Search Results (912)

Background/Objectives: Incomplete intertrochanteric proximal femur fractures pose a management dilemma regarding the choice between surgery and conservative care. This study compared radiographic and functional outcomes between surgical fixation and conservative treatment and evaluated whether immediate full weight-bearing (FWB) can be performed by conservatively managed patients. Methods: This is a retrospective cohort study of consecutive patients aged ≥ 60 who presented with MRI-confirmed incomplete intertrochanteric fractures at a tertiary trauma center and rehabilitation unit from 2010 to 2020. Clinical outcomes were compared between conservatively managed and surgically treated patients. The primary outcome was radiographic bone union at 3 months; the secondary outcomes included secondary displacement, mobility at discharge, hospital length of stay, and mortality at 3 months and 1 year. Results: Forty-two patients met the inclusion criteria: 10 were managed conservatively, and 32 were managed operatively. Baseline age and sex distributions were similar between groups. At 3 months post-injury, bone union rates were 100% in both groups, with no incidences of secondary displacement regardless of whether a course of protected weight-bearing was prescribed. Functional mobility at discharge and length of stay were comparable. Mortality at 3 months and 1 year did not differ significantly between groups. Conclusions: The preliminary findings of this retrospective cohort study demonstrated managing MRI-diagnosed incomplete intertrochanteric proximal femur fractures conservatively to be feasible. Despite the limited sample size, all included patients who were treated conservatively achieved bone union by 3 months without secondary displacement. Their clinical outcomes were also comparable to the outcomes of those who were treated with surgical fixation. However, given the small sample size and lack of randomization, further investigation is warranted before clinical application. Full article

Laryngeal pathology requires individualized management because the larynx integrates airway protection, phonation, swallowing, and respiratory function within a compact and highly variable anatomical framework. This narrative review examines how laryngeal anatomy and morphometry support interdisciplinary collaboration and personalized care in oncologic, stenotic, functional, and reconstructive laryngeal disease. Evidence from morphometric studies, CT, MRI, endoscopy, ultrasonography, three-dimensional reconstruction, artificial intelligence, and multidisciplinary clinical workflows was synthesized qualitatively. Key parameters—including vocal fold length, glottic width, thyroid cartilage angle, cricoid diameter, subglottic diameter, anterior commissure thickness, and the status of paraglottic and pre-epiglottic spaces—provide actionable information for diagnosis, T-staging, airway assessment, surgical planning, reconstruction, and functional rehabilitation. Morphometry concretely informs clinical decisions: thyroid cartilage angle guides thyroplasty and phonosurgical planning; subglottic diameter supports stenosis surgery and airway instrumentation; and anterior commissure, conus elasticus, cartilage, and deep-space measurements refine oncologic staging and margin strategy. Technological accelerators, including AI segmentation, radiomics, 3D printing, photogrammetry, and ultrasonography, extend morphometry from static measurement toward predictive modeling and patient-specific simulation. However, implementation remains limited by heterogeneous CT protocols, inconsistent measurement planes, uneven access to advanced technologies, lack of global normative databases, and unresolved ethical issues surrounding AI validation and data governance. This review supports standardizing CT morphometry using parallel vocal fold planes, routinely measuring anterior commissure thickness in T1 glottic cancer, incorporating ultrasonography as a first-line morphometric tool in voice clinics, and validating AI segmentation against population-specific morphometric norms. Laryngeal morphometry should therefore become a routine decision-making framework for precision laryngology. Full article

