Research

PURPOSE OF REVIEW: Exercise is a recommended non-pharmacological approach to treat multiple sclerosis (MS) symptoms. Mind-body movement interventions (MBMIs) offer a multi-component exercise option that integrates movement, breathwork, and mindfulness. Using an umbrella review, we assessed the current best evidence on MBMIs (ai chi, dance, Pilates, qigong, tai chi, and yoga) for managing MS symptoms.

RECENT FINDINGS: MBMIs significantly improved balance, equal to or superior to active controls (AC) or usual care (UC). Ai chi/tai chi/qigong significantly improved depression. Analyzed with other mind-body therapies, yoga reduced pain compared to AC/UC. Mixed results were found for fatigue. Physical function and quality of life were comparable to AC/UC. The certainty of evidence was low to very low for most MBMIs. Most reviews were "critically low" quality. MBMIs are commonly included in MS exercise reviews and may improve balance, pain, and depression. However, larger trials with active comparators and comprehensive reporting are needed to improve quality and certainty.

BACKGROUND: Delirium is a common complication of hospitalization with poor outcomes, but its underlying pathophysiology is poorly understood. We investigated the association of preoperative glial fibrillary acidic protein (GFAP), a biomarker of reactive astrocytosis, with delirium incidence and severity.

METHODS: Data were obtained from the ongoing prospective Successful Aging after Elective Surgery (SAGES) study. GFAP was measured in preoperative plasma (n = 529). Post-operative delirium incidence and severity were measured using the Confusion Assessment Method (CAM) and CAM-S (0-19, 19 worst), respectively. A multivariable generalized linear model (GLM) with log link and binary or Poisson error distribution was used to estimate the relative risk of delirium by GFAP quartile scale, and GLM with identity link was used to examine the association of preoperative GFAP and delirium severity.

RESULTS: Overall mean preoperative GFAP value was 289.6 ± 153.3 pg/ml; mean value by quartile (Q) was 148.1 ± 28.6 pg/ml for Q1, 220.5 ± 19.8 pg/ml for Q2, 298.2 ± 28.4 pg/ml for Q3, and 503.4 ± 128.3 pg/ml for Q4. Delirium incidence by GFAP level was 16% in Q1, 24% in Q2, 25% in Q3, and 28% in Q4 (Cochran Trend test P-value = 0.031; adjusted P-value = 0.205). Higher GFAP levels (4th vs. 1st quartile) were associated with greater risk of incident delirium (adjusted relative risk 1.70, 95% confidence interval (CI): 1.01-2.86) and greater delirium severity (adjusted mean difference 0.86, 95% CI: 0.004-1.71).

CONCLUSIONS: High preoperative plasma GFAP was associated with increased delirium incidence and severity, suggesting GFAP may serve as a risk marker for delirium. Brain vulnerability in the setting of astrocytosis may contribute to delirium pathophysiology.

BACKGROUND: Hypertension affects nearly half of U.S. adults. The 2025 American College of Cardiology/American Heart Association guideline adopts the Predicting Risk of Cardiovascular Disease Events (PREVENT) risk equations and updates treatment recommendations for stage 1 hypertension, potentially altering eligibility for antihypertensive therapy.

OBJECTIVES: The primary objective was to quantify changes in antihypertensive treatment eligibility under the 2025 vs 2017 guidelines. Secondary objectives were to characterize adults newly meeting treatment thresholds, assess concordance and discordance in eligibility, and evaluate robustness across PREVENT model variants.

METHODS: We conducted a simulation-based analysis using nationally representative National Health and Nutrition Examination Survey data (2017-2020) among adults aged 30 to 79 years. Treatment eligibility was assigned using 2017 and 2025 guideline criteria. Survey-weighted estimates quantified population-level eligibility, newly eligible adults, and concordance patterns. Analyses were repeated using PREVENT Base, Full, hemoglobin A1c, and albumin-to-creatinine ratio variants, and multivariable models identified predictors of eligibility.

RESULTS: Among 5,578 adults (weighted population 160 million), 36.4% were eligible for treatment under the 2017 guideline and 36.6% under the 2025 guideline, representing a minimal net increase of 0.7% (approximately 400,000 adults). Most adults were consistently ineligible (63.3%), whereas one-third were consistently eligible (36.3%). Newly eligible adults were predominantly older women with higher body mass index and borderline glycemic measures but without established cardiovascular disease. Eligibility patterns were stable across racial and ethnic groups. Analyses were repeated across all PREVENT risk equation variants, and multivariable models identified predictors of eligibility.

CONCLUSIONS: Adoption of the 2025 American College of Cardiology/American Heart Association guideline results in a minimal expansion of antihypertensive treatment eligibility. Results were robust across PREVENT model variants, supporting risk-based guideline implementation.

Sankey diagram of agreement between dischareg summary, discharge instructions, and patient provided reasoning for chronic medication changes made during hospitalization.