Subgroup Analysis Research Articles

Hyperhomocysteinemia in Chronic Kidney Disease: A Meta-Analysis

Background: Hyperhomocysteinemia, an elevated level of homocysteine in the blood, has been implicated in the progression of chronic kidney disease (CKD). This meta-analysis aims to comprehensively evaluate the association between hyperhomocysteinemia and CKD and its potential impact on clinical outcomes. Methods: This study systematically searched electronic databases (PubMed, Embase, Cochrane Library) for studies published between 2018 and 2024 investigating the relationship between hyperhomocysteinemia and CKD. Studies reporting data on the association between hyperhomocysteinemia and CKD progression, cardiovascular events, or mortality were included. We extracted relevant data and performed a meta-analysis using random-effects models. Results: The meta-analysis included 25 studies comprising 5,672 patients with CKD. Hyperhomocysteinemia was significantly associated with an increased risk of CKD progression (pooled odds ratio [OR] 1.85, 95% confidence interval [CI] 1.52-2.24), cardiovascular events (pooled OR 1.63, 95% CI 1.31-2.02), and all-cause mortality (pooled OR 1.48, 95% CI 1.17-1.87) in CKD patients. Subgroup analyses revealed a consistent association across different CKD stages and etiologies. Conclusion: Hyperhomocysteinemia is an independent risk factor for CKD progression, cardiovascular events, and mortality. Monitoring and managing hyperhomocysteinemia may represent a potential therapeutic target to improve outcomes in CKD patients.

The association between bullying victimization and back pain in young people: a systematic literature review and meta-analysis

Abstract Back pain is a common and recurrent health complaint in adolescence. Psychosocial factors may be associated with the onset and persistence of back pain symptoms. This systematic review aims to determine the association between bullying victimization and back pain in young people. Observational studies that quantified the association between bullying victimization and back pain in participants were included in this systematic review. Estimates of associations and confidence intervals were extracted. A random effects meta-analysis of estimates of association was performed. The quality of evidence was assessed using the Joanna Briggs Institute critical appraisal checklist for analytical cross-sectional studies. Database searches yielded 18,311 citations. Nineteen studies (n = 212,058, 51.4% female) were included in our review. Meta-analysis showed a positive association between bullying victimization and back pain (odds ratio 1.93, confidence interval 1.75-2.13). Subgroup analysis showed no statistically significant effect of sex, age, bullying type, pain type, recall periods, bullying frequency, back pain frequency, risk estimate adjustment, and study critical appraisal rating. All studies were rated at moderate-high risk of bias. Our synthesis of evidence found a weak-moderate association between bullying victimization and back pain in young people. Methodological shortcomings and heterogeneity in the field limit causal inference. Future longitudinal studies are required.

Philadelphia-like B-cell acute lymphoblastic Leukaemia: Disease features and outcomes in the era of immunotherapy.

Philadelphia chromosome (Ph)-like acute lymphoblastic leukaemia (ALL) is a high-risk subtype with a gene expression profile similar to Ph-positive ALL, due to activation of tyrosine kinase signalling. To understand the clinical implications of Ph-like ALL, this single-centre retrospective study evaluates outcomes in 268 adults, largely Hispanic ALL patients treated between 2013 and 2024, with a subgroup analysis of 139 haematopoietic stem cell transplantation (HSCT) patients. ALL subtypes included 68 (25.4%) Ph-like, 89 (33.2%) Ph-positive, and 111 (41.4%) Ph-negative. Ph-like patients were the youngest age at diagnosis (p = 0.007), most likely to have refractory disease (p < 0.001), and least likely to achieve minimal residual disease (MRD) negativity after induction (p = 0.031). Relative to Ph-negative ALL, Ph-like achieved worse event-free survival (EFS) (HR = 1.66; 95% CI 1.12-2.46; p = 0.012), whereas Ph-positive had improved EFS (HR = 0.60; 95% CI 0.38-0.93; p = 0.024) and cumulative incidence of relapse (CIR) (HR = 0.59; 95% CI 0.35-0.99; p = 0.046). Within the transplant subgroup, Ph status did not impact disease-free survival (DFS), CIR, or overall survival (OS). However, patients who received blinatumomab within 1-year pre-HSCT had improved DFS (HR = 0.43; 95% CI 0.20-0.94; p = 0.034) and CIR (HR = 0.26; 95% CI 0.09-0.75; p = 0.13). In conclusion, our data suggest that Ph-like is less likely to respond to standard induction therapy and HSCT may result in similar survival outcomes to Ph-negative ALL.

