Therapeutics and Clinical Risk Management最新文献

{"title":"Improved Tubeless Airway Management in JORRP Surgery: Comparative Analysis of Pre- and Post-THRIVE Implementation.","authors":"Guiyu Lei, Siliu Yang, Lili Wu, Yue Yin, Chunhua Xi, Yang Xiao, Guyan Wang","doi":"10.2147/TCRM.S513941","DOIUrl":"https://doi.org/10.2147/TCRM.S513941","url":null,"abstract":"<p><strong>Background: </strong>Juvenile-onset recurrent respiratory papillomatosis (JORRP) is a severe pediatric condition requiring frequent surgical interventions to maintain airway patency. Managing oxygenation during tubeless anesthesia for these surgeries poses significant challenges. In 2021, our center introduced transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) as a novel method for airway management in JORRP surgeries. This study evaluated the impact of THRIVE on perioperative outcomes in pediatric JORRP surgeries.</p><p><strong>Methods: </strong>This was a retrospective study of 122 pediatric JORRP surgical cases carried out at a tertiary center. Patients who underwent surgery prior to the implementation of THRIVE served as the control group (pre-THRIVE), while those treated after its introduction served as the intervention group (post-THRIVE), with 61 patients in each group. Perioperative data, including surgery and anesthesia parameters and extubation frequency were collected.</p><p><strong>Results: </strong>A total of 122 patients were included. Baseline characteristics were comparable between groups. After the introduction of THRIVE, the median number of extubations significantly decreased from a median 3 in the pre-THRIVE group to 1 in the post-THRIVE group (<i>P</i> <0.001). Minimum intraoperative SpO₂ levels were significantly higher in the post-THRIVE group (98% vs 85%, <i>P</i> <0.001). Surgery duration was reduced from 41 minutes to 35.5 minutes (<i>P</i> =0.003), and anesthesia duration decreased from 67 minutes to 58.5 minutes (<i>P</i> =0.016). No significant differences were observed in PACU stay length or complications between the groups.</p><p><strong>Conclusion: </strong>The implementation of THRIVE in pediatric JORRP enhances intraoperative efficiency and safety. Further research is warranted to assess its long-term effect.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"647-654"},"PeriodicalIF":2.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12068389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016194","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":"A Retrospective Machine Learning Analysis to Predict 3-Month Nonunion of Unstable Distal Clavicle Fracture Patients Treated with Open Reduction and Internal Fixation.","authors":"Changke Ma, Wei Lu, Limei Liang, Kaizong Huang, Jianjun Zou","doi":"10.2147/TCRM.S518774","DOIUrl":"https://doi.org/10.2147/TCRM.S518774","url":null,"abstract":"<p><strong>Background: </strong>This retrospective study aims to predict the risk of 3-month nonunion in patients with unstable distal clavicle fractures (UDCFs) treated with open reduction and internal fixation (ORIF) using machine learning (ML) methods. ML was chosen over traditional statistical approaches because of its superior ability to capture complex nonlinear interactions and to handle imbalanced datasets.</p><p><strong>Methods: </strong>We collected UDCFs patients at Nanjing Luhe People's Hospital (China) between January 2015 and May 2023. The unfavorable outcome was defined as 3-month nonunion, as represented by disappeared fracture line and continuous callus. Patients meeting inclusion criteria were randomly divided into training (70%) and testing (30%) sets. Five ML models (logistic regression, random forest classifier, extreme gradient boosting, multi-layer perceptron, and category boosting) were developed. Those models were selected based on univariate analysis and refined using the Least Absolute Shrinkage and Selection Operator (LASSO). Model performance was evaluated using AUROC, AUPRC, accuracy, sensitivity, specificity, F1 score, and calibration curves.</p><p><strong>Results: </strong>A total of 248 patients were finally included into this study, and 76 (30.6%) of them had unfavorable outcomes. While all five models showed similar trends, the CatBoost model achieved the highest performance (AUROC = 0.863, AUPRC = 0.801) with consistent identification of the risk factors mentioned above. The SHAP values identified the CCD as the significant predictor for assessing the risk of 3-month nonunion in patients with UDCFs within the Chinese demographic.</p><p><strong>Conclusion: </strong>The refined model incorporated four readily accessible variables, wherein the CCD, HDL levels, and blood loss were associated with an elevated risk of nonunion. Conversely, the application of nerve blocks, including postoperative block, was correlated with a reduced risk. Our results suggest that ML, particularly the CatBoost model, can be integrated into clinical workflows to aid surgeons in optimizing intraoperative techniques and postoperative management to reduce nonunion rates.