Search Results (1,640)

Background: Knee osteoarthritis (KOA) is a progressive joint disorder that leads to pain, functional limitations, and reduced quality of life. While physical therapy (PT) and resistance exercise are effective in managing KOA, creatine supplementation (CS) may provide additional benefits. Aims/Objectives: To determine the additive effects of creatine supplementation alongside physical therapy (PT) and resistance exercise training in individuals with KOA. Methods: A parallel-design, double-blind, randomized controlled trial was conducted on 40 patients with KOA (≤grade III on Kellgren classification), aged 40–70 years. Participants were randomly allocated to either a placebo control group, which received placebo supplementation (maltodextrin) along with PT, including heat therapy, electrotherapy, manual therapy, and resistance exercises, for four weeks, or an experimental group, which received CS instead of maltodextrin in addition to the same treatment. Outcome measures included the visual analog scale (VAS), fall risk, Knee Injury and Osteoarthritis Outcome Score (KOOS), isometric muscle strength (IMS), five-repetition sit-to-stand test (5xSST), knee range of motion (ROM), and body composition analysis. Results: No significant differences were observed between the two groups at baseline. After four weeks of treatment, a significant interaction effect (treatment group x time) was observed for VAS (p = 0.001), fall risk score (p < 0.001), KOOS overall score (p < 0.001), IMS (p < 0.001), and body composition parameters (p < 0.05) in favor of the CS group. However, no significant interaction effect was observed for knee ROM and KOOS QOL subscale. Conclusions: CS, when combined with PT and resistance exercise, may provide additional benefits in terms of pain, function, muscle strength, and body composition parameters in individuals with KOA. However, no supplementary benefits of CS are observed in terms of quality of life and ROM. Full article

Mechanical pruning has emerged as a viable alternative to traditional hand pruning in apple orchards in labor-constrained and aging population workforces. While mechanical pruning reduces labor demand and enhances operational efficiency, their effects on tree physiology and fruit development remain poorly understood. In this study, we examined the physiological and transcriptional responses of apple trees to mechanical pruning (MP) and hand pruning (HP), with a focus on hormone metabolism, photosynthetic activity, and stress adaptation. Pruning treatments were applied in an orchard using a tractor-mounted mechanical pruner and manual shears, and distinct metabolic responses after pruning were assessed over multiple time points using transcriptomic analysis. At 168 h after MP, trees exhibited downregulation of MdLhcb genes, indicating a reduction in light harvesting capacity. In addition, MdDFR, a key gene in flavonoid biosynthesis, was also downregulated, suggesting a suppression of secondary metabolism and a distinct physiological response to MP. In addition, stress-responsive genes such as MdNHL3 were rather upregulated, indicating the activation of adaptive signaling networks. Conversely, HP trees showed relatively moderate responses in the same pathways, suggesting pruning method-specific regulatory mechanisms. These findings highlight how pruning methods distinctly influence tree recovery and gene expression dynamics, offering insights into optimizing pruning systems for sustainable and high-quality apple production under labor-constrained conditions. Full article

Given the increasing frequency of heat waves, it is likely that swimming in surface water not officially designated as swimming water (wild swimming) will become more popular. The goal of this exploratory case study was to determine the extent of wild swimming in the Vecht river basin in Germany and the Netherlands and to identify and minimize biological risks. Through several years of field observations, supplemented by data from key informants and online sources, we identified the number of visitors, their level of exposure to water, and the total number of water-contact-associated outbreaks. During the hot summers of 2018 to 2020, between 29,000 and 37,000 people a year sought cooling in the streams, rivers and canals of this watershed, into which 52 sewage treatment plants discharge. As a result, 85% of the wild swimmers in the area swam in surface waters that do not comply with the European Bathing Water Directive. Between 2016 and 2020, at least eight outbreaks of gastroenteritis potentially linked to wild swimming occurred in the region. Most outbreaks have been associated with waters containing the highest concentrations of sewage effluent. A total of 1201 people participated in activities linked to the outbreaks. Of those, at least 107 (11%), primarily children who had engaged in intensive water-based activities, became infected. Potential prevention strategies were assessed. Targeted awareness raising, promoting safe alternatives for water recreation, outbreak surveillance, and adaptation of prevention manuals, are expected to be relatively easy to apply, effective, socially acceptable and not very costly. Full article

