Search Results (725)

Background/Objectives: To investigate the prevalence and associated factors of postoperative radiculitis in patients treated with Anterior Lumbar Interbody Fusion (ALIF) in L4–L5 or L5–S1 utilizing lumbopelvic sagittal parameters and ideal alignment values calculated with GAP score components. Methods: A retrospective review using Natural Language Processing (NLP) for automated data extraction from clinical notes was conducted. 61 adult patients were included in the analysis. Postoperative radiculitis was defined as the new onset of unilateral or bilateral pain in the L4–S1 radicular territory with preserved motor function. Clinical parameters (Oswestry Disability Index), radiographic parameters (lumbopelvic sagittal alignment using GAP score components), and surgical factors (cage size and disc height modification) were evaluated and subsequently entered into a multivariable logistic regression analysis. Results: Postoperative radiculitis occurred in 29.5% of patients, with symptoms primarily manifesting within the first six weeks following surgery and lasting up to six months. Patients in the Pain group showed notable differences in pre- and postoperative GAP score parameters, specifically higher values for relative lumbar lordosis (RLL) and relative pelvic version (RPV). Furthermore, multivariable logistic regression identified postoperative RLL and the anterior disc height (ADH) ratio to be independently associated with the development of radiculitis. Conclusions: Excessive disc space enlargement during ALIF is associated with a higher likelihood of postoperative radiculitis, particularly in patients with pre-existing near-ideal lumbar alignment. To mitigate this iatrogenic complication in this group, the degree of correction must be individualized. This tailored approach should incorporate parameters from the GAP score and a careful assessment of the relationship between the anterior disc height and the vertebral body. Full article

Background: While ibuprofen is a widely used non-opioid analgesic with growing evidence in surgical settings, its safety and efficacy in acute burn care remain poorly characterized. This review aims to address this gap. Methods: A systematic search was conducted in accordance with PRISMA-ScR (September 2025) across PubMed, MEDLINE, CENTRAL, CINAHL, and Scopus for original, English-language studies evaluating the safety and/or efficacy of ibuprofen, distinguishable from multimodal regimens, for acute burn analgesia. Results: Of 136 studies, six met inclusion criteria (5 adult, 1 pediatric). Populations primarily consisted of second- and third-degree burns; only two studies included >10% total body surface area (TBSA). Study designs were heterogeneous, all with moderate to high risk of bias, including one retrospective study (oral ibuprofen), two experimental double-blind placebo randomized controlled trials (RCTs) (topical; oral), and three clinical RCTs (intravenous; topical; topical and oral). No study reported associations with increased adverse events; a retrospective study found no increased bleeding risk with perioperative ibuprofen in skin graft patients. Analgesic outcomes were not directly comparable across studies due to heterogeneity. Experimental models found that ibuprofen did not reduce acute burn pain, but attenuated pain within hyperalgesic skin. Among clinical studies, both oral and dressing ibuprofen formulations demonstrated reduced procedural pain. One topical study noted faster wound healing, though this was confounded by less frequent dressing changes. Conclusions: The available studies were insufficient to draw definitive conclusions, limited by sample size, heterogeneity, bias, and exclusion of high-risk patients. Nonetheless, no study reported increased adverse events across diverse ibuprofen protocols. These findings underscore the need for adequately powered, agent-specific trials in clinically representative burn populations to inform evidence-based multimodal compositions amidst growing advocacy for opioid-sparing analgesia. Full article

