Search Results (4,291)

Background: Supine flexible cystoscopy is already established in routine urological practice. However, real-world patient-reported pain across specific procedural stages and other patient-centered outcomes according to clinician-selected procedural position remain incompletely characterized. This study evaluated the associations of supine and lithotomy positioning with patient-reported and procedural outcomes in adult men undergoing flexible cystoscopy. Materials and Methods: This multicenter retrospective observational study included 80 adult male patients who underwent flexible cystoscopy under local anesthesia. Procedural position was selected by the treating urologist according to clinical feasibility and routine clinical judgment, including the patient’s ability to assume the lithotomy position. Patients were classified according to the position used during the procedure as supine (n = 40) or lithotomy (n = 40). Pain was assessed using a 0–10 Visual Analog Scale (VAS), with higher scores indicating greater pain. Patient satisfaction was assessed using a separate 0–10 scale. Secondary outcomes included procedure duration, procedural success, complication rates, and patient tolerance. Procedural tolerance and overall patient satisfaction were assessed immediately after cystoscopy using separate single-item 0–10 rating scales. For the satisfaction scale, 0 indicated “completely dissatisfied” and 10 indicated “completely satisfied”. Group comparisons and an exploratory multivariable linear regression analysis of the primary pain outcome were performed. Results: A total of 80 patients were included (40 supine and 40 lithotomy). Mean VAS scores were lower in the supine group during cystoscope insertion (2.1 ± 1.0 vs. 3.4 ± 1.2; mean difference [MD]: −1.30, 95% CI: −1.79 to −0.81; p < 0.001), bladder evaluation (1.8 ± 0.9 vs. 2.6 ± 1.1; MD: −0.80, 95% CI: −1.25 to −0.35; p = 0.001), and immediately after the procedure (1.2 ± 0.7 vs. 2.0 ± 0.9; MD: −0.80, 95% CI: −1.16 to −0.44; p < 0.001). Procedure duration was 6.8 ± 2.1 versus 7.4 ± 2.3 min (MD: −0.60 min, 95% CI: −1.58 to 0.38; p = 0.186). Procedural success occurred in 97.5% versus 95.0% of patients (risk difference [RD]: 2.5 percentage points, 95% CI: −8.5 to 14.2; p = 1.000). In an exploratory post hoc subgroup of patients with documented difficult catheterization (n = 40; 20 patients per group), cystoscopy-guided catheterization was successful in 19/20 patients (95.0%) in the supine group and 13/20 patients (65.0%) in the lithotomy group (RD: 30.0 percentage points, 95% CI: 4.9 to 52.1; p = 0.044). This small, non-prespecified subgroup analysis was considered hypothesis-generating. Complications occurred in 4/40 patients (10.0%) in the supine group and 7/40 patients (17.5%) in the lithotomy group (RD: −7.5 percentage points, 95% CI: −23.2 to 8.2; two-sided Fisher’s exact p = 0.518). Procedural tolerance (8.6 ± 1.1 vs. 7.2 ± 1.4; MD: 1.40, 95% CI: 0.84 to 1.96; p < 0.001) and overall satisfaction scores (8.8 ± 1.0 vs. 7.4 ± 1.3; MD: 1.40, 95% CI: 0.88 to 1.92; p < 0.001) were higher in the supine group. After adjustment for the available covariates, supine positioning remained associated with a lower insertion-related VAS score (β = −1.21, 95% CI: −1.75 to −0.67; p < 0.001). Conclusions: In this retrospective, non-randomized cohort, clinician-selected supine positioning was associated with lower reported pain and higher procedural tolerance and satisfaction compared with lithotomy positioning. No statistically significant between-group differences were observed in overall procedural success or complication rates. Because position selection was clinician-directed and potentially influenced by patient mobility and other unmeasured factors, these findings do not demonstrate a causal benefit of supine positioning. They should be considered hypothesis-generating and require confirmation in adequately powered prospective randomized studies before informing changes in routine clinical practice. Full article

