BACKGROUND AND OBJECTIVES:Disease-related malnutrition (DRM) mandates routine screening in many nations to ensure quality care as nutritional status often deteriorates during hospitalization. This study aimed to establish tool-specific prevalence benchmarks at admission and discharge, investigate sources of heterogeneity and evaluate diagnostic yields of one-step versus two-step GLIM approaches. METHODS AND STUDY DESIGN:A systematic search of Embase, PubMed, Web of Science, Cochrane Library, and CINAHL was conducted for cross-sectional studies on nutritional status published between 1 January 2018 and 30 Nov 2025 (PROS-PERO ID: CRD42023480467). Eligible studies were pooled in a meta-analysis of proportions using a random-effects model. RESULTS:Of 9,693 records retrieved, 179 studies involving 755,092 patients from 30 countries were included. At admission, the pooled prevalence was 0.41 (95% CI 0.35-0.49, I2 = 99.9%) by NRS2002 (≥3, adults), 0.62 (95% CI 0.57-0.67, I2 = 99.3%) by MNA-SF (≤11, older adults), 0.55 (95% CI 0.44-0.68, I2 = 98.5%) by STAMP (≥2, pediatric patients), and 0.39 (95% CI 0.35-0.44, I2 = 99.6%) by GLIM (adults). At discharge, three studies reported a pooled prevalence of 0.19 (95% CI 0.09-0.40, I2 = 94.6%) by NRS2002 for adults, significantly lower than admission (p = 0.044). Comparing GLIM strategies, no statistically significant difference was observed between one-step and two-step GLIM approaches (p = 0.062). CONCLUSIONS:DRM prevalence remains high at both admission and discharge, varying widely across countries and by tools. Discharge data are critically limited, reflecting gaps in routine screening practices. Regarding diagnosis, findings support a risk-adapted strategy. Pooled estimates may overestimate the true prevalence and should be interpreted with caution.

Objective:To characterize the drug-drug interaction (DDI) profile of the novel, long-acting GLP-1 receptor agonist ecnoglutide (XW003) with two widely co-prescribed drugs: metformin and narrow therapeutic index agent, warfarin. Methods:In this open-label, fixed-sequence, crossover study, 28 healthy participants received a single dose of warfarin and multiple doses of metformin, both with and without steady-state XW003 coadministration. The primary endpoint was the comparison of systemic exposure, assessed by whether the 90% confidence intervals (CIs) for the geometric mean ratios (GMRs) of key pharmacokinetic (PK) parameters fell within the 80.00%-125.00% no-effect bounds. The pharmacodynamic (PD) impact on warfarin was evaluated via International Normalized Ratio (INR). Results:Coadministration of XW003 did not clinically alter the total systemic exposure (AUC) of metformin or of either S- or R-warfarin enantiomer, as all corresponding GMRs and 90% CIs for AUC met the pre-specified no-effect criteria. While modest reductions in Cmax and delays in Tmax were observed for both object drugs, warfarin's anticoagulant activity remained unaffected, with INR profiles showing no clinically relevant changes. The safety profile of XW003 was consistent with the GLP-1 receptor agonist class. Conclusion:The findings demonstrate the absence of a clinically significant interaction between XW003 and either metformin or warfarin. This supports the concomitant use of XW003 with these medications without dose adjustment, providing crucial evidence for its safe application in real-world clinical practice where polypharmacy is common.

