Background Maternal obesity is an increasingly important public health concern and has been consistently associated with adverse pregnancy outcomes, including hypertensive disorders of pregnancy, cesarean delivery, fetal overgrowth, and preterm birth (PTB). Local institutional data remain valuable because patient characteristics and obstetric practice patterns may vary across healthcare settings. This study aimed to evaluate the unadjusted and adjusted associations between pre-pregnancy obesity and selected adverse obstetric outcomes - hypertensive disorders of pregnancy, postpartum hemorrhage (PPH), cesarean delivery, macrosomia, and PTB - among women delivering at Zhordania Medical Center, a secondary care center in Tbilisi, Georgia. Methods This retrospective cohort study included 428 pregnant women with documented pre-pregnancy body mass index (BMI) who delivered at Zhordania Medical Center during the study period. Participants were divided into two groups according to pre-pregnancy BMI: BMI ≥ 30 kg/m² (obese group, n = 145) and BMI < 30 kg/m² (non-obese group, n = 283). The outcomes of interest were hypertensive disorders of pregnancy, PPH, cesarean delivery, macrosomia, and PTB. Categorical variables were summarized as frequencies and percentages, and group comparisons were performed using the chi-squared test or Fisher's exact test, as appropriate. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using univariable logistic regression; multivariable logistic regression, adjusting for maternal age, parity, and (where estimable) prior cesarean delivery, was subsequently performed using patient-level data. A two-sided p-value < 0.05 was considered statistically significant. Results Women with pre-pregnancy BMI ≥ 30 kg/m² had significantly higher odds of hypertensive disorders of pregnancy than women with BMI < 30 kg/m² (26/145 vs. 14/283; OR 4.20, 95% CI 2.12-8.32; p < 0.001; adjusted OR 3.80, 95% CI 1.88-7.69). Cesarean delivery was also more common in the obese group (85/145 vs. 126/283; OR 1.77, 95% CI 1.18-2.65; p = 0.006; adjusted OR 1.83, 95% CI 1.19-2.81). Macrosomia, defined as birth weight > 4,000 g, occurred more frequently among women with obesity (23/145 vs. 23/283; OR 2.13, 95% CI 1.15-3.95; p = 0.014; adjusted OR 2.02, 95% CI 1.07-3.82). No statistically significant associations were observed for PPH (9/145 vs. 11/283; OR 1.64, 95% CI 0.66-4.04; p = 0.28) or PTB (15/145 vs. 19/283; OR 1.60, 95% CI 0.79-3.26; p = 0.19), though the achieved sample provided limited power (approximately 21% and 27%, respectively) to detect effects of this magnitude. Conclusions Pre-pregnancy obesity was associated with increased odds of hypertensive disorders of pregnancy, cesarean delivery, and macrosomia in this retrospective cohort from a secondary care center in Georgia, independent of maternal age, parity, and prior cesarean delivery where adjustment was feasible. These associative findings highlight the importance of preconception counseling and enhanced antenatal surveillance for women with obesity, although causal inference requires confirmation in larger, prospective studies.

BackgroundHigh-intensity transcranial alternating current stimulation (Hi-tACS) has shown beneficial effects on cognitive function in Alzheimer's disease (AD). However, data on the effects of hi-tACS on sleep quality and emotional state in patients with AD are still limited.ObjectiveThis study aimed to investigate the influences of hi-tACS on sleep quality and emotional state in AD.MethodsThe TRANSFORM-AD study was a double-blind, randomized-controlled trial that enrolled individuals with mild AD. Participants were randomized to receive hi-tACS group or sham stimulation group, and underwent 30 one-hour sessions of either 40 Hz tACS or sham stimulation over consecutive 15 consecutive days. Pittsburgh sleep quality index (PSQI), Hamilton anxiety Rating Scale (HAMA), Hamilton depression Rating Scale (HAMD) and Quality of life in Alzheimer's Disease scale (QOL-AD) were evaluated at baseline, and the end of the intervention.ResultsAmong 43 participants with complete baseline and post-intervention assessments, Hi-tACS reduced post-intervention PSQI scores compared with sham after adjustment for baseline PSQI (adjusted mean difference, -2.34 points; 95% CI, -3.63 to -1.05; p < 0.001). Baseline-adjusted effects for HAMA (-1.43; 95% CI, -2.89 to 0.02), HAMD (0.44; 95% CI, -1.28 to 2.15), and QOL-AD (2.07; 95% CI, -1.57 to 5.70) were imprecise and included the null.ConclusionHi-tACS improved subjective sleep quality in patients with mild AD. The present secondary analysis did not provide conclusive evidence of effects on anxiety, depression, or quality of life; these exploratory outcomes require confirmation in larger, adequately powered trials.Trial registration:ClinicalTrials.gov, NCT03920826.

