The influence of scaffolding on intrinsic motivation and autonomous adherence to a game-based, unsupervised home rehabilitation program for people with upper extremity hemiparesis due to stroke. A randomized controlled trial.

Background: This parallel, randomized controlled trial examines intrinsic motivation, adherence and motor function improvement demonstrated by two groups of subjects that performed a twelve-week, home-based upper extremity rehabilitation program. Seventeen subjects played games presenting eight to twelve discrete levels of increasing difficulty. Sixteen subjects performed the same activities controlled by success algorithms that modify game difficulty incrementally. Methods: 33 persons 20 to 80 years of age, at least six months post stroke with moderate to mild hemiparesis were randomized using a random number generator into the two groups. They were tested using the Action Research Arm Test, Upper Extremity Fugl Meyer Assessment, Stroke Impact Scale and Intrinsic Motivation Inventory pre and post training. Adherence was measured using timestamps generated by the system. Subjects had the Home Virtual Rehabilitation System [1]systems placed in their homes and were taught to perform rehabilitation games using it. Subjects were instructed to train twenty minutes per day but were allowed to train as much as they chose. Subjects trained for twelve weeks without appointments and received intermittent support from study staff. Group outcomes were compared using ANOVA. Correlations between subject demographics and adherence, as well as motor outcome, were evaluated using Pearson Correlation Coefficients. Classification and Regression Tree (CART) models were generated to predict responders using demographics and baseline measures. Results: There were 5 dropouts and no adverse events. The main effect of time was statistically significant for four of the five clinical outcome measures. There were no significant training group by time interactions. Measures of adherence did not differ between groups. 21 subjects from both groups, demonstrated clinically important improvements in UEFMA score of at least 4.25 points. Subjects with pre training UEFMA scores below 53.5 averaged a seven-point UEFMA increase. IMI scores were stable pre to post training. Conclusions: Scaffolding did not have a meaningful impact on adherence or motor function improvement. A sparsely supervised program of game-based treatment in the home was sufficient to elicit meaningful improvements in motor function and activities of daily living. Common factors considered barriers to the utilization of telerehabilitation did not impact adherence or motor outcome. Trial registration: Clinical Trials.gov - NCT03985761, Registered June 14, 2019.

A Convergent Mixed Methods Design to Assess the Use of the Home Virtual Rehabilitation System By Persons with Chronic Stroke.

Purpose: Patients poststroke utilized the Home Virtual Rehabilitation System (HoVRS) to perform home-based, gamified upper extremity rehabilitation over 12 weeks. Outcomes related to adherence and clinical improvement were collected, and semistructured interviews were conducted to assess intrinsic and extrinsic motivators that impacted engagement with the system. Methods: Subjects performed between 299 and 2020 minutes of self-scheduled, sparsely supervised hand rehabilitation activities in their homes. Results: As a group, the subjects demonstrated statistically significant improvements at the structure/function, activity, and activities of daily living levels of function. Qualitative analysis generated seven themes that both positively and negatively influenced each subject's experience with HoVRS, including challenge as a primary intrinsic motivator and pursuing additional therapy and/or a return to higher functional status as a key extrinsic motivator. Subjects' ratings of the system using the Intrinsic Motivation Inventory before and after treatment were uniformly positive, but interview-based feedback was more balanced between positive and negative.

A Review of the Use of Gaze and Pupil Metrics to Assess Mental Workload in Gamified and Simulated Sensorimotor Tasks.

Gaze and pupil metrics are used to represent higher cognitive processes in a variety of contexts. One growing area of research is the real-time assessment of workload and corresponding effort in gamified or simulated cognitive and motor tasks, which will be reviewed in this paper. While some measurements are consistent across studies, others vary and are likely dependent on the nature of the effort required by the task and the resulting changes in arousal. Pupil diameter is shown to consistently increase with task effort and arousal; however, the valence of arousal must be considered. In many cases, measures of pupil diameter were sensitive to both excessive and insufficient challenge. Overall, it is evident that gaze and pupil metrics are valuable to assess the cognitive state during gamified and simulated tasks, and further research is indicated regarding their use in clinical populations in rehabilitation to inform optimally engaging interventions.

