Heterogeneous Risk Research Articles

Socioeconomic and Geographic Differences in Mammography Trends Following the 2009 USPSTF Policy Update.

In 2024, the US Preventive Services Task Force (USPSTF) reversed a 2009 policy recommending only females aged 50 to 74 years complete a biennial mammogram. Understanding whether females facing heterogeneous breast cancer risks responded to the 2009 guidance may illuminate how they may respond to the latest policy update. To evaluate whether the 2009 policy was associated with changes in mammography screening in females no longer recommended to complete a biennial mammogram and whether these changes varied by factors associated with breast cancer risk. The difference-in-differences design compared biennial mammogram trends in the exposed groups (aged 40-49 and ≥75 years) with trends of the unexposed groups (aged 50-64 and 65-74 years), before and after the 2009 update. Population-based, repeated cross-sectional survey data came from the Behavioral Risk Factor Surveillance System (BRFSS) biennial cancer screening module (2000-2018). The sample was restricted to females between ages 40 and 84 years. Data were analyzed from March 1 to June 30, 2024. The outcome was a binary variable indicating whether the respondent reported a mammogram in the past 2 years (biennial). After 2009, females aged 40 to 49 and 75 or older years were exposed to the policy update, as a complete biennial mammogram was recommended. Subgroup analyses included race and ethnicity, educational level, household income, smoking history, current binge drinking status, and state of residence. The sample included 1 594 834 females; 75% reported a biennial mammogram. In those aged 40 to 49 years, the USPSTF update was associated with a 1.1 percentage-point (95% CI, -1.8% to -0.3 percentage points) decrease in the probability of a biennial mammogram, with the largest decreases in the non-Hispanic Black population (-3.0 percentage points; 95% CI, -5.5% to -0.5 percentage points). In the aged 75 years or older group, the USPSTF update was associated with a 4.8 percentage-point decrease (95% CI, -6.3% to -3.5 percentage points) in the probability of a biennial mammogram, with significant heterogeneity by race and ethnicity, binge drinking status, and state residence. In this study, socioeconomic factors were associated with differences in how females responded to the 2009 USPSTF mammography recommendation. Whether the 2024 update considered such differences is unclear. These findings suggest that including risk assessment into future USPSTF policy updates may improve adoption of risk-reducing interventions and shorten the time to diagnosis and treatment for high-risk patients.

Acupoint stimulation for postpartum breastfeeding insufficiency: a systematic review and meta-analysis

BackgroundInsufficient lactation, known as hypogalactia, is an important reason for weaning. To date, no effective methods have been established to increase lactation volume. With the advantages of low cost and convenience, acupoint stimulation—defined as any stimulation applied at acupoints—is a promising option.ObjectivesThe aim of this systematic review was to evaluate the effectiveness of acupoint stimulation for postpartum breastfeeding insufficiency.MethodsA systematic search of seven databases (PubMed, MEDLINE, Embase, Cochrane, CNKI, Airiti Library, ClinicalTrials.gov) was performed from their inception dates to September 30, 2023. Randomized trials were included. The inclusion criteria of the intervention included acupuncture, acupressure (including tuina and massage), electroacupuncture, laser stimulation, catgut embedding, and auriculotherapy. The primary outcomes were the amount of lactation and the level of prolactin. Secondary outcomes were colostrum time and adverse effects. The risks of bias were assessed using RoB 2.0.ResultsTwenty-four studies involving 3214 participants were included. When compared to the control group, the experimental group exhibited improved volume of milk production (MD = 81.30; 95% CI = 58.94–103.67) and higher prolactin levels (MD = 41.90, 95% CI = 28.57–55.22). Colostrum time was shorter in the control group ([MD = − 7.26; 95% CI = − 10.69 to − 3.83] for continuous data; [RR = 1.70; 95% CI = 1.38–2.08] for dichotomous data). Adverse effects were reported in only one trial, which included three cases of fear of acupuncture and one case of hypotension.ConclusionsAcupoint stimulation may have beneficial effects on postpartum breastfeeding insufficiency. However, the results should be interpreted with caution because of the presence of risks of bias and heterogeneity among studies.

Long-term survival of node-positive breast cancer with complete nodal response to neoadjuvant chemotherapy treated with sentinel lymph node biopsy alone: A meta-analysis.

