Medicine最新文献

This study investigates the relationship between intraocular pressure (IOP), optical coherence tomography (OCT) parameters, and visual field (VF) outcomes in 'Green' patients-those with normal OCT findings but potential VF abnormalities. Understanding this relationship is crucial for improving early detection and management strategies for glaucoma, especially in patients who show functional loss despite normal structural findings on OCT. A cross-sectional study was conducted at Taipei City Hospital, Renai Branch, Taiwan, from July 1, 2015, to July 1, 2023. Participants were referred for suspected glaucoma and included based on normal OCT parameters ('green' coding) and completed VF tests. Patients with any ocular disease that could confound results were excluded. Logistic regression models were used to assess relationships between IOP, OCT parameters (rim area, disc area, retinal nerve fiber layer thickness, cup-to-disc ratios, and cup volume), and VF outcomes. Age, sex, and IOP status (normal or ocular hypertension) were also included in the analysis. All data were analyzed using Statistical Package for the Social Sciences version 23.0. Larger disc area was a significant predictor of VF abnormalities, with an adjusted OR of 3.72 (95% confidence interval [CI], 1.14-12.15). Neither normal IOP nor ocular hypertension significantly predicted VF loss (adjusted OR = 0.89; 95% CI, 0.27-2.96). Female sex was associated with a higher likelihood of VF abnormalities (adjusted OR = 5.68; 95% CI, 1.03-31.25). Other OCT parameters, including retinal nerve fiber layer thickness and cup-to-disc ratios, were not significantly associated with VF outcomes. Disc area plays a critical role in predicting VF abnormalities in "green" patients, suggesting the importance of integrating disc size into screening and monitoring protocols. These findings challenge the reliance on IOP alone for predicting VF loss and support the need for more comprehensive assessments. Future research should explore longitudinal studies to further assess the predictive value of disc area and investigate additional factors, such as vascular and biomechanical influences, that may contribute to VF deterioration in this population.

The purpose of this study was to investigate the current status and influencing factors of night shift nurses' sense of occupational benefit, and to explore the influence of psychological resilience on the sense of occupational benefit. 2022 from August to October, a cross-sectional survey was conducted on 719 night shift nurses using a general information questionnaire, psychological resilience scale, and sense of occupational benefit scale. A total of 719 valid questionnaires were collected. The score of night shift nurses' sense of occupational benefit was (137.40 ± 21.10) and psychological resilience score was (65.63 ± 17.75). Age (β = 3.359, P < .05) was significantly correlated with sense of occupational benefit. Education (β = 3.586, P < .05) was significantly correlated with the sense of occupational benefit, and whether or not they had participated in outbreak prevention and control (β = -2.321, P < .05) was significantly correlated with the sense of occupational benefit. Similarly, psychological resilience (β = 0.859, P < .05) was significantly associated with the sense of occupational benefit. Night shift nurses' sense of occupational benefit was moderate to high, and interventions should be taken to enhance the sense of occupational benefit based on nurses' age, education, whether they have participated in epidemic prevention and control, and psychological resilience.

To improve the management level of general anesthesia during bronchoscopy in the children with diffuse alveolar hemorrhage (DAH). A retrospective study was conducted in the children with DAH who had performed bronchoscopy under general anesthesia with spontaneous respiration by face mask ventilation initially from June 2021 to June 2022 in our hospital. (1) Thirty-four children who had underwent 38 bronchoscopy procedures were included. (2) General anesthesia induction was performed by bolus of propofol intravenous in all the procedures. For maintaining anesthesia, combination use of propofol and remifentanil intravenously infusion were given in 31 procedures (81.6%) and propofol intravenously infusion alone was given in the rest 7 procedures (18.4%). An intravenous bolus of ketamine or propofol was given as an anesthetic adjuvant in 21 procedures (55.3%). Thirty-five procedures (92.1%) were successfully completed under non-tracheal intubation ventilation, whereas the rest 3 procedures (7.9%) needed change to tracheal intubation ventilation. (3) Respiratory depression was found in 7 procedures (18.4%), laryngospasm was found in 2 procedure (2.6%), and bronchospasm was found in 17 procedures (44.7%). Intraoperative hypoxemia occurred in 16 procedures (42.1%). The incidence of intraoperative hypoxemia in the procedures at the active phage of disease was significantly higher compared to those at the remission phage of the disease (P < .05). Intraoperative hypercapnia also occurred in 16 procedures (42.1%). Two procedures (5.3%) were complicated by severe pulmonary hemorrhage. General anesthesia with spontaneous respiration by face mask ventilation is feasible and relatively safe for the children with DAH undergoing bronchoscopy, whereas the anesthetic protocol still needs to be improved.

