chemoprevention

化学预防
  • 文章类型: Journal Article
    橄榄树(Oleaeuropaea)和橄榄油在欧洲具有重要的文化和历史意义。与橄榄油消费相关的健康益处已得到充分证明。本文探讨了橄榄油和橄榄叶的抗癌作用机制,专注于它们的关键生物活性化合物,即oleocanthal,油精,和橄榄苦苷.oleocanthal的化学预防潜力,油精,通过本系统评价,对橄榄苦苷进行了全面检查。我们进行了系统的文献检索,以识别Scopus的合格文章,PubMed,和WebofScience数据库发布到2023年10月10日。在4037篇文章中,有88篇合格的文章描述了oleocanthal的化学预防作用机制,油精,和橄榄苦苷.这些化合物具有抑制细胞增殖的能力,诱导细胞死亡(凋亡,自噬,和坏死),抑制血管生成,抑制肿瘤转移,并调节癌症相关的信号通路。此外,据报道,油精和橄榄苦苷也会破坏氧化还原止血。这篇综述提供了对O.europaea衍生的类环烯醚萜类化合物的化学预防机制的见解,阐明它们在化学预防中的作用。论文中总结的生物活性支持流行病学证据,表明橄榄油消费与癌症风险之间存在负相关。此外,绘制和总结的次级信号通路可能为阐明与其他化学预防剂的新协同作用以补充化疗和开发新的基于营养的抗癌方法提供信息.
    The olive tree (Olea europaea) and olive oil hold significant cultural and historical importance in Europe. The health benefits associated with olive oil consumption have been well documented. This paper explores the mechanisms of the anti-cancer effects of olive oil and olive leaf, focusing on their key bioactive compounds, namely oleocanthal, oleacein, and oleuropein. The chemopreventive potential of oleocanthal, oleacein, and oleuropein is comprehensively examined through this systematic review. We conducted a systematic literature search to identify eligible articles from Scopus, PubMed, and Web of Science databases published up to 10 October 2023. Among 4037 identified articles, there were 88 eligible articles describing mechanisms of chemopreventive effects of oleocanthal, oleacein, and oleuropein. These compounds have the ability to inhibit cell proliferation, induce cell death (apoptosis, autophagy, and necrosis), inhibit angiogenesis, suppress tumor metastasis, and modulate cancer-associated signalling pathways. Additionally, oleocanthal and oleuropein were also reported to disrupt redox hemostasis. This review provides insights into the chemopreventive mechanisms of O. europaea-derived secoiridoids, shedding light on their role in chemoprevention. The bioactivities summarized in the paper support the epidemiological evidence demonstrating a negative correlation between olive oil consumption and cancer risk. Furthermore, the mapped and summarized secondary signalling pathways may provide information to elucidate new synergies with other chemopreventive agents to complement chemotherapies and develop novel nutrition-based anti-cancer approaches.
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  • 文章类型: Journal Article
    已发表的文献显示,非甾体抗炎药(NSAIDs)对家族性腺瘤性息肉病(FAP)患者减少结直肠息肉的益处的报道不一。我们进行了系统评价和荟萃分析,以评估非甾体抗炎药对FAP患者结直肠息肉负担的影响。
    我们搜索了PubMed,EMBASE,和Cochrane用于随机对照试验(RCT),比较NSAIDs与安慰剂对FAP患者息肉数量和息肉大小变化百分比的影响。使用RevMan汇集2个研究组之间的平均差异。使用随机对照试验的Cochrane偏差风险工具评估偏差风险(RoB),使用建议分级评估来评估证据的确定性,发展,和评价方法。
    搜索策略确定了1021项研究,其中我们纳入了8项RCT,共279例患者。使用NSAIDs治疗6.4±2.2个月可使息肉数量减少-17.4%(95%置信区间-26.41%,-8.29%)(由于不精确和RoB问题而导致的低确定性[I289%]和息肉大小-15.9%(95%置信区间-24.98%,-6.73%)(由于不精确,确定性非常低(I284%),不一致,以及RoB的问题)。报告的最常见的胃肠道不良事件是口腔炎,腹泻,和腹痛。导致停药的副作用是胃肠炎和药物过敏。
    短期使用NSAIDs可减少息肉数量和息肉大小,但证据的确定性低至非常低。需要进一步的大型多中心研究来进一步探索NSAIDs作为FAP患者的化学预防措施。
    UNASSIGNED: Published literature shows mixed reports of the benefits of nonsteroidal anti-inflammatory drugs (NSAIDs) on reducing colorectal polyps in patients with familial adenomatous polyposis (FAP). We conducted a systematic review and performed a meta-analysis to assess the impact of NSAIDs on colorectal polyp burden in patients with FAP.
