Search Results (6,774)

Herpes simplex virus (HSV) is sexually transmitted via the anogenital mucosa where it initially infects epidermal keratinocytes and mononuclear phagocytes (MNPs). It then spreads to the dorsal root ganglion via sensory nerve endings, to remain latent for life with periodic reactivation. Currently, there is no cure or vaccine. Initial or recurrent HSV infection can produce serious complications and mediate acquisition of HIV. This review outlines the initial events after the HSV infection of human anogenital mucosa to determine the optimal window to target the virus before it becomes latent. After infection, HSV spreads rapidly within the mid-layers of epidermal keratinocytes in the explanted human inner foreskin. Infected cells produce chemokines, which modulate nectin-1 distribution on the surface of adjacent keratinocytes, facilitating viral spread. Epidermal Langerhans cells and dendritic cells become infected with HSV followed by a “viral relay” to dermal MNPs, which then present viral antigen to T cells in the dermis or lymph nodes. These data indicate the need for interruption of spread within 24 h by diffusible vaccine-induced mediators such as antiviral cytokines from resident immune cells or antibodies. Intradermal/mucosal vaccines would need to target the relevant dermal MNPs to induce HSV-specific CD4⁺ and CD8⁺ T cells. Full article

Cannabis, derived from Cannabis sativa plants, is a prevalent illicit substance in the United States, containing over 400 chemicals, including 100 cannabinoids, each affecting the body’s organs differently upon ingestion. Cannabis hyperemesis syndrome (CHS) is a gut–brain axis disorder characterized by recurring nausea and vomiting intensified by excessive cannabis consumption. CHS often goes undiagnosed due to inconsistent criteria, subjective symptoms, and similarity to cyclical vomiting syndrome (CVS). Understanding the endocannabinoid system (ECS) and its dual response (pro-emetic at higher doses and anti-emetic at lower doses) is crucial in the pathophysiology of CHS. Recent research noted that type 1 cannabinoid receptors in the intestinal nerve plexus exhibit an inhibitory effect on gastrointestinal motility. At the same time, the thermoregulatory function of endocannabinoids might explain compulsive hot bathing in CHS patients. The prevalence of cannabis CHS is expected to rise as legal restrictions on its recreational use decrease in several states. Education and awareness are vital in diagnosing and treating CHS as its prevalence increases. This comprehensive review explores the ECS’s involvement, CHS management approaches, and knowledge gaps to enhance understanding of this syndrome. Full article

Background: Total knee arthroplasty is a widely endorsed surgical intervention, extensively recognized within the orthopedic field for its efficacy in significantly reducing pain and enhancing overall mobility in patients suffering from advanced stages of osteoarthritis. Despite a general consensus on the core procedural steps, the rapid advancements in implant technology and the nuanced techniques in knee reconstruction have inevitably introduced subtle variations in surgical approaches. These variations often emerge due to individual surgeon preferences, their unique expertise, and comfort levels with specific techniques. Anterior knee pain, however, remains a frequent postoperative complication, likely attributed to the extensive and complex innervation of the patella. To address this challenge, some surgeons have adopted patellar denervation, hypothesizing that by reducing nerve signaling from the patellar region, patients may experience a measurable decrease in pain. Methods: A systematic search was performed to include eight recent level I studies to analyze this issue. Results: Of the eight reviews, there were four strong studies that concluded patellar denervation helps decrease anterior knee pain in the acute period, but this may not last long term. The other four papers did not show a difference in anterior knee pain after denervation. Conclusions: This review synthesizes and critically analyzes the current body of literature, aiming to provide clinicians with evidence-based insights into the potential benefits and limitations of incorporating patellar denervation into their surgical especially during the acute post-operative period. Full article

The widespread application of exoskeletons driven by soft actuators in motion assistance and medical rehabilitation has proven effective for patients who struggle with precise object grasping and suffer from insufficient hand strength due to strokes or other conditions. Repetitive passive flexion/extension exercises and active grasp training are known to aid in the restoration of motor nerve function. However, conventional pneumatic artificial muscles (PAMs) used for hand rehabilitation typically allow for bending in only one direction, thereby limiting multi-degree-of-freedom movements. Moreover, establishing precise models for PAMs is challenging, making accurate control difficult to achieve. To address these challenges, we explored the design and fabrication of a bidirectionally bending PAM. The design parameters were optimized based on actual rehabilitation needs and a finite element analysis. Additionally, a dynamic model for the PAM was established using elastic strain energy and the Lagrange equation. Building on this, an adaptive position control method employing a radial basis function neural network, optimized for parameters and hidden layer nodes, was developed to enhance the accuracy of these soft PAMs in assisting patients with hand grasping. Finally, a wearable soft hand rehabilitation exoskeleton was designed, offering two modes, passive training and active grasp, aimed at helping patients regain their grasp ability. Full article

