Objectives: The aim of this study was to determine the differences between groups with and without nocturnal pain (NP) in patients with knee osteoarthritis (KOA) in terms of radiographic stage, disease severity, neuropathic pain, central sensitivity, sleep quality, physical activity level, and number of hospital visits. Methods: The study included 150 patients with KOA (101 women, 49 men; mean age 64 years (IQR: 9; range: 40–81)). Kellgren–Lawrence (KL) grading was used for radiographic staging, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for KOA disease severity, the Douleur Neuropathique 4 (DN-4) questionnaire for neuropathic pain, the Central Sensitization Inventory (CSI) for central sensitization, the Pittsburgh Sleep Quality Index (PSQI) for sleep quality, and the International Physical Activity Questionnaire–Short Form (IPAQ-SF) for physical activity level. Results: In our KOA patient group, the prevalence of NP was found to be 64.7%. A multivariable binary logistic regression analysis was performed as the primary inferential analysis. Age, sex, educational level, body mass index, disease duration, KL grade, and WOMAC total score were entered simultaneously into the model. After adjustment for the included covariates, only the WOMAC total score remained independently associated with NP. Each one-point increase in the WOMAC total score was associated with an 11.7% increase in the odds of NP (adjusted OR = 1.117, 95% CI 1.068–1.168, p < 0.001). Conclusions: Given that it affects more than half of patients with KOA and is associated with higher disease severity, we emphasize the need for careful management of NP in KOA patients.

Purpose: Upper extremity motor impairments following stroke substantially limit independence in daily living. Hand-tracking virtual reality (VR) rehabilitation systems may support intensive task-oriented practice while enhancing motivation; however, evidence integrating objective kinematic indicators with usability and patient-reported outcomes for controller-free consumer-grade VR remains limited. The primary aim of this single-arm pilot study was to evaluate the feasibility, safety (tolerability), and usability of a hand-tracking VR rehabilitation system delivered as an adjunct to conventional physiotherapy in individuals with stroke; describing its preliminary in-game kinematic profile and exploring participants’ experiences through open-ended feedback were secondary aims. The study was explicitly not designed or powered to test clinical efficacy. Materials and Methods: Ten individuals with stroke completed a 20-session (8-week) single-arm pilot intervention; all participants concurrently received standard hospital-based physiotherapy (median 3 sessions/week, ∼45 min/session). Early-phase (sessions 1–5) and late-phase (sessions 16–20) within-subject performance were compared using the Wilcoxon signed-rank test with Holm–Bonferroni correction across four pre-specified primary outcomes. Movement smoothness was assessed using the Spectral Arc Length (SPARC), usability was evaluated using the System Usability Scale (SUS), and cybersickness was monitored with the Simulator Sickness Questionnaire (SSQ). Results: Sixteen patients were screened, of whom fourteen started the intervention and ten completed the 8-week per-protocol program (intervention completion rate, 10/14 = 71.4%; per-protocol session adherence among the ten completers, 200/200 = 100%; no SSQ-defined adverse events). Within-subject comparisons showed a $+10.6$-point increase in success rate (adjusted $p=0.020$), a $+0.10$ m/s increase in mean movement speed (adjusted $p=0.020$), a $-341$ ms reduction in pause duration (adjusted $p=0.022$), and a $+27.0$-point Hodges–Lehmann median-difference increase in SS-QOL (95% CI $14.0$–$41.0$; participant-level median $\mathsf{\Delta }$$+18.5$; adjusted $p=0.020$). The mean SUS score was $78.5\pm 5.4$, indicating “good” usability. Thematic analysis of post-intervention open-ended feedback identified three themes—motivation and engagement, the value of feedback, and design and comfort suggestions—that converged with the high adherence and good usability ratings. Correlations between VR-derived kinematic change and clinical change were non-significant trends ($p\ge 0.12$). Conclusions: A controller-free hand-tracking VR system was found to be feasible, well tolerated, and rated as having good usability when delivered as an adjunct to conventional therapy. Because the study used a single-arm design, included only ten participants, and did not control for the confounding effect of concurrent conventional physiotherapy or natural recovery, the observed within-subject changes cannot be causally attributed to the VR intervention and should be interpreted as exploratory feasibility signals. Adequately powered randomized controlled trials with stroke-specific clinical scales (e.g., FMA-UE, ARAT) are required before clinical efficacy can be claimed.

