Therapeutics and Clinical Risk Management最新文献

Purpose: Urinary incontinence (UI) is a common complication after radical prostatectomy (RP), adversely affecting patients' quality of life. This study aimed to evaluate the efficacy and safety of high-intensity focused electromagnetic (HIFEM) therapy as a non-invasive treatment for post-prostatectomy UI.

Patients and methods: Twenty-seven men (mean age ± SD: 67.9 ± 3.4 years) with persistent UI after RP underwent six HIFEM sessions (28 min, twice weekly) using the BTL EMSELLA^® chair. Outcomes were assessed after the sixth session and at one-month follow-up. Primary endpoints were changes in International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scores and daily pad use.

Results: Baseline mean ICIQ-SF score was 10.58 ± 4.15. This decreased to 5.43 ± 3.85 after treatment and to 4.16 ± 3.97 at one month, representing improvements of 53.1% and 60.6%, respectively (both p < 0.005). Daily pad use declined from baseline to 1.45 ± 1.54 after treatment and 1.13 ± 1.81 at follow-up (both p < 0.001). No adverse events were reported.

Conclusion: HIFEM therapy significantly improved UI severity and reduced pad dependence in men with post-prostatectomy incontinence, with effects sustained for at least one month and no observed side effects. These findings support HIFEM as a safe, non-invasive treatment option warranting further study in larger, long-term trials.

Background and aim: Nephrotic syndrome (NS) is frequently accompanied by serious complications such as edema-related infections, thromboembolism, and acute kidney injury, which can significantly impact prognosis. Nurses are essential in early identification, patient education, and implementation of preventive measures. This study explores the knowledge, attitude, and practice (KAP) levels of nurses concerning complication prevention in nephrotic syndrome and identifies relevant influencing factors.

Methods: A cross-sectional survey was conducted from January to December 2023 across Ruijin Hospital affiliated with Shanghai Jiao Tong University School of Medicine and Shanghai Baoshan Medical Emergency Center in China, targeting nurses working in nephrology-related units. A total of 246 valid responses were obtained using a structured and pre-validated KAP questionnaire. The instrument included domains assessing factual understanding, behavioral attitudes, and routine clinical practices. Data were analyzed using descriptive statistics, Pearson's correlation, and logistic regression to determine relationships between demographic variables and KAP outcomes.

Results: The mean knowledge score among respondents was 5.12±2.67, attitude score was 18.76±5.02, and practice score was 30.45±11.07. Correlational analysis revealed significant positive associations between knowledge and practice (r = 0.421, p < 0.001), and between attitude and practice (r = 0.336, p = 0.015). Regression analysis identified prior nephrology education, years of clinical experience, and academic qualifications as independent predictors of higher practice scores.

Conclusion: While nurses generally hold positive attitudes towards complication prevention in nephrotic syndrome (NS), there are significant gaps in their knowledge and inconsistencies in the application of preventive practices. These findings emphasize the need for targeted training programs to enhance nurses' practical competencies in managing NS complications. By improving nurses' knowledge and clinical practices, especially in early detection and prevention, patient outcomes can be significantly improved, leading to more effective management of NS-related complications.

Preoperative chemoradiotherapy (CRT) and sphincter-preserving total mesorectal excision (TME) effectively control tumor growth in locally advanced rectal cancer (LARC). However, associated complications can impair the quality of life (QoL) of the patients. Neoadjuvant therapies, such as consolidation neoadjuvant therapy and total neoadjuvant therapy (TNT), can improve tumor regression, potentially achieving a complete response and allowing organ preservation. Emerging clinical data suggest that these approaches can promote long-term cancer control in patients with LARC.

[This corrects the article DOI: 10.2147/TCRM.S466113.].

Objective: To investigate the predictive value of serum retinol-binding protein (RBP4), alkaline phosphatase (ALP), and interleukin (IL)-1β for postoperative recurrence of intrahepatic bile duct stones (IBDS).

