پزشکی توانبخشی
مقالهها، منابع و پژوهشهای تازه حوزه پزشکی توانبخشی
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جستوجوی دقیقتوانبخشی
بازیابی عملکرد، توانبخشی جسمی، ذهنی و گفتاری
زیرشاخهها
برای رسیدن به فهرست متمرکزتر، یک مسیر تخصصی را انتخاب کنید.
فیزیوتراپی
مقالهها، منابع و پژوهشهای تازه حوزه فیزیوتراپی
ورود به زیرشاخهکاردرمانی
مقالهها، منابع و پژوهشهای تازه حوزه کاردرمانی
ورود به زیرشاخهگفتاردرمانی
مقالهها، منابع و پژوهشهای تازه حوزه گفتاردرمانی
ورود به زیرشاخهشنواییشناسی
مقالهها، منابع و پژوهشهای تازه حوزه شنواییشناسی
ورود به زیرشاخهارتز و پروتز
مقالهها، منابع و پژوهشهای تازه حوزه ارتز و پروتز
ورود به زیرشاخهفناوریهای توانبخشی
مقالهها، منابع و پژوهشهای تازه حوزه فناوریهای توانبخشی
ورود به زیرشاخهتازهترین رکوردها
شواهد توانبخشی
PubMed2027
Skeletal Muscle Tissue Engineering: Methods and Analysis for the Bio-Fabrication and Validation of a 3D Scaffold-Free Muscle Construct.
The development of three-dimensional (3D) tissue constructs that accurately replicate the morphology and function of native tissues is critical for advancing tissue engineering and regenerative medicine. Two primary strategies are currently employed: scaffold-based and scaffold-free approaches. Both aim to reproduce a biomimetic microenvironment that supports cell-cell and cell-matrix interactions, enabling the formation of functional tissues. To circumvent the immunological and toxicological limitations related to the use of exogenous scaffold materials, scaffold-free tissue engineering has emerged as a promising alternative. This method utilizes multicellular aggregates that fuse into cohesive structures while naturally producing extracellular matrix (ECM). Harnessing the intrinsic capacity of cells to self-organize and assemble into sheets enhances cell-cell connectivity and promotes spontaneous ECM remodeling, facilitating the formation of scaffold-free tissues. This study outlines the methodology for generating a 3D skeletal muscle tissue in vitro without the use of scaffolds. Here, we describe key analytical techniques, including flow cytometry, immunofluorescence, and histological staining, used to evaluate tissue functionality in physiological and pathological contexts. The proposed protocols enable the creation of a mouse skeletal muscle model suitable for drug screening and testing, considering its advantages and limitations. Furthermore, the integration of patient-derived biopsies or induced pluripotent stem cells (iPSCs) establishes a basis for personalized therapeutic applications in clinical settings.
PubMed2026
Culturally Embedded Participation Restrictions in Indian Adults With Knee Osteoarthritis: An ICF-Based Qualitative Study.
OBJECTIVE: To identify culturally relevant functioning issues experienced by Indian adults with knee osteoarthritis (KOA) using the International Classification of Functioning, Disability and Health (ICF) framework. METHODS: A qualitative descriptive study using semi-structured focus group interviews was conducted with 38 ambulatory adults (35-85 years) diagnosed with knee osteoarthritis (KOA). Participants were recruited from physiotherapy outpatient departments and community settings using maximum variation sampling. Interviews were conducted in Gujarati, audio-recorded, transcribed verbatim, translated into English and analysed using reflexive thematic analysis. Meaningful concepts were systematically linked to ICF categories using established linking rules. Dual independent coding and consensus discussions ensured the analytic rigour. RESULTS: This study included 38 participants with KOA. Fifty-five meaningful second-level categories were identified. The most represented components were activities and participation (41.2%) and body functions (29.4%). Frequently mapped first-level categories included mobility (n = 22), neuromusculoskeletal and movement-related functions (n = 9), d6 domestic life (n = 10), community, social and civic life (n = 7) and products and technology (n = 9). Sixteen additional categories not represented in the existing ICF Core Set for OA emerged, particularly relating to culturally embedded activities such as floor sitting, squatting for toileting and religious participation. Environmental barriers, including inaccessible infrastructure and limited rehabilitation services, influenced disability experience. CONCLUSION: Functioning among Indian adults with KOA is influenced by culturally embedded participation demands and contextual barriers that are insufficiently captured in the existing ICF Core Set for osteoarthritis (OA). These findings provide preliminary empirical support for contextual validation of the ICF Core Set for OA and inform potential culturally responsive adaptation for KOA.
PubMed2026
Dose-Response Relationship Between Physical Activity and Intrinsic Capacity Decline Among Hospitalised Older Patients.
OBJECTIVE: Intrinsic capacity (IC) serves as the foundation for functional performance in older adults, and its decline exerts a significant negative impact on their overall health status. However, the dose-response relationship between physical activity (PA) and IC decline is unclear. The objective of this study was to examine the dose-response relationship between PA and IC decline in hospitalised older adults. METHODS: This cross-sectional study was conducted from August 2024 to July 2025, with hospitalised older patients recruited from three tertiary hospitals in Gansu Province, China. Data were collected using a general information questionnaire, the IC Assessment Scale and the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Binary logistic regression and restricted cubic spline (RCS) models were used to explore the association between PA and IC decline, adjusting for potential confounders. RESULTS: The final analyses included a total of 534 hospitalised older patients. Using the low PA group as the reference, the moderate PA group was associated with a 66% lower likelihood of IC decline (OR = 0.34, 95% CI: 0.23-0.50), and the high PA group was associated with a 74% lower likelihood (OR = 0.26, 95% CI: 0.14-0.49). In the RCS analysis, a J-shaped nonlinear association was observed between PA levels and IC decline. Subgroup analyses by sex indicated that sex may serve as a potential moderator in the association between PA and IC decline. CONCLUSIONS: This study revealed a J-shaped nonlinear association between PA and the likelihood of IC decline, with moderately higher PA levels associated with a lower likelihood of IC decline.
PubMed2026
Effects of Orthotic Interventions on Pain, Balance, and Plantar Pressure in Flexible Flatfoot: A Systematic Review.
OBJECTIVE: To systematically review the evidence for orthotic interventions on pain, balance, and plantar pressure distribution in individuals with flexible flatfoot. METHODS: Randomized and nonrandomized controlled trials of orthotic interventions for flexible flatfoot were included. Primary outcomes were pain, balance, and plantar pressure. MEDLINE via PubMed, EMBASE via Elsevier, and the Cochrane Library were searched from inception to October 16, 2025. All effect sizes were independently recomputed, and pooling required two or more compatible datasets. RESULTS: Eight studies with 382 participants were included: six randomized controlled trials, one nonrandomized controlled trial, and one within-subject repeated-measures study. No domain met the pooling condition, so all previously reported summary estimates and heterogeneity statistics are withdrawn. Pain against a comparator without arch support rested on Yurt et al. (n = 67): g = -1.02 [95% CI: -1.54, -0.49] on the trial's designated primary outcome, a 100 mm visual analog scale, but g = -0.28 on its Foot Function Index total. In Elsayed et al. (n = 40) both arms wore the same orthosis, so g = -0.97 [-1.62, -0.33] estimates added exercise, not the device. Balance rested on Yalfani et al. (n = 30): g = -0.86 [-1.59, -0.13]. In Khodaei et al. (n = 19), plantar load was redistributed rather than reduced, moving from the heel and lesser metatarsals (g = -1.93 to -1.09) to the medial midfoot (+1.76). Taspinar et al. were withdrawn as arithmetically irreproducible. CONCLUSIONS: Every domain rests on a single small study, so no general efficacy claim is supportable. The most defensible finding is mechanical: load shifts from the heel and lesser metatarsals to the medial midfoot, as a medial arch support is designed to do. The pain estimate is not robust to instrument choice within its own trial. GRADE certainty is very low for every outcome; certainty for plantar pressure began at low because the contributing study did not randomize allocation. The two nonrandomized studies were additionally appraised with ROBINS-I, at critical and serious risk, respectively. Adequately powered randomized trials with a defined comparator and a pre-specified primary outcome are required.
