Medicine最新文献

Background: Cardiogenic shock (CS) is a severe complication of acute myocardial infarction (AMI) with high mortality rates. While mechanical circulatory support devices like intra-aortic balloon pump (IABP) and Impella are used to manage CS, their comparative effectiveness remains unclear. This meta-analysis aims to evaluate the safety and efficacy of Impella in the treatment of AMI-associated CS.

Methods: A comprehensive literature search was performed across PubMed, EMBASE, Google Scholar, SCOPUS, and Web of Science. The primary efficacy endpoint was 6-month all-cause mortality. Secondary efficacy endpoints included 30-day mortality, major bleeding, limb ischemia, sepsis, and left ventricular ejection fraction. Pooled odds ratios (OR) and standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated using the random-effects model via Revman version 5.4. Statistical significance was determined at P < .05.

Results: Four RCTs with a total of 442 patients were included in this meta-analysis. The pooled analysis showed that the odds of 6-month all-cause mortality were significantly lower with Impella compared to standard of care (OR: 0.64, 95% CI: 0.43-0.95; P value: .03). However, 30-day mortality reported no statistically significant difference between the 2 groups (OR: 1.03; 95% CI: 0.43-2.48; P = .95). Our analysis found that the use of impella is associated with a statistically significant increase in the odds of major bleeding (OR: 3.61; 95% CI: 1.14-11.40; P = .03), limb ischemia (OR: 4.91; 95% CI: 1.37-17.59; P = .01), and sepsis (OR: 2.75; 95% CI: 1.25-6.08; P = .01). No statistical significance was found in left ventricular ejection fraction at follow-up between the 2 groups (SMD: -0.35; 95% CI: -0.78 to 0.07; P = .11).

Conclusion: Impella significantly reduces 6-month all-cause mortality in patients with CS following AMI compared to standard of care. However, this survival benefit is offset by a substantial increase in major bleeding, limb ischemia, and sepsis risks associated with Impella. Future large scale trials are needed to validate these findings and refine clinical guidelines for the optimal use of Impella in treating CS.

Diabetic foot ulcers are characterized by disturbances in the epidermis and/or a portion of the dermis in patients with the disease. With over a million amputations performed annually, it has also emerged as one of the primary causes of lower limb amputation globally. To better understand the severity and anatomical distribution of ulcerated areas in patients with type II diabetes mellitus, this study aimed to identify the factors associated with diabetic foot ulcers (DFUs). This descriptive cross-sectional study was conducted at M Abdur Rahim Medical College Hospital in Dinajpur, Bangladesh, from July to September 2023. The study population was selected using a purposive sampling technique based on the patients' availability during their usual and regular treatment at MARMCH. Using a Bangla questionnaire data was obtained to evaluate the DFUs, in addition to measuring blood pressure and assessing the affected area's neurological function. The severity of the ulcer is calculated by using the Wagner grading system. Data was analyzed by using STATS v15 and chi-square was applied. A total of 113 DFU patients took part in this study. The mean age in years was 56 ± 12 (SD + mean) and the male proportion was greater (61.9%). Most of them (93.91%) were negligent about foot care and suffered from severe DFU (86.37%). The majority of respondents (57.94%) had a right foot ulcer, of which 94.50% had severe ulcers. Almost all ulcers were severe (86.14%) and measured <5 cm in diameter (69.71%). The results highlight the tremendous burden of DFUs, which can have serious consequences and substantial mental and economic effects on patients' healthcare systems.

Primary open-angle glaucoma (POAG) is a common ocular disease, and there is currently no effective treatment for POAG therapy. Thus, identifying some effective diagnostic markers is beneficial to the treatment of patients. The expression profile was obtained from Gene Expression Omnibus (GEO) database. The functional enrichment was analyzed using Gene Ontology, Kyoto Encyclopedia of Genes and Genomes and gene set enrichment analysis. Co-expressed genes were identified using weighted gene co-expression network analysis (WGCNA). Hub genes were screened through Lasso regression, support vector machine-recursive feature elimination (SVM-RFE) and Random Forest, and receiver operating characteristic curve was used to assess diagnostic value. Immune cell infiltration was calculated using IOBR package. The regulatory network was constructed through STRING, miRactDB and Cytoscape. The oncoPredict package was employed to predict the candidate chemotherapy agents. According to GSE27276 database, 541 differentially expressed genes were identified. Five oxidative stress-related genes with high area under the curve value, namely HBB, MAOA, ACOX2, ALDH7A1 and TYMP, were determined using WGCNA and machine learning. Infiltration level of NK cells, CD4 T cells and dendritic cells were significantly increased in POAG group compared with normal group, while CD8 T cells and Tregs cells were significantly decreased. HBB was closely related to most immune cells. Hub genes were all targeted by 16 miRNAs. Drug sensitivity analysis exhibited that some drugs were more sensitivity for POAG, such as Acetalax_1804, Ibrutinib_1799 and OSI_027_1594. We identified 5 oxidative stress-related genes with high diagnostic value for POAG.

