Therapeutics and Clinical Risk Management最新文献

Purpose: Atrial fibrillation (AF) is classified into paroxysmal, persistent, long-term persistent, and permanent types. It is commonly treated by radiofrequency ablation (RFA), which is more successful than conventional anti-arrhythmic drugs, but it is still largely unknown whether these beneficial effects are equally present for all AF types. Here, we evaluated the impact that AF type has on post-RFA patient conditions and identified underlying factors affecting AF prognoses.

Patients and methods: Three hundred and twenty-nine AF patients who underwent RFA were retrospectively examined (221 paroxysmal, 56 persistent, 52 long-term persistent), during a post-RFA follow-up period, from 3-months to 2-years. Cardiac functional parameters, such as left atrial (LA), ventricular (LV), and pulmonary artery diameters, as well as ejection fraction (EF) and end-diastolic/systolic diameter ratio, were measured using echocardiography. Additionally, chronic kidney disease (CKD) was diagnosed among these AF patients, using the Modification of Diet in Renal Disease (MDRD) formula, and its impact on post-RFA patient outcomes was examined. Logistic regression analysis identified differences between AF and non-AF recurrence groups.

Results: In terms of functional parameters, persistent AF had significantly smaller LA, and larger EF, compared to paroxysmal and long-term persistent groups, while paroxysmal had significantly larger LV versus persistent and long-term persistent after RFA. For post-RFA patient conditions, paroxysmal, compared to persistent and long-term persistent, had significantly lower AF recurrence (18.10% versus 30.36% and 36.54%) and re-hospitalization rates (6.79% versus 14.29% and 19.23%); however, no significant difference was present between the 3 groups in terms of post-operative stroke rates, as well as re-hospitalization duration. Additionally, CKD patients, versus non-CKD, were more prone to AF recurrence and re-hospitalization, being 3.268 times more likely.

Conclusion: AF types and CKD were independent factors influencing AF recurrence, serving as highly sensitive predictors to monitor prognoses and guide treatments. Therefore, personalized treatment regimens should be recommended for different AF patients.

Purpose: To assess the effectiveness and safety of high-intensity focused electromagnetic technology (HIFEM) used as a therapeutic approach in patients with stress and mixed urinary incontinence.

Patients and methods: Thirty-five females suffering from stress and mixed urinary incontinence were included in the study. The electromagnetic chair (BTL EMSELLA^®) was applied to the patient's pelvic area twice a week for 28 minutes, totaling 6 sessions. The patients' "International Consultation on Incontinence Questionnaire-Short Form" (ICIQ-SF) scores and the number of daily absorbent pad usage were recorded. Results were evaluated after the sixth session and at a first-month follow-up.

Results: The average ICIQ-SF score at baseline was 10.18 ± 4.19 (ranging from 2-18) which declined to 5.33 ± 3.97 after six sessions, and further improved to 4.26 ± 3.94 points at the one-month follow-up. After six sessions, an average improvement of 52.06% in ICIQ-SF score was observed, and after one month of follow-up, an average improvement of 59.6% was detected, which was found to be statistically significant (p=0.038). In addition, the mean number of pads used per day decreased to 1.25 ± 1.54 after treatment, a significant improvement was observed, and the mean daily pad use decreased further to 0.91 ± 1.11 at the first-month follow-up.

Conclusion: HIFEM has demonstrated in our study its ability to safely and effectively treat female patients suffering from stress and mixed urinary incontinence, as evidenced by significant improvements in symptoms and quality of life observed in clinical trials.

Objective: In this study, we evaluated the effectiveness and safety of thalidomide by clinically observing 48 individuals with β-thalassemia who have been administered thalidomide in small and medium doses over a period of two years.

Methods: Thalidomide's efficacy was gauged by tracking hemoglobin (Hb) level alterations post its administration. Liver and kidney function impact was measured through tests for alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, and creatinine. Hemolysis effects were assessed via total bilirubin and indirect bilirubin level measurements. Thrombosis detection was performed using ultrasound examinations of deep vein vessels in the upper and lower extremities. Any adverse effects of thalidomide were recorded during the observation period. Lower dose thalidomide effectiveness was evaluated by monitoring Hb level changes following dosage reduction.

