To map medication adherence measurement methods used in studies examining medication safety outcomes in adults receiving long-term pharmacotherapy, and to describe how adherence-safety relationships have been studied and reported. A scoping review was conducted using systematic searches of PubMed, Web of Science, and Scopus from 1 January 2000 to 9 February 2026. Eligible studies were those that explicitly examined the relationship between adherence and at least one medication safety outcome. Of 2395 records identified, 216 full-text reports were assessed and 29 studies were included. Most studies showed a pattern of higher safety burden with poorer adherence (n = 18, 62.1%), while lower safety burden with better adherence (n = 4, 13.8%), mixed patterns (n = 3, 10.3%), no clear association (n = 3, 10.3%), and indirect safety-related nonadherence evidence (n = 1, 3.4%) were also identified. Analytical direction varied: 15 studies examined safety-to-adherence pathways, where medication safety burden or safety-related factors were treated as the exposure or predictor of adherence, non-adherence, or discontinuation; six examined adherence-to-safety pathways, where adherence, non-adherence, persistence, or adherence trajectory was treated as the exposure or predictor of subsequent medication safety outcomes; five were cross-sectional/descriptive/undirected; and three had complex or indirect analytical structures. This scoping review shows that adherence-safety relationships have been studied across heterogeneous diseases, measurement approaches, safety outcomes, and analytical directions. Most studies examined safety-to-adherence pathways, whereas fewer examined adherence-to-safety pathways, and many designs could not establish temporality. Findings suggest that adherence assessment, medication review, and adverse drug reaction monitoring may be more informative when considered together, particularly in pharmacy practice. Greater standardization of adherence constructs and safety outcome definitions, clearer reporting, longitudinal designs, and explicit conceptual models are needed to strengthen future research.
To evaluate the effectiveness of goserelin sustained-release microspheres versus sustained-release implants for androgen deprivation therapy (ADT) in patients with prostate cancer in a real-world setting, and to compare their safety profiles by integrating evidence from published studies. This retrospective study included 87 patients with prostate cancer who received goserelin-based ADT at Peking University Cancer Hospital Inner Mongolia Hospital between August 2024 and September 2025. Forty-four patients received goserelin sustained-release microspheres, and 43 received sustained-release implants. During the 12-week observation period, patients received median administrations of three and one, respectively, corresponding to comparable ADT exposure. Analyses were patient-based. The primary endpoint was the proportion achieving total prostate-specific antigen (TPSA) <0.2 ng/mL at day 85 (D85), with day 29 (D29) assessed as an early response point. A prespecified exploratory non-inferiority framework with a -10% margin was applied, with sensitivity analyses using TPSA <0.1 ng/mL. A PRISMA-compliant systematic review searched PubMed, Embase, Cochrane Library, and Web of Science through February 1, 2026. Eligible studies reporting goserelin safety outcomes were included. Safety outcomes were harmonized as any-grade adverse events (AEs), serious AEs, and grade ≥3 AEs. Pooled incidences were calculated using single-arm meta-analysis. Median age was 72 years, and median follow-up was 85 days. Baseline disease stage differed between groups, with more metastatic disease in the implant group. At D29, TPSA response rates were 81.8% and 95.2% in the microsphere and implant groups, respectively. At D85, rates were 86.4% and 93.0%, meeting the prespecified non-inferiority criterion. Sensitivity analyses using TPSA <0.1 ng/mL were consistent. The systematic review included three studies comprising 665 patients. The pooled incidence of any-grade AEs was 59.2%, with substantial heterogeneity, whereas pooled incidences of serious AEs and grade ≥3 AEs were 6.1% and 8.9%, respectively, with no new safety signals. Goserelin sustained-release microspheres demonstrated comparable real-world biochemical activity to sustained-release implants over matched 12-week ADT exposure. Although early PSA differences and baseline disease-stage imbalance warrant consideration, integrated evidence supports goserelin microspheres as an alternative ADT formulation with a manageable safety profile. https://www.crd.york.ac.uk/PROSPERO/view/, identifier CRD420261327915.
