Bioethanol lignin-rich residue from olive stones for electrospun nanostructures development and castor oil structuring.

This work describes the chemical and structural characterization of a lignin-rich residue from the bioethanol production of olive stones and its use for nanostructures development by electrospinning and castor oil structuring. The olive stones were treated by sequential acid/steam explosion pretreatment, further pre-saccharification using a hydrolytic enzyme, and simultaneous saccharification and fermentation (PSSF). The chemical composition of olive stone lignin-rich residue (OSL) was evaluated by standard analytical methods, showing a high lignin content (81.3 %). Moreover, the structural properties were determined by Fourier-transform infrared spectroscopy, nuclear magnetic resonance, and size exclusion chromatography. OSL showed a predominance of ß-ß' resinol, followed by ß-O-4' alkyl aryl ethers and ß-5' phenylcoumaran substructures, high molecular weight, and low S/G ratio. Subsequently, electrospun nanostructures were obtained from solutions containing 20 wt% OSL and cellulose triacetate with variable weight ratios in N, N-Dimethylformamide/Acetone blends and characterized by scanning electron microscopy. Their morphologies were highly dependent on the rheological properties of polymeric solutions. Gel-like dispersions can be obtained by dispersing the electrospun OSL/CT bead nanofibers and uniform nanofiber mats in castor oil. The rheological properties were influenced by the membrane concentration and the OSL:CT weight ratio, as well as the morphology of the electrospun nanostructures.

Senescent Schwann cells induced by aging and chronic denervation impair axonal regeneration following peripheral nerve injury.

Following peripheral nerve injury, successful axonal growth and functional recovery require Schwann cell (SC) reprogramming into a reparative phenotype, a process dependent upon c-Jun transcription factor activation. Unfortunately, axonal regeneration is greatly impaired in aged organisms and following chronic denervation, which can lead to poor clinical outcomes. While diminished c-Jun expression in SCs has been associated with regenerative failure, it is unclear whether the inability to maintain a repair state is associated with the transition into an axonal growth inhibition phenotype. We here find that reparative SCs transition into a senescent phenotype, characterized by diminished c-Jun expression and secretion of inhibitory factors for axonal regeneration in aging and chronic denervation. In both conditions, the elimination of senescent SCs by systemic senolytic drug treatment or genetic targeting improved nerve regeneration and functional recovery, increased c-Jun expression and decreased nerve inflammation. This work provides the first characterization of senescent SCs and their influence on axonal regeneration in aging and chronic denervation, opening new avenues for enhancing regeneration and functional recovery after peripheral nerve injuries.

Green solvents extraction-based detoxification to enhance the enzymatic hydrolysis of steam-exploded lignocellulosic biomass and recover bioactive compounds.

A novel strategy for pre-treated biomass detoxification combining emerging green solvents and low environmental impact extraction technologies was evaluated. Steam-exploded biomass was subjected to microwave-assisted or orbital shaking extraction using bio-based or eutectic solvents. The extracted biomass was enzymatically hydrolysed. The potential of this detoxification methodology was studied in terms of phenolic inhibitors extraction and sugar production improvement. The effect of adding a post-extraction water washing step before hydrolysis was also evaluated. Excellent results were achieved when steam-exploded biomass was subjected to the microwave-assisted extraction combined with the washing step. The highest sugar production was achieved when ethyl lactate was used as extraction agent (49.80 ± 3.10 g total sugar/L) over the control (30.43 ± 0.34 g total sugar/L). Results suggested that a detoxification step based on green solvents would be a promising option to extract phenolic inhibitors, which can be revalorized as antioxidants, and improve the sugar production from the extracted pre-treated biomass.

Enzyme-Catalyzed Polymerization of Kraft Lignin from Eucalyptus globulus: Comparison of Bacterial and Fungal Laccases Efficacy.

