Jianguo Xu, Qingyong Zheng, Tengfei Li, Ming Liu, Min Tian, Yonghong Zhu, Yingying Kang, Jinhui Tian, Ping Chen
Substances classified as medicine-food homology (MFH) are tested as dietary interventions for cardiometabolic disease. The usefulness of this fast-growing evidence depends on whether trials choose, measure, and report outcomes in ways that can be compared and combined. To map outcomes reported in randomized controlled trials (RCTs) of MFH substances primarily addressing cardiometabolic health identified through four selected databases, describing their distribution across substances, clinical interpretation, and signals of reporting completeness. Following PRISMA for Scoping Reviews, we searched four databases and included RCTs of MFH substances on the review’s 110-item operational list with a cardiometabolic focus. Outcomes were charted verbatim, coded inductively into domains, and grouped as clinical events and mortality (T1), intermediate cardiometabolic measures (T2), or mechanistic biomarkers (T3), with other outcomes retained separately. Findings were summarized descriptively. We included 416 studies reporting 2,231 outcome records (median 5 per study). Reporting concentrated on glycaemic (82.9% of studies), lipid (62.5%), anthropometric (53.4%), and blood-pressure (34.4%) domains, focusing heavily on five substances. The conventional lipid panel was commonly reported. Glycaemic measures covered different constructs and timescales; fasting glucose and HbA1c appeared in 50.1 and 31.3% of glycaemic studies, respectively. Of all outcome records, 0.7% were clinical events or mortality, 72.2% intermediate cardiometabolic measures, and 18.0% mechanistic biomarkers; 97.8% of studies reported no clinical event or mortality outcome. Among 328 studies naming a primary outcome, 165 (50.3%) named more than one. Outcomes in the identified MFH cardiometabolic RCTs are concentrated in a few intermediate domains, with variation in measurement and primary-outcome designation. Consistent definition, prospective registration, and clear primary-outcome reporting, adapted to study purpose and duration, would improve evidence usability.
Adenomyosis (AM) is characterized by ectopic endometrial invasion and myometrial fibrosis, yet the molecular links between local metabolic remodeling, lysine crotonylation (Kcr), and epithelial dysfunction remain poorly understood. We investigated the metabolic and crotonylation-related landscape of AM and sought to identify epithelial molecular features associated with these alterations. Clinical metabolic profiles, public and newly generated tissue metabolomic data, crotonyl-CoA measurements, and tissue crotonylation assays were integrated with single-cell and bulk transcriptomic analyses. Kcr-related transcriptional patterns were characterized using multiple gene-set scoring approaches and co-expression analysis, followed by multi-algorithm feature prioritization. SDC4-associated epithelial states were further examined using trajectory inference, cell-cell communication analysis, transcription-factor prediction, and in silico perturbation. Adjusted clinical analyses showed no robust differences in circulating lipid profiles, whereas tissue-level metabolomic analyses revealed alterations in lipid- and lysine-related metabolites in AM. Crotonyl-CoA estimates were higher in AM tissue, accompanied by increased H3K18cr. A higher p65-associated Kcr signal was also observed in a single IP comparison; given that only one IP measurement was available per group, this finding should be considered a preliminary descriptive observation. Single-cell analyses identified prominent Kcr-related transcriptional patterns in epithelial cells and linked this state to adhesion, junctional organization, and epithelial remodeling. SDC4 was consistently prioritized across five machine-learning procedures and was predominantly expressed in epithelial populations. SDC4-positive epithelial cells exhibited distinct inferred differentiation states and intercellular communication patterns, while computational perturbation further implicated SDC4-associated networks in epithelial adhesion, cytoskeletal organization, and junctional regulation. These findings connect local metabolic remodeling and crotonylation-related alterations with a distinct epithelial transcriptional state in AM and identify SDC4 as a consistently prioritized candidate associated with epithelial remodeling. The preliminary p65-associated Kcr observation provides additional context for investigating potential associations among Kcr, p65, and SDC4-related epithelial programs.
