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- Cochlear hair cell regeneration based on stem cells: A systematic reviewPublication . Costa, Vítor Bruno; Tomé, David; Çirtlik, Zeynep Yağmur; Öztürk, Yaren; Clemêncio, Filomena; Pitt-Byrne, Theresa; Tomé, David; Costa Clemêncio, Filomena MariaAccording to the World Health Organization (WHO), by 2050 at least 700 million people will need access to hearing care and hearing rehabilitation services. The search for cell or gene therapies has been intensifying, and stem cell therapy looks a promising candidate to support hearing regeneration and reduce these numbers. The aim of this study is to provide an overview of current advances in stem cellbased therapies for cochlear hair cell regeneration and the processes being developed for future applicability. Identification and review of all articles in the databases PubMed, Web of Science, and PLoS One using the terms stem cell, auditory hair cell regeneration, and mammalian during February 2023 and following the PRISMA guidelines. 50 articles were obtained, published between 2003 and 2022 and were systematically analyzed. The current research quantity is limited and further studies are needed, particularly in human tissue. The simultaneous use of cell therapy and gene therapy may lead to more promising results. Moreover, advances in cochlear hair cell regeneration with stem cells suggest there is a realistic potential to make the technique a useful future therapy.
- European Portuguese version of the Mini-BESTest: a cross-cultural adaptation and psychometric measurements in individuals with sensorimotor impairmentsPublication . Freitas, Marta; Pinho, Francisco; Cruz-Martins, Natália; Pinho, Liliana; Silva, Sandra; Figueira, Vânia; Vilas-Boas, João Paulo; Silva, Augusta; Ferreira Silva, Maria AugustaThis study aimed to translate and cross-culturally adapt the Mini-BESTest into European Portuguese and to evaluate its psychometric properties in individuals with sensorimotor impairments. A cross-sectional cross-cultural adaptation and validation study was conducted according to the COSMIN guidelines and the STROBE statement. The study included 100 participants with sensorimotor impairments who were able to walk 6 m. Cronbach’s alpha and item-total correlations were used to assess internal consistency. Interpretability was assessed by examining floor and ceiling effects and skewness. To investigate construct validity, Spearman correlation coefficients and Bland-Altman analysis were performed to compare the Berg Balance Scale and the Mini-BESTest Inter- and intra-rater reliability were assessed by calculating the ICC, SEM and MDC based on video recordings of the participants during the Mini-BESTest assessments. The European Portuguese Mini-BESTest showed good internal consistency (Cronbach’s α = 0.892) and no significant floor or ceiling effects. Excellent inter- and intra-rater reliability (ICC = 0.97) were also demonstrated, with MDC of 2.58 and 2.57, respectively. Furthermore, this instrument showed a significant correlation with the BBS (r = 0.902). Bland-Altman analysis showed small absolute differences. The European Portuguese Mini-BESTest is comparable to the original English version in terms of validity and reliability and is therefore highly recommended for use by Portuguese-speaking professionals to assess postural control.
- Methylphenidate and P300 in attention deficit hyperactivity disorder: A systematic review and meta-analysisPublication . Barroso, Beatriz C. R.; Mendonça, Fabiana; Mazer, Prune; Prata, Catarina; Pinto, Joana O.; Mazer, Prune; Pinto, Joana OMethylphenidate (MPH) is a stimulant medicine often used to treat attention deficit hyperactivity disorder (ADHD), as it may positively affect behaviour and brain activity. This work aims to systematise the current literature about the effects of MPH on the amplitude of P300 in individuals with ADHD. A systematic review and meta-analysis of empirical studies measuring P300 amplitude and comparing MPH administration to either a pre-MPH condition or healthy controls was conducted, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Our results revealed no overall (n = 13) significant differences between individuals diagnosed with ADHD and medicated with MPH and controls. Although, a moderation analysis by region found differences between both groups on frontal sites. When comparing the pre- and post-effects of MPH on the same individuals (n = 17), it appears that P300 amplitude tends to increase post-administration in central and posterior regions. In this second meta-analysis, a moderation by task revealed a larger effect size for go/no-go. In general, MPH was found to increase P300 amplitude in ADHD, somewhat normalising this aspect of their brain activity. The main limitations of the included studies are the insufficiently explained dosages and the skewness for male participants. Future research directions are discussed.
