Tag: pubmed

Tech Coloproctol. 2025 Dec 24. doi: 10.1007/s10151-025-03254-9. Online ahead of print.

ABSTRACT

INTRODUCTION: In sacral neuromodulation (SNM), the stimulation intensity is set at the sensory threshold (ST) level. However, subsensory stimulation as low as 50% of ST has proven effective in reducing faecal incontinence episodes.

AIM: To explore the relationship between functional outcomes and varying subsensory stimulation amplitude in newly implanted patients.

METHOD: This randomised, double-blind study was designed to include patients with ≥ 1 faecal incontinence episodes/week despite maximal conservative therapy. As part of another trial, patients were offered a one-stage procedure. Postoperatively, patients were randomised into two groups. G-1 received stimulation at 0.05 V, at 50% and 90% of the ST in three 4-week periods, followed by 12 weeks of stimulation at the ST. G-2 received stimulation at 90% of the ST in three 4-week periods, followed by 12 weeks of stimulation at ST. Patients were evaluated after each period using St. Marks’s Incontinence Score and a visual analogue scale (VAS) for patient satisfaction regarding social function, bowel function and quality-of-life, along with a bowel habit diary.

RESULTS: In total, 73 patients with a median age of 60 years [interquartile range (IQR: 50-69 years)] completed the trial. Faecal incontinence episodes were significantly reduced at all follow-ups, with no differences between groups. The only statistical difference between groups was deltaVAS for bowel function after 4 weeks. In G-1 with ultra-low stimulation amplitude [0.05 V – equivalent to 9.6% (IQR: 6.5-13.4) of ST], the improvement compared with baseline was 30 points (IQR: 10-50) significantly lower than G-2 with an improvement of 50 points (IQR: 10-70) (p-value: 0.05).

CONCLUSIONS: Subsensory stimulation is feasible in newly implanted patients with faecal incontinence. An amplitude of 0.05 V is as effective on the functional outcomes as stimulation with higher amplitudes.

PMID:41444840 | DOI:10.1007/s10151-025-03254-9

Alzheimers Dement. 2025 Dec;21 Suppl 3:e099806. doi: 10.1002/alz70857_099806.

ABSTRACT

BACKGROUND: Elevated central arterial stiffness is a risk factor for amnestic mild cognitive impairment (aMCI) and dementia, but the pathophysiological mechanisms underlying the relationship between vascular health and cognitive decline in patients with aMCI remain unclear. We examined the cross-sectional relationship between central arterial stiffness, brain default mode network functional connectivity (DMN-FC), and cognitive function in patients with aMCI.

METHOD: Participants aged 55-80 years, either cognitively normal or diagnosed with aMCI, and without major neurological, vascular, metabolic, or psychiatric diseases, were recruited. Data was analyzed from 21 cognitively normal (age 65.9±7.0) and 48 adults with aMCI (age 64.1±5.9). Central arterial stiffness was measured using carotid-femoral pulse wave velocity (cfPWV) and carotid β-stiffness via applanation tonometry and ultrasonography. DMN-FC was assessed with resting-state fMRI and seed-based correlation analysis, using the posterior cingulate cortex (PCC) as the seed. Episodic memory and executive function were evaluated with California Verbal Learning Test (CVLT) and Wisconsin Card Sorting Test (WCST). Data was analyzed using multiple variable linear regression and mediation analysis.

RESULT: Carotid β-stiffness index was slightly higher in aMCI patients (8.9±2.1) compared to cognitively normal older adults (8.0±1.7), but the difference was not statistically significant. Higher carotid β-stiffness index was associated with higher DMN-FC between the PCC and right precentral gyrus (PcG) in the cognitively normal (B=0.02, r² = 0.373, p = 0.003) and aMCI group (r² = 0.260, p = 0.0002). Higher DMN-FC between the PCC and right PcG was associated with worse CVLT performance in the aMCI group (B=-27.10, p = 0.012, 95%CI = -47.91, -6.30). Higher carotid β-stiffness index was associated with worse CVLT performance (B=-1.55, p = 0.045, 95%CI=-3.08, -0.03) and worse WCST performance (B=-2.62, p = 0.068, 95%CI = -5.45, 0.20) in the aMCI group. Higher DMN-FC between the PCC and right PcG mediated the association between higher carotid β-stiffness index and worse CVLT performance in the aMCI group.

