European Journal of Pain

Background: Chronic pain is a multidimensional condition that often persists despite conventional treatment and adversely affects multiple domains of daily life. Music listening has emerged as a promising non-pharmacological intervention, with accumulating evidence supporting its beneficial effects on pain and associated psychological outcomes. However, despite growing evidence of efficacy, the translation of music listening into routine clinical practice remains limited, partly because intervention reporting has received comparatively little attention. Objective: To evaluate the effectiveness of music listening interventions for chronic pain and systematically assess the methodological quality and completeness of intervention reporting to identify barriers to reproducibility and clinical implementation. Methods: Systematic searches were conducted in PubMed, Cochrane Library, CINAHL, and Web of Science through June 2025, with no date restrictions on publication. Randomized controlled trials involving adults with chronic pain receiving music listening interventions were included. Two independent reviewers screened studies, extracted data, and assessed risk of bias. Intervention reporting was evaluated using the TIDieR checklist, and a random-effects meta-analysis was performed for pain intensity outcomes. Results: Ten RCTs involving 538 participants were included. Music listening interventions varied substantially in delivery, duration, and music selection procedures, reflecting considerable heterogeneity in intervention design. Most studies reported significant improvements in pain and psychological outcomes. Meta-analysis of eight trials (10 effect estimates), demonstrated a moderate reduction in pain intensity (SMD = -0.53, 95% CI: -0.96 to -0.11, p = 0.014; I2 = 76.2%). Although intervention rationale and procedures were generally well described, reporting of intervention modifications, treatment fidelity, and adherence was frequently incomplete. These reporting deficiencies may compromise reproducibility and limit translation into clinical practice. Conclusions: Music listening appears to be a safe, accessible, and scalable non-pharmacological intervention for chronic pain management, with benefits extending beyond pain reduction to psychological wellbeing, quality of life, and functioning. However, incomplete reporting of key intervention components may limit reproducibility and hinder clinical implementation. Future trials should adopt standardized and transparent reporting standards to facilitate implementation into clinical practice.

Myofascial pain syndrome (MPS) is a major cause of chronic neck pain, with tissue ischemia implicated as a contributing factor. This prospective, single-arm interventional study evaluated the analgesic effect of ultrasound-guided fascia hydrorelease (US-FHR) performed around arteries supplying the neck in patients with chronic neck MPS. Thirteen adults (median age 53.0 years; 38.5% female) underwent US-FHR targeting the perivascular fascia of either the transverse cervical or dorsal scapular artery using 2 mL of normal saline. Pain intensity was assessed by visual analog scale (VAS) at rest and during movement; disability by the 5-item Pain Disability Index, Japanese version (PDI-5-J); and arterial blood flow volume before and after the procedure. The primary outcome, pain VAS during movement, decreased from 49.0 mm (interquartile range [IQR], 44.5-64.0) at baseline to 22.0 mm (IQR, 14.5-31.5) at 15 min and 22.0 mm (IQR, 14.0-34.0) at 1 week (Hodges&-Lehmann median difference, 30.5 mm [95% CI, 24.5 to 36.5] and 28.5 mm [95% CI, 18.5 to 37.0]; both P < 0.001). Pain VAS at rest improved from 21.0 mm (IQR, 13.0-43.5) to 8.0 mm at 15 min and 1 week (median difference, 14.5 mm [95% CI, 9.0 to 24.0; P = 0.001] and 13.5 mm [95% CI, 6.0 to 21.0; P = 0.007]). PDI-5-J decreased from 17.0 (IQR, 10.5-23.0) to 13.0 (IQR, 4.0-17.5) at 1 week (median difference, 5 [95% CI, 2 to 8; P = 0.004]). Blood flow volume increased from 11.2 mL/min (IQR, 4.5-14.4) to 17.2 mL/min (IQR, 6.1-23.7) immediately after US-FHR (median difference, +4.1 mL/min [95% CI, +2.5 to +8.9; P = 0.001]), although transient. One patient experienced transient bleeding that was promptly controlled. In this single-arm feasibility study, US-FHR around the target artery was simple and safe to perform and was associated with reduced neck pain. Because the study lacked a control group, these preliminary findings should be regarded as hypothesis-generating and require confirmation in controlled trials; they may also inform the future evaluation of MPS in other anatomical regions. Trial registration: UMIN Clinical Trials Registry, UMIN000053612.

