Medical Research Archives

Early screening for chronic obstructive pulmonary disease (COPD) is critical due to the progressive and debilitating nature. Preliminary diagnosis typically relies on pulmonary function tests, particularly the ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC). However, conventional spirometers are often bulky and non-portable, while most existing portable devices can only measure a single parameter, such as FVC, thereby limiting comprehensive assessment. To address these limitations, an integrated wearable system was proposed for both monitoring and rehabilitation training. This system is based on the innovative thermoelectric-airflow inversion (TAI) model, which quantitatively correlates convective heat transfer with thermoelectric voltage to reconstruct airflow velocity and volume in real time. The developed thermoelectric smart mask enables simultaneous measurement of two key obstructive indicators (FVC and FEV1) and automatically evaluates COPD risk via the FEV1/FVC ratio, alerting users to seek medical consultation when abnormalities are detected. In terms of performance, the device demonstrates a measurement accuracy of 99.10% and a coefficient of determination (R2) of 0.9947 compared to a commercial spirometer. Furthermore, the incorporated virtual reality assisted rehabilitation system was developed, yielding an average FVC improvement of 5.87% across three participants after one week of interactive training. Enabled by the TAI framework and a closed-loop multi-parameter design, this platform provides an intelligent, quantitative, and continuous solution for respiratory healthcare and rehabilitation.

Aphasia diagnosis in Indonesia remains challenging due to limited culturally and linguistically appropriate instruments. Widely used tools such as the Boston Diagnostic Aphasia Examination (BDAE) and Western Aphasia Battery (WAB) are not adapted to the Indonesian context, while Tes Afasia untuk Diagnosis, Informasi, dan Rehabilitasi (TADIR) provides screening but lacks diagnostic accuracy. To address this gap, we developed the Instrumen Diagnosis dan Evaluasi Afasia (IDEA) for native Indonesian speakers and evaluated its validity, reliability, and normative cutoff values in cognitively healthy Indonesian adults. Eighty-three cognitively normal adults (screened using MoCA-Ina) with no history of neurological disease were assessed using IDEA, which evaluates six language domains. Items were adapted from existing tools and reviewed by experts. Content validity, internal consistency (Cronbachs alpha), and construct validity (Exploratory Factor Analysis) were analyzed using SPSS v25. A total of 83 participants were included (median age = 55.81 years, 54% secondary education). IDEA demonstrated good feasibility, with an average completion time of 45-60 minutes depending on participant engagement. Content validity was established by unanimous expert consensus. Construct validity showed meritorious sampling adequacy (KMO = .872) and significant sphericity (Bartletts test {chi}^2 (15) = 278.523, p<.001), supporting factor analysis. Internal consistency showed good reliability across six domains (Cronbachs = 0.896). IDEA is a valid and reliable tool for assessing aphasia in Indonesian natives. It is a culturally appropriate assessment tool which offers structured, domain-based evaluation and supports differential diagnosis of both classical and progressive aphasia syndromes. Keywords: Aphasia, Language Assessment, Indonesian, IDEA, Validity

Background: Chronic and non-healing wounds remain a major clinical challenge with limited therapeutic options. Angiogenesis and inflammation are central to tissue repair, and mesenchymal stem cells (MSC) contribute to these processes through their trophic and immunomodulatory secretome. Cannabidiol (CBD) exhibits antioxidant and immunomodulatory properties. However, whether CBD-rich Cannabis sativa extract stimulate MSC toward a pro-angiogenic secretome remains unclear. Purpose: This study aims to determine whether purified CBD or a phytochemically CBD-rich full spectrum extract stimulate umbilical cord-derived human MSC (UC-hMSC) to secrete pro-angiogenic factors and enhance endothelial responses relevant to wound healing. Methods: UC-hMSC were preconditioned with either purified CBD or a CBD-rich full-spectrum extract. Transcriptional changes were assessed by qPCR. The functional impact of the resulting secretome was evaluated in vitro using HUVEC-based proliferation and tube formation assays, and in vivo through the chick chorioallantoic membrane assay. To explore underlying mechanisms, we examined HIF-1 stabilization and VEGFA release in UC-hMSC, and VEGFR-2/ERK signaling in HUVEC. Results: Purified CBD and full-spectrum CBD extract preconditioned UC-hMSC secretomes, increased HUVEC proliferation, tube formation, and enhanced vascular branching in the CAM assay. Mechanistic analyses indicated activation of the HIF-1/VEGF axis in UC-hMSC, and ERK1/2 activation in HUVEC that was sensitive to VEGFR-2 blockade. Conclusion: Purified CBD and CBD-rich full-spectrum extract prime UC-hMSC toward a pro-angiogenic secretome that promotes endothelial activation and neovascularization. These findings suggest that cannabinoid-based preconditioning of UC-hMSC involves the HIF-1/VEGF axis and VEGFR-2/ERK signaling pathways in endothelial cells, supporting further investigation of this approach in wound healing and regenerative therapies.