Laboratory-Based Examination of the Reliability and Validity of Kinematic Measures of Wrist and Finger Function Collected by a Telerehabilitation System in Persons with Chronic Stroke.

We have developed the New Jersey Institute of Technology-Home Virtual Rehabilitation System (NJIT-HoVRS) to facilitate intensive, hand-focused rehabilitation in the home. We developed testing simulations with the goal of providing richer information for clinicians performing remote assessments. This paper presents the results of reliability testing examining differences between in-person and remote testing as well as discriminatory and convergent validity testing of a battery of six kinematic measures collected with NJIT-HoVRS. Two different groups of persons with upper extremity impairments due to chronic stroke participated in two separate experiments. Data Collection: All data collection sessions included six kinematic tests collected with the Leap Motion Controller. Measurements collected include hand opening range, wrist extension range, pronation-supination range, hand opening accuracy, wrist extension accuracy, and pronation-supination accuracy. The system usability was evaluated by therapists performing the reliability study using the System Usability Scale. When comparing the in-laboratory collection and the first remote collection, the intra-class correlation coefficients (ICC) for three of the six measurements were above 0.900 and the other three were between 0.500 and 0.900. Two of the first remote collection/second remote collection ICCs were above 0.900, and the other four were between 0.600 and 0.900. The 95% confidence intervals for these ICC were broad, suggesting that these preliminary analyses need to be confirmed by studies with larger samples. The therapist's SUS scores ranged from 70 to 90. The mean was 83.1 (SD = 6.4), which is consistent with industry adoption. There were statistically significant differences in the kinematic scores when comparing unimpaired and impaired UE for all six measures. Five of six impaired hand kinematic scores and five of six impaired/unimpaired hand difference scores demonstrated correlations between 0.400 and 0.700 with UEFMA scores. Reliability for all measures was acceptable for clinical practice. Discriminant and convergent validity testing suggest that scores on these tests may be meaningful and valid. Further testing in a remote setting is necessary to validate this process.

Three Class Classification of Alzheimer's Disease Using Deep Neural Networks.

Alzheimer's disease (AD) is a prevalent type of dementia that can cause neurological brain disorders, poor decision making, impaired memory, mood swings, unstable emotions, and personality change. Deep neural networks are proficient in classifying Alzheimer's disease based on MRI images. This classification assists human experts in diagnosing AD and predicts its future progression. The paper proposes various Deep Neural Networks (DNN) for early AD detection to save cost and time for doctors, radiologists, and caregivers. A 3330-image-based Kaggle dataset is used to train the DNN, including 52 images of AD, 717 images of Mild Cognitive Impairment (MCI), and the remaining images of Cognitive Normal (CN). Stratified partitioning splits the dataset into 80% and 20% proportions for training and validation datasets. Proposed models include DenseNet169, DenseNet201, and Res- Net152 DNNs with additional three fully-connected layers and softmax and Kullback Leibler Divergence (KLD) loss function. These models are trained considering pre-trained, partially pre-trained, and fully re-trained extended base models. The KLD loss function reduces the error and increases accuracy for all models. The partially pre-trained DenseNet201 model outperformed all the other models. DenseNet201 gives the highest accuracy of 99.98% for training, 99.07% for validation, and 95.66% for test datasets. The DenseNet201 model has the highest accuracy in comparison to other state-of-artmethods.

Incidentally detected primary squamous cell carcinoma of the kidney: Case series with review of the literature.

ABSTRACT: Squamous cell carcinoma of the kidney is a rare malignancy, usually not suspected clinically because of the lack of any pathognomic sign and ambiguous clinical and radiological features, and thus, patients present at advanced stages resulting in poor prognosis. We report here four cases of incidentally diagnosed primary renal squamous cell carcinoma that were treated at our hospital. The mean age of the patients (two females and one male aged above 60 years, except one male whose age was 25 years) was 60 years. Both the males and one of the females had a history of multiple renal calculi, and the other female had staghorn calculus. Interestingly, renal carcinoma was not suspected clinically in all these patients. In one case, a computerized tomography scan (CT scan) showed suspicious mass. All underwent nephrectomy for the non-functioning kidney. In only two cases, tumor was identified on gross examination, whereas the other two only showed a distorted pelvis. Our case series emphasizes the need for pelvicalyceal biopsy during diagnosis and treatment for long-standing nephrolithiasis and thorough sampling of nephrectomy specimens of such patients to rule out malignancy.

