Search Results (261)

Introduction: The recognition of Complex Post-Traumatic Stress Disorder (CPTSD) as a distinct diagnosis in ICD-11 has intensified the need to clarify its boundaries with Borderline Personality Disorder (BPD), given their symptom overlap and shared traumatic origins. Therefore, this systematic review aimed to examine whether CPTSD is distinct from BPD, assess their comorbidity and symptom overlap, identify key criteria for differential diagnosis, and explore therapeutic implications. Method: A systematic search was conducted in PubMed, Scopus, and Web of Science following PRISMA 2020 guidelines. Seven empirical studies (2015–2025) were included, comprising 2574 adults (mean age 40.4 years; 73.3% women). Methods included latent class analysis, structural equation modeling, and network analysis. The methodological quality of the included studies was evaluated independently by two reviewers using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Results: Findings consistently supported that CPTSD and BPD are empirically distinguishable, though substantially correlated, particularly within the ICD-11 framework. High symptom co-occurrence was observed, with affective dysregulation identified as the symptom most centrally connecting the two symptom networks. Self-concept emerged as the most robust differentiator: stable and persistently negative in CPTSD versus unstable and fragmented in BPD. Shame was a key affective marker of more severe presentations, and trauma severity, rather than diagnostic category, was associated with symptom variation across studies. Conclusions: CPTSD and BPD are distinct yet frequently co-occurring conditions. Differential diagnosis should focus on self-concept stability, patterns of behavioral dysregulation, and shame. Treatment requires individualized, trauma-informed, and shame-sensitive approaches, with transdiagnostic emotion regulation strategies across presentations. These conclusions should be interpreted with caution, given the predominantly cross-sectional design and methodological heterogeneity of the available evidence. Full article

Background/Objectives: Calcaneal insufficiency fractures may be overlooked in older adults presenting with atraumatic heel-region pain because early radiographic findings can be absent or inconclusive. Evidence regarding how often these fractures are identified in routine outpatient practice remains limited. This study aimed to describe the observed frequency, diagnostic pathway, clinical characteristics, treatment, and documented clinical course of calcaneal insufficiency fractures in an orthopaedic outpatient cohort. Methods: We retrospectively reviewed consecutive patients aged 60 years or older who presented with atraumatic pain localised to the heel or calcaneal region between April 2012 and March 2020. All patients underwent initial plain radiography. Follow-up radiography and MRI were performed selectively when weight-bearing heel pain persisted, radiographic findings remained negative or equivocal, and clinical suspicion of an occult fracture remained. Observed fracture frequencies and exact 95% confidence intervals (CIs) were calculated. Results: Among 123 included patients, calcaneal insufficiency fractures were identified in 10, corresponding to an observed frequency of 8.1% (95% CI, 4.0–14.4%). Among 89 independently ambulatory patients, 9 fractures were identified, corresponding to an observed subgroup frequency of 10.1% (95% CI, 4.7–18.3%). These subgroup findings were descriptive and were not adjusted for potential confounders. All 10 fracture cases occurred in women, with a mean age of 78.4 years. Osteoporosis was newly identified in all fracture cases; the mean femoral-neck T-score was −3.42. Four fractures were identified on radiographic findings, whereas six required MRI to establish the diagnosis after radiographs remained negative or inconclusive. All cases were managed non-operatively. The mean interval from symptom onset to the first documented clinical improvement or resolution of heel pain was 28.4 days, and no displacement or subsequent surgical intervention was documented during the available follow-up. Conclusions: In this retrospective single-centre cohort, calcaneal insufficiency fractures were identified in a subset of older adults presenting with atraumatic heel-region pain. The observed frequencies should be interpreted as descriptive estimates rather than population prevalence figures. Calcaneal insufficiency fracture may be considered when focal heel pain persists despite normal or equivocal initial radiographs, with repeat radiography and MRI considered according to the clinical context. Prospective studies using standardised imaging and follow-up protocols are needed. Full article

