Background/Objectives: The cerebellum plays a central role in sensorimotor integration and temporal processing, yet its direct electrophysiological investigation in humans remains challenging, and cerebellar contributions to somatosensory responses remain poorly defined. This study aimed to determine whether cerebellar responses to peripheral nerve stimulation can be detected using scalp EEG and whether time-frequency analysis provides advantages over time-domain approaches. Methods: Scalp EEG was recorded during electrical stimulation of the median nerve and tibial nerve in 16 healthy participants. Electrode montages included posterior fossa placements targeting cerebellar activity, together with standard cortical and subcortical derivations. Data were analyzed in the time domain using evoked potentials and channel comparisons, including bipolar cerebellar derivations, and in the time-frequency domain using spectral power analysis. Results: Time-domain analyses revealed early and intermediate latency components following both upper- and lower-limb stimulation; however, these responses showed limited spatial specificity and were strongly influenced by reference effects and subcortical contamination. In contrast, time-frequency analysis consistently revealed sustained increases in oscillatory power in cerebellar channels. Power increases emerged approximately 50 ms after stimulation and persisted beyond 300 ms, peaking around ~20 Hz for upper-limb stimulation and ~10 Hz for lower-limb stimulation, with evidence of side specificity. Conclusions: Non-invasive EEG can detect cerebellar responses to peripheral nerve stimulation, particularly in the time-frequency domain. Oscillatory dynamics provide a more robust marker of cerebellar involvement than time-locked responses and may complement conventional somatosensory evoked potentials in studies of cerebellar physiology and spinocerebellar pathway integrity.

ObjectiveThis study aims to assess changes in the cross-sectional area of the tibial nerve in the disabled elderly.Materials and methodsThe study sample included 124 tibial nerves in 62 participants; 16 of which were disabled elderly patients (13 males, 3 females), with a mean age of 66.6, a mean height of 167.1 cm, a mean weight of 83.9 kg, and a mean BMI of 29.9. Twenty-three young controls (6 males, 17 females), a mean age of 48.4, a mean height of 154.9 cm, a mean weight of 79.8 kg, a mean BMI of 32.7, and 23 elderly non-disabled participants (13 males, 10 females), a mean age of 63.6, a mean height of 161.9 cm, a mean weight of 80.56 kg, and a mean BMI of 30.88.ResultsThe mean CSA of the TN in the elderly disabled group was 28.5 mm2. The mean CSA of the young control group’s TN was 20.45 mm2. The mean CSA of the TN in the elderly non-disabled group (both diabetic and non-diabetic) was 27.6 mm2. The mean CSA of the TN in the elderly diabetic non-disabled group was 29.9 mm2. The mean CSA of the TN in the elderly (non-diabetic) non-disabled group was 24.6 mm2.ConclusionIn conclusion, although our study suggests that nerve ultrasound could be a helpful tool for assessment of the tibial nerve in disabled elderly patients, disability status was not an independent predictor of tibial nerve CSA. Future studies with a larger sample size and a homogenous group are suggested.

MR neurography of tibial and common peroneal nerves in patients with Guillain-Barre syndrome and electrophysiological correlation.

Branches of the tibial nerve in the foot of fetal cadavers.

