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Simple Summary: Vulvar tumors are uncommon and have a considerable impact on the functional and aesthetic well-being of those affected. Their treatment necessitates a comprehensive, multidisciplinary approach at various levels, highlighting the importance of having standardized recommendations that are aligned with the latest scientific findings. Are scientific guidelines aligning with the advancements made in this field of oncology, spanning from diagnosis to palliative care at various levels? To address this, we conducted a systematic comparison of the main European and American guidelines for vulvar cancer management to assess their current status of update. From our comparisons, many divergences emerged in management strategies. Among them, lack of reference to the most up-to-date diagnostic classification systems, indication for an integrated gyneco-oncologic and plastic surgical approach to postoperative management with the most modern advanced dressing devices and palliative setting with the use of immuno- and electrochemotherapy. Background: Vulvar carcinoma is an uncommon gynecological tumor primarily affecting older women. Its treatment significantly impacts the quality of life and, not least, aesthetics because of the mutilating surgery it requires. Objectives: The management requires a multidisciplinary team of specialists who know how to care for the patient in her entirety, not neglecting psychological aspects and reconstructive surgery. How do the guidelines address multidisciplinarity, team surgical management, passing through preoperative diagnosis, and follow-up in such a challenging rare tumor to treat? Methods: To answer these questions, we compared the main scientific recommendations to identify similarities and differences in diagnostic and therapeutic management to provide an overview of the gaps that there are currently in European and American international recommendations in providing management guidance in a cancer that is both among the rarest and most difficult to manage. In this way, we aim to encourage an update in practices based on the latest scientific evidence. Results: A review of various international guidelines, some dating back to 2014, shows significant variation in approaches, ranging from initial diagnostic procedures to managing relapses. The most recent guidelines also lacked references to the latest literature, indicating that more robust scientific evidence is needed before new treatments, such as electrochemotherapy for palliation and reconstructive surgery post exenteration, can be widely adopted. Conclusions: From the systematic comparison of the main international guidelines, a strong heterogeneity emerged in the diagnostic and therapeutic recommendations as well as for the multidisciplinary approach that today is essential. Our work certainly stimulated an update of the main guidelines. [ABSTRACT FROM AUTHOR]

Simple Summary: Melanoma is a common and aggressive malignant skin tumor with the capacity to metastasize in both internal organs and skin. It has traditionally been resistant to conventional systemic chemotherapeutic drugs. With the development of systemic immunotherapy and new targeted therapies, the management and prognostic paradigm for advanced melanoma has changed. Along with the development of these new therapeutic agents, topical and intralesional treatments for metastatic cutaneous melanoma have also emerged and may be an alternative to surgical management when surgery is not feasible. The selection of the most adequate approach depends on the availability of the different treatments, the size of the lesion, the stage of the disease, the characteristics of the patient and the physician's experience and knowledge. In this narrative review, we focus on the outcomes offered by different topical and intralesional therapies for cutaneous metastatic melanoma, alone or in combination with systemic therapies. Cutaneous melanoma is a malignant neoplasm with local and distant metastatic potential. When feasible, surgery is the first line of treatment in locoregionally advanced disease. Topical and intralesional treatments can be an alternative second-line treatment. The aim of this article was to perform a narrative review of the most widely used topical and intralesional treatments for locoregionally advanced melanoma. Diphenciprone, imiquimod and 5-florouracil were included as topical treatments and bacillus Calmette-Guerin, interleukin 2, rose bengal, talimogene laherparepvec and electrochemotherapy were included as intralesional treatments. Brief comments on other alternatives in development such as interferon-alpha, interleukin-12, ipilimumab and intralesional daromun are presented. Topical treatments generally have higher response rates in epidermal metastases than in deeper metastases. In addition, the larger the lesions, the worse they tend to respond to local treatments. Some reports show that combining certain systemic treatments and topical or intralesional therapies can improve response rates. It has also been described in a few papers that non-injected lesions may respond after the application of a local therapy in distant skin-metastases. Many of these intralesional treatments are being combined in different investigations with systemic immunotherapies, with the aim of obtaining synergic responses in those patients with refractory disease. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Aims Methods Results Conclusion Cardiac implantable devices (CIED) such as pacemakers, implantable cardioverter‐defibrillators, or cardiac resynchronization devices are implanted in selected patients with bradyarrhythmia and advanced heart failure. The invasive character of these procedures poses a risk of early complications such as pneumothorax, bleeding, infections, or dislocations.There are no available data that analyzed the impact of the organization of procedures on the early complications risk after permanent pacing procedures. The aim of this study was to investigate if organizational aspects can impact early complications risk in CIED implantations.This retrospective study analyzed the medical records of 1673 patients who underwent CIED implantation at the Department of Cardiology of Cardinal Wyszynski Hospital in the years 2016–2020 (before the conduction system pacing era).The regression analysis revealed the predictive value of the number of leads on complication risk overall (β = 0.65, p < 0.001). Even though the significant differences in complications count were also observed for the consecutive days of the week (p = 0.002) and procedure order within the same day (p = 0.01), the regression analysis did not confirm their predictive value on complications’ risk. However, the subgroup analysis regarding the device type revealed the significant predictive value of procedure order on complications in the single‐chamber pacemaker subgroup (β = 1.10, p = 0.01). Moreover, the subgroup analysis confirmed the predictive value of the number of leads on pneumothorax (β = 0.89, p = 0.04) and dislocation (β = 0.67, p = 0.01), age of the patient, and the assist with the less experienced operator on hemopericardium (β = 0.11, p = 0.02, and β = 2.34, p = 0.04, respectively).The study showed that the number of leads is the main factor of early complications after CIED implantations. In the simplest devices such as single‐chamber pacemakers, the order of the procedure within the same day can also play a role in early complications risk. [ABSTRACT FROM AUTHOR]

Objectives: Electroceuticals refers to the constantly growing disciplines of bioelectric and bioelectronic medication. These include a broad variety of devices that have been invented and are now being utilized in medical implants, wearable medical electronics, and bioelectronics. The primary aim of this study is to encompass several facets of electroceuticals, their applications, and recent advancements in the field of medical challenges. Evidence acquisitions: A complete literature study was conducted, which included a comprehensive review of globally recognized scientific research databases. Results: The progressive refinement and diminution of technology, in conjunction with swift advancements in comprehending the role of electrical pathways in the human body, have rendered it progressively viable to manipulate these pathways for therapeutic purposes. Discussion and conclusion: Electrical stimulation impacts and modifies biological functioning and pathological processes in the body. In the contemporary era of medicine, health care practitioners from a variety of fields utilize electricity to cure disease or injury or to assess and diagnose using a variety of electrically driven medical tools. [ABSTRACT FROM AUTHOR]

