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Annals of Emergency Medicine Apr 2024Our primary objectives were to identify clinical practice guideline recommendations for children with acute mild traumatic brain injury (mTBI) presenting to an emergency...
STUDY OBJECTIVE
Our primary objectives were to identify clinical practice guideline recommendations for children with acute mild traumatic brain injury (mTBI) presenting to an emergency department (ED), appraise their overall quality, and synthesize the quality of evidence and the strength of included recommendations.
METHODS
We searched MEDLINE, EMBASE, Cochrane Central, Web of Science, and medical association websites from January 2012 to May 2023 for clinical practice guidelines with at least 1 recommendation targeting pediatric mTBI populations presenting to the ED within 48 hours of injury for any diagnostic or therapeutic intervention in the acute phase of care (ED and inhospital). Pairs of reviewers independently assessed overall clinical practice guideline quality using the Appraisal of Guidelines Research and Evaluation (AGREE) II tool. The quality of evidence on recommendations was synthesized using a matrix based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Evidence-to-Decision framework.
RESULTS
We included 11 clinical practice guidelines, of which 6 (55%) were rated high quality. These included 101 recommendations, of which 34 (34%) were based on moderate- to high-quality evidence, covering initial assessment, initial diagnostic imaging, monitoring/observation, therapeutic interventions, discharge advice, follow-up, and patient and family support. We did not identify any evidence-based recommendations in high-quality clinical practice guidelines for repeat imaging, neurosurgical consultation, or hospital admission. Lack of strategies and tools to aid implementation and editorial independence were the most common methodological weaknesses.
CONCLUSIONS
We identified 34 recommendations based on moderate- to high-quality evidence that may be considered for implementation in clinical settings. Our review highlights important areas for future research. This review also underlines the importance of providing strategies to facilitate the implementation of clinical practice guideline recommendations for pediatric mTBI.
Topics: Humans; Child; Brain Concussion; Emergency Service, Hospital
PubMed: 38142375
DOI: 10.1016/j.annemergmed.2023.11.012 -
Journal of Imaging Dec 2023Three-dimensional human pose estimation has made significant advancements through the integration of deep learning techniques. This survey provides a comprehensive... (Review)
Review
Three-dimensional human pose estimation has made significant advancements through the integration of deep learning techniques. This survey provides a comprehensive review of recent 3D human pose estimation methods, with a focus on monocular images, videos, and multi-view cameras. Our approach stands out through a systematic literature review methodology, ensuring an up-to-date and meticulous overview. Unlike many existing surveys that categorize approaches based on learning paradigms, our survey offers a fresh perspective, delving deeper into the subject. For image-based approaches, we not only follow existing categorizations but also introduce and compare significant 2D models. Additionally, we provide a comparative analysis of these methods, enhancing the understanding of image-based pose estimation techniques. In the realm of video-based approaches, we categorize them based on the types of models used to capture inter-frame information. Furthermore, in the context of multi-person pose estimation, our survey uniquely differentiates between approaches focusing on relative poses and those addressing absolute poses. Our survey aims to serve as a pivotal resource for researchers, highlighting state-of-the-art deep learning strategies and identifying promising directions for future exploration in 3D human pose estimation.
PubMed: 38132693
DOI: 10.3390/jimaging9120275 -
BMC Bioinformatics Dec 2023Irritable bowel syndrome (IBS) is a common chronic functional gastrointestinal disorder associated with a wide range of clinical symptoms. Some researchers have used...
BACKGROUND
Irritable bowel syndrome (IBS) is a common chronic functional gastrointestinal disorder associated with a wide range of clinical symptoms. Some researchers have used cluster analysis (CA), a group of non-supervised learning methods that identifies homogenous clusters within different entities based on their similarity.
OBJECTIVE AND METHODS
This literature review aims to identify published articles that apply CA to IBS patients. We searched relevant keywords in PubMed, Embase, Web of Science, and Scopus. We reviewed studies in terms of the selected variables, participants' characteristics, data collection, methodology, number of clusters, clusters' profiles, and results.
RESULTS
Among the 14 articles focused on the heterogeneity of IBS, eight of them utilized K-means Cluster Analysis (K-means CA), four employed Hierarchical Cluster Analysis, and only two studies utilized Latent Class Analysis. Seven studies focused on clinical symptoms, while four articles examined anocolorectal functions. Two studies were centered around immunological findings, and only one study explored microbial composition. The number of clusters obtained ranged from two to seven, showing variation across the studies. Males exhibited lower symptom severity and fewer psychological findings. The association between symptom severity and rectal perception suggests that altered rectal perception serves as a biological indicator of IBS. Ultra-slow waves observed in IBS patients are linked to increased activity of the anal sphincter, higher anal pressure, dystonia, and dyschezia.
