Search Results (423)

Background/Objectives: The SARS-CoV-2 and influenza A (H1N1)pdm09 pandemics have resulted in high numbers of ICU admissions, with high mortality. Identifying risk factors for ICU mortality at the time of admission can help optimize clinical decision making. However, the risk factors identified may differ, depending on the type of analysis used. Our aim is to compare the risk factors and performance of a linear model (multivariable logistic regression, GLM) with a non-linear model (random forest, RF) in a large national cohort. Methods: A retrospective analysis was performed on a multicenter database including 8902 critically ill patients with influenza A (H1N1)pdm09 or COVID-19 admitted to 184 Spanish ICUs. Demographic, clinical, laboratory, and microbiological data from the first 24 h were used. Prediction models were built using GLM and RF. The performance of the GLM was evaluated by area under the ROC curve (AUC), precision, sensitivity, and specificity, while the RF by out-of-bag (OOB) error and accuracy. In addition, in the RF, the im-portance of the variables in terms of accuracy reduction (AR) and Gini index reduction (GI) was determined. Results: Overall mortality in the ICU was 25.8%. Model performance was similar, with AUC = 76% for GLM, and AUC = 75.6% for RF. GLM identified 17 independent risk factors, while RF identified 19 for AR and 23 for GI. Thirteen variables were found to be important in both models. Laboratory variables such as procalcitonin, white blood cells, lactate, or D-dimer levels were not significant in GLM but were significant in RF. On the contrary, acute kidney injury and the presence of Acinetobacter spp. were important variables in the GLM but not in the RF. Conclusions: Although the performance of linear and non-linear models was similar, different risk factors were determined, depending on the model used. This alerts clinicians to the limitations and usefulness of studies limited to a single type of model. Full article

Exercise is an important component in the treatment and improvement of function in populations with or at risk of lower limb injury. Cycling is the most common exercise modality used by these populations. However, reduced lower limb joint excursion and/or range of motion (ROM) during cycling might limit the optimization of functional improvements. Increased hip flexion gait (HFgait) is a new exercise modality that might result in larger lower limb joint excursions compared to cycling. The purpose of this study was to compare lower limb kinematics between HFgait and cycling. Twelve healthy individuals participated in the study. Each participant performed cycling and HFgait. Hip, knee, and ankle kinematics in the sagittal, frontal, and transverse planes were analyzed with and without phase offset reduction (POR). Discrete and continuous analyses were performed. Discrete analysis indicated differences for at least one of the variables analyzed (maximum, minimum, and ROM) for the hip (p ≤ 0.041), knee (p ≤ 0.008), and ankle (p ≤ 0.040) across all planes. For the continuous analysis, differences between HFgait and cycling kinematics were observed during the cycles for the hip, knee, and ankle sagittal (hip: original: 85%; with POR: 77%; knee: original: 93%; with POR: 76%; ankle: original: 14%; with POR: 14%), frontal (hip: original: 93%; with POR: 98%; knee: original: 41%; with POR: 12%; ankle: original: 4%; with POR: 5%), and transverse (hip: original: 66%; with POR: 0%; knee: original: 14%; with POR: 0%; ankle: original: 3%; with POR: 0%) planes. HFgait resulted in larger hip (+60.2°) and knee (+38.2°) sagittal plane ROM while maintaining the hip in a more neutral position in the frontal plane compared with cycling. These findings can support the development of rehabilitation strategies with the goal of improving function and joint range of motion while also receiving the health benefits of exercise. Full article