Timely, concerted, and persistent culling (or manual removal) is required to effectively manage population irruptions of crown-of-thorns starfish (CoTS; Acanthaster spp.). However, there are concerns that handling and culling gravid starfish may induce spawning. This study explicitly tested the frequency and timing of spawning for Pacific CoTS (Acanthaster cf. solaris) injected with either bile salts (10 mL of 8 g·L⁻¹ Bile Salts No. 3) or vinegar (20 mL of 4% acetic acid, with 10 mL injected into each of two non-adjacent arms), up to 48 h after treatment, while also considering three distinct experimental controls (handling controls, injection controls, and spawning controls). This study showed that male CoTS often spawn within 24 h after different culling treatments. However, the incidence of spawning by male starfish injected with vinegar (70%) was nearly twice that of male starfish injected with bile salts (36.4%). In contrast, there were no instances of spawning by female CoTS following handling or injections of bile salts and vinegar. Variation in the incidence of spawning between culling treatments is largely attributable to differences in the rate of mortality, whereby CoTS injected with bile salts (n = 23) consistently died within 24 h and therefore had limited opportunity to spawn. Meanwhile, CoTS injected with vinegar generally died >24 h post-treatment, and many had not died even after 48 h. This suggests that, where available, bile salts (rather than vinegar) should be used when culling Acanthaster cf. solaris, especially during reproductive periods. However, sustained culling effort is still the most direct and effective way to suppress the local densities and reproductive capacity of CoTS. Full article

Background: Diastasis rectus abdominis (DRA) is a frequent concern following childbirth, particularly following a cesarean section (CS). Mobile exercise applications offer promising opportunities for enhancing physical therapy services, with potential positive outcomes. Purpose: This study compared the effect of a specific DRA-targeted mobile app-based exercise program on inter-recti distance (IRD) and multiple clinical measures to a traditional abdominal exercise program in post-CS mothers with DRA. Methods: This two-armed, parallel-group, randomized controlled trial involved 40 primiparous women undergoing CS; they were classified into two equal groups. Group A participated in Just Fit, a mobile app-based abdominal exercise program, while Group B received a traditional abdominal exercise program. Both exercise programs lasted 30 min, 3 times/week, for 8 weeks as a home program with follow-up sessions once weekly at an outpatient physical therapy clinic. Ultrasonography was used to measure IRD, a manual muscle test assessed abdominal muscle strength, a tape measure gauged circumferences, and a questionnaire evaluated satisfaction. Results: Both programs showed significant improvements in pre- and post-treatment measures of IRD, muscle strength, and girth (p ≤ 0.001 for all comparisons). Women in Group A exhibited significant post-treatment improvements in IRD above the umbilicus, abdominal muscle strength, girth measurements, and satisfaction compared with those in Group B. However, there were non-significant differences in IRD below the umbilicus and hip circumference between the two groups. Conclusions: The mobile app-based exercise program was associated with greater improvements in IRD above the umbilicus, abdominal muscle strength, waist and umbilical circumferences, and patient satisfaction compared with the traditional exercise program for post-CS DRA. These findings suggest that mobile app-guided rehabilitation may serve as an effective and accessible adjunct to traditional post-CS exercise programs, although larger trials are recommended to confirm these results. Full article

