Public Health and Healthcare

Abstract: Error enhancement (EE), also referred to as error augmentation (EA), represents a distinctive ap-proach to motor rehabilitation in which errors are not minimized but deliberately magnified in a controlled manner. The underlying premise is derived from contemporary theories of motor learning and sensorimotor adaptation: when the nervous system detects a discrepancy between the intended and actual consequences of a movement, this error provides a powerful teaching signal that can modify subsequent motor commands. Robotic systems make it possible to manipulate this error precisely by applying externally generated forces that deviate the limb from its intended trajectory. This review examines the theoretical basis of error enhancement, its development as a rehabilitation strategy in particular attention is given to studies conducted in healthy individuals and stroke survivors. The available evidence is then considered in relation to sensorimotor inte-gration, virtual reality, constraint-induced movement therapy, and the Bobath concept. Finally, the emergence of the BioXtreme/deXtreme robotic platform is discussed as a translational development that combines robotic force-field manipulation, three-dimensional movement, virtual reality and adaptive error enhancement. Although the evidence remains preliminary and larger controlled trials are required, error enhancement provides a compelling framework for converting movement error from a problem to be suppressed into a signal that can actively drive motor adaptation and rehabilitation.

Abstract: The countermovement jump (CMJ) is a widely used assessment of lower-limb power and neuromuscular function. The physical demands of padel, including repeated accelerations, decelerations, changes of direction, jumping, and landing, may contribute to inter-limb asymmetries influencing performance and injury risk. This quantitative cross-sectional study investigated lower-limb asymmetries during the CMJ in amateur (non-professional) padel athletes. Thirty participants (mean age: 41.2 ± 14.5 years; 63% male, 37% female) completed bilateral CMJ assessments using VALD ForceDecks force plates. Outcome measures included concentric, eccentric, and landing peak force, peak power, rate of force development and jump height. Significant dominant-limb advantages were identified for concentric (p = 0.002), eccentric (p = 0.024), and landing peak force (p = 0.044). Male athletes demonstrated greater jump heights than female athletes (p < 0.001), while female athletes exhibited greater landing-phase force asymmetry (p = 0.004). Amateur padel athletes display significant inter-limb asymmetries in force production across the concentric, eccentric, and landing phases of the CMJ, with greater force generation in the dominant limb. Furthermore, the greater landing asymmetry observed in female athletes may reflect reduced inter-limb load distribution during landing tasks. These results highlight the value of CMJ assessment in identifying neuromuscular asymmetries that may influence performance and increase injury risk in padel athletes.

Abstract: Background: Between-limb lean-mass asymmetry has been proposed for injury-risk and re-turn-to-sport monitoring. Dual-energy X-ray absorptiometry (DXA), the reference method, requires a fixed installation and ionizing radiation; segmental bioelectrical impedance analysis (BIA) is fast, inexpensive and field-applicable. Agreement for the asymmetry itself, rather than absolute limb values, is unresolved. Methods: In this cross-sectional method-comparison study, 127 trail runners (90 men, 37 women) underwent eight-electrode segmental BIA and DXA in the same session. An asymmetry index, the between-limb difference relative to the limb mean, was computed from raw leg resistance (BIA) and leg lean mass (DXA), and assessed by Bland–Altman analysis, concordance correlation (CCC) and kappa. Results: Mean bias was −0.97 percentage points, but the 95% limits of agreement spanned −6.67 to +4.73 pp, three to four times the observed interquartile range; CCC was 0.414. The same leg was identified in 70.9% of runners (kappa 0.309) against a right-side predomi-nance of 75.6%, and BIA did not outperform a constant right-leg rule (p = 0.451). Conclusions: Segmental BIA and DXA are not interchangeable for between-limb lean-mass asymmetry in trail runners: the disagreement between methods exceeds the asymmetries observed, and directional agreement must be read against the base rate.

