Observational Studies Research Articles

Mealtime Support by Direct Care Workers in Long-Term Care Facilities: Secondary Behavioural Analysis of Videos.

This study aimed to address two objectives: (1) To analyse the meal support behaviours of direct care workers in long-term care facilities in South Korea and (2) to explore associations between mealtime support behaviours and caregiver characteristics. Secondary analysis of behavioural coding of cross-sectional video recordings. Positive and negative staff behaviours at mealtimes were coded using the Mealtime Engagement Scale and Cue Utilization and Engagement in Dementia tool, respectively. Statistical analyses, including t-tests and analysis of variance, were used to examine differences in mealtime support behaviours based on caregiver characteristics. The average mealtime duration of residents was 19.03 ± 5.30 min. Positive meal support behaviours accounted for 91.1% of the observed interactions, whereas negative interactions accounted for 8.9%. The most frequent positive behaviour observed was 'providing one-on-one assistance', whereas the most frequent negative behaviour was 'leaving the resident alone'. Positive meal support behaviours were observed at significant higher frequencies among caregivers working during day shifts than those working during rotating shifts. Additionally, positive behaviours were associated with a higher carer-resident ratio. Positive mealtime support behaviours were frequently observed but were concentrated in a few specific actions. Negative behaviours, such as leaving the resident alone, were still observed in a considerable portion of mealtime interactions. Training programmes focusing on diverse positive mealtime support behaviours should be developed to improve the quality of dementia care in long-term care facilities. The findings emphasise the need for targeted training programmes to improve mealtime support and overall care quality in long-term care facilities. This approach signals a transformative shift in caregiver training, fostering more personalised and effective care for older adults with dementia. This study quantified positive and negative mealtime support behaviours. These findings contribute to understanding caregiver behaviours during mealtimes in dementia care, offering evidence-based insights for developing targeted training programmes and improving quality of care in long-term care facilities. We adhered to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. No patient or public contribution.

The Mirror of Erised: a retrospective population-wide study of Czech all-cause mortality data by COVID-19 vaccination status

BackgroundIn this study, we investigated the association between COVID-19 vaccination status and all-cause mortality (ACM) rate in the population of the Czech Republic between January 2020 and December 2022.MethodsIn this retrospective study based on official population-wide individual (record-level) data, we analyzed monthly ACM rates stratified by COVID-19 vaccination status, sex, and age. The ACM was compared to expected mortality based on pre-COVID data. The recipients of the Janssen vaccine were excluded from the study. The final dataset comprised N = 5,636,949 individuals from the Czech Republic, encompassing all residents born between 1925 and 1980 who were alive on January 1, 2020.ResultsMultiple peculiar patterns in ACM were revealed. The ACM of vaccinated individuals across several age cohorts was greatly diminished compared to the ACM of the unvaccinated, even in periods when virtually no COVID-19-related deaths were observed, suggesting a strong selection/indication bias. A similar drop in the ACM of newly vaccinated individuals was observed again during the booster campaign. With time from vaccination, the differences in ACM between groups with different vaccination statuses dwindled. Indication bias was observed at the beginning of the vaccination campaign when the frailest individuals were preferentially vaccinated.ConclusionsThe population-wide data strongly suggest the presence of selection/indication bias, warranting careful interpretation of vaccination effectiveness estimates derived from observational studies.

The Use of Propensity Score Matching in Observational Studies.

The Use of Propensity Score Matching in Observational Studies.

Higher versus Lower Phosphate Targets for Patients Undergoing In-Center Hemodialysis: A Randomized Controlled Trial.

