Clean intermittent self-catheterization (CISC) is the reference treatment for neurogenic and non-neurogenic voiding dysfunction, yet adherence falls over time. The Intermittent Catheterization Adherence Scale (ICAS) measures this adherence, but no Arabic version has existed. We translated the ICAS into Modern Standard Arabic (MSA) and tested its psychometric properties in 84 Tunisian adults on CISC at 2 rehabilitation departments. Translation followed forward and back translation guidelines, with a 6-member expert committee and a pretest of 20 patients. We assessed content validity with the content validity index (CVI), structure with exploratory factor analysis (EFA), internal consistency with Cronbach's alpha, and 10-day test-retest reliability with the intraclass correlation coefficient (ICC). The mean total score was 3.12 ± 2.03 on the 0 to 8 scale, with no floor or ceiling effect. Content validity was strong (scale-level CVI by averaging 0.99). The correlation matrix was suitable for factor analysis (Kaiser-Meyer-Olkin 0.780; Bartlett p < 0.001). Parallel analysis supported a single factor explaining 40.1% of the variance, on which item 5 loaded weakly (0.25). Internal consistency was acceptable (alpha 0.75) and test-retest reliability excellent (single-measures ICC 0.97, 95% CI 0.95-0.98). Associations with clinical indicators were weak and non-significant. The Arabic ICAS reads best as a single-dimension screening measure for Tunisian patients and needs confirmation in larger, independent Arabic-speaking cohorts.

Chronic low back pain with radiating lower-extremity symptoms in the absence of clear radiculopathy or major central canal stenosis remains a common diagnostic and therapeutic challenge. In patients with radiating low back pain without a convincing compressive correlate, posterior myofascial structures may be considered among several potential contributors; however, the present report evaluates the anatomical feasibility of a distal thoracolumbar fascia (TLF) hydrodissection approach rather than a clinical pain generator. We developed an ultrasound-guided hydrodissection technique targeting the distal TLF deep to the gluteus maximus and inferior to the sacroiliac joint. This technical report describes the clinical rationale, procedural technique, and cadaveric dye-spread assessment of injectate distribution and gross neural sparing. The technique was developed for a selected clinical context characterized by chronic low back pain radiating to the posterior thigh or calf, intact motor function, and lumbar magnetic resonance imaging (MRI) findings that may include fatty infiltration of the lower lumbar multifidus, with or without involvement of the gluteal origin region, after limited or unsustained benefit from standard image-guided interventions. For the described clinical technique, the symptomatic side would receive 10 mL of injectate prepared to a final concentration of 15% dextrose with 0.1% lignocaine. For cadaveric assessment, three fresh-frozen cadavers (two male, one female; mean age 74.3 years) underwent bilateral ultrasound-guided injection of the same target plane, yielding six injected sides. Each side received 10 mL of undiluted 1% methylene blue. Layered dissection demonstrated cephalad spread to approximately the L3 level in six out of six sides (100%). Multifidus staining occurred in six out of six (100%) and longissimus thoracis staining in six out of six (100%), whereas iliocostalis lumborum staining occurred in 0 out of six (0%). Partial proximal sacrotuberous ligament staining was observed in six out of six (100%). No gross dye was observed in the sciatic nerve, sacral plexus, neural foramina, or epidural space in 0 out of six sides (0%). In this fresh-frozen cadaver model, ultrasound-guided injection at the distal TLF-gluteal junction was technically achievable and produced a consistent gross cephalad dye-spread pattern toward the posterior fascial-paraspinal region. Because both sides of each cadaver were injected, the present design was not intended to determine contralateral crossover. These cadaveric findings do not exclude microscopic spread and do not establish histologic or in vivo safety. They also do not establish safety or efficacy of the described injectate formulation at this target in living patients. This report should be interpreted as hypothesis-generating rather than evidence of clinical effectiveness or safety.

The incidence of carbapenemase-producing (CP) Escherichia coli has increased worldwide, with the first reports in Europe dating back to the early 2000s. As part of the European Genomic Reference Laboratory Capacity Building (EURGen-RefLabCap) project, Slovenia conducted its first national genomic surveillance study of CP-E. coli. The aim was to characterize CP-E. coli isolates recovered from Slovenian patients between 1 January and 31 December 2023 using whole-genome sequencing (WGS), providing a national snapshot of the population structure and circulating strains.

