In stereotactic body radiotherapy for bone metastases using the CyberKnife system, spinal anatomy is generally employed as the alignment reference. However, when treating pelvic tumors such as those in the pubic bone or proximal femur, the spinal reference may be anatomically distant from the target, potentially compromising visualization and localization accuracy. This study evaluated the feasibility of using nonspinal bony landmarks, specifically the pubic bone and femoral neck, as reference points for image registration. Intrafractional positional deviations in six degrees of freedom and the frequency of intrafractional corrections were analyzed according to treatment site, including cases treated with conventional spine-based alignment. Alignment accuracy was visually and numerically verified by the treatment operator before beam delivery. Across all treatment sites, the mean translational and rotational deviations during treatment remained within ±0.5mm and ± 0.5°, respectively. Furthermore, no substantial differences were observed in the mean frequency of intrafractional corrections among the different alignment approaches. These findings demonstrate that nonspinal tumor-adjacent bony landmarks can provide clinically acceptable accuracy comparable to conventional spine-based registration. To our knowledge, this is the first study to systematically assess the clinical feasibility of this approach in CyberKnife-based pelvic radiotherapy. The proposed method may serve as a practical and reliable alternative to spine-based alignment, particularly when the spine is remote from the target.

The strategic development and sustainability of biobanks depend on systematic monitoring and evaluation of their performance. Defining appropriate key performance indicators (KPIs) remains challenging, as biobanks must balance the diverse needs of stakeholders with operational quality and alignment with international standards. In Slovakia, where the biobank network is still emerging, no systematic, stakeholder-driven effort to define context-specific KPIs has yet been undertaken. Building on a systematic literature review, we conducted a stakeholder survey to prioritize performance indicators for Slovak biobanks. A questionnaire with 54 indicators was distributed to over 150 representatives from research, health care, patient organizations, government, industry, and ethics committees. Respondents (n = 23) rated indicators on a 0-5 scale and selected their top 5 key and important indicators. Indicators were classified into four categories based on mean rating (>4), consensus (standard deviation <1), and frequency of selection. Twelve indicators were identified as key, 10 as very important, 27 as moderately important, and 5 as less important. Research outputs-such as the number of clinical studies involving the biobank and the number of research projects supported-were most frequently prioritized. Operational indicators, including stored sample quantity, quality control policies, comprehensiveness of clinical data, and adherence to standard operating procedures, were also highly valued. Despite the modest sample size, findings showed broad consensus across stakeholder groups. Continuous monitoring was rated extremely important (mean = 4.63, SD = 0.58), with qualitative feedback emphasizing sustainability, quality assurance, feedback, performance, and strategic development. This study provides the first stakeholder-driven prioritization of KPIs for Slovak biobanks. Results highlight a consensus on indicators reflecting scientific impact, operational reliability, and quality assurance, while financial and governance metrics were deprioritized. Establishing a context-specific monitoring framework can strengthen transparency, support strategic decision-making, and align Slovak biobanks with European initiatives and national priorities.

Acute watery diarrhoea (AWD) has not been well-treated with 20 mg elemental zinc, primarily because of adverse symptoms like vomiting. In contrast to 20 mg of zinc, this study sought to determine whether a lower dose of zinc, with or without probiotics, is as beneficial as 20 mg of zinc, yet tolerated better. The aim of this study was to compare the acceptability and efficacy of low-dose zinc (10 mg) with or without probiotics to the acceptability and efficacy of standard-dose zinc (20 mg) in children diagnosed with AWD. A prospective comparative study was conducted among children aged 6 months to 5 years with AWD at a tertiary healthcare centre. Eligible children were randomized into three groups: Group Z20 and Z10 were administered zinc acetate 20 mg/day and 10 mg/day, respectively, and Group Z10P with 10 mg/day with probiotics. Caregivers were followed daily via telephonic interviews for 14 days to record symptoms, adverse reactions, and treatment completion. Data were analyzed using Kruskal-Wallis test, one-way ANOVA, and the chi-square test. A total of 147 children were enrolled (49 in each group). The mean duration of AWD at enrollment was 3 ± 1.5 days, and the mean frequency was 5 ± 2 episodes/day. There was no significant difference in the mean duration of diarrhoea among the groups. The most common adverse reactions reported was vomiting (85%). Diarrhoea resolved within 3 days in 22.4% of Group Z10P, 10.2% of Group Z20, and 2% of Group Z10 (P = .03). Low-dose zinc (10 mg/day) was less effective than 20 mg zinc in controlling AWD. However, the combination of 10 mg zinc with probiotics significantly improved efficacy.

