搜索结果：Pain reports

The fascial distortion model (FDM) is an anatomical perspective and treatment technique within the discipline of osteopathic manipulative treatment (OMT). The FDM is unique in that it elucidates a set of common gestures and body language for each of the six recognized FDM distortions. Fascia not only surrounds structures but also links them, transmitting mechanical forces throughout the body in a continuous three-dimensional network. Dysfunction within this system, whether local or distant, can contribute to distinct patterns of body morphology. Although fascial anatomy provides a framework for identifying chains of injury, variations in palpated tension may point toward different underlying pathologies and guide clinical interpretation. Thus, a skilled palpation can detect areas of functional conflict and pain without verbalization. This case study explores the application of FDM in treating chronic low back pain in a Panamanian agricultural worker, highlighting its utility across language barriers. B.P. presented with chronic low back pain, limited range of motion (ROM), and hypertonicity of the lumbar paraspinal muscles. Lumbar active ROM was assessed using visual estimation before, during, and after treatment. B.P.'s nonverbal gestures indicated two trigger bands and two herniated trigger points, which were treated using the appropriate FDM techniques. Post-treatment evaluations revealed improvement in functional mobility and complete resolution of pain. B.P. demonstrated increased lumbar ROM and reported relief without requiring extensive verbal communication. This case report demonstrates the effectiveness of using the FDM to treat chronic low back pain, while giving credence to the universal nature of the body language described by the model. In B.P.'s case, FDM treatments facilitated a successful and culturally competent intervention that improved both pain and function, reinforcing the value of this treatment modality in global and resource-limited contexts.

Chronic pain remains a major unmet medical challenge, yet the metabolic checkpoints that govern its persistence are poorly defined. Astrocytes are increasingly recognized as chemically programmable hubs that tune neuronal excitability through metabolic circuits. Building on reports that astrocyte-neuron lactate shuttling (ANLS) in the anterior cingulate cortex (ACC) supports chronic pain, we asked how astrocytic metabolic states evolve over the course of pain chronification. Using untargeted metabolomics of the ACC combined with GFAP-RiboTag-based astrocyte-specific transcriptomics, we provide a time-resolved map of astrocytic metabolism across the transition from acute nociception to chronic neuropathic pain. This analysis reveals a biphasic glycogen program-an acute glycogenolysis-triggered glycogen supercompensation-that culminates in the emergence of a Warburg-like metabolic signature associated with late astrocyte-enriched glycolytic and lactate-related changes and persistent circuit activation. Using glycogen phosphorylase inhibitors (GPI-1, GPI-2) as pharmacological probes, we show that early glycogenolysis blockade attenuates this Warburg-like shift, partially normalizes ACC metabolic signatures, and reduces long-lasting mechanical hypersensitivity, without impairing acute nociceptive sensitization. These findings identify astrocytic metabolic reprogramming as a pharmacologically tractable circuit-level process and nominate glycogenolysis as an upstream biochemical gate and potential therapeutic control point in neuropathic pain.

