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Chronic low back pain (CLBP) is a leading cause of disability worldwide. Physiotherapy is a common treatment, but its effect on physical functioning is generally modest, particularly for patients with severe complaints (i.e., high levels of disability and pain). Virtual Reality (VR) may complement physiotherapy, yet evidence for its effectiveness remains limited. The aim of this study was to assess the effectiveness and feasibility of a VR intervention integrated within physiotherapy for people with severe CLBP. A cluster-RCT across Dutch physiotherapy practices was conducted. Patients in the control group received 12 weeks of usual care following physiotherapy guidelines. Patients in the intervention group received similar usual care, enhanced with integrated, home-based VR consisting of pain education, exercise therapy, and relaxation modules. The primary outcome was physical functioning at three months. Secondary outcomes included feasibility, pain intensity, and catastrophizing. Analyses were conducted using linear mixed-effect models accounting for clustering by physiotherapy practice. Twenty-five patients participated in the intervention group and seven in the VARIETY control group, instead of the planned sample size of 120 participants. Due to poor recruitment (n = 7), we supplemented the VARIETY control group with 18 historical controls from two comparable trials (total control n = 25), effectiveness analyses are therefore exploratory. Between-group differences were neither statistically significant nor clinically relevant for all outcome measures, compared to the VARIETY control group (e.g., ODI mean difference at three months: -4.80, 95%CI: -17.78;8.18), or the total control group (-8.80, 95%CI: -20.17;2.57). The intervention group showed greater improvements from baseline in physical functioning (42%), compared to the VARIETY control group (26%). The intervention was considered feasible and safe to use in practice. This study found limited support for the use of VR as an adjunct to physiotherapy for people with severe CLBP. Given the use of external control data and the limited sample size, the effectiveness results should be interpreted cautiously. Further well-powered trials should reconsider study procedures to optimize patient recruitment and corroborate VR's clinical effectiveness in physiotherapy. The study was registered with ClinicalTrials.gov on 2022-12-02 (reference number: NCT05701891).

The aim of the study was to examine the worsening of QoL in patients with HNC before and after cancer therapy and to assess the extent that each factor has in its worsening. A prospective study was developed to analyze the QoL of patients with HNC before and after curative radiotherapy. The patients were interviewed to assess QoL within 15 days after initiation and at least 15 days after completion of radiotherapy. QoL assessment was performed by University of Washington Quality of Life Questionnaire version 4.1. The questionnaire before and after radiotherapy was completed by 22 patients. "Fear of recurrence" was the main important domain pre- and post-radiotherapy. Regarding the global questions we noticed a lower percentage of patients who rated positively their QoL from before to after radiotherapy. It was possible to note that there were statistically significant differences for "taste" (p=0.018) and "saliva" (p<0.001). The comparison between Physical Function and Social-Emotional Function before and after radiotherapy showed that there was a statistically significant difference in QoL related to Physical Function, which worsens after radiotherapy. This pilot study showed that fear of recurrence is the most important domain for HNC patients undergoing radiation therapy, followed by saliva, taste and swallowing.

To compare the safety of conventional physiotherapy alone versus its combination with cycloergometry by analysing session interruptions and physiological tolerance in critically ill patients. Secondarily, efficacy was assessed through strength and functional related outcomes. Single-centre, parallel, two-arm, randomized clinical trial. Intensive Care Department. Mechanically ventilated patients. Control group received 30-min of conventional physiotherapy; intervention group received 15-min of cycloergometry and 15-min of conventional physiotherapy. Safety was evaluated by recording session interruptions and changes in blood pressure, heart rate, respiratory rate, SpO2, FiO2 and tidal volume before and after sessions. Muscle strength (modified Medical Research Council score, quadriceps and handgrip strength) was evaluated at first cooperation of participants, ICU discharge, 28-day and 6-month follow-up; Activities of Daily Living score and mobility scale at ICU discharge, 28 days and 6 months; and six-minute walking test and Short Form-36 at 28 days and 6 months. 46 participants completed 732 sessions. Both interventions produced significant but comparable physiological changes. Cycloergometry sessions were longer (30 vs. 25&#xa0;min, p&#xa0;<&#xa0;0.001) and had more interruptions (13% vs. 7%, p&#xa0;=&#xa0;0.008), mainly due to fatigue and lack of cooperation. With the applied methodology no significant differences were observed in muscle strength or functional outcomes at any time point. Partially replacing conventional physiotherapy with cycloergometry was safe and well tolerated in critically ill patients. However, due to methodological limitations and the small sample size, no firm conclusions regarding efficacy can be drawn.

