Inflammation has been implicated in psychosis, but its role in individuals at clinical (CHR) and genetic (GHR) high-risk remains unclear. We therefore conducted a network meta-analysis (NMA) to compare circulating cytokine levels across CHR, GHR, and healthy control (HC) groups. We systematically searched multiple databases up to February 2025, extracting cytokine levels (plasma/serum) from CHR, GHR, and HC groups. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were estimated using random-effects models. Given that no direct head-to-head comparisons between CHR and GHR were available, indirect comparisons were performed through the common comparator (HC). The transitivity assumption was assessed by comparing key study and participant characteristics across comparisons. Thirty studies were included (CHR: 1601, GHR: 675, HC: 1980). NMA estimates indicated higher IL-6 levels in CHR compared with GHR, while IL-6 and IL-1β levels were lower in GHR compared with HC. In pairwise subgroup analyses, CHR converters showed higher IL-13 levels than non-converters. The evidence network was sparse and star-shaped, with all CHR-GHR estimates relying exclusively on indirect comparisons. This study represents the first NMA to synthesize cytokine alterations in individuals at high risk for psychosis using indirect evidence. Elevated IL-6 in CHR individuals suggests immune activation, whereas reduced IL-6 in GHR may reflect a distinct immune profile. Increased IL-13 levels in converters highlight potential involvement of Th2-related pathways during transition to psychosis. However, the sparse nature of the evidence network necessitates cautious interpretation of the findings, and larger, standardized multi-center studies are required for confirmation.

Vonoprazan-based regimens achieve high Helicobacter pylori eradication rates, but the optimal duration is unclear. We performed a systematic review and meta-analysis of randomized trials comparing 10-day versus 14-day vonoprazan-based therapy. Multiple databases were searched from inception through November 2025 for randomized controlled trials comparing 10-day and 14-day vonoprazan regimens at equal doses. The primary outcome was H. pylori eradication. Secondary outcomes included compliance and adverse events. Random-effects models pooled proportions and risk ratios (RR) with 95% confidence intervals (CIs). Heterogeneity was assessed with I2. Seven open-label trials from China (n = 3731) were included. With dual therapy, eradication was lower with 10 versus 14 days in intention-to-treat (86.6% vs. 90.6%; RR 0.96, 95% CI 0.93-0.99) and per-protocol analyses (89.3% vs. 93.4%; RR 0.95, 95% CI 0.93-0.98). With quadruple therapy, eradication did not differ (intention-to-treat: RR 1.00, 95% CI 0.96-1.03; per-protocol: RR 1.00, 95% CI 0.98-1.03). Compliance was similar between durations. Across all regimens, pooled intention-to-treat eradication modestly favored 14 days (RR 0.97, 95% CI 0.95-1.00) but was sensitive to omission of one trial. Overall adverse events did not differ (RR 0.86, 95% CI 0.71-1.04), but nausea/vomiting (RR 0.73, 95% CI 0.57-0.94) and taste disturbance (RR 0.70, 95% CI 0.50-0.98) were less frequent with 10 days. Fourteen-day therapy provides a modest eradication benefit, most evident in dual therapy. Ten-day therapy is associated with fewer nausea/vomiting and taste disturbances. Findings are based entirely on trials from China and may not generalize elsewhere.

Heart failure (HF) affects over 64 million people globally and is characterized by high post-discharge vulnerability and frequent readmissions. A specific approach is essential to address the complexities of HF management. One such approach is nursing coaching, which integrates family support and follow-up care to improve patient self-care. However, this specific concept remains under-defined and has not been extensively explored within current nursing literature. Therefore, this concept analysis aims to define 'nursing coaching' within the context of HF management, specifically identifying its defining attributes, antecedents, consequences, and empirical referents to guide clinical nursing practice. This concept analysis utilizes the Walker and Avant method to achieve its systematic objectives. To ensure a comprehensive review, multiple electronic databases were searched, including PubMed, the Cochrane Library, CINAHL, Scopus, EMBASE, and ScienceDirect. The search strategy focused on peer-reviewed English-language studies involving nursing coaching, health coaching, and heart failure. Specific inclusion and exclusion criteria were applied to refine the selection, and the entire search and screening process is documented and visualized using a PRISMA flow diagram. Six key attributes were identified as follows patient-centered approach, empowerment and motivation, education and knowledge transfer, behavior change strategies, ongoing support and follow-up, and holistic approach. Antecedents included patient readiness, nurse coaching competency, educational resources, supportive policies, and technology integration; consequences included improved self-care, adherence, quality of life, and reduced avoidable utilization, without implying causality. As a concept analysis, findings clarify nursing coaching in HF and provide an operational definition and referents to inform clinical or community nursing practice design. Keywords: Concept analysis, heart failure, nursing coaching, patient empowerment, self-care

