Search Results (1,015)

Background and Objectives: The management of type 2 diabetes (T2D) extends beyond glycemic control, requiring a more global strategy that includes optimization of body composition, even more so in the context of sarcopenia and visceral adiposity, as they contribute to poor outcomes. Past reviews have typically been focused on weight reduction or glycemic effectiveness, with limited inclusion of new therapies’ effects on muscle and fat distribution. In addition, the emergence of incretin-based therapies and dual agonists such as tirzepatide requires an updated synthesis of their impacts on body composition. This review attempts to bridge the gap by taking a systematic approach to how current blood-glucose lowering therapies affect lean body mass, fat mass, and the risk of sarcopenia in T2D patients. Materials and Methods: Between January 2015 and March 2025, we conducted a narrative review by searching the PubMed, Scopus, and Web of Science databases for English-language articles. The keywords were combinations of the following: “type 2 diabetes,” “lean body mass,” “fat mass,” “body composition,” “sarcopenia,” “GLP-1 receptor agonists,” “SGLT2 inhibitors,” “tirzepatide,” and “antidiabetic pharmacotherapy.” Reference lists were searched manually as well. The highest precedence was assigned to studies that aimed at adult type 2 diabetic subjects and reported body composition results. Inclusion criteria for studies were: (1) type 2 diabetic mellitus adult patients and (2) reporting measures of body composition (e.g., lean body mass, fat mass, or muscle function). We prioritized randomized controlled trials and large observational studies and excluded mixed diabetic populations, non-pharmacological interventions only, and poor reporting of body composition. Results: Metformin was widely found to be weight-neutral with minimal effects on muscle mass. Insulin therapy, being an anabolic hormone, often leads to fat mass accumulation and increases the risk of sarcopenic obesity. Incretin-based therapies induced substantial weight loss, mostly from fat mass. Notable results were observed in studies with tirzepatide, demonstrating superior reduction not only in fat mass, but also in visceral fat. Sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors) promote fat loss but are associated with a small yet significant decrease in lean muscle mass. Conclusions: Blood-glucose lowering therapies demonstrated clinically relevant effects on body composition. Treatment should be personalized, balancing glycemic control, cardiovascular, and renal benefits, together with optimal impact on muscle mass along with glycemic, cardiovascular, and renal benefits. Full article

Background and objectives: Trismus is a frequent and debilitating complication in people with head and neck cancer (HNC) which leads to significant functional limitations and reduced quality of life. Rehabilitation interventions are commonly recommended to manage or prevent trismus. However, in many randomized controlled trials (RCTs), the theoretical justification for these interventions is poorly articulated, and the underlying biological or physiological mechanisms are not described in detail, limiting our understanding of why certain treatments may (or may not) work. This review aimed to identify and analyze how RCTs report the rationale for rehabilitation interventions and the explanations used to manage this population. Materials and Methods: A scoping review was conducted in accordance with the PRISMA-ScR guidelines. Five databases (PubMed, PEDro, Web of Science, Scopus, and EMBASE) were searched up to May 2025 for RCTs evaluating rehabilitation interventions for the management or prevention of treatment-induced trismus in patients with HNC. Data were extracted and synthesized narratively, focusing on the type of intervention, the rationale for its use, and the proposed mechanisms of action. Results: Of 2215 records identified, 24 RCTs met the inclusion criteria. Thirteen studies focused on preventive interventions—primarily exercise therapy—while the remainder addressed established trismus using exercise, manual therapy, electrotherapy, or combined treatment modalities. The rationales provided for intervention selection were heterogeneous and often lacked depth, with most studies justifying interventions based on their potential to improve mouth opening or reduce fibrosis but rarely grounding these claims in detailed pathophysiological models. Only half of the studies provided any mechanistic explanation for the intervention’s effects, and these were typically generic or speculative. Conclusions: RCTs investigating rehabilitation interventions for treatment-induced trismus in patients with HNC frequently lack comprehensive rationales and mechanistic explanations for their interventions. This gap limits the ability to refine and optimize treatment approaches, as the underlying processes driving clinical improvements remain poorly understood. Future research should be guided by theoretical models and include objective outcomes to better elucidate the mechanisms of action of interventions to inform clinical practice. Full article

