The potential role of renin angiotensin system in acute leukemia: a narrative review.

Acute leukemias (ALs) are the most common cancers in pediatric population. There are two types of ALs: acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Some studies suggest that the Renin Angiotensin System (RAS) has a role in ALs. RAS signaling modulates, directly and indirectly, cellular activity in different cancers, affecting tumor cells and angiogenesis. Our review aimed to summarize the role of RAS in ALs and to explore future perspectives for the treatment of these hematological malignancies by modulating RAS molecules. The database including Pubmed, Scopus, Cochrane Library, and Scielo were searched to find articles about RAS molecules in ALL and in pediatric patients. The search terms were "RAS", "Acute Leukemia", "ALL", "Angiotensin-(1-7)", "Pediatric", "Cancer", "Angiotensin II", "AML". In the bone marrow, RAS has been found to play a key role in blood cell formation, affecting several processes including apoptosis, cell proliferation, mobilization, intracellular signaling, angiogenesis, fibrosis, and inflammation. Local tissue RAS modulates tumor growth and metastasis through autocrine and paracrine actions. RAS mainly acts via two molecules, Angiotensin II (Ang II) and Angiotensin (1-7) [Ang-(1-7)]. While Ang II promotes tumor cell growth and stimulates angiogenesis, Ang-(1-7) inhibits the proliferation of neoplastic cells and the angiogenesis, suggesting a potential therapeutic role of this molecule in ALL. The interaction between ALs and RAS reveals a complex network of molecules that can affect the hematopoiesis and the development of hematological cancers. Understanding these interactions could pave the way for innovative therapeutic approaches targeting RAS components.

Performance and emissions data of an internal combustion engine operating with different ethanol/water mixtures and compression ratios.

This study presents performance and emissions data of an Otto cycle mono-cylinder combustion engine operating with two different compression rates and several mixtures of anhydrous ethanol fuel and water. The instrumented engine was mounted on a dynamometer with the ignition point and injection fuel advance calibrated to obtain the maximum torque and mixture in stoichiometric conditions. Characteristic engine performance parameters and emission fractions from its exhaust system were acquired from 2,000 rpm to 4,000 rpm with fuel mixtures of up to 50% water content. To our knowledge, data on this extreme operating condition are not available in the literature.

Decoding Electroencephalography Signal Response by Stacking Ensemble Learning and Adaptive Differential Evolution.

Electroencephalography (EEG) is an exam widely adopted to monitor cerebral activities regarding external stimuli, and its signals compose a nonlinear dynamical system. There are many difficulties associated with EEG analysis. For example, noise can originate from different disorders, such as muscle or physiological activity. There are also artifacts that are related to undesirable signals during EEG recordings, and finally, nonlinearities can occur due to brain activity and its relationship with different brain regions. All these characteristics make data modeling a difficult task. Therefore, using a combined approach can be the best solution to obtain an efficient model for identifying neural data and developing reliable predictions. This paper proposes a new hybrid framework combining stacked generalization (STACK) ensemble learning and a differential-evolution-based algorithm called Adaptive Differential Evolution with an Optional External Archive (JADE) to perform nonlinear system identification. In the proposed framework, five base learners, namely, eXtreme Gradient Boosting, a Gaussian Process, Least Absolute Shrinkage and Selection Operator, a Multilayer Perceptron Neural Network, and Support Vector Regression with a radial basis function kernel, are trained. The predictions from all these base learners compose STACK's layer-0 and are adopted as inputs of the Cubist model, whose hyperparameters were obtained by JADE. The model was evaluated for decoding the electroencephalography signal response to wrist joint perturbations. The variance accounted for (VAF), root-mean-squared error (RMSE), and Friedman statistical test were used to validate the performance of the proposed model and compare its results with other methods in the literature, including the base learners. The JADE-STACK model outperforms the other models in terms of accuracy, being able to explain around, as an average of all participants, 94.50% and 67.50% (standard deviations of 1.53 and 7.44, respectively) of the data variability for one step ahead and three steps ahead, which makes it a suitable approach to dealing with nonlinear system identification. Also, the improvement over state-of-the-art methods ranges from 0.6% to 161% and 43.34% for one step ahead and three steps ahead, respectively. Therefore, the developed model can be viewed as an alternative and additional approach to well-established techniques for nonlinear system identification once it can achieve satisfactory results regarding the data variability explanation.

