Press reviews
2024-09-09
Gastroenterology and Hepatology
Twelve randomised controlled trials published up to 2022 were included. Of a total of 1,746 patients, 458 received sorafenib + TACE (S+TACE arm) and 1,288 underwent TACE (TACE arm).
Overall survival (HR: 0.596, 95% CI: 0.507-0.685, p<0.001; I2=0.0%) and time to progression (HR: 0.379, 95% CI: 0.205-0.553, p<0.001; I2=4.5%) in the S+TACE arm were longer than in the TACE arm.
The objective response rate (RR: 2.101, 95% CI: 1.555-2.839, p < 0.001; I2 = 0.0%), disease control rate (RR: 1.547, 95% CI: 1.126-2.126, p = 0.007; I2 = 79.6%) and survival (RR: 1.416, 95% CI: 1.183-1.694, p < 0.001; I2 = 83.8%) in the S+TACE group were higher than in the TACE group.
Compared with the TACE group, higher risks of Hand-Foot Skin Reaction (HFSR), oral ulcer and diarrhoea in patients with hepatocellular carcinoma complicated by tumour thrombosis of the portal vein were found in the S+TACE group.
CONCLUSION: Sorafenib combined with TACE has good efficacy and mild adverse effects.
Source(s) :
Xu L ; Chen S ; Cao H ; Feng Z ; Yang C
;
To treat diseases such as cancer, conventional Paclitaxel (PTX)-based treatment regimens are becoming less effective due to the development of resistance. In this respect, the phytomolecule curcumin, which has ethnopharmacological significance in traditional South Asian remedies such as Ayurveda and traditional Chinese medicine, was investigated as a promising chemosensitising and synergistic partner of Paclitaxel.
This study evaluated the combined effect of Paclitaxel and curcumin compared with Paclitaxel therapy alone in both in vitro and in vivo settings.
An extensive PubMed search was performed in which 169 articles were screened and reviewed to identify 30 studies that reported the effect of Paclitaxel and curcumin in vitro, in vivo or both. The combined odds ratio (OR) was calculated at a 95% confidence interval (CI) to determine the effect of the combined treatment.
The meta-analysis indicated that Paclitaxel and curcumin combination therapy was associated with a significant decrease in cell viability (OR: 0.37, 95% CI: 0.27-0.51; p < 0.01) and tumour volume (OR: 0.32, 95% CI: 0.15-0.71; p = 0.01). In addition, the effect of this combination on drug-resistant cell lines showed a significant decrease in the odds of cell viability (OR: 0.45, 95% CI: 0.35-0.57; p < 0.01).
CONCLUSION: Overall, the current meta-analysis has shown that the combination of Paclitaxel and curcumin effectively inhibits cancer cell viability, reduces tumour volume and decreases the growth of drug-resistant cancer cells.
CONCLUSION: Overall, the current meta-analysis has shown that the combination of Paclitaxel and curcumin effectively inhibits cancer cell viability, reduces tumour volume and decreases the growth of drug-resistant cancer cells.
Source(s) :
Yasmin Fatima, Agneesh Pratim Das, Gaurab Kumar Jha, Subhash Mohan Agarwal
;
2024-09-09
Geriatrics
The relationship between periodontitis and cardiovascular disease (CVD) has been extensively studied, but the role of biological ageing in this relationship remains poorly understood.
This study sought to elucidate the causal association between periodontitis, CVD and biological ageing.
The authors included 3269 participants in the National Health and Nutrition Survey (2009-2014) with diagnostic information on periodontitis and cardiovascular events.
Biological ageing was assessed using both calculated biological age (KDMAge) and phenotypic age (PhenoAge) from the Klemera-Doubal method. Logistic regression, restricted cubic spline (RCS) analysis and subgroup analysis were used to analyse the data. Mediation analysis was used to explore the mediating role of biological ageing. Subsequently, Mendelian randomisation (MR) analyses were performed using genome-wide association study databases to explore potential causal relationships between periodontitis, CVD and biological ageing.
Periodontitis was associated with a higher risk of CVD. Participants with periodontitis had increased levels of biological ageing, and higher levels of biological ageing were associated with an increased risk of CVD. Mediation analyses showed a partial mediating effect of biological ageing (PhenoAge: 44.6%; KDMAge: 22.9%) between periodontitis and CVD risk.
