International Journal of Clinical Practice最新文献

Objective: This study aims to compare the clinical outcomes of forceps-assisted vaginal delivery (FAVD) and vacuum-assisted vaginal delivery (VAVD) in primiparous women and to identify risk factors contributing to moderate and severe postpartum hemorrhage (PPH) associated with these delivery methods.

Methods: A retrospective analysis was conducted on clinical data from 1237 primiparous women who delivered at the Obstetrics Department of Hunan Maternal and Child Health Hospital between April 2018 and April 2022. Among these, 711 underwent FAVD and 526 underwent VAVD. Maternal and neonatal characteristics, including age, gestational age, prepregnancy body mass index (BMI), pregnancy weight gain, neonatal weight, and labor duration, were evaluated. The study assessed labor duration, neonatal weight, maternal complications, neonatal complications, and the incidence and severity of PPH. Binary logistic regression analysis was performed to identify risk factors for moderate (500–1000 mL blood loss) and severe (> 1000 mL blood loss) PPH associated with the two delivery methods.

Results: Compared with FAVD, VAVD was associated with a higher incidence of uterine atony (p < 0.05) and increased risks of both moderate and severe PPH (p < 0.05). Pregnant women with significant gestational weight gain more frequently underwent VAVD (p < 0.05), which also correlated with prolonged second and total labor stages compared with FAVD (p < 0.05). Logistic regression revealed that uterine atony was a significant risk factor for both moderate and severe PPH (p < 0.05). Prolonged total labor independently increased the risk of severe PPH in VAVD cases (p < 0.05 and OR 1.575), while gestational weight gain and prolonged labor were independent risk factors for moderate PPH in FAVD cases (p < 0.05, OR 1.047 and OR 1.287, respectively).

Conclusions: VAVD is associated with longer labor duration, a higher likelihood of PPH, and increased neonatal scalp hematoma incidence compared with FAVD. Prolonged total labor significantly contributes to moderate PPH risk in FAVD and severe PPH risk in VAVD. Uterine atony is an independent predictor of both moderate and severe PPH.

Background: Previous studies have indicated a close association between vitiligo and inflammatory cytokines, yet the genetic predictive association remains unclear. The study aimed to predict the relationship between vitiligo and inflammatory cytokines in genetics.

Methods: A bidirectional analysis was conducted by the two-sample MR. We selected independent genetic tools for significant levels associated with inflammatory cytokines and vitiligo from corresponding meta-analyses of genome-wide association study (GWAS). The summary data for inflammatory cytokines were derived from a GWAS meta-analysis conducted on three separate Finnish population cohorts, comprising a total of 8293 individuals (N = 8293). The vitiligo data, on the other hand, were extracted from a GWAS meta-analysis conducted on individuals of European ancestry, totaling 44,266 individuals (N = 44,266). As the primary analytical approach, we employed the inverse variance weighted (IVW) method, and to ensure the reliability of our main findings, we also performed sensitivity analysis to evaluate the robustness.

Results: Compelling evidence indicated a causal association between genetically predicted IL-18 and IL-8 with vitiligo (odds ratio, OR: 1.162, 95% CI: 1.043–1.295, p = 0.006, and p_fdr = 0.020 and OR: 0.726, 95% CI: 0.602–0.876, p = 0.001, and p_fdr = 0.004). In addition, cytokines including stromal cell-derived factor-1 alpha (SDF1a) (Beta: 0.032, p = 0.016, and p_fdr = 0.039), IL-17 (Beta: 0.038, p = 0.005, and p_fdr = 0.027), basic fibroblast growth factor (FGFBasic) (Beta: 0.028, p = 0.034, and p_fdr = 0.170), monocyte chemoattractant protein-1(MCP1) (Beta: 0.026, p = 0.046, and p_fdr = 0.189), and platelet-derived growth factor BB (PDGFbb) (Beta: 0.026, p = 0.040, and p_fdr = 0.198) were suggested to be the consequences of vitiligo.

Conclusions: According to this investigation, it has been proposed that the etiology of vitiligo is likely associated with IL-18 and IL-8, whereas the downstream progression of vitiligo can be attributed to several inflammatory cytokines such as IL-17, SDF1a, PDGFbb, MCP1, and FGFBasic.

