Konstantinos I. Bougioukas

Purpose: This meta-analysis aimed to compare the performance of deaf and hard of hearing (DHH) children who use cochlear implants (CIs) or hearing aids (HAs) with their typically hearing (TH) peers on false belief (FB) understanding tasks. Method: Data were synthesized from 13 studies comprising 292 participants 1.92–14.03 years of age. A multilevel random-effects meta-analysis was conducted, followed by metaregression to examine the effects of age, mean age at onset, type of hearing amplifier, type of FB task, and method of response. Results: Results indicated significantly lower performance in DHH children ( g = −0.854, 95% confidence interval [−1.110, −0.599], p < .001) compared to their TH peers. Additionally, the CIs/HAs group showed a possible sensitivity when assessed with implicit tasks using eye gazing as a method of response. Conclusion: The results supported previous evidence on the essential role of language in FB skills development and indicated that performance in DHH children may be critically influenced by variability in task demands and method of response. Supplemental Material: https://doi.org/10.23641/asha.33228822

Background/Objectives: Sleep disturbances are increasingly implicated in age-related cognitive decline and may contribute to heterogeneity in cognitive and social–cognitive functioning in Mild Cognitive Impairment (MCI). Nevertheless, it remains unclear whether longitudinal actigraphy-derived sleep parameters predict social cognition, including theory of mind (ToM), across amnestic (aMCI) and non-amnestic (naMCI) MCI subtypes. This study examined longitudinal trajectories of cognitive control and ToM in individuals with aMCI and naMCI and healthy older adults, and investigated whether actigraphy-derived sleep indices prospectively predict subsequent cognitive control and higher-order social cognition across these groups. Methods: A total of 179 participants (46 healthy controls, 75 aMCI, 58 naMCI) were assessed across three waves over approximately 16–20 months. Actigraphy-derived sleep indices were obtained using wrist actigraphy. Cognitive control was assessed with Delis–Kaplan Executive Function System subtests, whereas ToM was evaluated through tasks involving non-literal language comprehension, metaphor and proverb interpretation, higher-order mentalizing, and emotion recognition. Longitudinal trajectories were examined using mixed-design ANOVAs, and prospective sleep effects were tested using longitudinal path models. Results: Both cognitive control and ToM declined over time in the MCI groups, whereas healthy controls showed relative stability. Subtype differences in cognitive control emerged primarily in higher-order planning and rule-monitoring processes, with naMCI showing greater impairment. ToM revealed a clearer and more consistent gradient (healthy controls > aMCI > naMCI), particularly in higher-order inferential tasks. Among the actigraphy-derived sleep indices, only TST prospectively predicted later ToM performance, whereas prospective associations with cognitive control were limited and inconsistent. Conclusions: Reduced sleep duration was prospectively associated with poorer subsequent performance in higher-order social cognition, independently of the executive-control measures examined. These findings highlight phenotypic heterogeneity across MCI subtypes and suggest that objectively measured sleep duration may serve as a clinically relevant longitudinal marker of social–cognitive vulnerability. Future studies are needed to determine whether interventions targeting sleep duration are associated with improved social–cognitive outcomes.

Background: The aim of this study is to investigate the pathophysiology of cataract by analyzing signaling pathways in three sample types obtained from four different lens groups: age-related (ARC), diabetic (DC), post-vitrectomy cataract (PVC) and clear control lenses. Methods: Three sample types—the aqueous humor, the anterior capsule and the phaco cassette content—were collected during cataract surgery from 39 participants (ARC = 12, DC = 11, PVC = 7 and control = 9). The samples were prepared based on Sp3 protocol. The recognition and quantification of proteins were performed with liquid chromatography online with tandem mass spectrometry using the DIA-NN software. Perseus software (v1.6.15.0) was used for statistical analysis. Data are available via ProteomeXchange with identifiers PXD045547, PXD045554, PXD045557, and PXD069667. Results: In total, 1986 proteins were identified in the aqueous humor, 2804 in the anterior capsule, and 3337 in the phaco cassette samples. Proteins involved in actin and microtubule cytoskeleton organization, including ACTN4, were downregulated in all three cataract groups compared to controls. Proteins involved in glycolipid metabolic process, including GAL3ST1, GAL3ST4, and GLA, were upregulated in ARC compared to controls. Proteins involved in the non-canonical Wnt receptor signaling pathway, including FRZB, SFRP1, SFRP2, SFRP5, WNT5A, and WNT7A, were upregulated in ARC compared to DC, PVC, and controls. Conclusions: Comprehensive proteomic profiles were generated using DIA proteomics by comparing ARC, DC, and PVC versus controls. This is the first study to use phaco cassette contents to investigate cataract formation in comparison to controls. Our findings significantly enhance the current understanding of human cataract pathophysiology and provide novel insights into the mechanisms underlying cataract formation.

