Clinical Populations Research Articles

An examination of noun and verb naming differences in aphasia: effects of lesion site, aphasia type and the use of static or dynamic stimuli

ABSTRACT Background Anomia has been extensively researched within the aphasia literature and a dissociation in naming nouns and verbs has been used in diagnostic classifications and related to lesion location. However, there is evidence that action naming is more difficult for many clinical populations as well as for healthy speakers. Confrontation naming tests have often been used to evaluate anomia, but static depiction has been considered a potential source of error in evaluations of verb naming, since actions are dynamic. Aims The first aim of this study was to examine the ability to name objects and actions in a stroke population and non-brain damaged controls and to explore naming ability in relation to lesion location and aphasia type (fluent or non-fluent). A second aim was to determine if action naming is facilitated by using dynamic rather than static stimuli. Methods & Procedures A cross-sectional study was carried out, where 19 participants with aphasia after stroke and 19 matched controls were included. Type of aphasia was based on connected speech samples. Naming performance was compared on two Swedish naming tests consisting of line drawings of high frequency nouns and verbs respectively, and a subset of action pictures was compared to a test using video depictions of actions as verb stimuli. Outcomes & Results There was a significant difference between nouns and verbs in 11 of 19 participants with aphasia. Only one participant, with a temporo-occipital lesion, had a substantial noun-verb difference (≥30%). Individual results showed some agreement with the fluent-nonfluent classification. However, at group level, there was no significant difference between scores on action and object naming for participants with aphasia. While only the control group achieved significantly higher scores on object than action naming, response latencies were longer for action than object naming for both groups. There was no difference in action naming performance that could be related to the use of dynamic or static stimuli. Conclusions The results suggest that a dissociation in naming nouns and verbs is common in aphasia. This finding underscores the importance of testing action as well as object naming. Even though there was some agreement with aphasia type, the relationship between noun-verb dissociation, lesion location and aphasia type is not straight forward. The study adds to previous findings suggesting that action naming is more difficult than object naming. The question whether action naming is facilitated by using dynamic stimuli needs to be further investigated.

Protocol for a randomised controlled trial of Overcome Death Anxiety: an online cognitive behavioural therapy intervention in a clinical sample.

Evidence suggests that death anxiety is a transdiagnostic construct underlying numerous anxiety-related conditions. A previous phase I trial of Overcome Death Anxiety (ODA), a novel online stand-alone psychological intervention to reduce death anxiety, demonstrated preliminary evidence of efficacy and acceptability in a clinical population. However, this trial was limited by a small sample size (n=20). To further evaluate the efficacy of this intervention in reducing death anxiety in a clinical population, compared with a waitlist control. This paper describes the protocol of a phase II randomized controlled, unblinded trial of ODA. A total sample of 256 adults living in Australia, diagnosed with an anxiety-related condition, will be recruited. These participants will be randomised to ODA or a waitlist control. Primary outcomes will be measured as changes in scores on death anxiety questionnaires, reflecting treatment efficacy. The secondary outcomes to be measured are depression, anxiety, stress, suicidality, insomnia, and meaning of life, as well as feedback about treatment program acceptability. This trial will assess the efficacy of ODA for reducing death anxiety in a population diagnosed with various anxiety-related conditions, as well as the overall acceptability and tolerability of the intervention. This study will provide evidence to evaluate the efficacy of ODA in people diagnosed with an anxiety-related condition.

Psychometric properties of an arabic translation of the short boredom proneness scale (SBPS) in adults

BackgroundThe Short Boredom Proneness Scale (SBPS) is a common tool for assessing individuals’ inclination toward Boredom. The Arabic version of the SBPS has not been validated despite the language being spoken by over 420 million people worldwide. Therefore, this study aims to translate the SBPS into Arabic and prove its psychometric properties on a sample of Arabic-speaking adults from Lebanon.MethodsIn this cross-sectional study, 410 participants (72.4% females, aged 18–52 years) were recruited to participate by completing the translated Arabic version of the SBPS through an online Google Forms survey. The validation of the scale was carried out using the Confirmatory Factor Analysis approach.ResultsConfirmatory Factor Analysis revealed a better fit after adding a correlation between residuals of items 2 and 6. The SBPS showed high internal reliability (ω = 0.81; α = 0.81). No significant differences were found in SBPS scores between males and females. Concurrent validity indicated that higher levels of anxiety, loneliness, and smartphone addiction were significantly associated with greater boredom proneness.ConclusionOur results confirm the reliability and validity of the Arabic version of the SBPS, suggesting its suitability for use among Lebanese general population adults. Further research is needed to assess its applicability in clinical settings and diverse Arabic-speaking populations. This concise and user-friendly tool potentially promotes cross-cultural research on boredom proneness.

