Search Results (402)

Refractory full-thickness macular holes (rFTMHs) present a significant challenge in vitreoretinal surgery, with reported incidence rates of 4.2–11.2% following standard vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade. Risk factors include large hole size (>400 µm), chronicity (>6 months), high myopia, incomplete ILM peeling, and post-operative noncompliance. Multiple surgical techniques exist, though comparative evidence remains limited. Current options include the inverted ILM flap technique, autologous ILM transplantation (free flap or plug), lens capsular flap transplantation (autologous or allogenic), preserved human amniotic membrane transplantation, macular subretinal fluid injection, macular fibrin plug with autologous platelet concentrates, and autologous retinal transplantation. Closure rates range from 57.1% to 100%, with selection depending on hole size, residual ILM, patient posturing ability, etc. For non-posturing patients, fibrin plugs are preferred. Residual ILM cases may benefit from extended peeling or flap techniques, while large holes often require scaffold-based (lens capsule, amniotic membrane) or fibrin plug approaches. Pseudophakic patients should avoid posterior capsular flaps due to lower success rates. Despite promising outcomes, the lack of randomized trials necessitates further research to establish evidence-based guidelines. Personalized surgical planning, considering anatomical and functional goals, remains crucial in optimizing visual recovery in rFTMHs. Full article

Background: Residual deficits after early treatment of developmental dysplasia of the hip (DDH) using osteotomy often led to asymmetrical gait deviations with increased repetitive rates of ground reaction force (GRF) in both hips, resulting in a higher risk of early osteoarthritis. This study investigated lower limb inter-joint coordination and swing foot control during level walking in adolescents with early-treated unilateral DDH. Methods: Eleven female adolescents treated early for DDH using Pemberton osteotomy were compared with 11 age-matched healthy controls. The joint angles and angular velocities of the hip, knee, and ankle were measured, and the corresponding phase angles and continuous relative phase (CRP) for hip–knee and knee–ankle coordination were obtained. The variability of inter-joint coordination was quantified using the deviation phase values obtained as the time-averaged standard deviations of the CRP curves over multiple trials. Results: The DDH group exhibited a flexed posture with increased variability in knee–ankle coordination of the affected limb throughout the gait cycle compared to the control group. In contrast, the unaffected limb compensated for the kinematic alterations of the affected limb with reduced peak angular velocities but increased knee–ankle CRP over double-limb support and trajectory variability over the swing phase. Conclusions: The identified changes in inter-joint coordination in adolescents with early treated DDH provide a plausible explanation for the previously reported increased GRF loading rates in the unaffected limb, a risk factor of premature OA. Full article

Background/Objectives: Early experiences can significantly influence brain development, particularly when they occur during specific time windows known as sensitive or critical periods. Therefore, the early promotion of neurodevelopmental functions is crucial in children at risk for neurodevelopmental disabilities, such as those with cerebral palsy. This article introduces AMIRA (A Multidimensional and Integrated Rehabilitation Approach), a rehabilitative framework designed for infants at risk of neurodevelopmental disabilities. Methods: AMIRA is intended to guide clinical–rehabilitation reasoning rather than prescribe a rigid sequence of predetermined activities for the child. The theoretical foundation and structure of AMIRA are presented by formalizing its criteria, objectives, tools, and intervention procedures. The framework comprises four distinct sections, each supported by adaptive strategies to facilitate access to materials and to promote play-based interactions among the child, their environment, and communication partners. Particular attention is given to optimizing both micro- and macro-environments for children with, or at risk of, co-occurring visual impairment. Each rehabilitative section includes three progressive phases: an initial observation phase, a facilitation phase to support the child’s engagement, and an active experimentation phase that gradually introduces more challenging tasks. Results: The intervention pathways in AMIRA are organized according to six core developmental domains: behavioral–emotional self-regulation, visual function, postural–motor skills, praxis, interaction and communication, and cognitive function. These are outlined in structured charts that serve as flexible guidelines rather than prescriptive protocols. Each chart presents activities of increasing complexity aligned with typical developmental milestones up to 24 months of age. For each specific ability, the corresponding habilitation goals, contextual recommendations (including environmental setup, objects, and tools), and suggested activities are provided. Conclusions: This study presents a detailed intervention approach, offering both a practical framework and a structured set of activities for use in rehabilitative settings. Further studies will explore the efficacy of the proposed standardized approach. Full article

