Aberrant proprioception is hypothesised to contribute to suboptimal motor adaptations that promote pain persistence. However, when these impairments in proprioception develop in the transition from acute to chronic pain is not well understood. Understanding the nature and time course of proprioceptive changes early in pain development may reveal critical insights. The primary aim of this systematic review and meta-analysis was, therefore, to evaluate the influence of acute pain on proprioception. Six databases (Pubmed, Medline, Web of Science, Psychinfo, Embase, and Scopus) were searched from inception to May 18[th], 2026 for studies examining the effect of experimentally-induced or clinical pain of < 3 months' duration on behavioural measures of proprioception. Behavioural outcomes included joint position reproduction, threshold to detect passive motion, force matching, velocity detection, and left/right judgement tasks (LRJT). Included articles (27 studies, n = 4,019 participants) were critically appraised using a modified Downs and Black checklist. Meta-analyses were performed using a random effects model on LRJT, and all other outcomes were synthesised descriptively due to study heterogeneity. The analysis revealed that individuals with acute clinical pain demonstrated worse accuracy on the LRJT when identifying images corresponding to the affected side (MD = -8.64, 95% CI = -16.93 to -0.34), with no corresponding change in response time. Acute pain was also associated with impairments in position and movement sense in a joint- and angle dependent manner. Interpretation of these findings should consider the heterogeneity of acute pain conditions included, particularly clinical and experimental models involving tissue injury or inflammation that may independently influence proprioceptive performance. Together, these findings raise the possibility that acute pain disrupts both sensory feedback relating to position and movement sense and processing of somatotopic proprioceptive representations. PERSPECTIVE: This review suggests that acute pain may alter proprioception in task-specific ways, disrupting position and movement sense as well as somatotopic body-related processing. These findings may help clarify early sensorimotor changes that contribute to maladaptive movement and provide mechanistic insight into the transition from acute to persistent pain.

Background: The oral application of adenovirus is hindered by its poor in vitro storage stability and rapid degradation by gastric acid. To address this, a biomimetic oral adenovirus delivery system (CSP-AdV@LYO) was constructed based on three key properties of natural chrysanthemum sporopollenin (CSP): chemical inertness, intelligent "acid-shrinking/alkali-swelling" responsiveness, and mucosal adhesion via its spike structures, aiming to enhance oral stability and delivery efficiency. Methods: First, low-allergenic chrysanthemum pollen was screened using proteomics and a zebrafish allergy model. High-purity sporopollenin (SPO) was then extracted via an acidolysis method, followed by systematic characterization of its morphology, particle size, zeta potential, contact angle, and reversible acid-shrinking/alkali-swelling behavior. Subsequently, a CSP-AdV@LYO formulation was prepared by optimizing a cryoprotectant formulation (sucrose:gelatin = 1:1) and a vacuum loading process. Its protective and release properties were evaluated in vitro using simulated gastric and intestinal fluids, and its long-term stability was assessed. Further in vivo studies in mice assessed its intestinal colonization efficiency. The adhesion mechanism of the sporopollenin spike structures was investigated through mucosal retention experiments. Results: Mucosal retention experiments confirmed that the spike structures on the sporopollenin surface enhanced retention by approximately 3-fold through mechanical interlocking compared to smooth particles. In long-term stability tests, the viral genome copy number retention rate was improved more than 10-fold compared to the virus stock solution. The system enabled a steady and controlled release of the virus in simulated intestinal fluid, with the released virus maintaining its infectivity. In vivo studies demonstrated that CSP-AdV@LYO promoted efficient intestinal colonization and reduced acute mortality from 75% (AdV@LYO group) to 25%. Conclusions: By leveraging the unique physicochemical properties of chrysanthemum sporopollenin, this study successfully developed a biomimetic oral delivery system for live adenovirus that provides gastric acid protection, intelligent pH-responsive release, and mucosal adhesion. This system significantly enhances the oral stability and intestinal delivery efficiency of adenovirus while reducing systemic exposure risks. It offers a novel biomimetic strategy for the oral delivery of adenovirus and other biological macromolecules.

