Myalgia Research Articles

Differences on lower trapezius pressure pain threshold, muscle strength and muscle thickness in individuals with chronic neck pain and active or latent myofascial triggers points.

Myofascial trigger points (MTrPs) in the lower trapezius have been recognized as an important source of neck pain. This study aims to compare the lower trapezius muscle strength, pressure pain threshold (PPT) and muscle thickness at rest and contraction between participants and painful vs. no-painful side with active and latent MTrPs; and to examine the associations among these variables with pain intensity, duration and disability in patients with neck pain. A cross-sectional study was carried out in 64 people with neck pain with active or latent MTrPs (34 Active MTrPs group and 30 Latent MTrPs groups). Muscle strength, pressure pain threshold and muscle thickness at rest and contraction of the lower trapezius was recorded. No significant differences were found in descriptive data, dominant side, or side of neck pain. However, the Active MTrPs Group had lower pain pressure thresholds (PPT) on the neck pain side compared to the Latent MTrPs Group, indicating greater sensitivity. Muscle thickness and strength showed minor differences between groups. Pain intensity correlated moderately with pain duration and strongly with neck pain disability. The results of the present study showed differences in PPT on the lower trapezius muscle in active and latent MTrP in neck side pain compared to non-neck side pain. In addition, lower trapezius strength reported differences between the neck side pain compared to non-neck side pain in both active and latent MTrP. Lower trapezius muscle strength showed significant moderate association with muscle thickness at contraction.

Immunogenicity and safety of live attenuated influenza vaccine in children aged 3-17years in China.

(1) Background: The administration of a live attenuated influenza vaccine (LAIV) has emerged as a viable option for preventing pediatric infections. The LAIV vaccine is available in China based on efficacy results. However, LAIV immunogenicity in children aged 3-17years old in China has not yet to be studied and reported broadly. (2) Methods: This is a substudy investigating the immunogenicity and safety of the LAIV under a Phase 3, multicentre, randomized, double-blind, placebo-controlled trial. A total of 3000 participants were enrolled in a randomized, double-blind, placebo-controlled trial, split in half between vaccine and placebo, was conducted to evaluate a single LAIV dose in this age group. Hemagglutination inhibition (HI) antibody titers and incidence of adverse events were used to evaluate immunogenicity and safety, respectively. (3) Results: Although there was no significant difference in frequencies of all solicited or unsolicited AEs, nasal congestion, headache, and muscle pain were statistically significantly more frequent in vaccine recipients as compared to placebo Seroconversions and geometric mean fold increases in HI antibody titers against all strains were significantly higher in the vaccine group than in the placebo group. (4) Conclusions: The LAIV is safe and immunogenic in Chinese children and adolescents.

Kinetic chain exercises on muscle cross-sectional area, pain, and functional mobility in knee osteoarthritis: A single-blinded, randomised multigroup clinical trial

Kinetic chain exercises on muscle cross-sectional area, pain, and functional mobility in knee osteoarthritis: A single-blinded, randomised multigroup clinical trial

Effectiveness of Instrument-assisted Soft-tissue Mobilization Versus Dry Cupping on Pain and Cervical Range of Motion in Treatment of Neck Pain

Abstract Background: Neck pain is characterized by symptoms of a nonspecific nature of the pain, which is of mechanical origin.[1,2] Frequently observed manifestations of neck discomfort encompass muscle pain, muscle spasms, headaches, facet joint pain, nerve pain, referred pain, and bone pain.[3] Instrument-assisted soft-tissue mobilization (IASTM) stands as a proficient myofascial intervention used for the treatment of soft tissues. Here, using instruments typically crafted from stainless steel featuring beveled edges and anatomically contoured designs to accommodate various body regions, this technique allows for enhanced depth of penetration.[4] Primarily used for the identification and therapeutic management of soft-tissue disorders, the approach involves the application of these specialized instruments.[5] Dry cupping, alternatively recognized as air cupping or suction cupping, constitutes a therapeutic methodology, wherein a vacuum is generated within cups and subsequently applied to targeted regions of the body. These cups, fabricated from diverse materials such as glass, silicone, or plastic, induce suction effects. Through the application of this suction, dry cupping serves to promote circulation, alleviate muscle tension, and facilitate the energetic flow within the treated areas. Material and Methods: The purpose of the study to effectiveness of instrument-assisted soft-tissue mobilization versus dry cupping on pain and cervical range of motion in treatment of neck pain. The study is comparative in nature, and total subjects were 15 subjects in each group. The assessment of pain and range of motion of cervical flexion and lateral flexion were taken before starting the treatment of both the groups. The patients were randomly assigned by lottery method for both the groups, and assessments were taken on 0 day and at the end of 4th week by VAS and ROM by a goniometer. Results: In IASTM treatment, the P value is 0.031. This suggests that there is a statistically significant difference between the pre-treatment and post-treatment values for the IASTM group. But, in dry cupping, the P value is 0.001. This indicates a highly significant difference between the precupping and postcupping values for this treatment group. The scores of variables VAS and ROM were improved significantly better in the subjects treated with dry cupping as compared to the group variables treated with instrument-assisted soft-tissue mobilization. Conclusion: The study conclude that the dry cupping is more beneficial for the treatment of neck pain and range of motion.

