The aim of this study was to assess the influence of sex on diagnostic stability in first-episode psychosis during the first year of follow-up. This was a prospective, observational study of 256 patients with FEP, of whom 188 (73.4
There are no robust, reliable and easy to administer tests to screen for mild cognitive impairment (MCI) in people living with diabetes. Since the retina is ontogenically brain-derived, we hypothesised that retinal biomarkers could be used, alone or in combination with other simple tests, to screen for MCI in people with diabetes. Baseline data from participants screened for RECOGNISED, a Horizon 2020-funded European project, were analysed. Main eligibility criteria for RECOGNISED included age ≥65 years, type 2 diabetes of over 5 years standing, no previous history of stroke or neurodegenerative disease, and no overt diabetic retinopathy or only mild-to-moderate non-proliferative diabetic retinopathy. Baseline characteristics of participants, including scores from the Montreal Cognitive Assessment test (MoCA) and Self-Administered Gerocognitive Examination, the Diabetes Specific Dementia Risk Score (DSDRS) and ophthalmological endpoints gathered from standardised seven field colour fundus photography, spectral domain optical coherence tomography, microperimetry and a hand-held portable electroretinography device (RETeval), were obtained and used in the work presented here as potential screening predictors for presence of MCI. MCI and normocognition (NC) were determined based on a full neuropsychological test battery and the Clinical Dementia Rating score. A stepwise selection of variables, based on Akaike’s information criterion, and logistic regression models for predicting MCI were undertaken. Area under the receiver-operating characteristic curve analyses were used to predict the probability of the presence of MCI as well as sensitivity and specificity cut-off points. A total of 313 people living with diabetes (128 with NC and 185 with MCI) were included. People with diabetes with MCI were older (p=0.006) and had fewer years of education (p<0.001), lower retinal sensitivity (p=0.01) and less capacity of gaze fixation (p≤0.001) than those with NC. Statistically significant differences in pupillary area ratio (p=0.002) and photopic b-wave amplitude (p=0.03) were detected between people with diabetes with NC and with MCI. Multivariable logistic regression showed that the best model to identify people with diabetes with MCI was that combining retinal sensitivity, gaze fixation, photopic b-wave amplitude and pupillary size change following stimulation, years of education, DSDRS and MoCA score, with an AUC of 0.84 (sensitivity 79.9, specificity 79.0). The visuo-construction domain was the most affected in people with diabetes with MCI and its impairment was independently related to retinal sensitivity and gaze fixation. The assessment of retinal neurodysfunction in combination with simple clinical variables appears useful to identify people with diabetes with MCI. This strategy could optimise current screening of MCI in people living with diabetes.
Background Antivirals remain an important treatment strategy for persons who experience severe and life-threatening COVID-19. Ensitrelvir is an oral 3CL protease inhibitor with potent antiviral activity. Methods We conducted an international randomized, placebo-controlled trial of ensitrelvir with standard of care (SOC) among adults hospitalized for COVID-19. The primary outcome was clinical recovery assessed by the days to recovery scale through day 60 (DRS-60), analyzed using a Van Elteren test. Results From 2023 to 2025, 589 participants received blinded study treatment (293 ensitrelvir and 296 placebo). Median age was 69 years, 49% were female, 68% were White, and SOC commonly included corticosteroids (61% and 54%) and remdesivir (62% and 60%) in ensitrelvir and placebo groups, respectively. Median DRS-60 category was 6 (IQR: 3-15) in the ensitrelvir and 5.5 (IQR: 3-12) in the placebo group (P = .19), and the OR was 0.82 (95% CI: 0.62-1.09) for a better DRS-60 category with ensitrelvir. Ensitrelvir participants had lower detectable viral antigen in plasma at Day 5 (13.4% vs 25.1%; P < .001). There was no difference in secondary clinical outcomes or prespecified safety outcomes, though the mortality rate was 6.1% vs 4.4% and the frequency of hemorrhagic events was 3.4% vs 0.3% among ensitrelvir and placebo groups, respectively. Conclusions Ensitrelvir treatment did not improve clinical recovery in addition to SOC for adults hospitalized for COVID-19. The lower illness severity in the Omicron era compared with earlier periods in the COVID-19 pandemic and high use of remdesivir and corticosteroids, may have contributed to the lack of clinical benefit.
Normothermic regional perfusion (NRP) is increasingly used in controlled donation after circulatory death (cDCD) to mitigate ischemia-reperfusion injury. While NRP reduces delayed graft function (DGF), its impact on long-term outcomes, particularly in elderly recipients, remains uncertain. We retrospectively analyzed first kidney transplants from cDCD donors in a national registry (2015-2023). Outcomes after NRP were compared with rapid recovery (RR) using 1:1 propensity score matching based on donor/recipient age, comorbidities, and transplant year. A predefined subcohort analysis focused on recipients aged ≥65 years. Endpoints included DGF, hospital stay, renal function, and 5-year graft and patient survival. Among 1414 transplants, 1153 were eligible, and 410 matched pairs were analyzed. DGF and median hospital stay were significantly lower with NRP than with RR (19% vs 34%; odds ratio for RR vs NRP 2.87; 95% CI, 2.1-4.0; P < .001 and 11 vs 13 days; difference -2.0 days; 95% CI, -3.6 to -0.4; P = .012, respectively). No significant differences were observed in estimated glomerular filtration rate trajectories or 5-year overall graft survival (P = .896), death-censored graft survival (P = .666), and patient survival (P = .981). Results were consistent in recipients ≥65 years. In this large real-world cDCD cohort, NRP improved early posttransplant outcomes without influencing midterm graft or patient survival.
The choice of vascular access (VA) plays a key role in the success of hemodialysis (HD). Despite their widespread use, central venous catheters (CVCs) are associated with higher rates of dysfunction, thrombosis, and catheter-related bloodstream infections (CRBSI). We investigated current practices in pediatric HD across European pediatric nephrology centers, focusing on VA choices, infection control measures, and CRBSI management. An online questionnaire was e-mailed to 119 members of the European Society for Pediatric Nephrology (ESPN) Dialysis Working Group and European Pediatric Dialysis Working Group (EPDWG). Descriptive statistics were used to summarize practices across centers, comparative analyses between centers in countries with Human Development Index (HDI) > 0.90 and < 0.90. Thirty-one centers across Europe participated in the survey. CVCs were the primary VA in 73.1
