. We hypothesized that heart rate and blood pressure control at rest and during postural maneuvers in MIS-C patients, months after the remission of the...

A stroke represents a significant medical condition characterized by the sudden interruption of blood flow to the brain, leading to cellular damage or death. The impact of stroke on individuals can vary from mild impairments to severe disability. Treatment for stroke often focuses on gait rehabilitation. Notably, assessing muscle activation and kin...

Continuous adaptations of the movement system to changing environments or task demands rely on superposed fractal processes exhibiting power laws, that is, multifractality. The estimators of the multifractal spectrum potentially reflect the adaptive use of perception, cognition, and action. To observe time-specific behavior in multifractal dynamics...

Objective: Promising methods for monitoring blood pressure (BP) are based on the Pulse Arrival Time (PAT) from finger photoplethysmography (PPG). This study aims to investigate the impact of PPG fiducial points, wavelengths, and PAT calibration models on short-term BP estimations. Methods: A multi-wavelength multi-sensor PPG device was developed to...

There is a growing interest in photoplethysmography (PPG) for the continuous monitoring of cardio-respiratory signals by portable instrumentation aimed at the early diagnosis of cardiovascular diseases. In this context, it is conceivable that PPG sensors working at different wavelengths simultaneously can optimize the identification of apneas and t...

Background: There is intense effort to develop cuffless blood pressure (BP) measuring devices, and several are already on the market claiming that they provide accurate measurements. These devices are heterogeneous in measurement principle, intended use, functions, and calibration, and have special accuracy issues requiring different validation th...

We assessed the capability of an integrated multisensory patch-type monitor (RootiRx®) in detecting episodes of reflex (pre)syncope induced by tilt table test (TTT). Firstly, we performed an intrapatient comparison of cuffless systolic blood pressure (SBP), R–R interval (RRI) and variability (power spectrum analysis) obtained by means of the RootiR...

Introduction: Orthostatic dysregulation occurs during exposure to an increased gravitational vector and is especially common upon re-entering standard Earth gravity (1 g) after an extended period in microgravity (0 g). External peripheral skin cooling (PSC) has recently been described as a potent countermeasure against orthostatic dysregulation dur...

The combination of noradrenergic (reboxetine) plus antimuscarinic (oxybutynin) drugs (reb-oxy) reduced obstructive sleep apnea (OSA) severity but no data are available on its effects on cardiac autonomic modulation. We sought to evaluate the impact of 1-week reb-oxy treatment on cardiovascular autonomic control in OSA patients. OSA patients were ra...

Little is known on the effects of respiratory patterns on baroreflex function in heart failure (HF). Patients with HF (n = 30, age 61.6 ± 10 years, mean ± SD) and healthy controls (CNT, n = 10, age 58.9 ± 5.6 years) having their R–R interval (RRI, EKG), systolic arterial blood pressure (SBP, Finapres) and respiratory signal (RSP, Respitrace) monito...

Distribution Entropy (DistEn) has been introduced as an alternative to Sample Entropy (SampEn) to assess the heart rate variability (HRV) on much shorter series without the arbitrary definition of distance thresholds. However, DistEn, considered a measure of cardiovascular complexity, differs substantially from SampEn or Fuzzy Entropy (FuzzyEn), bo...

Blood pressure is not a static parameter, but rather undergoes continuous fluctuations over time, as a result of the interaction between environmental and behavioural factors on one side and intrinsic cardiovascular regulatory mechanisms on the other side. Increased blood pressure variability (BPV) may indicate an impaired cardiovascular regulation...

In summary, this edited volume proves that methods are vital for innovation in the field of Computational Physiology and Medicine. It also highlighted the transitions the field is undergoing in respect to the methodological approaches. While increasing sophistication drives specialised expertise, multidisciplinary approaches become indispensable fo...

Background Sleep disordered breathing (SDB) may trigger nocturnal cardiac arrhythmias (NCA) in patients with heart failure with reduced ejection fraction (HFrEF). The NCA ancillary study of the ADVENT-HF trial will test whether, in HFrEF-patients with SDB, peak-flow-triggered adaptive servo-ventilation (ASVpf) reduces NCA. To this end, accurate sco...

Background Novel smartwatch-based cuffless blood pressure (BP) measuring devices are coming to market and receive FDA and CE labels. These devices are often insufficiently validated for clinical use. This study aims to investigate a recently CE-cleared smartwatch using cuffless BP measurement in a population with normotensive and hypertensive indiv...

Objective Psychopathology (and depression in particular) is a cardiovascular risk factor independent from any co-occurring pathology. This link is traced back to the mind-heart-body connection, whose underlying mechanisms are still not completely known. To study psychopathology in relation to the heart, it is necessary to observe the autonomic nerv...

Type 1 diabetes mellitus (T1DM) has an important impact on morbidity and mortality because it may start early in life. Therefore, the early detection of cardiovascular autonomic neuropathy (DCAN) in T1DM patients is important to intervene quickly and prevent further deterioration. Traditional autonomic function tests detect abnormalities in severel...