592. Immunogenicity and Safety of High-dose versus Double-dose Quadrivalent Inactivated Influenza Vaccine in Adult Kidney Transplant Recipients: A Randomized Controlled Trial

Abstract Background Both high-dose and double-dose inactivated influenza vaccines have been shown to better elicit a greater immune response compared to standard-dose influenza vaccine in solid organ transplant (SOT) recipients. However, a direct comparison between high-dose (HD) and double-dose (DD) quadrivalent inactivated influenza vaccine (QIIV) has not been explored. Methods From June to December 2023, we conducted an open-label randomized controlled trial to compare the immunogenicity and safety of the 2023 southern hemisphere HD QIIV at 60 ug (Effluelda, Sanofi) versus double standard-dose QIIV at 30 ug (Fluarix tetra, Sanofi) in adult kidney transplant (KT) recipients. Pre-immunization and 4-week post-immunization sera underwent strain-specific hemagglutination inhibition assays, and safety profiles were assessed. Results Eighty-four eligible KT recipients were randomly assigned to receive either HD QIIV or DD QIIV (42 each). Among them, 50 (59.5%) were male, with a mean age (SD) of 46 (11) years old, and 50 (60.7%) participants received kidneys from deceased donors. Common immunosuppressive regimens included mycophenolate mofetil (65.5%), tacrolimus (77.1%), and prednisolone (100%). SC to at least 1 strain was significantly greater in the HD QIIV group (95.2%) compared to the DD QIIV group (69%) (P = 0.006). The SC rate for A/H1N1, A/H3N2, B/Victoria, and B/Yamagata strains was higher in the HD QIIV group compared to the DD QIIV group, with the following percentages: 69.1% vs 52.4%, 52.4% vs 38.1%, 52.4% vs 42.9%, and 61.9% vs 40.5% (P = 0.118, P = 0.188, P = 0.382, and P = 0.049, respectively). In multivariate analysis, SC to at least 1 vaccine strain was significantly associated with the use of HD vaccine (OR 17.59, 95% CI [2.10, 147.22], P=0.008) and receiving the vaccine after 1-year post-KT (OR 34.76; 95% CI [2.59–454.45], P=0.007). There were significantly fewer occurrences of pain at the injection site and muscle ache in the HD QIIV group compared to the DD QIIV group, with the following percentages: 4.8% vs 19.0%, and 0% vs 9.5% (P = 0.040 and P = 0.043, respectively). Conclusion HD QIIV could marginally elicit a more pronounced immune response, alongside a comparatively reduced occurrence of adverse reactions, in adult SOT recipients when compared with DD QIIV. TCTR20230510005. Disclosures All Authors: No reported disclosures

P-731. Viruses Associated with Acute Respiratory Illness in a Community Cohort of Children and Adults, Oregon and Washington, United States, 2022 - 2023

Abstract Background Testing for most respiratory viruses in the U.S. occurs in limited settings, resulting in an incomplete understanding of the full burden of disease, especially among non-medically-attended infections. We used a U.S. community-based cohort of participants aged 6 months – 49 years in Washington and Oregon to assess respiratory virus detections and outcomes in participants with acute respiratory illness (ARI).Table 1.Number of participants enrolled in CASCADIA and acute respiratory illness* episodes, by age group. Methods At symptom onset, enrolled participants completed symptom surveys and self-collected nasal swabs. At days 7 and 14 post symptom onset, they completed follow-up symptom surveys. Swabs were tested for multiple viruses using TaqMan RT-PCR (OpenArray, ThermoFisher). We assessed viral detections and outcomes among ARI episodes during September 2022 — August 2023. ARI was defined as ≥ 2 of the following: fever, cough, congestion, muscle aches, sore throat, or shortness of breath. A distinct ARI episode was defined as a reported onset of a new illness > 30 days after a prior onset for the same participant. For each episode, we included test results from all swabs collected 0 – 7 days post-onset.Figure 1.Proportion of viruses detected among acute respiratory illness episodes with multi-pathogen OpenArray test results* (n=2,370), by age group. Results Among 3,407 participants enrolled during the analytic period (median age 17 years, IQR: 9 – 41; 59% female sex; 70% non-Hispanic White), we identified 2,788 ARI episodes, of which 2,370 (85%) had OpenArray virus test results (Table 1). Of these 2,370 episodes, 1,248 (53%) had a single virus detected, 249 (11%) had > 1 virus (i.e. viral codetections), and 873 (37%) had none; these results varied by age (Fig.1), and detected virus varied by month (Fig. 2). Among 1,248 detections of single viruses, rhinovirus/enterovirus (46%) and SARS-CoV-2 (16%) were detected most frequently; SARS-CoV-2 was more common in adults than children. Participant characteristics, symptoms, and illness outcomes are presented by virus type in Table 2. Healthcare was sought for 13% (range: 6 – 19% across viruses) of ARI episodes and missed work or school was reported for 26% (range: 20 – 45% across viruses).Figure 2.Number of acute respiratory illness episodes (n=2,370) and proportion positive on multi-pathogen OpenArray test*, by detected virus and month. Virus percentages include single detections and codetections. Conclusion Virus-associated ARI varied by age, and outcomes varied by virus, but healthcare needs and missed work/school were reported for all viruses. These data may inform clinical and socioeconomic burden estimates for respiratory viruses.Table 2.Age groups, clinical, and outcome characteristics of acute respiratory illness episodes (n=2,370), by detected virus*. Disclosures Jade James-Gist, MPH, NA: na Janet A. Englund, MD, Abbvie: Advisor/Consultant|AstraZeneca: Advisor/Consultant|AstraZeneca: Grant/Research Support|GlaxoSmithKline: Advisor/Consultant|GlaxoSmithKline: Grant/Research Support|Meissa Vaccines: Advisor/Consultant|Merck: Advisor/Consultant|Pfizer: Board Member|Pfizer: Grant/Research Support|Pfizer: Speaker at meeting|SanofiPasteur: Advisor/Consultant|Shinogi: Advisor/Consultant Helen Y. Chu, MD, MPH, Abbvie: Advisor/Consultant|Merck: Advisor/Consultant|Vir: Advisor/Consultant Jennifer L. Kuntz, MS, PhD, Hillevax, Inc: Grant/Research Support Richard A. Mularski, MD, MSHS, MCR, Pfizer, Inc: Grant/Research Support Mark A. Schmidt, PhD, MPH, HilleVax: Grant/Research Support|Janssen: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support|Vir Biotechnology: Grant/Research Support Neil D. Yetz, M.P.H., N/A: Expert Testimony