Background: Whether a patient's pain improved after emergency department (ED) treatment is read from the record to benchmark EDs, compare drugs, and label research outcomes. It is interpretable only if a post-treatment score is recorded, appropriately timed, and chosen by a fixed rule; its stability across these choices is unknown. Methods: Retrospective measurement study of adult headache visits in a de-identified ED database (MIMIC-IV-ED, 2011-2019). Among treated visits, we quantified reassessment completeness by time window, estimated meaningful relief (a reduction of at least 2 points) under score-selection rules and missing-data assumptions, tested whether reassessment was predictable at treatment, and compared headache with other painful presentations. Results: Among 19,501 visits (15,273 patients), 13,682 (70.2%) were treated. A post-treatment pain score appeared at any time for 77.1% (95% CI, 76.4 to 77.8), but within 2 hours of the analgesic for only 47.9% and within 1 hour for 27.5%. Meaningful relief was 66.9% using the first post-treatment score but 81.0% and 83.4% using the last or lowest score; it was 67.5% under inverse-probability weighting and could be bounded only between 51.8% and 74.4%. Whether a score was recorded was weakly predictable at treatment (area under the curve, 0.566) and unrelated to baseline pain. Completeness was similar across headache strata and comparator painful presentations. In an independent ED (MC-MED, a different EHR), the score-selection effect replicated: relief rose from 71.1% (first) to 80.6% (last) and 83.4% (lowest). Conclusions: Documented pain relief after ED headache treatment was not a stable outcome: it varied with the reassessment window and score-selection rule, was not point-identified for unreassessed patients, and behaved like other painful ED presentations. Programs and research that use documented relief should prespecify the reassessment window, score-selection rule, completeness denominator, and a missing-data range, and favor protocol-timed reassessment.

Chronic pain is a major risk factor for depression, yet the molecular mechanisms underlying this comorbidity remain poorly understood, particularly in women. To address this gap, we systematically investigated sex differences in the epigenomic adaptations associated with chronic pain-induced depressive-like behaviors. Neuropathic pain was induced in the mouse using the sciatic nerve cuff model, and molecular analyses were performed in the anterior cingulate cortex (ACC), a key brain region implicated in both pain and affective processing. We profiled genome-wide DNA methylation, three histone modifications (H3K27ac, H3K4me1, and H3K27me3), and gene expression using EM-seq, Cut&Tag sequencing, and RNA-seq, respectively. Differential analyses were conducted for each molecular layer and integrated through gene co-expression network analysis. We found that chronic pain induced extensive remodeling of DNA methylation and histone modification landscapes in both sexes. Strikingly, these changes occurred at largely distinct genomic loci in males and females, revealing pronounced sex-specific epigenetic responses. Despite this divergence, the affected regions displayed similar regulatory organization, including enrichment at shared genic features, transcription factor binding sites, and chromatin profiles. Importantly, these adaptations converged on partly overlapping genes, biological pathways, and co-expression modules across sexes. The most affected gene modules were predominantly associated with synapse-related processes, consistent with previous knowledge, and were closely connected to modules enriched for epigenetic regulatory functions. Together, these findings indicate that chronic pain engages sex-specific epigenetic mechanisms that ultimately converge on common functional outcomes. Such convergence highlights the potential value of targeting sex-specific epigenetic substrates in future therapeutic strategies.

