Search Results (1,585)

Background/Objectives: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) can produce comparable short-term clinical outcomes, but their regional effects on cervical muscle morphology are incompletely characterized. This study compared 12-month clinical outcomes and quantitative magnetic resonance imaging (MRI) changes after single-level C6–7 ACDF and CDA. Methods: This retrospective longitudinal cohort included 100 age-, sex-, and body mass index-matched patients (50 ACDF and 50 CDA). Neck and arm pain were assessed on 0–10 scales, and the Neck Disability Index (NDI) was analyzed as a 0–50-point score. Regional muscle cross-sectional area (CSA) and fatty infiltration (FI) were quantified on standardized preoperative and 12-month axial T2-weighted turbo spin-echo images at C6–7. The primary analysis included four posterior muscles. CSA change was expressed relative to baseline, whereas FI change was expressed in percentage points. Results: Clinical outcomes were statistically indistinguishable at 12 months (neck-pain score, 0.50 vs. 0.36, p = 0.318; NDI, 2.6 vs. 2.2 points, p = 0.479; perfect-outcome rate, 68.0% in both groups). Both groups showed significant regional posterior muscle CSA reduction and FI increase; however, the magnitude was greater after ACDF than after CDA (CSA reduction, −15% to −19% vs. −5% to −9%; absolute FI increase, +5.1 to +8.2 vs. +1.1 to +2.3 percentage points; all between-group q < 0.001). Surgical technique was independently associated with both MRI change metrics. Greater regional CSA reduction was modestly associated with higher concurrent 12-month neck-pain scores (β = −0.26, p = 0.022). This concurrent association does not establish causation or predict outcomes beyond 12 months. Conclusions: ACDF and CDA produced equivalent measured clinical outcomes at 12 months, while CDA showed a more favorable regional posterior muscle MRI profile. Differential device-related artifact was not quantitatively assessed and cannot be completely excluded, although concordant findings across four implant-remote posterior muscles make artifact unlikely to be the sole explanation. The functional and longer-term clinical significance of this imaging difference is not established and requires prospective longitudinal study. Full article

Background/Objectives: Chronic recurrent multifocal osteomyelitis/chronic nonbacterial osteomyelitis (CRMO/CNO) is an auto-inflammatory bone disease for which optimal treatment and imaging-based monitoring remain incompletely defined. Methods: We conducted a single-center retrospective review of nine pediatric patients with CRMO/CNO treated with tumor necrosis factor inhibitors (TNFis). Clinical improvement was assessed using Visual Analog Scale (VAS) pain scores, erythrocyte sedimentation rate (ESR), and physical examination findings. Radiographic assessment used longitudinal, site-specific magnetic resonance imaging (MRI) scored with a simplified approach adapted from the Chronic Nonbacterial Osteomyelitis Magnetic Resonance Imaging Scoring (CROMRIS) system. Results: Our cohort was composed of six females and three males with a median age of seven years. TNFi monotherapy was initiated as a first-line therapy (n = 4) or step-up (n = 5). During a median follow-up time of 26 months, treatment was tolerated well, except for the emergence of psoriasis in three patients (n = 3), among whom one necessitated treatment change. Eight patients on TNFis achieved clinical remission, including five with complete resolution of MRI lesions. Conclusions: In this small, single-center case series, TNFi monotherapy was associated with sustained disease control, as reflected by clinical improvement and MRI-documented lesion resolution. These findings emphasize the need for validation of our observations in larger multi-center cohorts. Full article

