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Cheon S, Kim JS, Woo MR, Ji SH, Park S, Ud Din F, Kim JO, Youn YS, Oh KT, Lim SJ, Jin SG, Chung JE, Choi HG. Establishment of nanoparticle screening technique: A pivotal role of sodium carboxymethylcellulose in enhancing oral bioavailability of poorly water-soluble aceclofenac. Int J Biol Macromol 2024; 277:134246. [PMID: 39098461 DOI: 10.1016/j.ijbiomac.2024.134246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/23/2024] [Accepted: 07/27/2024] [Indexed: 08/06/2024]
Abstract
A novel nanoparticle screening technique was established to mostly enhance the aqueous solubility and oral bioavailability of aceclofenac using nanoparticle systems. Among the polymers investigated, sodium carboxymethylcellulose (Na-CMC) showed the greatest increase in drug solubility. Utilizing spray-drying technique, the solvent-evaporated solid dispersion (SESD), surface-attached solid dispersion (SASD), and solvent-wetted solid dispersion (SWSD) were prepared using aceclofenac and Na-CMC at a weight ratio of 1:1 in 50 % ethanol, distilled water, and ethanol, respectively. Using Na-CMC as a solid carrier, an aceclofenac-loaded liquid self-emulsifying drug delivery system was spray-dried and fluid-bed granulated together with microcrystalline cellulose, producing a solid self-nanoemulsifying drug delivery system (SNEDDS) and solid self-nanoemulsifying granule system (SNEGS), respectively. Their physicochemical properties and preclinical assessments in rats were performed. All nanoparticles exhibited very different properties, including morphology, crystallinity, and size. As a result, they significantly enhanced the solubility, dissolution, and oral bioavailability in the following order: SNEDDS ≥ SNEGS > SESD ≥ SASD ≥ SWSD. Based on our screening technique, the SNEDDS was selected as the optimal nanoparticle with the highest bioavailability of aceclofenac. Thus, our nanoparticle screening technique should be an excellent guideline for solubilization research to improve the solubility and bioavailability of many poorly water-soluble bioactive materials.
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Affiliation(s)
- Seunghyun Cheon
- College of Pharmacy, Hanyang University, Ansan 15588, South Korea
| | - Jung Suk Kim
- College of Pharmacy, Hanyang University, Ansan 15588, South Korea
| | - Mi Ran Woo
- College of Pharmacy, Hanyang University, Ansan 15588, South Korea
| | - Sang Hun Ji
- College of Pharmacy, Hanyang University, Ansan 15588, South Korea
| | - Seonghyeon Park
- College of Pharmacy, Hanyang University, Ansan 15588, South Korea
| | - Fakhar Ud Din
- Department of Pharmacy, Quaid-I-Azam University, Islamabad 45320, Pakistan
| | - Jong Oh Kim
- College of Pharmacy, Yeungnam University, Gyongsan 38541, South Korea
| | - Yu Seok Youn
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, South Korea
| | - Kyung Taek Oh
- College of Pharmacy, Chung-Ang University, Seoul 06974, South Korea
| | - Soo-Jeong Lim
- Department of Bioscience and Biotechnology, Sejong University, Seoul 05006, South Korea
| | - Sung Giu Jin
- Department of Pharmaceutical Engineering, Dankook University, Cheonan 31116, South Korea.
| | - Jee-Eun Chung
- College of Pharmacy, Hanyang University, Ansan 15588, South Korea.
| | - Han-Gon Choi
- College of Pharmacy, Hanyang University, Ansan 15588, South Korea.
