Search Results (10,638)

Background: Genicular Artery Embolization (GAE) is an emerging minimally invasive procedure for the treatment of pain due to knee osteoarthritis (OA) in patients who are not candidates for joint replacement surgery. The aim of this study is to evaluate the clinical and functional outcomes of GAE performed with a temporary embolic agent and the persistence of its benefits up to 6 months of follow-up. Methods: In this prospective study, 15 consecutive patients (mean age 64.5 ± 6.7 years) with Kellgren–Lawrence grade III–IV knee OA, severe pain refractory to conservative treatments, and not eligible for joint replacement surgery were enrolled. All patients underwent GAE with selective embolization of hypervascular genicular branches using an imipenem/cilastatin suspension as a temporary embolic agent. Patients were evaluated before the procedure, on the first postoperative day, and at 3 and 6 months of follow-up using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Oxford Knee Score (OKS), and the Visual Analog Scale (VAS). Results: All clinical scores showed a significant improvement over time (p < 0.05). WOMAC decreased from 55.6 ± 7.3 to 16.3 ± 4.1 at 6 months; KOOS increased from 40.7 ± 8.1 to 70.3 ± 6.4; OKS improved from 18.4 ± 4.2 to 38.9 ± 4.6; VAS decreased from 7.8 ± 1.0 to 1.5 ± 0.8. No major complications were observed. Two patients (13.3%) developed a subcutaneous hematoma at the femoral access site, which resolved spontaneously. In two patients, pain recurred at the 1-month follow-up. Conclusions: GAE with a temporary embolic agent appeared to be a safe and effective procedure in improving pain and function in patients with advanced knee OA who are not candidates for joint replacement surgery. The clinical benefit was progressive and sustained up to 6 months, supporting the role of synovitis modulation as a therapeutic target. Full article

Background and Objectives: Superficial peritoneal endometriosis (SPE) remains one of the most difficult endometriosis phenotypes to diagnose non-invasively, because lesions are frequently small, multifocal, and poorly detectable using conventional imaging. Diagnostic laparoscopy therefore remains the reference standard for direct visualization of superficial peritoneal lesions. However, the inconsistent relationship between visible lesion burden and pain severity, together with the multifactorial nature of chronic pelvic pain, highlights the limitations of a purely lesion-based diagnostic model. This narrative review reassesses SPE from a cautious functional and molecular perspective, focusing on clinically established evidence, emerging but incompletely validated tools, and hypothesis-generating concepts. The novelty of this review lies in its specific focus on SPE as an unresolved diagnostic phenotype and in the proposed integration of surgical diagnosis, expert imaging, pain phenotyping, empirical treatment response, and molecular research within a non-replacement framework. Materials and Methods: A narrative literature review was performed using PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library for English-language articles published between January 2010 and April 2026. The search focused on SPE, diagnostic laparoscopy, dynamic transvaginal ultrasound, sliding sign, chronic pelvic pain, hormonal treatment response, neuroinflammation, liquid biopsy, circulating biomarkers, epigenetics, and microbiome research. Results: Dynamic transvaginal ultrasound, sliding sign assessment, pelvic organ mobility evaluation, and tenderness-guided examination may provide indirect functional information in selected patients with suspected SPE, but they remain operator-dependent and insufficiently standardized for this phenotype. Response to hormonal therapy may support clinical reasoning, but it has low specificity and may also reflect improvement of adenomyosis, primary dysmenorrhea, ovulation-related pain, abnormal uterine bleeding, or other estrogen-sensitive conditions. Liquid biopsy and molecular biomarkers, including circulating microRNAs, extracellular vesicles, cell-free DNA, inflammatory mediators, epigenetic signatures, adipokine-related markers, and microbiome-related signals, remain investigational and require phenotype-specific validation. Conclusions: Functional and molecular stratification of suspected SPE represents a promising research direction rather than a current clinical standard. Laparoscopy remains essential when definitive diagnosis or surgical treatment is required, particularly in patients with infertility, refractory symptoms, suspicious imaging, or suspected complex disease. Future validated models may help integrate clinical phenotype, expert imaging, treatment response, pain mechanisms, and molecular profiles to support more individualized and selective diagnostic pathways. Full article

