International Journal of Clinical Practice最新文献

{"title":"Factors Associated With Low TTR in Anticoagulation Management Following Prosthetic Heart Valve Replacement: A Retrospective Study","authors":"Xin Liu,&nbsp;Kegang Jia,&nbsp;Maoti Wei,&nbsp;Kangning Liu,&nbsp;Le Yang,&nbsp;Junfeng Liu","doi":"10.1155/ijcp/8222628","DOIUrl":"https://doi.org/10.1155/ijcp/8222628","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objective</h3>\u0000 \u0000 <p>Time in therapeutic range (TTR), the proportion of time the international normalized ratio (INR) remains within the target range, assesses warfarin anticoagulation quality. Using the INR range of 1.5–2.5 recommended by the <i>Chinese Guidelines for the Prevention and Treatment of Thrombotic Diseases</i>, we explored factors associated with TTR &lt; 60% during postoperative Days 7–90 after prosthetic valve replacement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively screened patients undergoing prosthetic valve replacement at Tianjin TEDA International Cardiovascular Hospital from August 2012 to July 2023. TTR was calculated by Rosendaal linear interpolation for INR 1.5–2.5; TTR &lt; 60% indicated suboptimal control. Univariate and multivariable logistic regression identified associated factors. Entropy balancing with weighted logistic regression assessed the valve-type association; bootstrap resampling (<i>n</i> = 1000) evaluated internal stability and optimism-corrected performance. Calibration and decision curve analysis (DCA) were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 443 patients (306 bioprosthetic and 137 mechanical valve recipients), 153 (34.5%) had TTR &lt; 60%. Age (OR = 1.021, 95% CI 1.001–1.042), log-transformed B-type natriuretic peptide (lnBNP; OR = 1.324, 95% CI 1.013–1.730), warfarin dose (OR = 1.409, 95% CI 1.138–1.744), red blood cell distribution width coefficient of variation (RDWCV; OR = 1.195, 95% CI 1.045–1.367), and amiodarone use (OR = 1.592, 95% CI 1.029–2.463) were independently associated with TTR &lt; 60%. The model showed modest discrimination (C-index = 0.655; bootstrap-corrected C-index = 0.630) and acceptable calibration (Hosmer–Lemeshow <i>p</i> = 0.599). DCA showed a positive net-benefit pattern across threshold probabilities of 0.24–0.52. Subgroup analyses identified different association patterns by valve location. After entropy balancing, valve type was not independently associated with TTR &lt; 60% (OR = 0.945, 95% CI 0.605–1.490; <i>p</i> = 0.807).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Age, BNP, RDWCV, warfarin dose, and amiodarone use were associated with suboptimal early postoperative anticoagulation control in Chinese patients after prosthetic valve replacement. These findings may help identify patients warranting closer monitoring, while valve-location differences should be interpreted cautiously.</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/8222628","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149048370","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":"Explainable Machine Learning for Fatal-Outcome Risk in Respiratory Adverse-Event Reports: A Temporally Validated Study With Deterministic Audit Checks","authors":"Fanzhen Yu,&nbsp;Ziqi Meng,&nbsp;Shanshan Cai,&nbsp;Daifeng Yang,&nbsp;Si Sun","doi":"10.1155/ijcp/6451709","DOIUrl":"https://doi.org/10.1155/ijcp/6451709","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Respiratory adverse drug reaction reports accumulate rapidly, but transparently identifying reports associated with fatal outcomes remains challenging because spontaneous-report data are heterogeneous and incomplete.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We extracted 1,933,080 FDA Adverse Event Reporting System (FAERS) reports from 2004 to 2025 containing at least one of 604 respiratory Medical Dictionary for Regulatory Activities (MedDRA) preferred terms. Mortality modelling included 1,123,787 outcome-coded reports from 2012Q4 onward, partitioned temporally into training (2012–2021), validation (2022) and held-out testing (2023–2025Q4). We calibrated four models—elastic-net logistic regression, XGBoost, LightGBM and random forest—and interpreted XGBoost with TreeSHAP. Evaluation included discrimination, precision–recall, calibration, decision-curve analysis and subgroup robustness. Six deterministic routines audited cohort counts, temporal leakage, model selection, attribution provenance, subgroup stability and current openFDA