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Adolescents engage in non-suicidal self-injury (NSSI) and social media more than any other age group. To understand the role of adolescents' subjective social media experiences in NSSI, this study examined the relationships between emotional responses to social media and NSSI urges and engagement. Data were collected from two studies, which included a cross-sectional study (N = 408) and an 8-week intensive-longitudinal study (N = 80) with ecological momentary assessment (3 surveys/day). The cross-sectional study revealed that positive responses to social media were associated with the presence of NSSI urges across all time points and frequency of NSSI engagement in the past year and lifetime. Negative responses to social media were associated with the presence of NSSI urges and engagement across all time points and frequency of NSSI engagement in the past week, month, and year. The intensive-longitudinal study revealed that positive responses to social media were not associated with daily NSSI urge intensity or presence of engagement, although negative responses to social media were associated with both daily NSSI urge intensity and presence of engagement. Interventions aiming to reduce adolescent NSSI may benefit from addressing ways to cope with negative social media experiences and promoting positive experiences.

Over the years, it has become increasingly clear that neurological conditions, such as multiple sclerosis (MS), commonly exhibit other health problems. Therefore, this is the first study aimed at investigating the prevalence of and factors associated with three binary outcomes: depression, anxiety, and an overactive bladder (OAB) among MS patients in the Qassim region, Saudi Arabia. This cross-sectional study was conducted in the neurological department of King Fahad Specialist Hospital in the Qassim region, Saudi Arabia, from January to December 2024. Data on age, sex, marital status, occupation, body mass index (BMI), MS duration, comorbidities, anxiety, depression, and OAB symptoms (frequency, nocturia, urgency, and urge incontinence) were obtained. Of the 262 MS patients in this study, 184 (70.2%) were females, and 78 (29.8%) were males. The median values [IQR] of age and MS duration were 34 [26-40] and 5 [2-9] years, respectively. The prevalence of depression, anxiety, and OAB were 53.4%, 43.9%, and 50%, respectively. Nocturia was the most frequent urinary symptom, and urge incontinence was significantly higher among females. Multiple logistic regression analyses were conducted to assess factors associated with three binary outcomes: depression, anxiety, and OAB. For depression, being single and anxiety were associated with increased risk. Regarding anxiety, being a student was related to decreased risk, while being female and having depression were associated with increased risk. For OAB, only anxiety was associated with increased risk. Approximately one in two MS patients experience either depression or OAB, while anxiety was reported by fewer than half of the patients. This high prevalence of the three outcomes has critical implications for healthcare policy and resource allocation. Thus, screening, early diagnosis, and intervention, as well as integrated care, should be prioritized by healthcare institutions and practitioners to address these conditions and improve MS patients' quality of life.

Stress urinary incontinence (SUI) is a prevalent condition that impairs quality of life; while midurethral sling (MUS) surgery is the standard treatment, intraurethral bulking injection offers a minimally invasive alternative. This study aimed to compare the efficacy and safety of intraurethral cross-linked hyaluronic acid/dextranomer (CLHA/Dx, DEXSUI&#xae;) injection with midurethral sling surgery in the treatment of stress urinary incontinence in women. This retrospective study included women who presented with stress urinary incontinence to &#x130;zmir Bak&#x131;r&#xe7;ay University, &#xc7;i&#x11f;li Training and Research Hospital between January 2024 and June 2025. Patients underwent either midurethral sling surgery or intraurethral CLHA/Dx (DEXSUI&#xae;) injection. Exclusion criteria included urge incontinence, urinary tract infection, and BMI > 35 kg/m&#xb2;. Quality of life was assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Urogenital Distress Inventory-6 (UDI-6), and Incontinence Quality of Life Questionnaire (I-QOL) questionnaires. Treatment success was defined by Patient Global Impression of Improvement (PGI)-I scores. Midurethral sling (MUS) was associated with significantly longer operative time (30.5 &#xb1; 7.8 vs. 11.4 &#xb1; 4.3 min, p < 0.001) and longer hospital stay (median 1 vs. 0 day, p < 0.001). At 1-month follow-up, complete dryness rates were similar (82.4% vs. 79.4%, p = 0.76). Both groups demonstrated significant improvement in ICIQ-SF, UDI-6, and Incontinence Quality of Life Questionnaire (I-QOL) scores compared with baseline (all p < 0.05), with slightly greater improvement observed in the MUS group; between-group differences were not statistically significant. Subgroup analysis by stress urinary incontinence (SUI) severity revealed consistently high dryness rates across mild, moderate, and severe categories, without significant intergroup differences. Intraurethral CLHA/Dx injection achieved clinical outcomes comparable to MUS, offering a less invasive alternative for SUI treatment.

