Compilation of a self-management assessment scale for postoperative patients with aortic dissection.

Objective: The aim of this research was to compile a self-management assessment scale for patients with aortic dissection (AD). The questionnaire is useful in making the patient aware of the need for post-operative care in order to contribute to improving the outcome and quality of life. Methods: The initial version of the "postoperative self-management assessment scale for patients with aortic dissection" was developed using the Delphi expert consultation method based on qualitative research results, consultation of self-management-related literature, reference to the existing self-management scale, and self-efficacy theory, combined with the disease characteristics of AD. By using the convenience sampling method, a total of 201 patients with AD who had undergone surgery were selected as the research participants. The initial version of the scale was used for follow-up investigation, and the scale entries were evaluated and exploratory factor analysis carried out to form the formal version of the "postoperative self-management assessment scale for patients with aortic dissection." A total of 214 patients with AD after surgery were selected as the research participants. The formal version of the scale was used for follow-up investigation, and its reliability and validity were evaluated. Results: The formal version of the scale had 6 dimensions and 35 entries. The Cronbach's α coefficient for the total scale was 0.908, the split-half reliability was 0.790, and the test-retest reliability after 2 weeks was 0.471. The content validity index of the total scale was 0.963. Exploratory factor analysis yielded six common factors, and the cumulative contribution rate of variance was 66.303%. Confirmatory factor analysis showed that except for the incremental fit index, Tucker-Lewis index, and comparative fit index >0.85, slightly lower than 0.90, χ 2/df <3, root mean square of approximation <0.08, parsimonious goodness-of-fit index, and parsimonious normed fit index >0.50; all other model fitting requirements were satisfied, indicating that the model fitting was acceptable. Conclusion: We compiled the postoperative self-management assessment scale for patients with AD, which has demonstrated excellent reliability and validity and can be used as a tool to evaluate the postoperative self-management level in patients with aortic dissection.

Exploring FGFR signaling inhibition as a promising approach in breast cancer treatment.

As our grasp of cancer genomics deepens, we are steadily progressing towards the domain of precision medicine, where targeted therapy stands out as a revolutionary breakthrough in the landscape of cancer therapeutics. The fibroblast growth factor receptors (FGFR) pathway has been unveiled as a fundamental instigator in the pathophysiological mechanisms underlying breast carcinoma, paving the way for the exhilarating development of precision-targeted therapeutics. In the pursuit of exploring inhibitors that specifically target the FGFR signaling pathways, a multitude of kinase inhibitors targeting FGFR has been assiduously engineered to address the heterogeneous landscape of human malignancies. This review offers an exhaustive exploration of aberrations within the FGFR pathway and their functional implications in breast cancer. Additionally, we delve into cutting-edge therapeutic approaches for the treatment of breast cancer patients bearing FGFR alterations and the management of toxicity associated with FGFR inhibitors. Furthermore, our contemplation of the evolution of cutting-edge FGFR inhibitors foresees their potential to spearhead innovative therapeutic approaches in the ongoing combat against cancer.

Identification of Panax notoginseng origin using terahertz precision spectroscopy and neural network algorithm.

Panax notoginseng (P. notoginseng), a Chinese herb containing various saponins, benefits immune system in medicines development, which from Wenshan (authentic cultivation) is often counterfeited by others for large demand and limited supply. Here, we proposed a method for identifying P. notoginseng origin combining terahertz (THz) precision spectroscopy and neural network. Based on the comparative analysis of four qualitative identification methods, we chose high-performance liquid chromatography (HPLC) and THz spectroscopy to detect 252 samples from five origins. After classifications using Convolutional Neural Networks (CNNs) model, we found that the performance of THz spectra was superior to that of HPLC. The underlying mechanism is that there are clear nonlinear relations among the THz spectra and the origins due to the wide spectra and multi-parameter characteristics, which makes the accuracy of five-classification origin identification up to 97.62%. This study realizes the rapid, non-destructive and accurate identification of P. notoginseng origin, providing a practical reference for herbal medicine.