Association between sleep duration and sleep quality with pre-sarcopenia in the 20–59-year-old population: evidence from the National Health and Nutrition Examination Surveys 2005–2014

BackgroundSarcopenia is a musculoskeletal disease characterized by a significant reduction in muscle mass, strength, and performance. As it mostly affects older adults, it is often recognized as a disease of old age. However, sleep is also closely related to its development. Hence, it becomes critical to explore the relationship between sleep and sarcopenia in populations under 60 years of age to develop strategies for preventing sarcopenia. We here aim to explore the specific association between sleep duration and sleep quality with pre-sarcopenia in the non-elderly population using large population samples.MethodsThis study involved 7,187 participants aged 20–59 years from the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2014. Pre-sarcopenia is defined based on the appendicular skeletal muscle mass (ASM) adjusted for body mass index (BMI). Self-reported sleep duration was categorized into three groups: <6 h (short sleep), 6–8 h (normal sleep), and > 8 h (long sleep). Sleep quality was assessed based on the Sleep Disorder and Trouble Sleeping Questionnaire. Univariate analysis and multivariate logistic regression were used to examine the relationship between sleep duration and sleep quality with pre-sarcopenia.ResultsSleep quality was significantly linked with the risk of pre-sarcopenia (OR 1.72, 95% CI 1.36–2.18, P < 0.01). Longer or shorter sleep duration did not affect the risk of pre-sarcopenia, in contrast to normal sleep duration. Subgroup analysis demonstrated a more pronounced association in individuals who are > 40 years old (P < 0.01), non-Hispanic (P ≤ 0.01), overweight (P < 0.01), have a higher income (P < 0.01), and are more educated (P ≤ 0.01). Moreover, this association was noted in populations with or without smoking (P < 0.01) and alcohol consumption (P < 0.01), hypertension (P < 0.01) and diabetes (P ≤ 0.02).ConclusionSleep quality is associated with an increased risk of pre-sarcopenia, while sleep duration is not in the population aged 20–59 years. Further prospective cohort studies with a large sample size are needed to determine causality and develop effective interventions for preventing sarcopenia in the population aged 20–59 years.

Artificial intelligence methods in diagnosis of retinoblastoma based on fundus imaging: a systematic review and meta-analysis.

Artificial intelligence (AI) algorithms for the detection of retinoblastoma (RB) by fundus image analysis have been proposed as a potentially effective technique to facilitate diagnosis and screening programs. However, doubts remain about the accuracy of the technique, the best type of AI for this situation, and its feasibility for everyday use. Therefore, we performed a systematic review and meta-analysis to evaluate this issue. Following PRISMA 2020 guidelines, a comprehensive search of MEDLINE, Embase,ClinicalTrials.gov and IEEEX databases identified494studies whose titles and abstracts were screened for eligibility. We included diagnostic studies that evaluated the accuracy of AI in identifying retinoblastoma based on fundus imaging. Univariate and bivariate analysis was performed using the random effects model. The study protocol was registered in PROSPERO under CRD42024499221. Six studies with 9902 fundus images were included, of which 5944 (60%) had confirmed RB. Only one dataset used a semi-supervised machine learning (ML) based method, all other studies used supervised ML, three using architectures requiring high computational power and two using more economical models. The pooled analysis of all models showed a sensitivity of 98.2% (95% CI: 0.947-0.994), a specificity of 98.5% (95% CI: 0.916-0.998) and an AUC of 0.986 (95% CI: 0.970-0.989). Subgroup analyses comparing models with high and low computational power showed no significant difference (p=0.824). AI methods showed a high precision in the diagnosis of RB based on fundus images with no significant difference when comparing high and low computational power models, suggesting a viability of their use. Validation and cost-effectiveness studies are needed in different income countries. Subpopulations should also be analyzed, as AI may be useful as an initial screening tool in populations at high risk for RB, serving as a bridge to the pediatric ophthalmologist or ocular oncologist, who are scarce globally. What isknown Retinoblastoma is the most common intraocular cancer in childhood and diagnostic delay is the main factor leading to a poor prognosis. The application of machine learning techniques proposes reliable methods for screening and diagnosis of retinal diseases. What isnew The meta-analysis of the diagnostic accuracy of artificial intelligence methods for diagnosing retinoblastoma based on fundus images showed a sensitivity of 98.2% (95% CI: 0.947-0.994) and a specificity of 98.5% (95% CI: 0.916-0.998). There was no statistically significant difference in the diagnostic accuracy of high and low computational power models. The overall performance of supervised machine learning was best than unsupervised, although few studies were available on the second type.

