Search Results (1,200)

A critical factor contributing to the burden of childhood asthma is the lack of effective self-management in homecare settings. Artificial intelligence (AI) and lung sound monitoring could help address this gap. Yet, existing AI-driven auscultation tools focus on wheeze detection and often rely on subjective human labels. To improve the early detection of asthma worsening in children in homecare setting, we trained and evaluated a Deep Learning model based on spirometry-labelled lung sounds recordings to detect asthma exacerbation. A single-center prospective observational study was conducted between November 2020 and September 2022 at a tertiary pediatric pulmonology department. Electronic stethoscopes were used to record lung sounds before and after bronchodilator administration in outpatients. In the same session, children also underwent spirometry, which served as the reference standard for labelling the lung sound data. Model performance was assessed on an internal validation set using receiver operating characteristic (ROC) curves. A total of 16.8 h of lung sound recordings from 151 asthmatic pediatric outpatients were collected. The model showed promising discrimination performance, achieving an AUROC of 0.763 in the training set, but performance in the validation set was limited (AUROC = 0.398). This negative result demonstrates that acoustic features alone may not provide sufficient diagnostic information for the early detection of asthma attacks, especially in mostly asymptomatic outpatients typical of homecare settings. It also underlines the challenges introduced by differences in how digital stethoscopes process sounds and highlights the need to define the severity threshold at which acoustic monitoring becomes informative, and clinically relevant for home management. Full article

Background/Objective: Systemic inflammation is a hallmark of end-stage renal disease (ESRD) and contributes to the high burden of cardiovascular morbidity and mortality in hemodialysis (HD) patients. The systemic immune–inflammation index (SII), derived from peripheral neutrophil, lymphocyte, and platelet counts, has emerged as a promising biomarker of immune–inflammatory status. This study aimed to assess the acute effect of a single HD session on systemic inflammation and to identify metabolic predictors associated with this response. Methods: In this single-center observational before–after study, 44 chronic HD patients were enrolled. Blood samples were collected immediately before and after a single HD session. SII was calculated as platelet count × neutrophil count/lymphocyte count. Subgroup analyses were conducted based on renal disease etiology and diabetic status. Multivariable linear regression models identified baseline predictors of SII variation. Results: Median SII significantly decreased post-HD in the overall cohort (from 553.4 [342.6–847.5] to 449.1 [342.6–866.6], p = 0.001), with a more pronounced reduction in patients with cardiometabolic etiologies (from 643.4 [353.3–1360.0] to 539.1 [324.8–1083.4], p = 0.007) and diabetes (from 671.1 [408.7–1469.1] to 458.3 [285.7–1184.4], p = 0.028), but not in those with nephroangiosclerosis (p = 0.182). Baseline total cholesterol (p = 0.001) and gamma-glutamyl transferase (p = 0.034) were positively associated with smaller reductions in SII, while higher baseline glycaemia predicted a greater decrease in post-dialysis SII (p = 0.021). Conclusions: HD acutely modulates systemic inflammation, as reflected by reduction in SII. The magnitude of this response is significantly influenced by individual metabolic profiles. These findings highlight the relevance of metabolic–immune crosstalk in ESRD and suggest that SII may serve as a dynamic biomarker integrating inflammatory and metabolic signals, deserving further validation in larger, outcome-driven studies. Full article

