Vascular dysfunction is a pathophysiological mechanism in peripheral artery disease (PAD). PAD patients exhibit reduced circulating expression of microRNA-126 (c-miRNA-126) and VEGF. Submaximal walking (SW) is recommended in PAD because it increases walking capacity, partially by improving vascular regulation, which can be observed after a walking session. Nevertheless, previous studies were conducted with maximal walking and in men. As women with PAD present worse disease characteristics and greater ischemia, they may be less responsive to SW, which needs to be investigated. Thus, this study compared the acute effects of SW on vascular function, c-miRNA-126 and angiogenic markers in men and women with PAD. Thirty patients (15 women) underwent, in a random order, 2 sessions: control (standing on treadmill) and SW (15 bouts of 2-min walking at moderate intensity intersected by 2-min rest). Circulating gene expression of miRNA-126, SPRED-1, PI3KR2, VEGF, and eNOS were evaluated before and after the interventions. Both genders presented similar maximal walking capacity. Vascular function did not change after the interventions in either gender. After SW, both groups presented a similar decrease in PI3KR2 and similar increases in c-miRNA-126, VEGF and eNOS. In men and women with PAD, an acute SW similarly increases c-miRNA-126 expression, which inhibits PI3KR2, enabling the progression of the VEGF angiogenic signaling pathway of PI3K-AKT-eNOS. These results support that SW is equally effective in inducing molecular angiogenic changes in men and women with PAD, supporting its recommendation for both genders. Future studies should address these possible chronic effects of walking.
To determine the dose-response relationship of a walking program and compare different delivery methods of walking exercise for patients with chronic low back pain (CLBP). A systematic search of PubMed/MEDLINE, Web of Science, Scopus, Embase, and the Cochrane Library was conducted from inception to October 21, 2024. We included randomized controlled trials (RCTs) of walking programs without other exercise cointerventions in people with CLBP. Outcome measures were pain intensity and disability. The dose-response relationship was assessed using a restricted cubic spline model. Thirteen RCTs were included. The meta-analysis showed a statistically significant reduction in pain intensity (standardized mean difference [SMD]: -0.59, 95% confidence interval [CI]: -0.95 to -0.24) and disability (SMD: -0.69, 95% CI: -1.14 to -0.23) with low and moderate certainty of evidence, respectively. The spline model showed a U-shaped association between total minutes of walking programs and reduction in pain intensity and disability. The largest effect for pain reduction was obtained at a total duration of 1000 minutes (SMD: -0.67, 95% CI: -0.76 to -0.59) distributed over a mean of 8 weeks, whereas for disability, the largest effect was found with a total of 900 minutes (SMD: -0.61, 95% CI: -0.69 to -0.53). Subgroup analysis showed larger effect sizes when walking exercise was performed outdoors and when motivational support was considered; however, no significant differences between subgroups were found. Accruing 1000 minutes of walking over 8 weeks is associated with the largest reduction in back pain, while 900 minutes is associated with the largest reduction in disability. These findings may be valuable in optimizing walking programs for people with CLBP.
Propulsive capacity - the maximum ability to generate forward propulsion during push-off in walking - is an important determinant of walking performance. Accordingly, an insufficient ankle push-off can limit physical activity and community accessibility. Wearable ankle exoskeletons (EXOs) have emerged as a strategy to augment ankle push-off, but most prior work has focused on metabolic cost or habitual walking mechanics, providing limited insight into how EXO assistance influences propulsive capacity in walking. Here, we used a treadmill-based propulsive stress test to determine how powered ankle EXO assistance affects propulsive capacity and its biomechanical determinants in healthy younger adults. Fifteen participants completed walking trials with four EXO assistance levels (none, low, medium, high) while a horizontal impeding force progressively increased until task failure. Propulsive capacity was defined as the maximum achievable impeding force. Group-level analyses revealed no main effect of assistance level on propulsive capacity or most biomechanical outcomes. However, exploratory within-subject analyses indicated that 12/15 participants improved propulsive stress test performance with assistance. Comparisons between unassisted walking and participants' best-performing assistance condition revealed significant increases in propulsive capacity and anterior ground reaction force (GRF) impulse without increases in peak biological ankle moment (AMom), trailing limb angle (TLA), or calf excitation. Improvements in propulsive capacity were associated with larger anterior GRF, which were jointly explained by those in AMom and TLA. These results highlight the importance of a capacity-based, within-subject framework to evaluate how ankle assistance influences maximal propulsive performance and provide a mechanistic foundation for future studies in populations with insufficient propulsion.