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Vitamin D 3/vitamin K 2/magnesium-loaded polylactic acid/tricalcium phosphate/polycaprolactone composite nanofibers demonstrated osteoinductive effect by increasing Runx2 via Wnt/β-catenin pathway. Int J Biol Macromol 2021; 190:244-258. [PMID: 34492244 DOI: 10.1016/j.ijbiomac.2021.08.196] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/15/2021] [Accepted: 08/26/2021] [Indexed: 11/22/2022]
Abstract
Vitamin D3, vitamin K2, and Mg (10%, 1.25%, and 5%, w/w, respectively)-loaded PLA (12%, w/v) (TCP (5%, w/v))/PCL (12%, w/v) 1:1 (v/v) composite nanofibers (DKMF) were produced by electrospinning method (ES) and their osteoinductive effects were investigated in cell culture test. Neither pure nanofibers nor DKMF caused a significant cytotoxic effect in fibroblasts. The induction of the stem cell differentiation into osteogenic cells was observed in the cell culture with both DKMF and pure nanofibers, separately. Vitamin D3, vitamin K2, and magnesium demonstrated to support the osteogenic differentiation of mesenchymal stem cells by expressing Runx2, BMP2, and osteopontin and suppressing PPAR-γ and Sox9. Therefore, the Wnt/β-catenin signaling pathway was activated by DKMF. DKMF promoted large axonal sprouting and needle-like elongation of osteoblast cells and enhanced cellular functions such as migration, infiltration, proliferation, and differentiation after seven days of incubation using confocal laser scanning microscopy. The results showed that DKMF demonstrated sustained drug release for 144 h, tougher and stronger structure, higher tensile strength, increased water up-take capacity, decreased degradation ratio, and slightly lower Tm and Tg values compared to pure nanofibers. Consequently, DKMF is a promising treatment approach in bone tissue engineering due to its osteoinductive effects.
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Borde S, Paul SK, Chauhan H. Ternary solid dispersions: classification and formulation considerations. Drug Dev Ind Pharm 2021; 47:1011-1028. [PMID: 33818224 DOI: 10.1080/03639045.2021.1908342] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The number of active pharmaceutical compounds from the biopharmaceutical classification system (BCS) belonging to Class II and IV have significantly increased in recent years. These compounds have high therapeutic potential but are difficult to formulate as oral dosage forms due to their poor aqueous solubility. The solubility and bioavailability of these poorly water-soluble compounds can be increased by various formulation approaches, such as amorphous solid dispersions (ASD), salt formation, complexations, etc. Out of these techniques, the ASD approach, where compounds are converted into amorphous form and embedded in the hydrophilic matrix, have been successfully used in many marketed preparations. The recent advancement of this ASD approach is the design of ternary solid dispersions (TSD), where an additional component is added to further improve their performance in terms of solubility, stability, and processability. This review discusses the classification, mechanism of performance improvement, preparation techniques, and characterizations for TSD.
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Affiliation(s)
- Shambhavi Borde
- School of Pharmacy and Health Professions, Creighton University, Omaha, NE, USA
| | - Sagar Kumar Paul
- School of Pharmacy and Health Professions, Creighton University, Omaha, NE, USA
| | - Harsh Chauhan
- School of Pharmacy and Health Professions, Creighton University, Omaha, NE, USA
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Choi JE, Kim JS, Choi MJ, Baek K, Woo MR, Kim JO, Choi HG, Jin SG. Effects of different physicochemical characteristics and supersaturation principle of solidified SNEDDS and surface-modified microspheres on the bioavailability of carvedilol. Int J Pharm 2021; 597:120377. [PMID: 33581270 DOI: 10.1016/j.ijpharm.2021.120377] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/04/2021] [Accepted: 02/07/2021] [Indexed: 02/08/2023]
Abstract
In this study, a solidified self-nanoemulsifying drug delivery system (solidified SNEDDS) and surface-modified microspheres were developed for enhancing the oral bioavailability of carvedilol. Based on the aqueous solubility test, liquid SNEDDS was composed of Peceol™ (oil), Tween® 80 (surfactant), and Labrasol® (co-surfactant) at a weight ratio of 25/50/25, generating the smallest nanoemulsion droplet size. Then, carvedilol was added to liquid SNEDDS and spray-dried with Aerosil® to fabricate the solidified SNEDDS. Surface-modified microspheres were manufactured using copovidone (polymer) and Tween® 80 (surfactant) according to aqueous solubility test results. The proper ratio of copovidone and Tween® 80 was determined based on the solubility and dissolution test. Both prepared formulations and carvedilol powder were compared using four different criteria: physicochemical characteristics, solubility, dissolution, and oral bioavailability. For solidified SNEDDS, carvedilol was encapsulated in liquid SNEDDS and absorbed to the Aerosil® surface, leading to the conversion from a crystalline to an amorphous state. However, the drug maintained its crystal form in the surface-modified microspheres. Round and even-sized particles were attached to the rough surfaces of drug, suggesting that hydrophilic carriers adhered to the hydrophobic drug. All formulations significantly improved drug solubility, dissolution, plasma concentrations, Cmax, and AUC compared to carvedilol powder. The parameters were ranked in the following order: solidified SNEDDS > surface-modified microspheres > carvedilol powder. As a result, different solubility-increasing mechanisms provided differences in performance. For carvedilol, the formation of a nano-emulsion in solidified SNEDDS resulted in an efficient supersaturated state, leading to improved solubility (~6.1 fold), dissolution (~1.8 fold), and oral bioavailability (~1.4 fold) that was superior to the hydrophilic microenvironment in surface-modified microspheres.
