Science Progress最新文献

ObjectiveTo compare the effectiveness, safety, and cost outcomes of brand-name febuxostat (feburic) and generic febuxostat (feuri) in patients with hyperuricemia or gout in a real-world clinical setting.MethodsWe conducted a retrospective cohort study using electronic medical records from Taichung Veterans General Hospital between November 2021 and December 2023. Adult patients with hyperuricemia or gout who initiated febuxostat therapy and had no prior urate-lowering treatment in the preceding 3 months were included. Serum uric acid levels were assessed at baseline, 3 months, and the final follow-up. Propensity score matching (1:1) was applied to balance baseline demographic, clinical, laboratory, cardiovascular, and renal characteristics. Clinical outcomes, laboratory parameters, and medication costs were compared between groups.ResultsBoth feuri and feburic were associated with significant reductions in serum uric acid levels after 3 months of treatment. At the 3-month assessment, the mean serum uric acid level was modestly lower in the feuri group (5.41 ± 2.06 mg/dL) than in the feburic group (5.75 ± 2.12 mg/dL; P = .001). At the final follow-up, serum uric acid levels remained numerically lower in the feuri group, although the difference was not statistically significant (P = .07). The feuri group was prescribed a lower final daily dose, which was associated with lower annual medication costs. The proportions of patients achieving recommended uric acid goals were similar between groups, suggesting broadly comparable clinical effectiveness in routine practice. After propensity score matching (n = 486 pairs), no significant differences were observed between groups in cardiovascular, renal, or overall safety outcomes.ConclusionsThis real-world study suggests that generic febuxostat is associated with safety outcomes comparable to those of the brand-name formulation and may be prescribed at lower doses and lower medication costs in routine clinical practice.

Colorectal cancer remains a major global health concern, highlighting the critical importance of effective colonoscopy, whose success depends on high-quality bowel preparation. Inadequate preparation is common and leads to prolonged procedure, and missed polyps and adenomas. It is important to recognize that not all individuals can attain adequate bowel preparation through a uniform regimen. Various risk factors influencing bowel preparation quality have been reported, and different laxative regimens each present distinct advantages and limitations. Understanding these elements can help improve patient bowel preparation outcomes. This is a narrative review. This article attempts to summarize available clinical trials and evidence regarding strategies to optimize bowel preparation for individuals.

ObjectiveTo estimate the prevalence of human papillomavirus (HPV) infection among males in Jinshan District, Shanghai, China.MethodsStudy design: single-center, retrospective cross-sectional study.

Setting: Tinglin Hospital, Jinshan District, Shanghai, China.

Participants: 116 males aged 22-71 years from outpatient, inpatient, and routine physical examination settings.

Outcomes: overall HPV prevalence, age-specific prevalence, and genotype distribution (high-risk and low-risk).ResultsWe first describe the overall and age-specific prevalence, followed by genotype distribution and the pattern of single versus multiple infections. A total of 116 males aged 22 to 71 years old were enrolled for investigation. The overall HPV infection rate was 31.90% (37/116). The infection rates of different HPV subtypes in various age groups were listed as follows: 12% (3/25) for the 22-30 age group, 27.59% (8/29) for the 31-40 age group, 50% (18/36) for the 41-50 age group, 16.67% (3/18) for the 51-60 age group, and 62.5% (5/8) for the over 60 age group. Among the infected individuals, 27 out of 116 (23.28%) suffered from single subtype infections, while 8 individuals (6.90%) endured dual infections, and 2 individuals (1.72%) had three or more subtypes detected. High-risk HPVs accounted for 30.17%, with the highest infection rates observed in HPVs including HPV-53, HPV-58, HPV-52, HPV-16, and HPV-31. In comparison, low-risk HPVs accounted for 12.93%, with the highest infection rates seen in HPVs including HPV-6, HPV-81, and HPV-11. Apart from that, HPVs such as HPV-18, HPV-59, HPV-73, HPV-70 and HPV-83 were not detected in any of the specimens.ConclusionMales are predominantly infected with a single-subtype HPV infection. The infection rate is highest in the age group of 60 and above, while the infection rate is the lowest in the age group of 22-30 years. It is essential to formulate corresponding strategies and screening plans for the elderly over 60 years to lower or prevent the risk of HPV infection.

