ObjectivesPhantom limb pain (PLP) is a disabling post-amputation neuropathic pain condition, and evidence regarding the long-term effectiveness of spinal cord stimulation (SCS) remains limited. This study evaluated trial stimulation outcomes, pain trajectories, device retention, explantation, and device-related complications in patients with refractory PLP.MethodsWe retrospectively reviewed 28 patients with refractory PLP who underwent SCS trial stimulation at our center between June 2010 and September 2023. Baseline characteristics, procedural data, Numeric Rating Scale (NRS) scores, progression to permanent implantation, revision or replacement procedures, and device explantation were recorded. Changes in NRS scores from baseline were assessed, and exploratory regression analyses were performed.ResultsEighteen patients (64%) met the criteria for trial success and proceeded to permanent SCS implantation. In an exploratory analysis, a higher baseline NRS score was associated with trial success. Among the 18 patients with permanent implants, the median follow-up was 78 months. Five SCS systems (28%) were explanted: three because of inadequate pain relief and two after battery depletion without replacement. In a post hoc analysis of the 13 patients who retained their devices at the last available follow-up, the mean NRS score decreased from 8.9 ± 0.8 at baseline to 2.8 ± 0.7 after trial stimulation and was 4.8 ± 0.6 at 1 year, 5.6 ± 1.0 at 2 years, and 6.2 ± 1.1 at the last available follow-up. Three patients underwent planned IPG replacement because of battery depletion, and two underwent unplanned device-related revision procedures.ConclusionsSCS provided substantial short-term pain relief in selected patients with refractory PLP. However, the magnitude of pain relief diminished over time, and device explantation occurred in a substantial minority of patients, underscoring the need for careful patient selection, long-term follow-up, and device management.

Stroke is an acute cerebrovascular disease that often leads to central post-stroke pain (CPSP), particularly in individuals who have experienced hemorrhagic strokes in the lateral thalamic regions. CPSP significantly impairs the quality of life of affected individuals, and effective treatments for this condition are currently lacking. In this study, we investigated the therapeutic potential of adipose-derived stem cells (ADSC) and explored the underlying mechanisms using a thalamic hemorrhagic rat model and microglial cells. All subjects were male. Our findings demonstrated that ADSC attenuates CPSP through the release of exosomal miR-137, which targets and inhibits P2RX7, thereby improving symptoms. We further show that P2RX7 interacts with and phosphorylates JAK3 at tyrosine 93. These results establish that ADSC-exosomes alleviate CPSP via miR-137-mediated regulation of the P2RX7/JAK3 axis.

BackgroundCervicogenic headache (CEH) is commonly treated with radiofrequency ablation (RFA) targeting the C2 dorsal root ganglion (DRG), yet the durability of analgesia is often limited. Endoscopic neurotomy (EN) enables direct visualization of the target neural structures and may provide more sustained pain relief; however, supporting evidence remains limited. We compared long-term outcomes of EN versus RFA targeting the C2 DRG in CEH.MethodsPatients with a positive diagnostic C2 DRG block were treated with EN or RFA. The Numerical Rating Scale (NRS), EuroQol 5-Dimension 5-Level (EQ-5D-5L), and Patient Global Impression of Change (PGIC) were obtained at baseline, and at 3 and 12 months postoperatively. The pain-free duration was recorded at every follow-up. The final follow-up was conducted in January 2026.ResultsOf 76 included patients, 21 underwent EN and 55 underwent RFA. Both groups demonstrated significant reductions in NRS and improvements in EQ-5D-5L at 3 and 12 months postoperatively compared with baseline (P < 0.001). NRS and EQ-5D-5L outcomes were comparable between groups at 3 months (P > 0.05), whereas EN showed superior effectiveness at 12 months (P < 0.05). PGIC favored EN at both 3 and 12 months (P < 0.05). No serious adverse events were observed in either group, although occipital-distribution numbness occurred in 21/21 (100%) EN patients and 48/55 (87.3%) RFA patients. Median pain-free duration was 33 months in the EN group and 8 months in the RFA group (P < 0.05).ConclusionsIn this retrospective cohort, both EN and RFA improved pain and quality of life in clinically selected patients with CEH. EN was associated with longer pain-free duration; however, given its invasiveness and the diagnostic overlap between CEH and occipital neuralgia, EN should be considered cautiously as an escalation option in carefully evaluated patients.

