Search Results (293)

The management of traumatic brain injury remains one of the greatest challenges in modern medicine. Determining whom to treat, when to intervene, and how aggressively to proceed and persist continues to define the central dilemma of neurotrauma care. While the injured brain possesses only limited regenerative capacity, substantial opportunity remains to mitigate the cascade of secondary brain injury. Previous technological and scientific advances have progressively challenged the therapeutic nihilism historically associated with severe neurotrauma, and the accelerating pace of innovation is invigorating efforts to push the boundaries of care. Contemporary neurotrauma research increasingly seeks to reduce the incidence of injury through prevention, enable ultra-early diagnosis and intervention, biologically subclassify heterogeneous injury patterns, and integrate multimodal neuromonitoring into precision-guided therapeutic strategies. Advances in artificial intelligence, computational modelling, imaging, biomarker science, and neurocritical care now build upon decades of foundational work established by prior generations of clinicians and scientists. Together, these developments may enable increasingly individualised approaches to neurotrauma management, with the aim of preserving meaningful neurological function, quality of life, and human potential on a global scale. Although many challenges remain, modern neurotrauma increasingly stands at the threshold of such transformation. This narrative review explores the emerging technologies, evolving paradigms, and future directions that may shape the next era of neurotrauma care. Full article

Traumatic spinal cord injury (SCI) is a catastrophic condition associated with profound neurologic disability, psychosocial disruption, high long-term healthcare utilization, and reduced life expectancy. Globally, SCI remains a major cause of morbidity, most commonly resulting from traumatic mechanisms such as motor vehicle collisions and falls, with a bimodal age distribution affecting both younger adults and older individuals. This narrative review provides a comprehensive, clinically oriented overview of SCIs with emphasis on classification, initial evaluation, imaging, and contemporary management strategies. The review highlights the dual-phase pathophysiology of SCIs—primary mechanical insult followed by secondary injury cascades—underscoring the rationale for rapid stabilization and timely, injury-specific interventions. Initial care is framed around immobilization and trauma resuscitation principles, with cervical spine clearance guided by validated decision tools and early, appropriate imaging acquisition. We discuss adjunctive imaging considerations and address the ongoing debate regarding MRI use in obtunded patients with negative initial studies. Acute inpatient management priorities include prevention of secondary complications, hemodynamic optimization, respiratory support, and vigilant surveillance for autonomic dysfunction. Pharmacologic neuroprotection with high-dose methylprednisolone remains controversial; current guideline recommendations are reviewed. Finally, we outline operative decision-making and evidence supporting early decompression in selected patients, as well as common surgical approaches and their indications. This review consolidates foundational concepts and current standards to support practical, evidence-informed SCI evaluation and management. Full article

Background and Objectives: Cardiovascular disease remains the leading cause of premature mortality worldwide. Subclinical glucose dysregulation, a contributor to accelerated vascular aging, is undetectable by conventional screening in apparently healthy individuals; even within the normal glycemic range, postprandial glucose excursions promote endothelial injury and inflammatory pathways independently of mean glucose levels. Hypothesis: Continuous glucose monitoring (CGM)-guided metabolic phenotyping, combined with personalized dietary optimization, structured fasting protocols, and selective longevity-oriented pharmacotherapy, constitutes a mechanistically coherent, hypothesis-generating preventive strategy that may attenuate cardiovascular risk and biological aging in apparently healthy non-diabetic adults, pending confirmation in prospective outcome trials. Materials and Methods: This narrative review synthesizes evidence from prospective cohort studies, randomized controlled trials, and mechanistic investigations connecting CGM-guided metabolic assessment with preventive cardiology and the emerging field of longevity medicine, focusing on glycemic variability biology, nutrient-sensing pathways, and the cardiovascular and longevity profiles of low-dose metformin and acarbose. Results: CGM-derived metrics capture inter-individual glycemic variability invisible to standard assessments and provide behavioral feedback for dietary personalization. Structured fasting and low-dose metformin converge on shared nutrient-sensing pathways implicated in both vascular aging and longevity, with CGM enabling objective confirmation of metabolic adaptation. Acarbose has shown cardiovascular and lifespan benefit signals in secondary trial analyses and preclinical longevity models, though these findings require replication and are not yet established in non-diabetic populations. Conclusions: We propose a four-phase research framework integrating CGM metabolic phenotyping, dietary optimization, fasting titration, and selective pharmacological augmentation for apparently healthy adults at cardiovascular risk. Prospective hard-endpoint trials are lacking, and this framework should be regarded as hypothesis-generating rather than an established clinical strategy, warranting rigorous outcome-based evaluation before clinical adoption. Full article