Obstructive sleep apnea (OSA) is a prevalent disorder with significant systemic and quality-of-life consequences. Mandibular advancement devices (MADs) are an established treatment option, but conventional follow-up often relies on intermittent visits and self-reported adherence. Sensor-integrated MADs and remote monitoring may enable objective adherence assessment and personalized longitudinal care, although their additional clinical value remains uncertain. This narrative review critically appraises current evidence on sensor-integrated MADs with remote monitoring for OSA, focusing on treatment adherence, objective monitoring, personalized therapy, and dentists' evolving role in longitudinal multidisciplinary care. We searched PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library through 2025 for English-language studies on MADs, sensor-integrated oral appliances, and remote monitoring in OSA. We synthesized evidence across six domains spanning pathophysiology, clinical practice, and digital innovation. The evidence indicates that MADs improve respiratory and patient-reported outcomes, while integrating sensor-based and remote monitoring technologies offers additional opportunities for objective assessment of adherence and nightly appliance use. Remote monitoring and feedback may improve the consistency of MAD use, although increases in total nightly wearing time have not been consistently demonstrated. Emerging smart MADs can also monitor parameters such as sleep duration, sleep position, and respiratory events, while adaptive systems may enable individualized adjustment of mandibular advancement. However, current evidence does not yet establish that smart MADs provide superior long-term physiological, cardiovascular, or patient-reported outcomes compared with conventional MAD therapy. Smart MADs may nonetheless strengthen adherence assessment, expand the dentist's role in longitudinal care, and support personalized, multidisciplinary OSA management; further clinical validation and standardized long-term studies are needed to determine their incremental therapeutic value.

The medial temporal lobe (MTL) is a key region in Alzheimer's disease (AD) pathogenesis, affected early by tau pathology. While female sex and APOE-ε4 are two known risk factors that affect tau levels, whether these factors drive tau in the MTL via amyloid-dependent or amyloid-independent mechanisms remains unclear. We investigated these relationships in two large neuropathological cohorts comprising 2550 participants from the Religious Orders Study/Memory and Aging Project (ROS/MAP; n=1587, main cohort) and Arizona Study of Aging and Neurodegenerative Disorders (AZSAND; n=963, replication cohort) covering the whole AD continuum. Neuropathological assessments of global neocortical and regional MTL amyloid-β burden were used to determine the extent to which amyloid-β pathology mediated associations of APOE-ε4 carriership and sex with MTL tau burden. In both cohorts, APOE-ε4 carriership and female sex were associated with significantly greater MTL tau pathology (all p<0.001). Adjustment for global amyloid-β attenuated but did not eliminate these associations (p≤0.024). However, after jointly accounting for global and MTL amyloid-β burden, the association between APOE-ε4 and MTL tau was no longer significant in either cohort (p≥0.19), whereas the association between female sex and MTL tau remained robust (p≤0.004). Models incorporating both global and regional MTL amyloid-β explained substantially more variance in MTL tau burden than models including only global amyloid-β, and results were replicated when further adjusting for diagnostic group or neocortical tau burden. These findings suggest that APOE-ε4 and female sex influence MTL tau accumulation through partially distinct pathogenic pathways, supporting an additional contribution of regional amyloid-β to the APOE-ε4-associated MTL tau burden while implicating additional amyloid-independent mechanisms in female vulnerability to tau accumulation.

