Therapeutics and Clinical Risk Management最新文献

{"title":"A Multi-Disciplinary Approach to the Management of Chemotherapy-Induced Nausea and Vomiting in Breast Cancer.","authors":"Fang Chen, Kai Cao, Xiaoyan Zhao, Liping Xia, Meng Liu, Yifan Jiang","doi":"10.2147/TCRM.S620981","DOIUrl":"10.2147/TCRM.S620981","url":null,"abstract":"<p><p>Chemotherapy is a cornerstone of comprehensive breast cancer treatment. However, its non-specific cytotoxic effects frequently involve the gastrointestinal tract, leading to a spectrum of digestive adverse reactions, including chemotherapy-induced nausea and vomiting (CINV), anorexia, diarrhea, and constipation. These symptoms not only compromise patients' quality of life but may also impair treatment adherence. In severe cases, they can necessitate dose reduction or treatment discontinuation. This review systematically examines the epidemiology, pathophysiology, and classification of gastrointestinal adverse reactions associated with breast cancer chemotherapy, with a focus on CINV management strategies. These strategies include pharmacological prophylaxis, individualized risk assessment, non-pharmacological interventions, and the use of standardized assessment tools. Based on the available evidence, we discuss the transition from an experience-based nursing model to a predictive one. We also emphasize the importance of patient education, psychological support, and family involvement, and highlight specific considerations for breast cancer patients. This review provides a systematic, evidence‑based reference for the clinical care of CINV in breast cancer to optimize gastrointestinal symptom management and improve treatment outcomes and quality of life for these patients.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"620981"},"PeriodicalIF":2.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13361188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune Checkpoint Inhibitors in Breast Cancer: Mechanisms, Biomarkers, and Future Therapeutic Strategies.","authors":"Qiu-Chan Deng, Wen-Bin Kuang, Yu-Jing Yang, Cai-Ping Gong, Yi-Peng Zhang, Qiong Luo, Liu-Ping Luo, Guang-Ming Wang","doi":"10.2147/TCRM.S547154","DOIUrl":"10.2147/TCRM.S547154","url":null,"abstract":"<p><p>The landscape of breast cancer treatment has been fundamentally transformed by the emergence of immune checkpoint inhibitors (ICIs), representing a paradigm shift from traditional cytotoxic approaches to precision immunotherapy. This comprehensive review examines the current state and future directions of ICIs in breast cancer, with particular emphasis on triple-negative breast cancer (TNBC) where these therapies have shown the most promise. We explore the mechanistic foundations of checkpoint inhibition targeting CTLA-4, PD-1, and PD-L1 pathways, examine resistance mechanisms and predictive biomarkers, and discuss emerging targets including LAG-3, TIM-3, and TIGIT. The integration of ICIs with conventional therapies has yielded encouraging clinical outcomes, leading to the first FDA approvals for immunotherapy in breast cancer. However, significant challenges remain in identifying optimal patient populations, overcoming resistance mechanisms, and developing robust predictive biomarkers. This review synthesizes current evidence from recent clinical trials and provides insights into future therapeutic strategies that promise to enhance the efficacy of immune checkpoint blockade in breast cancer treatment.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"547154"},"PeriodicalIF":2.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13360958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Median Effective Dose of Esketamine Combined with Remifentanil for Anesthesia Induction in Painless Colonoscopy.","authors":"Zhengqing Cao, Haixia Xue, Huilian Wang, Xin Liu","doi":"10.2147/TCRM.S584512","DOIUrl":"10.2147/TCRM.S584512","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to determine the median effective dose (ED&lt;sub&gt;50&lt;/sub&gt;) of esketamine in combination with remifentanil for anesthesia induction during painless colonoscopy, utilizing the sequential dosing method.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study adopted a sequential design.Patients scheduled for painless colonoscopy at the Endoscopy Center of Northern Jiangsu People's Hospital in April 2023 were screened for inclusion in this study. The inclusion criteria encompassed male and female participants aged 18 to 60 years, with a body mass index (BMI) between 18 and 30 kg/m&lt;sup&gt;2&lt;/sup&gt; and classified as American Society of Anesthesiologists (ASA) physical status I or II. Participants undergoing colonoscopy as the sole procedure, without severe communication barriers, were included. Exclusion criteria included patients undergoing additional diagnostic or therapeutic procedures besides colonoscopy and those with a history of oral sedative or analgesic use exceeding one month. Data were analyzed using SPSS 20.0. Normally and non-normally distributed data were expressed as mean ± standard deviation and median (interquartile range), respectively. ED50, ED95 and 95% CI were determined by Probit regression. Correlation and logistic regression analyses were performed, and the sample size was verified by power analysis (α=0.05).For anesthesia induction, the remifentanil dose was fixed at 0.3 μg/kg, while the esketamine dose was adjusted sequentially. The initial dose of esketamine was 0.1 mg/kg and was incrementally increased by a ratio of 1:1.2 for each subsequent dose administered. Successful induction of anesthesia was defined as a positive response, while unsuccessful induction was classified as a negative response. An \"inflection point\" was defined as the dose transition from a negative response (unsuccessful anesthesia induction) to a positive response (successful anesthesia induction) within the sequential dosing framework. The sample size was determined by identifying at least seven such inflection points, where each inflection point involved two consecutive participants: one demonstrating a negative response at a given dose, immediately followed by another demonstrating a positive response at the next dose. Data from these inflection points were aggregated for the final analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 23 study participants were included in this study, with the following distribution: 13 males and 10 females. 13 participants were classified as Grade I, and 10 were classified as Grade II. The ED&lt;sub&gt;50&lt;/sub&gt; of esketamine combined with remifentanil for anesthesia induction in painless colonoscopy was 0.209 mg/kg, with a 95% confidence interval (CI) of 0.178 to 0.248 mg/kg. The dose required for 95% efficacy (ED&lt;sub&gt;95&lt;/sub&gt;) was 0.259 mg/kg, with a 95% CI of 0.231 to 0.478 mg/kg.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The ED&lt;sub&gt;50&lt;/sub&gt; and ED&lt;sub&gt;95&lt;/sub&gt; of esketamine combined with remifentani","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"584512"},"PeriodicalIF":2.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13360962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of CYP2C19 Genotype-Guided Antiplatelet Therapy Following Neurovascular Endovascular Procedures: A Prospective Non-Randomized Controlled Study.","authors":"Shaowen Xu, Xinxin Wang, Guangjun Cui, Miaomiao Li, Guoning Chen, Jinhua Hu, Qizhi Zhang","doi":"10.2147/TCRM.S615918","DOIUrl":"10.2147/TCRM.S615918","url":null,"abstract":"<p><strong>Background: </strong>CYP2C19 loss-of-function alleles are highly prevalent in Asian populations and may reduce the effectiveness of clopidogrel. This study aimed to evaluate the efficacy and safety of CYP2C19 genotype-guided antiplatelet therapy in patients with symptomatic severe intracranial atherosclerotic stenosis undergoing neurovascular endovascular treatment (EVT).</p><p><strong>Methods: </strong>This prospective non-randomized controlled study enrolled 175 patients who underwent neurovascular intervention. Patients in the genotype-guided group (n=100) received individualized antiplatelet therapy according to CYP2C19 genotyping results, whereas patients in the conventional therapy group (n=75) received routine dual antiplatelet therapy with aspirin and clopidogrel. Safety events, 90-day neurological outcomes, and the cumulative incidence of ischemic events within one year were compared between groups.</p><p><strong>Results: </strong>The incidence of bleeding events did not differ significantly between the genotype-guided group and the conventional therapy group (1.0% vs 4.0%, P>0.05). At 90 days, a significantly higher proportion of patients achieved a favorable functional outcome (modified Rankin Scale score 0-1) in the genotype-guided group than in the conventional therapy group (84.0% vs 65.3%, P=0.004). At one year, the proportion of patients experiencing at least one ischemic event was significantly lower in the genotype-guided group than in the conventional therapy group (12.0% vs 26.7%, P=0.013). Multivariable Cox regression analysis demonstrated that patients in the conventional therapy group had a significantly higher risk of ischemic events during follow-up than those in the genotype-guided therapy group (HR: 2.723, 95% CI: 1.259-5.888, P = 0.011). Interaction analysis suggested that treatment effects differed according to device type, with a numerically greater benefit observed in the stent subgroup, although this finding should be considered exploratory.</p><p><strong>Conclusion: </strong>CYP2C19 genotype-guided antiplatelet therapy following neurovascular EVT was associated with improved neurological outcomes and a lower incidence of ischemic events without increasing bleeding risk. However, because ticagrelor exposure differed between treatment groups, the independent contribution of pharmacogenetic testing requires further confirmation in larger randomized studies.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"615918"},"PeriodicalIF":2.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13361352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential Effects of Telehealth on Psychological Outcomes in Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Firman Sugiharto, Yanny Trisyani, Aan Nuraeni, Khatijah Lim Abdullah","doi":"10.2147/TCRM.S617167","DOIUrl":"10.2147/TCRM.S617167","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) represents a significant global health challenge. Individuals with HF commonly experience psychological issues, including depression and anxiety, which negatively affect quality of life (QoL) and clinical outcomes. While telehealth has been identified as a promising approach for chronic disease management, its effectiveness in enhancing psychological outcomes in HF remains unclear.