MethodsX

ECG waveform data, which is increasingly required for artificial intelligence analyses, is often unavailable in raw data formats. Digitization can approximate original raw data from ECG images, but digitizers reconstruct ECG waveforms only approximately. Exact waveform reconstruction is needed to guarantee that any errors, even if small, do not unexpectedly propagate into downstream analyses. Portable document format (PDF) files containing vector graphics store waveforms derived directly from raw data. This improves reconstruction accuracy, but existing PDF reconstruction methods remain approximate because raw data values are rounded during PDF encoding/generation. Despite rounding, however, there is a 1:1 mapping between raw data and PDF-encoded values which can be reversed to recover the original raw data with no error. We developed open-source software in MATLAB and Python (http://github.com/BIVectors/pdf2ECG) for bit-exact waveform reconstruction of General Electric MUSE ECG PDFs based on double quantization of ECG waveform data. The software supports multiple PDF layouts and voltage gains, automatically flags waveform clipping under which exact reconstruction is not possible, and certifies if parameter values used for waveform reconstruction are consistent with parameter values used during PDF encoding. Accuracy was assessed by comparing PDF reconstructed waveforms to raw XML waveforms, and reconstruction parameters were perturbed to determine the accuracy of waveform certification. 1,632 PDF-XML pairs were assessed in 5 layouts, each at 3 gains. After software-identified waveform clipping was excluded, the software reconstructed 100% of ECG waveforms with zero error compared to ground-truth XML. Certification tests were extremely sensitive to minor perturbation in encoding parameters, and if passed, confirmed bit-exact waveform reconstruction without need for ground-truth comparisons. Although this method does not replace the need for general ECG image digitization, for MUSE generated PDFs this method is preferable to rasterization followed by image-based digitization.

Abstract Background: Conventional cuff based methods report single systolic and diastolic pressure values and depend either on Korotkoff sounds or on empirical oscillometric algorithms. Methods: We developed a patented cuff based method, termed plethysmometry, that simultaneously records cuff pressure and finger photoplethysmograms from the cuffed and contralateral arms. The contralateral photoplethysmogram serves as an internal physiological reference for pulse amplitude. Following an initial pressure ramp, 16 cuff pressure plateaus are applied. Absolute and normalized pulse amplitudes in the cuffed arm are related to cuff pressure to estimate lower and upper systolic and diastolic pressures. Mean arterial pressure is estimated independently from cuff pressure oscillation amplitude. The estimations are done by automated algorithms developed in MATLAB. Results: The method reports lower and upper systolic, diastolic and mean arterial pressure ranges (during the recording period), together with their average values. Average pulse pressure is also reported. Graphs are provided for reference to check the accuracy of reported pressures. Conclusion: Plethysmometry provides an objective digital record of the cuff pressure and pulse traces and estimates systolic and diastolic pressure ranges from the pulse response of the individual subject to graded cuff pressure. It also reports mean arterial pressure. Comparison of plethysmometric systolic and diastolic pressures with sphygmomanometrically derived pressures and diagnostic agreement are reported in a companion paper.

Background: Primary embryonic dorsal root ganglion (DRG) explants offer an accessible and physiologically relevant organotypic in vitro assay platform that preserves native three-dimensional cellular interactions and supports robust neurite outgrowth, enabling studies of sensory neuron development and neurite outgrowth, as well as controlled assessment of neurotoxicity, and pharmacological compound effects. Methods: Here we provide a comprehensive step-by-step method to micro-dissect and culture embryonic chicken DRGs and quantitatively measure neurite outgrowth. The protocol covers embryo preparation, vertebral column exposure, bilateral DRG microdissection, explant culturing, longitudinal phase-contrast imaging, and neurite image analysis. Results: DRG explants maintained their overall ganglion morphology and remained attached to the culture surface throughout the five-day culture period. Untreated control explants exhibited limited neurite outgrowth, whereas nerve growth factor (NGF) treated explants developed progressively longer and denser radial neurite networks. Neurite outgrowth was readily visualized by live phase contrast microscopy and quantified using an Image-based neurite tracing method, demonstrating the responsiveness of the explant model to NGF and its suitability for quantitative assessment of neurite outgrowth. Conclusion: This simple, low-cost protocol provides an in vitro assay platform for neurotoxicity, neuroregeneration, drug screening, and biomaterial evaluation.

