International Journal of Clinical Practice最新文献

Introduction: It is now known that the microbiota is far beyond the microbial communities living in certain parts of our body and functions like a metabolic organ. In addition, the microbiota, through its metabolites, is involved in the pathophysiology or progression of a wide range of diseases, from atherosclerotic diseases to metabolic diseases and even neurological diseases. Among these metabolites, trimethylamine n-oxide metabolite has been shown to be particularly effective in atherosclerotic heart diseases.

Materials and Methods: A total of 155 patients, who underwent coroner angiography for stable angina were included in the study. Of these patients, 81 patients with coronary artery ectasia (patient group) and 74 patients without coronary artery ectasia (control group) were evaluated for trimethylamine n-oxide metabolite.

Results: Statistically significantly higher trimethylamine n-oxide metabolite levels were observed in the coronary artery ectasia group compared to the control group.

Conclusion: The significantly higher trimethylamine n-oxide levels in patients with coronary artery ectasia without coronary artery disease suggest that the microbiota and its metabolites independently play a role in the pathophysiology or progression of vascular remodeling or endothelial dysfunctions. Also, its effect on the endothelial surface may depend on the threshold value.

Background: Recent evidence increasingly acknowledges the close interrelationship between immunity and gut microbiota (GM) in humans. Furthermore, previous studies have demonstrated a strong correlation between GM and gastroesophageal reflux disease (GERD). However, the specific impact of GM on immune factors in GERD remains largely unexplored. Therefore, we conducted the Mendelian randomization (MR) analysis to investigate the precise causal relationships and underlying mechanisms linking GM, immunity, and GERD.

Method: We employed the mediation MR utilizing summary statistics derived from Genome-Wide Association Study (GWAS) data to investigate the causal effects of 207 taxa and 205 bacterial pathways on GERD. The analysis concentrated on 731 immune cell traits as potential mediators. The inverse variance weighted (IVW) approach was the primary analytical method. To ensure robustness, we employed additional MR methods, including Bayesian weighted MR (BWMR), MR-Egger, Weighted Median, Weighted Mode, and Simple Mode. Furthermore, a series of sensitivity analyses, such as the Cochran’s Q test, leave-one-out test, MR-Egger intercept analysis, and MR-PRESSO test, were conducted to ensure the reliability and consistency of the findings.

Results: The study identified three taxa and eight bacterial pathways that exhibited a negative correlation with GERD. Mediation MR analyses indicated that four bacterial pathways influence GERD through four immune cell types acting as mediators. For instance, the “arginine, ornithine, and proline interconversion” pathway was implicated in reducing the risk of GERD via “PDL-1 on CD14- CD16+ monocyte” cells, with a total effect of −0.0484 and a mediation effect of −0.0093. Sensitivity analyses provided additional validation for the reliability of the MR findings.

Conclusion: Our study contributes evidence to the close causal relationship between the GM and GERD, emphasizing the possible role of immune cells as mediators. Future research should focus on developing microbiome-oriented therapeutic approaches for managing GERD.

Objective: Cardiovascular complications associated with COVID-19 are being increasingly recognized. They include potential long-term effects on the heart, although how these complications manifest in patients with stroke who are already vulnerable to cardiovascular issues is lacking. This study addressed this gap by investigating the influence of SARS-CoV-2 infection on cardiac hemodynamic changes in inpatients with stroke, thereby providing valuable insights into the management of cardiac complications in this population.

Methods: This retrospective cohort study enrolled inpatients with stroke who did or did not experience SARS-CoV-2 infection in Shenzhen Second People’s Hospital. Clinical information, hemodynamics data, serum myocardial enzyme levels, functional levels, including Barthel index, and Longshi scale assessment (bedridden, domestic, and community) were extracted from clinical records. An independent sample t-test and the Mann–Whitney U test were used for comparison between groups. Multiple logistic regression analysis was used to identify indicators associated with decline in cardiac function in patients with stroke post-COVID-19.