Stroke is a common disease with an extremely high disability rate. In addition to conventional training, environmental stimulation training is also an effective approach. However, its neuropsychological basis remains unexplored. Through electroencephalography (EEG), the effects of environmental stimulation interventions on brain activity in stroke patients were analyzed to explore the neuropsychological mechanism of functional recovery. The plantar pressure data and EEG data of 30 stroke patients during level-ground walking and environmental stimulation intervention were collected, and the changes in EEG characteristics in different conditions were compared to explore the influence of walking pattern changes on brain activity. Environmental stimulation interventions can significantly improve the symmetry of walking in patients after stroke. Moreover, the main effect of relative power in the alpha, delta, theta and gamma bands of EEG was significant, especially in the prefrontal lobe, left frontal lobe, middle frontal lobe, left and right parietal lobe and occipital lobe of alpha band. A possible neuropsychological mechanism of environmental stimulation intervention is that the capacity of the brain to process information is enhanced during walking under artificially designed environmental intervention, thus improving walking symmetry and correcting abnormal walking patterns, potentially through modulation of attentional networks.
As age increases, factors such as visual impairments, joint instability, muscle weakness, and unreliable postural reflexes contribute to reduced stability and a higher risk of fall. Weak hip abductors/adductors further increase this risk. Hip flexors and extensors, which govern sagittal-plane limb advancement and propulsion, also play a critical role in dynamic walking stability. While traditional assistive devices support mobility, exoskeleton technology may improve walking stability and reduce fall risk. This study examines the effects of five exoskeleton assistance timings and two torque magnitudes on gait stability and step characteristics. We hypothesized hip assistance would increase MoS (particularly in the ML direction) through changes in foot placement and that nonlinear COM metrics would change in a direction consistent with stability adaptations. Ten healthy young adults (four males, six females; age: 27.6 ± 5.9 years, body mass: 65.3 ± 13.1 kg, height: 1.66 ± 0.08 m) were assessed for Margin of Stability (MoS), step characteristics, and center of mass nonlinearity. Statistical analyses included linear mixed-model ANOVAs, paired t-tests, and Wilcoxon signed-rank tests. Exoskeleton assistance increased MoS in medial-lateral (ML) and anterior-posterior (AP) directions. Wider, more variable steps and increased gait irregularity suggest extensive adaptation is required. While hip exoskeletons improve walking stability, further research is needed to understand long-term adaptation and daily use. Future studies should explore larger clinical populations and the long-term implications of exoskeleton-assisted walking.
Handstands are a key skill in many specialist sports involving the use of upper limbs in a role usually associated with lower limbs. Handstand sports have a high incidence of pain in the shoulder, but with little understanding of handstand walking biomechanics. We aimed to explore the biomechanics of handstand walking in athletes with and without shoulder pain to assess underlying differences across whole limb function. Ten participants, who could handstand walk 6 steps, had force and positional data collected. Shoulder pain was assessed via questionnaire. Forces, centre of mass position, velocities, axial and torsional work, mechanical energy, and overall arm parameters were calculated from 237 stance phases. Two-way ANOVA assessed differences between participants with and without shoulder pain and arm (Right/Left). Participants with shoulder pain moved significantly slower (p = 0.005), exhibited shorter arm lengths (p = 0.013) and had greater net torsional work (p = 0.002) resulting in a lower axial-torsional work ratio. Altered handstand biomechanics in participants with pain demonstrate a more flexed position of the arm, often linked with higher joint loading. Handstand walking mechanics appear to closely resemble groucho-running enabling longer double support reducing limb loading on fatigable upper limbs. Future studies should account for confounders including disciplines, training volume, and gender, providing insight into the implications for upper limb full body loading.