Effects of custom insoles for symptomatic hallux valgus: protocol for a sham-controlled randomised trial.

INTRODUCTION: Hallux valgus (HV) is one of the most prevalent forefoot deformities, and its frequency increases with age, reaching nearly 23% in adulthood (females are usually more affected). Studies on customised insoles and orthoses for HV showed inconclusive results. There is no consensus in literature regarding the ideal insole or length of use for pain relief or functional improvement in individuals with HV. This study will assess the effects of a customised insole with retrocapital bar associated with an infracapital bar of the first metatarsal on pain and function of individuals with symptomatic HV. METHODS: This is the protocol for a blinded, sham-controlled randomised clinical trial. Eighty participants with symptomatic HV will be randomised into two groups (40 per group): customised insole or sham insole. Assessments will be performed at baseline (T0), six (T6) and 12 weeks (T12) of intervention. A follow-up will occur after 4 weeks of intervention (T16). The primary and secondary outcomes will be pain (Numerical Pain Scale) and function (Foot Function Index), respectively. STATISTICAL ANALYSIS: Analysis of variance with a mixed design or Friedman's test will be considered according to data distribution; post-hoc analyses will be performed using Bonferroni test. Time × group interaction and within-group and between-group differences will also be assessed. The intent-to-treat analysis will be used. A significance level of 5% and 95% s will be adopted for all statistical analyses. ETHICS AND DISSEMINATION: This protocol was approved by the research ethics committee of the Faculty of Health Sciences of Trairi/Federal University of Rio Grande do Norte (UFRN/FACISA; opinion number 5411306). The study results will be disseminated to participants, submitted to a peer-reviewed journal and presented in scientific meetings. TRIAL REGISTRATIONS NUMBER: NCT05408156.

Bilateral Stroke: A Case Report.

We present the case of a 74-year-old woman, functionally independent in her daily activities, with a medical history notable for hypertension and dyslipidemia. She presented to the emergency room with an altered level of consciousness, opening her eyes only to pain, no verbal response, and flexion withdrawal from pain coupled with a Glasgow Coma Scale of 7. The intensive care unit was promptly summoned, and the patient was intubated and admitted to intensive care. Comprehensive laboratory assessments revealed no abnormalities and an initial cerebral CT scan showed no acute changes. A subsequent CT scan performed 24 hours post-event disclosed bilateral ischemia affecting the territories of the anterior and middle cerebral arteries. Regrettably, this catastrophic event precluded any potential for recovery. Consequently, the decision was made not to pursue further investigations to determine the underlying cause. The medical team opted for supportive treatment and comfort measures. Tragically, the patient died on the 37th day of hospital admission.

Effects of insoles adapted in flip-flop sandals for persistent heel pain: a protocol for a sham-controlled randomised trial.

INTRODUCTION: Persistent heel pain is a prevalent complaint affecting up to 10% of the population. Insoles adapted in flip-flop sandals are an alternative treatment for pain and function of individuals with persistent heel pain, showing improvement within 12 weeks of treatment. Most studies considered foot posture and biomechanics to prescribe insoles for persistent heel pain, but few verified the effects of a 12-week treatment on pain catastrophising. This study will investigate the effects of insoles adapted in flip-flop sandals on pain intensity, function, functional walking capacity and pain catastrophising of individuals with persistent heel pain. METHODS AND ANALYSIS: This is a protocol for a sham-controlled randomised trial. Eighty individuals with persistent heel pain will be assessed and randomised into two intervention groups: insoles adapted in flip-flop sandals and flip-flop sandals with sham (ie, flat) insoles. Assessments will be conducted at baseline (T0), after 6 weeks (T6), 12 weeks postintervention (T12) and after a 4-week follow-up (T16). The primary outcome will be the pain intensity, and secondary outcomes will be foot function, functional walking capacity and pain catastrophising. Analysis of variance with mixed design (if normal distribution) or Friedman's test (if not normal distribution) will verify intergroup and intragroup differences. Bonferroni post hoc tests will be performed in case of significant group or time interaction. Intent-to-treat analysis will be used, and a significance level of 5% and 95% CIs will be considered. ETHICS AND DISSEMINATION: This study was approved by the research ethics committee of the Federal University of Rio Grande do Norte (registry no. 4,018,821). Results will be disseminated to individuals, submitted to a peer-reviewed journal and disclosed in scientific meetings. TRIAL REGISTRATION NUMBER: NCT04784598.

