Search Results (506)

Background: Shoulder disorders are among the leading causes of musculoskeletal pain and disability worldwide. Despite the widespread use of corticosteroid injections, concerns regarding their short-term efficacy and potential adverse effects have encouraged research into alternative therapies such as oxygen–ozone therapy. This systematic review aimed to evaluate the efficacy of oxygen–ozone therapy in the management of shoulder disorders. Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted up to 16 March 2026, according to PRISMA guidelines. Randomized controlled trials investigating localized oxygen–ozone injections for shoulder disorders were included. Pain scores and shoulder function were the main outcomes considered. Study quality was assessed using the Cochrane Risk of Bias 2 tool. Results: Five randomized controlled trials involving 263 participants with shoulder impingement syndrome, adhesive capsulitis, or chronic rotator cuff syndrome were included. Given the heterogeneity of the included studies, we only performed a qualitative synthesis. Oxygen–ozone therapy demonstrated significant improvement in pain and shoulder function across all of the included studies. Corticosteroid injections generally showed superior short-term pain relief, whereas oxygen–ozone therapy demonstrated more persistent clinical improvements during medium-to-long follow-up periods. Studies employing multiple ozone injection protocols reported more stable outcomes when compared with single-injection approaches. No major adverse events related to oxygen–ozone therapy were reported. However, substantial heterogeneity was observed regarding injection protocols, ozone concentrations, number of injections, and follow-up duration. Conclusions: Oxygen–ozone therapy appeared to be a potentially effective treatment option for shoulder disorders, particularly in patients with contraindications to corticosteroids or chronic degenerative conditions. While corticosteroid injection might provide short-term symptom relief, repeated oxygen–ozone injection protocols seemed to offer sustained clinical benefits over time. Further high-quality randomized controlled trials with standardized protocols and longer follow-ups are needed to better define the role of oxygen–ozone therapy in shoulder rehabilitation. Full article

Background and Objectives: Fibromyalgia (FM) is a chronic primary pain syndrome. Its hallmark symptom is widespread pain, often accompanied by fatigue, sleep disturbances, and cognitive symptoms. Online surveys efficiently collect patient-reported data, but individuals recruited through this approach remain poorly characterized. This study aimed to describe a large online cohort of individuals with FM, providing data for comparison with the Italian Fibromyalgia Registry (IFR). Materials and Methods: Participants who self-reported a physician diagnosis of FM completed an online survey assessing socio-demographic and clinical characteristics, treatments and their perceived effectiveness, lifestyle, and impact variables. Disease severity and symptom burden were assessed using the Fibromyalgia Impact Questionnaire—Revised (FIQR), Widespread Pain Index (WPI), and Symptom Severity Scale (SSS). Participants were classified according to the 2016 American College of Rheumatology (ACR) criteria. Descriptive statistics were computed, and exploratory analyses assessed sex differences and differences according to ACR status using independent-samples t-tests with Bonferroni correction. Results: A total of 6022 participants were included (mean age 52.3 ± 10.3 years, 96.7% female). Nearly half (49.6%) reported pain duration > 10 years, and 50.4% had received conflicting diagnoses. Disease burden was high, with >70% classified as moderate-to-severe according to the FIQR. Overall, 79.4% fulfilled the 2016 ACR criteria. Participants not fulfilling the criteria showed lower symptom severity, although considerable clinical overlap was observed between groups. Pharmacological treatments were used by 81.1% of participants and non-pharmacological approaches by 55.1%, both with moderate perceived effectiveness. FM substantially affected daily life, particularly work and social functioning. After correction for multiple comparisons, sex differences were limited to FIQR functioning and symptom domains, with small effect sizes. Conclusions: Compared with published registry-based data, participants recruited through this online survey reported a higher symptom burden and longer pain duration, while showing a broadly similar symptom profile. Although the descriptive nature of the comparison precludes causal inferences, the findings suggest that online surveys and clinical registries may provide complementary perspectives on the FM population. Full article

