EClinicalMedicine最新文献

{"title":"Development and validation of an explainable machine learning model for predicting postoperative pulmonary complications after lung cancer surgery: a machine learning study.","authors":"Shaolin Chen, Ting Deng, Qing Yang, Jin Li, Juanyan Shen, Xu Luo, Juan Tang, Xulian Zhang, Jordan Tovera Salvador, Junliang Ma","doi":"10.1016/j.eclinm.2025.103386","DOIUrl":"10.1016/j.eclinm.2025.103386","url":null,"abstract":"<p><strong>Background: </strong>Early identification and prediction of postoperative pulmonary complications (PPCs) are vital for patient management in lung cancer (LC) surgery. However, existing predictive models often lack comprehensive validation and interpretability. This study aimed to develop and validate an explainable machine learning (ML) model to predict PPCs in patients with LC undergoing surgery.</p><p><strong>Methods: </strong>A risk factor variable pool was determined by meta-analysis and Delphi surveys. Patients undergoing LC surgery who were admitted to the Thoracic Surgery Department at the Affiliated Hospital of Zunyi Medical University from 1st January 2022 to 31st October 2023 (retrospective) and from 1st November 2023 to 31st July 2024 (prospective) were used for model development and prospective validation, respectively. The retrospective cohort was randomly split into a training set and an internal validation set at an 8:2 ratio. Feature selection involved univariate analysis, collinearity analysis, nine ML algorithms, and expert consensus. Twelve independent ML models and 26 stacking ensemble models were developed. Predictive performance was evaluated using the area under the receiver-operating-characteristic curve (AUROC), accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and F1 score. Prospective validation was analysed using AUC, Hosmer-Lemeshow test, calibration curves, and decision curve analysis (DCA). The Shapley Additive Explanation (SHAP) method was utilised to interpret the predictive model.</p><p><strong>Findings: </strong>A total of 883 patients were included in the retrospective cohort with an incidence of PPCs of 35.4% (313/883), and a total of 308 patients were included in the prospective cohort with PPCs of 29.5% (91/308). Nine key characteristics were selected for model development: age, duration of surgery, Charson comorbidity index (CCI), tumour stage, measured carbon monoxide diffusion (DLCO, mmol/min/kPa), intra-operative infusion volume (IFIV, mL), red blood cell volume distribution width-coefficient of variation (RDW-CV, %), body mass index (BMI), and number of years of smoking. Amongst the independent models, the Gradient Boosting Decision Tree (GBDT) showed best performance, achieving an AUROC of 0.829 (95% CI: 0.774-0.885). The stacking ensemble combining Support Vector Machine (SVM) and Decision Tree (DT) showed the highest overall performance, with an AUROC of 0.860 (95% CI: 0.809-0.911), and DCA showed higher clinical utility compared to other models. In the prospective validation, the AUROC was 0.790 (95% CI: 0.744-0.835).</p><p><strong>Interpretation: </strong>The stacking ensemble model combining SVM and DT demonstrated robust predictive performance and favourable clinical utility for prediction PPCs in patients undergoing LC surgery. However, the model has not been applied in clinical practice and requires future validation in large, multi","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"86 ","pages":"103386"},"PeriodicalIF":10.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820915","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":"Estimated glomerular filtration rate, albuminuria, and risk of infection: a collaborative meta-analysis of individual participant data.","authors":"Junichi Ishigami, Aditya Surapaneni, Kunihiro Matsushita, Josef Coresh, Morgan E Grams, Shoshana H Ballew, Yingying Sang, Benedicte Stengel, Johan Ärnlöv, Samira Bell, Juan-Jesus Carrero, Alexander R Chang, Elizabeth L Ciemins, Richard Haynes, Joachim Ix, Fruzsina Kotsis, Jennifer S Lees, Krutika Pandit, Panduranga Rao, Cassianne Robinson-Cohen, Natalia Alencar de Pinho, Keiichi Sumida","doi":"10.1016/j.eclinm.2025.103372","DOIUrl":"10.1016/j.eclinm.2025.103372","url":null,"abstract":"<p><strong>Background: </strong>Infections are a major cause of hospitalization in people with chronic kidney disease (CKD), with incidence similar to cardiovascular disease, yet the risk of infection has not been systematically studied across stages of CKD.