Search Results (1,582)

Genu valgum (GV) is a common lower limb deformity that may increase the risk of anterior cruciate ligament (ACL) injury. This study used OpenSim musculoskeletal modeling and kinematic analysis to investigate the mechanical responses of the ACL under fatigue in females with GV. Eight females with GV and eight healthy controls completed a running-induced fatigue protocol. Lower limb kinematic and kinetic data were collected and used to simulate stress and strain in the anteromedial ACL (A–ACL) and posterolateral ACL (P–ACL) bundles, as well as peak joint angles and knee joint stiffness. The results showed a significant interaction effect between group and fatigue condition on A–ACL stress. In the GV group, A–ACL stress was significantly higher than in the healthy group both before and after fatigue (p < 0.001) and further increased following fatigue (p < 0.001). In the pre-fatigued state, A–ACL strain was significantly higher during the late stance phase in the GV group (p = 0.036), while P–ACL strain significantly decreased post-fatigue (p = 0.005). Additionally, post-fatigue peak hip extension and knee flexion angles, as well as pre-fatigue knee abduction angles, showed significant differences between groups. Fatigue also led to substantial changes in knee flexion, adduction, abduction, and hip/knee external rotation angles within the GV group. Notably, knee joint stiffness in this group was significantly lower than in controls and decreased further post-fatigue. These findings suggest that the structural characteristics of GV, combined with exercise-induced fatigue, exacerbate A–ACL loading and compromise knee joint stability, indicating a higher risk of ACL injury in fatigued females with GV. Full article

Background/Objectives: COVID-19 is a systemic viral infection that may lead to serious complications including acute kidney injury that requires kidney replacement therapy. The primary aim of this study was to evaluate urinary SerpinA3 (uSerpinA3) excretion as a biomarker of kidney recovery at 90 days, and the mortality in patients with critical COVID-19 and AKI requiring kidney replacement therapy (KRT). Methods: The study included patients with critical COVID-19 on invasive mechanical ventilation (IMV) requiring KRT. Blood and urine samples were obtained when KRT was initiated (day zero), and thereafter on days 1, 3, 7, and 14 post-replacement. uSerpinA3, kidney injury molecule-1 (uKIM-1), and neutrophil gelatinase-associated lipocalin (uNGAL) were measured in urine, and interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor alpha (TNF-α) in peripheral blood. In addition, metabolomics in sample days zero and 3, and in the survivors on sample day 90 was performed by employing gas chromatography coupled with mass spectrometry. Results: A total of 60 patients were recruited, of whom 29 (48%) survived hospitalization and recovered kidney function by day 90. In the survivors, 79% presented complete recovery (CRR) and the remaining (21%) recovered partially (PRR). In terms of uSerpinA3, levels on days 7 and 14 predicted CRR, with AUC values of 0.68 (p = 0.041) and 0.71 (p = 0.030), respectively, as well as mortality, with AUC values of 0.75 (p = 0.007) and 0.76 (p = 0.015), respectively. Among the other biomarkers, the excretion of uKIM-1 on day zero of KRT had a superior performance as a CRR predictor [(AUC, 0.71 (p = 0.017)], and as a mortality predictor [AUC, 0.68 (p = 0.028)]. In the metabolomics analysis, we identified four distinct profiles; the metabolite that maintained statistical significance in predicting mortality was p-cresol glucuronide. Conclusions: This study strongly suggests that uSerpinA3 and uKIM-1 can predict CRR and mortality in patients with critical COVID-19 and AKI requiring KRT. Metabolic analysis appears promising for identifying affected pathways and their clinical impact in this population. Full article

