EClinicalMedicine最新文献

{"title":"Corrigendum to Antipsychotic use during pregnancy and risk of specific neurodevelopmental disorders and learning difficulties in children: a multinational cohort study [eClinicalMedicine 70 (2024) 102531/DOI: 10.1016/j.eclinm.2024.102531].","authors":"Claudia Bruno, Carolyn E Cesta, Vidar Hjellvik, Sinna Pilgaard Ulrichsen, Marte-Helene Bjørk, Buket Öztürk Esen, Malcolm B Gillies, Mika Gissler, Alys Havard, Øystein Karlstad, Maarit K Leinonen, Mette Nørgaard, Sallie-Anne Pearson, Johan Reutfors, Kari Furu, Jacqueline M Cohen, Helga Zoega","doi":"10.1016/j.eclinm.2025.103139","DOIUrl":"https://doi.org/10.1016/j.eclinm.2025.103139","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1016/j.eclinm.2024.102531.].</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"81 ","pages":"103139"},"PeriodicalIF":9.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656507","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":"Response to comment about article 'changes in memory and cognition during the SARS-CoV-2 human challenge study'.","authors":"Christopher Chiu, Adam Hampshire","doi":"10.1016/j.eclinm.2025.103143","DOIUrl":"10.1016/j.eclinm.2025.103143","url":null,"abstract":"","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"81 ","pages":"103143"},"PeriodicalIF":9.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656534","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":"Comparative therapeutic efficacy and safety of first-line and second-line therapies for metastatic castration-resistant prostate cancer: a systematic review and network meta-analysis.","authors":"Bohao Jiang, Benqiao Wang, Yiming Chen, Yaang Chen, Bohan Li, Jianbin Bi","doi":"10.1016/j.eclinm.2025.103129","DOIUrl":"10.1016/j.eclinm.2025.103129","url":null,"abstract":"<p><strong>Background: </strong>There is no cross-sectional comparison on therapeutic and adverse effects for treatments of metastatic castration-resistant prostate cancer (mCRPCa). We aimed to horizontally compare them for all common first-line and second-line therapies.</p><p><strong>Methods: </strong>We conducted a network meta-analysis with a systematic review in four databases (Pubmed, Web of Science, Embase, and Cochrane Library) up to January 5th, 2025. All randomized controlled trials (RCT) related to mCRPCa treatments with a clear description in study design were included. Endpoints included the radiographic progression-free survival (rPFS), overall survival (OS), time to PSA progression (TTPP), PSA progression rate (PSARR), and adverse events. All data was extracted by two researchers and analyzed with Gemtc package in R and Stata15. This NMA protocol was registered online (ID: CRD42025633178).</p><p><strong>Findings: </strong>After screening among 33,694 articles, 24 RCTs involving 13,059 cases were included. For first-line treatments, combination therapies with second-generation androgen receptor inhibitors (ARIs) showed superior efficacies in OS [HR of poly(ADP-ribose) polymerase inhibitors (PARPi) + ARI: 0.63 (0.32,1.25)], TTPP [HR of Lu177 + ARI: 0.07 (0.01,0.87)] and PSARR [RR of Lu177 + ARI: 33.02 (15.56,71.62)] with the highest SUCRA (Surface under the Cumulative Ranking Curve) (72%, 91% and 97% respectively). PARPi + ARI also performed best for rPFS (SUCRA: 85%, with an insignificant HR [0.12 (0.02,2.35)]. For post-docetaxel second-line treatments, ARI also emerged as the preferred option. Efficacies of post-ARI second-line treatments were not evaluated due to the lack of related RCTs. No obvious heterogeneity and publication bias was detected during the therapeutic comparison.</p><p><strong>Interpretation: </strong>This study provided comparative evidence for first-line and post-chemotherapy second-line mCRPCa treatment options. Second-generation ARIs exhibited good efficacy, particularly when combined with other treatments. However, the safety analysis necessitated balance between benefits and adverse events, especially for combination therapies. Stronger evidence is needed through direct comparisons in future clinical trials.</p><p><strong>Funding: </strong>The study was supported by The National Natural Science Foundation of China (No. 82172568).</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"81 ","pages":"103129"},"PeriodicalIF":9.