Search Results (778)

Differentiating genuine hemiplegic gait (HG) in stroke survivors from hemiplegic-like gait voluntarily imitated by healthy adults (MHG) is essential for reliable assessment and intervention planning. Treadmill-based gait data were obtained from 79 participants—39 stroke patients (HG) and 40 healthy adults—instructed to mimic HG (MHG). Forty-eight spatiotemporal and force-related variables were extracted. Random Forest, support vector machine (SVM), and logistic regression classifiers were trained with (i) the full feature set and (ii) the 10 most important features selected via Random Forest Gini importance. Performance was assessed with 5-fold stratified cross-validation and an 80/20 hold-out test, using accuracy, F1-score, and the area under the receiver operating characteristic curve (AUC). All models achieved high discrimination (AUC > 0.93). The SVM attained perfect discrimination (AUC = 1.000, test set) with the full feature set and maintained excellent accuracy (AUC = 0.983) with only the top 10 features. Temporal asymmetries, delayed vertical ground reaction force peaks, and mediolateral spatial instability ranked highest in importance. Reduced-feature models showed negligible performance loss, highlighting their parsimony and interpretability. Supervised machine learning algorithms can accurately distinguish true hemiplegic gait from mimicked patterns using a compact subset of gait features. The findings support data-driven, time-efficient gait assessments for clinical neurorehabilitation and for validating experimental protocols that rely on gait imitation. Full article

The Bilbao parish, located on the slopes of the Tungurahua volcano (Ecuador), was heavily impacted by ashfall during eruptions between 1999 and 2016. Volcanic ash may contain toxic metals such as Pb, Cd, Hg, As, and Se, which are linked to neurological, renal, skeletal, pulmonary, and dermatological disorders. This study evaluated metal concentrations in soil (40–50 cm depth, corresponding to the rooting zone of forage grasses), forage (English ryegrass and Kikuyu grass), and raw milk to assess potential risks to livestock and human health. Sixteen georeferenced sites were selected using a simple random probabilistic sampling method considering geological variability, vegetation cover, accessibility, and cattle presence. Samples were digested and analyzed with a SpectrAA 220 atomic absorption spectrophotometer (Varian Inc., Victoria, Australia). Soils (Andisols) contained Hg (1.82 mg/kg), Cd (0.36 mg/kg), As (1.36 mg/kg), Pb (1.62 mg/kg), and Se (1.39 mg/kg); all were below the Ecuadorian limits, except for Hg and Se. Forage exceeded FAO thresholds for Pb, Cd, As, Hg, and Se. Milk contained Pb, Cd, and Hg below detection limits, while Se averaged 0.047 mg/kg, exceeding water safety guidelines. Findings suggest soils act as sources with significant bioaccumulation in forage but limited transfer to milk. Although immediate consumer risk is low, forage contamination highlights long-term hazards, emphasizing the need for monitoring, soil management, and farmer guidance. Full article

Despite its many important health benefits, fish consumption is associated with a growing risk of toxicity due to increasing levels of environmental pollution. Therefore, this study compared the potential risks to human health associated with the consumption of imported fish and locally produced fish, which may be contaminated with toxic elements. A selection of the most commonly consumed fish in Poland, imported and domestic, was assayed for 11 trace elements in muscle tissue using ICP-AES, CV-AAS and GF-AAS. In general, the levels of toxic elements decreased according to the following sequence: As > Hg > Cd > Pb; however, the values of lead were slightly higher than those of cadmium in cod. All imported fish contained significantly more cadmium than the Polish species. Our assessment of EDI, THQ, TTHQ, TWI, PTMI and BMDL₀₁ indicates that typical levels of consumption of fish do not pose a risk based on the assumed intake. The highest TTHQ was observed in tilapia, but it did not exceed 0.169. This was well below the acceptable value. Hence, the consumption of these fish does not appear to entail any non-carcinogenic or carcinogenic health risks. In addition, the estimated consumer risk parameters indicate no risk to consumer health in the short term; however, the presence of these elements may present a long-term hazard due to the potential for bioaccumulation. Continuous monitoring of trace element concentrations, especially toxic ones, is recommended for the protection of communities in both local and global contexts. Our findings provide a clearer picture of the health risk associated with the consumption of fish in the Polish market. Full article