Effective architectural design requires integrating multiple attributes to achieve optimal outcomes, yet students often struggle to balance these technical and conceptual demands. This study assesses the design preferences of undergraduate architecture students at Bingham University Karu to understand how these priorities impact their design outcomes and professional readiness. A quantitative research methodology was employed, utilizing a structured online questionnaire distributed to 189 students from the 200 to 400 levels. A total of 111 responses (58.7% response rate) were analyzed using descriptive statistics to determine mean scores and preference rankings across four key attributes: Interior Space Planning, Building Form and Appearance, Sustainability, and Site Planning. The findings revealed that students significantly prioritized Interior Space Planning, which achieved the highest mean score (4.44) and frequency of preference. Sustainability and Site Planning followed, while Building Form and Appearance received the least attention, ranking last with a mean score of 3.79. Data indicated that while students acknowledge site integration as important, it is often viewed as a supervisory requirement rather than a personal design passion. The results suggest a shift in architectural education away from pure formalism toward a functionalist, performance-based approach. However, the disparity in attribute prioritization highlights a gap in achieving a comprehensive skill set required for professional practice. The study recommends that architectural educators emphasize the integration of diverse attributes, particularly site responsiveness and incorporate building performance simulation tools to bridge the gap between functional necessity and technical validation

Abstract Lexical ambiguity, where a word has multiple related (polysemous) and/or unrelated (homographic) meanings, causes challenges in learning and teaching semi-technical medical vocabulary owing to its lack of consideration in current lexicographical resources, including wordlists and dictionaries. Academic wordlists fail to indicate polysemes and homographs, while conventional dictionaries number multiple meanings of a semi-technical medical word in a vertical format that is unlikely to showcase polysemous and homographic relations. This study focuses on a new lexicographical resource, named SemiMed, which addresses issues in wordlists and dictionaries arising from lexical ambiguity. Hsu’s (2013) Medical Word List (MWL), an academic list of semi-technical medical vocabulary, was selected as a starting point. A qualitative analysis underpinned by lexical semantic theories was conducted to analyse polysemes and homographs of MWL words. Then, a quantitative analysis that employed word sense disambiguation practices calculated MWL word meaning frequency. These analyses resulted in two key features, radial networks of meanings and technicality levels, that are expected to help SemiMed resolve issues in academic wordlists and conventional dictionaries caused by lexical ambiguity.

Recent findings have shown the influential role of theta-gamma cross-frequency coupling in the maintenance of items in working memory (WM). Specifically, it has been proposed that individual items are represented within gamma oscillations that are nested within slower theta waves. Thus, longer theta cycles would theoretically allow the retention of more items. On the basis of this theory, the present preregistered study aimed to test whether slowing theta rhythms via 4 Hz of transcranial alternating current stimulation over the frontoparietal network improves WM capacity. Given the potential role of individual differences in stimulation effects, participants were divided into high and low WM capacity groups based on initial screening. In addition, task difficult was also manipulated to maximize the likelihood of obtaining an improvement in performance. Contrary to our hypothesis, transcranial alternating current stimulation did not improve behavioral outcomes regardless of task difficulty or baseline WM capacity. Poststimulation EEG effects were also analyzed, but no modulation of theta power, peaks, or phase synchronization was found. Importantly, differences in mean theta frequency were observed before any stimulation between high- and low-capacity WM participants, with higher frequencies present in participants with better WM performance. Furthermore, higher mean frequency was also observed in high-load trials versus low-load trials. These findings contradict the predictions of the theta-gamma coupling theory. Taken together, these results raise questions about the validity of the theta-gamma coupling theory to explain cortical dynamics related to WM.

