Therapeutics and Clinical Risk Management最新文献

Respiratory inflammatory and infectious diseases continue to impose a substantial global health burden, compounded by persistent gaps in understanding their pathogenic mechanisms and limited therapeutic advancements. To address these challenges, this review systematically analyzed literature from PubMed, Web of Science, and Scopus databases (2005-2025) to evaluate the evolution and applications of airway organoid models in respiratory disease research. Key findings include: (1) the convergence of traditional culture techniques with advanced methodologies - including 3D matrix embedding, bioprinting and organoids-on-chips technologies - has enabled unprecedented recapitulation of human airway architecture and multicellular interactions; (2) these novel models provide unique insights into disease pathogenesis, host-microbe dynamics, and drug response variability; (3) the inherent capacity to maintain native cellular diversity and disease-associated phenotypes positions airway organoids as crucial platforms for personalized medicine approaches. Collectively, these advances establish airway organoids as transformative tools that bridge conventional in vitro models and clinical reality. Looking ahead, coupling organs-on-chips platforms with microgravity culture and single-cell lineage tracing will catalyze fundamental breakthroughs in respiratory disease research.

Background: To explore the effect of tranexamic acid (TXA) on perioperative blood loss in posterior decompression surgery of patient with metastatic spinal tumor.

Methods: Three hundred sixty-eight consecutive patients between May 2011 and Aug 2022 were retrospectively reviewed. One hundred eighty patients (182 surgeries) met the criteria and were included in the study. Sixty-two surgeries received preoperative intravenous TXA (TXA group), and 120 did not (non-TXA group). The primary outcome was total blood loss. T-test, Mann-Whitney U, and chi-square tests were used to evaluate the difference in baseline data, total blood loss, and other outcome measures between the two groups.

Results: Patients with hyper vascular tumors had significantly more blood loss compared with non-hyper vascular tumors (2002(1531,2792) mL vs 1469(1036,1962) mL, p=0.001). There was no significant different in the postoperative venous thromboembolism of the lower limb between the two groups. For patients with non-hyper vascular tumors, the blood loss (1216(827, 1709) mL vs 1561(1146, 2019) mL, p = 0.012) and postoperative drainage (1-day post-operation: 240(150,290) mL vs 280(150,395) mL, p=0.040; 3-days post-operation: 450(348,630) mL vs 613(398,799) mL, p=0.025) of TXA group were significantly less compared with that of the non-TXA group. Meanwhile, the TXA group had significantly less postoperative hospitalization compared with the non-TXA group (11.0(9.0, 13.3) days vs 12.5(9.0, 16.3) days, p=0.023). For patients with hyper vascular tumors, there were no significant differences in the blood loss and amount of postoperative drainage between the two groups.

Conclusion: Preoperative intravenous TXA demonstrated a trend toward decreased perioperative blood loss in posterior decompression surgery of spinal metastases with non-hyper vascular tumors.

Objective: To assess the clinical prognosis and reproductive outcomes in individuals presenting with moderate-to-severe intrauterine adhesion (IUA) following the administration of hysteroscopic adhesiolysis (HA) in conjunction with modified intrauterine stents.

Methods: A cohort comprising 156 individuals diagnosed with IUA (105 with moderate severity and 51 with severe severity) was enrolled. Subsequent to hysteroscopic intervention, all participants received intrauterine stent placement during the immediate postoperative phase. A comprehensive follow-up period of 2 years post-stent removal was instituted.

Results: The occurrence of adhesion recurrence increased progressively, demonstrating a recurrence rate of 11.54% at hysteroscopic reevaluation administrated in 3 months after surgery and surging to 32.69% during the 2-year follow-up period. Comparative analysis indicated a statistically significant reduction in recurrence rates among patients with moderate IUA compared to severe IUA (P < 0.05). The median duration of stent placement was determined to be 4 months. Postoperatively, patients exhibited a cumulative pregnancy rate of 71.79%, with a live birth rate of 79.28%. Significantly, patients with moderate IUA exhibited a significantly elevated pregnancy rate in comparison to those with severe IUA (P = 0.004). Multifactorial logistic regression analysis revealed that the severity of IUA was an independent risk factor for recurrence risk. Furthermore, the severity of IUA and postoperative re-adhesion emerged as contributory factors to the infertility observed in these patients.