Tau is a microtubule-associated protein that plays a vital role in the mammalian nervous system. Alternative splicing of the MAPT gene leads to the formation of tau isoforms with varying N-terminal inserts and microtubule-binding repeats. Dysregulation of tau alternative splicing has been linked to diseases in the central nervous system, but the roles of tau isoforms in the peripheral nervous system remain unclear. Here, we investigated the alternative splicing of tau exons 4A and 10 in the sciatic nerve and Schwann cells during development and following injury. We discovered that low-molecular-weight (LMW) tau, resulting from the exclusion of exon 4A, and 3R tau, generated by the exclusion of exon 10, diminishes with aging in rat sciatic nerve and Schwann cells. High-molecular-weight (HMW) tau and 3R tau increase in the adult sciatic nerve post-injury. We constructed viruses that expressed HMW−4R, LMW−4R, HMW−3R, and LMW−3R and introduced them into cultured cells or the distal part of the injured sciatic nerve to assess their effects on Schwann cell migration and proliferation. We also examined the effects of the four isoforms on axon growth and debris clearance after sciatic nerve injury. Our results demonstrated that tau isoforms inhibit Schwann cell proliferation while promoting Schwann cell migration and sciatic nerve regeneration. Specifically, the 3R−tau isoforms were more effective than the 4R−tau isoforms in promoting nerve regeneration. In conclusion, our study reveals the roles of tau isoforms in the peripheral nervous system and provides insights into the development of new therapeutic strategies for peripheral nerve injuries. Full article

Background: Guyon’s canal syndrome is a pathological condition caused by compression of the ulnar nerve at the level of the wrist. It is less frequent than other compression syndromes of the upper limb (cubital and carpal tunnel), and different causative agents, including vascular lesions, are described. Among these, aneurysm of the ulnar artery is described in the literature as an infrequent aetiology. Case Presentation: We report the case of a 25-year-old young man with Guyon’s canal syndrome caused by an aneurysm of the ulnar artery, who underwent surgical decompression of the Guyon’s canal without intervening on the aneurysm. The postoperative course was free of complications, and the patient reported satisfaction, with reduced symptoms. Clinical examination and ultrasound imaging showed mass reduction of the aneurysm in the postoperative period, which appears to be an evolution hitherto undocumented in the literature. Conclusions: Many treatments are available for Guyon’s canal syndrome. Past medical and surgical treatments, duration and severity of symptoms, causes, and pathogenesis are important for therapeutic choice. Surgical treatment based on ligament section and lysis of the Guyon’s canal downstream, without any action on the aneurysm and with ulnar artery preservation, determined a reduction in terms of volume, relief of the symptoms, and patient satisfaction. With this case we describe a surgical therapeutic option for the treatment of Guyon’s canal syndrome caused by an aneurysm of the ulnar artery, in which surgery is limited to canal decompression and consequential aneurism mass reduction with concomitant relief of symptoms. Full article

The brain is a biological system comprising nerve cells and orchestrates its embodied agent’s perception, behavior, and learning in dynamic environments. The free-energy principle (FEP) advocated by Karl Friston explicates the local, recurrent, and self-supervised cognitive dynamics of the brain’s higher-order functions. In this study, we continue to refine the FEP through a physics-guided formulation; specifically, we apply our theory to synaptic learning by considering it an inference problem under the FEP and derive the governing equations, called Bayesian mechanics. Our study uncovers how the brain infers weight changes and postsynaptic activity, conditioned on the presynaptic input, by deploying generative models of the likelihood and prior belief. Consequently, we exemplify the synaptic efficacy in the brain with a simple model; in particular, we illustrate that the brain organizes an optimal trajectory in neural phase space during synaptic learning in continuous time, which variationally minimizes synaptic surprisal. Full article