Background: Rotator cuff repair (RCR) is one of the most prevalent procedures to manage rotator cuff tears (RCT). Postoperative shoulder pain is a common complication following RCR and may be aggravated by activation of myofascial trigger points (MTrP) associated with the injury to the soft tissues surrounding the surgical incision. This study aimed to describe a preliminary, randomized, sham-controlled trial to evaluate the effectiveness of implementing 4 sessions of myofascial trigger point dry needling (MTrP-DN) as a muscle treatment approach along with 10 sessions of multimodal rehabilitation protocol (MRh) consisting of therapeutic exercise, manual therapy, and electrotherapy on postoperative shoulder pain, range of motion (ROM), strength, and functional outcome scores for patients following RCR surgery. Methods: Forty-six patients aged 40–75 following RCR surgery were recruited and randomly allocated into 2 groups: (1) MTrP-DN plus MRh (experimental group), and (2) sham dry needling (S-DN) plus MRh (control group). This trial had a 4-week intervention period. The primary outcome was the Numeric Pain Rating Scale (NPRS) for postoperative shoulder pain. Secondary outcomes were the Shoulder Pain and Disability Index (SPADI), ROM, and strength. The mentioned outcomes were measured at baseline and week 4. In the current study, adverse events were recorded as well. Results: No statistically significant differences were observed between groups when adding MTrP-DN to MRh for postoperative shoulder pain after 4 weeks of intervention (mean difference 0.32, [95% CI -0.41,1.05], p = 0.37). However, this trial found a small effect size for postoperative shoulder pain. No significant between-group differences were detected in any of the secondary outcomes (p > 0.05) either. We found significant within-group changes in all studied outcome measures. (p < 0.001). This study also reported minor adverse events. following the needling approach. Conclusion: The lack of statistically significant differences in the outcomes and small clinical significance in shoulder pain highlights the complexity of pain management, suggesting that alternative methodologies may be needed for meaningful clinical benefits. Future studies should consider different control groups, long-term follow ups, larger sample sizes, and more MTrP-DN sessions to better understand their potential impact. Trial registration: This trial was registered at (https://www.irct.ir), (IRCT20211005052677N1) on 19/02/2022. [ABSTRACT FROM AUTHOR]

Simple Summary: Although in most cases breast cancer is curable, some specific subtypes and late stages of the disease are difficult to treat, and treatment-related side effects often are severe. Two methods that focus on the local treatment of breast cancer, regional chemotherapy and electroporation, can be combined to increase the treatment efficacy at the tumor site and decrease systemic side effects. This publication explains the technique, systemic impact on circulating tumor cells, and first results of this treatment approach. Background: Relapsed unresectable triple-negative breast cancer is a demanding disease with only a few treatment options. Especially for patients with unresectable tumor masses, a treatment that offers rapid tumor shrinkage is needed. If patients are exhausted from several treatment lines, systemic side effects have to be avoided. Reversible electroporation has shown to be effective for breast cancer if combined with systemic bleomycin and/or cisplatin. To enhance the local effect and reduce the systemic side effects, we combined reversible electroporation with regional chemotherapy. Materials and Methods: Patients with advanced metastasized and relapsed breast cancer received regional chemotherapy via intra-arterial infusion and isolated thoracic perfusion combined with percutanous reversible electroporation. Circulating tumor cells (CETCs/CTCs) were counted before and 24 h after the treatment. Tumor response was evaluated by CT (computer tomography) control. Results: A total of 21 treatments were conducted for 14 patients who had a mean tumor size of 7.6 cm (standard deviation 3.3 cm). Higher local drug levels are present with arterial infusion compared to venous infusion and result in enhanced response rates. Circulating tumor cells decreased or stayed stable for 24 h after the treatment for 11 and 8 cases, respectively. An increase was observed in two cases. A total of 13 patients showed a clinical response with tumor shrinkage that led to resectability. One patient did not respond to the treatment regimen. Conclusions: The combination of reversible electroporation with intra-arterial chemotherapy is feasible and results in a good clinical response with neglectable side effects. The treatment is repeatable and can lead to resectability. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of interferential current (IFC) therapy combined with quadriceps strengthening exercise versus sham IFC plus exercise for pain relief and functional improvement in patients with knee osteoarthritis. Study Design: Double-blind randomised controlled trial. Setting: Outpatient rehabilitation clinic. Subjects: Knee osteoarthritis patients aged 50–85 years with a pain score ≥4/10. Methods: One hundred forty-four participants were randomly allocated into the study and control groups. The study group received 20 min of IFC therapy (carrier frequency: 4000 Hz, beat frequency: 100 Hz) five times per week for three weeks, while the control group received sham IFC following the same protocol, followed by 10 min of exercise in both groups. Outcome measures included Numeric Rating Scale for Pain, Western Ontario and McMaster Universities Index (WOMAC) score, gait speed, and EuroQol-Five Dimensions-Five Levels questionnaire assessed at baseline, Week 3, and Week 6. Adverse events and patient satisfaction were evaluated at Week 3. Results: At Week 3, the study group demonstrated statistical improvement compared to the control group for Numeric Rating Scale for Pain, WOMAC Total, WOMAC Pain, and WOMAC Stiffness. The mean difference (95% confidence interval) between groups was 0.76 (0.21–1.30), 0.49 (0.03–0.95), 0.63 (0.13–1.13), and 0.62 (0.04–1.20), respectively. However, the mean differences between groups were below the Minimally Clinically Important Difference values for each outcome. Additionally, there were no significant differences between groups at Week 6 for any outcome measure. Conclusion: IFC had no effect on pain reduction and functional improvement in patients with mild to moderate knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Introduction: Pulsed electric field (PEF) has emerged as a promising energy source for catheter ablation of atrial fibrillation (AF). However, data regarding the in‐vivo effect of PEF energy on erythrocytes during AF ablation procedures are scarce. This study aimed to quantify the impact of PEF energy on erythrocyte damage during AF ablation by assessing specific hemolytic biomarkers. Methods: A total of 60 patients (age: 68 years, males: 72%, serum creatinine: 91 µmol/L) with AF underwent catheter ablation of AF using PEF energy delivered by a multipolar pentaspline Farawave catheter (Farapulse, Boston Scientific, Inc.). Ablation beyond pulmonary vein isolation was performed at the operator's discretion. Peripheral venous blood was sampled for assessing the plasma levels of free hemoglobin (fHb), direct (conjugated) bilirubin, lactate dehydrogenase (LDH), and creatinine before, immediately after the ablation, and on the next day. Results: Following the PEF ablation with duration of [median (interquartile range)] 75 (58, 95) min, with 74 (52, 92) applications and PVI only in 27% of patients, fHb, LDH, and direct bilirubin significantly increased, from 40 (18, 65) to 493 (327, 848) mg/L, from 3.1 (2.6, 3.6) to 6.8 (5.0, 7.9) µkat/L, and from 12 (9, 17) to 28 (16, 44) µmol/L, respectively (all p <.0001). A strong linear correlation was found between the peak fHb and the number of PEF applications (R = 0.81, p <.001). The major hemolysis (defined as fHb >500 mg/L) was predicted by the number of PEF applications with the corresponding area under the receiver operating characteristic curve of 0.934. The optimum cut‐off value of >74 PEF applications predicted the major hemolysis with 89% sensitivity and 87% specificity. Conclusion: Catheter ablation of AF using PEF energy delivered from a pentaspline catheter is associated with significant intravascular hemolysis. More than 74 PEF applications frequently resulted in major hemolysis. However, the critical amount of PEF energy that may cause kidney injury in susceptible patients remains to be investigated. [ABSTRACT FROM AUTHOR]