Background: Surgical neck nonunions of the proximal humerus present a complex clinical challenge, especially in elderly patients with pre-existing glenohumeral arthritis. Reverse total shoulder arthroplasty (RTSA) offers a reliable treatment option in these cases; however, resection of the tuberosities may compromise joint stability, increase the risk of postoperative dislocation and compromise postoperative function. This article describes a reproducible RTSA technique that preserves and repairs the greater and lesser tuberosities, aiming to enhance construct stability and optimize outcomes. Methods: We present a 74-year-old female with underlying glenohumeral arthritis who underwent RTSA for a symptomatic surgical neck nonunion via an extended deltopectoral approach. The nonunion is first mobilized, and tuberosity osteotomies are performed. After implant placement, the tuberosities are secured to the implant, to each other, and to the humeral shaft. A cerclage suture is also passed circumferentially to reinforce the repair and prevent posterior gapping. Results: The patient regained her pre-injury level of function by her last follow-up. She had pain-free, active forward elevation to 110 degrees and radiographic evidence of maintained tuberosity reduction and healing. There was no evidence of instability. Conclusions: In conclusion, incorporating tuberosity preservation and repair into RTSA for proximal humerus nonunion may reduce dislocation risk and improve functional recovery in elderly, low-demand patients. Full article

Soccer, as a high-intensity sport, places significant physical demands on athletes and is associated with a high risk of injury. Electrical muscle stimulation (EMS), a training and rehabilitation technology, has gained attention for its potential benefits in sports settings. This systematic review, conducted under the PRISMA guidelines, rigorously assessed the effectiveness of EMS in improving muscle strength, promoting post-exercise recovery, and facilitating injury rehabilitation among soccer players. A comprehensive search of the PubMed, Scopus, and Web of Science databases identified 10 studies meeting the inclusion criteria. Among these, six studies demonstrated a significant improvement in athletic performance following local or whole-body EMS application. Four studies provided evidence supporting EMS’s efficacy in enhancing post-exercise recovery and reducing recovery time after injuries, with observed reductions in recovery time. However, the majority of the included studies were not double-blind, which limits the strength of the evidence. None of the included studies reported EMS-related adverse effects. Overall, the current results suggest that EMS may be a useful adjunct to improve athletic performance and facilitate recovery in soccer players. This review offers actionable insights for coaches and athletes regarding the safe and effective application of EMS in soccer training and rehabilitation programs. Full article

The rapid proliferation of wearable sensors and advanced tracking technologies has revolutionized data collection in elite sports, enabling continuous monitoring of athletes’ physiological and biomechanical states. This study proposes a comprehensive big data analytics framework that integrates data acquisition, processing, analytics, and decision support, demonstrated through synthetic datasets in football, basketball, and athletics case scenarios, modeled to represent typical data patterns and decision-making workflows observed in elite sport environments. Analytical methods, including gradient boosting classifiers, logistic regression, and multilayer perceptron models, were employed to predict injury risk, optimize in-game tactical decisions, and personalize sprint mechanics training. Key results include a 12% reduction in hamstring injury rates in football, a 16% improvement in clutch decision-making accuracy in basketball, and an 8% decrease in 100 m sprint times among athletes. The framework’s visualization tools and alert systems supported actionable insights for coaches and medical staff. Challenges such as data quality, privacy compliance, and model interpretability are addressed, with future research focusing on edge computing, federated learning, and augmented reality integration for enhanced real-time feedback. This study demonstrates the potential of integrated big data analytics to transform sports performance optimization, offering a reproducible and ethically sound platform for advancing personalized, data-driven athlete management. Full article

This retrospective study aimed to assess the effectiveness of prophylactic hepatoprotective therapy in decreasing the incidence of drug-induced liver injury (DILI) among patients with cervical cancer undergoing chemotherapy. The analysis was performed on patients with cervical cancer who received chemotherapy at a tertiary hospital between September 2019 and August 2020. Propensity score matching (PSM) was utilized to equilibrate baseline characteristics between the treatment group, which received prophylactic hepatoprotective drugs, and the control group, which did not receive prophylaxis. The incidence and severity of liver injury were evaluated using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Out of the 609 patients initially screened, 299 were included following PSM, with 105 in the treatment group and 194 in the control group. There were no significant differences in the incidence of liver injury (21.90% vs. 18.04%, p = 0.420) or its severity (p = 0.348) observed between the groups. Furthermore, none of the subgroups exhibited a significant reduction in DILI risk with prophylaxis. However, the number of patients experiencing an increase in their grade of liver injury was significantly higher in the treatment group (18.10% vs. 13.40%, p = 0.002), with these patients also exhibiting increased levels of alkaline phosphatase (ALP) and direct bilirubin (DBIL) post-chemotherapy (p < 0.05). Hepatoprotective drugs are not associated with a reduced risk of DILI and may in fact increase risk. Full article