This study aimed to evaluate the efficacy of personalized 3D printing osteotomy guides and artificial intelligence (AI)-assisted surgical planning in total knee arthroplasty (TKA). A cohort of 60 cases was randomly allocated into two groups: one receiving assistance from personalized 3D printing osteotomy guides and the other benefiting from AI-assisted surgical planning for the procedure. We compared surgical duration, intraoperative bleeding, postoperative incision drainage, length of hospital stay, surgical accuracy, and postoperative visual analog scale (VAS) and Hospital for Special Surgery (HSS) outcomes between the two groups. Continuous data conforming to a normal distribution were analyzed using independent-samples t-tests, while categorical data were assessed with chi-square tests. The findings of our study indicated that the 3D printing-assisted TKA (3D-TKA) group experienced significant lower levels (p < 0.05) of bleeding and drainage (160.1 ± 24.3 mL, 199.5 ± 29.6 mL) compared to the AI-assisted TKA (AI-TKA) group (174.7 ± 25.7 mL, 223.8 ± 29.2 mL). Furthermore, the duration of surgery and hospital stay (81.4 ± 8.9 min, 7.7 ± 1.3 day) was significantly longer (p < 0.05) in the 3D-TKA group than the AI-TKA group (72.9 ± 10.0 min, 6.8 ± 1.6 day). No significant differences (p > 0.05) were observed in surgical accuracy between the two groups. On the first day postoperation, VAS scores were significantly lower (p = 0.001) in the 3D-TKA group. In summary, each surgical approach offers distinct benefits. 3D printing primarily enhances patient outcomes, whereas AI assistance tends to favor surgical efficiency.

Background: This study aimed to analyze renal function markers and correlate the results with serum ferritin levels in patients with thalassemia in Bandar Abbas, Iran, in 2020.

Method: A cross-sectional study was conducted, and patients with a proven hemoglobinopathy diagnosis were included. Fasting blood was obtained to measure creatinine, sodium, potassium, calcium, phosphorus, magnesium, uric acid, and ferritin. In addition, a 24-h urine specimen was collected to determine the level of urine albumin, creatinine, sodium, potassium, calcium, phosphorus, magnesium, uric acid, and β2-microglobulin. Fractional excretion of sodium, potassium, calcium, phosphorus, magnesium, and uric acid was also calculated. Spearman’s coefficient of correlation was used to determine the correlations between serum ferritin level and other variables.

Results: Of the sixty-six patients studied, 3.0% had sickle cell thalassemia, 80.3% had major thalassemia, and 72.7% had intermediate thalassemia. In our study, serum ferritin, 24-h urine protein, and fractional excretion of sodium, calcium, and urine were higher than the normal range in thalassemia patients. There was a significant correlation between serum ferritin level and fractional excretion of magnesium, calcium, sodium, phosphorus, and uric acid with a negative correlation coefficient (p ≤ 0.05). We also found that the serum ferritin levels strongly correlated with microalbuminuria (p ≤ 0.05).

Aim: A high intake of dietary phosphorus with an effect on the serum phosphorus level may affect the health status and predict the occurrence of some clinical disorders. Therefore, in the current study, we aimed to determine phosphatemic index (PI) according to serum levels of phosphorus after intake of different foods and assess its association with the odds of nonalcoholic fatty liver disease (NAFLD).

Methods: The current study was conducted with case-control design on 225 newly diagnosed NAFLD cases and 450 controls aged 20–60 years. Dietary intake data were collected by a validated food frequency questionnaire. The PI was calculated as the area under the curve (AUC) of serum phosphorus after eating test food divided by the AUC for the food supply containing an equal quantity of phosphorus. Multivariable logistic regression models were used to evaluate the NAFLD odds according to tertiles of the PI score.

Results: The median (IQR) of dietary PI in participants of case and control groups was 83.9 (55.8–114.2) and 82.1 (52.6–119.6), respectively. In the age and sex-adjusted model, there was no statistically significant association between PI and the odds of NAFLD (OR = 1.47; 95% CI: 0.98–2.19, P_trend = 0.065). However, in fully adjusted model, after controlling the effects of age, sex, waist-to-hip ratio, smoking, dietary intake of energy, dietary fiber, physical activity, and socioeconomic status, the odds of NAFLD increased across tertiles of PI (OR = 1.97; 95% CI: 1.08–3.58, P_trend = 0.028).

Conclusions: Our results suggested that a diet with a higher PI score may contribute to an increase in the odds of NAFLD independent of common confounders.

Background: Patients with chronic rhinosinusitis (CRS) often exhibit sleep impairments that are closely associated with obstructive sleep apnea (OSA). However, objective evaluations of sleep quality in inpatients with CRS are lacking. This study explored the sleep-breath–related characteristics of CRS patients without nasal polyps (CRSsNP).

Methods: In this cross-sectional single-center study, we recruited 147 adult male inpatients diagnosed with CRSsNP between March 2019 and April 2020. OSA was diagnosed using standard PSG. The patients were classified into two groups based on the apnea–hypopnea index: CRSsNP with OSA and CRSsNP without OSA groups. Demographic features and sleep parameters were evaluated and compared between the groups.

