International Journal of Clinical Practice最新文献

Objective: To develop a predictive model for estimating the depth of the tibial nerve using anthropometric and demographic data to improve the safety and accuracy of needle-based interventions.

Design: Cross-sectional observational study.

Setting: European University of Madrid, Spain.

Methods: Fifty volunteers aged 18–45 years, without any conditions affecting muscle tone, significant lower limb asymmetries, or history of lower limb surgeries. Demographic and anthropometric data, including sex, age, height, weight, BMI, and measurements of leg length and circumference at specific points, were collected. Ultrasound imaging was used to measure the depth of the tibial nerve at the popliteal fossa and mid-third of the leg.

Results: The predictive model identified leg girth at the mid-third as a significant predictor of tibial nerve depth, explaining 22.3% of the variance (R² = 0.223, p < 0.05). Gender and leg girth together explained up to 17.8% of the variance for proximal tibial nerve depth (R² = 0.178, p < 0.05). Additionally, males exhibited greater leg length (mean = 95.9 cm) compared to females (mean = 90.8 cm, p = 0.01), with no significant difference in tibial nerve depth between genders (p > 0.05). Strong correlations were observed between tibial nerve depth and BMI at both the proximal and mid-third levels (r = 0.4–0.5, p < 0.001).

Conclusion: This predictive model shows that leg girth and gender are significant predictors of tibial nerve depth in a healthy cohort. However, its clinical utility remains preliminary and requires external validation in larger, diverse, and pathology-specific populations to confirm broader applicability in clinical settings.

Background: Peroxisome proliferator-activated receptor-gamma coactivator-1α (PGC-1α), a regulator of mitochondrial function, plays a critical role in inflammation and may be involved in cystitis glandularis (CG) development.

Methods: LPS was administered to establish a CG model in female Sprague–Dawley (SD) rats and to induce cellular injury in the human urothelial cell line SV-HUC-1. Subsequently, to elucidate the role of PGC-1α signaling in CG, both the animal and cellular models were treated with ZLN005, a specific activator of PGC-1α. Cell viability was assessed using the cell-counting kit-8 (CCK8) assay. Mitochondrial damage was quantified by measuring reactive oxygen species (ROS), assessing mitochondrial membrane potential, and examining mitochondrial ultrastructure via transmission electron microscopy (TEM). Enzyme-linked immunosorbent assays (ELISA) were utilized to determine the levels of inflammatory cytokines, namely, IL-1β, IL-6, and TNF-α. Furthermore, the protein expression of silent information regulation 1 (SIRT1), PGC-1α, mitochondrial transcription factor A (TFAM), nuclear respiratory factor 1 (NRF1), and nuclear respiratory factor 2 (NRF2) was evaluated using immunohistochemistry and/or Western blot analysis.

Results: LPS-treated rat bladder exhibited histological characteristics of CG, including increased urothelial proliferation and inflammation. PGC-1α protein levels were downregulated in human CG tissues, LPS-treated rat bladders, and SV-HUC-1 cells. Mitochondrial damage was observed in both rat CG and LPS-irritated cells with elevated ROS and diminished mitochondrial membrane potential. TEM documented mitochondrial morphological injury of the urothelium in rat CG. ZLN005 attenuated LPS-induced epithelial hyperplasia and inflammatory cytokine secretion in the rat CG model. Furthermore, ZLN005 partially reversed LPS-induced mitochondrial damage, as indicated by reduced ROS levels, restored mitochondrial membrane potential, and mitigated mitochondrial morphological injury in both rat CG and LPS-stimulated cells. In addition, ZLN005 restored the expression of PGC-1α and its associated signaling proteins SIRT1, TFAM, NRF1, and NRF2.

Conclusions: The downregulation of PGC-1α suggests its potential as a molecular marker for the progression of CG. Targeting the PGC-1α signaling pathway may offer an effective therapeutic intervention for the clinical management of CG.

Background: The prior studies showed that nanocurcumin (NC) has potential anti-viral properties against a wide range of viral infections, making it a promising candidate for treating COVID-19. This study aimed to investigate the effect of NC supplementation on the acute phase proteins, including interleukin-6 (IL-6), C-reactive protein (CRP), albumin (ALB) and Erythrocyte Sedimentation Rate (ESR), and biochemical markers including lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine transaminase (ALT) and complete blood cells (CBC) in the hospitalized patients with Coronavirus disease 2019 (COVID-19).