Tourette syndrome presents with diverse motor and vocal tics, yet involvement of Eustachian tube dynamics has not been previously described. We report the case of a 31-year-old woman who developed an unusual symptom she described as an "ear-popping tic," characterized by a strong premonitory urge to release air from the ears and clicking sounds. Her long clinical history included childhood-onset tics, emotional instability, psychiatric hospitalizations, and fluctuating tic severity. At age 31, she reported repetitive ear-popping sensations accompanied by voluntary suppression to some extent. Ear, nose, and throat examination revealed normal tympanic membranes and hearing thresholds. Acoustic Eustachian tube function testing objectively demonstrated repetitive Eustachian tube opening independent of swallowing, a finding not previously documented in tic disorders. The patient described a strong urge to engage in ear-popping and partial suppressibility, although the temporal relationship between the auditory sensation and the urge was unclear. Differential diagnoses included voluntary ear-popping behavior, palatal myoclonus, middle ear myoclonus, and tensor tympani syndrome. The repetitive non-swallow-related tube opening was considered most consistent with tic-like contractions of the tensor veli palatini and levator veli palatini muscles, although voluntary components could not be fully excluded. One month later, she adopted lifestyle practices inspired by traditional East Asian medicine, leading to gradual psychological stabilization. The ear-popping tic became less intrusive, and all medications were eventually discontinued. This case highlights the importance of objective assessment in distinguishing tic-like phenomena from other causes of Eustachian tube opening.

Tourette syndrome (TS) shows substantial clinical heterogeneity, but the factors contributing to this variability remain unclear. Socioeconomic status (SES) may influence brain functional connectivity (FC) and symptom expression, yet its role in pediatric TS is still not well understood. To clarify the role of SES in modulating brain-behavior relationships in TS. Resting-state fMRI data were acquired from 67 children and adolescents with TS and 49 matched controls. FC was computed within and between seven predefined brain networks. We identified group differences in FC, examined associations between SES and clinical measures, and tested whether SES indicators (family income, parental education, and residential location) moderated FC-symptom relationships. Compared with controls, children with TS showed significant alterations in FC, mainly characterized by increased connectivity involving somatomotor, frontoparietal control, default mode, attention, and limbic networks, and decreased connectivity within the right frontoparietal control network. Within the TS group, higher parental education was associated with greater premonitory urge severity. Moderation analyses showed that family income, parental education, and residential location moderated FC-premonitory urge associations; higher family income and parental education strengthened these associations, whereas rural residence weakened them. Socioeconomic context may contribute to variability in brain-symptom relationships in pediatric TS, particularly for premonitory urges rather than clinician-rated tic severity. These findings highlight the importance of considering socioeconomic context when interpreting neuroclinical heterogeneity in TS and may inform more context-sensitive clinical assessment and interpretation.

