Mitochondrial medicine: "from bench to bedside" 3PM-guided concept

Mitochondria are the primary sites for aerobic respiration and play a vital role in maintaining physiologic function at the cellular and organismal levels. Physiologic mitochondrial homeostasis, functions, health, and any kind of mitochondrial impairments are associated with systemic effects that are linked to the human health and pathologies. Contextually, mitochondria are acting as a natural vital biosensor in humans controlling status of physical and mental health in a holistic manner. So far, no any disorder is known as happening to humans independently from a compromised mitochondrial health as the cause (primary mitochondrial dysfunction) or a target of collateral damage (secondary mitochondrial injury). This certainty makes mitochondrial medicine be the superior instrument to reach highly ambitious objectives of predictive, preventive, and personalized medicine (PPPM/3PM). 3PM effectively implements the paradigm change from the economically ineffective reactive medical services to a predictive approach, targeted prevention and treatments tailored to individualized patient profiles in primary (protection against health-to-disease transition) and secondary (protection against disease progression) healthcare. Mitochondrial DNA (mtDNA) properties differ significantly from those of nuclear DNA (nDNA). For example, mtDNA as the cell-free DNA molecule is much more stable compared to nDNA, which makes mtDNA be an attractive diagnostic target circulating in human body fluids such as blood and tear fluid. Further, genetic variations in mtDNA contribute to substantial individual differences in disease susceptibility and treatment response. To this end, the current gene editing technologies, such as clustered regularly interspaced short palindromic repeats (CRISPR)/Cas, are still immature in mtDNA modification, and cannot be effectively applied in clinical practice posing a challenge for mtDNA-based therapies. In contrast, comprehensive multiomics technologies offer new insights into mitochondrial homeostasis, health, and functions, which enables to develop more effective multi-level diagnostics and targeted treatment strategies. This review article highlights health- and disease-relevant mitochondrial particularities and assesses involvement of mitochondrial medicine into implementing the 3PM objectives. By discussing the interrelationship between 3PM and mitochondrial medicine, we aim to provide a foundation for advancing early and predictive diagnostics, cost-effective targeted prevention in primary and secondary care, and exemplify personalized treatments creating proof-of-concept approaches for 3PM-guided clinical applications.

Acute mountain sickness prediction: a concerto of multidimensional phenotypic data and machine learning strategies in the framework of predictive, preventive, and personalized medicine

Background

Acute mountain sickness (AMS) is a self-limiting illness, involving a complex series of physiological responses to rapid ascent to high altitudes, where the body is exposed to lower oxygen levels (hypoxia) and changes in atmospheric pressure. AMS is the mildest and most common form of altitude sickness; however, without adequate preparation and adherence to ascent guidelines, it can progress to life-threatening conditions.

Aims

Due to the multi-factorial predisposition of AMS among individuals, identifying AMS biomarkers before high altitude exposure from multiple dimensions (e.g., clinical, metabolic, and proteomic markers) and integrating them to build an AMS predictive model enables early diagnosis and personalized interventions, which allows targeted allocation of medical resources, such as prophylactic medications (e.g., acetazolamide) and supplemental oxygen, to those who need them most and prevention of unnecessary complications. Consequently, predicting AMS utilizing biomarkers from multidimensional phenotypic data before high-altitude exposure is essential for the paradigm change in high-altitude medical research from currently applied reactive services to the cost-effective predictive, preventive, and personalized medicine (PPPM/3PM) in primary (reversible damage to health and targeted protection against health-to-disease transition) and secondary (personalized protection against disease progression) care.

Methods

To this end, this study recruited 83 Han Chinese male volunteers and obtained clinical, proteomic, and metabolomic profiles for analysis before they ascended to high altitudes. The Mann-Whitney U test was used to identify clinical features distinguishing AMS from non-AMS. The proteomic and metabolomic features were concatenated and clustered to find co-expression modules associated with AMS. A machine learning model, Mutual Information-radial kernel-based Support Vector Machine-Recursive Feature Elimination (MI-radialSVM-RFE) was employed for biomarkers selection and AMS prediction. A molecular docking technique was used to select molecular biomarkers that can bind with Traditional Chinese Medicine (TCM) ingredients.

Results

Among 83 participants, 66 were selected for detailed analysis after quality control steps. Six protein-metabolite co-expression modules were identified as significantly associated with AMS. The MI-radialSVM-RFE model selected 12 biomarkers (two clinical features: systolic blood pressure (SBP) and peak expiratory flow (PEF); six proteins: Acyl-CoA synthetase long-chain family member 4 (ACSL4), immunoglobulin kappa variable 1D-16 (IGKV1D-16), coagulation factor XIII B subunit (F13B), prosaposin (PSAP), poliovirus receptor (PVR), and multimerin-2 (MMRN2); and four metabolites: 2-Methyl-1,3-cyclohexadiene, calcitriol, 4-Acetamido-2-amino-6-nitrotoluene, and 20-Hydroxy-PGE2) for the AMS prediction model. The model exhibited excellent predictive performance in both training (n = 66) and validating cohorts (n = 24) with AUCs of 0.97 and 0.94, respectively. Additionally, molecular docking analysis suggested PSAP and ACSL4 proteins as potential molecular targets for AMS prevention.

Conclusion and expert recommendations

This study advances high-altitude medicine by developing a predictive model for AMS using clinical, proteomic, and metabolomic data. The identified biomarkers linked to energy metabolism, immune response, and vascular regulation offer insights into AMS mechanisms. High-altitude predictive approaches should focus on implementing biomarker-driven risk screening using clinical, proteomic, and metabolomic data to identify high-risk individuals before high-altitude exposure. Preventive measures should prioritize pre-acclimatization protocols, tailored nutritional strategies and interventions guided by biomarker profiles, and lifestyle adjustments, such as maintaining mitochondrial health through proper nutritional strategies.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-025-00404-9.

IgG N-glycosylation contributes to different severities of insulin resistance: implications for 3P medical approaches

Background

Reliable biomarkers capturing immunometabolic processes in insulin resistance (IR) remain limited. IgG N-glycosylation modulates immune responses and reflects metabolic disorders, yet its role in IR remains unclear. This study investigated its potential for early detection, risk stratification, and targeted prevention within the framework of predictive, preventive, and personalised medicine (PPPM/3PM).

Methods

A total of 313 participants were categorized into three groups based on the homeostatic model assessment for insulin resistance (HOMA-IR): insulin-sensitive (HOMA-IR < 2.69 without diabetes, n = 75), mild IR (HOMA-IR ≥ 2.69 without diabetes, n = 155), and severe IR (HOMA-IR ≥ 2.69 with type 2 diabetes, n = 83). Canonical correlation analysis was conducted to explore the overall relationship between IgG N-glycosylation and IR-related inflammation, indicated by tumour necrosis factor-α, interleukin- 6, C-reactive protein, and adiponectin. Mediation analysis was performed to evaluate the effect of IgG N-glycans on IR. Ordinal logistic regression was used to assess the association between IgG N-glycans and IR severity, with discriminative power evaluated using receiver operating characteristic curves.

Results

Pro-inflammatory IgG N-glycoforms, characterized by reduced sialylation and galactosylation, along with increased bisecting N-acetylglucosamine, were observed as IR severity increased. IgG N-glycosylation significantly correlated with inflammatory markers in the insulin-sensitive (r = 0.599, p < 0.05), mild (r = 0.461, p < 0.05), and severe (r = 0.666, p < 0.01) IR groups. IgG N-glycosylation significantly influenced IR (β = 0.406) partially via modulation of inflammation. Increased glycoforms FA2[6]G1 (OR: 0.86, 95% CI: 0.78-0.96) and A2G2S2 (OR: 0.88, 95% CI: 0.82-0.94) were associated with a lower IR risk, with respective area under the curves (AUCs) of 0.752, 0.683, and 0.764 for the insulin sensitive, mild, and severe IR groups.

Conclusions

IgG N-glycosylation contributes to IR by modulating inflammatory responses. Glycoforms FA2[6]G1 and A2G2S2 emerge as protective biomarkers, offering potential for predicting and preventing IR through primary prevention strategies within the PPPM framework.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-025-00410-x.

Targeting the MAPK signaling pathway: implications and prospects of flavonoids in 3P medicine as modulators of cancer cell plasticity and therapeutic resistance in breast cancer patients

Cancer drug resistance poses a significant challenge in oncology, primarily driven by cancer cell plasticity, which promotes tumor initiation, progression, metastasis, and therapeutic evasion in many different cancers. Breast cancers (BCs) are a prominent example of that, with an estimated 2.3 million new cases and 670,000 BC-related deaths registered worldwide annually. Triple-negative BC is especially challenging for treatments demonstrating particularly aggressive disease course, an early manifestation of metastatic disease, frequent drug-resistant cancer types, and poor individual outcomes. Although chemosensitizing agents have been developed, their clinical utility in oncology remains unproven. The mitogen-activated protein kinase (MAPK) pathway is considered a critical regulator of intracellular and extracellular signaling highly relevant for both - genetic and epigenetic modifications. Dysregulation of the MAPK signaling pathways plays a significant role in conferring chemoresistance in BC. Contextually, targeting the MAPK pathway represents a promising strategy for overcoming drug resistance and enhancing the therapeutic efficacy of anticancer agents in BC treatment. On the other hand, flavonoids, a prominent class of phytochemicals, are key modulators of MAPK signaling. Flavonoids interact with the ERK, JNK, p38, and ERK5 pathways of the MAPK signaling cascade and present a promising avenue for developing novel anti-cancer therapies and re-sensitizing agents for the treatment of BC. Compounds such as quercetin, kaempferol, genistein, luteolin, myricetin, EGCG, baicalein, baicalin, nobiletin, morin, delphinidin, acacetin, isorhamnetin, apigenin, silymarin, among others, have been identified as specific modulators of MAPK signaling, exerting complex downstream effects in BC cells increasing therewith drug efficacy and suppressing tumor growth and aggressivity. These properties reflect mechanisms of great clinical relevance to overcome therapeutic resistance in overall BC management. This article highlights corresponding mechanisms and provides clinically relevant illustrations in the framework of 3P medicine for primary (protection of individuals at high risk against health-to-disease transition) and secondary care (protection against metastatic BC progression). 3PM novelty makes good use of patient phenotyping and stratification, predictive multi-level diagnostics, and application of Artificial Intelligence (AI) tools to the individualized interpretation of big data - all proposed for cost-effective treatments tailored to individualized patient profiles with clear benefits to patients and advanced BC management.