application programming interface (API) recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The 2025Q2–Q4 update added 113,219 reports, including 11,037 with a death outcome. The held-out test set contained 294,855 reports, including 39,806 deaths (prevalence and no-skill AUPRC: 0.135). No model dominated all metrics. Elastic-net logistic regression had the highest AUROC (0.728), LightGBM the highest AUPRC (0.371) and F1 score (0.373) and random forest the lowest Brier score (0.103). TreeSHAP ranked respiratory arrest or failure, report year, older age, female sex and cancer indication among the leading contributors. Net benefit was positive across the evaluated review-threshold range. All 80 rank-selected drug–reaction pairs were recovered in a current openFDA snapshot.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Temporal validation, calibration, transparent attribution and deterministic audit checks yielded an interpretable tool for prioritising respiratory reports for expert pharmacovigilance review.</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/6451709","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149048372","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":"Global, Regional, and National Burden of Pelvic Organ Prolapse, 1990–2021: A Systematic Analysis of the Global Burden of Disease Study 2021","authors":"Bin-Jie Zhang,&nbsp;Xiao-Chun Liu","doi":"10.1155/ijcp/8216837","DOIUrl":"https://doi.org/10.1155/ijcp/8216837","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pelvic organ prolapse (POP) is a common gynecological condition that affects women exclusively, particularly in older age groups. Despite its high prevalence and substantial impact on women’s quality of life, POP has received limited global public health attention. Comprehensive estimates of its burden and temporal trends, especially across diverse sociodemographic settings, remain lacking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used data from the Global Burden of Disease Study 2021 to assess the burden of POP among females from 1990 to 2021 in 204 countries and territories. Four key indicators, including prevalence, incidence, deaths, and disability-adjusted life years, were analyzed using absolute numbers and age-standardized rates. Temporal trends were assessed using the estimated annual percentage change. We further evaluated the association between ASRs and the sociodemographic index globally, by region, and by country.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 2021, POP accounted for approximately 124.4 million prevalent cases, 14.0 million incident cases, 389,358 DALYs, and 486 deaths among women worldwide. The global ASRs showed significant decreasing trends for prevalence (EAPC: −0.58, 95% CI: −0.61 to −0.55), incidence (EAPC: −0.46, 95% CI: −0.50 to −0.42), DALYs (EAPC: −0.59, 95% CI: −0.63 to −0.56), and deaths (EAPC: −0.70, 95% CI: −0.86 to −0.54). The burden was concentrated in women aged 55–74 years. Low- and middle-SDI regions had the highest ASRs, while high-SDI regions experienced the most pronounced declines. ASRs were negatively correlated with SDI, although some countries deviated substantially from expected trends.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>POP remains a widespread and age-related health burden among women, with striking geographic and developmental disparities. Targeted interventions and greater investment in women’s lifelong pelvic health are urgently needed, especially in lower-SDI settings.</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/8216837","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149048371","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":"Therapeutic Effects of Different Doses of Ulinastatin in Acute Pancreatitis Patients: Results From a Propensity-Matched Analysis","authors":"Mei Yang,&nbsp;Haonan Liu,&nbsp;Jingwen Rao,&nbsp;Zhengang Zhou,&nbsp;Kunpeng Yang,&nbsp;Jie Wu,&nbsp;Liang Xia,&nbsp;Lingyu Luo,&nbsp;Yin Zhu,&nbsp;Nonghua Lu,&nbsp;Wenhua He","doi":"10.1155/ijcp/9778409","DOIUrl":"https://doi.org/10.1155/ijcp/9778409","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ulinastatin is a urinary trypsin inhibitor which inhibits the activation of pancreatic enzymes. It is widely used in Asia for the treatment of acute pancreatitis (AP), but the efficacy of high-dose regimens in reducing pancreatic necrosis is unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To assess the effect of