Forest Plots Research Articles

Overweight and obesity significantly increase colorectal cancer risk: a meta-analysis of 66 studies revealing a 25-57% elevation in risk.

The incidence of colorectal cancer (CRC) has been steadily rising, and obesity has been identified as a significant risk factor. Numerous studies suggest a strong correlation between excess body weight and increased risk of CRC, but comprehensive quantification through pooled analysis remains limited. This study aims to systematically review and meta-analyze the existing literature to evaluate the association between obesity and CRC risk, considering variations across sex and study designs. A systematic literature search was conducted in PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science to identify randomized controlled trials and human clinical trials from 1992 to 2024. Statistical analysis was performed using the https://metaanalysisonline.com web application using a random effects model to estimate the pooled hazard rates (HR). Forest plots, funnel plots, and Z-score plots were utilized to visualize results. We identified 52 clinical trials and 14 case-control studies, encompassing a total of 83,251,050 and 236,877 subjects, respectively. The pooled analysis indicated that obesity significantly increased the prevalence of CRC (HR = 1.36, 95% CI = 1.24-1.48, p < 0.01). This effect was consistent across sexes, with HRs of 1.57 (95% CI = 1.38-1.78, p = 0.01) for males and 1.25 (95% CI = 1.14-1.38, p < 0.01) for females. Case-control studies specifically showed an effect, but with marginal significance only (HR = 1.27, 95% CI = 0.98-1.65, p = 0.07). The Z-score plot indicated the need for additional analysis in the case-control group. A significant heterogeneity was observed across studies in all four settings. This meta-analysis provides robust evidence that obesity is a significant risk factor for colorectal cancer, with an overall hazard rate indicating a 36% increased risk. The effect is pronounced across both sexes, with males showing a slightly higher risk compared to females. Although case-control studies showed a weaker association, the overall trend supports the link between obesity and CRC. These results underscore the importance of public health interventions aimed at reducing obesity to potentially lower the risk of colorectal cancer.

Different peripheral nerve blocks for patients undergoing total knee arthroplasty: a network meta-analysis of randomized controlled trials.

To comprehensively compare the effect of different peripheral nerve blocks for patients undergoing total knee arthroplasty (TKA). PubMed, Embase, Cochrane Library, and Web of Science were comprehensively searched. The outcomes included postoperative pain, postoperative function, adverse events, oral morphine equivalent (OME), and perioperative indicators. Network plots, forest plots, league tables and rank probabilities were drawn for all outcomes. Totally 30 studies were included. For postoperative pain, continuous adductor canal block (cACB) + genicular nerve block (GNB) was most likely to be the most effective block regarding rest pain score at 24h; cACB + GNB was most likely to result in the lowest rest pain score at 48h; patients undergoing cACB + infiltration between the popliteal artery and the capsule of the knee (IPACK) + GNB was most likely to have the lowest motion pain score at 24h; patients undergoing cACB + GNB was most likely to have the lowest motion pain score at 48h. For postoperative function, patients undergoing cACB + IPACK + GNB had the highest likelihood to exhibit the shortest time in Timed Up and Go test (TUG); cACB + tibial nerve block (TNB) was most likely to be the most effective block in terms of range of motion (ROM); cACB + IPACK was most likely to be the optimal block concerning the ambulation distance. cACB combined with IPACK/GNB may be the most favorable block after TKA, continuous blocks may be better than single-shot blocks, and combined blocks may be better than separate blocks.

The Proper Calculation of Risk Ratios: How and Why

AbstractA recent article (Joslyn, P. R., &amp; Morris, S. L. in Perspectives on Behavior Science, 47(1), 167–196, 2024) advocates the use of risk ratios, or relative risk, in behavior analysis. The authors present a strong case for the use of risk ratios and how they might improve the science and application of behavior analysis. Unfortunately, their computation of the risk ratio is incorrect and their examples gloss over important nuances in how risk ratios should be used. The present article corrects the calculations, describes how to determine whether a particular risk ratio differs from a reference group, comments on the importance of stability of the data entering the calculation, and demonstrates approaches to presenting them visually, such as Forest plots.

Creating an interactive database for nasopharyngeal carcinoma management: applying machine learning to evaluate metastasis and survival.