EEG Based Resting State Connectivity Changes in the Motor Cortex Associated with Upper Limb Motor Recovery in the Subacute Period Post-Stroke.

Stroke is a heterogeneous condition that would benefit from valid biomarkers of recovery for research and in the clinic. We evaluated the change in resting state connectivity (RSC) via electroencephalography (EEG) in motor areas, as well as motor recovery of the affected upper limb, in the subacute phase post-stroke. Fifteen participants who had sustained a subcortical stroke were included in this study. The group made significant gains in upper limb impairment as measured by the Upper Extremity Fugl-Meyer Assessment (UEFMA) from baseline to four months post-stroke (24.78 (SD 5.4)). During this time, there was a significant increase in RSC in the beta band from contralesional M1 to ipsilesional M1. We propose that this change in RSC may have contributed to the motor recovery seen in this group. Clinical Relevance- This study evaluates resting state connectivity measured via EEG as a neural biomarker of recovery post-stroke. Biomarkers can help clinicians understand the potential for recovery after stroke and thus help them to establish therapy goals and determine treatment plans.

Evaluation of Changes in Kinematic Measures of Three Dimensional Reach to Grasp Movements in the Early Subacute Period of Recovery from Stroke.

This study examines longitudinal data of subjects initially examined in the early subacute period of recovery following a stroke with a test of reach to grasp (RTG) kinematics in an attempt to identify changes in movement patterns during the period of heightened neural recovery following a stroke. Subjects (n=8) were a convenience sample of persons with stroke that participated in an intervention trial. Baseline Upper Extremity Fugl Meyer Assessment (UEFMA) scores ranged between 31 and 52 and ages were between 49 and 83. The UEFMA and RTG test were collected prior to intervention, immediately after the intervention (approximately 18 days later post baseline) and one month after the intervention. RTG data for the uninvolved UE was collected at the one-month session. Subjects reached for objects placed on a table 10 cm from their sternums, picking them up and placing them on a target 30 cm from their acromioclavicular joints. Data was collected using an optical motion capture system. Active makers were placed on each fingertip, metacarpophalangeal, and proximal interphalangeal joint. Four additional passive markers were placed on the dorsum of the hand, the elbow, the shoulder, and the sternum. Subjects demonstrated statistically significant improvements in reaching duration, reaching trajectory smoothness, time after peak velocity and peak grip aperture. All of these measures correlated significantly with improvements in UEFMA. Clinical Relevance- Kinematic measures of reaching and grasping collected early in the subacute period of recovery from stroke may offer insight into specific aspects of the recovery of upper extremity motor function that differ from the information gleaned from clinical scales.

Aurora B-dependent polarization of the cortical actomyosin network during mitotic exit.

The isotropic metaphase actin cortex progressively polarizes as the anaphase spindle elongates during mitotic exit. This involves the loss of actomyosin cortex from opposing cell poles and the accumulation of an actomyosin belt at the cell centre. Although these spatially distinct cortical remodelling events are coordinated in time, here we show that they are independent of each other. Thus, actomyosin is lost from opposing poles in anaphase cells that lack an actomyosin ring owing to centralspindlin depletion. In examining potential regulators of this process, we identify a role for Aurora B kinase in actin clearance at cell poles. Upon combining Aurora B inhibition with centralspindlin depletion, cells exiting mitosis fail to change shape and remain completely spherical. Additionally, we demonstrate a requirement for Aurora B in the clearance of cortical actin close to anaphase chromatin in cells exiting mitosis with a bipolar spindle and in monopolar cells forced to divide while flat. Altogether, these data suggest a novel role for Aurora B activity in facilitating DNA-mediated polar relaxation at anaphase, polarization of the actomyosin cortex, and cell division.

Loss of neuronal Miro1 disrupts mitophagy and induces hyperactivation of the integrated stress response.