Optical redox ratio (ORR) is a commonly used metric to quantify the metabolic state of biological samples based on autofluorescence of NAD(P)H and FAD. Despite its relevance and popularity, little work has been done to quantify the estimation error of ORR, especially in low-photon count data. Here, we provide an analytical solution to determine ORR variability in the presence of shot noise and dark counts. We then validate this analytical model with simulated and experimental data. This work will enable researchers to quantify the uncertainty in their ORR measurements, aiding in more accurate and efficient experimental design and data analysis.

The chick embryo is a widely used vertebrate model for developmental biology, cardiovascular, and bioengineering research. We present an automated laser speckle contrast imaging (LSCI) platform for non-invasive, longitudinal, label-free imaging of the developing heart and extraembryonic vasculature of the chick embryo through the intact eggshell. The platform can detect blood vessels as small as 70 +/- 17 um in diameter and enable repeated imaging from day 0 to day 8 of incubation without disturbing normal embryonic development. It provides both structural (a map of growing extraembryonic blood vessels) and functional (blood flow dynamics and heart rate) information. Using this system, we generated the first continuous, non-invasive, time-lapse recordings of the early functioning chick heart and its extraembryonic vessels. Longitudinal imaging was performed on 15 embryos from different chicken breeds with eggshell colors white, brown and green. Analysis revealed slight variability in early cardiac and vascular morphogenesis across breeds and shell types and shows its potential for automated developmental staging. Finally, for the first time, the growing vasculature of the yolk sac and the chorioallantoic (CAM) membrane was imaged from day 4 to 8. The heart rate and growth of the extraembryonic blood vessels were quantified automatically during imaging.

To explore adapting qPCR systems for end-point nucleic acid quantification using dyes such as SYTO-9, we quantified serial dilutions of DNA and RNA standards in the range of 0.75 - 200 ng/{micro}l on 384-well qPCR devices. SYTO-9 fluorescence was successfully measured using standard SYBR Green settings. Blank-subtracted relative SYTO-9 signal showed a logarithmic dependence on DNA/RNA concentration (R2 > 0.95). Measurements were highly stable with different incubation times, temperatures of up to 95{degrees}C, and photobleaching. The described approach is a valuable QC option for high-throughput DNA/RNA isolations and could be adapted to additional fluorometric assays beyond nucleic acids.

BackgroundTrunk flexor and extensor measurement tools are useful for measuring progress throughout the identification, treatment and management of spinal pathologies. Handheld dynamometry is popular amongst clinicians due to its convenience. However, poor standardisation of the testing position can lead to suboptimal intra-rater reliability, which consequently reduces the validity of the results. The VALD ForceFrame Strength Testing System is a portable and standardized hybrid strength-assessment system that quantifies strength and power outputs. ObjectiveThis study aims to assess the test-retest reliability of isometric trunk flexion and extension strength using the ForceFrame testing technology. MethodsA total of 29 healthy participants undertook two testing sessions, each requiring them to perform maximal isometric trunk flexion and extension using the ForceFrame. Test re-test reliability was assessed using the Intraclass Correlation Coefficient (ICC), and the standard error of measure (SEM) was used to calculate the minimum detectable change. ResultsExcellent reliability was observed for both trunk flexion (ICC 0.92; 95% CI 0.83-0.96) and extension (ICC 0.93; 95% CI 0.86-0.97) tests, and the minimum detectable changes observed were 71.35N and 101.20N, respectively. ConclusionsThe results from this study suggest that the VALD force frame offers clinicians a reliable method of assessing change in trunk flexor and extensor strength.

