Activation of a Rhythmic Lower Limb Movement Pattern during the Use of a Multimodal Brain-Computer Interface: A Case Study of a Clinically Complete Spinal Cord Injury.

Brain-computer interfaces (BCIs) that integrate virtual reality with tactile feedback are increasingly relevant for neurorehabilitation in spinal cord injury (SCI). In our previous case study employing a BCI-based virtual reality neurorehabilitation protocol, a patient with complete T4 SCI experienced reduced pain and emergence of non-spastic lower limb movements after 10 sessions. However, it is still unclear whether these effects can be sustained, enhanced, and replicated, as well as the neural mechanisms that underlie them. The present report outlines the outcomes of extending the previous protocol with 24 more sessions (14 months, in total). Clinical, behavioral, and neurophysiological data were analyzed. The protocol maintained or reduced pain levels, increased self-reported quality of life, and was frequently associated with the appearance of non-spastic lower limb movements when the patient was engaged and not experiencing stressful events. Neural activity analysis revealed that changes in pain were encoded in the theta frequency band by the left frontal electrode F3. Examination of the lower limbs revealed alternating movements resembling a gait pattern. These results suggest that sustained use of this BCI protocol leads to enhanced quality of life, reduced and stable pain levels, and may result in the emergence of rhythmic patterns of lower limb muscle activity reminiscent of gait.

Typhoid Fever and Non-typhoidal Salmonella Outbreaks: A Portrait of Regional Socioeconomic Inequalities in Brazil.

Typhoid fever occurs in an endemic form in Brazil and is a serious public health problem in some regions. In this scenario, further research is urgently needed to identify the associations between socioeconomic factors and typhoid fever, contributing to guiding policy decisions in the country. We aimed to investigate the influence of socioeconomic disparities on the prevalence of typhoid fever and non-typhoidal Salmonella (NTS) in Brazil. A search for data from 2010 to 2019 was carried out with the national health and human development agencies. As milk and derivatives are the fourth food incriminated in food outbreaks in Brazil, analyses for detecting Salmonella spp. in commercial dairy products allowed us to assess whether the outbreaks associated with these foods are due to inadequacies in sanitary control in dairy establishments or whether they are mainly home-based outbreaks. Predictive models validated by the bootstrapping method demonstrate an association of NTS prevalence reduction with improvements in the Sanitation Service Index (Rv ≥ -8 0.686; p ≤ 0.01) and Municipal Human Development Index - MHDI - (Rv = -0.789; p ≤ 0.02). In the North, typhoid fever prevalence had seasonal variability with the rainfall, while sanitation services (Rv ≥-0.684; p ≤ 0.04) and MHDI (Rv ≥-0.949; p ≤ 0.003) directly influenced Northeast and South Brazil. Thus, the unequal distribution of investments in the sanitation sector contributed to disparities in typhoid fever prevalence among Brazilian regions. The absence of Salmonella spp. in commercial samples ratified the collected data that the outbreaks of Salmonella spp. in the Brazilian population occur mainly at residences. These findings show that implementing public health education and increasing investments in sanitation in regions with poor service can control outbreaks of Salmonella spp. in Brazilian endemic areas.

First immediate transfusion at a prehospital environment in Latin America: A case report

According to the World Health Organization, trauma from external causes remains the major cause of death and disability among people aged from 5 to 29 years old.1 In order to reestablish hemodynamic stability and adequate hemostasis of these patients, without the dilutional effects of infusing large volumes of crystalloids, the concept of hemostatic resuscitation was developed.2 The purpose of this report is to discuss a case in which hemostatic resuscitation was performed quickly, resulting in a good macro-hemodynamic response of the patient at the first prehospital transfusion service in Latin America.

Physicochemical, Rheological, and Nutritional Quality of Artisanal Fermented Milk Beverages with Cupuassu (Theobroma grandiflorum) Pulp and Flour.