Magnetic resonance analysis showed that periodontitis played a causal role in increasing the risk of small-vessel stroke, while myocardial infarction increased the risk of periodontitis. In addition, inverse MR analysis showed that phenotypic ageing can increase the risk of periodontitis, and that there is a bidirectional causal relationship between CVD and biological ageing.
Conclusions: Periodontitis is associated with an increased risk of CVD, partially mediated by biological ageing, with a complex causal interrelationship. Targeted periodontal health interventions may slow biological ageing processes and reduce the risk of CVD.
Source(s) :
Zhaoqi Zhang, Xingru Zhao, Shang Gao, An Li, Ke Deng, Kai Yang, Wei Liu , Mi Du
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2024-09-05
Cardiology and Vascular Medicine
Given that the effects of antihypertensive drugs taken once a day are most pronounced in the first few hours after ingestion, their administration in the evening may be a feasible treatment for nocturnal hypertension (HT). However, no relevant meta-analysis has been performed in patients with nocturnal HT.
This meta-analysis included randomised controlled trials involving patients with elevated mean nocturnal blood pressure and compared evening versus morning administration of anti-HT. Several databases were searched. Study selection and data extraction were performed by two independent authors. Risk of bias and overall quality of evidence were assessed using the Cochrane risk of bias tool and GRADE by two independent authors. A total of 107 studies were included, 76 of which were reviewed in China and had not been identified in previous reviews. Only one trial was classified as being at low risk of bias.
Evening administration of anti-HT drugs was effective in reducing nocturnal systolic blood pressure (4.12-9.10 mmHg; I2 = 80.5-95.2%) and diastolic BP (3.38-5.87 mmHg; I2 = 87.4-95.6%). Subgroup analyses revealed that the efficacy of evening administration was influenced by data from the Hermida group and China.
Evening administration did not further reduce nocturnal, daytime or 24-hour BP in nonHermida/non-Chinese studies (I2 = 0) and in meta-analyses including studies with uncertain or low risk of bias.
The efficacy in reducing nocturnal BP was similar across drug types, doses and half-lives.
Evening administration of anti-HT drugs may reduce proteinuria, left ventricular hypertrophy (LVH) and morning peak. The overall quality of the evidence was rated as very low to low.
These results highlight the paucity of studies with low risk of bias and underscore the need for such trials to evaluate the efficacy of evening administration of anti-HT drugs as standard treatment for patients with nocturnal HT in diverse populations.
Source(s) :
Lee, EK ; Wang S ; Ng WL ; Ramdzan SN ; Tse E ; Chan L ; Rashid AA ; Chin WY ; Yu CP
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2024-09-05
Endocrinology and metabolism
It remains to be determined whether platelet-rich plasma (PRP) offers an additional advantage over Minoxidil in the treatment of androgenetic alopecia. The authors reviewed randomised controlled trials (RCTs) comparing PRP + Minoxidil scalp injections versus Minoxidil alone for the management of androgenetic alopecia.
All RCTs published in Embase, Cochrane Library and PubMed comparing PRP plus Minoxidil with Minoxidil alone were eligible. The literature search was completed on 5 March 2024. The opinion was registered on PROSPERO (CRD42024509826).
However, the small number of studies with a high risk of bias and heterogeneity in PRP preparation methods is a major limitation of the current evidence. Further studies with larger sample sizes and uniform PRP preparation protocols are needed.
Of five RCTs included, three had a high risk of bias, while one had some concerns.
A systematic review of the studies showed that all trials reported better results with PRP plus Minoxidil than with Minoxidil alone.
The meta-analysis showed that hair density at one month (DM: 11.07, 95% CI: 1.20, 20.94, I2 = 0%), three months (DM: 21.81, 95% CI: 10.64, 33.00, I2 = 57%) and 5/6 months (DM: 17.80, 95% CI: 7.91, 27.69, I2 = 80%) follow-up was significantly better in the PRP plus Minoxidil group compared to Minoxidil alone.
The meta-analysis of adverse events showed that the risk of adverse events was comparable in both groups (OR: 0.55 95% CI: 0.22, 1.36 I2 = 0%). The confidence level of the evidence on the GRADE assessment was ‘low to very low’.