Background/Objectives: Irritable bowel syndrome (IBS) is among the most prevalent disorders of gut–brain interaction, yet its implications for spine surgery remain poorly characterized. This narrative review examines how IBS influences symptom presentation and postoperative outcomes in spine surgery patients. Methods: We synthesized the neurobiologic, epidemiologic, and perioperative literature linking IBS with musculoskeletal pain, spine-related symptomatology, and surgical outcomes, drawing on spine-specific data where available and on related surgical and chronic-pain populations where it was not. Results: IBS is characterized by central sensitization, impaired descending inhibition, increased temporal summation, autonomic dysregulation, and a high prevalence of psychiatric comorbidity, which manifest as widespread hyperalgesia and symptom amplification that overlap with pain mechanisms common in spine surgery patients. Epidemiologic studies indicate that patients with IBS undergo musculoskeletal and spinal procedures at disproportionately high rates, reflecting both symptom burden and diagnostic uncertainty from viscerosomatic overlap. These same factors have been associated with greater postoperative pain, elevated opioid requirements, slower functional recovery, and reduced satisfaction after spine surgery, although direct IBS-specific spine data remain limited. IBS may also confound preoperative assessment by mimicking radicular, discogenic, or sacroiliac pain. Conclusions: IBS represents an under-recognized potential modifier of symptom localization, perioperative pain trajectories, and functional recovery in spine surgery. Greater awareness of IBS-related nociplastic and psychosocial mechanisms may improve preoperative evaluation, risk stratification, perioperative management, and the design of future outcome studies. Full article

Background: Neuropathic pain (NP), a debilitating condition resulting from nervous system lesions, is poorly managed by current therapies. The cingulate cortex is crucial for affective pain processing, yet a comprehensive spatiotemporal understanding of its molecular changes in NP is lacking. Methods: We performed RNA sequencing to profile transcriptomic alterations in the anterior cingulate (ACC) and midcingulate (MCC) cortices of mice at two and four weeks after spared nerve injury. Bioinformatics analyses, including differential expression, functional enrichment, weighted gene co-expression network analysis, and protein–protein interaction (PPI) network construction, were employed. Results: We identified widespread, time-dependent transcriptional dysregulation in both regions, with differentially expressed genes increasing over time. Functional analyses confirmed central roles for synaptic plasticity and neuroinflammatory pathways, and further identified pathways related with neurodegeneration and mitochondrial dysregulationin NP pathogenesis. Subregion analysis revealed that the ACC exhibited broader pathway alterations than the MCC, including neuroinflammation (early phase) and mitochondrial dysfunction/neurodegeneration (late phase), indicating a progressive stress response unique to the ACC. PPI analysis identified stage-specific hub genes (e.g., early interferon-stimulated genes and late ribosomal proteins in ACC; persistent extracellular matrix components in MCC). Conclusions: This study provides a detailed transcriptomic atlas of the cingulate cortex in NP, reinforcing known synaptic and neuroinflammatory mechanisms, and suggests a possible role of mitochondrial dysregulation in NP pathogenesis. The findings provide a basis for further mechanistic studies. Full article

Background: Carpal tunnel syndrome (CTS) is a common peripheral nerve entrapment disorder with multifactorial etiologies, while fibromyalgia is a chronic centralized pain condition characterized by widespread pain and central sensitization. Although shared mechanisms such as neurogenic inflammation and altered pain processing have been proposed, longitudinal evidence evaluating whether CTS predisposes to subsequent fibromyalgia remains limited. Methods: We conducted a retrospective cohort study using the TriNetX Global Collaborative Network. Adults aged ≥ 18 years with ≥2 clinical encounters between 2018 and 2023 were included. Patients with CTS formed the exposure cohort, while individuals without CTS undergoing routine health examinations served as controls. Those with prior fibromyalgia, malignancy, or death before index were excluded. One-to-one propensity score matching was performed to balance demographics, body mass index, psychiatric conditions, socioeconomic factors, healthcare utilization, and comorbidities including mood, anxiety, stress-related, and sleep disorders. The primary outcome was incident fibromyalgia. Sensitivity analyses included alternative matching strategies, extended washout periods, stricter exposure definitions, and active comparator analyses using osteoarthritis. Stratified analyses by age and sex were conducted. Associations were estimated using hazard ratios with 95% confidence intervals. Results: After matching, 217,208 patients were included in each cohort. CTS was associated with a significantly increased risk of fibromyalgia (HR 2.709, 95% CI 2.521–2.911). Consistent findings were observed across sensitivity analyses. Compared with osteoarthritis, CTS remained associated with higher fibromyalgia risk (HR 1.331, 95% CI 1.254–1.411). Stratified analyses demonstrated consistent associations across age groups (18–64 years: HR 2.820, 95% CI 2.595–3.065; ≥65 years: HR 2.717, 95% CI 2.337–3.159) and sexes (male: HR 3.018, 95% CI 2.482–3.672; female: HR 2.655, 95% CI 2.457–2.869). Conclusions: CTS was associated with coded fibromyalgia diagnosis in this large real-world cohort, and this association was observed across multiple sensitivity and stratified analyses. These findings should be interpreted as evidence of an epidemiologic association rather than a causal relationship. CTS may serve as a clinical marker for patients who warrant attention to broader pain-related symptoms, while future studies are needed to clarify temporality and underlying mechanisms. Full article