Results: Eighty-three patients with stroke (average age of 66.0 ± 15.5 years) were recruited (42 patients in the study group and 41 in the control group). No significant difference in general characteristics was observed between the groups. The ejection fraction (EF, 56.45 ± 12.46 vs. 47.64 ± 14.76, p = 0.04) was decreased, and the end-diastolic volume (EDV, 142.74 ± 80.00 vs. 193.34 ± 140.17, p = 0.001) was increased significantly in patients infected with SARS-CoV-2 compared with the noninfected participants. SARS-CoV-2 infection was an independent risk factor for EF (−10%) decrease (OR: 5.205, 95% CI: 1.621–16.720, p = 0.006). The risk of cardiac function decline among bedridden infected patients was 15.43 times higher than that of uninfected nonbedridden patients (OR: 15.430, 95% CI: 1.402–169.805, p = 0.025).

Conclusion: Patients who are bedridden after stroke face a higher potential risk of cardiac hemodynamic impairment following SARS-CoV-2 infection, emphasizing the need for meticulous hemodynamic monitoring during treatment and rehabilitation of these patients to prevent any potential cardiovascular complications.

Trial Registration: ClinicalTrials.gov identifier: ChiCTR2300071376.

Objective: Recent trends involving increased screening have led to broad populations being diagnosed with atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS); as a result, many patients have had to receive surgery followed by standard treatment for ADH or DCIS. The common interest in reducing the use of superfluous invasive treatment has led us to question the necessity of surgical treatment for ADH or DCIS patients in a retrospective review. This work is expected to be a particularly useful reference as there have yet to be any studies describing the outcomes of initial treatment with tamoxifen without curative surgery in Korea.

Methods: The clinicopathological characteristics and oncologic outcomes of 36 patients with DCIS or ADH diagnosis who received initial treatment with tamoxifen between 2013 and 2019 were investigated.

Results: Among 36 patients enrolled, 30 were diagnosed with DCIS and six were diagnosed with ADH. The median age in the included cohort was 47 years old (range, 26–81 years). There was a change in the follow-up strategy including the need for surgery in 13.9% of cases. The median time to surgery in those patients was 32 months (IQR, 17.5–63.5 months). Only one patient had upgraded to a higher nuclear grade, which was a case of ADH upgrading to intermediate DCIS. Three (8.3%) of 36 patients were upstaged to an invasive disease. Of them, two patients were upstaged to microinvasive ductal carcinoma, whereas one patient was diagnosed with metastatic invasive ductal carcinoma.

Conclusion: The use of endocrine therapy without surgery could be a potential treatment strategy in patients with DCIS or ADH. Further validation in larger cohorts and in the context of clinical trials is needed.

Introduction: The aim of this study was to evaluate the potential biomarkers of bacterial translocation: lipopolysaccharide-binding protein (LBP) and soluble CD14 subtype (sCD14-ST), and intestinal wall damage: intestinal fatty acid binding protein (I-FABP), zonulin, and regenerating islet-derived protein-3α (REG3α), in the patients with multiple organ dysfunction syndrome (MODS).

Methods: The study involved 78 patients over the age of 18 with MODS set according to the Sequential Organ Failure Assessment (SOFA) scale. Venous blood was sampled during diagnostics of MODS, on the 3rd and on the 7th day of its development. The sCD14-ST, LBP, I-FABP, REG3α, and zonulin in blood serum were determined by enzyme-linked immunosorbent assay (ELISA).

Results: Out of 78 patients with MODS, 43 patients survived (55.1%) and 35 patients died (44.9%). Levels of sCD14-ST on Day 1, I-FABP on Day 3, and REG3α on Days 3 and 7 and SOFA scores on Days 1, 3, and 7, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores on Days 1, 3, and 7, and Modified Nutrition Risk in Critically Ill (mNUTRIC) scores on Days 1, 3, and 7 were statistically significantly higher in deceased patients (p < 0.05).