Up to 10% of patients with Lyme borreliosis (LB) will experience symptoms that fulfill the Infectious Disease Society of America (IDSA) criteria of post-treatment Lyme disease syndrome (PTLDS). This study assesses PTLDS in the Burden of Lyme Disease (BOLD) study through clinical assessment (“PTLDS Assessed by Clinicians”) and by post hoc evaluation of patient-reported outcomes, including the 36-Item Short Form Health Survey, Fatigue Severity Scale, and Cognitive Failures Questionnaire (“PTLDS Assessed by Questionnaire”). Among 242 LB cases who completed antibiotic treatment and had objective manifestations stabilized or resolved, 99 (40.9%) reported ≥1 symptom of fatigue, musculoskeletal pain, or cognitive impairment 10 months after diagnosis. Fifteen (6.2%) cases met the PTLDS criteria assessed by either clinicians or predefined questionnaire severity thresholds; four (1.7%) met both. PTLDS cases assessed by questionnaires and LB cases with persistent symptoms both reported greater symptom severity and poorer physical functioning than PTLDS cases assessed by clinicians. These exploratory findings suggest that clinician- and questionnaire-based assessments may identify partially different subsets of patients with PTLDS and either method could underestimate the proportion of patients with PTLDS. Full article

Background/Objectives: Acupuncture is effective for labor pain yet rarely used in the UK. Midwife-delivered acupuncture (commonplace in Europe) is cost-effective but typically demands a protocol-based approach. Randomized controlled trial (RCT) protocols have varied greatly in terms of acupuncture rationale/style, needle number/location and retention time. The aim of this study was to determine the intrapartum acupuncture experience of professional UK acupuncturists specializing in pregnancy/childbirth and compare their treatment recommendations with research evidence regarding acupuncture “dose” during labor. Methods: Fifty self-identified obstetric acupuncturists (various styles) with 10 [4, 6] years of experience (median [interquartile range]) were surveyed about their personal intrapartum acupuncture experience and recommendations regarding traditional acupuncture point selection and overall treatment approach. Results: Of 50 respondents, 36% (n = 18) had never attended a labor. For those with experience, the median number of labors attended was 0.4/year [interquartile range 0.1–0.3]. Only 12% (n = 6) had attended ≥10 labors. Recommendations included using between 2 [1, 2] and 8 ± 4 (mean ± standard deviation) needles left in situ for 5 [1, 10] to 30 [30, 30] min. Only 32% (n = 16) advised retention throughout labor, of which 25% (n = 4) would tape needles down. The remainder advised interval treatments, typically 1–2 hourly. Most practitioners highlighted the need to vary the treatment according to individual needs/sensitivity. Regarding points, only SP6 and LI4 were ubiquitous, although 41/51 RCT points were mentioned, which were most often segmental and/or so-called major points for central effects (SP6/LI4/BL32/BL60/LR3/BL67/PC6/BL31/ST36/Shenmen). Regarding needle stimulation, 18% (n = 9) recommended none, 20% (n = 10) elicitation of de qi only, and 54% (n = 27) repetitive manual manipulation (every 5–15 min). Only 8% endorsed electroacupuncture use. Conclusions: UK experience with intrapartum acupuncture appears limited. Most practitioners recommended short periods of needling using relatively few needles, i.e., low-dose acupuncture. Full article

