Search Results (637)

Background/Objectives: Ankle–foot orthoses (AFOs) are commonly used to improve gait in children with cerebral palsy (CP), but their effect on specific gait patterns is underreported. This study evaluates the utilization of the Gait Pattern Classification System for Children with Spastic CP (GaP-CP) to investigate the effects of ankle–foot orthoses on gait kinematics, spatio-temporal parameters and the energy cost of walking. Methods: In this retrospective study, 66 ambulatory children with spastic CP underwent 3D gait analysis with and without AFOs or functional electrical stimulation. Gait patterns were classified according to GaP-CP. AFOs were articulated, flexible, or rigid. Thirty-six children also performed a 5 min walk test with gas exchange measurements. Step length, walking speed, and the energy cost of walking were calculated. Gait kinematics were analyzed with statistical nonparametric mapping. Non-parametric statistics were used to investigate orthotic effects for the total group and for each gait pattern. Results: Ankle kinematics improved in swing phase and initial contact (10 degrees less plantarflexion, p < 0.05) for the total group, dropfoot and genu recurvatum. During the stance phase, reduced knee extension in genu recurvatum (by 3 degrees, p < 0.05) and increased knee extension in crouch (by 3 degrees, p < 0.05) were observed. Median changes in non-dimensional step length were clinically significant (>0.039, p ≤ 0.02, effect size ≥ 0.55) for the total group and the dropfoot, genu recurvatum, and crouch subgroups, while changes in most gait indices, walking speed and the energy cost of walking were not clinically significant. Conclusions: The combined use of GaP-CP and kinematic analysis provided new insights into the effects of ankle–foot orthoses on gait. Articulated and flexible orthoses may not have provided adequate support for genu recurvatum and crouch gait, showing a potential value in gait pattern specific orthotic design to optimize gait kinematics. Full article

Flexible electrolyte-gated synaptic field-effect transistors (EGFETs) have emerged as a promising platform for neuromorphic visual systems, owing to their low-voltage operation, diverse synaptic plasticity, and exceptional mechanical flexibility. In particular, gel-based electrolytes, including hydrogels and ion gels, play a pivotal role as functional gate dielectrics, enabling efficient ion transport and strong ion–electron coupling through electric double-layer (EDL) formation. By leveraging these unique properties at the semiconductor/gel interface, EGFETs can effectively emulate essential biological synaptic behaviors, including short-term and long-term plasticity under optical stimulation. The inherent compatibility of EGFETs with a broad range of semiconductor channels, gel electrolytes, and flexible substrates enables the development of wearable and conformable neuromorphic platforms that seamlessly integrate sensing, memory, and signal processing within a single device architecture. Recent advances in gel material engineering, such as polymer network design, ionic modulation, and nanofiller incorporation, have significantly improved ion transport dynamics, interfacial stability, and device performance. Despite remaining challenges related to ion migration stability, multi-physical field coupling, and large-area device uniformity, these developments have substantially advanced the practical potential of gel-based systems. This review provides a comprehensive overview of the operating mechanisms, gel-based material systems, synaptic functionalities, mechanical reliability, and future prospects of flexible electrolyte-gated visual synapses, highlighting their considerable potential for next-generation intelligent perception and artificial vision technologies. Full article

Background: Electrochemotherapy enhances the intracellular delivery of anticancer agents through electroporation but is traditionally limited to cytotoxic drugs associated with significant side effects. Vitamin C (ascorbic acid) exhibits selective anticancer activity when accumulated at high intracellular concentrations; however, its therapeutic application is restricted by poor membrane permeability and rapid systemic clearance. Methods: In this study, we investigated whether reversible electroporation, applied using a custom-designed variable plate electrode system designed to deliver a uniform electric field, could potentiate the antitumor efficacy of low-dose vitamin C. Numerical simulations were performed to optimize electrode spacing and stimulation voltage, suggesting homogeneous electric field coverage throughout the tumor volume. The proposed approach was evaluated in vitro using MDA-MB-231 and 4T1 breast cancer cell lines and in vivo in a 4T1 murine breast cancer model. Results: Low-dose vitamin C alone produced minimal cytotoxic effects, whereas its combination with electroporation significantly reduced cell viability and increased apoptotic and necrotic cell death in vitro. In vivo, vitamin C–assisted electrochemotherapy resulted in pronounced tumor growth suppression, with tumor volumes reduced to approximately 0.34-fold of baseline by day 15, accompanied by decreased proliferation and marked tissue disruption. Conclusions: These findings demonstrate that uniform-field reversible electroporation markedly enhances the intracellular delivery and antitumor activity of low-dose vitamin C, supporting this technology-driven strategy as a promising, low-toxicity alternative to conventional chemotherapeutic agents in electrochemotherapy for solid tumors. Full article

