Knowledge gaps remain in the field of back pain research, with few systematic efforts undertaken to identify research priorities that reflect the preferences of individuals affected by the condition. The objective of this study was to identify the top 10 research priorities for back pain, as defined by individuals with lived experience of back pain and healthcare professionals. A James Lind Alliance Priority Setting Partnership approach was conducted in Norway. This involved (1) establishing a Steering Committee; (2) defining a scope; (3) gathering stakeholders' evidence uncertainties about back pain using focus group interviews; (4) summarising evidence uncertainties and verifying uncertainties by checking existing evidence; (5) shortlisting evidence uncertainties using an online survey; and (6) determining the top 10 research priorities through a priority-setting workshop. In total, 230 questions were generated through three focus group interviews involving 12 individuals with lived experience of back pain and seven healthcare professionals. Generated questions were summarised into 37 core questions. None of the core questions had been sufficiently addressed by existing evidence (prioritising high-quality evidence, preferably systematic reviews). The shortlisting survey was completed by 284 respondents (263 individuals with lived experience of back pain (93%), and 40 healthcare professionals (14%), with some respondents identifying as both). The top 25 core questions were brought forward to the priority-setting workshop involving five healthcare professionals and four individuals with lived experience of back pain. The top research priority was "How can implementation of evidence-based treatment recommendations for back pain be ensured in the Norwegian healthcare system?". Adopting the JLA approach, this study has identified the top 10 research priorities for back pain from the perspectives of both individuals with lived experience of back pain and healthcare professionals. These findings should be considered a guide to research areas that are meaningful to end-users.
While different objective metrics have been used in the literature to evaluate exoskeletons' performance, less research has examined how these metrics represent users' perception of exoskeleton performance. This study aimed to investigate the relationships between muscle activity and joint kinematics with users' perceptions of a soft back-support exoskeleton performance across multiple subjective factors, including comfort, biomechanical support, pain, mobility restriction, and overall experience, while using a soft back-support exoskeleton. The study also examined how users' overall exoskeleton selections align with their preferences across these subjective factors. Ten able-bodied individuals performed trunk bending and weight-lifting while wearing different exoskeleton configurations (eight configurations of four different sizes and two strength levels). Lower back muscle activity as well as trunk and knee joint kinematics were recorded using wearable sensors. A similarity index was used to quantify the similarity between users' subjective feedback across different factors, as well as the similarity between subjective feedback and objective metrics. The results showed that users' perceptions of comfort, absence of pain, and mobility restriction were highly consistent, with similarity indices exceeding 90% between these factors. Participants preferred low-strength elastic bands for comfort (75%), absence of pain (80%), mobility restriction (75%), and overall experience (68%), while higher-strength bands were preferred for biomechanical support (70%). Their overall exoskeleton selections reflected an intermediate compromise between comfort- and support-oriented configurations. Similarity analyses showed that comfort, absence of pain, and mobility restriction were more strongly associated with trunk range of motion (p < 0.01). Muscle activity represented human perception of support to some extent, with median similarity indices of 73.7% for trunk bending and 63.6% for weight-lifting. Overall, this research laid the foundations for understanding how different biomechanical metrics align with user perceptions of the soft exoskeleton performance and highlighted that users consider a broader range of factors when selecting their preferred exoskeleton setting.
