Search Results (398)

Powassan virus (POWV) is an emerging tick-borne orthoflavivirus with consistently increasing annual prevalence. Though understood as a vector-transmitted virus associated with neurological disease, a 2016 fatal case of an immunocompromised 63-year-old man reported testicular pain with postmortem detection of viral antigen in the testes, suggesting an altered tropism. The extent to which POWV can infect testes remains unclear. We used a BALB/c mouse model of POWV to elucidate the potential of POWV to establish infection in testes and model a potential mechanism of testicular tropism. Here, we report that POWV productively infects the male reproductive tract of mice. We find that POWV consistently infects mouse testes and epididymides at 3 and 5 days post-infection (dpi) with peak titers measuring 6.1 log₁₀ PFU/gram of tissue in testes. Furthermore, we find that at 5 dpi, POWV-infected mice testes are significantly higher in mass than uninfected controls. Due to macrophages being implicated in driving testicular pathogenesis in Zika virus, a related orthoflavivirus, we depleted phagocytic cells using clodronate liposomes prior to POWV infection and compared them to control liposome-treated mice. Depletion of phagocytic cells was associated with higher and sustained viremia and significantly higher viral organ burden in the male reproductive tract of mice. Gene expression analysis revealed a robust antiviral, inflammatory, and chemokine response in the testes that was further amplified following phagocytic-cell depletion. These findings implicate the male reproductive tract as a previously underrecognized target of POWV disease and identify phagocytic cells as key in limiting viral infection of testes in mice. Full article

Postsurgical adhesions are common complications of abdominal and pelvic surgeries, often leading to bowel obstruction, chronic pain, and increased risks during reoperation. Although various physical barrier materials have been developed to prevent postsurgical adhesions, retaining anti-adhesive materials at surgical sites is challenging. In this study, we developed thermosensitive injectable gallic acid-conjugated hyaluronic acid (HA-GA) and Pluronic F127 (PluF) composite hydrogels to retain anti-adhesive materials and prevent postsurgical adhesion. The incorporation of HA-GA reduced the critical gelation concentration of PluF from approximately 18 to 12 wt% and decreased the gelation temperature from 28.5 °C for PluF to 25.6 °C for HA-GA (2 wt%)/PluF hydrogels with the left-shift in sol–gel curves. The G′ values increased from 10.1 ± 1.7 kPa for PluF to 24.8 ± 3.6 kPa for HA-GA (2 wt%)/PluF hydrogels at 37 °C. In addition, the HA-GA/PluF hydrogels exhibited enhanced mass retention as a function of time compared to PluF hydrogels alone. HA-GA (2 wt%)/PluF hydrogels retained 33.4 ± 3.5% of their initial mass after 7 d, whereas PluF was completely eroded within 3 d. The anti-adhesion efficacy of the HA-GA/PluF hydrogels was evaluated using a rat cecum abrasion model. Notably, the HA-GA (2 wt%)/PluF hydrogels showed reduced adhesion scores, with an adhesion extent score of 0.67 and 2.33 on postoperative day 7 and 21, respectively, compared with the untreated control group (3 and 3 on postoperative day 7 and 21). In addition, the adhesion severity scores of HA-GA (2 wt%)/PluF hydrogel groups were 0.33 and 1.33 on postoperative day 7 and 21, respectively, compared with the untreated control groups (1.67 and 2.33 on postoperative day 7 and 21). Therefore, HA-GA/PluF hydrogels provide reversible thermosensitive properties with enhanced stability and retention, supporting their potential as injectable physical barriers for postoperative adhesion prevention. Full article

