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Introduction: The revised international standards for neurological classification of spinal cord injury (ISNCSCI) have facilitated the documentation of non-spinal cord injury-related impairments, such as chronic peripheral nerve injuries and muscle weakness due to immobility. This advancement addresses potential biases in muscle strength examinations. Utilizing electrically evoked contractions from paralyzed muscles, enhanced by electrodiagnosis, holds promise in identifying false-negative diagnoses of non-responsiveness to neuromuscular electrical stimulation. This concept prompts the exploration of polyneuromyopathy arising from nonuse in paralyzed muscles., Case Series Presentation: To substantiate our hypothesis, we recruited nine participants for a case series aimed at elucidating the potential benefits of incorporating the stimulus electrodiagnostic test (SET) to mitigate non-responsiveness during preparation for functional electrical stimulation (FES)-assisted cycling. In our convenience sample (n = 5), we conducted neurological mapping based on ISNCSCI and applied SET on the quadriceps. The SET guided optimal dosimetry for evoking contractions and revealed responses similar to those observed in peripheral neuropathies, with α coefficients equal to or lower than 2.00. This observation is likely attributable to nonuse of paralyzed muscles, indicative of an ongoing polyneuropathy in individuals with chronic spinal cord injury (SCI)., Discussion: Among the nine initially recruited subjects, seven exhibited responsiveness to neuromuscular electrical stimulation (78% responsiveness), with two participants excluded based on exclusion criteria. In the final five reported cases, all displayed α coefficient values indicating impaired neuromuscular accommodation, and one presented no α coefficient within the normal range. The inclusion of electrodiagnosis appears effective in averting non-responsiveness, suggesting the presence of ongoing polyneuropathies in paralyzed muscles., (© 2024 John Wiley & Sons Ltd.)

Objectives: To evaluate the compressive modulus, translucency, and light curing irradiance transmittance of four clear polyvinyl siloxane (PVS) materials used for the injection molding technique at varying thicknesses, and to assess the correlation between color parameters and irradiance transmittance., Materials and Methods: Four clear PVS materials (Exaclear, Clear Bite Matrix, Affinity Crystal, and Memosil 2) were used in this study. Compressive modulus was measured by compressing cylindrical PVS specimens (n = 9; d = 10 mm; t = 6 mm) up to 30% strain using a universal testing machine. For the translucency analysis and irradiance transmittance, specimens (n = 5) were fabricated with five different thicknesses (d = 12 mm and t = 2, 4, 6, 8 and 10 mm). The L*, a, *b* values of specimens were obtained using a CIELab spectrophotometer (CMD-700, Konica Minolta) with calibrated white and black tiles; the translucency parameter was calculated. The same specimens were placed onto a spectrophotometer (MARC Light Collector) to measure irradiance transmitted through the specimens from a light curing unit (Valo Corded, Ultradent). Data were analyzed using analysis of variance (ANOVA) with Tukey post hoc test and the correlation between translucency and irradiance transmittance of materials for each thickness was evaluated using Pearson's correlation., Results: Compressive modulus differences in PVS materials were significant (one-way ANOVA: df = 3, F = 76.27, p < 0.001); Affinity and Memosil 2 were highest with no significant difference between them (Tukey: t = -1.62; p = 0.382). Clear Bite was higher than Exaclear (Tukey: t = -3.70; p = 0.004). Exaclear was lowest. Translucency decreased with thickness (Two-way ANOVA: df = 3, F = 586.53, p < 0.001; thickness: df = 4, F = 1389.34, p < 0.001). Exaclear was most translucent at all thicknesses. L*, a*, b* values varied by material and thickness (L*: df = 3, F = 1213.32, p < 0.001; a*: df = 3, F = 10766.8, p < 0.001; b*: df = 3, F = 3260.42, p < 0.001). Memosil 2 had lowest b* values. Irradiance transmittance was affected by material and thickness (Two-way ANOVA: df = 4, F = 2388.86, p < 0.001). Exaclear had highest irradiance transmission, surpassing control at >6 mm. Violet/blue irradiance ratio decreased with thickness; Exaclear maintained a constant ratio, indicating preserved violet irradiance. There was a strong positive correlation between translucency and light irradiance (Pearson's r = 0.97, R 2  = 0.86-0.96). Radiant exposure analysis suggests adjusting the curing time based on PVS thickness for optimal exposure (10 J/cm 2 ) is achievable within 13-14 s for <2 mm and 21-30 s for 8-10 mm with Clear Bite, Affinity, and Memosil 2; whereas Exaclear requires less time., Conclusions: Compressive modulus in clear PVS materials varied by type; Affinity and Memosil 2 demonstrate higher modulus, offering more stability of the clear mold. Translucency and irradiance transmission through clear PVS materials decreased as their thickness increased, yet Exaclear exceled in maintaining high translucency and superior light transmission capabilities. Additionally, there is a strong positive linear correlation between translucency and light irradiance transmittance, offering a method to adjust curing times effectively based on material translucency., Clinical Significance: The light curing time to adequately polymerize composite through clear impression material may need to be increased, particularly with thicker matrices or less translucent materials., (© 2024 Wiley Periodicals LLC.)

Introduction: Currently studies indicate the need to incorporate the user`s perspective in the testing of new assistive technologies. The objective of this paper is to test a baropodometric insole prototype for monitoring and treatment weight-bearing asymmetry, according to the Participatory Design., Methods: We used a qualitative case study approach during the testing phase of the baropodometric insole prototype. The focus group approach addressed topics related to the experience and accessibility of the potential user in conjunction with professionals, researchers, and physiotherapy students. Facilitators, barriers, and requirements for the device were collected through audio recordings of the discussions during and after prototype testing., Results: Key steps in the prototype testing process were divided into (1) Test of the prototype according to the Participatory Design, divided into Who, When, How, and Why the potential user was involved in the study; and (2) Facilitators, barriers and requirements to improve the prototype., Conclusions: The baropodometric insole prototype can be seen as a promising device for monitoring and treating weight-bearing asymmetry., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: M, HR is a founding partner and board member of Visuri SA, which manufactures baropodometric insoles prototype. Other authors state no conflict of interest., (© The Author(s) 2024.)

Objective: The present study aimed to determine the association between neuromuscular function, motor function impairment, and muscle and tendon structures in individuals with spinal cord injury (SCI) compared to a control (non-disabled) population., Design: A cross-sectional study with a control group., Setting: Center of Adapted Sports Training and Special Physical Education., Participants: Fifteen individuals with SCI and motor function impairments participated in the study. A paired non-disabled group was recruited for comparison., Interventions: Not applicable., Outcome Measures: Muscle (biceps brachii, rectus femoris, vastus lateralis, vastus medialis, and tibialis anterior) and tendon (quadriceps and patellar tendons) structures were assessed by ultrasound imaging (thickness, pennation angle, fascicle length, and echogenicity). Neuromuscular electrophysiological disorders were also assessed using electrodiagnosis techniques (stimulus non-responsivity and chronaxie) in the same muscles., Results: Except for the biceps brachii muscle, muscle thickness, pennation angle, and fascicle length were lower ( p  < 0.01) while echogenicity and chronaxie were greater ( p  < 0.01) in SCI participants. The SCI participants had a higher prevalence of neuromuscular electrophysiological disorders for all muscles, except the biceps brachii., Conclusion: Neuromuscular disorders occur in association with muscle and tendon maladaptation in individuals with chronic SCI. A higher prevalence of electrophysiological disorders suggests an acquired polyneuromyopathy for muscles with motor function impairment even though the muscle was innerved, in addition to widespread muscle atrophy.