Age-related declines in muscle strength and neuromuscular control make sit-to-stand transitions and walking progressively more difficult, compromising mobility and independence. Although wearable assistive technologies have been proposed to alleviate these challenges, few have demonstrated clear benefits in facilitating sit-to-stand movements for older adults who retain a degree of independent mobility. Here, we introduce a soft hip exosuit designed to assist both sit-to-stand transitions and walking activities. In a feasibility study involving ten older adults, the exosuit increased 1-minute sit-to-stand repetitions by an average of 1.8 and reduced the metabolic cost of walking by 13.6% compared with the unassisted condition. These improvements were achieved while preserving natural kinematics, lower-limb stability, and maintaining a strong sense of agency. Our findings demonstrate that soft exosuits can enhance sit-to-stand and walking performance in older adults while preserving biomechanical naturalness and user autonomy, highlighting their potential for practical home-integrated mobility assistance.
The prediction and recognition of unstable human walking patterns are of high importance for active video surveillance, smart environments, and assistive healthcare, particularly for fall detection in the elderly. This research investigates the utility of Gait Energy Images (GEIs) combined with deep learning, vision transformers, and few-shot learning architectures to enhance the classification of stable and unstable pedestrian walking patterns. We evaluate and compare twelve methodologies: six classical or feature-based machine learning models (Linear SVM, HOG + SVM, LBP + RBF-SVM, Random Forest, XGBoost, and an adapted GaitSet baseline), three deep learning models (MobileNet, Vision Transformer (ViT), and YOLOv8-cls), and three episodic few-shot learning techniques (Prototypical, Matching, and Relation Networks) under data-scarcity regimes. To facilitate this evaluation, we introduce the Unstable and Stable Walking Pedestrian (USWP) dataset, constructed by fusing and harmonizing sequences from seven public action recognition databases, containing 3250 unique GEIs with a subject-independent evaluation protocol to prevent identity-based domain leakage. Our experiments demonstrate that the YOLOv8-cls model achieves an overall accuracy of 96.92% (97.14% on Loss-of-Balance anomalies and 94.67% on Active Motion anomalies), significantly outperforming the conventional Linear SVM baseline (75.38%) and MobileNet (91.08%). Conversely, Relation Networks exhibit lower few-shot performance (71.08%) due to optimization complexities in learning similarity metrics from sparse data. Leave-One-Dataset-Out (LODO) cross-validation reveals an average generalization accuracy of 83.28%, indicating significant domain bias across source databases and underscoring that within-dataset evaluations overestimate real-world generalization. Computational complexity analysis shows that MobileNet provides an optimal trade-off for real-time edge deployment (4.2 ms latency), while preprocessing ablation studies demonstrate that integrating the Segment Anything Model (SAM) with MediaPipe-derived Regions of Interest (ROIs) yields a 12.50% absolute improvement in accuracy by eliminating background noise.