The use of fruits and their by-products in food has dramatically impacted the food industry due to the nutritional benefits and the technological and sensory effects of food matrices. Therefore, this research aimed to evaluate the effects of adding cupuassu (Theobroma grandiflorum) pulp and flour on fermented milk beverages' physicochemical, microbial, and sensory properties during refrigerated storage (0, 7, 14, 21, and 28 days). Twelve formulations were realized with different percentages of cupuassu pulp (0, 5, 7.5, and 10% w/v) and flour (0, 1.5, and 3% w/v). The treatments with 3% cupuassu flour presented the highest percentages of protein, fat, fiber, and carbohydrates, compared with the samples containing pulp. On the other hand, the addition of pulp increased water retention capacity and color parameters (L*, a*, b*, and C*) and decreased pH and syneresis on day 0 of storage. During storage, the samples with pulp showed increases in pH values, consistency index, and apparent viscosity. In comparison, cupuassu flour addition decreased syneresis values and increased L* and b* during storage, as did pulp. In addition, sample HPHF (10% pulp and 3% cupuassu flour), based on just-about-right, penalty, and check-all-that-apply analyses, improved some sensory attributes of the fermented milk beverage, such as brown color, acid taste, bitter taste, cupuassu flavor, and firm texture. It can be concluded that cupuassu pulp and flour addition improves the physicochemical and sensory quality of fermented milk beverages and can provide nutritional value to the product.

Artisanal Goat Coalho Cheese with Cachaça as Flavoring Agent.

Cachaça is a traditional Brazilian drink that has the potential to offer a new sensory and technological strategy for artisanal cheesemaking, particularly for small-scale producers and family farming. This study aimed to investigate the effects of cachaça immersion on the physicochemical, microbiological, color, texture, and sensory parameters of artisanal goat coalho cheeses using three different varieties of cachaça immersion. The results showed that cachaça immersion did not affect the cheese's proximate composition or starter culture viability, indicating its suitability as a new method for artisanal cheese production. Additionally, gold cachaça aged in oak casks was the most effective variety for sensory acceptance and purchase intention, suggesting that it may be a valuable strategy for small-scale producers to add value and encourage the consumption of artisanal goat coalho cheeses without compromising their quality. Thus, this study provides important insights for small-scale producers and family farming to enhance their product offerings and increase their competitiveness in the market.

Neurophysiological correlates of tactile width discrimination in humans.

Introduction: Tactile information processing requires the integration of sensory, motor, and cognitive information. Width discrimination has been extensively studied in rodents, but not in humans. Methods: Here, we describe Electroencephalography (EEG) signals in humans performing a tactile width discrimination task. The first goal of this study was to describe changes in neural activity occurring during the discrimination and the response periods. The second goal was to relate specific changes in neural activity to the performance in the task. Results: Comparison of changes in power between two different periods of the task, corresponding to the discrimination of the tactile stimulus and the motor response, revealed the engagement of an asymmetrical network associated with fronto-temporo-parieto-occipital electrodes and across multiple frequency bands. Analysis of ratios of higher [Ratio 1: (0.5-20 Hz)/(0.5-45 Hz)] or lower frequencies [Ratio 2: (0.5-4.5 Hz)/(0.5-9 Hz)], during the discrimination period revealed that activity recorded from frontal-parietal electrodes was correlated to tactile width discrimination performance between-subjects, independently of task difficulty. Meanwhile, the dynamics in parieto-occipital electrodes were correlated to the changes in performance within-subjects (i.e., between the first and the second blocks) independently of task difficulty. In addition, analysis of information transfer, using Granger causality, further demonstrated that improvements in performance between blocks were characterized by an overall reduction in information transfer to the ipsilateral parietal electrode (P4) and an increase in information transfer to the contralateral parietal electrode (P3). Discussion: The main finding of this study is that fronto-parietal electrodes encoded between-subjects' performances while parieto-occipital electrodes encoded within-subjects' performances, supporting the notion that tactile width discrimination processing is associated with a complex asymmetrical network involving fronto-parieto-occipital electrodes.

Embodiment Comfort Levels During Motor Imagery Training Combined With Immersive Virtual Reality in a Spinal Cord Injury Patient.