Background: Sacroiliac joint (SIJ) pain is a common musculoskeletal condition among postpartum women due to hormonal, biomechanical, and physiological changes during pregnancy and childbirth. Increased ligament laxity, altered posture, weight gain, and pelvic instability may contribute to sacroiliac joint dysfunction. This condition often leads to pelvic girdle pain, low back pain, and functional limitations that affect daily activities such as walking, sitting, standing, and childcare. Objective: To determine the prevalence of sacroiliac joint pain and assess the level of disability among postpartum females in Sialkot. Materials and Methods: A descriptive cross-sectional study was conducted among 300 postpartum women aged 20-40 years from public and private hospitals in Sialkot. Non-probability convenience sampling approach was employed. Sacroiliac joint pain was assessed using clinical provocation tests including FABER, compression, and distraction tests. Pain intensity was measured using the Numerical Pain Rating Scale (NPRS), and functional disability was evaluated using the Oswestry Disability Index (ODI). Data were analyzed using SPSS version 25. Results: Clinical provocation testing demonstrated positive SIJ pain provocation in 84.0% (n=252) of acute postpartum participants, with severe functional disability observed in 46.0% (n=138). Most women reported moderate pain (74.7%), while 20.7% experienced severe pain. According to the ODI, 46% of participants had severe disability, 37.7% moderate disability, 10.7% minimal disability, and 5.7% were classified as crippled. Conclusion: Sacroiliac joint pain is highly prevalent among postpartum females and is associated with considerable functional disability. Early screening and physiotherapy-based rehabilitation may help reduce pain and improve functional outcomes. Keywords: Sacroiliac joint pain, Postpartum women, Pelvic girdle pain, Functional disability, Oswestry Disability Index.

Abstract Background Advanced in vitro models of the human heart have become promising tools for studying cardiac diseases and drug discovery. Three-dimensional (3D) engineered heart tissues (EHTs) provide more adult cardiac tissue-like structural organization compared to traditional two-dimensional (2D) in vitro models with straightforward contractile readouts. However, the assessment of the architecture of EHTs, especially the quantification of cellular and tissue structural components, has remained poorly studied. Here we demonstrate the use of light-sheet microscopy for structural imaging of intact EHTs and provide quantification of the EHT cellular and subcellular structures. Methods We developed an in-house inverted selective plane illumination microscopy (iSPIM) platform and combined it with iterative indirect immunofluorescence (IT-IF) staining for better signal acquisition. We developed an image-processing and analysis pipeline dedicated to volumetric EHT analysis. Results With this integrated platform, we achieved volumetric imaging of intact EHTs and quantification of 3D tissue architecture, revealing aligned cardiomyocytes within the imaged volume and increasing cardiac nuclei content towards the core of the tissue. The developed methods allowed the detection of heterogeneities between tissue sections, demonstrating the sensitivity required for future disease modeling or maturation studies. Conclusions The developed integrated platform opens new possibilities for volumetric analysis and characterization of 3D tissue structure using iSPIM, providing new insights into EHT architecture and the use of EHTs as disease modeling tools.

Background: Temporomandibular disorders (TMDs) are common conditions in the general population. Several therapeutic approaches are available, but there is no consensus on the most effective, particularly in physiotherapy. Objectives: To assess the efficacy of manual therapy (MT) and therapeutic exercise (TE) in reducing pain in patients with TMDs. Methods: Four databases (MEDLINE, PEDro, EMBASE, CINAHL) were searched up to March 2025. We included randomized controlled trials (RCTs) evaluating the effects of MT and/or TE in individuals with TMDs, compared to any other rehabilitation treatment, with pain intensity as the primary outcome. The methodological quality was assessed using the PEDro scale. A network meta-analysis was performed to compare the effectiveness of different rehabilitative approaches. Results: 25 RCTs for a total of 1,540 people were included. The main comparisons were: MT and/or TE vs no treatment or placebo, occlusal splint, and instrumental physiotherapy. In most studies, MT and TE were more effective than controls in reducing pain. However, the network meta-analysis indicated that multimodal treatments were the most effective. The methodological quality of the included studies ranged from 3 to 9 points. Conclusion: MT and TE are effective strategies for reducing pain in subjects with TMDs and should be used as first-line interventions before more invasive treatments; the combination of dry needling and manual therapy appears to be the most effective approach. Nonetheless, the variability in study quality suggests that further high-quality research is needed to confirm these findings.