Background/Objectives: Guidelines recommend patients with heart failure with reduced ejection fraction (HFrEF) receive four-pillar heart failure (4P-HF) therapy, which significantly reduces cardiac morbidity and mortality. However, implementing these guidelines effectively into clinical practice remains challenging. Methods: Patients with HFrEF on submaximal 4P-HF therapy were identified from a large, multicentre Cardiology network database using a natural language processing tool, supported by manual file review. A nurse-led, remotely delivered, medication uptitration program aimed to optimise therapy in this real-world cohort. Results: The final cohort included 2004 patients with a mean age of 72.7 ± 11.6 years. Utilisation of 4P-HF increased from 11.1% at baseline to 49.8% post intervention, and each individual medication class increased significantly post intervention (all p < 0.001). The largest increase was observed with the use of sodium–glucose cotransporter 2 inhibitors, which rose from 17.3% to 73.9%, followed by mineralocorticoid receptor antagonists (51.6% to 65.7%), beta-blockers (88.4% to 97.0%), and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor blocker–neprilysin inhibitors (89.8% to 96.4%). In patients on submaximal therapy, barriers were documented in all cases. Following medication optimisation, left ventricular ejection function (LVEF) improved significantly (38.5% ± 10.8% vs. 42.5% ± 11.7, p < 0.001). Conclusions: This nurse-led, remotely delivered, medication optimisation program significantly improved the adoption of 4P-HF therapy and LVEF in patients with HFrEF. The program demonstrates a practical, scalable solution for the optimisation of HFrEF therapy across a large healthcare network. Full article

Background: Despite distinct etiologies, type 1 diabetes (T1D) and type 2 diabetes (T2D) share chronic inflammation as a core feature. Interleukins, key immune mediators, play important yet still not fully understood roles in the development and complications of both conditions. Objective: This narrative review aims to provide a comprehensive and critical synthesis of current evidence on the role of key interleukins in T1D and T2D, highlighting their immunological functions, genetic associations, clinical correlations, and translational potential. Methods: A targeted literature search was conducted in PubMed, Google Scholar, and ScienceDirect up to January 2025, focusing on English-language clinical and experimental studies involving interleukins and their relevance to T1D and T2D. Reference lists were manually screened for additional sources. Interleukins (ILs) were reviewed individually to assess their immunobiology, disease specificity, and biomarker or therapeutic value. Findings: Pro-inflammatory cytokines such as IL-1β, IL-6, and IL-17 contribute to islet inflammation, insulin resistance, and microvascular damage in both T1D and T2D. Anti-inflammatory mediators including IL-4, IL-10, and IL-13 exhibit protective effects but vary in expression across disease stages. Less-characterized interleukins such as IL-3, IL-5, IL-9, and IL-27 demonstrate dual or context-dependent roles, particularly in shaping immune tolerance and tissue-specific complications such as nephropathy and neuropathy. Polymorphisms in IL-10 and IL-6 genes further suggest genetic contributions to interleukin dysregulation and metabolic dysfunction. Despite promising insights, translational gaps persist due to overreliance on preclinical models and limited longitudinal clinical data. Conclusions: Interleukins represent a mechanistic bridge linking immune dysregulation to metabolic derangements in both T1D and T2D. While their diagnostic and therapeutic potential is increasingly recognized, future research must address current limitations through isoform-specific targeting, context-aware interventions, and validation in large-scale, human cohorts. A unified interleukin-based framework may ultimately advance personalized strategies for diabetes prevention and treatment. Full article

This study examines the safety and cost-effectiveness of implementing shoulder rumble strips (SRS) and road lighting on Saudi Arabian freeways, providing insights into their roles in fostering sustainable transport systems. By leveraging the Highway Safety Manual (HSM) framework, this research develops localized Crash Modification Factors (CMFs) for these interventions, ensuring evidence-based and context-specific evaluations. Data were collected for two periods—pre-pandemic (2017–2019) and post-pandemic (2021–2022). For each period, we obtained traffic crash records from the Saudi Highway Patrol database, traffic volume data from the Ministry of Transport and Logistic Services’ automated count stations, and roadway characteristics and pavement-condition metrics from the National Road Safety Center. The findings reveal that SRS reduces fatal and injury run-off-road crashes by 52.7% (CMF = 0.473) with a benefit–cost ratio of 14.12, highlighting their high cost-effectiveness. Road lighting, focused on nighttime crash reduction, decreases such crashes by 24% (CMF = 0.760), with a benefit–cost ratio of 1.25, although the adoption of solar-powered lighting systems offers potential for greater sustainability gains and a higher benefit–cost ratio. These interventions align with global sustainability goals by enhancing road safety, reducing the socio-economic burden of crashes, and promoting the integration of green technologies. This study not only provides actionable insights for achieving KSA Vision 2030’s target of improved road safety but also demonstrates how engineering solutions can be harmonized with sustainability objectives to advance equitable, efficient, and environmentally responsible transportation systems. Full article