BackgroundDiabetic peripheral neuropathy (DPN) is a common and disabling complication of type 2 diabetes mellitus (T2DM).Noninvasive imaging such as high-frequency ultrasound (HFUS) and shear wave elastography (SWE) can capture structural and mechanical changes in peripheral nerves. This study sought to identify predictors for DPN and develop a clinically useful nomogram based on HFUS and SWE parameters of the median nerve and tibial nerve plus routine clinical and laboratory indicators.MethodsA total of 118 adults with T2DM classified as DPN or non-DPN (NDPN) were retrospectively enrolled and randomized into the training dataset and testing dataset in a 7:3 ratio. HFUS and SWE were utilized to measure the cross-sectional area (CSA) of the median nerve and tibial nerve, the shear wave velocity (SWV) of the same nerve. These factors, plus clinical variables, were compared between DPN and NDPN. Univariate analysis and multivariate logistic regression analysis were conducted on the training dataset to identify independent predictors for DPN, construct a binary logistic regression model, and develop a corresponding nomogram. Its performance was evaluated using the receiver operating characteristic (ROC) analysis, decision curve analysis (DCA), and clinical impact curve (CIC).ResultsSignificant differences were detected in age, course of T2DM, postprandial 2-h C-peptide (2-h C-P), CSA of the median nerve and tibial nerve, and SWV of the tibial nerve between the DPN and NDPN (P < 0.05). Multivariate logistic regression analysis identified the course of T2DM, 2-h C-P, TN-CSA1, TN-CSA3, TN-SWV2, and TN-SWV3 as independent predictors for DPN. Using them, the nomogram demonstrated an AUC of 0.867 in the training dataset and 0.824 in the testing dataset. DCA plotted a net benefit within the risk threshold of 0.15–0.85. CIC validated the nomogram’s high predictive accuracy at the risk threshold of 0.4 and above.ConclusionCourse of T2DM, 2-h C-P, TN-CSA1, TN-CSA3, TN-SWV2, and TN-SWV3 are independent predictors for DPN. The DPN nomogram based on HFUS and SWE demonstrated a favorable diagnostic performance and may assist in clinical decision-making.

ABSTRACTIntroduction/AimsPrevious studies of children with spinal muscular atrophy (SMA) have focused on the ulnar and median nerves, while lower‐limb and proximal motor nerves remain insufficiently characterized. This study aimed to evaluate compound muscle action potential (CMAP) amplitudes in upper‐ and lower‐limb motor nerves in children with SMA and changes after nusinersen treatment.MethodsIn this single‐center retrospective study, CMAP amplitudes were collected from children with SMA and age‐matched controls without neuromuscular disease. CMAP amplitudes of the tibial, peroneal, femoral, median, and ulnar nerves were assessed in children with SMA types 1–3. A cross‐sectional analysis was conducted to assess CMAP amplitudes prior to treatment. Longitudinal changes after SMA disease‐modifying therapies (nusinersen monotherapy or nusinersen plus risdiplam treatment) were evaluated.ResultsA total of 47 children with SMA were included. The baseline CMAP amplitudes of the peroneal, tibial, median, and ulnar nerves were the highest in type 3, followed by type 2, and lowest in type 1. Femoral nerve CMAP amplitudes were low in all SMA subtypes. At preliminary diagnosis, children with SMA had significantly reduced CMAP amplitudes for the five nerves compared with age‐matched controls (n = 63, p < 0.05). After 18 months of nusinersen treatment, CMAP amplitudes showed significant increases from baseline in the peroneal, femoral, median, and ulnar nerves (p < 0.05).DiscussionCMAP amplitudes can differentiate SMA disease severity and may increase after nusinersen treatment. Large‐scale longitudinal studies are required to investigate CMAP amplitude as a biomarker of treatment response in patients with SMA.

Objective: Tethered cord syndrome (TCS) is traditionally considered a pediatric disorder, yet an increasing number of adults are now diagnosed with symptomatic tethering.Adult presentations often differ from childhood cases, and the extent to which microsurgical detethering benefits this population remains a subject of clinical interest.This study aims to evaluate the clinical and radiological outcomes of microsurgical detethering in adults with TCS. Materials and Methods: This retrospective study included patients aged 18 years who underwent detethering between 2015 and 2024.Preoperative variables included symptoms, neurological findings, cutaneous stigmata, magnetic resonance imaging (MRI) features, urodynamic results, and tibial nerve somatosensory evoked potentials latency.All patients underwent microsurgical filum sectioning or release of pathological adhesions with routine intraoperative neuromonitoring.Outcomes were assessed through postoperative clinical follow-up and MRI studies.Results: Twenty-one patients (mean age 26.2 years) were included.Back pain (81%), urinary dysfunction (67%), and radicular pain (57%) were the most common symptoms.A low-lying conus was present in 95% of subjects, and a thick filum in 76%.Split cord malformation occurred in 38% of patients and syringomyelia in 24% of patients.At a mean follow-up of 21.3 months, leg pain resolved in all affected patients, urinary incontinence improved in 78% of patients, and syringomyelia decreased in 60% of patients.Only one cerebrospinal fluid leak occurred, and no retethering was observed.Conclusion: Microsurgical detethering resulted in meaningful symptom relief and radiological improvement in most adult TCS patients, with low complication rates.These findings support surgical intervention as an effective treatment option for symptomatic adults.

