Search Results (475)

Traditional acupoint localization methods rely heavily on manual operation, resulting in high subjectivity and limited accuracy. To improve the precision and stability of acupoint detection, this study integrates machine vision technology with in situ projection to achieve automated recognition and real-time visualization of human acupoints. First, an automatic calibration method based on image processing is proposed for back acupoints. Spinal features are extracted from the blue channel, enhanced using adaptive histogram equalization, and processed through region of interest extraction, minimum-threshold binarization, and morphological operations. Key spinal curve points are then fitted using Bézier functions. Canny edge detection is used to extract the human silhouette, locate the acromion, and derive the pixel scale of the “cun” measurement, enabling coordinate computation for 141 back acupoints. In the deep learning component, an improved YOLOv8-Pose model is developed for acupoint localization. Unlike existing methods that use local attention or the original Object Keypoint Similarity (OKS) loss, we introduce two innovations: a non-local attention module for global dependency modeling, and a novel Efficient Object Keypoint Similarity (EOKS) loss function that incorporates geometric constraints—namely, width, height, and center distance—in addition to Euclidean distance. A non-local attention mechanism is incorporated into the backbone to enhance global feature extraction, and the EOKS loss function is designed to improve spatiogeometric regression accuracy. An inference mechanism is further introduced to derive the remaining acupoints from 49 detected keypoints; experiments demonstrate that the improved model achieves 95.0% detection accuracy, outperforming the baseline by 2.62%, with an inference time of 14.5 ms. Finally, an in situ projection platform is constructed, combining camera calibration, four-point proportional scaling, and an OpenCV 4.5.4-based interactive interface. The system supports real-time translation, rotation, and scaling, enabling accurate projection of detected acupoints onto the human body. Full article

Background/Objectives: Nurses’ engagement in research is essential to strengthen evidence-based practice, knowledge translation, and quality of care. However, individual, organisational, and cultural barriers may limit nurses’ participation in research activities. This study aimed to cross-culturally adapt and psychometrically test the Italian version of the Barriers to Nurses’ Participation in Research Questionnaire within the Italian cultural and healthcare organisational context, and to explore perceived obstacles to research engagement among nurses in Italy. Methods: A cross-sectional methodological study was conducted. The instrument was translated, back-translated, reviewed by the original instrument developer and an expert panel, and evaluated for content validity by 12 clinical research professionals. Data were collected online between September and October 2024 from 196 nurses working across Italian healthcare settings, including hospitals, university hospitals, IRCCS, primary care, and private hospitals. Exploratory Structural Equation Modelling was used to examine the factor structure. Results: A total of 196 nurses were enrolled in the study. A two-factor structure was identified, comprising Research Resources and Personal Relevance of Research, which explained 35.37% and 25.14% of the variance, respectively. Both factors demonstrated good reliability. The most prominent barrier was the lack of incentive or reward for nurses to engage in research, whereas the least relevant barrier was the perception that research was not interesting or valuable. Greater barriers were reported by younger nurses, those with fewer years of experience, and those without specific research training. Lack of time to conduct research emerged as a pervasive obstacle across the sample. Conclusions: The Italian version of the Barriers to Nurses’ Participation in Research Questionnaire provides preliminary evidence of validity and reliability for assessing perceived barriers to research participation among Italian nurses. Owing to the structural modifications introduced during adaptation, the instrument should be interpreted as a culturally adapted and modified Italian version rather than as a direct replication of the original structure. Its use may support organisational diagnosis, research mentorship, training planning, and future research-capacity-building initiatives, although further validation in larger and more heterogeneous samples is warranted. Full article

Musculoskeletal pain is a major cause of disability and long-term analgesic use, increasing interest in safe non-pharmacological interventions. This focused narrative review examines light-emitting diode (LED)-based photobiomodulation (PBM) for musculoskeletal pain, integrating molecular, mechanistic, clinical, and translational evidence. Red and near-infrared LED-PBM may act through mitochondrial and non-mitochondrial photoacceptors, modulation of ATP production, reactive oxygen species, nitric oxide, calcium signaling, inflammatory pathways, oxidative stress responses, and extracellular matrix repair. Clinical evidence suggests a potential benefit in selected conditions, particularly temporomandibular disorders, fibromyalgia, cervical and myofascial pain, tendon and plantar fascia disorders, knee osteoarthritis, and mild-to-moderate peripheral nerve compression, while findings for non-specific low back pain remain inconsistent. The reviewed literature indicates that therapeutic response depends less on emitter identity alone than on wavelength, irradiance, radiant exposure, treatment geometry, target depth, timing, disease phenotype, and protocol quality. LED-based PBM appears generally well tolerated and clinically promising as an adjunct to rehabilitation, but current evidence is limited by heterogeneous devices, incomplete dosimetry, variable comparators, and short follow-up. Future studies should prioritize standardized reporting, depth-aware dosing, phenotype-based recruitment, biomarker-linked outcomes, and direct laser–LED comparisons under dosimetrically matched conditions. Full article