Background. Ventilator-associated tracheobronchitis (VAT) and pneumonia (VAP) are the most frequent nosocomial infections in the critical care setting and are associated with increased morbidity. At the same time, VAP is also associated with attributable mortality, especially when caused by difficult-to-treat (DTR) Gram-negative bacteria (GNB) that have limited treatment options. Studies have assessed the impact of nebulized aminoglycosides or colistin to improve VAT and VAP outcomes or as an adjunct to intravenous antimicrobial treatment or as a preventive approach. Objective. This overview aimed to assess systematic reviews that examine the efficacy and safety of antimicrobial nebulization for preventing and treating ventilator-associated infections in the critically ill. Methods. Systematic reviews, meta-analyses, and original randomized controlled trials and prospective observational studies were included. Searches were conducted in MEDLINE (via PubMed), the Cochrane, Epistemonikos, and PROSPERO. The methodological quality assessment was performed using standardized tools. Results. Regarding VAP treatment, the included systematic reviews presented critically low quality. The clinical response effect size to amikacin and colistin nebulization were RR 1.23 (95% CI 1.13–1.34), I2 = 47% and OR 1.39 (0.87–2.20), I2 = 56%. The main safety concern was bronchospasm with RR 2.55 (1.40–4.66), I2 = 0% and OR 5.19 (1.05–25.52), I2 = 0%. The certainty of evidence was usually very low. For VAT treatment, limited evidence showed a better clinical response and less emergence of resistant bacteria. Regarding VAP prevention, data are limited to two trials; however, only the larger one presented a low risk of bias and resulted in a reduced VAP rate. Conclusions. Delivery via nebulization might be considered in addition to IV antimicrobial treatment of GNB ventilator-associated infections. The available evidence is weak, and more studies focused on infections due to DTR-GNBs should be prioritized.

Background/Objectives: Surgical Site Infections (SSIs) rank among the most common complications following stoma takedown and lead to increased morbidity, increased Length of Hospital Stay (LOS), and higher healthcare costs. Negative Pressure Wound Therapy (NPWT) systems have emerged as a promising option for optimizing wound management and minimizing SSI rates. This systematic review and meta-analysis compares postoperative outcomes of NPWT and conventional Non-Pressure Dressings following stoma reversal. Methods: A search of the literature published up to 1 September 2024 was conducted across MEDLINE/PubMed, and the Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus, as well as ClinicalTrials.gov. Only Randomized Controlled Trials (RCTs) were included. The primary outcome was SSI rate, while secondary outcomes included time to complete wound healing, LOS, and patient-reported wound cosmesis. Quality assessment was performed using the Cochrane Risk of Bias 2 (RoB 2) tool. The results were synthesized using means and Standard Deviations for continuous variables, counts and percentages for categorical variables, and presented as Odds Ratios (OR) or Mean Differences (MD) with 95% Confidence Intervals, using random or fixed effects models based on heterogeneity (I²). Results: Six RCTs, including 328 patients, were ultimately eligible for inclusion. No significant difference was revealed in SSI rates between the NPWT and conventional dressing groups (OR = 0.95; 95% CI: 0.27–3.29; p = 0.94; I² = 38%). Time to complete wound healing was significantly lower in the NPWT group compared to conventional dressings (MD = −3.78 days; 95% CI: −6.29 to −1.27; p = 0.003). Two studies reported a lower rate of wound healing complications other than SSIs in the NPWT group (OR = 0.22; 95% CI: 0.05–1.09; p = 0.06). No substantial differences were observed in terms of LOS (MD = −0.02 days; 95% CI: −1.22 to 1.17; p = 0.97) and patient-reported wound cosmesis (SMD = 0.31; 95% CI: −0.49 to 1.11; p = 0.44). The review’s limitations include potential risk of bias, variability in study designs, and heterogeneity between studies. Conclusions: NPWT contributes to improved wound management through reducing wound healing time compared to Non-Pressure Dressings after stoma reversal, although it does not appear to substantially impact SSI rates, LOS, or patient-assessed wound cosmesis. Further large-scale, multicenter RCTs are necessary to validate these results and identify patient populations most likely to benefit from NPWT application.

Background: The purpose of this study was to detect proteomic alterations and corresponding signaling pathways involved in the formation of age-related cataract (ARC), diabetic cataract (DC), and post-vitrectomy cataract (PVC). Methods: Three sample types, the aqueous humor (AH), the anterior capsule (AC), and the content of the phaco cassette, were collected during phacoemulsification surgery. The samples were obtained from 12 participants without diabetes mellitus (DM), 11 participants with DM, and 7 participants without DM, with a history of vitrectomy surgery in the past 12 months. The Sp3 protocol (Single-Pot, Solid-Phase, Sample-Preparation) was used for the sample preparation. The recognition and quantification of proteins were carried out with liquid chromatography online with tandem mass spectrometry. The DIA-NN software was applied for the identification and quantification of peptides/proteins. Statistical analysis and data visualization were conducted on Perseus software. Data are available via ProteomeXchange. Results: A very rich atlas of the lens and AH proteome has been generated. Glycosaminoglycan biosynthesis and the non-canonical Wnt receptor signaling pathway were differentially expressed in ARC compared to both the DC and PVC groups. In the PVC group, complement activation was differentially expressed in AH samples, while glutathione metabolism and oxidoreductase activity were differentially expressed in AC samples. Microfilament motor activity, microtubule cytoskeleton organization, and microtubule binding were differentially expressed in the DC and PVC groups in both AH and AC samples. Conclusions: The results of this study expand the existing knowledge on pathways involved in the pathophysiology of cataract, and suggest possible important druggable targets for slower progression or even prevention of cataract.