Our study aimed to assess potential associations between food colouring additives and cancer incidence in the French NutriNet-Santé cohort. A total of 105,260 adults (78.3% females; mean age 42.0 ± 14.5y) without prevalent cancer and who completed ≥ 2 24-hour dietary records at baseline were followed for > 7 years. Dietary intakes were assessed using repeated brand-specific 24h records, and cumulative time-dependent exposure to food additives was evaluated through multiple composition databases and ad-hoc laboratory assays in food matrices. Associations between exposures to food colouring additives (sex-specific tertiles if proportion of exposed participants > 2/3, or non-exposed/lower/higher exposed based on sex-specific median otherwise) and cancer incidence were assessed using multivariable Cox models. We identified 4,226 incident cancer cases (508 prostate, 1,208 breast [387 premenopausal and 821 postmenopausal], and 352 colorectal). Total food colouring additives were associated with higher overall [HRhigher versus non/lower consumers (95%CI): 1.14 (1.05-1.24); absolute risk at age 60: 13.3% (higher consumers) vs. 12.1% (lower/non-consumers)], breast [1.21 (1.03-1.42); 5.7%, 4.8%], and postmenopausal breast [1.32 (1.09-1.61); 14.9%, 12.5%] cancer incidence. After False Discovery Rate correction, only plain caramel (European code: E150a) was associated with overall cancer [1.15 (1.07-1.25); 14.0%, 12.1%] and beta-carotene (E160a) with overall [1.16 (1.07-1.25); 13.7%, 11.9%] and breast cancer [1.41 (1.23-1.62); 6.2%, 4.4%]. This study provides novel exploratory evidence linking colouring additives to cancer incidence. Further research is needed to elucidate underlying mechanisms. Findings support recommendations to limit exposure to non-essential food additives (i.e. used primarily for sensory or aesthetic purposes rather than for food safety or preservation) and inform regulatory reassessment.

Reverse-screening methodologies have emerged as powerful tools for identifying molecular targets of bioactive compounds, complementing experimental approaches and accelerating drug discovery. Recent developments in integrative strategies combining multiple databases of protein-ligand interactions, gene expression profiles, and structural information, offer improved accuracy and broader coverage in mapping compound-target networks. In this review, we highlight the principles, strengths, and limitations of these integrative reverse-screening approaches, with particular attention to their application in natural product research. As an illustrative case study, we discuss hydroxytyrosyl punicate (HT-PA), a synthetic phenolipid derived from hydroxytyrosol and punicic acid, which exhibits antiproliferative and antiparasitic effects. The application of multi-database reverse screening to HT-PA identified potential targets, including arachidonate 5-lipoxygenase (ALOX5), transient receptor potential channels (TRPs), and peroxisome proliferator-activated receptors (PPARs), which are central to inflammation, metabolism, and pain regulation. This case exemplifies how integrative computational frameworks can provide mechanistic insights, prioritize targets for experimental validation, and guide the therapeutic development of natural product derivatives. More broadly, we argue that multi-database reverse screening represents a versatile platform for uncovering the molecular basis of bioactivity and advancing rational drug discovery from complex natural compounds.