Background. Clostridioides difficile infection (CDI) imposes a burden that extends well beyond the gastrointestinal tract, yet existing outcome measures only partially capture the patient experience. We used frontier large language models (LLMs) on patient and caregiver narratives at scale to describe how burden shifts with disease course. Methods. We analyzed 189 testimonials from the Peggy Lillis Foundation corpus, sorted into four cohorts with recurrence (r) and fulminant (f) severity as axes (rfCDI, fCDI, rCDI, non-rfCDI). Two independent LLMs coded eight thematic domains, four fulminant flags, thirteen emerging semantic fields, the dominant dimension, and narrative arcs. Two clinicians independently coded a subset for inter-rater reliability (PABAK, Gwet's AC1). Results. Treatment trajectory was the dominant theme in recurrent disease, whereas death and near-death dominated non-recurrent fulminant narratives. Psychological burden was near-universal in fulminant disease (98.0% in rfCDI, 97.2% in fCDI). Caregiver and bereavement content concentrated in fCDI (66.7%). Diagnostic failure was frequent across recurrent cohorts (47.6 - 56.1%). Bacteriotherapy tracked recurrence (60.2% rfCDI versus 5.6% fCDI). Financial, mental-health, and caregiver burdens were prominent and are currently unaddressed by guidelines. Human-human reliability was substantial (PABAK 0.79 for semantic fields, 0.76 for domains); arc coding was least reliable. Conclusions. Patient narratives reveal a course-dependent, multidimensional burden in CDI. Concrete gaps exist between what patients prioritize, what guidelines recommend, and what therapy access provides. Frontier-LLM coding, validated against clinicians, offers a reproducible route to translate these priorities into research, care, and policy.

Background: Shared decision-making (SDM) is a key component in patient-centered care for people consulting health care due to chronic musculoskeletal pain, including subacromial pain syndrome (SAPS). Limited research has explored how patients, relatives, and healthcare professionals perceive the content and delivery of SDM for managing SAPS in primary care. Thus, this study aims to explore stakeholder perspectives on the content, delivery, and contextual requirements for a context-specific SDM intervention for SAPS, and to identify shared challenges and co-develop ideas to inform intervention development. Methods: We conducted three separate future workshops (patients/relatives, physiotherapists/chiropractors, and general practitioners), each consisting of structured critique, fantasy, and implementation phases. A rapid preliminary analysis of workshop data was followed by semi-structured stakeholder interviews to validate, challenge, or elaborate the findings. All data were analysed thematically using an iterative, reflexive approach. Results: Twenty-eight participants took part across three workshops: patients/relatives (n = 10), physiotherapists/chiropractors (n = 12), and general practitioners (n = 6). Six additional stakeholders provided inputs via subsequent interviews (three physiotherapists, one patient, one relative and one GP). Thematic analysis identified 20 themes and 59 sub-themes, which were refined into two overarching categories: (1) shared barriers to SDM in SAPS care, including diagnostic uncertainty, fragmented clinical care pathways, time constraints, and decision fatigue; and (2) stakeholder visions for future SDM interventions, emphasising continuity, tailored communication tools, and supportive digital ecosystems. Conclusion: Based on stakeholder input, SDM in SAPS care may consider integrating dynamic, integrated systems that account for diagnostic ambiguity, contextual constraints, and varying patient capacities. These findings provide an actionable foundation for co-developing and piloting a context specific SDM intervention for primary care.

Background: Long COVID is a syndrome characterized by symptoms and conditions across all biological systems. This breadth of Long COVID phenotypes impedes efforts to identify the mechanistic pathways of Long COVID. Low serotonin may play a role in long-term sequelae of COVID-19, and selective serotonin reuptake inhibitors (SSRIs) may prevent these sequelae. Evaluation of the relationship between SSRIs and distinct categories of symptoms and conditions associated with Long COVID can highlight the mechanistic pathways that drive these relationships. Methods: We evaluated electronic health record data from a retrospective cohort of patients in the National Clinical Cohort Collaborative with comorbid depression and COVID-19 between October 2021 and February 2024. We estimated the relationship between SSRI prescription (versus no SSRI prescription) during acute COVID-19 and the one-year cumulative incidence of Long COVID-related conditions and symptoms across 14 human phenotype ontology categories. We applied Super Learner and targeted maximum likelihood estimation to estimate risk ratios while adjusting for confounders of interest and correcting for false discoveries from repeated testing. Results: We evaluated EHR data from 542,938 patients. We found that patients who were prescribed SSRIs during COVID-19 had a significantly lower risk of symptoms and conditions related to gastrointestinal factors (adjusted risk ratio (aRR) 0.95, 95% CI 0.92, 0.97), general health (aRR 0.91, 95% CI 0.88, 0.95), headaches (aRR 0.96, 95% CI 0.92, 0.99) and skin (aRR 0.92, 95% CI 0.87, 0.98). Discussion: We found that the prescription of SSRIs during acute COVID-19 was associated with a significantly lower risk of post-COVID sequelae related to gastrointestinal, headache-related, skin-related, and general symptoms and conditions, compared with no SSRI prescription. These findings highlight the role of serotonin in Long COVID and specific sequelae that may be reduced by SSRIs.

