Search Results (529)

Background/Objectives: Lower limb amputation (LLA) negatively affects the physical and psychological health of individuals, leading to a lower quality of life and sedentary lifestyle. The objective of this scoping review is to search for evidence regarding physical activity interventions in individuals with LLA, investigating improvements in specific outcomes related to quality of life and performance. Methods: PRISMA guidelines—extension for scoping reviews—were used to structure the study. The research was conducted between 26 July 2023 and 30 September 2023; it was structured by defining two PICO questions (P = amputation, I = physical exercise, O1 = quality of life, and O2 = performance) through Pubmed, Cochrane, and Pedro databases. The study included subjects with LLA of any etiology, in prosthetic or pre-prosthetic phase, practicing non-competitive physical activity. The results were then subjected to both qualitative and quantitative analysis. Results: Of the 615 studies identified, 18 were included in the review. They consisted of 6 systematic reviews (SR), 5 RCTs, 4 case–control studies, 1 case report (CR), and 2 cross-sectional (CS). Physical activity (PA) interventions were extremely heterogeneous and were, therefore, categorized into 6 modalities: surveys were the most reported strategies (57%), followed by personalized training (23%), strength training (13%), endurance training (13%), combined training (2%), and gait training (5%). Due to the heterogeneity of the studies, the variety of interventions proposed and the different outcomes registered, there is no evidence that one approach is more effective than another, while each group showed benefits on different specific outcomes. In total, five outcome categories were identified: quality of life was the most frequently analysed (42%), followed by cardiovascular fitness (20%), muscular fitness (14%), gait parameters (13%), functionality and disability (11%). Conclusions: PA represents a valuable strategy for improving performance and quality of life in individuals with LLA, offering a variety of interventions. Although there is no evidence that one strategy is better than the others, each activity has proven to be effective on specific outcomes, therefore, the choice must depend on the patient’s necessities. The preferred option should be the personalization of the training according to individual needs, coupled with long-term planning and remote monitoring. Creating meeting places and supporting occasions for sports activities could be a valid option. Further research could help to clarify the benefits of such interventions and enhance the understanding of how to optimize the management of LLA patients. Full article

Atrial fibrillation (AF) management has historically relied on thermal ablation modalities—radiofrequency (RF) and cryoballoon—which have established a high benchmark for pulmonary vein isolation (PVI). However, the inherent risk of collateral thermal injury and lesion inconsistency has driven the search for alternative energy sources. The recent clinical adoption of pulsed-field ablation (PFA), based on irreversible electroporation, represents a significant technological evolution. This narrative review provides a critical appraisal of the transition from thermal to pulsed-field technologies. We synthesized data from pivotal trials and recent health-economic analyses to evaluate the biophysical mechanisms, clinical efficacy, and safety profiles of contemporary devices. We conduct a head-to-head comparison of all modalities regarding critical safety endpoints (esophageal, neurological, and vascular), real-world procedural challenges (anesthesia, lesion assessment), and economic sustainability. While PFA offers distinct advantages in procedural speed and tissue selectivity, we highlight that thermal modalities—particularly cryoballoon and very-high-power RF—retain competitive profiles in terms of cost-effectiveness and established long-term durability. This review aims to provide a balanced roadmap for clinicians navigating the complex choice between established thermal efficacy and the promising, yet evolving, landscape of electroporation. Full article

