World journal of methodology最新文献

Background: Historically intraoperative drains were employed after pancreatic surgery but over the last decade, there has been debate over the routine usage of drains.

Aim: To assess the necessity of intra-abdominal drain placement, identify the most effective drain type, and determine the optimal timing for drain removal.

Methods: A systematic review of electronic databases, including PubMed, MEDLINE, PubMed Central, and Google Scholar, was conducted using Medical Subject Headings and keywords until December 2023. From an initial pool of 1910 articles, 48 were included after exclusion and screening. The primary outcomes analyzed were clinically relevant postoperative pancreatic fistula (CR-POPF), delayed gastric emptying (DGE), overall morbidity, and mortality. Subgroup analyses were performed for pancreaticoduodenectomy and distal pancreatectomy.

Results: Routine use of drains is associated with a statistically significant increase in the risk of CR-POPF and DGE. Conversely, patients who did not have drains placed experienced a significant reduction in morbidity, readmission rates, and reoperations. No significant differences were observed between active and passive drain types. Early drain removal (< 3 days) yielded favorable outcomes compared to delayed removal.

Conclusion: Analysis of randomized controlled trials and cohort studies did not demonstrate an advantage of routine drain placement following pancreatic resection, potentially contributing to increased morbidity and mortality. The decision to use drains should be left to the discretion of the operating surgeon. However, early drain removal can substantially reduce morbidity.

Recurrent aphthous stomatitis (RAS) is a very frequent condition in developed countries whose basic symptom is a lesion referred to as an aphthous ulcer. High levels of interleukin (IL)-1 and IL-6 and low salivary levels of IL-10 are the basis of RAS pathogenesis. Sublingual supplements based on IL-10 can be very useful in reducing the phenomenon of aphthous recurrence in patients with RAS. An observational clinical experience with a group of 5 patients with RAS receiving a commercially available IL-10-based supplement was reported by the authors. The findings revealed a subsequent reduction in the incidence of mouth ulcers.

Background: Severe dengue children with critical complications have been attributed to high mortality rates, varying from approximately 1% to over 20%. To date, there is a lack of data on machine-learning-based algorithms for predicting the risk of in-hospital mortality in children with dengue shock syndrome (DSS).

Aim: To develop machine-learning models to estimate the risk of death in hospitalized children with DSS.

Methods: This single-center retrospective study was conducted at tertiary Children's Hospital No. 2 in Viet Nam, between 2013 and 2022. The primary outcome was the in-hospital mortality rate in children with DSS admitted to the pediatric intensive care unit (PICU). Nine significant features were predetermined for further analysis using machine learning models. An oversampling method was used to enhance the model performance. Supervised models, including logistic regression, Naïve Bayes, Random Forest (RF), K-nearest neighbors, Decision Tree and Extreme Gradient Boosting (XGBoost), were employed to develop predictive models. The Shapley Additive Explanation was used to determine the degree of contribution of the features.

Results: In total, 1278 PICU-admitted children with complete data were included in the analysis. The median patient age was 8.1 years (interquartile range: 5.4-10.7). Thirty-nine patients (3%) died. The RF and XGboost models demonstrated the highest performance. The Shapley Addictive Explanations model revealed that the most important predictive features included younger age, female patients, presence of underlying diseases, severe transaminitis, severe bleeding, low platelet counts requiring platelet transfusion, elevated levels of international normalized ratio, blood lactate and serum creatinine, large volume of resuscitation fluid and a high vasoactive inotropic score (> 30).

Conclusion: We developed robust machine learning-based models to estimate the risk of death in hospitalized children with DSS. The study findings are applicable to the design of management schemes to enhance survival outcomes of patients with DSS.

Pulmonary arterial hypertension (PAH) is a progressive disease marked by degeneration of the lung's blood vessels. As the disease progresses, the resistance to blood flow in the pulmonary arteries increases, putting a strain on the right side of the heart as it pumps blood through the lungs. PAH is characterized by changes in the structure of blood vessels and excessive cell growth. Untreated PAH leads to irreversible right-sided heart failure, often despite medical intervention. Patients experience a gradual decline in function until they are unable to perform daily activities. Advances in treatment have improved the prognosis for many PAH patients. Currently approved therapies target the prostacyclin, endothelin, nitric oxide, or phosphodiesterase pathways to slow the progression of the disease. To address the unmet need for effective PAH therapies, research efforts are focused on identifying new targets and developing therapies that specifically address the underlying disease mechanisms and restore vascular wall homeostasis. Among these, sotatercept, a fusion protein that targets the transforming growth factor-β superfamily signaling pathway, has emerged as a promising therapeutic option. In this review, we examine the available evidence from clinical trials to assess the potential of sotatercept as a treatment for PAH.