Background and Objectives: Chronic non-specific neck pain (CNNP) is common among desk-based workers exposed to increased ergonomic risk and is accompanied by functional impairments. This study examined associations between exercise participation and pain intensity, upper-extremity disability, body awareness, and perceived sagittal trunk appearance in this population. Materials and Methods: This cross-sectional study included 250 of 512 screened desk-based workers with CNNP, pain severity ≥4/10, and a Rapid Upper Limb Assessment (RULA) score ≥ 3/7. Physical activity, upper-extremity disability, body awareness, perceived sagittal trunk appearance, and ergonomic risk were assessed using the IPAQ-SF, QuickDASH, Body Awareness Rating Questionnaire (BARQ), KyphoTAPS, and a video-call-based RULA. Results: Participants reporting exercise participation had lower QuickDASH scores (p = 0.003, d = −0.42) and higher BARQ total scores (p = 0.023, d = 0.33) than non-exercisers. BARQ function and awareness scores were higher in this group (p = 0.004 and p = 0.033), while pain severity, perceived sagittal trunk appearance, and ergonomic risk were similar between groups. QuickDASH scores were positively correlated with pain severity (rho = 0.636–0.727) and negatively correlated with BARQ total scores (rho = −0.477). RULA scores showed a weak positive correlation with general neck pain (rho = 0.288) (FDR-adjusted p < 0.002). Exploratory adjusted analyses showed that participants reporting regular exercise participation had lower QuickDASH and higher BARQ total scores than non-exercisers in all models. Participants reporting low-frequency exercise participation had lower QuickDASH scores than non-exercisers only in Model 4. Conclusions: Self-reported exercise participation may be associated with lower QuickDASH scores and higher BARQ total scores in desk-based workers with CNNP and increased ergonomic risk. Because maintaining consistent exercise participation can be challenging in occupational settings, future studies should investigate feasible exercise strategies to address pain-related, functional, and perceptual outcomes among occupational populations exposed to prolonged ergonomic loading. Full article

Background: Frozen shoulder (FS) is a debilitating condition characterized by pain and restricted range of motion (ROM), often leading to prolonged treatment and economic burden. Home exercise programs are effective for FS, so we developed the Defrozen app to support home exercise. This randomized controlled trial (RCT) compared app- versus pamphlet-assisted home exercise programs in patients with FS. Methods: In this RCT, twenty-one patients with FS who received corticosteroid injections were randomized (2:1) to app or pamphlet-assisted home exercise. Baseline assessments were performed, and all participants initiated their assigned home exercise program, which lasted 4 weeks. Outcomes included shoulder ROM, pain intensity (numeric rating scale, NRS), and functional outcomes (Oxford Shoulder Score [OSS] and Quick Disabilities of the Arm, Shoulder, and Hand [QuickDASH] score). Results: Both groups demonstrated significant within-group improvements in ROM measures, NRS, OSS, and QuickDASH scores (p < 0.05). Between-group comparisons using analysis of covariance (ANCOVA) showed significantly greater gains in shoulder abduction (p = 0.023) and internal rotation (p = 0.020) in the app-assisted group compared with the pamphlet group. Conclusions: A four-week app-based home exercise program provides additional benefits in improving shoulder ROM compared with conventional pamphlet-based instruction in FS after corticosteroid injection. Full article

Background/Objectives: Low back pain (LBP) is a leading cause of disability worldwide, and exercise-based rehabilitation is recognized as an effective management strategy. However, adherence to exercise remains challenging. Fully immersive virtual reality (VR) exercise interventions may enhance engagement and clinical outcomes. This study aimed to examine the effect of a fully immersive VR exercise game on pain, fear-avoidance beliefs, and disability in individuals with chronic non-specific LBP. Methods: A single-blinded randomized controlled trial was conducted, involving 28 participants aged 18–60 years with chronic non-specific LBP. Participants were randomly allocated to either a VR exercise group with standard education (n = 14) or a conventional home exercise group with standard education (n = 14). Both groups performed their assigned intervention once per day for two weeks. Outcomes included the Fear-Avoidance Beliefs Questionnaire (FABQ), Numeric Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), Back Beliefs Questionnaire (BBQ), and functional performance tests (six-minute walk test, repeated sit-to-stand, and trunk flexion). Measures were assessed at baseline and after a 2-week intervention period. Exercise adherence was recorded using a self-reported log. Results: No significant within- or between-group differences were observed for FABQ scores. However, a significant between-group difference was reported for pain reduction in the VR group (p = 0.044). No significant differences were reported for disability or belief-related outcomes, or for physical performance outcomes, including the 6 min walk test, repeated sit-to-stand test, and trunk flexion test. Conclusions: A fully immersive VR exercise intervention resulted in greater short-term pain reduction compared to conventional exercise in individuals with chronic non-specific LBP. However, it had little impact on fear-avoidance beliefs or disability, highlighting the need for multimodal approaches that address broader biopsychosocial factors. Full article