Background: Sickle cell disease (SCD) is a hereditary hemoglobinopathy characterized by chronic anemia, recurrent pain episodes, and multi-organ complications, which collectively impact patients’ quality of life and functional capacity. Exercise and physical activity are recognized as essential components of general health and well-being; however, their role in individuals with SCD remains underexplored due to concerns regarding safety, tolerance, and the potential to precipitate vaso-occlusive crises. This study aimed to assess the patterns and frequency of exercise and physical activity among patients with sickle cell disease using a validated questionnaire. Methods: We conducted a cross-sectional study on patients diagnosed with sickle cell disease at King Abdulaziz University Hospital in Jeddah, Saudi Arabia. After obtaining ethical approval, we contacted the patients by phone or met them in person and administered the Global Physical Activity Questionnaire (GPAQ). Data on age, gender, comorbid conditions, disease-related variables, and weekly physical activity were collected. Total physical activity was expressed in metabolic equivalent of task (MET)-minutes per week, and participants achieving ≥600 MET-minutes per week were classified as meeting the World Health Organization (WHO) recommendation. Results: Of the 97 patients, males represented 52.6% of the participants, with a median age of 33 years. Overall, 70.1% of the patients were on hydroxyurea, and 14.4% had undergone splenectomy. More than half of the patients (56.7%) reported difficulties with exercise. According to the findings, 39% of the patients were getting enough physical activity each week, as recommended by the WHO. Male patients were significantly more likely to meet the WHO physical activity recommendation (p = 0.003), whereas no statistically significant associations were observed for age, nationality, body mass index, hemoglobin level, hydroxyurea use, splenectomy, hospital admissions, transfusion history, comorbidities, or exercise-related symptoms (all p > 0.05). Conclusions: Our data suggest that a significant proportion of patients with SCD did not achieve the WHO-recommended physical activity level, with adherence observed in only about forty percent of participants, and that adherence was more common in male patients (adjusted odds ratio 3.30, 95% CI 1.36–8.52, after multivariable adjustment for age, body mass index, hemoglobin, and transfusion status). This association was concentrated in occupational rather than recreational activity and was not explained by the clinical variables measured. Because no comparison group was studied, the extent to which this shortfall is attributable to SCD itself, rather than to the population-level inactivity already documented in Saudi Arabia, cannot be determined from these data. These findings identify a potential area for targeted intervention, particularly among women, and underscore the need for further research into disease-specific and sociocultural barriers before tailored programs can be developed. Further larger, controlled, multi-center studies are necessary to clarify the specific contribution of SCD to inactivity and to guide individualized physical activity promotion in this population. Full article

Rheumatoid arthritis (RA) is a chronic autoimmune disease in which fatigue and sleep disturbances, in addition to articular symptoms, are of significant importance. These symptoms are among the most common and burdensome complaints reported by patients; they affect their daily functioning and quality of life, and can also exacerbate one another. Currently, the treatment of RA focuses not only on reducing inflammatory activity and preventing structural damage, but also on improving outcomes that matter most to patients. In modern RA treatment, Janus kinase inhibitors (JAKis) are becoming increasingly important; by inhibiting the JAK/STAT pathway, they limit the activity of cytokines involved in the inflammatory response. This review aimed to analyse the effect of selected JAKis on fatigue and sleep quality in patients with RA. An analysis of available study results showed that baricitinib, filgotinib, tofacitinib and upadacitinib reduce fatigue severity. In many cases, improvement was observed as early as the initial stages of treatment and persisted at later follow-up points. At the same time, the extent of this improvement was not uniform and depended on the drug used, the dose, the patient population, and the assessment method adopted. Some analyses also suggested that this effect may have been partly due to reduced pain and improved disease activity. The data on sleep quality are less extensive, but the results suggest that tofacitinib and upadacitinib may also have a beneficial effect in this regard. With tofacitinib, improvements in sleep quality were observed early, affected multiple sleep domains, and, in some studies, persisted over the long term. For upadacitinib, an improvement in sleep quality appeared to be associated with disease control and remission. The smaller number of studies on sleep quality than on fatigue highlights the need to consider this parameter more thoroughly when assessing the efficacy of JAKi treatment and emphasises the importance of a more holistic approach in clinical practice. Full article

