Aim: High-impact infectious diseases pose major global health challenges, underscoring the urgent need for robust public health preparedness. Despite efforts to improve global health security, recent pandemics have revealed significant weaknesses in health systems’ preparedness and response capabilities.
Methods: We reviewed and synthesized key strategies and lessons from existing public health preparedness plans for high-impact infectious diseases. This included examining national and global plans, focusing on strategic approaches, evidence integration, and real-world implementation lessons. A narrative synthesis, based on the Public Health Emergency Preparedness (PHEP) model, identified effective practices and areas needing improvement.
Results: We screened 1987 documents, selecting 38 for detailed analysis. Findings highlighted strategies for long-term health emergency preparedness, workforce development, enhancing global health frameworks, and investing in infrastructure. Challenges included maintaining laboratory detection, managing sentinel surveillance, and logistical issues. Effective approaches emphasized early threat detection, rapid response, healthcare capacity, medical supply management, and strategic communication.
Conclusions: Effective public health preparedness for high-impact infectious diseases requires a coordinated approach, including early threat detection, rapid response, robust healthcare systems, and strategic communication. Past outbreaks show the need for continuous investment, evidence-based policies, and adaptable health systems. Future research should assess ongoing preparedness efforts and implementation challenges.
Background: Airway management during the perioperative period is a vital component of perioperative care. However, there is a lack of consensus on the selection of medications, timing of administration, and the management of airway complications. This consensus aimed to promote a more rational and standardized application of airway management medications.
Methods: Clinical medical and pharmaceutical experts were invited to participate in this study using the modified Delphi method. Participants completed two rounds of online surveys, with the second round based on the responses from the first round.
Results: Participants (n = 42) reached a consensus on 11 clinical issues and formed 11 recommendations for clinical practice, each with a consensus degree of more than 80%. The recommendations covered aspects of preoperative, intraoperative, and postoperative risk factors evaluation, along with crucial points of medication monitoring in preventing and treating perioperative pulmonary complications.
Conclusions: The modified Delphi method resulted in consensus recommendations for the perioperative physician–pharmacist airway co-management. We hope this consensus will prevent pulmonary complications and improve patient outcomes through collaborative discussions between physicians and pharmacists.
Objective: Tic disorders are neurodevelopmental conditions that manifest in childhood or adolescence and can significantly impact the quality of life of affected children and their families to varying degrees. Integrated traditional Chinese and Western medicine treatment strategies have demonstrated more pronounced efficacy and better safety profiles. However, there is currently no standardized clinical expert consensus on this approach. To address this, the National Administration of Traditional Chinese Medicine initiated a project, and the China Association of Chinese Medicine assembled a team of authoritative domestic experts to develop this expert consensus, aiming to provide practical and feasible integrated treatment strategies for clinical practice.
Methods: This consensus identified clinical issues through research, conducted literature reviews, and established evidence based on systematic evaluations. Expert surveys, two rounds of Delphi questionnaires, and expert consensus meetings were conducted to formulate a series of recommendations.
Results: We established a multidisciplinary consensus development panel. Based on systematic literature reviews, Delphi questionnaires, and consensus meetings, ten clinical issues were identified. Ultimately, a series of recommendations were developed, considering the balance of benefits and risks, the certainty of evidence, clinical feasibility, accessibility, and clinical acceptability.
Conclusions: These recommendations comprehensively address key issues in the field of integrated traditional Chinese and Western medicine treatment, including indications for the use of Chinese or Western medicine alone or in combination, specific treatment protocols, methods for dose reduction and discontinuation, evaluation intervals, and the management of adverse reactions.
Aim: The development of artificial intelligence (AI) for traditional Chinese medicine (TCM) has played an important role in clinical decision-making, mainly reflected in the intersectionality and variability of symptoms, syndromes, and patterns for TCM multiple diseases holistic differentiation (MDHD). This study aimed to develop a TCM AI method and system for clinical decisions more transparent with explainable structural framework.
Methods: This study developed the TCM syndrome elements integration with priori rule and deep learning (TCM-SEI-RD) method and TCM-MDHD system by high-quality expert knowledge datasets, to predict various TCM syndromes and patterns in hierarchical modules. TCM-BERT-CNN model fused the BERT with CNN model capture feature-related sequence, as the benchmark model in the TCM-SEI-RD method, to improve the performance of predicting TCM syndrome elements. The framework of the TCM-MDHD system involved the TCM-SEI-RD method and TCM “diseases—syndromes—patterns” benchmark sequences, to provide distributed results with credibility.
Results: For predicting results to the overall TCM syndrome elements, the TCM-SEI-RD achieves 95.4%, 94.43%, and 94.89% in precision, recall, and F1 score, respectively, and 3.33%, 2.28%, and 2.81% improvement over the benchmark model. TCM-MDHD system demonstrates credibility grading at each stage in various diseases and uses the practical example to illustrate the process of distributed decision-making results and transparency with credibility.
Conclusions: Our method and system, as the general AI technologies for TCM syndromes and patterns diagnosis in multiple diseases, can provide the clinical diagnostic basis with the best performance for the TCM preparations rational use, and distribute interpretability to the clinical decision-making process.