Background and Clinical Significance: Granulomatous reactions are rare but clinically significant complications of aesthetic procedures involving dermal fillers, particularly in individuals with underlying immune dysregulation. These reactions present diagnostic and therapeutic challenges, especially when associated with undiagnosed or latent autoimmune diseases. This case illustrates the interaction between filler composition, immune status, and the risk of delayed inflammatory responses, underscoring the need for thorough patient evaluation and individualized management strategies. Case Presentation: A 49-year-old woman developed delayed-onset subcutaneous nodules following midface augmentation with two filler types: a monophasic, cross-linked hyaluronic acid gel (concentration 20 mg/mL, 1.0 mL per side) injected into the deep malar fat pads, and a calcium hydroxyapatite suspension (30% CaHA microspheres in a carboxymethylcellulose carrier, 0.5 mL per side) placed in the subdermal plane along the zygomatic arch. The procedure was performed in a single session using a 22 G blunt cannula, with no immediate adverse events. High-resolution ultrasound demonstrated hypoechoic inflammatory nodules without systemic symptoms. A retrospective review of her medical history revealed a latent, previously undisclosed diagnosis of granulomatosis with polyangiitis (GPA). The immune-adjuvant properties of calcium hydroxyapatite likely triggered a localized pro-inflammatory response in this predisposed patient. A conservative, staged, non-invasive therapeutic protocol—saline infiltration, intradermal polynucleotide injections, and manual lymphatic drainage—achieved complete clinical and radiological resolution without systemic immunosuppression or surgical intervention. Conclusions: This case highlights the critical importance of pre-procedural immunological assessment in aesthetic medicine. Subclinical autoimmune conditions may predispose patients to delayed granulomatous reactions after filler injections. An individualized, conservative management strategy can effectively resolve such complications while minimizing the risks associated with aggressive treatment. Greater awareness of immune-mediated responses to dermal fillers is essential to ensure patient safety and optimize clinical outcomes. Full article

Background: Hand function is critical for daily living, occupational performance, and sports. Optimal training approaches for healthy adults remain unclear. Objective: To evaluate the effects of hand-focused strength and proprioceptive training on grip strength, pinch strength, manual dexterity, maximum voluntary contraction, joint position sense, and force sense in healthy younger and older adults. Methods: PubMed, Google Scholar, Semantic Scholar, Web of Science, Cochrane CENTRAL and registers were searched until July 2025 for randomized controlled trials (RCTs) involving adults (≥18 years) without upper limb dysfunction. Studies with clinical populations, single-session interventions, or lacking pre–post outcome data were excluded. Risk of bias was assessed using the Cochrane RoB 2 tool. Random-effects meta-analyses (Hedges’ g) pooled pre–post change score differences for each outcome; subgroup analyses examined age, training type, and comparator. Results: Twenty-two RCTs (n = 1017 participants; 19–78 years) met the inclusion criteria. Strength and proprioceptive training produced a small-to-moderate improvement in grip strength (g = 0.44, 95% CI [0.23–0.64], 95%PI [–0.09, 0.96]) and a large improvement in manual dexterity (g = 1.11, 95% CI [0.52–1.71], 95%PI [–0.01, 2.23]). Effects on pinch strength were positive but non-significant (g = 0.63, 95% CI [–0.09–1.35], 95%PI [–1.38, 2.63]) and showed substantial heterogeneity. Moderator analyses indicated greater effects in older adults (g = 0.97) compared to younger adults (g = 0.18). Strength-only protocols showed significant effects, while combined protocols yielded smaller, non-significant effects; however, the difference between them was not statistically significant. Effects were also larger when compared with passive controls than with untrained hands. Limitations: Evidence quality was limited by high risk of bias, measurement variability, and small study numbers for some outcomes. Conclusions: Strength-focused hand training, particularly in older adults, yields meaningful improvements in grip strength and dexterity. Further high-quality RCTs are needed for under-studied outcomes. Full article