Clearance of mitochondria following damage is critical for neuronal homeostasis. Here, we investigate the role of Miro proteins in mitochondrial turnover by the PINK1/Parkin mitochondrial quality control system in vitro and in vivo. We find that upon mitochondrial damage, Miro is promiscuously ubiquitinated on multiple lysine residues. Genetic deletion of Miro or block of Miro1 ubiquitination and subsequent degradation lead to delayed translocation of the E3 ubiquitin ligase Parkin onto damaged mitochondria and reduced mitochondrial clearance in both fibroblasts and cultured neurons. Disrupted mitophagy in vivo, upon post-natal knockout of Miro1 in hippocampus and cortex, leads to a dramatic increase in mitofusin levels, the appearance of enlarged and hyperfused mitochondria and hyperactivation of the integrated stress response (ISR). Altogether, our results provide new insights into the central role of Miro1 in the regulation of mitochondrial homeostasis and further implicate Miro1 dysfunction in the pathogenesis of human neurodegenerative disease.

Virtual Rehabilitation of the Paretic Hand and Arm in Persons With Stroke: Translation From Laboratory to Rehabilitation Centers and the Patient's Home.

The anatomical and physiological heterogeneity of strokes and persons with stroke, along with the complexity of normal upper extremity movement make the possibility that any single treatment approach will become the definitive solution for all persons with upper extremity hemiparesis due to stroke unlikely. This situation and the non-inferiority level outcomes identified by many studies of virtual rehabilitation are considered by some to indicate that it is time to consider other treatment modalities. Our group, among others, has endeavored to build on the initial positive outcomes in studies of virtual rehabilitation by identifying patient populations, treatment settings and training schedules that will best leverage virtual rehabilitation's strengths. We feel that data generated by our lab and others suggest that (1) persons with stroke may adapt to virtual rehabilitation of hand function differently based on their level of impairment and stage of recovery and (2) that less expensive, more accessible home based equipment seems to be an effective alternative to clinic based treatment that justifies continued optimism and study.

Online Analytical Processing for Business Intelligence in Big Data.

Online analytical processing (OLAP) approach is widely used in business intelligence to cater the multidimensional queries for decades. In this era of cutting-edge technology and the internet, data generation rates have been rising exponentially. Internet of things sensors and social media platforms are some of the major contributors, leading toward the absolute data boom. Storage and speed are the crucial parameters and undoubtedly the burning issues in efficient data handling. The key idea here is to address these two challenges of big data computing in OLAP. In this article, the authors have proposed and implemented OLAP on Hadoop by Indexing (OOHI). OOHI offers a simplified multidimensional model that stores dimensions in the schema server and measures on the Hadoop cluster. Overall setup is divided into various modules, namely: data storage module (DSM), dimension encoding module (DEM), cube segmentation module, segment selection module (SSM), and block selection and process (BSAP) module. Serialization and deserialization concept applied by DSM for storage and retrieval of the data for efficient space utilization. Integer encoding adopted by DEM in dimension hierarchy is selected to escape sparsity problem in multidimensional big data. To reduce search space by chunks of the cube from the queried chunks, SSM plays an important role. Map reduce-based indexing approach and series of seek operations of BSAP module were integrated to achieve parallelism and fault tolerance. Real-time oceanography data and supermarket data sets are applied to demonstrate that OOHI model is data independent. Various test cases are designed to cover the scope of each dimension and volume of data set. Comparative results and performance analytics portray that OOHI outperforms in data storage, dice, slice, and roll-up operations compared with Hadoop based OLAP.

Hand Focused Upper Extremity Rehabilitation in the Subacute Phase Post-stroke Using Interactive Virtual Environments.

