Best Practice Recommendations for Dysphagia Management in Intensive Care Unit (ICU): A Delphi Study from Multidisciplinary Experts in Turkey.

There is no study about all aspects of oropharyngoesophageal (OPE) dysphagia from diagnosis to follow-up in a multidisciplinary manner in the world. In order to close this gap, we aimed to create a recommendation study that can be used in clinical practice, addressing all aspects of dysphagia in the ICU in detail with the opinion of experienced multidisciplinary experts. This recommendation paper was generated by a multidisciplinary team, using the seven-step process and a three-modified Delphi round via e-mail. Firstly, 15 open-ended questions were created, and then detailed recommendations including general principles, management, diagnosis, rehabilitation, and follow-up were created with the answers from these questions, Each recommendation item was voted on by the experts as overall consensus (strong recommendation), approaching consensus (weak recommendation), and divergent consensus (not recommended).In the first Delphi round, a questionnaire consisting of 413 items evaluated with a scale of 0-10 was prepared from the opinions and suggestions given to 15 open-ended questions. In the second Delphi round, 55.4% were accepted and revised suggestions were created. At the end of the third Delphi round, the revised suggestion form was approved again and the final proposals containing 133 items were created. This study includes comprehensive and detailed recommendations, including a broad perspective from diagnosis to treatment and follow-up, as detailed as possible, for management of dysphagia in patients with both oropharyngeal- and esophageal-dysphagia in ICU.

Investigation of The Effectiveness of Extracorporeal Shock Wave Therapy in Patients Diagnosed with Plantar Fasciitis: Comparison of Radial and Focus Applications.

The aim of the study was to investigate the effectiveness of radial and focus ESWT treatment on pain, function and size of the calcaneal spur in patients with clinical and radiological diagnosis of plantar fasciitis. A total of 112 patients aged between 18 and 95 years, were divided into two groups; group 1, rESWT (2.4 bar 12 hz 2000 beats), group 2 received fESWT (0.14 bar 14 hz 1000 beats) three times a week for three weeks. All patients were evaluated using the Visual Analog Scale (VAS)-pain and Foot Function Index (FFI) before and after the treatment, at 4 week and 12 weeks. Calcaneal spur size was measured radiographically in the patients before and after the treatment at the 12 th week follow-up. According to our records, VAS scores were found to be similar between the groups before treatment and at follow-ups (all p>0.05). In both groups, a significant decrease in VAS scores was found in the follow-ups compared to before treatment (p<0.001). FFI total, pain, activity and disability scores were found to be similar between the groups before treatment and at follow-up (all p>0.05). In both groups, a significant decrease in FFI scores was found in the follow-ups compared to before treatment (p<0.001). Both of rESWT and fESWT were effective in plantar fasciitis treatment there were no significiant difference between two modalities in long term. LEVEL OF CLINICAL EVIDENCE: III.

Ultrasound-guided erector spinae plane block in patients with chronic lumbar facet joint pain: A prospective case-controlled study.

PURPOSE: The aim was to evaluate the efficacy of ultrasound-guided erector spinae plane (ESP) block and compare with the conventional physical therapy in chronic low back pain (LBP). MATERIALS AND METHODS: This prospective case-controlled study included patients with chronic LBP. Their clinical and demographic data were obtained, and they were divided into two groups for conventional physical therapy and ESP blocks. Prior to treatment, on the first day, the second week, and the third month, the Oswestry Disability Index (ODI) and visual analog scale (VAS) pain score were evaluated. RESULTS: The study included 43 patients, 21 in the ESP block group and 22 in the conventional physical therapy group. The VAS in movement was higher in the ESP block group at baseline (p = 0.047). On the first day after the treatments, the ESP block group showed lower resting (p < 0.001) and movement (p = 0.001) VAS values than the conventional physical therapy group. At the end of 3 months, both groups had improved VAS and ODI scores (all p < 0.001). CONCLUSION: US-guided ESP block might be considered a successful, safe, and technically simple alternative treatment in patients with chronic LBP to control pain and reduce the cost of physical therapy and lost workdays.