[Opening experiments: synthesis, purification, and characterization of polyethyleneimine-modified carbon dots].

Open experiments are an effective means of cultivating top-notch innovative talents. Based on student interests, research hotspots and our laboratory conditions, an experimental scheme was designed. In this experiment, polyethyleneimine modified carbon dots (PEI-CDs) were prepared via a one-step hydrothermal method using citric acid (CA) as the carbon source and PEI as the surface passivator. First, CA and PEI were completely dissolved in 0.1 mol/L HCl and transferred into an autoclave. The autoclave was heated to 130 ℃ for 2 h. PEI-CDs solution was obtained. After cooling to room temperature, the solution was concentrated to 2 mL by rotary evaporation. Finally, the PEI-CDs were precipitated, washed with ethanol, and dried under vacuum at 70 ℃ for 12 h. The obtained PEI-CDs were characterized by fluorescence spectrophotometry, absorption spectrophotometry, infrared spectrometry, and transmission electron microscopy. The results indicated that anhydrous-ethanol precipitation is a simple, rapid, economical, and green purification method. The as-prepared PEI-CDs had unique properties, such as good water solubility, high luminescence, uniform particle sizes, and good stability. Through this open experiment, students can not only master the operation of large-scale instruments but also enhance their interest in scientific research.

Laparoscopic surgery for ectopic pregnancy: A comparative study on the clinical benefits and impact on tubal patency and reproductive outcomes.

BACKGROUND: Ectopic pregnancy is a major contributor to maternal morbidity and mortality across the globe. OBJECTIVE: This study aims to investigate the clinical benefits of laparoscopic surgery in treating ectopic pregnancy, and its impact on tubal patency and reproductive outcomes. METHODS: A clinical study was conducted to compare laparoscopic and medical conservative treatment for ectopic pregnancy. A total of 206 patients were treated for ectopic pregnancy at our hospital from January 2018 to June 2020. Among them, 46 underwent laparoscopic ipsilateral salpingectomy, 54 underwent laparoscopic ipsilateral salpingostomy with lesion removal, and 106 were treated conservatively with medication. RESULTS: The age range and average age of each group are provided, with no significant differences in these general demographic characteristics (p> 0.05). Both the salpingostomy and medication groups had higher rates of ectopic pregnancy compared to the salpingectomy group, with statistically significant differences (p< 0.05). The comparison of ectopic pregnancy rates between the salpingostomy and medication groups showed no significant difference. Within three years, the salpingostomy group had 10 cases of recurrent ectopic pregnancy, with 2 cases on the same side, while the medication group had 18 cases, with 8 cases on the same side. At 3 months after the normalization of blood ß-HCG, the salpingostomy group showed 43 cases of tubal patency (patency rate: 79.63%), while the medication group showed 57 cases (patency rate: 53.77%), with a statistically significant difference between the two groups (p= 0.01). CONCLUSION: Laparoscopic surgery for ectopic pregnancy offers significant clinical benefits over conservative medical treatment, including higher rates of tubal patency and improved reproductive outcomes. These findings support laparoscopic surgery as an effective approach for the management of ectopic pregnancy.

MonoAux: Fully Exploiting Auxiliary Information and Uncertainty for Monocular 3D Object Detection.

