10:I[41824,["/_next/static/immutable/chunks/0qu9viw6uk0o5.js","/_next/static/immutable/chunks/1ycu_xculwvzt.js"],"default"] 11:Tcb1,The objectives of this study were to determine whether the cost of care for malignant brain and other central nervous system tumors (MBT) in the US Military Health System differs between the Department of War-operated direct care (DC) network and the affiliated civilian-operated private sector care (PSC) network, as well as to identify the treatment types (i.e., surgery, radiation therapy, chemotherapy) driving any observed cost differences. Linked cancer registry and administrative-claims data from the Military Cancer Epidemiology database-including 574 patients ages 18-64 diagnosed with MBT between 2003 and 2014-were used to describe and compare patient characteristics and costs in 2022 US dollars associated with primary treatment in each setting. Because of the skewed distribution of cost data, the possibility that the effect of the care setting may have varied for patients with different levels of total cost, and to allow greater flexibility in modeling associations between independent variables and cost, nonparametric and semiparametric methods were used for the primary aims of this study. First, we used Wilcoxon-Mann-Whitney tests and Hodges-Lehmann difference estimator 95% confidence intervals (CIs) to compare DC and PSC median total cost and individual treatment type cost per patient. Next, we used quantile regression to compare DC and PSC costs at five levels between the 10th and 90th percentiles of total cost and individual treatment type cost per patient, while controlling for administrative, demographic, health, and tumor characteristics. Most patients were male (69%), younger than 29 years (28%), or older than 50 years (30%). Glioblastomas were the most commonly diagnosed tumor type (38%). Overall, 270 patients (47%) were treated in DC and 304 (53%) were treated in PSC. The median unadjusted total cost of treatment per patient was significantly higher for PSC at $87,652 compared to DC at $55,361 (Hodges-Lehmann difference estimator 95% CI [-49,544,-10,086], p < .001). While median unadjusted surgery costs were similar, radiation therapy and chemotherapy costs were significantly higher in PSC than in DC. After controlling for confounders, total cost per patient was significantly higher in PSC compared to DC for patients near the median, 75th, and 90th percentiles of the cost distribution, with the additional total cost per patient associated with PSC increasing from $31,443 (95% CI [4,216,58,669], p = .024) near the median to $305,200 (95% CI [211,412,398,897], p < .001) at the 90th percentile. After controlling for confounders, radiation therapy was significantly more costly for patients at each quantile in PSC compared to DC, while surgery costs were similar for patients in PSC and DC at each quantile of the cost distribution. The decision to internally deliver care or outsource services for complex and costly diagnoses such as MBT involves multiple strategic considerations, including treatment costs. Using data from the universal-access Military Health System, this study demonstrated that providing care within system-owned and operated facilities may be more cost-efficient than outsourcing care to affiliates, especially for patients whose treatment costs are above the median.12:T8ce,Ehlers-Danlos syndrome (EDS) is a group of inherited disorders affecting collagen and extracellular matrix proteins, which can cause skin hyperelasticity, joint hypermobility, atrophic scarring, and blood vessel fragility. Complications include joint dislocation, chronic pain, fatigue, functional gastrointestinal disorders, mast cell hyperactivity, orthostatic intolerance, anxiety disorders, and pelvic and bladder dysfunction, among others. This article discusses the orthopedic concerns and complications, diagnosis, genetic testing, and multidisciplinary approach to management in EDS patients. A comprehensive review of the literature in PubMed was performed, focusing on EDS and its orthopedic implications, diagnosis, genetic testing, and management. Search terms included EDS with/without diagnosis, orthopedics, and management. Peer-reviewed journals were prioritized. Each source's credibility, findings, and level of evidence were organized by theme to synthesize the information. Literature within 5 years was prioritized. However, given the little information available about EDS, this was expanded to include landmark and highly relevant sources. EDS patients often have weak spinal muscles, deformities, and reduced column support leading to joint instability, recurrent dislocations, and chronic pain. Diagnosis is primarily clinical, but identifying the type of EDS by the gene encoding the defect in collagen or other proteins is essential to guide management. Physical therapy, pain management, skin care, and nutrition form the cornerstone of EDS management. Orthopedic surgery to address orthopedic concerns such as joint stability is controversial due to the potential for complications and should be considered only after