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Objectives: Vitiligo is an autoimmune skin disorder characterized by melanocyte destruction and frequently associated with autoantibodies such as antinuclear antibodies (ANA). However, the clinical relevance of ANA positivity in relation to phototherapy response remains unclear. This study aimed to evaluate whether ANA positivity influences the efficacy and safety of 308-nm excimer light therapy in patients with vitiligo.

Methods: In this cohort study, 86 patients with vitiligo received 308-nm excimer light therapy combined with topical agents, with oral mini-pulse prednisone added for active disease when necessary. Patients were stratified by ANA status, and therapeutic response was evaluated using the Vitiligo Area Scoring Index and standardized photographs over 6 months.

Results: Of the 23 ANA-positive patients (26.7%), 19 (82.6%) had a titer of 1:100 and 4 (17.4%) had a titer of 1:320, with women comprising 73.9% of this group. ANA-positive lesions on the face and neck more frequently achieved moderate repigmentation (50-74%) but were less likely to reach excellent repigmentation (≥75%) compared with ANA-negative lesions. No significant differences were observed in cumulative treatment doses, adverse events, or the occurrence of new autoimmune conditions.

Conclusions: In conclusion, this single-center cohort study suggests that ANA positivity does not significantly affect the efficacy or safety of 308-nm excimer light therapy in vitiligo, indicating that the impact of low-titer ANA may be limited.

Objectives: To investigate the factors influencing the volume reduction rate (VRR) at 12 months after ultrasound (US)-guided high-intensity focused ultrasound (HIFU) for breast fibroadenoma (FA).

Materials and methods: A retrospective analysis of 104 patients with 302 FAs who underwent US-guided HIFU from January 2021 to May 2023 was conducted. All patients received US assessment and contrast-enhanced US (CEUS) evaluation, and treatment information was recorded. VRR ≥ 80% was set as the dependent variable, while nineteen baseline- and treatment-related factors were considered as the independent variables. A logistic regression model was constructed to predict 12-month VRR.

Results: All patients successfully underwent one-session HIFU. Significant differences were observed in volume, distance from the superficial margin of FA to skin, distance from the deep margin of FA to chest wall, mean power, energy efficacy factor, type of near-field acoustic pathway, and appearance of hyperechoic changes. Multivariate analysis revealed that type of near-field acoustic pathway, distance from the deep margin of FA to chest wall, and appearance of hyperechoic changes were independent predictors of the 12-month VRR after HIFU. The area under Receiver Operating Characteristic curve was 0.688.

Conclusions: The type of near-field acoustic pathway, distance from the deep margin of FA to chest wall, and appearance of hyperechoic changes could serve as predictors of 12-month VRR following HIFU treatment for FA.

Background: Anterior cruciate ligament (ACL) injury is one of the most common sports-related injuries, often resulting in not only mechanical instability but also long-term proprioceptive dysfunction. The ACL is richly innervated with mechanoreceptors that contribute to sensorimotor control. Injury-induced degeneration of these receptors leads to disrupted afferent signaling and maladaptive central nervous system (CNS) responses, which can compromise functional recovery and increase the risk of reinjury.

Objective: This review aims to summarize current knowledge on ACL-associated proprioception, including mechanoreceptor anatomy, injury-induced changes in neural signaling, and advances in evaluation and rehabilitation techniques. Emphasis is placed on the integration of peripheral and central mechanisms and their implications for clinical interventions.

Content: We detail the types and distribution of mechanoreceptors within the ACL and describe how their disruption alters joint position sense and kinesthesia. We further explore CNS neuroplasticity, such as cortical reorganization and bilateral sensorimotor changes. Traditional and emerging methods for proprioceptive assessment are critically evaluated. Finally, we discuss surgical and rehabilitative strategies-including remnant-preserving reconstruction, neuromuscular training, and neurofeedback-that target proprioceptive recovery through neuroplastic adaptation.

Conclusion: Restoration of proprioceptive integrity following ACL injury requires a multifaceted approach that addresses both peripheral mechanoreceptor preservation and central sensorimotor reorganization. Future research should focus on standardized assessments, long-term neurophysiological monitoring, and the integration of sensor-based technologies to support individualized, neuroplasticity-driven rehabilitation strategies.