Background/Objective: Perioperative nursing care encompasses a diverse patient population with varying needs, anatomical and physiological characteristics, and differing levels of vulnerability, demanding specialized knowledge and skills. This study aims to identify key research priorities in perioperative nursing across the lifespan. Methods: A two-round e-Delphi study was conducted across three Portuguese hospitals, involving expert perioperative nurses (87 in the first round and 69 in the second). Participants rated the importance of various research topics on a 5-point Likert scale about six dimensions: (1) professional development and non-technical skills, (2) person-centered care, (3) organizational aspects and work environment, (4) patient and team safety, (5) digital innovation, and (6) patient outcomes and quality of care. Data were analyzed using mean scores, Content Validity Ratio (CVR) for initial validation, and the Coefficient of Variation (CV) to determine the level of consensus. The reporting of this study followed the DELPHISTAR (Guideline for Reporting Delphi Studies) recommendations. Results: A high degree of consensus was achieved (all CV < 0.20). The experts established a consensus on 48 components. The highest-rated priority was nurse burnout and professional satisfaction (Mean = 4.74). This was closely followed by patient safety (Mean = 4.68), team safety (Mean = 4.65), disaster response (Mean = 4.62), and emergency management (Mean = 4.58). Acute pain control and interdisciplinary communication also emerged as critical areas. Topics such as digital innovation and artificial intelligence, while valued, received lower priority scores. Conclusions: The identified priorities should direct funding toward research, education, quality improvement, and health policies. Future studies should focus on developing interventions to promote a favorable perioperative environment and optimize clinical responses to individuals’ conditions, catastrophes, and life-threatening situations across the lifespan. Full article

Background: Chronic low back pain (CLBP) is a leading cause of global disability, linked to elevated IL-6 and vitamin D deficiency or insufficiency. While interferential current (IFC) therapy and exercise therapy are established treatments, their combined effect with vitamin D supplementation on inflammatory biomarkers, pain, and functional disability remains underexplored. Objective: The aim of this study was to evaluate the combined effects of physiotherapy and vitamin D supplementation on pain, disability, IL-6 expression, and vitamin D levels in CLBP patients. Methods: This two-arm, parallel-group, randomized controlled trial enrolled 60 CLBP patients, randomized into Group A (physiotherapy alone: IFC therapy and exercise therapy; n = 30) or Group B (physiotherapy plus vitamin D supplementation; n = 30). Outcomes included pain intensity (11-point Numeric Pain Rating Scale (NPRS)), disability (Arabic Oswestry Disability Index (ODI), 0–100%), and serum IL-6 and 25-hydroxyvitamin D (both by ELISA; pg/mL and ng/mL, respectively), which were assessed at baseline and 6 weeks. All 60 participants enrolled had laboratory-confirmed vitamin D deficiency or insufficiency (serum 25(OH)D < 20 ng/mL) at screening. Independent samples t-tests compared continuous baseline characteristics and between-group differences in 6-week change scores; paired t-tests assessed within-group change from baseline to 6 weeks; the chi-square test compared the categorical variable of gender (α = 0.05). Results: Both groups showed significant improvements in NPRS and ODI at six weeks (p < 0.001). Group B demonstrated significant reductions in NPRS (−3.01 vs. −1.71) and ODI (21.83% vs. 16.33%). IL-6 decreased significantly only in Group B (18.24 pg/mL, p < 0.001), with no significant change in Group A (25.96 pg/mL, p = 0.626). Vitamin D levels increased significantly in Group B (31.68 ng/mL, p < 0.001) compared with Group A (19.68 ng/mL, p = 0.115), a between-group difference that was also statistically significant. Conclusions: Combining physiotherapy with vitamin D supplementation improves outcomes in the management of CLBP. This approach effectively reduces pain, functional disability, inflammation, and vitamin D deficiency or insufficiency, offering a comprehensive, evidence-based treatment strategy. Full article