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656501","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":"Public health, war and cross-border challenges: the recent cVDPV2 polio outbreak in Gaza.","authors":"Itamar Grotto, Hazem Agha, Ahmad Abu Al-Halaweh, Nadav Davidovitch, Martin McKee, Dorit Nitzan","doi":"10.1016/j.eclinm.2025.103136","DOIUrl":"10.1016/j.eclinm.2025.103136","url":null,"abstract":"<p><p>The recent vaccine-derived poliovirus type 2 (cVDPV2) outbreak in Gaza, linked to strains circulating in Egypt, highlights the challenges of maintaining vaccination efforts in conflict zones. Amid prolonged hostilities and a deteriorating healthcare system, vaccination coverage has significantly declined, leaving many children vulnerable to poliovirus and other preventable diseases. This report analysed the outbreak's context, vaccination strategies, and outcomes by reviewing vaccination coverage data, environmental surveillance reports, and public health interventions. It focused on the novel oral polio vaccine type 2 (nOPV2) campaigns and their effectiveness in mitigating transmission. The outbreak, detected in June 2024, included six environmental samples and one confirmed case of poliomyelitis in a 10-month-old child. Despite operational challenges, a vaccination campaign immunised 560,000 children under 10 years by September 2024. However, ongoing violence delayed subsequent rounds of vaccination, particularly in northern Gaza. Contributing factors included vaccine hesitancy, logistical hurdles, and the safety risks healthcare workers face. Regional collaboration remains limited despite cross-border transmission risks. The Gaza outbreak illustrates the critical need for robust vaccination programs, enhanced surveillance, and international cooperation to prevent poliovirus resurgence. Addressing vaccine hesitancy and logistical challenges is vital. Sustained funding and innovative strategies, including nOPV2 use, are essential to combat outbreaks in fragile settings and advance global eradication efforts.</p><p><strong>Funding: </strong>No additional funding was used in the preparation of this report.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"81 ","pages":"103136"},"PeriodicalIF":9.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11919384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656512","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":"Deep learning-based model for prediction of early recurrence and therapy response on whole slide images in non-muscle-invasive bladder cancer: a retrospective, multicentre study.","authors":"Fan Jiang, Guibin Hong, Hong Zeng, Zhen Lin, Ye Liu, Abai Xu, Runnan Shen, Ye Xie, Yun Luo, Yun Wang, Mengyi Zhu, Hongkun Yang, Haoxuan Wang, Shuting Huang, Rui Chen, Tianxin Lin, Shaoxu Wu","doi":"10.1016/j.eclinm.2025.103125","DOIUrl":"https://doi.org/10.1016/j.eclinm.2025.103125","url":null,"abstract":"<p><strong>Background: </strong>Accurate prediction of early recurrence is essential for disease management of patients with non-muscle-invasive bladder cancer (NMIBC). We aimed to develop and validate a deep learning-based early recurrence predictive model (ERPM) and a treatment response predictive model (TRPM) on whole slide images to assist clinical decision making.</p><p><strong>Methods: </strong>In this retrospective, multicentre study, we included consecutive patients with pathology-confirmed NMIBC who underwent transurethral resection of bladder tumour from five centres. Patients from one hospital (Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China) were assigned to training and internal validation cohorts, and patients from four other hospitals (the Third Affiliated Hospital of Sun Yat-sen University, and Zhujiang Hospital of Southern Medical University, Guangzhou, China; the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China; Shenshan Medical Centre, Shanwei, China) were assigned to four independent external validation cohorts. Based on multi-instance and ensemble learning, the ERPM was developed to make predictions on haematoxylin and eosin (H&E) staining and immunohistochemistry staining slides. Sharing the same architecture of the ERPM, the TRPM was trained and evaluated by cross validation on patients who received Bacillus Calmette-Guérin (BCG). The performance of the ERPM was mainly evaluated and compared with the clinical model, H&E-based model, and integrated model through the area under the curve. Survival analysis was performed to assess the prognostic capability of the ERPM.</p><p><strong>Findings: </strong>Between January 1, 2017, and September 30, 2023, 4395 whole slide images of 1275 patients were included to train and validate the models. The ERPM was superior to the clinical and H&E-based model in predicting early recurrence in both internal validation cohort (area under the curve: 0.837 vs 0.645 vs 0.737) and external validation cohorts (area under the curve: 0.761-0.802 vs 0.626-0.682 vs 0.694-0.723) and was on par with the integrated model. It also stratified recurrence-free survival significantly (p < 0.0001) with a hazard ratio of 4.50 (95% CI 3.10-6.53). The TRPM performed well in predicting BCG-unresponsive NMIBC (accuracy 84.1%).</p><p><strong>Interpretation: </strong>The ERPM showed promising performance in predicting early recurrence and recurrence-free survival of patients with NMIBC after surgery and with further validation and in combination with TRPM could be used to guide the management of NMIBC.