Sleep Duration and Quality in Adolescents: Associations With Suicidal Ideation.

Inadequate sleep duration and sleep-related problems are highly prevalent among adolescents and pose a significant health risk during a critical development stage. This study seeks to explore associations between sleep and suicidal ideation among adolescents. Cross-sectional questionnaire data from the baseline wave (2016-2018) of a cohort of 12- to 16-year-old Swedish adolescents (n = 4433, 50.39% girls) were analyzed. A split-sample approach was used for exploratory analyses and model selection. Logistic regression was used to estimate the associations between suicidal ideation and self-reported sleep parameters (weekday sleep duration, sleep quality), both adjusted and unadjusted for depression. Adolescents with suicidal ideation slept on average 60 min less on weekdays and reported worse sleep quality compared to those without suicidal ideation. Suicidal ideation was significantly associated with weekday sleep duration (p = 0.0267) and self-perceived sleep quality (p = 0.0003). Associations remained after controlling for depression. Sleep problems in adolescents are associated with suicidal ideation, beyond the effect of depression. Findings may have implications for screening and suicide prevention among clinical populations of adolescents, as well as for public health interventions aimed at promoting sleep and mental health in adolescents.

On-TRACC Pilot Study: A Novel Intervention for Persistent Post-Concussive Cognitive Symptoms.

To present the results of a pilot study of On-TRACC (Tools for Recovery and Clinical Care), a novel intervention for individuals experiencing persistent cognitive difficulties after mild traumatic brain injury (mTBI). On-TRACC is a 5-session, 1:1 manualized treatment that integrates psychoeducation, cognitive rehabilitation strategies, and self-management skills to target symptoms and increase understanding of the interaction between cognitive difficulties, injury history, and comorbid medical and psychological conditions. The primary study goals were to evaluate the feasibility, acceptability, and preliminary effectiveness of On-TRACC. Veterans Affairs medical center and an academic medical center. Veterans and civilian adults (n=28) >3months post-mTBI with current self-reported cognitive difficulties. In this single-group, open-label pilot study, all participants received On-TRACC (5 sessions) via video-based telehealth. Primary measures were feasibility (eg, session attendance and homework completion rate, dropout rate, and treatment fidelity) and acceptability (treatment satisfaction/helpfulness ratings). Preliminary effectiveness was explored by measuring pre- to post-intervention change in cognitive symptom level and attribution, perceived self-efficacy, use of compensatory strategies, daily functioning, quality of life, and planned future engagement in health care. The On-TRACC completion rate for all enrolled participants was 79% (with 88% treatment completion rate for participants who started On-TRACC); homework was fully or partially completed for 98% of attended sessions. Treatment satisfaction ratings were high, with 95% satisfied with the information and skills learned. There were no adverse events. Positive pre- to posttreatment changes were seen in cognitive self-efficacy, symptom attribution, functional status, quality of life, and planned engagement in care for comorbid conditions. On-TRACC was a feasible and acceptable intervention for individuals with chronic cognitive difficulties following mTBI. Additional research, including a randomized clinical trial, is needed to evaluate the efficacy of this intervention and its long-term impact on outcomes in this clinical population.

Psychological responses to acute exercise in patients with stress-induced exhaustion disorder: a cross-over randomized trial

