Search Results (677)

Background and Objectives: Sarcopenia is highly prevalent among maintenance hemodialysis (HD) patients, particularly in the presence of diabetes mellitus (DM). Dietary glycemic and insulinemic characteristics may contribute to metabolic disturbances associated with muscle deterioration, although evidence in HD populations remains limited. This study aimed to investigate the associations between dietary indices, sarcopenia, nutritional status, and clinical outcomes in diabetic (DM+) and non-diabetic (DM−) HD patients. Materials and Methods: This cross-sectional study included 92 maintenance HD patients (43 DM+ and 49 DM−). Dietary intake was assessed using three-day food records, and dietary insulin index (DII), dietary insulin load (DIL), dietary glycemic index (DGI), and dietary glycemic load (DGL) were calculated. Sarcopenia was evaluated using handgrip strength, bioelectrical impedance analysis, gait speed, and SARC-F. Anthropometric, biochemical, nutritional, and sarcopenia-related parameters were compared across tertiles of dietary indices. Results: Sarcopenia was identified in 32.6% of patients with diabetes and 36.7% of those without diabetes. Diabetic patients exhibited significantly lower handgrip strength, slower walking speed, longer walking time, and higher SARC-F scores (p < 0.01). Across DGL tertiles in DM+ patients, significant progressive increases were observed in body weight (p < 0.05), body mass index (p < 0.05), lean mass (p < 0.05), mid-upper arm circumference (p < 0.01), and triceps skinfold thickness (p < 0.01). Higher DIL and DGL tertiles were also associated with elevated serum phosphorus, LDL cholesterol, triglycerides, and total cholesterol levels (p < 0.05). DIL and DGL showed stronger associations with overall energy and nutrient intake compared with DII and DGI. However, no significant associations were identified between dietary indices and sarcopenia diagnosis or sarcopenia-related risk indicators after adjustment for age and sex. Conclusions: Dietary indices were associated with various anthropometric, biochemical, and nutritional parameters in HD patients, with more pronounced associations observed among patients with DM, suggesting a potential role of dietary quality in the nutritional and metabolic profile of this population. Full article

Background/Objectives: Digital, remote, and ecological tools may complement clinic-based assessment in multiple sclerosis (MS), but the distribution of evidence across fatigue/fatigability, mobility, and real-world functional activity remains unclear. This scoping review mapped tools, metrics, constructs, contexts of use, and reported clinical utility in adults with MS, with attention given to whether the evidence was balanced across domains. Methods: Following Joanna Briggs Institute guidance and PRISMA-ScR/PRISMA-S reporting standards, five databases were searched on 14 March 2026. After deduplication, title/abstract screening, full-text assessment, and manual extraction and verification, the findings were synthesized descriptively without formal critical appraisal. Results: Of 3100 records identified, 1433 unique records were screened and 125 sources were included. Gait was the most frequently assessed domain (105/125), followed by fatigue/fatigability (33/125), physical activity (29/125), and sleep (2/125). The most frequent technologies were wearable devices (60/125), accelerometry (54/125), remote/home-based/telemonitoring modalities (52/125), and inertial measurement units (42/125). Conclusions: The evidence is predominantly gait- and mobility-focused, while fatigue/fatigability and broader real-world functional activity are less consistently represented. Reported clinical utility was usually framed around functional assessment, longitudinal/remote monitoring, rehabilitation planning, patient stratification, and decision support, but these characteristics were extracted as reported and were not independently appraised. Full article