Background/Objectives: Humeral head osteonecrosis is a recognised complication of locked plate fixation for proximal humeral fractures, yet the significance of necrotic lesion extent is poorly characterised. This study quantified MRI-defined osteonecrosis extent and its associations with radiographic severity, shoulder motion, and functional outcomes. Methods: Twenty-five patients with Neer three- or four-part proximal humeral fractures treated by locked plate fixation between 2010 and 2022 were retrospectively reviewed. Shoulder range of motion, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and visual analogue scale (VAS) pain were assessed. Osteonecrosis severity was graded by the Cruess classification. Necrotic extent was quantified on MRI using an angle-based method on coronal and sagittal images; associations were assessed by simple linear regression among patients with confirmed osteonecrosis (n = 12). Results: At a mean follow-up of 85.4 ± 34.1 months, osteonecrosis was present in 12 of 25 patients (48%). Affected patients had lower shoulder abduction (96.7 ± 27.1° vs. 121.8 ± 29.2°; mean difference −25.1°, 95% CI −47.9 to −2.3; p = 0.031), internal rotation (48.3 ± 15.9° vs. 66.4 ± 15.5°; mean difference −18.1°, 95% CI −32.1 to −4.1; p = 0.014), and external rotation (36.7 ± 16.7° vs. 51.8 ± 26.4°; mean difference −15.1°, 95% CI −29.5 to −0.7; p = 0.041). Functional scores did not differ. Among patients with osteonecrosis (n = 12), greater necrotic angle correlated with higher Cruess stage and reduced abduction (β = −0.141; 95% CI −0.259 to −0.024; p = 0.020). Conclusions: MRI-defined osteonecrosis extent correlates with radiographic severity and reduced shoulder motion after locked plate fixation. Larger necrotic lesions are linked to decreased abduction, with no clear relationship to global functional scores. Quantitative MRI may provide useful information on the structural severity of post-traumatic humeral head osteonecrosis. Full article

Background/Objectives: Chronic pain is a prevalent and complex condition associated with substantial physical, psychological, and social burden. Behavioural activation (BA), a structured psychological intervention originally developed for depression, may be relevant to chronic pain through its focus on reducing behavioural avoidance and increasing engagement in meaningful activities. Although BA has been applied in studies involving people with chronic pain, the safety and effectiveness of BA in this population have not been comprehensively synthesised. This systematic review and meta-analysis will examine the safety and effectiveness of BA for people with chronic pain. Methods: A systematic review and meta-analysis of literature evidence will be conducted. This protocol was developed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and prospectively registered with PROSPERO (CRD420261379007). Randomised controlled trials (RCTs) evaluating BA or BA-based interventions for individuals with chronic pain will be eligible. MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Emcare, Web of Science Core Collection, Scopus and the Cochrane Central Register of Controlled Trials (CENTRAL), trial registries, and citation tracking will be searched. Two reviewers will independently screen records, extract data, and assess risk of bias using the Cochrane Risk of Bias 2 (RoB 2) tool. Where appropriate, meta-analysis will be conducted using a random-effects model. Pain intensity will be the primary outcome. Reported adverse events and other safety outcomes will be extracted and synthesised. Certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: Not applicable; this is a protocol. Findings will be synthesised as specified in the Methods. Conclusions: The review will evaluate the effectiveness of BA with respect to pain intensity among people with chronic pain and examine what is known about its safety based on reported adverse events and other safety outcomes in existing trials. The review is expected to clarify the extent, consistency, and certainty of the randomised evidence on the effectiveness and safety of behavioural activation interventions for chronic pain and to identify gaps in adverse-event reporting and safety monitoring. Findings may inform clinical decision-making, intervention adaptation, and future research on BA for chronic pain. Full article

