Search Results (6,535)

Background: Major level escalation following distal amputation for diabetic foot—defined as subsequent below-knee amputation (BKA)—represents a clinically meaningful endpoint with substantial functional implications. Identifying reliable and readily available preoperative biomarkers capable of predicting major level escalation remains a clinical challenge. This study aimed to evaluate the independent prognostic value of the C-reactive protein-to-albumin ratio (CAR) and blood urea nitrogen-to-albumin ratio (BAR) in predicting postoperative major level escalation. Methods: We retrospectively analyzed 151 consecutive patients who underwent distal lower extremity amputation for diabetic foot between January 2020 and October 2025. The primary outcome was ipsilateral below-knee amputation within the follow-up period. Preoperative CAR and BAR were calculated using laboratory parameters obtained within 24 h prior to surgery. Given the shared albumin component, two separate multivariable logistic regression models were constructed to evaluate independent associations, adjusting for age, peripheral arterial disease (PAD), and index amputation level. Results: During follow-up, 46 patients (30.5%) required major level escalation (BKA). Both CAR and BAR were significantly higher in patients who developed BKA (p < 0.001 and p = 0.006, respectively). In receiver operating characteristic (ROC) analysis, CAR demonstrated acceptable discriminative ability (AUC = 0.745; 95% CI 0.653–0.827), whereas BAR showed modest performance (AUC = 0.640; 95% CI 0.536–0.738). The optimal cutoff values were 1.50 for CAR (sensitivity 76.1%, specificity 61.9%) and 0.61 for BAR (sensitivity 73.9%, specificity 44.8%), although these thresholds were considered exploratory. In the primary multivariable analysis, both CAR (OR 1.16; 95% CI 1.02–1.32; p = 0.024) and BAR (OR 4.02; 95% CI 1.85–8.73; p = 0.005) were independently associated with major level escalation. In sensitivity analyses, BAR retained independent significance, whereas CAR did not (p = 0.100). Conclusions: Preoperative BAR demonstrated robust independent association with major level escalation across both primary and sensitivity analyses, while CAR showed association in the primary model only. These composite biomarkers may provide hypothesis-generating insights into systemic risk profiling in diabetic foot surgery, pending external validation. Full article

Background: The epiligament (EL) of the medial collateral ligament (MCL) has recently attracted increasing attention as a biologically active structure. Emerging evidence suggests that it may contribute to ligament healing by providing progenitor cells, vascular components, and signaling mediators. However, its cellular composition and possible regional variability remain insufficiently characterized. Aim: This study evaluated the expression of vimentin, S100 protein, and epithelial membrane antigen (EMA) to better characterize the EL compared with the ligament proper (LP). Methods: Twelve human MCLs obtained from twelve deceased donors were divided into proximal, middle, and distal segments. Thirty-six paraffin blocks were prepared, from which 180 sections were obtained and equally assigned for immunohistochemical staining of vimentin, S100 protein, and EMA (60 slides for each marker). Systematic quantification of seven to eight non-overlapping microscopic fields per slide generated 900 standardized observations for each investigated marker. This sampling strategy provided 150 measurements for each sub-region (EL and LP across the three anatomical segments). Immunoreactivity was quantified using ImageJ software. Statistical differences were analyzed using a robust two-way analysis of variance (ANOVA), while biological associations between markers were assessed using Spearman’s rank correlation analysis. Results: Vimentin and S100 expression were consistently higher in the EL than in the LP across all anatomical regions (p < 0.0001). The highest vimentin values were observed in the proximal region (median 17.34 vs. 10.14) and distal region (median 19.34 vs. 11.23), whereas S100 showed the greatest expression in the proximal (median 16.9 vs. 7.2) and distal regions (median 14.1 vs. 8.9). EMA expression was generally lower overall; however, it remained significantly higher in the EL than in the LP within the proximal (median 6.87 vs. 5.77) and middle regions (median 4.80 vs. 3.26). No significant difference was identified in the distal region. Spearman rank correlation analysis demonstrated significant positive associations among all investigated markers (p < 0.001), with the strongest relationship observed between vimentin and S100 protein (Spearman correlation coefficient = 0.430). Conclusions: The EL of the MCL is a structurally and biologically distinct component, characterized by significantly higher expressions of vimentin, S100, and EMA than the LP. The significant positive correlations observed among these markers support the concept that the EL functions as an integrated biological microenvironment with clear regional heterogeneity, particularly within the proximal and distal segments. Further studies are warranted to clarify the functional relevance of these findings and their potential implications for clinical management and ligament healing strategies. Full article

