Therapeutics and Clinical Risk Management最新文献

Background: Calcaneal fracture is a common fracture in clinical practice. Open reduction and internal fixation of the calcaneal plate inevitably require cutting or damaging the calcaneofibulartibial fibrous ligament (CFL) beneath the sheath of the fibular muscle tendon. Hence, calcaneal fractures are mainly treated through the lateral L-shaped extension approach. However, there is still controversy over whether the integrity of CFL can be repaired during surgery. Thus, we aimed to explore the effect of repairing CFL during calcaneal fracture surgery on postoperative ankle joint function.

Methods: In this retrospective study, we analyzed the clinical data of 84 patients with Sanders type II and III calcaneal fractures admitted to Wuhan Fourth Hospital from March 2021 to May 2023. According to whether CFL was repaired during surgery, the patients were divided into a repair group (n=44) and non-repair group (n=40). These patients underwent surgery by the same surgeon. The perioperative conditions between the two groups were compared. After a one-year follow-up, the rates of excellent ankle function and incidence of complications was also compared.

Results: The duration of surgery and hospitalization in the repair group was longer than that in the non-repair group, and the intraoperative blood loss was greater than that in the non-repair group (P<0.05). After surgery, the excellent and good rate of ankle function in the repair group (90.91%) was higher than that in the non-repair group (67.50%) (P<0.05). The incidence of complications in the repair group (9.09%) was not significantly higher than that in the non-repair group (7.50%) (P>0.05).

Conclusion: Although preserving CFL integrity during calcaneal fracture surgery increases the duration of surgery and hospitalization, the postoperative recovery of range of motion is good, the rate of excellent ankle function is significantly improved, and there is no significant increase in complications.

Background: Adverse outcomes after hip arthroplasty in elderly patients are frequently observed; however, most existing studies concentrate on single complications. Comprehensive predictive models for a wider range of adverse outcomes remain insufficient. This study explores this issue and proposes new approaches for clinical practice.

Purpose: This study aimed to construct and verify risk prediction model for adverse outcomes after hip arthroplasty in elderly patients.

Patients and methods: The TRIPOD checklist was followed to guide the reporting of this study. Data from 620 subjects who underwent hip arthroplasty at a tertiary A-level hospital from January 1, 2021 to December 31, 2023 were used for the modelling group. Additionally, 264 post-hip arthroplasty patients admitted to the orthopaedic department of another tertiary A-level hospital from January 1, 2024 to December 31, 2024 were selected as the validation group. Risk prediction models were constructed by logistic regression, plotted in column line graphs and evaluated for their predictive effectiveness.

Results: The factors included in the prediction model were age, malignancy history, surgical procedure, albumin, prothrombin time, ASA grade, operation duration, and changeover surgery status. Hosmer-Lemeshow test, χ2=5.418, p=0.712, the area under the receiver operating characteristic curve (AUC) was 0.902. The Youden index is 0.668, with a sensitivity of 0.84 and a specificity of 0.828. The correct practical application rate was 83.33%.

Conclusion: The risk prediction model constructed in this study demonstrates favourable predictive performance and can serve as a reference for healthcare professionals in predicting the risk of adverse outcomes after hip arthroplasty in elderly patients.

Background: Percutaneous coronary intervention (PCI) is a cornerstone treatment for coronary artery disease (CAD), yet opportunities remain to improve clinical outcomes, symptom management, and long-term prognosis. Traditional Chinese Medicine (TCM), with its multi-target and multi-pathway mechanisms, offers a promising complementary approach to enhance PCI efficacy.

Methods: A systematic search was conducted in PubMed and Web of Science using the terms: ("Percutaneous Coronary Intervention" AND "Traditional Chinese Medicine") and ("Percutaneous Coronary Intervention" AND "Chinese Herbal Drugs"). Randomized controlled trials (RCTs) with ≥100 participants were included to evaluate TCM's clinical efficacy in PCI. Pharmacological studies were also reviewed to explore underlying mechanisms.

Results: A review of 20 RCTs showed that TCM plays multiple roles in CAD treatment during PCI. Specific interventions such as Danhong Injection, Tongxinluo Capsule, and Shenzhu Guanxin Granule were found to alleviate angina symptoms, restore cardiac function, reduce cardiac biomarkers, prevent no-reflow/slow-flow phenomena, inhibit in-stent restenosis, and improve prognosis while reducing complications. Mechanistically, TCM exerts its effects through antiplatelet action, anti-inflammation, inhibition of smooth muscle proliferation, vasodilation, microcirculation improvement, and endothelial protection.

Conclusion: This systematic review highlights the complementary benefits of TCM in PCI for CAD patients. Effective interventions such as Danhong Injection and Tongxinluo Capsule contribute to symptom relief, cardiac function restoration, restenosis inhibition, and prognosis improvement. These benefits are linked to TCM's multi-target mechanisms, including anti-inflammatory and antiplatelet effects. Future high-quality studies are needed to further validate these findings and refine clinical applications.