</p><p><strong>Methods: </strong>We conducted a meta-analysis of individual participant data including 1,246,912 individuals across 47 cohorts in the CKD Prognosis Consortium, with information on estimated glomerular filtration rate based on serum creatinine (eGFRcr) and urinary albuminuria (ACR) (or proteinuria converted to ACR), to examine the association of eGFR and ACR with the risk of hospitalization with infection. Outcomes were ascertained through diagnostic codes on hospital discharge records relevant to acute infections (i.e., upper and lower respiratory tract, urinary tract, skin and soft tissue, musculoskeletal, gastrointestinal tract, genital, nervous system, and cardiovascular system infections, and sepsis). Follow-up was censored on December 31, 2019 or on the last date of cohort follow-up, whichever was earlier. Multivariable Cox models were used to estimate hazard ratios (HRs).</p><p><strong>Findings: </strong>During follow-up, 170,864 (13.7%) individuals had a hospitalization with infection (IR, 22.0 [IQI, 16.2-31.0] per 1000 person-yrs). In Cox models, compared to eGFRcr 90-104 ml/min/1.73 m² and ACR <10 mg/g, lower eGFRcr and higher ACR were each independently associated with an increased hazard of infection in a graded manner, including in eGFRcr 60-89 and 45-59 ml/min/1.73 m² (adjusted HRs [95% CI], 1.09 [1.06-1.13] and 1.39 [1.34-1.45]) and ACR 10-29 and 30-299 mg/g (1.40 [1.33-1.47] and 1.82 [1.72-1.92]). High eGFRcr ≥105 ml/min/1.73 m² was also associated with the risk of infection (1.22 [1.17-1.26]). Combined, eGFRcr <30 ml/min/1.73 m² and ACR ≥ 300 mg/g were associated with more than 6-fold higher hazard of infections (6.27 [5.70-6.90]). These findings were consistent across infection subtypes (e.g., HRs for lower respiratory tract infections, 1.26 [1.22-1.30] per -15 ml/min/1.73 m² in eGFR and 1.48 [1.44-1.53] per 8-fold increase in ACR).</p><p><strong>Interpretation: </strong>Lower kidney function and higher albuminuria were independently associated with higher risk of infection. The risk was elevated even in mild to moderate CKD, with the highest risk seen in the most advanced stage of CKD. Infection prevention measures should target individuals across all CKD stages.</p><p><strong>Funding: </strong>US National Kidney Foundation and the National Institute of Diabetes and Digestive and Kidney Diseases.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"86 ","pages":"103372"},"PeriodicalIF":10.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820916","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":"Contraception and abortion information and care in community pharmacy for adolescents: a systematic review.","authors":"Anisa Rojanapenkul Assifi, Danielle Mazza","doi":"10.1016/j.eclinm.2025.103394","DOIUrl":"10.1016/j.eclinm.2025.103394","url":null,"abstract":"<p><strong>Background: </strong>Adolescents encounter greater barriers when accessing sexual and reproductive health (SRH) services than adults. Community-based pharmacists are uniquely positioned to address this due to their accessibility and availability within urban and rural contexts. This systematic review aimed to examine adolescents' experience and acceptability of contraception and abortion clinical and dispensing services in community pharmacy.</p><p><strong>Methods: </strong>Seven databases were systematically searched to identify original peer-reviewed studies from high-income countries, from 2000 to 2025, relating to adolescents, pharmacy, contraception and medication abortion. The search was conducted in June 2023 and updated in April 2025. This review is registered with Prospero (CRD42022298209).</p><p><strong>Findings: </strong>Thirty-four studies were included; the majority focused on the emergency contraceptive pill. Despite adolescents feeling that the pharmacy was an accessible and convenient source of SRH services and that pharmacists provided them with comprehensive information, adolescents experienced and feared embarrassment, judgement and stigma.