Dystonia is conventionally attributed to dysfunction in central motor circuits, yet several clinical features, including sensory tricks, task specificity, and abnormalities in somatosensory processing, indicate an influence of sensory input. Whether peripheral sensory afferents are passive conduits to central circuits or contribute to dystonia pathophysiology remains unresolved. To examine whether peripheral sensory afferents participate in dystonia networks beyond their role as upstream inputs. Evidence was synthesized across five domains: phenomenology, electrophysiology, neuroimaging, genetics, and treatment. Priority was given to studies that manipulated or quantified peripheral afferent input and assessed effects on motor output or network physiology. Sensory tricks produce rapid improvement across dystonia phenotypes, indicating that afferent input can influence motor output. Electrophysiological studies demonstrate impaired afferent modulation of intracortical inhibition, abnormal integration of converging sensory inputs, and reduced reflex suppression at spinal and brainstem levels. Neuroimaging studies show somatosensory representations and changes in network activity. Genetic and animal studies implicate dystonia-associated pathways in the regulation of proprioceptive afferent signaling, and sensory-neuron-specific manipulations can induce or reduce abnormal movements. Therapeutic interventions, including peripheral stimulation, botulinum toxin, and sensory blockade, have been associated with reductions in dystonic symptoms through mechanisms that alter afferent input. Findings from phenomenological, electrophysiological, neuroimaging, genetic, and therapeutic studies indicate that peripheral sensory afferents contribute to dystonia networks. These observations are consistent with a model in which abnormalities of afferent gating, sensory integration, and somatosensory representation contribute to dystonic expression across multiple levels of the neuraxis, with potential implications for therapeutic targeting.

The aims were as follows: (1) to adapt the Sophia Observation withdrawal Symptoms-Paediatric Delirium (SOS-PD) screening tool for use in neonates (SOS-ND), (2) to estimate the accuracy of SOS-ND (used by nurses) compared to assessment by a child psychiatrist using an adapted version of Vanderbilt Assessment of Delirium in Infants and Children and (3) to compare the outcome of assessments of the child psychiatrist and neonatologists.

A descriptive and comparative design was used. An interdisciplinary group adapted the SOS-PD to develop the SOS-ND. We compared three assessments done on the same day in hospitalized neonates with postmenstrual age at 35-44 weeks in a Danish level IV neonatal intensive care unit.

Twenty-six neonates were assessed and five were diagnosed with delirium by the child psychiatrist. An accuracy of 88% [CI 69.9-97.6] was found between SOS-ND screenings during the preceding 24 h and the child psychiatrist's assessment. Neonatologists did not positively identify delirium in the 26 neonates.

The findings suggest that nurses and the child psychiatrist observe the same condition. By contrast, the absence of delirium diagnosed by experienced neonatologists suggests differences in the conceptualization of the underlying neuropsychological condition.

Because of their involvement in outbreaks, hantaviruses as emerging zoonotic diseases have been regarded a public health issue. Recent reports have identified CNS symptoms of hantavirus infection, although the data are still relatively sparse and inconsistent, especially for Andes orthohantavirus (ANDV) and to a lesser extent Puumala virus (PUUV). Reported neurological features include headache, dizziness, altered mental state, seizures, focal deficits, and peripheral neuropathy, possibly accompanied by ocular symptoms such as impaired vision and photophobia. The results of neuroimaging have been inconsistent and nonspecific, ranging from hemorrhagic or edematous changes to thalamic or brainstem abnormalities and splenial lesions. Evidence could suggest that endothelial dysfunction, capillary leak, inflammatory damage, and, in certain situations, potential intrathecal immunological responses or direct viral presence may all contribute to CNS involvement. However, most evidence stems from case reports or case series, and causative neuroinvasion may not have been fully demonstrated. Recent studies, especially the recent ANDV-associated outbreak, may emphasize the necessity for rigorous neurological examination. A better understanding of the neurological range of hantavirus infection may enhance detection, risk stratification, and supportive therapy.