Low back pain (LBP) is a leading cause of disability worldwide, yet current clinical assessments rely heavily on subjective reports and static imaging, providing limited objective quantification of spinal dynamic function. This study aims to develop and evaluate HumanMoveNet, a novel digital framework that reconstructs a temporally consistent 3D human model with precise spinal curvature from monocular visual data to enable objective LBP screening and rehabilitation assessment. The proposed hybrid framework integrates static anatomical reconstruction, dynamic pose estimation, and temporal smoothing. From a human gait video, a 3D reconstruction network first generates a static human model with personalized spinal morphology. The gait video is then processed via optimized 2D pose estimation and parametric model regression to obtain frame-by-frame 3D human meshes. Graph convolutional and long short-term memory networks are employed to ensure temporal motion continuity. Finally, the static spine is fused with the dynamic pose sequence to create a "dynamic spine," from which key biomechanical parameters-lumbar range of motion (ROM), pelvic tilt range, and spinal symmetry index-are extracted. Validation on 146 subjects demonstrated superior reconstruction performance, achieving a 5.6% improvement (18.85 vs 17.85) in Peak Signal-to-Noise Ratio (PSNR), a 28.4% reduction in Hausdorff Distance (2.1126 mm vs 2.9505 mm), and a 5.1% increase in Intersection over Union (IoU) (0.4122 vs 0.3921) compared with state-of-the-art methods. Analysis of spinal curvature variation showed [Formula: see text] values of [Formula: see text] in females and [Formula: see text] in males, with no significant gender difference ([Formula: see text]). Gender-specific analysis further revealed that females had greater pelvic mobility ([Formula: see text] vs [Formula: see text], [Formula: see text]) and lumbar ROM ([Formula: see text] vs [Formula: see text], [Formula: see text]). HumanMoveNet provides a precise, label-free solution for assessing spinal dynamic function using conventional visual data. By combining high-fidelity spinal anatomy with dynamic motion analysis, it effectively captures LBP-related movement alterations, and shows strong potential for community-based screening, rehabilitation evaluation, and personalized care.

The clinical management of endometriosis encounters a significant obstacle: existing therapies inadequately address both the inhibition of ectopic lesion proliferation and the mitigation of the neuroinflammation associated with chronic pain. To tackle this dual challenge, this research created a bioinspired dual-targeted nanotherapeutic platform called Amy@NPs-MM/PL1. The platform is made up of biodegradable polymeric nanoparticles that are filled with amygdalin, hidden by macrophage membranes to avoid the immune system and target inflammatory sites, and linked to PL1 peptides to actively recognize lesion stromal cells. Characterization of the material showed that it had good nanoscale properties and was stable. Mechanistically, the platform effectively inhibits the pyroptosis process in endometrial stromal cells, thereby blocking the generation and pyroptosis propagation to neurons at the source. Animal studies showed that Amy@NPs-MM/PL1 greatly lowers the number of lesions, eases pain sensitivity and depressive-like behaviors, and lessens neuroinflammation. Additional metabolomic analysis indicated that the treatment reinstates metabolic homeostasis systemically. The developed nanoplatform facilitates synchronized intervention in both localized lesion pathology and central nervous system sensitization, presenting an innovative material-based approach for the comprehensive treatment of endometriosis.

Primary lymphoma of the bone is an uncommon malignancy that most frequently involves the long bones while the flat bone involvement is rare. We report the case of a man in his 20s who presented with progressive shoulder pain without systemic symptoms. Imaging demonstrated an intramedullary lytic lesion of the acromion with cortical thinning and minimal soft tissue involvement. Histopathological examination confirmed germinal centre type diffuse large B-cell lymphoma. Fluorine-18 fluorodeoxyglucose positron emission tomography/CT demonstrated a solitary hypermetabolic acromial lesion without nodal or visceral disease, consistent with stage I primary lymphoma of bone. The patient was treated with standard immunochemotherapy followed by consolidative involved-site radiotherapy. Interval imaging showed a marked reduction in metabolic activity and lesion size with sclerotic transformation, indicating a favourable treatment response. This case emphasises the rarity of acromial involvement and clarifies contemporary staging and tissue diagnostic considerations in suspected primary bone lymphoma.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune disorder characterized by demyelination and axonal damage in peripheral nerves, leading to progressive weakness and sensory impairment. Neurological complications have been reported in multiple COVID-19 cases, ranging from mild symptoms such as headaches to severe manifestations like demyelination and stroke. We report the case of a 20-year-old female who initially presented with feverish sensation, non-productive cough, generalized fatigue, arthralgia, and muscle pain. She tested positive for SARS-CoV-2 via polymerase chain reaction and received supportive treatment with home isolation for 20 days. While most symptoms resolved, muscle pain persisted. Over time, the patient developed progressive muscle pain and constant weakness in both upper and lower limbs, worsened by repetitive movement. Additional neurological symptoms included symmetrical foot drop, frequent falls, tremors, and difficulty performing fine motor tasks. Laboratory findings and nerve conduction studies were consistent with CIDP based on established diagnostic criteria. The patient received intravenous immunoglobulin therapy and had residual disability. Several case reports have associated CIDP with various infectious agents. With the advent of the COVID-19 pandemic, there has been an emergence of CIDP cases following SARS-CoV-2 infection or vaccination. This case adds to the growing body of evidence suggesting a link between COVID-19 and autoimmune neurological complications such as CIDP. This case highlights a rare instance of post-COVID-19 CIDP, underscoring the importance of considering autoimmune neuropathies in the differential diagnosis of patients presenting with progressive neuromuscular symptoms after COVID-19.