Background: Hemophilia A and B are hereditary bleeding disorders that result in recurrent joint and muscle hemorrhages, leading to hemophilic arthropathy, muscle atrophy, and disability. Recent evidence suggests that physiotherapeutic interventions, including resistance training and manual therapy, may mitigate these effects, although comprehensive studies remain limited. This case series aimed to describe the outcomes of an eight-week physiotherapy program combining progressive resistance training and manual therapy in four adolescent boys (aged 11–17 years) with severe hemophilia. Methods: The program targeted joint function, muscle strength, ultrasound findings, and pain, with additional exploratory evaluation of neuroinflammatory and endothelial biomarkers: interleukin-18 (IL-18), C-C motif chemokine ligand 2 (CCL2), soluble intercellular adhesion molecule-1 (ssICAM-1), β-nerve growth factor (β-NGF), and soluble receptor for advanced glycation end-products (sRAGE). Results: After the intervention, Hemophilia Joint Health Score (HJHS) total scores decreased by 35–62%, indicating functional improvement, while muscle strength increased across most joints. No progression of arthropathy was observed on ultrasound (HEAD-US). IL-18 and ssICAM-1 levels decreased on average by 42% and 29%, respectively, whereas β-NGF and sRAGE increased by 39% and 11%, suggesting potential anti-inflammatory and neuroprotective responses. Conclusions: These descriptive findings indicate that individualized physiotherapy may serve as a supportive component of hemophilia care, while biomarker monitoring provides exploratory insight into treatment-related physiological responses. Full article

Background/Objectives: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an effective treatment for motor symptoms in Parkinson’s disease (PD), but concerns remain regarding its impact on cognitive function. Identifying neuroanatomical predictors of postoperative cognitive decline could improve patient selection and outcomes. This study aims to investigate the relationship between preoperative brain morphology and postoperative neuropsychological outcomes in PD patients undergoing bilateral STN-DBS. Methods: Thirty-eight PD patients underwent standardized neuropsychological testing and preoperative MRI before and 3–24 months after STN-DBS. Manual MRI morphometric measurements were obtained for 42 cortical, subcortical, and ventricular parameters. Changes in cognitive domains—including executive function, memory, language, visuospatial abilities, attention, and global cognition—were analyzed, and correlations between structural metrics and cognitive changes were assessed using Spearman’s coefficients. Results: Significant postoperative declines occurred selectively in language functions: verbal fluency (phonemic and semantic, d = −0.49 to −0.84) and confrontation naming (d = −0.47). Memory, executive functions, attention, and global cognition remained preserved. Enlarged lateral ventricles were consistently associated with poorer outcomes across multiple domains, while increased left precentral gyrus width correlated with executive and memory decline. Additionally, smaller midbrain and cingulate gyrus width were associated with greater executive impairment. Conclusions: STN-DBS in PD is associated with selective postoperative cognitive changes, most prominently in verbal fluency. Simple preoperative MRI morphometric measures, including ventricular size, limbic structure volumes, and specific cortical parameters, may serve as clinically feasible predictors of cognitive risk. Incorporating such measures into preoperative assessments could enhance patient selection, counseling, and individualized surgical planning. Full article

