...to the authors' findings, the duration or tapering of corticosteroids did not appear to affect mortality benefits. ...the authors did not report on the risk of hyperglycemia, a significant adverse ...event associated with corticosteroid use. ...the authors omitted the assessment of certainty or confidence in the body of evidence for each evaluated outcome.
...compared with relative risk (RR) that Kim and colleagues selected for the analysis of all-cause mortality, hazard ratio (HR) is supposed to be a more appropriate statistic, as it incorporates time ...into the consideration. ...we followed Kim and colleagues' inclusion criteria and reconducted the meta-analysis with the introduction of a subgroup analysis based on valve position. In summary, when taking the valve position into consideration, our subgroup analysis revealed that MP may be a feasible choice in dialysis patients undergoing AVR given significant lower long-term all-cause mortality with comparable bleeding risk as compared with BP. Tsu-Hsien Wang, MD; Yi-No Kang, MA; Wan-Ying Lin, MD; Kuan-Yu Chi, MD Affiliations: From the Department of Education, Center for EvidenceBased Aledicine, Taipei Aledical University Hospital, Taipei, Taiwan (Wang, Kang, Chi); the Department of Family Aledicine, Taipei Medical University Hospital, Taipei, Taiwan (Lin); the Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, N.Y., U.S.A. (Chi). Nishimura RA, Otto CA4, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
Proton pump inhibitors (PPI), one of the most commonly prescribed medications, carry a myriad of adverse events. For colorectal cancer (CRC) patients, it still remains unclear whether the concurrent ...use of proton pump inhibitors (PPI) would negatively affect chemotherapy. PubMed, Medline, Embase, and Cochrane Library were searched from inception to 10 June 2022, to identify relevant studies involving CRC patients receiving chemotherapy and reporting comparative survival outcomes between PPI users and non-users. Meta-analyses were performed using random-effects models. We identified 16 studies involving 8,188 patients (PPI = 1,789; non-PPI = 6,329) receiving either capecitabine-based or fluorouracil-based regimens. The overall survival (HR, 1.02; 95% CI, 0.91 to 1.15; I
= 0%) and progression-free survival (HR, 1.15; 95% CI, 0.98 to 1.35; I
= 29%) were similar between PPI users and non-users in patients taking capecitabine-based regimens, with low statis-tical heterogeneity. Although the subgroup analysis indicated that early-stage cancer patients taking capecitabine monotherapy with concurrent PPI had a significantly higher disease progression rate (HR, 1.96; 95% CI, 1.21 to 3.16; I
= 0%) than those who did not use PPIs, both groups had comparable all-cause mortality (HR, 1.31; 95% CI, 0.75 to 2.29; I
= 0%). On the other hand, there was little difference in both OS and PFS in both early- and end-stage patients taking capecitabine combination therapy between PPI users and non-users. Conversely, the use of concomitant PPI in patients taking fluorouracil-based regimens contributed to a marginally significant higher all-cause mortality (HR, 1.18; 95% CI, 1.00 to 1.40; I
= 74%), but with high statistical heterogeneity. In conclusion, PPI has little survival influence on CRC patients treated with capecitabine-based regimens, especially in patients taking capecitabine combination therapy. Thus, it should be safe for clinicians to prescribe PPI in these patients. Although patients treated with fluorouracil-based regimens with concomitant PPI trended toward higher all-cause mortality, results were subject to considerable heterogeneity.
identifier https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022338161.
(1) Although emerging evidence suggests that proton pump inhibitor (PPI)-induced dysbiosis negatively alters treatment response to immune checkpoint inhibitors (ICIs) in cancer patients, no study ...systematically investigates the association between PPIs, ICIs, and chemotherapy; (2) Cochrane Library, Embase, Medline, and PubMed were searched from inception to 20 May 2022, to identify relevant studies involving patients receiving ICIs or chemotherapy and reporting survival outcome between PPI users and non-users. Survival outcomes included overall survival (OS) and progression-free survival (PFS). Network meta-analyses were performed using random-effects models.