There exist concerns regarding the use of sentinel lymph node (SLN) biopsy alone in node-positive breast cancer patients who have a clinical/radiological complete response in the axilla and are negative on histopathology after neoadjuvant chemotherapy (NACT). We hereby conducted a meta-analysis examining 5-year overall survival (OS) and disease-free survival (DFS) of such patients. PubMed, the Cochrane CENTRAL library, Embase, Web of Science, and Scopus were searched up to 30th July 2024 for studies reporting survival data. OS and DFS were pooled in a meta-analysis. Subgroup analysis was conducted based on the location of the study, pre-NACT node assessment, and SLN mapping technique. Random-effects meta-regression was conducted for the following moderators: age, initial T3-4, initial N2-3, breast-conserving surgery, breast pathological complete response (pCR), number of SLN removed, adjuvant radiotherapy, endocrine therapy, and follow-up Results: 16 studies with 5249 patients were included. Meta-analysis showed that node-positive breast cancer patients showing nodal pCR after NACT and undergoing only SLN biopsy had a 5-year OS and DFS of 94% (95% CI: 92%, 96%) and 89% (95% CI: 87%, 92%) respectively. There was not much variation in the survival rate on sensitivity and subgroup analyses. Meta-regression showed that OS and DFS were higher in studies with a greater number of patients receiving endocrine therapy. Breast cancer patients with cN+ who achieve a complete clinical/radiological axillary response after NACT and subsequently become SLN biopsy negative may have high rates of DFS and OS after 5 years. Given the high degree of heterogeneity, results should be interpreted with caution. We do not recommend change in treatment plans given the high risk of bias and large heterogeneity in the patient population included in the studies. Only high-quality large multicentric randomised trials can provide better evidence.

CarDiac magnEtic Resonance for prophylactic Implantable-cardioVerter defibrillAtor ThErapy in Non-Dilated Left Ventricular Cardiomyopathy: a sub-study from the DERIVATE Registry

Abstract Background Accurate risk stratification for patients with non-dilated left ventricular cardiomyopathy (NDLVC) remains challenging due to lack of dedicated clinical trials. This post-hoc analysis aims to delineate the arrhythmic risk and assess the incremental value of cardiac magnetic resonance (CMR) imaging in the DERIVATE (CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DebrillAtor ThErapy) study cohort meeting the NDLVC diagnostic criteria. Methods Patients with NDLVC from DERIVATE registry were identified in the absence of left ventricular (LV) dilatation and in the presence of non-ischaemic LV scarring (“fibrotic NDLVC”) or isolated LV systolic dysfunction (LV ejection fraction <50%) without fibrosis (“hypokinetic NDLVC”). The primary endpoint was all-cause mortality. Major adverse arrhythmic cardiac events (MAACE) were the secondary endpoint and included sudden cardiac death (SCD) and aborted SCD. Results One hundred ninety-seven NDLVC patients were identified from the cohort of the DERIVATE study (Mean age: 59±14 years; Male: 135). Over a median follow-up of 2.7 years, 15 (8%) patients died, and 8 (4%) experienced MAACE. Patients with “hypokinetic” NDLVC had significantly lower rates of MAACE than non-ischaemic dilated cardiomyopathy (NIDCM) (p=0.001), while patients with “fibrotic” NDLVC had same rate of both primary (p=0.48) and secondary endpoints (p= 0.616) compared to NIDMC patients. Multivariable analysis identified LGE with midwall distribution as an independent predictor of MAACE in NDLVC patients (Hazard Ratio 6.7, 95% Confidence Interval: 1.33-33.67; p=0.021). Conclusions NDLVC patients exhibit a heterogeneous risk profile for arrhythmic events. The presence of midwall LGE, similarly to NIDCM, is a significant predictor of MAACE, highlighting the importance of CMR imaging for risk stratification.

Critical assessment of uncertainty in economic evaluations on influenza vaccines for the elderly population in Spain