    UNASSIGNED: We searched PubMed, EMBASE, and Cochrane for randomized controlled trials (RCTs) comparing the effect of NSAIDs vs placebo on the percent change in polyp number and polyp size in patients with FAP. Mean differences between the 2 study arms were pooled using RevMan. The risk of bias (RoB) was assessed using the Cochrane Risk of Bias tool for RCTs, and certainty in the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology.
    UNASSIGNED: The search strategy identified 1021 studies, out of which we included 8 RCTs with a total of 279 patients. Treatment for 6.4 ± 2.2 months with NSAIDs reduced polyp numbers by -17.4% (95% confidence interval -26.41%, -8.29%) (low certainty [I2 89%] due to imprecision and issues with RoB) and polyp size by -15.9% (95% confidence interval -24.98%, -6.73%) (very low certainty (I2 84%) due to imprecision, inconsistency, and issues with RoB). The most common gastrointestinal adverse events reported were stomatitis, diarrhea, and abdominal pain. Side effects leading to drug discontinuation were gastroenteritis and drug allergy.
    UNASSIGNED: Short-term use of NSAIDs reduced polyp number and polyp size but with low to very low certainty of evidence. Further large multicenter studies are needed to further explore NSAIDs as a chemopreventive measure in patients with FAP.
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  • 文章类型: Journal Article
    MicroRNA是短的非编码RNA,其在转录后水平上抑制基因表达。异常的microRNA表达与不同的人类疾病,包括癌症.表观遗传变化,突变,转录失调,DNA拷贝数异常,生物发生机制的缺陷在microRNA异常表达中起着重要作用。已经出现了通过组合治疗方法通过天然试剂调节microRNA以增强常规化疗的功效。这篇综述总结了目前对癌症中microRNA异常表达的认识。microRNA的不同细胞机制,以及通过天然化合物预防它们。了解癌症发展过程中的microRNA表达模式可能有助于识别阶段特异性分子标志物。通过调节microRNA发挥调节作用的天然化合物可通过直接靶向microRNA或作为增加对现有化疗方案的敏感性的方式用于更好的癌症化学预防策略。
    MicroRNAs are short non-coding RNAs that inhibit gene expression at the post-transcriptional level. Abnormal microRNA expression has been associated with different human diseases, including cancer. Epigenetic changes, mutation, transcriptional deregulation, DNA copy number abnormalities, and defects in the biogenesis machinery play an important role in abnormal microRNA expression. Modulation of microRNAs by natural agents has emerged to enhance the efficacy of conventional chemotherapy through combinatorial therapeutic approach. This review summarizes the current understanding of abnormal microRNA expression in cancer, the different cellular mechanisms of microRNA, and their prevention by natural compounds. Understanding microRNA expression patterns during cancer development may help to identify stage-specific molecular markers. Natural compounds that exert regulatory effects by modulating microRNAs can be used in better cancer chemopreventive strategies by directly targeting microRNAs or as a way to increase sensitivity to existing chemotherapy regimens.
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  • 文章类型: Systematic Review
    豆科植物广泛分布于世界各地,尤其是在欧洲,亚洲和北美。它们是异黄酮的丰富来源,具有雌激素样活性的化合物,怀疑对激素依赖性癌症有化学预防作用。按照PRISMA准则,我们进行了系统综述,旨在评估豆科植物提取物对激素依赖性癌细胞的影响以及植物原料中活性化合物的含量。我们分析了来自体外和体内研究的63篇文章的结果,这些文章描述了含异黄酮的植物提取物对癌细胞的影响,以及它们的抗炎和抗氧化潜力。在这个过程中,我们确定了研究的局限性和未来的研究方向。收集的结果表明植物物种具有潜在的高含量的植物雌激素和抗炎,抗氧化和细胞毒性。他们指出,植物在饮食中的潜在用途是提供癌症预防的化合物的来源。
    Plants from the Fabaceae family are widely distributed around the world, especially in Europe, Asia and North America. They are a rich source of isoflavones, compounds with estrogen-like activity, which are suspected of having a chemopreventive effect against hormone-dependent cancers. Following the PRISMA guidelines, we conducted a systematic review aimed at assessing the impact of Fabaceae plant extracts on hormone-dependent cancer cells and the content of active compounds in plant raw materials. We analyzed the results of 63 articles from in vitro and in vivo studies describing the effect of plant extracts containing isoflavones on cancer cells, along with their anti-inflammatory and antioxidant potential. In the process, we determined the research limitations and future research directions. The collected results indicate the plant species with potentially high contents of phytoestrogens and anti-inflammatory, antioxidant and cytotoxic properties. They point to the potential use of plants in the diet as a source of compounds offering cancer prevention.