P-2044. Analysis of Post COVID-19 Condition After Ensitrelvir Treatment in Asymptomatic or Mild-Symptoms Only Patients in the SCORPIO Phase2b/3 Study

Abstract Background Ensitrelvir is an oral SARS-CoV-2 3CL protease inhibitor developed to treat COVID-19. In the Phase3 SCORPIO-SR trial targeting mild/moderate COVID-19 patients, the proportion of patients who experienced Post COVID-19 Condition (PCC) until Day 337 was lower in ensitrelvir groups than in placebo group [A. Fukushi et al. The Ninth ESWI Influenza Conference]. Here we report the effect of ensitrelvir on PCC in less symptomatic patients enrolled in another part, Phase2b/3. Proportion of patients with Post-COVID-19 Condition (PCC) and risk reduction versus placebo. Eligible patients were randomized (1:1:1) to orally receive once-daily ensitrelvir 125 mg (375 mg on Day 1), 250 mg (750 mg on Day 1), or placebo for 5 days. The number of patients with mild COVID-19 symptoms was 350 and the number of asymptomatic participants was 34. Among asymptomatic participants (9 in ensitrelvir 125mg, 13 in ensitrelvir 250mg, and 12 in placebo group), 2 participants had PCC (one in 125 mg and the other is placebo group). Data are summarized for patients who completed the PCC questionnaire for at least one timepoint in the intention-to-treat population. a Stuffy nose, runny nose, sore throat, shortness of breath, cough, low energy or tiredness, muscle or body aches, headache, chills or shivering, feeling hot or feverish, nausea, vomiting, diarrhea, loss of smell, loss of taste, muscle weakness, hair loss, palpitations, joint pain, decreased appetite, dizziness, chest pain, skin rash, difficulty with concentration and thinking, difficulty in reasoning and solving problems, memory loss, or insomnia. b Difficulty with concentration and thinking, difficulty in reasoning and solving problems, memory loss, or insomnia. Methods This multinational, multicenter, randomized, double-blind, placebo-controlled study was conducted in 2022 when the Omicron-variant was dominant. Individuals with confirmed SARS-CoV-2 infection, regardless of their vaccination status or risk factors for severe disease, were enrolled. This study targeted patients with diagnosis of COVID-19 asymptomatic/mild symptoms who were screened but not enrolled in Phase3 SCORPIO-SR study. Participants were randomized to either ensitrelvir 125 mg, 250 mg, or placebo. PCC was defined as a condition reported as “not returned to pre-COVID health” with at least one mild/more severe symptom among prespecified 27 symptoms on Day 85, 169, and 337. Investigators and patients remained blinded to drug assignment up to Day 337. Results In total, 124 ,129 ,131 patients were assessed in the ensitrelvir 125 mg, 250 mg, and placebo groups, respectively (mean age, 38.8–41.6 years; men, 51.1–61.2%; 89.9–93.1% had vaccination history). Proportion of patients with PCC on Day 337 for any of the 27 symptoms was 3.5%, 3.4% and 8.8% in ensitrelvir 125 mg, 250 mg and placebo groups, respectively. Ensitrelvir 125 mg and 250 mg showed 60.5% and 61.1% risk reductions versus placebo, respectively. For any of the 4 neurological symptoms, proportion of patients with PCC on Day 337 was 1.7%, 2.6% and 6.4% in ensitrelvir 125 mg, 250 mg and placebo groups, respectively. Risk reductions versus placebo were 72.8% and 59.9% in ensitrelvir 125 mg and 250 mg, respectively (Figure). Conclusion It is suggested that ensitrelvir treatment may reduce PCC in this limited subpopulation with asymptomatic/mild disease. Disclosures Takumi Imamura, M.Math, Shionogi & Co., Ltd.: Stocks/Bonds (Private Company) Hiroshi Yotsuyanagi, MD PhD, Japanese Society of Infectious Disease: President|Shionogi & Co., Ltd.: Board Member|Shionogi & Co., Ltd.: Lecture fees, travel and meeting support, and Chairs in sponsored symposiums|ViiV Healthcare: Lecture fees; Chairs in sponsored symposiums Yohei Doi, MD, PhD, bioMerieux: Lecture fees|Entasis: Grant/Research Support|Fujifilm: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|GSK: Advisor/Consultant|KANTO CHEMICAL CO.,INC.: Grant/Research Support|KANTO CHEMICAL CO.,INC.: Patent for genotyping kit|MeijiSeika Pharma: Advisor/Consultant|Moderna: Advisor/Consultant|MSD: Lecture fees|Pfizer: Advisor/Consultant|Shionogi & Co., Ltd.: Grant/Research Support|Shionogi & Co., Ltd.: Lecture fees Masaya Yamato, MD, PhD, Shionogi & Co., Ltd.: Lecture fees Hiroki Sakaguchi, MA, Shionogi & Co., Ltd.: Stocks/Bonds (Private Company) Hideki Yamanaka, n/a, Shionogi & Co., Ltd.: Stocks/Bonds (Private Company) Ryosuke Imaoka, n/a, Shionogi & Co., Ltd.: Stocks/Bonds (Private Company) Akimasa Fukushi, n/a, Shionogi & Co., Ltd.: Stocks/Bonds (Private Company) Genki Ichihashi, MA, Shionogi & Co., Ltd.: Stocks/Bonds (Private Company) Yuko Tsuge, MSc, Shionogi & Co., Ltd.: Stocks/Bonds (Private Company) Takeki Uehara, Ph.D., Shionogi & Co., Ltd.: Stocks/Bonds (Private Company) Hiroshi Mukae, M.D., Ph.D., AstraZeneca: Lecture fees|Gilead Sciences: Lecture fees|GSK: Lecture fees|MSD: Advisor/Consultant|MSD: Lecture fees|Pfizer: Lecture fees|Shionogi & Co., Ltd.: Advisor/Consultant|Shionogi & Co., Ltd.: Grant/Research Support|Shionogi & Co., Ltd.: Lecture fees