Oral mucositis is a frequent adverse effect of cancer therapy and is often complicated by pain, oral dryness, and secondary infection. Freeze-dried hyaluronic acid (HA) sheets can protect and moisturize the oral mucosa, but their intrinsic antibacterial activity is limited. We developed freeze-dried HA sheets containing the commercial persimmon tannin product PANCIL^® PS-M and evaluated their release behavior, pH profile, antimicrobial activity, and in vitro cytocompatibility. Persimmon tannin release into phosphate-buffered saline was quantified over 8 h using the Folin–Ciocalteu method. Antimicrobial activity against Streptococcus mitis, Prevotella intermedia, and Candida albicans was assessed by colony counting, and cytocompatibility was evaluated using the human oral cell line T3M-1. Approximately 95% of the incorporated persimmon tannin was released within 8 h, while the surrounding pH remained near neutral to mildly alkaline. The antibacterial HA sheets markedly reduced viable counts of S. mitis and P. intermedia, whereas no inhibitory effect was observed against C. albicans. Neither HA sheet nor antibacterial HA sheet solutions significantly reduced T3M-1 cell viability at concentrations up to 100 µg/mL after 24 h. These findings suggest that persimmon tannin-containing HA sheets may provide sustained antibacterial activity without detectable cytotoxicity under the tested conditions and may serve as a topical adjunct for cancer treatment-related oral mucositis. Full article

Background/Objectives: Prospective studies of omega-3 supplementation during breast cancer chemotherapy differ in intervention composition, co-supplementation, dose, treatment setting, and outcomes. We summarized and critically appraised interventions comprising DHA alone, EPA + DHA, EPA + DHA + GLA, or EPA + DHA with or without vitamin D, stratified by intervention composition and outcome domain. Methods: PubMed/MEDLINE, the Cochrane Library/CENTRAL, ClinicalTrials.gov, Scopus, Web of Science Core Collection, and Embase were last searched on 8 July 2026, supplemented by citation searching. Eligible studies prospectively administered EPA and/or DHA during chemotherapy and reported inflammatory/biological, nutritional/functional, quality-of-life, treatment-related, anticancer-response, or safety outcomes. Active co-supplementation was analyzed separately. Owing to clinical and methodological heterogeneity, findings were synthesized narratively; risk of bias and outcome-specific certainty were assessed using RoB 2-informed and GRADE approaches. Results: Fourteen reports representing ten prospective interventional trials were included. No eligible EPA-only trial was found. Interventions comprised EPA + DHA/fish oil without another active nutrient, DHA alone, EPA + DHA plus gamma-linolenic acid, and a factorial trial of EPA + DHA with or without vitamin D. One trial reported lower paclitaxel-induced neuropathy, whereas another found no benefit for paclitaxel-associated acute pain or neuropathic symptoms. Biomarker, nutritional, functional, and quality-of-life findings were inconsistent and often derived from small trials, exploratory or compliance-restricted analyses, companion reports, or co-supplementation designs. No consistent improvement in treatment response or survival was demonstrated. Serious supplementation-related adverse events were not reported, although adverse-event reporting varied. Certainty was low for safety and very low for efficacy-related domains. Conclusions: Current evidence is preliminary. The evaluated interventions appeared generally tolerated, but independent clinical efficacy of DHA alone, EPA + DHA without another active nutrient, EPA + DHA + GLA, or EPA + DHA with or without vitamin D during breast cancer chemotherapy remains unproven. Full article