This article proposes the evaluation of the passive movement of the affected elbow during the pendulum test in people with stroke and its correlation with the main clinical scales (Modified Ashworth Scale, Motor Activity Log, and Fulg Meyer). An inertial sensor was attached to the forearm of seven subjects, who then passively flexed and extended the elbow. Joint angles and variables that indicate viscoelastic properties, stiffness (K), damping (B), E1 amp, F1 amp, and relaxation indices were collected. The results show that the FM scale is significantly correlated with the natural frequency ( p = 0.024). The MAL amount-of-use score correlates with the natural frequency ( p = 0.024). The variables E1 amp, F1 amp, RI, and ERI are not correlated with the clinical scales, but they correlate with each other; the variable E1 amp correlates with F1 amp ( p = 0.024) and RI ( p = 0.024), while F1 amp correlates with ERI ( p = 0.024). There was also a correlation between the natural frequency and K (r = 0.96, p = 0.003). Non-linear results were found for the properties of the elbow joint during the pendulum test, which may be due to the presence of neural and non-neural factors. These results may serve as a reference for future studies if alternative scales do not provide an accurate reflection.

Purpose: Prostate cancer (PCa) is the second most frequent cancer among men in the Western population. Infections, such as the one caused by the human papillomavirus (HPV), have been shown to promote inflammation that can lead to the appearance of neoplasms. This study aimed to verify the presence of HPV in neoplastic and non-neoplastic prostate tissue in patients undergoing prostate biopsy and its possible relationship with PCa., Methods: Prostate tissue fragments were collected by prostate biopsy and subjected to polymerase chain reaction with primers for the HPV L1 gene to identify the presence of the virus., Results: Among 162 patients, 10 (6.2%) had HPV and in 152 (93.8%) HPV was not identified in prostate biopsies. HPV was detected in 7/95 (7.4%) of patients with PCa, in 2/55 (3.6%) of patients without PCa, and in no patient with an inconclusive diagnosis of PCa. There was no significant difference (p = 0.487) of HPV presence in the tissue of patients with PCa., Conclusions: There were no significant levels of HPV L1 protein in prostate tissue. The findings suggest the absence of HPV oncogenic activity in the prostate tissue of patients with PCa.

Objectives/background: The prevalence of obstructive sleep apnea (OSA) in people over 70 years can reach up to 95%. Aerobic or combined exercise programs have been shown to impact positively on OSA severity. Resistance training changes leg fluid retention. We hypothesized that through this mechanism it may have an impact on the OSA severity in older adults., Patients/methods: We evaluated changes in the respiratory event index (REI) of older adults with moderate-severe obstructive sleep apnea in a randomized, masked, controlled, parallel group trial. Participants between the age of 65 and 80 years with REI between 20 and 50 events/hour were assigned randomly to 12 weeks of resistance training or healthy life-style recommendations. Change in REI was the primary outcome. Muscle thickness, maximum strength, and physical function were secondary outcomes and body mass index (BMI) and body water content were assessed as mediators., Results: Twenty-three subjects were included, 57% men, aged 71 ± 5 years, randomized to training (n = 12) and control intervention (n = 11). The baseline REI in the training and control groups were 30 ± 7/h and 29 ± 9/h; at follow-up, the delta REI were -3.6/hour (95% confidence interval -0.7 to -5.4) and 6.7/hour (5.2-8.6), respectively, with significant time × group interaction that remained significant after adjusting the generalized estimating equations model for delta BMI and delta body water content., Conclusions: Twelve weeks of resistance training in older adults significantly changed the respiratory event index and was well tolerated. Changes in body water content were slight but cannot be dismissed as contributing to REI reduction., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interests., (Copyright © 2022 Elsevier B.V. All rights reserved.)

To explore pain complaints and health-related conditions, verifying if permanent or temporary usage of forearm crutches could be associated with them. We designed a cross-sectional study from a sample who answered a five-month public call. We organized data into five domains: (1) diseases, signs and symptoms; (2) personal factors related to age, sex, marital status, and paid occupation; (3) body structure and functional components defined by body mass index, arterial pressure, mental state, and pain; (4) activities and participation assessed by satisfaction with Assistive Technology; (5) and environmental factors focused on medicines and forearm crutch usage. The sample was geo-referenced by address, and the frequency of the codified health conditions was distributed according to ICD-10's chapters. We recruited three times more permanent than temporary users dealing with chronic and external causes of diseases. Pain mapping suggested different pattern of complaints between permanent and temporary users. Women who were temporary users seemed more likely to be injured because of external causes. Moreover, both users reported intense (31%) and moderate (53%) levels of pain. In contrast, mild pains were only reported by permanent users (16%), suggesting a distinction between acute and chronic pain according to the kind of forearm crutch usage.

Background: The cross-sectional area (CSA) records make an essential measurement for determining the mechanical properties of tendons, such as stress and strength. However, there is no consensus regarding the best method to record the CSA from different tendons., Purpose: To determine intra- and inter-rater reliability for CSA measures from magnetic resonance imaging (MRI) of the following tendons: tibialis anterior; tibialis posterior; fibularis longus and brevis; and Achilles., Material and Methods: We designed an observational study with repeated measures taken from a convenience sample of 20 participants diagnosed with acute or chronic ankle sprain. Two independent raters took three separate records from the CSA of ankle tendon images of each MRI slice. The intra-class correlation coefficient (ICC) and 95% limits of agreement (LoA) defined the quality (associations) and magnitude (differences), respectively, of intra- and inter-rater reliability on the measures plotted by the Bland-Altman method., Results: Data showed very high intra- and inter-rater correlations for measures taken from all tendons analyzed (ICC 0.952-0.999). It also revealed an excellent agreement between raters (0.12%-2.3%), with bias no higher than 2 mm 2 and LoA in the range of 4.4-7.9 mm 2 . The differences between repeated measures recorded from the thinnest tendons (fibularis longus and brevis) revealed the lowest bias and narrowest 95% LoA., Conclusion: Reliability for the CSA of ankle tendons measured from MRI taken by independent rates was very high, with the smallest differences between raters observed when the thinnest tendon was analyzed.

Introduction: Frontline healthcare workers providing care for COVID-19 are more likely to get infected and die compared with other professionals. Deaths or sick leaves due to COVID-19 can affect the smooth operation of health services in areas with shortage of workers., Objectives: To analyze factors associated with the death of healthcare workers due to COVID-19 in the state of Amapá, Brazil., Methods: Analytical cross-sectional study using COVID-19 data from Amapá between March 2020 and January 2021. The association of independent variables (sex, race/color, age group, region of residence, comorbidity) with death was analyzed by logistic regression., Results: Data from 1,258 workers were analyzed. The majority were women (67.7%; 852/1,258), multiracial (66.9%; 759/1,135), aged between 18 and 64 (98.3%; 1,226/1,247), with no comorbidity (86.6%; 1,090/1,258), from the Macapá metropolitan area (56.7%; 713/1,258). The mortality rate was 1.59%. Factors associated with death were: age group = 65 years (odds ratio = 10.43; 95% confidence interval [CI] = 2.78-39.11), comorbidity (odds ratio = 4.52; 95%CI = 1.74-11.74), and residence in the Macapá metropolitan area (odds ratio = 4.37; 95%CI = 1.25-15.29)., Conclusions: The recognition of factors that may have caused the death of healthcare workers in Amapá can support the recommendation of protective measures for the most susceptible, such as switching to activities with lower exposure to the virus or teleworking., Competing Interests: Conflicts of interest: None

Since the first Cybathlon 2016, when twelve teams competed in the FES bike race, we have witnessed a global effort towards the development of stimulation and control strategies to improve FES-assisted devices, particularly for cycling, as a means to practice a recreational physical activity. As a result, a set of technical notes and research paved the way for many other studies and the potential behind FES-assisted cycling has been consolidated. However, engineering research needs instrumented devices to support novel developments and enable precise assessment. Therefore, some researchers struggle to develop their own FES-assisted devices or find it challenging to implement their instrumentation using commercial devices, which often limits the implementation of advanced control strategies and the possibility to connect different types of sensor. In this regard, we hypothesize that it would be advantageous for some researchers in our community to enjoy access to an entire open-source FES platform that allows different control strategies to be implemented, offers greater adaptability and power capacity than commercial devices, and can be used to assist different functional activities in addition to cycling. Hence, it appears to be of interest to make our proprietary electrical stimulation system an open-source device and to prove its capabilities by addressing all the aspects necessary to implement a FES cycling system. The high-power capacity stimulation device is based on a constant current topology that allows the creation of biphasic electrical pulses with amplitude, width, and frequency up to 150 mA, 1000 µs, and 100 Hz, respectively. A mobile application (Android) was developed to set and modify the stimulation parameters of up to eight stimulation channels. A proportional-integral controller was implemented for cadence tracking with the aim to improve the overall cycling performance. A volunteer with complete paraplegia participated in the functional testing of the system. He was able to cycle indoors for 45 min, accomplish distances of more than 5 km using a passive cycling trainer, and pedal 2400 m overground in 32 min. The results evidenced the capacity of our FES cycling system to be employed as a cycling tool for individuals with spinal cord injury. The methodological strategies used to improve FES efficiency suggest the possibility of maximizing pedaling duration through more advanced control techniques.