Objectives: The choice between endovascular treatment and microsurgery for unruptured intracranial aneurysm (UIA) is influenced by aneurysm location, with middle cerebral artery (MCA) UIAs traditionally requiring surgery. This study compares these treatment modalities using propensity score matching (PSM). Methods: This single-center analysis included adults with saccular MCA UIAs who underwent treatment. PSM incorporated patient and aneurysm characteristics to create comparable groups. Results: Before matching, 124 patients underwent microsurgery and 28 underwent endovascular treatment. With a median follow-up of 76.5 months, 93.4% achieved good functional outcome (modified Rankin Scale [mRS] 0–2), including 117 (93.4%) in the surgical group and 25 (89.3%) in the endovascular group. Complications occurred in 15.3% of surgical and 10.7% of endovascular patients (p > 0.05). Three patients developed subarachnoid hemorrhage post-treatment: two from other aneurysms and one from an endovascularly treated MCA UIA. Proximal location predicted worse outcomes (p = 0.04), whereas distal location was associated with better outcomes (p < 0.01). Ordinal logistic regression revealed no additional associations. After PSM, we did not observe significant between-group differences in complications or mRS at follow-up, and ordinal logistic regression predicting mRS at follow-up revealed no differences. Distal MCA remained associated with better outcomes (p < 0.01). No differences in survival were found between groups before or after PSM (log-rank test p = 0.34 and p = 0.49, respectively). Conclusions: No differences in long-term outcomes or complications were observed in this cohort after endovascular treatment vs. microsurgery. Distal location was the only factor associated with favorable outcomes. At a median follow-up of 6.4 years, most patients achieved good functional outcomes. These results likely reflect individualized treatment selection within an experienced team and should be considered exploratory given limited statistical power and generalizability. Full article

Background/Objectives: Managing large midline olfactory groove meningiomas is especially difficult in elderly patients who have limited physiological reserves. Here we describe a unique and dangerous geriatric case where we used new quantifiable anatomical measurements and developed a structured multidisciplinary preoperative and postoperative protocol to assist in all aspects of surgery. Case Presentation: A 68-year-old male with fronto-lobe syndrome and disability (astasia-abasia; Tinetti Balance Score of 4/16 and Gait Score of 0/12) as well as cognitive dysfunction (MoCA score of 12/30) and blindness bilaterally. Imaging prior to surgery demonstrated a very large olfactory groove meningioma which severely compressed both optic pathways at the level of the optic canals (up to 71% reduction in cross-sectional area of the optic nerves) and had complex vascular relationships with the anterior cerebral artery complex (210° contact surface). Due to significant cardiovascular disease and liver disease, his care followed a coordinated optimization protocol for the perioperative period. He underwent bifrontal craniotomy, initial early devascularization and then staged ultrasonic internal decompression (approximately 70% reduction in tumor volume) and finally microsurgical dissection of the tumor under multi-modal monitoring of neurophysiology. Discussion: We analyzed his imaging data prior to surgery using a standardized measurement protocol to provide quantitative measures of the degree of compression of the optic pathways (traction-stretch index = 1.93; optic angulation = 47.3°). These quantitative measures allowed us to make a risk-based evaluation of the anatomy and to guide our choices of corridors through which to dissect and remove the tumor. Following surgery, imaging studies demonstrated complete removal of the tumor with significant relief of the frontal lobe and optic apparatus from compression. His pathology showed that he had a WHO Grade I meningioma with an AKT1(E17K) mutation identified on molecular profiling. Conclusions: This case is intended to demonstrate the feasibility of integrating quantitative anatomical measurements into a multidisciplinary, protocol-based perioperative pathway to maximize the safety and effectiveness of the surgical removal of a complex and high-risk skull-base tumor. While the proposed quantitative indices are experimental and require additional validation, the use of a systematic approach such as this may serve as a useful paradigm for other complex skull-base cases. Full article

The willingness to adopt Autonomous Vehicles (AVs) represents a crucial advancement from the sustainable mobility perspective. This is progressively continuing in the developed countries. A comparable shift is expected in developing nations; however, empirical studies remain limited, especially in areas where AVs have not yet been deployed. This study investigates the willingness to adopt AVs in a developing city where AVs have not been deployed yet. A comprehensive travel behavior questionnaire was conducted among local commuters in Alexandria, Egypt, to identify the influential variables affecting AV choice. The well-known machine learning classifier, Extreme Gradient Boosting (XGB), was employed to develop a forecasting model, which indicated a notable accuracy. The results indicated that trip cost was the most influential feature. On the other hand, there is a considerable level of mode captivity, since most travelers prefer to remain with their current mode, regardless of the effects of other variables. A significant share of travelers expressed concerns about shifting to AVs due to safety worries associated with the travel behavior of other transportation modes’ commuters. The analysis provides nuanced perspectives on the variables promoting modal shift toward the AVs, supporting future policies for smart urban mobility. Full article