Objectives: This study aimed to demonstrate the feasibility of a novel wireless energy-transmitting implantable diaphragm pacemaker for restoring respiratory ventilation. Methods: The diaphragm pacing (DP) system was designed based on the principle of electromagnetic resonance coupling. The safety of device implantation was analyzed through finite-element simulations of multi-field coupling between electromagnetic heating and biological tissue. In vitro testing with coils embedded in pork demonstrated the system output characteristics. This device was used in miniature Bama pigs that underwent deep anesthesia and respiratory arrest (N = 8). Respiratory airflow, diaphragmatic displacement, and blood gases were used to evaluate the effectiveness of the designed DP system. Results: Thermal effect simulation results show that the temperature rise of the surrounding tissue does not exceed 2 °C during 1 h of transmission power (0.5–1.3 W) operation of the receiver. In vitro tests with two receivers embedded in pork showed that the DP system can effectively output stimulation waveforms over a certain transmission distance (5–35 mm). The stimulation waveform output by the receiver is consistent with the parameters set by the external controller. In phrenic nerve electrical stimulation experiments, the peak respiratory airflow and tidal volume remained stable over 50 consecutive respiratory cycles. The tidal volume (108.63 mL) and diaphragmatic displacement (0.883–2.15 cm) in a pig induced by DP demonstrate the effectiveness of respiratory ventilation. The arterial blood gas analysis results and temperature rise experiment during implantation further confirmed the effectiveness and safety of the ventilation. Conclusions: The implantable diaphragmatic pacemaker developed in this study exhibits good thermal safety, stable output, and effective respiratory ventilation. A control group with commercial diaphragmatic pacemakers and data from chronic implantation experiments are needed to further evaluate its effectiveness. Full article

Weak alternating electric fields are widely used in neuromodulation techniques such as transcranial alternating current stimulation (tACS), yet the precise biophysical mechanisms underlying neuronal responses remain incompletely understood. Current computational models often neglect the electrical properties of the extracellular microenvironment, limiting their predictive accuracy. Motivated by experimentally observed frequency-dependent modulation of neuronal activity, we developed a two-compartment model of hippocampal CA3 pyramidal neurons in which extracellular resistance is explicitly parameterized and systematically examined as a key factor influencing neuronal response properties under external electric fields. Within a dual-compartment Hodgkin–Huxley framework, the neuron is divided into a “soma–basal dendrite unit” and an “apical dendrite unit,” accounting for voltage polarization induced by external fields. Using phase-locking ratio curves and three-dimensional parameter response surface, we systematically characterized neuronal sensitivity to field parameters and examined how potassium equilibrium potential ($V_K$) and extracellular resistance ($R_{\mathrm{out}}$) modulate these responses. Our results demonstrate that increasing $R_{\mathrm{out}}$ enhances neuronal responsiveness to external fields, while $V_K$ variations primarily regulate intrinsic excitability. These findings provide mechanistic insights into the frequency-dependent modulation of neuronal responses under weak electric fields, consistent with phenomena observed in biological neural systems, and provide a mechanistic and theoretical framework for understanding the joint effects of electric field amplitude and frequency on neuronal sensitivity to weak electric fields, which may help inform future neuromodulation strategies. Full article

