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Omega-3 polyunsaturated fatty acids (PUFAs) docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), possess anti-inflammatory properties, yet their association with obesity-depression comorbidity remains unclear. This study investigated the association among US adults and explored underlying mechanisms. We performed a cross-sectional analysis of 4,423 individuals participating in the National Health and Nutrition Examination Survey (NHANES) 2003–2004 & 2011–2014. Serum fatty acids were quantified by gas chromatography. Obesity was defined using anthropometric criteria, and depression was assessed using the PHQ-9 or antidepressant use. Multivariable logistic regression estimated odds ratios (ORs) per standard deviation (SD) increase in PUFA levels. Mechanistic explore through network pharmacology identified potential pathways, which were examined using correlation analyses with inflammatory indices. Higher omega-3 PUFA levels were associated with lower odds of central obesity comorbid depression in females (OR: 0.82, 95% CI: 0.69–0.96) and older adults (OR: 0.79, 95% CI: 0.64–0.97). DHA was significantly associated with lower odds of central obesity (OR: 0.83, 95% CI: 0.73–0.95), depressive symptoms (OR: 0.88, 95% CI: 0.77–1.00), and their comorbidity (OR: 0.85, 95% CI: 0.74–0.98), whereas no significant associations were found for EPA. Mechanistic exploration implicated DHA in TNF and IL-17 signaling pathways, supported by inverse correlations with monocyte-to-HDL ratio (r: −0.138, P < 0.001) and lymphocyte-to-HDL ratio (r: −0.108, P < 0.001). In conclusion, serum DHA is inversely associated with obesity-depression comorbidity, with potential involvement of anti-inflammatory pathways. These findings underscore the potential of DHA for the management of obesity comorbid depression and the need for further interventional trials.
Prior observational studies have reported conflicting results regarding whether antidepressant treatment reduces long-term dementia risk, likely due to confounding by indication and reverse causation. We aimed to investigate the association between baseline antidepressant use and incident dementia, incorporating cognitive and neuroimaging outcomes.
Methods
We conducted a prospective cohort study using UK Biobank participants free of dementia at baseline. Antidepressant use was self-reported at baseline (2006–2010). Incident dementia was identified through linked electronic health records until December 19, 2022. Cox proportional hazards models estimated hazard ratios (HRs) for all-cause dementia, Alzheimer’s disease (AD), and vascular dementia (VD), adjusting for sociodemographic, lifestyle, health-related, antidepressant indication factors, and co-medication of other anticholinergics. In subsamples, cognitive performance (n = 57,330) and structural brain imaging (n = 42,276) were examined as intermediate outcomes.
Results
Among 461,464 participants, 33,721 (7.3%) reported baseline antidepressant use. Over a mean follow-up of 13.4 years, 7,922 (1.7%) developed incident dementia. Baseline antidepressant use was associated with higher risks of all-cause dementia (adjusted HR: 1.47, 95% CI 1.36–1.60), AD (1.53, 1.36–1.73), and VD (1.44, 1.23–1.70). Users performed worse on fluid intelligence and prospective memory tasks and showed lower total and gray matter volume, regional reductions in the hippocampal gray matter and basal nucleus, and greater white matter hyperintensity volume.
Conclusions
Baseline antidepressant use was linked to a higher risk of dementia, poorer cognitive performance, and adverse brain structural changes. These findings underscore the importance of judicious prescribing, regular cognitive monitoring, and consideration of non-pharmacological approaches in clinical care.
Neuropsychiatric symptoms (NPSs) are prevalent in Alzheimer’s disease (AD), yet their neurobiological etiology remains elusive. We investigated relationships between NPS subsyndromes, plasma neurofilament light chain (NFL), AD-vulnerable brain atrophy, and cognition.
Methods
We included 146 participants from a Chinese cohort. NPSs were assessed using the Neuropsychiatric Inventory Questionnaire and clustered into four subsyndromes (hyperactivity, psychosis, affective, apathy), each graded by severity (none, mild, severe). Sequential mediation analyses examined whether NPSs influence cognition through NFL and atrophy. Additionally, 1534 ADNI participants were enrolled to (1) replicate mediation effects; (2) examine longitudinal relationships of NPSs with incident cognitive decline; and (3) evaluate cognitive discrimination of NPSs and NFL and onset hazards of NPS subsyndromes.
