Remimazolam versus propofol on seizure adequacy in electroconvulsive therapy: a retrospective cohort study

ObjectiveElectroconvulsive therapy (ECT) is a core treatment modality for severe mental disorders, and the choice of anesthetic induction agent directly impacts seizure quality and therapeutic outcomes. This study aimed to compare the effects of remimazolam versus propofol on seizure adequacy during ECT.MethodsThis retrospective secondary analysis was conducted using data from a prospective observational cohort. A total of 859 ECT sessions from 114 patients were included. The primary outcome was the rate of adequate seizure, defined as an electroencephalographic (EEG) ictal duration of ≥15 seconds. Secondary outcomes included EEG seizure duration, post-ictal suppression index (PSI), maximum sustained power (MSP), and average seizure energy index (ASEI). Stabilized inverse probability of treatment weighting was employed to balance baseline covariates between groups, with balance assessed by standardized mean differences. Generalized linear mixed models were used to compare intergroup differences, accounting for random effects at the patient level. Subgroup analysis, E-value calculation, and propensity score matching (PSM) at 1:1 and 1:2 ratios were performed as sensitivity analyses to assess the robustness of the results. ResultsA total of 859 ECT sessions were included, with 179 in the remimazolam group and 680 in the propofol group. Baseline characteristics were well-balanced between groups after weighting. The remimazolam group exhibited a significantly higher rate of adequate seizures compared with the propofol group (adjusted odds ratio: 12.054, 95% confidence interval: 5.758–25.233, P < 0.001), along with prolonged EEG seizure duration and elevated MSP. No significant between-group differences were observed in PSI or ASEI. The results of all sensitivity analyses were consistent with those of the primary analysis.ConclusionRemimazolam was associated with a higher rate of EEG seizure adequacy and longer EEG seizure duration; however, whether this electrophysiological advantage translates into better clinical outcomes remains to be investigated in prospective studies.

Latest developments in the use of e-cigarettes by people with schizophrenia spectrum disorders who smoke: a scoping review

BackgroundTobacco use is significantly more prevalent among individuals with schizophrenia spectrum disorders (SSD) compared to the general population, contributing to elevated rates of premature mortality from smoking-related diseases. Despite a decline in smoking prevalence in the general population, individuals with SSD continue to smoke at persistently high rates, driven by biological, psychological, and social factors. Standard smoking cessation approaches yield markedly poorer outcomes in this group compared to non-psychiatric populations. This scoping review aimed to map the emerging evidence on the use of e-cigarettes among individuals with SSD or serious mental illness (SMI).MethodsThis scoping review was conducted in accordance with the Population–Concept–Context (PCC) framework and reported following the PRISMA extension for Scoping Reviews (PRISMA-ScR) guidelines. The review focused on studies published between January 2020 and February 2026, searched on PubMed and EMBASE, providing an up-to-date synthesis of emerging evidence on e-cigarette use in this vulnerable population.ResultsThree studies reported across four publications were included (total N = 323); one research group (Pratt et al.) contributed two separate publications reporting distinct outcomes from the same study cohort. Findings suggest that e-cigarette-based interventions are feasible and acceptable in individuals with SSD and SMI, with preliminary evidence of smoking reduction and decreased exposure to tobacco-related carcinogens. However, sustained harm reduction appeared dependent on a combined approach considering that device provision was empowered in its efficacy to sustain harm reduction over time when integrated with behavioral support.ConclusionsThe available evidence, while preliminary and limited by the small number of included studies, should be interpreted with caution regarding generalizability to patients with Schizophrenia Spectrum Disorders exclusively, as three of the four included publications recruited participants with broader SMI diagnoses of which SSD represents only a subset. Further research, including larger adequately powered trials with standardized outcome measures and longer follow-up, is needed to establish the generalizability and long-term impact of these interventions.