Background/Objectives: The renin–angiotensin–aldosterone (RAA) system is a key regulator of cardiovascular homeostasis. Recent evidence suggests that Angiotensin II (Ang II) can trigger ferroptosis, an iron-dependent form of cell death. We previously demonstrated that periodontitis induces neurovascular dysfunction, and our preliminary observations indicate that this oral inflammatory model is associated with elevated blood pressure. However, the mechanism by which Ang II impaired nitrergic vasodilation and triggered ferroptosis in cerebral arteries remains unclear. This study investigates the functional effects of electrical and chemical nerve stimulation in adult spontaneously hypertensive rats (SHR) and Wistar-Kyoto rats (WKY). Methods: Endothelium-denuded basilar arterial (BA) rings from SHRs and WKYs were used to assess the impact of Ang II on neurogenic relaxation via wire myography. Results: Vascular relaxation responses to nicotine and transmural nerve stimulation (TNS) were significantly diminished in SHRs compared to WKYs. This impairment was reversed by both acute preincubation and chronic treatment with losartan (an AT1 receptor antagonist). In WKY BAs, exogenous Ang II pretreatment inhibited relaxation responses to nicotine, TNS, and isoproterenol. Importantly, this inhibition was effectively reversed by marimastat (MMP inhibitor), catalase (antioxidant), and ferrostatin-1 (ferroptosis inhibitor). Conclusions: Our findings indicate that Ang II induces functional alterations in neurovascular signaling patterns by triggering ferroptosis within nerve terminals. This process leads to a functional imbalance between sympathetic and parasympathetic influences, ultimately impairing neurogenic nitrergic dilation in the BAs of SHRs. These results suggest that targeting Ang II-induced ferroptosis may alleviate the neuroinflammation and cognitive decline associated with hypertension-related cerebrovascular dysfunction. Full article

Piezoelectric biomaterials have attracted considerable interest in osteochondral tissue engineering owing to their inherent ability to produce electrical signals in response to mechanical stimuli without external power, thereby closely mimicking the physiological electrical microenvironment required for tissue regeneration. This review comprehensively summarizes recent insights into biological piezoelectricity from the molecular to the macroscopic level, highlighting its interplay with streaming potentials and its regulatory roles in bone and cartilage regeneration. We critically analyze recent advances in major piezoelectric material systems, including ceramics, polymers, and composite scaffolds, with emphasis on their structural characteristics, bioactive performance, and suitability for tissue-specific repair. Among them, polymer-based composite and hybrid piezoelectric scaffolds appear particularly promising for the development of flexible, high-performance osteochondral repair platforms, as they offer a more favorable balance between mechanical compliance, electromechanical output, and biological adaptability. Despite encouraging preclinical findings, significant challenges remain, including biocompatibility, controlled degradation kinetics, and the precise modulation of electrical cues for specific biological contexts. To address these barriers, future research should focus on optimizing scaffold design, integrating responsive and multimodal stimulation strategies, and establishing standardized protocols for preclinical evaluation and clinical translation. Overall, piezoelectric biomaterials hold substantial potential for the development of innovative regenerative therapies for complex osteochondral defects. Full article

Selectively modulating specific brain-rhythm bands with physical stimuli helps both to reveal neural mechanisms and to provide non-pharmacological treatment avenues for brain disorders. This study proposes and implements a multi-channel transcranial magneto-acoustic stimulation driving system based on amplitude-modulated (AM) sine waves (AM-TMAS) intended to supply a reliable hardware platform for noninvasive, focal low-frequency rhythmic electrical stimulation of deep-brain structures. The driving system implements a 64-channel AM module based on an FPGA plus high-speed DACs. Multi-channel precision is achieved via a unified high-speed clock and a global UPDATE trigger. To overcome the large separation between envelope and carrier frequencies, we developed a high-fidelity AM waveform generation method based on DDS + LUT + envelope multiplication. The algorithm first centers the carrier samples to preserve waveform symmetry, then applies LUT-based envelope coefficients and fixed-point envelope multiplication, enabling high-precision AM outputs with carrier frequencies from 100 kHz to 2 MHz and envelope frequencies from 0.1 Hz to 100 kHz. We tested the system’s rhythmic multi-channel AM output performance across frequencies and also measured magneto-acoustic-coupled rhythmic electrical signals produced by the AM-TMAS driving setup. Any single channel reliably produced high-fidelity AM waveforms with a 500 kHz carrier and 8 Hz/40 Hz envelopes; the measured carrier was 499.998 kHz with excellent frequency stability. Both envelope and carrier frequencies are flexibly tunable. At the nominal 500 kHz carrier, envelope fidelity was further quantified: the extracted envelopes achieved NRMSEs of 1.0795% (8 Hz) and 1.9212% (40 Hz), confirming high-fidelity AM synthesis. Under a 0.3 T static magnetic field, the AM-TMAS driving system generated rhythmic electrical responses in physiological saline that carried the expected 40 Hz envelope. The proposed AM-TMAS driver achieves high accuracy in AM waveform generation and robust multi-channel performance, and—when combined with an external static magnetic field—can produce rhythmically modulated magneto-acoustic electrical stimulation. This platform provides a practical technical tool for brain-function research and the development of rhythm-targeted neuromodulation therapies. Full article