- Presence of pain shows greater effect than tendon structural alignment during landing dynamicsPublication . Silvia, Ortega-Cebrián; Silva, Diogo C. F.; Carneiro, Daniela F.; Zárate, Victor; Alves, Leonel A. T.; Guedes, Diana C.; Zárate-Tejero, Carlos A.; Cadellans-Arróniz, Aïda; Montes, António Mesquita; Mesquita Montes, António; Silva, Diogo C. F.; C. Guedes, Diana"Eccentric loading during landing is considered a key factor in the development of patellar tendinopathy and is associated with stiff landings and patellar tendinopathy. This study aims to investigate the relationship between tendon structure, presence of pain, and sex differences in landing kinematics and kinetics during countermovement jumps (CMJ) and tuck jump tests (TJT) in professional volleyball players. Professional volleyball players aged 18 to 30 years old (14 females and 25 males) participated in a cross-sectional study. Data included the Victorian Institute of Sport Assessment Patellar Tendon (VISA-P) questionnaire; patellar tendon ultrasound characterization tissue (UTC) scans, in order to identify groups with misaligned tendon fibers (MTF) or aligned tendon fibers (ATF); and biomechanical assessments for CMJ and TJT. The joint angle (JA) at the lower limb was measured at peak ground reaction force (peak_vGRF) and maximal knee flexion (max_KF). A general linear model was used to evaluate joint JA differences between tendon alignment, pain, and sex variables. Sample t-tests compared peak_vGRF, load time, load rate, and area based on tendon alignment, pain presence, sex, and jump. The statistical significance of p-value is >0.05, and the effect size (ES) was also calculated. The MTF group revealed decreased knee JA during TJT at peak_vGRF (p = 0.01; ES = −0.66) and max_KF (p = 0.02; ES = −0.23). The presence of pain was associated with increased JA during the CMJ, particularly at peak_vGRF and max_KF for trunk, hip, and ankle joints. Females showed decreased peak_vGRF than males. Landing with misaligned tendon fibers showed longer load times compared to aligned tendon fibers (p = 0.021; ES = −0.80). The TJT exhibited a greater load rate than the CMJ (p = 0.00; ES = −0.62). Pain is a critical factor influencing greater JA during landing, particularly at the trunk, hip, and ankle joints in CMJ. Misaligned tendon fibers compromise landing dynamics by increasing trunk JA during TJT. Kinetics varied significantly by sex and jump type, while pain and tendon structure revealed limited differences. "
- Feasibility of 3D body tracking from monocular 2D video feeds in musculoskeletal telerehabilitationPublication . Clemente, Carolina; Chambel, Gonçalo; Silva, Diogo C. F.; Montes, António Mesquita; Pinto, Joana F.; Silva, Hugo Plácido da; Mesquita Montes, António; Silva, Diogo C. F.Musculoskeletal conditions affect millions of people globally; however, conventional treatments pose challenges concerning price, accessibility, and convenience. Many telerehabilitation solutions offer an engaging alternative but rely on complex hardware for body tracking. This work explores the feasibility of a model for 3D Human Pose Estimation (HPE) from monocular 2D videos (MediaPipe Pose) in a physiotherapy context, by comparing its performance to ground truth measurements. MediaPipe Pose was investigated in eight exercises typically performed in musculoskeletal physiotherapy sessions, where the Range of Motion (ROM) of the human joints was the evaluated parameter. This model showed the best performance for shoulder abduction, shoulder press, elbow flexion, and squat exercises. Results have shown a MAPE ranging between 14.9% and 25.0%, Pearson’s coefficient ranging between 0.963 and 0.996, and cosine similarity ranging between 0.987 and 0.999. Some exercises (e.g., seated knee extension and shoulder flexion) posed challenges due to unusual poses, occlusions, and depth ambiguities, possibly related to a lack of training data. This study demonstrates the potential of HPE from monocular 2D videos, as a markerless, affordable, and accessible solution for musculoskeletal telerehabilitation approaches. Future work should focus on exploring variations of the 3D HPE models trained on physiotherapy-related datasets, such as the Fit3D dataset, and post-preprocessing techniques to enhance the model’s performance.