This study provides a chronological analysis of how Extended Reality (XR) interaction techniques have evolved from early controller-centered interfaces to natural hand- and gaze-based input and, more recently, to multimodal input, with a particular focus on the role of XR devices. We collected 46 user study–based XR interaction papers published between 2016 and 2024, including only studies that explicitly defined their interaction techniques and reported quantitative and/or qualitative evaluation results. For each study, we documented the XR hardware and software development kits (SDKs) used as well as the input modalities applied (e.g., controller, hand tracking, eye tracking, wrist rotation, multimodal input). These data were analyzed in relation to a device and SDK timeline spanning major platforms from the HTC Vive and Oculus Rift to the Meta Quest Pro and Apple Vision Pro. Using frequency summaries, heatmaps, correspondence analysis, and chi-square tests, we quantitatively compared input modality distributions across device generations. The results reveal three distinct stages of XR interaction development: (1) an early controller-dominant phase centered on the Vive/Rift (2016–2018), (2) a transitional phase marked by the widespread introduction of hand- and gaze-based input through the Oculus Quest, HoloLens 2, and the Hand Tracking SDK (2019–2021), and (3) an expansion phase in which multisensor and multimodal input became central, driven by MR-capable devices such as the Meta Quest Pro (2022–2024). These findings demonstrate that the choice of input modalities in XR research has been structurally shaped not only by researcher preference or task design but also by the sensing configurations, tracking performance, and SDK support provided by devices available at each point in time. By reframing XR interaction research within the technological context of device and SDK generations—rather than purely functional taxonomies—this study offers a structured analytical framework for informing future multimodal and context-adaptive XR interface design and guiding user studies involving next-generation XR devices. Full article

People with visual impairments (VIPs) can participate in orientation and mobility (O&M) training to learn how to navigate to their desired goal locations. During O&M training, personal wayfinding preferences with regard to cue use and wayfinding strategy choice are taken into account. However, there is still a lack of clarity about which factors shape VIPs’ wayfinding experiences and how. Background/Objectives: In this study, we mapped individual differences in preferred sensory modality (both orientation- and mobility-related), and classified which personal and environmental factors are relevant for these preferences. Methods: To this end, interviews were conducted with eleven Dutch VIPs whose impairment varied in onset, ontology, and severity. Results: We concluded from our thematic analysis that hearing is the most important sensory modality to VIPs for orientation purposes, although it varies per person how and how often other resources are relied upon (i.e., other sensory modalities, existing knowledge of an environment, help from others, or navigational aids). Additionally, environmental factors such as weather conditions, crowdedness, and familiarity of the environment influence if, how, and which sensory modalities are employed. These preferences and strategies might be mediated by individual differences in priorities and needs pertaining to energy management. Conclusions: We discuss how the current findings could be of interest to orientation and mobility instructors when choosing a training strategy for individual clients. Full article

Background/Objectives: People with visual impairments can participate in orientation and mobility (O&M) training to learn how to navigate to their desired destinations. Instructors adapt their approach to each individual client. However, assessments of client characteristics and resulting instructional adaptations are not standardised and may therefore vary. This study aimed to identify which individual differences instructors consider during O&M training and why. Methods: We conducted semi-structured qualitative interviews with 10 O&M instructors. Participants were asked to describe how they prepare for a training trajectory, and to describe a route they taught a specific client. Thematic analysis was used to determine instructional choices and the relevant client-specific factors. Results: We observed a common four-step instructional process in which clients are taught to notice, interpret, act upon, and anticipate relevant sensory cues until a destination is reached. Four main themes captured the individual differences impacting this process: Sensory modalities, Capacities and limits, Personal contextual characteristics, and Training approach. Conclusions: Instructors perceive route learning to be shaped by clients’ sensory abilities (even fluctuating within sensory modalities), mental and physical capacities (especially concentration and energy), and personal characteristics (especially age and anxiety). The dynamic social context in which training takes place (e.g., the instructor–client relationship) is shaped by individual differences between both clients and instructors. We speculate that trust-related themes (e.g., building confidence) may explain why certain client characteristics are emphasised by instructors, as they are associated with training outcomes. Full article