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

Background/Objectives: The optimal management of anterior cruciate ligament (ACL) rupture remains debated, especially regarding long-term outcomes after early ACL reconstruction (ACLR) versus rehabilitation-first with optional delayed ACLR. The interpretation of randomized evidence is complicated by frequent treatment crossover. This review synthesized evidence from randomized controlled trial (RCT) cohorts comparing surgical versus rehabilitation-first management strategies across available follow-up durations. Methods: A structured review based on a systematic literature search and narrative synthesis was conducted, with study identification and reporting guided by PRISMA 2020. MEDLINE (via PubMed) and Google Scholar were searched in February 2026 for English-language human RCTs (2000–2026) comparing early ACLR plus rehabilitation with rehabilitation-first management allowing delayed ACLR for persistent instability. A linked-report PubMed search using the KANON trial registration number (ISRCTN84752559) was additionally performed to identify cohort-derived follow-up publications. Reports were grouped by underlying RCT cohort. Data were extracted on crossover, follow-up, and clinical outcomes. Risk of bias for primary RCT reports was assessed with Cochrane RoB 2. Results: Twenty-seven reports representing three RCT cohorts (KANON, COMPARE, ACL SNNAP) were included; six index reports were prioritized for synthesis. In acute ACL rupture (KANON, COMPARE), early ACLR did not show a consistent long-term superiority in patient-reported outcomes versus rehabilitation-first with optional delayed ACLR, although COMPARE reported a statistically significant 2-year subjective functional difference favoring early ACLR; early ACLR more consistently improved mechanical stability and reduced instability episodes. Crossover from rehabilitation to delayed ACLR was common. In non-acute ACL injury with persistent symptomatic instability (ACL SNNAP), surgery-first improved 18-month patient-reported outcomes. Meniscal procedure rates and osteoarthritis-related outcomes did not consistently favor early ACLR. Conclusions: In acute ACL rupture, rehabilitation-first with timely access to delayed ACLR appears to provide long-term patient-reported outcomes comparable to an early ACLR strategy in many patients, while early ACLR more consistently improves knee stability. In non-acute symptomatic ACL deficiency, a surgery-first strategy appears more effective in the mid-term. These randomized trials should be interpreted as comparisons of management strategies rather than of “pure” operative versus nonoperative treatment approaches. Full article

Model-Based Diagnosis (MBD) is widely used to identify minimal conflicts and repair actions in constraint-based systems. Recent advances in parallel reasoning have significantly reduced runtime in large-scale models through speculative and multicore execution strategies. However, existing approaches primarily focus on computational efficiency and implicitly assume that minimal diagnoses are inherently suitable explanations for human decision makers. In complex configuration environments, minimality does not necessarily imply interpretability, as diagnoses may involve structurally dispersed or semantically heterogeneous constraints. To address this limitation, this paper introduces a multi-objective explainability-aware framework for parallel MDB. Diagnosis selection is formulated as a Pareto optimization problem balancing total computational cost and a formally defined interpretability penalty. Interpretability is quantified using graph-based structural dispersion, semantic entropy, hierarchical complexity, and ambiguity metrics. The proposed E-ParetoDiag algorithm computes non-dominated diagnoses and identifies balanced knee-point solutions without modifying correctness guarantees of underlying diagnosis algorithms. Experimental evaluation on large-scale benchmark datasets demonstrates a measurable trade-off between runtime and interpretability, particularly in dense constraint systems. Comparative analysis against classical selection strategies shows that the proposed approach reduces structural dispersion by up to 18% while increasing computational cost by only 7%. Statistical validation confirms that these improvements are significant (p < 0.01) in medium- and high-density scenarios. The results indicate that aggressive parallelism may improve computational efficiency while increasing explanation complexity, highlighting the need for multi-objective selection strategies. Overall, the proposed framework extends scalable symbolic reasoning toward a human-centered diagnosis paradigm and establishes a principled foundation for explainability-aware optimization in constraint-based systems. Full article

