Therapeutics and Clinical Risk Management最新文献

Background and objective: This retrospective study analyzed to compare the effects of general anesthesia (GA) versus combined anesthesia (CA) on postoperative pain and negative emotions in patients undergoing uterine fibroid surgery, providing evidence for optimizing anesthesia protocols aiming to achieve more effective analgesia and improve patient satisfaction scores.

Methods: A retrospective analysis was conducted on data from 148 patients who underwent uterine fibroid surgery at a tertiary hospital between April 2023 and December 2024. Patients were divided into a control group (GA) and a study group (CA) based on anesthesia type. The control group received conventional GA, while the study group received ropivacaine quadratus lumborum block (QLB) combined with GA. After propensity score matching (PSM), 74 patients were included in each group. The primary outcome was postoperative 2-12h visual analog scale (VAS) pain scores. Secondary outcomes included stress indicators (ACTH, Cor), emotional scales (SAS/SDS), cognitive function (MMSE), and sleep quality (PSQI).

Results: The study group had shorter anesthesia duration, postoperative flatus time, postoperative ambulation time, and hospital stay compared to the control group (all P<0.05). VAS scores at 2h, 4h, 8h, and 12h postoperatively were significantly lower in the study group (all P<0.05). Preoperative differences in emotional, stress, cognitive, and sleep indicators were not statistically significant (all P>0.05). Postoperatively, the study group showed significantly lower SAS/SDS scores, ACTH/Cor levels, and PSQI scores, alongside higher MMSE scores compared to the control group (all P<0.05).

Conclusion: Combined anesthesia effectively reduces postoperative pain and negative emotions in uterine fibroid patients, lowers stress levels, improves sleep quality, and promotes rapid recovery, making it worthy of clinical promotion.

Background: Hemorrhage is a leading cause of preventable death in trauma. While both blood transfusion and tranexamic acid (TXA) improve outcomes, the combined effect of prehospital TXA and transfusion remains uncertain. This study aims to evaluate the impact of prehospital TXA combined with blood transfusion on short-term mortality in trauma patients at risk for hemorrhage.

Methods: We performed a retrospective cohort study of 408 adult trauma patients at risk for hemorrhage admitted between 2018 and 2023. Patients were grouped into transfusion only (n=240) or prehospital TXA plus transfusion (n=168). The primary outcome was 30-day mortality. Secondary outcomes included 24-hour mortality, transfusion requirements, multiple organ failure (MOF), and venous thromboembolism (VTE).

Results: Compared with transfusion alone, prehospital TXA plus transfusion significantly reduced 30-day mortality (14.3% vs 31.3%, p<0.01) and 24-hour mortality (6.0% vs 19.6%, p<0.01). The TXA group also had lower MOF incidence (14.3% vs 28.7%, p<0.01) and required less plasma and crystalloid resuscitation, without an increase in VTE (p=0.17). Kaplan-Meier analysis confirmed a survival advantage (log-rank p<0.01), and multivariate Cox regression identified combination therapy as an independent predictor of reduced 30-day mortality (HR=2.16, 95% CI: 1.35-3.46, p<0.01).

Conclusion: Prehospital TXA combined with transfusion significantly improves short-term survival and reduces organ failure in bleeding trauma patients, without increasing thromboembolic risk. These findings support early integration of TXA into prehospital transfusion protocols.

Background: The immediate administration of drugs and fluids is critical for successful resuscitation in out-of-hospital cardiac arrest (OHCA). Vascular access selection plays a pivotal role in ensuring timely delivery of therapeutic interventions during OHCA management. This study aims to compare the safety and efficacy of intraosseous (IO) and intravenous (IV) access in OHCA management.

Methods: We conducted a comprehensive search of PubMed, EMbase, Google Scholar, and the Cochrane Library databases to identify studies published up to February 20th, 2025, evaluating IO and IV access in OHCA patients. The outcomes of interest included return of spontaneous circulation (ROSC), survival from hospital admission to discharge, neurological outcome, comorbidities, and access time.

