Search Results (596)

Contusions are highly prevalent injuries in the armed forces. They can substantially impair physical performance, particularly in special operations forces, where operational readiness depends on maintaining a high level of physical fitness. Transcutaneous microcurrent therapy (TMCT) is a non-invasive intervention that has been reported to promote tissue repair. The aim of this case report was to describe the evolution of creatine kinase levels, functional outcomes, pain, and perceived well-being during TMCT following an acute traumatic contusion. Case presentation: A 34-year-old special operations military officer with an acute traumatic contusion in the dorsum of the left foot received TMCT applied over the injured area for 72 h. The device delivered a monophasic rectangular current at 21 mV and 42 μA, with a total application time of 2360 min over the 72-h observation period. CK and the Hooper Index were assessed at baseline and at 24, 48, and 72 h, whereas NPRS and LLFI were assessed at baseline and at 72 h. Over the 72-h observation period, CK decreased from 571 to 203 IU/L, the Hooper Index decreased from 15 to 12 points, the NPRS score decreased from 7 to 6 points, and the LLFI score increased from 52% to 84%. No intervention-related adverse events were reported. Conclusions: During the 72-h observation period, reductions in CK and pain and an increase in perceived lower-limb function were observed while the participant was receiving TMCT. These preliminary observations support further investigation of TMCT as a potential adjunct to standard conservative care. However, the single-case design and the absence of a control condition prevent the observed changes from being attributed to TMCT. Controlled studies are required to evaluate its efficacy and clinical applicability. Full article

The effects of transcutaneous electroacupuncture stimulation (TEAS) on large-scale brain function remain insufficiently characterized. This study employed a graph-theoretical approach to analyze electroencephalogram (EEG) data from 48 healthy participants in the Pilot-6 TEAS study. Participants received sham (0 pps), 2.5 pps, 10 pps, and 80 pps stimulation during baseline, stimulation, and recovery phases. Functional connectivity was assessed using coherence and the weighted phase-lag index, followed by calculation of global and nodal graph measures from thresholded weighted undirected sensor-level networks. Descriptive analysis indicated potential frequency-related differences in EEG network organization. The 2.5 pps condition exhibited the highest average degree, whereas the 80 pps condition demonstrated the highest average clustering coefficient. At 10 pps, sensor-level maps revealed a distinct frontal–central betweenness-centrality pattern. Although 48 participants provided usable EEG data for descriptive analysis, only 3 participants had complete matched graph-metric data for all four stimulation conditions, limiting repeated-measures statistical validation. After correction for multiple comparisons, no statistically significant frequency-related effects were observed, and nodal hub differences were not independently confirmed. Consequently, these patterns should be interpreted as descriptive and exploratory rather than established group-level effects. These findings indicate that graph-theoretical EEG analysis may facilitate the identification of candidate network features for future investigations of TEAS-related brain network organization. Full article

Perianal fistula, or anal fistula, is an abnormal granulomatous tract connecting the anal canal or rectum to the surrounding skin. It causes perianal pain and fistulous discharge, negatively impacting patients’ quality of life. The mechanism underlying fistula formation remains incompletely understood. Medical imaging is essential for accurate preoperative assessment of the shape, number and branching of fistulous tracts, identification of internal openings and Parks’ classification. This pictorial review provides an image-based overview of the key medical imaging concepts essential for the diagnosis of perianal fistulae and summarises the roles, advantages and limitations of the available imaging modalities for evaluating perianal fistulae. The current evidence on X-ray fistulography, computed tomography (CT) fistulography, transcutaneous ultrasonography (TCUS), endoanal ultrasonography (EAUS) and pelvic magnetic resonance imaging (MRI) was reviewed, emphasising on their diagnostic performance and clinical applications. Conventional X-ray fistulography has progressively been abandoned because it is invasive, is uncomfortable for patients, provides poor soft tissue contrast and inadequately visualises anal sphincters, complex fistulous tracts, secondary branches and abscesses. CT fistulography is useful for evaluating perianal abscesses and fistula when MRI and EAUS are unavailable. TCUS is widely available, non-invasive and radiation-free but is operator-dependent and has limited ability to evaluate high perianal fistulae. EAUS accurately evaluates fistulous tracts, can be performed at the bedside or intraoperatively and is reliable when MRI is contraindicated. However, EAUS is operator-dependent, is contraindicated in patients with severe anal stenosis or acute anal pain, and has a small field of view. Pelvic MRI is the gold standard, providing excellent visualisation of anal canal anatomy, superior soft tissue contrast, accurate mapping of fistulous tracts, localisation of internal openings, assessment of the involvement of anal sphincters and detection of secondary tracts, abscesses and associated complications. Consequently, MRI is a preferred imaging modality, which can guide treatment decisions and monitoring of treatment response. Full article

