Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 2 appraisals
Cardiovascular toxicology
Mechanisms of Cardiovascular Toxicity Induced by Silver Nanoparticles: A Systematic Review of Preclinical Evidence
Silver nanoparticles (AgNPs) have emerged as one of the most widely used nanomaterials in medical and consumer products, yet their cardiovascular safety remains inadequately characterized. While their antimicrobial properties are well-documented, accumulating evidence reveals that AgNPs pose a significant threat to the cardiovascular system. Exposure to AgNPs through inhalation, ingestion, or dermal contact enables these particles to enter systemic circulation, where they accumulate in cardiac and vascular tissues in a dose-, time-, and size-dependent manner. Once deposited, AgNPs initiate a cascade of pathological events, including oxidative stress, mitochondrial dysfunction, DNA damage, and disruption of calcium and sodium channel signaling. These molecular disturbances translate into physiological alterations such as bradycardia, atrioventricular conduction block, impaired contractility, and exacerbated ischemia-reperfusion injury. AgNPs also trigger endothelial activation, leading to upregulation of adhesion molecules, namely vascular cell adhesion molecule-1 (VCAM-1), intracellular adhesion molecule-1 (ICAM-1) and recruitment of inflammatory cells, creating a proinflammatory and prothrombotic environment. Elevated cardiac biomarkers, including creatine kinase-MB fraction (CK-MB), brain natriuretic peptide (BNP), lactate dehydrogenase (LDH), and histopathological changes, including pericardial edema, myofibril disorganization, fibrosis, and inflammatory infiltration are consistently observed. Vascular dysfunction manifests as impaired vasorelaxation, enhanced vasoconstriction via endothelin-1 upregulation, thrombosis, and abnormal angiogenesis driven by vascular endothelial growth factor (VEGF) dysregulation. Although plant-based AgNPs have shown cardioprotective potential in limited studies, the overall evidence indicates significant cardiovascular risk. This systematic review synthesizes findings from 38 preclinical studies (35 in vivo, 3 in vitro), providing a comprehensive analysis of AgNP-induced cardiotoxicity with emphasis on oxidative stress, inflammation, and molecular dysregulation as core mechanistic drivers.
13 July 2026
Read appraisal →Journal of medical systems
Beyond Validation: Operationalising Post-Deployment Surveillance of AI Medical Devices in Clinical Practice
Artificial intelligence medical devices are increasingly deployed in clinical practice, yet practical approaches to post-deployment monitoring remain poorly defined. We present a structured, decision-oriented approach to monitoring within healthcare institutions, grounded in our own deployment experience. By framing surveillance as a set of interdependent decisions, this model supports effective performance assessment and governance-linked corrective action, enabling safer and more accountable integration of AI into routine clinical care.
21 June 2026
Read appraisal →