Search Results (1,875)

Background and Objectives: Severe COVID-19 frequently fulfills Sepsis-3 criteria and is characterized by thrombo-inflammation and endothelial injury. We evaluated whether a bedside endothelial activation index (EAI = D-dimer/fibrinogen) identifies biologically distinct phenotypes and relates to interleukin-6 (IL-6) response after therapeutic plasma exchange (TPE), and whether baseline IL-6 predicts a ≥50% IL-6 reduction. Methods: Retrospective single-center ICU cohort of adults with SARS-CoV-2 infection, sepsis-related organ dysfunction, and ≥1 TPE session (n = 51). Patients were stratified by median EAI (low vs. high). Outcomes included peri-procedural biomarker/physiology changes (post–baseline), IL-6 responder status (≥50% reduction), correlations with IL-6 reduction (%), and multivariable predictors of response. Results: Compared with low EAI (n = 25), high EAI (n = 26) had higher baseline D-dimer (6.2 vs. 2.2 µg/mL) and lower fibrinogen (2.9 vs. 7.1 g/L) (both p < 0.001). Low EAI showed larger CRP decreases (ΔCRP −84.0 vs. −2.3 mg/L; p = 0.001) and larger fibrinogen falls (Δ −3.1 vs. −0.4 g/L; p < 0.001), while high EAI had larger D-dimer decreases (Δ −2.5 vs. −0.6 µg/mL; p = 0.004) and a modest SOFA improvement (Δ −0.3 vs. +0.1; p = 0.026). IL-6 responders (n = 20) had higher baseline IL-6 than non-responders (365.2 vs. 47.1 pg/mL; p < 0.001). Baseline IL-6 independently predicted response (per doubling: OR 1.94, 95% CI 1.27–2.95; p = 0.002), while age reduced odds (OR 0.91/year, 95% CI 0.84–0.99; p = 0.032). IL-6 reduction correlated with ΔCRP (ρ = −0.41; p = 0.003) and ΔPaO₂/FiO₂ (ρ = 0.37; p = 0.01). Conclusions: EAI stratifies distinct thrombo-inflammatory patterns around TPE, while baseline IL-6 is the dominant predictor of achieving large IL-6 reductions. To emphasize the novelty and clarify the study objective, this exploratory analysis used a phenotype-stratified framework to test whether a simple bedside endothelial activation index could enrich biological response assessment to adjunctive TPE. The prespecified primary outcome was achievement of a ≥50% IL-6 reduction after completion of the TPE course; secondary outcomes included peri-procedural biomarker, oxygenation, SOFA, and ICU endpoints. Full article

Hyperekplexia is a neurologic disorder of marked perinatal significance. Affected neonates display generalized hypertonia and exaggerated startle reflex in response to innocuous stimuli, potentially leading to life-threatening apneic episodes. Although symptom severity typically diminishes during the first year of life, affected individuals often continue to exhibit disabling motor dysfunction and frequent unprotected falls throughout adulthood. Currently, no targeted therapeutic interventions are available. The pathophysiology involves partial or complete disruption of inhibitory glycinergic neurotransmission. Mutations in the gene encoding the neuronal glycine transporter GlyT2 (SLC6A5) represent the second-most frequent genetic etiology of human hyperekplexia. To investigate the mechanistic basis for the heightened severity of symptoms during the perinatal period, we examined the role of GlyT2 in neuronal differentiation using the PC12 cell model. Pharmacological induction of differentiation demonstrated that clones stably expressing GFP-GlyT2 exhibit increased expression of neuronal differentiation markers and enhanced neurite outgrowth—both in number and length—relative to parental PC12 cells. These clones also displayed elevated cytosolic calcium levels, which were attenuated by calmodulin overexpression, subsequently downregulating differentiation marker expression. We hereby proved that GlyT2 is clearly implicated in growth cone progression and differentiation of PC12 cells into neurons by increasing internal calcium and binding to growth cone proteins. Finally, our results were validated in primary neurons. Full article

