Search Results (4,368)

Diabetic retinopathy (DR) is a progressive retinal disorder and a leading cause of vision impairment worldwide affecting the livelihood of millions. Its pathogenesis is driven by chronic hyperglycemia-induced neuronal and microvascular injury, leading to capillary occlusion, increased vascular permeability, and the eventual formation of fragile neo vessels. These changes mark the progression from non-proliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR). Diabetic macular edema (DME), characterized by blood–retinal barrier disruption and macular fluid accumulation, further contributes to vision loss. This review provides an integrative perspective on the cellular and molecular mechanisms of DR, highlighting both vascular and neuroglial contributions to retinal pathology. Current therapeutic approaches, including anti-VEGF agents and corticosteroids, offer symptomatic relief but are limited by the need for repeated administration and variability in patient response. Emerging evidence implicates the role of thioredoxin-interacting protein (TXNIP) as one of mediators of the disease progression. Strongly upregulated under hyperglycaemic stress, TXNIP induces oxidative damage, inflammation, and neuronal apoptosis, exacerbating neurovascular dysfunction. We explore potential therapeutic strategies such as gene therapy, TXNIP-targeted molecular interventions, and stem cell-based approaches aimed at achieving long-term modulation of disease mechanisms. This article thus attempts to address a comprehensive understanding of DR pathophysiology and innovative new strategies to improve long-term visual outcomes. Full article

Background/Objective: The quality of care afforded to rural, remote, and First Nations Peoples is dependent on access to a health workforce with the capacity to contextualize healthcare and practice to the needs and expectations of these populations. In Australia, the lack of representation of rural health in undergraduate and post graduate health professional education undermines this preparedness and consideration of rural practice uptake and longevity, compounding the inequities confronted by 7 million Australians residing in these locations. Urgent educational reforms are required to address this omission, the deficit discourses used to characterize rural healthcare, and the persistent health workforce shortages experienced. This paper presents the Anabranch Framework for the Ruralization of Health Professional Education, a high-level strategy to transform rural healthcare provision, professional practice, and health workforce outcomes. Methods: The framework was developed through an iterative process involving a series of systematic steps. The process included the following: individual and group critical dialogues with internal academic educators, external health service leaders, metropolitan academic allies, and leaders of other rural health academic departments; an internal review of empirical studies of relevance to the ruralization of health professional education and practice; the visualization of a place-based framework; the academic conceptualization of the framework; and further critical dialogues to test the framework’s face validity. Results: The Anabranch Framework comprises four inter-related rural domains: theories, pedagogies, practices, and connectivity; four constructs: knowledge acquisition and generation, immersion in rural curriculum, knowledge translation and sharing, and relational practice; and two structural elements: spiraled and scaffolded curriculum and duration and the quality of rural placement and practice. Conclusions: The Anabranch Framework is a high-level strategy to ruralize health professional worldviews, advance rural person-centered practice, enable a deeper understanding of rural places and the development of an equity-orientated, sustainable and rural-literate health workforce. Full article

Background/Objectives: Knee osteoarthritis (KOA) is associated with pain, functional decline, and altered biomechanics. The Step-Up and Down-Forwards (StUD-F) task provides an ecologically relevant assessment of challenging movements. This study investigated neuromuscular activation and lower-limb kinematics of leading and trailing-limbs during the StUD-F in individuals with KOA. Methods: Forty participants with KOA (65.3 ± 7.68 years; 21M/19F; BMI 28.9 ± 4.52 kg/m²) completed a 25 cm box StUD-F task. Surface electromyograph recorded bilateral activation of the vastus medialis (VM), vastus lateralis (VL), bicep femoris (BF), and semitendinosus (ST). Triplanar hip, knee, and ankle joint angles were estimated using inertial measurement units. StUD-F events (initial stance; step contact; ascent completion; descent preparation; step-down touchdown; and descent completion) were identified using custom algorithms. Pain was assessed using visual analogue scales and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Limb differences were analysed for leading or trailing roles using paired samples t-tests or non-parametric equivalents; waveforms were visually inspected. Results: Distinct neuromuscular and kinematic asymmetries were observed when affected and contralateral limbs were compared within each role (leading/trailing). During step-up, the affected leading limb demonstrated higher quadriceps activation at initial stance (VM: p = 0.035; VL: p = 0.027) and reduced trailing-limb activation at step contact (VM: p = 0.015; VL: p = 0.018), with sagittal-plane ankle differences (p = 0.004). During step-down, when the affected limb initiated ascent, trailing limb activation was higher at descent completion (VL: p < 0.001; VM: p = 0.003; BF: p = 0.009), with coronal-plane hip deviations (p < 0.001). When the contralateral limb-initiated ascent, trailing-limb muscles activation differences (VM: p < 0.001; VL: p = 0.015; BF: p = 0.007) and ankle/coronal-plane asymmetries (p ≤ 0.049) persisted. Conclusions: The StUD-F task elicits altered strategies in KOA, including elevated quadriceps–hamstring co-activation and altered sagittal/coronal alignment, and habitual limb choice across ascent and descent. These adaptations may enhance stability and joint protection but could increase medial compartment loading. The findings support rehabilitation focused on dynamic control, alignment, and shock absorption. Full article