Abstract Patients with peripheral T cell lymphoma (PTCL) who achieved tumor response with first-line standard therapy were at high risk of disease relapse. We explored golidocitinib (150 mg once daily) as maintenance therapy for this group of patients (JACKPOT26, NCT06511869). This study included two cohorts: patients achieving a complete response (Cohort 1 (CR), N = 30) and a partial response (Cohort 2 (PR), N = 18) during induction stage. All enrolled patients were transplant ineligible or did not have a transplant plan. All dosed patients were included in the efficacy and safety analysis. In Cohort 1, the 24-month disease free survival (DFS) rate was 74.2% with golidocitinib treatment. In nodal subtypes (AITL, NOS, ALK- ALCL), the 24-month DFS rate was 62.7%. In Cohort 2, median progression free survival (PFS) was 17.4 months, and 24-month PFS rate was 48.6%. Nine out of 18 patients with initial PR achieved complete response, leading to a complete response rate of 50.0%, and median duration of response of 23.9 months. The most common ≥grade 3 treatment-related treatment-emergent adverse events (TRAEs) were hematological adverse events in nature, including neutrophil count decreased (47.9%), white blood cell count decreased (31.3%), lymphocyte count decreased (14.6%) and leukopenia (12.5%). The majority of these TRAEs were reversible and clinically manageable. TRAEs leading to treatment interruption and discontinuation occurred in 60.4% and 10% of patients, respectively. No TRAEs leading to fatal outcomes were reported. This study suggests the potential of golidocitinib as maintenance therapy for patients with PTCL.

The regimen of rituximab we not determined based on evidence from pharmacokinetics. However, rituximab exhibited significant pharmacokinetic variability among different clinical populations, which might be a key factor influencing individual exposure and response to this monoclonal antibody. This systematic review aimed to analyze the traditional and population pharmacokinetics of rituximab and to investigate covariates influencing its pharmacokinetics. A systematic search was conducted in three English databases (Medline, Embase, Cochrane Central Register of Controlled Trials) and two Chinese database (China National Knowledge Infrastructure and Wanfang Data). Traditional and population pharmacokinetics of rituximab conducted in humans were included. Study designs, population characteristics, pharmacokinetic parameters, and covariates were extracted. The ClinPK’s checklist was used to assess the reporting quality of the included studies. The PROSPERO registered ID was CRD420251085784. The systematic research yield 25 traditional pharmacokinetics studies and 26 population pharmacokinetics studies. The included studies mainly investigated the pharmacokinetics of rituximab in patients with non-Hodgkin’s lymphoma, rheumatoid arthritis, kidney disease and anti-neutrophil cytoplasmic antibody-associated vasculitis. Significant variability in pharmacokinetic parameters existed among different clinical populations as well as among different subjects encountering similar clinical conditions. Most (23, 88.5

BackgroundPre-eclampsia remains a leading cause of maternal morbidity and mortality worldwide. However, evidence regarding the implementation of risk management strategies in low- and middle-income settings remains limited. This exploratory survey assessed knowledge, clinical practices, guideline implementation, and perceived barriers related to pre-eclampsia risk management among obstetricians in China.MethodsA web-based exploratory cross-sectional survey using convenience and snowball sampling was conducted among obstetricians in China. An anonymous 38-item questionnaire was developed based on two-step pre-eclampsia risk management strategies and distributed through academic networks and professional groups. Descriptive analyses were performed using frequencies and proportions for categorical variables and medians with interquartile ranges for continuous variables. Exploratory subgroup analyses were conducted by participant characteristics. Guideline adherence was assessed against key recommendations from four guidelines used in China.ResultsAmong 307 obstetricians, 91.9% reported performing pre-eclampsia risk prediction, primarily based on medical history, obstetric history, and current pregnancy factors. However, considerable variation existed in assessment timing and risk classification approaches. Although the FMF competing-risk model was recognized as important, only 61.6% had heard of the model and 36.5% reported clinical use. Limited biomarker availability and lack of automated calculation tools were the main barriers. Low-dose aspirin prophylaxis was widely reported, with 90.9% prescribing aspirin for women at moderate or high risk. The most common regimen was 100 mg once daily, initiated at 12 weeks and discontinued at 36 weeks. Only 56.0% reported initiating aspirin before 16 weeks, and 1.0% reported continuation until delivery, indicating substantial variation in aspirin management.ConclusionsThis exploratory survey suggests that obstetricians in China have incorporated some components of pre-eclampsia risk management into clinical practice, but substantial variability remains in guideline implementation. Limited adoption of standardized risk assessment tools and inconsistent aspirin prophylaxis strategies highlight potential areas for improvement. Enhancing implementation support and improving access to evidence-based tools may facilitate more consistent pre-eclampsia prevention practices.