nonoperative medical treatments have failed. EDS presents unique considerations that must be addressed, especially when orthopedic intervention is being considered. Due to the unique symptom presentation, goals and care plans should be individualized. The orthopedic nurse plays a vital role throughout all phases of care and should be aware of the special considerations with patients with EDS. The focus of treatment should be on patient safety, symptom management, and the prevention of future injuries.13:T53f,Cerebellar tonsillar reduction or resection can be performed as part of the surgical management of Chiari type 1 malformation when it is accompanied by symptomatic brainstem compression or syringomyelia. The purpose of this study is to characterize the early postoperative magnetic resonance imaging (MRI) findings in patients with Chiari type 1 malformations who undergo cerebellar tonsillar reduction via electrocautery. The extent of cytotoxic edema and microhemorrhages demonstrated on MRI scans obtained within 9 days following surgery was assessed and correlated with neurological symptoms. Cytotoxic edema was found on all postoperative MRI examinations included in this series, with superimposed hemorrhage in 12 of 16 patients (75%) and was primarily located along the margins of the cauterized inferior cerebellum. Cytotoxic edema was present beyond the margins of the cauterized cerebellar tonsils in 5 of 16 patients (31%) and was associated with new focal neurological deficits in 4 of 5 patients (80%). Cytotoxic edema and hemorrhages along the cerebellar tonsil cautery margins can be expected findings in early postoperative MRI in patients who undergo Chiari decompression accompanied by tonsillar reduction. However, the presence of cytotoxic edema beyond these regions can be associated with new focal neurological symptoms.14:T6b6,This study quantitatively analyze the evaluation indicators used in premenstrual disorder clinical trials, establishes a placebo response model, observes its influencing factors, and provides a basis for the design of future clinical trials. A comprehensive search was conducted in PubMed, EMBASE, Cochrane Library, and PsychINFO for randomized controlled trials (RCTs) related to premenstrual disorders. The time course of the placebo responses were modeled and analyzed for common evaluation indicators. Furthermore, the placebo response for each indicator under various conditions was simulated to provide an external control and inform sample size estimation. In the 47 studies included in the analysis, it includes 5406 patients, 5 common evaluation indicators were identified: total symptom score, depression symptom score, anxiety symptom score, irritability symptom score, and physical symptom score. The maximum placebo response ranged from 20.9% to 38.4%, with the efficacy plateau being reached within 2 to 3 months. The total symptom score is recommended as the primary outcome due to its minimal placebo response size, rapid onset of action, and low intertrial variability. Using this model as an external control, the study suggests that the efficacy of natural S-equol was not significantly different from that of a placebo. Furthermore, the placebo response model was found to provide accurate effect sizes for sample size estimation under various conditions. The placebo response models of common evaluation indicators in clinical trials of drugs for premenstrual disorders have been established, providing an important basis for the optimized design and decision-making of subsequent clinical trials.15:Tb78,Intraspinal anomalies (IA) are reported to occur in 7% to 19% of patients undergoing surgery for adolescent idiopathic scoliosis (AIS). However, these studies have not focused on IA that require neurosurgical intervention and have not assessed whether deformity characteristics predict their underlying presence. We hypothesized that specific radiographic deformity parameters would be associated with underlying IA in a population of presumed AIS patients undergoing posterior spinal fusion (PSF). A retrospective cohort study was performed over a 10-year period, identifying all patients with presumed AIS undergoing PSF who had a preoperative total spine MRI at a single, tertiary care pediatric hospital. The presence of an intraspinal anomaly was confirmed by MRI, and subsequent neurosurgical evaluation and intervention were recorded. Coronal and sagittal plane radiographic criteria were recorded, with a focus on previously identified predictive criteria. Radiographic criteria were compared against the whole population, as well as just those with thoracic deformities, seeking to identify factors associated with the presence of IA, as well as those associated with the need for neurosurgical intervention. A total of 427 patients met the inclusion criteria (mean 14.6±2.3 y, 80.7% female). Of these, 33 patients (7.7%) were diagnosed with an IA: 23 syringomyelia, 14 Chiari I malformation, 4 tethered spinal cord, and 8 cerebellar tonsillar ectopia, with only 8 patients (1.9%) undergoing neurosurgical treatment. Thoracic deformities