Folic Acid Supplementation for Blood Pressure Reduction in Hypertension: A Meta-Analysis

Background: Hypertension is a major risk factor for cardiovascular disease. While antihypertensive medications are the cornerstone of treatment, adjunctive therapies like folic acid supplementation have gained attention for their potential to lower blood pressure. This meta-analysis aims to comprehensively assess the impact of folic acid supplementation on blood pressure in hypertensive individuals. Methods: A systematic search of electronic databases (PubMed, Embase, Cochrane Library) was conducted from January 2018 to December 2023 to identify randomized controlled trials (RCTs) evaluating the effect of folic acid supplementation on blood pressure in adults with hypertension. Data on systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were extracted. A random-effects model was used to pool data, and heterogeneity was assessed using the I² statistic. Results: Twenty-three RCTs involving 2,853 hypertensive participants were included. Folic acid supplementation was associated with a significant reduction in SBP (mean difference [MD] -2.93 mmHg, 95% confidence interval [CI] -4.11 to -1.75, p &lt; 0.00001), DBP (MD -1.87 mmHg, 95% CI -2.63 to -1.11, p &lt; 0.00001), and MAP (MD -2.21 mmHg, 95% CI -3.01 to -1.41, p &lt; 0.00001) compared to placebo or control. Subgroup analyses revealed that the blood pressure-lowering effect of folic acid was more pronounced in individuals with low baseline folate levels, those with higher baseline blood pressure, and in studies with longer durations of supplementation. Conclusion: Folic acid supplementation appears to be a safe and effective adjunctive therapy for reducing blood pressure in hypertensive individuals. These findings support the potential role of folic acid in improving cardiovascular outcomes in this population.

Long-term outcomes in rapamycin on renal allograft function: a 30-year follow-up from a single-center experience

ObjectivesTo evaluate long-term renal graft prognosis and the role of rapamycin from a single-center in China over a 30-year follow-up.MethodsThis study enrolled a total of 654 patients who underwent kidney transplantation between 1989 and 2020. The basic characteristics of the included patients were collected. Graft survival was described and compared using Kaplan-Meier curves (K-M curves). Both continuous and categorical variables were included in a multivariate Cox proportional-hazards model. Patients were divided into rapamycin-based quadruple immunosuppression regimen group (rapa group, n = 41) and conventional tacrolimus-based triple immunosuppression regimen group (control group, n = 218). The indication biopsy results of the two groups were further reviewed to compare the incidence of rejection, acute rejection, and banff score.ResultsThe overall 5, 10, 15, 20-year graft survival rate of our center is 87.5%, 62.4%, 46.4% and 20.9%, respectively. The median survival time after surgery is 14 years. Multiple Cox regression analysis identified BMI (p = 0.035), dialysis type (p < 0.001), immunosuppressants (p < 0.01), urine albumen (p < 0.001), globulin (p = 0.041), and blood glucose (p = 0.002) as risk factors. The 20-year, 10-year and 5-year AUC is 0.78, 0.75 and 0.75. The combination of FK506 and rapamycin was further suggested by the model to effectively improve the graft prognosis (p < 0.01, HR = 0.763). The K-M curve showed that the long-term survival rate of renal grafts in the rapa group was significantly better than that in the conventional group (p < 0.001). In addition, indication biopsy records revealed a lower possibility of immune rejection in the rapa group than that in the conventional group (p < 0.001). Banff score indicated that rapa group had less vascular inflammation in the transplanted kidney.ConclusionsIn this study, a 30-year follow-up was performed in a single center, and a total graft 20-year survival rate of 20.9% was reported. The prognostic model and subgroup analysis suggested that FK506 combined with rapamycin could effectively improve the prognosis of renal transplantation, which could be explained by reduced acute rejection and less vascular inflammation.

Atezolizumab Combined With Platinum and Maintenance Niraparib for Recurrent Ovarian Cancer With a Platinum-Free Interval >6 Months: ENGOT-OV41/GEICO 69-O/ANITA Phase III Trial.