Background/Objectives: Tension-type headache (TTH) is the most prevalent form of primary headache. The etiology of TTH is not yet fully understood, although it is associated with the presence of myofascial trigger points (MTPs) in cervical and facial muscles. Dry needling (DN) therapy has emerged as an effective and safe non-pharmacological option for pain relief, but there are a lack of systematic reviews focused on its specific characteristics in TTH. The aim of this paper is to examine the characteristics and methodologies of DN in managing TTH. Methods: A scoping review was conducted with inclusion criteria considering studies that evaluated DN interventions in adults with TTH, reporting target muscles, diagnostic criteria, and technical features. The search was performed using PubMed, Embase, Scopus, and the Web of Science, resulting in the selection of seven studies after a rigorous filtering and evaluation process. Results: The included studies, primarily randomized controlled trials, involved a total of 309 participants. The most frequently treated muscles were the temporalis and trapezius. Identification of MTPs was mainly performed through manual palpation, although diagnostic criteria varied. DN interventions differed in technique. All studies included indicated favorable outcomes with improvements in headache symptoms. No serious adverse effects were reported, suggesting that the technique is safe. However, heterogeneity in protocols and diagnostic criteria limits the comparability of results. Conclusions: The evidence supports the use of DN in key muscles such as the temporalis and trapezius for managing TTH, although the diversity in methodologies and diagnostic criteria highlights the need for standardization. The safety profile of the method is favorable, but further research is necessary to define optimal protocols and improve reproducibility. Implementing objective diagnostic criteria and uniform protocols will facilitate advances in clinical practice and future research, ultimately optimizing outcomes for patients with TTH. Full article

In modern vehicles, Autonomous Driving Systems (ADSs) are designed to operate partially or fully without human intervention. The ADS pipeline comprises multiple layers, including sensors, perception, localization, mapping, path planning, and control. The Robot Operating System (ROS) is a widely adopted framework that supports the modular development and integration of these layers. Among them, the path-planning and control layers remain particularly challenging due to several limitations. Classical path planners often struggle with non-smooth trajectories and high computational demands. Meta-heuristic optimization algorithms have demonstrated strong theoretical potential in path planning; however, they are rarely implemented in real-time ROS-based systems due to integration challenges. Similarly, traditional PID controllers require manual tuning and are unable to adapt to system disturbances. This paper proposes a ROS-based ADS architecture composed of eight integrated nodes, designed to address these limitations. The path-planning node leverages a meta-heuristic optimization framework with a cost function that evaluates path feasibility using occupancy grids from the Hector SLAM and obstacle clusters detected through the DBSCAN algorithm. A dynamic goal-allocation strategy is introduced based on the LiDAR range and spatial boundaries to enhance planning flexibility. In the control layer, a modified Pure Pursuit algorithm is employed to translate target positions into velocity commands based on the drift angle. Additionally, an adaptive PID controller is tuned in real time using the Differential Evolution (DE) algorithm, ensuring robust speed regulation in the presence of external disturbances. The proposed system is practically validated on a four-wheel differential drive robot across six scenarios. Experimental results demonstrate that the proposed planner significantly outperforms state-of-the-art methods, ranking first in the Friedman test with a significance level less than 0.05, confirming the effectiveness of the proposed architecture. Full article

