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Association between epilepsy duration and glymphatic dysfunction assessed by DTI-ALPS: A systematic review and meta-analysis

2026-06-09T07:49:01Z

Title: Association between epilepsy duration and glymphatic dysfunction assessed by DTI-ALPS: A systematic review and meta-analysis Authors: Lee, Su Ji; Cho, Soomi; Shin, Hui Jin; Lee, Hyunji; Cho, Minjae; 신희진 Abstract: Objective: To systematically evaluate whether epilepsy duration is associated with glymphatic dysfunction as measured by diffusion tensor image analysis along the perivascular space (DTI-ALPS). Methods: A systematic review and correlation-based meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, Embase, Scopus, Web of Science, and Google Scholar were searched from inception through January 20, 2026, for observational studies reporting correlations between epilepsy duration and DTI-ALPS values. Correlation coefficients were pooled using random-effects models after Fisher's z transformation. Subgroup analyses and meta-regression were performed to explore heterogeneity. Results: Ten observational studies comprising 449 patients with epilepsy were included. Pooled analysis demonstrated a significant negative association between epilepsy duration and the DTI-ALPS index (r = -0.37, 95% confidence interval [CI]: -0.53 to -0.19), indicating lower glymphatic function with longer disease duration. A significant association persisted in temporal lobe epilepsy (r = -0.30, 95% CI: -0.54 to -0.02) and was stronger in late-onset epilepsy (r = -0.68, 95% CI: -0.79 to -0.54). Meta-regression identified age as a significant moderator of effect size, whereas mean disease duration did not significantly explain variability. Sensitivity analyses confirmed the robustness of findings, and no publication bias was detected. Conclusion: Longer epilepsy duration is associated with greater glymphatic dysfunction as measured by DTIALPS. Age significantly modulates this relationship, suggesting that seizure chronicity and aging-related vulnerability may synergistically influence perivascular clearance pathways. These findings support DTI-ALPS as a promising non-invasive marker of cumulative glymphatic burden in epilepsy and provide a quantitative framework for future longitudinal studies.

Role of Fat-Free Mass-Adjusted Cardiorespiratory Fitness in Predicting Hospitalization Risk in Patients with Heart Failure

2026-06-12T08:09:38Z

Title: Role of Fat-Free Mass-Adjusted Cardiorespiratory Fitness in Predicting Hospitalization Risk in Patients with Heart Failure Authors: Kim, Young Seok; Lee, Wonhee; Yi, Tae Im; 김영석 Abstract: Purpose: Reduced cardiorespiratory fitness (CRF) is associated with hospitalization risk in heart failure (HF). Traditional peak oxygen uptake (VO2) scaling uses total body weight (TBW), potentially underestimating CRF due to adiposity. The prognostic value of fat-free mass (FFM)-adjusted peak VO2 remains unclear, particularly in Asian populations. Materials and Methods: A retrospective cohort study included HF patients who underwent cardiopulmonary exercise testing and bioelectrical impedance analysis. Two peak VO2 cutoffs-14 mL/TBW kg/min and 19 mL/FFM kg/min-were applied to predict all-cause and HF-specific 1-year hospitalization. The prognostic performance was assessed using Cox proportional hazards models adjusted for the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score. Likelihood ratio tests were conducted to evaluate the incremental value of adding the FFM-adjusted cutoff. Results: A total of 83 patients (mean age, 60.0 years; 14 female; 37 obese) were analyzed. Both TBW-and FFM-adjusted cutoffs were significantly associated with increased risk of all-cause hospitalization [hazard ratio (HR)=3.86, 95% confidence interval (CI), 1.40-10.63 vs. HR=5.02, 95% CI, 1.98-12.72] and HF-specific hospitalization (HR=4.00, 95% CI, 1.00-16.05 vs. HR=7.26, 95% CI, 1.92-27.46). Adding the FFM-adjusted cutoff significantly improved model fit when added to a model with the TBW-adjusted cutoff (p<0.05). The difference in c-indices between the two cutoffs after bootstrapping was not statistically significant. Conclusion: The FFM-adjusted cutoff can complement the traditional TBW-adjusted cutoff by correcting the confounding bias of excessive adiposity or low muscle mass, providing incremental prognostic value for risk stratification in Asian patients with HF.