The neural mechanisms underlying how early-life pain leads to long-term impairments in adult social deficit remain largely elusive. Here, by establishing a juvenile inflammatory pain model in mice and employing a combination of neuromodulation techniques, we found that early-life pain experience induces a specific and enduring social deficit in adulthood. This deficit originates from a persistent excitatory/inhibitory (E/I) imbalance within the anterior cingulate cortex (ACC). Specifically, during social interaction, we observed diminished activity in ACC excitatory neurons alongside hyperfunction of inhibitory GABAergic neurons, resulting in insufficient synaptic glutamate release. Targeted metabolomics analysis further confirmed aberrant levels of glutamate and GABA within the ACC. Targeting this mechanism, we demonstrated that either enhancing ACC excitation or dampening its inhibition via optogenetic and chemogenetic manipulations effectively rescued the social deficit. Importantly, deep brain stimulation (DBS) targeting the ACC also activated excitatory neurons and successfully reversed this social deficit. This study unveils a core mechanism whereby early-life pain impairs social function by inducing a state of hypoexcitation and hyperinhibition in the ACC. Furthermore, we establish that DBS can effectively rectify this ACC imbalance, providing a novel theoretical basis and a potential translational strategy for intervening in social deficits associated with developmental trauma.

OBJECTIVE:To examine recurrence after microvascular decompression (MVD) for hemifacial spasm (HFS) and determine whether recurrence correlates differ by postoperative recovery pattern. METHODS:We screened 411 consecutive HFS patients undergoing MVD; 344 who achieved complete remission lasting ≥ 30 days were included and grouped as early complete remission (≤7 days; n = 226) or delayed cure (>7 days; n = 118).Time zero was the first date of complete remission; recurrence was the event and others were censored at last follow-up.Cox regression was performed in the overall cohort and within subgroups, and recurrence-free survival was compared by Kaplan-Meier/log-rank. RESULTS:Overall, no uniform independent factor associated with recurrence was identified; preoperative Cohen grade was not significantly associated with recurrence in the multivariable model(HR=1.61, 95%CI 0.96-2.70; P = 0.073). In subgroup analyses, preoperative Cohen grade was independently associated with recurrence in the early complete remission group (HR=2.09, 95%CI 1.07-4.07; P = 0.030), whereas AICA was independently associated with recurrence in delayed cure (HR=2.27, 95%CI 1.01-5.11; P = 0.047). Crude recurrence rates were similar between groups (23.01% vs 25.42%; P = 0.618), and recurrence-free survival did not differ significantly (log-rank P = 0.8969). CONCLUSIONS:Although no definitive predictor of recurrence was identified in the pooled cohort, stratification by postoperative recovery pattern may help reveal subgroup-specific factors associated with recurrence among HFS patients who achieve complete remission after MVD.

Background Pain accelerates physical performance impairment in people with cognitive frailty (CF). Identifying the correlational paths through which pain affects physical performance in this population is crucial, yet the underlying mechanisms remain incompletely understood. Objective This study aimed to examined associations of Instrumental Activities of Daily Living (IADL) and insomnia on the relationship between pain and physical performance in older people with CF, providing clinical insights for preventing and delaying CF. Design A cross-sectional survey was conducted in two communities in Beijing, China (Jan–Jun 2025), involving 524 community-dwelling older adults with CF. Key indicators were assessed using standardized scales: Fried Frailty Phenotype, Montreal Cognitive Assessment (Beijing version), Clinical Dementia Rating Scale, Verbal Rating Scale for pain, Short Physical Performance Battery (SPPB), IADL scale, Athens Insomnia Scale, and a demographic/clinical characteristics questionnaire. Model 6 in SPSS was used to examine the associations. Results Pain was negatively associated with SPPB through two paths: (1) Pain impaired SPPB by reducing IADL capacity (β = -0.084, P < 0.001); and (2)Pain negatively affected SPPB by exacerbating insomnia symptoms (β = -0.009, P ≤ 0.05). In addition, pain exerted a strong direct effect on physical performance (β = -0.201, P < 0.001). Conclusion Pain was associated with physical performance through multiple correlational paths, with IADL and insomnia serving as statistical linking variables. Clinical interventions for older adults with CF should prioritize comprehensive pain management, IADL support, functional training, and insomnia care as an auxiliary strategy. Future research should explore additional correlational factors.