Background/Objectives: Standing training is essential for individuals with spinal cord injury (SCI), yet maintaining regular practice after acute rehabilitation remains challenging. To address the need for more practical and accessible standing equipment, we developed a novel spring-assisted standing training device designed to overcome barriers to regular standing practice. This study aimed to assess the safety and feasibility of our newly developed device in individuals with SCI. Methods: Six participants with chronic SCI (neurological level of injury T4-L3, American Spinal Injury Association Impairment Scale A-C; 2 females, mean age 41.7 ± 13.4 years) underwent a single session using our chair-based device incorporating passive gas spring mechanisms. We designed this device to enable independent sit-to-stand transitions without electrical power or complex controls. Primary outcomes included safety (adverse events) and feasibility (number of repetitions, Modified Borg Scale). Changes in Modified Ashworth Scale (MAS) scores were assessed as exploratory measures. Results: All participants successfully completed training without adverse events. Repetitions ranged from 5 to 60 (median 37), with Modified Borg Scale ratings of 0–4. Notably, the participant with T4 complete injury performed the training without requiring trunk orthosis, demonstrating the device’s inherent stability. MAS sum scores showed a reduction from median 8.75 to 4.25, though this did not reach statistical significance (p = 0.13). Conclusions: Our newly developed spring-assisted standing training device proved safe and feasible for individuals with SCI, including those with complete thoracic injuries. The device successfully enabled independent sit-to-stand transitions with low perceived exertion, potentially addressing key barriers to regular standing practice and offering a practical rehabilitation solution. Full article

Background: Speech and Language Impairment (SLI) significantly affects children’s communication skills, limiting their social and academic development. Case Information: This single-case study evaluates the effects of a personalized intervention in a 9-year-old child diagnosed with SLI, integrating linguistic and cognitive strategies to remediate core deficits typically observed in children with SLI. Two main objectives were established: (1) to assess the child’s psycholinguistic competencies and cognitive processes and (2) to analyze the impact of the intervention on skills such as phonology, semantics, syntax, executive functions, and emotional well-being. The longitudinal and personalized design included pre- and post-intervention assessments conducted over two and a half years using tools such as the ITPA and Peabody Vocabulary Test. The intervention sessions were structured into linguistic and cognitive activities, with a frequency of two weekly language sessions and one cognitive functions session. Statistical analysis included ANOVA to evaluate significant changes. Conclusions: The results showed significant improvements in linguistic areas such as auditory comprehension (from 3–5 to 10 years) and verbal expression (from 5–10 to 9–6), as well as in cognitive aspects such as visuomotor sequential memory and visual comprehension, which exceeded the expected values for the child’s age. However, skills such as grammatical integration and auditory association did not show significant progress. This demonstrates that personalized and multidisciplinary interventions can considerably improve linguistic and cognitive abilities in children with SLI, although some areas require more specific approaches. The findings highlight implications for designing tailored intervention strategies, emphasizing the need for further research with larger samples and control groups to generalize the results. This case reaffirms the importance of comprehensive approaches in the treatment of SLI to maximize the academic and social development of affected children. Full article

Background: Primary dysmenorrhea (PD) is a common gynecological condition among women of reproductive age, often leading to pain and functional limitations. Myofascial release (MFR) has been suggested as a potential non-pharmacological intervention. This study aimed to investigate the immediate effects of a single MFR session on pain intensity, menstrual symptoms, and uterine artery hemodynamics in women with PD. Methods: In this randomized controlled trial, 34 women with PD were randomly assigned to either the MFR group (n = 18) or the placebo MFR group (n = 16). All participants received 10 min of thermotherapy followed by 30 min of either MFR or placebo MFR. Pain intensity (NRS), pressure pain thresholds (PPT) at myofascial trigger points, menstrual symptoms (MDQ-T), and uterine artery pulsatility index (PI) and resistance index (RI) were assessed at three time points: baseline, immediately after the intervention, and 3 h post-intervention. Results: Both groups demonstrated significant within-group reductions in pain intensity and menstrual symptoms post-intervention (p < 0.01), with no significant group-by-time interaction. However, significant interaction effects were observed for the PI and RI of the right uterine artery, showing greater reductions in the MFR group compared to the placebo group at 3 h post-intervention (p < 0.05). Conclusions: A single MFR session resulted in improvements in uterine hemodynamics, suggesting autonomic modulation as a potential mechanism. Although subjective symptom improvements were observed in both groups, only MFR showed objective vascular benefits. These findings support the physiological plausibility of MFR in PD management and suggest its potential application as a personalized, non-pharmacological intervention. Further studies are warranted to explore its long-term and individualized therapeutic effects. Full article

