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AnteayerInterdisciplinares

Effects of glucagon-like peptide-1 analogues on hard binary outcomes for patients at increased risk of cardiovascular events: a protocol for a systematic review with network meta-analysis and Trial Sequential Analysis

Por: Sillassen · C. D. B. · Faltermeier · P. · Petersen · J. J. · Kamp · C. B. · Grand · J. · Dominguez · H. · Frolich · A. · Gaede · P. H. · Gluud · C. · Mathiesen · O. · Jakobsen · J. C.
Background

Cardiovascular diseases, overweight, type 2 diabetes and chronic kidney disease increase the risk of cardiovascular events.

Glucagon-like peptide-1 analogues are recommended by the European Society of Cardiology and the American College of Cardiology to lower the risk of death and progression of cardiovascular disease in patients with cardiovascular disease and type 2 diabetes. Semaglutide, tirzepatide and liraglutide are approved by the US Food and Drug Administration and the European Medicines Agency for the treatment of type 2 diabetes mellitus and overweight. CagriSema is currently not approved, but several phase III trials are ongoing.

No previous systematic review has investigated the effects of semaglutide, tirzepatide, CagriSema and liraglutide, which may not be disease-specific, on hard binary outcomes for all trial populations at increased risk of cardiovascular events.

Methods and analyses

We will conduct a systematic review and search major medical databases (Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, Latin American and Caribbean Health Sciences Literature, Science Citation Index Expanded, Conference Proceedings Citation Index—Science) and clinical trial registries from their inception and onwards to identify relevant randomised trials. We expect to perform the literature search in December 2025. Two review authors will independently extract data and assess the risk of bias. We will include randomised trials assessing the effects of semaglutide, tirzepatide, CagriSema and/or liraglutide in participants with an increased risk of cardiovascular events. The primary outcome will be all-cause mortality. Secondary outcomes will be myocardial infarction, stroke and all-cause hospitalisation. Data will be synthesised by aggregate data meta-analyses, Trial Sequential Analyses and network meta-analysis, risk of bias will be assessed with Cochrane Risk of Bias tool V. 2, and the certainty of the evidence will be assessed by Grading of Recommendations, Assessment, Development and Evaluations and the Confidence in Network Meta-Analysis approach.

Ethics and dissemination

This protocol does not present any results. Findings of this systematic review will be published in international peer-reviewed scientific journals.

PROSPERO registration number

CRD42024623312.

Age-dependent patterns of cardiac complexity unveiled by topological data analysis of pediatric heart rate variability

by Andy Domínguez-Monterroza, Alfonso Mateos Caballero, Antonio Jiménez-Martín

Heart rate variability (HRV) is a well-established marker of autonomic regulation and undergoes profound maturation during early human development. In this study, topological data analysis (TDA) is applied to investigate the evolving geometric complexity of HRV across pediatric developmental stages. Using persistent homology in homological dimension 1, we extracted topological descriptors from time-delay embedded RR interval series of 127 individuals aged 1 month to 17 years. We identified statistically significant, age-dependent transformations in the topological structure of HRV signals. Neonates and infants exhibited a greater number and strength of persistent features, reflecting highly heterogeneous cardiac control dynamics during early autonomic maturation. In contrast, adolescents displayed reduced topological complexity and increased entropy, suggesting a shift toward more uniform and structured physiological control. Topological measures correlated with conventional HRV indices, confirming their physiological relevance. Furthermore, pairwise distances between persistence landscapes revealed an inverse relationship between intra-group topological variability and classical HRV measures. Collectively, our findings demonstrate that persistent homology provides a powerful, multiscale-aware framework to capture developmental trajectories in cardiac autonomic regulation, with potential applications in pediatric monitoring, developmental physiology, and early detection of dysautonomia.

Sex-specific sleep profiles in Spanish adults: cross-sectional actigraphy-PSQI study with cluster analysis in Salamanca and Avila

Objective

To identify sex-specific patterns based on determinants related to sleep quality, using a representative sample of the Spanish adult population.

Design

Cross-sectional, age-stratified and sex-stratified study.

Setting

Community-based assessments in two Spanish provinces (Salamanca and Ávila).

Participants

Adults aged 25–65 years (n=500), equally distributed by sex and five age strata, selected from the regional health-card database.

Primary and secondary outcome measures

Objective sleep metrics from wrist actigraphy (time in bed, total sleep time (TST), sleep efficiency, wake after sleep onset, number/duration of awakenings, fragmentation/movement indices) and self-reported sleep quality (Pittsburgh Sleep Quality Index).