CONCLUSION: Our findings suggest that elevated central arterial stiffness may impair cognitive performance in patients with aMCI through alterations in DMN functional connectivity, potentially reflecting compensatory mechanisms. These findings underscore the importance of addressing vascular health as part of efforts to prevent or delay cognitive decline in aging populations, particular those at risk of dementia.

PMID:41444801 | DOI:10.1002/alz70857_099806

Alzheimers Dement. 2025 Dec;21 Suppl 3:e101375. doi: 10.1002/alz70857_101375.

ABSTRACT

BACKGROUND: Neuropsychiatric symptoms (NPS), such as depression and anxiety, are common in the early stages of Alzheimer’s disease (AD). These symptoms often appear before cognitive decline becomes evident, posing significant challenges for patients and caregivers. Despite their prevalence, the underlying mechanisms of NPS remain poorly understood, particularly in underserved populations.

METHOD: A retrospective cohort study will utilize REDGESAM’s electronic clinical records, focusing on patients aged 50 and older diagnosed with mild cognitive impairment (MCI) or subjective cognitive decline (SCD). Data sources include standardized neuropsychiatric scales and brain imaging reports. Advanced statistical analyses, including regression modeling, will assess associations between NPS, imaging findings, and cognitive decline.

RESULT: This study anticipates identifying key correlations between NPS and brain imaging markers such as hippocampal volume and white matter integrity. These findings will provide a deeper understanding of how early psychiatric symptoms align with biological changes in the brain.

CONCLUSION: By leveraging REDGESAM’s robust data, this research will inform targeted interventions for depression and anxiety in AD, improve patient outcomes, and contribute to dementia care strategies worldwide.

PMID:41444800 | DOI:10.1002/alz70857_101375

Sci Rep. 2025 Dec 24. doi: 10.1038/s41598-025-33517-2. Online ahead of print.

ABSTRACT

Short-term rainfall forecasting presents a complex spatiotemporal modeling challenge, critical for adaptation and mitigation of high-impact hydrometeorological events such as flash floods and cloudbursts. This study examines hourly rainfall patterns in the Northwest Himalayan (NWH) region of India, enhancing forecasting accuracy using spatial correlations. The region shows a significant decline in hourly rainfall trends over the period 2019-2024, with approximately 50% of the area exhibiting statistically significant decreasing trends. The analysis reveals that high-elevation regions exhibit stronger initial 1-hour lag correlation (>0.8) and a rapid temporal decay over 9 hours. In contrast, lower-altitude areas (below 600 m) display a more gradual decrease in correlation, suggesting broader spatial influence with less intense propagation. Across all locations, rainfall variability as defined by statistically significant correlations, typically dissipates within 6 to 7 hours. Our analysis further identifies a prominent belt of high rainfall coherence aligned along the central Himalayan zone, highlighting pronounced spatial homogeneity. To improve predictive performance, this study proposes an attention-guided spatial correlation mechanism integrated within a Deformable Convolutional Long Short-Term Memory (DConvLSTM) framework. The proposed model, termed SARITA, processes hourly rainfall and spatial correlations, with the attention mechanism dynamically using spatial dependencies. This integration enhances the model’s ability to generalize across spatial-temporal patterns. Model evaluation using statistical metrics demonstrates that SARITA consistently outperforms baseline models such as ConvLSTM and standard DConvLSTM, achieving a 25% improvement in hourly rainfall forecasts. Furthermore, the model also improves anomaly detection by 3.5% over the standard DConvLSTM model.

PMID:41444798 | DOI:10.1038/s41598-025-33517-2

Sci Rep. 2025 Dec 24;15(1):44547. doi: 10.1038/s41598-025-28320-y.

