International Journal of Clinical Practice最新文献

Objective: To investigate the relationship between peripheral blood neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-C-reactive-protein ratio (LCR), and monocyte-to-leukocyte ratio (MWR) and the efficacy of neoadjuvant chemotherapy (NAC) for patients with locally advanced rectal cancer before and after chemotherapy.

Methods: Seventeen rectal cancer patients who underwent NAC at West China Hospital of Sichuan University from March 31, 2022, to April 30, 2024, were selected as the study subjects, and the predictive value of peripheral blood NLR, LMR, PLR, LCR, and MWR were included in the least absolute shrinkage and selection operator (LASSO) regression analysis for the pathological efficacy, and the significant variables were screened out and the nomogram was constructed from them. Decision curve analysis (DCA) was applied to evaluate the predictive performance of the model.

Results: LASSO regression screened three predictive variables of NLR, LMR and LCR before neoadjuvant therapy that could predict pathological complete remission (pCR), as well as changes in PLR, LCR, and MWR after neoadjuvant therapy that could predict chemotherapy inefficacy. Nomograms and DCA curves were drawn based on the variables, and internal validation showed that the model had good predictive ability.

Conclusion: The comprehensive hematological prediction model for effective NAC in rectal cancer has a good predictive ability for NAC efficacy, which can provide guidance for individualized patient treatment.

Objective. The genuine causal nexus between mitochondrial function-related proteins and diabetic nephropathy remains enigmatic and arduous to delineate conclusively. In this study, we employed a bidirectional two-sample Mendelian randomization analysis, a robust approach, to scrutinize and discern the causal interplay between them. Methods. In this investigation, the datasets pertaining to diabetic nephropathy and mitochondrial function-related proteins were meticulously extracted from the comprehensive IEU OpenGWAS Project database. The principal analytical method employed was the inverse variance weighted approach. In addition, MR-Egger regression, simple median, and weighted median methodologies were utilized as supplementary tools to interrogate the causal associations of mitochondrial function-related proteins with the risk of diabetic nephropathy. Semsitivity analyses were conducted using the Cochran’s Q test and MR-Egger regression intercept. The significance level, as indicated by the P value, was employed as the pivotal metric for interpreting the findings. Result. A total of 90 single nucleotide polymorphisms associated with mitochondrial function-related proteins were meticulously screened as instrumental variables. The inverse variance weighted analysis unveiled a positive causal nexus between mitochondrial glutamate carrier 2, 2,4-dienoyl-CoA reductase mitochondrial levels, 39S ribosomal protein L52 mitochondrial, ATP synthase subunit beta mitochondrial, Serine--tRNA ligase mitochondrial, itochondrial sodium/hydrogen exchanger 9B2, and Esseential MCU regulator mitochondrial, and diabetic nephropathy. Conversely, pyruvate dehydrogenase (acetyl-transferring) kinase isozyme 1 mitochondrial exhibited a negative causal relationship with diabetic nephropathy., the MR-Egger intercept test yielded non-multiplicative results (P  >  0.05), affirming the robustness and validity of Mendelian randomization as an effective method for causal inference in this investigation. Furthermore, the reverse Mendelian randomization analysis failed to demonstrate any causal link between diabetic nephropathy and an augmented risk associated with positively identified mitochondrial function-related proteins. Conclusion. Pyruvate dehydrogenase (acetyl-transferring) kinase isozyme 1 mitochondrial stands out as an independent protective factor against diabetic nephropathy. The findings bear significant clinical implications, offering pivotal insights into the development of targeted preventive and therapeutic interventions, tailored specifically for combating diabetic nephropathy.