Background: Individuals with spinal cord injury (SCI) frequently experience chronic pain, trunk instability, and respiratory dysfunction. This pilot trial investigated the synergistic effects of a combined neuro-orthotic approach (thoracolumbosacral orthosis (TLSO) plus transcutaneous electrical nerve stimulation (TENS)) versus TLSO alone on pain, trunk control, and respiratory function in chronic incomplete SCI. Methods: Twelve adults with chronic incomplete SCI (T6–T12) were randomized to a combined group (TLSO + TENS) or a control group (TLSO alone) for a four-week intervention. Outcomes included pain (Visual Analogue Scale), trunk control (Trunk Assessment Scale), and respiratory function (tidal volume [VT], respiratory rate [RR], oxygen uptake [VO₂], ventilatory equivalent for oxygen [VE/VO₂], and inspiratory duty cycle [Ti/Ttot]) assessed at three time points (before intervention, immediately after intervention, and after one month). Results: The combined group demonstrated a significant reduction in pain (47.8% vs. 10.4%, p = 0.01) and an improvement in Ti/Ttot (33.3% vs. 4.9%, p = 0.008) compared to the control group. Both groups showed significant improvements in VT and RR over time (p < 0.05), reflecting the biomechanical benefits of TLSO. Conclusions: Integrating TENS with TLSO offers a non-invasive strategy for managing chronic pain and improving respiratory pattern coordination in incomplete SCI. While TLSO optimizes basic ventilatory mechanics, adding TENS significantly enhances neural drive for efficient breathing and pain gating. Future large-scale trials incorporating active task-specific training are needed to restore functional trunk control. Full article

Background: This study investigated changes in electrical sensory threshold (ST) following horizontal whole-body vibration (WBV) and compared these effects with passive relaxation. Additionally, the influence of sex, age, and body composition on baseline ST and the WBV-induced immediate changes in ST was evaluated. Methods: The study comprised a preliminary controlled phase including participants exposed to WBV (n = 44) or passive relaxation (n = 44), followed by a main phase involving 266 healthy young adults (147 women, 119 men). ST was assessed before and after a 30 min WBV session or passive relaxation using transcutaneous electrical stimulation. Results: WBV significantly increased ST in the preliminary phase (13.75 to 16.00 mA, p < 0.001, r = 0.65), whereas passive relaxation produced the opposite effect, significantly decreasing ST (13.00 to 10.00 mA, p < 0.001, r = 0.84). In the main phase, WBV resulted in an increase in ST in both women (14.00 to 15.50 mA, p < 0.001, r = 0.48) and men (16.00 to 18.50 mA, p < 0.001, r = 0.43). Women exhibited lower ST than men both before and after WBV, although the magnitude of the WBV-induced response was comparable between the sexes. Statistically significant associations between body composition and baseline ST were observed in women, whereas no significant associations were identified in men. A weak positive association between age and the WBV response was observed in women, whereas no significant association was found in men. Conclusions: Horizontal WBV induces an immediate increase in electrical ST, suggesting an immediate effect on somatosensory processing. Baseline ST and the immediate ST response to WBV exhibited different patterns of association with age and body-composition parameters. Because these analyses were exploratory, the findings should be considered hypothesis-generating and require confirmation in future studies. Full article