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  • 文章类型: Journal Article
    黑色素瘤发病率的上升激发了人们对预防策略的兴趣。非甾体抗炎药(NSAIDs),尤其是阿司匹林,显示出降低癌症风险的潜力。NSAIDs作用于环氧合酶(COX)酶,影响与炎症和癌症进展相关的COX-2。本文探讨了阿司匹林在皮肤黑色素瘤预防中的作用。阐明其机制,并承认不同的文献结果。而不是提供结论性的建议,审查强调了个人因素的影响,促进正在进行的关于阿司匹林在黑色素瘤预防中的复杂性的对话。PubMed使用\"阿司匹林\"和\"皮肤黑色素瘤\"搜索产生相关的英语语言,同行评审的研究。选择标准专门针对皮肤癌,特别是皮肤黑色素瘤。排除包括涵盖各种癌症的研究,一些非皮肤病学的,和那些没有评估阿司匹林独立使用但与NSAIDs联合使用的人。阿司匹林和NSAIDs对黑色素瘤的潜在化学预防作用已引起关注,因为它们与各种癌症包括胃癌的风险降低有关。结直肠,和乳房。通过抑制COX酶和NF-κB通路,这些药物理论上减缓恶性细胞的活动,提出了预防癌症的前景。阿司匹林表现出值得注意的效果,消耗生长刺激激素,产生对癌细胞有害的活性氧,抑制COX-2与癌症进展有关。有限的文献表明,在II期和III期黑色素瘤中使用阿司匹林对生存有益,可能是由于疾病进展缓慢,在较小的Breslow深度很明显。对阿司匹林的性别特异性反应值得注意,一些研究报告女性的化学预防相关性更强。重要的是要注意地理差异,人口队列,个体特异性因素是混杂变量,这些变量可能导致阿司匹林对黑色素瘤影响的结果相互矛盾.阿司匹林的使用和黑色素瘤的风险之间的关联是复杂的,不同人群的发现相互矛盾。尽管似乎更多的研究表明阿司匹林具有保护作用,而不是没有,证据缺乏一致性。性别等因素,地理,种族,阳光照射,健康状况在塑造这些不同结果方面发挥作用,需要大规模,前瞻性研究研究和标准化参数,以获得更有结论性的见解,这可能有助于指导针对黑色素瘤预防的量身定制的临床策略。
    Rising melanoma rates have spurred interest in preventive strategies. Nonsteroidal anti-inflammatory drugs (NSAIDs), particularly aspirin, show potential in reducing cancer risks. NSAIDs act on cyclooxygenase (COX) enzymes, impacting COX-2 associated with inflammation and cancer progression. This paper explores aspirin\'s role in cutaneous melanoma prevention, elucidating its mechanisms and acknowledging varying literature outcomes. Rather than providing conclusive recommendations, the review emphasizes the influence of individual factors, contributing to the ongoing dialogue on aspirin\'s complexities in melanoma prevention. A PubMed search using \"Aspirin\" AND \"Cutaneous melanoma\" yielded relevant English-language, peer-reviewed studies. Selection criteria focused exclusively on skin cancers, specifically cutaneous melanoma. Exclusions included studies covering various cancers, some non-dermatologic, and those not evaluating aspirin use independently but in conjunction with NSAIDs. The potential chemopreventive effects of aspirin and NSAIDs against melanoma have gained attention due to their association with a reduced risk of various cancers including gastric, colorectal, and breast. By inhibiting COX enzymes and the NF-κB pathway, these agents theoretically slow malignant cell activities, presenting a prospect for cancer prevention. Aspirin exhibits noteworthy effects, depleting growth-stimulating hormones, generating reactive oxygen species harmful to cancerous cells, and inhibiting COX-2 linked to cancer progression. Limited literature suggests survival benefits with aspirin use in stage II and III melanoma, possibly due to slowing disease progression, evident in smaller Breslow depths. Gender-specific responses to aspirin are notable, with some studies reporting a stronger chemopreventive correlation in females. It\'s crucial to note that geographic disparities, demographic cohorts, and individual-specific factors are confounding variables that may contribute to conflicting findings regarding aspirin\'s impact on melanoma. The association between aspirin use and melanoma risk is complex, with conflicting findings across diverse populations. Although it appears that more studies suggest a protective role for aspirin rather than not, evidence lacks consistency. Factors such as gender, geography, race, sun exposure, and health conditions play a role in shaping these varied outcomes, necessitating large-scale, prospective studies research and standardized parameters for more conclusive insights that may help guide tailored clinical strategies for melanoma prevention.