Background: Systematic reviews (SRs) synthesize and evaluate data, mainly from randomized trials, which then guides the development of clinical recommendations in evidence-based medicine. However, the data and methodological information in the included papers can often be lacking or unclear, and reviewers usually need to contact the authors of included studies for clarifications. Contacting authors is recommended, but it is unclear how often SR teams do it, or what the level of response is.

Aim: To investigate how often reviewers undertake contact with the authors of included randomized controlled trials (RCTs) for clarification on data and risk of bias concerns, to explore the factors that influence whether SR authors contact or do not contact the authors, and the content and level of responses.

Methods: We conducted a systematic electronic database search in MEDLINE using the search string "(systematic review)" AND "(RCT OR randomized OR trial)" for articles published between 1 January 2024 and 19 February 2024, without language restrictions. Screening and data extraction was done independently by two reviewers, and conflicts resolved by a senior author. Contact authors of included SRs were contacted for clarifications.

Results: Of the 329 included SRs, 38% (n = 125) explicitly mentioned contact with the authors of included studies. The remaining 62% (n = 204) did not. We attempted contact with all SR teams for clarifications and received 90 responses (19.4%). Of the 50 respondents who did not explicitly mention contact in their SRs, 25 (50%) replied that they did make contact. We received a total of 64 responses on the level and content of information sought. The mean ± SD contacts SR teams made were 10 (10), replies received 5 (6.7), and response waiting time 10.1 (28.3) weeks. Resources, time, poor previous experience, perceived likelihood of poor response and bias concerns were reported as barriers to attempting contact.

Conclusion: The majority of SRs published in 2024 did not confirm seeking clarifying or missing information from primary study authors. However, SR teams reported that 50% of contacted primary authors respond. Additional research can clarify this rate of response and establish methods to increase the integration of this core methodological element in SRs.

Background: Cardiopulmonary bypass (CPB) is a life-support technology widely used in surgery. Review articles reflect research advances in a certain topic or field within a certain period of time.

Aim: To perform a bibliometric analysis of the review articles that focused on CPB for cardiovascular surgery.

Methods: This study was based on a bibliometric analysis. Data were acquired from the Web of Science and basic bibliometric parameters were analyzed and visualized using VOSviewer and Excel.

Results: We identified 141 review articles on CPB. Generally, the number of publications increased, and most of them were published in the 2010s (n = 57, 40.4%) and the 2020s (n = 45, 31.9%). There were 113 (80.1%) narrative review articles, 21 (14.9%) meta-analysis studies and 7 (5.0%) systematic review papers. The United States (n = 25, 17.7%) and China (n = 21, 14.9%) were the leading countries in terms of publication number. The articles were published in 98 different journals. The Journal of Cardiothoracic and Vascular Anesthesia (n = 14, 10.0%) and Perfusion-United Kingdom (n = 11, 7.8%) were preferred by the authors. The high-frequency keywords included inflammatory response, children, acute kidney injury, meta-analysis and off-pump, except for CPB and cardiac surgery. Inflammatory response had the closest relationship with CPB during cardiac surgery. The complications of CPB, including inflammatory response, kidney injury and ischemia, caught lots of concern.

Conclusion: The rapid increase of review papers shows that the research on CPB in cardiac surgery is increasingly being emphasized by scholars and clinical staff worldwide. Meta-analysis has been widely conducted to analyze clinical controversies and further guide clinical practice. Strategies to improving the outcomes of patients undergoing cardiac surgery with CPB are the hot spots in this field.