</p><p><strong>Objective: </strong>To evaluate the effectiveness of telehealth interventions in improving psychological outcomes among individuals with HF.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted across six electronic databases (PubMed, Scopus, EBSCOhost, Springer Nature, Taylor & Francis, and Sage Journals). Methodological quality was evaluated with the JBI and RoB 2 tools. Pooled effects were reported as standardized mean differences (SMD) or mean differences (MD), applying fixed- or random-effects models based on heterogeneity (I²). Subgroup analyses were conducted by delivery model, intervention duration, and measurement tool. Publication bias was examined using funnel plots, Egger's test, and Begg's test.</p><p><strong>Results: </strong>26 RCTs were included, with 17 (n = 4,796) entered the meta-analysis. Telehealth showed no significant effect on QoL (SMD=-0.31; <i>p</i>=0.25; I²=98%) or depression (SMD= -0.65; <i>p</i>=0.07; I²= 96%), but were associated with a significant reduction in anxiety (SMD= -0.91; <i>p</i>=0.009; I² = 94%). Subgroup analyses indicated that mobile applications significantly improved QoL (SMD= -0.92; <i>p</i>=0.01), while phone-call support significantly reduced depression (SMD= -1.28; <i>p</i>=0.02). Significant reductions in depression were also observed when using HADS (<i>p</i>=0.006) and BDI (<i>p</i>=0.010), and with follow-up >6 months (<i>p</i>=0.03).</p><p><strong>Conclusion: </strong>Telehealth interventions significantly reduced anxiety among individuals with HF but demonstrated limited effects on depression and QoL. The presence of very high heterogeneity across all outcomes reduces the certainty of these findings and necessitates cautious interpretation. The effectiveness of telehealth as a psychological intervention may depend on specific design and implementation factors.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"617167"},"PeriodicalIF":2.6,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13333073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes and Treatment-Related Complications in Triple-Negative Breast Cancer: A Review of 24 Case Reports from 2020 to 2025.","authors":"Raden Maya Febriyanti, Muhammad Lukman Nur Hakim, Itsna Rofiidatul, Maura Syafa Islami, Putri Sagita Utami, Salwa Putri Qurrotuaini, Eli Halimah, Najihah Mohd Hashim, Ajeng Diantini","doi":"10.2147/TCRM.S619823","DOIUrl":"10.2147/TCRM.S619823","url":null,"abstract":"<p><p>Triple-negative breast cancer (TNBC) is clinically heterogeneous, and selected patients experience rare complications, unusual responses, or biomarker-discordant treatment trajectories that are not fully represented in aggregate trial evidence. This review aims to synthesize published case-report evidence on clinical outcomes and treatment-related complications in TNBC, with an emphasis on host vulnerability, tumor biology, biomarker-guided treatment, and therapy-associated toxicity. A descriptive review of PubMed-indexed case reports was performed for records published from January 1, 2020, to December 31, 2025. Two reviewers independently screened records, extracted data, and appraised the reporting quality using the CARE domains. Results were synthesized narratively without meta-analysis. Seventy-one records were screened, and 24 case reports were included. All patients were female, with a median age of 45 years (range 28-87 years). The cases consisted of 11 with metastatic or advanced disease, 10 with early or localized disease, 1 with a local recurrence, and 2 with unclear disease settings. Actionable or resistance-informative biomarker signals were described in 12 cases, and biomarker-matched therapy was reported in 11. Immunotherapy was used in 9 cases. Serious or clinically significant complications were reported in 10 cases, including two fatal treatment-related events. Favorable outcomes were reported in 17 cases, but these selected reports cannot be used to estimate response rates, survival, or the incidence of toxicity. TNBC case reports provide clinically instructive, hypothesis-generating evidence on rare toxicities, biomarker-guided treatment decisions, and individualized risk assessment.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"619823"},"PeriodicalIF":2.6,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13332762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transnasal Humidified Rapid-Insufflation Ventilatory Exchange versus Oropharyngeal Airway-Assisted Face-Mask Ventilation for Gastric Insufflation During Induction of General Anesthesia in Patients at High Risk for Obstructive Sleep Apnea.","authors":"Zhe Jia, Yangfei Xu, Can Zhang, Huifang Jiang, Yingying Han, Xiaohong Yuan, Hongwei Wang, Kangjie Xie","doi":"10.2147/TCRM.S608591","DOIUrl":"10.2147/TCRM.S608591","url":null,"abstract":"<p><strong>Purpose: </strong>Obstructive sleep apnea (OSA) is an independent risk factor for gastric insufflation during the induction of general anesthesia. We aimed to compare the impact of oropharyngeal airway-assisted face-mask ventilation and transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) on gastric insufflation in patients with high-risk OSA.