Spermatogenic failure (SPGF) is a severe form of male infertility with limited evidence-based medical treatment options. Aromatase inhibitors represent a promising therapeutic strategy for SPGF, but high-quality evidence is lacking. To evaluate the efficacy and safety of letrozole for improving sperm concentration categories in men with SPGF. This multicenter, open-label, assessor-blinded randomized clinical trial was conducted at 10 male infertility centers in China from July 2023 to March 2024. Men with SPGF (nonobstructive azoospermia [NOA], cryptozoospermia, or severe oligozoospermia) were enrolled. Follow-up for the primary outcome was completed in June 2024. Data were analyzed from July 2024 to March 2025. Participants were randomized to receive letrozole (2.5 mg daily) plus vitamins C and E or vitamins C and E alone (control group) for 3 months. The primary outcome was World Health Organization Sperm Concentration Categories (WHO-SCC) upgrade rate at 3 months after randomization. The secondary outcomes were WHO-SCC grades, Dutch Society of Obstetrics and Gynecology Total Motile Sperm Count Categories (NVOG-TMSCC) upgrade rate, semen parameters, and reproductive hormone levels. Among 296 participants (mean [SD] age, 30.2 [3.9] years; 218 [73.6%] with NOA; 147 randomized to the letrozole group and 149 to the control group), 247 (83.4%) completed the trial, and all 296 were included in the primary analysis. WHO-SCC upgrade rates were 14.3% (21 of 147 participants) with letrozole vs 5.4% (8 of 149 participants) with control (risk difference, 9.2% [95% CI, 2.5%-15.8%]; P = .01). Participants in the letrozole group had higher odds of achieving a better WHO-SCC grade than those in the control group (common odds ratio, 2.65 [95% CI, 1.28-5.47]; P = .008). The NVOG-TMSCC upgrade rate was also higher with letrozole. Letrozole significantly increased serum gonadotropins and testosterone while decreasing estradiol. There were no significant between-group differences in semen parameters. Decreased libido (18 [12.2%] vs 8 [5.4%]; P = .04) was more frequent with letrozole than with control. In this randomized clinical trial of men with spermatogenic failure, letrozole significantly improved sperm concentration categories and was well tolerated, supporting its use as an option to downstage infertility severity and potentially enable less invasive reproductive management. chictr.org.cn Identifier: ChiCTR2300073861.
Extended-spectrum β-lactamase (ESBL)-producing Enterobacterales are an increasing cause of complicated urinary tract infections (UTIs). Reliance on carbapenems to treat these infections accelerates resistance, underscoring the urgent need for effective oral transition options to preserve last-line agents and lessen healthcare burden. We conducted a multicenter, open-label, randomized, noninferiority trial at four tertiary hospitals in South Korea (November 2022-June 2025). Adults hospitalized with complicated UTIs due to ESBL-producing Enterobacterales who improved after 3-7 days of intravenous antibiotics were randomized (1:1) to either continue intravenous carbapenem or β-lactam/β-lactamase inhibitor therapy or switch to oral fosfomycin trometamol (3 g once daily). The primary outcome was clinical cure, defined as resolution of urinary tract infection-related symptoms and signs within 4 days after completion of treatment. Secondary outcomes included microbiological cure, readmission, adverse events, and 30-day recurrence. Of the 344 screened patients, 299 were randomized (152 oral fosfomycin; 147 intravenous therapy). Clinical cure occurred in 92.8% of the oral fosfomycin group and 95.2% of the intravenous group (risk difference, -2.47%; 95% CI -7.84 to 2.89), confirming noninferiority. Microbiological cure was similarly high in both groups: urine (98.0% vs 96.6%) and blood (97.3% vs 97.5%). Safety profiles and 30-day outcomes were also comparable. Oral fosfomycin was noninferior to continued intravenous therapy when used as oral transition therapy for complicated UTIs caused by ESBL-producing Enterobacterales. These findings provide evidence to support oral fosfomycin transition as a carbapenem-sparing antibiotic stewardship strategy for patients with complicated UTIs caused by ESBL-producing Enterobacterales. KCT0007669.
