The rising prevalence of neuroimmune disorders such as multiple sclerosis and fibromyalgia has renewed interest in the hygiene hypothesis, which posits that reduced early-life microbial exposure deprives the immune system of formative “noise” that calibrates thresholds of tolerance. We extended this framework by introducing stochastic resonance (SR), a system phenomenon in which optimally tuned noise enhances weak-signal detection in nonlinear networks, as a potential surrogate for missing microbial variability. As electrical noise and subthreshold stimulation have been shown to modulate cortical excitability and enhance perception, microbial noise may be necessary for sustaining immune plasticity. Conversely, a lack of stimulation, whether microbial or electrical, can lead to maladaptive states characterized by dysregulated signaling and heightened vulnerability to chronic inflammation. Evidence from immunology highlights noise-aware processes, such as T-cell receptor proofreading, NF-κB pulsatility, and cytokine quorum sensing, all of which exploit stochastic fluctuations. Computational tumor–immune models similarly suggest that tuned noise can optimize immune surveillance. Clinical data from neuroscience demonstrate that subsensory electrical noise improves motor excitability and sensory perception, whereas vagus nerve stimulation modulates inflammatory pathways, underscoring translational feasibility. We propose that SR reframes noise from a biological error to a therapeutic resource capable of recalibrating dysregulated neuroimmune thresholds. This conceptual synthesis positions microbial and electrical noise as parallel modulators of tolerance and outlines testable predictions with translational potential for neuroimmune disorders.

Background: Parkinson’s disease (PD) is a progressive neurodegenerative disorder causing disabling motor dysfunction and substantial socioeconomic burden. Photobiomodulation (PBM), a noninvasive red/near-infrared light therapy, has shown preclinical promise, but its clinical efficacy and safety in PD remain uncertain. Objectives: To systematically evaluate the efficacy and safety of PBM on motor outcomes in PD. Methods: This PRISMA-compliant systematic review was prospectively registered in PROSPERO (CRD420261411269). Databases were searched through May 2026. Randomized and non-randomized trials in adults with PD were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias (RoB 2.0; ROBINS-I). Where data permitted, random-effects meta-analyses used mean difference (MD) with REML estimation and Hartung–Knapp–Sidik–Jonkman confidence intervals. Results: Eight trials (n = 279) were included, exhibiting substantial heterogeneity in wavelength, device type, stimulation sites, and dosimetry. PBM was safe and well tolerated, with only minor adverse effects. Meta-analysis of four RCTs found no significant effect on MDS-UPDRS-III (MD = −1.37 points, 95% CI: −5.55 to 2.80; I² = 20.6%) or TUG (MD = −0.52 s, 95% CI: −5.03 to 3.99; I² = 55.1%). An exploratory TMWT meta-analysis (k = 2) yielded MD = −0.65 s (95% CI: −1.78 to 0.49; I² = 0.0%), with direction consistently favoring PBM. Individual effect sizes ranged from negligible (d = 0.03–0.06) to small-to-moderate (d = 0.41). Conclusions: PBM appears safe, feasible, and acceptable in PD, but current evidence does not support clinically meaningful motor benefits. Heterogeneous protocols, small samples, and absent target-engagement biomarkers limit definitive interpretation. Well-powered standardized trials with mechanistic endpoints are needed.