BackgroundThis study aimed to evaluate outcomes after a minimum 5-year follow-up of feet with tarsal tunnel syndrome (TTS) after electroneuromyographic (ENMG) diagnosis and treatment. Possible predictive factors of outcome were sought.MethodsAll patients underwent, at the least, initial clinical evaluation, ENMG diagnosis, ultrasound and medical treatment for TTS. If treatment was unsuccessful after 6 months, tibial nerve release was proposed. Outcomes were classified as satisfactory (excellent and good) or unsatisfactory (fair and poor) based on Pfeiffer's classification.ResultsSeventy-six feet received conservative treatment, with 65% of satisfactory outcomes, rising to 78% in case of additional tibial nerve release (16 feet, 21%, excellent results in 10 of 76 feet). Improvement was insufficient in 14% of feet, but the patients did not consider that surgery was necessary. Five years after medical treatment, outcome was satisfactory in 5 of 8 feet with nerve contact on ultrasound within the tarsal tunnel, and in 9 of 10 feet with isolated talus-nerve contact. Finally, 18% of feet had nerve contact on ultrasonography and a satisfactory outcome after conservative treatment when evaluated after a minimum of 5 years. Results tended to be better in the absence of static disorders (P = .058), hindfoot varus in particular (P = .032), and in women (P = .047).ConclusionsConservative treatment of TTS yielded satisfactory outcomes at 5-year follow-up. Except in rare cases, it should be the first-line treatment even when nerve contact is seen on imaging. Surgical release appeared to be beneficial after failure of medical treatment at 6 months. Outcomes appeared poorer in feet with static disorders and better in women.Levels of Evidence:Therapeutic, Level IV, Retrospective.

A 41-year-old serviceman. A year ago, while performing a combat mission in the Special Military Operations (SMO) zone, he sustained a blind shrapnel wound to his right lower extremity as a result of a shell explosion. The metal fragment was not removed due to its deep location in the tissue of the lower leg. The wound healed by primary intention, and he returned to military service 10 days after seeking medical attention. Six months later, he felt the development of a tumor-like rounded mass in his right popliteal region, which continued to grow. A year after the injury, he developed numbness in his foot and decreased sensation in his fingers. An ultrasound examination revealed a false aneurysm of the popliteal artery (PA) and an arteriovenous fistula (AVF) between the PA and popliteal vein (PV). Due to the risks of transporting the patient to a specialized hospital during active combat operations and the progression of tibial nerve neuropathy symptoms, a decision was made to perform reconstructive surgery at a military field hospital in the SMO zone. The following surgery was performed: removal of the PA false aneurysm, removal of the AVF between the PA and PV, and autologous vein grafting of the PA with a reversed great saphenous vein. The postoperative period was uneventful. Symptoms of tibial nerve neuropathy regressed 14 days after surgery. The patient was discharged and returned to military service 30 days after surgery.