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"633-645"},"PeriodicalIF":2.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049352","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":"Development and Validation of an Interpretable Machine Learning Model for Prediction of the Risk of Clinically Ineffective Reperfusion in Patients Following Thrombectomy for Ischemic Stroke.","authors":"Xiaolong Hu, Dayong Qi, Suya Li, Shifei Ye, Yue Chen, Wei Cao, Meng Du, Tianheng Zheng, Peng Li, Yibin Fang","doi":"10.2147/TCRM.S520362","DOIUrl":"https://doi.org/10.2147/TCRM.S520362","url":null,"abstract":"<p><strong>Background: </strong>Despite successful recanalization after thrombectomy in patients with acute ischemic stroke, poor prognosis often persists. This study aimed to investigate the factors contributing to clinically ineffective reperfusion (CIR), develop and validate a machine-learning model to predict CIR, and provide guidance for future clinical treatments.</p><p><strong>Methods: </strong>We collected data from patients undergoing thrombectomy at Shanghai Fourth People's Hospital between December 2021 and June 2024. The clinical variables were compared between the clinically ineffective and effective recanalization groups using univariate analysis. Four machine learning models were developed: random forest (RF), support vector machine (SVM), decision tree (DT), and k-nearest neighbor (KNN). Model performance was evaluated using receiver operating characteristic (ROC) curves and heatmap visualization. The SHAP method rank the feature importance and provided interpretability for the final model.</p><p><strong>Results: </strong>Among the four machine learning models, the RF model showed the best performance, with an area under the curve (AUC) of 0.96 (95% CI: 0.91-1.0), accuracy of 0.93, and specificity of 0.97 on the test dataset. The SHAP algorithm identified the number of endovascular thrombectomy (EVT) attempts as the key factor influencing CIR. Based on the RF model, a web-based calculator for CIR prediction is available at https://ineffectivereperfusion.shinyapps.io/calculate/. The final model included ten parameters: EVT attempts, diabetes mellitus, previous ischemic stroke, National Institutes of Health Stroke Scale (NIHSS score), preoperative infarction in the basal ganglia, baseline diastolic blood pressure, clot burden score (CBS)/basilar artery on computed tomography angiography (BATMAN) score, stroke cause, collateral grade, and MLS.</p><p><strong>Conclusion: </strong>We developed and validated the first interpretable machine learning model for CIR prediction after EVT, surpassing traditional methods. Our CIR risk prediction platform enables early intervention and personalized treatment. The number of EVT attempts has emerged as a key determinant, underscoring the need for optimized procedural timing to improve outcomes.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"621-631"},"PeriodicalIF":2.8,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035880","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 Factors for Postoperative Infections in Severe Traumatic Brain Injury Patients Undergoing Emergency Craniotomy.","authors":"Zhiyu Zhang, Lin Xu, Sheng Xu","doi":"10.2147/TCRM.S512780","DOIUrl":"https://doi.org/10.2147/TCRM.S512780","url":null,"abstract":"<p><strong>Background and aim: </strong>Severe traumatic brain injury (TBI) patients undergoing emergency craniotomy are at high risk of postoperative infections. This study aims to identify the risk factors associated with these infections to improve patient outcomes.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted, including 312 severe TBI patients who underwent emergency craniotomy at Brain Hospital of Hunan Province between December 2019 and December 2021. Clinical data were collected, and both univariate and multivariate logistic regression analyses were performed to identify risk factors for postoperative infections.</p><p><strong>Results: </strong>Among the 312 patients, 57 (18.3%) developed postoperative infections. Multivariate analysis identified several significant risk factors, including older age (OR=1.75, 95% CI: 1.23-2.49), prolonged surgery duration (OR=2.01, 95% CI: 1.38-2.92), presence of preoperative infection (OR=2.59, 95% CI: 1.64-4.09), and lower Glasgow Coma Scale (GCS) score on admission (OR=1.82, 95% CI: 1.21-2.74).</p><p><strong>Conclusion: </strong>Identifying patients at high risk for postoperative infections can help guide preventive measures and improve outcomes in severe TBI patients undergoing emergency craniotomy.