Sustainable spatial development requires land-use allocation that aligns with reflects the environment’s biophysical capacity. However, rapid urbanization and agricultural expansion often result to spatial mismatches between land utilization and land capability, the reby increasing environmental degradation and disaster vulnerability. East Java Province, one of Indonesia’s most densely populated regions, has experienced significant land-use transformation driven by demographic pressure and economic development. This study aims to evaluate the environmental carrying capacity by assessing the spatial compatibility among land capability, existing land use, and the Provincial Spatial Plan (RTRWP) using a Geographic Information System (GIS)-based analytical approach. Land capability was determined based on key biophysical parameters, including slope gradient, soil texture, drainage conditions, erosion susceptibility, effective soil depth, and flood hazard. Spatial overlay analysis was employed to identify areas of conformity and mismatch between land capability and both current and planned land uses. The results indicate that only approximately 52% of the provincial area is utilised in accordance with its land capability. In comparison, the remaining 48% exhibits varying degrees of spatial mismatch. Erosion is identified as the dominant limiting factor, affecting more than 43% of the region, particularly in mountainous and hilly landscapes. Furthermore, over 60% of East Java falls within Land Capability Classes III–VII, indicating moderate to severe environmental constraints on limitations intensive land use. High levels of spatial mismatch are concentrated in the southern upland districts—such as Pacitan, Trenggalek, southern Malang, and Lumajang, which are highly susceptible to landslides, as well as in the northern lowland corridor, including the Surabaya–Gresik–Sidoarjo metropolitan region, which faces a significantly flood risk. These findings suggest that land-use practices exceeding environmental carrying capacity substantially amplify disaster risk. Therefore, integrating land capability assessment into spatial planning and zoning regulations is essential and for promoting ecosystem-based disaster risk reduction and achieving sustainable spatial development in East Java Province. Full article

Background and Clinical Significance: Immunoglobulin G4-related disease (IgG4-RD) is a systemic immune-mediated fibroinflammatory disorder that can mimic infection or malignancy. Spinal involvement is exceedingly rare and usually limited to pachymeningitis or epidural pseudotumors. True vertebral bone destruction has been reported only sporadically. Case Presentation: A 54-year-old man presented to our emergency department with severe neck pain after a fall. CT and MRI revealed extensive osteolysis of the C1 posterior arch and odontoid process with atlantoaxial subluxation. Following a second inpatient fall, he developed acute tetraparesis. Emergency posterior occipitocervical fusion (C0–C4) with C1–C2 laminectomy and foramen magnum decompression was performed. Histopathology demonstrated dense lymphoplasmacytic infiltration and fibrosis with up to 36 IgG4⁺ plasma cells per high-power field and an IgG4⁺/IgG ratio > 40%, confirming IgG4-RD. The patient recovered substantial motor function postoperatively and regained independent ambulation after neurological rehabilitation. Conclusions: IgG4-RD can rarely present as destructive craniovertebral osteolysis with neurological compromise. Unexplained C1–C2 osteolytic lesions should prompt evaluation for IgG4-RD, a rare but treatable cause of cervical instability. Full article

Background and Objectives: Adults diagnosed with type 2 diabetes mellitus (T2DM) frequently exhibit diminished sleep quality, which is affected by their glycemic control. Both poor sleep and inadequate glycemic management increase the risk of complications worldwide. However, the relationship between sleep quality, daytime dysfunction, and glycemic control in adults with T2DM is not well understood. To address this gap, this study aimed to examine the association between overall sleep quality, including daytime dysfunction, and glycemic control in adults with T2DM. Materials and Methods: A hospital-based cross-sectional study included 200 T2DM patients (103 females, 97 males) from January 2019 to January 2020. The Pittsburgh Sleep Quality Index (PSQI) was administered to each participant to assess sleep quality, including daytime dysfunction. Glycemic control was assessed by measuring hemoglobin A1c (HbA1c) and fasting blood glucose (FBG) levels. The associations among sleep quality, daytime dysfunction, and glycemic metrics were examined utilizing both conventional statistical methods and Bayesian analytical approaches. Results: A total of 32% of patients had poor sleep quality (PSQI > 5), and 43.5% reported daytime dysfunction. Higher HbA1c and fasting blood glucose were each correlated with longer sleep-onset latency and greater daytime dysfunction. In multivariable analyses, higher HbA1c and longer sleep-onset latency were independently associated with poor sleep quality (generalized linear model, R² = 0.602), whereas higher fasting blood glucose and longer sleep-onset latency were associated with greater daytime dysfunction severity (R² = 0.378). Conclusions: Sleep quality and delay in falling asleep are interdependent with impaired glycemic control and daytime dysfunction in T2DM. Future randomized trials targeting sleep-onset latency are warranted to determine causal effects on glycemic outcomes. Full article

