Search Results (217)

Objectives: The present study aimed to investigate changes in forearm muscle activity associated with short-term go-kart driving (680 m) and its potential effect on muscle activation patterns. Methods: Eleven male karting league drivers (mean age: 23.18 ± 1.40 years; body mass: 83.27 ± 10.98 kg; height: 182.73 ± 5.66 cm) volunteered to participate. Electromyographic (EMG) activity was recorded from four muscles: extensor carpi radialis (ECR), extensor carpi ulnaris (ECU), flexor carpi radialis (FCR), and flexor carpi ulnaris (FCU). Baseline EMG was measured before the intervention, followed by two consecutive kart-driving sessions on a 680 m closed track. Post-exercise EMG data were then collected. A repeated-measures analysis of covariance (ANCOVA) was used to analyze the effects of time (pre vs. post) while controlling for cumulative race time as a covariate. Results: A significant time effect with cumulative time as a covariate was observed, particularly in the ECR and ECU muscles on both the left and right sides. Notable findings include increases in maximum and mean activity of the left and right ECR (e.g., ECR right max: F = 51.57; p < 0.001; η² = 0.851) and ECU (e.g., ECU right max: F = 36.170; p < 0.001; η² = 0.801). Additionally, a significant increase was found in the maximum activation of the left FCR (F = 11.019; p = 0.009; η² = 0.550, which remained significant after controlling for total driving time. This heightened activation likely reflects an acute neuromuscular fatigue response to the demands of kart steering, rather than a long-term adaptation. Conclusions: The findings suggest that even short bouts of kart driving can induce measurable changes in neuromuscular activation of the forearm muscles, particularly in those involved in grip control and steering stability. This highlights the physical demands of karting and its potential impact on the upper limb muscle conditioning. Full article

Background and Objectives: This study aimed to assess the frequency and distribution of facial bone injuries in terms of age, sex, residence, location, and etiology in the north-eastern region of Romania. Materials and Methods: This retrospective study was conducted within the Oral and Maxillofacial Clinics of “Sf. Spiridon” Hospital, Iași. The study group included 701 subjects (mean age 41.02 ± 18.45; sex: 603 males and 98 females) who were diagnosed with an orbital wall disorder. The epidemiological data on orbital wall fractures—including sociodemographic features, etiology, and location—were statistically analyzed. Results: The prevalence of orbital pathology was 1.47% congenital cases, 1.75% tumors, and 96.7% orbital fractures. The distribution of sex, age group, residence, and orbital localization varied significantly among the three diagnostic categories: tumors, congenital conditions, and fractures. Regarding sex, fractures were significantly more frequent in males (87.0%) compared to congenital cases (70.0%) and tumors (41.7%), while tumors showed a female predominance (58.3%) (p < 0.001). Congenital conditions predominantly affected patients under 20 years old (90.0%), whereas fractures were more evenly distributed across age groups, with higher frequencies between 31 and 50 years. In contrast, tumors involving the orbital walls were more frequent in older patients, with 33.3% in the 61–70 age group and 25.0% over 70 years. Regarding orbital localization, fractures were more likely to be bilateral (37.3%) or on the right side (44.3%), whereas congenital orbital defects and orbital tumors were predominantly unilateral and left-sided (70.0% and 66.7%, respectively). Bilateral involvement was rare in congenital cases (10.0%) and absent in tumors. Conclusions: The data support the finding that men are significantly more prone to trauma and orbital fractures, especially as a result of interpersonal violence and accidents, highlighting the need for preventive measures tailored to sex and socio-professional context. Full article