Aim: This study aimed to develop and evaluate an automated large language model (LLM)-based system for assessing the quality of medical imaging guidelines and consensus (GACS) in different languages, focusing on enhancing evaluation efficiency, consistency, and reducing manual workload.
Method: We developed the QPC-HASE-GuidelineEval algorithm, which integrates a Four-Quadrant Questions Classification Strategy and Hybrid Search Enhancement. The model was validated on 45 medical imaging guidelines (36 in Chinese and 9 in English) published in 2021 and 2022. Key evaluation metrics included consistency with expert assessments, hybrid search paragraph matching accuracy, information completeness, comparisons of different paragraph matching approaches, and cost-time efficiency.
Results: The algorithm demonstrated an average accuracy of 77%, excelling in simpler tasks but showing lower accuracy (29%–40%) in complex evaluations, such as explanations and visual aids. The average accuracy rates of the English and Chinese versions of the GACS were 74% and 76%, respectively (p = 0.37). Hybrid search demonstrated superior performance with paragraph matching accuracy (4.42) and information completeness (4.42), significantly outperforming keyword-based search (1.05/1.05) and sparse-dense retrieval (4.26/3.63). The algorithm significantly reduced evaluation time to 8 min and 30 s per guideline and reduced costs to approximately 0.5 USD per guideline, offering a considerable advantage over traditional manual methods.
Conclusion: The QPC-HASE-GuidelineEval algorithm, powered by LLMs, showed strong potential for improving the efficiency, scalability, and multi-language capability of guideline evaluations, though further enhancements are needed to handle more complex tasks that require deeper interpretation.
Aims: Metabolic dysfunction associated steatotic liver disease (MASLD) is a universal hepatic disease, and many recent randomized clinical trials (RCTs) have explored whether hypoglycemic agents may be beneficial for its treatment. This study aimed to assess the relative effectiveness of each hypoglycemic agent for MASLD.
Methods: China National Knowledge Infrastructure（CNKI）, WanFang, Weipu, PubMed, Embase, The Cochrane Library, and Web of Science Core Collection were searched for RCTs on the efficacy of hypoglycemic agents in MASLD published up to December 31, 2024. All statistical analyses were performed using R version 4.3.3. The network meta-analysis was conducted using Bayesian statistical methods.
Results: A total of 26 hypoglycemic agents for treating MASLD in 37 studies with 2406 participants were included. Empagliflozin was most effective in improving liver stiffness measurement (LSM), whereas liraglutide showed significant benefits in body weight, body mass index (BMI), and waist circumference. Both sodium-glucose co-transporter 2 (SGLT-2) inhibitors (e.g., empagliflozin) and glucagon-like peptide-1 (GLP-1) receptor agonists (e.g., liraglutide) improved liver enzymes (alanine aminotransferase [ALT], aspartate aminotransferase [AST], gamma-glutamyltransferase [GGT]), glucose metabolism (fasting plasma glucose [FPG], and homeostasis model assessment of insulin resistance [HOMA-IR]), and lipid profiles. Pioglitazone had limited benefits in these outcomes. Secondary outcomes such as inflammatory markers and fibrosis showed minimal changes.
Conclusions: Several hypoglycemic agents can improve laboratory and imaging indicators in adult patients with MASLD. Liraglutide is more effective than other agents, whereas empagliflozin emerged as the most effective for reducing LSM. However, different agents have different effects on the indicators; therefore, the relevant agents must be selected according to the specific patient condition.
Objective: The use of external controls in clinical trials can reduce sample size and increase efficiency. Propensity score (PS)-integrated Bayesian borrowing methods discount external controls based solely on prior-data conflict or covariate similarity. We aim to propose a PS-integrated Bayesian proactive dynamic borrowing method that simultaneously considers the similarity of covariates and outcomes and to evaluate its performance under various biases through simulations.
Methods: Using a two-stage strategy, covariates were balanced via the PS during the design phase, independent of outcomes. In the analysis phase, Power Prior, Elastic Prior, and Mixture Prior with the random discounting parameter were adopted. We proposed a weakly informative initial prior, using the PS overlap between concurrent and external controls as its mean. It was compared to competitors under selection bias, unmeasured confounders, measurement errors (in covariates and outcomes), and effect drift.
Results: Under selection bias, our approach outperformed using Bayesian dynamic borrowing alone. Compared with the discounting parameter fixed at the PS overlap, it exhibited better control of bias and the Type I error rate. Compared with the noninformative uniform prior, it yielded higher power and a narrower 95% credible interval. However, under other biases, it and other PS-integrated Bayesian borrowing methods exhibited undesirable control of bias and the Type I error rate.
Conclusions: Our approach has an advantage in borrowing external controls with selection bias. However, biases that severely affect PS estimation and outcomes can undermine the performance of PS-integrated Bayesian borrowing methods, particularly those that rely solely on covariate similarity for discounting.
Aim: Chronic obstructive pulmonary disease (COPD) is a critical disease, with lung function closely linked to disease severity. This study aimed to evaluate the clinical efficacy of treatments for stable COPD in patients with pulmonary function Grades I and II.