Effective postoperative pain control is essential following laparoscopic cholecystectomy, yet the analgesic value of a standardised 150 mg preoperative dose of pregabalin has not been clearly established. This systematic review and meta-analysis synthesised evidence from seven randomised controlled trials published between 2008 and 2025 to evaluate the efficacy and safety of pregabalin when administered before surgery. Four trials reported 24-hour postoperative pain scores, and pooled analysis demonstrated that pregabalin significantly reduced pain compared with control (SMD = 0.80 lower; 95% CI, 1.42 to 0.18 lower; p = 0.01), although statistical heterogeneity was high (I-squared = 81%). Pregabalin also produced notable reductions in opioid consumption, including fentanyl (SMD = 1.24 lower; p = 0.002) and tramadol (SMD = 4.21 lower; p = 0.002), again with considerable variability across studies. Sedation was slightly increased but did not reach statistical significance, and there were no significant differences in postoperative nausea, vomiting, or headache. Sensitivity analyses supported the stability of these findings. Overall, the results indicate that a single 150 mg preoperative dose of pregabalin meaningfully reduces postoperative pain and opioid requirements following laparoscopic cholecystectomy while maintaining an acceptable safety profile, supporting its use as part of a multimodal analgesic strategy.

Exogenous opioids that activate mu-opioid receptors (MORs) in nociceptive circuits mediate transient pain relief lasting minutes to hours but have more limited utility for treating chronic pain. By comparison, electrical or magnetic stimulation of the motor cortex can induce pain relief lasting weeks, for which the underlying mechanisms have remained unclear. Here we report an unconventional role for endogenous opioidergic signaling in the rapid induction of long-lasting analgesia from motor cortical stimulation, which triggers opioid-peptide-dependent neural plasticity in the rostral ventromedial medulla (RVM), a key node in the brain's descending pain control pathways. To dissect the circuit and cellular bases for these effects, we created a miniaturized, millimeter-sized device allowing focal, non-invasive transcranial magnetic stimulation (TMS) of the mouse motor cortex. In mice with chronic neuropathic pain, reflexive and affective pain behaviors diminished for 1-2 weeks after one session of TMS treatment. Chemogenetic and optogenetic manipulations showed that motor cortical layer 5 pyramidal neurons with axonal projections to the RVM mediated TMS-induced pain relief. High-density electrophysiological recordings revealed that TMS treatment shifted the balance of RVM activity between pain-ON and pain-OFF neurons to a state promoting greater suppression of pain. Genetic and neuropharmacological manipulations revealed that NMDA-receptor-dependent signaling and MOR activation by endogenous opioid peptides in the RVM jointly mediate the long-lasting analgesia induced by a transient bout of TMS. Strikingly, enkephalinase inhibition in the RVM during TMS treatment enhanced the amplitude and duration of analgesia, showing that transiently boosting endogenous opioidergic signaling during TMS increases analgesia-conferring plasticity. In accord, re-analyses of data from human subjects with chronic pain support the idea that opioid administration amplifies analgesia from motor cortical TMS. Overall, our results showcase miniaturized TMS devices as versatile tools for basic and translational neuroscience and detail a hybrid, long-range neural network and NMDA- and opioid-receptor-dependent plasticity mechanism for durable pain relief. These findings point the way to mechanistically grounded, synergistic neurostimulation and drug therapies for brain diseases and disorders that jointly target neural circuit and molecular signaling pathways.