Independent and combined effects of astaxanthin and omega-3 on behavioral deficits and molecular changes in a prenatal valproic acid model of autism in rats.

Objectives: Autism is a devastating neurodevelopmental disorder and recent studies showed that omega-3 or astaxanthin might reduce autistic symptoms due to their anti-inflammatory properties. Therefore, we investigated the effects of omega-3 and astaxanthin on the VPA-induced autism model of rats.Material and Methods: Female Wistar albino pups (n = 40) were grouped as control, autistic, astaxanthin (2 mg/kg), omega-3 (200 mg/kg), and astaxanthin (2 mg/kg)+omega-3 (200 mg/kg). All groups except the control were prenatally exposed to VPA. Astaxanthin and omega-3 were orally administered from the postnatal day 41 to 68 and behavioral tests were performed between day 69 and 73. The rats were decapitated 24 h after the behavioral tests and hippocampal and prefrontal cytokines and 5-HT levels were analyzed by ELISA.Results: VPA rats have increased grooming behavior while decreased sociability (SI), social preference index (SPI), discrimination index (DI), and prepulse inhibition (PPI) compared to control. Additionally, IL-1ß, IL-6, TNF-α, and IFN-γ levels increased while IL-10 and 5-HT levels decreased in both brain regions. Astaxanthin treatment raised SI, SPI, DI, PPI, and prefrontal IL-10 levels. It also raised 5-HT levels and decreased IL-6 levels in both brain regions. Omega-3 and astaxanthin + omega-3 increased the SI, SPI, DI, and PPI and decreased grooming behavior. Moreover, they increased IL-10 and 5-HT levels whereas decreased IL-1ß, IL-6, TNF-α, IFN-γ levels in both brain regions.Conclusions: Our results showed that VPA administration mimicked the behavioral and molecular changes of autism in rats. Single and combined administration of astaxanthin and omega-3 improved the autistic-like behavioral and molecular changes in the VPA model of rats.

Rehabilitative management of post-acute COVID-19: clinical pictures and outcomes.

This study aimed to detect patients' characteristics who suffered severe and critical COVID-19 pneumonia admitted to the post-acute COVID-19 rehabilitation clinic in Ankara City Hospital, Physical Medicine and Rehabilitation Hospital and to share our experiences and outcomes of rehabilitation programmes applied. This study was designed as a single-centre, retrospective, observational study. Severe and critical COVID-19 patients, admitted to the post-acute COVID-19 rehabilitation clinic, were included in patient-based rehabilitation programmes, targeting neuromuscular and respiratory recovery. Functional status, oxygen (O2) requirement and daily living activities were assessed before and after rehabilitation. Eighty-five patients, of which 74% were male, were analysed, with the mean age of 58.27 ± 11.13 and mean body mass index of 25.29 ± 4.81 kg/m2. The most prevalent comorbidities were hypertension (49.4%) and diabetes mellitus (34.1%). Of the 85 patients, 84 received antiviral drugs, 81 low-molecular-weight heparin, 71 corticosteroids, 11 anakinra, 4 tocilizumab, 16 intravenous immunoglobulin and 6 plasmapheresis. 78.8% of the patients were admitted to the intensive care unit, with a mean length of stay of 19.41 ± 18.99 days, while those who needed O2 support with mechanic ventilation was 36.1%. Neurological complications, including Guillain-Barré syndrome, critical illness-related myopathy/neuropathy, cerebrovascular disease and steroid myopathy, were observed in 39 patients. On initial functional statuses, 55.3% were bedridden, 22.4% in wheelchair level and 20% mobilised with O2 support. After rehabilitation, these ratios were 2.4%, 4.7% and 8.2%, respectively. During admission, 71 (83.5%) patients required O2 support, but decreased to 7 (8.2%) post-rehabilitation. Barthel Index improved statistically from 44.82 ± 27.31 to 88.47 ± 17.56. Patient-based modulated rehabilitation programmes are highly effective in severe and critical COVID-19 complications, providing satisfactory well-being in daily living activities.