Backgrounds: Baricitinib, an oral selective inhibitor of Janus kinase 1 and 2, is approved for moderate and severe rheumatoid arthritis (RA) with insufficient response to conventional synthetic disease-modifying antirheumatic drugs. The study evaluated the safety of baricitinib 24 weeks 4 mg or 2 mg for the treatment of RA.

Methods: The net change (least squares mean [LSM]) of alanine aminotransferase (ALT), creatinine, low-density lipoprotein cholesterol (LDL-C) levels from baseline with the comparison of baricitinib versus placebo was pooled, respectively. The risk ratios (RR) of serious advanced events (SAEs), major cardiovascular events (MACEs), infection, serious infection, and advanced events (AEs) at the end of treatment across groups were compared.

Results: Five randomized controlled trials with 2901 patients were included in the summary analysis. Results showed that baricitinib 4 mg significantly increased ALT and creatinine levels, the net LSM change was respectively 3.59 U/L with 95% confidence interval (CI) (1.75-5.43), 4.25 µmol/L with 95% CI (3.38-5.12), however, baricitinib 2 mg of ALT and creatinine levels were not significantly different. Baricitinib 4 mg and 2 mg significantly increased LDL-C levels, the net LSM change was respectively 11.44 mg/dL with 95% CI (6.08-16.80), 8.70 mg/dL with 95% CI (4.19-13.20). Baricitinib 4 mg significantly increased the incidence of infection, the pooled RR (95% CI) was 1.29 (1.13-1.47), and baricitinib 2 mg was not significantly different. However, the pooled RRs of SAEs, MACEs, and serious infection were not statistically significant across groups. The pooled RRs of AEs were not statistically significant between baricitinib 4 mg and 2 mg.

Conclusions: This study confirmed that patients with RA taking 4 mg baricitinib increased levels of ALT, creatinine, as well as an increased risk of infections, compared with those taking 2 mg baricitinib. Both 2 mg and 4 mg also increased the level of LDL-C, but it increased the most severely at 4 mg baricitinib. However, the incidence of SAEs, MACEs, and serious infection was not significantly different in patients treated with baricitinib 4 mg and 2 mg compared with placebo, the incidence of AEs was not significantly different between baricitinib 4 mg and 2 mg.

Rationale: Primary plasma cell leukemia is a rare and highly aggressive malignancy of the blood system, with rapid disease progression and a high early mortality rate. Currently, there is no recognized therapeutic regimen, leading to the adoption of strategies typically utilized for multiple myeloma, which, however, exhibit limited efficacy. Selinexor is considered effective in treating relapsed/refractory multiple myeloma, but there are currently no reports on its application in primary plasma cell leukemia. Here, we reported a case of primary plasma cell leukemia with multiple high-risk genetic factors (including 1q21+, 17p-, and 13q-) who received a chemotherapy regimen including selinexor, pomalidomide, and dexamethasone.

Patient concerns: This case was a 58-year-old male presenting with lower back pain, abdominal pain, and various systemic symptoms.

Diagnoses: The initial diagnosis of intestinal obstruction at a local hospital was followed by a referral to our emergency department due to abnormal blood test results indicative of a hematologic disorder. Further investigations confirmed a rare diagnosis of primary plasma cell leukemia of the IgA-k light chain subtype.

Interventions: The patient was promptly treated with a chemotherapy regimen comprising selinexor, pomalidomide, and dexamethasone in addition to supportive care.

Outcomes: Subsequent assessments showed a significant response to treatment, with improvement in symptoms, normalization of blood parameters, and achievement of very good partial response. However, due to financial constraints, the patient declined hematopoietic stem cell transplantation and eventually opted to discontinue treatment, leading to disease progression.

Lessons: The combination of selinexor with pomalidomide and dexamethasone has shown good efficacy in primary plasma cell leukemia with high-risk genetic abnormalities. Our case may provide evidence for developing an effective selinexor-based regimen for treating primary plasma cell leukemia with high-risk genetic abnormalities.