CONCLUSION
IBS has different subgroups based on different factors. Most IBS patients have low clinical severity, good QoL, high rectal sensitivity, delayed left colon transit time, increased systemic cytokines, and changes in microbial composition, including increased Firmicutes-associated taxa and depleted Bacteroidetes-related taxa. However, the number of clusters is inconsistent across studies due to the methodological heterogeneity. CA, a valuable non-supervised learning method, is sensitive to hyperparameters like the number of clusters and random initialization of cluster centers. The random nature of these parameters leads to diverse outcomes even with the same algorithm. This has implications for future research and practical applications, necessitating further studies to improve our understanding of IBS and develop personalized treatments.
Topics: Male; Humans; Irritable Bowel Syndrome; Quality of Life; Cluster Analysis; Cytokines
PubMed: 38102564
DOI: 10.1186/s12859-023-05567-8 -
Toxicology Letters Jan 2024This systematic review aimed to assess the association between neuropsychiatric effects of substance use and occurrence of ER stress and unfolded protein response (UPR)...
INTRODUCTION
This systematic review aimed to assess the association between neuropsychiatric effects of substance use and occurrence of ER stress and unfolded protein response (UPR) through comprehensive electronic search of existing literature and review of their findings.
METHODS
A comprehensive electronic literature search was carried out on research articles published between 1950 to July 2023 through major databases, such as Scopus, Web of Science, Google Scholar, PubMed, PsycINFO, EMBASE, Medline and Cochrane Library.
RESULTS
A total of 21 research articles were selected for review, which were comprised of sixteen animal studies, four human studies and one study on postmortem human brain samples. The selected studies revealed that alcohol, methamphetamine, cocaine, opioid and kratom exposures contributed to neuropsychiatric effects: such as decline in learning and memory function, executive dysfunction, alcohol, methamphetamine, opioid, and kratom dependence. These effects were associated with activation and persistent of ER stress and UPR with elevation of BiP and CHOP expression and the direction of ER stress is progressing towards the PERK-eIF2α-ATF4-CHOP pathway and neuronal apoptosis and neurodegeneration at various regions of the brain. In addition, regular kratom use in humans also contributed to elevation of p-JNK expression, denoting progress of ER stress towards the IRE1-ASK1-JNK-p-JNK pathway which was linked to kratom use disorder. However, treatment with certain compounds or biological agents could reverse the activation of ER stress.
CONCLUSIONS
The neuropsychiatric effects of alcohol, methamphetamine, cocaine, opioid and kratom use may be associated with persistent ER stress and UPR.
Topics: Animals; Humans; Endoplasmic Reticulum Stress; eIF-2 Kinase; Analgesics, Opioid; Unfolded Protein Response; Endoplasmic Reticulum; Apoptosis; Methamphetamine; Substance-Related Disorders; Cocaine
PubMed: 38101493
DOI: 10.1016/j.toxlet.2023.12.008 -
JAMA Network Open Dec 2023There is a gap in the evidence regarding nature-based interventions (NBIs) for children with autism spectrum disorder (ASD). (Meta-Analysis)
Meta-Analysis
IMPORTANCE
There is a gap in the evidence regarding nature-based interventions (NBIs) for children with autism spectrum disorder (ASD).
OBJECTIVE
To systematically review and meta-analyze available evidence on the health-related outcomes in NBIs for children with ASD.
DATA SOURCES
The Cumulative Index to Nursing and Allied Health Literature, Cochrane, Embase, Emcare, Education Resources Information Center, Global Health, MEDLINE, PsycInfo, SPORTDiscus, and Web of Science were searched from inception until May 2023. Google Scholar and references from included studies were searched for additional studies.
STUDY SELECTION
Included studies were randomized clinical trials (RCTs), controlled studies, and single-group before-and-after studies that reported health-related outcomes.
DATA EXTRACTION AND SYNTHESIS
This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting guidelines. Random-effects meta-analyses were used to synthesize the data. The findings of studies that were ineligible for meta-analysis were summarized according to the Synthesis Without Meta-analysis (SWIM) reporting guidelines.
MAIN OUTCOMES AND MEASURES
The outcomes of interest were health-related outcomes (ie, social functioning, behavioral functioning, emotional functioning, sensory functioning) and the self-reported well-being of children with ASD.
