International Journal of Clinical Practice最新文献

Objectives. To determine the pericapsular nerve group (PENG) block’s postoperative analgesic efficacy and safety compared to the suprainguinal fascia iliaca (SFI) block in patients undergoing primary hip arthroplasty using the same injectate volume. Material and Methods. Between January 2021 and March 2022, American Society of Anesthesiologists Physical Status (ASA-PS) classification I–III patients scheduled for hip arthroplasty were included in this study. After standard monitoring and subarachnoid anesthesia, an ultrasound-guided PENG or SFI block with 20 ml of 0.25% levobupivacaine was performed for postoperative analgesia. All patients were assessed with a numerical rating scale (NRS) at presurgery, upon arrival at the postanesthesia care unit (PACU), and in the postoperative period at 2, 4, 12, and 24 hours. The need for analgesic rescue and adverse effects was also assessed. Results. A total of 130 patients were included in the study (62 PENG block and 68 SFI block). Both blocks were equally effective in managing postoperative pain without any statistically significant differences except at 12 h (p = 0.023), where the deviation found was not clinically relevant. The median total morphine consumption was 0 mg [0–2] in the PENG block group and 0 mg [0–2] in the SFI block group. A more significant motor block was found in the first 6 hours in the SFI block group (p = 0.001). There was no significant difference in the ease of performing PENG (79%) or SFI (85%) blocks. No major complications were recorded in both groups, and patient satisfaction was high (83.9% for the PENG block group vs. 91.2% for the SFI block group). Discussion. Both blocks have been demonstrated to be effective for postoperative analgesia in hip arthroplasty and should be integrated as a multimodal analgesic strategy. The lesser degree of motor block recorded in the first hours with the PENG block makes it the most suitable option for early recovery. Both techniques were easy and safe to perform.

Objective. Nonalcoholic fatty liver disease (NAFLD) is becoming more prevalent in the nonobese population. The aim of this study was to investigate the combined effects of metabolism-related mixtures on NAFLD subjects in nonobese populations using four statistical models. Study Design. This was a retrospective observational study. Methods. Our study included 904 nonobese patients who had taken part in the 2017-2018 National Health and Nutrition Examination Survey (NHANES). We used logistic regression models, Bayesian kernel machine regression (BKMR), and the weighted quantile sum (WQS) regression model to estimate the association between metabolism-related indicators and NAFLD in the nonobese population. Finally, we included several indicators to create nomograms to predict the risk of NAFLD occurrence in the nonobese population. Results. Among the 904 participants, 116 (12.83%) had NAFLD. The logistic regression model found that the waist-to-hip ratio (WHR), HDL-c, triglyceride (TG), and HbA1c were positively associated with the outcomes. The WQS regression model showed that the WQS index was significantly associated with the occurrence of NAFLD in the nonobese population (OR: 5.789, 95% CI: 3.933–8.520), and WHR, TC, and TG had the largest weight. The BKMR model’s WHR and TG increased from the 25th percentile to the 75th percentile (other metabolite exposure remained fixed at the 75th percentile) and the risk of developing NAFLD increased in the nonobese people. The significant predictors mentioned above were introduced to construct the nomogram. The calibration curve, DCA, and AUROC (0.796) (95% CI: 0.743–0.843) all indicated that the model had a good potential clinical performance. Conclusions. By comparing the results of the four models together, WHR and TG were identified as important factors associated with NAFLD in the nonobese population. Further research is warranted to investigate the risk factors and pathogeny of NAFLD in nonobese populations.

Background Aim. To compare the efficacy of omeprazole to other proton-pump inhibitors (PPIs) or placebo for the treatment of acid peptic disorders (APDs) using a comprehensive literature search including hard-to-access journals and non-English articles. Methods. PubMed, Google Scholar, and China National Knowledge Infrastructure were searched (from inception to March 2023) for trials comparing omeprazole to other types of PPIs or placebo for the treatment APD. Efficacy was analyzed separately for erosive diseases and nonerosive diseases. Primary outcomes included improvement of APD symptoms and frequency of ulcer or erosion healing. Secondary outcomes included adverse events, cost effectiveness, nocturnal acid breakthrough, and length of stay if hospitalized. Random and fixed-effects models were used to determine estimates of efficacy. Results. Thirty-one eligible trials (N = 10,539 participants) were analyzed, including 12 articles not typically included in previous reviews due to translation or journal access issues. Omeprazole significantly improved heartburn compared to placebo (RR = 2.47, 95% CI: 2.13 and 2.86, and p < 0.001) and was equivalent to the other five types of PPI. Omeprazole had significantly fewer patients reporting adverse events versus placebo (11% versus 31%, respectively) and other PPIs. Omeprazole was the most cost-effective PPI compared to the other types of PPIs in India. Conclusions. Omeprazole continues to be an effective proton-pump inhibitor to treat patients with acid peptic disorders and was well tolerated. Omeprazole was significantly better than placebo and was equivalent with other PPIs for curing heartburn and was equivalent to other PPIs for the healing of ulcers or erosions in addition to being the most cost-effective.

