Explore the vast range of titles available.

Objectives The detection of renal cell carcinoma (RCC) tumors in the earlier stages is of great importance for more effective treatment. Encouraged by the key role of imaging in the management of RCC, we conducted a systematic review and meta-analysis of the studies that made use of artificial intelligence (AI) for the detection of RCC to quantitatively determine the performance of AI for distinguishing related renal lesions. Materials and methods PubMed, Scopus, CENTRAL, and Embase electronic databases were systematically searched in November 2024 to identify studies that applied AI for the detection or classification of RCC. We conducted a meta-analysis to evaluate the diagnostic performance of utilized algorithms. Moreover, meta-regression was conducted over suspected covariates to evaluate potential sources of inter-study heterogeneity. Publication bias and quality assessment were also done for the included studies. Results Sixty-four studies were included in this systematic review, of which 31 studies were selected for meta-analysis. The studies assessing algorithms’ performance on internal validation showed pooled sensitivity and specificity of 85% (95% confidence interval [CI], 82 to 87) and 76% (95% CI, 70 to 80), respectively. Moreover, externally validated Al algorithms had a pooled sensitivity and specificity of 80% (95% CI, 73 to 84) and 90% (95% CI, 84 to 93), respectively. Studies that performed internal validation for clinician performance had a pooled sensitivity of 79% (95% CI, 72 to 85) and specificity of 60% (95% CI, 49 to 70). Conclusion The findings of the present study validate the acceptable performance of AI algorithms when contrasted with medical professionals in the identification and categorization of RCC. Nevertheless, the presence of heterogeneity between studies and the absence of coherence in the results underscore the necessity for the cautious interpretation of these results and additional prospective studies.

Background: Insulin resistance (IR) contributes significantly to major adverse cardio-cerebrovascular events (MACCE), with the estimated glucose disposal rate (eGDR) serving as a novel marker for assessing IR. This systematic review and meta-analysis investigate the association between eGDR and MACCE outcomes, aiming to clarify its predictive value across different diabetes statuses. Methods: We searched databases for studies examining the relationship between eGDR and MACCE, including myocardial infarction (MI), stroke, ischemic heart disease (IHD), cardiovascular disease (CVD), and all-cause mortality. We compared groups with the lowest versus highest eGDR. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using random effect models. Subgroup analyses assessed eGDR efficacy by diabetes status. Results: Our search identified 16 studies with 198 626 participants. The group with the lowest eGDR had a significantly higher risk of MACCE compared to the group with the highest eGDR (HR = 2.21, 95% CI 1.17-4.18). Additionally, the group with the lowest eGDR had notably worse outcomes for all-cause mortality, MI, stroke, CVD, and IHD with HRs of 2.03 (95% CI 1.05-3.90), 1.82 (95% CI 1.30-2.55), 2.82 (95% CI 1.66-4.69), 2.95 (95% CI 1.99-4.37), and 7.97 (95% CI 2.57-24.73), respectively. Subgroup analyses revealed consistent results for CVD in both populations with diabetes and non-diabetes status, for stroke in the population with non-diabetes status, and for IHD in the population with diabetes. Conclusions: Lower eGDR, indicating higher IR, is linked with a significantly increased risk of MACCE. This parameter could enhance risk stratification models for predicting MACCE. Further studies are needed to evaluate the clinical role of eGDR in managing cardio-cerebrovascular risk across subgroups. Plain Language Summary How Insulin Resistance Measured by eGDR Relates to Heart and Stroke Risks in People With and Without Diabetes: A Review and Analysis of Studies Insulin resistance is a condition where the body does not respond well to insulin, a hormone that helps control blood sugar levels. This condition is known to increase the risk of serious heart and brain problems, such as heart attacks and strokes. A new way to measure insulin resistance is called the estimated glucose disposal rate (eGDR). Our study looked at how well eGDR can predict the chance of having major heart and brain events. We reviewed 16 studies involving nearly 200 000 people. We compared those with the lowest eGDR (meaning higher insulin resistance) to those with the highest eGDR (lower insulin resistance). We found that people with lower eGDR had more than twice the risk of serious heart and brain problems compared to those with higher eGDR. This included a higher risk of death from any cause, heart attacks, strokes, and other heart diseases. We also looked at people with and without diabetes separately. The increased risks were seen in both groups, showing that eGDR is a useful measure regardless of diabetes status. In conclusion, a lower eGDR, which shows greater insulin resistance, is linked to a higher chance of having major heart and brain health problems. Measuring eGDR in patients with risk factors could help doctors better identify people at risk and improve prevention strategies. More research is needed to understand how this measure can be used in everyday medical care. Plain Language Summary This graphical abstract summarizes the comparison of clinical outcomes between groups with the lowest versus the highest estimated glucose disposal rate (eGDR). Across all measured outcomes the lowest eGDR group demonstrated a significantly higher risk compared to the highest eGDR group. we further categorized the analyzed studies into 3 subgroups based on diabetes status: (1) studies involving populations with diabetes, (2) studies involving individuals without diabetes, and (3) studies including the general population without specific categorization by diabetes status. The 2 pictures of men in the graphical abstract illustrate the relationship between clinical factors and eGDR. A person with higher blood pressure (indicated by positive hypertension in the eGDR formula), increased waist circumference, and elevated HbA1c tends to have a lower eGDR. This lower eGDR is associated with increased risk of adverse outcomes (CI, confidence interval; CVD, cardiovascular disease; eGDR, estimated glucose disposal rate; HbA1c, glycosylated hemoglobin A1C; HR, hazard ratio; HTN, hypertension; IHD, ischemic heart disease; MACCE, major adverse cardio-cerebrovascular events; MI, myocardial infarction; WC, waist circumference).