Background/Objectives: University students frequently engage in risky alcohol consumption, making them a priority population for targeted interventions. Motivational interventions (MIs) have been widely implemented to address this issue, but evidence of their effectiveness remains heterogeneous. This study aimed to evaluate the efficacy of MIs in reducing alcohol consumption and related harm among university students through a systematic review and meta-analysis. Methods: A systematic search was conducted in PubMed, Scopus, and BVS Library, including randomized controlled trials (RCTs) published up to April 2025. The PRISMA and RoB-2 tools guided reporting and risk of bias assessment. Random-effects models were applied to pool effect sizes for changes in alcohol consumption patterns and related consequences. Results: Fifteen RCTs were included. MIs significantly reduced daily alcohol intake (−0.55 drinks/day; 95% CI: −0.78 to −0.32), with additional reductions in weekly consumption and binge drinking episodes, though these were not statistically significant. Positive effects were also observed in reducing alcohol-related consequences and blood alcohol concentration levels. Short, single-session formats (45–90 min) showed consistent efficacy across studies, with effects sustained at 2–3 months and, in some cases, up to one year post-intervention. Conclusions: MIs are effective, brief, and adaptable strategies for reducing harmful alcohol use and associated negative outcomes among university students. Their simplicity, feasibility, and sustained effects make them valuable tools for university health programs. Future research should focus on optimizing intervention components and evaluating their effectiveness in diverse cultural and socioeconomic contexts. Full article

Background: Supported infant-directed singing (IDS) for parents and their preterm infants has proven beneficial for parents and preterm infants’ health and relationship building. Studying parent–infant contingent interactions through behavioral observations is an established method for assessing the quality of interactions. Very few studies have measured contingency between parent and preterm infants in the neonatal period during supported IDS. Methods: We conducted a feasibility study to assess the possibility of analyzing parent–very preterm infant dyads’ contingency during supported IDS in the NICU. We recruited four mother–infant dyads and video-recorded a single music therapy (MT) session before their discharge from the hospital. Two independent researchers coded three selected segments (beginning, middle, and end) from each video, according to adapted behavioral scales with inter-rater agreement analysis. Contingency between infant and maternal behaviors was analyzed. Results: Twelve video segments were coded. High inter-rater agreements (Cohen’s kappa) were found for infant eye-opening (0.93), hand positions (0.79), and head orientation (0.94), as well as maternal head orientation (0.95) and vocalizations (0.95). During supported IDS, increased infant head orientation toward the mother, eyes closed, as well as maternal head orientation toward the infant (all p < 0.001), were recorded compared to no IDS. Direction of the maternal head toward her infant was contingent on the infant’s closed eyes, extended hands, and head not toward mother. Conclusions: This feasibility study demonstrates contingency between mothers and their preterm infants’ specific behaviors during IDS. These interactions can be analyzed through video segments with high inter-rater agreement. The method described might help in evaluating other modalities that might be related to contingency. Recent advances in AI can make this tool easier to accomplish, with further studies to evaluate the importance of contingency for child development. The findings suggest that supported IDS influences infant attention and regulation. Full article

Patient education is a crucial component of a physician’s responsibility, and effective patient education can improve patient health outcomes and satisfaction. However, there is currently no formalized training for residents to develop and practice these skills at our large, academic internal medicine residency program. We created a virtual, case-based, interactive session for all residents to practice patient education skills and receive real-time feedback. Residents were given three scenarios: heart failure (HF), breast cancer (BC), and chronic kidney disease (CKD), and role-played as the physician, patient, and observer. The intervention was studied with single-group, pre-post intervention surveys. The session was virtual due to restrictions related to the COVID-19 pandemic. Mean Likert scale scores were compared by paired Wilcoxon rank-sign tests. The sessions were attended by 177 residents; 95 completed both pre- and post-session surveys (53.6%). Participants felt significantly more comfortable teaching patients about HF, BC, and CKD pathophysiology and treatments after the session (HF: pre-median = 4, post-median = 4, p = 0.0032; BC: pre-median = 2, post-median = 4, p < 0.0001; CKD: pre-median = 3, post-median = 4, p = 0.0016). There was a trend towards a significant increase in belief that teaching patients about common diseases should be integrated into the residency curriculum, but this did not reach statistical significance (pre-median = 4, post-median: 5, p = 0.0548). A targeted session for residents to practice patient education improved resident comfort with explaining three common diseases. These data suggest that the session was effective in a virtual format, demonstrating feasibility to be adapted in the increasingly online realm of patient encounters. Full article