Background: Navigated repetitive TMS (nrTMS) is widely used for non-invasive mapping of cortical functions. Methodological improvement might be achieved by optimizing coil positioning based on electric-field modeling and augmented reality (AR)-guided neuronavigation to enhance spatial targeting accuracy and stimulation-induced language errors. Therefore, we compared electric-field-optimized, AR-guided nrTMS with conventional nrTMS using manually planned coil positioning. Methods: Twenty-eight healthy subjects underwent two MRI-guided left hemispheric nrTMS language mapping sessions. Each session used 10 Hz stimulation at a 100% resting motor threshold applied for 1.5 s per region of interest (ROI) during a synchronized object naming task. ROIs were defined according to the Corina cortical parcellation system. Manually defined and electric-field-optimized coil placements obtained using SimNIBS (v4.1.0) were applied; the optimized session was assisted by AR goggles. The primary outcome was the quantitative and categorical differences in cortical regions mapped as language-eloquent. Resting-state fMRI was acquired to provide a reference for comparing nrTMS-derived language maps. Outcomes: Electric-field-optimized nrTMS did not result in an increase in positively mapped ROIs. A different distribution of language errors was observed between sessions. Manual mapping roughly followed the extracted resting-state language and motor networks, whereas electric-field-optimized mapping might correspond less. Optimized coil positions were not always practically feasible. AR guidance improved target location accuracy. Conclusions: While AR was a useful addition to the TMS experiment, electric-field optimization did not translate into significant behavioral differences. However, altered distribution of language errors can give insight into underlying neurophysiological processes of rTMS. Full article

Transcutaneous electrical nerve stimulation (TENS) is constrained by high skin impedance and unstable electrode contact. This study proposes a novel composite electrode system comprising a polyvinyl alcohol/silver (PVA/Ag) microneedle array and a highly conductive polyacrylamide/lithium chloride (PAAm/LiCl) hydrogel. The PVA/Ag microneedles (~365 µm in height, ~48 µm tip diameter) possess sufficient mechanical strength to penetrate the stratum corneum, establishing a low-resistance pathway. The complementary PAAm/LiCl hydrogel exhibits high conductivity (10.28 S/m) and mechanical flexibility, further optimizing the interface contact. The experimental results demonstrate that this composite system achieves low electrochemical impedance and induces stable, clear electromyographic responses in vivo. It effectively addresses the common issues of electrode detachment and signal attenuation associated with conventional electrodes, offering a promising hardware solution for efficient and comfortable wearable rehabilitation devices. Full article

Background: Mas-related G-protein-coupled receptor b4 (Mrgprb4)-lineage neurons in the peripheral nervous system are a type of C fibers in hairy skin. Our prior work demonstrated that these neurons respond to both noxious and innocuous mechanical and thermal stimuli. Ablating them eliminates the pleasant sensation elicited by gentle pressure on a mouse’s nape. However, their potential role in mitigating pain and pain-related negative emotions in response to somatic stimuli remains unclear. Methods: A CFA-induced chronic pain and anxiety comorbidity model was established in C57BL/6J mice. In vivo calcium imaging of dorsal root ganglia (DRG) neurons in Mrgprb4-GCaMP6s transgenic mice characterized neuronal responses to transcutaneous electrical nerve stimulation (TENS) at the Zusanli (ST36) acupoint. Optogenetic activation (Mrgprb4-ChR2 mice) and viral ablation of Mrgprb4-lineage neurons were employed to evaluate their role in mediating TENS effects on mechanical pain thresholds and anxiety-like behaviors. Results: In vivo calcium imaging revealed that 0.5 mA TENS preferentially activated Mrgprb4-lineage neurons compared to 2.0 mA TENS. In CFA model mice, 0.5 mA TENS at ST36 significantly increased mechanical pain thresholds and reduced anxiety-like behaviors in the open-field test. Optogenetic activation of Mrgprb4-lineage neurons at ST36 replicated these analgesic and anxiolytic effects, demonstrating the sufficiency of these neurons for therapeutic outcomes. Conversely, viral ablation of L3–L5 Mrgprb4-lineage neurons substantially attenuated the therapeutic effects of 0.5 mA TENS for both pain relief and anxiety reduction, indicating their necessity in mediating TENS efficacy. Conclusions: Mrgprb4-lineage neurons serve as critical peripheral mediators of TENS-induced analgesia and anxiolysis. These findings identify a specific neuronal population underlying the therapeutic effects of somatic stimulation at ST36, providing mechanistic insights that may guide optimization of TENS parameters for treating chronic pain and comorbid anxiety in clinical settings. Full article