Results: The overall response rate (ORR) among the 48 participants was 91.7% (44 out of 48), with the main reaction (MaR) reaching 72.9% (35 out of 48). Hepatorenal toxicity was not monitored during the 2-year observation period, and there was no improvement in hemolysis. Most adverse effects were mild, with no instances of venous thrombosis and no cases of grade 2 or higher neurotoxicity. When the observation group was divided into three age categories (12-14 years old, 14-18 years old, and over 18 years old), there were no statistically significant differences in the occurrence of adverse reactions among the three groups. As there were some adverse reactions in ten cases, the treatment dose was reduced for them. The maintenance efficacy rate at one year of observation was 90% (9 out of 10).

Conclusion: This study confirmed that thalidomide in small doses over a 2-year observation period is effective, and has no instances of grade 2 or higher neurotoxicity. Long-term maintenance with small doses is recommended for enhanced safety.

Objective: This study aims to establish a quantitative relationship between cervical lordosis (CL) and the rotation angle of the axis for the surgical reduction of atlantoaxial dislocation (AAD) and to explore the potential applications of this relationship in preoperative planning and selection of surgical techniques.

Methods: To construct the correlation between horizontal gaze and location of axis, we introduced the angle B, defined as the angle between the Frankfort horizontal line and the extension line of the posterior edge of the axis, and explored its application in surgical planning. We retrospectively analyzed imaging data from computed tomography of 23 AAD patients who had undergone posterior reduction and fixation. Theoretical equations were deduced through a series of angular transformations, and linear regression analysis was used to validate our findings.

Results: Our results showed a strong linear relationship between the change in CL (ΔCL) and the change in B(ΔB) (y=-1.0402x, coefficient of determination R²=0.978, P<0.001), supporting our deduction that ΔCL=ΔB. Furthermore, we found that the rotation angle of the axis (angle D) was equal to ΔCL. By resolving the atlantoaxial interval into the vertical dimension (h) and horizontal dimension (d), we could calculate the maximum vertical and horizontal distance that the axis could move theoretically according to a patient's maximum ΔCL. This finding supports our theory that the introduction of angle B can provide more precise preoperative planning and surgical technique selection for patients with AAD.

Conclusion: By introducing angle B and deducing the equation ΔB=ΔCL=D, we have provided an innovative tool for preoperative planning and surgical technique selection for patients with AAD. This equation not only helps surgeons achieve more precise and effective surgical reductions but also emphasizes the important role of angle B in surgical planning.

Objective: Patients transported by Helicopter Emergency Medical Services (HEMS) suffer a series of haemodynamic changes, mainly in terms of blood pressure, heart rate, and oxygen saturation, which worsen at different stages of the flight. The aim of this study was to identify haemodynamic changes in adult patients transported by the Helicopter Emergency Medical Service.

Methods: A systematic review of studies published between January 2013 to April 2023 was conducted following the PRISMA 2020 guidelines criteria in the Pubmed, Scopus and Web of Science electronic databases. Methodological quality was assessed using the critical appraisal tool for non-randomised studies of the Joanna Briggs Institute (JBI). The followed protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) with code CRD4202222355798. Two independent reviewers read and extracted the information of the studies.

Results: Eight studies were included in the review, which showed significant haemodynamic changes during transport by HEMS. All studies recorded readings at three points of the mission: pre-flight, in-flight, and post-flight. The greatest change in physiological variables is visible in oxygen saturation, during the in-flight phase, with a decrease in this value. Blood pressure mainly increased in various phases of the mission, especially in the in-flight phase. Heart rate also changed across the mission phases, mainly in the pre-flight and post-flight phases, increasing and decreasing during the flight.

Conclusion: Patients transported by helicopter undergo haemodynamic changes during the different stages of evacuation (pre-flight, in-flight, and post-flight). However, there is a need for further studies on helicopter transport of patients due to the paucity of publications on this topic.

Background: Ankle fractures are common injuries with substantial implications for patient mobility and quality of life. Traditional imaging methods, while standard, have limitations in detecting subtle fractures and distinguishing them from complex bone structures. The advent of 3D Convolutional Neural Networks (3D-CNNs) offers a promising avenue for enhancing the accuracy and reliability of ankle fracture diagnoses.

