Search Results (5,126)

Objectives: Tandem spinal stenosis (TSS) is often underdiagnosed and traditionally managed with multi-stage surgery (MSS). Single-stage surgery (SSS) is an alternative, but prior studies largely emphasize younger, healthier patients. This study evaluated perioperative and functional outcomes after SSS for TSS in a surgically diverse cohort. Methods: A retrospective chart review included 20 patients who underwent SSS for TSS at a single academic institution. Mean age was 63.75 years, and median modified frailty index was 2. Etiologies included degenerative, traumatic, and neoplastic disease across cervical, thoracic, and lumbar regions. Outcomes included operative characteristics, complications, readmissions, and functional recovery measured by Visual Analog Scale (VAS) pain and modified Japanese Orthopaedic Association (mJOA) scores. Results: The mean number of operated levels was 5.2, mean operative time was 232.4 min, total OR time was 355.1 min, and length of stay was 6.9 days. Surgical complications occurred in 15% of patients, medical complications in 25%, and 90-day readmission in 15%, with no 30-day mortality. Mean mJOA improved from 12.86 at baseline to 16.08 at first follow-up and 16.46 at 3 months; REML mixed-effects modeling showed a significant timepoint effect (F (4, 34.55) = 9.15, p < 0.001), with significant Sidak-adjusted improvement at both timepoints. VAS pain showed no significant longitudinal effect. Conclusions: SSS for TSS appears feasible in a real-world, surgically diverse cohort including older and moderately frail patients. These findings support individualized SSS candidacy assessment. Full article

Objective: To determine whether contrast therapy improves recovery after climbing-specific forearm fatigue in amateur climbers. Methods: In a randomized repeated-measures trial, 40 climbers were allocated to passive recovery (n = 20) or Game Ready contrast therapy (n = 20). Both groups completed a fixed-task intermittent fingerboard protocol on a 20 mm edge using a half-crimp grip, with 7 s of work and 3 s of rest for five sets; the load was not individualized to climbing-specific maximal finger-flexor force. The intervention group received bilateral forearm treatment consisting of alternating 1 min cold (3 °C) and heat (45 °C) phases combined with pneumatic compression ranging from 15 to 75 mmHg. Sessions lasted 20 min and were administered immediately after post-fatigue testing, at 24 h and 48 h, and then three times weekly on alternate days for 8 weeks, for a total of 27 sessions. Outcomes were assessed at baseline, immediately after fatigue, at 24 h and 48 h, and after 8 weeks. Outcomes included perfusion, reactive hyperemia, stiffness, pressure pain threshold, grip strength, perceived recovery, creatine kinase, and interleukin-6. Results: Immediate post-fatigue responses were comparable. Contrast therapy produced greater 24 h and 48 h resting perfusion responses (+7.28 percentage points, 95% CI 6.58 to 7.98; +7.62, 95% CI 6.94 to 8.31; both adjusted p < 0.001). At week 8, peak hyperemic perfusion improved more with contrast therapy (+6.21 PU, 95% CI 5.62 to 6.79; p < 0.001). Recovery favored contrast therapy for stiffness at 48 h (−71.7 N/m, 95% CI −75.6 to −67.8), pressure pain threshold at week 8 (+8.1 N/cm², 95% CI 7.3 to 8.8), and grip strength at 48 h (+7.8 kgf, 95% CI 7.3 to 8.3; all p < 0.001). CK and IL-6 differences were transient, and no serious adverse events or intervention-related discontinuations were recorded. Conclusions: Contrast therapy was associated with more favorable cutaneous perfusion, post-occlusive reactive hyperemia-derived, and neuromechanical recovery outcomes, whereas biochemical differences were limited and time-dependent. The vascular findings do not establish improved endothelial function or nitric-oxide-mediated vasodilation because these mechanisms were not directly assessed. Trial registration: ISRCTN49499065 on 23 June 2025. Full article

