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Nonobstructive epicardial coronary artery disease: an evolving concept in need of diagnostic and therapeutic guidance. 非阻塞性心外膜冠状动脉疾病:一个需要诊断和治疗指导的不断发展的概念。
Pub Date : 2024-05-01 Epub Date: 2024-05-31 DOI: 10.1080/00325481.2024.2360888
Angel Lopez-Candales, Khalid Sawalha, Talal Asif

For decades, we have been treating patients presenting with angina and concerning electrocardiographic changes indicative of ischemia or injury, in whom no culprit epicardial coronary stenosis was found during diagnostic coronary angiography. Unfortunately, the clinical outcomes of these patients were not better than those with recognized obstructive coronary disease. Improvements in technology have allowed us to better characterize these patients. Consequently, an increasing number of patients with ischemia and no obstructive coronary artery disease (INOCA) or myocardial infarction in the absence of coronary artery disease (MINOCA) have now gained formal recognition and are more commonly encountered in clinical practice. Although both entities might share functional similarities at their core, they pose significant diagnostic and therapeutic challenges. Unless we become more proficient in identifying these patients, particularly those at higher risk, morbidity and mortality outcomes will not improve. Though this field remains in constant flux, data continue to become available. Therefore, we thought it would be useful to highlight important milestones that have been recognized so we can all learn about these clinical entities. Despite all the progress made regarding INOCA and MINOCA, many important knowledge gaps continue to exist. For the time being, prompt identification and early diagnosis remain crucial in managing these patients. Even though we are still not clear whether intensive medical therapy alters clinical outcomes, we remain vigilant and wait for more data.

几十年来,我们一直在治疗那些出现心绞痛、心电图变化提示缺血或损伤的患者,但在诊断性冠状动脉造影术中并未发现心外膜冠状动脉狭窄的罪魁祸首。遗憾的是,这些患者的临床疗效并不比那些已被确认患有阻塞性冠状动脉疾病的患者好。技术的进步使我们能够更好地描述这些患者的特征。因此,越来越多的缺血且无阻塞性冠状动脉疾病(INOCA)或无冠状动脉疾病的心肌梗死(MINOCA)患者现已得到正式承认,并在临床实践中更为常见。尽管这两种疾病在核心功能上可能有相似之处,但它们在诊断和治疗上都提出了巨大的挑战。除非我们能更熟练地识别这些患者,尤其是高危患者,否则发病率和死亡率都不会改善。尽管这一领域仍在不断变化,但数据仍在不断涌现。因此,我们认为有必要重点介绍已被确认的重要里程碑,以便我们都能了解这些临床实体。尽管在 INOCA 和 MINOCA 方面取得了诸多进展,但仍存在许多重要的知识空白。就目前而言,及时识别和早期诊断仍然是管理这些患者的关键。尽管我们仍不清楚强化医学治疗是否会改变临床结果,但我们仍会保持警惕,等待更多的数据。
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引用次数: 0
Usefulness of risk assessment tools in predicting hemodynamic outcome after balloon pulmonary angioplasty: a comparative analysis. 风险评估工具在预测球囊肺血管成形术后血流动力学结果方面的实用性:对比分析。
Pub Date : 2024-05-01 Epub Date: 2024-05-30 DOI: 10.1080/00325481.2024.2358745
Xin Li, Yi Zhang, Qing Zhao, Tao Yang, Qixian Zeng, Qi Jin, Anqi Duan, Zhihua Huang, Meixi Hu, Sicheng Zhang, Luyang Gao, Changming Xiong, Qin Luo, Zhihui Zhao, Zhihong Liu

Objectives: Several parameters of widely used risk assessment tools for pulmonary arterial hypertension (PAH) have been linked to hemodynamic outcomes of balloon pulmonary angioplasty (BPA). Therefore, we aimed to determine whether these risk assessment tools could be used to predict hemodynamic outcomes following BPA.

Methods: In this retrospective study, we included 139 patients with chronic thromboembolic pulmonary hypertension who had undergone BPA at Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (Beijing, China). We compared the accuracies of seven well-validated risk assessment tools for predicting hemodynamic outcomes following BPA. A favorable hemodynamic outcome was defined as a mean pulmonary arterial pressure < 30 mmHg at follow-up.

