EClinicalMedicine最新文献

{"title":"Small intestinal bacterial overgrowth in chronic liver disease: an updated systematic review and meta-analysis of case-control studies.","authors":"Ayesha Shah, Liam Spannenburg, Parag Thite, Mark Morrison, Thomas Fairlie, Natasha Koloski, Purna C Kashyap, Mark Pimentel, Ali Rezaie, Gregory J Gores, Michael P Jones, Gerald Holtmann","doi":"10.1016/j.eclinm.2024.103024","DOIUrl":"10.1016/j.eclinm.2024.103024","url":null,"abstract":"<p><strong>Background: </strong>Small Intestinal Bacterial Overgrowth (SIBO) has been implicated in the pathophysiology of chronic liver disease (CLD). We conducted a systematic review and meta-analysis to assess and compare the prevalence of SIBO among CLD patients (with and without with complications of end stage liver disease) and healthy controls.</p><p><strong>Methods: </strong>Electronic databases were searched from inception up to July-2024 for case-control studies reporting SIBO in CLD. Prevalence rates, odds ratios (ORs), and 95% confidence intervals (CIs) of SIBO in patients with CLD and controls were calculated utilizing a random-effects model. The protocol was prospectively registered with PROSPERO (CRD42022379578).</p><p><strong>Findings: </strong>The final dataset included 34 case-control studies with 2130 CLD patients and 1222 controls. Overall, the odds for SIBO prevalence in CLD patients compared to controls was 6.7 (95% CI 4.6-9.7, p < 0.001). Although the prevalence of SIBO among patients with CLD with cirrhosis was higher at 42.9% (95% CI: 35.9-50.2) compared to 36.9% (95% CI: 27.4-47.6) in those without cirrhosis, this difference failed statistical significance. However, CLD patients with decompensated cirrhosis had a significantly higher prevalence of SIBO compared to those with compensated cirrhosis, with an OR of 2.6 (95% CI: 1.5-4.5, p < 0.001). Additionally, the prevalence of SIBO was significantly higher in CLD patients with portal hypertension (PHT) than in those without PHT, with an OR of 2.1 (95% CI: 1.4-3.1, p < 0.001). The highest prevalence of SIBO was observed in patients with spontaneous bacterial peritonitis (SBP) (57.7%, 95% CI 38.8-74.5), followed by patients with hepatic encephalopathy (41.0%, 95% CI 16.0-72.3) and patients with variceal bleed (39.5%, 95% CI 12.1-75.6).</p><p><strong>Interpretation: </strong>Overall, there is a significantly increased prevalence of SIBO in CLD patients compared to controls. The prevalence is even higher in CLD patients with PHT, especially those with SBP. This meta-analysis suggests that SIBO is associated with complications of CLD and potentially linked to the progression of CLD.</p><p><strong>Funding: </strong>National Health and Medical Research Council, Centre for Research Excellence (APP170993).</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"80 ","pages":"103024"},"PeriodicalIF":9.6,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022757","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 artificial intelligence for diagnosing cervical intraepithelial neoplasia and cervical cancer: a systematic review and meta-analysis.","authors":"Lei Liu, Jiangang Liu, Qing Su, Yuening Chu, Hexia Xia, Ran Xu","doi":"10.1016/j.eclinm.2024.102992","DOIUrl":"10.1016/j.eclinm.2024.102992","url":null,"abstract":"<p><strong>Background: </strong>Cervical cytology screening and colposcopy play crucial roles in cervical intraepithelial neoplasia (CIN) and cervical cancer prevention. Previous studies have provided evidence that artificial intelligence (AI) has remarkable diagnostic accuracy in these procedures. With this systematic review and meta-analysis, we aimed to examine the pooled accuracy, sensitivity, and specificity of AI-assisted cervical cytology screening and colposcopy for cervical intraepithelial neoplasia and cervical cancer screening.</p><p><strong>Methods: </strong>In this systematic review and meta-analysis, we searched the PubMed, Embase, and Cochrane Library databases for studies published between January 1, 1986 and August 31, 2024. Studies investigating the sensitivity and specificity of AI-assisted cervical cytology screening and colposcopy for histologically verified cervical intraepithelial neoplasia and cervical cancer and a minimum of five cases were included. The performance of AI and experienced colposcopists was assessed via the area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) through random effect models. Additionally, subgroup analyses of multiple diagnostic performance metrics in developed and developing countries were conducted. This study was registered with PROSPERO (CRD42024534049).