Results: Inpatients with CRSsNP were at high risk of OSA (61.2%). Interestingly, the oxygen desaturation index (ODI), sleep efficiency (SE), and wake duration showed no differences between the CRSsNP with OSA and CRSsNP without OSA patients. The CRSsNP with OSA group exhibited a higher prevalence of obesity, slept for less time, was more easily aroused, and exhibited higher SE and larger CT90 scores during sleep (p < 0.05) compared to the CRSsNP without OSA group. Linear regression analysis revealed that the average SpO₂ value (β = 1.182; p = 0.036) and ODI (β = 0.818; p < 0.001) remained significantly associated with OSA in CRS patients even after adjusting for age and body mass index.

Conclusions: Male inpatients with CRSsNP exhibited a high prevalence of OSA. CRSsNP patients evidenced severe hypoxia and exhibited more awakenings during sleep.

Numerous studies have investigated into the antioxidant and anti-inflammatory properties of silymarin, as well as its ability to reduce reactive oxygen species and inflammation biomarkers. The effect of silymarin on inflammation and oxidative stress was investigated using the keywords “milk thistle” OR “Silybum marianum” OR “Silybum” OR “silymarin” OR “Silibinin” AND “MDA” OR “Malondialdehyde” OR “TAC” OR “total antioxidant capacity” OR “IL-10” OR “Interleukin-10” OR “IL-6” OR “Interleukin-6” OR “TNF-α” OR “tumor necrosis factor alpha” on the Web of Science, Scopus, Embase, PubMed, and Cochrane Library, up until March 2023. Data were combined using a random-effects model, and the weighted/standardized mean differences (WMDs/SMDs) with a 95% confidence interval (CI) were used as the overall effect size. Our meta-analysis indicated that silymarin supplementation resulted in a significant decrease in levels of C-reactive protein (CRP) (WMD: −3.39 mg/L, 95% CI: −5.99, −0.79, p = 0.01) and malondialdehyde (MDA) (SMD: −1.69, 95% CI: −2.62, −0.76, p < 0.001). Furthermore, silymarin significantly increases IL-10 (WMD: 2.03 pg/mL; 95% CI: 1.04, 3.01, p < 0.001), superoxide dismutase (SOD) (SMD: 3.39, 95% CI: 1.42, 5.37, p = 0.001), and glutathione peroxidase (GPx) (SMD: 1.94; 95% CI, 0.89 to 2.99; p < 0.001) level. However, silymarin supplementation did not have significant effects on TAC (SMD: 2.91; 95% CI: −0.30, 6.11, p = 0.076) and IL-6 (WMD: −0.70 pg/mL; 95% CI: −1.42, 0.02, p < 0.056) level. Silymarin supplementation may significantly improve oxidative stress and inflammation in adults by decreasing CRP and MDA and increasing IL-10, SOD, and GPx. However, additional studies with longer study periods are required to ascertain the long-term effects of silymarin on oxidative stress and chronic inflammation.

Background: Rhabdomyolysis (RM) is a severe clinical syndrome with substantial heterogeneity that involves the rapid dissolution of skeletal muscles. The condition has a high prevalence and poor prognosis, particularly in critically ill patients. Subtypes of RM in critically ill patients have not been investigated.

Objective: The study aimed to link the clinical RM heterogeneity with distinct prognoses and associated characteristics among different subtypes using an unsupervised analysis.

Methods: Patients diagnosed with RM in the intensive care unit (ICU) from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database and the eICU Collaborative Research Database (eICU) were retrospectively enrolled. K-means clustering, guided by correlation coefficients and expert opinions in intensive care medicine, was applied to identify distinct RM clinical subtypes using routinely available parameters from the first 24 h after patient ICU admission. The primary endpoint was 28-day mortality. We assessed associations between subtypes and 28-day mortality, as well as between treatments and 28-day mortality in the derived subtypes, using multivariate Cox proportional hazards regression. The eICU database patients served as an external validation set. The SHapley Additive exPlanations (SHAPs) were used to visualize features of each clinical subtype.

Results: A total of 2269 eligible subjects were extracted from the MIMIC-IV. Two distinct subtypes were identified (A and B) using 17 readily available clinical and biological variables. Patients assigned to Subtype A (n = 511) had a higher 28-day mortality. The proportion of organ support, comorbidity index, SAPS II, and SOFA scores were all significantly higher in the Subtype A group than in the Subtype B group (n = 1836). After adjusting for relevant covariates, Subtype A patients were independently associated with increased 28-day mortality (HR [95% CI] = 1.70 [1.36–2.11], p < 0.001). These findings were further validated using an external cohort from the eICU dataset. Notably, Subtype A patients showed a higher mortality risk associated with sodium bicarbonate use (HR [95% CI] 1.62 [1.20–2.19], p = 0.002).

Conclusions: We identified two subtypes with distinct clinical features and outcomes. Subtype A is independently associated with poor outcomes and shows increased mortality risk with sodium bicarbonate use. These findings may help clinicians better distinguish prognoses and treatment responses among RM patients.