early, variable-dose ulinastatin on the prevention and treatment of pancreatic necrosis in patients with AP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective analysis of AP patients admitted to the Department of Gastroenterology at First Affiliated Hospital of Nanchang University from 1 January 2010 to 31 December 2022. Patients were divided into high-dose (900,000 U/day) and low-dose (300,000 U/day) ulinastatin groups according to treatment received. Clinical endpoints including the incidence of necrotizing pancreatitis, organ failure, and in-hospital mortality were compared between the two cohorts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1431 patients with AP were enrolled, 128 patients in the high-dose ulinastatin group and 1303 patients in the low-dose ulinastatin group. After propensity score matching (PSM), 119 patients per group were analyzed. A lower incidence of necrotizing pancreatitis was observed in the high-dose ulinastatin cohort compared to the low-dose group (10.1% vs. 21.0%, <i>p</i> = 0.02). No significant differences were noted between groups regarding organ failure rates (respiratory, renal, and cardiovascular), morbidity, mortality, length of hospital stay, or intensive care unit days (<i>p</i> &gt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Early administration of high-dose ulinastatin in patients with AP appears to reduce the risk of pancreatic necrosis and warrants further investigation of its therapeutic potential.</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/9778409","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149048284","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":"Diagnostic Accuracy of Combined Clinical Tools for Carpal Tunnel Syndrome: A Cross-Sectional Study","authors":"Yanjun Lin,&nbsp;Min Huang,&nbsp;Chengming Ke,&nbsp;Zhenwei Jiang","doi":"10.1155/ijcp/1126239","DOIUrl":"https://doi.org/10.1155/ijcp/1126239","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to evaluate the diagnostic accuracy of clinical assessment tools—including the CTS-6 diagnostic scale (CTS-6), Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS), and Katz Hand Symptoms Diagram (Katz HSD)—both individually and in combination, with the goal of reducing reliance on nerve conduction studies (NCS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cross-sectional study involving 67 consecutively recruited outpatients (96 hands) with clinically suspected carpal tunnel syndrome (CTS). All participants were assessed using the CTS-6, BCTQ-SSS, and Katz HSD. NCS served as the reference standard, with positivity defined as distal motor latency ≥ 4.2 ms or sensory latency ≥ 3.2 ms. Diagnostic accuracy parameters—including the area under the curve (AUC), sensitivity (Sn), and specificity (Sp)—were calculated using ROC analysis. For the combined diagnostic tools, optimal Sn, Sp, positive predictive value (PPV), and negative predictive value (NPV) were determined at varying thresholds.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared with individual tools, dual-instrument combinations demonstrated superior diagnostic accuracy (<i>p</i> &lt; 0.05). The Katz HSD/BCTQ-SSS pair achieved the highest AUC (0.914, 95% CI: 0.857–0.971), with Sn = 0.770 and Sp = 0.955. In this cohort, the protocol reduced the need for NCS by 78.1% (preliminary estimate) through definitive exclusion (Katz “Unlikely”) or confirmation (Katz “Classic” or BCTQ-SSS ≥ 17.5).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The combined use of noninvasive tools may improve diagnostic accuracy and reduce reliance on NCS, pending external validation. A stepwise diagnostic model, consisting of initial screening tools followed by confirmatory NCS, could be considered in resource-limited settings. Future multicenter prospective studies are warranted to validate this strategy across diverse populations and explore synergistic integration with emerging diagnostic modalities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2026 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ijcp/1126239","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149048202","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":"Blood Lead Exposure, Oxidative Stress, and Hyperlipidemia Risk: A Mediation Analysis of the National Health and Nutrition Examination Survey","authors":"Yifan Chen,&nbsp;Ling Kuang,&nbsp;Yaxuan Li,&nbsp;Hongxuan Huang,&nbsp;Haojie Chen,&nbsp;Weiying Zheng,&nbsp;Houde He,&nbsp;Shuxian