Background: Non-missile penetrating traumatic brain injury (pTBI) is a rare but life-threatening condition. In self-inflicted cases involving the frontal sinus, a rigorous preoperative diagnostic workup is crucial to assess foreign body fragmentation, trajectory, and potential vascular compromise. The complexities of such cases demand a highly structured approach to prevent severe secondary brain injury and long-term infectious sequelae. Case Presentation: A 36-year-old male with schizophrenia presented after attempting suicide by stabbing a kitchen knife through his frontal sinus. Multimodal diagnostic imaging was immediately employed. Skull radiographs and computed tomography (CT) precisely delineated the blade traversing the frontal sinus and entering the anterior cranial fossa. Crucially, given the proximity to the skull base, digital subtraction angiography (DSA) was proactively performed, which confirmed the absence of major cerebrovascular injury and safely guided the surgical strategy. Based on these precise imaging findings, a bifrontal craniotomy was performed. During the procedure, the main blade was extracted, and a retained broken metallic tip—recognized upon close intraoperative inspection of the extracted blade—was successfully retrieved from the intracranial compartment. Postoperative wound infections (with causative pathogens isolated as Serratia odorifera and coagulase-negative Staphylococci) were effectively eradicated with targeted antibiotics. The patient achieved a favorable neurological recovery. Conclusions: Multimodal neuroimaging, particularly the combination of CT and DSA, can be highly beneficial in the diagnostic workup of complex pTBI. Precise preoperative imaging helps guide the optimal surgical approach, ensuring complete foreign body removal and minimizing severe secondary complications. Early intervention, guided by standardized imaging and followed by aggressive medical management, can yield positive outcomes even in severely morbid presentations. Full article

Hypertriglyceridaemia (HTG) is an increasingly recognised aetiology of acute pancreatitis (AP), driven by the global rise in metabolic disorders. Although traditionally defined by triglyceride levels ≥ 1000 mg/dL, emerging evidence suggests a continuum of risk in which both genetic predisposition and secondary metabolic stressors contribute to disease onset and severity. Mechanistically, HTG-AP is characterised by lipotoxic injury mediated by free fatty acids, microcirculatory dysfunction, and amplified inflammatory responses, resulting in increased risk of organ failure and recurrence compared with AP of other aetiologies. Recent guideline updates emphasise early risk stratification, goal-directed supportive care, and prompt identification of underlying causes; however, HTG-specific management strategies remain heterogeneous. While insulin therapy and extracorporeal lipid removal techniques (e.g., plasmapheresis) are widely used, high-quality evidence supporting their superiority is limited. Long-term prevention relies on aggressive lipid control and modification of metabolic risk factors. This review provides a comprehensive synthesis of the aetiology, pathophysiology, clinical characteristics, and management of HTG-AP, highlighting recent advances, ongoing controversies, and future directions towards precision medicine. Full article

