Nevin Manimala

Neurorehabil Neural Repair. 2025 Jun 17:15459683251345444. doi: 10.1177/15459683251345444. Online ahead of print.

ABSTRACT

BACKGROUND: Vestibular dysfunction occurs in 30% to 70% of cases with multiple sclerosis (MS).

OBJECTIVE: To compare the clinical and cost-effectiveness of a customized vestibular rehabilitation (VR) program with a generic booklet-based VR intervention in people with MS with clinical signs of vestibulopathy.

METHODS: People with MS and symptoms of vertigo and/or imbalance were screened for vestibulopathy (n = 73). Seventy recruited participants were randomly allocated to a 12-week generic booklet-based home program with telephone support (n = 35) or a 12-week customized VR program (n = 35, 12 face-to-face sessions and a home exercise program). The primary clinical outcome was the Dizziness Handicap Inventory (DHI) at 26 weeks post-randomization. The primary economic endpoint was quality-adjusted life-years (QALYs). Secondary outcomes included vertigo severity, balance, gait, and perceived impact of physical symptoms in MS.

RESULTS: There was no significant between-group difference in the DHI: mean reduction -1.76 (95% confidence interval -10.02, 6.50) at week 26 in favor of the customized group (P = .670). There were significant differences in favor of the customized group for vertigo symptom score, balance confidence, walking, and perceived impact of MS. Primary cost-effectiveness analysis showed customized VR to be less costly and more effective. However, removal of 2 cost outliers in sensitivity analysis resulted in a mean cost-per-QALY of £30 147. Customized VR was also cost-effective from a societal perspective.

DISCUSSION: Impairment level improvements did not translate into functional improvements as measured by the DHI perhaps reflecting that vestibular dysfunction is one of several impairments in MS. The findings indicate the potential cost-effectiveness of the customized program.

CLINICAL TRIAL REGISTRATION: ISRCTN27374299.

PMID:40528281 | DOI:10.1177/15459683251345444

Alzheimers Dement. 2025 Jun;21(6):e70361. doi: 10.1002/alz.70361.

ABSTRACT

INTRODUCTION: Clinical characterization of behavioral variant frontotemporal dementia (bvFTD) and Alzheimer’s disease (AD) is challenging due to overlapping neuropsychiatric symptoms and cognitive profiles between the two conditions.

METHODS: We used clinical network analysis to characterize and compare clinical profiles in AD and bvFTD using initial visit data from the National Alzheimer’s Coordinating Center.

RESULTS: The final matched sample included 890 patients per group (AD: mean age = 63.02, standard deviation [SD] = 9.34, 36.4% female; bvFTD: mean age = 62.87, SD = 9.46, 36.52% female). Both networks were densely connected, reflecting comorbidity between neuropsychiatric symptoms and cognitive scores. Memory performance, hallucinations, and motor disturbance were bridge symptoms in the AD network, whereas elation was the sole bridge symptom in the bvFTD network.

DISCUSSION: Distinct networks highlight unique clinical profiles in AD and bvFTD. Treatment of bridge symptoms may relieve overall symptom burden. Findings can advance clinical characterization of AD and bvFTD, leading to development of targeted interventions.

HIGHLIGHTS: We compared clinical features of Alzheimer’s disease (AD) and behavioral variant frontotemporal dementia (bvFTD). Clinical networks showed comorbidity between neuropsychiatric symptoms and cognitive manifestations. Clinical networks significantly differed between AD and bvFTD, highlighting unique behavioral and cognitive profiles. Distinct symptoms were important for overall symptom comorbidity. Findings can be used to characterize AD and bvFTD and inform targeted treatment.

PMID:40528277 | DOI:10.1002/alz.70361

Antimicrob Resist Infect Control. 2025 Jun 17;14(1):69. doi: 10.1186/s13756-025-01593-8.

ABSTRACT

BACKGROUND: Unstandardised reprocessing procedures for flexible endoscopes can lead to infection outbreaks and threaten the lives of ICU patients. Despite recent updates to technical specification, there was a paucity of studies on the current status of flexible endoscopic reprocessing, particularly concerning flexible bronchoscopes (FB). This study aimed to assess the current practices of reprocessing FBs in ICUs in Hubei Province, China.