PURPOSECombined-modality therapy (CMT) improves survival in patients with early-stage extranodal natural killer-/T-cell lymphoma (ENKTCL) compared with radiotherapy (RT) alone. However, the effect is inadequate for low-risk patients as defined by nomogram-revised risk index (NRI). As such, it remains unclear whether the survival benefits outweigh the additional costs.MATERIALS AND METHODSA Markov model was constructed to compare CMT versus RT alone for patients with early-stage ENKTCL, according to five risk groups defined by NRI model. Transition probabilities, effectiveness, and cost data were derived from the China Lymphoma Collaborative Group cohort, while health utility data were estimated from adverse effects. Life-years, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios were calculated from the perspective of Chinese payers. Evaluations for customized countries or settings can be accomplished using a web-based tool.RESULTSOver the 6-year horizon, CMT increased life-years by 5.47, 5.19, 4.82, 4.62, and 4.49 years at $517,472 US dollars (USD)/QALY, $22,871 USD/QALY, $7,865 USD/QALY, $4,598 USD/QALY, and $2,278 USD/QALY for the low-risk (NRI = 0), intermediate-low-risk (NRI = 1), intermediate-high-risk (NRI = 2), high-risk (NRI = 3), and very high-risk (NRI = 4) groups, respectively. The probabilities of cost-effectiveness at a willingness-to-pay threshold of $5,208 USD/QALY were 0.00%, 0.01%, 7.40%, 72.07%, and 99.10% for each risk group. Over the lifetime horizon, all risk groups, except for low-risk group, had a probability of over 90% of being cost-effective. Estimates were varied according to country settings, integrated through a web-based customized analysis.CONCLUSIONCMT is unlikely to be cost-effective for low-risk patients but highly likely to be cost-effective for high-risk and very high-risk patients. As for intermediate-low or intermediate-high-risk patients, the cost-effectiveness of CMT varies depending on the time horizon and willingness-to-pay threshold.

BackgroundPulmonary thromboembolism is rare in children, but can be life-threatening. Timely diagnosis and treatment of pulmonary thromboembolism are crucial for reducing mortality associated with pulmonary thromboembolism in children. While guidelines for pulmonary thromboembolism in adults are available, guidelines for standardized diagnosis and management of pulmonary thromboembolism in children are not. This expert consensus aims to provide recommendations for the management of pulmonary thromboembolism in children based on the current best available evidence.Data sourcesFollowing the World Health Organization Handbook for Guideline Development, the expert panel consisted of 30 members from different clinical areas. The panel identified clinical questions through systematic reviews and expert discussions, systematically reviewed evidence on pulmonary thromboembolism in children, and evaluated the quality of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Using the GRADE Evidence to Decision Framework, the panel made recommendations, considering the effects of interventions, resource use, values and preferences, equity, acceptability, and feasibility.ResultsThe epidemiology, classification, and pathophysiology characteristics are summarized. The expert panel developed 33 recommendations addressing 20 questions related to diagnosis steps, treatment approaches such as anticoagulant therapy, thrombolysis therapy, catheter-based interventional therapy, surgical embolectomy, multidisciplinary team, and treatment of patients with comorbidities, prognosis, education, as well as follow-up. Among these, 18 are weak recommendations based on very low quality evidence, and 15 are good practice statements.ConclusionsThe expert panel provided recommendations for pulmonary thromboembolism in children based on available evidence, which was generally low in quality and volume. The panel urges further research on early identification and diagnosis strategies, preventive and therapeutic regimens, and long-term management for pulmonary thromboembolism.