To establish a reliable thermoelectric module evaluation, a Standard Reference Thermoelectric Module (SRTEM) was developed based on stability. Open-circuit voltage (V_oc) was selected as the key calibration parameter due to its consistent response to temperature differences (ΔT). The SRTEM consists of eight p–n thermoelectric couples composed of metallic thermoelectric materials—Ni₉₀Cr₁₀ (chromel), Cu₅₅Ni₄₅ (constantan), Fe₆₄Ni₃₆ (invar), and pure Fe—selected based on their thermoelectric properties, structural compatibility, and contact resistance. Among the tested combinations, the chromel–constantan pair exhibited the highest V_oc of 55 mV at ΔT = 150 K. To increase V_oc and expand the usable calibration range, leg-shape modification and substrate replacement were investigated. Module simulation revealed that replacing the rectangular-leg geometry with a double-hourglass (2H/G) structure could increase V_oc by 20.2%. Furthermore, measurement of single-leg modules with substrates attached confirmed a 16.0% improvement in V_oc for the 2H/G shape over the rectangular shape, consistent with the predicted enhancement due to increased thermal resistance. In addition, replacing the alumina substrate with a higher thermal conductivity material, such as AlN, increased ΔT across the legs and yielded a further 9.1% improvement in V_oc. These results demonstrate the potential of the proposed SRTEM as a calibration standard for consistent thermoelectric module measurements. Full article

Background: Arm swing exercise (ASE) is a simple and accessible form of physical activity that has been reported to reduce disease risk and enhance overall health across various populations. In alignment with the World Health Organization’s recommendations for promoting physical activity, ASE requires no specialized equipment or professional supervision. However, systematic evidence on its health benefits remains limited. Objective: This systematic review and meta-analysis aimed to assess the effects of ASE on body composition, glycemic control, cardiovascular health, and musculoskeletal outcomes. Methods: A comprehensive systematic search was conducted in four major databases, including PubMed, Embase, Scopus, and the Thai-Journal Citation Index Center, covering studies published from inception to October 2024. Articles published in both English and Thai were included. Two independent reviewers screened and selected eligible randomized controlled trials and quasi-experimental studies. Methodological quality was assessed using the JBI critical appraisal tool, and meta-analyses were performed using Stata software (version 18), presenting mean differences (MD) with 95% confidence intervals (CI). Results: Thirteen studies were included, comprising eight randomized controlled trials and five quasi-experimental studies, with intervention durations ranging from 5 to 24 weeks. The ASE significantly reduced waist circumference (MD = −4.76; 95% CI: −8.36 to −1.17; and p < 0.05), hemoglobin A1C (MD= −0.80%; 95% CI: −1.19 to −0.40; and p < 0.001), fasting blood glucose (MD = −17.62 mg/dL; 95% CI: −25.93 to −9.32; and p < 0.05), and diastolic blood pressure (MD = −9.74 mmHg; 95% CI: −17.84 to −1.65; and p < 0.05). The ASE showed a non-significant reduction in systolic blood pressure (MD = −3.65 mmHg; 95% CI: −10.37 to 3.08; and p = 0.29). Additionally, the ASE significantly increased high-density lipoprotein cholesterol (HDL-C) levels (MD = 6.96 mg/dL; 95% CI: 2.20 to 11.71; and p < 0.05). Conclusions: This study, representing the first systematic review and meta-analysis focusing on ASE, demonstrates that ASE is an effective intervention for improving body composition, glycemic control, and cardiovascular health. Given its simplicity, low cost, and broad applicability, ASE could serve as a practical public health strategy to promote health and prevent chronic diseases across diverse populations. Full article