Objective To determine the comparative effectiveness of different digital health interventions for adults with low back pain. Design Systematic review and network meta-analysis of randomised controlled trials. Data sources PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, APA PsycINFO, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), from inception to 19 March 2026 (updated to 8 August 2026). Study selection Randomised controlled trials enrolling adults with low back pain. Interventions were classified as telemedicine, web-based applications (Web-App), mobile applications (Mobile-App), virtual reality (VR), exergaming, biofeedback devices, face-to-face care, and control. Paired reviewers independently screened records, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2 tool. Methods Frequentist random-effects network meta-analyses synthesised pain intensity and physical function (primary outcomes), and pain-related fear avoidance, health-related quality of life, self-efficacy, anxiety, and depression (secondary outcomes), assessed at post-intervention (from the end of treatment to < 2 months post-intervention), short-term ([&ge;]2 to <6 months), mid-term ([&ge;]6 to <12 months), and long-term ([&ge;]12 months) follow-up. Effects were reported as standardised mean differences with 95% confidence intervals. Transitivity was examined across potential effect modifiers, and Confidence in Network Meta-Analysis (CINeMA) informed confidence ratings. Results Ninety-two reports representing 84 trials involving 11 649 participants were included. At post-intervention, compared with control, VR showed the largest estimated reduction in pain intensity (SMD -1.43, 95% CI -1.87 to -0.98; moderate confidence) and improvement in physical function (-0.86, -1.45 to -0.26; very low confidence). VR was also associated with lower pain-related fear avoidance (-1.14, -1.68 to -0.61) and better health-related quality of life (0.97, 0.57 to 1.36) (both moderate confidence). Exergaming, Mobile-App, Web-App and telemedicine were also associated with lower pain intensity, while Mobile-App, Web-App, telemedicine, and biofeedback devices were associated with better physical function. For self-efficacy, exergaming (0.77, 0.05 to 1.49) showed favourable post-intervention effects, although confidence in this estimate was very low. No intervention showed a clear effect on anxiety, with confidence ranging from very low to moderate across comparisons, whereas telemedicine was associated with lower depression (-0.22, -0.44 to 0.00; low confidence). Networks became progressively sparse at later follow-up, and evidence of sustained effects was inconsistent across interventions and outcomes. Global inconsistency was detected in the post-intervention pain-intensity network, with local inconsistency identified for selected exergaming comparisons, and substantial heterogeneity was present in several networks. Conclusions Among adults with low back pain, VR showed the largest estimated post-intervention effects versus control for pain intensity, physical function, pain-related fear avoidance, and health-related quality of life, although comparative effects differed across outcomes. Self-efficacy showed favourable estimates for selected interventions, whereas evidence for anxiety and depression was limited. Evidence beyond treatment completion was increasingly sparse, and confidence in many network estimates was low or very low; firm comparative recommendations therefore remain premature. Systematic review registration PROSPERO CRD420261339841

Background Vitamin D may influence bone healing and recovery after spine surgery, but its clinical effects remain uncertain. Objective To evaluate clinical, functional, and bone-related outcomes associated with vitamin D status and supplementation in patients undergoing spine surgery. Methods This systematic review and meta-analysis was registered in PROSPERO (CRD420261467482) and reported according to PRISMA 2020. PubMed/MEDLINE, Scopus, Web of Science, Embase, and the Cochrane Library were searched from inception through 1 June 2026. Random-effects meta-analyses used mean differences (MDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes. Direct supplementation analyses were prioritized, while analyses combining supplementation, baseline vitamin D status, or co-interventions were considered exploratory. Risk of bias was assessed using design-specific Joanna Briggs Institute tools. Results Thirteen studies were included. Four supplementation studies involving 177 participants showed no significant reduction in postoperative pain (MD -0.82, 95% CI -2.50 to 0.86; I2 = 84.3%). Three studies involving 277 participants showed lower Oswestry Disability Index scores in an exploratory analysis (MD -6.40, 95% CI -10.41 to -2.39; I2 = 96.8%). Three supplementation studies involving 128 participants showed no significant improvement in fusion rate (RR 1.17, 95% CI 0.78 to 1.74; I2 = 31.5%). An exploratory four-study fusion analysis was also not statistically significant (RR 1.24, 95% CI 0.98 to 1.57; I2 = 45.5%). Conclusion Current evidence does not establish that vitamin D supplementation independently improves postoperative pain or fusion rates after spine surgery. Possible benefits for disability and other bone-related outcomes remain uncertain because of small study numbers, heterogeneity, co-interventions, and residual confounding. Larger randomized trials stratified by baseline vitamin D status are needed.