The Effect of Sham Controlled Continuous Theta Burst Stimulation and Low Frequency Repetitive Transcranial Magnetic Stimulation on Upper Extremity Spasticity and Functional Recovery in Chronic Ischemic Stroke Patients.

OBJECTIVE: This randomized controlled study examined the effect of continuous theta burst stimulation (cTBS) and low frequency repetitive transcranial magnetic stimulation (rTMS) on upper extremity spasticity and functional recovery in chronic ischemic stroke patients. MATERIALS AND METHODS: Twenty chronic ischemic stroke patients were randomized into three groups as real rTMS group (n = 7), real cTBS group (n = 7) and sham cTBS group (n = 6), in which real rTMS with physical therapy (PT), real cTBS with PT and sham cTBS with PT were applied in 10 sessions, respectively. The evaluation parameters were assessed at pre-treatment, post-treatment and follow up at 4 weeks. RESULTS: Ten sessions of real rTMS or real cTBS combined with PT were found beneficial in motor functional recovery and daily living activities both at post-treatment and follow up at 4 weeks (p Ë‚ 0.05). In the sham cTBS group, functional improvement was not significant (p > 0.05). In addition, in the real rTMS group, elbow flexor, pronator, wrist flexor and finger flexor spasticity were significantly decreased; in the real cTBS group, significant decrease was observed in the elbow flexor and wrist flexor spasticity (p Ë‚ 0.05). In comparison with sham cTBS group, only in the real cTBS group, significant improvement was observed in the level of wrist flexor spasticity at follow up at 4 weeks (p Ë‚ 0.017). CONCLUSIONS: In this study, it was observed that real cTBS or real rTMS combined with PT provided improvement on upper extremity motor functions and daily living activities in chronic ischemic stroke patients, but improvement in spasticity was limited.

Spontaneous regression of extruded lumbar disc herniation: Correlation with clinical outcome.

OBJECTIVE: To evaluate the natural history of lumbar extruded disc with conservative treatment on MRI and to assess relation between the radiologic changes and clinical outcome. METHODS: This prospective observational study was conducted at University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital between May 2015-June 2018. It included consecutive patients who were diagnosed as having lumbar symptomatic extruded disc as shown in MRI. After an average period of 17.0±7.2 months, repeat MRI was taken in 40 patients who received only conservative care during follow-up. Changes in the volume of herniated disc was measured. The patients were assigned into 3 groups as follow: (1) non-regression, (2) partial-regression, and (3) complete resolution. Numeric Rating Scale (NRS) pain score, the Oswestry Low Back Pain Disability Index (ODI) and muscle weakness were evaluated. RESULTS: Based on disc volume of the T2-weighted MR images; four patients (10%) did not show any regression, six patients (15%) had a partial regression, and 30 patients (75%) had a complete resolution. Patients with complete resolution showed a significant improvement in the NRS pain score and the ODI score (p<0,001) over time. In patients with partial regression, only the ODI score improved significantly (p=0,043). Non-regression group did not show any improvement in any clinical outcome measure (p>0,05). Changes in the NRS scores over time were significantly higher in complete resolution group compared to non-regression group (p=0.016). CONCLUSION: The majority of the patients with extruded lumbar disc herniation might have reduction in size of herniated disc in the long run along with improvement in symptoms and function with conservative care.

Role of Magnetic Resonance Imaging in Ascertaining the Success of Transforaminal Epidural Steroid Injection for Lumbar Radicular Pain.