Introduction. Accumulated hazardous waste containing hazardous pollutants are potential and actual sources of adverse impact on the environment, which contributes to a significant deterioration in public health and reduces the quality and life expectancy. During the operation of the industrial facility of Usolye-Sibirskoye Chemical Plant LLC (Usolsky District), mercury levels in the bodies of people living near secondary contamination sites were found to be above acceptable limits. Only 42.8% of people had mercury concentrations within the normal range. The incidence of disease in the population of Usolye-Sibirskoye was studied. According to the literature, the causes of the increased incidence were environmental pollution and the long-term effects of exposure to harmful industrial factors.The aim of the study is to investigate neurophysiological and immunobiochemical changes in industrial workers exposed to mercury through inhalation and in the adult population, depending on the distance of the place of residence from the source of contamination.Materials and methods. Group 1 included long-term workers exposed to mercury (mean age 49.2 ± 4.4 years); group 2 included individuals exposed to chronic mercury intoxication in the late period (CMI, mean age 53.4 ± 4.3 years); group 3 included individuals living less than 3 km from the industrial site (mean age 47.4 ± 3.9 years), group 4 included individuals living 3‒5 km from the industrial site (mean age 48.1 ± 4 years). The subjects underwent electroencephalography, electroneuromyography, and measurements of serotonin, dopamine, BDNF, and concentrations of neurotropic antibodies to myelin basic protein (MBP), voltage-dependent calcium channels, and dopamine receptors.Results. In group 1, there were found moderate changes in brain bioelectric activity with high β1-activity, dysfunction of the midline structures, focal changes in the frontal-temporal areas; in group 2, slow-wave activity of the Δ-range in the frontal areas; In group 1, the impulse conduction velocity along the ulnar nerve in the elbow joint and along the tibial nerve decreased; in groups 2 and 3, a decrease was observed in the median and ulnar nerves, respectively; in group 4, an increase in the proximal-distal ratio. In group 1, serotonin and BDNF decreased, in group 2, dopamine, antibodies to voltage-dependent calcium channels, MBP increased, BDNF decreased; In groups 3 and 4, dopamine, antibodies to dopamine receptors, and BDNF decreased.Limitations. A correlation between neurotransmitter levels and EEG and ENMG has not been established.Conclusion. Individuals not exposed to the toxicant developed moderate general cerebral changes, including polyrhythmic polymorphic activity, high levels of slow-wave activity, changes in the normal distribution of fundamental rhythms, a focus of pathological activity, and dysfunction of midline structures. Changes in sensory and motor axons, an imbalance in the neurotransmitter system, and antibody synthesis were also recorded. A correlation between neurotransmitter levels and EEG and ENMG has not been established.Compliance with ethical standards. Conclusion of the LEK of the Federal State Budgetary Scientific Institution «East Siberian Institute of Medical and Environmental Research», No. 1 dated 02/21/2023. All participants gave informed voluntary written consent to participate in the study.Contribution: Rusanova D.V. – study concept and design, data collection and processing, statistical processing, writing text, structuring an article, editing; Katamanova E.V. – data processing, statistical processing, writing text; Kudaeva I.V. – study concept and design, data collection and data processing, writing text; Lakhman O.L. – study concept and design, editing; Protasova E.N. – data collection and data processing, statistical processing, writing text; Prokhorova P.G., Starkova A.S. – collection and processing of material. All authors are responsible for the integrity of all parts of the manuscript and approval of the manuscript final version.Conflict of interest. The authors declare no conflict of interest.Funding. This work was carried out within the framework of state assignment.Received: October 7, 2025 / Revised: November 11, 2025 / Accepted: December 2, 2025 / Published: January 15, 2026

Nerve ultrasound is becoming increasingly important for diagnosing and monitoring peripheral nerve disorders in children. This research seeks to determine reference values for ultrasound cross-sectional area (CSA) and elastography of peripheral nerves in healthy children from northern China. A total of 150 healthy children aged 2-16 years were recruited. To make the results more intuitive and applicable, the CSA data were divided into five age groups and the elastography data into two. The CSA measurements included nerves of the cervical region (C5, C6, vagus), upper limb (median, ulnar, radial), and lower limb (sciatic, tibial, common peroneal, sural). Shear wave velocity (SWV) measurements were performed solely on the median nerve in the right forearm. t Tests and analysis of variance (ANOVA) were used to compare the data. The average CSA of all nerves increased with age, particularly in the sciatic, tibial, and common peroneal nerves. No sex-based differences were observed in nerve CSA, which increased with weight and height. Among groups categorized by weight and height, significant differences were noted in the larger nerves, with the exception of the vagus and sural nerves. The mean median nerve SWV in this cohort was 3.48 ± 0.62 m/s, with no significant variations attributable to sex, age, height, weight, or CSA. In children, nerve CSA as measured by ultrasound changes with age, height, and weight, while median nerve SWV values remain consistent despite these variations.

