Many children with autism spectrum disorder (ASD) have altered sensory processing - including auditory sensory over-responsivity (SOR). Few treatment options exist for children with ASD and auditory SOR. This study investigated whether music-based auditory stimulation (The Listening Program® SPECTRUM with Waves™ bone conduction headphones), could reduce auditory SOR, sensory dysfunction, and behaviors common to children with ASD and improve adaptive functioning. Six boys between the ages of 5 and 10 with ASD and auditory SOR completed listening sessions at home for 40 wk. Participants had statistically significant improvements in the Hearing construct of the Sensory Processing Measure that were sustained 3 months post-intervention. Participants also had significant improvements across multiple other sensory constructs, social skills, and communication skills. This study provides support for The Listening Program® SPECTRUM with Waves™ bone conduction headphones to improve sensory processing and reduce hypersensitivity to sound, which may lead to better social and communication skills for children with ASD and auditory SOR. Larger, randomized-controlled studies are needed.
Tobacco is a globally significant agricultural commodity, in which analytical chemistry plays a pivotal role for quality assessment. This study aimed to develop an integrated analytical strategy to decipher the quality traits of flue-cured tobacco cultivars. An integrated framework combining sensory evaluation, biochemical characterization, and volatile organic compound (VOC) profiling was applied to eleven flue-cured tobacco cultivars. Statistical analyses included hierarchical cluster analysis (HCA) and partial least squares-discriminant analysis (PLS-DA) based on VOC data, and Spearman correlation analysis (with Bonferroni correction) to explore relationships between sensory attributes, biochemical components, and VOCs. Sensory analysis categorized the cultivars into two groups: Group I (YN228, YN105, YN223, GY20, and YN87) scored higher in aftertaste, offensive taste, and moistness, while Group II (YN222, XY7, NC103, TZ113, GY2, and XZ01) excelled in aroma quality and cleanness. Biochemical profiling also revealed two distinct groups: Group I (YN228, TZ113, NC103, and YN87) had higher nitrogen and alkaloid contents, whereas Group II (YN222, XY7, GY20, XZ01, GY2, YN105, and YN223) exhibited elevated sugar and potassium levels. VOC-based HCA and PLS-DA identified three chemical clades and highlighted 75 VOCs (VIP > 1.0) as key differentiators. Significant correlations were established between biochemical components and sensory attributes; notably, total sugar content was positively correlated with irritancy, aroma quality, and smoke concentration. Specific VOCs, such as (furan-2-yl)methanol and 3-oxo-α-ionol, showed significant positive correlations with moistness and smoke concentration, respectively, while phenol was negatively correlated with aroma quality. This study establishes a reproducible sensory-omics framework that provides a robust analytical foundation for the quality assessment of agricultural products. The findings demonstrate the practical value of integrated analytical approaches in addressing complex quality assessment challenges, offering actionable insights for the evaluation and potential improvement of tobacco cultivars.
The anterolateral thigh flap (ALT) is a reliable soft tissue reconstruction option, especially for lower extremity defects. Recent advancements in flap innervation methods show promise in promoting sensory recovery, yet the current literature lacks a comprehensive summary of its outcomes. A systematic review of PubMed, Embase, Web of Science, and Scopus was performed by identifying all studies examining sensory recovery outcomes in lower extremity reconstruction using innervated ALT flaps. Of 793 unique articles, eight studies (n = 206 patients) met the inclusion criteria. The mean age was 47.9 ± 11.1 (range: 6-80). The most common etiologies of soft tissue defect were trauma (n = 94, 45.6%), diabetic foot ulcers (n = 64, 31.1%), and malignancy (n = 45, 21.8%). There were 108 (52.4%) patients who underwent reconstruction with a neurotized ALT flap, and 98 (47.6%) without. Of patients with neurotized flap reconstruction, nerve coaptation was performed end-to-end (n = 31, 28.7%) or end-to-side (n = 14, 12.9%). Recipient nerves included the medial plantar (n = 16, 14.8%), medial dorsal cutaneous (n = 9, 8.3%), calcaneal (n = 7, 6.5%), posterior tibial (n = 5, 4.6%), superficial peroneal (n = 4, 3.7%), or sural (n = 1, 0.9%) nerves. The overall complication rate was 16.5%, of which 11 (5.3%) were major flap complications requiring a return to the operating room. Overall, three studies found evidence of improved sensory recovery when using neurotized ALT flaps. Lower extremity reconstruction with innervated ALT flaps predominantly involves the foot and ankle region (98.5%), as the improved sensory recovery may be helpful in reducing secondary injury risk, such as diabetic foot ulcers. No cases involving reconstruction of soft tissue defects above the knee were identified.