Background/Objectives: Transcranial direct current stimulation (tDCS) is increasingly used by athletes, yet sport-performance-enhancement findings are mixed and often small, with outcomes depending on stimulation target, timing, and task demands. Aim: This scoping review mapped and synthesized the soccer-specific trial evidence to identify (i) which tDCS targets and application schedules have been tested in soccer players, (ii) which soccer-relevant outcomes show the most consistent immediate (minutes–hours) or training-mediated benefits, and (iii) where evidence gaps persist. Methods: We conducted a scoping review of clinical trials in footballers, following review best-practice guidance (PRISMA-informed) and a preregistered protocol. Searches (August 2025) spanned PubMed/MEDLINE, ResearchGate, Google Scholar, and Cochrane, using combinations of “football/soccer” and “tDCS/transcranial direct current stimulation,” with inclusion restricted to trials from 2008–2025. Dual independent screening was applied. Of 47 records identified, 21 studies met the criteria. Across these, the total N was 593 (predominantly male adolescents/young adults; wide range of levels). Results: Prefrontal protocols—most commonly left-dominant dorsolateral prefrontal cortex (DLPFC) (+F3/−F4, ~2 mA, ~20 min)—most consistently improved post-match recovery status/well-being (e.g., fatigue, sleep quality, muscle soreness, stress, mood), and when repeated and/or paired with practice, shortened decision times and promoted more efficient visual search. Effects on classic executive tests were inconsistent, and bilateral anodal DLPFC under fatigue increased risk-tolerant choices. Motor-cortex targeting (C3/C4/Cz) rarely changed rapid force–power performance after a single session—e.g., multiple well-controlled trials found no immediate CMJ gains—but when paired with multi-week training (core/lumbar stability, plyometrics, HIIT, sling), it augmented strength, jump height, sprint/agility, aerobic capacity, and task-relevant EMG. Autonomic markers (exercise HR, early HR recovery) showed time-dependent normalization without specific tDCS effects in single-session, randomized designs. In contrast, a season-long applied program that added prefrontal stimulation to standard recovery reported significantly reduced creatine kinase. Across studies, protocols and masking were athlete-friendly and rigorous (~2 mA for ~20 min; robust sham/blinding), with only mild, transient sensations reported and no serious adverse events. Conclusions: In soccer players, tDCS shows a qualified pattern of benefits that follows a specificity model: prefrontal stimulation can support post-match recovery status/well-being and decision efficiency, while M1-centered stimulation is most effective when coupled with structured training to bias neuromuscular adaptation. Effects are generally modest and heterogeneous; practitioners should treat tDCS as an adjunct, not a stand-alone enhancer, and align montage × task × timing while monitoring individual responses. Full article