Background: Pain is a prominent and disabling manifestation of inflammatory bowel disease (IBD), including abdominal, pelvic, musculoskeletal, axial, and neuropathic pain phenotypes. Patients referred to pain clinics represent a selected subgroup with clinically meaningful, persistent, refractory, or diagnostically complex pain. Objective: To characterize pain phenotypes, treatment patterns, interventional pain-care exposure, and utilization burden among patients with IBD evaluated in tertiary pain-clinic settings and to explore differences between Crohn’s disease and ulcerative colitis patients. Methods: We performed a retrospective electronic medical-record cohort study of patients with documented IBD who were evaluated in pain-clinic settings between 24 October 2010 and 14 May 2026. Repeated clinical entries were aggregated into unique visit dates and patient-level variables. IBD diagnosis, pain phenotypes, treatment documentation, interventional procedures, and pain-clinic utilization were summarized descriptively using counts, percentages, means, medians, interquartile ranges, and ranges as appropriate. Crohn’s disease and ulcerative colitis subgroups were compared using univariable odds ratios with 95% confidence intervals and two-sided p-values. Because repeated clinical entries could belong to the same patient, the primary analytic unit was the patient rather than the individual note. Results: The source dataset included 19,615 clinical entries representing 7053 unique pain-clinic visits among 596 unique patients with IBD. The cohort included 314 patients with Crohn’s disease (52.7%), 247 with ulcerative colitis (41.4%), and 35 with IBD-unclassified (5.9%). The mean number of pain-clinic visits per patient was 11.8, with a median of four visits (interquartile range, 1–11). The dominant patient-level pain phenotypes were limb or peripheral joint pain (395/596, 66.3%), back or axial spine pain (358/596, 60.1%), and abdominal or pelvic pain (246/596, 41.3%). Overall, 437 patients (73.3%) had documentation of at least one interventional pain procedure. Compared with ulcerative colitis, Crohn’s disease was associated with higher documentation of abdominal or pelvic pain (148/314, 47.1% vs. 82/247, 33.2%; odds ratio, 1.79; 95% confidence interval, 1.27–2.53; p = 0.001) and fibromyalgia-like or widespread pain (83/314, 26.4% vs. 39/247, 15.8%; odds ratio, 1.92; 95% confidence interval, 1.25–2.93; p = 0.0027). In contrast, radiofrequency procedures (59/314, 18.8% vs. 78/247, 31.6%; odds ratio, 0.50; 95% confidence interval, 0.34–0.74; p = 0.0005) and facet or medial branch procedures (79/314, 25.2% vs. 87/247, 35.2%; odds ratio, 0.62; 95% confidence interval, 0.43–0.89; p = 0.012) were less frequently documented in Crohn’s disease than in ulcerative colitis. Conclusions: Among patients with IBD referred to tertiary pain-clinic evaluation, pain was heterogeneous and predominantly musculoskeletal, axial, neuropathic, and procedurally targetable rather than exclusively visceral. These findings support structured, mechanism-based pain assessment integrated with gastroenterology, rheumatology, and pain-medicine care. Full article