Nasopharyngeal carcinoma (NPC) patients frequently present with distant metastasis (DM), which is typically associated with poor prognosis. This study aims to develop and apply machine learning models to predict DM, overall survival (OS), and cancer-specific survival (CSS) in NPC patients to provide optimal tools for improved predictive accuracy and performance. We retrieved over 8,000 NPC patient samples with associated clinical information from the Surveillance, Epidemiology, and End Results (SEER) database. Utilizing two methods for handling missing values-imputation or deletion-we created various cohorts: DM-all, DM-slim, OS-all, OS-slim, CSS-all, and CSS-slim. Five machine learning models were deployed for the binary classification task of DM, and their performance was evaluated using the area under the curve (AUC). For the survival prediction tasks of OS and CSS, we constructed 45 combinations using nine survival machine learning algorithms. The Concordance Index (C-index), 5-year AUC, and Brier score assessed model accuracy. Patients were stratified into two risk groups for survival analysis, and the survival curves were presented. This study examines the relationships between clinical factors and survival in NPC patients. The analysis, visualized through forest plots, indicates that demographic and clinical variables like gender, marital status, tumor grade, and stage significantly affect metastatic risks and survival. Specifically, factors such as advanced stages increase metastasis and survival risks, while enhanced treatments improve survival rates. In the cohort for DM prediction, results revealed that the random forest model was the most effective, with an AUC of 0.687. In contrast, when predicting overall survival (OS), the random survival forest (RSF) model consistently showed superior performance with the highest mean C-index of 0.802, a 5-year AUC of 0.857, and a Brier score of 0.167. Similarly, for cancer-specific survival (CSS) prediction, the RSF model demonstrated a mean C-index of 0.822, a 5-year AUC of 0.884, and a Brier score of 0.165. An online Shiny server was developed to allow the models to be used freely and efficiently via http://npcml.shinyapps.io/NPCpre. This study successfully established an online tool by machine learning models for NPC metastasis and survival prediction, providing valuable references for clinicians.

Phytohormonal balance and differential gene expression in chronically irradiated Scots pine populations from the chernobyl affected zone.

The impact of chronic radiation exposure on phytohormone content and expression of phytohormone- and stress-related genes of Scots pine in the zone affected by the Chernobyl accident was studied. Needle samples were collected from three plots with contrasting levels of radioactive contamination in the Polesye State Radiation-Ecological Reserve, Republic of Belarus, and two reference plots in the Kozeluzhsky forest in June 2022. The experimental plots were located within the artificial plantations of Scots pine established in 1982, before the accident in 1986. The activity of radionuclides 137Cs, 90Sr, 241Am, 238Pu, and 239+240Pu in soil and needles ensured dose rates ranging from 3.3 to 87 mGy × year-1, while at the reference plots, the range was 0.7‒0.8 mGy × year-1. Concentrations of plant hormones, including indole-3-acetic acid (IAA), indole-3-butyric acid (IBA), zeatin, and abscisic acid (ABA) in needles were evaluated using high-performance liquid chromatography (HPLC). We demonstrate that chronic radiation exposure is a significant stress factor that affects both phytohormonal balance and the expression of some important phytohormone- and stress-related genes. We found a tendency toward decreased ABA and auxin concentrations in trees from plots contaminated with radionuclides. The ratio (IAA + IBA + zeatin)/ABA was drastically raised at the most contaminated plots Masany and Kulazhin, reflecting the functional rearrangements of cellular metabolism that ensure plant adaptation under chronic radiation exposure. Changes in gene expression indicated modulation of ABA and Ca2+ signalling pathways, decreased potential of zeatin biosynthesis, and activation of heat shock proteins biosynthesis.

A Functional Assessment of Community Vulnerability to the Loss of Myrtaceae From Myrtle Rust

ABSTRACTAimWoody ecosystems provide critical ecosystem functions and services but are increasingly threatened as invasive pathogens spread globally. Myrtle rust, caused by Austropuccinia psidii, arrived in New Zealand in 2017 and infects at least 12 of 18 species in the susceptible Myrtaceae plant family. Among these are species of structural, successional and cultural importance. We aim to assess whether the functional consequences of Myrtaceae loss could be mitigated if co‐occurring species with shared functional attributes are able to replace them.LocationNew Zealand (but with concepts and methodologies that apply globally).MethodsUsing a nationwide forest and shrubland plot data set, we assessed community vulnerability to the loss of Myrtaceae species by analysing proportional changes in average trait values when they are absent and produced spatial predictions indicating where species loss might have the greatest impact on community functionality. We then assessed whether compensatory infilling by co‐occurring species would mediate community vulnerability.ResultsForests and shrublands containing Kunzea ericoides and Leptospermum scoparium are highly vulnerable to their loss. Areas most vulnerable overall are the central and south‐eastern North Island, north‐eastern South Island and Stewart Island. For all species, compensatory infilling moderated the impact of their loss. However, if co‐occurring Myrtaceae were unable to respond, possibly if they were also infected, community vulnerability almost always increased because infilling species had different functional attributes, compounding the functional impact.Main ConclusionsEarly successional woody plant communities and Myrtaceae‐dominated old‐growth forests are at most risk. Our spatial assessment of species‐level functional impacts from myrtle rust will facilitate better‐informed landscape‐level responses. Management actions and monitoring can now be targeted to areas and communities at greatest risk of losing ecosystem‐level processes.