RESULTS
A total of 24 studies with 717 participants (mean age range, 5.3 to 17.8 years; 141 [21.9%] female) were included. A meta-analysis from 13 studies indicated a significant negative moderate association between NBIs and social communication (standardized mean difference [SMD], -0.59; 95% CI, -0.85 to -0.34). For behavioral functioning outcomes, NBIs showed a significant moderate association with reduced hyperactivity (SMD, -0.56; 95% CI, -0.86 to -0.26) and a small to moderate association with reduced irritability (SMD, -0.49; 95% CI, -0.79 to -0.19). For sensory functioning, NBIs were significantly associated with improved inattention and distractibility (SMD, 1.13; 95% CI, 0.67 to 1.60). Significant moderate associations were observed in sensory seeking (SMD, 0.77; 95% CI, 0.33 to 1.22; P < .001; I2 = 0%) and sensory sensitivity (SMD, 0.56; 95% CI, 0.12 to 1.00; P = .01; I2 = 0%). Heterogeneity of the intervention effects was not high, and I2 ranged from 0% to 67%.
CONCLUSIONS AND RELEVANCE
The findings of this systematic review and meta-analysis suggested an association of NBIs in group-based recreational therapy with experiential learning with positive short-term outcomes on sensory, social, and behavioral functioning for children with ASD. Future evidence using robust study design to aid the health and functional trajectories of children with ASD is recommended.
Topics: Child; Female; Humans; Child, Preschool; Adolescent; Male; Autistic Disorder; Emotions; Autism Spectrum Disorder; Behavior Therapy; Communication
PubMed: 38060224
DOI: 10.1001/jamanetworkopen.2023.46715 -
Archives of Medical Research Dec 2023Predictors of first-generation somatostatin receptor ligands (fgSRLs) response in acromegaly have been studied for over 30 years, but they are still not recommended in...
BACKGROUND AND AIMS
Predictors of first-generation somatostatin receptor ligands (fgSRLs) response in acromegaly have been studied for over 30 years, but they are still not recommended in clinical guidelines. Is there not enough evidence to support their use? This systematic review aims to describe the current knowledge of the main predictors of fgSRLs response and discuss their current usefulness, as well as future research directions.
METHODS
A systematic search was performed in the Scopus and PubMed databases for functional, imaging, and molecular predictive factors.
RESULTS
A total of 282 articles were detected, of which 64 were included. Most of them are retrospective studies performed between 1990 and 2023 focused on the predictive response to fgSRLs in acromegaly. The usefulness of the predictive factors is confirmed, with good response identified by the most replicated factors, specifically low GH nadir in the acute octreotide test, T2 MRI hypointensity, high Somatostatin receptor 2 (SSTR2) and E-cadherin expression, and a densely granulated pattern. Even if these biomarkers are interrelated, the association is quite heterogeneous. With classical statistical methods, it is complex to define reliable and generalizable cut-off values worth recommending in clinical guidelines. Machine-learning models involving omics are a promising approach to achieve the highest accuracy values to date.
CONCLUSIONS
This survey confirms a sufficiently robust level of evidence to apply knowledge of predictive factors for greater efficiency in the treatment decision process. The irruption of artificial intelligence in this field is providing definitive answers to such long-standing questions that may change clinical guidelines and make personalized medicine a reality.
Topics: Humans; Acromegaly; Somatostatin; Receptors, Somatostatin; Retrospective Studies; Artificial Intelligence; Treatment Outcome
PubMed: 38042683
DOI: 10.1016/j.arcmed.2023.102924 -
Frontiers in Neurology 2023An association between weight status and migraine has been previously reported; however, this relationship has only been studied in adults, not in the paediatric...
INTRODUCTION
An association between weight status and migraine has been previously reported; however, this relationship has only been studied in adults, not in the paediatric population.
OBJECTIVE
To evaluate the association between weight status and migraine in the paediatric population.
METHODS
We searched PubMed/Medline, Scopus, Web of Science, Ovid Medline, and Embase using a cut-off date of May 2023. We included observational studies that evaluated the association between weight status (underweight, overweight, obese, and excess weight) and migraine in the paediatric population (children and adolescents). Normal weight was the comparator. The outcome was migraine (all types, episodic and chronic). We performed meta-analyses using a random-effects model to estimate the pooled effects for each outcome. Sensitivity analysis was performed based on study design and risk of bias (using the Newcastle-Ottawa Scale). Certainty of evidence was assessed using the GRADE approach.