Background: Dialysis is a life-sustaining treatment for patients with end-stage renal disease (ESRD), but it requires high financial costs due to the need for continuous treatment and the associated expenses of medical supplies, equipment, and related care. Objective: This study aims to compare the out-of-pocket (OOP) health expenditure incurred by patients undergoing haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). Methods: The data for this observational cross-sectional study were obtained through a survey at two public hospitals, comprising a sample of 220 ESRD patients. In order to compare the OOP health expenditure between two modalities, the Mann–Whitney U test and the chi-square test were employed. Multiple linear-regression analysis was then used to identify the contributing factors associated with the aforementioned OOP expenses. Results: The estimated median monthly OOP health expenditure for HD patients was MYR 388 (interquartile range [IQR: 224–519]), significantly higher than CAPD (MYR 160 [IQR: 100–231]; p < 0.001). Our findings confirm that the choice of dialysis modality significantly affects the OOP health expenditures for dialysis patients $\left(\mathrm{M}\mathrm{Y}\mathrm{R} 145.73; 95\mathrm{\%} \mathrm{C}\mathrm{I}: 75.51–218.15; p < 0.05; 0.001\right).$ Additional determinants of OOP health expenditure identified in this study include the interaction between the modality choice and the distance from home to the dialysis centre (MYR 3.39; 95% CI: 0.27–6.66; p < 0.05; 0.022), comorbidity status (MYR 49.51; 95% CI: 9.09–90.77; p < 0.05; 0.031), duration of illness (MYR 4.01; 95% CI: 0.71–7.63; p < 0.05; 0.041), and household income MYR 67.43 (95% CI: 1.71–134.81; p < 0.05; 0.021). Conclusions: This study emphasises the need to improve the training and awareness of CAPD to increase its use, as it requires less travel and lowers OOP expenses. In addition, introducing a travel reimbursement scheme is also recommended to reduce the transportation costs for HD patients. Full article

This work presents a first-iteration bio-faithful dragonfly-inspired wing designed for future flapping micro air vehicle (MAV) applications. Using high-resolution imaging, the natural venation pattern of fore- and hindwings was reconstructed in CAD and reproduced through high-precision stereolithography at 1:1 and 3:1 scale. The printed polymeric wings successfully preserved the anisotropic stiffness distribution of the biological structure, enabling realistic bending and torsional responses. Modal analysis and dynamic testing confirmed that the lightweight designs operate within the biologically relevant 20–40 Hz range and that geometry and material choices allow predictable tuning of natural frequencies. Preliminary aerodynamic estimates captured the characteristic anti-phase lift behavior of four-wing flapping, while schlieren and infrared thermography demonstrated that heat dispersion and flow features follow the vein-driven structural pathways of the printed wings. Together, these results validate the feasibility and functional relevance of bio-faithful venation architectures and establish a solid foundation for future iterations incorporating membranes, full kinematic actuation, and higher-fidelity aeroelastic modeling. Full article

Background: Automated pain assessment aims to enable objective measurement of patients’ individual pain experiences for improving health care and conserving medical staff. This is particularly important for patients with a disability to communicate caused by mental impairments, unconsciousness, or infantile restrictions. When operating in the critical domain of health care, where wrong decisions harbor the risk of reducing patients’ quality of life—or even result in life-threatening conditions—multimodal pain assessment systems are the preferred choice to facilitate robust decision-making and to maximize resilience against partial sensor outages. Methods: Hence, we propose the MultiModal Supervised Contrastive Adversarial AutoEncoder (MM-SCAAE) pretraining framework for multi-sensor information fusion. Specifically, we implement an application-specific model to accomplish the task of pain recognition using biopotentials from the publicly available heat pain database BioVid. Results: Our model reaches new state-of-the-art performance for multimodal classification regarding all pain recognition tasks of ‘no pain’ versus ‘pain intensity’. For the most relevant task of ‘no pain’ versus ‘highest pain’, we achieve $84.22\%$ accuracy ($F_1$-score: $83.72\%$), which can be boosted in practice to an accuracy of ≈$95\%$ through grouped-prediction estimates. Conclusions: The generic MM-SCAAE framework offers promising perspectives for multimodal representation learning. Full article

