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Antioxidants (Basel, Switzerland) Mar 2024Non-alcoholic fatty liver disease (NAFLD) and its progressive stage, non-alcoholic steatohepatitis (NASH), are becoming one of the most common chronic liver diseases... (Review)
Review
Roles of Traditional and Next-Generation Probiotics on Non-Alcoholic Fatty Liver Disease (NAFLD) and Non-Alcoholic Steatohepatitis (NASH): A Systematic Review and Network Meta-Analysis.
Non-alcoholic fatty liver disease (NAFLD) and its progressive stage, non-alcoholic steatohepatitis (NASH), are becoming one of the most common chronic liver diseases globally. Lifestyle interventions such as weight reduction, increased physical activity, and maintaining healthy diets play a pivotal role in managing NAFLD/NASH. Recent studies suggest that the gut microbiome is associated with the pathogenesis of NAFLD/NASH, prompting microbiome-targeted therapy to emerge as a new therapeutic option for NAFLD/NASH. We conducted a systematic review based on the PRISMA statement and employed network meta-analysis to investigate the effects of traditional probiotics and next-generation probiotics (NGPs) on NAFLD/NASH. Comparative analysis reveals that traditional probiotics primarily reduce liver fat deposition and inflammation by improving gut microbiota composition, enhancing intestinal barrier function, and modulating immune responses. In contrast, NGPs demonstrate a more significant therapeutic potential, attributed to their direct effects on inhibiting oxidative stress and their ability to enhance the production of short-chain fatty acids (SCFAs), NGPs appear as a new potential strategy for the management of NAFLD/NASH through their dual action of directly inhibiting oxidative stress and enhancing SCFA production, highlighting the importance of understanding and utilizing the direct and indirect regulatory mechanisms of oxidative stress in the management of NAFLD/NASH.
PubMed: 38539862
DOI: 10.3390/antiox13030329 -
BMC Infectious Diseases Mar 2024Coronavirus disease 2019 (COVID-19) is frequntly accompanied by venous thromboembolism (VTE), and its mechanism may be related to the abnormal inflammation and immune... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Coronavirus disease 2019 (COVID-19) is frequntly accompanied by venous thromboembolism (VTE), and its mechanism may be related to the abnormal inflammation and immune status of COVID-19 patients. It has been proved that interleukin-6 (IL-6), ferritin and lactate dehydrogenase (LDH) may play an important role in the occurrence of VTE in COVID-19 infection. But whether they can server as predictors for VTE in COVID-19 is still unclear. In this study, we performed a systematic review and meta-analysis to compare IL-6, ferritin and LDH in VTE and non-VTE COVID-19 patients in order to shed light on the prevention and treatment of VTE.
METHODS
Related literatures were searched in PubMed, Embase, Web of Science, Google Scholar, China National Knowledge Infrastructure (CNKI), WANGFANG. COVID-19 patients were divided into VTE group and non-VTE group. Meta-analysis was then conducted to compare levels of IL-6, ferritin and LDH between the two groups.
RESULTS
We finally included and analyzed 17 literatures from January 2019 to October 2022. There was a total of 7,035 COVID-19 patients, with a weighted mean age of 60.01 years. Males accounted for 62.64% and 61.34% patients were in intensive care unit (ICU). Weighted mean difference (WMD) of IL-6, ferritin and LDH was 31.15 (95% CI: 9.82, 52.49), 257.02 (95% CI: 51.70, 462.33) and 41.79 (95% CI: -19.38, 102.96), respectively. The above results indicated that than compared with non-VTE group, VTE group had significantly higher levels of IL-6 and ferritin but similar LDH.
CONCLUSION
This systematic review and meta-analysis pointed out that elevated levels of IL-6 and ferritin were significantly possitive associated with VTE, thus could be used as biological predictive indicators of VTE among COVID-19 patients. However, no association was found between level of LDH and VTE. Therefore, close monitoring of changes in IL-6 and ferritin concentrations is of great value in assisting clinicans to rapidly identify thrombotic complications among COVID-19 patients, hence facilitating the timely effective managment. Further studies are required in terms of the clinical role of cytokines in the occurrence of VTE among COVID-19 infection, with more reliable systematic controls and interventional trials.