Musculoskeletal disorders (MSDs) are the leading work-related health issue in Europe. While passive back-support exoskeletons have shown promise in reducing physical strain in laboratory settings, their medium-term effects under real-world working conditions remain largely unexplored. This study will assess the applicability and the medium-term effects of passive back-support exoskeletons on MSDs in the logistics and healthcare sectors. ELSA LogiCare is a multicenter, parallel-designed, randomized controlled trial. Participants will be randomly assigned in a 2:1 ratio to either an intervention group or a control group. The intervention group will be randomly assigned (1:1) to use one of two passive back-support exoskeleton models for 3 months, while the control group works unassisted as usual. We aim to recruit a total sample size of 120 participants, resulting in approximately 80 participants in the intervention group and 40 participants in the control group. Primary outcomes focus on feasibility and use of the exoskeleton, including daily wearing time. Effectiveness-related outcomes include musculoskeletal complaints after 3 months, assessed using the Cornell Musculoskeletal Discomfort Questionnaire. Secondary outcomes include physical and mental workload (NASA-Raw Task Load Index), job satisfaction (Copenhagen Psychosocial Questionnaire), cognitive performance (Wiener Testsystem), fatigue (Fatigue Scale), acceptance of exoskeletons (Technology Commitment), user satisfaction (Quest 2.0), user experience and implementation barriers (short interviews), absences due to illness, blood pressure, physical activity (Fitbit/Garmin) and dropouts. Outcomes will be assessed at baseline, every 4 weeks during, and immediately after the intervention. The study is open-label, with blinding applied to outcome assessors and data analysts only. Primary analyses will follow the intention-to-treat principle and will be conducted using mixed-effects models with repeated measures to estimate feasibility- and effectiveness-related outcomes over time. When effectively integrated into workplace environments, passive back-support exoskeletons have the potential to significantly alleviate physical strain and enhance efforts to reduce the risks associated with MSDs. Our process evaluation can also help to understand how passive back-support exoskeletons can be successfully integrated into the logistics and care sectors. German Clinical Trials Register (DRKS) under the DRKS-ID: DRKS00036072.
To compare the effects of two different breathing-training modalities combined with core stability exercise (CSE) versus CSE alone on pain, function, and related multidimensional outcomes in individuals with chronic nonspecific low back pain within a hybrid telerehabilitation model. Assessor-blinded randomized controlled trial. Fifty-four participants were randomly assigned to diaphragmatic breathing plus CSE, abdominal drawing-in maneuver plus CSE, or CSE alone. All received a 4-week hybrid telerehabilitation programme with 3-month follow-up. Primary outcomes were pain intensity and disability. Secondary outcomes included kinesiophobia, health-related quality of life, perceived recovery, proprioception, and postural balance. Compared with CSE alone, both breathing-combined interventions resulted in greater reductions in pain intensity (abdominal drawing-in maneuver [ADIM]+CSE: -0.67; diaphragmatic breathing exercise [DBE]+CSE: -0.98) and greater improvements in functional disability (ADIM+CSE: -1.71; DBE+CSE: -2.25), with partial effects maintained at 3 months. Both intervention groups also showed superior improvements in kinesiophobia, perceived recovery, proprioception, and postural control under eyes-closed conditions. No significant differences were observed between breathing modalities. In this small randomized trial, combining breathing training with core stability exercise was associated with greater short-term improvements in pain, functional disability, and selected sensorimotor outcomes than CSE alone. These preliminary findings require confirmation in larger trials. In patients with chronic nonspecific low back pain, combining breathing training with core stability exercises within a hybrid telerehabilitation model may provide additional benefits compared with core stability exercises alone.Diaphragmatic breathing and the abdominal drawing-in maneuver showed comparable effects on patient-reported and sensorimotor outcomes when combined with core stability exercise.Hybrid telerehabilitation combining face-to-face supervision with remote exercise delivery appears feasible for exercise-based rehabilitation in individuals with chronic nonspecific low back pain.