Methods and Materials: In a double-blind placebo-controlled clinical trial conducted at Ali-Asghar Hospital of Shiraz University of Medical Sciences, 76 COVID-19 patients with mild to moderate disease severity were randomly assigned to two groups. All patients received the national treatment guideline for COVID-19. The intervention group was administered 160 mg/day of NC for a period of 2 weeks. Blood samples were obtained at the start and the end of the research, and nutritional consumption was determined using a 24 h dietary recall.

Results: The mean age of participants in the NC and placebo groups was 54.69 ± 13.44 and 53.94 ± 11.62 years, respectively. In the NC group, compared with placebo group, the levels of IL-6 (p = 0.017) and LDH (p = 0.004) was significantly reduced. There was no significant difference in the mean changes of AST (p = 0.197), ALT (p = 0.086), ALB (p = 0.560), CRP (p = 0.197), ESR (p = 0.298), hemoglobin (Hb) (p = 0.372), white blood cells (WBC) (p = 0.995), neutrophils (p = 0.264), and lymphocyte (p = 0.418) between two groups.

Conclusion: According to the research results, it seems that adding NC supplementation to the treatment plan for COVID-19 patients who are hospitalized and have mild to moderate illness severity might possibly reduce inflammation.

Trial Registration: ClinicalTrials.gov identifier: IRCT20211126053183N1.

Background: We investigated a visual model for estimating prognosis in older patients with nonmetastatic nasopharyngeal carcinoma (NPC) and analyzed the survival rates in different patient groups during intensity-modulated radiotherapy (IMRT).

Methods: Between January 2012 and March 2021, patients with NPC aged > 65 years who received IMRT and were initially diagnosed with no distant metastases were enrolled. Propensity score analysis with 1:1 matching was used to balance baseline characteristics, including age, sex, tumor stage, and comorbidities. Kaplan–Meier analysis was used to calculate survival. Cox regression analysis was used to identify independent prognostic factors for overall survival (OS). A nomogram was constructed based on the determined prognostic factors, and prediction accuracy was evaluated using receiver operating characteristic (ROC) and calibration curves.

Results: In total, 140 patients were included in the analysis (median age: 69 years; range: 66–81 years). The median follow-up was 84.9 (26.2–131.5) months. Compared with radiotherapy (RT) alone, chemotherapy during RT failed to improve OS (54.2% vs. 50.0%, respectively; p = 0.969), cancer-specific survival (CSS) (59.1% vs. 60.5%, respectively; p = 0.712), distant metastasis–free survival (DMFS) (66.7% vs. 70.5%, respectively; p = 0.824), or locoregional relapse–free survival (LRFS) (85.0% vs. 86.9%, respectively; p = 0.811). After the final regression analysis, age, age-adjusted Charlson comorbidity index (ACCI) score, N stage, and total stage were identified as independent factors affecting OS prognosis. The OS nomogram was applied to the data and, based on the value of the area under the ROC and calibration curves, demonstrated satisfactory predictive performance.

Conclusions: Survival outcomes in older patients with NPC treated with RT alone were similar to those in patients treated with both chemotherapy and RT. Our nomogram had good performance in predicting OS in older patients with NPC and may benefit the clinical decision-making process.

Studies on depression aggravation in hospitalized elderly patients with chronic heart failure (CHF) are scarce. This study analyzed the influencing factors for depression and depression aggravation in elderly CHF patients in China. A total of 196 elderly CHF patients admitted to Xuanwu Hospital from March 2019 to October 2022 were consecutively selected. Information such as demographics, comorbidities, primary disease and etiology, elderly hospitalization assessment, laboratory test outcomes, cardiac function, oral medications for CHF, and management during hospitalization were collected on admission. The patients were divided into the depressed and nondepressed groups according to their depression scores, and the independent predictors for depression were analyzed using multivariable logistic regression. Another depression assessment was performed at discharge, and independent factors for worsened depression during hospitalization were also analyzed. A high frailty index score was an independent predictor for depression in elderly CHF patients. The overall depression score of the patients at discharge was significantly higher than that on admission. Low educational attainment, a low left ventricular ejection fraction, long hospitalization, and admission to the intensive care unit (ICU) were independent predictors for depression exacerbation during hospitalization. Clinical assessment of depression is necessary for elderly hospitalized CHF patients, particularly for those who have low education, a high frailty index score, a low left ventricular ejection fraction, ICU admission, and long hospitalization. The findings of this study may deepen our understanding of depression in elderly CHF patients.