Abstract: Background: Converting skinfold thicknesses into body fat percentage (%BF) assumes that subcutaneous adipose tissue (SAT) represents a fixed fraction of total fat, an assumption untested at extreme leanness. This study assessed whether skinfold–dual-energy X-ray absorptiometry (DXA) disagreement is random or structured by regional SAT. Methods: Thirty-five elite (Tier 4) female trail runners underwent anthropometry (Withers equation) and DXA in one session. Agreement was evaluated via Bland–Altman analysis and Lin's concordance correlation coefficient (CCC). The inter-method difference (%BF_GAP = %BF_WITHERS − %BF_DXA) was regressed on android SAT, adjusted for total adiposity, and benchmarked against DXA-derived negative controls. Results: The methods correlated closely (r = 0.866, 95% CI: 0.749 to 0.931) but showed poor concordance (CCC = 0.311). Skinfolds systematically underestimated DXA by 5.50 percentage points (pp; total error 5.74 pp), displaying proportional bias that widened with adiposity. Android SAT pre-dicted %BF_GAP (R² = 0.489). Residualized on total fat mass, SAT retained an independent contribution (ΔR² = 0.106), which no negative control showed. Propagated skinfold imprecision (SD = 0.19 pp) accounted for only ~1.3% of the observed difference variance (SD = 1.66 pp). Conclusions: The disagreement is systematic, phenotype-dependent, and structured by regional SAT, reflecting accuracy rather than precision limitations. Con-verted skinfold %BF should not be reported alone or compared against DXA reference data; raw skinfold sums are preferable, as a variable to be observed rather than a target to be reduced.

Abstract: Flexible flatfeet may affect foot alignment and ankle muscle function, which may be particularly relevant in children and adolescent surfers who require continuous postural control and weight shifting. This study investigated the effects of a 12-week rhythm step training (RST) program on radiographic foot alignment and isometric ankle muscle strength in children and adolescent surfers with flexible flatfeet. A total of 169 participants were allocated to either the general flat feet training (GFFT) group (n = 86) or the RST group (n = 83). Both groups completed one 50-min exercise session per week for 12 weeks. Radiographic foot alignment was assessed using the calcaneal pitch angle (CPA), calcaneal–first metatarsal angle (CFMA), and navicular–cuboid overlap ratio (OR), while isometric ankle dorsiflexion (DF) and plantarflexion (PF) strength were assessed. Two-way mixed analyses of variance revealed significant time × group interactions for bilateral CPA, CFMA, and navicular–cuboid OR (p < 0.05). The RST demonstrated greater improvements in radiographic foot alignment than the GFFT. Significant time × group interactions were also observed for bilateral PF and DF strength (p < 0.001), with greater improvements in the RST. These findings suggest that RST may be an effective exercise approach for improving radiographic foot alignment and isometric ankle muscle strength in children and adolescent surfers with flexible flatfeet.

Abstract: Total knee arthroplasty (TKA) can correct lower-limb alignment; however, postoperative muscle weakness may persist and affect functional recovery. This study investigated the effects of early gluteus medius–based rehabilitation on knee muscle function and coronal lower-limb alignment following TKA. Eighty-eight patients undergoing TKA were randomly assigned to either a con-ventional knee rehabilitation (CKR) group or a gluteus medius–based rehabilitation (GBR) group. Both groups completed a 12-week rehabilitation program beginning 2 days after surgery. The hip–knee–ankle (HKA) angle was assessed using weight-bearing radiographs, and isokinetic knee ex-tensor and flexor strength and endurance were measured at angular velocities of 60°/s and 180°/s. Outcomes were analyzed using a two-way repeated-measures analysis of variance. HKA align-ment improved significantly over time in both groups (p < 0.001). Compared with the CKR group, the GBR group demonstrated greater improvements in knee extensor and flexor strength and en-durance (p < 0.001) and less variability in post-intervention HKA values. These findings suggest that early gluteus medius–based rehabilitation may enhance postoperative knee muscle recovery and support more consistent coronal alignment following TKA.