To investigate the effects of multisensory-integrated virtual reality (VR) training on gait adaptability and its regulatory mechanisms on the somatomotor network (SMN) in patients with stroke. In this randomized controlled trial, 68 patients with stroke were allocated to a VR group (multisensory-integrated VR training) or a control group (conventional rehabilitation). Both groups received 30-minute sessions, 5 days/week for 4 weeks. The primary outcome was gait adaptability assessed by the Dynamic Gait Index (DGI). Secondary outcomes included the Timed Up and Go Test (TUGT), Berg Balance Scale (BBS), and Fugl-Meyer Assessment for Lower Extremity (FMA-LE). Functional near-infrared spectroscopy (fNIRS) measured resting-state functional connectivity within the SMN and task-evoked activation during stepping and obstacle crossing. The VR group showed significantly greater improvements than the control group in DGI total score (P = 0.010), TUGT (P = 0.005), and BBS (P < 0.001 ). fNIRS analysis revealed that the VR group exhibited significantly greater increases in task-evoked activation in the right posterior parietal cortex (PPC) and supplementary motor area (SMA) during stepping (P = 0.029 and P = 0.032, respectively), and in the right SMA during unaffected-limb obstacle crossing (P = 0.048). Resting-state functional connectivity analysis showed significantly enhanced connections within the SMN, including left SMA-right PPC and right PPC-left dorsolateral prefrontal cortex (DLPFC) (both P < 0.05). Correlation analyses revealed that increased right SMA activation during obstacle crossing was positively correlated with TUGT improvement (r = 0.590, P = 0.001), while enhanced right PPC-left DLPFC connectivity was positively correlated with DGI improvement (r = 0.403, P = 0.041). Multisensory-integrated VR training was associated with improvements in gait adaptability and balance in patients with stroke. The underlying mechanisms may involve enhanced activation in the SMA and PPC, along with changes in functional connectivity within the SMN and between the SMN and cognitive control networks. However, given that the significant improvements in DGI, TUGT, and BBS were not sustained under the most conservative assumptions about missing data, these findings should be considered preliminary and warrant confirmation in studies with lower attrition rates. Chinese Clinical Trial Registry, ChiCTR2500111919 (retrospectively registered). Registered 7 November 2025. Available from https//www.chictr.org.cn (registration number ChiCTR2500111919). Protocol The full trial protocol is available from the corresponding author upon reasonable request.
Taste-active peptides (TAPs) are food-protein-derived peptides that elicit or modulate gustatory sensations; presently gaining interest as natural umami-enhancing, bitterness-modifying, kokumi, and saltiness-aiding molecules. This review provides a synthesis of progress across discovery pipeline steps, from hydrolysis-based generation and process-intensified extraction to purification/identification workflow and sensory interpretation. Receptor-level mechanisms involved in peptide taste perception are summarized, and structure-activity patterns associated with important taste modalities are collated. On the data side, computational models are profiled for prioritization of candidates from proteome-derived libraries, with emphasis on curated peptide-receptor labels, transparent feature construction (e.g., sequence/physicochemical descriptors with docking-derived interaction summaries), and reproducible benchmarking. Practical bottlenecks (dataset curation, assay comparability in sensory validation, and scalable computation) are mapped together with emerging resources that can standardize tasks and reporting. By combining approaches and demonstrations from experimental and computational disciplines, the review offers an operations-focused reference for the design and validation of TAPs in clean-label product development.