BackgroundInfluenza is a seasonal infection with a huge impact on morbidity and mortality in older adults, for whom vaccination is recommended. New influenza vaccines for this population have been introduced in Spain in the past 5 years, and a number of cost-effectiveness analyses (CEA) have been published to aid healthcare decision-making. The objective of this study was to assess possible sources of uncertainty in the CEAs of influenza vaccines for the older adults in Spain.MethodsA systematic review was performed to identify Spanish CEAs published since 2016. Potential sources of structural, methodologic and parametric uncertainty in CEA results were systematically analysed using the TRansparent Uncertainty ASsessmenT (TRUST) Tool, quality assessment checklists, and the WHO guidance on economic evaluations of influenza vaccine strategies. The primary sources of efficacy/effectiveness were analysed in depth to ascertain whether they could support the conclusions of the respective CEAs.ResultsSeven CEAs were included. Overall, they were designed and performed in accordance with the applicable guidelines; however, some critical sources of uncertainty were detected, mainly: (1) the choice and use of efficacy/effectiveness data (real-world single season studies, meta-analyses including studies with high risk of bias and/or high heterogeneity with biased interpretation); (2) use of fewer than 5 seasons to estimate influenza burden; (3) generalized use of influenza-like illness data to estimate effectiveness and burden, among others.ConclusionsSeemingly well-designed studies may conceal important sources of uncertainty that affect the results. This must be taken into account when interpreting results to support decision-making.

The role of risk attitudes in shaping digital privacy preferences: evidence from a large-scale survey

This paper investigates the relationship between individuals’ heterogeneous risk attitudes and privacy preferences using survey data from 24,899 respondents. It moves beyond demographic factors to examine how risk attitudes, the key psychological parameters in the utility function that determines consumer behaviors, related to consumers’ privacy decisions. Participants indicated their privacy preferences across eight dimensions, including age privacy, marital status privacy, and privacy preferences in the investment and financial obligation realms. We evaluated their risk attitudes through qualitative assessment and quantitative investment loss tolerances, as well as their risk attitudes towards rare and distant events. The study reveals that individuals with higher risk aversion exhibit more significant privacy concerns, especially regarding financial information. Individuals who perceive climate change—a non-immediate and rare risk—as a threat to their lives are also more likely to exhibit heightened concerns about their privacy. In addition, we observe that while these concerns translate into higher non-disclosure actions, the privacy paradox persists regardless of individuals’ risk attitudes. The findings suggest that privacy policies could be more effective through tailored approaches, including customized privacy settings and targeted educational campaigns that account for individual risk aversion.

Meta-analysis of the efficacy of plate fixation and external fixator fixation in the treatment of AO-C type distal radius fractures

Meta-analysis of the clinical efficacy of plate and external fixator fixation in the treatment of AO-C type distal radius fractures. PubMed, Embase, Cochrane Medical Library, Web of Science, CNKI, Wanfang, VIP and SinoMed databases were searched for all literature on randomized controlled clinical trials of AO-C distal radius fractures. The search time limits were from each database. The database will be established until June 30, 2023. The included studies were extracted according to the Cochrane Handbook (Version 6.3, 2022) for information extraction and literature quality evaluation. RevMan 5.4 was used to evaluate the risk of Publication bias, test heterogeneity and Perform Meta-analysis. The outcome indicators were:imaging anatomy indicators (volar inclination angle, ulnar deviation angle, radial height), wrist joint mobility (flexion, extension, rotation, ulnar deviation), complication rate, and comparison of surgical treatments (operative blood loss, operation time, hospitalization time, fracture healing time) and wrist joint function scores and related scales. (1) A total of 28 studies were included, with a total of 2 192 patients, including 1 096 cases in the plate internal fixation group and 1 096 cases in the external fixation group.(2) Meta analysis results showed:the surgical treatment situation of the external fixation group:surgical blood loss MD=-37.93, 95%CI(-48.54, -27.31), P<0.000 01;operation time MD=-31.58, 95%CI(-48.96, -14.20), P<0.000 4;hospitalization time MD=-4.58, 95%CI(-5.44, -3.71), P<0.000 01;the fracture healing time MD=-0.88, 95%CI(-1.35, -0.41), P<0.000 2, which were significantly better than that of the plate internal fixation group(P<0.05).(3) The two groups:palmar inclination angle MD=-0.17, 95%CI(-0.95, 0.61), P=0.68;ulnar declination MD=0.22, 95%CI(-0.73, 1.17), P=0.65, radial height MD=-0.24, 95%CI(-1.15, 0.67), P=0.60;flexion and extension MD=-5.63, 95%CI(-11.85, 0.58), P=0.08;rotation MD=-5.80, 95%CI(-12.77, 1.17), P=0.10, radioulnar deviation MD=-2.86, 95%CI(-10.87, 5.15), P=0.48;complication rate RR=0.96, 95%CI(0.63, 1.46), P=0.83;Gartland-Werley clinical wrist score MD=0.13, 95%CI(-0.80, 1.06), P=0.78;excellent and good rate of Gartland-Werley wrist clinical score RR=0.93, 95%CI(0.87, 1.01), P=0.08;excellent and good rate of Cooney wrist score RR=0.99, 95%CI(0.62, 1.59), P=0.98;wrist DASH score MD=-4.67, 95%CI(-14.96, 5.62), P=0.37;the differences were not significant (P>0.05). Compared with internal fixation with plate, external fixation can significantly reduce the amount of surgical bleeding, shorten the operation time, hospitalization time and fracture healing time, and its imaging anatomical indicators, wrist mobility, and complications can be significantly reduced in treating AO-C distal radius fractures. Rates and wrist function scores were equivalent.