Background/Objectives: Telewellness programs can expand access to exercise and social opportunities for older adults, especially those with mobility disabilities. The TechSAge Tele Tai Chi clinical trial assessed whether the Tai Chi for Arthritis and Fall Prevention program was feasible and acceptable when delivered in a virtual format for adults aging with mobility disabilities, and examined pre-to-post changes in two primary outcomes: physical activity and social connectedness. Methods: The TechSAge Tele Tai Chi study was a single-arm clinical trial. Sixty community-dwelling adults (60–77 years of age; M = 69.2, SD = 4.8) with self-identified long-term mobility disability (≥10 years) joined the virtual classes from home twice a week for 8 weeks. Participants exercised along with pre-recorded video lessons and engaged in guided social discussion. Assessments at baseline, post-intervention, and 1-month follow-up were analyzed with linear mixed models. Results: Leisure physical activity (PASIPD) increased significantly, with back-transformed marginal means rising from 14.2 MET h/wk at baseline to 28.7 MET h/wk post-intervention (p < 0.001). The Social Participation subscale of social connectedness also increased from baseline to post-intervention (p = 0.014); the overall social-connectedness composite did not change significantly. The virtual translation was feasible with high intervention fidelity and adherence, and participants reported high acceptability, satisfaction, enjoyment, and intention to continue. Conclusions: Adults aging with mobility disabilities can safely and successfully participate in virtual group tai chi with appropriate modifications and technology support. Full article

Background and Objectives: The Back Beliefs Questionnaire (BBQ) is a patient-reported outcome measure used to assess beliefs about back pain. This study aimed to cross-culturally adapt the BBQ into Serbian and evaluate the psychometric properties of the Serbian version (BBQ-Srb) in patients with chronic low back pain. Materials and Methods: A cross-sectional study involving cross-cultural adaptation and psychometric validation was conducted in 143 patients with chronic low back pain. The adaptation process included forward and backward translation, expert review, and pilot testing. Psychometric evaluation included assessment of floor and ceiling effects, internal consistency, test–retest reliability, measurement error, exploratory and confirmatory factor analyses, and construct validity testing using predefined hypotheses. Construct validity was examined through associations between BBQ-Srb scores and pain intensity, disability, pain catastrophizing, and work absenteeism. Results: The BBQ-Srb showed acceptable internal consistency, with Cronbach’s alpha of 0.728 and McDonald’s omega of 0.735. Total-score analyses were based on the preliminary exploratory 8-item BBQ-Srb version excluding BBQ13, whereas floor and ceiling effects were examined for the original 9-item scored BBQ-Srb version. Test–retest reliability was excellent (ICC = 0.916). Exploratory factor analysis suggested a predominantly one-factor structure, but the explained variance was modest. Confirmatory factor analysis of the 8-item version provided only partial support for unidimensionality, with marginal model fit and a low average variance extracted. The 8-item BBQ-Srb total score showed significant negative correlations with pain intensity, disability, and pain catastrophizing, confirming three of four predefined hypotheses. Conclusions: The BBQ-Srb demonstrated acceptable reliability and preliminary evidence of construct validity as a Serbian patient-reported outcome measure for assessing beliefs about back pain. However, structural validity was only partially supported, and the exploratory 8-item structure requires confirmation in larger, independent, and more diverse Serbian-speaking samples. Full article

