Search Results (775)

Background: Millimetric ST-segment elevation (STEMI) rules miss more than half of angiographic coronary occlusions. Re-casting acute infarction as Occlusion MI (OMI) versus Non-Occlusion MI (NOMI) and embedding that paradigm in Bayesian reasoning could shorten time to reperfusion while limiting unnecessary activations. Methods: We derived age- and sex-specific baseline prevalences of OMI from national emergency-department surveillance data and contemporary angiographic series. Pre-test probabilities were adjusted with published likelihood ratios (LRs) for chest-pain descriptors and clinical risk factors, then updated again with either (1) the stand-alone accuracy of ST-elevation or (2) the pooled accuracy of a broader OMI ECG spectrum. Two decision thresholds were prespecified: post-test probability >10% to trigger catheterization and >75% to justify fibrinolysis when angiography was unavailable. The framework was applied to five consecutive real-world cases that had elicited diagnostic disagreement in clinical practice. Results: The Bayesian scaffold re-classified three “NSTEMI” tracings as intermediate or high-probability OMI (post-test 27–65%) and prompted immediate reperfusion; each was confirmed as a totally occluded artery. A fourth patient with crushing pain and a normal ECG retained a 17% post-ECG probability and was later found to have an occluded circumflex. The fifth case, an apparent South-African-Flag pattern, initially rose to 75% but fell after a normal bedside echo and normal troponins. Conclusions: Layering pre-test context with sign-specific LRs transforms ECG interpretation from a binary rule into a transparent probability calculation. The OMI/NOMI Bayesian framework detected occult occlusions that classic STEMI criteria missed. Full article

Introduction: Pain is highly prevalent among community-dwelling older adults and can undermine their ability to perform Instrumental Activities of Daily Living (IADL), which are essential for independent living. This systematic review aimed to summarize existing research to clarify the relationship between pain and IADL disability in community-dwelling older adults. Methods: We conducted a search of PubMed on 27 July 2025. Eligible studies met the following criteria: (1) assessed the association between pain and IADL disability; (2) included community-dwelling older adults aged 60 and older; and (3) were published in English. Results: Of the 400 records screened, 29 studies met the inclusion criteria. Of these, 23 studies (18 cross-sectional and 5 cohort studies) reported a significant association between pain and IADL disability, while 6 cross-sectional studies did not. Pain was assessed using diverse instruments across varying recall periods and thresholds, and IADL disability was measured using multiple scales. Such methodological heterogeneity precluded quantitative synthesis. Conclusions: In community-dwelling older adults, pain consistently predicts IADL disability across designs and settings. However, the lack of standardized, multidimensional measures and incomplete adjustment for treatment, multimorbidity, and polypharmacy limits precise effect estimation. Future research should adopt harmonized assessment tools, control comprehensively for relevant confounders, and perform meta-analyses where data permit to clarify pain’s true impact on functional independence. Full article

Timely, objective pain recognition in dairy cattle is essential for welfare assurance, productivity, and ethical husbandry yet remains elusive because evolutionary pressure renders bovine distress signals brief and inconspicuous. Without verbal self-reporting, cows suppress overt cues, so automated vision is indispensable for on-farm triage. Although earlier systems tracked whole-body posture or static grimace scales, frame-level detection of facial micro-expressions has not been explored fully in livestock. We translate micro-expression analytics from automotive driver monitoring to the barn, linking modern computer vision with veterinary ethology. Our two-stage pipeline first detects faces and 30 landmarks using a custom You Only Look Once (YOLO) version 8-Pose network, achieving a 96.9% mean average precision ($mAP$) at an Intersection over the Union (IoU) threshold of 0.50 for detection and 83.8% Object Keypoint Similarity (OKS) for keypoint placement. Cropped eye, ear, and muzzle patches are encoded using a pretrained MobileNetV2, generating 3840-dimensional descriptors that capture millisecond muscle twitches. Sequences of five consecutive frames are fed into a 128-unit Long Short-Term Memory (LSTM) classifier that outputs pain probabilities. On a held-out validation set of 1700 frames, the system records 99.65% accuracy and an F1-score of 0.997, with only three false positives and three false negatives. Tested on 14 unseen barn videos, it attains 64.3% clip-level accuracy (i.e., overall accuracy for the whole video clip) and 83% precision for the pain class, using a hybrid aggregation rule that combines a 30% mean probability threshold with micro-burst counting to temper false alarms. As an early exploration from our proof-of-concept study on a subset of our custom dairy farm datasets, these results show that micro-expression mining can deliver scalable, non-invasive pain surveillance across variations in illumination, camera angle, background, and individual morphology. Future work will explore attention-based temporal pooling, curriculum learning for variable window lengths, domain-adaptive fine-tuning, and multimodal fusion with accelerometry on the complete datasets to elevate the performance toward clinical deployment. Full article