ABSTRACT

Living with diabetes over an extended period impacts not only physical health but also the psychosocial well-being of patients. Diabetes distress is a widespread concern affecting individuals with diabetes mellitus across all age groups, cultures, and populations. Given its significance in effective disease management, identifying modifiable factors that contribute to diabetes distress is essential for developing targeted interventions. This study was therefore undertaken to examine the prevalence and associated determinants of diabetes distress among patients receiving care at the University of Gondar Comprehensive Specialized Referral Hospital in northwest Ethiopia. An institution-based cross-sectional study was conducted from August to September 2021. A systematic random sampling technique was employed to select 376 diabetes patients. A structured, pretested, interviewer-administered questionnaire was used to collect data. The data was entered in Epi Info version 7, analyzed using SPSS version 21, and presented using frequencies, percentages, tables, and graphs. Bivariable and multivariable analyses were investigated using a binary logistic regression model. Finally, variables with a P value < 0.05 were declared statistically significant. A total of 364 diabetes patients participated in the current study, making a response rate of 96.8%. Of the 364 participants, 45.6% (95% CI (40.1-50.8%)) of them had moderate to high levels of diabetes distress. Having type 1 DM [AOR = 3.03, 95% CI (1.71, 5.37)], rural residency [AOR = 2.73, 95% CI (1.55, 4.79)], insulin injection only [AOR = 2.38, 95% CI (1.73, 4.39)], and poor family support [AOR = 2.76, 95% CI (1.73, 4.39)] were associated with increased odds of diabetes distress. The prevalence of diabetes distress among diabetes patients was high. Having type 1 DM, rural residency, using insulin injection only, and having poor family support were significantly associated with diabetes distress. It is better to combine the assessment for diabetes distress as part of regular actions for diabetes care and give attention to modifiable factors like family support. To improve outcomes, healthcare policies should prioritize integrating psychosocial support into diabetes management programs, especially in rural settings, and train providers to routinely screen for diabetes distress.

PMID:41444790 | DOI:10.1038/s41598-025-28320-y

Sci Rep. 2025 Dec 24. doi: 10.1038/s41598-025-28954-y. Online ahead of print.

ABSTRACT

A newly developed handheld device, the IC01 transpalpebral tonometer, was engineered to determine intraocular pressure (IOP) autonomously through upper eyelid palpation. This study aimed to evaluate the repeatability of the IC01 and to investigate its agreement with a non-contact tonometer (TOPCON CT-800). A comparative design was employed to analyze the agreement in IOP measurements between the innovative IC01 device and both the non-contact (TOPCON CT-800) and rebound (iCare IC200) tonometers, as well as its repeatability. Trained operators recorded measurements from 189 subjects at both the initial and one-month follow-up visits, adhering to a randomized sequence. IOP measurements from the IC01 showed no statistically significant difference from those obtained with the iCare IC200 or TOPCON CT-800. Repeatability, indicated by the intraclass correlation coefficient, averaged 0.77 for right eyes and 0.75 for left eyes. Furthermore, the mean IOP values at the one-month follow-up were 8.65 ± 4.15 mmHg for the right eye and 7.68 ± 2.61 mmHg. No sight-threatening adverse events occurred. Regarding patient preference among a subset of 69 respondents, 46.37% (n = 32) favored the IC01, compared to 17.39% (n = 12) for the TOPCON CT-800, while 36.23% (n = 25) expressed no preference. Gender did not show a significant correlation with outcomes. However, participants aged 50 years or younger demonstrated a greater preference for the IC01 (χ² = 5.68, P = 0.012). The IC01 tonometer demonstrated clinical equivalence to established devices, showing superior repeatability and higher patient acceptance. Its distinctive practical advantages include the avoidance of corneal contact, operational independence from a clinician, and a design suitable for self-monitoring in a home environment.

PMID:41444789 | DOI:10.1038/s41598-025-28954-y

Alzheimers Dement. 2025 Dec;21 Suppl 4:e096332. doi: 10.1002/alz70858_096332.

ABSTRACT

BACKGROUND: Lecanemab, an anti-amyloid monoclonal antibody, modestly slows cognitive decline in early Alzheimer’s disease but may cause adverse events, including amyloid-related imaging abnormalities due to edema (ARIA-E) or hemorrhage (ARIA-H). A small percentage of ARIA-E and ARIA-H cases may be disabling or fatal. As lecanemab becomes available, understanding clinician communication of its benefits and risks to patients and caregivers is crucial. This qualitative study investigates clinician communication of lecanemab’s risks and benefits to support patient and caregiver decision-making.