Molecular Defense Response of Pine Trees (Pinus spp.) to the Parasitic Nematode Bursaphelenchus xylophilus.

Pine wilt disease (PWD) is a severe environmental problem in Eastern Asia and Western Europe, devastating large forest areas and causing significant economic losses. This disease is caused by the pine wood nematode (PWN), Bursaphelenchus xylophilus, a parasitic migratory nematode that infects the stem of conifer trees. Here we review what is currently known about the molecular defense response in pine trees after infection with PWN, focusing on common responses in different species. By giving particular emphasis to resistance mechanisms reported for selected varieties and families, we identified shared genes and pathways associated with resistance, including the activation of oxidative stress response, cell wall lignification, and biosynthesis of terpenoids and phenylpropanoids. The role of post-transcriptional regulation by small RNAs in pine response to PWN infection is also discussed, as well as the possible implementation of innovative RNA-interference technologies, with a focus on trans-kingdom small RNAs. Finally, the defense response induced by elicitors applied to pine plants before PWN infection to prompt resistance is reviewed. Perspectives about the impact of these findings and future research approaches are discussed.

Active Actions in the Extraction of Urban Objects for Information Quality and Knowledge Recommendation with Machine Learning.

Due to the increasing urban development, it has become important for municipalities to permanently understand land use and ecological processes, and make cities smart and sustainable by implementing technological tools for land monitoring. An important problem is the absence of technologies that certify the quality of information for the creation of strategies. In this context, expressive volumes of data are used, requiring great effort to understand their structures, and then access information with the desired quality. This study are designed to provide an initial response to the need for mapping zones in the city of Itajaí (SC), Brazil. The solution proposes to aid object recognition employing object-based classifiers OneR, NaiveBayes, J48, IBk, and Hoeffding Tree algorithms used together with GeoDMA, and a first approach in the use of Region-based Convolutional Neural Network (R-CNN) and the YOLO algorithm. All this is to characterize vegetation zones, exposed soil zones, asphalt, and buildings within an urban and rural area. Through the implemented model for active identification of geospatial objects with similarity levels, it was possible to apply the data crossover after detecting the best classifier with accuracy (85%) and the kappa agreement coefficient (76%). The case study presents the dynamics of urban and rural expansion, where expressive volumes of data are obtained and submitted to different methods of cataloging and preparation to subsidize rapid control actions. Finally, the research describes a practical and systematic approach, evaluating the extraction of information to the recommendation of knowledge with greater scientific relevance. Allowing the methods presented to apply the calibration of values for each object, to achieve results with greater accuracy, which is proposed to help improve conservation and management decisions related to the zones within the city, leaving as a legacy the construction of a minimum technological infrastructure to support the decision.

Static Attitude Determination Using Convolutional Neural Networks.

The need to estimate the orientation between frames of reference is crucial in spacecraft navigation. Robust algorithms for this type of problem have been built by following algebraic approaches, but data-driven solutions are becoming more appealing due to their stochastic nature. Hence, an approach based on convolutional neural networks in order to deal with measurement uncertainty in static attitude determination problems is proposed in this paper. PointNet models were trained with different datasets containing different numbers of observation vectors that were used to build attitude profile matrices, which were the inputs of the system. The uncertainty of measurements in the test scenarios was taken into consideration when choosing the best model. The proposed model, which used convolutional neural networks, proved to be less sensitive to higher noise than traditional algorithms, such as singular value decomposition (SVD), the q-method, the quaternion estimator (QUEST), and the second estimator of the optimal quaternion (ESOQ2).

