Therapeutics and Clinical Risk Management最新文献

Objective: To evaluate the effectiveness of a personalized nursing pathway in reducing hospital-acquired infections among leukemia patients during hospitalization through a single-center retrospective analysis.

Methods: This study retrospectively reviewed the clinical records of 291 adult leukemia patients admitted to the Hematology Department of The First Hospital of Putian between January 2018 and December 2022. Patients were divided into two groups based on nursing intervention models: the control group (n = 138) received standard nursing care, while the intervention group (n = 153) was managed using a personalized nursing pathway, which included individualized infection risk assessment, dynamic nursing goals, targeted hygiene protocols, and real-time multidisciplinary coordination. Primary outcomes included infection incidence, infection-related readmission, antibiotic use duration, and length of hospital stay. Secondary outcomes included patient satisfaction and nursing compliance rates.

Results: The incidence of hospital-acquired infections was significantly lower in the intervention group compared to the control group (12.4% vs 24.6%, p < 0.01). The average duration of antibiotic therapy was reduced by 2.6 days (p = 0.015), and hospital stay was shortened by 3.2 days on average (p = 0.022). Patient satisfaction with nursing care improved notably (92.8% vs 78.3%, p < 0.01), and nursing compliance to infection control protocols increased to 95.6% in the intervention group.

Conclusion: A personalized nursing pathway significantly reduces the risk of infection among hospitalized leukemia patients and enhances the efficiency and quality of nursing care. This model offers a feasible, effective approach for infection prevention in high-risk hematology wards and warrants further prospective validation.

Objective: This study aims to explore the anatomical foundations and clinical utility of personalized free ilioinguinal zone flaps for reconstructing skin and soft tissue defects in the hand.

Methods: Anatomical evaluations of the superficial circumflex iliac and the superficial epigastric arteries and veins were performed on 10 cadavers within the inguinal region. Forty-two patients received flap transplants from January 2017 to December 2022 to repair hand tissue defects. Flap areas ranged from 4.0 cm × 6.0 cm to 11.0 cm × 23.0 cm, with arterial anastomosis ensuring vascular connection to recipient sites. Donor sites were directly sutured for closure and healing.

Results: The arteries, sourced from the femoral artery, were consistently identified in all cadavers, with a common trunk found in 70% of cases. Of the 42 transplants, 40 successfully survived, showing a high efficacy rate. Complications included two vascular crises; one was successfully managed, and one led to necrosis. Post-operative observations included soft flap texture, mild bloating, sensory recovery from S2 to S3, and minimal scarring at the donor site.

Conclusion: The personalized free ilioinguinal zone flap is highly effective for repairing hand skin and soft tissue defects, offering advantages like direct donor site closure and reliable vascularity. This method shows great promise in enhancing outcomes in reconstructive hand surgery.

Background: The efficacy of intravenous thrombolysis (IVT) in treating acute ischemic stroke (AIS) has shown a rapid decline with time; however, the impact of this trend on IVT prior to endovascular thrombectomy (EVT) remains uncertain.

Methods: This study retrospectively analyzed patients from multicenter trials who received EVT after IVT in the anterior circulation. The endpoints included unfavorable outcomes (defined as a 90-day modified Rankin Scale score of 3-6) and hemorrhagic complications. Patients were stratified into two groups based on onset-to-needle time (ONT), with a 2-hour threshold. ONT was defined as the interval from the first observed stroke symptoms (or the last known well state) to the initiation of IVT. Multivariate logistic regression and propensity score matching (PSM) were used to compare outcomes.

Results: Among the 176 patients following PSM (with a median age of 67.5 years and 60.8% being female), the median ONT was 120 minutes (85 minutes vs 176 minutes in early and late phase group), with 88 patients in each group. Multivariate analysis revealed that late phase IVT (ONT > 2 hours) was significantly associated with unfavorable outcomes (odds ratio [OR] = 2.213; 95% confidence interval [CI] = 1.078-4.646; P = 0.032). No significant differences were observed in mortality and hemorrhagic complications between the groups. Subgroup analysis revealed no significant disparities among the predefined subgroups.

Conclusion: Early phase IVT (ONT ≤ 2 hours) before EVT was linked to reduced unfavorable outcomes for AIS. No significant differences were observed among predefined subgroups.