BackgroundUnderstanding psychological responses to acute exercise, defined as a single bout of physical exercise, in clinical populations is essential for developing tailored interventions that account for the psychological benefits and challenges of exercise. Given its effectiveness in reducing symptoms in various psychological disorders, exercise should be further explored in Exhaustion Disorder ICD-10-SE: F43.8A (ED), characterized by persistent exhaustion following long-term psychosocial stress. Currently, no studies address the psychological responses to acute exercise in ED patients.AimsThis study aims to (1) compare the psychological responses to acute exercise between ED patients and healthy controls and (2) assess response differences between low and moderate exercise intensities.MethodsWe conducted a two-armed cross-over trial comparing ED patients (n = 30) and healthy controls (n = 30). Participants completed a 22-min exercise at low or moderate intensity on a cycle ergometer, on separate occasions, in randomized order. The primary outcome was perceived fatigue (POMS); secondary outcomes included feelings of energy, anxiety, stress, exertion, and psychological discomfort, measured before, during, and up to 24 h post-exercise. Exercise effects were assessed using repeated measures analysis of variance.ResultsED patients reported higher levels of exertion, psychological discomfort, fatigue, anxiety, and stress but lower energy throughout the trial compared to controls. Unlike controls, the ED group showed significant fatigue and stress reductions post-exercise (p < 0.05). Additionally, ED patients showed a more elevated energy after moderate-intensity exercise compared to controls (p < 0.05). Both groups experienced anxiety reductions post-exercise, with no group interactions over time. No differences were observed between pre- and 6 or 24 h post-exercise in any variables. The only intensity effect (p < 0.05) in the ED patients was a more pronounced energy decline 30 min after moderate-intensity exercise.ConclusionsA 22-min exercise session was perceived as more strenuous by patients with exhaustion disorder (ED) and generated greater improvements in feelings of fatigue, energy, and stress compared to healthy individuals without delayed negative effects. These findings highlight the specific psychological responses in ED to exercise and can inform intervention design tailored specifically to this population.Trial registrationThe study was retrospectively registered on 05/30/2024 at Clinical Trials.gov, with trial registration number 2022–04943-01.

Progress in mentalizing ability among people with psychosis through dialogic literary gatherings

BackgroundPeople with psychosis often experience a fragmented sense of self, making it difficult to integrate perceptions, memories, thoughts, and emotions related to themselves and others. Enhancing mentalization processes and fostering reflection are crucial for comprehensive recovery. As these processes are naturally developed through meaningful interactions and dialogue, incorporating a dialogic approach into the treatment of psychotic disorders may significantly support recovery.MethodsThis study examines the impact of Dialogic Literary Gatherings (DLGs) on the ability of mentalizing in individuals with psychosis. A quasi-experimental mixed-methods study was conducted with 23 participants (6 women and 17 men) diagnosed with psychosis. Over five months, participants engaged in 18 DLG sessions. Mentalizing ability was assessed using the Mentalization Scale (MentS), and qualitative data included interviews (n = 2) and focus groups (n = 3), to explore changes in mentalization.ResultsParticipants reported an increase in mentalizing towards others and toward him or herself, and in motivation to mentalize. Dialogues during DLGs fostered empathy, awareness of individual differences, and deeper engagement with others’ emotions. Besides, sharing feelings in this dialogic environment enabled participants to reflect on past experiences and find purpose in life. Consistently, patients reported that these dialogues provided a platform for expressing emotions, re-evaluating life perspectives, and achieving greater self-awareness.ConclusionsThis study highlights Dialogic Literary Gatherings as a valuable tool for enhancing the ability to mentalize in clinical populations, offering a complementary approach to traditional psychotherapeutic interventions for individuals with psychosis.

The cognitive underpinnings of irony comprehension: Fluid intelligence but not working memory modulates processing

Abstract The comprehension of irony involves a sophisticated inferential process requiring language users to go beyond the literal meaning of an utterance. Because of its complex nature, we hypothesized that working memory (WM) and fluid intelligence, the two main components of executive attention, would be involved in the understanding of irony: the former by maintaining focus and relevant information active during processing, the latter by disengaging irrelevant information and offering better problem-solving skills. In this eye-tracking reading experiment, we investigated how adults (N = 57) process verbal irony, based on their executive attention skills. The results indicated a null (or indirect) effect for WM, while fluid intelligence directly modulated the comprehension and processing of irony during reading. As fluid intelligence is an important individual-difference variable, the findings pave the way for future research on developmental and clinical populations who tend to struggle with nonliteral language.

Lipoprotein(a) Atherosclerotic Cardiovascular Disease Risk Score Development and Prediction in Primary Prevention From Real-World Data.

