International Journal of Clinical Practice最新文献

Background

Post-COVID syndrome (PCS) is a condition that occurs after COVID-19 infection that lasts for more than three months and adversely affects the autonomic nervous system (ANS). The aim of this study was to investigate and compare the effectiveness of transcutaneous auricular vagus nerve stimulation (taVNS) and sham taVNS in fatigue in individuals with PCS.

Methods

Forty-two patients (20 male, 22 female) with PCS participated in this study. The severity of fatigue was assessed with the fatigue severity scale (FSS). Heart rate variability (HRV) was measured in participants at baseline and after taVNS. The participants were randomly divided into two groups (taVNS and sham taVNS). taVNS was applied for 20 consecutive days for 30 min each (10 Hz, 300 μs).

Results

The groups were similar in FSS and HRV at baseline (p > 0.05). After the intervention, FSS decreased in taVNS (p = 0.018) and sham taVNS (p = 0.036). RMSSD increased in taVNS (p = 0.010), with no change in sham taVNS (p > 0.05) from baseline to after treatment. Stress index showed no change in both groups (p > 0.05). PNS index increased in taVNS (p = 0.007) and sham taVNS (p = 0.049). The SNS index and low frequency (LF) power decreased in taVNS (p = 0.001, p = 0.017, respectively), with no change in sham taVNS (p > 0.05). High frequency (HF) power showed no change within groups (p > 0.05). LF/HF decreased in taVNS (p = 0.002), with no change in sham taVNS (p > 0.05). Pre- and Post-tests showed taVNS was more effective than sham taVNS in decreasing FSS (p = 0.022) and LF power (p = 0.029), in increasing PNS index (p = 0.016). There was a difference in HF power between groups after treatment (p = 0.042).

Conclusion

Both taVNS and sham taVNS were effective in reducing the severity of fatigue, with sham taVNS being superior to taVNS. The observed effect size was smaller than anticipated. This suggests that larger-sample-size studies are required to verify these results.

Trial Registration: ClinicalTrials.gov identifier: NCT05679505.

Background

Gastric cancer (GC) represents one of the leading malignancies globally. Although notable progress has been achieved in diagnostic and therapeutic approaches, the prognosis of advanced GC patients remains unsatisfactory. Recent studies suggest that Glia maturation factor beta (GMFB) participates in cancer progression; however, the precise function and clinical relevance of GMFB in GC are not fully elucidated.

Methods

GMFB expression was assessed utilizing publicly available databases and further confirmed through immunohistochemistry (IHC) analysis in GC tissues. Associations between GMFB expression and multiple clinicopathological parameters were investigated. Survival outcomes were analyzed using Kaplan–Meier (KM) methods to evaluate GMFB’s prognostic significance. In order to investigate biological functions, GMFB expression was reduced in AGS and HGC-27 GC cells, subsequently evaluating alterations in proliferation, migration, invasion, and processes related to epithelial-mesenchymal transition (EMT). Functional experiments were performed to assess the biological effects of GMFB downregulation.

Results

GMFB expression exhibited a significant increase in GC cell lines and tissues when contrasted with their normal counterparts. Elevated expression levels of GMFB showed a significant correlation with advanced tumor stage, lymph node metastasis (LNM), and a poor prognosis. The KM survival curves indicated a significant association between increased GMFB levels and a decrease in both progression-free interval (PFI) and disease-free interval (DFI), with p values less than 0.001 for both measures. The downregulation of GMFB significantly inhibited the proliferation of GC cells and diminished both migration and invasive capabilities. Moreover, the inhibition of GMFB expression led to downregulation of EMT-associated proteins, including N-cadherin, vimentin, SLUG, and SNAIL, along with upregulation of the epithelial marker E-cadherin, suggesting that GMFB may play a role in tumor progression by enhancing EMT.

Conclusion

GMFB is overexpressed in GC, contributing to tumor growth, migration, and EMT processes. GMFB represents a promising prognostic indicator and potential therapeutic target for GC.