Kraft lignin, a side-stream from the pulp and paper industry, can be modified by laccases for the synthesis of high added-value products. This work aims to study different laccase sources, including a bacterial laccase from Streptomyces ipomoeae (SiLA) and a fungal laccase from Myceliophthora thermophila (MtL), for kraft lignin polymerization. To study the influence of some variables in these processes, a central composite design (CCD) with two continuous variables (enzyme concentration and reaction time) and three levels for each variable was used. The prediction of the behavior of the output variables (phenolic content and molecular weight of lignins) were modelled by means of response surface methodology (RSM). Moreover, characterization of lignins was performed by Fourier-transform infrared (FTIR) spectroscopy and different nuclear magnetic resonance (NMR) spectroscopy techniques. In addition, antioxidant activity was also analyzed. Results showed that lignin polymerization (referring to polymerization as lower phenolic content and higher molecular weight) occurred by the action of both laccases. The enzyme concentration was the most influential variable in the lignin polymerization reaction within the range studied for SiLA laccase, while the most influential variable for MtL laccase was the reaction time. FTIR and NMR characterization analysis corroborated lignin polymerization results obtained from the RSM.

NMR Study on Laccase Polymerization of Kraft Lignin Using Different Enzymes Source.

The usage of laccases is a sustainable and environmentally friendly approach to modifying the Kraft lignin structure for use in certain applications. However, the inherent structure of Kraft lignin, as well as that resulting from laccase modification, still presents challenges for fundamental comprehension and successful lignin valorization. In this study, bacterial and fungal laccases were employed to modify eucalypt Kraft lignin. To evaluate the type and range of the chemical and structural changes of laccase-treated lignins, different NMR techniques, including solution 1H and 2D NMR (heteronuclear single quantum correlation (HSQC)), and solid-state 13C NMR, were applied. Size exclusion chromatography and infrared spectroscopy were also used. Interestingly, HSQC analysis showed substantial changes in the oxygenated aliphatic region of lignins, showing an almost complete absence of signals corresponding to side-chains due to laccase depolymerization. Simultaneously, a significant loss of aromatic signals was observed by HSQC and 1H NMR, which was attributed to a deprotonation of the lignin benzenic rings due to polymerization/condensation by laccase reactions. Then, condensed structures, such as α-5', 5-5', and 4-O-5', were detected by HSQC and 13C NMR, supporting the increment in molecular weight, as well as the phenolic content reduction determined in lignins.

Emulsion Stabilization by Cationic Lignin Surfactants Derived from Bioethanol Production and Kraft Pulping Processes.

Oil-in-water bitumen emulsions stabilized by biobased surfactants such as lignin are in line with the current sustainable approaches of the asphalt industry involving bitumen emulsions for reduced temperature asphalt technologies. With this aim, three lignins, derived from the kraft pulping and bioethanol industries, were chemically modified via the Mannich reaction to be used as cationic emulsifiers. A comprehensive chemical characterization was conducted on raw lignin-rich products, showing that the kraft sample presents a higher lignin concentration and lower molecular weight. Instead, bioethanol-derived samples, with characteristics of non-woody lignins, present a high concentration of carbohydrate residues and ashes. Lignin amination was performed at pH = 10 and 13, using tetraethylene pentamine and formaldehyde as reagents at three different stoichiometric molar ratios. The emulsification ability of such cationic surfactants was firstly studied on prototype silicone oil-in-water emulsions, attending to their droplet size distribution and viscous behavior. Among the synthetized surfactants, cationic kraft lignin has shown the best emulsification performance, being used for the development of bitumen emulsions. In this regard, cationic kraft lignin has successfully stabilized oil-in-water emulsions containing 60% bitumen using small surfactant concentrations, between 0.25 and 0.75%, which was obtained at pH = 13 and reagent molar ratios between 1/7/7 and 1/28/28 (lignin/tetraethylene pentamine/formaldehyde).

Different Kraft lignin sources for electrospun nanostructures production: Influence of chemical structure and composition.