A Case Report of an Emergency Hypertensive Episode During Trastuzumab Therapy.

Human epidermal growth factor receptor 2 (HER2+) targeted therapies, such as trastuzumab emtansine, has been shown to have a significant positive effect on the outcome of breast cancer. Rarely, this therapy can cause adverse cardiovascular effects such as cardiac dysfunction, arrhythmias and hypertension. We report a case of a 60-year-old woman who presented to the emergency department with an episode of hypertensive emergency. She had been recently diagnosed with hypertension which was found to be poorly controlled. The recent administration of trastuzumab together with this hypertensive episode led us to suspect trastuzumab as the cause for this rise in her blood pressure. With this case we intend to raise awareness of hypertension, a potentially preventable condition, as an adverse effect of human epidermal growth factor receptor 2 targeted therapies such as trastuzumab. Additionally we propose an appropriate and careful management of arterial hypertension among those receiving this first-in-class drug.

Os conhecimentos e as práticas adotadas pelos enfermeiros dos cuidados de saúde primários, na prevenção da recorrência da urolitíase / Knowledge and practices adopted by nurses in primary health care in preventing recurrence of urolithiasis

A probabilidade de recorrência da urolitíase é elevada, e manifesta-se no sofrimento do doente, da sua família e pessoas significativas. Há gastos dispendiosos em novos internamentos, medicação, bem como ocorrência de absentismo laboral. Daí a necessidade urgente do ensino ao doente e à família no sentido de adotar medidas de forma a prevenir a formação de novos cálculos e nada melhor do que envolver o enfermeiro que é um educador para a saúde por excelência. Decorrente desta necessidade decidiu-se avaliar os conhecimentos e as práticas adotadas pelos enfermeiros dos cuidados de saúde primários, alargando e tornando mais equitativo o acesso à prevenção da urolitíase. Com o objetivo de avaliar os conhecimentos e as práticas adotadas pelos enfermeiros dos cuidados de saúde primários de um Agrupamento de Centros de Saúde na Região Centro de Portugal, na prevenção da recorrência da urolitíase, realizou-se um estudo de natureza quantitativa, descritivo, correlacional e transversal. O método de recolha de dados foi o questionário construído para o efeito. Definiu-se como população todos os enfermeiros de cuidados de saúde primários que prestam cuidados num ACES na Região Centro de Portugal e que participaram de forma voluntária. Neste estudo verificou-se que o nível de conhecimentos dos inquiridos não foi influenciado pelo perfil académico e profissional. Constatou-se que o nível de conhecimentos no geral é bom. Identificaram-se como áreas deficitárias a eliminação urinária diária e a dieta. Quanto aos dados obtidos e relacionados com as práticas e comportamentos de educação para a saúde, observa-se que a frequência é baixa e por este motivo os dados são pouco expressivos. Pode-se afirmar que há bons conhecimentos nesta área, mas há pouca implementação prática e comportamental dos mesmos. Espera-se que com este estudo haja um despertar para a necessidade da elaboração de novos estudos nesta área. Sugere-se que em estudos futuros, explorem a compreensão das práticas e dos comportamentos de educação para a saúde adotados pelos enfermeiros de cuidados de saúde primários, comparando-o com uma população de enfermeiros que cuidam diariamente de utentes diagnosticados com urolitíase.