Microalgae and exercise: from molecular mechanisms and brain health to clinical perspectives in the context of 3P medicine

Microalgae are emerging as innovative bioresources with diverse therapeutic applications, particularly in cardiovascular health, neuroprotection, anti-inflammatory, and antioxidant responses. These bioactive compounds effectively reduce inflammatory mediators, mitigate oxidative stress, and support mitochondrial health-critical factors in exercise performance, recovery, and chronic disease management. Notably, microalgae such as Spirulina and Chlorella exhibit promising biological activities in preclinical and limited clinical studies, including anti-inflammatory and neuroprotective effects. However, large-scale, randomized controlled trials (RCTs) remain scarce, limiting their clinical translation. Although preliminary evidence suggests potential benefits for sports performance, oxidative stress reduction, and cognitive function, most studies are small-scale, preclinical, or observational. Large, well-powered RCTs are needed to confirm their efficacy and safety. Within the framework of Predictive, Preventive, and Personalized Medicine (PPPM/3PM), this review explores microalgae's potential in predictive diagnostics, targeted prevention, and individualized supplementation strategies. Despite promising findings, clinical application requires a cautious approach due to insufficient high-quality trials supporting microalgae-based interventions in medical practice. Future research should prioritize RCTs, pharmacokinetic studies, and long-term safety assessments to establish evidence-based guidelines for their use in health and disease management.

Vision transformer-based stratification of pre/diabetic and pre/hypertensive patients from retinal photographs for 3PM applications

Objective

Diabetes and hypertension pose significant health risks, especially when poorly managed. Retinal evaluation though fundus photography can provide non-invasive assessment of these diseases, yet prior studies focused on disease presence, overlooking control statuses. This study evaluated vision transformer (ViT)-based models for assessing the presence and control statuses of diabetes and hypertension from retinal images.

Methods

ViT-based models with ResNet-50 for patch projection were trained on images from the UK Biobank (n = 113,713) and Singapore Epidemiology of Eye Diseases study (n = 17,783), and externally validated on the Singapore Prospective Study Programme (n = 7,793) and the Beijing Eye Study (n = 6064). Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC) for multiple tasks: detecting disease, identifying poorly controlled and well-controlled cases, distinguishing between poorly and well-controlled cases, and detecting pre-diabetes or pre-hypertension.

Results

The models demonstrated strong performance in detecting disease presence, with AUROC values of 0.820 for diabetes and 0.781 for hypertension in internal testing. External validation showed AUROCs ranging from 0.635 to 0.755 for diabetes, and 0.727 to 0.832 for hypertension. For identifying poorly controlled cases, the performance remained high with AUROCs of 0.871 (internal) and 0.655-0.851 (external) for diabetes, and 0.853 (internal) and 0.792-0.915 (external) for hypertension. Detection of well-controlled cases also yielded promising results for diabetes (0.802 [internal]; 0.675-0.838 [external]), and hypertension (0.740 [internal] and 0.675-0.807 [external]). In distinguishing between poorly and well-controlled disease, AUROCs were more modest with 0.630 (internal) and 0.512-0.547 (external) for diabetes, and 0.651 (internal) and 0.639-0.683 (external) for hypertension. For pre-disease detection, the models achieved AUROCs of 0.746 (internal) and 0.523-0.590 (external) for pre-diabetes, and 0.669 (internal) and 0.645-0.679 (external) for pre-hypertension.

Conclusion

ViT-based models show promise in classifying the presence and control statuses of diabetes and hypertension from retinal images. These findings support the potential of retinal imaging as a tool in primary care for opportunistic detection of diabetes and hypertension, risk stratification, and individualised treatment planning. Further validation in diverse clinical settings is warranted to confirm practical utility.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-025-00412-9.

Advancing predictive, preventive, and personalized medicine in eyelid diseases: a concerns-based and expandable screening system through structural dissection

Background/aims

Early recognition of eyelid morphological abnormalities was crucial, as untreated conditions could lead to blinding complications. An eyelid screening system that could provide both anatomical and pathological information was essential for formulating personalized treatment strategies. This study aimed to develop a clinically concerns-based framework capable of identifying common eyelid diseases requiring further intervention by evaluating individual anatomical and pathological changes. This approach would enhance individualized and efficient prevention, while supporting targeted treatment strategies.

Methods

The eyelid disorder screening system, Eyetome, was developed based on a morphological atlas and comprised four modules designed to identify 14 common eyelid disorders and pathological changes. A total of 6180 eye patches were analyzed to extract anatomical and pathological features. The performance of Eyetome was evaluated using average accuracy (aACC) and F1 score, with comparisons made against traditional models and ophthalmologists. To assess the system's expandability, an additional test was conducted in a multimorbidity scenario.

Results

Eyetome demonstrated high performance in recognizing single diseases, achieving an aACC of 98.83% and an F1 score of 0.93. The system outperformed classic models, with an aACC of 98.83% compared to 96.72% for Desnet101 and 97.59% for Vit. Additionally, Eyetome's aACC exceeded that of a junior ophthalmologist (JO) (97.11%) and was comparable to a senior ophthalmologist (SO) (98.69%). In the extended multimorbidity dataset, Eyetome maintained robust performance with an accuracy of 97.97%, surpassing JO (95.47%) and closely matching SO (97.81%).

Conclusions

This study developed a clinical concerns-based system for screening and monitoring eyelid disorders, aimed at supporting predictive diagnosis, preventing diseases progression, and facilitating more effective, patient-centered treatment of common eyelid disorders, aligning with the principles of predictive, preventive, and personalized medicine (PPPM/3PM). The system's interpretability, scalability, and user-friendly data acquisition design could further enhance its acceptance among both doctors and patients, facilitating the shift from reactive medicine to proactive precision medicine.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-025-00401-y.

The role of orthobiologics in bone healing and joint and tendon degeneration in the upper limb

This review article examines the role of orthobiologics, specifically platelet-rich plasma (PRP), mesenchymal stem cells (MSCs) and bone morphogenetic protein (BMP), in bone healing and the treatment of joint and tendon degeneration in the upper limb. The historical development, theorized mechanisms and clinical applications of these orthobiologics are explored, focussing on their effectiveness in fracture non-unions, osteoarthritis and tendinopathies. The evidence for bone healing shows promising results, particularly for MSCs and BMP in the treatment of non-unions. However, despite preclinical evidence of regenerative abilities of PRP and MSCs, the clinical trials do not support their use for tendinopathies or osteoarthritis. Before widespread clinical application of PRP or MSCs for upper limb degenerative conditions, their efficacy needs to be established through large, high-quality trials.

Monoclonal antibody immune therapy response instrument for stratification and cost-effective personalized approaches in 3PM-guided pan cancer management

Background

Immune checkpoint inhibitors (ICIs), such as anti-PD-1, anti-PD-L1, and anti-CTLA-4 therapies, have revolutionized cancer treatment by harnessing the body's immune system to eliminate cancer cells. Despite their considerable promise, the efficacy of ICIs significantly differs based on tumor types and specific patient conditions, highlighting the necessity for personalized approaches in the framework of predictive preventive personalized medicine (PPPM; 3PM).

Main body

This review proposes a stratification instrument within the 3PM framework to enhance the therapeutic efficacy of ICIs across Pan-cancer. Predictive approaches need to be utilized to enhance the effectiveness of ICIs. For example, biomarkers such as particular genetic alterations and metabolic pathways provide key information on patient treatment responses. To predict treatment outcomes, uncover resistance mechanisms, and tailor medications, we examine biomarkers including PDL-1 and CTLA4. Focusing on cancers like melanoma, bladder, and renal cell carcinoma, we highlight advances in combination therapies and cellular approaches to overcome resistance. We conducted an analysis of clinical trials and public datasets (TCGA, GEO) to evaluate ICI responses across number of cancer types. Survival analysis employed Kaplan-Meier curves and Cox regression. Pan-cancer analysis shows response rates ranging from 19.8% in bladder cancer to > 39% in melanoma when combination therapy is used, emphasizing the potential of 3PM to improve outcomes. By exploring resistance mechanisms and emerging therapeutic innovations, we propose a cost-effective model for better patient stratification and care. Validation of this model requires standardized biomarkers and prospective trials, promising a shift toward precision oncology.

Conclusion

Within the 3PM framework, this review addresses the urgent need for cost-effective stratification tools and adaptive combinatorial strategies to optimize outcomes.

Beyond hormones: 3PM approach to vaginal microbiota dynamics in postmenopausal women

Menopause marks a critical transition characterized by ceased ovarian function and declining estrogen levels, affecting multiple systems with vasomotor symptoms and genitourinary syndrome of menopause (GSM). Recent evidence shows vaginal microbiota undergoes significant alterations during menopause, influencing GSM severity. This comprehensive review examined vaginal microbiota dynamics in postmenopausal women through Predictive, Preventive, and Personalized Medicine (3PM/PPPM), revealing characteristic shifts-increased alpha diversity, reduced Lactobacillus dominance, and transitions toward non-Lactobacillus species-that serve as potential predictive biomarkers for the menopausal state, premature ovarian insufficiency, and GSM symptoms. The analysis evaluated microbiota-based risk stratification strategies for vaginal dysbiosis and demonstrated the effectiveness of both hormonal interventions (systemic/local estrogen, tibolone, ospemifene) and non-hormonal alternatives (probiotics, energy-based devices, pessary) in normalizing microbiota composition and improving vaginal health. The application of PPPM/3PM transformed menopausal healthcare from reactive to proactive precision-based care by establishing microbiota-based biomarkers that predict health risks, enable early targeted interventions tailored to specific microbiota profiles, and guide personalized treatment approaches based on individual microbial compositions. While this paradigm shift significantly advances gynecological medicine, research gaps remain in validating baseline microbiota signatures as predictive biomarkers and establishing standardized screening protocols. Further studies are needed to validate interventions such as probiotics and prebiotics, optimizing strain selection for personalized, evidence-based preventive and therapeutic strategies. Developing standardized yet personalized protocols to restore a balanced vaginal microbiome could help alleviate menopause-related symptoms. Advancing microbiota-based personalized therapeutic approaches is crucial to enhancing the quality of life for postmenopausal women through targeted and individualized vaginal health management.

Development and validation of a prediction model for the depressive symptom risk in commercial airline pilots

Background/aims

Shift workers, such as medical personnel, and pilots, are facing an increased risk of depressive symptoms. Depressive symptoms significantly impact an individual's quality of life and affect work performance, decision-making abilities, and overall public safety. This study aims to establish a multidimensional depressive symptom prediction model based on a large sample of commercial airline pilots to facilitate early identification, prevention, and personalized intervention strategies.

Methods

This population-based study included 11,111 participants, with 7918 pilots in the training set and 3193 pilots in the external validation set. Depressive symptom severity was assessed using the Patient Health Questionnaire-9 (PHQ-9). Physiological, psychological, and lifestyle factors potentially associated with depressive symptom risk were collected. The optimal predictors for model development were selected using the Boruta algorithm combined with the LASSO method, and a nomogram was developed using multivariate logistic regression to predict depressive symptoms in pilots. The model performance was evaluated using Receiver Operating Characteristic (ROC) curves, calibration curves, and accuracy measures, such as the Brier score and Spiegelhalter z-test. Additionally, decision curve analysis (DCA) was performed to assess the model's clinical utility.