Stress urinary incontinence (SUI) is the most common subtype of urinary incontinence in women and significantly their affects quality of life. The aim of this study was to summarize the current evidence about conservative (non-surgical) treatments for female SUI and outline their clinical applicability. A narrative review was performed using structured research involving medical databases over the last 15 years, including systematic reviews, randomized controlled trials, observational studies and key guidelines regarding pelvic floor muscle training (PFMT), electrical and tibial nerve stimulation, acupuncture, pharmacological therapies, local estrogen, pessaries and bulking agents. PFMT represents the primary first-line therapy, with strongest evidence for reducing leakage episodes and improving quality of life when performed correctly and consistently. Other conservative options (electrical and tibial nerve stimulation, acupuncture, duloxetine, local vaginal estrogen, pessaries and bulking agents) may be efficient for selected patients, but generally they have a weaker or more heterogeneous evidence base. They are considered adjuncts or tailored alternatives when PFMT alone is insufficient, not feasible or not accepted. Conservative management, centered on PFMT, should be offered as initial treatment to most women with mild to moderate SUI, with additional modalities being used selectively according to symptom profile, comorbidities and patient preference. A stepwise, individualized approach can control symptoms in many women and may delay or avoid surgical therapy.

Tibial nerve stiffness is related to maximum angle of ankle dorsiflexion.

Background Dysfunction of the peripheral nerve microcirculation is crucial in the onset and progression of diabetic neuropathy. Purpose To evaluate the feasibility of superresolution US for quantifying tibial nerve microvasculature in diabetic adults with and without peripheral neuropathy, and in control participants. Materials and Methods In this prospective single-center study, consecutive participants were enrolled between June 2024 and October 2024 and divided into three groups: group I, diabetic peripheral neuropathy with ulcers; group II, type 2 diabetes without peripheral neuropathy; and group III, the control group. All participants underwent conventional US in the tibial nerves followed by superresolution US with intravenous microbubble injection. Regions of interest were delineated manually along the tibial nerve. Quantitative parameters, including interfascicular and intrafascicular vessel ratio, complexity, density, velocity, perfusion index, and single-vessel curvature were compared using one-way analysis of variance (parametric) and Dunn-corrected Kruskal-Wallis (nonparametric) tests. Results A total of 100 participants were enrolled, including 30 participants in group I (mean age, 67 years ± 10 [SD]; 23 men), 35 in group II (mean age, 61 years ± 11; 20 men), and 35 in group III (mean age, 54 years ± 14; 15 men). Superresolution US showed group I had higher vessel ratio (23% vs 10% vs 6%), complexity level (1.3 vs 1.2 vs 1.1), maximum density (25 vs 20 vs 12), mean velocity (12.6 vs 8.7 vs 8.4 mm/sec), perfusion index (4.5 vs 1.4 vs 0.9), and curvature (1.19 vs 1.09 vs 1.05) compared with groups II and III, respectively (all P < .05). Microvascular tortuosity was observed in 83% (25 of 30), 43% (15 of 35), and 14% (five of 35) of groups I, II, and III, respectively (P < .001). Conclusion Superresolution US provided a 10-μm scale resolution view of tibial nerve microvascular structure, helping to identify microvascular alterations in participants with diabetic peripheral neuropathy with ulcers. © RSNA, 2026 Supplemental material is available for this article.

The sciatic nerve (SN) is the largest and longest peripheral nerve in the human body. Its anatomical course demonstrates considerable variability, particularly in its relationship with the piriformis muscle (PM). Several bifurcation patterns of the tibial nerve (TN) and common fibular nerve (CFN) have been described and classified into six types (I-VI) to facilitate their identification and prevalence assessment. The present study reports a newly observed and atypical variant of SN division, which, to our knowledge, has not been previously documented in the literature. During routine cadaveric dissection, an unusual configuration of the SN was identified on the left side. The TN passed inferior to the PM, whereas the CFN bifurcated into two distinct branches: a superior branch traversing the fibers of the PM, and an inferior branch accompanying the TN beneath the muscle. No such variation was found on the contralateral side. A comprehensive understanding of SN anatomical variations is crucial for improving the precision and outcomes of surgical procedures. Magnetic resonance imaging (MRI) can serve as a valuable tool in preoperative planning by delineating the course and morphology of the SN. Such knowledge aids in diagnosing piriformis syndrome (PS) and helps minimize postoperative neurological complications. Our research team is the first to describe this particular variant of SN bifurcation.

