BackgroundLow Back Pain (LBP) is a major health problem at work. While prevention measures can focus on physical risk factors, negative beliefs about pain can also contribute to LBP chronicity.ObjectiveThis study evaluates the impact of educational training based on the biopsychosocial model of pain on meat processing workers' low back pain beliefs.MethodsWorkers of two sectors of a meat processing plant in France (n = 34) were assigned into a control group and an educational group. The latter participated in a training programme consisting of two 90-min sessions focused on the biopsychosocial model of pain. Low back pain beliefs were assessed with the Back Pain Attitudes Questionnaire (Back-PAQ, 34 items) in the two groups in pre- and post-intervention periods.ResultsIn the pre-intervention period, the Back-PAQ score was not different between the control (118.5 ± 9.9) and the educational (122.5 ± 10.0) groups. In the post-intervention period, the Back-PAQ score was significantly reduced in the educational group (83 ± 16.5; -39.5 points; p < 0.001) while it did not significantly change in the control group (117.5 ± 10.3; -0.9 points, p = 0.57). The Back-PAQ score was significantly lower in the educational compared to the control group (-34.5 points, p < 0.001).ConclusionsThis study provides preliminary support that an educational training based on biopsychosocial model of pain can positively influence meat processing workers' low back pain beliefs. Therefore, such an educational programme may represent a course of action for limiting LBP and more globally improving musculoskeletal health management in an industrial environment.
Neuropathic pain is a chronic pain disorder refractory to conventional analgesics. Iron-dependent neuronal ferroptosis has been implicated in its pathogenesis. G protein-coupled receptor 4 (GPR4), a proton-sensing receptor, is involved in inflammation and ferroptosis, but its role in neuropathic pain and spinal neuronal ferroptosis remains unclear. Neuropathic pain was induced in rats using the spared nerve injury (SNI) model, and GPR4 expression and its effects on pain behaviors, neuronal ferroptosis, and spinal inflammation were examined. GPR4 was inhibited by a selective antagonist or small interfering RNA (siRNA), while Ras homolog family member A (RhoA) and Yes-associated protein (YAP) were activated via intrathecal injection of specific agonists. Spinal GPR4 expression was significantly upregulated and neuronal ferroptosis was induced by SNI, as evidenced by increased iron accumulation, lipid peroxidation, and dysregulated ferroptosis-related protein expression. SNI-induced mechanical allodynia, cold hyperalgesia, neuronal ferroptosis, and spinal inflammation were attenuated by GPR4 inhibition or knockdown. Mechanistically, the spinal RhoA/YAP signaling pathway was activated by SNI, and this activation was reversed by GPR4 inhibition. Furthermore, the analgesic and anti-ferroptotic effects of GPR4 inhibition were abolished by RhoA or YAP activation. It is demonstrated that GPR4 regulates neuropathic pain, neuronal ferroptosis, and spinal inflammation via the spinal RhoA/YAP signaling pathway, suggesting that GPR4 inhibition may represent a promising novel therapeutic strategy for neuropathic pain.
Pain management is a core ethical principle in emergency medicine, yet gender-related differences in analgesic treatment have been reported. This study examines whether patient and emergency physician gender influence prehospital pain management. This retrospective observational cohort study included all primary helicopter emergency medical service missions conducted by DRF Stiftung Luftrettung in Germany between January 2012 and June 2025. Adult patients (≥ 18 years) with a Glasgow Coma Scale score ≥ 11 and without airway management were analyzed. Pain severity was assessed using the Numeric Rating Scale (NRS). Patient characteristics, analgesic treatment, and emergency physician gender were analyzed using descriptive statistical methods. The study was approved by the Ethics Committee Freiburg (25-1272-S1, August 19th 2025). A total of 106,888 cases was included, of which 38.5% were female and 61.5% male. Initial pain severity was comparable between genders, with a similar distribution across NRS categories. Despite this, women received analgesic treatment less frequently than men (62.0% vs. 66.9%; p < 0.001), whereas a greater effect is seen when particularly examining the use of opioid analgesics (50.0% vs. 57.1%; p < 0.001). This finding is consistent across all pain severity subgroups. Pain scores at patient handover were similar for women and men, indicating comparable pain levels at the end of prehospital care. Despite comparable pain intensity, women received analgesic and opioid treatment less frequently than men in prehospital care, indicating potential gender-based inequalities in pain management. These findings underscore the need for strategies to ensure equitable analgesic treatment.