-scores, with a value between 0 and 1, were calculated to quantify the treatment ranking, with a higher score suggesting a higher probability of greater effectiveness. We also conducted pairwise meta-analyses of observational studies to complement our network meta-analysis; (3) We identified 62 studies involving 26,484 patients (PPI = 8834; non-PPI = 17,650), including non-small cell lung cancer (NSCLC), urothelial carcinoma (UC), melanoma, renal cell carcinoma (RCC), hepatocellular carcinoma (HCC), and squamous cell carcinoma (SCC) of the neck and head. Eight post-hoc analyses from 18 randomized-controlled trials were included in our network, which demonstrated that, in advanced NSCLC and UC, patients under ICI treatment with concomitant PPI (
-score: 0.2016) are associated with both poorer OS (HR, 1.49; 95% CI, 1.37 to 1.67) and poorer PFS (HR, 1.41; 95% CI, 1.25 to 1.61) than those without PPIs (
-score: 1.000). Patients under ICI treatment with concomitant PPI also had poorer OS (HR, 1.18; 95% CI, 1.07 to 1.31) and poorer PFS (HR, 1.30; 95% CI, 1.14 to 1.48) in comparison with those receiving chemotherapy (
-score: 0.6664), implying that PPIs may compromise ICI's effectiveness, making it less effective than chemotherapy. Our pairwise meta-analyses also supported this association. Conversely, PPI has little effect on patients with advanced melanoma, RCC, HCC, and SCC of the neck and head who were treated with ICIs; (4) "PPI-induced dysbiosis" serves as a significant modifier of treatment response in both advanced NSCLC and UC that are treated with ICIs, compromising the effectiveness of ICIs to be less than that of chemotherapy. Thus, clinicians should avoid unnecessary PPI prescription in these patients. "PPI-induced dysbiosis", on the other hand, does not alter the treatment response to ICIs in advanced melanoma, RCC, HCC, and SCC of the head and neck.
ObjectivesRandomised controlled trials (RCTs) have demonstrated conflicting results regarding the effects of corticosteroids on the treatment of severe community-acquired pneumonia (CAP). We aimed to ...investigate the efficacy and safety of different corticosteroids on patients who were hospitalised for severe CAP.MethodsWe performed a systematic search through PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus from inception to May 2023. The primary outcome was all-cause mortality. Data analysis was performed using a random-effects model.ResultsA total of 10 RCTs comprising 1962 patients were included. Corticosteroids were associated with a lower rate of all-cause mortality (risk ratio (RR), 0.70 (95% CI 0.54 to 0.90); I2=0.00%). When stratified into different corticosteroid types, hydrocortisone was associated with an approximately 50% lower mortality risk (RR, 0.48 (95% CI 0.32 to 0.72); I2=0.00%). However, dexamethasone, methylprednisolone or prednisolone were not associated with an improvement in mortality. Furthermore, hydrocortisone was associated with a reduction in the rate of mechanical ventilation, acute respiratory distress syndrome, shock and duration of intensive care unit stay. These trends were not observed for dexamethasone, methylprednisolone or prednisolone. Corticosteroids were not associated with an increased risk of adverse events including gastrointestinal bleeding, secondary infection or hyperglycaemia.ConclusionsThe use of hydrocortisone, but not other types of corticosteroids, was associated with a reduction in mortality and improvement in pneumonia outcomes among patients hospitalised with severe CAP.PROSPERO registration numberCRD42023431360.
As the lightest and cheapest transition metal dichalcogenide, TiS2 possesses great potential as an electrode material for lithium batteries due to the advantages of high energy density storage ...capability, fast ion diffusion rate, and low volume expansion. Despite the extensive investigation of its electrochemical properties, the fundamental discharge–charge reaction mechanism of the TiS2 electrode is still elusive. Here, by a combination of ex situ and operando X-ray absorption spectroscopy with density functional theory calculations, we have clearly elucidated the evolution of the structural and chemical properties of TiS2 during the discharge–charge processes. The lithium intercalation reaction is highly reversible and both Ti and sulfur are involved in the redox reaction during the discharge and charge processes. In contrast, the conversion reaction of TiS2 is partially reversible in the first cycle. However, TiO related compounds are developed during electrochemical cycling over extended cycles, which results in the decrease of the conversion reaction reversibility and the rapid capacity fading. In addition, the solid electrolyte interphase formed on the electrode surface is found to be highly dynamic in the initial cycles and then gradually becomes more stable upon further cycling. Such understanding is important for the future design and optimization of TiS2 based electrodes for lithium batteries.