Background/Objectives. Social and Emotional Education (SEE) interventions during early childhood have shown considerable promise in enhancing children’s emotion understanding, social competence, and behavioural adjustments. However, few studies have examined their long-term impact, especially across the preschool-to-primary school transition. This study evaluated the effectiveness of a manualized SEE program, Timmy’s Trip to Planet Earth, in promoting emotional, behavioural, and social functioning over time. Methods. A quasi-experimental longitudinal design was adopted with pre- and post-test assessments conducted approximately 18 months apart. Participants were 89 typically developing children (aged 59–71 months), assigned to an experimental group (n = 45) or a waiting-list group (n = 44). The program combined teacher training, classroom-based lessons, home activities, and teachers’ ongoing implementation support. The effectiveness of the program was measured via the Test of Emotion Comprehension (TEC), the Strengths and Difficulties Questionnaire (SDQ), and the Social Competence and Behavior Evaluation (SCBE-30). Results. Significant Time × Group interactions were observed for the TEC External and Mental components, indicating greater improvements in emotion recognition and mental state understanding in the intervention group. The SDQ revealed significant reductions in conduct problems and increased prosocial behaviours. In the SCBE-30, a significant interaction effect was found for social competence, with the intervention group showing greater improvement over time compared to the control group. Conclusions. The findings suggest that SEE programs can produce meaningful and lasting improvements in children’s emotional and social skills across key educational transitions. Teacher training and family involvement likely played a critical role in supporting the program’s sustained impact. Full article

Background/Objectives: Autism spectrum disorder (ASD) is a neurodevelopmental disorder distinguished by an extensive range of symptoms, including reduced social interaction, communication difficulties and tiresome behaviors. Early detection of ASD is important because it allows for timely intervention, which significantly improves developmental, behavioral, and communicative outcomes in children. However, traditional diagnostic procedures for identifying autism spectrum disorder (ASD) typically involve lengthy clinical examinations, which can be both time-consuming and costly. This research proposes leveraging automated machine learning (AUTOML) to streamline the diagnostic process and enhance its accuracy. Methods: In this study, by collecting data from various rehabilitation centers across Pakistan, we applied a specific AUTOML tool known as Tree-based Pipeline Optimization Tool (TPOT) for ASD detection. Notably, this study marks one of the initial explorations into utilizing AUTOML for ASD detection. The experimentations indicate that the TPOT provided the best pipeline for the dataset, which was verified using a manual machine learning method. Results: The study contributes to the field of ASD diagnosis by using AUTOML to determine the likelihood of ASD in children at prompt stages of evolution. The study also provides an evaluation of precision, recall, and F1-score metrics to confirm the correctness of the diagnosis. The propose TPOT-based AUTOML framework attained an overall accuracy 78%, with a precision of 83%, a recall of 90%, and an F1-score of 86% for the autistic class. Conclusions: In summary, this research offers an encouraging approach to improve the detection of autism spectrum disorders (ASD) in children, which could lead to better results for affected individuals and their families. Full article

Accurate photovoltaic (PV) panel characterization is critical for optimizing renewable energy systems, but it is often hindered by the high cost of commercial tracers or the slow, error-prone nature of manual methods. This paper presents a low-cost, Arduino-based I–V curve tracer that overcomes these limitations through fully automated resistive load switching. By integrating a relay-controlled resistor bank managed by a single microcontroller, the system eliminates the need for manual intervention, enabling rapid and repeatable measurements in just 45 s. This rapid acquisition is a key advantage over manual systems, as it minimizes the impact of fluctuating environmental conditions and ensures the resulting I–V curve represents a stable operating point. Compared to commercial alternatives, our open-source solution offers significant benefits in cost, portability, and flexibility, making it ideal for field deployment. The system’s use of fixed, stable resistive loads for each measurement point also ensures high repeatability and straightforward comparison with theoretical models. Experimental validation demonstrated high agreement with a single-diode PV model, achieving a mean absolute percentage error (MAPE) of 4.40% against the manufacturer’s data. Furthermore, re-optimizing the model with field-acquired data reduces the MAPE from 18.23% to 7.06% under variable irradiance. This work provides an accessible, robust, and efficient tool for PV characterization, democratizing access for research, education, and field diagnostics. Full article