METHODS: A cross-sectional study was conducted utilizing convenience sampling from October 11, 2024, to December 6, 2024, in the ICUs of 216 hospitals in Hubei Province, China. A self-developed questionnaire was distributed through an online survey platform to either the person in charge of the ICU or the frontline technicians. The information regarding the reprocessing of FBs was collected, including general characteristics, personnel and training, layout and facilities, reprocessing operations, and reprocessing quality monitoring.

RESULTS: The content validity index of the questionnaire was 0.94. There were 202 valid questionnaires collected with a validity rate of 93.52%, including 158 ICUs in tertiary hospitals and 44 in secondary and primary hospitals. The ICUs of tertiary hospitals were better than the ICUs of secondary and primary hospitals in terms of the number of FBs available, the number of dedicated technicians, the opportunity for training, the availability of some equipment and facilities (ultrasonic cleaners, whole tube irrigators, etc.), and some reprocessing operations (FB sterilisation method and storage cabinet sterilisation frequency) (P < 0.05).

CONCLUSIONS: There were variations in FB reprocessing practices across ICUs in hospitals of all levels in Hubei, along with some common issues. Most ICUs were standardised in personnel training, operation, and recording, and ICUs in tertiary hospitals behaved better than in secondary and primary hospitals. However, there remained a need for improvement in the layout of the reprocessing environment, equipment configuration, and quality monitoring. Future research could apply implementation science to identify barriers and propose strategies to align practice with guidelines.

PMID:40528274 | DOI:10.1186/s13756-025-01593-8

Cancer. 2025 Jun 15;131(12):e35886. doi: 10.1002/cncr.35886.

NO ABSTRACT

PMID:40528271 | DOI:10.1002/cncr.35886

J Health Popul Nutr. 2025 Jun 17;44(1):203. doi: 10.1186/s41043-025-00958-4.

ABSTRACT

BACKGROUND: Considering the associations of insulin resistance and glycemic control with immunity, the present study sought to evaluate the association between dietary glycemic index (GI) and glycemic load (GL), as the main dietary determinants of these conditions, with the risk of COVID-19 infection in the participants of Shiraz University of Medical Sciences employees’ health cohort.

METHODS: In this prospective study, data from 3319 cohort study participants were analyzed. Demographic, anthropometric and dietary intake data were collected at the time of recruitment. Dietary GI and GL were calculated based on the data from the food frequency questionnaire. In the follow-ups, data on COVID-19 infection were recorded. To investigate the associations between dietary GI and GL with COVID-19, Cox regression statistics were used. Analysis of variance was used to compare the rate of COVID-19 infection in the tertiles of GI and GL.

RESULTS: The mean age of the participants was 40.92 ± 6.99 years. Of these, 210 cases with COVID-19 were recorded. The hazard ratios of COVID-19 infection in the second and third tertile of the GI were 3.44 (95% CI = 2.13-5.55) and 6.45 (95% CI = 4.11-10.12) times greater than in the first tertile, respectively. Also, this risk ratio in the second and third tertile of the GL was 8.78 (95% CI = 4.62-16.69) and 54.04 (95% CI = 27.18-107.46) times more than in the first tertile.

CONCLUSIONS: The present study showed a higher risk of COVID-19 infection in higher tertiles of dietary GI and GL.

PMID:40528260 | DOI:10.1186/s41043-025-00958-4

J Eat Disord. 2025 Jun 17;13(1):115. doi: 10.1186/s40337-025-01319-6.

ABSTRACT

BACKGROUND: This study investigated the shared and distinct features of emotional dysregulation and impulsivity in women with bulimia nervosa (BN) and bipolar disorder (BD) as well as their relationship with comorbidity between the two conditions.

METHOD: This study included data from 115 women with BN and 76 women with BD, including 37 individuals with comorbid BN-BD, from a psychiatric outpatient clinic as well as 72 healthy female controls. All participants underwent a diagnostic interview and completed several self-administered assessments of mood and impulsivity. Statistical analyses were conducted to compare mood and impulsivity across the BN-only, BD-only, BN-BD comorbid, and control groups.