Diabetic kidney disease (DKD) treatment remains a significant clinical challenge; however, despite the recently demonstrated benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i), the residual risk of progression is still present, and strategies involving combined interventions may provide additional benefits. We investigated the effects of SGLT2i (empagliflozin, 35 mg/kg/day) and moderate-intensity physical training (50-min sessions every 48 h at 60-80% of maximal velocity), both individually and in combination, on DKD progression. Male C57BL/6J mice exposed to a high-fat diet and a single dose of streptozotocin (40 mg/kg) were assigned to four groups (n=12/group): Control, SGLT2i, physical training (PhTr), and SGLT2i+PhTr. Mice were evaluated over 25 weeks. Body mass, caloric intake, blood glucose, glomerular morphology, neutrophil gelatinase-associated lipocalin (NGAL) expression, oxidative stress markers, inflammatory cytokines, and inflammasome-pyroptosis axis were evaluated. At week 25, the SGLT2i+PhTr group exhibited significantly lower body mass than the Control group. SGLT2i and SGLT2i+PhTr demonstrated the most pronounced effects on blood glucose level reduction. All treatments improved glomerular morphology and reduced NGAL expression. SGLT2i treatment decreased oxidative stress markers in kidney tissue, whereas the combined therapy modulated inflammatory cytokines in skeletal muscle. All interventions reduced gasdermin D immunoexpression despite unchanged inflammasome components. These findings highlight distinct renal- and muscle-specific responses to SGLT2i and PhTr. Both single and combined interventions demonstrated distinct effects in experimental DKD, underscoring the potential benefits of a multimodal therapeutic approach.

Dizziness and vertigo affect millions annually, creating a $13.3 billion US economic burden. Physical therapists are key in treating vestibular disorders, but entry-level training varies significantly, necessitating specialized post-professional education. This study evaluates whether the Advanced Vestibular Physical Therapist (AVPT) Certificate Program effectively prepares PTs to meet patient needs. A cross-sectional survey was distributed to 230 graduates from four AVPT cohorts. The 18-question survey assessed program impact on clinical practice, professional development, and patient outcomes using 5-point Likert scales, plus demographic information and open-ended feedback. Sixty-seven graduates responded (29% response rate). Nearly all (97%) agreed the program prepared them as frontline vestibular providers, while 92% reported improved patient outcomes. All participants (100%) agreed the program met continuing education needs, and 98% reported changed clinical practice. Average likelihood to recommend was 9.69/10. However, 30% reported employers did not value the certification, and 91% received no additional compensation. The AVPT program successfully creates competent expert vestibular providers, improving clinical confidence, differential diagnosis skills, and patient outcomes while addressing critical gaps in entry-level education.

