EClinicalMedicine最新文献

{"title":"Comments regarding \"Current evidence gaps to support systematic cytomegalovirus screening in pregnancy\".","authors":"Claire Périllaud-Dubois, Olivier Picone, Alexandre J Vivanti, Yves Ville, Christelle Vauloup-Fellous","doi":"10.1016/j.eclinm.2026.103905","DOIUrl":"https://doi.org/10.1016/j.eclinm.2026.103905","url":null,"abstract":"","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"95 ","pages":"103905"},"PeriodicalIF":10.0,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13136759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing <i>Enterococcus faecium</i> bloodstream infection: a Delphi document on clinical recommendations and research agenda.","authors":"Matteo Rinaldi, Michele Bartoletti, Piergiorgio Cojutti, Laura Escolà-Vergé, Nuria Fernández-Hidalgo, Daniel Hornuss, Milo Gatti, Carlota Gudiol, Belén Gutiérrez-Gutiérrez, Luis Eduardo López-Cortés, Winfried Vincenz Kern, Ibai Los-Arcos, Patricia Muñoz, Alessandra Oliva, Matthaios Papadimitriou-Olivgeris, Manjunath Pai, Federico Pea, Juan Manuel Pericas, Siegbert Rieg, Alessandro Russo, Alex Soriano, Karin Thursky, Andrew Udy, Mario Venditti, Dafna Yahav, Yin Mo, Pierluigi Viale, Maddalena Giannella","doi":"10.1016/j.eclinm.2026.103925","DOIUrl":"https://doi.org/10.1016/j.eclinm.2026.103925","url":null,"abstract":"<p><strong>Background: </strong>Management of <i>E faecium</i> bloodstream infections (BSIs) remains debated, particularly the clinical impact of vancomycin resistance, the role of follow-up cultures, and optimal therapeutic regimens. This study aimed to reach expert consensus on these unresolved clinical domains and identify priorities for future research.</p><p><strong>Methods: </strong>We first conducted a systematic review and meta-analysis in January 20, 204 focusing on four predefined areas: mortality in <i>E faecium</i> BSIs compared with other BSIs, mortality in vancomycin-resistant enterococci (VRE)-BSIs compared with vancomycin-susceptible enterococci-BSIs, management of catheter-related <i>E faecium</i> BSIs, and 4) optimal antibiotic therapy for VRE-BSIs. These results informed a three-round Delphi process involving a panel of experts. An iterative approach was adopted: 16 initial questions developed from the systematic review (6-point Likert scale) were refined across rounds based on expert feedback. Consensus was defined as at least 80% agreement or disagreement.</p><p><strong>Findings: </strong>13 statements were generated across three broader domains. Regarding clinical outcomes and diagnostics, experts agreed that mortality is heavily influenced by comorbidities; thus, therapeutic assessment should rely on clinical trends and inflammatory markers, with follow-up blood cultures used to confirm eradication. Catheter-related BSI should be managed with device removal and short-course (<7 days) antibiotics in selected uncomplicated cases. For therapeutic management, teicoplanin is preferred for vanB VRE-BSI. For vanA VRE-BSI, both linezolid and high-dose daptomycin (>9 mg/kg per day) are effective, reserving daptomycin-based combinations for challenging cases (deep-seated infections and/or high Minimum Inhibitory Concentrations). Finally, future trials evaluating the impact of antimicrobial therapy should use Desirability-of-Outcome-Ranking analysis; the in-vitro potential of oritavancin justifies targeted randomized trials to define its clinical efficacy in VRE-BSI.</p><p><strong>Interpretation: </strong>This paper delineates current evidence and expert consensus on management of <i>E faecium</i> BSI while identifying crucial knowledge gaps to guide future clinical research.</p><p><strong>Funding: </strong>None.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"95 ","pages":"103925"},"PeriodicalIF":10.0,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13136728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors' reply: comments regarding \"Current evidence gaps to support systematic cytomegalovirus screening in pregnancy\".","authors":"Agathe Billette de Villemeur, Bruno Hoen, Louis-Rachid Salmi","doi":"10.1016/j.eclinm.2026.103906","DOIUrl":"https://doi.org/10.1016/j.eclinm.2026.103906","url":null,"abstract":"","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"95 ","pages":"103906"},"PeriodicalIF":10.0,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13136761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurocognitive impairment and substance use in adult survivors of childhood cancer: a cross-sectional analysis from the Childhood Cancer Survivor Study.","authors":"Rachel Webster, Eleanor O Chambers, Weiyu Qiu, Rikeenkumar Dhaduk, Lei Wang, Yutaka Yasui, Yan Yuan, Paul C Nathan, Wendy Leisenring, Gregory T Armstrong, Rebecca Howell, Tilman Schulte, Matthew Yalch, Matthew Cordova, Kevin R Krull, Tara M Brinkman, Kim Edelstein","doi":"10.1016/j.eclinm.2026.103924","DOIUrl":"https://doi.org/10.1016/j.eclinm.2026.103924","url":null,"abstract":"<p><strong>Background: </strong>Adult survivors of childhood cancer are at risk for neurocognitive impairment, emotional distress, and chronic pain, factors independently associated with substance use. However, interrelationships among these factors and their association with substance use remain poorly understood.