</p><p><strong>Interpretation: </strong>Though this review identified community pharmacies as safe, accessible settings where adolescents can conveniently seek care, competency in adolescent-friendly care needs to be optimised, with greater focus on expanding pharmacists' scope-of-practice.</p><p><strong>Funding: </strong>No funding was received for this study.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"86 ","pages":"103394"},"PeriodicalIF":10.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820913","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 effect of maternal pre-pregnancy body mass index on hypertensive disorders of pregnancy (HDP): a systematic review and dose-response meta-analysis of cohort studies involving 50 million pregnancies.","authors":"Yiquan Xiong, Jingwen Chen, Yue Wu, Peng Zhao, Mingyu Liao, Jin Guo, Chunrong Liu, Mengyuan Zheng, Yan Ren, Kang Zou, Xin Sun, Jing Tan","doi":"10.1016/j.eclinm.2025.103395","DOIUrl":"10.1016/j.eclinm.2025.103395","url":null,"abstract":"<p><strong>Background: </strong>Hypertensive disorders of pregnancy is a prevalent pregnancy complication worldwide, and the dose-response association between maternal pre-pregnancy body mass index (BMI) and hypertensive disorders of pregnancy has not been precisely studied. The aim of this study was to assess dose-response association between maternal pre-pregnancy BMI and hypertensive disorders of pregnancy, including pregnancy induced hypertension, preeclampsia and eclampsia.</p><p><strong>Methods: </strong>This dose-response meta-analysis searched four electronic databases (Pubmed, Web of science, OVID Embase and OVID Medline) for relevant publications up to October, 2023. Cohort studies evaluated the association between pre-pregnancy or early pregnancy maternal BMI and pregnancy induced hypertension, preeclampsia, eclampsia and hypertensive disorders of pregnancy were included. Non-linear or linear dose-response association was modeled. Unadjusted and adjusted effects were pooled separately, and four subgroups, meta-regression, five sensitivity analyses were conducted. Study protocol was registered on the PROSPERO (CRD42022290318).</p><p><strong>Findings: </strong>157 cohort studies involving 51,813,975 pregnancies were finally included. Of 157 studies, multiple outcomes were reported: 58 on pregnancy induced hypertension, 92 on preeclampsia, 6 on eclampsia, and 84 on hypertensive disorders of pregnancy, have assessed the association with pre-pregnancy BMI. A significant linear dose-response relationship was identified between BMI and pregnancy induced hypertension with a crude relative risk (cRR) of BMI per 5-unit increase of 1.73 (95% confidence intervals [CI]: 1.65-1.81), and an adjusted odds ratio (aOR) per 5-unit increase of 1.82 (95% CI: 1.74-1.90). Similar dose-response relationship was observed between BMI and preeclampsia (cRR: 1.63, 1.58-1.69; aOR: 1.70, 1.61-1.80), eclampsia (cRR: 1.40, 1.28-1.53; aOR: 1.36, 1.20-1.53) and hypertensive disorders of pregnancy (cRR: 1.68, 1.63-1.74; aOR: 1.75, 1.68-1.82). Subgroup analyses revealed that the pooled risk of BMI for pregnancy induced hypertension, preeclampsia, eclampsia, and hypertensive disorders of pregnancy was likely higher in Asian pregnant women compared to those in American and European regions. Sensitivity analyses results were mainly consistent with the primary results.</p><p><strong>Interpretation: </strong>This meta-analysis demonstrated a clear and significant dose-response relationship between increasing maternal pre-pregnancy BMI and elevated risks of pregnancy induced hypertension, preeclampsia, eclampsia, and overall hypertensive disorders of pregnancy, underscoring the clinical importance of maintaining a healthy BMI prior to conception. Pre-pregnancy BMI may be an important focus for preconception counseling and subsequent pre-pregnancy weight management for both clinicians and women.</p><p><strong>Funding: </strong>National Natural Science Foundation of China (72174","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"86 ","pages":"103395"},"PeriodicalIF":10.