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Affiliation(s)
- Ji Eun Choi
- Department of Pharmaceutical Engineering, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan 31116, South Korea
| | - Jung Suk Kim
- College of Pharmacy & Institute of Pharmaceutical Science and Technology, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan 15588, South Korea
| | - Min-Jong Choi
- Department of Pharmaceutical Engineering, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan 31116, South Korea
| | - Kyungho Baek
- Department of Pharmaceutical Engineering, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan 31116, South Korea
| | - Mi Ran Woo
- College of Pharmacy & Institute of Pharmaceutical Science and Technology, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan 15588, South Korea
| | - Jong Oh Kim
- College of Pharmacy, Yeungnam University, 214-1 Dae-Dong, Gyongsan 38541, South Korea
| | - Han-Gon Choi
- College of Pharmacy & Institute of Pharmaceutical Science and Technology, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan 15588, South Korea.
| | - Sung Giu Jin
- Department of Pharmaceutical Engineering, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan 31116, South Korea.
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Yang B, Wei C, Qian F, Li S. Surface Wettability Modulated by Surfactant and Its Effects on the Drug Release and Absorption of Fenofibrate Solid Dispersions. AAPS PharmSciTech 2019; 20:234. [PMID: 31236817 DOI: 10.1208/s12249-019-1446-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 06/01/2019] [Indexed: 12/29/2022] Open
Abstract
The objective of this study is to explore the surface wettability modulated by a surfactant and its effects on the drug release and absorption of fenofibrate solid dispersions (FF SDs). Both the polyvinylpyrrolidone/sodium lauryl sulfate (PVP/SLS) coprecipitate and FF SDs were prepared by solvent evaporation method. The contact angle of PVP/SLS coprecipitate with various PVP/SLS weight ratios was determined to screen out the suitable content of SLS incorporated in FF SDs. Scanning electron microscopy-energy dispersive spectroscopy (SEM-EDS) was used to analyze the surface composition of the PVP/SLS coprecipitate, suggesting that SLS molecules were prone to concentrate on the carrier surface. The physicochemical characteristics of FF, PVP, SLS, FF SDs, and FF physical mixtures (PMs) were evaluated by thermal analysis, XRD, FTIR, and SEM, which revealed that FF was molecularly dispersed in SDs. The interaction between SLS and PVP or FF confirmed by FTIR would affect the surface morphology of SDs. Finally, the contact angle of FF SDs was measured to explore the effects of surface wettability on the dissolution behavior and drug absorption of FF SDs. The interesting thing is that the wettability of the PVP/SLS coprecipitate was positively related to that of FF SDs. The improved wettability of FF SDs or the PVP/SLS coprecipitate by adding SLS contributed to the slight enhancement of initial drug release and absorption, which implied that wettability would be a promising tool in the formulation studies.
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Mustapha O, Kim KS, Shafique S, Kim DS, Jin SG, Seo YG, Youn YS, Oh KT, Lee BJ, Park YJ, Yong CS, Kim JO, Choi HG. Development of novel cilostazol–loaded solid SNEDDS using a SPG membrane emulsification technique: Physicochemical characterization and in vivo evaluation. Colloids Surf B Biointerfaces 2017; 150:216-222. [DOI: 10.1016/j.colsurfb.2016.11.039] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 11/25/2016] [Accepted: 11/28/2016] [Indexed: 10/20/2022]
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Analysis and optimization of drug solubility to improve pharmacokinetics. JOURNAL OF PHARMACEUTICAL INVESTIGATION 2017. [DOI: 10.1007/s40005-016-0299-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kim DS, Choi JS, Kim DW, Kim KS, Seo YG, Cho KH, Kim JO, Yong CS, Youn YS, Lim SJ, Jin SG, Choi HG. Comparison of solvent-wetted and kneaded l-sulpiride-loaded solid dispersions: Powder characterization and in vivo evaluation. Int J Pharm 2016; 511:351-358. [PMID: 27397868 DOI: 10.1016/j.ijpharm.2016.07.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 06/20/2016] [Accepted: 07/06/2016] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to compare the powder properties, solubility, dissolution and oral absorption of solvent-wetted (SWSD) and kneaded (KNSD) l-sulpiride-loaded solid dispersions. The SWSD and KNSD were prepared with silicon dioxide, sodium laurylsulfate and D-α-tocopheryl polyethylene glycol 1000 succinate (TPGS) using a spray dryer and high shear mixer, respectively. Their powder properties, solubility, dissolution and oral absorption were assessed compared to l-sulpiride powder. The drug in SWSD was in the amorphous state; however, in KNSD, it existed in the crystalline state. The SWSD with a drug/sodium laurylsulphate/TPGS/silicon dioxide ratio of 5/1/2/12 gave the higher drug solubility and dissolution compared to the KNSD with the same composition. The oral absorption of drug in the SWSD was 1.4 fold higher than the KNSD and 3.0 fold higher than the l-sulpiride powder (p<0.05) owing to better solubility and reduced crystallinity. Furthermore, the SWSD at the half dose was bioequivalent of commercial l-sulpiride-loaded product in rats. Thus, the SWSD with more improved oral absorption would be recommended as an alternative for the l-sulpiride-loaded oral administration.