Patients and Methods: We conducted a multicenter, randomized, double-blind, placebo-controlled trial (registration number: NCT01486186). A total of 502 patients were randomly assigned to an experimental group (n = 251, treated with Bufei, Bufei Jianpi, and Bufei Yishen granules based on traditional Chinese medicine [TCM] syndromes) and a control group (n = 251, treated with a Chinese medicine-based placebo). Acute exacerbations (AEs), lung function, clinical symptoms, 6-min walking distance (6MWD), and dyspnea were assessed over 12 months of treatment and 12 months of follow-up.
Results: A total of 432 patients, including 214 and 218 patients in the experimental and control groups, respectively, completed the trial. The early treatment group had fewer AEs (p < 0.05), better clinical symptom scores (p < 0.05), longer 6MWD (p < 0.05), and better Modified Medical Research Council (mMRC) scores than the control group (p < 0.05). No significant differences were found in forced vital capacity (FVC) and forced expiratory volume in first second (FEV1%) between the two groups, but there was a significant difference in FEV1 and the annual rate of FEV1 decline between the groups over 2 years (p < 0.05).
Conclusion: Treatment with TCM for stable COPD significantly reduced AEs, increased the 6MWD, and alleviated dyspnea in patients with pulmonary function Grades I and II. FEV1 was improved, and the slower FEV1 decline indicates a potential benefit in mitigating disease progression.
Aim: Chronic Obstructive Pulmonary Disease (COPD) is a common chronic airway disease that can lead to decreased lung function in patients. It places a heavy economic burden on patients and society. Traditional Chinese medicine (TCM) and Western medicine have played important roles in managing COPD. We aimed to develop an evidence-based guideline for treating COPD with Chinese and Western Medicine.
Methods: We formed a guideline panel of multidisciplinary experts. The clinical questions were identified based on two rounds of issue solicitation and expert demonstration. We searched the literature for direct evidence on the management of COPD and assessed its certainty-generated evidence using the grading of recommendations, assessment, development, and evaluation (GRADE) approach. The recommendations and their strengths were formulated using the Delphi method.
Results: Our guideline covers aspects of the diagnosis and treatment of COPD such as principles and commonly used medications for both traditional Chinese medicine and Western medicine, complications, and the high-risk populations. 9 clinical questions and 35 recommendations were identified, which covered the combinations of YuPingFeng granule, Buzhong Yiqi decoction, Gushen Dingchuan Pill, Bufei Huoxue Capsules, Runfei cream, Bailing Capsule, Tanyin Pills, etc., and nonpharmacological therapy of TCM such as combined acupoint application, electroacupuncture, and Chinese exercise techniques (Tai Chi, Baduanjin), etc. Recommendations were either high or low or in the form of ungraded consensus-based statements.
Conclusions: This is a comprehensive and systematic evidence-based guideline and we hope it can systematically and effectively guide clinicians in managing COPD and improve overall medical care.
Families constitute important settings for the nutritional management of older adults, and there is a growing demand for continuous nutritional management services extending from hospital care to home-based care. Since the publication of the Chinese Expert Consensus on Home Nutrition Administration for the Elderly (2017 Edition) 7 years ago, accumulating research evidence and practical experience in home-based nutritional management has highlighted an urgent need for updating this consensus. In this revised edition, a total of 35 recommendations and expert consensus statements have been proposed to guide community-based health professionals in delivering scientifically sound, rational, and standardized home nutritional management services to elderly populations residing at home or within community settings.
Objective: This study aimed to evaluate the effectiveness of various formulas and the ability of breastfeeding with the exclusion of cow milk protein to reduce the Scoring Atopic Dermatitis (SCORAD) index and promote growth in infants with cow milk protein allergy.
Methods: We conducted a systematic search of PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, China National Knowledge Infrastructure, WanFang Data, Weipu, and the China Biomedical Literature Database. The search period ranged from the inception of each database to December 2023 (with an update until January 15, 2025). We included randomized controlled trials (RCTs) comparing formulas and breastfeeding for cow's milk protein allergy in infants. Two independent reviewers extracted data via standardized methods and assessed the risk of bias via the revised Cochrane risk-of-bias 2.0 tool. We performed a network meta-analysis (NMA) via a Bayesian fixed-effects model in RStudio and assessed the certainty of the evidence via the Confidence in Network Meta-Analysis (CINeMA) online application. The protocol for this NMA was preregistered in PROSPERO (No. CRD42024504707).
Results: This analysis included 23 RCTs involving 1997 children and assessed 12 interventions. Compared with the regular formula, the pectin-thickened amino acid formula (TAAF) might reduce the SCORAD index (−12.49, 95% confidence interval [CI] −20.38 to −4.48, low certainty). At ≤6 months of follow-up, compared with rice-hydrolyzed formula (RHF), breastfeeding might improve the length-for-age Z score (LAZ) (0.47, 95% CI 0.13–0.81, moderate certainty), and breastfeeding (0.39, 95% CI 0.02–0.77, low certainty) and extensively hydrolyzed formula (EHF) with probiotics (0.38, 95% CI 0.00–0.77, low certainty) might respectively improve the weight-for-age Z score (WAZ) and weight-for-length Z score (WLZ). At the 12-month follow-up, EHF might improve the LAZ (0.41, 95% CI 0.11–0.71, low certainty) and WLZ (0.37, 95% CI 0.18–0.56, low certainty) compared with RHF, whereas the amino acid formula (AAF) may improve the WAZ (0.33, 95% CI 0.02–0.63, low certainty).