To explore the effect of electroacupuncture (EA) at front-mu and back-shu points of large intestine on autophagy of Cajal interstitial cells (ICCs) in the colon of rats with slow transit constipation (STC), and to analyze the mechanism of EA for mitigating STC. Thirty-six SD rats were randomly divided into a blank group, a model group, an EA group, a mosapride group, an EA+rapamycin (RAPA) group and an EA+3-methyladenine (3-MA) group, with 6 rats in each group. The STC model was established by intragastric administration with loperamide hydrochloride. In the EA group, the EA+RAPA group and the EA+3-MA group, EA was operated at bilateral "Tianshu" (ST25) and "Dachangshu" (BL25), with dense-disperse waves (2 Hz/15 Hz in frequency), for 15 min each time. In the mosapride group, intragastric administration with mosapride solution was operated. In the EA+RAPA group and the EA+3-MA group, 30 min before acupuncture, the intraperitoneal injection was administered with RAPA and 3-MA solution, respectively. The intervention was delivered once daily and for consecutive 14 days in each group. After model establishment, the defecation time of the first red fecal particle was recorded in each group. After modeling and intervention, the number of fecal particles and fecal quality were recorded in each group over a 24-hour period. After intervention, the small intestinal propulsion rate was calculated in each group. HE staining was used to observe the histological morphology of colonic tissue, transmission electron microscopy was used to observe the ultrastructure of ICCs in the colon tissues, the immunofluorescence assay was used to observe the positive expression of the ICCs marker tyrosine kinase receptor (C-kit) in colonic tissue, the real-time quantitative PCR assay was used to detect C-kit mRNA expression, and Western-blot was used to detect C-kit and autophagy-related protein expression in each group. After modeling, compared with the blank group, the model group exhibited the prolonged defecation time of the first red fecal particle and the reduced number of fecal particles, and the decline of fecal quality and small intestinal propulsion rate (P<0.01). After intervention, compared with the model group, the EA group and the mosapride group showed the increase in the number of fecal particles, fecal quality, and small intestinal propulsion rate (P<0.01). Compared with the EA group, fecal quality and small intestinal propulsion rate were reduced in the EA+RAPA group (P<0.01). Compared with the blank group, the model group showed the impaired colonic mucosal structure and reduced goblet cell count; and autophagosomes and mitochondrial swelling were markedly observed in the cytoplasm of ICCs. The average fluorescence intensity of C-kit, the mRNA expression of C-kit, and the protein expression of C-kit and P62 all decreased, while the protein expression of LC3 and ATG5 increased in the model group (P<0.01). Compared with the model group, all other groups showed the improvements in colonic mucosal structure and ICCs ultrastructure, with the increase in average