Literature Screening Research Articles

Chromium dynamics in soil and detoxification of chromite belts using rhizospheric soil-plant interface.

The chromium-contaminated soil expresses its severe eco-toxicity on living organisms of the locality and adjoining regions. This review has focused on the chemical interactions of chromium variants in soil and the sequestration of chromium using the soil-plant interface in the rhizosphere. The application of plant hyper-accumulators on chromium-contaminated soil for chromium sequestration is an attempt to minimize chromium toxicity of mining and industrial belts. This review utilized the PRISMA 2009 systematic review methodology. The literature screening was conducted by searching databases such as Scopus, Google Scholar, and Web of Science up to 2025using specific keywords. In countries like Kazakhstan, South Africa, and India, more than 90% of world shipping-grade mine reserves of chromium are present. The mining and metallurgy of chromium can threaten the environmental quality and the region's public health. The Sukinda chromite mines in India are globally known for their rich chromite mining, metallurgy, and eco-toxicity. The present article analyzes the ecological challenges and searches for possible interactions of chromium variants in soil. The solution to mitigate chromium toxicity is possible using the rhizospheric soil-plant interface. This article's findings and discussion section help solve ecological challenges and strive for healthy soil at chromium-polluted sites. This review article can contribute to sustainable soil quality improvement at mining and industrial belts. Further research on the isotopic tracer technique is recommended to enhance the understanding of chromium dynamics in soil.

Neurovascular and cognitive damages of diabetes mellitus to the central nervous system

Diabetes mellitus is a chronic metabolic disease that not only impairs peripheral nerves but also causes significant damage to the central nervous system (CNS) and aggravates the risk of cerebrovascular diseases, even promoting cognitive decline and the development of neurodegenerative diseases. A comprehensive review was conducted to elucidate the mechanisms and scope of these effects by analyzing 70 peer-reviewed studies published between 1998 and 2024 from PubMed and ScienceDirect. This review reveals multiple potential damages of diabetes to the function of CNS, including aggravation of cerebrovascular disease, decline of cognitive function, and acceleration of neurodegenerative diseases, etc., via rigorous literature screening, evaluation, and comprehensive analysis, which provides a new perspective for us to understand the full impact of diabetes on the CNS and an essential scientific basis for developing future treatment strategies.

Streamlining systematic reviews with large language models using prompt engineering and retrieval augmented generation

BackgroundSystematic reviews (SRs) are essential to formulate evidence-based guidelines but require time-consuming and costly literature screening. Large Language Models (LLMs) can be a powerful tool to expedite SRs.MethodsWe conducted a comparative study to evaluate the performance of a commercial tool, Rayyan, and an in-house LLM-based system in automating the screening of a completed SR on Vitamin D and falls. The SR retrieved 14,439 articles, and Rayyan was trained with 2,000 manually screened articles to categorize the rest as most likely to exclude/include, likely to exclude/include and undecided. We analyzed Rayyan’s title/abstract screening performance using different inclusion thresholds. For the LLM, we used prompt engineering for title/abstract screening and Retrieval-Augmented Generation (RAG) for full-text screening. We evaluated performance using article exclusion rate (AER), false negative rate (FNR), specificity, positive predictive value (PPV), and negative predictive value (NPV). Additionally, we compared the time required to complete screening steps of the SR using both approaches against the manual screening method.ResultsUsing Rayyan, including considered as undecided or likely to include for title/abstract screening resulted in an AER of 72.1% and an FNR of 5%. The total estimated screening time, including manual review of articles flagged by Rayyan, was 54.7 hours. Lowering the Rayyan threshold to ‘likely to exclude’ reduced the FNR to 0% and the AER to 50.7%, but increased the screening time to 81.3 h. Using the LLM system, after title/abstract and full-text screening, 78 articles remained for manual review, including all 20 identified by traditional methods. The LLM achieved an AER of 99.5%, specificity of 99.6%, PPV of 25.6%, and NPV of 100%, with a total screening time of 25.5 h, including manual review of the 78 articles, reducing the manual screening time by 95.5%.ConclusionsThe LLM-based system significantly enhances SR efficiency, compared to manual methods and Rayyan while maintaining low FNR.