Lp(a; Lipoprotein[a]) is a predictor of atherosclerotic cardiovascular disease (ASCVD); however, there are few algorithms incorporating Lp(a), especially from real-world settings. We developed an electronic health record (EHR)-based risk prediction algorithm including Lp(a). Utilizing a large EHR database, we categorized Lp(a) cut points at 25, 50, and 75 mg/dL and constructed 10-year ASCVD risk prediction models incorporating Lp(a), with external validation in a pooled cohort of 4 US prospective studies. Net reclassification improvement was determined among borderline-intermediate risk patients. We included 5902 patients aged ≥18 years (mean age 48.7±16.7 years, 51.2% women, and 7.7% Black). Our EHR model included Lp(a), age, sex, Black race/ethnicity, systolic blood pressure, total and high-density lipoprotein cholesterol, diabetes, smoking, and hypertension medication. Over a mean follow-up of 6.8 years, ASCVD event rates (per 1000 people-years) ranged from 8.7 to 16.7 across Lp(a) groups. A 25 mg/dL increment in Lp(a) was associated with an adjusted hazard ratio of 1.23 (95% CI, 1.10-1.37) for composite ASCVD. Those with Lp(a) ≥75 mg/dL had an 88% higher risk of ASCVD (hazard ratio, 1.88 [95% CI, 1.30-2.70]) and more than double the risk of incident stroke (hazard ratio, 2.55 [95% CI, 1.54-4.23]). C-statistics for our EHR and EHR+Lp(a) models in our EHR training data set were 0.7475 and 0.7556, respectively, with external validation in our pooled cohort (n=21 864) of 0.7350 and 0.7368, respectively. Among those at borderline/intermediate risk, the net reclassification improvement was 21.3%. We show the feasibility of developing an improved ASCVD risk prediction model incorporating Lp(a) based on a real-world adult clinic population. The inclusion of Lp(a) in ASCVD prediction models can reclassify risk in patients who may benefit from more intensified ASCVD prevention efforts.

Remodeling the light-adapted electroretinogram using a bayesian statistical approach

ObjectiveTo present a remodeling of the electroretinogram waveform using a covariance matrix to identify regions of interest and distinction between a control and attention deficit/hyperactivity disorder (ADHD) group. Electroretinograms were recorded in n = 25 ADHD (16 male; age 11.9 ± 2.7 years) and n = 38 (8 male; age 10.4 ± 2.8 years neurotypical control participants as part of a broad study into the determining if the electroretinogram could be a biomarker for ADHD. Flash strengths of 0.6 and 1.2 log cd.s.m− 2 on a white 40 cd.m− 2 background were used. Averaged waveforms from each eye and flash strength were analyzed with Bayesian regularization of the covariance matrices using 100 equal length time intervals. The eigenvalues of the covariance matrices were ranked for each group to indicate the degree of complexity within the regularized waveforms.ResultsThe correlation matrices indicated less correlation within the waveforms for the ADHD group in time intervals beyond 70 msec. The eigenvalue plots suggest more complexity within the ADHD group compared to the control group. Consideration of the correlation structure between ERG waveforms from different populations may reveal additional features for identifying group differences in clinical populations.

Evaluating Biomechanical and Viscoelastic Properties of Masticatory Muscles in Temporomandibular Disorders: A Patient-Centric Approach Using MyotonPRO Measurements

The temporomandibular joint (TMJ) is essential for chewing and speaking functions, as well as for making facial expressions. However, this joint can be affected by disorders, known as temporomandibular disorders (TMDs), induced by complex causes that lead to limitations in daily activities. Building on the methodology and findings from our previous study on TMJ function, our research aims to apply the established criteria and norms to patients with TMDs. The primary goal is to evaluate the applicability and clinical relevance of these reference norms in predicting the severity and progression of TMJ disorders within a clinical population. Using non-invasive myotonic measurements, we evaluated 157 subjects, including both non-TMD-affected and TMD-affected individuals. To achieve optimal results, five primary parameters (frequency, stiffness, decrement, relaxation time, and creep) were analyzed using statistical–physical tools, providing quantitative functionality degrees across different previously examined clinical groups. The obtained results identified significant quantitative markers for early diagnosis and personalized treatment of TMJ disorders. This interdisciplinary approach leads to a deeper understanding of TMJ dysfunctions and makes a meaningful contribution to clinical practice, providing more precise tools for managing and treating this complex condition.

Physiological Responses to Aversive and Non-aversive Audiovisual, Audio, and Visual Stimuli.