Background: Large-to-massive rotator cuff tears with advanced fatty degeneration and retears after previous repair remain major clinical challenges. Despite advances in surgical techniques, clinical outcomes remain unsatisfactory. This study evaluated the 5-year outcomes of rotator cuff repair (RCR) with autologous fascia lata augmentation in patients at high risk of repair failure. Methods: We retrospectively reviewed 14 patients (mean age, 64.1 ± 6.6 years) who underwent RCR with autologous fascia lata augmentation. All patients had large-to-massive rotator cuff tears with Goutallier grade 3 or 4 fatty degeneration or retears after prior cuff repair. Clinical outcomes were evaluated using the visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, and the Constant score. Postoperative cuff integrity was assessed using magnetic resonance imaging (MRI) or ultrasonography. Results: At the 1-year follow-up, significant improvements were observed in pain VAS (from 5.1 ± 1.6 to 1.3 ± 1.0, p < 0.001), ASES score (from 51.9 ± 19.1 to 85.2 ± 7.8, p < 0.001) and Constant score (from 51.3 ± 13.8 to 70.8 ± 7.0, p < 0.001). These improvements were maintained throughout the 5-year follow-up. Postoperative imaging demonstrated an overall retear rate of 7.1% (1/14). No patient underwent revision surgery during follow-up. Conclusions: Autologous fascia lata augmentation was associated with sustained pain relief and functional improvement throughout the 5-year follow-up, with a low retear rate on postoperative imaging. These findings suggest that autologous fascia lata may be a viable graft option for rotator cuff augmentation in selected patients, although further prospective comparative studies with larger cohorts are warranted. Full article

Background/Objectives: Interventional endoscopic ultrasound (I-EUS) has evolved from a diagnostic imaging modality into a transformative therapeutic platform encompassing biliary drainage, pancreatic interventions, luminal bypass, pain management, and ablative therapies. Despite the rapid proliferation of I-EUS research, a comprehensive bibliometric analysis characterizing the global intellectual architecture of this field is lacking. Methods: A Web of Science Core Collection search identified 4340 records, of which 2237 were included (2001–2024), analyzed with R bibliometrix (version 5.0) and VOSviewer (version 1.6.20). Results: Publication output demonstrated three distinct phases with pronounced acceleration from 2017. The United States led global output (n = 625, 27.9%), followed by Japan (n = 435, 19.4%) and Italy (n = 166, 7.42%). At the continental level, Asia collectively produced the largest share of output (n = 884, 39.5% of the total corpus), exceeding the Americas (n = 687, 30.7%) and Europe (n = 492, 22.0%). Gastrointestinal Endoscopy was the most productive journal (n = 173). Tokyo Medical University was the most productive institution (n = 93, 4.16%). Four thematic clusters were identified: EUS-guided biliary and pancreatic ductal drainage; diagnostic, ablative, and injection EUS for pancreatic tumors; LAMS-enabled luminal bypass and gallbladder drainage; and pancreatic fluid collections and necrotizing pancreatitis. Temporal overlay confirmed EUS-guided gastroenterostomy, EUS-guided gallbladder drainage, and EUS-guided radiofrequency ablation as the leading research frontiers. Annual output showed no discernible contraction during the COVID-19 pandemic period (2020–2021). Conclusions: The United States led global I-EUS research output with higher rates of international collaboration compared with East Asian nations, although Asia as a continent generated the largest aggregate volume of publications. EUS-guided biliary drainage and pancreatic fluid collection management constitute the established, high-volume core of the field, while EUS-guided gastroenterostomy and novel ablative technologies represent the most dynamic investigative frontiers. Full article

