International Journal of Clinical Practice最新文献

{"title":"Tryptophan Metabolism-Related Transcriptional Programs and Enterocyte-Associated Epithelial Heterogeneity in Gastric Intestinal Metaplasia","authors":"Shanglin You,&nbsp;Rui Yu,&nbsp;Ziting Mo,&nbsp;Jingdong Xiao,&nbsp;Yan Li","doi":"10.1155/ijcp/2106936","DOIUrl":"https://doi.org/10.1155/ijcp/2106936","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Gastric intestinal metaplasia (IM) is a precancerous lesion associated with chronic inflammation, but the cellular distribution of tryptophan metabolism-related transcriptional changes remains incompletely defined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We integrated bulk RNA-sequencing data from GSE191275 (10 IM and 10 nonatrophic gastritis [NAG] samples) with single-cell RNA-sequencing data from a nine-biopsy subset of GSE134520 (six IM and three NAG biopsies; 16,908 cells after quality control). Random forest and K-nearest neighbors were used only for supportive feature prioritization, and candidate expression was evaluated in GSE78523.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>HAAO, MAOA, ACMSD, and DDC formed the intersection of the two primary top-five rankings. In nonprogressing IM versus healthy gastric mucosa, MAOA and DDC, but not HAAO or ACMSD, remained significant after Benjamini–Hochberg correction across the four prespecified genes. None of the four genes differed significantly between progressing and nonprogressing IM. Single-cell analysis localized candidate-gene expression mainly to a KRT20/CDH17/FABP1-supported, marker-defined enterocyte compartment. Because this compartment contained not only 4197 IM cells but only six NAG cells, enterocyte subclustering and pseudotime primarily described within-IM heterogeneity. Sample-level immune-cell analyses yielded no differences after false-discovery-rate correction. In a biopsy-aware CellChatDB-guided comparison restricted to five adequately represented cell classes, none of the 290 pathways or 3233 ligand–receptor interactions remained significant after correction; enterocytes were excluded from that comparison because the three NAG biopsies contained only one, two, and three enterocytes. MAOA virtual network perturbation was interpreted as hypothesis-generating.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These findings provide candidate genes with partial external expression support and marker-defined epithelial states for spatial, metabolic, and functional follow-up. They are hypothesis-generating and do not establish causality, progression risk, therapeutic utility, or relevance to immunotherapy-related inflammatory complications; these possibilities require direct evaluation in independent, treatment-exposed cohorts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2026 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ijcp/2106936","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149146524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Angiogenesis-Related Scoring System Identifies an Immune-Inflamed Phenotype and Characterizes the Tumor Immune Microenvironment in Esophageal Squamous Cell Carcinoma","authors":"Yusheng Li,&nbsp;Lei Xu,&nbsp;Chuntong Yin,&nbsp;Fan Wang","doi":"10.1155/ijcp/1390370","DOIUrl":"https://doi.org/10.1155/ijcp/1390370","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Tumor angiogenesis intricately modulates the tumor immune microenvironment (TIME), but whether angiogenesis-related transcriptional features can stratify prognosis and immune phenotypes in esophageal squamous cell carcinoma (ESCC) remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Transcriptomic and clinical data were obtained from public databases. An angiogenesis-related scoring system (ARSys) was constructed using univariate Cox regression and least absolute shrinkage and selection operator (LASSO) and then validated in an independent cohort. Prognostic performance was assessed via Cox regression and receiver operating characteristic (ROC) analysis. TIME characterization employed TIMER, ssGSEA, and ESTIMATE; pathway analyses used gene set variation analysis (GSVA), gene set enrichment analysis (GSEA), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Gene Ontology (GO). Key genes were screened by LASSO and support vector machine-recursive feature elimination (SVM-RFE). <i>TNFSF10</i> expression was further validated by immunohistochemistry, Western blot, and RT-qPCR in clinical samples.