Developmental dysplasia of the hip (DDH) associated with an acute proximal femoral fracture on the same side is uncommon, and performing a one-stage total hip arthroplasty (THA) with concurrent fracture stabilization in such cases poses significant technical challenges. We present a case involving a 57-year-old female with a long history of right-sided DDH who was involved in a vehicular accident, leading to acute pain in her right hip, shortening of the limb, and restricted movement. Imaging studies indicated Hartofilakidis type II DDH along with a comminuted intertrochanteric fracture of the proximal femur and a pseudoacetabulum. Utilizing thin-slice computed tomography, we created a customized three-dimensional (3D) printed model of the pelvis and proximal femur, which allowed for detailed preoperative planning. This included evaluating the acetabular bone quality, identifying the true center of the acetabulum, selecting the appropriate cup size and orientation, and strategizing the femoral osteotomy and fixation with plates and cables. A one-stage cementless THA was executed through a posterolateral approach, featuring a small hemispherical cup securely placed in the true acetabulum and a size-16 biological femoral stem anchored distally across the fracture site, followed by the application of a lateral plate and titanium cable to stabilize the proximal femoral fracture. The patient began ambulation with the assistance of a walker on postoperative day 1. At 2 months after surgery, the pain score had decreased to 1/10 on the visual analog scale (VAS), and radiographic evaluation demonstrated ongoing fracture healing. By 3 months postoperatively, the patient was pain-free (VAS 0/10), had achieved a Harris Hip Score of 92, and showed restoration of lower-limb length. Imaging confirmed fracture union and stable prosthesis positioning, and the patient had returned to work independently. This case suggests that individualized 3D printing-assisted preoperative planning may improve the feasibility and early safety of one-stage cementless total hip arthroplasty combined with internal fixation for adult DDH with an ipsilateral proximal femoral fracture, and may provide a useful reference for preoperative decision-making in similarly complex cases.

