Enhanced Compound Analysis Using Reactive Paper Spray Mass Spectrometry: Leveraging Schiff Base Reaction for Amino Acid Detection.

Paper spray mass spectrometry (PS-MS) has evolved into a promising tool for monitoring reactions in thin films and microdroplets, known as reactive PS, alongside its established role in ambient and direct ionization. This study addresses the need for rapid, cost-effective methods to improve analyte identification in biofluids by leveraging reactive PS-MS in clinical chemistry environments. The technique has proven effective in derivatizing target analytes, altering hydrophobicity to enhance elution and ionization efficiency, and refining detection through thin-film reactions on paper, significantly expediting reaction rates by using amino acids (AAs) as model analytes. These molecules are prone to interacting with substrates like paper, impeding elution and detection. Additionally, highly abundant species in biofluids, such as lipids, often suppress AA ionization. This study employs the Schiff base (SB) reaction utilizing aromatic aldehydes for AA derivatization to optimize reaction conditions time, temperature, and catalyst presence and dramatically increasing the conversion ratio (CR) of formed SB. For instance, using leucine as a model AA, the CR surged from 57% at room temperature to 89% at 70 °C, with added pyridine during and after 7.5 min, displaying a 43% CR compared to the bulk reaction. Evaluation of various aromatic aldehydes as derivatization agents highlighted the importance of specific oxygen substituents for achieving higher conversion rates. Furthermore, diverse derivatization agents unveiled unique fragmentation pathways, aiding in-depth annotation of the target analyte. Successfully applied to quantify AAs in human and rat plasma, this reactive PS-MS approach showcases promising potential in efficiently detecting conventionally challenging compounds in PS-MS analysis.

Solvent-Assisted Laser Desorption Flexible Microtube Plasma Mass Spectrometry for Direct Analysis of Dried Samples on Paper.

The present study investigated the potential for solvent-assisted laser desorption coupled with flexible microtube plasma ionization mass spectrometry (SALD-FµTP-MS) as a rapid analytical technique for direct analysis of surface-deposited samples. Paper was used as the demonstrative substrate, and an infrared hand-held laser was employed for sample desorption, aiming to explore cost-effective sampling and analysis methods. SALD-FµTP-MS offers several advantages, particularly for biofluid analysis, including affordability, the ability to analyze low sample volumes (<10 µL), expanded chemical coverage, sample and substrate stability, and in situ analysis and high throughput potential. The optimization process involved exploring the use of viscous solvents with high boiling points as liquid matrices. This approach aimed to enhance desorption and ionization efficiencies. Ethylene glycol (EG) was identified as a suitable solvent, which not only improved sensitivity but also ensured substrate stability during analysis. Furthermore, the addition of cosolvents such as acetonitrile/water (1:1) and ethyl acetate further enhanced sensitivity and reproducibility for a standard solution containing amphetamine, imazalil, and cholesterol. Optimized conditions for reproducible and sensitive analysis were determined as 1000 ms of laser exposure time using a 1 µL solvent mixture of 60% EG and 40% acetonitrile (ACN)/water (1:1). A mixture of 60% EG and 40% ACN/water (1:1) resulted in signal enhancements and relative standard deviations of 12, 20, and 13% for the evaluated standards, respectively. The applicability of SALD-FµTP-MS was further evaluated by successfully analyzing food, water, and biological samples, highlighting the potential of SALD-FµTP-MS analysis, particularly for thermolabile and polarity diverse compounds.

Dielectric Barrier Discharge Ionization Mechanisms: Polycyclic Aromatic Hydrocarbons as a Case of Study.