PubMed2026
Focused Extracorporeal Shock Wave Therapy Versus Therapeutic Ultrasound as Adjuncts to Exercise-Based Rehabilitation for Functional Limitation in Ankylosing Spondylitis: An Assessor-Blinded Randomized Comparative Trial.
BACKGROUND: The comparative effectiveness of adjunctive physical modalities alongside exercise for ankylosing spondylitis (AS) remains inadequately evaluated. OBJECTIVE: To compare the relative association of focused extracorporeal shock wave therapy (ESWT) versus therapeutic ultrasound, both added to identical exercise-based rehabilitation, with long-term functional outcomes in AS. METHODS: This assessor-blinded randomized comparative trial (conducted March 2024-August 2025) evaluated 106 AS patients with chronic lumbar stiffness (90 completed 12-month follow-up). Participants received either focused ESWT (weekly × 4 weeks, n = 45) or ultrasound (3 × /week × 4 weeks, n = 45), alongside identical 12-week supervised exercise and stable pharmacotherapy. The primary outcome was functional capacity (BASFI). Secondary outcomes included disease activity (BASDAI), pain, spinal mobility (modified Schober) and disability (DFI). This trial was not prospectively registered and lacked an exercise-only control arm; therefore, findings should be interpreted as exploratory. RESULTS: Both groups improved significantly across all outcomes (p < 0.001). At 12 months, the ESWT group was associated with lower BASFI scores (2.2 ± 1.8 vs. 3.7 ± 2.3; p = 0.001; Cohen's d = 0.72) and lower disability (DFI: p = 0.003; d = 0.63) than the ultrasound group. Lumbar mobility differed nominally (p = 0.030) but did not survive correction for multiple secondary comparisons. No significant between-group differences were observed for BASDAI (p = 0.424) or pain (p = 0.284). CONCLUSIONS: When added to identical exercise and pharmacotherapy, focused ESWT was associated with greater long-term functional improvement compared with therapeutic ultrasound. However, in the absence of an exercise-only control, the incremental benefit of either modality over exercise alone cannot be determined. Given the lack of prospective registration and other methodological limitations, these preliminary findings require confirmation through properly registered trials before any clinical recommendations can be made.
PubMed2026
Ultrasound-guided high-voltage vs conventional pulsed radiofrequency in elderly cervical radiculopathy: A randomized controlled trial.
BACKGROUND: Elderly patients with cervical radiculopathy present therapeutic challenges owing to comorbidities and medication-related risks. Long-term pharmacotherapy and surgical interventions are often suboptimal, necessitating evaluation of optimized pulsed radiofrequency strategies under image guidance. OBJECTIVES: This superiority trial compared the efficacy and safety of ultrasound-guided cervical nerve root high-voltage pulsed radiofrequency (HVP-PRF) versus conventional pulsed radiofrequency (C-PRF) for pain management in elderly patients with cervical radiculopathy. METHODS: This single-center, parallel-group, assessor-blinded randomized controlled trial enrolled patients aged 60-85 years with cervical radiculopathy, randomly assigned (1:1) to HVP-PRF (70 V) or C-PRF (45 V). Procedures were performed under ultrasound guidance with sensory/motor stimulation confirmation and temperature ≤42°C. The primary outcome was change in upper-limb radiating pain on the Numeric Rating Scale (ΔNRS) from baseline to 3 months. Secondary outcomes included Neck Disability Index (NDI), neck pain NRS, Patient Global Impression of Change, responder rates, rescue analgesia use, and adverse events. Follow-up occurred at 1 week, 1, and 3 months. RESULTS: A total of 104 patients were randomized and 101 received treatment. At 3 months, HVP-PRF demonstrated significantly greater radiating pain improvement versus C-PRF (adjusted mean difference 1.24, 95% CI 0.46-2.02, P=0.002). Functional improvement (NDI) was superior in the HVP-PRF group at 3 months (AMD 6.47, 95% CI 2.11-10.83, P=0.004). Responder rates (≥50% pain reduction) were higher with HVP-PRF at 3 months (68.75% vs. 42.22%, OR 3.01, P=0.011) and 6 months (65.22% vs. 43.18%, OR 2.52, P=0.035). Rescue analgesic use was lower in the HVP-PRF group during 1-3 months intervals (both P<0.05). Adverse event rates were comparable (27.45% vs. 32.00%). CONCLUSION: Under ultrasound visualization and electrical stimulation-based target confirmation with temperature control ≤42°C, HVP-PRF provided greater and more durable relief of upper limb radiating pain compared with C-PRF in elderly patients with cervical radiculopathy, with a comparable safety profile.
PubMed2026
Capsulectomy at Explant: Rethinking Spinal Cord Stimulator Infected Generator Pocket Management in the Immunocompromised-A Case Series.
BACKGROUND: Surgical site infections (SSI) associated with spinal cord stimulation (SCS) implants pose risks of morbidity, mortality, and increased healthcare costs. Immunocompromised patients are especially vulnerable due to impaired immune responses, delaying diagnosis and increasing complications. Current guidelines recommend SCS explantation for deep or inadequately treated superficial SSI, though the role of capsulectomy remains underexplored despite its use in other fields like plastic surgery and cardiology. CASE PRESENTATION: We present two cases of immunocompromised patients with SSI treated with SCS explantation and capsulectomy. Case 1 involved a 64-year-old woman with ulcerative colitis and psoriatic arthritis treated with immunosuppressive agents who developed fever and myalgia and had normal imaging. Despite treatment with a course of antibiotics, she developed granulation tissue at the midline incision which tracked to the lead anchors. Explantation revealed necrotic tissue, and capsulectomy of the implanted pulse generator pocket and around lead anchors was performed. Staphylococcus schleiferi, likely linked to pet exposure, was identified. Case 2 involved a 52-year-old woman with postlaminectomy syndrome and rheumatoid arthritis on immunosuppressants, who presented with erythema and wound dehiscence weeks post-implant. Explantation and capsulectomy were performed to remove fibrotic tissue potentially harboring biofilm. MRSA infection was identified. Targeted antibiotics facilitated recovery in both cases. CONCLUSION: These cases suggest capsulectomy during SCS explantation may mitigate complications, particularly in immunocompromised patients. Current guidelines recommend capsule debridement but do not routinely address capsulectomy; its use may improve infection resolution in high-risk populations, perhaps by eliminating biofilm associated with the capsule.
PubMed2026
Clinical Implications of Preoperative Thoracic Spine Magnetic Resonance Imaging for Percutaneous Spinal Cord Stimulation Procedures: A Large Retrospective Cohort Study.