To evaluate atezolizumab combined with platinum-based chemotherapy (CT) followed by maintenance niraparib for late-relapsing recurrent ovarian cancer. The multicenter placebo-controlled double-blind randomized phase III ENGOT-OV41/GEICO 69-O/ANITA trial (ClinicalTrials.gov identifier: NCT03598270) enrolled patients with measurable high-grade serous, endometrioid, or undifferentiated recurrent ovarian cancer who had received one or two previous CT lines (most recent including platinum) and had a treatment-free interval since last platinum (TFIp) of >6 months. Patients were stratified by investigator-selected carboplatin doublet, TFIp, BRCA status, and PD-L1 status in de novo biopsy and randomly assigned 1:1 to receive either atezolizumab or placebo throughout standard therapy comprising six cycles of a carboplatin doublet followed (in patients with response/stable disease) by maintenance niraparib until progression. The primary end point was investigator-assessed progression-free survival (PFS) per RECIST v1.1. Between November 2018 and January 2022, 417 patients were randomly assigned (15% BRCA-mutated, 36% PD-L1-positive, 66% TFIp >12 months, 11% previous poly [ADP-ribose] polymerase inhibitor after frontline CT, and 53% previous bevacizumab). Median follow-up was 28.6 months (95% CI, 26.6 to 30.5 months). Atezolizumab did not significantly improve PFS (hazard ratio, 0.89 [95% CI, 0.71 to 1.10]; P = .28). Median PFS was 11.2 months (95% CI, 10.1 to 12.1 months) with atezolizumab versus 10.1 months (95% CI, 9.2 to 11.2 months) with standard therapy. Subgroup analyses generally showed consistent results, including analyses by PD-L1 status. The objective response rate (ORR) was 45% (95% CI, 39 to 52) with atezolizumab and 43% (95% CI, 36 to 49) with standard therapy. The safety profile was as expected from previous experience of these drugs. Combining atezolizumab with CT and maintenance niraparib for late-relapsing recurrent ovarian cancer did not significantly improve PFS or the ORR.

Association of diastolic and systolic blood pressure with depression: a cross-sectional study from NHANES 2005-2018

BackgroundMany studies worldwide have reported the association between mental health and blood pressure, but the results are mixed, and even contradictory. We aim to investigate the relationship between systolic and diastolic blood pressure and depression in the entire US population.MethodsThis study analyzed cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. All adults completed 3-4 blood pressure measurements after sitting quietly for 5 minutes. Depression was diagnosed based on the Patient Health Questionnaire (PHQ-9), with a score ≥10 defined as depression. Weighted logistic regression and restricted cubic splines (RCS) were used to assess the relationship between blood pressure and depression. Two-piecewise linear regression was used to determine the inflection point. Additionally, subgroup analyses and interaction tests were conducted to identify potential subgroups. Finally, two sensitivity analyses were conducted.ResultsA total of 26,581 American adults were included, with a mean age of 47.2 years, of whom 13,354 (49.54%) were male; 2,261 individuals were defined as depressed, with a weighted prevalence of 7.41%. All participants’ mean systolic blood pressure (SBP) was 121.7 mmHg, and the mean diastolic blood pressure (DBP) was 70.9 mmHg. RCS showed a nonlinear association between SBP and depression, while DBP showed a positive linear association with depression. Two-piecewise linear regression showed that the inflection point of the association between SBP and depression was 129.7 mmHg. Weighted logistic regression showed that after fully adjusting for depression-related risk factors, there was a significant positive correlation between per 10 mmHg increase in DBP and depression (OR: 1.06, 95% CI: 1.00-1.12, P=0.04); however, only on the left side of the inflection point, SBP tended to decrease the odds of depression (P =0.09). Furthermore, interaction analysis showed that the association between DBP and depression was significantly stronger in cancer patients (P for interaction=0.02); on the left side of the inflection point (&amp;lt;129.7 mmHg), current smokers also significantly interacted with SBP (P for interaction=0.018). Finally, two sensitivity analyses also supported our findings.ConclusionIn the adult population of the United States, there is a positive linear association between DBP and depression, while the association between SBP and depression exhibits a significant threshold effect, maintaining SBP at 129.7 mmHg is associated with the lowest prevalence of depression.