High beta diversity of gaps contributes to plot-level tree diversity in a tropical forest.

Canopy gaps are widely recognized as being crucial for maintaining the diversity of forest tree communities. But empirical studies have found mixed results because the differences in diversity between individual gaps and non-gaps are often small and statistically undetectable. One overlooked factor, however, is how small individual gap versus non-gap differences may accumulate across sites and potentially have a large effect on forest diversity at the plot scale. Our study investigated sapling richness, density, and composition in 124 treefall gaps, and 200 non-gap sites in the 50-ha tropical forest plot at Barro Colorado Island (BCI), Panama. Additionally, we analyzed species accumulation curves to understand how species richness increases with increasing stem numbers. We observed that sapling richness and density were only slightly higher in gaps 7 years after formation and statistically indistinguishable from non-gaps after 12 years. However, species accumulation curves across multiple gaps were substantially higher than those across non-gaps. Species composition showed small differences between individual gaps and non-gaps but differed significantly between collections of gaps and non-gaps. Specifically, 55 species specialized in 7-year-old gaps compared with 24 in non-gaps; of these, 23 gap-specialized species and zero non-gap species were pioneers. Our results indicate that tree species richness is higher in gaps because of both higher stem density and the presence of gap-specialized species. Our study has finally provided compelling evidence to support the idea that gaps enhance the overall diversity of tropical forest tree communities.

Research Review: Pharmacological and non-pharmacological treatments for adolescents with attention deficit/hyperactivity disorder - a systematic review of the literature.

Attention Deficit/Hyperactivity Disorder (ADHD) demonstrates unique developmental manifestations in adolescence with implications for optimized, age-appropriate treatment. This 10-year update is the third in a series of systematic reviews examining the efficacy and safety of adolescent ADHD treatments. We broadly examined efficacy on ADHD symptoms, impairments, and other reported outcomes. Acute and long-term efficacy, and treatment moderators, were considered. We performed PubMed, EMBASE, and PsycINFO searches for articles published or in press from 2013 to 2024, integrated with hand search and randomized controlled trials (RCTs) identified in this series' earlier reviews. RCTs examining the safety or efficacy of interventions delivered to adolescents (ages 10.0-19.9) with a diagnosis of ADHD were included. Study characteristics were extracted and reviewed, quality of evidence was assessed using GRADE, and effect sizes were calculated for individual studies and illustrated using forest plots. Sixty-three RCTs were identified. Quality of evidence ranged from high (medication; k = 29) to very low (nutrient supplementation, neurofeedback, occupational therapy; k = 1 each). Medications demonstrated consistent strong impact on ADHD symptoms and inconsistent impact on impairment. Diverse cognitive/behavioral treatments (C/BTs) demonstrated inconsistent impact on ADHD symptoms but strong and consistent impact on impairment and executive function skills, plus moderate benefits on internalizing symptoms. No interventions demonstrated significant safety concerns. Long-term maintenance (up to 3 years post-treatment) was demonstrated for C/BTs, though moderate quality of evidence was noted because participants cannot be fully blinded to receipt of treatment. The effects of C/BTs and medication appear complementary, not duplicative. Combining medication and C/BT is advised at treatment outset to maximize engagement, maintenance, and response breadth (i.e. improving both ADHD symptoms/cognitive performance and coping skills/functional impairments). Engagement strategies (e.g. motivational interviewing) may facilitate uptake. Novel treatments do not yet demonstrate effects on ADHD symptoms or impairments in adolescents but remain a promising area for research.

Exploration in association between vitamin D, sleep quality, and osteoarthritis: A modeling study.