Background: Emerging lipid-related biomarkers, including the Visceral Adiposity Index (VAI), Lipid Accumulation Product (LAP), and Atherogenic Index of Plasma (AIP), have demonstrated potential in predicting metabolic disorders such as diabetes mellitus (DM) and associated microvascular complications, particularly diabetic kidney disease (DKD) and diabetic retinopathy (DR). Objectives: This systematic review and meta-analysis aims to evaluate the association between these biomarkers and microvascular complications in individuals with DM, as well as to assess their diagnostic performance. Data sources and methods: A systematic literature search was performed in PubMed, Scopus, Embase, and Web of Science following PRISMA guidelines. Eligible studies examined the relationship between VAI, LAP, and AIP and microvascular complications in DM. The meta-analysis synthesized data using pooled weighted mean differences (WMDs) and area under the receiver operating characteristic curve (AUC) values to evaluate the predictive utility of these biomarkers for DKD and DR. Results: A total of 23 studies were included. Patients with DKD had significantly higher levels of LAP (WMD: 12.67; 95% CI: 7.83–17.51; P < .01), AIP (WMD: 0.11; 95% CI: 0.03–0.19; P < .01), and VAI (WMD: 0.63; 95% CI: 0.38–0.89; P < .01) compared to those without DKD. Additionally, each 1-unit increase in LAP (OR: 1.005; 95% CI: 1.003–1.006; P < .01), AIP (OR: 1.08; 95% CI: 1.04–1.12; P < .01), and VAI (OR: 1.05; 95% CI: 1.03–1.07; P < .01) was associated with an elevated risk of DKD. In contrast, no significant associations were identified between these biomarkers and DR. The diagnostic performance of VAI, LAP, and AIP was limited for both DR and DKD, with low discriminatory power. Conclusion: VAI, LAP, and AIP are significant predictors of DKD in individuals with DM but exhibit limited relevance for the detection of DR. Although these biomarkers show potential in identifying DKD risk, their overall diagnostic accuracy for DKD and DR remains modest, underscoring the need for further studies to enhance their clinical applicability. Plain Language Summary Can Lipid Biomarkers Help Predict Complications in diabetes mellitus? Why This Study Was Done: Diabetes diabetes can lead to serious complications like kidney disease and vision problems. Researchers are looking for new ways to predict these complications early on. Emerging lipid biomarkers, such as VAI, LAP and AIP show promise in predicting metabolic issues. What the Researchers Did: The team conducted a comprehensive review and analysis of studies that looked at how these lipid biomarkers are linked to kidney disease and vision problems in people with diabetes mellitus. What They Found: The analysis included data from 23 studies. It showed that patients with kidney disease had higher levels of these biomarkers compared to those without. However, these biomarkers were not as effective in predicting vision problems. What It Means: This study suggests that certain lipid biomarkers can help identify people with diabetes mellitus who are at risk of developing kidney disease. However, more research is needed to see if these biomarkers are better than traditional methods for managing diabetes and predicting other complications.

