American journal of translational research最新文献

Objective: To examine the association of proximal femoral nail anti-rotation (PFNA) and dynamic hip screw (DHS) with bone mineral density T-value (BMDT) in middle-aged and elderly patients suffering from hip fractures.

Methods: Clinical data were collected from 110 patients with hip fractures who underwent internal fixation surgery between October 2020 and June 2021. Patients treated with DHS were included in the control group, and those treated with PFNA were classified into the observation group. The disparity in BMDT between the two groups was assessed. Patients were further divided into two groups based on the median BMDT at 6 months post-surgery: a high BMDT group (BMDT>-1.1 SD) and a low BMDT group (BMDT≤-1.1 SD). Factors influencing BMDT were analyzed.

Results: Repeated measures ANOVA showed that BMDT in the observation group was higher than that in the control group at 7 days, 1 month, 3 months, and 6 months after the surgery (between-group effect: F=258.400, P<0.001). BMDT in both groups increased with time but remained lower than pre-surgery levels (time effect: F=28.760, P<0.001), with an interaction between group and time (F=6.478, P<0.05). Correlation analysis showed a significant correlation between internal fixation techniques and BMDT at 7 days, 1 month, 3 months, 6 months after the surgery (P<0.05). Logistic regression analysis showed that advanced age and a higher VAS score at 72 hours post-surgery were risk factors for low BMDT at 6 months post-surgery, while PFNA was a protective factor (all P<0.05).

Conclusion: Compared to DHS, PFNA significantly improves BMDT in middle-aged and elderly patients following hip fracture surgery, promoting better early-stage recovery. PFNA should be prioritized in clinical practice to enhance postoperative outcomes.

Objective: To assess the efficacy of combining acupuncture with pricking blood therapy to treat chronic spontaneous urticaria (CSU) and compare its outcomes with those of second-generation H1-antihistamines.

Methods: Seventy CSU patients were enrolled and randomly assigned to receive treatment with either oral loratadine tablets or a combination of acupuncture and pricking blood therapy (n=35 each). Evaluations were conducted at baseline, at the conclusion of the 4-week treatment period, and at the 4th and 8th weeks post-treatment time points. We used six scales to gauge the severity of the skin lesions, itchiness, quality of life, and emotional and sleep states of the CSU patients.

Results: Upon completion of the treatment, both groups demonstrated a significant reduction in the scores of six scales from the baseline (P < 0.05). Notably, the scores of the itch visual analog scale (VAS), Hamilton Anxiety Scale, and Hamilton Depression Scale in the acupuncture and pricking blood therapy group were lower than those in the loratadine group (all P < 0.05). At the 8-week follow-up, the scores for all six scales were reduced from baseline in both groups (all P < 0.05), though the acupuncture and pricking blood therapy group showed significantly lower scores on the 7-day urticaria activity scale, with the Dermatology Life Quality Index, and the itchiness VAS compared with the loratadine group (all P < 0.05).

Conclusions: Acupuncture combined with pricking blood therapy significantly ameliorated skin lesions, itchiness, and the associated psychological distress in CSU patients. This integrative approach not only matched the short-term efficacy of oral loratadine but surpassed its long-term benefits.

Objective: Intertrochanteric femur fractures are prevalent among the elderly, leading to substantial morbidity. Proximal femoral nail anti-rotation (PFNA) is commonly used for internal fixation, but excessive lateral migration of the PFNA blade poses a significant complication. Understanding the risk factors for this complication is crucial for optimizing patient care.

Methods: A retrospective case-control study was conducted on elderly patients with intertrochanteric femur fractures who underwent PFNA internal fixation. Patients were categorized based on the occurrence of excessive lateral migration of the blade. The differences in general information, surgical indices, imaging measures, fracture stability indicators, VAS score, Harris score, and other factors were analyzed. Single factor correlation analysis and multivariate logistic regression were utilized to identify risk factors associated with excessive blade lateral migration.

Results: Risk factors significantly associated with excessive blade lateral migration included the Singh index for osteoporosis, quality of calcar reduction, surgical indices (hospital stays, revision surgery for blade prominence), imaging measures (blade position, lateralization, and migration), fracture stability indicators (tip-apex distance, AO/OTA classification), and postoperative functional outcomes (VAS and Harris scores). Multivariate logistic regression identified these factors as independent predictors of excessive lateral migration, underlining the multifactorial nature of this complication.