Results

A total of 7918 pilots were included in the training set and 3193 were included in the external validation set. Five characteristic indicators were selected based on their significance in the prediction of depressive symptom risk: living status, alcohol drinking, family history of mental health disorder, subjective health, and subjective sleep quality. The model showed acceptable overall discrimination (AUCtrain = 0.836, 95%CI 0.818 to 0.854; AUCvalidation = 0.840, 95%CI 0.811 to 0.868) and calibration (Brier scoretrain = 0.048; Brier scorevalidation = 0.051). The decision curve analysis showed that the net benefit was superior to intervening on all participants or not intervening on all participants.

Conclusions

This study provides a reliable tool for early prediction and customized management of depressive symptoms among commercial airline pilots. This approach promotes the development of the field by transitioning from passive mental health care to active mental health prevention, emphasizing personalized prevention strategies.

Gene therapy for cardiac arrhythmias

Cardiovascular diseases are the leading cause of death globally, with cardiac arrhythmias contributing substantially to this burden. Gene therapy, which directly targets the underlying disease pathobiology, offers an appealing treatment strategy for cardiac arrhythmias owing to its potential as a one-time, curative solution. Over the past two decades, substantial efforts have been made to develop new gene therapy approaches that overcome the limitations of conventional treatments. In this Review, we describe the rationale for gene therapy to treat cardiac arrhythmias; discuss advantages and disadvantages of gene silencing, gene replacement, gene suppression-and-replacement and gene editing technologies; summarize vector modalities and delivery approaches used in the field; present examples of gene therapy strategies used for atrial and ventricular arrhythmias; and highlight the current challenges and limitations in the gene therapy field.

Virtual reality solution to promote adapted physical activity in older adults: outcomes from VR2Care project exploratory study

Background

Insufficient physical activity is one of the leading risk factors for death worldwide. Regular exercise can improve physical performance and quality of life, reduce the risks of falls and depressive symptoms, and reduce the likelihood of cognitive decline in older adults. Virtual reality (VR) and serious games (SG) are promising tools to improve physical and cognitive functioning. As part of the VR2Care project activities, four pilot sites explored the capabilities of the VR environment in a remote psychomotor training with SG and a hybrid approach with local groups of older adults performing physical activity.

Objective

The present study aimed to explore and measure the impact on older adults' quality of life and physical activity of using VR2Care solution and the level of usability, satisfaction and acceptance.

Methods

The study is a mixed method study, using qualitative and quantitative surveys to evaluate quality of life and physical activity of older users, and usability, satisfaction and acceptance of the solution. The data collection is a mix of investigator site data entry and users' self-reported data through the solutions or through online and paper-based means. Data were collected at baseline and after a follow-up of 6 weeks. Data are expressed as mean ± standard deviation (SD) unless otherwise stated. Within the group, baseline to end of observation differences were assessed by paired sample t-test. A p = 0.05 was considered significant.

Results

No significant improvements in quality of life and physical activity were found. Little improvement, although not significant, in physical activity was found, comparing the Total MET average value of users who participated in phase I and II, therefore using SmartAL and Rehability. Little improvement, although not significant, in physical activity applies in ≥76 population. Users' feedback on usability, satisfaction and acceptance of VR2Care is generally positive. VR2Care was appreciated mostly for its usefulness in managing physical activity and the capacity to influence the consistency of attending physical activity sessions as prescribed by doctors.

Conclusion

Our results suggest that randomized controlled trial will be needed to assess correlations between specific features of the solution and health outcomes.

Bifidobacterium animalis Supplementation Improves Intestinal Barrier Function and Alleviates Antibiotic-Associated Diarrhea in Mice

Probiotics have gained increasing recognition for their potential to mitigate antibiotic-associated diarrhea (AAD). However, the precise mechanisms underlying their effects remain unclear. This study developed a mouse model of AAD using ceftriaxone to investigate the alleviating effects and mechanisms of Bifidobacterium animalis A6 (A6). The findings indicated that A6 supplementation effectively attenuated ceftriaxone-associated diarrhea in mice. The morphological damage to the villi and crypts was partially restored and more neatly reorganized following the A6 intervention. Additionally, intestinal morphology observations revealed a significant increase in the thickness of the mucus layer in the A6-treated group. Further examination of key regulatory genes associated with mucus secretion demonstrated that the A6 intervention effectively upregulated the expression of mucin1, thereby reinforcing the mucus layer. Concurrently, the A6 intervention upregulated the expression of the AQP4 and SLC26A3 genes in the intestine, which is responsible for restoring water absorption capacity in AAD mice. Additionally, the A6 treatment reduced ceftriaxone-induced harm to the intestinal microbiota of the mice, boosting beneficial bacteria like Bacteroidales, Akkermansia, Bifidobacterium, and Lactobacillus. Overall, this study offers valuable insights into the potential therapeutic role of A6 in restoring intestinal homeostasis and alleviating symptoms associated with AAD.

A randomized trial on the safety and efficacy of sensate water-based and silicone-based personal lubricants for relief of intimate discomfort associated with vaginal dryness

BACKGROUND

Personal lubricants with different formulations and properties, including ingredients designed to enhance sensation or feeling, can be used to alleviate vaginal dryness and affect sexual function. Clinical data to support their safety and efficacy are limited.

AIM

Determine safety and efficacy of two sensate personal lubricants for relief of discomfort associated with vaginal dryness in female participants, and report the impact on sexual satisfaction in female participants and male partners.

METHODS

A two-arm, parallel design study was performed in women (18-65 years) experiencing vaginal dryness. Participants were randomized to one of two sensate lubricants (water-based [tingling] or silicone-based [warming]), which had to be used during vaginal intercourse at least once a week over a 4-week period.

OUTCOMES

Primary outcome: change from baseline in total Female Sexual Function Index (FSFI) score after 4 weeks of lubricant use. Secondary outcomes: change from baseline in FSFI domain scores; adverse events (AE); vulvovaginal and oral tolerance; female participant and male partner perception of lubricants; improvement in sexual intimacy (assessed using Subject Perceived Questionnaires [SPQ] and Patient Global Impression of Change).

RESULTS

Sixty-six female participants completed the study. The primary endpoint (prespecified increase in FSFI ≥4 points from baseline) was achieved for both lubricants. A positive change was observed across all six FSFI domains. All AEs were mild in severity; no serious AEs were reported; the discontinuation rate was 1.5% (one female participant; warming lubricant). For both lubricants, vulvovaginal tolerance was "good/very good" and oral tolerance was generally "very good" ("acceptable" for one participant in each treatment arm). For both lubricants, most female participants and their male partners agreed that first penetration during vaginal sex was smoother, and there was an improvement in sexual intimacy.

CLINICAL IMPLICATIONS

Safety and efficacy of both lubricants containing sensate ingredients was demonstrated, giving reassurance that they can be safely recommended by healthcare professionals to relieve vaginal dryness and enhance sexual pleasure.

STRENGTHS/LIMITATIONS

Evidence is provided for the safety and efficacy of two sensate lubricants for relieving vaginal dryness and improving sexual pleasure in healthy participants across a wide age range. The SPQ is not a clinically validated tool, and the sample of participants was not diverse, which may limit the generalizability of data.

CONCLUSIONS

The use of sensate lubricants showed significant improvement in sexual function coupled with improved satisfaction for both male and female participants. No severe or serious AE were reported during the study period.

Improved uterine conditions following ovarian transplantation of adipose-derived mesenchymal stem cell conditioned media in rats with letrozole-induced polycystic ovary syndrome: Histomorphometrical, biochemical, and molecular analysis

Regenerative medicine is a new hope for the treatment of diseases such as polycystic ovarian syndrome (PCOS). Due to the beneficial effects of adipose stem cell-derived conditioned media transplantation (ASC-CM) on polycystic ovary phenotypes and also considering the relationship between uterine function and ovarian hormone level, this study, for the first time, evaluates the transplantation of ASC-CM in compared to ASC on the altered state of the uterus, estrogen level as well as its receptors expression in PCOS model. Animals were divided randomly into two groups, including the CMC group and the PCOS group. After PCOS confirmation, the PCOS rats were allocated into four subgroups, including PCOS-Vehicle, PCOS-Media, PCOS-ASC, and PCOS-ASC-CM. After four weeks, the uterus tissues were removed for weighing, histomorphometrical evaluation, and immunoblotting assessments of estrogen receptors (ERα and ERβ). The sera were obtained for estrogen hormone level evaluation. Uterine histopathological conditions, such as marked reductions of the heights of the luminal and glandular epithelial cells as well as altered lining epithelial cells of the lumen and glands, alongside diminished uterine weight and thickness, were observed in the PCOS-V and PCOS-Media groups when compared to those of the CMC group. Additionally, their estrogen levels and ERα and ERβ expression levels decreased. However, ASC-CM administration, compared to ASCs alone, more effectively improved these altered uterine conditions of PCOS rats, resulting in enhanced uterine and endometrial wall thickness, luminal and glandular epithelial cell heights, estrogen levels, and also ESRα and ESRβ mRNA transcripts expression compared to those of the PCOS-V and PCOS-Media groups. So, the transplantation of ASC-CM, compared to ASC, could induce more estrogenic histological changes in the PCOS uterine alterations, which suggests a helpful strategy for improving forgotten uterine status in PCOS phenotypes.

Temperature-dependent microfluidic impedance spectroscopy for non-invasive biofluid characterization

Remote health monitoring has the potential to enable individuals to take control of their own health and well-being and to facilitate a transition toward preventative and personalized healthcare. Sweat can be sampled non-invasively and contains a wealth of information about the metabolic state of an individual, making it an excellent candidate for remote health monitoring. An accurate, rapid, and low-cost biofluid characterization technique is required to enable the widespread use of remote health monitoring. We previously introduced microfluidic impedance spectroscopy for the detection of electrolyte concentration in fluids, whereby a novel device architecture, measurement method, and analysis technique were presented for the characterization of cationic species. The purely electrical nature of this measurement technique removes the intermediate steps inherent in common rival technologies such as optical and electrochemical sensing, offering a range of advantages. In this work, we investigate the effect of temperature on microfluidic impedance spectroscopy of ionic species commonly present in biofluids. We find that the impedance spectra and concentration determination are temperature-dependent; remote health monitoring devices must be calibrated appropriately as they are likely to experience temperature fluctuations. Importantly, we demonstrate the ability of the method to measure the concentration of anionic species alongside that of cationic species, enabling the detection of chloride and lactate, which are useful biomarkers for hydration, cystic fibrosis, fatigue, sepsis, and hypoperfusion. We show that the presence of neutral species does not impair accurate determination of ionic concentration, thus, demonstrating the suitability of microfluidic impedance spectroscopy for non-invasive biofluid characterization.

How is Value Defined in Molecular Testing in Cancer? A Scoping Review

OBJECTIVE

To identify how value is defined in studies that focus on the value of molecular testing in cancer and the extent to which broadening the conceptualisation of value in healthcare has been applied in the molecular testing literature.