Artificially sweetened beverages do not influence metabolic risk factors: a systematic review and meta-analysis

IntroductionThe influence of artificially sweetened beverages (ASBs) on metabolic risk factors for non-communicable diseases (NCDs) remains unclear. This study aimed to systematically review the literature concerning whether the effects of ASBs on body weight and metabolic risk factors are equivalent to those of unsweetened beverages (USBs).MethodsWe searched PubMed, Embase, Web of Science, and Cochrane Library databases from their establishment until March 3, 2025. Only randomized controlled trials (RCTs) comparing ASBs and USBs were included. Literature screening, data extraction, and bias evaluations were performed. Statistical analyses were performed using Review Manager 5.4 and Stata 15.0 software.ResultsNine RCTs involving 1,457 individuals were included. Meta-analysis findings indicated no statistically significant differences between ASB and USB groups in terms of weight, waist circumference, fasting blood glucose, glycated hemoglobin, homeostatic model assessment for insulin resistance, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, systolic blood pressure, and diastolic blood pressure (all p > 0.05).ConclusionThe study findings do not support the hypothesis that ASBs pose significant risks or benefits in terms of metabolic risk factors for NCDs. However, given this study applied a heterogeneous ASB formula, it could not adequately consider the role of specific artificial sweeteners. Further research is needed to evaluate the potential effect of different artificial sweeteners and their doses on health.Systematic review registrationhttps://www.crd.york.ac.uk, identifier CRD420251027794.

Telesimulation in Medical Education for High-Acuity Low-Occurrence Procedures and Clinical Encounters for Physicians and Medical Trainees in Emergency Medicine: Protocol for a Systematic Review.

Proficiency in high-acuity low-occurrence (HALO) procedures and clinical encounters is crucial for physicians and medical trainees in emergency medicine. Simulation-based medical education (SBME) provides valuable learning opportunities for these skills. However, accessing SBME can be challenging. Remotely delivered SBME, known as telesimulation, can enhance access to such training, especially in remote locations. Based on this review, the research team aims to evaluate the effectiveness of telesimulation in enhancing learning outcomes of HALO procedures and clinical encounters in emergency medicine. A systematic review will be conducted using the electronic databases PubMed, CINAHL, Embase, and Cochrane, focusing on studies published in English from 2011 to the present. The inclusion criteria are emergency physicians and medical trainees as learners; telesimulation sessions where the adequate performance of the procedure or clinical encounter, retention of information, or user feedback after implementing telesimulation were assessed; and original research in the form of a randomized controlled trial or nonrandomized experiments with an intervention and control group and pre- and posttest design. The exclusion criterion is defined as any study that does not fully meet the inclusion criteria. The primary outcome is the effectiveness of telesimulation in enhancing learning outcomes for HALO procedures and clinical encounters for physicians and medical trainees in emergency medicine. The secondary outcomes are the effectiveness of telesimulation for these procedures and clinical encounters delivered asynchronously and synchronously for physicians and medical trainees in emergency medicine. At least two reviewers will conduct data extraction and quality assessment. The primary and secondary outcomes will be analyzed through a systematic narrative synthesis. The methodological quality of comparative studies will be assessed using the Downs and Black checklist. The interrater reliability among the authors will be analyzed with Cohen κ. This project was funded in the summers of 2022 and 2023 by two Summer Undergraduate Research Awards from the Memorial University of Newfoundland Faculty of Medicine. The literature search and screening will begin in April 2025, and the results of the systematic review will be available in the summer of 2026. The results of the systematic review could inform the development of research on telesimulation for HALO procedures in emergency medicine. By investigating this topic, more effective telesimulation sessions can be designed in the future, potentially enhancing the skills of physicians and medical trainees. PRR1-10.2196/53565.