METHODS: We conducted semi-structured interviews with clinicians who prescribe anti-amyloid therapy at seven academic medical centers. An interdisciplinary research team used hybrid inductive-deductive thematic analysis.

RESULTS: 27 clinicians completed interviews (Women [n = 17], White [n = 19], Neurologists [n = 20]). Three preliminary themes emerged. First, clinicians used varied approaches to describe the therapy’s benefits and risks. They used analogies to explain lecanemab’s mechanisms and discussed statistical outcomes from the CLARITY-AD clinical trial, often stating ‘this is not a cure.’ While all clinicians communicated the risks, they differed in how much they emphasized or de-emphasized their clinical impact, particularly ARIA. Second, patient contextual factors shaped communication. Clinicians personalized conversations based on patients’ comorbidities, caregiver support, treatment hopes and fears, and eligibility criteria fit. Third, For example, while clinicians honor patients’ choices to pursue treatment, many do not routinely ‘recommend’ it (but may recommend against it given particular patient factors).

CONCLUSIONS: Clinicians at the forefront of lecanemab treatment use a variety of communication approaches to discuss benefits and risks. These insights can guide future interventions to improve communication and decision-making for lecanemab.

PMID:41444782 | DOI:10.1002/alz70858_096332

Alzheimers Dement. 2025 Dec;21 Suppl 2:e099273. doi: 10.1002/alz70856_099273.

ABSTRACT

BACKGROUND: Frontotemporal dementia (FTD) is a heterogeneous neurodegenerative disease. Its variability in pathology and symptoms makes individual prognosis and diagnosis difficult. Most neuroimaging research assumes homogeneity within cohorts, but novel neuroanatomical modelling now allows for the estimation of individual deviations in brain regions from the norm. For the first time, this study aims to quantify patterns of neuroanatomical dissimilarity in patients with sporadic FTD.

METHOD: T1-weighted brain MR images of 355 participants (healthy controls – HC: n = 116, 78 females, mean age=51.16 years; patients with behavioural variant FTD – bvFTD: n = 197, 78 females, mean age=66.43 years; patients with semantic variant primary progressive aphasia – svPPA: n = 42, 23 females, mean age=63.85 years) were processed using FreeSurfer v.6.0.0, and the output was visually inspected. Cortical thickness and subcortical volumes across 187 regions were extracted and used as input for a normative model, with a reference dataset of ∼58,000 healthy individuals. 70% of HCs were used to adapt the Bayesian linear regression algorithm, accounting for age, sex, and site. The remaining 30% of HCs and all patients were used as testing data. Regions with a z-score <-1.96 were classified as outliers. Normative modelling steps were completed using PCNtoolkit (v.0.31), and statistical analyses were performed using R Studio v.4.4.2.

RESULT: Mean (SD) cortical thickness z-scores were -2.01(2.18), -2.04(1.94), 0.16(1.22) for bvFTD, svPPA and HCs (Figure 1). bvFTD and svPPA groups exhibited significantly more dissimilarity in cortical and subcortical regions compared to HCs (one-way ANOVAs F(2,271)=100.62; 123.81, respectively; Tukey post hoc tests both p <0.001) (Figure 2 and 3). Regions with the highest proportion of outliers were the right inferior temporal gyrus for bvFTD (54%), and the left anterior, inferior and superior-lateral temporal gyri for svPPA (>83%). The left amygdala and hippocampus were the subcortical structures with the most outliers (45% and 47% in bvFTD; 64% and 67% in svPPA, respectively).

CONCLUSION: These results demonstrate that bvFTD and svPPA patients exhibit greater heterogeneity in subcortical and cortical regions compared to HCs, particularly in the right inferior temporal gyrus and left lateral temporal gyrus, respectively. Analysis of other FTD variants and correlations with cognitive and clinical data are ongoing.

PMID:41442185 | DOI:10.1002/alz70856_099273

Int J Qual Health Care. 2025 Dec 24:mzaf134. doi: 10.1093/intqhc/mzaf134. Online ahead of print.

