Enzymatic Synthesis of Copolyesters with the Heteroaromatic Diol 3,4-Bis(hydroxymethyl)furan and Isomeric Dimethyl Furandicarboxylate Substitutions.

Polyesters from furandicarboxylic acid derivatives, i.e., dimethyl 2,5-furandicarboxylate (2,5-DMFDCA) and 2,4-DMFDCA, show interesting properties among bio-based polymers. Another potential heteroaromatic monomer, 3,4-bis(hydroxymethyl)furan (3,4-BHMF), is often overlooked but holds promise for biopolymer synthesis. Cleaning and greening synthetic procedures, i.e., enzymatic polymerization, offer sustainable pathways. This study explores the Candida antarctica lipase B (CALB)-catalyzed copolymerization of 3,4-BHMF with furan dicarboxylate isomers and aliphatic diols. The furanic copolyesters (co-FPEs) with higher polymerization degrees are obtained using 2,4-isomer, indicating CALB's preference. Material analysis revealed semicrystalline properties in all synthesized 2,5-FDCA-based co-FPEs, with multiple melting temperatures (Tm) from 53 to 124 °C and a glass-transition temperature (Tg) of 9-10 °C. 2,4-FDCA-based co-FPEs showed multiple Tm from 43 to 61 °C and Tg of -14 to 12 °C; one of them was amorphous. In addition, all co-FPEs showed a two-step decomposition profile, indicating aliphatic and semiaromatic segments in the polymer chains.

Unknown rheumatic cardiac disease as cause of acute onset post-partum dyspnea: a case report.

BACKGROUND: Acute post-partum dyspnea configures an obstetric challenge with multiple differential diagnosis. CASE PRESENTATION: We present a case of a previous healthy woman with preeclampsia who developed severe dyspnea 30 h after delivery. She complained of cough, orthopnea, and bilateral lower extremities oedema. She denied headaches, blurry vision, nausea, vomiting, fever or chills. Auscultation revealed a diastolic murmur, and was compatible with pulmonary oedema. A timely bedside echocardiogram showed moderate dilated left atrium with severe mitral insufficiency suggestive of an unknown rheumatic disease. She was managed with noninvasive ventilation, loop diuretics, vasodilators, thromboprophylaxis, head-end elevation, and fluid restriction with progressive improving. CONCLUSIONS: Hemodynamic changes in pregnant patients with previously silent cardiac disease may pose a challenge and cause post-partum dyspnea. This scenario requires a timely and multidisciplinary approach.

Home-Based Rehabilitation of the Shoulder Using Auxiliary Systems and Artificial Intelligence: An Overview.

Advancements in modern medicine have bolstered the usage of home-based rehabilitation services for patients, particularly those recovering from diseases or conditions that necessitate a structured rehabilitation process. Understanding the technological factors that can influence the efficacy of home-based rehabilitation is crucial for optimizing patient outcomes. As technologies continue to evolve rapidly, it is imperative to document the current state of the art and elucidate the key features of the hardware and software employed in these rehabilitation systems. This narrative review aims to provide a summary of the modern technological trends and advancements in home-based shoulder rehabilitation scenarios. It specifically focuses on wearable devices, robots, exoskeletons, machine learning, virtual and augmented reality, and serious games. Through an in-depth analysis of existing literature and research, this review presents the state of the art in home-based rehabilitation systems, highlighting their strengths and limitations. Furthermore, this review proposes hypotheses and potential directions for future upgrades and enhancements in these technologies. By exploring the integration of these technologies into home-based rehabilitation, this review aims to shed light on the current landscape and offer insights into the future possibilities for improving patient outcomes and optimizing the effectiveness of home-based rehabilitation programs.

Long-Term Electrode-Skin Impedance Variation for Electromyographic Measurements.

This study aims to observe the evolution of the electrode-skin interface impedance of surface EMG electrodes over the time taken to determine the time of stabilization. Eight healthy subjects participated in the study. Electrode-skin impedance was evaluated in the rectus abdominal muscle every five minutes, over a total period of 50 min. A reduction of 13.23% in the impedance values was observed in minute 10 (p = 0.007), and a reduction of 9.02% was observed in minute 15 (p = 0.029). No statistically significant differences were observed in the other instants evaluated. The findings obtained in the present study demonstrate a decrease in electrode-skin impedance from minute 5 to minute 15, followed by a stabilization period with a low percentage of variation till minute 50.