The Wheelchair Skills Test-Questionnaire form for Manual Wheelchairs Operated by Wheelchair Users (WSTQ-M-WCU 4.3) assesses wheelchair skills that may influence users' occupational performance in their daily activities. The purpose of this study was to cross-culturally adapt the WSTQ-M-WCU 4.3 to Brazilian Portuguese and to examine the inter-rater and test-retest reliabilities. This is a methodological study of cross-cultural adaptation and psychometric properties of reliability. The agreement achieved in the cross-cultural adaptation concerning idiomatic, cultural, conceptual and semantic aspects was 100%, 99.2%, 100% and 96.18%, respectively. We analyzed the test-retest and inter-rater reliabilities in a convenience sample of 46 manual wheelchair users using Cronbach's Alpha and Bland-Altman plots. The Brazilian version has excellent internal consistency (α > 0.9) and strong inter-rater reliability ( p < .05). This instrument can guide practitioners in training wheelchair skills, thus contributing to the planning of interventions and for evidence-based practice in Assistive Technology.

Mobility is essential for activities of daily living and therapists should give priority to evaluate its effects in their client's performance. We aimed to ascertain the intra- and inter-rater reliability of Functional Mobility Assessment (FMA) and to identify correlations among satisfaction, independence, and skills in 44 users of manual wheelchairs and three users of powered wheelchairs. We analyzed the test-retest and inter-rater reliability of the FMA in a sample of 47 wheelchair users using the Cronbach's Alpha. For correlations with FMA were used the Quebec User Evaluation of Satisfaction with Assistive Technology, Functional Independence Measure, and Wheelchair Skills Test Questionnaire (manual and powered forms). The test-retest reliability showed good internal consistency (α > 0.9). Associations between functional independence, wheelchair skills, and functional mobility were significant ( p < .05). The Brazilian version of the FMA is reliable for use among wheelchair users, and its correlation with other measurements suggests cohesion among assessments related to mobility devices.

Introduction: The state of Amapá is located in Brazil's Legal Amazon and comprises 16 municipalities. Its history is marked by social vulnerability and industrial mining; therefore, its current socioeconomic and occupational context should be analyzed considering possible sociohistorical and geographic influences., Objectives: To analyze and/or describe the epidemiological profile of workers, occupational accidents, the socioeconomic context, and time evolution of the number of workers in the state and their relationship with the state's gross domestic product., Methods: This is an analytic time series study based on official public data. We used a simple regression test to analyze the relationship between the number of workers and gross domestic product and to assess the time trend of the number of workers. The studied period was from 2007 to 2017., Results: The number of workers presented an increasing trend over time (R 2 = 0.902; p < 0.001), with a relative increase of 49.8% between 2007 and 2017. We observed a positive relationship between the annual increase in the number of workers and the state's gross domestic product (R 2 = 0.899; p < 0.001). The economic activity with the highest mean number of workers was public administration, defense, and social security. The highest socioeconomic indicators were observed in the state capital Macapá. Non-hazardous waste management was the activity concentrating the highest absolute number of occupational accidents., Conclusions: This study highlighted important socioeconomic contrasts within the state. The significant increases in the gross domestic product and number of workers are signs of development, but the high number of occupational accidents represents a serious public health problem., Competing Interests: Conflicts of interest: None

Functional electrical stimulation (FES) is a technique used in rehabilitation, allowing the recreation or facilitation of a movement or function, by electrically inducing the activation of targeted muscles. FES during cycling often uses activation patterns which are based on the crank angle of the pedals. Dynamic changes in their underlying predefined geometrical models (e.g., change in seating position) can lead to desynchronised contractions. Adaptive algorithms with a real-time interpretation of anatomical segments can avoid this and open new possibilities for the automatic design of stimulation patterns. However, their ability to accurately and precisely detect stimulation triggering events has to be evaluated in order to ensure their adaptability to real-case applications in various conditions. In this study, three algorithms (Hilbert, BSgonio, and Gait Cycle Index (GCI) Observer) were evaluated on passive cycling inertial data of six participants with spinal cord injury (SCI). For standardised comparison, a linear phase reference baseline was used to define target events (i.e., 10%, 40%, 60%, and 90% of the cycle's progress). Limits of agreement (LoA) of ±10% of the cycle's duration and Lin's concordance correlation coefficient (CCC) were used to evaluate the accuracy and precision of the algorithm's event detections. The delays in the detection were determined for each algorithm over 780 events. Analysis showed that the Hilbert and BSgonio algorithms validated the selected criteria (LoA: +5.17/-6.34% and +2.25/-2.51%, respectively), while the GCI Observer did not (LoA: +8.59/-27.89%). When evaluating control algorithms, it is paramount to define appropriate criteria in the context of the targeted practical application. To this end, normalising delays in event detection to the cycle's duration enables the use of a criterion that stays invariable to changes in cadence. Lin's CCC, comparing both linear correlation and strength of agreement between methods, also provides a reliable way of confirming comparisons between new control methods and an existing reference.

Objective: Nanotechnology has progressed significantly and particles as small as 3 nm are being employed in resin-based restorative materials to improve clinical performance. The goal of this review is to report the progress of nanotechnology in Restorative Dentistry by reviewing the advantages, limitations, and applications of resin-based restorative materials with nanoparticles., Materials and Methods: A literature review was conducted using PubMed/Medline, Scopus and Embase databases. In vitro, in vivo and in situ research studies published in English between 1999 and 2020, and which focused on the analysis of resin-based restorative materials containing nanoparticles were included., Results: A total of 140 studies were included in this review. Studies reported the effect of incorporating different types of nanoparticles on adhesive systems or resin composites. Mechanical, physical, and anti-bacterial properties were described. The clinical performance of resin-based restorative materials with nanoparticles was also reported., Conclusions: The high surface area of nanoparticles exponentially increases the bioactivity of materials using bioactive nanofillers. However, the tendency of nanoparticles to agglomerate, the chemical instability of the developed materials and the decline of rheological properties when high ratios of nanoparticles are employed are some of the obstacles to overcome in the near future., Clinical Significance: In spite of the recent advancements of nanotechnology in resin-based restorative materials, some challenges need to be overcome before new nano-based restorative materials are considered permanent solutions to clinical problems., (© 2020 Wiley Periodicals LLC.)

Study Design: Systematic review., Objective: To determine the effectiveness of physiotherapy interventions for the treatment of spasticity in people with spinal cord injuries., Setting: Not applicable., Methods: A comprehensive search was undertaken to identify all randomised controlled trials of physiotherapy interventions that included an assessor-reported (objective) or participant-reported (subjective) measure of spasticity. Only trials that provided a physiotherapy intervention on more than one occasion were included. The susceptibility to bias of each trial was rated on the PEDro scale. Data were extracted to derive mean between-group differences (95% CI) for each trial., Results: Twenty-eight trials were identified but only 17 provided useable data. Seven trials compared a physiotherapy intervention to no intervention (or a sham intervention) and 10 trials compared one physiotherapy intervention to another physiotherapy intervention. The median (IQR) PEDro score of the 17 trials was 6/10 (6-8). The most commonly used assessor- and participant-reported measures of spasticity were the Ashworth scale and Spinal Cord Injury Spasticity Evaluation Tool, respectively. Only one trial demonstrated a treatment effect. This trial compared continuous passive motion of the ankle to no treatment on the Ashworth scale. The remaining 16 trials were either inconclusive or indicated that the treatment was ineffective for reducing spasticity., Conclusions: There is no high-quality evidence to indicate that physiotherapy interventions decrease spasticity but this may reflect a lack of research on the topic. Future trials should focus on participant-reported measures of spasticity that distinguish between the immediate, short-term and long-term effects of any physiotherapy intervention.

