Journal of clinical medicine research最新文献

Background: Chronic obstructive pulmonary disease (COPD) and atrial fibrillation (Afib) are frequently comorbid, with COPD patients exhibiting a higher risk of Afib-related hospitalizations. This study investigated the relationship between COPD and Afib, focusing on 30-day readmission rates and outcomes.

Methods: We conducted a retrospective cohort study using the Nationwide Readmissions Database (NRD) from 2016 to 2020. We included adult patients (≥ 18 years) with a primary diagnosis of Afib while excluding those with December discharges to ensure a complete 30-day follow-up. We compared patients with and without COPD, analyzing 30-day readmission rates, length of stay (LOS), hospital costs, in-hospital mortality, and associated factors using multivariable Cox and logistic regression models.

Results: A total of 1,064,982 patients admitted with Afib were included, of which 873,070 had no COPD, and 191,912 had it. COPD patients were older (73.19 vs. 70.82 years), had a shorter LOS (coefficient = -0.05, P = 0.002, 95% confidence interval (CI): -0.08 to -0.02), and had a higher comorbidity burden (Elixhauser comorbidity index: 5.13 vs. 3.43, P < 0.0001). The 30-day readmission rate was significantly higher in the COPD group (16.0% vs. 9.0%, P < 0.001). Logistic regression revealed that COPD increased the odds of readmission (odds ratio: 1.35, 95% CI: 1.32 to 1.39, P < 0.001).

Conclusion: COPD is a significant risk factor for 30-day readmission and in-hospital mortality among Afib patients, underscoring the need for integrated approaches targeting both diseases.

Background: Migraine, vestibular migraine (VM), and tension-type headache (TTH) are commonly associated with dizziness, vertigo, and postural instability, which increases patients' risk of falling and contributes to anxiety and depression. However, the vestibular pathophysiology underlying these primary headache disorders remains unclear. This study aimed to assess the saccular and utricular functions using vestibular evoked myogenic potentials (VEMPs), to investigate the peripheral and central vestibular involvement across these headaches.

Methods: A total of 353 patients diagnosed with migraine, VM, or TTH, based on the International Classification of Headache Disorders, third edition (beta version, ICHD-3β), were recruited from the Dizziness and Headache Clinic at People's Hospital of Weifang between December 2019 and September 2022. All participants underwent standardized clinical assessments and demographic data collection. VEMP tests were performed using 95 dB air-conducted sound stimuli to evaluate peripheral and central vestibular functions prior to enrollment.

Results: Sleep disturbances and psychiatric comorbidities (i.e., anxiety and depression) were significantly more prevalent in TTH patients compared to those with VM and migraine. VM patients also demonstrated higher rates of psychiatric comorbidities than migraine patients. The average headache duration in VM patients was 7.14 years, which was notably longer than the average dizziness duration of 4.03 years. Transient vertigo was reported in 22% of VM patients and 17.65% of TTH patients. The prevalence of occipital and/or neck pain was significantly higher in VM patients than in migraine patients. Absent ocular VEMP (oVEMP) responses, both unilateral and bilateral, were found at a significantly higher rate in VM patients compared to migraine patients. Additionally, cervical VEMP (cVEMP) asymmetry ratios (ARs) were significantly higher in VM patients compared to TTH patients, and marginally higher than in migraine patients (P = 0.05). Prolonged cVEMP latencies (right p13, n23, and interpeak intervals) were observed in both VM and migraine compared to TTH. Left-sided latencies were significantly prolonged in migraine than TTH.

Conclusions: Psychiatric comorbidities were most pronounced in TTH, followed by VM and migraine. Both VM and TTH were associated with transient vertigo, exposing patients to drop-attack risk. The significantly higher occipital and/or neck pain reported in VM than in migraine may suggest the cervical neurovascular involvement in its pathophysiology. VEMP results indicate peripheral vestibular dysfunctions in VM patients and lower brainstem involvement in both VM and migraine patients, with the right-sided abnormalities more severe than the left-sided ones.