Background: The Rockwood classification is the most widely used radiographic framework for grading acromioclavicular (AC) joint dislocations. However, native anatomical variation may be associated with differences in the radiographic appearance of AC joint dislocations. Purpose: To evaluate the association between the acromioclavicular joint coronal orientation angle (AJCO) and Rockwood grade and to characterize the relationship between native coronal orientation and radiographic grade. Methods: This retrospective observational radiographic study included 198 adults with acute AC joint dislocations classified as Rockwood II, III, or V on standardized bilateral Zanca radiographs. AJCO was measured on the contralateral, uninjured side as the angle between the AC joint orientation line and a vertical reference. Two blinded orthopedic surgeons performed measurements independently, with reliability assessed using intraclass correlation coefficients. AJCO was compared across Rockwood groups, its monotonic association with grade was evaluated using Spearman correlation, and exploratory receiver operating characteristic analysis was performed for the tested binary contrast. Results: AJCO differed significantly across Rockwood injury grades, decreasing progressively from type II to type V injuries (median [IQR]: type II, 18.3° [14.6-26.0°]; type III, 15.3° [12.0-21.3°]; type V, 14.0° [8.6-18.0°]; p < 0.001). Consistent with this finding, AJCO demonstrated an inverse weak-to-moderate association with Rockwood grade (Spearman ρ = -0.338, 95% CI -0.453 to -0.214; p < 0.001). AJCO showed limited ability to discriminate higher-grade injuries (Rockwood ≥ III), with an AUC of 0.694 (95% CI, 0.612-0.777; p < 0.001), characterized by high specificity but low sensitivity at the optimal threshold. Furthermore, lower AJCO values remained significantly associated with higher Rockwood grades after adjustment for age and sex (OR = 0.899 per degree increase, 95% CI, 0.864-0.935; p < 0.001). Conclusions: Lower AJCO values were associated with higher Rockwood grades in this cohort, but the magnitude of association and discriminatory performance were limited. These findings support AJCO as a morphology-related contextual variable associated with Rockwood grade rather than as a stand-alone diagnostic or treatment-guiding measure.

Background/Objectives: Acute hypercapnic respiratory failure is associated with significant morbidity and mortality despite advances in non-invasive mechanical ventilation (NIMV) therapy. The frontal QRS-T angle is a simple electrocardiographic marker reflecting ventricular depolarization-repolarization heterogeneity and has been associated with adverse cardiovascular outcomes. However, the relationship between dynamic changes in frontal QRS-T angle and NIMV treatment response in acute hypercapnic respiratory failure remains unclear. This study aimed to evaluate the association between frontal QRS-T angle changes after NIMV treatment and clinical outcomes in patients with acute hypercapnic respiratory failure. Methods: This retrospective observational cohort study included 186 adult patients hospitalized with acute hypercapnic respiratory failure and treated with bilevel positive airway pressure between January 2024 and December 2025. Frontal QRS-T angle values were obtained from standard 12-lead electrocardiograms recorded before NIMV initiation (T0) and at the 24th hour of treatment (T24). Clinical, laboratory, arterial blood gas, and electrocardiographic parameters were analyzed. Receiver operating characteristic (ROC) analysis, Kaplan-Meier survival analysis, correlation analysis, and multivariable logistic regression analysis were performed to evaluate the prognostic significance of frontal QRS-T angle. Results: Successful NIMV treatment was achieved in 143 patients (76.9%), whereas 43 patients (23.1%) experienced NIMV failure. Patients with failed NIMV treatment had significantly higher baseline frontal QRS-T angle values compared with the successful group [128° (94-156) vs. 71° (48-101), p < 0.001]. Frontal QRS-T angle significantly decreased after treatment in the successful NIMV group but not in the failed group. A significant positive correlation was observed between ΔPaCO2 and Δfrontal QRS-T angle (r = 0.624, p < 0.001). ROC analysis demonstrated that baseline frontal QRS-T angle predicted NIMV failure with an AUC of 0.842 (95% CI: 0.773-0.898) and in-hospital mortality with an AUC of 0.811 (95% CI: 0.735-0.873). Kaplan-Meier analysis showed significantly lower survival rates in patients with frontal QRS-T angle >90° (log-rank p < 0.001). Multivariable logistic regression analysis identified frontal QRS-T angle >90° as an independent predictor of in-hospital mortality (OR: 3.617, 95% CI: 1.484-8.813, p = 0.005). Conclusions: Baseline frontal QRS-T angle was associated with NIMV failure and in-hospital mortality, while its 24-h change was associated with physiological response among patients with paired T0-T24 measurements. These findings are hypothesis-generating and do not establish the utility of frontal QRS-T angle monitoring for immediate escalation or intubation decisions.

Forward head posture (FHP) is common in young adults using technological devices and often accompanied by increased thoracic kyphosis. This study reports the design and custom manufacturing of a 3D-printed craniocervical orthosis and a pilot application evaluating its effects on the craniocervical angle (CVA), thoracic kyphosis angle (TKA), and user satisfaction. In this prospective, single-arm, within-subject pilot study, each participant underwent 3D scanning, and a custom orthosis was manufactured from their scan data using a common three-point CAD template via FDM 3D printing. Ten volunteers aged 18-25 years completed the study without a priori sample size calculation. The CVA and TKA were assessed photogrammetrically at baseline and weeks 2, 4, and 6, under orthosis-assisted and non-assisted conditions, with devices iteratively adjusted over six weeks. Satisfaction was evaluated at follow-up completion using the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0-TR), and data were analyzed using a linear mixed model. Of the 13 individuals screened, 10 completed the protocol (one discontinued owing to discomfort and two withdrew voluntarily); no serious adverse events occurred. The CVA was significantly higher, and the TKA significantly lower, under the orthosis condition at every time point (all p < 0.001), reflecting an acute, device-on effect rather than a demonstrated lasting, unassisted postural correction. Mean device satisfaction was 4.88 ± 0.12/5 and mean service satisfaction was 5.00 ± 0.00/5 among the 10 completers; these scores exclude the participant who discontinued owing to discomfort and two who withdrew for unrelated reasons, which likely inflates the apparent satisfaction level. The custom-manufactured orthosis was feasible to design and fabricate, tolerable after iterative adjustment, and associated with improved craniocervical and thoracic alignment when worn; these findings reflect an acute, device-on effect and do not yet establish lasting postural correction without the orthosis. Given the single-arm, non-blinded pilot design, findings are preliminary and hypothesis-generating, supporting further confirmatory trials.