Invasive lobular breast cancer (ILC) is the most commonly diagnosed special histological subtype of breast cancer (BC). Metastatic ILC (mILC) is less sensitive to FDG-PET imaging and often metastasizes to unusual sites -peritoneum, gastrointestinal ( GI) tract, ovaries, urinary tract, and orbit-which may go unrecognized after a long disease-free interval. Some metastatic sites cause nonspecific symptoms, like abdominal/epigastric pain, with numerous published case reports of mILC misdiagnosed as gastric cancer. These atypical BC metastatic sites may lead to late and/or misdiagnosis, thereby delaying effective treatments. We developed a patient survey to investigate the patient-reported prevalence of delayed diagnosis or misdiagnosis of mILC and their potential impact upon treatment outcomes. A 45-question survey was developed and piloted with breast cancer researchers, clinical oncologists, and patient advocates. This IRB-approved survey was then distributed to patients with ILC. Analyses including data QC and visualization were conducted in R using descriptive statistics. Incomplete or inconsistent responses were excluded, and summary statistics were stratified by four common mILC sites to highlight subgroup differences. 525 patient surveys were completed, with 450 patients diagnosed with ILC, and of those 321 diagnosed with mILC. For those with mILC, 33.3% (n=107) were diagnosed with de novo mILC at initial presentation. Of the patients diagnosed with mILC, 32.1% (n=103) presented with other medical conditions at diagnosis. Misdiagnosis was reported by 26.2% (n=84) of patients with mILC, and of these cases, 31% (n=26) had ≥2 misdiagnoses. The top 5 misdiagnoses were bone-related condition (24.7%), benign breast condition (23.4%), another type of BC (7.8%), diagnostic delay (7.8%), and menopause related (5.2%). 44.5% of patients waited ≥1 year for an accurate diagnosis. 49 patients were treated for their misdiagnosis, and 6 received incorrect cancer treatments. The most frequently reported contributors to delayed or misdiagnosis were inconclusive imaging, providers' lack of ILC knowledge, and initial misdiagnosis. Of the 321 patients with mILC, 138 (42.9%) reported symptoms before diagnosis; the most common were back pain (16.5%), fatigue/malaise (14.9%), GI symptoms (11.8%), bloating (8.4%), and weight loss (8.1%). Although 40% of patients reported having a mammogram at the time of their initial misdiagnosis, ILC was detected in only 20.5% (24/116) of these cases, and mammography detected only 5 (25%) of the 20 de novo mILC cases. Patients reported additional diagnostic testing within 1-3 months of their initial mammogram, includingbiopsy, ultrasound (US), and MRI. 47.9% of patients were in active BC surveillance after curative intent therapy at the time of their mILC diagnosis; however, no statistical difference was seen in time to diagnosis versus those patients not under surveillance. Our survey results underscore the urgent need to improve diagnostic strategies for mILC. Addressing delays and diagnostic errors in mILC is critical to optimizing treatment strategies and improving patient outcomes.

Percutaneous cervical cordotomy (PCC) is a minimally invasive radiofrequency procedure for intractable unilateral cancer pain. Commonly performed under conscious sedation, awake PCC enables real-time patient feedback, potentially improving targeting precision and expanding eligibility for patients in whom sedation poses risks. This article presents the structured protocol for awake PCC implemented at our center, including pre-procedural training, positioning, fluoroscopic guidance, impedance monitoring, sensory and motoric testing, lesioning strategy, and aftercare. The key principle is to create the smallest effective lesion, applied incrementally until spinothalamic tract disruption is confirmed. In our experience, awake PCC enables precise targeting and has yielded up to 90% success in pain relief. The approach requires substantial preparation, including training for both patient and team to ensure cooperation, clear communication, and tolerance of brief intraoperative discomfort. Although these demands can be challenging, we have found awake PCC to be a safe and effective last-resort option for patients facing devastating pain. This technical note provides a practical and stepwise approach to awake PCC. It may assist clinicians in adopting or refining the technique.

Boutonniere deformity results from damage to the central band and structures stabilizing the finger's extensor apparatus, leading to flexion of the proximal interphalangeal (PIP) joint and hyperextension of the distal interphalangeal (DIP) joint. Untreated or delayed diagnosis of boutonniere deformity results in progression of both deformity and degenerative changes in the PIP joint. In advanced, chronic deformities (Burton IV), surgical treatment includes arthrodesis or PIP joint replacement. In the presented case, a 29-year-old right-handed man presented with a persistent boutonniere deformity of the fifth finger of his right hand and pain that limited his function. The patient had two finger injuries, 13 and 11 years earlier. X-rays of the injuries revealed no fractures, and the finger was immobilized. After the immobilization of the second injury was removed, the patient experienced mild pain and observed a gradual worsening of the finger deformity. Upon admission to the orthopedic clinic, examination revealed 55° of flexion in the PIP joint, 30° of hyperextension of the DIP joint, complete lack of motion in the PIP joint. Mobility in the DIP joint was complete. X-rays revealed advanced degenerative changes in the PIP joint. The patient underwent implantation of a cementless, semi-constrained PIP endoprosthesis (Interphalangeal Proximal Prosthesis (IPP2); 3S Ortho, Lyon, France) and central band reconstruction. Postoperative immobilization lasted six weeks, followed by intensive rehabilitation. Fifteen weeks after surgery, 50° of flexion and a 5° of extension deficit were achieved in the PIP joint, with full DIP mobility. After 21 weeks, the PIP joint flexion range increased to 85°, and the pain completely resolved. The patient returned to full manual dexterity and physical activity. Chronic boutonniere deformity can lead to progression of PIP joint arthrosis and significant impairment of hand function. PIP joint arthroplasty combined with extensor reconstruction is a valuable alternative to arthrodesis in patients requiring preserved mobility and grip precision. A properly selected treatment method and early, intensive rehabilitation allow for excellent functional outcomes.

