Medicine最新文献

{"title":"Application of extracorporeal shockwave to regulate subchondral bone homeostasis through tumor necrosis factor-α/hypoxia-inducible factor-1α/vascular endothelial growth factor signaling pathway in treatment of talus bone marrow edema.","authors":"Zifan Wang, Zhizhou Wang, Fei Wu","doi":"10.1097/MD.0000000000040228","DOIUrl":"10.1097/MD.0000000000040228","url":null,"abstract":"<p><p>To investigate the effect of extracorporeal shock wave on the treatment of talus bone marrow edema by regulating subchondral bone homeostasis through tumor necrosis factor-α (TNF-α)/hypoxia-inducible factor-1α (HIF-1α)/vascular endothelial growth factor (VEGF) signaling pathway. A total of 81 patients with talus bone marrow edema admitted to our hospital from May 2019 to May 2021 were studied and divided into control group (n = 40) and extracorporeal shock group (n = 41) according to random number table method. The control group was given conventional treatment, and the extracorporeal shock group was combined with extracorporeal shock wave therapy on the basis of the control group. The expression of TNF-α, HIF-1α, and VEGF in the 2 groups were compared, pain degree, and the area of talus bone marrow edema was evaluated by magnetic resonance imaging. The visual analogue scale scores of 1 month, 2 months and 5 months after treatment were decreased in both groups, and the extracorporeal shock group was lower than the control group (P < .05). After 5 months of treatment, the expressions of TNF-α and HIF-1α were decreased in both groups, and the extracorporeal shock group was lower than the control group, VEGF was increased, and the extracorporeal shock group was higher than the control group (P < .05), and the western blot expression levels of TNF-α, HIF-1α and VEGF in the extracorporeal shock group were higher than the control group (P < .05). The dorsiflexion motion and plantar flexion motion of both groups were increased, and the extracorporeal shock group was higher than the control group (P < .05). Extracorporeal shock wave therapy can regulate subchondral bone homeostasis through TNF-α/HIF-1α/VEGF signaling pathway to treat talus bone marrow edema, reduce the pain degree of talus bone marrow edema, and improve ankle joint function.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"103 45","pages":"e40228"},"PeriodicalIF":1.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623140","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 gut microbiota, plasma metabolites, and ovarian cancer: A Mendelian randomization study.","authors":"Yu Wang, Shanxiang Gao, Yangyu Liu, Yongai Li, Hui Yao, Yan Han, Xinyue Liu","doi":"10.1097/MD.0000000000040479","DOIUrl":"10.1097/MD.0000000000040479","url":null,"abstract":"<p><p>Numerous studies have demonstrated a correlation between alterations in gut microbiota (GM) and levels of body metabolites in ovarian cancer (OC). However, the specific causal relationships underlying these associations remain unclear. This study utilized summary statistics of GM from the MiBioGen consortium, along with an unprecedented dataset comprising 1091 blood metabolites and 309 metabolite ratios from the UK Biobank, in conjunction with OC data from the FinnGen Consortium R9 release. We conducted bidirectional Mendelian randomization (MR) analyses to investigate the causal relationships between GM and OC. Additionally, a two-step MR approach was employed to identify potential mediating metabolites. Our analysis revealed significant associations between 6 specific microbiota taxa and OC. Furthermore, we identified several plasma metabolites that act as mediators of the association between GM and OC. In the two-step MR analysis, we observed a negative correlation between 4-methoxyphenol sulfate and pregnenetriol disulfate levels with OC. The genus Lachnospiraceae UCG008 potentially increases the risk of OC by decreasing 4-methoxyphenol sulfate levels, while the genus Howardella may elevate the risk of OC by reducing pregnenetriol disulfate levels, with mediation proportions of 22.35% and 4.23%, respectively. Additionally, levels of dilinoleoyl-GPE (18:2/18:2) and N-acetylkynurenine (2) were positively correlated with OC. The inhibitory effect of the genus Ruminococcus 1 on OC may be mediated through 1,2-dilinoleoyl-GPE (18:2/18:2) and N-acetylkynurenine (2), with mediation proportions of 10.15% and 11.32%, respectively. Our findings highlight the complex relationship among GM, plasma metabolites, and OC. The identified associations and mediation effects offer valuable insights into potential therapeutic approaches targeting GM for the management of OC.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"103 45","pages":"e40479"},"PeriodicalIF":1.