Spontaneous activity in primary sensory neurons has been implicated in neuropathic symptoms, yet its earliest origins and immediate functional consequences remain incompletely understood. This gap is especially consequential in chemotherapy-induced peripheral neuropathy (CIPN), where sensory toxicities commonly limit effective cancer treatment. Using in vivo recordings in rats, we show that a single dose of oxaliplatin (OX) induces spontaneous firing within 24 h across touch and proprioceptive low-threshold mechanoreceptor (LTMR) afferents. Spontaneous firing consistently originated distally in peripheral axons and was accompanied by enhanced responses to mechanical stimulation, identifying LTMR sensory endings as the earliest source of spontaneous firing and a common site for spontaneous and stimulus-evoked hyperexcitability. OX also induced early structural abnormalities at sensory endings; however, SF+ LTMRs retained mechanosensory response profiles, indicating that spontaneous firing can emerge within otherwise functional sensory endings. Although coincident spontaneous and stimulus-evoked activity distorted encoding in individual LTMRs, these effects had little impact on population LTMR responses or motor behavior relying on mechanosensory feedback. Together, these findings identify sensory endings as an early target of OX neurotoxicity and demonstrate that spontaneous firing spanning multiple tactile and proprioceptive LTMR submodalities can coexist with largely preserved sensory function, indicating that even broad engagement across mechanosensory pathways is insufficient to disrupt all LTMR-dependent functions. These observations indicate that abnormal afferent activity initiated at sensory endings may be sufficient to engage sensory pathways underlying some paresthetic symptoms while leaving others largely unaffected, whereas progression to chronic neuropathic symptoms may require subsequent recruitment of the dorsal root ganglion.

Importance Childhood sexual abuse (CSA) is linked to adverse psychiatric outcomes in adulthood, but evidence on its association with cardiovascular disease and mortality from large, diagnostically ascertained cohorts remains limited. Objective To assess the 10-year risk of all-cause mortality, suicide or self-harm, drug overdose or poisoning, and cardiovascular disease among patients with a diagnosed history of CSA compared with a matched unexposed cohort. Methods In this retrospective cohort study, we used deidentified electronic health record data from 68 health care organizations in the TriNetX US Collaborative Network. Patients diagnosed with confirmed or suspected childhood sexual abuse (CSA) before age 18 between January 1, 2003, and December 31, 2015, who had a subsequent adult encounter, were propensity score matched 1:1 with unexposed patients on age, sex, race and ethnicity, and baseline psychiatric and medical comorbidities (n = 9,083 per cohort). Outcomes--all-cause mortality, suicide or self-harm, drug overdose or poisoning, and cardiovascular disease--were assessed over 10 years from the index adult encounter using risk and time-to-event analyses to estimate risks, risk ratios, and hazard ratios. Results Among 18,166 matched patients (mean [SD] age, 19.0 [2.0] years; 14,813 [81.6%] female), CSA was associated with significantly elevated risk of suicide or self-harm (5.1% vs 2.8%; risk ratio [RR], 1.84; 95% CI, 1.57-2.16), drug overdose or poisoning (5.5% vs 3.7%; RR, 1.47; 95% CI, 1.28-1.69), and cardiovascular disease (12.3% vs 9.3%; RR, 1.31; 95% CI, 1.20-1.44), with concordant hazard ratios (all P < .001). All-cause mortality was numerically higher but not statistically significant (0.5% vs 0.4%; RR, 1.16; 95% CI, 0.75-1.79; P = .51). Conclusions and Relevance A diagnostically confirmed history of CSA was associated with substantially elevated 10-year risk of self-harm, overdose, and cardiovascular disease, independent of baseline demographic and psychiatric comorbidity. These findings support integrated psychiatric and cardiovascular screening for adult survivors of CSA and trauma-informed care extending beyond mental health services alone.