INTRODUCTION: Spinal cord stimulation (SCS) is an effective method for pain relief in patients with Persistent Spinal Pain Syndrome (PSPS) type II. International guidelines recommend preoperative imaging to assess spinal anatomy for placement of thoracic SCS leads. This study examines the clinical implications of routine preoperative imaging in patients scheduled for thoracic percutaneous SCS lead placement. METHODS: A single-center retrospective study of MRIs was performed in patients who were planned for SCS lead placement in a period from January 2020 to March 2023. The study excluded lead revisions and cervical or dorsal root lead placements. We examined the impact of imaging findings on procedural planning and execution, categorizing the clinical impact as minor (additional imaging or consultation) or major (cancellation or technical modification of the procedure). We also evaluated the correlation between abnormalities in the epidural space and periprocedural (but not postprocedural) complications such as dural puncture or improper lead positioning at Th7. RESULTS: Of the 167 patients who underwent MR imaging, 129 continued with SCS lead placement. The major reason for not proceeding with lead placement was patient and/or physician preference for conservative treatment. MRI revealed abnormalities in 58 patients-22 in the relevant epidural space and 36 incidental findings. In 29 of the patients (17.4% of total) these abnormalities had no clinical consequences. There were minor consequences in 23 patients (13.8% of total) and major consequences in 6 patients (3.6% of total). Major consequences included the decision to perform a primary surgical implantation in one patient, changes in epidural entry level in two patients, surgical decompression in two patients, and cancellation of the procedure in one patient. Of all MRI findings with clinical implications, 14 of 29 (48.2%) (and 3 of 6 for major consequences) were visible on prior imaging. Although not specifically powered for this correlation, statistical analysis using a Fisher exact test found no significant association between epidural abnormalities on MRI and the occurrence of dural puncture, the inability to place the lead at the desired position, or perioperative neurological sequelae. CONCLUSION: Routine preoperative MRI before thoracic SCS lead placement often detects abnormalities with major consequences in 3.6% of cases. In half of these cases, the abnormalities could not be identified on previous imaging, all of which were in the thoracic region. There was no association between epidural abnormalities and periprocedural complications in our data.
PubMed2026
Comparison of Pain and Quality-of-Life Outcomes Following Bipolar Versus Monopolar Pulsed Radiofrequency Treatment for Chronic Lumbosacral Radicular Pain: An Observational Study.
OBJECTIVE: Pulsed radiofrequency of the dorsal root ganglion (DRG) is an established treatment for chronic lumbosacral radicular pain, yet comparative evidence on monopolar versus bipolar configurations, particularly regarding quality-of-life outcomes, remains limited. This study aims to compare the analgesic and quality-of-life effects of bipolar versus monopolar pulsed radiofrequency of the lumbosacral DRG. METHODS: We conducted a mixed retrospective and prospective observational review of 143 patients with chronic radicular pain due to lumbosacral disc herniation who underwent DRG pulsed radiofrequency in 2022 and 2023. Patients received either bipolar (n = 79) or monopolar pulsed radiofrequency (n = 64). Pain intensity was recorded using the Numeric Rating Scale at baseline and at 1st, 2nd, and 6th month post-procedure. Quality of life was assessed with Short Form-36 (SF-36) at baseline and 6 months. Any potential complications were recorded to evaluate the safety of procedures. RESULTS: Baseline demographic and clinical characteristics were comparable between groups. All patients exhibited significant reductions in pain scores over time (p < 0.001). However, bipolar pulsed radiofrequency produced significantly greater pain relief at all follow-up points, with mean pain scores at 6 months of 2.32 versus 4.78 in the monopolar group (p < 0.001). At 6 months, bipolar pulsed radiofrequency also resulted in significantly higher SF-36 scores across all eight domains and in total score (583.61 vs. 425.29, p < 0.001). DISCUSSION: Bipolar pulsed radiofrequency of the lumbosacral DRG was associated with greater improvements in pain and quality of life compared with the monopolar modality in patients with chronic lumbosacral radicular pain. These show the potential of bipolar PRF to enhance clinical and functional outcomes in this population.
PubMed2026
Ethical Concerns and Implementation Barriers to Early Mobilisation in Critically Ill Adult and Older Adult Patients: Perspectives of ICU Nurses.
BACKGROUND: Early mobilisation is central to contemporary critical care, yet implementation remains inconsistent and ethically complex, particularly when patient safety, autonomy and resource constraints must be balanced. AIMS: To examine ICU nurses' perceptions of ethical concerns and implementation barriers related to early mobilisation in critically ill adults, including older adults, and their associations with professional characteristics. DESIGN: A single-centre analytical cross sectional study. METHODS: A convenience sample of ICU nurses completed a self-administered questionnaire comprising demographic and professional data and the researcher-developed Ethical Issues in Early Mobilisation-Critical Care Scale and Early Mobilisation Barriers Scale. Data were analysed using descriptive statistics, independent-samples t-tests, one-way analysis of variance, Pearson's correlation and multiple linear regression. RESULTS: A total of 100 ICU nurses participated in the study. The mean ethical-concern score was 113.41/150 (75.6% of the maximum possible score), and the mean barrier score was 69.94/90 (77.7%). Beneficence and Patient Well-being had the highest ethical-domain score. Patient-related barriers had the highest descriptive domain score, although all four barrier domains were closely distributed (76.6%-79.2%). Ethical-concern and barrier scores were modestly correlated (r = 0.292, 95% CI 0.103-0.461; p = 0.003), indicating limited shared variance. In mutually adjusted models, education level, ICU experience and previous early-mobilisation training were associated with both outcomes. The coded ICU-type term was associated with ethical-concern scores only, whereas professional nursing classification was associated with neither outcome. Age and gender were not associated with either score. CONCLUSIONS: Early mobilisation emerged as an ethical and organisational challenge, not merely a technical task. Ethical concerns and implementation barriers were related but largely distinct. Associations with education, ICU experience and training should be interpreted as correlational rather than causal. Integrated, context-sensitive approaches combining graded safety assessment, ethical decision-making, role clarity and organisational support warrant prospective evaluation. RELEVANCE TO CLINICAL PRACTICE: The findings support the development of evidence-based protocols, targeted educational initiatives and organisational strategies that strengthen nurses' clinical decision-making and facilitate the safe and consistent implementation of early mobilisation in critical care settings.
PubMed2026
Implementation of a Multidisciplinary Non-Pharmacological Program to Improve Urinary Incontinence in an Intermediate Care Hospital.