Kinesthetic motor imagery (KMI), the mental rehearsal of a motor task without its actual performance, constitutes one of the most common techniques used for brain–computer interface (BCI) control for movement-related tasks. The effect of neural injury on motor cortical activity during execution and imagery remains under investigation in terms of activations, processing of motor onset, and BCI control. The current work aims to conduct a post hoc investigation of the event-related potential (ERP)-based processing of KMI during BCI control of anthropomorphic robotic arms by spinal cord injury (SCI) patients and healthy control participants in a completed clinical trial. For this purpose, we analyzed 14-channel electroencephalography (EEG) data from 10 patients with cervical SCI and 8 healthy individuals, recorded through Emotiv EPOC BCI, as the participants attempted to move anthropomorphic robotic arms using KMI. EEG data were pre-processed by band-pass filtering (8–30 Hz) and independent component analysis (ICA). ERPs were calculated at the sensor space, and analysis of variance (ANOVA) was used to determine potential differences between groups. Our results showed no statistically significant differences between SCI patients and healthy control groups regarding mean amplitude and latency (p < 0.05) across the recorded channels at various time points during stimulus presentation. Notably, no significant differences were observed in ERP components, except for the P200 component at the T8 channel. These findings suggest that brain circuits associated with motor planning and sensorimotor processes are not disrupted due to anatomical damage following SCI. The temporal dynamics of motor-related areas—particularly in channels like F3, FC5, and F7—indicate that essential motor imagery (MI) circuits remain functional. Limitations include the relatively small sample size that may hamper the generalization of our findings, the sensor-space analysis that restricts anatomical specificity and neurophysiological interpretations, and the use of a low-density EEG headset, lacking coverage over key motor regions. Non-invasive EEG-based BCI systems for motor rehabilitation in SCI patients could effectively leverage intact neural circuits to promote neuroplasticity and facilitate motor recovery. Future work should include validation against larger, longitudinal, high-density, source-space EEG datasets. Full article

Background: The purpose of this study was to evaluate Achilles tendon ruptures (ATR) in NHL players and the effects on return to play and player performance metrics. The incidence, mechanism of injury, management strategy, return to play (RTP), and post-injury were assessed from official online sports databases. Methods: A retrospective review of NHL players who sustained a partial or complete tear of the Achilles tendon from 2008 to 2024 was performed. Data were collected from NHL injury databases and media reports, and included player demographics, injury mechanism, treatment, and post-injury performance metrics. A Wilcoxon signed rank test was used to compare pre-injury and post-injury performance metrics, with significance set at p < 0.05. Results: Here, 15 NHL players with a mean age of 27.8 years were identified, with a prevalence rate of 0.125 injuries per 10,000 athletic exposures. Overall, 73.3% of ATRs were non-contact in nature, with 60.0% of ATRs occurring during off-season training. Fourteen players were managed with non-operative treatment, with no re-ruptures reported. The RTP rate was 93.3%, with players missing a mean number of 45.7 games. However, there was a deterioration in post-injury performance metrics, including games played per season, plus/minus rating, and time on ice per game post-injury. Conclusions: This study found that Achilles tendon ruptures are an uncommon injury in NHL players, with a prevalence rate of 0.125 injuries per 10,000 athletic exposures. A high RTP rate of 93.3% was observed in this cohort. However, there was a deterioration in post-injury performance metrics, including games played per season, plus/minus rating, and time on ice per game post-injury, highlighting the potential devastating sequelae of ATRs in elite NHL athletes. Full article

Background: Endonasal endoscopic approaches to the skull base are still under investigation, with research aiming to achieve minimally invasive procedures that maximize resection while minimizing complications. This study shares our experience with a mononostril technique and compares it with the existing literature on mononostril approaches for sellar lesions. Methods: A systematic review of eight large series, totaling 1520 patients who underwent endoscopic mononostril transsphenoidal surgery, was performed. The surgical technique was detailed, and parameters such as resection completeness, operative time, complications, and nasal symptoms were analyzed. Results: Gross total resection ranged from 56% to 100% for non-functioning adenomas, 54% to 89% for hormone-secreting adenomas, and 83% to 100% for other sellar lesions. The most common complications were CSF leaks (1.5–4.1%) and nasal issues, such as epistaxis or sinusitis (0–6%). Internal carotid artery injury occurred in 0–1% of cases. The average surgical duration was 87 to 168 min. Conclusions: The mononostril approach offers comparable resection rates, CSF leak risks, and morbidity to binostril or microsurgical methods. The mononostril approach is fast, minimally invasive, and preserves the nasal mucosa, making it a viable option for many sellar lesions. Full article