CONCLUSION: There is very low quality evidence that the addition of injectable PRP to topical Minoxidil may improve outcomes in patients with androgenetic alopecia. The addition of PRP has been shown to significantly improve hair density and patient satisfaction.
However, the small number of studies with a high risk of bias and heterogeneity in PRP preparation methods is a major limitation of the current evidence. Further studies with larger sample sizes and uniform PRP preparation protocols are needed.
Source(s) :
Yao J ; Zhu L ; Pan M ; Shen L ; Tang Y ; Ventilateur L
;
2024-09-05
Urology-nephrology
Despite the efficacy of onabotulinumtoxinA, its safety profile remains a cause for concern.
This meta-analysis examined the major adverse events (AEs) associated with intravesical treatment with onabotulinumtoxinA in patients with neurogenic detrusor overactivity (NDO) and idiopathic overactive bladder (IAB).
Randomised controlled trials (RCTs) conducted between January 2000 and December 2022 were searched for adult patients who received different doses of onabotulinumtoxinA or onabotulinumtoxinA versus placebo. Quality assessment was performed using the Cochrane Collaboration Tool, and statistical analysis was performed using Review Manager version 5.3. A total of 26 RCTs were included in the analysis, including 8 on NDO and 18 on iOAB.
Administration of onabotulinumtoxinA versus placebo significantly increased the incidence of urinary tract infections (UTIs) in patients with NDO (relative risk, or RR, 1.54) and iOAB (RR, 2.53). There was no difference in RR with different doses of onabotulinumtoxinA.
Urinary retention was frequent with the use of onabotulinumtoxinA in the NDO (RR, 6.56) and iOAB (RR, 7.32) groups. Similar observations were made regarding the risks of de novo clean intermittent catheterisation (CIC).
The risk of difficulty urinating increased with the use of onabotulinumtoxinA in patients with iOAB.
Systemic AEs of onabotulinumtoxinA, including muscle weakness (RR, 2.79) and nausea (RR, 3.15), were noted in patients with NDO; most systemic AEs were low incidence and sporadic
Source(s) :
Yu PH, Wang CC
;
2024-09-11
Efficacy and safety of etrolizumab in the treatment of inflammatory bowel disease: a meta-analysis
Gastroenterology and Hepatology
This study explores the efficacy and safety of etrolizumab in the treatment of inflammatory bowel disease (IBD) through a meta-analysis.
A comprehensive search encompassed randomised controlled trials examining the efficacy of etrolizumab in the treatment of IBD in PubMed, Embase, the Cochrane Library and Web of Science, with a search cut-off date of 1 December 2023. Quality assessment was based on the Cochrane Manual's risk of bias assessment, while Stata 15 undertook the data analysis.
Five randomised controlled trials involving 1,682 individuals were finally included. The results of the meta-analysis suggest that, compared with placebo, etrolizumab may improve clinical response (RR = 1.26, 95% CI [1.04-1.51]), clinical remission (RR = 1.26, 95% CI [1.04-1.51]) and endoscopic relief (RR = 2.10, 95% CI [1.56-2.82]) in patients with IBD, endoscopic improvement (RR = 2.10, 95% CI [1.56-2.82]), endoscopic remission (RR = 2.10, 95% CI [1.56-2.82], histological remission (RR = 1.62, 95% CI [1, 26-2.08]), with no increase in adverse events (RR = 0.95, 95% CI [0.90-1.01]) or serious adverse events (RR = 0.94, 95% CI [0.68-1.31]).
According to this study, etrolizumab is a promising drug for IBD.
Source(s) :
Yong Gang Dai 1 2, Dajuan Sun 1, Jiahui Liu 1, Xiunan Wei 1, Lili Chi 1, Hongya Wang 2
;
2024-09-11
Oncology
Platinum-based chemotherapy represents the standard of care for the first-line treatment of advanced urothelial carcinoma (mUC). The benefit of adding immune checkpoint inhibitors (ICIs) to platinum-based chemotherapy has recently been investigated. The authors conducted a meta-analysis of individual patient data (IPD) from phase 3 clinical trials comparing ICI-based therapies.