Background/Objectives: Total knee arthroplasty (TKA) is an effective surgical intervention for end stage knee osteoarthritis in elderly patients, with emerging robotically assisted techniques aiming to enhance surgical precision and patient outcomes. This study aimed to compare medium-term balance and functional outcomes between robotically assisted and conventional manual TKA in community-dwelling elderly patients. Methods: This cross-sectional study included 50 elderly patients undergoing TKA, who were divided into robotically assisted (n = 25) and conventional manual (n = 25) groups. Demographic and clinical data, balance performance, and functional outcomes were compared at nearly 1.5 years postoperatively. Outcome measures included balance performance assessed by the Berg Balance Scale (BBS), pain via the Visual Analog Scale (VAS), knee function as measured by the Lysholm Knee Scoring Scale, quality of life using the Short Form-12 (SF-12), joint awareness as evaluated by the Forgotten Joint Score-12 (FJS-12), and surgical satisfaction. Results: The groups had similar demographic and clinical data regarding age, gender, follow-up duration, surgical time, and anesthesia type (p > 0.05). The robotically assisted group demonstrated better balance performance on the BBS (p = 0.043) and had a statistically shorter length of hospital stay (1.22 vs. 1.42 days; p = 0.005). However, no statistically significant differences were observed in VAS activity pain (p = 0.053), Lysholm Knee Scoring Scale (p = 0.117), SF-12 physical and mental scores (p = 0.174 and p = 0.879), FJS-12 (p = 0.760), and surgical satisfaction (p = 0.218). Conclusions: Robotically assisted TKA is associated with advantageous postoperative recovery, particularly in terms of balance performance, showing no clinical difference in other functional outcomes compared to the conventional manual technique. From a physical therapy perspective, these findings emphasize the importance of developing tailored and effective rehabilitation strategies in the medium term for functional recovery in the elderly population. Full article

Background/Objectives: Knee osteoarthritis is one of the most significant diseases globally and in Portugal. Despite the availability of international guidelines, there is a lack of tailored, evidence-based recommendations specifically for Portuguese physiotherapists to manage their knee osteoarthritis patients with non-pharmacological and non-surgical interventions. This study aimed to develop a clinical practice guideline that integrates the latest international evidence with local clinical practice data to enhance patient outcomes. Methods: To achieve the objective, a comprehensive search was conducted in November 2024 across major health-related databases, to identify robust and recent evidence regarding the efficacy of non-pharmacological and non-surgical interventions, as well as their usage in the national context. Two key sources were identified: An umbrella and a mixed-methods study. Data from both sources were independently reviewed and integrated through a comparative analysis to identify interventions with robust scientific support and high local acceptability. Recommendations were then formulated and categorized into gold (strong), silver (moderate), and bronze (weak) levels based on evidence quality and clinical relevance. A decision-making flowchart was developed to support guideline implementation and clinical usage. Results: The integrated analysis identified three gold-level interventions, namely Nutrition/Weight Loss, Resistance Exercise, and Self-care/Education. Five silver-level recommendations were Aerobic Exercise, Balneology/Spa, Extracorporeal Shockwave Therapy, Electrical Stimulation, and Manual Therapy. Similarly, five bronze-level recommendations comprised Kinesio Taping, Stretching, Ultrasound Therapy, Thermal Agents, and Walking Aids. Conclusions: This clinical practice guideline provides a context-specific, evidence-based framework for Portuguese physiotherapists managing knee osteoarthritis. By bridging international evidence with local clinical practice, the guideline aims to facilitate optimal patient care and inform future research and guideline updates. Full article