METHODS

A scoping review was undertaken using Joanna Briggs Institute (JBI) guidance. Medline, Embase, EconLit and Cochrane Library were searched in August 2023. Articles were eligible if they reported costs relative to outcomes, novel costs, or novel outcomes of molecular testing in cancer. Results were synthesised and qualitative content analysis was performed with deductive and inductive frameworks.

RESULTS

Ninety-one articles were included in the review. The majority (75/91) were conventional economic analyses (comparative economic evaluations and budget impact assessments) and undertaken from a healthcare system perspective (38/91). Clinical outcomes dominate the assessment of value (61/91), with quality-adjusted life-years (QALYs) the most common outcome measure (45/91). Other definitions of value were diverse (e.g. psychological impact, access to trials), inconsistent, and largely not in keeping with evolving guidance.

CONCLUSIONS

Broader concepts of value were not commonly described in the molecular testing literature focusing on cancer. Conventional approaches to measuring the health costs and outcomes of molecular testing in cancer prevail with little focus on non-clinical elements of value. There are emerging reports of non-clinical outcomes of testing information, particularly psychological consequences. Intrinsic attributes of the testing process and preferences of those who receive testing information may determine the realised societal value of molecular testing and highlight challenges to implementing such a value framework.

Multi-omics identification of a polyamine metabolism related signature for hepatocellular carcinoma and revealing tumor microenvironment characteristics

Background

Accumulating evidence indicates that elevated polyamine levels are closely linked to tumor initiation and progression. However, the precise role of polyamine metabolism in hepatocellular carcinoma (HCC) remains poorly understood.

Methods

We conducted differential expression analysis on bulk RNA sequencing data from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) to identify 65 polyamine metabolism-related genes. By employing unsupervised consensus clustering, AddModuleScore, single-sample gene set enrichment analysis (ssGSEA), and weighted gene co-expression network analysis (WGCNA), we identified polyamine metabolism-related genes at both the bulk RNA-seq and single-cell RNA-seq (scRNA-seq) levels. Utilizing 101 machine learning algorithms, we constructed a polyamine metabolism-related signature (PMRS) and validated its predictive power across training, testing, and external validation cohorts. Additionally, we developed a prognostic nomogram model by integrating PMRS with clinical variables. To explore immune treatment sensitivity, we assessed tumor mutation burden (TMB), tumor immune dysfunction and exclusion (TIDE) score, mutation frequency, and immune checkpoint genes expression. Immune cell infiltration was analyzed using the CIBERSORT algorithm. Finally, RT-qPCR experiments were conducted to validate the expression of key genes.

Results

Using 101 machine learning algorithms, we established a polyamine metabolism-related signature comprising 9 genes, which exhibited strong prognostic value for HCC patients. Further analysis revealed significant differences in clinical features, biological functions, mutation profiles, and immune cell infiltration between high-risk and low-risk groups. Notably, TIDE analysis and immune phenotype scoring (IPS) demonstrated distinct immune treatment sensitivities between the two risk groups. RT-qPCR validation confirmed that these 9 genes were highly expressed in normal cells but significantly downregulated in tumor cells.

Conclusions

Our study developed a polyamine metabolism-based prognostic risk signature for HCC, which may provide valuable insights for personalized treatment strategies in HCC patients.

Advancing personalized, predictive, and preventive medicine in bladder cancer: a multi-omics and machine learning approach for novel prognostic modeling, immune profiling, and therapeutic target discovery

Objective

This study aimed to identify and analyze immunogenic cell death (ICD)-related multi-omics features in bladder cancer (BLCA) using single-cell RNA sequencing (scRNA-seq) and bulk RNA-seq data. By integrating these datasets, we sought to construct a prognostic signature (ICDRS) and explore its clinical and biological implications, including its association with immune cell infiltration, tumor microenvironment (TME), and drug sensitivity.

Methods

Publicly available datasets from TCGA and GEO, including scRNA-seq (GSE222315, 9 samples) and bulk RNA-seq (TCGA-BLCA, 403 samples; GSE13507, 160 samples), were analyzed. Single-cell data were processed using Seurat, and ICD scores were calculated using single-sample gene set enrichment analysis (ssGSEA). Weighted gene co-expression network analysis (WGCNA) identified ICD-related modules, and machine learning algorithms (Lasso, Ridge, CoxBoost) were employed to construct the ICDRS. Survival analysis, immune infiltration, pathway enrichment, and drug sensitivity were evaluated to validate the model.

Results

The ICDRS, based on eight key genes (IL32, AHNAK, ANXA5, FN1, GSN, CNN3, FXYD3, CTSS), effectively stratified BLCA patients into high- and low-risk groups with significant differences in overall survival (OS, P < 0.001). High ICDRS scores were associated with immune-suppressive TME, including increased infiltration of T cells CD4 memory resting (P = 0.02) and macrophages M0/M1/M2 (P = 0.01). Pathway enrichment revealed correlations with cholesterol homeostasis, epithelial-mesenchymal transition (EMT), and KRAS signaling. Drug sensitivity analysis showed high-risk groups were resistant to Cisplatin (P = 0.003), Mitomycin C (P = 0.01), and Paclitaxel (P = 0.004), with IC50 values significantly higher than low-risk groups.

Conclusion

The ICDRS serves as a robust prognostic biomarker for BLCA, offering insights into tumor immune evasion mechanisms and potential therapeutic targets. Its integration with clinical features enhances personalized treatment strategies, highlighting the importance of ICD in BLCA immunotherapy and precision medicine. The model's predictive accuracy and biological relevance were validated across multiple datasets, underscoring its potential for clinical application.

Probiotic treatment induces sex-dependent neuroprotection and gut microbiome shifts after traumatic brain injury

BACKGROUND

Recent studies have highlighted the potential influence of gut dysbiosis on traumatic brain injury (TBI) outcomes. Alterations in the abundance and diversity of Lactobacillus species may affect immune dysregulation, neuroinflammatory responses, anxiety- and depressive-like behaviors, and neuroprotective mechanisms activated in response to TBI.

OBJECTIVE

This study aims to evaluate the protective and preventive effects of Pan-probiotic (PP) treatment on the inflammatory response during both the acute and chronic phases of TBI.

METHODS

Males and female mice underwent controlled cortical impact (CCI) injury or sham. They received a PP mixture in drinking water containing strains of Lactobacillus plantarum, L. reuteri, L. helveticas, L. fermentum, L. rhamnosus, L. gasseri, and L. casei. In the acute group, mice received PP or vehicle (VH) treatment for 7 weeks before TBI, continuing until 3 days post-injury (dpi). In the chronic group, treatment began 2 weeks before TBI and was extended through 35 dpi. The taxonomic microbiome profiles of fecal samples were evaluated using 16S rRNA V1-V3 sequencing analysis, and Short-chain fatty acids (SCFAs) were measured. Immunohistochemical, in situ hybridization, and histological analyses were performed to assess neuroinflammation post-TBI, while behavioral assessments were conducted to evaluate sensorimotor and cognitive functions.

RESULTS

Our findings suggest that a 7-week PP administration induces specific microbial changes, including increased abundance of beneficial bacteria such as Lactobacillaceae, Limosilactobacillus, and Lactiplantibacillus. PP treatment reduces lesion volume and cell death at 3 dpi, elevates SCFA levels at 35 dpi, and decreases microglial activation at both time points, particularly in males. Additionally, PP treatment improved motor recovery in males and alleviated depressive-like behaviors in females.

CONCLUSION

Our findings indicate that PP administration modulates microbiome composition, reduces neuroinflammation, and improves motor deficits following TBI, with these effects being particularly pronounced in male mice.

Development and validation of a prediction model for gestational diabetes mellitus based on clinical characteristics and laboratory biomarkers among Chinese women

BACKGROUND AND AIMS

Early detection of gestational diabetes mellitus (GDM) is critical for maternal and child health. Although several prediction models exist, their complexity and reliance on less clinically accessible biomarkers have limited generalizability. This study aimed to develop and validate a clinically practical GDM prediction model.

METHODS AND RESULTS

Based on a retrospective cohort containing 30 480 pregnant women from China (2014-2019), three prediction models (basic, full and optimal) were developed using logistic regression to select predictors. Predictive accuracy of prediction models was evaluated by the area under receiver operating characteristic curve (AUC). The nomogram was established to predict individual probability of GDM, with decision curve analysis (DCA) assessing clinical utility. A total of 8161 (26.8 %) women were diagnosed with GDM. The optimal model, incorporating nine clinical characteristics and biochemical indicators, had a good predictive effect for GDM with AUCs of 0.74 (95 % CI: 0.74-0.75) in the training cohort and 0.74 (0.73-0.76) in the validation cohort. The performance of the optimal model was significantly greater than the basic model (AUC of 0.62) and close to the full model (AUC of 0.75). The calibration curve showed that the established nomogram had good accuracy to predict individual probability of GDM. The DCA showed that the prediction model had a positive net benefit at threshold between 0.1 and 0.8.

CONCLUSION

The nine-item optimal prediction model yielded high predictive accuracy, facilitating the identification of high-risk women, and the refinement of personalized diagnostic and treatment modalities.

Exploring Innovative Approaches for Managing Spinal Cord Injury: A Comprehensive Review of Promising Probiotics and Postbiotics

Spinal cord injury (SCI) affects millions of people worldwide annually, presenting significant challenges in functional recovery despite therapeutic advancements. Current treatment strategies predominantly focus on stabilizing the spinal cord and facilitating neural repair, yet their effectiveness remains uncertain and controversial. Recent scientific investigations have explored the potential of probiotics and postbiotics to modulate inflammation, influence neurotransmitters, and aid in tissue repair, marking a potential paradigm shift in SCI management. This review critically evaluates these innovative approaches, emphasizing their ability to harness the natural properties of microorganisms within the body to potentially enhance outcomes in SCI treatment. By analyzing the latest research findings, this review provides valuable insights into how probiotics and postbiotics can revolutionize inflammation management and neurological recovery following SCI, underscoring their promising role in future therapeutic strategies aimed at improving the quality of life of SCI patients globally.

Therapeutic potential of heat-killed Lactobacillus reuteri against bile acid-induced male reproductive toxicity

Exposure of testicular tissue to supraphysiological concentrations of bile acids can lead to infertility. This study aimed to investigate the protective effects of heat-killed Lactobacillus reuteri (L. reuteri) against male reproductive toxicity induced by bile duct ligation (BDL). Thirty-two male Wistar rats were randomly assigned to four groups (N = 8): control normal (CN), sham-control (SC), BDL-control (underwent BDL surgery), and BDL + heat-killed L. reuteri (received probiotic supplementation for 7 days before and 21 days after BDL). At the end of the study, reproductive parameters, including sex hormones, sperm characteristics, oxidative stress markers, antioxidant status, and inflammatory gene expression in testicular tissue, were analyzed. Additionally, histological assessments of the testis and epididymis were performed. The administration of heat-killed L. reuteri significantly improved sperm viability (p ≤ 0.05) and luteinizing hormone levels (p ≤ 0.05) while reducing total oxidative status, carbonyl protein, and oxidative stress index (p ≤ 0.05) compared to the BDL-control group. Moreover, nitric oxide levels were significantly increased (p ≤ 0.05) in the probiotic-treated group. The expression levels of TNF-α and IL-6 were notably downregulated (p ≤ 0.05), indicating reduced testicular inflammation. Histological analysis demonstrated significant improvements in epithelial height, spermatogenic epithelial area ratio, lumen diameter, and lumen area (p ≤ 0.05) in the probiotic-treated group. These findings suggest that heat-killed L. reuteri alleviates cholestasis-related male reproductive toxicity through its antioxidant and anti-inflammatory effects.