</p><p><strong>Patients and methods: </strong>Patients at high risk for OSA scheduled for elective major abdominal surgery under general anesthesia were randomized 1:1 to either Group T (THRIVE throughout induction) or Group M (face-mask preoxygenation followed by oropharyngeal airway-assisted pressure-controlled ventilation). Gastric antrum ultrasonography was performed at baseline (T₁), after preoxygenation (T₂), and post-intubation (T₄) to assess changes of antral cross-sectional area (CSAa). Arterial blood gases were analyzed at T₁, T₂, after induction during ventilation/apnea (T₃), and T₄. Adverse events and patient comfort were recorded. The primary outcome was the incidence of gastric insufflation at T₄. Secondary outcomes included CSAa percentage change, oxygenation and arterial blood gas variables, adverse events, and patient comfort.</p><p><strong>Results: </strong>Of 100 randomized patients, 94 completed the study (47 per group). Group T demonstrated a significantly lower incidence of gastric insufflation post-intubation compared to Group M (23.4% vs 44.7%; <i>P</i> = 0.030) and a smaller median percentage increase in antral cross-sectional area (7.62% vs 13.24%; <i>P</i> = 0.070). THRIVE provided superior preoxygenation (higher PaO₂ at T₂, <i>P</i> < 0.001). During apnea (T₃-T₄), Group T maintained adequate oxygenation (SpO₂ >92%) without mechanical ventilation but developed mild hypercapnia, which was expected to improve following continued mechanical ventilation after intubation. Adverse event rates were non-significant (<i>P</i> = 1.000). Patient comfort scores were significantly higher in Group T (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>In patients at high risk for OSA, THRIVE reduces the incidence of gastric insufflation during induction compared with oropharyngeal airway-assisted face-mask ventilation. THRIVE improves preoxygenation and patient comfort. Oxygenation was maintained during apnea, with a transient increase in PaCO₂ observed after intubation.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"608591"},"PeriodicalIF":2.6,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13317547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148362603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood-Based Inflammatory and Metabolic Biomarkers for Assessing Symptom Burden and Quality of Life in Older Adults with Cancer: A Narrative Review.","authors":"Lu Lu, Yu Zhang","doi":"10.2147/TCRM.S611486","DOIUrl":"10.2147/TCRM.S611486","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the clinical utility of blood-based inflammatory and metabolic biomarkers in assessing symptom burden and quality of life among older adults with cancer.</p><p><strong>Methods: </strong>This review synthesizes current evidence regarding the clinical utility and underlying pathophysiological mechanisms of blood-based biomarkers, focusing particularly on the neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and modified Glasgow prognostic score (mGPS).</p><p><strong>Results: </strong>Elevated inflammatory markers, such as NLR and SII, independently correlate with increased frailty and functional decline. Concurrently, nutritional-metabolic markers, including hypoalbuminemia and a high mGPS, are strongly associated with anorexia and cancer cachexia. These composite indicators effectively capture the synergistic effects of \"inflammaging\", neuroinflammation, and tumor-driven metabolic reprogramming.</p><p><strong>Conclusion: </strong>Objective, cost-effective, and dynamically measurable inflammatory and metabolic biomarkers represent promising adjunctive tools for early symptom screening. The integration of these markers into comprehensive geriatric assessments may enhance risk stratification and symptom management. However, current evidence is constrained by study heterogeneity, retrospective designs, a lack of standardized cutoffs, and insufficient prospective validation in older cancer populations. Therefore, these biomarkers should be regarded as complementary to traditional assessments rather than definitive standalone tools.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"611486"},"PeriodicalIF":2.6,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13285912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148309486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcranial Magnetic Stimulation Combined with Speech-Language Therapy for Post-Stroke Aphasia Recovery: A Systematic Review and Network Meta-Analysis.","authors":"Jine Lin, Yangjuan Bao, Min Fang, Huafang Zhang","doi":"10.2147/TCRM.S597978","DOIUrl":"10.2147/TCRM.S597978","url":null,"abstract":"<p><strong>Background: </strong>Speech-language therapy (SLT) is standard care for post-stroke aphasia (PSA), and adjunctive transcranial magnetic stimulation (TMS) may further improve language function. Which TMS protocol optimally complements SLT for which language domain at which time point remains unresolved, motivating this network meta-analysis.</p><p><strong>Objective: </strong>To compare TMS protocols combined with SLT across immediate and long-term language outcomes in post-stroke aphasia.