Home Play-based Intervention for Parents and Infants

Conditions: Attention-Deficit/Hyperactivity Disorder (ADHD); Autism Spectrum Disorder; Premature Birth; Global Developmental Delay

Interventions: Behavioral: SPRINT Intervention; Other: Waitlist Protocol

Sponsors: Nanyang Technological University; Agency for Science, Technology and Research (A*STAR); KK Women’s and Children’s Hospital; Institute for Human Development and Potential (IHDP), Singapore

Not yet recruiting

Defining and Assessing Empathic Communication in Patient Portal Secure Messages: Adapted Coding Framework Development Study

Background: Empathic communication in the clinical setting has been associated with improved clinical outcomes, decreased anxiety, and increased patient satisfaction, treatment adherence, and trust. Despite the recent growth in patient portal use, the expression of empathic communication through patient portal secure messages is not well understood. Objective: This study aimed to construct a coding schema to define and assess empathic opportunities initiated by patients and primary care clinicians’ responses to these opportunities within a patient portal messaging environment. Methods: Data for this study included adult patient secure messages and responding messages from clinicians working in family practice clinics within a regional health care system serving central and northeast Pennsylvania between January 2018 and December 2023. We conducted a manual review of messages using the Empathic Communication Coding System as a guiding framework, which defines empathic opportunities created by patients and corresponding empathic responses by clinicians. We double-coded 500 patient messages for 3 empathic opportunity types: statements of emotion, progress, and challenge. Coding definitions were iteratively updated to describe specific textual cues unique to the patient portal context. This procedure was repeated to code for empathy in clinician responses to empathic opportunities. An additional 100 patient messages were double-coded for interrater reliability testing, and 500 patient messages were single-coded using the finalized coding schema. Results: Among 1100 patient messages coded, 576 (52.4%) included an empathic opportunity. Of these messages, 100 (17.3%) included a statement of emotion, 85 (14.7%) included a statement of progress, and 539 (93.6%) included a statement of challenge. Statements of challenge were primarily characterized by patients explicitly describing physical or mental health issues, a barrier in care, or difficulties in their personal lives. Among the 576 patient messages with empathic opportunities, 446 (77.4%) received at least 1 response from a clinician. Clinicians sent 483 response messages, of which 64 (13.2%) expressed empathy. Conclusions: While patients created empathic opportunities in over half of patient portal secure messages, primary care clinicians infrequently responded with empathy. The findings of this study provide initial evidence of gaps in empathic communication within patient portal secure messages and lay the groundwork for using artificial intelligence models to systematically measure and improve this communication across the patient portal messaging system.
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Protein Protects Against Tau Tangles, Synaptic Loss in Mouse Model of Tauopathy

Alzheimer’s disease (AD) and many other forms of neurodegeneration share a common culprit. In these diseases, tau proteins that normally stabilize neuronal microtubule filaments within nervous system networks instead form noxious knots and gradually disrupt the circuits they would otherwise preserve.

Scientists at Sanford Burnham Prebys have now shown that a different protein known as SORLA offers protection against the effects of these lethal loops. The results of the researcher’s’ study in mice suggests that future research may yield new treatments capable of boosting this protein’s ability to defend the brain.

Timothy Huang, PhD, assistant professor in the Center for Neurologic Diseases at Sanford Burnham Prebys, is senior and corresponding author of the team’s published paper in Science Advances, titled “SORLA up-regulation suppresses pathological effects in aged tauopathy mouse brain,” in which they concluded “These findings reveal a protective role for SORLA in multiple aspects of tauopathy pathogenesis and highlight its potential as a  therapeutic target.”

Normally, tau proteins are found throughout the brain and nervous system, helping to maintain the shape and structure of our neuronal wiring. But in certain diseases, including Alzheimer’s disease, tau proteins clump together inside nerve cells, forming what are known as tau tangles. These toxic tangles are linked to cognitive impairment and nerve cell death in diseases known as tauopathies. “In AD, amyloid-β (Aβ) plaques and neurofibrillary tangles (NFTs) comprising hyperphosphorylated tau accumulate in brain,” the authors explained.

The new study focused on the safeguarding capabilities of protein known as SORLA. “A role for the trafficking receptor SORLA (Sortilin-related receptor containing LDLR class A repeats) in reducing Aβ levels has been well established,” the investigators continued. “… however, relatively little is known with respect to whether and how SORLA can potentially affect tau pathology in vivo.”

Timothy Huang added, “In the last 15 or 20 years, considerable data has come out from our lab and other groups showing that SORLA can suppress one of the hallmarks of Alzheimer’s disease—amyloid-beta generation and accumulation. Very little was known, however, about whether SORLA affected the tau tangles reflected on the other side of the coin in Alzheimer’s disease.”

SORLA is expressed in both neurons and glia in mouse and human brain, the authors noted. For their newly reported study the team began by crossbreeding mice that produce extra human SORLA protein, with PS19 (P301S) mice that develop tau tangles, brain atrophy and cognitive deficits. This new mouse model enabled experiments to determine SORLA’s effects on tau protein buildup and its resulting harms.