Digitalization and Financial Inclusion: New Opportunities and Challenges in Developing Countries

It has become a critical strategy in terms of increasing financial inclusion in developing countries, combating poverty, reducing economic development and income inequality (Demirgüç-Kunt et al., 2018). In this context, Digital Financial Services (DFH) supports inclusiveness by providing a strong alternative for individuals who do not have access to traditional banking systems (Ozili, 2018). Digital vehicles such as mobile banking, digital wallets, credit services over the internet and fintech applications facilitate the integration of individuals living in low -income and rural areas into the financial system (GSMA, 2021). In this study, the impact of digital financial services on financial inclusion in developing countries was examined by literature screening method. The studies discussed; It shows that factors such as the development of digital infrastructure, regulatory frames, digital literacy level and gender inequality significantly affect the inclusion levels (Sahay et al., 2020). Furthermore, it has been found that the spread of digital financial instruments provides economic benefits at micro and macro level (Lukogga, 2020). This article argues that digital financial transformation should be considered as an inclusive development model in developing countries and provides strategic suggestions for policy makers.

Performance Comparison of Large Language Models for Efficient Literature Screening

Background: Systematic reviewers face a growing body of biomedical literature, making early-stage article screening increasingly time-consuming. In this study, we assessed six large language models (LLMs)—OpenHermes, Flan T5, GPT-2, Claude 3 Haiku, GPT-3.5 Turbo, and GPT-4o—for their ability to identify randomized controlled trials (RCTs) in datasets of increasing difficulty. Methods: We first retrieved articles from PubMed and used all-mpnet-base-v2 to measure semantic similarity to known target RCTs, stratifying the collection into quartiles of descending relevance. Each LLM then received either verbose or concise prompts to classify articles as “Accepted” or “Rejected”. Results: Claude 3 Haiku, GPT-3.5 Turbo, and GPT-4o consistently achieved high recall, though their precision varied in the quartile with the highest similarity, where false positives increased. By contrast, smaller or older models struggled to balance sensitivity and specificity, with some over-including irrelevant studies or missing key articles. Importantly, multi-stage prompts did not guarantee performance gains for weaker models, whereas single-prompt approaches proved effective for advanced LLMs. Conclusions: These findings underscore that both model capability and prompt design strongly affect classification outcomes, suggesting that newer LLMs, if properly guided, can substantially expedite systematic reviews.

Effectiveness of incorporating virtual reality-based training into exercise therapy for chronic spinal pain: A systematic review and meta-analysis.

BackgroundChronic spinal pain (CSP) is a major global health challenge. Virtual reality-based training (VRBT) shows promise as a complementary intervention for exercise therapy (ET).ObjectiveThis review aimed to provide conclusive evidence on the effectiveness of ET with and without the incorporation of VRBT for CSP.MethodsWe systematically searched six electronic databases for relevant randomized controlled trials (RCTs) available to July 1, 2024. Two independent reviewers conducted the literature screening, quality assessment, and data extraction processes. Quantitative syntheses used Review Manager 5.4 and Stata 15.1.ResultsThis analysis included 14 RCTs encompassing 554 participants. Incorporating VRBT into ET significantly enhanced the efficacy of ET for pain intensity and kinesiophobia both immediately after the intervention phase (MD = -1.29, 95% CI: -1.83 to -0.75, p < 0.001; SMD = -1.04, 95% CI: -1.95 to -0.13, p < 0.001) and at follow-up (MD = -1.44, 95% CI: -2.60 to -0.29, p = 0.01; SMD = -1.85, 95% CI: -3.54 to -0.15, p = 0.03). For disability, ET with VRBT showed significantly greater efficacy only immediately after the intervention phase (SMD = -1.02, 95% CI: -1.92 to -0.13, p = 0.02). Descriptive analyses showed that VRBT can further enhance the effectiveness of ET in reducing depression and anxiety, key components of negative emotions. However, this study faced limitations such as high heterogeneity (I²>90%) and relatively short follow-up durations (up to six months), which may impact the generalizability of these findings.ConclusionsCurrent evidence suggests that VRBT can serve as a valuable complement to ET, providing additional benefits for CSP patients, particularly in pain management, functional rehabilitation, and psychological intervention targeting kinesiophobia and negative emotions.