Introduction: Low back pain is one of the commonly overlooked late complications of an intestinal stoma. Its severity may be associated with impaired quality of life across multiple dimensions of patient functioning. Objective: This cross-sectional study evaluated the impact of low back pain on self-reported health-related quality of life in colostomy patients. Material and Methods: The study was conducted using a cross-sectional questionnaire-based design across 12 regional branches of the Pol-ILKO Association in Poland between December 2023 and September 2024. The study sample consisted of 95 patients. The standardized Oswestry Disability Index (ODI) questionnaire, which assesses the level of disability in patients with back pain, and the WHOQOL-BREF questionnaire, which assesses health-related quality of life, were used in the survey. In addition, detailed data on medical history, past surgical interventions, and stoma self-care skills were collected using an author-developed tool. Results: Greater disability due to back pain is associated with lower self-rated quality of life. The higher the degree of disability as assessed by the Oswestry questionnaire and the higher the number of postoperative complications, the worse the subjective rating of health-related quality of life (HRQoL) (p < 0.05). Factors associated with a significantly (p < 0.05) increased risk of lower back pain include postoperative complications, irrespective of the time since stoma creation, as well as avoidance or restriction of full trunk movements. Preoperative agreement on the stoma site was associated with greater independence in stoma hygiene. Conclusions: The results underscore the importance of early and targeted interventions to improve physical and psychosocial well-being in the subject population, especially at the preoperative stage. More attention should be paid to the needs of colostomy patients, both in hospitals and in outpatient specialty care centers, to improve their overall quality of life and self-assessment of their condition. Full article

Dual 6 degrees of freedom (6-DOF) series-parallel cooperative robot actuators are core execution components in modern intelligent manufacturing systems, which are widely used in high-end manufacturing scenarios such as aerospace precision assembly, laser precision machining, and core component assembly of new energy vehicles. However, in actual manufacturing processes, the pose deviation between theoretical model prediction and actual motion execution of the actuator, caused by kinematic model mismatch, unquantified core parameters, incomplete error processing chain, and complex on-site environmental interference, severely restricts the assembly accuracy, product qualification rate and production efficiency of the manufacturing system. To address these critical pain points of robot actuators in precision manufacturing systems, this paper proposes a four-layer hierarchical decoupling multi-modal fusion calibration algorithm for high-precision pose control of dual series-parallel robot actuators. The algorithm integrates singular value decomposition (SVD) for cross-structure coordinate alignment of heterogeneous actuators, chaotic mapping-enhanced particle swarm optimization (PSO) for nonlinear error suppression of the actuator system, attention-enhanced deep residual network (DRN) for unmodeled residual learning of the actuator, and Kalman filter (KF) for dynamic noise reduction in the manufacturing process. Meanwhile, a full-chain error transfer model of the actuator system in the manufacturing process is constructed, and the core parameters of the algorithm are quantified via dimensional sensitivity analysis and orthogonal experiments. Experimental results show that the static position error of the actuator system after calibration reaches 1.4 ± 0.08 mm, and the static pose error reaches 0.0059 ± 0.0003 rad in the laboratory environment; in the engineering application of laser precision machining in an actual manufacturing line, the position error and pose error only increase by 8.6% and 6.8% respectively, maintaining high stability in industrial manufacturing scenarios. Compared with mainstream calibration methods, the proposed algorithm reduces the position error and pose error of the actuator by up to 55.7% and 17.9% respectively, with lower computational complexity and higher engineering reproducibility. This work constructs an end-to-end error suppression chain with quantitative parameter criteria for the series-parallel actuator system in manufacturing systems, which provides a reliable high-precision calibration solution for industrial dual-robot cooperative manufacturing and has important guiding significance for improving the motion accuracy and operation stability of actuators in precision manufacturing systems. Full article