Brain-machine interfaces combining visual, auditory, and tactile feedback have been previously used to generate embodiment experiences during spinal cord injury (SCI) rehabilitation. It is not known if adding temperature to these modalities can result in discomfort with embodiment experiences. Here, comfort levels with the embodiment experiences were investigated in an intervention that required a chronic pain SCI patient to generate lower limb motor imagery commands in an immersive environment combining visual (virtual reality -VR), auditory, tactile, and thermal feedback. Assessments were made pre-/ post-, throughout the intervention (Weeks 0-5), and at 7 weeks follow up. Overall, high levels of embodiment in the adapted three-domain scale of embodiment were found throughout the sessions. No significant adverse effects of VR were reported. Although sessions induced only a modest reduction in pain levels, an overall reduction occurred in all pain scales (Faces, Intensity, and Verbal) at follow up. A high degree of comfort in the comfort scale for the thermal-tactile sleeve, in both the thermal and tactile feedback components of the sleeve was reported. This study supports the feasibility of combining multimodal stimulation involving visual (VR), auditory, tactile, and thermal feedback to generate embodiment experiences in neurorehabilitation programs.

Rational engineering of industrial S. cerevisiae: towards xylitol production from sugarcane straw.

BACKGROUND: Sugarcane hemicellulosic material is a compelling source of usually neglected xylose that could figure as feedstock to produce chemical building blocks of high economic value, such as xylitol. In this context, Saccharomyces cerevisiae strains typically used in the Brazilian bioethanol industry are a robust chassis for genetic engineering, given their robustness towards harsh operational conditions and outstanding fermentation performance. Nevertheless, there are no reports on the use of these strains for xylitol production using sugarcane hydrolysate. RESULTS: Potential single-guided RNA off-targets were analyzed in two preeminent industrial strains (PE-2 and SA-1), providing a database of 5'-NGG 20 nucleotide sequences and guidelines for the fast and cost-effective CRISPR editing of such strains. After genomic integration of a NADPH-preferring xylose reductase (XR), FMYX (SA-1 hoΔ::xyl1) and CENPKX (CEN.PK-122 hoΔ::xyl1) were tested in varying cultivation conditions for xylitol productivity to infer influence of the genetic background. Near-theoretical yields were achieved for all strains; however, the industrial consistently outperformed the laboratory strain. Batch fermentation of raw sugarcane straw hydrolysate with remaining solid particles represented a challenge for xylose metabolization, and 3.65 ± 0.16 g/L xylitol titer was achieved by FMYX. Finally, quantification of NADPH - cofactor implied in XR activity - revealed that FMYX has 33% more available cofactors than CENPKX. CONCLUSIONS: Although widely used in several S. cerevisiae strains, this is the first report of CRISPR-Cas9 editing major yeast of the Brazilian bioethanol industry. Fermentative assays of xylose consumption revealed that NADPH availability is closely related to mutant strains' performance. We also pioneer the use of sugarcane straw as a substrate for xylitol production. Finally, we demonstrate how industrial background SA-1 is a compelling chassis for the second-generation industry, given its inhibitor tolerance and better redox environment that may favor production of reduced sugars.

Pequi (Caryocar brasiliense) Waste Extract as a Synergistic Agent in the Microbial and Physicochemical Preservation of Low-Sodium Raw Goat Cheese.

The growth of spoilage and pathogenic bacteria during storage represents significant losses in marketing raw milk cheeses. Thus, reducing NaCl in these products is challenging, as sodium has a critical antimicrobial role. Despite advances in non-thermal technologies, the short shelf life still limits the availability of raw goat cheese. Thus, combined preservation methods can be promising because their synergies can extend shelf life more effectively. In this context, Principal Component Analysis (PCA) was applied to variables to investigate the effect of pequi waste extract (PWE), a native Brazilian fruit, combined with UV-C radiation (CEU) and vacuum packaging (CEV) on the preservation of low-sodium raw goat cheese. CEV samples had lower loadings for Staphylococcus subsp. and Enterobacteriaceae than other treatments in PC2, having a count's reduction up to 3-fold (P < 0.05) compared to vacuum alone. In contrast, CEU showed an increase of up to 1.2-fold on staphylococcal count compared to UV-C alone. Still, the addition of PWE to UV-C-treated cheeses resulted in 8.5% protein loss. Furthermore, PWE, especially in CEV, delayed post-acidification during storage. It made CEV up to 4.5 and 1.6-fold more stable for color and texture, respectively than vacuum alone. These data strongly suggest that PWE may be a novel and promising synergistic agent in the microbial and physicochemical preservation of low-sodium raw milk cheese when combined with the vacuum.