The airway epithelium plays a central role in maintaining respiratory homeostasis, and increasing evidence suggests that resident commensal bacteria contribute to airway protection through host-microbe interactions. However, the functional roles of individual airway commensals remain poorly defined. Here, we aimed to isolate and functionally characterize an airway commensal Staphylococcus epidermidis strain and to determine its influence on airway function as well as its safety profile. An airway commensal S. epidermidis strain, designated HK 95, was isolated and characterized using a combination of in vivo, in vitro, and genomic approaches. Airway functional responses were evaluated in mice and guinea pigs using citric acid-induced acute cough, phenol red expectoration, and bronchoconstriction models. Safety assessments included cytotoxicity, hemolysis, antibiotic susceptibility testing, and evaluation in mice, integrating relative organ weight indices, longitudinal body weight assessment, and hematological profiling. Whole-genome sequencing and bioinformatic annotation were performed to assess taxonomic identity and safety-related genomic features. Administration of S. epidermidis HK 95 significantly attenuated citric acid-induced airway irritation, as evidenced by reduced cough frequency and prolonged response latency in both mice and guinea pigs. In addition, S. epidermidis HK 95 enhanced tracheal secretion in mice, indicating improved airway secretory function, and significantly prolonged preconvulsive time in a guinea pig bronchoconstriction model, suggesting a protective effect on airway responsiveness. Comprehensive safety evaluations demonstrated that S. epidermidis HK 95 was non-haemolytic, exhibited a non-multidrug-resistant antibiotic susceptibility profile, and well tolerated following administration in mice, with no significant adverse effects or organ abnormalities. Whole-genome sequencing confirmed its taxonomic identity as S. epidermidis and did not identify genetic determinants associated with classical staphylococcal toxins or overt pathogenicity. These findings demonstrate that the airway commensal S. epidermidis HK 95 exerts protective effects on airway physiological responses while maintaining a favorable safety profile. This study extends current understanding of airway commensal bacteria beyond compositional associations and supports a functional role for S. epidermidis in maintaining airway physiological homeostasis. These results provide a foundation for future studies exploring host-microbe interactions in the airway and the potential development of commensal-based airway interventions.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used across the glycemic spectrum, yet their thyroid safety profile remains debated. Prior studies have shown inconsistent findings, and evidence across prediabetes, type 1 diabetes (T1D), and type 2 diabetes (T2D) is lacking. To evaluate diabetes-type-specific associations between GLP-1RA therapy and thyroid outcomes, including thyroid dysfunction, autoimmune thyroiditis, nontoxic goiter, and thyroid cancer. A real-world, retrospective target-trial emulation using electronic health records (EHR) from a large multicenter network. We used the TriNetX US Collaborative Network to identify adults with prediabetes, T1D, or T2D initiating GLP-1RAs. Active comparators included usual care and sodium-glucose cotransporter two inhibitors (SGLT2i). Propensity score matching with extensive covariate adjustment was applied. Participants were followed for incident thyroid outcomes for up to 5 years. Sensitivity and subgroup analyses were conducted to assess robustness. Across glycemic states, GLP-1RA therapy demonstrated distinct thyroid safety patterns. In prediabetes and T1D, GLP-1RA use was associated with reduced risks of thyroid dysfunction and all-cause mortality, suggesting potential metabolic or immunomodulatory benefits. By contrast, among individuals with T2D, GLP-1RA exposure was linked to modest increases in autoimmune thyroiditis and nontoxic goiter, particularly among those with obesity or without hypertension. Importantly, no increased risk of thyroid cancer was observed in any glycemic state, providing reassuring evidence regarding long-term endocrine safety. In this large-scale target-trial emulation, GLP-1RAs showed favorable thyroid safety profiles in prediabetes and T1D, while modestly increasing selected nonmalignant thyroid outcomes in T2D. The absence of elevated thyroid cancer risk across glycemic states supports the overall endocrine safety of GLP-1RAs. These findings highlight the importance of individualized monitoring, particularly in metabolically high-risk T2D populations.
Major depressive disorder (MDD) necessitates treatments that balance efficacy with tolerability. Electroconvulsive therapy (ECT) is highly effective but limited by cognitive side effects. Magnetic seizure therapy (MST), a more focal convulsive therapy, may offer a superior safety profile. This systematic review and meta-analysis directly compares the efficacy and cognitive safety of MST and ECT for MDD. We systematically searched PubMed, Embase, Cochrane CENTRAL, Web of Science, WanFang, and CNKI (inception to Nov 2025) for randomized and non-randomized controlled studies comparing MST and ECT in adults with MDD. Primary outcomes were antidepressant response and depression score changes. Secondary outcomes included cognitive function, reorientation time, and adverse events. Pooled effect estimates (RR, SMD, MD, OR) with 95% CIs were calculated. 13 studies (N = 607 participants) were included. MST and ECT demonstrated comparable clinical response (RR = 1.10, 95% CI: 0.94-1.27) and remission (RR = 1.04, 95% CI: 0.72-1.50) rates. Post-sensitivity analysis favored ECT for depression score change (SMD = 0.36, p=0.0001). MST was superior in preserving cognitive function (SMD = 1.19, p=0.005), enabling faster reorientation (MD=-16.72 min, p<0.00001), and reducing overall adverse event risk (OR = 0.23, p<0.00001), notably for memory loss, headache, and muscle pain. Seizure durations were shorter with MST. While MST and ECT had comparable response and remission rates, sensitivity analysis of depression score changes suggested potential superiority of ECT, warranting cautious interpretation. MST provided significantly better cognitive safety and tolerability, including fewer cognitive adverse events and faster reorientation. These findings support MST as a valuable alternative for MDD patients, especially when cognitive side effects are a primary concern.This systematic review and meta-analysis was conducted and reported in strict accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (23). https://www.crd.york.ac.uk/PROSPERO/view/CRD420261277041, identifier CRD420261277041.