Early neurodevelopment is a critical period during which environmental exposures can have lasting effects on brain function and behavior. One key indicator of early neurodevelopmental integrity in rodents is the production of neonatal ultrasonic vocalizations (USVs), which are essential for maternal-offspring communication. Given the widespread use of titanium dioxide nanoparticles (TiO2NPs) in food and consumer products, there is growing concern that perinatal exposure to these particles may interfere with normal neurodevelopment. However, the effects of TiO2NPs exposure on USV production remain poorly investigated. In the present study, pregnant mice were orally exposed to TiO2NPs (200µg/g) from conception to weaning, and their offspring underwent a maternal separation test to assess USVs between postnatal day P2 and P13. TiO2NP-exposed pups exhibited a significant reduction in the number of USVs at P6-7, accompanied by a delayed peak vocalization period. This reduction was primarily attributable to shorter vocalization series rather than fewer isolated calls. Additionally, acoustic analysis revealed that pups emitted two types of USVs, simple and complex, both of which were significantly reduced in number at P6-7 in the exposed group. Fast Fourier transform (FFT)-based analysis showed that complex USVs had a lower mean frequency, while both call types exhibited increased variability in mean frequency. Furthermore, TiO2NP-exposed pups displayed alterations in USV syntax, including a lower proportion of simple USVs and disrupted developmental maturation of call structure. Electrophysiological recordings revealed that the intermediate reticular oscillator (iRO), a key brainstem center involved in vocalization control, exhibited reduced excitability and an increased activity variability in exposed pups, suggesting that nanoparticle exposure compromises vocal motor regulation at the neural level. Lastly, playback experiments demonstrated that USVs from TiO2NP-exposed pups failed to elicit appropriate maternal attraction, indicating impaired communicative effectiveness. Perinatal exposure to TiO2NPs disrupts the normal development of USVs, impairing both vocalization patterns and neural excitability of the iRO. These changes may contribute to altered maternal-offspring interactions and highlight the potential neurodevelopmental risks of early-life TiO2NPs exposure. Given the widespread presence of TiO2NPs in consumer products, further research is necessary to assess their long-term consequences on neural circuits underlying communication and social behavior.

The primary barrier to maximizing the benefits of intermittently scanned continuous glucose monitoring (isCGM) is low scan frequency. Higher daily scan frequency correlates with better glycemic control. To evaluate the effect of a nurse-led educational intervention on scan frequency and behavioral change in adults with type 1 diabetes (T1D) showing low scanning frequency. In this 12-week quasi-experimental study, adults with T1D using isCGM and low scan frequency participated in a single, individualized, direct education session led by a diabetes nurse educator. The intervention focused on increasing daily scan frequency and supporting patient engagement in self-management. Thirty-four patients using isCGM participated. Mean daily scan frequency increased from 3.1 to 6.1 scans/day following the intervention. This rise was associated with an 8.0% improvement in TIR. A positive correlation was observed between scan frequency and TIR, with each additional daily scan associated with a 0.51% increase in TIR. A single, targeted educational session can significantly improve isCGM adherence and glycemic control in adults with T1D and low adherence, supporting its value as a practical strategy in routine clinical care. The protocol was publicly registered at ClinicalTrials.gov (NCT05570162).

High-density EEG microstates for functional evaluation of visual pathway in multiple sclerosis: a correlation study with visual evoked potentials.

