Nevin Manimala

Int Psychogeriatr. 2025 Oct 31:100159. doi: 10.1016/j.inpsyc.2025.100159. Online ahead of print.

ABSTRACT

BACKGROUND: Electroconvulsive therapy (ECT) is one of the most effective options for severe psychiatric disorders. However, it is often underutilized due to stigma and fear of cognitive side effects. This is the first systematic review and meta-analysis synthesizing the currently available evidence regarding ECT exposure and dementia risk.

METHODS: We included observational studies assessing the risk of developing dementia after ECT exposure or its incidence among ECT-treated patients to July 2025. Adjusted hazard ratios (HR) were pooled using a random-effects model.

RESULTS: Six observational cohort studies encompassing 286,995 patients, predominantly with affective disorders, were included. 9124 of the patients were exposed to ECT while 277,871 patients were not treated with ECT. Follow-up durations ranged from a median of 4.9-16.9 years, and the weighted mean baseline age was ∼51 years. Meta-analysis revealed no statistically significant association between ECT exposure and the overall risk of dementia (HR = 0.98, 95 %CI [0.79, 1.21], P = 0.83, I² = 67.1 %, very low certainty). Sensitivity analysis showed a marginally lower risk after excluding one study (HR = 0.87, P = 0.045). In older adults (>50 years; 112,842 patients), ECT was associated with a significantly lower risk of dementia (HR = 0.78, 95 %CI [0.69, 0.88], P < 0.001, I²= 0 %, moderate certainty).

CONCLUSION: The study provides preliminary insights on the long-term cognitive safety of ECT. ECT was not associated with increased risk of dementia in patients with affective disorders and was associated with lower risk among older adults. More studies are needed to confirm our results, particularly with proper adjustment for potential confounders.

PMID:41176476 | DOI:10.1016/j.inpsyc.2025.100159

J Voice. 2025 Oct 31:S0892-1997(25)00420-5. doi: 10.1016/j.jvoice.2025.10.004. Online ahead of print.

ABSTRACT

OBJECTIVES: Gender-affirming voice training (GAVT) can reduce voice dysphoria for some transgender/ gender-diverse individuals, but access is often limited by factors such as high cost and a shortage of well-trained providers. Interactive software could increase the accessibility of GAVT, but existing applications are limited in functionality, particularly in the area of resonance. This paper reports the design and usability testing of a web-based software module that provides visual-acoustic biofeedback for vocal tract resonance. This preliminary study focuses on the use of the software for voice feminization.

MATERIALS AND METHODS: The resonance module, part of a larger project to develop free GAVT software called TruVox, represents resonant frequencies of the vocal tract as peaks in a real-time linear predictive coding spectrum. It features built-in resonance targets for English vowel sounds, a routine for practicing resonance modification in utterances of increasing length, and video tutorials explaining how to use the website. This paper reports the results of both online and in-lab usability testing of the software. After an unstructured (online) or structured (in-person) interaction with the software, participants completed the system usability scale (SUS) and provided qualitative feedback. Participants in the in-lab study additionally completed the intrinsic motivation inventory and produced vowel targets in one-syllable words for acoustic measurement at the start and end of the session.

RESULTS: Participants who completed in-lab testing rated the software with an average SUS score of 75.25, indicating acceptable-to-good usability. In their qualitative feedback, users reported that the visual-acoustic biofeedback helped them understand and control their vocal resonance; they also identified a number of areas where usability could be improved. While little acoustic change was expected in light of the short duration of the session, 8/10 participants showed a trend in the expected direction for the vowel that was practiced most extensively.

CONCLUSION: The results of this usability testing suggest that our web-based biofeedback tool has the potential to enhance resonance training in the GAVT context. Future goals to improve the app include refining our automated resonance tracking algorithm for more interpretable feedback, allowing users to set individualized resonance targets based on their own voice at baseline, and adding targets for nonbinary and transmasculine users. Clinical trials to measure acoustic changes after an extended period of interaction with the software are also planned.