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"609-619"},"PeriodicalIF":2.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024068","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":"Impact of Relaxation and Music Intervention on Psychological and Gastrointestinal Health in Military Recruits: A Prospective Study.","authors":"Jun Liu, Tingwei Liu, Haoxu Lu, Xinyuan Zhao, Shanshan Ma, Fudan Song, Nanhai Qiao, Wanshu Cheng, Xingshun Qi","doi":"10.2147/TCRM.S509551","DOIUrl":"https://doi.org/10.2147/TCRM.S509551","url":null,"abstract":"<p><strong>Background and aims: </strong>Gastrointestinal symptoms are closely associated with psychological problems, such as anxiety and depression. This prospective before-after study aimed to explore whether progressive muscular relaxation training combined with music intervention, which is potentially beneficial for psychological conditions, can improve gastrointestinal symptoms.</p><p><strong>Methods: </strong>A total of 623 recruits' effective questionnaires before and after intervention were collected. They underwent progressive muscular relaxation training combined with music intervention for 4 weeks. They also completed the Self-Rating Depression Scale (SDS) and the Patient Health Questionnaire (PHQ-9) for assessment of depression, the Self-Rating Anxiety Scale (SAS) and the Generalized Anxiety Disorder-7 (GAD-7) for assessment of anxiety, the Gastrointestinal Symptom Rating Scale (GSRS) for assessment of gastrointestinal symptoms, and the Bristol Stool Form Scale (BSFS) for assessment of stool before and after interventions. Changes of psychological conditions and gastrointestinal symptoms were evaluated.</p><p><strong>Results: </strong>The SDS (P<0.001), PHQ-9 (P<0.001), SAS (P<0.001), GAD-7 (P<0.001), and GSRS (P<0.001) scores were significantly decreased after intervention. The proportions of regurgitation (P<0.001), abdominal pain (P<0.001), dyspepsia (P<0.001), and constipation (P<0.001) evaluated by the GSRS were significantly decreased after intervention, but not diarrhea (P=0.601). The proportions of severe (P<0.001) and mild (P<0.001) constipation evaluated by the BSFS decreased after intervention, but those of severe (P=0.632) and mild (P<0.001) diarrhea evaluated by the BSFS increased.</p><p><strong>Conclusion: </strong>Short-term progressive muscular relaxation training in combination with music intervention is potentially effective for most gastrointestinal symptoms, but not for diarrhea, in recruits.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"593-608"},"PeriodicalIF":2.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12054544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987501","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":"Assessment of the Impact of Dexmedetomidine on Myocardial Injury in TAVI Patients: A Retrospective Cohort Study Utilizing PSM-DID.","authors":"Yang Song, Jin Zhang, Huiping Xu, Chaoqun Gui, Hao Cheng, Yongquan Chen, Shaolin Wang","doi":"10.2147/TCRM.S507439","DOIUrl":"https://doi.org/10.2147/TCRM.S507439","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter Aortic Valve Implantation (TAVI) is a minimally invasive procedure for treating severe aortic valve diseases but can lead to perioperative myocardial damage (PMD). Dexmedetomidine (DEX), an α2-adrenergic receptor agonist, has shown potential to reduce myocardial injury in other cardiac procedures. This effect is attributed to its anti-inflammatory properties, which help reduce the inflammatory response associated with myocardial damage, and its antioxidant properties, which combat oxidative stress that contributes to cell injury. But its effectiveness during TAVI remains unclear.</p><p><strong>Objective: </strong>To assess the impact of DEX on myocardial injury in patients undergoing TAVI under general anesthesia.</p><p><strong>Methods: </strong>A retrospective cohort study of 159 patients (after exclusions) who underwent TAVI from January 2022 to August 2024. Patients were divided into DEX and control groups. Primary outcomes were peak levels of cardiac troponin I and CK-MB within 48 hours postoperatively. Secondary outcomes included IL-6, PCT, and NT-proBNP levels. Propensity score matching (PSM) and Differences-in-Differences (DID) method were used for analysis.</p><p><strong>Results: </strong>After PSM, the DEX group exhibited significantly lower peak values of troponin I (P < 0.001) and CK-MB (P < 0.001) compared to the control group, indicating reduced myocardial injury. No significant differences were observed in IL-6, PCT, and NT-proBNP levels between the groups. The DID analysis suggested a negative correlation between DEX use and major adverse postoperative events, highlighting DEX as a potential protective factor.