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All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research Bioscientia Medicina : Journal of Biomedicine and Translational Research
Adrianison
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Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience

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The Bidirectional Relationship Between Obstructive Sleep Apnea and Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Systematic Review and Meta-Analysis of Longitudinal Studies Nurul Anisa; Adrianison
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1391

Abstract

Background: Obstructive sleep apnea (OSA) and metabolic dysfunction-associated steatotic liver disease (MASLD) are highly prevalent, interconnected metabolic disorders. While their cross-sectional association is established, the temporal and potentially causal relationship remains unclear. This study aimed to quantitatively synthesize longitudinal evidence on the bidirectional risk between OSA and MASLD. Methods: We systematically searched PubMed, Scopus, and Web of Science (January 1st, 2015 - July 1st, 2025) for longitudinal cohort studies in adults assessing the OSA-MASLD relationship. Two reviewers independently selected studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale (NOS). The primary analysis, pre-specified for studies using objective diagnostics (Polysomnography/Imaging), utilized a random-effects model to pool hazard ratios (HR). Heterogeneity was quantified with the I2 statistic. Results: The search identified 2,148 articles, with six longitudinal studies (185,432 participants) meeting eligibility criteria. Four studies (116,298 participants) assessed incident MASLD, while two (69,134 participants) assessed incident OSA. The primary meta-analysis of two studies using objective diagnostics found that baseline OSA was associated with a significantly increased risk of incident MASLD (pooled HR: 2.29; 95% CI: 1.93-2.71; I2=35%). A secondary analysis including two studies using administrative codes yielded a pooled HR of 1.87 (95% CI: 1.51-2.32), though with substantial heterogeneity (I2=78%). For the reverse direction, a narrative synthesis of two studies suggests MASLD increases the risk of incident OSA; an exploratory pooled analysis yielded an HR of 1.65 (95% CI: 1.39-1.96; I2=45%), a finding to be interpreted with caution due to the small study number. Conclusion: This systematic review of longitudinal data provides the strongest evidence to date supporting a significant, bidirectional relationship between OSA and MASLD. The presence of objectively-diagnosed OSA more than doubles the risk of developing future MASLD. These findings provide a strong rationale for implementing mutual, risk-stratified screening and developing integrated management strategies to disrupt the vicious cycle linking these two common and morbid conditions.
The Bidirectional Relationship Between Obstructive Sleep Apnea and Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Systematic Review and Meta-Analysis of Longitudinal Studies Nurul Anisa; Adrianison
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1391

Abstract

Background: Obstructive sleep apnea (OSA) and metabolic dysfunction-associated steatotic liver disease (MASLD) are highly prevalent, interconnected metabolic disorders. While their cross-sectional association is established, the temporal and potentially causal relationship remains unclear. This study aimed to quantitatively synthesize longitudinal evidence on the bidirectional risk between OSA and MASLD. Methods: We systematically searched PubMed, Scopus, and Web of Science (January 1st, 2015 - July 1st, 2025) for longitudinal cohort studies in adults assessing the OSA-MASLD relationship. Two reviewers independently selected studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale (NOS). The primary analysis, pre-specified for studies using objective diagnostics (Polysomnography/Imaging), utilized a random-effects model to pool hazard ratios (HR). Heterogeneity was quantified with the I2 statistic. Results: The search identified 2,148 articles, with six longitudinal studies (185,432 participants) meeting eligibility criteria. Four studies (116,298 participants) assessed incident MASLD, while two (69,134 participants) assessed incident OSA. The primary meta-analysis of two studies using objective diagnostics found that baseline OSA was associated with a significantly increased risk of incident MASLD (pooled HR: 2.29; 95% CI: 1.93-2.71; I2=35%). A secondary analysis including two studies using administrative codes yielded a pooled HR of 1.87 (95% CI: 1.51-2.32), though with substantial heterogeneity (I2=78%). For the reverse direction, a narrative synthesis of two studies suggests MASLD increases the risk of incident OSA; an exploratory pooled analysis yielded an HR of 1.65 (95% CI: 1.39-1.96; I2=45%), a finding to be interpreted with caution due to the small study number. Conclusion: This systematic review of longitudinal data provides the strongest evidence to date supporting a significant, bidirectional relationship between OSA and MASLD. The presence of objectively-diagnosed OSA more than doubles the risk of developing future MASLD. These findings provide a strong rationale for implementing mutual, risk-stratified screening and developing integrated management strategies to disrupt the vicious cycle linking these two common and morbid conditions.
Genetic and Epigenetic Alterations in Exhaled Breath Condensate for Early Detection of Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis Riki Liswanto; Adrianison
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 11 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i11.1427