</p><p><strong>Findings: </strong>Seventy-seven studies met the eligibility criteria for inclusion in this study. The pooled diagnostic parameters of AI-assisted cervical cytology via Papanicolaou (Pap) smears were as follows: accuracy, 94% (95% CI 92-96); sensitivity, 95% (95% CI 91-98); specificity, 94% (95% CI 89-97); PPV, 88% (95% CI 78-96); and NPV, 95% (95% CI 89-99). The pooled accuracy, sensitivity, specificity, PPV, and NPV of AI-assisted cervical cytology via ThinPrep cytologic test (TCT) were 90% (95% CI 85-94), 97% (95% CI 95-99), 94% (95% CI 85-98), 84% (95% CI 64-98), and 96% (95% CI 94-98), respectively. Subgroup analysis revealed that, for AI-assisted cervical cytology diagnosis, certain performance indicators were superior in developed countries compared to developing countries. Compared with experienced colposcopists, AI demonstrated superior accuracy in colposcopic examinations (odds ratio (OR) 1.75; 95% CI 1.33-2.31; P < 0.0001; I² = 93%).</p><p><strong>Interpretation: </strong>These results underscore the potential and practical value of AI in preventing and enabling early diagnosis of cervical cancer. Further research should support the development of AI for cervical cancer screening, including in low- and middle-income countries with limited resources.</p><p><strong>Funding: </strong>This study was supported by the National Natural Science Foundation of China (No. 81901493) and the Shanghai Pujiang Program (No. 21PJD006).</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"80 ","pages":"102992"},"PeriodicalIF":9.6,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001722","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, regional, and national burden of male breast cancer in 204 countries and territories: a systematic analysis from the global burden of disease study, 1990-2021.","authors":"Yunhai Li, Ying Huang, Hongbo Huang, Tingting Wei, Aijie Zhang, Lei Xing, Xuedong Yin, Hongyuan Li, Guosheng Ren, Fan Li","doi":"10.1016/j.eclinm.2024.103027","DOIUrl":"10.1016/j.eclinm.2024.103027","url":null,"abstract":"<p><strong>Background: </strong>Male breast cancer (MBC) is a rare malignancy that has been under-investigated, with limited global epidemiological research dedicated to it. A comprehensive estimate of the global, regional, and national burden of MBC is valuable for policy planning. This study aims to evaluate the burden of MBC across 204 countries and territories.</p><p><strong>Methods: </strong>MBC data were collected from the 2021 Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates spanning from 1990 to 2021. The global incidence, prevalence, deaths, and disability-adjusted life-years (DALYs) attributed to MBC, as well as corresponding age-standardized rates, were calculated. Temporal trends, projections of incidence and mortality to 2050, lifetime risk, and risk factors of MBC were also estimated according to regions and countries.</p><p><strong>Findings: </strong>In 2021, there were 38,827 (95% uncertainty interval [UI], 24,650-47,846) new cases, 320,459 (95% UI, 220,533-384,317) prevalent cases, 13,274 (95% UI, 9074-16,240) deaths, and 380,917 (95% UI, 252,922-476,417) DALYs attributed to MBC worldwide, with the highest disease burden observed in the Eastern Sub-Saharan Africa region. From 1990 to 2021, the age-standardized incidence and mortality rates of MBC significantly increased, but they are projected to decrease over the next 30 years. High-middle Socio-demographic Index (SDI) quintile had the highest lifetime risk of developing MBC, while the low SDI quintile had the highest lifetime risk of dying from MBC. Dietary risk and alcohol use were identified as important risk factors for MBC deaths and DALYs globally.</p><p><strong>Interpretation: </strong>The global burden of MBC significantly increased from 1990 to 2021, with notable geographic disparities. Efforts aimed at MBC prevention and control strategies should take into account the inequities in its global distribution.