RESULTS: The disorder groups exhibited significantly higher levels of affective lability, attentional impulsivity, sensitivity to punishment, negative urgency, and both internally and externally directed impulsive behaviors compared with the control group. Comorbidity with BN-BD was further associated with increased severity in anger, attentional impulsivity, reward sensitivity (fun seeking), and externally directed impulsive behaviors relative to the BN-only group. Among these shared psychopathological features, negative urgency was significantly higher in the BN-only and BN-BD comorbid groups than in the BD-only group, indicating its unique relevance to binge eating. Attentional impulsivity was the only parameter that demonstrated significantly greater severity in the comorbidity group than in both the BN-only and BD-only groups. This finding implies that attentional impulsivity is associated with an elevated risk of externally directed impulsive behaviors in the BN-BD comorbid group relative to the BN-only group.

CONCLUSIONS: BN and BD share overlapping affect dysregulation and impulsivity profiles. Negative urgency and attentional impulsivity may make major contributions to binge eating and external impulsive behaviors, respectively, in individuals with comorbid BN-BD. Our findings highlight the importance of targeting emotion regulation skills as well as behavioral control of binge eating and associated impulsive behaviors when treating individuals with BN and BD comorbidity.

PMID:40528255 | DOI:10.1186/s40337-025-01319-6

Trials. 2025 Jun 18;26(1):211. doi: 10.1186/s13063-025-08931-6.

ABSTRACT

BACKGROUND: Participant Information Leaflets (PILs) are lengthy and increasingly complex, and could deter research participation. A shortened PIL may be more appealing as it is likely to provide a more a manageable volume of information. Previous research has found that shortened PILs are no less effective for recruitment outcomes, and we deemed it useful to replicate this in an online setting. We also decided to compare retention rates, given the potential for more information to increase participants’ motivation.

AIM: To evaluate the efficacy of a shortened vs standard-length PIL on trial recruitment and retention rates.

METHODS: This two-arm study within a trial (SWAT) was embedded in a host randomised controlled trial (RCT)-IBD-BOOST. Potential participants were randomised to receive a standard-length or shortened PIL electronically for recruitment to the host RCT. An ethics committee approved potential participants being blinded to this randomisation.

PRIMARY OUTCOME: The percentage of SWAT participants receiving the shortened vs standard PIL who were recruited to the RCT.

RESULTS: Four thousand two hundred one participants were randomised to the standard-length (n = 2099) and shortened (n = 2102) PIL arms. Thirty-four email queries were received about the PILs-18 from those who received the standard and 16 from those receiving the shortened. Seven hundred eight SWAT participants were recruited to the RCT-333 (15.86%) who received the standard-length PIL and 375 (17.84%) who received the shortened (OR = 1.15, (95%CI = 0.98, 1.35), p = 0.09). Retention rates in the RCT were not statistically different between groups.

CONCLUSION: We did not find evidence of a significant difference between RCT recruitment and retention rates in participants randomised to the standard-length PIL compared with the shortened. It may be that a shortened PIL has the same effect on recruitment and retention outcomes, providing that the trial does not require extensive information for other reasons (e.g. safety). Therefore, it could be argued that researchers have a choice about how long to make PILs, perhaps with a link to more detail. Alternatively, given that there was no benefit of the shortened PIL, it may be worth comparing written PILs with other methods of conveying information to determine optimal means of encouraging participation and retention in decentralised trials.

HOST TRIAL REGISTRATION: A randomised controlled trial of supported, online, self-management for symptoms of fatigue, pain and urgency/incontinence in people with inflammatory bowel disease: the IBD-BOOST trial (ISRCTN71618461 on ISRCTN registry).

PMID:40528252 | DOI:10.1186/s13063-025-08931-6

J Exp Clin Cancer Res. 2025 Jun 18;44(1):176. doi: 10.1186/s13046-025-03435-2.

ABSTRACT

Diffuse-type gastric cancer (DGC) accounts for approximately one-third of gastric cancer cases, but it is clinically more aggressive and associated with poorer survival prognosis compared to intestinal-type gastric cancer (IGC). Our study revealed significantly reduced ESRP1 expression in DGC patients relative to IGC counterparts, with its high expression positively correlating with DGC patient prognosis. Both in vitro and in vivo experimental models demonstrated that ESRP1 has the ability to hinder the malignant progression of DGC. Mechanistically, ESRP1 interacts with DHCR7, a ferroptosis-promoting regulator, thereby upregulating DHCR7 expression and enhancing ferroptosis susceptibility in DGC cells. In DGC patients with high ESRP1 expression, ferroptosis-inducing therapy emerges as a promising treatment alternative. Moreover, for ESRP1-low DGC cases, we identified several potent small-molecule drugs. These findings collectively position ESRP1 as a potential therapeutic target for DGC intervention.