Assessment of the Effects of Subclinical Hypothyroidism on Male Reproductive Parameters: A Meta-Analysis Approach

Subclinical hypothyroidism (SCH) is a common endocrine disorder that potentially affects reproductive health. Despite its prevalence, the precise relationship between SCH and sperm quality remains unclear. A comprehensive search was conducted across electronic databases to identify relevant studies exploring the association between SCH and sperm quality parameters, covering literature published from January 2000 to January 2024. The standard mean difference (SMD) was used to compute pooled effect estimates with 95% confidence intervals (CIs). Additionally, meta-regression and subgroup analyses were performed to investigate the potential sources of heterogeneity. The meta-analysis included a thorough examination of ten studies comprising 2239 participants. According to the findings of this meta-analysis, SCH significantly affects sperm quality. Specifically, the study suggests a decrease in the volume of seminal fluids (SMD = -0.186; 95% CI: -0.385 to 0.013; P = 0.067), total sperm count (SMD = -0.604; 95% CI: -1.178 to -0.030; P = 0.039), sperm morphology (SMD = -0.784; 95% CI: -1.405 to -0.162; P = 0.013), and progressive motility (SMD = -1.437; 95% CI: -2.147 to -0.727; P &lt; 0.001). However, SCH was also associated with an increase in sperm concentration (SMD = 0.112; 95% CI: -0.058 to 0.281; P = 0.017). Our meta-analysis provides compelling evidence of the adverse effects of SCH on sperm quality parameters. These findings underscore the importance of considering the thyroid function in the assessment and management of male infertility.

Impact of Biologics on Surgery in Chronic Rhinosinusitis with Polyps and Allergic Fungal Sinusitis.

To compare the efficacy of th2-targeted biologic medications (dupilumab, omalizumab, and mepolizumab) on absolute risk reduction (ARR) of functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) and allergic fungal rhinosinusitis (AFRS). The TriNetX Research Network database was queried for each mAb's market lifespan through March 2024. Adults with CRSwNP were propensity score matched against non-mAb controls based on age, sex, race, and asthma diagnosis. The primary outcome was rate of FESS, with secondary outcomes including inpatient admission, emergency department (ED) visit, and incidence of acute sinusitis. Subgroup analysis was performed for patients with AFRS. All mAbs decreased FESS risk (dupilumab, ARR 11.48%, 95% CI 9.82%-13.15%, p < 0.001; omalizumab, ARR 12.02%, 95% CI 4.36%-19.68%, p = 0.002; mepolizumab, ARR 10.32%, 95% CI 5.24%-15.40%, p < 0.001) in CRSwNP patients. Only dupilumab also reduced risk of inpatient admission (ARR 8.59%, 95% CI 7.04%-10.15%, p < 0.001), ED visit (ARR 5.94%, 95% CI 4.28%-7.61%, p < 0.001), and acute sinusitis (ARR 2.60%, 95% CI 1.09%-4.12%, p = 0.001). In AFRS patients, only dupilumab reduced the risk of all outcomes: FESS (ARR 6.97%, 95 CI 2.86%-11.09%, p = 0.001), inpatient admission (ARR 16.93%, 95% CI 11.30%-22.57%, p < 0.001), ED visit (ARR 13.15%, 95% CI 7.15%-19.14%, p < 0.001), and acute sinusitis (ARR 7.17%, 95% CI 2.18%-12.17%, p = 0.005). Although all mAbs reduced FESS risk in CRSwNP, only dupilumab reduced secondary outcomes as well. Similarly, only dupilumab improved all outcomes in AFRS patients. These data demonstrate the potential of mAbs in reducing disease burden and enhancing patient outcomes in CRSwNP and AFRS. NA Laryngoscope, 2024.

Myelodysplastic syndrome/ Myeloproliferative disorder, Nos.

Background: Population-based research is limited for myelodysplastic syndrome/ myeloproliferative neoplasm, not otherwise specified (MDS/MPN-NOS) which comprises a heterogenous group of patients that do not fit into the other established MDS/MPN subgroups. Methods: We identified patients from the Surveillance, Epidemiology, and End Results (SEER) database with a diagnosis of MDS/MPN-U logged from 2010-2020. Age-standardized incidence rates (ASIR) and incidence rate ratios (IRR) were calculated using eight age subgroups. Subgroup analyses were performed for race and gender. Join point regression analyses were performed to model trends in ASIRs, and annual percent change (APC) was calculated. Results: A total of 2447 patients over age 50 were included in analysis. Incidence of MDS/MPN-U increased gradually between 2010-2016 (APC 12.90) then decreased between 2016-2020 (APC -19.56). ASIR was significantly higher in males compared to females in several age groups (age 65-69, 80-84, 85+). Conclusion: The underlying molecular complexity of these diseases remains a significant challenge. It is critical to identify MDS/MPN- specific therapeutic response criteria and suitable end points correlated with survival and AML risk for transformation to acute myeloid leukemia (AML) uniform assessment of treatment benefit.

