Search Results (476)

The effectiveness of upper extremity rehabilitation in post-stroke patients significantly depends on patient motivation and adherence to therapeutic regimens. Rehabilitation-assistive technologies, including wearable sensors, have been adopted to facilitate intensive and repetitive exercises aimed at reducing hand dysfunction and enhancing quality of life. Building upon the previously introduced Przypominajka (reminder) system reported in this journal—a wearable sensory glove coupled with a mobile application providing exercise guidance and monitoring—we conducted a feasibility study to evaluate its effectiveness in supporting upper limb rehabilitation. Sixteen post-stroke patients with hemiparesis were equally randomized into experimental and control groups. Both groups performed upper limb exercises for 45 min daily for over two weeks. The experimental group utilized the sensor-equipped glove and tablet-based exercises, whereas the control group followed printed exercise instructions. Clinical improvements were measured using the Fugl–Meyer Assessment–Upper Extremity (FMA-UE), Functional Independence Measure (FIM), and MORE scales. The experimental group demonstrated a minimal clinically important difference (MCID) on the FMA-UE and reported greater overall improvement than the control group. This study confirms the feasibility and potential clinical benefit of supplementing post-stroke rehabilitation with sensor-augmented exercises provided by the previously described Przypominajka device. Full article

This paper introduces a novel hybrid shifted Gegenbauer integral–pseudospectral (HSG-IPS) method to solve the time-fractional Benjamin–Bona–Mahony–Burgers (FBBMB) equation with high accuracy. The approach transforms the equation into a form with only a first-order derivative, which is approximated using a stable shifted Gegenbauer differentiation matrix (SGDM), while other terms are computed with precise quadrature rules. By integrating advanced techniques such as the shifted Gegenbauer pseudospectral method (SGPS), fractional derivative and integral approximations, and barycentric integration matrices, the HSG-IPS method achieves spectral accuracy. Numerical results show it reduces average absolute errors (AAEs) by up to 99.99% compared to methods like Crank–Nicolson linearized difference scheme (CNLDS) and finite integration method using Chebyshev polynomial (FIM-CBS), with computational times as low as 0.04–0.05 s. The method’s stability is improved by avoiding ill-conditioned high-order derivative approximations, and its efficiency is boosted by precomputed matrices and Kronecker product structures. Robust across various fractional orders, the HSG-IPS method offers a powerful tool for modeling wave propagation and nonlinear phenomena in fractional calculus applications. Full article

The global emergence of multidrug- and pandrug-resistant Klebsiella pneumoniae poses a critical threat to public health, particularly in hospital settings. This study describes a nosocomial outbreak caused by K. pneumoniae in a tertiary-care hospital in Mexico and provides a comprehensive genomic analysis of six clinical isolates. All isolates exhibited pandrug resistance, including carbapenems and colistin. Whole-genome sequencing identified 37 antimicrobial resistance genes, including blaNDM-1, blaOXA-1, blaCTX-M-15, and a pmrB R256G mutation associated with colistin resistance. Two conjugative plasmids (pAA046 and pAA276) carried multiple resistance genes and mobile genetic elements. Although all isolates harbored CRISPR-Cas type I-E systems, no spacers matched resistance plasmids, suggesting functional inactivity. Capsular typing identified the KL27 locus with the wzi187 allele. Phylogenetic and cgMLST analyses confirmed clonal dissemination and close genetic relatedness to strains from Europe and the USA. Despite the absence of classical hypervirulence markers, the presence of kfu, fimH, and mrkD genes indicates adaptation to the hospital environment. These findings confirm the clonal spread of pandrug-resistant K. pneumoniae ST392-KL27 in a Mexican hospital, underscoring the role of plasmid-mediated resistance and the potential for global dissemination. Full article