Dielectric barrier discharge ionization (DBDI) is a versatile tool for small-molecule mass spectrometry applications, helping cover from polar to low polar molecules. However, the plasma gas-phase interactions are highly complex and have been scarcely investigated. The ionization mechanisms of plasmas have long been assumed to be somewhat similar to atmospheric pressure chemical ionization (APCI). Here, we evaluated the ionization mechanisms of a two-ring DBDI ion source, using different discharge gases to analyze vaporized liquid samples. Polycyclic aromatic hydrocarbons (PAHs) were used as model analytes to assess the mechanisms' dominance: protonation, [M + H]+, or radical ion species formation, [M]·+. In the present work, two different ionization trends were observed for APCI and DBDI during the PAH analysis; the compounds with proton affinities (PA) over 856 kJ/mol were detected as [M + H]+ when APCI was used as ionization source. Meanwhile, independently of the PA, DBDI showed the prevalence of charge exchange reactions. The addition of dopants in the gas-phase region shifted the ionization mechanisms toward charge exchange reactions, facilitating the formation of [M]·+ ion species, showing anisole a significant boost of the PAH radical ion species signals, over nine times for Ar-Prop-DBDI analysis. The presence of high-energy metastable atoms (e.g., HeM) with high ionization potentials (IE = 19.80 eV) did not show boosted PAH abundances or extensive molecule fragmentation. Moreover, other species in the plasma jet region with closer and more appropriate IE, such as N2 B3Πg excited molecules, are likely responsible for PAH Penning ionization.

A Shared Prebiotic Formation of Neopterins and Guanine Nucleosides from Pyrimidine Bases.

The prebiotic origins of biopolymers and metabolic co-factors are key questions in Origins of Life studies. In a simple warm-little-pond model, using a drying phase to produce a urea-enriched solution, we present a prebiotic synthetic path for the simultaneous formation of neopterins and tetrahydroneopterins, along with purine nucleosides. We show that, in the presence of ribose and in a formylating environment consisting of urea, ammonium formate, and water (UAFW), the formation of neopterins from pyrimidine precursors is robust, while the simultaneous formation of guanosine requires a significantly higher ribose concentration. Furthermore, these reactions provide a tetrahydropterin-pterin redox pair. This model suggests a prebiotic link in the origin of purine nucleosides and pterin cofactors that provides a possible deep prebiotic temporal connection for the emergence of nucleic acids and metabolic cofactors.

A Shared Prebiotic Formation of Neopterins and Guanine Nucleosides from Pyrimidine Bases.

Invited for the cover of this issue are the groups of César Menor-Salván, Facundo Fernández and Nicholas V. Hud at the University of Alcala and the Georgia Institute of Technology. The image depicts the authors contemplating the origin of pterins and guanosine nucleosides from a common precursor, with the art-gallery setting embodying their feeling that the common synthetic pathways of these molecules in both the prebiotic world and in biochemistry is a natural work of (chemical) art. Read the full text of the article at 10.1002/chem.202200714.

Liquid chromatography-dielectric barrier discharge ionization mass spectrometry for the analysis of neutral lipids of archaeological interest.

Dielectric barrier discharge ionization has gained attention in the last few years due to its versatility and the vast array of molecules that can be ionized. In this study, we report on the assessment of liquid chromatography coupled to dielectric barrier discharge ionization with mass spectrometry for neutral lipid analysis. A set of different neutral lipid subclasses (triacylglycerides, diacylglycerides, and sterols) were selected for the study. The main species detected from our ionization source were [M-H2 O+H]+ , [M+H]+ or [M-R-H2 O+H]+ , attributed to sterol dehydration, protonation or the fragmentation of an acyl chain accompanied by a water loss of the glycerolipids, respectively. In terms of sensitivity, the dielectric barrier discharge displayed overall improved abundances and comparable or better limits of quantitation than atmospheric pressure chemical ionization for both acylglycerols and sterols. As a case study, different archaeological samples with variable content in neutral lipids, particularly triacylglycerides, were studied. The identification was carried out by combining accurate mass and the tentative formula associated with the exact mass, retention time matching with standards, and additional structural information from in-source fragmentation. The high degree of unsaturation and the presence of sterols revealed the potential vegetal origin of the material stored in the analyzed samples.