Transdiagnostic psychotherapies were developed to address multiple diagnostic presentations via a single, easier-to-implement protocol. However, despite advances, these protocols are largely limited to longer formats designed for mental health settings. The present study investigated a version of Transdiagnostic Behavior Therapy (TBT-PC) that was adapted for primary care settings. Forty-one participants with emotional disorders received 6 sessions of TBT-PC, with symptoms of depression and anxiety assessed at baseline, immediate post-treatment, and at 3-month follow-up. Medium treatment effects for symptoms of depression and anxiety were evidenced at post-treatment and sustained at follow-up. Treatment feasibility was supported by excellent attendance, treatment completion, and patient satisfaction scores. Together, the present findings provide initial support for TBT-PC in primary care patients with emotional disorders. Full article

Background: Basketball is a high-intensity, multidirectional sport involving frequent jumping, sprinting, and rapid changes of direction, which may expose the musculoskeletal system to varying and potentially asymmetric mechanical demands. The mechanical loading associated with basketball-specific movements may also serve as a consistent osteogenic stimulus, potentially leading to side-specific adaptations in body composition and bone characteristics. Long-term participation in basketball may lead to functional and structural asymmetries between the lower and upper limbs, potentially increasing the risk of injury and impacting performance. This study aimed to investigate structural and functional asymmetries in male basketball players using body composition, health, and performance-related measures. Methods: Thirty-eight right-handed basketball players (age: 21.1 ± 2.8 years; body mass: 86.2 ± 9.2 kg; height: 1.91 ± 8.3 cm) were assessed in a single testing session. The evaluation included bioelectrical impedance analysis (BIA), dual-energy X-ray absorptiometry (DXA), single-leg countermovement rebound jumps (CMRJs), and handgrip strength testing. Results: Significant interlimb differences were observed in lean mass and the phase angle for both the arms and legs. Performance differences favored the left leg in terms of maximum jump height (12.0 ± 17.5%, p = 0.001) and reactive strength index (RSI), whereas the right arm exhibited greater grip strength than the left (6.4 ± 5.9%, p = 0.001). DXA analysis revealed significant asymmetries in bone parameters, including bone mineral density (BMD) of the trochanter (1.81 ± 5.51%, p = 0.031, dz = 0.37), total hip (1.41 ± 4.11%, p = 0.033, dz = 0.36), and total arms (–1.21 ± 2.71%, p = 0.010, dz = 0.43), as well as bone mineral content (BMC) in total arms (–2.16 ± 5.09%, p = 0.012) and total legs (1.71 ± 3.36%, p = 0.002, 0.54). Conclusions: These findings suggest that basketball may induce both functional and structural adaptations, likely due to repetitive unilateral loading and sport-specific movement patterns. However, individual variability and the use of diverse assessment methods may complicate the detection and interpretation of asymmetries. Coaches and practitioners should monitor and address such asymmetries to reduce injury risk and optimize performance. Full article