Background/Objectives: A comprehensive comparison of intraoperative, oncological, and functional outcomes of RARP performed with different robotic surgical platforms is critically needed. Our aim is to compare the oncological and functional outcomes of RARP performed using the novel Hugo™ RAS system with those from the daVinci system, the reference standard, at a high-volume robotic center, with an extended follow-up period (one year). Methods: We analyzed the data of 400 patients undergoing RARP ± pelvic lymph node dissection between 2021 and 2023, using propensity score (PS) matching to correct for treatment selection bias. All procedures were performed by three surgeons with HugoTM RAS or daVinci. This analysis extends the follow-up period to 1 year, focusing on specific functional and oncological outcomes, building on our previous 3-month evaluation of perioperative outcomes. The primary outcome was the trifecta rate, defined as freedom from biochemical recurrence, continence, and erectile function recovery. Secondary outcomes included detailed assessments of oncological outcomes (PSA levels) and functional outcomes (continence and erectile function). Results: The propensity score-matched cohort included 99 matched pairs (198 patients), balanced for all covariates. No significant differences were found in trifecta rates between the two platforms at 1-year follow-up (Hugo: 25.25%, daVinci: 27.27%, p = 0.743). Both groups showed improved trifecta rates when considering only nerve-sparing procedures (Hugo: 36.84%, daVinci: 35.59%, p = 0.889). Continence rates were similar (Hugo: 87.9%, daVinci: 89.9%, p = 0.327), as were the undetectable PSA rates (Hugo: 92.9%, daVinci: 88.8%, p = 0.158). Also, the erectile function recovery rate did not differ significantly between the groups. Conclusions: This is the first study comparing 1-year functional and oncological outcomes of RARP performed with Hugo™ RAS and daVinci surgical robotic systems using PS matching. Functional and oncological outcomes of RARP were comparable between the two robotic platforms. These findings confirm that the transition to the Hugo™ platform does not compromise surgical proficiency or patient outcomes, even if further long-term studies are necessary to confirm these results. Full article

Background and Objectives: Leprosy primarily affects peripheral nerves, leading to significant neurological complications such as polyneuritis, mononeurosis, and autonomic dysfunction, which contribute to severe disabilities and impaired quality of life for patients. This scoping review aims to investigate the neurological manifestations and main treatments of leprosy patients. Materials and Methods: Studies were identified from an online search of PubMed, Web of Science, Cochrane Library, Embase, and Scopus databases. This review has been registered on OSF (n) PQBYH. Results: Neurological complications of leprosy, such as neuropathy and paralysis, necessitate accurate diagnosis and treatment, as immunological reactions can exacerbate nerve damage. Various studies highlight the effectiveness of personalized therapies, such as corticosteroids, multi-drug therapy (MDT), and surgical interventions, in improving symptoms and neurological function in leprosy patients. Conclusions: Managing neurological complications of leprosy necessitates careful diagnosis and treatment, as many patients experience unresolved peripheral neuropathy despite multidrug therapy. Future research should focus on improving diagnostic tools, exploring the link between neuropathic pain and psychological issues, and developing effective vaccines and treatments to enhance patient outcomes. Full article

Background/Objectives—Parkinson’s disease (PD) is the second most common neurodegenerative disorder caused by the destruction of neurons in the substantia nigra of the brain. Clinical diagnosis of this disease, based on monitoring motor symptoms, often leads to a delayed start of PD therapy and control, where over 60% of dopaminergic nerve cells are damaged in the brain substantia nigra. The search for simple and stable characteristics of EEG recordings is a promising direction in the development of methods for diagnosing PD and methods for diagnosing the preclinical stage of PD development. Methods—42 subjects participated in work, of which 4 female/10 male patients were included in the group of patients with non-motor disorders, belonging to the risk group for developing PD (median age: 62 years, height: 164 cm, weight: 70 kg, pulse: 70, BPsys and BPdia: 143 and 80)/(median age: 68 years, height: 170 cm, weight: 73.9 kg, pulse: 75, BPsys and BPdia: 143 and 82). The first control group of healthy participants included 6 women (median age: 33 years, height: 161 cm, weight: 66 kg, pulse: 80, BPsys and BPdia: 110 and 80)/8 men (median age: 36.3 years, height: 175 cm, weight: 69 kg, pulse: 78, BPsys and BPdia: 120 and 85). The second control group of healthy participants included 8 women (median age: 74 years, height: 164 cm, weight: 70 kg, pulse: 70, BPsys and BPdia: 145 and 82)/6 men (median age: 51 years, height: 172 cm, weight: 72.5 kg, pulse: 74, BPsys and BPdia: 142 and 80). Wavelet oscillatory pattern estimation is performed on patients’ nocturnal sleep recordings without separating them into sleep stages. Results—Amplitude characteristics of oscillatory activity in patients without motor disorders and the prodromal PD stage are significantly reduced both in terms of changes in the number of patterns and in terms of their duration. This pattern is especially pronounced for high-frequency activity, in frequency ranges close to 40 Hz. Conclusions—The success of the analysis of the electrical activity of the brain, performed over the entire duration of the night recording, makes it promising to further use during daytime monitoring the concept of oscillatory wavelet patterns in patients with non-motor disorders, belonging to the risk group for developing PD. The daytime monitoring system can become the basis for developing screening tests to detect neurodegenerative diseases as part of routine medical examinations. Full article