Monocular 3D object detection plays a pivotal role in autonomous driving, presenting a formidable challenge by requiring the precise localization of 3D objects within a single image, devoid of depth information. Most existing methods in this domain fall short of harnessing the limited information available in monocular 3D detection tasks. They typically provide only a single detection outcome, omitting essential uncertainty analysis and result post-processing during model inference, thus limiting overall model performance. In this paper, we propose a comprehensive framework that maximizes information extraction from monocular images while encompassing diverse depth estimation and incorporating uncertainty analysis. Specifically, we mine additional information intrinsic to the monocular 3D detection task to augment supervision, thereby addressing the information scarcity challenge. Moreover, our framework handles depth estimation by recovering multiple sets of depth values from calculated visual heights. The final depth estimate and 3D confidence are determined through an uncertainty fusion process, effectively reducing inference errors. Furthermore, to address task weight allocation in multi-task training, we present a versatile training strategy tailored to monocular 3D detection. This approach leverages measurement indicators to monitor task progress, adaptively adjusting loss weights for different tasks. Experimental results on the KITTI and Waymo dataset confirm the effectiveness of our approach. The proposed method consistently provides enhanced performance across various difficulty levels compared to the original framework while maintaining real-time efficiency.

Leave It to Large Language Models! Correction and Planning with Memory Integration.

As humans, we can naturally break down a task into individual steps in our daily lives and we are able to provide feedback or dynamically adjust the plan when encountering obstacles. Similarly, our aim is to facilitate agents in comprehending and carrying out natural language instructions in a more efficient and cost-effective manner. For example, in Vision-Language Navigation (VLN) tasks, the agent needs to understand instructions such as "go to the table by the fridge". This understanding allows the agent to navigate to the table and infer that the destination is likely to be in the kitchen. The traditional VLN approach mainly involves training models using a large number of labeled datasets for task planning in unseen environments. However, manual labeling incurs a high cost for this approach. Considering that large language models (LLMs) already possess extensive commonsense knowledge during pre-training, some researchers have started using LLMs as decision modules in embodied tasks, although this approach shows the LLMs' reasoning ability to plan a logical sequence of subtasks based on global information. However, executing subtasks often encounters issues, such as obstacles that hinder progress and alterations in the state of the target object. Even one mistake can cause the subsequent tasks to fail, which makes it challenging to complete the instructions through a single plan. Therefore, we propose a new approach-C (Correction) and P (Planning) with M (Memory) I (Integration)-that centered on an LLM for embodied tasks. In more detail, the auxiliary modules of the CPMI facilitate dynamic planning by the LLM-centric planner. These modules provide the agent with memory and generalized experience mechanisms to fully utilize the LLM capabilities, allowing it to improve its performance during execution. Finally, the experimental results on public datasets demonstrate that we achieve the best performance in the few-shot scenario, improving the efficiency of the successive task while increasing the success rate.

Effect of Humanistic Pain Management in Postpartum Women after Cesarean Delivery Based on Active Pain Assessment and Visual Analog Scale.

Objective: To explore the effect of humanistic pain management based on active pain assessment and the visual analog scale in postpartum women after cesarean delivery. Methods: We selected 100 postpartum women who underwent cesarean delivery in Xuzhou Maternity and Child Health Care Hospital from April to December 2021 and divided the postpartum women into a management group and a conventional group, with 50 cases in each group. The conventional group was given routine pain management, while the management group was given humanistic pain management based on active pain assessment and visual analog scale score. The quality of pain management, sleep quality, unhealthy emotion, maternal comfort, breastfeeding rates, and patient compliance in the 2 groups were compared. Results: The most severe degree of pain, the least degree of pain, the frequency of moderate and severe pain, and the influence of pain on sleep were lower in the management group than in the conventional group. The Pittsburgh Sleep Quality Index score was lower and the Self-Rating Anxiety Scale and the Self-Rating Depression Scale scores were higher in the management group than in the conventional group. In addition, the comfort scores for the second day and the third day after delivery were higher in the management group than in the conventional group. The breastfeeding rate and patient compliance were higher in the management group than in the conventional group. Conclusion: Humanistic pain management based on active pain assessment and the visual analog scale can improve the quality of maternal pain management, the quality of sleep, and maternal comfort, ameliorate maternal adverse emotions, and promote breastfeeding and patient compliance.

The burden of mental disorders in Asian countries, 1990-2019: an analysis for the global burden of disease study 2019.