</p><p><strong>Methods: </strong>Participants from the Childhood Cancer Survivor Study (CCSS) who reported symptoms of neurocognitive problems, distress, pain, and substance use were included. Data for these cross-sectional analyses were drawn from CCSS follow up questionnaires administered between 2003 and 2007. Polytomous regressions examined associations between neurocognitive impairment and substance use (alcohol: occasional, risky, heavy; smoking: current) and whether these associations were moderated by psychosomatic symptoms. The CCSS cohort study is registered with ClinicalTrials.gov, NCT01120353.</p><p><strong>Findings: </strong>11,151 participants were included (53.2% female; mean age 31.4 years, SD 7.5). Survivors reported risky (40.9%; n = 4059/9894), or heavy (11%; n = 1096/9894) alcohol use and more than 25% reported previous (14.6%; n = 1482/10,182) or current (13.7%; n = 1395/10,182) cigarette use. Impaired emotional regulation was associated with smoking (odds ratio 1.81, 95% CI 1.53-2.14) and risky drinking (1.59, 1.25-2.03). Impaired emotion regulation with somatisation was associated with decreased occasional (0.54, 0.0-0.95) and heavy drinking (0.54, 0.0-0.95). Organisation impairment with somatisation was associated with decreased heavy drinking (0.34, 0.15-0.73), whereas pain with organisation impairment was associated with increased occasional (1.81, 1.03-3.19) and risky drinking (2.18, 1.24-3.85). Memory impairment was associated with risky (1.38, 1.10-1.73) and occasional drinking (1.37, 1.09-1.71).</p><p><strong>Interpretation: </strong>Neurocognitive impairment was associated with substance use and modified by psychosomatic symptoms. Findings support integrated screening to inform targeted interventions.</p><p><strong>Funding: </strong>National Cancer Institute, Princess Margaret Cancer Centre Foundation, Ontario Ministry of Health and Long-Term Care, National Cancer Institute Cancer Center, and American Lebanese Syrian Associated Charities.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"95 ","pages":"103924"},"PeriodicalIF":10.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histotripsy for liver tumours: a systematic review and meta-analysis of current clinical evidence.","authors":"Chase J Wehrle, Joshua Lee, Ahmed Sayed Ahmed, Syed Imad Ul Hassan, Federico Aucejo, Ammar A Javed, Mikhail Silk, David C H Kwon, D Brock Hewitt","doi":"10.1016/j.eclinm.2026.103926","DOIUrl":"https://doi.org/10.1016/j.eclinm.2026.103926","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Histotripsy is a novel, non-invasive, non-ionising, non-thermal method of mechanical tumour disruption that received US FDA approval in October 2023 for the treatment of liver tumours. This study aims to summarise and evaluate the safety and outcomes data following histotripsy of primary and secondary liver tumours.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This systematic review and meta-analysis followed PRISMA guidelines. Records were identified through review of PubMed, Embase, and Scopus (database inception to December 2025) and manual review. Eligible studies were prospective or retrospective cohort studies and clinical trials published in English between Jan 1, 2015 and Dec 31, 2025 reporting clinical outcomes of histotripsy for liver tumours in three or more patients. Literature reviews, editorials, conference abstracts, animal studies, and case reports of two or fewer patients were excluded. Evaluated outcomes included post-procedural complications, local tumour control (LTC), overall survival, procedural technical success, tumour volume reduction, and off-target effects. Study quality was assessed using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. Heterogeneity was quantified using the I&lt;sup&gt;2&lt;/sup&gt; statistic and Cochran's Q test. Publication bias was assessed using funnel plot visual inspection and Egger's regression test. Finally, the histotripsy technology was assessed using the IDEAL framework to inform the design of future trials. This work was registered with PROSPERO (CRD420261299804).