Background and Objectives: This study aims to investigate the relationship between isokinetic knee strength and competition performance in elite male ski mountaineering sprint athletes and to identify strength parameters that predict performance and contribute to injury prevention. Materials and Methods: Thirteen male athletes participating in the Ski Mountaineering Turkey Cup final stage were included. Isokinetic knee flexion (FLX) and extension (EXT) strength of dominant (DM) and non-dominant (NDM) legs were measured at angular velocities of 60°/s and 180°/s using the DIERS-Myolin Isometric Muscle Strength Analysis System. Competition performance was evaluated using the ISMF scoring system. Data were analyzed using SPSS 26.0 with Pearson correlation and multiple regression analyses after normality, linearity, and homoscedasticity checks. Results: Strong positive correlations were found between hamstring strength at high angular velocities (180°/s) and performance (DM FLX: r = 0.809; NDM FLX: r = 0.880). Extension strength showed moderate correlations at low velocities (60°/s) (DM EXT: r = 0.677; NDM EXT: r = 0.699). Regression analysis revealed that DM FLX at 180°/s and DM EXT at 60°/s explained 49% of performance variance (Adj. R² = 0.498). For NDM legs, only 180°/s FLX was a significant predictor (β = 1.468). Conclusions: High-velocity hamstring strength plays a critical role in ski mountaineering sprint performance, particularly during sudden directional changes and dynamic balance. Quadriceps strength at low velocities contributes to prolonged climbing phases. Moreover, identifying and addressing bilateral strength asymmetries may support injury prevention strategies in elite ski mountaineering athletes. These findings provide scientific support for designing training programs targeting explosive hamstring strength, bilateral symmetry, and injury risk reduction, essential for optimizing performance in the 2026 Winter Olympics sprint discipline. Full article

Background: Although the difficulty level of figure skating programs has increased in the last two decades, particularly at the junior level, trends in performance have not been reported. This retrospective observational study investigated performance development trends among the top five junior figure skaters competing at international levels in both the ladies’ and men’s singles disciplines from 2005 to 2020. Data from 160 junior single ladies and 160 junior single men were analyzed. The focus was on the progression of technical elements—particularly jumps—and their potential correlation with injury risk. It was hypothesized that younger athletes are increasingly performing jumps with more revolutions, thereby enhancing overall competition standards. Materials and Methods: Using data from the Junior World Championships and Junior Grand Prix Finals, linear regression analysis and one-way ANOVA were conducted to track the frequency of double, triple, and quadruple jumps, as well as trends in age development among athletes in the singles categories from 2005 to 2020. Results: The results indicate a significant increase in the execution of higher-revolution jumps among junior athletes. Between 2005 and 2012, the frequency of double jumps declined across all events, with the most pronounced reductions observed in the Ladies’ Junior World Championships (Δ = 0.216, p = 0.004, d = 1.64) and the Men’s Junior World Championships (Δ = 0.500, p = 0.001, d = 1.82). From 2005 to 2011, the frequencies of triple and quadruple jumps increased, while double jumps remained stable or showed only slight increases. Triple jumps showed slight downward trends (e.g., R² = 0.0202 at the Men’s Junior World Championships). Although still rare, the frequency of quadruple jumps has shown a consistent upward trend across multiple competitions. Between 2000 and 2009, all four events exhibited declining age trends, with decreases ranging from −0.029 to −0.078 years of age per year. In the subsequent decade (2010–2020), when averaged across all events, the observed difference slope (Δ = 0.014) indicated a continued decline in athlete age. Conclusions: In summary, increases in more difficult jumps were found, with simultaneous decreases in less difficult jumps. As jump complexity rises, a parallel increase in sport-specific injury incidence can be anticipated, highlighting the need for proactive strategies for injury prevention and athlete well-being. Full article