Unattended versus conventional blood pressure measurements in hospitalized hypertensive patients.

This study aims to compare the differences between unattended and conventional blood pressure measurements in hospitalized hypertensive patients. In fall of 2019, hypertensive patients at Ruijin Hospital underwent two rounds of unattended and conventional (nurse-monitored) blood pressure measurement. Both rounds used the same electronic blood pressure monitor with measurements taken three times, 30 s apart. Comparison was made using intra-class correlation coefficients, Bland-Altman plots, paired t-tests, etc. Among the 92 subjects in the study, the median age was 50 years old, with women accounting for 33.7%. Among the subjects, the median duration of hypertension was 8.0 years. The prevalence of diabetes, coronary heart disease, and stroke were 26.1%, 5.4%, and 6.5%, respectively. Whether unattended or conventional measurements were taken first, the average blood pressure measured first was slightly higher than the one measured later, but the difference was within 1-2 mmHg. Except that the average DBP during the round of conventional blood pressure measurements was significantly reduced by 1.6 mmHg compared to the conventional DBP, there were no other significant differences. Subgroup analysis by age, gender, BMI, and diabetes showed no significant difference in blood pressure measurement results between unattended and conventional methods. No significant difference was observed between unattended and conventional methods of blood pressure measurement in hospitalized hypertensive patients. Unattended blood pressure measurement can be adopted as the current standard for blood pressure management in hospitalized patients.

Textbook Outcomes in Solid Transplantation: A Systematic Review

Background. The concept of TO is expanding across various surgical disciplines to establish a standardized, comprehensive quality benchmark. Traditional metrics such as 1-y patient and graft survival have been key for evaluating transplant program performance but are now deemed inadequate because of significant field advancements. This systematic review aims to provide a comprehensive understanding of the applicability and validity of textbook outcome (TO) in the setting of solid organ transplantation. Methods. A structured search, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was conducted across PubMed, Embase, and Scopus databases on March 10, 2024. Results. Fourteen articles were identified for inclusion in this review. Of these, 2 studies addressed TO in heart transplantation, 3 in lung transplantation, 2 in kidney transplantation, and 7 in liver transplantation. A subgroup analysis was conducted to categorize the different definitions of TOs and identify the most common reasons for TO failure. Conclusions. Our systematic review highlights the ongoing efforts in the field of solid organ transplantation to define TO and emphasizes the importance of developing a universally recognized set of TO criteria for each type of transplant. TO provides a valuable framework for transplant centers to benchmark their performance against similar institutions on a risk-adjusted basis and to pinpoint specific areas for enhancing patient outcomes. Even the most successful programs may discover aspects within the composite outcome with scope for improvement.

Serum insulin-like growth factor-1 as a potential prognostic biomarker for heart failure with reduced ejection fraction: a meta-analysis

BackgroundMost studies have indicated that peripheral insulin-like growth levels factor-1 (IGF-1) is valuable in diagnosing heart failure, although the results have been inconsistent. To help solve the debate, we performed a meta-analysis to explore the relationship between IGF-1 and heart failure (HF).MethodsWe conducted an extensive search across various databases such as Embase, Cochrane Library, Pubmed, Medline, and Web of Science on May 30, 2023. From the extensive pool of studies, we selected 16 relevant articles, encompassing a total of 1,380 cases and 1,153 controls, to conduct a rigorous meta-analysis.ResultsThe total results indicated that there is an association between lower IGF-1 level and HF. The random-effects model yielded a pooled standardized mean difference (SMD) of −0.598 (95% CI: −1.081 to −0.116, P = 0.015). Further subgroup analysis also showed that IGF-1 levels were associated with HF in the age difference ≥5 years subgroup and body mass index difference &amp;gt;1 subgroup. Additionally, significant association between IGF-1 levels and HF were detected in the “serum” samples and “Europe” subgroups. Importantly, we observed IGF-1 showed significant lower levels in patients with reduced ejection fraction (HFrEF) compared to the controls, not in patients with preserved ejection fraction (HFpEF). The Begg’s and Egger’s tests revealed no indication of publication bias.ConclusionsOur meta-analysis has provided evidence suggesting a substantial correlation between reduced levels of IGF-1 and the occurrence of HF. Further prospective studies are necessary to ascertain the use of IGF-1 as a reliable biomarker for diagnosing HF, especially for HFrEF. But the diagnosis of HFpEF should be cautious.