Posttraumatic stress disorder (PTSD) has been linked to impaired physical function, which in turn predicts falls, morbidity, and mortality. However, few studies have used objective measures such as handgrip strength to assess physical function. In this cross-sectional study, we investigated associations of average PTSD symptom severity and symptom domain severity with measures of maximum handgrip strength and handgrip asymmetry from 11/2021–12/2023, among 381 male firefighters and emergency medical responders who responded to the World Trade Center disaster, using covariate-adjusted linear regression models. PTSD was diagnosed using the Structured Clinical Interview for the DSM-5 in 17% of responders. Greater overall PTSD average symptom severity was associated with weaker maximum handgrip strength (β = −4.43 lbs; 95%; CI: −8.77, −0.09; p = 0.045). Higher re-experiencing symptom severity was associated with weaker maximum handgrip strength (β = −4.17 lbs; 95% CI: −8.13, −0.22; p = 0.039). Avoidance symptoms were associated with weaker handgrip strength in adjusted models (β = −4.14 lbs; 95% CI: −7.56, −0.73; p = 0.018), and associated with a larger negative difference assessing for hand asymmetry (β = −2.20 lbs; 95% CI: −4.18, −0.22; p = 0.029). Findings suggest that PTSD may contribute to long-term physical decline, even in populations with high baseline fitness. Full article

Background/Objectives: Severe acquired brain injury (sABI) disrupts early rehabilitation because arousal fluctuates, trunk control is fragile, and agitation limits therapy tolerance; land-based practice is frequently constrained by fall risk and staffing. We aim to reframe aquatic therapy as a programmable multisensory environment to stabilize arousal and support axial alignment before conventional impairment targets are feasible. Here, programmable denotes the deliberate titration and reporting of water depth, turbulence or perturbation, temperature, body orientation, and flotation and manual support as intervention inputs. Methods: This perspective integrates principles from neurobehavioral assessment, motor control, and immersion physiology to propose the Arousal–Alignment–Action loop as a falsifiable model and to define manipulable aquatic inputs (water depth, turbulence or perturbation, temperature, body orientation, and flotation and manual support) as dosing parameters. We outline a pragmatic testing ladder (within-session micro-experiments, feasibility studies, and embedded evaluations) and a minimal outcomes and confounder set to support cumulative evidence. Results: The framework links state regulation to alignment and goal-directed behavior, specifies predictions that can fail, and highlights boundary conditions (sedation, autonomic instability, pain, recent surgery or wounds, and cervical or cardiopulmonary constraints). A minimal outcome package spanning arousal/responsiveness, trunk control, behavioral dysregulation, participation/tolerance, and basic physiology is proposed, with optional objective adjuncts for mechanism-oriented studies. Conclusions: Treating water as a measurable and titratable medium, rather than a generic modality, may reduce early intensity bottlenecks and improve implementability and comparability of aquatic neurorehabilitation research in medically stable sABI; however, the model is intended as hypothesis-generating until supported by stronger direct clinical evidence. Full article

Falls pose severe risks to vulnerable populations, particularly the elderly and individuals with adverse neurological conditions, necessitating reliable and non-obstructive detection systems. While previous multi-modal approaches utilizing video and audio have demonstrated strong performance, they face significant limitations regarding sensitivity to environmental noise. This paper presents a robust, video-only fall detection framework that eliminates reliance on acoustic data to enhance universality. We conduct a comprehensive comparative analysis of five optical flow (OF) algorithms—Horn–Schunck, Lucas–Kanade (LK), LK-Derivative of Gaussian, Farneback, and the spectral method SOFIA—to determine the range of applicability of each technique for capturing fall dynamics. Beyond detection accuracy, we investigate the computational efficiency of each configuration. This optimized, privacy-centric pipeline offers a scalable solution for continuous monitoring in home and clinical settings, addressing the critical need for immediate intervention following high-impact falls. Full article