</p><p><strong>Funding: </strong>This study was supported by the National Natural Science Foundation of China (grant numbers 82372996 and 82202913) and the Chongqing Natural Science Foundation (grant number CSTB2023NSCQ-MSX0480).</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"80 ","pages":"103027"},"PeriodicalIF":9.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11741047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001721","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":"Dynamic changes and future trend predictions of the global burden of anxiety disorders: analysis of 204 countries and regions from 1990 to 2021 and the impact of the COVID-19 pandemic.","authors":"Si Chen, Wei Huang, Min Zhang, Yan Song, Chunshan Zhao, Hongwei Sun, Yanyu Wang, Jihong Wang, Yali Sun, Lei Zhou, Yan Zhu, HongYuan Wang, ZhengYang Xu, YuRui Bai, Cheng Chang","doi":"10.1016/j.eclinm.2024.103014","DOIUrl":"10.1016/j.eclinm.2024.103014","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Anxiety disorders is a significant contributor to the Global Burden of Diseases (GBD), particularly in the aftermath of the COVID-19 pandemic, which has exacerbated the issue. Previous studies have not examined the impact of the COVID-19 pandemic on anxiety disorders over the entire time series, nor have they offered predictions regarding future trends of global anxiety disorders in the aftermath of the pandemic. This study aims to present the Age-Standardized Prevalence Rates (ASPR), Age-Standardized Incidence Rates (ASIR), and disability-adjusted life years (DALYs) associated with anxiety disorders from 1990 to 2021 across 204 countries and regions, emphasizing the age structure and the disease burden following the pandemic. Additionally, it examines the relationship between the burden of anxiety disorders and the COVID-19 pandemic, as well as trend predictions for the incidence of anxiety disorders from 2022 to 2050.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We analysed data from the GBD 2021 study, employed the GBD method to integrate epidemiological data on ASPR, ASIR, and DALYs to accurately assess the global burden of anxiety disorders across various regions, genders, and age groups. Additionally, joint point regression analysis was applied to rigorously examine the time trends of anxiety disorders from 1990 to 2021, calculating the annual percentage change (APC), annual average percentage change (AAPC), and their corresponding 95% confidence intervals (CIs). Furthermore, path analysis was utilized to investigate the impact pathways between the COVID-19 pandemic and anxiety disorders. Finally, a Bayesian age-period-cohort (BAPC) model was employed to predict the prevalence trends of anxiety disorders from 2022 to 2050.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;From 1990 to 2021, the ASPR, ASIR, and DALYs associated with anxiety disorders worldwide exhibited a significant upward trend, particularly evident from 2019 to 2021, during which all three metrics experienced a sharp increase. The most pronounced changes in the burden of anxiety disorders from 2019 to 2021 were observed in high socio-demographic index (SDI) regions, where the ASIR surpassed expected levels in tropical Latin America, high-income North America, and Australia in 2021. Bulgaria recorded the highest increase in anxiety disorders burden during this period, with a change rate of 0.32, while Bhutan experienced the smallest increase, with a total change rate of 0.02. Notably, the global anxiety disorders burden among women is greater than that among men. From 2019 to 2021, women aged 20-24 years were particularly impacted by the COVID-19 pandemic, with a change rate of 0.21. Additionally, the ASIR of COVID-19 pandemic in 2021 had a significant positive correlation with the prevalence of anxiety disorders, standardized path coefficient value of 0.224 (z = 2.708, P &lt; 0.01). Projections indicate that by 2050, the number of individuals affected by anxiety disorders ","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"79 ","pages":"103014"},"PeriodicalIF":9.