Background. We aimed to determine the multifocality and detectability of prostate cancer (Pca) with 3-Tesla (3T) multiparametric magnetic resonance imaging (mpMRI). Methods. The data of the patients who underwent radical prostatectomy in our institution between April 2020 and April 2021 were analyzed. Patients were included in the study at the stage of radical prostatectomy. Demographic and histopathological data were retrospectively collected, and then MRIs of eligible patients were re-evaluated for the study. Suspicious regions of interest (ROIs) were evaluated by a radiologist with 4 years of experience in uroradiology and scored based on Prostate Imaging Reporting and Data System (PIRADS) v2.1. The reader was blinded to the pathological outcomes of any biopsy specimen. Lesions with a PIRADS score ≥3 were considered positive and included in the study. All cases were evaluated histopathologically by a pathologist with ten years of experience in uropathology. We utilized the mapping method which provided exactly the same information as the whole-mount histopathology along with processing the entire prostatectomy specimen. Results. A total of 142 histopathologic tumoral lesions were detected among 70 patients. In relation to postoperative histopathology, tumor multifocality was established in 78.6% (n = 55), and 52.1% (n = 74) of 142 foci recognized were clinically significant. By detecting a total of 67 lesions, mpMRI showed an overall sensitivity of 47%. Whilst the sensitivity was 73% (54/74) in clinically significant lesions, the sensitivity was only 17.6% (12/68) in clinically insignificant lesions. For the group with detected tumors, the mean prostate-specific antigen (PSA) and PSA density were higher, there were more high-grade lesions, and the rate of the extraprostatic extension was significantly greater (p < 0.05, respectively). According to the multivariate analysis, only tumor size and Gleason Score (GS) were independent predictors regarding the ability of mpMRI to detect tumor foci within the prostate (p < 0.0001). Conclusion. mpMRI exhibited an acceptable sensitivity in detecting high-risk and large Pca foci. The diagnostic accuracy is observed to be markedly diminished in small, low GS, and nonindex tumors. A considerable percentage of missed lesions are clinically significant.

Aims and Objectives. Admission in the intensive care unit is highly stressful, for both the child and family. This study aimed to identify the factors influencing the nurse-parent partnership in the pediatric intensive care units. Methods. The data were collected from 71 ICU nurses through a web-based survey by the Pediatric Nurse-Parent Partnership (NPP) Scale, Wong and Law Emotional Intelligence (EI) Scale, and patient-centered communication (PCC) proficiency by Park and Oh’s. Descriptive and inferential statistics were used to analyze the data. Results. The mean scores for NPP, EI, and PCC skills were 67.91 ± 9.62, 55.16 ± 5.77, and 33.38 ± 4.81, respectively. There was a positive correlation between NPP, EI (r = 0.71, p < 0.001), and PCC skills (r = 0.59, p < 0.001). In hierarchical multiple regression analysis, EI (p < 0.01) and PCC skills (p = 0.05) were the two stronger primary variables influencing NPP than the general variables such as gender, children, and an additional qualification in pediatric nursing with higher variance (59% vs 14%). Conclusion. The findings of the study supported that nurses’ EI and PCC skills as well as additional qualification or training in pediatric nursing were the primary factors influencing nurse-parent partnership in intensive care settings. Thus, effective intervention programs focusing on these factors should be initiated to strengthen NPP.

Background. There is still no consensus on the treatment of frozen shoulder (FS). Clinical studies on extracorporeal shockwave therapy (ESWT) combined with arthroscopic capsular release (ACR) for FS are still lacking. Objectives. To investigate the effect of ESWT on short-term functional recovery after arthroscopic capsular release (ACR). Methods. A randomized clinical trial including 49 patients who under ACR was included. The patients were assigned to the ESWT group (n = 24) or non-ESWT group (n = 25) 2 weeks after surgery. Routine advanced rehabilitation program are given to all participants, while the ESWT group additionally received 5 times shockwave therapy. Visual analog scale (VAS) pain score, Constant score, University of California Los Angeles score (UCLA), UCLA-satisfaction, and shoulder range of motion (ROM) in four directions of flexion, abduction, internal, and external rotation were analyzed at the baseline (2 weeks postsurgery), 2 weeks, 8 weeks, and 12 weeks of follow-up. Repeated measure ANOVA is used to analyze the above outcomes. Results. A total of 46 participants completed all assessments. Pain and function improved in both groups. Comparing between the groups, we found that lower VAS pain scores and higher internal rotation were found in the ESWT group at each follow-up stage (all P < 0.05, 12 weeks VAS-pain 95% CI: [ESWT: 1.55–2.19, non-ESWT: 2.11–2.76], and 12 weeks internal rotation 95% CI: [ESWT: 5.42–7.27, non-ESWT: 7.20–9.06]). Regarding functional scores, the UCLA and UCLA-satisfaction of the ESWT group was significantly higher than that of the control group at 8 weeks and 12 weeks of follow-up (all P < 0.05, 12 weeks UCLA 95% CI: [ESWT: 31.94-33.45, non-ESWT: 27.94-29.45], 12 weeks UCLA-satisfaction 95% CI: [ESWT: 4.32–5.00, non-ESWT: 2.50–4.32]), but there was no significant difference in Constant (P > 0.05, 12 weeks Constant 95% CI: [ESWT: 82.98-92.94, non-ESWT: 78.24–88.20]). Conclusion. Extracorporeal shockwave therapy has a good analgesic effect and improves internal rotation after arthroscopic capsular release through short-term follow-up.

