Search Results (2,305)

Balance is a fundamental quality for trampoline athletes, the basis for completing complex skills. We aimed to compare balance control strategies between elite trampolinists (ETs) and sub-elite trampolinists (Sub-ET) by integrating linear and nonlinear center of pressure (COP) measures across stable and unstable surfaces. Twenty-four male athletes (12 ET, 12 Sub-ET) participated. Each participant performed 15-s static standing trials with eyes closed on a firm surface (FI) and a foam surface (FO). COP parameters were extracted, including ellipse area, sway velocity, sway range, and sample entropy (SampEn) in the medio-lateral (ML) and antero-posterior (AP) directions. Repeated-measures ANOVA was applied to examine the effects of group and surface condition. Linear analyses indicated that ET athletes exhibited greater sway amplitudes and faster velocities than Sub-ET athletes, with both groups showing larger sway on FO compared with FI. Nonlinear analyses revealed that ET athletes demonstrated lower SampEn, suggesting more structured and automatized control strategies. ET athletes maintained consistent entropy across both conditions, reflecting stronger adaptability to unstable surfaces. These results emphasize the importance of combining linear and nonlinear measures in balance assessment and suggest that incorporating unstable or trampoline-like surfaces into training may enhance adaptability, improve performance, and reduce injury risk. Full article

Background: Primary healthcare plays a vital role in delivering pediatric services. This study aimed to examine the epidemiology of pediatric visits to a model primary healthcare (PHC) center and identify factors associated with referrals to specialized care. Methods: A retrospective chart review was conducted for all pediatric visits between January and December 2024 at a model PHC center affiliated with an academic medical city in the Kingdom of Saudi Arabia (KSA). Descriptive statistics, chi-squared tests, and multivariable logistic regression were used to assess predictors of referral. Diagnoses were categorized, and clinic types stratified to explore seasonal and diagnostic trends. Ethical approval was obtained prior to data access. Results: A total of 4520 pediatric visits were analyzed. Just over half of the patients were female, and the largest age group was school-aged children (38.1%). Visit frequency peaked in winter and spring. Most visits (78.4%) were first-time consultations, and the majority occurred in general family medicine clinics. Overall, 10.95% of visits resulted in referrals. Referrals were more common during outpatient consultations than urgent care visits and were strongly associated with specific diagnoses, particularly neurological (aOR = 11.73), eye (aOR = 8.77), ENT-related conditions (aOR = 7.73), and genitourinary or pubertal conditions (aOR = 6.60). Demographic variables such as sex and nationality were not significant predictors. Conclusions: The observed referral rate may indicate effective gatekeeping within Saudi primary care, though referral frequency alone cannot determine appropriateness. Enhancing diagnostic support and behavioral health integration could further optimize referral practices and support Vision 2030 goals for strengthened child health services. Full article

Background: The purpose of this study was to assess differences in clinical symptoms and signs of DED in non-adherent to treatment patients to describe long-term disease progression. Methods: 120 patients previously diagnosed with Dry Eye Disease (DED) were contacted to undergo a second eye examination. The final included participants were classified into three groups based on when the second examination was scheduled: 4 years (Group 1; n = 33), 6 years (Group 2; n = 18) or 8 years (Group 3; n = 37) since the diagnostic visit. All included participants were classified as ‘non-adherent to DED treatment’, defined as patients who reported not following their prescribed DED therapy. In both examinations, Ocular Surface Disease Index (OSDI) questionnaire, tear film osmolarity, inter-eye osmolarity (osmolarity|OD-OS|), Fluorescein Break-Up Time (FBUT), Maximum Blink Interval (MBI) and corneal staining were evaluated. Results: OSDI score improved after 4 years of DED diagnosis (Group 1, mean difference close to 12 points, p < 0.001) and after 8 years (Group 3, mean difference of 9 points, p < 0.001), but remained stable after 6 years (Group 2, p = 0.328). Osmolarity worsened only after 6 years of DED diagnosis (Group 2, mean difference of 13.2 mOsm/L, p = 0.011), while osmolarity|OD–OS| showed no change (all p ≥ 0.231). FBUT values were stable across all groups (all p ≥ 0.265). MBI increased after 4 and 8 years of DED diagnosis (Groups 1 and 3, p ≤ 0.003), but not after 6 years (Group 2, p = 0.391). Corneal staining worsened after 8 years of DED diagnosis (Group 3, 0.55 points, p = 0.011), with no changes at 4 or 6 years (Groups 1 and 2, both p ≥ 0.318). Conclusions: In non-adherent DED patients, osmolarity|OD-OS| and tear film stability remain stable during the natural course of the disease, while ocular surface damage increases. However, the subjective symptomatology and the nociceptive blink reflex due to ocular discomfort decreased since the diagnostic visit. Full article