The present study aimed to evaluate the effect of different root canal sealers and obturation strategies on colour stability and fracture resistance of maxillary incisors following a staining and walking bleaching protocol. One hundred and twenty human maxillary incisors were prepared and allocated to six groups (n = 15) according to sealer type (AH Plus or MTA Cem S), presence of gutta-percha, and application of staining/bleaching procedures. Two additional groups included teeth that underwent staining/ bleaching without endodontic treatment and intact teeth. Colour was measured spectrophotometrically in the CIE Lab* colour space at serial time points, and CIEDE2000 (ΔE00) values were calculated for interval-specific and cumulative colour change. Fracture resistance was measured in Newtons using a universal testing machine, and fracture patterns were classified as repairable or non-repairable. Colour-coordinate data were analysed using linear mixed-effects models. ΔE00 values and fracture resistance were compared using one-way ANOVA followed by Tukey HSD test. In the six experimental root-filled groups, a 2 × 3 factorial ANOVA was additionally performed to examine the interaction between bleaching status and filling strategy. Repairability was analysed using the Pearson chi-square test. Significant within-group changes in L* and a* values were observed across all experimental conditions, whereas significant changes in b* values were detected in the staining/bleaching groups-including those with gutta-percha combined with AH Plus, gutta-percha combined with MTA Cem S, MTA Cem S alone, and the staining/bleaching control-as well as in the intact control group, but not in the corresponding non-stained/non-bleached groups. Significant between-group differences were found for ΔE00 2-1, ΔE00 4-2, and ΔE00 4-1, whereas ΔE00 3-2, ΔE00 4-3, and ΔE00 3-1 did not differ significantly among groups. The greatest residual overall colour change was observed in gutta-percha combined with AH Plus. Gutta-percha combined with MTA Cem S yielded the highest mean fracture resistance (p < 0.05). In the factorial analysis of experimental groups, fracture resistance and ΔE00 4-1 both showed significant bleaching × filling-strategy interactions. Repairability did not differ significantly among groups. Gutta-percha combined with MTA Cem S yielded the highest mean fracture resistance, whereas the AH Plus-containing stained/bleached condition showed the greatest residual colour change. The aesthetic and mechanical outcomes observed after the staining/bleach sequence should be interpreted in conjunction with the overall filling-restorative condition rather than as isolated effects of bleaching alone.
Mothers' persistent involvement is a critical but underexplored area of autistic youth's transition to employment. Using a qualitative research design, this study interviewed five mothers, two fathers, five autistic youth, and seven teachers to explore the lived experiences of Chinese mothers who supported autistic youth towards employment. By foregrounding mothers' voices, five interconnected themes were developed and represented in a spiralling model: (1) navigating educational pathways, (2) preparing for employment from childhood, (3) building a long-term support system, (4) balancing hope and uncertainty in lifelong planning, and (5) redefining motherhood over time. These findings highlight that maternal support for autistic youth evolves across the lifespan, revealing the dynamic strategies and roles mothers adopt to foster their children's development and work preparation, unfolding progressively as children move towards adulthood. These insights underscore the need for coordinated, lifelong autism services and targeted parent training programmes that strengthen family-centred and gender-sensitive support.Lay AbstractSupporting a child with autism as they grow into adulthood and enter the workforce can be a long and challenging journey. Mothers usually play a key role in helping autistic youth prepare for work. Yet, we don't know much about how mothers support autistic youth as they prepare for work. This study aims to explore the experiences of Chinese mothers who have supported autistic youth towards employment. Through interviews with five mothers, two fathers, five autistic youths, and seven teachers, the research identifies five key aspects of mothers' support: (a) helping children access schooling and manage their learning, (b) preparing them for future jobs from an early age, (c) building long-term support networks for autistic youth, (d) balancing hope and worry about the future, and (e) adapting their multiple roles as mothers over time. The study shows that maternal support is not limited to a single stage of autistic youth's lives but evolves continuously from childhood into early adulthood. These findings reveal the various strategies and roles that mothers adopt to help their children, while also highlighting the need for services and programmes that can better help families. Understanding mothers' experiences can help schools, policymakers, and service providers design support that prepares autistic young people for work while also caring for their caregivers' well-being.