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>ARSys independently predicted prognosis and stratified patients into two distinct immunophenotypes. The high-risk subgroup exhibited a markedly “immune-inflamed” phenotype, characterized by elevated infiltration of effector T cells, heightened expression of multiple immune checkpoints, and significant enrichment of inflammatory pathways (complement cascade, antigen processing, and T-cell receptor signaling). <i>TNFSF10</i>, a key ARSys gene with the highest weighting, was significantly upregulated in ESCC tissues at the protein and mRNA levels. This immuno-inflammatory signature indicates that ARSys^high tumors display an immune-inflamed phenotype; however, the present datasets do not permit inference regarding ICI response or irAE risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ARSys provides prognostic stratification and characterization of tumor immunophenotypes in ESCC. <i>TNFSF10</i> emerges as a promising biomarker associated with unfavorable prognosis in ESCC. The potential relevance of ARSys to immunotherapy response or toxicity requires validation in dedicated ICI-treated cohorts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2026 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ijcp/1390370","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149146497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploratory IHC-Anchored Deep Learning Analysis of HE-Stained Images for Distinguishing Dual-Phenotype Hepatocellular Carcinoma","authors":"Dan-Dan Xiong,&nbsp;Rong-Quan He,&nbsp;Da-Zhi Li,&nbsp;Zhen-Ling Tang,&nbsp;Yu-Yan Pang,&nbsp;Wei-Jia Mo,&nbsp;Gang Chen","doi":"10.1155/ijcp/8363795","DOIUrl":"https://doi.org/10.1155/ijcp/8363795","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Purpose&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Dual-phenotype hepatocellular carcinoma (DPHCC) closely resembles non-DPHCC (nDPHCC) on routine hematoxylin–eosin (HE)–stained sections, but it is associated with more aggressive clinicopathological features and is currently diagnosed mainly by immunohistochemistry (IHC). This exploratory study aimed to investigate whether deep learning (DL) models could distinguish HE image patches corresponding to IHC-confirmed dual-phenotype tumor regions from nDPHCC patches and to compare the performance of multiple neural network architectures in this IHC-anchored patch-level classification task.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Pathological HE sections, matched immunohistochemical data, and related clinicopathological data from patients diagnosed with nDPHCC and DPHCC following surgery were retrospectively collected. Differences between the two groups in various clinicopathological parameters were compared. HE-stained slides were scanned as WSIs, and DPHCC patches were extracted from HE regions corresponding to IHC-confirmed dual-phenotype tumor components. The image patch dataset was randomly split at the patch level into training and validation subsets (7:3), and six DL models were developed and evaluated: ResNet50, MobileNetV3 Large, VGG19, InceptionResNetV2, InceptionV3, and Swin Transformer.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Compared with nDPHCC, DPHCC showed more aggressive clinicopathological features, including younger age, poorer differentiation, higher frequency of microvascular invasion, more advanced stage, and higher AFP levels. In the patch-level validation subset, ResNet50 achieved the highest overall AUC (0.9615) and accuracy (0.8954), closely followed by MobileNetV3 Large (AUC 0.9614, accuracy 0.8936). VGG19 showed the highest sensitivity for DPHCC (0.9307), indicating fewer false-negative predictions, while Swin Transformer showed lower patch-level performance (AUC 0.9064). Other CNN models achieved intermediate results, with AUC values above 0.927.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;These findings suggest that HE patches from IHC-confirmed DPHCC regions may contain learnable morphological information detectable by DL models. However, because validation was performed using a patch-level split, the reported performance may overestimate performance in independent patient cohorts and should not be interpreted as patient-level diagnostic performance. Multicenter validation, patient-level splitting, and WSI-level evaluation are required before clinical application.