Serum phosphate targets in maintenance hemodialysis are based on observational studies. The HiLo trial aimed to compare the effect of a higher versus a lower phosphate target on clinical events in patients receiving maintenance hemodialysis. HiLo was a pragmatic, multicenter randomized trial that compared higher (≥6.5 mg/dl; "Hi") versus lower (<5.5 mg/dl; "Lo") phosphate targets in patients undergoing maintenance hemodialysis. The goal was to enroll 4400 cluster-randomized patients to assess the primary hierarchical composite outcome of all-cause mortality, followed by all-cause hospitalization using the win ratio. Due to an imbalance in baseline serum phosphate between groups, raising concern for biased recruitment due to post-randomization consent, HiLo transitioned to individual randomization 23 months after the trial began. Ultimately, HiLo was stopped early due to insufficient enrollment and inadequate phosphate separation between groups. For this report, we combined the cluster- and individually randomized cohorts, analyzing the individually randomized cohort as two additional clusters and applying a variance inflation factor to account for site-level clustering effects. Between March 2020 and November 2023, 352 patients in the Hi group and 441 in the Lo group were enrolled. After a median follow-up of 1.4 years (quartiles 1, 3: 0.5, 2.8 years), there were 11 deaths per 100 person-years in the Hi group and 13 per 100 person-years in the Lo group. The Hi group experienced 134 hospitalizations per 100 person-years compared to 96 per 100 person-years in the Lo group. The primary hierarchical composite outcome did not differ between groups (win ratio for Hi versus Lo targets was 0.97; 95% confidence interval, 0.55-1.71). Insufficient enrollment and inadequate phosphate separation between groups preclude inferences about the effects of phosphate targets on clinical outcomes.

Left atrial appendage occlusion in patients with atrial fibrillation and previous Intracranial Hemorrhage or Cerebral Amyloid Angiopathy: a systematic review and meta-analysis.

Patients with atrial fibrillation (AF) on oral anticoagulation (OAC) who have a history of intracranial hemorrhage (ICrH) or cerebral amyloid angiopathy (CAA) have an elevated risk of ICrH recurrence. Left atrial appendage occlusion (LAAO) has emerged as a potential alternative to OAC for stroke prevention in high-bleeding-risk AF patients. Small observational studies suggest that LAAO may be safe and feasible in patients with ICrH, when using single or dual antiplatelet therapy or short-term OAC post-procedure, though data remain limited. This systematic review and meta-analysis aims to consolidate evidence on the safety and efficacy of LAAO in patients with prior ICrH or CAA. We conducted a systematic review and meta-analysis examining the safety and efficacy of LAAO in patients with non-valvular AF and prior ICrH and/or CAA. PubMed/MEDLINE and EMBASE (via Scopus) databases were systematically searched from inception until 29 February 2024. Eligible studies included randomized control trials, observational studies, and case series (≥10 participants) reporting stroke events in patients with AF and previous history of ICrH and/or CAA undergoing LAAO. Pooled incidence rates (IRs) with corresponding 95% confidence intervals (CIs) were calculated for primary outcomes (post-procedural ischemic stroke and recurrent ICrH) and secondary outcomes. Fourteen studies including 1,235 patients met inclusion criteria. The pooled average follow-up period was 17.1 months. The pooled IRs for ischemic stroke, recurrent ICrH, and major hemorrhage were 2% (95%CI: 1%-3%, I2=2%), 2% (95%CI: 0.4%-3%, I2=45%) and 3% (95%CI: 1%-5%, I2=54%), respectively. In prespecified subgroup analyses of studies focusing on patients with intraparenchymal hemorrhage and/or CAA, pooled IRs for ischemic stroke, recurrent ICrH, and major hemorrhage IR of 4% (95%CI: 1%-8%), 4% (95%CI: 0.4%-10%) and 6% (95%CI: 3%-12%), respectively. LAAO may be a safe and effective treatment for selected AF patients with a history of ICrH and/or CAA, but the quality of evidence is poor. Future randomized controlled trials are essential to validate LAAO's efficacy and long-term safety.

Psychedelics for Alcohol Use Disorder: A Narrative Review with Candidate Mechanisms of Action.

