Importance Fibromyalgia is characterized by chronic widespread pain that is often exacerbated by movement that interferes with daily activities. Development of effective treatments for movement-evoked pain is essential for improving function for individuals with fibromyalgia. Objective To evaluate whether the addition of transcutaneous electrical nerve stimulation (TENS) to outpatient physical therapy improves fibromyalgia-associated movement-evoked pain. Design, Setting, and Participants The Fibromyalgia TENS in Physical Therapy (FM-TIPS) study was a cluster-randomized clinical trial of participants with fibromyalgia at 28 outpatient PT clinics from 6 health care systems. Between February 1, 2021, and September 31, 2024, 958 participants were screened, 459 participants enrolled, and 384 completed baseline data collection, with final data collected in March 2025. Intervention Clinics were randomized to PT plus TENS (PT-TENS) and PT-only groups. Data were captured on days 1, 30, 60 (primary end point, randomized phase), 90, and 180. Participants in the PT-only group received TENS after day 60 (extension phase). TENS was applied to the upper and lower back with instructions to use 2 hours daily with parameters of modulating frequency of 2 to 125 Hz for 100 to 180 microseconds at a strong but comfortable intensity. Main Outcomes and Measures The primary outcome was a change in movement-evoked pain (scale of 0-10, with 0 indicating no pain and 10 indicating worst pain imaginable) from baseline to day 60 rated during a 5-times sit-and-stand task using a linear mixed-effects model. In addition, patient-reported improvement based on the Patient Global Impression of Change score and patient-reported adverse events were assessed. Results A total of 384 FM-TIPS participants (mean [SD] age, 53 [15] years; 351 [91%] female) completed baseline data collection (modified intention-to-treat), with 191 individuals in PT-TENS group and 193 in PT-only group. Movement-evoked pain at day 60 during TENS treatment was significantly lower in the PT-TENS group compared with the PT-only group (group mean difference, −1.2; 95 CI, −1.6 to −0.7; d = 0.46). A dose-response effect for TENS was observed, with more participants in the PT-TENS group reporting improvement on the Patient Global Impression of Change (120 [72%] vs 86 [51%], P = .001) and a 30% or greater reduction in movement-evoked pain in responder analysis (66 of 161 [41%] vs 22 of 169 [13%]; P < .001). At day 180, 217 respondents (81%) found TENS helpful and 147 (55%) used TENS daily. There were no serious adverse events, and 109 of 358 (30%) experienced minor adverse events during the entire 6 months of the study. Conclusions and Relevance In this cluster randomized clinical trial of TENS in fibromyalgia, TENS meaningfully reduced movement-evoked pain and remained effective for 6 months. This study’s results suggest that TENS is a safe, inexpensive, and readily available treatment for fibromyalgia. Trial Registration ClinicalTrials.gov Identifier: NCT04683042
Intertrochanteric fracture fixation requires optimization of both mechanical stability and the biological environment governing bone repair. This study presents a comparative in silico mechanobiological model of cephalomedullary nailing (CMN) and dynamic hip screw (DHS) osteosynthesis under peptide-inspired healing modulation. A dynamic MATLAB/Simulink R2025b model was developed to simulate implant behavior under evolving healing conditions, incorporating a biologically inspired healing term to represent regenerative support and its indirect effect on fracture-site stabilization. The model was used to estimate temporal changes in effective implant stress and to compare the mechanical behavior of CMN and DHS across matched loading and healing scenarios. A predictive decision-support module was also implemented to stratify simulated fixation scenarios according to healing favorability and risk profile. Within the simulated classification setting, the predictive module demonstrated good discriminative performance (AUC > 0.85). Healing modulation was associated with progressive reduction in effective implant stress, while CMN showed a more favorable mechanical profile than DHS under the modeled conditions. This study proposes a mechanobiological computational platform that integrates implant biomechanics, healing modulation, and predictive scenario stratification within a unified in silico framework. These findings should be interpreted as hypothesis-generating and require further biomechanical, experimental, and clinical validation.
High- energy fractures of lower leg are complex lesions that may be associated with soft tissue damage and severe complications, such as compartment syndrome and infection. This case report interests a professional motocross freestyler with complex tibia and fibular open fracture, with soft tissue damage. Case presentation We report the case of 31-year-old man, presented with injuries resulting from accident, as professional freestyler motorcyclist, including open horizontal multifragmentary fracture with angulation of the proximal and middle part of the left tibia and horizontal fracture with angulation of the proximal and middle part of the left fibula. The initial assessment revealed surgical stabilization of the tibia, intramedullary osteosynthesis with wedge. The open lacero-contused wound of the anterior lower leg after the surgery complicated with infection. Necrectomy and Suprasorb A + Ag dressing was performed for per secondar healing of the wound. Conclusion For mounts later, despite the complexity of the fractures, the gravity of the soft tissue lesion and subsequent complications, the patient healed. This satisfactory result depended on the correct management in terms of type of treatment and timing. It highlights the importance of a multidisciplinary approach, incorporating trauma surgeons, plastic and reconstructive surgeon and intensive care specialist to navigate the intricacies of high energy trauma care.
We present a patient which is complex patient regarding the risks for skin graft survival. Multidisciplinary management of the risks is the only way of skin grafting survival. Choosing the right time, right donor region, right techniques of harvest the skin grafts, choice and preparation of graft, fixation techniques, good preparation of the recipient region and controlling the chronic diseases which are bringing risks such as Diabetes mellitus, arteriosclerosis, vascular diseases, infection, are the key of surviving the skin graft.
Introduction: Probiotics are live microorganisms with documented benefits in preventing and treating pediatric illnesses, particularly those related to gastrointestinal health. Objective: To assess the level of knowledge, attitudes, and practices among Macedonian mothers regarding probiotic use in children. Methods: A cross-sectional study was conducted using a structured online questionnaire distributed to 527 Macedonian mothers through social media parenting groups. Results: 89.9% of respondents knew what probiotics are. 56% understood that probiotic formulations differ. 89.2% breastfed their babies and knew breast milk contains beneficial bacteria. 97.3% reported administering probiotics to their children. 64.1% gave probiotics after birth; 46.5% during breastfeeding. 71.6% administered probiotics concurrently with antibiotics. 65.1% noticed improvement in the child's health following probiotic use. Conclusion: Macedonian mothers exhibit a good level of awareness and engagement regarding probiotics. Their attitudes and practices align with current recommendations for the use of probiotics in pediatric care.