Zhang,&nbsp;Yingying Zhang,&nbsp;Ye He,&nbsp;Huahai Huang,&nbsp;Wenjun Li","doi":"10.1155/ijcp/8532220","DOIUrl":"https://doi.org/10.1155/ijcp/8532220","url":null,"abstract":"<p>While the effects of lead on lipid metabolism have been demonstrated in various experiments, epidemiological evidence for the association between increasing environmental lead exposure and hyperlipidemia is equivocal, particularly regarding factors that statistically account for this relationship. To fill this research gap, we investigated the cross-sectional association between blood lead levels (BLLs) and hyperlipidemia, using data from 31,225 adults in NHANES (1999–2018). Dose–response relationships were evaluated using multivariable logistic regression and restricted cubic splines (RCS). Mediation analyses were conducted to assess whether the oxidative stress mediators of interest (gamma-glutamyl transferase [GGT], uric acid [UA], bilirubin-to-albumin ratio [BAR], UA-to-albumin ratio [UAR], and creatinine-to-albumin ratio [CAR]) statistically mediated this association. Results indicated that elevated BLLs were independently and nonlinearly associated with increased odds of hyperlipidemia (the highest vs. the lowest quartile: OR = 1.46, 95% CI 1.20–1.66; <i>p</i> for trend &lt; 0.001). RCS showed a monotonic, nonlinear relationship without a safe lower threshold, with stronger associations observed in adults &lt; 60 years (<i>p</i> for interaction = 0.003) and those with normal body mass index (<i>p</i> for interaction &lt; 0.001). GGT, UA, and UAR statistically accounted for 29.1%, 15.3%, and 5.5% of the association, respectively (all <i>p</i> &lt; 0.001). In contrast, BAR acted as a negative mediator, accounting for −11.7% of the total association (<i>p</i> &lt; 0.001), and CAR showed no mediation effect. In conclusion, lead exposure is associated with hyperlipidemia even at low-exposure levels, and oxidative stress appears to be a statistical mediator among U.S. adults, providing evidence of lead-related metabolic dysfunction.</p>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2026 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ijcp/8532220","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149048247","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":"Pan-Cancer Analysis Reveals TRPM4 as a Prognostic Biomarker and Immune Modulator in PAAD","authors":"Wei Yuan,&nbsp;Guiju Liu,&nbsp;Min Li,&nbsp;Peng Xiao,&nbsp;Weijuan Li,&nbsp;Yan Wang,&nbsp;Zhaorui Wang,&nbsp;Jiazhuan Mei,&nbsp;Ziyou Lin","doi":"10.1155/ijcp/5597277","DOIUrl":"https://doi.org/10.1155/ijcp/5597277","url":null,"abstract":"<p>Pancreatic adenocarcinoma (PAAD) is a highly aggressive malignancy with poor prognosis and limited therapeutic options. Identifying molecular targets that contribute to tumor progression and immune escape is essential for improving outcomes. TRPM4, a calcium-activated monovalent cation channel, has been implicated in various cancers, but its role in PAAD remains unclear. In this study, we performed an integrative pan-cancer and PAAD-focused analysis of TRPM4 using transcriptomic, clinical, epigenetic, and single-cell data from TCGA, GTEx, GEO, and TISCH2. TRPM4 was significantly overexpressed in multiple cancers, with particularly high expression in PAAD, where it was associated with poor overall and progression-free survival. Single-cell analysis revealed TRPM4 enrichment in malignant and endothelial cells, with negative correlations to CD8⁺ and CD4⁺ T cell infiltration, indicating an immunosuppressive phenotype. TRPM4 expression was associated with hallmark oncogenic features. Epigenetically, promoter methylation alterations and transcription factor regulation may contribute to its upregulation. TRPM4-high tumors also showed distinct cancer-related pathway and immune-subtype profiles. Drug sensitivity analysis revealed significant correlations between TRPM4 expression and resistance to multiple agents, including AKT and BCL2 inhibitors. These findings suggest that TRPM4 contributes to immune evasion and therapeutic resistance in PAAD and may serve as a prognostic biomarker and potential therapeutic target.