Humans and other vertebrates contain two estrogen receptors (ERs), ER-alpha and ER-beta, which mediate the physiological actions of three estrogens: estrone (E1), estradiol (E2) and estriol (E3). Of these three estrogens, in vivo, E2 is the strongest transcriptional activator of ER-alpha and ER-beta, E1 is next most active, followed by E3. We studied transcriptional activation of human ER-alpha and ER-beta by E2, E1 and E3 in African green monkey kidney (COS-7) cells, which we compared with studies of estrogen stimulation of ER transcription in human em-bryonic kidney (HEK-293) cells. To our surprise, in COS-7 cells, E3 had the lowest half-maximal response (EC50) for human ER-alpha and ER-beta than either E2, which was second most active estrogen, or E1. In contrast, for human ER-alpha and ER-beta transfected into HEK-293 cells, E2 was the most active estrogen, followed by E1 and E3. Similar results were found in COS-7 cells and HEK-293 cells transfected with elephant shark ER-alpha and ER-beta. Thus, under some conditions, E3 is a more active estrogen than either E2 or E1. This suggests that E3 may be a novel physiological ligand for the ER in some mammalian cells.

Senescence human bone marrow mesenchymal stem cells (BMSCs), vulnerable to age-related defects, is poor in tissue regeneration. Cells in bone marrow accumulated senescent contributing to the development of metabolic energy regulation hold prospects for therapeutic advances. This study aimed to evaluate energy metabolic changes in male bone marrow mesenchymal stem cells senescence process. Our research established cell specific surface marker and enzymes expression level changes, as well as ECAR and OCR resonance. Notably, CD14, HLA-DRB1 and CD90 upregulated, glycolysis-related genes are increased, tricarboxylic acid cycle-related genes are decreased. We firstly identified links between time-dependent cell aging process and energy metabolism in BMSCs.

Background: RSV is a major cause of severe lung infections in young children, with over 95% of deaths occurring in poorer countries. Bangladesh has high rates of RSV illness in children but lacks genetic data from after the COVID-19 pandemic. New vaccines and antibody treatments are now available, making local genetic information essential. Objectives: We sequenced complete RSV genomes from Bangladeshi patients to study virus types, genetic changes, and protein mutations, and shared our data openly. Methods: From August 2024 to December 2025, we took 59 RSV-positive samples with high virus levels from hospital patients and sequenced their full genomes using Oxford Nanopore technology. Results: Among 11,874 patients, 1,390 (11.7%) had RSV, mostly RSV-A (94.6%). We obtained 49 good-quality full genomes from the 59 samples (83% success): 43 RSV-A (ON1 type, five sub-lineages) and 6 RSV-B (BA9 type). We found S276N in 35% of RSV-A and S389P in all RSV-B, but neither stops current antibody treatments. All RSV-A viruses gained a new sugar attachment site on their F protein, and most RSV-B viruses gained one too. We uploaded all 49 genomes to GISAID for public use. Conclusion: This work shows we can do full RSV genome sequencing in Bangladesh. The viruses here still match the targets of new vaccines and antibodies, which is reassuring. Our findings provide a foundation for planning RSV prevention in Bangladesh and South Asia.