Background/Objectives: White–Sutton syndrome (WHSUS; OMIM 616364) is a rare neurodevelopmental disorder caused by pathogenic variants in the POGZ gene and characterized by developmental delay, intellectual disability, speech impairment, autism spectrum features, and dysmorphic traits. Although most reported cases are sporadic, inherited forms are exceptionally rare. We describe a familial case of WHSUS involving an affected mother and two children carrying a heterozygous POGZ nonsense variant, highlighting marked intra-familial phenotypic variability and expanding the clinical spectrum of the disorder. Methods: Clinical evaluation included multidisciplinary assessments. Genetic testing was performed using clinical exome sequencing (CES) with a virtual neurodevelopmental disorder (NDD) gene panel, followed by Sanger confirmation and segregation analysis in family members. The POGZ transcript reference NM_015100.3 was used for variant nomenclature and verified with the Mutalyzer tool. CNV detection from NGS data was performed using the Alissa CNV caller (Agilent) and visualized via IGV; the Xp11.22 microduplication was confirmed by chromosomal microarray (aCGH) and parental segregation analyses. Results: CES identified the heterozygous pathogenic POGZ variant c.1522C>T (p.Arg508*) in the female proband (III₆), an infant presenting with global developmental delay, hypotonia, speech impairment, gait abnormalities, and characteristic dysmorphic features. Segregation analysis demonstrated maternal inheritance and confirmed the presence of the variant in her affected brother (III₄), who also carries a de novo 1.79 kb microduplication at Xp11.22, while the maternal grandparents tested negative, indicating a de novo origin in the mother. The mother exhibited an attenuated phenotype, including mild neuropsychiatric and gastrointestinal manifestations. The variant is predicted to undergo nonsense-mediated decay (NMD), consistent with a moderate clinical presentation; however, experimental validation was not performed. Conclusions: This report documents a rare familial occurrence of WHSUS with highly variable expressivity. Our findings broaden the phenotypic and molecular characterization of POGZ-related disorders and emphasize the importance of comprehensive segregation studies and early genomic diagnosis. While experimental data link POGZ deficiency to DNA repair defects, no longitudinal clinical studies have demonstrated increased cancer risk in WHSUS; therefore, formal malignancy screening guidelines cannot be established at present, and this issue deserves future study in larger cohorts or registries. Full article

Background: Polypharmacy is highly prevalent among older adults with type 2 diabetes mellitus (T2DM) and is traditionally considered a marker of geriatric vulnerability. However, it remains unclear whether polypharmacy is more closely associated with multidimensional frailty or metabolic burden in this population. Methods: In this retrospective cross-sectional study, 278 adults aged ≥65 years with T2DM underwent comprehensive geriatric assessment (CGA), including evaluation of functional status, cognition, nutrition, depressive symptoms, frailty, and physical performance. Frailty was assessed using the Fried phenotype. Polypharmacy was defined as the concurrent use of ≥5 medications. Multivariable logistic regression and interaction analyses were performed to identify independent predictors of polypharmacy. Receiver operating characteristic (ROC) analyses were conducted to evaluate the discriminative performance of metabolic parameters. Results: Polypharmacy was present in 54.7% of participants. Patients with polypharmacy had significantly higher HbA1c and fasting glucose levels compared with those without polypharmacy (both p < 0.001). In multivariable analysis, higher HbA1c levels remained independently associated with polypharmacy (OR = 4.99, 95% CI: 3.18–7.84, p < 0.001), whereas frailty status was not significantly associated with polypharmacy (OR = 0.58, 95% CI: 0.15–2.21, p = 0.427). No significant interaction was observed between HbA1c and frailty status (p for interaction > 0.05). Among CGA domains, only functional status and gait speed differed in unadjusted analyses, while cognition, nutritional status, and depressive symptoms were not significantly associated with polypharmacy after adjustment. HbA1c demonstrated strong discriminative performance for polypharmacy (AUC = 0.898, 95% CI: 0.863–0.931), with an optimal cut-off of 6.81%. Conclusions: In older adults with T2DM, polypharmacy appeared to be more closely associated with markers of poor glycemic control, particularly HbA1c levels, than with frailty status itself. These findings suggest that medication burden in older adults with T2DM may reflect treatment intensification and suboptimal glycemic control in addition to geriatric vulnerability. Full article

Acoustic gait recognition is an emerging passive biometric modality that identifies individuals by unique walking sound patterns. This work presents a reproducible benchmarking framework for convolutional neural network (CNN)-based acoustic gait recognition, providing a systematic evaluation methodology across varying identity pool sizes. Raw footstep recordings from the AFPILD dataset were converted into 128-bin mel-spectrograms and used to train a compact CNN across identity pool sizes from 10 to 40 subjects. To ensure statistical reliability, a three-times-repeated five-fold stratified cross-validation protocol was implemented. Experimental results demonstrate strong discriminative capability, with validation accuracy reaching 94.92% and Equal Error Rate (EER) of 1.31% for the 40-subject configuration. A multi-seed subset validation experiment across five independent random subject draws per pool size confirmed that the observed scaling trend is consistent across subset compositions rather than an artifact of a single subject selection. Additional analysis confirmed the framework’s resilience to moderate environmental noise and its superiority over classical Mel-Frequency Cepstral Coefficients paired with a Support Vector Machine (MFCC-SVM) and Convolutional Recurrent Neural Network (CRNN) baselines, supporting the feasibility of acoustic gait recognition as a passive biometric modality. Full article