Background/Objectives: Cervical radiculopathy is a frequent cause of pain, often leading to disability, reduced quality of life, and significant healthcare utilization. Cervical epidural steroid injections are widely used, though safety concerns have been reported. Ultrasound-guided cervical retrolaminar block (RLCB) is a potential alternative. The purpose of this study was to evaluate the long-term clinical trajectory after ultrasound-guided cervical retrolaminar block, including pain outcomes, patient-reported improvement, and the rate of subsequent cervical spine surgery. Methods: This is a retrospective cohort analysis that was conducted at the Pain and Spine Surgery units in a single center. : We included 121 patients with cervical radiculopathy treated between January 2020 and September 2022 (mean age 49.4 ± 11.1 years; 51.2% male). All patients underwent RLCB. s: Primary outcome measures were subsequent cervical decompressive surgery and composite pain response (≥2-point absolute and ≥50% relative NRS reduction). Secondary outcome measures included recurrence, analgesic use, global rating of change (GRC), satisfaction, willingness to repeat, and safety. Baseline data was extracted from records; structured follow-up interviews were conducted at two years. Results: At two years, 9.1% required surgery, and 57.9% achieved composite pain response; 74.4% reported ≥2-point NRS reduction. GRC scores showed improvement (mean 5.0 ± 3.4), with 37% reporting “very much better.” Satisfaction was high, with 70.2% willing to repeat. Pain recurred in 71.1% but persisted in 28.9%. No major complications occurred; minor events were reported in 6.6%. Outcomes were less favorable in patients with pre-injection pain duration ≥1 year. p. Conclusions: In this retrospective cohort, cervical RLCB was associated with sustained patient-reported improvement, high satisfaction, and a 9.1% observed subsequent surgery rate at two years. These findings are hypothesis-generating and require confirmation in prospective controlled studies. Full article

Objective: Patellofemoral pain syndrome (PFPS) is one of the most common causes of anterior knee pain and is associated with biomechanical, muscular, and functional impairments affecting the extensor mechanism of the knee. Quadriceps muscle dysfunction, altered tendon morphology, and impaired lower extremity biomechanics have been suggested to contribute to patellofemoral joint instability and pain development. The aim of this study was to evaluate the muscle and tendon thicknesses of the extensor mechanism using ultrasonography in individuals with PFPS and to investigate the relationship of these measurements with knee pain, knee function, and physical performance, with particular emphasis on the combined assessment of muscle morphology, tendon morphology, and functional performance parameters. Methods: This cross-sectional study was conducted between 5 November 2019 and 15 December 2019, including 80 individuals aged 18–45 years who presented with anterior knee pain and were clinically diagnosed with patellofemoral pain syndrome (PFPS). Demographic characteristics of the participants were collected. Pain severity was assessed using the Visual Analog Scale (VAS), and functional status was evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Physical performance was assessed using the 6 m walk test and the five-repetition sit-to-stand test. Ultrasonographic examination was used to measure rectus femoris muscle thickness, vastus intermedius muscle thickness, quadriceps tendon thickness, and patellar tendon thickness using a high-frequency linear probe in a standardized supine position with the knee relaxed and the lower extremity muscles at rest. Results: The mean age of the participants was 32.11 ± 7.08 years, and the mean body mass index (BMI) was 25.05 ± 4.11 kg/m². Of the participants, 42 (52.5%) were male and 38 (47.5%) were female; 46 (57.5%) were smokers and 34 (42.5%) were non-smokers. Ultrasonographic measurements showed that rectus femoris muscle thickness was 1.98 ± 0.45 cm, vastus intermedius muscle thickness was 1.75 ± 0.53 cm, quadriceps tendon thickness was 0.54 ± 0.12 cm, and patellar tendon thickness was 0.35 ± 0.08 cm. Rectus femoris, vastus intermedius, and quadriceps tendon thicknesses were significantly higher in males compared to females (p = 0.001). Individuals with BMI > 25 had greater rectus femoris (p = 0.023) and vastus intermedius (p = 0.001) muscle thicknesses. A negative correlation was found between rectus femoris muscle thickness and WOMAC total (r = −0.227, p = 0.042) and WOMAC pain scores (r = −0.233, p = 0.028). Additionally, a significant relationship was observed between quadriceps tendon thickness and the five-repetition sit-to-stand test (r = −0.247, p = 0.044). Conclusions: In patients with PFPS, quadriceps muscle and tendon thicknesses were found to be associated with certain demographic and clinical parameters. Ultrasonographic evaluation of muscle and tendon structures may be a useful, non-invasive, dynamic, and radiation-free method for better understanding the clinical characteristics of PFPS and its relationship with physical performance. Ultrasonographic assessment may also provide complementary information for rehabilitation planning and functional evaluation in individuals with PFPS, although these findings should be interpreted cautiously because of the cross-sectional design and weak correlations observed. Full article