Background: Retinal dystrophies are often challenging to diagnose. At early stages, they may resemble benign retinal pigment epithelium alterations and drusen present in otherwise healthy individuals. With the increased incidence of autoimmunity-related disorders and new treatments for retinal dystrophies on the horizon, thorough investigations and making the correct diagnosis in time are particularly important for these patients. Case report: A 44-year-old myopic female was admitted to the Ophthalmology Department with a 3-week history of painless blurred vision in her right eye. Fundoscopic examination revealed the presence of optic disc edema in this eye with pigmentary and atrophic changes in the macular regions of both eyes. She had no prior ophthalmic history nor systemic comorbidities known at the time. Marked hyperglycemia and renal angiomyolipoma were discovered subsequently. Ultimately, a diagnosis of Maternally Inherited Diabetes and Deafness was made. Discussion and Conclusion: Maternally Inherited Diabetes and Deafness is a rare mitochondrial disorder that should be considered in the differential diagnosis of retinal dystrophies, particularly due to multi-organ syndromes they can occur with, requiring collaborative medical care of several specialists. Integrating the findings and comparing them with other online sources facilitates clinical differential and treatment selection, eventually promoting faster accurate diagnosis of patients. It is especially important because of a long waiting time for results of genetic testing, while ophthalmic pathology can be the first sign of the disease. Full article

Background/Objectives: The purpose of this study was to evaluate the implementation of ultra-widefield swept-source optical coherence tomography (SS-OCT) in characterizing peripheral retinal degenerations and rhegmatogenous lesions, and to assess its potential implications for clinical management. These lesions are often challenging to visualize with conventional techniques, highlighting the need for advanced imaging modalities to improve detection and characterization. Methods: We conducted a retrospective observational study involving patients diagnosed with peripheral retinal degenerations and/or rhegmatogenous lesions referred to our center. All participants underwent comprehensive ophthalmological evaluation, including slit-lamp biomicroscopy, dilated fundus examination, and peripheral SS-OCT imaging. Key parameters assessed included the presence of vitreoretinal attachment, vitreous traction, full-thickness retinal defects, and subretinal fluid associated with the peripheral lesions under investigation. Results: A total of 107 eyes from 95 patients were included. The mean spherical equivalent was −2.18 ± 2.5 diopters, and mean BCVA was 0.03 ± 0.11. Peripheral SS-OCT imaging successfully captured and characterized 130 retinal lesions, including retinal tears (n = 34), lattice degeneration (n = 25), retinal holes (n = 21), peripheral retinoschisis (n = 17), and schisis/detachment (n = 7). Less commonly observed lesions were snail track degeneration (n = 4), white without pressure (n = 4) microcystic degeneration (n = 2), dialysis (n = 2), condensed vitreous (n = 2), and paving stone degeneration (n = 1). SS-OCT provided high-resolution visualization of the peripheral retina and vitreoretinal interface, revealing findings such as vitreous traction, everted edges in retinal holes, and associated subretinal fluid, some of which were not clinically detectable and, in several cases, directly influenced management decisions. Conclusions: Ultra-widefield SS-OCT significantly enhanced the visualization of peripheral retinal degenerations and rhegmatogenous lesions, providing clinically meaningful details that may influence diagnosis and clinical decision-making. Full article

Previous research has shown that the perceptual span in Chinese reading extends three characters to the right of the fixation point. However, little is known regarding the types of preview information that can be extracted from such a distant position; namely, the character at the N + 3 position. Using the parafoveal priming paradigm combined with eye-tracking technology, we manipulated the preview type and preview duration to examine whether Chinese readers could extract orthographic, phonological, and semantic information from the character at the N + 3 position across three experiments. Experiment 1 revealed an orthographic preview cost: orthographically similar previews delayed the target character recognition compared to unrelated previews. Experiment 2 showed no evidence of phonological preview effects. Experiment 3 demonstrated a semantic preview benefit: semantically related previews significantly facilitated the target character recognition relative to unrelated previews. Taken together, these findings indicate that Chinese readers are able to extract orthographic and semantic, but not phonological, information from a distant parafoveal position. Full article