</p><p><strong>Funding: </strong>National Natural Science Foundation of China, the Science and Technology Planning Project of Guangdong Province, the National Key Research and Development Programme of China, the Guangdong Provincial Clinical Research Centre for Urological Diseases, and the Science and Technology Projects in Guangzhou.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"81 ","pages":"103125"},"PeriodicalIF":9.6,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647551","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":"Impact of delayed cord clamping on respiratory distress in late preterm and early term infants in elective cesarean section: a single centre, phase Ⅲ, randomised controlled trial.","authors":"Tingting Wang, Silu Wang, Ming Zhou, Yi Duan, Wei Chen, Liping Pan, Zhen Li, Jianguo Zhou, Jiang-Qin Liu","doi":"10.1016/j.eclinm.2025.103126","DOIUrl":"https://doi.org/10.1016/j.eclinm.2025.103126","url":null,"abstract":"<p><strong>Background: </strong>Delayed cord clamping (DCC) has the potential to alleviate respiratory distress by augmenting blood volume and oxygenation, although there is currently a lack of direct evidence to support this. Late preterm and early term infants born via elective cesarean section (CS) are known to be more vulnerable to the neonatal respiratory distress (NRD). This study was designed to examine the effect of DCC on NRD of these infants.</p><p><strong>Methods: </strong>Conducted from January 1, 2019 to January 31, 2024 at Shanghai First Maternity and Infant Hospital, this single-centre, phase Ⅲ, open-label randomised controlled trial included newborns delivered via elective CS between 34⁺⁰ and 38⁺⁶ weeks of gestation. Participants were excluded if fetus had suspected or confirmed congenital malformations, metabolic diseases, intrauterine growth restriction, late fetal heart rate deceleration or fetal distress. Pregnant women and their infants were randomised into immediate cord clamping (ICC) within 10 s of birth or DCC for 60 s and stratified by late preterm or early term. The primary outcome was the incidence of NRD which was defined as requiring oxygen or airway pressure support within the first 24 h of life. This study was approved from the Ethics Committee of Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University (KS 18126, KS1947). Chinese Clinical Trial Registry (ChiCTR1800017865), registered on August 18th, 2018.</p><p><strong>Findings: </strong>Of 2610 randomised women, 1418 neonates were included in the DCC group and 1419 in the ICC group. The mean maternal age for both groups was 33 (4) years, and all mothers were of Han ethnicity. The mean gestational age of the neonates was 37.9 (0.9) weeks in both groups. NRD occurred in 119 (8.4%) in DCC versus 135 (9.5%) in ICC (Adjusted Relative Risk [aRR] 0.93, 95% CI 0.75-1.14). There were no significant differences in infant and maternal adverse events such as low Apgar score (aRR 0.74, 95% CI 0.25-2.19), hypothermia (aRR 1.00, 95% CI 0.89-1.12), hypoglycemia (aRR 1.04, 95% CI 0.77-1.38), maternal intrapartum massive bleeding (aRR 0.96, 95% CI 0.76-1.19), or the requirement for transfusion (aRR 0.34, 95% CI 0.10-1.15).</p><p><strong>Interpretation: </strong>Delayed cord clamping was safe for both mothers and infants in late preterm and early term delivered by elective cesarean section, while it did not reduce the risk of early respiratory diseases.</p><p><strong>Funding: </strong>This trial was funded by Shanghai Municipal Health Commission, China in 2019 (201940140) and National Natural Science Foundation of China in 2022 (82204047).</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"81 ","pages":"103126"},"PeriodicalIF":9.6,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647612","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":"Explainable deep learning algorithm for identifying cerebral venous sinus thrombosis-related hemorrhage (CVST-ICH) from spontaneous intracerebral hemorrhage using computed tomography.","authors":"Kai-Cheng Yang, Yunzhi Xu, Qing Lin, Li-Li Tang, Jia-Wei Zhong, Hong-Na An, Yan-Qin Zeng, Ke Jia, Yujia Jin, Guoshen Yu, Feng Gao, Li Zhao, Lu-Sha Tong","doi":"10.1016/j.eclinm.2025.103128","DOIUrl":"https://doi.org/10.1016/j.eclinm.2025.103128","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Misdiagnosis of hemorrhage secondary to cerebral venous sinus thrombosis (CVST-ICH) as arterial-origin spontaneous intracerebral hemorrhage (sICH) can lead to inappropriate treatment and the potential for severe adverse outcomes. The current practice for identifying CVST-ICH involves venography, which, despite being increasingly utilized in many centers, is not typically used as the initial imaging modality for ICH patients. The study aimed to develop an explainable deep learning model to quickly identify ICH caused by CVST based on non-contrast computed tomography (NCCT).