Results
In the discovery cohort, global NPSs burden and three subsyndromes (hyperactivity, affective, apathy) were associated with elevated plasma NFL, poorer global cognition and memory, and reduced brain volumes (all P < 0.05). Sequential mediation revealed that plasma NFL and atrophy mediated the cross-sectional NPSs–cognition relationship, replicated in ADNI. Adding NPSs and NFL improved cognitive discrimination (AUC: 0.6754 to 0.8210, P < 0.001). Additionally, apathy and psychosis showed lower onset hazards than affective and hyperactivity (both P < 0.001).
Conclusions
Baseline NPSs were cross-sectionally associated with elevated NFL, brain atrophy, and poorer cognition. Sequential mediation models supported a pathway linking NPSs to cognition via NFL and atrophy, though longitudinal evidence did not fully confirm temporal directionality. These hypothesis-generating findings require prospective validation.
Pronounced variations in suicide mortality persist across Europe. Understanding long-term temporal patterns through age, period and cohort (APC) effects, alongside suicide means, is essential for tailored prevention. This study aims to determine how suicide mortality rates in Europe have changed across APC dimensions at national and subregional levels.
Methods
Our analysis was restricted to European countries with complete age- and sex-specific suicide mortality data from 1990 to 2019 within the World Health Organization mortality database. The analysis comprised two components. The first component disentangled long-term suicide mortality trends (1990–2019) into APC dimensions using an age-period-cohort model via the National Cancer Institute’s APC Web Tool. The second component involved an assessment of suicide means, restricted to 2010–2019 and to countries with detailed International Classification of Diseases, 10th Revision (ICD-10) cause-of-death data.
Results
In 2019, Europe recorded 47,793 male and 13,111 female suicide deaths. Overall suicide mortality rates declined in most subregions from 1990 to 2019, with the largest reductions among Eastern European men, from 77.81 (95% CI: 77.17–78.45) per 100,000 in the mid-1990s to 22.93 (95% CI: 22.58–23.28) per 100,000 by 2019, although this region retained the highest male suicide burden. Age-specific risk patterns differed markedly: among men, risk peaked in early adulthood and then declined in Eastern Europe, while in Western and Southern Europe, it was lower and more stable but rose after age 60; for women, risk was generally lower, with peaks in early adulthood in Eastern Europe and in midlife elsewhere. Period reflected continued improvement, especially in Eastern Europe where the period risk in 2015–2019 was approximately 60% lower than 2000–2004. Cohort effects similarly showed progressive declines. However, upward trends emerged among younger generations. In Northern Europe, the cohort relative risk for females increased from 0.73 (95% CI: 0.68–0.78) in the 1980 cohort to 0.90 (95% CI: 0.70–1.04) in the 2000 cohort. While the completeness of suicide means analysis varied by subregion, the primary data indicated that hanging was the predominant means for both sexes during 2010–2019.
Conclusions
Despite an overall decline, suicide mortality in Europe exhibits persistent regional and demographic differences. This study reveals emerging risks among younger cohorts, specifically Northern European women and Southern European men, signalling shifting patterns that are not apparent from overall temporal trends alone. This evolving risk profile calls for sustained surveillance and research to investigate the drivers of these population-specific vulnerabilities.
An experimental study was conducted to investigate the characteristics of unsteady oblique shock trains in a constant-area rectangular duct under an asymmetric incoming boundary layer. High-speed schlieren techniques and high-frequency pressure measurements were utilised in this study. The results indicate that the oblique shock train mainstream leans significantly towards the thin-boundary-layer side. Under downstream periodic excitation, the shock train moves periodically, and its shape changes during the movement. This phenomenon occurs to match the downstream pressure by altering the relative Mach number in front of the shock train, with the average pressure rise slope along the thick-boundary-layer side changing periodically. Additionally, unlike a normal shock train, the pressure rise distribution along the thick-boundary-layer side is nearly linear, and the correlation coefficients between the transducers on this side and the most downstream transducer are higher than those on the thin-boundary-layer side. Due to differences in flow structure and pressure rise distribution, the existing amplitude prediction model proposed by Xiong et al. (J. Fluid Mech. vol. 846, 2018, pp. 240–262) for the unsteady normal shock train is no longer applicable to the unsteady oblique shock train. Therefore, a new prediction model is derived and verified by experiments. Moreover, it is found that using only the downstream pressure transducer information on the thick-boundary-layer side can effectively predict the amplitude of the shock-train motion. Combined with the prediction model, a novel method is proposed to estimate the amplitude of the shock-train motion conveniently.
