Physical Assessment Research Articles

Introduction of AI Technology for Objective Physical Function Assessment

Objective physical function assessment is crucial for determining patient eligibility for treatment and adjusting the treatment intensity. Existing assessments, such as performance status, are not well standardized, despite their frequent use in daily clinical practice. This paper explored how artificial intelligence (AI) could predict physical function scores from various patient data sources and reviewed methods to measure objective physical function using this technology. This review included relevant articles published in English that were retrieved from PubMed. These studies utilized AI technology to predict physical function indices from patient data extracted from videos, sensors, or electronic health records, thereby eliminating manual measurements. Studies that used AI technology solely to automate traditional evaluations were excluded. These technologies are recommended for future clinical systems that perform repeated objective physical function assessments in all patients without requiring extra time, personnel, or resources. This enables the detection of minimal changes in a patient’s condition, enabling early intervention and enhanced outcomes.

Barriers and Facilitators Associated With Remote Concussion Physical Assessments From the Perspectives of Clinicians and People Living With Workplace Concussions: Focus Group Study.

Evaluating the clinical status of concussions using virtual platforms has become increasingly common. While virtual approaches to care are useful, there is limited information regarding the barriers and facilitators associated with a virtual concussion assessment. This study aims to identify the barriers and facilitators associated with engaging in virtual concussion assessments from the perspective of people living with workplace concussions; identify the barriers and facilitators to completing virtual concussion assessments from the perspectives of clinicians; and identify the clinical measures related to 4 clinical domains that would be most appropriate in virtual practice: general neurological examination and vestibular, oculomotor, and cervical spine assessment. We also evaluated effort. Separate online focus groups were conducted with expert concussion clinicians and people living with workplace concussions. A moderator led the focus groups using a semistructured interview guide that targeted a discussion of participants' experiences with virtual assessments. The discussions were recorded, transcribed, and analyzed by 2 reviewers using content analysis. Barriers and facilitators associated with completing the physical concussion examination were categorized based on the domain of the concussion examination and more general barriers and facilitators. Clinician-selected measures believed to work best in a virtual practice were described using frequency counts. A total of 4 focus groups with 15 people living with workplace concussions and 3 focus groups with 14 clinicians were completed using Microsoft Teams. Barriers were identified, such as triggering of symptoms associated with completing an assessment over video (mentioned 13/162 (8%) and 9/201 (4%) of the time for patient and clinician participants, respectively); challenges with location and setup (mentioned 16/162 (10%) of the time for patient participants); communication (mentioned 34/162 (21%) and 9/201 (4%) of the time for patient and clinician participants, respectively); and safety concerns (mentioned 11/162 (7%) of the time for patient and 15/201 (7%) for clinician participants). Facilitators were identified, such as having access to support (mentioned 42/154 (27%) and 21/151 (14%) of the time for patient and clinician participants, respectively); implementing symptom management strategies throughout the assessment (mentioned 11/154 (7%) of the time for patient participants); and having access to resources (mentioned 25/151 (17%) of the time for clinician participants). From the perspective of the clinician participants included in this study, the clinical measures recommended most for a virtual practice were finger to nose testing; balance testing; the Vestibular/Ocular Motor Screening tool; saccades; and cervical spine range of motion within their respective domains (ie, neurological examination, vestibular, oculomotor, and cervical spine assessment). Virtual assessments appear to be useful for both people living with workplace concussions and clinicians. While barriers were identified, such as challenges associated with exposure to screens, virtual assessments have benefits such as improved access to care. The clinician-selected measures that were considered best in a virtual practice will be investigated in an upcoming evaluative study. RR2-10.2196/40446.

Clinical Evidence Regarding Spermidine–Hyaluronate Gel as a Novel Therapeutic Strategy in Vestibulodynia Management