were predominant in 350 patients (81.7%), which was statistically similar for IA and AIS (84.9% vs. 83.3%). For the whole cohort, a left thoracic curve apex was significantly more likely in a patient with an underlying IA (IA: 21% vs. AIS: 6.2%; P <0.001) and was predictive on logistic regression analysis (odds ratio: 0.25, 95% CI: 0.1-0.67; P =0.003). Neurosurgical intervention was also associated with a left thoracic curve apex within the subset of thoracic-only deformities (IA: 38% vs. AIS: 6.5%, P =0.005) with a 37.5% sensitivity and 92.7% specificity. However, all patients requiring neurosurgical intervention also showed neurological symptoms, such as occipital headaches, sleep apnea, or extremity neurological symptoms. The presence of an intraspinal anomaly occurred in 33 patients (7.7%) of this presumed AIS cohort, but only 8 patients (24%) required neurosurgical intervention (1.9% of the total cohort). Only a left thoracic apex was associated with the need for neurosurgical intervention. However, all patients requiring neurosurgical intervention presented with concomitant neurological symptoms. Selective MRI screening protocols incorporating patient sex, radiographic criteria, and neurological indicators may prove sufficient in contrast to universal MRI screening in children with presumed AIS undergoing PSF while minimizing health care expenditures.16:T71e,Previous researchers have mainly examined the general recovery of patients with chronic venous disease after iliac vein stent placement for iliac vein compression syndrome. However, little is known about the specific challenges faced by patients who remain in an unresolved postoperative recovery phase after stenting. In this study, we aimed to explore the challenges faced by patients with chronic venous disease during unresolved postoperative recovery after iliac vein stenting. A descriptive phenomenological design was employed. Purposive sampling was used to recruit 12 patients from a teaching hospital in Taiwan. Semistructured interviews were conducted between January 2024 and July 2025, and the data were analyzed using Colaizzi's 7-step method with NVivo-assisted coding. Findings indicated that patients with iliac vein compression syndrome experienced a central phenomenon of internalized distress. Four major themes emerged: (1) severe physical discomfort and restricted mobility, reflecting persistent and unpredictable symptoms; (2) resigned endurance, with suppressed distress until nearing emotional breakdown; (3) feeling trapped and regretful, leading to delayed but urgent help-seeking; and (4) breaking free from constraints and regaining physical control, achieved through self-soothing and behavioral adjustments. Patients with unresolved recovery from chronic venous disease after iliac vein stenting experience multidimensional distress that extends beyond physical symptoms. These findings underscore the importance of postoperative care that integrates continuous psychological support, culturally sensitive communication, and proactive follow-up. Developing personalized tools to assess well-being and guide tailored interventions may enhance recovery outcomes in this vulnerable population.17:T6f0,The purpose of this study is to investigate the association between cannabis usage and thyroid eye disease (TED) in patients with autoimmune hyperthyroidism. While the association between cigarette smoking and TED is well established, the effect of cannabis on TED is unclear. This cohort study examined data from TriNetX, an electronic health record platform, for patients with autoimmune hyperthyroidism between December 1, 2003, and December 1, 2023. Primary outcomes were TED presentation (exophthalmos, eyelid retraction, eyelid edema, orbital edema, strabismus, and optic neuropathy) and treatment (teprotumumab, methylprednisolone, tarsorrhaphy, and orbital decompression) in cannabis users, nicotine users, and control patients. Propensity matching was performed to control for characteristics such as age, sex, race, prior thyroidectomy, and/or radio ablation. Relative risk between cohorts was calculated for each outcome in 6-month, 1-year, and 2-year intervals following diagnosis of autoimmune hyperthyroidism. Of 36,186 patients with autoimmune hyperthyroidism, 783 were cannabis users, 17,310 were nicotine users, and 18,093 were control patients without cannabis or nicotine usage. Compared with control patients, cannabis users were more likely to be younger, male, and Black/African American and have anxiety or depression. After propensity matching, cannabis users were 1.9 times more likely to develop exophthalmos ( p = 0.03) and 1.6 times more likely to develop any TED presentation ( p = 0.049) in the 1-year interval although these differences did not remain statistically significant in the 2-year interval. Cannabis users had a significantly increased risk for TED outcomes in the 1-year interval. Further research is needed to inform TED management.18:T68b,Increasing evidence shows that CD8+ T cells are the pathogenic mediators of tissue injury in systemic lupus erythematosus (SLE), sustaining