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Many cells require cilia to receive environmental signals. Mutations in the ciliary gene fam149b1 result in the ciliopathy Joubert syndrome. The C. elegans homolog of fam149b1 , xbx-4 , is required for normal cilium structure. We found that loss of XBX-4 hinders multiple cilium-mediated behaviors. xbx-4 mutants display mild defects in male mating and nose touch behaviors and dramatic changes in social feeding. Unexpectedly, xbx-4 mutants increased reversal behavior in response to ethanol, a control stimulus used in olfactory assays. Variation in the magnitude of phenotypes for different neurons is consistent with known cell-specific impacts of XBX-4 loss on cilium structure.
Differences in visual sensory sensitivity/reactivity are documented in autism and ADHD. Measuring these differences could guide interventions and accommodations, improving quality of life. No current self-report questionnaires focus specifically on the range of affective and behavioural responses to visual stimuli reported in autism and ADHD. This study aimed to develop such a measure (ViPro-SR) for neurodivergent adults. Using online survey responses, psychometric properties of ViPro-SR were assessed, including factor structure, gender-related measurement invariance, internal consistency reliability and validity. An 11-item, stable 3-factor solution was derived, with factors representing: hypersensitivity to contrast, detail focus, and peripheral vision activation. Internal consistency reliability was satisfactory for the total scale (ω = 0.85) and each subscale (ω > 0.70). Evidence towards convergent validity of ViPro-SR was provided through highly significant, moderate to strong correlations with existing sensory measures. Discriminative validity was supported by significant differences in ViPro-SR total scores between autistic/ADHD groups and a not autistic/ADHD comparison group. ViPro-SR is a psychometrically sound instrument, currently recommended for subscale-level scoring, that could inform visual sensory accommodations and contribute to a research toolkit. The online version contains supplementary material available at 10.1007/s12144-026-09409-7.
Solid-state fermentation with culinary fungi (mushrooms commonly used in cooking) could be a scalable means of producing nutrient-dense protein foods, while improving digestibility and bioavailability and valorizing agricultural commodities and byproducts. Advancing the science of these processes has major implications for both nutrition security and resilient, sustainable food systems. This review synthesizes how substrate selection, fungal strain choice, and controllable growth conditions can transform underutilized or under-consumed plant materials into minimally processed, consumer-acceptable foods through enhanced sensory characteristics and nutritional profiles. We conducted a narrative review to synthesize peer-reviewed and applied literature to map substrate-strain-process combinations that could enhance nutritional composition, sensory performance, food safety, scalability, and sustainable food-system outcomes. Across cereals, legumes, and oilseed meals, solid-state fermentation consistently increases protein concentration and quality, improves nutrient bioavailability, decreases anti-nutritional factors, and generates flavor-active metabolites while enhancing texture. Outcomes can be further optimized through manipulation of growth conditions such as moisture, temperature, particle size, aeration, light, residence time, and post-process thermal finishing. Integrating culinary fungi with commodity crops enables circular use of side streams, shortens protein production cycles relative to animal sources, and can support rural economies while aligning with scientific dietary guidance. Factorial process studies linking growth stage inputs to sensory acceptance, standardized safety and regulatory frameworks and techno-economic analyses that quantify cost-per-nutrient and edible output per hectare would help extend this knowledge for maximal impact. Solid-state fermentation should be considered as an important strategy for improving diet quality and food security.