Objective: To explore the outcome differences of lumbar transforaminal epidural steroid injection (TFESI) according to magnetic resonance imaging (MRI) findings in patients with lumbar radicular pain. Design: Retrospective study. Setting: Single university-based interventional pain management unit. Patients: Fifty-nine patients who had lumbar radicular pain with a recent lumbar MRI and three-month follow-up were included. Methods: MRI findings were reviewed for the following items: herniation type (bulging, protrusion, extrusion), herniation location (central, subarticular, foraminal, extraforaminal), high intensity zone (HIZ), and nerve root impingement (NRI). Pain severity was evaluated using a visual analogue scale (VAS) at time of before injection, then two weeks and three months after. Results: Pain scores improved significantly in each group ( P < 0.05) at all time points, but there were no statistically significant differences in improvements according to type or location of disc herniation. Pain scores were significantly lower in patients with HIZ at the second week and in patients with NRI at the third month ( P < 0.05). Conclusions: TFESI was an effective treatment method in patients with radicular pain, irrespective of the type or location of disc herniation. However, greater improvement in pain may be expected at the second week in patients with HIZ and at the third month in patients with NRI.

Ultrasonographic evaluation of the femoral cartilage thickness in patients with chronic renal failure.

OBJECTIVE: To investigate the effects of chronic renal failure (CRF) on the distal femoral cartilage thickness by using ultrasonography and to determine the relationship between cartilage thickness and certain disease-related parameters. DESIGN: Fifty-seven CRF patients (41 male and 16 female) (mean [SD] age, 44.7 [12.1] years) and 60 healthy controls (41 male and 19 female) (mean [SD] age, 43.5 [13.3] years) were enrolled in this study. Demographic and clinical characteristics were recorded. Cartilage thickness measurements were taken from the medial and lateral condyles, and intercondylar areas of both knees. RESULTS: Groups were similar in terms of age, weight, height, body mass index and gender (all p>0.05). The mean cartilage thickness was found to be less in CRF patients than in controls (statistically significant for medial condyles and intercondylar areas both in right and the left knees [all p<0.05]). Cartilage thickness showed no correlation with eGFR, and with the levels of serum urea, creatinine, calcium, magnesium, phosphor, hemoglobin, uric acid and as well as steroid use (all p>0.05) in CRF patients. CONCLUSION: In the light of our findings, we imply that patients with CRF have thinner femoral cartilage than healthy controls. This result may support the view that patients with CRF are at increased risk for developing early knee osteoarthritis. Last but not least, clinicians should be aware of the importance of rehabilitation strategies aimed at decreasing onset and progression of knee osteoarthritis in patients with CRF.

The relationship between prosthesis use, phantom pain and psychiatric symptoms in male traumatic limb amputees.

OBJECTIVES: The purpose of this study was to identify psychiatric symptoms by comparing male patients with traumatic leg amputations (LAs) with healthy controls and to determine the association between these psychiatric symptoms and phantom pain and prosthesis use characteristics. METHODS: One hundred four volunteers, 51 LA patients (group 1) and 53 healthy controls (group 2) were included. Demographic data including age, height, weight, time since amputation, duration of prosthesis use, and Satisfaction with Prosthesis Questionnaire scores were recorded. Phantom pain was measured a visual analog scale (VAS). Psychiatric symptoms were measured using the Symptom Checklist-90-R, Beck Depression Inventory, Pittsburgh Sleep Quality Index, Rosenberg Self-Esteem Scale, and State-Trait Anxiety Inventory. Correlations were determined between time since amputation, duration of prosthesis use and satisfaction with prosthesis questionnaire scores and psychiatric scale scores. RESULTS: Amputee patients had higher phobic anxiety, state anxiety, trait anxiety and sleep disturbance scores (p<0.05) than the controls. No difference was determined in terms of psychiatric symptoms between the phantom pain and no phantom pain groups (p>0.05). There were significant negative correlations between time since amputation, duration of prosthesis use, duration of daily prosthesis use, and satisfaction with prosthesis questionnaire scores and psychiatric symptoms. CONCLUSIONS: Apart from anxiety (state, trait or phobic) and disturbed sleep, other psychiatric symptoms in amputee patients undergoing lengthy prosthetic rehabilitation may not differ from those of healthy controls. The presence and severity of phantom pain appear to be unrelated to general psychiatric symptomatology. Length of time since amputation, length of prosthesis use, daily length of prosthesis use and prosthesis satisfaction are negatively correlated with general psychiatric symptoms. These characteristics must be borne in mind in psychiatric and prosthetic rehabilitation.