Background and Objectives: Postoperative pain after thoracic surgery is a multidimensional experience that includes both sensory, evaluative, and affective components. While transcutaneous electrical nerve stimulation (TENS) has demonstrated benefits for postoperative pain management, its association with affective pain outcomes remains less explored. This study aimed to explore the affective dimension of postoperative pain through a secondary analysis of data from a previously conducted randomized controlled trial. Materials and Methods: Data were derived from a randomized controlled trial investigating the effects of TENS on postoperative recovery after thoracic surgery. A total of 109 patients were included and allocated into three groups: experimental (TENS + physiotherapy, n = 37), placebo (sham TENS + physiotherapy, n = 37), and control (physiotherapy alone, n = 35). The main outcome of interest in this exploratory secondary analysis was the affective dimension of pain, assessed using the Pain Rating Index—Affective (PRI-A) subscale of the McGill Pain Questionnaire before and after the 3-week rehabilitation program. Results: Improvements were observed across several pain-related variables during the intervention period. For the affective dimension of pain, the experimental group demonstrated greater reduction in PRI-A scores than the placebo and control groups. The mean reduction in PRI-A was 0.97 in the experimental group, compared to 0.27 in the placebo group and 0.57 in the control group (p < 0.0001). Between-group comparisons showed moderate to large standardized effect sizes favoring the experimental group, although the absolute magnitude of PRI-A changes was modest. Conclusions: This secondary exploratory analysis suggests that TENS combined with physiotherapy may contribute to improvements in the affective dimension of postoperative pain following thoracic surgery. These findings support further investigation of multidimensional pain outcomes within postoperative rehabilitation settings. Full article

Contrast-enhanced low-mechanical-index endoscopic ultrasound (CELMI-EUS) extends the diagnostic capabilities of endoscopic ultrasound by enabling real-time assessment of hepatic microvascularization and perfusion using intravenous ultrasound contrast agents. Owing to its close proximity to the liver and high spatial resolution, CELMI-EUS is particularly suited for the detection and characterization of small or otherwise inconspicuous focal liver lesions. This review summarizes the technical principles of CELMI-EUS, contrast agent usage, vascular phase interpretation, and standardized assessment of benign and malignant focal liver lesions, including the potential and provisional application of CEUS Liver Imaging Reporting and Data System (LI-RADS) terminology in patients at risk for hepatocellular carcinoma, while acknowledging that dedicated validation for CELMI-EUS is lacking. Typical enhancement patterns of common benign lesions such as hemangioma, focal nodular hyperplasia, hepatocellular adenoma, biliary hamartomas, and abscesses are discussed, as well as malignant entities including metastases, hepatocellular carcinoma, and cholangiocarcinoma. In addition, the role of CELMI-EUS in lesion detection, interventional guidance, and its limitations and pitfalls are addressed. Integrated into a multimodality imaging approach alongside transcutaneous CEUS and cross-sectional imaging, CELMI-EUS represents a valuable complementary tool that improves diagnostic confidence and supports optimized management of patients with focal liver lesions. Full article

Inflammatory bowel disease (IBD), encompassing Crohn’s disease (CD) and ulcerative colitis (UC), is a chronic inflammatory disorder characterized by dysregulated host–microbiota interactions, epithelial barrier dysfunction, and aberrant immune activation. Despite advances in biologic and small-molecule therapies, a substantial proportion of patients exhibit incomplete response, loss of response, or treatment-related adverse effects, underscoring the need for novel adjunctive therapeutic approaches. The vagus nerve exerts a pivotal effects on immune homeostasis through the cholinergic anti-inflammatory pathway, thereby integrating peripheral immune sensing with central autonomic regulation. Within the context of IBD, a diminution in vagal tone has been observed to correlate with persistent mucosal inflammation and immune dysregulation. Transcutaneous auricular vagus nerve stimulation (ta-VNS) is a non-invasive neuromodulation technique that may activate vagal circuits and modulate neuroimmune signaling without surgical intervention. This review endeavors to critically evaluate the potential efficacy of ta-VNS in the context of IBD, with particular emphasis on its discernible effects on immune, epithelial barrier, microbiota-related, and autonomic biomarkers. Emerging evidence, stemming from preliminary investigations, suggests that ta-VNS may exert an influence on inflammatory cytokine profiles, epithelial tight junction integrity, gut microbial composition, and systemic autonomic balance, warranting further elucidation. In addition, the review discusses differential responses between Crohn’s disease and ulcerative colitis, summarizes current preclinical and clinical evidence, and highlights biomarker-based strategies for evaluating therapeutic response in future randomized controlled trials. Although current evidence remains preliminary and stimulation parameters are not yet standardized, ta-VNS represents a promising adjunctive neuroimmune modulation strategy in IBD. Full article