Mobile-health solutions based on heart rate variability often require electrocardiogram (ECG) recordings by inexperienced operators or real-time automatic analyses of long-term recordings by wearable devices in free-moving individuals. In this context, it is useful to associate a quality index with the ECG, scoring the adequacy of the recording for...

OBJECTIVE: To investigate whether any association exists between the heart rate variability measurements and sub-threshold depressive symptoms in a sample of healthy adult subjects. Methods: In this cross-sectional study, two short-term HRV recordings (5 min-supine and sitting) have been analyzed in 77 healthy adult subjects. Here we adopted a thre...

The interest in photoplethysmography (PPG) for sleep monitoring is increasing because PPG may allow assessing heart rate variability (HRV), which is particularly important in breathing disorders. Thus, we aimed to evaluate how PPG wearable systems measure HRV during sleep at high altitudes, where hypobaric hypoxia induces respiratory disturbances....

Aims Autonomic dysfunction is a prevalent and independent risk factor for adverse cardiovascular events and mortality in chronic coronary syndrome (CCS). Beta-blockers (BB), directly inhibiting adrenergic receptors, have been associated with a significant reduction in mortality and/or cardiovascular events in patients with recent acute coronary syn...

Aims Takotsubo Syndrome (TS) occurs as an acute coronary syndrome (ACS) characterized by severe left ventricular (LV) dysfunction that typically recovers spontaneously within days or weeks and in the absence of obstructive coronary artery disease. Although during the acute phase it is well documented that an exaggerated sympathetic tone plays a cen...

The efficacy of cardiac rehabilitation in heart-failure patients who received a left-ventricular assist device (LVAD) instead of heart transplantation (HTx) is still unclear. This study aims to evaluate whether cardiac rehabilitation is beneficial in LVAD as HTx patients in the short term and whether its effects in LVAD patients persist over time....

The Detrended Fluctuation Analysis (DFA) is a popular method for quantifying the self-similarity of the heart rate that may reveal complexity aspects in cardiovascular regulation. However, the self-similarity coefficients provided by DFA may be affected by an overestimation error associated with the shortest scales. Recently, the DFA has been exten...

Recent advancements in detrended fluctuation analysis (DFA) allow evaluating multifractal coefficients scale-by-scale, a promising approach for assessing the complexity of biomedical signals. The multifractality degree is typically quantified by the singularity spectrum width ( W SS ), a method that is critically unstable in multiscale applications...

Background: Although we recently reported that a noradrenergic (reboxetine) plus an antimuscarinic (oxybutynin) drugs (reb-oxy) greatly reduced obstructive sleep apnea (OSA) severity, no data are available about the risk of sympathetic overactivity in response to noradrenergic drug intake. We aim to evaluate the impact on the cardiovascular autonom...

The red blood cell distribution width (RDW) measures the variability in the size of circulating erythrocytes. Previous studies suggested a powerful correlation between RDW obtained from a standard complete blood count and cardiovascular diseases in both primary and secondary cardiovascular prevention. The current study aimed to evaluate the prognos...

We read with interest the inspiring work of Borin et al. and we agree with the authors that modified multiscale fuzzy entropy (MMFE) is a promising tool for evaluating short signals over multiple scales. However, we want to underline two methodological aspects: one, to better reflect the state-of-the-art of the entropy estimates; the other, to miti...

Long-duration Antarctic expeditions are characterized by isolation, confinement, and extreme environments. Here we describe the time course of cardiac autonomic modulation assessed by heart rate variability (HRV) during 14-month expeditions at the German Neumayer III station in Antarctica. Heart rate recordings were acquired in supine position in t...

Aortic stiffness (AS), defined as the elastic resistance to deformation resulting from complex interactions between vascular smooth muscle cells and the extracellular matrix is a marker of increased cardiovascular (CV) risk and mortality. Age, hypertension, diabetes, atherosclerosis, and chronic kidney disease may represent the most important contr...

The idea that most physiological systems are complex has become increasingly popular in recent decades [...]

Recent developments of detrended fluctuation analysis (DFA) provide multifractal/multiscale (MFMS) descriptions of the heart rate self-similarity, a promising approach to cardiovascular complexity. However, it is unclear whether the MFMS DFA may also describe the nonlinear components of heart rate variability. Our aim is to define MFMS DFA indices...

Objective: Although it is known that increased visit-to-visit or home day-by-day variability of blood pressure (BP), independently of its average value, results in an increased risk of cardiovascular events, the prognostic value of in-hospital day-by-day BP variability in secondary cardiovascular prevention has not yet been established. Methods:...

Inflammation is associated with atrial fibrillation (AF), but little is known about the association of AF with the inflammatory serum cytokines after the acute postoperative phase. Thus, we aimed to explore how plasma cytokines concentrations modify during a 3-week cardiac rehabilitation after heart surgery, comparing patients who developed postope...

The surface electromyography (sEMG) records the electrical activity of muscle fibers during contraction: one of its uses is to assess changes taking place within muscles in the course of a fatiguing contraction to provide insights into our understanding of muscle fatigue in training protocols and rehabilitation medicine. Until recently, these myoel...