Intensive care unit (ICU) residents work in highly stressful environments characterized by clinical uncertainty and critically ill patients. During residency, physicians need to adapt to demanding workplace conditions while also navigating stressors related to their stage of life. How residents respond to stress depends on multiple personal and psychological factors, including coping mechanisms. Excessive stress may impair performance and negatively affect patient outcomes, underscoring the need to better understand its determinants.

This study aimed to identify baseline psychological factors and personal characteristics measured prior to ICU residency that influence stress levels across a three-week rotation.

We analyzed a secondary dataset from 54 ICU residents during a three-week clinical rotation. Before the rotation, participants completed validated measures of stress, burnout, affect, depression, anxiety, personality traits, social support, and conflict. Stress was assessed twice daily across the rotation. Associations between baseline factors and stress trajectories were estimated using generalized estimating equations (GEE).

Compared with PGY-1 residents, PGY-2 and PGY-3 residents reported lower daily across the rotation. Higher trait anxiety and higher negative affect at baseline predicted higher stress, whereas higher agreeableness predicted lower stress, and higher conscientiousness predicted higher stress. Burnout due to exhaustion at baseline was counterintuitively associated with lower reported stress during the rotation. Other baseline factors, including burnout due to disengagement, depression, social support, and conflict, were not significantly associated with stress.

Baseline psychological profiles meaningfully shape how residents experience stress during ICU rotations. Identifying these factors prior to clinical training may help target interventions to support residents at higher risk of stress, thereby enhancing both physician well-being and patient safety.

Arterial spin labeling (ASL) MRI noninvasively quantifies cerebral blood flow (CBF), but its role as a mechanistic biomarker and surrogate endpoint in trials of cognitive impairment remains undefined. This review evaluates evidence linking regional CBF to cognition across Alzheimer's disease, mild cognitive impairment (MCI), and cerebral small vessel disease (SVD), with particular emphasis on CADASIL as a mechanistically informative model.

Multipostlabeling-delay ASL, spatial coefficient of variation metrics, and harmonized processing pipelines have improved reproducibility. Cross-sectional and longitudinal studies consistently link reduced CBF to cognitive impairment, with baseline CBF predicting cognitive decline, MCI-to-Alzheimer's disease conversion, white matter hyperintensity progression, and vascular events. In CADASIL, CBF is independently associated with cognitive performance and predicts subcortical hyperintensity progression over 2 years. Interventional data from SPRINT MIND, PRESERVE, and pilot lecanemab studies indicate that ASL-CBF is responsive to therapy.

Within the FDA-NIH BEST framework, ASL-CBF appears to meet several criteria consistent with a reasonably likely surrogate endpoint, capturing upstream, potentially reversible hemodynamic dysfunction beyond established structural markers. CADASIL provides an optimal context for qualifications. Larger clinical trials linking treatment-induced CBF changes to clinical benefit, further protocol harmonization, and regulatory engagement are needed to translate ASL-CBF into a validated trial endpoint.

Missed nursing care threatens quality and safety, but patient counts may not capture shift-level demands. We examined associations of patient-count and perceived workload indicators with missed care, separating within- and between-nurse effects.

A multicenter observational study using repeated shift-level measurements.

The study included 502 shift records from 213 nurses in 16 medical-surgical units across six Italian hospitals; the primary analysis included 480 records from 196 nurses. Patient-count indicators were nurse-reported numbers of assigned, isolated, and specialist-care patients; perceived workload included work rhythm/quantity, mental workload, emotional workload, and work organization. Grouped-binomial generalized estimating equations modeled the proportion of applicable activities missed, with nurse clustering, robust standard errors, exchangeable correlation, and hospital fixed effects. Workloads were decomposed into within- and between-nurse components, and four missed-care domains were examined.