Background: Needle-related procedures such as venipuncture can be distressing for children and may trigger severe fear and behavioral dysregulation, particularly in those with previous traumatic experiences. Trauma-informed care (TIC) is a framework that recognizes the widespread impact of trauma and integrates this knowledge into clinical practice to prevent re-traumatization and support emotional regulation during medical procedures. Methods: This before-and-after study included 135 children aged 4–8 years who had previously shown severe distress during venipuncture, including escape attempts, shouting, or self/other-directed aggressive behaviors. Before venipuncture, children and their families received a TIC-based intervention delivered by a psychological counselor in a dedicated preparation room. Fear, behavioral responses during venipuncture, procedural pain, and heart rate were evaluated before and after the intervention using parent reports, the Children’s Fear Scale, the Wong–Baker FACES Pain Rating Scale, and pulse oximetry. Results: Following the TIC intervention, significant pre–post reduction were observed in distress-related behaviors during venipuncture, including escape attempts, shouting/crying, and self-/other-directed harmful behaviors. The proportion of children rated as experiencing high levels of fear decreased from 96.2% before the intervention to 15.5% after. Among the 85 children with complete heart-rate measurements available, mean heart rate decreased from 113.6 ± 10.1 beats/min to 87.3 ± 8.43 beats/min. Many families reported a more positive venipuncture experience compared with previous procedures. Conclusions: A trauma-informed care intervention delivered before venipuncture is associated with meaningful reductions in behavioral distress, fear, and physiological arousal in children with prior needle-related traumatic experiences. These pre–post associations support the feasibility and potential value of the TIC model, though controlled studies are needed to confirm these findings without confounding clinical effects. Full article

Background: Fibromyalgia is a chronic condition characterised by widespread pain, fatigue, sleep disturbances, and psychological symptoms. Mindfulness-based approaches are increasingly used as complementary interventions for symptom management. This study aimed to investigate the effectiveness of mindfulness-based yoga (MBY) delivered via telerehabilitation in individuals with fibromyalgia. Methods: This trial included 64 women with fibromyalgia who were randomly assigned to an 8-week mindfulness-based yoga program delivered via telerehabilitation or active control group including walking and physiotherapy modalities. Both groups received patient education at the outset. Assessments were conducted before and after the intervention. Outcome measures included fatigue, anxiety, depression, sleep quality, symptoms associated with central sensitization, kinesiophobia, pain intensity, mindfulness level, impact of fibromyalgia on life, biopsychosocial status, and pain catastrophising. Data were analyzed using mixed-design analysis of variance (ANOVA), with additional t-tests and analysis of covariance (ANCOVA) conducted for post hoc analyses. Results: Compared to the control group, the mindfulness-based yoga (MBY) group showed more pronounced improvements in terms of fatigue, anxiety, symptoms associated with central sensitization, biopsychosocial status, symptom severity, catastrophising about pain, ruminative thoughts about pain, and cognitive dimensions of pain. Although no significant differences were found between groups for other variables, intra-group improvements were observed in the MBY group. Conclusions: It was concluded that the MBY intervention administered via telerehabilitation is a viable complementary approach to traditional treatments in reducing the symptom burden of fibromyalgia. It was thought that the effectiveness of the research could be increased by conducting studies involving long-term follow-up assessments and investigating the integration of different mindfulness-based telerehabilitation interventions into the clinical setting. Full article

Low back pain (LBP) is a major global health problem and can result in a variety of movement impairments. Advances in smart technology have enabled the collection of novel streams of movement data, and machine learning (ML) methods have been increasingly used for data analysis. However, many existing technologies remain expensive and unsuitable for widespread clinical use, and ML approaches have largely focused on distinguishing people with LBP from healthy controls rather than identifying meaningful subgroups within the LBP population. Motion Tape (MT) is a recently developed wearable strain sensor that translates skin deformation from underlying movement and muscle engagement into electrical signals. In this exploratory study involving 10 participants with LBP, we demonstrate that MT data from six sensors applied on the lower back capture rich movement information capable of characterizing movement patterns among participants with LBP. We propose a feature engineering approach based on biomechanical features as well as time-series causal discovery applied to multivariate sensor time-series data to extract directed inter-segment coordination patterns. We further develop an exploratory subgroup discovery pipeline by aggregating clustering coassociation information across diverse movement tasks. Our causal coordination features show promising discriminative information across several movement types, capturing aspects of motor control not reflected in amplitude-based or embedding-based features alone, such as asymmetries and movement restrictions. Preliminary ensemble clustering analysis indicates three potential LBP subgroups distinguished by biomechanical and inter-segment coordination patterns, which may reflect varied strategies under different movement demands. We investigate the differences in clinical characteristics among these LBP subgroups. We show that time-series foundation models are not well suited for LBP subgrouping due to their uninterpretability, which is improved in our feature engineering pipeline. This framework could reveal additional subgroups with larger cohorts and may generalize to other sensor modalities. Full article