Rheological, Physical and Sensory Evaluation of Low-Fat Cupuassu Goat Milk Yogurts Supplemented with Fat Replacer.

The use of skim milk is a strategy to increase goat milk yogurt acceptability. However, it can negatively affect yogurt rheology because fat plays a vital role in dairy structural integrity. Thus, this study aimed to investigate the effects of fat replacers on the rheological, physical, and sensory parameters of low-fat cupuassu goat milk yogurts during refrigerated storage (28 days). Five goat milk yogurts formulations were carried out: whole yogurt (WY), skim yogurt (SY), skim yogurt with inulin (SIY), skim yogurt with maltodextrin (SMY), and skim yogurt with whey protein (SWY). Treatments were subjected to bacterial counts, chemical composition, pH, water holding capacity, instrumental color and texture, rheological and sensory analyses. All samples showed reducing pH values, water holding capacity, and L* and b* value during storage. Regarding texture, the firmness and consistency decreased during storage. On the other hand, the viscosity index significantly increased during refrigerated storage time. Moreover, all treatments exhibited viscoelastic behaviour. In addition, SIY and SMY showed the highest apparent viscosity. Furthermore, SIY, SMY, and SWY formulations exhibited positive sensory scores for appearance, color, aroma, texture, and viscosity. However, the overall acceptability and purchase intention did not differ statistically between WY and the fat-replacement treatments (SIY, SMY, and SWY). These results indicate that fat substitutes improved the quality of skimmed formulations. Thus, inulin and maltodextrin have the potential as functional fat replaces to produce low-fat goat milk yogurts.

Renin-angiotensin system modulation through enalapril and/or exercise training improves visceral adiposity in obese mice.

INTRODUCTION: Obesity-related metabolic diseases occur as a result of disruptions in white adipose tissue (WAT) plasticity, especially through visceral fat accumulation and adipocyte hypertrophy. This study aimed to evaluate the impact of renin-angiotensin system (RAS) and bradykinin receptors modulation by enalapril treatment and/or exercise training on WAT morphology and related deleterious outcomes. METHODS: Male C57BL/6 mice were fed either a standard chow or a high-fat (HF) diet for 16 weeks. At the 8th week, HF-fed animals were divided into sedentary (HF), enalapril treatment (HF-E), exercise training (HF-T), and enalapril treatment plus exercise training (HF-ET) groups. Following the experimental protocol, body mass gain, adiposity index, insulin resistance, visceral WAT morphometry, renin-angiotensin system, and bradykinin receptors were evaluated. RESULTS: The HF group displayed increased adiposity, larger visceral fat mass, and adipocyte hypertrophy, which was accompanied by insulin resistance, overactivation of Ang II/AT1R arm, and favoring of B1R in bradykinin receptors profile. All interventions ameliorated visceral adiposity and related outcomes by favoring the Ang 1-7/MasR arm and the B2R expression in B1R/B2R ratio. However, combined therapy additively reduced Ang II/Ang 1-7 ratio. CONCLUSION: Our results suggest that Ang 1-7/MasR arm and B2R activation might be relevant targets in the treatment of visceral obesity.

Detection of Saint Louis encephalitis virus in two Brazilian states.

We describe the circulation of Saint Louis encephalitis virus (SLEV) in two Brazilian States during outbreaks of Dengue and Zika viruses. We detected the virus in a patient from Araraquara, State of São Paulo, and in patients and in a mosquito pool of Culex quinquefasciatus from Sinop, State of Mato Grosso. Phylogenetic analysis grouped samples from this study within genotype V, which are closely related to other strains that previously circulated in other parts of the country. Genotype V seems to have established circulation in Brazil.