Decreased time to cardiac catheterization improves survival and limits cardiac tissue damage in ST Elevation myocardial infarction (STEMI). Emergency medical services delays account for half of treatment delays in STEMI. Helicopter air ambulance (HAA) can reduce the time to percutaneous intervention (PCI), and therefore may reduce mortality. The impact of physical distance between the PCI hospital helipad and the PCI laboratory on the door-to-door-to-balloon time (DDBT) for cardiac intervention in STEMI patients transported through HAA from remote community hospitals to PCI facilities was assessed. This was a retrospective chart review of interfacility STEMI patients where HAA was activated to reduce DDBT from January 1, 2020, to January 1, 2023. The HAA agency under review transports STEMI patients to 2 PCI centers. There is a significant difference in the distance between the helipad and the PCI laboratory at the 2 hospitals. Descriptive statistics were used to compare DDBT as well as the time from HAA arrival at the PCI hospital helipad to the cardiac catheterization laboratory. Data were available for 91 STEMI cases. The median time for DDBT was 89.9 minutes with a median time of 10.5 minutes from helipad arrival to catheterization laboratory (Table 1). Of the 91 cases, 69 (76%) were from hospital A and 22 (24%) were from hospital B. There was no detectable difference in the distribution of DDBT times between hospitals (P = .47). Helipad arrival times to cardiac catheterization laboratory were significantly longer for hospital A than hospital B (P < .001). The median time for hospital A was 11.0 minutes (interquartile range, 9.2-14.0) compared with hospital B, which had a median of 5.4 minutes (5.0-7.3). The physical distance a PCI laboratory is located from the helipad can be a significant addition to ischemic time for STEMI patients.

Adolescents living with HIV demonstrate suboptimal adherence to antiretroviral therapy compared with adults. This significantly impedes progress toward achieving the UNAIDS 95-95-95 targets. Understanding the relationship between self-reported adherence and virological outcomes among this population is essential for guiding treatment monitoring strategies and intervention development in resource-limited settings. A cross-sectional study was conducted among 515 adolescents aged 10 to 19&#xa0;years living with HIV and receiving ART at seven health facilities in the Ashanti Region of Ghana between August and November 2023. Self-reported adherence was measured using the adapted AIDS Clinical Trials Group 4-day recall questionnaire combined with items from the LifeWindows Information-Motivation-Behavioral Skills adherence questionnaire. Viral load data were extracted from medical records. Spearman's rank correlation was used to examine the relationship between adherence rates and viral load outcomes. The mean adherence rate was 92% (SD&#x2009;=&#x2009;18.93). Males comprised 49.5% of participants and females 50.5%, with a mean age of 15.44&#xa0;years (SD&#x2009;=&#x2009;2.62). Most participants (67.9%) lived with parents, and 98% had low to middle economic status. The mean number of missed doses showed an ascending pattern across the four-day recall period: 0.056 (Day 1), 0.075 (Day 2), 0.077 (Day 3), and 0.093 (Day 4). Spearman's rank correlation revealed a weak negative correlation between adherence rate and viral load (rs&#x2009;=&#x2009;-0.052, p&#x2009;=&#x2009;0.235, 95% CI: -0.141 to 0.037), which was not statistically significant. Among participants, 323 (62.7%) achieved viral suppression, while 192 (37.3%) did not. Despite high self-reported adherence levels, the weak and non-significant correlation with virological outcomes raises important validity concerns regarding self-reported adherence as a proxy measure for viral suppression among adolescents in this setting. The temporal mismatch between four-day adherence recall and longer-term viral load measurements may partly explain this discordance. Findings underscore the need for objective adherence measures, routine viral load monitoring, and adolescent-specific interventions that address psychosocial barriers affecting both adherence behavior and its biological impact.

Conventional chemical and physical methods for nanoparticle synthesis often involve toxic reagents, high energy demands, and limited biocompatibility. As a result, the biosynthesis of precious metal nanoparticles (PMNPs) using green algal extracts has gained attention as an eco-friendly, low-cost alternative, particularly for biomedical applications. This review explores the synthesis of PMNPs, i.e., silver, gold, platinum, palladium, rhodium, iridium, osmium, and ruthenium, via green algae, emphasizing the role of algal metabolites and phytochemicals in nanoparticle reduction and stabilization. Biosynthesized PMNPs consistently exhibit strong anticancer properties, including dose-dependent cytotoxicity, reactive oxygen species generation, apoptosis induction, and selective activity against cancer cells, especially in breast, cervical, liver, and colorectal cancer models. However, challenges such as limited mechanistic understanding, variability in synthesis outcomes, and scalability constraints remain. This review highlights the cancer therapeutic promise of green algae-mediated PMNPs while outlining critical directions for future research in anticancer nanomedicine.