Ischemic stroke (IS) is an important disease leading to high disability and mortality, and the current clinical treatment is limited. Tongnao Decoction (TND) is a traditional Chinese herbal formula for treating IS, but its pharmacological mechanism remains unclear. This study aims to elucidate the molecular mechanism through network pharmacology, molecular docking, and related experimental verification. First, the bioactive components of TND, along with their potential targets and IS-related gene targets, were identified through multiple databases. Subsequently, an "herb-active component-disease gene target" network and a protein-protein interaction (PPI) network were constructed. Combined with enrichment analysis, key biological processes and signaling pathways were identified. Following this, molecular docking experiments were conducted to preliminarily validate drug-target interactions. Finally, the efficacy of the relevant pathway targets was validated in a photochemically induced mouse cerebral ischemia model. A total of 90 active compounds and 615 target genes were screened. PPI network analyses suggested that TP53, EGFR, STAT3, AKT1, and IL-6 were the hub targets. TND significantly modulates inflammatory biological processes and the PI3K-Akt signaling pathway during IS treatment. Molecular docking analysis indicated that the primary components of TND may exhibit favorable binding affinity to multiple hub target proteins, including TP53, EGFR, STAT3, AKT1, and IL-6. Further invivo experiments showed that TND dramatically improved neurological function, reduced neuronal damage, and decreased IL-6 expression in brain tissue. In addition, TND stimulated the PI3K/Akt/GSK-3β pathway. These findings imply that TND and its key bioactive components, coryincine, dihydrocapsaicin, and 4 (4'-hydroxybenzyloxy)benzyl methylether exert therapeutic effects on IS through the IL-6/PI3K/Akt/GSK-3β pathway.

Postoperative delirium (POD) is a common and serious complication after cardiac surgery. Although family involvement is considered a promising nonpharmacological strategy, its efficacy specifically in patients undergoing cardiac surgery remains inadequately supported by systematic evidence. Our aim was to evaluate the effectiveness of family interventions in preventing POD among patients undergoing cardiac surgery. We systematically searched multiple databases from inception to July 2025 for randomized controlled trials (RCTs) assessing family intervention for POD in patients undergoing cardiac surgery. Study selection, quality assessment, and data extraction were performed independently by 2 reviewers. We conducted a meta-analysis using RevMan 5.4 and Stata 18.0, with effects expressed as risk ratios or standard mean differences and 95% confidence intervals (CIs). We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework to evaluate evidence quality. The protocol was registered on PROSPERO (CRD42024627097). A total of 6 RCTs with 508 patients were included in the analysis. Family intervention significantly reduced the incidence of POD (risk ratio = 0.38, 95% CI: 0.25-0.58, P < .001) and shortened hospital length of stay (standard mean difference = -1.07, 95% CI: -1.91 to -0.24, P < .05). Our subgroup analysis revealed no significant differences in outcomes based on family involvement level, age, or sample size. Additionally, interventions improved psychological well-being and increased caregiver satisfaction (P < .05). Family intervention reduces POD incidence and hospital stay and enhances psychological outcomes for patients and caregivers. However, due to small sample sizes, further large-scale high-quality RCTs are warranted.

Introduction: Truncus arteriosus (TA) is a rare congenital cardiac anomaly requiring early surgical intervention, typically through either a single-stage neonatal repair {primary correction (PC)} or staged repair (SR), involving initial palliation followed by definitive correction. The optimal approach remains debatable. Methods A systematic search of multiple databases identified studies comparing SR and PC in TA. Pooled odds ratios (ORs), mean differences (MDs), and 95% confidence intervals (CIs) were calculated using RevMan v8.13.0. Time-to-event data for freedom from reoperation were reconstructed from published Kaplan-Meier (KM) curves, and pooled hazard ratios (HRs) with 95% CI were estimated using a Cox frailty model. Results: Five studies comprising 534 pediatric patients were included, with 274 (51.3%) in the SR cohort. SR was associated with a significantly lower incidence of unplanned surgical reinterventions following complete repair at the end of follow-up [OR 0.28; 95% CI 0.14-0.55; P = .02], while mortality at follow-up did not differ significantly between the approaches [OR 0.59; 95% CI 0.10-3.34; P = .32]. Reconstructed KM curve demonstrated greater freedom from reoperation in the SR group over 12 years [HR 0.39; 95% CI 0.17-0.89; P = .025]. Early perioperative outcomes, including cardiopulmonary bypass and aortic cross-clamp times, delayed sternal closure, intubation duration, early mortality, intensive care unit, and hospital stay, were similar between groups. Conclusion SR demonstrated fewer late unplanned reoperations over 12 years with comparable survival and perioperative outcomes to PC. However, these findings are based on low-certainty evidence from limited retrospective studies, warranting cautious interpretation.