Objective. The aim of the study was to assess some psychological factors that may be related to the attitude towards vaccination against COVID-19. Methods. The study involved 419 responders, including 317 people aged 36.10 ± 13.41 years who received vaccination against COVID-19 and 102 people aged 38.16 ± 12.33 years who decided not to be vaccinated. The study was conducted online in January-June 2022 in the Polish population. The following methods were used for the study: the generic conspiracist beliefs scale (GCBS), the perceived stress scale (PSS-10), and the state-trait anxiety inventory (STAI-X2). Results. In the conspiracy beliefs questionnaire, an average score of 34.41 ± 12.95 points was obtained in the vaccinated group and in the unvaccinated group 48.67 ± 13.62 points. The difference was statistically significant (P < 0.01). In the PSS-10 questionnaire, the vaccinated respondents obtained an average score of 19.55 ± 6.75 points, and in the unvaccinated group, the mean score was 18.44 ± 7 points. When comparing the two groups, no statistically significant differences were found. In the vaccinated group, the mean score was 46.96 ± 7.69 points in the state anxiety questionnaire (X2), and 45.85 ± 8.18 points in the unvaccinated group. There were no statistically significant differences between the study groups. Significant positive correlations were found in the results obtained in the conspiracy thinking scale (GCBS), the PSS-10 stress scale, and the anxiety scale as a personality trait (STAI-X2) in both study groups. Conclusions. People presenting conspiracy thinking may be more likely to show antivaccine attitudes compared to people not showing a tendency to this kind of thinking. Conspiracy thinking may not only be associated with a high level of anxiety as a personality trait but also with the level of experienced stress. In the group of unvaccinated people, stress was a significant predictor of conspiratorial thinking. In the group of vaccinated people, anxiety turned out to be a significant predictor of conspiracy thinking. Due to the presence of antivaccine groups, the task of the medical personnel is to educate the public. Moreover, extensive information campaigns are needed to promote vaccination safety in an accessible and understandable language.

Objectives. This study aimed to use laboratory and clinical data of systemic lupus erythematosus (SLE) patients to construct prediction models for fundus complications in SLE. Methods. Routine blood test data and clinical information of 277 SLE patients were collected retrospectively. Based on their fundus examination, they were divided into two groups, with or without fundus lesions, defined as retinopathy and choroidopathy in this study. The data of the two groups were compared, and the prediction model was established using binary logistic regression analysis. Results. There were 85 patients in the fundus lesions’ group and 192 patients in the control group. Between the two groups, age, SLEDAI, serositis, hypertension, diabetes, anticardiolipin antibody (ACA), anti-Sm antibody, C-reactive protein (CRP), hemoglobin (Hb), platelet count (PLT), albumin (Alb), serum creatinine(Scr), urea, uric acid(UA), and immunoglobulin G(IgG) were significantly different (p < 0.05). Besides, age, SLEDAI, serositis, hypertension, diabetes, anti-SSB, CRP, Hb, PLT, FIB, Alb, Scr, urea, UA, GLU, and IgG were significantly correlated with SLE-related fundus lesions. PLT, fibrinogen (FIB), IgG, and urea were independent risk factors of SLE-related fundus lesions. The area under the curve (AUC) was 0.830 (p < 0.001; 95% CI = 0.762–0.898), and the nomogram was established with great evaluation efficiency demonstrated by the calibration curve and the Hosmer–Lemeshow test. The result of k-fold cross-validation also showed high prediction accuracy. Conclusions. We have found the independent risk factors of SLE-related fundus lesions and developed a model to improve the prediction of fundus lesions in SLE.

