Therapeutics and Clinical Risk Management最新文献

{"title":"Knowledge Graphs for Cervical Cancer Across the Care Continuum: From Vaccination and Screening to Personalized Therapy.","authors":"Jiyan Leng, Wenzhi Wei, Xiaohua Wen, Shan Lu, Yanru Liu","doi":"10.2147/TCRM.S619879","DOIUrl":"10.2147/TCRM.S619879","url":null,"abstract":"<p><p>Cervical cancer remains one of the leading causes of cancer-related death among women worldwide, with a disproportionately high burden in low- and middle-income countries. Infection with human papillomavirus (HPV) is the central etiological factor. Although HPV vaccination and standardized screening can substantially reduce incidence and mortality, major bottlenecks persist in real-world settings, including inadequate coverage, loss to follow-up, data silos, and limited interpretability of algorithms. Knowledge graphs (KGs), characterized by their core \"entity-relation\" structure, can integrate electronic medical records, HPV genotyping, pathology/imaging, multi-omics, and public health data within a unified semantic framework, and provide traceable evidence chains and reasoning pathways to support clinical decision-making. KGs may become an important enabler. This review summarizes the potential mechanisms and application paradigms of KGs along the full continuum of cervical cancer prevention and care, including primary prevention (vaccination strategies and health education), screening and diagnosis (multimodal data integration, explainable AI, and clinical decision support systems, CDSS), as well as therapeutic decision-making and follow-up management (molecular subtyping, drug associations, and recurrence monitoring. We further highlight key challenges such as ontology standardization, cross-institutional interoperability, dynamic knowledge updating, and reliability of automated knowledge extraction. Future work should focus on establishing reusable, engineering-oriented pathways for the synergy of \"KG + large language models (LLMs)/multimodal AI\", the development of explainability evaluation metrics, privacy-compliant frameworks, and deployable solutions for primary care settings, in order to accelerate progress toward the global cervical cancer elimination goal.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"619879"},"PeriodicalIF":2.6,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of a Motor-Cognitive Stepping Training Program During Acute Hospitalization in Patients with Traumatic Brain Injury.","authors":"Julia Brechbühl, Anne-Katrin Hickmann, Erik Schulz, Alexandra Steurer, Eleftheria Giannouli","doi":"10.2147/TCRM.S599343","DOIUrl":"https://doi.org/10.2147/TCRM.S599343","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) survivors often experience mobility issues which are further worsened by cognitive deficits. Dual-task training has shown promising effects in people with TBI. This study aims to evaluate the feasibility of the novel training concept \"StepIt\", which addresses motor and cognitive falls-related aspects during acute hospitalization in TBI patients.</p><p><strong>Methods: </strong>Persons admitted to the hospital with a mild to severe TBI received individual training sessions of approximately 15 minutes per session during their hospital stay according to the \"StepIt\" training concept. The main outcome was feasibility as measured by rates of recruitment, inclusion, adherence, compliance, attrition, and safety. Secondary outcomes were training performance and user evaluation.</p><p><strong>Results: </strong>Rates for recruitment, adherence, and compliance were 72.9%, 87.5%, and 93.8%, respectively. No intervention-related adverse events occurred during the study period. The inclusion rate was 7.4% and attrition rate was 42.9%. Overall, four of the six predefined feasibility criteria were met, indicating that modifications to the study design are required before proceeding to a larger-scale study.</p><p><strong>Conclusion: </strong>The findings support the feasibility of StepIt during acute hospitalization in people with TBI, although modifications to the study design are needed. Future studies should examine its feasibility in different settings, such as inpatient or outpatient rehabilitation.