Background and Objectives: Many patients suffer from chronic pain of the shoulder, neck, upper back, and/or arm. They may be diagnosed with fibromyalgia, complex regional pain syndrome, myofascial pain, thoracic outlet, subacromial pain, cervical radiculopathy, cervicogenic headaches, post-mastectomy pain, and/or occupational shoulder disorder. The pectoralis minor (PM) is the only muscle of the scapula controlled by the lower trunk of the brachial plexus. In the Human Disharmony Loop (HDL), this neurologic asymmetry produces persistent protraction of the scapula. Protraction deforms the scapula’s connections, generating headaches and neck stiffness, upper back tightness, shoulder weakness, and hand numbness. We hypothesize patients with the above who meet HDL diagnostic criteria will benefit from PM tenotomy with brachial plexus neurolysis (PM+ICN). Materials and Methods: Patients diagnosed with the above disorders who also met HDL criteria of medial coracoid tenderness and scapula protraction on exam underwent PM+ICN, with secondary neurolysis after 3 months if needed. Clinical neuropathy was diagnosed via the scratch-collapse test. Outcomes included self-reported Visual Analogue Score pain scores, active shoulder abduction range of motion (ROM), prevalence of occipital headaches. Results: N = 318 patients were included. Average age was 51; 68.0% were female. Following treatment, average pain decreased from 7.3/10 to 2.1/10 (p < 0.001), average shoulder ROM increased from 96 to 170 degrees (p < 0.001), and occipital headaches decreased from 76.7% to 1.6% (p < 0.001). Scapular protraction normalized from 98.8% static to 92.5% none (p < 0.001). Overall, 17% required subsequent neurolysis, chiefly of the axillary, radial, and ulnar nerves. The pain reductions were statistically indistinguishable across all diagnoses (p = 0.709, I² = 0.02%). Average follow-up was 22 months. Conclusions: PM+ICN significantly reduced self-reported pain and headaches in select intractable patients. The PM pathologizing the scapula may constitute a shared anatomic mechanism that contributes to chronic pain across heterogenous disorders of the upper limb. Full article

This study aimed to evaluate the therapeutic effects of platelet-rich plasma (PRP) and Cervus and Cucumis polypeptide (CCP) injections in rats with post-traumatic osteoarthritis (OA). The model was established by transection of the anterior cruciate ligament, and the animals were subsequently treated with PRP and CCP. Articular cartilage degeneration was assessed through gross morphological observation, histopathological staining, and a standardized scoring system. Concurrently, pain-related behaviors, joint swelling, levels of inflammatory cytokines, and markers associated with extracellular matrix degradation were measured. The results demonstrated that, compared with the OA model group, PRP and CCP exhibited varying degrees of functional improvement, specifically, a reduction in pain-related behaviors and an alleviation of joint swelling. Furthermore, cartilage morphological damage was diminished, inflammatory marker levels decreased, and indicators of extracellular matrix degradation were attenuated. Histopathological examination of liver and kidney tissues revealed no apparent abnormalities. This study provides valuable experimental evidence for further treatment strategies for OA. Full article

To address the industry pain points of domestic traditional fish meal processing equipment, such as low protein retention, low drying efficiency, and poor operational reliability, this study focuses on high-moisture, heat-sensitive cod meal as the test material to investigate the structural improvement and synergistic optimization of process parameters for vacuum low-temperature fish meal dryers. The conventional uniform-pitch heating coil was optimized into a three-section differentiated structure, with a wear-resistant protective structure additionally incorporated to fundamentally resolve issues including insufficient heat transfer at the feed end, coking at the discharge end, and coil wear-induced leakage. Verification via COMSOL Multiphysics simulation revealed that the axial temperature gradient of the optimized equipment decreased from 8.6 °C/m to 6.2 °C/m, while the thermal fatigue life of the coil was extended from 2–3 years to over 10 years. A three-factor, three-level response surface methodology (RSM) was employed to design the experiments, with the heating temperature, vacuum degree, and drying time as independent variables and the fish meal protein content as the response variable. A total of 17 experimental runs were constructed, including 12 factorial points and 5 central points; each run was replicated three times in parallel, and data were reported as mean values. Analysis of variance (ANOVA) demonstrated that the regression model was highly statistically significant (p < 0.0001), with a coefficient of variation (CV) of 0.2464% and a coefficient of determination (R²) of 0.9944, indicating excellent fitting accuracy. The determined optimal process parameters were as follows: a drying temperature of 65 °C, vacuum degree of 0.08 MPa, and drying time of 75 min. Compared with the traditional process, the optimized process shortened the drying cycle by 37.5%, reduced unit energy consumption by 29.2%, and increased the fish meal protein content by 6.6%. This research provides a reliable technical solution for the localized processing of high-end fish meal. Full article