Supercharge end-to-side (SETS) nerve transfer enhances motor recovery in proximal nerve injuries by providing early reinnervation. However, the optimal indications and mechanisms remain unclear. This study examined the role of donor nerves using rat models of varying injury severity to clarify the clinical indications for SETS. Eighty female Sprague-Dawley rats were assigned to five groups: Control, Mild-SETS(-), Mild-SETS(+), Severe-SETS(-), and Severe-SETS(+). The tibial nerve was transected, decellularized, and reconstructed with a 10 mm (mild) or 20 mm (severe) graft. SETS consisted of end-to-side coaptation of the donor peroneal nerve to the tibial nerve 5 mm distal to the graft. Assessments included the sciatic functional index (SFI; measured every 4 weeks), compound muscle action potentials (CMAPs), gastrocnemius weight, and immunostaining for neurofilament (NF)-positive axons and S100β-positive Schwann cells at 8 and 16 weeks. In mild models, SETS accelerated early recovery in CMAP amplitude and muscle weight without affecting long-term outcomes. In severe models, SETS showed significant increases in CMAP amplitude and muscle weight at 16 weeks. NF-positive axons and S100β-positive Schwann cells increased distal to the coaptation site at 8 and 16 weeks in mild models, whereas both distal and proximal increases were observed in severe models. Donor nerves in SETS enable early arrival of axons and Schwann cells, leading to faster motor improvement. In the long term, spontaneous recovery compensates in mild models, whereas severe models benefit from sustained donor support that promotes regeneration. SETS nerve transfer may therefore be particularly useful in selected mild cases where rapid recovery is desired, and especially in severe cases where spontaneous regeneration is insufficient.

Background:Hindfoot varus deformity is often corrected using lateral sliding calcaneal osteotomies, which may compress the tarsal tunnel and risk tibial nerve entrapment. Minimally invasive surgery (MIS) techniques may mitigate soft tissue disruption, but their impact on tarsal tunnel biomechanics remains unclear. Purpose is to evaluate the effect of calcaneal lateralization using a 3-mm MIS burr on tarsal tunnel volume and pressure in a cadaveric model.Methods:Ten matched pairs of fresh frozen cadaveric lower limbs underwent lateral-to-medial calcaneal osteotomy using a 3-mm MIS burr. Computed tomography (CT) scans measured tarsal tunnel volume pre- and post-osteotomy. Intra-compartmental pressure within the tarsal tunnel was assessed using an ultrasound-guided pressure monitor. Volumes were calculated using CT-derived cross-sectional reconstructions, and pressures were compared before and after lateralization.Results:Calcaneal lateralization led to significantly decreased tarsal tunnel volume (mean Δ = −3.06 ± 1.50 cm³, P < .0001) and significantly increased tunnel pressure (mean Δ = +11.18 ± 6.19 mm Hg, P < .0001). There was a significant inverse relationship between lateralization distance and volume change (R2 = 0.184, P < .0001), and a direct relationship between lateralization and pressure increase (R2 = 0.129, P = .026). Percentage volume change was negatively correlated with percentage pressure change (R2 = 0.042, P = .009). The average lateralization achieved was 6.33 mm.Conclusion:MIS calcaneal lateralization significantly reduces tarsal tunnel volume and increases intratunnel pressure, which may theoretically contribute to tibial nerve compression. However, the magnitude of pressure increase observed was generally below levels associated with neural dysfunction. Although MIS approaches offer soft tissue advantages, this study suggests that tarsal tunnel decompression and flexor retinaculum release may still be warranted if symptoms develop postoperatively. In cases where greater lateralization is required, the flexor retinaculum release performed during a tarsal tunnel decompression allows for greater translation without the concomitant rise in tarsal tunnel pressure.Clinical Relevance:This model demonstrates the volume and pressure changes and lateralization distance that occur during an MIS lateral slide calcaneal osteotomy.

