Search Results (349)

Nephrogenic diabetes insipidus (NDI) is a rare hereditary disorder characterized by renal resistance to arginine vasopressin (AVP), resulting in the kidneys’ inability to concentrate urine. Approximately 90% of NDI cases follow an X-linked inheritance pattern and are associated with pathogenic variants in the AVPR2 gene, which encodes the vasopressin receptor type 2. The remaining 10% are attributed to mutations in the AQP2 gene, which encodes aquaporin-2, and may follow either autosomal dominant or recessive inheritance patterns. We present the case of a male infant, younger than nine months of age, who was clinically diagnosed with NDI at six months. The patient presented recurrent episodes of polydipsia, polyuria, dehydration, hypernatremia, and persistently low urine osmolality. Despite adjustments in pharmacologic treatment and strict monitoring of urinary output, the clinical response remained suboptimal. Given the lack of improvement and the radiological finding of an absent posterior pituitary (neurohypophysis), the possibility of coexistent central diabetes insipidus (CDI) was raised, prompting a therapeutic trial with desmopressin. Nevertheless, in the absence of clinical improvement, desmopressin was discontinued. The patient’s management was continued with hydrochlorothiazide, ibuprofen, and a high-calorie diet restricted in sodium and protein, resulting in progressive clinical stabilization. Whole-exome sequencing identified a novel homozygous missense variant in the AQP2 gene (c.398T > A; p.Val133Glu), classified as likely pathogenic according to the American College of Medical Genetics and Genomics (ACMG) criteria: PM2 (absent from population databases), PP2 (missense variant in a gene with a low rate of benign missense variation), and PP3 (multiple lines of computational evidence supporting a deleterious effect)]. NDI is typically diagnosed during early infancy due to the early onset of symptoms and the potential for severe complications if left untreated. In this case, although initial clinical suspicion included concomitant CDI, the timely initiation of supportive management and the subsequent incorporation of molecular diagnostics facilitated a definitive diagnosis. The identification of a previously unreported homozygous variant in AQP2 contributed to diagnostic confirmation and therapeutic decision-making. The diagnosis and comprehensive management of NDI within the context of polyuria-polydipsia syndrome necessitates a multidisciplinary approach, integrating clinical evaluation with advanced molecular diagnostics. The novel AQP2 c.398T > A (p.Val133Glu) variant described herein was associated with early and severe clinical manifestations, underscoring the importance of genetic testing in atypical or treatment-refractory presentations of diabetes insipidus. Full article

Background/Objectives: Neck pain caused by myofascial pain syndrome (MPS) is a highly prevalent musculoskeletal condition. Repetitive peripheral magnetic stimulation (rPMS) is a promising treatment option; however, its therapeutic effect and optimal treatment frequency remain unclear. This study aimed to investigate the therapeutic effect and duration of effect of rPMS in patients with MPS of the neck. Methods: In this randomized, sham-controlled, crossover trial, 27 patients with neck MPS and baseline visual analog scale (VAS) scores ≥ 40 were enrolled. The mean age was 43.8 ± 9.1 years, and 63% were female. Participants were randomly assigned to receive either an initial rPMS treatment (a 10 min session delivering 3900 pulses at 5–10 Hz) or sham stimulation. After 7 days, groups crossed over. Pain intensity (VAS), disability (Neck Disability Index; NDI), and analgesic use were recorded daily for seven consecutive days. A linear mixed-effects model was used for analysis. Results: At baseline, the VAS and NDI scores were 61.8 ± 10.5 and 26.0 ± 6.3, respectively. rPMS produced a significantly greater reduction in both VAS and NDI scores, with the greatest differences observed on Day 4: the differences were −24.1 points in VAS and −8.5 points in NDI compared to the sham group. There was no significant difference in analgesic use between the two groups. Conclusions: A single rPMS session provides short-term improvement in pain and disability in neck MPS. Based on the observed therapeutic window, more frequent sessions (e.g., twice weekly) may provide sustained benefit and should be explored in future studies. Full article