Background: Rapid onset of muscular fatigue is still one of the main issues of functional electrical stimulation (FES). A promising technique, known as distributed stimulation, aims to activate sub-units of a muscle at a lower stimulation frequency to increase fatigue-resistance. Besides a general agreement on the beneficial effects, the great heterogeneity of evaluation techniques, raises the demand for a standardized method to better reflect the requirements of a practical application., Methods: This study investigated the fatigue-development of 6 paralysed quadriceps muscles over the course of 180 dynamic contractions, evaluating different electrode-configurations (conventional and distributed stimulation). For a standardized comparison, fatigue-testing was performed at 40% of the peak-torque during a maximal evoked contraction (MEC). Further, we assessed the isometric torque for each electrode-configuration at different knee-extension-angles (70°-170°, 10° steps)., Results: Our results showed no significant difference in the fatigue-index for any of the tested electrode-configurations, compared to conventional-stimulation. We conjecture that the positive effects of distributed stimulation become less pronounced at higher stimulation amplitudes. The isometric torque produced at different knee-extension angles was similar for most electrode-configurations. Maximal torque-production was found at 130°-140° knee-extension-angle, which correlates with the maximal knee-flexion-angles during running., Conclusion: In most practical applications, FES is intended to initiate dynamic movements. Therefore, it is crucial to assess fatigue-resistance by using dynamic contractions. Reporting the relationship between produced torque and knee-extension-angle can help to observe the stability of a chosen electrode-configuration for a targeted range-of-motion. Additionally, we suggest to perform fatigue testing at higher forces (e.g. 40% of the maximal evoked torque) in pre-trained subjects with SCI to better reflect the practical demands of FES-applications.

Objective: The aim of the present study was to verify the intra- and inter-rater reliability and agreement of the stimulus electrodiagnostic test (SET) measurements obtained by pen and square electrodes in the vastus lateralis and tibialis anterior muscles. Design: An intra- and inter-rater reliability and agreement study was performed for the SET by two independent raters. Two different sizes of cathode electrodes (1 cm 2 and 25 cm 2 ) and two muscles were assessed (tibialis anterior and vastus lateralis). Results: Chronaxie did not change according to the different electrodes. A high intra-rater reliability (0.72 ≤  r ≤ 0.88) was detected independently of the electrode and muscle assessed. Moreover, moderate and almost perfect agreements (0.51 ≤ Kappa ≤ 1.00) were detected on intra-rater assessment. Similar correlations (0.74 ≤  r ≤ 0.79) were found for intra-rater reliability. However, dissimilar inter-rater agreement was detected: Kappa ≤ 0.40 for tibialis anterior and Kappa = 1.00 for vastus lateralis. Conclusion: The SET presented high reliability and moderate agreement in intra-rater evaluations. A fair agreement was found in the inter-rater assessment of the tibialis anterior. Evaluations performed with different electrode sizes did not influence the results. Therefore, the SET should be performed by a unique rater in test retest situations.

Study Design: Psychometric Study., Objectives: To assess responsiveness of the Motor Capacities Scale (MCS) in people with tetraplegia who have undergone upper limb reconstructive surgery., Settings: Rehabilitation clinics in France., Methods: The MCS is an arm/hand function test with 31 basic tasks, subdivided into four sub-categories (MCS A, MCS B, MCS C, and MCS D). Data were recorded preoperatively and following full completion of the surgical program. The Functional Independence Measure (FIM) and a ten-point numeric scale related to patients' satisfaction with the overall surgical result were included. Data were analyzed using responsiveness measures-the effect size (ES), the standardized response mean (SRM), and the minimal clinically important difference (MCID)., Results: Twenty-seven participants were included. Fourteen patients underwent unilateral surgery and 13 bilateral surgery. ES and SRM were moderate or good (ES/SRM of MCS B = 0.76/0.81, ES/SRM MCS C = 0.68/0.77, and ES/SRM MCS D = 0.77/0.88). For MCS A and FIM, both SRM and ES showed a small degree of responsiveness. For the MCS total score, the ES value indicated a moderate degree of responsiveness while SRM was excellent. Total MCS score, MCS C subscore and MCS D subscore showed significantly higher ES values in the "bilateral surgery" group than in the "unilateral group". The estimation of MCIDs showed low threshold values of MCS scores changes (total score and subscores) beyond which the satisfaction rate is >6., Conclusions: This study provides evidence of acceptable responsiveness of the MCS to changes using the SRM following upper limb reconstruction in patients with tetraplegia.

Context: People with spinal cord injury (SCI) experience the effects of a sedentary lifestyle very early on. Literature data suggest that programs using FES-assisted cycling would contribute to reduce the consequences of physical inactivity. The objective was to assess the feasibility of 12-month training on a FES-assisted bike of a subject with paraplegia for 21 years, T3, Asia Impairment Scale (AIS) A. An evaluation of morbidity, self-esteem, satisfaction, quality of life and duration of pedaling was performed. The impact on pain, cardiorespiratory function, body composition and bone metabolism were also assessed., Findings: The acceptability score of the training constraints increased from 51 to 59/65 and satisfaction was high around 8/10. The pedaling duration increased from 1' to 26' on the recumbent bike and from 1' to 15' on open terrain. No significant changes were found with BMD and cardiorespiratory measures during exercise tests. SF 36 showed significant improvement of more than 10% and the Rosenberg Self Esteem score rapidly improved from 36 to 39/40. At the end of the training, the patient reached the objective of the Cybathlon 2016 by covering 750 m in less than 8 minutes, at an average speed of 5.80 km/hr., Conclusion/clinical Relevance: A person with high and complete level of SCI for more than 20 years can undertake this type of challenge if the prerequisites are met; this training is without danger if the safety precautions are respected; the challenge of participating in a competition had a powerful impact on JP's self-esteem and perceived quality of life.

Zika virus (ZIKV) has caused an explosive epidemic linked to severe clinical outcomes in the Americas. As of June 2018, 4,929 ZIKV suspected infections and 46 congenital syndrome cases had been reported in Manaus, Amazonas, Brazil. Although Manaus is a key demographic hub in the Amazon region, little is known about the ZIKV epidemic there, in terms of both transmission and viral genetic diversity. Using portable virus genome sequencing, we generated 59 ZIKV genomes in Manaus. Phylogenetic analyses indicated multiple introductions of ZIKV from northeastern Brazil to Manaus. Spatial genomic analysis of virus movement among six areas in Manaus suggested that populous northern neighborhoods acted as sources of virus transmission to other neighborhoods. Our study revealed how the ZIKV epidemic was ignited and maintained within the largest urban metropolis in the Amazon. These results might contribute to improving the public health response to outbreaks in Brazil., Competing Interests: Declaration of Interests The authors declare no competing interests., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Study Objectives: The accuracy of obstructive sleep apnea (OSA) screening instruments in seniors may change as the predictive role of sex, age, and body mass index (BMI) changes with aging. We investigated the diagnostic performance of the STOP-BANG questionnaire in older individuals with aging-adapted scores and thresholds., Methods: Independent community-dwelling adults aged 65 years or older were screened for OSA. The STOP-BANG questionnaire was tested with different configurations and compared to the apnea-hypopnea index (AHI) obtained from home sleep apnea testing (HSAT). Epworth Sleepiness Scale (ESS) and Athens Insomnia Scale (AIS) were tested as possible supplementary screening criteria., Results: We recruited 458 individuals with a mean age of 71 ± 5 years, 41% men, BMI of 28.5 ± 4.6 kg/m². Mild, moderate, and severe OSA were present in, respectively, 34%, 30%, and 19% of the sample. The STOP questions had an area under the curve (AUC) of the receiver operating characteristic curve significantly lower than the STOP-BANG and the STOP+BMI > 28 kg/m² (STOP-B28). Both STOP-BANG and STOP-B28 had high sensitivity and low specificity in all OSA levels with similar AUC to predict AHI ≥ 5 events/h, 0.64. ESS and AIS were nonsignificant as adjunctive instruments., Conclusions: Novel modifications of a standard instrument created the STOP-B28, a simpler-to-obtain and similarly performing variation of the STOP-BANG using fewer inputs, and useful to exclude OSA. Screening seniors via questionnaires to detect OSA is problematic. Considering the 83% OSA prevalence in this age group, it may be a sensible option to indicate objective tests, oximetry, HSAT, or even polysomnography, as a first step in OSA investigation., (© 2020 American Academy of Sleep Medicine.)