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  • 文章类型: Journal Article
    恶性肿瘤是全球第二大常见死亡原因。人们越来越关注人体氧化还原平衡受损与癌症发病率之间的联系。来自植物的多酚受到了很多关注,因为它们的特性之一是抗氧化特性:消除活性氧和氮的能力,螯合特定的金属离子,调节影响炎症的信号通路,并提高抗氧化酶的水平和活性,同时降低具有氧化作用的酶。以下三种化合物,白藜芦醇,槲皮素,还有姜黄素,是多酚调节多个分子靶标,或增加促凋亡蛋白表达水平和降低抗凋亡蛋白表达水平。在动物和人体内进行的体外和体内实验表明,基于抗氧化特性,将它们用作化学预防剂。这些天然多酚的优点是低毒性和较高剂量的弱副作用。然而,所讨论的化合物的特点是生物利用度和溶解度低,这可能使实现所需效果所需的血液浓度具有挑战性。该溶液可能存在于天然存在的多酚的衍生物中,这些衍生物经过了结构修饰,从而增强了它们的有益效果,或者致力于实现递送抗氧化剂的新方法,从而改善了它们的溶解度和生物利用度。
    Malignant tumors are the second most common cause of death worldwide. More attention is being paid to the link between the body\'s impaired oxidoreductive balance and cancer incidence. Much attention is being paid to polyphenols derived from plants, as one of their properties is an antioxidant character: the ability to eliminate reactive oxygen and nitrogen species, chelate specific metal ions, modulate signaling pathways affecting inflammation, and raise the level and activity of antioxidant enzymes while lowering those with oxidative effects. The following three compounds, resveratrol, quercetin, and curcumin, are polyphenols modulating multiple molecular targets, or increasing pro-apoptotic protein expression levels and decreasing anti-apoptotic protein expression levels. Experiments conducted in vitro and in vivo on animals and humans suggest using them as chemopreventive agents based on antioxidant properties. The advantage of these natural polyphenols is low toxicity and weak adverse effects at higher doses. However, the compounds discussed are characterized by low bioavailability and solubility, which may make achieving the blood concentrations needed for the desired effect challenging. The solution may lie in derivatives of naturally occurring polyphenols subjected to structural modifications that enhance their beneficial effects or work on implementing new ways of delivering antioxidants that improve their solubility and bioavailability.
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  • 文章类型: Journal Article
    异硫氰酸酯是由主要存在于十字花科十字花科蔬菜中的芥子油苷水解产生的生物活性产物。大量研究表明各种异硫氰酸酯具有不同的生物活性,包括抗癌,抗炎,和抗氧化性能。大自然拥有不同的异硫氰酸酯前体,芥子油苷,如葡萄糖苷和葡萄糖胃泌素,每个都以独特的结构为特征,物理性质,和药理潜力。这项全面的审查旨在巩固目前对辣木异硫氰酸酯的理解,主要是4-[(α-L-鼠李糖氧基)苄基]异硫氰酸酯),将该化合物与其他充分研究的异硫氰酸酯,如萝卜硫烷和苯基乙基异硫氰酸酯进行比较。重点是阐明这些化合物作为抗癌药物的功效的差异和相似性。抗炎,和抗氧化性能。
    Isothiocyanates are biologically active products resulting from the hydrolysis of glucosinolates predominantly present in cruciferous vegetables belonging to the Brassicaceae family. Numerous studies have demonstrated the diverse bioactivities of various isothiocyanates, encompassing anticarcinogenic, anti-inflammatory, and antioxidative properties. Nature harbors distinct isothiocyanate precursors, glucosinolates such as glucoraphanin and gluconastrin, each characterized by unique structures, physical properties, and pharmacological potentials. This comprehensive review aims to consolidate the current understanding of Moringa isothiocyanates, mainly 4-[(α-L-rhamnosyloxy) benzyl] isothiocyanate), comparing this compound with other well-studied isothiocyanates such as sulforaphane and phenyl ethyl isothiocyanates. The focus is directed toward elucidating differences and similarities in the efficacy of these compounds as agents with anticancer, anti-inflammatory, and antioxidative properties.