</p>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2026 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ijcp/5597277","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149048248","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":"Current Status and Influencing Factors of Out-of-Hospital Anticoagulation Decision-Making in Gynecologic Oncology Patients With Very High VTE Risk: A Cross-Sectional Study","authors":"Chengcheng Li,&nbsp;Jianhua Tang,&nbsp;Ying Peng,&nbsp;Yue Huang,&nbsp;Jiao Li,&nbsp;An Shi,&nbsp;Zewen Pan,&nbsp;Zhenjun Liu","doi":"10.1155/ijcp/5561146","DOIUrl":"https://doi.org/10.1155/ijcp/5561146","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aim&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To investigate the current status and influencing factors of out-of-hospital anticoagulation decision-making in gynecologic oncology patients with very high venous thromboembolism (VTE) risk.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This study employs a questionnaire survey to explore the current status of conflicts in outpatient anticoagulation decisions and the influencing factors among patients with very high VTE risk related to gynecologic tumors.&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;This study was conducted in two centers between January and July 2024. A total of 192 questionnaires were distributed, and 188 valid questionnaires were included in the analysis. Data were collected using a general information questionnaire, a VTE knowledge questionnaire, and the Chinese version of the Decisional Conflict Scale (DCS). To avoid overfitting, the dataset was randomly divided into a training set (75%) and a test set (25%). Stepwise multiple linear regression was performed to identify influencing factors.&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;The mean DCS score was 57.86 (10.20), and 97.87% of patients experienced high levels of decision-making conflict. Stepwise multiple linear regression analysis revealed that medical payment method (&lt;i&gt;β&lt;/i&gt; = −0.342, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), level of VTE knowledge (&lt;i&gt;β&lt;/i&gt; = −0.615, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), number of hospitalizations (&lt;i&gt;β&lt;/i&gt; = 0.176, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), and disease duration (&lt;i&gt;β&lt;/i&gt; = 0.090, &lt;i&gt;p&lt;/i&gt; = 0.037) were significant influencing factors, collectively explaining 74.3% of the variance in decisional conflict.&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;Gynecologic oncology patients with very high VTE risk experience substantial decision-making conflict regarding out-of-hospital anticoagulation. Targeted interventions should focus on improving patient knowledge, reducing financial burden, and addressing the specific needs of patients with longer disease duration and repeated hospitalizations.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Implications for the Profession and/or Patient Care&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This study suggests that clinical medical staff should focus on patients with high levels of decisional conflict, help them clarify doubts, enhance their awareness of VTE prevention, and prevent the occurrence of VTE.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 ","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2026 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ijcp/5561146","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149047967","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":"Machine Learning–Driven Identification of Hematological and Immunological Biomarkers for Predicting Cerebral Edema in Patients With Intracerebral Hemorrhage","authors":"Yue Zhang,&nbsp;Yu Kang,&nbsp;Wenyao Cui","doi":"10.1155/ijcp/5818378","DOIUrl":"https://doi.org/10.1155/ijcp/5818378","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cerebral edema is a severe complication following intracerebral hemorrhage (ICH) and is associated with poor neurological outcomes. Early prediction remains challenging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To identify hematological and immunological biomarkers for predicting cerebral edema in patients with ICH using machine learning approaches.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Material</h3>\u0000 \u0000 <p>A retrospective analysis of 82 ICH patients, including 48 with cerebral edema (CWE) and 34 without cerebral edema (NCWE), was conducted using advanced statistical methods such as LASSO regression, elastic net, and backward stepwise regression. The predictive performance of identified biomarkers was evaluated using receiver operating characteristic (ROC) curve analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study identified platelet (PLT) count and brain natriuretic peptide (BNP) as candidate biomarkers associated with cerebral edema, with the combined PLT–BNP model achieving an AUC of 0.876. Additionally, elevated neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were associated with increased cerebral edema risk. These findings suggest that systemic inflammation and coagulation dysfunction play crucial roles in cerebral edema development.