Functioning, disability, and health of individuals with Hikikomori (prolonged social withdrawal) and their families: A systematic review and meta-analysis of case-control studies.

Currently, paradoxical findings exist regarding the level of functioning in individuals with Hikikomori (prolonged social withdrawal). This systematic review aimed to clarify the functioning, disability, and health of individuals with Hikikomori and their families in comparison to those without Hikikomori. Relevant studies were searched from April 22 to 25, 2022, using MEDLINE, PsycINFO, Scopus, and two Japanese databases. Functions were categorized into 'body functions"; "structure"; and "activity and participation', which were further classified into subcategories. Of the 8,181 studies screened, 24 studies with 1,769 individuals with Hikikomori were included. Twelve, three, and four indicators from six studies on depression and anxiety, three on addiction, and two on thought problem symptoms, respectively, were higher in the Hikikomori group than in the comparison group, with at least moderate effect sizes. Three indicators from three studies on interpersonal relationships were worse in the Hikikomori group, with at least moderate effect sizes. The meta-analyses showed that internalizing symptoms, externalizing symptoms, and thought disorders were significantly higher in the Hikikomori group than those in the comparison group with moderate-to-high effect sizes. Contrastingly, communication/interpersonal interactions were significantly lower in the Hikikomori group than those in the comparison group. No significant differences were observed in daily life/social life and the families' communication/interpersonal interactions and relationship. The study limitations include a high risk of bias and heterogeneity. Overall, individuals with Hikikomori often have impaired mental and interpersonal interaction functions; thus, comorbidities of this condition should be carefully assessed.PROSPERO: CRD42022320592.

Physiologic Pulmonary Phenotyping of Infants Born Preterm and Post-Discharge Respiratory Morbidity.

To determine whether airway and parenchymal function identifies subgroups of infants born preterm according to the predominant pulmonary pathophysiology, and whether these subgroups have different risks for respiratory disease during infancy. We prospectively enrolled a cohort of 125 infants born preterm with planned clinical follow-up after NICU discharge. The study included monthly questionnaires for wheeze and visits to a physician or care provider for any respiratory illness. In addition, infant lung function testing near 5-months corrected-age included measures of airways and parenchymal function using forced expiratory flows, alveolar volume (VA), and the carbon monoxide transfer constant (DL/VA). Phenotypes were defined using two approaches: an a priori defined phenotypes based on FEF75 and DL/VA z-scores, and an unbiased approach to classifying infants using k-means clustering. Results We identified four pulmonary physiologic phenotypes that distinguished participants with predominantly decreased airway and/or parenchymal function. Although the worst physiologic phenotypes were associated with a lower gestational age (GA) at birth, these phenotypes had a better predictive value than GA, sex, and diagnosis of BPD for increased respiratory morbidity during infancy (AUC = 0.71 vs 0.63 for respiratory illness and 0.69 vs 0.63 for wheeze). Physiologic pulmonary phenotypes of infants born preterm were associated with differential risks for respiratory morbidities as infants, which may identify heterogeneous risks for long-term respiratory sequelae to individualize therapeutic strategies.

Navigating the Uncertainty of B3 Breast Lesions: Diagnostic Challenges and Evolving Management Strategies.