Objectives: To prospectively evaluate a mindfulness protocol and pelvic floor physical therapy (PFPT) for women with chronic pelvic pain (CPP) who were otherwise physically and mentally healthy, comparing the effectiveness of the treatments separately and together. Materials and Methods: Women with CPP were randomized into two groups. Each group initially underwent a mindfulness protocol or PFPT (including electrotherapy, biofeedback, trigger point massage, and basic pelvic kinesiotherapy guidance), being switched to the other therapy after the first intervention, so all participants underwent both interventions. Participants were evaluated at 4 time points: Baseline, after each intervention and 8 months after the final therapy using the SF-36, the Mindful Attention Awareness Scale (MAAS), the visual analog scale (VAS), pelvic assessment, and electromyography questionnaires. Results: Of 49 included women, 38 participated in both interventions and completed all 4 evaluations. In 7 physical examination and biofeedback scores, the group performing PFPT first achieved significant gains (p<0.05) immediately after the first intervention, while the group starting with mindfulness achieved significant gains only after the second intervention. In other 6 physical examination and biofeedback scores, both groups achieved significant gains immediately after the first intervention. In the MAAS, VAS, and in 4 domains of the SF-36, the sum of the interventions showed progressively significant improvement. At follow-up, gains were sustained in more than 85% of the 29 domains. Conclusion: The results suggest that performing both therapies simultaneously could optimize gains in quality of life, pain management, and pelvic floor health in women with CPP. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to investigate the effect of ultrasound-guided corticosteroid injection to the subacromial-subdeltoid bursa (SSB) and coracohumeral ligament (CHL) in treating adhesive capsulitis, with a particular focus on evaluating the potential benefits of regular electrotherapy and conventional rehabilitation exercises. Methods: A total of 29 patients with unilateral shoulder pain and restricted shoulder range of motion (ROM) were included. Corticosteroids were delivered to the subacromial-subdeltoid bursa (SSB) and coracohumeral ligament (CHL) through a single percutaneous injection. Group 1 consisted of 18 patients who received injections only, while Group 2 comprised 11 patients who received injections in combination with regular physiotherapy. Shoulder Pain and Disability Index (SPADI) scores and ROM were assessed before the injection, and again at 4, 8, and 12 weeks following the intervention. A multivariate mixed-effects model with repeated measurements was conducted for the variables. Results: Electrotherapy and traditional rehabilitation exercises did not enhance the effectiveness of this injection approach. Pain, upper extremity function, and ROM in all planes were all significantly improved with a corticosteroid injection to the CHL and SSB. Conclusions: Physiotherapy did not offer additional benefits when combined with ultrasound-guided corticosteroid injection to the CHL and SSB. The injection alone significantly improved pain, disability, and ROM in patients with adhesive capsulitis. Further research is required to optimize current physiotherapy with electrotherapy and traditional rehabilitation exercises after ultrasound-guided corticosteroid injections. [ABSTRACT FROM AUTHOR]

Bleomycin ElectroScleroTherapy (BEST) is a new approach in the treatment of vascular malformations. After bleomycin is administered to the malformation, electric pulses are applied to the target area to enhance the effectiveness of bleomycin. The mode of action is comparable to the effect of electrochemotherapy on tumour vasculature. For the wider and safer use of BEST in the clinical treatment of low-flow vascular malformations, this Current Operating Procedure (COP) is being prepared. It is a proposal for the clinical standardisation of BEST using the Cliniporator® as the electrical pulse generator with its associated electrodes. The electrical parameters considered in this protocol are those validated by the European Standard Operating Procedures for Electrochemotherapy (ESOPE) with the Cliniporator®. General requirements are proposed, and, depending on the type of lesion, local skills and the availability of radiological equipment, two technical approaches of BEST are described based on ultrasound guided intervention or combined ultrasound and fluoroscopic guided intervention. [ABSTRACT FROM AUTHOR]

Context: Exercising intrinsic foot muscles (IFMs) can improve dynamic balance and foot posture. The exercises are not intuitive and electrotherapy (neuromuscular electrical stimulation [NMES]) has been suggested to help individuals execute the exercises. The aim of this study was to evaluate the effects of training IFM program on dynamic balance and foot posture and compare traditional training methods (TRAIN) with traditional training plus NMES on the perceived workload of the exercises, balance, and foot posture. Design: Randomized controlled trial. Methods: Thirty-nine participants were randomized to control, TRAIN, or NMES. TRAIN and NMES performed IFM exercises daily for 4 weeks; NMES received electrotherapy during the first 2 weeks of training. The Y-Balance test and arch height index were measured in all participants at baseline. The training groups were measured again at 2 weeks; all participants were measured at 4 weeks and 8 weeks, after 4 weeks of no training. Perceived workload (National Aeronautics and Space Administration Task Load Index) of exercises was assessed throughout the first 2 weeks and at 4 weeks. Results: A 4-week IFM training program demonstrated increases in Y-Balance (P =.01) for TRAIN and in arch height index (seated P =.03; standing P =.02) for NMES, relative to baseline. NMES demonstrated improvement in Y-Balance (P =.02) and arch height index standing (P =.01) at 2 weeks. There were no significant differences between the training groups. Groups were similar in the number responding to exercises in excess of minimal detectable change on all clinical measures. Perceived workload of the exercises decreased during the first 2 weeks of training (P =.02), and more notably at 4 weeks (P <.001). The groups did not differ in how they perceived the workload. Conclusions: A 4-week IFM training program improved dynamic balance and foot posture. Adding NMES in early phases of training provided early improvement in dynamic balance and foot posture, but did not affect perceived workload. [ABSTRACT FROM AUTHOR]

Context: Pulsed current and kilohertz frequency alternating current are 2 types of neuromuscular electrical stimulation (NMES) currents often used by clinicians during rehabilitation. However, the low methodological quality and the different NMES parameters and protocols used in several studies might explain their inconclusive results in terms of their effects in the evoked torque and the discomfort level. In addition, the neuromuscular efficiency (ie, the NMES current type that evokes the highest torque with the lowest current intensity) has not been established yet. Therefore, our objective was to compare the evoked torque, current intensity, neuromuscular efficiency (evoked torque/current intensity ratio), and discomfort between pulsed current and kilohertz frequency alternating current in healthy people. Design: A double-blind, randomized crossover trial. Methods: Thirty healthy men (23.2 [4.5] y) participated in the study. Each participant was randomized to 4 current settings: 2 kilohertz frequency alternating currents with 2.5 kHz of carrier frequency and similar pulse duration (0.4 ms) and burst frequency (100 Hz) but with different burst duty cycles (20% and 50%) and burst durations (2 and 5 ms); and 2 pulsed currents with similar pulse frequency (100 Hz) and different pulse duration (2 and 0.4 ms). The evoked torque, current intensity at the maximal tolerated intensity, neuromuscular efficiency, and discomfort level were evaluated. Results: Both pulsed currents generated higher evoked torque than the kilohertz frequency alternating currents, despite the similar between-currents discomfort levels. The 2 ms pulsed current showed lower current intensity and higher neuromuscular efficiency compared with both alternated currents and with the 0.4 ms pulsed current. Conclusions: The higher evoked torque, higher neuromuscular efficiency, and similar discomfort of the 2 ms pulsed current compared with 2.5-kHz frequency alternating current suggests this current as the best choice for clinicians to use in NMES-based protocols. [ABSTRACT FROM AUTHOR]

Background: Bell palsy is a sudden facial nerve paralysis that affects many individuals annually. It significantly impacts patients and their families, leading to a reduced quality of life if left untreated. The International Classification of Functioning, Disability, and Health (ICF) framework focuses on outcome measures, functional limitations, and overall quality of life of the patients. Early diagnosis is crucial for effective management of the condition. In order to standardize clinical practice and contribute to recommendations of certain interventions, this paper focuses on the optimal dosage of physiotherapy intervention for Bell palsy patients, which includes exercise therapy and electrotherapy. Case presentation: An Indian 33-year-old male visited our physiotherapy department 15 days after being diagnosed with right-sided Bell palsy with unknown aetiology. His chief complaints were right-eye dryness, facial pain, drooping of the face, and difficulty performing facial activities. The outcome measures are the strength duration curve (SD curve), House-Brackmann grading, manual muscle testing, and visual analogue scale (VAS) scale. The physiotherapy intervention includes two primary components: electrotherapy and exercise therapy. Conclusion: The Kabat rehabilitation technique, along with nerve stimulation and an active exercise regimen, is significantly effective in treating Bell palsy, and the outcome measures show significant improvement with optimal therapy dosage. [ABSTRACT FROM AUTHOR]