Pericarditis remains a common and clinically relevant cardiovascular condition whose diagnosis and management have evolved substantially over time. Understanding this historical progression provides important context for contemporary practice and emerging therapeutic strategies. Early descriptions, dating back to Hippocrates, framed pericarditis as a clinical observation, with more precise diagnostic characterization emerging in the 19th century through the work of Laennec and later refined by clinicians such as Spodick and Hatle. Initial treatment approaches were largely symptomatic or surgical, including pericardiectomy for advanced constrictive disease. The mid-twentieth century marked a shift toward medical therapy with the introduction of nonsteroidal anti-inflammatory drugs and corticosteroids, which improved symptom control but were limited by high recurrence rates. The advent of echocardiography transformed pericardial disease evaluation by enabling noninvasive diagnosis, hemodynamic assessment, and safer pericardiocentesis. More recently, cardiac magnetic resonance imaging has further advanced care by allowing detailed tissue characterization and improved risk stratification. Randomized trials established colchicine as a cornerstone therapy for both acute and recurrent pericarditis. A major paradigm shift has occurred with the recognition of autoinflammatory mechanisms underlying recurrent disease and the introduction of targeted interleukin-1 inhibition, including anakinra and rilonacept, particularly for refractory cases. Together, these advances reflect a transition from empirical management toward mechanism-based, personalized care. Ongoing progress in imaging, biomarker integration, and targeted immunomodulation is expected to further refine diagnosis, treatment, and long-term outcomes for patients with pericardial disease.

We describe the clinical and radiographic outcomes of a patient presenting with post‑traumatic loss of cervical lordosis following a motor vehicle collision (MVC). A 27‑year‑old man reported to a spine rehabilitation clinic complaining of neck pain, low back pain, and headaches following an MVC one month prior. The patient scored moderate disability: 36% and 34% on the neck and headache indices, respectively. Radiograph screening of the cervical spine demonstrated severe anterior head translation (AHT) of 59.9 mm (ideal = 0 mm), complete loss of the cervical lordosis (C2-C7 absolute rotation angle = -1.6°; ideal = -42°), and a sharp reversal of the C5-C6 intersegmental angle of +5.9° (ideal = -8.0°). Chiropractic BioPhysics® (CBP®) (Chiropractic BioPhysics Seminars, Eagle, ID, USA) treatment aimed at restoring cervical lordosis and sagittal balance was performed over 6.5 months with a 17-month follow-up. Symptomatic improvement progressed to being negligible over the 6.5-month treatment duration. At the final follow-up, radiographic parameters improved by 38 mm in AHT, 17° in lordosis, and 10.5° in the C5-C6 segmental kyphosis. This case illustrates that meaningful structural correction is achievable and may coincide with profound and sustained clinical recovery, supporting further investigation into sagittal alignment restoration as a central therapeutic objective in patients suffering from cranio-cervical symptoms following an MVC.

Radiomics has emerged as a transformative tool in medical imaging, offering the ability to extract complex quantitative features that are generally indiscernible to the human eye. These radiomic features can be interrogated non-invasively on medical imaging. Importantly, in contrast to traditional diagnostic methods reliant on a single, often scalar, measure, radiomics features can form a high-dimensional data space from imaging data suitable for machine learning. Within the framework of artificial intelligence, radiomic features can be harnessed for differentiating healthy from pathological tissue, risk-stratifying patients for benign and malignant fractures, and clinical outcome measures. This review presents an introduction to the methodology underlying radiomics feature selection, reproducibility, feature analysis and model building, assessment of model performance, and open-source libraries for extracting radiomics features from imaging. The review then highlights the application of radiomics in osseous and cartilaginous spinal imaging for identifying osteoporosis and the prediction of fragility vertebral fractures, chronic low back pain and the assessment of intervertebral disc degeneration and herniation, cancer metastatic spine disease and the differentiation of benign vs. malignant lesions and the classification of benign vs. malignant vertebral fractures. Throughout this stage, we endeavor to demonstrate how radiomics can analyze imaging biomarkers to detect subtle structural changes in vertebral bone microarchitecture, assess tissue quality and early-stage fractures, and identify radiomic biomarkers of low back pain chronicity and intervertebral disc heterogeneity that signal degeneration and herniation risk. The review culminates with the presentation of the current limitations and future research directions, including opportunities for integration with multi-omics analysis, highlighting radiomics' potential for enhanced diagnostic accuracy and more personalized patient care. The application of radiomics in spinal imaging offers a promising avenue for improving non-invasive image early detection, risk stratification, and personalized management of spinal pathology, paving the way for more effective interventions and improved patient outcomes.