Background: In phenylketonuria (PKU), the lifelong phenylalanine (Phe)-restricted diet may contribute to altered feeding behaviours and disordered eating. The true prevalence of disordered eating and eating disorders remains uncertain, partly because validated PKU-specific assessment tools are lacking. This systematic review aimed to identify, appraise, and synthesise the evidence on disordered eating and eating disorders in PKU. Methods: Four electronic databases (PubMed, Scopus, Web of Science, and Cochrane) were searched from inception to 24 February 2026. English-language studies reporting disordered eating or eating disorders in early-diagnosed individuals with PKU managed with a Phe-restricted diet, with or without drug therapy, were included. Studies of late- or never-treated patients, pregnancy, lactation, reviews, and preclinical studies were excluded. Two independent reviewers conducted study selection and data extraction. Outcomes included the prevalence of eating disorders, disordered eating behaviours and attitudes, associated factors, and the influence of drug treatment. Findings were synthesised qualitatively, and risk of bias was assessed using the NIH Study Quality Assessment Tools. Results: Twenty-four studies (2928 individuals with PKU) met the inclusion criteria. Most were observational or survey-based. Eating disorders were reported more frequently in PKU (3–13%) than in the general population (n = 4 studies). Common disordered eating features included food neophobia (n = 5 studies), limited food variety (n = 9), food aversion or refusal (n = 5), poor appetite (n = 5), prolonged mealtimes (n = 3), negative parent–child mealtime interactions (n = 6), and specific taste preferences (n = 5). Delayed feeding skill development (n = 6 studies), reduced social eating (n = 6), gastrointestinal symptoms (n = 8), and psychological or neurodevelopmental difficulties (n = 7) were also associated with disordered eating. Early feeding difficulties frequently persisted into adulthood, and longstanding eating behaviours did not consistently improve with pharmaceutical treatment (n = 6 studies). Most studies were rated as fair quality (19/24), with common limitations including small sample sizes, lack of sample-size justification, non-validated assessment tools, and absence of randomised controlled trials. Conclusions: Current evidence suggests that people with PKU experience a greater burden of eating-related difficulties than the general population, although robust estimates of eating disorder prevalence remain lacking. Existing screening tools may misclassify treatment-related dietary behaviours as pathological or fail to identify PKU-specific eating concerns. Development of PKU-specific screening tools could support routine clinical discussions about eating behaviours and the psychosocial impact of dietary treatment, facilitating earlier identification of individuals requiring specialist eating disorder assessment. (Prospero registration: CRD42024539600). Full article

Background and Clinical Significance: Encephalitis is a rare neurological complication associated with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. In rare cases, focal neuroinflammation can manifest as a mass-like parenchymal lesion, creating profound diagnostic and treatment dilemmas by mimicking primary central nervous system neoplasms. Case Presentation: A 34-year-old female presented with cephalalgia, nausea, confusion, facial palsy, and a new onset of focal impaired awareness seizures (FIAS). Brain magnetic resonance imaging (MRI) revealed a prominent hyperintense lesion within the left temporal lobe with associated vasogenic edema and focal leptomeningeal enhancement highly suspicious of a low-grade glial neoplasm. Although nasopharyngeal RT-PCT was negative, the presence of serum anti-SARS-CoV-2 IgM and IgG suggested recent subclinical SARS-CoV-2 infection. To resolve diagnostic ambiguity and avoid empiric oncological overtreatment, a stereotactic brain biopsy was performed. Histopathology revealed acute neuroinflammation characterized by reactive gliosis, microglial hyperplasia, and perivascular lymphatic cuffing, with no evidence of neoplastic presence. Quantitative tissue RT-PCR confirmed the presence of SARS-CoV-2 (Ct33). Follow-up imaging demonstrated complete resolution of the abnormalities following conservative treatment with corticosteroids and antiepileptics, though mild clinical symptoms persisted for 12 months thereafter. Conclusions: Encephalitis presents a rare yet critical manifestation of SARS-CoV-2. Establishing definitive etiology remains challenging. Stereotactic biopsy is a valuable tool to guide appropriate treatment in cases of ambiguous imaging and clinical findings. Radiographic resolution may precede complete clinical recovery. Full article