Background: Tibial bone stress injury (TBSI) with associated bone marrow edema (BME) is a common and clinically challenging condition in athletes, often requiring prolonged load restriction and delayed return to sport. Evidence for adjunctive interventions that improve both symptoms and MRI-derived recovery remains limited. The aim of this study was to investigate whether adding Functional Magnetic Stimulation (FMS) to standardized rehabilitation improves pain, function, and MRI-derived outcomes over 16 weeks in athletes with MRI-confirmed TBSI. Materials and Methods: Forty athletes with Fredericson grade 2–3 TBSI were randomized to FMS plus rehabilitation (n = 20) or rehabilitation alone (n = 20). Both groups completed a 4-week load-based rehabilitation program, while the FMS group additionally received eight 30 min FMS sessions at 40 Hz. Outcomes were assessed at baseline, 4 weeks, and 16 weeks. The primary outcome was activity-related pain (NPRS), while secondary outcomes included lower-limb function (LEFS-GR), BME extent, and Fredericson grade. Continuous outcomes were analyzed using two-way mixed ANOVA, whereas Fredericson grade was analyzed using an ordinal generalized estimating equation model. The level of statistical significance was set at p < 0.05. Results: Groups were comparable at baseline. Significant group × time interactions favored FMS for NPRS, F(2, 76) = 12.46, p < 0.001, η²p = 0.247; LEFS-GR, F(1.08, 41.09) = 81.56, p < 0.001, η²p = 0.682; and BME extent, F(1.44, 54.85) = 49.33, p < 0.001, η²p = 0.565. At 16 weeks, the FMS group showed lower NPRS scores, higher LEFS-GR scores, and lower BME extent than controls. Fredericson grade also showed a significant group × time effect, Wald χ²(2) = 20.38, p < 0.001. The FMS group had significantly lower cumulative odds of classification in a higher Fredericson grade at 4 weeks (OR = 0.045, 95% CI: 0.012–0.163, p < 0.001), whereas the corresponding difference at 16 weeks remained directionally favorable but did not reach statistical significance (OR = 0.033, 95% CI: 0.001–1.029, p = 0.052). Conclusions: The addition of FMS to load-based rehabilitation was associated with greater clinical and functional improvements, greater reductions in BME extent, and a more favorable longitudinal trajectory in MRI severity classification than rehabilitation alone in athletes with TBSI. However, because the study did not include a sham-FMS condition and participants could not be blinded, the self-reported pain and functional outcomes should be interpreted cautiously. FMS may represent a useful adjunct to structured rehabilitation, although sham-controlled and longer-term studies should determine its effects on return-to-sport progression and recurrence risk. Full article

Background/Objectives: The implementation of tattoo-free radiotherapy (RT) for breast cancer reflects an effort to mitigate the psychological distress of permanent marks through surface-guided techniques, while simultaneously evaluating its utility in meeting setup precision requirements. Methods: In this prospective trial, patients were positioned for breast cancer RT including regional nodal irradiation exclusively using surface-guided RT (SGRT). Cone-beam computed tomography (CBCT) was acquired at each fraction as the ground truth to analyze translational setup deviations. Results: A total of 457 paired SGRT–CBCT data points in 30 patients were acquired. A residual translational setup deviation of ≤6 mm was achieved in 97.6% of all fractions with a median deviation of 2 mm (range: 0–12). Neither age, comorbidities, body mass index, extent of target volumes, choice of breathing technique, nor patient-reported symptoms (pain, dermatitis, anxiety) correlated significantly with setup deviations. The median in-room positioning time was 92 s (range: 20 s–6 min and 37 s) and significantly prolonged in patients with an elevated BMI and higher grades of pain and skin dermatitis, and for chest wall irradiation. Manual assessment of the accuracy of regional nodal CTVs in each CBCT relative to the planning CT showed good-to-minor deviations in 99.7% (Level 1/2), 95.0% (Supra-/infraclavicular), and 90.8% (Internal mammary), respectively, with major deviations in only 0.3% (Level 1/2), 5.0% (Supra-/infraclavicular) and 9.2% (Internal mammary). A forward dose calculation on CBCT geometries (n = 86) revealed high median CTV dose coverage of 100.0% (range: 57.1–107.7%) of the original target dose for all lymph node levels combined. Conclusions: The tattoo-free positioning setup for regional nodal irradiation in breast cancer patients exhibited pronounced robustness, maintaining its accuracy and reliability irrespective of patient-, tumor-, or treatment-specific variables with high clinical efficiency. However, larger cohorts are required to confirm whether these parameters genuinely operate independently of setup accuracy. Full article

Background and Objectives: Hallux rigidus is a degenerative condition of the first metatarsophalangeal joint that causes pain and limitation of motion. The aim of this study was to evaluate the clinical outcomes of a modified interpositional arthroplasty technique using an iliotibial band autograft fixed to the proximal phalanx in patients with advanced hallux rigidus. Materials and Methods: This prospective observational case series included 19 patients with Coughlin–Shurnas Grade III or IV hallux rigidus who underwent surgery between February 2023 and February 2025. Clinical outcomes were assessed using Visual Analog Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS), and range-of-motion (ROM) measurements preoperatively and at postoperative 1, 6, and 12 months. Results: The mean VAS score decreased from 9.0 ± 0.82 preoperatively to 1.58 ± 0.51 at 12 months (p < 0.001). The mean AOFAS score increased from 35.1 ± 2.7 to 74.8 ± 10.9 (p = 0.001). ROM improved significantly at 1 and 6 months; however, the 12-month ROM was not significantly different from the preoperative value (36.3° ± 5.6° vs. 31.0° ± 5.5°, p = 0.082). Conclusions: Interpositional arthroplasty using an iliotibial band autograft fixed to the proximal phalanx was associated with short-term reductions in pain and improvements in functional scores. However, the early increase in range of motion was not maintained to the same extent at 12 months. Full article