Abstract: Background/Objectives: Posterior shoulder stretching is widely prescribed for gleno-humeral internal rotation deficit (GIRD) and posterior shoulder tightness (PST), but durability of benefit and adherence to home programmes are poorly reported. This review evaluated the outcomes and adherence of home-based posterior shoulder stretching programmes in active populations, with pre-specified emphasis on outcomes measured beyond the immediate post-intervention period. Methods: Nine electronic sources, including ClinicalTrials.gov, were searched. Eligible studies were controlled interventions of primarily home-based posterior shoulder stretching in adolescents or adults with GIRD and/or PST. Screening and extraction were performed in duplicate. Risk of bias was assessed using RoB 2 and certainty using GRADE. Continuous outcomes were pooled using random-effects models with mean differences or standardised mean differences. Results: Of 1,228 records, 70 full texts were assessed and nine studies (361 randomised participants) were included. Compared with no stretching or usual activity, stretching increased internal rotation by 13.91° (95% CI 2.61–25.22; two studies, 99 participants; I² = 94%; very low certainty) and horizontal adduction (standardised mean difference 1.20, 95% CI 0.77–1.63; two studies, 99 participants; I² = 0%; low certainty). Sleeper and cross-body stretches did not differ (−0.16°, 95% CI −9.83–9.50; two studies, 53 participants). Five studies reported adherence using five different formats. Conclusions: Low- to very-low-certainty evidence suggests that home-based posterior shoulder stretching may improve shoulder mobility over three to eight weeks, without demonstrated superiority of one technique. No included study provided a post-intervention comparison capable of determining whether stretching-related mobility gains were retained; therefore, durability remains uncertain.

Abstract: Long-term rehabilitation after acquired brain injury (ABI) must support participation, autonomy, and quality of life alongside impairment reduction. This article introduces the Model of Goal-Oriented Neuroplastic Rehabilitation (MGONR), a practice-derived and theory-informed framework. MGONR proposes that personally meaningful goals, when operationalised and supported by positive commitment, may organise repeated goal-directed behaviour and create favourable conditions for experience-dependent learning and functional adaptation. The framework is informed by three empirical components. A five-year analysis (2019–2023) included 62 participants with ABI and examined 253 general life goals and 1,122 specific rehabilitation goals. A 2023–2024 assessment examined the association between self-evaluated goal achievement and QOLIBRI scores in 47 participants. A supplementary analysis of routine QOLIBRI assessments (2022–2025) examined annual patterns and within-person change. Mean self-evaluated goal achievement increased across the five years. Self-evaluated goal achievement showed a positive, non-significant trend towards higher perceived quality of life (F(1, 42) = 3.81, p = 0.058, partial η² = 0.083). Among 25 participants assessed in both 2022 and 2025, reconstructed QOLIBRI Total and QOLIBRI-OS scores increased significantly, with medium within-person effect sizes. These findings provide initial clinical and behavioural grounding for MGONR but do not demonstrate neuroplastic change or validate all pathways of the model.

Abstract: Telehealth approaches are needed to enhance access to rehabilitation, particularly for rural populations; yet clinician use of video‑based telehealth, including for administering Physical Performance Measures (PPMs), remains suboptimal. Most PPMs were designed for in‑person use and lack guidance for remote delivery. This Special Communication reports a Quality Improvement (QI) initiative within the U.S. Veterans Health Administration (VHA) using a Plan–Do–Study–Act (PDSA) framework to: develop, beta test, refine, and disseminate telehealth‑adapted instructions for selected PPMs. The project identified 66 PPMs with potential for telehealth delivery. Using predefined feasibility criteria for synchronous and asynchronous administration, 16 of these were identified for further consideration. Using a modified Delphi process, an expert panel then selected five PPMs for refining instructions to enable video administration: 30‑Second Chair Stand, 4‑Stage Balance Test, Timed Get Up and Go, 30‑Second Arm Curl, and Finger Tapping Test. Revised instructions were drafted using established procedures and expert panel input. Twelve clinicians conducted pragmatic beta testing with 30 Veterans over four months. Survey feedback indicated usability of the adapted instructions and minimal refinement needs. Follow‑up interviews with Veterans (n=5) similarly confirmed ease of use. Refinements included adding brief patient‑facing videos. This QI initiative demonstrates a practical, replicable approach for producing telehealth‑adapted PPM instructions that beta testers perceived as clear, feasible, and safe. This communication offers resources and a structured QI process for organizations or rehabilitation services to enable the use of PPMs within their telehealth platforms.

