Therapeutics and Clinical Risk Management最新文献

Purpose: Endoscopy-assisted anterior cervical discectomy and fusion (EA-ACDF), which integrates the advantages of conventional ACDF and spinal endoscopy, is an innovative technique for treating cervical spondylotic myelopathy (CSM). We compared the clinical efficacy of EA-ACDF and ACDF for treating patients with single-segment CSM.

Methods: One-hundred and thirty-six CSM patients were retrospectively included from January 2021 to September 2023, of whom 61 underwent EA-ACDF and 75 underwent ACDF. Propensity score matching (PSM) was conducted to adjust for imbalances in covariates between groups. Then, clinical and imaging outcomes, perioperative data, and complications were compared.

Results: After matching, 108 patients were included and followed for 15-38 months. Compared to the ACDF group, the EA-ACDF group had less intraoperative bleeding volume, less drainage volume, and shorter postoperative hospital stays (P < 0.05). At 7 days and 3 months after the surgery, the visual analog scale (VAS), Japanese Orthopedic Association score (JOA), and neck disability index (NDI) improved more significantly in the EA-ACDF group (P < 0.05). Regarding imaging, intervertebral height index (IHI), C_2-7 cervical lordosis (C_2-7 CL), and C_2-7 range of motion (C_2-7 ROM) exhibited no statistical differences between the two groups (P > 0.05). The complication rates between the EA-ACDF (3.7%) and ACDF (14.8%) groups demonstrated statistical differences (P = 0.046).

Conclusion: Both EA-ACDF and conventional ACDF for single-segment CSM provide satisfactory clinical efficacy. The EA-ACDF procedure provides a clearer surgical field, causes less trauma, allows faster recovery, and has the potential to reduce the risk of complications.

Purpose: A proportion of COVID-19 pneumonia patients develop respiratory failure despite tocilizumab administration. This retrospective cohort study aimed to identify prognostic factors associated with progressive respiratory failure within 14 days among patients with severe COVID-19 pneumonia treated with Tocilizumab and to describe treatment outcomes.

Patients and methods: Patients with severe COVID-19 pneumonia were assessed, and their demographic, clinical, laboratory data, and prior treatment were collected on the day of tocilizumab administration. A multivariable Cox proportional hazard model was employed to identify prognostic factors.

Results: Of the 109 patients, 32 (29.4%) progressed to respiratory failure. We identified the following independent prognostic factors for progressive respiratory failure: pulse oximetry saturation to fraction of inspired oxygen ratio (SpO₂/FiO₂) ≤ 160 (HR 2.97, 95% CI 1.41-6.23, P = 0.004), estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m² (HR 3.21, 95% CI 1.23-8.39, P = 0.017), and serum potassium ≤ 4 mmol/L (HR 2.82, 95% CI 1.38-5.80, P = 0.005). A predictive model based on these factors effectively stratified the risk of progressive respiratory failure (area under the curve = 0.72, 95% CI 0.63-0.80). Patients experiencing progressive respiratory failure had poor clinical outcomes, with a mortality rate of 62.5%, compared to 0.0% in the non-respiratory failure group (p < 0.001).

Conclusion: In severe COVID-19 pneumonia patients treated with Tocilizumab, low SpO₂/FiO₂ ratio, low eGFR, and relatively low serum potassium were independent predictors for progressive respiratory failure. This simple clinical score may help identify high-risk patients early, though external validation is required before routine implementation.

Objective: The aim of this study is to compare the anesthetic effect and cognitive function impact of propofol-sufentanil (PS) versus propofol-fentanyl (PF) in elderly patients undergoing transurethral resection of the prostate (TURP) under general anesthesia (GA).