Chronic pancreatitis (CP) precipitates complex malnutrition through synergistic mechanisms: exocrine pancreatic insufficiency–driven maldigestion, duodenal or pancreatobiliary strictures limiting nutrient flow, cholestasis impairing micelle formation, alcohol-related anorexia, pain-induced hypophagia, proteolytic catabolism from type 3c diabetes, and a chronic inflammatory milieu that accelerates sarcopenia and bone demineralisation. Consequent calorie–protein depletion, micronutrient and fat-soluble vitamin deficits, and metabolic derangements markedly amplify morbidity. Pancreatic enzyme replacement therapy (PERT) with targeted micronutrient repletion is foundational; high-protein regimens co-administered with PERT curb muscle loss, and medium-chain triglycerides (MCTs) can augment caloric delivery by bypassing lipase dependence, although their benefit over personalised dietetic counselling is marginal. Optimal dietary fat thresholds and timing of escalation from oral to enteral or parenteral feeding remain unresolved. Comprehensive care also demands alcohol abstinence, effective analgesia and stringent glycaemic control. Serial monitoring—biochemical indices, densitometry, dual-energy X-ray absorptiometry and imaging-based body-composition metrics—permits early detection of high-risk patients and precision tailoring of interventions. Intensified multidisciplinary programmes already improve prognostic endpoints and are unveiling biomarkers of nutritional resilience. A structured, evidence-based strategy integrating PERT, macronutrient engineering, micronutrient repletion and metabolic surveillance is essential to mitigate nutrition-related morbidity, enhance long-term outcomes and optimise quality of life in CP. Full article

Microneedles represent an emerging transdermal drug delivery platform offering painless, minimally invasive penetration of the stratum corneum. This study addresses limitations of conventional lidocaine hydrochloride formulations, such as slow onset and poor patient compliance, by developing lidocaine hydrochloride-loaded dissolvable microneedles (LH-DMNs) for rapid local anesthesia. LH-DMNs were fabricated via centrifugal casting using polyvinyl alcohol (PVA) as the matrix material in polydimethylsiloxane (PDMS) negative molds, which imparts high mechanical strength to the microneedles. Biocompatibility assessments showed negligible skin irritation, resolving within 3 min. And drug-loading capacity reached 24.0 ± 2.84 mg per patch. Pharmacodynamic evaluation via mouse hot plate tests demonstrated significant analgesia, increasing paw withdrawal latency to 36.11 ± 1.62 s at 5 min post-application (p < 0.01). The results demonstrated that the LH-DMNs significantly elevated the pain threshold in mice within 5 min, surpassing the efficacy of conventional anesthetic gels and providing a rapid and effective solution for pain relief. These findings validate the system’s rapid drug release and efficacy, positioning dissolvable microneedles as a clinically viable alternative for enhanced transdermal anesthesia. Full article