P-44. Immunogenicity and Safety of High-dose versus Standard-dose Quadrivalent Inactivated Influenza Vaccine in Patients Living with HIV: A Randomized Controlled Trial

Abstract Background Influenza can lead to severe complications in patients living with HIV (PLWH). Annual standard-dose (SD) quadrivalent inactivated influenza vaccine (QIIV) is recommended for PLWH, although it is associated with poor vaccine response. We aimed to investigate the immunogenicity and safety of high-dose (HD) versus SD QIIV in PLWH, as well as safety. Methods We conducted a randomized, open-label, controlled trial to compare the immunogenicity of the 2023 southern hemisphere HD QIIV at 60 μg (Efluelda, Sanofi) versus SD QIIV at 15 μg (Fluarix tetra, Sanofi) in patients living with HIV (PLWH) during August and November 2023. Seroprotection (SP), defined as serum hemagglutination-inhibition antibody titers ≥1:40 at 1 month post-vaccination, was assessed. Adverse events (AEs) following vaccination were also evaluated. Results We enrolled 110 patients who received the study vaccine, and 103 (52 HD; 51 SD) were eligible for analysis. Among them, 65 (62.1%) were male, with a mean age (SD) of 49.6 (11.2) years and a median CD4 count (IQR) of 555 (418-680) cells/mm3. The integrase strand transfer-based regimen was the most common antiretroviral regimen (57.3%), and the majority had an undetectable HIV viral load (93.2%). Fifty-two (50.5%) achieved SP to all strains (A/H1N1, A/H3N2, B/Victoria and B/Yamagata) after vaccination. Those who received HD QIIV reached SP significantly more compared to SD QIIV (61.5% vs. 39.2%, p = 0.02). In particular, SP to the A/H3N2 strain was significantly greater in the HD QIIV group compared to the SD QIIV group (76.9% vs. 52.9%, p = 0.011). Use of HD QIIV were independent factors for SP to all strains (OR 2.7, 95%CI 1.9-6.1, p = 0.02) and SP to the A/H3N2 strain (OR 3.2, 95%CI 1.4-7.8, p = 0.01). Twenty-nine (57.3%) participants in the HD group reported AEs, including muscle ache (36.5%), pain at the injection site (21.2%), and fever (13.5%). Those were all non-severe and comparable to those receiving SD QIIV. Conclusion HD QIIV could offer significantly better immunogenicity across all strains, especially the A(H3N2) strain, compared to SD QIIV in PLWH and should be considered as the preferred influenza vaccine for this population, without safety concerns. TCTR20230501002. Disclosures All Authors: No reported disclosures

P-1925. Incidence of long COVID symptoms during the year post admission among patients hospitalized for COVID-19