Introduction: Salivary gland tumor operations are associated with complications including facial nerve dysfunction (FND) and salivary fistula. The objective of this study was to investigate the effect of extracapsular dissection (ECD) and the application of Clostridium botulinum toxin (CBT) in contrast to partial and lateral parotidectomy on complications. Methods: All salivary gland tumor operations performed within the last 6 years were retrospectively examined. Data were collected from electronic patient files from our otorhinolaryngology clinic. Total parotidectomies and submandibulectomies were not included in the analysis of CBT application. Results: In total, 418 cases were examined, including 84 (20%) malignant tumors. In total, 18 patients underwent ECD, 93 partial parotidectomy, 199 lateral parotidectomy, 76 total parotidectomy, and 32 submandibulectomy. The most common complication was transient FND (49%; n = 205; data available for 415 patients), which was measured at four days. Additional complications included salivary fistula (n = 56), infection (n = 49), bleeding or hematoma (n = 21). Preoperative facial nerve paralysis (p < 0.0001), pain (p < 0.0001), and a history of squamous cell skin carcinoma (SCC) (p < 0.001) were predictive of malignancy. The application of CBT did not reduce the risk of salivary fistula (p-value: 0.0182) and was associated with a higher combined complication rate (p-value: 0.0199). ECD was not associated with a lower likelihood for FND (p = 0.350). Conclusions: Preoperative pain, facial paralysis, or a history of SCC are predictors of malignancy. Use of CBT was not associated with a reduced risk of salivary fistula, but rather a higher complication rate. Full article

Background/Objectives: Esophagectomy is the mainstay of treatment in esophageal cancer. Minimally invasive esophagectomy (MIE) remains a challenging procedure and has been associated with a high rate of complications and mortality. Routine lymphadenectomy includes two-field lymphadenectomy for distal-esophageal or gastroesophageal junction Siewert I–II tumors. Superior mediastinal lymphadenectomy (SML) refers to an extended two-field lymphadenectomy or total mediastinal lymphadenectomy during MIE for cancer. The exact benefits of SML have been the subject of prolonged debate, with no conclusive evidence indicating improved clinical and oncological results. Herein, we aim to present our surgical technique of thoracoscopic SML during MIE in the prone position, with short-term clinical and oncological outcomes. Methods: About 150 consecutive patients underwent totally MIE within 3 years period (2016–2019). SML included right-paratracheal nodes and nodes along the right-recurrent laryngeal nerve throughout its mediastinal route in cases of extended two-field lymphadenectomy, as well as left-paratracheal nodes and nodes along the left recurrent laryngeal nerve during total mediastinal lymphadenectomy. Eligible patients underwent SML during two-stage or three-stage MIE. Results: Twenty consecutive patients underwent SML during the study period. The 30- and 90-day mortality rates were 0. Pulmonary complications were observed in 16.5% of the patients. There was 1 right recurrent laryngeal nerve palsy noted. The median length of stay was 9 days. The median number of resected lymph nodes was 45, with the median SML nodes count being 8. The median follow-up was 24 months. Conclusions: SML during prone position thoracoscopy for esophageal cancer is safe and feasible, although technically demanding. Minimally invasive esophagectomy with SML may offer meaningful benefits in oncological outcomes without introducing additional significant morbidity. Further comparative studies are needed to better elucidate our results. Full article