A systematic literature search was performed in the MEDLINE and CENTRAL databases. Results were filtered by including only reports of clinical trials or randomised clinical trials from 2018 to 2023, including 3047 patients from four clinical trials (EV302, CHECKMATE-901, IMVIGOR130, KEYNOTE-361). A meta-analysis of individual patient data was performed using Kaplan-Meier curve reconstruction. The primary endpoints were overall survival and progression-free survival of Pembrolizumab + EV compared with the experimental arms of the other immunotherapy + chemotherapy trials.
CONCLUSIONS: The EV302 experimental arm showed better overall and progression-free survival compared with the other immunochemotherapy combinations. An immunochemotherapy combination strategy at the start of treatment for advanced urothelial carcinoma appears to be superior in terms of overall and progression-free survival compared with platinum-based chemotherapy alone. EV-Pembrolizumab showed better results than avelumab, rather than other immunochemotherapy combinations. However, given the heterogeneity of these studies, longer follow-up and prospective trials are needed to confirm these data.
A systematic literature search was performed in the MEDLINE and CENTRAL databases. Results were filtered by including only reports of clinical trials or randomised clinical trials from 2018 to 2023, including 3047 patients from four clinical trials (EV302, CHECKMATE-901, IMVIGOR130, KEYNOTE-361). A meta-analysis of individual patient data was performed using Kaplan-Meier curve reconstruction. The primary endpoints were overall survival and progression-free survival of Pembrolizumab + EV compared with the experimental arms of the other immunotherapy + chemotherapy trials.
Analysis of overall survival showed an advantage of IPD in the EV302 trial over all other trials. For EV302 vs KEYNOTE-361, the HR was 0.51; for EV302 vs IMVIGOR130, the HR was 0.47; and for EV302 vs CHECKMATE-901, the HR was 0.66 (95% CI 0.51-0.85). In the analysis of progression-free survival, the EV302 group showed a statistically significant advantage over CHECKMATE-901 (HR 0.66) and over IMVIGOR130 (HR 0.51).
LIMITATIONS: Using reconstructed DPI curves, it was not possible to adjust covariates at the patient level, and the heterogeneity of the included population may have affected the pooled results.
CONCLUSIONS: The EV302 experimental arm showed better overall and progression-free survival compared with the other immunochemotherapy combinations. An immunochemotherapy combination strategy at the start of treatment for advanced urothelial carcinoma appears to be superior in terms of overall and progression-free survival compared with platinum-based chemotherapy alone. EV-Pembrolizumab showed better results than avelumab, rather than other immunochemotherapy combinations. However, given the heterogeneity of these studies, longer follow-up and prospective trials are needed to confirm these data.
2024-09-11
Pharmacology and toxicology
Elevated levels of interleukin-6 are correlated with diseases such as cancer, autoimmune diseases and infections. IL-6 receptor inhibitors (IL-6Ri), used for rheumatoid arthritis and COVID-19, may have wider uses.
The authors applied Mendelian randomisation (MR) to study the effects of IL-6Ri. To simulate the effects of IL-6R gene blockade, they selected single nucleotide polymorphisms (SNPs) within or near the IL6R gene that show genome-wide significant associations with C-reactive protein. Using rheumatoid arthritis and COVID-19 as positive controls, key outcomes included risk of asthma, asthmatic pneumonitis, small cell lung cancer, Parkinson's disease, Alzheimer's disease, ulcerative colitis, Crohn's disease, systemic lupus erythematosus, type 1 diabetes and type 2 diabetes. The IVW (Inverse Variance Weighted) method was their main analytical approach, with MR hypotheses assessed by sensitivity and colocalization analyses. In addition, they performed Bayesian Mendelian randomisation analyses to minimise confounding and reverse causality biases as much as possible.
Bayesian Mendelian randomisation analyses were performed to minimise confounding and reverse causality bias.
IL-6 inhibitors significantly reduced the risk of idiopathic pulmonary fibrosis (OR = 0.278, 95% [CI], 0.138-0.558; P <0.001), Parkinson's disease (OR = 0.354, 95% CI, 0.215-0.582; P <0.001) and positively influenced the causal relationship with type 2 diabetes (OR = 0.759, 95% CI, 0.637-0.905; P = 0.002).
However, these inhibitors increased the risk of asthma (OR = 1.327, 95% CI 1.118-1.576; P = 0.001) and asthmatic pneumonia (OR = 1.823, 95% CI 1.246-2.666; P = 0.002). The causal effect estimates obtained using the BWMR method are consistent with those based on the IVW approach. Similarly, IL-6R also exerts a significant influence on these diseases.