The probability of recurrence of urolithiasis is high, and is manifested in the suffering of the patient, his family and significant people. There are high expenses for new hospitalizations, medication, as well as the need of work absenteeism. Hence the urgent need for teaching the patient and their families to adopt measures in order to prevent the formation of new urinary stones, nothing is better than involving nurses, who are excellent health educators. As a result of this need, it was decided to evaluate knowledge and practices adopted by nurses in primary health care, expanding and making the access to urolithiasis prevention more equitable. In order to assess the knowledge and practices adopted by primary care nurses of an ACES in the Central Region of Portugal, in the prevention of recurrence of urolithiasis, a quantitative, descriptive, correlational and cross-sectional study was carried out. The data collection method was a questionnaire built for the purpose. The population was defined as all primary health care nurses who provide care in a Group of Health Centres in the Central Region of Portugal and who participated on a voluntary basis. In this study it was found that the level of knowledge of the respondents was not influenced by their academic and professional profile. It was found that the level of knowledge in general is good. Daily urinary elimination and diet were identified as deficient areas. As for the data obtained and related to health education practices and behaviours, it is observed that the frequency is low and for this reason the data is not very expressive. It can be said that there is good knowledge in this area, but there is little practical and behavioural implementation. It is hoped that with this study there will be an awakening to the need for further studies in this area. It is suggested that in future studies, they explore the understanding of health education practices and behaviours adopted by primary health care nurses, comparing it with a population of nurses who care for users diagnosed with urolithiasis on a daily basis.

RespiraConNosotros: A Viable Home-Based Telerehabilitation System for Respiratory Patients.

Currently, there are more than 1.55 million cases of SARS-CoV-2 infection in Spain. Of these, it is estimated that around 45% will present respiratory complications, which represents approximately 620,000 patients who will need respiratory rehabilitation. The health system has no resources for this huge quantity of patients after the hospital discharge to finish the complete recovery and avoid the chronicity of the symptoms. We propose an application named RespiraConNosotros. The application has been created and designed to guide users in performing respiratory rehabilitation exercises, especially for COVID-19 patients, and it also facilitates patient-physiotherapist contact via chat or video calling to help patients. It is accessible for all users and on all devices. All exercises would be guided and supervised by a specialized physiotherapist who suggests, adapts, and guides the exercise according to the function level of each patient. Data obtained was satisfactory; all patients pointed out the easy access, the intuitive format, and the advantage of communicating with an expert. Concerning functional assessment, all participants improved their score on the Borg scale after performing the intervention with the application.This platform would help respiratory patients to make rehabilitation treatments to recover their pulmonary function and to decrease or eliminate the possible complications they have. It never substitutes any prescribed treatment. In conclusion, RespiraConNosotros is a simple, viable, and safe alternative for the improvement and maintenance of respiratory capacity and patient's functionality affected by COVID-19. It could be used as a complement to face-to-face treatment when the situation allows it.

Physical disabilities caused by leprosy in 100 million cohort in Brazil.

BACKGROUND: Leprosy continues to be an important cause of physical disability in endemic countries such as Brazil. Knowledge of determinants of these events may lead to better control measures and targeted interventions to mitigate its impact on affected individuals. This study investigated such factors among the most vulnerable portion of the Brazilian population. METHODS: A large cohort was built from secondary data originated from a national registry of applicants to social benefit programs, covering the period 2001-2015, including over 114 million individuals. Data were linked to the leprosy notification system utilizing data from 2007 until 2014. Descriptive and bivariate analyses lead to a multivariate analysis using a multinomial logistic regression model with cluster-robust standard errors. Associations were reported as Odds Ratios with their respective 95% confidence intervals. RESULTS: Among the original cohort members 21,565 new leprosy cases were identified between 2007 and 2014. Most of the cases (63.1%) had grade zero disability. Grades 1 and 2 represented 21 and 6%, respectively. Factors associated with increasing odds of grades 1 and 2 disability were age over 15 years old (ORs 2.39 and 1.95, respectively), less schooling (with a clear dose response effect) and being a multibacillary patient (ORs 3.5 and 8.22). Protective factors for both grades were being female (ORs 0.81 and 0.61) and living in a high incidence municipality (ORs 0.85 and 0.67). CONCLUSIONS: The findings suggest that the developing of physical disabilities remains a public health problem which increases the burden of leprosy, mainly for those with severe clinical features and worse socioeconomic conditions. Early diagnosis is paramount to decrease the incidence of leprosy-related disability and our study points to the need for strengthening control actions in non-endemic areas in Brazil, where cases may be missed when presented at early stages in disease. Both actions are needed, to benefit patients and to achieve the WHO goal in reducing physical disabilities among new cases of leprosy.