C-kit fluorescence intensity (P<0.01); the mRNA expression of C-kit and the protein expression of C-kit and P62 were elevated (P<0.01), while the protein expression LC3 and ATG5 were reduced in the EA group (P<0.01). When compared with the EA group, the protein expression of P62 decreased in the EA+3-MA group (P<0.01). Electroacupuncture at front-mu and back-shu point of large intestine can effectively alleviate intestinal motility disorder in rats with slow transit constipation, which may be related to inhibiting excessive autophagy of ICCs and repairing the structure and quantity of ICCs. 目的：观察电针大肠俞募穴对慢传输型便秘（STC）大鼠结肠Cajal间质细胞（ICCs）自噬的影响，探讨电针改善STC的作用机制。 方法：将36只SD大鼠随机分为空白组、模型组、电针组、莫沙必利组、电针+雷帕霉素（RAPA）组及电针+3-甲基腺嘌呤（3-MA）组，每组6只。采用盐酸洛哌丁胺灌胃法建立STC模型。电针组、电针+3-MA组、电针+RAPA组予以电针双侧“天枢”“大肠俞”干预，选择疏密波（频率2 Hz/15 Hz），每次15 min；莫沙必利组予莫沙必利溶液灌胃；电针+RAPA组在针刺前30 min予RAPA溶液腹腔注射；电针+3-MA组在针刺前30 min予3-MA溶液腹腔注射，以上干预均每日1次，连续14 d。造模后，记录各组大鼠首粒红便排出时间；造模后和干预后，记录各组大鼠24 h排便粒数和粪便质量；干预后，计算各组大鼠小肠推进率，HE染色观察各组大鼠结肠组织形态，透射电镜观察各组大鼠结肠组织ICCs超微结构，免疫荧光法观察各组大鼠结肠组织ICCs标志物酪氨酸激酶受体（C-kit）阳性表达，实时荧光定量PCR法检测各组大鼠结肠组织C-kit mRNA表达，Western-blot法检测各组大鼠结肠组织C-kit及自噬相关蛋白表达。 结果：造模后，与空白组比较，模型组大鼠首粒红便排出时间延长，24 h排便粒数、粪便质量及小肠推进率降低（P<0.01）。干预后，与模型组比较，电针组、莫沙必利组大鼠24 h排便粒数增加、粪便质量及小肠推进率升高（P<0.01）。与电针组比较，电针+RAPA组粪便质量及小肠推进率降低（P<0.01）。与空白组比较，模型组结肠黏膜结构受损，杯状细胞数量减少，ICCs细胞质内可见明显自噬体、线粒体肿胀，C-kit平均荧光强度、C-kit mRNA、C-kit及P62蛋白表达均降低，LC3、ATG5蛋白表达升高（P<0.01）。与模型组比较，其余各组结肠黏膜结构及ICCs超微结构均有所改善，C-kit平均荧光强度升高（P<0.01）；电针组C-kit mRNA、C-kit及P62蛋白表达升高（P<0.01），LC3、ATG5蛋白表达降低（P<0.01）。与电针组比较，电针+RAPA组C-kit mRNA表达升高（P<0.01）；电针+3-MA组P62蛋白表达降低（P<0.01）。 结论：电针大肠俞募穴可有效改善STC大鼠的肠道动力障碍，其作用机制可能为抑制ICCs过度自噬，修复ICCs结构与数量。.
Retrospective cohort study to evaluate the efficacy and safety of ultrasound-guided myofascial platelet-rich plasma (PRP) injection for myofascial pain syndrome (MPS)-induced chronic low back pain. Fifty-eight patients treated between May and December 2024 received a single ultrasound-guided PRP injection (n = 32) or two weekly normal saline injections (n = 26), and both groups underwent myofascial hydrodissection targeting trigger points in the longissimus lumborum. Pain intensity was assessed via Visual Analog Scale (VAS), functional disability by the Oswestry Disability Index (ODI). Surface electromyography (sEMG) measured neuromuscular activity through root mean square (RMS) and median frequency (MF). Statistical analyses used SPSS v.27. Both groups showed significant VAS reduction at 12 weeks (p < 0.001), with greater improvement in the PRP group (r = 0.501). PRP also yielded significant ODI improvement (r = 0.611) exceeding the minimum clinically important difference. RMS values decreased markedly in the PRP group (p = 0.001) and modestly in the NS group (p = 0.006). MF demonstrated a transient decline at week 4 (p = 0.014). No adverse events occurred. Ultrasound-guided myofascial PRP injection effectively reduces pain, enhances function, and modulates MTrPs activity in MPS at short-term follow-up, with good safety. These results support further randomized trials to validate the rehabilitative benefits of PRP for chronic low back pain.