Background and Objectives: This retrospective cohort study aimed to evaluate the association between sagittal tibial tunnel angle and radiological and clinical outcomes following transtibial pull-out repair of medial meniscus posterior root tears. Materials and Methods: A total of 81 patients who underwent arthroscopic transtibial pull-out repair between January 2022 and October 2025 and had a minimum follow-up of 6 months were retrospectively evaluated. Demographic, clinical, radiological, and functional data were analyzed. Meniscal extrusion, hip–knee–ankle angle, mechanical axis deviation, sagittal and coronal tunnel angles, International Knee Documentation Committee (IKDC) score, and Numeric Pain Rating Scale (NPRS) score were assessed preoperatively and at 6 months postoperatively. Receiver operating characteristic (ROC) analysis was performed to explore the ability of sagittal tibial tunnel angle to discriminate achievement of the patient acceptable symptom state (PASS) based on the postoperative IKDC score. The ROC-derived 51.5° value was considered an exploratory, cohort-specific threshold. For secondary between-group comparisons, patients were classified into two groups according to sagittal tibial tunnel angle: ≤51.5° and >51.5°. Results: The cohort included 56 female patients, and the mean age was 50.0 ± 9.97 years. Receiver operating characteristic analysis identified 51.5° as the exploratory cohort-specific threshold, with an area under the curve of 0.754, sensitivity of 77.8%, and specificity of 68.9%. Patients with a sagittal tunnel angle >51.5° had lower postoperative meniscal extrusion than those with an angle ≤51.5° (3.0 mm versus 4.0 mm, p < 0.001), greater reduction in meniscal extrusion (1.10 mm versus 0.3 mm, p < 0.001), higher postoperative IKDC (71.62 ± 10.69 versus 53.0 ± 15.44, p < 0.001), and lower postoperative NPRS scores (1 versus 4, p < 0.001). Achievement of the patient acceptable symptom state was also more frequent in the >51.5° group (66.7% vs. 17.9%, p < 0.001). Conclusions: A greater sagittal tibial tunnel angle measured on 6-month postoperative MRI was associated with lower concurrent meniscal extrusion, higher functional scores, and lower pain scores following transtibial pull-out repair. However, the retrospective design and short follow-up period limit causal and long-term interpretation. The cohort-derived 51.5° threshold should be considered exploratory and requires external validation before clinical application. Full article

Background: Alcohol use disorder (AUD) is generally regarded as a relative contraindication to pancreas transplantation. Yet the effect of documented AUD before transplantation on long-term results after pancreas transplantation is still poorly understood. Therefore, we used a large real-world electronic health records database to compare the three-year outcomes among pancreas transplant recipients who had and who had not had documented AUD before transplantation. Methods: We carried out a retrospective cohort study involving propensity score matching using the TriNetX US Collaborative Network. Each adult patient who had a documented case of alcohol use disorder (ICD-10-CM codes F10.1/F10.2) before transplantation was paired one to one with a patient who did not have such a disorder, matching them on demographic characteristics, comorbidities, transplant-related factors, medications, body mass index, and glycated hemoglobin. The outcomes were evaluated from one day after transplantation up to three years later and comprised all-cause mortality, emergency visits, transplant complications, cachexia, severe protein–calorie malnutrition, pain, vitamin deficiencies, iron deficiency anaemia, diarrhea, and adult failure to thrive. Results: Out of 14,367 eligible recipients, propensity score matching resulted in 439 patients in each group. Pretransplant AUD was linked to a significantly higher rate of all-cause mortality (15.1% compared with 8.5%; risk ratio [RR] 1.78, 95% CI 1.22–2.60; hazard ratio [HR] 1.86, 95% CI 1.25–2.78; p = 0.002). Cachexia affected 5.2% rather than 2.5% (RR 2.09, 95% CI 1.03–4.24; HR 2.16, 95% CI 1.06–4.44; p = 0.036), while diarrhea occurred in 39.6% compared with 28.2% (RR 1.40, 95% CI 1.16–1.69; HR 1.54, 95% CI 1.22–1.94; p < 0.001). There were no significant differences in the case of emergency visits (49.0% versus 44.6%; p = 0.199), transplant complications (11.1% versus 14.4%; p = 0.163), severe protein–calorie malnutrition (12.1% versus 8.9%; p = 0.123), pain (59.0% versus 54.7%; p = 0.195), vitamin deficiencies (31.4% versus 29.4%; p = 0.509), iron deficiency anemia (21.2% versus 21.9%; p = 0.805), or adult failure to thrive (7.3% versus 4.3%; p = 0.061). Conclusions: The presence of a history of alcohol use disorder (AUD) before transplantation was found to be independently linked to a higher three-year mortality rate, as well as the occurrence of cachexia and diarrhea after pancreas transplantation, but it was not associated with an increased number of coded transplant complications or most of the other adverse outcomes following the procedure. These results indicate that pancreas transplant recipients with a history of AUD should have enhanced monitoring in the areas of nutrition, the gastrointestinal system, and addiction. Full article