Health-Related Telemonitoring Parameters/Signals of Older Adults: An Umbrella Review.

Aging is one of the greatest challenges in modern society. The development of wearable solutions for telemonitoring biological signals has been viewed as a strategy to enhance older adults' healthcare sustainability. This study aims to review the biological signals remotely monitored by technologies in older adults. PubMed, the Cochrane Database of Systematic Reviews, the Web of Science, and the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports were systematically searched in December 2021. Only systematic reviews and meta-analyses of remote health-related biological and environmental monitoring signals in older adults were considered, with publication dates between 2016 and 2022, written in English, Portuguese, or Spanish. Studies referring to conference proceedings or articles with abstract access only were excluded. The data were extracted independently by two reviewers, using a predefined table form, consulting a third reviewer in case of doubts or concerns. Eighteen studies were included, fourteen systematic reviews and four meta-analyses. Nine of the reviews included older adults from the community, whereas the others also included institutionalized participants. Heart and respiratory rate, physical activity, electrocardiography, body temperature, blood pressure, glucose, and heart rate were the most frequently measured biological variables, with physical activity and heart rate foremost. These were obtained through wearables, with the waist, wrist, and ankle being the most mentioned body regions for the device's placement. Six of the reviews presented the psychometric properties of the systems, most of which were valid and accurate. In relation to environmental signals, only two articles presented data on this topic. Luminosity, temperature, and movement were the most mentioned variables. The need for large-scale long-term health-related telemonitoring implementation of studies with larger sample sizes was pointed out by several reviews in order to define the feasibility levels of wearable devices.

Could Electromyographic and Pressure Related Signals Identify Differences in Abdominal Activity and Postural Control between Women with and without C-Section?

BACKGROUND: Scars interfere with the motor system; however, the influence of c-section scars has not been described yet. The aim of this study is to relate the presence of abdominal scars from a caesarean section with changes in postural control-stability and orientation and abdominal and lumbar neuromuscular control in the orthostatic position. METHODS: Cross-sectional analytical observational study comparing healthy primiparous women with caesarean delivery (n = 9) and physiologic delivery (n = 12) who have delivered more than one year before. The relative electromyographic activity of the rectus abdominis, transverse abdominis/oblique internus and lumbar multifidus muscles, antagonist co-activation, the ellipse area, amplitude, displacement, velocity, standard deviation, and spectral power of the centre of pressure, and thoracic and lumbar curvatures, were evaluated in the standing position in both groups, through an electromyographic system, a pressure platform and spinal mouse system. In the "caesarean delivery" group, scar mobility was evaluated using a modified adheremeter. RESULTS: Significant differences in CoP medial-lateral velocity and mean velocity were observed between groups (p < 0.050), while no significant differences were in the level of muscle activity, antagonist co-activation, and thoracic and lumbar curvatures (p > 0.05). CONCLUSIONS: The information provided by the pressure signal seems to identify postural impairments in women with c-sections.

A Machine Learning App for Monitoring Physical Therapy at Home.

Shoulder rehabilitation is a process that requires physical therapy sessions to recover the mobility of the affected limbs. However, these sessions are often limited by the availability and cost of specialized technicians, as well as the patient's travel to the session locations. This paper presents a novel smartphone-based approach using a pose estimation algorithm to evaluate the quality of the movements and provide feedback, allowing patients to perform autonomous recovery sessions. This paper reviews the state of the art in wearable devices and camera-based systems for human body detection and rehabilitation support and describes the system developed, which uses MediaPipe to extract the coordinates of 33 key points on the patient's body and compares them with reference videos made by professional physiotherapists using cosine similarity and dynamic time warping. This paper also presents a clinical study that uses QTM, an optoelectronic system for motion capture, to validate the methods used by the smartphone application. The results show that there are statistically significant differences between the three methods for different exercises, highlighting the importance of selecting an appropriate method for specific exercises. This paper discusses the implications and limitations of the findings and suggests directions for future research.

Repeatability and Temporal Consistency of Lower Limb Biomechanical Variables Expressing Interlimb Coordination during the Double-Support Phase in People with and without Stroke Sequelae.