RESULTS
Eight studies (6 cross-sectional, 1 case-control and 1 cohort) covering 16,556 patients were included. The overall certainty of evidence was very low for the association between overweight, obesity, and excess weight with migraine. In the sensitivity analysis, meta-analyses of studies with a low risk of bias found that the overweight population probably had an increased odds of migraine (OR: 1.70; 95% CI: 1.14 to 2.53; = 32.3%, = 0.224) and that excess weight may increase the odds of migraine (OR: 1.58; 95% CI: 1.06 to 2.35; = 83.7%, = 0.002). Additionally, cohort and case-control studies found that obesity probably increases the odds of migraine. No studies analysed the association between underweight and migraine.
CONCLUSION
The associations between overweight, obesity, excess weight and migraine were uncertain, but studies with better methodological quality reported increased odds. Future longitudinal studies with proper confounding control are needed to disentangle their causal relationship.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, identifier CRD42021271533.
PubMed: 38033769
DOI: 10.3389/fneur.2023.1225935 -
How are overweight and obesity associated with reinforcement learning deficits? A systematic review.Appetite Feb 2024Reinforcement learning (RL) refers to the ability to learn stimulus-response or response-outcome associations relevant to the acquisition of behavioral repertoire and... (Review)
Review
Reinforcement learning (RL) refers to the ability to learn stimulus-response or response-outcome associations relevant to the acquisition of behavioral repertoire and adaptation to the environment. Research data from correlational and case-control studies have shown that obesity is associated with impairments in RL. The aim of the present study was to systematically review how obesity and overweight are associated with RL performance. More specifically, the relationship between high body mass index (BMI) and task performance was explored through the analysis of specific RL processes associated with different physiological, computational, and behavioral manifestations. Our systematic analyses indicate that obesity might be associated with impairments in the use of aversive outcomes to change ongoing behavior, as revealed by results involving instrumental negative reinforcement and extinction/reversal learning, but further research needs to be conducted to confirm this association. Hypotheses regarding how obesity might be associated with altered RL were discussed.
Topics: Humans; Overweight; Learning; Reinforcement, Psychology; Obesity; Case-Control Studies
PubMed: 37992896
DOI: 10.1016/j.appet.2023.107123 -
The Cochrane Database of Systematic... Nov 2023The prevalence of e-cigarette use has increased globally amongst children and adolescents in recent years. In response to the increasing prevalence and emerging evidence...
BACKGROUND
The prevalence of e-cigarette use has increased globally amongst children and adolescents in recent years. In response to the increasing prevalence and emerging evidence about the potential harms of e-cigarettes in children and adolescents, leading public health organisations have called for approaches to address increasing e-cigarette use. Whilst evaluations of approaches to reduce uptake and use regularly appear in the literature, the collective long-term benefit of these is currently unclear.
OBJECTIVES
The co-primary objectives of the review were to: (1) evaluate the effectiveness of interventions to prevent e-cigarette use in children and adolescents (aged 19 years and younger) with no prior use, relative to no intervention, waitlist control, usual practice, or an alternative intervention; and (2) evaluate the effectiveness of interventions to cease e-cigarette use in children and adolescents (aged 19 years and younger) reporting current use, relative to no intervention, waitlist control, usual practice, or an alternative intervention. Secondary objectives were to: (1) examine the effect of such interventions on child and adolescent use of other tobacco products (e.g. cigarettes, cigars types, and chewing tobacco); and (2) describe the unintended adverse effects of the intervention on individuals (e.g. physical or mental health of individuals), or on organisations (e.g. intervention displacement of key curricula or learning opportunities for school students) where such interventions are being implemented.
SEARCH METHODS
We searched CENTRAL, Ovid MEDLINE, Ovid Embase, Ovid PsycINFO, EBSCO CINAHL, and Clarivate Web of Science Core Collection from inception to 1 May 2023. Additionally, we searched two trial registry platforms (WHO International Clinical Trials Registry Platform; US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov), Google Scholar, and the reference lists of relevant systematic reviews. We contacted corresponding authors of articles identified as ongoing studies.
SELECTION CRITERIA
We included randomised controlled trials (RCTs), including cluster-RCTs, factorial RCTs, and stepped-wedge RCTs. To be eligible, the primary targets of the interventions must have been children and adolescents aged 19 years or younger. Interventions could have been conducted in any setting, including community, school, health services, or the home, and must have sought to influence children or adolescent (or both) e-cigarette use directly. Studies with a comparator of no intervention (i.e. control), waitlist control, usual practice, or an alternative intervention not targeting e-cigarette use were eligible. We included measures to assess the effectiveness of interventions to: prevent child and adolescent e-cigarette use (including measures of e-cigarette use amongst those who were never-users); and cease e-cigarette use (including measures of e-cigarette use amongst children and adolescents who were e-cigarette current-users). Measures of e-cigarette use included current-use (defined as use in the past 30 days) and ever-use (defined as any lifetime use).