Olfactory stimulation has emerged as a non-invasive strategy to modulate brain function; however, the molecular mechanisms linking odorant-receptor interactions to central neurobiological outcomes remain poorly defined. In this study, we investigated the antidepressant-like effects of linalyl acetate (LA) and elucidated its olfactory-driven signaling mechanisms using integrated computational, transcriptomic, and in vivo approaches. In silico analyses identified OR2B3 as a candidate olfactory receptor for LA, supported by structural similarity assessment and docking simulations. In human nasal epithelial cells, LA treatment induced coordinated transcriptional programs enriched for olfactory receptors, chemosensory cilia, GPCR signaling, and synapse-related pathways, indicating activation of receptor-guided sensory signaling networks. These findings were further supported by RT-PCR validation, which confirmed significant upregulation of OR2B3 and OR6A2, as well as modulation of cilium-associated signaling components, including ADCY3. In vivo, repeated LA inhalation significantly reduced immobility time in the tail suspension test, demonstrating antidepressant-like behavioral effects. These behavioral outcomes were accompanied by decreased serum corticosterone and pro-inflammatory cytokines, together with increased brain-derived neurotrophic factor levels in serum, cerebral cortex, and hippocampus. Neurochemical analyses further revealed enhanced monoaminergic (dopamine, noradrenaline, serotonin) and cholinergic signaling. Transcriptomic profiling of the olfactory bulb and hippocampus revealed dose-dependent enrichment of metabolic, synaptic, neurotrophin, and intracellular signaling pathways, highlighting coordinated metabolic-synaptic coupling and neuroplasticity-associated programs. Collectively, these findings demonstrate that LA engages olfactory receptors to activate cilia-centered chemosensory signaling that propagates into central metabolic, synaptic, and neurotrophic networks, ultimately modulating stress-related neurobiology. This study establishes a molecular framework for odorant-mediated neuromodulation and supports the therapeutic potential of olfactory-based interventions for mood regulation.
This research investigated the extraction and functional characterization of novel umami peptides from bay scallop by-products and explored the molecular basis of their flavor-enhancing effects. The by-products were subjected to sequential enzymatic hydrolysis using alkaline protease AP200-A and flavor protease FF106, followed by multistep purification. Sensory testing revealed that fraction F2 exhibited the strongest umami intensity. Peptide identification using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) led to the detection of 65 potential umami peptides. Virtual screening subsequently identified three promising candidates: HELPRY, WDGRDGAVD, and AHELPRYG. Sensory evaluation and electronic tongue analysis demonstrated that all three synthetic peptides exhibited significant umami intensity and umami-enhancing effects, with detection thresholds ranging from 0.10 to 0.51 mmol/L and enhancement thresholds from 0.08 to 0.41 mmol/L. Notably, the detection thresholds were relatively low. To elucidate the molecular mechanism underlying their taste, molecular docking and dynamics simulations were performed. The results showed that all three peptides formed stable complexes with the umami receptor T1R1/T1R3, with hydrogen bonding as the primary driving force. Key binding residues, including ASN150, SER158, LYS155, ASP219, PRO57, and ARG255, played critical roles in receptor recognition. Molecular docking and dynamics simulations confirmed stable binding to T1R1/T1R3, with binding energies ranging from -9.353 to -8.476 kcal/mol, and hydrogen bonding was identified as the predominant interaction. This study provides novel umami peptides from a sustainable source and elucidates their interaction mechanism with the taste receptor, offering a theoretical basis for the high-value application of shellfish by-products in the flavoring industry.
Prolonged sedentary behavior and slump sitting posture may impair neuromuscular function; however, acute effects on postural sway and potential differences between athletes and non-athletes remain unclear. Therefore, this study aims to examine the acute effects of prolonged slump sitting on postural sway in female athletes and non-athletes. In this study, 24 females (12 athletes, 12 non-athletes; age 18-30 years) completed balance assessments using the Biodex Balance System, followed by a 30-minute standardized slump sitting protocol. Outcomes included static postural stability test (PST), Modified Clinical Test of Sensory Interaction on Balance (mCTSIB), and limits of stability (LOS). Group differences were analyzed using analysis of covariance (ANCOVA). Prolonged slump sitting significantly influenced selected postural sway outcomes. Athletes demonstrated greater post-intervention sway compared with non-athletes in the Overall Stability Index (p = 0.01) and the eyes-closed firm-surface mCTSIB condition (p = 0.02). A significant group difference was also observed in static left LOS performance (p = 0.01). In a nutshell, the present study demonstrated that prolonged slump sitting may influence postural sway in female athletes and non-athletes, with specific differences emerging between groups under certain sensory and stability conditions. By highlighting the potential impact of slump sitting on postural stability, this research contributes to the fields of sports science, ergonomics, and rehabilitation, emphasizing the need for strategies that mitigate the negative effects of prolonged sedentary behavior.