Overactive bladder (OAB) is a prevalent condition, particularly among women, and is associated with substantial economic and quality-of-life burdens. Although stress urinary incontinence during and after pregnancy is well documented, the association between childbirth and OAB symptoms remains unclear. This study aimed to investigate the relationship between childbirth history and OAB symptoms among Japanese women using a large-scale internet-based survey. A total of 4800 Japanese women aged 40&#x2009;years and older were recruited through an online survey platform. Participants were stratified by age and completed the Overactive Bladder Symptom Score (OABSS) questionnaire. Subjects were grouped based on childbirth history (parous vs. nulliparous), and OABSS scores were compared between the groups. Subgroup analyses were conducted for women aged 40-60&#x2009;years and for parous women based on delivery mode (vaginal vs. cesarean). The OABSS total score and scores for nocturia, urgency, and urgency incontinence were significantly higher in the parous group compared to the nulliparous group (all p&#x2009;<&#x2009;0.001). These trends persisted in the 40-60-year-old subgroup. No significant differences in OABSS scores were found between women who had vaginal deliveries and those who had cesarean sections. BMI showed minimal correlation with OABSS, while symptom severity increased with age. A history of childbirth may be associated with more severe OAB symptoms among Japanese women, independent of age. These findings highlight childbirth as a potential risk factor for OAB and underscore the need for long-term urinary health monitoring in women.

Urinary incontinence (UI), defined as involuntary leakage of urine, is a common condition in women, particularly after 50&#xa0;years of age. Despite its recognition as a disease by the International Classification of Diseases, UI remains underreported due to stigma and misconceptions, with a significant impact on quality of life, mental health, and social functioning. This review outlines the classification of UI (stress, urge, mixed, overflow, functional), underlying pathophysiology, and contributory factors such as ageing, trauma, surgery, and menopause. Evaluation includes detailed history, physical examination, urological tests, and urodynamic studies to differentiate causes and guide management. Management strategies range from lifestyle modification, pelvic floor muscle therapy, bladder training, and medical interventions (antimuscarinics, &#x3b2;3 adrenergic agonists, vaginal oestrogens) to surgical procedures including mid-urethral slings, urethropexy, periurethral injectables, and artificial sphincters. Emerging therapies such as neuromodulation, onabotulinumtoxin A injections, and electromagnetic devices (Emsella chairs) show promise. UI is strongly associated with depression, sexual dysfunction, poor sleep, and reduced productivity. UI is a multifactorial condition requiring patient-centred, multidisciplinary care. Advances in bladder physiology research, genetic studies, and novel therapies targeting bladder microbiota highlight future directions. Early detection, prevention, and improved patient-reported outcomes remain central to enhancing quality of life in affected women.

Little is known about the efficacy of sacral neuromodulation in patients with central nervous system (CNS) pathology. The objective of this study was to assess the rate of internal pulse generator (IPG) implantation for sacral neuromodulation (SNM) in patients with CNS pathology with overactive bladder (OAB) or urinary retention in women. This was a retrospective study utilizing the TriNetX Research Network platform, using the years 2010 to 2025, collected on March 27, 2025. Two separate queries of the data set were performed to obtain our cohorts due to the differences in inclusion criteria and endpoints. For our OAB cohorts, adult (18 years or older) female participants were included in the study if they had OAB, urge incontinence, or urgency of urination via International Classification of Diseases (ICD) codes. We then developed 6 cohorts for (1) dementia, (2) Parkinson disease, (3) stroke, (4) multiple sclerosis (MS), (5) normal pressure hydrocephalus (NPH), and (6) an aggregate cohort. We utilized ICD codes and medication codes for the aforementioned diagnoses. Each cohort had either stage 1 SNM placement or peripheral nerve evaluation (PNE) via Current Procedural Terminology (CPT) codes after 2010. Control participants included all female adult participants without any of the aforementioned neurological diagnoses. The primary outcome was the rate of neurostimulator device IPG placement within 1 month of stage 1 or PNE. A second group of cohorts was developed for urinary retention. Adult female participants were included in the study if they had retention of urine. We developed 4 cohorts: (1) dementia, (2) Parkinson disease, (3) stroke, and (4) MS, utilizing the previous ICD codes and medications. Each cohort had either stage 1 SNM placement or PNE placed after 2010. The primary outcome was the rate of neurostimulator device IPG placement (CPT code 64590) within 3 months of stage 1 or PNE. Compared with the control (4,337 of 7,805, 55.56%), there was a statistically significant reduction in the rates of SNM IPG implantation in patients with dementia (179 of 375, 47.73%) and the aggregate (483 of 984, 49.09%). There was no significant difference in SNM IPG implantation for the Parkinson disease, stroke, MS, and NPH cohorts. In the urinary retention group, compared with the control population, there were no statistically significant differences in the rate of SNM IPG implantation in the cohorts. Our study suggests that SNM has equal efficacy in patients with CNS pathology with OAB or urinary retention, similar to the nonneurogenic population, except in patients with dementia, who have lower rates of IPG implantation for OAB.