INTRODUCTION: Urinary incontinence (UI) is a prevalent geriatric syndrome that significantly affects the physical, psychological, and social well-being of older adults. Non-pharmacological interventions are recommended as the first-line approach, especially in frail older adults. DESIGN: This was a prospective pre-post observational study. METHODS: The study included sixty-one patients with rehabilitable UI who were admitted to an intermediate care hospital. The nurse-led multidisciplinary program integrated education, hygiene-dietary measures, pelvic floor physiotherapy, behavioral strategies, and transcutaneous electrical nerve stimulation (TENS). The primary outcomes were UI severity (International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF)), voiding awareness, diurnal and nocturnal voids, disposable absorbent product use, functional status (Barthel Index), cognitive status (Pfeiffer test), and quality of life (EQ-5D). Data were collected at baseline and discharge. RESULTS: Data from 61 participants were analyzed. Significant improvements were observed in the ICIQ-SF scores (16.72 ± 3.39 vs. 9.10 ± 5.86; p < 0.001), daytime voiding awareness (83.6% vs. 100%; p = 0.002), nocturnal voiding awareness (66.7% vs. 88.5%; p = 0.002), nocturnal voids (3.46 ± 2.22 vs. 2.35 ± 1.68; p < 0.001), Barthel Index (49.83 ± 23.84 vs. 70.33 ± 19.59; p < 0.001), and EQ-5D scores (0.39 ± 0.28 vs. 0.56 ± 0.26; p < 0.001). The use of disposable absorbent products decreased from 98.36% to 62.30% (p = 0.065). The patient's cognitive status remained stable. The mean satisfaction with the program was 8.53/10. CONCLUSIONS: A nurse-led, multidisciplinary, non-pharmacological intervention effectively reduced UI severity, increased voiding awareness, enhanced functional autonomy, and improved the quality of life in older adults. These findings support the implementation of individualized, evidence-based programs in intermediate care settings. CLINICAL RELEVANCE: Non-pharmacological interventions led by advanced practice nurses provide effective, patient-centered management of urinary incontinence, improving autonomy and quality of life while potentially reducing healthcare costs.
PubMed2026
Management of Neuropathic Pain in Complex Regional Pain Syndrome: A Comprehensive Review.
OBJECTIVE: Complex regional pain syndrome (CRPS) is a complex and multifaceted condition in which pain may be neuropathic, nociplastic, nociceptive, or mixed in nature. This review aims to summarize the available pharmacological and non-pharmacological strategies for managing neuropathic pain in CRPS Types I and II. METHODS: Scopus, PubMed, Cochrane Library, and Google Scholar were searched for randomized controlled trials, meta-analyses, case series, and case reports addressing the management of CRPS, with a focus on neuropathic pain. Studies were analyzed from the perspective of pharmacological and non-pharmacological approaches, with attention to differences between CRPS Type I and II. RESULTS: Gabapentin (Level 1 evidence) and physiotherapy (Level 2 evidence) showed the strongest support among the treatments reviewed. Evidence remains limited or inconsistent for other pharmacological options (e.g., anticonvulsants other than gabapentin, opioids, antidepressants, ketamine, botulinum toxin) and for non-pharmacological interventions (e.g., mirror therapy, spinal cord stimulation, acupuncture). No significant differences in treatment efficacy were identified between CRPS Type I and II. CONCLUSION: Given the complex and heterogeneous nature of CRPS, a multimodal, individualized treatment approach is recommended. Further well-structured studies are needed to strengthen the evidence base for the management of neuropathic pain in CRPS.
PubMed2026
Predicting Clinical Improvement in Chronic Low Back Pain Using Exercise-Induced IVIM Perfusion: Threshold Evaluation and Disability-Dependent Effects.
Chronic low back pain (LBP) is the leading cause of disability worldwide, yet responses to exercise-based rehabilitation vary substantially and remain not well characterized. Impaired activation of the lumbar paraspinal muscles has been proposed as a mechanism limiting rehabilitation treatment response. Intravoxel incoherent motion (IVIM) magnetic resonance imaging assesses muscle diffusion and perfusion after exercise, offering physiological markers of dynamic function. In a previous pilot study, we reported that acute exercise-induced IVIM responses were reduced in individuals with LBP and that thresholds in diffusion (D) and pseudodiffusion (D*) parameters could predict those who would or would not respond to an exercise-based rehabilitation program. The present study aimed to prospectively validate these findings in a larger, independent cohort. Thirty-seven individuals with chronic LBP underwent IVIM before and after an acute standardized lumbar extension exercise, followed by a 12-week rehabilitation program. Participants were classified as responders or nonresponders based on changes in disability after 12 weeks (Δ Oswestry Disability Index Score ≥ or < 0). In line with the pilot study, responders exhibited higher increase in D following acute exercise than nonresponders (p = 0.05). Previously identified thresholds for D and D* did not discriminate between responders and nonresponders within this new cohort (Sn < 0.40 and Sp = 0.65). Exploratory analyses revealed that baseline disability moderated IVIM responses, as a marked increase in D was primarily observed in responders with low baseline disability, whereas individuals with higher disability showed attenuated responses. New significant thresholds were explored within the validation cohort while controlling for disability levels. An increase ≥ 0.014 × 10-3 mm2/s for D predicted who would respond to the exercise-based program, with a Sn of 0.59 and a Sp of 0.90 (area under the curve [AUC] 0.72, 95%CI 0.55 to 0.90, p = 0.02). These findings confirm that acute IVIM responses are associated with rehabilitation outcomes but may be better understood as part of a broader, integrative framework characterizing the physiological mechanisms associated with treatment response. Integrating physiological and clinical factors to better understand variability in treatment response will help guide more personalized approaches to LBP rehabilitation.
PubMed2026
Similar acute increases in muscle size, but discrete perceptual responses to low-load blood flow restriction protocols.
The purpose of this investigation was to assess muscle size and perceptual responses following acute bouts of low-load blood flow restriction resistance exercise performed with a 75-repetition (1 × 30, 3 × 15), 3 sets to failure, and a 1 set to failure protocols. Nineteen females randomly performed a 75-repetition, 3 sets to failure, and 1 one set to failure low-load blood flow restriction protocols consisting of unilateral, submaximal (30% of maximal voluntary isometric contraction), isokinetic (90°·s-1), leg extension muscle actions. The minimal difference (MD) was used to determine real changes in each dependent variable from pretest to posttest. There were no significant (p = 0.191-0.567) interactions, main effects of Condition (p = 0.108-0.931), or main effects of Muscle (p = 0.103-0.958) for muscle thickness (MTH), cross-sectional area (CSA), or echo intensity (EI) of the rectus femoris or vastus lateralis. Across the protocols, the changes in MTH, CSA, and EI exceeded the minimal difference for 16-19, 18-19, and 11-19 of the 19 participants, respectively. Following the final set of each protocol, 3 sets to failure (8.94 ± 1.07 au) resulted in a greater rating of perceived exertion compared to the 1 set to failure (8.02 ± 1.08 au) and 75-repetition (8.05 ± 1.35 au) protocols. All three protocols resulted in comparable acute changes in muscle size; however, the 3 sets to failure resulted in the greatest perceptual response. Therefore, comparable acute muscle size responses can be achieved with the 75-repetition protocol or one set performed to failure with a reduced level of exertion.
PubMed2026
Single-Area Versus Multiple-Area Passive Recharge Burst During Spinal Cord Stimulator Trials: An Independent Prospective Randomized, Double-Blind Study.
INTRODUCTION: Intermittent passive recharge burst therapy is an established therapy to optimize pain relief and mitigate the problems associated with battery life and charging burden. Newer programming parameters have been explored to provide patients with this targeted burst therapy in multiple areas. These areas are programmed separately to optimize pain relief for a complex patient population and those with multi-area pain. This study examined single vs. multi-area passive recharge burst therapy in a neurostimulation naive population during percutaneous SCS trial. METHODS: This study was performed at a single institution by a single trialing physician. Candidates for the study were enrolled on a consecutive basis for any painful condition in the management of chronic intractable pain of the back, trunk and limbs. Subjects were randomized to receive either single area burst therapy or two-area burst therapy-with both subject and physician blinding. Programming was adjusted mid-trial based on optimizing pain relief and could include up to four-area burst. Patient outcomes included VAS, percent pain relief, proceeding to implant, and PROMIS-29 scores. RESULTS: All planned 30 patients completed follow up. The average VAS pain score was 70.2 at baseline and 22.2 at the end of the trial. The average pain relief at mid-trial was 53%, which improved to 67% at the end of the trial with conversion to multi-area programming. There was an overall 87% trial to permanent conversion ratio, with 83% of the patients ending trial on multi-area burst therapy. Analysis of PROMIS-29 scores demonstrates the most significant improvements in pain intensity, pain interference, physical function, sleep, and anxiety. CONCLUSION: Multi-area passive recharge burst has demonstrated a high rate of trial success with significant pain and symptom relief. In addition, there were improvements in pain intensity, pain interference, physical function, sleep, and anxiety. Multi-area passive recharge burst therapy is a viable option to be utilized during a trial to improve patient outcomes and optimize trial success.