Dietary plant-derived bioactive compounds for enhancing physiological health are becoming a prevalent strategy for antibiotic alternatives. Our study revealed the effects and underlying mechanism of osthole (OST) and OST-tetramethylpyrazine (TMP) compound in Litopenaeus vannamei based on network pharmacology, molecular docking and a 42-d feeding trial verification. The results illustrated that OST and OST-TMP compound significantly improved the survival rate, weight gain rate, specific growth rate and feed conversion ratio, strengthening the growth performance of L. vannamei. Meanwhile, combining the predictive results from network pharmacology and molecular docking, we propose that OST and TMP synergistically enhance the antioxidant defence capacity of shrimp through the synergistic Nrf2 signalling pathway, thereby enhancing the expression of total antioxidant capacity, superoxide dismutase, catalase and glutathione peroxidase. Furthermore, OST-TMP exhibited a significant increase of the immune response in haemocyte and intestine of shrimp, increasing the expression of antimicrobial peptide and lysozyme and suppressing the inflammatory factors, via the synergistic (NF-κB) and complementary targets predicted by network pharmacology. Additionally, gut microbiota composition of L. vannamei was improved, and the dominant genera were correlated with intestinal immune in the compound groups. For the first time, we elucidated the mechanism of plant-derived bioactive compounds mediating physiological health in aquatic animals via a new strategy of network pharmacology-molecular docking-experimental verification and identified the optimal addition amount of OST-TMP in shrimp (150 mg/kg TMP + 20 mg/kg OST), providing a technical safeguard for the animal health and the safety of aquatic products.
The classification of the species in the genus Actias Leach, 1815 (Lepidoptera: Saturniidae) is challenging because many species have a highly similar morphology, while differences in database classification standards also provoke identification problems. To help resolve these issues, we conducted an integrative analysis of 741 cytochrome oxidase subunit I (COI) barcode sequences available by combining phylogenetic reconstruction, population genetic (Fst) metrics, and biogeographic data. This approach delineated 44 molecular operational taxonomic units (MOTUs) and established a genus-specific, empirical genetic distance threshold of 2.05% from a baseline of 29 morphologically validated MOTUs. These 29 MOTUs/morphospecies were then utilized to assess the interspecific genetic distance gap of this genus and further used as the species-level genetic distance to delimit the remaining morphospecies. Applying this multi-evidence framework allowed us to propose a significant re-evaluation of species boundaries, including several taxonomic reclassifications, and to generate the molecular inventory for Actias. Our study illustrates the power of an integrated molecular approach to resolve complex taxonomic issues and provides a robust, data-driven foundation for future research on Actias.
Empathy involves communicating and understanding others’ emotion in multisensory contexts, including visual and auditory modalities. Schizophrenia (SCZ) patients have impaired empathy, but whether the impact of visual/auditory context would be altered in SCZ patients and people with high social anhedonia (HSoA) remained unclear.
Methods
We administered the modified Chinese version of the Empathic Accuracy Task (EAT) to clinical (50 SCZ patients and 50 healthy controls) and subclinical samples (59 HSoA and 60 low social anhedonia [LSoA] participants). The EAT employed audio-only, audiovisual, and audioavatar visual conditions to assess the impact of multimodal information on empathy during positive and negative emotional events.
Results
In positive-valenced context, SCZ patients performed worse than controls in cognitive and affective empathy. The Modality-by-Group interaction on empathic accuracy was significant, that is, SCZ patients performed worse than controls in both audiovisual and audioavatar visual conditions, but comparable to controls in audio-only condition. In negative-valenced context, SCZ patients performed worse than controls in cognitive empathy. The Modality-by-Group interaction on empathic accuracy was significant, that is, SCZ patients performed worse than controls in audio-only and audiovisual conditions. Moreover, HSoA participants exhibited lower cognitive empathy than controls in positive-valenced context; and lower cognitive empathy and empathic motivation in negative-valenced context. No significant Modality-by-Group interaction was found in the HSoA–LSoA sample.
Conclusions
SCZ patients have generalized impairments of cognitive and affective empathy across positive and negative contexts, particularly in multimodal conditions. HSoA individuals are primarily impaired in cognitive empathy and empathic motivation.