Background/Objectives: Adequate bowel preparation (BP) is crucial for effective colorectal cancer (CRC) surveillance in ulcerative colitis (UC). While active inflammation is known to negatively impact cleansing, data regarding predictors of BP quality specifically in UC patients with inactive disease remain limited. This study aimed to investigate risk factors for inadequate BP in UC patients in clinical/endoscopic remission and to compare the efficacy of 1L-PEG-ASC versus 2L-PEG regimens. Methods: A multicentric, retrospective, cohort study was conducted across eight Italian centers. Consecutive adult outpatients with UC undergoing colonoscopy between January-2021 and December-2022 who were in endoscopic and clinical remission were included. Boston Bowel Preparation Scale (BBPS) was assessed in patients undergoing 1L-PEG-ASC or 2L-PEG bowel preparation. Univariable and multivariable logistic regression analyses were performed to identify risk factors for inadequate BP and compare outcomes between PEG regimens. Results: A total of 379 patients were included (58% M, mean age 52.3 ± 15.4 years). The overall rate of adequate BP was 90.5%. Traditional risk factors, including demographic, clinical, and endoscopic characteristics, were not predictive of inadequate preparation in this remission cohort. Comparing regimens, 1L-PEG-ASC yielded significantly higher median total BBPS scores compared to 2L-PEG (8 [IQR 7–9] vs. 6 [IQR 6–8]; p < 0.001) and a higher exam completion rate (99.5% vs. 95.7%; p = 0.02), although the difference in adequate BP rates did not reach statistical significance (92.6% vs. 87.7%; p = 0.12). Multivariable analysis confirmed that 2L-PEG was independently associated with lower odds of achieving higher BBPS scores (OR 0.30; 95% CI 0.20–0.45). Conclusions: In UC patients with clinical and endoscopic remission, BP adequacy rates are high and comparable to the general population, suggesting that traditional IBD-related risk factors are less relevant in the absence of active inflammation. However, the 1L-PEG-ASC regimen demonstrated superior cleansing quality and exam completion rates compared to 2L-PEG. These findings support the prioritization of 1L-PEG-ASC to optimize mucosal visualization during CRC surveillance in this population. Full article

Anticoagulant pharmacology is a cognitively demanding domain in undergraduate medical education, with persistent challenges in learner engagement, retention, and safe clinical application. Cinematic Clinical Narratives (CCNs) offer a theory-informed multimedia approach designed to support learning through narrative structure, visual mnemonics, and affective engagement. We conducted a multi-site quasi-experimental study within a six-week Cancer, Hormones, and Blood course across a distributed medical education program. First-year medical students received either a traditional case-based lecture or an animated CCN (Twilight: Breaking Clots) during a one-hour anticoagulant pharmacology session. Learning outcomes were assessed using pre- and posttests, learner engagement was measured with the Situational Interest Survey for Multimedia (SIS-M), and exploratory eye tracking with second-year medical students was used to assess visual attention to embedded mnemonics. Both instructional groups demonstrated significant learning gains, with fold-change analyses indicating greater relative improvement among students exposed to the CCN. The animated CCN elicited significantly higher triggered situational interest compared with non-animated cases (p = 0.019), while also being preferred by the majority of participants. Qualitative analysis revealed that learners perceived CCNs as particularly effective for initial encoding and memorization, while non-animated cases supported subsequent clinical application. Eye-tracking data demonstrated high visual uptake and sustained attention to key mnemonic elements. Together, these findings support expert-designed, genAI-assisted CCNs as a validated and complementary instructional approach in medical education. Full article

Despite the increasing adoption of desktop virtual reality (VR) in higher education, the specific instructional efficacy of 3D interactive prompts remains inadequately understood. This study examines how such prompts—specifically dynamic spatial annotations and 3D animated demonstrations—influence learning outcomes within a desktop virtual learning environment (DVLE). Employing a quasi-experimental design integrated with eye-tracking and multimodal learning analytics, university students were assigned to either an experimental group (DVLE with 3D prompts) or a control group (basic DVLE) while completing physics tasks. Data collection encompassed eye-tracking metrics (fixation heatmaps, pupil diameter and dwell time), post-test performance (assessing knowledge comprehension and spatial problem-solving), and cognitive load ratings. Results indicated that the experimental group achieved significantly superior learning outcomes, particularly in spatial understanding and dynamic reasoning, alongside optimized visual attention patterns—characterized by shorter initial fixation latency and prolonged fixation on key 3D elements—and reduced cognitive load. Eye-tracking metrics were positively correlated with post-test scores, confirming that 3D prompts enhance learning by improving spatial attention guidance. These findings demonstrate that embedding 3D interactive prompts in DVLEs effectively directs visual attention, alleviates cognitive burden, and improves learning efficiency, offering valuable implications for the design of immersive educational settings. Full article