Membranous nephropathy (MN) is the most prevalent cause of nephrotic syndrome (NS) in adults, and it can be primary (idiopathic) with an unknown cause or secondary due to a variety of conditions (lupus, infections, malignancies, medications, etc.). It progresses to chronic kidney disease (CKD) in up to 60% of patients, and 10 to 30% develop end-stage kidney disease (ESKD). This retrospective study examines the importance of specific factors, including baseline demographic and clinical data, kidney biopsy PH findings, and selected biochemical parameters, influencing MN outcomes after 10 years of follow-up. The cohort included 94 individuals in whom a diagnosis of MN was established by percutaneous biopsy of the left kidney’s lower pole at the University Clinical Center of Serbia (UCCS) between 2008 and 2013. According to the outcomes, patients were divided into three groups: the recovery (Rec) group, with complete remission, including normal serum creatinine (Scr) and proteinuria (Prt), the group with development of chronic kidney disease (CKD), and the group with development of end-stage kidney disease (ESKD). Nephropathologists graded pathohistological (PH) results from I to III based on the observed PH findings. During the follow-up period, 33 patients were in the Rec group, CKD developed in 53 patients, and ESKD developed in 8 patients. Baseline creatinine clearance levels (Ccr), Scr, and uric acid (urate) were found to be significantly associated with the outcomes (p < 0.001). The lowest values of baseline Scr and urate were observed in the Rec group. The presence of acute kidney injury (AKI) or CKD at the time of kidney biopsy was associated with the more frequent development of ESKD (p = 0.02). Lower Ccr was associated with a higher likelihood of progressing to CKD (B = −0.021, p = 0.014), whereas older age independently predicted progression to ESKD (B = 0.02, p = 0.032). Based on this study, it was concluded that the most important biochemical and clinical factors that are associated with the outcomes of this disease are the values of Scr, Ccr, and urate and the existence of CKD at the time of kidney biopsy. Unlike most previous studies, the presence of HTN had no statistical significance in the outcome of the disease. Full article

Road traffic accidents are a leading cause of injury and death among adolescents, making road safety education crucial. This study assesses the performance of and users’ opinions on the Route 2 School (R2S) traffic safety education program, designed for secondary school students (13–17 years) in Belgium. The program incorporates gamified e-learning modules containing, among others, podcasts, interactive 360° visuals, and virtual reality (VR), to enhance traffic knowledge, situation awareness, risk detection, and risk management. This study was conducted across several cities and municipalities within Belgium. More than 600 students from school years 3 to 6 completed the platform and of these more than 200 students filled in a comprehensive questionnaire providing detailed feedback on platform usability, preferences, and behavioral risk assessments. The results revealed shortcomings in traffic knowledge and skills, particularly among older students. Gender-based analysis indicated no significant performance differences overall, though females performed better in risk management and males in risk detection. Furthermore, students from cities outperformed those from municipalities. Feedback on the R2S platform indicated high usability and engagement, with VR-based simulations receiving the most positive reception. In addition, it was highlighted that secondary school students are high-risk groups for distraction and red-light violations as cyclists and pedestrians. This study demonstrates the importance of gamified, technology-enhanced road safety education while underscoring the need for module-specific improvements and regional customization. The findings support the broader application of e-learning methodologies for sustainable, behavior-oriented traffic safety education targeting adolescents. Full article

This study is the first to systematically integrate supervised machine learning (decision tree) and association rule mining techniques to analyze accident data from the Taipei Metro system, conducting a large-scale data-driven investigation into both passenger injury and train malfunction events. The research demonstrates strong novelty and practical contributions. In the passenger injury analysis, a dataset of 3331 cases was examined, from which two highly explanatory rules were extracted: (i) elderly passengers (aged > 61) involved in station incidents are more likely to suffer moderate to severe injuries; and (ii) younger passengers (aged ≤ 61) involved in escalator incidents during off-peak hours are also at higher risk of severe injury. This is the first study to quantitatively reveal the interactive effect of age and time of use on injury severity. In the train malfunction analysis, 1157 incidents with delays exceeding five minutes were analyzed. The study identified high-risk condition combinations—such as those involving rolling stock, power supply, communication, and signaling systems—associated with specific seasons and time periods (e.g., a lift value of 4.0 for power system failures during clear mornings from 06:00–12:00, and 3.27 for communication failures during summer evenings from 18:00–24:00). These findings were further cross-validated with maintenance records to uncover underlying causes, including brake system failures, cable aging, and automatic train operation (ATO) module malfunctions. Targeted preventive maintenance recommendations were proposed. Additionally, the study highlighted existing gaps in the completeness and consistency of maintenance records, recommending improvements in documentation standards and data auditing mechanisms. Overall, this research presents a new paradigm for intelligent metro system maintenance and safety prediction, offering substantial potential for broader adoption and practical application. Full article