Recommendations for the preventive management of pre-eclampsia remain inconsistent across existing guidelines, which may adversely affect clinical decision-making. It is crucial to summarize and compare the existing guidelines to identify inconsistencies and guide future research. We conducted a systematic review and quality assessment of clinical guidelines for the preventive management of pre-eclampsia. Six literature databases and 19 guideline databases or official websites were searched from their inception to May 31, 2024. Two reviewers initially screened the retrieved articles. Data extraction was performed by one reviewer and verified by another. Five reviewers appraised the quality using the AGREE II instrument. Basic characteristics of the guidelines were described as frequency and proportion. A qualitative analysis was performed to compare inconsistencies in the recommendations. The intraclass correlation coefficient (ICC) was calculated to evaluate the consistency of item scores in the AGREE II tool among reviewers. The standardized domain scores for all guidelines were expressed as median and interquartile range (IQR). The Heat maps and Sankey diagrams were generated to visualize variations. A total of 32 guidelines published between 2004 and 2024 were included. Recommendations for risk factors exhibited marked variations, with only 8 (27

Background:Medication non-adherence is widely occurring in children and adolescents with ADHD, which may lead to adverse consequences. However, the pooled adherence rate and influencing factors are inconsistent in different studies. Methods:We searched PubMed, Embase (Ovid), Cochrane Library, and four Chinese Databases from inception to 20 February 2024. All types of studies were included. Two researchers independently extracted data and assessed the risk of bias based on ROBINS-I, NOS, and AHRQ. A random-effects meta-analysis was conducted to pool the prevalence estimates and factors that can be combined. Results:After screening 2,360 publications, 63 studies were finally included, involving 450,759 participants. The general quality of the included studies was moderate to high quality. Adherence rates were reported in 50 studies, and a pooled adherence rate was 43.6% (95% Confidence Interval [CI] 39.0%-48.3%). The sensitivity analysis shows robust study results. However, both the primary analysis and the sensitivity analysis indicated high heterogeneity. The results of Meta-analysis identified five factors influencing adherence, of which female (Odds Ratio [OR] = 1.07, 95%CI:1.03-1.11), fewer medication doses (OR = 0.45, 95%CI:0.27-0.75), parental agreement with the medication plan (OR = 1.87, 95%CI:1.16-3.02), single-child families (OR = 1.80, 95%CI:1.29-2.52), and medication education for parents (OR = 6.34, 95%CI:3.97-10.12) can improve medication adherence. Besides, we also identified seven factors influencing adherence by qualitative analysis. Conclusion:Medication adherence is challenging for children and adolescents with ADHD, moreover, the meta-analysis of adherence rates showed high heterogeneity. We identified five modifiable factors by meta-analysis that are related to medication adherence, while other factors require further research. Systematic Review Registration:identifier CRD42024514310.

Drug shortages have been reported to lead to insufficient treatment, delays or cancellations in care, poor medication adherence, prolonged hospital stays, increased medication errors, adverse events related to alternative therapies, and even deaths, posing a serious threat to public health. Despite ongoing and substantial efforts to address this issue, many drug shortages continue to persist. Against this backdrop, this study aims to conduct a scoping review of the mechanisms for preventing and managing global drug shortages, to offer insights and recommendations for countries seeking to resolve this pressing problem. Seven online literature databases were systematically searched, including PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Chinese biomedical literature database (CBM), China Science and Technology Journal Database (VIP), and Wanfang Database, from inception to October 2022. Supplementary searches were conducted using Bing and other public search engines. We included studies that discussed prevention, early warning, or response strategies for managing drug shortages in various countries. Thematic synthesis was used to analyze and categorize the extracted data on early warning and response measures. Our search strategy retrieved 7,821 references, of which 69 studies published between 2008 and 2022 met the inclusion criteria. The majority of included articles were reviews or systematic reviews (50 studies), providing comprehensive insights into drug shortage prevention, warning mechanisms, and response measures across different countries. Regarding preventive and early warning strategies, interventions at the production stage received significant attention, with regulatory recommendations focused on minimizing the risk of disruption. Regarding response strategies, the literature primarily addressed necessary actions at production, distribution, clinical use, and regulatory levels. This review underscores the urgent need for an integrated, cross-sectoral approach to drug shortage prevention and response. Strengthening connections across the pharmaceutical supply chain, refining stakeholder incentive structures, and leveraging technological innovations are essential for building systemic resilience. In practice, this calls for the establishment of international data-sharing agreements, investment in real-time monitoring infrastructure, and policy frameworks that balance regulatory oversight with market sustainability.