Against the backdrop of the dual-carbon goals, a new power system is undergoing rapid construction, and distributed renewable energy is being connected at high density to regional ring networks. This study deeply explores the impact of photovoltaic (PV) power station connection positions on energy distribution and flow, as well as the voltage and energy loss of ring networks. Firstly, it takes the actual 220 kV/500 kV ring network in a certain city in Yunnan Province as the research object, and constructs a high-precision ETAP simulation model. It then systematically explores the mechanism of how PV power connection positions and grid connection penetration rates affect node voltage and line loss and derives the energy loss calculation formula. On this basis, two differentiated operation scenes corresponding to renewable energy output peaks and valleys are established. Through comparative analysis of multiple sets of simulation data, this study reveals the coupling laws among PV output fluctuation, bidirectional reverse power flow, system energy loss, and voltage over-limit. Finally, combined with the operational pain points of existing ring network and distribution network connection modes, this study proposes diversified loss reduction optimization strategies, including coordinated optimization of active and reactive power, and coordinated regulation of PV power and energy storage. The relevant research conclusions and optimization methods can improve the line loss analysis theory for ring networks integrated with PV power, and provide important engineering references for renewable energy planning and design, operation regulation, and loss management for similar mountain power grids. Full article

Background: Celiac disease is a chronic autoimmune enteropathy whose only established treatment is a strict, lifelong gluten-free diet (GFD). Beyond physical symptoms, the disease and its dietary management affect emotional, social, and economic functioning. Objectives: This study aimed to assess health-related quality of life (HRQoL) in adult patients with celiac disease and to identify factors associated with their daily functioning and adherence to the GFD. Methods: A cross-sectional survey was conducted between February and March 2026 among 101 adults with a self-reported diagnosis of celiac disease made by a gastroenterologist, recruited through online support groups. Data were collected using an author-designed sociodemographic questionnaire, the Gastrointestinal Quality of Life Index (GIQLI), and the Celiac Dietary Adherence Test (CDAT). Analyses (Mann–Whitney U and Kruskal–Wallis tests, repeated-measures ANOVA, Spearman correlations with false-discovery-rate correction, and multivariable linear and logistic regression with prespecified sensitivity analyses) were performed in R 4.5.2, with α = 0.05. Results: The most frequently reported difficulties were eating away from home, the high cost of the GFD, and limited product availability; the most common symptoms after inadvertent gluten exposure were abdominal pain, bloating, fatigue, diarrhea, and headache. HRQoL was lowest in the emotional and physical domains. Better dietary adherence was significantly correlated with higher HRQoL across the total score and all domains except the social domain, whose weak internal consistency in this sample (α = 0.57) precludes substantive interpretation (total GIQLI: ρ = −0.50; p < 0.001), and in the multiple regression, adherence remained the strongest independent correlate of HRQoL (β = −0.36; adjusted R² = 0.41). Longer time on the diet was independently associated with better adherence (adjusted OR = 0.55 per duration category; p = 0.017). In a small vocational education subgroup (n = 8), poorer adherence and lower HRQoL were observed relative to participants with higher education, though only the HRQoL difference survived correction for multiple testing (FDR-adjusted p = 0.011 vs. 0.060 for adherence); given the size of this subgroup, this comparison is exploratory and hypothesis-generating. Higher HRQoL was also associated with milder symptoms, better-rated medical care, greater product availability, and higher household income. Conclusions: In this sample, HRQoL scores were lowest in the emotional and physical domains; because the design was cross-sectional and included no comparison group, these data characterize the distribution of HRQoL within the sample and do not establish that celiac disease reduces HRQoL. Dietary adherence was the strongest correlate of patient functioning, alongside symptom burden, self-rated quality of medical care, and product availability. Because the design is cross-sectional, these associations do not establish direction, and whether comprehensive health education and psychological support improve outcomes requires prospective and interventional evaluation. Full article

