ASIDE internal medicine最新文献

Introduction: Type 2 diabetes mellitus (T2DM) is associated with dyslipidemia and significantly increased cardiovascular risk, making lipid-modifying therapy a crucial preventive intervention in these patients. Despite clear guidelines recommending statin therapy for both primary and secondary prevention, real-world prescription routines and practices show gaps in clinical care. We aimed to evaluate the rates and patterns of lipid-modifying therapy under prescription among T2DM patients across U.S. healthcare facilities.

Methods: We conducted a retrospective observational analysis using the TriNetX US Collaborative Network database, including data from 69 healthcare organizations throughout the United States. Patients with T2DM patients aged 40-75 years were included in our cohort. Under-prescription rates were calculated and analyzed across demographic subgroups using standardized protocols within the TriNetX platform.

Results: Among 5,007,910 T2DM patients, we observed significant statin under-prescription rates. Our analysis showed a prescription rate of 55.1% for statins in eligible patients with T2DM.

Conclusions: Our findings revealed a significant under-prescription of lipid-modifying therapy in T2DM patients. The universal nature of under-prescription suggests barriers to guideline implementation. These results underscore the urgent need for systematic interventions, including automated identification systems, standardized protocols, and optimized provider education to improve cardiovascular risk management in patients with T2DM.

Introduction: The Alberta Stroke Program Early CT Score (ASPECTS) is widely used to evaluate early ischemic changes and guide thrombectomy decisions in acute stroke patients. However, significant interobserver variability in manual ASPECTS assessment presents a challenge. Recent advances in artificial intelligence have enabled the development of automated ASPECTS scoring systems; however, their comparative performance against expert interpretation remains insufficiently studied.

Methods: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. We searched multiple scientific databases for studies comparing automated and manual ASPECTS on Non-Contrast Computed Tomography (NCCT). Interobserver reliability was assessed using pooled interclass correlation coefficients (ICCs). Subgroup analyses were made using software types, reference standards, time windows, and computed tomography-based factors.

Results: Eleven studies with a total of 1,976 patients were included. Automated ASPECTS demonstrated good reliability against reference standards (ICC: 0.72), comparable to expert readings (ICC: 0.62). RAPID ASPECTS performed highest (ICC: 0.86), especially for high-stakes decision-making. AI advantages were most significant with thin-slice CT (≤2.5mm; +0.16), intermediate time windows (120-240min; +0.16), and higher NIHSS scores (p=0.026).

Conclusion: AI-driven ASPECTS systems perform comparably or even better in some cases than human readers in detecting early ischemic changes, especially in specific scenarios. Strategic utilization focusing on high-impact scenarios and region-specific performance patterns offers better diagnostic accuracy, reduced interpretation times, and better and wiser treatment selection in acute stroke care.

Introduction: Diabetes mellitus represents a significant public health challenge, however, the current trends in its epidemiology remain incompletely characterized. This study aimed to analyze epidemiological changes and demographic patterns in diabetes incidence and prevalence across the United States from 1990 to 2024.

Methods: We conducted a retrospective cohort study utilizing the TriNetX Global Health Research Network, analyzing de-identified electronic health records from 52,922,301 patients across 92 U.S. healthcare organizations. Time-based changes in disease trends regarding diabetes incidence and prevalence were targeted, and stratified by age, sex, race, and diabetes type.

Results: Combined diabetes incidence increased from 3.98 per 1,000 in 1990-1994 to 60.98 per 1,000 in 2020-2024, while prevalence doubled from 6.26% to 12.00%. T2DM showed a twenty-fold increase in incidence (3.52 to 59.30 per 1,000), while T1DM peaked at 7.46 per 1,000 in 2010-2014 before declining to 4.59 per 1,000. Significant disparities were observed across demographic groups, with the highest rates among Native Hawaiians/Pacific Islanders (incidence: 94.75 per 1,000; prevalence: 20.65%) and consistent male predominance (incidence: 69.40 vs 54.07 per 1,000).