Topics: Male; Humans; Middle Aged; COVID-19; Interleukin-6; Venous Thromboembolism; Ferritins; L-Lactate Dehydrogenase
PubMed: 38493138
DOI: 10.1186/s12879-024-09205-3 -
Current Problems in Cardiology May 2024Heart failure is a clinical syndrome with different etiologies and phenotypes. For all forms, supervised exercise training and individual physical activity are class IA... (Meta-Analysis)
Meta-Analysis
A review regarding the article 'Supervised exercise training in heart failure with preserved ejection fraction: A systematic review and meta-analysis of randomized controlled trials'.
Heart failure is a clinical syndrome with different etiologies and phenotypes. For all forms, supervised exercise training and individual physical activity are class IA recommendations in current guidelines. Over the past two decades it has become recognized that physical deconditioning may play a key role in the progression of symptoms and poor outcomes. A number of prior studies have assessed the ability of exercise training to improve functional capacity in patients with HF. Most of these previous studies showed positive effects of exercise training on exercise capacity, quality of life, and biomarkers and observed relatively few complications during training. These studies also suggested that exercise training might improve survival and decrease HF hospitalizations. Despite the failure of pharmacological interventions to reduce mortality and hospitalization in HFpEF, exercise training has shown efficacy in improving maximal exercise capacity, assessed through peak oxygen consumption (peak V˙o2), in clinically stable patients. Nonetheless, there remains a safety concern regarding exercise training in HF. Although the complication rate for patients participating in cardiac rehabilitation has been reported to be extremely low, the complication rate for HF patients in clinical trials of exercise training has been substantially higher. One potential reason is the 100-fold increased risk for myocardial infarction and 50-fold increased risk of sudden death that exercisers, who are habitually sedentary, experience when initiating exercise training. Additionally, comprehensive insights into the potential effects of exercise training, not only on critical clinical outcomes such as hospitalization, mortality, and cardiovascular events but also on cost-effectiveness, require longer-term trials.
Topics: Humans; Heart Failure; Quality of Life; Exercise Therapy; Stroke Volume; Randomized Controlled Trials as Topic; Exercise; Exercise Tolerance
PubMed: 38492623
DOI: 10.1016/j.cpcardiol.2024.102518 -
Prostate Cancer and Prostatic Diseases Mar 2024This study supports a value-based approach to prostate cancer (PCa) treatment by systematically reviewing economic evaluations that compare the cost and... (Review)
Review
BACKGROUND
This study supports a value-based approach to prostate cancer (PCa) treatment by systematically reviewing economic evaluations that compare the cost and cost-effectiveness of low-dose-rate brachytherapy (LDR-BT) with that of other treatment options for localised and locally advanced PCa.
METHODS
Studies published between 2008 and 2023 were searched for in MEDLINE, EMBASE and Tufts Medical Center's Cost-Effectiveness Analysis (CEA) Registry (Prospero protocol CRD42023-442027). Two reviewers independently screened the title and abstracts based on agreed inclusion and exclusion criteria, followed by full-text screening. The Drummond checklist was used to critically appraise the quality of the included studies.
RESULTS
After screening 453 records, 36 were sought for retrieval and 14 eligible studies included. Of them, 11 compared treatments for low- and/or favourable intermediate-risk PCa, 2 compared options for unfavourable intermediate- and/or high-risk disease and 1 analysed treatments for both risk groups. Considerable heterogeneity was seen in the populations, perspectives, time horizons, costs and outcomes data used. If the oncological outcomes of standard treatment approaches are considered equivalent, LDR-BT was the most cost-effective type of radiation therapy (RT) in 9 (75%) of 12 studies, was more cost-effective than radical prostatectomy (RP) in 6 (67%) of 9 studies and, depending on the time horizon, was more cost-effective than active surveillance (AS) in 3 (60%) of 5 studies. LDR-BT was more cost-effective than high-dose-rate brachytherapy (HDR-BT) in all 4 (100%) of the studies that made this comparison and, overall, LDR-BT was the least costly of all active treatment options in 7 (50%) of the 14 studies.
CONCLUSION
The available health economic evidence suggests that LDR-BT has significant cost advantages and an important role to play in the delivery of value-based PCa care. In the future these advantages could be challenged if radiotherapy favours ultrahypofractionated strategies such as stereotactic body radiation therapy (SBRT) and reduced fractionation in HDR-BT.
