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Background: Adhesive capsulitis (AC) is a chronic inflammatory condition with limited range of motion (ROM) in the glenohumeral joint. The main goals in managing AC are pain reduction and returning joint function. Intra-articular hyaluronic acid (HA) has been considered a safe modality in AC. This study compared the effectiveness of intra-articular injection of low molecular weight (LMW) with high molecular weight (HMW) HA in patients with AC.

Methods: Fifty-six patients with AC were randomized in this triple-blinded clinical trial. All underwent standard physical therapy. The outcomes were visual analog scale (VAS), Oxford shoulder score (OSS), active ROM, and patient satisfaction at 4, 12, and 24 weeks.

Results: No significant differences were detected in between-group variables at baseline. Both groups showed marked improvement in VAS, OSS, and ROM over time. At four weeks LMW-HA group had lower pain (P = 0.049). Conversely, the trend of VAS at 12-week and 24-week endpoints favors HMW-HA (Baseline to endpoint: -5.48 ± 1.68 and -3.91 ± 1.31 reduction in VAS as the primary outcome, P < 0.001). Satisfaction had significantly improved in both groups.

Conclusion: HMW-HA was associated with greater pain reduction and functional improvement compared with LMW-HA.

Trial registration: The trial protocol was registered at the Iranian Registry of Clinical Trials (IRCT), a WHO Primary Register setup (registration No: IRCT20170608034390N4; First registration date: 01/01/2020).

Aim: Given the chronic nature of acne, two 6-month studies were conducted to evaluate the long-term efficacy and tolerability of clindamycin phosphate 1.2%/adapalene 0.15%/benzoyl peroxide (BPO) 3.1% gel (CAB)-the only approved triple-combination acne topical-and its effects on scarring/dyspigmentation in participants with moderate to severe acne.

Materials and methods: Data were pooled from 2 identical, open-label, single-center studies conducted in participants (N = 50) aged ≥12 years with Investigator's Global Assessment (IGA) score of 3/4. Endpoints included change from baseline in IGA score, inflammatory/noninflammatory lesions, skin appearance (dryness, postinflammatory hyperpigmentation [PIH], postinflammatory erythema [PIE]), and scarring. Adverse events and tolerability (itching, burning, redness, swelling) were assessed.

Results: At week 24, 67% of participants achieved treatment success, and significant reductions from baseline in inflammatory (88%) and noninflammatory (68%) lesions were observed (p < 0.001, both). Significant reductions in scarring (33%), investigator- and participant-assessed PIH (71%; 78%, respectively), and PIE (77%; 77%, respectively) were demonstrated (p < 0.001, all). Most participants (>70%) reported no tolerability issues throughout the studies. Seven adverse events occurred; 4 were related to CAB, and 3 led to study discontinuation (BPO allergy [n = 2], irritant contact dermatitis to BPO [n = 1]).

Conclusions: These findings suggest that CAB is an appropriate and effective topical option for the long-term treatment of acne vulgaris.

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.