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  • 文章类型: Meta-Analysis
    背景:烟酰胺是通过内源性合成获得的维生素B3(烟酸)的活性形式,主要通过色氨酸代谢和膳食补充剂,鱼,肉类,谷物,和乳制品。它参与细胞能量代谢并调节多种细胞存活和死亡途径。烟酰胺已被广泛研究作为减少光化性角化病(AKs)和非黑素瘤皮肤癌(NMSC)的安全化学预防剂。
    方法:我们使用了Medline,EMBASE,PubMed,和Cochrane数据库搜索“烟酰胺”的概念,“化学预防”,和“皮肤癌”到2023年8月。在搜索全文以获取资格标准之前,三名独立作者筛选了标题和摘要以进行干预和研究设计。主要结果是口服烟酰胺对高危患者NMSC发生率的影响。我们还进行了系统的搜索,以确定已发表的评估膳食烟酸摄入量和NMSC风险的相关流行病学研究。
    结果:回顾了二百二十五项研究,四人符合纳入标准。NAM消费与鳞状细胞癌(SCC)风险之间没有关联(比率(RR)0.81,95%CI0.48-1.37;I2=0%),基底细胞癌(BCC)(RR0.88,95%CI0.50-1.55;I2=63%),和NMSC(RR0.82,95%CI0.61-1.12;I2=63%)。不良事件罕见且可接受,允许患者对治疗的最佳依从性。我们发现只有一篇文章评估烟酸饮食摄入量与NMSC风险之间的关系,支持烟酸摄入对SCC而不是BCC或黑色素瘤的潜在有益作用。
    结论:本荟萃分析显示,通过汇集有免疫能力和免疫抑制的患者,没有足够的证据表明口服烟酰胺治疗显著减少角质形成细胞癌的数量。
    BACKGROUND: Nicotinamide is the active form of vitamin B3 (niacin) obtained through endogenous synthesis, mainly through tryptophan metabolism and dietary supplements, fish, meats, grains, and dairy products. It participates in cellular energy metabolism and modulates multiple cellular survival and death pathways. Nicotinamide has been widely studied as a safe chemopreventive agent that reduces actinic keratosis (AKs) and non-melanoma skin cancers (NMSC).
    METHODS: We used the Medline, EMBASE, PubMed, and Cochrane databases to search the concepts \"nicotinamide\", \"chemoprevention\", and \"skin cancer\" up to August 2023. Three independent authors screened titles and abstracts for intervention and study design before searching full texts for eligibility criteria. The primary outcome was the impact of oral nicotinamide on the incidence of NMSC in high-risk patients. We also conducted a systematic search to identify relevant epidemiological studies published evaluating dietary niacin intake and the risk of NMSC.
    RESULTS: Two hundred and twenty-five studies were reviewed, and four met the inclusion criteria. There was no association between NAM consumption and risk for squamous cell carcinoma (SCC) (rate ratio (RR) 0.81, 95% CI 0.48-1.37; I2 = 0%), basal cell carcinoma (BCC) (RR 0.88, 95% CI 0.50-1.55; I2 = 63%), and NMSC (RR 0.82, 95% CI 0.61-1.12; I2 = 63%). Adverse events were rare and acceptable, allowing optimal compliance of patients to the treatment. We found only one article evaluating the association between niacin dietary intake and NMSC risk, supporting a potential beneficial role of niacin intake concerning SCC but not BCC or melanoma.
    CONCLUSIONS: The present meta-analysis shows, by pooling immunocompetent and immunosuppressed patients, that there is insufficient evidence that oral nicotinamide therapy significantly reduces the number of keratinocyte cancers.