A puzzle for evolutionary theory is the existence of two seemingly offsetting behavioral "biases," overconfidence and loss aversion. Overconfidence is a call to action, while loss aversion curbs initiative. The most prominent evolutionary explanation of overconfidence, proposed by Trivers (1976), is that self-deceit arises to better deceive others. Missing from this account is why sincere messages are believed, especially given the widespread prevalence of self-deception. Moreover, if overconfidence is adaptive, why is it at least partially canceled by loss aversion? We propose a signaling theory according to which the role of self-deception is to better inform others. Since the decision error associated with high self-belief is less burdensome for the more able, and the benefit of being perceived as able increases with ability, hardwired overconfidence is a credible signal of true ability. Evidence supports this interpretation. A further implication of signaling is that loss aversion is part of the equilibrium. It partially ameliorates the decision costs of overconfidence, but as it is usually hidden, it does not eliminate its signaling role. "Biases" are thus symbiotic-the payoff to agents from an integrated set of biases is higher than would be the case in their absence. From this perspective, Kahneman's advice that individuals eliminate both overconfidence and loss aversion is poorly founded. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Independent walking is more than a developmental milestone, as it reflects the integration of neuromuscular maturation, postural control, and sensorimotor coordination. In children born preterm, both the timing and the characteristics of independent walking may differ from those observed in term-born peers. This narrative review synthesizes current evidence on independent walking acquisition and gait features in preterm-born children throughout different stages of life, from toddler to school age, and discusses the clinical implications of quantitative gait assessment, with a focus on innovative wearable technologies, during neurodevelopmental follow-up. Preterm birth is consistently associated with a 1-2-month delay in independent walking onset compared with term-born peers, even after correction for gestational age (GA), with greater delays reported in infants born at lower GA or with very low birth weight (BW). Beyond milestone attainment, both qualitative and quantitative studies describe less mature gait patterns during early walking and the preschool years, including shorter step length, wider base of support, prolonged double-support phase, increased temporal variability, and reduced gait complexity. These characteristics likely reflect compensatory strategies related to immature postural control and sensorimotor organization. Although many spatiotemporal parameters improve with age and walking experience, subtle differences may persist into school age, particularly under more demanding conditions such as dual-task walking. However, currently available studies on preterm gait are quite heterogeneous in terms of GA, BW, and/or individual walking experience of included individuals and gait analysis methods employed. Furthermore, evidence regarding gait characteristics in preschool and school-aged preterm children is still relatively scarce, thus hampering a deeper understanding of preterm-born children's gait development after the toddler stage.  Instrumented gait analysis systems and wearable technologies, including inertial measurement units, enable objective and ecologically valid assessment of gait performance. Quantitative gait parameters have shown associations with standardised gross motor scores and may provide additional information beyond milestone history alone. Incorporating structured quantitative gait assessment into longitudinal follow-up programmes could support more detailed monitoring of motor development and inform individualised rehabilitation planning in children born preterm. • Children born preterm generally achieve independent walking later than term-born peers and may show immature gait features, particularly during the first years of life. • Most available evidence is heterogeneous and focuses mainly on walking onset or early gait, with limited data extending into preschool and school age. • This review integrates evidence on gait development from the fi rst independent steps to school age, identifying persistent abnormalities mainly in children born at lower gestational ages, with lower birth weight, or under demanding walking conditions. • It highlights the potential role of quantitative gait analysis and wearable inertial sensors as complementary tools for longitudinal neurodevelopmental follow-up and individualized rehabilitation planning.
Clinical gait analysis is essential for understanding motor and cognitive contributions to mobility impairment. Continued methodological advancement in gait analysis is needed to detect important and subtle changes in walking behaviour that will inform this understanding. This study evaluated the reliability of a Finite State Machine (FSM) algorithm for stride segmentation during preferred walking and dual task walking (DTW) and examined changes to temporal and accelerometry kinematic outcomes between tasks. Participants diagnosed with Alzheimer's disease or mild cognitive impairment completed a gait assessment as part of the Ontario Neurodegenerative Disease Research Initiative foundational study. Ankle worn accelerometers and a GAITRite walkway captured data during preferred walking and three DTW conditions (counting backwards by ones, animal naming, counting backwards by sevens). Acceleration data were processed using the FSM algorithm to extract temporal and accelerometry kinematic outcomes defined by the FSM intra stride segments. Stride time demonstrated excellent reliability (ICC≥0.97). Gait speed was significantly associated with gait variability during animal naming and counting backwards by sevens (p<0.05), but not during counting backwards by ones. The FSM approach showed changes to stride phases and accelerometry derived kinematics not seen with conventional stride-based approaches. There was a reduction in flat-foot phase and an increase in push-off phase across all dual-task conditions compared with PREF (p<0.05), where conventional stance-phase segmentation did not show consistent differences. Kinematic outcomes were also significantly lower during DTW conditions when compared to preferred walking trials (p<0.05) for the mid-swing peak amplitude and the slope of the accelerometer push-off. Findings demonstrate differences in performance between preferred and DTW conditions, the influence of gait speed on gait variability, and unique accelerometry derived kinematics. The FSM segmentation method advances gait assessment by providing precise stride characteristics using low cost, clinically accessible tools.