Background/Objectives: Standard mechanical compression applied during screening mammography is a primary barrier that reduces patient compliance. Current guidelines attempt to standardize compression based solely on the one-dimensional “breast thickness” measured by the device. This study aimed to investigate the effects of three-axis anatomical breast dimensions, applied compression force, menstrual cycle phases, and BI-RADS breast density patterns on pain scores during mammography within a comprehensive biomechanical model. Methods: This retrospective cohort study included 443 female patients who underwent routine screening or diagnostic mammography. Patients with a history of breast implants, lactation, or prior breast surgery that could alter tissue biomechanics were excluded. Maximum pain scores (1–10 on a Visual Analog Scale [VAS]) were recorded. Transverse, anteroposterior, and superoinferior breast biometric measurements for each patient were calculated using advanced radiological workstations. Data were analyzed using One-Way ANOVA and Multiple Linear Regression (OLS) models. Results: The mean age of the participants was 49.7 ± 9.4 years, the mean applied compression force was 62.4 ± 10.3 N, and the mean pain score was 2.03 ± 2.12 (range: 1–10). The multiple linear regression analysis was statistically significant overall (F = 2.516, p = 0.015). Having a BI-RADS Type D (extremely dense) breast pattern was identified as the strongest independent factor associated with an increased pain score (p = 0.082, coefficient = 1.219). Age showed a trend toward a negative effect on pain (p = 0.072), while compression force showed a trend toward a positive effect (p = 0.067). Conversely, breast thickness (p = 0.231) and the three-dimensional mean breast size index (p = 0.568) demonstrated no independent predictive power. The menstrual cycle phase did not reach independent significance in the multivariate regression model (p = 0.117); however, non-parametric univariate analysis revealed a significant difference in pain across hormonal groups (Kruskal–Wallis H = 10.04, p = 0.039), with actively menstruating and luteal-phase women reporting higher pain than menopausal women. Conclusions: The pain experienced during mammography depends on the internal fibroglandular architecture (elasticity and stiffness) of the tissue rather than its external volumetric dimensions. Notably, neither device-measured breast thickness nor manually calculated three-dimensional breast dimensions independently predicted pain, challenging the widespread assumption that breast size drives mammographic discomfort. “One-size-fits-all” or thickness-based compression strategies should be abandoned in routine practice. Instead, “personalized compression” protocols that prioritize patient comfort without compromising image quality should be developed, particularly for younger patients and those with BI-RADS Type D, and to a lesser extent Type C, density patterns. Full article

Background/Objectives: Fibromyalgia (FM) is a complex disease with symptoms such as brain fog, widespread body pain, sleep disturbances, and mood changes, and its etiology is not clearly understood. Our main aim in this study was to evaluate emotional eating and emotional dysregulation in patients with FM and examine the possible effects of these disorders on disease severity. Materials and Methods: This observational study included 94 patients with FM (6 males, 88 females; mean age: 44.64 ± 9.04 years; range, 19–65 years) and 76 controls (7 males, 69 females; mean age: 41.91 ± 10.874 years; range, 18–64 years). The patient and control group participants completed a form including sociodemographic data. Participants also completed the Fibromyalgia Impact Questionnaire (FIQ), Emotional Eating Questionnaire (EEQ), and Difficulties in Emotion Regulation Scale (DERS). Results: In unadjusted comparisons, DERS-goals and DERS-strategies scores were higher in the FM group than in controls; however, these differences did not remain statistically significant after Bonferroni correction. In the linear regression model, it was found that the total score of the Difficulties in Emotion Regulation Scale (DERS-Total) (p = 0.010) was the only variable that significantly affected the FIQ value. Even though the patient group had slightly higher EEQ scores, there was no statistically significant difference between the two groups (p = 0.721). Conclusions: Emotional regulation difficulties were associated with FM symptom severity, whereas emotional eating did not differ significantly between groups and was not associated with symptom severity. These findings suggest that emotion-related psychological processes should be considered within the biopsychosocial framework of FM. Full article