Abstract: Background: The aim of this review is to present the current possibilities for using low-level laser therapy (LLLT) and high-intensity laser therapy (HILT) in musculoskeletal rehabilitation programs for knee osteoarthritis (KOA). Methods: A narrative review of the scientific literature published in PubMed, Scopus, Web of Science, Cochrane CENTRAL and Google Scholar was conducted. Scientific articles containing information regarding the application of LLLT and/or HILT for musculoskeletal rehabilitation in KOA were searched. This review included observational studies, randomized controlled trials, systematic reviews, and meta-analyses. Results: Data were found indicating a high degree of disability due to degenerative musculoskeletal conditions. This requires the optimization of osteoarthritis management strategies. Evidence of varying levels of significance was identified regarding the benefits of LLLT and/or HILT in reducing osteoarthritis symptoms. However, at this stage, no firm recommendations have been made regarding the inclusion of LLLT and/or HILT in musculoskeletal rehabilitation programs. Conclusions: The use of LLLT and/or HILT therapeutic lasers in musculoskeletal rehabilitation programs may have a positive effect on osteoarthritis by improving tissue trophism and pain reduction, as well as improving range of motion and functional activity, and may also help to reduce the use of pharmacological agents. However, there is no strong recommendations were found for the inclusion of LLLT and/or HILT in osteoarthritis management programs. Therefore, it is necessary to standardize laser therapy protocols and to conduct higher-quality scientific studies in the future that can be easily transformed from a scientifically based achievement into a real applied therapeutic option in clinical practice.

Abstract: Hemorrhagic fever with renal syndrome (HFRS) is a zoonotic disease associated with orthohantaviruses maintained in natural rodent hosts. This study assessed the detection and spatial distribution of hantavirus RNA among small mammals in the West Kazakhstan Region in 2025 and compared rodent surveillance findings with human HFRS occurrence. An observational descriptive-analytical study was conducted in August–September 2025 in four districts. A total of 343 small mammals were captured and morphologically identified. Lung tissues were tested using 123 pooled testing units, while 14 specimens were tested individually during the same surveillance campaign. Thus, 137 testing units representing 343 animals were evaluated by real-time and conventional RT-PCR. The minimum infection rate (MIR) was calculated as a descriptive minimum estimate, and a pooled-testing likelihood model was used to account for variation in testing-unit size. Hantavirus RNA was detected in 47/137 testing units, including 45 positive pooled units and two individually positive specimens, corresponding to a descriptive MIR of 13.7%. The model-based individual-level infection probability was estimated at 18.0% (95% profile-likelihood CI: 13.5–23.1%). Positive testing units were observed among Apodemus uralensis, Myodes glareolus, and Microtus arvalis. At the district level, the descriptive MIR ranged from 11.6% in Burlinsky to 19.0% in Chingirlauisky. Sampling sites overlapped spatially with settlements reporting human HFRS cases, including Utvinka, Daryinsk, and Rubezhinskoye; however, spatial coincidence does not establish direct transmission.

Abstract: Progressive gait impairments remain a major challenge for children with cerebral palsy (CP), often limiting independence and quality of life. While neuromuscular electrical stimulation (NMES) shows promise for improving gait, prior studies in this population have largely targeted only a single muscle. To address this gap, we examined multi-muscle versus single-muscle NMES during treadmill walking in six children with CP, comparing seven protocols, including an individualized physical-therapist-derived (PT-derived) protocol against a no-stimulation baseline and typically developing controls. Gait quality was assessed using the Gait Deviation Index (GDI) as the primary outcome, alongside the Coefficient of Variation (CV) and targeted kinematic measures. Results were mixed: group-level GDI differences were not significant, though CV analyses showed multi-muscle conditions produced more consistently favorable gait patterns than single-muscle stimulation. Stimulation condition significantly affected maximum knee extension and Dynamic Time Warping during ankle loading response and hip pre-swing; however, after correction for multiple comparisons, no protocol differed significantly from baseline. The PT-derived condition showed favorable directional trends across several outcomes, though not consistently significant. These preliminary findings suggest multi-muscle, individualized NMES strategies may produce phase- and joint-specific biomechanical effects, but larger studies with better gait-phase detection and longer exposure are needed before drawing clinical conclusions.