Methods: This retrospective study included 320 patients with intrahepatic bile duct stones (IBDS) admitted to our hospital from May 2020 to May 2022, all of whom underwent laparoscopic choledocholithotomy combined with choledochoscopy. Patients were divided into a recurrence group and a non-recurrence group based on their postoperative status. Serum levels of RBP4 and IL-1β were measured by ELISA; liver function indicators including ALP were analyzed using a biochemical analyzer; levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were also detected by ELISA; toll-like receptor 4 (TLR4) and thyroid-stimulating hormone (TSH) were measured by radioimmunoassay.Pearson correlation analysis was performed to assess the relationships between serum RBP4, ALP, IL-1β and laboratory indicators. Multivariate logistic regression analysis was used to identify factors influencing postoperative recurrence of IBDS. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of serum RBP4, ALP, and IL-1β for IBDS recurrence after surgery.

Results: The levels of serum RBP4, ALP, IL-1β, TNF-α, TLR4, and TSH in the recurrence group were significantly higher than those in the non-recurrence group (P < 0.05). Pearson correlation analysis showed that serum RBP4, ALP, and IL-1β were all positively correlated with TNF-α, TLR4, and TSH (P < 0.05). Multivariate logistic regression analysis identified RBP4, ALP, IL-1β, TNF-α, TLR4, and TSH as independent risk factors for postoperative recurrence of IBDS (P < 0.05).According to ROC curve analysis showed that the area under the curve (AUC) for serum RBP4 in predicting postoperative recurrence of IBDS was 0.844, for serum ALP was 0.822, and for serum IL-1β was 0.732. The combined detection of RBP4, ALP, and IL-1β yielded an AUC of 0.892, which was superior to the predictive performance of each marker alone (Z = 2.654, Z = 2.668, Z = 2.650; all P < 0.05).

Conclusion: Serum levels of RBP4, ALP, and IL-1β are significantly elevated in patients with IBDS, and their combined detection can enhance the predictive value for postoperative recurrence of IBDS.

Purpose: Osteoporosis is closely related to specific immune cell, yet the causal mechanism has not been clarified. Previous studies mostly adopted traditional unidirectional Mendelian randomization (MR) for analysis, failing to fully clarify their relationship. This study is the first to analyze the bidirectional causal relationship between the characteristics of peripheral immune cells and the risk of osteoporosis.

Methods: A bilateral two-sample MR was performed, with immune cells serving as instrumental variables and the incidence of osteoporosis as the outcome. We used five algorithms to evaluate the causal relationship between immune cells and the incidence of osteoporosis (inverse-variance weighted [IVW], MR-Egger, simple mode, weight median, and weight mode). The Cochran Q and leave-one-out tests were used to evaluate heterogeneity and stability, and the MR-Egger intercept test was used to evaluate horizontal pleiotropy.

Results: The eosinophil percentage of granulocytes (odds ratio [OR] = 1.25, 95% confidence interval [CI] = 1.08-1.44, P = 0.002), eosinophil percentage of white cells (OR = 1.17, 95% CI = 1.02-1.35, P = 0.027), and sum eosinophil basophil counts (OR = 1.16, 95% CI = 1.02-1.32, P = 0.027) had positive causal associations with the incidence of osteoporosis. The lymphocyte counts (OR = 0.83, 95% CI = 0.71-0.97, P = 0.016), neutrophil percentage of granulocytes (OR = 0.78, 95% CI = 0.67-0.90, P < 0.001) played negative effect on osteoporosis. The reverse direction showed that osteoporosis had no causal effect on the characteristics of the immune cells. Non-significant heterogeneity and horizontal pleiotropy indicated the results were robust.

Conclusion: This study identified a unidirectional causal link between five immune cell traits and osteoporosis, providing new insights into osteoporosis pathogenesis and potential targeted immunotherapy.

Aim: Although penile fracture is a rare condition, the damage it may cause afterwards is challenging for patients. We aimed to investigate the relationship between late presentation to the hospital and the frequency of erectile dysfunction (ED) in patients with penile fractures.

Methods: In our cross-sectional, retrospective study, the frequency and severity of ED were calculated according to the International Index of Erectile Function (IIEF) scoring in patients with penile fracture admitted to Dicle University Hospital in the inter-operative period between the event and the operation and the subsequent controls. The relationship between these two conditions was analysed.

Results: Forty-six patients who met the inclusion criteria were included in our study. The mean age was 37 (28-46) years. The mean preoperative IIEF was 25 (20-28), and the mean postoperative IIEF was 21.3 (15-27). The mean event-operation time was 9 (6-15) hours. The rate of sexual intercourse was 50%, trauma was 30%, development after masturbation was 11%, and other causes were 9%.