Triboelectric Nanogenerator Ion Mobility-Mass Spectrometry for In-Depth Lipid Annotation.

Lipids play a critical role in cell membrane integrity, signaling, and energy storage. However, in-depth structural characterization of lipids is still challenging and not routinely possible in lipidomics experiments. Techniques such as collision-induced dissociation (CID) tandem mass spectrometry (MS/MS), ion mobility (IM) spectrometry, and ultrahigh-performance liquid chromatography are not yet capable of fully characterizing double-bond and sn-chain position of lipids in a high-throughput manner. Herein, we report on the ability to structurally characterize lipids using large-area triboelectric nanogenerators (TENG) coupled with time-aligned parallel (TAP) fragmentation IM-MS analysis. Gas-phase lipid epoxidation during TENG ionization, coupled to mobility-resolved MS3 via TAP IM-MS, enabled the acquisition of detailed information on the presence and position of lipid C═C double bonds, the fatty acyl sn-chain position and composition, and the cis/trans geometrical C═C isomerism. The proposed methodology proved useful for the shotgun lipidomics analysis of lipid extracts from biological samples, enabling the detailed annotation of numerous lipid isobars.

Comparison of High-Resolution Fourier Transform Mass Spectrometry Platforms for Putative Metabolite Annotation.

Fourier transform ion cyclotron resonance (FT-ICR) and Orbitrap mass spectrometry (MS) are among the highest-performing analytical platforms used in metabolomics. Non-targeted metabolomics experiments, however, yield extremely complex datasets that make metabolite annotation very challenging and sometimes impossible. The high-resolution accurate mass measurements of the leading MS platforms greatly facilitate this process by reducing mass errors and spectral overlaps. When high resolution is combined with relative isotopic abundance (RIA) measurements, heuristic rules, and constraints during searches, the number of candidate elemental formula(s) can be significantly reduced. Here, we evaluate the performance of Orbitrap ID-X and 12T solariX FT-ICR mass spectrometers in terms of mass accuracy and RIA measurements and how these factors affect the assignment of the correct elemental formulas in the metabolite annotation pipeline. Quality of the mass measurements was evaluated under various experimental conditions (resolution: 120, 240, 500 K; automatic gain control: 5 × 104, 1 × 105, 5 × 105) for the Orbitrap MS platform. High average mass accuracy (<1 ppm for UPLC-Orbitrap MS and <0.2 ppm for direct infusion FT-ICR MS) was achieved and allowed the assignment of correct elemental formulas for over 90% (m/z 75-466) of the 104 investigated metabolites. 13C1 and 18O1 RIA measurements further improved annotation certainty by reducing the number of candidates. Overall, our study provides a systematic evaluation for two leading Fourier transform (FT)-based MS platforms utilized in metabolite annotation and provides the basis for applying these, individually or in combination, to metabolomics studies of biological systems.

Prebiotic Origin of Pre-RNA Building Blocks in a Urea "Warm Little Pond" Scenario.

Urea appears to be a key intermediate of important prebiotic synthetic pathways. Concentrated pools of urea likely existed on the surface of the early Earth, as urea is synthesized in significant quantities from hydrogen cyanide or cyanamide (widely accepted prebiotic molecules), it has extremely high water solubility, and it can concentrate to form eutectics from aqueous solutions. We propose a model for the origin of a variety of canonical and non-canonical nucleobases, including some known to form supramolecular assemblies that contain Watson-Crick-like base pairs.The dual nucleophilic-electrophilic character of urea makes it an ideal precursor for the formation of nitrogenous heterocycles. We propose a model for the origin of a variety of canonical and noncanonical nucleobases, including some known to form supramolecular assemblies that contain Watson-Crick-like base pairs. These reactions involve urea condensation with other prebiotic molecules (e. g., malonic acid) that could be driven by environmental cycles (e. g., freezing/thawing, drying/wetting). The resulting heterocycle assemblies are compatible with the formation of nucleosides and, possibly, the chemical evolution of molecular precursors to RNA. We show that urea eutectics at moderate temperature represent a robust prebiotic source of nitrogenous heterocycles. The simplicity of these pathways, and their independence from specific or rare geological events, support the idea of urea being of fundamental importance to the prebiotic chemistry that gave rise to life on Earth.