Military sexual trauma (MST) is associated with substantial psychiatric sequelae, but treatment options lack evidence-based protocols tailored to this specific trauma. To evaluate the efficacy of a MST-focused treatment using an 8-week virtual delivery format compared with an active control treatment to reduce symptoms of posttraumatic stress disorder (PTSD). This randomized clinical trial compared Warrior Renew (MST-focused group) with Health and Wellness (active control group) at baseline, week 8 (after treatment), and week 16 (follow-up). The study was conducted at 2 Veterans Affairs health care systems in the Pacific Northwest region of the US. Participant enrollment occurred from July 19, 2023, to March 24, 2025. Veterans aged 18 to 75 years with a history of MST-related PTSD symptoms were recruited via informational letters, self-referral, and clinician referral. Participants were randomized 1:1 to the MST-focused group or active control group. Analysis of participants with baseline data was based on the intention-to-treat principle. The MST-focused treatment targets themes of MST using cognitive and experiential strategies, including imagery reprocessing. The active control targets health and well-being, including behavioral engagement with weekly goals. Both treatments consisted of 8 weekly, 90-minute sessions delivered via telehealth in groups separated by sex. The primary outcome was change in PTSD symptom severity from baseline to week 8, which was measured by the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5) and the Posttraumatic Cognitions Inventory (PTCI). A linear mixed model was used to compare outcomes of the treatments at weeks 8 and 16. Of the 191 veterans who consented, 140 (mean [SD] age, 50.6 [14.7] years; 71 males [50%]) completed baseline assessments and were included in the intent-to-treat analyses. Participants in the MST-focused group showed significant score improvements from baseline to week 8 on the PCL-5 (-7.97; 95% CI, -11.01 to -4.92; P < .001) and the PTCI (-19.99; 95% CI, -26.86 to -13.12; P < .001), which were maintained at week 16. Active control group participants also showed significant score improvements on the PCL-5 and PTCI; however, the MST-focused group demonstrated greater score improvements on the PTCI (-9.61; 95% CI, -18.98 to -0.25; P = .04) and the PTCI self-blame subscale (-3.10; 95% CI, -5.30 to -0.90; P = .006) compared with the active control group. Additionally, only participants in the MST-focused group exceeded a 10-point score threshold indicating meaningful change on the PCL-5 at week 16. Women in the MST-focused group demonstrated greater results on the PCL-5 over the control group (-5.90; 95% CI, -11.58 to -0.22; P = .04) at week 8. Both treatments had low dropout rates (around 11%). This randomized clinical trial showed that both treatments demonstrated efficacy in reducing PTSD symptoms, but the MST-focused treatment compared with the active control demonstrated greater improvements in posttraumatic cognitions. The results support the use of the MST-focused group treatment for PTSD symptoms associated with MST. ClinicalTrials.gov Identifier: NCT05776719.
We previously demonstrated in a randomized controlled trial that antibiotic prescribing feedback to family physicians reduced antibiotic use. However, that trial did not evaluate for patient harms from potential under-prescribing of antibiotics. To evaluate the safety of an antibiotic audit and feedback intervention. We performed a post hoc secondary analysis of a randomized controlled trial that compared an intervention group, who received a mailed antibiotic prescribing peer comparison feedback letter, compared with a control group who did not receive a letter. The initial trial was limited to patients aged 65 years or older due to availability of pharmacy claims data. The primary outcome was an emergency department visit or hospital admission for a bacterial infection. The outcome was assessed at 6 months post-intervention using administrative data claims data and multivariable linear regression models. The initial trial was registered (NCT04594200). We included 4879 physicians-3909 intervention physicians and 970 control physicians. There were 37 345 severe infection events in the 6 month post-intervention period. The observed mean (SD) of all severe infection events per physician was 7.73 (12.42) for control and 7.64 (11.91) for intervention groups. The model-based adjusted mean difference was -0.23 (95% CI, -0.92 to 0.45; P = 0.505). In this post hoc analysis of a randomized controlled trial comparing antibiotic prescribing feedback versus no feedback to physicians in primary care, there was no evidence of severe bacterial infection complications associated with reduced antibiotic prescribing. These findings support antibiotic peer comparison feedback as a safe and effective tool to reduce unnecessary antibiotic prescribing.