Their studies showed that an overabundance of SORLA protein protected against a number of biological processes linked to the formation of tau tangles and progression of neurodegeneration. These include reducing the addition of too many phosphate groups to tau—known as hyperphosphorylation—and the ability of misshapen tau to serve as “seeds” that attract more tau and form clumps. This protection also extended to preservation of the synapses at the junction between neurons and the brain’s ability to adjust these connection points—which is called synaptic plasticity. “Using complementary approaches, we show that SORLA overexpression attenuates ventricular enlargement, tau phosphorylation and seeding, synaptic loss, impaired synaptic plasticity, and glial hyperactivation in the PS19 mouse brains,” the team wrote in summary.

An overabundance of SORLA protein protects against a number of biological processes linked to the formation of tau tangles and progression of neurodegeneration. These include reducing the addition of too many phosphate groups to tau, known as hyperphosphorylation. In these biopsy images, less phosphorylated tau—stained to appear green—has accumulated in the bottom sample overexpressing SORLA. [Tim Huang, Huijie Huang, Sanford Burnham Prebys]
An overabundance of SORLA protein protects against a number of biological processes linked to the formation of tau tangles and progression of neurodegeneration. These include reducing the addition of too many phosphate groups to tau, known as hyperphosphorylation. In these biopsy images, less phosphorylated tau—stained to appear green—has accumulated in the bottom sample overexpressing SORLA. [Tim Huang, Huijie Huang, Sanford Burnham Prebys]

“When you upregulate SORLA, you can suppress the negative effects found in tauopathies,” said first author Huijie Huang, PhD, a staff scientist in the Huang lab at Sanford Burnham Prebys. “We found there was less brain atrophy and less tau accumulation, which was very exciting to see.”

Because some people have mutations that disable the gene carrying the code for SORLA, Sorl1, the scientists wanted to compare the outcome of having extra SORLA to having none of it at all. Tests of mice genetically modified to lack Sorl1 told a very different story. “The opposite turned out to be true when we deleted the ability to produce SORLA proteins,” said Timothy Huang. “A lack of SORLA exacerbated the harmful effects observed in tauopathies.”

To address how extra SORLA or a lack of SORLA were either ameliorating or aggravating diseases featuring tau tangles, the research team used a combination of sequencing techniques capturing the levels of all proteins and gene expression in each cell, as well as mapping the spatial relationship of RNA and proteins within brain tissue. The scientists found that upregulated SORLA prevented problematic protein production changes in the synapses between neurons while also suppressing other drivers of tauopathy disease progression. They also observed that extra SORLA tamped down on disease-related gene expression patterns in brain cells known as glial cells that support and protect neurons in many ways. “One particularly notable finding that we can build on is the upregulation of a member of the plexin-B family of receptors in the absence of SORLA,” said Huijie Huang.

“There are unique drugs that can target this class of receptors that we may be able to apply to tau-related dementia disorders,” suggested Tim Huang. “One potential future direction is to repurpose these drugs to target overactivation of glial cells and perhaps reverse some of the phenotypes in tauopathies.”

The scientists also want to better understand what happens in each individual cell type when they upregulate or downregulate SORLA. “While it is not possible to specifically determine how cell-specific modulation of SORLA can affect tau using the global transgenic overexpression/deletion models used here, we are interested in further characterizing specific effects of SORLA on tau in neurons, and the extent of SORLA modulation on glia in influencing overall tau pathology,” they stated. The team plans to graft human neurons or glial cells into the mouse brain to study the effects of different SORLA mutations.

“Mouse cells and human cells are different,” said Tim Huang. “Because we’re looking at human disease, it’s more informative if we can observe the modulation and dysfunction of SORLA in the context of a human cell inside of a diseased brain environment.”

This continued research will reveal more knowledge about the ability of SORLA to safeguard against the toxic effects of tau tangles, and how to develop new treatments or repurpose existing therapies to benefit patients suffering from Alzheimer’s disease and other tau-related dementia disorders.

The post Protein Protects Against Tau Tangles, Synaptic Loss in Mouse Model of Tauopathy appeared first on GEN – Genetic Engineering and Biotechnology News.