With the continued rise in outpatient surgical procedures, modern medicine requires more advanced tools for pain and anxiety monitoring and management. The current standard of care requires patient responses on visual analog scales, which may be subjective and are difficult to assess when a subject is unresponsive. Electrodermal activity (EDA) and pulse rate variability (PRV), two non-invasive, wearable, and objective measurements of sympathetic nervous system activity, can help provide insight into a patient’s psychological or emotional state without user input, allowing for continued monitoring even when a patient is unable to respond. However, methods based on these measurements have largely been relegated to longer duration (>60 s) or post hoc analysis, which does not suit the needs of medical care environments. Here we propose new methods for handling ultra-short (<10 s) signals to allow rapid evaluation of pain and anxiety state. We show how machine learning models trained on these signals can obtain high degrees of classification performance (AUC > 0.88) between no pain or anxiety and medium or higher pain and anxiety on signals obtained during two different forms of painful stimulation. We also show how these signals can measure the degree of stimulation irrespective of perceived pain from the patient. Further development of these algorithms will allow for greater monitoring and control of patient comfort in a clinical setting. Full article

Background/Objectives: Valgus deformities of the knee and ankle are frequently diagnosed during adolescence. Hemiepiphysiodesis (HED) using the tension-plate technique has become the standard approach for guided growth in both joints. Notably, valgus deformities may simultaneously affect both joints. While substantial data supports monoarticular guided growth, evidence for ipsilateral biarticular growth modulation remains limited. The aim of this case series was to evaluate the feasibility, safety and short-term radiographic outcome of simultaneous ipsilateral biarticular HED for concomitant valgus deformities in the knee and ankle (CKAVD). Methods: This retrospective monocentric observational study included 21 legs from 21 consecutive children treated with simultaneous ipsilateral biarticular HED for CKAVD between 2013 and 2022. The initiation and termination of growth modulation were based on clinical (intermalleolar distance, pain in both joints) and radiological parameters. Standing whole-leg coronal plain radiographs were evaluated at the start of modulation and after complete hardware removal, assessing the anatomical femorotibial angle (aFTA), anatomical lateral distal femoral angle (aLDFA), medial proximal tibial angle (MPTA), and lateral distal tibial angle (LDTA). Results: The mean age at implantation was 11.5 years (SD 1.08); females (n = 7) were younger than males (n = 14, p < 0.05). The mean duration of growth modulation was 14.3 months (SD 4.3). The intermalleolar distance improved by an average of 10 cm (SD 4.4). The aFTA improved by an average of 6.9 degrees (SD 2.6), the aLDFA by 6.7 degrees (SD 2.7), the MPTA by 7.2 degrees (SD 2.3), and the LDTA by 7.1 degrees (SD 3.0). Two-stage hardware removal was required in 6 legs (29%). In one case, a relapse of knee valgus occurred. Conclusions: Comprehensive evaluation of all major joints seems to be crucial during the diagnostic workup for coronal plane deformities of the lower extremity. For children with ipsilateral symptomatic CKAVD, simultaneous biarticular HED may be considered as a feasible treatment approach, demonstrating promising short-term outcomes and a low observed complication rate. Full article

Minimally invasive surgery (MIS) has transformed modern surgical operations by reducing pain, trauma, scarring and recovery time for the patient. However, precision, stability and accuracy continue to limit surgical performance. Robots can exhibit better precision and stability than humans and have the potential to improve MIS results. This work presents the design and development of a patented 3R1T parallel robot for MIS. The mechanism incorporates a coaxial spherical parallel architecture enabling three rotational degrees of freedom, combined with a remotely actuated translational fourth degree of freedom, therefore reducing the weight of the moving structure, decreasing inertial forces and increasing the system accuracy. The kinematic design is analyzed to achieve the required workspace, motor torque requirements are calculated, and a control system with integrated inverse kinematics is developed. A prototype was manufactured, and preliminary experiments were conducted to evaluate the orientation repeatability of the robot. Results demonstrated a repeatability of ±22.86 μm, commensurate with typical MIS constraints. This suggests that the proposed robot offers potential improvements in precision and control for minimally invasive surgical procedures, over traditional manual methods. Full article