Background: Written educational materials are widely used in community pharmacies to support patient education, and available evidence suggests their effectiveness in improving short-term knowledge. However, there remains a need for well-documented, practice-oriented evaluations of pharmacist-developed materials in real-world community pharmacy settings. The aim of this study was to evaluate the immediate impact of a pharmacist-developed educational leaflet on women’s health knowledge and its perceived usefulness, clarity, and acceptability. Methods: This study evaluated pharmacist-developed educational leaflets addressing women’s health topics using a pre–post study design. The study was conducted in Poland and involved 266 adult women. All participants completed a five-question knowledge test before and immediately after reading the educational leaflet, followed by a self-assessment of perceived usefulness, clarity, and visual appeal. Descriptive statistics were performed to summarize the results. Results: A statistically significant increase in knowledge was observed after exposure to the educational material, with mean scores rising from 2.8 ± 1.2 to 4.6 ± 0.7 (out of 5, p < 0.001). The greatest improvements were noted in topics related to sexually transmitted infection self-testing and pregnancy testing. Most participants rated the leaflet as useful, comprehensible, attractive, and engaging, with higher ratings reported among younger and better-educated respondents. Conclusions: Pharmacist-developed educational leaflets can support short-term knowledge acquisition and are perceived positively by women across age groups. These findings highlight the potential role of community pharmacies in delivering accessible written health education, while underscoring the need for future studies to assess long-term knowledge retention, behavioral outcomes, and topic-specific, targeted materials. Full article

Background: The implantable miniature telescope is used to provide functional vision for patients with advanced AMD. However, despite the considerable cost of the device, there are strict criteria to be met for this procedure, since the patients require challenging neuroadaptation afterward, which sometimes fails and leads to the necessity of device explantation. Visual outcomes also depend on the stability of the microtelescope; tilts cause unwanted optical aberrations and can lead to device luxation, with sight-threatening complications. Case report: This case presents a novel technique for fixing the ophthalmic telescope device SING-IMT™. A 76-year-old female with pre-operative visual acuity of 15 letters on the ETDRS scale underwent surgery on her left eye. The superior haptic was fixed at the 12 o’clock position with a Prolene 5-0 suture, achieving good postoperative stability. The implant was stable throughout the entire observation period. Conclusions: Implant stability is crucial for maximizing visual potential in patients with advanced AMD selected for the procedure, since visual acuity in the peripheral retina, where the perceived image eventually lands, is much lower than the macula. Therefore, there is a need to standardize surgical approaches and use objective follow-up measures to assess long-term patient satisfaction. Full article

Table tennis has increasingly been adopted as a tool to promote physical and mental health, yet evidence on its outcomes and implementation remains scattered. This study conducted a rapid scoping review to summarise available research on the health outcomes of table tennis within recreational or non-elite settings and identify how table tennis-for-health activities are structured and delivered. Peer-reviewed articles in English were included when they focused the outcomes of table tennis participation on health in community or social settings. Searches across two multidisciplinary databases, complemented by reference screening, led to 17 studies published between 2010 and 2025 being included. Studies were then charted for their methodological, intervention and outcome characteristics. Most studies employed quantitative methods, with experimental or controlled designs predominating, and targeted children, adolescents, older adults, and individuals with conditions such as ADHD or Parkinson’s disease. Across various settings, table tennis was associated with improvements in physical fitness, balance, agility, and body composition, alongside cognitive benefits such as enhanced executive functioning and visual–perceptual skills. Psychological and social outcomes, including improved self-efficacy, emotional regulation, cooperation and social interaction, were also reported. Though no formal quality assessment was conducted, there are clear methodological limitations, including small sample sizes, geographic and gender imbalances, and limited reporting on intervention characteristics that restrict the strength and generalisability of the findings. Overall, this review provides a starting point for trainers and health professionals in the area, presenting promising but preliminary evidence for table tennis as a health-enhancing activity and highlighting the need for more rigorous and comprehensive evaluation. Full article