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  • 文章类型: Meta-Analysis
    背景:严重贫血与幼儿住院死亡率高相关。在疟疾流行地区,存活儿童出院后死亡或再次入院的风险也增加.我们进行了系统评价和个体患者数据荟萃分析,以确定每月出院后化学预防对从严重贫血中恢复的儿童的疗效。
    方法:根据PRISMA-IPD指南进行分析。我们在2023年8月28日搜索了多个数据库,没有日期或语言限制,对于在疟疾流行的非洲接受严重贫血的儿童(年龄<15岁)中比较每月出院后疟疾化学预防与安慰剂或标准护理的随机对照试验。使用每日或每周预防疟疾的试验不合格。所有符合条件的试验的研究者共享假名数据集,它们被标准化和合并以进行分析。主要结果是干预期间的全因死亡率。在改良的意向治疗人群中进行了分析,包括为端点做出贡献的所有随机分配的参与者。使用风险比(RR)的固定效应两阶段荟萃分析来生成死亡率的汇总效应估计。使用一阶段混合效应Prentice-Williams-Peterson总时间模型分析了经常性的事件发生时间数据(再入院或临床就诊),以获得风险比(HR)。这项研究在PROSPERO注册,CRD42022308791。
    结果:我们的搜索确定了91篇文章,其中78个被标题和摘要排除在外,另有10人不符合资格标准。三个双盲,安慰剂对照试验,包括3663名患有严重贫血的儿童,纳入系统评价和荟萃分析;3507(95·7%)对改良的意向治疗分析做出了贡献。参与者每月接受磺胺多辛-乙胺嘧啶治疗,直至疟疾传播季节结束(平均每名儿童3·1疗程[范围1-6];n=1085;冈比亚),出院后第4周和第8周(n=1373;马拉维)结束时每月给予蒿甲醚-lumefantrine,或在出院后第2、6和10周结束时每月给予双氢青蒿素-哌喹(n=1049;乌干达和肯尼亚)。干预期间,出院后疟疾化学预防与死亡率降低77%相关(RR0·23[95%CI0·08-0·70],p=0·0094,I2=0%),全因再入院率降低55%(HR0·45[95%CI0·36-0·56],p<0·0001)与安慰剂相比。保护作用仅限于干预期,在药物的直接药效学作用减弱后不能持续。少量的试验限制了我们评估异质性的能力,其来源,和出版偏见。
    结论:在疟疾流行的非洲,出院后的疟疾化学预防降低了刚从严重贫血中恢复的出院儿童的死亡率和再入院率.出院后的疟疾化学预防可能是管理高危人群的宝贵策略。未来的研究应该集中在交付方法上,延长保护持续时间的选项,其他高危住院群体,和针对出院后发病的非疟疾原因的干预措施。
    背景:挪威研究理事会和比尔-梅林达-盖茨基金会通过全球抗疟药研究网络。
    BACKGROUND: Severe anaemia is associated with high in-hospital mortality among young children. In malaria-endemic areas, surviving children also have an increased risk of mortality or readmission after hospital discharge. We conducted a systematic review and individual patient data meta-analysis to determine the efficacy of monthly post-discharge malaria chemoprevention in children recovering from severe anaemia.
    METHODS: This analysis was conducted according to PRISMA-IPD guidelines. We searched multiple databases on Aug 28, 2023, without date or language restrictions, for randomised controlled trials comparing monthly post-discharge malaria chemoprevention with placebo or standard of care among children (aged <15 years) admitted with severe anaemia in malaria-endemic Africa. Trials using daily or weekly malaria prophylaxis were not eligible. The investigators from all eligible trials shared pseudonymised datasets, which were standardised and merged for analysis. The primary outcome was all-cause mortality during the intervention period. Analyses were performed in the modified intention-to-treat population, including all randomly assigned participants who contributed to the endpoint. Fixed-effects two-stage meta-analysis of risk ratios (RRs) was used to generate pooled effect estimates for mortality. Recurrent time-to-event data (readmissions or clinic visits) were analysed using one-stage mixed-effects Prentice-Williams-Peterson total-time models to obtain hazard ratios (HRs). This study is registered with PROSPERO, CRD42022308791.