Background: The rehabilitative treatment of muscle injuries is mostly conservative, but it does not always follow precise protocols. Appropriate physiotherapy, exercises, and training are essential components of the rehabilitation and reconditioning of injured muscles. The purpose of this review is to assess the good rehabilitative practices in the treatment of patients affected by muscle injuries. Methods: We performed research on Medline and Cochrane Database. Guidelines focusing on the rehabilitative treatment of muscle injuries were evaluated for inclusion. Statements about non-rehabilitative treatments were also reported only for the guidelines that mainly focused on rehabilitative treatments. Results: Eight guidelines meeting the inclusion criteria were included in the review. Results were framed into a narrative overview. Two of them mainly focused on hamstring rehabilitation, the others focused on several muscular districts. Conclusions: Conservative treatment of muscle injuries is currently the gold standard, with good results in terms of both rehabilitation times and post-injury sports performance. However, there is not a complete agreement on the type of exercises and the timing of rehabilitation when these should be performed. More research is needed to draw conclusions about the use of physical therapy instruments and other rehabilitation approaches and techniques. Full article

Background: Brazilian Jiu-Jitsu (BJJ) is a physically demanding sport associated with a notable risk of musculoskeletal injuries. Understanding injury patterns, rehabilitation approaches, and psychological readiness to return to sport (RTS) is essential for prevention and management strategies. This study aimed to investigate injury characteristics among Italian BJJ athletes, assess their rehabilitation processes and psychological recovery, and identify key risk factors such as belt level, body mass index (BMI), and training load. Methods: A cross-sectional survey was conducted among members of the Italian BJJ community, including amateur and competitive athletes. A total of 360 participants completed a 36-item online questionnaire. Data collected included injury history, rehabilitation strategies, RTS timelines, and responses to the Injury-Psychological Readiness to Return to Sport (I-PRRS) scale. A Random Forest machine learning algorithm was used to identify and rank potential injury risk factors. Results: Of the 360 respondents, 331 (92%) reported at least one injury, predominantly occurring during training sessions. The knee was the most frequently injured joint, and the action “attempting to pass guard” was the most reported mechanism. Most athletes (65%) returned to training within one month. BMI and age emerged as the most significant predictors of injury risk. Psychological readiness scores indicated moderate confidence, with the lowest levels associated with playing without pain. Conclusions: Injuries in BJJ are common, particularly affecting the knee. Psychological readiness, especially confidence in training without pain, plays a critical role in RTS outcomes. Machine learning models may aid in identifying individual risk factors and guiding injury prevention strategies. Full article