Globally, diverse regions are experiencing significant salinization, yet research leveraging two-dimensional spectral indices derived from fractional-order differentiated hyperspectral data remains relatively scarce. Given that the Yellow River Delta exemplifies a severely salinized area, this study employs it as a case study to advance salinization monitoring by integrating fractional-order differentiation with two-dimensional spectral indices. Compared to fractional-order differentiation (FOD) and deep learning models, integer-order differentiation and traditional detection models suffer from lower accuracy. Therefore, a two-dimensional spectral index was constructed to identify sensitive parameters. Modeling methods such as Convolutional Neural Networks (CNNs), Partial Least Squares Regression (PLSR), and Random Forest (RF) were employed to predict soil salinity. The results show that FOD effectively emphasizes gradual changes in spectral curve transformations, significantly improving the correlation between spectral indices and soil salinity. The 1.6-order NDI spectral index (1244 nm, 2081 nm) showed the highest correlation with soil salinity, with a coefficient of 0.9, followed by the 1.6-order RI spectral index (2242 nm, 1208 nm), with a correlation coefficient of 0.882. The CNN model yielded the highest inversion accuracy. Compared to the PLSR and RF models, the CNN model increased the RPD of the prediction set by 0.710 and 1.721 and improved the R² by 0.057 and 0.272, while reducing the RMSE by 0.145 g/kg and 1.470 g/kg. This study provides support for monitoring salinization in the Yellow River Delta. Full article

This study examines the decision-making processes that were used in the development of the National Disability Insurance Scheme (NDIS). It draws on research that highlights that decision-making can be improved if organisations follow specific decision-making processes. This study sought to examine whether formal decision-making rules and processes were used in the development of the NDIS. Semi-structured interviews were conducted with 58 senior public servants between 2016 and 2021 in the Commonwealth government departments that had policy oversight and responsibility for both the design and implementation of the NDIS. The data showed that there were examples of data-driven decisions and risk analysis used, but also considerable gaps in decision-making processes. These gaps potentially resulted in poorer decision-making quality, which may have negatively impacted the design of the NDIS and could potentially explain some of the current problems with the scheme. The paper concludes with recommendations for future research to improve decision-making processes within public administration. Full article

Retrospective Cohort Study. Objectives: The objectives of this study are to (1) compare post-operative patient-reported outcome measures (PROMs) between non-diabetic (non-DM) and diabetic (DM) patients undergoing Anterior Cervical Discectomy and Fusion (ADCF), (2) characterize the clinical trajectory, and (3) compare the rate of post-operative complications. Methods: A total of 261 non-DM and 52 DM patients were included. Patient demographics, Neck Disability Index (NDI) and Patient-Recorded Outcomes Measurement Information System (PROMIS) scores were collected up to one year after operation. Maximum medical improvement (MMI) was defined as the timepoint where more than 90% of the cohort achieved a minimal clinically important difference (MCID) in survey scores. Post-operative complications were collected. Descriptive and inferential statistics were performed. Results: Non-DM patients achieve MMI significantly more quickly than DM patients (non-DM: 6 months; DM: 1 year, p < 0.010). No difference in ∆NDI (non-DM: 24.9; DM: 23.0; p = 0.824) or ∆PROMIS-Physical Function (non-DM: 7.1; DM: 9.1; p = 0.373) was found between the two cohorts. In diabetic patients undergoing single-level fusion ACDF, a pre-operative HbA1c of ≥7.3% demonstrates 100% sensitivity and 25% specificity in detecting failure to achieve 1-year PROMIS MCID (AUC = 0.833, p = 0.009). There was no association between diabetic status and post-operative complication rate. Conclusions: Diabetic patients may demonstrate a slower rate of achieving maximum medical improvement despite equal subjective and clinical outcomes. Pre-operative HbA1c ≥ 7.3% demonstrates a significant correlation with worse subjective outcomes following single-level ACDF. Full article