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Ten studies (553 patients) met inclusion criteria. No studies exhibited a high risk of bias; seven demonstrated a moderate risk of bias in at least one domain. Using a random-effects model, the pooled technical success rate was 94.1% (95% CI: 90.4%-96.4%; I&lt;sup&gt;2&lt;/sup&gt; = 0%). Four studies reported major complications (grade ≥3), with a pooled event rate of 7.0% (95% CI: 2.0%-21.5%; I&lt;sup&gt;2&lt;/sup&gt; = 76.4%). The pooled event rate for absence of nodular enhancement was 89.3% (95% CI: 48.2%-98.7%; I&lt;sup&gt;2&lt;/sup&gt; = 61.6%). The pooled mean tumour volume reduction was 49.4% (95% CI: 9.0%-89.8%; I&lt;sup&gt;2&lt;/sup&gt; = 99.6%). The pooled off-target tumour effect rate was 10.0% (95% CI: 5.0%-20.0%; I&lt;sup&gt;2&lt;/sup&gt; = 6.6%). No significant publication bias was detected for mortality and safety outcomes; however, formal assessment of publication bias was limited by the small number of studies for these and all outcomes. All radiological control outcomes showed substantial heterogeneity across studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;Although there is notable heterogeneity across studies, pooled results indicate that histotripsy has high rates of technical feasibility and local control with a favourable side effect profile. Interpretation of these findings is limited by the small number of available studies, variability in outcome definitions and imaging assessment methods, and sh","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"95 ","pages":"103926"},"PeriodicalIF":10.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global complications among patients with mpox: a systematic review and meta-analysis.","authors":"Ya Gao, Gordon Guyatt, Wenshuo Zhao, Rongna Lian, Ming Liu, Yunli Zhao, Zhifan Li, Davy Ratovondramamy, Ping Liu, Wanyu Zhao, Kenji Numata, Wimonchat Tangamornsuksan, Fengwen Yang, Junhua Zhang, Fuzhong Xue, Jinhui Tian, Qiukui Hao","doi":"10.1016/j.eclinm.2026.103911","DOIUrl":"https://doi.org/10.1016/j.eclinm.2026.103911","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Despite increasing global attention, significant knowledge gaps remain regarding the incidence of adverse outcomes associated with mpox. To support the development of World Health Organization (WHO) mpox guidelines, this systematic review and meta-analysis evaluated the incidence of complications among patients with mpox.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We searched Medline, Embase, CENTRAL, CINAHL, Global Health, medRxiv, bioRxiv, and SSRN from database inception to December 20, 2025, for studies reporting complications in patients with laboratory-confirmed mpox of all ages. Paired reviewers independently screened studies, extracted data, and assessed risk of bias. We conducted proportional meta-analyses using the inverse variance method fixed-effect model with the Freeman-Tukey double arcsine transformation and evaluated the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. We classified mpox as severe or non-severe based on the need for hospitalization or the study's criteria. We registered the protocol with PROSPERO (CRD42024595685).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Of 4566 records, 170 studies with 127,564 patients (mean age 6.9-43.0 years) proved eligible. Among patients with non-severe mpox, serious complications were rare. Mortality, intensive care unit admission, sepsis, pneumonia, encephalitis, epiglottitis, myocarditis, gastrointestinal bleeding, and pleural effusion all occurred in ≤0.5% of patients (moderate to high certainty evidence). Urinary retention, mechanical ventilation, urethritis, gastroenteritis, and keratitis occurred in 0.7%-1.8% (moderate to high certainty evidence). Severe pain, abscess, tonsillitis, conjunctivitis, and cellulitis occurred in 2.2%-3.7% of patients (moderate certainty evidence) and hospitalization occurred in 4.4% (low certainty evidence). Patients who were vaccinated had a lower hospitalization rate than those who were unvaccinated. Patients in low- and middle-income countries (LMICs) had a higher rate of pneumonia (2.21% versus 0.02%) than those in high-income countries (HICs). In patients with severe mpox, complication rates were substantially higher. All-cause mortality, abscess, sepsis, tonsillitis, keratitis, and mechanical ventilation occurred in 2.5%-5.5% of patients (moderate certainty evidence). Acute kidney injury, pleural effusion, respiratory failure, and conjunctivitis occurred in 1.4%-2.0% (moderate to high certainty evidence). Patients with severe mpox in LMICs had a higher mortality (3.18% versus &lt;0.01%) than those in HICs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;Non-severe mpox is associated with low complication rates and very low mortality, while severe disease carries substantial risks of life-threatening complications and death. These findings provide baseline risk estimates for both patients with severe and non-severe mpox, emphasize the importance of early risk stratification in clini","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"95 ","pages":"103911"},"PeriodicalIF":10.0,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13129458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility, accuracy, and