Conclusions: Low-certainty evidence suggested that TAAF might reduce the SCORAD index. Moderate or low certainty evidence indicated that, at ≤6 months of follow-up, breastfeeding might improve the LAZ and WAZ, whereas EHF with probiotics might improve the WLZ. At the 12-month follow-up, EHF might improve the LAZ and WLZ, whereas AAF might improve the WAZ. However, further high-quality studies would be needed to confirm these findings and assess their safety and cost-effectiveness.
Aim: Breast cancer imposes a serious disease and economic burden on patients. This guideline aims to develop a living evidence-based clinical practice recommendations to guide the use of integrative therapies for the improvement of patient-reported outcomes (PROs) in breast cancer survivors.
Methods: We searched systematic reviews and meta-analyses or conducted de nova systematic reviews and meta-analyses to support the recommendations. The grading of recommendations, assessment, development, and evaluation approach was used to rate the certainty of evidence and the strength of recommendations.
Results: The guideline panel issued 17 recommendations: for alleviating anxiety, strong recommendations in favor of muscle relaxation training, yoga, acceptance and commitment therapy, cognitive behavioral therapy, psychological education, and Tai Chi in general breast cancer survivors; for alleviating depression, strong recommendations in favor of mindfulness therapy, cognitive behavioral therapy, group psychotherapy, muscle relaxation training, acceptanceand commitment therapy in general breast cancer survivors, and exercise intervention for patients received radiotherapy; for sleep quality, conditional recommendations for all therapies; for pain, strong recommendations in favor of exercise intervention for postoperative breast cancer survivors; for alleviating fatigue, strong recommendations in favor of mindfulness therapy and group psychotherapy in general breast cancer survivors; for improving the quality of life, strong recommendations in favor of mindfulness therapy in general breast cancer survivors, Baduanjin and exercise intervention for patients undergoing anticancer treatment.
Conclusion: This proposed guideline provides recommendations for improving the PROs of breast cancer survivors. We hope these recommendations can help support practicing physicians and other healthcare providers for breast cancer survivors.
Aim: This study aims to synthesize current meta-analyses to propose a potentially existing association between diabetes and hearing impairment (HI), elevating their relationship to “high” level of evidence.
Methods: A systematic search was performed in 9 databases up to March 31, 2025. The pooled results were synthesized to elucidate the direction and magnitude of the effects. We used the AMSTAR-2 scale to assess study quality and the GRADE tool to assess the certainty of the evidence. Subgroup analysis was conducted according to age (PROSPERO-ID: CRD42024606416).
Results: This umbrella review comprehensively encompassed over 22 million participants from more than 226 studies. After screening, 21 studies were finally included. Primary outcomes showed that individuals with HI were at a higher risk of developing diabetes, referring to [odds ratio (OR) = 1.88, 95% confidence interval (CI): (1.01, 3.50)] with moderate evidence certainty. Simultaneously, participants with diabetes exhibited a more prevalent occurrence of HI. Higher pure tone audiometric thresholds, lower distortion product otoacoustic emission amplitudes, and increased auditory brainstem-evoked response latency time collectively indicated an increased risk of HI associated with diabetes. Subgroup analysis results revealed that in the younger population, the association between HI and diabetes risk is also high.
Conclusions: Overall, the current body of evidence underscores a latent bidirectional association between diabetes and HI, coupled with mutually aggravating effects. Our findings suggest that HI may serve as an indicator of the risk of developing diabetes.
Integrating Traditional Chinese Medicine (TCM) and Modern Medicine faces significant barriers, including the absence of unified frameworks and standardized diagnostic criteria. While Large Language Models (LLMs) in Medicine hold transformative potential to bridge these gaps, their application in integrative medicine remains underexplored and methodologically fragmented. This review systematically examines LLMs' development, deployment, and challenges in harmonizing Modern and TCM practices while identifying actionable strategies to advance this emerging field. This review aimed to provide insight into the following aspects. First, it summarized the existing LLMs in the General Domain, Modern Medicine, and TCM from the perspective of their model structures, number of parameters and domain-specific training data. We highlighted the limitations of existing LLMs in integrative medicine tasks through benchmark experiments and the unique applications of LLMs in Integrative Medicine. We discussed the challenges during the development and proposed possible solutions to mitigate them. This review synthesizes technical insights with practical clinical considerations, providing a roadmap for leveraging LLMs to bridge TCM's empirical wisdom with modern medical systems. These AI-driven synergies could redefine personalized care, optimize therapeutic outcomes, and establish new standards for holistic healthcare innovation.
Aim: Implementing evidence-based practice (EBP) is a complex process requiring healthcare providers to integrate evidence-based medicine (EBM) into clinical practice, ultimately improving clinical outcomes. This systematic review examined the sources of information for EBP, analyzed the extent of EBP implementation by healthcare providers, and explored the factors influencing EBP in Africa.