Deep Learning-Based Acoustic Screening for Penetration-Aspiration Events Using Short Voice Recordings

2026-07-10T07:43:49Z

Title: Deep Learning-Based Acoustic Screening for Penetration-Aspiration Events Using Short Voice Recordings Authors: Na, Yong Jae; Lee, Jun Hyeok; Choi, Eunyoung; Chang, Jong Yoon; Seo, Kyung Cheon; Lee, Jaeho; Ko, Hunseok; Kang, Sang-Ick; Yoo, Myungeun; Park, Yoon Ghil; Park, Jinyoung; Kim, Jiyoung; Lee, Ju Kang; Choi, Kyounghyo Abstract: To evaluate the feasibility of a smartphone-based deep learning artificial intelligence (AI) tool for detecting post-swallow airway compromise through brief acoustic analysis of voice recordings obtained before and after swallowing. This multicenter prospective study employed a simple 1.5-second sustained phonation ("a similar to") recorded on a smartphone in patients referred for videofluoroscopic swallowing studies (VFSS). Cases were classified using the Penetration-Aspiration Scale (PAS), with PAS 1 defined as normal and PAS 2-8 as abnormal (penetration-aspiration events). An autoencoder-based anomaly detection model was trained on normal data (PAS 1) and validated using sensitivity, specificity, accuracy, and the area under the receiver operating characteristic curve (AUC). Among 208 participants, the AI model achieved a sensitivity of 90.9% and specificity of 87.5% in the validation set, with an accuracy of 90.4% and an AUC of 0.98. In the independent test set, sensitivity was 91.9%, specificity 50.0%, accuracy 85.2%, and AUC 0.76. A brief 1.5-second voice recording analyzed with a deep learning AI model showed promising internal performance for screening post-swallow airway compromise. This approach may serve as a practical and accessible adjunct to identify individuals requiring further instrumental assessment.

Flexibility-enhancing Interventions for Ankle Range of Motion: A Network Meta-analysis

2026-07-13T02:06:55Z

Title: Flexibility-enhancing Interventions for Ankle Range of Motion: A Network Meta-analysis Authors: Park, Jong Mi; Lee, Kun Wook; Yoon, Seo Yeon; Kim, Yong Wook; Lee, Sang Chul Abstract: This systematic review and network meta-analysis compared the effectiveness of five flexibility-enhancing interventions-static stretching, dynamic stretching, ballistic stretching, proprioceptive neuromuscular facilitation, and foam rolling-on ankle dorsiflexion range of motion in physically active healthy adults. A comprehensive search of multiple databases was conducted up to August 4, 2025. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and was registered in prospectively registered in the International Prospective Register of Systematic Reviews. Effect sizes were synthesized using a random-effects network meta-analysis, and intervention rankings were based on the surface under the cumulative ranking curve. Forty-one randomized controlled trials (n =1,670) were included. For the passive range of motion, proprioceptive neuromuscular facilitation (surface under the cumulative ranking curve: 76.8%) and foam rolling (67.8%) were the most effective overall. In long-term protocols (>1 mo), both proprioceptive neuromuscular facilitation (standardized mean difference 1.04 [0.64-1.44]) and foam rolling (standardized mean difference 1.03 [0.53-1.53]) remained superior to controls. For active range of motion, foam rolling ranked the highest (surface under the cumulative ranking curve: 87.2%) and demonstrated the largest short-term improvement, while static stretching showed the most favorable long-term maintenance (surface under the cumulative ranking curve: 72.4%). No intervention-related adverse events were reported. Proprioceptive neuromuscular facilitation and foam rolling are optimal for long-term flexibility enhancement, whereas foam rolling is recommended for short-term, pre-exercise movement preparation. Static stretching may support sustained active range of motion across extended training periods. Intervention selection should align with specific performance goals and training timelines.