</p><p><strong>Methods: </strong>Web of Science, EMBASE, PubMed, and the Cochrane Library were searched from inception to 24 January 2026 for randomized trials of TMS plus SLT in post-stroke aphasia. Bayesian network meta-analyses were run in R 4.4.2 with the gemtc and rjags packages, with outcomes grouped into seven immediate and four long-term language domains and effect sizes reported as standardized mean differences (SMDs) with 95% credible intervals (CrIs). Treatments were ranked by the surface under the cumulative ranking curve (SUCRA), and certainty of evidence was rated using GRADE (Grading of Recommendations Assessment, Development and Evaluation).</p><p><strong>Results: </strong>Across 26 trials enrolling 1,136 patients, three protocols led across the language domains. LF-rTMS+Music+SLT ranked first for immediate aphasia severity (SUCRA = 96.86%), repetition (97.25%), naming (99.69%), and spontaneous speech (95.67%); LF-rTMS+SLT, for writing (87.73%); and Dual-rTMS+SLT, for immediate functional communication (91.49%) and comprehension (97.57%). Dual-rTMS+SLT was also optimal across all four long-term outcomes (overall aphasia severity 95.82%, comprehension 95.06%, naming 99.74%, repetition 97.90%). Heterogeneity was low-to-moderate (moderate-to-high for immediate aphasia severity), and all Bayesian models converged (PSRF < 1.05). Evidence was moderate-to-high for standard comparisons (LF-rTMS+SLT vs SLT) but low to very low for the highest-ranked novel combinations such as LF-rTMS+Music+SLT, driven by imprecision and indirectness.</p><p><strong>Conclusion: </strong>The optimal TMS-plus-SLT protocol depends on which language domain and which time point matters. LF-rTMS+Music+SLT led the immediate domains, while Dual-rTMS+SLT led the long-term domains. Standard adjunctive comparisons (e.g. LF-rTMS+SLT vs SLT) rest on moderate-to-high certainty evidence, but the highest-ranked novel combinations rest on low-certainty evidence and require head-to-head confirmation.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"597978"},"PeriodicalIF":2.6,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13248975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148219885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Future of Interventional Keratoconus Management: Perspectives on Integrating Epithelium-on Oxygen-Enriched Cross-Linking into Comprehensive Care Pathways.","authors":"Kenneth A Beckman, Zeba A Syed, Susan J Gromacki","doi":"10.2147/TCRM.S580025","DOIUrl":"10.2147/TCRM.S580025","url":null,"abstract":"<p><p>This perspective presents a new conceptual framework for the comprehensive care of patients with keratoconus. Keratoconus is an ectatic degeneration of the cornea associated with progressive vision loss and diminished quality of life. Until recently, treatment consisted of optical correction in early stages and corneal transplantation in later stages, neither of which impacted the progressive nature of the disease. The development of corneal cross-linking-a minimally-invasive procedure that stabilizes the disease process and prevents progressive ectasia and vision loss-has significantly altered the therapeutic approach to keratoconus. Until recently, the procedure required removal of the corneal epithelium, but a newly FDA-approved epithelium-on oxygen-enriched option may simplify the process with a favorable benefit-to-risk balance. The FDA indication for this new epithelium-on treatment option also does not require disease progression, further facilitating earlier intervention. Interventional keratoconus management is a novel paradigm characterized by early diagnosis enhanced by new and emerging technology, and early proactive intervention to prevent vision loss and quality of life. Some technologies like epithelium-on oxygen-enriched cross-linking are FDA-approved, while others such as pharmaceutical treatments and customized cross-linking are in development. A decentralized coordinated effort from all eyecare providers, including optometrists, comprehensive ophthalmologists, and corneal surgeons may be necessary for identification of early cases and timely referral for early interventional cross-linking treatment. This approach facilitates preservation of vision and quality of life for patients with keratoconus; it also may reduce the economic burden of keratoconus for health systems and society by reducing the long-term costs of care as well as lost productivity and disability. Development and implementation of a viable community-based, patient-centered, interventional keratoconus care pathway will likely require expanded awareness and education regarding keratoconus and its treatment, as well as creating recommendations and guidelines for healthcare systems and providers to streamline screening, referral, and treatment processes. Given that evidence is emerging and clinical practices are evolving for this novel technology, the paper represents a modern perspective based on a synthesis of available evidence, rather than a traditional consensus guideline.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"580025"},"PeriodicalIF":2.6,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13248972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148219890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}