the chronic inflammation through the accumulation of long-lived cytotoxic memory populations. However, the transcriptional mechanisms that prevent the aberrant differentiation of pathogenic CD8+ T cells remain poorly understood. Here, the transcription factor E4BP4 (NFIL3) was identified as a critical restraint of cytotoxic effector-memory CD8+ T cells in lupus. E4BP4 expression was reduced in CD8+ T cells from SLE patients and inversely correlated with disease activity. Using a lupus-like disease model, we found that E4BP4 deficiency accelerated disease progression, resulting in heightened autoantibody production, immune complex deposition, and renal pathology. This phenotype was associated with the systemic accumulation of cytotoxic effector-memory CD8+ T cells. Depletion of CD8+ T cells significantly ameliorated the disease phenotype, confirming the functional contribution of CD8+ T cells to lupus-like immunopathology. Competitive adoptive transfer experiments revealed that E4BP4 functions cell-intrinsically to limit the cytotoxicity and proliferation of CD8+ T cells in autoimmunity. Beyond autoimmunity, E4BP4 deficiency also resulted in an exuberant CD8+ effector-memory T cell response to Listeria monocytogenes infection, indicating a broader role for E4BP4 in limiting CD8+ T cell effector-memory responses. Collectively, these findings establish E4BP4 as a transcriptional checkpoint that restricts pathogenic CD8+ effector-memory T cell responses to maintain immune homeostasis in autoimmunity and infection.19:T656,Hashimoto's thyroiditis (HT) is a common autoimmune thyroid disorder with a complex genetic background. Interleukin-6 (IL-6) has been implicated in its pathogenesis, but the genetic mechanisms remain unclear. Two-sample Mendelian randomization (MR) using expression quantitative trait loci (eQTL) and gene set enrichment analysis (GWAS) data identified IL‑6-HT genes. In vivo validation in nonobese diabetic (NOD) mice involved siRNA knockdown, histopathology HE/Immunohistochemistry (HE/IHC), and enzyme-linked immunosorbent assay (ELISA). GSEA and molecular docking explored mechanisms. Western blot in THP‑1 cells assessed Nuclear factor kappa-light-chain-enhancer of activated B cells (NF‑κB) pathway proteins (pIKKβ, IKKβ, pTAK1, TAK1, pp65, p65) and associations with SLC45A3/CCDC77 at 2, 24, 48 h (β‑actin control). MR analysis identified CCDC77 and SLC45A3 as key genes associated with both IL-6 and HT. In vivo experiments showed that knockdown of CCDC77 exacerbated thyroid damage, increased serum anti-thyroperoxidase antibody (TPOAb), anti-thyroglobulin antibody (TGAb), and IL-6 levels, while reduced free triiodothyronine (FT3) and free thyroxine (FT4). Conversely, SLC45A3 knockdown alleviated thyroiditis, reduced antibody levels, and improved thyroid function. GSEA Western blot analysis further revealed that both CCDC77 and SLC45A3 were involved in regulating the activation of NF‑κB signaling pathway. Our study demonstrated that SLC45A3 and CCDC77 were involved in modulating HT progression through NF‑κB-IL-6 axis, providing novel therapeutic strategies for clinical applications.1a:T813,Interstitial cystitis/bladder pain syndrome (IC/BPS) is a persistent and heterogeneous condition diagnosed by exclusion, defined by a bladder-associated unpleasant sensation (e.g. pain, pressure, or discomfort), and affecting patients' quality of life. This real-world study aimed to describe all-cause healthcare resource utilization (HCRU) and costs associated with IC/BPS in the United States. This matched-cohort study compared patients with an IC/BPS diagnosis to those without using real-world claims from the Merative MarketScan Commercial and Medicare Supplemental Databases (Set B; January 1, 2016-June 30, 2025). The index date was the first IC/BPS diagnosis during the identification period (January 1, 2017-September 30, 2022). During the baseline and follow-up periods, all-cause HCRU and costs (i.e. billed expenses) were reported as means per patient per year (PPPY) and rate ratios (RR). In the 1-year baseline period, the IC/BPS cohort demonstrated higher all-cause HCRU and costs across all categories compared with the control cohort. During the follow-up period, mean all-cause total visits were nearly 2-fold higher in the IC/BPS cohort than in the control cohort (21.78 vs. 10.94 PPPY; RR, 1.99; 95% CI, 1.95-2.04); mean all-cause total healthcare costs were also nearly 2-fold higher in the IC/BPS cohort than in the control cohort ($20,288 vs. $10,222 PPPY; RR, 1.98; 95% CI, 1.92-2.05). This observational study of all-cause HCRU based on claims data provides insights rather than conclusions. Claims data rely on coded diagnoses and may lack information on disease severity, adherence, and indirect costs, introducing bias (e.g. diagnosis misclassification or residual confounding) and affecting the generalizability of results. This exploratory study demonstrated that the healthcare burden among patients diagnosed with IC/BPS remained substantial over time. These findings highlight the need for further research on cost drivers and management strategies to improve outcomes and reduce all-cause HCRU and costs among patients with IC/BPS.1b:Tbc6,To investigate the association between the duration of the second stage of labour (SSL) and early postpartum pelvic floor dysfunction (PFD) in primiparous women delivering macrosomic foetuses. 