Introduction. Globally, hospitals are an important place in end-of-life care and most frequent place of death in Germany (47%), but at the same time, the least preferred one—both for patients and their informal caregivers. As hospital care in the dying phase on non-palliative care wards has rarely been studied systematically, we assessed the current state of care in the dying phase in hospitals as a first step. Methods. In an online survey, N = 165 national health experts were invited to answer eight open questions on care aspects, facilitators, barriers, and needs for improvement as well as COVID-19 pandemic specifics regarding hospital care in the dying phase. Sociodemographic data were analysed descriptively, and responses were analysed using qualitative thematic analysis. Results. Of n = 65 experts, 52% work as nursing staff and 30% as physicians. We identified facilitators, barriers, and needs for improvement regarding 11 topics on the following three levels: institutional level (general institutional conditions, hospital culture, and integration of specialist palliative care), team level (attitude towards and dealing with death and dying, competencies, communication, and teamwork) and care level (dying phase, symptom control, patient centredness, and involvement of informal caregivers). Conclusion. Improving care in the dying phase has to overcome barriers on various levels. We assume that rather “small” measures will find their way into clinical routine and contribute to the improvement of hospital care in the dying phase.

Most elderly persons suffer from chronic diseases. To treat chronic diseases, good medication adherence and refilling medication as physicians’ advice are key points of pharmaceutical therapy. However, the literature revealed that only limited studies have focused on the medication adherence of the elderly in rural communities. This study evaluated the adherence to medication and the degree of refilling prescriptions as physician’s advice by the Adherence to Refills and Medications Scale (ARMS) and evaluated the factors associated with poor adherence to medication. This cross-sectional study focused on the medication use of the elderly population in rural areas in western Taiwan and analyzed related personal and social factors which influence the behaviors of pharmaceutical therapy. In conclusion, most of the elderly who lived in rural areas in western Taiwan have poor adherence (ARMS score over 12) to medication and a poor degree of refilling prescriptions as per physicians’ advice. Moreover, age ≥75 years and low urbanization were significantly associated with poor adherence. Future research is warranted to assess the effect of the interventions to improve medication adherence on chronic disease control, disability, and mortality.

Background. Delayed cord clamping (DCC) for more than one minute is associated with nutritional and developmental benefits for newborns. However, there is limited evidence regarding the relationship between DCC and outcomes in resource-limited settings. This study aims to assess the effect of the time of cord clamping on serum bilirubin level 24 hours after birth in an Ethiopian Tertiary Care hospital. Methods. A three-arm, single-blind, exploratory randomized controlled trial was conducted between October 2019 and January 2020 targeting healthy, full-term neonates. Study participants were randomly assigned into one of the following intervention groups depending on the timing of cord clamping: immediate cord clamping (<30 seconds), intermediate cord clamping (60 seconds), and DCC (180 seconds). The primary outcome is serum bilirubin level in the newborns, which was assessed 24 hours after birth and before they were discharged home. Descriptive analysis was applied to assess differences between groups in terms of demographic, obstetric, and social characteristics of the participants, while a linear regression model was employed to examine the association between cord clamping time and serum bilirubin level. Result. A total of 141 term newborns were included and randomized into the three categories. The demographic, social, and obstetrics characteristics of included participants were not different across groups except for the labor duration (P value <0.05). While the time of cord clamping was not a significant predictor of total serum bilirubin levels at 24 hours postbirth, cord blood total serum bilirubin (coefficient: 0.24; p < 0.05) and bilirubin nomogram high-risk zone (coefficient: 6.25; p < 0.001) were found to be significant predictors. (4) Conclusion. Our findings indicate that the time of umbilical cord clamping does not affect the total serum bilirubin level of neonates at least within 24 hours of birth.