Alfalfa spring black stem and leaf spot (ASBS), caused by Ascochyta medicaginicola, threatens alfalfa yield, forage quality, and stand persistence. Conventional resistance assessments of alfalfa cultivars generally rely on disease incidence, disease severity, or the percentage of healthy plants. Although these measures describe symptom occurrence and development, they do not capture biomass retention or root growth after infection. In this study, 12 alfalfa cultivars were spray-inoculated with A. medicaginicola under greenhouse conditions and evaluated 14 days after inoculation. Disease incidence was positively correlated with the disease severity index and negatively correlated with relative fresh weight, relative dry weight, and relative root length. We integrated these five indicators using a membership-function-based standard-deviation coefficient weighting method to derive a comprehensive response score (D value). D values ranged from 0.0340 to 0.9611. Magnum 2 had the highest D value, followed by Gannong No. 3, Adrenalin, and Dryland, whereas Thunder, Zhongmu No. 1, and Aohan had the lowest values. Compared with the National Alfalfa and Forage Alliance classification based on the percentage of healthy plants, the D-value ranking provided additional discrimination among cultivars within the same resistance class under the present greenhouse conditions. The first two principal components explained 89.24% of the total variation and separated resistant, intermediate, and susceptible response types. Thus, combining disease suppression with growth retention yielded a complementary quantitative description of cultivar performance under the conditions tested. 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

Background/Objectives: Allergic conjunctivitis (AC) is a frequent inflammatory ocular surface disease that significantly affects quality of life, particularly in children. Current treatments mainly provide temporary symptom relief and often require prolonged use. Bacterial suspensions have emerged as potential immunomodulatory treatments for other allergies but have yet to be completely explored for ocular allergies. Our study’s objective was to describe the clinical, ophthalmological, and quality-of-life changes in patients with AC treated with a bacterial suspension (BS) as complementary therapy. Methods: A before-and-after open, non-controlled clinical study was conducted in five children aged 7 to 9 years with a diagnosis of moderate-to-severe persistent allergic conjunctivitis and negative skin prick test results. Clinical ocular signs and symptoms, quality of life, and changes in CD19⁺IL-10⁺ cells were assessed. Results: After 90 days of BS treatment, reductions in allergic symptoms, including itching, light sensitivity, and burning, were observed, along with a marked reduction in ocular inflammation. An evaluation of quality-of-life revealed improvements across all domains and an increase in CD19⁺IL-10⁺ cells. Conclusions: BS therapy demonstrated favorable clinical and immune-modulatory effects in children with AC, supporting its potential as a promising complementary therapeutic option. Full article

Shallot (Allium cepa var. aggregatum) is an annual herbaceous plant of the Amaryllidaceae family cultivated worldwide for its gastronomic importance, unique flavour, and nutritional properties. In Ecuador, shallot is considered an emerging crop; however, the lack of effective detection and treatment options for phytoviruses remains a challenge for farmers. These viruses negatively impact crop yield, leading to substantial economic losses and declining crop quality. Simultaneous infections can synergistically exacerbate crop damage. In this study, the molecular detection of the five most common shallot viruses—Shallot latent virus (SLV), Onion yellow dwarf virus (OYDV), Shallot virus X (ShVX), Leek yellow stripe virus (LYSV), and Iris yellow spot virus (IYSV)—were investigated in shallots obtained from different market suppliers in Quito, Ecuador. We identified two viruses using RT-PCR: SLV (latent) and IYSV (responsible for severe disease symptoms). Shoot tip culture produced shallot plants completely free of IYSV, while SLV persisted in the regenerated plants. This study reports IYSV for the first time in shallots in Ecuador and shows that shoot tip culture can serve as a partial cleaning method to improve crop quality and support more effective pathogen management and control strategies. Full article