Land-use effects on mosquito biodiversity and potential arbovirus emergence in the Southern Amazon, Brazil.

The Amazon rainforest is considered the largest reservoir of culicids and arboviruses in the world. It has been under intense human-driven alteration, especially in the so-called 'Arc of Deforestation', located in the eastern and southern regions. The emergence and transmission of infectious diseases are increasing, potentially due to land-use change. We used landscape-scale mosquito surveillance across a forest fragmentation gradient in the southern Amazon to evaluate the relationship between forest disturbance and the composition and structure of mosquito communities with a particular focus on the potential for arbovirus emergence in the region. Generalized linear models and logistic regression were used to associate the degree of landscape disturbance with arbovirus vectors' richness and abundance. A total of 1,960 culicids, belonging to 50 species, were collected from 2015 to 2016. Among these species, 20 have been associated with the transmission of arboviruses. Our results show an association of land use, more specifically small size of forest remnants with more irregular shape and higher edge density, with the increase of arbovirus vectors' richness and abundance. Six species of mosquito vectors exhibited a higher probability of occurrence in landscapes with medium or high degrees of disturbance. Our results indicate that land-use change influences mosquito communities with potential implications for the emergence of arboviruses.

Isopropanol-butanol-ethanol production by cell-immobilized vacuum fermentation.

The Isopropanol-Butanol-Ethanol productivity by solventogenic clostridia can increase when cells are immobilized on low-cost, renewable fibrous materials; however, butanol inhibition imposes the need for dilute sugar solutions (less than40 g/L). To alleviate this problem, the in-situ vacuum product recovery technique was applied to recover IBE in repeated-batch cultivation of Clostridium beijerinckii DSM 6423 immobilized on sugarcane bagasse. Five repeated batch cycles were conducted in a 7-L bioreactor containing P2 medium (∼60 g/L glucose) and bagasse packed in 3D-printed concentric annular baskets. In three cycles, glucose was consumed by 86% on average, the IBE productivity was 0.35 g/L∙h or 30% and 17% higher relative to free- and immobilized (without vacuum)-cell cultures. Notably, the product stream contained 45 g/L IBE. However, the fermentation was unsatisfactory in two cycles. Finally, by inserting a fibrous bed with hollow annuli in a vacuum fermentation, this work introduces the concept of an internal-loop boiling-driven fibrous-bed bioreactor.

Perceptions of patients in the waiting line for bariatric surgery: contributions from the experience of an educational process / Percepções de pacientes na fila de espera para cirurgia bariátrica: contribuições a partir da experiência de um processo educativo / Percepciones de pacientes en la fila de espera para cirugía bariátrica: contribuciones a partir de la experiencia de un proceso educativo

The present study is a qualitative research with the objective of analyzing the perceptions of patients in the face of the challenges in the bariatric surgery line through focal groups. All patients were treated with an outpatient protocol, however, they were divided into two groups, one participated in the educational process and the other did not. Four categories of analysis were drawn up and discussed in the light of the current literature. Patients from the educational process were able to express themselves with greater positivity in view of the challenges and they showed better resources for going through the emotional suffering, the worsening of comorbidities and the risk of death. The results show the potential of education in health and of group work in the promotion of self-care and well-being.(AU)

O presente estudo trata-se de uma pesquisa qualitativa com o objetivo de analisar as percepções dos pacientes diante dos desafios na fila da cirurgia bariátrica por meio de grupos focais. Todos os pacientes foram atendidos com protocolo ambulatorial, porém, foram divididos em dois grupos, um participou do processo educativo e o outro não. Quatro categorias de análise foram elaboradas e discutidas à luz da literatura atual. Os pacientes do processo educativo conseguiram se expressar com maior positividade diante dos desafios e apresentaram melhores recursos para atravessar o sofrimento emocional, o agravamento das comorbidades e o risco de morte. Os resultados mostram o potencial da educação em saúde e do trabalho em grupo na promoção do autocuidado e do bem-estar.(AU)