The Trier Social Stress Test (TSST) elicits affective responses and has been linked to smoking behavior. However, its remote use during a planned quit attempt-when stress reactivity may influence early lapse-remains understudied. To quantify affective reactivity to a remotely administered TSST on a planned quit date following overnight abstinence and evaluate associations with cigarette use and lapse within 48 h. This secondary analysis used data from a randomized controlled trial of adult smokers completing a remotely administered TSST following overnight nicotine abstinence. Urge, anxiety, and stress were assessed using visual analog scales and summarized using area under the curve (AUC) metrics. Smoking outcomes included cigarette count and lapse within 48 h. Associations were estimated using generalized estimating equations. In adjusted models, anxiety reactivity-but not urge or stress-was associated with cigarette count and lapse. Greater anxiety exposure (AUCtot) and change above baseline (AUCab) were associated with higher cigarette count (IRR=1.0004, 95%CI:1.0002-1.001, p=.002; IRR=1.01, 95%CI: 1.002-1.01, p=.002) and increased odds of lapse (OR=1.001, 95%CI: 1.0001-1.002, p=.03; OR=1.02, 95%CI: 1.001-1.03, p=.03). Effect sizes were small. Anxiety reactivity under nicotine deprivation was associated with increased cigarette use and lapse 48 h post quit attempt, suggesting individual differences in stress-evoked anxiety may serve as a behavioral marker for early lapse. Remote TSST administration appears feasible for eliciting affective responses on a quit date.

In 2026, the US Centers for Medicare & Medicaid Services implemented an update to the Physician Fee Schedule establishing a unified reimbursement rate for skin substitutes, also referred to as cellular, acellular and matrix-like products (CAMPs). This policy change introduced a fixed payment of [Formula: see text]127.14 per cm2, regardless of product type or regulatory classification. The aim of this work was to assess perceived impacts of the revised fee schedule that went into effect on 1 January 2026. The Wound and Hyperbaric Association conducted an online national survey of wound care practitioners and practices from 4 February 2026 to 14 April 2026. The Access Crisis Feedback Form consisted of 13 questions, including two open-ended items. Over the 69 days that the survey was open, 130 (~3%) responses were received from a comparative pool of 4551 National Provider Identifiers that had applied a CAMP in 2024. Collectively, respondents reported providing care to approximately 12,000 patients with wounds per week. Geographic representation included 36 of 50 (72%) states and Washington DC, and 8 of 12 (67%) Medicare Administrative Contractors. Most respondents (82%) practiced in non-facility settings; however, hospital-affiliated outpatient wound centres, and ambulatory surgery centres were also represented. The most severe concern identified was the 'Closure or planned closure of a wound care practice or service line', reported by just over 45% of responding settings. Only five (4%) respondents reported no significant impact, indicating that 96% perceived at least one operational impact following implementation of the revised payment policy. The most frequently cited concern (61%) was 'Authorisation delays for clinically eligible patients'. Analysis of the survey data suggests widespread impacts of the implemented CAMPs universal fee schedule across diverse wound care delivery settings in the US, including a substantial risk of service line closures. These findings raise concerns that a uniform CAMP product payment may not achieve site-of-care neutrality when hospital outpatient departments receive a separate application facility payment, while non-facility providers do not. Respondents reported that patients are already experiencing reduced access to advanced wound care, with associated complications such as: infection; sepsis; amputation; wound deterioration or enlargement; hospital readmission; the need for surgical debridement in the operating room setting; and flap- or graft-based salvage procedures. Responding wound care providers and practices, across diverse care settings and geographic regions, urge reevaluation of the current reimbursement framework to ensure the financial sustainability of wound care services, and to protect patient access and outcomes.