Mesial temporal lobe epilepsy (TLE) is the most common and severe form of focal epilepsy. This review examines the diverse mechanisms by which the GABAergic system contributes both to seizure generation and to protective processes that limit epileptogenesis and seizure progression in TLE. We focus on findings from established animal models of TLE as well as studies of surgically resected tissue from patients who had undergone therapeutic intervention. Experimental models include sustained electrical stimulation of the perforant path, as well as the kainic acid (KA) and Li-pilocarpine models. Although these paradigms induce status epilepticus (SE) through distinct mechanisms, they ultimately converge on prolonged excitation of hippocampal CA3 pyramidal neurons and interconnected regions of the hippocampus and broader limbic network. In response to epileptic seizures, GABA synthesis is enhanced, as evidenced by the marked upregulation of the GABA-synthesizing enzymes GAD65 and GAD67, along with their ectopic expression in glutamatergic mossy fibers of the hippocampus. Shortly after acute seizures, a transient expression of the embryonic GAD67 splice variant, GAD25, is observed, although its functional significance remains unclear. At the receptor level, animal models of TLE show upregulation of GABA_A receptor subunits α2, α4, β3, and γ2, accompanied by downregulation of α5 and δ subunits, suggesting reduced tonic inhibition. In contrast, hippocampal tissue from patients with TLE exhibits pronounced upregulation of α5 and δ subunits, indicative of enhanced extrasynaptic tonic inhibition. Similarly, whereas GABA_A receptor subunits are mildly downregulated in animal models, they are consistently upregulated across hippocampal subfields in human TLE, pointing toward strengthened GABAergic inhibition. Conversely, genetic variants of GABA_A receptor subunits and autoantibodies targeting these receptors can contribute to the etiology of epilepsy, often with onset in childhood. Moreover, degeneration or functional silencing of specific GABAergic interneuron populations—such as parvalbumin-positive neurons in the subiculum—can induce epilepsy in rodent models and is likewise associated with TLE in humans. Full article

Electric Vehicles (EVs) can contribute significantly to reducing greenhouse gas emissions and addressing climate change problems. Modern EVs are primarily powered by electrochemical batteries such as lead-acid (Pb-acid), nickel-metal hydride (NiMH), sodium-ion (Na-ion), solid-state and lithium-ion (Li-ion) batteries. When compared to other battery types, Li-ion batteries are the most suitable for EV applications due to their practical features such as their high energy density, high charging and discharging efficiency and extended lifetime. However, the main risk of Li-ion batteries is that they are exposed to thermal runaway phenomena, which raises severe concerns about the safety of EV propulsion systems. Thermal runaways should be considered carefully as they cannot be stopped once they start and can lead to battery explosion. One of the main reasons leading to this phenomenon is abusing the state of charge (SoC) of the battery. Therefore, the battery management system (BMS) plays a crucial role in mitigating the stimulation of the thermal runaway process by accurately estimating and properly managing the battery cells. To help researchers and designers with understanding this matter, this paper proposes a review of the most effective SoC estimation methods for EV Li-ion batteries and links these methods with practical energy management systems in the EV market. Full article