Immune checkpoint inhibitor (ICI) monotherapy for patients with recurrent, unresectable, or metastatic (RUM) head and neck squamous cell carcinoma (HNSCC) is associated with poor outcomes. Low-dose, hypofractionated, quad-shot radiotherapy (QSRT) may enhance the efficacy of ICIs. To evaluate the efficacy and toxic effects of ICIs in combination with QSRT for patients with RUM HNSCC that is amenable to QSRT. This single-arm, phase 2, nonrandomized clinical trial was conducted at a single, academic, National Cancer Institute-designated Comprehensive Cancer Center and included patients with RUM HNSCC who were going to receive treatment with pembrolizumab monotherapy and had a targetable site in the head and neck that was amenable to QSRT (based on location, prior radiotherapy dose, and tolerance). Patients were enrolled and treated between February 2021 and May 2024. Pembrolizumab (200 mg/m2) was administered every 3 weeks until disease progression, intolerance, or a maximum duration of 2 years. QSRT comprised 14.8 Gy in four 3.7-Gy fractions that were delivered twice daily on consecutive days. QSRT courses were delivered cyclically between pembrolizumab cycles. The primary outcome was overall response rate per Response Evaluation Criteria in Solid Tumors, version 1.1, in patients with at least 1 response assessment. Secondary outcomes were progression-free survival (PFS), overall survival (OS), and clinician-rated (Common Terminology Criteria for Adverse Events, version 5.0) and patient-reported (patient-reported outcomes version of the Common Terminology Criteria for Adverse Events, version 1.0) adverse effects (AEs). Of the 29 individuals who were screened, 21 enrolled, and 15 patients (median [range] age, 61 [33-86] years) were eligible for response analysis: 5 women (33.3%), 10 men (66.7%), 9 individuals with oropharyngeal/oral cavity primary tumors, and 14 current/former smokers (93.3%). Fourteen patients had received prior systemic therapy, and 11 had received prior RT. Among evaluable patients, the overall response rate was 47% (95% CI, 21%-73%). Median PFS and OS among the treated patients (n = 20) were 9.2 months (95% CI, 3-17) and 14.9 months (95% CI, 5 to not estimable), respectively. For the 15 patients who were evaluable for the primary end point, median PFS was 11.5 months (95% CI, 5.1 to not estimable), and median OS was 15.3 months (95% CI, 6.3 to not estimable). Grade 3 and 4 AEs occurred for 6 and 2 patients, respectively. Patient-reported AEs did not substantially change over time. This nonrandomized trial demonstrated the feasibility of pembrolizumab plus QSRT for patients with RUM HNSCC and provides preliminary evidence of a potential benefit to this novel combination that warrants investigation in future randomized clinical trials. ClinicalTrials.gov Identifier: NCT04454489.
Wide-awake local anesthesia no tourniquet (WALANT) is increasingly used for flexor tendon repair, but comparative data versus general/regional anesthesia(GA/RA) are limited. The aims of the WAFER trial were to generate high quality comparative data on WALANT versus GA/RA for flexor tendon repair and assess the feasibility of performing a large multicenter trial of this nature. WAFER was a multicenter, assessor-blinded, parallel-group RCT with embedded qualitative and health economic components across four major hand units. Patients were randomized on a 1:1 basis to have flexor tendon repair under GA/RA or WALANT. The primary feasibility outcomes were recruitment, retention and trial acceptability in addition to clinical outcomes which included range of motion (Total-active-motion score), grip/pinch strength, finger circumference, complications and patient reported outcome measures(PROMS) (Michigan-Hand-Questionnaire, EQ-5D-5L). Qualitative interviews were conducted with clinicians and participants to assess acceptability and equipoise. Economic analyses summarized intra-operative costs and impact on productivity. The primary analysis set was per-protocol. Sixty participants were randomized across all sites (30 WALANT; 30 GA/RA); 56 were analyzed per-protocol. At 6 months, mean TAM score(SE) for GA/RA was 67.6(5.6) vs 60.3(6.3) in the WALANT group. Tendon rupture was reported in two patients in the GA/RA group and three in the WALANT group. PROMs improved over time in both groups, patients in the WALANT arm reported consistently higher MHQ scores across domains. Participants in WALANT arm returned to work earlier than participants in GA/RA arm (mean 3.0 vs 6.7weeks). Intra-operative costs were lower with WALANT by 54% (-£398, 95% CI -£509 to -£287). A pragmatic comparison of WALANT versus GA/RA with tourniquet for primary flexor tendon repair is deliverable and safe. Inter-arm clinical differences were small; however, WALANT showed lower intra-operative costs and a signal for earlier return to work.
Recurrent acute rhinosinusitis (RARS) decreases quality of life. The effects of endoscopic sinus surgery (ESS) in RARS are understudied. To compare the quality of life between patients with RARS who had surgery and medical treatment vs medical treatment alone. This is an open-label randomized clinical trial with 2 parallel groups with a 6-month follow-up. Patients referred to Oulu University Hospital Otolaryngology Clinic between May 2020 and June 2024 were recruited to participate in the trial. Inclusion criteria were adults with physician-diagnosed RARS episodes occurring at least 3 times during the past 6 months, 4 times during the past year, or twice per year for 3 consecutive years. Conservative treatment had been insufficient for symptom relief. Data collection and analyses were planned before commencing recruitment. Data collection was performed from May 2020 to December 2024, and analysis from January 2025 to January 2026. The operative group received ESS and medical treatment, and the conservative group received medical treatment alone. The main outcome was the difference between groups in mean SinoNasal Outcome Test 22 (SNOT-22) score change from baseline to a 6-month follow-up. The SNOT-22 questionnaire measures rhinosinusitis-related quality of life. Sinonasal symptoms, number of health care visits, antibiotic courses, absences from work or study, and the adverse effects of operative treatment were also studied. A total of 59 patients (mean [SD] age, 40 [14] years; 52 women [88%]) were recruited, 30 in the operative and 29 in the conservative group. Intention-to-treat analysis of the primary outcomes was performed. The mean SNOT-22 score change from baseline to 6 months was greater after ESS compared to medical treatment only (difference, 22.41 points (95% CI, 13.67-31.10 points). Per-protocol analyses of secondary outcomes supported the primary findings for the most part. Only 4 patients received intervention for an operative complication (3 infections, 1 synechia with septal perforation). In this randomized clinical trial, ESS improved patient-related outcomes at a 6-month follow-up in adults with RARS. Conservative treatment had no clinically meaningful effect. These results suggest that ESS is an effective treatment without major problems. ClinicalTrials.gov Identifier: NCT04241016.