The prevalence of obesity in the pediatric population is increasing, driven by a multifactorial etiology that includes genetic predisposition as well as both prenatal and postnatal influences. We aimed to explore associations between child physical activity (PA) at ages one and three years and body composition at age three. Furthermore, we investigated associations between maternal PA during pregnancy and child body composition at age three. Mother-child pairs (n&#x2009;=&#x2009;68) from a pregnancy PA intervention study were included. Children's PA was assessed at one- and three-year follow-ups using 7-day accelerometry and categorized into 24-hour PA and daytime PA (6 a.m. - 8 p.m.). Child body composition was measured by Dual-energy X-ray absorptiometry and expressed as fat-free mass (FFM) and body fat percentage (BF%). Maternal moderate-to-vigorous intensity PA (MVPA) was measured using a commercial activity tracker. Associations between maternal and child PA and child body composition were examined using linear regression. Variables used for model adjustment included maternal pre-pregnancy body mass index, gestational weight gain, maternal educational level at baseline, parity, maternal age at baseline, child walking status at age one, child sex, and child age at the three-year follow-up. We found a positive association between daytime PA at age one and child FFM at age three. Daytime PA at age three was positively associated with FFM, and 24-hour PA at age three was negatively associated with BF% and positively associated with FFM. A 10% increase in 24-hour PA was associated with approximately 400&#xa0;g higher FFM. Maternal MVPA during pregnancy showed no association with child body composition at age three. More daytime PA at ages one and three was associated with higher FFM at age three in children. These findings highlight the importance of research focusing on early PA habits to support healthy body composition in young children.

Bile acids (BAs), the main component of bile, play a key role in the digestion of lipids. However, recent studies have demonstrated that BAs can also act as signaling molecules, regulating metabolism by binding to BA receptors. Ferroptosis is an iron-dependent form of cell death characterized by lipid peroxidation, and it is closely associated with lipid and iron metabolism. Recent studies have shown that BA levels are significantly correlated with ferroptosis in certain diseases, including liver and gallbladder diseases, colitis, tumors, and infectious diseases. However, the effect of BAs on ferroptosis varies. Some BAs, such as deoxycholic acid (DCA), glycochenodeoxycholic acid (GCDCA), and ursodeoxycholic acid (UDCA), can trigger cellular oxidative stress, which, in turn, induces ferroptosis. While other BAs, such as taurolithocholic acid (TLCA) and tauroursodeoxycholic acid (TUDCA), significantly inhibit ferroptosis, thereby attenuating cell and tissue damage. To our knowledge, this review is the first to systematically summarize the roles and mechanisms of BAs in regulating ferroptosis under different disease conditions. Potential therapeutic methods and clinical applications have also been proposed for targeting BA-mediated ferroptosis in various diseases, providing guidance for subsequent research on BAs and ferroptosis.

Chronic low back pain is notoriously challenging to diagnose and manage, especially when imaging fails to reveal a cause. Superior cluneal nerve entrapment is an increasingly recognized, but often overlooked, source of pain that can mimic lumbosacral radiculopathy. We describe a 43-year-old woman with longstanding chronic low back pain unresponsive to physical therapy, extracorporeal shockwave therapy, and targeted sacroiliac joint injections. A physical examination revealed focal tenderness along the posterior iliac crest, a positive Tinel sign, and pain over the iliac crest. Lumbar magnetic resonance imaging was unremarkable. She underwent fluoroscopic and ultrasound-guided superior cluneal nerve blocks in separate sessions; each block produced immediate and complete pain resolution. Superior cluneal nerve entrapment should be considered when a patient has axial low back pain with negative imaging. Ultrasound-guided superior cluneal nerve blocks are a safe and effective alternative to fluoroscopic guidance, offering real-time visualization without radiation exposure.