El presente estudio se trata de una investigación cualitativa con el objetivo de analizar las percepciones de los pacientes ante los desafíos en la fila de la cirugía bariátrica por medio de grupos focales. Todos los pacientes fueron atendidos con protocolo ambulatorio, pero se dividieron en dos grupos, uno participó en el proceso educativo y el otro no. Se elaboraron y discutieron cuatro categorías de análisis a la luz de la literatura actual. Los pacientes del proceso educativo consiguieron expresarse con mayor positividad antes los desafíos y presentaron mejores recursos para pasar por el sufrimiento emocional, el agravamiento de las comorbilidades y el riesgo de muerte. Los resultados muestran el potencial de la educación en salud y del trabajo en grupo de la promoción del autocuidado y del bienestar.(AU)

Bioactive Compounds from Kefir and Their Potential Benefits on Health: A Systematic Review and Meta-Analysis.

Despite evidence of health benefits from kefir administration, a systematic review with meta-analysis on bioactive compounds associated with these benefits is still absent in the literature. Kefir is fermented milk resulting from the metabolism of a complex microbiota in symbiosis. Recent researches have investigated the bioactive compounds responsible for the preventive and therapeutic effects attributed to kefir. However, differences in functional potential between industrial and artisanal kefir are still controversial. Firstly, we identified differences in the microbial composition among both types of kefir. Available evidence concerning the action of different bioactive compounds from kefir on health, both from in vitro and in vivo studies, was subsequently summarized to draw a primary conclusion of the dose and the intervention time for effect, the producer microorganisms, the precursor in the milk, and the action mechanism. Meta-analysis was performed to investigate the statistically significant differences (P < 0.05) between intervention and control and between both types of kefir for each health effect studied. In summary, the bioactive compounds more commonly reported were exopolysaccharides, including kefiran, bioactive peptides, and organic acids, especially lactic acid. Kefir bioactive compounds presented antimicrobial, anticancer, and immune-modulatory activities corroborated by the meta-analysis. However, clinical evidence is urgently needed to strengthen the practical applicability of these bioactive compounds. The mechanisms of their action were diverse, indicating that they can act by different signaling pathways. Still, industrial and artisanal kefir may differ regarding functional potential-OR of 8.56 (95% CI: 2.27-32.21, P ≤ .001)-according to the observed health effect, which can be associated with differences in the microbial composition between both types of kefir.

A nutritionist approach to psychiatric treatment: Notes from a brief experience

ABSTRACT Objective: This study aims to describe the work of the nutritionist in a psychiatric outpatient clinic of a university hospital, with patients with excess weight due to the use of certain psychiatric medications. Method: Content analysis of the clinical history and brief field notes, as complementary material. The clinical-qualitative method was applied in data collection and analysis. Results: Conversations with patients focused on their relationship with food were more effective in managing excessive weight gain than insistence on individualized and restrictive diets. The role of the family was important to strengthen the bond and favor dietary changes. Efforts to identify the emotions involved in eating, including the pleasures given by emotional, cultural, and social factors were also important. Conclusions: Nutritional care in the psychiatric field should emphasize dialogue related to the eating practices of patients. Strict dietary prescriptions can have the same unproductive effect as traditional biomedical practices if they do not consider subjective aspects of patients.

RESUMEN Objetivo: El objetivo de este estudio fue describir el trabajo del nutricionista en una clínica ambulatoria de psiquiatría de un hospital universitario, en pacientes con exceso de peso debido al uso de ciertos medicamentos psiquiátricos. Método: Análisis del contenido de la historia clínica y de breves notas de campo, como material complementario. Se aplicó el método clínico-cualitativo en la recolección y análisis de los datos. Resultados: El autor principal de este artículo, una nutricionista, indica que las conversaciones con pacientes centradas en su relación con la comida fueron más efectivas para manejar el aumento de peso excesivo do que la insistencia en las dietas individualizadas y restrictivas. El rol de la familia fue importante para fortalecer el vínculo e favorecer los cambios alimentarios. También fueran importantes los esfuerzos para identificar las emociones involucradas en la alimentación, incluidas los placeres dados por factores emocionales, culturales y sociales. Conclusiones: La atención nutricional en el campo psiquiátrico debe enfatizar el diálogo relacionado con las prácticas alimentarias de los pacientes. Las prescripciones estrictamente dietéticas pueden tener el mismo efecto improductivo que las prácticas biomédicas tradicionales si tampoco toman en cuenta los aspectos subjetivos de los pacientes.