A clinical perspective towards oropharyngeal dysphagia management in neurological conditions: a brief literature review

Dysphagia is a condition affecting the passage of solid and liquid food into the stomach due to impaired swallowing mechanisms caused by neurological factors like stroke, progressive diseases, and brain injury. Symptoms usually manifest within seconds of swallowing. In this brief review, the clinical perspective towards oropharyngeal dysphagia management from a speech and language therapist’s point of view in neurological conditions will be outlined. This review was carried out by a brief literature screening. This review includes swallowing performance assessment and oropharyngeal dysphagia therapy techniques. Instrumental evaluation techiques were typically used to determine dysphagia presence in the clinical settings. Based on the findings of instrumental evaluation, clinicians must decide the therapy plan. In dysphagia, treatments contain behavioral interventions, central nervous system stimulation, and postural techniques. Behavioral therapy approaches include maneuvers, swallowing exercises, and postural techniques. Electrical stimulation approaches, such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), improve the brain's ability to change and adapt, known as neural plasticity. In conlusion, the significance of evidence-based treatment in swallowing therapies is essential to enhance the comprehension of dysphagia therapy efficacy, particularly through randomized controlled trials.

The efficacy and safety of corticosteroids in treating severe COVID-19 patients: A meta-analysis with trial sequential analysis

Background and Objective: Corticosteroids (CSs) are often administered for coronavirus disease 2019 (COVID-19); however, the advantages and disadvantages of CSs remain controversial. Accordingly, we performed a meta-analysis with trial sequential analysis (TSA) to ascertain the efficacy and safety of CSs in treating COVID-19. Methods: From their inception until April 2023, PubMed, Embase, The Cochrane Library, Web of Science, and China Biology Medicine(CBM) were searched to gather randomized controlled trials on the administration of CSs for COVID-19 treatment. Following the literature screening according to the inclusion criteria, data extraction and quality assessment were conducted by two reviewers, and then we conducted a meta-analysis with trial sequential analysis using RevMan 5.4 and TSA v0.9, respectively. This meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, and the study protocol was registered with PROSPERO (CRD42023458633). Results: A total of 6,077 literatures were obtained through the search, and 14 studies were finally included for quantitative meta-analysis. The meta-analysis revealed that the all-cause mortality in the group treated with CSs and standard treatment was significantly lower than that in the control group that received only standard treatment (RR 0.89, 95% CI: 0.82–0.96, P=0.002), with a statistically significant difference. However, the TSA analysis revealed that the cumulative Z value exceeded the traditional boundary value yet did not surpass the TSA boundary value, indicating a possibility of false positive outcomes in the meta-analysis. The incidence of adverse reactions in the group receiving CSs treatment was higher than that in the control group, but the distinction was not statistically significant (RR 1.02, 95% CI: 0.64–1.63, P=0.93). Conclusion: CSs appear to be effective and safe in decreasing the overall mortality of patients who suffer from severe COVID-19; however, further assessment is required to determine adverse reactions and improvements in clinical symptoms associated with CS administration. doi: https://doi.org/10.12669/pjms.41.5.9545 How to cite this: Zhang Y, Hu J,Xu Q, Zhang F, Sun C, Liu K. The efficacy and safety of corticosteroids in treating severe COVID-19 patients: A meta-analysis with trial sequential analysis. Pak J Med Sci. 2025;41(5):1517-1525. doi: https://doi.org/10.12669/pjms.41.5.9545 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The incidence of metabolic syndrome in psoriasis patients and its correlation with disease activity: a systematic review and meta-analysis

