Search Results (2,093)

Background and Objectives: Parkinson’s disease (PD) is a progressive neurodegenerative disorder in which gait and balance disturbances substantially increase the risk of falls and loss of independence. Pharmacological treatment alleviates several motor symptoms but has limited effects on postural instability. Backward walking (BW), a demanding locomotor task, has recently been investigated as both an assessment tool and a rehabilitation strategy in PD. The purpose of this focused systematic review is to analyse the benefits and limitations of retro walking in relation to the gait parameters and balance control of PD patients. Materials and Methods: A structured literature search (2015–2025) was conducted across multiple databases in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Eligibility criteria, screening procedures, and qualitative synthesis methods were predefined. Nine studies (including two randomized controlled trials) met the inclusion criteria. Methodological quality was assessed using PEDro and ROBINS-I tools, and the certainty of evidence was evaluated using GRADE. Results: The research results indicate within-group improvements in balance and gait parameters following BW training. Some of the included studies also suggest that BW may be a sensitive marker of balance deficits and fall risk. However, the evidence is limited by small sample sizes, heterogeneity of interventions, and a predominance of non-randomized designs. Conclusions: Current evidence regarding BW in PD remains preliminary. While BW may be considered as a supplementary component of rehabilitation, its specific efficacy cannot be clearly distinguished from general exercise effects. Further high-quality randomized controlled trials with standardized protocols and long-term follow-up are required. Full article

Artificial intelligence (AI) tools are increasingly integrated into mathematics education, yet most reviews emphasize achievement rather than how AI shapes mathematical thinking. This scoping review mapped literature published between 2020 and 2026 on AI-supported mathematics learning through three cognition frameworks: APOS (Action–Process–Object–Schema), Sfard’s process–object duality and reification, and Conceptual Image theory. Searches were conducted in Scopus, Web of Science, ERIC, PsycINFO, Education Source, and IEEE Xplore, followed by duplicate removal and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR)-aligned screening. Twenty-one peer-reviewed studies met inclusion criteria (18 empirical studies plus three theoretically oriented studies). Evidence growth accelerated after 2022, with most studies situated in secondary and higher education. Large language models (LLMs) and Intelligent Tutoring Systems (ITS) were the most frequently investigated modalities. Across studies, AI commonly supported theoretically inferred action-level execution and procedural management (APOS) via adaptive feedback, hinting, and stepwise scaffolding, and it often broadened learners’ conceptual images through multiple representations and generated explanations. However, these interpretations were necessarily cautious, because very few studies directly operationalized theory-linked conceptual mechanisms such as process internalization, object encapsulation, reification, or alignment between conceptual images and formal definitions. In LLM-supported contexts, gains in explanation quality coexisted with risks of procedural outsourcing when students relied on generated solutions without prior reasoning. By contrast, ITS-based environments more often supported tightly structured procedural engagement, suggesting that different AI modalities afford different forms of cognitive support and risk. Overall, AI’s conceptual impact appears to depend less on tool availability and more on instructional orchestration (task design, prompting, and teacher mediation). The findings also suggest that sustainability-related dimensions—particularly learner agency, transparency of AI support, and equitable participation—are closely connected to whether AI use promotes durable conceptual learning rather than superficial performance gains. Future research should operationalize cognitive transitions, assess structural understanding, and report AI-use conditions transparently to support cumulative, theory-driven synthesis. Full article