Anoxia is a major stress for most vertebrates and frequently accompanies harsh winter conditions, particularly in species that spend much of the season frozen solid. North American freeze-tolerant wood frogs (Rana sylvatica) can survive several months without oxygen and endure whole-body freezing for up to eight months of the year, with [~]70% of total body water frozen as extracellular ice, yet revive when temperatures rise in spring. Survival depends on multiple adaptations, including tolerance of prolonged oxygen deprivation while frozen, when breathing and circulation are halted. A key strategy involves hepatic glycogen mobilization, producing large amounts of glucose that are distributed to tissues where it functions both as a cryoprotectant and as a substrate for anaerobic ATP production. The present study examines the role of histone lysine methylation and demethylation in regulating liver proteins under anoxic conditions. Relative protein expression of seven histone methyltransferases (ASH2L-S, ASH2L-L, RBBP5, SETD8, SMYD2, ESET, SETD1), six lysine demethylases (KDM1A, KDM3B, KDM4A, KDM4B, KDM5A, KDM5C), and eight histone marks (H3K4me1, H3K4me2, H3K9me3, H3K27me3, H3K36me3, H3K79me3, H4K20me1, H4K20me3) were evaluated in wood frog liver under control, 4-hour, and 24-hour anoxia exposures. The data indicate that histone lysine methylation and demethylation contribute significantly to transcriptional regulation under anoxia. Specifically, H3K4, H3K36, and H3K79 methylation were associated with transcriptional activation, whereas H3K9, H3K27, and H4K20 methylation correlated with transcriptional repression. These findings highlight the dynamic role of epigenetic regulation in supporting hypometabolism and stress adaptation in freeze-tolerant wood frogs.

The Next Generation Impactor (NGI) is one of the regulatory gold standards for characterizing aerodynamic particle size distributions (APSDs) of orally inhaled drug products (OIDPs); however, its reliance on complex, resource-intensive in vitro testing under tightly controlled environmental conditions limits experimental flexibility and introduces variability. In alignment with the growing regulatory emphasis on New Approach Methodologies (NAMs) for drug development, this study presents a rigorously validated computational fluid particle dynamics (CFPD) based virtual NGI (vNGI) as an in silico method complementary to conventional testing. The vNGI replicates a significant portion of the NGI geometry and airflow physics, enabling high-resolution spatiotemporal analysis of aerosol transport and deposition mechanisms that are otherwise inaccessible experimentally. A comprehensive verification and validation framework was implemented, including mesh and particle independence studies, turbulence model assessment, and comparison of stagewise deposition efficiencies with available in vitro data at 30 L/min. The model's capabilities were further extended to low and high flow rates, and two bio-relevant mouth-throat models and polydisperse particle laden aerosol were added. The model demonstrates strong predictive capability for a few stages and provides mechanistic insight into discrepancies in other stages, depending on the type of analysis. Importantly, this work establishes the vNGI as a fit-for-purpose according to NAM by (i) defining a clear context of use for APSD prediction and inhaler performance evaluation, (ii) capturing physically and biologically relevant air-particle interactions, and (iii) demonstrating technical robustness and reproducibility through systematic validation. The platform can potentially further enable simulation of environmental and physiological conditions, such as humidity effects, that are difficult to control experimentally, thereby improving human relevance and reducing reliance on costly and time-consuming in vitro testing. This study positions the vNGI as a scalable, regulatory aligned NAM capable of supporting early stage drug device combination product development, device optimization, and an alternative bioequivalence assessment, contributing to ongoing efforts to enhance predictive performance, reduce experimental burden, and transition toward human centric, inhalation product evaluation.