This study aimed to discuss the clinical value of health education using an animated video for postoperative patients with digital subtraction angiography (DSA)-guided implantable venous access ports. Retrospective study. Based on expert consensus and clinical experience, we created an animated video presenting postoperative health education for patients to watch after infusion port implantation and uploaded it to a multimedia room. A total of 93 patients who underwent DSA-guided implantable venous access port placement at our hospital from March to June 2022 and from July to October 2022 were selected. Forty-six patients who received traditional oral and written education from March to June 2022 were selected as the control group. Forty-seven patients who received animated video-assisted health education from July to October 2022 were selected as the experimental group. The time spent on health education and patients' awareness of the educational content were compared between the 2 groups. The time spent on health education in the experimental group was 3.51 ± 0.62 minutes, which was less than that of the control group, 6.76 ± 1.14 minutes (t = 17.07, P < .001). Patients' awareness of educational content in the experimental group was 8.62 ± 1.26 points, which was significantly better than the control group's 7.26 ± 1.63 points (t = -4.490, P < .001). Animated video-assisted health education can enable patients to gain a better understanding of educational content in a shorter time. Moreover, it can improve nurses' interventional efficiency. Therefore, this health education method is worthy of clinical promotion.

As an important innate immune cell in the body, macrophages have a strong ability to phagocytic tumor cells and maintain the innate immune response. Tumor-associated macrophages play a more prominent role in regulating tumor immunity and are currently an important target of antitumor immunity. As a new type of antitumor therapy, tumor immunotherapy has great potential, combined chemotherapy, targeting and other therapeutic means can significantly enhance the antitumor therapy effect. At present, a number of natural products have been proved to have significant immunomodulatory and antitumor effects, and have become a hot field of antitumor immunity research. Studies have found that a variety of natural products, such as polysaccharides, flavonoids, saponins, lactones, and alkaloids, can induce the polarization of M1 macrophages, inhibit the polarization of M2 macrophages, and regulate the expression of immune-related cytokines by targeting specific signaling pathways to enhance the killing effect of macrophages on tumor cells and improve the tumor immune microenvironment, and finally better play the antitumor immune function. In this paper, by summarizing the research results of the specific mechanism of natural products targeting tumor-associated macrophages to exert antitumor immunity in recent years, we discussed the aspects of natural products targeting tumor-associated macrophages to enhance antitumor immunity, in order to provide a new research idea for tumor immunotherapy and further improve the effectiveness of clinical antitumor therapy.

The aim was to investigate the independent risk factors for postoperative recurrence of lumbar disc herniation treated by percutaneous intervertebral laminectomy, and to establish a nomogram prediction model accordingly. Data on patients with lumbar disc herniation were collected from January 2018 to December 2023 in our hospital, and single-factor and multifactorial logistic regression analyses were used to determine the independent risk factors for postoperative recurrence of lumbar disc herniation and establish the corresponding nomogram. The receiver operating characteristic curves were plotted the area under the curve was calculated, and the calibration curves and decision curves were plotted to evaluate the model performance. A total of 644 patients with lumbar disc herniation were included in the study, and 61 patients had a postoperative recurrence, with a recurrence rate of 9.5%. After univariate and multivariate logistic regression model analysis, a total of 7 variables were identified as independent risk factors for postoperative recurrence of lumbar disc herniation: age > 60 years (OR, 3.709; 95% CI, 1.284-10.714), type of nucleus pulposus protrusion as herniation (OR, 7.342; 95% CI, 1.500-35.929), nucleus pulposus degeneration grade III-V (OR, 4.068; 95% CI, 1.214-13.627), operative segment L4-L5 (OR, 5.060; 95% CI, 1.659-15.431), incomplete intraoperative medullary removal (OR, 5.355; 95% CI, 2.017-14.220), and broken fibrous ring (OR, 5.229; 95% CI, 1.235-22.142), and postoperative high-intensity activity (OR, 5.096; 95% CI, 1.420-17.669). The nomogram constructed in this study for postoperative recurrence of lumbar disc herniation treated by percutaneous intervertebral foramenoscopy has good predictive accuracy, which helps orthopedic surgeons to intervene in advance in patients at high risk of postoperative recurrence of lumbar disc herniation treated by percutaneous intervertebral foramenoscopy.

Investigating the causal relationship between circulating immune cells, blood metabolites, and severe COVID-19 and revealing the role of blood metabolite-mediated circulating immune cells in disease onset and progression. Genetic variation data of 731 circulating immune cells, 1400 blood metabolites, and severe COVID-19 from genome-wide association study open-access database (https://gwas.mrcieu.ac.uk) were used as instrumental variables for bidirectional and two-step Mendelian randomization analysis. The study identified 11 circulating immune cells with unidirectional causality to severe COVID-19. Two-step Mendelian randomization analysis showed 10 blood metabolites were causally associated with severe COVID-19, and blood Myristate and Citrulline to phosphate ratio mediated the association of circulating effector memory double negative % DN and CD8dim natural killer T cell % T cells, respectively, with severe COVID-19 (Myristate mediated effect ratio was 10.20%, P = .011; Citrulline to phosphate ratio mediated effect ratio was -9.21%, P = .017). This study provides genetic evidence assessing the causal relationship between circulating immune cells, blood metabolites, and severe COVID-19, elucidates the role of blood metabolite-mediated circulating immune cells in severe COVID-19 development, and offers new insights into severe COVID-19 etiology and related preventive and targeted therapeutic strategies.