Early-life adversity durably alters neural development through complex mother-offspring interactions whose underlying mechanisms remain poorly understood. We investigated how neonatal maternal separation (NMS) affects the large repertoire of maternal behaviors and subsequently influences spinal nociceptive circuit development and pain responses in rat offspring. Rat dams underwent NMS from postnatal day 2 (P2) to P12, 3h/day, and maternal behaviors were assessed before and after the separation period. These behaviors were compared to those of control (non-separated) dams. Offspring spinal cord and dorsal root ganglia were analyzed at P14 and P24 for several neurotrophic, glutamatergic, and GABAergic gene expression patterns. Offspring nociceptive sensitivity was also assessed at P24. NMS induced increased maternal behaviors (including longer arched-back nursing, higher nest occupancy, and better pup retrieval efficiency), alongside reduced self-care behaviors. These behavioral adaptations were correlated with spinal gene reprogramming in offspring, characterized by a biphasic developmental pattern. At P14, we observed elevated neurotrophic signaling alongside increased GABAergic and glutamatergic markers. By P24, neurotrophic factors decreased while compensatory changes emerged, yet persistent excitatory-inhibitory imbalances remained evident. Parallel to these results, NMS rats also showed mechanical and thermal hot hypersensitivity at P24. These findings reveal that despite apparent maternal behavioral compensation following NMS, offspring exhibit neurotrophic-driven developmental dysregulation resulting in persistent spinal circuit alterations. The disconnect between maternal behavioral normalization and sustained molecular changes suggests that early separation stress triggers enduring neurobiological cascades independent of ongoing maternal care quantity, with long-term consequences for sensory processing and pain sensitivity.

Introduction: Multimorbidity clusters have been associated with increased dementia risk. While lifestyle factors may modify dementia risk, their role in multimorbidity clusters remains unclear. Method: Data from UK Biobank was used to identify clusters of chronic conditions using latent class analysis, assess their associations with dementia risk using Cox regression, and potential moderating effects of lifestyle factors. Results: We included 465,175 participants (mean age (SD) = 56.52 (8.01), 53.87 % female). Five clusters were identified and significantly associated with increased dementia risk, with the cardiometabolic (HR = 2.14, p < 0.001) and mental health cluster (HR =1.99, p < 0.001) exhibiting the highest risk. Only moderate physical activity lowered dementia risk in the pain-dominated multimorbidity cluster (HR = 0.77, p = 0.039). Discussion: Lifestyle factors including physical activity may protect against dementia in specific multimorbidity clusters. Future research involving objective and multiple lifestyle measures is needed.

Major depressive disorder (MDD) is a heterogeneous mental disorder characterised by rumination. Mindfulness-based cognitive therapy (MBCT) is an evidence-based treatment developed to target rumination and recurrence risk. Ongoing studies have begun to identify neural changes associated with treatment effects. However, the low-dimensional organisation underlying whole-brain dynamics remains largely unexplored and may provide a more complete characterisation of the neural processes through which MBCT exerts its therapeutic effects in MDD. Here, we investigated functional magnetic resonance imaging (fMRI) of a randomised controlled trial of MBCT with treatment as usual (TAU), or TAU alone, in a group of MDD patients (N=80). We applied a novel framework, complex harmonics decomposition (CHARM), to uncover low-dimensional manifolds in the spacetime domain, capturing local as well as non-local interactions made possible by brain criticality and amplified by the anatomical long-range connectivity. We successfully identified distinct distributed spatiotemporal manifolds across brain states and outperformed traditional dimensionality reduction techniques. During rumination after MBCT we found consistent recruitment of regions involved in bodily and interoceptive processing integrated within the whole-brain across manifolds, changes in latent configurations associated with clinical and behavioural improvements, and greater flexibility within the reduced space. Integration of bodily and interoceptive processing regions within distributed whole-brain manifolds and greater brain flexibility may be associated with reduced 'stickiness' of ruminative thinking patterns following mindfulness training in depression. Our findings highlight the promise of low-dimensional manifolds and long-range interactions arising from critical brain dynamics in understanding how mindfulness targets depressive ruminative processing.