200 eligible primiparous women were stratified by SSL duration into Group A (t ≥ 3h), Group B (2h ≤ t < 3h), and Group C (t < 2h). At six weeks postpartum, transperineal ultrasound was performed to determine bladder neck position and levator ani hiatus (LAH) area. Pelvic floor muscle (PFM) strength was evaluated using the Oxford scale, while PFM function was measured via vaginal pressure testing. The occurrences of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) were recorded. The incidence of POP was significantly higher in Group A (23.33%) compared with Group B (6.67%) and C (5%) (P < 0.05). Weak PFM strength was observed in 56.67% of women in Group A versus 21.67% and 21.25% in Groups B and C, respectively (P < 0.05). Vaginal pressure in Group A (class I fibres: 61.38 ± 4.97; class II fibres: 80.63 ± 3.18) was markedly lower than in Group B (I: 78.35 ± 5.08; II: 93.73 ± 4.39) and C (I: 76.55 ± 4.49; II: 92.10 ± 4.40) (P < 0.001). Muscle fatigue was notably higher in Group A (I: 8.65 ± 0.95; II: 3.98 ± 0.65) compared with Group B (I: 4.78 ± 0.61; II: 2.28 ± 0.49) and C (I: 4.25 ± 0.56; II: 2.53 ± 0.55) (P < 0.001). LAH area during Valsalva was significantly larger in Group A (25.48 ± 3.77) than in Groups B (18.55 ± 2.87) and C (17.68 ± 2.72) (P < 0.001), with corresponding LAH expansion rate of 75%, 40%, and 43.75% (P < 0.05). A prolonged SSL (≥ 3 h) is associated with weaker PFM strength, greater muscle fatigue, enlarged levator hiatus, and a higher incidence of POP in primiparous women delivering macrosomic foetuses. This study investigated how the duration of the second stage of labour (the pushing phase during childbirth) affects pelvic floor health in first-time mothers who delivered large infants weighing more than 4000 g. At six weeks postpartum, we examined 200 eligible mothers using ultrasound to assess pelvic floor structure, measured pelvic floor muscle strength, and recorded symptoms such as urinary incontinence or pelvic organ prolapse. Our findings showed that women who pushed for three hours or longer were more likely to have weaker and more easily fatigued pelvic muscles. They also demonstrated a larger opening of the pelvic floor on ultrasound and a higher rate of pelvic organ descent compared with women who had shorter pushing times. These results suggest that prolonged pushing during childbirth can negatively affect pelvic floor function shortly after delivery, particularly in women giving birth to larger babies. Recognising the potential risks associated with extended pushing may help clinicians make informed decisions during labour and guide early rehabilitation strategies to protect long-term pelvic health.1c:T8d4,Constipation and bloating are common bothersome gastrointestinal (GI) symptoms that frequently occur concurrently. It is important to recognize the underlying condition(s) and tailor therapeutic interventions appropriately. This review discusses the evaluation and management of patients with constipation who also have bloating as a predominant symptom. Key areas reviewed are potential etiologies for constipation with bloating and clinical evaluation, including differentiation between common underlying causes such as chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C). Management approaches discussed include dietary modification, biofeedback, and pharmacologic therapy, including over-the-counter treatments, plecanatide, linaclotide, lubiprostone, tenapanor, neuromodulators, and antibiotics. Constipation and bloating are common GI symptoms; however, bloating is a relatively nonspecific symptom with a complex pathophysiology. While specifically treating constipation may also improve bloating, this strategy does not improve bloating in all patients. There is a need for additional research to further understand the physiology of bloating. In an era when personalized medicine is becoming increasingly emphasized, understanding the pathophysiology of bloating for an individual patient, be it alongside constipation or other GI and non-GI symptoms, will be paramount to improve treatment outcomes. Patients presenting with constipation, with bloating as a predominant symptom, should be evaluated for underlying conditions, including irritable bowel syndrome with constipation (IBS-C), chronic idiopathic constipation (CIC), pelvic floor dysfunction, and microbial overgrowth (e.g. intestinal methanogen overgrowth), among other causesIf food intolerances are suspected, a trial of dietary restriction, such as a low-fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet, can be suggestedImprovement in bloating has been demonstrated in large, randomized trials of several gastrointestinal-targeted pharmacologic therapies (e.g. secretagogues) in patients with IBS-C or CICPelvic floor physical therapy with biofeedback should be