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820921","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":"Clinician underprescription of and patient nonadherence to clinical practice guideline-recommended medications for peripheral artery disease: a systematic review and meta-analysis.","authors":"Aidan M Kirkham, Maude Paquet, Dean A Fergusson, Ian D Graham, Justin Presseau, Daniel I McIsaac, Sudhir K Nagpal, David de Launay, Sami Aftab Abdul, Risa Shorr, Jeremy M Grimshaw, Derek J Roberts","doi":"10.1016/j.eclinm.2025.103391","DOIUrl":"10.1016/j.eclinm.2025.103391","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Guidelines recommend that adults with peripheral artery disease (PAD) take antiplatelets, statins, and antihypertensives. However, it is unclear how frequently clinicians do not prescribe these medications (ie, underprescription), how often patients fail to fill/refill their prescriptions (ie, nonadherence), which factors increase underprescription/nonadherence risk, and whether underprescription/nonadherence are associated with outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We searched MEDLINE, EMBASE, CENTRAL, and Evidence-Based Medicine Reviews (January 1, 2006-to-February 18th, 2025) for studies reporting cumulative incidences/point prevalences of clinician underprescription and/or patient nonadherence to antiplatelets, statins, and/or antihypertensives; adjusted-risk factors for underprescription/nonadherence; and adjusted-outcomes associated with underprescription/nonadherence among adults with PAD. Two investigators independently screened citations, extracted data, and assessed risk of bias. Data were pooled using random-effects models. Estimate certainty was communicated using GRADE. The study was registered on PROSPERO (CRD42022362801).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Among 4206 citations identified, 125 studies (n = 14,681,801 participants; 37% female) were included. The pooled cumulative incidence of antiplatelet, statin, and antihypertensive (among those with PAD and hypertension) underprescription was 28% (95% confidence interval [CI] = 21-36%; moderate-certainty), 34% (95% CI = 31-38%; high-certainty), and 43% (95% CI = 33-53%; moderate-certainty), respectively. The cumulative incidence of antiplatelet, statin, and antihypertensive nonadherence was 27% (95% CI = 20-35%; moderate-certainty), 28% (95% CI = 24-33%; high-certainty), and 23% (95% CI = 22-24%; low-certainty), respectively. Underprescription was more common in population-based studies and those enrolling more females and past/current smokers while nonadherence was more common in studies enrolling more patients with diabetes. Underprescription risk factors included female sex, advanced age, malignancy history, and chronic limb-threatening ischemia (all moderate-certainty). Nonadherence risk factors included advanced age, comorbidity burden, and receiving specialist mental health care (all moderate-certainty). Underprescription was associated with increased major adverse cardiac events, all-cause mortality, and decreased amputation-free time (all moderate-certainty).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;One-quarter-to-one-half of adults with PAD are not prescribed antiplatelets, statins, and antihypertensives. Further, approximately one-quarter of these patients do not adhere to these medications after prescription.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Funding: &lt;/strong&gt;This research was supported by a 2024 Vanier Canada Graduate Scholarship (awarded to AMK and supervised by DJR), a Graham Farquharson Physician Services Incorporated Knowledge Translation Fellowship (a","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"86 ","pages":"103391"},"PeriodicalIF":10.