Background: Keratoconus is a progressive corneal condition that leads to visual impairment and is primarily managed with corneal cross-linking (CXL), a procedure designed to halt its progression. However, while the clinical outcomes of CXL are well-documented, its impact on patient well-being, including postoperative pain and recovery, remains underexplored. This study aimed to evaluate postoperative pain, functional limitations, visual recovery, and patient-reported outcomes following corneal cross-linking (CXL) for keratoconus. Methods: A structured survey was conducted among 31 patients who underwent CXL for keratoconus. The survey assessed postoperative pain using a Numeric Rating Scale (NRS) and collected information on visual recovery, functional limitations, and the socioeconomic effects of the procedure. Clinical data, including best-corrected visual acuity (BCVA) and keratometry, were also recorded before and after CXL to evaluate the procedure’s efficacy. Results: The study found that postoperative pain was moderate, with a mean pain score of 6.06 ± 1.82, typically lasting 1–3 days. Nearly 54.8% of patients reported significant disruption to daily activities, including missing work or studies, and 77.4% experienced some degree of functional limitation. A statistically significant correlation was observed between postoperative pain intensity and quality-of-life impairment (Spearman’s ρ = 0.503, p = 0.004). Despite these challenges, 93.5% of participants reported improvement in vision, with most recovering within a week. Objective clinical data supported the effectiveness of the procedure. Conclusions: Corneal cross-linking is associated with favorable clinical outcomes; however, the early postoperative period is characterized by moderate pain and functional limitations, highlighting the importance of patient-centered care. Full article

Background/Objectives: Burning mouth syndrome (BMS) is a chronic idiopathic orofacial pain disorder characterized by persistent intraoral burning in the absence of detectable mucosal alterations. Diagnosis is challenging due to the lack of specific biomarkers and the need to exclude numerous systemic and local conditions that can mimic oral burning. This literature review aims to summarize current and emerging therapeutic strategies for BMS. Methods: A structured and filtered search of PubMed, Scopus, and Web of Science identified studies evaluating pharmacological, phytotherapeutic, and non-pharmacological interventions. Results: Various antidepressants, anticonvulsants, benzodiazepines, H2 receptor antagonists, and low-dose naltrexone have demonstrated varying degrees of symptom reduction, while alpha lipoic acid (ALA) and phytomedicines such as capsaicin, Hypericum perforatum, Catuama, lycopene, crocin, and melatonin show mixed clinical benefits. Non-pharmacological approaches, including photobiomodulation (PBM), oral cryotherapy, neuromodulation techniques, and cognitive behavioral therapy, also provide meaningful symptom improvement in many patients. Conclusions: Across all modalities, therapeutic responses remain heterogeneous and generally incomplete, underscoring the absence of a universally effective treatment. Current evidence supports an individualized and multidisciplinary approach that integrates pharmacological, psychological, and adjunctive therapies to address the multifactorial nature of BMS. Full article