Traumatic brain injury from a peripheral axis perspective: Uncovering the roles of liver and adipose tissue in temperature regulation

Traumatic brain injury (TBI) is a major cause of death and disability worldwide. Most current treatments for TBI and other neurological disorders focus on the brain, often overlooking the significant contributions of peripheral organs to disease progression. Emerging evidence suggests that organs such as the liver and adipose tissue play crucial roles in TBI pathogenesis. The liver synthesizes lipids and proteins vital for brain function, while adipose tissue provides hormones and metabolites that influence brain activity. New research indicates that the liver and adipose tissue work in concert with the hypothalamus to regulate essential processes, such as body temperature, which become disrupted in TBI. Additionally, the brain-peripheral axis-a complex network of visceral nerve pathways, hormones, and metabolites-plays a bidirectional role in regulating brain plasticity and function. Understanding how TBI leads to dysregulation of the liver, adipose tissue, and other organs could unlock new therapeutic opportunities for treating TBI and related neurological disorders. The intricate autonomic network involving hypothalamic and enteric neurons, along with visceral nerve pathways and hormones, presents both pathological targets and therapeutic potential. We examine scientific evidence suggesting that correcting disturbances in systemic physiology could enhance the brain's capacity for healing. However, the interdependence of this autonomic network implies that treating dysfunction in one area may affect others. Therefore, we also explore the mechanisms by which diet and exercise can comprehensively impact the brain-peripheral axis, supporting the healing process. CHEMICAL COMPOUNDS: D-Fructose (PubChem CID 2723872); docosahexaenoic acid (PubChem CID 45934466); eicosapentaenoic acid (PubChem 5282847).

Evaluation of the safety and probiotic properties of Limosilactobacillus fermentum BGI-AF16, a uric acid-lowering probiotic strain

Some beneficial microorganisms in the intestine have the potential to degrade uric acid, offering a novel strategy for the prevention of hyperuricemia. In this study, the safety and probiotic potentials of Limosilactobacillus fermentum BGI-AF16 were evaluated by whole genome sequence analysis and in vitro experiments. Based on the gene analysis of antibiotic resistance and virulence factors, L. fermentum BGI-AF16 has been shown to be safe. We identified probiotic-related genes by genome annotation tools and conducted in vitro experiments to evaluate the ability of L. fermentum BGI-AF16 to inhibit pathogenic bacteria, tolerate a simulated gastrointestinal environment, and degrade uric acid. The results from in vitro experiments showed that L. fermentum BGI-AF16 had inhibitory effects on four clinically relevant pathogens and was highly tolerant to the gastrointestinal environment. In addition, L. fermentum BGI-AF16 was able to rapidly degrade uric acid within the first hour, and the strain could degrade 56.36 ± 2.32 % of uric acid by the third hour. The genome of the strain contains genes encoding flavin adenine dinucleotide (FAD)-dependent urate hydroxylase (EC.1.14.13.113), an enzyme that directly metabolizes uric acid. And the strain has a complete uric acid metabolic pathway. These results suggest that L. fermentum BGI-AF16 is a probiotic candidate with significant potential for reducing uric acid level.

Probiotics and Prebiotics: Meeting Dietary Requirements for Optimal Health and Planetary Sustainability

Probiotics and prebiotics are valuable in enhancing human health and fostering sustainable development. This review focuses on the role of probiotics and prebiotics at all stages of life to promote nutrient absorption, boost immunity, and support healthy aging by mitigating cognitive decline and chronic disease. Health and environmental sustainability are deeply connected, making probiotics and prebiotics promising tools for promoting well-being and achieving global sustainability goals. In addition to health, probiotics and prebiotics contribute to sustainable development by optimizing agricultural byproducts, reducing reliance on antibiotics in animal feed, lowering greenhouse gas emissions, and supporting environmental protection. Future research should focus on personalizing treatments, improving bioavailability, and expanding applications to effectively address global health and the sustainable development goals.

Unlocking the Interactions Between the Whole-Body Microbiome and HPV Infection: A Literature Review

The human microbiome plays a vital role in maintaining human homeostasis, acting as a key regulator of host immunity and defense mechanisms. However, dysbiotic microbial communities may cause disruption of the symbiotic relationship between the host and the local microbiota, leading to the pathogenesis of various diseases, including viral infections and cancers. One of the most common infectious agents causing cancer is the human papilloma virus (HPV), which accounts for more than 90% of cervical cancers. In most cases, the host immune system is activated and clears HPV, whereas in some cases, the infection persists and can lead to precancerous lesions. Over the last two decades, the advent of next-generation sequencing (NGS) technology and bioinformatics has allowed a thorough and in-depth analysis of the microbial composition in various anatomical niches, allowing researchers to unveil the interactions and the underlying mechanisms through which the human microbiota could affect HPV infection establishment, persistence, and progression. Accordingly, the present narrative review aims to shed light on our understanding of the role of the human microbiome in the context of HPV infection and its progression, mainly to cervical cancer. Furthermore, we explore the mechanisms by which the composition and balance of microbial communities exert potential pathogenic or protective effects, leading to either HPV persistence and disease outcomes or clearance. Special interest is given to how the microbiome can modulate host immunity to HPV infection. Lastly, we summarize the latest findings on the therapeutic efficacy of probiotics and prebiotics in preventing and/or treating HPV infections and the potential of vaginal microbiota transplantation while highlighting the significance of personalized medicine approaches emerging from NGS-based microbiome profiling and artificial intelligence (AI) for the optimal management of HPV-related diseases.

Use of corticosteroids for adult chronic pain interventions: sympathetic and peripheral nerve blocks, trigger point injections - guidelines from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, the American Society of Interventional Pain Physicians, and the International Pain and Spine Intervention Society

BACKGROUND

There is potential for adverse events from corticosteroid injections, including increase in blood glucose, decrease in bone mineral density and suppression of the hypothalamic-pituitary axis. Published studies note that doses lower than those commonly injected provide similar benefit.

METHODS

Development of the practice guideline was approved by the Board of Directors of American Society of Regional Anesthesia and Pain Medicine with several other societies agreeing to participate. The scope of guidelines was agreed on to include safety of the injection technique (landmark-guided, ultrasound or radiology-aided injections); effect of the addition of the corticosteroid on the efficacy of the injectate (local anesthetic or saline); and adverse events related to the injection. Based on preliminary discussions, it was decided to structure the topics into three separate guidelines as follows: (1) sympathetic, peripheral nerve blocks and trigger point injections; (2) joints; and (3) neuraxial, facet, sacroiliac joints and related topics (vaccine and anticoagulants). Experts were assigned topics to perform a comprehensive review of the literature and to draft statements and recommendations, which were refined and voted for consensus (≥75% agreement) using a modified Delphi process. The United States Preventive Services Task Force grading of evidence and strength of recommendation was followed.

RESULTS

This guideline deals with the use and safety of corticosteroid injections for sympathetic, peripheral nerve blocks and trigger point injections for adult chronic pain conditions. All the statements and recommendations were approved by all participants after four rounds of discussion. The Practice Guidelines Committees and Board of Directors of the participating societies also approved all the statements and recommendations. The safety of some procedures, including stellate blocks, lower extremity peripheral nerve blocks and some sites of trigger point injections, is improved by imaging guidance. The addition of non-particulate corticosteroid to the local anesthetic is beneficial in cluster headaches but not in other types of headaches. Corticosteroid may provide additional benefit in transverse abdominal plane blocks and ilioinguinal/iliohypogastric nerve blocks in postherniorrhaphy pain but there is no evidence for pudendal nerve blocks. There is minimal benefit for the use of corticosteroids in trigger point injections.

CONCLUSIONS

In this practice guideline, we provided recommendations on the use of corticosteroids in sympathetic blocks, peripheral nerve blocks, and trigger point injections to assist clinicians in making informed decisions.

Excipients for Cerium Dioxide Nanoparticle Stabilization in the Perspective of Biomedical Applications

Rare earth metal nanoparticles, some of which are already widely used in medicine, are of growing interest in the modern scientific community. One of the promising rare earth metals for biomedical applications is cerium, specifically its oxide form, which is characterized by a higher level of stability and safety. According to a number of studies, cerium dioxide has a wide range of biological effects (regenerative, antimicrobial, antioxidant, antitumor), which justifies the interest of its potential application in medicine. However, these effects and their intensity vary significantly across a number of studies. Since cerium dioxide was used in these studies, it can be assumed that not only is the chemical formula important, but also the physicochemical parameters of the nanoparticles obtained, and consequently the methods of their synthesis and modification with the use of excipients. In this review, we considered the possibilities of using a number of excipients (polyacrylate, polyvinylpyrrolidone, dextran, hyaluronic acid, chitosan, polycarboxylic acids, lecithin, phosphatidylcholine) in the context of preserving the biological effects of cerium dioxide and its physicochemical properties, as well as the degree of study of these combinations from the point of view of the prospect of creating drugs based on it for biomedical applications.

Supplementation with Rare Earth-Chitosan Chelate Improves Tibia Quality, Disease Resistance Capacity, and Performance in Nursery Pigs

The aim of this study was to investigate the effects on the tibia, liver, and gut, and on performance, when supplementing nursery pigs with different levels of rare earth-chitosan chelate (RECC). A total of 80 piglets, weaned at 7.67 ± 0.09 kg, were randomly assigned to groups RECC0 (RECC, 0 mg/kg diet), RECC200 (RECC, 200 mg/kg diet), RECC400 (RECC, 400 mg/kg diet), and RECC600 (RECC, 600 mg/kg diet), with four replicates in each group and five pigs per replicate during a 28 d experiment. Samples of the left hind tibia, serum, and feces were collected for analysis. The results indicated that, compared to pigs from group RECC0, pigs from group RECC200 presented with the following: a longer trabecular perimeter (p < 0.05), a larger trabecular area (p < 0.01), a higher trabecular number (p < 0.05), a smaller degree of trabecular separation (p < 0.01), and a lower number of osteoclasts (p < 0.01) in the tibia; higher abundances of beneficial fecal bacteria such as g_Prevotellaceae_NK3B31_group, g_UCG_005, g_Rikenellaceae_RC9_gut_group, g_Acetitomaculum, g_Glutamicibacter, g_Frisingicoccus, and g_Alistipes; higher (p < 0.01) serum levels of IgM, IgA, IgG, and IL-10; a lower (p < 0.01) serum concentration of TNF-α; a higher (p < 0.05) average daily gain and feed conversion ratio; and a lower (p < 0.01) incidence of diarrhea. The dietary addition of RECC contributes to improvements in tibia quality, gut health, and performance in nursery pigs.