Urinary tract infections (UTIs) present a significant health challenge for women globally, particularly due to high recurrence rates. This randomized, double-blinded, placebo-controlled study conducted at AIIMS Bhubaneswar, India, evaluated the effectiveness of a multi-strain lactobacilli probiotic formulation as an adjunct to standard antibiotic therapy in preventing recurrent UTIs. Fifty-one adult women (18–50 years) with recurrent UTIs received either the probiotic or a placebo for 24 weeks. The primary outcome was UTI recurrence, while secondary outcomes included the number of UTI episodes and changes in urinary nerve growth factor (NGF) and serum macrophage colony-stimulating factor (M-CSF) levels. The results showed a significant reduction in UTI recurrence in the probiotic group, with 75% remaining recurrence-free, compared to 33% in the placebo group (p = 0.007). The relative risk for recurrence absence was 2.67 (95% CI: 1.19–5.99). Although the mean number of UTI episodes decreased in the probiotic group, the difference was not statistically significant (p = 0.379). The urinary NGF and serum M-CSF levels significantly decreased from baseline in both groups, but there were no significant differences between them. This study suggests probiotics may be a valuable adjunct therapy for preventing recurrent UTIs. Full article

Background: Trigeminal neuralgia (TN) is a disease that causes severe pain that can seriously affect the quality of life. This study aimed to compare the effectiveness of two different low-level laser therapies (LLLT) as alternatives to medical treatment to reduce pain and improve the quality of life in patients with TN. Methods: A total of 45 patients were randomly divided into 3 groups. In the first group, a new-generation diode laser (GRR laser) was applied at predetermined points in the trigeminal nerve line. In the second group, a low-level neodymium-doped yttrium aluminum garnet (Nd:YAG) laser was applied along the affected nerve line. The placebo group received the same protocol with a Nd:YAG laser without the device switched on. The scores were recorded pre- and post-treatment using the Brief Pain Inventory-Facial (BPI-facial) scale. Results: A statistically significant difference was found between the pre- and post-treatment values of all four variables in the GRR laser, Nd:YAG laser, and placebo groups. When the post-treatment values were compared, statistically significant differences were found between the groups in pain frequency, pain intensity, and interference in facial-specific activities, but no differences were found in general activities. Conclusions: Both LLLTs can be considered alternative treatment modalities for TN, but the GRR laser treatment was more effective than the Nd:YAG laser treatment in reducing pain and improving the quality of life in patients with TN. Full article

Background/Objectives: Facial asymmetry is gaining an increasing diagnostic interest in many clinical contexts. Several three-dimensional surface-based methods have been proposed for its assessment; however, they might provide non-equivalent data. Since there is a lack of comparative studies in these terms, this study aims to compare three methods for assessing the asymmetry of the face and facial thirds, thus addressing whether the potential differences can be considered clinically acceptable or not. Methods: Two ‘maxillofacial’ methods based on the trigeminal nerve distribution and one ‘orthodontic’ method based on reference horizontal planes were used to identify the facial thirds on 3D facial models of 80 Italian healthy adults to calculate the asymmetry of the face, and the upper, middle, and lower thirds of the face differently selected by each method. As a measure of asymmetry, the Root Mean Square value was calculated through a mirroring surface-based registration. Intra- and inter-operator reliability was verified for each method. Differences and interchangeability between the methods were tested, respectively, by two-way repeated measures ANOVA (Analysis of Variance) and Bland–Altman and Similarity Percentage model analysis. Additionally, the time required to perform each method was assessed. Results: All methods demonstrated excellent intra- and inter-operator reliability. While the ANOVA analysis found significant differences (p < 0.001) for the majority of facial Regions of Interest between each method, the Bland–Altman analysis revealed that the differences were clinically acceptable (<0.50 mm) for all facial regions between the trigeminal methods, and for the face and the upper third of the face between the orthodontic method, which was revealed to be faster, and the trigeminal ones. The additional similarity percentage model provided visual support for the complete interchangeability of the two trigeminal methods, as evidenced by the lower Coefficient of Variation value. Conclusions: There is no best method for assessing facial asymmetry that applies to all types of clinical settings, as we have shown that different methods may not be completely interchangeable. However, we suggest that the methods based on the trigeminal subdivision can be used interchangeably in contexts where the morpho-functional analysis of maxillofacial regions with different embryological origins is considered. Thus, the clinical setting imposes the choice of one method over another and, as we have pointed out, the consequent comparison of data with those obtained with methods whose interchangeability has been demonstrated. Full article