International Journal of Clinical Practice最新文献

Life’s Essential 8 (LE8), a comprehensive metric integrating behavioral and physiological cardiovascular health factors, may serve as a valuable stratification tool for identifying high-risk subgroups within patients already diagnosed with cardiovascular disease (CVD). In this study, we analyzed data from 3681 individuals with CVD from the US National Health and Nutrition Examination Survey (2007–2018) linked with mortality data. LE8 scores were calculated based on multidomain health indicators, and survival outcomes were assessed across score quartiles. We employed adjusted weighted Cox regression analyses, which accounted for the complex survey design by incorporating appropriate sample weights, strata, and primary sampling units through survey-weighted statistical methods. Higher LE8 scores were significantly associated with reduced all-cause mortality (adjusted HR per unit increase: 0.76 and 95% CI: 0.69–0.85), with a 60% reduction in mortality risk observed in the highest quartile compared with the lowest. These associations remained robust after adjustment for key sociodemographic covariates. Restricted cubic spline analysis confirmed a dose-response relationship between LE8 and mortality risk. Our findings underscore the value of composite health metrics such as LE8 in refining disease taxonomies, enhancing risk stratification, and potentially guiding personalized intervention strategies. This population-scale phenotypic analysis offers a clinical foundation for future AI-driven or multiomics investigations to unravel the mechanistic underpinnings and identify modifiable therapeutic targets among phenotypically diverse CVD populations.

This study assessed anesthesiologists’ knowledge, attitude, and practice (KAP) regarding perioperative neurocognitive dysfunction (PND). This multicenter, cross-sectional study was conducted among anesthesiologists in mainland China from February 23, 2024, to March 23, 2024. Self-administered questionnaires were used to collect demographic information and assess KAP scores. Finally, 594 nonproblematic questionnaires were included. Among the respondents, 311 (52.36%) were male, and 172 (28.96%) had received training related to PND. The mean scores for the KAP dimensions were 8.98 ± 2.32 (range: 0–13), 35.53 ± 3.00 (range: 8–40), and 28.49 ± 6.70 (range: 8–40), respectively. According to multivariable logistic regression analysis, higher knowledge scores (odds ratio [OR] = 1.099, 95% confidence interval [CI]: 1.012–1.194, p = 0.025), higher attitude scores (OR = 1.112, 95% CI: 1.043–1.188, p = 0.001), and participation in PND-related training (OR = 2.876, 95% CI: 1.973–4.207, p < 0.001) were associated with proactive practice. Path analysis revealed that knowledge was associated with attitude (β = 0.31, p < 0.001) and practice (β = 0.52, p < 0.001) and that attitude was associated with practice (β = 0.29, p = 0.002). Anesthesiologists in mainland China demonstrate limited knowledge but a positive attitude and a proactive approach to PND. Targeted educational interventions are recommended to improve anesthesiologists’ understanding and management of PND, enhancing perioperative care and patient outcomes.

Hemispherectomy (HS) is recognized as a highly effective surgical intervention for pediatric patients with refractory epilepsy. After surgery, seizures are not only effectively controlled, but improvements in gross and fine motor functions of the contralateral limbs are also observed in some patients. This phenomenon underscores the remarkable neural plasticity, whereby the contralateral hemisphere demonstrates functional reorganization and advancement postoperatively. The present literature review synthesizes prior studies on motor function recovery after HS in patients with refractory epilepsy, elucidating the mechanisms by which postoperative motor functions are sustained by the contralateral hemisphere. Key factors influencing postoperative motor outcomes are highlighted, including age at surgery and underlying etiology, with particular emphasis on the critical role of white matter tracts originating from the ipsilateral cortex in facilitating motor compensation after surgery. This review seeks to advance comprehension of the inherent mechanisms underlying neural plasticity in the human cerebral hemispheres, offering valuable insights into the reorganization of the postoperative motor system.