&lt;/p&gt;\u0000 ","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2026 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ijcp/8363795","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149146523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Cardiac Troponin I Elevation in Inpatients With Rhabdomyolysis Based on a Multicenter Retrospective Cohort Study","authors":"Zigan Xu,&nbsp;Tingting Shen,&nbsp;Caixing Liang,&nbsp;Jinlian Shi,&nbsp;Shuangjun Cao,&nbsp;Qingxian Li,&nbsp;Shanshan Wang,&nbsp;Dongna Li,&nbsp;Shuyuan Zhang,&nbsp;Xing Wei,&nbsp;Lijun Zhao,&nbsp;Jing Hu,&nbsp;Jingying Zhu,&nbsp;Lianghong Yin,&nbsp;Shaodong Luan","doi":"10.1155/ijcp/7105799","DOIUrl":"https://doi.org/10.1155/ijcp/7105799","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This multicenter retrospective cohort study aimed to investigate the prevalence of cardiac troponin I (cTnI) elevation among hospitalized patients with rhabdomyolysis (RM) in China and to identify associated influencing factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 214 inpatients with RM who were admitted to the hospital between January 2015 and December 2024 were enrolled. Based on their cTnI test results, patients were divided into cTnI-positive and cTnI-negative groups. Age, sex, body mass index (BMI), and other clinical indicators were compared between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 214 patients, 29 had positive cTnI results, corresponding to a positive rate of 13.55%. Univariate analysis showed that age, creatine kinase (CK) level, and the proportion of patients receiving dialysis were significantly higher in the cTnI-positive group than in the cTnI-negative group. In contrast, the proportions of patients with normal electrocardiograms and those with causes such as intense exercise or crayfish consumption were significantly lower in the cTnI-positive group (<i>p</i> &lt; 0.05). No significant differences were observed between the groups in sex, BMI, hypertension, smoking, diabetes, or other variables (<i>p</i> &gt; 0.05). Multivariate logistic regression analysis demonstrated that dialysis treatment and abnormal electrocardiogram were independent risk factors for cTnI positivity (<i>p</i> &lt; 0.05), whereas advanced age, elevated CK levels, and vigorous exercise were not statistically significant independent influencing factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>cTnI elevation is relatively common among hospitalized patients with RM. The underlying mechanism is complex and may be associated with dialysis treatment, abnormal electrocardiogram findings and other factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2026 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ijcp/7105799","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149146522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Antibiotic Use and Patient Outcomes After Pharmacist-Led Antimicrobial Stewardship Interventions at Nigist Eleni Mohammed Memorial Referral Hospital, Southern Ethiopia: A Quasi-Experimental Pre–Post Study","authors":"Mengistu Girma Tirore,&nbsp;Atalay Mulu Fentie,&nbsp;Zenebe Negash,&nbsp;Aschalewu Tsegaye Seyoum,&nbsp;Aster Bankifisa Yirga,&nbsp;Melaku Tesfaye Woldemariam,&nbsp;Bruke Berhanu Billoro","doi":"10.1155/ijcp/1924353","DOIUrl":"https://doi.org/10.1155/ijcp/1924353","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Antimicrobial resistance is a major global public health threat, particularly in developing countries. Antimicrobial stewardship, particularly pharmacist-led stewardship, can play a vital role in combating antimicrobial resistance, and there are limited data on its impact in low-resource healthcare settings. This study aimed to assess the effect of pharmacist-led antimicrobial stewardship (AMS) on antimicrobial use and patient outcomes in Nigist Eleni Mohammed Memorial Referral Hospital (NEMMRH), Southern Ethiopia.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Method&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A prospective quasi-experimental pre–post study was conducted from March 2023 to February 2024. In the pre-intervention phase, pharmacists audited antibiotic use without feedback, while during the intervention phase, pharmacists audited and provided feedback to the treating team (verbal and written). Our primary outcome variable was antimicrobial use, measured by duration of therapy and days of therapy per 1000 patient days. Secondary outcomes were length of hospital stay and in-hospital mortality. The two groups (preintervention and postintervention) were compared using Fisher’s exact or &lt;i&gt;χ&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; tests for categorical variables, and an independent &lt;i&gt;t&lt;/i&gt;-test for continuous variables. Statistical significance was declared at &lt;i&gt;p&lt;/i&gt; value &lt; 0.05.