PubMed2026
The "Spiked Helmet Sign" on Electrocardiogram Following Left Ventricular Assist Device Implantation: A Case Report.
BACKGROUND: The ECG "Spiked Helmet Sign," with diffuse concave ST-segment elevation and a J-point spike, typically suggests acute pericarditis. However, after LVAD implantation, it may herald a localized pericardial hematoma and impending tamponade. CASE PRESENTATION: A 68-year-old male with end-stage ischemic cardiomyopathy underwent LVAD placement. Hours postoperatively, ECG showed this sign with QTc prolongation (578 ms). Bedside echocardiography revealed a 6-mm localized pericardial/mediastinal hematoma. Troponin I peaked on day 1 and fell. Conservative management was successful. CONCLUSION: Recognition of this ECG sign after LVAD surgery should prompt immediate echocardiography to detect pericardial complications.
PubMed2026
Acceptability and preference of self-collected vaginal samples for human papillomavirus DNA testing compared with physician-collected Pap smear.
BACKGROUND: Self-collected vaginal sampling for human papillomavirus (HPV) DNA testing provides a promising alternative to physician-collected Pap smears, especially in low-resource settings. However, data on its acceptability and preferences among Filipino women remain limited. This study aimed to assess women's perceptions, experiences, willingness and preferences regarding self-collected vaginal sampling for HPV DNA testing compared with Pap smears. METHODS: A cross-sectional study was conducted among 592 women. Participants underwent both physician-collected Pap smears and self-collected vaginal sampling for HPV DNA testing. Perceptions were measured using five-point Likert scale questionnaires before and after self-collection. Descriptive statistics were used, and paired and independent Wilcoxon tests were used to compare Likert responses. Willingness to undergo screening was analyzed with Cochran's Q and McNemar tests. Participants' reasons for their preferred screening method were categorized thematically and displayed in stacked bar charts. RESULTS: Self-collection was generally viewed as painless, not uncomfortable, non-embarrassing, and easy and convenient. Acceptability significantly increased after participants performed self-collection (P < 0.001 for pain and discomfort). Compared with Pap smears, self-collection was seen as less embarrassing (P < 0.001), but rated as less easy (P = 0.01) and less convenient (P = 0.004). Most participants preferred physician-administered screening (84.8%) due to trust in medical expertise, and confidence in the procedure's accuracy, safety and cleanliness. CONCLUSIONS: Self-collected vaginal sampling was highly acceptable, yet physician-collected screening remained the preferred method. Improving education, demonstrations, and support for self-collection may enhance the uptake of HPV DNA testing and broaden access to cervical cancer screening in the Philippines.
PubMed2026
Adherence to treatment recommendations in older adults with vertigo, dizziness, and balance disorders: the MobilE-TRA 2 cohort study.
BACKGROUND: Specific exercises and lifestyle-related recommendations are used to manage vertigo, dizziness, and balance disorders (VDB), but evidence on adherence and its determinants in older adults is limited. This study examined adherence changes and associations with condition-related and patient-related factors from 3 to 12 months after therapeutic recommendations. METHODS: We used data from the MobilE-TRA 2 prospective cohort of adults aged ≥60 years treated for VDB at a tertiary referral centre in Germany. The participants were assessed at baseline and followed up after 3 and 12 months. Self-reported adherence was measured using a five-point Likert scale and dichotomised at predefined cut-offs. Perceived dizziness-related handicap was assessed using the Dizziness Handicap Inventory (DHI). Longitudinal associations were analysed using logistic generalised linear mixed-effects models with random intercepts. RESULTS: Overall, 337 participants were included (53% women; mean age 71 years). In adjusted analyses, adherence to specific exercises was lower at 12 than at 3 months (odds ratio (OR) 0.28; 95% confidence interval (CI) 0.12-0.67). Higher baseline DHI scores were significantly associated with higher adherence to specific exercises (OR 1.03; 95% CI 1.00-1.06), but not with lifestyle-related recommendations (OR 1.00; 95% CI 0.98-1.02). Male gender was associated with lower adherence to lifestyle-related recommendations (OR 0.37; 95% CI 0.16-0.88), while higher self-efficacy was associated with higher adherence (OR 1.65; 95%CI 1.02-2.66). CONCLUSIONS: Adherence differed by recommendation type, participant characteristics and over time in older adults with VDB. These findings may inform strategies to support adherence in VDB beyond initial follow-up.
PubMed2026
Co-creating and testing a bibliotherapy e-storybook for children coping with parental complex post-traumatic stress disorder.
Background: Children living with a parent with complex post-traumatic stress disorder (CPTSD) may struggle to understand and respond to parental behaviours, increasing their risk of distress and mental health difficulties. Despite this, few evidence-informed narrative resources exist to support these children.Method: A free bibliotherapy e-storybook was co-created with over 30 participants from the affected communities and partners, including individuals with lived experience, service providers, clinicians, and an international interdisciplinary research team. Public feedback on a draft version informed further refinement. A cross-sectional online survey of additional community members and partners assessed the e-storybook. Twenty-two additional participants completed closed-ended and six open-ended survey questions.Results: Findings indicated that the co-creation approach was effective in developing a targeted and relevant resource for children.Conclusion: The e-storybook was perceived as a useful bibliotherapy tool to support child and family outcomes and to facilitate meaningful conversations about family experiences.
PubMed2026
Dose- and modality-specific effects of exercise on BDNF and depression in middle-aged and older adults with mild cognitive impairment: A Bayesian network meta-analysis.
OBJECTIVE: To evaluate the effects of exercise modality and weekly exercise dose on peripheral brain-derived neurotrophic factor (BDNF) and depressive symptoms in middle-aged and older adults with mild cognitive impairment (MCI), and to examine the robustness of the dose-specific predictions from the primary quadratic model across alternative dose-response functions. METHODS: PubMed, Embase, Web of Science, the Cochrane Library, and APA PsycInfo were searched from inception to 13 April 2026. Randomized controlled trials involving adults aged 50 years or older with MCI and reporting BDNF or depression-related outcomes were included. Effect sizes were expressed as Hedges' g. Separate Bayesian random-effects network dose-response meta-analyses were conducted for BDNF, overall depressive symptoms, and modality-specific depressive symptoms. The quadratic model was used as the primary model to predict intervention effects at different exercise doses. Linear, Emax, and natural cubic spline models were fitted as functional-form sensitivity analyses. RESULTS: Twenty-eight studies involving 2,262 participants were included. In the primary quadratic analysis, the largest model-predicted effect on BDNF occurred at 440 MET-min/week (posterior mean, 0.752; 95% credible interval [CrI], 0.287 to 1.249), whereas the largest model-predicted effect on depressive symptoms occurred at 670 MET-min/week (posterior mean, 0.382; 95% CrI, 0.147 to 0.674). Dancing and multicomponent exercise showed comparatively favourable estimates at selected dose levels, whereas estimates for Tai Chi, walking, and yoga were less precise. Functional-form sensitivity analyses identified different dose locations for the maximum predicted effects. Therefore, 440 and 670 MET-min/week represent the maximum prediction points for BDNF and depressive symptoms, respectively, under the primary quadratic model, rather than established optimal exercise doses. CONCLUSION: Exercise interventions were associated with increased peripheral BDNF levels and improved depressive symptoms in middle-aged and older adults with MCI. The primary quadratic model predicted the largest effects at 440 MET-min/week for BDNF and 670 MET-min/week for depressive symptoms, suggesting a potentially non-linear dose-response relationship. Although these prediction points are important findings of the quadratic analysis, cross-model sensitivity indicates that they should be used to inform future dose-ranging research rather than be regarded as confirmed clinical optima.