Intrathecal baclofen therapy provides effective relief for severe spasticity, but pump infections pose a critical management challenge. Standard care involves removing both the pump and the catheter, often necessitating rapid transition to oral therapy, which may be poorly tolerated in high-dose or anatomically complex patients. A 47-year-old man with spastic quadriplegic cerebral palsy, prior spinal fusion, and longstanding intrathecal baclofen therapy developed a pump site infection 5 days after pump replacement. The pump was explanted, but the catheter was preserved and externalized under sterile conditions. Continuous intrathecal infusion at 30 &#x3bc;g/hr, with gradual introduction of oral baclofen, maintained neurologic stability without withdrawal. Following a 10-day antibiotic course, the pump was successfully reimplanted using the preserved catheter. Externalization of an intrathecal catheter can serve as a safe bridging strategy in pump infections, preventing withdrawal and enabling reimplantation in select high-risk patients.

Melanoma recurrence risk is highest within the first 2 years after diagnosis and progressively declines thereafter. Current surveillance strategies remain largely guided by clinicopathologic risk stratification, with the comprehensive medical history, physical examination, and complete skin assessment forming the cornerstone of follow-up. Although cross-sectional imaging and lymph node ultrasound are used in selected higher-risk patients, routine intensive imaging has not consistently demonstrated survival benefit and may increase costs and false-positive findings. Emerging technologies are reshaping melanoma surveillance and clinical management. Circulating tumor DNA (ctDNA) has shown promise as a minimally invasive biomarker capable of detecting molecular residual disease and anticipating clinical recurrence. Persistent or newly positive ctDNA after surgery is consistently associated with inferior recurrence-free survival. However, ctDNA does not reliably detect all recurrence patterns and its sensitivity varies according to disease burden and metastatic site. Prospective validation and clarification of how ctDNA should guide adjuvant therapy or imaging strategies remain necessary. In parallel, CD8-targeted positron emission tomography (CD8 PET) has emerged as a novel functional imaging modality capable of noninvasively visualizing whole-body T-cell dynamics. By differentiating tumor burden from immune infiltration and capturing early T-cell recruitment, CD8 PET offers predictive insights into immunotherapy response. Nevertheless, limitations of this technique include dependence on optimal imaging timing, limited tracer availability, cost, and an inability to directly assess T-cell functionality. Together, ctDNA and immune-focused imaging approaches represent promising steps toward precision surveillance and management of melanoma. Further robust prospective studies are required to define their integration into clinical decision making and optimize patient outcomes.

There is a need to scale up effective physical activity interventions among the general population, particularly those incorporating resistance training. Ecofit is a community-based, multicomponent intervention promoting resistance and aerobic physical activity through smartphone technology, the outdoor built environment, and social support. This study aimed to scale up ecofit by comparing Low versus Moderate implementation support on the reach (outdoor gym use) of ecofit within two large regional municipalities. A hybrid type 3 implementation-effectiveness trial was conducted across two large municipalities in eastern Australia. Outdoor gyms (n&#x2009;=&#x2009;18) were randomized to Low (ecofit app only) or Moderate [ecofit app, QR (quick response) codes on equipment, face-to-face workout sessions] implementation support. The primary outcome of "reach" was defined as the baseline-adjusted difference in the number of outdoor gym users (i.e. adults using outdoor gym equipment for resistance training) between groups. Reach was measured at baseline and 3-month follow-up using a modified System for Observing Play and Recreation in Communities tool, with blinded assessors observing community members perceived to be &#x2265;18&#x2009;years [categorized as Adults (aged 18-59) or Seniors (aged &#x2265;60)]. Secondary outcomes included app uptake, dose received, implementation fidelity, and acceptability, feasibility, and dose-satisfaction regarding the app and guided sessions. There was no significant difference in people using outdoor gym equipment for resistance training between Low and Moderate support groups at 3-month follow-up [incidence rate ratio (IRR)&#x2009;=&#x2009;1.68, 95% CI: 0.96-2.94]. Among adults (aged 18-59), the Moderate support group showed significantly higher outdoor gym use at follow-up (IRR&#x2009;=&#x2009;1.83, 95% CI: 1.01-3.31) compared to the Low support group. Over 6 months, 1273 users registered for the app, completing 503 workouts, 62% of which occurred indoors. Ecofit shows promise for promoting resistance training, particularly among adults. Broader marketing and enhanced engagement strategies may be required to increase outdoor gym use and sustain participation over time. Outdoor gyms are increasingly installed in parks to encourage free, accessible exercise, yet they are often underused. We implemented the ecofit intervention, a free mobile app designed to help people use outdoor gyms for resistance and aerobic exercise, across two large regional municipalities in Australia. The app includes predesigned workouts, instructional videos, customizable options, and self-monitoring tools. We compared two levels of implementation support: nine gyms received Low support (ecofit app only), while another nine received Moderate support [ecofit app, QR (quick response) codes on equipment, and three cost-free group workouts led by an exercise professional]. The main aim was to compare the number of people using outdoor gyms receiving Low and Moderate support at baseline and 3 months. There was no significant difference in overall outdoor gym use between the Low and Moderate support groups. However, more adults under 60 used outdoor gyms with Moderate support compared to Low support at follow-up. Over 6 months, more than 1200 people registered for the app and completed 503 workouts. Users found the app easy to use and motivating, though many preferred private settings for exercise. Ecofit shows promise for promoting resistance training using outdoor gyms. Future studies should incorporate broader marketing and collaborate with municipal councils and local government agencies to improve engagement and accessibility.