Abstract: Winter’s lack of sunshine often leads to seasonal affective disorder, and insufficient morning light exposure can likewise provoke insomnia or even precipitate depression. To address these issues, light therapy has been introduced. However, certain light‐therapy protocols can cause ocular discomfort; in particular, overexposure to blue-rich white light is known to induce photoretinitis. Consequently, there is an urgent need for approaches that balance retinal safety with therapeutic efficacy. To date, no quantitative studies have tackled this dual requirement. Here, we propose a novel model that, under the constraint of retinal friendliness, maximizes the effectiveness of light therapy. Our model quantifies therapeutic efficacy via melatonin suppression sensitivity (MSS) and sets the retinal permissible exposure limit (MPE) as the upper bound on treatment duration. Under these parameters, a 6.5-hour light therapy session can achieve up to 79 % of the maximal effect, requiring an illuminance of 2,240 lx. Alternatively, a 1.5-hour targeted treatment using 1,000 lx of 620 nm orange light yields 59 % efficacy. Furthermore, continuous home illumination at 1,700 K for 6.5 hours produces 77 % of the maximal therapeutic effect.

Abstract: Background/Objectives: Physiotherapy practice involves patient handling, sustained or awkward postures, repetitive manual techniques, and prolonged standing. This study estimated Neck Disability Index (NDI)-defined neck disability among physiotherapists in Saudi Arabia, examined demographic and workplace associations with disability severity, and compared quality of life across NDI levels.Methods: A cross-sectional online convenience survey was conducted from 2 April to 22 May 2024 through email and professional networks. The invitation denominator was not tracked, so a response rate could not be calculated. Eligible participants had at least one year of clinical experience. The NDI and WHOQOL-BREF were administered in English. Associations were evaluated using exact tests for sparse tables, Holm adjustment, and a five-variable multinomial model with HC0 robust standard errors. An expanded 11-factor mean bias-reduced multinomial model was the principal sensitivity analysis; additional analyses examined age stability.Results: Among 367 participants, 197 had NDI-defined disability (53.7%; 95% CI, 48.6%–58.7%), predominantly mild (156, 42.5%), and 41 had moderate-or-worse disability (11.2%; 95% CI, 8.3%–14.8%). In the five-variable model, mild disability was associated with female sex (adjusted relative risk ratio [RRR], 2.49; 95% CI, 1.54–4.03) and BMI ≥25 kg/m² (RRR, 2.04; 95% CI, 1.26–3.29); moderate-or-worse disability was associated with non-private employment (RRR, 4.47; 95% CI, 2.06–9.73) and BMI ≥25 kg/m² (RRR, 2.25; 95% CI, 1.05–4.84). The expanded model retained the female-sex/mild and workplace/moderate-or-worse patterns, but the latter BMI interval included 1 (RRR, 2.13; 95% CI, 0.96–4.69). WHOQOL-BREF domain medians were lower across higher NDI levels (all four omnibus Holm-adjusted p < 0.001).Conclusions: Neck disability was common in this convenience sample, and higher NDI severity co-occurred with lower quality-of-life scores. Female-sex and workplace associations were consistent across the principal models; BMI findings require caution. The associations are cross-sectional, exploratory, non-causal, and not nationally representative.

Abstract: Background: Neurological disorders substantially affect physical, cognitive, and psychosocial functioning. Smart wearable technologies may support objective assessment, monitoring and intervention in clinical and real-world settings, but applicability across neurological conditions and outcome domains remains unclear. Methods: This scoping review followed PRISMA-ScR. Five databases—MEDLINE, EBSCOhost, Cochrane Library, IEEE Xplore, and Web of Science—were searched for studies evaluating smart wearables for assessment, monitoring, or intervention in adults with neurological disorders. Methodological quality was assessed using NIH Study Quality Assessment Tools. Sustained adherence and structured patient-reported usability were evaluated. Results: Seventy-nine studies were included, with evidence concentrated in stroke and Parkinson’s disease. Most studies evaluated physical and motor outcomes, particularly gait, mobility, and activity; this emphasis remained after Poor-rated studies were excluded. Methodological quality was uneven: seven studies were Good, fifty-four Fair, and eighteen Poor, with observational cohort or cross-sectional designs predominating. Sustained adherence, structured patient-reported usability, and long-term real-world use were infrequently assessed. Conclusions: Smart wearables show the clearest applicability in physical and motor applications, predominantly assessment and monitoring, but evidence remains uneven, concentrated in stroke and Parkinson’s disease, and limited for other neurological conditions. Rigorous longitudinal real-world studies are needed, particularly in underrepresented conditions and physiological and psychosocial outcomes.