Background and Objectives: Children with mild intellectual disability (MID) frequently experience difficulties during dental treatment due to increased sensitivity to environmental stimuli and limited cooperation. Sensory-adapted dental environments (SADE) have been proposed as a strategy to improve the dental experience of patients with neurodevelopmental conditions; however, evidence regarding their effectiveness in children with MID remains limited. This randomized clinical trial aimed to evaluate the effects of a sensory-adapted dental environment on pain-related behaviors and treatment cooperation during professional oral hygiene procedures in children with MID and moderate dental anxiety. Materials and Methods: A randomized clinical trial was conducted at the IRCCS Oasi Research Institute (Troina, Italy). A total of 200 children were screened for eligibility. Following the application of the predefined inclusion and exclusion criteria, 160 children (76 males and 84 females; age range: 6–7 years) with a diagnosis of mild intellectual disability (MID) and moderate dental anxiety, assessed using the Corah Dental Anxiety Scale (DAS), were enrolled. Participants were randomly assigned to either a sensory-adapted dental environment (SADE; n = 80) or a regular dental environment (RDE; n = 80). All participants underwent a single session of professional oral hygiene using an ultrasonic scaler. Pain-related behaviors were assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) Scale, whereas cooperation during treatment was evaluated using the Frankl Behavior Rating Scale. Owing to the non-normal distribution of the outcome variables, between-group comparisons were performed using the Mann–Whitney U test. Statistical significance was set at p < 0.05. Results: Participants treated in the SADE showed significantly lower FLACC scores compared with those treated in the RDE (3.10 ± 1.86 vs. 5.05 ± 2.36, p < 0.001), indicating reduced pain-related behaviors during treatment. Moreover, children in the SADE group demonstrated significantly higher Frankl scores than those in the RDE group (2.78 ± 0.48 vs. 2.41 ± 0.84, p = 0.006), reflecting improved cooperation. Sex-stratified analyses confirmed significantly lower FLACC scores in both males and females treated in the SADE. No significant Group × Sex interaction was observed for either outcome, suggesting that the beneficial effects of sensory adaptation were independent of sex. Conclusions: SADE significantly reduced pain-related behaviors and improved cooperation during professional oral hygiene procedures in children with mild intellectual disability and moderate dental anxiety. These findings support the implementation of sensory-adapted strategies in pediatric dental settings to improve treatment experiences and facilitate dental care for children with neurodevelopmental disorders. Full article

Background and Objectives: Knee osteoarthritis is a major cause of chronic pain and disability. Because the benefit of intra-articular corticosteroid injection is often limited, this study compared fluoroscopy-guided corticosteroid injection alone with corticosteroid injection combined with pulsed radiofrequency (PRF). Materials and Methods: This retrospective comparative study included 386 consecutive patients with symptomatic knee osteoarthritis treated with fluoroscopy-guided intra-articular corticosteroid injection alone (IAS, n = 190) or combined with PRF (IAS + PRF, n = 196). Pain and function were assessed using the Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline and 1 week, 1, 3, and 6 months. The primary endpoint was the 6-month VAS score. Baseline-adjusted linear mixed-effects models were the primary analyses, with propensity score-matched analyses as sensitivity analyses. Results: Both groups showed significant improvements in pain over time. In the primary baseline-adjusted analyses, adding PRF was associated with greater early- and mid-term pain reduction, including significantly lower VAS scores at the 6-month primary endpoint and higher rates of clinically meaningful pain improvement (≥50% response). However, this adjusted difference was modest (below the minimal clinically important difference) and was no longer statistically significant after propensity score matching (6-month VAS median 5.0 in both groups; p = 0.763), indicating that baseline imbalance contributed to the apparent advantage. Conclusions: In baseline-adjusted analyses, adding PRF to intra-articular corticosteroid injection was associated with more favourable early- and mid-term pain outcomes than corticosteroid injection alone, although the difference was modest and was not confirmed after propensity score matching. Given the retrospective, non-randomized design and baseline imbalance, these findings should be considered hypothesis-generating. Prospective randomized, sham-controlled studies with longer follow-up are needed to clarify the role of PRF as an adjunctive treatment for knee osteoarthritis. Full article

Background/Objective: The Patient-Specific Functional Scale (PSFS) is a patient-centered outcome measure that captures limitations in activities that are personally meaningful to patients. Although the Arabic PSFS has demonstrated acceptable validity and reliability, its responsiveness in individuals with lower extremity musculoskeletal disorders has not been established. This study aimed to examine the responsiveness of the Arabic PSFS in detecting changes in lower extremity function over time. Methods: A prospective cohort study was conducted in three outpatient physical therapy clinics in Riyadh, Saudi Arabia. Seventy-two adults with lower extremity musculoskeletal disorders receiving physical therapy care completed the Arabic PSFS, RAND-36, and Numeric Pain Rating Scale (NPRS) at baseline and follow-up. At the follow-up, participants also completed the Global Rating of Change (GRC). Responsiveness was evaluated using eight a priori hypotheses following COSMIN recommendations. Change scores were analyzed using correlation coefficients, paired t-tests, effect size (ES), and standardized response mean (SRM). Results: Sixty participants (83.3%) reported improvement in the GRC. PSFS scores improved significantly (mean difference = 1.66; p < 0.001), demonstrating a large magnitude of improvement (ES = 0.80; SRM = 0.92). PSFS change scores correlated moderately with RAND-36 physical functioning (r = 0.51) and GRC (r = 0.55) and weakly with emotional well-being (r = 0.26) and showed smaller-than-expected associations with pain measures. Six out of eight (75%) predefined hypotheses were confirmed. Conclusions: The Arabic PSFS demonstrates sufficient responsiveness in detecting improvement in lower extremity function and is suitable for monitoring rehabilitation outcomes in Arabic-speaking adults with lower extremity musculoskeletal disorders receiving outpatient physical therapy. Full article

