Acid-sensitive prodrugs; a promising approach for site-specific and targeted drug release.

Drugs administered through conventional formulations are devoid of targeting and often spread to various undesired sites, leading to sub-lethal concentrations at the site of action and the emergence of undesired effects. Hence, therapeutic agents should be delivered in a controlled manner at target sites. Currently, stimuli-based drug delivery systems have demonstrated a remarkable potential for the site-specific delivery of therapeutic moieties. pH is one of the widely exploited stimuli for drug delivery as several pathogenic conditions such as tumor cells, infectious and inflammatory sites are characterized by a low pH environment. This review article aims to demonstrate various strategies employed in the design of acid-sensitive prodrugs, providing an overview of commercially available acid-sensitive prodrugs. Furthermore, we have compiled the progress made for the development of new acid-sensitive prodrugs currently undergoing clinical trials. These prodrugs include albumin-binding prodrugs (Aldoxorubicin and DK049), polymeric micelle (NC-6300), polymer conjugates (ProLindac™), and an immunoconjugate (IMMU-110). The article encompasses a broad spectrum of studies focused on the development of acid-sensitive prodrugs for anticancer, antibacterial, and anti-inflammatory agents. Finally, the challenges associated with the acid-sensitive prodrug strategy are discussed, along with future directions.

Kidney and cardiovascular-protective benefits of combination drug therapies in chronic kidney disease associated with type 2 diabetes.

Given the substantial burden of chronic kidney disease associated with type 2 diabetes, an aggressive approach to treatment is required. Despite the benefits of guideline-directed therapy, there remains a high residual risk of continuing progression of chronic kidney disease and of cardiovascular events. Historically, a linear approach to pharmacologic management of chronic kidney disease has been used, in which drugs are added, then adjusted, optimized, or stopped in a stepwise manner based on their efficacy, toxicity, effects on a patient's quality of life, and cost. However, there are disadvantages to this approach, which may result in missing a window of opportunity to slow chronic kidney disease progression. Instead, a pillar approach has been proposed to enable earlier treatment that simultaneously targets multiple pathways involved in disease progression. Combination therapy in patients with chronic kidney disease associated with type 2 diabetes is being investigated in several clinical trials. In this article, we discuss current treatment options for patients with chronic kidney disease associated with type 2 diabetes and provide a rationale for tailored combinations of therapies with complementary mechanisms of action to optimize therapy using a pillar-based treatment strategy. [This article includes a plain language summary as an additional file].

Comparative efficacy of tocotrienol and tocopherol (vitamin E) on atherosclerotic cardiovascular diseases in humans.

Objective: To compare the efficacy of tocotrienol and tocopherol in the management of patients with atherosclerotic cardiovascular diseases. METHODS: The systematic review was conducted in line with Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines 2020, and comprised literature search from 2002 till January 5, 2023, on PubMed, Google Scholar, Cochrane Library, Google, Wiley-Inter Science Library, Medline, SpringerLink, Taylor and Francis databases. The search was conducted using key words, such as: "tocopherol", "tocotrienol", "vitamin E", "dyslipidaemia", "cardiovascular diseases" "cardioprotective", "hypercholesterolemia" and "atherosclerosis" along with Boolean operators. Human clinical studies regarding the use of tocotrienol or tocopherol or comparison of its efficacy in patients having atherosclerosis, dyslipidaemia leading to cardiovascular diseases, and studies including details of efficacy of any of the four alpha, beta, gamma, delta isomers of tocopherol or tocotrienol were included. Pertinent data from the eligible studies was retrieved and reviewed. RESULTS: Of the 516 articles identified, 26 (5%) articles met eligibility criteria. Of them 5(19%) were subjected to detailed analysis. Tocotrienol showed significant anti-oxidant efficacy at (250 mg/d) by decreasing cholesterol and serum inflammatory biomarkers i.e C-reactive protein (40%), malondialdehyde (34%), gamma-glutamyl transferase (22%) (p<0.001). Total anti-oxidant status (TAS) levels raised 22% (p<0.001) and Inflammatory cytokines i.e resistin, interleukin (IL)-1, IL-12, Interferon-gamma were decreased 15-17% (p<0.05-0.01) respectively by tocotrienol. Several microRNA (miRNA-133a, miRNA-223, miRNA-214, miRNA-155) were modulated by δ-tocotrienol. Whereas, tocopherol showed heterogeneity of results by either decreasing or increasing the risk of mortality in atherosclerotic cardiovascular diseases. Conclusion: Compared to tocopherol, tocotrienol was found to be safe and potential candidate for improving cardiovascular health in the management of atherosclerotic cardiovascular diseases.