In this study, we have optimized a stabilizer formulation using native corn starch (A: 0-2%), acetylated distarch phosphate (B: 0-2%), and gelatin (C: 0.1-0.4%) via a D-optimal mixture design approach. The study aimed to quantify main and interaction effects and identify an optimum formulation under predefined quality targets. Physicochemical, textural, and sensory characteristics were monitored during storage at 4 °C. Syneresis after 28 days was predominantly influenced by ingredient type and concentration; gelatin significantly reduced syneresis, whereas native and modified starches contributed to increased syneresis. Gelatin showed a softening effect on texture immediately post-production but induced hardness during storage. Both starch types increased hardness throughout storage. Gelatin improved overall acceptability and a significant positive interaction was observed among all three ingredients (ABC). Conversely, binary interactions (AB and AC) negatively impacted sensory scores. Two optimized formulations with highest desirability were optimum 1 (0.998% A, 0.872% B, and 0.129% C) and optimum 2 (1.116% A, 0.526% B, and 0.358% C). After the experiments, observed values for optimum 1 closely matched the predicted values, confirming model accuracy and it was recommended for stirred yogurt formulation.
To address the rapid lipid oxidation and quality deterioration of coated peanuts during storage, an edible film based on a heterogeneous acetylated starch‑sodium alginate matrix loaded with black rice anthocyanin extract (BRA) was developed in this study, and the content of BRA was optimized. When the BRA content was 0.75‰, the film exhibited the most uniform and dense microstructure. It showed excellent mechanical strength, improved thermal stability and optimal light/water vapor/oxygen barrier performance. Films with different BRA loadings were further applied to coated peanuts, followed by accelerated oxidation of the film-treated samples under thermal and UV conditions. The films achieved stable coverage on the surface of coated peanuts and achieved high sensory acceptance. After 20 days, the films not only improved the retention rate of anthocyanins by 30%, but also slowed down the oxidative deterioration of the samples. The films significantly inhibited the increases in peroxide and acid values, reducing them by 17-31% and 12-21%, respectively, compared to the control. Furthermore, the films effectively maintained the unsaturated fatty acid profile by mitigating lipid degradation. Meanwhile, these films effectively maintained the appearance, color, flavor and texture of the samples, with the film containing 0.75‰ BRA achieving the highest overall sensory acceptance. In general, this film combined physical barrier protection with the antioxidant activity of BRA to maintain the overall quality of coated peanuts.
Psychiatric and neurodevelopmental disorders such as schizophrenia (SZ) and autism spectrum disorder (ASD) are challenging to characterize in part due to their heterogeneous presentation in individuals, with symptoms now believed to exist on a continuum. Conventional diagnostic and neuroimaging analytical approaches rely on subjective assessment or group differences, but typically ignore progression between groups or heterogeneity within a group. To estimate the neuropsychiatric continuum and heterogeneity, we proposed a functional network connectivity (FNC) interpolation framework based on a variational autoencoder (VAE) using static FNC (sFNC) and dynamic FNC (dFNC) data from controls and patients with SZ or ASD. We demonstrated that VAEs significantly outperformed a linear baseline and a semi-supervised counterpart. For both sFNC and dFNC interpolation, the generated results effectively captured representative and generalizable properties in the original data. The interpolated continua from controls to patients in both SZ and ASD revealed group-wise gradients characterized by reduced positive correlations within the auditory, sensorimotor, and visual networks, as well as between the subcortical and cerebellar domains. In contrast, anti-correlations weakened between the subcortical domain and the sensory domains, and between the cerebellar domain and the sensory domains. Finally, we showed examples of how to generate continuous FNC data following group- or state-based trajectories in the VAE latent space. The proposed framework offers added advantages over traditional methods, including data-driven discovery of hidden relationships, visualization of individual differences, imputation of missing values along a continuous spectrum, and estimation of the stage where an individual falls within the continuum.