Ore mining and smelting are often related to environmental pollution. This study provides information about the geochemical features of Technosols at historical mining and metallurgical sites in the Tatra Mountains, southern Poland, evaluating the contents of potentially toxic trace elements (PTTE) and their behaviours in soils, as well as the influence of soil properties on PTTE mobility. Thirteen soil profiles were studied in eight abandoned mining and smelting sites. PTTE concentrations, including rare earth elements (REE), were measured using ICP-MS and ICP-OES. Selected elements (Cu, Zn, Pb, Cd, As, Sb, Ba, Sr, Co, Ni, Mn and Cr) were fractionated using the modified European Community Bureau of Reference (BCR) four-step sequential extraction. Contamination of soils with PTTE was compared against Polish regulatory limits, which were exceeded for Cu, Zn, Pb, Mo, Hg, As, Co, Ni and Ba, with concentrations exceeding limits by 16, 18, 34 and 160 times for Cu, Hg, As and Ba, respectively, in some profiles. Based on geochemical features depending on parent material properties, the soils examined were divided into three groups. Group I Technosols (near-neutral soils developed from Fe/Mn-ore and carbonate-bearing mining waste) were particularly enriched in Co, Ni, Mn and REE. Group II Technosols (acidic soils developed from polymetallic ore-bearing aluminosilicate mining waste) contained elevated concentrations of Cu, Zn, Hg, As, Sb, Bi, Co, Ag, Ba, Sr, U and Th; they contained lower contents of REE than Group I Technosols. Group III Technosols (soils developed in smelting-affected areas and containing metallurgical waste) were rich in Cu, As, Sb, Ba, Hg, Co and Ag and contained the lowest REE contents among the studied soils. Sequential BCR extraction revealed that PTTE mobility varied strongly according to soil group, with higher mobility of Mn, Cu and Zn in acidic polymetallic ore-derived soils (Group II), while carbonate-rich soils (Group I) showed mainly immobile forms. Metallurgical slag-derived soils (Group III) exhibited complex PTTE behaviour controlled by organic matter and Fe/Mn oxides. Soil properties (pH, carbonates and TOC) seem to control PTTE mobility. Full article

Introduction: Evidence on steroid treatment for established bronchopulmonary dysplasia (BPD) is sparse. To our knowledge, a systematic review has never been conducted on this topic. This meta-analysis aims to synthesize available evidence for the use of postnatal steroids to treat established BPD. Methods: MEDLINE, Embase, Cochrane databases, and gray literature sources were searched without time or language restrictions until October 2024. We included randomized and non-randomized trials (analyzed separately) that evaluated postnatal steroids started from 28 days of life in preterm infants diagnosed with BPD. Certainty of evidence was assessed using the GRADE approach. Results: The search retrieved 9113 records, and 20 studies were included. Meta-analysis of the RCTs demonstrated that steroids significantly reduced oxygen requirement (daily mean difference of 1.6%, 95% CI 0.25–2.95), but the analysis did not identify significant differences in total duration of supplemental oxygen, length of stay, or mortality (moderate quality). From a safety perspective, steroids resulted in a transient increase in systemic blood pressure (mean difference of 6.8 mmHg, 95% CI 4.6–8.9) (moderate quality). Weight gain during treatment was lower in the systemic steroid group (−9.2 g/day, 95% CI −11.7 to −6.8) (moderate quality), although overall growth was reported as equal (2.4 g/day, 95% CI −0.3 to 6.3) (moderate quality). One retrospective study reported the incidence of steroid treatment among infants with established BPD (any definition) to be as high as 36%. Two single-arm studies reported a prolonged high-dose systemic steroid regimen as the routine treatment strategy for severe established BPD. Conclusions: Moderate quality of evidence suggests that steroid treatment cannot be recommended as standard of care for established BPD. However, corticosteroids are often used to this end. Large-scale RCTs designed to treat BPD are urgently needed. Furthermore, careful consideration for patient selection and compliance with GRADE methodology is essential. Full article