Cooperative Communication Based Protocols for Underwater Wireless Sensors Networks: A Review.

Underwater wireless sensor networks are gaining popularity since supporting a broad range of applications, both military and civilian. Wireless acoustics is the most widespread technology adopted in underwater networks, the realization of which must face several challenges induced by channel propagation like signal attenuation, multipath and latency. In order to address such issues, the attention of researchers has recently focused on the concept of cooperative communication and networking, borrowed from terrestrial systems and to be conveniently recast in the underwater scenario. In this paper, we present a comprehensive literature review about cooperative underwater wireless sensor networks, investigating how nodes cooperation can be exploited at the different levels of the network protocol stack. Specifically, we review the diversity techniques employable at the physical layer, error and medium access control link layer protocols, and routing strategies defined at the network layer. We also provide numerical results and performance comparisons among the most widespread approaches. Finally, we present the current and future trends in cooperative underwater networks, considering the use of machine learning algorithms to efficiently manage the different aspects of nodes cooperation.

Preoperative and postoperative predictive models of early recurrence for colorectal liver metastases following chemotherapy and curative-intent one-stage hepatectomy.

INTRODUCTION: Accurate prediction of patients at risk for early recurrence (ER) among patients with colorectal liver metastases (CRLM) following preoperative chemotherapy and hepatectomy remains limited. METHODS: Patients with CRLM who received chemotherapy prior to undergoing curative-intent resection between 2000 and 2020 were identified from an international multi-institutional database. Multivariable Cox regression analysis was used to assess clinicopathological factors associated with ER, and an online calculator was developed and validated. RESULTS: Among 768 patients undergoing preoperative chemotherapy and curative-intent resection, 128 (16.7 %) patients had ER. Multivariable Cox analysis demonstrated that Eastern Cooperative Oncology Group Performance status ≥1 (HR 2.09, 95%CI 1.46-2.98), rectal cancer (HR 1.95, 95%CI 1.35-2.83), lymph node metastases (HR 2.39, 95%CI 1.60-3.56), mutated Kirsten rat sarcoma oncogene status (HR 1.95, 95%CI 1.25-3.02), increase in tumor burden score during chemotherapy (HR 1.51, 95%CI 1.03-2.24), and bilateral metastases (HR 1.94, 95%CI 1.35-2.79) were independent predictors of ER in the preoperative setting. In the postoperative model, in addition to the aforementioned factors, tumor regression grade was associated with higher hazards of ER (HR 1.91, 95%CI 1.32-2.75), while receipt of adjuvant chemotherapy was associated with lower likelihood of ER (HR 0.44, 95%CI 0.30-0.63). The discriminative accuracy of the preoperative (training: c-index: 0.77, 95%CI 0.72-0.81; internal validation: c-index: 0.79, 95%CI 0.75-0.82) and postoperative (training: c-index: 0.79, 95%CI 0.75-0.83; internal validation: c-index: 0.81, 95%CI 0.77-0.84) models was favorable (https://junkawashima.shinyapps.io/CRLMfollwingchemotherapy/). CONCLUSIONS: Patient-, tumor- and treatment-related characteristics in the preoperative and postoperative setting were utilized to develop an online, easy-to-use risk calculator for ER following resection of CRLM.

Potential application of artificial intelligence in cancer therapy.

