World journal of methodology最新文献

Background: The neutrophil-lymphocyte ratio (NLR) has been proposed as a potential prognostic marker for mortality outcomes in various conditions, yet its association with chronic hemodialysis (HD) remains underexplored. We aim to study its utility by conducting a meta-analysis of this specific population.

Aim: To determine whether elevated NLR is associated with all-cause mortality (ACM) and cardiovascular mortality (CVM) in patients undergoing chronic HD.

Methods: A comprehensive search from PubMed, Google Scholar, and Scopus identified studies showing the association between NLR and mortality outcomes in patients with chronic HD. Random-effects models with 95%CIs were employed to pool adjusted hazard ratios (aHRs), odds ratios (ORs), and I² statistics for evaluating the heterogeneity of findings. Leave-one-out sensitivity and meta-regression analyses assessed changes in overall effects and identified confounders, respectively. The Joanna Briggs Institute (JBI) tool was used to assess the quality of studies.

Results: 19 studies comprising 9047 patients with a mean age of 59.5 ± 5.86 years and a mean follow-up duration of 46.7 months were included in our study. Our meta-analysis revealed a significant association between NLR > 2.5 and increased risks of ACM (aHR: 1.25, 95%CI: 1.14-1.37, P < 0.0001) and CVM (aHR: 1.24, 95%CI: 1.02-1.49, P = 0.03). Studies reporting outcomes in OR reported similar findings for ACM (OR: 4.59, 95%CI: 1.74-12.11, P = 0.002) and CVM (OR: 1.11, 95%CI: 1.01-1.23, P = 0.03). Sensitivity analysis revealed no variations. Meta-regression revealed increasing male proportion is positively associated with ACM. Pooled area under the curve (AUC) was 0.71 (95%CI: 0.63-0.80, P < 0.0001). The JBI tool revealed high-quality studies.

Conclusion: This meta-analysis suggests that elevated NLR may serve as a useful prognostic marker for ACM and CVM in patients on chronic HD and can be useful in planning for the prevention of mortality-related strategies.

Hengyang City faces challenges from rapid aging, including weakened family care and a shortage of resources. The "three social linkage" mechanism integrates community of practice, social organizations, and professional support to improve health services for the aged. However, issues like low smart device use and talent shortages persist. This study aims to optimize resource allocation and service efficiency through a "chain + virtual elderly care" model. This article explores the "three social linkage" mechanism and the integration of chain services with virtual elderly care models in Hengyang City. It examines three core elements: Resource integration, service collaboration, and professional support. The community coordinates resources and maintains databases of elderly care needs, while social organizations provide services and social workers design care plans. Data was gathered through case studies, interviews, and observations, focusing on smart technology integration and service outcomes. The study also evaluates cross-departmental data sharing, social worker training, and funding mechanisms, using performance indicators like service delivery time, user satisfaction, and resource use. The analysis of elderly care services in Hengyang City reveals key issues and improvements within the "three social linkage" mechanism. The three social linkage mechanism has facilitated better resource integration and service collaboration. Communities have created resource lists and service demand databases, improving coordination. Social organizations provide specialized services, and social workers conduct home visits to create personalized care plans. The virtual elderly care platform has enhanced service efficiency, with smart devices like bracelets enabling real-time health monitoring. The "chain + virtual elderly care" model in Hengyang has effectively addressed issues of scattered and outdated resources by integrating services through community hubs, standardized stations, and dynamic resource databases. Smart elderly care platforms, especially devices like wristbands, have improved service efficiency and emergency response.