This study analyzed the spatial distribution characteristics of the foot-end trajectory of a robotic leg mechanism during different gait phases. Based on this analysis, a task space partition-based dimensional parameter optimization method was proposed. To further evaluate the spatial distribution of the high-performance transmission regions after optimization, a box-counting dimension and lacunarity were introduced as supplementary characterization indices. First, according to the functional requirements of different gait phases, the task space of the mechanism is partitioned into stance, mid-swing, and swing-transition regions. A unified kinematic model and singularity criterion are then established for the planar five-bar mechanism, and mechanism performance indices for different task regions are constructed based on the Jacobian matrix to characterize the force and velocity transmission capabilities of the mechanism, as well as its singularity margin. A genetic algorithm is used to perform dimensional synthesis optimization of the mechanism parameters. Furthermore, a task space transmission performance field is introduced, and the area ratio, box-counting dimension, and lacunarity of regions with high performance are used to characterize the spatial structure of high-performance transmission regions before and after optimization. Finally, a series of theoretical calculations and physical experiments are conducted to verify that the differential characteristics of the mechanism have a significant influence on both its static and dynamic performance. The experimental results show that the optimized mechanism achieves lower normalized objective values in all task regions and outperforms the reference mechanism in load capacity, static power consumption, positioning accuracy, and trajectory consistency. The maximum static load capacity reaches 1.29 times that of the reference mechanism, while the static power consumption is reduced to approximately one half of that of the reference mechanism. Full article

Pupil response may be a useful biomarker in Parkinson’s disease (PD) due to links with autonomic function and cognitive load. However, research has focused on static tasks, missing functional demands during real-world activities like walking. Methods: We recruited 38 people with PD and 16 healthy controls who walked for 2 min under single- and dual-task conditions while wearing mobile eye-tracking glasses (Tobii Pro Glasses 2, 100 Hz). Pupil response outcomes (velocity, size, difference between eyes) were extracted alongside gait characteristics from inertial sensors. Known groups validity compared PD and controls; convergent/divergent validity examined relationships with cognitive, visual, clinical, and gait measures. Results: People with PD had significantly altered pupil constriction/dilation velocity (p = 0.01), a larger difference between their left and right pupils (p = 0.04), and a larger mean and minimum pupil size (p ≤ 0.01) compared to controls during walking. Pupil response correlated with cognitive function (JLO, CLOX1, TMTB), visual acuity, disease severity (MDS-UPDRS-III), and gait characteristics in both groups. No dual-task effects were observed. Conclusions: Pupil response during walking demonstrates known groups and convergent validity, indicating potential as a clinical biomarker for PD. Following this initial study, more research is required to further validate pupil response in PD (e.g., analytical validation and testing within real-world ecologically valid environments). Full article