Serious Game Design and Clinical Improvement in Physical Rehabilitation: Systematic Review.

BACKGROUND: Serious video games have now been used and assessed in clinical protocols, with several studies reporting patient improvement and engagement with this type of therapy. Even though some literature reviews have approached this topic from a game perspective and presented a broad overview of the types of video games that have been used in this context, there is still a need to better understand how different game characteristics and development strategies might impact and relate to clinical outcomes. OBJECTIVE: This review assessed the relationship between the characteristics of serious games (SGs) and their relationship with the clinical outcomes of studies that use this type of therapy in motor impairment rehabilitation of patients with stroke, multiple sclerosis, or cerebral palsy. The purpose was to take a closer look at video game design features described in the literature (game genre [GG], game nature [GN], and game development strategy [GDS]) and assess how they may contribute toward improving health outcomes. Additionally, this review attempted to bring together medical and game development perspectives to facilitate communication between clinicians and game developers, therefore easing the process of choosing the video games to be used for physical rehabilitation. METHODS: We analyzed the main features of SG design to obtain significant clinical outcomes when applied to physical rehabilitation of patients recovering from motor impairments resulting from stroke, multiple sclerosis, and cerebral palsy. We implemented a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) database-adjusted electronic search strategy for the PubMed, IEEE Xplore, and Cochrane databases. RESULTS: We screened 623 related papers from 2010-2021 and identified 12 that presented results compatible with our inclusion criteria. A total of 512 participants with stroke (8 studies, 417 participants), cerebral palsy (1 study, 8 participants), and multiple sclerosis (2 studies, 46 participants) were included; 1 study targeting the elderly (41 participants) was also included. All studies assessed motor, sensory, and functional functions, while some also measured general health outcomes. Interventions with games were used for upper-limb motor rehabilitation. Of the 12 studies, 8 presented significant improvements in at least one clinical measurement, of which 6 presented games from the casual GG, 1 combined the casual, simulation, and exergaming GGs, and 2 combined the sports and simulation GGs. CONCLUSIONS: Of the possible combinations of game design features (GG, GN, and GDS) described, custom-made casual games that resort to the first-person perspective, do not feature a visible player character, are played in single-player mode, and use nonimmersive virtual reality attain the best results in terms of positive clinical outcomes. In addition, the use of custom-made games versus commercial off-the-shelf games tends to give better clinical results, although the latter are perceived as more motivating and engaging.

Green and Healthier Alternatives to Chemical Additives as Cheese Preservative: Natural Antimicrobials in Active Nanopackaging/Coatings.

The side effects and potential impacts on human health by traditional chemical additives as food preservatives (i.e., potassium and sodium salts) are the reasons why novel policies are encouraged by worldwide public health institutes. More natural alternatives with high antimicrobial efficacy to extend shelf life without impairing the cheese physicochemical and sensory quality are encouraged. This study is a comprehensive review of emerging preservative cheese methods, including natural antimicrobials (e.g., vegetable, animal, and protist kingdom origins) as a preservative to reduce microbial cheese contamination and to extend shelf life by several efforts such as manufacturing ingredients, the active ingredient for coating/packaging, and the combination of packaging materials or processing technologies. Essential oils (EO) or plant extracts rich in phenolic and terpenes, combined with packaging conditions and non-thermal methods, generally showed a robust microbial inhibition and prolonged shelf life. However, it impaired the cheese sensory quality. Alternatives including EO, polysaccharides, polypeptides, and enzymes as active ingredients/nano-antimicrobials for an edible film of coating/nano-bio packaging showed a potent and broad-spectrum antimicrobial action during shelf life, preserving cheese quality parameters such as pH, texture, color, and flavor. Future opportunities were identified in order to investigate the toxicological effects of the discussed natural antimicrobials' potential as cheese preservatives.