With the rapid advancement of artificial intelligence (AI) computing power, the creation and development of human-AI collaborative teams have become a significant trend in organizational development. However, in organizational practice, the introduction of AI is often accompanied by significant psychological resistance and algorithm aversion among employees. Based on this, this article aims to investigate the critical variable of AI safety voice, analyzing its impact mechanism on employees' willingness to collaborate. The study focuses on examining the mediating roles of perceived AI capability and perceived AI benevolence, as well as the moderating effect of voice endorsement within this framework. Drawing upon the theory of mind perception, this study investigated mediating and moderating effects through a multi-wave questionnaire survey administered to 385 enterprise employees routinely engaged in human-AI collaboration. Employees' perceptions of AI capability and benevolence mediate the relationship between AI safety voice and employees' willingness to work with AI. Furthermore, voice endorsement positively moderates the relationships between AI safety voice and perceived AI capability as well as perceived AI benevolence, further enhancing the indirect effect of AI safety voice on employees' willingness to work with AI. The findings contribute to enhancing the relationship between human and AI teammates and provide practical insights for organizations aiming to introduce human-AI collaborative teams, thereby improving team synergy and work output.
Propofol is widely used in clinical anesthesia, but its cardiorespiratory depressive effects may limit its safety in older patients. With the growing number of older adults requiring anesthesia, ciprofol has attracted interest because of its higher potency and relatively mild hemodynamic impact. This meta-analysis evaluated the efficacy and safety of ciprofol compared with propofol in older patients undergoing general anesthesia or painless endoscopy. We conducted a comprehensive search of PubMed, Embase, the Cochrane Library, and Web of Science up to 7 November, 2025, to identify eligible studies. All statistical analyses were performed using RevMan 5.4 and R version 4.5.1. A total of 12 randomized controlled trials involving 2027 older participants were included. For safety outcomes, ciprofol significantly reduced the incidence of hypotension (risk ratio = 0.76, 95% confidence interval 0.68-0.84; p < 0.00001) and injection pain (risk ratio = 0.16, 95% confidence interval 0.09-0.26; p < 0.00001) compared with propofol. No significant differences were observed between the two agents in the incidence of bradycardia, hypoxemia, and postoperative nausea and vomiting. Regarding efficacy outcomes, ciprofol was associated with a longer time to loss of consciousness compared with propofol (mean difference = 4.67 seconds, 95% confidence interval 0.65-8.70; p = 0.02), while no significant differences were observed in anesthesia success rate, procedure completion rate, and awakening time. Based on the currently available evidence from randomized trials conducted in China, ciprofol showed comparable efficacy to propofol and was associated with lower incidences of hypotension and injection pain in older patients. These findings may still be informative for anesthetic management in broader settings, although further validation is needed. PROSPERO registration number: CRD420251179366.