Prolonged standing demands continuous postural adjustments to redistribute weight and maintain comfort. People with Parkinson's disease (PwPD) may show impaired adaptability due to motor symptoms and rigidity. The effects of dopaminergic medication on postural control during prolonged standing are not well understood. This study aims to analyze the impact of dopaminergic medication on postural control during prolonged standing in PwPD, focusing on both global sway characteristics and discrete postural adjustments. Twenty-two PwPD (Hoehn and Yahr II-III) performed a 15-min standing task on a force plate in randomized ON (medicated) and OFF (unmedicated) sessions. Global sway parameters (sway area, root mean square, velocity, and frequency) and discrete postural adjustments (shifts, fidgets, and drifts) were calculated from center of pressure data. Nonparametric and parametric tests compared ON and OFF states. In the ON state, participants showed significantly larger sway area, increased root mean square and velocity in anterior-posterior and mediolateral directions, and higher sway frequency (all p < .05). The number and amplitude of discrete adjustments were greater in the ON state, especially anterior-posterior drifts and mediolateral shifts. These changes indicate enhanced postural dynamics under dopaminergic medication. Dopaminergic therapy promotes a more dynamic and adaptable postural control strategy during prolonged standing in PwPD. Rather than reflecting instability, increased sway and frequent adjustments suggest adaptive behaviors facilitating comfort and stability over time. These findings underscore the value of prolonged standing tasks for assessing postural control and guiding rehabilitation strategies in PwPD beyond what short static tests capture.

Postural and autonomic adjustments are commonly described during the observation of emotional stimuli. Thus, this study investigated the physiological impact of emotional images viewing revealed by whole-body expressions. Body sway and cardiorespiratory signals were recorded in thirty-nine healthy young people who maintained an upright stance while observing 20 neutral, 20 happiness (positive) or 20 anger (negative) images from the Bodily Expressive Action Stimulus Test (BEAST) database. Participants rated each image considering their valence and arousal dimensions with the Self-Assessment Manikin. Additionally, emotional recognition level was rated using a three alternative-forced-choice task (happiness, anger, and neutral). A repeated-measures one-way analysis of variance (ANOVA) was used to compare the main physiological variables among emotionally-laden blocks. Valence statistically differed among blocks. The emotional recognition rate was above 70 % for all blocks. There was a significant decrease in body sway area during the observation of anger whole-body expressions compared to the neutral and happiness ones. The mean power frequency in the medial-lateral axis showed a significant increase during viewing anger images compared to the neutral one. Further, there was a significant increase in the heart rate variability during observation of anger whole-body expressions compared to the happiness one. These findings revealed physiological adjustments in the observer while viewing whole-body expressions consistent with the emotional processing experience. Therefore, the observation of images depicting anger whole-body expressions led to postural and autonomic changes in agreement with defensive responses ("postural immobility").

Usefulness of anesthetic block of the greater occipital nerve in the treatment of migraine in children and adolescents.