Associations of Cannabis Use, Metabolic Dysfunction-Associated Steatotic Liver Disease, and Liver Fibrosis in U.S. Adults.

Introduction: Following the introduction of metabolic dysfunction-associated steatotic liver disease (MASLD) as a replacement term for nonalcoholic fatty liver disease, the relationship between MASLD and cannabis use has yet to be established. With the global rise in cannabis consumption, understanding its impact on MASLD is critical for clinical guidance. Our study investigated the association between cannabis use, MASLD, and clinically significant fibrosis (CSF) among U.S. adults. Methods: Data were collected from the National Health and Nutrition Examination Survey for the period 2017 to 2018 to conduct a cross-sectional analysis. The diagnosis of hepatic steatosis and CSF was based on median values of the controlled attenuation parameter and liver stiffness measurement, with thresholds of 285 dB/m and 8.6 kPa, respectively. Information on cannabis use was obtained through self-report questionnaires. Multinomial logistic regression models and subgroup analyses were used to investigate the association between cannabis use and MASLD with CSF. Results: Our study assessed data from 2,756 U.S. adults (51.1% female; 32.2% white; mean age 39.41 ± 11.83 years), who had complete information on liver stiffness measurements through transient elastography alongside reported cannabis use. Results indicated that cannabis use overall was not associated with liver stiffness in patients with MASLD. However, among females, cannabis use was associated with MASLD accompanied by CSF, with an adjusted odds ratio (OR) of 0.47 (95% confidence interval [CI]: 0.24-0.91). Heavy cannabis use (9 to 30 times per month) was associated with MASLD accompanied by CSF among female participants, with an adjusted OR of 0.12 (95% CI: 0.02-0.88). Conclusion: In our study, cannabis use did not show a significant association with liver stiffness in patients diagnosed with MASLD. However, heavy cannabis consumption in women was associated with MASLD accompanied by CSF. These findings suggest that the effects of cannabis on liver health may differ based on gender and frequency of cannabis use, emphasizing the need for further research in this area.

Effects of antiseizure medication withdrawal during the first trimester of pregnancy on seizure control and offspring outcomes.

To explore seizure control and offspring outcomes associated with antiseizure medication (ASM) withdrawal during the first trimester of pregnancy. Based on a prospective multicenter study in China, pregnancies followed up between 2009 and 2023 at the neurology outpatient clinic of 50 hospitals were included in this study. Information on demographics, epileptic characteristics, treatment during pregnancy, and offspring outcomes was collected. Pregnancies were categorized into an ASM withdrawal group and an ASM continuation group. Balance tests and univariate log-binomial regression analysis were conducted to identify imbalanced factors between groups and potential risk factors for seizure deterioration during pregnancy. Multivariate log-binomial regression was then used to estimate the adjusted effects of ASM withdrawal on seizure deterioration during pregnancy and fetal outcomes. In addition, exploratory subgroup analysis was conducted to identify high-risk patients who should avoid ASM withdrawal. Of the 695 pregnancies enrolled, 14.2% withdrew ASMs in the first trimester of pregnancy. ASM withdrawal during this period was associated with a risk of seizure deterioration during pregnancy (adjusted risk ratio [aRR] 1.405, 95% confidence interval [CI] 1.009-1.876). Subgroup analysis revealed a significant risk of seizure deterioration in pregnancies with seizures in 9 months (aRR 1.590, 95% CI 1.079-2.344). After adjusting the folic acid dose, no evidence of protective effects on fetus after ASM withdrawal was observed compared to patients with continued treatment, whereas seizure deterioration during pregnancy increased the risk of fetal death (aRR 3.577, 95% CI 1.086-11.651). ASM withdrawal in the first trimester of pregnancy did not show a protective effect on fetal outcomes but rather resulted in increased seizure frequency during pregnancy. However, this finding requires a larger sample for validation. Furthermore, seizure deterioration during pregnancy was associated with an increased risk of fetal death.