Navigation line extraction is essential for visual navigation in agricultural machinery, yet existing methods often perform poorly in complex environments due to challenges such as weed interference, broken crop rows, and leaf adhesion. To enhance the accuracy and robustness of crop row centerline identification, this study proposes an improved segmentation model based on SegNeXt with integrated adaptive region of interest (ROI) extraction for multi-growth-stage maize row perception. Improvements include constructing a Local module via pooling layers to refine contour features of seedling rows and enhance complementary information across feature maps. A multi-scale fusion attention (MFA) is also designed for adaptive weighted fusion during decoding, improving detail representation and generalization. Additionally, Focal Loss is introduced to mitigate background dominance and strengthen learning from sparse positive samples. An adaptive ROI extraction method was also developed to dynamically focus on navigable regions, thereby improving efficiency and localization accuracy. The outcomes revealed that the proposed model achieves a segmentation accuracy of 95.13% and an IoU of 93.86%. The experimental results show that the proposed algorithm achieves a processing speed of 27 frames per second (fps) on GPU and 16.8 fps on an embedded Jetson TX2 platform. This performance meets the real-time requirements for agricultural machinery operations. This study offers an efficient and reliable perception solution for vision-based navigation in maize fields. Full article

Background: Augmented reality (AR) and mixed reality (MR) promise to enhance anatomical understanding, spatial orientation, and workflow in cardiac surgery. Their clinical adoption remains limited and the translational path is incompletely defined. Methods: A PubMed search was conducted by two independent reviewers from database inception through July 2025 and identified peer-reviewed, English-language articles describing peri- or intra-operative AR/MR applications in cardiac surgery. Relevant clinical, preclinical, technical, and review articles were selected for inclusion based on scope and content. Given the narrative approach and heterogeneity across studies, findings were synthesized qualitatively into application domains. Results: Fourteen studies were included. Five domains emerged: (1) preoperative planning and patient-specific modelling—MR enhanced spatial orientation and planning for minimally invasive and valve procedures; (2) intraoperative navigation and visualization—AR improved targeting and interpretation with preclinical overlay errors ≈ 5 mm; (3) physiological/functional guidance—thermographic AR detected ischemia in vivo with strong correlation to invasive thermometry; (4) robotic integration and workflow optimization—AR-guided port placement and stepwise robotic adoption supported the feasibility of totally endoscopic CABG; (5) AR-based early rehabilitation. Conclusions: Early clinical and preclinical evidence supports AR/MR feasibility and utility for visualization and orientation in cardiac surgery. Priorities include deformable, motion-compensated registration, ergonomic integration with robotic platforms, and multicentre trials powered for operative efficiency and patient outcomes. Full article

Background: Minimally invasive glaucoma surgery, often performed with phacoemulsification (PHACO-MIGS), for the management of primary open angle glaucoma (POAG), has good clinical outcomes and safety profiles. However, few studies have comprehensively evaluated the impact of PHACO-MIGS on patients’ quality of life (QoL). We determined the post-operative effectiveness of PHACO-MIGS on glaucoma-specific QoL domains in mild–moderate POAG patients. Methods: In this prospective study, adults aged ≥ 21 years with mild–moderate POAG in one eye scheduled for PHACO-MIGS at the Singapore National Eye Centre were administered a digital patient-reported outcome measure (PROM) that utilizes computerized adaptive testing (CAT) to precisely estimate glaucoma-specific QoL across 12 different domains (GlauCAT^TM), pre-surgery and at 6 months post-surgery. The 12 domains included the following: Visual Symptoms (VSs), Ocular Comfort Symptoms (OSs), Emotional (EM), Activity Limitation (AL), Driving (DV), Lighting (LT), Mobility (MB), Treatment Convenience (TCV), Concerns (CNs), Social (SC), General Convenience (GCV), and Economic (EC). Clinical variables collected included intraocular pressure (IOP), better eye visual acuity (VA), visual field deficit (VFD) and number of glaucoma drops prescribed. Linear mixed models were utilized to determine the within-group changes in each domain, adjusted for relevant clinical, treatment and sociodemographic variables. Results: Of the 83 patients (mean age ± SD: 70.84 ± 6.70 years; 65.1% male; 90.4% Chinese), 61 (73.5%) underwent PHACO-MIGS with Hydrus^® Microstent, and 22 (26.5%) with iStent^® inject. Mean (SD) improvements in VA and IOP were observed post-surgery (0.11 [0.15] LogMAR units and 1.35 [4.20] mmHg, respectively), while VFD and the average number of anti-glaucoma medications prescribed decreased by 0.90 (2.97) dB and 1.30 (0.11) drops (all p < 0.05). Compared to pre-operative scores, four GlauCAT^TM domains [VSs (13.04%, p < 0.001; ES: 0.84), OSs (6.42%, p < 0.001; ES: 0.52), CNs (7.53%, p = 0.002; ES: 0.51), and GCV (6.34%, p = 0.004; ES: 0.45)] showed significant improvements post-surgery. The improvements across these four domains were driven primarily by a reduction in IOP and improvements in VA. Conclusions: Using a novel and AI-driven QoL PROM, we found significant post-operative improvements in Visual and Ocular Comfort Symptoms, Convenience, and Concerns in patients with POAG undergoing combined PHACO-MIGS, driven by improvements in IOP and VA post-surgery. Full article