Abstract: Background: Neuromuscular fatigue reduces a muscle’s capacity to generate force and is a key determinant of performance and injury risk. In basketball, the quadriceps femoris (QF) is central to jumping, acceleration, and changes of direction, so objective detection of QF fatigue is clinically valuable. Objective: To develop and validate ma-chine-learning models for detecting QF neuromuscular fatigue in professional basket-ball players from surface electromyography (sEMG), and to relate fatigue-induced changes to knee biomechanics. Methods: In this pilot study, eight male athletesIn a real cohort, eight male athletes (n = 8; basketball; 18–40 years) performed standardized isometric and isotonic 30-repetition knee-extension fatigue protocols (isometric con-traction at 60% of maximal voluntary contraction [MVC]; isotonic 30-repetition set against a fixed submaximal load of 60% of MVC), measured on both legs (16 limbs). sEMG from vastus lateralis (VL) and vastus medialis (VM) was recorded per SENIAM guidelines at baseline, during, and post-fatigue. Time-domain (RMS), frequen-cy-domain (MDF, MNF), and non-linear features (approximate entropy, sample en-tropy, recurrence quantification analysis), plus the VL/VM ratio, were extracted; Ran-dom Forest, Support Vector Machine, and CNN–LSTM classifiers were trained and evaluated with participant-level nested cross-validationwere trained (k-fold cross-validation) and knee loading examined with finite-element (FEM) analysis. Re-sults: Fatigue reduced MDF and MNF and increased RMS in both muscles (p < 0.001), increased signal determinism, and shifted the VL/VM ratio (0.97 → 1.14, p < 0.01). The CNN–LSTM model reached the highest within-subject accuracy (0.93, AUC 0.97); however, under participant-level (leave-one-subject-out) nested cross-validation this did not generalize across athletes, with the classical models reaching only modest per-formance (accuracy ~0.69, AUC ~0.73)achieved the best classification (accuracy 0.93, AUC 0.97), exceeding classical approaches; FEM indicated increased localized carti-lage stress under fatigue. Conclusions: A multimodal framework combining sEMG, biomechanics, and artificial intelligence detected the canonical fatigue signature (ris-ing RMS with falling MNF) in 32/57 trials and, under participant-level (leave-one-subject-out) nested cross-validation the classifiers generalized only mod-estly (accuracy ~0.69, AUC ~0.73), well below the within-subject estimate; these pre-liminary findings require confirmation in a larger, adequately powered cohort.enables accurate, objective assessment of neuromuscular fatigue, with translational potential in sports medicine and injury prevention. In this pilot cohort (eight athletes, 16 limbs, 57 sEMG trials)In the real cohort (eight athletes, 16 limbs, 57 sEMG trials), RMS in-creased in 50 and MNF decreased in 37 trials, with the fatigue signature present in 32/57 (56%).

Abstract: Background: Trail running is a sport characterized by taking place in natural environ-ments and requiring constant adaptation to irregular terrain, making postural balance crucial for preventing falls and coping with the coordinative demands of these races. Objectives: This study aimed to analyse the acute effects of the elevation on dynamic and static balance in young trained trail runners. Methods: Fifteen highly trained young ath-letes (8 females, 7 males; age 16.8 ± 2.14 years) completed two similar training sessions except for the elevation gain (1000 m vs. 15 m, flat). Static Balance was evaluated using the Balance Error Scoring System (BESS), and dynamic balance was assessed with the Y Balance Test (YBT) before and after each session. Results: No statistically significant dif-ferences were found in the dynamic balance, YBT results between elevation and flat ses-sions when comparing pre- vs. post-session in the composite index (83.79 ± 7.59 vs. 83.32 ± 7.92, p = 0.763). In contrast, static balance BESS showed an average increase of 3 errors after elevation training compared with flat training (15.53 ± 1.23 vs. 12.67 ± 1.33, p < 0.001). Conclusions: These findings highlight the need for specific strategies to preserve postural balance—especially static balance—during training and after trail races, and support tak-ing elevation gain into account when programming training load in young trail runners.