PMID:41176464 | DOI:10.1016/j.jvoice.2025.10.004

Midwifery. 2025 Oct 14:104634. doi: 10.1016/j.midw.2025.104634. Online ahead of print.

ABSTRACT

PROBLEM: Despite progress in maternal and newborn health, China still lacks a validated and multidimensional tool to monitor care quality and guide improvements.

BACKGROUND: The Quality Maternal and Newborn Care Framework index (QMNCFi) is a novel but comprehensive and globally developed tool for assessing maternity care quality from the service user’s perspective, offering huge potential for assessing care quality in China.

AIM: This study aimed to validate the Chinese version of the QMNCFi and report initial findings from economically diverse settings.

METHODS: An online survey was conducted in five hospitals in five provinces in China among women between 6 weeks to 1 year postpartum. Construct validity was assessed using confirmatory factor analysis. Reliability was evaluated through internal consistency and test-retest reliability. Inferential statistics were used to analyze score differences across sub-groups.

FINDINGS: 547 mothers completed the survey. Confirmatory factor analysis indicated that the construct of the Chinese version aligned with the original version. The Cronbach’s α for the survey’s 13 sections ranged from 0.629 to 0.975, and the Intraclass Correlation Coefficient of test-retest ranged from 0.620 to 0.926. There is a modest correlation between regional economic level and QMNCFi scores at all time periods (p < 0.05). Pregnancy sub-index scores were slightly higher among women in rural areas compared to urban areas (p < 0.05).

CONCLUSION: The Chinese version of the QMNCFi is feasible to obtain service user perceptions of the quality of care at scale in China.

PMID:41176456 | DOI:10.1016/j.midw.2025.104634

J Prosthet Dent. 2025 Oct 31:S0022-3913(25)00841-8. doi: 10.1016/j.prosdent.2025.10.035. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: To ensure long-term stability and performance, removable partial dentures (RPDs) must be fitted precisely. Although 3-dimensional (3D) printing has been widely used, studies comparing various methods of manufacturing and designs for mandibular removable partial denture (RPD) frameworks are lacking.

PURPOSE: The aim of this in vitro study was to compare the trueness of RPD metal frameworks with 2 different major connector design types (lingual bar and lingual plate) fabricated with direct and indirect metal 3D printing with those fabricated with the conventional lost wax technique.

MATERIAL AND METHODS: A Type IV stone cast of a Kennedy classification II modification 1 partially edentulous mandibular arch was prepared as the reference cast. A total of 30 definitive casts were fabricated from the reference cast and scanned into standard tessellation language (STL) files. Ten of these casts were used to fabricate cobalt chromium (Co-Cr) frameworks with the conventional lost wax technique (CLW group), 10 were used to fabricate frameworks by printing into a castable resin pattern followed by conventional casting (RPC group), and 10 were used to print metal frameworks directly using a selective laser melting printer (DSLM group). For each fabrication method, the group was divided into 2 design types: 5 casts for lingual plate frameworks and 5 for lingual bar frameworks (n=5). All metal frameworks were scanned and superimposed with the definitive casts with the Geomagic Control X software program. Gap discrepancies were measured as mean ±standard deviation (trueness), and the data were statistically analyzed with the 2-way ANOVA test (α=.05) to determine the interaction of the fabrication methods and design types on trueness. The Tukey HSD test was used to compare mean trueness among groups (α=.05).

RESULTS: The CLW group demonstrated the highest overall gap discrepancies in the lingual plate frameworks, measuring 0.207 ±0.035 mm, whereas the DSLM group recorded the lowest value at 0.141 ±0.022 mm. No statistically significant difference was found between the DSLM and RPC groups (P>.05). The DSLM group exhibited the lowest mean gap for the lingual bar frameworks, 0.091 ±0.016 mm, with no significant difference between the RPC and CLW groups (P>.05). The 2-way ANOVA indicated that trueness was significantly affected by fabrication methods and design types. The color mapping of the lingual plate and bar in the DSLM frameworks shows minimal deviations relative to other groups.