Psychedelics have been studied since the 1950s as a potential treatment for alcohol use disorder (AUD), with over a dozen clinical trials of lysergic acid diethylamide (LSD), and several contemporary trials of psilocybin and ayahuasca for this indication. Herein, we characterize foundational studies from the 1950s to the present, with emphasis on key design factors that varied considerably between published studies. Critically, those design factors include pharmacological factors, such as presence or absence of a placebo control and the nature of the placebo (e.g., ephedrine, dextroamphetamine, diphenhydramine, or low-dose LSD), and non-pharmacological factors, such as the treatment setting and the presence or absence of psychotherapy. We found that observational studies nearly uniformly show promising results, but trials in which psychedelics were tested against placebo or standard of care control groups have been more inconsistent in both outcomes and methodologies. Given the inconsistency in published results, we review candidate mechanisms of action for psychedelics in the context of AUD. We take a biopsychosocial approach, reviewing mechanisms spanning several different hierarchical levels of analysis, including cellular neuroplasticity, cognitive neuroscience, subjective experience, and social connection. Taken together, this review highlights key findings on both the efficacy and potential mechanisms of psychedelics for the treatment of AUD, which could motivate future studies in this rapidly developing field.

The Trends in the Prevalence of Arthritis and Arthralgia and Their Associations with Extra-Articular Manifestations in Patients with Behcet's Disease: A Systematic Review and Meta-Analysis.

Articular involvement has been one of the most common findings of Behcet's disease. The present study aimed to systematically evaluate the trends in the prevalence of arthritis and arthralgia, as well as their potential associations with extra-articular manifestations of the disease. Observational studies that reported the prevalence of arthritis or arthralgia were included. Pooled prevalence with corresponding 95% confidence intervals were calculated. Univariate meta-regression was performed to evaluate the potential associations of articular manifestations with extra-articular manifestations of Behcet's disease. A total of 120 articles were included. The pooled prevalence of arthritis and arthralgia were 0.34 (95%CI: 0.30-0.39) and 0.37 (96%CI: 0.30-0.45). The peripheral joints were mostly affected in the form of oligoarthritis. There were significant positive associations between the prevalence of arthralgia and the proportion of females and skin lesions, and between the prevalence of arthritis and skin lesions and erythema nodosum. The present study highlighted the decreasing trend of arthritis over the years and the predominance of peripheral involvement and oligoarthritis, particularly in the knees. Additionally, it showed that there are significant associations but not necessarily causal relationships between the prevalence of both arthritis and arthralgia and the prevalence of skin lesions.

Interpregnancy Weight Gain and Risks of Perinatal Death: A Systematic Review and Meta-Analysis.

The link between interpregnancy weight gain (IPWG) and perinatal death remains unclear. This meta-analysis examines the impact of interpregnancy body mass index (BMI) increase on perinatal mortality. A comprehensive search was conducted in July 2024 across MEDLINE, Embase, Cochrane Library, and Web of Science. Observational studies quantitatively reporting IPWG and associated perinatal mortality outcomes were included. IPWG was defined as a weight gain of ≥ 2 BMI units or moving to a higher BMI category between consecutive pregnancies. The risk of bias was assessed using the ROBINS-I tool. Random effects meta-analyses were performed to generate pooled adjusted odds ratios (aORs) and 95% confidence intervals (CIs). The analysis included 10 studies (3,072,698 pregnancies). The primary outcome was perinatal death (deaths occurring at ≥ 20 weeks of gestation up to 28 days postpartum). Secondary outcomes were stillbirth (intrauterine fetal death at ≥ 20 weeks) and neonatal death (deaths among live-born infants within 28 days of life). IPWG significantly increases the risk of perinatal death (aOR, 1.49; 95% CI, 1.32-1.69), stillbirth (aOR, 1.46; 95% CI, 1.23-1.72), and neonatal death (aOR, 1.39; 95% CI, 1.19-1.61), compared to stable interpregnancy weight. These findings suggest that IPWG may increase the risk of perinatal death, highlighting the importance of weight management counseling during the interpregnancy period.

The Effect of Early Fluid Resuscitation on Mortality in Sepsis: A Systematic Review and Meta-Analysis.