Eosinophilic ureteritis (EU) is a rare inflammatory condition characterized by eosinophilic infiltration of the ureter, often presenting with flank pain, hematuria, or obstructive uropathy. Fewer than 30 cases have been reported in the literature, and no standardized treatment strategy currently exists. We report the case of a 54-year-old woman with a history of eosinophilic cystitis who developed progressive left-sided flank pain and hydronephrosis following radical cystectomy. Ureteroscopy with biopsy confirmed EU. A six-week course of corticosteroids resulted in partial radiographic improvement but persistent eosinophilic infiltration on repeat biopsy. Given ongoing biopsy-proven eosinophilic inflammation despite corticosteroid therapy, a multidisciplinary discussion between urology and rheumatology led to initiation of mepolizumab (300 mg administered as three 100-mg subcutaneous injections every four weeks) to target IL-5-mediated eosinophilic inflammation. Following initiation of therapy, the patient experienced progressive clinical improvement, with symptom relief beginning approximately three months after treatment initiation. Repeat imaging demonstrated decreased ureteral inflammation, and follow-up ureteral biopsy showed complete absence of eosinophils, consistent with remission of active disease. The patient has remained clinically stable for approximately 18 months of follow-up without the need for ureteral stenting or additional surgical intervention. This case suggests a potential therapeutic role for IL-5 pathway inhibition with mepolizumab in EU and highlights the biologic rationale for targeting eosinophil-mediated inflammation in this condition. However, because this report describes a single patient and off-label biologic therapy, these findings should be interpreted cautiously. Further investigation through additional case series, prospective studies, and rare-disease registries will be necessary to better define the role of IL-5-targeted therapies in EU, with potential for future clinical trials if sufficient evidence emerges.

To evaluate the safety, tolerability, and early clinical and ultrasound effects of a 1726-nm laser for hidradenitis suppurativa (HS) tunnels in a pediatric patient with skin of color. A 16-year-old female (Fitzpatrick skin type VI) with moderate HS and bilateral axillary draining tunnels underwent 4 monthly treatments with a 1726-nm laser (22-24 J/cm²) directed only to the right axillary tunnel. The patient was receiving concurrent adalimumab therapy throughout the treatment period. Outcomes included investigator-rated Vancouver Scar Scale (VSS), patient-reported drainage, flare frequency, and pain (0-10 visual analog scale), as well as standardized photography and high-frequency ultrasound imaging performed at baseline and through week 15.5. By week 15.5, VSS of the treated right axilla improved from 9 to 2, primarily reflecting improved scar pliability (4 to 1). Drainage of the treated tunnel resolved after the first laser session and did not recur. In contrast, the untreated left axillary tunnel remained chronically draining. Ultrasound imaging of the treated side demonstrated a reduction in tunnel dimensions over time. Treatment was well tolerated, with a mean pulse-associated pain score of 3/10 that resolved immediately post-procedure, and no adverse events were observed. Treatment with a 1726-nm laser was associated with early resolution of drainage, improved scar pliability, and reduced tunnel dimensions on ultrasound. Although interpretation is limited by concurrent biologic therapy, the early unilateral response supports a localized laser effect. Larger controlled studies with longer follow-up are warranted to clarify the role of 1726-nm laser therapy in the management of HS tunnels.