City-county consolidation is a prevalent practice observed worldwide, serving as a common strategy adopted by policymakers to effectively respond to the development requirements of large metropolises. Existing literature has extensively explored the effects arising from this particular policy. Nevertheless, how consolidation affects energy efficiency in consolidated regions is rarely examined. Based on the large-scale city-county consolidation reform from 2000 to 2017 in China, our study explores the causal implications of this policy on energy efficiency at the county level through the application of a staggered difference-in-difference method. Our outcomes demonstrate that a consolidation reform is tied to a statistically significant reduction in energy efficiency of consolidated counties relative to their non-consolidated counterparts. We provide additional evidence that the rise in energy usage, the relocation of low-tech and energy-intensive industries, and the intensification of economic agglomeration are potential contributors to the decrease in energy efficiency.
Cylindrical vector (CV) $\gamma$ rays can introduce spatially structured polarization as a new degree of freedom for fundamental research and practical applications. However, their generation and control remain largely unexplored. Here, we put forward a novel method to generate CV $\gamma$ rays with tunable hybrid polarization via a rotating electron beam interacting with a solid foil. In this process, the beam generates a coherent transition radiation field and subsequently emits $\gamma$ rays through nonlinear Compton scattering. By manipulating the initial azimuthal momentum of the beam, the polarization angle of $\gamma$ rays relative to the transverse momentum can be controlled, yielding tunable hybrid CV polarization states. Three-dimensional spin-resolved particle-in-cell simulations demonstrate continuous tuning of the polarization angle across $\left(-90{}^{\circ},\ 90{}^{\circ}\right)$ with a high polarization degree exceeding 60%. Our work contributes to the development of structured $\gamma$ rays, potentially opening up new avenues in high-energy physics, nuclear science and laboratory astrophysics.
Dysregulation of fatty acids metabolism has been associated with the risk of osteoarthritis (OA), yet current evidence from epidemiological or genetic studies remains inconclusive. We aimed to investigate the phenotypic association and genetic architecture between total fatty acids, saturated fatty acids (SFA), MUFA, PUFA and OA. Leveraging individual-level data from the UK Biobank, combined with the hitherto largest genome-wide association studies of fatty acids (n 136 016) and OA (n 826 690) in European individuals, we implemented a comprehensive analytical framework. This included observational and genetic analyses, incorporating phenotypic associations, genetic correlations, cross-trait meta-analysis, enrichment analysis and Mendelian randomisation (MR). Observational analysis identified SFA as a risk factor, while MUFA and PUFA as protective factors for OA. Despite a lack of genome-wide genetic correlation, statistically significant local signals were detected within three specific genomic regions. Cross-trait meta-analysis identified sixty-eight pleiotropic loci shared between fatty acids and OA, of which nine were novel. Enrichment analysis revealed the shared genes were enriched in lipoprotein metabolism, immune response and inflammation regulation pathways. Two-sample MR provided evidence for a causal relationship of MUFA and PUFA on OA that survived false discovery rate correction. This study supports associations between circulating fatty acids and OA, with MUFA and PUFA exerting a protective role. Our findings provide new perspectives into OA prevention especially regarding the potential dietary interventions.
Recently, Alfvénic ion temperature gradient (AITG) modes have been observed in the core plasma on the HL-2A tokamak. Only when electron cyclotron resonance heating (ECRH) and neutral beam injection are simultaneously injected into the deuterium plasma do the AITG modes become unstable. The instability is electromagnetic and localised in the core plasma with an internal transport barrier. Dynamic evolution of AITG modes is greatly affected by the off-axis ECRH. Theoretical analysis suggests that there is a strong dependence of the AITG modes on $\eta _i\simeq \boldsymbol{\nabla }\ln T_i/\boldsymbol{\nabla }\ln n_i$, where $n_i$ is the ion density. It is also found that ECRH can enhances AITG modes by causing a drop of electron density and an increase of $\tau =T_e/T_i$; here $T_e$ and $T_i$ are the electron and ion temperatures, respectively. Besides, high-power ECRH may also change the safety factor or magnetic shear and then contribute to the mitigation of AITG modes. The new findings can not only enrich scientific knowledge for pressure gradient-driven instability, but also be beneficial to active control of core-localised electromagnetic modes in future fusion devices.
Cognitive impairment in major depressive disorder (MDD) may be driven by neuro-inflammatory processes involving pro-inflammatory cytokines.
Aims
This study aimed to examine the relationship between serum tumour necrosis factor-alpha (TNF-α) levels and cognitive performance across different domains in individuals with MDD.
Method
Sixty patients with MDD and 60 healthy controls were recruited. Cognitive function was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and serum TNF-α levels were measured via flow cytometry.