The main anthropogenic sources of air pollution in big cities are vehicular traffic and industrial activities. The emissions of primary pollutants are produced directly from the combustion of fossil fuels of vehicles and industry, whilst the secondary pollutants, such as tropospheric ozone ($O_3$), are produced from precursors like Carbon monoxide ($CO$), among others, and meteorological factors such as radiation. In this study, we analyze the time series of $\mathrm{CO}$ and ${\mathrm{O}}_3$ concentrations monitored by the RAMA program between 2019 and 2023 in the southwest of the Mexico City Metropolitan Area, encompassing the COVID-19 lockdown period declared from March to September–October 2020. After removing cyclic patterns and normalizing the data, we applied informational and topological methods to investigate variability changes in the concentration time series, particularly in response to the lockdown. Following the onset of lockdown measures in March 2020—which led to a significant reduction in industrial activity and vehicular traffic—the informational quantities $N_X$ and Fisher Information Measure (FIM) for $\mathrm{CO}$ revealed significant shifts during the lockdown, while these metrics remained stable for ${\mathrm{O}}_3$. Also, the coefficient of variation of the degree $C{V}_k$, which was defined for the network constructed for each series by the Visibility Graph, showed marked changes for $\mathrm{CO}$ but not for ${\mathrm{O}}_3$. The combined informational and topological analysis highlighted distinct underlying structures: $\mathrm{CO}$ exhibited localized, intermittent emission patterns leading to greater structural complexity, while ${\mathrm{O}}_3$ displayed smoother, less organized variability. Also, the temporal variation of the FIM and $N_X$ provides a means to monitor the evolving statistical behavior of the $CO$ and $O_3$ time series over time. Finally, the Visibility Graph (VG) method shows a behavioral trend similar to that shown by the informational quantifiers, revealing a significant change during the lockdown for $CO$, although remaining almost stable for $O_3$. Full article

Background/Objectives: Predicting comprehensive patient characteristics is essential for optimal individualized rehabilitation plans for acute stroke patients. However, current models primarily predict single outcomes. This study aimed to assess the applicability of latent class analysis (LCA) in rehabilitation practice by identifying comprehensive characteristics and associated predictors in acute stroke patients. Methods: We conducted a retrospective observational study using the Japan Association of Rehabilitation Database, including 10,270 stroke patients admitted to 37 acute-care hospitals between January 2005 and March 2016. Patients were classified using LCA based on outcomes at discharge, including Functional Independence Measure (FIM), National Institutes of Health Stroke Scale (NIHSS) subscales for upper-extremity function, length of hospitalization, and discharge destination. Predictor variables at admission included age, FIM scores, NIHSS subscales for upper-extremity function, stroke type, and daily rehabilitation volume. Results: 6881 patients were classified into nine distinct classes (class size: 4–29%). Class 1, representing the mildest cases, was noted for independent ambulation and good upper limb function. Class 2 comprised those with the most severe clinical outcome. Other classes exhibited a gradient of severity, commonly encountered in clinical practice. For instance, Class 7 included right-sided paralysis with preserved motor activities of daily living (ADLs) and modified dependence in cognitive functions, such as communication. All predictors at admission were significantly associated with class membership at discharge (p < 0.001). Conclusions: LCA effectively identified unique clinical subgroups among acute stroke patients and demonstrated that key admission variables could predict class membership. This approach offers a promising insight into targeted, personalized rehabilitation practice for acute stroke patients. Full article

The shallow water equations (SWEs) model fluid flow in rivers, coasts, and tsunamis. Their nonlinearity challenges analytical solutions. We present a numerical algorithm combining the finite integration method with Chebyshev polynomial expansion (FIM-CPE) to solve one- and two-dimensional SWEs. The method transforms partial differential equations into integral equations, approximates spatial terms via Chebyshev polynomials, and uses forward differences for time discretization. Validated on stationary lakes, dam breaks, and Gaussian pulses, the scheme achieved errors below ${10}^{-12}$ for water height and velocity, while conserving mass with volume deviations under ${10}^{-5}$. Comparisons showed superior shock-capturing versus finite difference methods. For two-dimensional cases, it accurately resolved wave interactions over complex topographies. Though limited to wet beds and small-scale two-dimensional problems, the method provides a robust simulation tool. Full article

Background: Dystonic cerebral palsy (DCP) is a complex, disabling manifestation of secondary dystonia, which significantly impacts motor function, quality of life, and well-being. Conventional pharmacologic therapies frequently do not relieve symptoms sufficiently. Deep brain stimulation (DBS) of the globus pallidus internal segment (GPi) has gained increasing attention as a neuromodulatory therapy for refractory dystonia. Still, the experience of the effect of GPi DBS treatment in adults with DCP has, until recently, been limited. Methods: We performed a retrospective, two-center case series of 11 adult patients with medically refractory DCP who underwent bilateral GPi-DBS. The clinical outcomes were evaluated based on the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS), the Functional Independence Measure (FIM), the Gross Motor Function Classification System (GMFCS), and the Caregiver Burden Scale (CBS). The assessments were done preoperatively and at 1-year follow-up. Changes in continuous variables were analyzed using paired t-tests. Results: At the 1-year follow-up, the mean BFMDRS score improved from 69.6 ± 27.6 to 54.3 ± 36.5 (p = 0.001), indicating a significant reduction in overall dystonia severity. Functional independence also improved, demonstrated by the rise in FIM scores from 65.3 ± 33.9 to 79.2 ± 43.4 (p = 0.006). Although GMFCS levels did not change in most patients (p = 0.125), the burden on caregivers decreased significantly, with CBS scores falling from 35.7 ± 18.8 to 32.0 ± 17.1 (p = 0.015). There were no surgical complications. Conclusions: In adults, bilateral GPi-DBS is a safe and effective intervention for DCP, improving motor control and increasing functional independence while decreasing caregiver burden. These findings lend support to its role in the multidisciplinary management of DCP. Full article