Diseases such as Alzheimer's disease, Crohn's disease, pulmonary heart disease, systemic lupus erythematosus, type 1 diabetes, non-small cell lung cancer and ulcerative colitis showed non-significant associations (p > 0.05) and were excluded from further analysis. Similarly, small cell lung cancer was excluded due to inconsistent results.
Conclusion: IL-6Ri may represent a promising therapeutic pathway for idiopathic pulmonary fibrosis, Parkinson's disease and type 2 diabetes.
Source(s) :
Fu C, Wang L, Cai W
;
A new, more sensitive rapid diagnostic test (HS-RDT) for Plasmodium falciparum malaria (Alere™/Abbott Malaria Ag P.f RDT [05FK140], now called NxTek™ Eliminate Malaria Ag Pf) was launched in 2017. The test has already been used in numerous research studies across a wide range of geographical areas and use cases.
In this study, the authors collate all available unpublished and published studies using HS-RDT and assess its performance in (i) prevalence surveys, (ii) clinical diagnosis, (iii) screening pregnant women and (iv) active case detection. Two individual-level datasets from asymptomatic populations are used to fit logistic regression models to estimate the probability of HS-RT positivity as a function of histidine-rich protein 2 (HRP2) concentration and parasite density. The performance of the HS-RDT in prevalence surveys is estimated by calculating the sensitivity and positive proportion compared with the polymerase chain reaction (PCR) and conventional malaria RDTs.
In prevalence surveys from 18 studies, the mean sensitivity of HS-RDT was estimated to be 56.1% (95% confidence interval [CI] 46.9-65.4%) compared with 44.3% (95% CI 32.6-56.0%) for conventional RDT (co-RDT) when nucleic acid amplification techniques were used as the reference standard. In studies where prevalence was estimated using both HS-RDT and con-RCT, prevalence was on average 46% higher with HS-RDT compared with co-RDT. For clinical diagnosis and screening of pregnant women, HS-RDT was not significantly more sensitive than a co-RDT.
Overall, the evidence presented here suggests that HS-RT is more sensitive in asymptomatic populations and may provide a marginal improvement in the clinical diagnosis and screening of pregnant women. Although the HS-RT has claims of limited temperature stability and shelf life compared to co-RTs, there is no evidence to suggest, given that this test has the same cost as current RDTs, that it would have negative impacts in terms of misdiagnosis of malaria if it were widely used in the four population groups explored here.
2024-09-03
Antivirals for post-exposure prophylaxis of influenza: systematic review and network meta-analysis
Pharmacy
Antiviral post-exposure prophylaxis with neuraminidase inhibitors can reduce the incidence of influenza and the risk of symptomatic influenza, but the efficacy of other classes of antivirals remains uncertain. To support an update of WHO guidelines on influenza, this systematic review and network meta-analysis evaluated antiviral drugs for post-exposure prophylaxis of influenza.
The authors systematically searched MEDLINE, Embase, the Cochrane Register of Controlled Trials, the Cumulative Index of Nursing and Allied Health Literature, Global Health, Epistemonikos and ClinicalTrials.gov for randomised controlled trials published up to 20 September 2023 that assessed the efficacy and safety of antivirals compared with another antiviral or placebo or standard care for the prevention of influenza. Pairs of reviewers independently examined the studies, extracted the data and assessed the risk of bias. They performed network meta-analyses with the frequentist random effects model and assessed the confidence level of the evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. The outcome measures of interest were symptomatic or asymptomatic infection, hospital admission, all-cause mortality, antiviral-related adverse events and serious adverse events. This study is registered with PROSPERO, CRD42023466450.
The authors systematically searched MEDLINE, Embase, the Cochrane Register of Controlled Trials, the Cumulative Index of Nursing and Allied Health Literature, Global Health, Epistemonikos and ClinicalTrials.gov for randomised controlled trials published up to 20 September 2023 that assessed the efficacy and safety of antivirals compared with another antiviral or placebo or standard care for the prevention of influenza. Pairs of reviewers independently examined the studies, extracted the data and assessed the risk of bias. They performed network meta-analyses with the frequentist random effects model and assessed the confidence level of the evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. The outcome measures of interest were symptomatic or asymptomatic infection, hospital admission, all-cause mortality, antiviral-related adverse events and serious adverse events. This study is registered with PROSPERO, CRD42023466450.