To improve detection of equine back-related disorders, it is important to establish how movement dynamics in horses' thoraco-lumbo-sacral spine are normally affected by intrinsic and extrinsic factors. This cross-sectional study aimed to quantify how discipline, gait, and surface impact differential rotational and translational movements along the backs of 107 horses from the military and police forces. The horses were walked and trotted in-hand in a straight-line over hard and soft surfaces. During the exercises, nine inertial sensors (XSens MTw) were mounted to the poll, withers, thoracic vertebrae-13 (T13) and 18 (T18), lumbar vertebra-3 (L3), sacrum (between tubera sacrale), left and right tubera coxae, and caudal sacrum ('tail'). Linear mixed models assessed whether horse discipline (load pulling or non-load pulling), surface (soft or hard), age, or stride time influenced rotational and translational range of motion differences between adjacent sensors at either walk or trot (significance at p < 0.05). When compared to non-load pullers, it was apparent that the load pullers had reductions in differential rotational movements (0.5-3.1º in walk, p ≤ 0.039; and 0.5-2.3º in trot, p ≤ 0.049) and reductions in differential cranio-caudal, medio-lateral and dorso-ventral translations (2.2-15.0 mm in walk, p ≤ 0.039; and 1.2-7.6 mm, p ≤ 0.045 in trot), plus an increase in differential cranio-caudal translation at the Poll-Withers (12.8 mm in trot, p < 0.001). Soft surfaces increased differential rotational movements (0.1-1.2º in walk, p ≤ 0.048; and 0.2-2.9º in trot, p ≤ 0.007) and differential translational movements (1.4-16.3 mm in walk, p ≤ 0.002; and 0.5-2 mm in trot, p ≤ 0.007) in most regions of the thoraco-lumbo-sacral spine compared to hard surfaces. The amplitude of differential rotational and translational movements did not show systematic patterns with stride time and age. Further work is needed to understand whether the observed changes to differential rotational and translational movements along the equine thoraco-lumbo-sacral spine, imposed by working discipline and surface conditions, impact long-term equine health, well-being, or susceptibility to injury. This work will lay foundations for the development of an equine back dynamics reference framework, to which individual data may be compared.

Background Musculoskeletal (MSK) pain is a well-known risk among surgeons, resulting from the multifactorial physical demands of the occupation. Because of the demands faced by resident surgeons, many individuals find themselves with sometimes debilitating MSK pain. Although these risks are well documented and there have been proposed solutions, there is little discussion on the role that osteopathic manipulative treatment (OMT) can play in relief of MSK pain over time in this population. Objective The purpose of this study is to determine the prevalence and distribution of MSK pain among general and orthopedic surgery residents at Cleveland Clinic Foundation (CCF). Based on the results, future work incorporating OMT during surgical residency could be done to address both the physical and psychosocial aspects of their pain. Methodology From April 10, 2024, through June 30, 2024, an observational survey study was conducted among general and orthopedic surgery residents at CCF. An online survey was sent to 164 residents. To maximize the response rate during that time period, three follow-up emails were sent. The survey asked residents: postgraduate year (PGY), gender, age group, whether they have completed a research year, any past injuries, and how often they experienced pain at various anatomical regions. Results A total of 43 of 164 (26.2%) CCF orthopedic and general surgery residents responded to the survey: 20 (46.5%) men and 23 (53.5%) women. The mean age of participants was 30-34 years. The PGY level ranged from 1 to 7, with 16/43 (37.2%) participants having completed a research year. Among the respondents of the online survey, at least one resident reported pain in all regions listed on the survey. The three most common were neck pain in 35/43 (81.3%), lower back pain in 34/43 (79.0%), and upper back pain in 25/43 (58.1%) of participants. Conclusions Our study demonstrates that daily to weekly MSK pain starts in residency as early as PGY 1, with the mean age of residents surveyed being 30-34 years old. This is regardless of past injuries. MSK pain is a serious consequence of the occupational hazards of the surgical field. Our study demonstrates that the neck, lower back, and the upper back are the three most common anatomical regions where CCF general and orthopedic surgery residents experience MSK pain. Prior research focuses on MSK pain throughout a surgeon's career. Additional research is needed to better characterize the cause of MSK pain in surgical residents and to evaluate OMT as a potential treatment intervention for this population.