Background and Objectives: The foramen lacerum (FL), located at the base of the skull, is generally considered the safest anatomical pathway for accessing the internal carotid artery (ICA) and the vidian canal (VC) during surgical procedures. We aimed to evaluate the morphometric characteristics of FL, VC, and related structures. Materials and Methods: This study utilized cranial computed tomography (CT) images obtained between 2016 and 2018 at Balıkesir University Faculty of Medicine for various clinical indications. A retrospective analysis was performed on cranial CT images from 77 patients, comprising 42 females and 35 males. The length and width of the FL, the length of the VC, and the angles formed between the VC and the pterygosphenoidal fissure and between the VC and the palatovaginal canal were measured. All measurements were performed using the three-dimensional (3D) Slicer software to ensure precision and consistency. Results: Males had significantly longer right and left FL lengths and left FL width than females (p < 0.05). No significant gender-based differences were found in VC length on either side. The angle between the VC and the pterygosphenoidal fissure was significantly larger in males (p < 0.05). Additionally, increased FL length and width were significantly correlated with larger angles between the VC and the pterygosphenoidal fissure in all subjects (p < 0.05). The anatomical variations of the FL Type 1 (normal) were identified as the most prevalent configuration across the study population. Type 2 (canal-shaped) ranked as the second most frequent variant in females, whereas Type 3 (bridged) was the second most commonly observed form in males. Conclusions: Preoperative identification of FL anatomical variations, which differ between individuals and sexes, may enhance the safety of skull base surgeries and minimize postoperative complications. The morphometric data presented in this study provide valuable guidance for clinicians planning interventions involving the FL and surrounding structures, and contribute valuable insights to anatomists regarding regional morphology. Full article

In the current clinical psychiatric practice in most of the world, treatment decisions are based on a person’s capacity to make these decisions. When a person lacks the capacity to understand and appreciate treatment decisions, in many jurisdictions a third-party substitute decision maker (SDM) is appointed on his or her behalf in order to promote safety and optimal clinical outcome. In Ontario, Canada, for example, family members (typically) or public guardians are appointed as SDMs, and they form an integral part of the medical–legal system in psychiatric care. Clinicians working with both patients and their SDMs in these circumstances encounter unique challenges and deliver care in specialized ways, though little research has focused on their experiences and reflections. Based on focus group data, this qualitative study uses a descriptive and interpretative phenomenological approach through thematic analysis to examine these aspects from clinicians working in both inpatient and outpatient settings of an urban teaching hospital’s psychiatric services in Toronto, Canada. Seven key themes emerged: Clinicians (1) appreciate hardships and challenges in lives of SDMs and patients—including the challenging emotions and experiences on both sides, and the risks and relational changes from being an SDM; (2) have an understanding of the patient’s situation and respect for patient autonomy and wishes—they are promoter of autonomy and mindful of patients’ prior wishes amidst patients’ fluctuating capacity, facilitating communication, keeping patients informed and promoting transitioning from SDM to self-determination; (3) have a special working relationship with family SDMs—including supporting SDMs, avoiding harm from delayed or denied treatment, and educating and collaborating with SDMs while maintaining professional boundaries; (4) at times find it difficult working with SDMs—stemming from working with over-involved or uninterested family SDMs, coping with perceived poor SDM decisions, and they sometimes ponder if SDMs are necessary; (5) delineate differences between family and Public Guardian and Trustee (PGT) SDMs—they see PGT as closely aligned with medical decision makers, while family SDMs are more intimately involved and more likely to disagree with a physician’s recommendation; (6) recognize the importance of the SDM role in various contexts—through seeing social values in having SDMs, and acknowledging that having SDMS help them to feel better about their actions as they work to protect the patients; and (7) express ideas on how to improve the current system—at public, societal, and family SDM levels. We conclude that clinicians have unique mediating roles, with privilege and responsibility in understanding the different roles and challenges patients and SDMs face, and have opportunities to improve patient and SDM experiences, clinical outcomes, carry out education, and advocate for ethically just decisions. These clinical roles also come with frustration, discomfort, moral distress and at times vicarious trauma. Clinicians’ unique understanding of this complex and nuanced intersection of patient care provides insight into the core issues of autonomy, duty to care and protect, advocacy, and emotional dynamics involved in this sector as a larger philosophical and social movement to abolish SDMs, as advocated by the Convention on the Rights of Persons with Disability (CRPD), is taking place. We briefly discuss the role of supported decision making as an alternative as. Full article