Methods: We identified articles published between January 1992 and March 2024 by searching Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMbase, PubMed, and Scopus databases. The pooled effect sizes for the prevalence of EBP and odds ratios (ORs) were estimated using random- and fixed-effects models as appropriate. For the qualitative component of the study, we performed a thematic analysis and subsequently integrated and interpreted findings from both the quantitative and qualitative analyses.
Results: Thirty-three studies were included in this review, involving 9722 healthcare providers: 60.3% nurses, 15.9% physicians, and 15.4% midwives. Our findings revealed a lack of detailed information on how healthcare providers utilized different forms of EBM to inform EBP and clinical outcomes in Africa. Self-reported EBP was 57.3% among nurses and 37.3% among physicians. Nigeria had the highest self-reported EBP (75.2%), whereas Egypt had the lowest (18.9%). Common sources of information reported for EBP were PubMed, UpToDate, the Cochrane Library, clinical guidelines, and training programs. Factors associated with EBP included knowledge of EBP (OR = 2.13, 95% confidence interval [CI]: 1.83–2.47), positive attitude toward EBP (OR = 1.95, 95% CI: 1.76–2.15), and having EBM training (OR = 3.08, 95% CI: 2.08–4.57), and a managerial role (OR = 2.16, 95% CI: 1.37–3.41). The availability of guidelines (OR = 1.88, 95% CI: 1.5–2.37) and internet access (OR = 1.90, 95% CI: 1.54–2.34) were also found to increase EBP. Our qualitative analysis identified common barriers to EBP, including a lack of support, resistance to change, poor communication, and failure to integrate EBP courses into the continuing education curricula.
Conclusion: This systematic review found limited information on the sources of EBM, how it was delivered, and its frequency of use in clinical practice. Thus, the correlation between EBM, EBP, and clinical outcomes was not fully transparent. Further studies are required to examine the medical conditions addressed within providers’ scopes of practice, the types of evidence utilized, the frequency and consistency of EBP implementation, and its effect on enhancing patient outcomes.
Objective: To assess the knowledge, attitudes, and practices (KAP) of medical stakeholders regarding the use of generative artificial intelligence (GAI) tools.
Methods: A cross-sectional survey was conducted among stakeholders in medicine. Participants included researchers, clinicians, and medical journal editors with varying degrees of familiarity with GAI tools. The survey questionnaire comprised 40 questions covering four main dimensions: basic information, knowledge, attitudes, and practices related to GAI tools. Descriptive analysis, Pearson's correlation, and multivariable regression were used to analyze the data.
Results: The overall awareness rate of GAI tools was 93.3%. Participants demonstrated moderate knowledge (mean score 17.71 ± 5.56), positive attitudes (mean score 73.32 ± 15.83), and reasonable practices (mean score 40.70 ± 12.86). Factors influencing knowledge included education level, geographic region, and attitudes (p < 0.05). Attitudes were influenced by work experience and knowledge (p < 0.05), while practices were driven by both knowledge and attitudes (p < 0.001). Participants from outside China scored higher in all dimensions compared to those from China (p < 0.001). Additionally, 74.0% of participants emphasized the importance of reporting GAI usage in research, and 73.9% advocated for naming the specific tool used.
Conclusion: The findings highlight a growing awareness and generally positive attitude toward GAI tools among medical stakeholders, alongside the recognition of their ethical implications and the necessity for standardized reporting practices. Targeted training and the development of clear reporting guidelines are recommended to enhance the effective use of GAI tools in medical research and practice.
Objectives: To evaluate the relationship between socioeconomic status (SES), lifestyle factors, and their combined impact on chronic respiratory diseases (CRDs).
Methods: Participants were from the UK Biobank and were categorized into SES groups using latent class analysis based on family income, education, and employment status. Lifestyle factors were assessed via 24-hour dietary recalls and structured questionnaires. Each criterion scored 1 (healthy) or 0 (unhealthy), creating a total score from 0 to 4. Multivariable Cox proportional hazards models, interaction analyses, and mediation analyses were conducted.
Results: Among 296,731 participants, 12,128 (4.1%) participants were diagnosed with CRDs. Among low SES groups, healthy lifestyle groups with scores 2, 1, and 0 showed significantly increased hazard ratios of 1.32 (95% CI: 1.21–1.44), 1.77 (95% CI: 1.63–1.93) and 2.36 (95% CI: 2.15–2.60) compared with the healthy lifestyle scores ≥3. The combined effect of SES and healthy lifestyle increased the risk of CRDs by 15% over the risk expected from simply adding their respective effects. The proportion of SES on CRDs incidence mediated by healthy lifestyle factors was statistically significant (p < 0.001), accounting for about 2%.
Conclusions: The risk of incident CRDs in the low SES population with an unhealthy lifestyle increased by 32%–136%. Unhealthy lifestyles significantly affect the incidence of CRDs in different SES subgroups. About 2% of the risk between SES and incident CRDs was mediated by lifestyle factors. These findings highlight the importance of addressing socioeconomic disparities and unhealthy lifestyle behaviors in public health strategies aimed at preventing CRDs.