Knee osteoarthritis (KOA) is a leading cause of pain and disability worldwide, and current treatments remain largely symptomatic, with no disease-modifying therapy established for routine use. This narrative review evaluates extracellular vesicles (EVs) as biological nanocarriers and a cell-free alternative to mesenchymal stromal cell therapy for KOA by examining the biological rationale, preclinical evidence, clinical studies, and current methodological and regulatory requirements. Preclinical findings indicate that EVs may exert immunomodulatory, anti-inflammatory, and chondroprotective effects, supporting their potential to influence joint homeostasis. The review also summarizes current recommendations for EV nomenclature, characterization, and quality control in accordance with the Minimal Information for Studies of EVs 2023 guidelines and highlights key translational challenges, including scalable manufacturing, potency assessment, and regulatory compliance. Clinical evidence to date suggests a favorable safety profile, but efficacy data remain limited and inconsistent; a randomized placebo-controlled trial showed no superiority over placebo, whereas small early human studies suggested possible benefit in selected cases. Overall, EVs represent a promising cell-free strategy for KOA, but current evidence is insufficient to support routine clinical use, emphasizing the need for standardized production, validated potency assays, and robust randomized clinical trials. Full article

Background: Digital health has accelerated telehealth uptake, yet evidence comparing video-based musculoskeletal assessment with traditional in-person examination is limited. This study evaluated the concurrent validity and interrater reliability of video-based physiotherapy assessment versus face-to-face assessment in patients with knee pain. Methods: Patients with knee pain underwent randomized consecutive in-person and video-based assessments by experienced musculoskeletal physiotherapists. Clinical diagnoses were categorized into seven groups (red flag, yellow flag, arthrogenic, tendinopathy, patellofemoral pain, muscle sprain, neurogenic). Primary outcomes were intermethod agreement and Cohen’s kappa; sensitivity, specificity, PPV, NPV, and interrater reliability for video assessments were also reported. Results: Forty-five participants (mean age 38 ± 6.5 years; 55.6% female) completed the study. In-person and video-based assessments produced identical diagnoses in 43/45 cases (Cohen’s κ = 0.92, p < 0.001). Telehealth accuracy was high across all diagnostic categories (90–100%). Interrater agreement between video-based assessors was 93.3% (κ = 0.89, p < 0.001). Agreement between assessments was moderately associated with KOOS (r = 0.312, p = 0.037). Conclusions: In this selected pragmatic sample, video-based physiotherapy assessment demonstrated high concurrent agreement and excellent interrater reliability with face-to-face assessment. Given the study’s sample size, repeated-measures design, and lack of an independent reference standard, these results indicate feasibility and intermethod agreement rather than diagnostic equivalence. Video assessment may be a feasible option for triage and management in selected settings, but further research in larger, more diverse populations and evaluation against independent reference standards is required. Full article

The squat is a fundamental multi-joint movement widely studied in strength training and biomechanics. While numerous experimental and computational studies have examined squat kinematics and joint loading, the mechanisms governing how squat technique adapts to increasing external load remain insufficiently understood. In particular, inverse-dynamics-based approaches often overlook explicit constraints imposed by limited joint moment capacity. This study presents a computational framework for predicting load-dependent adaptations of squat posture. The human body was represented as a multi-segment rigid-body system, with joints modeled as nonlinear rotational elements with bounded moment capacity. A reference squat trajectory was first generated kinematically, and a constrained optimization procedure was then applied at each motion frame to determine a mechanically admissible posture under increasing barbell load. The results show that higher loads lead to systematic posture adaptations, including increased torso inclination and redistribution of rotational demand from the knee toward the hip joint. For the highest load, peak torso pitch increased from 30° to over 40°, while joint utilization exceeded unity, indicating the onset of yielding. These findings identify joint moment capacity as a key constraint governing squat technique and demonstrate the potential of the proposed framework for predictive biomechanical analysis. Full article

Introduction: Although gait alterations associated with excess body weight have been widely studied, most available evidence comes from laboratory-based analyses, which limit ecological validity and the translation of findings into clinical practice. This study addresses this gap by examining gait biomechanics across BMI categories using portable sensor-based insoles that allow gait assessment in real-world conditions. Methods: A cross-sectional study including 96 adults categorized as normal weight (NW), overweight (OW), or obese (OB) was conducted. Gait biomechanics were recorded using PODOSmart^® intelligent insoles, which capture spatiotemporal and angular parameters during natural walking. Foot health, quality of life and comorbildities were evaluated throught valeted questionnarires. Differences between groups were analyzed using ANOVA and chi-square tests. Age and sex, known to influence gait, were comparable across BMI groups and were considered in the interpretation of the results. Results: Overall, the participants in the OB group exhibited reduced stride length, gait speed, and swing time, increased double-support time, and greater pronation–supination and progression angles than OW and NW participants. Partial eta-squared values (η²p) were predominantly medium to large, reinforcing the robustness of these between-group differences (e.g., double-support time, p > 0.001; η²p = 0.19). Individuals with obesity reported poorer general and foot health and more difficulty finding suitable footwear. BMI was also significantly associated with hypertension, dyslipidemia, arthritis, and depression (all p <0.05), whereas diabetes, cardiopathies, knee pain, and fatigue andwalking or social activity limitations showed no significant differences. Conclusions: By using portable gait analysis technology in ecological conditions, this study provides novel evidence of clinically meaningful gait impairments across BMI groups. Higher BMI is associated with clinically relevant gait impairments, poorer perceptions of foot and general health, and a higher prevalence of several comorbidities. Full article