Abstract: Background/Objectives: Structured exercise may modulate the myostatin–follistatin (MSTN–FST) axis, but evidence across exercise modalities and doses remains uncertain. Methods: We systematically searched seven bibliographic databases for controlled exercise interventions lasting at least four weeks in adults (PROSPERO CRD420261492548). Multilevel random-effects models with study-clustered CR2 correction accounted for dependent effect sizes; sensitivity, exercise-modality subgroup, and linear duration analyses were exploratory. Results: Thirty-seven independent studies were included. Structured exercise was associated with lower circulating MSTN (16 effects from 10 studies; Hedges’ g = 1.79, 95% confidence interval [CI] 0.62–2.96) and higher circulating FST (12 effects from 7 studies; g = 1.62, 95% CI 0.18–3.06). Heterogeneity was high and both prediction intervals crossed the null. Effect directions generally persisted across assumed within-study correlations and after excluding HIFT/CrossFit-type interventions, although excluding extreme effects attenuated the estimates. Exploratory analyses showed no clear difference between resistance-based and non-resistance-based exercise, and program duration was not linearly associated with either outcome. GRADE certainty was moderate for both outcomes. Conclusions: Structured exercise may favorably alter circulating MSTN and FST, but sparse modality- and dose-specific evidence precludes identifying a superior modality, optimal dose, confirmed intracellular mechanism, or validated clinical surrogate endpoint.

Abstract: Musculoskeletal ultrasonography (MSKUS) is increasingly used to assess masticatory-muscle morphology and mechanical properties, but its clinical interpretability in temporomandibular disorders (TMDs) and bruxism remains uncertain. We systematically reviewed quantitative B-mode, elastographic, functional, diagnostic, and measurement-property evidence. The final pre-submission search combined PubMed/MEDLINE, Scopus, Embase, and Web of Science Core Collection, with supplementary discovery in Europe PMC and Lens, through 20 August 2026 (PROSPERO CRD420261481058). Random-effects meta-analyses used restricted maximum likelihood (REML) with Hartung-Knapp inference. Resting masseter thickness showed no consistent case-control difference (k=14; MD -0.19 mm, 95% CI -0.78 to 0.40; I²=88.9%), nor did contracted masseter thickness (k=11; MD -0.06 mm, 95% CI -1.16 to 1.03; I²=95.9%). Anterior temporalis thickness remained inconclusive at rest (k=5; MD 0.33 mm, 95% CI -0.59 to 1.25; I²=83.4%) and during contraction (k=5; MD -0.05 mm, 95% CI -1.59 to 1.49; I²=94.5%). Resting masseter stiffness measured by shear-wave elastography remained higher in clinical/bruxism groups (k=4; Hedges' g 1.80, 95% CI 0.15 to 3.44; I²=83.5%). Certainty was very low for all pooled outcomes. MSKUS is currently better supported for adjunctive phenotyping and longitudinal monitoring than as a stand-alone diagnostic test.

Abstract: Patient-specific dressings for diabetic foot ulcers (DFUs) must follow the individual lesion, yet pub- lished image-to-fabrication pipelines rely on depth sensing and seldom report the accuracy of the fabricated object. We present IMTOP, a low-cost pipeline that turns a single calibrated RGB photograph into a printable patient-specific patch, with a validation framework centred on the patch itself. Abso- lute scale is recovered from two operator-placed points on a reference of known length; the wound contour is offset by a perilesional margin and extruded to a watertight STL solid. The patch error is decomposed into segmentation, scale and printing terms, measured on 149 public clinical DFU images (uncalibrated, in pixel units) with three segmenters and on 18 printed phantoms of known geometry, the scale term coming from a Monte Carlo simulation of calibration-point placement. By mean magnitude segmentation was the largest term (6.4% for the Segment Anything Model, against 5.0% for scale at an assumed 3 px placement noise and 0.69% for printing; combined 8.1%), whereas by variance scale prevailed for two of three segmenters; phantoms were reconstructed to 0.32% area error, pointing to wound-border ambiguity as the main clinical error source. Mask overlap correlated with, but did not determine, the patch error, and the residual under-coverage sized a segmenter-specific perilesional offset covering the wound in 95% of the evaluated cases.