considered for patients with dyssynergic defecation.1d:T73c,To evaluate the safety and efficacy of sequential combination therapy comprising gonadotropin-releasing hormone agonist (GnRH-a), hysteroscopic surgery (residual lesion resection plus endometrial ablation), and levonorgestrel-releasing intrauterine system (LNG-IUS) insertion in patients with adenomyosis who exhibited suboptimal response to high-intensity focused ultrasound (HIFU) ablation (non-perfused volume (NPV) ratio < 50%). This retrospective study enrolled 71 patients with adenomyosis who underwent HIFU ablation with an NPV ratio < 50% and subsequently received three doses of GnRH-a, followed by hysteroscopic surgery (residual lesion resection plus endometrial ablation) with concurrent LNG-IUS insertion (HIFU-GHL regimen). All patients completed a minimum follow-up of 24 months. Clinical efficacy was assessed using the visual analogue scale (VAS) for dysmenorrhea and the sensation quantity scale (SQS) for menstrual blood volume at baseline and at 6, 12, 18, and 24 months post-treatment. The median follow-up duration was 39 months (IQR: 29-53 months). The median NPV ratio following HIFU ablation was 22.2% (IQR: 12.0%-36.2%). Compared with baseline, significant reductions in both VAS and SQS scores were observed at all post-treatment time points (all p < 0.05), with no significant differences among the four follow-up intervals (p > 0.05). Only two patients (2.8%) required re-intervention for recurrent dysmenorrhea. The sequential regimen of GnRH-a, hysteroscopic surgery (lesion resection plus endometrial ablation), and LNG-IUS insertion is a safe and effective uterine-preserving salvage strategy for adenomyosis patients with suboptimal HIFU ablation (NPV ratio < 50%). Prospective randomized trials with extended follow-up are warranted to validate these findings.1e:Te82,Adenomyosis causes severe dysmenorrhoea and menorrhagia. While the Levonorgestrel-Releasing Intrauterine System (LNG-IUS) is a highly effective conservative treatment, its success is frequently compromised by high expulsion rates (15%-37.5%) caused by uterine enlargement and cavity distortion. This review evaluates the principles, clinical efficacy, and safety of emerging intrauterine fixation techniques designed to prevent LNG-IUS downward displacement and expulsion. A comprehensive literature search was conducted across PubMed, Web of Science, and Google Scholar for articles published between January 2000 and February 2026. The review synthesised data from observational studies, retrospective cohorts, and controlled trials focusing on the surgical modification and stabilisation of the LNG-IUS in patients with adenomyosis. Current intrauterine fixation strategies are broadly classified into hysteroscopic suture fixation (utilising non-absorbable sutures to anchor the device to the myometrium) and non-suture fixation (encompassing combined frameless IUD fixation, device-modified anchoring, and direct tail-embedding). Current literature indicates that these techniques significantly reduced expulsion rates, generally to below 7%, compared to conventional placement failure rates that can exceed 30%. This mechanical stabilisation maintains the device's pharmacological efficacy, yielding sustained improvements in dysmenorrhoea and reducing menstrual blood loss. Nonetheless, these procedures introduce new clinical and safety challenges. Key concerns include off-label regulatory issues regarding manual device modification, altered sonographic imaging profiles, increased removal complexity requiring secondary hysteroscopic intervention, and theoretical long-term risks associated with myometrial micro-scars. Intrauterine fixation significantly mitigates LNG-IUS expulsion in adenomyosis. While highly effective, the manual and invasive nature of these techniques necessitates careful patient selection and rigorous safety monitoring. Future research must prioritise large-scale randomised controlled trials. Ultimately, clinical practice should transition from manual surgical modifications towards the standardised industrial development of next-generation LNG-IUS devices equipped with inherent anti-expulsion features. Adenomyosis is a painful condition where the lining of the womb grows deep into its muscle wall. This causes severe cramps, heavy menstrual bleeding, and makes the womb larger. A very effective treatment is a small, hormone-releasing device placed inside the womb to reduce bleeding and pain. However, because the disease changes the size and shape of the womb, the body often pushes the device out. When the device falls out, the painful symptoms quickly return.To solve this problem, doctors have developed new techniques to securely attach the hormone device directly to the inside wall of the womb. Instead of simply placing it inside, surgeons use small stitches or special anchors to hold the device in place.Our review looked at recent studies to see how well these new methods work. We found that stitching or anchoring the device stops it from falling out in almost all cases. This allows women to get long-lasting relief