Background/Objective: In 2022, the American Academy of Pediatrics (AAP) revised the guidelines used to manage neonatal hyperbilirubinemia with a focus on reducing unnecessary testing and phototherapy. However, pediatricians’ knowledge and compliance with the current guidelines have not been assessed. We conducted a survey to evaluate New Jersey pediatricians’ current knowledge and practice patterns with the newly proposed guidelines. Patients and Methods: A questionnaire consisting of 28 closed-ended Likert-scale questions, along with demographic data, was distributed twice in 2024 to all members of the New Jersey AAP Chapter. Of 128 respondents, 120 who defined their involvement in the care of neonates with hyperbilirubinemia were analyzed. Results: The majority of survey respondents were general pediatricians (71.7%). Up to 70% recognized the risk factors for developing severe hyperbilirubinemia, except for Down Syndrome. Up to 60% of respondents utilized transcutaneous bilirubin in low-risk hyperbilirubinemia neonates and serum bilirubin after phototherapy initiation in high-risk neonates as recommended by the AAP. Almost all of the respondents followed the AAP recommended post-discharge follow-up and/or bilirubin measurement. The majority reported phototherapy initiation at the recommended thresholds; however, only 12.5% of surveyed pediatricians followed the recommended threshold for phototherapy discontinuation. Conclusions: Surveyed pediatricians in our study were most likely to comply with the 2022 AAP guidelines; however, opportunities remain for improving pediatricians’ awareness of specific risk factors, reducing unnecessary laboratory testing and discontinuation of phototherapy at the recommended level. Full article

Diabetic kidney disease (DKD) is characterized by progressive renal dysfunction driven by oxidative stress, inflammation, and hemodynamic alterations. Photobiomodulation (PBM) has emerged as a potential non-invasive therapeutic strategy targeting these pathways. To evaluate the effects of PBM on kidney function, hemodynamics, oxidative stress, and inflammatory profile in a rat model of DKD. Adult male Wistar rats were randomly assigned to four groups: control (Ct), Ct + PBM, DKD, and DKD + PBM. Diabetes was induced by streptozotocin (60 mg/kg, i.v.). PBM (808 nm, 100 mW) was applied transcutaneously (3 J per point; 30.48 J/cm²), bilaterally over the renal region, three times per week for six weeks. Kidney function (inulin clearance, serum creatinine, albuminuria), hemodynamics (mean arterial pressure, renal blood flow, renal vascular resistance), oxidative stress markers (urinary H₂O₂, NOx, thiols, Nrf2), and IL-1β levels were evaluated. DKD animals showed impaired kidney function, increased oxidative stress, and elevated inflammatory markers. PBM treatment significantly improved inulin clearance, reduced albuminuria and serum creatinine, increased renal blood flow, and decreased mean arterial pressure and vascular resistance. Oxidative stress markers and IL-1β levels were attenuated, with partial restoration of antioxidant capacity. No significant histological differences were observed. PBM improves kidney function and modulates redox and inflammatory pathways in experimental DKD, supporting its potential as a non-invasive adjunct therapy. Full article

Transcutaneous electrical stimulation (TES) is limited by cutaneous discomfort caused by unavoidable activation of superficial sensory nerves during current delivery to deep targets. While psychophysical studies have empirically identified waveforms that reduce skin sensation, existing computational models typically employ quasi-static approximations that neglect the pronounced dielectric dispersion of biological tissues, leaving the biophysical mechanisms poorly understood. We developed a finite-element model of the human forearm incorporating the frequency-dependent dielectric properties of skin, fat, muscle, bone, and nerve tissues (DC to 1 MHz), coupled with a linear time-invariant signal-processing framework based on the system transfer function H(f). The model quantitatively reproduced the waveform-dependent sensation trends reported by Hsu et al. We introduced a penetration ratio to quantify deep-to-superficial nerve activation and found that all time-varying waveforms exhibit lower penetration than direct current (DC), revealing a skin-effect-like behavior of electrical current in biological tissues. Moreover, deep and superficial nerve activations co-varied under waveform parameter changes, indicating that waveform optimization alone cannot improve depth selectivity. Electrode spatial configuration was shown to offer a complementary strategy: positioning the active electrode close to the target muscle nerve while avoiding superficial cutaneous nerves, combined with sufficient transverse spacing, enhances depth selectivity. This work bridges psychophysical observations with tissue electrophysiology and provides a computational tool for waveform and electrode optimization in TES. Full article