Results: The baseline risk profiles varied significantly among the risk assessment tools. The US Registry to Evaluate Early and Long-Term PAH Disease Management risk scales and the French risk assessment tools rated most patients as high-risk, while the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA) series and laboratory examination-based risk scales categorized most patients as having intermediate-risk profile. COMPERA 2.0 (4-strata) exhibited the highest predictive power among all risk stratifications. Noninvasive risk stratification (COMPERA 2.0 [3-strata]) showed a comparable predictive ability to that of invasive risk stratification (COMPERA 1.0) (area under the curve 0.649 vs. 0.648). Moreover, incorporating diffusing capacity of the lungs for carbon monoxide and tricuspid regurgitation velocity into COMPERA 2.0 (4-strata) further enhanced its predictive power (net reclassification index 0.153, 95% confidence interval 0.009-0.298, p = 0.038). Additionally, this refined COMPERA version had a high calibration accuracy (slope 0.96).

Conclusion: Although the risk strata distribution varied among different risk assessment tools, the proportion of patients achieving favorable hemodynamics decreased with the escalation of risk stratification in most models. The well-validated risk assessment tools for PAH could also predict hemodynamic outcomes following BPA, and the refined COMPERA 2.0 model exhibited the highest predictive ability among these. Applying risk assessment tools before BPA can facilitate early identification of patients in need of closer monitoring and more intensive interventions, contributing to a better prognosis after BPA.

目的:广泛使用的肺动脉高压(PAH)风险评估工具的一些参数与球囊肺血管成形术(BPA)的血液动力学结果有关。因此,我们旨在确定这些风险评估工具是否可用于预测 BPA 术后的血液动力学结果:在这项回顾性研究中,我们纳入了 139 名接受过 BPA 的慢性血栓栓塞性肺动脉高压患者。我们比较了七种经过严格验证的风险评估工具预测 BPA 术后血流动力学结果的准确性。良好的血液动力学结果被定义为平均肺动脉压结果:不同风险评估工具的基线风险概况差异很大。美国早期和长期 PAH 疾病管理评估登记风险量表和法国风险评估工具将大多数患者评定为高风险,而肺动脉高压新疗法比较前瞻性登记(COMPERA)系列和基于实验室检查的风险量表将大多数患者归类为中度风险。在所有风险分层中,COMPERA 2.0(4层)的预测能力最高。无创风险分层(COMPERA 2.0 [3-strata])的预测能力与有创风险分层(COMPERA 1.0)相当(曲线下面积 0.649 vs. 0.648)。此外,将肺部一氧化碳弥散能力和三尖瓣反流速度纳入 COMPERA 2.0(4-strata)进一步提高了其预测能力(净重新分类指数 0.153,95% 置信区间 0.009-0.298,p = 0.038)。此外,改进后的 COMPERA 版本具有较高的校准准确性(斜率为 0.96):结论:尽管不同风险评估工具的风险分层分布各不相同,但在大多数模型中,随着风险分层的升级,获得良好血流动力学的患者比例有所下降。经过充分验证的 PAH 风险评估工具也能预测 BPA 后的血流动力学结果,其中改进后的 COMPERA 2.0 模型的预测能力最高。在 BPA 前应用风险评估工具有助于及早识别需要更密切监测和更强化干预的患者,从而改善 BPA 后的预后。
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引用次数: 0
Recognizing cardiac murmurs in childhood: a survey of physicians' approaches and knowledge levels. 识别儿童心脏杂音:医生的方法和知识水平调查。
Pub Date : 2024-05-01 Epub Date: 2024-05-28 DOI: 10.1080/00325481.2024.2360387
Osman Küçükkelepçe, Fedli Emre Kılıç, Erdoğan Öz, Osman Kurt, Mehmet Emin Parlak, Hüseyin Tanrıverdi

Objective: This study aimed to assess physicians' approach to cardiac murmurs and their level of knowledge about this sign, which is a crucial finding in childhood cardiac anomalies.