Limited inclusion of ethnically diverse and socioeconomically disadvantaged populations in pain research undermines external validity, generalizability, and equity. This comprehensive review synthesized evidence on effective strategies to recruit and retain these populations in pain studies. We searched Medline, Web of Science, Embase, Scopus, and CENTRAL (12 April 2025) and included studies in which ethnically diverse and socioeconomically disadvantaged participants comprised ≥75% of the sample. Quantitative data were pooled using random-effects meta-analyses of proportions, with prespecified subgroup analyses, and qualitative findings were integrated through thematic synthesis. Certainty of evidence was evaluated using GRADE. Eighteen studies (n = 4611; 11 experimental, 5 observational, 2 qualitative), primarily from the United States and involving chronic pain, met inclusion criteria. Overall enrollment among ethnically diverse and socioeconomically disadvantaged groups was 37% (95% CI 18–58%), with significantly higher enrollment in observational studies (84%, 95% CI 78–90%) than in experimental trials (22%, 95% CI 10–36%; p < 0.001). Overall retention was 77% (95% CI 64–88%) and did not differ significantly by study design. Statewide disease-clinic networks, purposive community-leader engagement, and snowball sampling produced the highest enrollment, whereas medical-record screening yielded the lowest enrollment but the highest retention. Compensation and reminder strategies were similarly effective for retention. Thematic synthesis highlighted trust, culturally and linguistically tailored communication, hybrid and flexible visit schedules, transportation assistance, and clinician engagement as key facilitators. GRADE certainty was low for enrollment and moderate for retention. Community-engaged recruitment strategies, clinician referrals, culturally tailored materials, hybrid procedures, and modest incentives can substantially improve participation of ethnically diverse and socioeconomically disadvantaged populations in pain research. Standardized CONSORT-style reporting of recruitment/retention flowcharts according to strategy and ethnicity/socioeconomic status is essential to refine evidence-based strategies in the future.

BACKGROUND Necrotizing enterocolitis (NEC) is a prevalent, life-threatening gastrointestinal disease in premature neonates, characterized by intestinal inflammation, ischemia, and potential perforation. Protective measures such as ostomies of various types are a strategy to help patients during recovery from postoperative complications. Protective jejunostomy (PJ) in such cases aims to minimize intraluminal pressure and protect distal anastomoses or compromised bowel segments. However, the optimal timing for closure remains a matter of debate, between balancing bowel rest and avoiding complications associated with prolonged ostomies. CASE REPORT We report an unusual case of a 6-month-old female patient, who presented with NEC and extensive intestinal compromise. Emergency laparotomy revealed multiple areas of bowel perforation and partial ischemia without perfusion. Surgical management included selective resection of non-viable bowel segments, primary closure of smaller perforations, creation of a PJ, and a distal ileostomy. The "clip and drop" technique was not used; instead, distal bowel patency was confirmed by a second intraoperative assessment and through intestinal saline solution injection on the tenth postoperative day due to high stoma output and persistent hydroelectrolyte imbalance. Postoperatively, the patient developed 2 new ileal perforations, requiring reoperation. Following the third surgical intervention, the patient demonstrated gradual recovery without major complications, followed by elective ileostomy closure after 6 months. CONCLUSIONS This case highlights the complexity of the surgical option and timing of PJ closure in complicated NEC in a 6-month-old female patient. Early closure can mitigate complications related to the stoma but carries the risk of compromising the fragile and recovering intestine. Decision-making must be careful and individualized, balancing the risks and benefits.

Background: Chronic pain affects nearly one in five adults worldwide and is increasingly recognized not only as a disease but as a potential risk factor for neurocognitive decline and dementia. While some evidence supports this association, existing systematic reviews are static and rapidly outdated, and none have leveraged advanced methods for continuous updating and robust uncertainty modeling. Objective: This protocol describes a living systematic review with dose–response Bayesian meta-analysis, enhanced by artificial intelligence (AI) tools, to synthesize and maintain up-to-date evidence on the prospective association between any type of chronic pain and subsequent cognitive decline. Methods: We will systematically search PubMed, Embase, Web of Science, and preprint servers for prospective cohort studies evaluating chronic pain as an exposure and cognitive decline as an outcome. Screening will be semi-automated using natural language processing models (ASReview), with human oversight for quality control. Bayesian hierarchical meta-analysis will estimate pooled effect sizes and accommodate between-study heterogeneity. Meta-regression will explore study-level moderators such as pain type, severity, and cognitive domain assessed. If data permit, a dose–response meta-analysis will be conducted. Living updates will occur biannually using AI-enhanced workflows, with results transparently disseminated through preprints and peer-reviewed updates. Results: This is a protocol; results will be disseminated in future reports. Conclusions: This living Bayesian systematic review aims to provide continuously updated, methodologically rigorous evidence on the link between chronic pain and cognitive decline. The approach integrates innovative AI tools and advanced meta-analytic methods, offering a template for future living evidence syntheses in neurology and pain research.