Diparetic cerebral palsy affects approximately 2 in 1000 people, and can result in gait impairments such as excessive knee flexion and excessive ankle dorsiflexion during the stance phase in gait. Short-term clinical trials using robotic rehabilitation devices have shown gait improvements comparable to invasive multilevel surgery for spastic cerebral palsy. This study aimed to determine if the stiffness of articulated forms of ankle-foot orthoses influences the effectiveness of a powered knee-ankle-foot orthosis on crouch gait reduction. It was hypothesized that AFO stiffness would be an important factor influencing crouch gait in individuals with diparetic cerebral palsy when walking with a powered KAFO. A pilot study with three participants with diparetic cerebral palsy causing crouch gait was conducted to evaluate the effects of varying ankle stiffness of ankle-foot orthoses on sagittal plane kinematics and kinetics while walking with a powered-knee knee-ankle-foot orthosis. Experimental ankle foot orthoses were made to enable adjustable joint stiffness during the experiment. Optical motion capture and in-ground force plates were used to capture gait biomechanics during self-selected walking for eight experimental conditions. Overall, the presence or absence of a powered knee and AFO stiffness had an impact on ankle and knee biomechanics during walking. Across conditions using the powered KAFO, the greatest improvement in crouch at both the ankle and knee was observed with the highest-stiffness experimental AFO. Ankle torque increased with AFO use, while knee torque increased with the powered KAFO but was lower when paired with the experimental AFOs. Ankle power was not consistently improved by the KAFO and AFO conditions, while knee power generally increased with KAFO use and was highest in the powered conditions. This study provides preliminary results on the impact of ankle-foot orthoses in conjunction with a powered knee exoskeleton, and may inform further exploration of treatment of pathological gaits using robotic assistive devices.
The human foot possesses passive elastic mechanisms that recycle energy during gait, yet these mechanisms are largely neglected in walking assistance exoskeletons, which predominantly focus on the ankle joint leaving the foot's distal energy modulation capacity unaddressed. In this study, we developed a low-profile passive foot exoskeleton that improves gait economy through intra-foot energy recycling. The exoskeleton stores energy at heel strike using a torsion spring embedded beneath the hindfoot and releases it at push-off via a mechanically gated clutch, producing an assistive moment at the metatarsophalangeal (MTP) joint aligned with biological propulsion. We evaluated the system in walking experiments with fifteen healthy male participants. Compared to mass-matched shoes, the exoskeleton reduced net metabolic cost by 3.31% (p = 0.001), reflecting decreased whole-body and local muscular demand. Electromyographic analysis showed a reduction in late-stance plantarflexor activity. Biomechanical data further demonstrated temporally consistent assistance and effective intra-foot energy redirection across walking speeds. These results demonstrate that MTP-targeted assistance, implemented entirely below the ankle, can contribute to offloading plantarflexor workload and enhancing gait economy. The proposed system establishes a new passive exoskeleton paradigm centered on intra-foot energy recycling, offering a compact, standalone solution for unobtrusive and metabolically efficient walking assistance.
Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of disability and death worldwide. Early identification remains challenging, as existing prediction models largely rely on clinic-based assessments and self-report measures that are resource-intensive and prone to bias. This study aimed to determine whether real-world mobility metrics could predict incident COPD. This prospective cohort study included 28,251 UK Biobank participants aged 60-78 years who wore wrist-worn accelerometers. Digital gait biomarkers were derived using signal-processing and machine-learning algorithms. Incident COPD was identified via linked electronic health records. Associations between digital gait biomarkers and incident COPD were examined using Cox proportional hazards models with internal validation adjusted for age, sex, body mass index, smoking pack-years, air pollution exposure, and asthma history. Model discrimination was evaluated using Harrell's concordance index. Among 28,251 participants, 639 (2.26%) developed COPD over a mean follow-up period of 8.5 (SD=1.3) years. Lower running duration, slower maximal walking speed, shorter walking bout duration, and a lower proportion of walks longer than 8 seconds were independently associated with incident COPD. A model incorporating these four digital gait biomarkers, and four easily collectable self-report measures, age, sex, smoking pack-years, and asthma history, achieved a Harrell's concordance index of 0.80; comparable to existing models that require clinic-based tests and extensive self-report items. Real-world mobility metrics are early indicators of incident COPD, providing an accessible and automatic approach for early risk identification in older people and enabling early intervention to delay disease progression and preserve quality of life. Chronic obstructive pulmonary disease (COPD) is a common lung condition that often develops slowly and is often diagnosed late. Earlier identification could enable timelier treatment and help reduce disease burden. However, most current screening approaches rely on clinic-based tests or detailed questionnaires, which can be difficult to access and challenging to scale. In this study, we explored whether everyday movement patterns, measured automatically using wrist-worn smartbands, could help identify people at risk of developing COPD. We analysed data from over 28,000 older people from the UK Biobank who wore the smartband for up to a week. We then followed their health records for up to nine years. People who developed COPD tended to move differently in everyday life: they walked more slowly, spent less time running, and had shorter periods of continuous walking. These differences were linked to a higher chance of developing COPD, even after considering factors like age, sex, smoking, and asthma. Importantly, by combining a few simple movement measures with basic self-reported information, we could predict COPD risk just as well as methods that rely on clinical tests. This suggests COPD risk could be identified earlier and more easily, without needing clinic visits. These findings suggest that wearable devices could offer a scalable, practical and low-cost way to identify people at risk of COPD earlier. This may support earlier intervention, helping to slow disease progression and maintain quality of life.
This study reports a robust DNA polymer spherical nucleic acid (PSNA) nanomachine based on domain-crosslinked self-assembly for highly selective and ultrasensitive imaging of microRNAs (miRNAs) in living cells. The nanomachine is constructed from DNA micelles formed via self-assembly of amphiphilic monomers followed by radical-initiated polymerization. This design effectively overcomes key limitations of conventional spherical nucleic acids, including poor biostability, inefficient cellular uptake, and nonspecific signal leakage, by providing a covalently stabilized architecture with high DNA loading capacity. A target-recognizing lock-walking strand and a fluorophore-labeled track strand containing the substrate sequence are immobilized on two distinct PSNA particles, respectively. Upon specific activation by endogenous miRNA-21 within tumor cells, the DNA walker is released and initiates a cyclic walking process that binds to the substrate strands and triggers a fuel-driven strand displacement cycle, leading to significant signal amplification. This walking mode is multi-legged and spatially confined. It enables high-speed reaction kinetics, substantially enhances fluorescence signals, and improves imaging clarity. The resulting PSNA nanomachine exhibits excellent stability and amplification capability, permitting ultrasensitive miRNA detection under low-background conditions. Moreover, this platform has been successfully applied for in situ imaging of miRNA in various cell lines, demonstrating strong potential for early clinical diagnostics and real-time monitoring of therapeutic responses.