Background: Postoperative nausea and vomiting (PONV) are significant perioperative challenges. This study evaluated the efficacy of perioperative esketamine in preventing PONV.

Materials and methods: We systematically searched Embase, PubMed, Web of Science, and the Cochrane Library from inception to August 2025 for randomized controlled trials investigating the effect of perioperative esketamine on PONV. The primary outcome was PONV incidence. Secondary outcomes included time to first flatus, postoperative pain degree, anxiety scores, agitation, anesthesia recovery time, and post-anesthesia care unit (PACU) stay duration. Data were analyzed using RevMan 5.4 and STATA 15.0 software. Sensitivity and subgroup analyses were performed to assess result stability and explore potential sources of heterogeneity.

Results: Thirty-eight randomized trials (3,425 patients) were included. Esketamine reduced the risk of nausea (RR=0.69, 95% CI: 0.53-0.90) and vomiting (RR=0.75, 95% CI: 0.57-0.98), shortened time to first flatus (SMD=-0.81, 95% CI: -1.48 to -0.15), and decreased rescue analgesic needs within 2 days (SMD=0.32, 95% CI: 0.2-0.5). However, it prolonged anesthesia recovery time (SMD=0.97, 95% CI: 0.28-1.67) and PACU stay (SMD=0.76, 95% CI: 0.27-1.26).

Conclusions: Perioperative esketamine may reduce PONV and aid gastrointestinal recovery, but its potential to delay anesthesia recovery and PACU discharge requires consideration. Further studies are needed to clarify its risk-benefit profile.

Date of first submission to prospero: 10 March 2024.

Date of the start of study screening against eligibility criteria: 21 March 2024.

Background and objectives: Targeting macro-autophagy (MAut) through Nano-medicine can be more prospective than traditional medicine subjected to resistance in atrophic arthritis (RA). MAut is a degenerative process that restores healthy chondrocytes it plays a vital role in RA onset and cell homeostasis this opened Novel Avenue in targeting RA via liposomal drug delivery system. The insufficient response to existing therapies or systemic toxicity and poor bioavailability, are quiet unsettled problems lying across the full retardation of RA treatment. Various Nano-carriers with sustained drug release, improved physicochemical properties, and active targeting were designed to promote the drug delivery efficiency.

Methods: Single subcutaneous dose of Norphytane (200 μL) induced Atrophic arthritis in rat model then rats were treated with Liposomal loaded-Isethione or Isethione.

Results: Liposomal-Isethione ameliorated autophagy biomarkers including Beclin-1, P62, and X-box binding protein-1 (XBP-1), cell survival, and oncogenic biomarkers including Signal transducer and activator of transcription (STAT-3A), Phosphoinisitol kinase-3 (PI3K), AKT Serine/Threonine Kinase-1 (AKT), and Phosphatase and tensin homolog (PTEN) post elevation via Norphytane. Moreover, rheumatoid factor biomarkers including Cartilage oligomeric matrix protein (COMP), matrix metalloproteinase (MMP-9), tumor necrosis factor (TNF-α).

Conclusion: Liposomal-Isethione significantly targeted MAut signaling pathways, including Beclin-1/XBP/COMP/STAT-3A/PI3K/AKT/PTEN via increased bioavailability and targeting inflamed tissues, thus decreased drug resistance.

Background: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) presents a significant clinical challenge in urology. Traditional pathophysiological models emphasize infection and local inflammation; however, the limited efficacy of conventional therapies suggests the involvement of deeper regulatory mechanisms.

Methods: This comprehensive review synthesizes evidence from the past five years regarding neuroendocrine pathways in CP/CPPS. We systematically analyzed literature from the PubMed, Web of Science, and CNKI databases, focusing on neuropeptide functions, hypothalamic-pituitary-adrenal (HPA) axis dysregulation, sympathetic nervous system (SNS) signaling, glial cell activation, and gut-prostate axis interactions.

Results: Neuroendocrine mechanisms significantly contribute to the pathophysiology of CP/CPPS through multiple pathways. Substance P and calcitonin gene-related peptide promote neurogenic inflammation, while B-type natriuretic peptide exhibits analgesic effects. Dysregulation of the HPA axis and sympathetic overactivation create stress-related imbalances. Central glial cell activation leads to central sensitization, and the emerging concept of the gut-prostate axis reveals bidirectional neuroendocrine-immune communication.