Surface electromyography (sEMG) is a promising biofeedback method for swallowing intervention. Current sensors are either costly rigid platforms or short-lived wearables. We developed a second-generation flexible wearable sEMG patch (i-Phagia) designed to record submental muscle activity. This study validated the signal quality and preclinical performance of i-Phagia against conventional sensors in two age groups. A randomized crossover study involved 30 young (17 women, 13 men; aged 18-29 years) and 30 older healthy adults (17 women, 13 men; aged 50-82 years). Participants completed liquid and semisolid swallows under two conditions: with i-Phagia sensors and with conventional sensors, in a counterbalanced order. Comparisons focused on signal-based factors (signal-to-noise ratio [SNR], baseline amplitude, and normalized mean sEMG amplitude), as well as safety, satisfaction, and placement efficiency. SNR and baseline amplitude were examined with linear mixed models and equivalence tests; Pearson correlations were used to analyze normalized mean sEMG amplitude. Safety/adverse effects were assessed with descriptive statistics, while satisfaction and efficiency were analyzed with linear mixed models. SNR values were equivalent between sensor types (effect size: -0.0178; confidence interval [CI] [-0.2226, 0.2004]); however, the i-Phagia patch showed significantly lower baseline amplitude than conventional sensors (effect size: 0.48; CI [0.3144, 0.6422]), indicating better signal quality. High correlations (r > .7) between normalized sEMG amplitudes across swallows suggest consistent muscle activity patterns across sensors. No pain was reported; skin redness was rare but twice as common after removing conventional sensors. Satisfaction was higher (p < .0001), and application was more efficient with i-Phagia (M = 1:28 vs. 2:19, p < .05). The optimized i-Phagia patch is safe, provides signal quality comparable to conventional sensors, and shows advantages in user satisfaction and placement efficiency. These findings support its feasibility for future clinical testing as a wearable sEMG option for swallowing rehabilitation. https://doi.org/10.23641/asha.32608575.
Antibiotic resistance undermines conventional Helicobacter pylori (H. pylori) eradication therapies. Tegoprazan-amoxicillin (TA) dual therapy is a promising alternative, but its efficacy and safety compared with other treatment regimens remain unclear. The aim of this meta-analysis was to comprehensively evaluate the efficacy and safety of TA dual therapy in eradicating H. pylori. PubMed, Embase, CENTRAL, and Web of Science were searched from inception to December 2025. Eligible randomized controlled trials (RCTs) compared TA dual therapy with bismuth-containing quadruple therapy (BQT) or proton pump inhibitor (PPI)-based high-dose dual therapy (PPI-HDDT) in adults with H. pylori infection. The outcomes were H. pylori eradication rate, adverse events, and medication adherence. Evidence quality was assessed via GRADE. Six RCTs (n = 1909) were included. TA dual therapy showed no significant difference in eradication rate compared with BQT (n = 5 RCTs, ITT analysis: 78.0% vs. 81.4%, RR = 0.97, 95% CI: 0.88-1.05, p = 0.44; PP analysis: 84.6% vs. 86.2%, RR = 0.96, 95% CI: 0.87-1.06, p = 0.39; low-quality evidence), confirmed by trial sequential analysis. TA dual therapy had a lower overall adverse event rate (11.3% vs. 22.5%, RR = 0.50, 95% CI: 0.37-0.67, p < 0.00001; moderate-quality evidence) but similar adherence (95.7% vs. 94.5%, RR = 1.01, 95% CI: 0.99-1.03, p = 0.31; moderate-quality evidence) compared with BQT. Efficacy and safety were comparable between TA dual therapy and PPI-HDDT (n = 1 RCT). The TA dual therapy exhibits similar efficacy compared with BQT and PPI-HDDT for H. pylori eradication, with a better safety profile compared with BQT. However, its overall eradication efficacy is suboptimal, necessitating further regimen optimization in the future.