This study aimed to evaluate the relationship between the Insall-Salvati ratio (ISR) and femoral cartilage thickness (FCT) in patients with knee osteoarthritis (KOA), and to examine their associations with radiographic disease stage, clinical findings, and functional capacity, including the ability of mean FCT to discriminate late-stage KOA. This cross-sectional study included 104 patients (52/group) diagnosed with KOA via American College of Rheumatology criteria: early stage (Kellgren-Lawrence [K-L] 1-2) and late stage (K-L 3-4). One index knee per participant was analyzed. The ISR was measured on radiographs, and FCT on ultrasonography. Visual Analog Scale (VAS), Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 100-m walking time were recorded. Data were analyzed using age- and body mass index (BMI)-adjusted ANCOVA. Stage-specific Pearson correlations were adjusted via the Benjamini-Hochberg false discovery rate (FDR) procedure. Multivariable regression and receiver-operating characteristic curve analyses were also conducted. After FDR correction, mean ISR correlated with FCT in late-stage KOA (r = 0.527, q < 0.001) but not in early-stage KOA (r = 0.331, q = 0.058). Age- and BMI-adjusted ANCOVA confirmed between-stage differences in mean FCT, VAS, KOOS, WOMAC, and 100-m walking time (all P < .001); however, mean ISR did not differ by stage (P = .419). In multivariable regression, late-stage KOA (B = -0.411 mm) and mean ISR (B = 0.829 mm per 1-unit increase) were independently associated with mean FCT (R2 = 0.463). Mean FCT discriminated late-stage KOA (area under the curve = 0.845, 95% CI: 0.771-0.919); a cutoff of ≤1.82 mm yielded 63.5% sensitivity and 88.5% specificity. Ultrasonographic FCT is strongly associated with radiographic stage, pain, functional scores, and walking performance, showing good discrimination of late-stage KOA. While ISR was not stage discriminative, it was independently associated with FCT. These findings should be viewed as exploratory; causal inferences cannot be drawn from this cross-sectional design. Cite this article as: Yesilmen N, Elbastı MŞ, Korkmaz M. Insall-Salvati ratio and femoral cartilage thickness: Ultrasonographic and clinical evaluation in knee osteoarthritis. ArchRheumatol. Published online April 27, 2026. doi:10.5152/ArchRheumatol.2026.26308.
This study aimed to elucidate safety of early ambulation following aneurysmal subarachnoid hemorrhage (aSAH) onset and related factors influencing early ambulation in patients with mild aSAH. A total of 150 patients were screened for eligibility. Final analysis included 62 patients with mild aSAH. The early ambulation group (n = 41) comprised patients who initiated walking training within 14 days as part of rehabilitation program, whereas the late ambulation group (n = 21) included those who initiated walking training after 14 days. Differences in baseline characteristics, rehabilitation interventions, SAH-related events, clinical outcomes, and blood test results were compared between two groups. The early ambulation group exhibited a significantly shorter duration of spinal drainage than the late ambulation group. The early ambulation group exhibited significantly lower hydrocephalus onset than the late ambulation group. Symptomatic cerebral vasospasm (SCV) onset and blood examination results were not significantly different between two groups. Early ambulation within 14 days in patients with mild aSAH was not associated with life-threatening complications, including SCV and hydrocephalus. However, given retrospective design and potential time-dependent bias, a causal relationship cannot be established. Early ambulation may be considered in patients with mild aSAH after removal of spinal drain. Early ambulation in patients with mild aneurysmal subarachnoid hemorrhage (aSAH) may be feasible without showing a significant relationship with either symptom exacerbation or an increased risk of life-threatening complications.The presence or absence of a spinal drain is a factor enabling early ambulation in patients with mild aSAH.
Quantitative gait analysis is an important tool in clinical assessment and biomechanical research. Vision-based motion capture systems used in dedicated gait laboratories are considered the reference standard, providing highly accurate kinematic measurements, but they require specialized infrastructure and controlled environments. As a result, wearable inertial sensor systems have become a practical alternative for clinical and everyday gait assessment. This study presents a comparative evaluation of a smartphone-based gait analysis method and a clinically established wearable inertial system.
Gait recordings representing healthy, mildly asymmetric, and impaired walking patterns were analysed using both approaches. The comparison focused on clinically relevant parameters, including cadence, swing-phase duration symmetry, and vertical acceleration symmetry. The smartphone-based method employs median-based statistics and robust outlier rejection to enhance reliability under non-ideal measurement conditions. 
For healthy and mildly asymmetric gait, both systems produced comparable parameter estimates. In gait patterns with pronounced imbalance, the smartphone-based method detected larger deviations, indicating enhanced sensitivity to asymmetry and pathological alterations, highlighting the benefits of robust statistical modelling when gait data deviate from Gaussian distributions.
These findings demonstrate a strong level of agreement between the proposed smartphone-based method and a clinically established wearable inertial system while supporting the practical applicability and robustness of the approach for quantitative gait assessment.
The method provides gait parameters comparable to those obtained with a wearable reference system while maintaining stable performance across different walking conditions. Its low instrumentation requirements and applicability outside laboratory settings 
make it suitable for rehabilitation follow-up, fall risk assessment, and repeated gait evaluation over time.