Background/Objectives: Long COVID is characterised by persistent symptoms such as fatigue, pain, cognitive impairment, sleep disturbances, and reduced quality of life (QoL) following SARS-CoV-2 infection. Proposed mechanisms include persistent immune activation, chronic inflammation, oxidative stress, endothelial dysfunction, mitochondrial disturbances, and virus-induced cellular senescence. Current management is largely supportive, highlighting the need for complementary strategies targeting these pathways. Natural polyphenols such as quercetin and curcumin possess anti-inflammatory, antioxidant, immunomodulatory, and potential senolytic properties that may modulate multiple pathways implicated in Long COVID. This study aimed to explore the potential complementary effects of oral quercetin–curcumin co-supplementation, administered alongside usual symptomatic management, in adults with persistent Long COVID symptoms. Methods: This single-centre, open-label, single-arm, pragmatic exploratory study enrolled 15 adults with Long COVID in an outpatient real-life clinical practice setting. Participants received a nutraceutical formulation containing quercetin (65 mg) and Curcuma longa extract standardised to provide 42 mg curcumin (Nasafytol^®), administered as two capsules twice daily for 8 weeks in addition to standard care. The primary endpoint was change in overall symptom burden assessed using the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS). Secondary outcomes included fatigue (Fatigue Severity Scale, FSS), pain (Brief Pain Inventory—Short Form, BPI-SF), cognitive function (Patient-Reported Outcomes Measurement Information System Cognitive Function Short Form 8a, PROMIS-CF-8a), mood (Hospital Anxiety and Depression Scale, HADS), sleep quality (Pittsburgh Sleep Quality Index, PSQI), autonomic symptoms (Composite Autonomic Symptom Score-31, COMPASS-31), and health-related QoL (Medical Outcomes Study 36-Item Short-Form Health Survey, SF-36). Results: After 8 weeks, overall symptom burden significantly decreased (C19-YRS median 50 to 32; q = 0.018). Significant reductions were observed in patient-reported fatigue (q = 0.006), pain severity and interference (q = 0.006), and improved physical health-related QoL (SF-36 PCS; q = 0.025). Numerically favourable changes were also observed in cognitive function, anxiety, sleep quality, and autonomic symptoms, although these did not reach statistical significance. The supplementation was generally well tolerated with no serious adverse events. Conclusions: Quercetin–curcumin co-supplementation was associated with lower patient-reported symptom burden, fatigue, and pain and better physical health-related QoL after 8 weeks of supplementation in adults with Long COVID. These observed findings represent treatment-associated changes within this uncontrolled exploratory study and should be interpreted cautiously. Further evaluation in adequately powered randomised placebo-controlled trials is warranted. Trial registration: ClinicalTrials.gov (ID NCT06974058). Full article

Neuropathic pain is a chronic, difficult-to-treat condition arising from injury or disease of the somatosensory nervous system. Current pharmacological treatments provide limited relief for many patients and are often associated with adverse effects, highlighting the need for complementary mechanism-based strategies. Neuroinflammation and oxidative stress are pivotal and interdependent drivers of neuropathic pain, promoting glial activation, cytokine release, mitochondrial dysfunction, redox imbalance, ion channel sensitization, and peripheral and central sensitization. Nutraceuticals and dietary bioactive compounds have gained attention because of their pleiotropic actions, i.e., multiple pharmacological activities, on inflammatory, oxidative, metabolic, mitochondrial, and neuroimmune pathways. This review summarizes the mechanistic roles of neuroinflammation and oxidative stress in neuropathic pain and discusses evidence supporting nutraceutical-based interventions, including polyphenols, terpenoids, alkaloids, fatty acids and lipid-derived compounds, antioxidant nutraceuticals, vitamins, and micronutrients. Preclinical studies indicate that these compounds can attenuate pain-related behaviors by modulating redox-sensitive inflammatory signaling, glial reactivity, mitochondrial function, nociceptive ion channels, and endogenous antioxidant defenses. Although clinical evidence remains limited, selected compounds, including alpha-lipoic acid, palmitoylethanolamide, omega-3 fatty acids, B-complex vitamins, vitamin D, and capsaicin, show translational promise. Future studies should prioritize standardized formulations, bioavailability, dosing, safety, mechanistic biomarkers, and robust randomized trials to clarify their clinical role as complementary, multi-target strategies for neuropathic pain management. Full article