Anterior cruciate ligament (ACL) injury risk is elevated in female youth football, yet knee joint loading has mainly been studied under controlled laboratory conditions. This limits understanding of how injury risk emerges during realistic match situations. This study provided a field-based kinetic characterization of football-specific movements by estimating knee abduction moments (KAMs) using wearable sensors and machine learning. Fifty-two highly talented female youth players performed agility tasks during training, including structured exercises (F-EX) and game-based play (F-GAME). Full-body kinematics were collected with inertial measurement units, and a validated support vector machine model, trained on synchronized motion capture and force plate data, classified trials as high or low KAM. Across 662 change-in-direction trials, 9–12% were classified as high KAM in both conditions, indicating that potentially high-risk loading regularly occurs during routine actions. High KAM trials showed reduced knee and pelvis flexion, increased hip flexion, and greater pelvis rotation toward the cutting direction, reflecting upright, stiff movement strategies. Performance analyses revealed smaller cut angles in exercises and greater approach acceleration in game play, without differences in peak velocity. These findings demonstrate the feasibility of field-based kinetic screening and support a complex-systems perspective on ACL injury risk. Full article

Background: Frail patients undergoing hip and knee revision surgery represent a major anesthetic challenge because of advanced age and multiple comorbidities. Continuous spinal anesthesia (CSA) with titrated low-dose levobupivacaine may offer a potentially useful alternative to general anesthesia or single-shot spinal anesthesia in this high-risk population. Methods: A retrospective review was conducted of ASA II-III patients who underwent complex hip and knee revision surgeries between February and October 2024 under CSA. The technique was performed using a 25-gauge spinal catheter with incremental boluses of 0.25% levobupivacaine (2.5 mg). Hemodynamic parameters, including mean arterial pressure (MAP), stroke volume index (SVI), and cardiac index (CI), were continuously monitored using the EV1000 hemodynamic monitoring system. Postoperative complications were recorded. Results: 37 high-risk patients were included in the study. Catheter placement was successful in all patients, with no conversions to general anesthesia. MAP decreased by a mean of 14.6% after boluses (p < 0.05); 9 patients (24.3%) experienced reductions ≥ 20%, but all remained >65 mmHg and responded to fluid therapy. CI and SVI decreased by 10.1% and 10.5%, respectively (p < 0.05), without clinical instability. No major complications (neurological injury, infection, post-dural puncture headache) were observed. Conclusions: In this retrospective single-center experience, CSA with titrated low-dose levobupivacaine was feasible and associated with stable hemodynamic profiles and a low rate of complications in frail patients undergoing complex lower-limb revision surgery. However, given the absence of a control group and the limited sample size, these findings should be interpreted cautiously. Further prospective comparative studies are needed to better define the role of CSA in high-risk orthopedic patients. Full article

Background/Objectives: To evaluate the utility of phase angle (PhA) derived from bioelectrical impedance analysis as a screening indicator for pre-frailty in community-dwelling older adults. Methods: This cross-sectional study included 171 participants (36 men and 135 women) in Japan in 2023. PhA at 50 kHz was measured using bioelectrical impedance analysis and evaluated as a potential screening indicator for pre-frailty. Assessments included body composition, physical function tests (maximum walking speed, Timed Up and Go (TUG), grip strength, knee extension strength, and one-leg stance time with eyes open), cognitive function (MoCA-J), and the Motor Fitness Scale (MFS), a questionnaire assessing physical function, along with the Kihon Checklist (KCL). Frailty status was defined using KCL scores (4–7: pre-frailty; ≥8: frailty), and participants were classified into robust and pre-frail/frail groups. Results: PhA was significantly correlated with physical function measures, including grip strength (r = 0.54, p < 0.01), MFS (r = 0.36, p < 0.01), maximum walking speed (r = 0.20, p < 0.05), knee extension strength (r = 0.16, p < 0.05), and TUG (r = −0.17, p < 0.05). In women, logistic regression analysis showed that PhA was independently associated with pre-frailty (age-adjusted odds ratio: 2.38; 95% CI: 1.08–5.23; p < 0.05). ROC analysis yielded an area under the curve of 0.65 (95% CI: 0.56–0.74), indicating modest discriminative ability. Age-adjusted cutoff values of PhA were 4.19° and 4.74°, corresponding to points prioritizing sensitivity and specificity, respectively. Conclusions: PhA is associated with physical function and may serve as a simple, non-invasive indicator for identifying pre-frailty in community settings. However, given its modest discriminative ability, PhA alone may not be sufficient as a standalone screening tool and should be used in combination with other clinical indicators for clinical application. Full article