IndoorPlant: A Model for Intelligent Services in Indoor Agriculture Based on Context Histories.

The application of ubiquitous computing has increased in recent years, especially due to the development of technologies such as mobile computing, more accurate sensors, and specific protocols for the Internet of Things (IoT). One of the trends in this area of research is the use of context awareness. In agriculture, the context involves the environment, for example, the conditions found inside a greenhouse. Recently, a series of studies have proposed the use of sensors to monitor production and/or the use of cameras to obtain information about cultivation, providing data, reminders, and alerts to farmers. This article proposes a computational model for indoor agriculture called IndoorPlant. The model uses the analysis of context histories to provide intelligent generic services, such as predicting productivity, indicating problems that cultivation may suffer, and giving suggestions for improvements in greenhouse parameters. IndoorPlant was tested in three scenarios of the daily life of farmers with hydroponic production data that were obtained during seven months of cultivation of radicchio, lettuce, and arugula. Finally, the article presents the results obtained through intelligent services that use context histories. The scenarios used services to recommend improvements in cultivation, profiles and, finally, prediction of the cultivation time of radicchio, lettuce, and arugula using the partial least squares (PLS) regression technique. The prediction results were relevant since the following values were obtained: 0.96 (R2, coefficient of determination), 1.06 (RMSEC, square root of the mean square error of calibration), and 1.94 (RMSECV, square root of the mean square error of cross validation) for radicchio; 0.95 (R2), 1.37 (RMSEC), and 3.31 (RMSECV) for lettuce; 0.93 (R2), 1.10 (RMSEC), and 1.89 (RMSECV) for arugula. Eight farmers with different functions on the farm filled out a survey based on the technology acceptance model (TAM). The results showed 92% acceptance regarding utility and 98% acceptance for ease of use.

Tongue Hematoma With Necrosis.

Spontaneous tongue hematoma is a known rare adverse side effect associated with warfarin therapy. There is a long list of drug-to-drug interactions with warfarin that may contribute to a rise in international normalized ratio (INR) levels, increasing the risk of bleeding. We present a case of an elderly female patient who presented with oral dysphagia and spontaneous oral cavity bleeding while on warfarin therapy. She was found to have tongue hematoma and necrosis. A week prior she started treatment with topical miconazole for oral candidiasis and a few days later topical clarithromycin was added. Treatment given was mainly supportive with intravenous vitamin K, fresh frozen plasma, and aminocaproic acid. Full recovery was achieved. It is our intention to raise awareness of a rare adverse side effect related to warfarin therapy that may have been precipitated with the use of medications known to contribute to INR elevation. As learning points, we emphasize close monitoring of INR levels when using known drug-to-drug interactions with warfarin and also consider replacing warfarin for a direct oral anticoagulant if no contraindication is present.

Main types of insoles described in the literature and their applicability for musculoskeletal disorders of the lower limbs: A systematic review of clinical studies.

The objective of this review was to identify the main types of insoles described in the literature that are used to treat musculoskeletal alterations of lower limbs and to analyze the existence of previous evaluation for the prescription of these insoles. To this end, two researchers, independently and blindly, searched the PubMed, SciELO, Bireme, MEDLINE, Lilacs, PEDro, Cochrane Library and Web of Science databases between June and July of 2018, from the free combination of the following descriptors: insoles, foot orthoses, foot, orthoses, musculoskeletal diseases and clinical trial. We included randomized or non-randomized clinical trials in which at least one intervention group used insoles and individuals with some type of musculoskeletal disorder had been sampled. Of the 227 documents identified in date bases, 20 were included in this review. In general, it is suggested to carry out more studies with more precise methods and that include evaluation before the prescription. This is a systematic review of clinical trials registered in PROSPERO (International Prospective Register of Systematic Reviews) under the protocol no. CRD42018099534e.