Objectives: Given the high injury burden in football and the documented limitations of strength-based screening, novel approaches are warranted. Adaptive Force (AF)being closer to injury-prone movements than pushing/pulling strength--offers an alternative. This study examined the association between AF-based muscle stability and musculoskeletal complaints in football players and compared AF-derived and conventional strength parameters in their discriminative capacity, complemented by a preliminary prospective follow-up. Methods: AF and maximal voluntary isometric contraction (MVIC) were measured in 23 male football players across five bilateral muscle groups (knee extensors/flexors; hip flexors/adductors/abductors). AF parameters (maximal isometric AF, maximal AF, AF-Ratio), MVIC and hamstrings-to-quadriceps (H:Q) ratio were compared between players with and without complaints assessed via questionnaire at baseline and six-month follow-up (n=13). Results: Stability deficits were strongly associated with complaints (OR=54.0, 82% side concordance). AF-Ratio discriminated clearly between players with and without complaints (d=-1.47), with hip abductors showing the strongest effect (d=-1.64). Players with subsequent complaints showed lower baseline AF-Ratio (d=-1.45) and more stability deficits (d=1.67). MVIC and H:Q ratio did not discriminate (p>0.430). Conclusion: The findings suggest that muscle stability assessment outperforms conventional strength parameters in discriminating players with and without complaints, with preliminary follow-up data providing tentative support for predictive value. The concept of functional instability syndrome (FIS) provides a mechanistic framework for non-contact injuries and musculoskeletal complaints. AF assessment offers potential for screening, including return-to-sport decisions. Further studies are needed to verify the results, investigate predictive value, and evaluate whether personalised stability-based interventions can reduce injury incidence.

Social media users often feel that time vanishes while scrolling, but real feeds confound novelty, rewards, social signals, and self-paced control, leaving the driver of this distortion unclear. We tested whether self-paced visual exploration is sufficient to compress subjective time by comparing active scrolling with passive, yoked viewing and a static baseline. Twenty-three adults viewed sequences of natural images under three within-subject conditions: Scrolling (self-paced mouse clicks), Watching (a passive, yoked replay of their own scrolling sequence), and a Baseline (a static image). Participants estimated the elapsed duration of each block. Subjective duration was most compressed under Scrolling (48% of elapsed time), followed by Watching (51%) and Baseline (65%). Two sources separated these effects. Adding back the empty inter-image fixations brought the image-rich conditions to within seconds of the Baseline, showing that observers barely counted the blank gaps; the Scrolling--Watching difference, by contrast, was independent of these shared gaps, isolating self-paced control as a second source of compression. Electrophysiology linked that control to anticipatory neural states and the timing of early visual responses, with no amplified encoding of individual images. The results favor an attention-weighted account of timing, on which subjective duration tracks how much attention reaches the clock, a resource that a self-paced stream and its uncounted gaps both draw away.

The spatial arrangement of immune cells in the tumor microenvironment (TME) varies widely, from dispersed to clustered and tumor excluded to infiltrating. Multiplexed spatial profiling is an effective means of characterizing tumor-infiltrating lymphocytes (TILs) and immune complexes such as tertiary lymphoid structures (TLS) in the TME. However, few approaches have been described for objectively parametrizing patterns of immune organization and assessing their association with biological or clinical variables. This makes it difficult to evaluate whether a set of tumors is relatively immunologically cold or hot. Here we describe an intuitive set of statistical tools (available in the R package, tlsR) for characterizing lymphocyte patterns in the TME of solid cancers. We apply tlsR to primary prostate cancer (PCa), which is often described as immunologically cold. Using a cohort of 29 radical prostatectomy specimens stratified into low Gleason-grade (LGG; n=15) and high Gleason-grades (HGG; n =14) we show that HGG PCa is significantly more infiltrated than LGG PCa with lymphocytes organized into B cell or T cell enriched immune clusters (BICs and TICs). A subset of these ICs have the B and T cell zonation and follicular dendritic cells characteristic of a bona fide TLS. HGGs are also enriched with ICs containing precursor exhausted T cells (Tpex) and proliferating B cells and their tumor compartments harbor granzyme-B+ cytotoxic T cells in contact with cancer cells. Thus, far from being cold, a subset of HGG PCa has features associated with active immune surveillance, a finding with implications for emerging PCa immunotherapies.