Objective: To evaluate the efficacy and safety of paclitaxel-based regimens, including traditional Chinese medicine (TCM) combinations, for the treatment of triple-negative BC (TNBC) using a network meta-analysis.
Methods: PubMed, EMBASE, The Cochrane Library, Web of Science, CNKI, CBM, VIP, WanFang database were searched comprehensively from inception to February 27, 2025. Eligible studies included adult TNBC patients treated with paclitaxel alone or in combination with other therapies. Outcomes included objective response rate (ORR), overall survival (OS), progression-free survival, pathologic complete response, disease-free survival, and adverse events (AEs). Statistical analyses were performed using the frequentist contrast-based method and random effects model. The Grading of Recommendations, Assessment, Development, and Evaluation approach using CINeMA application and a modified Cochrane Risk of Bias Tool were used to assess the certainty of evidence and methodological quality.
Results: 93 randomized controlled trials (108 publications) involving 19,016 patients were included. Paclitaxel-based quadruple and quintuple therapies significantly improved ORR (relative risk (RR) = 1.74, 95% confidence interval (CI) [1.39–2.71], low certainty of evidence) and OS duration (weighted mean difference (WMD) = 59.16 weeks, 95% CI [28.81–89.51], low) compared to monotherapy. Paclitaxel-based monotherapy and double therapy had the least potential to cause neutropenia. Regimens incorporating TCM showed superior ORR compared to non-TCM combinations and monotherapy (18 randomized controlled trials, 1570 patients; RR = 1.29. 95% CI [1.17–1.41], moderate; RR = 1.55, 95% CI [1.37–1.75], moderate).
Conclusions: Combination therapies, especially those incorporating targeted agents or platinum-based regimens, may exhibit superior efficacy while maintaining acceptable safety profiles. Additionally, TCM may be associated with a higher ORR and a reduced risk of AEs. Further large-scale, high-quality studies are warranted to investigate the efficacy and safety of combining paclitaxel with targeted agents, platinum-based therapies, or TCM in the treatment of TNBC.
Purpose: This study aimed to investigate COVID-19's indirect influence on chronic respiratory disease (CRD) patients for two years since the COVID-19 pandemic began.
Methods: Using population-based data in Hong Kong, we included CRD patients diagnosed from January 2011 to December 2021. Interrupted Time Series Analysis were applied to assess mortality, complications, and healthcare utilization rates during the “pre-COVID-19 pandemic” (January 2012–January 2020), “initial COVID-19 pandemic” (February 2020–February 2021), and “post-initial COVID-19 pandemic” (March 2021–December 2021) periods.
Results: Among 587,049 patients with CRD, all-cause mortality had an increasing trend during the post-initial COVID-19 pandemic period (incidence rate ratio (95% CI): 1.019 (1.005, 1.034); p = 0.007), compared with pre-COVID-19 pandemic period. Nonrespiratory mortality had an increasing trend in the initial COVID-19 pandemic period (1.020 (1.006, 1.033); p = 0.004) and was higher than the pre-pandemic level in the post-initial COVID-19 pandemic. We observed abrupt declines in the incidence rates of asthma exacerbation, acute exacerbation of chronic obstructive pulmonary disease, pneumonia, and acute respiratory failure in the first month of initial COVID-19 pandemic period, remaining below pre-COVID-19 pandemic levels throughout the initial pandemic period.
Conclusion: The disruption of usual healthcare impacts mortality rates among patients with CRD without COVID-19, particularly nonrespiratory mortality. Contingency plans on continuing follow-up and monitoring of CRD patients are needed, for example, teleconsultations, shared primary care, and tele-reminders on red-flag symptoms for patients with CRD, when healthcare services may be disrupted during public health crises.
Aim: This study seeks to assess the reporting quality of published health economic evaluations (HEEs) on vaccination and pharmaceuticals for Coronavirus Disease 2019 (COVID-19), and identify potential predictors associated with reporting quality.
Methods: A systematic literature search was performed in PubMed, Web of Science, Embase, the Cochrane Library, INAHTA, and Chinese databases (e.g., SinoMed, CNKI, and WANGFANG Database). HEEs published between January 1, 2020, and August 20, 2022, that considered both costs and outcomes of vaccination and pharmaceuticals for COVID-19 were included. The Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement scored the reporting quality for incorporated studies. A linear regression analysis was employed to characterize the impact of various features on reporting quality.
Results: Fifty-two studies were included in the analysis. The average CHEERS score was 18.54±3.41, with the scoring rate of reporting quality was 67% (±12%). The most inadequately reported items included health economic analysis plan, time horizon, valuation of outcomes, heterogeneity, uncertainty, distributional effects, and stakeholder involvement. Higher reporting compliance was associated with articles applying a longer time horizon (no less than 1 year) and those using a societal perspective (p < 0.05). The investigations that did not specify a study perspective received the lowest scores among the subgroups.
Conclusion: Overall, the included HEEs on vaccination and pharmaceuticals for COVID-19 had moderate reporting quality. Future HEEs should be transparently and sufficiently reported in accordance with standard guidelines (e.g., the CHEERS 2022 statement), to increase the interpretability of results, improve the reporting quality, and better inform the decision-making.