Aim. To evaluate the accuracy, run-to-run consistency, and agreement of large language models on the Ukrainian Integrated Licensing Examination Krok 2 for the Specialty of Physical Therapy. Materials and Methods. Five cloud-based LLMs (ChatGPT-5.5, Claude 5 Sonnet, Gemini 3.5 Flash, Grok 4, DeepSeek-V3) were evaluated using 150 Ukrainian-language multiple-choice questions from the official Krok 2 database. Each model completed two independent runs with identical inputs. Accuracy (with 95% confidence intervals, Wilson method), run-to-run consistency, and agreement were assessed. Statistical analysis included Cohen's {kappa}, Cochran's Q and pairwise McNemar tests with Holm-Bonferroni correction. Results. All models achieved >80% accuracy in both runs, exceeding the passing threshold of [&ge;]64%. In the first run, accuracy ranged from 80.00% (DeepSeek-V3) to 93.33% (Gemini 3.5 Flash); in the second run, from 82.67% (Claude 5 Sonnet) to 88.67% (Gemini 3.5 Flash). In the first run significant differences were observed between Gemini 3.5 Flash and Grok 4 (93.33% vs 84.00%; p=0.0022) and DeepSeek-V3 (93.33% vs 80.00%; p=0.0001). There were no statistically significant differences between models in the second run. R2R consistency exceeded 90% for all models with the highest in ChatGPT-5.5 (98.67%) and lowest in DeepSeek-V3 (90.00%). Cohen's {kappa} ranged from 0.64 to 0.94, indicating substantial to almost perfect agreement. The stability of LLMs' response correctness across two runs ranged from 77.33% (DeepSeek-V3) to 88.00% (Gemini 3.5 Flash). Conclusions. All LLMs demonstrated high performance on Ukrainian-language Krok 2 examination tasks. Gemini 3.5 Flash showed the highest accuracy in both runs and response correctness stability while ChatGPT-5.5 exhibited the greatest response consistency and agreement. Although the accuracy and stability of LLM responses may be interrelated, they represent distinct aspects of model performance. This highlights the need for a comprehensive approach to evaluating LLMs. The findings indicate the potential of LLMs as an auxiliary tool in the professional practice of physical therapy specialists.

Background: Long COVID can result in persistent functional limitations, pain, and fatigue after acute COVID-19. Evidence describing these outcomes among survivors in Bangladesh remains limited. This study assessed functional impairment, pain, and fatigue and explored factors associated with these outcomes among long COVID survivors in Bangladesh. Methods: This multisite cross-sectional study included 240 adults with a history of COVID-19. Functional status was assessed using the Post-COVID-19 Functional Status Scale. Pain and fatigue were assessed using the Brief Pain Inventory and Brief Fatigue Inventory, respectively. Descriptive statistics, Spearman correlation, and regression analyses were used to examine functional impairment and factors associated with pain and fatigue outcomes. Results: Functional limitations were common, with moderate limitation particularly frequent in basic activities of daily living, while slight limitation predominated across several other domains. Pain and fatigue measures showed significant correlations. Older age was associated with greater impairment in basic activities of daily living. Booster vaccination was associated with lower pain and fatigue scores, although the booster subgroup was small (n = 17). Tobacco non-use was also associated with lower scores across several pain and fatigue domains. Physiotherapy-related variables showed associations with some functional and symptom outcomes; however, these findings may reflect confounding by indication because participants with greater impairment or more complex symptoms may have been more likely to receive rehabilitation. Conclusions: Long COVID survivors in Bangladesh experience substantial and multidimensional functional, pain, and fatigue burdens. The findings support a comprehensive assessment that considers functional status, pain, fatigue, and participation together. Longitudinal studies with larger samples and standardized rehabilitation protocols are needed to clarify symptom trajectories, identify potentially modifiable factors, and evaluate the effectiveness of individualized rehabilitation interventions.

Breast cancer is the most common cancer in women worldwide and chemicals disrupting estrogen or progesterone signaling are recognized as potential risk factors. However, chemicals that alter the mammary gland (MG) development and function remain understudied, highlighting the need for additional research in this area. To address this gap, we investigate the relevance of using high-content imaging assays and more specifically, Cell Painting technology to measure cell morphology perturbation caused by chemical exposure and identify morphological features that could characterize mammary carcinogens (MC) risk factors. Using a dataset of MC and non-mammary carcinogens (Non-MC) with Cell Painting profiles from the JUMP-CP dataset, we retrieved 51 compounds: 28 MC, 23 non-genotoxic Non-MC. We characterized the morphological data by non-linear dimensionality reduction (UMAP) and hierarchical clustering. We, then, developed a Guilt-By-Association (GBA) framework comparing multiple configurations of similarity metrics, risk-score aggregation approaches and features representations. Morphological profiles clustered by mechanism of action rather than carcinogenicity label: genotoxic MC produced strong perturbations in endoplasmic reticulum, mitochondria, nucleus, and RNA compartments, whereas hormonally active compounds were indistinguishable from controls, reflecting the lack of functional steroid hormone receptors in the cell line used. Our best GBA configuration achieved an AUC-ROC of 0.630 and an AUC-PR of 0.696. Applied prospectively to endocrine disruptors chemicals, it prioritized clofentezine, 3-methylpyrazole, resorcinol, 2-tert-butyl-4-methoxyphenol, and thiabendazole as candidates for confirmatory testing. This study provides a transparent, interpretable tool for prioritizing chemicals in mammary carcinogenicity assessment, highlights limitations and clarifies where Cell Painting datasets must be complemented by hormone-sensitive models.