Abstract Background The CDC defines long COVID as new, returning or ongoing health problems occurring at least 4 weeks after infection. However, it is uncertain how long different conditions may last after the infection. Our objective was to characterize incidence of common conditions that may be associated with long COVID across the first year after admission among patients hospitalized for COVID-19.Table 1.Patient DemographicsIQR, interquartile rangea Immunocompromised condition during the past 12 months (symptomatic HIV infection, haematologic and solid malignancy, organ transplant, rheumatologic/inflammatory, or other immune conditions).1. Patel M, et al. Emerg Infect Dis. 2020;26(8):1720-1730b Measured 365 to 15 days prior to admission Methods We identified patients hospitalized with COVID-19 from May 1, 2020-January 21, 2024 and with at least 31 days of followup in the HealthVerity claims and hospital chargemaster database. Patients with a diagnosis of long COVID (ICD-10-CM U09.9) were excluded. We assessed the incidence of long COVID outcomes, based on diagnosis codes, during two periods – 31-197 days and 198-365 days after hospital admission – to determine if incidence of these outcomes changed over the year. Rates per 1000 person-years and 95% confidence intervals were calculated for all hospitalized patients, patients who had no record of those conditions in the year prior to admission, and immunocompromised patients. The percentage change in the rates for each symptom between the time periods was also calculated.Table 2.Rate of long COVID conditions per 1000 person-years in 31- to-197-day and 198- to- 365-day time periods post hospital admission, all hospitalized patients (N=92,913) Results We identified 92,913 patients who met the study criteria. Cohort characteristics are described in Table 1; some outcomes were already present at baseline. In the overall hospitalized population (Table 2), incidence of all outcomes decreased between the first and second time periods. The decrease varied by symptom from 4% for muscle pain to 69% for hair loss. The trend was similar for the 12,100 patients who had none of the conditions at baseline (Table 3) and for the 39,185 immunocompromised patients (Table 4); some of the rare outcomes showed a nominal increase from the first to the second time periods, but this may be due to small sample sizes.Table 3.Rate of long COVID conditions per 1000 person-years in 31- to-197-day and 198-to- 365-day time periods post hospital admission, among hospitalized patients who had none of the conditions at baseline (N=12,100) Conclusion The observed consistent tendency towards a decline in incidence over time indicates that many of these outcomes may have resulted from COVID-19 infection. Of note, incidence tended to decline more steeply for some conditions than others. This could be a result of an improvement in inflammatory response or decline in viral reservoir over the year. Additional research on drivers of long COVID over time is necessary.Table 4.Rate of long COVID conditions per 1000 person-years in 31- to- 197-day and 198-to- 365-day time periods post hospital admission, among immunocompromised hospitalized patients (N=39,185) Disclosures Mark Berry, PhD, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds (Public Company) Valentina Shvachko, MS, Gilead Sciences: employee|Gilead Sciences: Stocks/Bonds (Public Company)|Gilead Sciences, Inc.: Employee of Gilead Sciences, Inc.|Gilead Sciences, Inc.: Stocks/Bonds (Public Company) Amanda Kong, DrPH, Aetion Inc: Employee|Aetion Inc: Stocks/Bonds (Public Company) Rohan Shah, BS, Aetion Inc: employee|Aetion Inc: Stocks/Bonds (Public Company) Gina Brown, MD, Gilead Sciences, Inc.: Employee of Gilead Sciences, Inc.|Gilead Sciences, Inc.: Stocks/Bonds (Public Company) Anand Chokkalingam, PhD, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds (Public Company)

Neurological evaluation of "post-COVID-19 syndrome" (PCS)

The so-called "post-COVID-19 syndrome" (PCS) includes a variety of subjective complaints and represents a challenge to medical evaluation. The review focuses on symptom validation of the most common neurological, neuropsychiatric and neuropsychological PCS symptoms like fatigue, loss of smell and taste, problems speaking or communicating, cognitive disorders, dysaesthesia and persistent muscle pain.

Comparing the Effects of Transcutaneous Electrical Nerve Stimulation (TENS) and Ultrasound Therapy (US) on Knee Osteoarthritis: A Case Study

Background: Knee osteoarthritis (OA) is a widespread degenerative joint condition that affects individuals across various age groups, particularly in older adults. Effective management strategies, including physiotherapy interventions such as Transcutaneous Electrical Nerve Stimulation (TENS) and Ultrasound Therapy (US), are essential for alleviating symptoms like pain, stiffness, and functional limitations. However, limited research compares the combined effects of these modalities along with structured exercise on outcomes such as pain reduction, muscle strength, and functional improvement. Objective: The current case study aims to assess the impact of TENS & US, combined with a consistent exercise regimen, on pain reduction, muscle strength, and Quality of Life in patient with knee OA. Case Report: A 52-year-old female patient with chronic right knee pain underwent a four-week treatment protocol consisting of two phases: Phase 1 involved TENS therapy (Weeks 1-2), and Phase 2 involved US therapy (Weeks 3-4). Both phases were complemented by a uniform exercise program focused on strengthening, flexibility, and aerobic conditioning. Results: Pain, measured using the Visual Analog Scale (VAS), decreased from 7/10 at baseline to 4/10 after TENS therapy and further reduced to 3/10 after US therapy. And pain decreased from 15/20 to 10/20 in TENS and 7/20 in US in Intermittent and Constant Osteoarthritis Pain: Knee Osteoarthritis (ICOAP). Muscle strength improved in both quadriceps and hamstrings, with an increase in strength from Grade 3 to Grade 4 in the quadriceps and Grade 4 to Grade 4+ in the hamstrings. Range of Motion (ROM): Flexion: 100° (right), 130° (left); Extension: 0° bilaterally. The SF-36 score, indicating the patient’s functional capability and QOL, improved from 45/100 to 55/100 after TENS therapy and 45/100 to 65/100 after US therapy over the course of the study. Discussion: The combination of TENS and US therapy provided significant benefits for pain relief, muscle strength, and functional recovery in this knee OA patient. TENS was effective in managing acute pain, allowing better engagement in rehabilitation exercises, while US therapy contributed to long-term functional improvements. Conclusion: This case study suggests that a sequential approach combining TENS and US therapy, alongside a structured exercise program, can be an effective strategy for managing knee OA. More research with bigger sample sizes and longer follow-up periods is necessary to validate these results and improve treatment guidelines. Keywords: Knee osteoarthritis, Transcutaneous Electrical Nerve Stimulation (TENS), Ultrasound Therapy (US), Physiotherapy, Pain management, Muscle strength, Functional outcomes, Rehabilitation, Case study.