B3 breast lesions, classified as lesions of uncertain malignant potential, present a significant diagnostic and therapeutic challenge due to their heterogeneous nature and variable risk of progression to malignancy. These lesions, which include atypical ductal hyperplasia (ADH), papillary lesions (PLs), flat epithelial atypia (FEA), radial scars (RSs), lobular neoplasia (LN), and phyllodes tumors (PTs), occupy a "grey zone" between benign and malignant pathologies, making their management complex and often controversial. This article explores the diagnostic difficulties associated with B3 lesions, focusing on the limitations of current imaging techniques, including mammography, ultrasound, and magnetic resonance imaging (MRI), as well as the challenges in histopathological interpretation. Core needle biopsy (CNB) and vacuum-assisted biopsy (VAB) are widely used for diagnosis, but both methods have inherent limitations, including sampling errors and the inability to determine malignancy in some cases definitively. The therapeutic approach to B3 lesions is nuanced, with treatment decisions strongly influenced by factors such as the lesion size, radiological findings, histopathological characteristics, and patient factors. While some lesions can be safely monitored with watchful waiting, others may require vacuum-assisted excision (VAE) or surgical excision to rule out malignancy. The decision-making process is further complicated by the discordance between the BI-RADS score and biopsy results, as well as the presence of additional risk factors, such as microcalcifications. This review provides an in-depth analysis of the current diagnostic challenges and treatment strategies for B3 lesions, emphasizing the importance of a multidisciplinary approach to management. By synthesizing the most recent research, this article aims to provide clinicians with a clearer understanding of the complexities involved in diagnosing and treating B3 breast lesions while highlighting areas for future research, such as artificial intelligence and genomics, to improve the diagnostic accuracy and patient outcomes.

Informing Risk Hotspots and Critical Mitigations for Rainstorms Using Machine Learning: Evidence from 268 Chinese Cities.

Climate change is exacerbating rainstorms, increasing the risk of flooding and threatening urban sustainability, which could undermine climate action. Here, we propose a machine learning-based framework to assess heterogeneous risks and identify critical mitigation measures for rainstorms across 268 Chinese cities. Nighttime light serves as a proxy for urban functionality, and meteorological, socio-economic, and infrastructural factors are incorporated to uncover underlying impact mechanisms. The Causal Forest (CF) model identifies 150 and 250 mm monthly rainstorm totals as critical thresholds, with significant negative impacts in the risk hotspots of eastern and north-central China. Additionally, Random Forest and SHAP (RF-SHAP) analysis highlight effective mitigation strategies, including well-developed drainage and bridges, expanded road networks, and sufficient dams. The Fixed Effects (FE) model reveals that the greatest negative impacts of rainstorms occur in spring, particularly in April, followed by autumn and winter for both the 50 and 150 mm thresholds. Our results demonstrate that the three models complement and validate each other, enhancing the reliability of the estimates. This novel framework leverages machine learning model to inform evidence-based mitigation, contributing to the achievement of Sustainable Development Goals 11 and 13─building resilient cities and combating climate change.

Efficacy of modified posterior shoulder stretching exercises on shoulder function in subacromial impingement syndrome: A comprehensive meta-analysis.

Subacromial impingement syndrome (SIS) is a common cause of shoulder pain and dysfunction. Modified posterior shoulder stretching exercises have been proposed as a treatment method aimed at improving shoulder function and reducing pain in patients with SIS. However, the efficacy of these exercises remains controversial, necessitating a systematic meta-analysis to comprehensively evaluate their effectiveness. A systematic search was conducted across PubMed, Cochrane Library, Embase, and Web of Science databases to identify randomized controlled trials (RCTs) and observational studies evaluating the efficacy of modified posterior shoulder stretching exercises in patients with SIS. Inclusion criteria required that participants be diagnosed with SIS, the intervention be modified posterior shoulder stretching exercises, and key outcomes such as shoulder function improvement and pain relief be reported. Meta-analysis was performed using RevMan 5.3 software, calculating standardized mean differences (SMD) with 95% confidence intervals (CI), and heterogeneity and bias risk were assessed. A total of 10 RCTs with 628 patients were included. The modified posterior shoulder stretching exercises demonstrated significant effects in reducing pain at rest (SMD = -1.00, 95% CI: -1.85 to -0.15, P = .02) and during activity (SMD = -1.45, 95% CI: -2.49 to -0.41, P = .006). Additionally, the exercises showed positive effects in improving internal rotation (SMD = 0.49, 95% CI: 0.22-0.75, P = .0003) and external rotation range of motion (SMD = 0.29, 95% CI: 0.00-0.58, P = .05), as well as enhancing shoulder function (CMS score: SMD = 0.95, 95% CI: 0.64-1.25, P < .00001) and reducing disability (quick DASH score: SMD = -0.85, 95% CI: -1.12 to -0.58, P < .00001). Sensitivity analysis indicated high robustness of the results, and Egger test did not reveal significant publication bias (P > .05). Modified posterior shoulder stretching exercises are significantly effective in improving shoulder function and reducing pain in patients with SIS, with the study results showing high robustness and low risk of bias. However, further high-quality research is needed to validate these findings.