Methods: The study intended to include all family physicians in the Adıyaman province of Turkey, but ultimately 150 out of 210 physicians participated and was completed with a percentage response rate of 71%. Participants were asked about their approach to cardiac murmurs, answered knowledge questions, and completed a questionnaire on demographic characteristics. Subsequently, eight heart sounds were played, and participants were asked to identify the nature of each sound.

Results: Family medicine specialists (all scores were p < 0.001) and physicians who completed a pediatric internship lasting over a month (knowledge score p = 0.012, behavioral score p = 0.021, recording score p = 0.01) demonstrated significantly higher knowledge, approach, and recording scores. Age and years in the profession showed a negative correlation with recording scores.

Conclusions: The study highlights the significant impact of various factors such as gender, specialization, internship duration, experience, and theoretical knowledge on the ability to recognize and approach cardiac murmurs. These findings underscore the importance of incorporating these factors into medical education and development programs, especially those aimed at improving cardiac examination skills.

研究目的本研究旨在评估医生处理心脏杂音的方法以及他们对这一征象的了解程度,这是儿童心脏畸形的一个重要发现:这项研究旨在调查土耳其阿德亚曼省的所有家庭医生,但最终 210 名医生中有 150 名参加了调查,调查完成率为 71%。研究人员询问了他们处理心脏杂音的方法,回答了知识问题,并填写了一份人口统计学特征问卷。随后播放了八种心音,并要求参与者辨别每种心音的性质:结果:全科医学专家(所有得分 p = 0.012,行为得分 p = 0.021,记录得分 p = 0.01)在知识、方法和记录方面的得分明显更高。年龄和从业年限与记录得分呈负相关:本研究强调了性别、专业、实习时间、经验和理论知识等各种因素对识别和处理心脏杂音能力的重要影响。这些发现强调了将这些因素纳入医学教育和发展计划的重要性,尤其是那些旨在提高心脏检查技能的计划。
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引用次数: 0
Association between serum ferritin and bone turnover marker levels in type 2 diabetes mellitus patients with non-alcoholic fatty liver disease. 患有非酒精性脂肪肝的 2 型糖尿病患者血清铁蛋白与骨转换标志物水平之间的关系。
Pub Date : 2024-04-01 Epub Date: 2024-03-25 DOI: 10.1080/00325481.2024.2333718
Chongyang Chen, Yangting Zhao, Xiaoyu Lv, Kai Li, Yawen Wang, Dengrong Ma, Mei Han, Xiaohui Zan, Xinyuan Guo, Jingfang Liu

Objective: To investigate the correlation between serum ferritin (SF) and bone turnover markers in type 2 diabetes mellitus (T2DM) patients with non-alcoholic fatty liver disease (NAFLD).

Methods: Seven hundred and forty-two people with T2DM were selected. Serum bone turnover markers: osteocalcin (OC), type I procollagen N-terminal peptide (PINP), β-I type collagen carboxy-terminal peptide (β-CTx), and 25-hydroxyvitamin D3 (25-[OH]-D) levels were detected. High SF (HF) was defined as the indicated SF levels above 400 ng/mL in males and more than 150 ng/mL in females. Patients were divided into four groups: T2DM+normal SF (non-HF); T2DM+high SF (HF); T2DM+NAFLD+non-HF; andT2DM+NAFLD+HF. Relationships between SF and bone turnover markers were analyzed.

Results: Compared with the T2DM+non-HF group, β-CTx levels were higher in the T2DM+HFgroup. Compared with the T2DM+NAFLD+non-HF group, β-CTx levels were increased and 25-(OH)-D levels decreased in the T2DM+NAFLD+HF group (all p < 0.05). SF was positively correlated with β-CTx [β = 0.074; 95% CI (0.003, 0.205)] and negatively correlated with 25-(OH)-D [β=-0.108; 95%CI (-0.006, -0.001)]. Compared with the T2DM+non-HF group, an independent positive correlation was found between β-CTx and SF in the T2DM+NAFLD+HF group [OR = 1.002; 95% CI (1.001, 1.004)]. Among males, SF was positively correlatedwith β-CTx [β = 0.114; 95% CI (0.031, 0.266)]. SF was negatively correlated with 25-(OH)-D levels in both male and female patients [β=-0.124; 95% CI (0.007,0.001) and β=-0.168; 95% CI (-0.012, -0.002)]. Among those >50 years of age and postmenopausal females, SF was negatively correlated with 25-(OH)-D levels [β=-0.117; 95% CI (-0.007, -0.001) and β=-0.003; 95% CI (-0.013, -0.003)].