The calcitonin gene-related peptide (CGRP) is a 37-amino acid neuropeptide belonging to the calcitonin family, discovered as a product of alternative splicing of the calcitonin gene. CGRP has emerged as a pleiotropic signaling molecule with widespread distribution in the central and peripheral nervous systems, particularly within primary sensory neurons. This narrative review synthesizes current knowledge on the CGRP system, integrating recent advances in its molecular structure, gene organization, and post-translational processing with high-resolution structural insights into its heterodimeric receptor complex (CLR-RAMP1) obtained through cryo-electron microscopy. We also include long-term safety data on anti-CGRP monoclonal antibodies, emerging cardiovascular risk signals, and novel therapeutic applications in vestibular migraine and pediatric populations. The intracellular signaling cascades activated by CGRP, including the canonical cAMP-PKA pathway, MAP kinase activation, and context-dependent calcium signaling, are discussed in relation to its diverse physiological functions. These encompass vasodilation, nociception modulation, neurogenic inflammation, gastrointestinal motility, bone metabolism, tissue regeneration, and energy homeostasis. The central role of CGRP in migraine pathophysiology is examined to understand the development of targeted therapies. The current pharmacological landscape is reviewed, including the evolution of small-molecule CGRP receptor antagonists (gepants) through three generations and the four approved monoclonal antibodies targeting CGRP or its receptor, with comparative analysis of their efficacy, safety profiles, and clinical positioning. Beyond migraine, emerging and predominantly preclinical roles of the CGRP system are discussed in chronic pain, osteoarthritis, cardiovascular diseases, sepsis, cancer (particularly bone metastases and tumor microenvironment immunomodulation), and neurodegenerative disorders such as Alzheimer’s disease. In these areas, the available evidence remains heterogeneous and, in most cases, is not yet sufficient to support clinical translation. Finally, future directions are discussed, including the development of stable CGRP analogs, allosteric modulators, and the potential expansion of therapeutic applications into oncology, intensive care medicine, and neuroprotection. Full article

Primary pulmonary artery sarcoma (PPAS) is a mesenchymal tumor originating from the pulmonary artery, accounting for approximately 0.001–0.003% of all sarcomas. The early clinical symptoms are atypical, and diagnosis is often delayed, making the management of this disease challenging. The widespread availability of multidetector computed tomography (MDCT), ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT), and high-resolution echocardiography has significantly improved the diagnostic capability for PPAS. We herein report a 74-year-old female patient who presented with a 3-week history of exertional dyspnea without an apparent trigger. She had received anti-inflammatory therapy at another hospital for one week. Five days before admission, she experienced right-sided chest pain without apparent cause, which was respiratory-related. On the day of admission, laboratory tests revealed a slight elevation in D-dimer levels. Echocardiography showed an irregular, moderately echogenic mass at the origin of the right pulmonary artery. Enhanced computed tomography (CT) of the chest revealed a filling defect in the right pulmonary artery accompanied by bilateral pleural effusion. The patient was given heparin anticoagulation therapy. To confirm the nature of these lesions, a PET/CT scan was conducted five days after admission, which indicated hypermetabolism in the right pulmonary artery, suggesting primary pulmonary artery sarcoma. Due to the poor efficacy of anticoagulation therapy, the patient continued to experience breath-holding after physical activity. Subsequently, catheter-guided interventional angiography was carried out for pulmonary artery thrombectomy and biopsy, and histopathological examination revealed pulmonary artery sarcoma. Given the patient’s respiratory failure and heart failure, as well as the uncertain efficacy of radiotherapy and chemotherapy, interventional pulmonary artery thrombectomy alleviated the chest pain. Currently, the patient’s overall condition is stable. Full article

