This study aims to evaluate the efficacy of Apnex, Inspire, and ImThera hypoglossal nerve stimulation (HGNS) devices in changing the severity of obstructive sleep apnea (OSA). ology: A systematic search was conducted across the databases to collect baseline and postoperative outcome measures. Articles were then filtered and data from post-filtration was extracted. The efficacy of each device was assessed individually, and the reported outcomes were analyzed at short-term (≤ 1 year) and long-term (> 1 year) intervals. A total of 30 papers were included; 26 were single-arm studies encompassing 549 middle-aged overweight patients. Four RCTs included 273 participants. Results show that HGNS is an effective and safe treatment option. The Inspire device significantly improved, reducing the apnea-hypopnea index (AHI) by -20.14 events/h in the short term and -15.91 events/h in the long term. It also decreased the oxygen desaturation index (ODI) by -14.16 events/h (short term) and -12.95 events/h (long term). Patient-reported outcomes showed decreased Epworth Sleepiness Scale (ESS) scores by -5.02 (short term) and -4.90 (long term) and improved Functional Outcomes of Sleep Questionnaire (FOSQ) scores by 3.58 (short term) and 3.28 (long term). The Apnex and the ImThera devices featured similar improvements but to a lesser extent. Hypoglossal nerve stimulation is a safe and effective treatment for patients with OSA, exhibiting high adherence and satisfaction rates. However, it is important to note the potential for refining selection criteria to include a wider spectrum of patients with OSA.

This review provides an updated overview of the pathogenesis, classification, current management, and emerging therapies for diabetic retinopathy (DR). DR development involves dysregulation of the polyol pathway, formation of advanced glycation end products, activation of protein kinase C, and upregulation of vascular endothelial growth factor (VEGF). Disruption of the retinal neurovascular unit, including neurons, glial cells, and vascular elements, also plays a pivotal role, leading to microvascular damage, neurodegeneration, and inflammation. DR progresses from non-proliferative (NPDR) to proliferative stages (PDR) characterized by retinal neovascularization. Management emphasizes glycemic and blood pressure control, with advanced stages treated using laser photocoagulation, vitrectomy, and intravitreal anti-VEGF injections. Novel imaging technologies like optical coherence tomography angiography (OCTA) and electroretinography (ERG) enable early diagnosis and disease monitoring. Genetic factors, including VEGF polymorphisms and genes linked to oxidative stress and angiogenesis, significantly influence DR susceptibility. Innovative treatments under investigation include nanotechnology-based drug delivery, microRNA-targeted therapies, and AAV-mediated gene therapies aimed at anti-angiogenic pathways. Stem cell-based strategies utilizing adipose, bone marrow, amniotic, and umbilical cord-derived. It shows promise for retinal repair and neuroprotection. Future directions encompass CRISPR-Cas9 gene editing for precise genomic interventions, personalized medicine approaches, and integrated screening programs powered by artificial intelligence. A multifaceted approach involving risk factor modification, lifestyle interventions, advanced therapeutics, and cost-effectiveness analysis is essential to reduce the public health burden of diabetic retinopathy.

Background: In the absence of a cure for dementia, efforts towards prevention remain the most worthwhile interventions. Separate from their benefits to control blood pressure, Angiotensin (Ang) II‐stimulating antihypertensives may have additional neuroprotective benefits that could reduce the risk of cognitive impairment, compared to Ang II‐inhibiting drugs. We aim to evaluate the difference between Ang II‐stimulating antihypertensives versus Ang II‐inhibiting antihypertensives on cognitive measures indicative of dementia. Method: We conducted a retrospective, cross‐sectional analysis of existing data from an ongoing clinical trial, BrainSafe. Baseline cognitive data of 705 participants were linked to two‐year pre‐enrollment electronic medical records data. Based on their medication use, participants were classified into four groups: control (non‐users), Ang II‐stimulating antihypertensives users, Ang II‐inhibiting antihypertensives users, and mixed users. Individual cognitive test scores were standardized into z‐scores, adjusted for demographics, using non‐users as the reference group. Compound scores were constructed for specific cognitive domains (i.e., memory, language, processing speed and executive functioning) and global cognitive score was calculated as the average z‐score across all domains. To compare cognitive performance across groups, generalized linear models with least squares (LS) means were used. Models were adjusted for covariates, including strong anticholinergic use, number of medications, and average blood pressure measurements. Result: The table describes characteristics of participants. Compared to the control group, Ang II‐stimulating antihypertensives users had positive β values for memory (β=0.13, SE=0.13), language (β=0.14, SE=0.14), executive functioning (β=0.02, SE=0.14), processing speed (β=0.04, SE=0.16), and global cognitive score (β=0.11, SE=0.10) (see Figure). In contrast, Ang II‐inhibiting antihypertensives users had negative β values for memory (β=‐0.01, SE=0.09), language (β=‐0.09, SE=0.10), executive functioning (β=‐0.02, SE=0.10), processing speed (β=‐0.15, SE=0.12), and global cognitive score (β=‐0.04, SE=0.08). Mixed users had negative β values for all domains, compared to control, except for memory: memory (β=0.03, SE=0.10), language (β=‐0.02, SE=0.11), executive functioning (β=‐0.04, SE=0.11), processing speed (β=‐0.17, SE=0.12), and global cognitive score (β=‐0.02, SE=0.08). Conclusion: Ang II‐stimulating antihypertensives users consistently exhibited higher cognitive scores across all measured domains compared to both the control group and Ang II‐inhibiting antihypertensives users. Mixed users performed worse in all domains, compared to the control group, except for memory.