Conclusion: This study identified several significant risk factors for excessive lateral migration of the PFNA blade, including bone quality, calcar reduction, surgical indices, imaging measures, and fracture stability indicators.

Objective: To evaluate the effectiveness of real-time shear wave elastography (SWE) in quantitative evaluation of chronic kidney disease (CKD) in pediatric patients.

Methods: SWE was conducted on 58 pediatric patients with CKD (CKD group) and 70 healthy volunteers (Control group). Computer-assisted quantitative analysis was utilized to determine the percentage of interstitial fibrosis (IF) in images from the CKD group, categorizing them into mild, moderate, and severe groups according to IF% values. The differences in Young's modulus (YM) and estimated Glomerular Filtration Rate (eGFR) between the renal cortex and medulla in these groups were compared. Additionally, the relationships between YM and IF% as well as YM and eGFR, were analyzed.

Results: The YM values in right lower pole cortex and medulla of the CKD group were significantly higher than those in the control group (all P < 0.05). Significant differences were observed in eGFR among mild, moderate, and severe CKD patients (F = 40.882). YM demonstrated a correlation with eGFR in both the renal cortex and medulla (r = -0.329, P = 0.012; r = 0.417, P = 0.001). YM values increased with the severity of renal interstitial fibrosis in a pronounced trend across groups (F = 109.962, F = 72.950, all P < 0.001). Additionally, YM correlated with IF% in both the renal cortex and medulla (r = 0.362, P = 0.006; r = 0.483, P < 0.001). The optimal cut-off value of renal cortex YM for distinguishing between CKD and control group was 4.05 kPa.

Conclusion: SWE enables quantitative assessment of kidney YM values, revealing significantly higher values in children with CKD compared to healthy individuals. YM is correlated with the severity of renal interstitial fibrosis, thereby establishing SWE as a valuable non-invasive tool for quantitative evaluation of pediatric CKD.

Objective: To evaluate the effectiveness of dexmedetomidine epidural anesthesia combined with nano-silver polyurethane dressing in gynecological surgery.

Methods: This retrospective study analyzed data of 80 patients who underwent epidural anesthesia at Jinan Maternal and Child Health Care Hospital from January 2018 to May 2022. The patients treated with propofol and routine postoperative wound treatment were assigned into a control group, while the patients treated with dexmedetomidine and nano-silver polyurethane dressing were classified into an observation group. The baseline data, anesthesia effect, intraoperative basic indexes, hemodynamics indexes, postoperative recovery indexes, recovery quality, inflammatory response and adverse reactions were compared between the two groups.

Results: The observation group demonstrated a significantly higher rate of excellent and good outcomes (97.5%) compared to the control group (85.0%) (P < 0.05). The anesthesia recovery time of the observation group was notably longer than that of the control group (P < 0.05). The Ramsay score and levels of mean arterial pressure in the observation group were higher than those in the control group, while the heart rate level was significantly lower than that in the control group (all P < 0.05). The wound healing time, dressing change times and visual analogue scale (VAS) score in the observation group were obviously lower than those in the control group (all P < 0.05). The Pittsburgh sleep quality index score in the observation group was lower than that in the control group, and the 40-items quality of recovery score in the observation group was higher than that in the control group (both P < 0.05). The serum IL-6, CRP and TNF-α levels in the observation group were lower than that in the control group (all P < 0.05). The total incidence of adverse reactions in the observation group (7.5%) was significantly lower than that in the control group (25.0%) (P < 0.05).

Conclusion: In gynecological surgeries utilizing epidural anesthesia, dexmedetomidine minimally impacts hemodynamics and provides good anesthesia and sedation with a low incidence of adverse drug reactions. Nano-silver polyurethane dressing accelerates wound healing, reduces the dressing changes, alleviates the inflammatory response, and reduces the occurrence of wound infection, thereby enhancing postoperative recovery quality.

Objective: This retrospective study aimed to evaluate the impact of intraoperative dexmedetomidine on myocardial injury markers (heart-type fatty acid binding protein [H-FABP], creatine kinase-mb [CK-MB], and cardiac troponin I [cTnI]) and postoperative delirium in patients undergoing heart valve replacement.

Methods: Clinical data from 160 cardiac patients who underwent heart valve replacement with cardiopulmonary bypass (CPB) between January 2019 and January 2024 were analyzed. Patients were divided into an observation group (n = 82) receiving dexmedetomidine and a control group (n = 78) without dexmedetomidine. After propensity score matching, both groups comprised 53 patients each. Outcome measures included myocardial injury markers, postoperative delirium incidence, and perioperative parameters.