Background/Objectives: The study evaluates pain perception in children aged 5–9 during dental extractions, comparing intraligamentary anesthesia (ILA) delivered with a Computer-Controlled Local Anesthetic Delivery System (CCLADS) vs. the traditional inferior alveolar nerve block (IANB). Methods: A randomized clinical trial with 60 healthy, cooperative children measured pain both subjectively using the Wong–Baker Faces Pain Rating Scale (WBFPRS) and objectively using the Sound-Eye-Motor (SEM) scale. Results: Results showed significantly lower mean pain scores with CCLADS during anesthesia administration: WBFPRS was 2.0 ± 2.2 vs. 6.9 ± 2.6 for IANB (p < 0.001). Objective SEM scores during anesthesia delivery were also lower with CCLADS (3.7 ± 0.8) compared with IANB (5.7 ± 1.2) (p < 0.001). During the extraction itself, SEM scores did not differ significantly between groups. Conclusions: The authors conclude that ILA via CCLADS reduces discomfort during anesthesia without compromising anesthetic effectiveness. Full article

Background/Objectives: SPINEHealthie is a smartphone-based application enabling remote patient monitoring, care delivery and standardized collection of patient-reported outcome measures (PROMs). This registry-based analysis evaluates patient satisfaction with the platform across a large, heterogeneous spine surgery cohort. Methods: A total of 1729 thoracolumbar spine surgery cases were eligible for analysis. Among these, 881 (50.9%) completed the in-app feedback survey and constituted the primary feedback cohort. The global app experience was categorized as “Very Good” or “Poor”. Clinical outcomes, i.e., the Visual Analogue Scale (VAS) for back and leg pain and the Oswestry Disability Index (ODI) were assessed at baseline and in the postoperative period; Δ denotes the change from baseline to two weeks postoperation. Results: Among feedback responders, 800 patients (90.8%) rated their app experience as “Very Good”, while 80.8% of 639 patients with surgical outcome data reported that the surgery met their expectations. However, app experience and surgical outcome expectations were assessed using different items at different postoperative time points. Among patients whose surgery did not meet expectations, 84.6% rated their app experience as “Very Good”. Patients with a “Very Good” app-experience rating demonstrated significantly greater improvement in back pain (ΔVAS Back pain 2.94 vs. 2.13, p = 0.027), leg pain (ΔVAS Leg pain 3.16 vs. 2.14, p = 0.019) and disability (ΔODI 11.00 vs. 2.41, p < 0.001). In the primary model, older age, shorter follow-up duration and smaller ODI improvement were associated with an unfavorable app experience; only the association with age remained consistent across sensitivity analyses. Conclusions: Among feedback responders, SPINEHealthie was associated with a high proportion of favorable global app-experience ratings. Favorable app-experience ratings remained high, even among patients with unmet surgical expectations or failure to achieve the exploratory two-week ODI-improvement threshold, suggesting that perceived platform value is not solely explained by surgical outcome. Older patients and those with limited functional recovery were identified as subgroups that may benefit from targeted onboarding and engagement strategies. Full article