Nocturia is a common clinical condition that severely affects patients' quality of life and is strongly associated with complications such as depression, cognitive dysfunction, mood disorders, and fall-related injuries. The etiology of nocturia is complex and mainly includes increased total urine output, nocturnal polyuria, decreased functional bladder capacity, sleep disorders, and confounding factors. In recent years, with the in-depth study of the pathophysiological mechanisms of nocturia, the diagnostic methods have been updated, and the application of tools such as the frequency volume chart, bladder capacity index, and bladder diary have provided an important basis for the precise identification of the etiology. Behavior modification has been widely used in clinical practice as a first-line treatment. In addition, advances in pharmacotherapy have provided new directions for the management of nocturia, and the efficacy and safety of α-blockers, cholinergic receptor antagonists, adrenergic β-agonists, desmopressin, melatonin, and other medications have been gradually validated. However, there are still some limitations in the existing studies, especially in the long-term safety and efficacy of drug therapy as well as the mechanism of action still need to be further explored. This article reviews the latest research advances in nocturia, aiming to provide clinicians with diagnostic and therapeutic strategies based on evidence-based medicine, and to promote the standardization and individualization of nocturia management.

Background: Artificial intelligence (AI) is transforming healthcare by improving diagnostic accuracy and predictive analytics. Periodontal diseases are recognized as risk factors for systemic conditions, including type 2 diabetes mellitus, cardiovascular disease, Alzheimer's disease, polycystic ovary syndrome, thyroid dysfunction, and post-coronavirus disease 2019 complications. These conditions exhibit complex bidirectional interactions, underscoring the importance of early detection and risk stratification. Current diagnostic tools often fail to capture these interactions at an early stage, limiting timely intervention. This study hypothesizes that AI-driven approaches can significantly improve early diagnosis and risk prediction of periodontal-systemic interactions, enhancing clinical outcomes.

Aim: To evaluate AI's role in diagnosing and predicting periodontal-systemic interactions in studies from 2010 to 2024.

Methods: This systematic review followed PRISMA guidelines (2009) and included peer-reviewed articles from PubMed, Scopus, and Embase. Studies with large sample sizes (≥ 500 participants) were selected, focusing on AI models integrating multi-omics data and advanced imaging techniques such as cone beam computed tomography and magnetic resonance imaging. Machine learning models processed structured clinical data, deep learning models combined imaging and clinical data, and natural language processing models extracted insights from clinical notes.

Results: AI applications significantly enhanced diagnostic and predictive accuracy, reducing diagnostic time by 40% and improving predictive accuracy by 25% in periodontal patients with type 2 diabetes mellitus. Studies with sample sizes of 1000-1500 participants reported diagnostic accuracy improvements up to 92%, with specificity and sensitivity rates of 94% and 90%, respectively. Increasing sample sizes over the years reflected advancements in AI, data collection, and model training, reinforcing model reliability.

Conclusion: AI's integration of multi-omics and imaging data has transformed early diagnosis and risk prediction in periodontal-systemic interactions, improving clinical outcomes and decision-making.

Background: Relieving pain is central to the early management of knee osteoarthritis, with a plethora of pharmacological agents licensed for this purpose. Intra-articular corticosteroid injections are a widely used option, albeit with variable efficacy.

Aim: To develop a machine learning (ML) model that predicts which patients will benefit from corticosteroid injections.

Methods: Data from two prospective cohort studies [Osteoarthritis (OA) Initiative and Multicentre OA Study] was combined. The primary outcome was patient-reported pain score following corticosteroid injection, assessed using the Western Ontario and McMaster Universities OA pain scale, with significant change defined using minimally clinically important difference and meaningful within person change. A ML algorithm was developed, utilizing linear discriminant analysis, to predict symptomatic improvement, and examine the association between pain scores and patient factors by calculating the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and F2 score.

Results: A total of 330 patients were included, with a mean age of 63.4 (SD: 8.3). The mean Western Ontario and McMaster Universities OA pain score was 5.2 (SD: 4.1), with only 25.5% of patients achieving significant improvement in pain following corticosteroid injection. The ML model generated an accuracy of 67.8% (95% confidence interval: 64.6%-70.9%), F1 score of 30.8%, and an area under the curve score of 0.60.

Conclusion: The model demonstrated feasibility to assist clinicians with decision-making in patient selection for corticosteroid injections. Further studies are required to improve the model prior to testing in clinical settings.