Aedes albopictus is a major arboviral vector whose global expansion, driven by human activities and climate change, poses a growing public health concern for a number of neglected tropical diseases in both tropical and temperate regions. As a poikilotherm, its biology and population dynamics are strongly influenced by temperature, thereby shaping disease transmission. To thwart and control its geographic expansion, effective vector control strategies are increasingly critical. Densoviruses (DVs), such as AalDV2, are being explored as mosquito viral biocontrol agents due to their restricted host range and ability to disseminate through oviposition sites. However, the influence of environmental parameters on the interactions between Ae. albopictus and AalDV2 remains poorly understood. This makes their performance under realistic, fluctuating thermal regimes difficult to estimate. In this study, we investigated the combined effects of temperature and AalDV2 exposure on Ae. albopictus survival and development across its full life cycle. Mosquitoes were reared under fluctuating temperature regimes (26-28 {degrees}C and 32-34 {degrees}C, 12:12 day[ndash]night cycles) and exposed to AalDV2 or a control treatment. Chronic exposure to 32-34 {degrees}C significantly reduced overall survival, decreasing median lifespan by approximately 10 days (HR=2.21, p=0.0018), with a deleterious effect increasing over time. It extended aquatic lifespan and increased pupal mortality. It also reduced adult lifespan in both sexes with a stronger effect in females. AalDV2 exposure had no significant effect on overall survival, stage-specific mortality, or adult lifespan. However, a significant interaction between viral exposure and thermal stress was detected on aquatic lifespan: AalDV2-exposed females showed further extended larval and pupal development specifically under the 32-34 {degrees}C regime, without any effect on survival. These results indicate that the biocontrol potential of AalDV2 cannot be assessed independently of thermal context: while lethal effects were absent under both fluctuating regimes, the prolongation of aquatic development by the virus under thermal stress may have indirect consequences for mosquito population dynamics that warrant further investigation.

Cystic fibrosis (CF) is characterized by defective CFTR-mediated chloride transport, resulting in elevated sweat chloride concentrations. As people with CF (PwCF) now live longer due to highly effective CFTR modulators, exercise has become integral to maintaining health, yet it introduces additional physiological demands on salt and fluid balance. In this study, we used a wearable microfluidic biosensor (CF Patch) to quantify sweat rate and chloride loss during exercise performed both in the supervised laboratory and remote free-living in PwCF and healthy volunteers (HV). Participants completed exercise sessions under both conditions, with continuous heart rate monitoring and sweat collection with real-time measurement of sweat characteristics. Sweat volume and chloride concentration were assessed by colorimetric image analysis, enabling estimation of total fluid and chloride loss at the end of each exercise session. PwCF exercised for a longer duration at a lower average heart rate during remote exercise compared to laboratory exercise though exercise volume (average heart rate x duration) was greater during remote exercise. There was a positive association between exercise volume and both fluid and chloride loss for both PwCF and HV. PwCF exhibited greater chloride loss for a given exercise volume compared to HV, though fluid loss was similar. Further, compared to HV, PwCF demonstrated significantly greater intra- and interindividual variability in sweat chloride loss across the remote exercise sessions. Collectively, these findings provide evidence for the feasibility and physiological validity of remote exercise assessment and establish the feasibility and physiological validity of wearable sweat sensing for remote monitoring of fluid and electrolyte dynamics during real-world exercise. In addition, the variability of chloride loss in response to exercise suggests utility of the CF Patch in providing personalized fluid and salt repletion data for PwCF and advances the translational potential of digital sweat diagnostics for personalized CF care.

Wood is commonly used in the building sector, emitting volatile organic compounds (VOCs) contributing to indoor air quality. These VOC profiles can have a pleasant smell and positive effects e.g., induce relaxation. Contrarily, VOCs can have adverse health effects in higher concentrations. Therefore, some VOCs are regulated by guide values (GV). Potentially positive and negative effects of pinewood emissions, ranging from 0.2 mg/m3 (German GV I for bicyclic terpenes) to 2.0 mg/m3 (GV II) were investigated in an experimental 2 h exposure study using a within-subject design. Thirty-two healthy participants rated the perception, pleasantness, symptoms of irritation, and indicators of well-being. During a demanding working memory task (n-back) and a resting period, heart rate (HR) and HR variability (HRV) changes were measured. Before and after each session physiological markers of sensory irritation were assessed. Ratings indicated that the exposure to GV I and GV II were not perceived as more intense or pleasant. Mostly concentration-independent effects were revealed, indicating that inter-individual factors influenced the ratings rather than the VOCs. The pinewood odors during the n-back task did not cause distraction nor did it facilitate performance as previously suggested. HR/V changes indicated that pinewood odors during and after the n-back tasks did not induce relaxation. Only symptoms of nasal irritation showed some weak concentration-dependency, not supported by physiological markers or comparable ratings of sensory irritation. In conclusion, the fact that no distinct odor is detected suggests that interfering factors potentially prevent the regulation of odors at relevant indoor air concentrations.