Results: Twenty-three studies, comprising 48945 cases of IO access and 188966 cases of IV access for OHCA management, were included. Overall, the rate of favorable neurological outcome was similar between patients with IO and IV access (odds ratio [OR] = 0.73; 95% confidence interval [CI] = 0.37 to 1.45, I²=95.3%). IO access was associated with significantly lower odds of shockable rhythms in both adult (OR = 0.77; 95% CI = 0.70 to 0.85, I²=86%) and pediatric (OR = 0.20; 95% CI = 0.12 to 0.33) patients. Additionally, IO access was linked to a lower rate of ROSC in pediatric OHCA patients (OR = 0.30; 95% CI = 0.21 to 0.42). Prospective studies and those with unadjusted time to intervention analysis demonstrated markedly lower rates of survival at discharge, favorable neurological outcome, and ROSC in the IO group compared to the IV group. It should also be noted that the interpretation of the results should take into account the high heterogeneity and potential biases, despite the corresponding subgroup analyses we conducted.

Conclusion: In OHCA management, IO access may be associated with less favorable outcomes in terms of survival, neurological function, and ROSC compared to IV access. Further research is needed to address limitations and provide more robust evidence regarding the comparative effectiveness of intraosseous and intravenous access in this clinical setting.

Objective: We performed a meta-analysis of randomized controlled trials to assess the safety and efficacy of ticagrelor or other P2Y12 inhibitors in combination with oral anticoagulants as a part of DAPT/SAPT for the patients with atrial fibrillation (AF) and acute coronary disease (ACS) or undergoing percutaneous coronary intervention (PCI).

Methods: We searched PubMed, Web of Science and ClinicalTrials.gov for randomized controlled trials (published from January 1, 1998, up to June 6, 2023; no language restrictions) comparing safety and efficacy of ticagrelor and DOACs or VKAs combination treatment arm with or without aspirin to other P2Y12 inhibitors treatment strategies. Main endpoints were clinically relevant bleeding as safety outcomes, all-cause mortality, and major adverse cardiovascular events (MACE) as efficacy outcomes.

Results: Of 248 identified studies, 3 were eligible and were included in our analysis (N= 9463 participants). Ticagrelor and DOAC or VKA combination treatment with or without aspirin strategy was associated with an increased rate of bleeding compared with clopidogrel (odds ratio [OR] 1.39, 95% CI 1.15 to 1.67, I²=0%). MACE was similar between ticagrelor versus clopidogrel (OR 1.00, 95% CI 0.54 to 1.86, I²=68.1%) and between ticagrelor versus prasugrel (OR 0.86, 95% CI 0.28 to 2.65, I²=0%).

Conclusion: The use of ticagrelor is associated with significantly higher rates of bleeding when compared with clopidogrel in patients with concomitant atrial fibrillation and coronary artery disease.

Nicotine dependence, a chronic addictive disorder characterized by high relapse rates, represents a significant global public health challenge. This study employed a randomized, single-blind, parallel-group controlled design to systematically evaluate the efficacy and safety of electroacupuncture compared with varenicline in the treatment of nicotine dependence. The results demonstrated that electroacupuncture achieved significantly superior outcomes across multiple key outcome measures relative to varenicline: the electroacupuncture group exhibited a greater mean daily reduction in Fagerström Test for Nicotine Dependence (FTND) scores (-1.11 points/day vs -0.33 points/day, P < 0.001) and a higher rate of sustained improvement at the 3-month follow-up (84.4% vs 69.5%). With respect to the Heaviness of Smoking Index (HSI), the electroacupuncture group showed a more rapid and sustained decline (sustained rate: 81.7% vs 63.9%, P = 0.002). Moreover, electroacupuncture demonstrated significant advantages in alleviating nicotine withdrawal symptoms (sustained rate: 75.3% vs 52.8%, P = 0.026) and reducing daily cigarette consumption (79.0% vs 56.2%, P < 0.001). The potential mechanism may involve modulation of the mesolimbic dopamine system. These findings support electroacupuncture as a safe, effective, and sustainable non-pharmacological intervention for smoking cessation, particularly suitable for individuals with high nicotine dependence who are sensitive to adverse drug reactions or exhibit poor medication adherence, and suggest its potential role as a complementary or alternative strategy in clinical smoking cessation programs. Future research should further validate its long-term efficacy and investigate the neurobiological mechanisms underlying its effects on relapse prevention.