Background: Vestibulodynia (VBD) represents a summation and overlapping of trigger factors (infections, hormonal disturbances, allergies, genetic aspects, psychological vulnerability, and others) with broad individual variability. As there are no standard treatment options for VBD, the disease is still in need of appropriate therapeutic tools. Objectives: A prospective observational trial was performed to confirm the efficacy of a topical gel containing a spermidine–hyaluronate complex (UBIGEL donna™) as either a stand-alone or companion treatment through a multicenter study on a large sample population. Methods: For women with VBD (n = 154), the treatment consisted of approximately two months (4 + 4 weeks) of applications according to the posology of UBIGEL. Evaluation of symptoms was performed on relevant clinical endpoints: dyspareunia and vulvovaginal pain/burning by a visual scale (VAS); vestibular trophism by a vestibular trophic health (VeTH) score; vulvoscopy through a cotton swab test; and the level of hypertonic pelvic floor by a physical graded assessment of levator ani hypertonus. Results: A total of 154 patients treated with UBIGEL donna™ showed significant improvements across all five evaluated parameters, including pain, dyspareunia, swab test results, muscle hypertonicity, and vestibular trophism. Pain and dyspareunia scores decreased by 46.5% and 33.5%, respectively, while significant improvements were also observed in the other parameters (p < 0.0001). These improvements were consistent across various stratifications, including age and disease duration. Conclusions: The findings of the present study suggest that UBIGEL donna™ is effective in alleviating pain and dyspareunia, as well as reducing vestibular hypersensitivity in women with VBD. Although UBIGEL donna™ alone cannot serve as a comprehensive substitute for all recommended therapies, we suggest that multimodal therapy strategies may be crucial for attaining substantial improvement in any aspect of the condition.

Functional outcomes of patients in the medical and trauma critical care units using the chelsea critical care physical assessment tool

Abstract Background Outcome measures in clinical practice assist in establishing progress for effective quality of care. Physiotherapists in the intensive care unit (ICU) promote lung function and facilitate early mobilization to prevent ICU-related complications. Objectives To determine the physical functional outcomes in critically ill patients in the trauma and medical critical care units at three hospitals in the Tshwane District. Method This was a quantitative prospective observational cohort study. Adult patients admitted in the trauma, medical ICU, and high care (HC) units were recruited. Ethical clearance was obtained from the [Masked for blind review], the National Department of Health Research (NHRD), and the Chief Executive Officers (CEOs) of the hospitals. Written consent was obtained from the recruited patients. Assessments were done on Mondays, Wednesdays, and Fridays using the Chelsea Critical Care Physical Assessment (CPAx) Tool until discharge from the units. Data were analyzed using SPSS version 28. Results Functional outcomes that improved quicker were respiratory function, cough reflex, rolling in the bed, and grip strength. An increase in CPAx scores correlated with improvement in the Glasgow coma scale (GCS) in both groups. Median and inter-quartile CPAx scores in the medical ICU for the initial assessments were 3(2–8) with an increase to 8(3.75–28.25) in the final assessment (p = 0.003). The median and interquartile CPAxs scores for initial assessments in the trauma ICU were 2(1–11.75) and 5(3.25–14) for the final assessments, with a p-value of 0.005 which showed statistical significance. Conclusion CPAx mean scores in the trauma ICU were higher than in the medical ICU. There were significant positive changes in the scoring of both populations but this was slightly better in the trauma ICU. Using the CPAx tool in a HC setting seemed feasible and patients showed higher scores compared to both trauma and medical ICU. Clinical implications The CPAX tool assists in the development of rehabilitation goals in the ICU and HC by physiotherapists. The tool can be adapted in the medical and trauma critical care units to assess functional outcomes. Trial registration Pan African Clinical Trials Registry, PACTR202305860988637, Registered 7 May 2023-Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=25542.

Therapeutic Peptides Encapsulated into Lipid-Based Nanovesicles: Scaling from Lab to Plant