DATA COLLECTION AND ANALYSIS
Two review authors independently screened the titles and abstracts of references, with any discrepancies resolved through consensus. Pairs of review authors independently assessed the full-text articles for inclusion in the review. We planned for two review authors to independently extract information from the included studies and assess risk of bias using the Cochrane RoB 2 tool. We planned to conduct multiple meta-analyses using a random-effects model to align with the co-primary objectives of the review. First, we planned to pool interventions to prevent child and adolescent e-cigarette use and conduct two analyses using the outcome measures of 'ever-use' and 'current-use'. Second, we planned to pool interventions to cease child and adolescent e-cigarette use and conduct one analysis using the outcome measure of 'current-use'. Where data were unsuitable for pooling in meta-analyses, we planned to conduct a narrative synthesis using vote-counting approaches and to follow the Cochrane Handbook for Systematic Reviews of Interventions and the Synthesis Without Meta-analysis (SWiM) guidelines.
MAIN RESULTS
The search of electronic databases identified 7141 citations, with a further 287 records identified from the search of trial registries and Google Scholar. Of the 110 studies (116 records) evaluated in full text, we considered 88 to be ineligible for inclusion for the following reasons: inappropriate outcome (27 studies); intervention (12 studies); study design (31 studies); and participants (18 studies). The remaining 22 studies (28 records) were identified as ongoing studies that may be eligible for inclusion in a future review update. We identified no studies with published data that were eligible for inclusion in the review.
AUTHORS' CONCLUSIONS
We identified no RCTs that met the inclusion criteria for the review, and as such, there is no evidence available from RCTs to assess the potential impact of interventions targeting children and adolescent e-cigarette use, tobacco use, or any unintended adverse effects. Evidence from studies employing other trial designs (e.g. non-randomised) may exist; however, such studies were not eligible for inclusion in the review. Evidence from studies using non-randomised designs should be examined to guide actions to prevent or cease e-cigarette use. This is a living systematic review. We search for new evidence every month and update the review when we identify relevant new evidence. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
Topics: Adolescent; Child; Humans; United States; Vaping
PubMed: 37965949
DOI: 10.1002/14651858.CD015511.pub2 -
Frontiers in Immunology 2023The surge in the number of publications on psoriasis has posed significant challenges for researchers in effectively managing the vast amount of information. However,...
BACKGROUND
The surge in the number of publications on psoriasis has posed significant challenges for researchers in effectively managing the vast amount of information. However, due to the lack of tools to process metadata, no comprehensive bibliometric analysis has been conducted.
OBJECTIVES
This study is to evaluate the trends and current hotspots of psoriatic research from a macroscopic perspective through a bibliometric analysis assisted by machine learning based semantic analysis.
METHODS
Publications indexed under the Medical Subject Headings (MeSH) term "Psoriasis" from 2003 to 2022 were extracted from PubMed. The generative statistical algorithm latent Dirichlet allocation (LDA) was applied to identify specific topics and trends based on abstracts. The unsupervised Louvain algorithm was used to establish a network identifying relationships between topics.
RESULTS
A total of 28,178 publications were identified. The publications were derived from 176 countries, with United States, China, and Italy being the top three countries. For the term "psoriasis", 9,183 MeSH terms appeared 337,545 times. Among them, MeSH term "Severity of illness index", "Treatment outcome", "Dermatologic agents" occur most frequently. A total of 21,928 publications were included in LDA algorithm, which identified three main areas and 50 branched topics, with "Molecular pathogenesis", "Clinical trials", and "Skin inflammation" being the most increased topics. LDA networks identified "Skin inflammation" was tightly associated with "Molecular pathogenesis" and "Biological agents". "Nail psoriasis" and "Epidemiological study" have presented as new research hotspots, and attention on topics of comorbidities, including "Cardiovascular comorbidities", "Psoriatic arthritis", "Obesity" and "Psychological disorders" have increased gradually.
CONCLUSIONS
Research on psoriasis is flourishing, with molecular pathogenesis, skin inflammation, and clinical trials being the current hotspots. The strong association between skin inflammation and biologic agents indicated the effective translation between basic research and clinical application in psoriasis. Besides, nail psoriasis, epidemiological study and comorbidities of psoriasis also draw increased attention.
Topics: Humans; United States; Psoriasis; Arthritis, Psoriatic; Bibliometrics; Dermatitis; Machine Learning; Inflammation
PubMed: 37954610
DOI: 10.3389/fimmu.2023.1272080