International Journal of Clinical Practice最新文献

Purpose. To design a new nomogram predicting the probability of stone-free status of shock wave lithotripsy (SWL) in patients with ureteral stones. Materials and Methods. We retrospectively enrolled 2,144 patients with ureteral stones who underwent SWL between January 1993 and April 2020. The demographic and clinical parameters were assessed. The predictors of stone-free status following SWL were identified. A logistic regression-based nomogram was created by including the significant predictors in the multivariate analysis. Results. The mean age was 42.93 ± 13.85 in the stone-free group (Group 1) and 46.51 ± 13.66 in the treatment-failure group (Group 2) (p = 0.001). The cutoff value of the age was 45.5 years. The mean stone load was 0.71 ± 0.36 cm² in Group 1 and 0.96 ± 0.51 cm² in Group 2 (p = 0.001). Of the 2,144 patients, 1,708 (79.6%) were stone-free within the first three SWL sessions. According to the multiple logistic regression analysis, older age, a stone load larger than 1 cm², the presence of multiple stones, third-generation lithotripter use, and pre-SWL catheterization were statistically associated with low stone-free rates. The C-index was determined to be 0.75 in the bootstrapping method. Conclusion. A stone load larger than 1 cm², age older than 45.5 years, the presence of multiple stones, new- (third-) generation lithotripter use, and pre-SWL catheterization had statistically significant effects on lower stone-free rates in patients who underwent SWL due to ureteral stones. A nomogram was developed to predict the success of SWL. As a result of the internal validation of the nomogram, it was concluded to be suitable for clinical use.

Introduction. Fiberoptic bronchoscopy (FOB) and endobronchial ultrasonography (EBUS) are safe and frequently used minimally invasive procedures. However, the decision to undergo an interventional procedure causes anxiety development and negative consequences in the individual. Objective. To determine the role of the State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), visual analog scale (VAS), and serum copeptin levels, their sensitivity, specificity, and the correlation between them in the anxiety levels of patients before undergoing FOB and EBUS. Method. A total of 219 patients who were scheduled to undergo FOB/EBUS were included in this prospective observational study. Demographic data were recorded. Patients’ anxiety levels before the procedure were evaluated using STAI-SA, STAI-TA, BAI, and VAS. Copeptin levels were measured before and after the procedure. Results. Patients were moderately anxious according to STAI-SA, STAI-TA, and VAS and were mildly anxious according to the BAI. Women and patients aged under 65 years were significantly more anxious. All scales were positively correlated. Serum copeptin levels before the procedure were 5.8 ± 4.8 and 4.3 ± 3.9 ng/mL afterwards, with a significant difference between them. The specificity and sensitivity of VAS were found to be the highest. Conclusion. All anxiety scales are correlated with each other, and we recommend VAS as a powerful alternative for determining anxiety levels in terms of easier understanding and implementation. Serum copeptin levels before the procedure were significantly higher than afterwards and may be used as a potential biomarker for preprocedural anxiety.

Aims. To analyze the short-term and long-term outcomes of laparoscopy versus laparotomy in treatment of endometrioid adenocarcinoma and examine the benefits of laparoscopy. Methods. From January 2012 to July 2020, 693 endometrioid adenocarcinoma patients undergoing laparoscopy versus laparotomy were retrospectively identified and enrolled in this study. Basic information for the patients, their perioperative indexes, and recurrence rates were reviewed to assess the therapeutic effect of these two approaches for endometrioid adenocarcinoma. Results. A total of 365 endometrioid adenocarcinoma patients underwent laparoscopy, and 328 patients underwent laparotomy. When compared with the laparotomic group, the laparoscopic group had longer operative times, lower intraoperative bleeding volumes, and shorter postoperative hospital stays. The rate of less-radical hysterectomy and radical hysterectomy performed in the laparoscopic group (59/365, 16.16%) was significantly lower than that in the laparotomic group (162/328, 49.39%). There was no statistically significant difference in the local recurrence rate between the two groups; however, the remote recurrence rate in the laparotomic group (15/308, 4.87%) was significantly higher than that in the laparoscopic group (3/351, 0.85%). A further subgroup analysis revealed a higher survival benefit both in I/II patients (314/314, 100%, vs. 7/242, 28.93%) and III/IV patients (35/37, 94.59%, vs. 51/66, 77.27%) in the laparoscopic group, when compared with the laparotomic group. Conclusion. Patients who received laparoscopic surgery had a faster surgical recovery and a lower postoperative recurrence rate in the short term than patients who received laparotomic surgery. Laparoscopic surgery is a safe and effective treatment for endometrioid adenocarcinoma.