Background: Acute rheumatic fever (ARF) is a clinical syndrome triggered by group A streptococcal (GAS) infections and characterized by fever, carditis, and arthritis as its main manifestations. Diagnosis relies on the revised Jones criteria. We report a rare case of ARF diagnosed in Switzerland. Case Presentation: An 18-year-old woman presented to the emergency department five days after returning from a one-week stay in Egypt with intermittent fever and a transient sore throat, followed by migratory joint pain. Laboratory testing revealed leukocytosis, elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Chest X-ray, urine analysis, and (travel-associated) pathogen-testing (Epstein–Barr virus, Cytomegalovirus, human immunodeficiency virus, Malaria, Dengue, Zika, Chikungunya) were unremarkable. Blood cultures remained negative. Initially, a viral respiratory infection was suspected and symptomatic treatment established. Days later the patient was re-evaluated due to persistent symptoms. Leukocyte count (Lc) and CRP further increased and subcutaneous nodules appeared. The antistreptolysin-O (ASO)-titer was elevated more than three times higher than the normal upper limit and proofed serological evidence of a preceding streptococcal infection (GAS throat culture had not been performed). ARF was diagnosed according to the Jones criteria. Treatment with amoxicillin and a high dose of acetylsalicylic acid (ASA) led to a rapid clinical improvement. Secondary prophylaxis with depot penicillin (benzathine penicillin G; 1.2 million units; once monthly) was initiated to prevent rheumatic heart disease. Conclusions: This case highlights a rare occurrence of ARF following travel to Egypt, with probable acquisition of group A streptococcal infection during the trip. It emphasizes consideration of ARF even in Western countries with low ARF-prevalence if clinical history is suggestive. Early recognition and initiation of antimicrobial and anti-inflammatory therapy is crucial to prevent cardiac involvement. To the best of our knowledge, this represents one of the first cases diagnosed in Switzerland in the past 20 years. Full article

Background and Objectives: Persistent COVID-19 sequelae, often referred to as “long COVID”, still constitute a major global medical challenge. In particular, general fatigue is the most widely reported, serious symptom. In the framework of Japanese traditional (Kampo) medicine (JTM), post-infection fatigue is frequently considered a “Qi deficiency”, a significant loss of vital energy. In JTM, accurately diagnosing Qi deficiency is essential for determining the appropriate treatment. However, one challenge in JTM diagnosis is that mastering traditional diagnostic techniques takes time. We sought to validate the “Qi deficiency score”, a quantitative patient-reported outcome measure designed to assess Qi deficiency in patients suffering from long COVID. Materials and Methods: This was a methodological study. We conducted a cross-sectional study of 237 patients who sought treatment at the post-COVID-19 clinic (COVID-19 Aftercare Clinic) at Okayama University Hospital. The patient population was randomly split into two cohorts: one for Exploratory Factor Analysis (EFA, n = 122) and another for Confirmatory Factor Analysis (CFA, n = 115). The simple Qi-deficiency score comprises eight items derived from Terasawa’s diagnostic criteria, with a total range of 0–56. We evaluated internal consistency using Cronbach’s α/McDonald’s ω and examined structural validity. Convergent validity was established by examining correlations between the simple Qi deficiency score and the Fatigue Assessment Scale (FAS), the Self-rating Depression Scale (SDS), and Quality of Life (QOL) metric. Results: The score’s internal consistency (α = 0.64 and ω = 0.63) was considered modest for screening traditional clinical syndromes. EFA showed major factors representing Qi deficiency symptoms. CFA supported a one-factor model with modest fit indices (CFI = 0.87; RMSEA = 0.079; SRMR = 0.077; TLI = 0.82). Factor loadings revealed that “Body feels tired (now)” (0.98) and “Tires easily (tendency)” (0.73) were the most significant symptoms. Convergent validity showed a strong positive correlation with the FAS (r = 0.61, ρ = 0.60) and a moderate correlation with the SDS (r = 0.55, ρ = 0.55). A significant negative correlation was found with QOL scores (r = −0.42, ρ = −0.43). Conclusions: The simple Qi deficiency score may be useful for evaluating Qi deficiency in patients with post-COVID-19 condition. Full article