ABSTRACT

BACKGROUND: Patient safety concerns arise as large language models (LLMs) are increasingly integrated into healthcare delivery, given the absence of adequate quality-assurance frameworks. This study aimed to develop risk-stratified quality indicators for AI-assisted medical consultations and assess patient safety implications across varying clinical scenarios.

METHODS: Two hundred clinical scenarios representing different risk levels across four medical complexity categories (50 scenarios per category) were evaluated using established quality and safety frameworks. Twelve healthcare specialists independently evaluated Claude Sonnet 4.0 responses using validated quality indicators. This single-model evaluation provides baseline performance metrics and a methodological framework that can be used in future comparative studies involving multiple LLM systems.

RESULTS: Significant variations in performance were identified across clinical complexity categories. Routine care scenarios achieved excellent performance (89.2%, 95% CI: 86.1-92.3%), while acute care situations showed concerning limitations (65.4%, 95% CI: 61.8-69.0%). Inter-rater reliability was excellent across all domains (ICC: 0.85-0.91). Statistical analysis revealed significant between-group differences (F(3,196) = 47.3, p < 0.001), suggesting potential patterns in AI performance across clinical complexity levels.

CONCLUSION: These preliminary findings suggest that implementation of AI-assisted healthcare consultations may benefit from risk-stratified deployment strategies, pending validation in larger studies. Current findings inform the development of safety frameworks and quality indicators essential for maintaining high standards of care while leveraging the benefits of AI.

PMID:41442171 | DOI:10.1093/intqhc/mzaf134

Alzheimers Dement. 2025 Dec;21 Suppl 2:e097150. doi: 10.1002/alz70856_097150.

ABSTRACT

BACKGROUND: We assessed differences in retinal structure and microvasculature among individuals with Alzheimer’s disease (AD), APOE ε4 carriers, and APOE ε4 noncarriers.

METHOD: Participants underwent cognitive evaluation with Mini-Mental State Examination. Optical coherence tomography (OCT) angiography (Zeiss Cirrus HD-5000 AngioPlex) vessel density (VD) and perfusion density (PD) in the Early Treatment Diabetic Retinopathy Study 3-mm and 6-mm circles and rings were analyzed. OCT angiography peripapillary measurements (capillary perfusion density (CPD), capillary flux index (CFI)) and OCT retinal thickness parameters (retinal nerve fiber layer (RNFL), ganglion cell-inner plexiform layer (GC-IPL), central subfield thickness (CST)) were also compared among groups. Participants with diabetes, glaucoma, or vitreoretinal pathology were excluded. Age and sex-adjusted generalized estimating equations were used for statistical analysis.

RESULT: 275 eyes from 150 AD participants, 373 eyes from 189 cognitively normal APOE ε4 carriers, and 422 eyes from 214 cognitively normal APOE ε4 noncarriers were enrolled. 6mm circle PD and 6mm inner ring VD were significantly lower in APOE ε4 carriers vs noncarriers (p = 0.037 and p = 0.047, respectively). AD did not have significantly different retinal microvasculature measurements vs APOE ε4 carriers except for peripapillary CPD, which was significantly higher in AD vs APOE ε4 carriers or noncarriers (p = 0.003 & p < 0.001, respectively). Comparing AD to noncarriers, CST (p = 0.014), 6mm circle PD (p = 0.025), 6mm circle VD (p = 0.036), and 6mm inner ring VD (p = 0.042) were significantly lower in AD vs APOE ε4 noncarriers. GC-IPL thickness, RNFL thickness, 3mm circle and ring VD and PD, and peripapillary CFI did not differ significantly among or between groups (all p > 0.05).

CONCLUSION: APOE ε4 carriers generally did not have significant differences in retinal microvasculature compared to AD, but showed differences compared to ε4 noncarriers, which may indicate that ε4 carriers have begun to show biomarker signs of AD without clinical symptoms. Peripapillary CPD was significantly higher in AD vs APOE ε4 carriers, which may be due to imaging time point during disease course. Longitudinal studies may better elucidate the role of these potential biomarkers along the AD spectrum.

PMID:41442156 | DOI:10.1002/alz70856_097150