Reliable biomechanical methods to assess interlimb coordination during the double-support phase in post-stroke subjects are needed for assessing movement dysfunction and related variability. The data obtained could provide a significant contribution for designing rehabilitation programs and for their monitorisation. The present study aimed to determine the minimum number of gait cycles needed to obtain adequate values of repeatability and temporal consistency of lower limb kinematic, kinetic, and electromyographic parameters during the double support of walking in people with and without stroke sequelae. Eleven post-stroke and thirteen healthy participants performed 20 gait trials at self-selected speed in two separate moments with an interval between 72 h and 7 days. The joint position, the external mechanical work on the centre of mass, and the surface electromyographic activity of the tibialis anterior, soleus, gastrocnemius medialis, rectus femoris, vastus medialis, biceps femoris, and gluteus maximus muscles were extracted for analysis. Both the contralesional and ipsilesional and dominant and non-dominant limbs of participants with and without stroke sequelae, respectively, were evaluated either in trailing or leading positions. The intraclass correlation coefficient was used for assessing intra-session and inter-session consistency analysis. For most of the kinematic and the kinetic variables studied in each session, two to three trials were required for both groups, limbs, and positions. The electromyographic variables presented higher variability, requiring, therefore, a number of trials ranging from 2 to >10. Globally, the number of trials required inter-session ranged from 1 to >10 for kinematic, from 1 to 9 for kinetic, and 1 to >10 for electromyographic variables. Thus, for the double support analysis, three gait trials were required in order to assess the kinematic and kinetic variables in cross-sectional studies, while for longitudinal studies, a higher number of trials (>10) were required for kinematic, kinetic, and electromyographic variables.

Differences in Trapezius Muscle H-Reflex between Asymptomatic Subjects and Symptomatic Shoulder Pain Subjects.

In chronic shoulder pain, adaptations in the nervous system such as in motoneuron excitability, could contribute to impairments in scapular muscles, perpetuation and recurrence of pain and reduced improvements during rehabilitation. The present cross-sectional study aims to compare trapezius neural excitability between symptomatic and asymptomatic subjects. In 12 participants with chronic shoulder pain (symptomatic group) and 12 without shoulder pain (asymptomatic group), the H reflex was evoked in all trapezius muscle parts, through C3/4 nerve stimulation, and the M-wave through accessory nerve stimulation. The current intensity to evoke the maximum H reflex, the latency and the maximum peak-to-peak amplitude of both the H reflex and M-wave, as well as the ratio between these two variables, were calculated. The percentage of responses was considered. Overall, M-waves were elicited in most participants, while the H reflex was elicited only in 58-75% or in 42-58% of the asymptomatic and symptomatic participants, respectively. A comparison between groups revealed that the symptomatic group presented a smaller maximum H reflex as a percentage of M-wave from upper trapezius and longer maximal H reflex latency from the lower trapezius (p < 0.05). Subjects with chronic shoulder pain present changes in trapezius H reflex parameters, highlighting the need to consider trapezius neuromuscular control in these individuals' rehabilitation.

Highly Flexible Poly(1,12-dodecylene 5,5'-isopropylidene-bis(ethyl 2-furoate)): A Promising Biobased Polyester Derived from a Renewable Cost-Effective Bisfuranic Precursor and a Long-Chain Aliphatic Spacer.

The continuous search for novel biobased polymers with high-performance properties has highlighted the role of monofuranic-based polyesters as some of the most promising for future plastic industry but has neglected the huge potential for the polymers' innovation, relatively low cost, and synthesis easiness of 5,5'-isopropylidene bis-(ethyl 2-furoate) (DEbF), obtained from the platform chemical, worldwide-produced furfural. In this vein, poly(1,12-dodecylene 5,5'-isopropylidene -bis(ethyl 2-furoate)) (PDDbF) was introduced, for the first time, as a biobased bisfuranic long-chain aliphatic polyester with an extreme flexibility function, competing with fossil-based polyethylene. This new polyester in-depth characterization confirmed its expected structure (FTIR, 1H, and 13C NMR) and relevant thermal features (DSC, TGA, and DMTA), notably, an essentially amorphous character with a glass transition temperature of -6 °C and main maximum decomposition temperature of 340 °C. Furthermore, PDDbF displayed an elongation at break as high as 732%, around five times higher than that of the 2,5-furandicarboxylic acid counterpart, stressing the unique features of the bisfuranic class of polymers compared to monofuranic ones. The enhanced ductility combined with the relevant thermal properties makes PDDbF a highly promising material for flexible packaging.