Conclusion: Penile fracture is a real urological emergency, and as urologists, we need to intervene as early as possible in patients experiencing this condition. We found that patients who presented to the hospital more than 12.5 hours after penile fracture had a significantly higher risk of developing ED or worsening ED in the subsequent period.

Background: Congenital heart disease(CHD) is a congenital malformation caused by abnormal development of the heart and large blood vessels, and left-to-right shunt CHD is a relatively common type. Surgical treatment has the problem of prolonged hospital stay in CHD patients. It is of great significance to explore the influencing factors of prolonged hospital stay after surgery therapy for children and adolescents with left-to-right shunt CHD.

Methods: A total of 463 children and adolescents with left-to-right shunt CHD who received surgery therapy were retrospectively analyzed. Medical records (gender, CHD types, echocardiography, invasive mechanical ventilation, blood transfusion, tracheal intubation, intraoperative blood loss, and length of hospital stay) were collected. The threshold for prolonged hospital stay was defined based on the third quartile (75th percentile) of length of hospital stay in all patients. The relationship between clinical features and prolonged hospital stay was analyzed.

Results: The mean length of hospital stay was 13.00 (7.00, 18.00) days, there were 330 (71.3%) patients with non-prolonged hospital stay (<18.0 days) and 133 (28.7%) with prolonged stay (≥18.0 days). There were statistically significant differences in the distributions of types of CHD (χ²=67.959, p<0.001), severity of mitral insufficiency (χ²=14.171, p=0.002) and pulmonary hypertension (χ²=49.611, p<0.001), and the proportion of treated with invasive mechanical ventilation (χ²=104.657, p<0.001), blood transfusion (χ²=117.649, p<0.001), and tracheal intubation (χ²=67.752, p<0.001) between CHD patients with prolonged and non-prolonged hospital stay. Multivariate logistic regression analysis showed that male (odds ratio(OR): 2.137, 95% confidence interval(CI): 1.278-3.574, p=0.004), compound types CHD (OR: 2.021, 95% CI: 1.178-3.469, p=0.011), pulmonary hypertension (OR: 3.179, 95% CI: 1.537-6.572, p=0.002), invasive mechanical ventilation (OR: 4.069, 95% CI: 1.567-10.564, p=0.004), and blood transfusion (OR: 5.128, 95% CI: 2.421-10.862, p<0.001) were independently associated with prolonged hospital stay.

Conclusion: Male, compound types CHD, pulmonary hypertension, invasive mechanical ventilation, and blood transfusion were independently associated with prolonged hospital stay in CHD patients. It provides valuable information to guide the hospitalization management of CHD.

Objective: This study aimed to assess the impact of continued cardiac rehabilitation on cardiac function, psychological well-being, and prognostic outcomes in patients diagnosed with heart failure and improved ejection fraction (HFimpEF).

Methods: This study adopted a retrospective design, and a total of 150 patients with HFimpEF who experienced reduced ejection fraction after the first acute myocardial infarction were included. All patients underwent emergency percutaneous coronary intervention (PCI). Participants were categorized into a control group (n = 70) or an observation group (n = 80) based on their participation in ongoing cardiac rehabilitation. The follow-up period extended for one year. Comparative analyses were conducted to assess differences between the two groups in baseline characteristics, cardiac function, anxiety and depression scores, and the incidence of cardiovascular events.

Results: No statistically significant differences were observed between the groups in terms of sex, age, past medical history, blood lipid levels, blood glucose levels, or renal function. Similarly, pre-treatment assessments of cardiac function, six-minute walk test results, Self-Rating Anxiety Scale (SAS) scores, Self-Rating Depression Scale (SDS) scores, or the incidence of cardiovascular events showed no significant differences. Compared to the control group, the observation group demonstrated significantly better cardiac function and six-minute walk test performance, along with significantly lower SAS and SDS scores. Furthermore, the incidence of heart failure and rehospitalization was significantly lower in the observation group than in the control group.

Conclusion: Sustained cardiac rehabilitation in patients with HFimpEF was associated with significant improvements in cardiac function, enhanced six-minute walk test performance, reduced anxiety and depression levels, and a lower incidence of heart failure and rehospitalization. These findings highlight the key role of sustained cardiac rehabilitation in improving clinical outcomes for patients with HFimpEF.