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;After the intervention period, a total of 128 (44.4%) patients’ cases involving antibiotic prescriptions requiring intervention were identified and intervened by the AMS team. Of these, 71 (24.7%) were recommended to discontinue, while 42 (14.6%) were advised to change the antibiotics. The most commonly prescribed antibiotics before and after the intervention phase were ceftriaxone 211 (73.3%) versus 175 (60.8%) and vancomycin 161 (55.9%) versus 91 (31.6%). Average duration of antibiotic treatment decreased significantly, from 10.02 ± 3.30 before intervention to 6.29 ± 2.58 during the intervention period (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). Additionally, the days of therapy/1000 patient days declined from 660 ± 139.2 to 539 ± 114.6 (&lt;i&gt;p&lt;/i&gt; = 0.01). The length of hospital stay was reduced from 14.17 ± 6.92 days in preintervention phase to 9.06 ± 3.97 days in the postintervention phase (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). Furthermore, all-cause mortality decreased from 10.4% to 6.9%, although the difference was not statistically significant.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The findings indicated that pharmacist-facilitated AMS interventions were associated with lower inap","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2026 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ijcp/1924353","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149146498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distinct Fluid Balance Trajectories in ICU Patients With Acute Ischaemic Stroke: Persistent Positive Balance Associated With Increased Mortality","authors":"Mingzhu Huang,&nbsp;Jinfeng Miao,&nbsp;Ruihan Zhu,&nbsp;Yuanxiao Li,&nbsp;Shujuan Gan,&nbsp;Jintao Chen,&nbsp;Jianhua Guan,&nbsp;Bingbo Zhuang,&nbsp;Hanrong Dong,&nbsp;Zhiting Chen,&nbsp;Min Zhang,&nbsp;Yanmin Wu,&nbsp;Wenhuo Chen,&nbsp;Tingyu Yi","doi":"10.1155/ijcp/1893384","DOIUrl":"https://doi.org/10.1155/ijcp/1893384","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although fluid management is fundamental to acute stroke care, evidence-based protocols tailored to the distinct haemodynamic requirements of stroke patients are lacking. We investigated longitudinal fluid-balance trajectory patterns among patients with acute ischaemic stroke (AIS) admitted to the intensive care unit (ICU) and their association with mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study analysed 834 AIS patients from the MIMIC-IV database. Longitudinal k-means clustering identified fluid-management trajectories from weight-standardised daily fluid input, output and balance (mL/kg/day) over the first seven ICU days. The primary outcome was 90-day mortality; secondary outcomes were 28-day and in-ICU mortality, ICU length of stay and survival time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three trajectories emerged: Trajectory 1 (<i>n</i> = 451, 54.1%) showed low input with medium output and progressively negative balance (median −16.57 mL/day); Trajectory 2 (<i>n</i> = 188, 22.5%) showed medium input with low output and persistent positive balance (median +974.24 mL/day); Trajectory 3 (<i>n</i> = 195, 23.4%) showed high input with high output and an initial positive balance that crossed over to negative balance after the third ICU day. Compared with Trajectory 1, Trajectory 2 was associated with significantly increased mortality (in-ICU OR = 1.85, 95% CI 1.10–3.11; 28-day OR = 1.59, 95% CI 1.08–2.32; and 90-day OR = 1.53, 95% CI 1.07–2.19). Stratified analyses revealed significant associations specifically in patients aged ≥ 60 years (OR = 1.51, 95% CI 1.02–2.23) and in male patients (OR = 1.85, 95% CI 1.09–3.12).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Persistent positive fluid balance was independently associated with increased mortality in ICU patients with AIS, particularly elderly and male patients. Avoiding sustained positive balance may be more important than achieving any specific fluid target; prospective validation is warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2026 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ijcp/1893384","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149146760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct Traction Combined With Electrified Snare: A Clinical Study on the Removal of Retained Metallic Clips After Gastric Endoscopic Resection (ER)","authors":"Bing Bai,&nbsp;Long Xu,&nbsp;Dengpan Dai,&nbsp;Bingxi Zhou,&nbsp;Xiuqi Wang,&nbsp;Shengli Kuang","doi":"10.1155/ijcp/2659422","DOIUrl":"https://doi.org/10.1155/ijcp/2659422","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to