Siranart, Noppachai

Background: Idiopathic intracranial hypertension (IIH) is commonly linked to obesity. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and bariatric surgery may improve outcomes beyond conventional therapy, but comparative evidence is limited. Methods: We systematically searched MEDLINE, EMBASE, and Cochrane from inception until June 2025. Eligible randomized and observational studies compared GLP-1RAs or bariatric surgery (each plus conventional care) against conventional management. Primary outcomes were the change in papilledema, visual acuity, and visual field. Secondary outcomes included body mass index (BMI), retinal nerve fiber layer (RNFL) thickness, monthly headache days, and risks of papilledema, visual disturbance, and headache. Pairwise random-effects meta-analyses and frequentist network meta-analysis ( P -scores) were performed. Results: Out of 429 records, 8 studies were included. Versus conventional therapy, GLP-1RAs reduced BMI (mean difference −1.55 kg/m 2 ; 95% confidence interval [CI]: −2.13 to −0.97) and lowered risks of papilledema (relative risk [RR]: 0.47; 95% CI: 0.34–0.65), visual disturbance (RR: 0.48; 95% CI: 0.24–0.98), and headache (RR: 0.78; 95% CI: 0.69–0.88). Changes in papilledema severity and RNFL thickness were not different; visual acuity favored GLP-1RAs at the end of follow-up, whereas visual field values were worse at some time points. In indirect comparisons with bariatric surgery, no significant differences were detected across outcomes. Conclusions: Adjunctive GLP-1RA therapy may be associated with weight loss and improved clinical/ophthalmic outcomes in IIH relative to conventional care, with a signal for worse visual fields at certain time points. Indirect comparisons suggest comparable efficacy to bariatric surgery. High-quality randomized trials are needed to define comparative effectiveness, safety, and optimal use.

Cataracts are the leading cause of blindness worldwide. Obesity, a key component of metabolic syndrome (MetS), may represent a modifiable risk factor for cataracts. However, the evidence regarding the association between MetS or its components and cataracts remains controversial. Therefore, our meta-analysis aims to clarify the relationship between MetS or its components and cataracts. A search was conducted until February 2024 via the MEDLINE, EMBASE, and Cochrane databases. The primary endpoint included the association between MetS or its components, including body mass index (BMI), diabetes mellitus (DM), hypertension (HT), and dyslipidemia (DLP), and cataracts. Secondary endpoints included the association between levels of blood pressure, blood sugar, and lipid profiles and cataracts. A total of 27 studies were included with a total of 1,010,014 patients (134,498 with cataracts and 875,516 without cataracts). Of these, there were 2 prospective cohort studies, 6 case–control studies, and 19 cross-sectional studies. The prevalence of cataracts was 13.3%. MetS was significantly associated with cataracts with an odds ratio (OR) of 1.60 (95% confidence interval [CI]: 1.44–1.77, I 2 = 93%). Among MetS components, high BMI and being diagnosed with DM, HT, and DLP were associated with cataracts with ORs of 1.45 (95% CI: 1.33–1.58, I 2 = 80%), 1.77 (95% CI: 1.69–1.85, I 2 = 51%), 1.23 (95% CI: 1.19–1.28, I 2 = 62%), and 1.38 (95% CI: 1.30–1.46, I 2 = 0%). Among the metabolic parameters, high total cholesterol, high triglycerides, low high-density lipoprotein cholesterol, and high low-density lipoprotein cholesterol were associated with cataracts with ORs of 1.25 (95% CI: 1.04–1.49, I 2 = 48%), 1.05 (95% CI: 1.04–1.06, I 2 = 68%), 1.07 (95% CI: 1.01–1.13, I 2 = 0%), and 1.30 (95% CI: 1.10–1.53, I 2 = 71%), respectively. MetS, obesity, DM, HT, and DLP are associated with cataracts. Prevention or treatment of MetS or its components likely represent a modifiable risk factor in cataract development.