PubMed2026
Extraction-string ureteral stents and postoperative infection after flexible ureteroscopy: an IPTW-adjusted analysis.
Extraction-string ureteral stents facilitate non-cystoscopic removal after ureteroscopy, but concerns remain regarding postoperative infection and accidental dislodgement. We evaluated whether extraction-string stents were associated with postoperative infection after flexible ureteroscopic lithotripsy (fURSL) in a cohort restricted to procedures with the distal Double-J (D-J) stent portion positioned within the bladder. This retrospective observational study included 102 procedures in 92 unique patients: 58 extraction-string and 44 conventional non-string procedures. Postoperative infection was defined as fever > 38 °C or a positive postoperative urine culture during the stent-indwelling period. Propensity scores incorporated age, sex, positive preoperative urine culture, preoperative pyuria, and procedure laterality. Stabilized inverse probability of treatment weights were truncated at the 1st and 99th percentiles; effective sample size was 85.38. Crude postoperative infection occurred in 8/58 (13.8%) extraction-string and 6/44 (13.6%) non-string procedures. After weighting, estimated infection rates were 13.6% and 8.8%, respectively (OR 1.64, 95% CI 0.50-5.44; P = 0.416). Fever, positive postoperative urine culture, postoperative pyuria, and postoperative day 1 pain did not differ significantly. Sensitivity analyses accounting for repeated procedures and propensity-model specification were consistent with the primary analysis. Extraction-string stent use was not significantly associated with postoperative infection after fURSL; however, the limited number of events and wide confidence intervals preclude exclusion of a clinically meaningful difference.
PubMed2026
Round versus tape sutures with interference fit anchors perform similarly in cadaveric glenoid and greater tuberosity biomechanical testing.
PURPOSE: To determine whether suture shape (flat-tape vs. round-wire) influences biomechanical performance at the suture-anchor-bone interface in interference-fit anchors used for rotator cuff and glenoid labrum repair. METHODS: Four matched pairs of human cadaveric shoulders were used for the glenoid model, with six anchor sites per glenoid. Five matched pairs of cadaveric humeri were used for the rotator cuff model, with three anchor sites per humerus. Each model tested multiple suture-anchor constructs under cyclic loading followed by load-to-failure. Biomechanical outcomes included cyclic displacement, yield characteristics, ultimate failure strength, stiffness, and force at fixed displacements. A linear mixed-effects model was used to compare suture types, with suture type and anchor position as fixed effects and specimen as a random effect. RESULTS: In the glenoid/labrum model, there were no significant differences among suture types in cyclic displacement (cycles 1, 50, or 100; p = 0.376, 0.101, 0.109), displacement at yield (p = 0.406), yield force (p = 0.880), force at 1 mm (p = 0.264) or 5 mm (p = 0.085), or ultimate failure strength (p = 0.204). Stiffness (p = 0.050) and force at 2 mm displacement (p = 0.033) differed at the overall model level, however, no significant pairwise differences were observed. In the humerus/rotator cuff model, displacement at cycle 50 (p = 0.022) and cycle 100 (p = 0.019) differed overall, although post hoc comparisons were not significant. Ultimate strength (p = 0.037), yield force (p = 0.012), and stiffness (p = 0.005) differed among groups, with post hoc analysis showing greater ultimate strength, yield force, and stiffness for 2-mm FiberTape compared with 2-mm XbraidTT. No other pairwise comparisons were significant. CONCLUSION: Suture shape did not meaningfully influence interference-fit fixation properties in the glenoid and humeral models evaluated in this study. Tape-type and round-type sutures demonstrated comparable biomechanical performance at the suture-anchor interface within the tested constructs. LEVEL OF EVIDENCE: Controlled Laboratory Study.
PubMed2026
Short-term prophylactic biliary stenting after complete common bile duct stone removal to prevent post-ERCP cholangitis in Japan (STEP-ERCP study): study protocol for a confirmatory multicentre randomised controlled trial.
INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP) is the standard treatment for common bile duct stones. Although complete stone removal can be achieved in most cases, post-ERCP cholangitis still occurs in a subset of patients, even in the absence of preprocedural cholangitis. Temporary prophylactic biliary stenting after complete stone extraction may reduce post-ERCP cholangitis by preventing transient biliary obstruction caused by papillary oedema, impaired bile drainage or residual biliary sludge. However, evidence supporting this strategy is currently limited to retrospective studies. The STEP-ERCP study is designed to test the hypothesis that short-term prophylactic biliary stenting after complete removal of common bile duct stones reduces the incidence of post-ERCP cholangitis compared with no biliary stenting. METHODS AND ANALYSIS: The STEP-ERCP study is a multicentre, prospective, open-label, randomised controlled superiority trial. Adult patients undergoing ERCP for common bile duct stones without evidence of acute cholangitis at the time of ERCP and achieving complete stone clearance will be enrolled. Participants will be randomly assigned in a 1:1 ratio to prophylactic biliary stenting using a spontaneous dislodgement biliary stent or no stenting. Randomisation will be stratified by participating institution and maximum stone diameter (<10 mm vs ≥10 mm). The primary endpoint is the incidence of post-ERCP cholangitis within 7 days after ERCP, diagnosed using modified Tokyo Guidelines 2018 criteria adapted for post-ERCP conditions. Secondary endpoints include cholangitis severity, time to cholangitis onset, therapeutic antibiotic use, repeat ERCP or biliary drainage, ERCP-related adverse events and revisit or readmission within 30 days after ERCP. A total of 186 participants will be enrolled. ETHICS AND DISSEMINATION: The study will be conducted in accordance with the Declaration of Helsinki and the Ethical Guidelines for Medical and Health Research Involving Human Subjects in Japan.The study protocol was approved by the Institutional Review Board of Yokohama City University Hospital on 11 May 2026. Additional approval will be obtained from participating institutions before study initiation.Written informed consent will be obtained from all participants.Study findings will be disseminated through peer-reviewed publications and scientific conferences. TRIAL REGISTRATION NUMBER: jRCT1032260128.
PubMed2026
The effect of different CAD/CAM materials and thickness on the immediate load-bearing capacity of occlusal veneers.