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820912","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":"Examining the feasibility of a crisis-focused Cognitive Behaviour Therapy (CBT)-informed psychological intervention for inpatients experiencing psychosis (the CRISIS study): results from a pilot randomised controlled trial.","authors":"Lisa Wood, Anthony P Morrison, Mary Birken, Ceri Dare, Ella Guerin, Patrick Nyikavaranda, Nira Malde-Shah, Karen Persaud, Panarai Ford, Cyntheia Nebo, Caroline S Clarke, Brynmor Lloyd-Evans, Kathryn Greenwood, Glyn Lewis, Barbara Lay, Graeme MacLennan, Nicola Morant, Fiona Nolan, Vanessa Pinfold, Colette Christiansen, Claire Williams, Sonia Johnson","doi":"10.1016/j.eclinm.2025.103380","DOIUrl":"10.1016/j.eclinm.2025.103380","url":null,"abstract":"<p><strong>Background: </strong>Cognitive Behavioural Therapy for psychosis (CBTp) is a psychological intervention that should be offered in the acute phase of psychosis. However, there is little evidence to guide its delivery. The aim of this study was to examine the feasibility of a randomised controlled trial (RCT) of a crisis-focused CBTp-informed intervention (cCBTp) with inpatients. The intervention was co-produced with a stakeholder group.</p><p><strong>Methods: </strong>Participants were included if they were experiencing psychosis and receiving care from a psychiatric inpatient service at the time of consent. We aimed to recruit n = 60 inpatients and randomise them on a 1:1 ratio to either receive cCBTp plus treatment as usual (TAU) or TAU alone. Follow-ups were conducted at 2, 6, and 12 months. An average of 6-8 sessions of the intervention were offered. The primary objective was to examine indicators of feasibility (recruitment, data collection rates, intervention delivery). The study was prospectively registered (ISRCTN59055607) and is now complete.</p><p><strong>Findings: </strong>Between 1st February 2021 and 28th February 2022, 145 participants were referred to the study and 52 participants were randomised (during the COVID-19 pandemic). 26 were randomly allocated to cCBTp and 26 to TAU. We were able to recruit 87% of our target sample size. The face-to-face data collection rate (measures of symptoms, recovery, quality of life and service use) was 58% at 2 months and 60% at 6 months, which was below the proposed feasibility threshold. Collection of Electronic Health Record (EHR) data (relapse, rehospitalisation, and adverse events) was at 86% at 6 months and 83% at 12 months. Nine (35%) participants in the cCBTp arm and n = 7 (27%) in the TAU arm had an adverse or serious adverse event. None were assessed as related to participation in the intervention or the trial.</p><p><strong>Interpretation: </strong>This study demonstrated that a pilot RCT of cCBTp was feasible with inpatients experiencing psychosis. A further large-scale fully powered trial is required to evaluate its effectiveness and cost-effectiveness, including modified strategies for follow-up data collection.</p><p><strong>Funding: </strong>This research was funded by the National Institute of Health Research (ICA-CL-2018-04-ST2-013).</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"86 ","pages":"103380"},"PeriodicalIF":10.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820917","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 trends in mortality related to pulmonary embolism: an epidemiological analysis of data from the World Health Organization mortality database from 2001 to 2023.","authors":"Hideharu Hagiya, Ko Harada, Yoshito Nishimura, Maki Yamamoto, Sayoko Nishimura, Michio Yamamoto, Takahiro Niimura, Yuka Osaki, Quynh Thi Vu, Mariko Fujii, Nanami Sako, Tatsuaki Takeda, Hirofumi Hamano, Yoshito Zamami, Toshihiro Koyama","doi":"10.1016/j.eclinm.2025.103389","DOIUrl":"10.1016/j.eclinm.2025.103389","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Pulmonary embolism (PE) remains a major contributor to the global disease burden. However, disparities in international trends of PE-related mortality have not been comprehensively examined across geographic, economic, and healthcare system parameters. We employed multifaceted stratification to analyse long-term trends in PE-related mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This epidemiological analysis used registration data from the World Health Organization Mortality Database. PE-related mortality was defined with the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes for acute PE (I26) and any forms of venous thromboembolism (I80, I822, I828, I829, O882, O222, O223, O229, O870, O871, and O879). Countries were deemed eligible for inclusion in the analysis if they provided mortality data for 5-year age intervals