This work focuses on the structural features and physicochemical properties of different Kraft lignins and how they can influence the electrospinning process to obtain nanostructures. Structural features of Kraft lignins were characterized by nuclear magnetic resonance, size exclusion chromatography, fourier-transform infrared spectroscopy, and thermal analysis, whereas chemical composition was analyzed by standard method. The addition of cellulose acetate (CA) improves the electrospinning process of Kraft lignins (KL). Thus, solutions of KL/CA at 30 wt% with a KL:CA weight ratio of 70:30 were prepared and then physicochemical and rheologically characterized. The morphology of electrospun nanostructures depends on the intrinsic properties of the solutions and the chemical structure and composition of Kraft lignins. Then, surface tension, electrical conductivity and viscosity of eucalypt/CA and poplar/CA solutions were suitable to obtain electrospun nanostructures based on uniform cross-linked nanofibers with a few beaded fibers. It could be related with the higher purity and higher linear structure, phenolic content and S/G ratios of lignin samples. However, the higher values of electrical conductivity and viscosity of OTP/CA solutions resulted in electrospun nanostructure with micro-sized particles connected by thin fibers, due to a lower purity, S/G ratio and phenolic content and higher branched structure in OTP lignin.

Mutational Switch-Backs Can Accelerate Evolution of Francisella to a Combination of Ciprofloxacin and Doxycycline.

Combination antimicrobial therapy has been considered a promising strategy to combat the evolution of antimicrobial resistance. Francisella tularensis is the causative agent of tularemia and in addition to being found in the nature, is recognized as a threat agent that requires vigilance. We investigated the evolutionary outcome of adapting the Live Vaccine Strain (LVS) of F. tularensis subsp. holarctica to two non-interacting drugs, ciprofloxacin and doxycycline, individually, sequentially, and in combination. Despite their individual efficacies and independence of mechanisms, evolution to the combination arose on a shorter time scale than evolution to the two drugs sequentially. We conducted a longitudinal mutational analysis of the populations evolving to the drug combination, genetically reconstructed the identified evolutionary pathway, and carried out biochemical validation. We discovered that, after the appearance of an initial weak generalist mutation (FupA/B), each successive mutation alternated between adaptation to one drug or the other. In combination, these mutations allowed the population to more efficiently ascend the fitness peak through a series of evolutionary switch-backs. Clonal interference, weak pleiotropy, and positive epistasis also contributed to combinatorial evolution. This finding suggests that the use of this non-interacting drug pair against F. tularensis may render both drugs ineffective because of mutational switch-backs that accelerate evolution of dual resistance.

Lignin-enriched residues from bioethanol production: Chemical characterization, isocyanate functionalization and oil structuring properties.

Lignin-enriched waste products from bioethanol production of agriculture residues were tested as structuring agents in castor oil once functionalized with hexamethylene diisocyanate. Cane bagasse, barley and wheat straw were processed through steam explosion, pre-saccharification and simultaneous saccharification and fermentation (PSSF). Alternatively, cane bagasse was submitted to steam explosion and enzymatic hydrolysis (EH). Several Nuclear Magnetic Resonance techniques were used to characterize both residues and NCO-functionalized counterparts. The ß-O-4'/resinol/phenylcoumaran content and hydroxyphenyl/guaiacyl/syringyl distribution depend on biomass source, pretreatment, and enzymatic hydrolysis. Total hydroxyl content (from 1.23 for cane bagasse to 1.85 for wheat straw residues), aromatic/aliphatic hydroxyl ratio (0.78 for cane bagasse and 0.61 and 0.49 for barley and wheat straw residues, respectively) and S/G ratio (ranging from 0.25 to 0.86) influence the NCO-functionalization and oleogel rheological response. Oleogels obtained with barley straw residues exhibited the highest values of the storage modulus; around 2 × 105 Pa and 104 Pa for 25% and 20% contents, respectively. PSSF process showed weaker modification, leading to softer viscoelastic response compared to EH. These oleogels exhibited rheological properties similar to lubricating greases of different NLGI grades. Therefore, we herein show an integrative protocol for the valorization of lignin-enriched residues from bioethanol production as potential thickeners of lubricating greases.