PubMed: 38480973
DOI: 10.1038/s41391-024-00817-z -
JMIR MHealth and UHealth Mar 2024Home assessment is a critical component of successful home modifications, enabling individuals with functional limitations to age in place comfortably. A high-quality... (Review)
Review
BACKGROUND
Home assessment is a critical component of successful home modifications, enabling individuals with functional limitations to age in place comfortably. A high-quality home assessment tool should facilitate a valid and reliable assessment involving health care and housing professionals, while also engaging and empowering consumers and their caregivers who may be dealing with multiple functional limitations. Unlike traditional paper-and-pencil assessments, which require extensive training and expert knowledge and can be alienating to consumers, mobile health (mHealth) apps have the potential to engage all parties involved, empowering and activating consumers to take action. However, little is known about which apps contain all the necessary functionality, quality appraisal, and accessibility.
OBJECTIVE
This study aimed to assess the functionality, overall quality, and accessibility of mHealth home assessment apps.
METHODS
mHealth apps enabling home assessment for aging in place were identified through a comprehensive search of scholarly articles, the Apple (iOS) and Google Play (Android) stores in the United States, and fnd.io. The search was conducted between November 2022 and January 2023 following a method adapted from PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Reviewers performed a content analysis of the mobile app features to evaluate their functionality, overall quality, and accessibility. The functionality assessment used a home assessment component matrix specifically developed for this study. For overall quality, the Mobile Application Rating Scale (MARS) was used to determine the apps' effectiveness in engaging and activating consumers and their caregivers. Accessibility was assessed using the Web Content Accessibility Guidelines (WCAG) 2.1 (A and AA levels). These 3 assessments were synthesized and visualized to provide a comprehensive evaluation.
RESULTS
A total of 698 apps were initially identified. After further screening, only 6 apps remained. Our review revealed that none of the apps used thoroughly tested assessment tools, offered all the functionality required for reliable home assessment, achieved the "good" quality threshold as measured by the MARS, or met the accessibility criteria when evaluated against WCAG 2.1. However, DIYModify received the highest scores in both the overall quality and accessibility assessments. The MapIt apps also showed significant potential due to their ability to measure the 3D environment and the inclusion of a desktop version that extends the app's functionality.
CONCLUSIONS
Our review revealed that there are very few apps available within the United States that possess the necessary functionality, engaging qualities, and accessibility to effectively activate consumers and their caregivers for successful home modification. Future app development should prioritize the integration of reliable and thoroughly tested assessment tools as the foundation of the development process. Furthermore, efforts should be made to enhance the overall quality and accessibility of these apps to better engage and empower consumers to take necessary actions to age in place.
Topics: Humans; Aged; United States; Mobile Applications; Independent Living; Telemedicine
PubMed: 38466987
DOI: 10.2196/52996 -
The Patient Jul 2024Compared with early stages (eBC) metastatic BC (mBC) is incurable. In mBC, aggressive treatment may increase the duration of survival but may also cause severe treatment...
INTRODUCTION
Compared with early stages (eBC) metastatic BC (mBC) is incurable. In mBC, aggressive treatment may increase the duration of survival but may also cause severe treatment side effects. A better understanding how patients with BC value different aspects of drug therapy might improve treatment effectiveness, satisfaction and adherence. This systematic review aims to identify and summarise studies evaluating patient preferences for drug therapy of BC and to compare preferences of patients with eBC and mBC.
METHODS
The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The electronic databases PubMed and Web of Science were searched on 22 June 2023. All studies published to this point were considered. Original studies reporting patient preferences on BC drug therapy determined by any type of choice experiment were eligible. A narrative synthesis of the effect measures presented as relative importance ratings, trade-offs (required benefit to make a therapy worthwhile) or monetary values of the treatment attributes was reported for each study. Risk of bias assessment for individual studies was performed using the checklist for observational studies from the STROBE Statement and the checklist from 'Conducting Discrete Choice Experiments to Inform Healthcare Decision Making: A User's Guide'. The study protocol was registered at the PROSPERO database (CRD42022377031).
RESULTS
A total of 34 studies met the inclusion criteria were included in the analysis evaluating the preferences of patients with eBC (n = 18), mBC (n = 10) or any stage BC (n = 6) on, for example, chemotherapy, endocrine therapy, hormonal therapy or CKD4/6-inhibitors using different types of choice experiments. Regardless of the stage, most patients valued treatment effectiveness in terms of survival gains higher than potential adverse drug reactions (ADRs). Treatment cost, mode of administration, treatment regimen and monitoring aspects were considered as least important treatment attributes. In addition, preferences concerning 16 different types of ADRs were described, showing high heterogeneity within BC stages. Yet, comparable results across BC stages were observed.