Cecal volvulus is a rare cause of acute abdominal pain, resulting from torsion of the cecum and ascending colon due to abnormal mobility caused by inadequate peritoneal fixation. Clinical presentation is often vague and nonspecific, which can delay diagnosis and treatment. Computed tomography (CT) is the imaging modality of choice, as it not only confirms the presence and location of the volvulus but also identifies serious complications such as ischemia or perforation. Abdominal radiographs may be inconclusive, especially when the twisted bowel loop is fluid-filled, aligned antero-posteriorly, or obscured by adjacent gas-filled loops. We present the case of a 65-year-old woman who arrived at the emergency department with sudden-onset abdominal pain. Abdominal CT revealed classic signs of cecal volvulus, including the rarely reported ‘embryo sign,’ which proved crucial for swift diagnosis and intervention. Recognizing both common and less common CT features, such as the embryo sign, is paramount for rapid diagnosis and appropriate management in emergency situations. Familiarity with the full radiologic spectrum of this condition can significantly improve patient outcomes. Full article

Objective: The aim was to evaluate the effects of two high-resistance training (RT) protocols combined with curcumin supplementation on antioxidant capacity, systemic inflammation, bone and muscle health, and body composition. Methods: Eighty-one apparently healthy older adults [(68.2 ± 4.6 years (57% women); BMI 26.4 ± 4.8 kg/m²; minimally active according to IPAQ] were randomly allocated to accentuated eccentric (Aecc), maximal strength (Max), or a non-training control (C). Additionally, participants received either a bio-optimized curcumin formulation (Cur) or a placebo (Pla), resulting in six study groups: Aecc-Cur, Aecc-Pla, Max-Cur, Max-Pla, C-Cur, and C-Pla. Participants underwent pre- and post-intervention assessments of oxidative stress, inflammation, and bone health parameters, whole-body composition, and muscle function. Aecc and Max performed six familiarization sessions and a 16-week intervention. Participants in the curcumin groups received 500 mg/day of a bio-optimized curcumin formulation (Cursol^TM; 2 × 250 mg capsules per day, corresponding to 10.50 mg/day of curcumin) throughout the intervention. Data were analyzed using three-way repeated-measures ANOVA/ANCOVA with time (pre–post) as the within-subject factor and training group and supplementation as between-subject factors, with Least Significant Difference post hoc comparisons and effect sizes (Hedges’ g, ηp²) reported, and the significance level set at p < 0.05. Results: Aecc was the most effective in improving antioxidant capacity (glutathione; F = 25.57, p ≤ 0.001, ηp² = 0.262) and bone biomarkers (serum-procollagen type I N-propeptide—P1NP, p ≤ 0.001, ηp² = 0.504; serum beta C-terminal cross-linked telopeptide of type I collagen—β-CTX—p = 0.022, ηp² = 0.074, and their ratio—P1NP/β-CTX—p ≤ 0.001, ηp² = 0.605). Interleukin-6 (IL-6) decreased more in Aecc (p ≤ 0.001, ηp² = 0.584) and tumor necrosis factor-alpha (TNF-α) in Max (p ≤ 0.001, ηp² = 0.471). Both groups similarly improved body composition and muscle function. Bone mineral density was generally unchanged. Overall, curcumin supplementation enhanced the benefits of high-RT programs (further glutathione increase in Aecc [Hedge’s g: 0.49]; IL-6 decrease in both modalities [Hedge’s g: 0.48–1.27]; decrease in TNF-α in controls [Hedge’s g: 0.47]; better outcomes in P1NP/β-CTX in all groups [Hedge’s g: 0.46–1.46]; among others). Conclusions: Aecc is recommended for supporting antioxidant capacity and bone health, while the choice between Aecc and Max may depend on the individual’s inflammatory profile. Curcumin supplementation further amplifies the benefits of both RT protocols across most outcome variables. Full article