Background: The treatment of juvenile myoclonic epilepsy (JME) is limited, with most patients requiring long-term medication and over half experiencing seizure recurrence upon drug withdrawal. As a third-generation antiseizure medication, brivaracetam (BRV) has emerged as a promising therapeutic option. Its efficacy has been investigated in focal epilepsies and genetic generalized epilepsies (GGEs), with promising results. Objectives: This study aims to evaluate the safety and preliminary efficacy of BRV as an off-label initial monotherapy in patients with newly diagnosed JME, with a specific focus on the control of myoclonic seizures. Design: A prospective, single-center, and observational study. Methods: This study prospectively enrolled drug-naïve patients with JME. All participants received BRV monotherapy. Clinical data were collected at baseline and after a 6-month follow-up period, including demographic characteristics, electroencephalography (EEG), cranial magnetic resonance imaging (MRI), and comprehensive neuropsychological assessments. Changes in seizure frequency, cognitive function, levels of anxiety and depression, sleep quality, and quality of life from baseline to the 6-month follow-up were analyzed and compared. Results: A total of 19 patients were included with a mean age of 20.26 ± 6.88 years (median: 18, interquartile range: 8), and a male-to-female ratio of 12:7. The average age of onset was 14.58 ± 3.42 years, and the average duration of epilepsy prior to BRV treatment was 5.71 ± 7.40 years (median: 2, interquartile range: 5). The mean frequency of myoclonic seizures at baseline was 38.79 ± 45.60 times per month (median: 10, interquartile range: 86). Eighteen patients (94.73%) experienced both generalized tonic-clonic seizures (GTCS) and myoclonic seizures, one patient only experienced myoclonic seizures, The MRI findings were negative in all patients (100%). The EEG of all patients at baseline was abnormal, revealing 3–5.5 Hz generalized spike-and-wave or polyspike-and-wave discharges. At the 6-month evaluation, all patients achieved seizure-free status ( p &lt; 0.001), neuropsychological assessments also demonstrated significant improvement, including Montreal Cognitive Assessment (MoCA; p &lt; 0.001), Hamilton Anxiety Scale (HAMA; p &lt; 0.001), Hamilton Depression Scale (HAMD; p &lt; 0.001), Pittsburgh Sleep Quality Index (PSQI; p &lt; 0.001), and Quality of Life in Epilepsy-31 (QOLIE-31; p &lt; 0.001). Only one patient complained of poor sleep after BRV administration. Conclusion: This study suggests that BRV may offer promising efficacy, specifically in controlling myoclonic seizures and favorable tolerability as an off-label initial monotherapy for JME patients. While the evaluation of efficacy against GTCS requires longer follow-up, our findings support the potential of BRV as a therapeutic option for JME. Further randomized controlled trials are warranted to validate these observations.

Objective:This study aims to examine the factors influencing patients' choices of physicians, alongside their awareness and attitudes towards Family Physicians (FPs).MethodsIt was a nationwide cross-sectional study conducted between September 2023 and March 2024. Data was collected on participant demographics, awareness of the role of FPs, and choice of physician for different health conditions. Descriptive analysis assessed knowledge and attitudes towards Family Medicine (FM). One-way ANOVA and T-test evaluated the associations between demographic factors and the mean frequency of selecting a FP for various conditions, with significance set at p &lt; 0.05.ResultsThe final sample consisted of 341 participants with a median age of 26 years. Only 184 (54%) respondents knew about the qualifications of a FP, and for most health conditions, the majority preferred to consult other healthcare workers instead of FPs. Participants over 26 years had a significantly higher mean frequency (4.1 ± 2.64) of selecting FPs for health conditions as compared to those below 26 years (3.1 ± 2.42, p=0.000). Among participants who preferred a FP, convenient location and easier appointment scheduling were common factors influencing their choice.Conclusion There was a significant gap in awareness and preference for FPs, with age as an important contributing factor. To increase the utilization of FM services, further initiatives are needed to raise awareness and improve access.

A new Convex Hull microdosimetric technique has been incorporated in Geant4-DNA to enhance geometrical modeling of microdosimetry at nanometric scales. This new microdosimetric technique aims to provide a direct relationship between electron track structures and their effectiveness in radiobiology. Track structures in liquid water were simulated using monoenergetic electrons ranging from 0.1 keV to 1000 keV, including clinical electron beams between 6 MeV and 18 MeV. The CH technique, based on the Jarvis-March gift wrapping algorithm, has been incorporated in Geant4-DNA to increase computational efficiency by geometrically encapsulating track-associated microdosimetric quantities. Dose mean lineal energy and frequency mean lineal energy were used in conjunction with the Microdosimetric Kinetic Model to estimate radiobiological parameters and relative biological effectiveness. These results are compared with the reference results obtained using the KURBUC and FLUKA codes. The CH approach correctly predicts the reference microdosimetric quantities within 5% accuracy for the micrometer scale, while larger systematic differences are found on the nanometer scale due to the different definitions of the track volume. Theαparameter increases with increasing incident particle energy, ranging from 0.094 Gy-1for an incident particle energy of 0.1 keV to 0.265 Gy-1for an incident particle energy of 5 keV, which results in an RBE of approximately 1.04, showing the effect of ionization clustering. A comparison of the results with the reference results reveals differences of 7%-12%. The RBE results for clinical electron beams are found to be nearly independent of the incident particle energy and remain close to 0.85 when normalized to the results obtained for x-rays. The CH-based approach provides an efficient computational scheme for the calculation of the micro- and nanodosimetric quantities, which allows the model-based calculation of the RBE and the quantification of the quality of the radiation on the nanometric scale.