Results
After adjusting for covariates, RBANS total and subscale scores were significantly lower in MDD patients compared with controls (P < 0.001), while log10-transformed TNF-α levels were significantly higher in the MDD group (P = 0.006). In MDD patients, log10TNF-α levels were inversely correlated with immediate memory scores after adjusting for confounding factors (r = −0.35, P = 0.009); however, this relationship was not observed in healthy controls (r = −0.02, P = 0.90). Stepwise multivariate regression analysis further confirmed the negative association of log10TNF-α with immediate memory scores in MDD patients (β = −14.58, t = −4.14, P < 0.001), but not in healthy controls (β = −0.02, t = −0.14, P = 0.89).
Conclusions
These findings suggest that elevated serum TNF-α may contribute to the pathophysiology of MDD and is specifically associated with deficits in immediate memory.
African swine fever (ASF) is a highly contagious animal disease caused by African swine fever virus (ASFV). It is listed by the World Organization for Animal Health (WOAH) as an animal disease subject to statutory reporting. ASFV, a large, enveloped double-stranded DNA virus with high genomic complexity, exhibits a case fatality rate of up to 100%, posing a significant threat to the global pig industry and food safety. To date, the absence of a safe commercial ASFV vaccine primarily stems from challenges in identifying immunogenic viral antigens, insufficient characterization of ASFV pathogenesis, and limited understanding of the virus’s immune evasion mechanisms. Here, we review the pathogenic characteristics (morphological structure, clinical symptoms, and epidemiological characteristics), molecular biological characteristics, and infection mechanism of ASFV, as well as the immune response mechanism, vaccine research, and the latest information on ASFV in other areas. This review will be in favour of understanding the current state of knowledge of ASF and developing effective vaccines to control this disease.
Previous research has mainly explored the relationship between bilingual language control and domain-general cognitive control through behavioral correlations, often revealing epiphenomenal links rather than causality. This study utilizes transcranial magnetic stimulation (TMS) to investigate the causal roles of the left inferior frontal gyrus (LIFG) and left middle temporal gyrus (LMTG) in 33 unbalanced Chinese-English bilinguals. Continuous theta burst stimulation was applied in separate sessions to decrease cortical excitability, with vertex stimulation as a control. LIFG stimulation significantly increased switching costs in nonverbal switching tasks, highlighting its role in domain-general cognitive control. LMTG stimulation did not affect switching or mixing costs in language or nonverbal switching tasks, suggesting no causal involvement, but it reduced reaction times (RTs) during language switching tasks, underscoring its specialization in language processing. These findings highlight distinctions between the neural mechanisms of bilingual language control and domain-general cognitive control, particularly in the LIFG.
American silk moth, Antheraea polyphemus Cramer 1775 (Lepidoptera: Saturniidae), native to North America, has potential significance in sericulture for food consumption and silk production. To date, the phylogenetic relationship and divergence time of A. polyphemus with its Asian relatives remain unknown. To end these issues, two mitochondrial genomes (mitogenomes) of A. polyphemus from the USA and Canada respectively were determined. The mitogenomes of A. polyphemus from the USA and Canada were 15,346 and 15,345 bp in size, respectively, with only two transitions and five indels. The two mitogenomes both encoded typical mitochondrial 37 genes. No tandem repeat elements were identified in the A+T-rich region of A. polyphemus. The mitogenome-based phylogenetic analyses supported the placement of A. polyphemus within the genus Antheraea, and revealed the presence of two clades for eight Antheraea species used: one included A. polyphemus, A. assamensis Helfer, A. formosana Sonan and the other contained A. mylitta Drury, A. frithi Bouvier, A. yamamai Guérin-Méneville, A. proylei Jolly, and A. pernyi Guérin-Méneville. Mitogenome-based divergence time estimation further suggested that the dispersal of A. polyphemus from Asia into North America might have occurred during the Miocene Epoch (18.18 million years ago) across the Berling land bridge. This study reports the mitogenome of A. polyphemus that provides new insights into the phylogenetic relationship among Antheraea species and the origin of A. polyphemus.