Background: Cervicogenic headache (CEH) is a secondary headache disorder originating from dysfunction in the cervical spine. In addition to pain, individuals with CEH frequently experience disturbances in postural control and sensorimotor integration, which may compromise functional capacity and quality of life. Conventional clinical assessments typically focus on pain intensity and cervical range of motion; however, these measures often fail to capture the multifactorial mechanisms underlying balance impairments in this population. Machine learning (ML) methods offer the ability to integrate multidimensional clinical data and may provide a more comprehensive approach for identifying patterns of postural stability and the factors influencing balance regulation in CEH. Methods: A secondary analysis was conducted using baseline data pooled from three registered randomized controlled trials, comprising 68 independent participants diagnosed by a neurologist according to the International Classification of Headache Disorders, 3rd edition (ICHD-3). Postural Stability Class served as the primary outcome and was derived from quantitative stability scores categorized as High, Moderate, or Low. Predictor variables included demographic characteristics (age, gender), clinical measures (pain intensity, headache frequency, symptom duration, cervical range of motion), and sensorimotor parameters (center-of-pressure sway and gaze accuracy). Five machine learning algorithms—Random Forest, XGBoost, Support Vector Machine, Logistic Regression, and Gradient Boosting—were trained and evaluated using 10-fold cross-validation with procedures implemented to reduce overfitting. Results: The Gradient Boosting classifier demonstrated the best performance, achieving an accuracy of 0.857 and an F1 score of 0.857, with a cross-validated accuracy of 0.802 ± 0.063. Random Forest and XGBoost achieved accuracies of 0.786. Feature importance analysis identified center-of-pressure sway and pain intensity as the most influential predictors of stability classification, followed by cervical flexion range of motion and gaze accuracy. Demographic variables showed minimal contribution to model performance. Conclusions: Machine learning models were able to distinguish different levels of postural stability in individuals with CEH. The findings highlight the central role of pain and sensorimotor control in balance regulation and suggest that predictive analytics may support precision physiotherapy by enabling rehabilitation strategies tailored to individual sensorimotor profiles. Full article

Pediatric phlebotomy is a common invasive procedure frequently associated with pain, anxiety, and fear, which may negatively affect children’s cooperation and overall healthcare experiences. Virtual reality (VR) has emerged as a promising non-pharmacological intervention capable of providing immersive distraction and emotional engagement during painful medical procedures. The aim of this systematic review was to evaluate the effectiveness of immersive VR in reducing pain perception and anxiety-related outcomes among pediatric patients undergoing phlebotomy procedures. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The research question was developed using the PICO framework. Randomized controlled trials and comparative controlled studies published between January 2020 and September 2025 were identified through systematic searches of PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL). Studies involving children and adolescents aged 4–17 years undergoing phlebotomy or venipuncture procedures were eligible for inclusion. A total of six studies comprising 557 pediatric participants were included in the review. The VR interventions involved immersive and interactive environments, including educational simulations, animated scenarios, and game-based experiences delivered through head-mounted displays. Four studies reported statistically significant reductions in pain and/or anxiety among participants exposed to VR compared with control groups, whereas two studies found no significant differences. Across the included studies, VR interventions were generally well accepted by children, parents, and healthcare professionals, with only mild and transient adverse effects reported. However, substantial heterogeneity was observed regarding clinical settings, VR technologies, intervention protocols, and outcome assessment methods. The current evidence suggests that immersive VR is a promising adjunctive strategy for reducing pain and anxiety during pediatric phlebotomy procedures. Nevertheless, the available evidence remains limited by methodological heterogeneity and relatively small sample sizes. Future research should focus on larger, well-designed randomized controlled trials using standardized intervention protocols and outcome measures to support evidence-based implementation of VR in pediatric clinical practice. Full article