Background: Trigeminal neurostimulation of the dorsal anterior mucosal surface of the tongue has been proposed to treat a variety of pathologies and to promote neuro-muscular coordination and rehabilitation. Dental ULFTENS can also be considered a form of trigeminal neurostimulation applied to the skin surface bilaterally at the level of the tragus. It has been used for years in dentistry for practical and diagnostic purposes. Previous work has combined the two stimulation techniques showing an efficacy in improving HRV in healthy young women of dental ULFTENS applied to the mucosal surface of the tongue. This work sought to assess whether there is a difference in HRV in relation to the site of application of dental ULFTENS (tragus vs. tongue). If effective in reducing the activity of arousal circuits, this tongue-level stimulation technique could have new clinical applications. Material and method: A new intraoral device allowed electrical stimulation of the dorsal anterior mucosa of the tongue in 80 healthy young women divided into two groups: TUD group (ULFTENS stimulation on the mucosa of the tongue) and Tragus group (stimulation with ULFTENS bilaterally in the area of the tragus). The effects on HRV were monitored by photoplethysmographic wave (PPG). The HRV parameters studied were RMSSD, HF, LF, LF/HF. Results: Only the TUD group showed a significant change in selected HRV parameters that was maintained even in the epoch after the end of electrical stimulation. This effect can be considered as a vagal activation and an increased of HRV parameter. The Tragus group did not show significant change in the direction of increased HRV but showed an opposite trend. There were no undesirable or annoying effects of stimulation. Conclusion: Stimulation of the dorsal anterior (trigeminal) mucosal surface of the tongue with ULFTENS applied with an intraoral device was shown to be able to increase HRV while the same stimulation on tragus area, according to traditional dental ULFTENS procedure, did not show the same effects. Clinical implications: This stimulation technique could be an aid in the diagnosis and treatment of disorders characterized by autonomic disequilibrium such as, in the dental field, TMDs. Trial registration: "Effects of Trigeminal Neurostimulation on Heart Rate Variability: Comparing Tragus and Tongue Stimulation". ID number: NCT06549205. Date of first registration: August 1st 2024. https://clinicaltrials.gov/study/NCT06549205?id=%09NCT06549205&rank=1. [ABSTRACT FROM AUTHOR]

Purpose: Electrotherapies are commonly used to treat adult musculoskeletal pathologies. However, there is insufficient evidence supporting the use of electrotherapies for lower limb conditions in children. Currently, it is unknown how electrotherapies are used in paediatric clinical practice. This study aimed to investigate if practitioners use electrotherapy to treat children's lower limb conditions, frequency and why. Materials and methods: A custom-built online survey was disseminated via social media targeting international medical and healthcare practitioners who treat children with lower limb conditions using electrotherapy. Practitioners were asked if they did or did not use electrotherapies, and their reasons. Responses were described in frequencies and with thematic analysis. Results: There were 445 practitioners who responded. From these, 301(68%) indicated they used electrotherapy, with the most frequently used being Transcutaneous Electrical Nerve Stimulation (n = 110). The most common reason cited for using electrotherapy was practitioner preference due to the alleged effectiveness of the chosen modality. The remaining 144 (32%) practitioners reported not using electrotherapy, the most common reason being lack of evidence. Conclusions: We found that a majority of practitioners used electrotherapies on children. The reasons for using or not using electrotherapy were practitioner centred. IMPLICATIONS FOR REHABILITATION: Electrotherapy modalities are commonly used to treat musculoskeletal injuries in adults The management of children differs from adults due to physiological and psychological differences. The use of electrotherapy to treat musculoskeletal lower limb pathologies children is currently not supported by evidence, and the frequency of use of these modalities in children is not known. This study found that despite that, a majority of medical and health practitioners surveyed in this study routinely use electrotherapy to treat paediatric musculoskeletal injuries. [ABSTRACT FROM AUTHOR]

Purpose: This research aims to investigate the effect of instrument-assisted soft tissue mobilization (IASTM) and Faradic electrotherapy (FES) on lower limb coupling during gait in a patient with excessive ankle stiffness. Methods: The study was conducted on a single patient who was diagnosed with ankle stiffness, decreased muscle strength due to 3.5... [ABSTRACT FROM AUTHOR]

The present study aimed to develop wearable, electrically conductive hygienic electrodes and their use for Transcutaneous Electrical Nerve Stimulation (TENS) application. The development of electrodes was done in two stages. Firstly, the dispersion of conductive activated carbon particles was done into flexible elastomer followed by its silver electroplating. The Orthogonal Array Testing (OATS) technique was used to optimize the silver-plating recipe. The Fourier transform infrared spectroscopy (FTIR) analysis confirmed the impact of activated carbon by increase in intensity of stretching bands. To improve electrode properties in response to various human body movements, resistivity changes due to stretching and repeated extension were tested on conductive elastomers. Increasing the extension degree allowed a very minute change in electrical resistivity. Therefore, the resistivity can be considered almost constant within the 0-60 % stretch range. While, a notable increase in electrical resistivity was observed after 70 % of stretch. However, the resistivity of elastomers remained stable even after repetitive extension (for over 100 cycles). Conversely, no significant change in resistivity was observed over time when subjected to a constant current. Furthermore, to minimize the effect of skin electrode resistivity during electrotherapy, the range of different pressure was applied over the surface of electrodes. Minimum value of resistivity about 1 Ω.mm was obtained at 6 N/cm2 of applied pressure. Additionally, hygienic properties, such as antiviral, antibacterial and antifungal were examined using different pathogens to assess the impact of the deposited silver particles. In the end, the durability of electrodes against washing and rubbing was confirmed. The potential applications of prepared electrodes are in the field of electrostimulation and electrotherapy etc. [ABSTRACT FROM AUTHOR]

Simple Summary: In-transit metastases (ITM) are a challenging aspect of advanced melanoma, traditionally treated with surgery. However, recent advances in systemic therapies, such as immune checkpoint inhibitors and targeted treatments, have significantly improved patient outcomes. These modern therapies are now often preferred over surgery alone. This article reviews the benefits of combining systemic and locoregional treatments, highlighting their potential to enhance survival and quality of life for patients with ITM. By integrating these approaches, we aim to provide a comprehensive strategy for optimizing melanoma treatment outcomes. In-transit metastases (ITM) in melanoma present a significant therapeutic challenge due to their advanced stage and complex clinical nature. From traditional management with surgical resection, ITM treatment has evolved with the advent of systemic therapies such as immune checkpoint inhibitors and targeted therapies, which have markedly improved survival outcomes. This study aims to review and highlight the efficacy of both systemic and locoregional treatment approaches for ITM. Methods include a comprehensive review of clinical studies examining the impact of treatments like immune checkpoint inhibitors, targeted therapies, Isolated Limb Perfusion, and electrochemotherapy. The results indicate that combining systemic therapies with locoregional treatments enhances both local disease control and overall survival rates. The introduction of modern immunotherapies has not diminished the effectiveness of locoregional therapies but rather improved patient outcomes when used in conjunction. The conclusions emphasize that a multidisciplinary approach integrating systemic and locoregional therapies offers a promising strategy for optimizing the management of ITM in melanoma patients. This integrated treatment model not only improves survival rates but also enhances the quality of life for patients, suggesting a shift in standard care practices toward more comprehensive therapeutic regimens. [ABSTRACT FROM AUTHOR]

Facial nerve lesions lead to a variety of functional, motor, and psychological limitations in all stages of the disease. Acute therapy in neurology and neurosurgery has long defined procedures based on evidence-based medicine. However, in follow-up, rehabilitation therapy procedures are inconsistent, with therapies applied according to empirical experience with little support from the evidence. Currently, some procedures are already being validated, but still either in a small sample of patients or only in individual areas. For example, in the field of electrotherapy, methodologies are inconsistent, without clearly defined recommendations. There are also no conclusive data on the effect of relaxation methods, massage, and manual lymphatic drainage. The use of mirror therapy and virtual therapy with biofeedback is positive, but here too, there appears a need for standardization of practice and the addition of evidence. [ABSTRACT FROM AUTHOR]