Early-Onset Schizophrenia (EOS) and Early-Onset Bipolar Disorder (EOBD) share overlapping clinical and genetic features. This study aims to compare the neuro-social cognitive performance of healthy siblings of adolescents with EOS (EOS-Sib) and EOBD (EOBD-Sib) to identify candidate neurocognitive markers of familial liability and evaluate the impact of environmental stressors, such as childhood trauma, on neurocognitive and social cognitive performance. The study included 164 participants: 36 EOS-Sib, 40 EOBD-Sib, and 88 healthy controls (HC) aged 11-23. All subjects underwent a rigorous screening process using the semi structured interview (K-SADS-PL) to exclude any psychopathology. Neuro-social cognitive performance was assessed using the University of Pennsylvania Computerized Neurocognitive Battery. Also, Childhood Trauma Questionnaire and Children's Depression Rating Scale are used for the clinical evaluation. A composite 'G-score' was derived to represent global neurocognitive performance. Although both sibling groups differed from healthy controls on selected neurocognitive measures, no significant differences were detected between the EOS-Sib and EOBD-Sib groups, indicating substantial overlap in neurocognitive performance across the two familial-risk groups. This null finding suggests shared transdiagnostic neurocognitive vulnerability rather than disorder-specific cognitive differentiation at the familial-risk level. After controlling for age, maternal education, paternal education, depressive symptom severity, and childhood trauma, both EOS-Sib and EOBD-Sib groups exhibited significant deficits in global neurocognitive performance compared to healthy controls (p < .001). For emotion recognition (ER), a significant impairment was observed only in the EOS-Sib group (p = .003). Childhood trauma was independently associated with poorer ER performance (p = .007), but was not significantly associated with general neurocognitive performance (p = .746). The Neurocognitive G-score demonstrated good group-level discriminative ability between adolescents with familial liability and healthy controls (AUC = 0.805). In conclusion, unaffected siblings of adolescents with EOS and EOBD exhibited overlapping neurocognitive impairments, particularly in executive functioning and working memory, supporting these domains as candidate neurocognitive markers associated with familial liability. The Neurocognitive G-score demonstrated good group-level discriminative ability between adolescents with known familial liability and healthy controls; however, it should be regarded as an exploratory neurocognitive risk indicator rather than a definitive screening tool, and longitudinal studies are needed to determine its prognostic value for future psychopathology. Furthermore, childhood trauma was independently associated with poorer ER performance after adjustment for relevant covariates, highlighting the potential contribution of environmental adversity to social cognitive functioning in at-risk adolescents.

BackgroundThe association between benzodiazepine (BZD) use and dementia risk remains controversial owing to conflicting observational findings and incomplete adjustment for confounders.ObjectiveTo examine the association between BZD use and incident dementia, including Alzheimer's disease (AD), and to determine whether BZD use accelerates progression to severe dementia, using nationwide claims data with detailed comorbidity adjustment.MethodsWe conducted a matched cohort study using Korean National Health Insurance Service data, comparing 132,805 BZD users with 132,805 age- and sex-matched controls. Incident dementia (AD [F00], vascular dementia [F01], and other subtypes) was defined by ≥3 diagnostic claims within one year, and severe cases by national special-registration codes. Hazard ratios (HRs) were estimated using Cox models adjusted for the Charlson Comorbidity Index (CCI) and clinical covariates.ResultsDementia incidence was 382.4/100,000 person-years in BZD users versus 280.7 in controls. BZD users had higher multimorbidity (CCI ≥7: 42.5% versus 26.5%) and psychiatric comorbidity (e.g., anxiety disorders: 42.6% versus 2.7%). After full adjustment, the HR for overall dementia attenuated from 1.43 to 1.15 (95% CI, 1.09-1.22), with similar attenuation for AD and severe dementia. The risk of progression from dementia to severe dementia was not increased among BZD users (adjusted HR, 0.98; 95% CI, 0.84-1.14), with no dose- or duration-response observed.ConclusionsBZD use showed only a modest association with incident dementia, largely attributable to the higher multimorbidity burden among users, and was not associated with accelerated progression to severe dementia.