Best practice guidelines recommend access to psychological support within routine musculoskeletal care, but this remains limited. This mixed methods study aimed to explore the feasibility and acceptability of adding an online psychologically informed pain management program to usual care provided by musculoskeletal clinicians. Australian-based musculoskeletal clinicians recruited patients with persistent musculoskeletal pain. Clinicians screened, recruited and invited patients to complete an online, psychologically informed pain management program provided by an Australian digital psychology clinic. Feasibility was determined via calculating patient recruitment rate, retention in the study and adherence to the online psychologically informed pain management program. Perspectives of clinicians and patients were explored through semi-structured interviews, which were audio-recorded, and transcribed verbatim. Qualitative analyses used a reflexive thematic approach with themes then mapped to the Theoretical Domains Framework. N = 168 patients were screened, n = 60 patients recruited n = 40 completed an application and n = 29 enrolled in a psychologically informed pain management program. Thematic analysis from clinicians and patients identified a range of skills, attitudes and beliefs regarding the addition of psychological care and identified individual, systemic and practice-level barriers and enablers to engagement. Lending support to initial feasibility and acceptability, musculoskeletal clinicians could screen and recruit patients into the study. Subsequently, 66% of these patients applied, 48% enrolled and 36% completed an online psychologically informed pain management program. Qualitative results suggest the need for targeted clinician education, streamlined referral processes, and supportive practice environments to enhance digital psychology adoption.
This study examined the effects of preoperative video-assisted distraction on postoperative anxiety, pain on awakening, and emergence delirium during early postanesthetic recovery in children undergoing tonsillectomy. A randomized controlled trial using stratified randomization based on age and sex. Children aged 4-9 years were stratified by age and sex and randomly assigned to a distraction group (n = 30) or control group (n = 29). The intervention consisted of an interactive video featuring a hand puppet explaining anesthesia, surgery, and recovery. Outcomes were measured using the FACES Anxiety Scale, a pediatric pain scale, and the Pediatric Anesthesia Emergence Delirium scale. Significant group-by-time interactions were observed for anxiety and pain scores. At 10 min after post-anesthesia care unit (PACU) admission, children in the intervention group demonstrated lower anxiety and pain scores than those in the control group. Lower pain scores remained evident in the intervention group at 30 min after PACU admission. Although Pediatric Anesthesia Emergence Delirium Scale scores were lower in the intervention group at both postoperative assessment points, the group-by-time interaction for emergence delirium was not statistically significant. Video-assisted preparation and distraction may be an effective nurse-led, non-pharmacological intervention for reducing postoperative anxiety and pain during early PACU recovery in children undergoing tonsillectomy. Further studies are needed to determine the effects of this intervention on emergence delirium and longer-term recovery outcomes.
This systematic review and meta-analysis aimed to evaluate the effectiveness of Virtual Reality (VR) as a nonpharmacological intervention for reducing pain and anxiety in women undergoing outpatient gynecological procedures. Conducted in accordance with PRISMA guidelines, this review analyzed randomized controlled trials (RCTs) published between January 2014 and March 2026. Comprehensive searches were performed across seven electronic databases. The methodological quality was assessed using the Cochrane Risk of Bias 2 tool. A total of 11 RCTs (n = 1,222 patients) met the inclusion criteria, primarily focusing on office hysteroscopy, hysterosalpingography, and intrauterine device insertion. The pooled analysis demonstrated a statistically significant reduction in pain scores (Z = 4.25, P < .0001) and anxiety levels in the VR group compared to standard care. While high statistical heterogeneity (I² = 92%) was observed, likely due to variations in VR content and patient characteristics, VR interventions consistently led to significantly higher patient satisfaction and procedural tolerance. Even in studies where pain reduction was nonsignificant, patients reported a strong preference for VR in future procedures. VR-based interventions appear to be a highly effective digital therapeutic adjunct for office gynecologic procedures. Beyond reducing procedural pain, VR also contributes to anxiety reduction, improved patient satisfaction, and enhanced procedural tolerance by providing psychological immersion and cognitive distraction. Incorporating VR into perioperative protocols can improve clinical outcomes and patient comfort without the side effects of pharmacological sedation.