Mental disorders are the leading contributors to the globally nonfatal burden of disease. This study was aimed to estimate the burden of mental disorders in Asian countries. Based on GBD 2019, the prevalence and disability-adjusted life of years (DALYs) rates with 95% uncertainty intervals (UI) were estimated in Asian countries. Predictions for the future burden of 8 selected countries, ranks of the burden of mental disorders and correlations with Sociodemographic Index (SDI) were also estimated. During the past 3 decades, while the number of DALYs of mental disorders increased from 43.9 million (95% UI: 32.5-57.2) to 69.0 million (95% UI: 51.0-89.7), the age-standardized rates of DALYs of mental disorders remained largely consistent from 1452.2 (95% UI: 1080.16-1888.53) per 100,000 population in 1990 to 1434.82 (95% UI: 1065.02-1867.27) per 100,000 population in 2019, ranked as the eighth most significant disease burden in Asia in 2019. Depressive disorders (37.2%) were the leading contributors to the age-standardized DALY rates of mental disorders in Asia, followed by anxiety disorders (21.5%). The age-standardized DALY rates in females were higher than their male counterparts, both peaked at 30-34 years. The age-standardized DALY rates were predicted to remain stable, with the number of DALYs presented an upward trend in the future. There was no significant correlation between the burden of mental disorders and SDI. All mental disorders ranked higher in 2019, compared in 1990. To reduce this burden, urgent measures for prevention, treatment, and rehabilitation for mental disorders need to be taken by Asian governments.

Reversible single-crystal-to-single-crystal transition in Gd(III) metal-organic frameworks induced by heat and solvents with a significant magnetocaloric effect.

The design and synthesis of a Gd(III) metal-organic framework with the formula [Gd4(BTDI)3(DMF)4]n (JXUST-40, H4BTDI = 5,5'-(benzo[c][1,2,5]thiadiazole-4,7-diyl)diisophthalic acid) are reported hererin. Interestingly, a reversible single-crystal-to-single-crystal transition between JXUST-40 and {[Gd4(BTDI)3(H2O)4]·6H2O}n (JXUST-40a) was achieved under the stimulation of heat and solvents. Both JXUST-40 and JXUST-40a exhibited good stability when soaked in common solvents and aqueous solutions with pH values of 1-12. Magnetic studies showed that JXUST-40a has a larger magnetocaloric effect with -ΔSmaxm = 26.65 J kg-1 K-1 at 2 K and 7 T than JXUST-40 due to its larger magnetic density. Structural analyses indicated that the coordinated solvent molecules play a crucial role in the coordination environment around the Gd(III) ions and the change in the framework, ultimately leading to the changes in the pore size and magnetism between JXUST-40 and JXUST-40a. In addition, both isomorphic [Dy4(BTDI)3(DMF)4]n (JXUST-41) and {[Dy4(BTDI)3(H2O)4]·6H2O}n (JXUST-41a) displayed slow magnetic relaxation behaviour.

Maslinic acid alleviates intervertebral disc degeneration by inhibiting the PI3K/AKT and NF-κB signaling pathways.

Intervertebral disc degeneration (IDD) is the cause of low back pain (LBP), and recent research has suggested that inflammatory cytokines play a significant role in this process. Maslinic acid (MA), a natural compound found in olive plants ( Olea europaea), has anti-inflammatory properties, but its potential for treating IDD is unclear. The current study aims to investigate the effects of MA on TNFα-induced IDD in vitro and in other in vivo models. Our findings suggest that MA ameliorates the imbalance of the extracellular matrix (ECM) and mitigates senescence by upregulating aggrecan and collagen II levels as well as downregulating MMP and ADAMTS levels in nucleus pulposus cells (NPCs). It can also impede the progression of IDD in rats. We further find that MA significantly affects the PI3K/AKT and NF-κB pathways in TNFα-induced NPCs determined by RNA-seq and experimental verification, while the AKT agonist Sc-79 eliminates these signaling cascades. Furthermore, molecular docking simulation shows that MA directly binds to PI3K. Dysfunction of the PI3K/AKT pathway and ECM metabolism has also been confirmed in clinical specimens of degenerated nucleus pulposus. This study demonstrates that MA may hold promise as a therapeutic agent for alleviating ECM metabolism disorders and senescence to treat IDD.