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623476","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":"The causal relationship between diabetes mellitus and the risk of sensorineural hearing loss: A Mendelian randomization study.","authors":"Qingqing Guo, Dingren Niu, Ling Zhou","doi":"10.1097/MD.0000000000039950","DOIUrl":"10.1097/MD.0000000000039950","url":null,"abstract":"<p><p>An increasing body of evidence suggests that diabetes mellitus (DM) plays a role in sensorineural hearing loss (SNHL). However, the specific causal relationship between DM and SNHL remains partially uncertain. This study aimed to investigate the causal relationship between DM and the risk of SNHL using a Mendelian randomization (MR) study. Single nucleotide polymorphisms closely related to DM were selected as instrumental variables using open genome-wide association study datasets. Three methods based on inverse variance weighted were utilized to investigate the causal relationship between DM and SNHL. Subsequently, multivariable MR (MVMR) was executed to adjust for confounding genetic associations. In addition, a range of sensitivity analyses were performed to assess the stability and reliability of the MR results. The inverse variance weighted analysis indicated a potential genetic causality between DM and SNHL (odds ratio [OR]: 2.179; 95% confidence interval [CI]: 1.123-4.231; P = .021). The sensitivity analyses showed that the included single nucleotide polymorphisms had no heterogeneity, horizontal pleiotropy, and outliers (P > .05). Moreover, the leave-one-out method further verified the robustness of the MR analysis results. Finally, the results of the MVMR study predicted that there was a genetic causal relationship between type 1 DM and SNHL (OR: 1.032; 95%CI: 1.018-1.047; P = 5.45 × 10-6), while there was no causality between type 2 DM and SNHL (OR: 1.000; 95%CI: 0.958-1.036; P = .853). Our study suggested that DM and type 1 DM may be genetically responsible for SNHL. Although our study did not detect a genetic causal relationship between type 2 DM and SNHL, this does not rule out a relationship between them at other mechanistic levels. Further studies are required to confirm the findings and look into the physiological and pathological mechanism underlying these relationships.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"103 45","pages":"e39950"},"PeriodicalIF":1.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623626","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":"The impact of Tanreqing injection on mucus hypersecretion and cough in bronchiectasis: A meta-analysis of randomized controlled trials.","authors":"Jinzhi Zhang, Zi Yang, Shasha Yuan, Yuanyuan Duan, Qing Miao","doi":"10.1097/MD.0000000000040465","DOIUrl":"10.1097/MD.0000000000040465","url":null,"abstract":"<p><strong>Background: </strong>Bronchiectasis clinically manifests airway mucus hypersecretion as mucopurulent sputum production and chronic cough. In the past decade, Tanreqing injection (TRQ) has been often used in clinical practice as an add-on treatment for bronchiectasis in China. Several in vivo studies have indicated that TRQ is effective in improving sputum expectoration and cough in acute exacerbation of bronchiectasis but results of individual studies are inconsistent. Therefore, systematically and critically evaluating the effectiveness and safety of TRQ on mucus hypersecretion and cough in bronchiectasis is necessary.</p><p><strong>Methods: </strong>Randomized controlled trials examining the treatment of bronchiectasis with TRQ were systematically searched from databases including PubMed, Cochrane Library, Embase, Web of Science, Chinese National Knowledge Infrastructure, Vip Information Database, Wanfang data, and Chinese Biomedical Literature Database, based on a preregistered protocol and adhering to Cochrane methods. Pertinent data were taken out from the included studies and a methodological quality assessment was done. R language (version 4.4.1) was used to perform the meta-analysis.</p><p><strong>Results: </strong>Twenty randomized controlled trials involving 1544 patients were analyzed. The results demonstrated that TRQ significantly improved mucus hypersecretion, shortened the duration of cough and phlegm, reduced symptom scores, and enhanced both forced expiratory volume in 1 second and forced vital capacity. Additionally, TRQ effectively lowered inflammatory markers, including C-reactive protein, procalcitonin, white blood cell count, neutrophil count, interleukin-6, and tumor necrosis factor-alpha. Moreover, TRQ increased the partial pressure of oxygen and decreased carbon dioxide pressure.