Pulmonary arterial hypertension (PAH) remains progressive despite contemporary background therapy. Sotatercept is a novel activin signaling inhibitor that targets pulmonary vascular remodeling and may improve clinical and hemodynamic outcomes. To evaluate the efficacy, hemodynamic effects, and safety of sotatercept in patients with PAH. Systematic review and meta-analysis of randomized controlled trials (RCTs). Five electronic databases were searched through October 2, 2025, for eligible RCTs. Time-to-event outcomes were analyzed using pooled individual patient data with hazard ratios (HRs), while secondary outcomes were assessed using random-effects risk ratios (RRs) and mean differences (MDs), with 95% confidence intervals (CI). Trial-sequential analysis (TSA) evaluated the conclusiveness of results. In four RCTs (n = 889), sotatercept reduced clinical worsening or death by 77% (HR 0.23, 95% CI 0.16-0.32, p < 0.001) and prolonged event-free survival by ~40 weeks. World Health Organization (WHO) functional class improved in 40.3% vs 24.3% (RR 1.71, 95% CI 1.32-2.21), and 6-minute walk distance increased by MD 30.27 m (95% CI 13.45-47.08), while pulmonary vascular resistance (PVR) declined significantly (MD -247 dyn·s·cm-5, 95% CI -301.7; -192.2). Serious adverse events were slightly less frequent with sotatercept (26.2% vs 31.7%, RR 0.83); however, total bleeding (37.9% vs 18.7%, RR 2.00), epistaxis (26.7% vs 5.4%, RR 4.89), and telangiectasia (19.8% vs 6.4%, RR 3.24) were more common. TSA revealed conclusiveness in clinical worsening, WHO functional class, and PVR, as well as increases in bleeding events and epistaxis. Sotatercept significantly improves clinical outcomes and extends event-free survival in PAH, with an acceptable safety profile; however, caution is warranted regarding bleeding events. These results support its role as an add-on therapy in PAH management. PROSPERO ID: CRD420251166414. New hope for pulmonary hypertension: sotatercept significantly improves exercise capacity and reduces disease progressionPulmonary arterial hypertension (PAH) is a serious and progressive condition in which high blood pressure in the lungs places strain on the heart, often leading to heart failure and death. Current treatments help control symptoms but rarely stop the disease from getting worse. Sotatercept is a new medication that targets abnormal blood vessel growth and helps restore normal vessel function. This study combined results from four high-quality clinical trials including 889 adults with PAH who were already receiving standard therapy. Half the participants received sotatercept injections every three weeks, and the other half received placebo. Researchers looked at how long patients remained free from major disease events, such as hospitalization or worsening symptoms, and also measured exercise capacity and heart–lung function. Patients who received sotatercept were 77% less likely to experience disease worsening or death compared with those on placebo. On average, they could walk about 30 meters farther during a six-minute walk test, and their heart pressures and blood vessel resistance improved significantly. The drug also increased overall event-free survival by around 40 weeks. While most side effects were mild or moderate, nosebleeds and small visible blood vessel spots on the skin (telangiectasia) were more common with sotatercept, and a few patients experienced higher hemoglobin levels or mild decreases in platelets. Overall, sotatercept was well tolerated and showed strong evidence of improving daily function and reducing the risk of clinical deterioration. These findings support its use as an additional therapy for adults with PAH who continue to have symptoms despite standard treatments. Further long-term studies are recommended to confirm its impact on survival and long-term safety.
Recombinant human prourokinase (rhPro-UK) has been investigated as an alternative thrombolytic agent to alteplase for acute ischemic stroke (AIS). While alteplase remains the standard of care, uncertainties persist regarding whether rhPro-UK provides similar efficacy and safety outcomes. This systematic review and meta-analysis aimed to compare intravenous rhPro-UK with alteplase in patients with AIS. A systematic literature search was conducted in PubMed, Embase, and Cochrane Central up to January 2025. Randomized controlled trials (RCTs) comparing intravenous rhPro-UK with alteplase were included. Outcomes of interest were functional recovery (modified Rankin Scale [mRS] 0-1 and 0-2 at 90 days), early neurological improvement (National Institutes of Health Stroke Scale [NIHSS] reduction within 24 hours), intracranial hemorrhage, all-cause mortality, and recurrent stroke. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated under a random-effects model. Risk of bias was assessed with the Cochrane RoB 2 tool. Three RCTs involving 2295 patients were included (1209 treated with rhPro-UK; 1148 with alteplase). No statistically significant differences were observed between groups for intracranial hemorrhage (OR 1.04; 95% CI: 0.73-1.48), mRS 0-1 at 90 days (OR 0.91; 95% CI: 0.77-1.08), mRS 0-2 at 90 days (OR 0.95; 95% CI: 0.79-1.14), early NIHSS improvement (OR 0.94; 95% CI: 0.79-1.11), all-cause mortality (OR 1.16; 95% CI: 0.66-2.03), or recurrent stroke (OR 0.72; 95% CI: 0.31-1.66). Intravenous rhPro-UK demonstrated comparable efficacy and safety to alteplase in AIS, supporting its role as a potential alternative thrombolytic, particularly in regions with limited access to alteplase.