Health 5.0 increasingly involves medical robots and haptic systems that sustain physical interaction with patients and clinicians. This proof-of-concept study examined fatigue-related surface electromyography (sEMG) spectral changes during a 400 s repetitive haptic-writing task in 20 adults. Five upper-limb muscles were monitored at 1000 Hz, and mean frequency (MNF) and median frequency (MDF) trajectories were summarized by fitted start-to-end spectral decline and combined into arm-level indices. MDF had the higher association with the archived participant-level fatigue-analysis score ($r=0.954$ versus $r=0.783$; $\Delta r=0.171$; Holm-adjusted $p=0.0035$). Small-sample influence analysis supported the stability of this within-sample ordering: after omitting each participant in turn, $\Delta r$ remained positive in 20/20 analyses (range 0.125–0.218), although the exact paired label-swap sensitivity test remained inconclusive ($p=0.082$). Exploratory leave-one-participant-out calibration produced lower held-out error for MDF (MAE 4.38, RMSE 5.87 percentage points) than for MNF (MAE 9.24, RMSE 12.02 percentage points). The raw seven-category Q2 responses and the archived 0–100 analysis score are reported as separate data products because they are not numerically equivalent under direct linear rescaling. Accordingly, the results identify MDF as the more promising spectral summary for prospective validation in this task, rather than establishing universal superiority or numerical replacement of subjective fatigue. The experiment was a laboratory haptic-writing study and did not test a surgical robot, rehabilitation robot, patient population, or clinical controller; Health 5.0 is therefore presented as a translational motivation rather than a demonstrated application. Full article

Introduction: Cardiac rehabilitation (CR) is an evidence-based secondary prevention strategy that improves functional capacity, quality of life, and cardiovascular outcomes. However, adherence to CR programs remains suboptimal, limiting their effectiveness. Methods: A retrospective multicenter cohort study was conducted among patients enrolled in outpatient CR programs at two specialized cardiovascular centers. Adherence was defined as attendance at ≥70% of the prescribed sessions (≥25 of 36 sessions). Bivariate analyses were performed to compare adherent and non-adherent participants. Variables with p < 0.20 were included in a multivariable logistic regression model to identify factors independently associated with adherence. Results: A total of 210 participants were included, of whom 77.6% (163/210) were classified as adherent. The median age was 68 years (IQR 60.3–75.0), and 64.3% were men. Most participants (70.5%) completed more than 30 rehabilitation sessions. Adherence rates were highest among patients undergoing surgical myocardial revascularization (80.6%) and valve surgery (76.0%). In multivariable analysis, program duration was the only factor significantly associated with adherence (OR = 4.59; 95% CI: 2.46–8.59; p < 0.001). History of dyslipidemia showed a non-significant trend toward higher adherence (OR = 3.29; 95% CI: 0.91–11.90; p = 0.069). Educational level, left ventricular ejection fraction, and health insurance affiliation were not independently associated with adherence. Conclusions: Adherence to CR was high in this cohort. Longer participation in the program was the only independent predictor of adherence, highlighting the importance of strategies that promote sustained engagement throughout the rehabilitation process. Full article

Background/Objectives: Surgical indications for spondylodiscitis are controversial, particularly when epidural extension and evolving neurological compromise are present. This study aimed to describe the clinical, neurological, pain-related, and inflammatory outcomes of patients with spondylodiscitis treated with decompressive laminectomy without spinal stabilization, at a single tertiary center. Methods: We retrospectively reviewed 15 consecutive patients with spondylodiscitis who underwent decompressive laminectomy at the University Hospital of Trieste between January 2017 and December 2023. Inclusion required at least 6 months of clinical and laboratory follow-up. Patients treated with acute vertebral stabilization were excluded. Collected data included spinal level, timing from diagnosis to surgery, visual analog scale (VAS) pain score, Cooper Scale grade, modified Japanese Orthopedic Association score (mJOA), white blood cell count, and C-reactive protein (CRP). Assessments were performed preoperatively (T0), 1 week after surgery (T1), and at 6 months (T2). Imaging findings from representative cases were reviewed to illustrate the radiographic evolution after decompression combined with antibiotic therapy and orthotic support. Results: The cohort included 8 women and 7 men with a mean age of 57.33 years. Twelve patients (80%) underwent surgery within 48 h because of neurological deterioration or urgent compressive findings. Thoracic involvement was predominant (11 cases, 73%), whereas cervical and lumbar disease accounted for 1 and 3 cases, respectively. Intraoperative cultures were positive in 9 patients (60%), and Staphylococcus aureus was isolated in 7 of these 9 cases (77.8%). Mean VAS pain score improved from 6.3 at T0 to 4.3 at T1 and 1.4 at T2. Mean lower-extremity Cooper Scale grade improved from 2.7 to 2.1 to 0.6; mean upper-extremity Cooper Scale grade improved from 1.3 to 1.0 to 0. Mean mJOA improved from 10.3 to 11.4 to 16.0. Mean white blood cell count declined from 11.58 to 8.35 to 6.14 × 10³/µL, and mean CRP declined from 123.9 to 72.81 to 19.44 mg/L. No patient worsened neurologically after surgery. No patient required acute stabilization or delayed arthrodesis during follow-up. Conclusions: In our case series of patients with compressive or progressive neurological spondylodiscitis, decompressive laminectomy combined with antibiotic treatment, bracing, and rehabilitation was associated with early neurological stabilization, substantial pain relief, and marked reduction in inflammatory markers, without subsequent need for instrumented stabilization. These data support the role of spinal decompression as part of a personalized, effective treatment strategy in patients with neurological decline. Full article