Ascending aortic aneurysms typically present with chest or back pain; however, atypical presentations may delay diagnosis. A 58-year-old woman presented with acute lower abdominal pain and diaphoresis. Hypertension and a new diastolic murmur prompted cardiology evaluation, revealing clinical signs of chronic severe aortic regurgitation. Imaging confirmed a giant ascending aortic aneurysm (89 × 83 mm) with severe aortic regurgitation. This case emphasizes atypical presentations of thoracic aortic disease, compensated high-risk anatomy, and timely referral to specialized aortic centers to facilitate definitive surgical care despite temporary institutional capacity constraints. Giant ascending aortic aneurysms may remain clinically compensated despite high-risk anatomy and present atypically, requiring high clinical suspicion and early multimodality imaging. When definitive repair is delayed by system-level constraints, structured interim stabilization, surveillance, and referral coordination are critical.
Hemorrhagic adrenal infarction is a rare and potentially under-recognized cause of acute flank pain. We report the case of a 29-year-old woman presenting with acute left flank pain of two days' duration. Initial contrast-enhanced abdominal CT, including unenhanced and portal venous phases, was interpreted as normal. Retrospective review demonstrated subtle enlargement of the left adrenal gland with mildly reduced enhancement compared with the contralateral gland. Following clinical deterioration with fever, a repeat CT performed five days later showed marked enlargement of the left adrenal gland with absent enhancement and surrounding periadrenal fat stranding, consistent with hemorrhagic adrenal infarction. MRI confirmed heterogeneous signal intensity, diffusion restriction, and lack of post-contrast enhancement, supporting the diagnosis. Laboratory evaluation revealed severe primary hypothyroidism consistent with autoimmune thyroiditis and heterozygous hemoglobin S (sickle cell trait). Endocrine assessment showed preserved adrenal function without evidence of adrenal insufficiency. Initial thrombophilia testing demonstrated abnormalities in coagulation factors interpreted in the context of an acute inflammatory state, and was considered non-contributory on hematology review. The patient was managed conservatively following multidisciplinary discussion, without anticoagulation, and showed favorable clinical and radiological evolution. This case highlights an important imaging pitfall: early unilateral adrenal infarction may present with subtle CT findings and can be missed on initial interpretation. Careful adrenal evaluation and short-interval follow-up imaging are essential in patients with persistent or worsening acute flank pain despite an initially negative CT.
This study evaluated the effects of providing 3-15 kg of a soluble and biodegradable biopolymer-based enrichment material (blend of biodegradable polymers and natural fibers) to prepartum sows housed in farrowing crates. Fifteen sows were blocked by body weight and backfat thickness and assigned to three treatments: no enrichment material (CONT), 3 kg of enrichment material (BN3), or 15 kg of enrichment material with added nutritional value (BN15; 14.50 MJ ME/kg; composition: a blend of biodegradable natural polymers and natural fibers). The material was supplied 24 h before the expected farrowing date. Behavioral observations were performed during the 18 h preceding farrowing. Sow and piglet blood glucose concentrations were determined from venipuncture of auricular vein. Pain-related facial expressions, piglet birth intervals, and litter performance parameters were also evaluated. Behavioral analysis revealed significant differences between treated and control sows, with BN3 and BN15 sows showing reduced ventral lying, redirected nest-building behaviors, floor interaction, and postural changes during the pre-farrowing period (p < 0.05). A quadratic relationship was observed between piglet birth order and birth interval (p < 0.001), birth interval was longer early in parturition, decreased in the middle stages, and increased at the end of parturition. In addition, compared with CONT sows, BN15 sows provided exhibited shorter birth intervals (p = 0.030), while BN3 sows showed a tendency toward shorter birth intervals (p = 0.084). Sows in BN15 tended to have higher glycemia at farrowing onset than CONT (96.6 vs. 80.2 mg/dL; p = 0.022). Piglets from BN3 and BN15 tended to have higher birth glycemia than CONT (44.06 and 43.79 vs. 37.92 mg/dL; p < 0.10). Pain scores assessed through facial expressions/grimace score were lower (p < 0.10) in BN3 and BN15 than in CONT between 120 and 240 min after farrowing onset. Overall, providing biopolymer-based enrichment material, improved behavioral and physiological indicators associated with sow welfare.