Background: Core stability is a cornerstone of optimum athletic performance, and its reduction is a risk factor for athletic injuries. Evidence has shown that core impairments can alter lower-limb mechanics through the kinetic chains. Additionally, plantar pressure can be influenced by proximal conditions, such as core muscle fatigue. Therefore, this study aimed to investigate the correlation between core endurance and plantar pressure distribution (PPD) during double-leg stance, single-leg stance, and single-leg squat positions in healthy male athletes. Methods: A total of 21 healthy male recreational athletes between 19 and 26 years of age volunteered to participate in this correlational study. The McGill core endurance test was used to measure the endurance of their core flexors, extensors, and lateral flexors. The participants’ PPD was evaluated using the Tekscan Mobile Mat pressure measurement system in three positions (double-leg stance, single-leg stance, and single-leg squat) for both the dominant and non-dominant feet. Results: There was a poor and insignificant correlation (p > 0.05) between the core flexors’, extensors’, and side flexors’ endurance and the peak and total PPD in all the tested positions for both the dominant and non-dominant feet. Conclusions: Core muscle endurance is neither a component that affects nor is affected by the PPD in this study population. Thus, the endurance of core flexors, extensors, and side flexors may not be considered in screening, examination, or intervention for the total and peak pressure during double-leg stance, single-leg stance, and single-leg squat positions for both the dominant and non-dominant feet in the study population. Further similar studies are warranted in various sports and during dynamic tasks to better understand the different dimensions of the studied relationship in athletes. Full article

Background: Proton pump inhibitors (PPIs) are frequently used after endoscopic variceal ligation (EVL) to reduce post-procedural bleeding, though studies have shown mixed results regarding their efficacy. While some suggest benefits, others report no significant advantage and highlight potential risks, including infection, kidney injury, and hepatic complications in cirrhotic patients. This study utilizes the TriNetX global health research network to evaluate the outcomes of PPI use following elective EVL for primary prophylaxis. Methods: This retrospective cohort study was conducted using the TriNetX database to evaluate adult patients with cirrhosis and esophageal varices who underwent EVL for primary prophylaxis. Patients who received at least two weeks of PPI therapy following EVL were compared to those who did not receive PPI within one month post-procedure. Outcomes assessed included esophageal bleeding, adverse events such as acute kidney injury (AKI), pneumonia, spontaneous bacterial peritonitis (SBP), Clostridioides difficile infection, hepatic encephalopathy, and all-cause mortality at 4 weeks and 8 weeks. Results: Of 6196 patients with cirrhosis and esophageal varices who underwent EVL, 12% (n = 764) received adjuvant PPI post-procedure, while 88% (n = 5432) did not receive PPI. After 1:1 propensity score matching, two well-balanced cohorts of 618 patients each were analyzed. PPI use was not associated with a reduction in esophageal bleeding at either 4 weeks (1.8% vs. 1.7%, p = 0.89) or 8 weeks (2.3% vs. 1.9%, p = 0.60). However, the composite adverse event rate—including SBP, hepatic encephalopathy, pneumonia, C. difficile, and acute kidney injury (AKI)—was significantly higher in the PPI group at both 4 weeks (7.9% vs. 3.0%, p < 0.01) and 8 weeks (13.2% vs. 3.0%, p < 0.01). Subgroup analysis showed no significant differences in pneumonia, SBP, or C. difficile infection at either time point. Hepatic encephalopathy was significantly more frequent in the PPI group at 8 weeks (4.9% vs. 2.0%, p = 0.01), and AKI occurred more often at both 4 weeks (5.7% vs. 2.0%, p < 0.01) and 8 weeks (9.6% vs. 2.1%, p < 0.01). Mortality was similar at 4 weeks but significantly higher in the PPI group at 8 weeks (4.3% vs. 1.7%, p < 0.01). Conclusions: PPI use after prophylactic EVL did not reduce bleeding risk and was linked to higher rates of adverse events. These findings suggest routine use may not be beneficial and should be reconsidered in cirrhotic patients who undergo EVL for primary prophylaxis. Full article