Background: Data on the use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in individuals with type 2 diabetes mellitus (T2DM) during Ramadan fasting is limited. No meta-analysis has summarized the safety and effectiveness of GLP-1RAs in these situations.

Aim: To evaluate the safety and efficacy of GLP-1RA in patients with T2DM fasting during Ramadan.

Methods: Electronic databases were systematically searched for relevant studies that featured GLP-1RA in the intervention arm and other glucose-lowering medications in the control arm. The primary outcome was adverse events (AEs) during Ramadan for both groups; other outcomes included changes in glycemic and anthropometric measures during the peri-Ramadan period.

Results: Four studies [three randomized-controlled trials with low risk of bias (RoB) and one prospective observational study with serious RoB] involving 754 subjects were analyzed. GLP-1RA group achieved greater glycated hemoglobin reduction than the non-GLP-1RA group [mean difference (MD): -0.31%, 95%CI: -0.61 to -0.01, P = 0.04, I ² = 77%] with a lower risk of documented symptomatic hypoglycemia (risk ratio = 0.38, 95%CI: 0.16 to 0.88, P = 0.02). Any AEs, serious AEs, or AEs that led to treatment discontinuation were comparable between the two groups. The GLP-1RA group experienced greater weight loss compared to the non-GLP-1RA group (MD: -2.0 kg, 95%CI: -3.37 to -0.63, P = 0.004, I ² = 95%). There were comparable changes in blood pressure and lipid profile between the two groups. GLP-1RA users experienced higher risks of gastrointestinal AEs, nausea, and vomiting; however, the risks of heartburn, abdominal pain, and diarrhea were similar in both groups.

Conclusion: Limited evidence suggests that GLP-1RAs are safe for T2DM management during Ramadan, offering modest benefits in blood sugar control and weight loss. Large multicenter trials are needed to confirm their safety and efficacy in at-risk populations, improving clinical practice decision-making.

Portal hypertension (PH) is a major complication of chronic liver disease, often leading to serious clinical consequences such as variceal bleeding, ascites, and splenomegaly. The current gold standard for PH diagnosis, namely, hepatic venous pressure gradient measurement, is invasive and not widely available. Transient elastography has emerged as a non-invasive alternative for assessing liver stiffness (LS), and recent studies have highlighted the potential role of splenic stiffness (SS) in evaluating PH severity. This narrative review summarizes the available evidence on the utility of splenic transient elastography in assessing PH. We evaluated its diagnostic accuracy, technical challenges, and clinical applications, particularly in distinguishing between cirrhotic PH (CPH) and non-cirrhotic PH (NCPH). A comprehensive literature search was conducted using the PubMed database, focusing on studies that assess splenic elastography in the diagnosis and prognosis of PH. This review compares splenic elastography with other non-invasive imaging modalities, including MR elastography and shear-wave elastography. Additionally, we examined the role of SS using elastography in predicting the presence of esophageal varices and its potential impact on reducing the need for endoscopic screening. Studies have demonstrated that splenic elastography correlates well with PH severity, with cut-off values ranging between 45 kPa and 50 kPa for significant PH detection. Splenic elastography, when combined with platelet count and LS measurements, improves diagnostic accuracy and risk stratification for the occurrence of variceal bleeding. Despite its clinical promise, technical challenges such as patient positioning, body habitus, and probe selection remain key limitations. Notably, splenic elastography may be particularly useful in diagnosing NCPH, where LS remains normal but PH is present. Splenic transient elastography is a valuable adjunct in the non-invasive assessment of PH. Its ability to predict varices, differentiate between CPH and NCPH, and reduce unnecessary endoscopies suggests that it should be incorporated into routine hepatology practice. Future research should focus on refining SS cut-offs, evaluating its cost-effectiveness, and integrating splenic elastography into clinical guidelines for PH management.