MINST treatment was more effective in reducing median periodontal outcomes at 12-month follow-up than the conventional approach. Across 12-months follow-up, the overall PPD reduction was significantly influenced by a high number of cigarettes/day, erratic/non-compliance supportive treatment, high no. pockets ≥ 4 mm BoP+, number of pockets 4-5 mm, number of pockets ≥ 6 mm, and by high FMBS.
During exercise, fine hemodynamic adjustments are essential to ensure adequate energy supply. Although cyclic treadmill exercise has been widely studied, isometric exercise with Handgrip (HG) has gained relevance in conditioning and rehabilitation contexts, yet data on the acute hemodynamic effects of combining these modalities remain scarce. In this context, the present study tested the hypothesis that isometric contraction with HG modifies the hemodynamic responses of Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Double Product (DP) during cyclic treadmill exercise. A clinical trial was conducted with 40 young, active or irregularly active men, using a crossover design in which three protocols were applied: protocol 1 without HG, protocol 2 with HG at 30% of handgrip strength (HGS), and protocol 3 with HG at 60% of HGS. The exercise sessions were performed on a treadmill and consisted of four blocks of 2 min at 50% of heart rate reserve, followed by 1 min at 30%. Statistical analysis was carried out using Kruskal-Wallis and Friedman tests with appropriate post hoc procedures. The results demonstrated that protocols 2 and 3 significantly increased SBP and DBP compared to protocol 1 (p < 0.05), while DP was significantly higher only in protocol 3 (p < 0.01). Heart rate increased throughout exercise in all protocols (p < 0.05), with no differences between them. Additionally, HG did not modify the hemodynamic response during recovery. Overall, HG promotes increases in SBP, DBP, and DP during treadmill exercise without altering HR. Durante el ejercicio, los ajustes hemodinámicos precisos son esenciales para garantizar un suministro energético adecuado. Si bien el ejercicio cíclico en cinta rodante ha sido ampliamente estudiado, el ejercicio isométrico con agarre manual (AG) ha cobrado relevancia en contextos de acondicionamiento y rehabilitación, aunque los datos sobre los efectos hemodinámicos agudos de la combinación de estas modalidades siguen siendo escasos. En este contexto, el presente estudio puso a prueba la hipótesis de que la contracción isométrica con AG modifica las respuestas hemodinámicas de la frecuencia cardíaca (FC), la presión arterial sistólica (PAS), la presión arterial diastólica (PAD) y el doble producto (DP) durante el ejercicio cíclico en cinta rodante. Se realizó un ensayo clínico con 40 hombres jóvenes, activos o con actividad irregular, utilizando un diseño cruzado en el que se aplicaron tres protocolos: protocolo 1 sin AG, protocolo 2 con AG al 30% de la fuerza de agarre manual (GAM) y protocolo 3 con AG al 60% de la GAM. Las sesiones de ejercicio se realizaron en una cinta rodante y consistieron en cuatro bloques de 2 minutos al 50% de la reserva de frecuencia cardíaca, seguidos de 1 minuto al 30%. Se realizó un análisis estadístico utilizando las pruebas de Kruskal‐Wallis y Friedman con los procedimientos post hoc apropiados. Los resultados demostraron que los protocolos 2 y 3 aumentaron significativamente la PAS y la PAD en comparación con el protocolo 1 (p < 0.05), mientras que la PAD fue significativamente mayor solo en el protocolo 3 (p < 0.01). La frecuencia cardíaca aumentó durante el ejercicio en todos los protocolos (p < 0.05), sin diferencias entre ellos. Además, la HG no modificó la respuesta hemodinámica durante la recuperación. En general, la HG promueve aumentos en la PAS, la PAD y la PAD durante el ejercicio en cinta rodante sin alterar la frecuencia cardíaca.