Background: Chronic kidney disease (CKD) is a global public health concern, affecting approximately 850 million people worldwide. Guidelines recommend early identification and management of CKD to mitigate disease progression and delay the onset of complications. Recording a CKD diagnosis in medical records is associated with improved kidney function and blood pressure monitoring, better use of disease-modifying therapy, and reduced risk of CKD progression. REVEAL-CKD is a multinational, observational study that aims to estimate the prevalence of stage 3 CKD which is unrecorded in administrative databases.

Methods: Data were extracted from country-specific databases of patient medical records in Australia, Brazil, Canada, England, and Spain. Included patients (aged ≥ 18 years) had two consecutive estimated glomerular filtration rate (eGFR) measurements between 30 and < 60 mL/min/1.73 m² taken 91–730 days apart. Patients were considered to have unrecorded CKD if they had no CKD diagnosis code (any stage) at any time before and up to 6 months after study index (date of second qualifying eGFR).

Results: Across countries, median age was 72–78 years, median eGFR was 46.5–53.5 mL/min/1.73 m², and availability of urinary albumin—creatinine ratio testing ranged from 4.9% (Brazil) to 53.5% (Canada). The prevalence of unrecorded stage 3 CKD was 90.0% (1002/1113 patients) in Australia, 97.0% (10,925/11,262) in Brazil, 92.0% (42,226/45,914) in Canada, 56.9% (84,237/148,153 in England, and 84.8% (27,035/31,866) in Spain.

Conclusions: More than half of the patients with laboratory evidence of stage 3 CKD lacked a CKD diagnosis code in all countries examined. Substantial intercountry variations in rates of CKD recording and testing were observed. International sharing of best practice guidance, systematic changes to improve data quality, and increased awareness of the importance of timely coding among healthcare professionals will help to improve accurate recording of stage 3 CKD.

Trial Registration: ClinicalTrials.gov identifier: NCT04847531.

Background: Sepsis is a leading cause of mortality worldwide, and increasing studies have found that high ratio of blood urea nitrogen to blood albumin ratio (BAR) was associated with mortality in inflammatory diseases. We used a multicenter database and propensity score–adjusted approach to address the mortality association of BAR in critically ill septic patients.

Methods: Using the eICU Collaborative Research Database, we enrolled adult septic patients who fulfilled the sepsis-3 criteria. We used Cox proportional hazards analysis and propensity score–adjusted analyses, consisting of propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and covariate balancing propensity score (CBPS) to determine hazard ratios (HRs) and 95% confidence intervals (CIs) of in-hospital all-cause mortality.

Results: We analyzed data from 8069 critically ill septic patients in 335 ICUs. The median age was 67 (interquartile range, 56–79) years, with 46.9% being female. The nonsurvivors (31.4%) were older and had higher APACHE IV scores, more shock, and more mechanical ventilation usage. Cox regression identified that higher BAR was independently associated with increased mortality (adjusted HR 1.247, 95% CI 1.142–1.361) after adjusting for covariates. The propensity score–based approach found a consistent and robust association, with adjHRs in the PSM, IPTW, and CBPS populations were 1.191 (95% CI 1.074–1.321), 1.178 (95% CI 1.068–1.299), and 1.215 (95% CI 1.111–1.329), respectively.

Conclusions: This multicenter study demonstrated that high BAR, which is a ready-for-use biomarker in critical care, correlated with increased mortality in critically ill septic patients, and more studies are warranted to explore the underlying mechanism.