Streptococcus cristatus is an oral commensal organism belonging to the viridans group streptococci. Although generally nonpathogenic, recent reports have highlighted its potential to cause invasive infections. However, gastrointestinal infections due to this organism have not been previously documented. We report the first case of a biliary tract infection with S. cristatus bacteremia, highlighting its clinical relevance. A 74-year-old Japanese man with hypertension and diabetes mellitus presented with severe epigastric pain and vomiting. Contrast-enhanced computed tomography confirmed choledocholithiasis, revealing common bile duct dilatation with an 8-mm stone near the ampulla of Vater. Blood cultures obtained on admission grew gram-positive cocci in chains, later identified as S. cristatus by 16S rRNA gene sequencing. The isolate was susceptible to beta-lactam antibiotics. Intravenous cefmetazole was administered for 6 days. Endoscopic retrograde cholangiopancreatography with sphincterotomy was performed on hospital days 2 and 5, achieving biliary drainage and stone removal. The patient recovered uneventfully and was discharged without sequelae on day 10. This case represents the first documented biliary tract infection associated with S. cristatus bacteremia. Accurate species-level identification is critical, as it helps recognize the pathogenic potential of organisms traditionally considered commensal.

Extended robotic-assisted thoracic surgery (E-RATS) involving combined resection of adjacent structures remains uncommon, and consolidated reports are limited. This study aimed to describe our institutional early experience with E-RATS and evaluate perioperative outcomes, including the role of hybrid techniques. We retrospectively reviewed a prospectively maintained database of patients who underwent planned E-RATS between January 2017 and October 2024. E-RATS was defined as robotic pulmonary resection combined with bronchoplasty, pulmonary arterioplasty, or resection of adjacent structures. A hybrid approach was defined as planned use of a small thoracotomy solely for pulmonary artery clamping and/or chest wall resection, with all other procedures performed robotically. Patients converted to full thoracotomy were excluded. Perioperative outcomes were analyzed descriptively. Eighteen patients (1.4% of 1276 robotic resections) were included. Procedures comprised bronchoplasty (n = 9), pulmonary arterioplasty (n = 6), and combined resection of the chest wall, diaphragm, or pericardium. Median operative time was 255 minutes, and median blood loss was 10 mL. Major postoperative complications (Clavien-Dindo grade ≥III) occurred in 4 patients (22%). Postoperative pain was assessed using a numerical rating scale on postoperative day 1 and is reported descriptively. All resections achieved negative margins, and no 90-day mortality was observed. In this single-institution early experience, extended robotic-assisted thoracic surgery, including selected hybrid procedures, was technically feasible and associated with acceptable perioperative outcomes. These findings provide descriptive and educational insight into the application of robotic-assisted techniques for selected complex thoracic resections.

As cancer survivorship rises, provision of information during cancer care is increasingly important, especially regarding potential impacts on patients' health-related quality of life. We sought to understand information needs patients had before initiating anti-cancer treatment using data from a qualitative study designed to examine appropriate recall periods in patient-reported outcome measures of physical function (PF). In this secondary analysis from the Patient Reports of Physical Functioning Study (PROPS) research program, we report on: What do patients wish they had known about their PF before starting treatment? In this secondary analysis, we examined transcripts from PROPS to describe what patients wish they had known about their PF before starting treatment. We used qualitative content analysis to analyze 72 semi-structured transcripts conducted with adults with cancer who had undergone anti-cancer treatment in the previous 6 months. The purpose of this analysis was to identify categories of patient information needs. Of the 72 participants, over half indicated a desire for additional information about their PF before starting treatment, including the impact of side effects/symptoms, such as pain and fatigue, on PF, or a better understanding of expectations for PF. Most of these participants reported PF limitations during the interview. The remaining participants reported feeling fully informed, with most reporting no PF limitations. Patients are interested in learning about the impact of treatment on their PF, but the amount of detail desired varies. Providing personalized information may enhance shared decision-making, empower patients in self-management and treatment decisions, and support timely referrals to specialists. These findings highlight the need for tailored communication strategies in cancer care to better address patient concerns and improve overall treatment experiences.