Through-space charge transfer (TSCT) between spatially adjacent donor and acceptor units has garnered considerable attention as a promising design principle for optoelectronic materials. While TSCT systems incorporating rigid spacers have been extensively studied to enhance through-space interactions, transition metal complexes connected by flexible linkers remain underexplored, despite increasing interest in their potential TSCT behavior. Herein, we report the design and synthesis of a donor–acceptor–donor (D-A-D)-type complex (1), in which a central naphthalenediimide (NDI) electron acceptor is linked to 2-phenylpyridinato(salicylaldiminato)platinum(II) complexes via flexible alkyl linkers. By systematically varying the linker length (n = 3, 4, 5, 6; 1a–d), we achieved precise control over the spatial arrangement between the NDI core and the platinum moieties in solution. Notably, compound 1a (n = 3) adopts an S-shaped conformation in solution, giving rise to a distinct TSCT absorption band. The structural and photophysical properties were thoroughly investigated using single-crystal X-ray diffraction, ¹H NMR, NOESY analysis, and DFT calculations, which collectively support the existence of the folded conformation and associated TSCT behavior. These findings highlight that TSCT can be effectively induced in flexible molecular systems by exploiting intramolecular spatial proximity and non-covalent interactions, thereby offering new avenues for the design of responsive optoelectronic materials. Full article

Intraventricular hemorrhage (IVH) is a common complication encountered in extremely-low-birth-weight (ELBW) and very-low-birth-weight (VLBW) premature babies. The neurologic outcome of these patients is influenced by the magnitude of the hemorrhagic process that damages the involved anatomic structures but also by the impaired circulation of cerebrospinal fluid (CSF) through the ventricular system, leading to posthemorrhagic ventriculomegaly (PHVM). Cranial ultrasound (CUS) performed by neonatologists (point-of-care ultrasound—POCUS) facilitates the early diagnosis of IVH and PHVM and can objectively quantify structural alterations. Our aim was to identify the best sonographic criteria to follow-up with ventricular dilatation and predict the need for neurosurgery and neurologic deterioration. We performed a literature review in search of the most relevant ventricular measurements considered by neurosurgeons, neonatologists, and pediatric neurologists to reflect the risk of white matter injury and high intracranial pressure (HIP), thus anticipating neurologic developmental impairment (NDI). The tridimensional picture of ventricular dilatation is best captured if more than one index (ventricular index and anterior horn width) or ratio (Evans ratio, fronto-occipital horn ratio, and fronto-temporal horn ratio) is used. Conclusions: If performed using the correct protocol, serially and comprehensively, CUS is an indispensable tool for the diagnosis and follow-up of neurologic complications of preterm babies, and it can make a difference in guiding adequate intervention and improving long-term developmental outcomes. Full article

Objective: The aim of the study was to evaluate the effect of postural stabilization exercises, in addition to cervical stabilization (CS), on the craniovertebral angle (CVA), pain, neck disability index (NDI), and quality of life in people with chronic neck pain. Methods: This study was performed on 60 women with chronic neck pain, aged 20–60 years, who were randomly divided into two groups. Individuals in the first group underwent CS exercises, in addition to scapular and lumbopelvic stabilization (SLPS) exercises, three times a week for 6 weeks. The individuals in the second group underwent only CS exercises for the same period. Moreover, stretching exercises and a 20 min hot pack were applied to the muscles around the neck of all patients. The CVA was measured using photogrammetry. The visual analog scale (VAS) was used to assess pain. The disability level was measured using the NDI. The Turkish version of the 36-Item Short-Form Health Survey (SF-36) was used to assess quality of life. The assessments were conducted before treatment, after treatment, and at the 2-month follow-up. To assess changes over time and between groups, a two-way repeated measures analysis of variance (ANOVA) was conducted. Results: Post-treatment measurements revealed significant differences favoring the SLPS group. The VAS and NDI scores were markedly lower in the SLPS group than in the CS group, both post-treatment (p < 0.001) and at follow-up (p < 0.001). The CVA was significantly greater in the SLPS group at both the post-treatment (p < 0.001) and follow-up (p < 0.001) assessments. However, in all sub-parameters except the SF-36 general health subscale, the SLPS group reported higher scores than the CS group post-treatment and at follow-up. Effect sizes for between-group comparisons ranged from moderate to very large (Cohen’s d = 0.65 to 2.31), and partial eta-squared (η²) values indicated moderate to large effect magnitudes (η² = 0.09 to 0.48), supporting the clinical relevance of the findings. Conclusion: In individuals with neck pain, including SLPS exercises in the treatment program, rather than just exercises for the cervical region, provides more positive results in terms of reducing disability and pain and increasing functionality. Clinical Trial Registration Number: NCT06578481. Full article