While general agreement exists on many sepsis management principles, the details of early fluid resuscitation in sepsis remain contentious. The aim of the current review is to examine the impact of early (≤ 8 hr) fluid dosing, timing, and guideline-based resuscitation on mortality in sepsis. PubMed, Scopus, Cochrane, and Google Scholar from January 1, 2000, to November 8, 2024. Randomized controlled trials and observational data, adjusting for confounding, for adults (≥ 18 yr) with sepsis. From 2,169 citations, 30 studies with 119,583 patients were included. Dosing: three randomized trials suggest no mortality difference between more liberal (~43-72 mL/kg) vs. more restrictive (as low as 30 mL/kg) fluid resuscitative strategies (relative risk, 1.00 [0.81-1.24]). Eleven of 13 studies observed mortality risk when low-fluid volumes were administered (< 20 mL/kg; effect direction/sign test: p < 0.001). Six of 11 studies observed mortality risk when fluid volume dosing exceeded higher limits (> 45 mL/kg; p = 0.55). Timing: four of four studies observed a survival benefit with earlier completion of 30 mL/kg (within 3 hr; p = 0.12). Thirty mL/kg by discrete time: less than or equal to 1 and less than or equal to 2 hours-two studies observed survival benefit; less than or equal to 3 hours-one study observed survival benefit and three studies observed no mortality impact; and less than or equal to 6 hours-two studies observed a survival benefit, four studies observed no impact, and two studies observed increased mortality risk (both > 30 groups received > 50 and > 70 mL/kg). For fluid resuscitation within 8 hours of sepsis diagnosis: 1) randomized trials suggest no mortality difference between more restrictive and more liberal fluid resuscitative strategies (certainty of evidence: low); 2) dosing less than 20 mL/kg has an effect on increased mortality (low certainty); 3) observational studies trend toward increased mortality with higher volume resuscitation (> 45 mL/kg) but are not supported by randomized trials (very low certainty); and 4) survival benefit is observed when 30 mL/kg is completed within 3 hours (low certainty).

Statins: Novel Approaches for the Management of Doxorubicin-Induced Cardiotoxicity-A Literature Review.

This study aims to evaluate the potential role of statins in preventing doxorubicin-induced cardiotoxicity. With the rising number of cancer survivors and the persistent use of doxorubicin in treatment protocols, there is an urgent need for effective cardioprotective strategies to mitigate long-term cardiovascular complications. Statins, widely used for cardiovascular disease prevention, offer a promising repurposing opportunity due to their pleiotropic effects. A comprehensive review of existing animal and clinical studies was conducted to assess the cardioprotective effects of statins. Key mechanisms such as reduction of oxidative stress, inflammation, and apoptosis were examined, alongside current clinical evidence evaluating their use in patients receiving doxorubicin. Preclinical studies consistently demonstrate that statins significantly reduce doxorubicin-induced cardiotoxicity by modulating multiple cellular pathways involved in oxidative stress, inflammation, and programmed cell death. These findings highlight statins' multifaceted mechanisms of action in protecting cardiac tissue. Numerous observational studies have shown that statin therapy may reduce the incidence and severity of doxorubicin-induced cardiotoxicity, reflected by less decline in left ventricular ejection fraction and a lower risk of heart failure in those receiving statins, but results from randomized controlled trials remain inconsistent. Given the growing burden of cancer therapy-related cardiovascular disease and the established safety profile of statins, further large-scale clinical trials are warranted to confirm their protective role, determine optimal dosing strategies, and facilitate integration into oncology practice. Establishing their utility could improve long-term outcomes for cancer patients vulnerable to cardiotoxicity.