The rising burden of diabetic kidney disease (DKD) and its associated lipid abnormalities underscores the need for new mechanistic insights. Uromodulin, a kidney-enriched protein, has been associated with metabolic disorders in human studies, yet its functional role in systemic lipid metabolism remains elusive. In this study, transcriptomic datasets were analyzed to investigate uromodulin expression and biological function in DKD. Subsequently, a diabetic model was induced in UMOD^+/+ and UMOD^−/− rats using a combination of a high-fat diet, unilateral nephrectomy, and streptozotocin to assess renal and metabolic phenotypes. Public RNA-seq data indicated that uromodulin expression was downregulated in DKD and was enriched in the fatty acid metabolism pathway. At baseline, UMOD^−/− rats resembled UMOD^+/+ rats in terms of growth, routine serum lipids, and major organ function. However, in diabetes, UMOD^−/− rats exhibited higher mortality and pronounced hyperlipidemia. Hyperlipidemia occurred prior to the onset of renal dysfunction. Of note, this exacerbated lipid dysregulation represented a lipodystrophy-like phenotype rather than secondary changes in the pancreas, liver, or circulating cytokines (IL-6, IL-1β, and TNF-α). Moreover, UMOD^−/− rats displayed exacerbated tubular injury and enhanced renal lipid accumulation in DKD relative to UMOD^+/+ rats. Collectively, uromodulin protects diabetic rats from death, prevents epididymal white adipose tissue from browning, and attenuates kidney injury. Our findings identify uromodulin as a novel regulator of the kidney–adipose axis. Full article

Background: Intraoperative vascular injuries during elective hip and knee arthroplasty are uncommon but limb-threatening complications. Real-world evidence on emergency on-call vascular management in this setting remains limited. We aimed to identify the intraoperative ischemia time threshold associated with progression to a more severe ischemic presentation (Rutherford IIb) at vascular consultation, in order to support early multidisciplinary activation and prevent irreversible ischemic limb damage. As a secondary aim, we described the clinical spectrum, treatment strategies, and 30-day outcomes of patients managed by a 24 h on-call vascular service (in-hospital coverage during working hours, formal on-call rota out of hours). Non-ischaemic events recorded in the series (e.g., isolated venous injuries and haemorrhagic complications) are documented as part of the overall clinical spectrum but were not the subject of specific time-related analysis. Methods: Single-centre retrospective analysis of 33 consecutive patients undergoing emergency vascular intervention for vascular injury during elective total knee (TKA) or total hip arthroplasty (THA) at a tertiary orthopaedic referral centre in Milan, Italy (January 2023—December 2025). The primary analytical objective was to identify the intraoperative ischemia time threshold associated with Rutherford IIb presentation at vascular consultation; 30-day limb salvage was the primary clinical outcome. Secondary outcomes included technical success, primary 30-day patency, postoperative ankle–brachial index (ABI), length of stay, and Clavien–Dindo complications. Non-ischaemic events (including isolated venous injuries and haemorrhagic complications) are documented as part of the clinical spectrum but were not subject to specific time-related analysis. Receiver operating characteristic (ROC) analysis assessed the discriminative role of intraoperative ischemia time for a Rutherford IIb presentation; univariate logistic regression explored predictors of postoperative complications. Results: Thirty-three patients (mean age 76.3 ± 6.3 years; 54.5% female; ≥2 comorbidities in 81.8%) underwent emergency vascular repair after TKA (60.6%) or THA (39.4%). Injuries were mixed arteriovenous (54.5%), purely venous (24.2%), or purely arterial (21.2%). Mean call-to-incision time was 45.4 ± 11.3 min. In the 25 ischemic cases, the mean intraoperative ischemia time was 130.4 ± 18.7 min. ROC analysis identified an optimal cut-off of 131 min for Rutherford IIb (AUC 0.851, 95% CI 0.679–0.982; p < 0.001), with sensitivity 81.8% and specificity 85.7%. Median ischemia time was significantly higher in IIb than IIa cases (144 vs. 124.5 min; p = 0.003). Technical success and 30-day limb salvage were 100% (95% CI 89.6–100); mean postoperative ABI 0.89 ± 0.03; primary 30-day patency 88.0% (95% CI 70.0–95.8), with secondary patency 100%. All postoperative complications were Clavien–Dindo grade 1; no Clavien–Dindo ≥ 2 events and no 30-day mortality were observed. Conclusions: A dedicated 24 h on-call vascular service achieves excellent 30-day limb salvage and patency in iatrogenic vascular injuries occurring during arthroplasty. An intraoperative ischemia threshold of 131 min identifies higher-risk presentations and supports rapid multidisciplinary activation in high-volume orthopaedic centres. Full article