Virtual reality (VR)-based rehabilitation is an established modality for upper extremity motor recovery; however, existing systems frequently rely on fixed, random, or therapist-tuned target placement that disregards patient-specific motor capacity and population-level priors. This study proposes a cross-patient collaborative swarm intelligence framework that derives zone-based patient profiles from real VR trajectories and augments them with a similarity-weighted cohort prior distilled from clinically similar patients’ successful trajectory clouds and zone-transition graphs. A hybrid Ant Colony Optimization (ACO)–Particle Swarm Optimization (PSO) algorithm optimizes 12 targets per session across a 27-zone ($3\times 3\times 3$) workspace using a five-component fitness function encompassing reachability, zone balance, movement efficiency, heatmap-guided challenge coverage, and swarm-flow consistency. The framework was evaluated retrospectively on a single-center cohort of 36 post-stroke patients and 6373 sessions under a leakage-safe simulation protocol with 70/30 chronological splits; outcomes are model-based proxy success rates derived from each patient’s profile rather than directly observed task success. The hybrid strategy achieved a mean simulated success rate of 85.5% ± 5.5%, a 36.4% relative improvement over random placement (Wilcoxon $p<{10}^{-7}$, Cohen’s $d=4.91$); the leakage-safe split yielded 80.1% on the held-out segment versus 61.1% for random, with no statistically significant train–test gap ($p=0.470$). Ablation confirmed both PSO and ACO are individually necessary ($\mathsf{\Delta }\ge 2.7$ pp, $p<0.001$). Total session-start computation is 78 ms on standard CPU hardware. These findings constitute a proof-of-concept that collaborative personalized swarm optimization can substantially outperform heuristic target placement under in silico evaluation; clinical efficacy in terms of standardized motor outcome measures remains to be established in a prospective randomized controlled trial, and the findings should be replicated across centers, task modes, and a larger cohort before generalization.

Fonksiyonel hipotiroidi, klasik tanı kriterleriyle açıklanamayan ancak hipotiroidi benzeri semptomlarla seyreden heterojen bir klinik tabloyu ifade eder. Bu spektrum içerisinde en iyi tanımlanmış alt grup, tiroid bezinin intrinsik fonksiyonları korunmasına rağmen, periferik hormon metabolizmasındaki değişikliklerle karakterize olan düşük T3 sendromudur. Bu sendrom; düşük serbest T3 (fT3), artmış ters T3 (rT3) ve normal veya baskılanmış TSH düzeyleri ile tanımlanır ve genellikle sistemik hastalıklar, inflamasyon, kronik stres ve metabolik yüklenmeye karşı gelişen adaptif bir yanıt olarak değerlendirilir. Patofizyolojik olarak süreç; deiyodinaz enzim aktivitesindeki değişimlerle ilişkilidir; Tip 1 ve Tip 2 deiyodinaz aktivitesinin azalması ve Tip 3 deiyodinaz aktivitesinin artması, T4’ün aktif T3’e dönüşümünü azaltırken, inaktif rT3 üretimini artırır. Bu durum metabolik hızın düşmesi ve enerji tasarrufu ile sonuçlanır. Etiyolojide sepsis, kronik organ yetmezlikleri, travma, malnütrisyon ve bazı ilaçlar (glukokortikoidler, amiodaron, dopaminerjik ajanlar) önemli rol oynar. Mitokondriyal disfonksiyon, inflamasyon ve mikro besin eksiklikleri (özellikle demir, selenyum, çinko) düşük T3 paternini derinleştiren temel faktörlerdir. Ferritin düzeyleri, hem tiroid hormon sentezi hem de periferik dönüşüm açısından kritik öneme sahiptir. Tanıda yalnızca TSH’ye odaklanmak yetersiz olup, klinik bulgularla birlikte FT3 ve FT4 düzeylerinin bütüncül değerlendirilmesi gereklidir. rT3 ölçümü teorik olarak anlamlı olsa da, standardizasyon sorunları nedeniyle rutin kullanımda önerilmemektedir. Tedavi yaklaşımı; tiroid hormon replasmanından ziyade altta yatan patolojinin düzeltilmesine odaklanır. İnflamasyonun azaltılması, insülin direncinin düzeltilmesi, stres yönetimi ve mitokondriyal fonksiyonun desteklenmesi temel stratejilerdir. Sonuç olarak düşük T3 sendromu, sistemik hastalıkların biyokimyasal bir yansıması olup, multidisipliner ve bütüncül bir değerlendirme gerektirir.