Non-peptide gonadotropin-releasing hormone (GnRH) receptor antagonists exhibit remarkable potency and specificity in inhibiting GnRH receptor activity. The orally administered versions of these drugs, notably elagolix and relugolix, have obtained official clearance in various countries for treating moderate-to-severe endometriosis-related pain. Concurrently, linzagolix and opigolix (ASP1707) continue to advance through late-stage clinical trials. The primary objective of this review is to comprehensively evaluate the clinical efficacy and safety profile of oral GnRH antagonists, specifically elagolix, relugolix, linzagolix, and opigolix, for the management of endometriosis-associated pain. Specifically, this study summarizes and analyzes their effectiveness in alleviating dysmenorrhea and non-menstrual pelvic pain, evaluates the dose-dependent impacts on bone mineral density and adverse effects such as hot flushes, and explores the role of add-back therapy in improving treatment safety and patient adherence. Research has demonstrated that oral GnRH antagonists effectively alleviate endometriosis-related pain while enhancing patients' quality of life. Furthermore, when combined with add-back therapy, these medications enhance treatment safety and contribute to greater patient compliance. Compared to alternative hormonal treatments, oral GnRH antagonists emerge as a particularly promising approach for managing endometriosis.

[This retracts the article DOI: 10.14740/jocmr2541e.][This retracts the article DOI: 10.14740/jocmr3470w.][This retracts the article DOI: 10.14740/jocmr2443w.].

Background: Epidemiological studies have reported that hyperuricemia is associated with the development of metabolic syndrome, hypertension, dyslipidemia, type 2 diabetes, and chronic kidney disease (CKD). Renal uric acid (UA) reabsorption is mainly mediated by urate transporter 1 (URAT1) in renal proximal tubule epithelial cells. Recently, URAT1 was found to be expressed in the liver and adipose tissue in addition to the kidney. UA enters such organs via URAT1 and induces inflammation and oxidative stress, which may lead to metabolic disorders. We investigated the effects of long-term treatment with the novel uricosuric drug, a highly selective inhibitor of URAT1, dotinurad, on metabolic parameters and renal function.

Methods: We retrospectively picked up patients who had taken dotinurad for the treatment of asymptomatic hyperuricemia for more than 2 years. We compared metabolic parameters and renal function at baseline with the data at 6, 12, 18, and 24 months after starting dotinurad.

Results: Pharmacologically, dotinurad decreases serum UA, by selectively inhibiting URAT1 and decreasing renal reabsorption of UA, which was supported by our result that dotinurad significantly increased urine UA and reduced serum UA. In addition to UA-lowering, dotinurad was associated with improvements in body weight, liver function, hepatic steatosis index as the marker for metabolic dysfunction-associated steatotic liver disease (MASLD), serum lipids, and albuminuria. The ATP-binding cassette transporter G2 (ABCG2) regulates renal and intestinal excretion of UA and uremic toxins and strongly affects renal function. Our study also indicates that switching from xanthine oxidase inhibitors, which inhibit ABCG2, to dotinurad, which does not inhibit ABCG2, was beneficial for albuminuria and maintaining the estimated glomerular filtration rate.

Conclusion: Dotinurad may improve obesity, MASLD, serum lipids, and CKD by blocking the entry of UA via URAT1 to the adipose tissue, liver, and kidney.

Background: Breast cancer is a leading malignancy among women globally, with chemotherapy as a cornerstone of treatment. However, the side effects and toxicity associated with chemotherapy necessitate the exploration of adjunctive therapies to improve efficacy and reduce adverse effects. Thymoquinone (TQ) has shown potential anti-cancer properties. This systematic review aimed to evaluate the effectiveness of TQ in combination with chemotherapeutic agents in treating breast cancer.

Methods: This study thoroughly reviewed and synthesized existing research following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The selected databases, including PubMed, ProQuest, ScienceDirect, Epistemonikos, and Google Scholar, were searched over the past 10 years. Eligibility criteria were based on the PICOS framework, focusing on experimental studies involving TQ-chemotherapy combinations. Data extraction and quality assessment were performed using SYRCLE and SCIRAP tools. This review included 18 in vitro and six in vivo studies.

Results: Findings revealed that TQ enhances the efficacy of chemotherapeutic agents by inducing apoptosis, enhancing autophagy, inhibiting tumor growth, and regulating cancer cell signaling pathways as well as multiple phases of the cell cycle. Additionally, TQ reduced chemotherapy-related toxicity, such as heart, blood, liver, and kidney damage, and also improved patient tolerance. Nanoparticle-based delivery systems further amplified these synergistic effects.

Conclusions: The TQ-chemotherapy combination shows significant potential as a therapy for breast cancer, enhancing treatment efficacy while mitigating side effects. Future clinical studies are needed to establish its safety and therapeutic applicability.