Altered-state phenomenology around ketamine may relate to longer-term changes in imaginal processes, but observations across routine care are scarce. We report an educational case focusing on pre-defined dream motifs over time, without making treatment efficacy claims. A 48-year-old Japanese man with severe chronic primary low back pain reported dreams during insight-oriented psychotherapy from 2009 to 2025; over 360 narratives were contemporaneously documented. In 2014, he received five low-dose outpatient intravenous ketamine infusions (15 mg; 0.23 mg/kg; first 20 min, then 30 min; no premedication) and described a void-like dissociative state during the first session. Using a pre-specified codebook, two raters (treating clinician and external psychiatrist) independently coded an ID-based, period-stratified random subset of 50 dreams after re-ordering and masking of period labels for three primary motifs (obstruction, fear, anger) plus a descriptive social-interaction/role-completion motif. Obstruction decreased from pre- to post-ketamine periods in both raters (treating clinician: 6/9 vs 4/30; external psychiatrist: 6/9 vs 7/30). In the double-labelled subset, the social-interaction/role-completion motif was labelled more often post- than pre-ketamine by both raters (2/9 pre; 10/30 and 11/30 post). Across the observation window that included outpatient ketamine infusions in 2014, dream content shifted from recurrent obstruction toward imagery of movement, interpersonal engagement, and everyday role completion (illustrated by selected de-identified dream narratives; Table 5). These single-patient, hypothesis-generating observations describe ketamine-associated void-like phenomenology and longitudinal dream-content change without making efficacy claims. In insight-oriented outpatient ketamine care, clinicians may prepare patients for possible dissociative/dream-like experiences, invite brief narrative documentation, and offer post-session integration while maintaining standard physiological monitoring.
Low back pain (LBP) is a major cause of disability worldwide and is usually attributed to musculoskeletal etiologies. However, non-musculoskeletal causes should be considered in patients with persistent or atypical symptoms. Renal causes, such as renal calcific disorders, are less frequently considered, especially in the absence of urinary symptoms. Medullary nephrocalcinosis is a rare renal calcific disorder characterized by calcium deposition in the renal medullary parenchyma and tubules. We report the case of a 46-year-old woman with a three-year history of chronic LBP without urinary tract symptoms, managed conservatively as musculoskeletal pain, without improvement. Bedside point-of-care ultrasound (POCUS) revealed bilateral echogenic medullary pyramids suggestive of medullary nephrocalcinosis. Confirmatory imaging with computed tomography showed calcification of the medullary pyramids and multiple bilateral renal medullary cysts, consistent with medullary nephrocalcinosis and medullary sponge kidney. This case highlights an atypical presentation of medullary nephrocalcinosis and underscores the diagnostic utility of POCUS as a valuable, low-cost, noninvasive tool for assessing renal causes of LBP.
Nonspecific chronic low back pain (cLBP) frequently accompanies psychiatric comorbidities, including anxiety, depression, insomnia, and substance use disorders (SUDs), which worsen patient outcomes. However, research characterizing the prevalence and temporal risk of these comorbidities using large-scale, age-stratified data remains limited. Objectives: This study evaluated the prevalence of anxiety, depression, insomnia, and SUDs after cLBP diagnosis and the population's vulnerability to these conditions. We performed a retrospective cohort study using the TriNetX network, analyzing deidentified electronic health records from over 150 million patients. Individuals with cLBP from 2014 to 2023 were categorized into age groups (0-25, 26-49, and 50+ years) based on neurodevelopmental milestones and cLBP epidemiology. Annual point prevalence of anxiety, depression, insomnia, and SUDs was calculated for each group. Competing risk analysis determined the 10-year cumulative incidence of each outcome after cLBP diagnosis. Among 1,045,921 individuals with cLBP, all psychiatric comorbidities rose in prevalence across age groups from 2014 to 2023. By 2023, anxiety prevalence reached 30.8% (0-25), 39.0% (26-49), and 33.0% (50+); depression prevalence was 20.9%, 28.7%, and 27.1%, respectively. Insomnia prevalence increased from 6.9% (0-25) to 13.6% (26-49) and 20.1% (50+). SUD substantially increased from 0 to 25 (7.73%) to 26 to 49 (27.7%) and 50+ (23.2%) groups. For all groups, females showed higher anxiety, depression, and insomnia rates, whereas SUDs were more common in males. Ten-year competing risk cumulative incidence showed that anxiety had the highest risk across all groups: 30.5% (0-25), 27.3% (26-49), 20.5% (50+). Individuals with cLBP face a rising and substantial burden of psychiatric comorbidities, with age- and sex-specific increasing patterns. Screening and interventions should be tailored by age to improve outcomes for this high-risk population.