Introduction: Expanded hemodialysis using medium cut-off (MCO) dialyzers effectively removes middle-molecule uremic toxins, comparable to hemodiafiltration, but their single-use designation increases the dialysis costs. This study evaluated the efficacy and safety of reusing two MCO dialyzers available in Thailand. Methods: In this randomized controlled trial, hemodialysis patients were assigned to receive treatment with either Theranova^® 500 or Elisio^® 21HX dialyzers. Each dialyzer was reprocessed using peracetic acid and reused for up to 15 sessions. Dialyzer performance was assessed by the reduction ratios (RRs) of solutes, including β2-microglobulin (β2-MG), kappa and lambda free light chains (κ-FLC, λ-FLC), and interleukin-6 (IL-6), at baseline and the 2nd, 5th, 10th, and 15th sessions. Results: Forty-eight patients were enrolled (mean age 63.6 ± 13.7 years; 62.5% male) and randomized into 2 groups with comparable baseline characteristics. RRs for β2-MG, κ-FLC, and λ-FLC were similar between the groups and declined modestly over time after dialyzer reused (β2-MG: 78.2% to 72.5% vs. 77.2% to 74.5%, κ-FLC: 64.6% to 51.3% vs. 58.9% to 49.5%, and λ-FLC: 51.2% to 46.4% vs. 49.4% to 39.2% in the Theranova^® 500 and Elisio^® 21HX groups, respectively). Theranova^® 500 demonstrated significantly higher IL-6 clearance in the 2nd (29.9% vs. 16.0%; p = 0.018) and 5th (23.8% vs. 7.7%, p = 0.031) sessions. It also showed a non-significant trend toward lower dialyzer survival (HR 3.98; p = 0.085) and higher, though clinically acceptable, albumin loss (mean difference 0.56 g/session; p < 0.001), which decreased with reuse. Conclusions: Both MCO dialyzers demonstrated comparable overall performance during reuse. Theranova^® 500 provided better IL-6 clearance with manageable albumin loss. Implementation of high-quality dialyzer reuse protocols may optimize clinical efficacy and patient outcomes while balancing cost, accessibility, and environmental considerations. Full article

Engineers are often faced with complex problems that require both technical and social expertise. However, typical engineering curricula teach technical skills in isolation, without introducing social issues. To address this gap, we implemented a sociotechnical module that linked the circuits topic of capacitors with the social issue of conflict minerals in a single class session of a large “Introduction to Circuits” course. Using a midterm student feedback survey and student group interviews, we explored students’ responses to the module, their takeaways, and their general attitudes towards sociotechnical content in technical engineering courses. Overall, students found the module to be valuable and relevant, with many noting that it helped them understand real-world engineering practice. While some expressed concern about adding new material to an already content-heavy course, more than half agreed that this type of content is important and that they would like to see more sociotechnical topics in their engineering courses. Full article

Exercise is a promising intervention for reducing drug craving, but recent studies have shown inconsistent effects. This meta-analysis aims to evaluate the effect of exercise interventions on drug craving and identify the key exercise factors that affect its effectiveness. The literature was searched in four English databases. Two authors independently performed literature screening, data extraction, and quality assessment. Subgroup, sensitivity, and meta-regression analyses were conducted to explore potential heterogeneity. The results demonstrated that exercise (SMD = −0.74, 95% CI: −0.91, −0.58; p < 0.00001) was more effective than control groups in reducing drug craving among people with drug use disorder. Subgroup analyses demonstrated that aerobic (SMD = −0.79, 95% CI: −1.03, −0.54; p < 0.00001), multi-component (SMD = −0.96, 95% CI: −1.73, −0.18; p = 0.02), and mind–body exercise (SMD = −0.57, 95% CI: −0.88, −0.26; p = 0.0003) could significantly reduce drug craving, while resistance exercise (SMD = −0.59, 95% CI: −1.33, 0.16; p = 0.12) could not. Moreover, moderate (SMD = −0.77, 95% CI: −0.95, −0.58; p < 0.00001) and high-intensity exercise (SMD = −0.63, 95% CI: −1.08, −0.19; p = 0.006) were effective in reducing drug craving. In addition, regardless of intervention period, single-session duration, and weekly frequency, exercise could significantly reduce drug craving. This study indicates that exercise effectively reduces drug craving, with type and intensity as key factors affecting the effectiveness. Full article