Post-stroke depression (PSD) is a common neurological and psychiatric sequelae following a stroke, often surpassing the primary effects of the stroke due to its strong correlation with high mortality rates. In recent years, non-pharmacological therapy has garnered significant attention as a supplementary treatment for PSD, becoming widely adopted in clinical practice. However, the efficacy of specific intervention strategies remains unclear. This study aimed to conduct a network meta-analysis (NMA) of published studies to compare the efficacy of different non-pharmacological therapies for treating PSD. We systematically searched five databases from inception through March 2024 to identify randomized controlled trials (RCTs) evaluating non-pharmacological therapies for the treatment of PSD. We considered individual intervention and intervention class. Intervention classes included traditional Chinese medicine (TCM), non-invasive electrotherapy stimulation (NIES), psychotherapy (PT), exercise therapy, hyperbaric oxygen, and combined interventions. The NMA was conducted using R and Stata software, following a frequency-based methodology. Assessment of methodological quality and risk of bias was conducted using the Risk of Bias assessment tool 2.0. Therapies were ranked using the P-score, and box-plots visualization, meta-regression, and sensitivity analysis, were performed to assess transitivity, heterogeneity, and consistency, respectively. The NMA included 43 studies with a total of 3138 participants. Random-effects models revealed significant efficacy for acupuncture (ACUP) (P-score = 0.92; pooled standardized mean difference (95% CI): −3.12 (−4.63 to −1.60)) and transcranial direct current stimulation (P-score = 0.85; −2.78 (−5.06 to −0.49)) compared to the treatment as usual (TAU) group. In categorical comparisons, TCM_PT (P-score = 0.82; −1.91 (−3.54 to −0.28)), TCM (P-score = 0.79; −1.65 (−2.33 to −0.97)), and NIES (P-score = 0.74; −1.54 (−2.62 to −0.46)) showed significant differences compared to TAU group. Furthermore, our results indicated no significant difference between PT and the control groups. However, Confidence in Network Meta-Analysis results indicated very low overall evidence grade. Limited evidence suggests that ACUP may be the most effective non-pharmacological therapy for improving PSD, and TCM_PT is the best intervention class. However, the evidence quality is very low, underscoring the need for additional high-quality RCTs to validate these findings, particularly given the limited number of RCTs available for each therapy. • Acupuncture showed the greatest improvement in depression symptoms in patients with post-stroke depression. • Given the overlap between stroke and depression symptoms, passive therapiesmay be more appropriate and efficacious for patients. • Categorical comparisons suggest that traditional Chinese medicine combined with psychotherapy may have the best efficacy in treating post-stroke depression. [ABSTRACT FROM AUTHOR]

Purpose: To synthesise evidence evaluating non-pharmacological interventions targeting mobility among people with advanced cancer, considering the type, efficacy and contextual factors that may influence outcome. Methods: Systematic review of studies of non-pharmacological interventions in adults (≥ 18 years) with advanced (stage III-IV) cancer, and assessing mobility using clinical or patient-reported outcome measures. Searches were conducted across three electronic databases (MEDLINE, EMBASE and CINAHL) up to June 2024. Methodological quality was assessed using Joanna Briggs Institute tools and contextual factors were evaluated through the Context and Implementation of Complex Interventions framework. A narrative synthesis was conducted due to clinical heterogeneity of included studies. Results: 38 studies encompassing 2,464 participants were included. The most frequent mobility outcome measure was the 6-min walk test (26/38 studies). Exercise was the most common intervention, (33 studies: 27 aerobic and resistance, 5 aerobic, 1 resistance versus aerobic training) and improvements in mobility were found in 21/33 outcomes. Electrotherapy interventions led to significant improvements in mobility in 3/5 studies. Geographical factors (e.g. distance, transport, parking requirements) potentially limited participation in 18/38 studies. A lack of ethnic diversity among populations was evident and language proficiency was an inclusion criterion in 12 studies. Conclusion: Exercise and neuromuscular electrical stimulation appear to improve mobility outcomes in advanced cancer. The evaluation of other non-pharmacological interventions targeting mobility should consider access and inclusivity, and be adaptable to the needs of this population. [ABSTRACT FROM AUTHOR]

Anaplastic gliomas compromise about 5.9% of primary CNS tumors. The main goal of the operation is the maximum removal of the tumor, reduction of the tumor mass and reduction of the increased intracranial pressure. Different pathohistological subtypes of anaplastic gliomas show significantly different prognosis depending on the applied oncological therapeutic protocol as well as the modality of the applied radiotherapy. The study was designed as a retrospective, clinical observational study. The study included 34 participants who were diagnosed with anaplastic glioma in the followed time period. Survival rates were calculated based on the localization, modality of therapy and complications. We concluded that 20,4% of anaplastic gliomas were formed by transformation from previously operated lower grade gliomas. The initial sign of the disease is the appearance of epileptic seizures. Anaplastic gliomas most oftenly occur in the frontal region, with a frequency of 47%. The incidence of anaplastic gliomas in the temporal lobe is 23,5%. The length of survival is in relation to the localization of tumor expansion(p<0.05). The overall survival in the group of anaplastic gliomas operated on in the Department of Neurooncology KCS in the follow-up period of five years is 52.9%. The application of different chemotherapy modalities is not significant predictor in the length of survival. The radical nature of the operation has significance in the length of patient survival, which confirms the conclusions of most of the conducted studies cited in oncology textbooks. [ABSTRACT FROM AUTHOR]

Chronic granulocytic leukemia (CGL), Ph + is a chronic myeloproliferative disorder, which, due to its specificity for many decades, has attracted the attention of researchers of numerous specialties. This disease was among the first malignant haemopathies that received their "ID card" since molecular analyzes precisely defined the basic pathological substrate, that is, the origin of the disease. Over the past decades we have witnessed the evolution of the therapeutic approach in the treatment of CGL from oral cystostatic therapy, radiotherapy, through recombinant interferon alpha (IFN-alpha), haematopoeza stem cell transplantation, to the targeted molecular therapy of the tyrosine kinase inhibitor (TKI). In this report we present patient with a diagnosis of CGL, Ph + in the early chronic phase at the age of 13 years based on all relevant analyzes. During the past 26 years, all therapeutic modalities of CGL treatment were applied in patients, according to the time period, concluding with the second generation TKI, resulting in complete remission of diseases with excellent quality of life and identical expectations for the future, as well as in the healthy population. [ABSTRACT FROM AUTHOR]

Malignant psoas syndrome (MPS) is associated with proximal lumbosacral plexopathy and is characterized by severe intractable pain, despite multimodal medical treatment. Spinal dexmedetomidine and lumbar sympathetic nerve block in combination with pulsed radiofrequency (PRF) are rarely performed for intractable lumbosacral plexopathy pain. We present a combination of spinal dexmedetomidine lumbar sympathetic nerve block and caudal-epidural PRF in the management of MPS, refractory to medical and physical treatment. A 49-year-old female with recurrent lung adenocarcinoma was admitted with shooting pain on the right side over the psoas muscle with irradiation into the right groin and weakness of quadriceps at motion. She was managing her pain with a number of opioids, including oxycodone, morphine, fentanyl, and intramuscular meperidine. The total oral morphine equivalent opioid dose equaled 460 mg. At the first admission, we successfully palliated pain with spinal dexmedetomidine and simultaneously reduced the patient's opioid addiction. On the second admission, lumbar sympathetic nerve block at L3 with additional caudal-epidural PRF led to a significant reduction in her thigh pain visual analog scale (VAS) score to 1–2/10. In addition, improvement in quadriceps functionality and sleep quality, along with a remarkable reduction in analgesic medicine doses, earned patients high satisfaction. Our patient passed away 6 months later with average VAS severity of 4/10. Spinal dexmedetomidine, caudal-epidural PRF, and lumbar sympathetic nerve block should be added as a therapeutic option to the treatment guidelines for the management of MPS, acquired due to lumbosacral plexopathy. [ABSTRACT FROM AUTHOR]