Mental fatigue is highly prevalent in chronic low back pain (cLBP) but rarely assessed in clinical practice. Standard physical capacity tests may underestimate functional abilities when mental fatigue is present. This study investigated whether a simple handgrip endurance task could objectively detect mental fatigue effects on physical performance in cLBP patients. One hundred twenty participants (60 cLBP patients, 60 pain-free controls) performed a handgrip endurance task at 13% of maximal voluntary contraction before and after either a mentally fatiguing Stroop task (30 minutes) or watching a neutral documentary. Time to exhaustion (TTE) was compared between conditions within each group using analysis of variance. cLBP patients who performed the Stroop task showed significantly greater reduction in endurance (mean decrease: 118 seconds) compared to those who watched the documentary (mean decrease: 71 seconds), p <0.05. This mental fatigue effect was not observed in pain-free participants (p =0.644). Importantly, both groups performed similarly on the Stroop task itself, indicating that cognitive performance did not differ between populations. Mental fatigue selectively impairs physical endurance in cLBP patients. The handgrip endurance test offers a practical, low-cost tool to objectively assess mental fatigue in clinical settings. These findings have important implications for functional capacity evaluations and return-to-work assessments, as standard tests may systematically underestimate patients' true abilities when mental fatigue goes unrecognized.
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Similar phenotypic traits can evolve independently in response to comparable environmental challenges. A striking example of this process is the repeated and irreversible loss of flight in birds, particularly on islands. The rail family (Rallidae) provides an exceptional model for studying this phenomenon, as nearly a quarter of the 130 extant species have independently become flightless. Here, we present the first genome-wide comparative analysis of multiple independent flightless rail lineages to identify the molecular basis of flight loss. We compared coding regions from seven rail species (four flightless and three volant) using more than 11,000 alignments and multiple phylogeny-based tests, including branch-site models of selection, relative evolutionary rate analyses, and assessments of function-altering amino acid substitutions. Across all analyses, 116 genes showed significant associations with flightlessness, of which 37 were linked to biological functions related to flight capacity-such as muscle, bone, limb, and heart development-or to traits reflecting ecological consequences of flight loss, including immune response, renal function, lipid metabolism, cognition, and sensory perception. Many genes under selection in flightless species were also involved in gene regulation and post-translational modification. These findings suggest that convergent loss of flight in rails arises not from major mutations in a few key loci but from numerous small, repeated genetic changes affecting both developmental pathways and regulatory mechanisms.
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Evaluate the relationship between risk of occupational low-level blast (LLB) exposure and health outcomes (ie, substance use disorder, long-term opioid receipt, headaches, and back pain). We integrated 2 established military occupation-based LLB exposure risk classification strategies (Belding and colleagues and Carr and colleagues) to use military service occupation as a proxy for LLB exposure risk. Records were drawn from the Substance Use and Psychological Injury Combat Study and included Military Health System inpatient and outpatient care data, pharmacy fill records, and military history characteristics. Enlisted Army soldiers returning from an Afghanistan/Iraq deployment during fiscal years 2008-2014 (n = 477 746). Longitudinal and observational with exposure and outcome periods before and after the date of return from the first deployment ending in the study period, respectively. Belding and Carr classification strategies were integrated to create a 5-level LLB exposure risk framework (ie, High-Belding & Carr, High-Belding Only, Medium-Belding Only, Mixed, Low-Belding Only). Outcomes were long-term opioid receipt and diagnoses of substance use disorder, headache (including migraine), and back pain; covariates included demographic and military history characteristics, exposure-period traumatic brain injury diagnosis, exposure-period mental health and self-harm/suicidal behavior, and exposure-period observation of outcomes measures. Approximately 6.0% were classified as high exposure by the High-Belding & Carr classification, and 27.2% were classified as High-Belding Only. Comparing the High-Belding Only and High-Belding & Carr groups, respectively, with the Low-Belding Only group, survival models revealed elevated hazard ratios for long-term opioid receipt (1.29, P < .001; 1.33, P < .001) and substance use diagnoses (1.19, P < .001; 1.27, P < .001), somewhat elevated hazard ratios for headache (1.12, P < .001; 1.08, P < .001), and slightly lowered hazard ratios (0.98, P < .001; 0.98, P < .01) for back pain. Study results add to the existing research underscoring the urgency for advancing knowledge about LLB exposure and potential military health impacts and provide direction for future research.