Background and Objectives: Hepatolithiasis (HL), or intrahepatic bile duct stone disease, shows regional variation and is a rare condition in Western countries. While cases from East Asia are often linked to chronic biliary infections and brown pigment stones, Western HL more frequently involves cholesterol or black pigment stones, typically in the context of prior cholecystectomy, biliary interventions, or congenital anomalies. The disease is generally associated with significant morbidity, including recurrent cholangitis, biliary strictures, and risk of cholangiocarcinoma. This study aimed to characterize HL disease in an Italian case series. Materials and Methods: We retrospectively reviewed 1450 patients with biliary stone disease treated between 2010 and 2024. HL was diagnosed in 14 patients (0.96%). Clinical records, imaging (ultrasound, CT, magnetic resonance cholangiopancreatography—MRCP, cholangiography), bile cultures, and stone composition (categorized as cholesterol, brown pigment, black pigment, or mixed using FTIR/XRD) were analyzed. Results: Among the 14 patients (mean age: 60.1 years; 64.3% female), 71.4% presented with recurrent cholangitis, while 28.6% were asymptomatic. Stones were left-sided in 57.1%, right-sided in 21.4%, and bilateral in 21.4%. Stone composition was cholesterol/mixed in 50%, brown pigment in 35.7%, and black pigment in 14.3%. Risk factors for bile stasis were present in 71.4% of cases. Bile cultures (available in nine cases) were positive in 77.8%. MRCP was highly effective for diagnosis. Hepatectomy achieved complete resolution in 35.7% of patients with unilobar disease; endoscopic/percutaneous therapy had a 44.4% recurrence rate. Interestingly, no cholangiocarcinoma was observed over a median follow-up of 4.8 years. Conclusions: Western HL is a rare, heterogeneous disease with distinct features. Cholesterol-predominant, infection-negative cases suggest a metabolic or surgical etiology. Hepatectomy offers durable outcomes in unilobar disease. Advanced imaging (MRCP, cholangioscopy) and personalized strategies are key to effective management. Full article

Renal cell carcinoma (RCC) is the most common type of kidney cancer, accounting for a significant proportion of all cancer cases in Korea. This case report presents a unique instance of spontaneous dramatic tumor regression in a 42-year-old Korean male diagnosed with clear cell RCC. The patient initially presented with right lower back pain, weight loss, and a loss of appetite. Following systemic immunotherapy with nivolumab and ipilimumab, and right radical nephrectomy, the patient was diagnosed with metastatic clear cell RCC, with new metastatic lesions detected in the liver, and on the chest wall on follow-up imaging. Second-line systemic treatment with pazopanib was initiated. Shortly thereafter, the patient developed severe systemic inflammatory syndrome, resulting in a mental stupor and acute kidney failure. Intensive care, including continuous renal replacement therapy and high-dose immunosuppressants, was administered. The patient’s condition improved significantly with the intensive care regimen, leading to unintended tumor regression. These potentially fatal side effects occurred without infection, as confirmed by negative blood and urine cultures, and were attributed to the recent introduction of pazopanib. Follow-up imaging showed a significant reduction in hepatic metastatic lesions and the disappearance of chest wall nodules. This is the first reported case of RCC tumor regression following the side effects of pazopanib, underscoring the need for further studies into the immune mechanisms involved in RCC treatment and highlighting potential therapeutic strategies that leverage innate immune responses. Full article

This study systematically explored the impact of the spatial metaphor of time on attentional bias using visual order stimuli. Three experiments were conducted. Experiment 1, comprising Experiments 1a and 1b, investigated how the spatial metaphor of time shaped attentional bias across five disorder levels. Experiment 1a examined horizontal orientations, while Experiment 1b focused on vertical orientations. Experiment 2 compared attentional biases toward stimuli with the same disorder level in both orientations. The key distinction between the stimuli was that one represented short-term memory, while the other did not involve memory. Building on the findings of Experiment 2, Experiment 3 compared attentional biases between fully ordered structures (intact Gestalt structures) as non-memory representations and partially disordered structures in short-term memory. The results revealed a significant preference for future-related information, particularly on the right side in horizontal orientations. Short-term memory representations enhanced attentional attraction and triggered inhibition of return (IOR), while fully ordered structures attracted attention as effectively as partially disordered structures, thereby neutralizing attentional biases. Overall, this study contributes to a deeper understanding of the cognitive mechanisms underlying visual attention and the influence of temporal metaphors. Full article