Background: Neoadjuvant systemic therapy (NST), whose primary purposes include response assessment and treatment individualization, is a key strategy in the treatment of HER2-positive breast cancer. This study investigated the predictive value of the magnetic resonance imaging (MRI)-derived tumor volume reduction rate (δV1) for the early identification of pathological complete response (pCR) during NST and established clinically applicable δV1 thresholds for patient stratification. Methods: HER2-positive breast cancer patients who received THP (taxane, trastuzumab, pertuzumab) followed by epirubicin/cyclophosphamide (EC) were enrolled. MRI was performed at baseline, after THP, and after EC. Tumor volumes were manually segmented using 3D Slicer, and δV1/δV2 were calculated via Python (version3.13). Longest diameter reduction rates (δL1/δL2) were recorded. pCR (ypT0/is ypN0) was the primary endpoint. Receiver operating characteristic (ROC) analysis determined predictive accuracy, and logistic regression identified independent predictors. Thresholds for δV1 were explored, and subgroup analyses were conducted by hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status. Results: Overall, 59.3% of patients achieved pCR. δV1 demonstrated superior predictive accuracy compared with longest diameter reduction (δL1), with an AUC of 0.745 (95% CI: 0.642–0.847) vs. 0.634 (95% CI: 0.512–0.757). A δV1 cutoff of 0.85 discriminated responders (68.4% vs. 41.4%, p = 0.016), while one of 0.91 represented the optimal predictive threshold. In multivariate analysis, δV1 was independently associated with pCR (OR = 1227.1, 95% CI: 6.86–219,562; p = 0.007), along with HER2 3+ expression (OR = 4.24, 95% CI: 1.26–14.31; p = 0.020). Among HR-positive patients, δV1 < 0.93 identified a subgroup with significantly lower pCR rates (19.0% vs. 81.0%, p < 0.001). Conclusions: δV1 is a reliable and early MRI-based imaging biomarker for predicting pCR in HER2-positive breast cancer. Defining thresholds such as 0.85 and 0.91 supports early therapeutic stratification and may help identify patients who could benefit from anthracycline-containing regimens. Full article

Thyroid diseases in horses are rare and pose challenges for veterinarians due to the complexity of clinical and diagnostic approaches. This retrospective case series describes cases of equine thyroid disease in a referral hospital population. Files of horses examined for suspected thyroid disease at an equine university clinic between 2009 and 2024 were reviewed. Data from nine horses examined for suspected thyroid disease, including signalment, clinical presentation, laboratory results, imaging findings, fine needle aspirates, biopsies, diagnoses, and treatments, were summarised. Diagnoses included thyroid adenoma (n = 6), multiple thyroid cysts (possibly thyroid adenoma (n = 1)), non-thyroidal illness syndrome (NTIS, n = 1), and iodine deficiency goitre (n = 1). Diagnostic modalities varied, with, besides manual palpation performed in every patient, basal thyroid hormone measurement and ultrasonography being the most common. Low serum iodine concentrations were noted in four horses, yet iodine supplementation was inconsistently applied. Hemithyroidectomy was performed in four horses, enabling histopathological diagnosis (three out of four). Despite being rare, thyroid diseases in horses require consistent and thorough diagnostic approaches, including imaging, laboratory, and histopathological examinations. Improved screening tools and research could enhance the diagnostic accuracy and management of equine thyroid disorders. Full article

Coagulation is a critical unit process in drinking water treatment plants (DWTPs), where accurate dosing of coagulants such as polyaluminum chloride (PAC) and polyaluminum hydroxide chloride silicate (PACS) directly determines turbidity removal and operational stability. However, nonlinear interactions among water-quality variables complicate dosage prediction, and jar tests or operator heuristics cannot support real-time control. This study presents a scientifically interpretable and operationally transferable framework based on polynomial multiple linear regression (PMLR) with Lasso regularization, which was specifically developed for full-scale DWTP environments. While conventional PMLR rapidly overfits beyond polynomial degrees of 4–5, the Lasso-regularized model maintained stable generalization even at a degree of 10 by automatically pruning redundant terms and suppressing multicollinearity, thereby minimizing the need for manual hyperparameter tuning. Using 8303 hourly operational records from a full-scale DWTP in Korea, the Lasso-PMLR achieved R² = 0.951, RMSE = 0.120, and MAPE = 7.02%, outperforming traditional linear regression (R² = 0.896; MAPE = 8.64%). This proportional stability across increasing polynomial degrees, demonstrated directly using long-term real-world data, is particularly valuable for practical deployment because it ensures robustness without complex model-selection procedures. The transparent coefficient structure enables operators—who typically rely on jar tests—to understand and adjust dosing behavior, offering a field-ready and interpretable alternative to black-box models and supporting more efficient coagulant use, reduced sludge production, and sustainable automation in DWTP operation. Full article