Objective: To examine changes in function and pain interference among patients utilizing a digital exercise therapy application (DETA) for knee and shoulder pain. Methods: We conducted a retrospective analysis of data from patients utilizing a DETA for non-operative knee and shoulder pain. Primary outcomes for the study were 8-week changes in physical function, measured using the PROMIS-Physical Function (knee pain) and PROMIS-Upper Extremity Function (shoulder pain); and pain interference, measured using the PROMIS-Pain Interference. Data on patient characteristics was used to examine outcomes among specific patient subgroups. Results: We observed a 3.5 point (SD: 7.8) increase in function and a 3.9 point (SD: 7.5) decrease in pain interference overall (p<0.001), with changes in function and pain interference surpassing the minimal clinically important difference for patients with knee and shoulder pain. Patients with knee pain experienced greater improvements in function than those with shoulder pain (p=0.02), as did patients who report moderate-high levels of exertion during exercise compared to those reporting low levels of exertion (p=0.05). We saw greater reductions in pain interference among those with higher education (p=0.03), those with more acute symptoms (p=0.01) and those reporting moderate-high levels of exercise exertion (p=0.02). Conclusion: We observed a clinically meaningful improvement in pain interference and function among patients utilizing a DETA for knee and shoulder pain. Patients with knee pain, higher levels of education, more acute symptoms, and those who reported higher levels of exertion with exercise experienced the greatest changes in function and pain. Impact Statement: This study indicates that self-guided interventions, such as those delivered through a DETA, may be beneficial for patients with knee and shoulder pain. These results may also inform the development of patient profiles that can be used to identify patients most appropriate to receive care through a mobile application.

Purpose Sarcopenia, the progressive loss of muscle mass and function with age, is diagnosed by assessing muscle strength, physical performance, and muscle mass. However, the tools required are often costly, inaccessible, or unsuitable for use in low-resource or remote settings. This study aimed to identify practical surrogate measures that are conceptually aligned with established sarcopenia diagnostic criteria and can be integrated into digital health platforms to enable remote screening and monitoring using an expert agreement process. Methods A narrative literature review was conducted to identify proxy measures for muscle strength (HGS), physical performance, and muscle mass. This was followed by two rounds of expert agreement. The Content Validity Index (CVI), defined as the number of experts in agreement divided by the total number of experts for each pragmatic proxy, was calculated after each round to assess the relevance and appropriateness of each measure. A pragmatic proxy with a CVI of 0.7 or higher was included. Results Eight proxies for HGS were identified across ten studies, with the five-times sit-to-stand test (5STS) being the most common. The 5STS has a higher agreement and was considered a relevant and appropriate surrogate by the expert panel for both muscle strength (CVI = 0.8 for both relevance and appropriateness) and physical performance (CVI = 1 for relevance and 0.8 for appropriateness), whereas the TUG could be a promising measure for physical performance (CVI = 1 for both relevance and appropriateness). Calf circumference (CC) offers a low-cost alternative for assessing muscle mass (CVI = 1 for relevance and 0.7 for appropriateness). Conclusion The 5STS, TUG, and CC were identified as relevant and appropriate pragmatic proxy measures for assessing sarcopenia, with potential for integration into digital screening tools in low-resource settings. Further clinical studies are required to establish their validity, reliability, and feasibility for remote assessment.