Lipid-based peptide-encapsulated nanovesicles represent a cutting-edge approach in drug delivery systems, offering enhanced stability, targeted delivery, and controlled release of therapeutic peptides. This review explores the comprehensive science and techniques behind the robust formulation and analytical methods for these nanovesicles, spanning from lab-scale research to large- scale manufacturing. Critical aspects include lipid selection, detailing how the choice of lipids impacts the stability and efficacy of the nanovesicles, and various peptide encapsulation techniques, emphasizing methods to achieve high encapsulation efficiency and controlled release. Key processes in vesicle formation, such as thin film hydration, sonication, and microfluidics, are discussed to highlight their roles in producing nanovesicles with consistent size and morphology. The importance of stability studies, including physical, chemical, and thermal assessments, is underscored. Analytical techniques such as Dynamic Light Scattering (DLS), Zeta Potential measurement, High-Performance Liquid Chromatography (HPLC), and Mass Spectrometry (MS) are detailed, showcasing their crucial roles in characterizing nanovesicles and ensuring their quality, safety, and efficacy for pharmaceutical use. The review addresses the challenges and solutions associated with scaling up production, including maintaining consistent product quality, optimizing manufacturing processes, and controlling production costs. It also navigates the regulatory landscape, discussing the stringent guidelines set by agencies such as the FDA and EMA and the necessity of strategic regulatory planning to facilitate market approval. This comprehensive review aims to serve as an in-depth resource for experts in the field, aiding in the translation of lipid-based peptide-encapsulated nanovesicle formulations from bench to bedside, ultimately enhancing therapeutic outcomes and expanding treatment options for various disease. Key Words: Peptide, Amino acid, Degradation, Pharmacokinetics, Peptide encapsulation, drug delivery systems, Peptide Characterization

Presentation and physical therapy management using a neuroplasticity approach for patients with hypermobility-related upper cervical instability: a brief report

BackgroundUpper cervical instability (UCI) is a potentially disabling complication of the connective tissue disorders hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders (hEDS/HSD). UCI can impact various neurological structures, including the brainstem, spinal cord, cranial nerves, and blood supply to and from the brain, resulting in complex neurological signs and symptoms in this population. The current study was an observational study applying recent expert consensus recommendations for physical therapy assessment and management of patients with UCI associated with hEDS/HSD.MethodsThis was a retrospective observational study describing how the clinical decision-making model was used to screen, examine, and treat three patients with highly irritable hEDS/HSD-related UCI, resulting in complex neurological presentation. The treatment used a neuroplasticity approach, including proprioception and motor control training emphasizing patient education and biofeedback. Outcome measures tracked progress.ResultsAll patients started with significant disability associated with UCI. One patient returned to full function with intermittent flares that he was able to manage. The second patient continued to have mild-moderate irritability but returned to parenting responsibilities and full-time work. The third patient required cervical fusion and remained disabled but was better able to minimize flares. The number of initial red and yellow flags was associated with the final outcomes, suggesting that the decision-making model might be useful for predicting patient prognosis.ConclusionThis brief report applies recent recommendations for safely evaluating and managing hypermobility-related UCI and provides a first step in experimental studies to test both the assessment and physical therapy treatment approaches.

Physical fitness and body build parameters of children and adolescents participating in the physical activity promotion programme “Athletics for all!”

BackgroundThis study attempts to analyse physical fitness and basic anthropometric parameters of children and adolescents participating in the nationwide physical activity promotion programme “Athletics for All!” (AFA). The programme aims to establish a national system for diagnosing, selecting, recruiting, and identifying talents in youth training. It also aims to build a career development path for athletics, forming the basis of a new structure for youth training in Poland. The primary goal of this study was to assess physical fitness of AFA participants over the years of its implementation (2015–2022) and to identify the leading motor ability with consideration for age, gender, and body build parameters determined with Body Mass Index and Ponderal Index.MethodsNationwide measurements of basic anthropometric parameters as well as physical fitness tests were conducted among 31,790 girls (F) and 22,260 boys (M) participating in the AFA programme. Physical fitness assessments were performed using the OSF test (3 × 10 m shuttle run, standing broad jump, 1 kg medicine ball throw, 4-minute run). Comparative analysis of OSF test results, considering gender, was conducted using the independent samples T-test. The strength and direction of correlations between variables were calculated using the rho-Spearman coefficient.ResultsOSF test results were converted into points, considering age and gender. Gender was found to be a significantly differentiating factor in physical fitness of AFA participants. Among twelve- and fifteen-year-olds, statistically significant differences were observed in all analysed variables, i.e. in each of the four tests and the overall score. It was noted that the examined girls aged 11 to 17 exhibited higher levels of strength compared to their male counterparts. Statistical analysis revealed significant correlations between OSF test results and the age and body build indicators, with the strength of the correlations being negligible in most cases.ConclusionsParticipants of the nationwide programme “Athletics for All!” demonstrate a high level of physical fitness, with endurance being a fundamental motor ability. Physical fitness levels show significant correlations with the anthropometric parameters of children and adolescents. The study results confirm the need and justification for implementing physical activity promotion programmes for the younger generation.