Introduction: Recurrent ankle sprains can lead to chronic ankle instability. The flossing technique aims to modify the function and characteristics of fascial tissue. The objective was to evaluate the effectiveness of flossing and sliding techniques in improving subjects with previous ankle sprains. Methods: Randomized, double-blind clinical study with a follow-up period. Twenty-six subjects were assigned to two study groups: experimental (flossing technique and passive manual therapy techniques) and placebo control group (flossing technique without compression and manual therapy techniques without sliding). The intervention lasted three weeks, with two sessions per week. The study variables were dorsiflexion under load (Leg Motion^®), ankle mobility under unloaded conditions (goniometer), pressure pain threshold (algometer), and stability (Rs Scan^® pressure platform). Three measurements were taken: pre-treatment (T0), post-treatment (T1), and after 3 weeks of follow-up (T2). Results: There were significant intergroup differences in dorsiflexion under load (F = 4.90; p = 0.02). Range of motion in plantar flexion without load (F = 3.78; p = 0.04), in the ellipse area (F = 4.72; p = 0.01), left stability (F = 3.74; p = 0.03), and right stability (F = 3.73; p = 0.03) without visual support. Conclusions: A physiotherapy protocol using flossing and manual sliding therapy can increase loaded dorsal flexion in young adults with previous ankle sprains. This intervention can also improve ankle plantar flexion under unloaded conditions. The area of the ellipse without visual support can improve in young adults with a history of ankle sprains following a program of flossing and manual therapy. Full article

Introduction: Chronic primary low back pain (CPLBP) is a prevalent condition in primary care and a leading cause of disability and absenteeism worldwide. Multidimensional approaches may be necessary to achieve physical and mental health benefits in individuals with CPLBP. Objective: The BACKFIT randomized controlled trial aims to evaluate the effectiveness of a multidimensional intervention—combining supervised exercise and mindfulness—on pain, physical fitness, mental health, and functional outcomes in individuals with CPLBP. Hypothesis: Both the supervised exercise program focused on motor control and trunk muscle strength (IG1) and the multidimensional intervention combining supervised exercise with mindfulness training (IG2) are expected to produce significant health improvements in individuals with CPLBP. It is further hypothesized that IG2 will yield greater improvements compared to IG1, both immediately post-intervention and at the two-month follow-up. Design: Randomized controlled trial. Setting: Virgen de las Nieves University Hospital, Granada (Spain). Participants: 105 individuals. Inclusion criteria: Previously diagnosed with CPLBP, aged ≥18 and ≤65 years, able to read and understand the informed consent, and able to walk, move, and communicate without external assistance. Exclusion criteria: serious lumbar structural disorders, acute or terminal illness, physical injury, mental illness, and medical prescriptions that prevent participation in the study. Intervention: Individuals will be randomly assigned to a supervised physical exercise group (2 days per week, 45 min per session), a multidimensional intervention group (same as supervised physical exercise group, and mindfulness 1 day per week, 2.5 h per session) or an active control group (usual care, 2 days per week, 45 min per session). The intervention will last 8 weeks. Main Outcome Measures: Primary outcome: pain threshold, perceived acute pain, and disability due to pain. Secondary measures: body composition, muscular fitness, gait parameters, device-measured physical activity and sedentary behavior, self-reported sedentary behavior, quality of life, pain catastrophizing, mental health, sleep duration and quality, and central sensitization. The groups will undergo pre-intervention, post-intervention, and a 2-month follow-up after a detraining period. Statistical Analysis: Both per-protocol and intention-to-treat approaches (≥70% attendance) will be used. Program effects will be assessed via one-way ANCOVA for between-group changes in primary and secondary outcomes. Conclusions: Given the complex nature of CPLBP, multidimensional approaches are recommended. If effective, this intervention may provide low-cost alternatives for health professionals. Full article