: Recently, a multifractal-multiscale approach to detrended fluctuation analysis (DFA) was proposed to evaluate the cardiovascular fractal dynamics providing a surface of self-similarity coefficients α(q,τ), function of the scale τ, and moment order q. We hypothesize that this versatile DFA approach may reflect the cardiocirculatory adaptations in...

Background The higher cardiovascular variability and the increased prevalence of arrhythmias in patients with obstructive sleep apneas may contribute to their higher rate of fatal events during sleep. In this regard, the use of beta blockers (BB) is debated because they may induce bradyarrhythmias and alter the pattern of heart rate changes induced...

Stays at high altitude induce alterations in cardiovascular control and are a model of specific pathological cardiovascular derangements at sea level. However, high-altitude alterations of the complex cardiovascular dynamics remain an almost unexplored issue. Therefore, our aim is to describe the altered cardiovascular complexity at high altitude w...

The Detrended Fluctuation Analysis (DFA) is widely employed to quantify the fractal dynamics of R-R intervals (RRI). This is usually done by estimating a short- and a long-term coefficient, but it is still unclear how much the information provided by such a bi-scale DFA is independent of that of traditional spectral indices. However, more sophistic...

Objective: While several studies assessed the autonomic cardiovascular control after a spinal cord lesion by heart rate variability (HRV) indices in the frequency and time domain, complexity measures were rarely used, even if Detrended Fluctuation Analysis (DFA) appeared promising. Recent DFA developments decompose the multifractal contributions b...

Multiscale entropy (MSE) provides information-domain measures of the systems’ complexity. The increasing interest in MSE of the cardiovascular system lies in the possibility of detecting interactions with other regulatory systems, as higher neural networks. However, most of the MSE studies considered the heart-rate (HR) series only and a limited nu...

Complexity is ubiquitous among physiological systems, originating from fractal structures, self-organization, nonlinearity, interactions at different levels/scales and interconnections through physiological networks. Biomedical signals carry information on the system complexity that may help to monitor the health conditions or to predict pathologic...

Closed-loop models of the interactions between blood pressure (BP) and heart rate variations allow for estimation of baroreflex sensitivity (feedback effects of BP changes on heart rate) while also considering the feedforward effects of heart rate on BP. Our study is aimed at comparing modulations of feedback and feedforward couplings over 24 h in...

Detrended fluctuation analysis (DFA) is a popular tool in physiological and medical studies for estimating the self-similarity coefficient, α, of time series. Recent researches extended its use for evaluating multifractality (where α is a function of the multifractal parameter q) at different scales n. In this way, the multifractal-multiscale DFA p...

Baroreflex dysfunction is a diffuse chronic condition that is expected to be followed by a profound loss of organization of BP and HR variability. Nevertheless, long-term effects of baroreflex withdrawal are still debated. Aim of our work was to study BP and HR changes long term after sino-aortic denervation (SAD). Inter-beat-interval (IBI) and int...

Head-down-tilt bed rest (HDT) mimics the changes in hemodynamics and autonomic cardiovascular control induced by weightlessness. However, the time course and reciprocal interplay of these adaptations, and the effective exercise protocol as a countermeasure need further clarification. The overarching aim of this work (as part of a European Space Age...

Anxiety and depression are thought to influence the genesis of ischemic diseases and not of valvular diseases, but little is known on the psychological profile of cardiac patients after surgery. Aim of this study was to investigate differences in disease experience and mood between patients undergoing cardiac rehabilitation after coronary artery by...

Cardiovascular events in hypertensives are associated with elevated average blood pressure (BP) and higher short-term BP variability (V), but little is known on treatment effects on BPV and on how to assess changes in short-term BPV. Aim of our study was to address the methodology of short-term BPV assessment and its reduction by Lercanidipine (L)...

The autonomic response to pain might discriminate among consciousness disorders. Therefore, aim of this study was to describe differences between minimally conscious state (MCS) and unresponsive wakefulness syndrome (UWS) patients in their autonomic response to a nociceptive stimulus. ECG, respiration, finger blood pressure (BP) and total periphera...

Individual scores of the Nociception Coma Scale. (DOCX)

Short-term analysis: Individual increments from “reference” to “stimulus” and to “response” conditions. Individual increments of the parameters HR, SBP, DBP, SV and TPR from “reference” to “stimulus” and to “response” conditions in the short-term analysis. (DOCX)

Long-term analysis: Individual values in “reference” and “response” conditions. Individual increments of the parameters HR, SBP, DBP, SV and TPR from “reference” to “stimulus” and to “response” conditions in the long-term analysis. (DOCX)

Background: An abnormal frontal QRS-T angle (fQRSTa) is associated with increased risk of death in primary and secondary cardiovascular prevention. The aim of this study was to evaluate the fQRSTa prognostic role in patients undergoing myocardial revascularization and/or cardiac valve surgery. Methods: We enrolled and prospectively followed for...

Heart transplant (HTx) and left ventricular assist device (LVAD) implant are the best options for symptomatic end stage heart failure, but LVAD patients show lower rehabilitative outcome than HTx patients. To investigate the causes, we compared biomarkers levels and their association with rehabilitative outcome in 51 HTx and in 46 LVAD patients ent...