Jean-Martin Charcot (1825–1893) did not show much interest in the peripheral nervous system and its associated pathologies. He found it difficult to place the peripheral nerve within his classification of disorders; it appeared to be an exception to his theories. Even the pathology that he described in 1886 with Pierre Marie (1853–1940), at the same time as Henry Tooth (1856–1925), and which is now known as Charcot-Marie-Tooth neuropathy, was considered by Charcot to be a potential myelopathy. Charcot, like other physicians, paid little heed to the observations made by Louis Duménil (1823–1890) to support the existence of primitive damage to the peripheral nerve. Charcot approached peripheral nerve pathologies through two indirect routes: amyotrophies not explained by spinal or muscular damage, and the trophic cutaneous consequences of what he called névrites (neuritis), the lesional site of which remains debated. It is noteworthy that Charcot’s approach to peripheral nervous system disorders differed from that of other neurologists of the same time. Augusta Dejerine-Klumpke (1859–1927) in France was more precise than Charcot in her anatomical and clinical descriptions, and Hugo von Ziemssen (1829–1902) in Germany made effective use of electrodiagnostics. Charcot supported the electrical work of Guillaume Duchenne de Boulogne (1806-1875), whom he sometimes presented as one of his mentors. The German physician Wilhelm Erb (1840–1921) developed electrodiagnosis by galvanic and faradic currents. Charcot never made use of Erb’s electrological advancements. With his electrophysiologist Romain Vigouroux (1831–1911), Charcot used medical electricity only for electrotherapy in hysteria. [ABSTRACT FROM AUTHOR]

Chronic wounds affect ~2% of the U.S. population and increase risks of amputation and mortality. Unfortunately, treatments for such wounds are often expensive, complex, and only moderately effective. Electrotherapy represents a cost-effective treatment; however, its reliance on bulky equipment limits its clinical use. Here, we introduce water-powered, electronics-free dressings (WPEDs) that offer a unique solution to this issue. The WPED performs even under harsh conditions--situations wherein many present treatments fail. It uses a flexible, biocompatible magnesium-silver/silver chloride battery and a pair of stimulation electrodes; upon the addition of water, the battery creates a radial electric field. Experiments in diabetic mice confirm the WPED's ability to accelerate wound closure and promote healing by increasing epidermal thickness, modulating inflammation, and promoting angiogenesis. Across preclinical wound models, the WPED-treated group heals faster than the control with wound closure rates comparable to treatments requiring expensive biologics and/or complex electronics. The results demonstrate the WPED's potential as an effective and more practical wound treatment dressing. [ABSTRACT FROM AUTHOR]

Objective Ultrasound-guided tibial nerve pulsed radiofrequency (US-guided TN PRF) and fluoroscopy-guided intralesional radiofrequency thermocoagulation (FL-guided intralesional RFT) adjacent to the painful calcaneal spur are two interventions for pain management in painful calcaneal spur and plantar fasciitis. This study aimed to compare the effectiveness of the two procedures. Design A prospective, randomized, single-blind study. Setting Single-center pain clinic. Subjects Forty-nine patients who met the inclusion criteria were randomized into two groups. Methods Group U (25 patients) received US-guided TN PRF at 42°C for 240 s, whereas Group F (24 patients) received FL-guided intralesional RFT at 80°C for 90 s. The most severe numeric rating scale (NRS) score during the first morning steps and the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were used to evaluate the effectiveness of the procedures. The study's primary outcome assessed treatment effectiveness via the NRS, whereas the secondary outcomes included changes in the AOFAS score and the incidence of procedure-related mild adverse events. Results NRS and AOFAS scores significantly improved in Groups U and F at 1 and 3 months compared with baseline (P  < .05), and there was no significant difference between the groups. At month 1, 50% or greater pain relief was achieved in 72% of patients in Group U and 75% of patients in Group F. No significant difference was observed in the incidence of mild adverse events between the groups. Conclusions US-guided TN PRF and FL-guided intralesional RFT have shown significant effectiveness in the treatment of painful calcaneal spur and plantar fasciitis. Larger randomized controlled trials are needed. Clinical Trial Number NCT06240507. [ABSTRACT FROM AUTHOR]

Introduction Peripheral nerve stimulation is a neuromodulation modality that is increasing used to treat chronic pain. The permanent peripheral nerve stimulator systems, while easy to implant, are designed to stay in place and scar at the implantation site. There is a paucity of literature on explantation techniques for peripheral nerve stimulators. Methods In this report, we describe a needle infiltration assisted technique for lead explantation. This novel technique is minimally invasive, cost-effective, and utilizes a combination of fluoroscopy and ultrasound imaging. We describe the successful use of this technique in 3 cases without any adverse events. Conclusion There are many situations which might require a permanent peripheral nerve stimulator to be explanted such as infection, lead erosion, patient request, or need for the patient to undergo magnetic resonance imaging. In these scenarios, we propose a novel needle infiltration assisted technique of explantation that is safe, effective, and easy to replicate. [ABSTRACT FROM AUTHOR]

Outpatient and inpatient rehabilitation, as a complex and multimodal treatment concept, makes significant use of methods that are assigned to conservative orthopedics, in particular the procedures of physical therapy. In contrast to physiotherapy and medical training therapy, physical therapy is a form of therapy provided with technology. The spectrum ranges from hydrotherapy, mechanotherapy and thermotherapy to balneotherapy, massage forms and electrotherapy. Climatotherapy, phototherapy and aerosol/inhalation therapy have less of an impact on the orthopaedic field. Although the forms of therapy are often referred to as passive, the effect is based on physical laws, physiological reactions and adaptation. In addition, these are predominantly forms of therapy, some of which have been in use for centuries, some for thousands of years, these efficient treatments with a good safety and tolerability profile gained by means of empiricism. [ABSTRACT FROM AUTHOR]

This systematic review with meta-analysis aimed to assess the effectiveness of electrophysical agents in improving pain, function, disability, range of motion, quality of life, perceived stiffness, and time to recovery in subjects with frozen shoulder (FS). A thorough search of MEDLINE, Cochrane Library, PEDro, and EMBASE yielded 1143 articles, of which 23 randomized controlled trials were included. Risk of bias (RoB) was assessed through Cochrane Risk of Bias 2 tool. The certainty of evidence was evaluated through the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). The analysis included a total of 1073 subjects. None of the studies were judged as low RoB. Potentially clinically significant differences were observed in pain at 6 weeks and 5 months after extracorporeal shockwave therapy (ESWT), and in disability up to 3 months with laser therapy, albeit with uncertain results due to the high RoB and to the study heterogeneity. Ultrasound (US) therapy did not yield significant differences in any outcomes. The certainty of evidence was very low. Based on the high heterogeneity and low quality and certainty of evidence, ESWT, laser, and US cannot be recommended for FS treatment. Caution should be exercised in interpreting the findings. Although a clinical difference in pain and disability was observed, the certainty of the evidence was low. Ultrasound therapy is not recommended in patients with frozen shoulder. Electrophysical agents may not ensure adequate therapeutic efficacy. [ABSTRACT FROM AUTHOR]

The article discusses research which investigated the effectiveness of electroacupuncture in treating chondromalacia patella (CMP) in soldiers. Topics explored include a comparison between electroacupuncture and physical therapy in terms of treatment efficacy and complications, the management of clinical symptoms of CMP particularly anterior knee pain, and the pain and disability Visual Analog Scale (VAS) scores recorded following treatment.