Individuals who sustained a spinal cord injury often lose important motor skills, and cannot perform basic daily living activities. Several assistive technologies, including robotic assistance and functional electrical stimulation, have been developed to restore lost functions. However, designing reliable interfaces to control assistive devices for individuals with C4-C8 complete tetraplegia remains challenging. Although with limited grasping ability, they can often control upper arm movements via residual muscle contraction. In this article, we explore the feasibility of drawing upon these residual functions to pilot two devices, a robotic hand and an electrical stimulator. We studied two modalities, supra-lesional electromyography (EMG), and upper arm inertial sensors (IMU). We interpreted the muscle activity or arm movements of subjects with tetraplegia attempting to control the opening/closing of a robotic hand, and the extension/flexion of their own contralateral hand muscles activated by electrical stimulation. Two groups were recruited: eight subjects issued EMG-based commands; nine other subjects issued IMU-based commands. For each participant, we selected at least two muscles or gestures detectable by our algorithms. Despite little training, all participants could control the robot's gestures or electrical stimulation of their own arm via muscle contraction or limb motion.

Since the outset of body image reconstruction for diagnosis purposes, ultrasound has been used to investigate structural changes located in tendons. Ultrasound has clinical applications in the intensive care unit, but its utility for tendon imaging remains unknown. Thus, we aimed to determine intra- and inter-rater reproducibility of measures obtained by images generated through morphological tendon sonographic analysis recorded from critically ill patients. We designed a cross-sectional study to assess thickness, cross-sectional area, and echogenicity of patellar and quadriceps tendons in a convenience sample formed with 20 critically ill patients. Two independent raters (experienced and novice) recorded repeated measures, checking for agreement (Kappa statistics) and reliability (Intraclass coefficient Correlation-ICC and Bland-Altman). The quality of images acquired by the two independent raters substantially agreed (k = 0.571-1.000), regardless of the region on the patellar tendon or the studied tendon (patellar or quadriceps). Regardless of how much experience the rater had, their repeated records (intra-rater reliability) always demonstrated almost complete correlation, ICC ranging from 0.89 to 0.98 for both tendons in all outcomes. At the same way, the statistically significant inter-rater ICC ranging from 0.87 to 0.97. Both repeated measures by the raters (intra-rater) and the repeated single and double measures between the raters (inter-rater) presented a minimum measurement error constituting a predominant pattern of random variability. We conclude that ultrasound imaging acquisition performed by independent raters for tendon thickness, CSA, and echogenicity monitoring of critically ill patients are acceptable and are not influenced by rater experience., Competing Interests: The authors have declared that no competing interests exist.

Study Design: This work is a systematic review with meta-analysis OBJECTIVE: Evaluate the effect of electrical stimulation (ES) on skeletal muscle volume and spasticity in individuals with spinal cord injury (SCI)., Setting: University of Brasilia, Brazil METHODS: Searches were conducted of the Cochrane Library, MEDLINE, CINAHL, PEDro, PsycINFO and EMBASE electronic databases for relevant articles published up to June 2018. No restrictions were imposed regarding the year of publication. The inclusion criteria were randomized controlled trials involving adults with SCI comparing ES to an active or passive control. Two independent reviewers extracted the data from the selected studies and methodological quality was assessed using the PEDro scale., Results: The initial search led to the retrieval of 164 studies, seven of which met the eligibility criteria, but only six were included in the meta-analysis. The six studies comprised 104 patients with complete or incomplete SCI. In the two studies that investigated the use of ES on muscle volume of the lower limbs, the overall effect was statistically significant in patients with acute SCI (mean difference: 0.86; 95% CI: 0.04 to 1.69; p < 0.04). Among the four studies that examined the use of ES for spasticity of the lower limb, the overall effect was non-significant (mean difference: 0.55; 95% CI: -0.31 to 1.41; p = 0.21)., Conclusions: Electrical stimulation was found to be an effective method for increasing muscle volume in SCI patients, but had no effect on spasticity. Further investigation of the effect of ES on spasticity in SCI is needed.

Background Stroke represents the largest cause of chronic disability resulting in muscle weakness and instability in the trunk muscles. Despite the reliable measures from isokinetic devices for upper/lower limb muscles, there is a lack of measures for trunk muscles in post-stroke hemiparesis. Objectives To investigate the reliability of the strength and endurance measures from an isokinetic dynamometer for able-bodied and post-stroke hemiparesis people. Methods The measures were taken from both groups (control/hemiparesis) performing antagonistic movements (flexion/extension) during different protocols (seated-compressed and semi-standing) to assess strength (60º/s) and endurance (120º/s). The intra-class correlation coefficient (ICC) and limits of agreement (LOA) defined the quality and magnitude of reliability on the measurements plotted with 95% confidence interval (95% CI) by Bland-Altman method. Results ICC ranged from 0.58 to 0.99, with few ICC values classified as moderate when repeated by raters during test and a single value during retest. The total work was the only variable to present LOA higher than the limits. Conclusion Results indicate acceptable reliability, in two different protocols, confirming the repeatability of the isokinetic measures for trunk muscles in able-bodied and post-stroke hemiparesis.

Study Design: Systematic review., Objective: The purpose of the study was to identify and organize evidence regarding quality of life influenced by assistive technology related to computers for people with traumatic and non-traumatic spinal cord injury (SCI)., Setting: Distrito Federal, Brazil., Methods: A search strategy was conducted on the PubMed, PEDro, LILACS, PsycINFO, and SCIELO. All types of study designs considering assistive technology to improve quality of life for individuals with SCI were included. After search strategy procedures, ten references were included to review. The methodologic quality of each study was evaluated using the Level of Evidence proposed by the Oxford Centre for Evidence-based Medicine., Results: Most of the studies showed that devices for computer access improve the quality of life of people with SCI, regardless of the level of injury and type of resource. However, the positive outcomes in the quality of life should be interpreted with caution, as several methodological limitations were observed in the articles., Conclusions: Despite the scarcity of studies and their methodological limitations, there is evidence that assistive technology for computer access favors the quality of life of people with tetraplegia due to SCI, since it improves participation, independence, and self-esteem.

Central nervous system diseases include brain or spinal cord impairments and may result in movement disorders almost always manifested by paralyzed muscles with preserved innervations and therefore susceptible to be activated by electrical stimulation. Functional electrical stimulation (FES)-assisted cycling is an approach mainly used for rehabilitation purposes contributing, among other effects, to restore muscle trophism. FES-assisted cycling has also been adapted for mobile devices adding a leisure and recreational benefit to the physical training. In October 2016, our teams (Freewheels and EMA-trike) took part in FES-bike discipline at the Cybathlon competition, presenting technologies that allow pilots with spinal cord injury to use their paralyzed lower limb muscles to propel a tricycle. Among the many benefits observed and reported in our study cases for the pilots during preparation period, we achieved a muscle remodeling in response to FES-assisted cycling that is discussed in this chapter. Then, we have organized some sections to explore how FES-assisted cycling could contribute to functional rehabilitation by means of changes in the skeletal muscle disuse atrophy.