Conclusion: The combination of HA with a modified intrauterine stent demonstrates efficacy in the treatment of IUA; however, outcomes remain suboptimal for cases characterized by severity. The prognostic assessment of patients and the suggested criteria for the removal of intrauterine stents, as delineated in the study, are considered both feasible and recommendable for clinical practice. Furthermore, conscientious and attentive management is imperative for the mitigation of adverse pregnancy such as early pregnancy loss in individuals afflicted with IUA during pregnancy.

Objective: To analyze the effect of the Single Tooth Anesthesia (STA) technique in dental outpatient patients undergoing the extraction of impacted teeth and its impact on patient anxiety levels.

Methods: This retrospective study included clinical data from 130 patients who underwent the extraction of a single mandibular impacted tooth in our dental outpatient department between April 2022 and June 2024. According to the anesthesia method, patients were divided into two groups: the Traditional Group (n = 65, receiving traditional local injection anesthesia) and the STA Group (n = 65, receiving Single Tooth Anesthesia). Parameters including intraoperative bleeding, duration of anesthesia, extent of anesthetic infiltration, blood pressure [systolic blood pressure (SBP), diastolic blood pressure (DBP)], heart rate (HR), pain [visual analog scale (VAS)], compliance (Frankl treatment compliance scale), tolerance (Houpt behavior scale), and anxiety level [modified dental anxiety scale (MDAS)] were compared between the two groups.

Results: There were no significant differences in the amount of bleeding, anesthesia duration, or infiltration range between the two groups (P > 0.05). In the Traditional Group, SBP at 3 minutes after anesthesia and post-extraction was significantly higher than before anesthesia (P < 0.05), whereas DBP and HR showed no significant changes (P > 0.05). In the STA Group, SBP, DBP, and HR remained stable across the three time points (P > 0.05). Compared with the Traditional Group, the STA Group showed significantly lower pain scores, reduced anxiety, and higher rates of treatment compliance and tolerance (P < 0.05).

Conclusion: Within the limitations of this retrospective study, the STA anesthesia technique showed advantages over traditional local injection anesthesia in reducing pain and anxiety, while improving compliance and tolerance during impacted tooth extraction in dental outpatients.

Objective: This study aimed to investigate the influence of onset-to-needle time (ONT) on early neurological deterioration (END) in patients with acute ischemic stroke (AIS) undergoing intravenous thrombolysis.

Methods: Patients with AIS receiving intravenous thrombolysis at The Fifth Hospital of Wuhan between March 2021 and December 2023 were enrolled. Patients were divided into an END group (n=104) and a non-END group (n=317) based on a National Institutes of Health Stroke Scale (NIHSS) score increase of ≥4 points within 24 hours. Baseline and clinical data were analyzed using univariate, multivariable logistic regression, and subgroup analyses. A logistic regression model was developed to predict END, and its performance was assessed using receiver operating characteristic (ROC) curves.

Results: Univariate analysis revealed significant differences between groups in age, total cholesterol, low-density lipoprotein cholesterol (LDL-C), lipoprotein-associated phospholipase A2 (Lp-PLA2), white blood cell count, activated partial thromboplastin time (APTT), pre-admission NIHSS score, and ONT (all P<0.05). Heart disease history, infarct location, and Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification also differed significantly (all P<0.05). Multivariable analysis identified age (Odds Ratio [OR]=1.098, 95% Confidence Interval [CI]: 1.031-1.169, P=0.003), LDL-C (OR=2.785, 95% CI: 1.360-5.710, P=0.005), Lp-PLA2 (OR=1.008, 95% CI: 1.001-1.015, P=0.045), complete anterior circulation infarction (vs lacunar; OR=8.050, 95% CI: 5.180-12.510, P=0.023), cardioembolic stroke (vs small vessel occlusion; OR=12.810, 95% CI: 8.420-19.530, P=0.002), and ONT (OR=1.015, 95% CI: 1.002-1.028, P=0.028) as independent risk factors for END. Subgroup analysis by admission NIHSS score showed that for moderate and severe strokes, each minute increase in ONT raised END risk by 1.5% (95% CI: 1.002-1.028, P=0.031) and 3.0% (95% CI: 1.009-1.052, P=0.005), respectively.

Conclusion: Prolonged ONT is an independent risk factor for END in AIS patients, particularly those with moderate to severe strokes. Prompt thrombolysis is crucial for mitigating neurological decline.