Methods: This is a retrospective cohort study conducted in First People's Hospital of Yongkang City. They included 98 patients aged 65 and above who underwent TURP under GA between October 2023 and March 2025. 49 patients who received PS were matched with a cohort of propofol-fentanyl (PF) in a 1:1 ratio. Compare the hemodynamic parameters (heart rate (HR) and mean arterial pressure (MAP)) of two groups at 30 minutes before anesthesia induction (T0), after anesthesia completion (T1), at the time of skin incision (T2), at the end of surgery (T3), at the postanesthesia care unit (PACU) (T4), 15 minutes after PACU arrival (T5), and 30 minutes after PACU arrival (T6). Compare two perioperative indicators (anesthesia onset time, postoperative awakening time, and extubation time). Compare the pain visual analogue scale (VAS) scores of two groups at three, 12, and 24 hours after surgery. And the Montreal Cognitive Assessment Scale (MoCA) was used to evaluate the number of patients with cognitive impairment at six, 24, and 72 hours after surgery in two groups. Compare the incidence of adverse reactions within 72 hours after surgery between two groups.

Results: Compared with the PF group, the PS group had more stable hemodynamics during T2-T5 (P<0.05); VAS scores were lower at 12 and 24 hours postoperatively (P<0.05); The anesthesia onset time, postoperative awakening time, and extubation time of the PS group were significantly shorter than those of the PF group (P<0.05); The incidence of cognitive dysfunction was lower at six and 24 hours after surgery (P<0.05). However, there was no significant difference in the incidence of various complications between the two groups (P>0.05).

Conclusion: PS is more effective for TURP anesthesia and has a better protective effect on early postoperative cognitive function.

Objective: To evaluate the efficacy of ultra-early rehabilitation combined with coagulation monitoring in preventing deep vein thrombosis (DVT) in patients following surgical intervention for hypertensive intracerebral hemorrhage (HICH).

Methods: A retrospective cohort study was conducted involving 126 HICH patients treated at the Neurosurgery ICU of The Affiliated Hospital of Xuzhou Medical University and the Rehabilitation Department of Xuzhou Central Hospital between January 2023 and December 2024. Participants were stratified into an experimental group (ultra-early rehabilitation with daily coagulation testing, n=63) and a control group (conventional care, n=63) based on the management protocol they received during their hospitalization. Hemodynamic parameters, muscle strength, and coagulation markers were assessed at baseline (T0: pre-intervention), T1 (postoperative day 1), T7 (postoperative day 7), and T14 (postoperative day 14).

Results: Baseline characteristics demonstrated comparability between groups (P>0.05). The experimental group exhibited superior muscle strength recovery in both upper and lower extremities, with statistically significant differences emerging at T14 (P<0.05). Coagulation parameters including fibrinogen (FIB), fibrinogen degradation products (FDP), D-dimer, thrombin-antithrombin III complex (TAT), plasmin-antiplasmin complex (PIC), and thrombomodulin (TM) demonstrated progressive decline in the experimental cohort. At T7, FIB, FDP, and D-dimer levels were significantly lower in the experimental group compared to controls (P<0.05), with more pronounced reductions observed at T14. TAT, PIC, and TM similarly demonstrated substantial decreases at T14 (P<0.01). DVT incidence was significantly reduced in the experimental group (12.70% vs 31.75%, P<0.05).

Conclusion: Ultra-early rehabilitation guided by systematic coagulation monitoring appears to be associated with favorable modulation of hemostatic markers (FIB, FDP, D-dimer, TAT, PIC, TM) and enhanced muscle strength recovery following HICH surgery. This integrated approach may effectively reduce postoperative DVT incidence, offering a promising strategy for thromboprophylaxis management.

Purpose: This study aimed to conduct an updated systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the hepatic safety of febuxostat and allopurinol in gout patients. Subgroup analyses were conducted based on age, dosage, and treatment duration.

Methods: This study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Published studies were reviewed in PubMed, The Cochrane Library, and Scopus. The Cochrane Risk of Bias (RoB) 2 tool was used to assess the quality of the included studies. Risk ratios (RR) were estimated using binary outcomes of fixed effect model and were reported with corresponding 95% confidence intervals (CI). This study is registered on PROSPERO with number CRD42024611074.