Background: Three-dimensional (3D)-printed vertebral body replacement (VBR) and artificial vertebral body (AVB) implants are increasingly used for anterior column reconstruction after spinal tumor resection. However, the available evidence on complications remains limited, heterogeneous, and methodologically inconsistent. This systematic review aimed to synthesize reported complications, revision patterns, and mechanical outcomes of 3D-printed VBR/AVB implants in spinal oncology and to critically appraise the quality of the available clinical literature. Methods: This systematic review was conducted in accordance with PRISMA 2020. PubMed/MEDLINE, Embase, and the Cochrane Library were searched from 1 January 1980 to 26 February 2026. Eligible studies included clinical series and cohort studies reporting extractable complication and/or revision data in patients who underwent spinal tumor resection followed by reconstruction with a 3D-printed VBR/AVB implant. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Case Series. Due to substantial clinical and methodological heterogeneity, a structured narrative synthesis was performed. Results: Eleven studies comprising 217 analyzable 3D-printed reconstructions were included. Most were retrospective single-center series and showed marked heterogeneity in tumor histology, spinal level, implant strategy, follow-up duration, and complication definitions. Because adverse-event reporting was inconsistent across studies, no pooled overall complication rate was calculated. Reported perioperative non-mechanical complications included neurological deterioration, cerebrospinal fluid- or dural-related events, wound infection, pleural effusion, pneumonia, and vascular injury. Mechanical implant failure appeared relatively uncommon, although radiographic subsidence was variably defined and inconsistently reported. Implant mismatch and hardware-related problems were infrequent but clinically relevant, particularly with prefabricated or off-the-shelf devices. Revision procedures were most commonly associated with wound complications, clinically significant subsidence, hardware failure, or tumor recurrence. Overall study quality was limited by retrospective designs, small sample sizes, and non-standardized outcome reporting. Conclusions: Current evidence suggests that 3D-printed VBR/AVB implants are a feasible option with encouraging mechanical performance for spinal reconstruction after tumor resection. Most reported adverse events appear to reflect the complexity of oncologic spine surgery rather than device-specific failure alone. However, the available evidence remains low level and heterogeneous. Larger multicenter comparative studies with standardized outcome definitions and longer follow-up are needed to better define the clinical value and durability of 3D-printed vertebral reconstruction in spinal oncology. Full article

Growing evidence indicates that myocardial infarction (MI) is the clinical manifestation of heterogeneous plaque substrates with distinct molecular, cellular, and biomechanical mechanisms. Acute coronary thrombosis (ACT) most commonly arises from plaque rupture (PR), plaque erosion (PE), and calcified nodules (CNs), each associated with different inflammatory profiles, thrombus composition, clinical presentation, and prognosis. This comprehensive review provides a clinician-oriented synthesis of the pathophysiological mechanisms underlying these three principal plaque phenotypes and discusses their implications for the contemporary management of acute coronary syndromes (ACS). We examine the molecular and cellular determinants of plaque instability and highlight how systemic factors such as plaque burden, impaired healing responses, and myocardial jeopardy modulate clinical risk. The role of intracoronary and non-invasive imaging is discussed primarily as a tool to elucidate plaque biology with direct clinical relevance rather than merely as a procedural guide. Building on these insights, we propose a conceptual framework for integrating plaque biology into clinical decision-making across the acute phase, secondary prevention, and long-term follow-up. In particular, recognizing the biological heterogeneity of plaque substrates may support more personalized therapeutic strategies, enabling clinicians to tailor pharmacological and interventional approaches according to the underlying plaque phenotype and patient-specific risk profile. Finally, we briefly address emerging perspectives, including the potential role of artificial intelligence (AI) in refining plaque characterization, risk stratification, and precision cardiovascular prevention. Overall, recognition of PR, PE, and CNs as biologically distinct entities supports a shift toward mechanism-informed and personalized management of MI, aligning advances in plaque biology with the principles of precision cardiovascular medicine. Full article

Alpha-ketoglutarate (aKG) is a central intermediate of cerebral energy metabolism and a precursor for glutamate synthesis in the brain. Alterations in aKG metabolism occur in pathological contexts, including isocitrate dehydrogenase (IDH) mutant astrocytomas and oligodendrogliomas, in which mutant IDH converts aKG to the oncometabolite 2-hydroxyglutarate. Given its central role in brain metabolism, non-invasive interrogation of aKG-dependent metabolic flux is needed. Hyperpolarized (HP) ¹³C MR enables real-time visualization of metabolic conversion by transiently enhancing signal intensity by several orders of magnitude. Leveraging this approach, we report the first-in-human feasibility and safety study of HP [1-¹³C]aKG MR spectroscopy in the healthy brain (n = 3). A standard operating procedure (SOP) was developed for sterile [1-¹³C]aKG dose production, achieving reproducible polarization levels averaging 30.5 ± 2.2%. Following intravenous administration, time-resolved ¹³C spectra in healthy volunteers demonstrated the detection of HP aKG resonance and a measurable downstream glutamate signal, consistent across repeat acquisitions, with a delayed temporal profile relative to aKG observed in a representative dataset. Although performed in healthy volunteers, these results establish feasibility for HP [1-¹³C]aKG metabolic imaging to open a new window into normal and pathological brain cellular metabolism. Full article