This research seeks to examine the correlation between the triglyceride-glucose index and the hazard of all-cause and cardiovascular death in individuals with cardiovascular disease (CVD). By evaluating the index, we can better anticipate and assess the risk and prognosis of CVD patients, and provide precise and individualized guidance for clinical treatment and management. Demographic and clinical data of 2185 CVD patients from 10 cycles of the National Health and Nutrition Examination Survey database from 1999 to 2018 were extracted for analysis. Employed the 3-level quantile method to group data, and a multivariate Cox proportional hazard model along with subgroup analysis to study the correlation between index and both mortalities. Additionally, restricted cubic spline examination was employed to assess the correlation, aiming to enhance the comprehension of their interrelation. Over the course of an average post-observation duration of 89.5 months involving 2185 CVD individuals, 607 patients suffered from all-cause mortality and 313 patients suffered from CVD-related mortality. An inverted U-shaped correlation was identified through restricted cubic spline analysis. During the multivariate COX regression analysis, it was found that individuals in the T2 and T3 had a dramatically lower hazard of both mortalities as opposed to those in the T1. The results were overall consistent across subgroup analyses according to age, gender, race, body mass index, diabetes, and hypertension, the interaction between these characteristics and the index was not remarkable (P > .05). Studies conducted on CVD individuals in the US have revealed a U-shaped correlation between triglyceride-glucose index and hazard of both all-cause and CVD-related death. However, further investigations are required to examine the particular function of index in forecasting the prognosis of CVD individuals. This will be helpful in accurately evaluating the risk and prognosis of CVD patients, and ultimately in developing more precise and personalized treatment and management strategies.

This study reviews the long-term efficacy of short-segment posterior instrumentation and fusion (SSPIF) in treating thoracolumbar burst fractures. Authors retrospectively reviewed the radiographic results of single-level thoracolumbar burst fractures treated by SSPIF. Vertebral body height and wedge angles were measured on the preoperative, postoperative, and follow-up radiographic images. The degree of pain and work ability was measured using the Denis scale. The analysis consisted of 12 patients with a mean age of 39.7 years (range 21-60) and a mean follow-up of 225.6 ± 20.3 months. There were significant differences among the wedge angles at preoperative and other periods of time, but there was no significant difference between the early postoperative and all other time periods afterwards (P < .001, P = .567, P = .937, P = .879). SSPIF effectively restored the anterior and middle vertebral body height and wedge angle deformities, and the improvement was maintained for almost 20 years after the surgery. Therefore, SSPIF is a safe and effective modality of treatment for thoracolumbar burst fractures.

The increasing use of electric scooters (e-scooters) has been accompanied by an increase in the number of traumas. Noncompliance with regulations and the effectiveness of legal measures remain subjects of ongoing debate. This study aimed to investigate the demographic characteristics of patients with e-scooter-related orthopedic injuries, temporal distribution of trauma, and patterns of these injuries. We retrospectively evaluated 534 patients with e-scooter-related injuries who were referred to the Department of Orthopedics and Traumatology between January 2020 and October 2023. Variables such as patient sex, age, time of trauma, type of hospital transfer, mechanism of trauma, injury location and type, accompanying head trauma in extremity injuries, and treatment approach were recorded. Temporal analysis was performed by hour, day, month, season, and weekday versus weekend. The majority of patients were male (80.0%), with injuries most common in the 25 to 39 age group (33.7%). Trauma was frequent in the summer (45.7%), especially in July (16.5%), with most hospital visits occurring on Fridays (18.2%) and weekends (32.2%). Blunt soft tissue injuries (47.3%) and fractures (42.4%) were prevalent, particularly in the elbow (18.4%), wrist (16.9%), and knees (14.3%). A total of 247 fractures were identified, with the radial head (17.0%) and distal radius (10.9%) being the most common fractures. Fracture rates have increased in 2022 and 2023 compared to those in previous years. While 86.0% of patients received nonsurgical treatment, 14.0% underwent surgery, with a rise in surgical cases in 2022 and 2023. Elbow (19.0%), knee (16.7%), and wrist (16.7%) were the most frequent surgical sites. The increasing use of e-scooters among young people has increased trauma cases, with a growing proportion of fractures over time. The higher incidence of injuries, particularly in the elbow and knee joints, underscores the importance of protective equipment. Therefore, additional legal regulations can help to prevent such injuries.