Conclusion: SF level was positively correlated with β-CTx in T2DM patients with NAFLD, which may promote bone resorption and increase the risk of bone loss.

目的研究非酒精性脂肪肝(NAFLD)2 型糖尿病(T2DM)患者血清铁蛋白(SF)与骨转换指标的相关性。检测血清骨转换标志物:骨钙素(OC)、I型胶原蛋白N端肽(PINP)、β-I型胶原羧基端肽(β-CTx)和25-羟维生素D3(25-[OH]-D)水平。高SF(HF)的定义是男性SF水平超过400纳克/毫升,女性超过150纳克/毫升。患者被分为四组:T2DM+正常 SF(非 HF);T2DM+高 SF(HF);T2DM+NAFLD+非 HF;T2DM+NAFLD+HF。分析了SF与骨转换标志物之间的关系:与 T2DM+ 非 HF 组相比,T2DM+HF 组的β-CTx 水平更高。与 T2DM+NAFLD+non-HF 组相比,T2DM+NAFLD+HF 组的 β-CTx 水平升高,25-(OH)-D 水平降低(均为 50 岁以下绝经后女性,SF 与 25-(OH)-D 水平呈负相关[β=-0.117;95% CI (-0.007,-0.001) 和 β=-0.003;95% CI (-0.013,-0.003)]:非酒精性脂肪肝的 T2DM 患者的 SF 水平与 β-CTx 呈正相关,这可能会促进骨吸收并增加骨质流失的风险。
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引用次数: 0
A machine learning stacking model accurately estimating gastric fluid volume in patients undergoing elective sedated gastrointestinal endoscopy. 机器学习堆叠模型可准确估计接受择期镇静胃肠道内窥镜检查患者的胃液量。
Pub Date : 2024-04-01 Epub Date: 2024-03-22 DOI: 10.1080/00325481.2024.2333720
Yuqing Yan, Yuzhan Jin, Yaoyi Guo, Mingtao Ma, Yue Feng, Yi Zhong, Chen Chen, Chun Ge, Jianjun Zou, Yanna Si

Background: The current point-of-care ultrasound (POCUS) assessment of gastric fluid volume primarily relies on the traditional linear approach, which often suffers from moderate accuracy. This study aimed to develop an advanced machine learning (ML) model to estimate gastric fluid volume more accurately.

Methods: We retrospectively analyzed the clinical data and POCUS data (D1: craniocaudal diameter, D2: anteroposterior diameter) of 1386 patients undergoing elective sedated gastrointestinal endoscopy (GIE) at Nanjing First Hospital to predict gastric fluid volume using ML techniques, including six different ML models and a stacking model. We evaluated the models using the adjusted Coefficient of Determination (R2), mean absolute error (MAE) and root mean square error (RMSE). The SHapley Additive exPlanations (SHAP) method was used to interpret the importance of the variables. Finally, a web calculator was constructed to facilitate its clinical application.

Results: The stacking model (Linear regression + Multilayer perceptron) performed best, with the highest adjusted R2 of 0.718 (0.632 to 0.804). The mean prediction bias was 4 ml (MAE: 4.008 (3.68 to 4.336)), which is better than that of the linear model. D1 and D2 ranked high in the SHAP plot and performed better in the right lateral decubitus (RLD) than in the supine position. The web calculator can be accessed at https://cheason.shinyapps.io/Stacking_regressor/.

Conclusion: The stacking model and its web calculator can serve as practical tools for accurately estimating gastric fluid volume in patients undergoing elective sedated GIE. It is recommended that anesthesiologists measure D1 and D2 in the patient's RLD position.