effect of a rapid point-of-care serological test (SeroSelectTB) to identify presumptive pulmonary TB patients for confirmatory testing in Ethiopia, South Africa, and Tanzania: a multicenter, open-label, parallel-group, randomized, controlled trial.","authors":"Miloje Savic, Grant Theron, Kidist Bobosha, Balthazar Melchior Nyombi, Ida Laake, Aleksandar Josifoski, Jordancho Arsov, Tamirat Assefa, Jemrath Bikombo, Nick Borain, Jovan Davchev, Stephan Grunwald, Yonas Abebe Habtesilase, Debora Charles Kajeguka, Kristin Kremer, Flavia Mayo, Andrew Medina-Marino, Sasho Najdov, Anna Olutoyin Okunola, Arnold Japhet Ndaro, Welile Vumile Nwamba, Gaudensia Alois Olomi, Julianne du Plessis, Hadija Hamisi Semvua, Tim Welsink, Mekdelawit Wondiyfraw, Melese Yeshambaw, Samuel Asmamaw Yesuf, Solomon Abebe Yimer, Carol Church Holm-Hansen","doi":"10.1016/j.eclinm.2026.103914","DOIUrl":"https://doi.org/10.1016/j.eclinm.2026.103914","url":null,"abstract":"<p><strong>Background: </strong>The feasibility, accuracy and effect of a rapid point-of-care serological test, SeroSelectTB, was assessed to identify presumptive pulmonary tuberculosis (TB) patients at primary healthcare facilities in Ethiopia, South Africa, and Tanzania.</p><p><strong>Methods: </strong>We conducted a multicenter, open-label, parallel-group, randomized controlled trial from 2020 through 2025. Adults were recruited at selected healthcare facilities with symptoms suggestive of active pulmonary TB. Eligible participants were randomized to standard-of-care (SOC, routine clinical investigation) or intervention (screening with SeroSelectTB) study arms. Our primary outcome was time-to-treatment initiation, calculated as the time from enrollment to treatment initiation. Data were analyzed using intention-to-treat. This trial was registered with Clinicaltrials.gov (NCT04752592) on 2 April 2021.</p><p><strong>Findings: </strong>Between September 21, 2021, and June 19, 2025, 9097 presumptive pulmonary TB patients were randomly assigned to the SOC (n = 4545) and intervention (n = 4552) study arms. Pulmonary TB was confirmed in 1087 (11.5%) participants (SOC = 527; Intervention = 560). SeroSelectTB was associated with a shorter time-to-treatment initiation compared to SOC (crude hazard ratio (HR): 1.20; 95% CI: 1.06-1.35). The median time-to-treatment initiation among patients with confirmed TB in South Africa, Ethiopia, and Tanzania was 1, 3 and 3 days in the intervention arm compared to 2, 5, and 6 days in SOC arm, respectively. The SeroSelectTB sensitivity was 75.9% and specificity 49.5% in a high HIV setting, whereas sensitivity and specificity were 68.8% and 76.0% among HIV negative participants, respectively.</p><p><strong>Interpretation: </strong>SeroSelectTB reduces the time-to-treatment initiation for pulmonary TB patients and could be considered for integration into TB testing algorithms at primary healthcare facilities. Rapid tests with a lower than optimal specificity can serve an important role as triage tools when adequate sensitivity is demonstrated.</p><p><strong>Funding: </strong>This project (RIA2018D-2493, SeroSelectTB) is part of the EDCTP2 Programme supported by the European Union with funding from UK National Institute for Health and Care Research (NIHR). NIHR is funded by the Department of Health and Social Care. The NIHR Global Health Research portfolio supports high-quality applied health research for the direct and primary benefit of people in low- and middle-income countries, using international development funding from the UK Government. The views expressed in this publication are those of the authors and not necessarily those of the EDCTP, NIHR or the UK government.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"95 ","pages":"103914"},"PeriodicalIF":10.0,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13129460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of metformin and exercise training on cardiorespiratory, blood pressure, and metabolic adaptations across the spectrum of glucose dysregulation: a systematic review and meta-analysis.","authors":"Paula Etayo-Urtasun, Mikel L Sáez de Asteasu, Mikel Izquierdo","doi":"10.1016/j.eclinm.2026.103915","DOIUrl":"https://doi.org/10.1016/j.eclinm.2026.103915","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Metformin and structured exercise are routinely co-prescribed across the spectrum of glucose dysregulation, under the assumption of a cardiometabolic potentiating effect. Experimental data, however, suggest that metformin might blunt some exercise-induced adaptations, but this potential interaction has not been systematically quantified.