CONCLUSIONS: The direct and indirect 3D printing of lingual plate RPD frameworks demonstrated better trueness compared with conventional casting methods. Direct 3D metal printing showed better fit and lower discrepancy for lingual bar designs. Both conventional and 3D printing methods demonstrated clinically acceptable adaptation.

PMID:41176439 | DOI:10.1016/j.prosdent.2025.10.035

J Environ Manage. 2025 May 3:125549. doi: 10.1016/j.jenvman.2025.125549. Online ahead of print.

ABSTRACT

In the new era of high-quality economic development, the digital economy presents new opportunities for China to achieve low-carbon transformation and enhance environmental protection. This paper analyzes daily data from January 3, 2019, to March 25, 2025, employing the variational mode decomposition (VMD) algorithm to separate China’s digital economy, environmental protection, and carbon neutrality markets into long-term, short-term, and disturbance-term components. Furthermore, this study utilizes a model-free connectedness approach to investigate spillover effects and portfolio strategies among these three markets. The results reveal strong spillovers between the digital economy, environmental protection, and carbon neutrality markets, with the long-term spillover from carbon neutrality to the digital economy being the most pronounced. The spillover network indicates that carbon neutrality is the source, environmental protection is the recipient, and the digital economy is the intermediary. These spillovers are time-varying; short-term and disturbance-term effects significantly intensified with the emergence of ChatGPT and generative AI technologies. Additionally, the portfolio strategies demonstrate that the digital economy offers lower hedging costs and high efficiency in addressing short-term and disturbance-term effects. Conversely, carbon neutrality proves to be a more effective long-term hedging tool. Moreover, this study suggests that long-term strategies are a better benchmark during rising returns. In contrast, a disturbance-term hedging strategy is recommended for managing non-systemic risks during declining portfolio return phases. The findings provide practical guidance for asset allocation and risk management in the digital, environmental, and carbon sectors.

PMID:41176431 | DOI:10.1016/j.jenvman.2025.125549

J Rheumatol. 2025 Nov 1:jrheum.2025-0475. doi: 10.3899/jrheum.2025-0475. Online ahead of print.

ABSTRACT

OBJECTIVE: We aimed to investigate the prevalence and incidence of atlantoaxial subluxation (AAS) in psoriatic arthritis (PsA), identify associated risk factors, and describe the clinical and radiographic characteristics of affected patients.

METHODS: We included individuals from our observational cohort of PsA, excluding those with a history of trauma or cervical spine surgery. We calculated prevalence and incidence of AAS, and we used descriptive statistics to summarize and compare baseline demographic and disease-related characteristics between patients with and without AAS. Additionally, we used Cox regression with time-varying covariates to identify factors linked to AAS development and performed multivariable GEE analysis to assess associations with AAS.

RESULTS: Among 1,535 PsA patients, 34 (2.21%) were identified with AAS, including 20 at baseline and 14 during follow-up, with an incidence of 1.16 per 1000 person-years. Patients with AAS had higher rates of radiographic sacroiliitis (71.0%) and greater peripheral joint damage. Elevated ESR was observed in 86.7% of cases. Cox regression identified radiographic sacroiliitis (HR 6.61, 95% CI 1.64-26.67) as the strongest predictor of AAS, while male sex was associated with a lower hazard (HR 0.42, 95% CI 0.07-0.89). In GEE analysis, radiographic sacroiliitis (OR 3.64, 95% CI 1.6-8.24) and higher modified Steinbrocker scores were associated with AAS, whereas older age (OR 0.95, 95% CI 0.93-0.98) and male sex (OR 0.40, 95% CI 0.17-0.92) were associated with lower ORs.

CONCLUSION: AAS is an uncommon complication in PsA strongly associated with radiographic sacroiliitis and radiographic damage in peripheral joints.

PMID:41176349 | DOI:10.3899/jrheum.2025-0475

Vector Borne Zoonotic Dis. 2025 Oct 30. doi: 10.1177/15303667251392007. Online ahead of print.