Menarche-a journey into womanhood: age at menarche and health-related outcomes in East Asians.

STUDY QUESTION: Are there associations of age at menarche (AAM) with health-related outcomes in East Asians? SUMMARY ANSWER: AAM is associated with osteoporosis, Type 2 diabetes (T2D), glaucoma, and uterine fibroids, as demonstrated through observational studies, polygenic risk scores, genetic correlations, and Mendelian randomization (MR), with additional findings indicating a causal effect of BMI and T2D on earlier AAM. WHAT IS KNOWN ALREADY: Puberty timing is linked to adult disease risk, but research predominantly focuses on European populations, with limited studies in other groups. STUDY DESIGN, SIZE, DURATION: We performed an AAM genome-wide association study (GWAS) with 57 890 Han Taiwanese females and examined the association between AAM and 154 disease outcomes using the Taiwanese database. Additionally, we examined genetic correlations between AAM and 113 diseases and 67 phenotypes using Japanese GWAS summary statistics. PARTICIPANTS/MATERIALS, SETTING, METHODS: We performed AAM GWAS and gene-based GWAS studies to obtain summary statistics and identify potential AAM-related genes. We applied phenotype, polygenic risk scores, and genetic correlation analyses of AAM to explore health-related outcomes, using multivariate regression and linkage disequilibrium score regression analyses. We also explored potential bidirectional causal relationships between AAM and related outcomes through univariable and multivariable MR analyses. MAIN RESULTS AND THE ROLE OF CHANCE: Fifteen lead single-nucleotide polymorphisms and 24 distinct genes were associated with AAM in Taiwan. AAM was genetically associated with later menarche and menopause, greater height, increased osteoporosis risk, but lower BMI, and reduced risks of T2D, glaucoma, and uterine fibroids in East Asians. Bidirectional MR analyses indicated that higher BMI/T2D causally leads to earlier AAM. LIMITATIONS, REASONS FOR CAUTION: Our findings were specific to Han Taiwanese individuals, with genetic correlation analyses conducted in East Asians. Further research in other ethnic groups is necessary. WIDER IMPLICATIONS OF THE FINDINGS: Our study provides insights into the genetic architecture of AAM and its health-related outcomes in East Asians, highlighting causal links between BMI/T2D and earlier AAM, which may suggest potential prevention strategies for early puberty. STUDY FUNDING/COMPETING INTEREST(S): The work was supported by China Medical University, Taiwan (CMU110-S-17, CMU110-S-24, CMU110-MF-49, CMU111-SR-158, CMU111-MF-105, CMU111-MF-21, CMU111-S-35, CMU112-SR-30, and CMU112-MF-101), the China Medical University Hospital, Taiwan (DMR-111-062, DMR-111-153, DMR-112-042, DMR-113-038, and DMR-113-103), and the Ministry of Science and Technology, Taiwan (MOST 111-2314-B-039-063-MY3, MOST 111-2314-B-039-064-MY3, MOST 111-2410-H-039-002-MY3, and NSTC 112-2813-C-039-036-B). The funders had no influence on the data collection, analyses, or conclusions of the study. No conflict of interests to declare. TRIAL REGISTRATION NUMBER: N/A.

In situ imaging of mRNA transcripts based on split-aptamer and split protein in living cells.