Methods: In this study, we acquired 1453 high-resolution CT scans and processed them through three distinct 3D-CNN models: 3D-Mobilenet, 3D-Resnet101, and 3D-EfficientNetB7. Our approach involved meticulous preprocessing of images, including normalization and resampling, followed by a systematic comparative evaluation of the models based on accuracy, Area Under the Curve (AUC), and recall metrics. Additionally, the integration of Gradient-weighted Class Activation Mapping (Grad-CAM) provided visual interpretability of the models' predictive focus points.

Results: The 3D-EfficientNetB7 model outperformed the other models, achieving an accuracy of 0.91 and an AUC of 0.94 after 20 training epochs. It demonstrated particularly effective in the accurate detection and localization of subtle and complex fractures. Grad-CAM visualizations confirmed the model's focus on clinically relevant areas, aligning with expert assessments and enhancing trust in automated diagnostics. Spatial localization techniques were pivotal in improving interpretability, offering clear visual guidance for pinpointing fracture sites.

Conclusion: Our findings highlight the effectiveness of the 3D-EfficientNetB7 model in diagnosing ankle fractures, supported by robust performance metrics and enhanced visualization tools.

Background: The effects of intraoperative permissive hypercapnia (PaCO₂ of 45-55 mmHg) on the central nervous system remain unclear. Neurofilament light chain (NfL, a protein found in the axons and nerve fibers of neurons) has been associated with central nervous system disorders. This study investigated the effect of intraoperative permissive hypercapnia on plasma NfL concentration 1 day postoperatively, and in turn on the central nervous system, during laparoscopic surgery.

Methods: This investigation was a prospective, single-blind randomized controlled trial. Eighty-four individuals aged above 60 years were randomly allocated to either the normocapnia group with an PaCO₂ of 35-45 mmHg (n=42) or the hypercapnia group with a PaCO₂ of 45-55 mmHg (n=42). The primary outcome was the 1-day postoperative plasma NfL concentration. Secondary outcomes included the area under the curve (AUC) values for PaCO₂ and regional cerebral oxygen saturation (rSO₂). The Mann-Whitney U-test was mainly used to analyze the outcomes.

Results: The final analysis included 38 and 40 patients in the normocapnia and hypercapnia groups, respectively. There was no statistically significant difference observed between the groups regarding the preoperative and 1-day postoperative plasma NfL concentration (14.0 [11.1, 19.9] vs 16.3 [9.06, 19.9] pg/mL, P>0.05; 23.4 [16.8, 32.3] vs 21.5 [15.6, 29.9] pg/mL, P>0.05, respectively). However, in both groups, the postoperative plasma concentration of NfL showed a significant increase when compared with the preoperative levels (both P < 0.001). The AUCs of PaCO₂ and rSO₂ from the beginning to the end of the pneumoperitoneum were significantly higher in the hypercapnia group compared with the normocapnia group (both P<0.05).

Conclusion: Our results indicate that intraoperative permissive hypercapnia targeting a PaCO₂ of 45-55 mmHg does not significantly influence postoperative early plasma NfL elevation levels in elderly patients undergoing laparoscopic surgery. During general anesthesia, intraoperative permissive hypercapnia might not significantly impact the central nervous system.

Aims of the study: To assess the prescribing patterns of medications associated with geriatric syndromes (MAGS) in older adult patients with multiple comorbidities and to identify factors that may increase the risk of MAGS prescribing in the same population.

Methodology: This study involved a retrospective analysis of the electronic medical records of older adult patients (≥ 65 years) who visited outpatient clinics at King Abdullah University Hospital (KAUH) in Jordan between January 1, 2019, and June 1, 2024. The collected data included patient demographics, medical history, and medications, focusing on those associated with geriatric syndromes. Descriptive and logistic regression statistical analyses were performed using SPSS with the significance level set at p < 0.05.

Results: The study included 1087 older adult patients (52.7% female), with a median age of 71 years. The common conditions existed were peptic ulcer disease (57.1%), hypertension (54.65%), and uncomplicated diabetes (50%). Polypharmacy was presented in 94.8% of total patients number, with 41.6% experiencing excessive polypharmacy. Antihypertensives (78.4%), non-opioid analgesics (56.5%), and antidiabetics (51.8%) were the most frequently prescribed MAGS, which frequently resulted in falls (96%), urinary incontinence (87.6%), and depression (87.3%). Patients with excessive polypharmacy had significantly higher MAGS scores than those with moderate or mild polypharmacy (95% CI: -2.230 to -1.770 and -3.322 to -2.678, respectively, P < 0.001).