Aim: To establish evidence-based guidelines for the application of the foldable capsular vitreous body (FCVB) in managing severe ocular trauma and silicone oil–dependent eyes.
Methods: We conducted a comprehensive search across multiple databases, screening, extracting, and evaluating research evidence. Experts in ocular trauma and vitreoretinal surgery provided practical insights and formulated key questions. Using the Delphi method, the working group identified seven clinical issues and established outcome indicators. Seven recommendations were developed, reviewed, and approved by a multinational consensus expert group.
Results: This consensus presents seven evidence-based recommendations for FCVB implantation, emphasizing the importance of patient assessment, FCVB model selection, and intraoperative and postoperative management. Each recommendation is supported by detailed explanations and evidence, highlighting the potential benefits of FCVB as an alternative to traditional treatments for severe ocular trauma and silicone oil–dependent eyes, including reduced complications and improved visual outcomes.
Conclusions: On the basis of existing literature and expert consensus, this consensus provides evidence-based guidance for FCVB application in treating severe ocular trauma and silicone oil–dependent eyes. The recommendations serve as a valuable resource for ophthalmologists, facilitating more effective and safer treatment options for patients.
Objective: The effects of malnutrition on postoperative delirium (POD) after cardiac surgery remains understudied. We hypothesized that preoperative prognostic nutrition index (PNI) has a significant clinical role in predicting POD among mechanically ventilated patients undergoing cardiac surgery.
Methods: We conducted a multicenter retrospective study of adult patients who underwent cardiac surgery and subsequently received mechanical ventilation (MV) in the Intensive Care Unit at Nanjing First Hospital (NFH-ICU) and from Medical Information Mart for Intensive Care IV (MIMIC-IV). The relationship between PNI and POD was examined by Cox proportional hazards models, propensity score matching, mediation analysis, subgroup analysis, and sensitivity analysis.
Results: 2725 participants of NFH-ICU and 3368 participants of MIMIC-IV were included in this study. Reduced PNI levels were identified as an independent risk factor for POD, and its addition enhanced the accuracy of predicting POD. After adjusting for all confounders, Cox analysis revealed that PNI≤45.5 was significantly associated with the risk of progressing to POD (NFH-ICU: HR = 1.46, 95% CI 1.01–2.11, p = 0.044; MIMIC-IV: HR = 1.53, 95% CI 1.14–2.07, p = 0.005). We also analyzed the mediating role of duration of MV on malnutrition and POD. The proportions mediated were 31.64% and 9.71% in NFH-ICU and MIMIC-IV, respectively.
Conclusion: The decreased PNI can increase the risk of POD after cardiac surgery. Meanwhile, the increased risk of POD associated with low PNI was partially mediated by prolonged duration of MV after surgery. The study highlights the preoperative nutritional management as an important intervention to prevent postoperative delirium in patients undergoing cardiac surgery.
Objectives: The demand for high-quality clinical evidence supporting acupuncture remains urgent, necessitating the establishment of a suitable methodological framework to promote its generation.
Methods: Following internal deliberations and extensive online discussions with experts in the IDEAL Collaboration, we proposed the IDEAL-Acu framework specifically for acupuncture, based on the surgery-focused IDEAL model with necessary modifications to accommodate the characteristics of acupuncture. To ensure consensus on recommendations, a panel of external experts and internal research team members was convened, and any disagreements were iteratively resolved through expert review.
Results: This article introduces an IDEAL-Acu framework with five stages for evaluating acupuncture outcome and improving practice to optimize treatment. The framework includes Idea (proposal of an acupuncture regime), Development (optimization or standardization of the acupuncture regime), Exploration (feasibility assessment for conducting a definitive RCT), Assessment (evaluation of effects through comparison with standard therapy or sham acupuncture), and Long-term monitoring (examination of long-term efficacy and safety) stages. We provide clear recommendations for each stage along with specific examples.
Conclusion: The framework highlights the importance of conducting studies at each stage in acupuncture evaluation process and can serve as a helpful guide for assessing its effects and promoting evidence-based practice in acupuncture.
Fibromyalgia is a prevalent chronic condition marked by widespread pain, fatigue, and other debilitating symptoms. This guideline provides evidence-based recommendations for nonpharmacological treatments, developed by a multidisciplinary expert group, including specialists in rheumatology, rehabilitation, pain management, traditional Chinese medicine (TCM), and evidence-based medicine. The guideline follows the RIGHT checklist and is registered with the International Practice Guideline Registry Platform. The literature review incorporates systematic reviews, meta-analyses, and randomized controlled trials (RCTs) up to March 2023, focusing on the effects of nonpharmacological interventions on pain intensity, fatigue, sleep quality, mood, and quality of life. A total of 57 studies were included, with findings supporting acupuncture and health education as core therapies. These interventions significantly reduce pain, alleviate fatigue, and improve sleep quality, and are strongly recommended based on moderate-quality evidence. Additionally, aerobic exercise and resistance training are recommended for their proven effectiveness in reducing pain, enhancing physical function, and providing long-term benefits. Emerging therapies, such as transcranial magnetic stimulation (TMS) and nutritional supplements, show promise but require further research due to low-certainty evidence.