Teucrium chamaedrys L. (Lamiaceae) is a medicinal plant broadly exploited in conventional Algerian therapy. These findings provide scientific validation for its folk applications and highlight potential for advanced pharmacological development targeting pain and inflammation. This study aimed to examine the composition and assess the anti-inflammatory, analgesic, toxicological, and in silico capabilities of T. chamaedrys L., collected from northern Algeria. Phytochemical profiling of T. chamaedrys L. crude extract (CrE) involved determining major classes, including total phenolic and flavonoid contents. Ultra-high-performance liquid chromatography-high-resolution mass spectrometry (UHPLC-HRMS) analysis was conducted to tentatively annotate and characterize the phytochemicals present in this plant extract. The in vitro anti-inflammatory activity was investigated by inhibiting BSA denaturation. Acute and sub-acute toxicity were evaluated orally in Albino mice, and anti-inflammatory and analgesic properties were assessed in Wistar rats. Molecular docking was performed to investigate interactions between the tentatively identified compounds and relevant therapeutic targets, while ADMET (absorption, distribution, metabolism, excretion, and toxicity) predictions were used to assess their pharmacokinetic properties and potential toxicity. The CrE yielded 19.11 ± 1.07% and was rich in polyphenols (244.65 ± 2.36 μg GAE/mg CrE) and flavonoids (41.45 ± 0.38 μg QE/mg CrE). The results of UHPLC-HRMS analysis showed twenty tentatively identified compounds, including flavonoids and their derivatives (luteolin, naringenin, etc.), phenolic acid (chlorogenic acid), iridoid glycoside (harpagide), phenylethanoid glycosides (teucrioside, verbascoside and poliumoside), triterpenoids (maslinic acid) and a cyclitol and cyclohexanecarboxylic acid (quinic acid). In vitro assays demonstrated a significant anti-inflammatory activity with an IC50 of 437.80 ± 21.11 μg/mL. In vivo studies demonstrated that the CrE did not exhibit any acute or sub-acute toxicity effects in the tested animals. Moreover, significant anti-inflammatory and analgesic effects were recorded at 500 mg/kg b.w., with inhibition values of 76.60 ± 1.96% and 77.77 ± 2.30%, respectively. Molecular docking studies indicated that luteolin and its derivatives, verbascoside, apigenin 7-O-rutinoside, poliumoside and maslinic acid interacted strongly with tumor necrosis factor alpha (TNF-α), cyclooxygenase-2 (COX-2) and voltage-gated sodium channel 1.7 (NaV1.7), suggesting a possible role in anti-inflammatory and analgesic effects. ADMET and pharmacokinetic assessments indicated that the tentatively identified compounds from CrE have favorable pharmacological properties, including good intestinal absorption, high solubility, and no predicted hepatotoxicity or carcinogenicity, suggesting potential safety in preclinical and therapeutic settings. T. chamaedrys L. from Algeria appears to be a promising source of bioactive metabolites, with demonstrated safety in acute and sub-acute toxicity studies. It exhibited anti-inflammatory and analgesic activities, supported by both experimental and computational findings. Overall, these findings provide scientific support for the traditional use of T. chamaedrys and offer a basis for future pharmacological investigations.