investigate the efficacy and safety of direct traction combined with electrified snare for the removal of retained metallic clips after gastric endoscopic resection (ER) and to provide a reliable clinical protocol for minimizing complication risks and enhancing postoperative recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted on 48 patients with retained metallic clips after gastric ER, admitted between January 2022 and December 2024. The clip retention duration ranged from 3 to 12 months. Removal was attempted by direct traction first; an electrocautery-assisted snare was used as a rescue when traction failed. All patients were followed up for 3 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 62 retained clips, 60 (96.8%) were successfully retrieved endoscopically—40 (64.5%) by traction alone and 20 (32.3%) with electrocautery assistance—giving a 100% (48/48) successful-procedure rate, with a procedure time of 2–10 min. Two clips (3.2%) in two patients were left in situ because they were deeply embedded with a high perceived bleeding risk. Minor oozing occurred in 3 patients (6.3%) and was managed endoscopically; no perforation occurred. At 3 months, presenting symptoms had resolved in the symptomatic patients, and wounds were healed endoscopically.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The combination of direct traction and an electrified snare is a safe and effective approach for the management of retained metallic clips after gastric ER. This technique appears feasible and safe for clip retrieval in this preliminary, single-center series; comparative studies are warranted before broader clinical application can be advocated. Further studies are warranted to evaluate its long-term efficacy and safety.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2026 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ijcp/2659422","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149048587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between PACU Workload Periods and Prolonged PACU Stay: A Retrospective Cohort Study","authors":"Qianwei Sun,&nbsp;Anyan Xu,&nbsp;Sijia Mi,&nbsp;Yuanyuan Ji,&nbsp;Feifei Dong,&nbsp;Qi Kong,&nbsp;Jiao Wu","doi":"10.1155/ijcp/8000830","DOIUrl":"https://doi.org/10.1155/ijcp/8000830","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The association between PACU workload periods and prolonged PACU stay remains unclear. This study evaluated the association between different workload periods and prolonged PACU stay after elective surgery under general anesthesia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study included 16,327 elective surgical patients between February and September 2024. PACU workload periods were categorized into low-activity, routine-activity, subpeak-activity, and peak-activity periods. Prolonged PACU stay was defined as a stay exceeding 2 h. Multivariable logistic regression analysis was performed to identify factors associated with prolonged PACU stay.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The overall incidence of prolonged PACU stay was 4.18%. Compared with the low-activity period, routine-activity (aOR = 2.59, 95% CI: 1.73–3.98), subpeak-activity (aOR = 1.75, 95% CI: 1.20–2.65), and peak-activity periods (aOR = 1.83, 95% CI: 1.27–2.72) were independently associated with prolonged PACU stay (all <i>p</i> &lt; 0.01). Advanced age, comorbidities, surgical complexity, longer operation duration, and greater intraoperative fluid administration were also associated with prolonged PACU stay.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Higher PACU workload periods were independently associated with prolonged PACU stay after general anesthesia. These findings support workload-based optimization of perioperative resource allocation and patient transfer workflow.</p>\u0000 \u0000 <p><b>Trial Registration:</b> Chinese Registry of Clinical Trials: ChiCTR2500112022</p>\u0000 </section>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2026 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ijcp/8000830","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149048286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence–Guided Clinical Decision Support for Immunotherapy in Advanced Hepatocellular Carcinoma: From Benefit–Risk Stratification to Adaptive Management","authors":"Tian Liang,&nbsp;Anchun Mo","doi":"10.1155/ijcp/4610497","DOIUrl":"https://doi.org/10.1155/ijcp/4610497","url":null,"abstract":"<p>Immune checkpoint inhibitor–based regimens have become central to the systemic management of advanced hepatocellular carcinoma (HCC). Nevertheless, substantial