ABSTRACT Background Pulmonary vein isolation (PVI) is the mainstay treatment for rhythm control in patients with persistent atrial fibrillation (PsAF). However, due to the complex mechanisms of PsAF, the efficacy of PVI alone remains modest. Spatiotemporal electrogram dispersion (STED) ablation is a promising strategy to enhance outcomes. This study aims to evaluate the efficacy of STED ablation plus PVI versus PVI alone in PsAF ablation. Methods A systematic search was conducted to identify studies published up to November 2024 comparing PVI plus STED ablation (PVI‐STED group) versus PVI alone (PVI group) in patients with PsAF. The primary outcomes were AF recurrence and sinus rhythm (SR) conversion. Results Eleven studies (three randomized controlled trials, three prospective cohorts, five retrospective cohorts) involving 1607 patients (mean age of 63.9 ± 9.3 years) were included. The PVI‐STED group was significantly associated with a lower risk of AF recurrence (OR: 0.40, 95% CI: 0.27–0.59, I ² = 25%) and a higher likelihood of SR conversion (OR: 7.04, 95% CI: 1.62–30.62, I 2 = 79%). No significant differences were observed in procedural time (MD: 27.61 min, 95% CI: −29.12 to 84.33, I ² = 97%), ablation time (MD: 4.4 min, 95% CI: −11.3 to 20.0, I 2 = 98%), or fluoroscopy time (0.25 min, 95% CI: −3.4 to 3.9, I 2 = 95%). The overall rate of AEs in the PVI‐STED group was 1% (95% CI: 1%–3%, I 2 = 0%). Conclusion The PVI‐STED approach demonstrated both efficacy and safety in treating PsAF, as evidenced by reduced AF recurrence and improved SR conversion rates.

Background: Pulsed field ablation (PFA) and high-power short-duration radiofrequency ablation (HPSD) are emerging techniques for treating atrial fibrillation (AF), offering promising results compared to cryoballoon ablation (CBA). This network meta-analysis aims to evaluates the efficacy and safety of PFA, HPSD, and CBA. Method: PubMed, Embase, Cochrane Central Register of Controlled Trials, and EBSCO Information Services were systematically searched for relevant studies until April 2024. The primary outcome is freedom from atrial arrhythmia. A random-effects model was used for data synthesis, and P-scores were employed for outcome ranking. Point estimation (odd ratios) was calculated for comparisons. Results: Fifteen studies were included in our network meta-analysis, involving 5,093 atrial fibrillation patients: 812 (16%), 2,659 (52%), and 1,622 (32%) patients underwent PFA, CBA, and HPSD, respectively. PFA demonstrated the highest efficacy (P-scores 99.3%). Point estimation between PFA and HPSD, and PFA and CBA, were 1.394 (95% CI: 1.047-1.858) and 1.479 (95% CI: 1.134–1.929), respectively. PFA had higher complications compared to HPSD (OR=4.44, 95% CI: 1.405-14.031) and CBA (OR=2.581, 95% CI: 0.992–6.720). HPSD had the shortest fluoroscopic time (P-scores 100%), while CBA had the longest (P-scores 0%). PFA had the shortest procedural time compared to CBA and HPSD with P-scores of 100% 50% and 0%, respectively. Conclusion: PFA showed higher efficacy but higher complication risk than HPSD and CBA. HPSD and CBA demonstrated similar efficacy and safety.