up to ≥85 years, from 2001 to 2023 (last update, February 2025). Countries with incomplete age- and sex-stratified demographic data were excluded. We used locally weighted regression (LOESS) to show global trends in crude and age-standardised mortality rates. Subgroup analyses by geographic region and income level were also performed. Additionally, joinpoint regression analysis was performed to estimate the average annual per cent change (AAPC) in the age-standardised mortality trends for each country during 2010-2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Data from 73 countries, encompassing 1,550,883 participants [57.8% (896,393) of whom were female], were eligible for the LOESS analysis, while those from 75 countries, including 915,518 participants (56.9% (520,587) of whom were female) were valid for the joinpoint analysis. The LOESS estimates of global age-standardised PE-related mortality rate (per 100,000) decreased from 3.49 (95% confidence interval [CI], 3.20-3.79) in 2001 to 2.42 (95% CI, 2.04-2.80) in 2023. The age-standardised mortality rates considerably reduced in European regions, such as Western Europe, from 5.24 (95% CI, 4.75-5.74) to 2.25 (95% CI, 1.62-2.87) in 2023; however, in Africa, they remained high from 4.23 (95% CI, 3.82-4.64) in 2001 to 3.90 (95% CI, 2.81-5.00) in 2023. High-income countries showed a continuous downward trend, from 3.68 (95% CI, 3.28-4.08) in 2001 to 2.20 (95% CI, 1.68-2.71) in 2023, whereas lower-to middle-income countries showed a rising trend, from 0.92 (95% CI, 0.04-1.81) in 2001 to 4.82 (95% CI, 3.12-6.52) in 2023. Higher increases in the age-standardised mortality rates were predominantly observed in lower-middle-income countries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;Globally, the PE-related mortality rate has declined over the last two decades, except in countries with certain geographical and economic conditions. Despite the potential limitation of misclassification and underreporting, our efforts corroborated that greater efforts are needed to reduce PE-related mortality, especially for populations in sus","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"86 ","pages":"103389"},"PeriodicalIF":10.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820919","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":"Shorter versus longer-duration antibiotic treatments for immunocompetent patients with bloodstream infections: a systematic review and meta-analysis.","authors":"Ming Liu, Ya Gao, Li Zheng, Zhifan Li, Liang Yao, Jianguo Xu, Qingyong Zheng, Ping Zeng, Jinhui Tian","doi":"10.1016/j.eclinm.2025.103397","DOIUrl":"10.1016/j.eclinm.2025.103397","url":null,"abstract":"<p><strong>Background: </strong>The optimal duration of antibiotic treatment for bloodstream infections remains uncertain. This study aimed to compare the efficacy and safety of shorter versus longer duration antibiotic treatment for immunocompetent patients with bloodstream infections.</p><p><strong>Methods: </strong>We searched Medline, Embase, and Cochrane Central Register of Controlled Trials without language restrictions for randomized controlled trials (RCTs) published between database inception and 25 November 2024, comparing shorter-duration antibiotic treatments with longer-duration antibiotic treatments in patients with bloodstream infections with a minimum difference of 3 days in duration of therapy. We employed random-effects meta-analyses to summarize the evidence. We used the mean difference (MD) with 95% confidence intervals (CIs) for continuous outcomes. For dichotomous outcomes, we used the odds ratios (ORs) or risk ratios (RRs) with 95% CIs. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to assess the certainty of evidence. This study is registered with Open Science Framework (https://osf.io/egs8q).