Background/Objectives: Normative values of ocular parameters can be influenced by a variety of factors. This study evaluates the relationship of axial length (AL), anterior and posterior corneal curvature, anterior chamber, and corneal thickness variables with age, spherical equivalent (SE), and gender. Methods: A retrospective cohort study at three hospitals identified patients from June 2019 to July 2022. Eyes with no prior history of surgery and anterior segment pathology were included, with one eye per patient being examined by Pentacam AXL Wave (Oculus, Germany). Results: The 1075 patients included had a mean age of 52.9 (± 19.5 years), with 41.5% (446) identified as males. Compared to all variables, anterior chamber angle was most strongly associated with age, with a Spearman’s correlation coefficient (r) of −0.62 (p < 0.001), while AL was most strongly correlated with SE (r = −0.75, p < 0.001). The mean radius of anterior corneal curvature showed a significant positive correlation with SE (r = 0.08, p = 0.013). Between the two genders, males had larger median anterior chamber volume (157.8 versus 147.9 mm³, p < 0.001), depth (p < 0.05 internal and external), AL (24.2 versus 23.7 mm, p < 0.001), and flatter corneas (p < 0.05 anteriorly and posteriorly) compared to females. Conclusions: Age and SE were significantly negatively correlated with AL and anterior chamber parameters. While males showed longer AL and deeper and larger anterior chambers, females had steeper corneas but similar anterior chamber angles. The differences warrant considering age, SE, and gender when interpreting a patient’s examinations against normative data. Full article

Background: Adults with congenital heart disease (CHD) are living longer but face increasing comorbidities. Sleep is a key health determinant, yet objective data in CHD remain limited. This study compared sleep characteristics of adults with CHD and controls using wearable technology and a Health Application Programming Interface (API). Methods: A total of 175 CHD patients (33.1 ± 10.3 years, 49.2% women) and 52 controls (34.4 ± 12.4 years, 40.4% women) completed seven continuous days of wrist-worn Garmin Vivosmart^® 5 during routine follow-up at the TUM Klinikum Deutsches Herzzentrum. Sleep duration, phases, Sleep Scores, and weekday-weekend differences were analyzed, and multivariate models examined clinical and demographic predictors. Results: Total sleep duration and rapid eye movement (REM) sleep did not differ between groups. CHD patients had more deep sleep (83 ± 19 vs. 75 ± 16 min, p = 0.004) but lower Sleep Scores (74 ± 9 vs. 77 ± 9, p = 0.041). Within CHDs, deep sleep was higher on weekends than on weekdays (p = 0.033). Multivariate analyses showed no overall group effect, but age (p = 0.016), sex (p = 0.013), and body mass index (BMI; p < 0.001) significantly predicted sleep outcomes. Regression analyses in CHDs revealed female sex associated with longer REM sleep (p < 0.001), while higher BMI consistently predicted poorer outcomes. Disease severity was linked to lower Sleep Scores. Conclusions: Sleep in CHDs is broadly comparable to controls, but BMI, sex, and disease severity significantly shape outcomes. The additional variability between weekends and weekdays and a higher risk of sleep-disordered breathing, according to the literature, underscores that sleep is an underestimated target for prevention and clinical care in CHD. Full article

Background/Objectives: Evaluate outcomes and treatment patterns with 2 mg intravitreal aflibercept injection among patients who completed the phase 3 PANORAMA trial and enrolled in the VOYAGE (ClinicalTrials.gov identifier, NCT04708145; 12 January 2021) long-term extension study. Methods: During VOYAGE, patients were evaluated every 16 weeks and treated with 2 mg intravitreal aflibercept injection as needed depending on ophthalmoscopic examination findings. Those with no history of panretinal photocoagulation (PRP) received aflibercept if their clinician-determined diabetic retinopathy severity scale (DRSS) level was ≥47. Patients with a history of PRP received aflibercept if active neovascularization was present. New or worsening diabetic retinopathy (DR) severity prompted more frequent treatment. Results: 320 patients (1 eye per patient) from 87 sites completed the PANORAMA trial. Of these, 41 patients (13% of PANORAMA completers) from 14 sites (16%) enrolled in VOYAGE after a mean interim period of 33.7 months, and 35 patients (85%) completed study visits through 1 year. At year 1 in VOYAGE, the mean number of anti-vascular endothelial growth factor (VEGF) injections increased from 1.1 per year during the interim period to 3.4 per year and was associated with stabilization or improvement in DRSS level in 81% (26/32) of patients. Mean best-corrected visual acuity (BCVA) remained relatively stable, and mean central subfield thickness (CST) improved by 24.4 µm to 269.5 μm through year 1 of VOYAGE. There were no unexpected safety events. Conclusions: Following a mean of 3 years of routine clinical care with associated declines in DRSS level, CST, and BCVA, stabilization of DRSS level and BCVA with reductions in CST was achieved through year 1 of the VOYAGE extension study, with a concurrent increase in aflibercept dosing frequency. Full article