Background: High-heeled footwear is widely used by women, yet its systemic influence on spatiotemporal gait parameters, pelvic kinematics, and propulsion across a range of heel heights remains incompletely characterised. This study aimed to quantify gait changes across four footwear conditions and assess the contribution of anthropometric characteristics to observed gait variability. Methods: A within-subject repeated-measures study was conducted with 75 healthy young adult women (mean age 24.3 years, BMI 21.3 kg/m²) assessed barefoot, in ballerina flats, 8 cm heels, and 12 cm heels using the G-WALK inertial measurement system (BTS Bioengineering). Thirty gait parameters were analysed using the Friedman test with Bonferroni-corrected Wilcoxon post hoc comparisons (α_adj = 0.0083), Spearman rank correlations, multiple linear regression, and Kruskal–Wallis tertile analysis. Results: Footwear significantly affected 22 of 30 parameters. Walking speed was higher in all shod conditions than barefoot (up to +9.2%), driven entirely by stride elongation with cadence unchanged, indicating a general effect of footwear rather than heel elevation specifically. Stride length peaked at 8 cm heel (+8.9% vs. barefoot) and declined at 12 cm. Gait symmetry decreased progressively with heel height. Ballerina shoes produced a distinctively dynamic temporal profile—shortest stance duration, lowest double support, and highest single support time—significantly different from both barefoot and heeled conditions. The propulsion index increased height-dependently with heel height, rising 23.3% from barefoot (8.20) to 12 cm heel (10.11; p < 0.001). Pelvic obliquity symmetry was disrupted at 12 cm heel, while tilt symmetry was unaffected. Anthropometric analysis identified 110/600 significant Spearman correlations (23 surviving Benjamini–Hochberg FDR correction) and 29/120 significant regression models (14 surviving FDR); age, body weight, and shoe size were the most consistent predictors, most reliably in the barefoot condition. Conclusions: Heel height exerts condition-specific effects on gait biomechanics. Ballerina shoes produce a gait pattern distinct from both barefoot and heeled walking. Propulsion demand increases height dependently with heel elevation. Because participants walked in their own footwear, the observed effects reflect the combined characteristics of each shoe type rather than heel elevation in isolation. Anthropometric characteristics—particularly age, body weight, and shoe size—are modestly associated with footwear–gait responses and may inform future biomechanical research, although clinical application requires confirmation in standardised-footwear studies and clinical populations. Full article

Neuropathic pain is a debilitating condition lacking objective and quantitative assessment tools, as current evaluations rely largely on subjective reports. Hyperspectral imaging (HSI) is a non-invasive technology that quantifies spatial and spectral tissue characteristics and has been applied in rheumatologic and metabolic disorders. This study investigated whether HSI-detected paw skin alterations correlate with graded nerve injury severity in a chronic constriction injury (CCI) model. Sprague–Dawley rats were assigned to sham or CCI groups with one to four sciatic nerve ligatures. Behavioral assessments (CatWalk XT gait analysis, thermal hyperalgesia, and mechanical allodynia) and paw HSI measurements were performed longitudinally. Histological and molecular analyses were conducted from paw skin to dorsal spinal cord tissues. At 1100 nm, HSI demonstrated progressive and significant spectral deviations proportional to injury severity across all CCI groups, whereas 1300 nm changes were only detected in severe injuries. Histology revealed increased fibrosis, NGF, TNF-α, synaptophysin, and microglial activation with greater injury severity, alongside reduced PGP9.5, neurofilament, AChR, Desmin, GAP-43, Pax3, and BDNF expression. These molecular findings were supported by electrophysiological and behavioral impairments, which correlated with injury grade by HSI. In conclusion, HSI at 1100 nm provides a sensitive and objective indicator of neuropathic pain severity and holds promise as a quantitative translational tool. Full article

Background/Objectives: The suboccipital muscles (SOMs) are rich in muscle spindles and play a critical role in proprioceptive input and postural control. However, the relationship between SOM tone, head posture, and balance performance remains unclear. Therefore, this study aimed to investigate the association between SOM tone and postural balance, including the craniovertebral angle (CVA), static balance, and dynamic balance, in healthy adults. Methods: A total of 112 healthy adults participated in this study. SOM, cervical extensor muscle (CEM), and upper trapezius muscle (UTM) tones were assessed. Head posture was evaluated by measuring the CVA. Static balance was assessed through the trajectory of the center of pressure (COP), whereas dynamic balance was evaluated using gait parameters. Results: Participants with a higher SOM tone exhibited a significantly smaller CVA, increased COP path length and velocity, and narrower step width during walking than did those with a lower tone. The regression analysis showed that SOM tone was significantly associated with CVA (β = −0.219, p = 0.020), COP path length (β = 0.308, p = 0.001) and velocity (β = 0.296, p = 0.002), and step width (β = −0.242, p = 0.014), whereas CEM and UTM tone were not significantly associated with these variables. Conclusions: These findings suggest that SOM tone may be associated with postural control characteristics among healthy adults. Full article

