Background: Traumatic brain injury (TBI) and depression are major global health burdens, yet their bidirectional causal relationship remains unclear. Objective: To explore the causal relationship between depression and TBI, and to clarify whether depression is one of the potential risk factors for TBI and whether TBI is one of the pathogenic factors for depression. Methods: This bidirectional two‐sample Mendelian randomization (MR) analysis investigated causal relationships between depression ( n = 170,756) and TBI ( n = 3193) using genome‐wide association study (GWAS) summary statistics. Genetic instruments were selected as single nucleotide polymorphisms (SNPs) significantly associated with exposures (depression/TBI) and outcomes (TBI/depression) at genome‐wide significance ( P < 5 × 10⁻⁶). The inverse variance weighted (IVW) method under fixed‐effects and multiplicative random‐effects models served as the primary analytical approach, with Cochran's  Q  test evaluating SNP heterogeneity. To address horizontal pleiotropy, MR‐Egger regression and MR‐PRESSO(MR Pleiotropy RESidual Sum and Outlier)outlier correction were applied. Sensitivity analyses included weighted median, penalized weighted median, maximum likelihood estimation, and leave‐one‐out validation to ensure robustness. All analyses were conducted using the TwoSampleMR package in R (v4.3.2), with effect estimates reported as odds ratios (OR) and 95% confidence intervals (CI). Results: MR analyses revealed bidirectional causal relationships between depression and TBI. In forward analyses, depression increased TBI risk across multiple IVW frameworks (fixed‐effects IVW: OR = 1.137, 95% CI = 1.019–1.271, P = 0.022; multiplicative random‐effects IVW: OR = 1.137, 95% CI = 1.014–1.277, P = 0.028), corroborated by maximum likelihood estimation (OR = 1.137, 95% CI = 1.017–1.274, P = 0.024). Reverse analyses demonstrated TBI's causal effect on depression through IVW models (fixed‐effects: OR = 1.083, 95% CI = 1.036–1.131, P < 0.001; multiplicative random‐effects: OR = 1.083, 95% CI = 1.043–1.124, P < 0.001) and penalized weighted median methods (OR = 1.079, 95% CI = 1.018–1.145, P = 0.011). Robustness was confirmed by null heterogeneity (Cochran's Q: forward P = 0.209, reverse P = 0.596) and absence of horizontal pleiotropy (MR‐PRESSO: forward P = 0.218, reverse P = 0.672; MR‐Egger intercepts: forward P = 0.661, reverse P = 0.874). All effect estimates remained stable in sensitivity analyses, supporting unconfounded causal inference. Conclusion: Our MR analyses robustly demonstrate bidirectional causality: depression is a risk factor for TBI (OR = 1.137, 95% CI = 1.019–1.271), and TBI subsequently increases depression risk (OR = 1.083, 95% CI = 1.036–1.131), advocating integrated clinical monitoring.

Traumatic brain injury (TBI) is a leading cause of global mortality and disability. Early identification of mortality risk factors is crucial for improving outcomes. The Braden Scale score, a routinely collected nursing assessment tool originally designed for pressure injury risk assessment, has been underexplored for mortality prediction in TBI patients. This study aimed to evaluate the association between Braden Scale scores at ICU admission and short-term all-cause mortality in TBI patients. This retrospective cohort study utilized the MIMIC-IV database as the derivation cohort and the eICU-CRD database for external validation. Adult TBI patients with complete Braden Scale assessments and outcome data were included. The primary exposure was the initial Braden Scale score, categorized into low and high groups based on the median value. Outcomes included 28 days and 60 days all-cause mortality in both hospital and ICU settings. We also evaluate the components of braden scores by cox regression for outcoms. Statistical analyses included multivariable Cox regression, restricted cubic splines, subgroup analyses, and assessments of predictive performance using IDI, NRI, ROC curves, and decision curve analysis. A total of 2355 patients were analyzed. The low Braden score group showed significantly higher mortality across all endpoints: hospital 28 days (48.1% vs. 19.7%), hospital 60 days (49.4% vs. 20.7%), ICU 28 days (46.2% vs. 18.9%), and ICU 60 days (47.6% vs. 19.8%) (all p < 0.001). After multivariable adjustment, low Braden scores remained independently associated with mortality, with adjusted hazard ratios ranging from 1.78 to 1.84. In a cox regression analysis for the components of Braden Scale, we identified significant inverse associations of sensory perception, activity, nutrition, and friction/shear with multiple mortality outcomes. A nonlinear dose–response relationship was observed, with mortality risk increasing sharply at scores below 12–15. Subgroup analyses indicated a more pronounced association in patients aged ≤ 65 years, while the association was attenuated in those with renal disease. The Braden score demonstrated robust discriminative ability (AUCs: 0.77–0.82) and clinical utility in decision curve analysis. The Braden Scale score is a strong, independent, and readily available predictor and risk factor of short-term mortality in TBI patients, demonstrating a nonlinear inverse relationship with death risk. Subitem analysis further identified sensory perception, activity, nutrition, and friction/shear as key components significantly associated with reduced mortality. These properties support its practical utility for risk stratification at the bedside.