heterogeneity persists in treatment efficacy, duration of response, toxicity, and preservation of liver function. Conventional biomarkers, including programmed death-ligand 1 expression, tumor mutational burden, and alpha-fetoprotein, have limited capacity to reflect the biological, spatial, and temporal complexity of HCC. Artificial intelligence (AI) offers a clinically relevant framework for integrating routinely available clinical variables, laboratory measurements, cross-sectional imaging, digital pathology, circulating biomarkers, and longitudinal treatment data. Current evidence indicates that radiomics and machine learning models may improve pretreatment risk stratification and response prediction, whereas longitudinal imaging analysis may facilitate earlier identification of treatment failure. Digital pathology and blood-based biomarkers may further refine the characterization of immune-inflamed, immune-excluded, and immunosuppressive phenotypes. However, most available models remain retrospective and prognostic rather than genuinely treatment-predictive. This review summarizes the current clinical applications of AI in advanced HCC immunotherapy, with emphasis on pretreatment benefit–risk assessment, early response evaluation, treatment adaptation, resistance detection, toxicity monitoring, and the requirements for prospective clinical implementation.</p>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2026 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ijcp/4610497","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149048373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnancy-Related Anxiety in Women With Systemic Lupus Erythematosus and Takayasu Arteritis in the Preconception Period: A Cross-Sectional Survey","authors":"Andac Komac,&nbsp;Tuba Demirci Yildirim,&nbsp;Ozlem Ozdemir Isik,&nbsp;Ayten Yazici,&nbsp;Fatos Onen,&nbsp;Ayse Cefle","doi":"10.1155/ijcp/6632986","DOIUrl":"https://doi.org/10.1155/ijcp/6632986","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Systemic lupus erythematosus (SLE) and Takayasu arteritis (TAK) predominantly affect women of reproductive age. This study aimed to evaluate pregnancy-related anxiety (PRA), disease-specific pregnancy concerns, and perceptions regarding the relationship between rheumatic disease and pregnancy in women with SLE and TAK.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Women of reproductive age with SLE or TAK were enrolled. Disease activity and damage indices, the Hospital Anxiety and Depression Scale (HADS), and the Pregnancy-Related Anxiety Questionnaire–Revised 2 (PRAQ-R2) were administered. A structured questionnaire was used to assess pregnancy intentions and disease-specific pregnancy perceptions. Exploratory Spearman correlation analyses with false discovery rate correction were performed to evaluate associations between disease-specific pregnancy concerns and PRA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 55 women with SLE and 27 with TAK were included. Nearly half of the participants (48.8%) reported concerns about their ability to conceive, with disease-related factors accounting for 95% of these concerns, and 67.1% considered postponing pregnancy because of their disease. More than half (51.2%) reported insufficient knowledge regarding disease progression during pregnancy. Most participants believed that pregnancy could pose risks to both maternal (85.9%) and fetal (87.2%) health; 62.8% were concerned about their ability to care for their baby after delivery, and 74.1% worried about transmitting their disease to their child. HADS anxiety and depression scores were positively correlated with the total PRAQ-R2 score and its subscales. Higher PRA was also significantly associated with concerns regarding disease worsening during and after pregnancy, medication-related fetal harm, adverse fetal outcomes, and disease transmission to the child after correction for multiple comparisons.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Women with SLE and TAK experience substantial pregnancy-related concerns even before conception. PRA is associated with psychological distress and disease-specific pregnancy perceptions but not with disease activity or damage, emphasizing the need for comprehensive preconception counseling that addresses both disease management and pregnancy-related concerns.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2026 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ijcp/6632986","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149048285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}