Background/Objectives: Despite the growing popularity of specialised training interventions aimed at developing motor abilities relevant to combat sports, scientific evidence regarding their effectiveness in Brazilian Jiu-Jitsu (BJJ) remains limited. This study aimed to estimate the effects of the experimental Grappler Quest (GQ) training program on the motor fitness profile of BJJ athletes and to explore whether training experience was associated with the magnitude of training-related changes. Methods: In this randomised trial, 44 competitive male BJJ athletes were allocated to an experimental group (EXP; n = 22) or a control group (CON; n = 22). Both groups followed an 8-week training protocol: the EXP group performed the structured GQ program, consisting of small circuit-based workouts, including resistance, plyometric, gymnastic, and BJJ-related exercises, whereas the CON group followed a standard BJJ training cycle. The motor profile was assessed before and after the intervention (pretest vs. posttest) using selected motor tests. The prespecified primary outcomes were strength-endurance performance in the bench press and squat performed with 50% body mass. Other motor-performance outcomes were treated as secondary or exploratory. Associations between training experience and intervention-related changes were analysed exploratorily. Results: ANCOVA of adjusted post-intervention means indicated between-group differences favouring the EXP group. Large effects were observed for the primary strength-endurance outcomes: bench press at 50% body mass (η² = 0.52) and squat at 50% body mass (η² = 0.40). Large effects were also observed for selected secondary outcomes, including pull-ups with a judogi (η² = 0.39), trunk flexibility (η² = 0.49), and maximal straddle sitting position (η² = 0.37) (all p < 0.001). After Benjamini–Hochberg false discovery rate adjustment, most between-group differences remained statistically significant, although secondary outcomes should be interpreted cautiously. In EXP, improvements were observed across multiple outcomes, including 1RM bench press (mean gain $\tilde{\mathrm{x}}$ = 5.23 kg), 1RM squat ($\tilde{\mathrm{x}}$ = 4.27 kg), pull-ups ($\tilde{\mathrm{x}}$ = 1.91 reps), judo-gi hangs (bent arms $\tilde{\mathrm{x}}$ = 3.91 s; straight arms $\tilde{\mathrm{x}}$ = 4.90 s), and flamingo balance ($\tilde{\mathrm{x}}$ = 4.59 s) (all p < 0.001). In the EXP group, exploratory correlations suggested that shorter training experience was generally associated with greater conditioning-related improvements, whereas flexibility and balance showed the opposite pattern. Conclusions: The GQ intervention package was associated with greater improvements in the motor fitness profile than standard BJJ training. The findings support the potential usefulness of structured circuit-based conditioning as an adjunct to standard BJJ practice, particularly for strength-endurance development. However, the study does not allow the isolated effect of the specific GQ exercise content to be separated from the effect of adding a structured conditioning block, and no direct conclusions can be drawn regarding injury prevention or return-to-play outcomes. Full article