Alpinia oxyphylla Miquel is a perennial medicinal plant widely cultivated in the provinces of Fujian, Guangdong, and Hainan in China. The dried mature fruit of A. oxyphylla, officially recorded as Alpiniae Oxyphyllae Fructus in the pharmacopoeia of the People's Republic of China (since 2012), is one of the four primary southern medicinal materials in traditional Chinese medicine (TCM). In TCM, the fruit is traditionally used to support kidney function, regulate urination, and alleviate gastrointestinal disorders such as diarrhea. Its continued use across Southeast Asia underscores its enduring ethnopharmacological relevance. The plant is rich in bioactive constituents, including terpenoids, flavonoids, diphenylheptanes, and sterols, which exhibit diverse biological activities, including antioxidant, anti-inflammatory, anticancer, neuroprotective, and gastrointestinal protective effects. Information on Alpinia oxyphylla was collected from multiple databases, including Web of Science, Google Scholar, PubMed, Baidu Scholar, ScienceDirect, CNKI, and the Pharmacopoeia of the People's Republic of China. The search strategy included keywords related to A. oxyphylla, its chemical constituents, biological activities, pharmacological effects, traditional medicinal uses, and safety. A bibliometric analysis of 217 English-language publications (2014-2025) using CiteSpace revealed a marked increase in global research interest, with keyword clustering and burst analyses highlighting oxidative stress, Alzheimer's disease, and cognitive enhancement as emerging research hotspots. Moreover, 692 patents were identified, demonstrating substantial technological innovation related to A. oxyphylla, particularly in essential oil formulations, functional foods, and health-promoting applications. Overall, this review integrates phytochemical, pharmacological, bibliometric, and patent perspectives to provide a holistic understanding of A. oxyphylla and its medicinal fruit, offering a solid scientific foundation for future research, standardization, and translational development.

Effective adjuvant treatments in resected or ablated hepatocellular carcinoma (HCC) were elusive over the preceding decades. Recently, immune checkpoint inhibitors (ICIs) have been investigated in the adjuvant setting, with conflicting results. A systematic literature search was conducted in multiple databases. Studies investigating adjuvant ICIs as monotherapy or combined with tyrosine kinase inhibitors (TKIs) or anti-angiogenics compared with surveillance in resected or ablated HCC were eligible. The primary and secondary outcomes were recurrence-free survival (RFS) and overall survival (OS). The generic inverse-variance method and random-effects model were utilized. Eighteen studies with a total of 3478 patients were included. The adjuvant treatment modalities were "ICI monotherapy" and "ICI plus TKI/anti-angiogenic" in eight and 10 of the studies, respectively. RFS was significantly improved by "all ICI-based" (HR: 0.51, 95% CI: 0.44-0.60, p < 0.001), "ICI monotherapy" (HR: 0.46, 95% CI: 0.35-0.60, p < 0.001), and "ICI-TKI/anti-angiogenic" combinatory (HR: 0.55, 95% CI: 0.45-0.68, p < 0.001) adjuvant treatments, with no difference between the two (p = 0.29). Subgroup analyses showed consistent benefits regardless of curative treatment modalities of resection or ablation, presence of transarterial chemoembolization, and study design. OS was improved by ICI-based adjuvant therapies compared with surveillance (HR: 0.51, 95% CI: 0.40-0.65, p < 0.001). Adjuvant ICIs with or without TKI/anti-angiogenics may provide survival benefits in resected or ablated HCC. Yet the results are limited by the observational nature and territoriality of the included studies. The results of global, randomized, controlled, phase III clinical trials with longer follow-up data will inform clinical practice. CRD42025640036.