Background: Few studies have examined exercise-based treatments for migraine and tension-type headache (TTH), and even fewer have focused on strength training and chronic headache, as these present greater challenges. Objectives: This study aimed to evaluate the effectiveness of a group-based neck and shoulder strength training intervention combined with postural correction for patients with chronic headache. Methods: This prospective, single-arm, uncontrolled pilot study with a pre–post design included patients with chronic migraine (n = 10) and TTH (n = 12) who participated in an 8-week group-based program consisting of neck and shoulder strength training three times per week, along with instructions for postural correction. The primary outcome was change in headache frequency. Secondary outcomes included changes in the intensity and duration of headache, number of days of analgesic use, and functionality. Results: In total, 22 patients completed the intervention and were included in the analysis. Headache frequency decreased at follow-up for the overall group (r = 0.531; p = 0.014). In-depth analysis showed that 45% of participants experienced an average reduction of 38% in headache frequency. Additionally, large to moderate effect sizes were observed for the secondary outcomes. Conclusions: This is the first study to introduce a group-based exercise program targeting the neck and shoulder muscles, combined with postural correction and standard pharmacological treatment, for patients with chronic primary headache. It was found to be a safe, well-tolerated, useful, and promising intervention for improving headache frequency, duration, and functionality. Full article

Modern vehicles are rapidly transforming into interconnected cyber–physical systems that rely on advanced sensor technologies and pervasive connectivity to support autonomous functionality. Yet, despite this evolution, standardized methods for quantifying cybersecurity vulnerabilities across critical automotive components remain scarce. This paper introduces a novel hybrid model that integrates expert-driven insights with generative AI tools to adapt and extend the Common Vulnerability Scoring System (CVSS) specifically for autonomous vehicle sensor systems. Following a three-phase methodology, the study conducted a systematic review of 16 peer-reviewed sources (2018–2024), applied CVSS version 4.0 scoring to 15 representative attack types, and evaluated four free source generative AI models—ChatGPT, DeepSeek, Gemini, and Copilot—on a dataset of 117 annotated automotive-related vulnerabilities. Expert validation from 10 domain professionals reveals that Light Detection and Ranging (LiDAR) sensors are the most vulnerable (9 distinct attack types), followed by Radio Detection And Ranging (radar) (8) and ultrasonic (6). Network-based attacks dominate (104 of 117 cases), with 92.3% of the dataset exhibiting low attack complexity and 82.9% requiring no user interaction. The most severe attack vectors, as scored by experts using CVSS, include eavesdropping (7.19), Sybil attacks (6.76), and replay attacks (6.35). Evaluation of large language models (LLMs) showed that DeepSeek achieved an F1 score of 99.07% on network-based attacks, while all models struggled with minority classes such as high complexity (e.g., ChatGPT F1 = 0%, Gemini F1 = 15.38%). The findings highlight the potential of integrating expert insight with AI efficiency to deliver more scalable and accurate vulnerability assessments for modern vehicular systems.This study offers actionable insights for vehicle manufacturers and cybersecurity practitioners, aiming to inform strategic efforts to fortify sensor integrity, optimize network resilience, and ultimately enhance the cybersecurity posture of next-generation autonomous vehicles. Full article