Introduction: Cobra (Naja species) envenomation in tropical regions like Vietnam frequently leads to severe hand tissue necrosis, creating complex defects that challenge conventional reconstruction. This study evaluates a staged approach combining vacuum-assisted closure (VAC) therapy with free anterolateral thigh (ALT) flap for these challenging injuries.

Methods: Eleven patients with extensive hand defects involving skin and/or tendon due to cobra envenomation were included. Following surgical debridement, VAC therapy was applied to prepare the wound bed. Subsequently, definitive reconstruction was performed using tailored ALT flaps, which included fasciocutaneous or thinned configurations depending on defect complexity. Postoperative evaluation included flap viability, range of motion (ROM), and complication assessment.

Results: The mean duration of VAC therapy was 11.5 ± 4.2 days. Eleven ALT flaps with an average dimension of 14.5×7.0 cm were harvested. Flap thinning was performed in eight cases (72.7%), achieving a mean final thickness of 4.6 ± 1.3 mm. Eight flaps (72.7%) were used to cover defects spanning both digital and dorsal or palmar subunits. Over a mean follow-up of 15.3 months, patients with digital reconstruction achieved a functional ROM at the metacarpophalangeal joint, with 0° of extension and up to 60° of flexion. The main issue was flap bulkiness; no donor-site morbidity was observed.

Conclusion: A staged approach combining VAC therapy for wound bed preparation and subsequent reconstruction with a free ALT flap is a safe and effective strategy for managing complex hand defects resulting from cobra bites. This method facilitates optimal wound conditions and provides versatile, well-vascularized tissue coverage, thereby promoting functional hand recovery.

Objective: Pulmonary vein isolation (PVI) remains the cornerstone of catheter ablation for atrial fibrillation (AF); however, a substantial proportion of patients with non-paroxysmal AF (non-PAF) experience recurrence following ablation. With numerous prognostic models available to predict recurrence, the aim of this study is to compare the predictive performance of multiple scoring systems in patients with non-PAF undergoing PVI as a standalone procedure.

Methods: A retrospective analysis was conducted involving 166 patients with non-PAF (22.3% female; mean age 60 ± 9 years) who underwent initial PVI alone. Clinical data, including transthoracic echocardiography and either cardiac computed tomography or transesophageal echocardiography, were collected. The evaluated prognostic scoring systems included APPLE, BASE-AF₂, C₂HEST, CAAP-AF, CHA₂DS₂-VASc, CHADS₂, DR-FLASH, HATCH, MB-LATER, PAT₂C₂H, and SCALE-CryoAF.

Results: Recurrence of AF following a 90-day blanking period was observed in 41 individuals (24.7%), including 24 (51.8%) in the cryo-balloon ablation (CBA) subgroup and 17 (48.2%) in the radiofrequency catheter ablation (RFCA) subgroup. Among the evaluated models, BASE-AF₂ (AUC = 0.666, 95% CI: 0.572-0.759, p = 0.001), MB-LATER (AUC = 0.734, 95% CI: 0.646-0.821, p < 0.001), and SCALE-CryoAF (AUC = 0.702, 95% CI: 0.600-0.804, p < 0.001) demonstrated superior prognostic performance for recurrence. After propensity score matching, MB-LATER (AUC = 0.734, 95% CI: 0.570-0.899, p = 0.019) was identified as the most effective predictor of recurrence in the CBA subgroup, while BASE-AF₂ (AUC = 0.758, 95% CI: 0.578-0.937, p = 0.013) indicated superior predictive accuracy in the RFCA subgroup.

Conclusion: The BASE-AF2, MB-LATER, and SCALE-CryoAF scoring systems demonstrated enhanced prognostic use for predicting AF recurrence following PVI alone in patients with non-PAF. MB-LATER exhibited superior performance in those treated with CBA, while BASE-AF2 was more predictive for those who underwent RFCA.