Background/Objectives: Helicobacter pylori infection is a major cause of chronic gastritis, peptic ulcer disease, and gastric cancer. Although accurate diagnostic tests are available, their cost, accessibility, and invasiveness may limit their routine use, particularly in resource-limited settings. Because dyspeptic symptoms are frequently used to guide testing decisions, identifying symptom patterns associated with H. pylori infection may improve patient selection for diagnostic testing. This study evaluated the association between gastrointestinal symptoms, particularly burning epigastric pain that worsens on an empty stomach, and H. pylori stool antigen positivity. Methods: This retrospective observational study included 589 adults who underwent H. pylori stool antigen testing at a private laboratory in Tehran, Iran, between May 2021 and June 2022. Patients were classified as H. pylori-positive (n = 353) or H. pylori-negative (n = 236) based on stool antigen test results. Gastrointestinal symptoms documented in patient records were compared between groups using chi-square analysis. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of burning epigastric pain were also calculated. Results: Burning epigastric pain that worsens on an empty stomach was significantly more common in H. pylori-positive than H. pylori-negative patients (76.2% vs. 4.2%; p < 0.00001). Significant associations were also observed for bloating, persistent vomiting, dysphagia, diarrhea, constipation, and melena. Burning epigastric pain demonstrated a sensitivity of 76.2%, specificity of 95.8%, PPV of 96.4%, and NPV of 72.9%. Overall, 99.7% of H. pylori-positive patients reported at least one gastrointestinal symptom compared with 35.2% of H. pylori-negative patients. Conclusions: Burning epigastric pain that worsens on an empty stomach was strongly associated with H. pylori stool antigen positivity and may help clinicians identify patients who are more likely to benefit from diagnostic testing. However, symptoms alone are insufficient for diagnosis and should complement, rather than replace, established diagnostic methods. Prospective studies using standardized symptom assessment and multiple diagnostic modalities are needed to validate these findings. Full article

Background: As many as two-thirds of acutely dizzy patients presenting to the emergency department report intermittent symptoms only, consistent with a transient acute vestibular syndrome (single episode lasting < 24 h) or an episodic vestibular syndrome (recurrent episodes, each lasting < 24 h). A broad differential diagnosis, presentation outside the episode(s), and difficulties in describing the symptoms make the diagnostic workup of transient vestibular symptoms (TVS) challenging. Methods: This critical review provides an overview on the management of TVS, focusing on structured history-taking and bedside testing, but also reviewing the role of neuroimaging and eye movement recordings. Results: Asking about timing and triggers helps clarify the temporal evolution of symptoms (transient vs. persistent) and the circumstances of occurrence (spontaneous vs. triggered). Such structured history-taking narrows down the differential diagnosis and ensures appropriate bedside tests. On clinical examination, identifying focal neurologic signs, (subtle) ocular motor findings, and gait imbalance is essential. While positional testing should be applied in all patients with TVS, HINTS+ has not been validated in those patients without nystagmus or with transient (already resolved) symptoms. For neuroimaging, MRI with diffusion-weighted imaging is preferred, but early false-negative findings in up to 20% (to even 50% for small brainstem strokes) of cases must be considered. Quantitative eye movement recordings may be especially valuable in rural areas, supporting telemedicine consults. Conclusions: Special emphasis should be put on distinguishing vertebrobasilar transient ischemic attack from vestibular migraine and cardiac arrhythmia. In the case of triggered TVS, immediate and sustained response to liberation maneuvers strongly supports benign paroxysmal positional vertigo over vestibular migraine or structural central positional nystagmus. Treatment strategies in TVS strongly depend on the underlying cause, ranging from hyperacute stroke treatment to migraine prophylaxis to liberation maneuvers. Full article

Background: Long COVID is a heterogeneous post-viral condition in which persistent neurological, autonomic, cognitive, and psychometric symptoms often occur without clear isolated biomarker abnormalities. This mismatch suggests that disease persistence may be driven not only by changes in individual markers, but by longitudinal reorganization of biological and clinical interactions. Materials and Methods: This observational longitudinal study evaluated patients with persistent symptoms after confirmed SARS-CoV-2 infection at 3 and 6 months. Clinical assessment included neurological examination, Hospital Anxiety and Depression Scale, Beck Depression Inventory, and COMPASS-31. Biomarkers representing hypoxia signaling, oxidative/redox stress, endothelial and renin–angiotensin system activity, glycation-related processes, and complement regulation were analyzed. Correlation analysis, association-level biomarker–clinical network modeling, and complementary Graphical LASSO-based sparse network estimation were used to compare network density, community organization, centrality, and edge rewiring between time points. Results: Conventional paired analysis identified HIF-1$\alpha$ as the only continuous variable with a statistically significant longitudinal change (Wilcoxon statistic = 610.0, $p=0.000350$), whereas association-level network analysis revealed a broader systems-level signal. The association-level biomarker–clinical network preserved a similar global size at 3 and 6 months, with 16 nodes, 27 versus 26 edges, and densities of 0.225 versus 0.217. However, this apparent stability concealed substantial rewiring: 19 edges were shared, 8 were lost, and 7 emerged. Complementary Graphical LASSO analysis with 1000 bootstrap resamples supported this pattern by identifying a conservative sparse conditional-dependency core, including seven shared conditional-dependency edges across time points and selective weakening of four early conditional dependencies. The C3–C4 relationship reversed from negative to positive correlation ($r=-0.618$ to $r=0.618$), indicating marked remodeling of complement-associated regulation. A psychometric–autonomic module involving Beck, HADS I, HADS II, and COMPASS-31 remained stable across both assessments. Conclusions: Long COVID progression was characterized by dynamic remodeling of immune, endothelial/RAS, oxidative-redox, hypoxia-related, autonomic, and psychometric interactions. Longitudinal network analysis identified a systems-level interaction structure that was not captured by isolated biomarker comparisons alone and that was further supported by complementary sparse conditional-dependency analysis. Full article