Acute severe hypoxia reduces systemic oxygen availability and may impose different constraints on cerebral and muscular oxygenation. We tested whether the prefrontal cortex (PFC) and vastus lateralis (VL) exhibit distinct oxygenation patterns during exercise by combining dual-site NIRS with phase-plane vector analysis of oxyhemoglobin (HbO2) and deoxyhemoglobin (HHb). Twelve physically active adults (11 men, 1 woman; VO2max: 52.03 ± 9.84 mL·kg[-1]·min[-1]) performed maximal incremental exercise in normobaric normoxia and severe normobaric hypoxia (FiO2 = 11%, ~5000 m equivalent). Responses were compared at lactate-matched submaximal intensities (2 and 4 mmol·L-1) and peak exercise. At rest, hypoxia reduced tissue saturation index (TSI) more in PFC than VL (10.82 ± 2.48 vs. 3.37 ± 4.75 percentage points). During, hemoglobin-derived variables mainly reflected exercise intensity and regional differences. Phase-plane angle K differed between hypoxia and normoxia in the PFC already at 2 mmol·L[-1] (118.11 ± 35.73° vs. -15.41 ± 110.08°; p < 0.001), whereas mean VL K remained within the 90-180° sector across intensities and conditions (116-133°), without significant between-condition differences. No between-condition difference in PFC K was detected at peak exercise. These findings describe regional oxygenation responses to severe hypoxia, with condition-dependent differences in the submaximal PFC response. These regional oxygenation responses may partly reflect hypocapnia-related constraints on prefrontal perfusion and compensatory vasodilation in exercising muscle, although K does not directly quantify blood flow or oxygen extraction and its interpretation warrants caution when PFC vector magnitudes are small.

An 80-year-old woman presented with a painful red eye four months after XEN gel stent implantation for primary open-angle glaucoma. Examination revealed an exposed gel stent through a conjunctival defect, corneal edema, hypopyon, and vitreous membranes, consistent with acute exogenous endophthalmitis. She underwent vitreous aspiration with intravitreal vancomycin and ceftazidime, followed by pars plana vitrectomy with stent explantation and silicone oil tamponade. Vitreous cultures grew Abiotrophia defectiva, recovered on routine media and identified to species by automated phenotypic testing within 6 hours, without molecular confirmation. Following silicone oil removal, vision returned to her baseline of 5/200, limited by prior central retinal vein occlusion. This represents the second reported case of A. defectiva endophthalmitis associated with an exposed gel stent. Contemporary automated identification may reduce diagnostic delay for this organism, though isolate-level susceptibility testing remains essential to guide targeted therapy.

We examined the influence of running cadence manipulation on femoral cartilage deformation in runners and assessed the association between knee biomechanics and cartilage characteristics. Thirty-one runners (15 females and 16 males) completed a habitual and high cadence (+10%) run 2-7 days apart in a counterbalanced order. Participants underwent ultrasound imaging of their femoral trochlear cartilage before and after running. A force instrumented treadmill with an 8-camera motion capture system obtained the peak knee flexion angle, peak knee extensor moment, peak patellofemoral joint force (PFJF), peak patellofemoral joint stress (PFJS), and cumulative PFJS. A 2 (condition) by 2 (time) ANOVA with repeated measures revealed medial cartilage thickness decreased similarly between conditions after running (1.97 (95% CI: 1.86, 2.09) vs. 1.89 (95% CI: 1.78, 2.01) mm; mean difference = -0.078 (95% CI: -0.130, -0.026) mm, p = 0.005). No main effect of condition or interaction effect was found despite a difference between biomechanics outcomes (all p < 0.001). Higher peak and cumulative PFJS were associated with a greater decrease in medial cartilage thickness following high cadence running (p = 0.011). Higher PFJS was associated with thicker medial, central, and lateral cartilage thickness (all p < 0.05). Increasing running cadence may be a viable intervention to decrease external joint loading while maintaining an internal stimulus to knee cartilage. Cartilage is avascular and relies on mechanical loading to facilitate nutrient diffusion. As such, joint stress during running may be beneficial for cartilage development.