Objectives: To evaluate the clinical accuracy and patient-reported outcomes (PROMs) of robotic-assisted full-arch implant rehabilitation performed with an autonomous robotic implant system. Materials and Methods: Six consecutive edentulous patients requiring implant-supported full-arch rehabilitation were treated using the Yakebot task-autonomous robotic implant system following a fully digital workflow. A total of 36 Straumann Bone Level Tapered implants were placed using a flapless approach. Implant placement accuracy was assessed by comparing planned and postoperative CBCT datasets. Coronal, apical, depth, and angular deviations were automatically calculated using dedicated robotic planning software. Patient-reported outcomes were prospectively evaluated through a structured questionnaire assessing preoperative perceptions, postoperative morbidity, and overall treatment satisfaction. Results: All implants were successfully placed according to the robotic-assisted workflow without intraoperative complications or conversion to conventional surgery. Mean three-dimensional coronal and apical deviations were 0.45 ± 0.18 mm and 0.47 ± 0.19 mm, respectively, while mean total angular deviation was 1.30 ± 0.63°. Patients reported low preoperative anxiety (0.5 ± 0.8/10), limited postoperative pain (2.2 ± 3.5/10), swelling (1.3 ± 2.2/10), and interference with daily activities (1.3 ± 2.2/10). Overall surgical experience was highly rated (9.7 ± 0.8/10). Final satisfaction scores were exceptionally high, with all patients indicating they would undergo robotic-assisted surgery again and recommend the procedure to others. Conclusions: Robotic-assisted full-arch implant rehabilitation demonstrated a high level of clinical accuracy, with submillimetric coronal and apical deviations and low angular discrepancies. In addition, treatment was associated with low postoperative morbidity, excellent patient acceptance, and very high satisfaction. These findings support the potential of autonomous robotic implant surgery as a predictable and patient-centered approach for full-arch rehabilitation, although larger controlled studies are required to confirm these results. Full article

Background: Chronic lower limb wounds, such as diabetic and vascular ulcers, affect up to 2% of the global population, imposing high healthcare costs and a significant risk of amputation. Although nursing care and traditional treatments are fundamental, single-use portable Negative Pressure Wound Therapy PICO 7 system, has emerged as a cost-effective alternative. The objective of this study was to evaluate the effectiveness of PICO 7, compared to the usual treatment in chronic lower limb wounds or their dehiscence in amputations. Methodology: A randomized, controlled, open-label clinical trial was conducted at the Hospital Universitario de Toledo (2024–2026). The final analyzed sample consisted of 31 patients (Intervention Group, IG: 14; Control Group, CG: 17). Both groups followed the dynamic TIME strategy to standardize wound bed preparation. Primary variables included healing rate, healing time, wound area reduction, clinical safety (infections and adverse effects), pain levels, health-related quality of life, and physical activity. Statistical analysis was performed using SPSS v.28. Results: The IG showed a higher mean percentage reduction in wound size, although the between-group difference did not reach statistical significance. No infections were recorded in the IG. Regarding quality of life and physical activity, the CG showed a significant post-intervention decline, whereas the IG remained stable. A significant negative correlation was found between final wound size and hours of sleep, suggesting that wound reduction facilitates better rest. Conclusions: The PICO 7 system appears to be a safe and feasible alternative to conventional wound care. Favorable trends in wound area reduction should be interpreted cautiously given the lack of statistically significant between-group differences. Full article