Medical Biorepositories of South Africa: Establishing a Medical Biorepository Network in South Africa to Advance Health Research

Biobanking is crucial for advancing medical research and personalized medicine, offering high-quality biospecimens for studies on biomarkers, drug development, and diagnostics. Despite its global potential, challenges such as fragmented governance and varying standards hinder biorepository collaboration, particularly in South Africa (SA). A unified national biobank network could enhance research and healthcare by improving biospecimen access, ethical governance, and collaboration. Global biobank networks offer models for standardization, data sharing, and international cooperation. SA can benefit from these models by creating a centralized biobank platform, promoting capacity building, and fostering regional and global partnerships. To address the challenges SA faces regarding biobanking, the Medical Biobanks Cluster established a network named Medical Biorepositories of SA (MBirSA), which seeks to build a cohesive network of medical biorepositories in SA. Through this network, it plans to foster an inclusive culture of biospecimen and data protocol harmonization, while encouraging adherence to legal, ethical, and quality best practices and standards. The network aims to bring stakeholders together, increasing visibility and transparency, and encouraging sector-wide collaboration. MBirSA also aims to offer training to build capacity in global best practices, aid in the development of dependable biorepository infrastructure, and promote research partnerships to enhance healthcare advancements.

Preclinical Safety Assessment of the Oral Administration of Lactobacillus plantarum GUANKE in Animal Models

Probiotics have a long history as fermented food or food supplements. The health benefits and safety profiles of probiotics are strain-specific and should be evaluated individually. The aim of this study was to assess the safety of the Lactobacillus plantarum GUANKE (GUANKE) strain by conducting pharmacological studies, oral toxicity assessments, and investigating the colonization and translocation of GUANKE in experimental animal models. Three pharmacological studies were conducted to examine the effects of oral administration of GUANKE on gastric emptying, bile secretion, and gastric juice secretion. In an acute toxicity study, rats were orally administrated with different doses of GUANKE and monitored for 14 days. In the subacute toxicity study, both rats and beagles were administrated with varying doses of GUANKE for 28 consecutive days to evaluate hematologic, biochemical, and histological effects. The results showed that GUANKE administration did not result in any adverse effect on hematological parameters, biochemical parameters, urinary parameters, and organ indices. Importantly, no translocation of GUANKE to extra-intestinal organs or blood was observed following administration of the CFDA-SE labeled strain. In summary, this study demonstrated the safety of GUANKE intake, which encourages its potential application as a probiotic in clinical trials.

Association of prebiotic/probiotic intake with MASLD: evidence from NHANES and randomized controlled trials in the context of prediction, prevention, and a personalized medicine framework

Objective

Metabolic-associated fatty liver disease (MASLD) is a growing global health concern. From the standpoint of preventive and personalized medicine, understanding the early determinants and modifiable risk factors is essential for targeted prevention and personalized treatment strategies. This study aimed to evaluate the specific association between probiotics/prebiotics and the occurrence of MASLD, contributing to the development of innovative preventive measures and personalized therapeutic approaches.

Methods

Data were obtained from the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2018. The study employed logistic regression analysis to examine the relation between MASLD and probiotics/prebiotics. The efficacy of various MASLD predictive models was assessed using receiver operating characteristic (ROC) curves. A meta-analysis was conducted by searching databases up to 4 May 2024. The analysis included randomized controlled trials of liver function in patients with MASLD or nonalcoholic steatohepatitis treated with probiotics, prebiotics, or yogurt for a minimum of 6 months.

Results

A total of 5014 adults from NHANES were included in this study, with a weighted prevalence of MASLD observed at 24.47%. MASLD adults who consumed both probiotics and prebiotics exhibited a reduced risk of MASLD (OR = 0.71, 95% CI: 0.53 to 0.94). The use of probiotics/prebiotics can enhance the simplicity and practicality of the model. Model 1, adjusted for sex, BMI, race, and HEI-2015, achieved an area under the curve (AUC) of 0.8544, while Model 2, adjusted for sex, BMI, race, and prebiotics/probiotics use, showed a similar AUC of 0.8537. The comparison between the two models revealed no statistically significant difference (0.8544 vs. 0.8537; 95% CI: - 0.0010 to 0.0025; Z = 0.8332; p = 0.4047). Subgroup analysis of the NHANES data revealed that individuals aged 40 and older benefit from consuming probiotics or prebiotics. Furthermore, the meta-analysis demonstrated that probiotic or prebiotic interventions resulted in significant improvements in biochemical markers, including alanine aminotransferase, aspartate aminotransferase, low-density lipoprotein cholesterol, and triglycerides.

Conclusions

The consumption of probiotics/prebiotics has been linked to a reduced risk of developing MASLD in adults. Integrating probiotics/prebiotics into early intervention and personalized treatment plans may facilitate targeted prevention and management of MASLD, promoting a more individualized approach to disease prevention and care.

Supplementary information

The online version contains supplementary material available at 10.1007/s13167-025-00398-4.

Physical activity, cardiovascular disease, and mortality across obesity levels

Aims

High physical activity (PA) is associated with decreased risk of cardiovascular disease (CVD) and mortality. However, whether PA can be sufficient to reduce the risk of CVD and mortality contributing to adiposity remains unclear. From the standpoint of predictive, preventive, and personalized medicine (PPPM/3PM), joint assessment of PA and adiposity provides novel insights for individual risk assessment, targeted prevention, and personalized intervention of CVD.

Methods

This prospective cohort study included 92,931 participants in the Kailuan study in Tangshan, followed between the years 2006 and 2020. Adiposity was assessed by body mass index (BMI) and waist circumference (WC). The CVD incidence and all-cause mortality associated with 3 PA levels (low, medium, and high PA) were analyzed by applying Cox regression models to different adiposity subgroups.

Results

After a median follow-up period of 14.02 years, 9997 incident CVD cases and 12,586 deaths occurred. Surprisingly, low PA and lean body mass were at a lower risk for CVD than other phenotypes. Participants with high PA still had a 35% higher CVD risk from obesity (hazard ratio (HR) BMI: 1.35, 95% confidence interval (CI): 1.18-1.54) and a 10% higher CVD risk from central obesity (HRcentral obesity: 1.10, 95% CI: 1.00-1.21) than those with lean. However, only in obese individuals, high PA has a protective effect on CVD (HR: 0.78, 95% CI: 0.64-0.95). Overall obesity and high PA were not associated with increased risk of all-cause mortality, whereas high PA could not attenuate mortality risk associated with central obesity.

Conclusion

High PA did not attenuate the risk of CVD associated with adiposity compared with lean body mass among the Chinese population, whereas the combination of high PA and healthy WC might improve healthy aging and longevity. In addition, this study revealed the importance of maintaining muscle health in obese individuals via PA or other ways. It provides a novel strategy for mitigating the risk of CVD by exercising intervention or maintaining body mass, thereby enhancing effective prevention and targeted intervention.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-025-00397-5.

Identifying Specificity Protein 2 as a key marker for diabetic encephalopathy in the context of predictive, preventive, and personalized medicine

Background

Transcription factor specificity protein (SP2) regulates various cellular functions, including cell division, proliferation, invasion, metastasis, differentiation, and death; however, its role has not been studied in prominent medical conditions including diabetic encephalopathy (DE). Therefore, this study addressed its physiological function in the context of DE to also better characterize its possible use in the context of predictive, preventive, and personalized medicine (PPPM).

Methods

The anti-inflammatory and anti-DE actions of SP2 were investigated using three animal models (SP2-/- mice, streptozocin-treated mice, and db/db mice) and two cell lines (primary cultured hippocampal neurons and N2A cells). The db/db mice were a leptin deficiency model often used to study type 2 diabetes. An equal number of males and females (8-12 weeks of age) was selected. Behavioral changes in mice were determined using both morris water maze (MWM) test and Y-maze (YM) test. The alterations in oxidative stress and inflammation were examined via immunofluorescence assay, flow cytometry, co-immunoprecipitation, and immunoblotting.

Results

Mechanistically, SP2-knockout (SP2-/-) mice showed dysregulation of insulin/glucose homeostasis, neuroinflammation, and cognitive loss. Otherwise, in db/db DE mice and STZ-induced DE mice, neuroinflammation, neuroapoptosis, and cognitive decline were significantly attenuated when SP2 was overexpressed in the brain. On the other hand, SP2 overexpression activates the insulin signaling pathway and improves insulin resistance via targeting X-box binding protein 1 (XBP1) in neurons. Moreover, SP2 overexpression significantly reduces oxidative stress by interacting with XBP1 and nuclear factor erythroid 2-related factor 2 (NRF2) in neurons. Furthermore, SP2 enhances the suppression of inflammatory response triggered by nuclear factor kappa B (NFκB) through the recruitment of XBP1 and NRF2 and by the in vitro inactivation of IκB kinase (IKK) complex.

Conclusions

These findings highlight SP2 as key biological targets for DE and reveal the infammation-related potential molecular mechanism of DE, which is helpful for early risk prediction and targeted prevention of DE. In conclusion, our study provides a new perspective for developing a PPPM method for managing DE patients.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-024-00394-0.

Prediction of risk for isolated incomplete lateral meniscal injury using a dynamic nomogram based on MRI-derived anatomic radiomics and physical activity: a proof-of-concept study in 3PM-guided management

Background

The 3PM framework revolutionizes disease management by facilitating early risk prediction, disease prevention, and personalized treatment. For isolated incomplete lateral meniscal injuries (IILMI), where early diagnosis is challenging due to non-specific symptoms, 3PM's proactive approach is beneficial in preventing knee joint disease progression and maintaining patients' quality of life.

Aims

This study aimed to develop a predictive model within the 3PM framework, integrating knee MRI anatomical features with individual physical activity (PA) patterns to enhance early IILMI detection and treatment efficacy, improving patient outcomes and quality of life.

Methods

The training dataset comprised 254 patients. Using logistic regression analyses and least absolute shrinkage and selection operator (LASSO), IILMI was identified among various preoperative factors containing knee MRI and PA features. A dynamic nomogram was constructed and subjected to internal and external validations (91 patients). Validation encompassed C-index, receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA), and clinical impact curves. ROC analysis determined the risk stratification cut-off.

Results

Six independent IILMI factors were identified, including PA intensity, PA type, degree of PA intensity, and MRI-derived anatomical parameters. The dynamic nomogram showed high predictive accuracy (C-index, 0.829 in training, 0.906 in validation). IILMI patients were divided into low-risk, medium-risk, and high-risk groups according to the cut-off value.