Compositional characterization of complex protopeptide libraries via triboelectric nanogenerator Orbitrap mass spectrometry.

RATIONALE: Understanding of the molecular processes that led to the first biomolecules on Earth is one of the key aspects of origins-of-life research. Depsipeptides, or polymers with mixed amide and ester backbones, have been proposed as plausible prebiotic precursors for peptide formation. Chemical characterization of depsipeptides in complex prebiotic-like mixtures should benefit from more efficient ion sources and ultrahigh-resolution mass spectrometry (UHR-MS) for elemental composition elucidation. METHODS: A sliding freestanding (SF) Triboelectric Nanogenerator (TENG) was coupled to glass nanoelectrospray emitters for the analysis of a depsipeptide library created using 11 amino acids and 3 alpha-hydroxy acids subjected to environmentally driven polymerization. The TENG nanoelectrospray ionization (nanoESI) source was coupled to an UHR Orbitrap mass spectrometer operated at 1,000,000 resolution for detecting depsipeptides and oligoesters in such libraries. Tandem mass spectrometry (MS/MS) experiments were performed on an Orbitrap Q-Exactive mass spectrometer. RESULTS: Our previous proteomics-like approach to depsipeptide library characterization showed the enormous complexity of these dynamic combinatorial systems. Here, direct infusion UHR-MS along with de novo sequencing enabled the identification of 524 sequences corresponding to 320 different depsipeptide compositions. Van Krevelen and mass defect diagrams enabled better visualization of the chemical diversity in these synthetic libraries. CONCLUSIONS: TENG nanoESI coupled to UHR-MS is a powerful method for depsipeptide library characterization in an origins-of-life context.

Robotic Surface Analysis Mass Spectrometry (RoSA-MS) of Three-Dimensional Objects.

Many technologies currently exist that are capable of analyzing the surface of solid samples under ambient or vacuum conditions, but they are typically limited to smooth, planar surfaces. Those few that can be applied to nonplanar surfaces, however, require manual sampling and a high degree of human intervention. Herein, we describe a new platform, Robotic Surface Analysis Mass Spectrometry (RoSA-MS), for direct surface sampling of three-dimensional (3D) objects. In RoSA-MS, a sampling probe is attached to a robotic arm that has 360° rotation through 6 individual joints. A 3D laser scanner, also attached to the robotic arm, generates a digital map of the sample surface that is used to direct a probe to specific ( x, y, z) locations. The sampling probe consists of a spring-loaded needle that briefly contacts the object surface, collecting trace amounts of material. The probe is then directed at an open port liquid sampling interface coupled to the electrospray ion source of a mass spectrometer. Material on the probe tip is dissolved by the solvent flow in the liquid interface and mass analyzed with high mass resolution and accuracy. The surface of bulky, nonplanar objects can thus be probed to produce chemical maps at the molecular level. Applications demonstrated herein include the examination of food sample surfaces, lifestyle chemistry, and chemical reactions on curved substrates. The modular design of this system also allows for modifications to the sampling probe and the ionization source, thereby expanding the potential of RoSA-MS for a great diversity of applications.

A flowing atmospheric pressure afterglow as an ion source coupled to a differential mobility analyzer for volatile organic compound detection.