Messenger RNA (mRNA) is an essential component of cell development and growth. However, the detection of endogenous mRNA in living cells is currently limited. To address this issue, we have developed a novel strategy that comprises split-aptamer and split fluorescent protein dual-color, "turn-on" probes that specifically target mRNA with complementary sequences. Our split-aptamer and split-protein-initiated fluorescence complementation (sAPiFC) approach for live-cell imaging has demonstrated selectivity, stability, and capability for targeting various mRNAs.

A Real-World Pharmacovigilance Study of Ceftazidime/Avibactam: Data Mining of the Food and Drug Administration Adverse Event Reporting System Database.

Ceftazidime/avibactam (CAZ/AVI) is a combination of a well-known third-generation, broad-spectrum cephalosporin with a new beta-lactamase inhibitor that has been approved for the treatment of various infectious diseases (especially multidrug-resistant Gram-negative bacterial infections) by the Food and Drug Administration (FDA). The current study extensively assessed CAZ/AVI-related adverse events (AEs) in the real world through data mining of the FDA Adverse Event Reporting System (FAERS) database to better understand toxicities. The signals of CAZ/AVI-related AEs were quantified using disproportionality analyses, including the reporting odds ratio, the proportional reporting ratio, the Bayesian confidence propagation neural network, and the multi-item gamma Poisson shrinker algorithms. Out of 10,114,815 records retrieved from the FAERS database, 628 cases were identified, where CAZ/AVI was implicated as the primary suspect drug. A total of 61 preferred terms with significant disproportionality that simultaneously met the criteria of all four algorithms were retained. Several unexpected safety signals may also occur, including melena, hypernatremia, depressed level of consciousness, brain edema, petechiae, delirium, and shock hemorrhagic. The median onset time for AEs associated with CAZ/AVI was 4 days, with most cases occurring within 3 days after CAZ/AVI initiation.

A dinuclear CdII cluster-based stable luminescent metal-organic framework for the consecutive and visual detection of H2PO4- and OCN.

Due to their hazard to biological systems, it is urgent to develop materials that can rapidly and sensitively detect the concentration of H2PO4- and OCN- ions. In this work, a new CdII-based luminescent metal-organic framework with the formula [Cd(BTDB)(2,6-BBIP)]n (JXUST-47, H2BTDB = (benzo[c][1,2,5]thiadiazole-4,7-diyl)dibenzoic acid, 2,6-BBIP = 2,6-bis(benzimidazol-1-yl)pyridine) and sql topology was successfully synthesized using a mixed-ligand strategy. JXUST-47 shows good chemical and thermal stability. It also exhibits weak quenching and fluorescence blue shift for H2PO4- and red shift for OCN-, with the detection limits of 0.106 and 0.128 mM, respectively. In addition, considering the demand for H2PO4- and OCN- ion detection, by combining this with the functions of a smartphone, the chroma of photographs have been used to realize the consecutive visual detection of the concentration of these ions.

Deep learning and machine learning predictive models for neurological function after interventional embolization of intracranial aneurysms.