Of the 11,845 registrations identified, 33 trials involving six antivirals (zanamivir, oseltamivir, laninamivir, baloxavir, amantadine and rimantadine) enrolled 19,096 people (mean age 6.75-81.15 years) included in this systematic review and network meta-analysis. Most studies were assessed as having a low risk of bias.
Zanamivir, oseltamivir, laninamivir and baloxavir are likely to significantly reduce the number of symptomatic influenza cases in people at high risk of severe disease (zanamivir : relative risk 0.35, 95% CI 0.25-0.50; oseltamivir: 0.40, 0.26-0.62; laninamivir: 0.43, 0.30-0.63; baloxavir: 0.43, 0.23-0.79; moderate certainty) when administered promptly (eg. eg, 48 hours) after exposure to seasonal influenza. These antivirals are unlikely to significantly reduce the number of symptomatic cases of influenza in people at low risk of severe illness when administered rapidly after exposure to seasonal influenza (moderate confidence).
Zanamivir, oseltamivir, laninamivir and baloxavir could significantly reduce the number of cases of symptomatic zoonotic influenza in people exposed to novel influenza A viruses associated with severe disease in infected humans when administered rapidly after exposure (low confidence level).
Oseltamivir, laninamivir, baloxavir and amantadine probably reduce the risk of all influenza (symptomatic and asymptomatic infection; moderate certainty).
Zanamivir, oseltamivir, laninamivir and baloxavir probably have little or no effect on preventing asymptomatic influenza infection or all-cause mortality (high or moderate certainty).
Oseltamivir probably has little or no effect on hospital admission (moderate certainty).
The six antivirals do not significantly increase the incidence of drug-related adverse events or serious adverse events, although the level of confidence in the evidence varies.
2024-09-03
Neurology
Chronic diseases, such as diabetes, cardiovascular disease and lung disease, require prolonged medication. Many of the drugs used for these diseases have varying degrees of neurological side-effects, while some drugs may have potential protective effects for neuropsychiatric disorders.
Pre-marketing clinical trials of drugs often only assess short-term neuropsychiatric symptoms, leaving the long-term effects of drugs on brain structures and associated psychiatric conditions unrecognised.
How can oral drugs affect brain structures and disease? In addition to direct means such as crossing the blood-brain barrier, influencing target gene expression and activating signalling pathways in neurons, the gut microbiota may serve as a key mediator linking oral drug use to brain structure and disease. Pharmacomicrobiomics has revealed that drugs can have an impact on the composition of the gut microbiota by directly killing microbes, modulating the host immune response and altering gut pH. The gut microbiota can also influence brain function via the microbiota-gut-brain axis, producing tryptophan metabolites and other neurotransmitters.
The authors comprehensively analysed the FDA Adverse Event Reporting System database and conducted Mendelian randomisation (MR) studies on six common drug classes, 477 brain imaging-derived phenotypes (BIPs) and eight psychiatric disorders.
Pre-marketing clinical trials of drugs often only assess short-term neuropsychiatric symptoms, leaving the long-term effects of drugs on brain structures and associated psychiatric conditions unrecognised.
How can oral drugs affect brain structures and disease? In addition to direct means such as crossing the blood-brain barrier, influencing target gene expression and activating signalling pathways in neurons, the gut microbiota may serve as a key mediator linking oral drug use to brain structure and disease. Pharmacomicrobiomics has revealed that drugs can have an impact on the composition of the gut microbiota by directly killing microbes, modulating the host immune response and altering gut pH. The gut microbiota can also influence brain function via the microbiota-gut-brain axis, producing tryptophan metabolites and other neurotransmitters.
The authors comprehensively analysed the FDA Adverse Event Reporting System database and conducted Mendelian randomisation (MR) studies on six common drug classes, 477 brain imaging-derived phenotypes (BIPs) and eight psychiatric disorders.
Results: Among the 19 drug classes, six drugs were found to be associated with higher risks of psychiatric adverse events, while 11 drugs were associated with higher risks of gastrointestinal adverse events in the FAERS analysis. The authors identified ten drug-psychiatric disorder associations, 202 drug-brain imaging associations, 16 drug-microbiota associations and four drug-microbiota-medical imaging causal links.