An Architectural Multi-Agent System for a Pavement Monitoring System with Pothole Recognition in UAV Images.

In recent years, maintenance work on public transport routes has drastically decreased in many countries due to difficult economic situations. The various studies that have been conducted by groups of drivers and groups related to road safety concluded that accidents are increasing due to the poor conditions of road surfaces, even affecting the condition of vehicles through costly breakdowns. Currently, the processes of detecting any type of damage to a road are carried out manually or are based on the use of a road vehicle, which incurs a high labor cost. To solve this problem, many research centers are investigating image processing techniques to identify poor-condition road areas using deep learning algorithms. The main objective of this work is to design of a distributed platform that allows the detection of damage to transport routes using drones and to provide the results of the most important classifiers. A case study is presented using a multi-agent system based on PANGEA that coordinates the different parts of the architecture using techniques based on ubiquitous computing. The results obtained by means of the customization of the You Only Look Once (YOLO) v4 classifier are promising, reaching an accuracy of more than 95%. The images used have been published in a dataset for use by the scientific community.

Connected Elbow Exoskeleton System for Rehabilitation Training Based on Virtual Reality and Context-Aware.

Traditional physiotherapy rehabilitation systems are evolving into more advanced systems based on exoskeleton systems and Virtual Reality (VR) environments that enhance and improve rehabilitation techniques and physical exercise. In addition, due to current connected systems and paradigms such as the Internet of Things (IoT) or Ambient Intelligent (AmI) systems, it is possible to design and develop advanced, effective, and low-cost medical tools that patients may have in their homes. This article presents a low-cost exoskeleton for the elbow that is connected to a Context-Aware architecture and thanks to a VR system the patient can perform rehabilitation exercises in an interactive way. The integration of virtual reality technology in rehabilitation exercises provides an intensive, repetitive and task-oriented capacity to improve patient motivation and reduce work on medical professionals. One of the system highlights is the intelligent ability to generate new exercises, monitor the exercises performed by users in search of progress or possible problems and the dynamic modification of the exercises characteristics. The platform also allows the incorporation of commercial medical sensors capable of collecting valuable information for greater accuracy in the diagnosis and evolution of patients. A case study with real patients with promising results has been carried out.

Effects of insoles adapted in flip-flop sandals in people with plantar fasciopathy: a randomized, double-blind clinical, controlled study.

OBJECTIVE: To evaluate the effects of insoles adapted into flip-flop sandals on pain and function in individuals with plantar fasciopathy (PF). DESIGN: Randomized, double-blind controlled study. SETTING: Physiotherapy clinic of the Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil. SUBJECTS: Sixty-six patients of both genders with PF were randomized into two groups: sandal insole group (SI; n = 34), which received a pair of custom flip-flop sandals with insoles covered with smooth synthetic leather; and plain sandal group (PS; n = 32), which received an identical pair of flip-flop sandals, but without the insoles. INTERVENTIONS: Patients were instructed to wear the flip-flops for 12 weeks for at least 4 hours/day. MAIN MEASURES: Pain (visual analogue scale-VAS) in the morning and at the end of the day were considered primary outcomes. Function (Foot Function Index-FFI and Foot and Ankle Ability Measure-FAAM) and functional capacity (6-minute walk test-6MWT) were considered secondary outcomes. The outcomes were evaluated at baseline and immediately after the intervention by a blind assessor. RESULTS: Between-group differences were observed in terms of morning pain (mean difference (MD) = -1.82 cm; 95% confidence interval (CI) = -3.3 to -0.3; P = 0.016) and function (MD = -0.10; 95% CI = -0.19 to -0.01; P = 0.023) after the interventions with the SI group showing superior improvements in comparison to the PS group. CONCLUSION: The use of insoles adapted in flip-flop sandals for 12 weeks was effective at improving pain and function in individuals with PF. LEVEL OF EVIDENCE: 1b.