Differentiating central diabetes insipidus (CDI), nephrogenic diabetes insipidus (NDI), and primary polydipsia (PP) in pediatric patients with polyuria–polydipsia syndrome (PPS) remains a clinical challenge. The water deprivation test (WDT) is the traditional gold standard; however, it is time-consuming, burdensome, and prone to equivocal results. Stimulated copeptin, a surrogate marker of vasopressin, has emerged as a promising diagnostic alternative. We conducted a prospective, observational, cross-sectional study involving 27 pediatric patients (ages 2–17) presenting with PPS. Each patient underwent a WDT with desmopressin and hypertonic saline infusion (3% NaCl) for stimulated copeptin testing. Diagnostic accuracy was assessed using clinical diagnoses as a reference. The WDT showed high accuracy with an area under the curve (AUC) of 0.97, and there was an increased optimal threshold of ≥14% urine osmolality after desmopressin acetate (1-deamino-8-D-arginine vasopressin, DDAVP) administration (sensitivity 88.9%, specificity 100%). Stimulated copeptin at a threshold of <6.5 pmol/L demonstrated 100% sensitivity and specificity (AUC = 1.00) for CDI versus PP. Basal copeptin ≥21.4 pmol/L accurately identified all NDI cases. The agreement between the WDT and copeptin was low (κ = 0.06, McNemar p = 0.021), suggesting that copeptin has greater specificity, particularly for borderline or partial CDI. These results support the use of stimulated copeptin as a first-line diagnostic tool in pediatric PPS, offering improved objectivity, tolerability, and diagnostic clarity compared with the WDT. Basal copeptin also demonstrated excellent performance in rapid noninvasive NDI identification. Full article

Introduction: Spinal thrust manipulation has been found useful for improving pain and mobility in musculoskeletal conditions of the thoracic spine. This case report highlights the importance of incorporating high-velocity low-amplitude (HVLA) thrust manipulation to the mid-thoracic rib articulations in a patient experiencing thoracic spine pain associated with an acute onset of osteomyelitis at levels T7–T9. Detailed Case Description: A 49-year-old female who was recovering from osteomyelitis of the thoracic spine 4 months prior was referred to physical therapy by her neurosurgeon. Her osteomyelitis infection resulted in a bone-on-bone interaction between T7 and T9, resulting in significant thoracic spine pain. Severe restrictions in active range of motion (AROM) were found in extension and right and left rotation. At initial evaluation, the patient’s pain intensity score was 8/10 (NPRS, 0–10), the disability score was 46/50 (NDI, 0–50), and the patient-specific functional scale score was 3/10 (PSFS, 0–10). Initially, interventions included grades I-IV posterior to anterior (PA) mobilizations of the thoracic spine from levels T2 to T9, mobilization with movement of the thoracic spine for extension and rotation bilaterally, scapular stabilization, and thoracic mobility exercises. Treatment progressed to HVLA thrust manipulation techniques targeting the costotransverse articulations of ribs 2–9. Discussion: Following the initial eight treatment sessions over 4 weeks, minimal improvement was observed for pain (NPRS from 8/10 to 6/10), disability (NDI from 46/50 to 34/50), and thoracic extension AROM (13°). However, during visits 9–16, the addition of HVLA thrust manipulation targeting the costotransverse articulations resulted in significant improvements in pain, disability, and AROM. The patient was subsequently discharged after 16 visits and able to return to a full workday as a teacher without any thoracic pain or ROM restrictions. At the 6-month follow-up, the patient outcomes remained, and she was working with no restrictions. Conclusion: The addition of HVLA thrust manipulation targeting the mid-thoracic rib articulations to a program of non-thrust mobilization and exercise appeared useful for improving pain, disability, and range of motion in a patient recovering from osteomyelitis of the thoracic spine. Full article