Background: Symptomatic patients with unilateral obstructive coronary artery disease (CAD) identified by coronary computed tomography angiography (CCTA), involving either the right or left coronary artery, typically undergo per-protocol bilateral coronary visualization during invasive coronary angiography (ICA). However, a selective visualization approach may be sufficient. Objectives: The objectives of this study were to assess the accuracy of CCTA in excluding hemodynamically significant coronary stenosis in patients with unilateral CAD and to evaluate whether a CCTA-guided selective ICA strategy can reduce procedure time and contrast agent use. Methods: In this cross-sectional cohort study, 454 patients with clinically suspected stable CAD who underwent CCTA prior to ICA were included. The study population consisted of 190 patients with unilateral obstructive CAD, defined as ≥50% diameter stenosis on CCTA, and an absence of obstructive CAD on the contralateral side. ICA with invasive functional assessment was used as the reference standard. Results: CCTA demonstrated a high accuracy, 97.4% (95% CI: 94–99%), in excluding hemodynamically significant disease in the contralateral arteries without obstructive CAD. Compared to the conventional ICA approach, a CCTA-guided selective visualization strategy resulted in significant reductions in procedure time and contrast agent usage: procedure time and contrast agent usage were reduced by 27% (95% CI: 12.1–47.5%) and 46.8% (95% CI: 27.5–67.0%), respectively. Conclusions: In patients with unilateral obstructive CAD identified by CCTA, a CCTA-guided selective ICA visualization strategy is highly accurate in ruling out hemodynamically significant CAD on the contralateral side. Additionally, this unilateral ICA approach has the potential to reduce both contrast agent usage and procedure time compared to the conventional bilateral visualization strategy. Full article

Assume that A, $A_1$, and $A_2$ are three selfadjoint linear relations (multi-valued linear operators) in a certain complex Hilbert space. In this study, conditions are presented for the multi-valued operator equality $A=A_1{A}_2$ to hold when the inclusion $A\subset A_1{A}_2$ is assumed to be satisfied. The present study is strongly motivated by the invalidity of a classical result from A. Devinatz, A. E. Nussbaum, and J. von Neumann in the general case of selfadjoint linear relations. Two types of conditions for the aforementioned equality to hold are presented. Firstly, a condition is given in terms of the resolvent sets of the involved objects, which does not depend on the product structure of the right-hand side, $A_1{A}_2$. Secondly, a condition is also presented where the structure of the right-hand side is taken into account. This one is based on the notion of the $\mathfrak{L}$-stability of a linear operator under linear subspaces. It should be mentioned that the classical Devinatz–Nussbaum–von Neumann theorem is obtained as a particular case of one of the main results. Full article

Background/Objectives: The detection of unknown primary tumours in the palatine tonsils (PTs) on imaging relies heavily on asymmetry in size between the right and left sides, but the expected normal range in asymmetry is not well documented. This study aimed to document the expected range of asymmetry in the size of the PTs in adults without cancer. Methods: This retrospective study evaluated 250 pairs of normal PTs on MRIs of adults without head and neck cancer. The size (volume, V) of the PTs on the left and right sides were measured, and the percentage difference in volume (ΔV%) between the two sides was calculated. An additional analysis of PT volumes in 29 patients with ipsilateral early-stage palatine tonsillar cancer (PTCs) was performed. Results: In patients without PTC, the normal PTs had a mean volume of 3.0 ± 1.7 cm³, and there was a difference in size between the left and right PTs, showing a median ΔV% of 11.6% (range: 0.1–79.0%); most patients had a ΔV% of ≤40% (95%) for PTs. In patients with ipsilateral PTC, the normal PT had a smaller size compared with PTC (p < 0.01), showing a median ΔV% of 132.9% (range: 8.5–863.2%). Compared with patients without PTC, those with PTC showed a greater ΔV% (p < 0.01). An optimal ΔV% threshold of >39.6% achieved the best accuracy of 95% for identifying PTC. Conclusions: PTs are asymmetrical in size in adults without PTC. An additional analysis involving patients with PTC confirmed a threshold of ΔV% of 40% for PTs, which may be clinically valuable to help detect pathology using MRI. Full article