Urinary incontinence (UI), a prevalent quality-of-life-limiting condition, frequently coexists with hip osteoarthritis, potentially through pelvic floor dysfunction related to obturator internus muscle involvement. Several reports suggest improvement after total hip arthroplasty (THA), although postoperative time-course changes remain unclear. This study aimed to clarify the temporal trends in UI after THA and examine association of postoperative UI trajectories with functional recovery. This retrospective study included 118 female patients who underwent THA for hip osteoarthritis between October 2021 and March 2024. UI, assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), was defined as ICIQ-SF&#x2009;&#x2265;&#x2009;1 preoperatively and at 3, 6, 9, and 12&#xa0;months postoperatively, and classified as stress (SUI), urge (UUI), or mixed (MUI). Hip-related patient-reported outcomes were evaluated using the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). Associations with BMI, age, surgical approach (direct lateral/Bauer vs. modified Watson-Jones/OCM), and UI type were tested using Mann-Whitney U, chi-squared, and repeated-measures ANOVA tests. Of 118 patients (mean age at surgery, 67&#xa0;years; mean BMI, 24.3&#xa0;kg/m2) preoperatively, 73 (61.9%) reported UI (mean ICIQ-SF 7.88), including SUI (n&#x2009;=&#x2009;20), UUI (n&#x2009;=&#x2009;26), and MUI (n&#x2009;=&#x2009;27), with a higher baseline severity in MUI than in UUI. The mean ICIQ-SF improved markedly by 3&#xa0;months (3.88) with a significant time effect (p&#x2009;<&#x2009;0.001, &#x3b7;2&#x2009;=&#x2009;0.39), but then plateaued through 12&#xa0;months. Although most patients improved, 45/73 (61.6%) had persistent UI at 12&#xa0;months. These patients had higher preoperative ICIQ-SF and significantly worse postoperative JHEQ (notably pain) across multiple time points, while BMI, approach, and UI type showed no significant group differences. UI symptoms improved significantly within the first 3&#xa0;months following THA; however, subsequent recovery was limited. Persistent UI was associated with poorer functional recovery and higher pain levels.

Restless legs syndrome (RLS) is a neurologic disorder characterized by an irresistible urge to move the legs, typically worsening during periods of rest and at night. The disorder significantly impairs sleep and quality of life. Despite available pharmacologic options, many patients experience suboptimal long-term control, likely reflecting an incomplete understanding of RLS mechanisms. A literature review was performed using PubMed, Scopus, and Google Scholar. Publications from 2015 to 2025 were screened, prioritizing landmark clinical trials, neuroimaging studies, and mechanistic investigations. Data were synthesized to identify consistent and emerging themes in RLS pathophysiology. The most consistently supported mechanisms involve dopaminergic dysfunction, altered striatal dopamine receptor activity, abnormalities in brain iron metabolism, and hyperglutamatergic state linked to hypoadenosine dysfunction. Genetic susceptibility and circadian modulation also appear to contribute to disease expression. Recent evidence suggests a novel role for hypo-adenosine signaling, potentially linking dopaminergic and iron pathways through adenosine modulation. Over the past decade, neuroimaging and molecular research advances have expanded understanding of RLS pathophysiology beyond traditional dopamine and iron models. The emerging hypo-adenosine hypothesis may offer a unifying framework to explain variability in treatment response and disease progression. Future research integrating these pathways could guide the development of more targeted and durable therapies. This narrative review synthesizes findings from the past ten years to examine how current models of restless legs syndrome pathophysiology have evolved, why key mechanistic findings remain inconsistent, and which gaps warrant priority in future investigation.