Background Endoscopic retrograde cholangiopancreatography (ERCP) is a widely utilized procedure for diagnosing and treating biliary and pancreatic disorders. However, it carries a risk of post-ERCP pancreatitis (PEP). N-Acetylcysteine (NAC) has been proposed as a potential prophylactic agent due to its antioxidant properties, yet its efficacy remains debated. This systematic review and meta-analysis aimed to evaluate the effectiveness of NAC in preventing PEP in patients undergoing ERCP. Method We conducted a comprehensive literature search across multiple databases, including PubMed, Scopus, Web of Science, and EMBASE, for randomized controlled trials (RCTs) on humans published from January 2000 to end of August 2024. The primary outcome was the incidence of PEP in the group who received the NAC compared to the group receiving routine medication. Study selection and data extraction was performed according to PRISMA guidelines. Quality assessment was accomplished using risk of bias (RoB2) tool for RCTs. Results A total of four RCTs involving 773 patients were included in the final analysis. The meta-analysis demonstrated a non-significant lower incidence of post-ERCP pancreatitis in the NAC group compared to controls (Risk Ratio: 0.66; 95% Confidence Interval: 0.38–1.16). Sensitivity analyses indicated low robustness of these results, with moderate heterogeneity observed among studies (I 2  = 55.89%). Egger test did not provide evidence of publication bias. The trim-and-fill correction suggested one potentially missing study on the left side of the funnel plot. Imputation for this potentially missing study yielded an effect size of RR: 0.57; 95% CI: 0.32—0.99), which was statistically significant this time. The results were additionally statistically non-significant stratified by severity of the PEP. Conclusion While NAC shows promise in reducing the incidence of PEP, the current evidence does not support its routine use as a prophylactic agent. Further research is warranted to clarify its role and optimize preventive strategies for PEP.

Metabolic syndrome (MetS) poses an additional risk for the development of coronary artery disease and major adverse cardiac and cerebrovascular events (MACCE). In this study, we investigated the association between MetS and its components and MACCE after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). The presence of MetS was calculated at baseline using the NCEP-ATP III criteria. The primary outcome was MACCE and its components were secondary outcomes. Unadjusted and adjusted Cox Regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CI) of the association between MetS or its components and MACCE and its components. A total of 13,459 ACS patients who underwent PCI (MetS: 7939 and non-MetS: 5520) with a mean age of 62.7 ± 11.0 years (male: 72.5%) were included and median follow-up time was 378 days. Patients with MetS had significantly higher MACCE risk (adjusted HR [aHR] 1.22, 95% CI 1.08–1.39). The only component of MACCE that exhibited a significantly higher incidence in MetS patients was myocardial infarction (aHR 1.43, 95% CI 1.15–1.76). MetS components that were significantly associated with a higher incidence of MACCE were hypertension and impaired fasting glucose. Having three MetS components did not increase MACCE (aHR 1.12, 95% CI 0.96–1.30) while having four (aHR 1.32, 95% CI 1.13–1.55) or five (aHR 1.42, 95% CI 1.15–1.75) MetS components was associated with a higher incidence of MACCE. MetS was associated with a higher risk of MACCE in ACS patients undergoing PCI. Among MACCE components, myocardial infarction was significantly higher in patients with MetS. Impaired fasting glucose and hypertension were associated with a higher risk of MACCE. Identifying these patterns can guide clinicians in choosing appropriate preventive measures.