The role of thymectomy during parathyroidectomy in multiple endocrine neoplasia type 1-associated hyperparathyroidism: a systematic review and meta-analysis

BackgroundCurrent guidelines recommend transcervical thymectomy (TCT) during parathyroidectomy (PTX) for Multiple Endocrine Neoplasia Type 1 (MEN1)-associated primary hyperparathyroidism (PHPT) despite limited evidence substantiating efficacy. We aimed to determine the role of TCT in disease control and safety outcomes.MethodsA systematic review and meta-analysis were conducted on comparative observational studies exploring the efficacy of PTX with or without concomitant TCT for managing PHPT in patients with MEN1. Pooled event proportions were estimated using Freeman-Tukey double arcsine transformation method and converted to relative risk. Six studies (n = 306 patients) were included.ResultsTCT showed significantly reduced rates of persistent (relative risk 0.15; 21.9% vs. 3.1%; p < 0.01) and recurrent PHPT (RR 0.34, 43.8% vs. 12.9%; p = 0.004) necessitating re-operation compared to PTX alone, suggesting improved disease control. Interestingly, the addition of TCT reduced rates of transient PHPT (RR 0.07; 9.3% vs. 0%; p < 0.01 and permanent recurrent laryngeal nerve injury (RR 0.32, 3.9% vs. 1.0%; p = 0.04), indicating possible benefits in morbidity.ConclusionsConcomitant TCT may improve the safety and efficacy of PTX in MEN1-associated PHPT by synergistically clearing all cervical disease and minimizing adverse sequelae. Our findings provide further evidence to support existing recommendations for TCT and can guide surgical decision-making.

Cardiothoracic Wound Management in Pediatrics: A Scoping Review.

Congenital heart defects represent the most prominent cause of mortality in a child's first year of life. Management of cardiothoracic wounds in pediatric populations is complex, attributed to the fragility of soft tissue, with healing progressing differently in adults. Understanding the breadth of wound care management is essential in establishing its applicability to clinical practice, especially in the prevention of complications. The aim of this study was to expansively explore preoperative, intraoperative, and postoperative cardiothoracic wound care in pediatrics. In this scoping review, a systematic search of MEDLINE, EMBASE, and Cumulative Index to Nursing and Allied Health Literature was conducted to retrieve interventional studies on pediatric cardiothoracic surgical patients (younger than 21 years) with wounds requiring intervention published in the preceding 10 years. A total of 2379 studies were retrieved, with 23 studies included. This review predominantly consisted of observational studies (n = 13, 57%), with 2 randomized clinical trials (8.7%). Most studies focused on procedural interventions (n = 14, 41.2%), with an equal distribution of management-focused (n = 10, 29.4%) and bundle-focused (n = 10, 29.4%) interventions. Interventions were most used in the postoperative period (n = 68, 49.6%). Study authors typically assessed the association of pharmaceutical, dressing, mechanical, and decontamination interventions with the incidence of sternal wound infections, healing, other infections, nutrition, parental outcomes, and postoperative complications. Frequency of wound surveillance and dressing changes were heterogeneous and rarely reported among studies. This review demonstrated the limited availability of high-level evidence evaluating the effectiveness of wound care interventions associated with pediatric cardiothoracic surgery. It is paramount that researchers leverage existing clinical networks to establish clinical trials.

The association between the MIND diet and cognitive health in middle-aged and older adults: A systematic review.

The association between the MIND diet and cognitive health in middle-aged and older adults: A systematic review.

Prevalence and Risk Factors of Delirium Subtypes in the Surgical Intensive Care Unit: A Retrospective Study.