ABSTRACT

Background: Brucellosis is a zoonotic bacterial disease that can affect humans and animals. It is often transmitted to humans through the consumption of contaminated animal products or by direct contact with infected animals. In Kenya, data on human and animal brucellosis are limited. Methods: To investigate the seroprevalence and molecular prevalence of human brucellosis in Kenya, we randomly selected from the healthy participants with possible exposure to animals and animal products and randomly selected 348 out of 2,779 human blood samples, that were obtained from a larger longitudinal cohort study that investigated of dengue, chikungunya and Rift Valley Disease exposure in western (Kisumu) and coastal (Ukunda) Kenya. Results: Our study included 126 males (36%), 222 females (64%) in different age categories, and 61 children aged 16 years and younger (18%), with an overall median age of 29.5 years (2- to 75-year age range). Samples were tested by Abnova Brucella IgG enzyme-linked immunosorbent assay (ELISA) Kit (KA0954). Of the tested individuals, anti-Brucella IgG antibodies were detected in 96 (28%) of 348 randomly selected participants. All samples yielded negative results in quantitative polymerase chain reaction (qPCR) analysis. There was no statistically significant correlation between Brucella exposure and study site, gender, age, socioeconomic status, ownership of particular livestock (sheep, goats, and cattle), or consumption of raw animal products. However, highly educated individuals were more likely to have Brucella exposure (odds ratio = 2.02, 1.20-3.41, p = 0.01). Conclusion: In comparison to previous seroprevalence-based studies conducted in nonpastoral Kenyan communities, our study revealed relatively higher seropositivity. This article emphasizes the importance of conducting surveillance for brucellosis in urban areas. Urban brucellosis surveillance within the framework of One Health could serve as a baseline to guide future research on brucellosis in humans.

PMID:41176335 | DOI:10.1177/15303667251392007

J Immunother Cancer. 2025 Oct 31;13(10):e012432. doi: 10.1136/jitc-2025-012432.

ABSTRACT

PURPOSE: A recently published phase 2 neoadjuvant trial in patients with early-stage non-small cell lung cancer (NSCLC) (NCT02818920) evaluated the potential efficacy of pembrolizumab administration in the absence of chemotherapy. This communication reports on conventional and distribution-based immune profiling efforts in efforts to identify novel biomarkers predictive of benefit.

METHODS: Patients with stage 1B-3A NSCLC received two cycles of pembrolizumab (P), followed by surgical resection of the remaining tumors (NCT02818920). Banked peripheral blood mononuclear cells (PBMCs) were analyzed at baseline and following the second dose of P. Resected tumors were disaggregated, and cells were viably cryopreserved. Based on pathologic examination of the tumors, patients were categorized as major pathologic responders (MPR; ≤10% viable tumor present), or non-MPR (>10% viable tumor present). High-parameter immune phenotyping by flow cytometry was performed on all available tumor and PBMC specimens, and results were expressed using both conventional phenotypic frequency analyses as well as a novel distribution-based biomarker identification strategy aimed at discovery of patterns associated with MPR.

RESULTS: Conventional, frequency-based flow cytometric immune phenotyping of participant tumor microenvironments and PBMC revealed several MPR-associated trends, only a few of which reached statistical significance. The distribution-based biomarker identification strategy greatly enhanced the discovery of statistically significant cell types and patterns of change associated with MPR.

CONCLUSIONS: This novel, distribution-based analytic framework identified MPR-associated immune cell subsets in baseline PBMC that were not evident using conventional frequency-based immune profiling. Profiling the microenvironment of MPR-associated tumors revealed statistically significant distributional differences among highly expressed cellular markers on CD8⁺ cells.

PMID:41176317 | DOI:10.1136/jitc-2025-012432

Int J Psychophysiol. 2025 Oct 30:113283. doi: 10.1016/j.ijpsycho.2025.113283. Online ahead of print.