Conclusion

In 3PM-guided management, the dynamic nomogram enables early IILMI diagnosis in patients while promoting IILMI stratification making personalized treatment feasible. With further development, it holds promise for effectively predicting IILMI risk, preventing severe knee pathologies, and enhancing the quality of life for at-risk patients.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-025-00399-3.

Multiomics as instrument to promote 3P medical approaches for the overall management of respiratory syncytial viral infections

Respiratory syncytial viral (RSV) infection is a leading persisting pulmonary disease-causing agent. It causes loss of lives especially among infants, old ages, and adults immunocompromised individuals. This viral pathogen infects children more especially those under the age of 2 and may lead to death. It causes 3 million hospitalizations and up to 60,000 deaths annually for under the age of 5. The most vulnerable are immunocompromised individuals and asthmatic children with suboptimal antiviral defenses. It is associated with bronchiolitis, pneumonia, and bronchopneumonia. Despite all the current interventions and clinical trials, the only available therapeutic strategies for this viral infection are palliative care. Therefore, it is imperative to understand the pathogenicity of RSV and the corresponding host immune response to depict a sort of a targeted intervention. With the increasingly cutting-edge methods in harnessing the pathogenicity of this viral infection, high throughput systems including omics technological advances are at the spotlight. For instance, the associated genes with RSV complications for the host, the set of microbiome identified as operational taxonomic unit, the upregulated or downregulated metabolites, the protein subtypes, and the small molecules can help explain the viral microenvironment. Moreover, these big data will lead to RSV patients' stratification through individualized patient profiles that will bring in targeted prevention and treatment algorithms tailored to individualized patients' profiles. Through this, the virus and host interactions based on the pathogenicity of infection will provide a strong ground for depicting the prevention, prediction, and personalized medicine (3PM) for RSV. The 3PM approach brought cutting edge functional medicine to the healthcare givers, thus conferring targeted prevention and precision medicine while observing personalized treatment as well as preventive regularities. The viral replication mechanisms against the host defense mechanisms are crucial for the development of safe and effective therapy. Integrative personal omics profiles, whose analysis is based on the combined proteomics, transcriptomics, genomics, proteoformics, metabolomics, and autoantibody profiles, are very robust for predicting the risk of RSV infection. The targeted prevention will emerge from the patient stratification when the diagnosis is accurately predicted. In addition, the personalized medical services will give an effective prognostic assessment for RSV complications.

Preoperative Geriatric Characteristics Associated with Changes in Postoperative Cognitive Function and Quality of Life: A Prospective Observational Analytic Multicenter Study

BACKGROUND

Changes in cognitive function are associated with increased depression and decreased quality of life (QOL). This study aimed to determine the relationship between the characteristics of geriatric patients and anesthetic management with changes in postoperative cognitive function and QOL of geriatric patients undergoing elective surgery.

METHODS

This prospective observational analytic multicenter study included patients aged ≥60 years who underwent elective surgery in hospitals in Indonesia. We used the whole sampling method and performed follow-up 30 days after surgery. Data were analyzed using bivariate chi-square and multivariate regression tests with a confidence interval of 95% and α=5%.

RESULTS

Among the 933 geriatric patients included in this study 55.0%, females most (59.8%) received general anesthesia. Factors including age (p<0.001, B=-0.374, odds ratio [OR]=0.688), body mass index (BMI) (p<0.05, B=0.129, OR=1.138), and physical status based on American Society of Anesthesiologists (ASA) classification (p<0.001, B=-0.458, OR=0.633) were significantly associated with postoperative cognitive function. BMI (p<0.001, B=-0.218, OR=1.244), absence of comorbidities (p<0.05, B=-0.312, OR=0.732), regional anesthesia (p<0.05, B=0.606, OR=1.883), and changes in cognitive function (p<0.05, B=0.288, OR=1.334) were significantly correlated with changes in postoperative QOL.

CONCLUSION

Age, BMI, and ASA physical status were significantly associated with postoperative cognitive function in geriatric patients, whereas BMI, comorbidities, regional anesthesia, and changes in postoperative cognitive function were associated with QOL. These preoperative factors can predict postoperative cognitive function and QOL and may be useful during preoperative planning.

Mitochondria in cutaneous health, disease, ageing and rejuvenation-the 3PM-guided mitochondria-centric dermatology

Association of both intrinsic and extrinsic risk factors leading to accelerated skin ageing is reflected in excessive ROS production and ir/reversible mitochondrial injury and burnout, as abundantly demonstrated by accumulating research data. Due to the critical role of mitochondrial stress in the pathophysiology of skin ageing and disorders, maintained (primary care) and restored (secondary care) mitochondrial health, rejuvenation and homoeostasis are considered the most effective holistic approach to advance dermatological treatments based on systemic health-supportive and stimulating measures. Per evidence, an effective skin anti-ageing protection, wound healing and scarring quality - all strongly depend on the sustainable mitochondrial functionality and well-balanced homoeostasis. The latter can be objectively measured and, if necessary, restored in a systemic manner by pre- and rehabilitation algorithms tailored to individualised patient profiles. The entire spectrum of corresponding innovations in the area includes natural and systemic skin rejuvenation, aesthetic and reconstructive medicine, sustainable skin protection and targeted treatments of skin disorders. Contextually, mitochondria-centric dermatology is instrumental for advanced 3PM-guided approach which makes a good use of predictive multi-level diagnostics and targeted protection of skin against both - the health-to-disease transition and progression of relevant disorders. Cost-effective targeted protection and new treatment avenues focused on sustainable mitochondrial health and physiologic homoeostasis are proposed in the article including in-depth analysis of patient cases and exemplified 3PM-guided care with detailed mechanisms and corresponding expert recommendations presented.

Pathways to chronic disease detection and prediction: Mapping the potential of machine learning to the pathophysiological processes while navigating ethical challenges

Chronic diseases such as heart disease, cancer, and diabetes are leading drivers of mortality worldwide, underscoring the need for improved efforts around early detection and prediction. The pathophysiology and management of chronic diseases have benefitted from emerging fields in molecular biology like genomics, transcriptomics, proteomics, glycomics, and lipidomics. The complex biomarker and mechanistic data from these "omics" studies present analytical and interpretive challenges, especially for traditional statistical methods. Machine learning (ML) techniques offer considerable promise in unlocking new pathways for data-driven chronic disease risk assessment and prognosis. This review provides a comprehensive overview of state-of-the-art applications of ML algorithms for chronic disease detection and prediction across datasets, including medical imaging, genomics, wearables, and electronic health records. Specifically, we review and synthesize key studies leveraging major ML approaches ranging from traditional techniques such as logistic regression and random forests to modern deep learning neural network architectures. We consolidate existing literature to date around ML for chronic disease prediction to synthesize major trends and trajectories that may inform both future research and clinical translation efforts in this growing field. While highlighting the critical innovations and successes emerging in this space, we identify the key challenges and limitations that remain to be addressed. Finally, we discuss pathways forward toward scalable, equitable, and clinically implementable ML solutions for transforming chronic disease screening and prevention.

Pyridoxal 5'-phosphate and risk of stroke: triangulation of evidence from a nationally representative cohort and bidirectional Mendelian randomization analysis

Background

Stroke is a leading cause of mortality and disability worldwide. Identifying predictive biomarkers and modifiable risk factors is crucial for stroke prevention in the context of predictive, preventive, and personalized medicine (PPPM). We aimed to investigate the association of serum pyridoxal 5'-phosphate (PLP) levels with stroke prevalence in a nationally representative cohort and to assess the causal relationship using bidirectional Mendelian randomization (MR) analysis, with a focus on the implications for PPPM strategies in stroke management.

Methods

We included 6839 participants aged ≥ 18 years from the National Health and Nutrition Examination Survey (NHANES) 2005-2013. Serum PLP levels were measured by high-performance liquid chromatography. Stroke prevalence was ascertained by self-report. We used generalized linear models, Kaplan-Meier curves, restricted cubic splines, stratified analysis, receiver operating characteristic (ROC) curves, and bidirectional two-sample MR to examine the association of PLP levels with stroke prevalence and assess the causal relationship.

Results

In the fully adjusted model, participants with low serum PLP levels had significantly higher odds of stroke compared to those with high levels (odds ratio (OR) = 6.51e-01, 95% confidence interval (CI) 4.46e-01-9.50e-01, P = 2.74E-02). Kaplan-Meier curves showed significantly lower survival probability in the low PLP group (P < 0.05). The restricted cubic spline analysis revealed a non-linear association, with the highest stroke risk at lower PLP levels. The stratified analysis showed significant associations in several subgroups. The ROC analysis indicated good predictive performance of the fully adjusted model (area under the curve (AUC) > 0.7). The MR analysis supported a protective causal effect of PLP on stroke risk (OR = 0.7723581, 95% CI 0.6388086-0.9336201, P = 0.00345), while the reverse MR analysis did not suggest a causal effect of stroke on PLP levels.

Conclusions

Low serum PLP levels are significantly associated with higher stroke prevalence in a nationally representative the United States (US) sample. Integration of observational and genetic evidence supports a protective causal role of PLP in stroke risk. Serum PLP may serve as a promising predictive biomarker for stroke risk assessment and a potential target for personalized nutritional interventions in stroke prevention, in line with PPPM strategies. Our findings highlight the importance of maintaining optimal vitamin B6 status for effective PPPM-guided stroke prevention and management.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-024-00392-2.

Mass spectrometry-based analysis of eccrine sweat supports predictive, preventive and personalised medicine in a cohort of breast cancer patients in Austria

Objective

Metabolomics measurements of eccrine sweat may provide novel and relevant biomedical information to support predictive, preventive and personalised medicine (3PM). However, only limited data is available regarding metabolic alterations accompanying chemotherapy of breast cancer patients related to residual cancer burden (RCB) or therapy response. Here, we have applied Metabo-Tip, a non-invasive metabolomics assay based on the analysis of eccrine sweat from the fingertips, to investigate the feasibility of such an approach, especially with respect to drug monitoring, assessing lifestyle parameters and stratification of breast cancer patients.

Methods

Eccrine sweat samples were collected from breast cancer patients (n = 9) during the first cycle of neoadjuvant chemotherapy at four time points in this proof-of-concept study at a Tertiary University Hospital. Metabolites in eccrine sweat were analysed using mass spectrometry. Blood plasma samples from the same timepoints were also collected and analysed using a validated targeted metabolomics kit, in addition to proteomics and fatty acids/oxylipin analysis.

Results

A total of 247 exogenous small molecules and endogenous metabolites were identified in eccrine sweat of the breast cancer patients. Cyclophosphamide and ondansetron were successfully detected and monitored in eccrine sweat of individual patients and accurately reflected the administration schedule. The non-essential amino acids asparagine, serine and proline, as well as ornithine were significantly regulated in eccrine sweat and blood plasma over the therapy cycle. However, their distinct time-dependent profiles indicated compartment-specific distributions. Indeed, the metabolite composition of eccrine sweat seems to largely resemble the composition of the interstitial fluid. Plasma proteins and fatty acids/oxylipins were not affected by the first treatment cycle. Individual smoking habit was revealed by the simultaneous detection of nicotine and its primary metabolite cotinine in eccrine sweat. Stratification according to RCB revealed pronounced differences in the metabolic composition of eccrine sweat in these patients at baseline, e.g., essential amino acids, possibly due to the systemic contribution of breast cancer and its impact on metabolic turnover.