Knee pain relief with genicular nerve blockage in two brain injured patients with heterotopic ossification.

BACKGROUND: Heterotopic ossification (HO) is the ectopic bone formation in non-osseous tissues. This study aimed to present two patients with traumatic brain injury (TBI) who had HO in knee joint and pain relief after genicular nerve blockage. Case 1: A 14-year-old patient with TBI was admitted with bilateral knee pain and limited range of motion. Physical examination and x-ray graphics revealed calcification which was diagnosed as HO. Ultrasonography (US) guided genicular nerve blockage was performed to both knees with 2 ml lidocaine and 1 ml betamethasone. VAS of pain was decreased to 30 mm from 80 mm. At 6-month follow-up, VAS of pain was still 30 mm. Case 2: A 29-year-old patient with TBI was admitted for rehabilitation. He had right knee pain and his pain was 80 mm according to VAS. Investigation revealed HO. US guided genicular nerve blockage was performed to the right knee and pain was decreased to 20 mm. DISCUSSION: US guided genicular nerve blockage can provide pain relief in HO and this technique may be effective and alternative for pain relief in patients with neurogenic knee HO to increase patient's compliance.

Effects of dietary supplement use during COVID-19 treatment on post-COVID academic motivation: a sample of college students.

INTRODUCTION: Although few studies have emphasized the preventive and therapeutic efficacy of dietary supplements in COVID-19, their efficacy in the postinfection period has not been focused. The aim of the current study was to examine the effects of therapeutic use of dietary supplements during COVID-19 treatment on post-COVID academic motivation in college students METHODOLOGY: The study was conducted with 1584 college students studying at Karamanoglu Mehmetbey University. Three-day food consumption was recorded and anthropometric measurements (height and body weight) were taken to assess nutritional status. The Academic Motivation Scale (AMS), a 28-item 7-point Likert scale consisting of three subdimensions (amotivation, intrinsic motivation, and extrinsic motivation), was used to assess the motivational status of participants. RESULTS: The rate of participants who survived COVID-19 was 35.9% (n = 568). There was no significant difference in AMS subscores between participants who routinely used dietary supplements and those who did not. Participants who used dietary supplements preventively had higher intrinsic motivation scores than those who did not. Lastly, all AMS subscores of COVID-19 survivors who used dietary supplements therapeutically during treatment were found to be more favorable than those who did not. However, there was no significant difference in AMS subscores between the types of dietary supplements most frequently used therapeutically. CONCLUSIONS: The finding of higher post-COVID academic motivation in COVID-19 survivors who used dietary supplements as an adjunct to treatment will make an important contribution to the literature. However, longitudinal intervention studies examining the effectiveness of specific dietary supplements in COVID-19 will undoubtedly provide more valuable results.

A marine-derived antioxidant astaxanthin as a potential neuroprotective and neurotherapeutic agent: A review of its efficacy on neurodegenerative conditions.

Astaxanthin is a potent lipid-soluble carotenoid produced by several different freshwater and marine microorganisms, including microalgae, bacteria, fungi, and yeast. The proven therapeutic effects of astaxanthin against different diseases have made this carotenoid popular in the nutraceutical market and among consumers. Recently, astaxanthin is also receiving attention for its effects in the co-adjuvant treatment or prevention of neurological pathologies. In this systematic review, studies evaluating the efficacy of astaxanthin against different neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, multiple sclerosis, cerebrovascular diseases, and spinal cord injury are analyzed. Based on the current literature, astaxanthin shows potential biological activity in both in vitro and in vivo models. In addition, its preventive and therapeutic activities against the above-mentioned diseases have been emphasized in studies with different experimental designs. In contrast, none of the 59 studies reviewed reported any safety concerns or adverse health effects as a result of astaxanthin supplementation. The preventive or therapeutic role of astaxanthin may vary depending on the dosage and route of administration. Although there is a consensus in the literature regarding its effectiveness against the specified diseases, it is important to determine the safe intake levels of synthetic and natural forms and to determine the most effective forms for oral intake.