Background and Objective: Pulsed electromagnetic fields (PEMF) and extracorporeal magnetotransduction therapy (EMTT) have shown promising results in various musculoskeletal disorders; however, substantial heterogeneity in application parameters has hindered the establishment of clear relationships between electromagnetic dosing and clinical response. This systematic review aims to evaluate the safety and effectiveness of PEMF and EMTT therapies for treating chronic musculoskeletal injuries in adults, based on research from 2015 to 2026. By analyzing how specific dosage parameters (such as intensity, frequency, and duration) influence clinical results, the study seeks to establish standardized, evidence-based guidelines for electromagnetic treatment prescriptions. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420251059359). A comprehensive search was performed in PubMed/MEDLINE, CENTRAL, and ScienceDirect for the 2015–2025 period. Randomized clinical trials, quasi-experimental studies, and case reports were included. Study selection, data extraction, and risk of bias assessment were performed by two independent reviewers using RoB 2, ROBINS-I, and Joanna Briggs Institute checklists. Results were synthesized narratively following SWiM (Synthesis Without Meta-analysis) recommendations. Results: Twenty-eight studies (1060 participants) were included. A dosimetric dichotomy emerged: high-intensity protocols with rapid field variation rates (e.g., EMTT > 60 kT/s) were consistently associated with robust improvements in structural and mechanically driven pathologies. Conversely, low-intensity protocols (e.g., <5 mT) often yielded results indistinguishable from placebo or active controls, particularly in nociplastic pain conditions. Quantitative analysis indicated that in structural pathologies, functional gains were maintained or amplified post-treatment, whereas nociplastic conditions showed potential symptom recurrence. No serious adverse events were reported, confirming a favorable safety profile. Conclusions: PEMF and EMTT are promising adjunctive therapies for musculoskeletal disorders, with efficacy appearing sensitive to electromagnetic dosimetry. However, significant methodological heterogeneity and the use of combination therapies limit these findings to exploratory trends. The lack of standardized safety reporting and technical parameters (e.g., waveform, dB/dt) underscores a critical translational gap. Future research must prioritize rigorous, standardized randomized controlled trials to establish definitive, evidence-based therapeutic recommendations. Full article

Introduction/Objectives: Temporomandibular joint osteoarthritis (TMJOA) causes pain, mandibular dysfunction, fibrocartilage degradation, and synovial inflammation. Current therapies are mainly palliative and limited by rapid intra-articular clearance and insufficient disease-modifying effects. This review summarizes injectable hydrogels for TMJOA as regenerative scaffolds, drug delivery systems, joint lubricants, and mechanical buffers. Methods: Relevant studies were identified from PubMed/MEDLINE, Web of Science and Google Scholar using terms related to TMJOA, injectable hydrogels, intra-articular delivery, tissue engineering, cartilage repair, lubrication, viscosupplementation and mechanical buffering. Studies were selected if they addressed hydrogel design, biological function, mechanical performance, biosafety or translational evaluation. Results: Injectable hydrogels have been investigated mainly as bioactive regenerative scaffolds and acellular functional biomaterials. Bioactive systems may regulate inflammation and oxidative stress, deliver cells, exosomes, drugs or growth factors, and support fibrocartilage repair. Acellular systems primarily aim to improve intra-articular retention, lubrication, viscoelastic adaptation and mechanical buffering. However, current evidence remains largely preclinical, with limited validation of long-term residence, degradation behavior, TMJ-specific mechanical performance, repeat dosing, biosafety and functional outcomes. Conclusions: Injectable hydrogels represent promising multifunctional platforms for TMJOA treatment. Cell-, exosome-, and growth factor-loaded systems show regenerative potential but face manufacturing, safety, regulatory, and long-term validation challenges. Acellular multifunctional hydrogels may be more feasible for near-term translation. Clinical Significance: Injectable hydrogels may provide minimally invasive, locally sustained treatment for TMJOA by integrating symptom control, microenvironment modulation, and mechanical adaptation. Full article