from heavy bleeding and pain without needing major surgery to remove their womb.While these techniques are very helpful, they require special surgical skills and may carry some risks, such as making the device harder to remove later. In the future, medical companies should design better hormone devices with built-in features that prevent them from falling out, so doctors do not have to rely on manual stitching or custom modifications.1f:Ta66,The causal relationship between variations in thyroid dysfunction and brain structure remains elusive. We intended to probe into this causal connection using a Mendelian randomization (MR) approach. Aggregated statistics from the genome-wide Association Study (GWAS) on Autoimmune thyroid dysfunction were obtained from the FinnGen database, including autoimmune hyperthyroidism (N = 2,190) and autoimmune hypothyroidism (N = 49,055). Aggregate statistics on cortical area and thickness for GWAS were obtained from the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) Consortium (N = 51,665). The main method employed is inverse variance weighting (IVW), supplemented by weighted median, Mr-Egger regression, MR-pleotropy residuals, and outliers. Some sensitivity analyses were conducted to determine heterogeneity and pleiotropy. For autoimmune hypothyroidism (exposure), significant causal associations were observed with cortical thickness (outcome type) in the following regions: pars triangularis (β = -0.003, 95% CI: -0.005 to -0.001, PTH = 0.023; PTH: P-value for cortical thickness,), posterior cingulate (β = 0.003, 95% CI: 0.000-0.006, PTH = 0.034), and transverse temporal (β = 0.006, 95% CI: 0.002-0.010, PTH = 0.004; β = 0.006, 95% CI: 0.001-0.011, PTH = 0.010). For autoimmune hyperthyroidism (exposure), significant causal associations were observed with cortical surface area (outcome type) in the entorhinal (β = -2.576, 95% CI: -4.714 to -0.437, PSA = 0.018; PSA: P-value for cortical surface area), frontal pole (β = -1.195, 95% CI: -2.118 to -0.271, PSA = 0.011), lateral occipital (β = -15.787, 95% CI: -31.171 to -0.403, PSA = 0.044), lingual (β = -10.778, 95% CI: -20.888 to -0.668, PSA = 0.037), postcentral (β = -16.360, 95% CI: -28.410 to -4.309, PSA = 0.008), precentral (β = -16.089, 95% CI: -29.281 to -2.897, PSA = 0.017), and superior parietal (with global weighting; β = 11.360, 95% CI: 0.435-22.285, PSA = 0.042). Additionally, autoimmune hyperthyroidism was causally associated with cortical thickness (outcome type) in the entorhinal (β = 0.009, 95% CI: 0.000-0.018, PTH = 0.039) and posterior cingulate (β = 0.004, 95% CI: 0.001-0.008, PTH = 0.025). These findings remained reliable in the sensitivity analyses. These findings suggest that autoimmune hyperthyroidism and autoimmune hypothyroidism may have potential causal effects on the surface area and thickness of specific regions of the cerebral cortex, but further studies are needed to fully understand the nature of this relationship.5:["$","div",null,{"style":{"maxWidth":"1100px","margin":"0 auto","padding":"48px 24px 96px"},"children":[["$","div",null,{"style":{"marginBottom":"48px"},"children":[["$","p",null,{"style":{"fontSize":"12px","color":"var(--text-faint)","marginBottom":"10px","letterSpacing":"0.08em","textTransform":"uppercase","fontWeight":600},"children":"spoons.world"}],["$","h1",null,{"style":{"fontSize":"clamp(30px, 5vw, 48px)","fontFamily":"Georgia, serif","marginBottom":"14px","lineHeight":1.1},"children":"Patient Experience Database"}],["$","p",null,{"style":{"fontSize":"17px","color":"var(--text-secondary)","lineHeight":1.65,"maxWidth":"640px","marginBottom":"20px"},"children":["A structured, continuously updated evidence base for chronic illness — combining peer-reviewed research with real-world patient experience across"," ",["$","strong",null,{"style":{"color":"var(--text)"},"children":[77," conditions"]}],". 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Nurses are in the unique position to support and provide education to patients who may be experiencing sacroiliac dysfunction or possibly apply this knowledge to themselves, as low back pain is a significant problem experienced by nurses. A patient's clinical presentation, including pain patterns and characteristics, functional limitations, common etiologies and musculoskeletal system involvement, current diagnostic tools, and realm of treatments, are discussed along with their respective efficacy. 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Despite persistent thrombocytopenia, his mean platelet volume remained normal, an atypical feature of Wiskott-Aldrich syndrome (WAS). His course was complicated by stage-5 chronic kidney disease, renal anemia, IgA nephropathy, and recurrent infections. Laboratory tests consistently showed low lymphocyte counts and reduced WAS protein (WASp) levels. After confirming WAS, the original plan of kidney transplantation alone was changed to combined hematopoietic stem cell and kidney transplantation to restore immunity and reduce graft failure risk. 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Patient Experience Database