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002121","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":"Long term health outcomes in people with diabetes 12 months after hospitalisation with COVID-19 in the UK: a prospective cohort study.","authors":"Safoora Gharibzadeh, Ash Routen, Cameron Razieh, Francesco Zaccardi, Claire Lawson, Clare Gillies, Simon Heller, Melanie Davies, Helen Atkins, Stephen C Bain, Nazir L Lone, Krisnah Poinasamy, Tunde Peto, Elizabeth Robertson, Bob Young, Desmond Johnston, Jennifer Quint, Jonathan Valabhji, Khalida Ismail, Michael Marks, Alex Horsley, Annemarie Docherty, Ewen Harrison, James Chalmers, Ling-Pei Ho, Betty Raman, Chris Brightling, Omer Elneima, Rachel Evans, Neil Greening, Victoria C Harris, Linzy Houchen-Wolloff, Marco Sereno, Aarti Shikotra, Amisha Singapuri, Louise Wain, Claudia Langenberg, John Dennis, John Petrie, Naveed Sattar, Olivia Leavy, Mattew Richardson, Ruth M Saunders, Anne McArdle, Hamish McASuley, Tom Yates, Kamlesh Khunti","doi":"10.1016/j.eclinm.2024.103005","DOIUrl":"10.1016/j.eclinm.2024.103005","url":null,"abstract":"<p><strong>Background: </strong>People with diabetes are at increased risk of hospitalisation, morbidity, and mortality following SARS-CoV-2 infection. Long-term outcomes for people with diabetes previously hospitalised with COVID-19 are, however, unknown. This study aimed to determine the longer-term physical and mental health effects of COVID-19 in people with and without diabetes.</p><p><strong>Methods: </strong>The PHOSP-COVID study is a multicentre, long-term follow-up study of adults discharged from hospital between 1 February 2020 and 31 March 2021 in the UK following COVID-19, involving detailed assessment at 5 and 12 months after discharge. The association between diabetes status and outcomes were explored using multivariable linear and logistic regressions.</p><p><strong>Findings: </strong>People with diabetes who survived hospital admission with COVID-19 display worse physical outcomes compared to those without diabetes at 5- and 12-month follow-up. People with diabetes displayed higher fatigue (only at 5 months), frailty, lower physical performance, and health-related quality of life and poorer cognitive function. Differences in outcomes between diabetes status groups were largely consistent from 5 to 12-months. In regression models, differences at 5 and 12 months were attenuated after adjustment for BMI and presence of other long-term conditions.</p><p><strong>Interpretation: </strong>People with diabetes reported worse physical outcomes up to 12 months after hospital discharge with COVID-19 compared to those without diabetes. These data support the need to reduce inequalities in long-term physical and mental health effects of SARS-CoV-2 infection in people with diabetes.</p><p><strong>Funding: </strong>UK Research and Innovation and National Institute for Health Research. The study was approved by the Leeds West Research Ethics Committee (20/YH/0225) and is registered on the ISRCTN Registry (ISRCTN10980107).</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"79 ","pages":"103005"},"PeriodicalIF":9.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002125","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":"Safety and effects of anti-obesity medications on weight loss, cardiometabolic, and psychological outcomes in people living with overweight or obesity: a systematic review and meta-analysis.","authors":"Leiling Liu, Zhiqi Li, Wenrui Ye, Pu Peng, Yurong Wang, Luqing Wan, Jiangnan Li, Mei Zhang, Yihua Wang, Runqi Liu, Danyan Xu, Jingjing Zhang","doi":"10.1016/j.eclinm.2024.103020","DOIUrl":"10.1016/j.eclinm.2024.103020","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Overweight and obesity pose serious health challenges for individuals and societies. This study aims to facilitate personalised treatment of obesity by summarising recent research on weight-loss pharmacotherapies, with a focus on their effects on weight reduction, cardiometabolic health, psychological outcomes, and adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This systematic review and meta-analysis included searches of Web of Science, PubMed, and Cochrane Central Register of Controlled Trials from inception to June 8, 2024. Randomised controlled trials evaluating weight-loss pharmacotherapies approved by the Food and Drug Administration (FDA) or European Medicines Agency (EMA) for treating overweight or obesity were included. Primary outcomes included changes in body weight, cardiometabolic indicators, psychological outcomes, and adverse events. Summary data was extracted from published reports. Random-effects meta-analyses were used to calculate weighted mean differences (WMDs), risk ratios (RRs), and 95% confidence intervals (CI). The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used to assess the certainty of evidence for each pooled analysis. PROSPERO registration: CRD42024547905.