Circular RNAs have emerged as important regulators of gene expression in cardiovascular disease, expanding the current understanding of the molecular mechanisms that underlie cardiac remodeling and dysfunction. Initially regarded as byproducts of aberrant splicing, circRNAs are now recognized as stable, abundant, and functionally versatile molecules with marked tissue specificity and diverse modes of action. In the cardiovascular system, circRNAs are generated through tightly regulated back-splicing mechanisms and act through multiple molecular pathways, including microRNA sequestration, protein scaffolding, modulation of transcription and splicing, regulation of mitochondrial and metabolic homeostasis, and in some cases, peptide translation. These properties position circRNAs as regulatory hubs that connect molecular interactions to functional cellular outcomes. Across a broad range of cardiovascular conditions, including heart failure, myocardial ischemia, fibrosis, arrhythmias, cardiotoxicity, and cardiorenal syndrome, circRNAs have been implicated in processes such as hypertrophy, inflammation, cell death, extracellular matrix remodeling, and regenerative responses. Beyond their mechanistic relevance, circRNAs also hold preclinical relevance as circulating biomarkers and therapeutic targets owing to their stability in biofluids and their capacity to modulate disease-relevant networks. Nevertheless, major challenges remain, including incomplete functional validation, methodological heterogeneity, annotation inconsistencies, and barriers to clinical translation. In this review, we synthesize the current knowledge on circRNA biogenesis, molecular function, disease-specific roles, biomarker potential, and therapeutic applications and discuss the conceptual and technical advances required to move the field from descriptive association toward mechanistic and clinical impact. Full article

Low back pain (LBP) is a major global health problem and can result in a variety of movement impairments. Advances in smart technology have enabled the collection of novel streams of movement data, and machine learning (ML) methods have been increasingly used for data analysis. However, many existing technologies remain expensive and unsuitable for widespread clinical use, and ML approaches have largely focused on distinguishing people with LBP from healthy controls rather than identifying meaningful subgroups within the LBP population. Motion Tape (MT) is a recently developed wearable strain sensor that translates skin deformation from underlying movement and muscle engagement into electrical signals. In this exploratory study involving 10 participants with LBP, we demonstrate that MT data from six sensors applied on the lower back capture rich movement information capable of characterizing movement patterns among participants with LBP. We propose a feature engineering approach based on biomechanical features as well as time-series causal discovery applied to multivariate sensor time-series data to extract directed inter-segment coordination patterns. We further develop an exploratory subgroup discovery pipeline by aggregating clustering coassociation information across diverse movement tasks. Our causal coordination features show promising discriminative information across several movement types, capturing aspects of motor control not reflected in amplitude-based or embedding-based features alone, such as asymmetries and movement restrictions. Preliminary ensemble clustering analysis indicates three potential LBP subgroups distinguished by biomechanical and inter-segment coordination patterns, which may reflect varied strategies under different movement demands. We investigate the differences in clinical characteristics among these LBP subgroups. We show that time-series foundation models are not well suited for LBP subgrouping due to their uninterpretability, which is improved in our feature engineering pipeline. This framework could reveal additional subgroups with larger cohorts and may generalize to other sensor modalities. Full article

The absence of a culturally adapted instrument to assess menopause-specific quality of life in Vietnamese women limits both clinical practice and research in this population. This study aimed to translate, culturally adapt, and psychometrically validate the Vietnamese version of the Utian Quality of Life (VN-UQOL) Scale. A cross-sectional design was employed with 384 community-dwelling postmenopausal women aged 46–65 years. The UQOL was translated and adapted following established guidelines, including forward-back translation, expert review, and pilot testing. Internal consistency was evaluated using Cronbach’s alpha, construct validity through confirmatory factor analysis (CFA), and concurrent validity via Pearson correlations with the Vietnamese Menopause Rating Scale (VN-MRS). The VN-UQOL demonstrated excellent internal consistency, with a total scale Cronbach’s alpha of 0.87 and sub-scale alphas ranging from 0.81 to 0.93. Content validity indices (I-CVI, S-CVI) were 1.0. CFA confirmed the original four-factor structure, with all factor loadings exceeding 0.50 and good model fit indices (CFI = 0.921, RMSEA = 0.072). Concurrent validity was supported by significant negative correlations between the VN-UQOL sub-scales and corresponding VN-MRS domains (p < 0.01). The VN-UQOL is a reliable and valid instrument for assessing menopause-specific quality of life in Vietnamese women, providing a valuable tool for clinical practice and research in this underserved population. Full article

Background/Objectives: Temporomandibular disorders (TMDs) constitute an umbrella term encompassing a spectrum of conditions, including pain in the temporomandibular joint (TMJ), masticatory muscle pain, and restricted mandibular movement. The objective of the present study was to translate the Fonseca and TMD-7 questionnaires into Romanian, to assess their face validity, and to determine the reliability of the Romanian-language versions for use in the diagnosis of temporomandibular disorders (TMDs) and in subsequent epidemiological and clinical studies. A secondary objective was to establish a scoring scale for the TMD-7 questionnaire. Methods: Both questionnaires were translated from English into Romanian and back-translated by two independent teams of translators, after which the final versions were established for face validity assessment and reliability testing. Results: The study demonstrated reliability according to the Cronbach’s α coefficient, with values of 0.862 for the TMD-7 questionnaire and 0.840 for the Fonseca questionnaire. The scoring scale corresponding to the Fonseca questionnaire could not be implemented for the TMD-7 questionnaire. Conclusions: Both Romanian-language questionnaires demonstrated high corresponding Cronbach’s α coefficients; however, for clinical use, the Fonseca questionnaire will be utilized, as the TMD-7 questionnaire does not have a scoring scale. Full article