Background/Objectives: Optimizing surgical visualization via controlled hypotension and managing postoperative pain remain challenging in arthroscopic Bankart repair. While interscalene brachial plexus block (ISBPB) is effective, pharmacological adjuncts may further improve hemodynamics and prolong analgesia. The aim of this study was to assess the impact of intraoperative intravenous dexmedetomidine on visual clarity, hemodynamics, and postoperative pain during arthroscopic Bankart repair. Methods: This retrospective, single-center cohort study evaluated 63 patients undergoing isolated anterior Bankart repair under ISBPB. The dexmedetomidine group (Group D, n = 33) received an intravenous dexmedetomidine loading dose (1 mcg/kg) and maintenance infusion (0.5 mcg/kg/h) alongside ISBPB. A historical control group (Group C, n = 30) received ISBPB alone. Secondary outcomes included serial intraoperative hemodynamics, blinded surgeon-rated surgical visualization, and pain scores, while the primary outcome was postoperative analgesia duration. Results: Baseline characteristics were comparable between groups. Group D yielded significantly higher surgeon satisfaction for visual clarity (p < 0.001). Intraoperatively, Group D showed a significantly lower diastolic blood pressure at the 50 min mark after correction for multiple comparisons. Postoperatively, Group D exhibited significantly lower 24 h visual analog scale (VAS) pain scores (p < 0.001) and a significantly prolonged duration of analgesia (7.45 vs. 4.16 h; p = 0.001). Overall patient satisfaction and Pain Catastrophizing Scale scores did not differ significantly between cohorts. Conclusions: In this retrospective cohort, adjunctive intravenous dexmedetomidine added to ISBPB was associated with improved surgeon-rated visualization, lower postoperative pain scores, and prolonged analgesia, without an increase in adverse events. Due to the retrospective design and historical control group, these findings should be interpreted as associations; prospective randomized trials are required to confirm them. Full article

Background: Cervical radiculopathy is a common and disabling condition with both nociceptive and neuropathic pain components. Epidural steroid injections (ESIs) are widely used as an interventional treatment modality; however, the optimal cervicothoracic interlaminar access level and injectate volume remain subjects of ongoing debate. Because injection level and injectate volume have historically been varied together in routine practice rather than independently, prospectively designed comparative data are lacking. Methods: In this retrospective, multicenter cohort study, 166 patients with MRI-confirmed cervical radiculopathy treated between January 2022 and December 2025 at three participating institutions received fluoroscopy-guided cervicothoracic interlaminar epidural steroid injections with dexamethasone and bupivacaine at either C7/T1 (6 mL; n = 87) or T1/T2 (8 mL; n = 79), with protocol determined by the treating institution rather than randomization. The prespecified primary outcome was the baseline-adjusted between-group difference in arm-pain Numeric Rating Scale (NRS) score at 3 months, analyzed by analysis of covariance (ANCOVA) adjusted for a directed acyclic graph-informed covariate set (age, symptom duration, baseline pain severity, number of stenotic levels, DN4 score, and treatment center); the same covariates were used in a generalized estimating equation (GEE) model with a group-by-time interaction and in a multivariable logistic regression for treatment response. Secondary outcomes—neck-pain NRS and VAS, neuropathic pain (DN4), functional disability (NDI), quality of life (SF-36, EQ-5D), Patient Global Impression of Change (PGIC), analgesic consumption, and cardiovascular/metabolic safety outcomes—were assessed at baseline, 3 months, and 6 months. Results: Both groups showed significant within-group reductions in arm-pain NRS (C7/T1: 8.7 ± 0.4 to 3.5 ± 0.4 at 3 months and 4.1 ± 0.6 at 6 months; T1/T2: 9.2 ± 0.7 to 3.9 ± 0.5 at 3 months and 4.9 ± 0.7 at 6 months; both p < 0.001). Baseline pain scores and symptom duration were not balanced between groups (baseline-adjusted analysis was therefore used). After adjustment for baseline severity, age, symptom duration, and center, the T1/T2–8 mL protocol was associated with higher (worse) adjusted arm-pain NRS than the C7/T1–6 mL protocol at 3 months (adjusted difference 0.41 points, 95% CI 0.21–0.61) and 6 months (0.66 points, 95% CI 0.35–0.97); a multivariable-adjusted logistic regression model likewise showed lower odds of achieving a ≥50% arm-pain reduction at 3 months with the T1/T2–8 mL protocol (adjusted OR 0.18, 95% CI 0.04–0.82). NDI decreased from a mean of 48.1 points at baseline to 28.1 points at 3 months (pooled cohort, score capped at the 0–50 scale maximum; the majority of baseline NDI source records could not be individually verified and this is reported as a limitation), and analgesic consumption decreased over follow-up. Among hypertensive patients (45/166, 27.1%), 78% experienced transient blood pressure elevation and 40% required temporary antihypertensive adjustment; among diabetic patients (13/166, 7.8%), 92% developed transient hyperglycemia. Because injection level, injectate volume, and treatment center were confounded by design, these findings should be interpreted as a comparison of two center-specific treatment protocols rather than an isolated effect of anatomical level or volume. Conclusions: Both center-specific cervicothoracic interlaminar epidural steroid injection protocols were associated with improvements in pain and function over six months, with no catastrophic procedural complications documented; however, near-complete confounding of injection level with injectate volume and treatment center, together with imbalanced baseline pain severity, precludes conclusions about the comparative effectiveness of C7/T1 versus T1/T2 access. Transient cardiovascular and metabolic effects were common and support consideration of post-procedural monitoring in patients with pre-existing hypertension or diabetes. Full article