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;A total of 154 randomised controlled trials (n = 112,515 participants) were included. Tirzepatide had the greatest weight-loss effect (WMD -11.69, 95% CI -19.22 to -4.15; &lt;i&gt;P&lt;/i&gt; = 0.0024; I&lt;sup&gt;2&lt;/sup&gt; = 100.0%; moderate certainty), followed by semaglutide (-8.48, -12.68 to -4.27; &lt;i&gt;P&lt;/i&gt; &lt; 0.0001; I&lt;sup&gt;2&lt;/sup&gt; = 100.0%; moderate certainty). Tirzepatide had the strongest antihypertensive effect on both systolic (WMD -5.74, -9.00 to -2.48; &lt;i&gt;P&lt;/i&gt; = 0.0006; I&lt;sup&gt;2&lt;/sup&gt; = 99.8%; moderate certainty) and diastolic blood pressure (WMD -2.91, -4.97 to -0.85; &lt;i&gt;P&lt;/i&gt; = 0.0056; I&lt;sup&gt;2&lt;/sup&gt; = 99.8%; moderate certainty) and best reduced triglycerides (WMD -0.77, -0.85 to -0.69; &lt;i&gt;P&lt;/i&gt; &lt; 0.0001; I&lt;sup&gt;2&lt;/sup&gt; = 3.2%; high certainty), fasting glucose (WMD -3.06, -5.53 to -0.59; &lt;i&gt;P&lt;/i&gt; = 0.015; I&lt;sup&gt;2&lt;/sup&gt; = 100.0%; moderate certainty), insulin (WMD -4.91, -8.15 to -1.68; &lt;i&gt;P&lt;/i&gt; = 0.0029; I&lt;sup&gt;2&lt;/sup&gt; = 97.0%; moderate certainty), and glycated haemoglobin levels (WMD -1.27, -1.82 to -0.73; &lt;i&gt;P&lt;/i&gt; &lt; 0.0001; I&lt;sup&gt;2&lt;/sup&gt; = 100.0%; moderate certainty). Semaglutide (RR 0.83, 0.74-0.92; &lt;i&gt;P&lt;/i&gt; &lt; 0.0001; I&lt;sup&gt;2&lt;/sup&gt; = 0.0%; high certainty) and liraglutide (0.87, 0.79-0.96; &lt;i&gt;P&lt;/i&gt; = 0.0059; I&lt;sup&gt;2&lt;/sup&gt; = 0.0%; high certainty) reduced the risk of major adverse cardiovascular events (MACEs). However, all three medications were associated with adverse gastrointestinal effects. Naltrexone/bupropion increased the risk of elevated blood pressure (RR 1.72, 1.04-2.85; &lt;i&gt;P&lt;/i&gt; = 0.036; I&lt;sup&gt;2&lt;/sup&gt; = 0.0%; high certainty). Topiramate increased depression risk (RR 1.62, 1.14 to 2.30; &lt;i&gt;P&lt;/i&gt; = 0.0077; I&lt;sup&gt;2&lt;/sup&gt; = 0.0%; high certainty), and phentermin","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"79 ","pages":"103020"},"PeriodicalIF":9.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002137","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 efficacy and acceptability of non-invasive neuromodulation technologies and botulinum toxin injections for post-stroke spasticity and motor function: a network meta-analysis of randomised controlled trials.","authors":"Jiapeng Huang, Chuncha Bao, Yin Chen, Wenyi Zhu, Kexin Zhang, Chunlong Liu, Chunzhi Tang","doi":"10.1016/j.eclinm.2024.103034","DOIUrl":"10.1016/j.eclinm.2024.103034","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Non-invasive neuromodulation is a promising approach for improving spasticity and motor function after stroke. However, it is still unclear which type of non-invasive neuromodulation is effective and evidence of important differences between them and botulinum toxin (BoNT) injection is limited. We aimed to assess the comparative efficacy and acceptability of non-invasive neuromodulation technologies and BoNT for post-stroke spasticity and motor function.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this network meta-analysis, Cochrane Library, EMBASE, MEDLINE, Web of Science, Scopus, CNKI, and Wan Fang Data were searched from the earliest records to 8 October 2024. Randomised controlled trials that compared any type of non-invasive neuromodulation therapies, BoNT, and control treatments (including sham or no stimulation/injection) for post-stroke spasticity measured by modified Ashworth scale (MAS) were included. MAS, motor function, and acceptability were pooled using random-effects model with summary weighted mean difference (WMD) or risk ratios (RR) alongside 95% confidence interval (CI). Ranking probabilities of the treatments were estimated. Clinical importance was categorized as definite, probable, possible, or definitely not, considering the relationship between effect measures (95% CI) and minimal clinically important difference (1, 6, and 1.5 points for MAS, motor function, and acceptability, respectively). The quality of evidence was assessed using CINeMA online web. PROSPERO registration CRD42024543494.