Delirium is a frequent, yet often underdiagnosed, condition in intensive care units (ICUs), especially in postoperative patients. It has three subtypes: hyperactive, hypoactive and mixed, each with distinct clinical manifestations and outcomes. A deeper understanding of each subtype's prevalence and risk factors is essential for improving ICU patient care. This study aims to figure out the prevalence of each type of delirium and risk factors associated with each subtype of delirium. This retrospective study included 4234 postoperative patients admitted to the surgical ICU between January 2017 and June 2019. Delirium was diagnosed using the Confusion Assessment Method for the ICU, and subtypes were determined using the RASS score. Multivariate logistic regression analysis was used to identify the risk factors associated with each delirium subtype. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. The prevalence of delirium was 8.7%, with mixed delirium being the most common subtype (47.7%), followed by hypoactive delirium (40.3%) and hyperactive delirium (12.0%). Each subtype was linked to different risk factors: hypoactive delirium was correlated with shorter ICU stays and pH and O2 imbalances, hyperactive delirium was associated with physical restraints and mixed delirium was linked to sedative medication and restraint use. Among postoperative ICU patients, mixed delirium was the most prevalent subtype, followed by the hypoactive and hyperactive forms. Identifying the unique risk factors for each subtype highlights the need for targeted prevention and management approaches in ICU. Further research is warranted to investigate the underlying mechanisms and to develop effective interventions tailored to each delirium subtype. This study is distinct from previous research in that it comparatively analysed the risk factors for delirium according to subtype. By distinguishing between the subtypes of delirium and identifying their incidence and risk factors, it is possible to enhance the overall understanding of delirium, particularly given that some of the known risk factors are more strongly associated with certain types of delirium. Identifying risk factors according to the type of delirium can facilitate the planning of proactive interventions based on risk factors. Furthermore, it can serve as a valuable resource for the development of tools for predicting different types of delirium to provide more tailored and evidence-based care for patients with delirium. No patient or public contribution.

Causal Association Between Genetically Predicted Ankle Spacing Width and Risk of Age-Related Bone Mineral Density

While observational studies suggest associations between ankle spacing width (ASW, defined as the horizontal distance between the medial malleoli under weight-bearing conditions) and osteoporosis (OP), fractures, and falls, causal evidence remains limited. This gap hinders the translation of ASW measurements into clinical risk stratification tools. This study aimed to investigate the causal relationships between ASW indicators and site-/age-specific bone mineral density (BMD), bone fracture and fall risks. Genetic exposure data for ASW indicators were retrieved from the MRC-IEU datasets, and the outcome data were all derived from the Genetic Factors for Osteoporosis Consortium (GEFO). Genome-wide associations of single nucleotides polymorphisms (SNPs) were served as instrumental variables (IVs) to infer causal effects using two-sample mendelian randomization (TSMR) and multivariable mendelian randomization (MVMR) analyses. The results of sites-specific TSMR analysis revealed that per unit increase in ASW (including left and right) were causally associated with lower estimated from quantitative heel ultrasounds BMD (eBMD, reflecting calcaneal bone density) and total-body BMD (TB-BMD, assessed via DEXA scans), with pronounced effects in individuals aged over 60 years. Age-stratified analyses revealed no significant associations between ASW and TB-BMD in younger age groups (age ≤ 15, 15 < age ≤ 30, 30 < age ≤ 45, 45 < age ≤ 60) or site-specific fractures/falls. MVMR adjustment for BMI, smoking, and alcohol consumption confirmed persistent causal associations between ASW and reduced eBMD and TB-BMD, particularly for TB-BMD in individuals aged over 60 years. Our study provides evidence that genetically predicted ASW is associated with reduced eBMD and TB-BMD, and a causal association between ASW and TB-BMD (aged over 60), suggesting ASW as a potential auxiliary biomarker for monitoring age-dependent bone loss.

Examination of body image perception and quality of life of women with segmental or total mastectomy: a cross-sectional study

BackgroundBreast cancer is the most common type of cancer in women, and it has severe effects on quality and duration of life. The aim of this study was to examine the body image perception and quality of life of women who underwent segmental or total mastectomy.MethodsThe study was conducted in a city hospital in southern Turkey and included 170 participants. Data were collected using a patient identification form, a breast cancer body image scale, and a breast cancer specific quality of life scale (versions C30 and BR23). SPSS v.25.0 was used in the analysis. The study adhered to the Strengthening Reporting of Observational Studies in Epidemiology (STROBE) guidelines.ResultsWhile there was a negative relationship between women’s general health (such as pain, nausea, vomiting, and fatigue) (p < 0.001, r=-0.503) and social function (such as maintaining family life, engaging in social activities, and financial difficulties) (p < 0.001, r=-0.487) and their body image perceptions, there was a positive relationship between increased body functions (such as walking, carrying, and bathing) and their body image perceptions. This study showed that mastectomy type was associated with body image perception (p < 0.001. η²=0.105) and general health (p < 0.001, η²=0.121). Both have a moderate effect size according to the eta squared coefficient.ConclusionIn this study, women who had undergone total mastectomy had a more negative body image perception than those who had undergone segmental mastectomy. Women who underwent segmental mastectomy had better general health status and higher quality of life and functioning levels. Current data have indicates that body image perception has a direct relationship with general health and quality of life. The results of this study highlight the importance of developing personalised care plans and providing psychosocial support to women after mastectomy.Clinical trial numberNot applicable.