Conclusions: CP/CPPS is a systemic condition involving complex neuro-endocrine-immune interactions. Therapeutic strategies targeting neuroendocrine mechanisms-including neuropeptide receptor antagonists, glial cell inhibitors, and neuromodulation techniques-offer promising directions for precision medicine. Future research should focus on multi-omics approaches and neuroendocrine-based patient classification for individualized treatment.

Objective: Given the paucity of systematic research on self-circumcision, this study aims to synthesize existing case data to highlight its risks and inform preventive measures.

Methods: We summarized the case data on academic websites and reports from news media as well as items from online shopping platforms, and analyzed the prevalence, motivations, methods, and complications of self-circumcision.

Results: We found that self-circumcision is an under-researched subject in the medical community. Its most common motivations include economic factors, cultural and religious beliefs, fear of medical environment, and social and psychological factors. Some of the most commonly reported complications include bleeding and hematomas, infection, skin necrosis and tissue damage, urethral damage, penile deformities, and psychological effects. Some circumcision products on e-commerce platforms contain exaggerated, misleading, and false claims.

Conclusions: Self-circumcision represents a dangerous and largely unregulated practice with potentially severe medical and psychological consequences.

Aim: Upper airway anatomy is important in obstructive sleep apnea (OSA). This study conducted a correlation analysis between the apnea-hypopnea index (AHI) score and upper airway measurements obtained from cone-beam computed tomography (CBCT), arch measurements obtained from diagnostic casts, and subjective data from patients' records, including the Berlin Sleep Questionnaire and Epworth Sleepiness Scale.

Methods: Twenty-five subjects with a confirmed diagnosis of OSA via polysomnography with a mean AHI of 25.5 (SD18.5) were enrolled in this study.

Results: A significant correlation was found between the AHI score and the following factors: male sex, obesity categories, Berlin questionnaire category, sleep efficiency, and maxillary intermolar width measured between the mesiobuccal cusp tip of the right and left first molars. Airway measurements from CBCT, including anterior cranial base length, facial proportion, and the length of the soft palate in the mid-sagittal plane and the retroglossal area in the axial plane, were significantly correlated with the AHI score.

Conclusion: In addition to male gender and obesity, anatomic factors related to upper airway measurements on CBCT are significantly correlated with AHI, indicating upper airway limitations, OSA severity, and aiding early diagnosis.

Objective: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has improved outcomes in colorectal cancer (CRC) patients with peritoneal metastases (PM), yet evidence regarding perioperative risk and long-term survival in those 75 years or older remains uncertain. The aim of this study was to evaluate whether age ≥75 years impacts on overall survival (OS) and postoperative in-hospital morbidity, according to Clavien-Dindo classification (CD), compared with patients aged <75 years.

Method: This population-based study collected data from the National Swedish HIPEC Registry, including patients with colorectal PM operated with CRS-HIPEC. Patients were stratified by age (≤74 vs ≥75) with OS as primary outcome. Secondary outcomes were in-hospital mortality, postoperative morbidity and disease free survival (DFS). Potential variables assessed for association with OS were Complete Cytoreduction Score (CCS), Peritoneal Carcinomatosis Index (PCI) score, p/ypN stage of the primary tumor, postoperative morbidity and age.

Results: A total of 592 patients were operated between 2004 and 2021, of which 553 were ≤74 years and 39 were ≥75 years. OS did not differ between age groups (p = .951). Factors affecting OS negatively were high CCS (p = .004), PCI ≥21 (p = .009) and p/ypN2 (p = .041). No difference was observed in DFS (p = .525). The rate of CD grade III-IV was 27% in patients ≤74 years and 21% in patients ≥75 years (p = .495). The in-hospital mortality rate was 1.3% in patients ≤74 and none in patients ≥75 years. Reoperation rates were similar between groups.

Conclusion: These results indicate that age above 74 should not automatically exclude patients from undergoing CRS-HIPEC. Careful selection ensures favorable survival without an increase in postoperative morbidity.