Statins were associated with higher risks of ‘reduced self-esteem’ (OR = 18.92 [14.09, 25.42]), ‘agitated depression’ (OR = 9.76 [4.54, 20.99]) compared with other drugs, and significant changes in various brain structures.
GLP-1R agonists, a class of hypoglycaemic agents highly recommended for the treatment of type 2 diabetes, have been shown to improve cognitive functions such as episodic memory. A recent study found that they exert anti-inflammatory effects in relation to central neuronal GLP-1R, further indicating the importance of the CNS effects of this class of drugs. A 16-week randomised controlled trial showed that liraglutide improved cognitive function in delayed memory, attention and executive function, partly through a direct effect on activation of the left hippocampus.
For thiazolidinediones, a class of hypoglycaemic agents, the authors identified that they were significantly associated with a higher risk of type II bipolarity.
Common medications can affect the structure of the brain and the risk of psychiatric disorders. Oral medicines in particular can exert some of these effects by influencing the intestinal microbiota. This study calls for greater attention to be paid to the neuropsychiatric adverse effects of drugs and encourages the reallocation of drugs.
The article entitled ‘Acupuncture modulates emotional network resting-state functional connectivity in patients with insomnia disorder: a randomized controlled trial and fMRI study’ explores the effects of acupuncture on resting-state functional connectivity of emotional networks in patients with insomnia disorder.
Insomnia is a common sleep disorder that is often accompanied by symptoms of anxiety and depression. Functional magnetic resonance imaging (fMRI) studies have shown that sleep disorders and negative emotions are linked to dysregulation of the brain networks involved in emotional processing in patients with insomnia. Acupuncture has been recognised as an effective treatment for improving sleep quality and mood in patients suffering from insomnia. However, the neurobiological mechanisms involved in these effects remain unclear.
The main objective of this study was to evaluate the effect of acupuncture on the resting state functional connectivity (rsFC) of the emotional network (EN) in patients suffering from insomnia.
The study was a randomised, single-blind, controlled clinical trial involving 60 patients suffering from insomnia, randomly divided into two groups: real acupuncture and simulated acupuncture. Thirty healthy participants were also included as a control group.
Acupuncture was administered for 4 weeks, with three sessions per week. Participants underwent fMRI scans before and after treatment. The functional connectivity at rest of the areas involved in emotion management (thalamus, hippocampus, amygdala, anterior cingulate cortex, dorsolateral prefrontal cortex) was assessed. The Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD), Pittsburgh Sleep Quality Index (PSQI) and actigraphy data were used to assess clinical efficacy.
Functional connectivity analyses at rest revealed abnormalities centred on the thalamus and dorsolateral prefrontal cortex (DLPFC) in the emotional network of patients with insomnia, compared with healthy participants. After treatment with real acupuncture, an increase in functional connectivity between certain regions, notably the anterior cingulate cortex, the hippocampus and the amygdala, was observed compared with the simulated acupuncture group. Specifically, functional connectivity between the left amygdala and left thalamus decreased after 4 weeks of real acupuncture treatment, which correlated with improved sleep efficiency and reduced anxiety scores in patients.
These results suggested that acupuncture may have a positive effect by modulating the functional connectivity of networks involved in emotional processing in patients suffering from insomnia. Brain areas such as the hippocampus, anterior cingulate cortex and amygdala, which play a key role in emotion regulation, showed an increase in functional connectivity after acupuncture, which could explain the clinical improvements observed in terms of sleep quality and reduction in anxiety symptoms. The study highlights the importance of the amygdala in regulating emotions and sleep, particularly in interaction with other regions such as the thalamus and hippocampus.
Acupuncture can improve sleep quality and reduce anxiety in patients suffering from insomnia by modulating functional connectivity within emotion-related brain networks. These results offer promising prospects for the use of acupuncture as a complementary treatment for sleep disorders, particularly for patients suffering from insomnia associated with emotional disorders.
2024-08-27
Consumption of yoghurt and probiotics is associated with a reduced risk of sleep disorders
General medicine
The research article entitled ‘Association between yogurt and dietary supplements containing probiotic consumption with sleep disturbance in US adults: Results from NHANES, 2009-2018’ explores the relationship between consumption of yogurt and dietary supplements containing probiotics and sleep disturbance in US adults.