Evaluating embodied perception, the interaction between body movement, sensory input, and the environment, is crucial for addressing diverse needs in mountainous historic districts. Unlike flat districts, where research has explored how spatial elements affect different population groups, perception differences across age groups in mountainous areas remain understudied. This pilot study investigated these differences between younger and older participants in various alley types within Chongqing's Ciqikou historic district, identifying the spatial factors influencing their perceptions. Data were collected from 46 participants using wearable equipment to monitor real-time psychological and physiological responses. Compound box plots, two-way repeated-measures ANOVA, and Spearman's correlation were applied to analyze perception differences and the relationships between spatial elements and both physiological and psychological perceptions. Significant physiological differences were found between age groups. The stair alley had a stronger impact on perception than flat alleys. Younger participants exhibited higher stress but more positive emotional feedback compared to older participants. Key factors of mountainous environments, such as slope, spatial openness, and specific sounds, primarily influenced physiological changes. A high degree of coherence between auditory and visual landscape elements was observed across the district, with consistent correlations between spatial characteristics and physiological perception and the correlation between physiological and psychological perceptions. The study recommends improving dynamic and static zoning, lookout spaces, and multi-sensory experiences to enhance spatial quality and preserve the historical identity of mountainous cities.
Misophonia is a decreased sound tolerance (DST) condition characterized by disproportionate emotional, autonomic, and behavioral responses to specific, typically low-intensity sounds. Despite increasing recognition, its neurobiological basis remains incompletely understood, particularly with respect to its typical onset during late childhood and adolescence. Existing models emphasize auditory-limbic conditioning but may not fully account for developmental vulnerability or stimulus specificity. This theory-building review proposes a developmental neurobiological framework in which misophonia is conceptualized as a disorder of perception-emotion coupling, potentially shaped by maladaptive plasticity across interacting auditory, salience, limbic, and prefrontal networks during sensitive periods of maturation. A theory-driven narrative review was conducted, integrating evidence from neuroimaging, electrophysiological, autonomic, and clinical studies. Relevant literature was identified through PubMed, Scopus, and Web of Science databases, covering the period up to early 2026. Search terms included "misophonia," "auditory processing," "salience network," and "development." Jastreboff's conditioned reflex model was considered alongside contemporary frameworks from network neuroscience. This review is selective and hypothesis-generating rather than systematic. Available evidence suggests that exaggerated, stimulus-specific salience attribution to auditory stimuli-potentially mediated by anterior insula-centered networks-may interact with relatively immature prefrontal regulatory mechanisms during development. This interaction may contribute to the strengthening of auditory-limbic associations and the emergence of persistent, context-dependent misophonic responses. Reframing misophonia within a developmental network framework may help situate the condition within disorders involving altered sensory appraisal and emotional regulation, while preserving its stimulus-specific profile. This perspective generates testable hypotheses and may provide a basis for future empirical research and the development of mechanism-informed intervention strategies.
Predictive coding theory suggests that the brain continuously anticipates upcoming words to optimize language processing, but the neural mechanisms remain unclear, particularly in naturalistic speech. Here, we simultaneously recorded EEG and MEG data from 29 participants while they listened to an audio book and assigned predictability scores to nouns using three LLMs: one BERT model and two multilingual LLaMA models. Our results show that higher predictability is associated with reduced neural responses during word recognition, as reflected in lower N400 amplitudes, and with increased anticipatory activity before word onset. EEG data revealed increased pre-activation in left fronto-temporal regions, while MEG showed a tendency for greater sensorimotor engagement in response to low-predictability words, suggesting a possible motor-related component to linguistic anticipation. These findings provide new evidence that the brain dynamically integrates top-down predictions with bottom-up sensory input to facilitate language comprehension. To our knowledge, this is the first study to demonstrate these effects using naturalistic speech stimuli, bridging computational language models with neurophysiological data. Our findings provide novel insights for cognitive computational neuroscience, advancing the understanding of predictive processing in language and inspiring the development of neuroscience-inspired AI.