OBJECTIVES: Minimally invasive occlusal veneers fabricated from ceramic and resin-based materials have gained increasing popularity in recent years. The aim of this study was to evaluate the effect of different CAD/CAM materials and restoration thicknesses on the immediate load-bearing capacity of occlusal veneers. MATERIALS AND METHODS: A total of 100 human mandibular molars were prepared for occlusal veneers with a 1-mm circumferential rounded chamfer finish line. A preparation height of 1.5 mm extending from the preparation margin to the occlusal plane was created. The teeth were divided into 10 groups (n = 10), and occlusal veneers were fabricated in two different thicknesses (0.6 and 1.5 mm) using four CAD/CAM block materials: lithium disilicate glass ceramic (IPS e.max), nanoceramic composite (Lava Ultimate and Cerasmart 270), hybrid ceramic (Enamic), and an experimental short fiber-reinforced composite (SFRC CAD). The tested thickness of 0.6 mm is below the minimum thickness recommended by all manufacturers. Restorations were designed using Cerec software. After adhesive cementation, all specimens were stored in water at 37 °C for 2 days, followed by quasi-static loading testing. Data were analyzed using 2-way ANOVA (´restorative material´ and ´restoration thickness`) and Tukey's post hoc test (α <0.05). RESULTS: The two-way ANOVA demonstrated significant main effects of both restorative material and restoration thickness on fracture load (p < 0.001), whereas the material-thickness interaction was not significant (p = 0.200). SFRC CAD exhibited the highest fracture load (SFRC 0.6 mm = 2560.2 ± 424.5N and SFRC 1.5 mm = 2799.0 ± 655.9N) while IPS e.max (IPS e.max 0.6 mm = 1224.2 ± 363.4N and IPS e.max 1.5 mm = 1799.9 ± 436.8N) showed the lowest. Increasing restoration thickness from 0.6 mm to 1.5 mm significantly resulted in higher fracture load regardless of the restorative material. CONCLUSION: Both restorative material and restoration thickness play important roles in the mechanical performance of occlusal veneers. Among the evaluated CAD/CAM materials, the experimental short fiber-reinforced composite demonstrated the highest load-bearing capacity, whereas ceramic and resin-based CAD/CAM materials showed lower values. However, the higher incidence of catastrophic failures involving both restoration and tooth structure in the SFRC CAD groups indicates that fracture load alone should not be considered the only factor for material selection. These findings suggest that ultrathin occlusal veneers may have potential for minimally invasive restorative applications; however, their long-term clinical performance and failure behavior should be further investigated before clinical recommendations can be established. CLINICAL RELEVANCE: Occlusal veneers with a thickness of 0.6 mm, minimum thickness recommended by manufacturers, exhibited promising immediate load-bearing capacity, supporting their potential use in minimally invasive restorative. Furthermore, the experimental short fiber-reinforced composite CAD/CAM material demonstrated superior load-bearing capacity compared with the other CAD/CAM materials evaluated in this study.
PubMed2026
Trajectory changes in psychosocial adaptation levels of patients after implantation of cardiac implantable electronic devices and development of the intervention programme: a mixed-methods research protocol.
INTRODUCTION: The implantation of cardiac implantable electronic devices (CIEDs) has become an important treatment for various types of arrhythmias and severe heart failure, effectively improving patient prognosis and increasing survival rates. However, patients after CIED implantation need to go through a process of coexisting with and adapting to the internal electronic device. This may result in limitations in daily activities, discomfort and lifestyle changes, which can easily lead to negative emotions and psychosocial maladjustment in the patients, seriously affecting their physical and mental rehabilitation and prognosis. This study aims to explore the trajectory of psychosocial adaptation and its influencing factors among patients after CIED implantation and to gain an in-depth understanding of their process of physical and psychological adjustment. Drawing on the research findings and existing literature, this study will develop an intervention programme to improve psychosocial adaptation among patients after CIED implantation, thereby providing a theoretical and practical basis for future clinical interventions in this population. METHODS AND ANALYSIS: This study focuses on patients who have undergone CIED implantation. A mixed-methods approach will be adopted, combining a cross-sectional survey, a prospective longitudinal quantitative design and a qualitative design. (1) Quantitative study: The Basic Information Questionnaire, Chinese version of Self-report Psychosocial Adjustment to Illness Scale, Chinese version of Medical Coping Modes Questionnaire, Chinese version of Acceptance of Illness Scale, Chinese version of Multidimensional Scale of Perceived Social Support, Self-efficacy for Managing Chronic Disease and Health Literacy Management Scale will be administered to patients after CIED implantation to explore the latent categories, associated factors and longitudinal trajectories of psychosocial adaptation. Statistical analysis will be conducted using Statistical analysis was performed using IBM SPSS Statistics version 26 (SPSS 26) and Mplus software. (2) Qualitative study: Based on descriptive phenomenology, semi-structured interviews will be conducted with patients after CIED implantation to gain an in-depth understanding of their life experiences of psychosocial adaptation, as well as their process of physical and psychological adjustment. The data will be analysed using the Colaizzi 7-step method of phenomenological analysis, supported by NVivo software for data organisation and coding. (3) Development of the intervention programme: Based on the literature review and theoretical framework, and integrating findings from both the quantitative and qualitative phases, an intervention programme for improving the psychosocial adaptation among patients after CIED implantation will be initially developed. The Delphi method will be used to evaluate and revise the initially developed intervention programme. A pilot test will subsequently be conducted to further refine the programme. ETHICS AND DISSEMINATION: This research plan has been approved by the Ethics Committee of the First People's Hospital of Foshan (Approval Number: LSY-2025-019). Data collection is authorised by the Ethics Committee of the First People's Hospital of Foshan. The results of this study will be published in relevant peer-reviewed journals. TRIAL REGISTRATION NUMBER: ChiCTR2600124496.
PubMed2026
A preliminary model for estimating mass-specific oxygen uptake during manual wheelchair propulsion from mechanical power and heart rate.
Manual wheelchair users may have reduced physical activity and total energy expenditure, while wearable devices may not adequately capture external mechanical demand during wheelchair propulsion. This pilot study examined whether wheel-level mechanical power combined with heart rate could estimate mass-specific oxygen uptake (V̇O2/kg) during manual wheelchair propulsion. Ten long-term manual wheelchair users aged 29-38 years completed 3-min trials under three progressively loaded conditions on a wheelchair ergometer. Wheel velocity and braking torque were measured, mechanical power was calculated from trial-mean torque and angular velocity, and metabolic variables were assessed using a wearable respiratory gas analyzer. A two-predictor linear regression model was developed, with participant-clustered standard errors and leave-one-participant-out cross-validation (LOPO-CV) for internal evaluation. V̇O2/kg increased across conditions despite lower velocity under the highest load. The final model was V̇O2/kg = 5.5738 + 0.2444P + 0.03587HR. Mechanical power (95% CI: 0.1330-0.3558) and heart rate (95% CI: 0.01342-0.05833) were significant positive predictors. The model explained 72.2% of the variance (R2 = 0.722; adjusted R2 = 0.701). LOPO-CV yielded an RMSE of 1.128 mL O2·kg-1·min-1, an MAE of 0.917 mL O2·kg-1·min-1, and R2 = 0.575. Repeated-measures Bland-Altman analysis of LOPO-CV predictions showed a mean bias of -0.156 mL O2·kg-1·min-1 (95% CI: -0.6259 to 0.2022), with limits of agreement from -2.389 (95% CI: -3.1667 to -1.7711) to 2.077 mL O2·kg-1·min-1 (95% CI: 1.6096 to 2.6636). Mechanical power and heart rate may provide complementary information for estimating metabolic demand during manual wheelchair propulsion. However, the model was developed in a small exploratory sample, was only internally evaluated, and requires external validation before practical application.