In 1908–1909, Norwegian artist Edvard Munch (1863–1944), best remembered for The Scream (1893), spent eight months under Daniel Jacobson's care in a private nerve clinic in Copenhagen. Munch was suffering from alcohol abuse, and his signs and symptoms included auditory hallucinations, persecutory delusions, paresthesias, paralyses, violent mood swings, depression, loss of control, fatigue, and the loss of his basic ability to take care of himself. He was treated with rest, a fortifying diet, massages, baths, fresh air, limited exercise, and nonconvulsive electrotherapy. After he had settled in, Jacobson allowed Munch to draw, paint, and engage in photography. Munch responded with a portrait of Jacobson and a small but intriguing sketch of himself at one of his electrotherapy sessions. In this article, we examine the circumstances that brought Munch to Jacobson's clinic and his therapies, with particular attention to electrotherapies. In so doing, we hope to provide a more complete picture of Munch's crisis in 1908, his nerve doctor, the rationales for medical electricity and other treatments he endured, and Scandinavian psychiatry at this moment in time. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of diadynamic currents administered prior to exercises on pain and disability in patients with osteoarthritis of the knee. Design: A randomized-controlled trial. Setting: Special Rehabilitation Services in Taboão da Serra. Participants: Patients with bilateral knee osteoarthritis. Intervention: Participants were randomly allocated to Group I (diadynamic currents and exercises; n = 30, 60 knees) or Group II (exercises alone; n = 30, 60 knees) and were treated three times a week for 8 weeks. Main outcome measures: The primary outcome measures were change in knee pain evaluated by visual analog scale and disability Index Score (Lequesne). Secondary outcomes included change in mobility (Timed Up and Go test), range of motion (goniometer), muscle strength (dynamometer), a composite score for pain and disability (Western Ontario and McMaster Universities Osteoarthritis questionnaire), and a drug diary to measure consumption of rescue pain medication (paracetamol). All measurements were collected at baseline, 8 weeks, and 6 months from baseline (follow-up). Results: There were 60 participants with a mean (SD) age of 63.40 (8.20) years. Between-group differences in the follow-up (8 weeks and 6 months) were observed for pain at rest, pain during activities of daily living and disability. There was improvement in Group I that was maintained for the three variables 6 months after treatment. Mean difference for pain at rest was −3.08 points (95% confidence interval −4.13; −2.02), p < 0.01 with an effect size of 1.4; mean difference for pain during activities of daily living was −2.40 points (95% confidence interval −3.34; −1.45), p < 0.01 with an effect size of 1.24; and mean difference for disability was −4.08 points (95% confidence interval −5.89; −2.26), p < 0.01 with an effect size of 1.04. Conclusion: Patients with symptomatic knee osteoarthritis receiving 8 weeks of treatment with diadynamic currents as an adjunct to a program of exercises had significantly greater improvements in pain and disability than those receiving exercises alone. Beneficial effects were sustained for 6 months. [ABSTRACT FROM AUTHOR]

Cranial electrotherapy stimulation (CES) is beneficial in reducing anxiety in psychiatric patients. However, no studies have reported on elderly patients with generalized anxiety disorders (GAD). This study aimed to determine the efficacy and safety of a 6-week CES intervention for late-life GAD. This single-arm pilot study assessed 6-week CES treatment (Alpha-Stim AID) for late-life GAD and 4-week follow-up post intervention. The Hamilton Rating Scale for Anxiety (HAMA) and Beck Anxiety Inventory (BAI) were used as baseline and outcome measures at weeks 4, 6, and 10, respectively. Treatment response was defined as 50 % or more reduction of the HAMA score and remission was defined as a of score ≤7 on the HAMA. Other measures included depression, sleep quality, and quality of life assessment. We included participants (n = 27) aged 68.0 ± 5.0 years, 81.5 % of whom were female. Fifteen (55.6 %), 18 (66.7 %), and 15 (55.6 %) patients were concurrently treated with antidepressants, BZDs, and antipsychotics, respectively. Intention-to-treat (ITT) analysis revealed a significant decrease in HAMA scores from baseline (20.96 ± 3.30) to week 6 (12.26 ± 7.09) and one-month (12.85 ± 7.08) follow-up at W10 (all p < 0.001). The response and remission rates were 33.3 %, 40.7 %, and 48.1 % and 25.9 %, 29.6 %, and 25.9 % at W4, W6, and W10, respectively. The CES improved depression and sleep conditions as measured by the Beck Depression Inventory-II and Pittsburgh Sleep Quality Index. CES clinically reduces symptoms of anxiety and depression and may improve sleep quality in late-life GAD. Future randomized controlled study is needed. [ABSTRACT FROM AUTHOR]

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The article discusses various surgical interventions and their outcomes in urological treatments, focusing on pediatric and adult cases. Topics discussed include the use of sacral neuromodulation for pediatric bladder and bowel dysfunction, outcomes of continent catheterizing channels in high-risk patients, and comparisons between different surgical approaches for vesicoureteral reflux and post-prostatectomy urinary incontinence.

Background: Chemotherapy‐induced peripheral neuropathy (CIPN) is a debilitating disturbance among patients who received chemotherapy, with no effective treatment available. Scrambler therapy (ST) is a noninvasive treatment capable of improving multiple quality‐of‐life symptoms beyond pain. We aimed to evaluate the efficacy of ST for pain and nonpain symptoms related to CIPN. Methods: Ten patients with moderate to severe CIPN symptoms for >3 months were enrolled in a single‐arm trial of ST for 10 daily sessions. CIPN‐related symptoms were measured throughout the treatment period and up to 6 months thereafter. Results: The worst pain was reduced by 6 months (p = 0.0039). QST demonstrated the greatest improvement in pressure of 60 g (p = 0.308, Cohen's d = 0.42) and cold temperature threshold of 2.5°C (p = 0.9375, Cohen's d = 0.51) in the gastrocnemius area. Symptoms of numbness, tingling, trouble walking, and disturbed sleep had significant improvements at 6 months. Pain medication use decreased by 70% at the end of treatment and by 42% at 6 months. Patient satisfaction was high (82%) and no adverse events with ST treatment were reported. Conclusions: The results of this pilot trial support the use of ST by demonstrating improvement in multiple domains of quality of life for CIPN patients during an extended follow‐up of 6 months. However, further large‐scale studies are needed to confirm our findings. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: This study was carried out to investigate the effect of low-frequency pulsed electrotherapy combined with acupoint massage on postpartum urinary retention (PUR). Methods: The patients were divided into control group, intervention group 1, and intervention group 2 according to the nursing method. The control group received conventional postpartum care, intervention group 1 received conventional postpartum care and low frequency pulsed electrotherapy, and intervention group 2 received conventional postpartum care, low-frequency pulsed electrotherapy, and Shuidao point massage. The bladder function, comfort score, and quality of life score before and after intervention were compared among the three groups. Results: The bladder function, comfort level, and quality of life of intervention group 1 and intervention group 2 after nursing were significantly better than those of the control group. In addition, intervention group 2 had better bladder function than intervention group 1, with lower residual urine volume and higher bladder compliance. In the Kolcaba score, the mental dimension of intervention group 2 was significantly higher than that of intervention group 1. In terms of QOL scores, the social function, physical function, and state of material life scores of intervention group 2 were significantly higher than those of intervention group 1. Conclusions: Low-frequency pulsed electrotherapy combined with acupoint massage can significantly improve the bladder function, comfort, and quality of life of patients with PUR. [ABSTRACT FROM AUTHOR]