Metagenomic next-generation sequencing in pediatric infectious disease diagnosis: A comprehensive systematic literature review and meta-analysis.

Perianal fistulising Crohn's disease (pfCD) is a heterogeneous phenotype of Crohn's disease with marked variability in anatomical complexity, symptomatology, and disease trajectory. This often creates uncertainty in the optimal approach to management, particularly the surgical aspects of when to perform examination under anaesthesia (EUA) and when to insert or remove setons. We conducted a systematic review following PRISMA guidelines. Multiple databases were searched from inception through December 2025. Eligible publications included clinical guidelines on pfCD and/or rectovaginal fistulas that reported indications for EUA, seton insertion, and/or seton removal. We stratified recommendations by fistula complexity, the presence of abscesses, and clinical symptoms. Risk of bias was assessed using the AGREE II Instrument. Twenty-four guidelines met inclusion criteria. EUA (and often seton placement) was universally recommended for perianal abscesses and frequently for symptomatic complex pfCD. For asymptomatic complex or symptomatic simple fistulas, recommendations were variable and often conditional on the presence of proctitis or plans for biologic therapy. In contrast, EUA and setons were not broadly endorsed for asymptomatic simple fistulas. Recommendations for seton removal varied widely, ranging from predefined intervals after anti-TNF therapy initiation to individualised criteria based on clinical or radiologic response. Most guidelines did not consider symptom type/severity, prior surgery, suitability for surgical closure, and asymptomatic abscesses detected by imaging. Substantial heterogeneity and limitations exist across guidelines on the surgical management of pfCD. This underscores the need for international consensus informed by multidisciplinary expertise to standardise care in this complex population.

While antineutrophil cytoplasmic antibody (ANCA)-associated small-vessel vasculitis (AAV) is increasingly recognized, cases presenting with initial gastrointestinal symptoms remain underexplored. This study aimed to analyze the clinical characteristics of AAV patients with gastrointestinal onset. Seven AAV patients meeting ACR/EULAR criteria, who presented with gastrointestinal symptoms between January 2017 and 2024, were retrospectively identified. A literature review was conducted across multiple databases, including PubMed, Web of Science, Cochrane Library, Embase, CNKI, VIP, and Wanfang. In total, 23 patients were included in the study. Among the 23 AAV patients with gastrointestinal symptoms, 15 (65.2%) were male, with a median age of 54 years (range: 18-79). Common clinical manifestations included hematochezia (56.5%), weight loss (43.5%), and purpura (34.8%). Eight (34.8%) had superficial gastritis, and seven (30.4%) had colonic ulcers, as identified by gastrointestinal endoscopy. Laboratory findings revealed elevated D-dimer levels and anemia in most patients, with impaired renal function and a median hemoglobin level of 105 g/L. Anti-PR3 immunoglobulin G (IgG) and antimyeloperoxidase IgG antibodies were positive in 83.3 and 80% of cases, respectively. Abdominal computed tomography (CT) revealed wall thickening in 39.1% of patients, and chest CT identified interstitial lung disease in 73.9% of patients. Nine patients (39.1%) were initially misdiagnosed, with five (55.6% of those nine) misdiagnosed as having inflammatory bowel disease. Most patients responded well to glucocorticoid and immunosuppressive therapy, with 39.1% receiving a combination of glucocorticoids and cyclophosphamide. Gastrointestinal symptoms in AAV are rare, and misdiagnosis remains a concern. Early detection requires assessing gastrointestinal, pulmonary, and renal involvement.

Combining network pharmacology and multi-omics reveals the role of Shengdihuang-Huangqi herb pair in alleviating type 2 diabetes mellitus.