We examined differences in physiological responses to aversive and non-aversive naturalistic audiovisual stimuli and their auditory and visual components within the same experiment. We recorded five physiological measures that have been shown to be sensitive to affect: electrocardiogram, electromyography (EMG) for zygomaticus major and corrugator supercilii muscles, electrodermal activity (EDA), and skin temperature. Valence and arousal ratings confirmed that aversive stimuli were more negative in valence and higher in arousal than non-aversive stimuli. Valence also showed an emotional enhancement effect for cross-modal integration. Both heart rate deceleration and facial EMG potentiation for corrugator supercilii were larger for aversive compared to non-aversive conditions for audiovisual stimuli and their auditory components, even after controlling for arousal. Facial EMG potentiation for zygomaticus major was greater for aversive compared to non-aversive conditions for audiovisual stimuli and EDA was greater for aversive compared to non-aversive conditions for visual stimuli. Neither of these effects remained significant after controlling for arousal. These findings provide a benchmark for examining atypical sensory processing of mundane aversive stimuli for clinical populations.

Effectiveness of exercise on sarcopenia in HIV patients: a systematic review of current literature

ABSTRACT Exercise is vital in managing sarcopenia in people living with HIV (PLWH). This study explores the role of exercise in reducing sarcopenia in HIV patients. A systematic search of electronic databases including PubMed, Scopus, and Web of Science identifed relevant articles published in English up to April 2024. Inclusion criteria were: 1) humans aged 18 or older, 2) clinical trials involving exercise interventions, 3) outcomes addressing aging-related effects, and 4) English-language original articles. Study quality and risk of bias were assessed using the Newcastle-Ottawa scale (NOS). Ten studies with 2039 participants met the criteria. Exercise interventions included resistance training, cardiorespiratory training, and combined approaches at various intensities. Regular exercise can help prevent muscle wasting in PLWH and mitigate age-related sarcopenia. HIV itself is a risk factor for sarcopenia, but resistance training combined with moderate to high-intensity cardiorespiratory training, can increase muscle mass, reducing sarcopenia risk and improving life expectancy in PLWH. The findings emphasize the effectiveness of exercise, particularly combined resistance and cardiorespiratory training, in mitigating sarcopenia in PLWH. Healthcare providers are urged to promote exercise interventions as a preventive measure against sarcopenia in this clinical population.

High fatigue levels among psychiatric outpatients – the validity of the Danish Patient Reported Outcomes Measurement Information System Fatigue Short-Form (PROMISF-SF)

BackgroundPatient Reported Outcomes Measurement Information System Fatigue Short-Form (PROMIS-F-SF) is a self-administered, patient reported outcome (PRO) designed to assess fatigue in healthy and clinical populations and for tracking progress during treatment for disorders complicated with fatigue.MethodsPatients in the Mental Health Service Outpatient Clinics and healthy volunteers were invited to complete a survey, which included the Danish translation of the PROMIS-F-SF, the Chalder Fatigue Scale (CFS-11), and measures of depression and anxiety. We conducted a confirmatory factor analysis of the previously suggested single-factor structure of the instrument. We furthermore evaluated the construct validity of the PROMIS-F-SF by means of its relationship with the CFS-11. Finally, we evaluated the utility of the PROMIS-F-SF to identify patient-status by conducting receiver operating characteristic curves.Results70 healthy volunteers and 62 patients completed the instruments. The PROMIS-F-SF had a average fit to the previously reported single-factor structure. Cronbach’s alpha and McDonald’s omega showed good internal reliability (α = 0.96, ωtotal = 0.97). PROMIS-F-SF score was positively correlated with the CFS-11 (r =.76) and it correlated highly with depression (r =.78) and anxiety (r =.74) score. The optimal cut-off point in the ROC-analyses was 15, which yielded a sensitivity of 89% and a specificity of 67% in the prediction of patient status.ConclusionsLevel of fatigue among psychiatric outpatients is high in patients with psychiatric illness, compared to levels measured in healthy volunteers. The Danish PROMIS-F-SF shows good psychometric properties in this combined sample of healthy adults and psychiatric patients with non-psychotic disorders and it is recommended as PRO measure for psychiatric populations. Examination of psychometric properties in patient populations with somatic disorder could be a natural next step.