We showed before that the endogenous peptide Nociceptin blocks the premature differentiation of oligodendrocytes (OLGs), preventing untimely precocious myelination in the developing brain. Consistent with this early function, Nociceptin brain expression is developmentally regulated, sharply decreasing with the initiation and progression of myelination. However, we now found that at difference with controls and relapsing-remitting multiple sclerosis (RRMS), Nociceptin levels are highly elevated in cerebrospinal fluid from patients with the most severe progressive MS (PMS) forms. This questioned whether Nociceptin early developmental effects could be latter recapitulated, interfering with remyelination in PMS. This possibility was tested by inducing experimental autoimmune encephalomyelitis in older mice, at an age equivalent to that with increased risk of RRMS transition into PMS. Older animals develop persistently highly debilitating clinical symptoms, and display both brain and spinal cord demyelination. Importantly, these mice exhibit elevated brain Nociceptin levels, and their treatment with an antagonist of the Nociceptin receptor (NOR) elicits a regression of clinical scoring that is accompanied by higher ratios of OLGs/OLG progenitor cells, increased myelination, and reduction of reactive astrocytes. These findings suggest that Nociceptin may be a crucial player in the age-related progression of MS; interfering with OLG maturation and remyelination, and perhaps further exacerbating neurological dysfunction by targeting astrocyte populations. The upregulation of Nociceptin secretion by human astrocytes in response to proinflammatory cytokines, also points to this peptide as a mediator of microglia-astrocyte interactions supporting MS progression with aging. NOR may offer a novel pharmacological target for ameliorating the devastating effects of MS progression.

Temporal niche partitioning is a strategy for reducing interspecies competition and strengthening reproductive isolation. It relies on animals confining their daily activity to distinct diurnal, crepuscular, or nocturnal windows. However, a hardwired temporal niche is only advantageous under stable, predictable ecological regimes; surviving dynamic environments demands behavioral flexibility. Yet, it remains unclear how animals override rigid biological constraints to rapidly exploit transiently available fitness-critical time windows. To address this, we leveraged the twilight-active, species-rich Drosophila genus and monitored their daily activity under naturalistic conditions. Here, we show that intense sociosexual interactions rapidly drive a species-specific reformatting of their canonical crepuscular niche. The dominant sensory modality used for sexual communication predicts niche shift direction: reliance on chemosensation for courtship redirects behavioral activity into the night, while visual reliance shifts it into the day. This temporal plasticity bypasses the circadian clock, instead operating via a conserved dopaminergic pathway. Dopamine operates a dual-output brain circuit that simultaneously inhibits sleep and sustains sexual motivation. Our results reveal how mating imperatives decouple behavioral timing from circadian command, enabling conditional colonization of otherwise restricted temporal windows. Ultimately, by driving the divergence of previously overlapping niches, sociosexually induced temporal plasticity provides a powerful mechanism for sympatric coexistence in crowded environments.

Single-nucleus transcriptomic atlases offer an unprecedented opportunity to connect cellular molecular states with Alzheimer's disease (AD) neuropathology, but whether these profiles encode reproducible, predictive information about pathological burden remains unclear. We present the SEA-AD DREAM Challenge, an open, international, model-to-data competition built on the Seattle Alzheimer's Disease Brain Cell Atlas to predict Alzheimer's disease neuropathological severity from single-nucleus RNA-sequencing data. Participants developed containerized models to predict categorical neuropathological staging, including overall Alzheimer's disease neuropathologic change, Braak stage, Thal phase, and CERAD score, as well as quantitative amyloid-{beta} and phospho-tau burden measured by 6E10 and AT8 immunohistochemistry. Across 17 eligible teams from 15 countries, the crowdsourcing framework enabled systematic comparison of diverse computational approaches and surfaced a broad landscape of modeling strategies and candidate predictive features. Top-performing methods achieved near-perfect prediction of categorical staging, with the best submission reaching a quadratic weighted kappa of 1.0 for the Overall AD Neuropathological Change score (ADNC), and competitive prediction of quantitative pathological burden in held-out data, with a best concordance correlation coefficient of 0.48. Post hoc perturbation analyses revealed that top categorical-stage predictions relied heavily on donor-level metadata-driven signals rather than transcriptomic features, whereas quantitative pathology prediction was more robust and supported by transcriptomic and cell-type-associated features with potential biological relevance to AD progression. The challenge also introduced the first AI Agent Track in a DREAM Challenge, providing an early benchmark for autonomous and human-guided agentic model development in single-cell neuroscience. This work demonstrates that single-nucleus transcriptomes encode substantial information about Alzheimer's disease pathology, establishes a reproducible benchmark for molecular neuropathology prediction, and highlights critical principles for designing privacy-preserving, leakage-aware community challenges using deeply phenotyped human brain data.