Chinese government had implemented 8 rounds of National Centralized Drug Procurement (NCDP) in mainland China from 2019 to 2023. The purpose of this study is to assess the affordability profile and variation of policy-related antihypertensive drugs in the context of NCDP, generic substitution, and basic medical insurance policy pre-NCDP (in 2018) and post-NCDP (in 2023) in Xi’an. The affordability of 34 NCDP policy-related drugs, including 17 bid-winning generic drugs (GDs) in the NCDP list and 17 originator brands (OBs) containing the same ingredients with these GDs, was analyzed and compared, respectively, by the standard survey method of World Health Organization and Health Action International (i.e., the ratio of monthly out-of-pocket expenditure to minimum daily wage standard). Under pre-NCDP policy, the monthly out-of-pocket drug cost of all OBs and 10 GDs was more than 1 day’s wage and was unaffordable. Under post-NCDP policy, the affordability of all drugs was improved dramatically; for uninsured patients, 11 OBs and only GD (lercanidipine tablets) were still unaffordable; for patients with Urban Employee Basic Medical Insurance, all of OBs and GDs were affordable, and for patients with Urban and Rural Residents Basic Medical Insurance, 7 OBs were unaffordable, and all of GDs was considered affordable. The implementation of the NCDP policy had remarkably enhanced affordability of selected drugs. GDs are more affordable than OBs. There was obvious affordability discrepancy between outpatients with different types of medical insurance in Xi’an. To enhance affordability of antihypertensive drugs, more effective and long-term measures should be implemented, such as expanding the scope of centralized purchased drugs, promoting substitution of GDs for OBs, and increasing reimbursement of outpatient drug expenses for patients with urban and rural residents’ basic medical insurance.

Sport concussion receives substantial attention as a public health concern. Conversely, performing artists, including dancers, sustain concussions, but these aesthetic athletes do not receive the same level of consideration nor care for this injury as that offered to traditional athletes. The concussion literature pertaining to dance is sparse, and, to our knowledge, no recommendations exist for the crucial aspect of care related to returning to dance following a concussion. The purpose of this article is to assimilate the current knowledge about post-concussion return to activity management in sport—the closest analog of the physical demands required in dance—as a means to delineate a framework for returning to dance following a concussion. Specific guidance is provided based on a review of evidence-based practice so clinicians can ensure that dancers return safely to both their dance activity and any academic work they are required to undertake. Concussion in dance is not an infrequent occurrence and dancers and healthcare practitioners alike will benefit from dance-specific guidance for returning to dance post-concussion. Overall, the principles that form the foundation for return-to-sport decisions are remarkably robust for application to dance.

Introduction: The working principle of artificial intelligence in medicine is primarily as follows: The data are collected and entered into the system, the computer uses an algorithm to gather information via these data, and finally, it analyzes this algorithm to utilize in the diagnosis and treatment of the disease. In this study, we investigated the achievement of mammographic breast area/microcalcification cluster area ratio (BA/MCA) in the grouping of BI-RADS 4 (a, b, c) lesions. We planned to contribute to the development of artificial intelligence in medicine with a simple calculation program to be attached to the mammography computer.

Methods: 125 patients who underwent surgery with the diagnosis of mammographic BI-RADS 4 lesion (could not be detected in lesion-specific ultrasonography) between 2019 and 2022 in the Department of Surgical Oncology of Health Sciences University Gulhane Medical Faculty Training and Research Hospital were retrospectively examined. The mammographic MCA was divided by the breast area and their ratio was calculated. The relationship between the ratios we found and the BI-RADS values defined by radiology was analyzed.

Results: We found the median BA/MCA value of BI-RADS 4a patients to be 24943.5, BI-RADS 4b patients to be 12609.2, and BI-RADS 4c patients to be 11547.1 (p = 0.003). According to ROC curve analysis, we detected the BA/MCA ratio for BI-RADS 4c to be 14183.34 (AUC = 0.686, p = 0.005, sensitivity 54.2%). This ratio is inversely related, and the probability of BI-RADS 4c increases in patients with a BA/MCA ratio less than 14183.34. We revealed that the malignancy rate of radiological BI-RADS 4c patients was 90%, and the cutoff value of BI-RADS 4c patients was 72%. Using both classifications together, we detected the malignancy rate to be 98%.

Conclusion: The increase in the ratio of MCA to BA might have a place in the differentiation of BI-RADS 4 lesions. We foresee that artificial intelligence could also have a place in the classification of BI-RADS lesions with software to be installed on the mammography computer.