Background/Objectives: Ultrasound-guided fascial plane blocks have emerged as opioid-sparing analgesic strategies for cardiac surgery; however, evidence regarding combined block techniques remains limited. This randomized controlled trial evaluated the analgesic efficacy of combined pectoserratus plane block (PSPB) and pecto-intercostal fascial plane block (PIFB) in patients undergoing cardiac surgery via median sternotomy. Methods: Sixty-two adult patients undergoing cardiac surgery via median sternotomy were randomized to either a block group receiving bilateral PSPB and PIFB after anesthetic induction or a control group receiving conventional analgesia alone. The primary outcome was postoperative visual analog scale (VAS) pain score at 6, 12, 24, and 48 h after surgery. Secondary outcomes included Korean version of Quality of Recovery-15 (QoR-15K) scores, total opioid consumption, rescue analgesic dose, time to first rescue analgesia, extubation time, intensive care unit (ICU) stay, hospital stay, and the incidence of postoperative nausea and vomiting. Results: Fifty-four patients were included in the final analysis. Postoperative VAS scores did not differ significantly between groups after Bonferroni correction for repeated measurements. No significant overall between-group effect was observed in repeated-measures ANOVA. ICU stay was statistically shorter in the block group, although the absolute difference was small and of uncertain clinical relevance. No significant differences were observed in the remaining secondary outcomes. Conclusions: Combined PSPB and PIFB did not reduce postoperative pain or improve recovery outcomes after cardiac surgery via median sternotomy. Early postoperative pain scores were numerically higher in the block group, although these differences were not statistically significant after correction for multiple comparisons. The incremental analgesic benefit of combined fascial plane blocks may therefore be limited in this clinical setting. Full article

Chronic pain is increasingly understood as a multidimensional condition in which, in a substantial subgroup of patients, a protective symptom can evolve into a persistent maladaptive disorder of the nervous system, while in others it may remain closely tied to ongoing mechanical or structural factors. Central sensitization (CS) represents a key mechanism underlying this transition, characterized by enhanced neural responsiveness and impaired endogenous pain inhibition, leading to a dissociation between pain and tissue pathology. The aim of this narrative review is to critically discuss current evidence on CS as a mechanism-based explanation for persistent pain, using lumbar disk herniation (LDH) as a clinical model of the radiological-clinical mismatch, and to discuss its direct implications for identifying sensitized phenotypes, multimodal assessment, and rehabilitation strategies. A total of 77 sources published between 2006 and 2026 were synthesized. These reviewed sources demonstrate that identification of the sensitized phenotype requires a multimodal assessment approach combining self-report measures, such as the Central Sensitization Inventory (CSI), with psychophysical methods including quantitative sensory testing (QST) and conditioned pain modulation (CPM). Cognitive-emotional factors are also critical, as postoperative kinesiophobia affects approximately 38.3% of LDH patients and is associated with increased pain intensity and reduced self-efficacy. Management strategies reported in these publications focus on mechanism-based interventions, particularly pain neuroscience education (PNE) and graded, time-contingent exercise, which aim to modify pain-related cognitions and restore endogenous inhibitory processes. These approaches may be supported by adjunctive therapies, including dry needling (DN), electro-dry needling (EDN), centrally acting pharmacological agents (e.g., serotonin–norepinephrine reuptake inhibitors [SNRIs] and gabapentinoids), and psychologically informed treatments such as cognitive behavioral therapy (CBT). While surgical decompression may reduce CS-related symptoms, preoperative sensitization does not necessarily predict poorer outcomes, highlighting the interaction between peripheral and central mechanisms. Adopting a sensitization-informed perspective may encourage a broader integration of contemporary pain models alongside traditional structural views in lumbar disc herniation clinical care. Full article