PubMed2026
A Visual Support System for Stent-Assisted Treatment of Cerebral Aneurysms Using 3D Imaging and Augmented Reality.
Precise visualization of vascular structures is crucial for planning and performing stent-assisted interventions in cerebral aneurysms. Traditional 2D imaging frequently lacks sufficient spatial information, which restricts clinicians' ability to evaluate vessel morphology, branching patterns, and how stents would interact with the vessel wall. This paper introduces an integrated visual support platform that unites workflow-driven medical image processing, numerical simulation of stent deployment, and augmented reality (AR) visualization via Microsoft HoloLens. The platform features a configurable workflow engine to handle medical data processing covering: vessel segmentation, medial-axis computation, mesh creation, and region-of-interest definition, followed by interactive simulation of stent expansion using computationally efficient approximation techniques. The resulting 3D models of the vasculature and stent are displayed in a dedicated AR environment that supports gesture-based interaction, real-time stent adjustment, and immersive navigation inside the vessels. This system provides intraoperative decision support by enabling clinicians to analyze stent placement, aneurysm coverage, and possible geometric limitations, and it also supports replay of simulations for training and educational purposes. The work shows that integrating 3D imaging, numerical modeling of stent-vessel interactions, and augmented reality can markedly improve precision, safety, and situational awareness in neurointerventional procedures.
PubMed2026
Buried K-wires in paediatric fracture fixation: infection and complication rates in a large cohort.
PURPOSE: Kirschner wires (K-wires) are widely used for fracture fixation in paediatric trauma surgery. Although infectious complications are uncommon, they remain clinically relevant. Subcutaneous burial of K-wires has been proposed to reduce the risk of infection, but robust data from large paediatric cohorts remain limited. This study aimed to evaluate infectious and non-infectious complications following routine use of buried K-wires in children. METHODS: In this retrospective cohort study, paediatric patients (≤ 18 years) who underwent fracture fixation with routinely buried K-wires at a Level I trauma centre between January 2005 and November 2025 were included. Only patients with complete follow-up, including radiographic assessment and wire removal at the study institution, were analysed. The primary outcome was postoperative infection related to K-wire fixation. Secondary outcomes included non-infectious wound complications, reoperations, and fracture healing. RESULTS: A total of 634 patients with a mean age of 10.2 ± 4.2 years were included; 96.8% sustained upper-extremity fractures. One superficial infection occurred (0.16%; 95% CI 0.00-0.88%), with no cases of deep infection or osteomyelitis. Secondary skin perforation without infection was observed in 8.36%, and minor wound-healing disturbances in 0.32%. No infection-related reoperations were required, and all fractures healed radiographically. CONCLUSIONS: Routine subcutaneous burial of K-wires in paediatric fracture fixation was associated with an exceptionally low rate of infectious complications and no cases of osteomyelitis in this large retrospective cohort. However, secondary skin perforation occurred in 8.36% of patients, and planned wire removal under anaesthesia represents an additional procedural burden. Given the predominance of upper-extremity fractures and the absence of an exposed-wire control group, these findings should be interpreted within the studied population and do not establish superiority over exposed K-wires.
PubMed2026
Early structured rehabilitation following open retromuscular incisional hernia repair: a prospective randomized controlled trial.
INTRODUCTION: Incisional hernias remain a common postoperative problem for general surgeons. In recent years, early postoperative rehabilitation has gained increasing attention as a potential strategy to enhance recovery following abdominal wall reconstruction. This study aimed to evaluate whether structured early postoperative rehabilitation improves objectively measured abdominal wall and trunk muscle functional recovery after open retromuscular (Rives-Stoppa) incisional hernia repair while maintaining postoperative safety. MATERIALS AND METHODS: Thirty adults undergoing elective open retromuscular (Rives-Stoppa) repair of European Hernia Society W2 incisional hernias were randomized to structured postoperative rehabilitation (n = 15) or standard postoperative care (n = 15). Baseline and approximately 2-month postoperative trunk muscle performance were assessed using Biodex dynamometry. The rehabilitation program consisted of supervised, progressive exercises initiated at postoperative week 3 and delivered according to the standardized study protocol. The primary analyses compared individual patient-level changes in trunk flexor and extensor peak torque between groups at angular velocities of 60°/s and 90°/s using the Mann-Whitney U test. Secondary outcomes included additional dynamometric parameters and postoperative clinical outcomes. RESULTS: Thirty patients were included in the analysis. Between-group comparisons demonstrated a statistically significant difference only for the change in trunk flexor peak torque at 90°/s, favoring the rehabilitation group (Δ + 34.3 vs. - 3.8 N·m; Mann-Whitney U = 80.0, p = 0.023). Between-group differences were not statistically significant for trunk flexor peak torque at 60°/s (p = 0.081), trunk extensor peak torque at 60°/s (p = 0.224), or trunk extensor peak torque at 90°/s (p = 0.254). Because four primary peak-torque comparisons were performed without adjustment for multiplicity, the isolated statistically significant finding should be interpreted cautiously. No apparent increase in postoperative complications was observed in the rehabilitation group. Two recurrences occurred during the 12-month follow-up, both in the control group. However, the study was not powered to evaluate recurrence. CONCLUSIONS: Structured early postoperative rehabilitation was associated with a greater improvement in trunk flexor peak torque at 90°/s compared with standard postoperative care. No statistically significant between-group differences were observed for the other assessed peak-torque outcomes. Given the small sample size, baseline imbalances, multiple unadjusted comparisons, and effort-dependent nature of dynamometric testing, the findings should be considered exploratory and hypothesis-generating. Larger adequately powered randomized trials incorporating patient-centered outcomes are required.
PubMed2026
Increased screw backout with non-inlay design retrograde femoral nails.
PURPOSE: To compare the rate of distal interlocking screw backout between inlay-design and non-inlay design retrograde intramedullary femoral nails in the treatment of distal femur fractures. METHODS: Adults with AO/OTA 33 distal femur fractures treated with a retrograde ultra-high molecular weight polyethylene (UHMWPE) inlay-design nail (RFNA; DePuy Synthes) or a non-inlay design nail (T2 SCN; Stryker) between January 2015 and June 2025 at a single Level I academic trauma center with a minimum follow-up of 3 months were retrospectively reviewed. The primary outcome was distal interlocking screw backout. Secondary outcomes included time to backout diagnosis, backout distance, and rate of symptomatic screw removal. All outcomes were compared between the inlay-design and the non-inlay design cohorts. RESULTS: A total of 134 patients were included: 76 in the inlay cohort and 58 in the non-inlay cohort. The inlay cohort demonstrated a significantly lower rate of distal interlocking screw backout compared to the non-inlay cohort (5.3% vs. 19.0%; RR 0.28, 95% CI 0.09-0.83; p = 0.02), corresponding to a 72.2% relative risk reduction. Time to backout diagnosis and backout distance did not differ significantly between designs. The rate of symptomatic screw removal was significantly lower in the inlay cohort (1.3% vs. 10.3%; p = 0.04). The distal transverse screw was the most common screw with backout in both cohorts. CONCLUSION: The ultra-high molecular weight polyethylene (UHMWPE) inlay at the distal interlocking interface of a retrograde femoral nail was associated with significantly lower rates of distal interlocking screw backout and symptomatic screw removal. When backout did occur, polyethylene inlay did not impact time to diagnosis and backout distance.