Objectives

This study aimed to investigate the prevalence and characteristics of spinning-induced rhabdomyolysis in Chinese patients.

Methods

Patients with exercise-induced rhabdomyolysis at a single center from Jun 1, 2010, to Nov 30, 2019, were retrospectively analyzed.

Results

Among the 66 patients (26.0 ± 7.7 years old), 27 (40.9%) had spinning-induced rhabdomyolysis, 13 (19.7%) had other aerobic exercise-induced rhabdomyolysis, and 26 (39.4%) had anaerobic exercise-induced rhabdomyolysis. The number of cases and proportion of spinning-induced increased notably during the period of 2016–2019 (n = 25, 46.3% of exercise-induced rhabdomyolysis) compared to 2010–2015 (n = 2). Most patients in the spinning-induced group (88.5%) developed RM during their first spinning session, and 42.3% of them had warm-up exercises. There were significant differences in levels of serum creatine kinase, lactate dehydrogenase, and creatinine among the three groups (p = 0.002, p = 0.004, p = 0.009, respectively). Continuous renal replacement therapy was applied in 11.1% for spinning-induced patients, 7.7% for other aerobic patients, and 19.2% for anaerobic patients (p = 0.646). Sixty-five patients (99%) completed treatment, and all achieved full recovery without recurrence.

Conclusion

Spinning is an important cause of rhabdomyolysis in young people. A supervised warming-up period, a gradual increase in exercise intensity for novices may reduce the number of cases of rhabdomyolysis.

Background

Negative fluid balance during continuous renal replacement therapy (CRRT) is associated with improved clinical outcomes. The effects of negative fluid balance in patients with heterogeneous characteristics undergoing CRRT remain unknown.

Methods

This retrospective study included 2658 adult patients who received CRRT for ≥ 4 days between 2009 and 2020. Patients were divided according to disease category. Fluid balance was assessed using percent change in body weight (PCB) or cumulative input/output (I/O). Primary outcome was 90-day mortality.

Results

More positive PCB results in the fluid overload phase and fewer negative PCB results in the fluid removal phase were associated with mortality. A less negative PCB in the fluid removal phase was associated with mortality in medical patients (odds ratio [OR]: 1.052; 95% confidence interval [CI]: 1.023–1.082, and p = 0.001 in the medical patients and OR: 1.064; 95% CI: 1.011–1.120, and p = 0.017 in cardiovascular medical patients) but not in surgical patients. In patients with discrepancies between PCB and cumulative I/O, PCB was associated with mortality, which was consistent with the overall pattern; however, cumulative I/O was not associated with mortality.

Conclusions

Early negative fluid balance is associated with better survival in medical patients but not in surgical patients, who may require more careful fluid balance.

Purpose

To evaluate nondrug treatments for hot flashes (HFs) in prostate cancer (PC) patients.

Methods

Eight databases (Cochrane Library, Embase, PubMed, Web of Science, ClinicalTrials.gov, China National Knowledge Infrastructure, Wanfang Data, and Chinese Biomedical Literature Service System) were searched from their inception to May 2025. R software was used to conduct the meta-analysis. Risk of bias and the overall quality of evidence were assessed using the Risk of Bias 2.0 tool and the Grade Profiler 3.6.

Results

A total of 5 studies were included, and 4 were eligible for meta-analysis. Compared to the control group, nonpharmacological therapies showed a small but significant improvement in the severity of HFs (d = −0.27; 95% CI: −0.81 to 0.26; p = 0.1; I² = 57.4%) but was not statistically significant with HFs frequency (d = 0.2; 95% CI: −0.11 to 0.5; p = 0.34; I² = 11.1%). Cognitive-behavioral therapy (CBT) showed short-term reductions in HFs severity and psychological distress, but these benefits diminished over time. One trial reported significant HF frequency reductions with both electroacupuncture and traditional acupuncture, with benefits persisting up to 9 months, though no modality outperformed the other. Dietary interventions (soy protein) yielded inconsistent HFs relief but transient QoL improvements. High heterogeneity in intervention protocols, small sample sizes, and variable outcome measures limited comparability. Adverse events were minimal and mild.