Objectives: To evaluate the clinical accuracy and patient-reported outcomes (PROMs) of robotic-assisted full-arch implant rehabilitation performed with an autonomous robotic implant system. Materials and Methods: Six consecutive edentulous patients requiring implant-supported full-arch rehabilitation were treated using the Yakebot task-autonomous robotic implant system following a fully digital workflow. A total of 36 Straumann Bone Level Tapered implants were placed using a flapless approach. Implant placement accuracy was assessed by comparing planned and postoperative CBCT datasets. Coronal, apical, depth, and angular deviations were automatically calculated using dedicated robotic planning software. Patient-reported outcomes were prospectively evaluated through a structured questionnaire assessing preoperative perceptions, postoperative morbidity, and overall treatment satisfaction. Results: All implants were successfully placed according to the robotic-assisted workflow without intraoperative complications or conversion to conventional surgery. Mean three-dimensional coronal and apical deviations were 0.45 ± 0.18 mm and 0.47 ± 0.19 mm, respectively, while mean total angular deviation was 1.30 ± 0.63°. Patients reported low preoperative anxiety (0.5 ± 0.8/10), limited postoperative pain (2.2 ± 3.5/10), swelling (1.3 ± 2.2/10), and interference with daily activities (1.3 ± 2.2/10). Overall surgical experience was highly rated (9.7 ± 0.8/10). Final satisfaction scores were exceptionally high, with all patients indicating they would undergo robotic-assisted surgery again and recommend the procedure to others. Conclusions: Robotic-assisted full-arch implant rehabilitation demonstrated a high level of clinical accuracy, with submillimetric coronal and apical deviations and low angular discrepancies. In addition, treatment was associated with low postoperative morbidity, excellent patient acceptance, and very high satisfaction. These findings support the potential of autonomous robotic implant surgery as a predictable and patient-centered approach for full-arch rehabilitation, although larger controlled studies are required to confirm these results. Full article

Tendinopathies represent a major clinical challenge. Vasculature, neuromuscular junctions, low cellularity, and slow extracellular matrix (ECM) turnover restrict endogenous repair and predispose injured tendons to fibrosis, mechanical weakness, and reinjury. Current therapeutic strategies including rehabilitation protocols, anti-inflammatory medications, platelet-rich plasma (PRP) injections, and surgical repair primarily address symptoms or structural deficits without correcting the underlying biological limitations of tendon healing. Cell-based therapies have emerged as a promising regenerative approach aimed at restoring tissue homeostasis through modulation of angiogenesis, collagen synthesis, immune responses, and tenogenic differentiation. Mesenchymal stem cells (MSCs), adipose-derived stem cells (ADSCs), tendon-derived stem cells (TDSCs), induced pluripotent stem cells (iPSCs), differentiated tenocytes, and extracellular vesicle (EV)-based products have demonstrated the ability to enhance vascularization, promote type I collagen remodeling, suppress excessive inflammation, and stimulate tenocyte lineage commitment. These effects are mediated through paracrine signaling, growth factor secretion, and activation of key pathways, including HIF-1α, TGF-β/SMAD, NF-κB, and PI3K/Akt signaling. Despite promising preclinical data, significant translational challenges remain, including limited cell survival at the injury site, variability in cell sources and dosing, immunogenicity, risk of misdifferentiation, and lack of standardization across clinical protocols. Emerging strategies such as genetic modification, hypoxic preconditioning, scaffold-based delivery systems, and extracellular vesicle engineering aim to enhance therapeutic efficacy and reproducibility. This review synthesizes current evidence on cell-based tendon repair, critically evaluates mechanistic insights, clinical trials, and translational barriers, and outlines future directions toward biologically informed regenerative therapies. Full article