When the demand for public health care increases, governments often prioritize citizens over foreign nationals. In South Africa, limited resources and socio-economic inequalities pose unique challenges to epidemic control. The overcrowding and increasing demand for public healthcare have led to protests by some community groups, which have led to the denial of healthcare to migrants. Denying treatment to some infected individuals has the propensity to lead to an increase in the size of an epidemic. We introduce a novel epidemiological model that incorporates health care denial as a dynamic factor influencing the transmission of COVID-19. It incorporates healthcare denial as a key parameter influencing the progression and recovery rates of infections. The study presents a novel framework for understanding the intersection of healthcare access denial and the transmission dynamics of COVID-19. While much of the existing literature has focused on the direct effects of healthcare interventions on pandemic control, this research uniquely emphasizes the role that restricted access to healthcare services, whether due to policy decisions, resource shortages, or system inefficiencies, can exacerbate the spread of infectious diseases. The treatment class of the model is partitioned to account for individuals denied treatment at public healthcare facilities. Analytical results establish conditions for the existence and stability of both disease-free and endemic equilibria, with the basic reproduction number R₀ explicitly derived to quantify transmission potential under varying healthcare access scenarios. Sensitivity analysis reveals that increasing denial of care can significantly elevate R₀, resulting in higher infection peaks, prolonged epidemic duration and greater cumulative mortality. Numerical simulations further illustrate the non-linear relationship between treatment accessibility and outbreak severity. The findings highlight that equitable healthcare provision is not only a public health necessity but also a critical determinant for reducing the COVID-19 burden. Policy implications stress the integration of inclusive healthcare strategies to ensure epidemic resilience and minimize transmission risks, especially in vulnerable populations. Strategies that will accommodate every infected person who goes to the hospital for treatment should be adopted to reduce the disease burden.

IntroductionHeparin-induced thrombocytopenia (HIT) is a severe complication of heparin treatment, characterized by low platelet counts and heightened thrombotic risk. Blood urea nitrogen (BUN), which serves as an indicator of both renal function and illness severity, has been associated with poor outcomes in different contexts. However, its association with mortality in HIT remains poorly understood. Our study aimed to explore this relationship in critically ill patients with HIT.MethodsThis study was a retrospective cohort analysis utilizing the MIMIC-IV 3.1 database from 2008 to 2019. Patients with HIT were pinpointed through ICD codes. Those without BUN data or whose intensive care unit (ICU) admission was not their first were excluded. The main outcome measured was all-cause mortality, evaluated at multiple time points. The associations were examined using multivariate Cox regression models and Kaplan-Meier survival analysis.ResultsThe research encompassed 246 individuals with HIT (average age 66.2 years, 54.9% male). BUN levels showed a significant association with all-cause mortality during the hospital stay (HR 1.01, 95% CI 1.01-1.02, p = 0.001), within 30 days (HR 1.01, 95% CI 1.01-1.02, p < 0.001), within 90 days (HR 1.01, 95% CI 1.01-1.02, p < 0.001), and within 365 days (HR 1.01, 95% CI 1.01-1.02, p < 0.001). Quartile analysis revealed that the highest BUN quartile (Q4) was associated with the greatest mortality risk compared to the lowest quartile (Q1) at all time points. Kaplan-Meier and restricted cubic spline analyses corroborated these results, indicating a linear relationship between BUN and mortality.ConclusionElevated BUN levels were significantly associated with higher mortality rates among HIT patients in the ICU. Monitoring BUN levels may help identify patients at greater risk and inform clinical choices. Further research is warranted to elucidate the underlying mechanisms and possible treatments.

ObjectiveThe use of aspirin in patients undergoing open tracheostomy is an issue for which there is still no clear conclusion. This uncertainty leads surgeons to make decisions based on the risks and benefits of continuing versus discontinuing aspirin. Therefore, this study aims to investigate complications related to aspirin use. The primary outcome was bleeding complications, while other complications were secondary outcomes.MethodsThis was a retrospective study compiling data from patients who underwent open tracheostomy at the Department of Otolaryngology, Faculty of Medicine, Chulalongkorn university and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, between January 2019 and December 2023. Demographic data, medical conditions, indications for tracheostomy, surgeon characteristics, operative time, aspirin use status, and complications were reviewed.ResultsThere were 47 patients in total in this study: 15 patients in the aspirin continuation group and 32 patients in the aspirin discontinuation group. In the aspirin continuation group, there were no major or minor bleeding events. In the discontinuation group, there were two cases of major bleeding and two cases of minor bleeding (an incidence of 6.3% for each), although the differences observed were not statistically significant. There were no other complications that showed statistically significant differences between the two groups.ConclusionThis study has shown that low-dose aspirin (81 mg) does not increase the risk of bleeding or other complications in patients who undergo open tracheostomy. These results support that the continuation of aspirin may be safe in patients undergoing this procedure.

ObjectivesPolypharmacy, the concurrent use of multiple medications, presents significant challenges and risks in modern healthcare systems, particularly among older individuals and those with chronic diseases. This study aimed to investigate the prevalence and determinants of potential drug-drug interactions (pDDIs) among older adults at Jerusalem, Gaza Strip, and the West Bank of Palestine. This study serves as a baseline assessment before the October 2023 Palestine crisis, which led to extensive forced displacement.MethodsThis cross-sectional study examined the prescribed medications for 403 participants, conducted between May 2023 and August 2023, 2 months prior to the invasion of Gaza. This study served as a baseline evaluation of the potential pDDIs before the 7 October 2023 of Palestine crisis. Participants recruited using simple random sampling technique from medical records' lists of patients. They were interviewed at various pharmacies and hospitals across Jerusalem, the Gaza Strip, and the West Bank of Palestine using an online questionnaire created via Google Forms. Descriptive, Univariate and multivariate analyses, and Chi-square tests were carried-out by SPSS v21.ResultsThe study revealed a high prevalence of pDDIs among the Palestinian population, with a substantial proportion of participants experiencing moderate to major interactions. Participants receiving a higher number of medications were significantly more likely to experience major pDDIs. Additionally, marital status was a significant factor associated with major pDDIs, with married individuals being more likely to experience major interactions compared to non-married individuals. Regional differences were also observed, with participants residing in the northern region of the West Bank more likely to experience moderate pDDIs. Moreover, participants diagnosed with dyslipidemia and diabetes mellitus were significantly more prone to moderate pDDIs.ConclusionsThese findings emphasize the interaction of clinical and demographic factors in influencing the risk of pDDIs among participant patients in Palestine. Healthcare providers should consider these factors when prescribing medications and designing interventions to reduce the risks associated with polypharmacy.