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The study population included patients diagnosed with CVST-ICH and other spontaneous ICH from January 2016 to March 2023 at the Second Affiliated Hospital of Zhejiang University, Taizhou First People's Hospital, Taizhou Hospital, Quzhou Second People's Hospital, and Longyan First People's Hospital. A transfer learning-based 3D U-Net with segmentation and classification was proposed and developed only on admission plain CT. Model performance was assessed using the area under the curve (AUC), sensitivity, and specificity metrics. For further evaluation, the average diagnostic performance of nine doctors on plain CT was compared with model assistance. Interpretability methods, including Grad-CAM++, SHAP, IG, and occlusion, were employed to understand the model's attention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;An internal dataset was constructed using propensity score matching based on age, initially including 102 CVST-ICH patients (median age: 44 [29, 61] years) and 683 sICH patients (median age: 65 [52, 73] years). After matching, 102 CVST-ICH patients and 306 sICH patients (median age: 50 [40, 62] years) were selected. An external dataset consisted of 38 CVST-ICH and 119 sICH patients from four other hospitals. Validation showed AUC 0·94, sensitivity 0·96, and specificity 0·8 for the internal testing subset; AUC 0·85, sensitivity 0·87, and specificity 0·82 for the external dataset, respectively. The discrimination performance of nine doctors interpreting CT images significantly improved with the assistance of the proposed model (accuracy 0·79 vs 0·71, sensitivity 0·88 vs 0·81, specificity 0·75 vs 0·68, &lt;i&gt;p&lt;/i&gt; &lt; 0·05). Interpretability methods highlighted the attention of model to the features of hemorrhage edge appearance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;The present model demonstrated high-performing and robust results on discrimination between CVST-ICH and spontaneous ICH, and aided doctors' diagnosis in clinical practice as well. Prospective validation with larger-sample size is required.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Funding: &lt;/strong&gt;The work was funded by the National Key R&D Program of China (2023YFE0118900), National Natural Science Foundation of China (No.81971155 and No.81471168), the Science and Technology Department of Zhejiang Province (LGJ22H180004), Medical and Health Science and Technology Project of Zhejiang Pr","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"81 ","pages":"103128"},"PeriodicalIF":9.6,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647557","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":"Effects of lifestyle interventions on mental health in children and adolescents with overweight or obesity: a systematic review and meta-analysis.","authors":"Jiali Zhou, Yuan Song, Jiayao Ying, Chenhao Zhang, Jing Wu, Shiyi Shan, Jindian Zha, Liying Zhou, Wenhan Xiao, Peige Song","doi":"10.1016/j.eclinm.2025.103121","DOIUrl":"https://doi.org/10.1016/j.eclinm.2025.103121","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Childhood obesity and mental health disorders are increasingly prevalent. While lifestyle interventions are widely recognized as effective for managing obesity in children and adolescents, their effects on mental health remain unclear. This study aimed to systematically evaluate the effects of lifestyle interventions on mental health outcomes among children and adolescents with overweight or obesity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this systematic review and meta-analysis, we searched five databases (PubMed, Embase, MEDLINE, CENTRAL and CINAHL) for relevant randomised controlled trials (RCTs) or non-randomised studies of interventions (NRSIs) published from database inception to December 7, 2024, without language restrictions. Lifestyle interventions are defined as structured programs that promote health-related behavioural changes across diverse domains, such as physical activity, dietary adjustments, cognitive training, and psychosocial support. We included studies that assessed the effects of lifestyle interventions on mental health outcomes among children and adolescents with overweight or obesity. Two reviewers independently screened records for eligibility, extracted study-level data and assessed risk of bias of RCTs and NRSIs via the revised Cochrane Risk of Bias Tool for randomised controlled trials (RoB 2) and the Risk of Bias in Non-randomised Studies-of Interventions (ROBINS-I), and certainty of the evidence by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. RCTs were prioritized as the primary source of evidence, while NRSIs served as supplementary evidence. A random-effects meta-analysis model was performed to calculate pooled standardized mean differences (SMDs) and 95% confidence intervals (CIs). Subgroup analyses stratified by age, body mass index (BMI) category, intervention type, theoretical framework, duration, and World Bank income region, were further conducted to identify potential sources of heterogeneity. The review protocol was registered in PROSPERO, CRD42024571061.