Objective: The objective of this study is to develop a model to predicts the postoperative Hunt-Hess grade in patients with intracranial aneurysms by integrating radiomics and deep learning technologies, using preoperative CTA imaging data. Thereby assisting clinical decision-making and improving the assessment and prognosis of postoperative neurological function. Methods: This retrospective study encompassed 101 patients who underwent aneurysm embolization surgery. 851 radiomic features were extracted from CTA images. 512 deep learning features are extracted from last layer of ResNet50 deep convolutional neural network model. The feature screening process pipeline encompassed intraclass correlation coefficient analysis, principal component analysis, U test, spearman correlation analysis, minimum redundancy maximum relevance algorithm and Lasso regression, to identify features most correlated with postoperative Hunt-Hess grading. In the model construction phase, three distinct models were constructed: radiomics feature-based model (RSM), deep learning feature-based model (DLM), and deep learning-radiomics feature fusion model (DLRSCM). The study also calculated the radiomics score and combined it with clinical data to construct a Nomogram for predictive modeling. DLM, RSM and DLRSCM model was constructed by 9 base algorithms and 1 ensemble learning algorithm - Stacking ensemble model. Model performance was evaluated based on the area under the Receiver Operating Characteristic (ROC) curve (AUC), Matthews Correlation Coefficient (MCC), calibration curves, and decision curves analysis. Results: 5 significant radiomic feature and 4 significant deep learning features were obtained through the feature selection process. These features were utilized for model construction. Bootstrap resampling method was used for internal validation of the models. In terms of model evaluation, the DLM model, the stacking ensemble algorithm results achieved an AUC of 0.959 and MCC of 0.815. In the RSM model, the stacking ensemble model AUC was 0.935 and MCC was 0.793. The stacking ensemble model in DLRSCM outperformed others, with an AUC of 0.968 and MCC of 0.820. Results indicated that the ANN performed optimally among all base models, while the stacked ensemble learning model exhibited the highest predictive performance. Conclusion: This study demonstrates that the combination of radiomics and deep learning is an effective approach to predict the postoperative Hunt-Hess grade in patients with intracranial aneurysms. This holds significant value in the early identification of postoperative neurological complications and in enhancing clinical decision-making.

Evaluating the depression state during perinatal period by non-invasive scalp EEG.

Perinatal depression, with a prevalence of 10 to 20% in United States, is usually missed as multiple symptoms of perinatal depression are common in pregnant women. Worse, the diagnosis of perinatal depression still largely relies on questionnaires, leaving the objective biomarker being unveiled yet. This study suggested a safe and non-invasive technique to diagnose perinatal depression and further explore its underlying mechanism. Considering the non-invasiveness and clinical convenience of electroencephalogram for mothers-to-be and fetuses, we collected the resting-state electroencephalogram of pregnant women at the 38th week of gestation. Subsequently, the difference in network topology between perinatal depression patients and healthy mothers-to-be was explored, with related spatial patterns being adopted to achieve the classification of pregnant women with perinatal depression from those healthy ones. We found that the perinatal depression patients had decreased brain network connectivity, which indexed impaired efficiency of information processing. By adopting the spatial patterns, the perinatal depression could be accurately recognized with an accuracy of 87.88%; meanwhile, the depression severity at the individual level was effectively predicted, as well. These findings consistently illustrated that the resting-state electroencephalogram network could be a reliable tool for investigating the depression state across pregnant women, and will further facilitate the clinical diagnosis of perinatal depression.

Comparing clinical outcomes of peroral endoscopic myotomy for achalasia between Eastern and Western countries: a systematic review and meta-analysis.

Peroral endoscopic myotomy (POEM) has revolutionized the therapeutic strategy for achalasia with promising results. We conducted this meta-analysis to compare clinical outcomes between Eastern and Western countries. A comprehensive literature search was conducted in PubMed, EMBASE, Web of Science and Cochrane Library databases to query for studies that assessed the efficacy of POEM for achalasia. All articles published from inception to December 31, 2021 were included. The primary outcome was the pooled clinical success rate. The secondary outcomes included the pooled technical success rate, incidence of adverse events, procedure time and hospital stay. Eighteen Eastern studies involving 5962 patients and 11 Western studies involving 1651 patients were included. The pooled clinical success rate and technical success rate for POEM was equal in the Eastern studies compared to Western studies. The pooled incidence of procedure adverse events for POEM was a little lower in the Eastern studies compared to Western studies (6.6% vs. 8.7%). Similarly, the incidence of reflux-related adverse events was lower in Eastern studies than that in Western studies. The pooled procedure time of POEM was shorter in Eastern studies compared to Western studies (61 minutes vs. 80 minutes), while the length of hospital stay was longer in Eastern studies compared to Western studies (5.8 days vs. 2.4 days). Overall, Eastern countries have the similar POEM outcomes compared to Western countries. However, Eastern countries still need to do more to reduce the length of hospital stay.