Effect of Inhaled Volatile and IV Anesthetics on Biological Markers of Inflammation in Adult ICU and Thoracic Surgical Patients: A Systematic Review and Meta-Analysis.

Inhaled anesthetics may reduce alveolar and systemic inflammation in surgical and critically ill patients. This study aimed to perform a systematic review and meta-analysis comparing the effect of inhaled volatile and IV anesthetics on alveolar and plasma cytokines in patients with surgical or medical acute lung injury. Medline, Embase, and Cochrane CENTRAL databases from 2000 to July 2021. Randomized control trials, prospective, and retrospective observational studies comparing inhaled volatile to IV anesthetics in ventilated adult patients with acute lung injury from lung resection or critical illness. A systematic review and meta-analysis was performed. Primary outcome was alveolar inflammatory cytokines levels that were meta-analyzed using a random effects model. Secondary outcomes were plasma inflammatory cytokine levels, mortality, pulmonary complications, and duration of hospital and ICU stay. The quality of studies was assessed using the Cochrane Risk of Bias tool for randomized control trials and the Cochrane Risk Of Bias In Non-randomized Studies of Interventions tool for retrospective cohort studies. From 2522 screened studies, 28 (27 thoracic surgery and 1 ICU, n = 4175) were included. Meta-analysis of patients undergoing lung resection demonstrated lower levels of alveolar tumor necrosis factor-alpha (TNF-α) (standard mean difference 1.04; 95% CI, 0.32-1.77; p < 0.01; I2 82%) and interleukin (IL)-6 (0.64; 95% CI, 0.52-0.75; I2 0%; p < 0.01) at 1-2 hours in the inhaled anesthesia group, with no difference in other cytokines at various time points. The single ICU study demonstrated lower plasma TNF-α and IL-6 and alveolar TNF-α, IL-6, and IL-8 at 48 hours in patients sedated with sevoflurane compared with midazolam. Clinical outcomes were infrequently reported. Limited evidence suggests that inhaled anesthesia may reduce proinflammatory cytokines TNF-α and IL-6 during lung resection and critical illness. Further studies are needed to clarify its effects on biological markers and clinical outcomes.

Omega-3 Polyunsaturated Fatty Acids and Adipose Tissue Inflammation in Humans: A Scoping Review.

Adipose tissue (AT) inflammation is a topic of increasing interest given its role in initiating systemic subclinical inflammation. Evidence from preclinical studies suggests that n-3 polyunsaturated fatty acids (PUFAs) may ameliorate AT inflammation through various pathways. However, fewer data are available from humans, and existing studies are heterogeneous in design and findings. The objective of this scoping review was to identify, review, and map the current literature on the relationship between n-3 PUFAs and AT inflammation in healthy humans. MEDLINE, EMBASE, and Cochrane databases were searched from inception to August 4, 2022. Eligible studies included experimental trials and observational studies, enrolling nonpregnant adult study populations free of diagnosed chronic/infectious diseases. Screening and data extraction were performed on study characteristics. Overall, the 25 retained studies were heterogeneous in study design, intervention formulation/exposure assessment, comparator, study duration, and methods used to characterize AT inflammation. Most experimental trials used EPA+DHA [eicosapentaenoic acid (EPA, 20:5n-3) and docosapentaenoic acid (DPA, 22:5n-3)] supplementation and measured circulating adiponectin and leptin to characterize AT inflammation. A wide range of comparators were employed, including saturated/unsaturated oils, ketogenic diets, and n-6 PUFAs. All observational studies reported a significant association with ≥1 of their primary outcomes, while 15 of 20 experimental trials documented a significant effect of n-3 supplementation on ≥1 outcomes. Existing human literature on n-3 PUFAs and AT inflammation is inconclusive due to the limited number of studies available and their heterogeneous designs. Therefore, larger, longer-term longitudinal studies and experimental trials using AT biopsy measures or validated AT-specific biomarkers are needed. Registration: Open Science Framework (https://doi.org/10.17605/OSF.IO/29WGQ).