Examining Cost Differences in Malignant Brain and Central Nervous System Tumor Treatment Across US Military Health System Care Settings.

Complications and Management of Ehlers-Danlos Syndromes and Hypermobility Spectrum Disorders: A Literature Review.

Advances in the diagnosis and concept of Sjögren's syndrome (autoimmune exocrinopathy).

Complications and Management of Ehlers-Danlos Syndromes and Hypermobility Spectrum Disorders: A Literature Review.

Early Postoperative Magnetic Resonance Imaging Findings Related to Electrocauterization for Cerebellar Reduction During Chiari Decompression Surgery.

Quantitative Analysis of Placebo Response Models to Optimize Clinical Trials in Premenstrual Disorders: A Model-Based Meta-analysis.

Recognition of Cutaneous Symptoms of Common Tick-Borne Illness in the Emergency Department.

Spinal Deformity Characteristics Associated With Intraspinal Anomalies in a Population of Presumed Adolescent Idiopathic Scoliosis (AIS).

Challenges Experienced by Patients With Chronic Venous Disease in Unresolved Postoperative Recovery After Iliac Vein Stenting: A Phenomenological Study.

Effect of Cannabis Usage on Thyroid Eye Disease.

What You Need to Know About Sacroiliac Dysfunction.

E4BP4 restrains effector-memory CD8+ T cell responses in systemic lupus erythematosus.

Atypical Wiskott-Aldrich syndrome presenting with normal platelet volume and end-stage renal disease: from misdiagnosis as ITP to combined transplantation.

CCDC77 and SLC45A3 mediate the genetic mechanism of Hashimoto's thyroiditis through IL-6.

Real-world all-cause healthcare resource utilization and costs among patients with interstitial cystitis/bladder pain syndrome in the United States.

Second stage labour duration and pelvic floor outcomes in primiparous women delivering macrosomic foetuses: a prospective study.

Constipation with bloating: a clinical approach to evaluation and management.

Efficacy and safety of combined GnRH-a, hysteroscopic surgery, and LNG-IUS for adenomyosis with suboptimal HIFU ablation: a retrospective study.

Fixation techniques for the Levonorgestrel-Releasing Intrauterine system in adenomyosis: a narrative review.

Causal effect of thyroid function on cortical brain structure: A two-sample Mendelian randomization study.

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