Background: Population aging represents a major public health challenge, accompanied by an increasing prevalence of chronic diseases and age-related functional decline. Declines in lower-extremity physical function are particularly important, as they are strongly associated with mobility limitations, loss of independence, increased risk of falls, hospitalization, and mortality in older adults. Reliable and valid tools to assess physical performance are therefore essential in both clinical and research settings. The Short Physical Performance Battery (SPPB) is a widely used instrument for assessing lower-extremity physical performance in older adults and is recommended within the diagnostic algorithm of the European Working Group on Sarcopenia in Older People (EWGSOP2) for evaluating physical performance severity. However, the SPPB has not yet been psychometrically validated in the Croatian older population. This study aimed to evaluate the reliability and validity of the SPPB in Croatian older adults. Methods: This study examined the metric properties of the SPPB in a sample of 153 older adults recruited from nursing homes and community settings. Results: The SPPB demonstrated acceptable internal consistency (Cronbach’s alpha = 0.74) and good test–retest reliability (ICC = 0.893) for the total score. Convergent and construct validity were supported by significant associations with established measures of functional mobility and muscle strength. Conclusions: The Croatian version of the SPPB is a reliable and valid instrument for assessing lower-extremity physical performance in older adults. Its use is supported in clinical practice and research settings in Croatia. Further studies should examine responsiveness and predictive validity in nationally representative samples. Full article

Background/Objectives: Approximately 1 in 10 community-dwelling older adults are affected by or at risk of malnutrition, and this prevalence increases to nearly 1 in 3 among those receiving home care or recently hospitalized, contributing to higher rates of frailty, falls, hospitalization, functional decline, and mortality. Many of these individuals depend on informal or family caregivers for nutritional care, including assistance with grocery shopping meal preparation, feeding, and monitoring dietary intake. Thus, informal caregivers play an increasingly central role in supporting dietary intake and maintaining nutritional status. This narrative review aims at assessing the relationship between informal caregiver involvement and malnutrition in community-dwelling older adults who are dependent for nutritional-related needs, summarizing evidence on caregiver’s role and caregiver-associated determinants of malnutrition, as well as on interventions that incorporate caregivers into nutrition care. We discuss factors associated with malnutrition in later life, with particular emphasis on caregiver knowledge, burden, interventions and outcomes. In addition, caregiver-inclusive models of care and tools, including nutrition education and guidelines/recommendations, medical nutrition therapy, and multidisciplinary care models will be addressed. Methods: A structured review of the literature was conducted (date of last search December 2025), searching multiple databases for pertinent articles. Following identification of eligible articles for inclusion, a narrative synthesis of evidence was completed. Results and Conclusions: Despite the high degree of heterogeneity in methodology, observational studies demonstrate that several caregiver attributes influence the nutritional status of care recipients, including caregiver’s own nutritional status, burden, knowledge and literacy, psychosocial, environmental and economic factors. Intervention studies show that caregiver-focused, -inclusive and -delivered interventions have a positive impact on several outcomes, including improved older care recipient dietary intakes, nutritional status and quality of life without impacting on caregiver burden. Thus, strengthening caregiver support and integrating caregivers into nutrition screening and intervention frameworks may represent a critical opportunity to reduce malnutrition risk and improve health outcomes among older adults. Still, significant gaps remain in caregiver-focused intervention research, particularly in diverse cultural and social contexts. Full article

Background: Traumatic spinal injuries (TSI) are often associated with substantial physical burden and potential psychological consequences. Early detection of depressive symptoms may be important for improving quality of life during recovery. Despite the high prevalence of injury, unique sociocultural factors affecting mental health, and the need to optimize long-term rehabilitation outcomes, there is a lack of longitudinal assessments of depression in TSI patients in this region of the MENA (Middle East and North Africa). This study aimed to examine the occurrence of depressive symptoms following TSI over a 3-month period. Methods: A prospective cohort study was conducted to assess the occurrence of depression in TSI patients admitted between 2019 and 2022 at the Hamad Trauma Center. Conscious patients aged 18–65 years diagnosed with TSI were included. Perceived social support was assessed using the RAND Social Support Survey (Medical Outcomes Study Social Support Survey), a validated instrument measuring multiple dimensions of social support. Patient Health Questionnaire-9 (PHQ-9), a widely validated self-administered screening tool for depressive symptoms, was utilized twice: at 2 weeks and at 3 months post-trauma to evaluate early-onset depressive symptoms and their persistence or resolution over time. Results: A total of 189 TSI were included. The cohort was predominantly young individuals. The most common mechanisms of injury included falls (42.1%) and motor vehicle crashes (31.1%). The mean Injury Severity Score was 16.5 ± 8.2 and the spine Abbreviated Injury Scale score was 2.4 ± 0.7. Injuries involved cervical (32.8%), thoracic (38.1%), and lumbo-sacral (6.9%) regions. A total of 32.6% underwent spinal surgery, and 9.0% experienced neurological deficits. Most patients reported emotional and informational support (69%), and 62% reported caregiving support. At 2 weeks post-trauma, patients demonstrated mild depressive symptoms, with a mean PHQ-9 score of 4.6 ± 5.1, which decreased to 2.5 ± 4.2 at 3 months. The proportion of patients screening positive for depressive symptoms (PHQ-9 ≥ 5) decreased from 39.1% (52/133) at 2 weeks to 19.5% (26/133) at 3 months, corresponding to a 19.6% absolute reduction over the follow-up period. A subset of patients reported increased feelings of depression or hopelessness and sleep disturbances at three months compared with two weeks post-trauma. Conclusions: Patients with TSIs experience psychological distress in the early post-injury period, with a subset screening positive for depressive symptoms. Although depressive symptom scores declined over 3 months, continued psychological screening and follow-up care remain important components of comprehensive TSI management during recovery and rehabilitation. Our results should be considered cautiously because of gender-biased findings, single center data and potential attrition bias. Full article