Background and Objectives: Free flap reconstruction is the gold standard for complex head and neck defects following oncological ablation. While surgical techniques have improved flap success rates, donor site sensory morbidity remains relatively understudied. The radial forearm free flap (RFFF) and fibula free flap (FFF) are the two most commonly used free flaps for head and neck reconstruction and sensory abnormalities at their donor sites represent a significant but underrecognized source of postoperative morbidity. Materials and Methods: The aim of this study is to systematically review and synthesize the existing evidence on the prevalence, characteristics and assessment methods of sensory abnormalities and pain at the donor sites of RFFF and FFF harvests. A systematic review was conducted according to PRISMA 2020 guidance. PubMed/MEDLINE, Scopus, Web of Science, the Cochrane Library, and Google Scholar were searched from inception to 1 October 2025, with additional gray-literature and reference-list screening. Primary studies reporting sensory abnormalities, donor-site pain, neuropathic pain, or cold intolerance after RFFF and/or FFF harvest were included; prior reviews were used for citation tracking and contextual comparison only. Risk of bias was assessed with study-design-specific Joanna Briggs Institute (JBI) checklists, and the level of evidence was classified using the Oxford Centre for Evidence-Based Medicine (OCEBM) framework. Descriptive prevalence summaries and exploratory random-effects pooled estimates were calculated when numerators and denominators could be extracted. Results: From 1247 initially identified records, 73 studies met the inclusion criteria (36 RFFF-specific, 35 FFF-specific, and 2 addressing both flap types). Most studies were observational, and sensory outcomes were frequently secondary endpoints. For RFFF, reported sensory abnormalities ranged from 0% to 100% across extractable studies (median 31.3%; IQR 13.1–55.0%), reflecting differences in definitions, follow-up, and testing; the exploratory pooled prevalence was 34.4% (95% CI 23.6–47.1%; I2 = 88.4%). General donor-site pain ranged from 0% to 36.8% (median 12.0%; pooled 16.0%, 95% CI 9.9–24.8%), whereas Douleur Neuropathique en 4 Questions (DN4)-defined neuropathic pain was 18% in the largest dedicated RFFF study and 18% in a smaller pain-focused study. Cold intolerance ranged from 0% to 40.0% (median 16.2%). For FFF, sensory abnormalities ranged from 0% to 76.3% (median 21.4%; IQR 8.2–46.8%; pooled 24.0%, 95% CI 16.5–33.6%; I2 = 88.6%). General pain ranged from 0% to 72.7% (median 17.5%; pooled 18.8%, 95% CI 13.9–24.9%), and DN4-defined neuropathic pain was 21% in the only dedicated FFF study. Objective testing (quantitative sensory testing [QST], Semmes-Weinstein monofilaments, two-point discrimination, or standardized neurological examination) was used inconsistently, and no included study systematically used nerve conduction studies or electromyography (EMG). Conclusions: Sensory abnormalities and pain after RFFF and FFF harvest appear common, but available estimates remain uncertain because of heterogeneous definitions, follow-up intervals, assessment instruments, and predominantly Level 2b-4 evidence. The literature shows a persistent gap between patient-reported symptoms and objective sensory testing. Future prospective studies would benefit from standardized neuropathic pain screening, structured neurological examination, and QST; however, current data do not support strong causal inferences or a validated treatment algorithm. Full article