Background Cardiovascular diseases (CVDs) remain the leading global cause of mortality despite advances in revascularization strategies like coronary artery bypass grafting (CABG) and percutaneous interventions. Exosomes have emerged as dual-function agents, acting both as paracrine mediators of vascular repair and as drug-delivery vehicles. This systematic review evaluates the therapeutic efficacy of exosome-based therapies in cardiac revascularization procedures. Methods A comprehensive search of Embase, PubMed, Scopus, and Web of Science was conducted from inception to January 2025. We included experimental studies, evaluating animal subjects undergoing revascularizations. Risk of bias was assessed using SYRCLE’s tool. Study characteristics, population characteristics, intervention details, various outcomes, and limitations of each study were extracted from each included study. Results Eight preclinical studies met our inclusion criteria. We observed that exosome therapies demonstrated significant benefits. Sirolimus-loaded exosomes (SIR-EXO) reduced stenosis to 5% vs. 59% in controls. Exosome-coated stents (ACC-Exo-REDV) suppressed neointimal hyperplasia by 60% compared to bare stents. Brown adipose tissue-derived exosomes increased left ventricular ejection fraction, while CABG + exosome patches restored diastolic function. Exosome-eluting stents reduced pro-inflammatory cytokines (IL-1β, TNF-α) by 93% and promoted M2 macrophage polarization. Exosome-enhanced stents improved endothelial cell proliferation by 40% and reduced platelet adhesion by 70%. Conclusion Exosome-based therapies show promise in enhancing vascular repair, mitigating restenosis, and modulating post-revascularization inflammation.

Background Weight regain (WR) and insufficient weight loss (WL) occur in 20–25% of patients after bariatric surgery due to various factors. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have shown promise in promoting WL; however, evidence regarding their effectiveness in managing WL and preventing WR post-bariatric surgery remains limited. Objective This study aims to evaluate the role of GLP-1RAs in treating and preventing WR following bariatric surgery. Methods A systematic search was conducted across PubMed, Scopus, and Web of Science for studies assessing the impact of GLP-1RAs on WR after bariatric surgery. Results Our search identified 27 original studies, with 10 included in the meta-analysis involving 769 participants (392 treated with GLP-1RAs). The mean age was 44.05 years, with 30.47% male. The time interval from surgery to the initiation of GLP-1RAs treatment ranged from 1.5 to 86.7 months, with treatment durations between 4 and 12 months. The analysis showed significantly greater WL in the GLP-1RAs group compared to placebo (SMD = 0.82, 95% CI 0.23 to 1.42). Subgroup analysis for treatment durations ≤ 6 months indicated a higher WL in the GLP-1RAs group (SMD = 0.79, 95% CI 0.25 to 1.34). Adverse events were primarily gastrointestinal, with nausea significantly more frequently in the GLP-1RAs group (OR = 2.01, 95% CI 1.24 to 3.27). Conclusion GLP-1RAs effectively promote WL among participants experiencing WR after bariatric surgery. Initiating GLP-1RAs therapy shortly after surgery may help prevent WR. Further research is warranted to explore long-term outcomes and optimize treatment protocols for this patient population. Graphical Abstract Highlights GLP-1RAs promoted weight loss in post-bariatric surgery patients faced with weight regain or insufficient weight loss. Significant weight loss in the group treated with GLP-1RA was observed compared to the group got placebo in short-term (≤6 months) subgroup analysis. Nausea was the most common adverse event, significantly higher in the GLP-1RA group compared to placebo.

Background The potential benefits and risks of combination therapy with sodium-glucose co-transporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) versus monotherapy remain a subject of debate to optimize metabolic and cardiovascular outcomes in patients with type 2 diabetes mellitus. This study aims to systematically review and meta-analyze the available evidence from randomized controlled trials. Methods A comprehensive search identified relevant randomized controlled trials comparing combination therapy with SGLT-2i and GLP-1RA to monotherapy or treatment as usual (TAU). The main outcome was the incidence of hospitalization for heart failure. Other outcomes included major adverse cardiovascular events (MACE) (cardiovascular mortality, all-cause mortality, stroke, and myocardial infarction), changes in metabolic parameters, and adverse events. Random-effects meta-analysis estimated risk ratios (RRs), mean difference (MD), and 95% confidence intervals (CIs). We assessed the risk of bias in included studies using the Cochrane ROB 2.0 tool. Results The meta-analysis included 10 randomized controlled trials with 42,651 participants, of which 2,820 were on combination therapy and the rest on SGLT-2i (37.1%), GLP-1RA (20.1%) monotherapies or TAU (42.8%). Combination therapy had a lower risk of hospitalization for heart failure versus GLP-1RA monotherapy (RR = 0.37, 95% CI 0.22; 0.65), SGLT-2i monotherapy (RR = 0.37, 95% CI 0.19; 0.75), and TAU (RR = 0.43, 95% CI 0.24; 0.75), respectively. Combination therapy also had a significantly lower risk of MACE versus TAU (RR = 0.73, 95% CI 0.61; 0.88). Combination therapy showed greater weight loss and hemoglobin A1c reduction versus SGLT-2i monotherapy (MD = -2.20, 95% CI −3.09; −1.31 and MD = −0.74, 95% CI −1.21; −0.27), respectively, while no difference was noted versus GLP-1RA monotherapy. The incidence of nausea and diarrhea was higher with combination therapy versus SGLT-2i monotherapy (MD = 3.34, 95% CI 1.74; 6.43 and MD = 1.75, 95% CI 1.10; 2.77), respectively. Conclusion Combination therapy with SGLT-2i and GLP-1RA may provide superior cardiovascular, weight, and Hemoglobin A1c outcomes versus monotherapy despite higher gastrointestinal adverse events. These results may impact the management of patients with metabolic and cardiovascular diseases and highlight the need for further research on combination therapy to optimize outcomes. Graphical Abstract