Previous studies on the relationship between vitamin D, sleep quality, and osteoarthritis (OA) have been controversial and the aim of this study is to analyze the association. In this study, relevant data from 2 survey cycles (2009-2010 with 2011-2012) are downloaded from the CDC's NHANES project to analyze the relationship between vitamin D, sleep quality, and osteoarthritis, as well as other related risk factors. The analysis of statistics in this study is performed using t-tests and chi-square tests, modeling is performed using logistic regression based on NHANES weights, and other risk factors are analyzed using forest plots. In association models between serum vitamin D, sleep quality, and OA is statistically significant during the stepwise inclusion of covariates. In model 1, Q3 (OR = 1.83; 95% CI: 1.05, 3.23) and Q4 (OR = 2.22; 95% CI: 1.27, 3.94) are significant. Neither model 2 nor model 3 is statistically significant and P for trend is more than .05 in all 3 models. After the inclusion of all covariates, forest plot showed that sleep deprivation (OR = 1.64; 95% CI: 1.05, 2.56), advanced age (OR = 1.03; 95% CI: 1.01, 1.04), female (OR = 1.79; 95% CI: 1.14, 2.85), overweight (25 ≤ BMI < 30) (OR = 1.92; 95% CI: 1.05, 3.61), and obesity (≥30) (OR = 2.06; 95% CI: 1.11, 3.93) are risk factors for OA. This study is based on a larger sample and a stepwise logistic regression of multiple covariates. We concluded that vitamin D may not influence OA. However other risk factors for OA are confirmed, including advanced age, female and high BMI, especially bad sleep quality.

The liver fibrosis-8 index is a predictor for all-cause mortality in cardiovascular disease patients: A cohort study.

Participants with cardiovascular diseases (CVD) often exhibit liver function abnormalities, hepatic fibrosis and cirrhosis. The extent of liver fibrosis is closely related to the prognosis of CVD. However, the association between the liver fibrosis-8 (FIB-8) index, a marker of liver fibrosis, and all-cause mortality in CVD participants remains unclear. This study aims to investigate the relationship between the FIB-8 index and all-cause mortality among individuals with CVD. A total of 1727 CVD American participants were enrolled from the National Health and Nutrition Examination Survey (NHANES) spanning from 1999 to 2018. Initially, we constructed weighted COX regression models and performed sensitivity analyses to examine the correlation between the FIB-8 index and all-cause mortality in CVD participants. Subsequently, we employed restricted cubic spline (RCS) to visualize their linear relationship. Finally, the stratified analyses and interaction tests of covariates were performed and presented in the forest plot. A total of 1727 participants were included in our study, with a mean age of 61.68 ± 0.47 years, with men accounting for 59.19%. After adjustment for relevant covariables, weighted COX regression models indicated that the hazard ratio (HR) and 95% confidence interval (95% CI) for the association between the FIB-8 index and all-cause mortality in CVD participants was 1.21 (1.12, 1.30). Sensitivity analysis was then conducted, revealing that the results remained stable. In fully adjusted model, individuals in quartiles 3 and 4 demonstrated significant statistical differences compared to the lowest FIB-8 index quartile, with HR (95% CI) values of 1.88 (1.23, 2.87) and 2.17 (1.33, 3.53), respectively. Subsequently, RCS showed a linear relationship between the FIB-8 index and all-cause mortality among CVD participants. Finally, the interaction test revealed that no other covariables had significant interactions with the FIB-8 index in this study. A positive and linear correlation was observed between the FIB-8 index and all-cause mortality among CVD adult participants in NHANES from 1999 to 2018. Our findings indicated that the FIB-8 index could serve as an excellent indicator for assessing all-cause mortality within the CVD population. The lower the FIB-8 index, the lower the all-cause mortality among CVD participants.

Effects of bamboo invasion on forest structures and diameter–height allometries

Forest structure is fundamental in determining ecosystem function, yet the impact of bamboo invasion on these structural characteristics remains unclear. We investigated 219 invasion transects at 41 sites across the distribution areas of Moso bamboo (Phyllostachys edulis) in China to explore the effects of bamboo invasion on forest structural attributes and diameter–height allometries by comparing paired plots of bamboo, mixed bamboo-tree, and non-bamboo forests along the transects. We found that bamboo invasion decreased the mean and maximum diameter at breast height, maximum height, and total basal area, but increased the mean height, stem density, and scaling exponent for stands. Bamboo also had a higher scaling exponent than tree, particularly in mixed forests, suggesting a greater allocation of biomass to height growth. As invasion intensity increased, bamboo allometry became more plastic and decreased significantly, whereas tree allometry was indirectly promoted by increasing stem density. Additionally, a humid climate may favour the scaling exponents for both bamboo and tree, with only minor contributions from topsoil moisture and nitrogen content. The inherent superiority of diameter–height allometry allows bamboo to outcompete tree and contributes to its invasive success. Our findings provide a theoretical basis for understanding the causes and consequences of bamboo invasion.