Background: Over half of ambulatory older adults are prescribed at least one anticholinergic medication to address a myriad of conditions, including incontinence, allergies, anxiety and insomnia. Longitudinal studies suggest an association between anticholinergic exposure and risk of dementia. Prior studies often rely on crude exposure measures (use vs. non‐use), lacking detailed analysis of anticholinergic effects across different cognitive domains indicative of dementia. This study adopts a more comprehensive exposure measure, considering dosage, duration, and strength, to explore its association with a spectrum of cognitive assessments commonly used in diagnosing dementia.Method: A retrospective observational design was employed, analyzing one‐year electronic prescription data of 735 participants (age, 70.12±6.33; 75.2% Female; 88.3% White) recruited in two clinical trials (BrainSafe and R2D2 studies). Anticholinergic exposure was quantified using total standardized daily doses (TSDD). Outcomes were cognitive test scores of phonemic fluency, semantic fluency, symbol digit modalities, oral trail making (OTMT Part A and B), and hopkins verbal learning test (HVLT) collected at baseline. Generalized Linear models were applied to evaluate the impact of TSDD on cognitive performance, and Least Square means with Tukey’s adjustment were utilized to compare effects across anticholinergic subclasses. Subclasses compared were antimuscarinics, antihistamines, skeletal muscle relaxants and antidepressants. Covariates included in all the models are age, gender, ethnicity, educational level, and Charlson Co‐morbidity Index (CCI) Scores.Result: Higher anticholinergic exposure was associated with poorer performance in semantic fluency test (p‐value = 0.0002) and OTMT‐A (p‐value = 0.0034). The comparison between anticholinergic subclasses showed that antimuscarinic only users performed significantly better in HVLT total recall test than those using a combination of antihistamines and antimuscarinics (p‐value = 0.0037), after adjusting for TSDD and other covariates. Both antihistamine users and antimuscarinic users exhibited worse outcomes than antidepressant users in semantic fluency (p‐value = 0.008 and p‐value = 0.005, respectively).Conclusion: This study indicates an adverse dose‐duration effect of anticholinergic drugs on language, complex attention, executive functioning, and processing speed. Specifically, antimuscarinics users and antihistamine users demonstrated inferior performance in language, processing speed, and executive function compared to those on antidepressants. Additionally, combination use of antihistamines and antimuscarinics may lead to worse memory recall compared to the use of antimuscarinics alone.

Introduction: Older adults have a higher prevalence of pain and are more likely to receive long‐term opioid therapy (LTOT) compared to other age groups. They are also at elevated risk of opioid‐related adverse events due to physiological changes and polypharmacy. This systematic review aimed to identify predictors and clinical outcomes associated with LTOT in older adults. Methods: We searched PubMed, Embase, and Cochrane Library to identify randomized clinical trials (RCT) and observational studies published from inception until July 31, 2025. We included studies that examined opioid use for ≥ 90 days and included participants aged ≥ 60 years. Data were synthesized using harvest plots and narrative synthesis. The Newcastle–Ottawa Scale was used for risk of bias assessment. Results: Forty‐one observational studies were included; no RCTs met the inclusion criteria. Patient‐related factors associated with LTOT across most studies were low income/wealth ( n = 6/6 studies), depressive disorders ( n = 6/9 studies), and dual insurance eligibility/enrollment ( n = 4/6 studies). Prescription/dispensation‐related factors associated with LTOT across most studies were opioid use before surgery/trauma ( n = 6/6 studies), prior/concurrent use of benzodiazepines ( n = 6/6 studies), anxiolytics/sedatives/hypnotics ( n = 3/4 studies), anticonvulsants ( n = 3/4 studies), opioid use after surgery/trauma ( n = 3/3 studies), long‐acting opioids ( n = 3/3 studies), and longer duration of initial opioid ( n = 2/2 studies). Regarding outcomes of LTOT, most studies reported positive associations between LTOT and hospital readmission/emergency department visit ( n = 3/4 studies), revision surgery ( n = 2/2 studies), health care costs ( n = 2/2 studies), opioid overdose ( n = 1/1 study), and falls ( n = 1/1 study). Evidence on the association of LTOT with mortality and fractures was inconclusive. Conclusions: This systematic review identified several predictors and adverse outcomes associated with LTOT in older adults. However, no evidence exists regarding the effectiveness of LTOT for pain management in this population. Prospective studies with long‐term follow‐up are needed to address this gap and inform benefit‐harm assessment of LTOT in clinical practice.