Chemical, Thermal and Antioxidant Properties of Lignins Solubilized during Soda/AQ Pulping of Orange and Olive Tree Pruning Residues.

Some agroforestry residues such as orange and olive tree pruning have been extensively evaluated for their valorization due to its high carbohydrates content. However, lignin-enriched residues generated during carbohydrates valorization are normally incinerated to produce energy. In order to find alternative high added-value applications for these lignins, a depth characterization of them is required. In this study, lignins isolated from the black liquors produced during soda/anthraquinone (soda/AQ) pulping of orange and olive tree pruning residues were analyzed by analytical standard methods and Fourier-transform infrared spectroscopy (FTIR), nuclear magnetic resonance (solid state 13C NMR and 2D NMR) and size exclusion chromatography (SEC). Thermal analysis (thermogravimetric analysis (TGA), differential scanning calorimetry (DSC)) and antioxidant capacity (Trolox equivalent antioxidant capacity) were also evaluated. Both lignins showed a high OH phenolic content as consequence of a wide breakdown of ß-aryl ether linkages. This extensive degradation yielded lignins with low molecular weights and polydispersity values. Moreover, both lignins exhibited an enrichment of syringyl units together with different native as well as soda/AQ lignin derived units. Based on these chemical properties, orange and olive lignins showed relatively high thermal stability and good antioxidant activities. These results make them potential additives to enhance the thermo-oxidation stability of synthetic polymers.

Properties versus application requirements of solubilized lignins from an elm clone during different pre-treatments.

Kraft pulping, organosolv process and acid hydrolysis were applied on an elm clone. The solubilized lignins were recovered and analyzed. Kraft pulping and acid hydrolysis led to lignins with higher phenolic OH content as result of extensive cleavage of ß-O-4' linkages, as revealed by 13C solid state and 13C-1H heteronuclear single quantum coherence nuclear magnetic resonance. This depolymerization also yielded lower molecular weight lignins inferred by size exclusion chromatography. Contrarily, organosolv process gave rise to a lignin with a more preserved structure, maintaining a large number of ß-O-4' linkages. Consequently, organosolv lignin presented lower phenolic OH content and higher molecular weight. Moreover, the high content of the labile native ß-O-4' linkages in organosolv lignin resulted in a lower thermostability as compared to the kraft and acid lignins. On the other hand, the solubilized lignins from kraft and acid processes displayed an enrichment of S-units, whereas lignin from organosolv process was slightly enriched in G-units, containing all of them different native as well as pre-treatment derived units. These results could help to increase the inventory of lignin sources available for future lignin-based products, for which knowledge of the lignin properties versus application requirements is crucial.

Populus alba L., an Autochthonous Species of Spain: A Source for Cellulose Nanofibers by Chemical Pretreatment.

In order to identify new sustainable sources for producing cellulose nanofibers (CNFs), fast-growing poplar (Populus alba L.) wood was evaluated herein. For that purpose, bleached poplar kraft pulp was produced and submitted to TEMPO (2,2,6,6-tetramethylpiperidine-1-oxyl radical) mediated oxidation (TEMPO-ox) chemical pretreatment followed by microfluidization. The resulting CNFs were thoroughly characterized, including a rheological study at different pH values. Poplar CNFs showed properties comparable to eucalypt CNFs (reference material for CNFs production), showing high carboxylate content (1048 ± 128 µmol g-1), fibrillation yield (87.3% ± 8.1%), optical transmittance (83% at 700 nm) and thermal stability (up to more than 200 °C). Regarding the rheological study, whereas pH from 4 to 10 did not produce significant changes in rheological behavior, a reduction of pH down to 1 led to an order-of-magnitude increase on the viscoelastic functions. Therefore, poplar CNF shows potential in the pH-sensitive hydrogels application field. Finally, the possible ecotoxicity of poplar CNF was assessed. The decrease in cell viability was very low so that only concentrations causing a 10% cytotoxicity could be calculated for the assay detecting alterations in cell metabolism (10 µg mL-1) and plasma membrane integrity (60 µg mL-1).