Objective: To investigate the efficacy of CT measurement parameters combined with AI-assisted 3D planning for personalized femoral prosthesis selection in total hip arthroplasty (THA).

Methods: A retrospective analysis was conducted on clinical data from 247 patients with unilateral hip or knee joint disorders treated at Renmin Hospital of Hubei University of Medicine between April 2021 and February 2024. All patients underwent preoperative full-pelvis and bilateral full-length femoral CT scans. The raw CT data were imported into Mimics 19.0 software to reconstruct a three-dimensional (3D) model of the healthy femur. Using 3-matic Research 11.0 software, the femoral head rotation center was located, and parameters including femoral head diameter (FHD), femoral neck length (FNL), femoral neck-shaft angle (FNSA), femoral offset (FO), femoral neck anteversion angle (FNAA), tip-apex distance (TAD), and tip-apex angle (TAA) were measured. AI-assisted THA 3D planning system AIJOINT V1.0.0.0 software was used for preoperative planning and design, enabling personalized selection of femoral prostheses with varying neck-shaft angles and surgical simulation. Groups were compared by gender, age, and parameters. ROC curves evaluated prediction efficacy.

Results: Females exhibited smaller FHD, FNL, FO, TAD, TAA but larger FNSA/FNAA vs males (P<0.05). Patients >65 years had higher FO, TAD, TAA (P<0.05). TAD-TAA correlation was strong (r=0.954), while FNSA negatively correlated with TAD/TAA (r=-0.773/-0.701). ROC analysis demonstrated high predictive accuracy: TAD (AUC=0.891, sensitivity=91.7%, specificity=87.6%) and TAA (AUC=0.882, sensitivity=100%, specificity=88.8%).

Conclusion: CT parameters (TAA, TAD, FNSA, FO) are interrelated and effective predictors for femoral prosthesis selection. Integration with AI-assisted planning optimizes personalized THA, reducing biomechanical mismatch risks.

Purpose: To investigate the diagnostic potency of the opacification-development ratio (ODR) for pediatric chronic rhinosinusitis based on CT scanning.

Patients and methods: Children aged 0-15 years who underwent nasal CT scanning from August 2011 through July 2021 were included in the research. The area under receiver operating characteristic curve (AUC) and predictive value were used to assess the diagnostic accuracy of the ODR and Lund-Mackay score based on CT scanning.

Results: A total of 1820 patients (217 in the positive symptom group and 1603 in the negative symptom group) who underwent CT scanning were included in the study. A significant positive correlation was observed between the ODR and the Lund-Mackay score in all age groups. In children aged 0-15 years, the AUC of the ODR and the Lund-Mackay score were 0.7970 and 0.7719, respectively (p > 0.05). The optimal cut-off value for the ODR was 25.83, with a sensitivity of 57.14% and a specificity of 94.2%. In contrast, the optimal cut-off value for the Lund-Mackay score was 6.5, with a sensitivity of 6.5% and a specificity of 85.84%. Notably, the ODR score demonstrated significantly superior performance compared to the Lund-Mackay score in children aged 0-4 years (p < 0.001).

Conclusion: In diagnosing pediatric chronic rhinosinusitis, the use of CT scans is associated with a higher rate of false positives when compared to clinical symptoms. The ODR score based on CT scanning is a valuable diagnostic tool for chronic rhinosinusitis in children aged 0-11, particularly those aged 0-4.

Purpose: Hepatitis B virus infection is one of the most common risk factors leading to the development of intrahepatic cholangiocarcinoma (ICC). This study aims to determine the impact of antiviral treatment (AVT) on the survival outcomes of ICC patients with hepatitis B virus infection.

Patients and methods: This retrospective study included ICC patients who had HBV infection and underwent hepatectomy from May 2009 to June 2023 at a single medical center. Patients' baseline characteristics were analyzed, and the 14-year follow-up data were investigated using Kaplan-Meier curves and multivariable Cox proportional hazards regression models. The propensity score matching method was performed to balance the baseline differences between the AVT group and the non-AVT group.