Wipe-out is defined as a sudden, unexplained, and irreversible loss of residual central vision following glaucoma surgery, typically in eyes with advanced visual field damage and severely compromised optic nerves. The purpose of this review is to critically assess the current incidence, risk factors, pathophysiological mechanisms, and clinical relevance of “wipe-out”, a rare but devastating complication of glaucoma surgery characterized by sudden, unexplained central vision loss postoperatively. A comprehensive literature review was conducted, analyzing key peer-reviewed studies from electronic databases (PubMed, Medline, and Google Scholar) published up to 2025. The data from the literature published prior to the year 2000 suggest that wipe-out incidences range broadly from <1% to 13%. Contemporary prospective studies and large-scale reviews indicate a significantly lower current incidence, frequently below 1%. Identified risk factors include severe preoperative visual field loss (especially split fixation), older age, immediate postoperative hypotony, and compromised optic nerve head perfusion. The proposed mechanisms involve acute vascular insults, ischemia–reperfusion injury, and accelerated apoptosis of already vulnerable retinal ganglion cells. Modern MIGS and refined trabeculectomy techniques exhibit notably lower wipe-out risks compared to historical data. The literature emphasizes preventive management, including careful patient selection, incremental intraocular pressure reduction, and minimally invasive anesthetic approaches. Although wipe-out syndrome represents a serious complication, its incidence in modern glaucoma surgery is minimal. The considerable benefits of contemporary surgical approaches—particularly MIGS—in preserving vision clearly outweigh this very low risk. Ophthalmologists should remain vigilant but confident in the safety and efficacy of modern glaucoma surgical techniques, emphasizing proactive intervention to prevent blindness rather than avoiding necessary surgery in consideration of the minimal risk of wipe-out. Full article

The by-products that may contain tetrodotoxin (TTX) produced during the processing of farmed pufferfish have caused food safety risks and environmental pollution. Peptidoglycan (PG) of lactic acid bacteria could adsorb TTX; however, its complex structure and poor solubility limited adsorption efficiency. In this study, hydroxyl modifications of three PGs (A3α, A1γ and A4α) were realized via TEMPO-mediated selective oxidation of the primary hydroxyl group. Compared with PGs, it was found that the carboxyl density of hydroxyl-modified PGs (HM-PGs) increased from 1.66 mmol/g to 3.33 mmol/g and the surface electronegativity increased from −36 mV to −59 mV. The adsorption capacity of HM-PGs to TTX reached 1.48 μg/mg, which was comparable to the adsorption of the conventional adsorbent chitosan for aflatoxin B1 (1.39 μg/mg). Moreover, HM-PGs decreased the toxicity of TTX from strong toxic to nearly non-toxic, with the toxicity reduction rate reached 99.85%. After treatment with HM-PGs, the mouse hippocampus and neuronal cell model confirmed that lower neural injury and sodium channel blocking effects were observed in the residual TTX, whose neurotoxicity was lower. Molecular docking simulation and physicochemical analysis revealed that the adsorption of TTX by HM-PGs was a complex adsorption mode driven by the synergy of physicochemical interaction. There were both physical adsorptions based on electrostatic and hydrophobic interactions and chemical binding with strong hydrogen bonding (1.46 Å) and Mayer bond order (0.1229). This study not only developed a new, efficient and safe tool for TTX removal, but also provided a theoretical basis for the development of biological toxin removal material. Full article