The short-, medium-, and long-term prevalence of physical health comorbidities in first-episode psychosis: a systematic review and meta-analysis protocol.

Individuals with first-episode psychosis (FEP) face an increased risk of physical comorbidities, notably cardiovascular diseases, metabolic disorders, respiratory disorders, and certain types of cancer. Previous reviews report pooled physical health prevalence from chronic psychosis and FEP groups. By contrast, this review will focus on antipsychotic-naïve FEP cohorts and incorporate data from observational longitudinal studies and antipsychotic intervention studies to understand the progression of physical health comorbidities from the onset to later stages of psychosis. This review aims to examine the short-, medium-, and long-term period prevalence of these comorbidities in FEP and variations related to demographic factors. Using the PRISMA and MOOSE guidelines, Medline, Embase, PsycINFO, and CINAHL+, as well as Clinical Trials gov.uk, OpenGrey, WHO International Clinical Trials Registry Platform, Current Controlled Trials, United States National Institute of Health Trials Registry, and the Irish Health Repository, will be searched from inception. Longitudinal studies and antipsychotic intervention studies monitoring health outcomes in antipsychotic naïve FEP individuals will be eligible for inclusion. Two reviewers will independently screen titles, abstracts, and full-text articles. Risk of bias will be assessed using the Joanna Briggs Institute Critical Appraisal Checklist. A meta-analysis of the short-, medium-, and long-term prevalence of cardiovascular, metabolic, cancer, and respiratory outcomes and a narrative synthesis will be conducted. Where feasible, a meta-regression on the impact of demographic variables will be conducted. Potential limitations include the risk of diagnostic heterogeneity across studies and possible underreporting of certain comorbidities. This systematic review will clarify the progression of physical health comorbidities in FEP, informing early intervention strategies and policies. Subsequent findings will be submitted to a leading journal, supplemented by a recovery education module and a lay summary for wider dissemination. The study was registered in PROSPERO, the International Prospective Register of Systematic Reviews ( CRD42023431072; 17/06/2023).

Effect of intraoperative fluid volume on postoperative pulmonary complications in thoracic surgeries: A systematic review and meta-analysis

Background and Aims: There is a lack of clear recommendations on fluid strategies in patients undergoing thoracic surgeries. The primary objective of this study was to compare the amount of intraoperative intravenous fluid (IVF) infused between those who developed postoperative pulmonary complications (PPCs) and those who did not. Methods: All studies comparing PPCs in intraoperative restrictive versus liberal fluid therapies were included. Those studies where the average fluid infused was compared between PPC and the ‘no PPC’ groups were also included. The pooled mean difference in IVF between patients with and without PPC and the pooled risk ratio of PPC in restricted versus liberal fluid arms were calculated. Results: Articles from PubMed (n = 157), EMBASE (n = 724) and citation searching (n = 4) were included. After excluding duplicates, title–abstract screening for 759 articles and full-text screening for 24 articles were done. The mean fluid infused in the 11 included articles was significantly higher in those with PPC (mean difference: 1.51 ml/kg/h, P = 0.001). The pooled proportion of PPC in liberal fluid arms was higher than in restricted fluid arms [risk ratio = 0.58 (95% confidence interval: 0.33, 1.02), P = 0.06]. There was high heterogeneity in both the meta-analyses. Conclusion: The meta-analysis showed that increased intraoperative IVF is associated with higher PPCs, and a restricted fluid strategy might be safer to reduce PPCs. However, since most studies were observational with a high risk of bias and high heterogeneity, well-conducted randomised controlled trials are needed to derive recommendations.

Efficacy and safety of low-intensity ultrasound therapy for myofascial pain syndrome: a systematic review and meta-analysis.