The impact of hepatitis B surface antigen seroconversion on the durability of functional cure induced by pegylated interferon alpha treatment

BackgroundHepatitis B surface antigen (HBsAg) loss is regarded as a pivotal criterion for assessing functional cure in patients diagnosed chronic hepatitis B (CHB). We conducted the research to investigate the real-world performance of HBsAg seroconversion in sustaining HBsAg loss.MethodsThis retrospective analysis confirmed 295 patients who attained HBsAg loss through combination therapy involving nucleos(t)ide analogues (NAs) and pegylated interferon alpha (peg-IFNα). Employing Kaplan–Meier estimates method to conduct survival analysis. The forest plot was used to visualize the results of multivariate Cox regression, and selected variables were included in the nomogram.ResultsHBsAg seroreversion was observed in 45 patients during follow-up periods, with a lower recurrence risk in patients with HBsAg seroconversion at the end of peg-IFNα therapy (EOT) (10.3% vs 37.3% at 96-week, P < 0.0001). Moreover, the sustainability of hepatitis B surface antibody (anti-HBs) in participants continuing therapy after HBsAg seroconversion was superior to those discontinued prematurely (72.5% vs 54.5% at 96 weeks, P = 0.012). Additionally, the former group was also relatively less likely to experience HBsAg reversion during long-term observation (8.4% vs 14.3% at 96 weeks, P = 0.280). Hepatitis B envelope antigen (HBeAg) status, anti-HBs status and consolidation treatment screened by multivariable analysis were utilized to construct a predictive model for HBsAg reversion. The concordance index(C-index = 0.77) and calibration plots indicated satisfactory discrimination and consistency of nomogram.ConclusionsHBsAg seroconversion was beneficial for sustaining functional cure in patients treated with peg-IFNα. Continuing consolidation therapy after HBsAg seroconversion also contributed to maintain HBsAg seroconversion and improve the durability of HBsAg loss. The nomogram illustrated its efficacy as a valuable instrument in showcasing survival probability of functional cure.

Monitoring the rewilding of the Brazilian Atlantic Forest on tree and mammal diversity: From a biodiversity hotspot to a biodiversity hopespot

The implementation of rewilding initiatives is crucial for biodiversity recovery, particularly in biodiversity hotspots such as the Brazilian Atlantic Forest. Long-term monitoring of rewilding initiatives is critical for assessing progress and informing management choices. This study assesses the efficiency of different reforestation practices for biodiversity recovery, including passive restoration, active reforestation with different native seedlings, and plantations of exotic species. We applied an ecosystem approach to estimate the tree and mammal diversity, collected through forest plots and camera traps. We selected differently managed areas and included the oldest forest patches as reference points for the assessment of biodiversity; a naturally disturbed montane forest in the area was included as a control category for the disturbance analysis. Moreover, we investigated the influence of ecological variables, such as biodiversity, aboveground biomass, and altitude, on rewilding processes. Our results suggest that Eucalyptus plantations, a simplified ecosystem made up of monocultures of exotic species, support lower biodiversity. On the contrary, active reforestation with different native species resulted in an ecological status comparable to naturally regrown secondary forests. We show that active reforestation can reduce the time required for rewilding. We also found a positive correlation between tree and mammal species richness. These results underscore the importance and potential of responsible restoration efforts in recovering local biodiversity, contributing to the vision of a future where the Brazilian Atlantic Forest can be acknowledged not only as a biodiversity hotspot but also as a “hopespot.”