Dietary and serum antioxidant capacity is inversely associated with patients in osteoarthritis: a case-control study.

This study aimed to examine dietary antioxidant and serum antioxidant capacity in patients with knee osteoarthritis (OA). This case-control study consisted of 47 patients with OA (case group) and 30 healthy subjects (control group). The control and case group were matched age, gender, and body mass index (p > 0.05). A food frequency questionnaire was administered to participants, and dietary total antioxidant capacity (DTAC) was estimated using the ferric reducing antioxidant power method (FRAP). Participants' serum total antioxidant capacity (TAC) and total oxidant capacity (TOC) measurements were performed, and the oxidative stress index (OSI) was calculated. DTAC of case group was found to be lower than the control group (p < 0.05). The daily consumption of red meat and butter of the individuals in the case group was higher than that of the control group, and their fish consumption, dietary vitamin A and carotene intakes were found to be lower (p < 0.05). In addition, OA patients have TAC and OSI was also found to be significantly higher than in control group (p = 0.001 and p < 0.001). Since low dietary total antioxidant capacity and high serum total oxidant capacity, individuals with OA should pay more attention to their diet to increase serum antioxidant status.

Adiponectin in spinal cord injury: What is the role of nutrition in serum adiponectin concentration?

Objectives: The study aimed to analyze the relationship between serum adiponectin concentration, Mediterranean diet (MD) adherence, and Dietary Approaches to Stop Hypertension (DASH) diet adherence in patients with spinal cord injury (SCI). Patients and methods: Thirty-three SCI patients (21 males, 12 females; median age: 33 years; range, 18 to 65 years) and 33 age-, sex-, and body mass index-matched healthy controls (21 males, 12 females; median age: 33 years; range, 18 to 64 years) were included in this cross-sectional study between March 2021 and March 2022. Serum adiponectin concentrations of all participants were measured. Body weight, height, and neck, hip, waist, and mid-upper arm circumferences were measured. Twenty-four-hour dietary records were obtained by the researchers for evaluation of the nutritional status. The DASH diet score and MD score were measured for each participant. Results: Most of the cases of SCI were due to motor vehicle collisions (n=12, 36.4%) and complete paraplegic. Mid-upper arm circumference, waist circumference, hip circumference, and neck circumference of the patient group were significantly higher than the control group (p=0.020, p=0.002, p=0.042, and p<0.001, respectively). Mediterranean diet scores and DASH diet scores of the patient group were significantly higher than the control group (p<0.001 and p=0.031, respectively). Serum adiponectin concentration of patients was significantly higher than the control group (p=0.049). No correlation was detected between adiponectin concentration, MD score, and DASH diet score in both groups. Conclusion: Although correlation analysis in the current research did not show significant relation between nutrition and adiponectin concentrations, nutrition of patients with SCI, as demonstrated by higher adherence to MD and DASH, may have provided positive effects on adiponectin concentrations. Future studies focused on the effect of a healthy diet intervention on serum adiponectin concentration is warranted.

Impact of Acute High-intensity Interval Training on Cortical Excitability, M1-related Cognitive Functions, and Myokines: A Randomized Crossover Study.

High-intensity interval training (HIIT) is a time-efficient, safe, and feasible exercise type that can be utilized across different ages and health status. This randomized cross-over study aimed to investigate the effect of acute HIIT on cortical excitability, M1-related cognitive functions, cognition-related myokines, brain-derived neurotrophic factor (BDNF), and Cathepsin B (CTSB). Twenty-three sedentary young adults (mean age: 22.78 years ± 2.87; 14 female) participated in a cross-over design involving two sessions: either 23 min of HIIT or seated rest. Before and after the sessions, cortical excitability was measured using transcranial magnetic stimulation, and M1-related cognitive functions were assessed by the n-back test and mental rotation test. Serum levels of BDNF and CTSB were assessed using the ELISA method before and after the HIIT intervention. We demonstrated that HIIT improved mental rotation and working memory, and increased serum levels of BDNF and CTSB, whereas cortical excitability did not change. Our findings provide evidence that one session of HIIT is effective on M1-related cognitive functions and cognition-related myokines. Future research is warranted to determine whether such findings are transferable to different populations, such as cognitively at-risk children, adults, and older adults, and to prescribe effective exercise programs.