Clinical Phenotypes Associated with the Gut Microbiome in Older Japanese People with Care Needs in a Nursing Home

Background: Frailty increases the risk of needing nursing care and significantly affects the life and functional prognosis of older individuals. Early detection and tailored interventions are crucial for maintaining and enhancing their life functions. Recognizing distinct clinical phenotypes is essential for devising appropriate interventions. This study aimed to explore diverse frailty phenotypes, focusing on poor nutrition in older Japanese individuals through observational research. Methods: Twenty-one nursing home residents underwent a comprehensive survey covering physical, blood, dietary, cardiac, cognitive, nutritional, nursing care, frailty, agitated behavior, and gut microbiome assessments (high-throughput 16S rRNA gene sequencing). Using clustering analysis with 239 survey items (excluding gut microbiome), participants were classified into subgroups based on clinical phenotypes, and group characteristics were compared through analysis. Results: Individuals with moderate or severe frailty and suspected dementia formed subgroups with distinct clinical phenotypes based on nutritional, defecation, and nursing care statuses. The gut microbiome significantly varied among these groups (p = 0.007), indicating its correlation with changes in clinical phenotype. Nutritional status differences suggested poor nutrition as a differentiating factor in the core clinical phenotype. Conclusions: This study proposes that the gut microbiome differs based on the clinical phenotype of Japanese older individuals with frailty, and targeted interventions addressing the gut microbiome may contribute to preventing frailty in this population.

A mixed methods study of student pharmacist perceptions of their confidence and competence in the provision of clinical assessment

Abstract Introduction Pharmacist involvement in clinical assessment or examination has recently come into the focus in the United Kingdom with the transition of the pharmacy workforce to prescribers. Clinical assessment starts with the collection of information on an individual’s past medical history and clinical presentation, and the interpretation of tests, observations, and physical assessments to inform a differential diagnosis.1 The range of clinical skills student pharmacists gain from placements during the MPharm is variable and shaped by local demands for pharmacy services. Therefore, there is a need for additional training on clinical assessment skills in classroom teaching.2-4 Aim To identify student pharmacist perceptions and beliefs on their competence in conducting clinical assessment. Methods Ethics approval for this research study was granted by the Strathclyde Institute of Pharmacy and Biomedical Sciences Ethics Committee and conducted between October-December 2023. A mixed-methods study was conducted using a survey and focus group discussions developed from the literature and validated through discussion to collect student pharmacist perceptions of the role of the pharmacist and current gaps/barriers to pharmacist provision of clinical assessments. Students from all years of the MPharm were invited by email to participate (n=615). Audio recordings captured from focus group discussions were thematically analysed to identify key themes. Results Four focus groups were held with a total of 30 students. There were 89 respondents to the online survey (119 in total). Across both approaches, five key themes were identified from the survey and four from the focus group interviews. These themes centred around student pharmacist perceived role of the pharmacist, time and technical resources available in the pharmacy workplace, and the current curriculum. Most students agreed that such clinics would be beneficial to their training. Discussion and Conclusions Student-led clinics are gaining popularity as a work-based approach to learning. We found varied perceptions of the pharmacist’s role by participant response, suggesting that the clinical nature of pharmacy as a profession must be highlighted to prospective students to ensure those entering the profession are aware of the responsibilities they may be required to undertake. A limitation of this study is that student perceptions reflect the views of a single institution. Careful design of future clinics is required to ensure their seamless integration in the existing MPharm curriculum, in a realistic setting reflecting the workplace, and sufficient support from practitioners to implement them. Future work in this area should focus on how clinical assessment skills should be learned and assessed in student populations.

Research on physical health assessment and intervention strategies for college students based on biomarkers

Effective physical health assessments and intervention strategies are crucial for college students, who often face unique stressors that can impact their physiological health. In this analysis, we explore how biomarkers can be utilized to assess physical health and the efficacy of targeted interventions for this demographic. Hypotheses were developed based on the three intervention groups: (1) a face-to-face intervention group receiving a tailored wellness program, (2) an Internet of Things (IoT) gadgets intervention group using a health management assessment, and (3) a control group with only baseline and follow-up measurements. College students (n = 204) were randomized into these groups. Biomarkers related to stress and inflammation (e.g., cortisol levels, high-sensitivity C-reactive protein (hs-CRP)) were measured at baseline, post-intervention (10 weeks), and follow-up (36 weeks). Psychological and physical health outcomes were also assessed using standardized questionnaires. The Mixed-Effects Models, ANOVA, and Structural Equation Modeling (SEM) were used to analyze the differences between groups, changes in biomarkers over time, and the relationships between psychological, physiological, and lifestyle variables. Results indicated that the face-to-face wellness group demonstrated significantly better physical health outcomes compared to both the IoT gadgets group and control group, with diet modification showing the highest effectiveness, followed by physical activity and stress management interventions.