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Suzetrigine, a non-opioid voltage-gated sodium channel 1.8 (NaV1.8) pain signal inhibitor with no addiction potential, is approved in the USA for moderate-to-severe acute pain. In this phase 4, single-arm study, suzetrigine (100 mg preoperatively, then 50 mg every 12 h) was administered as part of multimodal therapy (MMT) for ≤ 14 days. Participants (N = 47) underwent arthroscopic or laparoscopic procedures wherein opioids are commonly used ≥ 72 h postoperatively for pain management. Pre- and postoperative MMT was prespecified as suzetrigine, acetaminophen, and ibuprofen. Oxycodone or hydromorphone were permitted as opioid rescue. The primary endpoint was the proportion of participants reporting good/very good/excellent on a patient global assessment (PGA) for pain control after treatment. Opioid rescue and safety were also assessed. Participants had various surgeries, the most common being arthroscopic knee procedures (38.3%) or rotator cuff repair (17.0%), and laparoscopic hernia repair with mesh (29.8%). Most participants (90.9%) rated suzetrigine as part of MMT as good/very good/excellent on a PGA for pain control at end of treatment; results were consistent across surgeries. A majority of participants (76.1%) did not require opioid rescue; those who did received 2.2 tablets (mean) after surgery (mean: 1.7 days). Suzetrigine was generally safe and well tolerated. One participant had a serious adverse event (aspiration) considered unrelated to suzetrigine. Adverse events were consistent with postoperative settings. Suzetrigine demonstrated effective pain management and enabled opioid-free recovery for most participants when initiated preoperatively and as part of MMT in arthroscopic or laparoscopic procedures wherein opioids are commonly used postoperatively for pain management. In studies of similar surgeries, < 50% did not require opioids. Graphical abstract available for this article. NCT06887959.
Spine pain is a prevalent and costly condition affecting up to 85% of individuals throughout their lifetime, and spinal stenosis is one of the most debilitating sources of spine pain. Although conservative management is the first line of treatment for spinal stenosis, radiographically severe cases often are directly referred to surgical intervention due to the belief that conservative strategies delay necessary treatment. However, no studies support the premise that individuals with more radiographically severe stenosis respond poorly to conservative management. The purpose of this study was to compare improvements in pain, disability, strength, medication usage, and patient function after an exercise-based physical therapist-led program. This study was a retrospective analysis of a single arm clinical trial. This was in the setting of an outpatient exercise-based physical therapist-led program. One thousand eight hundred six individuals with radiographically mild, moderate, or severe lumbar spine stenosis participated in this study. The intervention was an exercise-based physical therapist-led program. Outcome measures included pain, low back pain related disability, patient specific function, analgesic medication use, and lumbar extensor strength. Participants demonstrated significant improvements in all variables of interest, and 11.5% of participants reported cessation of narcotic use with treatment. There were no significant differences in treatment response across radiographically mild, moderate, or severe stenosis groups for any outcome. Exercise-based rehabilitation is as beneficial in the short term for individuals presenting for nonoperative care with radiographically severe stenosis compared to their milder counterparts. Exercise-based rehabilitation results in the same magnitude of improvement in individuals with chronic low back pain regardless of radiographic severity of spinal stenosis.
Identifying temporal patterns in fatigue, pain, and mood may improve our understanding of variability in pwMS. Implementing real-time self-report measures alongside repeated biomarker collection offers a more comprehensive and time-specific understanding of these dynamic biopsychosocial profiles. Feasibility of morning and evening venipuncture for biomarker collection, alongside completion of a 10-day ecological momentary assessment (EMA; or symptom e-diary) at multiple times per day, was evaluated in pwMS. Participants (N = 29) completed a baseline questionnaire. Of those, 28 completed EMA diaries measuring fatigue, pain, and mood three times per day over 10 days. Among them, 21 participants completed two blood samples within 12 h (08:00 and 20:00) and 23 participants completed a usability questionnaire. Recruitment capability, data collection procedures, acceptability of procedures, and proof of concept were assessed. Overall compliance of EMA diaries and two blood collections was 57.1%. Seventy-two percent (21/29) of participants completed two blood draws within 12 h. Overall completion rate for e-diaries was 86.2%. EMA completion rates were higher on weekdays than weekends (p = 0.01). Combined use of EMA diaries and venipuncture was feasible in pwMS. Self-report measures paired with blood biomarkers may identify symptom patterns to inform personalized treatment strategies.