Background: The development of rehabilitation protocols after rotator cuff repair has long lacked objective benchmarks. Traditional time‑based regimens are limited by considerable inter‑individual variability and an increased risk of re‑tear. Musculoskeletal ultrasound allows dynamic assessment of tendon healing and muscle morphology, yet evidence for directly linking its use to rehabilitation decisions remains scarce. Objective: To systematically synthesize the evidence on the use of musculoskeletal ultrasound monitoring to inform rehabilitation decision‑making after rotator cuff repair. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta‑Analyses (PRISMA) guidelines, we searched PubMed, China National Knowledge Infrastructure (CNKI), and Wanfang Data from January 2020 to April 2026. Original studies were included if they involved patients who had undergone rotator cuff repair, used musculoskeletal ultrasound (including gray‑scale ultrasound, elastography, etc.) to evaluate the rotator cuff tendons or shoulder muscles, and reported at least one parameter related to rehabilitation decision-making or functional outcomes. Results: Eleven studies were included. Shear wave velocity (SWV), cross‑sectional area (CSA), and echo intensity (EI) were the most frequently reported ultrasound parameters. Available evidence indicated that SWV increased progressively after surgery, with an overall increase of approximately 22% to 25% from one week to 12 months postoperatively. This dynamic trajectory may serve as a reference baseline for judging rehabilitation progress. An abnormally elevated SWV in the early postoperative period was associated with an increased risk of re‑tear, suggesting that a more conservative rehabilitation strategy should be adopted. Tendon stiffness measured at 12 weeks after surgery independently predicted long‑term return to sport. Regarding muscle parameters, changes in CSA and EI were positively correlated with shoulder function scores, and the combination of these two parameters effectively identified patients with rehabilitation bottlenecks . Conclusion: Musculoskeletal ultrasound parameters are associated with the initiation of active movement, adjustment of exercise load, prediction of return‑to‑sport prognosis, and identification of retear risk. Among these, SWV shows particular promise as an objective monitoring parameter for supporting rehabilitation assessment after rotator cuff repair. Future randomized controlled trials are needed to determine whether ultrasound-informed assessment can improve rehabilitation outcomes compared with traditional time-based regimens, and to establish standardized measurement protocols and clinically applicable reference values. Key findings of this review are summarized in S1 File.

Background The development of rehabilitation protocols after rotator cuff repair has long lacked objective benchmarks. Traditional time‑based regimens are limited by considerable inter‑individual variability and an increased risk of re‑tear. Musculoskeletal ultrasound allows dynamic assessment of tendon healing and muscle morphology, yet evidence for directly linking its use to rehabilitation decisions remains scarce. Objective To systematically synthesize the evidence on the use of musculoskeletal ultrasound monitoring to inform rehabilitation decision‑making after rotator cuff repair. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta‑Analyses (PRISMA) guidelines, we searched PubMed, China National Knowledge Infrastructure (CNKI), and Wanfang Data from January 2020 to April 2026. Original studies were included if they involved patients who had undergone rotator cuff repair, used musculoskeletal ultrasound (including gray‑scale ultrasound, elastography, etc.) to evaluate the rotator cuff tendons or shoulder muscles, and reported at least one parameter related to rehabilitation decision-making or functional outcomes. Results Eleven studies were included. Shear wave velocity (SWV), cross‑sectional area (CSA), and echo intensity (EI) were the most frequently reported ultrasound parameters. Available evidence indicated that SWV increased progressively after surgery, with an overall increase of approximately 22% to 25% from one week to 12 months postoperatively. This dynamic trajectory may serve as a reference baseline for judging rehabilitation progress. An abnormally elevated SWV in the early postoperative period was associated with an increased risk of re‑tear, suggesting that a more conservative rehabilitation strategy should be adopted. Tendon stiffness measured at 12 weeks after surgery independently predicted long‑term return to sport. Regarding muscle parameters, changes in CSA and EI were positively correlated with shoulder function scores, and the combination of these two parameters effectively identified patients with rehabilitation bottlenecks. Conclusion Musculoskeletal ultrasound parameters are associated with the initiation of active movement, adjustment of exercise load, prediction of return‑to‑sport prognosis, and identification of retear risk. Among these, SWV shows particular promise as an objective monitoring parameter for supporting rehabilitation assessment after rotator cuff repair. Future randomized controlled trials are needed to determine whether ultrasound-informed assessment can improve rehabilitation outcomes compared with traditional time-based regimens, and to establish standardized measurement protocols and clinically applicable reference values. Key findings of this review are summarized in S1 File.