Myofascial Pain Syndrome (MPS) is a common pain disorder characterized by the presence of trigger points within the muscles or fascia. Low-intensity ultrasound therapy, as a noninvasive modality, has indeed found application in the management of MPS, but its efficacy for myofascial pain syndrome has still been controversial. The objective of this systematic review was to assess the safety and efficacy of low-intensity ultrasound therapy for MPS. We searched PubMed, Embase, PEDro, Web of Science, and CENTRAL for RCTs on ultrasound therapy in MPS patients. We included RCTs comparing ultrasound with other therapies or placebo-sham ultrasound. Clinical outcomes included pain scores and physical functional performance. Risk of bias and heterogeneity were assessed. Two authors of the review independently evaluated the risk of bias of each trial and extracted the data. This systematic review included sixteen RCTs involving a total of 1063 participants with MPS. None of the included studies reported adverse events. Comparing with sham or no treatment, the application of low-intensity ultrasound yielded additional benefits for pain (SMD [CI] = - 1.04 [- 1.72, - 0.36], P < 0.0003), with high heterogeneity (χ2 = 116.63, P < 0.00001, I2 = 91%). Patients receiving low-intensity ultrasound had improved on pressure pain threshold. Compared with other treatments, there were no differences in outcomes functional scores. The current study indicates that low-intensity ultrasound effectively reduces pain intensity in MPS patients. The heterogeneity regarding the parameters of ultrasound, including frequency, intensity, time was found to be high among the included studies. Each therapeutic modality works differently in various situations and may lead to multitudinous effects. The positive impact of low-intensity ultrasound on functional improvement needs to be further analyzed through more high-quality clinical trials with large sample sizes in the future. This study was registered on the following website: https://www.crd.york.ac.uk/PROSPERO/ . The PROSPERO registered ID is CRD42023472032.

The association between glycaemic variability and sleep quality and quantity in adults with type 1 and type 2 diabetes: A systematic review.

Individuals with diabetes frequently encounter sleep disturbances, which can detrimentally impact glycaemic management. We reviewed the relationship between sleep outcomes and glycaemic variability in adults with diabetes. We systematically searched Medline, EMBASE and Cochrane Library (2002-March 2023) for studies evaluating sleep and glycaemic variability in adults with type 1 and type 2 diabetes. Among the 3049 records, 27 met the inclusion criteria (type 1 diabetes studies = 22). Due to methodological heterogeneity, a qualitative analysis was conducted. Most studies measuring sleep quality (5 out 7; 71%) reported a significant association with glycaemic variability in type 1 and type 2 diabetes. Sleep duration was not significantly associated with glycaemic variability in type 1 diabetes, whereas other sleep metrics yielded inconclusive results. Hybrid closed-loop pump interventions (n = 12) demonstrated varying sleep outcomes with improved glycaemic variability. Similarly, sleep interventions (n = 3) consistently enhanced sleep but not glycaemic variability. Limitations included moderate to high risk of study bias, confounders, methodological heterogeneity and limited type 2 diabetes data. A potential association between sleep quality and glycaemic variability exists. However, associations with other sleep metrics remain elusive, with no discernible association between sleep duration and glycaemic variability in type 1 diabetes. Despite advancements in continuous glucose monitoring and ambulatory sleep monitoring, standardised sleep assessment methodologies are lacking in real-world studies. Establishing standard protocols for sleep assessment and defining optimal sleep targets are crucial for meaningful comparisons between studies. Understanding the complex interplay between sleep and glycaemic variability holds promise in improving diabetes management and sleep health.

Incentive Contract, Equity Pooling, and Optimal Securitization Design

ABSTRACTThis paper examines the optimal security design and financing structure for investment funds, considering investors with heterogeneous risk preferences. The private equity (PE) fund serves as an information intermediary that plays a crucial role in aligning incentives and facilitating financing activities. To address the potential misalignment between incentive structures and financing requirements, we develop an integrated framework that incorporates both internal moral hazard and external financing decisions. Our analysis demonstrates that optimal equity incentives effectively align the interests of fund manager and PE fund, thereby enhancing fund performance. The results indicate that the optimal financing mechanism comprises a “waterfall” structure consisting of equity, senior bonds, and junior bonds. Furthermore, we find that pooling equity and issuing asset‐backed securities substantially reduce financing costs, although these costs increase with the size of the financing gap. The dual information asymmetry framework offers novel insights into structured financing and corporate growth strategies.