Context: Different studies on football players with fifth metatarsal stress fractures have found that hip internal rotation (HIR)range of motion is significantly reduced, while lateral forefoot pressure is significantly increased; therefore, the purpose of this study was to determine whether HIR range of motion is related to lateral plantar pressure. Methods: The study included 120 college students (60 males and 60 females). HIR was measured using a smartphone inclinometer app in the prone position and a compass app in the supine position. Plantar pressure was assessed using the Gaitview AFA-50 system during standing and walking. Correlation analysis was performed using SPSS 27.0. Results: Among all subjects, HIR activity in the prone position was significantly negatively correlated with standing second through fourth metatarsophalangeal joints(MTPJ2-4), fifth metatarsophalangeal joint (MTPJ5), and midfoot (FM)pressures and significantly positively correlated with standing first toe (T1)pressure. During walking, there is a significant negative correlation between HIR in the prone position and MTPJ2-4, MTPJ5, FM, and lateral heel (LH). Similarly, in the supine position, HIR is significantly negatively correlated with MTPJ2-4, MTPJ5, FM, medial heel (MH), and LH. Conclusion: There is a significant negative correlation between HIR and lateral plantar pressure, indicating that reduced HIR is associated with increased lateral plantar pressure. Improving HIR through targeted rehabilitation may reduce lateral plantar pressure, offering new approaches for non-surgical treatment of little toe capsulitis and reducing the risk of fifth metatarsal stress fractures. Full article

Background: Adolescent idiopathic scoliosis (AIS) affects approximately 0.5–5.2% of adolescents. Only a minority of curves progress, and surgery is generally reserved for curves exceeding 45–50°. Selection of the lowest instrumented vertebra (LIV) remains contested and directly influences postoperative coronal balance, distal adding-on (DA) and revision risk. Aim: This narrative review synthesizes the biomechanical principles governing LIV selection, compares traditional anatomical landmarks with contemporary prediction formulas and machine learning (ML) tools, and defines what these tools can and cannot currently deliver at the bedside. Methods: A structured but deliberately non-systematic search of PubMed/MEDLINE, EMBASE and the Cochrane Library (January 2000–December 2024) was supplemented by purposive inclusion of seminal pre-2000 work. No PRISMA-compliant screening, risk-of-bias appraisal or quantitative synthesis was undertaken, and the article is therefore reported as a narrative review. Results: Traditional landmarks—end, neutral, stable, last touched (LTV) and last substantially touched vertebra (LSTV)—are compared; fusion at or distal to the LTV/LSTV lowers DA incidence, yet 8–28% of patients still develop DA. Prediction formulas estimate the residual lumbar curve to within approximately 6°, but each was derived within a single surgical team and none nominates a vertebral level. A composite index combining (LIV− Neutral vertebra) and (LIV− Stable vertebra) reported sensitivity 100% and specificity 92–94% in its derivation cohort, without external validation. Hypercorrection of the main thoracic curve (>53%) combined with postoperative LIV tilt < 10° is associated with DA. Machine learning models predict three-dimensional alignment within 5–7°, yet every published model predicts an outcome; none has shown that acting on a model-derived recommendation prevents DA. Conclusions: LIV selection is best framed as a multidimensional judgment integrating coronal balance, vertebral body rotation, sagittal alignment, skeletal maturity, lumbopelvic morphology and non-radiographic factors such as paraspinal muscle quality, bracing and rehabilitation. Prediction models and artificial intelligence remain hypothesis-generating: external validation and prospective outcome trials are prerequisites before they can be considered practice-changing. Full article