Background/Objectives: We report a case of severe dermatomyositis demonstrating characteristic widespread extraosseous uptake on ^99mTc-methylene diphosphonate (^99mTc-MDP) bone scintigraphy. This study highlights the diagnostic value of this modality in detecting active inflammatory myopathy when conventional muscle biopsy is inconclusive and introduces its novel use for intraoperative gamma-probe-guided biopsy to precisely target metabolically active muscle. This approach may help target metabolically active muscle in heterogeneous idiopathic inflammatory myopathies (IIMs). Case Presentation: A 49-year-old man developed progressive proximal muscle weakness (Medical Research Council grade 2/5 proximally, 5/5 distally) beginning in June 2025 following influenza infection, accompanied by dysphagia, classic dermatomyositis cutaneous manifestations, back pain, and difficulty standing. Laboratory evaluation revealed elevated inflammatory markers (ESR 55 mm/hr, CRP 20 mg/L), leukocytosis (16.58 × 10⁹/L), markedly raised creatine kinase (19,937 IU/L), and troponin T levels. An initial quadriceps muscle biopsy performed on 29 July 2025 was non-diagnostic. Three-phase ^99mTc-MDP scintigraphy (~1110 MBq) demonstrated intense, diffuse extraosseous uptake involving bilateral deltoids (symmetric), biceps and triceps (patchy), paraspinal muscles (longitudinal), gluteal muscles, thighs (quadriceps and hamstrings), and gastrocnemius muscles, with relative suppression of appendicular skeletal uptake on delayed images due to soft-tissue tracer dominance—findings consistent with severe inflammatory myopathy. Following reinjection (~1100 MBq), intraoperative gamma-probe-guided biopsy targeted areas of highest uptake (left quadriceps femoris and distal triceps brachii; intraoperative counts 1300–1400 versus background ~500). Histopathology revealed histiocyte-predominant inflammation with myofibre necrosis and regeneration, sparse CD4⁺ T-cell infiltrates, and absence of fibrosis, consistent with necrotising myopathy. Positive antinuclear antibodies and strong anti-Mi-2 antibodies confirmed the diagnosis of dermatomyositis. Treatment included pulse methylprednisolone followed by oral prednisone taper, methotrexate, azathioprine, intravenous immunoglobulin, and planned rituximab therapy. Discussion: Whole-body ^99mTc-MDP scintigraphy provided a complementary whole-body functional assessment of disease extent, revealing widespread muscular involvement. The novel application of intraoperative gamma-probe-guided biopsy enabled real-time targeting of metabolically active muscle, facilitating targeted sampling after an initial non-diagnostic biopsy and yielding supportive histopathological findings. This dual diagnostic and interventional role demonstrates the technical feasibility of gamma-probe guidance in a diagnostically challenging case of dermatomyositis. Conclusions: In our case, the integration of ^99mTc-MDP scintigraphy with gamma-probe-guided biopsy enabled precise targeting of metabolically active muscle following an initial non-diagnostic biopsy. This multimodal approach may be useful in selected diagnostically challenging cases of severe inflammatory myopathy. Larger studies are needed to evaluate its reproducibility and added value. Full article

Objective: This study aimed to evaluate patients who developed hypersensitivity reactions (HSRs) during rituximab treatment and report the outcomes of desensitization protocols implemented to allow treatment continuation. Methods: We retrospectively reviewed the institutional data of 76 patients who received rituximab therapy at the Adult Hematology Department between January 2022 and September 2023. Among these, 11 patients who experienced immediate hypersensitivity reactions during infusion were analyzed. The overall frequency of rituximab-associated HSRs was 14.47% (11 out of 76 patients). Demographic data, underlying diseases, timing and type of HSRs, and details of the desensitization protocols were recorded. Results: The overall frequency of rituximab-associated HSRs was 14.47% (11 out of 76 patients). Among the 11 patients, eight were male and three were female, with a median age of 56 years (range: 19–72). Eight patients had CD20-positive non-Hodgkin lymphoma (NHL) and three had acute B-lymphoblastic leukemia (B-ALL). HSRs occurred during the first rituximab exposure in nine patients, at the fourth dose in one patient, and at the eighth dose in another. Symptoms included widespread rash, pruritus, flushing, chills, shivering, dyspnea, dysphagia, back pain, dizziness, syncope, and throat discomfort. All the patients were consulted by the Allergy and Immunology Clinic. Based on prick and intradermal test (IDT) results and the planned rituximab dose, desensitization protocols consisting of a three-dilution/12-step and a four-dilution/16-step regimen were prepared. Overall, 46 desensitization procedures were successfully completed in 11 patients. Notably, no severe anaphylactic events or treatment discontinuations due to drug toxicity occurred during the implementation of the protocols. Conclusions: Although the number of patients was limited, our findings indicate that in patients with hematologic malignancies receiving rituximab who develop early HSRs, desensitization represents a safe and effective strategy before considering treatment modification. These results support that, in appropriately selected patients, desensitization protocols are an important approach to continue therapy without interruption while minimizing adverse reactions. Full article