Lung cancer remains a leading cause of cancer-related mortality worldwide, largely due to challenges in its early detection and effective management. Despite advances in treatment modalities, the complex nature of lung cancer, characterized by its molecular heterogeneity and resistance mechanisms, underscores the need for innovative approaches. Cell-free RNA (cfRNA) has emerged as a promising biomarker with significant clinical applications in lung cancer diagnosis, monitoring, and precision medicine. We explore key themes including the utility of cfRNA in early detection, differentiation between benign and malignant lung nodules, molecular subtyping, and real-time therapeutic monitoring. Advances in liquid biopsy technologies, particularly non-invasive cfRNA analysis, provide dynamic means of tracking tumor evolution. cfRNA biomarkers such as miRNA, long non-coding RNAs, and circular RNAs offer unique insights into tumor biology, paving the way for personalized treatment strategies. Further, we discuss the application of cutting-edge technologies such as AI-driven analytics, next-generation sequencing, and multi-omics integration, which are enhancing the clinical utility of cfRNA in identifying treatment resistance and improving outcomes in immunotherapy, targeted therapy, and chemotherapy. The review addresses significant challenges facing cfRNA applications, including pre-analytical variability, technical limitations in detection methods, economic constraints, and the lack of standardization in clinical protocols. Through multidisciplinary collaborations and standardized methodologies, significant progress can be made toward integrating cfRNA into routine clinical practice. Emphasis is placed on future research directions, which include validating cfRNA biomarkers across diverse populations, streamlining workflows, and addressing scalability issues for real-world applications. This comprehensive exploration positions cfRNA at the forefront of innovations in lung cancer management, offering a pathway for improved diagnostic accuracy and individualized care.

Purpose: Haemorrhagic transformation (HT) is an unpredictable complication of acute ischaemic stroke with large vessel occlusion following endovascular thrombectomy (EVT), and imaging parameters that are correlated with haemorrhage are unknown. We developed a modified version of the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) by adding a periventricular region to assess cerebral contrast extravasation (CE) on dual-energy computed tomography (DECT) and assessed its predictive value for HT.

Methods: In total, 101 patients who underwent DECT immediately after EVT were prospectively enrolled. CE was defined as incident hyperdensity on iodine overlay maps. We quantified the CT attenuation in Hounsfield units (HU) and iodine concentration within the CE regions. The modified ASPECTS divided the middle cerebral artery vascular territory into 11 regions and added one region (paraventricular) to the original score. CE was scored as 1 point for each region, and the cumulative score was determined. Follow-up imaging was performed within 7 days postoperatively to confirm the occurrence of HT. A receiver operating characteristic (ROC) curve was constructed to assess the predictive value of various DECT-measured parameters for HT.

Results: Overall, 75/101 (74.3%) patients exhibited CE following EVT, and 47/101 (46.5%) patients exhibited HT. In the ROC curve analysis, the DECT parameter with the maximal area under the curve (AUC) for HT was the modified ASPECTS (AUC=0.87), indicating that patients with a modified ASPECTS >2 were more likely to develop HT (sensitivity: 83.0%, specificity: 83.3%). The maximum iodine concentration (AUC=0.76) and maximum CT attenuation (AUC=0.68) in the hyperdense region were also predictors of postoperative HT.

Conclusion: The modified ASPECTS is a practical and sensitive method for assessing postoperative HT risk in patients following EVT.

Purpose: To evaluate the prognostic value of the CHA₂DS₂-VASc score for 12-month major adverse cardiovascular events (MACE) in Chinese patients with acute coronary syndrome (ACS) without atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI).

Patients and methods: This retrospective study included 992 consecutive ACS patients without AF who underwent PCI from January 2019 to December 2022. Patients were stratified into low- (0-1), moderate- (2), and high-risk (>2) groups based on the CHA₂DS₂-VASc score. The primary endpoint was MACE, defined as a composite of all-cause mortality, non-fatal myocardial infarction, and non-fatal stroke. Multivariate Cox regression was used to evaluate the association between risk groups and outcomes.

Results: During the 12-month follow-up, MACE occurred in 12.7%, 21.4%, and 28.8% of the low-, moderate-, and high-risk groups, respectively (P<0.01). After adjusting for confounders, the CHA₂DS₂-VASc score remained independently associated with MACE (HR=2.27, 95% CI: 1.34-3.86 for moderate risk; HR=3.83, 95% CI: 1.90-7.69 for high risk; both P<0.01).

Conclusion: The CHA₂DS₂-VASc score independently predicts 12-month MACE in non-AF ACS patients after PCI, with risks 2.27-fold higher in moderate-risk and 3.83-fold higher in high-risk patients compared with low-risk patients. This simple, readily available tool may help identify patients at higher risk for MACE and inform secondary prevention strategies.