Work-related musculoskeletal disorders (WMSDs) are among the most prevalent occupational health issues, particularly affecting public transport drivers due to prolonged sitting, constrained postures, and poorly adaptable cabins. This study addresses the ergonomic risks associated with tram driving, aiming to evaluate biomechanical load and postural stress in relation to drivers’ anthropometric characteristics. A combined methodological approach was applied, integrating two standardized observational tools—RULA and REBA—with anthropometric modeling based on three representatives European morphotypes (SmallW, MidM, and TallM). ErgoFellow 3.0 software was used for digital posture evaluation, and lumbar moments at the L4/L5 vertebral level were calculated to estimate lumbar loading. The analysis was simulation-based, using digital human models, and no real subjects were involved. The results revealed uniform REBA (Rapid Entire Body Assessment) and RULA (Rapid Upper Limb Assessment) scores of 6 across all morphotypes, indicating moderate to high risk and a need for ergonomic intervention. Lumbar moments ranged from 51.35 Nm (SmallW) to 101.67 Nm (TallM), with the tallest model slightly exceeding the recommended ergonomic thresholds. These findings highlight a systemic mismatch between cabin design and user variability. In conclusion, ergonomic improvements such as adjustable seating, better control layout, and driver education are essential to reduce the risk of WMSDs. The study proposes a replicable methodology combining anthropometric, observational, and biomechanical tools for evaluating and improving transport workstation design. Full article

Optical sensor technologies are reshaping obesity detection by enabling non-invasive, dynamic analysis of biomechanical and morphological biomarkers. This review synthesizes recent advances in three key areas: optical gait analysis, vision-based pose estimation, and depth-sensing voxel modeling. Gait analysis leverages optical sensor arrays and video systems to identify obesity-specific deviations, such as reduced stride length and asymmetric movement patterns. Pose estimation algorithms—including markerless frameworks like OpenPose and MediaPipe—track kinematic patterns indicative of postural imbalance and altered locomotor control. Human voxel modeling reconstructs 3D body composition metrics, such as waist–hip ratio, through infrared-depth sensing, offering precise, contactless anthropometry. Despite their potential, challenges persist in sensor robustness under uncontrolled environments, algorithmic biases in diverse populations, and scalability for widespread deployment in existing health workflows. Emerging solutions such as federated learning and edge computing aim to address these limitations by enabling multimodal data harmonization and portable, real-time analytics. Future priorities involve standardizing validation protocols to ensure reproducibility, optimizing cost-efficacy for scalable deployment, and integrating optical systems with wearable technologies for holistic health monitoring. By shifting obesity diagnostics from static metrics to dynamic, multidimensional profiling, optical sensing paves the way for scalable public health interventions and personalized care strategies. Full article

Background and Objectives: General-purpose multimodal large language models (LLMs) are increasingly used for medical image interpretation despite lacking clinical validation. This study evaluates the diagnostic reliability of ChatGPT-4o and Claude 2 in photographic assessment of adolescent idiopathic scoliosis (AIS) against radiological standards. This study examines two critical questions: whether families can derive reliable preliminary assessments from LLMs through analysis of clinical photographs and whether LLMs exhibit cognitive fidelity in their visuospatial reasoning capabilities for AIS assessment. Materials and Methods: A prospective diagnostic accuracy study (STARD-compliant) analyzed 97 adolescents (74 with AIS and 23 with postural asymmetry). Standardized clinical photographs (nine views/patient) were assessed by two LLMs and two orthopedic residents against reference radiological measurements. Primary outcomes included diagnostic accuracy (sensitivity/specificity), Cobb angle concordance (Lin’s CCC), inter-rater reliability (Cohen’s κ), and measurement agreement (Bland–Altman LoA). Results: The LLMs exhibited hazardous diagnostic inaccuracy: ChatGPT misclassified all non-AIS cases (specificity 0% [95% CI: 0.0–14.8]), while Claude 2 generated 78.3% false positives. Systematic measurement errors exceeded clinical tolerance: ChatGPT overestimated thoracic curves by +10.74° (LoA: −21.45° to +42.92°), exceeding tolerance by >800%. Both LLMs showed inverse biomechanical concordance in thoracolumbar curves (CCC ≤ −0.106). Inter-rater reliability fell below random chance (ChatGPT κ = −0.039). Universal proportional bias (slopes ≈ −1.0) caused severe curve underestimation (e.g., 10–15° error for 50° deformities). Human evaluators demonstrated superior bias control (0.3–2.8° vs. 2.6–10.7°) but suboptimal specificity (21.7–26.1%) and hazardous lumbar concordance (CCC: −0.123). Conclusions: General-purpose LLMs demonstrate clinically unacceptable inaccuracy in photographic AIS assessment, contraindicating clinical deployment. Catastrophic false positives, systematic measurement errors exceeding tolerance by 480–1074%, and inverse diagnostic concordance necessitate urgent regulatory safeguards under frameworks like the EU AI Act. Neither LLMs nor photographic human assessment achieve reliability thresholds for standalone screening, mandating domain-specific algorithm development and integration of 3D modalities. Full article