Preliminary validation of CCRacer serious game for assessing executive function after acquired brain injury.

Acquired brain injuries can profoundly impact executive functioning, yet traditional neuropsychological assessments often have limitations, such as being time-intensive, lacking ecological validity, or failing to engage patients effectively. To address these challenges, CCRacer, a serious game, was developed as a novel tool for assessing executive functions in clinical populations. This study evaluated the convergent and discriminant validity of CCRacer by applying it alongside established neuropsychological tests to a sample of 78 participants with acquired brain injury. Results revealed varying levels of convergent validity across tasks, with stronger correlations for measures of working memory (0.28-0.51) and planning (-0.46 to 0.34) and weaker correlations for inhibitory control (0.22). These findings suggest that CCRacer has the potential as a complementary tool in the neuropsychological assessment of an acquired brain injury, combining engaging and ecologically valid testing with the possibility of future use in cognitive training.

Post-exercise neural plasticity is augmented by adding blood flow restriction during low work rate arm cycling.

Blood flow restriction (BFR) combined with low work rate exercise can enhance muscular and cardiovascular fitness. However, whether neural mechanisms mediate these enhancements remains unknown. This study examined changes in corticospinal excitability and motor cortical inhibition following arm cycle ergometry with and without BFR. Twelve healthy males (24±4years) completed four, randomized 15-min arm cycling conditions: high work rate (HW: 60% maximal power output), low work rate (LW: 30% maximal power output), low work rate with BFR (LW-BFR) and BFR without exercise (BFR-only). For BFR conditions, cuffs were applied around the upper arm and inflated to 70% of arterial occlusion pressure continuously during exercise. Single-pulse transcranial magnetic stimulation was delivered to left primary motor cortex (M1) to elicit motor-evoked potentials (MEP) in the right biceps brachii during a low-level isometric contraction. MEP amplitude and cortical silent period (cSP) duration were measured before and 1, 10 and 15min post-exercise. MEP amplitude increased significantly from baseline to Post-10 and Post-15 for both the HW (both z<-7.07, both P<0.001) and LW-BFR conditions (both z<-5.56, both P<0.001). For the LW condition without BFR, MEP amplitude increased significantly from baseline to Post-10 (z=-3.53, P=0.003) but not Post-15 (z=-1.85, P=0.388). The current findings show that HW arm cycling and LW-BFR led to longer-lasting increases in corticospinal excitability than LW arm cycling alone. Future research should examine whether the increased corticospinal excitability is associated with the improvements in muscle strength observed with BFR exercise. A mechanistic understanding of BFR exercise improvement could guide BFR interventions in clinical populations.

Three-Dimensional Posture Analysis-Based Modifications After Manual Therapy: A Preliminary Study.

Background/Objectives: Manual therapies like Osteopathic Manipulative Treatment (OMT) and Gentle Touch Intervention (GTI) are widely employed for improving posture and spinal alignment, but their effects as measured using advanced technologies remain underexplored. This study aims to evaluate the short-term postural effects of these interventions using a non-invasive three-dimensional rasterstereography-based approach, focusing on the cervical arrow, lumbar arrow, kyphotic angle, and lordotic angle parameters. Methods: A three-armed randomized controlled trial was conducted with 165 healthy participants. The subjects were divided into control (CTRL), OMT, and GTI groups. Their postural parameters were assessed pre- and post-intervention using the Spine3D system by Sensor Medica (Guidonia Montecelio, Italy). The statistical analyses included paired t-tests and an ANOVA, with the significance set at p < 0.05. Results: Significant reductions in the cervical arrow were observed in both the OMT (p < 0.005) and GTI (p < 0.05) groups, while the kyphotic angle significantly improved only in the GTI group (p < 0.05). No significant changes were found in the lumbar arrow or the lordotic angle across the groups. The control group showed no postural variations, reinforcing the specificity of the interventions. Conclusions: Both OMT and GTI influence spinal posture, particularly in the cervical and thoracic regions. GTI, with its gentle approach, demonstrated unique effects on the thoracic curvature, suggesting neurophysiological mechanisms. These findings highlight the potential of manual therapies for posture modulation and suggest future research should explore their long-term benefits and applications in clinical populations.

Emerging evidence on the effects of electrode arrangements and other parameters on the application of transcutaneous spinal direct current stimulation.