Background/Objectives: This study aimed to develop and evaluate a noninvasive anemia screening method using fundus photographs analyzed by deep learning models, by transforming circular fundus photographs into square images suitable for convolutional neural network analysis. Methods: A total of 39,036 fundus images and clinical data collected from 2011 to 2023 were used. Eligible patients had clearly visible macula and optic discs and corresponding hemoglobin measurements. Three image preprocessing methods were applied—untransformed, stretching, and remapping. Results: Among preprocessing methods, the stretching method yielded the most accurate predictions. Deep learning analysis was conducted using multi-tasked cascaded convolutional neural networks. The hemoglobin prediction model based on EfficientNet B5 with remapping preprocessing achieved good performance (R² = 0.781, MAE = 1.23), while the anemia classification model demonstrated screening accuracy with AUC values exceeding 0.893. Conclusions: Deep learning analysis of fundus photographs demonstrates potential as a noninvasive screening method for anemia. This approach may be particularly beneficial for patients requiring regular hemoglobin monitoring. Full article

Anthralin has a long history as a topical treatment for psoriasis, where it reduces keratinocyte hyper-proliferation and effectively clears plaques. While it lowers inflammatory markers in psoriatic skin, it paradoxically induces inflammation in healthy skin through reactive oxygen species (ROS) and related pathways. However, its precise mechanism of action remains incompletely understood. Interestingly, the once undesirable pro-inflammatory effect in healthy skin may now represent a valuable adjuvant property for transcutaneous immunization (TCI). In particular, combining anthralin with the TLR7 agonist imiquimod (IMQ) elicits strong cytotoxic T-cell responses in pre-clinical studies. When paired with antigenic peptides that can penetrate the skin, this immunization approach is especially promising in the context of cancer therapy, given the central role of cytotoxic T-cells in tumor rejection. However, current evidence is largely derived from mouse models, but its efficacy and safety in humans remain to be established. This review therefore examines whether anthralin can be repurposed as a cutaneous adjuvant for transcutaneous immunization, and which mechanistic and translational constraints must be overcome before human application. Full article

The global obesity epidemic has become one of the most severe public health challenges of the 21st century, and existing treatment strategies have limitations such as poor long-term adherence, significant side effects, or high invasiveness. Dysregulation of feeding behavior is the core driver of obesity, and its precise regulation depends on the complete transmission of gut–brain axis signals. The nucleus of the solitary tract (NTS), as the first central relay station for visceral afferent signals, is a key hub for the regulation of feeding homeostasis. This article reviews the peripheral signal transduction mechanisms of hunger and satiety, the core afferent pathway of the vagus nerve, and the functional heterogeneity of neuron subpopulations within the NTS, focusing on the anatomical basis, neuroimaging evidence, and preclinical and clinical research progress of transcutaneous auricular vagus nerve stimulation (taVNS) targeting the NTS to exert anti-obesity effects. Accumulating evidence suggests that taVNS may modulate the activity of satiety-promoting neurons and attenuate aberrant hyperactivity of TH⁺ catecholaminergic neurons in obesity via the auricular branch of the vagus nerve–NTS pathway, which may in turn bidirectionally suppress homeostatic and hedonic feeding, reduce energy intake, and ameliorate metabolic dysregulation. Current research still has key gaps such as unstandardized stimulation parameters, lack of large-sample long-term randomized controlled trials, and unclear interaction mechanisms between the NTS and higher brain regions. This article provides a theoretical basis for in-depth understanding of the feeding regulatory network of the NTS and the translational application of taVNS in obesity management. Full article

After radical hysterectomy for cervical cancer, postoperative bladder dysfunction is common. This randomized controlled trial evaluated whether adjunctive transcutaneous electrical acupoint stimulation (TEAS) reduces urinary retention. A total of 108 patients were assigned to a control group (standard bladder training, n = 53) or a TEAS group (standard training plus daily 30 min TEAS for 7 days from postoperative day 3, n = 55). The primary outcome was urinary retention (post-void residual > 100 mL on day 11). Secondary outcomes included residual volume, recovery time, recatheterization, urinary tract infection (UTI), treatment efficacy, and quality of life (SF-36). Urinary retention occurred in 35.8% of controls versus 23.6% of TEAS patients (p = 0.164). TEAS significantly reduced median residual volume (70 vs. 85 mL, p = 0.004), shortened median recovery time (2 vs. 4 h, p < 0.001), and lowered recatheterization (16.4% vs. 34.0%, p = 0.036). UTI rates were similar. Treatment efficacy favored TEAS (p = 0.009), and all eight SF-36 domains significantly improved (all p < 0.01). In conclusion, adjunctive TEAS did not significantly reduce the primary outcome of urinary retention but significantly improved multiple secondary bladder-emptying measures and quality of life after radical hysterectomy for cervical cancer. Full article