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"599343"},"PeriodicalIF":2.6,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beta-Caryophyllene (BCP) Modulating the Endocannabinoid System and PPARγ to Combat Metabolic Dysregulation: A Narrative Review.","authors":"Siti Nur Asiyah Rahmah, Tasza Noor Aisyah, Anna Meiliana, Miski Aghnia Khairinisa, Anggih Retno Pratiwi","doi":"10.2147/TCRM.S616072","DOIUrl":"10.2147/TCRM.S616072","url":null,"abstract":"<p><p>Metabolic diseases are characterized by disruptions in normal metabolic processes and are often caused by genetic, environmental, or lifestyle-related factors. These conditions, including obesity, type 2 diabetes mellitus (T2DM), metabolic syndrome, and dyslipidemia, are associated with impaired regulation of glucose and lipid metabolism, chronic inflammation, and insulin resistance. Several studies have also shown that metabolic diseases cause the body to experience a state of dysregulation, characterized by impaired insulin signaling, chronic low-grade inflammation, mitochondrial dysfunction, and abnormal lipid and glucose homeostasis. This review summarizes current research on therapeutic strategies for modulating the molecular pathways involved in metabolic diseases. The primary focus is on the use of beta (β)-caryophyllene (BCP), which has demonstrated therapeutic potential in treatment through various molecular mechanisms involving activation of the endocannabinoid system and PPAR-γ receptors, either directly or indirectly. Crucially, BCP exerts its lipid-lowering and insulin-sensitizing effects by activating the AMPK/SIRT1 signaling pathways and inhibiting HMG-CoA reductase. Evidence from animal studies suggests that BCP reduces oxidative stress and systemic inflammation by lowering the levels of pro-inflammatory cytokines such as TNF-α and IL-6, while improving the expression of adiponectin and leptin. Unlike previous literature that predominantly focuses on isolated cellular pathways, the novelty of this review lies in its comprehensive integration of BCP's pharmacodynamics with its pharmacokinetic (ADME) limitations. By explicitly addressing translational hurdles-such as BCP's extensive first-pass metabolism and the need for advanced self-emulsifying delivery systems (SEDDS)-this work provides a uniquely balanced perspective. A comprehensive synthesis of BCP's molecular mechanisms in metabolic diseases is crucial for exploring its potential as a safer, effective complementary therapy. Given its unique mechanism of action and safety profile, BCP is a promising candidate for further clinical investigation. This review highlights the importance of exploring BCP as a complementary approach for managing metabolic health.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"616072"},"PeriodicalIF":2.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13598633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Risk Stratification of Severe Trauma in the Emergency Department: Integrating Clinical Scoring Systems, Dynamic Biomarkers, and Artificial Intelligence-A Narrative Review.","authors":"Xiabing Sun, Jie Han, Jianjian Ni, Yujie Shen","doi":"10.2147/TCRM.S619371","DOIUrl":"10.2147/TCRM.S619371","url":null,"abstract":"<p><p>Severe trauma remains a major global cause of death and disability, particularly among individuals younger than 45 years. Emergency departments are the main gateway to trauma care, where rapid risk stratification guides resuscitation, surgical decision-making, intensive care admission, and resource allocation. Conventional tools, including the Revised Trauma Score, Glasgow Coma Scale, Injury Severity Score, and Trauma and Injury Severity Score, standardize early assessment but rely largely on static variables and may not capture dynamic physiological changes during resuscitation. Dynamic biomarkers offer additional biological information. Glial fibrillary acidic protein, S100B, neuron-specific enolase, serum lactate, and lactate clearance may reflect neuronal injury, tissue hypoperfusion, metabolic stress, and how effectively resuscitation is restoring perfusion. Artificial intelligence and machine-learning models can integrate vital signs, laboratory findings, imaging data, biomarkers, and demographic variables to generate individualized predictions of mortality, clinical deterioration, intensive care requirements, and complications. Recent studies suggest that some machine-learning models may outperform conventional scoring systems; however, limitations involving data heterogeneity, algorithmic bias, interpretability, external validation, privacy, and clinical workflow integration remain. This narrative review synthesizes current evidence on conventional trauma scoring systems, dynamic biomarkers, and artificial intelligence-based prediction models for early risk stratification of severe trauma in emergency departments. It also examines the potential of multimodal frameworks that combine physiological, anatomical, molecular, and computational information. Although integrated prediction systems may improve accuracy and clinical decision-making, prospective multicenter validation and evidence of real-world clinical benefit are required before routine implementation.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"619371"},"PeriodicalIF":2.6,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Prognostic Value of Baseline CRP, NLR, and MLR for 12-Month Outcomes After Ischaemic Stroke: A Prospective Cohort Study.","authors":"Yu Zhao, Yutong Wang, Shengyuan Wang","doi":"10.2147/TCRM.S624708","DOIUrl":"10.2147/TCRM.S624708","url":null,"abstract":"<p><strong>Background and objective: </strong>C-reactive protein (CRP), the neutrophil-to-lymphocyte ratio (NLR) and the monocyte-to-lymphocyte ratio (MLR) are routinely available inflammatory markers of uncertain relative prognostic value after stroke. This study aimed to investigate the associations of baseline CRP, NLR, and MLR with 12-month mortality and recurrence in patients with stroke.