BackgroundThe TreeScan method is an emerging tool for active safety signal surveillance and has been increasingly applied in post-marketing monitoring of pharmaceuticals and vaccines.ObjectiveTo evaluate methodological developments and application patterns of the TreeScan method.MethodsA scoping review was conducted by searching Embase, Medline, Cochrane Library, China National Knowledge Infrastructure, Wanfang, VIP, and SinoMed from inception to 16 May 2025. Two researchers independently screened studies and extracted data. Descriptive analyses were performed on study characteristics, methodologies, and application domains. Included studies were categorized as methodological or applied research.ResultsForty-four articles were included, comprising 13 methodological studies (29.5%) and 31 applied studies (70.5%). Applied studies included drug safety surveillance (n = 10), vaccine safety surveillance (n = 16), and other areas such as drug repurposing and epidemiology (n = 5). Most studies originated from the United States (n = 28) and South Korea (n = 8). The Bernoulli model (43.2%), Poisson model (18.2%), and tree-temporal scan statistic (29.5%) were the most frequently used approaches. Positive controls we1re used in 63.6% of studies, while 36.4% employed within-group controls. Vaccine safety surveillance represented the most common application area, whereas methodological innovations focused on improving statistical performance, controlling confounding, and extending TreeScan to new data structures.ConclusionTreeScan research is increasingly application-oriented, particularly in vaccine safety surveillance Recent methodological advances have improved its performance in handling confounding, hierarchical outcomes, and complex data structures. Future research should should prioritize validating newer TreeScan variants across diverse real-world databases and expanding applications beyond safety surveillance.

OBJECTIVE:To synthesize evidence on the effectiveness and safety of different inhaled antibiotic regimens for treating LRTIs. METHOD:RCTs-based systematic reviews on inhaled antibiotics treating LRTIs were identified from electronic databases. Methodological quality was assessed using the ROBIS tool. Meta-analysis estimated effects on microbiological eradication, lung function, clinical response, exacerbations, adverse events, mortality and antibiotic resistance. Subgroup analysis was conducted by antibiotic type, nebulizer and primary pathogen. Evidence maps visualised outcomes and certainty. RESULT:A total of 21 systematic reviews and 69 RCTs (52 conducted in adults) were included, covering cystic fibrosis (CF), non-cystic fibrosis bronchiectasis (NCFB) and ventilator-associated pneumonia (VAP). Regarding effectiveness, inhaled antibiotics may improve lung function in CF and likely reduce exacerbation frequency in NCFB (RR 0.86, 0.78-0.96), while they may enhance microbiological eradication in CF (2.06, 1.19-3.57) and likely improve it in NCFB (2.16, 1.21-3.86). For VAP, adjunctive therapy may improve clinical response (1.22, 1.09-1.37) and pathogen clearance (1.38, 1.23-1.56). No significant decreases in mortality were observed. Regarding safety, inhaled antibiotics likely induce bronchospasm in NCFB (1.43, 1.05-1.96), and it may increase antibiotic resistance in both CF (RR 1.82, 1.06-3.11) and NCFB (RR 1.97, 1.55-2.49). Adjunctive therapy in VAP may induce bronchospasm (RR 2.53, 1.49-4.31) and reduce antibiotic resistance (RR 0.18, 0.05-0.64). Efficacy and safety outcomes varied across antibiotic types, nebulizers and target pathogens. CONCLUSION:Inhaled antibiotics may be beneficial in CF and NCFB, and may have value as adjunctive therapy in VAP. Prospective studies, especially in pediatric populations and comparing inhaled versus systemic antibiotics, remain needed.