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;6260 studies were identified and 185 trials (11,185 participants; 12 interventions) were included. Compared with control treatments, BoNT, high- and low-frequency repetitive transcranial magnetic stimulation (HFrTMS and LFrTMS), and anodal, cathodal, and dual transcranial direct current stimulation (atDCS, ctDCS, and dtDCS) significantly improved spasticity at short-term follow-up (WMD range -0.81 to -0.31), but did not achieve clinical importance. At mid-term, ctDCS (WMD = -2.00; 95% CI: -3.03, -0.97) and dtDCS (WMD = -1.62; 95% CI: -3.22, -0.02) were more efficacious than control treatments in reducing post-stroke spasticity with probable clinical importance. For motor function, atDCS, ctDCS, and dtDCS were more efficacious than control treatments (WMD range 6.29-13.00), with probable clinical importance, while BoNT, HFrTMS, and LFrTMS with possible clinical importance (WMD range 3.42-5.28). Various modalities have comparable acceptability to control treatments (RR range 0.48-1.46). Confidence in accordance with CINeMA ranged from high to low. Sensitivity and meta-regression analyses on limb measured, cointervention, and stroke stage confirmed the main findings of this study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;Taken together with clinical importance, evidence available supports three forms of tDCS as effective treatments for post-stroke spasticity and/or motor impairments, whe","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"80 ","pages":"103034"},"PeriodicalIF":9.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11741030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002101","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":"Cost-effectiveness of targeted next-generation sequencing (tNGS) for detection of tuberculosis drug resistance in India, South Africa and Georgia: a modeling analysis.","authors":"Suvesh Shrestha, Angelina Addae, Cecily Miller, Nazir Ismail, Alice Zwerling","doi":"10.1016/j.eclinm.2024.103003","DOIUrl":"10.1016/j.eclinm.2024.103003","url":null,"abstract":"<p><strong>Background: </strong>Targeted next-generation sequencing (tNGS) is promising alternative to phenotypic drug susceptibility testing (pDST) for detecting drug-resistant tuberculosis (DRTB). This study explored the potential cost-effectiveness of tNGS for the diagnosis of DR-TB across 3 settings: India, South Africa and Georgia.</p><p><strong>Methods: </strong>To inform WHO guideline development group (GDG) on tNGS we developed a stochastic decision analysis model and assessed cost-effectiveness of tNGS for DST among rifampicin resistance individuals. We also assessed tNGS as initial test for TB drug resistance in bacteriologically confirmed TB. Diagnostic accuracy and cost data were sourced from a systematic review conducted for GDG, covering studies published until September 2022. The primary outcome was incremental cost (2021 US$) per disability-adjusted life year (DALY) averted.</p><p><strong>Findings: </strong>tNGS when compared with in-country DST, tNGS proved cost-effective in South Africa (ICER: $15,619/DALY averted, WTP: $21,165) but not in Georgia (ICER: $18,375/DALY averted, WTP: $15,069). In India, tNGS dominated in-country DST practice, providing greater health impact at lower cost. When comparing tNGS with universal pDST, tNGS was dominated by pDST in all three countries. In Georgia, using tNGS as initial test for TB drug-resistance compared to Xpert MTB/Rif followed by pDST appeared cost-effective. Scenario with 50% reduction in tNGS test kit costs made tNGS cost-effective across all three countries, while a high Bedaquiline resistance prevalence (30%) led to a worsening cost-effectiveness.</p><p><strong>Interpretation: </strong>tNGS may be cost-effective in India, South Africa and Georgia when comprehensive DST is not routinely performed. Thus, existing DST practice and healthcare infrastructure should be considered before implementation and scale-up of tNGS.