Systematic Review on the Applicability of Principal Component Analysis for the Study of Movement in the Older Adult Population.

Principal component analysis (PCA) is a dimensionality reduction method that has identified significant differences in older adults' motion analysis previously not detected by the discrete exploration of biomechanical variables. This systematic review aims to synthesize the current evidence regarding PCA use in the study of movement in older adults (kinematics and kinetics), summarizing the tasks and biomechanical variables studied. From the search results, 1685 studies were retrieved, and 19 studies were included for review. Most of the included studies evaluated gait or quiet standing. The main variables considered included spatiotemporal parameters, range of motion, and ground reaction forces. A limited number of studies analyzed other tasks. Further research should focus on the PCA application in tasks other than gait to understand older adults' movement characteristics that have not been identified by discrete analysis.

Indicators and Instruments to Assess Components of Disability in Community-Dwelling Older Adults: A Systematic Review.

The epidemiological demands of aging point to the need for characterizing older adults regarding health and disability. This systematic review aims to summarize the indicators (instruments) identifying different components of disability as a result of aging exposition in community-dwelling older adults, considering the International Classification of Functioning, Disability, and Health framework. Taking the PRISMA 2020 recommendations as a reference, studies with community-dwelling older adults, reporting the development and/or age disability modifications were included. Two reviewers analyzed the observational studies searched in the MEDLINE, CINAHL, Web of Science, Scopus, and Embase databases. Of the 137 potentially eligible studies, 49 were included in this review. Several indicators (instruments) demonstrated older adults' disabilities according to the different domains of the ICF. Objective measures assessed Body Structures, Body Functions, and Environmental Factors and included handgrip strength (dynamometry, n = 8), cognitive function (Mini-Mental State examination, n = 7), gait speed (walk test, n = 6), and endurance (Chair stand-test, n = 4). Self-reported measures assessed Activities and Participation, but not the Body Structures, and included the basic and instrumental activities of daily living (ADL) (the Katz Index of ADL, n = 4 studies, the Lawton and Brody Instrumental ADL, n = 4 studies). The summary of the measures gathered can guide researchers and health professionals to select indicators (instruments) to assess and monitor older adults' disabilities resulting from aging exposition, to support the development of new wearables, and to provide improvements to the existing ones, allowing the tailored assessment of different health and disability dimensions.

Scapular Dynamic Muscular Stiffness Assessed through Myotonometry: A Narrative Review.

Several tools have been used to assess muscular stiffness. Myotonometry stands out as an accessible, handheld, and easy to use tool. The purpose of this review was to summarize the psychometric properties and methodological considerations of myotonometry and its applicability in assessing scapular muscles. Myotonometry seems to be a reliable method to assess several muscles stiffness, as trapezius. This method has been demonstrated fair to moderate correlation with passive stiffness measured by shear wave elastography for several muscles, as well as with level of muscle contraction, pinch and muscle strength, Action Research Arm Test score and muscle or subcutaneous thickness. Myotonometry can detect scapular muscles stiffness differences between pre- and post-intervention in painful conditions and, sometimes, between symptomatic and asymptomatic subjects.

Usability of Functional Electrical Stimulation in Upper Limb Rehabilitation in Post-Stroke Patients: A Narrative Review.

Stroke leads to significant impairment in upper limb (UL) function. The goal of rehabilitation is the reestablishment of pre-stroke motor stroke skills by stimulating neuroplasticity. Among several rehabilitation approaches, functional electrical stimulation (FES) is highlighted in stroke rehabilitation guidelines as a supplementary therapy alongside the standard care modalities. The aim of this study is to present a comprehensive review regarding the usability of FES in post-stroke UL rehabilitation. Specifically, the factors related to UL rehabilitation that should be considered in FES usability, as well a critical review of the outcomes used to assess FES usability, are presented. This review reinforces the FES as a promising tool to induce neuroplastic modifications in post-stroke rehabilitation by enabling the possibility of delivering intensive periods of treatment with comparatively less demand on human resources. However, the lack of studies evaluating FES usability through motor control outcomes, specifically movement quality indicators, combined with user satisfaction limits the definition of FES optimal therapeutical window for different UL functional tasks. FES systems capable of integrating postural control muscles involving other anatomic regions, such as the trunk, during reaching tasks are required to improve UL function in post-stroke patients.