Functional glycomimetics is suited to study the parameters of carbohydrate recognition that forms the basis of glycobiology. It is particularly attractive when a glycoligand allows for the investigation of two different states, such as varying distance between multiple glycoligands. Here, a xylopyranoside was employed as a scaffold for the presentation of two mannoside units which are ligands of the bacterial lectin FimH. The chair conformation of the central xyloside can be switched between a ⁴C₁ and a ¹C₄ conformation whereby the two conjugated mannoside ligands are flipped from a di-equatorial into a di-axial position. Concomitantly, the distance between the two glycoligands changes and, as a consequence, so does the biological activity of the respective bivalent glycocluster, as shown in adhesion–inhibition assays with live bacteria. Molecular modeling was employed to correlate the inter-ligand distance with the structure of the formed glycocluster–FimH complex. Our study suggests that conformational switches can be employed and further advanced as smart molecular tools to study structural boundary conditions of carbohydrate recognition in a bottom-up approach. Full article

This paper presents a visual active SLAM method considering measurement and state uncertainty for space exploration in urban search and rescue environments. An uncertainty evaluation method based on the Fisher Information Matrix (FIM) is studied from the perspective of evaluating the localization uncertainty of SLAM systems. With the aid of the Fisher Information Matrix, the Cramér–Rao Lower Bound (CRLB) of the pose uncertainty in the stereo visual SLAM system is derived to describe the boundary of the pose uncertainty. Optimality criteria are introduced to quantitatively evaluate the localization uncertainty. The odometry information selection method and the local bundle adjustment information selection method based on Fisher Information are proposed to find out the measurements with low uncertainty for localization and mapping in the search and rescue process. By adopting the method above, the computing efficiency of the system is improved while the localization accuracy is equivalent to the classical ORB-SLAM2. Moreover, by the quantified uncertainty of local poses and map points, the generalized unary node and generalized unary edge are defined to improve the computational efficiency in computing local state uncertainty. In addition, an active loop closing planner considering local state uncertainty is proposed to make use of uncertainty in assisting the space exploration and decision-making of MAV, which is beneficial to the improvement of MAV localization performance in search and rescue environments. Simulations and field tests in different challenging scenarios are conducted to verify the effectiveness of the proposed method. Full article

Background: While Asia contributes 44.3% of traumatic brain injuries (TBI) worldwide, data regarding Asian TBI inpatient rehabilitation length of stay (RLOS) is scarce. A retrospective cohort study was conducted to determine correlates of inpatient RLOS (days) and prolonged RLOS >30 days (PRLOS > 30). (2) Methods: Data extraction of discharged inpatient records was performed from 2018 to 2024. Dependent variables included RLOS (days) and PRLOS > 30. Independent variables included demographic characteristics, TBI severity (emergency-room Glasgow Coma Scale-GCS), admission/discharge Functional Independence Measure (FIM), intra-rehabilitation complications, post-traumatic amnesia (PTA) duration, and discharge placement. (3) Results: Altogether, 289 data sets were analysed, median (IQR) age, 64 (28) years, 78.9% (228/289) males, and 79.6% (230/289) Chinese. Median (IQR) RLOS was 28 (21) days, with PRLOS >30 at 39.8% (115/289); RLOS of 44 (19.5) days. PRLOS > 30 was significantly associated with PTA duration >28 days (OR 4.01, 95% CI 1.90–8.45, p < 0.001), admission FIM ≤ 40/126 (OR 4.71, 95% CI 2.32–9.59, p < 0.001), delayed neurosurgical complications (OR 4.74, 95% CI 1.28–17.6, p = 0.02) and discharge to non-home destination (OR 2.75. 95% CI 1.12–6.76, p = 0.03). (4) Conclusion: PRLOS >30 was significantly associated with longer PTA > 4 weeks, lower admission FIM score, delayed neurosurgical complications, and discharge to a nursing home. Full article