- Effects of a home-based pulmonary rehabilitation program in patients with Chronic Obstructive Pulmonary Disease in GOLD B group: A pilot studyPublication . Vilarinho, Rui; Serra, Lúcia; Coxo, Ricardo; Carvalho, João; Esteves, Cátia; Montes, António Mesquita; Caneiras, Cátia; Vilarinho, Rui; Mesquita Montes, AntónioPatients with chronic obstructive pulmonary disease (COPD) in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) B group can be included in pulmonary rehabilitation (PR) settings outside the hospitals. This study aimed to explore the feasibility of a home-based pulmonary rehabilitation (HBPR) program and assess its impact on patients with COPD in the GOLD B group. A real-world, pre–post intervention study was conducted with 12 weeks of HBPR (presential home visits and phone calls) using the self-management program Living Well with COPD. The 1- min sit-to-stand test (1MSTS), modified Medical Research Council Questionnaire (mMRC), COPD Assessment Test (CAT), Hospital Anxiety and Depression Scale (HADS), and London Chest Activity of Daily Living (LCADL) were used to assess the impact. Pre–post differences and correlations between changes in outcomes were calculated. In 30 patients (71.6 years, FEV1 (%) 52.8), significant improvements (p < 0.05) were observed on 1MSTS (Pre 17.2, Post 21.2), mMRC (Pre 2.0, Post 1.0), CAT (Pre 16.3, Post 9.9), HADS (Pre 14.4, Post 9.6), and LCADL (Pre 21.0, Post 15.8), with no adverse events reported. When significant, correlations between changes in outcomes were moderate or strong (0.48 ≤ ρ ≤ 0.66). HBPR can be feasible and safe, and it shows the potential to significantly improve outcomes of patients with COPD in the GOLD B group.
- Executive function in gambling disorder: A meta-analysis on neuropsychological evidencePublication . Peixoto, Miguel; Dores, Artemisa; Monteiro, Maria; Marques, António; Barbosa, Fernando; Pereira da Silva Marques, António José; Dores, Artemisa; de Faria Távora Moreira Peixoto, MiguelGambling disorder (GD) is associated with defcits in various cognitive functions. Specifcally for executive function (EF), previous fndings are inconsistent, despite defcits being reported for shifting, inhibition, planning, and working memory domains. Although a worse performance in EF measures related to GD severity is often reported, there is a need to clarify current evidence. This study aims to systematically review and perform a meta-analysis to clarify the association between EF defcits and GD. The current study followed the preferred reporting items for systematic reviews and meta-analyses protocols. The meta-analysis used a random efects model and robust variance estimation to analyze the data, using Hedge’s g to report efect sizes. A total of 21 studies were systematically reviewed, of which 17 were included for meta-analysis. Meta-analysis was performed for shifting, inhibition, planning, and verbal fuency. Due to a lower number of studies, working memory data was systematically reviewed, but no meta-analysis was performed. Significant efect sizes were found for shifting and inhibition, indicative of defcits in participants with GD. No signifcant defcits were found for the other EF domains. Working memory results revealed inconsistent evidence, even when divided into verbal and visuospatial modalities. There is enough evidence of defcits in shifting and inhibition in participants with GD. However, better sample characterization should be considered in future studies to better understand the sources of potential heterogeneity. Consideration of gambling severity as a continuous variable could allow for a more detailed analysis of EF alterations across the various degrees of GD.
- How useful is mixed reality in surgical treatment? - a Delphi StudyPublication . Magalhães, Renato; Lima, Ana Carolina; Marques, António; Pereira, Javier; Pereira da Silva Marques, António José; Magalhães, RenatoMixed reality (MR) is a tool that integrates elements from both the real and virtual worlds. Its potential applications are manifold, with promising developments observed in diverse fields, including healthcare, particularly in the context of surgical procedures. A number of studies have been conducted on mixed reality headsets, including the Microsoft HoloLens 2®, which may be employed in surgical training, planning, and navigation. It is imperative to ascertain whether medical professionals consider this technology indispensable in their professional lives. This study employs the Delphi method to assess the utility of MR in surgical settings and utilizes the Welphi online platform to facilitate this process. Furthermore, a PRISMA-like approach is employed to analyze the results of the initial round. The objective of this study is to examine the feasibility and advantages of mixed reality technology in surgical contexts. The findings are intended to inform and direct healthcare professionals, researchers, and developers in the advancement of mixed reality integration in surgical environments, with the ultimate goal of optimizing the quality and safety of treatments. A Delphi approach comprising of three rounds was implemented to ascertain consensus on the utility of MR surgical treatment. Participants were purposefully selected from experts with professional experience with technologies that provide a more immersive or interactive experience, such as virtual reality (VR), augmented