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are a cornerstone of heart failure (HF) therapy; however, landmark trials systematically excluded patients with severe renal impairment. Consequently, prescribing SGLT2i for HF patients with advanced chronic kidney disease (CKD stage 4) remains a clinical "blind spot" due to fears of acute kidney injury. This study aimed to evaluate the long-term efficacy and renal safety of SGLT2i in this vulnerable, real-world population. This single-center, retrospective observational cohort study evaluated HF patients with a baseline estimated glomerular filtration rate (eGFR) of 15-29 mL/min/1.73 m2 treated between January 2021 and December 2024. To minimize confounding by indication, a rigorous 1:1 propensity score matching (PSM) was performed. The primary efficacy outcome was a composite of heart failure hospitalization (HHF) or cardiovascular death. The primary safety outcome was major adverse kidney events (MAKE), defined as a sustained ≥40% eGFR decline, initiation of dialysis, or renal death. Long-term eGFR slopes were analyzed using linear mixed-effects models. Following PSM, the final analysis cohort comprised 320 balanced patients (160 in the SGLT2i group and 160 in the control group), with a median baseline eGFR of 22.4 mL/min/1.73 m2. Over a median follow-up of 2.1 years, the SGLT2i group demonstrated a 38% relative risk reduction in the primary efficacy composite outcome compared to controls (30.6% vs. 45.6%; adjusted HR 0.62, 95% CI 0.44-0.87, P = 0.005). The incidence of the primary safety outcome (MAKE) was statistically comparable between the two groups (14.4% vs. 16.9%; adjusted HR 0.86, 95% CI 0.52-1.43, P = 0.550), with no significant excess in severe acute kidney injury or hyperkalemia. Following an initial early "dip" in eGFR (-2.1 mL/min/1.73 m2), SGLT2i utilization was associated with a significantly shallower annualized eGFR decline trajectory compared to standard care (-1.2 vs. -3.5 mL/min/1.73 m2 per year, P < 0.001). In high-risk, real-world HF patients complicated by advanced CKD (Stage 4), SGLT2i therapy appears to be associated with substantial cardiovascular benefits and may attenuate long-term renal function decline. These findings suggest that severe renal impairment should not instinctively preclude the utilization of this life-saving therapy.
Pediatric acute respiratory failure (ARF) is a significant clinical challenge, often requiring respiratory support. While Continuous Positive Airway Pressure (CPAP) and conventional oxygen therapy (COT) are standard treatments, High-Flow Nasal Cannula (HFNC) has emerged as a promising non-invasive alternative, though its benefits remain unclear. This study aimed to compare the efficacy and safety of HFNC versus CPAP and COT in treating pediatric ARF. A literature search was conducted in Embase, PubMed, Cochrane Library, Scopus, and Web of Science until June 15, 2026. Randomized controlled trials (RCTs) comparing HFNC with CPAP and COT in children with ARF secondary to acute severe asthma, bronchiolitis, or pneumonia were included. Primary outcomes were treatment failure and intubation rates; secondary outcomes included oxygen therapy duration, pediatric intensive care unit (PICU) length of stay (LOS), hospital LOS, and mortality. Quality assessment used the Cochrane Risk of Bias Tool, and a random-effects meta-analysis was performed to calculate pooled odds ratios (ORs) and mean differences (MDs). A total of 22 RCTs involving 6,641 children were included in this analysis. Compared to COT, HFNC was associated with a significantly lower risk of treatment failure (OR: 0.509, 95% CI: 0.42-0.61). However, there were no significant differences in intubation rates (OR: 0.796, 95% CI: 0.39-1.63) or hospital mortality (OR: 0.654, 95% CI: 0.4-1.06) between the HFNC and COT groups. Compared to CPAP, HFNC showed increased risks for treatment failure (OR: 1.343, 95% CI: 0.75-2.4), intubation rates (OR: 1.044, 95% CI: 0.58-1.89), and hospital mortality (OR: 3.11, 95% CI: 0.96-10.1), although these increases did not reach statistical significance (P > 0.05). Additionally, there were no significant differences in the duration of oxygen therapy, pediatric PICU LOS, or hospital LOS between HFNC and either CPAP or COT. HFNC significantly reduces the risk of treatment failure compared to conventional oxygen therapy in children with ARF, though it does not differ significantly from CPAP regarding intubation rates or hospital mortality. Further research is necessary to clarify its relative efficacy and safety in comparison to CPAP. CRD420250652913.