PURPOSE OF REVIEW: This review underscores the critical role and challenges associated with the widespread adoption of artificial intelligence in cancer care to enhance disease management, streamline clinical processes, optimize data retrieval of health information, and generate and synthesize evidence. RECENT FINDINGS: Advancements in artificial intelligence models and the development of digital biomarkers and diagnostics are applicable across the cancer continuum from early detection to survivorship care. Additionally, generative artificial intelligence has promised to streamline clinical documentation and patient communications, generate structured data for clinical trial matching, automate cancer registries, and facilitate advanced clinical decision support. Widespread adoption of artificial intelligence has been slow because of concerns about data diversity and data shift, model reliability and algorithm bias, legal oversight, and high information technology and infrastructure costs. SUMMARY: Artificial intelligence models have significant potential to transform cancer care. Efforts are underway to deploy artificial intelligence models in the cancer practice, evaluate their clinical impact, and enhance their fairness and explainability. Standardized guidelines for the ethical integration of artificial intelligence models in cancer care pathways and clinical operations are needed. Clear governance and oversight will be necessary to gain trust in artificial intelligence-assisted cancer care by clinicians, scientists, and patients.

Potential nanomedicinal applications and physicochemical nature of Hyphaene thebaica-reduced nano-samaria.

Herein we described the biofabrication of samarium oxide nanoparticles (HT-Sm2O3 NPs) by applying the aqueous fruit extract of Hyphaene thebaica was utilized as an eco-friendly chelating agent. The prepared NPs were subjected to various physicochemical properties and potential in biomedical applications. X-ray Diffraction (XRD) pattern revealed sharp peaks that corroborated with the Joint Committee on Powder Diffraction Standards (JCPDS) card no. 00-042-1464. Crystallite size obtained from Debye-Scherrer approximation and Williamson-Hall (W-H) plot was 28.73 and 69.3 nm, respectively. Optical bandgap was calculated by employing Kubelka-Munk (K-M) function and was found to be ~4.58 eV. Raman shift was observed at 121, 351, 424-, and 561 cm-1. Photoluminescence (PL) spectra revealed two major peaks positioned at 360 and 540 nm. The high-resolution transmission electron microscopy (HR-TEM) analysis of HT-Sm2O3 nanoparticles (NPs) showed that they predominantly have spherical to cuboidal shapes. Additionally, the selected area electron diffraction (SAED) pattern presented spotty rings, indicating a high level of crystallinity in these NPs. The potential nanomedicine applications were studied using diverse bioassays using different treatments. The antioxidant activity demonstrated 45.71% ± 1.13% inhibition at 1000 µg/mL. Brine shrimp lethality assay revealed the highest cytotoxicity of 46.67% ± 3.33% at 1000 µg/mL and LC50 value of 1081 µg/mL. HT-Sm2O3 NPs exhibited inhibition of angiogenesis (20.41% ± 1.18%) at of 1000 µg/mL. MTT assay results indicated that HT-Sm2O3 NPs exhibit inhibitory effects on cell lines. Specifically, these NPs showed an IC50 value of 104.6 µg/mL against 3T3 cells. Against MCF-7 cells, the NPs demonstrated an IC50 value of 413.25 µg/mL. Additionally, in the inhibition of acetylcholinesterase (AChE), the newly synthesized NPs showed an IC50 value of 320 µg/mL. The antidiabetic assessment through α-glucosidase and α-amylase inhibition assays revealed, an IC50 value of 380 µg/mL for α-glucosidase and 952 µg/mL for α-amylase was calculated. Overall, our study suggested that the Sm2O3 NPs possess moderate anticancer, cholinesterase inhibition, and antidiabetic potential, however, needs further assessment. RESEARCH HIGHLIGHTS: In this work, nano-samaria is synthesized using an eco-friendly and green approach. The nanoparticles were characterized using techniques such as Raman, HR-TEM, FTIR, DRS, XRD, and so on, and the applications were studied using multiple in vitro bioassays for Diabetes, Alzheimer, and Cancer. The nano-samaria revealed good potential for potential biomedical applications.

Current Perspectives of Protein in Bone Tissue Engineering: Bone Structure, Ideal Scaffolds, Fabrication Techniques, Applications, Scopes, and Future Advances.