ObjectiveTo explore the association between psoriasis and metabolic syndrome (MetS) and analyze the impact of disease activity on the risk of MetS occurrence.MethodThis systematic review and meta-analysis used computer searches to search for relevant literature on psoriasis and MetS in databases including China National Knowledge Infrastructure (CNKI), PubMed, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL) and Embase. The search period was from the establishment of the database to February 8, 2025. Inclusion in case–control, cohort studies and cross-sectional, with language restrictions in Chinese and English during retrieval. After independent screening of literature, extraction of data, and evaluation of risk bias for inclusion in the study by two evaluators, meta-analysis and subgroup analysis were conducted using Stata17.0 software.ResultA total of 12 studies were analyzed, encompassing 9,641 patients with psoriasis and 2,554 patients suffering from MetS alongside psoriasis. The incidence of metabolic syndrome in psoriasis patients was analyzed and the combined effect size was 26.49% [95% CI (25.61, 27.39%)]. Results from the meta-analysis indicated that, in comparison to the control group, psoriasis patients demonstrated a heightened risk of developing MetS [OR = 1.27, 95% CI (1.21–1.33), p &amp;lt; 0.001]. Subgroup analysis revealed that patients with severe psoriasis (PASI≥10) had a significantly increased risk of developing metabolic syndrome [OR = 2.25 95% CI (1.27, 3.99), p &amp;lt; 0.001], indicating that greater disease activity is associated with an elevated likelihood of MetS occurrence.ConclusionPsoriasis is positively correlated with MetS risk, and increased disease activity further increases the risk. It is necessary to strengthen screening for metabolic abnormalities and multidisciplinary management.

The safety and efficacy of acupuncture in treating nonalcoholic fatty liver disease: A systematic review and meta-analysis based on randomized controlled trials.

Nonalcoholic fatty liver disease (NAFLD), the most common chronic liver ailment globally, remains a significant concern. Acupuncture has been increasingly utilized for the treatment of NAFLD in recent years. However, current evidence is insufficient to support its efficacy and safety. The aim of this study was to perform a recent and thorough meta-analysis concerning the impacts of acupuncture on NAFLD. Randomized controlled trials (RCTs) investigating acupuncture for NAFLD were retrieved from 6 databases. The search encompassed the period from the inception of each database until February 28, 2024. We conducted literature screening based on predefined inclusion and exclusion criteria, resulting in the selection of 30 articles. Analysis of the data was carried out utilizing Review Manager 5.4 and Stata 15.1. The meta-analysis revealed a marked enhancement in the overall clinical effectiveness rate within the acupuncture group in comparison to the control group (OR = 3.36; 95% CI:2.62 to 4.31; P < .00001, I2 = 0%). Acupuncture exhibited positive impact on liver function recovery, blood lipid reduction, glucose regulation, improvement in insulin levels, antiliver fibrosis treatment, and imaging outcomes. Comprehensive analysis revealed that acupoint embedding (OR = 3.14; 95% CI: 2.113 to 4.62; P < .00001, I2 = 0%) demonstrated the most effective and stable therapeutic effect, followed by manual acupuncture (MA) (OR = 3.27; 95% CI: 2.19 to 4.90; P < .00001, I2 = 0%) and electroacupuncture (EA) (OR = 3.32; 95% CI: 1.69 to 6.52; P < .0005, I2 = 0%). In contrast, acupoint injection (AI) (OR = 5.74; 95% CI: 2.23 to 14.883; P < .0003, I2 = 0%) exhibited relatively modest effects, particularly in lipid reduction. No significant adverse reactions were observed with acupuncture treatments. Acupuncture has demonstrated safety and efficacy in the treatment of NAFLD, significantly improving hepatic function, lowering glucose and lipid levels, and mitigating liver fibrosis. Nevertheless, these findings necessitate validation through large-scale, rigorously designed randomized controlled trials.

Efficacy of probiotics in patients with cognitive impairment: A systematic review and meta-analysis.