Background: Botulinum toxin type A (BoNT-A) is an established preventive therapy for chronic migraine (CM), yet the accompanying neurochemical changes remain incompletely characterized. Objective: To evaluate the effects of BoNT-A on plasma substance P (SP), γ-aminobutyric acid (GABA), glutamate, glutamine, and 5-hydroxytryptamine (5-HT), and on urinary 5-HT, and to explore relationships with clinical outcomes. Methods: In this prospective study, plasma neurotransmitters were analyzed in CM patients (n = 31) at baseline and one month after BoNT-A (155 U; PREEMPT protocol) and in healthy controls (n = 30). Plasma SP was measured using enzyme-linked immunosorbent assay (ELISA); plasma GABA, glutamate, and glutamine were quantified via liquid chromatography–tandem mass spectrometry (LC–MS/MS) with isotopically labeled internal standards; plasma and urinary 5-HT were determined by high-performance liquid chromatography (HPLC). Clinical outcomes included monthly headache frequency, Visual Analog Scale (VAS), and Migraine Disability Assessment (MIDAS). Statistical analyses applied appropriate parametric or non-parametric tests with p < 0.05 considered significant. Results: One month post-BoNT-A, headache frequency, MIDAS, and VAS were significantly reduced (all p < 0.001). SP levels were significantly higher after BoNT-A than at baseline and versus controls. Plasma 5-HT increased post-BoNT-A, while urinary 5-HT decreased. Plasma GABA was elevated in patients versus controls without statistical significance. Glutamine was significantly higher before treatment, whereas the Glu/Gln ratio increased after BoNT-A. Correlations revealed that higher GABA was associated with lower VAS and attack frequency post-treatment. Conclusions: BoNT-A provided short-term clinical improvement with distinct neurochemical changes, including increased plasma SP and 5-HT, decreased urinary 5-HT, reduced glutamine, and a higher Glu/Gln ratio. These biomarkers, particularly Glu/Gln, may serve as indicators of cortical excitability and therapeutic response in CM. Full article

Background/Objectives: Artificial teeth in complete dentures are classified according to the materials used: porcelain (PO) or composite resin (CR). However, these materials’ effects on function, patient satisfaction, and quality of life (QOL), as well as occlusal wear, remain unclear. We compared PO and CR complete dentures in edentulous patients by assessing masticatory function, patient satisfaction, and oral health-related QOL at 3, 6, and 12 months post-insertion, as well as occlusal surface morphology owing to material differences. Methods: In this open-label, randomized, single-center, parallel-group study, participants were edentulous patients who visited our hospital and underwent treatment with new complete dentures. The outcomes were oral health-related QOL; subjective satisfaction, assessed using a visual analog scale; and masticatory performance, evaluated with gummy jelly and were assessed at baseline and 3, 6, and 12 months post-denture insertion. Occlusal surface impressions were taken twice, digitized as STL models, superimposed, and analyzed for wear. The Wilcoxon rank-sum test was used to compare between groups. Results: All evaluated items showed improvement. However, no significant differences were observed between the PO and CR groups, including between the amount of wear observed in the two groups. However, the PO group showed a tendency toward less wear. Extended observation may be required to clarify the long-term effects of artificial tooth materials. Conclusions: In the short term, the artificial tooth material did not influence masticatory function, oral health-related QOL, or patient satisfaction. Full article