Background/Objectives: Improving the prevention and management of pressure injuries requires adequate nursing knowledge. In this context, understanding the current knowledge levels of nurses is important for informing educational and organizational strategies. This study aimed to assess the pressure injury knowledge of nurses at the national level and examine differences according to their educational, professional, and informational characteristics. Methods: A national cross-sectional quantitative study was conducted in public secondary-level hospitals in the Republic of Croatia. A total of 1139 participants from 19 hospitals across all four geographical regions of Croatia participated. The PZ-PUNKT instrument was used, and an analysis was conducted using descriptive and bivariate inferential statistics. Results: Participants with bachelor’s and master’s degrees achieved higher PZ-PUKT scores than those with secondary education (p = 0.026 to < 0.001), although the effect sizes were very small (ε² = 0.008–0.017). Significant differences were observed across clinical departments (p < 0.001; ε² = 0.03–0.04), whereas no statistically significant differences were found according to the frequency of working with patients with pressure injuries (p > 0.05). Participants who reported recently attending educational activities, consulting the professional literature, or searching for information achieved higher knowledge scores across all domains (p < 0.001); however, the effect sizes remained small (ε² = 0.034–0.060; rpb = 0.133–0.214). Conclusions: Although the observed effect sizes were generally small, higher knowledge scores were observed among nurses who reported recent engagement with educational activities, the professional literature, and information-seeking behaviors. No significant differences were identified according to the frequency of working with patients with pressure injuries. These findings provide a national overview of pressure injury knowledge among Croatian nurses and may inform future educational initiatives and research. Full article

Cytomegalovirus (CMV) is a major determinant of post-transplant morbidity in solid organ transplant recipients, not only through direct viral disease but also through a broad spectrum of indirect effects that may adversely influence graft and patient outcomes. This review summarizes current clinical and mechanistic evidence regarding the mechanisms of CMV-associated indirect injury in transplantation, drawing on human observational studies together with supporting in vitro and animal-model data. CMV establishes lifelong latency with intermittent reactivation and exerts sustained immunomodulatory effects on both innate and adaptive immunity, which may persist even during low-level viral replication. The mechanisms discussed include monocyte reprogramming, altered antigen presentation, T-cell and natural killer cell dysregulation, endothelial activation and dysfunction, chronic inflammatory signaling, impaired antimicrobial defense, and disturbances in metabolic regulation. The review considers how these mechanisms have been proposed to translate into major post-transplant complications, including acute rejection, chronic allograft dysfunction, cardiovascular and thrombotic disease, post-transplant diabetes, and increased susceptibility to secondary bacterial, fungal, and viral infections. It also addresses current preventive strategies, although evidence regarding their effectiveness in reducing indirect clinical outcomes remains limited and largely observational. Much of the supporting evidence is associative, and the contribution of CMV is often difficult to separate from that of the overall immunosuppressive burden and the comorbidities of transplant recipients. With these considerations, the available evidence supports regarding CMV not merely as an opportunistic pathogen, but as a persistent immunobiological driver of long-term transplant injury. Improved understanding of these indirect effects may enhance risk stratification, support biomarker-guided prevention, and inform future strategies aimed at reducing long-term graft dysfunction and patient morbidity after transplantation. Full article

Injuries of the gastrocnemius muscle and the common calcaneal tendon in dogs require effective stabilization of the tarsocrural joint to allow proper healing and prevent mechanical overload. This report described a novel minimally invasive technique for temporary internal tarsal stabilization using synthetic tape in two dogs. No comparison with other stabilization techniques was carried out. Both dogs presented with hindlimb lameness and partial plantigrade stance secondary to a subtotal injury of the lateral myotendinous gastrocnemius, and were treated without primary tenorrhaphy. Internal stabilization was achieved by placing polypropylene tape (Bühner’s tape) between the tibial tuberosity and the calcaneus, acting as a flexion-limiting device. A clinical, radiographic, and ultrasonographic follow-up was carried out for 5–9 months. Both dogs showed progressive clinical improvement with restoration of near-normal tarsal angles. Ultrasonography demonstrated progressive healing with fibrous tissue bridging the myotendinous junction. No major complications or radiographic signs of osteoarthrosis were observed. This technique may represent a promising option for selected cases; however, additional studies are needed to compare it with established external or rigid internal fixation methods. Full article