</p><p><strong>Findings: </strong>Eleven RCTs published between 2006 and 2025, involving a total of 5505 participants, proved eligible. There are probably little or no differences in mortality (RR 0.91, 95% CI 0.79-1.05; moderate certainty), treatment failure (RR 1.08, 95% CI 0.69-1.68; moderate certainty), and relapse rates (RR 1.15, 95% CI 0.82-1.63; moderate certainty) between shorter- and longer-duration antibiotics. Compared with longer-duration antibiotics, shorter-duration antibiotics do not increase hospital readmission (RR 0.91, 95% CI 0.75-1.1; high certainty), but reduce the length of hospital stay (MD -3.04, 95% CI -3.9 to -2.18; high certainty). With very low certainty evidence, we are uncertain whether shorter-duration antibiotics decrease any adverse events (RR 1.0, 95% CI 0.76-1.32) and serious adverse events (RR 0.67, 95% CI 0.39-1.14) compared with longer-duration antibiotics.</p><p><strong>Interpretation: </strong>Shorter- and longer-duration antibiotics show similar efficacy for bloodstream infections, with shorter courses reducing hospital stay. Consistent effects were observed across age groups and bacterial types, but cautious interpretation is needed due to limited subgroup data.</p><p><strong>Funding: </strong>None.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"86 ","pages":"103397"},"PeriodicalIF":10.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820920","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":"Development and validation of a conventional MRI-based model to predict cerebral palsy in infants (aged 6-24 months) with periventricular white matter injury: a multicentre, retrospective cohort study.","authors":"Tingting Huang, Jie Zheng, Heng Liu, Haoxiang Jiang, Chao Jin, Xianjun Li, Liang Wu, Lei Zhang, Congcong Liu, Yitong Bian, Miaomiao Wang, Fan Wu, Xin Zhao, Shengli Shi, Fei Wang, Mengxuan Li, Linlin Zhu, Yuying Feng, Gang Zhang, Jian Yang","doi":"10.1016/j.eclinm.2025.103364","DOIUrl":"10.1016/j.eclinm.2025.103364","url":null,"abstract":"<p><strong>Background: </strong>Periventricular white matter injury (PVWMI) is the most common form of brain injury and the leading cause of cerebral palsy (CP). Early prediction of CP within the first 2 years of life is crucial for timely and effective intervention. Early CP prediction tools for infants with PVWMI are lacking. This study aimed to develop and validate a conventional Magnetic Resonance Imaging (MRI)-based model to predict CP in infants with PVWMI.</p><p><strong>Methods: </strong>In this multicentre retrospective cohort study in China, infants with PVWMI who underwent conventional MRI between 6 and 24 months of corrected age (CA) were included from five hospitals and confirmed to have CP or non-CP by 5 years of age. Between April 2013 and September 2018, a multivariable regression logistic model was developed and internally validated using data from one hospital to identify significant independent MRI features associated with CP, followed by external validation across four other hospitals. A visual nomogram was constructed based on these factors. Predictive performance was evaluated via the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curves. Between October 2018 and January 2021, data from one hospital was included in a multiple readers test cohort (nine radiologists and two paediatric neurologists with varying experience) to assess the diagnostic performance and generalisability of the model. Subgroup analyses were conducted by age and sex.</p><p><strong>Findings: </strong>Across the two recruitment periods, 383 infants (65% male) with MRI-diagnosed PVWMI were included: 191 infants (122 with CP) in the derivation cohort, 115 (75 with CP) in the external validation cohort, and 77 (46 with CP) in the multiple readers test cohort. Five MRI features were associated with CP: abnormal signals in the posterior limb of the internal capsule (odds ratio [OR] 16.52; 95% confidence interval (CI) 5.78-52.67; <i>P</i> < 0.001), corticospinal tract in centrum semiovale (13.01; 3.49-62.30; <i>P</i> < 0.001), and cerebral peduncle (5.54; 1.20-32.15; <i>P</i> = 0.04), abnormal signals or atrophy in the thalamus (4.76; 1.41-19.32; <i>P</i> = 0.02) and lenticular nucleus (4.58; 1.24-21.35; <i>P</i> = 0.03). The model yielded an AUC of 0.94 (95% CI 0.91-0.98) in the derivation cohort. Similar AUCs were achieved in the internal (0.96 [0.93-0.99]) and external (0.92 [0.86-0.97]) validation cohorts. In the multiple readers test cohort, the average AUC, average sensitivity, and average specificity of 11 readers were 0.96 (95% CI 0.93-0.99), 0.90 (0.84-0.96), and 0.88 (0.77-0.98), respectively. Subgroup analyses were robust, yielding similar AUCs.