</p><p><strong>Funding: </strong>Global Tuberculosis Program, World Health Organization (2022/1249364-0).</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"79 ","pages":"103003"},"PeriodicalIF":9.6,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983084","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 antiparasitic therapy on cardiovascular outcomes in chronic Chagas disease. A systematic review and meta-analysis.","authors":"Anis Rassi, Alyssa Grimshaw, Ashwin Sarwal, Ranjit Sah, Sangam Shah, Nelson I Agudelo Higuita, Fabio Mahamed Rassi, Michaele Francesco Corbisiero, Hannah M Kyllo, Jordan Stellern, Samantha Kaplan, Luis A Marcos, Edgar A Ramírez-García, Martin Casapia, Peter Hotez, Maria Elena Bottazzi, Shital Patel, Carlos Franco-Paredes, José Antonio Marin-Neto, Andrés F Henao-Martínez","doi":"10.1016/j.eclinm.2024.102972","DOIUrl":"10.1016/j.eclinm.2024.102972","url":null,"abstract":"<p><strong>Background: </strong>Endemic in more than 20 countries, Chagas disease affects 6.3 million people worldwide, leading to 28,000 new infections and 7700 deaths each year. Previous meta-analyses on antiparasitic treatment need updates to encompass recent studies and to assess key clinically meaningful endpoints. This study aims to evaluate the impact of antitrypanosomal therapy in preventing or reducing disease progression and mortality in chronic Chagas disease.</p><p><strong>Methods: </strong>We performed a systematic review and meta-analysis of studies reporting the cardiovascular outcomes of antitrypanosomal therapy in patients with chronic Chagas disease. We searched Ovid Embase, Ovid MEDLINE, Ovid Global Health, Scopus, Web of Science Core Collection, Cochrane Library, PubMed, Google Scholar, and Virtual Health Library databases from inception to May 18, 2024. We included aggregated data from randomized controlled studies and observational reports (full articles and abstracts) featuring antiparasitic interventions with benznidazole or nifurtimox compared to a control group. Primary outcomes were electrocardiogram (ECG) changes, disease progression, cardiovascular death, and overall mortality. A customized risk of bias scale assessed the methodological quality of studies, and a random-effects model estimated the pooled risk ratios. This investigation was registered in PROSPERO (CRD42023495755).</p><p><strong>Findings: </strong>Out of 4666 reports screened, 23 met the pre-specified inclusion criteria (8972 participants). Compared to no treatment or placebo, antiparasitic treatment led to a reduction in i) ECG changes (17 studies, 4994 participants: risk ratio (RR): 0.48, 95% CI 0.36-0.66, p < 0.001; <i>I</i> ² = 76.4%) with a number needed to treat (NNT) of 5; ii) disease progression (12 studies, 5722 participants: RR: 0.35, 95% CI 0.23-0.51, p < 0.001; <i>I</i> ² = 72.4%) NNT of 6; iii) cardiovascular death (7 studies, 5662 participants: RR: 0.44, 95% CI 0.21-0.95, p = 0.04; <i>I</i> ² = 50.5%) NNT of 22; and iv) overall mortality (10 studies, 7694 participants: RR: 0.54, 95% CI 0.34-0.87, p < 0.001; <i>I</i> ² = 60%) NNT of 23.</p><p><strong>Interpretation: </strong>We found compelling evidence that antiparasitic treatment significantly reduces the risk of ECG changes, disease progression, cardiovascular death, and overall mortality in chronic Chagas disease. Although the quality of evidence ranges from low to intermediate, with considerable heterogeneity across studies, the potential benefits are substantial. These findings support the broader use of trypanocidal therapy in the management of Chagas disease, though further research remains necessary.</p><p><strong>Funding: </strong>This study had no funding source.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"79 ","pages":"102972"},"PeriodicalIF":9.6,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982139","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":"Inorganic nitrates to prevent in-stent restenosis. Is nitric oxide the Philosopher's stone?","authors":"Fernando Alfonso, Alexander Marschall, David Del Val","doi":"10.1016/j.eclinm.2024.103015","DOIUrl":"10.1016/j.eclinm.2024.103015","url":null,"abstract":"","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"79 ","pages":"103015"},"PeriodicalIF":9.6,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982640","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}