Introduction: Innovative motor therapies have attempted to reduce upper extremity impairment after stroke but have not made substantial improvement as over 50% of people post-stroke continue to have sensorimotor deficits affecting their self-care and participation in daily activities. Intervention studies have focused on the role of increased dosing, however recent studies have indicated that timing of rehabilitation interventions may be as important as dosing and importantly, that dosing and timing interact in mediating effectiveness. This study is designed to empirically test dosing and timing. Methods and Analysis: In this single-blinded, interventional study, subjects will be stratified on two dimensions, impairment level (Fugl-Meyer Upper Extremity Assessment (FM) and presence or absence of Motor Evoked Potentials (MEPs) as follows; (1) Severe, FM score 10-19, MEP+, (2) Severe, FM score 10-19, MEP-, (3) Moderate, FM score 20-49, MEP+, (4) Moderate, FM score 20-49, MEP-. Subjects not eligible for TMS will be assigned to either group 2 (if severe) or group 3 (if moderate). Stratified block randomization will then be used to achieve a balanced assignment. Early Robotic/VR Therapy (EVR) experimental group will receive in-patient usual care therapy plus an extra 10 h of intensive upper extremity therapy focusing on the hand using robotically facilitated rehabilitation interventions presented in virtual environments and initiated 5-30 days post-stroke. Delayed Robotic/VR Therapy (DVR) experimental group will receive the same intervention but initiated 30-60 days post-stroke. Dose-matched usual care group (DMUC) will receive an extra 10 h of usual care initiated 5-30 days post-stroke. Usual Care Group (UC) will receive the usual amount of physical/occupational therapy. Outcomes: There are clinical, neurophysiological, and kinematic/kinetic measures, plus measures of daily arm use and quality of life. Primary outcome is the Action Research Arm Test (ARAT) measured at 4 months post-stroke. Discussion: Outcome measures will be assessed to determine whether there is an early time period in which rehabilitation will be most effective, and whether there is a difference in the recapture of premorbid patterns of movement vs. the development of an efficient, but compensatory movement strategy. Ethical Considerations: The IRBs of New Jersey Institute of Technology, Rutgers University, Northeastern University, and Kessler Foundation reviewed and approved all study protocols. Study was registered in https://ClinicalTrials.gov (NCT03569059) prior to recruitment. Dissemination will include submission to peer-reviewed journals and professional presentations.

Development of the Home based Virtual Rehabilitation System (HoVRS) to remotely deliver an intense and customized upper extremity training.

BACKGROUND: After stroke, sustained hand rehabilitation training is required for continuous improvement and maintenance of distal function. METHODS: In this paper, we present a system designed and implemented in our lab: the Home based Virtual Rehabilitation System (HoVRS). Fifteen subjects with chronic stroke were recruited to test the feasibility of the system as well as to refine the design and training protocol to prepare for a future efficacy study. HoVRS was placed in subjects' homes, and subjects were asked to use the system at least 15 min every weekday for 3 months (12 weeks) with limited technical support and remote clinical monitoring. RESULTS: All subjects completed the study without any adverse events. Subjects on average spent 13.5 h using the system. Clinical and kinematic data were collected pre and post study in the subject's home. Subjects demonstrated a mean increase of 5.2 (SEM = 0.69) on the Upper Extremity Fugl-Meyer Assessment (UEFMA). They also demonstrated improvements in six measurements of hand kinematics. In addition, a combination of these kinematic measures was able to predict a substantial portion of the variability in the subjects' UEFMA score. CONCLUSION: Persons with chronic stroke were able to use the system safely and productively with minimal supervision resulting in measurable improvements in upper extremity function.

Autonomous Use of the Home Virtual Rehabilitation System: A Feasibility and Pilot Study.

Objective: This article describes the findings of a study examining the ability of persons with strokes to use home virtual rehabilitation system (HoVRS), a home-based rehabilitation system, and the impact of motivational enhancement techniques on subjects' motivation, adherence, and motor function improvements subsequent to a 3-month training program. Materials and Methods: HoVRS integrates a Leap Motion controller, a passive arm support, and a suite of custom-designed hand rehabilitation simulations. For this study, we developed a library of three simulations, which include activities such as flexing and extending fingers to move a car, flying a plane with wrist movement, and controlling an avatar running in a maze using reaching movements. Two groups of subjects, the enhanced motivation (EM) group and the unenhanced control (UC) group, used the system for 12 weeks in their homes. The EM group trained using three simulations that provided 8-12 levels of difficulty and complexity. Graphics and scoring opportunities increased at each new level. The UC group performed the same simulations, but difficulty was increased utilizing an algorithm that increased difficulty incrementally, making adjustments imperceptible. Results: Adherence to both the EM and UC protocols exceeded adherence to home exercise programs described in the stroke rehabilitation literature. Both groups demonstrated improvements in upper extremity function. Intrinsic motivation levels were better for the EM group and motivation levels were maintained for the 12-week protocol. Conclusion: A 12-week home-based training program using HoVRS was feasible. Motivational enhancement may have a positive impact on motivation, adherence, and motor outcome.