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Affiliation(s)
- Dong Shik Kim
- College of Pharmacy & Institute of Pharmaceutical Science and Technology, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan 426-791, South Korea
| | - Jong Seo Choi
- College of Pharmacy & Institute of Pharmaceutical Science and Technology, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan 426-791, South Korea
| | - Dong Wuk Kim
- College of Pharmacy & Institute of Pharmaceutical Science and Technology, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan 426-791, South Korea
| | - Kyeong Soo Kim
- College of Pharmacy & Institute of Pharmaceutical Science and Technology, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan 426-791, South Korea
| | - Youn Gee Seo
- College of Pharmacy, Yeungnam University, 214-1, Dae-Dong, Gyongsan 712-749, South Korea
| | - Kwan Hyung Cho
- College of Pharmacy, Inje University, Inje-ro 197, Gimhae 621-749, South Korea
| | - Jong Oh Kim
- College of Pharmacy, Yeungnam University, 214-1, Dae-Dong, Gyongsan 712-749, South Korea
| | - Chul Soon Yong
- College of Pharmacy, Yeungnam University, 214-1, Dae-Dong, Gyongsan 712-749, South Korea
| | - Yu Seok Youn
- School of Pharmacy, Sungkyunkwan University, 300 Cheoncheon-dong, Jangan-gu, Suwon 440-746, South Korea
| | - Soo-Jeong Lim
- Department of Bioscience and Biotechnology, Sejong University, Gunja-Dong, Seoul 143-747, South Korea
| | - Sung Giu Jin
- College of Pharmacy & Institute of Pharmaceutical Science and Technology, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan 426-791, South Korea.
| | - Han-Gon Choi
- College of Pharmacy & Institute of Pharmaceutical Science and Technology, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan 426-791, South Korea.
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Mustapha O, Din FU, Kim DW, Park JH, Woo KB, Lim SJ, Youn YS, Cho KH, Rashid R, Yousaf AM, Kim JO, Yong CS, Choi HG. Novel piroxicam-loaded nanospheres generated by the electrospraying technique: physicochemical characterisation and oral bioavailability evaluation. J Microencapsul 2016; 33:323-30. [PMID: 27188242 DOI: 10.1080/02652048.2016.1185475] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
To determine if a novel electrospraying technique could be applied to an oral drug delivery system for improving the solubility and oral bioavailability of poorly water-soluble piroxicam; the nanospheres were generated with drug and polyvinylpyrrolidone (PVP) using electrospraying technique; and their physicochemical properties, solubility, release and pharmacokinetics were evaluated in comparison with piroxicam powder. All nanospheres had significantly increased drug solubility and dissolution rates in comparison with the drug powder. In particular, the nanosphere composed of piroxicam and PVP at a weight ratio of 2:8 gave about 600-fold higher solubility, 15-fold higher release rate and 3-fold higher AUC in comparison to piroxicam powder, leading to significantly enhanced oral bioavailability in rats, due to the mingled effect of nanonisation along with transformation to the amorphous state. Thus, this electrospraying technique can be utilised to produce a novel oral nanosphere delivery system with enhanced solubility and oral bioavailability for poorly water-soluble piroxicam.
