OBJECTIVES:To evaluate the efficacy of intraoperative hemoadsorption (HA) during cardiopulmonary bypass (CPB) in reducing acute kidney injury (AKI) and other major postoperative complications in patients undergoing cardiac surgery. DESIGN:Systematic review and meta-analysis of randomized controlled trials (RCTs) conducted in accordance with PRISMA guidelines, with a protocol registered in PROSPERO (CRD42025638656). SETTING:Multicountry, multi-institutional hospital-based studies of patients undergoing cardiac surgery with CPB. PARTICIPANTS:A total of 1133 patients from 16 RCTs comparing CPB with versus without intraoperative HA. INTERVENTIONS:Intraoperative HA using sorbent-based devices (e.g., CytoSorb, oXiris, Jafron HA 380). MEASUREMENTS AND MAIN RESULT:Primary outcomes included AKI incidence, renal replacement therapy requirement, and mortality. Secondary outcomes included intensive care unit/hospital length of stay, postoperative delirium, stroke, sepsis, and reoperation. HA significantly reduced the incidence (RR 0.75; 95% CI 0.59-0.96; p = 0.020). No significant differences were observed for renal replacement therapy (RR 0.64; p = 0.58) or mortality (RR 0.96; p = 0.861). No significant effects were found for secondary outcomes. CONCLUSIONS:Intraoperative HA during CPB reduces the risk of AKI but does not significantly affect other major postoperative outcomes. Further studies are needed to determine its clinical relevance and optimal patient selection.
Limited knowledge and variability in findings exist regarding the resolution of cardiovascular outcomes following Multisystem Inflammatory Syndrome in Children (MIS-C). We conducted a systematic review to estimate the frequency of cardiovascular outcomes following MIS-C. A systematic search was conducted in Pubmed/Medline, Scopus, Embase, SciELO, LILACS, Cochrane Library, Web of Science, and medRxiv were searched up to February 2024. We included studies reporting cardiovascular events that began in acute MIS-C and persisted after discharge. Screening and data extraction were performed by independent reviewers. We performed a random-effects meta-analysis and assessed the certainty of the evidence using the GRADE approach. Eighty-four studies (n = 4,778) were included; seven had a comparator group. The frequency of cardiovascular outcomes—including coronary abnormalities (Z-score ≥ 2), left ventricle ejection fraction < 55
BACKGROUND:Lennox-Gastaut syndrome (LGS) is a highly drug-resistant epileptic encephalopathy. The high seizure burden in LGS contributes to substantial morbidity, reduced quality of life, and increased mortality, underscoring the need for alternative therapeutic strategies such as invasive neuromodulation. OBJECTIVES:We aimed to synthesize the efficacy and safety of invasive neuromodulation-vagus-nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS)-for seizure control in LGS. MATERIALS AND METHODS:We performed a systematic review and meta-analysis (International Prospective Register of Systematic Reviews, CRD420251088693). PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to November 2025. Studies enrolling individuals of any age with LGS who underwent VNS, DBS, or RNS were eligible; mixed-etiology studies were retained if individual patient data permitted LGS-specific extraction. Two reviewers screened records and extracted summary data. The primary outcomes were the proportion crossing predefined thresholds (0%-25%, <50%, ≥50%, ≥70%, and ≥90% seizure reduction). Adverse events were summarized descriptively. RESULTS:From 1058 records, 71 studies (47 VNS [1618 patients], 16 DBS [110 patients], and eight RNS [37 patients]) involving 1765 patients met the inclusion criteria. Overall, 55.76% (95% CI 48.39-62.88) experienced a ≥50% seizure reduction. DBS yielded the highest responder rate (78.50%; 65.48-87.55), followed by RNS (53.57%; 35.44-70.80) and VNS (48.72%; 41.04-56.46). Only 18.64% (12.05-27.69) reached a ≥90% reduction, and seizure freedom was rare. Age-band subgroup analyses showed no efficacy difference between pediatric, adult, and mixed-age cohorts (interaction p > 0.1). Adverse events were modality-specific yet predominantly mild and manageable; infections occurred in <5% of cases. Risk of bias was serious or critical in most observational studies; overall Grading of Recommendations Assessment, Development and Evaluation certainty was very low. CONCLUSIONS:Invasive neuromodulation can provide meaningful seizure reduction for LGS, with DBS showing the most favorable efficacy signal, but the evidence is low. Head-to-head randomized trials are required to confirm relative effectiveness and optimize target selection.
Acute high-altitude hypoxia increases erythropoietin (EPO) and erythroferrone (ERFE), which suppresses hepcidin and enhances iron absorption to support erythropoiesis. Whether these responses to acute exposure persist in long-term acclimatized individuals remains unclear. We conducted a prospective comparative study in 80 healthy Peruvian women (plasma ferritin <30 μg/L) who had lived for ≥5 years at high altitude (Huancavelica, 3670 m, n=40) or sea level (Lima, n=40). The groups were matched for age, body size, plasma ferritin and altitude-adjusted hemoglobin (Hb). Participants consumed ten standardized iron-biofortified potato-based meals, each labeled with 57FeSO4, twice daily for five consecutive days. We measured iron and erythropoiesis-related biomarkers and assessed cumulative fractional iron absorption (FIA) by measuring isotopic incorporation into red blood cells 14 days later. High-altitude residents had significantly higher EPO concentrations (13.6 vs. 4.4 IU/L) and unadjusted Hb concentrations (15.0 vs. 11.8 g/dL) (for both, P<0.01), consistent with chronic hypoxic stimulation of erythropoiesis. There were no differences in altitude-adjusted Hb, plasma ferritin, ERFE, or hepcidin between groups. FIA was higher at altitude (15.8%) compared to sea level (9.3%, P<0.05). At altitude, FIA correlated with intestinal fatty acid binding protein (ρ=0.343, P<0.05), a marker of enterocyte injury. Long-term residence at high altitude is associated with 3-fold higher EPO concentrations and ∼70% greater dietary iron absorption, without changes in ERFE or hepcidin. This suggests chronic adaptation to altitude increases iron absorption through hypoxia-mediated pathways in the gut, independent of hepcidin. This may be associated with increased iron requirements in high-altitude populations. (ClinicalTrials.gov. NCT05500014)