</p><p><strong>Interpretation: </strong>The conventional MRI-based model showed good performance for predicting CP in infants aged 6-24 months with PVWMI and also had good diagnostic performance and generalisability, which may assist in identifying high-risk infan","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"86 ","pages":"103364"},"PeriodicalIF":10.0,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820914","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":"Time-to-pregnancy in patients with previous breast cancer and unexposed women: a prospective exposed-unexposed cohort study.","authors":"Anne-Sophie Hamy, Agathe Chabassier, Clara Sebbag, Christine Rousset-Jablonski, Clémentine Berkach, Isabelle Ray-Coquard, Laura Sablone, Lauren Darrigues, Elise Dumas, Angélique Bobrie, William Jacot, Marc Espié, Sylvie Giacchetti, Floriane Jochum, Aullène Toussaint, Geneviève Plu-Bureau, Lorraine Maitrot-Mantelet, Anne Gompel, Paul Gougis, Raphaëlle Bas, Christine Decanter, Bernard Asselain, Charles Coutant, Lili Sohn, Guillemette Jacob, Claire Saule, Sophie Frank, Judith Abécassis, Florence Coussy, Fabien Reyal","doi":"10.1016/j.eclinm.2025.103392","DOIUrl":"10.1016/j.eclinm.2025.103392","url":null,"abstract":"<p><strong>Background: </strong>Data on fertility after breast cancer (BC) relative to the general population are lacking. This study aimed to compare the time-to-pregnancy between women with and without prior BC seeking to become pregnant.</p><p><strong>Methods: </strong>We conducted a prospective exposed-unexposed cohort study between March 13, 2018 and June 27, 2019, recruiting participants via the collaborative network Seintinelles. Women aged 18-43 years with a history of localized BC without relapse (exposed) were compared to women without BC (unexposed). Follow-up data were collected every six months over three years. The primary endpoint, time-to-pregnancy, was analyzed using Kaplan-Meier survival analysis with inverse probability weighting. Censoring was performed if women stopped trying to conceive for personal reasons, were lost to follow-up before conception, or completed the study without achieving pregnancy or using assisted reproductive technologies (ART).</p><p><strong>Findings: </strong>Among 4351 women enrolled, 642 sought pregnancy during the study period (76 exposed, 566 unexposed). Among them, 50 exposed (65.8%) and 402 weighted unexposed women (weighted percentage 71.0%) became pregnant at least once. Median time-to-pregnancy was 5.0 months, 95% CI [3.0-7.0] for exposed and 3.0 months, 95% CI [2.0-5.0] for unexposed women (difference in median time-to-pregnancy: 2.0 months, 95% CI [-2.5; 5]). Two years after starting to seek pregnancy, 74.9% of weighted unexposed women and 74.1% of exposed women obtained a pregnancy. Overall, 15 exposed women (19.8%) used either ART methods (<i>n</i> = 7, 9.2%) or cryopreserved material (<i>n</i> = 8, 10.5%) and 25 unexposed women (4.4%) used ART.The median time-to-pregnancy was 3.0 months for both exposed and unexposed women (95% CI [2.0; 5.0] and [2.0; 4.0] respectively) (difference in median time-to-pregnancy: -0.0 months [-2.0; 3.0]) in women who sought pregnancy spontaneously, and 14.0 months for exposed (95% CI [6.0-27.0]) and 17.6 months for unexposed women (95% CI [17.6-30.0]) in women seeking pregnancy with ART.</p><p><strong>Interpretation: </strong>In this study from a French collaborative research network, we found no strong evidence of a largely reduced time-to-pregnancy in exposed women seeking to become pregnant compared with unexposed women. Further research on fertility outcomes in the broader population of BC survivors is warranted.</p><p><strong>Funding: </strong>The FEERIC study was funded by <i>Institut National du Cancer</i> (InCA), InCA-SHS, grant no. 2016-124, and is part of the Young Breast Cancer Project, funded by Monoprix.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"86 ","pages":"103392"},"PeriodicalIF":10.0,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12329507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144798500","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}