reality (AR), 3D laparoscopy, robotics, and other similar technologies applied in the surgical field. The initial round of the study was designed to allow surgeons to provide their insights into the potential applications of MR in surgical procedures. This phase employed a structured approach, with open-ended questions organized into five distinct sections. In the second round, the questions were derived from the analysis of the first round and organized according to main and sub-topics for hierarchical structuring. In the third round, the questions were identical to those posed in the second round, including the percentage results obtained in the previous round. This afforded the experts the opportunity to review their previous responses. A consensus round was subsequently conducted. In the analysis, Kendall's tau-b coefficient for correlation analysis was employed and significant correlations between distinct aspects were identified. Twenty-two of the invited experts provided responses in both the initial and subsequent rounds, representing a 100% response rate. In the third round and consensus round, 20 experts participated, representing 91% response rate. The consensus round was conducted to present the results that had achieved a level of majority consensus of 95% on the usefulness of MR in surgical treatment. The objective was to have experts validate the results. The primary benefits of MR in surgery were identified as surgical navigation (with 75% of consensus), surgical planning (with 75% of consensus), and teaching and training (with 70% of consensus). According to the Delphi study, the areas where MR technology is most beneficial in surgical contexts are surgical navigation, training, and planning. However, the costs and investments required for implementation may present a potential limitation for the integration of this technology in surgical procedures. Moreover, it is of crucial importance to comprehend the ethical implications associated with this matter, which may have implications for the security of patients.
- Mixed reality in the operating room: A systematic reviewPublication . Magalhães, Renato; Oliveira, Ana; Terroso, David; Vilaça, Adélio; Veloso, Rita; Marques, António; Pereira, Javier; Pereira da Silva Marques, António José; Magalhães, RenatoMixed Reality is a technology that has gained attention due to its unique capabilities for accessing and visualizing information, becoming a valuable tool for medicine, particularly for the operating room and surgical learning; A systematic review was conducted following the PRISMA guidelines to answer the research questions established using the PICO framework; Although implementation of Mixed Reality applications in the operations room presents some challenges, when used appropriately, it can yield remarkable results. It can make learning easier, flatten the learning curve for several procedures, and facilitate various aspects of the surgical processes; Technical complexity, equipment costs, and steep learning curves present significant obstacles to the widespread adoption of Mixed Reality and computer-assisted evaluation. The possibility of integration of distinct medical imaging modalities and innovative functionalities holds promise for clinical applications. However, it is important to consider issues related to usability, bias, and statistical analyses need consideration. Mixed Reality offers significant benefits, but there are still open challenges such as ergonomic issues, limited field of view, and battery autonomy that must be addressed to ensure widespread acceptance.
- Precision and reliability of a dynamometer for trunk extension strength and steadiness assessmentPublication . Parolini, Franciele; Goethel, Márcio; Robalino, Johan; Becker, Klaus; Sousa, Manoela; Pulcineli, Barbara C.; Ervilha, Ulysses F.; Vilas-Boas, João Paulo; Santos, Rubim; Rubim Silva Santos, Manuel; Carvalho Santos Parolini, FrancieleLow back pain is a major cause of disability worldwide, often associated with deficits in trunk extensor strength control. Accurate assessment of trunk extension strength control is crucial for diagnosing impairments and monitoring interventions. This study evaluated the reliability of a dynamometry-based protocol for isometric trunk extension strength control assessment. Twenty-eight healthy volunteers (9 females, 19 males) completed two sessions, seven days apart. A single-point load cell system, encapsulated within a 3D-printed structure and connected to a Delsys system® at a sampling frequency of 2000 Hz, was used for data acquisition. Participants performed maximal voluntary contractions (MVC) and submaximal isometric contractions (SMVC) guided by trapezoidal visual feedback. Key outcome variables included peak force, mean force, and force steadiness. Calibration demonstrated high accuracy (R2 = 1) with a low root mean square error (0.55 N). Test–retest analysis showed excellent reliability for peak force (ICC = 0.81, SEM = 0.50, MDC = 1.39), mean force (ICC = 0.93, SEM = 0.17, MDC = 1.08), and steadiness (ICC = 0.87, SEM = 0.85, MDC = 2.36), with no significant intersession differences (p > 0.05). This study demonstrates the high reliability of using dynamometry to assess trunk extension strength during MVC and SMVC, endorsing the dynamometer as a tool for functional assessment and the development of personalized rehabilitation and training strategies.