Background and Objectives: The Nordic hamstring exercise (NHE) effectively strengthens the hamstrings, reduces the risk of hamstring strain, and induces fatigue in the muscles; thus, post-NHE recovery strategies should be optimized. Foam rolling (FR) is a widely used method, with the belief that it can speed up recovery. Thus, this study investigated the acute and 48-h effects of FR following the NHE on muscle stiffness, pain pressure threshold (PPT), flexibility, countermovement jump (CmJ) height, and maximal voluntary isometric contraction (MVIC). Materials and Methods: Thirty-two active males were randomly assigned to either an FR group (n = 16) or a passive recovery (PR, n = 16) group. Measurements were taken at three time points: pre-test, post-test_0h, and post-test_48h. Participants performed the NHE (3 sets × 10 reps) before the recovery interventions. Variables assessed included muscle stiffness (MyotonPro), flexibility (sit and reach), PPT (algometer), jump performance (force platform), and MVIC peak torque (dynamometer). Results: FR significantly improved acute flexibility (12.7%, p < 0.001) following the NHE and prevented flexibility loss at 48 h, compared to the PR group. However, FR showed no significant advantages over PR in terms of muscle stiffness, PPT, CmJ, or MVIC, both acutely and at 48 h (p > 0.05). Conclusions: FR is an effective acute recovery strategy for improving flexibility after the NHE but offers limited effects for muscle stiffness, PPT, and other functional muscle parameters, both acutely and at 48 h. Further research should explore the long-term effects and efficacy of FR across diverse populations and recovery scenarios. Full article

Retained products of conception (RPOC) represent a significant cause of morbidity in the post-abortive and postpartum periods, potentially leading to abnormal uterine bleeding, pelvic pain, infections, and intrauterine adhesions. Accurate diagnosis is crucial to avoid unnecessary surgical interventions and to preserve future fertility. Transvaginal ultrasound constitutes the primary imaging modality for identifying RPOC, but the lack of standardized diagnostic criteria complicates clinical decision-making. This narrative review explores the current literature on sonographic findings associated with RPOC, focusing on the diagnostic value of endometrial thickness (ET), the presence of intrauterine echogenic masses, and the use of Color Doppler imaging. Although an ET ≥15 mm is frequently used to suspect RPOC, the variability in cut-off thresholds and limited specificity reduce its diagnostic reliability. The detection of an echogenic intrauterine mass appears to be the most sensitive and specific sonographic feature. Color Doppler assessment, particularly the presence of enhanced myometrial vascularity (EMV) and classification systems like the Gutenberg score, offers further insight by stratifying hemorrhagic risk and guiding therapeutic choices. However, vascular parameters such as peak systolic velocity (PSV) and resistive index (RI) demonstrate a substantial overlap between benign and pathological conditions, limiting their stand-alone utility. The review also addresses the differential diagnosis of RPOC, including blood clots, arteriovenous malformations, placental polyps, gestational trophoblastic disease, and endometrial osseous metaplasia. The role of three-dimensional ultrasound remains limited in clinical practice, offering no significant advantage over two-dimensional imaging. Finally, the timing of follow-up ultrasound after medical treatment with misoprostol is critical: delayed assessment reduces overtreatment by allowing time for spontaneous resolution. In conclusion, despite advances in ultrasound technology, the diagnosis of RPOC remains challenging due to heterogeneity in imaging findings and inter-observer variability. A multimodal approach integrating grayscale and Doppler ultrasound with clinical evaluation is essential for optimal management. Full article

Background: Functional massage is a soft tissue intervention that combines tissue compression with specific joint movements to enhance muscle function, improve joint mobility and reduce pain. The physical working capacity at the fatigue threshold (PWC_FT) uses surface electromyography to determine the highest exercise intensity that can be sustained indefinitely. The purpose of this study, therefore, was to examine the influence of FM on a multi-joint exercise such as cycle ergometry. Methods: Twelve healthy college-aged men volunteered for the current study. On two occasions, separated by seven days and in randomized order, subjects either completed a 14 min FM on both legs prior to an incremental cycle ergometer test to determine PWC_FT, or rested for 14 min before performing the same cycling test. Results: The paired samples t-tests revealed a significant (p < 0.05) difference for the absolute and relative PWC_FT values between the no-FM and FM conditions. Conclusions: These results indicate that FM may delay the onset of neuromuscular fatigue for whole-body exercise. Full article