Bearings are critical elements in rotating machinery, where failures often accelerated by noise interference can cause severe economic and safety consequences. Reliable fault detection in noisy environments remains a major challenge. This paper proposes a novel approach combining advanced signal processing with machine learning to enhance diagnostic robustness. The matrix pencil (MP) method is applied to vibratory signals to extract matrix pencil mean frequency (MPMF) features, offering a noise-resilient spectral representation that highlights fault signatures. To improve generalization, additive white Gaussian noise (AWGN) is introduced both into the extracted features and directly into the vibratory signals, generating diverse datasets with varying signal-to-noise ratios (SNRs). This dual augmentation strategy effectively simulates real-world conditions and strengthens model resilience. A multilayer perceptron (MLP) classifier trained on the enriched feature set achieves outstanding performance, as validated on the University of Ottawa dataset (UORED-VAFCLS). The results demonstrate that the proposed method significantly enhances fault detection accuracy under noisy conditions, offering a promising solution for real-time, reliable condition monitoring in industrial applications.

This study characterizes the pluvial equator—defined as the latitude of maximum rainfall—across tropical Africa (20°S–20°N, 20°W–55°E) from 1981 to 2024. Using CHIRPS as the primary gauge-informed dataset, cross-validated with ERA5 and IMERG, we track the primary pluvial ridge latitude (ϕ 1) and the double-ridge frequency (F 2) at a monthly 0.25° resolution. The results reveal that the African rain belt consists of regionally distinct regimes. Over West Africa, the pluvial equator forms a coherent single rainband where F 2 is near zero in all seasons. Conversely, the rain belt is frequently double over the Congo Basin and southern tropical Africa during the March–May and September–November transition seasons, with regional mean frequencies reaching 0.4–0.5. In East Africa, double ridges occur with a moderate frequency of ∼0.22. Regarding climate drivers, ENSO drives robust shifts of 1–4° latitude in the primary ridge (ϕ 1) across central and eastern Africa during the December–February season. These shifts are statistically significant across ∼70 longitudes in CHIRPS and over 100 in ERA5, demonstrating strong inter-dataset agreement. ENSO drives robust December–February (DJF) shifts of 1–4° latitude in the primary ridge (ϕ 1) across central and eastern Africa. These shifts are statistically significant across ∼70 longitudes in CHIRPS and over 100 in ERA5, demonstrating strong inter-dataset agreement. Linear trends for both ridge latitude and modality are generally small; after False Discovery Rate (FDR) correction, they indicate regionally heterogeneous adjustments rather than a uniform continent-wide shift of the tropical rain belt.

The postural biofeedback technique has been of potential interest to postural rehabilitation, as it promotes conscious postural control and reduces sway, ensuring body stability. However, it remains unclear whether the enhanced awareness of postural performance with biofeedback influences psychological states. Existing research suggests that psychological states such as confidence and anxiety regarding postural and fall risk may impact postural control. This study investigated the effects of two postural biofeedback techniques on balance confidence and anxiety, as well as the association between posturographic parameters and confidence and anxiety, respectively. Twenty-six participants were tested in three 60s tasks on a force platform: (1) eyes open (EO); (2) posturographic biofeedback (BF-COP), requiring participants to keep the centre of pressure (COP) close to a visual target; (3) laser biofeedback (BF-Laser), involving pointing a handheld laser at the same target with right wrist movements. The following COP parameters were computed: sway area, standard deviation, mean velocity and mean frequency in the antero-posterior (AP) and medio-lateral (ML) directions. Balance confidence and anxiety were assessed after each task using visual analog scales (0–100). ANOVA revealed lower balance confidence in the BF-COP task (mean ± SD; 73 ± 22%) compared to EO (86 ± 22%). For the anxiety scale, no significant differences were found between EO (21 ± 33%), BF-COP (28 ± 25%) and BF-Laser (24 ± 30%). For the BF-COP task, sway area, ML standard deviation, and ML mean velocity showed a negative moderate correlation with balance confidence, with greater body sway corresponding to lower confidence. Current findings suggest that psychological factors may be associated with postural stability changes during the postural biofeedback.