With the widespread use of integrase strand transfer inhibitors (INSTIs) among people living with HIV (PLWH) in China, their impact on health-related quality of life (HRQOL) requires urgent evaluation. This study aimed to compare HRQOL between PLWH on first-line INSTI-based regimens and those switched from efavirenz (EFV) to INSTI, and explore factors associated with HRQOL in this INSTI-using population. A cross-sectional survey was conducted in four tertiary infectious disease hospitals in China from January to February 2025. People living with HIV receiving INSTI-based regimens were enrolled. Data on sociodemographic characteristics were collected through face-to-face interviews, while clinical data were obtained from physical examinations, laboratory tests and medical records. Self-reported HRQOL was assessed using the WHOQOL-HIV BREF instrument. Multivariable linear regression models were used to analyze influencing factors. A total of 567 PLWH (mean age 37.0 years; 97.2% male) were included in the study. There were 312 (55.0%) first-line INSTI users and 255 (45.0%) participants who had switched from EFV to INSTI. Multivariable analysis showed that scores in the general health item of HRQOL were significantly higher among first-line INSTI users compared to those switched from EFV to INSTI (B&#x2009;=&#x2009;0.21, 95% CI: 0.05&#x2009;-&#x2009;0.37, p&#x2009;=&#x2009;0.011). Additionally, a greater number of comorbidities was negatively associated with the general quality of life (QOL), general health, independence, and social relationships. An educational level of university or above, a higher monthly income (&#x2265;&#x2009;5000 CNY), and an antiretroviral therapy (ART) duration of &#x2265;&#x2009;2 years were positively associated with higher scores in some HRQOL domains, while full-time employment status was associated with decreased scores in the psychological and social relationships domains. In this cross-sectional survey of PLWH in China, first-line INSTI use was associated with modestly better HRQOL only in the general health item, compared with switching from EFV, without evidence of broader HRQOL superiority across other domains. Beyond regimen type, greater comorbidity burden was negatively associated with HRQOL.