P-70 THYMIC HYPERPLASIA AND GRAVES' DISEASE: IS THERE A HIDDEN AUTOIMMUNE DISORDER?

Abstract Introduction Thymic hyperplasia is reported in 10-38% of patients with Graves' disease. Clinical Case We present a case of a 45-year-old female with Graves' disease and thymic hyperplasia, exhibiting non-specific symptoms. The patient was diagnosed with Graves' disease at age 42 and treated with thiamazole. While she was taking thiamazol she was felt muscle pain, spasms, and pulsations. Her pituitary and adrenal hormones were within normal limits. Three months after diagnosis, she was hospitalized for recurrent transient ischemic attacks. Myasthenia gravis was suspected, but acetylcholine receptor antibody tests, though initially elevated, were later normal. The patient also experienced flushing, and neck and facial redness without a clear diagnosis. She developed erythematous changes on her thighs, arms, and cleavage. Mastocytosis was suspected, but skin biopsy and serum tryptase tests were negative. She also reported frequent nocturnal bowel movements. Tumor markers such as chromogranin A and glucagon were slightly elevated, but a Ga-68 Dotatoc PET CT scan showed no evidence of neuroendocrine tumors. After six months of remission, the patient discontinued thiamazole, leading to symptom resolution and normalization of anti-TRAb levels. However, her TSH receptor antibodies increased seasonally, from February to August, over the next two years, resulting in hyperthyroidism. Thyroid ultrasound revealed changes consistent with autoimmune thyroid disease. The patient declined thymectomy and thyroidectomy. Due to adverse reactions to thiamazole and propranolol, possibly linked to Myasthenia gravis, she was switched to propylthiouracil with a good response. The etiology of symptoms atypical for hyperthyroidism or thymic hyperplasia, such as facial muscle tingling, spasms, pulsations, and erythematous rash, may be related to other autoimmune or neurological conditions, including Stiff Person syndrome and Myastenia gravis. Additionally, the seasonal recurrence, from February to August, of Graves' disease over three consecutive years is notable. Given the high prevalence of thymic hyperplasia in Graves' disease, ruling out neurological autoimmune diseases is advisable, as specific symptoms can affect the quality of life and may be exacerbated by antithyroid therapy.

Monacolin K as a Natural Alternative for Synthetic Statins

Introduction: This review paper aims to verify the safety of monacolin K, examine the effect on blood cholesterol levels, discuss the contribution to the reduction of cardiovascular risk and indicate examples of pleiotropic effects of this substance. Materials and methods: A review of chosen literature in the PubMed database was conducted, using the following key words: ,,Monacolin K”, ,,Hypercholesterolemia’’, ,,Red yeast rice’’, ,,Supplementation’’. Summary: Monacolin K is considered to be natural statin contained in fermented red rice or oyster mushroom. The use of monacolin K may contribute to the development of mild muscle pain or rhabdomyolysis, but it is noticed less frequently than in treatment with synthetic statins. In addition, there are also concerns about liver and/or kidney damage, headaches and/or dizziness, musculoskeletal symptoms and gastrointestinal disturbances in some people, especially when high doses of monacolin K are used. Monacolin K lowers the level of cholesterol in the blood and contributes to reducing the risk of cardiovascular diseases. Furthermore, monacolin K has anti-inflammatory effects and anti-cancer mechanisms. Conclusions: Monacolin K improves the lipid profile by lowering low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and total cholesterol (TC) levels which indirectly reduces the cardiovascular risk with less frequently observed side effects. Monacolin K has many pleiotropic effects like anti-inflammatory and anti-cancer mechanisms by inhibiting cancer cell proliferation and stimulating apoptosis. It should be emphasized that the long-term safety of regular use of these preparations has not been fully documented. Some people taking these supplements experience side effects similar to those seen with statins. Both health benefits and side effects should be further investigated in future studies.

Poisoned in their homes - Red blood cell abnormalities in lead-exposed residents of a Pakistani Industrial Zone.

The present study investigated the clinical and hematological effects of chronic lead exposure in the population residing in Shadi Pura, a small industrial zone in Lahore, Pakistan. A cross-sectional analysis of 149 participants recruited through health camps was conducted to explore the hematological manifestations of environmental lead exposure, focusing on various red blood cell (RBC) indices and morphology. Moreover, the study examined the differences in the impact of lead exposure on RBC indices and morphology between men, women, and children. Participants exhibited symptoms of lead poisoning, including fatigue, muscle pain, and headache, with a significant percentage of women (44%) reporting miscarriages. Iron deficiency anemia was highly prevalent among all sub-groups of the study population, with adult females showing a significantly higher prevalence than adult males. Male children were the most affected subgroup, with 93% displaying anemia. The RBC count in children remained unchanged, while 31% of male and 7% of female participants displayed elevated RBC counts. RBC indices, mainly mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH), were below normal levels, with children being more affected than adults and adult males being the least affected group. Furthermore, RBC morphology was severely affected, with a considerable proportion of females and children displaying hypochromic microcytic morphology. Our results highlight variations in the hematological impacts of lead exposure in different sex and age cohorts. Overall, our findings underscore the urgency of addressing the issue of environmental lead exposure in similar industrial zones. It is critical to implement appropriate measures to reduce lead exposure and enhance the infrastructure for safe drinking water and waste disposal to protect the health of populations in such areas.