Primary sensory neurons serve as a critical link between the peripheral nervous system (PNS) and the central nervous system (CNS). They represent the initial neural tissue responsible for transmitting sensations and pain. In case where peripheral nerves are injured, nerve fiber regeneration can lead to severe pain. Semaphorin3A (Sema3A), an axon guidance molecule that can be secreted by Schwann cells, has been shown to effectively inhibit the regeneration of embryonic and adult dorsal root ganglion (DRG). However, its role in neuropathic pain and the underlying mechanisms remain unexplored. This study employed a chronic constriction injury (CCI) model of neuropathic pain in mice. We observed that increased expression of Sema3A could alleviate both mechanical and heat nociceptive behaviors in model mice. By overexpressing Sema3A in ipsilateral DRG neurons via DRG injection, we found that the phosphorylation of the PI3K/Akt/mTOR signaling pathway and eukaryotic initiation factor 2α (eIF2α) was inhibited, thereby inhibiting pain. eIF2α is a translation initiation factor and its phosphorylation can regulate global translation. The inhibition of eIF2α phosphorylation through PKR and PERK inhibitors also reduced the expression of ion channels and ultimately alleviated neuropathic pain. We found that Sema3A could suppress the phosphorylation of eIF2α by inhibiting the PI3K/AKT/mTOR pathway, thus affecting pain perception. These findings suggested that alterations in Sema3A expression and eIF2α phosphorylation were involved in the development of neuropathic pain, providing potential new targets for clinical pain-relief drug development. PERSPECTIVE: The expression of Sema3A in DRG neurons was decreased following peripheral nerve injury. Elevating Sema3A levels alleviated neuropathic pain by inhibiting the PI3K/Akt/mTOR pathway and eIF2α phosphorylation, thus affecting ion channel expression in DRG of neuropathic pain model animals. This highlighted Sema3A as potential therapeutic targets for pain relief.

Objective:This study aims to investigate the effects of exercise-cognitive dual-task training on frailty status, cognitive function, physical performance, and dual-task cognitive load in older adults with Cognitive frailty (CF) over a 16-week intervention period. Methods:This randomized controlled trial enrolled older adults with CF at community health service center in Chaoyang District, Beijing, between February and March 2024. Participants were randomly assigned to either the dual-task training group or the health education group in a 1:1 ratio. The dual-task training group received an exercise-cognitive dual-task training program, while the health education group received information on CF, including its symptoms, risk factors, and non-pharmacological prevention and treatment strategies. The primary outcomes were frailty status, while the secondary outcomes included cognitive function, balance and gait function, walking ability, and dual-task cognitive load. Results:A total of 72 participants (35 males) were enrolled, including 36 individuals (mean age: 74.81 ± 8.23 years, 17 males, mean BMI: 21.38 ± 2.83 kg/m2) in the dual-task training group, and 36 individuals (mean age: 76.50 ± 7.75 years, 18 males, mean BMI: 22.18 ± 2.12 kg/m2) in the health education group. Participants (n = 72) were 75.66 ± 7.9 years old; 48.6% (35/72) were male and 51.4% (37/72) were female. Following the intervention, the dual-task training group exhibited significant improvements compared to the health education group in the Tilburg Frailty Index (5.14 ± 0.99 vs. 7.36 ± 1.07, p < 0.001) and Montreal Cognitive Assessment scores (27.25 ± 2.41 vs. 23.47 ± 1.87, p < 0.001). Additionally, the dual-task training group demonstrated superior outcomes in the Performance-Oriented Mobility Assessment (POMA) scores (24.64 ± 5.50 vs. 17.39 ± 4.38, p < 0.001), Time Up and Go Test (TUGT) indicators (10.66 ± 1.76 vs. 12.01 ± 2.21, p < 0.05), and cognitive load measures (all p < 0.05). Conclusion:Exercise-cognitive dual-task training may effectively improve frailty status, cognitive function, physical performance, and dual-task cognitive load in older adults with CF, suggesting its potential for broader application in this population. Clinical trial registration:http://www.chictr.org.cn/, ChiCTR2400080105.