Diabetic painful neuropathy (DPN) is a common complication of diabetes. Despite ongoing efforts, the underlying biological mechanisms of DPN remain poorly understood. Hyperglycemia-mediated oxidative stress can affect cell barrier properties, triggering low-grade inflammation. Previous studies have reported increased histone deacetylase (HDAC) activity and altered expression of tight junction proteins in diabetes, which may link to nerve damage. This study examined the effects of the HDAC inhibitor FK228 on cell barrier-mediated changes in the spinal cord and dorsal root ganglia (DRG) of type 2 diabetic mice. Diabetic mice were treated with FK228 (1 mg/kg, twice a week for 3 weeks). Behavioral assessment of cold hypersensitivity was assessed at the end of the treatment regimen. In vitro studies were conducted using ND7/23 immortalized DRG cells. The expression of tight junction proteins (occludin, claudin-1, and zona occludens-1 or ZO-1) and a number of stress-related cellular markers, including HDAC2, growth-associated protein (GAP) 43, epidermal growth factor receptor (EGFR), and nuclear factor erythroid 2-related factor (Nrf2), were evaluated in DRG, spinal cord tissue, and cultured ND7/23 DRG cells following treatment. FK228 treatment demonstrated changes in cold pain sensitivity as well as the expression of tight junction proteins and stress related markers in both in vivo and in vitro models of diabetic neuropathy. These findings indicate that HDAC inhibition by FK228 may support the maintenance of tight junction protein expression and alter cellular stress responses in the spinal cord and DRG, suggesting a possible role of FK228 in mitigating DPN. Full article

Young breast cancer survivors often develop post-breast surgery pain syndrome (PBSPS). Despite potential benefit from physical activity, access to in-person programs is often limited by competing work and caregiving responsibilities. We assessed the feasibility and acceptability of a remotely delivered physical activity intervention for young Hispanic breast cancer survivors with PBSPS. Our single-arm, 12-week feasibility study enrolled Hispanic women aged ≤60, at least 3 months post-treatment for invasive breast cancer or ductal carcinoma in situ (DCIS), with PBSPS. Using a Fitbit Inspire 3 activity tracker and health coaching, the program encouraged whole-of-day movement to increase activity. Feasibility outcomes included recruitment, retention, and adherence. Secondary outcomes assessed pain measures, daily steps, and quality of life (QOL). Twenty-five breast cancer survivors enrolled (mean age 47.4 years [SD 6.3]), with 76% selecting Spanish-language health coaching. Retention at 12 weeks was 79% (19/24). Engagement with health coaching was high, with 95% completing at least 4 of 5 pre-planned calls. The mean change in daily step count was 1502 (−348, 3353), with twelve (66.7%) increasing in step count (median 2334.5, range: 14, 13,422). Each additional 1000-step increase was associated with a 2.67-point increase in pain self-efficacy scores (β = 2.669, 95% CI: 0.884 to 4.454, p = 0.006). A remotely delivered, health coaching physical activity intervention was feasible and acceptable for young Hispanic breast cancer survivors with PBSPS. This supports further evaluation in a larger trial. Accessible survivorship interventions for young breast cancer patients in their preferred language are needed. Full article

Background/Objectives: Postoperative pain is one of the most frequently reported complications following endodontic treatment. Bioceramic sealers have gained widespread clinical acceptance. However, comparative clinical data on postoperative pain between specific bioceramic sealers remains limited. This double-blind randomized clinical pilot trial aimed to evaluate and compare the incidence and intensity of postoperative pain following root canal obturation using two bioceramic sealers—Bio-C Sealer (Angelus, Brazil) and TotalFill BC Sealer (FKG Dentaire, Switzerland)—over a seven-day follow-up period. Methods: A total of 30 patients requiring non-surgical root canal treatment were recruited from the dental clinics at Al-Baha University, Saudi Arabia, and randomly allocated into two equal groups (n = 15 per group). All root canals were prepared and then obturated using the tested sealers with the single-cone technique. Postoperative pain was assessed using the Visual Analog Scale (VAS) at 24 h, 48 h, 72 h, and 7 days post-treatment. Statistical analysis was performed using Fisher’s exact test, Chi-square tests, and the independent t-test, with a significance threshold set at p < 0.05. Results: At 24 h, postoperative pain was reported by 33.3% of patients in the Bio-C Sealer group and 26.7% in the TotalFill BC Sealer group, with no statistically significant difference (p = 1.000). By 48 h, all patients in the TotalFill BC Sealer group were completely asymptomatic, whereas 13.3% of patients in the Bio-C Sealer group continued to report pain (p = 0.483). No significant associations were identified between postoperative pain and gender, tooth type, sealer extrusion, or preoperative pain status in either group (p > 0.05). Conclusions: Within the limitations of this randomized clinical pilot trial, the preliminary data suggest similar short-term clinical performance between Bio-C Sealer and TotalFill BC Sealer in terms of both the incidence and intensity of postoperative pain following non-surgical root canal treatment. Full article