Results: A total of 229 patients were finally enrolled in the analysis. In the total cohort, 81 patients were classified into the AVT group and 148 patients into the non-AVT group. Kaplan-Meier curves showed that the AVT group exhibited prolonged overall survival and recurrence-free survival compared to the non-AVT group. Cox proportional hazards regression models revealed that AVT was an independent prognostic factor for both overall survival (HR 0.453, 95% CI: 0.280-0.732) and recurrence-free survival (HR 0.659, 95% CI: 0.436-0.997). A 1:1 nearest-neighbor matching algorithm was adopted, and 64 pairs of AVT and non-AVT patients were included in the propensity score matching cohort. Multivariable survival analyses confirmed AVT as a significant predictor for a favorable overall survival (HR 0.277, 95% CI: 0.147-0.519), but no statistical significance for recurrence-free survival was observed between the AVT group and the non-AVT group after propensity score matching.

Conclusion: We analyzed the long-term follow-up data for ICC patients with hepatitis B virus infection who underwent hepatectomy. Notably, AVT exhibited a beneficial impact on overall survival for these postoperative ICC patients. However, our findings indicated no statistically significant effect of AVT on recurrence-free survival.

Objective: To establish a prediction model for the risk of inadequate bowel preparation for colonoscopy in the elderly, and to validate the model to test its prediction effect.

Methods: A total 927 patients who underwent colonoscopy in the First Affiliated Hospital to Chongqing Medical and Pharmaceutical College from January to December 2023 were selected as the modeling group, and were divided into the success group (839 patients) and failure group (88 patients) according to whether or not inadequate bowel preparation occurred, and then a logistic regression prediction model was established and transformed into a risk scoring system. The area under the ROC curve and the Hosmer-Lemeshow test were used for model differentiation and calibration, respectively, and the 10-fold cross-validation method was used for internal validation of the model. A total of 548 patients who underwent colonoscopy in our hospital from January to June 2024 were selected for external validation of the model.

Results: Logistic regression analysis showed that age ≥65 years, diabetes mellitus, exercise habits, Bristol stool characterization scale, frailty, and ambulatory functional status were independent factors influencing the inadequate bowel preparation for colonoscopy in the elderly. The area under the ROC curve for the modeling group was 0.806, and the Hosmer-Lemeshow test showed p=0.870. The area under the ROC curve of the validation group was (0.785±0.090). The area under the ROC curve of the validation group was 0.824, and the Hosmer-Lemeshow test showed P=0.907, with a sensitivity of 73.13%, a specificity of 80.70%, and a Jordon's index of 0.538.

Conclusion: The predictive model of the risk of inadequate bowel preparation for colonoscopy in elderly people can predict the risk of inadequate bowel preparation in elderly people, and can be used as a tool for clinical caregivers to screen the high-risk group of inadequate bowel preparation in the elderly.

Introduction: Ticagrelor is a widely used antiplatelet agent approved in over 70 countries, including the European Union and the United States, for reducing thrombotic events in patients with acute coronary syndromes (ACS). In clinical practice, combining ticagrelor with high-intensity statins is considered standard therapy for ACS. However, recent pharmacodynamic studies and case reports suggest potential drug-drug interactions that may increase the risk of adverse events, particularly muscular and renal complications. This study aimed to evaluate these risks in a real-world clinical setting in Saudi Arabia.

Methods: This retrospective observational cohort study was conducted at the Makkah Cardiology Center, Saudi Arabia. The study included adult patients (n = 577) who were prescribed high-intensity statins, with or without concurrent ticagrelor. The primary outcomes were the incidence of statin-associated muscular complications-defined as myalgia, myopathy, myositis, or rhabdomyolysis-and acute kidney injury (AKI). Clinical data were extracted from the hospital information system, and statistical comparisons were conducted between patients receiving statin monotherapy and those receiving combination therapy.

Results: The cohort consisted predominantly of male patients (74.5%). Muscle-related complications were significantly more common in the group receiving both ticagrelor and statins (20.2%) compared to the statin-only group (10.5%) (P = 0.001). Among comorbid conditions, hypertension was the only factor significantly associated with a higher incidence of muscle-related complications. Although a trend toward increased AKI incidence was observed in the combination therapy group, this difference did not reach statistical significance.

Conclusion: This study highlights potential safety concerns related to the co-administration of ticagrelor and high-intensity statins, particularly the increased risk of muscle-related complications. While the findings on AKI were inconclusive, the results support the need for cautious use of this combination and call for larger prospective studies to further evaluate its safety profile and optimize treatment strategies.