Myofascial pain syndrome (MPS) is characterized by increased muscle stiffness, trigger points, and functional limitations, yet clinical diagnosis remains largely subjective. Shear wave elastography (SWE) provides quantitative assessment of muscle mechanical properties, but its value for identifying biomechanical and clinical phenotypes of MPS is not fully established. This study evaluated whether stiffness parameters derived from multi-angle SWE can reliably characterize upper-trapezius anisotropy, and whether integrating SWE with bioimpedance spectroscopy (BIS), range of motion (ROM), and patient-reported outcomes (PROs) improves differentiation of MPS subgroups. Seventy-one adults completed upper-trapezius SWE, BIS, ROM assessments, and PRO measures. Clinically, 18 were classified as active MPS, 36 as latent, and 17 as normal. Shear wave speed measurements were modeled to estimate longitudinal (uL), transverse (uT), and anisotropy (uE) components. Reliability was examined using intraclass correlation coefficients. Unsupervised clustering and partial-correlation network analysis were applied to biomechanical and clinical variables. uT showed the strongest associations with BIS frequency parameters and ROM measures, indicating sensitivity to fascial composition, and mobility. Multimodal clustering incorporating uT with Fc or ROM identified subgroups with distinct tissue-level and functional characteristics. Network analysis demonstrated a progression in connectivity patterns, shifting from localized mechanical relationships to broader symptom-level coupling involving pain interference, sleep disturbance, emotional distress, and physical function. These findings indicate that SWE-derived stiffness parameters provide reliable, direction-specific quantification of trapezius mechanical properties. Combining SWE with impedance and mobility measures yields physiologically coherent MPS phenotypes that differ in both biomechanical features and clinical network structure, supporting more objective framework for characterizing MPS.

This study provides a direct and objective comparison of ECG signal quality and morphological feature preservation across four leading commercial smartwatches: the Apple Watch Series 9, Samsung Galaxy Watch 6, Fitbit Sense 2, and Withings ScanWatch, using a controlled dataset. The Philips TC30 is used as the reference standard. ECG signal quality is assessed using Signal-to-Noise Ratio (SNR), Standard Deviation of Baseline Wander, and Power Spectral Density (PSD). Preservation of morphological features is assessed by comparing the performance of our automatic J-point and ST deviation detection algorithms when applied separately to recordings from each smartwatch. J-point detection is evaluated by comparing each device's performance against the reference device, while ST deviation is assessed using simulator-defined ground truth values. The Apple Watch and Withings ScanWatch achieved the best SNR, while the Samsung Galaxy Watch showed substantially lower values. The Withings ScanWatch demonstrated the most stable baseline, whereas the Fitbit Sense 2 showed the greatest baseline variability. All devices exhibited a consistent negative bias in J-point detection, suggesting that internal signal processing tends to smooth small changes in waveforms. For ST-segment classification, the Apple Watch achieved the most balanced performance in terms of sensitivity and specificity. These results provide researchers and clinicians with data-driven guidance for selecting the most appropriate device for their specific needs.

Background Hypertension is the leading modifiable risk factor for cardiovascular disease (CVD). Despite availability of blood pressure (BP)-lowering therapies, BP control rates remain suboptimal. Reluctance to initiate treatment with combination therapy and delayed treatment intensification contribute to poor control. Early use of single-pill combinations (SPCs) within standardised treatment protocols (STPs) may improve outcomes, but evidence from India is limited. Objective To evaluate the effectiveness and safety of a new STP incorporating initial or early use of SPCs compared with usual care among adults with hypertension. Methods The New Standardised TrEatment Protocol (NewSTeP) trial is a pragmatic, multicentre, randomized, parallel-group, open-label trial conducted in tertiary healthcare centres in India. Adults with hypertension who are untreated or receiving one BP-lowering drug and require treatment initiation or intensification (n = 300) will be randomized 1:1 to either a new STP incorporating early SPC therapy or usual care. Participants will be followed for 6 months. The primary effectiveness outcome is change in home-measured mean systolic BP from randomization to month 6. The primary safety outcome is discontinuation of trial drug due to adverse events. Secondary outcomes include proportion of participants achieving BP control, change in diastolic BP, incidence of adverse events of special interest, treatment adherence, treatment modification, and time to BP control. A process evaluation will assess reach, implementation, acceptability, and sustainability, while an economic evaluation will assess cost-effectiveness of the intervention. Results Between October 2025 and March 2026, 300 participants were randomized across nine sites (150 to New STP; 150 usual care) from 360 screened individuals. Final follow-up is expected in September 2026, with results anticipated in October 2026. Conclusions The NewSTeP trial will provide evidence on the effectiveness, safety, implementation, and cost-effectiveness of an SPC-based STP for hypertension management in India and inform future hypertension control strategies and policies.