Background and Objectives: The Neck Disability Index (NDI) is one of the most widely used instruments for assessing self-reported neck-related functional limitations. However, a validated Albanian version has not previously existed, limiting its application in Albanian-speaking populations. This study aimed to translate, culturally adapt, and evaluate the psychometric properties of the Albanian version of the NDI (ANDI), focusing on its reliability and internal consistency. Materials and Methods: A standard forward–backward translation methodology was used to develop the Albanian version of the NDI, followed by cultural adaptation. A total of 83 participants with neck pain completed the ANDI at two time points, three days apart. Test–retest reliability was assessed using the intraclass correlation coefficient (ICC), while internal consistency was evaluated using Cronbach’s alpha and the item–total correlation (ITC). Results: The ICC values for all 10 sections of the ANDI ranged from 0.95 to 0.99, indicating excellent test–retest reliability. The highest reliability was observed in (personal care) and (pain intensity) with ICCs of 0.99 and 0.98, respectively. All sections demonstrated strong internal consistency, with ITC values ranging from 0.91 to 0.98 and a Cronbach’s alpha of 0.96. Mean scores between test sessions showed negligible variation, further confirming score stability. Conclusions: The Albanian version of the NDI demonstrated excellent reliability and internal consistency, confirming its validity for use in clinical and research settings. This represents the first validated neck disability assessment tool for the Albanian-speaking population, supporting more inclusive musculoskeletal health assessment. Full article

Background: Recreational participation in Mixed Martial Arts (MMA) has rapidly increased. Despite consistent evidence of a high injury prevalence in MMA athletes, the neuromuscular implications of regular MMA training remain underexplored. The cervical spine is particularly vulnerable to trauma due to repetitive impacts and high mechanical demands in combat sports. Methods: This case-control study compared cervical spine function and self-reported symptoms between 25 recreational MMA athletes and 25 matched individuals who engaged in general fitness training. Outcome measures included Neck Disability Index (NDI), Post-Concussion Symptom Scale (PCSS), pain and headache reports, cervical range of motion (ROM), proprioception, isometric strength, and endurance. Multivariate logistic regression analysis was used to identify the predictors of group classification. Results: The MMA group exhibited significantly higher values for post-concussion symptoms (p = 0.012), cervical flexor endurance (p = 0.031), and the number of concussions (p = 0.001) but lower flexion ROM (p = 0.031). No significant differences were observed in strength, proprioception, or NDI scores. Logistic regression identified the number of concussions, age, total cervical ROM, and average rotation strength as significant predictors of group membership (model AUC = 0.96; Nagelkerke R² = 0.797). Conclusions: Recreational MMA athletes demonstrated higher rates of concussion-related symptoms and reduced cervical flexion ROM than noncontact exercisers despite no statistically significant differences in strength and proprioception. These findings suggest that cumulative exposure to amateur MMA is associated with alterations in cervical neuromuscular characteristics. These results support the implementation of targeted mobility, endurance, and injury prevention programs in recreational MMA training. Full article