Conclusion

Mass spectrometry-based analysis of metabolites from eccrine sweat of breast cancer patients successfully qualified lifestyle parameters for risk assessment and allowed us to monitor drug treatment and systemic response to therapy. Moreover, eccrine sweat revealed a potentially predictive metabolic pattern stratifying patients by the extent of the metabolic activity of breast cancer tissue at baseline. Eccrine sweat is derived from the otherwise hardly accessible interstitial fluid and, thus, opens up a new dimension for biomonitoring of breast cancer in secondary and tertiary care. The simple sample collection without the need for trained personnel could also enable decentralised long-term biomonitoring to assess stable disease or disease progression. Eccrine sweat analysis may indeed significantly advance 3PM for the benefit of breast cancer patients.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-025-00396-6.

Big data for neuroscience in the context of predictive, preventive, and personalized medicine

Accurate and precise diagnosis made the medicine the hallmark of evidence-based medicine. While attaining absolute patient satisfaction may seem impossible in the aspect of disease recurrent, personalized their mecidal conditions to their responsive treatment approach may save the day. The last generation approaches in medicine require advanced technologies that will lead to evidence-based medicine. One of the trending fields in this is the use of big data in predictive, preventive, and personalized medicine (3PM). This review dwelled through the practical examples in which big data tools harness neuroscience to add more individualized apporahes to the medical conditions in a bid to confer a more personalized treatment strategies. Moreover, the known breakthroughs of big data in 3PM, big data and 3PM in neuroscience, AI and neuroscience, limitations of big data with 3PM in neuroscience, and the challenges are thoroughly discussed. Finally, the prospects of incorporating big data in 3PM are as well discussed. The review could point out that the implications of big data in 3PM are still in their infancy and will require a holistic approach. While there is a need to carefully sensitize the community, convincing them will come under interdisciplinary and, to some extent, inter-professional collaborations, capacity building for professionals, and optimal coordination of the joint systems.

Impact of a 7-day short peptide diet on gut microbiota and metabolomics in septic mice

Objective

Our study aim is to explore the mechanisms of short peptide passages on intestinal dysfunction in septic mice utilizing a metabolomics approach, which provides a new scientific basis for the clinical study of sepsis.

Methods

Mices were allocated at random into four groups: control (Con), cecal ligation and puncture followed by one, three or 7 day short-peptide-based enteral nutrition group (CLP + SPEN1), (CLP + SPEN3), and (CLP + SPEN7) groups. A liquid chromatography-mass spectrometry-based metabolomics method was used to analyze changes in serum metabolites in septic mice.

Results

Short peptides showed effectiveness in reducing symptoms, mucosal inflammation, and intestinal function damage scores in septic mice. The 16sRNA analysis showcased significant variances in the distribution of bacterial communities between the CLP + SPEN1, CLP + SPEN3, and CLP + SPEN7 groups. At the phylum level, statistically significant variances in the relative abundance of Proteobacteria, Firmicutes, and Bacteroidetes were recognized. The metabolomics analysis results showed significant separation of metabolites between the CLP + SPEN1 and CLP + SPEN3 groups, as well as significant differences in metabolite profiles between the CLP + SPEN3 and CLP + SPEN7 groups. Utilizing a differential Venn diagram, four metabolites were commonly different; 10-heptadecanoic and dodecanoic acids had statistical significance. The abundance of both dodecanoic and lactic acid bacteria was negatively associated at the genus level.

Conclusion

Short peptides were found to promote the growth of beneficial bacteria, Lactobacillus and uncultured_bacterium_f_Muribaculaceae, while reducing intestinal metabolites such as Dodecanoic acid and 10-Heptadecenoic acid. Moreover the Lactobacillus may play a significant therapeutic role in the treatment of sepsis. However, due to the limited number of experimental samples, the exact mechanism of action of short peptides awaits further confirmation.

Multiple Intra-Articular Injections of Adipose-Derived Mesenchymal Stem Cells for Canine Osteoarthritis Treatment

Osteoarthritis (OA) is one of the most common degenerative diseases in dogs and humans, which can lead to articular cartilage deterioration, chronic pain, and decreased quality of life. The anti-inflammatory, anti-fibrotic, analgesic, and cartilage regeneration properties of mesenchymal stem cell (MSC) therapy provide a new direction for the treatment development of OA in the future. Currently, MSC therapy lacks confirmed ideal sources, dosages, formulations, and specific characteristics. In this study, we evaluated the efficacy of multiple canine adipose-derived mesenchymal stem cell (ADSC) injections on anti-inflammation and joint cartilage damage in a canine OA model. Considering animal ethics, we simulated the effects of inflammation and cartilage repair during treatment through a mouse OA model. In the mouse OA model, through the detection of cartilage repair and inflammation-related key factors via histology and molecular biology, it was found that MSC therapy has a certain repair effect on cartilage, but the anti-inflammatory effect is time-dependent. In the canine OA model, we verified the feasibility of multiple injections of ADSCs. Compared with the control group, the cartilage repair effect of the treatment group was obvious, and the inflammatory factors decreased, showing an obvious therapeutic effect. This study demonstrates that multiple intra-articular injections of canine ADSCs could be effective in treating OA symptoms.

Preliminary quantitative analysis of renal sinus fat dysfunction in T2DM patients using MRI fat fraction and R2* mapping

Purpose

To quantitatively analyze renal sinus fat (RSF) dysfunction in type 2 diabetes mellitus (T2DM) patients using magnetic resonance imaging (MRI) fat fraction (FF) and R2* mapping.

Methods

The inpatients who underwent 1.5 T MRI examination (including MRI FF and R2* mapping) of the abdomen from January 2017 to December 2023 were enrolled. The RSF volume, FF and R2* of the right and left kidneys and the mean values were measured. Associations between mean FF and R2* value of RSF and T2DM were assessed with logistic regression. Receiver operating characteristic (ROC) curve was applied to calculate area under the curve (AUC) for the parameters to identify T2DM patients. Partial correlation coefficients after controlling for age, sex, and BMI were computed to analyze the correlations among the mean RSF volume, FF and R2*.

Results

A total of 186 participants were finally enrolled in this study including 38 patients in T2DM group and 148 patients in non-T2DM group. Univariate logistic regression analyses showed the significant correlations of mean RSF FF (OR: 1.111, 95%CI: 1.054 - 1.171), P < 0.001) and R2* (OR: 1.120, 95%CI: 1.013 - 1.237), P = 0.027) with T2DM. Multivariate analysis showed that mean RSF FF (OR: 1.231, 95% CI: 1.098 - 1.380) is independently associated with T2DM after adjusting for age, sex and BMI. The AUC of mean RSF FF was 0.701 (0.630 - 0.766) with the sensitivity and specificity of 57.89% and 75.68%, respectively, when using 34.40% as the cut-off value. The AUC of mean RSF R2* was 0.616 (0.542 - 0.686) with the sensitivity and specificity of 68.42% and 58.11%, respectively, when using 21.97 Hz as the cut-off value. Furthermore, mean RSF FF presents significantly higher diagnostic efficacy for T2DM than R2* (P < 0.05). And combining mean RSF FF and R2* improved the diagnostic performance (AUC = 0.729).

Conclusion

Mean RSF FF and R2* were significantly associated with T2DM, and mean RSF FF was the independent risk factor of T2DM. This finding indicates the hypertrophy of adipocytes and excessive iron deposition and hypoxia in RSF, which may represent dysfunction of RSF for T2DM.

Sheep-Derived Lactobacillus johnsonii M5 Enhances Immunity and Antioxidant Capacity, Alleviates Diarrhea, and Improves Intestinal Health in Early-Weaned Lambs

The early weaning of lambs frequently leads to weakened immunity, impaired intestinal function, and increased susceptibility to intestinal disease. Lactobacillus plays a role in regulating immunity, enhancing antioxidant capacity, and maintaining intestinal health. This study aims to isolate a strain of Lactobacillus with favorable probiotic properties from sheep feces and investigate its effects on the intestinal health of early-weaned lambs. In this study, the growth characteristics, acid production capacity, bacteriostatic capacity, bile salt tolerance, gastrointestinal fluid tolerance, self-coagulation capacity, and surface hydrophobicity of Lactobacillus isolated from sheep feces were analyzed for in vitro probiotic properties. Lactobacilli with strong probiotic properties were used for in vivo validation. A total of 72 Hu lambs were allocated into four groups: a ewe-reared group (ER), early-weaning group (EW), low-dose Lactobacillus group (LL), and high-dose Lactobacillus group (HL). Early weaning was performed in the EW, LL, and HL groups at the age of 28 days. Lactobacillus johnsonii M5 (L. johnsonii M5), isolated from sheep feces, exhibited strong probiotic properties in vitro. Feeding EW lambs with a low dose of L. johnsonii M5 significantly reduced their diarrhea rate (p < 0.05). Its supplementation increased the levels of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-Px) and total antioxidant capacity (T-AOC) in serum and jejunal mucosa and decreased levels of malondialdehyde (MDA) (p < 0.05). Compared to the EW group, serum immunoglobulin G (IgG) levels were significantly increased in the LL group (p < 0.05). Compared to the EW group, feeding with L. johnsonii M5 increased the content of anti-inflammatory cytokines, while reducing the content of pro-inflammatory cytokines in serum and jejunal mucosa (p < 0.05). Feeding early-weaned lambs with L. johnsonii M5 also decreased jejunal crypt depth and increased occludin and claudin-1 in jejunal mucosa (p < 0.05). These findings indicate that feeding early-weaned lambs with L. johnsonii M5 enhances their immunity and antioxidant capacity, improving intestinal health, and mitigates diarrhea in early-weaned lambs.

Case series: effects of platelet-rich plasma (PRP) on the recovery of bilateral muscle injuries after removal of semitendinosus and gracilis grafts in bilateral anterior cruciate ligament (ACL) reconstruction

To assess the healing of acute bilateral muscle injury in cases of bilateral anterior cruciate ligament reconstruction using platelet-rich plasma (PRP) after tendon graft removal. The study included 12 cases of bilateral anterior cruciate ligament reconstruction using semitendinosus and gracilis (STG) grafts. In the right knee, the STG graft was removed, and saline solution was applied; in the left knee, the graft was removed, and PRP was applied. Patients were evaluated using the visual analog scale, pre and postoperative isokinetic tests (5 months), and muscle area analysis. A slight difference in results was observed at 15 and 30 days on the PRP-treated side, but there was no variation in circumference and muscle strength. Due to the small sample size, the study will be continued to increase the number of cases, aiming for the publication of results.