Sleep disorders are a common public health problem, affecting a large proportion of the world's population. The gut microbiome, which plays a crucial role in brain homeostasis via the microbiota-gut-brain axis, is increasingly recognised for its involvement in sleep disorders. Probiotics, as living micro-organisms found in fermented dairy products such as yoghurt, have been shown to have potential beneficial effects on sleep quality.
This study evaluated the association between consumption of yoghurt and probiotic supplements and the prevalence of sleep disorders in a large cohort of American adults.
49,693 adult participants from the National Health and Nutrition Examination Survey (NHANES) were included in this study, between 2009 and 2018. After excluding participants under the age of 18 and those with missing data on yoghurt consumption, probiotic consumption or sleep disorders, the final sample comprised 24,820 participants. Consumption of yoghurt and probiotic supplements was assessed using a food questionnaire, while sleep disorders were measured using a questionnaire on sleep disorders and sleep duration.
Of the 24,820 participants, 14.24% consumed yoghurt and/or supplements containing probiotics, i.e. 3,535 participants. The prevalence of sleep disorders in this population was 16.22%, and only 53.51% of participants achieved the recommended sleep duration (7-9 hours per night). Weighted logistic regression models showed that consumption of probiotics was associated with a significant reduction in the risk of sleep disorders. This protective association was particularly notable in men, non-Hispanic whites and individuals with a normal BMI.
However, this effect was less significant in women and obese individuals. This suggests that the response to probiotics may vary according to sex, race and weight status. The results of this study suggested a positive association between probiotic consumption and improved sleep quality.
The study concludes that consumption of yoghurt and supplements containing probiotics is associated with a reduced risk of sleep disorders in American adults. The results underline the importance of probiotics as a public health strategy for improving sleep quality, with a potentially greater impact in specific populations. Future research should explore the underlying mechanisms and efficacy of different probiotic strains on sleep.
Source(s) :
Rui-zhi Yang, Shi-zhu Lin, Xi-yuan Xie, Yi-jie Tang, Jing-xuan Zheng, Chao-mei Yuan, Ya-yi Lin, Xiao-dan Wu, Kai Zeng,
;
2024-08-26
Coffee consumption is positively associated with skeletal muscle mass
Endocrinology and metabolism
The research article entitled ‘Association between coffee intake and skeletal muscle mass among U.S. adults: a population-based study’ explores the relationship between coffee consumption and skeletal muscle mass in adults.
Coffee, a beverage rich in caffeine and polyphenols, has antioxidant and anti-inflammatory properties.
The cross-sectional study was based on a sample of 8,333 participants selected from the National Health and Nutrition Examination Survey (NHANES). Measurements of skeletal muscle mass were obtained using two-photon X-ray absorptiometry (DXA) and adjusted for body mass index (ASMBMI). Coffee and caffeine consumption was assessed using a 24-hour dietary recall questionnaire. The association between coffee and caffeine consumption and ASMBMI was analysed using multiple linear regression models and smoothed curve fitting, taking into account demographic variables, energy intake, physical activity and other potentially confounding factors.
The results showed a positive and linear association between coffee (caffeinated or not) and caffeine consumption and an increase in ASMBMI. Participants with a higher consumption of coffee, caffeinated coffee or caffeine showed a higher ASMBMI after adjustment for confounding variables. This relationship persisted in subgroup analyses, except in participants with a BMI greater than 30 kg/m², where the association disappeared, suggesting that obesity could modify this relationship.
This study supports the hypothesis that increased consumption of coffee or caffeine may be beneficial for skeletal muscle mass, particularly in non-obese individuals. Suggested mechanisms include caffeine-induced autophagy, a key process for the maintenance of muscle mass, as well as the anti-inflammatory and antioxidant effects of coffee polyphenols. However, obesity appears to attenuate this effect, which could be due to increased catabolism of lean muscle mass in obese individuals.
Coffee and caffeine consumption is positively associated with skeletal muscle mass in American adults, and could therefore constitute a dietary strategy to prevent loss of muscle mass, particularly in people at risk of sarcopenia. However, further studies, particularly longitudinal ones, are needed to establish a clear causal relationship and explore the implications of these results in obese populations.