Continuous blood pressure (BP) monitoring provides valuable insight into the body’s dynamic cardiovascular regulation across various physiological states such as physical activity, emotional stress, postural changes, and sleep. Continuous BP monitoring captures different variations in systolic and diastolic pressures, reflecting autonomic nervous system activity, vascular compliance, and circadian rhythms. This enables early identification of abnormal BP trends and allows for timely diagnosis and interventions to reduce the risk of cardiovascular diseases (CVDs) such as hypertension, stroke, heart failure, and chronic kidney disease as well as chronic stress or anxiety disorders. To facilitate continuous BP monitoring, we propose an AI-powered estimation framework. The proposed framework first uses an expert-driven feature engineering approach that systematically extracts physiological features from photoplethysmogram (PPG)-based arterial pulse waveforms (APWs). Extracted features include pulse rate, ascending/descending times, pulse width, slopes, intensity variations, and waveform areas. These features are fused with demographic data (age, gender, height, weight, BMI) to enhance model robustness and accuracy across diverse populations. The framework utilizes a Tab-Transformer to learn rich feature embeddings, which are then processed through an ensemble machine learning framework consisting of CatBoost, XGBoost, and LightGBM. Evaluated on a dataset of 1000 subjects, the model achieves Mean Absolute Errors (MAE) of 3.87 mmHg (SBP) and 2.50 mmHg (DBP), meeting British Hypertension Society (BHS) Grade A and Association for the Advancement of Medical Instrumentation (AAMI) standards. The proposed architecture advances non-invasive, AI-driven solutions for dynamic cardiovascular health monitoring. Full article

In recent decades, information technology has grown. Computers have become a daily activity, facilitating access to information, faster communication and faster work. If used responsibly, it has many advantages. Objectives: To explore the potential link between prolonged use of computer input devices—such as keyboards and mice—and the development of compressive neuropathies, including carpal tunnel syndrome (CTS) and cubital tunnel syndrome (CuTS), in individuals whose daily routines are heavily reliant on computer-based activities. Methods: A comprehensive review of the literature was undertaken to assess the correlation between the use of computer input devices and the incidence of compressive neuropathies in the upper limbs, with particular attention to repetitive strain, ergonomic posture deviations, and personal risk factors. Results: Current evidence indicates a potential association between prolonged computer use and the development of upper limb compressive neuropathies; however, a definitive consensus within the scientific literature remains elusive. Repetitive movements and non-neutral postures appear to be significant contributing factors, particularly among individuals with predisposing risk factors. Despite increasing awareness of this issue, standardized, evidence-based clinical guidelines for the evaluation and management of work-related nerve disorders remain lacking. Conclusions: While the relationship between computer use and compressive neuropathies remains debated, healthcare professionals should be aware of the risks, particularly in individuals exposed to repetitive strain and ergonomic stress. Further research and the development of clinical guidelines are needed to better understand and manage these work-related conditions. Full article