Intensive virtual reality and robotic based upper limb training compared to usual care, and associated cortical reorganization, in the acute and early sub-acute periods post-stroke: a feasibility study.

BACKGROUND: There is conflict regarding the benefits of greater amounts of intensive upper limb rehabilitation in the early period post-stroke. This study was conducted to test the feasibility of providing intensive therapy during the early period post-stroke and to develop a randomized control trial that is currently in process. Specifically, the study investigated whether an additional 8 h of specialized, intensive (200-300 separate hand or arm movements per hour) virtual reality (VR)/robotic based upper limb training introduced within 1-month post-stroke resulted in greater improvement in impairment and behavior, and distinct changes in cortical reorganization measured via Transcranial Magnetic Stimulation (TMS), compared to that of a control group. METHODS: Seven subjects received 8-1 h sessions of upper limb VR/robotic training in addition to their inpatient therapy (PT, OT, ST). Six subjects only received their inpatient therapy. All were tested on measures of impairment [Upper Extremity Fugl-Meyer Assessment (UEFMA), Wrist AROM, Maximum Pinch Force], behavior [Wolf Motor Function Test (WMFT)], and also received TMS mapping until 6 months post training. ANOVAs were conducted to measure differences between groups across time for all outcome measures. Associations between changes in ipsilesional cortical maps during the early period of enhanced neuroplasticity and long-term changes in upper limb impairment and behavior measures were evaluated. RESULTS: The VR/robotic group made significantly greater improvements on UEFMA and Wrist AROM scores compared to the usual care group. There was also less variability in the association between changes in the First Dorsal Interosseus (FDI) muscle map area and WMFT and Maximum Force change scores for the VR/robotic group. CONCLUSIONS: An additional 8 h of intensive VR/robotic based upper limb training initiated within the first month post-stroke may promote greater gains in impairment compared to usual care alone. Importantly, the data presented demonstrated the feasibility of conducting this intervention and multiple outcome measures (impairment, behavioral, neurophysiological) in the early period post-stroke.

The Association Between Reorganization of Bilateral M1 Topography and Function in Response to Early Intensive Hand Focused Upper Limb Rehabilitation Following Stroke Is Dependent on Ipsilesional Corticospinal Tract Integrity.

Transcranial magnetic stimulation (TMS) induced motor evoked potentials (MEPs) are an established proxy of corticospinal excitability. As a binary measure, the presence (MEP+) or absence (MEP-) of ipsilesional hemisphere MEPs early following stroke is a robust indicator of long-term recovery, however this measure does not provide information about spatial cortical reorganization. MEPs have been systematically acquired over the sensorimotor cortex to "map" motor topography. In this investigation we compared the degree to which functional improvements resulting from early (<3 months post-stroke) intensive hand focused upper limb rehabilitation correlate with changes in motor topography between MEP+ and MEP- individuals. Following informed consent, 17 individuals (4 Female, 60.3 ± 9.4 years, 24.6 ± 24.01 days post first time stroke) received 8 one hour-sessions of training with virtual reality (VR)/Robotic simulations. Clinical tests [Box and Blocks Test (BBT), Wolf Motor Function Test (WMFT), Upper Extremity Fugl-Meyer (UEFMA)], kinematic and kinetic assessments [finger Active Range of Motion (finger AROM), Maximum Pinch Force (MPF)], and bilateral TMS mapping of 5 hand muscles were performed prior to (PRE), directly following (POST), and 1 month following (1M) training. Participants were divided into two groups (MEP+, MEP-) based on whether an MEP was present in the affected first dorsal interosseous (FDI) at any time point. MEP+ individuals improved significantly more than MEP- individuals from PRE to 1M on the WMFT, BBT, and finger AROM scores. Ipsilesional hemisphere FDI area increased significantly with time in the MEP+ group. FDI area of the contralesional hemisphere was not significantly different across time points or groups. In the MEP+ group, significant correlations were observed between PRE-1M changes in ipsilesional FDI area and WMFT, BBT, and finger AROM, and contralesional FDI area and UEFMA and MPF. In the MEP- group, no significant correlations were found between changes in contralesional FDI area and functional outcomes. We report preliminary evidence in a small sample that patterns of recovery and the association of recovery to bilateral changes in motor topography may depend on integrity of the ipsilesional cortical spinal tract as assessed by the presence of TMS evoked MEPs.