Although microvascular decompression is highly effective for treating hemifacial spasm, cases of ineffectiveness and recurrence can still occur. Ineffectiveness is primarily due to missed neurovascular compression (NVC), whereas recurrence is most often caused by adhesion of Teflon pledgets (Chestmedical Co., Ltd., Shanghai, China), both of which may necessitate revision surgery.1,2 However, adhesions in the surgical area make revision surgeries more difficult. This video presentation includes 2 cases of revision surgery for hemifacial spasm (Video 1). In the first case, symptom recurrence was due to pledget adhesion, with no NVC observed during surgery. After removing the pledget and carefully repositioning it to avoid any direct contact with the facial nerve root exit zone (REZ), the spasms were completely relieved. The second case involved a missed NVC, where the pledget was improperly placed between the artery and the cisternal portion of the facial nerve during the initial surgery, overlooking compression at the REZ, an error more common in less experienced centers. Subsequent decompression of the REZ resulted in full symptom relief. Our experience highlights the importance of thorough decompression of the REZ while ensuring the pledget does not come into direct contact with the REZ to prevent long-term adhesions and recurrent hemifacial spasm.

Objective:Aimed to investigate the risk factors associated with depression in community-dwelling older adults with cognitive frailty and to examine the mediating role of sleep quality in the relationship between activities of daily living (ADL) and depression. Methods:A cross-sectional study was conducted using convenience sampling, enrolling older adults with cognitive frailty from six communities in Beijing from July 2023 to December 2023. Cognitive frailty was assessed using the Montreal Cognitive Assessment (MoCA) alongside with the Fried Frailty Phenotype, while depressive symptoms were measured with the Geriatric Depression Scale (GDS-15). Multivariate logistic regression analysis was used to identify risk factors influencing depression, and mediation analysis was employed to explore the mediating effect of sleep quality on the relationship between ADL and depression. Results:Among the 529 elderly participants with cognitive frailty, 128 (24.2%) were found to exhibit depressive symptoms. Multivariate logistic regression identified ADL [Mild Dependence: OR = 176.729 (95% CI 32.427-963.172), p < 0.001; Moderate Dependence: OR = 51.769 (95% CI 12.541-213.697), p < 0.001], loneliness [OR = 13.821 (95% CI 6.095-31.338), p < 0.001], and sleep quality [Suspected Insomnia: OR = 7.310 (95% CI 2.316-23.074), p = 0.001] were significantly associated with depression. Sleep quality was found to mediate the relationship between ADL and depression, accounting for 2.82% of the total effect. Conclusion:Dependence in ADL, loneliness, and poor sleep quality are potential risk factors of depression for cognitive frailty in aging adults. Moreover, sleep quality was found to mediate the relationship between ADL dependence and depressive symptoms.