This cross-sectional observational study with prospectively collected outcome data compared speech recognition in noise and patient-reported outcomes in adults with single-sided deafness (SSD) who had previously received either a Baha Connect or an Osia bone-conduction hearing implant. Thirty-five patients were invited, of whom 32 had complete data available for analysis (questionnaires alone: n = 34). Speech-in-noise performance was assessed using the Digits-in-Noise test and expressed as the speech reception threshold at 50% intelligibility (SNR50) in frontal and side presentation conditions. Subjective hearing benefit and hearing-related quality of life were evaluated using the Glasgow Benefit Inventory, the Abbreviated Profile of Hearing Aid Benefit, and the Speech, Spatial and Qualities of Hearing Scale. No significant differences were observed between Baha Connect and Osia users in aided SNR50 thresholds or in any patient-reported outcome measure. A linear mixed-effects model showed a significant interaction between listening condition and presentation side (p = 0.023), indicating that speech-in-noise benefit depended on the spatial listening configuration rather than on device type. Both groups reported positive subjective outcomes, although spatial hearing remained the lowest-rated domain. Correlations between SNR50 improvement and questionnaire scores were weak and non-significant (Spearman’s ρ < 0.20; p > 0.29), suggesting that objective speech-in-noise improvement and perceived benefit capture partly different aspects of hearing rehabilitation. Baha Connect and Osia provided comparable objective and subjective outcomes in adults with SSD. Therefore, device selection should not be based solely on expected speech-in-noise performance, but should be guided by patient-specific surgical, practical and lifestyle factors. Full article

Perioperative management of antirheumatic medications in adults with rheumatoid arthritis (RA) undergoing orthopedic surgery requires balancing postoperative infection and impaired wound healing against disease flare, pain, and delayed rehabilitation. This systematic review aimed to evaluate how perioperative continuation, withholding, interruption timing, restart timing, dose modification, or exposure to antirheumatic medications relates to postoperative outcomes in adults with RA undergoing arthroplasty and non-arthroplasty orthopedic procedures. PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were searched from database inception to 18 April 2026 for English-language full-text clinical studies. The primary outcomes were surgical site infection/periprosthetic joint infection, delayed wound healing, and postoperative RA flare. Secondary outcomes included reoperation, revision, readmission, mortality, venous thromboembolism, dislocation, and other procedure-specific complications. Original studies were classified as direct perioperative strategy evidence, medication-exposure evidence, or supportive clinical-context evidence. Forty-three original clinical studies were included, together with six non-original contextual sources. The evidence was predominantly observational, clinically heterogeneous, and of very low certainty. Methotrexate continuation was not associated with an evident increase in early postoperative complications, whereas direct evidence for other conventional synthetic agents was limited. Longer interruption of biologic or targeted synthetic therapy did not consistently reduce infection or wound-healing complications, while several studies associated treatment interruption with postoperative flare. Chronic baseline glucocorticoid exposure was associated with adverse outcomes but was clinically distinct from short-term perioperative administration; stress-dose supplementation was not directly evaluated. Medication decisions should therefore be individualized according to drug class, disease control, glucocorticoid burden, surgical procedure, and patient risk profile. Full article