Functional Electrical Stimulation (FES) can elicit muscular contraction and restore motor function in paralyzed limbs. FES is a rehabilitation technique applied to various sensorimotor deficiencies and in different functional situations, e.g. grasping, walking, standing, transfer, cycling and rowing. FES can be combined with mechanical devices. FES-assisted cycling is mainly used in clinical environments for training sessions on cycle ergometers, but it has also been adapted for mobile devices, usually tricycles. In October 2016, twelve teams participated in the CYBATHLON competition in the FES-cycling discipline for persons with motor-complete spinal cord injury. It was the first event of this kind and a wide variety of strategies, techniques and designs were employed by the different teams in the competition. The approaches of the teams are detailed in this special issue. We hope that the knowledge contained herein, together with recent positive results of FES for denervated degenerating muscles, will provide a solid basis to encourage improvements in FES equipment and open new opportunities for many patients in need of safe and effective FES management. We hope to see further developments and/or the benefit of new training strategies at future FES competitions, e.g. at the Cybathlon 2020 (www.cybathlon.ethz.ch)., Competing Interests: Conflict of interest The authors declare no conflict of interest.

FES-assisted cycling has been recommended to people struggling to emerge from a disability to more functioning life after spinal cord injury. Recommendations issued by a gowing number of scientific papershas promised toimprove body composition and physical activity levels, as well as to controlinvoluntary muscle response; favoring activity and participation which break new grounds in expanding locomotion, leisure and occupational options for people with paraplegia and tetraplegia. In this report we described our experience to select and prepare a pilot to compete in the FES Bike Race modality at Cybathlon 2016 in Kloten (Zurick). He was a man, 38 years old, with a complete spinal cord injury, level T9, three years of injury. He took part in a two preparation phases lasting respectively 18 and 12 weeks each: (1st) pre-FES-cycling and a (2nd) FES-cycling. The 1st phase aimed to explore electrical stimulation response in the quadricps, hamstrings and gluteus muscles; searching for a standard muscular recruitment enable to propel the pedals of a trike. Following, in the 2nd phase, stationary to mobile FES-cycling was performed at the same time the development of the automation and control systems were being incorporated in the trike. We adapted a commercial tadpole trycicle anda pilot controlled system. Although we had planned a three session by week protocol, for reasons of term and time to finish the trike development and be prepared to compete, in the last two weeks before the Cybatlhon an intense level of exercise was maintained. After the race, we noticedinflammatory signs on the left knee which later revealed a patella fracture. The video footage analysis confirmed ithappened during the race's first lap., Competing Interests: Conflict of interest The authors declare no conflict of interests.

Functional electrical stimulation cycling has been proposed as an assistive technology with numerous health and fitness benefits for people with spinal cord injury, such as improvement in cardiovascular function, increase in muscular mass, and reduction of bone mass loss. However, some limitations, for example, lack of optimal control strategies that would delay fatigue, may still prevent this technology from achieving its full potential. In this work, we performed experiments on a person with complete spinal cord injury using a stationary tadpole trike when both cadence tracking and disturbance rejection were evaluated. In addition, two sets of experiments were conducted 6 months apart and considering activation of different muscles. The results showed that reference tracking is achieved above the cadence of 25 rpm with mean absolute errors between 1.9 and 10% when only quadriceps are activated. The disturbance test revealed that interferences may drop the cadence but do not interrupt a continuous movement if the cadence does not drop below 25 rpm, again when only quadriceps are activated. When other muscle groups were added, strong spasticity caused larger errors on reference tracking, but not when a disturbance was applied. In addition, spasticity caused the last experiments to result in less smooth cycling., (© 2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.)

Background: Obstructive sleep apnea (OSA) patients who suffer sudden cardiac death die predominantly during the night. We aimed to investigate whether all cardiovascular-related deaths display the same night-time peak as sudden cardiac death., Methods: Data from a large cohort of adults who underwent full-night polysomnography between 1985 and 2015 in a university-affiliated sleep clinic were analyzed. Time and cause of death of these patients and of persons from the general population were identified in death certificates from the State Health Secretariat. The day-night pattern of cardiovascular death was compared among groups of non-OSA, OSA (apnea-hypopnea index, AHI ≥5), CPAP users, and persons from the general population., Results: Among 619 certificates, 160 cardiovascular-related deaths were identified. The time of death of the 142 persons with OSA was uniformly distributed over 24 h, with neither an identifiable peak nor a circadian pattern (Rayleigh test; P = 0.8); the same flat distribution was seen in those with purported CPAP use (n = 49). Non-OSA individuals presented a morning peak and a night nadir of deaths, clearer when analyzed in eight-hour intervals. The same pattern was observed in 92 836 certificates from the State general population, with cardiovascular deaths showing the expected morning peak, night nadir, and a significant circadian pattern (Rayleigh test; P < 0.001)., Conclusions: In OSA patients, the distribution of cardiovascular-related deaths throughout the 24-h period is virtually flat, in contrast with the described nighttime peak of sudden cardiac death. OSA-related phenomena during nighttime might be blunting the mechanisms, arrhythmic or not, behind the morning peak of cardiovascular-related deaths., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Post-stroke hemiparesis causes compensated postures, which can modify the footedness established before the impairment. Recently, a paresis severity-modulated dominance hypothesis stated that measures to detect footedness become crucial to float new ideas for neurorehabilitation strategies. The Waterloo Footedness Questionnaire-Revised (WFQ-R) represents the most acceptable measure but it had not yet been cross-culturally adapted for Portuguese spoken in Brazil. Our aim was to cross-culturally adapt the WFQ-R to Brazilian Portuguese, verifying its reliability. We completed the essential steps to cross-culturally adapt one version, tested in 12 patients with post-stroke hemiparesis and 12 able-bodied individuals, sampled by convenience, to verify reliability. Measurements were taken by two independent raters during the test and by one of them at the one-week retest. No great semantic, linguistic or cultural differences were found, and acceptable reliability was recorded. The WFQ-R-Brazil is reliable and ready for use in the Brazilian able-bodied and post-stroke hemiparesis population.

Study Objectives: To investigate whether structured exercise and occupational activity are associated with obstructive sleep apnea (OSA) severity., Methods: The International Physical Activity Questionnaire was answered by 5,453 individuals who underwent full-night polysomnography. Participants were classified as exercisers or non-exercisers and also as occupationally active or non-active. The apnea-hypopnea index (AHI), minimum oxygen saturation (SaO 2 min), and time with saturation below 90% (TB90%) during polysomnography were used as indicators of OSA severity., Results: The sample included mostly men (59%), non-exercisers (56%), and occupationally non-active individuals (75%). Mean age (± standard deviation) was 44 ± 14 years, and mean body mass index was 29.9 ± 7.3 kg/m 2 . Non-exercisers had higher AHI (median 14, 25-75% interquartile range 4-34) than exercisers (8 [2-24]), lower SaO 2 min (83 ± 9 vs. 86 ± 8%), and longer TB90% (2 [0-18] vs. 0 [0-7] minutes), with p < 0.001 for all comparisons. AHI was higher in active (16 [6-34]) vs. non-active occupations (10 [3-27]; p < 0.001). Multinomial logistic regression with control for age, sex, overweight, obesity, and occupational activity showed that structured exercise was significantly associated with a 23% lower odds ratio for moderate OSA and 34% lower odds ratio for severe OSA. Active occupation was not associated with OSA., Conclusions: Structured physical exercise is associated with lower odds for OSA, independently of confounders. Occupational activity does not seem to replace the effects of regular exercise. Compensatory behaviors may be involved in these diverging outcomes. Our results warrant further research about the effect of occupational activity on OSA severity., (© 2017 American Academy of Sleep Medicine)

Transfer is a key ability and allows greater interact with the environment and social participation. Conversely, paraplegics have great risk of pain and injury in the upper limbs due to joint overloads during activities of daily living, like transfer. The main goal of this study is to verify if the use of functional electrical stimulation (FES) in the lower limbs of paraplegic individuals can assist the sitting pivot transfer (SPT). The secondary objective is to verify if there is a greater participation of the lower limbs during lift pivot phase. A preliminary study was done with one complete paraplegic individual. Temporal parameters were calculated and a kinetic assessment was done during the SPT. The preliminary results showed the feasibility of FES for assisting the SPT.