The potential of polyphenol compounds in grapes to reduce oxidative stress and inflammation after exercise: systematic review

Introduction: Mechanical stress and inflammation contribute to exercise-induced muscle damage. Objective: This research analyzed the potential of polyphenolic compounds in grapes to prevent inflammation and lower oxidative stress after exercise. Methodology: This research employed a systematic review to guide the researchers in achieving the objectives. It involved a thorough search of global databases, such as Web of Science, Scopus, Embase, and Pubmed. The inclusion criteria were articles investigating grapes, inflammation, oxidative stress, and physical exercise published within the last five years. On the other hand, articles that were not reputable or indexed by these databases were excluded from the search. The initial search process generated 2947 articles. After undertaking several screening processes, 8 articles were finally selected and analyzed. Results: This research shows that the polyphenol content in grapes has antioxidant and inflammatory properties which can reduce levels of oxidative stress and inflammation. Discussion: The polyphenol content works by reducing ROS, MDA, and TBARS levels and increasing GSH levels. Furthermore, grapes also have anti-inflammatory properties that reduce uncontrolled inflammation as a result of intense exercise. In this case, grapes work by blocking several inflammatory pathways and decreasing inflammatory markers. In vivo studies also confirmed these anti-inflammatory and antioxidant benefits by stimulating eNOS gene expression and increasing CAT, SOD, and GPx4 levels. Conclusions: The polyphenol content in grapes can potentially reduce oxidative stress due to its antioxidant properties. Besides, the grapes have anti-inflammatory properties, which are responsible for lowering uncontrolled inflammation and alleviating muscle pain fierceness.

Central projections of nociceptive input originating from the low back and limb muscle in rats

Since clinical features of chronic muscle pain originating from the low back and limbs are different (higher prevalence and broader/duller sensation of low back muscle pain than limb muscle pain), spinal and/or supraspinal projection of nociceptive information could differ between the two muscles. We tested this hypothesis using c-Fos immunohistochemistry combined with retrograde-labeling of dorsal horn (DH) neurons projecting to ventrolateral periaqueductal grey (vlPAG) or ventral posterolateral nucleus of the thalamus (VPL) by fluorogold (FG) injections into the vlPAG or VPL. C-Fos expression in the DH was induced by injecting 5% formalin into the multifidus (MF, low back) or gastrocnemius-soleus (GS, limb) muscle. A double-labeled DH neuron showing both c-Fos-immunoreactive nucleus and retrogradely transported FG in the cytoplasm was considered as a nociceptive projection neuron. Consistent with DH somatotopy for proximal vs. distal cutaneous inputs, DH neurons with MF input were located in the most lateral area of laminae I − II (segments Th12 − L5), while those with GS input were located in the middle area of laminae I − II (L3 − L5). DH neurons projecting to the vlPAG were located in superficial DH, while those projecting to VPL were located in deep DH. Supraspinal projection derived from more spinal segments for MF input than for GS input. These data suggest that nociceptive input from low back muscles is integrated more in craniocaudal direction than for limb muscles, and that these signals are then forwarded to both PAG and thalamus and contribute to the different nature of muscle pain arising from the low back and limbs.

The Rickettsia actin-based motility effectors RickA and Sca2 contribute differently to cell-to-cell spread and pathogenicity.

Rickettsia parkeri is an obligate intracellular, tick-borne bacterial pathogen that can cause eschar-associated rickettsiosis in humans. R. parkeri invades host cells, escapes from vacuoles into the cytosol, and undergoes two independent modes of actin-based motility mediated by effectors RickA or Sca2. Actin-based motility of R. parkeri enables bacteria to enter protrusions of the host cell plasma membrane that are engulfed by neighboring host cells. However, whether and how RickA and Sca2 independently contribute to cell-to-cell spread in vitro or pathogenicity in vivo has been unclear. Using live cell imaging of rickA::Tn and sca2::Tn mutants, we discovered both RickA and Sca2 contribute to different modes of cell-to-cell spread. Compared with Sca2-spread, RickA-spread involves the formation of longer protrusions that exhibit larger fluctuations in length and take a longer time to be engulfed into neighboring cells. We further compared the roles of RickA and Sca2 in vivo following intradermal (i.d.) infection of Ifnar1-/-; Ifngr1-/- mice carrying knockout mutations in the genes encoding the receptors for IFN-I (Ifnar1) and IFN-γ (Ifngr1), which exhibit eschars and succumb to infection with wild-type (WT) R. parkeri. We observed that RickA is important for severe eschar formation, whereas Sca2 contributes to larger foci of infection in the skin and dissemination from the skin to the internal organs. Our results suggest that actin-based motility effectors RickA and Sca2 drive two distinct forms of cell-to-cell spread and contribute differently to pathogenicity in the mammalian host.IMPORTANCERickettsia parkeri, a bacterium in the spotted fever group of Rickettsia species, can be transmitted from ticks to humans, leading to symptoms including fever, rash, muscle aches, and a lesion at the site of the tick bite. During Rickettsia parkeri infection, bacteria invade cells within the animal host, proliferate in the host cell's cytosol, move using a process called actin-based motility, and spread to neighboring host cells. Rickettsia parkeri is unusual in having two bacterial proteins that mediate actin-based motility. The significance of our research is to reveal that each of these bacterial actin-based motility proteins contributes differently to spread between cells and to the signs of infection in a mouse model of spotted fever disease. Our results are important for understanding the contribution of actin-based motility to mammalian infection by Rickettsia parkeri as well as to infection by other bacterial and viral pathogens that require this process to spread between cells and cause disease.