Acute coronary syndrome (ACS) remains a leading cause of cardiovascular morbidity and mortality worldwide. Although traditional cardiovascular risk factors remain central to ACS development, recreational drug use is increasingly recognized as a clinically relevant trigger, particularly in younger patients with fewer conventional risk factors. This narrative review synthesized evidence identified through searches of PubMed/MEDLINE and Scopus up to June 2026, including clinical guidelines, systematic reviews, observational studies, mechanistic investigations, and clinically informative case-based evidence. Cannabis, cocaine, amphetamines, methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA), opioids, lysergic acid diethylamide (LSD), synthetic cannabinoids, and polysubstance use may promote myocardial ischemia and infarction through overlapping mechanisms, including sympathetic activation, coronary vasospasm, endothelial dysfunction, oxidative stress, inflammation, platelet activation, thrombosis, arrhythmogenesis, and myocardial oxygen supply–demand mismatch. Clinical presentation may be typical or atypical and may overlap with intoxication, withdrawal, anxiety, neurological symptoms, or non-cardiac chest pain, making diagnosis challenging. Underreporting of recreational drug use is common, and targeted toxicology screening may improve diagnostic accuracy and risk stratification, particularly in patients younger than 50 years, those with few traditional cardiovascular risk factors, or those presenting with otherwise unexplained ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), coronary vasospasm, arrhythmias, or cardiac arrest. Acute management should generally follow standard ACS guidelines, while considering drug-specific issues such as stimulant-induced vasospasm, sympathetic excess, cautious use of beta-blockers during acute intoxication, and preference for primary percutaneous coronary intervention when fibrinolysis carries increased risk. Long-term care should combine evidence-based secondary prevention with substance-use counseling, addiction medicine referral, cardiac rehabilitation, and behavioural interventions. This review summarizes the pathophysiology, clinical manifestations, epidemiology, treatment considerations, preventive strategies, and knowledge gaps related to recreational drug-associated ACS. Full article

Stereotactic body radiotherapy (SBRT) is an effective and increasingly utilized treatment modality for abdominal tumors, offering high rates of local control with generally acceptable toxicity profiles. Nevertheless, rare but severe late gastrointestinal complications, including radiation-induced ulceration, may occur and significantly impair patients’ quality of life, as well as continuation of oncologic treatment. Hyperbaric oxygen therapy (HBOT) has shown potential benefit in the management of chronic radiation-induced tissue injury, although evidence regarding its role following SBRT remains limited. We report the case of a 75-year-old woman with cholangiocellular carcinoma who developed severe radiation-induced duodenal ulceration following liver SBRT, presenting with persistent postprandial pain, nausea, vomiting, and substantial weight loss despite standard supportive treatment. Helicobacter pylori testing was negative, non-steroidal anti-inflammatory drug use was excluded, and histopathology showed chronic inflammatory and fibrotic mucosal injury with reactive epithelial changes. Despite high-dose proton pump inhibition, bismuth subcitrate, and nutritional support, symptoms and endoscopic ulceration persisted. HBOT was administered at 2.4 atmospheres absolute for 60 min over 30 sessions. Clinical improvement was noted after three sessions, and treatment was completed without adverse effects. Follow-up endoscopy demonstrated almost complete ulcer regression, with complete symptom resolution, improved oral intake, and a 10 kg weight gain. To the best of our knowledge, this represents the first reported case describing the successful use of HBOT as a potentially effective adjunctive treatment for severe radiation-induced duodenal ulceration following liver SBRT in a patient with cholangiocarcinoma. Although encouraging, this observation should be interpreted cautiously, and prospective clinical studies are needed to further evaluate the efficacy, safety, and optimal timing of HBOT in this setting. Full article