Abstract Background: Non-specific chronic low back pain (NSCLBP) is a major cause of disability worldwide and is associated with low-grade systemic inflammation. This study investigated the effects of aerobic exercise on inflammatory biomarkers, pain intensity, and quality of life among individuals with NSCLBP. Methods: In this parallel-group randomized controlled trial, 41 participants with NSCLBP were allocated to either an aerobic exercise plus health education group (n=21) or a health education-only control group (n=20). Participants in the intervention group completed supervised aerobic cycling three times weekly for 12 weeks. Outcome assessors and laboratory personnel were blinded to group allocation. Outcomes were measured at baseline, Week 8, and Week 12. Results: Interaction effects were observed for TNF- (p=0.046), IL-6 (p<0.001), hs-CRP (p<0.001), and pain intensity (p<0.001). Significant improvements were also observed across all WHOQOL-BREF quality-of-life domains (all p<0.05). After adjustment for baseline values and age, participants in the intervention group had significantly lower Week 12 IL-6 (p=0.013), hs-CRP (p<0.001), and pain intensity (p<0.001) than controls. No serious adverse events were reported. Conclusions: Aerobic exercise combined with health education produced greater improvements in inflammatory biomarkers, pain intensity, and quality of life than health education alone among individuals with NSCLBP. These findings support the integration of structured aerobic exercise into rehabilitation programmes for chronic low back pain. Keywords: Non-specific chronic low back pain; aerobic exercise; inflammation; IL-6; hs-CRP; pain intensity; quality of life; randomized controlled trial.

Spinal cord injury (SCI) causes rapid and severe bone loss in the paralysed lower limbs, particularly at the distal femur and proximal tibia, where fragility fracture risk is high. In vitro nanoscale vibration at 1 kHz has been shown to promote osteogenic differentiation and inhibit osteoclastogenesis, suggesting potential as a targeted mechanical intervention. This study aimed to develop and evaluate a wearable device for delivering and monitoring localised nanovibration at the distal femur in individuals with SCI. The device delivered continuous sinusoidal nanoscale stimulation at 1 kHz via a bone-conduction transducer, with an opposing accelerometer used to monitor transmitted vibration in real time. Design and target-site selection were refined through two healthy-volunteer investigations comparing the distal femur, proximal tibia, and distal tibia. Bovine femur experiments characterised vibration transmission under controlled benchtop conditions. Preliminary repeated-use feasibility was assessed in one individual with motor-complete SCI. Healthy volunteer testing showed that although the ankle initially produced the highest transmitted amplitudes, these were highly variable, and positioning was inconsistent. Within the knee region, the distal femur provided the most practical and repeatable site for a wearable application. In bovine femur experiments, scanning laser vibrometry demonstrated measurable vibration on the condylar surface opposite the transducer, and depth-resolved measurements confirmed that nanoscale vibration remained detectable within bone. A gel interface layer reduced the transmitted amplitude. In the feasibility evaluation, 61 sessions were completed over 14 weeks, with logged accelerometry confirming repeated nanoscale vibration transmission. These findings establish feasibility and support further device optimisation and translational studies.