Conclusions: These findings reveal concerning trends in diabetes epidemiology, characterized by a prominent and significant elevation in disease burden and persistent demographic disparities. The results call for the urgent need for optimized preventive strategies, targeted interventions for high-risk populations, and systematic changes in healthcare delivery to address this growing public health challenge effectively.

Introduction: The increasing utilization of real-world data platforms in medical research necessitates a comprehensive understanding of their methodological strengths and limitations. TriNetX has emerged as a significant platform for exploring large healthcare datasets. This review aims to critically evaluate the methodological framework and limitations of TriNetX, assess the impact of electronic health record coding accuracy on data reliability, and analyze the platform's capacity for generating generalizable real-world evidence in clinical research.

Methods: We conducted a comprehensive review examining TriNetX's data architecture, quality metrics, and research applications, focusing on data integrity, platform architecture, and the external validity of research findings.

Results: The analysis reveals significant methodological considerations. TriNetX's reliance on retrospective data introduces biases such as selection bias and confounding variables. The coding accuracy of electronic health records, which have not been independently validated, is a critical determinant of data reliability. The demographic representation is limited, affecting the generalizability of results.

Discussion: Despite its extensive use, TriNetX's effective utilization requires careful consideration of its inherent limitations. The platform's data, predominantly from insured populations in academic and acute care settings, may not fully represent broader demographic groups. Addressing these methodological constraints is crucial for enhancing the reliability and applicability of research findings derived from TriNetX.

Conclusions: TriNetX is a valuable resource for healthcare research. However, its limitations must be acknowledged, and future research should focus on standardizing data collection and enhancing data validation processes to mitigate platform-specific biases and improve the quality and applicability of the findings.

Introduction: Idiopathic intracranial hypertension (IIH) is known to elevate cardiovascular disease (CVD) risk, but the extent to which obesity and IIH-specific factors contribute to this risk is not well understood. WE aim to separate the effects of obesity from IIH-specific factors on the risk of stroke and CVD, building on previous findings that indicate a two-fold increase in cardiovascular events in women with IIH compared to BMI-matched controls.

Methods: An obesity-adjusted risk analysis was conducted using Indirect Standardization based on data from a cohort study by Adderley et al., which included 2,760 women with IIH and 27,125 matched healthy controls from The Health Improvement Network (THIN). Advanced statistical models were employed to adjust for confounding effects of obesity and determine the risk contributions of IIH to ischemic stroke and CVD, independent of obesity. Four distinct models explored the interactions between IIH, obesity, and CVD risk.

Results: The analysis showed that IIH independently contributes to increased cardiovascular risk beyond obesity alone. Risk ratios for cardiovascular outcomes were significantly higher in IIH patients compared to controls within similar obesity categories. Notably, a synergistic effect was observed in obese IIH patients, with a composite CVD risk ratio of 6.19 (95% CI: 4.58-8.36, p<0.001) compared to non-obese controls.

Conclusions: This study underscores a significant, independent cardiovascular risk from IIH beyond obesity. The findings advocate for a shift in managing IIH to include comprehensive cardiovascular risk assessment and mitigation. Further research is required to understand the mechanisms and develop specific interventions for this group.

Introduction: Managing idiopathic intracranial hypertension (IIH) is challenging due to limited treatment options. This study evaluates metformin as a potential therapy for IIH, examining its impact on disease outcomes and safety.

Methods: We performed a retrospective cohort study using the TriNetX database, covering data from 2009 to August 2024. The study included IIH patients, excluding those with other causes of raised intracranial pressure or pre-existing diabetes. Propensity score matching adjusted for age, sex, race, ethnicity, Hemoglobin A1C, and baseline BMI at metformin initiation. We assessed outcomes up to 24 months.