Background: Physical frailty is a prevalent and clinically important manifestation of COPD. While the ERS/ATS recommends the Short Physical Performance Battery (SPPB), handgrip strength (HGS), 30 s sit-to-stand (30secSTS), and Timed-Up-and-Go (TUG) as frailty screening tools, their agreement and predictive performance remain unclear. Furthermore, the trajectory of frailty is poorly understood in patients who decline pulmonary rehabilitation (PR). Objective: To assess the prevalence of and change in physical frailty and its association with 12-month all-cause hospitalizations and mortality. Secondarily, to assess the agreement and predictive value (positive; PPV/negative; NPV) of recommended screening tests in COPD patients declining PR. Methods: In this prospective cohort study, 102 patients with COPD (61 females, mean ± SD age 70 ± 9 years, FEV₁ 34 ± 11%, SPPB 8.0 ± 3.2 points, CAT 19 ± 7) underwent repeated frailty assessments at baseline and after 12 months using the SPPB (reference), TUG, 30secSTS, and HGS. Results: At baseline, 39% were physically frail (SPPB ≤ 7). Frailty persisted in 86%, and 23% had died at 12 months. Baseline age-adjusted physical frailty was not statistically associated with 12-month all-cause hospitalization (OR 1.79 [0.61–5.24]) or mortality (OR 3.54 [0.95–13.16]). Agreement with SPPB was moderate for TUG (κ = 0.53) and fair for 30secSTS (κ = 0.38) and HGS (κ = 0.26), with similar findings at 12 months. TUG had the highest PPV/NPV (0.85/0.71). Conclusions: Physical frailty is prevalent and persistent in patients with severe COPD who decline PR. ERS/ATS-recommended tools showed fair to moderate agreement and predictive value. TUG was the most robust proxy, though tool selection should be guided by clinical context and purpose. Full article

Environmental contamination is a critical global concern, primarily due to detrimental greenhouse gas (GHG) emissions, especially carbon dioxide (CO₂), which significantly contribute to climate change. Moreover, the presence of harmful heavy metals like Ni, Cd, Cu, Hg, and Pb in soil and water ecosystems has led to poor water quality. Noble metal nanoparticles (MNPs), for instance, Pd, Ag, Pt, and Au, have emerged as promising solutions for addressing environmental pollution. However, the practical utilization of MNPs faces challenges as they tend to aggregate and lose stability. To overcome this issue, the reverse double-solvent method (RDSM) was utilized to synthesis melamine-based porous polyaminals (POPs) as a supportive material for the in situ growing of silver nanoparticles (Ag NPs). The porous structure of melamine-based porous polyaminals, featuring aminal-linked (-HN-C-NH-) and triazine groups, provides excellent binding sites for capturing Ag⁺ ions, thereby improving the dispersion and stability of the nanoparticles. The resulting material exhibited ultrafine particle sizes for Ag NPs, and the incorporation of Ag NPs within the porous polyaminals demonstrated a high surface area (~279 m²/g) and total pore volume (1.21 cm³/g), encompassing micropores and mesopores. Additionally, the Ag NPs@POPs showcased significant capacity for CO₂ capture (2.99 mmol/g at 273 K and 1 bar) and effectively removed Cu (II), with a remarkable removal efficiency of 99.04%. The nitrogen-rich porous polyaminals offer promising prospects for immobilizing and encapsulating Ag nanoparticles, making them outstanding adsorbents for selectively capturing carbon dioxide and removing metal ions. Pursuing this approach holds immense potential for various environmental applications. Full article

Objectives: To evaluate changes in intraocular pressure (IOP) before versus after a visual field test in glaucoma patients. Methods: A total of 132 patients with glaucoma and 103 control subjects who visited Konyang University Hospital between August 2024 and May 2025 were included in the study. the right eye of each patient was selected for analysis. Visual field tests were conducted using the Humphrey Visual Field (HVF) analyzer (Zeiss Humphrey, San Leandro, CA, USA) with the SITA standard program (Central 24-2). Intraocular pressure was measured by two ophthalmologists at five time points: before the test and immediately, 10 min, 30 min, and 60 min after the test. Results: The average intraocular pressure decreased from 15.09 mmHg before the test to 14.29 mmHg immediately afterward; it declined further to 13.59 mmHg at 10 min in glaucoma patients. It then gradually increased to 15.01 mmHg at 60 min, returning to pre-test levels. Participants were divided into three age groups (40s, 50s, and 60s) for analysis. Across all groups, the IOP followed a similar pattern: a significant decrease for up to 10 min, followed by recovery at 60 min. Although a reduction in IOP was also observed in the control group after visual field testing, the magnitude of the decrease was smaller compared to the glaucoma patients. Conclusions: IOP declined immediately after the visual field test and remained lower for up to 10 min. It subsequently returned to baseline by 60 min. Therefore, when measuring the IOP after a visual field test, there is no need to adjust for temporary fluctuations if the measurement is performed 60 min after the test. Full article