Objectives: Retrospective comparative cohort study. This study aimed to compare the clinical and radiological outcomes of rigid, dynamic, and hybrid stabilization systems in the surgical management of degenerative lumbar spine disease, with a focus on adjacent segment disease (ASD), fusion-related complications, and postoperative recovery. Rigid fusion techniques provide immediate stability but may increase mechanical stress at adjacent segments, leading to ASD. Dynamic and hybrid constructs aim to preserve more physiological motion, potentially reducing fusion-related complications. Methods: A retrospective analysis was conducted on 86 patients who underwent posterior lumbar stabilization between January 2017 and December 2021. Patients were categorized into four groups based on the surgical technique: Rigid (titanium rod), Dynamic (PEEK rod), Rigid + TLIF (Transforaminal Lumbar Interbody Fusion), and Hybrid (Dynamic + TLIF). Clinical evaluation included the Visual Analog Scale (VAS) for back and leg pain. Radiological assessments comprised segmental and total range of motion (ROM), disc and foraminal height, fusion success, pseudoarthrosis, and the presence of ASD. Results: All surgical approaches resulted in significant postoperative improvement in back and leg pain (p < 0.001). The incidence of ASD was highest in the Rigid + TLIF group (45.5%, p < 0.001) and lowest in the Dynamic (4.8%) and Hybrid (4.2%) groups. Pseudoarthrosis was most frequently observed in the Rigid group (26.3%). The Hybrid group demonstrated favorable outcomes, with a high anterior fusion rate (91.7%) and low rates of ASD and pseudoarthrosis. Conclusions: All stabilization techniques were associated with significant postoperative clinical improvement. In this retrospective cohort, dynamic and hybrid constructs showed lower observed rates of early symptomatic ASD than the Rigid + TLIF construct, while TLIF-treated groups showed higher anterior fusion rates. Because treatment allocation was nonrandomized and adjustment for all potential confounders was not possible, these findings demonstrate associations rather than causal treatment effects. Larger prospective studies with longer follow-up are required to determine whether the stabilization strategy independently influences ASD, fusion, or pseudoarthrosis. Full article

Background: Lumbar radicular pain, commonly referred to as sciatica, is a prevalent musculoskeletal condition that negatively impacts patients’ quality of life. Evidence regarding the use of foot orthoses in patients with sciatica secondary to lumbar disc herniation remains limited. Objectives: To determine the influence of custom-made foot orthoses on health-related quality of life and perceived pain in patients with chronic radicular pain secondary to non-traumatic lumbar or lumbosacral disc herniation. Methods: A randomized, controlled, double-blind clinical trial was conducted. Fifty-two patients (mean age: 46.12 ± 9.37 years; 53.8% men, 46.2% women) were allocated to either a customized functional foot orthoses group or a cushioning flat insole group. Pain, foot-related disability, low back disability, and health-related quality of life were assessed at baseline and after three months using the 11-point Numeric Pain Rating Scale (NPRS), Manchester Foot Pain and Disability Index (MFPDI), Oswestry Disability Index (ODI), and Short Form-12 (SF-12) questionnaire. Results: No statistically significant differences were observed between treatment groups in foot pain ($p=0.821$), lower-limb pain ($p=0.244$), low back pain ($p=0.497$), low back disability ($p=0.684$), or physical quality of life ($p=0.069$) after follow-up. However, participants treated with customized functional foot orthoses showed significant intragroup improvements in foot function (MFPDI-Function: $p=0.046$; MFPDI-Total: $p=0.033$) and in the physical component of health-related quality of life (SF-12 Physical: $p=0.031$), whereas no significant changes were observed in the cushioning insole group ($p>0.05$). Conclusions: Customized functional foot orthoses may improve foot function and physical health-related quality of life in patients with chronic radicular pain secondary to lumbar or lumbosacral disc herniation. Further studies with larger sample sizes and longer follow-up periods are required to confirm these findings. Full article