The prognostic value of myosteatosis in pancreatic cancer: A systematic review and meta-analysis

Background and aimsThe phenomenon of myosteatosis, characterized by the accumulation of ectopic fat within and surrounding skeletal muscle, has been identified as a potential adverse factor in the prognosis of individuals with cancer. This systematic review and meta-analysis sought to examine the association between myosteatosis and survival rates as well as postoperative complications in patients diagnosed with pancreatic cancer (PC). MethodsA systematic search was conducted on Web of Science, Embase, and Pubmed until March 25, 2024, to identify pertinent articles assessing the prognostic significance of myosteatosis in patients with PC, utilizing the search terms: myosteatosis, PC, and prognosis. The selected studies were utilized to investigate the prognostic impact of myosteatosis on the survival of PC patients. Forest plots and pooled effects models were employed to present the findings of this meta-analysis. The quality of the included studies was evaluated using the Newcastle-Ottawa Scale (NOS). A total of 565 studies were initially identified from the three databases, with 14 retrospective cohort studies ultimately included in the final quantitative analysis. ResultsThe meta-analysis revealed a significant association between myosteatosis and both overall survival (OS) [Hazard Ratio (HR): 1.55, 95% Confidence Interval (CI): 1.40-1.72, P < 0.001, I2=0.0%] and recurrence-free survival (RFS) (HR 1.48, 95% CI: 1.17-1.86, P = 0.001, I2=0.0%) in patients diagnosed with PC. Subgroup analyses revealed that myosteatosis continued to be a negative prognostic factor in PC across various treatment modalities, patient populations, and myosteatosis assessment methods. Additionally, myosteatosis was identified as a risk factor for postoperative complications, with a pooled odds ratio of 2.20 (95% CI: 1.45-3.35, P < 0.001, I2=37.5%). All included studies achieved NOS scores of 6 or higher, indicating a relatively high level of methodological quality. ConclusionThese results suggest that myosteatosis is significantly associated with both survival outcomes and postoperative complications in patients with PC.

Effects of dyadic interventions on psychological outcomes among cancer patients with non-active treatment: a systematic review and meta-analysis.

Cancer and its treatment can generate substantial psychological distress (depression and anxiety). The objective of this systematic review and meta-analysis is to explore the effectiveness of dyadic interventions on psychological outcomes in cancer patients with non-active treatment and to test subgroup analyses to explore the source of heterogeneity affecting effect sizes. Systematic searching across eight databases identified studies related to dyadic interventions for psychological outcomes of cancer patients published between 2007 and 2022. Rigorous inclusion and exclusion criteria were utilized. Random-effects models were used to compute effect sizes with Hedge's g, forest plot, and Q and I2 statistics to measure heterogeneity. Moderator analyses were examined. Eleven primary studies were identified (938 patients with cancer, 56.14 ± 7.29years old). Overall, dyadic interventions significantly improved depression (g = .36, 95% confidence interval .026 to .68, I2 = 76%) and anxiety (g = .29, 95% confidence interval 0.14 to .45, I2 = 0%) compared to controls. With subgroup analyses, fidelity of dyadic interventions, number of weeks across intervention, and number of days after intervention measured were moderators affecting effect sizes. Dyadic interventions appear to be effective among adults with cancer with non-active treatment. Additional research is needed to explore the efficacy of dyadic interventions among more diverse samples and to examine routes for integrating dyadic interventions into practice. IMPLICATIONS FORCANCER SURVIVORS: Adult with cancer might participate in the dyadic intervention for improving psychological outcomes.

The Prevalence of Amputation in Regional Asia due to Diabetic Foot Ulcers 2024: A Systematic Review and Meta-analysis

Background: Over the past decade, the prevalence of diabetic foot ulcers (DFUs) has notably increased, posing a significant risk of foot amputation in individuals with diabetes. Purpose: This systematic review and meta-analysis aimed to determine the rates of amputation associated with DFUs in patients with diabetes mellitus. Methods: A comprehensive literature search was conducted across multiple databases, including Scopus, PubMed, Cochrane, Web of Science, DOAJ, and Google Scholar. Full-text articles related to diabetic foot ulcer amputation were reviewed and extracted for analysis. Publication Bias: Assessed using a funnel plot in Jamovi (2.0.0), indicating a likelihood of publication bias. Meta-analysis Summary: Conducted using the Joanna Briggs Institute methodology, yielding a pooled meta-analysis result of 0.027. Odds Ratio (OR): Calculated for amputation risk in DFU patients, with a 95% Confidence Interval (CI). Random Effects Model: Employed to synthesize relevant outcomes. Heterogeneity: Evaluated using the I² statistic. Forest Plots: Generated to visualize study results. Results: Eighteen studies were included in the meta-analysis, encompassing a total of 7115 DFU patients in the Asian region. Among these patients, 2730 underwent foot amputations. Amputation Rate: The incidence of foot amputation was significantly higher among DFU patients. Pooled Odds Ratio: The OR for foot amputation in DFU patients was 0.34 (95% CI: 0.23-0.46). Publication Bias: The asymmetrical funnel plot suggested a high likelihood of publication bias. Conclusion: The presence of DFUs significantly elevates the risk of foot amputation in diabetic patients. Continuous monitoring and preventive strategies are essential to mitigate this risk, particularly in the Asian population.