Background: Medial-compartment knee osteoarthritis (KOA) carries substantial disability and long-term cost. High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are key joint-preserving or joint-replacing options for selected patients, but their comparative economic ranking remains uncertain. Methods: This critical narrative review synthesized comparative economic evidence on HTO versus UKA for isolated medial-compartment KOA. PubMed and Web of Science were searched as primary sources for English-language studies published from 1 January 2000 to 15 January 2026, while Google Scholar and citation tracking were used supplementarily to identify potentially missed records. Eligible studies were direct economic evaluations or comparative cost/resource studies with clear decision relevance to the HTO–UKA choice. Burden and cost-of-illness studies were used for contextual framing only and were not included in the core comparative synthesis. Results: The direct evidence base was small and methodologically heterogeneous and was dominated by decision-analytic models that differed in perspective, time horizon, utility metric, and assumptions regarding reoperation, revision, and conversion to total knee arthroplasty (TKA). These structural differences largely explain why a U.S. lifetime societal model favored HTO, a UK age-stratified 10-year model produced age-dependent findings, and a recent Canadian public-payer model favored UKA. Observational studies suggest that UKA episode costs can fall substantially in outpatient or ambulatory pathways, whereas HTO costs may rise when reoperations and technique-specific resource use are explicitly captured. Conclusions: Current evidence does not support a context-free economic ranking of HTO and UKA. Because the available studies are heterogeneous and incremental utility differences are often small, the findings should be interpreted cautiously and as scenario-dependent rather than definitive. Future comparative analyses should use contemporary pathway data, transparent and standardized costing, and explicit downstream event definitions for both procedures. Full article

Aluminum chloride (AlCl₃)-induced rat models are widely used to investigate Alzheimer-like neurodegeneration, yet substantial methodological variability limits cross-study comparability. A structured synthesis focused specifically on the methodological architecture of these models, including dose, exposure duration, route of administration, and behavioral assessment, remains lacking. This review aimed to synthesize the behavioral paradigms used to assess learning and memory in rat models of aluminum chloride-induced Alzheimer’s disease, with particular emphasis on dose, duration, and route of administration. A structured narrative review incorporating systematic elements was conducted following PRISMA-informed procedures using PubMed, Web of Science, and Scopus. The reviewed literature showed a predominance of oral administration, low-to-moderate AlCl₃ doses and subchronic exposure durations, most commonly 31–60 days. Behavioral assessment was dominated by hippocampal-dependent paradigms, particularly the Morris water maze and Y-maze. Across studies, AlCl₃ exposure was associated with multidomain behavioral impairment accompanied by consistent hippocampal and cortical histopathological abnormalities and convergent biochemical and molecular changes, including cholinergic dysfunction, oxidative stress, neuroinflammation, and amyloid- and tau-related alterations. Overall, the available literature does not support a standardized experimental protocol or a clear overall dose–effect or duration–effect relationship. Greater harmonization of study design is needed to improve reproducibility and translational relevance. Full article

Objectives: The aim of this systematic review was to evaluate whether artificial intelligence systems improve the diagnosis and localization assessment of impacted canines in radiological imaging. Methods: A systematic literature search was conducted across four electronic databases (MEDLINE/PubMed, Scopus, Embase, and Web of Science) for studies published after 2020, with no language restrictions. Eligible studies were comparative studies involving human subjects that evaluated AI-based systems against experienced clinicians or accepted radiological reference standards for the detection and localization of impacted canines. The risk of bias and applicability were assessed using the adapted QUADAS-3 tool. The review protocol was prospectively registered in PROSPERO (CRD42023487320). Results: The search strategy identified 110 records. After the removal of 41 duplicates, 69 articles were screened by title and abstract. Seventeen studies underwent full-text evaluation, and eight studies met the inclusion criteria and were included in the qualitative synthesis. Across the included studies, the overall risk of bias was considered high, primarily due to retrospective study design and limitations in reporting of methodological procedures. Conclusions: The available evidence does not provide high-quality studies addressing the studied issue. AI appears to yield more favorable results in CBCT analysis when compared to panoramic radiographs. However, this observation should be interpreted with caution, because the compared studies did not address the same clinical task, since these radiographs were taken in different clinical situations. Further well-designed studies with standardized datasets and external validation are required to better define the potential of artificial intelligence in orthodontic radiological diagnostics. Full article