ObjectiveTo evaluate the clinical efficacy of the direct posterior approach (DPA) with seagull-shaped plate fixation for treating posterior wall acetabular fractures.MethodsA retrospective cohort study of 17 patients (8 male, 9 female) with posterior wall acetabular fractures treated with DPA seagull-shaped plate fixation was conducted. Postoperative pelvic X-ray imaging and computed tomography were performed, and the quality of acetabular reduction was evaluated using the Matta score. The Merle d'Aubigné & Bone score, as modified by Matta, was used to assess hip joint function.ResultsThe mean ± standard deviation surgical incision length, operating time, and intraoperative blood loss were 9.7 ± 0.6 cm, 48.7 ± 9.1 min, and 235.3 ± 65.6 mL, respectively. According to the Matta score, 11 patients achieved excellent reduction quality, and six had good reduction quality, resulting in a 100% combined excellent or good reduction rate. All patients had good fracture healing, with a healing time of 9.7 ± 1.6 weeks. The modified Merle d'Aubigné & Bone score was 17.0 ± 1.6, with 11, 4, 2, and 0 patients rated as excellent, good, fair, and poor, respectively, yielding an 88.2% excellent or good outcome rate. Postoperative complications included fat liquefaction in one patient and deep vein thrombosis in the lower limbs of two patients, with an overall complication rate of 17.6%.ConclusionsDPA with seagull-shaped plate fixation provides satisfactory clinical outcomes for posterior wall acetabular fractures, improving patients' living ability and quality of life.

BackgroundSepsis, caused by a dysregulated host response to infection, is a life-threatening condition linked to nearly one-fifth of deaths worldwide. As a biomarker of myocardial stress, N-terminal pro B-type natriuretic peptide (NT-proBNP) has gained attention for its potential association with clinical outcomes in sepsis patients. This study investigated its association with short- and long-term mortality in sepsis.MethodsThis retrospective observational cohort study utilized data from the Medical Information Mart for Intensive Care IV database. Sepsis patients on their first intensive care unit admission with NT-proBNP measured within 24 h were categorized into four groups based on their natural log-transformed levels. The primary endpoint was 30-day all-cause mortality (ACM), with secondary endpoints of 90-day and 1-year ACM. Cox models, Kaplan-Meier curves, restricted cubic splines (RCS), and subgroup analyses were performed to assess the relationship between log(NT-proBNP) and 30-day, 90-day, and 1-year ACM.ResultsThe study cohort consisted of 1237 patients, with 54.41% male. The 30-day, 90-day, and 1-year ACM rates were 27.41%, 29.99%, and 31.69%, respectively. Multivariate Cox analysis showed that log(NT-proBNP) was independently associated with higher risks of 30-day ACM (hazard ratio[HR] 1.12 [95% confidence interval (CI) 1.03-1.22]; P = 0.01), 90-day ACM (HR 1.12 [95% CI 1.03-1.22]; P = 0.005), and 1-year ACM (HR 1.11 [95% CI 1.03-1.20]; P = 0.007). These associations remained robust in sensitivity analyses. The RCS curves demonstrated a linear increase in ACM risk as log(NT-proBNP) levels rose. Subgroup analyses confirmed these associations across different patient groups.ConclusionElevated log(NT-proBNP) in critically ill sepsis patients are significantly and independently associated with higher 30-day, 90-day, and 1-year ACM, suggesting that NT-proBNP may serve as a valuable risk marker for both short- and long-term mortality in this population.

ObjectiveTo evaluate the effectiveness of dental guards in preventing incisor injuries during direct laryngoscopy in microlaryngeal surgery (MLS).Study designNonrandomized retrospective comparative study.MethodsBetween 2022 and 2024, 50 patients who underwent elective MLS using a dental guard were consecutively selected as the dental guard group, and another 50 patients who underwent surgery without a dental guard were selected as the control group. A standardized silicone dental guard was applied to the maxillary incisors of the experimental group. An independent dentist conducted postoperative dental evaluations to assess incisor mobility and enamel damage.ResultsThe experimental group demonstrated significantly lower rates of dental injury (2% vs. 20%) compared with those of the control group. No adverse events related to dental guard use were reported.ConclusionDental guards effectively reduced the incidence of incisor injuries during direct laryngoscopy. Routine use is recommended to minimize perioperative dental complications.