Background: Deep surgical site infections (SSIs) represent a serious complication following abdominal trauma surgery; however, comprehensive risk factor analysis in large trauma populations remains limited. Although surgical site infections are recognized as preventable complications, little is known about the specific risk factors and clinical outcomes associated with deep SSIs in trauma patients at the national level. Methods: A retrospective cohort study analyzed data from the National Trauma Data Bank from 2020–2022, including 1,198,262 trauma patients with complete demographic, injury severity, and surgical procedure data. Deep SSI development, length of hospital stay, intensive care unit utilization, duration of mechanical ventilation, discharge disposition, and in-hospital mortality were assessed. Multivariate logistic regression was used to identify independent risk factors and quantify associations between patient characteristics and deep SSI occurrence. Results: Deep SSIs occurred in 601 patients (0.05%). Affected patients were younger (median 41 vs. 54 years, p < 0.001), predominantly male (73.7% vs. 61.8%, p < 0.001), and exhibited higher injury severity scores (median 17.0 vs. 5.0, p < 0.001). Major abdominal surgery was the strongest independent predictor (OR 3.08, 95% CI: 2.21–4.23, p < 0.001), followed by injury severity score (OR 1.05, 95% CI: 1.04–1.06, p < 0.001) and ICU length of stay (OR 1.04 per day, 95% CI: 1.03–1.05, p < 0.001). Patients with deep SSIs demonstrated dramatically increased hospital stays (89.5% vs. 4.5% exceeding 21 days, p < 0.001), reduced home discharge rates (28.5% vs. 48.9%, p < 0.001), and higher mortality (4.2% vs. 1.2%, p < 0.001). Conclusions: Major abdominal surgery and injury severity are primary risk factors for deep SSIs in trauma patients, with profound impacts on clinical outcomes and healthcare resource utilization. These findings highlight the importance of targeted prevention strategies for high-risk trauma patients undergoing major abdominal procedures and emphasize the significant burden that deep SSIs place on healthcare systems. Full article

Background: Wound healing and scar management remain significant challenges in dermatology and aesthetic medicine. Recent advances in regenerative medicine have introduced plant-derived exosome-like nanoparticles (PDENs) as potential therapeutic agents due to their bioactive properties. This study examines the clinical application of rose stem cell exosomes (RSCEs) in combination with established treatments for managing different types of scars. Methods: A case series of four patients with different scar etiologies (dog bite, hot oil burn, forehead trauma, and facial laser treatment complications) was treated with RSCEs in combination with microneedling (Dermapen 4.0, 0.2–0.4 mm depth) and/or thulium laser therapy (Lutronic Ultra MD, 8–14 J), or as a standalone topical treatment. All cases underwent sequential treatments over periods ranging from two to four months, with comprehensive photographic documentation of the progression. The efficacy was assessed through clinical photography and objective evaluation using the modified Vancouver Scar Scale (mVSS) and the Patient and Observer Scar Assessment Scale (POSAS), along with assessment of scar appearance, texture, and coloration. Results: All cases demonstrated progressive improvement throughout the treatment course. The dog bite scar showed significant objective improvement, with a 71% reduction in modified Vancouver Scar Scale score (from 7/13 to 2/13) and a 61% improvement in Patient and Observer Scar Assessment Scale scores after four combined treatments. The forehead trauma case exhibited similar outcomes, with a 71% improvement in mVSS score and 55–57% improvement in POSAS scores. The hot oil burn case displayed the most dramatic improvement, with a 78% reduction in mVSS score and over 70% improvement in POSAS scores, resulting in near-complete resolution without visible scarring. The facial laser complication case showed a 75% reduction in mVSS score and ~70% improvement in POSAS scores using only topical exosome application without device-based treatments. Clinical improvements across all cases included reduction in elevation, improved texture, decreased erythema, and better integration with surrounding skin. No adverse effects were reported in any of the cases. Conclusions: This preliminary case series suggests that plant-derived exosome-like nanoparticles, specifically rose stem cell exosomes (RSCEs), may enhance scar treatment outcomes when combined with microneedling and laser therapy, or even as a standalone topical treatment. The documented objective improvements, measured by standardized scar assessment scales, along with clinical enhancements in scar appearance, texture, and coloration across different scar etiologies—dog bite, burn, traumatic injury, and iatrogenic laser damage—suggest that this approach may offer a valuable addition to the current armamentarium of scar management strategies. Notably, the successful treatment of laser-induced complications using only topical exosome application demonstrates the versatility and potential of this therapeutic modality. Full article