Total hip arthroplasty is a painful surgical procedure; therefore, it is a challenge to manage effective pain control during the perioperative period. We compared the analgesic efficacy of the pericapsular nerve group block and the anterior quadratus lumborum block in patients undergoing unilateral hip arthroplasty. Randomized controlled trial. Operating room of a tertiary care center. 92 adult patients of >18 years who underwent elective, unilateral total hip arthroplasty under spinal anesthesia were randomized to either Group P (USG guided PENG block with 30 ml 0.25% ropivacaine +4 mg dexamethasone) or Group Q (USG guided QL block with 30 ml 0.25% ropivacaine +4 mg dexamethasone) 20 min before surgery. We compared the total perioperative fentanyl consumption between the two groups in the first 24 h as the primary outcome. Other outcomes included time to first rescue analgesia in the postoperative period, NRS scores at rest and on movement at 0, 2, 4, 6, 12, and 24 h, incidence of intraoperative hemodynamic changes, and incidence of postoperative PONV. There was no significant difference in the total fentanyl consumption between the two groups: 237.5 (150-450) μg in the P group and 250 (125-400) μg in the Q group; p = 0.617. The time to first rescue analgesia was similar in both groups: the P group (198 [123-268] minutes) and the Q group (241 [180-318] minutes); p = 0.120. There was also no difference in pain scores, intraoperative hemodynamic changes, or PONV. There was no difference in the perioperative opioid consumption, pain scores, and adverse event rates between the pericapsular nerve group block and anterior quadratus lumborum block in adult patients undergoing unilateral hip arthroplasty. Clinical Trials Registry of India (CTRI number: CTRI/2023/08/057157).
Plantar fasciitis is a frequent cause of heel pain, and local evidence describing risk factors, recurrence patterns, and treatment outcomes in Saudi Arabia remains limited. The objective of the study is to investigate the epidemiology, risk factors, treatment types and outcomes, recurrence rates, and recovery patterns of plantar fasciitis at King Saud Medical City in Riyadh, Saudi Arabia. A retrospective cohort study was conducted at King Saud Medical City in Riyadh, Saudi Arabia, from May 1, 2023, to November 28, 2025. Due to limited follow-up documentation in routine hospital records, data were collected using structured telephone interviews, while the hospital electronic medical record system was used to confirm eligibility by verifying the diagnosis of plantar fasciitis and to obtain updated contact information; verbal consent was obtained prior to interviews. A total of 121 adult patients were identified; 10 were included in a pilot phase and excluded, leaving 111 eligible patients, of whom 93 completed interviews and were included in the final dataset. Responses were entered into a structured electronic form during interviews and exported for cleaning and verification prior to analysis. Categorical variables were summarized using frequencies and percentages, and ordinal outcomes were summarized using medians and interquartile ranges; associations were evaluated using the Chi-squared test, with statistical significance set at a probability value less than 0.05. Among 93 participants, the largest age group was 51 to 60 years (29 (31.18%)), and women comprised 51 (54.84%). Sedentary occupation (73 (78.49%)) and physical inactivity based on World Health Organization recommendations (69 (74.19%)) were common. Most participants reported a single episode over the previous two years (76 (81.72%)), while recurrence occurred in 17 (18.28%). Symptom duration in the first episode was predominantly acute (72 (77.40%)), with fewer subacute (17 (18.30%)) and chronic (4 (4.30%)) presentations; recurrent episodes showed a shift toward longer subacute courses without chronicity. Management remained predominantly conservative across episodes, with rest or activity modification and non-steroidal anti-inflammatory drugs used in every reported episode; during the first episode, stretching exercises (68 (73.10%)), avoidance of non-supportive footwear (63 (67.70%)), and external support (58 (62.40%)) were commonly reported. Pain severity improved after treatment across episodes, with median pain scores decreasing from 5.00 to 2.00 in the first episode, 5.00 to 1.00 in the second episode, 5.00 to 1.00 in the third episode, and 4.00 to 3.00 in the fourth episode. Satisfaction was high, with 52 (55.91%) very satisfied and 25 (26.88%) satisfied. Recurrence was significantly associated with obesity, with a Chi-squared value of 4.25 and a probability value of 0.039; recurrence was more frequent among obese than non-obese participants, 28.57% versus 9.80%. In our cohort from King Saud Medical City, plantar fasciitis was managed mainly with conservative measures and was associated with meaningful patient-reported pain improvement and high satisfaction; however, recurrence was not uncommon and was significantly associated with obesity, supporting the importance of addressing weight-related risk alongside conservative management to reduce recurrence.