Atmospheric pressure glow discharges have been widely used in the last decade as ion sources in ambient mass spectrometry analyses. Here, an in-house flowing atmospheric pressure afterglow (FAPA) has been developed as an alternative ion source for differential mobility analysis (DMA). The discharge source parameters (inter-electrode distance, current and helium flow rate) determining the atmospheric plasma characteristics have been optimized in terms of DMA spectral simplicity with the highest achievable sensitivity while keeping an adequate plasma stability and so the FAPA working conditions finally selected were: 35 mA, 1 L min(-1) of He and an inter-electrode distance of 8 mm. Room temperature in the DMA proved to be adequate for the coupling and chemical analysis with the FAPA source. Positive and negative ions for different volatile organic compounds were tested and analysed by FAPA-DMA using a Faraday cup as a detector and proper operation in both modes was possible (without changes in FAPA operational parameters). The FAPA ionization source showed simpler ion mobility spectra with narrower peaks and a better, or similar, sensitivity than conventional UV-photoionization for DMA analysis in positive mode. Particularly, the negative mode proved to be a promising field of further research for the FAPA ion source coupled to ion mobility, clearly competitive with other more conventional plasmas such as corona discharge.

Miniaturized flexible micro-tube plasma ionization source for the effective ionization of non-easily ionizable pesticides in food with liquid chromatography/mass spectrometry.

In this article, we have studied the potential of flexible microtube plasma (FµTP) as ionization source for the liquid chromatography high-resolution mass spectrometry detection of non-easily ionizable pesticides (viz. nonpolar and non-ionizable by acid/basic moieties). Phthalimide-related compounds such as dicofol, dinocap, o-phenylphenol, captan, captafol, folpet and their metabolites were studied. Dielectric barrier discharge ionization (DBDI) was examined using two electrode configurations, including the miniaturized one based on a single high-voltage (HV) electrode and a virtual ground electrode configuration (FµTP), and also the two-ring electrode DBDI configuration. Different ionization pathways were observed to ionize these challenging, non-easily ionizable nonpolar compounds, involving nucleophilic substitutions and proton abstraction, with subtle differences in the spectra obtained compared with APCI. An average sensitivity increase of 5-fold was attained compared with the standard APCI source. In addition, more tolerance with matrix effects was observed in both DBDI sources. The importance of the data reported is not just limited to the sensitivity enhancement compared to APCI, but, more notably, to the ability to effectively ionize nonpolar, late-eluting (in reverse-phase chromatography) non-ionizable compounds. Besides o-phenylphenol ([M - H]-), all the parent species were efficiently ionized through different mechanisms involving bond cleavages through the effect of plasma reagent species or its combination with thermal degradation and subsequent ionization. This tool can be used to figure out overlooked nonpolar compounds in different environmental samples of societal interest through non-target screening (NTS) strategies.

Ion Heating in Advanced Dielectric Barrier Discharge Ion Sources for Ambient Mass Spectrometry.

Dielectric barrier discharges (DBD) are highly versatile plasma sources for forming ions at atmospheric pressure and near ambient temperatures for the rapid, direct, and sensitive analysis of molecules by mass spectrometry (MS). Ambient ion sources should ideally form intact ions, as in-source fragmentation can limit sensitivity, increase spectral complexity, and hinder interpretation. Here, we report the measurement of ion internal energy distributions for the four primary classes of DBD-based ion sources, specifically DBD ionization (DBDI), low-temperature plasma (LTP), flexible microtube plasma (FµTP), and active capillary plasma ionization (ACaPI), in addition to atmospheric pressure chemical ionization (APCI) using para-substituted benzylammonium thermometer ions. Surprisingly, the average extent of energy deposited by the use of ACaPI (90.6 kJ mol-1) was ∼40 kJ mol-1 lower than the other ion sources (DBDI, LTP, FµTP, and APCI; 130.2 to 134.1 kJ mol-1) in their conventional configurations, and slightly higher than electrospray ionization (80.8 kJ mol-1). The internal energy distributions did not depend strongly on the sample introduction conditions (i.e., the use of different solvents and sample vaporization temperatures) or the DBD plasma conditions (i.e., maximum applied voltage). By positioning the DBDI, LTP, and FµTP plasma jets on axis with the capillary entrance to the mass spectrometer, the extent of internal energy deposition could be reduced by up to 20 kJ mol-1, although at the expense of sensitivity. Overall, the use of an active capillary-based DBD can result in substantially less fragmentation of ions with labile bonds than alternate DBD sources and APCI with comparably high sensitivity.