Background • Primary dysmenorrhea is a common gynecological problem characterized by menstrual pain without any pelvic pathology. It affects a significant portion of women of reproductive age, impacting their quality of life and daily activities. Physiotherapy interventions such as therapeutic exercise, manual therapy, electrotherapy, and kinesio taping reduce menstrual pain and symptoms. However, there is no study investigating the effects of combined physiotherapy interventions. Primary Study Objective • This study aimed to evaluate and compare the effects of exercises combined with either kinesio taping or electrotherapy on reducing menstrual pain and associated symptoms in women suffering from primary dysmenorrhea. Methods • The randomized controlled clinical trial. Setting • Biruni University Department of Physiotherapy and Rehabilitation Laboratory. Participants • Thirty-six women diagnosed with primary dysmenorrhea by a Gynecologist and Obstetrician were randomized into the kinesiotaping group (n=19) and the electrotherapy group (n=17). Intervention • A similar exercise program was carried out in both groups for eight weeks, two days a week and 40 minutes a day. To increase blood flow in the pelvic region and reduce pain mediators, taping was applied to the sacral and pubic regions using the ligament technique in the kinesio taping group, and a vacuum interferential current was applied to the lumbar and gluteal regions in the electrotherapy group. Primary Outcome Measures •The menstrual pain intensity and menstrual symptoms were assessed with valid and reliable the Visual Analogue Scale (VAS) and the Menstrual Symptom Questionnaire (MSQ). Results • The VAS (kinesio taping and electrotherapy group: P < .001), MSQ-pain symptoms (kinesio taping group: P = .014, electrotherapy group: P = .032), and MSQ-coping methods scores (kinesio taping group: P = .001, electrotherapy group: P = .005) decreased both statistically and clinically in both groups. In addition, a statistically significant improvement in MSQ-negative effects/somatic complaints (P = .047) and MSQ total scores (P = .030) was observed in the electrotherapy group. There was no statistically significant difference between the two groups regarding substantial changes (P > .05). Conclusion • The exercises combined with either kinesio taping or electrotherapy effectively reduced menstrual pain intensity and menstrual symptoms related to pain and coping methods in women with primary dysmenorrhea. Notably, exercises combined with electrotherapy also improved menstrual symptoms related to negative effects and somatic complaints. These findings suggest that both kinesio taping and electrotherapy, when combined with exercises, are viable options for managing primary dysmenorrhea, potentially offering clinicians flexible treatment approaches. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to evaluate the efficacy of electrotherapy and manual therapy for the treatment of women with primary dysmenorrhea. Methods Systematic searches were conducted in Scopus, Web of Science, PubMed, CINAHL, and MEDLINE. The articles must have been published in the last 10 years, had a sample exclusively of women with primary dysmenorrhea, had a randomized controlled trial design, and used interventions that included some form of manual therapy and/or electrotherapy techniques. Two reviewers independently screened articles for eligibility and extracted data. Difference in mean differences and their 95% CIs were calculated as the between-group difference in means divided by the pooled standard deviation. The I2 statistic was used to determine the degree of heterogeneity. Results Twelve selected studies evaluated interventions, with 5 evaluating electrotherapy techniques and 7 evaluating manual therapy techniques. All studies analyzed identified improvements in pain intensity and meta-analysis confirmed their strong effect. Conclusions Manual therapy and electrotherapy are effective for the treatment of women with primary dysmenorrhea. Transcutaneous electrical nerve stimulation combined with thermotherapy and effleurage massage stands out for its effects on the intensity and duration of pain with the application of a few sessions and their long-term effects. Impact Manual therapy techniques and electrotherapy methods reduce the pain intensity of women with primary dysmenorrhea. Quality of life and degree of anxiety improved significantly with manual therapy interventions. Transcutaneous electrical nerve stimulation combined with thermotherapy and effleurage massage are the interventions with which positive effects were achieved with fewer sessions. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac contractility modulation (CCM) is a medical device‐based therapy delivering non‐excitatory electrical stimulations to the heart to enhance cardiac function in heart failure (HF) patients. The lack of human in vitro tools to assess CCM hinders our understanding of CCM mechanisms of action. Here, we introduce a novel chronic (i.e., 2‐day) in vitro CCM assay to evaluate the effects of CCM in a human 3D microphysiological system consisting of engineered cardiac tissues (ECTs). Methods: Cryopreserved human induced pluripotent stem cell‐derived cardiomyocytes were used to generate 3D ECTs. The ECTs were cultured, incorporating human primary ventricular cardiac fibroblasts and a fibrin‐based gel. Electrical stimulation was applied using two separate pulse generators for the CCM group and control group. Contractile properties and intracellular calcium were measured, and a cardiac gene quantitative PCR screen was conducted. Results: Chronic CCM increased contraction amplitude and duration, enhanced intracellular calcium transient amplitude, and altered gene expression related to HF (i.e., natriuretic peptide B, NPPB) and excitation‐contraction coupling (i.e., sodium‐ calcium exchanger, SLC8). Conclusion: These data represent the first study of chronic CCM in a 3D ECT model, providing a nonclinical tool to assess the effects of cardiac electrophysiology medical device signals complementing in vivo animal studies. The methodology established a standardized 3D ECT‐based in vitro testbed for chronic CCM, allowing evaluation of physiological and molecular effects on human cardiac tissues. [ABSTRACT FROM AUTHOR]

Diabetic peripheral neuropathy (DPN) is a prevalent neurological complication linked to diabetes mellitus, exerting a substantial impact on the quality of life for those affected. This review article aims to discuss and review advances in the pain management of patients with DPN. We reviewed recent DPN management literature primarily from PubMed and SCOPUS using specific keywords, focusing on original research and recent advancements. The pathophysiology of DPN involves metabolic and vascular changes in nerve fibers, leading to direct damage and a decrease in their natural repair capacity. Effective glycemic control plays a central role in managing DPN, along with addressing other contributing factors such as comorbidities and lifestyle modifications. Nutraceuticals, including alpha-lipoic acid and Vitamin B12, have shown promising results in some studies. Antineuropathic agents such as calcium channel a2-δ ligands, serotonin and noradrenaline reuptake inhibitors, tricyclic antidepressants, and sodium channel blockers are commonly used in DPN pain management. Topical therapies, including capsaicin and lidocaine patches, have also demonstrated efficacy. Opioids are generally discouraged due to weak evidence and long-term deleterious side effects, along with the risk of addictive potential. Neuromodulation has emerged as a modality in resistant cases not responding to pharmacological management. Individualized treatment plans based on symptomatology, comorbidities, and side effect profiles should be developed for DPN patients. Comprehensive management of DPN involves a multidisciplinary approach, emphasizing patient education, regular assessment, and counseling to prevent further damage and complications. [ABSTRACT FROM AUTHOR]

Background: This work aimed to analyze serum S100B levels and brain-derived neurotrophic factor (BDNF) in patients with lumbar disc prolapse to test their predictive values concerning the therapeutic efficacy of pulsed radiofrequency. Methods: This prospective interventional study was carried out on 50 patients candidates for radiofrequency for treating symptomatic lumbar disc prolapse. Pain severity and functional disability were assessed using the Numeric Rating Scale (NRS) and Functional rating index (FRI) before as well as two weeks, 1, 3, and 6 months after the radiofrequency. Quantitative assessment of serum S100B level and BDNF was done for all the included patients one day before radiofrequency. Results: The scores of NRS and FRI were significantly improved at two weeks, 1, 3, and 6 months following radiofrequency (P-value < 0.001 in all comparisons). Statistically significant positive correlations were found between duration of pain, NRS, and S100B serum level before radiofrequency, and both NRS (P-value = 0.001, 0.035, < 0.001 respectively) and FRI (P-value = < 0.001, 0.009, 0.001 respectively) 6 months following radiofrequency. Whereas there were statistically significant negative correlations between BDNF serum level before radiofrequency and both NRS and FRI 6 months following radiofrequency (P-value = 0.022, 0.041 respectively). NRS and S100B serum levels before radiofrequency were found to be independent predictors of NRS 6 months following radiofrequency (P-value = 0.040. <0.001, respectively). Conclusion: Serum level of S100B is a promising biomarker that can predict functional outcomes after pulsed radiofrequency in patients with lumbar disc prolapse. [ABSTRACT FROM AUTHOR]