Objective: We aimed to quantify the mechanical pressure required to reach the deep cervical and thoracolumbar fasciae, to examine its association with pressure pain threshold (PPT) and adipose tissue thickness, and to determine whether PPT and adipose tissue thickness can predict the mechanical pressure needed to reach the fascia. Methods: Forty-three subjects’ PPT, mechanical pressure and skinfold in the trapezius and lumbar regions were evaluated using an algometer, an ultrasound scanner, and an adipometer. The Wilcoxon test, Student’s t-test, and Pearson and Spearman’s correlation tests were used (p < 0.05). Results: The values of mechanical pressure in the cervical and lumbar regions were 6.06 ± 0.186 N/cm² and 5.85 ± 5.280, 7.287 N/cm², respectively. PPT values were 18.88 ± 0.917 N/cm², and 46.46 ± 2.408 N/cm², respectively (p < 0.001), and the adipose tissue thickness values in the cervical and lumbar regions were 0.88 ± 0.675 cm, 1.08 and 1.48 ± 0.069 cm (p < 0.001). There was no correlation between the variables in either region under study. Conclusions: The mechanical pressure required to reach the deep cervical and thoracolumbar fasciae was similar with an average value of approximately 6 N/cm², suggesting a consistent mechanical response across these anatomical regions. Mechanosensitivity and subcutaneous adipose tissue thickness did not influence the mechanical pressure needed to access the deep fascial tissue. Full article

Background: Chemotherapy-induced neuropathic pain is a major side effect of antineoplastic treatment. This study investigated the neuroprotective potential of Acmella oleracea L. extracts containing the N-alkylamide spilanthol, phenolic acids, and glycosylated flavonoids. Methods: Hydroalcoholic extracts of aerial parts (AP) and roots (R) of in vitro seedlings were quali-quantitatively characterized by HPLC-DAD-MS and by ¹H-NMR. Different concentrations (15–150 µg/mL) of AP and R were tested in SH-SY5Y cells differentiated into neurons exposed to oxaliplatin (10 µM), assessing cell viability (MTT), cytotoxicity (LDH), SOD activity, and expression of ATF-3, Ire1α, and Nf-H genes. To evaluate the impact on neuropathic pain, CD-1 mice were treated intraperitoneally with oxaliplatin (2.4 mg/kg), the effect of AP and R extracts (200–1200 mg/kg) were measured by the cold plate test. Results: AP extract was rich in phenols and alkylamides, whereas R extract showed higher phenolic levels but lower alkylamides content. Both extracts significantly reduced mortality and cytotoxicity and counteracted oxidative imbalance by enhancing SOD activity. Gene expression analysis confirmed their neuroprotective effects. In vivo, oxaliplatin induced a 50% reduction in pain threshold, while acute treatment with AP and R extracts dose-dependently alleviated neuropathic pain. Despite the lower spilanthol content in R extract, its efficacy was comparable to AP, suggesting an important role of phenolic compounds. Conclusions: Extracts from both aerial parts and roots of A. oleracea show promise in alleviating chemotherapy-induced neuropathy through mechanisms not solely related to spilanthol. Further studies to elucidate the contribution of phenolic components are desirable. Full article