Non-linear relationship between lipid accumulation products and risk of diabetes in Japanese adults

The lipid accumulation product (LAP) is a novel, sex-specific indicator of lipid accumulation. While previous studies have investigated the relationship between LAP and diabetes, they have not specifically addressed potential sex differences in this association. The present study explores the potential sex-specific differences in the relationship between LAP and diabetes mellitus (DM) risk in the Japanese population. From 2004 to 2015, a total of 15,263 Japanese individuals without DM underwent physical assessments at Murakami Memorial Hospital. The association between LAP and incident diabetes was analyzed using Cox proportional hazards regression models, incorporating cubic spline functions and smooth curve fitting to identify potential non-linear relationships. Subgroup and sensitivity analysis assessments were conducted to validate the robustness of our findings. After adjusting for covariates, a positive association between LAP and DM risk was observed in both females (HR: 1.02, 95% CI: 1.00-1.03, P = 0.0138) and males (HR: 1.01, 95% CI: 1.00-1.01, P = 0.0314). A non-linear association between LAP and incident DM was identified for both sexes. The inflection points for LAP were 16.58 for females and 11.11 for males. In females, the HR to the left and right of the inflection point were 1.09 (95% CI: 1.02–1.17) and 1.01 (95% CI: 1.00-1.03), respectively. In males, the HR to the left and right of the inflection point were 0.92 (95% CI: 0.86–0.98) and 1.01 (95% CI: 1.00-1.01), respectively. Sensitivity analysis indicated a stronger association between LAP and DM risk. Elevated baseline LAP levels were associated with an increased risk of incident DM, with the relationship exhibiting non-linear characteristics. These findings suggest that maintaining lower LAP levels may help mitigate the risk of developing diabetes.

Effectiveness and Durability of a Workplace Sedentary Behavior Intervention Based on the Total Worker Health® Approach

We used the Total Worker Health® approach to develop a multi-component workplace sedentary behavior intervention and tested intervention effectiveness in a cluster randomized trial. Participants (n = 198; 75% female) were recruited from three call-centers (two intervention and one usual practice control). All worksites received pedal stand active workstations. The usual practice site received no additional support, while the intervention group completed a six-month program of activities including computer-based training, behavioral self-monitoring, health and safety discussions, and pedaling competitions. Data collection included a survey, a physical health assessment, and accelerometer measures of sedentary behavior, physical activity, and sitting/standing time. Primary analyses were generalized estimating equations comparing changes between intervention and usual practice conditions over time, along with analyses of changes in both groups combined over time. Six-month results revealed less prolonged sitting and reductions in musculoskeletal pain in both groups (all p < 0.05), while the intervention group showed additional improvements in moderate physical activity (p < 0.001) and use of pedal stands (p < 0.01). At 12-months, the additional physical activity and pedal stand use in the intervention group regressed to baseline levels, while reductions in prolonged sitting in both groups were durable (p < 0.01). This study adds to previous research showing the effectiveness of the Total Worker Health® approach for workplace health and safety. Results also show that, while providing employees with health and safety resources is beneficial, providing ongoing support for the adoption and use of resources is more effective.

Dietary assessments in individuals living with coeliac disease: key considerations.