Methods

Standardised baseline assessments collected sociodemographic, clinical, mental-health and lifestyle variables using validated instruments. Actigraphy (ActiGraph GT3X+) recorded triaxial acceleration at 30 Hz over 5 days; data were aggregated in 60 s epochs (ActiLife). Sleep/wake was classified with Cole-Kripke and nocturnal episodes identified with Tudor-Locke before deriving sleep indices. Two-step cluster analysis was applied separately by sex.

Results

Three clusters were identified for each sex, with age and educational level being the most influential factors. In men, the 65-year-old cluster with university education and lower anxious–depressive load showed the highest sleep efficiency (91.8±3.8%) and the lowest TST (351.7±74.8 min). In contrast, the 35-year-old cluster with middle or high school presented the lowest efficiency (88.3±10.0%) and higher TST (368.1±83.8 min). In women, the 55-year-old cluster with middle or high school and low emotional load showed the highest efficiency (93.6±2.8%), despite a reduced TST (352.0±79.7 min), while the 35-year-old cluster, with middle or high school and high levels of anxiety and depression, showed the worst efficiency metrics (89.5±3.9%) and a higher TST (394.8±67.3 min).

Conclusion

Sleep quality in Spanish adults is heterogeneous across sex-specific clusters shaped by age, education and mental-health burden. Cluster-based characterisation may support tailored public-health interventions.

Trial registration number

NCT05324267.

Multidimensional determinants to adoption, use and effectiveness of digital technologies for healthy ageing in migrant populations: a scoping review protocol

Por: Stanciu · A. · Dominguez Rodriguez · A. · Westerhof · G. J.
Introduction

Digital technology can be effective in providing personalised healthcare in contexts of ageing societies and increasing international migration trends. However, the literature is scarce and unsystematic, considering healthy ageing in migrant populations. This knowledge gap delays the development of interventions, policies and technology that are inclusive of the healthcare needs and limitations in older migrants. We aim to map the scientific literature addressing structural, psychological, technical and ethical determinants to adoption, use and effectiveness of digital technology for healthy ageing in migrants. We aim to uncover major challenges, highlight solutions and derive an agenda for future research.

Methods and analysis

We plan a scoping review of peer-reviewed articles published in English, German and Spanish after 2010 without a geographical limitation. We will perform the review across specialised and interdisciplinary databases (EBSCO, IEEE Xplore, IET Digital Library, PsycINFO, PubMed, Scopus and Web of Science) and manage articles at Covidence.org. Our review will adhere to the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review guidelines for conducting and reporting reviews.

Ethics and dissemination

No primary data will be collected, and therefore, ethical approval is not required.

The results of this scoping review will be published in a peer-reviewed outlet and presented at conferences. A shiny web application will accompany the publication.

Impact of CMV-specific immune reconstitution at the end of letermovir prophylaxis on the development of late cytomegalovirus infection in haematopoietic stem cell transplant recipients (INMUNOEND): a protocol for a prospective, observational, multicentre

Por: Caston · J. J. · Aparicio · C. · Paez-Vega · A. · Pozo Lopez · L. · Garcia · E. · Martin · C. · Ruiz-Arabi · E. · Cuesta-Casas · M. A. · Bermudez-Rodriguez · M. A. · Cerezo-Martin · J. M. · Gonzalez-Sierra · P. A. · Machuca · I. · Martin Dominguez · F. M. · Saldana-Moreno · R. · He
Introduction

Cytomegalovirus (CMV) infection is a common complication in patients undergoing haematopoietic stem cell transplantation (SCT). Letermovir (LTV) prophylaxis during the first 100 days post-SCT is effective and safe in preventing this infection, although it may be associated with a delay in CMV-specific immune reconstitution. Hence, a study is needed to evaluate whether the absence of CMV-specific immune reconstitution at the end of LTV prophylaxis is associated with the development of late infection. This could facilitate the individualisation of CMV prophylaxis duration in these patients.

Methods and analysis

INMUNOEND is a multicentre, prospective, observational, non-interventional study including CMV seropositive patients undergoing allo-SCT who receive LTV prophylaxis during the first 100 days post SCT. Immunological and virological monitoring will be conducted until day+200 post-SCT. The primary outcome is the percentage of patients who develop clinically significant CMV infection up to day+200 post-SCT after completing LTV prophylaxis. Data collected will include baseline characteristics of the haematological diseases and comorbidities, variables related to SCT (ie, engrafment, graft-versus-host disease, use of LTV and CMV replication) and variables related to CMV-specific immune reconstitution.

Ethics and dissemination

Ethical approval has been obtained from the institutional review board (Comité de Ética de la Investigación de Córdoba; SICEIA-2024–0 01 762). The results of this study will be published in peer-reviewed journals and disseminated at national and international conferences.

Trial registration number

NCT06814301.

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