Chronic lateral epicondylitis (CLE) arises from overuse and repetitive strain on the extensor carpi radialis brevis (ECRB), particularly prevalent among racquet sport athletes. Given the compensatory workload on a weakened ECRB, this study specified how CLE influences muscle synergy through the neural common drive to motor units (MUs) in both the ECRB and extensor carpi radialis longus (ECRL). Eighteen patients with CLE (49.5 ± 9.2 years) and eighteen healthy participants (48.8 ± 10.4 years) took part in the study. The force dynamics and discharge characteristics of MUs in the agonists were compared between the patient and control groups during a graded force-increasing task. Patients with CLE showed significantly greater task errors (P = 0.005) with smaller mean frequency (MF) of force fluctuations (P = 0.006) than healthy controls. In addition to reduced maximal voluntary contraction (MVC), patients exhibited a lower common drive index (CDI) within the ECRB (P = 0.001) and between the ECRB and ECRL (P = 0.007), with no significant difference observed in the CDI within the ECRL (P > 0.05). The coefficient of variation of the CDI among MU pairs was significantly lower in the patient group for both within the ECRB (CV-CDIECRB) (P < 0.001) and between the ECRB and ECRL (CV-CDIECRB-ECRL) (P = 0.004). Functionally, the size of task errors was negatively correlated with CV-CDIECRB and CV-CDIECRB-ECRL (P < 0.05), while MF of force fluctuations was positively correlated with CV-CDIECRB. Impaired force control in chronic lateral epicondylitis is associated with altered variability and coordination of common synaptic input, highlighting the relevance of coordination-focused rehabilitation strategies.

We investigated the association between continuous glucose monitoring (CGM) and acute and chronic diabetes-related complications and mortality risk in adults with type 1 diabetes. This study included adults with type 1 diabetes who received intensive insulin therapy, based on data from the Korean National Health Insurance Service Cohort (2016-2022). The primary outcomes were diabetic ketoacidosis (DKA), severe hypoglycaemia (SH), end-stage kidney disease (ESKD), cardiovascular disease (CVD) and all-cause mortality. Between-group analyses (comparing outcomes between CGM users and non-users) were conducted using Cox proportional hazards regression models, and within-group analyses (comparing outcomes before and after CGM initiation) were performed using paired t tests. A total of 17,018 individuals (8509 CGM users and 8509 non-users) were included. CGM users had lower rates of DKA (adjusted hazard ratio [aHR] 0.40; 95% CI 0.33, 0.48), ESKD (aHR 0.43; 95% CI 0.32, 0.56), CVD (aHR 0.28; 95% CI 0.23, 0.33) and all-cause mortality (aHR 0.38; 95% CI 0.32, 0.46) than non-users. The aHR for SH was comparable between the two groups (aHR 0.92; 95% CI 0.77, 1.10 for users vs non-users). However, among CGM users, the mean frequency of SH decreased by 61.5% after CGM initiation (p<0.001). The frequencies of DKA and CVD-related hospitalisation or emergency department visits also decreased by 60.0% and 50.0%, respectively (p<0.001 for both). In this nationwide cohort study of adults with type 1 diabetes, CGM users had lower rates of both acute and chronic diabetes-related complications and all-cause mortality compared with non-users.