</p><p><strong>Methods: </strong>This single-center prospective cohort study enrolled hospitalized patients with stroke. Univariable analyses were performed to compare baseline characteristics according to 12-month mortality and recurrence status. Multivariable logistic regression models were constructed to evaluate the independent associations of CRP, NLR, and MLR with 12-month mortality and recurrence after adjustment for clinically relevant covariates.</p><p><strong>Results: </strong>A total of 2937 patients were included in the baseline analysis. Among them, 2166 were included in the 12-month mortality analysis, and 237 died during follow-up. In the multivariable logistic regression model, higher CRP was independently associated with an increased risk of 12-month mortality (OR = 1.01, 95% CI: 1.01-1.02, <i>P</i> < 0.001). NLR showed a borderline association with mortality (OR = 1.06, 95% CI: 1.00-1.13, <i>P</i> = 0.064), whereas MLR was not independently associated with mortality. A total of 2018 patients were included in the 12-month recurrence analysis, among whom 614 experienced recurrent events. In the multivariable model, higher CRP was independently associated with an increased risk of recurrence (OR = 1.01, 95% CI: 1.00-1.02, <i>P</i> = 0.025), whereas NLR and MLR was not independently associated with recurrence.</p><p><strong>Conclusion: </strong>Baseline CRP was independently associated with 12-month mortality and, more weakly, with recurrence. The mortality association was substantially stronger, and CRP should be regarded primarily as a marker of long-term mortality risk. NLR and MLR showed no independent association with either endpoint. CRP, combined with key clinical indicators, may assist long-term risk stratification after ischaemic stroke.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"624708"},"PeriodicalIF":2.6,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Management in First-in-Human Trials of Intravenous Drugs: Current Practices and Future Perspectives.","authors":"Wei Zhang, Dandan Yang, Rong Shao, Tiantian Lai, Xiuqin Feng","doi":"10.2147/TCRM.S623874","DOIUrl":"10.2147/TCRM.S623874","url":null,"abstract":"<p><p>In the first-in-human (FIH) study, the intravenous (IV) administration represents a critical juncture where preclinical data meet human physiology, characterized by immediate systemic exposure and an extremely narrow margin for safety. The current management measures for these trials are fragmented and lack a systematic framework. This narrative review, informed by a structured synthesis of peer-reviewed literature, regulatory guidance documents, and systematic institutional experience from multiple IV FIH trials conducted between 2020 and 2025, summarizes the key risk factors for FIH-IV trials, including pharmacological uncertainties, formulation-related toxicity, infusion rate sensitivity, and participant heterogeneity. It further evaluates preventive strategies such as determination of starting dose, personnel management and ensuring operational readiness, standardization of medication preparation and administration, comprehensive safety monitoring, and emergency response coordination and infrastructure. The primary aim is to propose a conceptual, stratified risk management framework that categorizes trials into low-, moderate-, and high-risk levels based on drug-related, procedural, and participant-specific variables. Corresponding management strategies are then applied to each level: standardized for low risk, enhanced for moderate risk, and advanced for high risk. This structured approach optimizes safety assurance in high-risk trials while avoiding the overutilization of resources in low-risk settings. The proposed framework is intended as a conceptual supplement to existing regulatory guidelines (eg, ICH E6(R3), EMA FIH guideline) and requires prospective multicenter validation before broad implementation.