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To assess the economic impact of Artificial Intelligence (AI)-assisted stress echocardiography (SE) in the National Health Service (NHS) diagnostic pathway for coronary artery disease (CAD) using cost-effectiveness analysis and cost-consequence analysis alongside a multicenter randomized controlled trial. This evaluation was embedded in the PROTEUS trial, a 20-hospital NHS randomized controlled trial enrolling 2213 patients with suspected CAD undergoing SE. Patients were randomized to standard care (control) or AI-assisted SE (intervention). Outcomes were assessed using EuroQol 5-dimension 5-level (EQ-5D-5L) and Seattle Angina Questionnaire (SAQ-7), with quality-adjusted life-years (QALYs) estimated over 6 months. NHS costs were obtained from a costing study. Cost-consequence analysis compared within- and between-group outcomes. Cost-effectiveness analysis used a decision tree incorporating AI cost scenarios and clinician time savings. Probabilistic sensitivity analysis assessed uncertainty. Diagnostic accuracy was high in both groups (97.2% control; 96.9% intervention). SAQ-7 scores improved significantly within both groups (P < .001), with no between-group differences. EQ-5D-5L showed no significant within-group changes, except self-care (control: P = .017; intervention: P = .032), and no between-group differences. QALYs were similar (0.392 intervention vs 0.390 control; P = .818). Mean NHS costs were £376.72 (intervention) vs £366.08 (control). In the base case without AI costs, the incremental cost-effectiveness ratio was £6939 per QALY. The intervention remained cost-effective for AI costs up to £35.35 per case or £45.93 with clinician time savings. Sensitivity analyses supported the results. AI-assisted SE may be a cost-effective addition to NHS CAD diagnostics, with value driven by costs, accuracy, and efficiency.
Beta-blockers after myocardial infarction (MI) are being questioned, specifically among persons with preserved left ventricular ejection fraction (LVEF). This raises consideration for beta-blocker discontinuation. The objective of this study was to conduct a systematic review and meta-analysis examining the effects of discontinuation vs continuation of beta-blockers after MI. We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Google Scholar, Epistemonikos from inception to September 11, 2025. Eligible studies were randomized controlled trials and nonrandomized studies among adults ≥18 years. Outcomes included mortality and major adverse cardiovascular (CV) events (MACE), as well as its components. We performed meta-analyses using an inverse-variance random-effects model and evaluated certainty of evidence using Grading of Recommendations, Assessment, Development, and Evaluation. We screened 4,103 titles/abstracts, and 10 studies were eligible (1 randomized controlled trial, 9 observational studies; N = 121,114). Eight studies involved patients with LVEF >40% and/or without heart failure. Compared with beta-blocker continuation, discontinuation might not be associated with increased risk of mortality (HR: 1.11; 95% CI: 0.96-1.28; 8 studies; low certainty evidence). Discontinuation might be associated with increased risk of MACE compared with continuation (HR: 1.12; 95% CI: 1.01-1.24; 7 studies; low certainty; driven by increased risk of CV hospitalizations) but might not be associated with an increased risk of MI (HR: 1.39; 95% CI: 0.95-2.04; 5 studies; low certainty). Among post-MI patients with LVEF >40% and without heart failure, beta-blocker discontinuation might not increase risk of mortality or MI, though there may be an increased risk of MACE primarily due to CV hospitalizations.
ES-481 is a novel potent and selective antagonist of TARP-y8-dependent AMPA receptors. We aimed to assess the potential efficacy, safety and tolerability, and pharmacokinetics of different doses of ES-481 as an add-on anti-seizure medication (ASM) in adults with drug-resistant epilepsy (DRE). This was a Phase 2A double-blind, randomized, dose-titration, cross-over, placebo-controlled trial followed by an open-label extension (OLE) conducted across four Australian Comprehensive Epilepsy Centers. The primary outcomes were: (i) efficacy, measured via change in seizure frequency for each treatment week, (ii) safety and tolerability, and (iii) pharmacokinetics. Secondary endpoints were change in anxiety and depressive symptom scores. 22 participants were randomized, 17 (77.3%) completed the double-blind treatment phase, and 16 entered the OLE study. Overall, based on seizure diaries, participants had 68%-80% improvement in seizure frequency on ES-481 treatment, compared with 38%-49% on placebo treatment (p = 0.097). For the highest dose of ES-481 treatment (75 mg bid), subjects had 80% improvement (90% confidence interval [Cl] 43%-97%), while participants on placebo for the corresponding week had 49% improvement (90% Cl 1%-74%) (p = 0.047). There was no significant difference in the reduction of seizure frequency at the lower ES-481 treatment doses. There were no significant differences in change in frequency of EEG epileptiform/seizure discharges >3 s in duration between the ES-481 and placebo treatments. There was no significance difference in serious treatment-emergent adverse events between the groups (placebo 14.3% vs. ES-481 4.8%) or treatment-emergent adverse events of special interest (e.g., dizziness, drowsiness; placebo 19.0% vs. ES-481 52.4%, p = 0.052). Treatment was well tolerated in the OLE for up to 36 weeks. ES-481 in doses up to 75 mg bid was safe and well tolerated for up to 36 weeks in participants with DRE and demonstrated potential anti-seizure efficacy compared with placebo at this dose. This was a first-in-disease, proof-of-concept early-phase trial of a novel anti-seizure medication, ES-481, in adults with a broad group of patients drug-resistant epilepsy, who continue to have seizures despite treatment with currently available medications. ES-481 was generally safe and well tolerated, and participants receiving the highest dose showed fewer seizures compared with placebo. These findings suggest ES-481 may offer a promising new treatment approach for people with difficult-to-control epilepsy, supporting the need for larger future studies. Registered at ClinicalTrials.gov ID: NCT04714996 (first submitted and met QC criteria Jan 14, 2021, first posted Jan 20, 2021) and Australian and New Zealand Clinical Trials Registry ID: ACTRN12621000033842 (registered January 15, 2021). First participant/first visit (assessment) occurred on January 29, 2021.