Background: Although depressive symptoms are common among adolescents who experience school bullying victimization, these symptoms show heterogeneity and seriously affect individuals’ physical and mental health. Our current understanding of the latent classes of depressive symptoms and their transition characteristics over time among adolescents who persistently experience school bullying victimization remains limited. Therefore, it is necessary to use latent transition analysis to identify different depressive symptom patterns and further examine the longitudinal stability and transition trajectories of these patterns. Methods: This retrospective study included 785 adolescents who reported experiencing school bullying victimization at both time points (T1 and T2). Among them, 60.9% were boys, with a mean age of 13.92 ± 1.69 years at T1 and an age range of 11 to 19 years. Participants completed a two-wave survey over a 12-month period. Latent transition analysis (LTA) was conducted to identify latent profiles of depressive symptoms and examine transitions between profiles over time. In addition, physical activity, sleep duration, and substance use were examined as predictors of transitions between depressive symptom profiles. Results: The depressive symptom profiles of adolescents who persistently experienced school bullying victimization were classified into the Low Symptom group, Moderate Symptom group, and High Symptom group. The proportions of these groups were 58.4%, 30.9%, and 10.7% at T1, and 32.1%, 45.3%, and 22.6% at T2, respectively. Overall, the profiles showed either class stability or transitions toward more severe symptom groups, with the High Symptom group showing a 75.8% probability of remaining in the same class at T2. Physical activity, sleep duration, and substance use were all important predictors of depressive symptom transitions among adolescents who persistently experienced bullying victimization. Specifically, physical activity and sleep duration were important protective factors (p < 0.001), whereas substance use was a negative influencing factor (p < 0.001). Conclusions: Depressive symptoms among adolescents who persistently experience bullying victimization show dynamic transition characteristics, and health behaviors significantly influence symptom evolution. These findings suggest that interventions should focus on improving health behaviors to alleviate or prevent the worsening of depressive symptoms. Full article

Background: Acute compartment syndrome is a surgical emergency that is most often associated with trauma. Rarely, however, it can develop without major trauma in patients receiving anticoagulation therapy. Methods: A 53-year-old woman receiving warfarin therapy presented with progressive swelling and pain in the left forearm after physical therapy. Computed tomography angiography showed preserved arterial flow. On clinical examination, pain and paralysis were present, whereas pallor and paresthesia were absent. Direct compartment pressure measurements demonstrated markedly elevated pressures in the dorsal and deep volar compartments, measuring 88 mmHg and 110 mmHg, respectively. Emergency fasciotomy was performed approximately 9 h after symptom onset. Results: Intraoperative findings showed hematoma formation and partial muscle necrosis in the deep volar compartment. After surgery, persistent bleeding required repeated hemostatic interventions and blood-product transfusion. Negative-pressure wound therapy was applied, and delayed primary closure was subsequently performed. Anticoagulation therapy was temporarily discontinued and later resumed. The patient recovered without further bleeding, wound complications, or functional impairment and was discharged in stable condition. No complications, including hematoma recurrence or infection, were observed during 6 months of follow-up. Conclusions: This case highlights a temporal association between physical therapy and acute forearm compartment syndrome in a patient receiving anticoagulation therapy. It also emphasizes that preserved peripheral pulses and intact arterial flow do not exclude the diagnosis. Early recognition and prompt surgical intervention remain essential to prevent irreversible tissue damage and optimize outcomes. Full article