Background/Objectives: Obstructive urosepsis mandates rapid source control, yet actionable time-to-decompression (TTD) thresholds and the influence of diversion route remain debated. This review synthesized evidence on TTD, early outcomes, and predictive biomarkers. Methods: Following PRISMA-2020, ten studies met eligibility: three large administrative cohorts and seven clinical series/trials comparing outcomes by TTD and/or initial decompression (retrograde stent [RUS] vs. percutaneous nephrostomy [PCN]) and reporting biomarkers. Results: Delays were consistently harmful. In a national cohort, a TTD of ≥ 2 days increased in-hospital mortality (adjusted OR, 1.29; 95% CI, 1.03–1.63). Another analysis showed mortality of 0.16% with ≤48 h vs. 0.47% when delayed (derived OR, 0.43; p = 0.044). Absence of decompression yielded the highest mortality (19.2% vs. 8.82%; OR, 2.6; 95% CI, 1.9–3.7). Septic shock remained frequent despite low crude mortality in clinical series: 20.8% and 33.3% across two cohorts. Post-decompression urosepsis occurred in 18.7% in a randomized study and was associated with pyonephrosis and higher procalcitonin (PCT). An ED cohort showed that earlier stenting reduced length of stay (≤6 h: 35.6 h vs. 71.6 h, p = 0.01; ≤10 h: 45.7 h vs. 82.4 h, p = 0.04). Modality effects were modest; one cohort reported higher ICU use with PCN vs. RUS (OR, 3.23; 95% CI, 1.24–8.41), likely reflecting confounding by indication. Conclusions: Across designs, timeliness—not device choice—was the dominant determinant of early outcomes. Biomarkers (notably, PCT) and imaging features can prioritize ultra-early decompression. Full article

Background: Central nervous system (CNS) tumors during pregnancy are rare but present significant diagnostic, therapeutic, and ethical challenges. These include both primary and metastatic lesions, which share overlapping clinical features and management complexities. Their clinical course is influenced by gestational physiological changes, which can mask symptoms and delay diagnosis, thereby increasing maternal and fetal risks. Objective: This review aims to synthesize current evidence on the epidemiology, pathophysiology, clinical presentation, diagnostic strategies, treatment options, prognosis, and ethical considerations related to CNS tumors in pregnant patients. Methods: A comprehensive literature review was conducted, including retrospective and prospective studies, clinical guidelines, and systematic reviews focusing on brain and spinal tumors diagnosed during pregnancy. Particular attention was given to the impact of gestational age, tumor histology, and maternal condition on treatment outcomes. Results: Hormone-sensitive tumors such as meningiomas and prolactinomas may exhibit accelerated growth during pregnancy due to elevated progesterone and prolactin levels. Diagnosis is often delayed due to symptom overlap with normal gestational changes. MRI without contrast remains the imaging modality of choice. Glucocorticoids and selected chemotherapy agents can be cautiously used depending on gestational age. Surgical resection, particularly in the second trimester, has been shown to be safe and effective in appropriate clinical scenarios. Multidisciplinary coordination is essential. Prognosis varies based on tumor type and timing of intervention, with maternal survival prioritized in high-risk situations. Ethical management hinges on patient autonomy, informed consent, and proportionality of medical interventions. Conclusions: CNS tumors during pregnancy require early recognition, individualized treatment planning, and ethical vigilance. Multidisciplinary collaboration is vital to optimizing outcomes for both mother and fetus. Future efforts should focus on developing standardized protocols and expanding evidence through multicenter studies. Full article