Background/Objectives: Dual task (DT) training consists of practicing exercises while simultaneously performing a concurrent motor or cognitive task. This training modality seems to have beneficial effects on both domains. Various forms of DT training have been implemented for older adults in recent years, but no official guidelines currently exist. This review sought to analyze the studies published on this topic in the last ten years and provide a standard operating procedure (SOP) for healthy older adults in this context. Methods: The review collected articles from PubMed, Web of Science, and Scopus, adopting a designated set of keywords. Selected manuscripts and relevant information were selected, extrapolated, including information related to the training frequency, intensity, time, and type, and secondary tasks adopted. The secondary tasks were grouped according to previously published studies, and the SOP was created based on the frequency of the parameters collected from the included articles. Results: A total of 44 studies were included in the review. Based on the results, the SOP recommends postural balance or resistance training as primary tasks, combined with a mental tracking task as a secondary component. Two 60-min sessions per week for at least 12 weeks are required to achieve measurable results. Conclusions: Despite heterogeneity in the literature reviewed, the findings support the proposal of a SOP to guide future research on DT training in healthy older adults. Given its feasibility and positive effects on both motor and cognitive functions, this type of training can also be implemented in everyday settings. Full article

Background and Objectives: Cerebral palsy (CP) is a non-progressive neurological disorder characterized by motor impairments such as spasticity and poor postural control. Among these, trunk control plays a critical role in maintaining balance and enabling functional mobility. Since spasticity is known to interfere with motor coordination and posture, evaluating its response to trunk-focused interventions may offer additional clinical insights. This systematic review and meta-analysis evaluated the effectiveness of trunk-focused interventions on trunk control, gross motor function, balance, and spasticity. Materials and Methods: A systematic search was conducted in PubMed, Embase, Web of Science, MEDLINE, and CINAHL for randomized controlled trials (RCTs) published in the last 10 years up to 11 April 2023. Studies targeting trunk-specific interventions in children with CP were included. Meta-analyses were performed using RevMan 5.3, calculating standardized mean differences (SMDs) with 95% confidence intervals (CIs). Study quality was assessed using the PEDro scale. Results: Fifteen RCTs involving 454 children were included. Trunk control improved significantly (SMD = 3.67; 95% CI: 3.10–4.25; I² = 0%). Gross motor function showed a small but significant improvement (SMD = 0.49; 95% CI: 0.06–0.92; I² = 44%). Balance exhibited a large, though not statistically significant, effect (SMD = 0.90; 95% CI: −0.00 to 1.79; I² = 81%). Subgroup analysis indicated that interventions performed more than four times per week produced a significant effect on balance (SMD = 0.54; 95% CI: 0.08–1.01). Only one study assessed spasticity and found no group difference. Conclusions: Trunk-based interventions significantly improve trunk control and gross motor function in children with CP. While improvements in balance were inconsistent, higher-frequency interventions yielded more favorable results. Further research is warranted to clarify effects on spasticity and optimize intervention protocols for clinical application. Full article

Objectives: The objective of this study was to evaluate changes in anatomical point position, cranio-cervical posture, and respiratory dimensions following conventional bimaxillary total prosthetic rehabilitation. Methods: A prospective, longitudinal, observational, analytical study was conducted on 12 patients, aged 55 to 75 years, at the Department of Dental Prosthetics at the University of Medicine and Pharmacy in Cluj-Napoca. All patients had complete bimaxillary edentulism and received removable dentures as treatment. Clinical and cephalometric analyses were performed before and after prosthetic treatment to compare changes. The cephalometric analysis was based on the guidelines of Tweed and Rocabado for evaluation. Quantitative data were described using the mean and standard deviation for normal distribution and represented by bar graphs with error bars. A paired samples t-test was used to determine differences between groups, with a significance threshold of 0.05 for the bilateral p-value. Results: When analyzing changes in cranial base inclination, the corresponding angles exhibited an increase, indicating cephalic extension. A statistically significant difference in the anteroposterior diameter of the oropharyngeal lumen with and without bimaxillary complete dentures was identified (p < 0.05). For hyperdivergent patients, modifications in the position of anatomical features on cephalometry slightly reduced the VDO and had a slight compensatory effect on skeletal typology. In contrast, for hypodivergent patients, modifications to the position of anatomical landmarks also had a compensatory effect on skeletal typology, increasing the VDO. Conclusion: Changes in the position of anatomical features on cephalometry generally have a compensatory effect on skeletal typology after complete denture placement. Complete prosthetic treatment with removable dentures can significantly influence respiratory function by reducing the oropharyngeal lumen and body posture by cephalic extension and attenuation of the lordotic curvature of the cervical spine. Full article