Background/Objectives: Nutrition at the end of life raises many dilemmas. “End of life” refers to the period associated with a progressive incurable disease, with a life expectancy of less than six months, and limited curative treatments. In intensive care units (ICUs), decisions about artificial nutrition and hydration (clinically assisted nutrition and hydration, CANH) are especially complex because patient goals shift from survival to comfort. Nutrition and hydration are often requested by patients and their families, even when clinical benefits are uncertain. This article aims to provide a multidimensional analysis of the pathophysiological, clinical, ethical and legal considerations of nutritional support in the final stages of life. Methods: We conducted a narrative review of the literature published between January 2000 and June 2025 by searching the PubMed/MEDLINE, Web of Science, and Scopus databases and included original articles, clinical trials, reviews, international guidelines, and public policy documents involving adult population at the end of life. The narrative approach enabled the multidimensional integration of the collected data. Results: Terminally ill patients often develop anorexia and cachexia leading to irreversible muscle loss and resistance to nutritional support. CANH (enteral or parenteral) has limited success and carries increased risks. In advanced cancer and dementia, studies do not show clear benefits for survival or quality of life. Nutritional counseling and oral supplements may help alleviate symptoms, but manual feeding remains the standard of care in the terminal stages. In ICU settings, starting or maintaining CANH demands careful evaluation of goals, prognosis, and burdens. Cultural legal differences and approaches between countries also influence clinical practice and family expectations. Conclusions: CANH at the end of life should be viewed as a medical intervention that requires both scientific and ethical justification. The decision to initiate or discontinue it should be individualized. Clear and empathetic communication between the medical team, patient, and family is essential to avoid inappropriate decisions. Full article

Background: Hospital-at-home (HAH) programs deliver hospital-level care in patients’ homes, improving satisfaction and optimizing resource use. While widely adopted in adults, pediatric HAH remains limited. At Sant Joan de Déu Hospital (Barcelona, Spain), the pediatric HAH program for acutely ill children has expanded to include more clinically complex cases. Family involvement is essential, as caregivers are trained to administer treatments, monitor clinical status, and support telematic follow-ups, supporting the healthcare team’s workload. Objective: To identify patient characteristics influencing healthcare workload and develop a predictive model to enhance resource allocation. Methods: This single-center, prospective cohort study included all patients admitted to the pediatric HAH program for one year. Primary variables were caregiver training time, home visiting time, patient age, type of care provided, and clinical complexity. Secondary variables included referral specialty and team composition. Data were collected using digital time-tracking, manual records, and clinical databases. Analyses included Kruskal–Wallis and Dunn’s multiple comparison tests. Results: All variables showed significant differences in training and visiting times. Training time ranged from 19 to 157 min; visiting time from 6.2 to 157 min. A predictive model using five key variables estimated visiting time, and another model based on care type estimated training time were created. Conclusions: Patient characteristics and caregiver involvement significantly affect direct care workload. These findings can inform strategies to optimize staffing and scale pediatric HAH programs effectively. Full article

Objective: Clinical trials are the cornerstone of medical innovation and set the standard for medical care. Cancer clinical trials drive critical innovation and availability of new treatments. However, obstacles to successful recruitment and participation of patients in clinical trials still significantly limit their success. Our objective is to evaluate trial enrollment trends according to both patient and trial demographics/features for those who have sought care at our multi-center, mixed-setting Gynecologic Oncology practice, allowing for us to describe specific trial criteria designs that are negatively associated with diverse enrollment or lack of enrollment completion on cancer clinical trials. Methods: An IRB-approved, retrospective cohort study was completed to evaluate patients who screened positive for a clinical trial through the Gynecologic Oncology practice’s manual screening process. We looked at how trial characteristics affect enrollment success. Results: After adjustment, there were no significant differences between patient factors and enrollment status. Higher rates of enrollment were seen among Asian patients and patients whose race was reported as “unknown” (>50%, p = 0.125). There was a drastic, unadjusted estimated increase in enrollment for Medicaid patients compared to patients with other insurance types (55.2% vs. 32%, p = 0.031), but multivariable logistic regression showed that insurance status (Medicaid vs. others) lost significance, p = 0.148. Patients with Stage I cancer accounted for 42.1% of patients enrolled, and enrollment rates were higher than for other cancer stages (p = 0.087). There was a significant increase in enrollment likelihood if the trial did not exclude subjects with prior cancer (50.0% vs. 33.3%, p = 0.046). Conclusions: We demonstrated equitable trial enrollment across different races and insurance statuses and were able to identify criteria that lend itself towards higher rates of enrollment. These findings can be used to tailor cancer trial portfolios to a diverse patient catchment. Full article