Background: Atrial septal defect (ASD) is a prevalent congenital heart condition, resulting in left-to-right shunting. Untreated ASDs may be associated with complications, including right-sided heart failure, pulmonary hypertension, and atrial arrhythmias. Percutaneous ASD closure, performed with various occluder devices, has become the preferred approach for symptomatic patients with suitable anatomy, yet data on device-specific efficacy and safety profiles remain limited. Methods: This study was a retrospective, single-center analysis involving patients who underwent percutaneous ASD closure between January 2000 and February 2023. Data on patient characteristics, indications for the procedure, procedural details, and clinical outcomes were extracted from electronic medical records. Endpoints included complications at the puncture site, pericardial effusion, atrial arrhythmias, device-related thrombus formation, and overall survival. Results: A total of 195 patients were included (mean age 53.6 ± 16.2 years; 60.5% female). Three different devices were used: Amplatzer ASD occluder (n = 111), Gore Septal Occluder (n = 67), and Occlutech ASD occluder (n = 17). Initial procedural success rate was 90.8%, with no significant differences observed between devices. Periprocedural complication rates were low and comparable across all devices. New-onset atrial fibrillation within the first month post-implantation occurred in 7.5% of patients with the Gore device, compared to 0.9% with the Amplatzer device (p = 0.03) and 0% with the Occlutech device. No statistically significant differences were observed among the devices regarding thrombus formation, late-onset pericardial effusion, device erosion, or stroke. Conclusions: Percutaneous ASD closure demonstrates high procedural success and low complication rates across different occluder devices, supporting its efficacy and safety as a treatment for adults. Although the Gore device showed a higher incidence of new-onset AF compared to the Amplatzer device, no significant differences were observed regarding thrombus formation, pericardial effusion, device erosion or stroke. Full article

The ‘forward lunge’ is a crucial movement in badminton that demands effective muscle activation and coordination. This study compared the muscle activation patterns of professional and amateur male badminton players during this movement. A total of 24 players (12 professionals and 12 amateurs) participated, with surface electromyography (sEMG) used to measure the activity of 12 muscles on the right side during the lunge. The movement was divided into swing and support phases based on ground reaction force data. The sEMG signals were analyzed using integral EMG (iEMG) and root-mean-square (RMS) amplitude, and muscle synergy patterns were extracted via non-negative matrix factorization (NNMF) and k-means clustering. The results showed significantly higher iEMG and RMS values in muscles such as the gastrocnemius, biceps femoris, gluteus maximus, external oblique, and latissimus dorsi in professional players (p < 0.05), while no significant differences were observed in the tibialis anterior, vastus medialis, vastus lateralis, deltoideus, biceps, and soleus muscles. Muscle synergy analysis revealed three activation patterns in the professional group, compared to two in the amateur group. The additional synergy pattern in the professional players involved greater recruitment of lower limb and core muscles, especially during the support phase. In contrast, the amateur group showed earlier muscle activation but exhibited less efficient coordination. These findings suggest that muscle activation and coordination patterns in the forward lunge are influenced by playing level, highlighting the importance of lower limb and core training for badminton athletes to optimize performance and reduce injury risk. Full article