Prediction of preterm birth using machine learning: a comprehensive analysis based on large-scale preschool children survey data in Shenzhen of China

BackgroundPreterm birth (PTB) is a significant cause of neonatal mortality and long-term health issues. Accurate prediction and timely prevention of PTB are essential for reducing associated child mortality and morbidity. Traditional predictive methods face challenges due to heterogeneous risk factors and their interaction effects. This study aims to develop and evaluate six machine learning (ML) models to predict PTB using large-scale children survey data from Shenzhen, China, and to identify key predictors through Shapley Additive Explanations (SHAP) analysis.MethodsData from 84,050 mother–child pairs, collected in 2021 and 2022, were processed and divided into training, validation, and test sets. Six ML models were tested: L1-Regularised Logistic Regression, Light Gradient Boosting Machine (LightGBM), Naive Bayes, Random Forests, Support Vector Machine, and Extreme Gradient Boosting (XGBoost). Model performance was evaluated based on discrimination, calibration and clinical utility. SHAP analysis was used to interpret the importance and impact of individual features on PTB prediction.ResultsThe XGBoost model demonstrated the best overall performance, with the area under the receiver operating characteristic curve (AUC) scores of 0.752 and 0.757 in the validation and test sets, respectively, along with favorable calibration and clinical utility. Key predictors identified were multiple pregnancies, threatened abortion, and maternal age of conception. SHAP analysis highlighted the positive impacts of multiple pregnancies and threatened abortion, as well as the negative impact of micronutrient supplementation on PTB.ConclusionOur study found that ML models, particularly XGBoost, show promise in accurately predicting PTB and identifying key risk factors. These findings provide the potential of ML for enhancing clinical interventions, personalizing prenatal care, and informing public health initiatives.

Efficient Risk Assessment of Time-to-Event Targets With Adaptive Information Transfer.

Using informative sources to enhance statistical analysis in target studies has become an increasingly popular research topic. However, cohorts with time-to-event outcomes have not received sufficient attention, and external studies often encounter issues of incomparability due to population heterogeneity and unmeasured risk factors. To improve individualized risk assessments, we propose a novel methodology that adaptively borrows information from multiple incomparable sources. By extracting aggregate statistics through transitional models applied to both the external sources and the target population, we incorporate this information efficiently using the control variate technique. This approach eliminates the need to load individual-level records from sources directly, resulting in low computational complexity and strong privacy protection. Asymptotically, our estimators of both relative and baseline risks are more efficient than traditional results, and the power of covariate effects testing is much enhanced. We demonstrate the practical performance of our method via extensive simulations and a real case study.

Unveiling the therapeutic role of Dachaihu decoction in acute cholecystitis: a comprehensive systematic review and meta-analysis of its efficacy and safety.

Dachaihu decoction (Dachaihu tang) plays a crucial role in treating acute illnesses. Recently, a significant number of clinical studies on Dachaihu decoction for acute cholecystitis (AC) have been published. This study was conducted to assess the efficacy and safety of Dachaihu decoction in patients with this condition. To identify relevant randomized controlled trials (RCTs), eight databases and three clinical trial registries were searched from inception to 30 June 2024. Two researchers independently screened and extracted data from eligible studies using EndNote X9 and Microsoft Office Excel 2019. RoB 2.0 was used to assess the risk of bias in the included studies. Stata 17.0 was used for data analysis. Publication bias and its impact on result stability were evaluated using a funnel plot and the "trim-and-fill" method. The quality of evidence was graded using the GRADE assessment system. Thirty-three RCTs involving 2,851 participants were included. The treatment group demonstrated improved clinical efficacy (RR = 1.18; 95% CI = 1.13 to 1.24), significantly reduced length of hospital stay (MD = -1.78 days; 95% CI = -2.02 to -1.53), and the incidence of adverse events (RR = 0.31; 95% CI = 0.20 to 0.48). Additionally, there appeared to be reductions in the time for abdominal pain to resolve (MD = -1.92days; 95% CI = -2.33 to -1.51), fever to disappear (MD = -1.52days; 95% CI = -1.90 to -1.14), white blood cell count to return to normal (MD = -2.89 days; 95% CI = -3.32 to -2.46), alanine aminotransferase (ALT) levels (MD = -11.88U/L; 95% CI = -15.29 to -8.47), aspartate aminotransferase (AST) levels (MD = -8.74U/L; 95% CI = -9.76 to -7.72), neutrophil percentage (MD = -9.68; 95% CI = -11.33 to -8.03), TNF-α levels (SMD = -2.10pg/L; 95% CI = -2.43 to -2.78), and certainty of evidence (moderate-to-low certainty). Dachaihu decoction may be an effective botanical formula for managing AC and a lower incidence of adverse events. However, due to the substantial risk of bias and heterogeneity across the included studies, these findings should be interpreted with caution and require further validation through well-designed, high-quality trials. https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=573332.