Plantar pressure monitoring is decisive in injury prevention, especially in at-risk populations such as people with diabetic foot. In this context, innovative solutions such as pneumatic insoles can be essential in plantar pressure management. This study describes the development of a variable pressure system that promotes the monitoring, stabilization, and offloading of plantar pressure through a pneumatic insole. This research was also intended to evaluate its ability to redistribute plantar pressure, reduce peak pressure in both static and dynamic conditions, and validate its pressure measurements by comparing the results with those obtained from a pedar^® insole. Tests were carried out under both static and dynamic conditions, before and after the pressure stabilization process by air cells and the subsequent pressure offloading. During the validation process, methods were used to evaluate the agreement between measurements obtained by the two systems. The results of the static test showed that pressure stabilization reduced pressure on the heel by 32.43%, distributing it to the metatarsals and toes. After heel pressure offloading, the reduction reached 42.72%. In the dynamic test, despite natural dispersion of the measurements, a trend to reduce the peak pressure in the heel, metatarsals, and toes was observed. Agreement analysis recorded 96.32% in the static test and 94.02% in the dynamic test. The pneumatic insole proved effective in redistributing and reducing plantar pressure, with more evident effects in the static test. Its agreement with the pedar^® system reinforces its reliability as a tool for measuring and managing plantar pressure, representing a promising solution for preventing plantar lesions. Full article

Background: People with spinal cord injury/disorder are at a high risk of pressure injury formation, and, in advanced cases, surgery is mandatory. These patients present specific clinical aspects to consider in order to reduce the risk of complications. This paper is a narrative review and expert opinion based on the authors’ institutional experience of over 10 years in a spinal unit. The specific protocols of treatment based on a multidisciplinary approach, protocols of flap selection, and strategies to prevent and manage complications are reviewed. The specific clinical aspects of each patient that should be considered during treatment to optimize the results and to reduce complication rates are reviewed. Conclusions: A multidisciplinary team approach and specific protocols for patient management allow for a reduction in complication rates in the surgical treatment of pressure injuries in spinal cord injury patients and implement an overall success rate. Complications management protocols should be developed and investigated to further improve the overall success rate. Full article

The knee is one of the most frequently injured joints, involving various structures. To prevent reinjury after rehabilitation, braces are commonly used. However, most studies on knee supports focus on subjects with anterior cruciate ligament (ACL) injuries and do not account for muscle fatigue, which typically occurs during prolonged intense training and can significantly increase the risk of injury. Hence, this study investigates the acute effects of wearing a knee brace on biomechanics in subjects with a history of various unilateral knee injuries or pain under muscle fatigue. In total, 50 subjects completed an intense fatigue protocol and then performed counter-movement jumps and running tests on a force plate while tracking kinematics with a marker-based 3D motion analysis system. Additionally, subjects filled out a visual analog scale (VAS) to assess knee pain and stability. Tests were conducted on the injured leg with and without a knee brace (Sports Knee Support, Bauerfeind AG, Zeulenroda-Triebes, Germany) and on the healthy leg. Results indicated that wearing the knee brace stabilized knee movement in the frontal plane, with a significant reduction in maximal medio-lateral knee acceleration and knee abduction moment during running and jumping. The brace also normalized loading on the injured leg. We observed higher maximal knee flexion moments, which were associated with increased vertical ground reaction forces, segment velocities, and knee flexion angles. Subjects reported less pain and greater stability while wearing the knee brace. Therefore, we confirm that wearing a knee brace on the injured leg improves joint biomechanics by enhancing stability and kinematics and reducing pain during running and jumping, even with muscle fatigue. Consequently, wearing a knee brace after a knee joint injury may reduce the risk of reinjury. Full article