CONCLUSIONS
Regardless of the stage, patients with BC consistently valued survival gains as the most important attribute and were willing to accept the risk of potential ADRs. Incorporating patient preferences in shared decision making may improve the effectiveness of interventions by enhancing adherence to drug therapy in patients suffering from BC.
Topics: Humans; Patient Preference; Breast Neoplasms; Female; Neoplasm Staging; Antineoplastic Agents; Neoplasm Metastasis
PubMed: 38451419
DOI: 10.1007/s40271-024-00679-6 -
Frontiers in Oncology 2024Acute lymphocytic leukemia is a hematological malignancy that primarily affects children. Long-term chemotherapy is effective, but always causes different toxic side... (Review)
Review
Acute lymphocytic leukemia is a hematological malignancy that primarily affects children. Long-term chemotherapy is effective, but always causes different toxic side effects. With the application of a chemotherapy-free treatment strategy, we intend to demonstrate the most recent results of using one type of epigenetic drug, histone deacetylase inhibitors, in ALL and to provide preclinical evidence for further clinical trials. In this review, we found that panobinostat (LBH589) showed positive outcomes as a monotherapy, whereas vorinostat (SAHA) was a better choice for combinatorial use. Preclinical research has identified chidamide as a potential agent for investigation in more clinical trials in the future. In conclusion, histone deacetylase inhibitors play a significant role in the chemotherapy-free landscape in cancer treatment, particularly in acute lymphocytic leukemia.
PubMed: 38450195
DOI: 10.3389/fonc.2024.1324859 -
JMIR MHealth and UHealth Mar 2024Mobile health interventions delivered through mobile apps are increasingly used in physiotherapy care. This may be because of the potential of apps to facilitate changes...
BACKGROUND
Mobile health interventions delivered through mobile apps are increasingly used in physiotherapy care. This may be because of the potential of apps to facilitate changes in behavior, which is central to the aims of care delivered by physiotherapists. A benefit of using apps is their ability to incorporate behavior change techniques (BCTs) that can optimize the effectiveness of physiotherapeutic interventions. Research continues to suggest that despite their importance, behavior change strategies are often missing in patient management. Evaluating mobile apps that physiotherapists can use to drive behavior change may inform clinical practice and potentially improve patient outcomes. Examining the quality of apps and exploring their key features that can support behavior change and physiotherapy care are important aspects of such an evaluation.
OBJECTIVE
The primary aim of this study was to describe the range of mobile apps in app stores that are intended for use by patients to support physiotherapy care. The secondary aims were to assess app quality, BCTs, and their behavior change potential.
METHODS
A systematic review of mobile apps in app stores was undertaken. The Apple App Store and Google Play were searched using a 2-step search strategy, using terms relevant to the physiotherapy discipline. Strict inclusion and exclusion criteria were applied: apps had to be intended for use by patients and be self-contained (or stand-alone) without the requirement to be used in conjunction with a partner wearable device or another plugin. Included apps were coded for BCTs using the Behavior Change Technique Taxonomy version 1. App quality was assessed using the Mobile App Rating Scale, and the App Behavior Change Scale was used to assess the app's potential to change behavior.
RESULTS
In total, 1240 apps were screened, and 35 were included. Of these 35 apps, 22 (63%) were available on both the Apple App Store and Google Play platforms. In total, 24 (69%) were general in their focus (eg, not condition-specific), with the remaining 11 (31%) being more specific (eg, knee rehabilitation and pelvic floor training). The mean app quality score (Mobile App Rating Scale) was 3.7 (SD 0.4) of 5 (range 2.8-4.5). The mean number of BCTs identified per app was 8.5 (SD 3.6). BCTs most frequently included in the apps were instruction on how to perform a behavior (n=32), action planning (n=30), and self-monitoring of behavior (n=28). The mean behavior change potential score (App Behavior Change Scale) was 8.5 (SD 3.1) of 21 (range 3-15).
CONCLUSIONS
Mobile apps available to support patient care received from a physiotherapist are of variable quality. Although they contain some BCTs, the potential for behavior change varied widely across apps.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
RR2-10.2196/29047.