In a complete kinematic synthesis process, a designer must select a planar linkage topology that is well suited to their problem situation. This involves weighing a set of competing priorities. For example, is it better to choose a simple topology like a four-bar mechanism that will be cheaper to produce, or a complex topology like an eight-bar mechanism that can produce intricate motions but will also be more expensive and more difficult to synthesize? The process of selecting the topology is broadly known as type synthesis, or sometimes structure synthesis, and has been studied in the past. However, past works on planar linkage type synthesis have overemphasized isomorphism detection, identifying the complete set of unique topologies up to a certain number of links, while the central problem of choosing the ideal topology has often been overlooked. In this work, a general procedure for forming basic kinematic chains (BKCs), a simplified topological representation, is presented. Then, a set of rules and design principles is provided that can help a designer narrow the infinite possible BKC options down to a manageable set. A few practical examples are provided to demonstrate the concepts and show that the procedure is effective. A literature review is also provided that examines past works, as well as introducing alternative approaches, such as simultaneous algorithmic methods and spatial methods. Full article

Herein, starting from (R)-(+)-α-methylbenzylamine, we report an efficient synthesis and full characterization of a new (R)-3-(1-hydroxyethylidene)-1-(1-phenylethyl)piperidine-2,4-dione, a new tetramic acid analog. The key steps involved a non-classical Corey–Chaykovsky intramolecular cyclization reaction to access the corresponding zwitterion, followed by a sequential desulfurization/reduction and condensation procedure. The titled product was obtained in five steps, and the desired product 7 with an overall 58% yield. Full article

Existing methods for selecting the number of teeth in complex planetary gear systems are often methodologically demanding. They do not always ensure all conditions required for proper operation and assembly. This paper presents an analytical methodology for determining gear tooth numbers. The method is demonstrated on a Ravigneaux planetary gear set with seven kinematic links and two degrees of freedom. It ensures the simultaneous satisfaction of all meshing and assembly conditions. Starting from the known transmission ratios, the number of teeth of one central gear, and the selected angular displacement of the outer planet gear, analytical relationships are derived. These allow the determination of the tooth numbers of all remaining gear elements. The procedure is implemented in Python 3.13. This enables a systematic evaluation of predefined input ranges and an automatic verification of geometric constraints, including interference and undercutting conditions. The proposed method yields six feasible configurations. Compared with the Borg-Warner M85 automatic transmission, deviations in individual gear ratios reach up to 10%. Significantly lower tooth numbers are achieved for several gears. These results suggest that the proposed methodology can achieve comparable kinematic performance while offering more compact gear designs and a potential weight reduction. The developed model also provides a basis for extension to more complex configurations and integration with optimisation and dynamic criteria in planetary gear synthesis. Full article

Virtual Reality (VR) has emerged as a non-pharmacological intervention for managing pain and anxiety during medical procedures. This study presents a systematic review with complementary bibliometric analysis of the scientific literature on the clinical effectiveness of VR in healthcare settings. A structured search was conducted across five databases (Web of Science (WoS), Scopus, PubMed, EMBASE, and MEDLINE), identifying 627 records, of which 26 studies met the inclusion criteria. Data were extracted on study design, population, type of intervention, and clinical outcomes related to pain and anxiety. Most included studies reported reductions in perceived pain and/or anxiety when VR was used as an adjunctive intervention, particularly in pediatric and procedural contexts. However, findings were heterogeneous in terms of study design, VR modalities, and outcome measures, limiting quantitative synthesis. The bibliometric analysis indicates growing research interest, with a strong focus on clinical outcomes, while evidence related to implementation and healthcare system integration remains limited. Overall, VR appears to be a promising complementary tool for improving patient experience during medical procedures. However, further high-quality studies with standardized methodologies are needed to establish its effectiveness and facilitate future meta-analyses. Full article

Emotion dysregulation and altered interoceptive processing are increasingly recognized as core processes in eating disorder (ED) psychopathology. Difficulties in identifying, tolerating, and regulating negative emotional states may interact with reduced trust in bodily signals and distorted interpretation of hunger and satiety cues, contributing to maladaptive eating behaviors. The aim of this PRISMA-guided qualitative systematic review was to synthesize original empirical evidence on the interaction between emotion dysregulation and interoceptive processing in EDs, with particular attention to how emotional distress may be misinterpreted as physical hunger or food-related urges. A systematic search of PubMed and Scopus identified 78 records; after removal of duplicates and screening procedures, 24 original empirical studies were included in the qualitative synthesis. Across ED presentations, emotion dysregulation consistently emerged as a central transdiagnostic process associated with symptom severity, impulsivity, maladaptive eating behaviors, and related risk outcomes. Interoceptive alterations were widely reported, particularly involving reduced body trust and distorted interpretation of internal sensations rather than a uniform deficit in interoceptive sensitivity. The reviewed studies also showed that emotional states and cognitive expectations may shape the appraisal of hunger and satiety cues, contributing to the misinterpretation of emotional distress as physiological need across restrictive, binge-purge, and binge-eating presentations. The findings support a close interplay between emotion dysregulation and altered interoceptive processing in EDs and highlight the clinical relevance of interventions that integrate emotion regulation and interoceptive awareness to promote more adaptive eating behaviors. Full article