Coeliac disease (CeD) is a type of enteropathy characterised by an immune-mediated reaction to ingested gluten, resulting in impaired absorption of nutrients and symptoms such as bloating, abdominal cramping and diarrhoea. Currently, the only treatment for CeD is adherence to a gluten-free diet (GFD). The latest draft guidance from the US Food and Drug Administration recommends that dietitians experienced in CeD management evaluate patients during the screening and treatment period of CeD clinical trials to assess adherence to a GFD. However, there are currently no standardised guidelines on dietary assessment of patients with CeD on a GFD and there is a lack of widespread availability of expertise in this field. Based on the findings of a literature review conducted between April and September 2023, this article provides an overview of key points to consider in the nutritional and dietary assessment of patients with CeD who are following a GFD, with particular focus on the clinical trial setting. Based on a consensus from dietitians and gastroenterologists experienced in treating patients with CeD, we present specific recommendations for registered dietitians who manage patients with CeD. We also describe the development of a simplified tool for assessment of adherence to a GFD, the Gluten-Free Adherence Survey, based on these recommendations. These guidelines cover nutritional and dietary assessment of patients with CeD, physical assessments, intake of oats, environmental considerations and the disease burden.

Ensuring Safe Practice by Late Career Physicians: Institutional Policies and Implementation Experiences.

Late career physicians (LCPs; physicians working beyond age 65 to 75 years) may be at higher risk for delivering unsafe care. To oversee LCPs, some health care organizations (HCOs) have adopted LCP policies requiring cognitive, physical, and practice performance screening assessments. Despite recent controversies, little is known about the content and implementation of such policies. To characterize key features of LCP policies and the perspectives of medical leaders responsible for policy development and implementation. Mixed-methods study using content analysis and key informant interviews. 29 U.S. HCOs with LCP policies active in 2020. 21 purposively sampled interviewees in physician leadership roles at 18 HCOs. Descriptive statistics of policy features and content analysis of interviews. Although policies had many commonalities-mandatory universal screening at a trigger age around 70 years, a strategy of screening followed by in-depth assessment of positive results, and commitment to patient safety as the key motive-they varied substantially in the testing required, funding, processes after a positive screening result, and decision making around concerning results. Policies prioritized institutional discretion in interpreting and responding to test results; many lacked clear language about appeals or other procedural protections for physicians. Leaders were generally satisfied with policies but reported preemptive retirements as physicians approached the screening age and cautioned that substantial investment in cultivating physicians' buy-in was required for successful rollout. Sampled policies and interviews may not be representative of all HCOs. The analysis excluded the experiences of HCOs that tried and failed to implement LCP screening. Policies about LCPs are considered successful by institutional leaders. Policy variations and early adopters' implementation experiences highlight opportunities to improve physician acceptance and program rigor. The Greenwall Foundation.

The Limping Child: A Guide for the Trainees.

Limping is a common presenting complaint in children. Despite this, it remains to be a diagnostic challenge for treating physicians due to an expanded list of etiologies. It arises from a spectrum of disorders, ranging from physiological variations of gait at different stages of development to systemic causes, such as inflammatory diseases or musculoskeletal infections. On rare occasions, non-musculoskeletal causes could result in limping. The diagnostic challenge increases in younger age children where a detailed physical examination that helps identify the exact source of pathology may not be possible. In older patients who have a well-developed gait cycle, the physical assessment might be easier. Clinical assessment in a child presenting with a limp includes gait analysis, which is essential to guide the appropriate request of diagnostic laboratory tests and imaging studies. In this paper, we provide a practical guide for a trainee in General Pediatric and Pediatric Rheumatology on an approach to a limping child, aiming to identify the common causes of limping and to describe normal and abnormal gait cycles. We also discuss other diagnostic considerations in the assessment of these children.

CSF Parvalbumin Levels at Multiple Sclerosis Diagnosis Predict Future Worse Cognition, Physical Disability, Fatigue, and Gray Matter Damage.