Background: Knee osteoarthritis (KOA) in people with overweight or obesity is clinically heterogeneous, reflecting mechanical loading, synovial and systemic inflammation, metabolic dysfunction, structural severity, and pain-related factors. We evaluated multidomain outcomes after semaglutide initiation and characterized clinically relevant response patterns. Methods: This retrospective, self-controlled cohort included 93 adults treated in routine rheumatology care; 88 completed a six-month follow-up. There was no untreated concurrent comparator; within-patient changes and exposure–outcome associations were therefore interpreted as non-causal. Changes in pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function, anthropometry, inflammatory markers, glycated hemoglobin (HbA1c), lipids, dose exposure, and safety were evaluated. Joint multivariable models included percentage weight loss and maximum achieved dose. Exploratory K-means phenotyping integrated dose, weight loss, body mass index (BMI) decrease, visual analog scale (VAS) and WOMAC improvement, and C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and HbA1c reductions, with candidate solutions and resampling stability examined. Results: At six months, mean weight decreased by 10.88 kg, VAS pain score by 2.47 points, WOMAC total by 22.50 points, CRP by 2.67 mg/L, ESR by 7.62 mm/h, and HbA1c by 0.51 percentage points (all p < 0.001). Weight loss remained independently associated with WOMAC improvement, while achieved dose retained positive adjusted associations with pain, function, inflammatory, and metabolic changes. Exploratory clustering identified five clinically interpretable patterns along a broader response-intensity gradient, including high-burden multidomain response, high-dose concordant response, dose-modified intermediate response, inflammation-preserved response despite moderate weight loss, and dose-limited graded response. These observational coefficients and clusters cannot distinguish treatment-related effects from residual confounding or co-interventions. Conclusions: Substantial within-patient improvements were observed, but the uncontrolled design precludes causal attribution. The exploratory patterns may be compatible with contributions from baseline disease burden, dose exposure, mechanical unloading, and residual inflammatory variation; they do not establish weight-independent pharmacologic effects or validated patient subtypes. Prospective controlled, multicenter validation is required. Full article

Background: Multiple sclerosis (MS) is a chronic inflammatory, autoimmune, and neurodegenerative disease of the central nervous system. Our study aimed to examine the relationship between serum iron levels and the following clinical parameters: depression, anxiety, fatigue, neuropathic pain, and disease activity on magnetic resonance imaging in patients with relapsing-remitting multiple sclerosis (RRMS). Material and methods: This study was designed as a clinical observational, cross-sectional study. This study was conducted at the Clinic of Neurology of the University Clinical Center Kragujevac, from 2022 to 2024, according to the ethical code of the Declaration of Helsinki. Demographic and clinical data on patients were obtained from the medical history. All MS patients were diagnosed according to the McDonald criteria (2017). This study included 65 patients in the experimental group and 11 healthy individuals in the control group, with an average age of 39.68 years. Serum iron levels were biochemically analyzed from venous blood. The following standardized tests were used to collect data on depression, anxiety, fatigue, and neuropathic pain: Beck Depression Inventory (BDI), Hamilton Anxiety Rating Scale (HAM-A), Modified Fatigue Impact Scale (MFIS), PainDETECT Questionnaire (PD-Q), and Visual Analogue Scale (VAS). Results: Serum iron level significantly correlates with disease activity on magnetic resonance imaging in patients with multiple sclerosis. Serum iron showed a moderate positive correlation with hemoglobin, hematocrit, total and direct bilirubin, and a weak positive correlation with uric acid, while a moderate negative correlation was observed with erythrocyte sedimentation rate. No statistically significant difference was found between serum iron levels and depression, anxiety, fatigue, and severity of neuropathic pain. The ROC curves show the diagnostic potential of the combined parameters in differentiating RRMS from controls, as well as the potential of iron in differentiating active from inactive MS. The presence of disease, hemoglobin and total bilirubin were recorded as significant independent predictors. Conclusion: This study is a descriptive attempt to present the potential role of iron in the radiological activity of the disease. High serum iron level may be associated with radiological disease activity in patients with multiple sclerosis. Full article