Objectives: Facial paralysis is a devastating yet frequent complication of skull base surgery, significantly impacting quality of life through functional impairments and psychosocial consequences. Management is complex and requires an individualized approach based on duration of paralysis, etiology and extent of nerve injury, overall prognosis, and rehabilitative goals. This review provides a comprehensive overview of current strategies for managing post-skull base surgery facial paralysis. Methods: A narrative review of the literature was performed, analyzing surgical reanimation techniques (nerve grafting, nerve transfers, regional and free muscle transfers), static procedures for facial symmetry and ocular protection, and non-surgical interventions such as physical therapy, botulinum toxin injections, and psychological support. Key criteria guiding treatment selection, including muscle viability and timing since injury, were examined. Results: Dynamic surgical approaches remain central to restoring movement. Nerve grafting and transfers are effective when viable musculature is present, whereas regional or free muscle transfers are required in long-standing paralysis with irreversible atrophy. Static procedures provide adjunctive improvements in resting symmetry and eye protection. Non-surgical strategies, including rehabilitation therapy and botulinum toxin, enhance functional outcomes and reduce synkinesis. Psychological counseling addresses the profound emotional burden associated with facial disfigurement. Across modalities, individualized treatment planning is crucial. Conclusions: Management of facial paralysis after skull base surgery demands a multidisciplinary, patient-centered approach. Combining surgical and non-surgical interventions optimizes functional and aesthetic outcomes, helping restore both facial movement and psychosocial well-being. Full article

Current research and development in understanding road users’ driving behaviors play a key role in improving traffic safety. Recently, several driving simulators have been employed as a suitable approach to investigate several drivers’ responses in challenging traffic scenarios. Although professional drivers represent a particular category among driving populations, the body of literature about their comparative behavioral and psychological characteristics remains limited. This study examined the differences in driving performance and visual and physiological responses between civilian and professional drivers in a simulated environment. A total of 30 drivers, with an equal split between professional and civilian categories, took part in a series of driving simulations. The simulations incorporated various infrastructure types, including four cone avoidance tasks and a high-speed motorway task. This study collected comprehensive data on performance metrics, hand usage, heart rate, and eye movements. Eye-tracking technology was used to measure visual attention. The findings revealed that during cone avoidance scenarios, civilian drivers exhibited a similar performance, visual behavior, and physiological response, except for the speed, experiment duration, and throttle, to professional drivers. In the motorway scenario, all metrics showed no significant difference between the two driver groups. These results highlight the need for cautious interpretation, particularly given the limitations of the sample. Revalidation is needed in larger studies, especially for understanding the differences between drivers’ metrics, which is crucial to elevate drivers’ safety, and assessing training programs in Hungary. Full article

Human allogeneic umbilical cord blood serum stands out as a potent adjunct to conventional therapies for ocular surface disorders related to severe Dry Eye Disease. By expediting ocular surface regeneration and fostering epithelial integrity, umbilical cord blood serum not only enhances subjective patient experiences but also improves objective clinical indicators. This makes it particularly useful in patients with corneal ulcers through ocular surface regeneration and anti-inflammatory activity. This retrospective, interventional, non-randomized clinical study aims to explore the efficacy of allogenic umbilical cord blood serum in patients who had previously received other treatments unsuccessfully. This study was a retrospective, non-comparative, interventional clinical study involving 55 patients (35 females and 20 males) aged 18–82 years with severe Dry Eye Disease who were unresponsive to standard treatments. The study was conducted at Eye Center “G.B. Morgagni-DSV”, Catania, Italy. Patients were categorized based on the etiology of severe Dry Eye Disease into four groups: group I consisted of 26 patients with filamentary keratitis and corneal ulcers associated with rheumatologic diseases such as Sjogren’s syndrome and systemic sclerosis; group II comprised 15 patients with graft-versus-host disease; group III consisted of 10 patients with corneal neurotrophic ulcers; group IV included four patients with Steven–Johnson syndrome. Outcomes evaluated before and after treatment were OSDI (Ocular Surface Disease Index) and SANDE (Symptom Assessment in Dry Eye) Questionnaires, VAS (Visual Analog Scale), Slit-Lamp Examination, Esthesiometry, Lissamine Green Staining, NIBUT (Non-Invasive Break-Up Time) and BUT, Fluorescein Staining with Photography and Oxford Classification, Schirmer Test, Best-Corrected Visual Acuity (BCVA), Meibography. We observed a significant improvement in SANDE, VAS and OSDI questionnaires, Schirmer Test, BUT, BCVA, and Oxford classification after treatment with allogeneic cord blood serum eyedrops. Clinical variables, such as corneal inflammation, conjunctivalization, corneal neovascularization, or pain, were also considered individually. Nevertheless, pain and inflammation reduced markedly over time until completely healed in all cases. Our study highlights the remarkable efficacy of allogeneic cord blood serum eyedrops in patients with severe Dry Eye Disease who have shown absent or inadequate response to usual treatments for dry eye. This underscores the need for further comprehensive investigations in this field. Full article