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;We identified 20,359 records, of which 26 studies (17 RCTs and nine NRSIs) involving 3511 children and adolescents with overweight or obesity were included. Mental health outcomes assessed included depression, anxiety, self-concept, self-efficacy, negative affect, quality of life, and emotional functioning. Lifestyle interventions evaluated encompassed physical activity, health education, emotion regulation, diet, and multicomponent approaches. Among RCTs, reductions in depression (SMD = -0.24, 95% CI: -0.39 to -0.10, &lt;i&gt;I-square&lt;/i&gt; [&lt;i&gt;I&lt;/i&gt; &lt;sup&gt;2&lt;/sup&gt;] = 0.0%) and improvements in quality of life (SMD = 0.24, 95% CI: 0.04-0.44, &lt;i&gt;I&lt;/i&gt; &lt;sup&gt;2&lt;/sup&gt; = 44.0%) were observed, with moderate certainty. Subgroup analyses revealed greater reductions in depression among adolescents and participants with obesity, in programs that involving multicomponent a","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"81 ","pages":"103121"},"PeriodicalIF":9.6,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11906288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647554","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":"Performance of an AI prediction tool for new-onset atrial fibrillation after coronary artery bypass grafting.","authors":"Hualong Ma, Dalong Chen, Weitao Lv, Qiuying Liao, Jingyi Li, Qinai Zhu, Ying Zhang, Lizhen Deng, Xiaoge Liu, Qinyang Wu, Xianliang Liu, Qiaohong Yang","doi":"10.1016/j.eclinm.2025.103131","DOIUrl":"https://doi.org/10.1016/j.eclinm.2025.103131","url":null,"abstract":"<p><strong>Background: </strong>There is lack of tools to predict new-onset postoperative atrial fibrillation (NOAF) after coronary artery bypass grafting (CABG). We aimed to develop and validate a novel AI-based bedside tool that accurately predicts predict NOAF after CABG.</p><p><strong>Methods: </strong>Data from 2994 patients who underwent CABG between March 2015 and July 2024 at two tertiary hospitals in China were retrospectively analyzed. 2486 patients from one hospital formed the derivation cohort, split 7:3 into training and test sets, while the 508 patients from a separate hospital formed the external validation cohort. A stacking model integrating 11 base learners was developed and evaluated using Accuracy, Precision, Recall, F1 score, and Area Under Curve (AUC). SHapley Additive exPlanations (SHAP) values were calculated and plotted to interpret the contributions of individual characteristics to the model's predictions.</p><p><strong>Findings: </strong>Seventy-seven predictive characteristics were analyzed. The stacking model achieved superior performance with AUCs 0·931 and F1 scores 0·797 in the independent external validation, outperforming CHA2DS2-VASc, HATCH, and POAF scores (AUC 0·931 vs. 0·713, 0·708, and 0·667; <i>p</i> < 0·05). SHAP value indicate that the importance of predictive features for NOAF, in descending order, include: Brain natriuretic peptide, Left ventricular end-diastolic diameter, Ejection fraction, BMI, β-receptor blockers, Duration of surgery, Age, Neutrophil percentage-to-albumin ratio, Myocardial infarction, Left atrial diameter, Hypertension, and smoking status. Subsequently, we constructed an easy-to-use bedside clinical tool for NOAF risk assessment leveraging these characteristics.</p><p><strong>Interpretation: </strong>The AI-based tool offers superior prediction of NOAF, outperforming three existing predictive tools. Future studies should further explore how various patient characteristics influence the timing of NOAF onset, whether early or late.</p><p><strong>Funding: </strong>This work was funded by Lingnan Nightingale Nursing Research Institute of Guangdong Province, and Guangdong Nursing Society (GDHLYJYZ202401).</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"81 ","pages":"103131"},"PeriodicalIF":9.6,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647615","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":"Online pharmacies: a double-edged sword.","authors":"eClinicalMedicine","doi":"10.1016/j.eclinm.2025.103133","DOIUrl":"https://doi.org/10.1016/j.eclinm.2025.103133","url":null,"abstract":"","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"80 ","pages":"103133"},"PeriodicalIF":9.6,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709435","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}