Recent studies have expanded the evidence on novel and existing non-pharmacological treatments for paediatric functional constipation (FC). This study aimed to systematically review the efficacy and safety of non-pharmacological therapies for FC in children. PubMed, MEDLINE, Embase, PsycINFO, Cochrane Library and trial registries were searched from inception to March 2025. Randomised controlled trials (RCTs), including children (0-18 years) with FC treated with non-pharmacological interventions compared with placebo, no treatment or other interventions, were included. Primary outcomes were treatment success, defecation frequency and withdrawals due to adverse events. Dual data extraction and appraisal was conducted. Certainty was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE). 93 RCTs comprising 7787 children (50.4% female) were included investigating dietary, psycho-educational, physiotherapeutic interventions, various complementary and complementary medicine interventions, and electrical stimulation. A substantial part of the therapies provided evidence that was of very low certainty, meaning no conclusions could be drawn. Abdominal transcutaneous electrical stimulation plus pelvic floor muscle exercises (PFME) may improve treatment success and defecation frequency compared with PFME alone (risk ratio (RR): 1.75 (95%CI 1.25 to 2.44) and mean differences (MD): 1.85 (95%CI 1.28 to 2.43), moderate certainty). Percutaneous tibial nerve stimulation plus PFME leads to more treatment success (RR: 1.73 (95%CI 1.08 to 2.77), low certainty) and greater defecation frequency (MD: 1.82 (95%CI 0.82 to 2.82), moderate certainty). Behavioural therapy plus polyethylene glycol may not improve treatment success (RR: 0.83 (95%CI 0.62 to 1.12), low certainty) and probably reduces defecation frequency (MD: -1.80 (95%CI -2.88 to -0.72), moderate certainty). Imprecise data, poor reporting and substantial heterogeneity led to downgrading in GRADE assessments. Some non-pharmacological treatment options for children with FC show beneficial effects, and these may be considered in the management of children. Future trials should aim to improve methodological rigour. CRD42023416891.

Catheter breakage is a rare complication of continuous peripheral nerve blocks. Retained fragments pose a significant technical challenge, particularly when they migrate from the insertion site. We report a 39‐year‐old woman with Fabry disease and chronic foot pain refractory to pharmacologic therapy who, after a successful diagnostic posterior tibial nerve block, received a continuous peripheral nerve catheter. She initially experienced excellent analgesia but, by Day 4, developed severe neuropathic symptoms; imaging showed proximal migration of a catheter fragment. Computed tomography and fluoroscopy guided surgical retrieval of the fragment was performed. This case highlights the need for early recognition of catheter‐related complications, precise localization with advanced imaging, and timely surgical intervention to reduce adverse outcomes from retained catheter fragments.

Introduction. Given the high frequency of neurological complications after mine-blast injuries, the most common trauma in contemporary armed conflicts, we aimed to characterize the time-dependent morphological and functional changes in the blood vessels of the central segment of a peripheral nerve following traumatic limb amputation caused by mine-blast injury. Materials and methods. We examined 50 segments of tibial nerves obtained on days 1–30 after mine-blast injury using histology, histochemistry (orcein), and immunohistochemistry (antibodies to CD31, α-SMA, and Ki-67). Morphometry was performed in three zones of the central nerve fragment: A, 1–2 cm from the amputation level; B, 5–7 cm; and C, 8–30 cm (within the same segment). Wagenvoort and Kernohan perfusion indices were calculated. Statistical analysis employed the Kruskal–Wallis test and linear mixed-effects models. Results. On days 1–2, we observed hemorrhages, traumatic edema, multiple fibrinous and hyaline thrombi, air/fat/tissue emboli, and a patchy arteriolar spasm. A peak of vasodilation was detected on days 3–7: the mean arteriolar luminal diameter approximately doubled (p&lt;0.001), while the Wagenvoort and Kernohan indices decreased by 25.9±4.3 and 1.46±0.31, respectively (p&lt;0.001). Between days 8 and 30, numerous CD31+ thin-walled vessels of granulation tissue formed across all nerve compartments; by day 13, perfusion metrics increased despite persistent luminal dilatation; and by day 30, they approached baseline values against the background of tunica intima and tunica media thickening. Conclusion. Following mine-blast injury, a triphasic vascular response is mediated by both local and systemic factors: initial spasm of the vasa nervorum, subsequent vasodilation corresponding to the hypodynamic (torpid) phase of traumatic shock, and delayed perfusion decline accompanied by focal neoangiogenesis and reorganization of granulation tissue. Keywords: mine-blast injury, peripheral nerve, vasa nervorum, Wagenvoort index, Kernohan index