</p><p><strong>Conclusion: </strong>The findings suggest that TRQ positively impacts mucus hypersecretion and mucociliary clearance, leading to improvements in sputum production and cough during bronchiectasis exacerbations, without increasing the risk of adverse effects. TRQ may be considered a viable option for managing bronchiectasis and could serve as a novel mucus-modifying agent.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"103 45","pages":"e40465"},"PeriodicalIF":1.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623727","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":"Visual analysis of patient safety research hotspots and trends in the context of telemedicine based on Web of Science.","authors":"Caijin Wen, Wenxia Luo, Yan Liu, Xi Luo, Jie Li, Jing Zhang","doi":"10.1097/MD.0000000000039387","DOIUrl":"10.1097/MD.0000000000039387","url":null,"abstract":"<p><p>To analyze the research status, hotspots, and trends of patient safety in the context of international telemedicine, and to provide reference for future research in various countries. The literature pertaining to patient safety within the realm of telemedicine was systematically retrieved from the Web of Science core collection database, encompassing the period from January 2010 to December 2023. Visual analysis of publication quantity, primary authorship, and keyword trends was conducted using CiteSpace (6.2R6) software. The geographical distribution of research focus was visualized through VOSviewer software and SCImago Graphica software, while research institutions were depicted using VOSviewer software and Highcharts software. Data organization was facilitated by Excel 2019 software. A total of 5356 related articles were included, and the number of published papers showed an overall upward trend, and the countries and institutions with the largest number of papers were the United States and Harvard University, respectively, and a stable core author research population had not yet been formed in this research field. Through keyword analysis, it can be seen that the research hotspots mainly focus on the research on the influencing factors of patient safety in the context of telemedicine, the research on the application value of telemedicine, and the research on coping strategies that affect patient safety. The research on patient safety in the context of telemedicine in foreign countries has a certain depth and breadth, which has important reference significance for improving the medical quality and patient safety of Internet hospitals in various countries.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"103 45","pages":"e39387"},"PeriodicalIF":1.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623777","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":"Concurrent Guillain-Barre/acute transverse myelitis overlap syndrome after COVID-19 infection in a patient with ITP: A case report.","authors":"Ruomeng Chen, Liang Wang, Binbin Wang, Xiujuan Song, Xiaoyun Liu","doi":"10.1097/MD.0000000000040346","DOIUrl":"10.1097/MD.0000000000040346","url":null,"abstract":"<p><strong>Rationale: </strong>Patients with chronic immune diseases, such as idiopathic thrombocytopenic purpura (ITP), should be alert for Guillain-Barre/acute transverse myelitis (GBS/ATM) overlap syndrome after infection with coronavirus disease 2019 (COVID-19).</p><p><strong>Patient concerns: </strong>A 65-year-old male with an ITP history, who presented with limb numbness and weakness, urinary retention, right peripheral facial paralysis, and diplopia 2 weeks after being diagnosed with COVID-19.</p><p><strong>Diagnosis: </strong>GBS/ATM overlap syndrome secondary to COVID-19.</p><p><strong>Interventions: </strong>Five days intravenous immune globulin, methylprednisolone (500 mg) was added for treatment. He was discharged with medicine and continued to take Methylprednisolone tablets (60 mg/d), Eltrombopag olamine (25 mg 1/d), Mecobalamine tablets, vitamin B1, and rehabilitation treatment outside the hospital.</p><p><strong>Outcomes: </strong>The patient significantly improved after initial treatment, he returned to normal life after 8 weeks. Five months later, he was infected with COVID-19 for the second time, exhibiting only symptoms of upper respiratory tract infection and no other discomfort.</p><p><strong>Lessons: </strong>COVID-19 infection can lead to secondary myelitis and GBS, and GBS/ATM overlap syndrome is rare, but patients are significantly better after immunization and hormone therapy.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"103 45","pages":"e40346"},"PeriodicalIF":1.