Tuberculosis (TB) remains a significant public health concern in China. Using data from the Global Burden of Disease (GBD) study 2021, we analyzed trends in age-standardized incidence rate (ASIR), prevalence rate (ASPR), mortality rate (ASMR), and disability-adjusted life years (DALYs) for TB from 1990 to 2021. Over this period, HIV-negative TB showed a marked decline in ASIR (AAPC = −2.34%, 95% CI: −2.39, −2.28) and ASMR (AAPC = −0.56%, 95% CI: −0.62, −0.59). Specifically, drug-susceptible TB (DS-TB) showed reductions in both ASIR and ASMR, while multidrug-resistant TB (MDR-TB) showed slight decreases. Conversely, extensively drug-resistant TB (XDR-TB) exhibited upward trends in both ASIR and ASMR. TB co-infected with HIV (HIV-DS-TB, HIV-MDR-TB, HIV-XDR-TB) showed increasing trends in recent years. The analysis also found an inverse correlation between ASIRs and ASMRs for HIV-negative TB and the Socio-Demographic Index (SDI). Projections from 2022 to 2035 suggest continued increases in ASIR and ASMR for XDR-TB, HIV-DS-TB, HIV-MDR-TB, and HIV-XDR-TB. The rising burden of XDR-TB and HIV-TB co-infections presents ongoing challenges for TB control in China. Targeted prevention and control strategies are urgently needed to mitigate this burden and further reduce TB-related morbidity and mortality.
We sought to assess the degree to which environmental risk factors affect CHD prevalence using a case–control study.
Methods:
A hospital-based study was conducted by collecting data from outpatients between January 2016 and January 2021, which included 31 CHD cases and 72 controls from eastern China. Risk ratios were estimated using univariate and multivariate logistic regression models and mediating effect analysis.
Results:
Residential characteristics (usage of cement flooring, odds ratio = 17.04[1.954–148.574], P = 0.01; musty smell, odds ratio = 3.105[1.198–8.051], P = 0.02) and indoor total volatile organic compound levels of participants’ room (odds ratio = 31.846[8.187–123.872, P < 0.001), benzene level (odds ratio = 7.370[2.289–23.726], P = 0.001) increased the risk of CHDs in offspring. And folic acid plays a masking effect, which mitigates the affection of the total volatile organic compound (indirect effect = -0.072[−0.138,-0.033]) and formaldehyde (indirect effect = −0.109[-0.381,-0.006]) levels on the incidence of CHDs. While food intake including milk (odds ratio = 0.396[0.16–0.977], P = 0.044), sea fish (odds ratio = 0.273[0.086–0.867], P = 0.028), and wheat (odds ratio = 0.390[0.154–0.990], P = 0.048) were all protective factors for the occurrence of CHDs. Factors including women reproductive history (history of conception control, odds ratio = 2.648[1.062–6.603], P = 0.037; history of threatened abortion, odds ratio = 2.632[1.005–6.894], P = 0.049; history of dysmenorrhoea (odds ratio = 2.720[1.075–6.878], P = 0.035); sleep status (napping habit during daytime, odds ratio = 0.856[0.355–2.063], P = 0.047; poor sleep quality, odds ratio = 3.180[1.037–9.754], P = 0.043); and work status (working time > 40h weekly, odds ratio = 2.882[1.172–7.086], P = 0.021) also influenced the CHDs incidence to differing degrees.
Conclusion:
Diet habits, nutrients intake, psychological status of pregnant women, and residential air quality were associated with fetal CHDs. Indoor total volatile organic compound content was significantly correlated with CHDs risk, and folic acid may serve as a masking factor that reduce the harmful effects of air pollutants.
Machine learning (ML) models have been developed to identify randomised controlled trials (RCTs) to accelerate systematic reviews (SRs). However, their use has been limited due to concerns about their performance and practical benefits. We developed a high-recall ensemble learning model using Cochrane RCT data to enhance the identification of RCTs for rapid title and abstract screening in SRs and evaluated the model externally with our annotated RCT datasets. Additionally, we assessed the practical impact in terms of labour time savings and recall improvement under two scenarios: ML-assisted double screening (where ML and one reviewer screened all citations in parallel) and ML-assisted stepwise screening (where ML flagged all potential RCTs, and at least two reviewers subsequently filtered the flagged citations). Our model achieved twice the precision compared to the existing SVM model while maintaining a recall of 0.99 in both internal and external tests. In a practical evaluation with ML-assisted double screening, our model led to significant labour time savings (average 45.4%) and improved recall (average 0.998 compared to 0.919 for a single reviewer). In ML-assisted stepwise screening, the model performed similarly to standard manual screening but with average labour time savings of 74.4%. In conclusion, compared with existing methods, the proposed model can reduce workload while maintaining comparable recall when identifying RCTs during the title and abstract screening stages, thereby accelerating SRs. We propose practical recommendations to effectively apply ML-assisted manual screening when conducting SRs, depending on reviewer availability (ML-assisted double screening) or time constraints (ML-assisted stepwise screening).