[This corrects the article DOI: 10.2147/TCRM.S527151.].

Purpose: The prevalence of acute ischemic stroke (AIS) is increasing among people of working age, posing socioeconomic and healthcare challenges. Inability to return to work can have significant negative consequences and contribute to the economic burden of stroke. Endovascular treatment (EVT) has been established as the standard of care for large vessel occlusion AIS patients. In this study, we aimed to identify factors predicting favorable outcome among working age AIS patients undergoing EVT.

Patients and methods: We analyzed data from 309 patients from five comprehensive stroke centers between 2019 and 2023. All patients were working age (18<59) with symptoms onset of within 24 hours. Modified thrombolysis in cerebral infarction (mTICI) score of 2b-3 was considered as successful recanalization. We used 3-months mRS post-EVT to evaluate the outcome; mRS of 0-2 was defined as favorable outcome, whereas mRS of 3-6 was considered unfavorable outcome.

Results: The unfavorable outcome group consisted of 150 patients, and 159 patients were in the favorable outcome group. More people in the unfavorable outcome group had diabetes (29.33% vs 15.72%, p=0.004) and hypertension (61.33% vs 40.88, p<0.001). A multivariable regression analysis demonstrated that several factors, including successful recanalization (odds ratio (OR) 5.298, 95% confidence interval (CI) 1.735-16.174, p=0.003), pre-EVT NIHSS (OR 0.892, 95% CI 0.852-0.934, p=0.000), baseline Alberta stroke program early CT score (ASPECTS) (OR 1.609, 95% CI 1.274-2.032, p=0.000), hypertension (OR 0.477, 95% CI 0.270-0.845, p=0.011), diabetes mellitus (OR 0.413, 95% CI 0.208-0.820, p=0.011), and symptomatic intracerebral hemorrhage (sICH) (OR 0.045, 95% CI 0.006-0.359, p=0.003) can predict the outcome of patients undergoing EVT.

Conclusion: Favorable outcome of working age patients with AIS undergoing EVT can be predicted using multiple factors, including hypertension, diabetes mellitus, successful recanalization, pre-EVT NIHSS, baseline ASPECTS, and sICH.

Study objective: To examine the impact of minimal-dose S-ketamine on postoperative analgesia in patients undergoing minimally invasive radical resection for esophageal cancer, with a focus on reducing opioid consumption, enhancing analgesic quality, and facilitating postoperative recovery.

Methods: A total of 216 patients undergoing minimally invasive radical resection of esophageal cancer under general anesthesia were randomly assigned into two groups (S-ketamine and control group), receiving intravenous S-ketamine (0.015 mg/kg/h) or an equal volume of saline for 48 h postoperatively. The primary outcome was cumulative oxycodone consumption in the first 48 h postoperatively. Secondary outcomes included functional activity score (FAS) after one bolus administration, numerical rating scale (NRS) pain scores at rest and when coughing, cumulative oxycodone consumption in different time periods, incidence of postoperative nausea and vomiting (PONV), level of sedation (LOS) score, time to first postoperative flatulence, postoperative delirium, activities of daily living assessed by BI (Barthel Index) and so on.

Main results: The postoperative opioid consumption within 48 hours in S-ketamine group was significantly lower than those in placebo group (P < 0.001), and the difference between the two groups was 40% (mean: 44.5 mg vs 74.8 mg). FAS after one bolus administration and BI in the S-ketamine group were notably superior to those in the control group (P < 0.001). There were Statistical differences between the two groups in the NRS scores at rest at postoperative hour 48 (P = 0.001) and the NRS scores when coughing at postoperative hour 12 (P = 0.011) with mean differences of -0.3 and 0.4, respectively.

Conclusion: Minimal-dose S-ketamine for managing acute postoperative pain in patients undergoing radical resection for esophageal cancer led to a 40% reduction in opioid consumption and promoted rehabilitation.

Objective: This study aimed to examine the long-term effects of left atrial posterior wall spontaneous potential (SP) in patients with non-paroxysmal atrial fibrillation (AF) who underwent pulmonary vein isolation (PVI) combined with left atrial posterior wall isolation (PVI+BOX) ablation.

Methods: Clinical data were retrospectively collected from 140 patients with symptomatic non-paroxysmal atrial fibrillation (NPAF) who underwent first-time radiofrequency ablation between 2022 and 2023. Based on the surgical procedure, patients were categorized into the pulmonary vein isolation group (PVI group) and the pulmonary vein isolation + left atrial posterior wall isolation group (PVI+BOX group). The PVI+BOX group was further subdivided into the spontaneous potential group (SP group) and the no-spontaneous potential group (no-SP group) based on the presence of SP after left atrial posterior wall isolation. Patients underwent monthly follow-ups in the clinic or via telephone and received 72-hour dynamic electrocardiography (ECG) at 3 and 12 months postoperatively. AF recurrence was compared among the groups, and factors associated with recurrence following AF ablation were analyzed.