Fibrosis is a key predictor of the long-term prognosis in metabolic dysfunction-associated steatotic liver disease (MASLD). Numerous clinical trials in drug development for MASLD have used fibrosis improvement as an efficacy endpoint. We aim to compare the efficacy of pharmacologic therapies for MASLD in improving fibrosis using histopathological and noninvasive assessments. A comprehensive search for randomized controlled trials (RCTs) was conducted across multiple databases, focusing on drug therapy in adult patients with MASLD. The primary outcome was more than 1-stage fibrosis improvement. The secondary outcomes included changes in liver stiffness measurement (LSM) via vibration-controlled transient elastography (VCTE) and magnetic resonance elastography. Each intervention's ranking probability was assessed using the surface under the cumulative ranking curve (SUCRA). Forty-eight RCTs involving 10 119 participants were included. For the primary outcome, pegozafermin, obeticholic acid (OCA), and resmetirom all outperformed placebo in the fibrosis stage F1-3 analysis. OCA was superior to placebo in the 1.5-year analysis. Pegbelfermin (SUCRA: 77.11%) and pegozafermin (SUCRA: 74.91%) at F1-3, and OCA at 1.5 years (SUCRA: 81.64%) were ranked as the most effective treatments. For the secondary outcome, pegozafermin significantly outperformed placebo for decreasing LSM via VCTE in 0.5-year analysis, ranking as the most effective treatment for this outcome (SUCRA: 96.98%). Several new drugs currently in clinical trials have shown potential therapeutic effects for fibrosis improvement in MASLD patients, especially those targeting fibroblast growth factor 21 (FGF21). More definitive efficacy will depend on the results of phase III clinical trials.

To examine the current landscape of artificial intelligence (AI) applications in vitreoretinal (VR) diseases and surgery, with the aim of identifying knowledge gaps and guiding future directions in this rapidly evolving field. Systematic review including original studies involving the use of AI and focusing on VR pathologies. A comprehensive electronic search of the literature was carried out in multiple databases. Thirty-seven studies were included. Most evaluated machine learning or deep learning models for preoperative prognostication using optical coherence tomography with or without clinical variables. Predictive performance for postoperative best-corrected visual acuity (BCVA) was high in several cohorts (R2 up to 0.80; area under the receiver operating characteristic curve [AUROC] > 0.95), with models consistently highlighting outer retinal biomarkers as key determinants of visual recovery after epiretinal membrane and macular hole surgery. For anatomical outcomes, deep learning models frequently achieved > 90% accuracy in predicting macular hole closure and retinal reattachment/reattachment-related endpoints. Intraoperative computer-vision systems demonstrated feasibility for real-time instrument detection and tracking, reporting precision above 90% in experimental or early clinical settings. Large language models showed moderate-to-high agreement with expert surgical planning (80-93%) and potential utility in education and workflow support; however, across domains, most studies were retrospective and single-center, with limited external validation. AI may transform vitreoretinal surgery, from outcome prediction to intraoperative guidance and workflow support. Despite strong performance in research settings, broader clinical adoption requires prospective validation to ensure reliability, transparency, and real-world benefit.

This systematic review evaluated the antibacterial efficacy of the GentleWave system compared with other endodontic irrigation systems. A comprehensive literature search was conducted across multiple databases (PubMed, MEDLINE, Web of Science, Scopus). The eligibility criteria were formulated using the PICOS framework, focusing on the antibacterial efficacy of the GentleWave system compared to other irrigation methods. A total of 2327 articles were screened, with five meeting the selection criteria for inclusion. Four studies were conducted in vitro, one in ex vivo, and various tooth types were tested. A bias assessment was conducted using the QUIN tool. Four studies had a low risk of bias, with one study scoring medium risk. All concluded that the GentleWave system significantly reduced microbial counts. Emerging evidence suggests that GentleWave may provide superior antibacterial efficacy in root canal therapy, making it a compelling option. However, further research is needed to confirm its benefits and promote broader adoption.

Prognostic significance and therapeutic potential of pyroptosis in gynecological malignancies.

Unveiling the genus Taraxacum: From folk medicine to chemodiversity-driven pharmacological and toxicological outcomes-A systematic review.

Progress in research on the hepatoprotective effects of C-21 steroidal glycosides from Baishouwu.