Type 2 diabetes mellitus (T2DM) affects over 500 million people worldwide, and dietary management is a cornerstone of treatment. This meta-analysis descriptively evaluated the comparative efficacy and safety of four common dietary patterns—Mediterranean diet (MD), intermittent fasting (IF), energy-restricted diet (ERD), and ketogenic diet (KD)—in adults with T2DM. \ We searched the Cochrane Library, Embase, PubMed, and Web of Science from inception to March 13, 2025, for randomized controlled trials (RCTs). Outcomes included glycemic control (FBG, HbA1c), anthropometric parameters (weight, BMI, waist circumference), lipid profiles (TC, LDL-C, TG), and safety data. Random-effects models were used, with heterogeneity assessed by the I 2 statistic, and sensitivity analyses via leave-one-out. Risk of bias was evaluated using the Cochrane RoB 2.0 tool. A total of 25 RCTs were included. Reductions in FBG (MD = −0.63; I 2 = 62.1%) and HbA1c (MD = −0.50; I 2 = 83.8%) were observed, but the pooled estimates were limited by substantial heterogeneity and prediction intervals crossing zero. The MD showed excellent cross-study consistency for FBG (I 2 = 0%) with its prediction interval entirely within the beneficial range, whereas the KD showed limited clinical relevance for FBG due to extremely high heterogeneity (I 2 = 79.7%). For weight loss, the overall MD was −3.00 kg, but with substantially high heterogeneity (I 2 = 93.9%) across subgroups. BMI outcomes were limited by extremely high heterogeneity (I 2 = 97.5%) and all prediction intervals crossing zero, while waist circumference showed no statistically significant effect. None of the diets demonstrated a statistically significant advantage in lipid modification (TC, LDL-C, TG), with all confidence intervals crossing the line of no effect. Safety analyses showed KD was associated with a higher incidence of adverse events (gastrointestinal symptoms, transient hypoglycemia), while the other three diets exhibited favorable safety profiles. This meta-analysis descriptively supports the potential benefits of all four dietary patterns for glycemic control and weight reduction. However, due to substantial inter-study heterogeneity and prediction intervals crossing the line of no effect, the pooled estimates preclude definitive claims of relative superiority among diets. Consequently, personalized dietary strategies balancing efficacy, safety, and patient preferences are recommended, with cautious interpretation of indirect cross-diet comparisons. https://www.crd.york.ac.uk/PROSPERO/view/CRD420261478257, identifier PROSPERO (CRD420261478257).
Junjie Hua, Wang Ju, Qiuying Gu, Jun Wu, Weiqing Zhang
Gastrointestinal point-of-care ultrasound has been investigated as a non-invasive, bedside adjunct for gastrointestinal assessment and enteral-feeding decision-making in critical care; however, existing protocols and their outcome reporting remain fragmented. This scoping review mapped the existing evidence landscape on the use of gastrointestinal point-of-care ultrasound in the management of enteral nutrition in critically ill adults. Comprehensive searches in 10 databases (PubMed, EMBASE, Web of Science, Cochrane, CINAHL, Scopus, China National Knowledge Infrastructure, Wanfang, VIP, China Biological Medicine Literature Database) identified 5,123 records. Studies focusing on ultrasound-assessed gastrointestinal function to guide enteral nutrition, or to predict enteral nutrition intolerance and clinical prognosis, were screened, summarized, and descriptively analyzed. 49 unique studies were identified, including 36 interventional and 13 observational studies. Geographically, the synthesized evidence was heavily concentrated in China. Ultrasound indicators for gastrointestinal function included the gastric antrum (gastric residual volume, motility index, cross-sectional area), colon (colon diameter and peristaltic frequency), small intestine (small intestine diameter, wall thickness, peristalsis), and superior mesenteric artery hemodynamics. Observational studies showed Area Under the Curve point estimates frequently around or above 0.70, with substantial heterogeneity and no independent external validation reported for enteral nutrition intolerance and mortality. Among interventional studies, time to achieve feeding goals and intensive care unit length of stay were the most frequently evaluated outcomes (27/36), whereas in-hospital mortality was evaluated in only 8 of 36 studies; outcome reporting was heterogeneous and is presented descriptively. The synthesized literature suggests the potential utility of gastrointestinal point-of-care ultrasound as an objective, non-invasive bedside tool for gastrointestinal assessment and feeding protocol modulation. However, because no formal critical appraisal or pooled comparative or diagnostic analysis was performed, this review cannot establish clinical effectiveness, universal thresholds, or patient-important benefit. Future research priorities include consensus definitions and acquisition standards, effect estimates with confidence intervals and patient-important outcomes, inter-operator reliability and training evaluation, and external validation across diverse health systems.