Integrating cognitive-behavioral training with immersive virtual reality intervention in ADHD: a case report

IntroductionAttention-Deficit/Hyperactivity Disorder (ADHD) is a condition characterized by persistent patterns of inattention and/or hyperactivity-impulsivity. This case highlights the potential benefit of integrating Immersive Virtual Reality (IVR) with cognitive-behavioral therapy (CBT) in the rehabilitation of a child with ADHD. It contributes to emerging evidence by showing how a combined approach may simultaneously target executive, attentional, and motor domains within a single intervention.Case presentationAn 8-year-old child with deficits in sustained and selective attention, impaired executive functioning (including planning and working memory), impulsivity, and difficulties in motor regulation, as revealed during baseline assessments, impacting daily functioning. The patient was diagnosed with combined-type ADHD and underwent a 12-week CBT intervention, followed by integrated IVR-CBT intervention targeting executive functions and self-control, once a week for 12 weeks. The intervention was conducted using the CAREN (Computer Assisted Rehabilitation Environment), an immersive virtual reality platform integrating multisensory input and interactive tasks to promote cognitive and motor engagement. Post-intervention assessments showed improvements in sustained and selective attention, planning, working memory, and balance. There was also an increase in involvement and a reduction in impulsivity.ConclusionThe findings support the hypothesis that immersive, embodied interventions targeting both executive and sensorimotor processes may represent a promising novelty adjunctive rehabilitation approach. Further studies are needed to evaluate efficacy, generalizability, and to confirm these findings in larger samples. This case report was prepared in accordance with the CARE Guidelines.

Thyroid-stimulating hormone, fasting blood glucose and suicidal ideation in Chinese adolescents with major depressive disorder: a cross-sectional study

BackgroundThyroid function and glycolipid metabolic alterations are often associated with major depressive disorder (MDD), yet their roles in suicide risk among adolescents with MDD remain unclear. This study aimed to investigate thyroid-stimulating hormone (TSH) levels, glycolipid metabolism parameters, and their associations with suicidal ideation (SI) in adolescents with MDD.MethodsThis cross-sectional study was conducted at one general hospital and one psychiatric hospital in Anhui Province, China. Socio-demographic data and laboratory parameters were collected from participants, and the patients’ depressive symptoms and SI severity were assessed using the 24-item Hamilton Depression Rating Scale (HAMD-24) and the Positive and Negative Suicide Ideation Inventory (PANSI), respectively. TSH levels and glycolipid metabolism parameters were also measured.ResultsA total of 146 adolescents with MDD and 70 healthy controls (HCs) were enrolled in this study. Compared with HCs, patients had lower fasting blood glucose (FBG) levels (P < 0.001). Logistic regression analyses showed that a worse relationship with family, a higher HAMD-24 total score, and higher TSH and FBG levels were independently associated with concurrent SI in adolescents with MDD (all P < 0.05). Furthermore, receiver operating characteristic (ROC) curve analysis showed that the combination of these four factors had a good discriminatory ability for SI, with an area under the curve (AUC) of 0.851.ConclusionIn this cross-sectional study, TSH and FBG levels were associated with SI in adolescents with MDD. Nevertheless, whether these parameters can serve as clinically useful biomarkers requires further validation in larger prospective studies.

Effects of exercise interventions on executive function in autism spectrum disorder: a three-level meta-analytic review

ObjectiveThis study aimed to use a three-level meta-analysis to examine the effects of exercise interventions on executive function (EF) in children and adolescents with autism spectrum disorder (ASD), and to explore the relationship between exercise dose and intervention effects through subgroup analyses.MethodsA systematic search was conducted in Web of Science, PubMed, Embase, and the Cochrane Library from database inception to November 17, 2025. All included studies were randomized controlled trials. A three-level random-effects model was applied to integrate multiple dependent effect sizes. Hedges’ g was used to calculate effect sizes, and negative values indicated improvements in EF following exercise interventions. Study quality was assessed using the PEDro scale, and publication bias was evaluated using Egger’s regression and the trim-and-fill method.ResultsSeventeen studies involving 626 participants were included. Exercise interventions produced a moderate and significant improvement in EF (g = –0.34, p < 0.0001) with low heterogeneity (Q = 50.42, p =0.268). Subgroup analyses showed that only intervention duration significantly moderated the effects, with programs lasting ≥10 weeks yielding the greatest benefits.ConclusionExercise interventions significantly improve EF in children and adolescents with ASD, with the largest effect sizes observed in interventions lasting ≥10 weeks. Further large-scale studies are needed to clarify dose–response relationships and inform optimal exercise prescriptions. This meta-analysis was designed and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251236112