Diseases related to cartilage abnormalities pose a serious threat to human health. Normal cartilage contains only one type of cell, chondrocytes. This study aims to investigate the impact of inositol polyphosphate-5-phosphatase E (INPP5E) on chondrocytes and its underlying mechanisms. Following transfection of small interfering RNA INPP5E into chondrocytes, real-time quantitative PCR (RT-PCR) and western blot (WB) assays were conducted to detect the expression of intraflagellar transport 88 (IFT88), Bcl-2-interacting protein 1 (Beclin1), microtubule-associated protein 1 light chain 3 alpha (MAP1LC3A), microtubule-associated protein 1 light chain 3 beta (MAP1LC3B), phosphoinositide 3-kinase (PI3K), protein kinase B (Akt), mammalian target of rapamycin (mTOR), collagen type II alpha 1 chain (COL2A1), and cyclin D1 (CCND1). Furthermore, immunofluorescence was used to detect the expression of acetylated α-tubulin and microtubule-associated protein 1 light chain 3 (LC3) II. RT-PCR, WB, and the dual luciferase assay demonstrated the regulation between SNHG12, hsa-miR-181a-5p, hsa-miR-138-5p, and INPP5E. Functional recovery experiments were used to observe the regulation of these factors on IFT88, Beclin1, LC3 I, LC3 II, p-PI3K, p-Akt, p-mTOR, collagen II, and cyclin D1 in chondrocytes. The results showed that silencing INPP5E inhibited the mRNA and protein expressions of the investigated factors in chondrocytes. SNHG12 promoted INPP5E expression by inhibiting hsa-miR-181a-5p or hsa-miR-138-5p, which resulted in regulation of the expression of various factors via the hsa-miR-181a-5p/hsa-miR-138-5p-INPP5E axis in chondrocytes. These findings provide a theoretical basis for the treatment of patients with cartilage-related abnormalities.

Background. The severe pregnancy complication hyperemesis gravidarum (HG) requires intravenous fluids, antiemetics, and nutrition to prevent maternal and fetal complications. Several guidelines exist for the treatment of HG within and across countries. The aim of this study was to investigate whether the guideline issued by the Norwegian Society for Obstetrics and Gynecology (NGF) was implemented in clinical practice by comparing department treatment protocols and assessing provided treatment. Methods. Department protocols for the treatment of HG were requested from all Norwegian gynecology departments and compared to the NGF guideline regarding the use of Pregnancy Unique Quantification of Emesis (PUQE-24) score, antiemetics, thiamine, and fluid and nutritional therapy. Additionally, we performed a retrospective chart review of provided treatment during 2017–2019 at four hospitals. Results. In all, 28 of 39 (72%) departments replied, of which 11 reported using the NGF guidelines unaltered. Of the 17 local department protocols in use, 16 closely resembled the NGF guidelines regarding the use of PUQE score, fluid therapy, nutritional treatment, and thiamine. Eight department protocols differed slightly from the NGF guidelines regarding the antiemetic medication treatment pathway, and two recommended antiemetic medication not supported by national or international guidelines. The retrospective chart review of 343 patients at four hospitals showed that the provided care aligned with the guidelines regarding intravenous fluids and the use of PUQE score, and the use of antiemetics mostly aligned with the treatment pathway provided in the NGF guideline. However, the proportion of patients receiving ondansetron varied between 32% and 79% and thiamine from 38 to 86% between hospitals. Overall, few patients were provided with nutritional treatment by partial peripheral nutrition (14%), enteral tube feeding (8%), or total parenteral nutrition (1.5%). Conclusion. The NGF guideline was used unaltered or largely integrated in department protocols. Treatment data suggest that the guideline was implemented in clinical practice, but differences in the provision of ondansetron and thiamine suggest geographical inequality of care. Infrequent use of nutritional treatment by parenteral nutrition or enteral feeding tube could suggest improvements in pharmacological symptom management or undertreatment of malnutrition.

Background. The activation of complement is involved in monocyte recruitment in tuberculous pleural effusion (TPE), while the role of the cleavage product of complement C3 in this process needs further research. Methods. The expression of complement components in pleural biopsy specimens of TPE patients was measured. The concentration of cleavage products of complement was tested in TPE by ELISA. Moreover, the colocalizations of C3b and CR1, C3d and CR3, and CXCL12 and CXCR4 in monocytes and pleural mesothelial cells (PMCs) isolated from TPE were determined by an immunofluorescent assay. Monocyte chemotaxis assay was analyzed via transwell chambers. Results. Three pathways of the complement system were activated in tuberculous pleurisy. In patients with TPE, C3 lysis was more active than peripheral blood in pleural cavity. Tuberculous protein Mpt64 and anaphylatoxin C3a could significantly promote CXCL12 production in human PMCs isolated from TPE. C3b-CR1, C3d-CR3, and CXCL12-CXCR4 were colocalized in PMCs and monocytes from TPE. The recruitment of monocytes into TPE mediated by PMCs could be inhibited by anti-CR1, anti-CR3, and anti-CXCL12 monoclonal antibodies (mAbs). Conclusions. Complement activates strongly in TPE, and PMCs induced monocytes to the pleural cavity through C3a, C3b, and C3d.