Cognitive impairment (CI) in multiple sclerosis (MS) is frequent and determined by a complex interplay between inflammatory and neurodegenerative processes. We aimed to investigate whether CSF parvalbumin (PVALB), measured at the time of diagnosis, may have a prognostic role in patients with MS. In this cohort study, CSF analysis of PVALB and Nf-L levels was performed on all patients at diagnosis (T0) and combined with physical, cognitive, and MRI assessment after an average of 4 years of follow-up (T4) from diagnosis. Cognitive performance was evaluated with a comprehensive neuropsychologic battery: both global (cognitively normal, CN, mildly CI, mCI, and severely CI, sCI) and domain cognitive status (normal/impaired in memory, attention/information processing speed, and executive functions) were considered. Cortical thickness and gray matter volume data were acquired using 3T MRI scanner. A total of 72 patients with MS were included. At diagnosis, PVALB levels were higher in those patients who showed a worsening physical disability after 4 years of follow-up (p = 0.011). CSF PVALB levels were higher in sCI patients than in CN (p = 0.033). Moreover, higher PVALB levels significantly correlated with worse global cognitive (p = 0.024) and memory functioning (p = 0.044). A preliminary clinical threshold for PVALB levels at diagnosis was proposed (2.57 ng/mL), which maximizes the risk of showing CI (in particular, sCI) at follow-up, with a sensitivity of 91% (specificity 30%). No significant results were found for these associations with Nf-L. In addition, patients with higher levels of PVALB at diagnosis showed higher cognitive (p = 0.024) and global fatigue (p = 0.043) at follow-up. Finally, higher PVALB levels also correlated significantly with more pronounced CTh/volume at T4 in the inferior frontal gyrus (p = 0.044), postcentral gyrus (p = 0.025), frontal pole (p = 0.042), transverse temporal gyrus (p = 0.008), and cerebellar cortex (p = 0.041) and higher atrophy (change T0-T4) in the right thalamus (p = 0.038), pericalcarine cortex (p = 0.009), lingual gyrus (p = 0.045), and medial frontal gyrus (p = 0.028). The significant association found between parvalbumin levels in the CSF at diagnosis and cognitive, clinical, and neuroradiologic worsening after 4 years of follow-up support the idea that parvalbumin, in addition to Nf-L, might represent a new potential prognostic biomarker, reflecting MS neurodegenerative processes occurring since early disease stages.

Phenyllactic acid modulates the gut microbiota, enhances intestinal health, and alleviates physical frailty in aging mice

Phenyllactic acid (PLA) is a natural antibiotic-like compound derived from certain foods and probiotics. PLA levels have been associated with age-related sarcopenia and provide benefits to metabolic health when derived from probiotics. However, the specific regulatory effects of PLA in aging remain largely unexplored. In this study, aging mice were administered PLA via gavage, followed by fecal 16S rRNA sequencing, measurements of targeted metabolites, glucose metabolism monitoring, and physical performance assessments. Our results indicate that PLA administration significantly altered gut microbiota composition, increased the abundance of short-chain fatty acids (SCFAs) and succinate producing microbiota, and enhanced gut integrity in aging mice. Furthermore, PLA treatment raised fasting blood glucose levels and improved physical activity. Mechanistically, PLA intake elevated the levels of circulating SCFAs and succinate, promoting glycogen metabolic homeostasis and maintaining skeletal muscle oxidative capacity. This study provides evidence that PLA modulates the gut microbiota in aging mice, supports intestinal health, promotes glucose homeostasis, and enhances physical activity.

Postpartum morbidity and its determinants with special reference to anemia among urban vulnerable population in Uttar Pradesh: A cross-sectional study

ABSTRACT Background: The postpartum period is critically important for comprehensive obstetric care; however, most women are neglected during this important period. Objective: This study was carried out to determine the burden of postpartum morbidities and associated factors among the urban vulnerable population in Gautam Buddha district, Uttar Pradesh. Methods: A cross-sectional study was conducted among 150 postpartum women in urban slums of Gautam Buddha district. A semi-structured questionnaire was used along with a physical examination and assessment of anemia by Sahli’s hemoglobinometer. Results: A total of 106 (70.7%) mothers reported at least one of the postpartum morbidities (PPMs). The most frequently reported morbidity was anemia (55.3%) followed by backache (29.3%). Almost a third (39, 36.8%) of all women, who suffered from PPM, did not seek any treatment for the same. Univariate analysis revealed that morbidities were higher among women with low literacy (Odds Ratio, OR: 5.63, 95% CI: 2.508–13.54, p = 0.000), low socioeconomic status (OR: 0.317, 95% CI: 0.151–0.657, p = 0.002), and inadequate antenatal care (OR: 0.108, 95% CI: 0.044–0.246, p = 0.0001). Similarly, young mothers (OR: 2.599, 95% CI: 1.332–5.14), less educated (OR = 3.603, 95% CI: 1.838–7.203, p = 0.000), those from lower economic status (OR: 0.247, 95% CI: 0.119–0.497, p = 0.001), with inadequate antenatal care (OR: 0.112, 95% CI: 0.052–0.232, p = 0.005), and low iron folic acid intake (OR: 0.371, 95% CI: 0.184–0.732, p = 0.004) showed higher prevalence of anemia. Conclusion: The role of education and adequate antenatal care are highlighted in the study. Antenatal visits should be utilized as opportunities to increase awareness regarding various aspects of care during the postnatal period. Maintaining more comprehensive support and involvement between health care providers and the mothers is needed to prevent many of these postpartum morbidities.