Topics: Humans; Behavior Therapy; Mobile Applications; Patients; Telemedicine
PubMed: 38437018
DOI: 10.2196/55003 -
PloS One 2024Effective nutrition management is fundamental in the comprehensive treatment of individuals with type 2 diabetes. Various strategies have been explored in this regard,...
BACKGROUND
Effective nutrition management is fundamental in the comprehensive treatment of individuals with type 2 diabetes. Various strategies have been explored in this regard, demonstrating their potential usefulness in improving clinical outcomes. This systematic review aims to assess the impact of meals frequency on the well-being of these patients.
METHODS AND FINDINGS
In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, PubMed, Embase, Web of Science, Cochrane Library, and Google Scholar databases were searched until July 10th, 2023. We included studies from the last 10 years in people with type 2 diabetes that had an intervention regarding their meal frequency. The risk of bias was evaluated based on the Cochrane tool according to the type of study. Of 77 retrieval articles, 13 studies matched our inclusion criteria. The primary focus of each study was to evaluate glycemic control as the major outcome. Studies suggest that meal frequency, time-restricted feeding, breakfast skipping, bedtime snacking, and chrononutrition practices all play roles in type 2 diabetes management and risk.
CONCLUSIONS
Restricting feeding to 2 to 3 meals per day and practicing time restricted feeding with less than 10 hours of daily food intake promotes weight loss and glycemic control in patients with type 2 diabetes. Aligning food consumption with the body's natural rhythm is beneficial, whereas skipping breakfast disrupts this rhythm. Snacking after evening or waiting 3-4 hours after meal helps control glucose levels, but consuming pre-bedtime snacks do not provide the same benefits.
PROSPERO REGISTRATION NUMBER
CRD42023431785.
Topics: Humans; Diabetes Mellitus, Type 2; Meals; Snacks; Breakfast; Databases, Factual
PubMed: 38421977
DOI: 10.1371/journal.pone.0298531 -
Multiple Sclerosis and Related Disorders Apr 2024EBV is a necessary but not sufficient factor in the pathophysiology of multiple sclerosis (MS). EBV antibodies to the nuclear antigen (EBNA1) and viral capsid antigen... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
EBV is a necessary but not sufficient factor in the pathophysiology of multiple sclerosis (MS). EBV antibodies to the nuclear antigen (EBNA1) and viral capsid antigen (VCA) rise rapidly prior to MS disease manifestations, and their absence has clinical utility with a high negative predictive value. It remains unclear whether EBV levels act as prognostic, monitoring, or pharmacodynamic/response biomarkers. Substantial literature on this topic exists but has not been systematically reviewed. We hypothesized that EBV levels against EBNA1 and VCA are potential prognostic and monitoring biomarkers in MS, and that patient population, MS clinical phenotype, and EBV assay method may play important roles in explaining variation among study outcomes.
METHODS
We systematically searched PubMed and EMBASE from inception to April 1, 2022. After removal of duplicates, records were screened by abstract. Remaining full-text articles were reviewed. Clinical and MRI data were extracted from full-text articles for comparison and synthesis.
RESULTS
Searches yielded 696 unique results; 285 were reviewed in full, and 36 met criteria for data extraction. Heterogeneity in sample population, clinical outcome measures, assay methods and statistical analyses precluded a meta-analysis. EBV levels were not consistently associated with clinical disease markers including conversion from CIS to RRMS, neurological disability, or disease phenotype. Studies using repeated-measures design suggest that EBNA1 levels may temporarily reflect inflammatory disease activity as assessed by gadolinium-enhancing Magnetic Resonance Imaging (MRI) lesions. Limited data also suggest a decrease in EBV levels following initiation of certain disease-modifying therapies.
CONCLUSION
Heterogeneous methodology limited generalization and meta-analysis. EBV antibody levels are unlikely to represent prognostic biomarkers in MS. The areas of highest ongoing promise relate to diagnostic exclusion and pharmacodynamic/disease response. Use of EBV antibodies as biomarkers in clinical practice remains additionally limited by lack of methodological precision, reliability, and validation.
Topics: Humans; Herpesvirus 4, Human; Epstein-Barr Virus Infections; Reproducibility of Results; Multiple Sclerosis; Antigens, Viral; Antibodies, Viral; Biomarkers; Capsid Proteins; Epstein-Barr Virus Nuclear Antigens
PubMed: 38401201
DOI: 10.1016/j.msard.2023.105410