Results: Out of 703 publications from the databases, a total of 15 studies met the inclusion criteria. The RR meta-analysis of the included studies was calculated using binary outcomes and a fixed effect model based on available hepatic safety events. We identified 5 RCTs with some concerns regarding the risk of bias, and 10 RCTs with a low risk of bias. Overall, hepatic safety outcomes were comparable between febuxostat and allopurinol, including across subgroups by age, dosage, and treatment duration. Febuxostat showed no significant difference in hepatic risk compared to allopurinol, with RRs of 1.03 (95% CI: 0.78-1.36) for overall liver function abnormalities, 1.03 (95% CI: 0.66-1.61) for investigator-defined liver abnormalities, and 1.21 (95% CI: 0.96-2.74) for hepatobiliary disorders.

Conclusion: This updated systematic review and meta-analysis found no difference in hepatic safety profiles between febuxostat and allopurinol in patients with gout across age categories, dosage levels, or treatment durations. Further research is warranted to address the limitations of sample sizes and the overall moderate quality of existing evidence.

Introduction: Surgical resection is a cornerstone of curative treatment for early-stage lung cancer. Multimodal prehabilitation, a comprehensive, patient-centered program integrating physical exercise, nutritional status, and psychological support, has emerged as a promising approach to enhance patients' physiological and psychological resilience prior to surgery. While multimodal prehabilitation is valuable for optimizing patients' tolerance of oncological treatment, there is a scarcity of studies incorporating multimodal interventions, likely due to the absence of clear guidelines for lung cancer patients. This systematic review aimed to assess the comprehensiveness and effectiveness of prehabilitation activities for lung cancer patients undergoing thoracic surgery.

Evidence acquisition: A systematic literature search was conducted according to PRISMA guidelines. The search was performed in PubMed, Google Scholar, PEDro, and Cochrane Library, with additional publications identified from reference lists. The search was completed on February 27, 2024. Studies published between 2019 and 2024 were included to capture the most recent evidence. The study was registered in PROSPERO (registration number CRD42024499622).

Evidence synthesis: Out of 1233 identified studies, 10 randomized controlled trials were included. Prehabilitation programs varied in duration and setting. Only three studies (Liu et al, 2020; Yao et al, 2022; Ferreira et al, 2021) employed a comprehensive multimodal approach integrating physical exercise, psychological care, and nutrition interventions. Prehabilitation was associated with improved exercise capacity (eg, increased 6MWT distance), reduced postoperative complications, and potential benefits for quality of life and psychological well-being. However, the impact on length of stay and cognitive function remains unclear.

Conclusion: This review highlights a significant gap in the implementation of comprehensive multimodal prehabilitation for lung cancer patients. While physical exercise is widely adopted, psychological and nutritional components are often overlooked. Further research is needed to establish clear guidelines and elucidate the full benefits of a comprehensive multimodal prehabilitation approach, particularly regarding its impact on mental health, quality of life, and long-term outcomes in lung cancer patients.

The human gut possesses a highly complex and metabolically functional microbial community. This microbial ecosystem, often termed a "super-organism", plays a critical function in regulating the host's metabolic processes, including gut motility, energy absorption, appetite, glucose and lipid metabolism, as well as hepatic fat storage. These metabolic functions of the gut microbiota (GM) play a central role in maintaining host homeostasis and overall metabolic health. This review synthesizes findings from recent clinical and preclinical studies, focusing on the interactions between gut microbiota, metabolic functions, and dietary interventions, to provide an evidence-based overview of current knowledge and future perspectives. Evidence was compiled through a narrative review of studies indexed in PubMed, Scopus, Web of Science, and Google Scholar using prespecified keywords related to gut microbiota, metabolic syndrome, diet, and dysbiosis.Recent advancements in nutritional science and microbiology have highlighted the substantial relation between the GM and multiple pathological conditions, including metabolic syndrome (MetS). A plethora of studies predict that disruptions in the GM, known as dysbiosis, may influence the progression of diabetes, obesity, and cardiovascular diseases (CVDs). Notably, elucidating the contributions of the GM in the pathogenesis of MetS could offer promising avenues for therapeutic interventions. Herein, we review the physiological and metabolic functions of the GM and its connection to MetS pathogenesis, while also highlighting the potential molecular mechanisms underlying these observed associations. Furthermore, we discuss the influence of different dietary approaches on MetS and the impact of nutritional therapeutic strategies to support the development of beneficial gut bacteria and alleviate dysbiosis. By integrating insights from both clinical and preclinical research, this study provides a comprehensive overview of how GM modulation can support metabolic health. The possibility of tailoring nutritional interventions based on individual microbiota profiles represents a promising frontier for personalized and effective approaches to improve metabolic health.