Background: Managing neuropathic pain (NP) is particularly challenging in the context of opioid use, and the mechanisms behind chronic pain remain unclear. Objective: This study evaluated the impact of turmeric bioactive compounds on brain regions including frontal cortex (FC), hippocampus (HPC), and hypothalamus (HPT) in the spinal nerve ligation (SNL) in a rat model of NP. Methods: Twenty-four SD rats were assigned to four groups (N = 6 per group), namely sham+vehicle (Sham-V), SNL+vehicle (SNL-V), SNL + 100 mg/kg curcumin (SNL+100CUR), and SNL + 50 mg/kg bisdemethoxycurcumin (SNL+50BDMC), treated daily for four weeks via oral gavage. Gene expression levels related to neuroinflammation, oxidative stress, and mitochondrial homeostasis were measured using qRT-PCR. Protein-level or functional mitochondrial assays were not performed due to limited sample availability. Results: In the FC, SNL decreased the expression level of NRF1 and OPA1, but only OPA1 was increased by BDMC. In the HPC, SNL increased CD11b, NRF2, and MFN1; BDMC decreased CD11b and increased IBA1, NRF1, TFAM, PGC1α and Complex I; and CUR increased NRF1, TFAM, DRP1 and Complex I levels. In the HPT, SNL decreased GFAP and MFN1, with CUR and BDMC further decreasing GFAP but not affecting MFN1. Additionally, CUR and BDMC decreased the expression of several key markers of neuroimmune signaling and mitochondrial homeostasis, including IBA1, CD11b, NFkB, NRF1/2, DRP1, OPA1, PGC1α, TFAM, and PINK1. Conclusions: CUR and BDMC induced region-specific transcriptional remodeling of mitochondrial homeostasis across FC, HPC, and HPT in SNL rats, with somewhat limited effects in the FC, mixed effects in the HPC, and broader downregulation in the HPT. Full article

Background/Objectives: Chronic pain is increasingly conceptualized as a systemic condition characterized by central sensitization, autonomic dysregulation, and persistent neuroimmune and neuroendocrine alterations. These systemic changes have been linked to microbial dysbiosis, most prominently within the gut microbiome. In contrast, the relevance of the urinary microbiome outside primary urological disease remains poorly understood, particularly in non-urological chronic pain conditions. The objective of this study was to determine whether patients with chronic low back pain exhibit differences in urinary microbial diversity, community composition, or taxon-specific abundance compared with pain-free controls. Methods: In this age- and sex-matched case–control study, midstream urine samples were collected from ten patients with chronic low back pain and ten pain-free controls and analyzed using 16S rRNA gene sequencing (V4 region). Sequence data were processed using nf-core/ampliseq and DADA2. Alpha diversity, beta diversity, and differential abundance were assessed using depth-adjusted models, compositional and phylogenetically informed distance metrics, and ANCOM-BC2, with multiple sensitivity analyses to account for the low-biomass nature of urinary microbiome data. Results: After accounting for sequencing depth, no significant differences in alpha diversity were observed between patients and controls for any metric. Beta diversity analyses revealed no significant differences in overall community composition between groups across all distance measures, and dispersion was comparable between groups. Differential abundance analysis did not identify any bacterial taxa that differed significantly between patients and controls after correction for multiple testing. Conclusions: In this cohort, chronic low back pain was not associated with detectable alterations in the urinary microbiome. These findings suggest that, unlike the gut microbiome, urinary microbial communities may be relatively stable in the context of non-urological chronic pain, highlighting the importance of phenotype specificity and multidimensional approaches in microbiome-based pain research. Full article