The critical role of patient-reported outcome measures (PROMs) in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific research. PROMs encapsulate a patient's health status directly from their perspective, encompassing various domains such as symptom severity, functional status, and overall quality of life. By integrating PROMs into routine clinical practice and research, healthcare providers can achieve a more nuanced understanding of patient experiences and tailor treatments accordingly. The deployment of PROMs supports dynamic patient-provider interactions, fostering better patient engagement and adherence to treatment plans. Moreover, PROMs are pivotal in clinical settings for monitoring disease progression and treatment efficacy, particularly in chronic and mental health conditions. However, challenges in implementing PROMs include data collection and management, integration into existing health systems, and acceptance by patients and providers. Overcoming these barriers necessitates technological advancements, policy development, and continuous education to enhance the acceptability and effectiveness of PROMs. The paper concludes with recommendations for future research and policy-making aimed at optimizing the use and impact of PROMs across healthcare settings.

Background: Non-ST segment elevation myocardial infarction (NSTEMI) poses significant challenges in clinical management due to its diverse outcomes. Understanding the prognostic role of hematological parameters and derived ratios in NSTEMI patients could aid in risk stratification and improve patient care.

Aim: To evaluate the predictive value of hemogram-derived ratios for major adverse cardiovascular events (MACE) in NSTEMI patients, potentially improving clinical outcomes.

Methods: A prospective, observational cohort study was conducted in 2021 at the Internal Medicine Clinic of the University Hospital in Tuzla, Bosnia and Herzegovina. The study included 170 patients with NSTEMI, who were divided into a group with MACE and a control group without MACE. Furthermore, the MACE group was subdivided into lethal and non-lethal groups for prognostic analysis. Alongside hematological parameters, an additional 13 hematological-derived ratios (HDRs) were monitored, and their prognostic role was investigated.

Results: Hematological parameters did not significantly differ between non-ST segment elevation myocardial infarction (NSTEMI) patients with MACE and a control group at T1 and T2. However, significant disparities emerged in HDRs among NSTEMI patients with lethal and non-lethal outcomes post-MACE. Notably, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were elevated in lethal outcomes. Furthermore, C-reactive protein-to-lymphocyte ratio (CRP/Ly) at T1 (> 4.737) demonstrated predictive value [odds ratio (OR): 3.690, P = 0.024]. Both NLR at T1 (> 4.076) and T2 (> 4.667) emerged as significant predictors, with NLR at T2 exhibiting the highest diagnostic performance, as indicated by an area under the curve of 0.811 (95%CI: 0.727-0.859) and OR of 4.915 (95%CI: 1.917-12.602, P = 0.001), emphasizing its important role as a prognostic marker.

Conclusion: This study highlights the significant prognostic value of hemogram-derived indexes in predicting MACE among NSTEMI patients. During follow-up, NLR, PLR, and CRP/Ly offer important insights into the inflammatory processes underlying cardiovascular events.

We hereby comment on the interesting systematic review by Grewal et al where they have provided an overall picture of the current status of available tele-health programs in the United States with emphasis on the Amazon Clinic. Their analysis is an appreciable effort in discovering the features available and features lacking in these tele-health programs. The concept of tele-health originated to curtail the need for physical attendance of patients at health clinics, and has been beneficial during the coronavirus disease 2019 pandemic. We implore that the pearls and pitfalls of these programs have to be understood by policymakers prior to forming a consensus regarding the availability, accessibility and affordability of these programs as methods of healthcare delivery. Unrestricted proliferation of tele-health programs in their current form may pose threats to patient and provider safety and medicolegal liability. However, patients and providers must work together to improve them to meet their expectations and enable them to provide the best care for the ailing public.

Inflammatory bowel disease (IBD) is a chronic inflammatory illness of the intestine. While the mechanism underlying the pathogenesis of IBD is not fully understood, it is believed that a complex combination of host immunological response, environmental exposure, particularly the gut microbiota, and genetic susceptibility represents the major determinants. The gut virome is a group of viruses found in great frequency in the gastrointestinal tract of humans. The gut virome varies greatly among individuals and is influenced by factors including lifestyle, diet, health and disease conditions, geography, and urbanization. The majority of research has focused on the significance of gut bacteria in the progression of IBD, although viral populations represent an important component of the microbiome. We conducted this review to highlight the viral communities in the gut and their expected roles in the etiopathogenesis of IBD regarding published research to date.