Structural inequities in neonatal care may influence human milk (HM) feeding outcomes. We examined whether allied health service (AHS) availability differs between safety-net (sn) and non-snNICUs and its association with HM use at discharge among very low birth weight (VLBW) infants. Population-based cohort study of California Perinatal Quality Care Collaborative (CPQCC) data (2022-2023) for infants born <29 weeks' gestation or <1500&#x2009;g birth weight (BW). Multivariable models assessed associations between AHS availability (lactation, occupational/physical therapy, social work, psychology) and HM use at discharge, adjusting for infant, maternal, and hospital factors. Among 138 NICUs, 35% were snNICUs; 64% of VLBW infants were discharged home. AHS availability did not differ between sn and non-snNICUs. Individual AHS availability was not associated with increased HM use, while greater cumulative AHS availability was associated with lower HM use. HM use at discharge was higher in non-snNICUs (70.2% vs. 63.1%, p&#x2009;<&#x2009;0.001). Higher infant gestation, BW, Apgar score, maternal Asian race, absence of infection and prenatal care were positive predictors; maternal Black and Hispanic race were negative predictors. Cumulative NICU AHS availability was not associated with higher HM use. Structural presence of AHS alone may not reflect integration into effective feeding practices. This statewide analysis examined relationships between allied health service (AHS) availability and human milk (HM) nutrition among preterm infants in California NICUs. Contrary to expectations, AHS availability did not differ between safety-net and non-safety-net hospitals. Individual AHS availability showed no association with HM use at discharge, while greater cumulative AHS availability correlated with lower HM use. Findings challenge assumptions that more AHS automatically improves HM outcomes and highlight the need to evaluate how allied health resources are integrated, coordinated, and aligned with family-centered lactation support in the NICU.

Chronic pain of peripheral nerve origin is a prevalent condition that often remains resistant to conservative therapies. Peripheral nerve stimulation (PNS) has proven to be an effective intervention for managing this type of pain. Receiver based PNS is a neuromodulation therapy designed to alleviate chronic pain by targeting specific peripheral nerves. This system involves implanting an electrode array and separate receiver to target pain-causing nerves, offering relief for patients with persistent pain. A case series involving 9 patients with chronic peripheral nerve pain treated with a peripheral nerve stimulation system with a separate receiver is presented. These patients had pain localized to specific nerve targets, including the suprascapular, infrapatellar saphenous, and superior cluneal nerves. After successful trials, the Freedom&#xae; PNS System (Curonix LLC) was implanted permanently. Pain relief was assessed using the Verbal Rating Scale (VRS), showing significant improvement in pain scores from baseline to follow-up periods of one, 3, and 6 months. PNS is a safe, effective method for treating chronic pain that originates in the peripheral nerves and is resistant to conservative therapy.

Erythromelalgia is a rare pain disorder, which causes hyperperfused, red, and painful extremities. Symptoms can be so extreme that patients often resort to soaking their limbs in ice-cold water for hours on end and socially isolating themselves to avoid triggering an episode. Treatment is challenging, as many cases are refractory to medical management, which is first line. Invasive procedures are typically trialed next, some of which are still considered experimental. We describe a case of a 26-year-old woman with erythromelalgia, who remained symptomatic despite extensive pharmacologic therapy. Long-term relief was achieved following a lumbar sympathetic block. Our case highlights the lumbar sympathetic block as a potentially effective treatment for erythromelalgia, especially in cases that are refractory to standard therapy.

Peripheral nerve injury (PNI), a common clinical condition, heavily relies on the functional condition of Schwann cells (SCs) for effective repair. Emerging evidence shows that excessive pyroptosis of SCs hinders neural regeneration. Low-intensity pulsed ultrasound (LIPUS), a non-invasive physical therapy, shows potential in tissue repair; however, its role in regulating SCs pyroptosis remains unclear. This study explores the mechanism by which LIPUS improves PNI recovery by reducing SCs pyroptosis. We find that LIPUS significantly enhances motor function recovery, promotes axonal regeneration and remyelination, and decreases gastrocnemius muscle atrophy through a rat sciatic nerve crush model. LIPUS biomechanically mitigates mitochondrial dysfunction in SCs, thereby suppressing the NLRP3/Caspase-1/GSDMD-N pyroptosis signaling pathway. This inhibition reduces IL-1&#x3b2; and IL-18 release, boosting SCs proliferation, migration, and clearance of myelin debris, collectively fostering a regenerative microenvironment that supports axonal regrowth, remyelination, and functional recovery. Our results demonstrate a mechanobiological mechanism by which LIPUS promotes peripheral nerve regeneration through alleviating pyroptosis, providing a promising therapeutic approach for PNI.