Association between periodontal disease and Alzheimer's disease: umbrella review

BackgroundAlzheimer's disease (AD) and periodontal disease (PD) are both chronic conditions with rising global prevalence. Emerging research suggests a possible link between PD-induced systemic inflammation and neurodegeneration observed in AD.ObjectiveEmploy an umbrella review to look into the association between periodontal disease and Alzheimer's disease.Materials and methodsA comprehensive search was conducted until March 2025 across various electronic databases, including: PubMed, Cochrane Library, Scopus, SciELO, Web of Science, Google Scholar, ProQuest, and OpenGrey, and Dissertations and Theses. There were no time or language restrictions on the inclusion of systematic reviews (SR), with or without meta-analysis, as long as they looked at primary research that connected PD and AD. The following were excluded: preclinical and fundamental research, summaries, comments, case reports, protocols, personal opinions, letters, posters, literary or narrative reviews, fast reviews, intervention studies, and observational studies. The quality and general confidence of the included studies were evaluated using the AMSTAR-2 technique.ResultsA total of 358 items were found following the first search. 16 articles were left for additional review after the selection criteria were applied. With odds ratios (OR) and risk ratios (RR) ranging from 1.67 to 2.17 and 1.11 to 2.26, respectively, 14 studies showed a correlation between PD and AD.ConclusionsDrawing from the findings and conclusions of the SR demonstrating a high overall confidence, it's established that PD and tooth loss exhibit an association with AD.Systematic Review RegistrationRegistered in the Open Science Framework (OSF): DOI 10.17605/OSF.IO/GS367.

Physical Activity before and during Pregnancy in Relation to Delivery, Neonatal, and Child Health Outcomes: A Meta-Analysis of Observational Studies with Meta-Regression.

An increasing number of observational studies suggest that physical activity (PA) before or during pregnancy may reduce the risks of adverse delivery, neonatal, and child health outcomes, but the results remain conflicted and inconclusive. Many pregnant women fail to follow PA guidelines, suggesting that there must be a synthesis of real-world evidence. To examine the influence of PA before and during pregnancy on delivery, neonatal, and child health outcomes. Ten electronic databases have been searched until December 17, 2024. All types of observational studies were included, except for case studies and reviews, as long as they had data on women before or during pregnancy, looked at physical activity (either measured or reported), compared it to low or no physical activity, and examined outcomes related to birth (like preterm birth, low birth weight, cesarean section, small-for-gestational-age, larger-for-gestational-age, macrosomia) and child health (like BMI-z score, overweight, body fat mass, and cognitive development). We included 79 observational studies (N = 371,046). 'Low' to 'very low' certainty evidence revealed that compared with low levels of PA, high levels of PA before and during pregnancy were associated with a 13-25% reduction in the odds of having a preterm delivery (before pregnancy: odds ratio (OR): 0.87, 95% confidence interval (CI): 0.79 to 0.97; I2 = 0%; during pregnancy: OR 0.75, 95% CI: 0.68 to 0.82; I2 = 84%). High levels of PA during pregnancy were also associated with reduced odds of having a cesarean section (OR: 0.73, 95% CI: 0.62 to 0.87; I2 = 89%). Other outcomes were not associated with PA. To achieve at least a 10% reduction in the odds of preterm birth, pregnant women need to accumulate at least 216 MET mins/week of leisure time physical activity. Observational evidence suggests that higher physical activity levels before and during pregnancy may be associated with improved birth outcomes.