Background/Objectives: Muscle dysmorphia (MD), a subtype of body dysmorphic disorder, is prevalent among males who engage in the non-medical use of anabolic–androgenic steroids (AASs) and performance-enhancing drugs (PEDs). These individuals often experience severe psychopathology, including mood instability, compulsivity, and a distorted body image. Despite its clinical severity, no randomized controlled trials (RCTs) have evaluated structured psychological treatments in this subgroup. This study aimed to assess the efficacy of a manualized cognitive behavioral therapy (CBT) protocol in reducing MD symptoms and associated psychological distress among male steroid users. Results: Participants in the CBT group showed significant reductions in MD symptoms from the baseline to post-treatment (MDDI: p < 0.001, d = 1.12), with gains sustained at follow-up. Large effect sizes were also observed in secondary outcomes including depressive symptoms (PHQ-9: d = 0.98), psychological distress (K10: d = 0.93), disordered eating (EDE-Q: d = 0.74), and exercise addiction (EAI: d = 1.07). No significant changes were observed in the control group. Significant group × time interactions were found for all outcomes (all p < 0.01), indicating CBT’s specific efficacy. Discussion: This study provides the first RCT evidence that CBT significantly reduces both core MD symptoms and steroid-related psychopathology in men engaged in AAS/PED misuse. Improvements extended to mood, body image perception, and compulsive exercise behaviors. These findings support CBT’s transdiagnostic applicability in addressing both the cognitive–behavioral and affective dimensions of MD. Materials and Methods: In this parallel-group, open-label RCT, 59 male gym-goers with DSM-5-TR diagnoses of MD and a history of AAS/PED use were randomized to either a 12-week CBT intervention (n = 30) or a waitlist control group (n = 29). CBT sessions were delivered weekly online and targeted distorted muscularity beliefs, compulsive behaviors, and emotional dysregulation. Primary and secondary outcomes—Muscle Dysmorphic Disorder Inventory (MDDI), PHQ-9, K10, EDE-Q, EAI, and BIG—were assessed at the baseline, post-treatment, and 3-month follow-up. A repeated-measures ANOVA and paired t-tests were used to analyze time × group interactions. Conclusions: CBT offers an effective, scalable intervention for individuals with muscle dysmorphia complicated by anabolic steroid use. It promotes broad psychological improvement and may serve as a first-line treatment option in high-risk male fitness populations. Future studies should examine long-term outcomes and investigate implementation in diverse clinical and cultural contexts. Full article

Intravenous infusion is an important clinical medical intervention, and its safety is critical to patient recovery. To mitigate the elevated risk of complications (e.g., air embolism) arising from delayed response to infusion endpoints, this paper designs a flexible double pole capacitive (FPB) sensor, which includes a main pole plate, an adaptive pole plate, and a back shielding electrode. The sensor establishes a mapping between residual liquid volume in the infusion bottle and its equivalent capacitance, enabling a non-contact adaptive monitoring system. The system enables precise quantification of residual liquid levels, suppressing baseline drift induced by environmental temperature/humidity fluctuations and container variations via an adaptive algorithm, without requiring manual calibration, and overcomes the limitations of traditional rigid sensors when adapting to curved containers. Experimental results showed that the system achieved an overall sensitivity of 753.5 $\mathrm{f}\mathrm{F}/\mathrm{m}\mathrm{m}$, main pole plate linearity of 1.99%, and adaptive pole plate linearity of 0.53% across different test subjects, linearity of 0.53% across different test subjects, with liquid level resolution accuracy reaching 1 mm. These results validate the system’s ultra-high resolution (1 mm) and robust adaptability. Full article

Background/Objectives: Gestational diabetes (GD), which affects approximately 15% of pregnancies worldwide, poses significant risks to both maternal and fetal health, underscoring the need for effective prevention and management strategies. This umbrella review aims to evaluate the role of probiotics in the prevention of GD. Methods: The review was conducted in accordance with the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis. A comprehensive literature search was performed in November 2024 across four databases: PubMed/Medline, Cochrane Library, Embase, and CINAHL. A total of 307 articles were identified, of which 6 met the inclusion criteria and were included in the final synthesis. Results: Probiotic supplementation was associated with a significant reduction in the incidence of GD in selected populations, particularly in women with a body mass index (BMI) < 26, age < 30 years [Relative Risk (RR): 0.58], and p < 0.05 in the other studies included, alongside improvements in several metabolic parameters. However, consistent benefits on maternal or neonatal complications were not observed but a 33% reduction in GD was confirmed (RR 0.67). The combination of probiotics with healthy lifestyle behaviors appeared to exert a stronger protective effect against GD and its potential complications. Conclusions: This umbrella review suggests that probiotics—particularly multi-strain formulations—may have a potential role in reducing the risk of GD in certain populations. However, the findings across the included studies are inconsistent and sometimes conflicting. While probiotics are generally considered safe and have recognized benefits for metabolic health, their efficacy as an adjunct intervention for GD prevention remains not fully clear. Further well-designed research is needed to clarify which specific probiotic interventions may be effective and to better guide clinical practice. Full article