ABSTRACT

Proactive control is defined as the capacity of an individual to selectively allocate attentional resources to task-relevant cues during the preparatory phase of a task, actively encode and sustain this information within working memory, and subsequently establish appropriate response readiness. Research demonstrates that proactive control has neuroplasticity. The dorsolateral prefrontal cortex (DLPFC) is critically implicated in the modulation of proactive control. Theta oscillations, functioning as a neural gating mechanism, facilitate the preferential allocation of attentional resources toward the processing of memory-relevant information, thereby enhancing the maintenance of such information and playing a pivotal role in memory encoding and cognitive resource distribution. The present study employed theta-frequency transcranial alternating current stimulation (tACS) targeting the DLPFC to further elucidate the neuroplasticity of proactive control. Concurrently, to investigate the relationship between fluid intelligence and proactive control, participants’ fluid intelligence was assessed pre- and post-stimulation. A cohort of 58 participants was randomly assigned to receive either left DLPFC stimulation (n = 29) or right DLPFC stimulation (n = 29). The results revealed that stimulation of the left DLPFC significantly enhanced participants’ proactive control capabilities. In ERP indicators, the CNV, following active stimulation, the CNV in the BX condition was significantly greater than that in the pre and sham stimulation (p ≤ 0.006). In behavioral outcomes, the accuracy rate for the BX condition was significantly higher after active stimulation compared to that in pre-stimulation and sham stimulation (p ≤ 0.017). In the lDLPFC group, fluid intelligence performance was significantly enhanced, and fluid intelligence scores after active stimulation were significantly higher compared to those during pre and sham stimulation (p ≤ 0.032). A statistically significant correlation was observed between participants’ proactive control capabilities and fluid intelligence. In the rDLPFC group, no significant changes in any of the indicators were observed. These findings underscore the efficacy of neuromodulatory interventions targeting the left DLPFC in augmenting proactive control and suggest a dynamic interplay between proactive control and fluid intelligence.

PMID:41176257 | DOI:10.1016/j.ijpsycho.2025.113283

J Pediatr Surg. 2025 Oct 30:162758. doi: 10.1016/j.jpedsurg.2025.162758. Online ahead of print.

ABSTRACT

BACKGROUND: Post-obstructive diuresis (POD) is a potentially serious complication following surgical correction of ureteropelvic junction obstruction (UPJO) in pediatric patients. Characterized by excessive urine output after decompression of a chronically obstructed renal system, POD may result in significant fluid and electrolyte imbalance. While physiologic POD is transient, pathologic forms require careful management. This study aimed to determine clinical and demographic risk factors associated with POD following UPJO surgery in a pediatric population.

METHODS: We conducted a retrospective cross-sectional study of pediatric patients undergoing UPJO correction at two tertiary centers in Mashhad, Iran, from July 1, 2020, to July 1, 2021. Data were extracted from hospital records, including age, sex, hydronephrosis grade, presence of renal tubular acidosis (RTA), serum creatinine, and anemia status. POD was defined as urine output >4 mL/kg/h for three consecutive hours postoperatively. Statistical analyses included Chi-square tests and independent t-tests; p < 0.05 was considered significant.

RESULTS: A total of 360 patients were included (65% male; mean age: 62.2 ± 18.3 months). POD occurred in 22 patients (6.1%). Patients with POD were significantly younger (mean age: 50.3 ± 10.7 months vs. 63.2 ± 18.6 months; p < 0.001) and more frequently presented with Grade 4 hydronephrosis (81.8% vs. 45.6%; p = 0.001). No significant associations were found between POD and sex (p = 0.435), RTA (p = 0.683), serum creatinine levels (p = 0.509), or anemia (p = 0.347).

CONCLUSION: Younger age and severe hydronephrosis were significantly associated with increased risk of POD after surgical correction of UPJO. These findings underscore the importance of close postoperative monitoring in high-risk pediatric populations. Prospective studies with standardized POD criteria are needed to validate these predictors and optimize perioperative care.

PMID:41176216 | DOI:10.1016/j.jpedsurg.2025.162758