Diabetic kidney disease (DKD) is a significant contributor to chronic kidney disease and end-stage renal disease. Cuproptosis, a newly recognized type of copper-dependent cellular demise, has been associated with the pathophysiology of DKD. Qidantang Granule, a traditional Chinese medicinal formulation, has demonstrated the renoprotective benefits, although its function in controlling cuproptosis is ambiguous. A mouse model of DKD was generated using streptozotocin (STZ) in male C57BL/6J mice. Mice received oral administration of Qidantang Granule (200 mg/kg/day) or a vehicle for a duration of 9 weeks. Renal function, histopathology, apoptosis, oxidative stress, and metabolic alterations were evaluated using biochemical tests, ELISA, and histological staining. Western blotting and qRT-PCR identified proteins and genes associated with apoptosis and cuproptosis, whereas inductively coupled plasma mass spectrometry assessed renal copper levels. Qidantang Granule treatment significantly reduced blood glucose levels, improved renal function parameters, and alleviated histological damage in DKD mice. Treatment inhibited Bax and active caspase-3 expression, decreased malondialdehyde levels, restored MnSOD activity and ATP content, and normalized levels of pyruvate, α-ketoglutarate, and succinic acid levels. Qidantang Granule decreased renal copper levels, downregulated SLC31A1 and Hsp70 expression, and reinstated lipoylation of dihydrolipoamide S-acetyltransferase and dihydrolipoamide S-succinyltransferase, signifying the suppression of cuproptosis. Qidantang Granule ameliorates DKD in STZ-induced mice by diminishing oxidative stress, modulating energy metabolism, and inhibiting cuproptosis, underscoring its promise as a treatment approach for DKD.

Background/Objective: The post-intensive care unit (ICU) period significantly impacts patients’ overall well-being, raising concerns among patients, families, healthcare professionals, and decision-makers. This study aims to evaluate 1-year survival rates, return to work, and daily functionality of individuals discharged from the ICU.

Materials and Methods: A retrospective analysis was conducted in a medical ICU, focusing on patients with a minimum 48-h ICU stay who were subsequently discharged from the hospital.

Results: The study included 154 patients with a median age of 51 (IQR: 34–68) years, of whom 79 (51%) were male. The 1-year mortality rate was 23.4%. Within the first year, rehospitalization occurred in 54.5%, and ICU readmission was observed in 20.1%. Notably, 89.8% of the patients were able to perform self-care activities, such as toileting and dressing. However, 63.6% of the patients had not returned to work within the first year. A comparison between patients requiring critical interventions and those who did not revealed a return-to-work rate of 21.4% for the former and 50% for the latter (p = 0.002).

Conclusion: The findings indicate that approximately one-quarter of patients treated in intensive care and discharged from the hospital died within 1 year. While a significant proportion (90%) could independently manage self-care tasks, the majority experienced delays in returning to work. These findings highlight the need for enhanced post-ICU care to improve patient outcomes.

Introduction: Optimal management of sacroiliac joint pain syndrome necessitates timely and effective therapeutic interventions to achieve favorable clinical outcomes. This study was designed to investigate the efficacy of a combined treatment approach, integrating Wa-shi pulling (WP) with core muscle strengthening exercises (CMSE), in patients with sacroiliac joint pain syndrome.

Methods: A prospective study was conducted on patients diagnosed with sacroiliac joint pain syndrome between October 1, 2019, and June 30, 2022. Participants were carefully selected and randomly allocated into two groups: the WP group and the WP + CMSE group.

Results: A total of 123 patients with sacroiliac joint pain syndrome were enrolled in the study. Following the intervention, significant reductions were observed in both McGill Pain Questionnaire scores and lumbosacral angles compared to baseline values (all p < 0.05). The WP + CMSE group demonstrated more pronounced reductions in McGill Pain Questionnaire scores (p = 0.029) and greater improvements in lumbosacral angles postintervention. Additionally, JOA scores increased significantly for both groups after treatment (all p < 0.05), with the WP + CMSE group exhibiting a more substantial improvement compared to the WP group (p = 0.039). These findings suggest a more robust therapeutic effect in the combined treatment group.

Conclusion: The integration of WP and CMSE showed therapeutic effects in sacroiliac joint pain syndrome, though with variability in statistical robustness across outcomes after Bonferroni correction. Evidence for a synergistic effect remains strongest for pain relief, with conclusions regarding lumbosacral biomechanics and functional status requiring cautious interpretation pending further validation. This study provides preliminary support for the therapeutic potential of combining these modalities, with the pain-specific findings meriting consideration in clinical practice.

Trial Registration: Chinese Registry of Clinical Trials: MR-33-20-001928