Extended reality (XR)-based rehabilitation is an emerging therapeutic approach that combines real and virtual environments to enhance patient engagement and promote motor and cognitive recovery. Its clinical utility in children with cerebral palsy (CP), particularly regarding gross motor skills, balance, and psychosocial well-being, remains underexplored. This preliminary study aimed to evaluate the potential effects of XR-based rehabilitation on gross motor function, balance, parental stress, and quality of life in children with cerebral palsy. Thirty children with cerebral palsy were randomly assigned to an extended reality training group (XRT, n = 15) or a conventional physical therapy group (CPT, n = 15). Both groups received 30 min sessions, three times per week for 6 weeks. Outcome measures included the Gross Motor Function Measure-88 (GMFM-88), Pediatric Balance Scale (PBS), Functional Independence Measure (FIM), Parenting Stress Index (PSI), and Pediatric Quality of Life Inventory (PedsQL), assessed pre- and post-intervention. A 2 (group) × 2 (time) mixed ANOVA was conducted. The XR group demonstrated improvements in GMFM-88, PBS, and FIM scores, with decreased PSI and increased PedsQL scores. Although most interaction effects were not statistically significant (GMFM-88: η² = 0.035, p = 0.329; PBS: η² = 0.043, p = 0.274), a marginal interaction effect was observed for PSI (p = 0.065, η² = 0.059), suggesting a potential benefit of XR-based rehabilitation in reducing parental stress. This preliminary study indicates that XR-based rehabilitation may provide beneficial trends in motor function and psychosocial health in children with CP, particularly in reducing parental stress. Further studies with larger sample sizes are needed to confirm these findings. Full article

Sternal bursitis is an underexplored lesion in poultry, often overlooked in microbiological diagnostics. In this study, we characterized 36 Escherichia coli isolates recovered from sternal bursitis in broiler chickens, combining phenotypic antimicrobial susceptibility testing, PCR-based screening, and whole genome sequencing (WGS). The genetic analysis revealed a diverse population spanning 15 sequence types, including ST155, ST201, and ST58. Resistance to tetracycline and ciprofloxacin was common, and several isolates carried genes encoding β-lactamases, including blaTEM-1B. Chromosomal mutations associated with quinolone and fosfomycin resistance (e.g., gyrA p.S83L, glpT_E448K) were also identified. WGS revealed a high number of virulence-associated genes per isolate (58–96), notably those linked to adhesion (fim, ecp clusters), secretion systems (T6SS), and iron acquisition (ent, fep, fes), suggesting strong pathogenic potential. Many isolates harbored virulence markers typical of ExPEC/APEC, such as iss, ompT, and traT, even in the absence of multidrug resistance. Our findings suggest that E. coli from sternal bursitis may act as reservoirs of resistance and virulence traits relevant to animal and public health. This highlights the need for including such lesions in genomic surveillance programs and reinforces the importance of integrated One Health approaches. Full article

Background: Hypotension following epidural labor analgesia (ELA) is its most common complication, affecting approximately 20% of patients and posing risks to both maternal and fetal health. As digital tools and predictive analytics increasingly shape perioperative and obstetric anesthesia practices, real-world implementation data are needed to guide their integration into clinical care. Current monitoring practices rely on intermittent non-invasive blood pressure (NIBP) measurements, which may delay recognition and treatment of hypotension. The Hypotension Prediction Index (HPI) algorithm uses continuous arterial waveform monitoring to predict hypotension for potentially earlier intervention. This clinical trial evaluated the feasibility, acceptability, and efficacy of continuous HPI-guided treatment in reducing time-to-treatment for ELA-associated hypotension and improving maternal hemodynamics. Methods: This was a prospective randomized controlled trial design involving healthy pregnant individuals receiving ELA. Participants were randomized into two groups: Group CM (conventional monitoring with NIBP) and Group HPI (continuous noninvasive blood pressure monitoring). In Group HPI, hypotension treatment was guided by HPI output; in Group CM, treatment was based on NIBP readings. Feasibility, appropriateness, and acceptability outcomes were assessed among subjects and their bedside nurse using the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM) instruments. The primary efficacy outcome was time-to-treatment of hypotension, defined as the duration between onset of hypotension and administration of a vasopressor or fluid therapy. This outcome was chosen to evaluate the clinical responsiveness enabled by HPI monitoring. Hypotension is defined as a mean arterial pressure (MAP) < 65 mmHg for more than 1 min in Group CM and an HPI threshold < 75 for more than 1 min in Group HPI. Secondary outcomes included total time in hypotension, vasopressor doses, and hemodynamic parameters. Results: There were 30 patients (Group HPI, n = 16; Group CM, n = 14) included in the final analysis. Subjects and clinicians alike rated the acceptability, appropriateness, and feasibility of the continuous monitoring device highly, with median scores ≥ 4 across all domains, indicating favorable perceptions of the intervention. The cumulative probability of time-to-treatment of hypotension was lower by 75 min after ELA initiation in Group HPI (65%) than Group CM (71%), although this difference was not statistically significant (log-rank p = 0.66). Mixed models indicated trends that Group HPI had higher cardiac output (β = 0.58, 95% confidence interval −0.18 to 1.34, p = 0.13) and lower systemic vascular resistance (β = −97.22, 95% confidence interval −200.84 to 6.40, p = 0.07) throughout the monitoring period. No differences were found in total vasopressor use or intravenous fluid administration. Conclusions: Continuous monitoring and precision hypotension treatment is feasible, appropriate, and acceptable to both patients and clinicians in a labor and delivery setting. These hypothesis-generating results support that HPI-guided treatment may be associated with hemodynamic trends that warrant further investigation to determine definitive efficacy in labor analgesia contexts. Full article