    RESULTS: Our search identified 91 articles, of which 78 were excluded by title and abstract, and a further ten did not meet eligibility criteria. Three double-blind, placebo-controlled trials, including 3663 children with severe anaemia, were included in the systematic review and meta-analysis; 3507 (95·7%) contributed to the modified intention-to-treat analysis. Participants received monthly sulfadoxine-pyrimethamine until the end of the malaria transmission season (mean 3·1 courses per child [range 1-6]; n=1085; The Gambia), monthly artemether-lumefantrine given at the end of weeks 4 and 8 post discharge (n=1373; Malawi), or monthly dihydroartemisinin-piperaquine given at the end of weeks 2, 6, and 10 post discharge (n=1049; Uganda and Kenya). During the intervention period, post-discharge malaria chemoprevention was associated with a 77% reduction in mortality (RR 0·23 [95% CI 0·08-0·70], p=0·0094, I2=0%) and a 55% reduction in all-cause readmissions (HR 0·45 [95% CI 0·36-0·56], p<0·0001) compared with placebo. The protective effect was restricted to the intervention period and was not sustained after the direct pharmacodynamic effect of the drugs had waned. The small number of trials limited our ability to assess heterogeneity, its sources, and publication bias.
    CONCLUSIONS: In malaria-endemic Africa, post-discharge malaria chemoprevention reduces mortality and readmissions in recently discharged children recovering from severe anaemia. Post-discharge malaria chemoprevention could be a valuable strategy for the management of this group at high risk. Future research should focus on methods of delivery, options to prolong the protection duration, other hospitalised groups at high risk, and interventions targeting non-malarial causes of post-discharge morbidity.
    BACKGROUND: The Research-Council of Norway and the Bill-&-Melinda-Gates-Foundation through the Worldwide-Antimalarial-Research-Network.
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  • 文章类型: Systematic Review
    疟疾仍然是撒哈拉以南非洲儿童发病和死亡的主要原因,尤其是5岁以下的儿童。为了帮助解决这一挑战,世卫组织建议对某些人群进行化学预防。对于儿童和婴儿,世卫组织建议季节性疟疾化学预防措施(SMC),常年性疟疾化学预防(PMC;以前是婴儿间歇性预防治疗[IPTi]),and,最近,学龄儿童间歇性预防性治疗(IPTsc)。这篇综述描述了上下文因素,包括可行性,可接受性,健康公平,财务考虑,价值观和偏好,影响这些战略的实施。2022年7月5日进行了系统的搜索,并在2023年4月13日重复进行了搜索,以确定相关文献。两名审稿人独立筛选标题的资格,从符合条件的文章中提取数据,并确定和总结了主题。在确定的6,295个独特的标题中,包括65个。最常评估的策略是SMC(n=40),其次是IPTi(n=18),然后是IPTsc(n=6)。总的来说,这些策略是高度可接受的,虽然有了IPTsc,社区关注向育龄女孩提供药物和使用非医务人员分发药物。对于SMC,送货上门带来了更高的覆盖率,改善护理人员的接受度,并降低成本。当护理人员被指控在没有监督的情况下给予剂量2和3时,注意到较低的依从性。对于SMC和IPTi,旅行距离和恶劣天气限制了可访问性。宣传和照顾者教育工作,保留高质量的药品分销商,改善交通是提高覆盖率的关键。需要更多的研究来了解社区价值观和偏好在化学预防实施中的作用。
    Malaria remains a leading cause of childhood morbidity and mortality in sub-Saharan Africa, particularly among children under 5 years of age. To help address this challenge, the WHO recommends chemoprevention for certain populations. For children and infants, the WHO recommends seasonal malaria chemoprevention (SMC), perennial malaria chemoprevention (PMC; formerly intermittent preventive treatment in infants [IPTi]), and, more recently, intermittent preventive treatment in school children (IPTsc). This review describes the contextual factors, including feasibility, acceptability, health equity, financial considerations, and values and preferences, that impact implementation of these strategies. A systematic search was conducted on July 5, 2022, and repeated April 13, 2023, to identify relevant literature. Two reviewers independently screened titles for eligibility, extracted data from eligible articles, and identified and summarized themes. Of 6,295 unique titles identified, 65 were included. The most frequently evaluated strategy was SMC (n = 40), followed by IPTi (n = 18) and then IPTsc (n = 6). Overall, these strategies were highly acceptable, although with IPTsc, there were community concerns with providing drugs to girls of reproductive age and the use of nonmedical staff for drug distribution. For SMC, door-to-door delivery resulted in higher coverage, improved caregiver acceptance, and reduced cost. Lower adherence was noted when caregivers were charged with giving doses 2 and 3 unsupervised. For SMC and IPTi, travel distances and inclement weather limited accessibility. Sensitization and caregiver education efforts, retention of high-quality drug distributors, and improved transportation were key to improving coverage. Additional research is needed to understand the role of community values and preferences in chemoprevention implementation.
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