Atrial fibrillation (AF) is a risk factor for respiratory syncytial virus (RSV)-related adverse cardiac events. This prespecified analysis of the DAN-RSV trial investigated RSVpreF vaccine effectiveness (VE) against respiratory and cardiovascular outcomes among older adults with and without AF. DAN-RSV was a pragmatic, open-label, individually randomized trial in Denmark during the 2024/2025 winter season. Adults ≥60 years were randomly assigned 1:1 to RSVpreF vaccine or no vaccine. Baseline and endpoint data were obtained from nationwide health registries. The primary endpoint was hospitalization for RSV-related respiratory tract disease, occurring 14 days after study visit until May 31, 2025. Prespecified respiratory and cardiovascular endpoints were assessed by AF status. Among 131,276 participants, 10,126 (7.7%) had a history of AF (mean age 73.2 ± 6.9 years, 30.4% female). AF participants had higher event rates compared with non-AF participants. RSVpreF vaccine lowered the incidence of the primary endpoint with no evidence of effect modification by AF status (AF: VE 80.6% (95%CI -84.7 to 99.6), no AF: VE 84.6% (95%CI 32.3 to 98.3), p-value for interaction >0.99). RSVpreF vaccine was further associated with a lower incidence of all-cause respiratory tract disease hospitalization (AF: VE 25.7% (95%CI -16.9 to 46.1), no AF: VE 13.0% (95%CI -3.3 to 27.8)) and RSV-related and overall cardio-respiratory disease hospitalization with no evidence of effect modification by AF status (p-value for interaction ≥0.45 for all). RSVpreF vaccine was not significantly associated with AF or stroke hospitalizations regardless of AF status (p-value for interaction≥0.34 for all). In older adults, RSVpreF vaccine was associated with a lower incidence of RSV-related and all-cause respiratory tract disease hospitalizations, as well as RSV-related and all-cause cardio-respiratory disease hospitalizations, with no evidence of effect modification by AF status. This prespecified analysis of a large, randomized trial examined whether an RSV vaccine reduces serious respiratory and cardiovascular hospitalizations in older adults with and without atrial fibrillation. In the DAN-RSV trial of 131,276 adults aged 60 years and older, including 10,126 (7.7%) individuals with atrial fibrillation, the RSVpreF vaccine reduced hospitalizations due to RSV-related respiratory and cardio-respiratory disease, with no evidence of effect modification by atrial fibrillation history.Individuals with atrial fibrillation experienced higher rates of respiratory and cardiovascular hospitalizations overall, and RSVpreF was associated with lower numbers needed to vaccinate in this higher-risk group. No significant associations were observed between RSVpreF vaccination and atrial fibrillation hospitalizations.
While botulinum neurotoxin type A (BoNT-A) has demonstrated efficacy in the treatment of blepharospasm and hemifacial spasm, comparative efficacy and safety of different BoNT-A formulations remain uncertain. We conducted a systematic review and network meta-analysis with random-effects Bayesian models of randomized controlled trials comparing BoNT-A preparations with each other or with placebo. Separate networks were constructed for duration of clinical effect, analyzed as mean differences (MD), and ptosis, analyzed as odds ratios (ORs). The network included 13 randomized controlled trials with 870 participants contributing to duration outcomes and 964 participants to ptosis outcomes. All BoNT-A preparations demonstrated a significantly longer duration of clinical effect compared with placebo in a combined blepharospasm and hemifacial spasm population. No clinically meaningful differences in duration were observed between active preparations. AbobotulinumtoxinA (Abo/BoNT-A), onabotulinumtoxinA (Ona/BoNT-A), incobotulinumtoxinA (Inco/BoNT-A) and lanbotulinumtoxinA (Lan/BoNT-A) were associated with significantly higher odds of ptosis compared with placebo. Abo/BoNT-A, which was generally administered at higher dose ratios in the included studies, showed higher odds of ptosis than Ona/BoNT-A, although estimates were imprecise with wide credible intervals. In the dose-level network, higher-dose BoNT-A was associated with a greater risk of ptosis than lower-dose BoNT-A. The available evidence suggests that BoNT-A formulations have comparable efficacy in the combined blepharospasm and hemifacial spasm population. Differences in ptosis risk may reflect differences in dosing strategies rather than intrinsic differences between BoNT-A formulations. The review protocol was registered in PROSPERO (CRD420261299121).