Background Human T-cell lymphotropic virus - 1 (HTLV-1) is the causative agent of Adult T-cell Leukaemia/Lymphoma (ATLL), a malignancy of CD4+ cells, and HTLV-1-associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP), a demyelinating disease. Globally, 10-20 million people are infected, though most remain asymptomatic and about 5% progress to severe disease. Transmission occurs mainly through breastfeeding, sexual contact, contaminated needles, and blood transfusion. In Ghana, evidence on the role of HTLV-1 in haematological malignancies remains scarce. Methods This was a cross-sectional study involving 200 patients with haematological malignancies (Acute Lymphoblastic Leukaemia - 4, Acute Myeloid Leukaemia - 6, Chronic Lymphocytic Leukaemia - 27, Chronic Myeloid Leukaemia - 63, Hodgkin Lymphoma - 21, Multiple Myeloma - 31, Myelodysplasia - 6, Myeloproliferative Neoplasm - 11) at the Haematology Day Care of the Korle-Bu Teaching Hospital. After informed consent was obtained, sera from study participants were tested for anti-HTLV-1 using MP Diagnostics GmbH ELISA immunoassay. Data were analysed using R software version 4.0.2 and SPSS version 31.0.0. Results The study population had a mean age of 49.1{+/-}17.7 years, with majority being females (n=109, 54.5%). Of the 200 samples, 16 (8.0%) were seropositive for HTLV-1, and these were detected in 4 males and 12 females. No statistically significant association was found between HTLV-1 infection and haematological malignancy (exact p = 0.061), sex (p=0.061), and history of blood transfusion (exact p= 1.000). Conclusion The findings show the seroprevalence of HTLV-1 of 8.0% among patients with haematological malignancies. Although there was no probable association between HTLV-1 and haematological malignancies, screening for HTLV-1 in patients with haematological malignancies may help to unravel the exact contribution in these conditions.

Cryopreservation of ram semen induces structural and functional alterations that compromise sperm fertility. Since seminal plasma contributes to the regulation and preservation of sperm function, increasing attention has been directed toward seminal plasma extracellular vesicles (EVs) that are involved in sperm physiology. EVs act as carriers of proteins that are involved in sperm membrane organization and capacitation, suggesting that they may contribute to the maintenance of sperm stability during cryopreservation.. Thus, the aim of this study was to evaluate the effect of seminal plasma-derived EVs on post-thaw functional parameters of ram sperm. Semen was cryopreserved in the presence or absence of EVs isolated by ultracentrifugation that have been characterized by nanoparticle tracking analysis (NTA) and Western blotting (WB). Post-thaw sperm quality was assessed by evaluating viability, membrane lipid disorder, reactive oxygen species production, protein phosphorylation, acrosome status, intracellular calcium levels, and sperm motility. Sperm cryopreserved with an extender containing EVs showed a significant reduction in membrane lipid disorder and lower intracellular calcium levels compared to control samples (p < 0.05). CASA analysis revealed that EV supplementation did not affect total or progressive motility but modified sperm kinematic patterns, with increased linearity and straightness, indicating improved trajectory efficiency without induction of hyperactivated motility. No differences were detected in viability, ROS content, phosphorylation of proteins in residuous tyrosine (pY) or PKA or acrosome status. These results provide the first evidence that seminal plasma derived extracellular vesicles exert a protective effect during ram semen cryopreservation, preserving membrane organization and calcium homeostasis and improving sperm functional quality after thawing. Highlights- Seminal EVs protect ram sperm during cryopreservation. - EVs reduce membrane lipid disorder and intracellular Ca2+ levels. - EVs modify kinematics, increasing linearity and straightness. - No effects on viability, ROS, phosphorylation or acrosome status. - EVs improve post-thaw sperm functional quality and stability. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=92 SRC="FIGDIR/small/732841v1_ufig1.gif" ALT="Figure 1"> View larger version (28K): org.highwire.dtl.DTLVardef@d1f8a9org.highwire.dtl.DTLVardef@11c3d6aorg.highwire.dtl.DTLVardef@104124forg.highwire.dtl.DTLVardef@4e355f_HPS_FORMAT_FIGEXP M_FIG C_FIG