Results: The PVI+BOX group included 78 cases, with 45 in the no-SP group and 33 in the SP group, while the PVI group comprised 62 cases. No significant difference was observed in the postoperative recurrence-free rate between the PVI+BOX and PVI groups. However, the SP group exhibited a higher postoperative recurrence-free rate compared to both the no-SP group (p = 0.039) and the PVI group (p = 0.020). No significant difference was found in the late recurrence-free rate between the no-SP and PVI groups. Multivariate logistic regression analysis indicated that the duration of AF and the presence of left atrial posterior wall SP were independent risk factors for post-ablation recurrence in patients with NPAF.

Conclusion: The presence of SP post-left atrial posterior wall isolation suggests a better long-term outcome in patients with NPAF following PVI+BOX catheter ablation.

Aim: This study aimed to determine the incidence of hypophosphatemia and evaluate anemia parameters following intravenous iron sucrose (IS) and iron carboxymaltose (FCM) therapy in patients diagnosed with iron deficiency anemia (IDA).

Methods: This retrospective study included 108 patients aged 18-67 who were diagnosed with IDA and received either FCM or IS therapy. The patients were divided into two groups: iron sucrose (n=55, 51%) and ferric carboxymaltose (n=53, 49%). We collected and analysed data on patient demographics, doses of FCM and IS, and laboratory parameters including serum phosphorus, ferritin, total iron-binding capacity (TIBC), iron, and haemoglobin (Hg) values.

Results: The pre-treatment blood phosphorus levels were significantly lower in the IS group than in the FCM group (p = 0.029). Following intravenous iron treatment, the TIBC and phosphorus levels were higher in the IS group compared to the FCM group (p = 0.011 and p <0.001, respectively). The ferritin levels were significantly higher in the FCM group compared to the IS group (p = 0.002).

Conclusion: It is important to be aware that hypophosphatemia may occur after intravenous iron therapy for iron deficiency anemia. Therefore, phosphate levels should be monitored closely following treatment. Furthermore, it would appear that hypophosphatemia is more prevalent following FCM therapy compared to IS.

Background: The study explores the incidence and clinical features of immune-related liver injury (irLI) in hepatocellular carcinoma (HCC) patients compared to those with other malignancies receiving immune checkpoint inhibitors (ICIs).

Methods: A retrospective analysis was conducted on patients treated with ICIs at Beijing Friendship Hospital. Individuals who experienced liver injury consistent with the criteria specified in the Common Terminology Criteria for Advanced Event version 5.0 for irLI were included in the study. The cohort was divided into an HCC group and a non-HCC malignancy group. HCC patients were further classified into three subgroups based on liver injury: no injury, irLI, or non-immune-related liver injury. Data on demographics, laboratory results, and mortality rates were compared.

Results: The study included 292 hCC patients and 1248 patients with other malignancies. Both groups underwent a similar number of ICIs cycles (p=0.237). Liver injury was more common in HCC patients [98 (33.6%) vs 288 (23.1%), p<0.001], but the irLI incidence was comparable between the groups [17 (5.8%) vs 62 (5.0%), p=0.556]. Tumor progression-related liver injury was higher in HCC patients (12.0%) compared to other malignancies (4.6%). Mortality rates showed no significant differences between groups.

Conclusion: HCC patients with underlying liver disease are more prone to liver injury during ICIs therapy, mainly due to tumor progression rather than irLI.

Background: Hypertension (HP) may significantly affect the prognosis of COVID-19 illness. Understanding the epidemiological and clinical characteristics of post-COVID-19 patients with HP and other comorbidities is important for improving outcomes.

Methods: We conducted a retrospective observational study in the Ternopil region of Ukraine involving 926 subjects: 848 individuals in the post-COVID period (0-90 days after a negative SARS-CoV-2 PCR test) and 78 (8.4%) in a control group. Data on medical history, clinical manifestations, treatment modalities, and pathomorphological findings were collected. Patients were categorized into four groups based on COVID-19 severity: mild, moderate, severe, and critical.

Results: HP was present in 46.2% of patients, with a prevalence of 75.0% among fatal cases (p<0.001). Diabetes mellitus (DM) was diagnosed in 17.6%. HP was not associated with increased susceptibility to SARS-CoV-2 infection. In-hospital mortality risk significantly correlated with age (r=0.306, p<0.001), HP (r=0.145, p=0.001), DM (r=0.144, p=0.001), combined HP and DM (r=0.159, p<0.001), and irregular antihypertensive treatment (r=-0.118, p=0.037). However, regular use of ACE inhibitors or ARBs did not significantly affect prognosis. Multivariable logistic regression identified age and irregular antihypertensive treatment as independent predictors of in-hospital mortality.

Conclusion: HP was not associated with increased susceptibility to SARS-CoV-2 infection, based on similar prevalence rates in patients and controls, but was linked to worse outcomes when combined with other risk factors. Age and irregular antihypertensive treatment emerged as independent predictors of in-hospital mortality. These findings highlight the importance of regular blood pressure management in reducing the severity and improving the prognosis of COVID-19 in hypertensive patients.