Conclusion: In patients with MODS, an increase in sCD14-ST, I-FABP, and REG3α in blood serum can indicate the violation of intestinal barrier function and increased bacterial translocation, which ultimately may aggravate the severity of MODS and increase the risk of death. It is required to further study the factors leading to intestinal wall permeability disorders in order to screen for timely intensive care measures that can help reduce the stay of patients in the intensive care unit (ICU) as well as mortality.

Trial Registration: ClinicalTrials.gov identifier: NCT06221293

Background. Extracellular vesicles, particularly those derived from stem cells, have demonstrated promising potential in osteoarthritis in recent years. However, there has been no bibliometric analysis focusing on the relationship between extracellular vesicles and osteoarthritis. This study aimed to investigate trends and hotpots of publications on extracellular vesicles in osteoarthritis. Methods. This study collected publications on extracellular vesicles in osteoarthritis from the Web of Science Core Collection database, focusing on English-language articles and reviews. Quantitative and visual analysis was performed using Microsoft Excel, R shiny, SCImago Graphica, VOS Viewer, and CiteSpace. The data set comprised information on keywords, authors, institutions, journals, and the country or region of the included literature. Journal impact factors and H-index values were obtained from the 2021 Journal Citation Reports and SJR-International Science Ranking. Furthermore, we conducted a frequency analysis of annual publications number and fitting curves of the growth trends in the publications. Moreover, we conducted a citation burst analysis of the top 20 keywords and a related bibliometric analysis (word frequency analysis and cocitation analysis) using CiteSpace. Results. A total of 715 documents were analyzed. The number of publications increased annually from 2012 to 2022. China had the highest number (n = 394, 55.1%) of publications and total citations during the decade, followed by the United States (n = 105, 14.7%). Shanghai JiaoTong University contributed the highest number of publications (n = 28, 3.9%). Wang Y has the highest number of publications (n = 40, 5.6%), and Stem Cell Research & Therapy is the journal with the highest number of publications (n = 64, 9.0%). The hotspots of extracellular vesicle research in recent years are umbilical cord blood, drug delivery, and scaffolds. Conclusion. Our findings indicate an increase in publications on the topic in utilizing extracellular vesicles in the context of osteoarthritis. Extracellular vesicle therapy for cartilage regeneration and repair of bone defects in osteoarthritis holds significant potential. Future research will focus on the development of novel drug delivery systems that utilize extracellular vesicles, the creation of novel biomaterials that incorporate extracellular vesicles, and the potential of extracellular vesicles as early diagnostic markers of disease.

Objective: Optimal therapeutic drug monitoring (TDM), including clinical pharmacokinetics, appropriate interpretation, and dose adjustment of drugs, is required to effectively monitor specific therapeutic drugs. Hospital pharmacists (HPs), being the most qualified healthcare professionals to implement TDM, must understand its applications to determine and adjust drug doses and avoid adverse drug reactions and toxicity. Therefore, in this knowledge, attitude, and practice (KAP) study, we assessed TDM level among HPs in Saudi Arabia.

Methods: This cross-sectional study was conducted with 414 HPs in the Makkah region with a valid pharmacy license from the Saudi Commission for Health Specialties. An overall score of 50% or higher of the total responses in each section was considered good, whereas an overall score lower than 50% was considered poor. Categorical data are expressed as frequency and percentage. Correlations were measured using Pearson’s correlation coefficient (r).

Results: The TDM-KAP levels of the participants were 50%, 80%, and 62% for KAP, respectively. Significant positive linear correlations were found between knowledge and attitude, knowledge and practice, attitude and practice, knowledge and classification, practice and classification, practice and experience, and knowledge and experience. The participants showed acceptable knowledge and practice of TDM levels with elevated attitude levels.

Conclusion: As a lack of TDM knowledge directly contributes to reduced practice levels, increasing TDM knowledge and practice by introducing more intensive pharmaceutical programs that illustrate TDM clinical applications in hospitals is recommended, which will enhance HP integration.

Background and Objective: It is still controversial whether circulating fibroblast growth factor 23 (FGF-23) can be used as a biomarker for the diagnosis of osteoporosis and fractures in patients with chronic kidney disease undergoing hemodialysis. We investigated the association of circulating FGF-23 concentrations with an increased risk of osteoporosis and fractures of hemodialysis patients in the prospective study.