Background/Objectives: Normal pressure hydrocephalus (NPH) is a treatable cause of gait impairment and fall risk in older adults, yet it remains frequently underdiagnosed. This study aimed to validate an automated measurement of the callosal angle, a recognized imaging marker of NPH, adapted for use on routine head computed tomography (CT). Methods: We performed a retrospective analysis of 198 patients with probable NPH, confirmed by gait improvement following lumbar tap test, and 198 age- and sex-matched controls presenting with headache and negative head CT findings (mean age 74 ± 7 years; 60% male in both groups). Manual callosal angle measurements were independently obtained by trained residents and reviewed by neuroradiologists. Automated and manual measurements were compared using intraclass correlation, and diagnostic performance was assessed across threshold values. Results: Automated callosal angle measurements demonstrated strong agreement with manual measurements (ICC = 0.90). Using an automated callosal angle threshold of <90°, diagnostic accuracy was 84.1%, with sensitivity of 90.4% and specificity of 77.8%. Optimization to a 95° threshold yielded an accuracy of 85.9%, with both sensitivity and specificity of 85.9%. The area under the receiver operating characteristic curve was 0.915 (95% CI, 0.897–0.933). Conclusions: Automated callosal angle assessment on routine head CT provides reliable and scalable detection of NPH, supporting its use as a screening tool to facilitate earlier diagnosis and treatment of a potentially reversible cause of dementia. Full article

Integrating depth sensors into mobile robots enables automated gait monitoring with potential applications in neurological disorders. This pilot study aims to evaluate the preliminary feasibility of robot-assisted gait assessment using Azure Kinect against Vicon, including individuals with multiple sclerosis, while simultaneously examining between-system, within-system, and environmental effects. A total of 20 participants were recruited to complete the eight-meter straight-line and 32 m corridor walking tests in the laboratory on the same day. Following independent data acquisition by both systems, temporal alignment was achieved through foot-event anchoring and interval trimming. On a unified timeline, 8 joint kinematic signals and 26 descriptors were extracted. Generalized estimating equations were applied, with a Bonferroni correction implemented for the 26 parallel tests to control the family error rate. The results showed: The spatiotemporal gait metrics exhibited general stability between systems and environments. Vicon better revealed variations in hip and pelvic amplitudes and restricted extension phenotypes, while the robotic system demonstrated greater sensitivity to knee posture and relative swing amplitude. The corridor environment induced an increase in stride length and a reduced step time compared to the laboratory, accompanied by a greater peak of hip and knee flexion and a greater forward lean of the trunk, with a largely preserved temporal organization. Within the Vicon-referenced framework, Azure Kinect-based robotic assessment demonstrated preliminary feasibility for capturing gait-related characteristics in individuals with multiple sclerosis. However, due to the limited number of analyzed MS participants, these findings should be interpreted as exploratory rather than as definitive clinical validation. The two systems exhibit complementary kinematic advantages. We recommend adopting an evaluation protocol that combines laboratory baseline with corridor validation, supplemented by descriptor-level mapping for cross-system data integration when necessary. This approach may support future tiered assessment, disease progression monitoring, and efficacy evaluation, but larger clinical cohorts are required to confirm its applicability in individuals with multiple sclerosis. Full article

WiFi sensing has gained widespread attention as a promising technology, owing to its non-intrusiveness, strong privacy-preserving characteristics, and cost-effective deployment, enabling diverse application scenarios. In addition, the stable spatial characteristics and symmetry-related patterns exhibited by human body postures in WiFi signal propagation provide new possibilities for robust person identification. In traditional WiFi-based person identification technologies, although gait recognition has achieved certain success, it is complex to operate and limited in application scenarios, increasing the constraints on recognition. This issue becomes more pronounced in large-scale user scenarios, where the system performance tends to degrade and exhibit instability. To overcome these challenges, we introduce a new person identification system called WiPID. The WiFi signals extracted from the static postures of users are treated as a “biometric fingerprint” for identity verification. An end-to-end deep learning framework is utilized by WiPID to process WiFi signals, and a convolutional autoencoder is adopted to preprocess the signals directly, effectively reducing redundant information and greatly simplifying the WiFi data processing. Furthermore, the integration of a multi-scale feature extraction module improves the system’s ability to capture discriminative features. The proposed system not only reduces operational complexity but also extends its applicability to a wider range of scenarios, thereby enhancing recognition performance. In an experiment involving 50 volunteers, WiPID achieved an average recognition accuracy of up to 98%, demonstrating the method’s suitability for large-scale person identification scenarios. In addition, a real-time identification experiment has been conducted on PCs and commercial WiFi devices. Experiments have proven that WiPID can achieve real-time person identification on Internet of Things devices, further validating its feasibility and stability in practical applications. Full article