Trace metals are persistent stressors in coastal ecosystems, yet most marine algal toxicity assessments still rely on freshwater model species and growth-based endpoints that provide limited mechanistic resolution. Here, we quantified the sensitivity of two ecologically contrasting marine diatoms—the benthic Cylindrotheca closterium and the planktonic Thalassiosira weissflogii—to ten environmentally relevant metals using a dual-endpoint approach that integrates chlorophyll fluorescence (photosystem function) and Nile Red-based lipid-body fluorescence (metabolic reallocation). Fluorescence-based EC₁₀ values revealed distinct species- and metal-specific patterns, with C. closterium consistently responding at lower concentrations and Hg producing the strongest inhibition in both species (EC₁₀ ≈ 0.04–0.06 mg L⁻¹). Lipid-body accumulation detected earlier metabolic disturbance for several metals, particularly Hg, As, Cr(VI), and Cd, and frequently occurred at concentrations where fluorescence remained minimally affected. These sequential thresholds indicate that pigment impairment and metabolic reallocation represent mechanistically distinct stages of the cellular stress response that differ among metals and between diatom guilds. Comparison with published toxicity data shows that the dual-endpoint sensitivities observed here fall within, or slightly above, the upper range of reported microalgal responses, underscoring the pronounced susceptibility of benthic diatoms to redox-active and thiol-reactive metals. The strong agreement between fluorescence-based EC values and traditional growth-derived benchmarks for key metals further supports fluorescence as an operationally efficient endpoint suitable for integration into emerging ISO marine algal bioassays. Overall, this study demonstrates that pairing a rapid functional marker with a mechanistically informative metabolic biomarker enables metal-specific toxicity fingerprinting and provides an ecologically grounded basis for incorporating benthic diatoms into coastal metal risk assessment frameworks. Full article

Background/Objectives: Suicide attempts represent a major global health problem. Traumatic suicide methods, such as falls from great heights, stab wounds, and gunshot wounds, frequently result in severe or fatal injuries. The COVID-19 pandemic, as well as broader societal stressors including economic uncertainty and geopolitical conflicts, has substantially increased psychological stress in the population and has been discussed as a potential influencing factor for suicidal behavior. The aim of this study was to analyze severe traumatic suicide attempts and to evaluate the potential influence of the COVID-19 pandemic in a multicenter analysis of the TraumaRegister (TR) DGU^®. Methods: This retrospective multicenter analysis is based on the TraumaRegister DGU^®, a standardized database for seriously injured patients. Patients from Germany, Austria, and Switzerland from 2010 to 2023 with an Injury Severity Score (ISS) ≥ 9, an age ≥ 10 years, and a documented suicide attempt, who arrived at the hospital alive, were included. Results: Among severely injured trauma patients recorded in the registry, 12,247 (4.4%) cases were classified as suspected traumatic suicide attempts. Severe traumatic suicide attempts showed a clear age-dependent distribution, with a marked increase from adolescence and a plateau between 20 and 55 years of age. Both the mean age of the general population and the age of patients with suicide attempts increased over the study period. This trend was reflected in the rise in the ≥70-year age group from 13.6% in 2010 to 19.6% in 2023. The most common method was jumping from a height greater than 3 m (65.3%), followed by stab wounds (11.9%) and gunshot wounds (8.0%). While a significant decline in severe traumatic suicide attempts was observed between 2010 and 2019, a significant increase to 4.5% occurred in 2020, remaining at a comparable level in the following years. Sex-specific differences were observed, with penetrating injuries occurring more frequently in men, whereas jumps from heights > 3 m were more common among women. The highest hospital mortality was observed in gunshot injuries (67.9%). Conclusions: This study demonstrates an increase in severe traumatic suicide attempts in 2020 that persisted at a similar level until 2023. Sex-specific differences in suicide methods highlight the need for targeted prevention strategies. In addition, demographic aging is reflected in the increasing proportion of suicide attempts among older individuals, emphasizing the need for age-specific prevention measures. The relatively high survival rate after certain methods, particularly after falls from height (77%), underlines the importance of structured postoperative psychiatric care pathways. These findings specifically reflect traumatic suicide attempts resulting in severe injury and requiring trauma center treatment. Full article