In view of their exceptional approach, excellent inherent biocompatibility and biodegradability properties, and interaction with the local extracellular matrix, protein-based polymers have received attention in bone tissue engineering, which is a multidisciplinary field that repairs and regenerates fractured bones. Bone is a multihierarchical complex structure, and it performs several essential biofunctions, including maintaining mineral balance and structural support and protecting soft organs. Protein-based polymers have gained interest in developing ideal scaffolds as emerging biomaterials for bone fractured healing and regeneration, and it is challenging to design ideal bone substitutes as perfect biomaterials. Several protein-based polymers, including collagen, keratin, gelatin, serum albumin, etc., are potential materials due to their inherent cytocompatibility, controlled biodegradability, high biofunctionalization, and tunable mechanical characteristics. While numerous studies have indicated the encouraging possibilities of proteins in BTE, there are still major challenges concerning their biodegradability, stability in physiological conditions, and continuous release of growth factors and bioactive molecules. Robust scaffolds derived from proteins can be used to replace broken or diseased bone with a biocompatible substitute; proteins, being biopolymers, provide excellent scaffolds for bone tissue engineering. Herein, recent developments in protein polymers for cutting-edge bone tissue engineering are addressed in this review within 3-5 years, with a focus on the significant challenges and future perspectives. The first section discusses the structural fundamentals of bone anatomy and ideal scaffolds, and the second section describes the fabrication techniques of scaffolds. The third section highlights the importance of proteins and their applications in BTE. Hence, the recent development of protein polymers for state-of-the-art bone tissue engineering has been discussed, highlighting the significant challenges and future perspectives.

Metal-organic frameworks: synthesis, properties, wound dressing, challenges and scopes in advanced wound dressing.

Wound healing is a critical but complex biological process of skin tissue repair and regeneration resulting from various systems working together at the cellular and molecular levels. Quick wound healing and the problems associated with traditional wound repair techniques are being overcome with multifunctional materials. Over time, this research area has drawn significant attention. Metal-organic frameworks (MOFs), owning to their peculiar physicochemical characteristics, are now considered a promising class of well-suited porous materials for wound healing in addition to their other biological applications. This detailed literature review provides an overview of the latest developments in MOFs for wound healing applications. We have discussed the synthesis, essential biomedical properties, wound-healing mechanism, MOF-based dressing materials, and their wound-healing applications. The possible major challenges and limitations of MOFs have been discussed, along with conclusions and future perspectives. This overview of the literature review addresses MOFs-based wound healing from several angles and covers the most current developments in the subject. The readers may discover how the MOFs advanced this discipline by producing more inventive, useful, and successful dressings. It influences the development of future generations of biomaterials for the healing and regeneration of skin wounds.

A Hole in the Heart, a Hole in the Defenses: A Case of Pseudomonas Endocarditis.

Infective endocarditis (IE) is a rare but serious infection of the cardiac endothelium. This case report presents a rare instance of left-sided Pseudomonas aeruginosa endocarditis in an immunocompetent patient without traditional risk factors for IE. Pseudomonas endocarditis is uncommon and usually associated with specific factors. The patient in this case was a 30-year-old male with end-stage renal disease, receiving hemodialysis through a tunneled dialysis catheter, who developed a fever. Blood cultures confirmed P. aeruginosa as the causative agent, which prompted the administration of appropriate antibiotics and the removal of the catheter. However, subsequent imaging revealed significant damage to the mitral valve. Despite timely mitral valve replacement and aggressive medical treatment, the patient's condition worsened, and he ultimately succumbed to the infection. This case also emphasizes the necessity of timely diagnosis and intervention. In this patient, by the time it was diagnosed and managed, significant mitral valve damage had already occurred. Therefore, it should be considered a differential diagnosis even in patients with no risk factors and should be managed vigorously. Pseudomonas endocarditis is associated with high mortality, and successful treatment often requires a combination of antipseudomonal antibiotics due to the organism's ability to develop resistance. Surgical intervention, such as valve replacement, is frequently necessary. This case underscores the importance of considering P. aeruginosa infection, even in patients without traditional risk factors for IE. Early diagnosis, appropriate antibiotic therapy, and timely surgical intervention are critical for improving outcomes in Pseudomonas endocarditis cases.

Stapler Strategies for Upcycling Mixed Plastics.