Avian pathogenic Escherichia coli (APEC) is highly infective in poultry, causing significant economic losses to the poultry industry. As an extraintestinal pathogenic strain, adherence is a critical step in the infection. The functions of several adhesins, including type I, P, and Curli fimbriae, have been extensively studied. However, the roles of other adhesins, like Sfm, remain largely unexplored. Sfm is widely present in E. coli. Although the Sfm cluster is an ortholog of the fim gene cluster of Salmonella type I fimbriae, the biological function of Sfm in APEC has not yet been elucidated. To investigate whether Sfm in APEC CE129 plays a role in virulence, in this study, we constructed recombinant strains by expressing Sfm in the fimbriae-deficient strain SE5000. Additionally, a CE129 sfmA mutant strain was constructed. The resulting changes in adherence, biofilm formation, resistance to macrophage phagocytosis, and resistance to serum bactericidal ability were observed. The adherence ability of CE129ΔsfmA was reduced by 41%. HD-11 cells demonstrated a 30% increase in the phagocytosis of CE129ΔsfmA, and a 50% reduction in SE5000 (pBR322-sfm). The sfm deletion mutant showed a 23.9% reduction in the resistance to serum bactericidal ability, while SE5000 (pBR322-sfm) displayed a 32% increase. SE5000 (pBR322-sfm) exhibited a 34% increase in biofilm formation, and CE129ΔsfmA demonstrated a 21% decrease. Real-time PCR was employed to examine the impact of Sfm deletion on the transcription level of key virulence factors (fimA, fliC, papC, tsh, ompA, and iss). The results indicated that Sfm in CE129 is closely associated with bacterial adherence and survivability, contributing to biofilm formation and influencing the expression of key virulence factors. This study yields initial insight into the functional roles of Sfm in APEC and provides a foundation for the effective control of E. coli in the poultry industry. Full article

Pseudomonas aeruginosa biofilm formation is critical to antibiotic resistance and persistence. Targeting cyclic di-GMP (c-di-GMP) signaling, a master biofilm formation and virulence regulator, presents a promising strategy to combat resistant bacterial infections. Myricetin, a natural polyphenolic flavonoid with documented antimicrobial and anti-biofilm activities, may enhance antibiotic efficacy against Pseudomonas aeruginosa. This study evaluated the synergistic effects of myricetin combined with azithromycin, ciprofloxacin, or cefdinir against both standard and drug-resistant Pseudomonas aeruginosa strains. Antibacterial activity, biofilm disruption, and motility inhibition were experimentally assessed, while molecular dynamic (MD) simulations elucidated myricetin’s molecular mechanism of action. Our results suggested that myricetin synergistically potentiated all three antibiotics, reducing c-di-GMP synthesis by 28% (azithromycin), 57% (ciprofloxacin), and 30% (cefdinir). It enhanced bactericidal effects, suppressed biofilm formation, and impaired swimming, swarming, and twitching motility. Computational analyses revealed that myricetin binds allosterically to FimX very well, a key regulator in the c-di-GMP signaling pathway. Hence, myricetin may act as a c-di-GMP inhibitor, reversing biofilm-mediated resistance in Pseudomonas aeruginosa and augmenting antibiotic efficacy. This integrated experimental and computational approach provides a framework for developing anti-virulence and antibiotic combination therapies against recalcitrant Gram-negative pathogens. Full article