Biofilm-associated infections pose a significant challenge in clinical settings due to their increased resistance to antibiotics and evasion of host immune responses. These infections are responsible for a large proportion of chronic and recurrent infections, leading to prolonged hospital stays, increased healthcare costs, and elevated morbidity and mortality rates. Vancomycin, a glycopeptide antibiotic, has long been a cornerstone in the treatment of infections caused by Gram-positive bacteria, particularly methicillin-resistant Staphylococcus aureus (MRSA). In addition, vancomycin-resistant Enterococcus (VRE) represents an important group of biofilm-forming pathogens, further complicating treatment strategies. However, its efficacy against biofilms remains a subject of ongoing research and debate. The ability of vancomycin to target biofilm-embedded bacteria is often hindered by multiple resistance mechanisms, including poor antibiotic penetration, metabolic adaptation of biofilm-associated cells, and the presence of persister cells. The aim of this review is to evaluate vancomycin's antibiofilm activity by examining its mechanism of action, pharmacokinetics, effectiveness, limitations, and potential strategies to enhance its therapeutic outcomes. Several novel approaches have been explored to augment vancomycin's antibiofilm activity, including combination therapies, adjuvant strategies, and nanotechnology-based drug delivery systems. Understanding these factors is crucial for optimizing therapeutic strategies and overcoming the persistent challenge of biofilm-related infections. This review synthesizes current evidence and highlights areas requiring further research to enhance vancomycin's efficacy against biofilm-associated infections.

Background: There is still no definite answer regarding the most advantageous patient positioning during total hip replacement (THR). We compared whether patient position (lateral vs supine) incur a difference on hospital length of stay (LOS) after primary THR.

Methods: This retrospective cohort study included primary THR patients at a single tertiary center (2017-2022). THR patients prepared in the lateral decubitus position were compared to those in the supine position. Propensity score matching at a 1:4 ratio was applied to minimize selection bias. Matching covariates included age, sex, body weight, comorbidities (hypertension, diabetes), anesthesia time, and intraoperative tranexamic acid use. After matching, 990 patients were analyzed (792 lateral; 198 supine).

Results: In supine group, the median LOS (5 days, IQR: 4-6) was shorter than the lateral group (5 days, IQR: 5-6; p<0.001). More supine patients were discharged before day 5 (45.5% vs 22.7%, p<0.001). Multivariate analysis revealed supine position as the strongest protective factor against long hospitalization (OR: 0.32, 95% CI: 0.23-0.46, p<0.001). Other notable predictors of long LOS included ASA ≥III (OR: 1.74), longer anaesthesia duration (OR: 1.78), and higher IV fluid administration (OR: 1.08). Patient positioning did not notably predict blood transfusion risk (OR: 1.32, p=0.144).

Conclusion: THR patients in supine positioning have a substantial reduction in hospital LOS compared to patients in lateral decubitus positioning, with supine position providing a 68% reduction in risk of long hospitalization. The two groups showed no difference in blood transfusion requirements.

Objective:  To evaluate the efficacy and safety of a stratified surgical strategy for convergence insufficiency-type exotropia (CIX(T)) tailored to the magnitude of near deviation, with a primary outcome of postoperative motor success (orthophoria) and a secondary outcome of stereopsis improvement.

Methods:  This retrospective cohort study included 85 CIX(T) patients (near deviation ≥ distance deviation by 15Δ) treated between July 2015 and June 2022. Patients were stratified into three groups based on near deviation magnitude. Group 1 (n=15, <30Δ) underwent unilateral medial rectus resection; Group 2 (n=38, 30-80Δ) received unilateral lateral rectus recession combined with medial rectus resection; Group 3 (n=32, 85-130Δ) underwent bilateral lateral rectus recession plus unilateral medial rectus resection. Ocular alignment (prism cover test) and stereopsis (Titmus test) were assessed preoperatively, at 1 week (short-term), and 3 months (intermediate-term) postoperatively.

Results:  Baseline characteristics were comparable across groups, except for the stratification variable of near deviation. At the 3-month follow-up, motor success was achieved in 20.0% of Group 1, 89.5% of Group 2, and 87.5% of Group 3. Group 1 showed a high rate of undercorrection (80.0%), whereas Groups 2 and 3 demonstrated stable alignment with minimal undercorrection (10.5% and 9.4%, respectively). Stereopsis scores significantly improved from preoperative levels in Group 2 (P<0.001) and Group 3 (P<0.001), but regressed in Group 1 (P>0.05). A planned slight initial overcorrection (10-15Δ) at distance was significantly correlated with better intermediate-term alignment (r = 0.68, 95% CI: 0.51 to 0.80, P<0.001).

Conclusion:  These findings support a stratified surgical approach for CIX(T) based on near deviation magnitude. While combined recession-resection procedures are effective for moderate-to-large angle deviations, unilateral medial rectus resection for small-angle CIX(T) resulted in high rates of undercorrection. This suggests that the surgical plan for small-angle CIX(T) may require more aggressive dosages or alternative strategies.