Background/Objectives: To evaluate the efficacy and safety of finerenone compared to placebo in improving renal outcomes in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D). Methods: A systematic review and meta-analysis were conducted, compiling RCTs evaluated the effect of finerenone compared to placebo in patients with CKD and T2D. Inclusion criteria included adults with CKD and T2D. Outcomes included kidney failure, end-stage renal disease (ESKD), and persistently decreased glomerular filtration rate (eGFR). Secondary outcomes included cardiovascular events, hospitalization due to hyperkalemia, and serious adverse events. Pooled relative risks (RRs) and mean differences (MDs) were calculated using a random-effects model. Results: Three RCTs with a total of 19,027 patients were included. Finerenone demonstrated a potential reduction in kidney failure risk (RR 0.86, 95% CI: 0.35–2.13) and ESKD (RR 0.82, 95% CI: 0.54–1.23); however, confidence intervals included the null effect. There were no statistically significant differences, as seen in the decrease in eGFR (RR 1.03; 95% CI: 0.27–3.85), but also in mortality due to renal causes (RR 0.62; 95% CI: 0.00–7168.81). Finerenone increased hyperkalemia-related hospitalizations (RR 4.57, 95% CI: 1.07–19.48) but had no significant effect on serious adverse events (RR 0.94, 95% CI: 0.92–0.97) or systolic BP (MD 0.08 mmHg, 95% CI: −0.36 to 0.52). Conclusions: Finerenone may provide renal protection in CKD and T2D, though benefits remain uncertain due to wide confidence intervals and study heterogeneity. The increased risk of hyperkalemia warrants careful patient selection and monitoring. Further research is needed to refine its clinical applicability. Review registration: PROSPERO CRD420250642593. Full article

Background and Objectives: Urinary tract infections (UTIs) are a major cause of emergency department (ED) visits and hospital admissions among older adults. Although most seniors present hemodynamically stable, a sizeable fraction deteriorate during hospitalization, and no ED-specific tool exists to identify those at greatest risk. We sought to determine risk factors for in-hospital mortality in this population and to develop a predictive model. Materials and Methods: We analyzed the MIMIC-IV-ED database (2011–2019) and enrolled culture-confirmed UTI patients aged ≥ 65 years who were hemodynamically stable—defined as a systolic blood pressure ≥ 100 mm Hg without vasopressor support. Demographics, comorbidities, triage vital signs, and initial laboratory tests were extracted. Least Absolute Shrinkage and Selection Operator (LASSO) regression with 10-fold cross-validation was performed for variable selection. Discrimination was quantified with the C-statistic, calibration with the Hosmer–Lemeshow test, and clinical utility with decision curve analysis. Internal validation was assessed via 1000-sample bootstrap resampling. Results: Among 1571 eligible encounters (median age 79 years, 33% male), in-hospital mortality was 4.5%. LASSO selected eight variables; six remained significant in multivariable analysis: age, systolic blood pressure, oxygen saturation, white blood cell count, red cell distribution width, and blood urea nitrogen. The predictive nomogram demonstrated a C-statistic of 0.73 (95% CI 0.66–0.79) and outperformed traditional early warning scores. Conclusions: A six-variable nomogram may stratify mortality risk in hemodynamically stable older adults with UTI. Because the model was developed in a single U.S. tertiary-care ED, it remains hypothesis-generating until validated in external, multicenter cohorts to confirm generalizability. Full article