The efficacy and safety of various dural sealants for dural closure have been evaluated in randomized controlled trials (RCTs). However, their associations with postcraniotomy complications remain to be compared. A Bayesian network meta-analysis (BNMA) was designed on the basis of studies published in PubMed, Embase, the Cochrane Library, Scopus, and Web of Science through July 9, 2025. Quality assessment was conducted using the National Institutes of Health (NIH) scale. BNMA was performed in R 4.5.1 with the "GeMTC" package, with SUCRA values and league tables generated to display comprehensive pairwise comparisons among different sealants. The certainty of evidence for each network estimate was assessed using the Confidence in Network Meta-Analysis (CINeMA) framework. Eleven studies (3094 patients who underwent craniotomy) were included. TissuePatchDural (RR = 0.03, 95% CrI (0.0007, 0.42), SUCRA = 90.52%), autologous materials (RR = 0.09, 95% CrI (0.003, 0.69), SUCRA = 73.07%) and synthetic hydrogels (RR = 0.16, 95% CrI (0.04, 0.48), SUCRA = 59.68%) had 95% CrIs excluding 1, suggesting a lower risk of postcraniotomy cerebrospinal fluid leakage than for conventional closure alone. Autologous materials showed a favorable probability for meningitis prevention (RR = 0.13, 95% CrI (0.02, 0.74), SUCRA = 82.70%). The SUCRA values indicated favorable probabilities for TissuePatchDural to prevent surgical site infection and pseudomeningocele and for autologous materials to reduce the risk of unplanned interventions, although these secondary outcomes lacked statistical significance. The results of this BNMA suggest that compared with conventional closure alone, TissuePatchDural has a greater probability of reducing cerebrospinal fluid leakage, whereas autologous materials showed favorable efficacy signals for postoperative meningitis.
Survivors of aortic dissection frequently restrict personal physical activity due to concerns about provoking recurrent aortic events. We conducted a multicenter randomized controlled trial to evaluate the safety and feasibility of a moderate-intensity, home-based guided exercise (GE) regimen. Between December 2022 and October 2024, adults ≥3 months post-Type A or B thoracic aortic dissection were randomized at 3 US academic medical centers to GE or usual care (UC; standardized exercise counseling and routine clinic visits). GE participants completed individualized training on a 6-exercise circuit and performed 12 months of home exercise with virtual follow-up visits. Coprimary outcomes were safety (aortic events, exertional hypertension, symptoms, injury, or events requiring medical care) and Patient-Reported Outcomes Measurement Information System 29-Item Profile scores. Secondary outcomes included exertional and ambulatory blood pressure and adherence. Continuous outcomes were compared using t or Mann-Whitney U tests; categorical using χ2 or Fisher tests. Ninety-three participants (mean age, 56 years; 30% women; 67% Type A aortic dissection) were randomized to GE (n=44) or UC (n=49). Sixteen participants (5 GE and 11 UC) were lost to follow-up, and 65 participants completed all trial milestones. There were no deaths, aortic operations, or recurrent dissections in either group. Exertional hypertension during supervised training occurred in 17 (39%) GE participants and was mitigated by exercise modification. There were no significant changes in paired ambulatory blood pressure measurements (25 GE, 28 UC) or Patient-Reported Outcomes Measurement Information System 29-Item Profile scores (30 GE, 35 UC). In this pilot randomized trial, moderate-intensity home exercise appeared feasible and was not associated with observed excess aortic events compared with usual care. Larger prospective trials are needed to determine long-term effects on cardiovascular outcomes.
Antibiotic resistance transmission and the increasing diversity of antibiotic resistance phenotypes pose growing threats to food safety and public health. Foodborne bacteria employ quorum sensing (QS) to regulate virulence expression and biofilm formation, enhancing pathogenicity and drug resistance. Therefore, targeting QS is regarded as a promising strategy to control bacteria. Quorum sensing inhibitors (QSIs) are highly promising for addressing bacterial resistance, as they do not rely on the direct killing of bacteria but rather on attenuation of bacterial spoilage effects in food by disrupting their group behavior. This review focuses on natural and synthetic compounds with QSI activity, elaborating their mechanisms and potential as antimicrobial agents. Additionally, the review proposes innovative antimicrobial strategies, including nanotechnology-based delivery systems, combination with phage, CRISPR-Cas technology, and multitargeted approaches cooperated with existing QSIs. These integrated strategies are designed to overcome challenges, providing novel methodologies for controlling bacterial contamination and infections while holding broad application prospects.