背景:目前的床旁超声(POCUS)胃液容量评估主要依赖于传统的线性方法,其准确性往往不高。本研究旨在开发一种先进的机器学习(ML)模型,以更准确地估计胃液容量:我们回顾性分析了在南京市第一医院接受择期镇静消化内镜检查(GIE)的1386名患者的临床数据和POCUS数据(D1:颅尾径,D2:前胸径),利用ML技术预测胃液量,包括6种不同的ML模型和1种堆叠模型。我们使用调整后的决定系数(R2)、平均绝对误差(MAE)和均方根误差(RMSE)对模型进行了评估。我们还使用了 SHapley Additive exPlanations(SHAP)方法来解释变量的重要性。最后,还制作了一个网络计算器,以方便临床应用:叠加模型(线性回归 + 多层感知器)表现最佳,调整后的 R2 最高,为 0.718(0.632 至 0.804)。平均预测偏差为 4 毫升(MAE:4.008(3.68 至 4.336)),优于线性模型。D1和D2在SHAP图中排名靠前,右侧卧位(RLD)比仰卧位表现更好。网络计算器可通过 https://cheason.shinyapps.io/Stacking_regressor/.Conclusion 访问:堆叠模型及其网络计算器可作为实用工具,用于准确估计接受择期镇静 GIE 患者的胃液量。建议麻醉医师在患者仰卧位时测量 D1 和 D2。
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引用次数: 0
Guideline-based management of metabolic dysfunction-associated steatotic liver disease in the primary care setting. 基于指南的基层医疗机构代谢功能障碍相关脂肪性肝病管理。
Pub Date : 2024-04-01 Epub Date: 2024-05-13 DOI: 10.1080/00325481.2024.2325332
Alina M Allen, Michael Charlton, Kenneth Cusi, Stephen A Harrison, Kris V Kowdley, Mazen Noureddin, Jay H Shubrook

Background: The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing worldwide. Primary care providers play a critical role in the screening, diagnosis, and management of MASLD and/or metabolic dysfunction-associated steatohepatitis (MASH), though they can face challenges in this setting, particularly where healthcare resources are limited and barriers to care exist. To address these challenges, several guidelines have been developed to provide evidence-based recommendations for the clinical assessment and management of patients with MASLD/MASH.

Aims: To provide a unified, simple-to-understand, practical guide for MASLD screening, diagnosis, and management based on current guideline recommendations, for use by primary care providers in daily practice.

Methods: Evidence-based recommendations from several international guidelines were summarized, focusing on the similarities and differences between them.

Results: Recommendations are broadly aligned across the guidelines, but several key differences are evident. Practical guidance is provided on screening, identifying target populations for risk stratification, initial evaluation of individuals with suspected MASLD, surveillance, risk stratification and referral, as well as approaches to the management of MASLD and associated comorbidities, with specific considerations for the primary care setting.

Conclusions: Primary care providers are ideally placed to identify at-risk individuals, implement evidence-based interventions to prevent the development of fibrosis and cirrhosis, and effectively manage comorbidities. Equipping primary care providers with the necessary knowledge and tools to effectively manage MASLD/MASH may help to improve patient outcomes and reduce the burden of liver disease.

背景:代谢功能障碍相关性脂肪性肝病(MASLD)的发病率在全球范围内呈上升趋势。初级保健提供者在 MASLD 和/或代谢功能障碍相关性脂肪性肝炎 (MASH) 的筛查、诊断和管理中发挥着至关重要的作用,尽管他们在这种情况下可能面临挑战,尤其是在医疗资源有限和存在护理障碍的地方。为了应对这些挑战,已经制定了一些指南,为 MASLD/MASH 患者的临床评估和管理提供循证建议。目的:根据当前的指南建议,为 MASLD 的筛查、诊断和管理提供统一、简单易懂、实用的指南,供初级保健提供者在日常实践中使用:方法:总结了多个国际指南中基于证据的建议,重点关注它们之间的异同:结果:各指南的建议大体一致,但也存在一些明显的差异。就筛查、确定风险分层的目标人群、对疑似MASLD患者进行初步评估、监测、风险分层和转诊,以及管理MASLD和相关合并症的方法提供了实用指导,并对初级医疗机构进行了具体考虑:结论:基层医疗机构是识别高危人群、实施循证干预以预防纤维化和肝硬化发展以及有效管理合并症的理想场所。让初级医疗服务提供者掌握必要的知识和工具来有效管理 MASLD/MASH,有助于改善患者的预后,减轻肝病负担。
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引用次数: 0
The evaluation of depression and anxiety levels of mothers of patients with periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome and familial Mediterranean fever. 对周期性发热、口腔炎、咽炎和腺炎综合征以及家族性地中海热患者母亲的抑郁和焦虑水平进行评估。
Pub Date : 2024-04-01 Epub Date: 2024-04-29 DOI: 10.1080/00325481.2024.2347829
Elif Arslanoglu Aydin, Esra Baglan, İlknur Bagrul, Nesibe Gokce Kocamaz, Serife Tuncez, Mehmet Bulbul, Semanur Ozdel