Introduction: Pelvic floor disorders (PFDs) are a very widespread clinical phenomenon and are known to affect millions of women worldwide, significantly impairing their quality of life. New technologies and innovations such as electrotherapy and photobiostimulation are currently revolutionizing what concerns conservative treatment, allowing clinicians to tailor therapy to every woman. The aim of this study was to evaluate the feasibility of use of electrotherapy and photobiostimulation in PFD management and the initial results of treatment in clinical practice. Methods: This prospective study (IRB code: GSM-RF 2025) aimed to analyze the impact of the innovative DAFNE system to treat PFDs through electrotherapy and photobiostimulation. We enrolled patients with mild pelvic organ prolapse and stress urinary incontinence who desired a conservative treatment for their conditions. The following validated scales were used for assessing baseline quality of life before and after treatment: Urinary Distress Inventory-6 (UDI-6), Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6), Female Sexual Function Index-6 (FSFI-6), 0–100 VAS Scale, and Vaginal Health Index. Electrotherapy was delivered through 4 gold rings, providing Functional Electrical Stimulation (FES), Transcutaneous Electrical Nerve Stimulation (TENS) and/or Microcurrent Electrical Neuromuscular Stimulation (MENS). The photobiostimulation system consisted of 24 LEDs per wavelength (420 nm UVA; 630 nm RED; 870 nm NIR/INFRARED) positioned at 360° along the entire length of the handpiece for antimicrobial purposes, microcirculation improvement, and anti-inflammatory action. The cycle of treatment consisted of 3–5 sessions, according to necessity. Overall improvement was measured through the Patient Global Impression of Improvement (PGI-I). Statistical analysis was performed using Student’s t-Test. A value of p < 0.05 was considered as significant. Results: In the period of interest, 32 women were treated with the DAFNE system. The mean age was 57.0 ± 16.6 years. Indications for treatment were stress urinary incontinence (16/32), mild pelvic organ prolapse (14/32), or both (2/32). The mean number of treatments per patient was 4. Quality of life improved as a consequence of the treatment according to the considered scales. Specifically, 87.5% of patients considered themselves improved. Conclusions: The DAFNE system has been successful in managing mild pelvic organ prolapse and stress urinary incontinence, improving quality of life scores. Embracing new technologies such as electrotherapy and photobiostimulation appears to be successful in conservatively managing a variety of PFDs. Full article

Background: Obstructive sleep apnea (OSA) is a highly prevalent and heterogeneous disorder associated with substantial cardiometabolic morbidity. Although continuous positive airway pressure (CPAP) remains first-line therapy, long-term effectiveness is frequently limited by suboptimal adherence. Advances in airway devices, surgical techniques, neuromodulation, and pharmacologic therapies have expanded the therapeutic landscape and created opportunities for individualized, mechanism-based treatment. Methods: We conducted a selective, narrative review with structured quantitative synthesis of randomized controlled trials, comparative cohorts, long-term follow-up studies, registries, and mechanistic investigations addressing OSA therapies beyond CPAP. Evidence spanning oral appliances, upper-airway and skeletal surgery, hypoglossal nerve stimulation, neuromuscular electrical stimulation, positional therapy, and pharmacologic interventions targeting metabolic and non-anatomical endotypes was integrated. Outcomes of interest included apnea–hypopnea index (AHI), oxygenation, blood pressure, patient-reported symptoms, durability, safety, and real-world adherence. Results: Mandibular advancement devices (MADs) consistently reduced AHI relative to placebo and produced symptom relief comparable to CPAP in mild-to-moderate OSA, largely due to superior adherence. Palatal surgery yielded meaningful short-term improvement in selected patients but demonstrated limited long-term durability. In contrast, maxillomandibular advancement (MMA) achieved the largest and most durable reductions in OSA severity, with efficacy comparable to CPAP and superior to other surgical modalities in appropriate skeletal phenotypes. Hypoglossal nerve stimulation (HNS) produced substantial, durable improvements in AHI and symptoms with high adherence, supported by randomized trials, long-term follow-up, and real-world registry data; newer bilateral and proximal stimulation systems may further broaden candidacy. Neuromuscular electrical stimulation and positional therapy provided modest, phenotype-dependent benefits, primarily as adjunctive or early-stage interventions. A major advance is the emergence of metabolic and endotype-targeted pharmacotherapy: longitudinal data demonstrate a dose-dependent relationship between weight change and OSA progression or regression, while randomized trials show that GLP-1-based therapies—particularly dual GLP-1/GIP agonism with tirzepatide—produce large, clinically meaningful reductions in AHI and cardiometabolic risk in obesity-associated OSA. Additional pharmacologic strategies targeting ventilatory loop gain and arousal threshold further support an endotype-driven treatment paradigm. Conclusions: Contemporary OSA management is shifting from a CPAP-centric model toward a precision-guided, multimodal framework that aligns therapy with dominant anatomic and physiological contributors to airway collapse. Integrating metabolic, neuromodulatory, and structural interventions—often in combination—offers the potential for durable disease control and improved patient-centered outcomes. Future priorities include head-to-head and combination trials, long-term cardiovascular outcomes, cost-effectiveness analyses, and pragmatic tools to operationalize personalized OSA therapy in routine clinical practice. Full article