The increasing use of dental implants raises questions about their efficacy in diabetic patients, particularly for immediate implant placement (IIP). Well-controlled diabetic patients may achieve success rates comparable with healthy individuals. To the best of our knowledge, however, comprehensive meta-analyses on IIP outcomes in diabetics remain limited. The present study aimed to judge whether IIP could be adopted in diabetic patients. A systematic search was conducted in PubMed, Embase, Web of Science, Cochrane, Google Scholar and China National Knowledge Infrastructure databases (January 2000 to March 2025). Studies comparing implant survival rates (SR), marginal bone loss (MBL), probing depth (PD) and bleeding on probing (BOP) between diabetic (well-/poorly controlled) and healthy patients undergoing IIP were included. The methodological quality and risk of bias of the included studies were assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed using RevMan 5.4 software to calculate mean difference (MD) and risk ratio (RR) with 95% confidence interval (CI). A random-effects model was employed to address heterogeneity. A total of 10 studies (1,350 patients, 1,623 implants) were included in the analysis, demonstrating moderate to high methodological quality overall. Compared with healthy patients, well-controlled diabetic patients showed no significant difference in SR (RR=1.00, 95% CI: 0.97-1.02, P=0.79); similarly, poorly controlled diabetic patients also exhibited SR comparable with what of healthy patients (RR=0.96, 95% CI: 0.88-1.06, P=0.47). However, well-controlled diabetic patients had significantly higher MBL than healthy patients (MD=0.08, 95% CI: 0.03-0.14, P=0.004), while poorly-controlled diabetic patients showed greater MBL (MD=0.39, 95% CI: 0.25-0.53, P<0.00001). Additionally, well-controlled diabetic patients showed no significant difference in PD compared with healthy patients (MD=0.17, 95% CI: -0.02-0.37, P=0.09), but had significantly higher BOP (MD=0.12, 95% CI: 0.07-0.17, P<0.00001). Poorly-controlled diabetic patients demonstrated significantly higher PD (MD=0.62, 95% CI: 0.38-0.86) and BOP (MD=0.24, 95% CI: 0.23-0.24; both P<0.00001). There was notable heterogeneity among studies included in the meta-analysis and individual studies may influence the overall findings. Despite these limitations, the present results suggested that for diabetic patients, particularly those with optimal glycemic control, IIP demonstrates comparable implant SR with healthy individuals, confirming its clinical feasibility. However, diabetic patients, especially those with poor glycemic control, face increased risks of peri-implant bone loss and inflammation. Strict preoperative glycemic management and diligent postoperative care are key to minimize complications and ensure long-term implant SR.
Bleeding from gastric varices (GVs) is a severe complication of portal hypertension. Conventional endoscopic cyanoacrylate injection (Con-ECI) is an effective treatment, but it is associated with significant risks of rebleeding and systemic ectopic embolism. Clip-assisted ECI (Clip-ECI), where clips are deployed before glue injection, has been developed to mitigate these risks, but its efficacy remains debatable. A comprehensive search of PubMed, Embase, Web of Science, and Scopus was conducted for studies up to August 2025. The primary outcomes were all-cause rebleeding and ectopic embolism. Secondary outcomes included variceal obliteration, mortality, and procedure-related complications. Risk ratios (RR) with 95% confidence intervals (CI) were pooled from randomized and non-randomized studies using a random-effects model. CRD420251163015. Seven studies involving 783 patients were included. Compared to Con-ECI, Clip-ECI was associated with a significantly lower risk of variceal rebleeding (RR: 0.24; 95% CI [0.12, 0.48]; P < 0.001) and ectopic embolism (RR: 0.31; 95% CI [0.13, 0.76]; P = 0.01). The pooled rates of variceal rebleeding and ectopic embolism in the Clip-ECI group were 7.1% and 2.1%, respectively. Also, Clip-ECI achieved a significantly higher rate of complete variceal obliteration (RR: 1.39; 95% CI [1.23, 1.57]; P < 0.001). There were no significant differences in all-cause mortality (P = 0.28), technical success (P = 0.35), or other adverse events. In patients with GVs, Clip-ECI significantly reduces the risks of rebleeding and ectopic embolism while improving variceal obliteration, without increasing adverse events, compared with Con-ECI.
Irinotecan, a topoisomerase I inhibitor, is available as both non-pegylated and pegylated formulations. The non-pegylated formulation is licensed for use in advanced colorectal cancer either in combination with other agents or as monotherapy. However, it is also used off-label across a range of gastrointestinal malignancies and in rare malignancies such as glioblastoma and sarcomas. The pegylated formulation is licensed for use as combination therapy in adult patients with metastatic pancreatic adenocarcinoma. Irinotecan is hydrolysed to its active metabolite, SN-38, which is predominantly inactivated by the enzyme uridine diphosphate glucuronosyltransferase UGT1A1. UGT1A1 is encoded by the gene UGT1A1, which is polymorphically expressed, with allele frequencies varying across populations. Poor metabolizers carry two variants that reduce UGT1A1 enzyme expression or activity, leading to increased risk of irinotecan toxicity. Any patient who is about to be prescribed irinotecan for an epithelial malignancy should have pharmacogenetic testing, to identify clinically relevant UGT1A1 variants, where testing is available. Irinotecan dose should be reduced by 30% at Cycle 1 treatment in poor metabolizers for all indications, with doses titrated thereafter based on tolerability and neutrophil counts. The lack of evidence precludes us from making any recommendation for rare malignancies such as sarcomas. Our guideline is consistent with other international pharmacogenetics prescribing guidelines. This guideline is grounded in the latest evidence but cannot account for all individual factors relevant to patient care. Therefore, prescribers must conduct a thorough assessment of each patient's risk-benefit profile, ensuring that therapy is optimized to maximize benefits while minimizing potential harms.