Methodological Considerations in Assessing Interlimb Coordination on Poststroke Gait: A Scoping Review of Biomechanical Approaches and Outcomes.

Objective: To identify and summarize biomechanical assessment approaches in interlimb coordination on poststroke gait. Introduction: Interlimb coordination involves complex neurophysiological mechanisms that can be expressed through the biomechanical output. The deepening of this concept would have a significant contribution in gait rehabilitation in patients with an asymmetric neurological impairment as poststroke adults. Inclusion criteria: Poststroke adults (>19 years old), with assessment of interlimb coordination during gait, in an open context, according to the Population, Concept, Context framework. Methods: A literature search was performed in PubMed, Web of Science™, Scopus, and gray literature in Google Scholar™, according to the PRISMA-ScR recommendations. Studies written in Portuguese or English language and published between database inception and 14 November 2021 were included. Qualitative studies, conference proceedings, letters, and editorials were excluded. The main conceptual categories were "author/year", "study design", "participant's characteristics", "walking conditions", "instruments" and "outcomes". Results: The search identified 827 potentially relevant studies, with a remaining seven fulfilling the established criteria. Interlimb coordination was assessed during walking in treadmill (n = 3), overground (n = 3) and both (n = 1). The instruments used monitored electromyography (n = 2), kinetics (n = 2), and kinematics (n = 4) to assess spatiotemporal parameters (n = 4), joint kinematics (n = 2), anteroposterior ground reaction forces (n = 2), and electromyography root mean square (n = 2) outcomes. These outcomes were mostly used to analyze symmetry indices or ratios, to calculate propulsive impulse and external mechanical power produced on the CoM, as well as antagonist coactivation. Conclusions: Assessment of interlimb coordination during gait is important for consideration of natural auto-selected overground walking, using kinematic, kinetic, and EMG instruments. These allow for the collection of the main biomechanical outcomes that could contribute to improve better knowledge of interlimb coordination assessment in poststroke patients.

Optimal multi-field functional electrical stimulation parameters for the "drinking task - reaching phase" and related upper limb kinematics repeatability in post stroke subjects.

BACKGROUND: No specific guidelines for the management of functional electrical stimulation (FES) parameters in post stroke patients have been defined yet, despite its frequent use. The purpose of this study is to characterize the optimal FES parameters that assist the reaching phase of drinking task ("drinking task - reaching phase") on post stroke subjects and to analyze the related upper limb (UL) movement quality indicators repeatability. METHODS: An observational study with a test and re-test design involving ten post stroke subjects with UL dysfunction was performed. End-point and joint kinematics of contralesional UL were assessed during the "drinking task - reaching phase" with FES through a test and retest design. FES parameters were adjusted to improve UL function according to a consensus between physiotherapists and patients' perspective. FINDINGS: It was possible to establish reliable FES parameters that assisted the "drinking task - reaching phase". All FES parameters presented high to very high repeatability and led to moderate to very high repeatability in almost UL movement quality indicators during the "drinking task - reaching phase". INTERPRETATION: These findings show that the main characteristics of FES parameters that improves patient perception of change are quite stable, which facilitate its implementation in clinical practice by allowing consistence between intervention sessions.

Optimal Multifield Functional Electrical Stimulation Parameters for the "Turn on the Light" Task and Related Upper Limb Kinematics Repeatability in Poststroke Subjects.