Background/Objectives: Sarcopenia is defined by the progressive loss of muscle mass, strength, and/or physical performance associated with aging. Radiofrequency ablation (RFA) of the medial branch nerves is a well-established and effective treatment for lumbar facetogenic pain. While sarcopenia is associated with poor outcomes following epidural steroid injections and lumbar spine surgeries, its impact on clinical outcomes in patients undergoing RFA for facetogenic pain remains unexplored. This study aims to evaluate the influence of sarcopenia on treatment outcomes in this patient cohort. Methods: Patients were classified into sarcopenia (n = 35) and non-sarcopenia groups (n = 67) based on predefined psoas muscle index (PMI) thresholds. The primary outcomes included changes in back pain intensity and the proportion of responders at 1, 3, and 6 months following RFA. The secondary outcome was to identify demographic, clinical, and sarcopenia-related factors predictive of treatment response at each follow-up interval. Results: Both groups demonstrated statistically significant improvements in pain scores compared to baseline at all follow-up points. However, the median pain scores at 3 months post-RFA remained significantly higher in the sarcopenia group. Despite this, the proportion of responders did not differ significantly between the two groups at any time point. At 3 months, the absence of prior spinal surgery was identified as a significant predictor of treatment response. At 6 months, favorable outcomes were significantly associated with the absence of diabetes, no history of spinal surgery, and a higher PMI. Conclusions: Sarcopenia may influence the extent of pain improvement following medial branch nerve RFA. Additionally, patient-specific factors, such as diabetes, prior spinal surgery, and PMI, should be considered when predicting treatment outcomes. Full article

Aim: To compare diabetic polyneuropathy (DPN) and cardiac autonomic neuropathy (CAN) between T1DM and T2DM patients. Methods: This study enrolled 66 T1DM and 79 T2DM patients. DPN was evaluated using three different methods: clinical examination, using neuropathy symptom score (NSS) and neuropathy disability score (NDS), current perception threshold (CPT) using Neurometer, and nerve conduction studies (NCSs). CAN was assessed by cardiovascular autonomic reflex tests (CARTs). Results: The prevalence of DPN did not differ between T1DM and T2DM (p > 0.05 for all), however, the proportion of DPN depended on the method used and was highest with CPT (53.0% vs. 46.8%), followed by NCSs (44.1% vs. 41.2%) and clinical examination (25.8% vs. 31.6%). T2DM vs. T1DM patients were more often diagnosed with painful DPN (51.9% vs. 27.3%, p = 0.004), reduced perception of vibration (72.2% vs. 48.5%, p = 0.006), and autonomic neuropathy (59.5% vs. 32.3%, p = 0.001), while NCSs revealed more prevalent motor nerve dysfunction in T1DM compared to T2DM (41.2% vs. 19.6%). Multivariate regression analysis showed increased DPN risk with age and CAN risk with worsening of eGFR in T1DM. No significant associations remained after multivariate adjustment for T2DM. Conclusions: The prevalence of DPN is highly varied and depends on the diagnostic method used. T2DM patients more often had symptoms and signs of diabetic neuropathy. However, stronger associations with risk factors were observed in T1DM. Full article

Objectives: This study aimed to investigate the efficacy of Percutaneous Electrolysis (PE), Percutaneous peripheral Nerve Stimulation (PNS), and Eccentric Exercise (EE) in patients with supraspinatus tendinopathy. Methods: Forty-six participants with supraspinatus tendinopathy were randomly allocated to either an invasive therapy group (four sessions in four weeks of PE+PNS and EE program) or a conventional physical therapy group (ten sessions for 2 weeks). The multimodal physical program included Ultrasound therapy (US), Transcutaneous Electric Nerve Stimulation (TENS) and the same EE program. The Numerical Pain Rating Scale (NPRS), shoulder Range of Motion (ROM), Pressure Pain Threshold (PPT), and disability (DASH and SPADI) were measured at baseline, at the end of treatment, and at 12- and 24-weeks follow-up. Results: The PE+PNS+EE group demonstrated consistently greater and statistically significant improvements across nearly all pain, mobility, and functional outcomes at all follow-up points (post-treatment, 12-weeks, and 24-weeks) compared to the TENS+US+EE group, with generally medium to large effect sizes. Conclusions: This study concludes that the combined PE+PNS+EE intervention offers safe and effective treatment for supraspinatus tendinopathy, demonstrating statistically significant improvements in pain, mobility, and function compared to conventional electrotherapy. Full article