Mechanical recycling is one of the simplest and most economical strategies to address ever-increasing plastic pollution, but it cannot be applied to immiscible mixed plastics and suffers from property deterioration after each cycle. By combining the amphiphilic block copolymer strategy and reactive compatibilization strategy, we designed a series of stapler strategies for compatibilizing/upcycling mixed plastics. First, various functionalized graft copolymers were accessed via different synthetic routes. Subsequently, the addition of a very small amount of stapler molecules induced a synergistic effect with the graft copolymers that improved the compatibility and mechanical properties of mixed plastics. These strategies were highly effective for various binary/ternary plastic systems and can be directly applied to postconsumer waste plastics, which can increase the toughness of mixed postconsumer waste plastics by 162 times. Most importantly, it also effectively improved the impact resistance, adhesion performance, and three-dimensional (3D) printing performance of mixed plastics, and permitted the recycling of plastic blends 20 times with minimal degradation in their mechanical properties.

Pharmacognostic Evaluation, Chemical Characterization, and Antibacterial Activity of Bassia indica (Wight) A.J. Scott.

Bassia indica (Wight) A.J. Scott is an Indian origin plant with documented medicinal and nutritional value, but has not been fully characterized yet. The present study was designed to establish pharmacognostic standards for the proper identification of the B. indica plant and its chemical characterization. The plant was standardized with World Health Organization (WHO) standardization tools and chemically characterized by Fourier transform infrared spectroscopy (FTIR) and gas chromatography-mass spectroscopy (GC-MS) analysis. Antibacterial potential was assessed by the zone of inhibition and minimum inhibitory concentration (MIC), and molecular docking studies were also performed. Pharmacognostic evaluation established the macroscopic and microscopic parameters for the identification of whole plant and its powder. Physicochemical parameters were also set forth while quantitative phytochemical analysis showed that the ethyl acetate fraction had the highest quantity of phenols, flavonoids, and tannins. FTIR analysis showed several functional groups such as phenols, alkanes, and alcohols while 55 phytochemicals were identified in the GC-MS analysis of the crude fraction. The crude extract and other fractions showed marked antibacterial activity, while the ethyl acetate fraction showed the least MIC (1.95-31.25 mg/mL). Phytochemicals identified in the GC-MS showed good molecular docking interactions against the DNA gyrase subunit B of bacteria with binding energies ranging from -4.2 to -9.4 kcal/mol. The current study describes the pharmacognostic characterization and phytochemical profiling of B. indica and provides scientific evidence to support its use in infections.

Association between Serum Vitamin D Status and Circadian Syndrome: A Cross-Sectional Study.

BACKGROUND: Circadian Syndrome (CircS) encompasses cardiometabolic risk factors and comorbidities, indicating an elevated susceptibility to cardiovascular disease and type 2 diabetes. METHODS: This cross-sectional study aimed to investigate the association between vitamin D levels and each of the following: CircS, metabolic syndrome (MetS), and the individual components of CircS. Data from 14,907 adults who participated in the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2018 were utilized. CircS was defined based on MetS components, alongside depression, short sleep, and non-alcoholic fatty liver disease (NAFLD). RESULTS: Our results indicated that low vitamin D levels exhibited meaningful associations with CircS, with vitamin D deficiency and inadequacy demonstrating 2.21-fold (95% CI 1.78-2.74, p < 0.001) and 1.33-fold (95% CI 1.14-1.54, p < 0.001) increases in CircS odds, respectively. The association between vitamin D deficiency and CircS was stronger than that with MetS. Additionally, a dose-response gradient in odds of CircS components, particularly with short sleep duration, was noted as serum vitamin D levels decreased. CONCLUSIONS: our findings highlight a significant association between low serum vitamin D levels and CircS and its components, particularly with short sleep. This suggests a potentially pivotal role of vitamin D in the pathogenesis of Circadian syndrome.

Synergistic adsorption of methylene blue using ternary composite of phosphoric acid geopolymer, calcium alginate, and sodium lauryl sulfate.