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Affiliation(s)
- Omer Mustapha
- a College of Pharmacy & Institute of Pharmaceutical Science and Technology , Hanyang University , Ansan , South Korea
| | - Fakhar Ud Din
- a College of Pharmacy & Institute of Pharmaceutical Science and Technology , Hanyang University , Ansan , South Korea ;,b Department of Pharmacy , Quaid-I-Azam University , Islamabad , Pakistan
| | - Dong Wuk Kim
- a College of Pharmacy & Institute of Pharmaceutical Science and Technology , Hanyang University , Ansan , South Korea
| | - Jong Hyuck Park
- a College of Pharmacy & Institute of Pharmaceutical Science and Technology , Hanyang University , Ansan , South Korea
| | - Kyu Bong Woo
- c College of Pharmacy , Yeungnam University , Gyongsan , South Korea
| | - Soo-Jeong Lim
- d Department of Bioscience and Biotechnology , Sejong University , Seoul , South Korea
| | - Yu Seok Youn
- e School of Pharmacy , Sungkyunkwan University , Suwon , South Korea
| | - Kwan Hyung Cho
- f College of Pharmacy , Inje University , Gimhae , South Korea
| | - Rehmana Rashid
- a College of Pharmacy & Institute of Pharmaceutical Science and Technology , Hanyang University , Ansan , South Korea ;,g Faculty of Pharmacy and Alternative Medicine , The Islamia University of Bahawalpur-Railway Road , Bahawalpur , Pakistan
| | - Abid Mehmood Yousaf
- a College of Pharmacy & Institute of Pharmaceutical Science and Technology , Hanyang University , Ansan , South Korea ;,h Faculty of Pharmacy , University of Central Punjab , Lahore , Pakistan
| | - Jong Oh Kim
- b Department of Pharmacy , Quaid-I-Azam University , Islamabad , Pakistan
| | - Chul Soon Yong
- b Department of Pharmacy , Quaid-I-Azam University , Islamabad , Pakistan
| | - Han-Gon Choi
- a College of Pharmacy & Institute of Pharmaceutical Science and Technology , Hanyang University , Ansan , South Korea
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Vasconcelos T, Marques S, das Neves J, Sarmento B. Amorphous solid dispersions: Rational selection of a manufacturing process. Adv Drug Deliv Rev 2016; 100:85-101. [PMID: 26826438 DOI: 10.1016/j.addr.2016.01.012] [Citation(s) in RCA: 236] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 12/21/2015] [Accepted: 01/19/2016] [Indexed: 11/19/2022]
Abstract
Amorphous products and particularly amorphous solid dispersions are currently one of the most exciting areas in the pharmaceutical field. This approach presents huge potential and advantageous features concerning the overall improvement of drug bioavailability. Currently, different manufacturing processes are being developed to produce amorphous solid dispersions with suitable robustness and reproducibility, ranging from solvent evaporation to melting processes. In the present paper, laboratorial and industrial scale processes were reviewed, and guidelines for a rationale selection of manufacturing processes were proposed. This would ensure an adequate development (laboratorial scale) and production according to the good manufacturing practices (GMP) (industrial scale) of amorphous solid dispersions, with further implications on the process validations and drug development pipeline.
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Affiliation(s)
- Teófilo Vasconcelos
- BIAL-Portela & Cª, S.A., Avenida da Siderugia Nacional, 4745-457 Trofa, Portugal; Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Rua de Jorge Viterbo Ferreira, n° 228, 4050-313 Porto, Portugal; I3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua do Campo Alegre, 823, 4150-180 Porto, Portugal; INEB-Instituto de Engenharia Biomédica, Universidade do Porto, Rua do Campo Alegre, 823, 4150-180 Porto, Portugal
| | - Sara Marques
- CIBIO/InBIO-UP-Research Centre in Biodiversity and Genetic Resources, University of Porto, Rua Padre Armando Quintas, n° 7, 4485-661 Vairão, Portugal
| | - José das Neves
- I3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua do Campo Alegre, 823, 4150-180 Porto, Portugal; INEB-Instituto de Engenharia Biomédica, Universidade do Porto, Rua do Campo Alegre, 823, 4150-180 Porto, Portugal
| | - Bruno Sarmento
- I3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua do Campo Alegre, 823, 4150-180 Porto, Portugal; INEB-Instituto de Engenharia Biomédica, Universidade do Porto, Rua do Campo Alegre, 823, 4150-180 Porto, Portugal; Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde and Instituto Universitário de Ciências da Saúde, CESPU, Rua Central de Gandra 1317, 4585-116 Gandra, Portugal.
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