Ultrasonography-guided botulinum toxin injection for lumbrical muscle spasticity in a hemiplegic patient.

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The inter-rater reliability of the Turkish version of Aphasia Rapid Test for stroke.

BACKGROUND: The Aphasia Rapid Test (ART) is a short bedside aphasia screening test developed originally in French for use with post-stroke patients in the acute phase of recovery. OBJECTIVES: The purpose of this study was to assess the inter-rater reliability of the Turkish version of the ART in stroke patients (ICTRP ID: NCT04386837). METHODS: The French ART was translated into Turkish. Inter-rater reliability was assessed in 30 post-stroke patients with aphasia by two independent speech-language pathologists blind to each other's ratings. RESULTS: 30 patients (18 men, 12 women; mean age 64.43 ± 16.60 years) were included within 10 days of stroke onset, as assessed by clinical examination and confirmed by CT and/or MRI. The mean (± SD) ART value was 16.26 (± 8.05) for rater 1 and 16.43 (±8.14) for rater 2. The inter-rater concordance coefficient was 0.997 (95% CI 0.994-0.999; p < .001). CONCLUSIONS: Findings indicate that the Turkish version of the original ART was successfully administered in Turkish-speaking patients.

Probiotics and prebiotics alleviate behavioral deficits, inflammatory response, and gut dysbiosis in prenatal VPA-induced rodent model of autism.

Autism spectrum disorders are neuropsychiatric conditions characterized by social interaction and communication disorders and repetitive stereotypical behaviors. These disorders are also accompanied by an inflammatory status. Bidirectional communication between microbiome, gut, and brain has been discovered as a major mechanism influencing core symptoms and biomarkers of autism. Therefore, the modulation of the gut microbiota in autism has recently attracted interest. In this study, probiotic- and prebiotic-mediated modulation of the gut microbiota was compared in terms of different symptoms and findings in an experimental autism model. Valproic acid (VPA) (500 mg/kg) was administered to Wistar rats (on prenatal day 12.5) to induce autistic-like behaviors. Based on the supply of probiotics and prebiotics, animals were grouped as control (saline), autistic-like (prenatal VPA), probiotic (prenatal VPA + 22.5 × 109 cfu/day probiotic), prebiotic (prenatal VPA + 100 mg/day prebiotic), and combined treatment (prenatal VPA + 22.5 × 109 cfu/day probiotic + 100 mg/day prebiotic). After the treatment process, behavioral tests (social behaviors, anxiety, stereotypical behavior, sensorimotor gating, and behavioral despair) and biochemical analyses (serum and brain tissue) were conducted, and the quantities of some phyla and genera were determined in stool samples. Significant positive effects of probiotic and combined treatments were observed on the sociability, social interaction, and anxiety parameters. In addition, all three treatments had positive effects on stereotypical behavior. However, the treatments did not affect sensorimotor gating deficits and behavioral despair. Further, probiotic treatment reversed the VPA-induced increase and decrease in serum IL-6 and IL-10 levels, respectively. Combined treatment also significantly increased the IL-10 levels. Prenatal VPA exposure decreased 5-hydroxytryptamine (5-HT) levels in the prefrontal cortex of the brain; however, combined treatment reversed this decrease. Prenatal VPA exposure also caused a decrease in Bacteroidetes/Firmicutes ratio in the gut microbiota, while the probiotic treatment significantly increased this ratio. These findings indicate that probiotic- and prebiotic-mediated microbial modulation may represent a new therapeutic approach to alleviate autistic-like symptoms.