Acute pancreatitis is commonly diagnosed on the basis of characteristic abdominal pain, elevation of pancreatic enzymes to greater than three times the upper limit of normal, and supportive imaging findings. However, pancreatic injury may occasionally arise from vascular mechanisms rather than the classical enzyme-mediated inflammatory process. Venous ischemic pancreatitis, secondary to splanchnic venous thrombosis, is an under-recognized clinical entity that may present with normal or even reduced pancreatic enzyme levels, creating a potential diagnostic challenge. We report the case of a 49-year-old woman who presented with severe abdominal pain and radiologic features consistent with pancreatic injury despite both amylase and lipase levels being below the normal reference range. Contrast-enhanced computed tomography (CT) demonstrated a bulky pancreas with areas of hypoenhancement along with extensive thrombosis of the splenic vein, portal vein, and superior mesenteric vein. CT angiography confirmed preserved arterial inflow, supporting venous outflow obstruction as the dominant mechanism of pancreatic ischemia. Comprehensive evaluation excluded common causes of pancreatitis, including gallstone disease, alcohol-related pancreatitis, malignancy, myeloproliferative neoplasms, antiphospholipid syndrome, and major inherited thrombophilias. Therapeutic anticoagulation was initiated promptly, resulting in rapid clinical improvement and preventing progression to bowel ischemia or pancreatic necrosis. This case highlights an under-recognized vascular phenotype of pancreatic injury consistent with venous ischemic pancreatitis and illustrates how careful integration of biochemical findings, vascular imaging, and clinical reasoning can guide timely anticoagulation and dramatically alter clinical outcomes.

We present the case of an immunocompetent, fully vaccinated 17-year-old female who developed severe, disseminated varicella-zoster virus (VZV) reactivation with visceral involvement, Ramsay Hunt Syndrome, and complications of suspected superimposed bacterial cellulitis, chronic pain, as well as postherpetic neuralgia. We aim to highlight the importance of early recognition and multidisciplinary management of varicella-zoster virus in immunocompetent patients to minimize disease complications. All data were obtained from the electronic medical record with permission from the patient and her parent. The patient underwent serial dermatologic examinations and a comprehensive immunologic workup. Positive VZV PCR testing of the lesion and blood confirmed active VZV infection. Despite an intensive multi-drug antiviral regimen, she developed suspected clinical drug resistance-although resistance testing was not performed-progressing to disseminated varicella with hepatic involvement. Inpatient complications included Ramsay Hunt Syndrome, suspected superimposed bacterial cellulitis, opioid withdrawal, and chronic pain. While outpatient, she developed postherpetic neuralgia and psychosocial impairment, preventing her from completing her academic year. This case illustrates a rare, but severe presentation of disseminated varicella-zoster virus with visceral involvement and concomitant Ramsay Hunt Syndrome in a healthy adolescent. It underscores the importance of considering VZV in the differential diagnosis of pediatric rash and neuropathy in all patients, irrespective of immune status.