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623778","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":"Clinical characteristics and bloodstream infection pathogens by gram-negative bacteria in different aged adults: A retrospective study.","authors":"Li Su, Yawen Cao, Yaomin Liu, Jianhua Zhang, Guomin Zhang","doi":"10.1097/MD.0000000000040411","DOIUrl":"10.1097/MD.0000000000040411","url":null,"abstract":"<p><p>This study aims to determine the characteristics and distribution of pathogenic bacteria in bloodstream infections (BSIs) by gram-negative bacteria in adults. One hundred seventy-one adult patients with BSIs who were treated at the Affiliated Hospital of Chengde Medical College between January 2018 and January 2020 were included in this study. The patients were assigned to the young- and middle-aged group and elderly group based on age. General patient data were analyzed. More elderly patients had BSIs and gram-negative bacteria than young- and middle-aged patients. The incidence of underlying diseases in elderly patients was significantly higher than the young- and middle-aged patients (P < .01). The composition of Brucella spp. was significantly different between the elderly group and young- and middle-aged group (P < .05). There were significantly more gallbladder infections in the elderly group than the young- and middle-aged group, and significantly fewer elderly patients had no definite infection sites than the young- and middle-aged group (P < .05). The incidence of complications and in-hospital mortality in the elderly group was higher than the young- and middle-aged group (P < .05). BSIs caused by gram-negative bacteria mainly involved elderly patients. BSIs were characterized by complications and a poor prognosis, as well as pathogenic bacteria and primary infection sites.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"103 45","pages":"e40411"},"PeriodicalIF":1.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623599","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":"Network pharmacology and molecular docking to explore the potential molecular mechanism of chlorogenic acid treatment of oral squamous cell carcinoma.","authors":"Zhanqin Feng, Puyu Hao, Yutao Yang, Xulong Xve, Jun Zhang","doi":"10.1097/MD.0000000000040218","DOIUrl":"10.1097/MD.0000000000040218","url":null,"abstract":"<p><p>Oral squamous cell carcinoma (OSCC) is a tumor type with a high mortality rate. Chlorogenic acid, abundant in resources and widely utilized in cancer treatments, has seen limited studies regarding its efficacy against OSCC. This paper investigates chlorogenic acid's mechanism in treating OSCC, aiming to guide the development of novel drugs. The study employed network pharmacology, molecular docking, and survival analysis methods. Network pharmacological analysis revealed chlorogenic acid targets 23 OSCC-related proteins, including ESR1, MMP2, MMP9, SRC, MAPK8, MAPK1, CDC42, ERBB2, ATM, and BRAF. Molecular docking simulations indicated that the primary target exhibits significant binding capacity with chlorogenic acid, with MMP9 associated with tumor migration and angiogenesis standing out. Survival analysis demonstrated that the downregulation of most primary targets correlates with improved survival rates in OSCC patients. Enrichment analysis of therapeutic targets highlighted the pivotal role of MAPK-ERK and MAPK-JNK signaling pathways in chlorogenic acid's efficacy against OSCC. This paper predicts chlorogenic acid's potential targets and proposes its molecular mechanism in treating OSCC, offering a theoretical foundation for its application in OSCC treatment. We used traditional Chinese medicine, a disease pharmacology-related information base, and an analysis platform to predict targets. The Cytoscape 3.9.1 and STING databases were used to address common targets for drugs and diseases, establish networks of protein interaction relationships, and screen core targets. Meastro11.5 was used for molecular docking simulation. R4.2.2 was used for survival analysis and joint target enrichment analysis. Network pharmacological analysis identified chlorogenic acid acting on 23 OSCC targets. Molecular docking simulations revealed a strong binding affinity of chlorogenic acid compounds with these targets, particularly MMP9, essential for tumor migration and angiogenesis. Survival analysis indicated that the downregulation of most core targets was correlated with improved OSCC patient survival. Enrichment analysis of therapeutic targets highlighted the critical roles of the MAPK-ERK and MAPK-JNK signaling pathways in the effectiveness of chlorogenic acid against OSCC. This study predicted the potential targets of chlorogenic acid in OSCC treatment and hypothesized its molecular mechanism, offering a theoretical foundation for its use in OSCC therapy.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"103 45","pages":"e40218"},"PeriodicalIF":1.