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"623874"},"PeriodicalIF":2.6,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medication Safety and Perioperative Risk Management of GLP-1 Receptor Agonists: A Pharmacist-Led Framework for Individualized Care.","authors":"Naitao Shen, Chenyang Zhu, Fengqing Wang, Miaolian Wu","doi":"10.2147/TCRM.S623743","DOIUrl":"10.2147/TCRM.S623743","url":null,"abstract":"<p><p>Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used for type 2 diabetes, obesity, and broader cardiometabolic, cardiorenal, and metabolic liver disease indications, creating new challenges for perioperative medication safety. This review summarizes current evidence on GLP-1RA-associated delayed gastric emptying and proposes a structured pharmacist-led framework for individualized perioperative risk management. GLP-1RAs may increase the likelihood of residual gastric contents during anesthesia or procedural sedation despite adherence to standard fasting recommendations. Perioperative outcome studies have not consistently shown an increased risk of aspiration pneumonia; however, these findings should be interpreted in light of the low incidence of aspiration-related events, the predominance of retrospective study designs, residual confounding, and heterogeneous definitions of residual gastric contents. We review mechanisms of delayed gastric emptying, treatment- and patient-related risk modifiers, perioperative clinical evidence, areas of agreement and divergence among major guidance statements, gastric ultrasonography as a selective risk-mitigation tool, and medication-safety issues beyond aspiration, including oral drug absorption and postoperative resumption. Because perioperative GLP-1RA decisions require accurate medication history, last-dose verification, symptom assessment, evaluation of glycemic consequences of drug interruption, coordination with anesthesia and surgical teams, and safe postoperative restart planning, pharmacists are well positioned to support this process. The proposed pharmacist-led pathway provides a structured approach to GLP-1RA medication verification, gastrointestinal symptom screening, risk phenotyping, multidisciplinary escalation, day-of-surgery reassessment, postoperative restart planning, patient education, and documentation. Perioperative GLP-1RA management should not rely on routine discontinuation alone, but should integrate treatment phase, dose escalation, gastrointestinal symptoms, comorbid motility disorders, procedural urgency, anesthetic risk, oral medication considerations, and the metabolic consequences of withholding therapy. This pathway represents a structured implementation framework informed by current evidence and guidance; prospective evaluation in real-world perioperative settings is needed.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"623743"},"PeriodicalIF":2.6,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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 Preoperative Mechanical Bowel Preparation and Postoperative Cognitive Dysfunction in Patients Undergoing Colorectal Surgery: A Pilot Randomized Controlled Trial.","authors":"Ayşe Ülgey, Gamze Talih, Tutkun Talih, Elif Funda Sener, Saliha Ozsoy, Oğuz Kaan Şimşek, Ersin Sönmez, Halime Dana","doi":"10.2147/TCRM.S613539","DOIUrl":"10.2147/TCRM.S613539","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative cognitive dysfunction (POCD) is a common condition that greatly threatens patients' quality of life. While mechanical bowel preparation (MBP) enhances surgical visibility, its effect on postoperative complication rates remains debated. This study aims to evaluate the effect of MBP on POCD in patients undergoing colorectal surgery and to investigate its association with tau protein, brain-derived neurotrophic factor (BDNF) and lipopolysaccharide-binding protein (LBP) levels.</p><p><strong>Methods: </strong>This is a single-center randomized controlled trial. 80 eligible ASA-PS II-III colorectal surgery patients were randomized into his pilot study, which was designed as a randomized controlled trial. Cognitive function was assessed preoperatively (T1), postoperatively on day 15 (T2), and on day 90 (T3) using the Montreal Cognitive Assessment (MoCA). Blood samples were collected simultaneously from the patients for biomarker analysis. A decline of > 1 standard deviation from baseline on the MoCA was defined as POCD.</p><p><strong>Results: </strong>The incidence of POCD was significantly lower in patients without MBP compared to those with MBP (7.5% vs. 55%). At T3, BDNF levels were significantly higher in Group I than in Group II (p < 0.001). LBP levels were significantly higher in Group II than in Group I at T3 (p = 0.001). In patients with POCD, tau protein levels were significantly higher at T2 and T3 (p = 0.007; p = 0.012), while BDNF levels were significantly lower at T3 (p < 0.001).</p><p><strong>Conclusion: </strong>MBP was associated with a higher incidence of POCD in patients undergoing colorectal surgery; however, these preliminary findings require confirmation in larger trials.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"613539"},"PeriodicalIF":2.6,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Medicinal Encircling Therapy for Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis.","authors":"Panpan Li, Zilai Li, Shang Ju","doi":"10.2147/TCRM.S602768","DOIUrl":"10.2147/TCRM.S602768","url":null,"abstract":"<p><strong>Purpose: </strong>Diabetic foot ulcers represent a major clinical challenge due to delayed healing and high risk of complications. Medicinal encircling therapy, a traditional external treatment, has been widely used as an adjunctive intervention in clinical practice. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of medicinal encircling therapy combined with conventional treatment for diabetic foot ulcers.</p><p><strong>Material and methods: </strong>A comprehensive literature search was conducted across major English and Chinese databases from inception to November 1, 2025. Randomized controlled trials comparing medicinal encircling therapy plus conventional care versus conventional care alone were included. Primary and secondary outcomes related to ulcer healing, symptom improvement, inflammatory markers, pain, and adverse events were synthesized using risk ratios or mean differences with corresponding 95% confidence intervals. This systematic review was prospectively registered with PROSPERO (CRD420261299230).</p><p><strong>Results: </strong>Fifteen randomized controlled trials were included, all of which were published in Chinese. The pooled results showed that adjunctive medicinal encircling therapy significantly improved complete ulcer healing rate compared with conventional treatment alone (RR = 1.78, 95% CI 1.39-2.28). Overall clinical response and several secondary outcomes generally favored the intervention, although heterogeneity was observed for some outcomes. No serious treatment-related adverse events were reported.</p><p><strong>Conclusion: </strong>These findings suggest that medicinal encircling therapy may be a promising adjunctive treatment for diabetic foot ulcers; however, the certainty and generalizability of the evidence are limited by methodological shortcomings, incomplete safety reporting, and the inclusion of Chinese-language studies only. Further high-quality, multicenter randomized controlled trials are warranted.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"602768"},"PeriodicalIF":2.6,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148607557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally Invasive Evacuation for Spontaneous Supratentorial Intracerebral Hemorrhage After Contemporary Randomized Trials: Patient Selection, Timing, and Platform Choice.","authors":"Xin Shao, Chen Tan, Meiqi Yu, Fan Yang","doi":"10.2147/TCRM.S619414","DOIUrl":"10.2147/TCRM.S619414","url":null,"abstract":"<p><p>Spontaneous intracerebral hemorrhage (ICH) accounts for only 10-15% of all strokes but contributes disproportionately to stroke-related death and long-term disability. For decades, surgical evacuation of supratentorial ICH failed to show consistent functional benefit in randomized trials. The Early Minimally Invasive Removal of Intracerebral Hemorrhage (ENRICH) trial altered this trajectory by providing the first positive randomized evidence that an early, protocolized minimally invasive parafascicular approach can improve utility-weighted 180-day outcome in a predominantly lobar population. Interpretation was complicated by the 2025 MIND trial, which tested Artemis-based minimally invasive evacuation in a cohort dominated by deep hemorrhage and, after early termination, did not show benefit on its primary endpoint. In parallel, the SWITCH trial suggested at most a limited role for decompressive craniectomy without clot evacuation in severe deep ICH, with any possible reduction in death or extreme disability tempered by substantial residual disability among survivors. These trials indicate that the current issue is no longer the general rationale for surgery, but the specific patients, treatment window, and technical conditions under which evacuation is most likely to confer net benefit. This review traces the evidence from the International Surgical Trial in Intracerebral Haemorrhage (STICH) program and the Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation (MISTIE) program to ENRICH and MIND, compares the major minimally invasive strategies, and examines hemorrhage location, hematoma volume, and treatment timing as the principal determinants of patient selection. On the basis of current randomized evidence, the clearest evidence-supported indication is early (<24 h) minimally invasive evacuation for patients resembling the ENRICH population: lobar supratentorial ICH, hematoma volume 30-80 mL, and treatment performed by a trained team using a standardized parafascicular workflow. Conversely, routine minimally invasive evacuation for most deep supratentorial hemorrhages, ultra-early (<8 h) intervention outside clinical trials, intervention beyond the ENRICH-supported early window, and the use of alternative platforms without comparable randomized support should be regarded as investigational or extrapolative rather than established standard care.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"619414"},"PeriodicalIF":2.6,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13401885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}