Conductive polymers play a crucial role in the advancement of modern technologies, particularly in the field of organic photovoltaics (OPVs). Due to advantages such as flexibility, low specific weight, ease of processing, and low production costs, polymeric materials present an attractive alternative to traditional photovoltaic materials. This study investigates the properties of a polymer blend composed of PCPDTBT (donor) and PNDI(2HD)2T (acceptor), used as the active layer in bulk heterojunction (BHJ) solar cells. The motivation behind this research was the search for a novel n-type polymer material with potentially better properties than the commonly used P(NDI2OD-T2). Comprehensive characterization of thin films made from the individual polymers and their blend was conducted using Fourier Transform Infrared Spectroscopy (FTIR), Atomic Force Microscopy (AFM), Scanning Electron Microscopy (SEM), Ultraviolet-Visible Spectroscopy (UV-Vis), four-point probe conductivity measurements, and photovoltaic testing. The prepared films were continuous, uniform, and exhibited low surface roughness (R_a < 2.5 nm). Spectroscopic analysis showed that the blend absorbs light in a broad range of the spectrum, with slight bathochromic shifts compared to individual polymers. Electrical measurements indicated that the blend’s conductivity (9.1 µS/cm) was lower than that of pure PCPDTBT but higher than that of PNDI(2HD)2T, with an optical band gap of 1.34 eV. Photovoltaic devices fabricated using the blend demonstrated an average power conversion efficiency (PCE) of 6.45%, with a short-circuit current of 14.37 mA/cm² and an open-circuit voltage of 0.89 V. These results confirm the feasibility of using PCPDTBT:PNDI(2HD)2T blends as active layers in BHJ solar cells and provide a promising direction for further optimization in terms of polymer ratio and processing conditions. Full article

The electrochromic naphthalenediimide (NDI) based monomer containing styrene pedant groups, which are capable of polymerization, was prepared, and the formation of its polymer via a photopolymerization reaction was described. Both the monomer and polymer exhibited a color change in the visible range from transparent or slightly yellow, respectively, followed by brown-red to green. This was the result of a two-step reduction reaction of NDI core to radical anion and dianion, respectively. The device constructed using the polymer as an active material was found to exhibit good electrochromic stability over 500 redox cycles. The switching times were calculated to be 18 s and 6 s for the coloration and bleaching steps, respectively. The presented results showed the usability of the photopolymerization of styrene-based monomers in the generation of the stable electrochromic layers of polymers. Full article

Background: In recent decades, the adoption of minimally invasive (non-endoscopic) cervical techniques has grown significantly. Advancements in surgical instrumentation have broadened the spectrum of available percutaneous interventions, thus providing viable alternative treatment options for patients with prolonged, conservative treatment-resistant ailments due to contained cervical disc herniation. The aim of this study was to perform a systematic review and meta-analysis in order to evaluate the effectiveness and safety of minimally invasive percutaneous (non-endoscopic) cervical techniques. Methods: A comprehensive literature search was conducted using the PubMed, Cochrane Library, and SCOPUS databases up to July 2024, in accordance with the PRISMA guidelines. Outcomes measured included Visual Analogue Scale (VAS) scores, the Neck Disability Index (NDI), and MacNab scores, assessing pain relief and functional recovery. The risk of bias was evaluated using the Cochrane risk of bias tool (RoB 2) and the risk of bias in nonrandomized studies of interventions (ROBINS-I) tool, with statistical analyses conducted in R software (version 4.3.1). Results: Out of 847 records, 21 studies (covering 1580 patients) were included in the final analysis. Five different percutaneous minimally invasive cervical procedures were incorporated into this review: nucleoplasty (n = 973), discectomy (n = 311), a combination of nucleoplasty and discectomy (n = 98), annuloplasty (n = 33), and pulsed radiofrequency (n = 17). The mean patient age was 49.5, with a gender distribution of 47.7% male and 52.3% female. A meta-analysis of six studies on cervical nucleoplasty (400 patients) demonstrated a significant reduction in pain scores, with a standardized mean difference (SMD) of −4.68 (95% CI: −8.77; −0.59, p = 0.032). However, a high heterogeneity (I² = 98.8%, Q = 407.31, p < 0.001) was observed, indicating significant variability across studies. The reoperation rate among patients was 3.4%, with discitis and device-related complications being the most frequently reported adverse events. Conclusions: Minimally invasive percutaneous cervical interventions provide effective pain relief and functional improvement for patients with cervical disc herniation, as evidenced by reductions in VAS scores and positive MacNab outcomes. The choice of the most appropriate technique should be based on individual clinical scenarios, surgeon expertise, and patient preferences, as no single method demonstrates clear superiority according to clinical outcomes or complication rates. Full article