Terminación de la psicoterapia desde la perspectiva de los pacientes / Psychotherapy Termination from the Patients' Perspective

Resumen El aumento de la oferta de servicios de psicoterapia en las últimas décadas justifica el estudio de los elementos relacionados con su terminación, y su relación con el cumplimiento de los objetivos y la adherencia de los pacientes al tratamiento. Objetivo: identificar los factores que influyen en la terminación de los procesos psicoterapéuticos desde la perspectiva de los pacientes. Metodología: se utilizó un diseño de investigación mixto de triangulación concurrente; se aplicaron encuestas estructuradas y entrevistas en profundidad sobre el fin de la terapia. A nivel cuantitativo se realizaron análisis descriptivos y de regresión, y, a nivel cualitativo, reducción de datos, comparación constante y triangulación de la información. Participaron 137 pacientes de dos centros universitarios de atención psicológica en Antioquia (Colombia), 100 participantes respondieron una encuesta y los restantes una entrevista cualitativa. Resultados: se identificaron tres dimensiones relacionadas con la terminación de los procesos psicoterapéuticos: el cumplimiento o no de los objetivos, el tipo de atribución causal del paciente (interna o externa) y la persona que decide finalizar. La mayoría de los pacientes del estudio dejaron de asistir a psicoterapia sin cumplir sus objetivos o con un cumplimiento parcial de estos, por atribuciones externas y por decisión propia. Discusión: los aspectos institucionales, terapéuticos y de la vida del paciente tienen un rol significativo en la terminación de los procesos psicoterapéuticos. Además, se plantea la importancia de considerar en la formación de los terapeutas las características de los procesos de cierre y los diferentes marcadores asociados con la terminación prematura.

Abstract The increase in the supply of psychotherapy services in recent decades justifies the study of the elements related to its termination. This is one of the main topics to understand achievement of therapeutic goals and adherence of patients in psychotherapy. Aim: to identify the factors that influence termination of psychotherapeutic processes from the patients' perspective. Method: a mixed research design of concurrent triangulation was used; and structured surveys inquiring and in-depth interviews about psychotherapy termination were conducted. It was carried out at the quantitative level, both descriptive and regression analyses, and at the qualitative level, data reduction, constant comparison, and triangulation of information. A total of 137 patients from two higher education centers of psychological care in Antioquia (Colombia) participated, 100 answered a survey and the remaining participants were interviewed in-depth. Results: Results show three dimensions that allow various conceptualizations of therapy termination: achievement of goals, causal attribution and the person who decides to terminate. Most of the patients in the study dropped out of psychotherapy without the completion of their objectives or with a partial completion of these, due to external attributions and their own decision. Discussion: it was discussed how institutional, therapeutic, and life patient´s aspects have a significant role in termination of psychotherapeutic processes. As well as the importance of considering therapists´ training in relation to the characteristics of these processes and the different indicators associated with premature termination.

Cellulose Nanofibers from a Dutch Elm Disease-Resistant Ulmus minor Clone.

The potential use of elm wood in lignocellulosic industries has been hindered by the Dutch elm disease (DED) pandemics, which have ravaged European and North American elm groves in the last century. However, the selection of DED-resistant cultivars paves the way for their use as feedstock in lignocellulosic biorefineries. Here, the production of cellulose nanofibers from the resistant Ulmus minor clone Ademuz was evaluated for the first time. Both mechanical (PFI refining) and chemical (TEMPO (2,2,6,6-tetramethylpiperidine-1-oxyl radical)-mediated oxidation) pretreatments were assessed prior to microfluidization, observing not only easier fibrillation but also better optical and barrier properties for elm nanopapers compared to eucalyptus ones (used as reference). Furthermore, mechanically pretreated samples showed higher strength for elm nanopapers. Although lower nanofibrillation yields were obtained by mechanical pretreatment, nanofibers showed higher thermal, mechanical and barrier properties, compared to TEMPO-oxidized nanofibers. Furthermore, lignin-containing elm nanofibers presented the most promising characteristics, with slightly lower transparencies.