The removal of dyes from the aquatic ecosystem is necessary being a major threat to life. For enhanced remediation of methylene blue (MB) dye, a new ternary biopolymer-geopolymer-surfactant composite adsorbent is synthesized by combining phosphoric acid geopolymer (PAGP), calcium alginate (Alg), and sodium lauryl sulfate (SLS). During the synthesis of the composites, PAGP and SLS were mixed with the alginate matrix, producing porous hybrid beads. The PAGP-SLS-alginate (PSA) beads prepared were characterized using different analytical tools, i.e., scanning electron microscopy (SEM), Fourier transform infrared spectrophotometry (FTIR), X-ray diffractometry (XRD), surface area and porosimetery (SAP), and thermogravimetric analysis (TGA). To ascertain the ideal conditions for the adsorption process, a batch reactor procedure was used to investigate the effects of several parameters on MB adsorption, including pH (2, 4, 6, 8, 10), PSA adsorbent dosage (0.06-0.12 g), MB concentration (50-500 mg/L), contact time (15 to 300 min), and temperature (25, 35, and 45 °C). The SEM investigation indicated that ~ 1860 µm-sized PSA beads with 6-8 µm voids are generated. Based on XRD, FTIR, and SAP examinations, the material is amorphous, having numerous functional groups and an average pore size of 6.42 nm. Variation of pH has a little effect on the adsorption process, and the pH of 7.44 was found to be the pHpzc of the PSA beads. According to the findings of the batch study, equilibrium adsorption was obtained in 270-300 min, showing that the adsorption process was moderately slow-moving and effective. The dye adsorption linearly increased with initial dye concentration over concentration range of 50-500 mg/L and reciprocally decreased with rise in temperature. 0.06 g adsorbent dose, 25 °C, pH10, and 270 min were found to be the better conditions for adsorption experiments. Langmuir isotherm fitted well compared to Freundlich, Temkin, and Dubinin-Radushkevich (DR) isotherm models on the experimental data, and the maximum adsorption capacity(qmax) calculated was 1666.6 mg. g-1. Pseudo-second-order (PSO) kinetics model and multi steps (two) intra particle diffusion (IPD) model fitted well on the adsorption kinetics data. The system's entropy, Gibbs free energy, and change in enthalpy were measured and found to be -109.171 J. mol-1. K-1, - 8.198 to - 6.014 kJ. mol-1, and - 40.747 kJ. mol-1. Thermodynamics study revealed that adsorption process is exothermic, energetically favorable and resulting in the decrease in randomness. Chemisorption is found to be the dominant mechanism as confirmed by pH effect, Langmuir isotherm, PSO kinetics, IPD model, and thermodynamics parameters. PSA beads were successfully regenerated using ethanol in a course of 120 min and re-used for five times. To sum up, the PSA adsorbent's impressive adsorption capability of 1666.66 mg/g highlights its potential as a successful solution for methylene blue removal. The results of this study add to the expanding corpus of information on sophisticated adsorption materials and demonstrate PSA's potential for real-world uses in wastewater treatment and environmental clean-up.

Knowledge, awareness and attitude towards breast cancer: Risk factors, signs and screening among Health and Allied students: A prospective study.

Introduction: Breast cancer (BC) is the second most common cancer in Saudi women. Therefore, understanding BC and its related risk factors, symptoms, and screening is critical for early detection and intervention. The current study was meant to explore the knowledge, awareness, and attitude (KAA) gap in BC: risk factors, symptoms, and screening. Material and Methods: This cross-sectional investigation was carried out with Health Professions Students (HPS) using a predesigned and validated study questionnaire to examine HPS knowledge and attitudes concerning BC and associated risk factors, symptoms, and screening. Results: A total of 277 female students responded to the survey. The frequency of correct answers for the BC knowledge questions varied from the lowest of 27.8% to the highest of 88.8%, with only 5 out of 15 questions (33.3%) answered correctly by more than 60% of the participants, displaying poor knowledge and awareness of BC. A majority (>60%) of the participants identified only 7 of the 18 risk factors of BC correctly, whereas 11 of the 13 early warning signs of BC were identified correctly by the majority (>60%) of the participants. Among the participants, only 26.4% were aware of the breast cancer screening center, but 94.6% of them agreed that early detection of breast cancer is important and 82.7% agreed to participate in the screening program if offered. Conclusion: Participants' knowledge and awareness of BC were found to be relatively low; however, their attitudes towards BC screening were positive. As a result, it is critical to develop effective education programs, curricular activities, and awareness campaigns to address the lack of awareness of BC and to have an appropriate response to screening to reduce disease burden.