Aim. The primary objective of this study was to investigate the attitudes towards the COVID-19 vaccine, the extent of vaccine hesitancy, and the factors influencing the Family Healthcare Center staff who are responsible for delivering primary healthcare services. Methods. The research, which employed a cross-sectional design, was carried out with a sample of 102 healthcare professionals employed at family healthcare centers located in the city center. The study data were collected using three instruments: the “Personal Information Form,” the “Vaccination Hesitancy in Pandemic Scale,” and the “Attitudes towards COVID-19 Vaccine Scale.” Results. A total of 13.7% of the participants said that they were hesitant about having themselves vaccinated. The mean total score of vaccine hesitancy in the pandemic was found to be 22.760 ± 8.323, and the attitude towards the COVID-19 vaccine was 3.640 ± 0.831. A negative and weak relation was detected between the total score of vaccine hesitancy and the total score of attitude towards the COVID-19 vaccine in the pandemic. It was also found that the situation of considering the vaccine as partially necessary increases the vaccine hesitancy in the pandemic and the decrease in the degree of considering the childhood vaccines as necessary decreases the attitude towards the COVID-19 vaccine. Discussion. Despite the relatively low prevalence of vaccination hesitancy among healthcare workers, it remains a noteworthy concern. It is imperative to conduct a thorough investigation into the various factors that contribute to vaccine hesitancy and the attitudes held by healthcare professionals, with a particular focus on those factors having a negative impact.

Background. Gliomas are primary malignant tumors of the central nervous system. The TEA domain transcription factor (TEAD) family proteins are the ultimate effector molecules of the Hippo pathway. However, their expression and function in gliomas have not been further studied. Methods. This study employed R software as the primary analysis tool. Public databases were used to analyze the expression and prognostic significance of TEADs. Functional enrichment analyses were conducted to determine the functions of the TEADs. We then explored their interaction with tumor-infiltrating immune cells and immune checkpoint proteins (ICPs). A Cox regression model was used to estimate the prognostic value of the TEADs. Finally, we conducted experiments to confirm TEAD3’s function in vitro. Results. TEAD expression was frequently increased in glioma and other malignant tumors. High TEAD expression was found to be substantially linked with isocitrate dehydrogenase (IDH) wild type, noncodeletion of 1p/19q, high WHO grade, and poor prognosis in glioma patients. Functional analyses revealed TEAD involvement in cancer cell transcription. The high expression of TEADs was greatly related to the myeloid-derived suppressor cells (MDSCs) and regulatory T-cells (Tregs) infiltration. TEADs also showed significant correlations with ICP expression in glioma tissues. The Cox regression model demonstrated significant diagnostic and prognostic efficacy in glioma patients. The reduction in TEAD3 affects tumor cell proliferation, migration, invasion, and immune regulation. RNA sequencing disclosed that TEAD3 regulates immune-related pathways, including negative regulation of the CTLA4 inhibitory pathway. Higher TEAD3 expression portended shorter overall survival (OS) and disease-free survival (DFS) in patients with gliomas based on clinical samples. Conclusions. TEADs are overexpressed in gliomas and are associated with a poor prognosis. Importantly, this study discovered that TEADs influence the immunological milieu of glioma by modulating genes associated with immune infiltration.

Cognitive dysfunction is the most common and important nonmotor symptom in Parkinson’s disease (PD) and can occur at any stage. However, there is still a lack of effective biomarkers to evaluate the decline in cognitive function and predict the progression of the disease, especially in the early stage. At present, the cognitive scale is widely used to evaluate the cognitive function of patients with PD, but its sensitivity and accuracy are relatively limited, especially in the early identification of mild cognitive impairment. Eye movement tracking is an advanced neurophysiological measurement method that serves as a powerful means to study the relationship between behavior and neural mechanisms. In recent years, eye movement tracking has been found to provide a nonverbal and less cognitive method to measure the disease progress of patients with cognitive impairment. Moreover, there is a good correlation between eye movement tracking and the traditional cognitive assessment scale, indicating that eye movement tracking can be used to evaluate and monitor the cognitive status, disease severity, and disease progression of patients with PD. Compared to the traditional cognitive scale, the eye movement detected by the instrument has better objectivity and repeatability. Existing studies have found that executive dysfunction is one of the most important manifestations of cognitive dysfunction in patients with PD and is related to an increase in the error rate of the saccade, an increase in the disinhibition of the delayed saccade task, and a prolongation of the saccade reaction time. This suggests that eye movement measurement plays an important role in the early diagnosis, progression, and differential diagnosis of PD and may even help to predict the disease progression of patients with PD and cognitive impairment. In this article, we review the correlation between cognitive impairment and eye movement disorder in patients with PD.