One out of every hundred live births present with congenital heart abnormalities caused by the aberrant development of the embryonic cardiovascular system. The conserved zinc finger transcription factor proteins, which include GATA binding protein 5 (GATA5) and GATA binding protein (GATA6) play important roles in embryonic development and their inactivation may result in congenital heart defects (CHDs). In this study, we performed genotypic–phenotypic analyses in two families affected by right-sided CHD diagnosed by echocardiography imaging. Proband A presented with pulmonary valve stenosis, and proband B presented with complex CHD involving the right heart structures. For variant detection, we employed whole-genome single-nucleotide polymorphism (SNP) microarray and family-based whole-exome sequencing (WES) studies. Proband A is a full-term infant who was admitted to the neonatal intensive care unit (NICU) at five days of life for pulmonary valve stenosis (PVS). Genomic studies revealed a normal SNP microarray; however, quad WES analysis identified a novel heterozygous [Chr20:g.61041597C>G (p.Arg237Pro)] variant in the GATA5 gene. Further analysis confirmed that the novel variant was inherited from the mother but was absent in the father and the maternal uncle with a history of heart murmur. Proband B was born prematurely at 35 weeks gestation with a prenatally diagnosed complex CHD. A postnatal evaluation revealed right-sided heart defects including pulmonary atresia with intact ventricular septum (PA/IVS), right ventricular hypoplasia, tricuspid valve hypoplasia, hypoplastic main and bilateral branch pulmonary arteries, and possible coronary sinusoids. Cardiac catheterization yielded anatomy and hemodynamics unfavorable to repair. Hence, heart transplantation was indicated. Upon genomic testing, a normal SNP microarray was observed, while trio WES analysis identified a novel heterozygous [Chr18:c.1757C>T (p.Pro586Leu)] variant in the GATA6 gene. This variant was inherited from the father, who carries a clinical diagnosis of tetralogy of Fallot. These findings provide new insights into novel GATA5/6 variants, elaborate on the genotypic and phenotypic association, and highlight the critical role of GATA5 and GATA6 transcription factors in a wide spectrum of right-sided CHDs. Full article

Background: Unilateral mastication (UM), defined as the habitual use of one side of the mouth for chewing, has been linked to various craniofacial asymmetries and systemic effects. This study aims to explore the relationship between UM and nasal airway asymmetry, investigating whether a habitual chewing side correlates with a narrowed nostril. These findings provide a preliminary understanding of how chewing practices might impact craniofacial anatomy and respiratory health. Methods: A pilot study involving 24 adults aged 18 and older was conducted. Inclusion criteria excluded individuals with prior orthodontic treatment or edentulism. The habitual chewing side was determined through self-report and direct observation of chewing gum activity. Nostril dimensions were assessed using ImageJ^® 1.54 software by blinded observers. Statistical analysis, including Fisher’s exact test and Kruskal-Wallis test, was performed using R version 4.4.1 to examine associations between the chewing side and nasal asymmetry. Results: Half of the participants (50%) preferred the right side for chewing. A significant association was found between the chewing side and the smaller nostril (p < 0.001). Participants with a smaller right nostril consistently preferred chewing on the right side, with a large effect size (ϕ = 0.845). No significant differences in age were observed across nostril groups (p = 0.47). Conclusions: This study reveals a strong association between unilateral mastication and nasal airway asymmetry, highlighting the potential role of chewing habits in influencing craniofacial development. These findings emphasize the need for further longitudinal studies to explore the systemic and aesthetic implications of habitual chewing patterns. Full article

Constructing a freeform surface that accurately satisfies both integrable condition and Snell’s law under a given invariant source–target map is challenging for freeform design. Here, we propose a fixed-point iteration method to address this problem. This process involves solving a set of balanced gradient equations in the form of fixed-point iterations that are derived from equivalent integrability conditions and Snell’s law. By using the convergence theorem of fixed-point iteration, a unique solution for the balanced gradient equations exists, which is determined by the natural geometric properties of the freeform surface and is independent of the mapping. The gradient operators on the left-hand side of the equations are converted into a differential matrix form via a finite difference scheme. In one iteration, differential operations are forward-performed on the right-hand side of the equations, and the system of linear equations is solved on the left-hand side of the equation. The constructed freeform surfaces work well in both the paraxial and nonparaxial regions, and convergence in the nonparaxial region is faster than that in the paraxial region. The robustness and high efficiency of the proposed method are demonstrated with several design examples. Full article