Background. Osteoporosis “OP” is classified as one of the most serious health conditions worldwide. OP increases the skeletal fracture risk by 35%, particularly at hip, spine, and wrist joints. Healthcare professionals should be aware of OP clinical signs and have good knowledge while managing all patients. Objectives. This study aims to investigate the current level of osteoporosis knowledge and awareness among physical therapy providers in Saudi Arabia. Methods. One hundred and sixty-eight physical therapy providers participated in this cross-sectional electronic survey from February to July of 2021. The participants completed the Osteoporosis Knowledge Assessment Tool questionnaire (OKAT). Descriptive analysis was utilized to assess the current level of osteoporosis knowledge among physical therapy providers. Results. Among the 168 participants, 55% (n = 92) were over 31 years old and 45% (n = 76) were 30 years old or under. The majority of participants 37% (n = 62) had more than 10 years of experience, 45% (n = 76) mainly treat orthopedic conditions, and 70% (n = 117) live in the western region. The results showed that 67.9% (n = 114) of participants had good knowledge about osteoporosis, while 19.6% (n = 33) had poor knowledge, and only 12.5% (n = 21) had excellent knowledge. Conclusion. Physical therapy providers in Saudi Arabia have a good knowledge of osteoporosis. The overall OP preventive measure knowledge questions were poor. It is crucial for physical therapy providers to act appropriately to prevent falls and mitigate any potential risks.

Objective. To evaluate the effectiveness and safety of pericapsular nerve group (PENG) block for hip fracture surgery under spinal anesthesia. Methods. This meta-analysis was registered on INPLASY (INPLASY202270005). PubMed, Embase, Cochrane, CNKI, and Wanfang databases were searched to collect the randomized controlled trials of the PENG block applied to hip fracture surgery in the setting of spinal anesthesia, with the search period from inception to 1 May 2023. Two independent researchers gradually screened the literature, evaluated the quality, extracted the data, and eventually pooled data using RevMan 5.4. Results. Fifteen articles with 890 patients were enrolled. The combined results showed that the PENG block reduced pain scores during position placement (SMD = −0.35; 95% CI [−0.67, 0.02]; P = 0.04; I² = 0%). Subgroup analyses showed that compared to the unblocked group, the PENG block reduced pain scores at 12 h, 24 h, and 48 h postoperatively. The incidence of postoperative hypokinesia was reduced (RR = 0.11; 95% CI [0.01, 0.86]; P = 0.04; I² = 0.00%). The time to first walking was advanced (SMD = −0.90; 95% CI [−1.17, 0.63]; P < 0.00001; I² = 0%). Conclusion. The PENG block can reduce postoperative pain and pain during spinal anesthesia positioning, which is helpful to improve the operability and comfort of spinal anesthesia and facilitate postoperative muscle strength recovery and early activity.

Pandemics such as coronavirus disease 2019 (COVID-19) can manifest as systemic infections that affect multiple organs and show laboratory manifestations. We aimed to analyze laboratory findings to understand possible mechanisms of organ dysfunction and risk stratification of hospitalized patients in these epidemics. Methods. This retrospective study was conducted among patients admitted to COVID-19 referral treatment center, Shahid Sadoughi Hospital, Yazd, Iran, from April 21 to November 21, 2021. It was the fifth peak of COVID-19 in Iran, and Delta (VOC-21APR-02; B.1-617.2) was the dominant and most concerning strain. All cases were positive for COVID-19 by RT-PCR test. Lab information of included patients and association of sex, age, and outcome were analyzed, on admission. Results. A total of 466 COVID-19 patients were included in the study, the majority of whom were women (68.9%). The average age of hospitalized patients in male and female patients was 57.68 and 41.32 years, respectively (p < 0.01). During hospitalization, abnormality in hematological and biochemical parameters was significant and was associated with the outcome of death in patients. There was incidence of lymphopenia, neutrophilia, anemia, and thrombocytopenia. The changes in neutrophil/lymphocyte (N/L) and hematocrit/albumin (Het/Alb) ratio and potassium and calcium levels were significant. Conclusion. Based on these results, new biochemical and hematological parameters can be used to predict the spread of infection and the underlying molecular mechanism. Viral infection may spread through blood cells and the immune system.