Background/Objectives: Cochlear “injury” is thought to be a significant cause of tinnitus in patients with hearing loss. Interestingly, individuals with normal hearing may also experience tinnitus. This study evaluates otoacoustic distortion product emissions (DPOAEs) in individuals with normal hearing who experience tinnitus perception. Methods: In this prospective study, the tinnitus group (TG) consisted of 34 subjects with tinnitus (four unilaterally) and normal hearing (threshold ≤ 25 dBHL at 0.25–8 kHz). The control group (CG) comprised 10 healthy volunteers (20 ears) without tinnitus and normal hearing. Medical history was recorded, and all participants underwent a complete otolaryngological examination, pure tone audiometry, and DPOAE recording (DP-gram, L1 = 55 dB, L2 = 65 dB, for F2: 619–10,000 Hz). Moreover, participants in the TG completed a detailed tinnitus history (with self-rated loudness scoring) and the Tinnitus Handicap Inventory (Greek-version THI-G) and underwent tinnitus analysis. Results: The recorded mean DPOAE values during the DP-gram of the CG were significantly larger in amplitude at low (t-test, Bonferroni-corrected p < 0.09) and high frequencies (t-test, Bonferroni-corrected p < 0.02) compared with the TG. Tinnitus assessment showed tinnitus pitch matching at the frequency area in the DP-gram, where the acceptance recording criteria were not met. There were no statistically significant differences in tinnitus onset, self-rated loudness scores of >70, and severe disability (THI-G > 58) for TG subjects in whom DPOAEs were not recorded at frequencies of ≤1000 Hz. Participants with abnormal DPOAEs at around 4000 Hz had tinnitus of sudden onset and severe disability (THI-G > 58). Finally, those with pathological recordings of DPOAEs at ≥6000 Hz had gradual onset tinnitus (Pearson Chi-square test, p < 0.05). Conclusions: DPOAEs in normal hearing individuals with tinnitus show lower amplitudes in low and high frequencies compared with normal hearing individuals without tinnitus. The tinnitus matched-frequency coincided with the frequency area where DPOAEs were abnormal. Full article

Some herbicides, such as saflufenacil, can persist as residues in sprayer tanks even after cleaning, causing phytotoxicity in sensitive crops. This study aimed to simulate potential injury caused by saflufenacil residues, applied alone or combined with glyphosate, on soybean. The field experiment was conducted using a randomized complete block design with four replicates. The treatments included glyphosate (1440 g ha⁻¹), eight saflufenacil doses ranging from 1.09 to 70.00 g ha⁻¹, each tested alone or combined with glyphosate, and a weed-free control, totaling 18 treatments. Phytotoxicity was assessed at 7, 14, 21, 28, and 35 days after treatment (DAT). Physiological variables were measured at 21 DAT, and grain yield components were evaluated at harvest. Saflufenacil caused increasing phytotoxicity at doses exceeding 4.38 g ha⁻¹ when applied alone and above 2.17 g ha⁻¹ when combined with glyphosate. The highest doses negatively affected soybean physiology and grain yield components. Soybean tolerated up to 2.17 g ha⁻¹ saflufenacil alone and up to 1.09 g ha⁻¹ combined with glyphosate without significant yield loss. These results highlight the importance of thorough and correct cleaning of the sprayer tank and suggest limit residue levels that avoid crop damage, helping to prevent unexpected damage to soybean in crop rotations. Full article

Objective: The primary objective was to identify whether there were differences in performance for the individual subcomponents of the instrumented timed “Up and Go” (iTUG) between adults with traumatic brain injury (TBI) and healthy controls. Methods: Fifteen adults with moderate-to-severe TBI and fifteen age- and sex-matched controls completed two separate trials of the iTUG. Paired t-tests or Wilcoxon signed rank tests were used to determine the differences between groups. Results: Adults with moderate-to-severe TBI took more time to complete the iTUG (14.50 ± 2.36 s vs. 9.85 ± 1.71 s; p-value = 0.0002), had slower chest flexion angular velocities (63.52 ± 23.25 s vs. 88.19 ± 29.20 s; p-value = 0.0486) and vertical acceleration (2.22 [1.23–2.74] s vs. 3.89 [3.36–5.02] s; p-value = 0.0005) during the sit-to-stand movements, and had slower angular velocities during the turns (p-value < 0.05 for both mean and peak turn angular velocities) compared with the controls. Conclusions: Adults with moderate-to-severe TBI completed the iTUG more slowly than healthy controls. Significant differences were noted in the sit-to-stand and turn subcomponents for adults with moderate-to-severe TBI compared with healthy controls, which would not be apparent from evaluating the total time taken alone. Full article