Background: Laryngopharyngeal reflux (LPR) is among the most common complications associated with modified electroconvulsive therapy (MECT). The purpose of this study was to assess the prevalence of LPR among patients undergoing MECT and to identify risk factors for LPR within this population.

Methods: This observational prospective study enrolled 107 consecutive patients who underwent MECT at the Third Affiliated Hospital of Sun Yat-sen University. Data regarding potential risk factors for LPR in patients undergoing MECT were collected. The salivary pepsin test was used to diagnose LPR.

Results: The incidence of LPR was 39.3% in this study. On univariate analysis, height (p = 0.040), history of acid regurgitation (p = 0.19), number of MECT session number (p = 0.014), succinylcholine dose (p = 0.032), and oral secretion volume (p = 0.01) were significantly associated with LPR. Outcomes from the multivariate analysis are shown as odds ratio (OR [95% confidence interval (CI)]), >3 MECT sessions (3.02 [1.20-7.58]), history of acid regurgitation (3.90 [1.20-12.70]), succinylcholine dose > 50 mg (2.54 [1.04-6.22]), oral secretion volume > 3 mL (3.66 [1.50-8.97]) were significantly and independently associated with the development of LPR.

Conclusion: A history of acid regurgitation, >3 MECT sessions, succinylcholine dose > 50 mg, oral secretion volume > 3 mL was significantly associated with an increased risk of LPR in patients undergoing MECT.

Background: MRI-derived vertebral bone quality (VBQ) rises with marrow fat and denotes poorer bone integrity. We examined whether simple inflammatory ratios-neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR)-relate to VBQ in degenerative lumbar disease.

Methods: We retrospectively studied 200 patients aged ≥50 years who underwent surgery between January 2022 and January 2024. VBQ was calculated on mid-sagittal T1-weighted MRI using vertebral and cerebrospinal-fluid regions of interest. Associations were tested with Spearman correlations and multivariable linear regression adjusting for age, sex, smoking, diabetes, and body mass index (BMI).

Results: Among 200 patients (mean age = 64.8 ± 8.7 years), those with higher VBQ values (indicating poorer bone quality) were older and had higher NLR and PLR (all p<0.001). VBQ showed significant positive correlations with age (ρ = 0.650), NLR (ρ = 0.534), and PLR (ρ = 0.452) (all p<0.001). In multivariable regression, age, NLR, and PLR remained independently associated with higher VBQ, whereas BMI, sex, smoking, and diabetes were not significant (adjusted R²=0.520; all VIF≤2.26). Standardized effect sizes indicated moderate independent contributions (β_std = 0.151 for NLR; β_std = 0.303 for PLR), corresponding to roughly 0.020-unit and 0.075-unit increases in VBQ per 1-unit NLR and 50-unit PLR increments, respectively.

Conclusion: Preoperative NLR and PLR were independently associated with higher MRI-derived VBQ and may aid imaging-based risk stratification; prospective validation with calibrated thresholds is needed.

Perioperative blood pressure fluctuations significantly contribute to postoperative complications in orthopedic surgery, particularly among high-risk patients. This clinical review synthesizes current evidence on individualized blood pressure management across the perioperative continuum, highlighting procedure-specific risks such as bone cement implantation syndrome, tourniquet-induced hemodynamic changes, and cerebral hypoperfusion in the beach-chair position. Special considerations for vulnerable populations, including frail elderly and anticoagulated patients, are discussed to balance bleeding and thrombotic risks. Maintaining mean arterial pressure within 10-20% of baseline through tailored anesthesia, goal-directed fluid therapy, and continuous monitoring is associated with improved outcomes. A multidisciplinary, risk-stratified approach is recommended to reduce perioperative morbidity and improve postoperative outcomes. Future research should validate personalized blood pressure targets and explore the role of advanced hemodynamic monitoring in enhancing patient safety.