To compare decompression alone with decompression with fusion in patients with degenerative lumbar spondylolisthesis. PubMed, Google Scholar, Ovid, and Web of Science databases were searched up to March 2025 for randomized controlled trials (RCTs). The primary outcomes were the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores. The secondary outcomes included operative time, length of hospital stay, intraoperative blood loss, reoperation, complications, and cost. Pooled analysis was performed using a random-effects model in Review Manager following Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020. The quality of included randomized trials was evaluated using the Cochrane risk-of-bias tool. Of the 4,507 studies, 5 RCTs (n = 898) were included. Both interventions improved ODI and VAS scores, with no significant differences for ODI (mean difference [MD], -3.21; 95% confidence interval [CI], -6.59 to 0.17, p = 0.06) or VAS leg pain (MD, -1.67; 95% CI, -8.85 to 5.51, p = 0.65). Decompression showed greater improvement in VAS back pain (MD, -7.48; 95% CI, -14.23 to -0.73, p = 0.03). Perioperative outcomes favored decompression, with a shorter operative time (95 min), shorter hospital stay (1.7 days), and lower blood loss (322 mL). Complications were more frequent with fusion, whereas reoperation rates did not differ. One study reported lower decompression costs (5,400 versus 12,200 USD). Both interventions significantly improved pain and disability. Decompression alone was associated with a lower perioperative morbidity and some evidence of greater back pain relief, supporting its role as a reasonable initial surgical option, with fusion reserved for patients requiring stabilization.
We sought to determine if age affects how women with pelvic organ prolapse (POP) perceive associated symptoms. A secondary analysis was performed on a previously published cross-sectional study of participants presenting for POP to three urogynecology centers in the United States, the United Kingdom, and Chile. Participants completed a questionnaire regarding the presence and bother of associated symptoms. Statistical analysis was performed using Mantel-Haenszel χ2 tests or Fisher's exact tests. Of 202 participants, 25 were under 50 years, 38 were aged 50-59 years, 71 were aged 60-69 years, and 68 were aged 70 years and above. The majority of participants below 50 and 50-59 years had POP-Q stage 2 prolapse (60% and 53%, respectively), and the majority of participants 60-69 years and 70 years and above had POP-Q stage 3 prolapse (70% and 51%, respectively). The most common symptom was bulge (80.2%). Only three symptoms, stress urinary incontinence, back pain, and pelvic pain, significantly varied in the degree of bother among the three groups, with pelvic pain and back pain almost twice as common in those below 50 years old (64.0% and 64.0%) compared with those 70 years and above (39.7% and 33.8%, P=0.04 and <0.01). Vaginal bulge is the most common prolapse-associated symptom. POP-associated pelvic floor symptoms are experienced similarly across study participants, regardless of age, with the exception of stress urinary incontinence and pain.