Background: Pes planus is a condition where the arch of the foot collapses, resulting in the entire sole contacting the ground. The biomechanical implications of pes planus on gait have been widely studied; however, research specific to Black African populations, particularly recreational runners, is scarce. Aim: This study aimed to describe the forefoot centre of pressure (CoP) trajectory during the barefoot gait cycle among Black African recreational runners with pes planus. Methods: A prospective explorative and quantitative study design was employed. Participants included Black African male recreational runners aged 18 to 45 years diagnosed with pes planus. A Freemed™ 6050 force plate was used to collect gait data. Statistical analysis included cross-tabulations to identify patterns. Results: This study included 104 male participants across seven weight categories, with the majority in the 70-to-79 kg range (34.6%, n = 36). Most participants with pes planus showed a neutral foot posture (74.0%, n = 77) on the foot posture index 6 (FPI-6) scale. Flexible pes planus (94.2%, n = 98) was much more common than rigid pes planus (5.8%, n = 6). Lateral displacement of the CoP was observed in the right forefoot (90.4%, n = 94) and left forefoot (57.7%, n = 60). Load distribution patterns differed between feet, with the right foot favouring the medial heel, arch, and metatarsal heads, while the left foot favoured the lateral heel, medial heel, and lateral arch. No statistical significance was found in the cross-tabulations, but notable lateral CoP displacement in the forefoot was observed. Conclusions: The findings challenge the traditional view of pes planus causing overpronation and highlight the need for clinicians to reconsider standard diagnostic and management approaches. Further research is needed to explore the implications of these findings for injury prevention and management in this population. Full article

Objectives: New smartphone-based methods for measuring cervical spine range of motion (CS-ROM) and posture are emerging. The purpose of this study was to assess the reliability and validity of three such methods in patients with non-specific chronic neck pain (NSCNP). Methods: The within-day test–retest reliability of CS-ROM and forward head posture (craniovertebral angle-CVA) was examined in 45 patients with NSCNP. CS-ROM was simultaneously measured with an accelerometer sensor (KFORCE Sens^®) and a mobile phone device (iHandy and Compass apps), testing the accuracy of each and the parallel-forms reliability between the two methods. For construct validity, correlations of CS-ROM with demographics, lifestyle, and other cervical and thoracic spine biomechanically based measures were examined in 90 patients with NSCNP. Male–female differences were also explored. Results: Both methods were reliable, with measurements concurring between the two devices in all six movement directions (intraclass correlation coefficient/ICC = 0.90–0.99, standard error of the measurement/SEM = 0.54–3.09°). Male–female differences were only noted for two CS-ROM measures and CVA. Significant associations were documented: (a) between the six CS-ROM measures (R = 0.22–0.54, p < 0.05), (b) participants’ age with five out of six CS-ROM measures (R = 0.23–0.40, p < 0.05) and CVA (R = 0.21, p < 0.05), (c) CVA with two out of six CS-ROM measures (extension R = 0.29, p = 0.005 and left-side flexion R = 0.21, p < 0.05), body mass (R = −0.39, p < 0.001), body mass index (R = −0.52, p < 0.001), and chest wall expansion (R = 0.24–0.29, p < 0.05). Significantly lower forward head posture was noted in subjects with a high level of physical activity relative to those with a low level of physical activity. Conclusions: The reliability of both CS-ROM methods was excellent. Reductions in CS-ROM and increases in CVA were age-dependent in NSCNP. The significant relationship identified between CVA and CWE possibly signifies interconnections between NSCNP and the biomechanical aspect of dysfunctional breathing. Full article