Background: Spinal deformities in children represent a relevant public health issue, with possible long-term consequences. Timely identification of their determinants is essential for adequate prevention. Methods: This study was a secondary analysis of data from the 2019 Serbian National Health Survey, including 1309 children aged 5–14 years. Logistic regression with LASSO regularization and multiple ML algorithms were tested, with XGBoost selected as the optimal model. Class imbalance was addressed using class weighting and SMOTE. Model interpretability was achieved using SHAP analysis. Results: The prevalence of spinal deformities was 8.6%. Univariable analyses showed that age, poorer self-rated health, chronic illness, recent injuries, and pes planus were significantly associated with spinal deformities. Family-related variables showed no significant associations. Among the evaluated models, XGBoost demonstrated the most stable performance across the applied evaluation metrics and the best balance between predictive performance and interpretability. SHapley Additive exPlanations (SHAP) analysis showed that pes planus was the strongest determinant, followed by age and chronic illness, while socio-demographic and family factors had minimal influence. Conclusion: Explainable machine learning models, particularly XGBoost combined with SHAP, can allow for the identification and interpretation of key determinants of spinal deformities in children. Pes planus was shown to be modifiable and relevant associated determinant, supporting its importance in early screening and preventive strategies. Full article

Background: Obstetric anal sphincter injuries (OASIS) are a major cause of long-term maternal morbidity. Identification of risk factors is central to prevention strategies. Methods: A retrospective cohort study was conducted including all singleton, term, cephalic vaginal births over a four-year period (September 2018 to September 2022) at a UK tertiary maternity unit. OASIS was defined as third- or fourth-degree perineal tears according to RCOG criteria. Multivariable logistic regression analysis was used to identify independent predictors. A pre-specified sensitivity analysis restricted to nulliparous women was performed. Secondary outcomes included postpartum haemorrhage (PPH), defined as blood loss >1 L. Reporting follows the STROBE statement for cohort studies. Results: Among 9586 vaginal births, 270 OASIS cases were identified, corresponding to an incidence of 2.82%. Independent predictors included nulliparity (aOR 7.12, 95% CI 5.07–10.01), Asian ethnicity (aOR 3.50, 95% CI 2.55–4.81), shoulder dystocia (aOR 3.45, 95% CI 1.89–6.32), and birthweight ≥4000 g (aOR 1.85, 95% CI 1.16–2.95). Maternal age ≥35 years showed a borderline association (aOR 1.34, 95% CI 0.99–1.80, p = 0.056). Using forceps as the reference, ventouse (aOR 0.28, 95% CI 0.17–0.47) and spontaneous vaginal delivery (aOR 0.23, 95% CI 0.13–0.39) were associated with lower OASIS odds. Episiotomy (recorded as a binary variable) was associated with lower adjusted odds of OASIS (aOR 0.27, 95% CI 0.17–0.44). PPH occurred in 21.5% of women with OASIS versus 6.5% without (p < 0.001). Conclusions: OASIS risk is driven by a combination of maternal, fetal, and intrapartum factors. Selective mediolateral episiotomy was associated with lower adjusted odds of OASIS in this cohort, but this is an observational finding and does not constitute proof of a causal protective effect. It should be interpreted cautiously given the retrospective design, the recording of episiotomy as a binary variable without procedural detail, and the substantial potential for residual confounding by indication. The findings support targeted perineal protection strategies and selective rather than routine episiotomy use. Full article