To conduct an in-depth exploration of the specific impacts of probiotics and prebiotic supplements on cognitive impairment, it is imperative to also investigate pertinent factors, including the optimal dosage of probiotics for enhancing cognitive function. This investigation is essential for optimizing probiotic interventions to prevent and treat cognitive decline, aimed at preventing and aiding in the treatment of cognitive decline among patients with cognitive impairment. A comprehensive computerized search was conducted across the Embase, PubMed, Web of Science, Cochrane Library, SinoMed, CNKI, Wanfang and WeiPu Data. Studies targeting randomized controlled trials (RCTs) were included. This search covered a timeframe extending from the inception of each database to September 2024. Following an independent process of literature screening, data extraction, and rigorous quality assessment conducted by two investigators, a meta-analysis was performed using Stata 15.0 software. A total of ten studies, involving 778 patients, were included in the analysis. The meta-analysis revealed that probiotics were effective in enhancing cognitive function among patients with cognitive impairment, with a standardized mean difference (SMD) of 0.52 (95% CI: 0.07, 0.98; P < 0.001). Subgroup analysis further demonstrated that the largest effect size was observed for studies utilizing the Mini-Mental State Examination (MMSE) scale as the outcome measure (SMD = 0.88). Additionally, the greatest efficacy was associated with single-strain probiotics (SMD = 0.81), and interventions lasting ≤12 weeks exhibited the most pronounced effect (SMD = 0.61). Probiotics have been shown to enhance cognitive function, with a probiotic intervention program featuring a single probiotic strain and a duration of ≤12 weeks demonstrating particularly robust efficacy in improving cognitive function, as assessed by the MMSE scale.

Systematic Review and Meta-Analysis of the Effects of Intestinal Microbiota on Liver Disease Using Mendelian Randomization.

The global incidence of liver diseases is on the rise, and targeting gut microbiota has become a new strategy for treating liver diseases. This study provides a comprehensive and objective analysis of the potential protective role of gut microbiota in liver disease, highlighting the need for continued research in this area. After literature screening, 24 related articles were included in the study. After article quality and risk of bias assessment, data extraction and data collation were carried out, and then comprehensive analysis was carried out using stata12.0 software. From the perspective of microbial community, most of the microbial communities at the phylum level are risk factors; from the perspective of the top ten families, the intestinal microbial communities play an obvious harmful role in Primary Biliary Cholangitis.From the perspective of disease, the microbial communities at the genus level mostly have protective effects on Chronic Hepatitis B ,Fatty Liver;and Primary Liver Cancer. Gut microbiota plays a significant role in the occurrence of liver diseases, and different bacterial levels play different roles in the disease.

Investigating the association between antiphospholipid syndrome and ovarian reserve: A systematic review and meta-analysis of the literature.

BackgroundAutoimmune diseases can reduce ovarian reserves. Women in reproductive ages are susceptible to an autoimmune disorder known as antiphospholipid syndrome (APS). The aim of this study is to investigate the association between APS and ovarian reserve (OR).MethodPubMed, Scopus, Web-of-Science, Science Direct, and the Google scholar search engine were searched (22 June 2024) for studies that investigated the effect of APS on OR. Literature screening, data extraction, and assessment of the risk of bias of the included studies were conducted by two reviewers independently. Mean differences were computed using a random effects model. Heterogeneity was assessed by I2%.ResultsFour cross-sectional studies were included in this meta-analysis. None of the studies had a high risk of bias. There was no significant association identified between primary (MD = -0.27, 95% CI, -1.42 to 0.87, p = 0.639) and secondary APS (SMD = -0.38, 95% CI, -2.46 to 1.69, p = 0.717) with antimullerian hormone amounts. The antral follicle count (AFC) was investigated in two studies revealed lower levels of AFC in women with primary APS. Regarding the levels of gonadotropins and estradiol in the participants' serum, the results are contradictory.ConclusionsThe results of this meta-analysis identified there is no relationship between primary and secondary APS with the reduction of ovarian reserves in women with APS. This issue should be considered in the reproductive health of women with APS, who can have children at the right time by consulting a rheumatologist and reproductive health specialist.

Impact of different exercise types on depression and anxiety in individuals with cancer: A systematic review and network meta-analysis of randomized controlled trials.

Impact of different exercise types on depression and anxiety in individuals with cancer: A systematic review and network meta-analysis of randomized controlled trials.

Magnetic resonance imaging to detect tumor hypoxia in brain malignant disease: A systematic review of validation studies.