Since 1994, the University of Michigan Diabetes Research and Training Center proposed an instrument to measure neuropathies not yet adapted to use in Brazil. Then, this study aimed to adapt cross-culturally the Michigan Neuropathy Screening Instrument (MNSI) into Brazilian Portuguese, verifying its reliability. Thirty diabetic patients were initially evaluated with the adapted version after completed the essential steps to accomplish the cross-cultural adaptation. Twenty-two of them completed the procedures to repeat the measured scores after day 1 (trial 0). The repeated measurements were tested at days 2 or 3 (trial 1) by another rater (inter-rater reliability) and retested at day 20 (trial 2) by one of the attended raters (inter-test reliability). There were not great semantics, linguistics or cultural differences between two versions and excellent reliability was confirmed by intra-class correlation coefficient above 0.840. It was concluded that MNSI in the Brazilian version is reliable and it is ready to use.

Functional Electrical Stimulation assisted cycling (FES-Cycling) is increasingly becoming an alternative option recommended to people with spinal cord injury struggling with paraplegia and interested in practicing sports. In order to propose preconditions to guide FES-Cycling recommendation, we aimed to investigate some features and their potential relationships with responsiveness to Neuromuscular Electrical Stimulation (NMES). Fourteen volunteers attended a public recruitment forum to be assessed about their responsiveness through the 16-sessions of NMES. Volunteers were separated in two groups (responsive and non-responsive to NMES) which were investigated in the light of some personal, clinical, structural and functional features. Fifty seven percent of the initial sample responded to electrical stimulation with a visual contraction. This responsive group was predominantly composed by subjects presenting traumatic spinal cord injuries above T12 vertebral level. Only two subjects became responsive at the 3rd and 16th sessions. Among the observed features, the etiology and level of injuries seems to be more associated to responsiveness. Our observations seem to indicate that subjects with traumatic spinal cord injury above T12 level were the best potential candidates for FES-cycling.

Background: Muscle weakness is the main cause of motor impairment among stroke survivors and is associated with reduced peak muscle torque., Objective: To systematically investigate and organize the evidence of the reliability of muscle strength evaluation measures in post-stroke survivors with chronic hemiparesis., Data Sources: Two assessors independently searched four electronic databases in January 2014 (Medline, Scielo, CINAHL, Embase)., Study Selection: Inclusion criteria comprised studies on reliability on muscle strength assessment in adult post-stroke patients with chronic hemiparesis., Data Extraction: We extracted outcomes from included studies about reliability data, measured by intraclass correlation coefficient (ICC) and/or similar. The meta-analyses were conducted only with isokinetic data., Results: Of 450 articles, eight articles were included for this review. After quality analysis, two studies were considered of high quality. Five different joints were analyzed within the included studies (knee, hip, ankle, shoulder, and elbow). Their reliability results varying from low to very high reliability (ICCs from 0.48 to 0.99). Results of meta-analysis for knee extension varying from high to very high reliability (pooled ICCs from 0.89 to 0.97), for knee flexion varying from high to very high reliability (pooled ICCs from 0.84 to 0.91) and for ankle plantar flexion showed high reliability (pooled ICC = 0.85)., Conclusion: Objective muscle strength assessment can be reliably used in lower and upper extremities in post-stroke patients with chronic hemiparesis.

Since the first Broca publications issued from 1970s, lateralized functions in the human brain have urged the researchers to postulate hypothesis based in the right-left asymmetries and, according to some theories, the lateralization of the voluntary motor control could represent a solution to avoid redundant process optimizing space and time. Supported by this idea, the clinicians and researchers tend to concept that the chronic hemiplegic stroke patients learn to use predominantly the non-affected hemibody after stroke in which is more convenient to execute their daily life activities, modifying their natural preference in some cases. Although could seems reasonable conceptualize the non-affected side as the predominantly-used hemibody for motor tasks after stroke (convenience hypothesis), evidences point to exist also hemiplegic patients that developed a predominantly use of the affected side. To float an idea, in terms of weight bearing distribution during upright position, the researchers have found patients overloading the non-affected hemibody, as expected; but also patients overloading the affected hemibody, not presenting necessarily Pusher's syndrome cases. Given the evidences, we could propose a severity-modulated predominance hypothesis which complements the convenience hypothesis. According to our complementary hypothesis, the severity of the motor disability presented in the hemiparesis condition (light, moderate and heavy severity) could determine a predominant use defined by preference (light to moderate severity) or convenience (moderate to heavy severity). In this hypothesis, we postulate ideas from a rehabilitation perspective to be incorporated in treatment programs., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

l-Arginine is an essential amino acid in Leishmania (Leishmania) amazonensis metabolism. A key enzyme for parasite l-arginine metabolism is arginase (ARG) that uses arginine to produce urea and ornithine, a precursor of polyamine pathway guaranteeing parasite replication in both insect and mammal hosts. There is an alternative pathway to produce ornithine via l-proline and glutamate, but this mechanism is not described in Leishmania. In the mammal host, two enzymes can use l-arginine as substrate, the host ARG and the induced nitric oxide synthase that produces nitric oxide. The competition between induced nitric oxide synthase and both parasite and host ARG can favor the success of the infection or its control. Here, we established the metabolomics profile of the polyamine pathway of wild type (WT) L. (L.) amazonensis, submitted or not to l-arginine starvation, and compared to the ARG-knockout mutant (arg - ). Our results indicated that arginine starvation induces a decrease in arginine, ornithine, and putrescine, but we could not detect the significative level changes of spermidine, spermine, or agmatine. However, the absence of ARG on the arg - induced an increase of arginine and citrulline levels, but decreased the levels of ornithine and putrescine. Similarly to the WT arginine-starved parasites, the arg - parasites presented lower levels of proline when compared to the WT ones. This could be indicative of an alternative pathway to surpass the enzyme or its substrate absence., (© 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

There is a rising resistance against antimony drugs, the gold-standard for treatment until some years ago. That is a serious problem due to the paucity of drugs in current clinical use. In a research to reveal how these drugs affect the parasite during treatment and to unravel the underlying basis for their resistance, we have employed metabolomics to study treatment in Leishmania infantum promastigotes. This was accomplished first through the untargeted analysis of metabolic snapshots of treated and untreated parasites both resistant and responders, utilizing a multiplatform approach to give the widest as possible coverage of the metabolome, and additionally through novel monitoring of the origin of the detected alterations through a 13C traceability experiment. Our data stress a multi-target metabolic alteration with treatment, affecting in particular the cell redox system that is essential to cope with detoxification and biosynthetic processes. Additionally, relevant changes were noted in amino acid metabolism. Our results are in agreement with other authors studying other Leishmania species.

Described as an alternative way of assessing weight-bearing asymmetries, the measures obtained from digital scales have been used as an index to classify weight-bearing distribution. This study aimed to describe the intra-test and the test/retest reliability of measures in subjects with and without hemiparesis during quiet stance. The percentage of body weight borne by one limb was calculated for a sample of subjects with hemiparesis and for a control group that was matched by gender and age. A two-way analysis of variance was used to verify the intra-test reliability. This analysis was calculated using the differences between the averages of the measures obtained during single, double or triple trials. The intra-class correlation coefficient (ICC) was utilized and data plotted using the Bland-Altman method. The intra-test analysis showed significant differences, only observed in the hemiparesis group, between the measures obtained by single and triple trials. Excellent and moderate ICC values (0.69-0.84) between test and retest were observed in the hemiparesis group, while for control groups ICC values (0.41-0.74) were classified as moderate, progressing from almost poor for measures obtained by a single trial to almost excellent for those obtained by triple trials. In conclusion, good reliability ranging from moderate to excellent classifications was found for participants with and without hemiparesis. Moreover, an improvement of the repeatability was observed with fewer trials for participants with hemiparesis, and with more trials for participants without hemiparesis.