Female Sexual Dysfunction (FSD) affects 40%-45% of women globally, with multifactorial causes including pelvic floor dysfunction and hormonal changes. While hormone therapy and psychobehavioral interventions have demonstrated efficacy, they are often limited by side effects, contraindications, variable adherence, and a lack of standardized protocols. Physical therapy (PT) approaches have emerged as promising non-invasive alternatives or adjuncts, targeting underlying neuromuscular, vascular, and structural mechanisms of FSD. This review focuses on PT approaches, evaluating their mechanisms and clinical outcomes to guide evidence-based practice. The review followed the PICO framework: Population (women with FSD), Interventions (PT modalities), Comparators (sham/control/alternative treatments), and Outcomes (sexual function scores, pelvic floor muscle parameters, safety). A systematic search was performed in PubMed, Embase, and Web of Science up to April 13, 2025. The search strategy combined relevant MeSH terms and keywords using Boolean operators across three conceptual blocks: including "Sexual Dysfunction, Physiological"[Mesh], "Hypoactive Sexual Desire Disorder", "Orgasmic Disorder" etc., AND "transcutaneous electrical nerve stimulation", "pelvic floor muscle training", "gradual dilation," etc., AND "Women"[Mesh], "Female," "female patient" etc. The full search strategy and screening flowchart is available in Supplementary Material. Inclusion criteria: Randomized controlled trials (RCTs), cohort studies, pilot studies, and case reports were included if they involved women with FSD who received PT interventions and reported outcomes related to sexual function. Exclusion criteria: non-PT interventions, non-FSD populations, and non-English publications. Study selection involved two independent reviewers screening titles/abstracts and full texts. Data on study design, population, intervention, outcomes, and key findings were extracted into standardized tables. Forty-nine clinical studies with 2742 participants were included. Electromagnetic therapy, electrical stimulation, Radiofrequency therapy, pelvic floor muscle training, multimodal pelvic floor physical therapy, vibratory stimulation, dilator therapy, and acupuncture all demonstrated potential efficacy in improving FSD-related symptoms, including sexual function, vaginal laxity, pain, and orgasmic function. Numerous physical therapy modalities have demonstrated potential efficacy in improving FSD-related symptoms, although evidence quality varies across interventions. Future large-scale RCTs with standardized protocols are needed to confirm long-term benefits and establish optimal treatment algorithms.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, with 25-30% arising from the small intestine. While GISTs commonly present with abdominal pain or gastrointestinal bleeding, they may rarely manifest as acute surgical emergencies such as small bowel volvulus (SBV). Presentation with diffuse metastatic disease, including umbilical involvement (Sister Mary Joseph's nodule), at initial diagnosis is exceptionally uncommon. A 60-year-old woman presented with acute abdominal pain, vomiting, and obstipation for 2 days. Clinical examination revealed a soft, non-tender, distended abdomen with preserved bowel sounds. Imaging revealed small bowel obstruction with the characteristic whirlpool sign, a pelvic mass, diffuse peritoneal deposits, a Sister Mary Joseph's nodule, and a hepatic lesion. Emergency laparotomy revealed a 13.0 × 7.5 × 6.5 cm jejunal mesenteric mass causing a 180° anticlockwise volvulus with widespread peritoneal, omental, and umbilical nodules. Segmental jejunal resection with jejunojejunal anastomosis was performed for symptom palliation. Histopathology confirmed spindle-cell GIST, positive for CD117 and DOG1, with a mitotic count of 1/5 mm2 and a Ki-67 index of 3%. The tumor was staged as pT4 Nx M1 and categorized as high-risk. The patient recovered uneventfully and was started on treatment with imatinib mesylate. SBV secondary to GIST is rare and typically occurs in the presence of large extramural tumors that act as a lead point for mesenteric rotation. This case highlights the insidious biological behavior of GISTs, wherein prolonged asymptomatic growth may culminate in advanced metastatic disease at presentation, despite low proliferative indices. The presence of Sister Mary Joseph's nodule further signifies advanced intra-abdominal dissemination and poor prognostic implications. GISTs should be considered in cases of unexplained SBV. This case emphasizes the diagnostic challenges, the need for prompt surgical palliation, and the role of systemic tyrosine kinase inhibitors in advanced presentation of GIST.