Effects of electronic and atomic structures of V‐doped 2D layered SnS2 are studied using X‐ray spectroscopy for the development of photocatalytic/photovoltaic applications. Extended X‐ray absorption ...fine structure measurements at V K‐edge reveal the presence of VO and VS bonds which form the intercalation of tetrahedral OVS sites in the van der Waals (vdW) gap of SnS2 layers. X‐ray absorption near‐edge structure (XANES) reveals not only valence state of V dopant in SnS2 is ≈4+ but also the charge transfer (CT) from V to ligands, supported by V Lα,β resonant inelastic X‐ray scattering. These results suggest V doping produces extra interlayer covalent interactions and additional conducting channels, which increase the electronic conductivity and CT. This gives rapid transport of photo‐excited electrons and effective carrier separation in layered SnS2. Additionally, valence‐band photoemission spectra and S K‐edge XANES indicate that the density of states near/at valence‐band maximum is shifted to lower binding energy in V‐doped SnS2 compare to pristine SnS2 and exhibits band gap shrinkage. These findings support first‐principles density functional theory calculations of the interstitially tetrahedral OVS site intercalated in the vdW gap, highlighting the CT from V to ligands in V‐doped SnS2.
The interstitially tetrahedral O–V–S site in the vdW gap of V‐doped 2D SnS2 establishes the origin of the charge transfer mechanism between metal ion V4+ 3d and ligand O2‐ 2p/S2‐ 3p states and the decrease in the band gap by studying synchrotron‐based techniques and first‐principles density functional theory.
Lithium dendrite growth dynamics on Cu surface is first visualized through a versatile and facile experimental cell by in operando transmission X-ray microscopy (TXM). Galvanostatic plating and ...stripping cycle(s) are applied on each cell. Upon plating/stripping at ∼1 mA cm–2, mossy lithium is clearly found growing and shrinking on the Cu surface as the application time increases. It is interesting to note that the aspect ratio (height/width) of deposited lithium has increased with charge passed during plating, indicating a faster growing from the base. In addition, the dendritic or mossy lithium has also been observed when various high current densities (25, 12.5, and 6.3 mA cm–2) are applied in different cycles, showing a severe dendritic lithium formation that could be induced by inhomogeneous current distribution. The clear structure of dead lithium is found after the cycling, which also shows a lower efficiency and higher hazard when a higher current density is applied. This work explores TXM as a useful tool for in operando dynamic visualization and quantitative measurement of lithium dendrite, which is difficult to achieve with ex situ measurements and other microscopy techniques. The understanding of the growth mechanism from TXM can be beneficial for the development of safe lithium ion and lithium metal batteries.
The outstanding thermoelectric performance of GeTe has attracted significant attention in the research community in recent years. However, many of the underlying physical mechanisms that contribute ...to GeTe's exceptionally high figure of merit ( zT ) remain not fully understood. In this study, an Sb–Bi codoped GeTe single crystal (Ge 0.86 Sb 0.08 Bi 0.06 )Te with an ultrahigh zT of 2.7 at 700 K and a record high device zT of 1.41 in the temperature range of 300–773 K was synthesized and investigated. The ultrahigh zT is attributed to the extremely low lattice thermal conductivity induced by strong electron–phonon (EP) interactions as revealed by the experimentally observed Kohn anomaly, through inelastic neutron scattering (INS) measurements. First-principles calculations further demonstrate that the remarkable EP interaction arises from the Fermi surface nesting featured in a one-dimensional (double-walled) topology. Our finding unravels the ultrahigh- zT mechanism in GeTe-based materials, serving as an inspiring guide toward high thermoelectric performance.
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