Background. The effects of oligopin as an antioxidant on polycystic ovarian morphology (PCOM) have not yet been examined. Therefore, the objective of this study was to evaluate the oligopin supplementation on PCOM among patients with polycystic ovarian syndrome (PCOS). Methods. This randomized, placebo-controlled trial was carried out at Shariati Hospital, Arash Hospital, and Yas Hospital, Tehran, Iran, to determine the effect of oligopin (50 mg/d) or placebo in PCOS patients. The ultrasonographic ovarian morphology was assessed in women aged 18–40 years, before and after 3 months of intervention. Results. Among 45 randomized participants, 32 participants, of whom 17 were in the oligopin group and 15 were in the placebo group completed the trial. There was only one adverse event in the oligopin group. The mean (standard deviation) age of the patients was 30.47 (6.30) years and the median (interquartile range) BMI was 27.50 (23.42–33.55). Three months of oligopin therapy significantly decreased ovarian stromal area (p = 0.01) and stromal/total area (p = 0.003). However, no significant differences were observed in the ovarian volume, ovarian area, 2–9 mm antral follicle counts, or peripheral follicle distribution pattern at 3 months. Conclusion. Among participants with PCOS, the use of oligopin (50 mg) daily, as compared with a placebo, resulted in improvement of the stromal area and stromal/total area at the end of the 3 months of treatment. Further studies are, however, needed to evaluate the longer-term efficacy and safety. This trial is registered with IRCT20140406017139N3.

Growth charts (GCs) are essential tools for monitoring children’s growth and overall health status. The extent to which healthcare professionals in Saudi Arabia (SA) use national and international GC, and adhere to standardized practices remains unclear. This study aimed to investigate current GC practices among healthcare practitioners in SA. A cross-sectional study was conducted on 193 healthcare practitioners in SA who completed an online questionnaire that assessed their characteristics and practices related to the use of GC. Descriptive, bivariate, and logistic regression analyses were performed. Participants reported using different GCs during the assessments, with the following distribution: GC of the Centers for Disease Control and Prevention (CDC) (24%), GC of the World Health Organization (WHO) (22%), Saudi GC (21%), and more than one type of GC (30%). Among the participants, 62% recorded GC data for both sick and well child, and 72.5% used GC with new and follow-up children. Only 56% reported discussing the GC output with patients or parents. Adjusting for covariates, dietitians were more likely to use GC with new and follow-up patients (odds ratio (OR): 2.61, 95% confidence interval (CI): 1.13, 6.02) and regularly discuss GC output with patients/parents (OR: 2.65, 95% CI: 1.29, 5.43) compared to other healthcare practitioners. Our findings showed significant variability in the use of GC among healthcare professionals in SA. The limited adoption of Saudi GC warrants further investigation to address practice obstacles and monitor children’s growth.

Background. This study utilized network pharmacology and bioinformatics analysis to identify the hub genes influenced by scopolamine in lung cancer. Methods. The effect of scopolamine on lung cancer was investigated by cell invasion assay and cell scratch assay. The analysis involved protein-protein interaction (PPI) networks topology analysis to identify these genes, and subsequent differential analysis and survival analysis were conducted using gene expression profile interaction analysis (GEPIA). Furthermore, the findings were supported by molecular docking experiments for verification. Results. Results from cell invasion and scratch assays suggest that scopolamine inhibits the migration of lung cancer cells. JAK2, JAK3, CCR5, and ACE were identified as the top four hub genes that have an impact on lung cancer. KEGG enrichment analysis revealed that the scopolamine response in lung cancer is significantly associated with ten pathways, including “neuroactive ligand-receptor interaction in cancer,” “PD-1 checkpoint pathway in cancer,” “chemokine signaling pathway,” “PD-L1 expression,” and others. Additionally, the expression levels of JAK2, JAK3, CCR5, and ACE were found to be correlated with survival in patients with lung cancer. Furthermore, molecular docking experiments demonstrated that scopolamine binds and forms stable complexes with the protein products of all four aforementioned genes. The main targets of scopolamine in the treatment of lung cancer are JAK2, JAK3, CCR5, and ACE. Conclusion. Scopolamine has a significant effect on various cellular functions in lung cancer cells, potentially reducing the likelihood of metastasis. Based on these findings, it is recommended to consider administering scopolamine as part of the preoperative phase for patients with lung cancer.

Objective. To investigate the potential association between nonalcoholic fatty liver disease (NAFLD) and colon polyps in Taiwan. Methods. We utilized 2006–2015 claims data of the Taiwan National Health Insurance Program as a data source. A case-control study was conducted, involving individuals 20 years or older with and without colon polyps. Cases comprised individuals diagnosed with colon polyps, identified through diagnosis codes. Controls were selected from individuals without colon polyps, matched to cases based on sex, age, and comorbidities. NAFLD was identified based on diagnosis codes. The logistic regression model with odds ratio (OR) and 95% confidence interval (CI) was employed to assess the association between NAFLD and colon polyps. Results. The study included 16,890 cases with colon polyps and 67,560 matched controls without colon polyps. The mean age was 57 years old and about 61% of study subjects were males. Among cases with colon polyps, 1.0% had a diagnosis of NAFLD, whereas only 0.4% exhibited NAFLD in the control group. After adjustment for confounding variables, a multivariable logistic regression model revealed a statistically significant association between NAFLD and colon polyps, with an odds ratio of 2.32 (95% CI = 1.91–2.82). Conclusion. This case-control study suggests a positive association between NAFLD and colon polyps. These results contribute to our understanding of the potential links between NAFLD and gastrointestinal health.