Conclusion: The findings demonstrate a high prevalence of excessive polypharmacy among older adult patients, significantly contributing to the elevated prescription level of medications associated with geriatric syndrome occurrence, particularly falls, urinary incontinence, and depression.

Background: This study aimed to investigate clinical efficacy, safety and short-term prognosis of plasma exchange (PE), plasma perfusion combining PE (PP+PE), dual-plasma molecular adsorption system combining PE (DPMAS+PE) in treating acute-on-chronic liver failure (ACLF).

Methods: Two hundred and fourteen ACLF patients admitted to our hospital were included and divided into PE (n = 72), PP+PE (n = 75), DPMAS+PE group (n = 67). Laboratory indexes and MELD scores were collected, and clinical efficacy was compared. Patients' adverse reactions during and 24-h after treatment were collected, and safety was compared. Survival status of patients was followed-up within 90 days, and prognosis was analyzed.

Results: PE, PP+PE and DPMAS+PE significantly reduce TBiL, DBiL, ALT, AST, SA, PT, INR, PCT and CRP levels, and increase PA and PTA levels, compared with pre-treatments (P < 0.05). WBC and SCR levels in DPMAS+PE group decreased significantly post-treatment (P < 0.05). Na⁺ and Cl^- levels in PE and PP+PE group decreased significantly post-treatment (P < 0.05). Total adverse reaction incidence in PE, PP+PE, DPMAS+PE group were 38.89%, 22.70%, 17.90%, respectively, with significant differences among three groups (P < 0.05). Ninety-day mortality rates of patients in PE, PP+PE, DPMAS+PE group were 41.67%, 34.67%, 20.90%, respectively, with significant differences among three groups (P < 0.05).

Conclusion: PE, PP+PE and DPMAS+PE three artificial liver treatment modes can effectively improve liver, kidney and coagulation function of ACLF patients. DPMAS+PE demonstrated better ability to remove endotoxin and inflammatory mediators, showed advantages in reducing ACLF patient mortality within 90 days, and had the least impact on electrolyte post-treatment. Therefore, DPMAS+PE can be used as a better choice for clinical treatment.

Background: Despite the efficacy of catheter ablation (CA) as a treatment for non-valvular atrial fibrillation (NVAF), many patients still experience atrial fibrillation (AF) recurrence after CA. This study aimed to evaluate the predictive value of speckle tracking echocardiographic (STE) parameters for AF recurrence post-ablation.

Methods: A total of 380 NVAF patients treated with CA at the First Affiliated Hospital of Guangxi Medical University from January 2020 to March 2023 were prospectively recruited. The mean age was 59.4 ± 10.8 years, and 72.1% were male, including 150 patients (39.5%) with persistent AF and 230 patients (60.5%) with paroxysmal AF. STE was used to evaluate baseline left atrial (LA) function before CA within 48h. Over a median follow-up of 9 (interquartile range, 4-17) months, AF recurrence occurred in 132 patients (34.7%).

Results: The recurrence group showed lower left ventricular ejection fraction, LA reservoir strain (LASr), and conduit strain (LAScd), but higher LA stiffness than non- recurrence group (all P < 0.05). Multivariable Cox regression identified LA stiffness and LASr as independent risk factors. Time-dependent ROC analysis showed that LA stiffness (AUC 0.768, 95% CI 0.705-0.831) and LASr (AUC 0.755, 95% CI 0.691-0.820) were better at predicting 1-year AF recurrence than other risk factors. For 2-year AF recurrence post-catheter ablation, LA stiffness (AUC 0.866, 95% CI 0.804-0.928) and LASr (AUC 0.860, 95% CI 0.800-0.920) also demonstrated superior predictive performance. Kaplan-Meier curves showed a significant difference in AF recurrence rate for patients with LA stiffness > 0.55 and LASr ≤ 24.3% (Log rank P < 0.01).

Conclusion: Evaluation of LA function using STE assists in stratifying the risk of AF recurrence in NVAF patients and guiding follow-up management. LASr and LA stiffness are independent predictors of AF recurrence following CA in NVAF patients, and potentially outperforming other morphological parameters.