Background and Clinical Significanc: Neuropathic corneal pain is a debilitating condition characterized by ocular pain disproportionate to clinical signs, often resulting from peripheral and central sensitization of the corneal somatosensory pathway. Emerging evidence suggests that chronic involuntary muscle contraction in blepharospasm may lead to irritation of trigeminal afferents and corneal neurogenic inflammation, potentially predisposing patients to neuropathic corneal pain. Given its debilitating nature, early recognition can prevent the progression of neuropathic sequelae. This study examines the potential role of blepharospasm as a predisposing factor contributing to neuropathic corneal pain. Case Presentation: This retrospective case series describes three cases (median age: 50 years) of neuropathic corneal pain in association with blepharospasm and their clinical course following multimodal treatment over a median follow-up period of one year. Ocular surface was evaluated using slit-lamp biomicroscopy, while corneal nerve structure and morphology were assessed with in vivo confocal microscopy. All the three subjects presented with minimal ocular surface staining but disproportionate ocular pain characterized by burning sensation and photophobia. Proparacaine challenge testing was performed to determine the subtype of neuropathic corneal pain. Pain symptoms and quality of life were evaluated using the Ocular Pain Assessment Survey and Ocular Surface Disease Index questionnaires. In vivo confocal microscopy demonstrated characteristic corneal nerve abnormalities including reduced corneal nerve density, increased nerve tortuosity, and the presence of microneuromas. Treatment included oral Pregabalin or Gabapentin, topical lubricants, Cyclosporine 0.05% (1 case), and 20% autologous serum eye drops (1 case). Two of the three cases received four to five injections of botulinum toxin for blepharospasm, whereas one had undergone a single injection prior to review. All patients also received weekly periorbital quantum molecular resonance electrotherapy for two months. Improvements were observed across multiple domains of the Ocular Pain Assessment Survey and Ocular Surface Disease Index evaluation, including ocular pain, photophobia, non-ocular pain, and quality-of-life measures following multimodal treatment. The co-existence of blepharospasm and neuropathic corneal pain observed in our cases supports a possible association between chronic periocular muscle hyperactivity and corneal nociceptor sensitization. Proposed mechanisms include chronic trigeminal nerve irritation, neurogenic inflammation, and sensitization mediated by pro-inflammatory neuropeptides. Multimodal treatment targeting both motor hyperactivity and neuropathic pain pathways appeared to provide symptomatic relief, including the use of quantum molecular resonance electrotherapy, which might modulate pain pathways, block nociceptor neurotransmission, and accelerate corneal nerve regeneration. Given the complexity of the neural pathways responsible for ocular discomfort, further studies are required to elucidate the relationship between neuropathic corneal pain and blepharospasm in larger cohorts, as well as refine existing therapeutic approaches, including evaluating the therapeutic role of electrotherapy. Conclusions: Blepharospasm may represent a potential predisposing factor of neuropathic corneal pain. Early recognition and concurrent treatment of blepharospasm and neuropathic corneal pain can effectively relieve symptoms and improve quality of life. Adopting a multimodal treatment approach is therefore recommended. Full article

Background/Objectives: Chronic primary pain (CPP) is a new diagnostic category including chronic pain conditions lacking clinical signs or a clear etiopathogenetic origin. These disorders may share a common neural mechanism known as central sensitization, where nociceptive neurons become hyper-responsive to standard or subthreshold pain stimuli, resulting in pain hyper-sensitivity. In this context, non-invasive brain stimulation (NIBS) appears to be a promising tool for improving CPP symptoms by targeting maladaptive brain activity and connectivity. To date, the effects of NIBS on CPP symptoms remain unexplored. To fill this gap, we conducted a meta-analysis, investigating the effect of NIBS in improving the three core symptoms of CPP, namely pain intensity, emotional distress, and functional disability. Methods: Following PRISMA guidelines, we screened four databases up to February 2025 for English-language, peer-reviewed randomized clinical trials that included CPP patients treated with NIBS and reported pre/post or follow-up scores on validated measures of at least one core symptom. Quality of life was examined as an additional outcome. Results: Fifty-four studies were included, with 1371 participants receiving real stimulation and 1103 sham. Findings highlighted that real stimulation improved CPP symptoms immediately after treatment and at one-month follow-up. Meta-regressions showed that longer CPP duration reduced short-term effects on emotional distress and diminished all outcomes at one-month follow-up. Conclusions: Further research is needed to establish standardized NIBS protocols for CPP management, to investigate the effectiveness at longer follow-up periods, and to test whether combining NIBS with other interventions enhances treatment effectiveness and durability. Full article

Objective: To assess the anatomical and clinical outcomes of a novel, mesh-free cerclage pectopexy technique that uses the round ligament for apical support following total laparoscopic hysterectomy in women with stage II uterine prolapse. Methods: This retrospective observational study included 120 women with stage II uterine prolapse who underwent total laparoscopic hysterectomy followed by laparoscopic non-mesh pectopexy between October 2023 and August 2024. In this procedure, the distal portion of each round ligament was fixed to the pectineal ligament using Ethibond sutures. Multiple plicating stitches were then placed to reinforce the ligament’s tensile strength, creating a biological suspension bridge between the pectineal ligament and the vaginal cuff. All patients were examined preoperatively and at 1, 3, 6, and 12 months postoperatively using the POP-Q system. Anatomical success was defined as an apical stage ≤ I at 12 months. Results: At the twelve-month follow-up, anatomical success was achieved in 95 percent of patients, with six cases of apical recurrence. POP-Q measurements showed significant improvement from baseline, and total vaginal length was preserved. Functional outcomes, including postoperative pain and dyspareunia, were favorable. Early complications were uncommon, and no intraoperative or mesh-related complications occurred. Conclusion: Round-ligament-based non-mesh cerclage pectopexy provides reliable apical support with minimal surgical morbidity following total laparoscopic hysterectomy. This technique appears to provide effective apical support with low surgical morbidity while avoiding synthetic mesh. Preservation of vaginal length and favorable short-term clinical outcomes were observed; however, longer-term comparative studies are required. Future prospective studies combining this procedure with other minimally invasive suspension techniques, such as McCall culdoplasty or uterosacral plication, may broaden its applicability to more advanced prolapse cases. Full article