BackgroundHigh-risk pregnancy was a major challenge to sustainably reduce maternal mortality rate to achieve the Sustainable Development Goals in China. This study aimed to analyze the temporal trend of high-risk pregnancy rate in China and to explore the influence of socioeconomic factors.MethodsPanel data of 31 provinces in China from 2002 to 2016 were extracted from the China Statistical Yearbooks and Health Statistical Yearbooks. We firstly adapted JoinPoint regression model to describe the temporal trend of high-risk pregnancy rate. Then, an auto-regressive integrated moving average model was built to predict high-risk pregnancy rate from 2017 to 2030. Finally, a linear mixed model was employed to evaluate the impact of socioeconomic factors on high-risk pregnancy rate at the provincial level.ResultsThe high-risk pregnancy rate increased substantially with an average annual percent change of 6.06% (95% CI: 5.70, 6.51%) from 1996 to 2016 in China. Except Tibet, the high-risk pregnancy rate of other 30 provinces all presented an upward trend with an average annual percent change ranging from 1.86% (95% CI: 1.47, 2.35%) to 11.15% (95% CI: 9.22, 13.10%). The predicted high-risk pregnancy rate would up to 38.76% (95% CI: 31.66, 45.85%) in 2030 in China. The number of hospital beds per 1,000 population was negatively associated with high-risk pregnancy rate (β = −0.0476, 95% CI: −0.0767, −0.0185). While female illiteracy and GRP per capita were positively correlated with high-risk pregnancy rate, the coefficient was 0.0127 (95% CI: 0.0050, 0.0203) and 0.1717 (95% CI: −0.0205, 0.3639) respectively.ConclusionThe high-risk pregnancy ratio in China has been increasing and sustains an upward trend, posing great challenge to maternal health improvement in China. Healthcare resources and other socioeconomic factors have significant effect on high-risk pregnant rate, such findings can provide evidence-based implications for long-term policy-making in healthcare resource allocation, urban development and gender equality. Constant efforts by all society should be made to enhance maternal health to achieve the goals of the Sustainable Development Goals and Healthy China 2030.

Background: Steroid resistance indicates poor prognosis in pediatric nephrotic syndrome, but predictive models and risk factors for steroid-resistant nephrotic syndrome (SRNS) remain poorly understood. Methods: We searched PubMed, Embase, Scopus, CNKI, SinoMed, Wanfang, and VIP (inception to 1 March 2025) for studies developing SRNS prediction models or identifying risk factors. Odds ratios and AUC were pooled using random-effects meta-analysis. Risk of bias was assessed with PROBAST and Newcastle-Ottawa Scale. Results: Out of 2264 studies, 23 were included. Prediction models were mainly developed using logistic regression (16/17, 94.1%). The most frequently reported predictors included erythrocyte sedimentation rate and vitamin D binding protein. The reported AUC ranged from 0.75 to 0.88. Only one model had undergone external validation with an accuracy of 0.94. A total of 22 independent risk factors were identified, five of which—low birth weight, decreased urine output, hypertension, serum albumin, and serum IgM—were not in existing models. In total, 76% of model studies and 26% of risk factor analyses were at high or moderate risk of bias. Conclusions: Existing SRNS prediction models reported apparent discrimination but had a high risk of bias and very limited external validation, which substantially restricts their current clinical applicability. Several relevant risk factors remain unincorporated. Future research should prioritize rigorous model development and multi-center external validation.