Development and Validation of Analytical Method for Simultaneous Estimation of Active Constituents in a Polyherbal Ointment by Gas Chromatography.

Background: The simultaneous, quantitative determination of all active ingredients present in the analgesic formulation (Dazzle ointment) requires an ideal and novel method by which these phytoconstituents can be separated with the highest resolution without any interference from one another. Objective: The present work was conducted to develop and validate a quantitative method for the simultaneous estimation of all five phytoconstituents present in a polyherbal analgesic ointment by GC. Methods: α-Pinene, 1,8-cineole, camphor, menthol, and methyl salicylate present in the ingredients of the ointment were analyzed and quantified by GC using a crosslinked 5% phenyl polydimethylsiloxane capillary column, nitrogen as a carrier gas, and a flame-ionization detector. Aniline was used as the internal standard. Method validation was also performed in order to demonstrate its selectivity, linearity, accuracy, precision, LOD, LOQ, and robustness. Results: The calibration curves of all five marker compounds showed good linear correlation coefficients (r² >0.998) within the tested ranges. The precision of the method was tested by carrying out intra- and interday analyses of the same sample. RSD values were observed to be <1.00%. The accuracy of the method, determined by performing recovery studies, was found to be between 99.25 and 101.39%. The developed method was also demonstrated to be robust (RSD <1.29%) by making small but deliberate variations in method parameters. Conclusions: The developed GC method is simple, precise, and accurate, it and can be used for the rapid quality control testing of the polyherbal formulation. Highlights: The developed GC method will assist in the standardization of polyherbal analgesic formulation consists of α-pinene, 1,8-cineole, camphor, menthol, and methyl salicylate as active constituents.

A comparative clinical study of Yashtimadhu Ghrita and lignocaine-nifedipine ointment in the management of Parikartika (acute fissure-in-ano).

BACKGROUND: Parikartika is a common painful condition among anorectal diseases which resembles with fissure-in-ano. In the present era, due to changing lifestyle such as sedentary work pattern, increased stress, improper dietary and sleep habits, various lifestyle disorders are increasing continuously. AIM AND OBJECTIVE: The aim is to assess the effect of Yashtimadhu Ghrita in comparison with lignocaine-nifedipine ointment in the management of Parikartika (Acute fissure-in-ano). MATERIALS AND METHODS: A total of 36 patients of acute fissure-in-ano were selected and randomly allocated into two groups (18 in each group). In Group A (n = 18), local application of Yashtimadhu Ghrita in fissure bed (Parikartika) twice a day after sitz bath for 4 weeks was given. In Group B (n = 18), local application of lignocaine-nifedipine ointment in fissure bed (Parikartika) twice a day after sitz bath for 4 weeks was given. RESULTS: Patients of Group A (Yashtimadhu Ghrita) taken more time than the patients of Group B (lignocaine-nifedipine ointment) to get relief from pain in ano. Ulcer in ano healed earlier in patients of Group A (Yashtimadhu Ghrita) in comparison with patients treated with lignocaine-nifedipine ointment application. Patients of both groups have taken similar time to get relieved from bleeding PR. Complete remission of symptoms of Parikartika was more in patients treated with Yashtimadhu Ghrita than lignocaine-nifedipine ointment. CONCLUSION: Both the interventions Yashtimadhu Ghrita and lignocaine-nifedipine ointment are equally effective in symptomatic relief in Parikartika (acute fissure-in-ano).