Severe traumatic brain injury (TBI) is one of the leading causes of mortality and disability worldwide. To date, there are no clinically effective neuroprotective agents. Biomaterials that combine structural support for damaged tissue with a depot for therapeutic agents may represent a key solution to this problem. To evaluate the neuroprotective potential of a collagen matrix derived from the jellyfish Rhizostoma pulmo (R. pulmo) and modified with sodium thiosulfate (Na₂S₂O₃) as an hydrogen sulfide (H₂S) donor in a bioengineered platform for the treatment of severe TBI. Comprehensive characterization of the collagen matrix (electrophoresis, fluorescence microscopy), its implantation in a mouse model of severe TBI, and subsequent morphological, histological, ultrastructural, and immunohistochemical analyses of connexin 43 (Cx43) and p53 protein (p53) were performed. In addition, molecular dynamics simulations of the interactions between sulfur-containing compounds and target proteins were conducted. The effects were compared with inhibition of endogenous H₂S synthesis using aminooxyacetic acid (AOAA). The collagen matrix retains the properties of type I collagen and forms a three-dimensional porous structure with high hydrophilicity and biocompatibility. Implantation ensures effective defect filling, reduces cystic degeneration, and preserves cortical structure. Modification with Na₂S₂O₃ results in a significant reduction in both nuclear and cytoplasmic accumulation of p53, prevention of Cx43 dysregulation, a decrease in the proportion of damaged neurons and inflammatory infiltration, and preservation of tissue ultrastructure. In contrast, inhibition of CBS with AOAA exacerbates pathological changes. Molecular modeling demonstrated that S₂O₃²⁻ is capable of forming stable electrostatic interactions with domains of p53 and Cx43 under conditions of acidosis and elevated Ca²⁺. A collagen matrix derived from R. pulmo and modified with Na₂S₂O₃ represents a promising biodegradable platform that combines structural support with local H₂S-dependent regulation of key mechanisms of secondary brain injury. This approach provides a multilevel neuroprotective effect and opens new opportunities for the development of therapeutic implants for severe TBI. Full article

Objectives: Karting imposes high neuromuscular demands on the forearm during dynamic steering, gripping and braking. This study examined whether a single high-velocity, low-amplitude (HVLA) manipulation of the elbow acutely modified surface EMG_RMS amplitude and EMG median frequency responses during standardized isometric forearm testing after simulated karting load, rather than EMG activity during dynamic driving itself. Methods: In this randomized, sham-controlled, within-subject trial, 15 drivers completed a single-session within-participant protocol in which one upper limb was randomly allocated to receive elbow HVLA manipulation (manipulated limb) and the contralateral limb received a standardized sham procedure (sham limb) involving therapist contact and low-grade oscillatory movement without end-range pre-tension or thrust. Drivers completed two 8 min simulated races separated by the allocated manual procedure. Surface electromyography (EMG) from four forearm muscles was collected outside the karting task during standardized laboratory-based isometric forearm contractions at baseline, after race 1, post-intervention, and after race 2. EMG was not recorded during real-time steering, braking, vibration exposure or competitive driving. The extensor carpi radialis (ECR) was specified as the principal muscle of interest because the HVLA technique pre-tensioned the common extensor origin and radial wrist extensors. The primary outcome was ECR mean EMG_RMS amplitude, expressed in µV, across the four measurement time points; the primary statistical test was the condition × time interaction. ECR maximal EMG_RMS amplitude and ECR median frequency were treated as secondary outcomes, whereas ECU, FCR, and FCU outcomes were treated as exploratory anatomical specificity outcomes. Mixed-model ANOVAs compared maximal and mean EMG amplitudes and median frequency between manipulated and sham limbs, treating limb condition and time as repeated within-participant factors. Results: For the primary outcome, ECR mean EMG_RMS amplitude showed a main effect of condition (p = 0.023) and a condition × time interaction (p < 0.001). As a secondary amplitude outcome, ECR maximal EMG_RMS amplitude showed a main effect of time (p = 0.009) and a condition × time interaction (p < 0.001), with higher post-manipulation values in the manipulated limb. No consistent limb-condition effects were found for the other muscles, and EMG median frequency showed only modest time-related changes (p = 0.031) without between-condition differences. Conclusions: A single-elbow manipulation produced short-lived, muscle-specific increases in ECR activation after simulated racing, whereas broader neuromuscular changes were not evident. These findings indicate only transient modulation of ECR surface EMG amplitude in a small sample of screened karting drivers and do not demonstrate improved recovery, neuromuscular efficiency, sport performance, or injury prevention. Because EMG was assessed during standardized isometric contractions rather than during dynamic steering, braking, vibration exposure or competitive racing, the findings should not be interpreted as direct evidence of altered neuromuscular behaviour during actual kart driving. Larger studies including force, performance, clinical, fatigue-specific and dynamic driving EMG outcomes are required. Full article