BACKGROUND:Posterior endoscopic cervical discectomy (PECD) is a minimally invasive procedure with no published reported case of intraoperative vertebral artery injury (VAI) to date. OBSERVATIONS:This report describes a case of VAI during PECD managed with emergency extension of the incision for tamponade hemostasis, followed by endovascular intervention to restore vascular integrity and spinal canal decompression subsequently, resulting in a satisfactory recovery for the patient. LESSONS:PECD carries the risk of intraoperative VAI. Extending the incision for hemostasis, endovascular intervention for revascularization, and spine lamina decompression help prevent three critical complications: hemorrhagic shock, posterior circulation ischemia, and spinal cord injury. https://thejns.org/doi/10.3171/CASE24809.

BACKGROUND:Several studies have suggested favorable results with endoscope-assisted microvascular decompression (EA-MVD) for treating patients with trigeminal neuralgia (TN); however, supporting evidence is limited. OBJECTIVES:This study aimed to compare the efficacy and safety of EA-MVD with microscopic microvascular decompression (M-MVD). STUDY DESIGN:Prospective controlled study. SETTING:We performed a prospective controlled clinical study that included 52 patients with TN (36, [69.2%] women; 16, [30.8%] men), from June 2021 through January 2022. METHODS:Patients were assigned to receive either EA-MVD (n = 23) or M-MVD (n = 29). The primary outcome was pain intensity relief, measured using the Visual Analog Scale (VAS) and the Barrow Neurological Institute grading scale. The secondary outcomes were the detection of multiple offending vessels, endoscopic use, operation time, hospital stay length, and complications. All patients were followed-up for >= 12 months. RESULTS:At 12 months, both treatment groups showed similar improvements in pain intensity (P = 0.099). The mean VAS score was 3.5 ± 1.6 and 2.9 ± 1.7 in the EA-MVD and M-MVD groups, respectively. Overall, most patients in both groups reached a pain-free status or had nearly pain-free relief (EA-MVD: 21/23, 91.3%; M-MVD: 27/29, 93.1%). The incidence of multiple offending vessels was higher in the EA-MVD group than in the M-MVD group (52.2% vs 17.2%, P = 0.038). The mean operating time in the EA-MVD group (158 ± 27 minutes) was longer and the hospital stay (6 ± 1 days) was shorter than those of the M-MVD group (144 ± 25 minutes and 8 ± 4 days). No mortality or endoscope-related serious adverse events were noted, with the exception of an intracranial infection case in the M-MVD group. LIMITATIONS:The mean follow-up time was relatively short and a single-center study and a small patient population, which might bring some clinical bias. CONCLUSIONS:M-MVD and EA-MVD achieved similar analgesic effects for TN; however, EA-MVD allowed observation of more probable offending vessels with good flexible operative visualization.

Microscopic microvascular decompression (M-MVD) is a classical treatment for relieving long-term hemifacial spasms (HFS). An endoscopy technique has recently been introduced to improve M-MVD; however, this application remains debatable. This study compared the safety and effectiveness of endoscope-assisted microvascular decompression (EA-MVD) and M-MVD for HFS. From February 2021 to September 2022, we enrolled 49 patients with HFS assigned to the EA-MVD (n = 26) and M-MVD (n = 23) groups. The patients were assessed with Park YS grades, operative time, hospital days, and complications. Evaluations were performed in the early postoperative period, at one month, 3 months, 6 months, and at least 12 months. Twenty-three (23/26, 88.5