Background Gait training incorporating visual feedback or rhythmic auditory cueing has shown promising results in neurological conditions but has rarely been investigated in clinical rehabilitation for persons with Multiple Sclerosis (pwMS). Objective To evaluate the feasibility of treadmill training (TT) with visual feedback (VF) and TT with visual feedback plus rhythmic auditory cueing (VF+RAC) during clinical rehabilitation and explore its effects on gait parameters. Methods PwMS were randomly allocated 1:1 to perform ten 30-minute training sessions of TT with VF or VF+RAC during inpatient rehabilitation. The primary outcome was feasibility (adherence, compliance, safety, and acceptability). Secondary outcomes were session-by-session developments in spatiotemporal and qualitative gait parameters. Results Sixty of 68 randomized participants completed the intervention (VF: n=29; VF+RAC: n=31). Adherence and compliance rates were 93% and 86%, respectively, with no differences between groups. The most common adverse event in both groups was (leg) pain (21/38 total adverse events). One fall occurred in 629 sessions. Both interventions were greatly accepted and perceived as fun, motivating and helpful to achieve rehabilitation goals. Both groups increased in distance, gait speed, and average step length. Step length variability did not change in the VF-group, while the VF+RAC-group slightly improved. Step length difference was constantly low in the VF+RAC-group, while the VF-group differences were elevated. Conclusions VF and VF+RAC are feasible training options for pwMS in a rehabilitation setting and are greatly accepted by participants. Qualitative gait parameters should be investigated in studies powered to detect clinically relevant differences in the future.

Distal radius fractures (DRFs) can delay return to activities of daily living and social participation because of postoperative pain, temporary joint immobilization, and limited wrist and forearm range of motion. The Ghost System developed at Saitama Prefectural University, Japan, combines visual action observation with tendon vibration stimulation and has shown potential as an adjunct to conventional rehabilitation. This Study Protocol describes a modified Ghost system intended to improve clinical implementation by replacing the head-mounted virtual reality display with iPad-based action observation and by using a wristband-type vibrator. This single-center, single-arm, open-label feasibility trial will enroll 10 adults after palmar locking plate fixation for DRF. The intervention will be delivered twice weekly during outpatient rehabilitation follow-up sessions from the early postoperative period (postoperative days 2-10 after enrollment) through the approved early postoperative rehabilitation period (generally up to postoperative week 8), in parallel with standard rehabilitation practices. Primary feasibility and preliminary clinical outcomes include device fit and acceptability, pain assessed using a 100-mm Visual Analog Scale, and wrist/forearm range of motion. Secondary implementation and safety outcomes include Disabilities of the Arm, Shoulder and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), Hand20 Questionnaire (HANDS-20), EuroQol 5 Dimensions 5 Levels (EQ-5D-5L), body ownership and hand-illusion questionnaires, setup time, setup errors, adherence, adverse events, and device incidents. We hypothesize that the modified Ghost system will be feasible and acceptable for early postoperative outpatient rehabilitation and will be delivered without serious device-related adverse events. Clinical outcomes will be summarized descriptively to inform a future controlled study rather than to establish efficacy.

Hearing hypersensitivity (hyperacusis) is a common hearing stress and can cause many psychological diseases, e.g., anxiety, learning disabilities, and attention-deficit/hyperactivity disorder (ADHD). Here, we report an unexpected finding that the upregulation of P2x2 ATP-purinergic receptors in the cochlea links to hyperacusis generation. We found that P2x2 expression in the cochlea but not in auditory centers was upregulated in the hyperacusis generated by Cx26 deficiency. Overexpression of P2x2 in the cochlea also caused hyperacusis. Conversely, downregulation of P2x2 expression or administration of P2x2 antagonists attenuated hyperacusis. We further found that upregulation of P2x2 receptors in the cochlea increased outer hair cell (OHC) electromotility through the post-transcription functional modulation to potentiate active cochlear amplification leading to hearing hypersensitivity. Such enhancements in OHC electromotility and active cochlear amplification were also suppressed by P2x2 receptor antagonists. Overall, these findings demonstrate that P2x2-mediated ATP-purinergic signaling in the cochlea plays a critical role in hyperacusis generation; targeting P2x2 receptors can attenuate hyperacusis stress, which may also offer a therapeutic strategy for other related psychological comorbidities. Significance statementHearing hypersensitivity is a common hearing stress and can cause many other psychological disorders. However, little is known about the underlying genetic and cellular mechanisms. Also, it lacks efficient drugs for their treatments in the clinic. In this study, we found that upregulation of P2x2 ATP-purinergic receptors in the cochlea can potentiate outer hair cell electromotility, which is an active cochlear amplifier in mammals and can increase hearing sensitivity and frequency selectivity, through post-transcription functional modulation to enhance active cochlear amplification leading to hearing hypersensitivity. These enhancements can be inhibited by administrations of P2x2 receptor antagonists both in vitro and in vivo. These findings revealed a new genetic and cellular mechanism underlying hyperacusis generation and opened a new avenue to develop an efficient therapy for this common hearing stress and other associated psychological comorbidities.