Background/Objectives: Our aim was to evaluate sleep quality and excessive daytime sleepiness in complex regional pain syndrome (CRPS) and explore their associations with pain characteristics, functional impairment, depressive symptoms, and pain coping strategies. Methods: This pilot exploratory, cross-sectional observational study was conducted at a single tertiary rehabilitation center using a convenience sample of 21 adults with CRPS Type I (n = 17) or Type II (n = 4). Sleep quality and daytime sleepiness were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Pain was assessed with the Numeric Rating Scale (NRS), Short-Form McGill Pain Questionnaire (SF-MPQ), and PainDETECT Questionnaire (PDQ). Limb-specific disability was measured using the Disability of the Arm, Shoulder and Hand (DASH) questionnaire for upper-extremity CRPS (n = 10) and the Lower Extremity Functional Scale (LEFS) for lower-extremity CRPS (n = 11). Psychological factors and central sensitization were assessed via BDI-II, CSQ, and CSI. Results: Poor sleep quality (PSQI > 5) occurred in 81.0% (17/21) of participants (mean PSQI: 10.1 ± 4.1). ESS-defined excessive daytime sleepiness was identified in 47.6% (10/21) of patients (mean ESS: 9.6 ± 5.8). In unadjusted bivariate correlation analyses of the full cohort (n = 21), global PSQI score significantly correlated with NRS pain intensity (ρ = 0.445, p = 0.0431), SF-MPQ sensory pain (ρ = 0.468, p = 0.0325), SF-MPQ affective pain (ρ = 0.461, p = 0.0354), and SF-MPQ total score (ρ = 0.504, p = 0.0199. Conclusions: Sleep disturbances and excessive daytime sleepiness are highly prevalent in CRPS patients in tertiary care. Exploratory unadjusted analyses link sleep quality with pain severity, particularly sensory and affective dimensions. Given the exploratory design and small subgroup sample sizes, larger prospective studies are needed to confirm these findings. Full article

Background: Application of the capsaicin 8% patch is commonly associated with treatment-related burning pain, which may necessitate rescue analgesia, compromise completion of the standardized 60 min application, and reduce acceptance of repeat treatment. Although capsaicin is an established therapy for painful diabetic peripheral neuropathy (PDPN), evidence supporting strategies to improve procedural tolerability remains limited. This study evaluated whether ultrasound-guided bilateral ankle nerve block (UGBANB) was associated with better procedural outcomes than topical eutectic mixture of lidocaine/prilocaine (EMLA) pretreatment or no pretreatment. Methods: This retrospective comparative cohort study included 90 adults with neurologist-confirmed PDPN who underwent capsaicin 8% patch therapy. Patients received no pretreatment (n = 30), topical EMLA pretreatment (n = 30), or UGBANB (n = 30). The primary outcome was cumulative procedural pain burden, quantified as the area under the Numeric Pain Rating Scale–time curve (AUC-NPRS) during the standardized 60 min application. Secondary outcomes included rescue tramadol requirements, treatment completion, early postprocedural pain intensity, procedural tolerability, willingness to undergo repeat treatment, and safety. Results: Cumulative procedural pain burden differed significantly among the three pretreatment strategies (one-way ANOVA: F = 289.8, p < 0.001; η² = 0.87). Mean AUC-NPRS was 481.5 ± 39.2 NPRS·min with no pretreatment, 429.2 ± 36.0 with topical EMLA, and 256.3 ± 38.4 with UGBANB, corresponding to approximately 47% and 40% lower cumulative pain burden with UGBANB than with no pretreatment and topical EMLA, respectively. No patient receiving UGBANB required intravenous rescue tramadol, compared with 60.0% receiving EMLA and 100.0% receiving no pretreatment (p < 0.001). Treatment completion was 100% with UGBANB, compared with 83.3% with EMLA and 73.3% with no pretreatment. UGBANB was also associated with lower early postprocedural pain, greater procedural tolerability, and greater willingness to undergo repeat treatment. No serious treatment- or block-related adverse events were observed during the available follow-up. Conclusions: UGBANB was associated with better procedural tolerability and treatment delivery during capsaicin 8% patch therapy than topical EMLA or no pretreatment in patients with PDPN. These findings relate specifically to procedural optimization and should not be interpreted as evidence that UGBANB enhances the intrinsic or long-term analgesic efficacy of capsaicin. Prospective multicenter randomized controlled trials are needed to confirm these associations and determine whether improved procedural tolerability translates into better long-term treatment adherence, clinical outcomes, health-related quality of life, safety, and cost-effectiveness. Full article