[This corrects the article DOI: 10.14740/jocmr6126.].

Background: The aim of this study was to evaluate the levels of kinesiophobia and its relationship with functional status, quality of life, pulmonary involvement, depression, and other clinical parameters of the disease in patients with systemic sclerosis (SSc).

Methods: A total of 100 individuals (40 patients with SSc and 60 healthy controls) were included in the study. The Tampa scale was used to assess kinesiophobia. Beck Depression Inventory (BDI) was used to assess depression. Scleroderma Health Assessment Questionnaire (SSc-HAQ) was used to assess functional status. Modified Rodnan skin score was used to assess skin thickness, and high-resolution computed tomography was used to assess lung fibrosis.

Results: The mean Tampa kinesiophobia score was significantly higher in patients with SSc compared to healthy controls. Depressive symptoms were present in 57.5% of patients with SSc. Disease duration, pain, fatigue, disease activity, functional status, pulmonary fibrosis, and depressive symptoms were correlated with kinesiophobia in patients with SSc.

Conclusion: There is an increased prevalence of kinesiophobia in patients with SSc, which seems to be more closely associated with disease duration, pain levels, and depressive symptoms.

Background: When performing clinical trials on lifestyle-related diseases at our hospital, we have sometimes experienced patients who fulfilled the inclusion criteria at the time of receiving an explanation of the trial but who no longer met the criteria when they arrived to provide their consent to participate 1 month later. In some of these cases, we noticed that the patient's lifestyle subsequently improved. Therefore, we hypothesized that receiving information on clinical trials may affect lifestyle-related diseases.

Methods: We enrolled patients aged 85 years or younger who received information on a double-blind randomized clinical trial on treatment-resistant hypertension (R-HT) or one on diabetic nephropathy. In these patients, we evaluated whether the trial information affected a range of variables. In addition, we compared the rate of change in variables between two groups, i.e., patients who became ineligible to participate and were not randomized (early dropouts) and patients who decided to participate and were randomized (patients randomized to treatment). We also conducted a questionnaire on changes in patients' motivation level, health awareness and behavior, and expectations and concerns and evaluated changes from before to after receiving an explanation of the trial.

Results: Seven patients who received an explanation of the R-HT trial and 14 who received an explanation of the diabetic nephropathy trial participated in the present study. The only significant change in any variable was in the R-HT clinical trial, where systolic and diastolic blood pressure significantly decreased in the early dropout group. There were no significant differences between the two groups in the rate of change in variables. After receiving information about one of the studies, patients who became more proactive or involved in changing their health-related behavior, such as their exercise, eating, and drinking habits, increased in both groups.

Conclusions: Receiving information on a clinical trial on hypertension can significantly affect blood pressure. Future research should examine whether providing information on clinical trials on other lifestyle-related diseases motivates patients to improve their lifestyles.

Background: Diabetes mellitus places a significant burden on society in terms of healthcare expenditures and poor health outcomes and complications. Heart failure is one of its complications which increases morbidity and mortality for patients with diabetes. The purpose of this study was to assess the prevalence of left ventricular diastolic dysfunction (LVDD) and its predictors among Saudi patients with type 2 diabetes mellitus (T2DM).

Methods: This retrospective cross-sectional study was conducted between May 2021 and May 2022 at King Saud University Medical City in Riyadh, Saudi Arabia. Medical records of adult patients with T2DM without prior cardiovascular disease who underwent echocardiographic examination were reviewed, and data were extracted. Echocardiographic findings were reviewed for the diagnosis of LVDD.

Results: A total of 251 participants were included in the study. LVDD was diagnosed in 66.9% of the participants. The majority (89.9%) had grade I. The mean age was 59 ± 9.1 years and the mean diabetes duration was 20 ± 8.5 years. Of the patients, 76.9% had hypertension and 81.2% had dyslipidemia. The mean body mass index was 32.9 ± 6.6 kg/m² and the mean glycated hemoglobin level was 7.7±2.3%. LVDD correlated with older age, longer duration of diabetes, obesity, poor glycemic control, higher systolic blood pressure, the presence of hypertension, and the usage of antihypertensive and lipid-lowering medications. In logistic regression analysis, older age and higher body mass index were the only independent risk factors of LVDD.

Conclusion: The prevalence of LVDD among Saudi patients with T2DM was high. It was associated significantly with age and obesity. These findings highlight the need for early monitoring, and treatment to prevent its progression and reduce morbidity and mortality.