Introduction: Major retroperitoneal arterial bleeding may remain clinically difficult to recognize when vital signs are initially stable. Case presentation: We report the case of a 67-year-old man who developed progressive abdominal and right groin pain radiating to the ipsilateral flank, accompanied by two episodes of vomiting and an early hemoglobin (Hb) and hematocrit decline on the first postoperative day after right-sided direct anterior total hip arthroplasty (THA). Despite the absence of hemodynamic instability, computed tomography angiography (CTA) demonstrated active contrast extravasation from the right external iliac artery (EIA) with a large retroperitoneal hematoma. CTA localized the bleeding source and enabled immediate endovascular treatment planning. Subsequent angiography confirmed active extravasation from the right EIA, and a covered stent–graft was deployed through ultrasound-guided superficial femoral artery access, achieving complete exclusion of the bleeding source with preserved arterial patency. The subsequent Hb nadir and transfusion were interpreted as reflecting preceding retroperitoneal blood loss rather than persistent bleeding, because follow-up CTA showed a stable hematoma without active extravasation. The patient was discharged in stable condition, and 1-month duplex ultrasound and following 3-month CTA confirmed stent–graft patency. Discussion: This case highlights the diagnostic mismatch that may occur between substantial retroperitoneal blood loss and initially reassuring hemodynamic findings. When progressive abdominal or groin symptoms are accompanied by a serial, otherwise unexplained Hb decline, CTA may be more informative than DUS for suspected deep pelvic bleeding because it can identify active extravasation, define hematoma extent, assess alternative abdominopelvic causes, and support treatment planning. In anatomically suitable lesions, covered stent–graft repair can rapidly control hemorrhage while preserving EIA patency. Conclusions: Stable vital signs do not exclude major retroperitoneal arterial bleeding after direct anterior THA. Progressive abdominal or groin pain with early postoperative Hb decline should raise suspicion for occult vascular injury, for which CTA can provide rapid diagnosis and guide immediate endovascular management. Full article

Background/Objectives: Male chronic pelvic pain syndrome (CPPS) is a heterogeneous condition involving overlapping urinary, psychosocial, organ-specific, infectious, neurological, myofascial, and sexual phenotypes. This complexity limits the effectiveness of routine symptom assessment and empirical treatment strategies. Artificial intelligence (AI) may support more reproducible interpretation, differential diagnosis, phenotyping, and personalized management. This up-to-date narrative mapping review aimed to identify AI-assisted approaches that are directly or indirectly relevant to the assessment of males with CPPS, classify them according to UPOINTS phenotypic domains and clinical functions, and critically discuss the extent to which current evidence is disease-specific or extrapolated from related conditions. Methods: A literature search was performed in PubMed/MEDLINE, the Cochrane Library, and Google Scholar from database inception to May 2026 using terms related to male CPPS, UPOINTS domains, diagnosis, treatment, prognosis, digital solutions, artificial intelligence, machine learning, deep learning, natural language processing, computer vision, and decision support. Studies were included if they described AI-based or AI-adjacent computational approaches relevant to male CPPS or to related conditions important for UPOINTS-based phenotyping, differential diagnosis, or phenotype-specific assessment. Results: Available evidence remains fragmented and is largely extrapolated from related urological, chronic pain, pelvic floor, infectious, neurological, and sexual medicine conditions. AI applications were most developed in urinary and organ-specific domains, including uroflowmetry analysis, bladder volume assessment, cystoscopy, prostate imaging, urinary biomarkers, and differential diagnosis of lower urinary tract disorders. AI tools also showed potential for infection detection, psychosocial screening, chronic pain monitoring, neuroimaging-based phenotyping, pelvic floor dysfunction assessment, and evaluation of sexual dysfunction. However, male-CPPS-specific validation remains limited. Conclusions: AI has promising potential to improve differential diagnosis, multidomain phenotyping, and individualized management in males with CPPS. Current evidence is mainly translational and hypothesis-generating. Future studies should focus on prospective male-CPPS-specific cohorts, external validation, explainable multimodal models, and integration of AI tools into clinically meaningful, patient-centered workflows. Full article