Background: Retrograde cricopharyngeus dysfunction (RCPD) is a recently described upper esophageal sphincter motility disorder caused by the inability of the cricopharyngeus muscle to relax, prohibiting belching. While clinical features and treatment have been reported, early-life experiences remain unclear. This study aimed to explore childhood experiences, comorbidities, and family history in adults reporting symptoms consistent with RCPD. Methods: This cross-sectional survey included adults recruited through an online community focused on RCPD who reported cardinal symptoms consistent with RCPD. The survey collected and descriptively analyzed demographics, symptom profile, family history, neonatal and childhood experiences, psychological factors, and physician visits. Results: Of 225 respondents, 207 met inclusion criteria (mean age 32 years; 69% female). Nearly all experienced abdominal bloating (98%), gurgling noises (98%), flatulence (90%), and inability to belch (100%). Painful hiccupping, a newer described symptom, was reported by 80%. Symptoms began before age 25 in 97%, and 29% reported a first-degree relative affected. Common early-life experiences included emetophobia (39%), anxiety (38%), and difficulty being burped as an infant (20%). No statistically significant crude differences were detected in symptom severity, frequency, gender, or age of onset by presence of experiences. Only 36% felt that any physician understood their condition, and 18% reported their gastroenterologist improved their symptoms. Conclusions: Psychological early-life experiences and family history were common, but exploratory analyses did not detect statistically significant differences in symptom burden by their presence. These findings provide a foundation for future studies investigating the disorder’s pathophysiology. Limited physician recognition highlights the need for greater clinical awareness of this emerging esophageal motility disorder. Full article

Introduction: Perioperative factors can significantly accelerate the development of sarcopenia in patients with aortic dissection, weakening their metabolic and functional reserves. Progressive sarcopenia after surgery is associated with a worse prognosis, increased mortality, and a higher risk of complications, which makes its early diagnosis and prevention key elements of care for this group of patients. Methods: The study included 116 patients hospitalized from April 2022 to May 2025 due to aortic dissection. Prospective studies were conducted using standardized tools as well as clinical data. The effect of blood transfusion, grip strength as measured with a hand dynamometer, and survival of patients after aortic dissection 3 months postoperatively were evaluated. Results: In the group of patients with a high risk of stroke, completely dependent and suffering from insomnia, transfusions were used significantly more often. SGA scores, CHA2DS2-VA score, and Barthel scale scores were dependent on the level of pain at discharge. Grip strength was significantly higher among patients who survived 3 months. The differences reached statistical significance on the second postoperative day. Conclusion: The results indicate that malnutrition is a key factor in the clinical condition of patients, increasing the risk of sarcopenia, stroke, and the severity of insomnia. At the same time, a higher degree of malnutrition is associated with reduced functional independence, which in turn affects the patient’s overall condition. The study found that malnutrition is a key factor in worsening the clinical condition of patients with aortic dissection, increasing the risk of sarcopenia, stroke and exacerbation of insomnia. The relationship between lower self-reliance and higher insomnia levels underscores the complex interplay among nutritional status, physical functioning, and sleep quality. Full article

Background: The pain experienced by people with fibromyalgia (FM) is thought to be the result of altered nociceptive processing, impaired descending inhibition and reduced tolerance to physical load. However, the relationship between the amount of exercise and pain reduction remains unclear. Methods: This study synthesized randomized controlled trials of exercise interventions for FM to quantify the combined analgesic effects of different types of exercise. A secondary aim was to standardize exposure using metabolic equivalent of task (MET)-based metrics and examine the association between cumulative intervention dose (MET·h) and analgesic response (Hedges’ g) across intervention arms. Following the PRISMA guidelines, a search was conducted in PubMed for randomized controlled trials published up to 31 December 2025. After screening and a full-text assessment, 15 trials were included. The protocols were converted into MET-defined intensity and weekly MET·min exposure, and the cumulative dose was calculated as the total MET·h accrued over the intervention period. Random-effects models were used to estimate the pooled effects within modality subgroups. Results: Across modalities, exercise was associated with reductions in pain, with effects typically falling within the small-to-moderate range. Larger improvements were observed in structured or supervised programs. The dose-response scatter plot showed wide variability across the dose range, with overlapping confidence intervals. An exploratory fourth-degree polynomial fit explained limited variance (R² = 0.1615) and did not indicate a monotonic dose-response pattern. This suggests that cumulative workload alone is a weak proxy for therapeutic response. Conclusions: Based on these findings, a pain-responsive algorithm combining weekly Visual Analogue Scale (VAS), ΔVAS and Talk Test thresholds was implemented as a preliminary online calculator to support the prescription of exercise tailored to symptoms. Full article