Intervertebral disk degeneration (IVDD) is widely recognized as a major contributor to discogenic low back pain (LBP), imposing a substantial burden on global public health and socioeconomic systems. Growing evidence confirms that disrupted redox homeostasis, excessive reactive oxygen species (ROS) accumulation, and oxidative stress act as major convergent mechanisms that propagate inflammatory cascades, nucleus pulposus cell dysfunction, and extracellular matrix degradation. Although conventional conservative therapies and surgical interventions are clinically effective in relieving macrostructural compression, they remain limited in resolving localized molecular dysregulation. In recent years, nanotechnology has emerged as a promising strategy for overcoming the limitations of traditional therapy for IVDD. This review provides an analysis of four categories of antioxidant nanotherapies for IVDD, including inorganic functional nanozymes, bioactive nanomaterials, stimuli-responsive nanosystems, and nanocomposite scaffolds. We elaborate on their mechanisms in scavenging excessive ROS, restoring redox equilibrium, protecting mitochondrial function, and ameliorating oxidative stress-induced degeneration. Integrating structural biomimicry with microenvironmental responsiveness enables the engineering of composite nanosystems with multi-pathway ROS-scavenging capabilities. Therefore, these platforms emerge as promising therapeutic strategies for arresting IVDD progression. Finally, we discuss the key obstacles to clinical translation. Overall, this review provides insights into the development of redox-targeted therapies. Full article

Lower back pain (LBP) is a leading cause of disability globally, characterized by multifactorial origins that complicate accurate diagnosis and effective treatment planning. Artificial intelligence (AI), including machine learning (ML), deep learning (DL), and radiomics, has shown promise for improving the reproducibility and quantitative assessment of spine neuroimaging. This narrative review synthesizes current evidence on AI-derived imaging biomarkers in magnetic resonance imaging (MRI) and computed tomography (CT), with emphasis on disc degeneration, spinal stenosis, endplate signal abnormalities, paraspinal muscle composition, vertebral fractures, and spinal alignment. AI-based reconstruction, segmentation, and classification methods may reduce reader variability and enable standardized quantification of imaging features. However, the current evidence base remains dominated by technical and retrospective validation studies, and high diagnostic performance should not be interpreted as proof of improved patient-centered outcomes. The present review distinguishes technical feasibility, diagnostic assistance, prognostic association, and clinical utility, and highlights the persistent efficacy-effectiveness gap in AI-based spine imaging. Although multimodal models integrating imaging, clinical, biomechanical, and patient-reported data may improve future risk stratification, clinical translation remains constrained by heterogeneous datasets, limited external validation, incomplete interpretability, and evolving regulatory frameworks. Prospective multicenter validation and outcome-linked evaluation are required before AI-derived imaging biomarkers can be considered established tools for routine LBP management. Full article

Background: Acute respiratory distress syndrome (ARDS), particularly in COVID-19–related severe respiratory failure, remains a major challenge in intensive care. Flow-controlled ventilation (FCV) may improve gas exchange by enabling precise airway pressure control; however, clinical data on its prolonged use in ARDS are limited. Methods: This single-center retrospective observational study included adult patients with moderate to severe ARDS who underwent FCV during invasive mechanical ventilation. FCV was delivered using the Evone^® ventilator with the Tritube^®. Demographic data, ventilatory settings, and arterial blood gas values were analyzed before and during 48 h of FCV and for 8 h after transition to conventional ventilation. Results: Seven patients with COVID-19–related ARDS were included. Following initiation of FCV, PaO₂ increased within the first 8 h (median increase: +24 mmHg), accompanied by a median 38% improvement in the PaO₂/FiO₂ ratio, which remained above baseline throughout follow-up. Arterial PCO₂ progressively declined, with the most pronounced reduction observed within the first 24 h (median decrease: −14 mmHg; approximately 22%). After transition back to conventional ventilation, mild deterioration in gas exchange parameters was observed; however, none returned to baseline values. All patients died during their ICU stay, mainly due to secondary infections and pulmonary embolism. Conclusions: In advanced COVID-19–related ARDS unresponsive to conventional ventilation, prolonged FCV application was technically feasible under controlled ICU conditions and associated with descriptively observed improvements in gas exchange parameters. However, late initiation of FCV did not translate into survival benefit. Prospective studies are required to define the optimal timing and patient selection for FCV. The present findings primarily support the technical feasibility and short-term physiological effects of FCV rather than clinical efficacy. Full article