Thioesters provide a plausible prebiotic path to proto-peptides.

It is widely assumed that the condensation of building blocks into oligomers and polymers was important in the origins of life. High activation energies, unfavorable thermodynamics and side reactions are bottlenecks for abiotic peptide formation. All abiotic reactions reported thus far for peptide bond formation via thioester intermediates have relied on high energy molecules, which usually suffer from short half-life in aqueous conditions and therefore require constant replenishment. Here we report plausible prebiotic reactions of mercaptoacids with amino acids that result in the formation of thiodepsipeptides, which contain both peptide and thioester bonds. Thiodepsipeptide formation was achieved under a wide range of pH and temperature by simply drying and heating mercaptoacids with amino acids. Our results offer a robust one-pot prebiotically-plausible pathway for proto-peptide formation. These results support the hypothesis that thiodepsipeptides and thiol-terminated peptides formed readily on prebiotic Earth and were possible contributors to early chemical evolution.

Laboratory evaluation of twelve portable devices for medicine quality screening.

BACKGROUND: Post-market surveillance is a key regulatory function to prevent substandard and falsified (SF) medicines from being consumed by patients. Field deployable technologies offer the potential for rapid objective screening for SF medicines. METHODS AND FINDINGS: We evaluated twelve devices: three near infrared spectrometers (MicroPHAZIR RX, NIR-S-G1, Neospectra 2.5), two Raman spectrometers (Progeny, TruScan RM), one mid-infrared spectrometer (4500a), one disposable colorimetric assay (Paper Analytical Devices, PAD), one disposable immunoassay (Rapid Diagnostic Test, RDT), one portable liquid chromatograph (C-Vue), one microfluidic system (PharmaChk), one mass spectrometer (QDa), and one thin layer chromatography kit (GPHF-Minilab). Each device was tested with a series of field collected medicines (FCM) along with simulated medicines (SIM) formulated in a laboratory. The FCM and SIM ranged from samples with good quality active pharmaceutical ingredient (API) concentrations, reduced concentrations of API (80% and 50% of the API), no API, and the wrong API. All the devices had high sensitivities (91.5 to 100.0%) detecting medicines with no API or the wrong API. However, the sensitivities of each device towards samples with 50% and 80% API varied greatly, from 0% to 100%. The infrared and Raman spectrometers had variable sensitivities for detecting samples with 50% and 80% API (from 5.6% to 50.0%). The devices with the ability to quantitate API (C-Vue, PharmaChk, QDa) had sensitivities ranging from 91.7% to 100% to detect all poor quality samples. The specificity was lower for the quantitative C-Vue, PharmaChk, & QDa (50.0% to 91.7%) than for all the other devices in this study (95.5% to 100%). CONCLUSIONS: The twelve devices evaluated could detect medicines with the wrong or none of the APIs, consistent with falsified medicines, with high accuracy. However, API quantitation to detect formulations similar to those commonly found in substandards proved more difficult, requiring further technological innovation.

Large-Area Triboelectric Nanogenerator Mass Spectrometry: Expanded Coverage, Double-Bond Pinpointing, and Supercharging.

Efficient ionization is a necessary condition for mass spectrometric analysis, but many compounds fail to ionize well enough to yield sufficient detection limits. Triboelectric nanogenerators (TENG) coupled to nanoelectrospray ionization (nanoESI) mass spectrometry (MS) are a highly effective approach to high sensitivity MS analysis. Here, we report on new, large-area TENG that constructively leverage the relationship between electrode size, created charges, and open-circuit voltage, leading to wider chemical coverage. Large-area TENG were found to also promote electrospray gas-phase oxidation reactions that enabled double bond position pinpointing for unsaturated lipids and species-specific lipid quantitation. Furthermore, large-area TENG MS of proteins was observed to yield higher charge state distributions (i.e., supercharging) without the need for high surface tension additives.