Evaluation of lignin-enriched side-streams from different biomass conversion processes as thickeners in bio-lubricant formulations.

This study explores the suitability of residual lignin-containing fractions generated as side-streams in different conversion processes of eucalypt and pine woods as thickening agents in bio-lubricant formulations. These conversion processes included fermentable sugars extraction by autohydrolysis or steam explosion and kraft pulping. Structural properties of lignin fractions were characterized by FTIR, 1H and 13C NMR, two-dimensional NMR, TGA and SEC, whereas their compositions were analysed by standard analytical methods. On the other hand, chemical oleogels were prepared with NCO-functionalized residual lignin fractions, and characterized by means of rheological, tribological and AFM techniques. Hydrolysis lignin fractions exhibited a great content of carbohydrates, especially glucose (46.0-48.5%), xylose (4.3-15.6%) and lignin (32.5-39.9%) with a well-maintained structure, displaying the main inter-unit linkages and low phenolic content. By contrast, kraft lignin fractions presented a lower carbohydrate content, mainly xylose (3.4-4.3%), and higher content (44.9-67%) of severely degraded lignin, showing a dramatic reduction of inter-unit linkages, and thereby high phenolic content. The rheological response of NCO-functionalized lignin fractions-based oleogels is highly influenced by the composition and chemical structure of residual lignin fractions. Moreover, these oleogels presented suitable tribological properties with values of the friction coefficient lower than those typically exhibited by standard lubricating greases.

Chemical and thermal analysis of lignin streams from Robinia pseudoacacia L. generated during organosolv and acid hydrolysis pre-treatments and subsequent enzymatic hydrolysis.

Lignin streams produced in biorefineries are commonly used to obtain energy. In order to increase the competitiveness of this industry, new lignin valorization routes are necessary, for which a depth characterization of this biological macromolecule is essential. In this context, this study analyzed lignin streams of Robinia pseudoacacia L. generated during organosolv and acid hydrolysis pre-treatments and during the subsequent enzymatic hydrolysis. These lignins included dissolved lignins from pre-treatment liquors and saccharification lignins from pre-treated materials. Chemical composition and structural features were analyzed by analytical standard methods and Fourier Transform Infrared spectroscopy (FTIR), size exclusion chromatography (SEC), 13C solid state nuclear magnetic resonance (13C NMR) and 1H-13C two-dimensional nuclear magnetic resonance (2D NMR); while thermal characterization included thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC). In general, all studied lignins contained a predominance of ß-O-4' aryl ether linkages, followed by resinol (ß-ß') and phenylcoumaran (ß-5'), with a predominance of syringyl over guaiacyl and hydroxyphenyl units. Nevertheless, the dissolved lignins revealed a removal of linkages, especially ß-O-4', leading to an enrichment of phenolic groups. Moreover, high thermal stability and good thermoplasticity were characteristics of these lignins. Contrary, the saccharification lignins exhibited a more intact structure, but with an important remaining carbohydrates content.

The role of side tail fibers during the infection cycle of phage lambda.

Bacteriophage λ has served as an important model for molecular biology and different cellular processes over the past few decades. In 1992, the phage strain used in most laboratories around the world, thought of as λ wild type, was discovered to carry a mutation in the stf gene which encodes four side tail fibers. Up to now, the role of the side tail fibers during the infection cycle, especially at the single-cell level, remains largely unknown. Here we utilized fluorescent reporter systems to characterize the effect of the side tail fibers on phage infection. We found that the side tail fibers interfere with phage DNA ejection process, most likely through the binding with their receptors, OmpC, leading to a more frequent failed infection. However, the side tail fibers do not seem to affect the lysis-lysogeny decision-making or lysis time.

Characterization of lignins from Populus alba L. generated as by-products in different transformation processes: Kraft pulping, organosolv and acid hydrolysis.