Introduction:This study aims to investigate the potential causal effects of modifiable risk factors on Fibromyalgia (FM). Methods:Genetic variants associated with 34 exposure factors were obtained from Genome-wide association studies (GWAS). Summary statistics for FM were acquired from the FinnGen consortium. Bidirectional Mendelian randomization (MR) analysis was conducted between all exposures and outcomes. The inverse-variance weighted (IVW) method was employed as the primary estimation technique. Heterogeneity and pleiotropy were assessed using MR-PRESSO global test, the weighted median, Cochran's Q statistic and MR-Egger. Results:Depression (OR=2.087, 95% CI: 1.466-2.971), alcohol consumption (OR=1.489, 95% CI: 1.094-2.028), body fat percentage (OR=1.524, 95% CI: 1.153-2.013) and body mass index (BMI) (OR=1.542, 95% CI: 1.271-1.872) were associated with an increased risk of FM among genetically susceptible individuals. Conversely, higher education level (OR=0.404, 95% CI: 0.297-0.549), longer years of education (OR=0.489, 95% CI: 0.290-0.825) and higher household income (OR=0.328, 95% CI: 0.215-0.502) were protective against FM. Additionally, rheumatoid arthritis (OR=1.138, 95% CI: 1.061-1.221) and ankylosing spondylitis (OR=1.079, 95% CI: 1.021-1.140) were identified as important risk factors for FM. Conclusion:This MR study unveiled a complex causal relationship between modifiable risk factors and FM. Psychosocial factors significantly increase the odds of FM, while obesity and some autoimmune diseases that frequently coexist with FM demonstrate causal associations. Additionally, lifestyle habits such as alcohol consumption are causally related to FM. Further investigation is needed to determine whether risk factors contribute to the pathogenesis of FM through mechanisms involving central sensitization, inflammatory, and hyperalgesia. This study enhances our understanding of the factors that drive FM onset and progression, offering valuable insights for future targeted prevention and treatment strategies.

BACKGROUND:This study aimed to evaluate the impact of a resistance exercise program in the bedridden older adults in China. METHODS:The patients aged 80 years and above with stable diseases were randomly divided into control group (receiving routine treatment and nursing) and training group (receiving the elastic ball and elastic band training applied for 55 minutes, 3 times a week during 6 months). RESULTS:A total of 59 patients (control group: 30; training groups: 29) completed the study. In terms of muscle strength, the patients of the training group had better grip strength and supine leg lifts and 30-s sit-to-stand actions. In terms of cardiopulmonary function and glycolipid metabolism, the patients in the training groups had better lung capacity and high-density lipoprotein. CONCLUSION:The low-load and low-intensity resistance training may effectively improve not only the muscle strength of the bedridden older adults, but also the lung function and blood lipid metabolism.

OBJECTIVES:Although hemispheric surgeries are among the most effective procedures for drug-resistant epilepsy (DRE) in the pediatric population, there is a large variability in seizure outcomes at the group level. A recently developed HOPS score provides individualized estimation of likelihood of seizure freedom to complement clinical judgement. The objective of this study was to develop a freely accessible online calculator that accurately predicts the probability of seizure freedom for any patient at 1-, 2-, and 5-years post-hemispherectomy. METHODS:Retrospective data of all pediatric patients with DRE and seizure outcome data from the original Hemispherectomy Outcome Prediction Scale (HOPS) study were included. The primary outcome of interest was time-to-seizure recurrence. A multivariate Cox proportional-hazards regression model was developed to predict the likelihood of post-hemispheric surgery seizure freedom at three time points (1-, 2- and 5- years) based on a combination of variables identified by clinical judgment and inferential statistics predictive of the primary outcome. The final model from this study was encoded in a publicly accessible online calculator on the International Network for Epilepsy Surgery and Treatment (iNEST) website (https://hops-calculator.com/). RESULTS:The selected variables for inclusion in the final model included the five original HOPS variables (age at seizure onset, etiologic substrate, seizure semiology, prior non-hemispheric resective surgery, and contralateral fluorodeoxyglucose-positron emission tomography [FDG-PET] hypometabolism) and three additional variables (age at surgery, history of infantile spasms, and magnetic resonance imaging [MRI] lesion). Predictors of shorter time-to-seizure recurrence included younger age at seizure onset, prior resective surgery, generalized seizure semiology, FDG-PET hypometabolism contralateral to the side of surgery, contralateral MRI lesion, non-lesional MRI, non-stroke etiologies, and a history of infantile spasms. The area under the curve (AUC) of the final model was 73.0%. SIGNIFICANCE:Online calculators are useful, cost-free tools that can assist physicians in risk estimation and inform joint decision-making processes with patients and families, potentially leading to greater satisfaction. Although the HOPS data was validated in the original analysis, the authors encourage external validation of this new calculator.