Combining multiple feature selection methods and structural equation modelling for exploring factors affecting stand biomass of natural coniferous-broad leaved mixed forests

Recognition of biotic and abiotic factors affecting biomass of natural mixed forests is of great importance for forest carbon estimation and management. When estimating stand biomass using models, different variable selection methods often yield inconsistent results, and there is lack of systematic analysis. This study aimed to combine multiple feature selection methods with structural equation modelling (SEM) to identify a set of variables affecting stand biomass more reasonably. Eight methods were applied for feature selection based on data from 286 permanent sample plots in natural coniferous-broad leaved mixed forests in northeast China. These methods included Pearson correlation analysis, two methods derived from principal component analysis (PCA), stepwise regression, redundancy analysis (RDA), generalized additive model (GAM), random forest (RF), and boosted regression tree (BRT). A total of 56 candidate variables were considered, covering stand, biodiversity, climate and soil features. Significant variability was observed in the variables selected, however, there were 6 variables consistently identified across all methods, including tree species diversity (N_Sp_Div), stand structural diversity (N_ Size_ Div), nearest taxon index (NRI), community weighted mean based on dry matter mass of leaves (CWM.LDMC), soil pH, and degree-days above 18 °C (DD18). Then, these variables were included in the SEM with stand average age and additive stand density index (aSDI) to explore the direction and magnitude of their impacts on stand biomass. The SEM results showed that aSDI and average age had the greatest positive effects on stand biomass, and structural diversity also had a significant positive effect. DD18 affected stand biomass both directly and indirectly, with the total negative effect. Soil pH indirectly affected stand biomass via aSDI. Our findings demonstrated that combining multiple feature selection methods with SEM was an effective approach for understanding multiple factors affecting stand biomass, and provided valuable insights for forest biomass estimation and carbon management.

Bryophytes in managed lowland forests of Slovakia (Central Europe): looking into species diversity across different forest types

AbstractThe majority of the woodland area in Central Europe is composed of managed forests. Although the species diversity and composition, particularly in older forests, may be similar to those of natural or close-to-nature forests, intensive forestry and other human activities have adverse impacts on biodiversity. The present study focused on bryophyte diversity in managed lowland forests, as these have received less attention compared to other types of forests. Our research targeted the area located within the Borská nížina Lowland in south-western Slovakia. In total, 37 forest sampling plots (SPs) were selected, representing five different forest types, namely Quercus, Fraxinus, Robinia, Pinus, and mixed forests. Multivariate statistical analyses were conducted across these forest types to demonstrate variations in bryophyte species richness, composition, and functional traits. Overall, 60 species of bryophytes were identified, of which five were liverworts and 55 were mosses. Epiphytes were the most abundant substrate group in deciduous and mixed stands, while epigeic species prevailed in Pinus forests. Considering environmental factors, the bryophyte diversity was influenced mostly by the forest type and area size of SPs. Clear differences in species composition were observed when comparing coniferous and deciduous stands, as well as non-native Robinia forests and native tree stands. Overall, intensive forest management results in a high concentration of hemerophilous and nitrophilous species, along with the absence of rare and threatened mosses and liverworts. Nevertheless, by adhering to proper management methods, even managed forests can provide suitable habitats for various bryophytes.

Effects of active vitamin D analogs and calcimimetic agents on PTH and bone mineral biomarkers in hemodialysis patients with SHPT: a network meta-analysis.