Trigeminal neuralgia is a disorder of the trigeminal nerve that results in intense episodic pain. Medical management is commonly used as the first therapeutic intervention; however, some patients become resistant to it, requiring further interventions. Stereotactic radiosurgery with the Gamma Knife (GK) is safe and effective in multiple retrospective series. However, in some cases, repeat radiosurgery may be needed, aiming to improve the patient's pain in the long term. We performed a systematic review and meta-analysis following the PRISMA guidelines. We included papers in English that reported patients with trigeminal neuralgia who didn't have their pain solved with standalone medications or a single dose of GK, needing repeat GK. All statistical analyses were conducted using R. Twenty-one studies met the inclusion criteria, totaling 2,486 patients initially treated and 2,020 undergoing repeat GKRS. The majority were female, with median ages 54.5-79.6 years, and idiopathic TN represented ~ 85% of cases. Most procedures targeted the trigeminal root entry zone using 70-80 Gy marginal doses. Pain relief occurred in 70-90% of patients, with marked improvement in BNI scores (typically IV-V to I-IIIb). Median follow-up ranged 14-74 months, and recurrence occurred in 10-35% of cases. Facial sensory disturbances were reported in 20-45%, while bothersome dysesthesias and anesthesia dolorosa were rare (< 3%). Meta-regression, including up to 10 studies, found no significant correlation between pain relief and age (p = 0.5682), pain duration (p = 0.3593), interval since last GKRS (p = 0.4093), or dose (p = 0.7857). Heterogeneity remained high (I2 = 55.6-91.8%, p < 0.0001), indicating inter-study variability. Repeat GKRS is a safe and effective option for TN patients experiencing persistent or recurrent pain after initial radiosurgery. Despite inter-study variability, outcomes support its use for long-term pain control. Further prospective studies are needed to optimize patient selection and treatment parameters.
No large-scale study has compared the outcomes of soft-tissue endoscopic surgery (SOFTES) with conventional open surgery (OS) for vascular anomalies and benign soft tissue tumors. We aimed to compare the operative safety, efficacy, and outcomes of the two approaches for soft tissue lesions. Patients (n = 414) undergoing SOFTES or OS in two centers were retrospectively reviewed. Propensity score matching was used to minimize selection bias and group differences. The treatment outcomes were compared between the two groups. After matching, 150 patients (SOFTES: 75; OS: 75) were included. Compared with the OS group, the estimated blood loss in the SOFTES group was significantly lower [20 mL (1-500) vs. 50 mL (5-600); p = 0.001]; however, the operative duration was significantly longer [223 minutes (35-490) vs. 173 minutes (37-494); p = 0.008]. Major complications were not observed. The incidence of focal burn of skin in the SOFTES group was higher than that in the OS group (p = 0.048). The incidences of superficial peroneal nerve injury, postoperative bleeding, persistent lymph drainage, local sensory paralyses (<5 cm2), surgical site infection, hematoma/seroma, and residual mild pain were not significantly different between the two groups. However, the incidence of wound dehiscence [n = 0 (0.00%) vs. n = 7 (9.33%); p = 0.010] and flap necrosis [n = 1 (1.33%) vs. n = 11 (14.67%); p = 0.005] was significantly higher in the OS group than in the SOFTES group. Residual pain was cured or significantly improved. All patients achieved resolution of contracture had normal or near-normal joint motion. Endoscopic surgery is a safe and effective treatment option for various vascular anomalies and benign soft tissue tumors in selected patients. This paradigm shift has many advantages in terms of clinical outcomes and reduces postoperative complications.