Comparative Profiles of the WATCHMAN™ and Amplatzer™ Cardiac Plug/Amplatzer™ Amulet™ Devices for Left Atrial Appendage Closure in Non-valvular Atrial Fibrillation: A Comprehensive Systematic Review and Meta-analysis.

Atrial fibrillation (AF) is a prevalent cardiac arrhythmia marked by irregular and frequent tachycardic rhythms in the atria, affecting 1%-2% of the general population. The WATCHMAN™ device from Boston Scientific (Marlborough, MA, USA) and the Amplatzer™ Amulet™ device from Abbott (Chicago, IL, USA) are two devices used globally for left atrial appendage closure (LAAC) in non-valvular AF. A systematic search was conducted in PubMed, the Cochrane Library, and Elsevier's ScienceDirect literature databases to identify studies comparing the WATCHMAN™ procedure with Amulet™ device implantation for LAAC in patients with AF. The analyses were conducted using the random-effects model. A total of 20 studies were identified, with 18 falling into the category of observational studies and 2 being randomized controlled trials. A total of 6310 participants were included in this meta-analysis, with 3198 individuals (50.68%) assigned to the WATCHMAN™ procedure group and 3112 individuals (49.32%) allocated to the Amplatzer™ Cardiac Plug (ACP) group. The analysis revealed a higher risk of stroke associated with the WATCHMAN™ technique (relative risk [RR], 1.14), albeit without statistical significance. Conversely, the WATCHMAN™ approach led to a significantly lower risk of cardiac death (RR, 0.44; P = .04). Notably, the risks of all-cause mortality (RR, 0.89; 95% confidence interval [CI], 0.73-1.08; I 2 = 0%; P = .25) and major bleeding (RR, 0.93; 95% CI, 0.65-1.33; I 2 = 31%; P = .70) were clinically reduced with the WATCHMAN™ procedure, although statistical significance was not achieved. Compared to Amulet™ device implantation, WATCHMAN™ device implantation decreased the risk of cardiac mortality, while the risks of stroke, systemic embolism, all-cause mortality, and major bleeding were not statistically significant.

Decomposing Socioeconomic Effects on the Consumption of Calories and Macronutrients in Pakistan Between 2006 and 2016.

Background: This study examines the impact of socioeconomic factors on calorie intake and macronutrient composition at the household level in Pakistan from 2006 to 2016, using data from the Household Integrated Income and Consumption Survey (HIICS). By applying a copula-based decomposition method, it identifies key drivers such as urbanization, household size, paternal education, income, and cultivation, highlighting their roles in dietary changes and implications for public health. The findings are crucial for understanding nutritional shifts and addressing non-communicable diseases. Objectives: This study was conducted to assess the socioeconomic changes in total calorie intake per capita and calories obtained from macronutrients (fat, protein, and carbohydrates) at the household level in Pakistan. Methods: : Cross-sectional data were taken from 2 national-level surveys published by the Pakistan Bureau of Statistics: the Household Integrated Economic Survey 2006 (14,948 households) and the Household Integrated Income and Consumption Survey 2016 (7842 households). Participants were from all 4 provinces of Pakistan. A copula-based decomposition method was applied to decompose the 10-y change in the distribution (mean, median, and quartiles) of the total calorie intake per capita and calories obtained from macronutrients. Results: The estimated results of decomposition revealed that total calorie intake per capita has increased on average and in the considered quartiles. The calories obtained from fat and carbohydrates have increased, whereas calories from protein have decreased, according to the distribution of the mean and quartile. The composition effect was negative for all outcome variables, and the main drivers of the composition effect were urbanization, household size, paternal education, income, and cultivation for all outcome variables. Conclusions: Household size and income are the most important covariates in an increase of total calories per capita and consumption of macronutrients, but urbanization, paternal education, and cultivation contribute negatively to the composition effect. Such findings are very important to inform researchers about nutritional change at the national level because the correlation between dietary change and risk factors for noncommunicable diseases such as heart disease and obesity is very strong.