Aim: Due to the limited evidence, the effects and neuroimaging mechanisms of acupuncture for amnestic mild cognitive impairment (aMCI) are still needed to investigate. Our objectives were to assess the effects and investigate its therapy-driven modification in functional neural response.
Methods: Right-handed aMCI patients were enrolled and randomly assigned to an acupuncture group (AG) or a waitlist control group (WG) in the randomized clinical trial using computer-generated randomization sequence method. Twenty normal cognition individuals were included in the normal control (NC) group. The primary outcomes were the changes in the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) subscale score from baseline to the 12th and 24th week. Acupuncture's neural responses were investigated by detecting changes in regional homogeneity (ReHo), seed-based functional connectivity (FC), and effective connectivity (EC) from baseline to the 12th week. Generalized estimating equations and correlational analyses were employed.
Results: Overall, 343 participants were screened, and 72 aMCI patients were included. The ADAS-Cog score changes at Weeks 12 and 24 of AG were significantly higher than that of WG. In neural response, aMCI patients had higher ReHo in the left dorsolateral prefrontal cortex (DLPFC.L) compared to NCs. Acupuncture significantly reduced ReHo in the DLPFC.L and its FC with the left anterior cingulate cortex (ACC.L) compared to the WG. The causal evidence for decreased EC from the DLPFC.L to the ACC.L after acupuncture, which correlated with change in ADAS-Cog score.
Conclusion: Acupuncture was effective in overall cognitive function in aMCI patients, and the effect was associated with the DLPFC.L-ACC.L circuit.
Objective: This study explored the independent and synergistic effects of cadmium (Cd) and uric acid (UA) levels on hypertension risk, with a focus on sex differences.
Methods: Data from 8043 National Health and Nutrition Examination Survey participants were analyzed using logistic regression, restricted cubic spline (RCS), and interaction effect models. A meta-analysis of eight studies was also conducted.
Results: Blood, urinary Cd, and UA levels were more strongly associated with hypertension in females than in males (p < 0.05). Among females, blood Cd (odds ratio [OR] = 1.84, 95% confidence interval [CI]: 1.20–2.83), urinary Cd (OR = 3.38, 95% CI: 2.15–5.30), and UA levels (OR = 3.67, 95% CI: 2.47–5.45) were significantly associated with increased hypertension risk. RCS analysis showed linear dose–response relationships for blood (Pnon-linear = 0.085) and urinary Cd (Pnon-linear = 0.070) levels, whereas UA levels (Pnon-linear = 0.031) exhibited a non-linear association with hypertension risk. Multiplicative interaction showed 176% (OR = 2.76, 95% CI: 2.00–3.80) and 370% (OR = 4.70, 95% CI: 3.49–6.33) increased hypertension risks for high blood Cd–UA and urinary Cd–UA levels, respectively. Additive interaction confirmed synergy (relative excess risk due to interaction [RERI] = 1.74, 95% CI: 0.37–3.10). The meta-analysis using a random-effects model confirmed that blood Cd (OR = 1.93, 95% CI: 1.28–2.93) and urinary Cd levels (OR = 1.81, 95% CI: 0.93–3.50) were significantly increased hypertension risk.
Conclusions: Elevated Cd and UA levels independently and synergistically increased hypertension risk, especially in females, highlighting the need for targeted prevention strategies.
Objective: This scoping review aims to map commonly reported multimorbidity patterns in China and summarize the methodologies used to identify these patterns.
Methods: We conducted a comprehensive search of six databases, including PubMed, EMbase, Web of Science Core Collection, WanFang, VIP, and CNKI from inception to December 31, 2024. Both quantitative and qualitative analyses were performed to map the scope of research on multimorbidity patterns and the methodologies used in the included studies. The results are presented in tabular form, with selected visual representations where appropriate.
Results: A total of 15,972 studies were retrieved, with 93 studies meeting the inclusion criteria. These studies, published between 2015 and 2024, were mostly cross-sectional with a median sample size was 10,084. Most studies employed a single method to explore multimorbidity patterns, with latent class analysis, association rules, and factor analysis being the most common. Arthritis/rheumatism and hypertension were the most prevalent diseases. Multimorbidity patterns were mainly classified into disease combination patterns and multimorbidity cluster patterns. The most frequent binary combinations were hypertension with diabetes and hypertension with dyslipidemia. The most common ternary combination was hypertension, dyslipidemia, and diabetes. The cardiovascular metabolic cluster was the most prevalent, followed by the respiratory cluster. Forty-nine studies explored influencing factors, with age being the most studied.
Conclusions: Studies on multimorbidity patterns in China have increased since 2020, with a focus on cardiovascular-metabolic clusters and the use of latent class analysis. However, variations in the interpretation of multimorbidity lead to inconsistent disease identification and diagnostic criteria, affecting the consistency of findings. Future research should establish consensus-driven guidelines for defining multimorbidity clusters and apply robust statistical techniques to improve methodological rigor.