PMID:40528239 | DOI:10.1186/s13046-025-03435-2

Scand J Trauma Resusc Emerg Med. 2025 Jun 17;33(1):106. doi: 10.1186/s13049-025-01423-1.

ABSTRACT

BACKGROUND: Resuscitative thoracotomy (RT) is a critical intervention for patients in traumatic cardiac arrest or hemorrhagic shock, where survival is highly dependent on the time required to perform the procedure. Despite its urgency, RT is still conducted using traditional thoracic retractors originally designed for scheduled surgeries, which pose challenges in emergency settings. To address these limitations, we developed a novel thoracic retractor optimized for RT and evaluated its performance compared to a conventional model.

METHODS: The novel retractor was designed with an arrow-shaped hook for improved intercostal insertion and a continuously rotatable handle to enhance procedural efficiency. A comparative study using excised porcine thoraxes was conducted to assess its performance. Six cm incisions were made in the intercostal spaces bilaterally before retractor insertion. Evaluators inserted the device, performed three handle rotations, and repeated the procedure using the other retractor on the contralateral side. The primary outcome was the time required for three rotations, while secondary outcomes included ease of insertion, ease of rotation, and hook stability, rated on a 6-point scale by evaluators.

RESULTS: Ten surgeons (n = 10) performed thoracotomy using both the novel and conventional retractors. Comparison of the time required for three handle rotations between the novel and conventional retractors demonstrated a statistically significant reduction with the novel retractor. The median time to complete three rotations was 16.0 [11.7-19.1] seconds with the novel retractor, compared to 7.0 [5.3-8.5] seconds with the conventional model (P < 0.01). The ease of insertion was rated significantly higher with the novel retractor compared to the conventional model (6.0 [5.5-6.0] vs. 2.5 [2.0-3.0], P < 0.01). The ease of rotation was also rated significantly higher with the novel retractor than with the conventional model (5.5 [5.0-6.0] vs. 2.5 [1.0-3.5], P < 0.01). In the evaluation of the hook stability, no significant difference was observed between the novel and conventional retractors (P = 1.0).

CONCLUSIONS: The novel thoracic retractor enables faster and easier thoracotomy compared to conventional model. Given the strong association between time and RT prognosis, this device is well-suited for RT procedures requiring rapid execution.

PMID:40528231 | DOI:10.1186/s13049-025-01423-1

Crit Care. 2025 Jun 17;29(1):246. doi: 10.1186/s13054-025-05494-5.

ABSTRACT

BACKGROUND: Selective Digestive Decontamination (SDD) prevents infections and reduces mortality in the intensive care unit (ICU). Microbiological surveillance is considered essential for effective decontamination and detecting antibiotic resistance. However, its optimal frequency is unclear. We compared microbiological yield and costs of different surveillance intervals during SDD.

METHODS: In a computational simulation study, using data from a Dutch ICU, three surveillance scenarios were compared: (A) twice-weekly, (B) once-weekly, and (C) no surveillance. The primary outcome was the number of clinically relevant potentially pathogenic microorganisms (PPMs) detected per scenario. Secondary outcomes included detection of colonisation persistence prompting SDD intensification and surveillance costs.

RESULTS: We included 8,499 ICU admissions, 52,553 clinical and 75,567 SDD cultures. Scenario A yielded 911 (95% CI 905-917) PPMs per 1,000 days, of which 90 (88-94) were clinically relevant: 9 (9-10) multidrug-resistant microorganisms, 68 (66-71) microorganisms resistant to standard therapy, and 13 (12-14) infection-related microorganisms. Scenarios B and C yielded 85 (82-88) and 77 (75-80) relevant PPMs, respectively (94% and 86% compared to scenario A). Scenario A identified 56 (55-58) cases of colonisation persistence per 1,000 days while scenarios B and C detected 43 (42-45) and 12 (11-12), respectively. Total costs of SDD surveillance were €78,774, €55,208, and €31,522 per 1,000 days for scenarios A, B and C.

CONCLUSION: Compared to twice-weekly surveillance, once-weekly microbiological surveillance reduces costs by 30% with 6% loss in clinically relevant PPM detections. No surveillance reduces costs by 60% with 14% detection loss.

PMID:40528229 | DOI:10.1186/s13054-025-05494-5