Redox balance is central to aerobic metabolism, yet acute heat stress can destabilize this balance by increasing metabolic rates and shifting the balance of critical electron carriers such as NADH. In early Drosophila melanogaster embryos, maintaining redox balance is particularly critical as embryos undergo a developmental redox shift and rely on oxidative phosphorylation to power nuclear divisions. Here, we assayed six isofemale D. melanogaster lines from temperate (Vermont, USA; France; Japan) and tropical (St. Kitts; Ghana; India) climates to assess metabolic responses to heat in heat-sensitive versus heat-tolerant embryos. We used untargeted LC--MS to measure 33 metabolites and the major redox couples (NADH/NAD+, NADPH/NADP+, and GSH/GSSG) at 25{degrees}C and after a 32{degrees}C heat shock. In all embryos, heat shock induced shared shifts in metabolic profiles, with increases in nucleotide monophosphates (e.g., AMP, CMP, and GMP) and amino acids (e.g., alanine, glutamic acid, serine). In contrast, redox metabolites diverged by region: heat-sensitive temperate embryos shifted toward a more oxidized state (46.6% decrease in NADH/NAD+ ratio and 4-fold increase in oxidized glutathione), while heat-tolerant tropical embryos maintained glutathione balance and increased the NADH/NAD+ ratio by 52.9%, indicating a more reduced state. These patterns are consistent with higher NADH oxidation and greater oxidative stress (inferred from oxidized glutathione) in the temperate embryos, versus better maintenance of redox balance in tropical embryos. Together, our results suggest that maintaining redox balance is a key determinant of acute heat tolerance, and healthy development overall, during early embryogenesis.

Spinal cord injury (SCI) is a devastating neurological injury that results in the profound loss of voluntary motor function and marked reduction in quality of life. Rehabilitation remains as the standard of care for recovery after SCI; however, it often falls short in recovering meaningful motor function. Spinal cord stimulation (SCS) has emerged as a promising neurostimulation approach to fill this gap and recover lost voluntary motor function. Two main approaches of SCS have been designed and implemented for human use: epidural and transcutaneous SCS. Over the last two decades, several clinical studies have shown convincing evidence that both epidural and transcutaneous SCS can be used in conjunction with rehabilitation to improve motor function of individuals after SCI. Yet fundamental clinical questions remain unanswered: when should clinicians choose epidural or transcutaneous SCS, which technique provides the most durable outcomes, and for whom is each therapy best? Without these answers, widespread and meaningful adoption of either approach into clinical practice will remain limited. To address these questions, in this Review, we define the distinct therapeutic goals, intended use cases, clinical parameters, and responder profiles for both epidural and transcutaneous SCS to guide their eventual adoption into clinical practice. We found that indeed epidural and transcutaneous SCS serve distinct therapeutic roles. Epidural SCS is designed as an assistive therapy that can restore muscle activity and single joint movements immediately within one week of implantation, while transcutaneous SCS is designed as a long-term therapeutic device with cumulative functional gains observed over treatment periods of up to 18 weeks. Lastly, epidural SCS produced benefits for all participants (AIS A-D) despite the extent of their injury, while transcutaneous SCS only consistently benefits individuals with incomplete motor injuries (AIS C-D).