Nurses reported a mean of 6.5 missed activities per shift; 29.9% of shifts had no missed care. The seven workload indicators were jointly associated with missed care (robust Wald χ²[7] = 22.95, p = 0.002). Work rhythm/quantity was the only individual indicator with a nominal p-value below 0.05 (OR 1.24 per SD, 95% CI 1.03-1.49; p = 0.023), but it did not remain significant after Benjamini-Hochberg correction (q = 0.159). Assigned patient count was not clearly associated (OR 1.14, 95% CI 0.94-1.40; p = 0.192). In exploratory within-between analyses, the between-nurse work rhythm/quantity component was associated with missed care (OR 1.42, 95% CI 1.11-1.82; p = 0.005), whereas the within-nurse component was not (OR 1.03, 95% CI 0.90-1.17; p = 0.649). Domain-specific associations did not remain significant after multiplicity adjustment.

The workload indicators were jointly associated with missed nursing care, with secondary analyses indicating that the global signal was evident in the perceived-workload block. However, no individual workload indicator remained statistically significant after multiplicity adjustment. Work rhythm/quantity and its between-nurse component should therefore be regarded as exploratory signals requiring confirmation in studies with denser repeated measurements.

Workload surveillance research should evaluate patient-count and multidimensional perceived-workload indicators together. The present coefficient-specific findings are insufficient to support the operational use of work rhythm/quantity as a stand-alone workload indicator.

Patients with inflammatory arthritis (IA) often report pain not necessarily coupled to active inflammation. We previously demonstrated that a significant subset of patients with newly diagnosed IA report features of centrally mediated pain. In this prospective study following the same IA cohort, we tracked the relative contributions of inflammatory/noninflammatory mechanisms to pain over 2 years. We used patient-reported outcome measures (PROMs), clinical data (including ultrasound), and standardised quantitative sensory testing. Mixed-effects regression models examined longitudinal associations. We recruited 66 patients. At 6, 12, and 24 months, 62%, 57%, and 49% of individuals, respectively, reported persistent pain (numerical rating scale ≥3). Using factor-derived composite scores, baseline and longitudinal inflammation was not associated with subsequent pain (b -0.05, P = 0.87), whereas higher centrally mediated pain markers predicted less pain reduction (b 1.41, 95%, P < 0.001). Baseline PROMs of centrally mediated pain (fibromyalgia severity average marginal effect [AME]: 0.94, P < 0.001, painDETECT AME: 1.03, P < 0.001) and mental health (eg, Generalised Anxiety Disorder-7 AME: 1.08, P < 0.001) were the strongest predictors of persistent pain. Baseline trapezius pressure pain threshold (PPT) and conditioned pain modulation (CPM) pain detection threshold (PDT) effect showed modest association (trapezius PPT AME: -0.51, P = 0.054, CPM PDT effect AME: -0.49, P = 0.051) whereas temporal summation of pain (AME: 0.09, P = 0.756) and CPM pain tolerance threshold effect (AME: -0.01, P = 0.964) did not. In our cohort, persistent pain was associated with higher baseline and longitudinal scores for centrally mediated pain according to PROMs rather than inflammation according to joint ultrasound. In IA, early identification and treatment of features of centrally mediated pain may improve pain-related outcomes.

CFTR modulators (CFTRms) have transformed cystic fibrosis care, yet concern exists regarding their mental health safety profile.

To provide further information, we conducted an analysis of CFTRm-related mental health disorders using two spontaneous pharmacovigilance reporting databases in real-world settings.

We analyzed reports from the French Pharmacovigilance Database (FPD) and VigiBase, the WHO global individual case safety reports database. Reports recorded between 2012 and 2024 involving any CFTRm and psychiatric disorders were included. In VigiBase, we conducted a case-non case, disproportionality analysis using the Reporting Odds Ratio (ROR), overall and stratified by age group (pediatrics vs. adults) and by CFTRm type. This study was conducted in accordance with the STROBE and the READUS-PV guidelines.