The purpose of this study was to examine associations between lower-limb mechanical strength, phase-oriented composite strength indices, generalized neuromuscular activation, and maximal soccer ball kicking speed in trained athletes. Twenty-five male soccer players (age: 20.64 ± 2.50 years; height: 179.28 ± 4.27 cm; body mass: 75.80 ± 9.41 kg) participated in this cross-sectional study. Isometric ankle and knee joint torques were assessed using an isokinetic dynamometer, and joint-specific and phase-oriented cross-joint composite indices were computed to represent integrated strength capacity across the kinetic chain. Neuromuscular activation was evaluated via surface electromyography during a standardized squat jump task. Ball-kicking speed was measured using Doppler radar during maximal instep kicks. Associations were analyzed using Pearson correlation coefficients (p ≤ 0.05) with false discovery rate correction for multiple comparisons. In unadjusted analyses, moderate positive correlations were observed for several ankle torque variables and composite ankle strength indices, while swing-phase composite measures demonstrated moderate correlations (r = 0.43–0.55). Knee strength indices and sEMG variables showed no significant relationships. However, none of the variables remained statistically significant after FDR correction, suggesting limited independent explanatory value of isolated isometric strength and non-task-specific neuromuscular activation assessed during a standardized squat jump for maximal kicking performance. Full article

Knee joint moment is an important biomechanical parameter for sports assessment, rehabilitation monitoring, and human–machine interaction. However, direct measurement is often restricted to laboratory-based settings. Surface electromyography (sEMG) offers a non-invasive alternative for indirect joint moment estimation, but many existing deep learning models remain too computationally demanding for potential wearable edge deployment. To address this gap, this study proposes Topo2DCNN-LSTM, a lightweight two-dimensional (2D) convolutional neural network model, designed for sagittal-plane knee flexion moment estimation. The model used a feature-based sequential representation, transforming raw sEMG signals into compact Root Mean Square (RMS) feature frames. The input was processed by a lightweight 2D convolutional neural network (CNN) encoder and paired with long short-term memory (LSTM) units. The model was trained on a public walking dataset of healthy subjects with synchronized sEMG and joint kinetics at two treadmill speeds. When compared with selected deep learning baselines, the quantized model achieved a mean RMS Error of 0.088 ± 0.020 Nm/kg at 1.2 m/s and 0.114 ± 0.034 Nm/kg at 1.8 m/s. On a SparkFun Thing Plus–SAMD51, it achieved an average inference latency of 28 ms using 71,316 bytes of random-access memory (RAM) and 257,172 bytes of flash. These results support its use as a proof of concept for personalized unilateral knee moment estimation with isolated on-device inference feasibility under resource-constrained and limited walking conditions. Full article

The badminton smash is a decisive scoring technique whose effectiveness depends on adequate preparation and a proper proximal-to-distal sequencing of the kinetic chain. This study integrates a You Only Look Once (YOLO)-based real-time vision detector with five wearable inertial measurement units (IMUs) attached to the right shoulder, right elbow, right wrist, right hip, and right knee of right-handed players. A high-speed camera provides video for shuttlecock and joint localization via YOLO, and the IMUs provide instantaneous joint accelerations at impact. The following four coaching-oriented indicators are defined: (1) rapid lowering of the center of mass after the opponent’s shot; (2) immediate forward acceleration after the shuttle is released; (3) alignment at the hitting position with the right shoulder/hip rotated backward and the left shoulder facing the approaching shuttle; and (4) a proximal-to-distal sequence in which the shoulder leads the elbow and then the wrist. Using two athletes with 15 trials each, the system achieved an overall recognition accuracy above 93% against manually annotated video. The method can provide objective feedback for coaches and players and is suitable for instructional use in physical education classes. Full article