Coamorphous systems of rebamipide: Selection of amino acid coformers based on protein-ligand docking, in vitro assessment and study of interactions by computational and multivariate analysis.

Three coamorphous systems of Rebamipide (REB) with the amino acids namely, Tryptophan (TRP), Phenylalanine (PHE) and Arginine (ARG) are reported. A unique approach for the virtual screening of amino acid coformers is presented by employing molecular docking studies based on interactions of the drug molecule with various amino acid fragments in the drug-receptor cocrystal structure. Successful formation of stable coamorphous systems with ARG, TRP and PHE served as the proof-of-concept along with negative benchmarking standards Histidine and Aspartic acid, wherein coamorphous systems could not be obtained despite multiple trials which resulted in crystalline physical mixtures. The coamorphous systems were characterized by a halo pattern in Powder XRD and a single glass transition temperature (Tg) in modulated DSC. Physical stability assessments of the coamorphous systems showed direct correlation of Tg with the observed stability of the amorphous phase which was found in the order ARGREB > TRPREB ≥ PHEREB. To determine the specific functional groups engaged in the interactions, multivariate analysis was performed on the FTIR spectra. These interactions were further validated by DFT and QTAIM analysis, which revealed key noncovalent interactions in the three coamorphous systems. All three coamorphous systems showed excellent release profiles of the API as demonstrated by the f2 and DE parameters in the order ARGREB ≥ TRPREB > PHEREB ≥ amorphous drug, far exceeding that of the crystalline drug. The interplay of multivariate analysis and QTAIM can be useful in estimating the interactions within the coamorphous systems which can further contribute to stability and physicochemical properties of the systems.

Multi-omics evaluation of clinical-grade human umbilical cord-derived mesenchymal stem cells in synergistic improvement of aging related disorders in a senescence-accelerated mouse model

BackgroundThe prevalence of age-related disorders, particularly in neurological and cardiovascular systems, is an increasing global health concern. Mesenchymal stem cell (MSC) therapy, particularly using human umbilical cord-derived MSCs (HUCMSCs), has shown promise in mitigating these disorders. This study investigates the effects of HUCMSCs on aging-related conditions in a senescence-accelerated mouse model (SAMP8), with a focus on DNA damage, gut microbiota alterations, and metabolic changes.MethodsSAMP8 mice were treated with clinical-grade HUCMSCs via intraperitoneal injections. Behavioral and physical assessments were conducted to evaluate cognitive and motor functions. The Single-Strand Break Mapping at Nucleotide Genome Level (SSiNGLe) method was employed to assess DNA single-strand breaks (SSBs) across the genome, with particular attention to exonic regions and transcription start sites. Gut microbiota composition was analyzed using 16S rRNA sequencing, and carboxyl metabolomic profiling was performed to identify changes in circulating metabolites.ResultsHUCMSC treatment significantly improved motor coordination and reduced anxiety in SAMP8 mice. SSiNGLe analysis revealed a notable reduction in DNA SSBs in MSC-treated mice, especially in critical genomic regions, suggesting that HUCMSCs may mitigate age-related DNA damage. The functional annotation of the DNA breaktome indicated a potential link between reduced DNA damage and altered metabolic pathways. Additionally, beneficial alterations in gut microbiota were observed, including an increase in short-chain fatty acid (SCFA)-producing bacteria, which correlated with improved metabolic profiles.ConclusionThe administration of HUCMSCs in SAMP8 mice not only reduces DNA damage but also induces favorable changes in gut microbiota and metabolism. The observed alterations in DNA break patterns, along with specific changes in microbiota and metabolic profiles, suggest that these could serve as potential biomarkers for evaluating the efficacy of HUCMSCs in treating age-related disorders. This highlights a promising avenue for the development of new therapeutic strategies that leverage these biomarkers, to enhance the effectiveness of HUCMSC-based treatments for aging-associated diseases.