Abstract Background: The relationships between exercise timing and health outcomes including anthropometric indices, metabolic markers, and sleep health have not been clearly established. To gain better insights, we performed the meta-analysis to determine the effects of morning versus evening exercise on various health outcomes. Methods: We collected studies from MEDLINE, EMBASE, and Cochrane databases from inception to March 2023 to perform a meta-analysis. Exercise is defined as performing activity at least moderate intensity. For the outcomes of interest, the mean differences (MD) were employed using a random-effects model, the generic inverse variance method of DerSimonian and Laird. Results: A total of 716 patients were analyzed from 14 studies including randomized controlled trial and observational studies. We found no significant associations between exercise timing and several health-related parameters. Specifically, the data showed no notable differences in body weight (MD: -0.12 kg [95% CI −0.81 to 0.58]) and BMI (MD: -0.07 kg/m2 [95% CI −0.46 to 0.32]) when comparing morning and evening exercise sessions. Similarly, sleep latency was not significantly affected by exercise timing (MD: -2.24 minutes [95% CI −5.83 to 1.35]). Furthermore, changes in metabolic biomarkers, including LDL (MD: -6.64 mg/dL [95% CI −20.08 to 6.79]) and HDL (MD: 0.09 mg/dL [95% CI 0 to 0.17]), were not significantly associated with the timing of exercise. Conclusion: This meta-analysis found no significant relationship between exercise timing and health outcomes including anthropometric indices, metabolic markers, and sleep health. While considered as hypothesis generating, timing of exercise should equally prune patients’ health outcomes.

AbstractIntroductionAtrioventricular nodal reentrant tachycardia (AVNRT) is the most common supraventricular tachycardia referred for ablation. Periprocedural conduction system damage was a primary concern during AVNRT ablation. This study aimed to assess the incidence of permanent atrioventricular (AV) block and the success rate associated with different types of catheters in slow pathway ablation.MethodA literature search was performed to identify studies that compared various techniques, including types of radiofrequency ablation (irrigated and nonirrigated) and different sizes of catheter tip cryoablation (4, 6, and 8‐mm), in terms of their outcomes related to permanent atrioventricular block and success rate. To assess and rank the treatments for the different outcomes, a random‐effects model of network meta‐analysis, along with p‐scores, was employed.ResultsA total of 27 studies with 5110 patients were included in the analysis. Overall success rates ranged from 89.78% to 100%. Point estimation showed 4‐mm cryoablation exhibited an odds ratio of 0.649 (95%CI: 0.202–2.087) when compared to nonirrigated RFA. Similarly, 6‐mm cryoablation had an odds ratio of 0.944 (95%CI: 0.307–2.905), 8‐mm cryoablation had an odds ratio of 0.848 (95%CI: 0.089–8.107), and irrigated RFA had an odds ratio of 0.424 (95%CI: 0.058–3.121) compared to nonirrigated RFA.ConclusionOur study found no significant difference in the incidence of permanent AV block between the types of catheters. The success rates were consistently high across all groups. These findings emphasize the potential of both RF ablation (irrigated and nonirrigated catheter) and cryoablation as viable options for the treatment of AVNRT, with similar safety and efficacy profile.

AbstractIntroductionCardiac resynchronization therapy (CRT) is a standard treatment for patients with heart failure with reduced ejection fraction. However, there is still a gap of evidence in congenital heart disease (CHD) patients regarding resynchronization therapy.MethodsWe performed a meta‐analysis and systematic review of CHD patients who received CRT implantation. We comprehensively searched the databases of MEDLINE, EMBASE, and Cochrane database from inception to June 2023. Studies that reported response rate to CRT, total mortality rate, change in QRS duration, change in left ventricular ejection fraction, and change in New York Heart Association functional class were included.ResultsA total of 14 studies were included in the study. There were 10 studies that reported response rates after implantation. The overall response rate to CRT in CHD patients was 68% (95% confidence interval [CI] 61%–75%, I2 32%). The response rates in patients with systemic right ventricle (RV), systemic left ventricle (LV), and single ventricle were 58% (95% CI 46%–70%, I2 0%), 80% (95% CI 74%–86% I2 14%), and 67% (95% CI 49%–80% I2 0%). Response to CRT in systemic RV was inferior to systemic LV with an odds ratio of 0.38 (95% CI 0.15–0.95, I2 38%). The total mortality rate from seven studies was 12% (95% CI 8%–18%, I2 55%). The parameters which represented ventricular dyssynchrony improved after CRT implantation.ConclusionThe overall response rate to CRT in CHD was 68%. Patients with systemic RV had a lower response rate to CRT when compared to patients with systemic LV. The total mortality rate after CRT implantation was 12%.