Background and Objectives: Foot bone marrow edema of presumed algodystrophic or bone marrow edema syndrome-like origin is clinically difficult to classify, and the relationship between MRI extent, pain severity, and functional impairment remains insufficiently defined. This study aimed to describe MRI distribution patterns and short-term clinical changes in a small real-world cohort of patients with persistent NSAID-resistant foot pain and presumed algodystrophic/BMES-like bone marrow edema. Materials and Methods: This retrospective single-center observational cohort study included 19 consecutive patients with persistent foot pain; MRI-demonstrated bone marrow edema; inadequate response to NSAIDs; management with a multimodal protocol that included neridronate, vitamin D supplementation, and, in selected patients, adjunctive physiotherapy and magnetotherapy; and available 3-month follow-up. The protocol consisted of intramuscular neridronate 25 mg once daily for 16 consecutive days, resulting in a total cumulative dose of 400 mg, together with vitamin D supplementation. Eleven patients also underwent adjunctive physiotherapy and magnetotherapy. MRI findings were categorized by anatomical location group, multilocalization, and compartment involvement. Clinical outcomes included baseline and 3-month Visual Analog Scale scores, WOMAC scores, and descriptive changes in NSAID use. Nonparametric paired and exploratory subgroup analyses were performed. Results: Mean age was 51.3 ± 14.9 years, and 52.6% of patients were female. MRI showed predominant midfoot involvement, with the navicular and third cuneiform most frequently affected. Median VAS changed from 8.0 at baseline to 3.0 at 3 months, and median WOMAC changed from 80.0 to 41.0; because no control group was available, these paired changes should be interpreted descriptively. Daily NSAID use decreased from 78.9% at baseline to 0% at follow-up. These findings describe clinical improvement after a multimodal management approach but do not establish the independent treatment effect of neridronate. In exploratory analyses, only two patients had multi-compartment involvement; therefore, any apparent pain-severity signal in this subgroup was considered unstable and hypothesis-generating only. Edema location group and multilocalization were not statistically associated with VAS or WOMAC outcomes. Conclusions: In this small retrospective single-center case series, presumed algodystrophic/BMES-like foot bone marrow edema most commonly involved the midfoot, particularly the navicular and cuneiform region. Pain scores, WOMAC scores, and daily NSAID use decreased over 3 months after multimodal care. However, the uncontrolled design, small sample size, concomitant vitamin D supplementation, adjunctive physiotherapy or magnetotherapy in many patients, and self-limiting nature of BMES-like conditions prevent attribution of these changes to neridronate or to any single treatment component. The apparent relationship between multi-compartment edema and greater pain severity was based on only two patients and should be regarded only as a weak exploratory observation. Full article

Background/Objectives: The mandatory spinal cord stimulation (SCS) trial was established in the era of tonic, paresthesia-dependent stimulation, when pre-implantation outcome prediction was unreliable, validated psychological screening was unavailable, and post-implantation programming options were limited. This narrative review examines whether universal trialing remains justified in the context of contemporary paresthesia-free waveforms, mechanistically informed psychological assessment, and current evidence on the predictive utility of screening trials. The objective was to evaluate the contemporary rationale for selective rather than universal trialing and to propose a structured four-step clinical decision framework integrating contraindication screening, pain phenotype certainty, psychological risk stratification, and centre-level criteria, with the aim of identifying patients in whom a trial is most likely to add prognostic information. Methods: PubMed and the Cochrane Library were searched using predefined search strings. Eligible publications included randomised controlled trials (including the TRIAL-STIM RCT), systematic reviews, registry-based cohort studies, health-economic analyses, and consensus guidelines. Results: The evidence base comprised randomised controlled trials of trial-versus-no-trial strategies, paresthesia-free waveforms, and closed-loop stimulation (including TRIAL-STIM, SENZA-RCT, EVOKE, and ECHO-MAC), together with large registry and cohort studies, systematic reviews, qualitative patient-experience data, and current consensus guidance. Modern paresthesia-free and physiology-guided paradigms reduce several technical functions historically served by trialing, although the extent varies by waveform. The only randomised trial designed specifically to compare trial-first and no-trial strategies (TRIAL-STIM) found no difference in pain outcomes at 6 or 36 months; however, its single healthcare setting and predominantly paresthesia-based waveform mix limit generalisability. Structured pre-implantation psychological evaluation may provide prognostic information that short-duration trialing cannot replicate. At the same time, contemporary guidelines continue to recommend trialing and several clinically relevant arguments for retaining it persist, including patient experiential learning, identification of screening false negatives, and grey-zone decision-making. Conclusions: In carefully selected patients with established neuropathic pain phenotypes and comprehensive pre-implantation evaluation, selective trialing may be clinically reasonable. The proposed four-step framework offers a structured basis for allocating trial stimulation to the patients most likely to benefit from it and should be interpreted as hypothesis-generating pending prospective validation. This review does not advocate abandoning trial stimulation; rather, it argues that its role should be examined within an individualised, phenotype- and risk-stratified pathway. Full article