Objective To evaluate the efficacy and safety of azithromycin in eradicating Ureaplasma and preventing bronchopulmonary dysplasia (BPD) in preterm infants.Design Six literature databases and three clinical trial registration platforms were searched for studies up to 22 July 2024. The meta-analysis was performed using RevMan V.5.3.Results A total of 1723 preterm infants from 10 randomised controlled trials and 3 case series were included. In all preterm infants, azithromycin significantly improved Ureaplasma clearance (relative risk (RR)=1.47, 95% CI 1.17 to 1.85) and reduced the duration of mechanical ventilation (mean difference (MD)=-2.16, 95% CI -2.65 to -1.68), duration of supplemental oxygen (MD=-5.46, 95% CI -6.65 to -4.37) and length of stay (MD=-4.98, 95% CI -7.19 to -2.76) compared with placebo; however, there was no significant reduction in BPD, BPD-death or mortality, with low quality of evidence. In Ureaplasma-positive preterm infants, azithromycin significantly reduced BPD-death (RR=0.83, 95% CI 0.70 to 0.99) and mechanical ventilation (MD=-2.20, 95% CI -2.72 to -1.69), compared with placebo, and significantly increased Ureaplasma clearance rate. Additionally, compared with erythromycin, azithromycin reduced BPD, without a statistically significant difference. Compared with placebo, azithromycin showed no statistically significant differences in the incidence of necrotising enterocolitis, retinopathy, intraventricular haemorrhage, etc.Conclusions Low-quality evidence indicated prophylactic use of azithromycin could reduce the incidence of BPD-death and the duration of mechanical ventilation in Ureaplasma-positive preterm infants. However, such benefits were not observed in all preterm infants. Meanwhile, azithromycin was found to be safe for administration in preterm infants.PROSPERO registration number CRD42024585836.

Obesity is a multifactorial metabolic condition characterized by dysregulated lipid accumulation and systemic energy imbalance with escalating global prevalence. This chronic disease drives a spectrum of life-threatening comorbidities, including metabolic dysfunction-associated steatotic liver disease (MASLD) and its progressive form, metabolic dysfunction-associated steatohepatitis (MASH), which now represent a primary cause of liver-related morbidity and transplantation. Both conditions share pathophysiological underpinnings such as insulin resistance, chronic inflammation, and mitochondrial dysfunction, creating a vicious cycle where obesity exacerbates hepatic steatosis and fibrosis. Although US Food and Drug Administration-approved antiobesity agents such as glucagon-like peptide-1 receptor agonists (eg, semaglutide) demonstrate weight loss efficacy, their long-term utility is constrained by gastrointestinal intolerance and variable effects on hepatic outcomes. Similarly, the recent approval of resmetirom for MASH, though groundbreaking, leaves unresolved challenges in durability, accessibility and some adverse effects including gastrointestinal reaction. The intricate molecular crosstalk linking adipose and hepatocyte dysfunction necessitates innovative therapeutics targeting shared pathophysiological pathways or novel molecular targets. Natural products, with inherent structural diversity and multitarget potential, offer a promising avenue for dual intervention in the obesity-MASH continuum. This review systematically evaluates emerging endogenous metabolites and plant-derived compounds, elucidating their directly validated molecular targets and preclinical evidence for metabolic reprogramming against obesity and MASLD/MASH. Furthermore, it synthesizes translational insights from natural product research and clinical trial experiences of related synthetic agonists. By integrating mechanistic discovery with a critical assessment of developmental challenges, this review aims to advance strategic frameworks for the concurrent management of obesity and MASLD/MASH. SIGNIFICANCE STATEMENT: Obesity-driven metabolic dysfunction-associated steatotic liver disease and steatohepatitis are leading causes of liver morbidity with limited treatment options. This review systematically evaluates natural products as multitarget therapeutics for these interconnected conditions. By integrating evidence of their efficacy and target mechanisms with modern discovery approaches, this study emphasizes pathways for clinical translation and aims to stimulate future research into novel, mechanism-based interventions.