Magnetic resonance imaging to detect tumor hypoxia in brain malignant disease: A systematic review of validation studies.

Effectiveness and recommendation strategies for videoconference-based interventions to alleviate social isolation and loneliness in older adults: A systematic review and meta-analysis.

Effectiveness and recommendation strategies for videoconference-based interventions to alleviate social isolation and loneliness in older adults: A systematic review and meta-analysis.

Resilient spatial transformation and governance of public spaces in historical districts in disaster time: a literature review

ABSTRACT Modern disaster prevention facilities cannot play an effective role in China’s high-density historic districts, and the coverage radius of refuge green space is not applicable. However, many resilient public spaces in historic districts could spontaneously transform into emergency spaces. This study aims to review the research on public space transformation and governance in disaster response to find out what lessons can we derive to improve response to future disaster. The research was divided into three stages: literature screening, data analysis, and literature categorisation. The results show that (1) Most of the existing studies are targeted at pre-planning type of disaster prevention from the top-down perspective, while few summaries of the spontaneous disaster response influencing factors. Some scholars have confirmed the potential of resilient public spaces to respond to disasters, and the spontaneous transformation module has shown positive results, but have not established a multidimensional influence mechanism research structure. (2) The spontaneous spatial response is a process of co-operative intervention by multiple types of participants. The different modes of their co-operation have different outcomes. This review provides useful summaries for the future use of resilience in historic districts in response to disasters, with potential value in finding balanced cooperation across participants.

Meta-analysis of targeted drugs for pulmonary hypertension to improve exercise tolerance and associated factors in eisenmenger syndrome

ObjectiveThe aim of this study was to systematically evaluate the effect of pulmonary arterial hypertension (PAH) targeting drugs on exercise tolerance in Eisenmenger syndrome (ES) and analyze related factors.MethodsTwo researchers conducted an independent search of the Chinese database and the English database, and conducted literature screening, data extraction and quality evaluation according to the inclusion and exclusion criteria respectively. According to the heterogeneity test results, the effect model was adopted for analysis by RevMan5.4 statistical software, in which the continuity data were represented by mean difference (MD) and 95% confidence interval (CI).ResultsA total of 393 patients with ES were included in 13 papers, including 8 studies of endothelin receptor antagonists (ERA), 2 studies of phosphodiesterase 5 inhibitors (PDE5i) and 3 studies of prostanoids. The results of these studies showed that the targeted drugs were effective in improving exercise tolerance in ES patients. Further analyses revealed that the differences in efficacy were related to the type of targeted drug, duration of drug treatment and the presence or absence of Down syndrome (DS). 6MWD (6 min Walk Distance) and cardiac function were significantly improved in ES patients with all three classes of drugs. Prostanoids (MD = 132.35, 95% CI: 14.82-249.89, P < 0.0001, I2 = 93%) improved 6MWD better than ERAs (MD = 41.60, 95% CI: 21.76–61.44, P < 0.0001, I2 = 32%) and PDE5i (MD = 52.33, 95% CI: 29.16–75.50, P < 0.0001, I2 = 0). Prostanoids demonstrated a more significant improvement in cardiac function compared to ERAs and PDE5i. Specifically, prostanoids [MD= -1.26, 95% CI: (-1.66, -0.86), P < 0.0001] showed a greater improvement than ERAs [MD=-0.54, 95% CI: (-0.96, -0.11), P = 0.01] and PDE5i [MD=-0.38, 95% CI: (-0.64, -0.13), P = 0.003]. Short-term pharmacological therapy (less than 12 months) significantly increased 6MWD and improved clinical cardiac function in included patients. Continued targeted drug therapy further increased the level of cardiac function (P < 0.0001). Targeted drug therapy was effective in increasing 6MWD in patients with ES combined with DS, but had no significant effect on cardiac function class. Targeted drug therapy had a favorable effect on both 6MWD and cardiac function class in non-DS patients.ConclusionEarly targeted drug therapy for ES can significantly improve the exercise tolerance of patients, and a better drug regimen and treatment time should be selected according to the clinical characteristics of patients.