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622433","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":"Efficacy of four internal fixation devices on femoral neck fractures in young adults: A systematic review and network meta-analysis.","authors":"Daotong Yuan, Zhimeng Zhang, Xu Wang, Wenjie Chang, Wenpeng Xie, Yongkui Zhang","doi":"10.1097/MD.0000000000040265","DOIUrl":"10.1097/MD.0000000000040265","url":null,"abstract":"<p><strong>Background: </strong>The primary treatment of femoral neck fracture in young adults is internal fixation. The high complication rate after femoral neck fracture greatly affects the life of patients. There are many internal fixation devices for femoral neck fracture, but each has its advantages and disadvantages. Our aim was to determine the best internal fixation for young people with femoral neck fractures.</p><p><strong>Methods: </strong>We searched 5 databases from January, 2016 to December, 2023. Randomized controlled trials and cohort studies that met the inclusion criteria were assessed for quality using the RoB.2 and ROBINS-I scales, respectively. The network meta-analysis was conducted within a Bayesian framework utilizing a random effect model. Data analysis was performed using the \"multinma\" package within the R 4.2.0 software.</p><p><strong>Results: </strong>A network meta-analysis of 34 studies involving 2291 patients was conducted. Results indicated that the inverted triangular cannulated screws demonstrated the lowest intraoperative bleeding volume (surface under the cumulative ranking curve [SUCRA] = 0.8732) based on the SUCRA. The medial buttress plate (MBP) exhibited superior efficacy in improving the Harris hip score (SUCRA = 0.8465), reducing complications (SUCRA = 0.9251), and accelerating fracture healing time (SUCRA = 0.8111). Additionally, the femoral neck system was ranked highest in terms of operation time (SUCRA = 0.7749) and femoral neck shortening (SUCRA = 0.7933).</p><p><strong>Conclusion: </strong>This network meta-analysis findings indicated that MBP resulted in superior postoperative hip function, reduced complication rate, faster fracture healing time. Considering the good physical condition of young adults, surgeon may consider utilizing MBP to achieve improved postoperative outcomes.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"103 45","pages":"e40265"},"PeriodicalIF":1.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623865","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":"Factors associated with subtherapeutic levels of valproic acid in hospitalized patients with epilepsy: A retrospective cohort study.","authors":"Tuanthon Boonlue, Papitchaya Sitsuer, Wasinee Phosri, Warisara Jinatongthai","doi":"10.1097/MD.0000000000040488","DOIUrl":"10.1097/MD.0000000000040488","url":null,"abstract":"<p><p>Valproic acid (VPA) is a commonly used anti-seizure medication, owing to its efficacy and cost-effectiveness. However, maintaining appropriate serum levels is crucial due to the narrow therapeutic window, as subtherapeutic levels can lead to treatment failure or adverse outcomes. This study aimed to identify the factors associated with subtherapeutic serum levels of valproic acid in patients undergoing treatment. This retrospective cohort study was performed at a tertiary care hospital and involved inpatients aged ≥ 18 years who were receiving valproic acid for epilepsy treatment. Data were obtained through chart reviews and a Therapeutic Drug Monitoring database. Subtherapeutic VPA levels were defined as < 50 mg/L. Logistic regression was used to identify risk factors for subtherapeutic levels. Of the 152 patients, 96 (63.2%) had subtherapeutic VPA levels (<50 mg/L). Males were more likely than females to have subtherapeutic levels (OR 2.45, 95% CI: 1.15-5.22; P = .02). Previous use of phenytoin significantly increased the risk of subtherapeutic VPA levels (OR 2.58, 95% CI: 1.16-5.71; P = .02). VPA administration by syrup and doses below 15 mg/kg/day were associated with subtherapeutic levels (OR 3.28 and 2.34, respectively). Additionally, co-medications, such as topiramate and meropenem, also increased this risk (OR 5.09 and 4.64, respectively). This study identified several factors significantly associated with subtherapeutic levels of valproic acid, including males, prior phenytoin use, co-medications, such as topiramate and meropenem, and lower VPA dosages. These findings underscore the importance of careful monitoring and individualized treatment plans to maintain therapeutic VPA levels in clinical practice. Further research is needed to explore the clinical implications and to develop strategies to minimize the risk of subtherapeutic levels in patients receiving VPA.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"103 45","pages":"e40488"},"PeriodicalIF":1.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623873","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}