Background and Objectives: Advances in medical, surgical, and acute burn care have shifted burn care from survival alone to survivorship; such improvement can be accompanied by extensive morbidity and disability in chronicity not previously encountered. The epidemiological characteristics of patients treated at a burn rehabilitation center, in the context of evolving social and occupational environments, may provide insights into current trends and their clinical implications. Notably, updated epidemiological data reflecting these changes in burn injury patterns remain scarce worldwide. To date, no epidemiological data from a burn rehabilitation center have been reported in Taiwan. Therefore, this study aimed to bridge this gap by providing a recent epidemiological review from the perspective of a burn rehabilitation center. Materials and Methods: This is a single-center, retrospective cross-sectional study enrolling patients who sustained burn injuries between January 2016 and December 2023. Data were collected from medical records and analyzed using SPSS version 20.0. Results: A total of 143 patients were recruited, of whom 101 were male (70.6%). The mean age was 38.51 years (SD = 20.28), and the mean total body surface area (TBSA) burned was 20.83% (SD = 18.77). Flame burns were the most common etiology, accounting for 67 cases (46.9%). Among the 143 patients, 73 (51.0%) sustained work-related burns, which were associated with a higher incidence of eye involvement compared with non-work-related burns (28.8% vs. 14.3%, p = 0.036). The upper extremity was the most frequently involved anatomical site, affecting 98 patients (68.5%). Conclusions: The present findings highlight an underrecognized need for stronger safety measures that address both personal and environmental risk factors. Risk-reduction strategies should particularly account for the aging workforce and vulnerable anatomical sites to mitigate preventable human and economic losses. Full article

Coital urinary incontinence is a frequently underdiagnosed manifestation of female pelvic floor dysfunction, characterized by involuntary urine leakage during sexual activity, particularly during vaginal penetration or orgasm. Although interest in this condition has increased in recent years, it remains insufficiently investigated in clinical practice and is often underreported by patients because of stigma, emotional distress, and the negative impact on intimate relationships and quality of life. Current evidence supports the existence of distinct pathophysiological mechanisms depending on the timing of urinary leakage. Leakage occurring during vaginal penetration is more commonly associated with stress urinary incontinence, urethral hypermobility, and pelvic support defects, whereas orgasm-associated urinary incontinence appears to be more closely related to detrusor overactivity and complex pelvic neurophysiological mechanisms. Hormonal changes associated with the peri- and postmenopausal period may further contribute to symptom progression through alterations in urethral and vaginal trophicity, local vascularization, and pelvic neuromuscular function. Clinical evaluation remains challenging because many affected women do not voluntarily report symptoms due to embarrassment or social stigma, therefore it requires targeted questioning regarding urinary leakage during sexual activity, associated lower urinary tract symptoms, and the impact on female sexual health. Therapeutic management should be individualized and tailored to the predominant underlying mechanisms, including pelvic floor rehabilitation, behavioral interventions, pharmacological treatment, local hormonal therapy, and surgical management of stress urinary incontinence or pelvic support defects. Minimally invasive and regenerative therapies, such as vaginal laser therapy, platelet-rich plasma, cellular therapies, and neuromodulation, represent promising therapeutic approaches. Greater awareness and proactive screening during urogynecological evaluation are essential for improving diagnosis, individualized treatment, sexual health, and overall quality of life in affected women. Full article

Haptic technology restores the sense of touch to robotic systems and has become increasingly important for safe and intuitive human–robot interaction in healthcare. Despite substantial advances over the past two decades, widespread clinical adoption remains limited, highlighting a persistent gap between laboratory research and real-world medical deployment. This review synthesizes research from robotics, human–computer interaction, neuroscience, and clinical medicine based on a systematic literature search conducted in IEEE Xplore, PubMed, and Scopus (2000–2025). The review adopts an information-centric perspective, focusing on the clinically relevant information conveyed through haptic feedback rather than force reproduction alone. The review examines tactile, kinesthetic, and hybrid feedback modalities; summarizes key principles of haptic rendering, stability, and control; and evaluates applications in surgical robotics, teleoperation, rehabilitation, prosthetics, and medical training. Evidence indicates that haptic feedback can improve performance, reduce excessive forces, and enhance situational awareness, although benefits remain task-dependent. Clinical translation continues to be constrained by sensing limitations, miniaturization challenges, stability requirements, human factors, and regulatory considerations. Current research is increasingly directed toward sensorless force estimation, artificial intelligence-assisted haptic rendering, wearable and soft haptic interfaces, and neurohaptic technologies, reflecting a shift toward task-oriented and information-centric feedback. Future progress will depend less on maximizing physical realism and more on delivering clinically meaningful information through stable, interpretable, and user-centered haptic systems. This review provides a roadmap for advancing clinically deployable haptic technologies in healthcare. Full article