Abstract

Background: Early detection of non-small cell lung cancer (NSCLC) is critical for improving patient survival, yet current methods face challenges of invasiveness and limited accuracy. Exhaled breath condensate (EBC) offers a non-invasive window into the deep airways. This study aimed to synthesize and critically evaluate the diagnostic accuracy of genetic and epigenetic alterations in EBC for NSCLC detection. Methods: We conducted a systematic review and meta-analysis of studies published between January 2015 and August 2025, sourced from PubMed, Scopus, Web of Science, and Embase. We included diagnostic accuracy studies evaluating genetic (KRAS, EGFR, p53) or epigenetic (gene methylation) markers in EBC against a histopathological reference standard. Data were used to construct 2x2 contingency tables. Methodological quality was assessed using the QUADAS-2 tool. A bivariate random-effects model was used to derive pooled accuracy estimates. Results: Seven case-control studies, comprising 812 NSCLC patients and 995 controls, met the inclusion criteria. The analysis yielded a pooled sensitivity of 0.81 (95% Confidence Interval [CI]: 0.74–0.87) and a pooled specificity of 0.96 (95% CI: 0.93–0.98). The pooled diagnostic odds ratio was 112 (95% CI: 65–194), and the area under the SROC curve was 0.95 (95% CI: 0.93–0.97). However, extreme statistical heterogeneity (I² > 80%) was observed, and all included studies were rated at high risk of bias due to their case-control design, suggesting the pooled estimates must be interpreted with significant caution. Conclusion: Analysis of DNA alterations in EBC shows promising diagnostic potential for NSCLC, particularly with high specificity. However, the current evidence is limited by significant methodological heterogeneity and study design flaws that likely overestimate performance. The primary contribution of this analysis is not a definitive accuracy value, but a critical appraisal of the monumental challenges in pre-analytical and analytical standardization that must be overcome for this technology to achieve clinical translation.
Genetic and Epigenetic Alterations in Exhaled Breath Condensate for Early Detection of Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis Riki Liswanto; Adrianison
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 11 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i11.1427

Abstract

Background: Early detection of non-small cell lung cancer (NSCLC) is critical for improving patient survival, yet current methods face challenges of invasiveness and limited accuracy. Exhaled breath condensate (EBC) offers a non-invasive window into the deep airways. This study aimed to synthesize and critically evaluate the diagnostic accuracy of genetic and epigenetic alterations in EBC for NSCLC detection. Methods: We conducted a systematic review and meta-analysis of studies published between January 2015 and August 2025, sourced from PubMed, Scopus, Web of Science, and Embase. We included diagnostic accuracy studies evaluating genetic (KRAS, EGFR, p53) or epigenetic (gene methylation) markers in EBC against a histopathological reference standard. Data were used to construct 2x2 contingency tables. Methodological quality was assessed using the QUADAS-2 tool. A bivariate random-effects model was used to derive pooled accuracy estimates. Results: Seven case-control studies, comprising 812 NSCLC patients and 995 controls, met the inclusion criteria. The analysis yielded a pooled sensitivity of 0.81 (95% Confidence Interval [CI]: 0.74–0.87) and a pooled specificity of 0.96 (95% CI: 0.93–0.98). The pooled diagnostic odds ratio was 112 (95% CI: 65–194), and the area under the SROC curve was 0.95 (95% CI: 0.93–0.97). However, extreme statistical heterogeneity (I² > 80%) was observed, and all included studies were rated at high risk of bias due to their case-control design, suggesting the pooled estimates must be interpreted with significant caution. Conclusion: Analysis of DNA alterations in EBC shows promising diagnostic potential for NSCLC, particularly with high specificity. However, the current evidence is limited by significant methodological heterogeneity and study design flaws that likely overestimate performance. The primary contribution of this analysis is not a definitive accuracy value, but a critical appraisal of the monumental challenges in pre-analytical and analytical standardization that must be overcome for this technology to achieve clinical translation.
Co-Authors Nurul anisa Riki Liswanto