Collecting urine samples from nontoilet-trained infants is challenging and time-consuming, and current methods have notable limitations. This study aimed to evaluate the success rate, procedure duration, pain, and physiological effects of the bladder stimulation technique in infants aged 1 to 12 months. In this randomized controlled trial, 64 infants were assigned to either an experimental group receiving the bladder stimulation technique or a control group with standard positioning. Data were obtained using a structured form and the face, legs, activity, cry, and consolability (FLACC) pain scale. The procedure was considered successful if urine was collected within 3 minutes, and the procedure duration was measured as the time until urine collection. Heart rate, oxygen saturation, and FLACC scores were recorded at baseline and at the first and third minutes of the intervention. The experimental group had a higher urine collection success rate than the control group (53.1% vs 25.0%; P = .021), with a relative risk of 2.13 (95% CI, 1.05-4.30) and an absolute risk difference of 28.1% (95% CI, 5.8%-50.4%). Median procedure duration did not differ significantly between the groups (46 vs 82.5 seconds; P = .38). FLACC scores increased over time in both groups (P < .001), with a rise from 2 to 3 points in the experimental group (P < .001) but not in the controls (P = .30). Heart rate increased and peripheral oxygen saturation decreased in both groups (P < .001), without between-group differences (P > .05). The bladder stimulation technique increased the success of procedural urine collection within a predefined 3-minute window in infants aged 1 to 12 months. However, it did not significantly reduce the duration of the procedure. The technique was associated with mild discomfort and no clinically concerning physiological changes under standardized study conditions. Because contamination rates, urine culture validity, and subsequent urine collection procedures were not assessed, these findings support the short-term procedural feasibility rather than diagnostic adequacy.
Vascular anomalies (VA) are tumors and malformations of blood vessels that may involve the genitourinary-perineal (GUP) region, causing pain, debility or aesthetic concerns. N-butyl-2 cyanoacrylate (n-BCA) glue embolization followed by surgical excision is an innovative management option for vascular malformations. This case series reviews clinical outcomes of this approach for GUP-VA. Female patients with GUP-VA who underwent glue embolization followed by surgical excision were identified from a tertiary children's hospital from 1998-2024. Demographics, operative procedure(s), complications, prior and subsequent treatment history were collected. Five female patients underwent glue embolization and excision (mean age 12.6 years, range 3-22). Four patients had congenital vulvar arteriovenous or venous malformations; one had a perineal venous malformation noted after saddle injury. Indications were swelling (100%), pain (40%) and bleeding (20%). Two patients had prior therapies: sclerotherapy (n=2) and prior surgical excision with recurrence (n=1). Targeted embolization was performed with 1:3 or 1:4 n-BCA glue in ethiodized oil and excision performed within one day. Procedures were successful in all patients: all had symptomatic improvement and none experienced recurrence. One had nontarget glue thromboembolism to a segmental pulmonary artery treated by suction thrombectomy without clinical sequela. One patient had wound separation healed by secondary intention. Mean and median surgical blood loss volumes were 46 and 50 mL (0-100 mL). Mean and median follow-up duration were 12.6 and three months (range 1-37 months). Glue embolization and excision is safe and effective for pediatric and adolescent patients with GUP-VA.