In the FPD, 116 cases were analyzed. ELX/TEZ/IVA was suspected in 98% of cases and no single case was reported with ivacaftor alone. Sleep (61%), mood (37%), and anxiety disorders (27%) were the most frequently reported, with suicidal behaviors being infrequent, including 6 suicide attempts and no completed suicide. In VigiBase (n = 3,407), sleep disorders predominated in children, whereas mood and suicidality disorders were most frequent in adolescents. The median time to onset was 60 days (Q1-Q3: 12-150 days). Mental health disorders were disproportionately reported with CFTRms, particularly ELX/TEZ/IVA, while they were not with other combination therapies, compared to other drugs in the database. Disproportionality signals were slightly stronger in pediatrics than in adults.

CFTRms, especially ELX/TEZ/IVA, are associated with increased reporting of mental health disorders, predominantly sleep and mood disorders. Pediatrics appear to be particularly affected. Prospective observational studies are warranted to confirm these findings and elucidate underlying pathophysiological mechanisms.

OSF: mfyx3.

Schizophrenia is known to be accompanied by chronic sterile inflammation and elevated circulating cell-free DNA (cfDNA) levels, but the cellular sources have not been fully identified. The aim of this study was to test the hypothesis regarding the contribution of NETosis to the increase in cfDNA and to investigate associations between cfDNA and DNA-associated molecules levels with clinical features and antipsychotic dosage in schizophrenia.

This case-control study included 63 healthy subjects and 60 patients with schizophrenia. Concentrations in plasma of total, nuclear, and mitochondrial cfDNA, total histone H3, and anti-DNA antibodies as non-specific markers of cell stress/death, and also high-mobility group protein B1 (HMGB1) and citrullinated histone H3 (CitH3) as NETosis-related biomarkers, were analysed using fluorimetric analysis, digital PCR, and ELISA.

Total cfDNA levels increased concomitantly with increases in nuclear cfDNA, histone H3, and anti-DNA antibodies, indicating a nuclear origin of plasma cfDNA, while mitochondrial cfDNA decreased in schizophrenia. Correlation analysis revealed a decrease in mitochondrial cfDNA with increasing antipsychotic therapy dosage. NETosis-related markers, CitH3 and HMGB1, did not changed significantly.

These findings did not provide direct evidence linking active NETosis to elevated cfDNA levels, suggesting the involvement of other cell death processes; however, they highlighted the associations between cfDNA and clinical features in schizophrenia.

Image- and video-based social media have been linked to body dissatisfaction and eating pathology, partly through increased appearance-based social comparison and self-focused attention. The Social Media Appearance Preoccupation Scale (SMAPS) assesses three behaviors relevant in this context: Online Self-Presentation, Appearance-Related Activity, and Appearance Comparison. Higher scores on these dimensions have been linked to more intensive social media use, increased anxiety, depressive symptoms, and disordered eating. However, research has largely relied on English-speaking, non-clinical samples. The present studies therefore aimed to translate and validate a German version of the SMAPS and to compare appearance-related social media behaviors between individuals with eating disorders and healthy controls.

The scale was translated in a systematic translation-back-translation procedure and then examined in two cross-sectional studies. In Study 1, N = 363 young adults completed a survey with the aim of testing the factor structure of the German SMAPS and its associations with eating disorder pathology, general psychological distress, and problematic internet use. In Study 2, multivariate analysis of variance was used to compare German SMAPS scores between n = 21 outpatients with diagnosed eating disorders and n = 37 healthy controls.

The three-factor structure of the German SMAPS showed acceptable model fit. All subscales exhibited good internal consistency (ω = 0.83-0.88). Of the three dimensions, Appearance Comparison was most strongly associated with eating disorder pathology and showed the most consistent associations with psychological distress and problematic internet use. It also significantly differentiated patients with eating disorders from healthy controls (p = .004, η²_p = 0.14, 90% CI [0.03, 0.29]).

The German SMAPS is a reliable and valid tool for assessing appearance-related social media behaviors in German-speaking populations. The findings suggest that the three dimensions may differ in clinical relevance, with appearance comparison warranting particular attention in future research.