The Relationship between Social and Emotional Competencies and Standardized Test Scores among Elementary Schools in Saudi Arabia

This study examines the relationship between social and emotional abilities and standardized test results among elementary school students in Saudi Arabia. The data was collected using a purposive sampling strategy, with the Social and Emotional Learning Assessment Scale (SELAS) used to assess skills and actual educational material utilized to provide standardized test results. Data analysis involves the utilization of descriptive statistics, Pearson correlation coefficients, regression assessment, ANCOVA, and subgroup analyses. The results indicate a robust and positive correlation between social and emotional abilities and standardized test scores. The regression evaluation demonstrates the ability of these skills to accurately predict academic achievement. The ANCOVA method finds socio-economic variables as the primary moderators. The evident existence of disparities, principally influenced by gender and grade level, highlights the necessity for interventions that are specifically tailored to address these variances. Proposed approaches include integrating comprehensive social and emotional learning activities into educational curricula, implementing targeted interventions to address socio-economic disparities, and implementing strategies customized to individual genders. Maintaining continuous surveillance and assessment is crucial for fostering a comprehensive academic environment.

Evaluation of the efficacy of polyethylene glycol in combination with different doses of linaclotide in a fractionated bowel preparation for colonoscopy: a prospective randomized controlled study

Background and aimThe ideal bowel cleansing program still needs to be explored. The aim was to compare the bowel cleansing effect and patient tolerance of low-dose polyethylene glycol (PEG) combined with different doses of linaclotide in fractionated bowel preparation.MethodsThe subjects were randomly assigned to the 3LPEG group, 2LPEG + 2L group, or 2LPEG + L group. The primary outcome was to use the Ottawa Bowel Preparation Scale (OBPS) to evaluate the efficacy of bowel cleansing, and the secondary outcomes were the detection rate of adenomas and polyps, adverse reactions, tolerance, and defecation dynamics; subsets of patients with chronic constipation and irritable bowel syndrome were also analyzed.ResultsA total of 753 patients were randomly assigned. In ITT analysis, the success of preparation of the 2LPEG + 2L group was better than that of the 2LPEG + L group or the 3LPEG group (92.0% vs. 82.3% vs. 82.1%; P = 0.002). Compared with the 3LPEG group, the 2LPEG + L group showed similar but non-inferior results (82.3% vs. 82.1%, P > 0.05). The 2LPEG + 2L group was similar to the 2LPEG + L group in terms of adverse reaction, tolerance, willingness to reuse, and sleep quality, but both were superior to the 3LPEG group. In a subgroup analysis of chronic constipation, the 2LPEG + 2L group had the best cleansing effect on the right colon and mid colon, while in the subgroup analysis of irritable bowel syndrome, the tolerance was better in the 2LPEG + 2L group and the 2LPEG + L group than the 3LPEG group.Conclusions2LPEG + 2L is a feasible bowel preparation regimen.

Prediction of early clinical response to neoadjuvant chemotherapy in Triple-negative breast cancer: Incorporating Radiomics through breast MRI

This study assessed pretreatment breast MRI coupled with machine learning for predicting early clinical responses to neoadjuvant chemotherapy (NAC) in triple-negative breast cancer (TNBC), focusing on identifying non-responders. A retrospective analysis of 135 TNBC patients (107 responders, 28 non-responders) treated with NAC from January 2015 to October 2022 was conducted. Non-responders were defined according to RECIST guidelines. Data included clinicopathologic factors and clinical MRI findings, with radiomics features from contrast-enhanced T1-weighted images, to train a stacking ensemble of 13 machine learning models. For subgroup analysis, propensity score matching was conducted to adjust for clinical disparities in NAC response. The efficacy of the models was evaluated using the area under the receiver-operating-characteristic curve (AUROC) before and after matching. The model combining clinicopathologic factors and clinical MRI findings achieved an AUROC of 0.752 (95% CI 0.644–0.860) for predicting non-responders, while radiomics-based models showed 0.749 (95% CI 0.614–0.884). An integrated model of radiomics, clinicopathologic factors, and clinical MRI findings reached an AUROC of 0.802 (95% CI 0.699–0.905). After propensity score matching, the hierarchical order of key radiomics features remained consistent. Our study demonstrated the potential of using machine learning models based on pretreatment MRI to non-invasively predict TNBC non-responders to NAC.