Mechanism and Treatment of the Rotator Cuff Tear

Among all the joints in the human body, the shoulder has the highest degree of motion, but its stability is relatively limited. As the population ages more rapidly, rotator cuff tear has become the most affected muscle and joint pain lesions in middle-aged and elderly patients and the prevalence rate is increasing year by year. According to imaging studies, rotator cuff injuries affect 30% of asymptomatic adults over 60 and 65% of asymptomatic adults over 70. The rotator cuff tear made pain to the patients, reduced joint range of motion and stability, joint dysfunction. So, the people more and more attach importance to rotator cuff tear. This paper summarizes in recent years about risk factors, mechanism and the treatment of rotator cuff tear, which hope to accelerate the treatment of diseases, which can made partial or complete layer tears. Due to the diversity of rotator cuff tear classification, future studies should be carried out with specific tear size or tear degree.

Efficacy of virtual reality balance training on rehabilitation outcomes following anterior cruciate ligament reconstruction: A systematic review and meta-analysis.

The objective of this systematic review and meta-analysis is to clarify the rehabilitation efficacy of virtual reality (VR) balance training after anterior cruciate ligament reconstruction (ACLR). This meta-analysis was registered in PROSPERO with the registration number CRD42024520383. The electronic databases PubMed, Web of Science, Cochrane Library, MEDLINE, Embase, China National Knowledge Infrastructure, Chinese Biomedical Literature, China Science and Technology Journal Database, and Wanfang Digital Periodical database were systematically searched to identify eligible studies from their inception up to January 2024. The investigated outcomes included International Knee Documentation Committee (IKDC) score, visual analogue scale (VAS), Holden grading, Extensor peak torque (EPT), Flexor peak torque (FPT), knee reaction time, knee reproduction angle difference. The pooled mean difference (MD) and 95% confidence intervals (CIs) were calculated using the random-effects model. Six RCTs with a total of 464 patients after unilateral ACLR were included for 8-12 weeks of VR balance training intervention. Analysis of the results showed that compared with the conventional rehabilitation control group, the VR balance training group significantly improved the International Knee Documentation Committee (IKDC) score (MD = 3.88, 95%CI: 0.95~6.81), Holden grading (MD = 0.42, 95%CI: 0.33~0.51), Extensor peak torque (EPT) (MD = 12.03, 95%CI: 3.28~20.78)and Flexor peak torque (FPT) (MD = 14.57, 95%CI: 9.52~19.63) in postoperative ACLR patients, and significantly reduced knee reaction time (MD = -0.30, 95%CI: -0.35~-0.25), knee angle reproduction difference at 30° (MD = -0.88, 95%CI: -1.16~-0.61), knee angle reproduction difference at 60° (MD = -0.80, 95%CI: -1.09~-0.50), and VAS score (MD = -0.52, 95%CI: -0.65~-0.39). Since many of the included results are based on low-or very-low-quality evidence, although the results show a certain trend, the conclusion has great uncertainty. In the rehabilitation training following ACLR and lower-limb balance training, the application of VR might be advantageous for the recovery of patients' knee joint function, lower-limb muscle strength, proprioception, and pain management. The level of immersion may influence the rehabilitation outcome. Because of the limitations in data quality and heterogeneity as well as the small sample size, the strength of the conclusions is weakened. These findings should be verified in further large-scale prospective studies.

Dysregulated autoantibodies targeting AGTR1 are associated with the accumulation of COVID-19 symptoms

Coronavirus disease 2019 (COVID-19) presents a wide spectrum of symptoms, the causes of which remain poorly understood. This study explored the associations between autoantibodies (AABs), particularly those targeting G protein-coupled receptors (GPCRs) and renin‒angiotensin system (RAS) molecules, and the clinical manifestations of COVID-19. Using a cross-sectional analysis of 244 individuals, we applied multivariate analysis of variance, principal component analysis, and multinomial regression to examine the relationships between AAB levels and key symptoms. Significant correlations were identified between specific AABs and symptoms such as fever, muscle aches, anosmia, and dysgeusia. Notably, anti-AGTR1 antibodies, which contribute to endothelial glycocalyx (eGC) degradation, a process reversed by losartan, have emerged as strong predictors of core symptoms. AAB levels increased with symptom accumulation, peaking in patients exhibiting all four key symptoms. These findings highlight the role of AABs, particularly anti-AGTR1 antibodies, in determining symptom severity and suggest their involvement in the pathophysiology of COVID-19, including vascular complications.