Background/Objectives: The aim of this study is to analyze outcomes in patients who underwent genicular artery embolization (GAE) with respect to pain, symptoms, physical activity, quality of life, and knee joint range of motion and muscle strength of the knee joint. The study will provide evidence of the treatment’s effectiveness using both subjective and objective measurements. In addition, the study will examine the impact of the severity of radiological changes in the knee joint and the number of embolized vessels on the extent of improvement in outcomes following the procedure. Methods: Patients eligible for GAE who exhibited symptoms of chronic exudative knee arthritis, confirmed by USG and MRI with contrast, did not have laboratory markers of inflammation, nor did they respond effectively to standard non-surgical treatments. The analysis included 34 patients. Subjective parameters were assessed using the VAS and KOOS scales. Knee range of motion and muscle strength were assessed using an electronic dynamometer and goniometer. Measurements were performed according to the same schedule before GAE, and at 1, 3 and 6 months after the procedure. The results were subjected to statistical analysis. Results: In the analysis up to 6 months, a significant time effect was demonstrated for the VAS and all KOOS subscales. The improvement was visible after 1 month and continued after 3 and 6 months. No significant changes over time were demonstrated for objective parameters. Exploratory analysis demonstrated a relationship between increased knee extensor strength and pain reduction up to 3 months and increased range of motion up to 6 months after the GAE. There was no significant association between radiological changes and the number of embolized vessels with improved outcomes after GAE. Conclusions: GAE appears to be a promising minimally invasive treatment option for patients with chronic knee synovitis. Clinically meaningful improvements were observed in patient-reported outcomes. Full article

Quintero is a Chilean coastal city located 40 km north of Valparaiso. In the surroundings of Quintero, there are a number of industries that generate high levels of atmospheric pollutants such as sulfur dioxide (SO₂), nitrogen oxides (NO_x), carbon monoxide (CO) and non-methane hydrocarbons (NMHCs). These compounds may also be generated during oil handling in storage facilities in this area. Quintero Bay has a port that is being used mainly for oil and copper transportation. Since 2010, there have been reports of events producing nausea, vomiting and abdominal pain in the residents of Quintero, and some previous studies have correlated these medical events with high concentrations of SO₂ and NMHCs. One of the main sources of SO₂ in the area was identified to be the Ventanas copper foundry. Following public pressure, the government stopped the operation of the foundry by mid-2023, which led to a significant decrease in SO₂ levels. However, reports of health problems persisted to some extent. In this work, delayed cross-correlation, trajectory and dispersion analyses indicate that an upwind source of air pollution impacting Quintero originates near the oil refinery in Concón, located 20 km to the south. This source of air pollution could provide a background of NMHCs, over which local emissions add up to attain very high concentrations in Quintero. Our analysis shows that there is evidence of the transport of NMHCs from the Concón refinery to the Quintero area. In 2022, of the 20 days with NMHC concentrations greater than 200 ppvb, 50% of them were associated with prevalent southwest winds. Using trajectory and dispersion analyses for eight episodes in Quintero, it has been found that an approximate fraction of pollution generated in Concón that could arrive in Quintero is between 2 and 24%. Full article