Objectives To review the application of prediction models and risk factors identified by prediction models for invasive fungal infection (IFI) in children, and assess model performance, methodological rigour and applicability.Design This is a systematic review of diagnostic prediction models and a meta-analysis of the risk factors. This study was registered on PROSPERO and performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis and Prediction model risk of bias assessment tool.Data sources PubMed, Embase (Ovid), Medline, Cochrane Library and four Chinese Databases were searched on 10 Mar 2025.Eligibility criteria We included original studies that developed diagnostic prediction models for IFI in children and excluded the informal records.Data extraction and synthesis Odds ratio (OR) with 95% confidence interval (CI) was calculated for risk factors, and a random-effects meta-analysis was applied to factors reported in at least two studies. For prediction models, a descriptive analysis was conducted to summarise model characteristics, model performance and the risk of bias.Results Nine studies were included from 4069 articles. Nine studies developed ten diagnostic prediction models, and logistic regression was the most commonly used method. The predictive performance showed an area under receiver operating curves (AUROC) ranging from 0.76 to 0.95, but meta-analysis of AUROC was not conducted due to heterogeneity. All studies were identified as having a high risk of bias in critical appraisal, particularly in the analysis, mainly due to the lack of validation, as well as the failure to appropriately evaluate model performance and overfitting. Only two of nine studies that developed prediction models used internal or external validation.Conclusions Logistic regression is a common method for predicting IFI in children, although machine learning methods have been popular in prediction models. Our study identified all studies as high risk of bias. To reduce bias, studies should use calibration measures, internal and external validation more frequently, and consider shrinkage methods when developing models.

Objectives Pulmonary thromboembolism (PTE) is rare but potentially life-threatening in children and differs substantially from adult PTE in epidemiology and risk factors. We conducted a systematic review and meta-analysis to summarise the epidemiology, clinical characteristics and risk factors of paediatric PTE.Design A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Data sources We searched eight databases (PubMed, Embase (Ovid), MEDLINE (Ovid), Cochrane Library and four Chinese databases) on 2 March 2023, with an updated search on 2 July 2024.Eligibility criteria We included original studies reporting epidemiology (incidence/prevalence, major clinical outcomes and long-term sequelae), clinical characteristics, or risk factors of PTE in patients younger than 18 years. Reviews, case reports/series without extractable epidemiological data and studies not focused on paediatric PTE were excluded.Data extraction and synthesis Two reviewers independently screened studies, extracted data and assessed risk of bias using appropriate tools for observational studies. A random-effects model was applied to pool prevalence and incidence estimates, along with related outcomes, and their 95% CIs, regardless of the degree of heterogeneity.Results From 14 438 records, 26 studies were included: 16 cross-sectional, 9 cohort and 1 case–control study. 23 studies were marked as high quality and three as moderate quality. The pooled incidence of paediatric PTE was 0.016% (95% CI 0.0011% to 0.0298%). Autopsy-confirmed prevalence was 5.29% (95% CI 1.28% to 9.30%). Case fatality was 4.04% (95% CI 0.49% to 7.58%), and recurrence was 26.31% (95% CI 19.62% to 33.01%). Available evidence suggested an increasing trend in PTE occurrence over recent years. Female sex and oral contraceptive use were frequently reported clinical characteristics in adolescents. Reported risk factors clustered into genetic predisposition, underlying diseases, immobilisation or surgery and central venous catheter-related thrombosis.Conclusions Paediatric PTE remains uncommon but appears to be increasing, with notable recurrence and non-negligible fatality. Given heterogeneous study settings and definitions, further high-quality, population-based studies are needed to refine epidemiological estimates and clarify age-specific risk profiles, thereby informing prevention strategies and clinical management.Trial registration number PREPARE-2023CN922.