Abstract Background Effective exercise for the frail elderly has been found to contribute to healthy aging; the corresponding relationship between intensity and volume of exercise and health effects remains unclear. The present study aimed to investigate the dose–response effects of resistance training on muscle strength and physical fitness in frail older adults. Methods In this randomized controlled trial, participants were randomized into seven groups: moderate‐volume low‐intensity, moderate‐volume moderate‐intensity, moderate‐volume high‐intensity, high‐volume low‐intensity, high‐volume moderate‐intensity, high‐volume high‐intensity and routine care, receiving 12 weeks of resistance training of different intensities and volumes of exercise. The outcomes were muscle strength (assessed by ergonomics force gauges) and physical fitness function (assessed by the 6‐min walking test [6MWT], the 30‐s sit‐to‐stand test [30sSTST] and the 8‐foot up‐and‐go test [8‐FUGT]) before and at 6 and 12 weeks of intervention. Results A total of 161 participants completed the exercise intervention. There were no significant differences in age, sex, height, body weight and body mass index among the seven groups. The exercise volume of resistance training showed linear relationships with muscle strength of the lower limbs, 30sSTST and 6MWT results and a non‐linear relationship with 8‐FUGT. Resistance training intensity was found to have a linear relationship with muscle strength of the lower limbs and 6MWT and non‐linear relationships with 30sSTST and 8‐FUGT. The mixed linear model analysis revealed that the lower limb muscle strength differed significantly before and during the intervention (W = 8571.5, Padj < 0.001), before and after the intervention (W = 6968, Padj = 0.001) and during and after the intervention (W = 2834.5, Padj < 0.001); that the 6MWT performance differed during and after the intervention (W = 3184, Padj < 0.001); and that the 30sSTST was different between before and during the intervention (W = 2350.5, Padj = 0.012) and between during and after the intervention (W = 2290.5, Padj = 0.045). Conclusions Resistance training was found to be associated with muscle strength and physical fitness in frail older adults in a dose‐dependent manner. High‐intensity resistance training could be more effective for improving the muscle strength of frail older adults, and the improvement of 6MWT performance was even higher. High‐volume resistance training significantly improved muscle strength, with even greater improvement in the 30sSTST and 6MWT performances. Both the intensity and volume of exercise were found to greatly value physical function in frail older adults. Low–moderate‐intensity resistance training and low–moderate‐volume resistance training also had some advantages in terms of safety, efficacy and acceptance in elderly with frailty.

Dorsal root entry zone (DREZ) lesioning is a classical and effective treatment for brachial plexus avulsion (BPA). However, because of a limited number of cases reported in the literature, the factors affecting surgical outcomes are not known. Furthermore, whether this ablative procedure in the spinal level can change the status of phantom limb pain (PLP) and phantom limb sensation (PLS) is unknown. We retrospectively reviewed the patients with preganglionic BPA who underwent DREZ lesioning at a single center. Patients' baseline characteristics and long-term pain and complications were collected. Postoperative changes in PLP and PLS were recorded. Kaplan-Meier analysis was used to evaluate pain-free survival. Multivariate Cox regression analysis was performed to identify factors affecting pain outcomes. A total of 112 patients met the study inclusion criteria. With an average (range) follow-up of 47.4 (10-134) months, the long-term effectiveness and complication rate were 82.1% and 25.9%, respectively. Of 37 patients (33.0%) who developed PLS, 67.6% (25/37) experienced pain relief, whereas in 45.9% (17/37), PLS disappeared or changed after DREZ lesioning. Multivariate analysis showed that patients with shorter pain duration (=5 years) and PLS had worse pain outcomes. This study revealed factors that predict the pain outcome of DREZ lesioning based on a large series of cases. The diverse postoperative changes in phantom limb indicate that the mechanisms underlying PLS and PLP at the spinal or supraspinal level may vary among patients with BPA. Future studies should investigate the contribution of maladaptive brain plasticity to the outcomes of patients undergoing DREZ lesioning.