COVID-19 pandemic was accompanied by many healthcare-related issues. Concrete national data regarding the care performance of critical ill cases of COVID-19 does not exist in Korea. The current study aimed to describe the treatment outcome and healthcare resource utilization of critically ill COVID-19 patients. Our multicenter retrospective cohort study enrolled critically ill COVID-19 patients from 22 tertiary care hospitals in Korea. Inclusion criteria: (1) patients aged 19 years or older, (2) patients with laboratory-confirmed SARS-CoV-2 infection who received at least one of following initial treatments such as high-flow oxygen therapy (HFOT) or noninvasive ventilation (NIV) or invasive mechanical ventilation (IMV) or extracorporeal membrane oxygenation. During the study wave, a total of 1358 eligible participants were enrolled, with 21 institutions participating in the study. Among them, data from 1113 patients were available and analyzed. Of 921 (82.7%), 621 (55.8%) were supported by IMV. Of the 921 patients supported by HFOT or NIV, 438 (47.6%) recovered without IMV, 429 (46.6%) required IMV, and 54 died who DNR after NIV was applied. Prone position ventilation was administered to 163 (33.1%) patients with IMV and 25 (6.2%) patients with HFOT. Extracorporeal membrane oxygenation was administered to 128 (20.6%) patients treated with IMV. The overall mortality rate was 26.4%. In South Korea, mortality rates for patients with severe COVID-19 pneumonia have been shown substantial fatality, with the highest mortality rates observed in wave 3. The increased mortality rate in wave 3 could be associated with the rapid escalation of critically ill COVID-19 patients and the consequent saturation of intensive care unit capacities. Patients received NIV therapy and prone position ventilation more frequently in wave 3 as the number of cases increased.

To investigate the value of circulating tumor cell (CTC) in cerebrospinal fluid (CSF) by Cyttel-Tech detection in patients with suspected leptomeningeal metastasis (LM) from malignant solid tumors. We collected CSF from 12 patients with suspected LM from malignant solid tumors at our hospital. Twelve milliliters (mL) of CSF were collected from each patient through the first lumbar puncture: 5 mL was for CTC detection by Cyttel-Tech method, 5 mL for CSF cytopathology examination, and 2 mL for cytology and biochemical analysis of the CSF. Additionally, all patients underwent cranial brain magnetic resonance imaging with both plain and contrast-enhanced scans. Among the 12 patients with suspected LM, CTC detection yielded a positivity rate of 11/12 (91.7%). The positivity rate for CSF cytopathology examination was 4/12 (33.3%). However, none of the patients showed positive findings on cranial brain magnetic resonance imaging with both plain and contrast-enhanced scans (0/12, 0%). The difference between CTC detection and cytopathology detection was statistically significant (P < .05). CTC detection may have a high positivity rate in diagnosing LM from malignant solid tumors. It potentially serves as a supplementary diagnostic method for patients with negative pathology results and be used for rapid and accurate adjunctive diagnosis of LM.

The development of an easy-to-use noninvasive model to screen nonalcoholic fatty liver disease (NAFLD) is warranted. This study aimed to develop and validate a simple noninvasive NAFLD risk score (NARS). We used the National Health and Nutrition Examination Survey 2017 to March 2020 cycle data. The sample size of derivation and validation cohort were 4056 and 2502, separately. The NAFLD was determined by FibroScan® measured controlled attenuation parameter scores of >285 dB/m in the absence of excessive alcohol use, steatogenic medications use, and viral hepatitis. The NARS was derived from a multivariable logistic regression model and variables were selected based on Boruta analysis. The performance of NARS was internally validated and compared with previous models using receiver-operating characteristics curve and C-statistics. The NARS was established using waist circumference, triglycerides, alanine aminotransferase, and fasting glucose, and the total score ranges from 0 to 8, with an increasing risk of NAFLD. NARS demonstrated ideal discrimination in the validation cohort, with C-statistics of 0.832 (95% confidence interval, 0.801-0.824), and was not inferior to any existing models. The optimal cutoff point for predicting NAFLD was obtained at 4 scores with a sensitivity of 82% and specificity of 69%. We reported the derivation and internal validation of a novel and easy-to-use risk score for detecting the presence of NAFLD. NARS demonstrated ideal discrimination performance and was practical in clinical practice for selecting individuals at higher risk of NAFLD for further examination or intervention.

Background: This study aimed to evaluate the effects of umbilical cord mesenchymal stem cells (UC-MSCs) in the treatment of knee osteoarthritis.

Methods: PubMed, Web of Science, Cochrane Library, Embase, Chinese National Knowledge Infrastructure and Wanfang databases were searched from inception to March 31, 2024. RevMan 5.3 was used to conduct meta-analyses of the final included studies.

Results: Three randomized controlled studies were conducted. Western Ontario and McMaster Universities Osteoarthritis Index was reduced in the UC-MSCs group compared that in to the control group (mean difference: -25.85; 95% confidence interval: -41.50, -10.20; P = .001). Knee Lysholm Score was improved in the UC-MSCs group compared with the control group (mean difference: 18.33; 95% confidence interval: 12.89, 23.77; P < .00001). Egger test showed P = .583, indicating no publication bias. Sensitivity analysis indicated that the results were stable.

Conclusion: Intra-articular injection of UC-MSCs improved function and reduced pain in patients with knee osteoarthritis. However, the number of included studies was small and more studies are needed to confirm this.