Objective: To investigate the effect of intermittent hypoxia-a model of obstructive sleep apnea (OSA)-on pancreatic expression of uncoupling protein-2 (UCP2), as well as on glycemic and lipid profiles, in C57BL mice., Methods: For 8 h/day over a 35-day period, male C57BL mice were exposed to intermittent hypoxia (hypoxia group) or to a sham procedure (normoxia group). The intermittent hypoxia condition involved exposing mice to an atmosphere of 92% N and 8% CO2 for 30 s, progressively reducing the fraction of inspired oxygen to 8 ± 1%, after which they were exposed to room air for 30 s and the cycle was repeated (480 cycles over the 8-h experimental period). Pancreases were dissected to isolate the islets. Real-time PCR was performed with TaqMan assays., Results: Expression of UCP2 mRNA in pancreatic islets was 20% higher in the normoxia group than in the hypoxia group (p = 0.11). Fasting serum insulin was higher in the hypoxia group than in the normoxia group (p = 0.01). The homeostasis model assessment of insulin resistance indicated that, in comparison with the control mice, the mice exposed to intermittent hypoxia showed 15% lower insulin resistance (p = 0.09) and 21% higher pancreatic β-cell function (p = 0.01). Immunohistochemical staining of the islets showed no significant differences between the two groups in terms of the area or intensity of α- and β-cell staining for insulin and glucagon., Conclusions: To our knowledge, this is the first report of the effect of intermittent hypoxia on UCP2 expression. Our findings suggest that UCP2 regulates insulin production in OSA. Further study of the role that UCP2 plays in the glycemic control of OSA patients is warranted.

Objective: Obstructive sleep apnea is a common disorder associated with aging and obesity. Apneas cause repeated arousals, intermittent hypoxia, and oxidative stress. Changes in glucolipidic profile occur in apnea patients, independently of obesity. Animal models of sleep apnea induce hyperglycemia. This study aims to evaluate the effect of the antioxidants melatonin and N-acetylcysteine on glucose, triglyceride, and cholesterol levels in animals exposed to intermittent hypoxia., Materials and Methods: Two groups of Balb/c mice were exposed to intermittent hypoxia (n = 36) or sham intermittent hypoxia (n = 36) for 35 days. The intermittent hypoxia group underwent a total of 480 cycles of 30 seconds reducing the inspired oxygen fraction from 21% to 7 ± 1% followed by 30 seconds of normoxia, during 8 hours daily. Melatonin or N-acetylcysteine were injected intraperitonially daily from day 21 on., Results: At day 35, glucose levels were significantly higher in the intermittent hypoxia group than in the control group. The intermittent hypoxia groups receiving N-acetylcysteine and vehicle showed higher glucose levels than the group receiving melatonin. The lipid profile was not affected by intermittent hypoxia or antioxidant administration., Conclusions: The present results suggest that melatonin prevents the well-recognized increase in glucose levels that usually follows exposure to intermittent hypoxia. Further exploration of the role of melatonin in sleep apnea is warranted.

Synaptic transmission is an essential process for neuron physiology. Such process is enabled in part due to modulation of neurotransmitter release. Adenosine is a synaptic modulator of neurotransmitter release in the Central Nervous System, including neurons of medulla oblongata, where several nuclei are involved with neurovegetative reflexes. Adenosine modulates different neurotransmitter systems in medulla oblongata, specially glutamate and noradrenaline in the nucleus tractussolitarii, which are involved in hypotensive responses. However, the intracellular mechanisms involved in this modulation remain unknown. The adenosine A2a receptor modulates neurotransmitter release by activating two cAMP protein effectors, the protein kinase A and the exchange protein activated by cAMP. Therefore, an in vitro approach (cultured cells) was carried out to evaluate modulation of neurotransmission by adenosine A2a receptor and the signaling intracellular pathway involved. Results show that the adenosine A2a receptor agonist, CGS 21680, increases neurotransmitter release, in particular, glutamate and noradrenaline and such response is mediated by protein kinase A activation, which in turn increased synapsin I phosphorylation. This suggests a mechanism of A2aR modulation of neurotransmitter release in cultured cells from medulla oblongata of Wistar rats and suggest that protein kinase A mediates this modulation of neurotransmitter release via synapsin I phosphorylation., (Copyright © 2014 Elsevier Ireland Ltd and the Japan Neuroscience Society. All rights reserved.)

Miltefosine (MT) (hexadecylphosphocholine) was implemented to cope with resistance against antimonials, the classical treatment in Leishmaniasis. Given the scarcity of anti- Leishmania (L) drugs and the increasing appearance of resistance, there is an obvious need for understanding the mechanism of action and development of such resistance. Metabolomics is an increasingly popular tool in the life sciences due to it being a relatively fast and accurate technique that can be applied either with a particular focus or in a global manner to reveal new knowledge about biological systems. Three analytical platforms, gas chromatography (GC), liquid chromatography (LC) and capillary electrophoresis (CE) have been coupled to mass spectrometry (MS) to obtain a broad picture of metabolic changes in the parasite. Impairment of the polyamine metabolism from arginine (Arg) to trypanothione in susceptible parasites treated with MT was in some way expected, considering the reactive oxygen species (ROS) production described for MT. Importantly, in resistant parasites an increase in the levels of amino acids was the most outstanding feature, probably related to the adaptation of the resistant strain for its survival inside the parasitophorous vacuole.

Metabolomics has become an invaluable tool to unveil biology of pathogens, with immediate application to chemotherapy. It is currently accepted that there is not one single technique capable of obtaining the whole metabolic fingerprint of a biological system either due to their different physical-chemical properties or concentrations. In this work, we have explored the capability of capillary electrophoresis mass spectrometry with a sheathless interface with electrospray ionization (CE-ESI-TOF-MS) to separate metabolites in order to be used as a complementary technique to LC. As proof of concept, we have compared the metabolome of Leishmania infantum promastigotes BCN 150 (Sb (III) IC(50) = 20.9 μM) and its variation when treated with 120 μM of Sb(III) potassium tartrate for 12 h, as well as with its Sb(III) resistant counterpart obtained by growth of the parasites under increasing Sb(III) in a step-wise manner up to 180 μM. The number of metabolites compared were of 264 for BCN150 Sb(III) treated versus nontreated and of 195 for Sb(III) resistant versus susceptible parasites. After successive data filtering, differences in seven metabolites identified in databases for Leishmania pathways, showed the highest significant differences, corresponding mainly to amino acids or their metabolite surrogates. Most of them were assigned to sulfur containing amino acids and polyamine biosynthetic pathways, of special relevance considering the deterioration of the thiol-dependent redox metabolism in Leishmania by Sb(III). Given the low concentrations typical for most of these metabolites, the assay can be considered a success that should be explored for new biological questions., (© 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Classically, Parkinson's disease (PD) is considered to be a motor system affliction and its diagnosis is based on the presence of a set of cardinal motor signs (e.g. rigidity, bradykinesia, rest tremor and postural reflex disturbance). However, there is considerable evidence showing that non-motor alterations (e.g. anxiety, depression, sleep, gastrointestinal and cognitive functions) precede the classical motor symptoms seen in PD. The management of these nonmotor symptoms remains a challenge. A pattern of regional neurodegeneration that varies considerably depending upon the neuronal population affected may explain the different symptoms. In fact, differential mechanisms of neuronal vulnerability within the substantia nigra pars compacta (SNpc) suggests that factors other than location contribute to the susceptibility of these neurons. In this review we discuss how these factors interact to ultimately target the SNpc. Remarkably, this region consists of approximately 95% of the tyrosine hydroxylase (TH)-immunoreactive neurons in both human and rat brains, and consequently this implicates elevated levels of dopamine metabolites, free radicals and other hazard species in these neurons. An understanding of how these factors promote neuronal death may be useful for the development of novel neuroprotective and/or neurorestorative strategies for PD.