Introduction: Myotonic dystrophies (DM) are progressive genetic disorders with multisystemic involvement, particularly affecting the muscular, respiratory, and neuropsychological systems. Myotonic dystrophy type 1 (DM1), or Steinert’s disease, may lead to severe respiratory complications, including sleep-disordered breathing and hypercapnia, often requiring noninvasive ventilation to manage respiratory failure. However, adherence to NIV remains a major challenge, often influenced by cognitive and psychological factors such as apathy and depression. This study aims to investigate the presence of depression and SDB in patients with DM1 initiating NIV, and to evaluate factors influencing adherence to ventilatory support. Materials and Methods: We selected 13 adult patients (≥18 years) with diagnosis of Steinert’s disease with respiratory impairment who needed to start respiratory support. Dysphagia was assessed in all patients at baseline by a videofluoroscopic swallow study. Beck’s Depression Inventory II was administered for measuring the severity of depression. The Montreal Cognitive Assessment was used as a screening tool to detect signs of neurocognitive disorders. We evaluated adherence to NIV. Results: The study population presented with sleep-disordered breathing, as indicated by a median apnea–hypopnea index (AHI) of 24 events per hour (IQR: 14.2–34.5) and an oxygen desaturation index (ODI) of 25 events per hour (IQR: 18–33). Adherence to NIV was obtained in seven patients. No difference in baseline lung function was observed. Adherent subjects had moderate hypercapnia at baseline; pCO2 was 52 vs. 49 mmHg. Non-adherent patients showed a higher prevalence of depression with a median BDI-II score of 18 vs. 6 in adherent patients. The findings highlight that psychological factors, especially depression, play a crucial role in adherence to NIV. Interestingly, depression was not linked to initial respiratory measurements but showed a significant association with nocturnal oxygen desaturation. This suggests that relying solely on clinical and respiratory assessments may not be adequate to predict or improve treatment adherence. Conclusions: Incorporating psychological evaluations and addressing mental health issues, such as depression, are essential steps to enhance NIV compliance and overall DM1 patient outcomes. A multidisciplinary approach combining respiratory and psycho-emotional interventions is crucial for effective disease management. Full article

Background/Objectives: This study examined the relationship between nutritional status and muscle strength in the upper and lower large muscles, with a specific focus on shoulder, hip, and knee muscle strength in community-dwelling older adults. It also investigated the relationship between nutritional status and functional performance as measured by the Timed Up and Go (TUG) test. Methods: A secondary analysis of a cross-sectional study involving 2045 older adults (aged 60 years or older) from 15 randomly selected primary health care centers in Riyadh was conducted between January 2015 and April 2017. After excluding participants with specific medical conditions, 1741 individuals were included in the analysis. Nutritional status was assessed using the Arabic version of the Mini-Nutritional Assessment (MNA). Handgrip strength (HGS) and large muscle strength (shoulder, hip, knee) were measured using a hydraulic hand dynamometer and the Nicholas Manual Muscle Tester, respectively. The TUG test was also assessed to evaluate physical performance. Results: The study revealed that well-nourished older adults had significantly greater upper and lower muscle strength than those who were malnourished or at risk (p ≤ 0.001), with males generally exhibiting stronger muscle strength than females. Furthermore, in both genders, older adults showed significant positive correlations between MNA scores and upper and lower muscle strength. Additionally, longer times on the TUG test indicated a higher risk of malnutrition (OR: 1.135, CI: 1.087–1.186; p ≤ 0.001). Conclusions: this study breaks new ground by being the first to explore the relationship between nutritional status and the muscular strength in the shoulder and hip regions. Findings indicate that muscle strength and physical performance were associated with malnutrition. Full article

Background: Trace elements and heavy metals can provide valuable forensic information for individual identification, lifestyle reconstruction, and association with the scene or time of death and may also assist in linking objects to criminal activities. However, the lack of standardized guidelines and post-mortem reference values represents a significant limitation in forensic investigations. Methods: This review was conducted in accordance with the PRISMA statement. We performed a comprehensive literature study over the last ten years focusing on the analysis of trace elements and heavy metals in post-mortem tissues. Results: The search results from the databases yielded 247 records. The screening, according to PRISMA criteria, allowed us to select and include 19 articles. The results showed the need for standardized guidelines and reference values. Although post-mortem trace element analysis shows high potential for forensic applications, substantial methodological heterogeneity persists. Some studies have proposed preliminary reference values for cadmium (Cd) in kidneys and mercury (Hg) in hair but validated post-mortem reference ranges remain largely unavailable. Conclusions: The current literature demonstrates the forensic potential of trace element and heavy metals analysis including Cd, Hg, lead (Pb), Manganese (Mn), Aluminum (Al), Copper (Cu), Zinc (Zn), Iron (Fe), Thallium (Tl), Polonium (²¹⁰Po) but also underlines the urgent need for standardized protocols and validated post-mortem reference values to improve interpretability and reliability in forensic contexts. Full article