Background/Objectives: Labor pain is a multidimensional experience associated with physiological, cultural, psychological, and contextual factors. This study aimed to examine the association of personality-related characteristics, cultural beliefs, obstetric characteristics, and proxy indicators of post-disaster context with labor pain perception among women giving birth in Hatay after the 2023 Türkiye earthquakes. Methods: This prospective observational study was conducted with 314 women admitted to Hatay Training and Research Hospital between February and June 2025. Participants were between 38 and 42 gestational weeks, had a singleton healthy fetus, were admitted in active labor, and were expected to give birth vaginally. Data were collected using a researcher-developed questionnaire, the Ten-Item Personality Inventory, and the Visual Analog Scale. Labor pain was assessed at 6 cm, 8 cm, and full cervical dilatation (10 cm). Results: VAS scores increased significantly across cervical dilatation points, from 5.04 ± 0.81 at 6 cm to 7.01 ± 0.82 at 8 cm and 8.06 ± 0.93 at full cervical dilatation (10 cm). Repeated-measures ANOVA showed a significant within-person increase in pain intensity across the three assessment points, F(2, 626) = 996.444, p < 0.001, partial η² = 0.761. Age was not significantly correlated with VAS pain score at full cervical dilatation. In exploratory unadjusted comparisons, VAS scores at full cervical dilatation differed according to education level, official marriage status, previous birth history and mode, attendance at antenatal education, and praying to relieve labor pain. In the multivariable regression model, higher Extraversion and higher education level were associated with lower VAS scores, whereas attendance at antenatal education, greater importance given to traditional rules, previous assisted vaginal/cesarean birth, and current place of residence were independently associated with VAS scores. Conscientiousness was not significantly associated with VAS scores in the adjusted model. Earthquake experience was not significantly associated with VAS scores. Conclusions: Labor pain perception was associated with selected sociodemographic, obstetric, and cultural characteristics. The findings support the importance of individualized, culturally sensitive, and trauma-informed midwifery care in disaster-affected regions. Personality-related findings should be interpreted cautiously because the corrected reliability analysis showed low internal consistency for Agreeableness, Emotional Stability, and Openness to Experience, although Extraversion showed high internal consistency and Conscientiousness showed relatively better but still limited internal consistency. Disaster-related findings should also be interpreted cautiously because post-disaster context was assessed using only limited proxy indicators; current place of residence was independently associated with VAS scores in the adjusted model, whereas earthquake experience was not. Because of the observational design, causal interpretations cannot be made. Full article

Background and Clinical Significance: Osteonevi, originally described by Heidingsfeld in 1908 and later by Nanta in 1911, because of whom it is known as osteonevus of Nanta, is a rare condition with not yet fully established etiopathogenesis; Case Presentation: Herein, we report a case of a 33-year-old female patient who presented to our institution with a papilliform pigmented lesion located on the projection of the left mandibular angle, measuring 2 × 1.5 cm. The lesion had been present since childhood; however, it had increased in size by approximately 5 mm over the previous month and had become painful. Surgical excision was performed, which went uncomplicated. Histology of the resected specimen showed a dermally based, symmetrical melanocytic proliferation, without signs of dysplasia, and an underlying keratocyst with rupture, accompanied by a surrounding foreign-body-type granulomatous reaction around inert keratin flakes. A third component of the lesion was also noted, represented by foci of osteoid and myeloid metaplasia underneath the melanocytic proliferation, without direct relation to the ruptured keratocyst. Based on the morphological findings, the diagnosis of osteonevus of Nanta was established; Conclusions: Oseonevus of Nanta is an extremely rare, benign morphological finding. The etiopathogenesis of these rare lesions is not yet fully established, despite several proposed mechanisms. The differential diagnosis, while typically straightforward, is broad. Full article