Objective: Periodic fever, aphthous stomatitis, pharyngitis and adenitis (PFAPA) syndrome and familial Mediterranean fever (FMF) are autoinflammatory disorders typically characterized by recurrent fever attacks. These recurrent fever attacks can lead to depression and anxiety in mothers of these patients. This study aimed to compare the depression and anxiety levels in mothers of PFAPA and FMF patients.

Methods: This study is a cross-sectional observational study. 48 mothers of children with FMF and 70 mothers of children with PFAPA participated in the study. Mothers in these two groups were compared in terms of anxiety and depression by using the validated Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI).

Results: Depression and anxiety scores of mothers were found to be similar in FMF and PFAPA groups. Moderate or high level of anxiety was seen in 32% of mothers of patients with PFAPA and 27% of mothers of patients with FMF. 23% of mothers of patients with PFAPA were evaluated as having moderate or severe depression, and 18% of mothers of patients with FMF were evaluated as having moderate depression. There was no statistically significant difference between the duration, frequency of attacks, recurrent hospitalizations, sociodemographic characteristics, and inventory scores.

Conclusion: Depression and anxiety scores of mothers with children diagnosed with FMF and PFAPA are similar. These two diseases affect families psychosocially at similar levels. It is important to provide psychosocial support to families.

目的:周期性发热、口腔炎、咽炎和腺炎(PFAPA)综合征和家族性地中海热(FMF)是以反复发热为典型特征的自身炎症性疾病。反复发热可导致这些患者的母亲抑郁和焦虑。本研究旨在比较 PFAPA 和 FMF 患者母亲的抑郁和焦虑水平:本研究是一项横断面观察性研究。48名FMF患儿的母亲和70名PFAPA患儿的母亲参加了研究。通过使用有效的贝克抑郁量表(BDI)和贝克焦虑量表(BAI)对两组母亲的焦虑和抑郁情况进行比较:结果:发现 FMF 组和 PFAPA 组母亲的抑郁和焦虑得分相似。32%的 PFAPA 患者母亲和 27% 的 FMF 患者母亲有中度或高度焦虑。23% 的 PFAPA 患者母亲被评估为患有中度或重度抑郁症,18% 的 FMF 患者母亲被评估为患有中度抑郁症。在持续时间、发作频率、反复住院、社会人口学特征和量表评分之间没有统计学意义上的差异:结论:被诊断为 FMF 和 PFAPA 患儿的母亲的抑郁和焦虑评分相似。这两种疾病对家庭社会心理的影响程度相似。为家庭提供社会心理支持非常重要。
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引用次数: 0
Opportunities to overcome underutilization of enhanced insulin delivery technologies in people with type 2 diabetes: a narrative review. 克服 2 型糖尿病患者对增强型胰岛素给药技术利用不足的机遇:叙述性综述。
Pub Date : 2024-04-01 Epub Date: 2024-03-21 DOI: 10.1080/00325481.2024.2331417
Davida F Kruger, Diana Isaacs, Lucille Hughes, Eden Miller, Timothy S Bailey

Use of innovative technologies such as continuous glucose monitoring (CGM) and insulin delivery systems have been shown to be safe and effective in helping patients with diabetes achieve significantly improved glycemic outcomes compared to their previous therapies. However, these technologies are underutilized in many primary care practices. This narrative review discusses some of the clinical and economic benefits of tubeless insulin delivery devices and discusses how this technology can overcome the main obstacles inherent to use of conventional insulin delivery devices.