Background: Post-stroke morphological and structural alterations in lower-leg muscles—including changes in muscle thickness, pennation angle, fascicle length, and echo intensity—are key factors contributing to gait impairment and functional disability in stroke survivors. Conventional clinical assessments, such as the Modified Ashworth Scale and Fugl-Meyer Assessment, are limited by subjectivity and an inability to quantify intramuscular structural changes. Musculoskeletal ultrasonography, as a non-invasive, real-time, and quantitative imaging tool, has emerged as a valuable technique for evaluating post-stroke muscle alterations. Objective: This systematic review aims to synthesize the literature published in the past 5 years on the application of musculoskeletal ultrasound—including B-mode, shear wave elastography, dynamic ultrasound, and quantitative ultrasound—in assessing morphological and functional changes of lower-leg muscles in stroke patients, and to explore its correlations with clinical outcomes and its utility in guiding rehabilitation interventions. Methods: PubMed, CNKI, and Wanfang Data were searched from January 2020 to December 2025 following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies were included if they were original research involving stroke patients, utilized ultrasound to assess lower-leg muscles, and reported at least one morphological or functional parameter. Results: A total of 8 studies published between 2020 and 2025 were included. The most frequently assessed muscles were the gastrocnemius and tibialis anterior. Compared with the non-paretic side or healthy controls, the paretic lower-leg muscles commonly exhibited reduced muscle thickness and cross-sectional area, altered pennation angle, shortened fascicle length, increased echo intensity (indicating fat infiltration or fibrosis), and elevated shear wave velocity or Young’s modulus (indicating increased stiffness). These ultrasound parameters showed significant correlations with clinical measures of spasticity (e.g., Modified Ashworth Scale), motor function (e.g., Fugl-Meyer Assessment), and muscle strength. Ultrasound was also effectively used to monitor treatment responses, including changes following botulinum toxin injection and rehabilitation training. Conclusion: Musculoskeletal ultrasonography is a promising imaging modality for objectively assessing structural and biomechanical alterations in lower-leg muscles after stroke. Recent evidence from the past 5 years confirms its value in providing insights into the pathophysiology of post-stroke muscle changes, correlating with functional outcomes, and guiding personalized rehabilitation. Future efforts should focus on establishing standardized imaging protocols to enhance clinical applicability and cross-study comparability.

Background The development of rehabilitation protocols after rotator cuff repair has long lacked objective benchmarks. Traditional time‑based regimens are limited by considerable inter‑individual variability and an increased risk of re‑tear. Musculoskeletal ultrasound allows dynamic assessment of tendon healing and muscle morphology, yet evidence for directly linking its use to rehabilitation decisions remains scarce. Objective To systematically synthesize the evidence on the use of musculoskeletal ultrasound monitoring to inform rehabilitation decision‑making after rotator cuff repair. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta‑Analyses (PRISMA) guidelines, we searched PubMed, China National Knowledge Infrastructure (CNKI), and Wanfang Data from January 2020 to April 2026. Original studies were included if they involved patients who had undergone rotator cuff repair, used musculoskeletal ultrasound (including gray‑scale ultrasound, elastography, etc.) to evaluate the rotator cuff tendons or shoulder muscles, and reported at least one parameter related to rehabilitation decision-making or functional outcomes. Results Eleven studies were included. Shear wave velocity (SWV), cross‑sectional area (CSA), and echo intensity (EI) were the most frequently reported ultrasound parameters. Available evidence indicated that SWV increased progressively after surgery, with an overall increase of approximately 22% to 25% from one week to 12 months postoperatively. This dynamic trajectory may serve as a reference baseline for judging rehabilitation progress. An abnormally elevated SWV in the early postoperative period was associated with an increased risk of re‑tear, suggesting that a more conservative rehabilitation strategy should be adopted. Tendon stiffness measured at 12 weeks after surgery independently predicted long‑term return to sport. Regarding muscle parameters, changes in CSA and EI were positively correlated with shoulder function scores, and the combination of these two parameters effectively identified patients with rehabilitation bottlenecks. Conclusion Musculoskeletal ultrasound parameters are associated with the initiation of active movement, adjustment of exercise load, prediction of return‑to‑sport prognosis, and identification of retear risk. Among these, SWV shows particular promise as an objective monitoring parameter for supporting rehabilitation assessment after rotator cuff repair. Future randomized controlled trials are needed to determine whether ultrasound-informed assessment can improve rehabilitation outcomes compared with traditional time-based regimens, and to establish standardized measurement protocols and clinically applicable reference values. Key findings of this review are summarized in S1 File.