The study analyzes a major deep-seated landslide affecting National Road 16 at KP 178+000 in the Rif region of northern Morocco, a corridor repeatedly impacted by geotechnical instability. Using historical information, detailed geological mapping, multiple field campaigns, and extensive subsurface investigations (core drilling, inclinometers), the authors characterize the site as a complex setting of metamorphosed, fractured, and altered peridotites overlain by Quaternary sediments dipping negatively toward the Mediterranean. The landslide is interpreted as deep-seated planar translational landslide and has been exacerbated by human activity, specifically the placement of excavated material on the downslope side during road upgrade works in late 2019. Inclinometer data show active movement extending to at least 20 m depth, confirming the deep-seated nature of the instability. Three remediation strategies were implemented: shifting the road alignment with terracing, combining road realignment with soil nailing and slope reprofiling, and installing large bored piles tied back with anchors, following recommendations from an external expert. The authors emphasize that robust geological investigations and properly regulated construction practices are essential to reduce landslide risk for infrastructure built in mountainous coastal regions. Full article

The management of European mountain landscapes is increasingly threatened by rural abandonment and escalating environmental risks. This study investigates an innovative Stewardship–Renewable Energy Communities model for the Central Apennines, exploring how post-seismic public reconstruction can serve as a financial engine for territorial maintenance. Utilizing Open Data Sisma administrative records and Photovoltaic Geographical Information System irradiation metrics, this research assesses the solar potential of 18 municipalities within the Sibillini seismic crater. To ensure a reliable baseline, a Building Suitability Coefficient was introduced as a conservative proxy for the public reconstruction sector. Results indicate that the implementation of a distributed network of 6.5 MWp across 325 public nodes, with a specific yield of 1390 kWh/kWp on the entire area, could generate 9 GWh/year. This translates to approximately EUR 1.08 million in annual revenue from energy incentives and sharing. This economic surplus provides a Stewardship Capacity sufficient to fund the active maintenance of 789.77 hectares per year through Nature-Based Solutions, based on a regional rate of 1200 EUR/ha. The novelty of this study lies in bridging post-disaster energy policy with landscape resilience, demonstrating that distributed rooftop solar portfolios represent a non-invasive, self-funding mechanism. By leveraging the reconstructed public stock, mountain territories can transition from passive neglect to active, energy-backed stewardship, offering a reproducible template for high-value cultural landscapes. Full article

Background: Ageism is a global public health concern associated with poorer health outcomes and inequities in care. Culturally adapted instruments are needed to assess ageist attitudes among healthcare professionals in Spain. This study aimed to cross-culturally adapt and evaluate the preliminary psychometric properties of the Spanish version of the Fraboni Scale of Ageism (FSA-SV). Methods: A methodological study was conducted, including translation and back-translation, expert review, and a pilot test. Content validity was assessed using the content validity index (CVI), the modified kappa coefficient, and Aiken’s V. A descriptive cross-sectional pilot study was conducted with 101 healthcare professionals from a single health department in Valencia to evaluate comprehension and reliability. Internal consistency was examined using Cronbach’s alpha and McDonald’s omega. Results: Content validity indices indicated acceptable agreement among experts (S-CVI = 0.745; Aiken’s V = 0.770). All items were retained to preserve conceptual and structural equivalence with the original instrument. The FSA-SV demonstrated high internal consistency (Cronbach’s alpha = 0.903; McDonald’s omega = 0.915). The mean total score was 51.2 (SD = 9.62), with no significant associations observed between ageism and participants’ sociodemographic or professional variables. Conclusions: This pilot study represents a first step in the cross-cultural adaptation and preliminary psychometric evaluation of the FSA-SV for use among healthcare professionals in Spain. The results suggest that the instrument shows promising initial properties for the preliminary assessment of ageism, supporting its potential utility in future research and in evaluating educational and organizational interventions aimed at reducing ageism and improving the quality and safety of care for older adults. Further studies with larger, more diverse samples are required to evaluate additional psychometric properties, including the factorial structure. Full article