Conclusion

Nonpharmacological therapies (e.g., CBT and acupuncture) may help alleviate ADT-related HFs in PC patients. However, the evidence is limited; future large-scale, high-quality research is required to verify effectiveness.

Background

Influenza-like syndromes (ILS), characterized by fever, cough, myalgia, and fatigue, present significant challenges in clinical management. Paracetamol (acetaminophen), known for its antipyretic and analgesic properties, is widely used to alleviate these symptoms. This article reports the results of an expert consensus on the efficacy, safety, and appropriate use of paracetamol in managing ILS, particularly in vulnerable populations.

Methods

A Delphi methodology was employed to gather expert opinions from 72 healthcare professionals, including general practitioners (GPs) and infectious disease specialists. The panelists rated 27 statements on a 5-point Likert scale, with a consensus threshold set at 66%. Statements covered the efficacy, safety, drug interactions, and patient communication related to paracetamol use in ILS. Results were presented in aggregate form, with specific attention to areas of consensus and divergence.

Results

The panel reached consensus on 26 out of 27 statements. Paracetamol was unanimously recognized as the preferred treatment for ILS due to its effective symptom control and minimal risk of drug interactions. It was deemed safer for fragile populations, including the elderly and those with multiple comorbidities. Concerns regarding hepatotoxicity were noted mainly in cases of overdose; however, rare cases have been reported even at therapeutic doses in patients with pre-existing liver disease, where alternative antipyretics may sometimes be considered. Divergence occurred in opinions on the potential immunosuppressive effects of nonsteroidal anti-inflammatory drugs and the associated risk of bacterial superinfections.

Conclusions

Paracetamol is a safer and more suitable option for managing ILS. This work highlights the need for further research on its frequent use in specific populations and emphasizes the importance of patient education on appropriate dosing to improve medication safety and compliance.

Objective

Our objective was to analyze the impact of previous infection with atypical pneumonia pathogens on mortality in COVID-19 patients.

Materials and Methods

We retrospectively studied complete blood count, procalcitonin, C-reactive protein, D-dimer, ferritin, biochemistry, antibody levels of atypical pneumonia pathogens, and COVID-19 (SARS-CoV-2) reverse transcriptase-polymerase chain reaction (PCR) test results in combined (pharyngeal + nasopharyngeal) swab specimens from the airways of patients admitted to the pandemic wards and intensive care units of Adıyaman Training and Research Hospital between 04/01/2020 and 12/31/2021. Patients with positive COVID-19 PCR test results were included in the study.

Results

The mean age of the 323 patients was 60.9 ± 18.5 years, and 58.8% were male. When comparing patients with positive and negative antibodies to atypical pneumonia pathogens, we found no differences in mean age, sex, place of hospitalization, length of hospital stay, need for intensive care, and mortality. However, CRP, D-dimer, and ferritin were significantly higher in the group of patients with antibody positivity for atypical pneumonia pathogens (p values 0.008, 0.004, and 0.004). According to the results of multivariate regression analysis in COVID-19 patients with positive antibodies with respect to atypical pneumonia pathogens, a glucose level higher than 148.5, an AST level higher than 26.5, and a lymphocyte count lower than 0.54 were found to be the most important risk factors for mortality in these patients (OR = 2.2, 95% CI 1.1–4.3, and p = 0.048, OR = 3.0, 95% CI 1.2–7.2, and p = 0.015, and OR = 4.1, 95% CI 1.9–8.9, and p < 0.001, respectively). According to the results of multivariate regression analysis, no risk factors for mortality were identified in patients with COVID-19 without positive antibodies against atypical pneumonia pathogens.

Conclusion

We found no association between positivity of antibodies of atypical pneumonia pathogens and mortality in COVID-19 patients. However, elevated glucose and AST levels and low lymphocyte count were found to be important risk factors for mortality in COVID-19 patients with positive antibodies against atypical pneumonia pathogens.