Background: Advanced materials and techniques are used to successfully manage the apexification of immature teeth with open apices. The use of mineral trioxide aggregate (MTA), bioceramic sealers, and sodium hypochlorite (NaOCl), combined with internal heating and ultrasonic activation, ensures that canals are cleaned, disinfected, and sealed properly. Magnification devices, such as dental operating microscopes (DOM), provide precise visualization for accurate material placement, while the micro apical placement system ensures void-free MTA delivery. This modern approach improves procedural outcomes, lowers iatrogenic errors, and increases long-term success in apexification, making it a dependable and predictable treatment option for immature teeth.

Case summary: Apexification is a regenerative endodontic procedure that involves creating a calcified barrier at the apex of a nonvital tooth with an open apex. This technique is commonly used in immature teeth with necrotic pulps to ensure proper root canal sealing. Traditionally, calcium hydroxide was the preferred material, but advances have introduced bioceramic cements like MTA or Biodentine, which provide superior results with less treatment time. Apexification not only helps to maintain the tooth's structural integrity but also prevents further complications, making it an important procedure in such cases.

Conclusion: This case demonstrates the effectiveness of integrating advanced materials, precise irrigation protocols, and magnification tools in the apexification of immature teeth with open apices. The use of MTA created a stable apical barrier, while bioceramic sealers enhanced the seal and promoted long-term healing. NaOCl with internal heating, ultrasonic activation, and double-sided vented needles ensured thorough irrigation and disinfection, especially in complex canal anatomy.

Background: The Food and Drug Administration has approved percutaneous atrial septal defect (ASD) and patent foramen ovale (PFO) closure devices for hemodynamically significant interatrial shunts, paradoxical emboli including stroke, and decompression sickness. We aimed to study the trends in utilization and reimbursements of transcatheter ASD/PFO closure devices.

Aim: To analyze trends in utilization and Medicare reimbursements for transcatheter ASD/PFO closure procedures from 2013 to 2022.

Methods: A query of administrative data on United States Medicare beneficiaries undergoing transcatheter ASD/PFO was conducted from 2013 to 2022 using the Centers for Medicare and Medicaid Services Part B National Summary Data File. Inflation adjustments were made using the 2023 Consumer Price Index. Trend analysis was quantified using growth rate and simple linear regression calculations. All analyses were performed using Microsoft Excel 16.77.1 (2023).

Results: The annual number of transcatheter ASD/PFO closure procedures increased by 81% since 2013, with an average yearly growth rate of 44% cases per year (P < 0.001). Annual Medicare reimbursements for transcatheter ASD/PFO therapies mirrored the annual procedure trends. The per-case reimbursements decreased by 18%, i.e., $1128.80 in 2013 and $ 770.21 in 2022 (P < 0.001). There was a significant drop in the number of procedures in the year 2020, which correlates to the onset of the coronavirus disease 2019 pandemic, followed by a sharp uptick in the number of cases in 2021 and 2022.

Conclusion: Medicare utilization of transcatheter ASD/PFO closure therapies has grown significantly in procedural volume from 2013 to 2022. However, this has been accompanied by a decrease in per-case reimbursements.

Irisin is a chief myokine released during physical activity and has garnered attention for its potential therapeutic effects on different metabolic and cardiovascular disorders. This review explores the intricate connections between irisin, physical activity, sarcopenia, type 2 diabetes mellitus (T2DM), and cardiovascular complications. Experimental data suggests that through irisin release, physical activity positively influences muscle health, metabolic regulation, and cardiovascular function. In individuals with sarcopenia, characterized by progressive muscle mass and function loss, irisin plays a pivotal role in maintaining muscle integrity and function. Additionally, irisin's beneficial effects on insulin sensitivity and glucose metabolism suggest its involvement in the pathophysiology of T2DM. The review will examine how irisin may modulate the development of cardiovascular complications, particularly in the context of diabetes and aging. Additionally, it will explore its potential as a therapeutic target for managing sarcopenia, T2DM, and cardiovascular complications, underscoring the importance of physical activity in mitigating these interconnected health challenges. Further research is needed to elucidate the precise mechanisms by which irisin mediates these effects and assess its clinical applicability in preventing and treating metabolic and cardiovascular disorders.