Perceptual systems adapt through individual experience across the lifespan, an ability referred to as plasticity. To understand perceptual plasticity, a promising avenue is to investigate how perception is shaped by cultural experience, as a process deeply embedded within collective practices of cultural production and social learning. The current review synthesizes findings from recent behavioral experiments investigating cross-cultural variation in rhythm perception. Specifically, these studies show that fundamental perceptual processes, such as event timing and rhythm categorization, display shared features but also systematic differences across cultural groups. Critically, these differences correlate with statistically prominent and socially relevant features of cultural production, revealing how perceptual systems are tuned to their music-cultural environments. Yet, how can cross-cultural differences in perception be related back to the collective practices that produce the diversity of cultural environments in the first place? To bridge this gap, we propose perceptual niche construction as an evolutionary approach that positions culture as both a source and a product of perceptual plasticity. That is, cultural experience tunes individual perception, yielding culturally diverse perceptual processes. These processes, in turn, function as cultural selection pressures shaping collective practices across nested timescales, thus contributing back to the diversity of cultural environments in which perception is tuned. Notably, this approach has important implications for research in psychology and neuroscience: it operationalizes culture as communities of practice, highlights the relevance of contextually situated research, and accounts for the coevolutionary nature of culture-driven perceptual plasticity.
Aging involves a network of interrelated biological processes that differ in causality and impact. This review proposes a hierarchical framework of primary, secondary, and tertiary drivers of human aging while emphasizing the extensive feedback loops and mechanistic redundancy. Primary mechanisms include molecular damage, particularly genomic and mitochondrial DNA damage, and mutation accumulation that cumulatively result in genomic instability, and telomere attrition, which represents a separate primary driver. Although rarely recognized as an independent aging mechanism, female sex hormone decline, particularly the abrupt loss of sex steroid signaling at menopause and earlier perimenopausal changes, may constitute a primary sex-specific driver of human aging as an evolved process that amplifies molecular and physiological deterioration. Mechanisms acting as both primary and secondary include damage to molecules other than DNA including protein damage with loss of proteostasis and lipid damage, which may arise directly from molecular insults or emerge as downstream consequences of DNA damage and other primary mechanisms, while also feeding back to accelerate upstream deterioration. Secondary mechanisms comprise cellular senescence, impaired macroautophagy, deregulated nutrient sensing, epigenetic alterations, mitochondrial dysfunction, and altered intercellular communication. These processes emerge downstream of initial damage and further reciprocally reinforce it. Tertiary mechanisms of aging comprise stem cell exhaustion, chronic inflammation, and dysbiosis, which represent the system-level deterioration exacerbating molecular dysfunction. This hierarchical network-based model suggests that many hallmarks of aging may represent manifestations of redundant upstream molecular insults. This review focuses on primary mechanisms as the causative drivers of aging and proposes that the strategy to extend healthspan may require preventive approaches targeting distinct redundant primary mechanisms. Complex preventive interventions that simultaneously reduce molecular damage, slow telomere attrition, and compensate for estrogen depletion may delay the initiation and amplification of secondary and tertiary aging mechanisms. This framework supports coordinated multi-target strategies for healthspan extension and underscores the need for validated biomarkers that reflect these upstream processes as part of an integrated preventive approach.
Speech prosody richly encodes both linguistic and social meaning. However, the prosody-meaning mapping varies across contexts and talkers, contributing to the lack of invariance problem in speech perception. This article extends a recent line of work targeting the adaptivity of the human comprehension system, mapping variable input to linguistic meanings in a talker-sensitive manner. Specifically, we investigate the stability of adaptation: Once a listener adapts to the prosody of a particular talker, how long does the effect last? We conducted a large-scale (N = 424) adaptation experiment using a two-session paradigm in which listeners go through a pretest, exposure, posttest sequence in the first session, in which exposure and feedback disambiguate an ambiguous prosodic contour as a question or a statement in a between-participants manner. They were then invited back on the 2nd day after a delay of 3, 5, or 7 days to repeat the same sequence. The results provide novel evidence that adaptation is both rapid and stable. Listeners showed robust adaptation within the first few trials of exposure in the first session, and they maintained some adaptive shift even after a delay of up to 7 days. This finding extends the scientific knowledge about the longevity of adaptive shifts seen across levels of speech hierarchy. We discuss possible memory mechanisms that support the long-term maintenance of cross-talker adaptation. (PsycInfo Database Record (c) 2026 APA, all rights reserved).