事实证明,使用连续血糖监测(CGM)和胰岛素给药系统等创新技术可以安全有效地帮助糖尿病患者显著改善血糖疗效。然而,这些技术在许多初级保健实践中并未得到充分利用。这篇叙述性综述讨论了无管胰岛素给药装置的一些临床和经济效益,并探讨了该技术如何克服使用传统胰岛素给药装置所固有的主要障碍。
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引用次数: 0
A scoping review of mechanisms of auricular acupuncture for treatment of pain. 耳针治疗疼痛机制的范围综述。
Pub Date : 2024-04-01 Epub Date: 2024-04-02 DOI: 10.1080/00325481.2024.2333232
Trish Elliott, Maria Merlano Gomez, Deborah Morris, Candy Wilson, Julie G Pilitsis

Objectives: Auricular acupuncture (AA) is becoming increasingly common in primary care clinics, emergency departments and peri-operatively for pain relief. Over the last decade, since the last comprehensive reviews were published, the literature has expanded. In this scoping review, we seek to document the efficacy of AA in treating both acute and chronic pain, describe the mechanism of action of AA in treating pain, and discuss how AA has been integrated into Western medicine to date.

Methods: The authors performed a MEDLINE search inclusive of articles from 1966 to June 2023 including articles written in English identifying literature. We included human studies when more than 3 patients were included. Three hundred and fourteen unique articles were identified and 152 were selected by title screen. After abstract review, 117 were chosen for full-text review. Following full-text review, 33 articles were excluded and 21 added from references, totaling 105 articles included in our scoping review.

Results: AA reduces pain severity in patients with both acute and chronic pain. The best studies in the acute settings have occurred in the peri-operative setting where sham AA is employed, multiple sessions of AA are given, and medication dosing is carefully monitored. In these cases, AA reduced pain and post-operative medications. In patients with chronic pain, multiple sessions of AA resulted not only in pain relief but also in improvements in function and disability. Literature suggests that AA works through multiple mechanisms with the most compelling data coupled to the autonomic nervous system and neuroendocrine system. Curriculums designed to teach AA and aid in implementation have been published.

Conclusion: AA is an accessible, effective means of pain relief. AA is relatively straightforward to learn, and protocols and curriculums exist to teach healthcare professionals this valuable skill. Overcoming implementation barriers, including patient education, are essential next steps.

目的:耳针(AA)在初级保健诊所、急诊科和围手术期的止痛治疗中越来越常见。在过去的十年中,自上一次发表全面综述以来,相关文献不断增加。在这篇范围综述中,我们试图记录 AA 治疗急性和慢性疼痛的疗效,描述 AA 治疗疼痛的作用机制,并讨论迄今为止 AA 如何融入西医:作者在 MEDLINE 上检索了 1966 年至 2023 年 6 月期间的文章,包括用英语撰写的识别文献。当纳入的患者超过 3 人时,我们将其纳入人体研究。共识别出 314 篇独特的文章,并通过标题筛选出 152 篇。摘要审查后,我们选择了 117 篇文章进行全文审查。全文审阅后,我们排除了 33 篇文章,并从参考文献中添加了 21 篇文章,总共有 105 篇文章纳入了我们的范围审查:结果:AA 可降低急性和慢性疼痛患者的疼痛严重程度。急性期的最佳研究是在围手术期进行的,在围手术期采用假性镇痛,给予多次镇痛治疗,并仔细监测药物剂量。在这些情况下,AA 可减少疼痛和术后用药。在慢性疼痛患者中,多次 AA 不仅能缓解疼痛,还能改善功能和残疾状况。文献表明,AA 通过多种机制发挥作用,其中最有说服力的数据与自主神经系统和神经内分泌系统有关。旨在教授 AA 和帮助实施 AA 的课程已经出版:结论:AA 是一种方便、有效的止痛方法。AA 的学习相对简单,已有协议和课程来教授医护人员这项宝贵的技能。克服实施障碍(包括患者教育)是接下来的重要步骤。
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引用次数: 0
Prognostic significance of body mass index and serum albumin as the indicators of nutritional status in small cell lung cancer. 体重指数和血清白蛋白作为小细胞肺癌营养状况指标的预后意义。
Pub Date : 2024-03-01 Epub Date: 2024-03-12 DOI: 10.1080/00325481.2024.2328512
Faruk Tas, Akın Ozturk, Kayhan Erturk