Results: Initially, 1,268 patients received metformin and 49,262 served as controls, showing disparities in various parameters. After matching, both groups consisted of 1,267 patients each. Metformin users had significantly lower risks of papilledema, headache, and refractory IIH at all follow-ups (p<0.0001). They also had fewer spinal punctures and reduced acetazolamide use. BMI reductions were more significant in the metformin group from 6 months onward (p<0.0001), with benefits persisting regardless of BMI changes. Metformin's safety profile was comparable to the control group.

Conclusions: The study indicates metformin's potential as a disease-modifying treatment in IIH, with improvements across multiple outcomes independent of weight loss. This suggests complex mechanisms at play, supporting further research through prospective clinical trials to confirm metformin's role in IIH management and its mechanisms of action.

Introduction: Optic nerve sheath fenestration (ONSF) is an important surgical management option for idiopathic intracranial hypertension (IIH) who failed medical treatment. We conducted a systematic review and meta-analysis to evaluate the outcomes of ONSF, with a focus to identify factors affecting treatment success.

Methods: A literature search was conducted up to December 2024. Primary outcomes included improvement in visual acuity, visual fields, and optic disc swelling resolution. We performed a detailed subgroup analysis based on geographic location, study design, surgical approach, and technical variations.

Results: Nineteen studies with a total of 1,159 patients were included in our study. ONSF significantly improved visual acuity in 34.5% (95% CI: 31.8-37.3%) and visual fields in 69.4% (95% CI: 65.9-72.7%) of cases. A 90.9% improvement rate was observed in reducing optic disc swelling. Significant heterogeneity was noted in visual acuity (I²=92.1%) and visual field improvements (I²=73.8%). The overall complication rate was 9% (95% CI: 5-16%). Centers that included 30 or more patients in their study demonstrated significantly lower postoperative complications.

Conclusions: ONSF demonstrates favorable efficacy in improving visual outcomes with an acceptable safety profile, lower postoperative complications were observed when the procedure was performed in high-volume centers using appropriate surgical techniques. Geographic variations and surgical approaches significantly affected outcomes, highlighting the importance of standardized protocols and adequate surgical experience. Future prospective studies with standardized outcome measures are needed to optimize patient selection and surgical techniques.

Introduction: Idiopathic Intracranial Hypertension (IIH) presents an increasing health burden with changing demographic patterns. We studied nationwide trends in IIH epidemiology, treatment patterns, and associated outcomes using a large-scale database analysis within the United States (US).

Methods: We performed a retrospective analysis using the TriNetX US Collaborative Network database (1990-2024). We investigated demographic characteristics, time-based trends, geographic distribution, treatment pathway patterns, comorbidity profiles, and associated risks with IIH. We used multivariate regression, Cox proportional hazards modeling, and standardized morbidity ratios to assess various outcomes and associations.

Results: Among 51,526 patients, we found a significant increase in adult IIH incidence from 16.0 per 100,000 in 1990-1999 to 127.0 per 100,000 in 2020-2024 (adjusted RR: 6.94, 95% CI: 6.71-7.17). Female predominance increased over time (female-to-male ratio: 3.29, 95% CI: 3.18-3.40). Southern regions showed the highest prevalence (43.0%, n=21,417). During the 2020-2024 period, initial medical management success rates varied between acetazolamide (42.3%) and topiramate (28.7%). Advanced interventional procedures showed 82.5% success rates in refractory cases during the same timeframe. Cox modeling for the entire study period (1990-2024) revealed significant associations between IIH and metabolic syndrome (HR: 2.14, 95% CI: 1.89-2.39) and cardiovascular complications (HR: 1.76, 95% CI: 1.58-1.94), independent of Body Mass Index.

Conclusions: Our findings highlight IIH as a systemic disorder with significant metabolic implications beyond its neurological manifestations. The marked regional disparities and rising incidence rates, especially among adults, suggest the need for targeted healthcare strategies. Early intervention success strongly predicts favorable outcomes, supporting prompt diagnosis and treatment initiation. These results advocate for an integrated approach combining traditional IIH management with broad metabolic screening care.