Hexapod robots are attractive for operation in cluttered and uneven environments, but their walking stability is strongly affected by the coupled effects of leg morphology and foot-end trajectory planning. In many existing designs, leg-segment proportions, reachable workspace, and swing-phase trajectory smoothness are considered separately, which makes it difficult to clarify how structural parameters and motion planning jointly influence locomotion stability. To address this issue, this study presents a spider-leg-inspired hexapod robot with a simplified three-degree-of-freedom leg configuration. Selected functional characteristics of spider legs, including segmented limb structure and compliant distal contact, were abstracted into an engineering-feasible hexapod platform rather than directly reproducing spider anatomy. A parametric workspace analysis was conducted under a fixed total leg length to compare six candidate femur-to-tibia ratios. Based on forward reach, vertical foot-lifting capability, stride potential, and structural compactness, a 4:6 femur-to-tibia ratio was selected. In addition, an eleventh-order Bézier curve was developed for swing-phase foot trajectory planning and compared with a conventional composite cycloid trajectory under identical tripod-gait conditions. Simulation and straight-line walking experiments showed that the Bézier-based trajectory reduced body-attitude fluctuation and produced smoother angular-velocity variation than the composite cycloid trajectory. The results indicate that the proposed structural design and Bézier-based trajectory can improve flat-ground walking stability of the hexapod robot. This work provides a practical reference for biomimetic structural design and gait-trajectory optimization of multi-legged robots, while further validation on more complex terrain remains necessary. Full article

Background and Objectives: Knee osteoarthritis (KOA) is a degenerative joint disease that affects quality of life through pain, impaired functional performance, and altered gait patterns. Hydrotherapy is a well-tolerated form of physical rehabilitation, especially suitable for patients with severe pain, as water’s properties support movement while reducing joint load. Its effects have been widely studied, primarily focusing on patient-reported outcomes, with limited synthesis of functional performance and gait-related outcomes. Materials and Methods: A systematic search was conducted in PubMed, Web of Science, Cochrane, PEDro, SpringerLink, ScienceDirect, and Google Scholar, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search strategy included a combination of Medical Subject Headings (MeSH) terms and keywords. For example, the PubMed search strategy was as follows: (“knee osteoarthritis” OR “knee OA”) AND (“hydrotherapy” OR “aquatic therapy” OR “water-based exercise”) AND (“gait” OR “walking” OR “functional performance”). Randomized controlled trials (RCTs) from the last 10 years involving patients with KOA undergoing aquatic therapy were included. Primary outcomes included functional performance assessed by measures such as the 6 min walking test (6MWT), the Timed Up and Go (TUG) test, the five sit-to-stand (5 STS) and stair climb (SC) tests, and by using gait-related parameters (e.g., speed, cadence, and step length) assessed clinically or using technology. Patient-reported outcomes, including the Visual Analog Scale (VAS), Western Ontario and McMaster University’s Osteoarthritis Index (WOMAC), and Knee Injury and Osteoarthritis Outcome Score (KOOS), were analyzed as a secondary objective. Results: A total of 479 studies were identified, of which 13 met the eligibility criteria. The results revealed improvements in functional performance, with increases in 6MWT in five studies, the TUG test in four trials, and better performance in the 5-STS and SC tests in five studies. Benefits in gait parameters were noted in four studies. Additionally, one of the articles reported improvements in static and dynamic balance, another showed enhanced proprioception, and a third described more efficient muscle activation during gait following hydrotherapy. Consistent benefits in pain reduction, joint stiffness, and activities of daily living, as reflected by VAS, WOMAC, and KOOS, were also noted immediately and maintained at follow-up. The variability in outcome measures and intervention characteristics limited the possibility of data integration and the calculation of effect sizes. Conclusions: Hydrotherapy as a rehabilitation intervention may be associated with improvements in functional capacity, mobility, and self-reported physical ability in patients with KOA, with some evidence supporting a beneficial effect on gait; however, the certainty of evidence remains low to moderate due to heterogeneity among studies and limited sample sizes. These findings should be interpreted in light of the methodological limitations identified across the included trials. Full article