Myotonic Dystrophy type 1 (DM1) is a complex disease affecting multiple tissues, including skeletal and cardiac muscles, the brain and the eyes. DM1 results from an expansion of CTG repeats in the 3′ UTR of the DMPK gene. Previously, we described that the small-molecule inhibitor of GSK3β, tideglusib (TG), reduces DM1 pathology in DM1 cell and mouse models by correcting the GSK3β-CUGBP1 pathway, decreasing the mutant CUG-containing RNA. Respectively, clinical trials using TG showed promising results for patients with congenital DM1 (CDM1). The drug development in DM1 human studies needs specific and noninvasive biomarkers. We examined the blood levels of active GSK3β in different clinical forms of DM1 and found an increase in active GSK3β in the peripheral blood mononuclear cells (PBMCs) in patients with CDM1, juvenile DM1 and adult-onset DM1 vs. unaffected patients. The blood levels of active GSK3β correlate with the length of CTG repeats and severity of muscle weakness. Thrombospondin and TGFβ, linked to the TG-GSK3β pathway in DM1, are also elevated in the DM1 patients’ blood. These findings show that the blood levels of active GSK3β might be developed as a potential noninvasive biomarker of muscle weakness in DM1. Full article

In mathematics, and in learning mathematics, representations (texts, formulae, and figures) play a vital role. Eye-tracking is a promising approach for studying how representations are attended to in the context of mathematics learning. The focus of the research reported here is on the methodological and conceptual challenges that arise when analysing students’ engagement with different kinds of representations using such data. The study critically examines some of these issues through a case study of three engineering students engaging with an instructional document introducing double integrals. This study reports that not only the characteristics of different types of representations affect students’ engagement with areas of interests (AOIs), but also methodological decisions, such as how AOIs are defined, will be consequential for interpretations of that engagement. This shows that both technical parameters and the inherent nature of the representations themselves must be considered when defining AOIs and analysing students’ engagement with representations. The findings offer practical considerations for designing and analysing eye-tracking studies when students’ engagement with different representations is in focus. Full article

Background: Visual, vestibular, proprioceptive and cutaneous sensory information is important for postural control during quiet stance. When the reliability of one source of sensory information used to detect self-motion for postural control is reduced, there may be a reweighting of inputs within and/or across the remaining sensory systems determining self-motion for postural control. Muscle vibration, which creates an illusion of muscle stretch and a compensatory movement to shorten the vibrated muscle, may be used to determine the weighting of muscle spindle Ia proprioception in postural control. The objective of this study was to determine the effect of vision occlusion on triceps surae (TS) Ia proprioceptive weighting in postural control during quiet stance, utilizing an 80 Hz muscle vibration stimulus and a quantitative measure of the body’s anterior to posterior ground center of pressure (COP) response to TS muscle vibration in subjects standing freely. Methods: Subjects (N = 41; mean (standard deviation), 19.6(2.0) years) were examined as they stood with eyes open (EO) or eyes closed (EC). Ground COP was measured during quiet standing with and without bilateral vibration of the TS muscles. Results: The mean backward COP shift induced by TS vibration was significantly greater during the EC condition compared to EO (EC: −4.93(1.62) centimeters; EO: −3.21(1.33) centimeters; p = 6.85 × 10⁻¹⁰; Cohen’s d = 1.29). Thirty-seven subjects increased, and two subjects decreased their vibration-induced COP backward shift in the EC condition compared to EO, although the magnitude of the change varied. Conclusions: The results support the idea that, for most young subjects, there is an increased triceps surae Ia proprioceptive weighting for postural control during EC stance, possibly due to the need for postural control to depend more on non-visual feedback. Full article