Type 1 Diabetes (T1D) management demands consistent attention to blood glucose levels, insulin dosing, physical activity, sleep, and diet-tasks that are especially burdensome for adolescents and young adults navigating new independence. While continuous glucose monitoring (CGM) systems and wearable fitness devices provide real-time physiological data, the cognitive load of interpreting this information and maintaining consistent self-care behaviors remains a significant barrier for patients and their support networks. We developed the Sugar Slay ecosystem, comprising a gamified mobile decision support application for T1D individuals and a companion application, Sugar Slay Care, for caregivers and supporters. The main application integrates CGM and wearable device data to generate real-time, personalized predictions using advanced machine learning models, including a Sequence-to-Sequence Bidirectional LSTM (Seq2Seq BiLSTM). To inform the design of Sugar Slay Care, we conducted a need-finding study with six caregivers and supporters to identify features critical to balancing autonomy with safety. Among the machine learning models evaluated, the Seq2Seq BiLSTM demonstrated the best performance in forecasting blood glucose trends. The need-finding study identified key caregiver requirements, informing the development of a companion application that supports safety monitoring without undermining patient independence. Sugar Slay integrates predictive modeling with habit-building gamification strategies to encourage daily engagement and proactive self-management. By addressing the social dimension of T1D care through Sugar Slay Care, this work contributes to next-generation digital health tools that unite physiological data, artificial intelligence, and behavioral science for user-centered chronic disease management.
Analyzing the clinical characteristics, potential mechanisms, and treatment strategies of pembrolizumab-induced immune-related hepatitis to improve clinical management and treatment safety. Case reports on pembrolizumab-induced immune-related hepatitis were retrieved from databases including PubMed, Science Direct, and Web of Science. Forty-two case reports were carefully reviewed and data on patient age, gender, primary disease, time to hepatitis onset, clinical manifestations, liver injury indicators, adverse reaction grading, treatment strategies, and prognosis were collected and analyzed. Among these patients, 27 were male and 14 were female, and the average age was 64.2 years. The clinical manifestations included liver toxicity, neurological symptoms, skin reactions, systemic symptoms, and digestive symptoms. The time from initiation of pembrolizumab to the onset of immune-related hepatitis varied significantly. The shortest duration is 2 days, while the longest is 630 days. Corticosteroids were the primary treatment. The pathogenesis may be related to the dysregulation of liver immune tolerance. Before initiating pembrolizumab, clinicians should thoroughly evaluate patients' liver function and history of liver disease, and consider the hepatotoxicity of concurrent medications. During the use of pembrolizumab, regular monitoring of liver function should be conducted. If any abnormalities are found, appropriate treatment should be given promptly. Meanwhile, further research is needed to better understand pembrolizumab-induced immune-related hepatitis.
This study investigates some granitoid intrusions in the North Eastern Desert of Egypt, specifically at Gabal Gharib area. Image processing of the remote sensing ASTER satellite data enabled updating the geological map of the study area, successfully identifying five distinct granitoid varieties (riebeckite arfvedsonite alkaline granite, alkali feldspar granite, monzogranite, tonalite-granodiorite, and gabbro-diorite association), and guiding the fieldwork and sampling. A total of 14 representative samples were analyzed using gamma ray spectrometry to determine the activity concentrations (Bq/kg) of 40K, 226Ra, 232Th, and 238U. The results show that alkali granite samples exhibit the highest concentrations levels of all four radionuclides, followed by monzogranite, granodiorite, tonalite, and diorite which showed the lowest levels. The elevated radioactivity is primarily attributed to K-bearing minerals (e.g., alkali feldspars and mica minerals) and accessory minerals (e.g., apatite, sphene, zircon, and allanite) whose flexible structure and crystal lattice readily incorporate uranium and thorium. Most of the measured rock samples exceed global average safety limits for all radionuclides, especially 40K, with only minor exceptions. We estimated five parameters: radium equivalent (Raeq), absorbed dose rate (D), external hazard index (Hex), internal hazard index (Hin), and radioactivity concentration index (Iγ) to further estimate the possibility of these granitoid rocks to be used as a building material. It is found that the granitoids of Gabal Gharib area generally fall outside the internationally recommended safety limits for construction and building materials. Notably, only the diorite variety is suitable for unrestricted use for indoor or outdoor construction and decorative purposes, whereas alkali granite and tonalite varieties failed to meet the safety requirements for such applications.