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our results highlight that PLT and BNP may have potential utility for cerebral edema risk stratification. Despite limitations inherent to retrospective studies, these findings provide a foundation for more precise risk stratification and tailored therapeutic interventions, emphasizing the importance of integrated models considering both inflammatory and coagulation pathways.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2026 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ijcp/5818378","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149047966","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":"Baseline Potassium and 1 Year Myocardial Recovery After Primary PCI in STEMI: Mediating Role of Microvascular Obstruction","authors":"Shancheng Wang,&nbsp;Jinhua Zhang,&nbsp;Yu Zhang,&nbsp;Ding Wang,&nbsp;Xianping Meng,&nbsp;Junwei Xu","doi":"10.1155/ijcp/6167099","DOIUrl":"https://doi.org/10.1155/ijcp/6167099","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;Serum potassium levels and microvascular obstruction (MVO) are both associated with myocardial recovery after ST-segment elevation myocardial infarction (STEMI), but whether MVO mediates the relationship between potassium and long-term cardiac function remains unknown. This study investigated whether baseline MVO mediates the association between baseline serum potassium levels and 1 year global longitudinal strain (GLS) recovery in STEMI patients undergoing primary percutaneous coronary intervention (PCI).&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;This retrospective cohort study enrolled 258 STEMI patients (mean age 51.3 ± 11.3 years, 93.8% male) at Affiliated Jiangyin Hospital of Nantong University, China, from January 2020 to December 2023. All patients underwent primary PCI after hospital admission (median time from symptom onset to reperfusion: 15.0 [IQR: 4.0–35.5] hours) and completed cardiovascular magnetic resonance (CMR) imaging at baseline (5–9 days post-PCI) and at 12-month follow-up (10–14 months post-PCI). Baseline serum potassium averaged 4.0 ± 0.6 mmol/L (range: 3.0–5.2 mmol/L). The primary outcome was 1 year GLS recovery (change in absolute GLS from baseline to 1-year). Causal mediation analysis with bootstrap resampling (5000 iterations) was employed to decompose total effects into natural indirect effects (NIE) and natural direct effects (NDE), adjusting for 8 confounders selected via variance inflation factor analysis.&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;Higher baseline potassium was associated with reduced baseline MVO (path a: &lt;i&gt;β&lt;/i&gt; = −3.638, 95% CI: −3.98 to −3.29, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and greater 1 year GLS recovery (total effect: &lt;i&gt;β&lt;/i&gt; = 3.621, 95% CI: 3.09 to 4.15, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). The NIE through MVO was statistically significant (&lt;i&gt;β&lt;/i&gt; = 2.232, 95% CI: 1.474 to 3.036, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), with a mediation proportion of 61.6% (95% CI: 39.8%–86.1%), indicating that approximately 61.6% of potassium’s protective association with GLS recovery was mediated through reduction in MVO. Drug-adjusted sensitivity analyses showed robust results (mediation proportion range: 61.0%–62.2%). Reverse mediation analysis confirmed the primary causal direction (NIE for reverse pathway: −0.246). The direct effect remained significant (&lt;i&gt;β&lt;/i&gt; = 1.389, 95% CI: 0.463 to 2.319, &lt;i&gt;p&lt;/i&gt; = 0.002).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In STEMI patients, baseline MVO substantially mediates the beneficial association between baseline serum potassium and 1 year GLS recovery, accountin","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2026 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ijcp/6167099","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149047936","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}