Background: Body mass index (BMI) and serum albumin (ALB) level are long-established markers that reflect the nutritional status and eventually the prognosis of cancer patients. The objective of the study was to determine the clinical significance of these factors and specify their roles in outcomes compared with performance status (PS) and weight loss (WL), which are considered the most significant patient-related prognostic factors in small cell lung cancer (SCLC) treated with platinum-etoposide-based chemotherapy.

Methods: A total of 378 patients with SCLC were enrolled in the study and analyzed retrospectively.

Results: BMI values were similar by clinical stage, whereas the percentages of the patients with WL, low serum ALB, and particularly poor (≥2) PS were significantly higher in patients with extended disease SCLC (ED-SCLC) compared to those with limited disease SCLC (LD-SCLC). In LD-SCLC, patients with poor PS lived for a significantly shorter time than patients with good PS (HR: 7.791, p = 0.0001); however, BMI (HR: 1.035, p = 0.8), WL (HR: 0.857, p = 0.5), and ALB (HR: 0.743, p = 0.3) had no significant effect on the outcome. In ED-SCLC, PS (HR: 4.257, p = 0.0001), WL (HR: 1.677, p = 0.001), and ALB (HR: 0.680, p = 0.007) had an impact on survival, but BMI did not (HR: 0.791, p = 0.08). In LD-SCLC, the univariate analysis showed that only poor PS was correlated with increased mortality (HR: 7.791, p = 0.0001); yet it lost significance in multivariate analysis. In ED-SCLC, poor PS (HR: 4.257, p = 0.0001), WL (HR: 1.667, p = 0.001), and a low ALB level (HR: 0.680, p = 0.007) were shown to be factors for poor prognosis in the univariate analysis; yet only PS remained significant in multivariate analysis (HR: 2.286, p = 0.001).

Conclusion: Even though BMI and serum albumin showed no prognostic value in SCLC patients treated with chemotherapy, PS was found to be the most significant prognostic factor in both LD- and ED-SCLC stages.

背景:体重指数(BMI)和血清白蛋白(ALB)水平是反映癌症患者营养状况和预后的公认指标。本研究的目的是确定这些因素的临床意义,并明确它们与表现状态(PS)和体重减轻(WL)相比在预后中的作用,后者被认为是接受以铂-依托泊苷为基础的化疗的小细胞肺癌(SCLC)患者最重要的预后因素:研究共纳入了 378 名 SCLC 患者,并对其进行了回顾性分析:不同临床分期的BMI值相似,而与局限性疾病SCLC(LD-SCLC)患者相比,扩展性疾病SCLC(ED-SCLC)患者中WL、低血清ALB和PS特别差(≥2)的患者比例明显更高。在LD-SCLC中,PS差的患者的存活时间明显短于PS好的患者(HR:7.791,p = 0.0001);然而,BMI(HR:1.035,p = 0.8)、WL(HR:0.857,p = 0.5)和ALB(HR:0.743,p = 0.3)对预后无明显影响。在 ED-SCLC 中,PS(HR:4.257,p = 0.0001)、WL(HR:1.677,p = 0.001)和 ALB(HR:0.680,p = 0.007)对生存率有影响,但 BMI 没有影响(HR:0.791,p = 0.08)。在 LD-SCLC 中,单变量分析显示,只有 PS 差与死亡率增加相关(HR:7.791,p = 0.0001);但在多变量分析中,PS 差失去了意义。在 ED-SCLC 中,单变量分析显示,不良 PS(HR:4.257,p = 0.0001)、WL(HR:1.667,p = 0.001)和低 ALB 水平(HR:0.680,p = 0.007)是预后不良的因素;但在多变量分析中,只有 PS 仍具有显著性(HR:2.286,p = 0.001):结论:尽管BMI和血清白蛋白对接受化疗的SCLC患者没有预后价值,但在LD-和ED-SCLC分期中,PS是最重要的预后因素。
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