The widespread presence of ciprofloxacin (CIP) in aquatic environments threatens ecological and public health, yet conventional treatment processes fail to remove such persistent contaminants. Conventional solvothermal synthesis of Bi-doped g-C₃N₄ photocatalysts involves complicated procedures and low productivity. Herein, we employ a single-step, template-free and solvent-free green calcination method to construct Bi³⁺-modified g-C₃N₄ with strong Bi-N coordination interactions. A series of Bi/g-C₃N₄ photocatalysts with Bi-doping mass ratios of 0.09–0.34 wt% was prepared, and the structure–performance relationship as well as the surface–interface reaction mechanism for ciprofloxacin (CIP) degradation were systematically elucidated. Experimental results confirm that Bi³⁺ incorporates into the lattice via Bi-N coordination bonds with nitrogen in the g-C₃N₄ framework, which narrows the band gap, suppresses photogenerated carrier recombination, and constructs a loose porous morphology beneficial for increasing specific surface area and active sites. Under optimal conditions, 15Bi/g-C₃N₄ achieves 97.6% degradation of 15 mg L⁻¹ CIP within 90 min, which is 13.7% higher than that of pristine g-C₃N₄. The effects of catalyst dosage, initial pH, CIP concentration, common coexisting ions, and different real water matrices on the degradation performance were systematically investigated. Radical quenching experiments combined with ESR characterization confirm that h⁺ is the dominant reactive species responsible for CIP degradation. This green, simple and scalable method yields uniform products, and the resulting materials exhibit high efficiency, economic feasibility and environmental safety, demonstrating promising potential for antibiotic wastewater treatment. Full article

Background/Objectives: The optimal management of anterior cruciate ligament (ACL) rupture remains debated, especially regarding long-term outcomes after early ACL reconstruction (ACLR) versus rehabilitation-first with optional delayed ACLR. The interpretation of randomized evidence is complicated by frequent treatment crossover. This review synthesized evidence from randomized controlled trial (RCT) cohorts comparing surgical versus rehabilitation-first management strategies across available follow-up durations. Methods: A structured review based on a systematic literature search and narrative synthesis was conducted, with study identification and reporting guided by PRISMA 2020. MEDLINE (via PubMed) and Google Scholar were searched in February 2026 for English-language human RCTs (2000–2026) comparing early ACLR plus rehabilitation with rehabilitation-first management allowing delayed ACLR for persistent instability. A linked-report PubMed search using the KANON trial registration number (ISRCTN84752559) was additionally performed to identify cohort-derived follow-up publications. Reports were grouped by underlying RCT cohort. Data were extracted on crossover, follow-up, and clinical outcomes. Risk of bias for primary RCT reports was assessed with Cochrane RoB 2. Results: Twenty-seven reports representing three RCT cohorts (KANON, COMPARE, ACL SNNAP) were included; six index reports were prioritized for synthesis. In acute ACL rupture (KANON, COMPARE), early ACLR did not show a consistent long-term superiority in patient-reported outcomes versus rehabilitation-first with optional delayed ACLR, although COMPARE reported a statistically significant 2-year subjective functional difference favoring early ACLR; early ACLR more consistently improved mechanical stability and reduced instability episodes. Crossover from rehabilitation to delayed ACLR was common. In non-acute ACL injury with persistent symptomatic instability (ACL SNNAP), surgery-first improved 18-month patient-reported outcomes. Meniscal procedure rates and osteoarthritis-related outcomes did not consistently favor early ACLR. Conclusions: In acute ACL rupture, rehabilitation-first with timely access to delayed ACLR appears to provide long-term patient-reported outcomes comparable to an early ACLR strategy in many patients, while early ACLR more consistently improves knee stability. In non-acute symptomatic ACL deficiency, a surgery-first strategy appears more effective in the mid-term. These randomized trials should be interpreted as comparisons of management strategies rather than of “pure” operative versus nonoperative treatment approaches. Full article