Background/Objectives: Non-muscle-invasive bladder cancer (NMIBC) accounts for the majority of newly diagnosed bladder cancers and is characterized by a high recurrence rate despite standard treatments. Photodynamic therapy (PDT) using 5-aminolevulinic acid (5-ALA) offers a promising alternative; however, objective methods for monitoring therapeutic response are needed. Quantitative magnetic resonance imaging (MRI), particularly T1 and T2 relaxation mapping, may provide non-invasive biomarkers of tissue response to PDT. Methods: In this ex vivo study, 50 samples obtained during transurethral electro-resection of bladder tumors were analyzed using a 1.5 Tesla MRI scanner. Twenty-five healthy control tissues (n = 25) served as the control group. Twenty-five NMIBC tissues were analyzed twice: before and after 5-ALA-PDT. T1 and T2 relaxation times were measured, and regions of interest (ROIs) were manually segmented to obtain quantitative values. Statistical analyses were performed to assess the significance of differences observed between study groups. Results: T1 relaxation times significantly differed between groups: 1351.7 ± 271.1 ms in healthy tissue, 727.7 ± 145.0 ms in untreated NMIBC, and 368.9 ± 65.2 ms in NMIBC after PDT (p < 0.0001). T2 values were 93.5 ± 20.3 ms (healthy), 78.5 ± 20.4 ms (NMIBC), and 55.7 ± 6.1 ms (NMIBC_PDT), with significant reduction after PDT (p < 0.01). Conclusions: Quantitative T1 and T2 mapping via MRI is a sensitive and non-invasive method for detecting structural and biochemical changes in bladder tissue following 5-ALA-PDT. These relaxation times may serve as reliable biomarkers for therapeutic response, facilitating in real-time monitoring and personalized treatment planning for NMIBC. Further in vivo studies are warranted to validate these findings and integrate them into clinical practice. Full article

Introduction: This case report presents the multifactorial surgical management and long-term outcome of a permanent patellar dislocation in a 16-year-old female patient. Case presentation: A 16-year-old female with permanent patellar dislocation of the left knee complained of progressive pain and functional limitations. Physical examination revealed a 20-degree passive flexion contracture, significant muscle weakness in knee extension, and a permanently laterally dislocated patella that could not be manually repositioned. Imaging studies revealed a complex knee deformity characterised by femoral valgus, tibial varus, posterior tibial slope, and trochlear dysplasia. The patient underwent a comprehensive surgical approach addressing all deformities, including femoral and tibial osteotomies, trochleoplasty, medial patellofemoral ligament (MPFL) plasty, and quadriceps muscle balancing. Results: At the eight-year follow-up, the patient demonstrated a full range of motion and adequate stability, and experienced mild pain only rarely. Outcomes improved significantly: the International Knee Documentation Committee (IKDC) score increased from 10.3% to 75.9%, the Lysholm score rose from 24 to 72, the Kujala score improved from 22 to 67, and the BPII score increased from 14.9 to 55.4. Conclusions: Comprehensive surgical correction of all predisposing factors achieved sustained functional improvement over eight years, demonstrating that systematic treatment of anatomical and functional abnormalities is essential for the successful management of permanent patellar dislocation. Level of evidence: V. Full article