Surgical site infections (SSIs) rank among the most common complications following stoma takedown and lead to increased morbidity, increased length of hospital stay (LOS), and higher healthcare costs. Negative Pressure Wound Therapy (NPWT) systems have emerged as a promising option for optimizing wound management and minimizing SSI rates. This systematic review and meta-analysis aims to compare postoperative outcomes of NPWT and conventional non-pressure dressings following stoma reversal. Methods: A literature search was conducted across MED-LINE/PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus, as well as ClinicalTrials.gov, up to September 1, 2024. Only randomized controlled trials (RCTs) were in-cluded. The primary outcome was SSI rate, while secondary outcomes included time to complete wound healing, LOS, and patient-reported wound cosmesis. Results: Six RCTs, including 328 pa-tients, were ultimately eligible for inclusion. No significant difference was revealed in SSI rates between the NPWT and conventional dressing groups (OR = 0.95; 95% CI: 0.27–3.29; P = 0.94; I² = 38%). Time to complete wound healing was significantly lower in NPWT group, compared to conventional dressings (MD = -3.78 days; 95% CI: -6.29 to -1.27; P = 0.003). Two studies reported a lower rate of wound healing complications other than SSIs in the NPWT group (OR = 0.22; 95% CI: 0.05–1.09; P = 0.06). No substantial differences were observed in terms of LOS (MD = -0.02 days; 95% CI: -1.22 to 1.17; P = 0.97) and patient-reported wound cosmesis (SMD = 0.31; 95% CI: -0.49 to 1.11; P = 0.44). Conclusions: NPWT contributes to improved wound management through re-ducing wound healing time compared to non-pressure dressings after stoma reversal, although it does not appear to substantially impact SSI rates, LOS, or patient-assessed wound cosmesis. Further large-scale, multicenter RCTs are necessary to validate these results and identify patient populations most likely to benefit from NPWT application.

Purpose: To compile real-time data on the preferred mydriasis practice patterns for retinopathy of prematurity (ROP) screening in Europe. Methods: A cross-sectional online survey was conducted from December 2022 to January 2023, using a self-report online questionnaire which was distributed via email to the members of the European Pediatric Ophthalmological Society and the Greek National ROP Task Force. A six-week period of recruitment was determined, and a reminder email was sent after two weeks. Descriptive statistics were used to explore the data, which was summarized with frequencies and percentages. Results: Sixty-six responses were recorded (response rate: 29.5%), representing practices in 55 Neonatal Intensive Care Units from 21 European countries. In 94.5%, the applied mydriatic regimen consists of phenylephrine with at least one muscarinic antagonist, either tropicamide or cyclopentolate. The concentration of phenylephrine ranges from 0.5% to 5%, of tropicamide from 0.25% to 1%, and of cyclopentolate from 0.2% to 1%. The most commonly used regimen (43.6%) contains phenylephrine 2.5% and tropicamide 0.5%, administered either combined or separately. About 54.5% of the reported mydriatic solutions are non-commercial, in-house preparations. Systemic adverse events, including oxygen desaturation, bradycardia and cardiopulmonary arrest were reported in 14.5%. Conclusion: There is considerable heterogeneity in the applied mydriatic regimens for ROP screening in Europe, reflecting the absence of universal guidelines. The wide use of in-house preparations underlines the gap in the pharmaceutical industry. Concern should be raised against the wide use of undiluted commercial drugs, that reach adult dose, in the fragile population of preterm infants.

Systematic reviews (SRs) have an important role in the healthcare decision‐making practice. Assessing the overall confidence in the results of SRs using quality assessment tools, such as “A MeaSurement Tool to Assess Systematic Reviews 2” (AMSTAR 2), is crucial since not all SRs are conducted using the most rigorous methods. In this article, we introduce a free, open‐source R package called “amstar2Vis” (https://github.com/bougioukas/amstar2Vis) that provides easy‐to‐use functions for presenting the critical appraisal of SRs, based on the items of AMSTAR 2 checklist. An illustrative example is outlined, describing the steps involved in creating a detailed table with the item ratings and the overall confidence ratings, generating a stacked bar plot that shows the distribution of ratings as percentages of SRs for each AMSTAR 2 item, and creating a “ggplot2” graph that shows the distribution of overall confidence ratings (“Critically Low,” “Low,” “Moderate,” or “High”). We expect “amstar2Vis” to be useful for overview authors and methodologists who assess the quality of SRs with AMSTAR 2 checklist and facilitate the production of pertinent publication‐ready tables and figures. Future research and applications could further investigate the functionality or potential improvements of our package.