OBJECTIVE: To characterize the optimal functional electrical stimulation (FES) parameters that assist the turn on the light task (TOTL) on poststroke participants and to analyze the related upper limb (UL) kinematics repeatability. DESIGN: Cross-sectional study. SETTING: Human movement research center. PARTICIPANTS: Poststroke individuals (N=11) with history of a single unilateral stroke that resulted in a motor control dysfunction of the contralesional UL. INTERVENTIONS: FES based on surface multifield technology applied to the contralesional wrist and finger extensors during the TOTL. MAIN OUTCOME MEASURES: FES outcome metrics (virtual electrodes, stimulation duration, intensity) and kinematic metrics (end-point kinematics [absolute and relative duration, mean and peak velocities, relative instant of peak velocity, index of curvature, number of movement units] and joint kinematics [shoulder, elbow, wrist end position and range of movement]). Outcome measures were assessed 2 times with a 72-hour maximum time interval. CONCLUSION: It was possible to establish reliable FES parameters that assisted the TOTL on poststroke participants. These stimulation parameters led to high to very high repeatability in terms of UL kinematics for most of the cases.

Tracking cognitive impairment in multiple sclerosis using the Brain on Track test: a validation study.

BACKGROUND: The accurate and regular monitoring cognitive performance in multiple sclerosis (MS) patients is critical to develop new prevention and management strategies for cognitive impairment (CI). The Brain on Track (BoT) test is a self-administered web-based tool developed for cognitive screening and monitoring. The objective of this study was to validate the use of the BoT in MS, by assessing its ability to distinguish between MS patients and matched controls, as well as detect CI among MS patients, by analysing its correlation with standard cognitive tests and its reliability and learning effects in repeatable use. METHODS: The BoT was applied in 30 patients with MS consecutively selected and 30 age- and education-matched controls, first in a hospital clinic, under supervision, and then 1 week later from home. After these first two trials, MS patients repeated the test from home every 4 weeks for 3 months. A standard neuropsychological battery was also applied to MS patients at baseline. RESULTS: The Cronbach's alpha was 0.89. Test scores were significantly different between MS patients and controls (Cohen's d = 0.87; p < 0.01). Among MS patients, scores were significantly lower in those with CI documented in the standard neuropsychological battery than in their cognitively preserved counterparts (Cohen's d = 2.0; p < 0.001). The BoT scores presented a good correlation with standard neuropsychological tests, particularly for information processing speed. Regarding test-retest reliability, 10/11 subtests presented two-way mixed single intraclass consistency correlation coefficients > 0.70. CONCLUSION: The BoT showed good neuropsychological parameters in MS patients, endorsing the use of self-administered computerized tests in this setting.

Correction to: Tracking cognitive impairment in multiple sclerosis using the Brain on Track test: a validation study.

The above article was published online with an error in author name's affiliations. Affiliation 8 has to be added to Maria Pia Amato and has to be deleted from Vitor Tedim.

The Acute Effects of Manual and Instrument-Assisted Cervical Spine Manipulation on Pressure Pain Threshold, Pressure Pain Perception, and Muscle-Related Variables in Asymptomatic Subjects: A Randomized Controlled Trial.

OBJECTIVE: The purpose of this study was to compare the immediate effects in asymptomatic participants of manual and instrument-assisted cervical manipulation on pressure pain thresholds, pressure pain perception, and muscle mechanical properties (tone, stiffness, and elasticity) over muscles anatomically related and unrelated to the manipulated level. METHODS: Fifty-nine asymptomatic participants (34 women and 25 men; age [mean ± standard deviation] = 21.1 ± 1.6 years) were randomly assigned to 4 groups in a double-blind, randomized, placebo-controlled trial. Two groups received cervical (C3/C4) manipulation, 1 manual and the other instrument-assisted; the third group received a sham manipulation; and the fourth group served as the control. Bilateral pressure pain threshold, pressure pain perception, muscle tone, stiffness, and elasticity in the upper trapezius and biceps brachii were evaluated before and immediately after the interventions. RESULTS: At baseline, there were no differences among the groups on any variable. After the interventions, a significant increase in pressure pain threshold was observed with both manual and instrument-assisted manipulation at local and distal sites (P < .05), whereas no changes were observed in either the control or the placebo group. The perception of pain pressure did not change significantly in any group. The interventions did not promote any statistically significant differences in muscle tone, elasticity, or stiffness at any site (local or distal). CONCLUSION: Cervical (C3/C4) manual and instrument-assisted manipulations produced an increase in pressure pain threshold bilaterally and over muscles related and unrelated to the vertebral segment, but had no effect on muscle tone, elasticity, or stiffness.