Results: The observation group showed shorter postoperative recovery durations, reduced intraoperative sufentanil requirements, and lower myocardial injury markers 1 day postoperatively (all P < 0.001). No significant differences were found in midazolam dosages (all P > 0.05), while propofol and sufentanil dosages were lower in the observation group (both P < 0.001). The incidence of postoperative delirium was significantly lower in the observation group (P = 0.014), with cardioversion time and propofol dosage identified as delirium risk factors.

Conclusion: Dexmedetomidine use during heart valve replacement surgery was associated with improved postoperative outcome, including reduced myocardial injury and lower postoperative delirium incidence. These findings suggest a potential role for dexmedetomidine in enhancing patient recovery, although further research is needed to explain its impact on postoperative delirium.

Objective: To explore the predictive value of high-resolution computed tomography (CT) parameters and inflammatory markers for spread through air spaces (STAS) in lung cancer patients.

Methods: A retrospective analysis was conducted on 72 lung cancer patients with STAS and 128 STAS-negative patients treated during the same period. Differences in high-resolution CT indicators and inflammatory markers between the two groups were assessed. Binary logistic regression was used to analyze the relationship between these indicators and STAS positivity. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive efficacy of these indicators for STAS positivity.

Results: Patients in the STAS-positive group exhibited a higher prevalence of leaf signs, pleural traction signs, and blurred tumor-lung boundaries than the STAS-negative group (P<0.05). Additionally, the STAS-positive group had elevated levels of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), interleukin-6 (IL-6), and C-reactive protein (CRP), alongside a lower lymphocyte-to-monocyte ratio (LMR) (P<0.05). The combined predictive model incorporating pleural traction sign, LMR, NLR, PLR, SII, IL-6, and CRP yielded an area under the curve (AUC) of 0.977, with a sensitivity of 94.4% and a specificity of 90.8%.

Conclusion: The integration of high-resolution CT parameters with inflammatory markers demonstrates significant value in predicting STAS positivity in lung cancer patients, with the combined predictive model showing superior performance.

Background: Metastatic spread to the pancreas from renal cell carcinoma is a relatively rare event. Even rarer is the metachronous occurrence of clear cell renal cell carcinoma (ccRCC) and pancreatic ductal adenocarcinoma (PDAC). Our case report contributes to the existing literature by documenting the unusual occurrence of metachronous ccRCC and PDAC in a 69-year-old patient, and we review the literature.

Objective: To explore the effectiveness of the Caprini model in preventing Deep venous thrombosis (DVT) in patients with nephrotic syndrome (NS), in order to provide a reference for reducing poor prognosis in patients with NS.

Methods: A retrospective study was conducted on 150 cases of NS patients treated at Zibo Central Hospital from January 2021 to January 2023. Their clinical data were collected from the medical record management system of the hospital. The patients were divided into two groups: an observation group (75 patients) who received Caprini risk evaluation at admission and designed interventions based on their risk level, and a routine group (75 patients) who received conventional interventions. Clinical data, including the occurrence of DVT, renal function, inflammation, complications and satisfaction with the work of medical staff, were compared between the evaluation and routine groups.

Results: The incidence of DVT in the observation group (6.67%) was significantly lower than that in the Routine group (17.33%) (P < 0.05). Three days after surgery, the difference in thigh circumference increased in both groups. However over time, the difference decreased, with the observation group consistently showing lower values (P < 0.05). On the fifth day after surgery, the D-D level was lower, and PT level higher in the observation group compared to the Routine group (both P < 0.05). Before intervention, 24 h urinary protein, BUN, SCr, WBC, Hs-CRP and IL-6 levels were similar between the two groups (all P > 0.05). After intervention, renal function and inflammation improved in both groups, with greater improvement observed in the observation group (P < 0.05). Additionally, the incidence of complications (except DVT) in the observation group (8.00%) was lower than in the Routine group (21.33%) (P < 0.05). Patients in the observation group also reported higher satisfaction with nursing and treatment.

Conclusion: The Caprini score is an effective tool for guiding predictive care in NS patients, significantly reducing the risk of DVT. Additionally, implementing risk-based interventions according to the Caprini score enhances renal function, decreases the incidence of complications, and improves patient satisfaction with nursing and treatment.