Active vitamin D analogs and calcimimetic agents are primary drugs for patients with secondary hyperparathyroidism. Due to the different pharmacological mechanisms, they have different effects on the level of parathyroid hormone, serum calcium, phosphorus, and bone turnover biomarkers. This study aimed to evaluate the active vitamin D analogs and calcimimetic agents in hemodialysis patients with secondary hyperparathyroidism. We included randomized clinical trials of hemodialysis patients with secondary hyperparathyroidism, comparing active vitamin D analogs to calcimimetic agents or placebo/control. The primary outcome was the change of PTH level from baseline to end-up. The secondary outcome was the change in serum calcium, phosphorus, calcium-phosphorus product, and bone turnover biomarkers. A network meta-analysis method was applied to complete this study. The forest plots reflected statistical differences in the outcomes between active vitamin D analogs and calcimimetic agents. The SUCRA result presented the ranking of impact on the outcomes. Twenty-one randomized clinical trials with 4653 patients were included in this network meta-analysis. Global and splitting-node inconsistencies provided no evidence of inconsistency in this study. There was no statistical difference between two active vitamin D analogs and three calcimimetic agents in the PTH, and phosphorus levels changed. Considering serum calcium level, compared with placebo, calcitriol (9.73, 3.09 to 16.38) and paricalcitol (9.74, 3.87 to 15.60) increase serum calcium. However, cinacalcet (- 1.94, - 3.72 to - 0.15) and etelcalcetide (- 7.80, - 11.80 to - 3.80) reduced the serum calcium, even a joint use of cinacalcet with active vitamin D analogs (- 5.83, - 9.73 to - 1.93). Three calcimimetic agents decreased calcium levels much more than calcitriol and paricalcitol. The same type of drugs was not distinct, with each one affecting the change in calcium level. Cinacalcet reduced calcium-phosphorus product much more than paricalcitol (- 3.66, - 6.72 to - 0.60). Evocalcet decreased calcium-phosphorus product more than cinacalcet (- 5.64, - 8.91 to - 2.37), calcitriol (- 9.36, - 14.81 to - 3.92), and paricalcitol (- 9.30, - 13.78 to - 4.82). Compared with paricalcitol, cinacalcet significantly increases the level of ALP (24.50, 23.05 to 25.95) and bALP (0.67, 0.03 to 1.31). The incidence of gastrointestinal disorders in cinacacet (29.35, 1.71 to 504.98) and etelcalcetide (20.92, 1.20 to 365.68) was notably higher than in paricalcitol. Etelcalcetide (0.71, 0.53 to 0.96) and evocalcet (0.46, 0.33 to 0.64) presented a lower rate of gastrointestinal disorders than cinacalcet. Cinacalcet ranked first in adverse gastrointestinal, nervous, and respiratory reactions. The same kinds of agents perform similar efficacy on the level of PTH, serum calcium, phosphorus, and calcium-phosphorus product. Paricalcitol did not lead to more hypercalcemia than calcitriol. The calcium decrease induced by cinacalcet was not settled even by associating it with active vitamin D analogs. Cinacalcet and evocalcet were superior to calcitriol and paricacitol in reducing calcium-phosphorus product. Calcimimetics induced more gastrointestinal disorders than active vitamin D analogs, especially cinacalcet.

Deoxynivalenol mycotoxin dietary exposure on broiler performance and small intestine health: A comprehensive meta-analysis

The effect of DON mycotoxins on broiler production performance and the small intestine is a critical factor in the health and well-being of broilers. Several studies have been conducted on this topic and have reported varying results and conclusions. Therefore, it is necessary to conduct systematic reviews and meta-analyses to thoroughly examine and draw unique conclusions. In this meta-analysis, we conducted a systematic review of multiple studies on the effects of DON mycotoxins in broilers. The analysis comprised 26 articles from reputable journals, and 14 parameters were identified based on the predetermined criteria. The forest plot results showed that DON treatment significantly reduced the ADFI and ADWG (SMD-1.50, 95 %CI [-1.68, -1.18]; I2= 51 %; p < 0.00001) and affected FCR (SMD 0.95, 95 %CI [ 0.62, 1.28]; I2= 77; p < 0.00001). In addition, it affects the small intestine structure duodenum (SMD -3.46, 95 %CI [-3.88, -3.05]; I2= 48 %; p < 0.00001), Jejunum (SMD -5.35, 95 %CI [-5.86, -4.83]; I2= 62 %; p < 0.00001), Ileum (SMD -2.6, 95 % CI [-3.12, -2.08]; I2= 82 %; p < 0.00001). Furthermore, DON exposure affects immunoglobulin (SMD -1.92, 95 % CI [ -2.39, -1.46]; I2 = 54 %; p < 0.00001) and antioxidant activities (SMD -2.1, 95 % CI [ -2.45, -1.75]; I2= 47 %; p < 0.00001). The overall effect of DON treatment was statistically significant compared with that of the control group. Furthermore, funnel plot analysis for publication bias did not reveal any significant asymmetry in most included studies. The results of this meta-analysis indicate that DON mycotoxins have a significant impact on both production performance and small intestine health and require strategic intervention.