Transcutaneous spinal direct current stimulation (TSDCS) has the potential to modulate spinal circuits and induce functional changes in humans. Nevertheless, differences across studies on basic parameters used and obtained metrics represent a confounding factor. Computer simulations are instrumental in improving the application of the TSDCS technique. Their findings allow a better interpretation of the tissue conductivities heterogeneity. Emerging findings indicate the electric field is maximal in the segments located between the electrodes and that factors such as the depth of the targeted area, and location of the electrodes on low conductive points, such as the spinous processes, may impact the electric field generated in the spinal cord, with consequences for thoracic versus lumbar or cervical applications. Recently, growing attention has been directed toward the importance of the TSDCS reference electrode's position and its influence on the current field properties at the targeted site. This review highlights the influence of dosage, polarity, and electrode position on the variety of TSDCS results in healthy and some clinical populations. Based on the available evidence, we suggest that although the current dosage appears to have a negligible effect, the variety of electrode montages and configurations of TSDCS can significantly impact the electric field distributions and potentially explain the conflicting results of experimental studies. Future human trials should systematically and thoughtfully evaluate the location of TSDCS electrodes based on the targeted neural structures.

A Concurrent Validity Study of the Mullen Scales of Early Learning (MSEL) and the MacArthur-Bates Communicative Developmental Inventory (CDI) in Infants with an Elevated Likelihood or Diagnosis of Autism.

Infants at elevated likelihood for or later diagnosed with autism typically have smaller vocabularies than their peers, as shown by the Mullen Scales of Early Learning (MSEL) and the MacArthur-Bates Communicative Developmental Inventory (CDI). However, the extent to which MSEL and CDI scores align remains unclear, especially across clinical and non-clinical populations. This study examined whether the concurrent validity of the MSEL and CDI differs based on autism likelihood and diagnosis. Data from 720 14-month-old infants were analysed, grouped by likelihood (elevated vs. typical) and diagnosis at 36 months (diagnosed vs. not diagnosed). Vocabulary scores were compared across both likelihood and diagnostic groups. Moderate correlations were observed between the MSEL and CDI in most groups (rs range = [.34-.58]). One exception was that the expressive scores of elevated likelihood infants on the MSEL and CDI were more closely associated than the expressive scores of typical likelihood infants. Diagnosed infants had lower vocabulary scores than non-diagnosed peers on both the MSEL and CDI. The elevated likelihood group showed lower scores on the MSEL but not the CDI compared to typical likelihood infants. The moderate correlations suggest that the MSEL and CDI assess different aspects of language in infancy. These associations were weaker than previously reported in autistic children. Differences in vocabulary scores across likelihood and diagnostic groups highlight the need for further research to understand the association between these measures.

Pharmacokinetic exposure and treatment outcomes of lenvatinib in patients with renal cell carcinoma and differentiated thyroid carcinoma.

After initial approval of lenvatinib for radioiodine-refractory differentiated thyroid cancer (DTC), it has also shown promising outcomes in among others metastatic renal cell carcinoma (mRCC). Given that trial populations typically do not represent routine clinical care populations, questions arise about how applicable trial outcomes are in clinical practice. This study aims to compare the pharmacokinetics (PK), toxicity patterns, and survival data of lenvatinib in a real-world cohort with DTC and mRCC to those observed in pivotal clinical trials. Patients were included when diagnosed with DTC or mRCC, had received current or prior treatment with lenvatinib, and had at least one available lenvatinib plasma concentration measurement. A descriptive comparison was made between the baseline characteristics, PK data, toxicity and survival data in this real-world cohort and those described in the phase III trials. Overall, 29 patients with mRCC and 35 patients with DTC were included. For mRCC, median time to treatment discontinuation (mTTD) was shorter than observed in the phase III trial (7.5 versus 11.0 months) with fewer dose-limiting toxicities, likely because 66% of the patients started with a reduced dose. mRCC patients were more pretreated and had a worse performance status than trial participants. This was resembled in overall lower PK exposure in mRCC patients. For DTC, mTTD was longer in our cohort (17.1 versus 13.8 months), with similar toxicity patterns and PK exposure as in the phase III trial. Our data suggests that patient characteristics and outcomes in routine clinical care deviate from clinical trials and show the need for alternative treatment strategies to manage tolerability to lenvatinib.