Helicobacter pylori infection is unequivocally associated with the development and progression of various digestive diseases. Clinical guidelines recommend eradication therapy for all eligible patients without contraindications. However, reports of high recurrence rates in earlier studies have raised concerns among clinicians and patients regarding the necessity of treatment, which has, to some extent, hindered the timely implementation of eradication strategies. This article provides a systematic review of the issue of H. pylori recurrence. A comprehensive analysis of literature retrieved from major databases such as PubMed, Web of Science, and Google Scholar, using keywords including "Helicobacter pylori", "recurrence", and "reinfection", indicates that the annual recurrence rate is significantly lower than previously thought, with modern epidemiological estimates ranging from 1.5% to 5.0%. The review further elucidates the underlying mechanisms of recurrence, identifies key modifiable risk factors, and highlights that optimizing eradication regimens and preventing intrafamilial transmission are central strategies for controlling recurrence. The conclusion emphasizes that concerns about recurrence should not preclude eradication therapy and offers a theoretical basis and practical directions for developing targeted prevention strategies in clinical practice.

Background: The OPRM1 A118G polymorphism has been implicated in modulating susceptibility to postoperative nausea and vomiting (PONV). Ondansetron, a 5-HT3 receptor antagonist, is widely utilized for PONV prophylaxis; however, whether its efficacy is influenced by OPRM1 A118G polymorphism remains unclear.

Methods: We conducted a retrospective cohort study including patients undergoing laparoscopic gynecological surgery between January 2019 and December 2024; propensity score matching was used to adjust for confounders. OPRM1 A118G genotypes (AA, AG, GG) were analyzed through polymerase chain reaction and sequencing. PONV incidence and severity were assessed using the Visual Analog Scale (VAS) at various postoperative time points.

Results: The Ondansetron group had significantly lower PONV incidence within 2 hours (38.82% vs 56.98%, p = 0.0174) and 2 ~ 24 hours (8.24% vs 19.77%, p = 0.0300). The OPRM1 A118G polymorphism was associated with higher PONV risk, particularly in patients with the AG/GG genotypes in the control group. In the Ondansetron group, the association was significant only within 2 hours (p = 0.0460).

Conclusion: The OPRM1 A118G polymorphism is associated with an increased risk of early PONV, particularly in patients with the G allele, which has been related to reduced μ-opioid receptor sensitivity and increased opioid requirements, thereby predisposing patients to a higher PONV risk. Ondansetron significantly reduces PONV incidence and severity, especially in patients with higher genetic susceptibility.

Purpose: To assess the effects of conventional ultrafiltration and conventional plus zero-balanced ultrafiltration on delirium and cognition in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).

Methods: A total of 116 adults who were scheduled for cardiac surgery with CPB were randomly assigned to the conventional ultrafiltration group or the conventional plus zero-balanced ultrafiltration group. CPB was managed with standard protocols. In the conventional ultrafiltration group, ultrafiltration began during the rewarming phase and was performed until the CPB was terminated. In another group, perfusionists conducted zero-balance ultrafiltration after aortic cross-clamping and began conventional ultrafiltration during the rewarming phase. The primary outcome was the incidence of postoperative delirium (POD) within 7 days; the secondary outcome was postoperative cognitive dysfunction (POCD) at 1 and 3 months. In addition, the patients' vital signs and postoperative complications at different points during the operation were also recorded.

Results: During the first 7 postoperative days, POD was observed in 12 patients in the zero-balance ultrafiltration group and 27 patients in the conventional ultrafiltration group (12/53 [22.64%] vs 27/53 [50.94%]; RR 0.45, 95% CI 0.25 to 0.78; P = 0.005). At 1 month after surgery, POCD occurred in 12 patients in the zero-balance ultrafiltration group versus 18 patients in the conventional ultrafiltration group (12/53 [22.64%] vs 18/53 [33.96%]; RR = 0.67; 95% CI 0.36-1.24; P = 0.281). By 3 months postoperatively, postoperative cognitive dysfunction occurred in 4 patients in the zero-balance ultrafiltration group and 7 patients in the conventional ultrafiltration group (4/53 [7.55%] vs 7/53 [13.21%]; RR = 0.57; 95% CI 0.18-1.84; P = 0.524).

Conclusion: In patients who underwent cardiac surgery with CPB, zero-balance ultrafiltration significantly reduced the incidence of delirium compared with conventional ultrafiltration alone within the first 7 postoperative days. In contrast, the incidence of cognitive dysfunction did not differ significantly between the two groups at 1 or 3 months postoperatively.