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a systematic review and meta-analysis of controlled trials in adults with conditions across the spectrum of glucose dysregulation, comparing exercise plus metformin with the same exercise programme plus placebo or no metformin, including studies published between 1 January 2000 and 12 December 2025. Randomised and non-randomised controlled trials were eligible. Outcomes included peak oxygen uptake (VO&lt;sub&gt;2&lt;/sub&gt;peak), body composition, blood pressure, glycaemic markers, and lipids. Mean differences (MDs) with 95% confidence intervals (CIs) were pooled using random-effects models, and the certainty of evidence was assessed with GRADE. Heterogeneity was evaluated through Cochran's Q test and Higgins' I&lt;sup&gt;2&lt;/sup&gt; statistic, while publication bias was estimated based on the visual examination of the funnel plot, Egger's test, and selection models. This systematic review with meta-analysis was registered in PROSPERO (CRD420251167325).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Nine studies (n = 827; 14 publications) met the inclusion criteria; all contributed to the meta-analyses. Compared with exercise alone, metformin was associated with smaller improvements in VO&lt;sub&gt;2&lt;/sub&gt;peak (MD -1.19 [95% CI -2.33 to -0.04]), attenuated reductions in systolic blood pressure (3.76 [0.63-6.89]) and attenuated reductions in diastolic blood pressure (1.98 [0.42-3.55]). No significant between-group differences were observed for changes in body weight, body mass index, waist circumference, fasting glucose, glycated haemoglobin, fasting insulin, homoeostatic model assessment of insulin resistance, or lipid outcomes. Based on GRADE assessment, the certainty of evidence was moderate for VO&lt;sub&gt;2&lt;/sub&gt;peak, blood pressure, and most anthropometric measures, and low to very low for most glycaemic and lipid markers. Most outcomes showed little heterogeneity, and no evidence of publication bias was observed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;Across controlled trials, adding metformin to structured exercise modestly attenuated improvements in cardiorespiratory fitness and blood pressure, while glycaemic and lipid indices were unchanged. These findings suggest that co-prescribing metformin and structured exercise may attenuate exercise-induced adaptations. It may therefore be advisable to consider strategies that prioritise physical exercise and support a more individualised approach to sequencing, dosing, and monitoring when metformin is co-initiated with exercise. Future research should examine the effects of combining metformin and exercise on exercise-induced adapt","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"95 ","pages":"103915"},"PeriodicalIF":10.0,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13112258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of trajectories and outcomes in early-stage metabolic dysfunction-associated steatotic liver disease: a narrative review.","authors":"Brittany Bromfield, Jeremy Chimene-Weiss, Gregory Gheewalla, Theodore Feldman, Emilie K Mitten, Piero Portincasa, Gyorgy Baffy","doi":"10.1016/j.eclinm.2026.103921","DOIUrl":"https://doi.org/10.1016/j.eclinm.2026.103921","url":null,"abstract":"<p><p>Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disorder, with manifestations ranging from steatosis to steatohepatitis, advanced fibrosis, cirrhosis, and hepatocellular carcinoma. At all stages, MASLD is also associated with increased risks of cardiovascular disease, type 2 diabetes, and extrahepatic malignancies. Timely and accurate prediction of disease onset, progression, and complications remains an unmet need. Although hepatic fibrosis is a strong predictor of liver-related and all-cause mortality, it reflects relatively advanced disease. Growing evidence suggests that steatosis may mark early divergence of disease trajectories. Effective MASLD forecasting therefore requires early risk assessment and longitudinal evaluation. Emerging approaches combine genetic risk with routine clinical, behavioural, and social data, allowing machine learning methods to better identify MASLD subtypes and predict individual disease courses. However, cost and logistical barriers limit widespread adoption, and further research is needed to determine whether early forecasting can improve long-term outcomes and healthcare value.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"95 ","pages":"103921"},"PeriodicalIF":10.0,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13127479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors' reply: Comments regarding \"Effects of therapeutic interventions on long COVID: a meta-analysis of randomized controlled trials\".","authors":"Chang Tan, Jiahao Meng, Xingui Dai, Shuguang Gao","doi":"10.1016/j.eclinm.2026.103883","DOIUrl":"10.1016/j.eclinm.2026.103883","url":null,"abstract":"","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"95 ","pages":"103883"},"PeriodicalIF":10.0,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13127471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}