Sleep quality often worsens in perinatal women because of physiological, endocrine, and psychosocial changes. This may increase the risk of maternal and infant complications, making it a public health concern. Because pharmacological treatments may pose safety risks, mind-body therapies have gained attention as a safe non-pharmacological option. However, current evidence mainly focuses on single intervention types, and their overall effect on sleep quality in perinatal women remains unclear. We systematically searched seven databases-PubMed, Web of Science, Embase, the Cochrane Library, Scopus, EBSCO, and ScienceDirect-and other sources up to January 20, 2026, to identify randomized controlled trials examining the effects of mind-body therapies on sleep quality in perinatal women. Two reviewers independently screened the literature, extracted the data, and assessed the risk of bias using the Cochrane Risk of Bias 2 (ROB2) tool. Meta-analysis was performed in Stata 17 using a random-effects model. Subgroup, sensitivity, and publication bias analyses were also conducted. In addition, the certainty of evidence for the primary outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A total of 13 randomized controlled trials involving 782 participants were included. The main interventions were mindfulness, Pilates, and yoga. Meta-analysis showed that, compared with controls, mind-body therapies significantly improved sleep quality in perinatal women (MD = -2.63, 95% CI -3.36 to -1.90). However, substantial heterogeneity was observed across studies (I2 = 89.0%, P < 0.001). Subgroup analyses showed significant between-group differences by country (P < 0.05), intervention duration (P < 0.01), and session length (P < 0.05), suggesting that these factors may partly explain heterogeneity. Sensitivity analysis and risk-of-bias assessment suggested that the results were statistically robust, and no significant publication bias was detected (P = 0.900). According to GRADE, the certainty of evidence for the primary outcome was rated as low. Mind-body therapies effectively improve sleep quality in perinatal women and may serve as a useful adjunct in clinical sleep health management. However, the certainty of evidence was rated as low according to GRADE; therefore, these findings should be interpreted cautiously and further confirmed by high-quality studies. https://www.crd.york.ac.uk/PROSPERO/view/CRD420261290532, identifier: CRD420261290532.
High-flow nasal cannula (HFNC) and bi-level positive airway pressure (BiPAP) are both employed in the management of acute hypercapnic respiratory failure, yet their comparative benefits remain uncertain. We conducted an updated systematic review and meta-analysis of randomized controlled trials (RCTs) to compare efficacy, safety, and tolerability of HFNC versus BiPAP in adults with hypercapnic respiratory failure. We searched PubMed, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), CNKI, and Wanfang Data through June 2025 for RCTs enrolling patients aged ≥ 16 years with arterial carbon dioxide partial pressure (PaCO2) > 45 mmHg. Primary outcomes were intubation rate and mortality. Secondary outcomes included arterial oxygen partial pressure (PaO2) or the ratio of PaO2 and inhaled oxygen fraction (FiO2; PaO2/FiO2), PaCO2, pH, respiratory rate, intensive care unit (ICU) length of stay, patient comfort, and device-related complications. Eleven RCTs (n = 1069) met inclusion criteria. Intubation (risk difference [RD] = -0.02, 95% CI -0.06 to 0.03) and mortality rates (RD = -0.02, 95% CI -0.06 to 0.02) were similar between modalities. HFNC and BiPAP showed no significant difference in PaCO2 reduction (mean differences [MD] = 0.74 mmHg; 95% CI, -1.21 to 2.70) or pH normalization (MD = -0.01; 95% CI, -0.01 to 0), or ICU stay (MD = -0.72 days; 95% CI, -1.90 to 0.46). However, BiPAP yielded minor statistically significant improvements in oxygenation (standardized mean differences [SMD] = 0.18, 0.03-0.33) and respiratory rate reduction (MD = 2.06; 95% CI, 1.17 to 2.94). HFNC achieved higher comfort scores and fewer skin or gastrointestinal complications. HFNC and BiPAP offer comparable clinical outcomes in acute hypercapnic respiratory failure. BiPAP offers modest physiological advantages, whereas HFNC provides better patient comfort and less adverse events. Large-scale, multicenter RCTs are needed to further delineate the comparative benefits of HFNC versus BiPAP in diverse patient groups.