Background While percutaneous coronary intervention (PCI) has improved survival rates, many patients remain at risk for future adverse cardio-cerebral events. This study explores the role of insulin resistance, measured by the estimated glucose disposal rate (eGDR), as a potential predictor of cardio-cerebrovascular outcomes and mortality. Methods This retrospective analysis included patients who underwent PCI at our center between 2015 and 2020. Patients were categorized by glycemic status into individuals with diabetes (DM) , pre-DM and normal glucose levels . Our primary outcome was major adverse cardiac and cerebrovascular event (MACCE). Results We included 2144 patients—236 patients with pre-DM, 1735 with DM, and 173 with normal glucose levels . After a mean follow-up of 550 days, patients with pre-DM in the Q3 and Q4 quartiles of eGDR were less likely to experience MACCE (HR: 0.172, 95% CI 0.036–0.813 and HR: 0.096, 95% CI 0.013–0.713, respectively). In the DM and non-DM groups, there was no significant relationship between eGDR and MACCE. After adjustment for lipid profile and history of statin medication, results remained consistent for both Q3 and Q4 in pre-DM subgroup with lower rate of MACCE (HR: 0.168, 95% CI 0.033–0.820) and (HR: 0.099, 95% CI 0.012–0.814). Additionally, the Q4 compared to Q1 in the non-DM group demonstrated significantly lower MACCE (HR: 0.000, 95% CI 0.000–0.759). Conclusions Our findings suggest that eGDR could be an important tool for assessing risk for future cardio-cerebral events and mortality in patients with pre-DM and normal glycemic levels who undergo PCI. However, its predictive power in patients with DM appears to be limited. Graphical abstract

Background The COVID-19 pandemic has imposed a significant global health burden. Identifying prognostic markers for COVID-19 and its severity could contribute to improved patient outcomes by reducing morbidity and mortality. This systematic review and meta-analysis aimed to evaluate the relationship between ischemic-modified albumin (IMA) and thiol levels, both indicators of oxidative stress, in patients diagnosed with COVID-19. Method We conducted a comprehensive search across PubMed, Scopus, Embase, and Web of Science for eligible original studies. The study assessed IMA and thiol levels in COVID-19 patients, examining their association with both disease severity and mortality. A random effect analysis was conducted to estimate the standardized mean difference (SMD) and confidence intervals (CI). Results Sixteen studies comprising 2010 COVID-19 patients and 982 controls were included. A diagnosis of COVID-19 was associated with significantly elevated IMA levels (Hedges's g = 1.02, 95% CI: 0.45 to 1.60) and reduced total thiol levels (Hedges's g = -1.08, 95% CI: -2.10 to -0.07). However, native thiol levels did not reveal a significant difference between infected patients and healthy participants. Subgroup analysis showed significantly lower total thiol levels in patients with critical and severe COVID-19, as well as lower native thiol levels specifically in critical COVID-19 patients. IMA levels were significantly higher across the critical, severe, and moderate COVID-19 groups. Conclusion Elevated IMA and reduced thiol levels may serve as novel markers for predicting COVID-19 severity and prognosis. Further research is needed to explore therapeutic interventions that target oxidative imbalance in COVID-19 patients.