Background/Objectives: Bariatric surgery has emerged as an effective intervention for severe obesity; however, post-operative dizziness remains poorly characterized in the literature. This study aimed to determine the prevalence of dizziness, imbalance, and hearing problems following bariatric surgery and to identify associated risk factors. Methods: A cross-sectional study was conducted among 156 patients who underwent bariatric surgery at multiple centers in Saudi Arabia. Data were collected through structured questionnaires assessing demographic characteristics, surgical details, and post-operative vestibular symptoms. Bivariate and multivariate logistic regression analyses were performed to identify predictors of dizziness. Results: The prevalence of post-operative dizziness was 77.3% (95% CI: 70.0–83.3%), imbalance was 38.0% (95% CI: 30.6–46.0%), and hearing problems were 10.7% (95% CI: 6.7–16.6%). Bivariate logistic regression identified weight loss was significantly associated with dizziness (OR = 1.063, 95% CI: 1.024–1.103, p = 0.001). In the multivariate model, each percentage point increase in weight loss was associated with a 6.1% increased dizziness (adjusted OR = 1.061, 95% CI: 1.017–1.107, p = 0.006). Dizziness was strongly associated with imbalance (chi-square = 14.325, p < 0.001) and falls (chi-square = 7.085, p = 0.008). Conclusions: Vestibular complications, particularly dizziness, are highly prevalent following bariatric surgery and demonstrate a significant dose–response relationship with the magnitude of weight loss. Enhanced awareness and systematic screening for dizziness in post-bariatric patients are warranted. Full article

The aims of this research were to characterize neuromuscular control features within the gait cycle in Parkinson’s disease (PD) from the perspectives of muscle synergies and cross-modal coupling and to propose a joint representation of the relationship between muscle activation patterns and kinematic dynamic outputs. PD participants (n = 19) were included. Lower-limb surface electromyography (EMG) and kinematic dynamic channels, including pelvic/hip, knee, and ankle angular acceleration, were collected during level-ground natural walking. EMG signals were first decomposed using non-negative matrix factorization (NMF) to extract muscle synergies, and the number of synergies was evaluated using reconstruction performance (R²). Multimodal matrix factorization (MMF) was then applied to jointly decompose the EMG and angular-acceleration channels, yielding a cross-modal synergy representation comprising a shared temporal structure (H) and modality-specific weight structures (W): non-negativity was imposed on EMG weights, whereas kinematic weights were allowed to take positive and negative values to encode directional contributions. Under the current task and muscle set, NMF achieved high EMG reconstruction performance with four synergies (R² = 0.882). The synergy weights showed an ankle-dominant pattern: tibialis anterior (TA) consistently carried high weights across multiple synergies, while lateral gastrocnemius (LG) and soleus (SOL) contributed prominently to another synergy. The synergy activation profiles exhibited phase-dependent fluctuations with multiple rises and falls across the gait cycle, suggesting that synergy output was primarily characterized by continuous modulation rather than single-peak recruitment. MMF further identified eight cross-modal synergies, simultaneously capturing the shared contributions of key muscle groups (e.g., RF, TA, and SOL) and pelvic/hip and knee/ankle angular-acceleration channels within the same decomposition framework and summarizing their descriptive co-variation through the shared temporal structure (H). Overall, A low-dimensional synergy analysis combining EMG-only NMF with cross-modal MMF enables simultaneous characterization of cohort-level modular organization of muscle activity during gait and its descriptive association with pelvis-to-lower-limb dynamic output. This joint framework provides a methodological basis for quantitatively describing gait-related modular organization and temporal modulation patterns in this PD cohort under natural level-ground walking and lays the groundwork for subsequent testing of associations between synergy features and gait phenotypes, clinical severity, and rehabilitation responses. Full article