Ambient (desorption/ionization) mass spectrometry methods for pesticide testing in food: a review.

Ambient mass spectrometry refers to the family of techniques that allows ions to be generated from condensed phase samples under ambient conditions and then, collected and analysed by mass spectrometry. One of their key advantages relies on their ability to allow the analysis of samples with minimal to no sample workup. This feature maps well to the requirements of food safety testing, in particular, those related to the fast determination of pesticide residues in foods. This review discusses the application of different ambient ionization methods for the qualitative and (semi)quantitative determination of pesticides in foods, with the focus on different specific methods used and their ionization mechanisms. More popular techniques used are those commercially available including desorption electrospray ionization (DESI-MS), direct analysis on real time (DART-MS), paper spray (PS-MS) and low-temperature plasma (LTP-MS). Several applications described with ambient MS have reported limits of quantitation approaching those of reference methods, typically based on LC-MS and generic sample extraction procedures. Some of them have been combined with portable mass spectrometers thus allowing "in situ" analysis. In addition, these techniques have the ability to map surfaces (ambient MS imaging) to unravel the distribution of agrochemicals on crops.

Sub-nanoliter metabolomics via mass spectrometry to characterize volume-limited samples.

The human metabolome provides a window into the mechanisms and biomarkers of various diseases. However, because of limited availability, many sample types are still difficult to study by metabolomic analyses. Here, we present a mass spectrometry (MS)-based metabolomics strategy that only consumes sub-nanoliter sample volumes. The approach consists of combining a customized metabolomics workflow with a pulsed MS ion generation method, known as triboelectric nanogenerator inductive nanoelectrospray ionization (TENGi nanoESI) MS. Samples tested with this approach include exhaled breath condensate collected from cystic fibrosis patients as well as in vitro-cultured human mesenchymal stromal cells. Both test samples are only available in minimum amounts. Experiments show that picoliter-volume spray pulses suffice to generate high-quality spectral fingerprints, which increase the information density produced per unit sample volume. This TENGi nanoESI strategy has the potential to fill in the gap in metabolomics where liquid chromatography-MS-based analyses cannot be applied. Our method opens up avenues for future investigations into understanding metabolic changes caused by diseases or external stimuli.

Efficacy of perturbation-based balance training in anterior cruciate ligament tears. A systematic review

Anterior cruciate ligament (ACL) tear is a serious and debilitating injury with significant physical, psychological, and socioeconomic consequences. Perturbation-based balance training (PBBT) is a type of neuromuscular training that involves the manipulation of mobile support surfaces, using controlled, unpredictable, multidirectional forces, in order to perturb the balance of the trained individual and thus improve the efficiency of muscle contraction patterns and the dynamic stability of the lower extremity joints. The aim of this review is to analyze the efficacy of the PBBT as a neuromuscular re-education method of choice for the recovery of functional capacity in individuals with ACL knee rupture. A systematic search was carried out in PubMed, Cinahl, Cochrane Library, Medline, PEDro Physiotherapy Evidence Database, Scopus, Web of Science and Sport Discus during January 2022. Only randomized clinical trials conducted in humans and published in English or Spanish were considered. The methodological quality was assessed using the PEDro scale and the risk of bias using the Risk-of-Bias tool of The Cochrane.12 studies were included. In 3 of them, the intervention with PBBT took place before ACL reconstruction, in 7 after ACL reconstruction and in 2 the subjects did not undergo surgical intervention. PBBT appears to be effective in the non-surgical recovery, improving joint stability and neuromuscular control. It was also effective as a preoperative treatment in normalizing knee excursion after ACL surgery. In contrast, the evidence does not support its efficacy as the neuromuscular re-education method of choice in the return-to-sport phase in previously operated athletes. (AU)