The complexity and heterogeneity of lignin requires a detailed understanding in order to decide about more efficient lignin valorization approaches. This study deals with the characterization of lignins from Populus alba L. generated as by-products in different transformation processes: kraft pulping, organosolv and dilute acid hydrolysis. In addition to the composition, the chemical and structural features of the different lignins were investigated by Fourier Transform infrared spectroscopy (FTIR), solid-state 13C nuclear magnetic resonance (13C NMR), two-dimensional nuclear magnetic spectrometry (2D NMR), size exclusion chromatography (SEC), and thermal analysis. Organosolv lignin showed noticeably different characteristics compared to kraft and acid hydrolysis lignins; higher molar mass, higher amount of side-chain linkages (mainly aryl-ß ether and resinol) together with lower phenolic content. On the contrary, kraft and acid hydrolysis lignins presented an extensive elimination of lateral chains and therefore a higher phenolic content, which suggests a much stronger lignin depolymerization (lower molar mass) during these processes. Moreover, thermal analysis results revealed that the thermal stability of kraft and acid hydrolysis lignins was higher than that of organosolv lignin, especially in the case of acid hydrolysis lignin. According to all these characteristics, several valorization pathways for studied lignin are discussed.

Lung and Heart Sounds Analysis: State-of-the-Art and Future Trends.

Lung sounds, which include all sounds that are produced during the mechanism of respiration, may be classified into normal breath sounds and adventitious sounds. Normal breath sounds occur when no respiratory problems exist, whereas adventitious lung sounds (wheeze, rhonchi, crackle, etc.) are usually associated with certain pulmonary pathologies. Heart and lung sounds that are heard using a stethoscope are the result of mechanical interactions that indicate operation of cardiac and respiratory systems, respectively. In this article, we review the research conducted during the last six years on lung and heart sounds, instrumentation and data sources (sensors and databases), technological advances, and perspectives in processing and data analysis. Our review suggests that chronic obstructive pulmonary disease (COPD) and asthma are the most common respiratory diseases reported on in the literature; related diseases that are less analyzed include chronic bronchitis, idiopathic pulmonary fibrosis, congestive heart failure, and parenchymal pathology. Some new findings regarding the methodologies associated with advances in the electronic stethoscope have been presented for the auscultatory heart sound signaling process, including analysis and clarification of resulting sounds to create a diagnosis based on a quantifiable medical assessment. The availability of automatic interpretation of high precision of heart and lung sounds opens interesting possibilities for cardiovascular diagnosis as well as potential for intelligent diagnosis of heart and lung diseases.

In-ear medical devices for acoustic therapies in tinnitus treatments, state of the art.

Cochrane reviews indicate there is very limited support for all forms of sound therapy and cognitive behavioral therapy has the strongest support. American Academy of Otolaryngology (AAO) recently published some guidelines which recommends Cognitive Behavioral Therapy (CBT) for tinnitus intervention, and only indicates that sound therapy should be considered an "option" for intervention. Nevertheless, acoustic therapy could lead to cause changes in the tinnitus perception and has been appreciated by the affected people for years. In the last decades, the use of sound or sound enrichment has become a central part of many tinnitus management programs used by audiologists, whether the intention was to mask tinnitus, suppress tinnitus, or interrupt the tinnitus generating neural activity. Several acoustic therapies have been developed and implemented in the last 40 years, but how can we determine which one is the most effective? We can determine the effects based on the results reported in many research studies, but in those studies are many factors that differ from one study to another, like in-ear medical devices used to apply acoustic therapy for tinnitus treatment. In this article, we review and analyze the different types of in-ear medical devices used in the most recently acoustic therapies in treatments against tinnitus, allowing us to identify the pros and cons. By our analysis, an optimal medical device could be characterized to enhance the application of acoustic therapies and in consequence the global results of the sound therapies that already exist. In this review, it was considered acoustic therapies, the technology implemented in medical devices and the clinical needs.