Methods: These data were collected in adult patients with hemodialysis in China from January 1 to December 30, 2016, and patients were followed up for 3.5 years. The association of circulating FGF-23 with the risk of osteoporosis and fractures was analyzed by multivariate analysis.

Results: The study included 1788 hemodialysis patients, with a median age of 56 years (50–64 years) and a female population of 54.5%. Of 1788 patients, 389 (21.8%) developed osteoporosis and 207 (11.6%) developed fractures. High concentrations of FGF-23 were significantly related to osteoporosis and fractures and were significantly related to different types of fractures (vertebral fractures, nonvertebral fractures, and hip fractures). Adjusted for all potential risk factors, high concentrations of FGF-23 were associated with the risk of osteoporosis or fractures.

Conclusion: High concentrations of circulating FGF-23 were associated with the risk of osteoporosis and fractures, including vertebral fractures and hip fractures. FGF-23, along with bALP, CTX, and OC, may be used as a serum biomarker for predicting the risk of osteoporosis and fractures in patients with hemodialysis.

Aim: To assess the role of Pitt bacteremia score (PBS) and Charlson Comorbidity Index (CCI) in predicting mortality among patients with intensive care unit (ICU)–acquired Gram-negative bacterial sepsis and to investigate other factors associated with mortality.

Methods: This retrospective study was carried out between January 2018 and January 2023. Patients diagnosed with ICU-acquired sepsis caused by Gram-negative bacteria were included in the study. Demographics, laboratory data, blood culture results, management, length of ICU stay, mortality, and other clinical data were recorded. PBS and CCI score were calculated based on data collected at time of blood withdrawal. The primary endpoint was mortality in ICU.

Results: Among the 425 patients included in the study, mortality was observed in 268 (63%). Age and sex were distributed similarly in the mortality and survival groups. CCI score with a cutoff value of > 5.5 (AUC = 0.611) and PBS with a cutoff value of > 2.5 (AUC = 0.904) were able to significantly predict mortality. Multivariable logistic regression revealed that mortality was independently associated with having any comorbidity, congestive heart failure, low platelet count, high lactate, high (> 2.5) PBS, and carbapenem resistance (p = 0.001).

Conclusion: PBS was more successful than CCI in predicting mortality in patients with ICU-acquired sepsis caused by Gram-negative bacteria. In addition to higher PBS, having any comorbidity (and additionally, congestive heart failure), lower platelet, higher lactate, and carbapenem resistance were risk factors for mortality.

Background: Medical malpractice is a significant global issue affecting various aspects of healthcare, including ethical, legal, and managerial perspectives. Defensive medicine, where physicians engage in excessive practices to avoid malpractice lawsuits, is prevalent. In Turkey, the impact of malpractice fears on obstetricians and gynecologists (OB/GYNs) has not been extensively studied. This study aims to investigate the frequency of medical malpractice lawsuits, defensive medicine practices, the prevalence of medical malpractice stress syndrome (MMSS), and potential preventive measures among OB/GYNs in Turkey.

Methods: A cross-sectional survey was conducted with 212 OB/GYNs in Turkey, following ethical approval. Participants completed a questionnaire on their experiences with malpractice, defensive practices, and MMSS. The survey included sociodemographic questions, standardized scales for defensive medicine practices, and MMSS-related questions. Data were analyzed using SPSS 18 with a 95% confidence level.

Results: The majority of participants were experienced professionals aged 30–39, predominantly female, and working in the public sector with limited subspecialty training. Defensive medicine was widespread, with 95.5% of participants engaging in such practices, and 79.2% reported altering their practice due to malpractice fears. Older age, female gender, extensive experience, private sector employment, and specific subspecialties were associated with higher defensive practices and MMSS.

Conclusion: Defensive medicine is common among Turkish OB/GYNs, driven by malpractice fears. The study highlights the need for improved support systems, better legal protections, and educational interventions to address defensive practices and reduce malpractice-related stress.