</p><p><strong>Conclusion: </strong>Dexmedetomidine administration during TAVI was associated with reduced levels of myocardial injury markers, indicating a potential cardioprotective role. By reducing myocardial injury, DEX may contribute to improved perioperative outcomes, including a decreased risk of major adverse postoperative events. These results highlight the potential clinical utility of DEX in the perioperative management of TAVI patients, suggesting that its inclusion in anesthetic protocols could enhance patient care and recovery.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"583-592"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038410","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":"Clinical Efficacy of Microplasma Radiofrequency in Treating Post-Traumatic Pigmentary Deposition: A VISIA Quantitative Analysis.","authors":"Yan Xu, Yan Yin, Zai-Quan Yang, Jing Li, Li-Na Guo, Chao Ma","doi":"10.2147/TCRM.S508522","DOIUrl":"https://doi.org/10.2147/TCRM.S508522","url":null,"abstract":"<p><strong>Objective: </strong>To observe the clinical efficacy of microplasma radiofrequency in treating post-traumatic pigmentary deposition using VISIA quantitative analysis, an innovative approach not previously emphasized in microplasma radiofrequency studies.</p><p><strong>Methods: </strong>Twenty patients with post-traumatic pigmentary deposition, treated at Cangzhou Central Hospital between July 2022 and December 2022, were selected. Pigmented areas were divided into four regions (A: control; B, C, D: treated with increasing energy parameters). Adverse effects (erythema, edema, micro-crusts, pruritus) were monitored at 2, 4, and 6 weeks post-treatment using CTCAE v5.0 criteria. Pigmentary deposition scores and VISIA parameters (spots, ultraviolet spots, red areas, brown spots) were evaluated.</p><p><strong>Results: </strong>At 2, 4, and 6 weeks, Groups B, C, D showed significant reductions in pigment scores and VISIA parameters vs Group A (P < 0.05), with Group D (highest energy) achieving maximal improvement. Transient mild-moderate erythema (60-100%), edema (40-80%), and micro-crusts (20-60%) occurred in treated groups, resolving spontaneously within 14 days; no severe adverse events were observed.</p><p><strong>Conclusion: </strong>Microplasma radiofrequency significantly improves post-traumatic pigmentary deposition, with energy-dependent efficacy. Despite transient side effects at higher energies, its favorable safety profile supports clinical adoption. VISIA quantitative analysis provides robust objective evaluation, advancing standardization in pigment management.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"575-582"},"PeriodicalIF":2.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12048295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043488","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":"Higher Neutrophil-Percentage-to-Albumin Ratio Was Associated with Poor Outcome in Endovascular Thrombectomy Patients.","authors":"Maoxia Xu, Qian Zhai, Bin Wei, Shuaiyu Chen, Yan E, Zhihang Huang, Jinwen Qi, Yiming Xu","doi":"10.2147/TCRM.S519263","DOIUrl":"https://doi.org/10.2147/TCRM.S519263","url":null,"abstract":"<p><strong>Background and purpose: </strong>The neutrophil percentage-to-albumin ratio (NPAR) is connected with all-cause mortality and stroke-related pneumonia. The purpose of this study was to assess the diagnostic efficacy of NPAR in predicting functional outcomes at 90 days after endovascular thrombectomy (EVT).</p><p><strong>Methods: </strong>We retrospective analyzed consecutive patients who underwent EVT at Nanjing First Hospital from October 2019 to June 2024. NPAR was defined as the percentage of neutrophils divided by the albumin levels. An unfavorable outcome was indicated by a modified Rankin Scale score of 3-6 at 90 days. Multivariable logistic regression models were utilized to investigate the association between NPAR and functional outcomes after EVT treatment.</p><p><strong>Results: </strong>A total of 713 patients (mean age, 70.5 ± 11.9 years; 430 males) were finally enrolled for analysis. Among these, 357 (50.1%) patients exhibited unfavorable outcomes at 90 days. Multivariate regression analysis indicated that elevated NPAR levels at admission were independently associated with poor outcome (adjusted odds ratio: 6.921; 95% confidence interval, 4.216-11.363; <i>P=</i>0.001) in ischemic stroke patients undergoing EVT. Furthermore, the restricted cubic spline observed a positive and nonlinear association between the NPAR and poor outcome at 90 days (<i>P</i> for linearity=0.001).</p><p><strong>Conclusion: </strong>This study indicated that higher NPAR levels were associated an increased risk of poor outcome at 90 days in patients treated with EVT, suggesting that NPAR could serve as a viable prognostic biomarker for ischemic stroke after EVT.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"565-573"},"PeriodicalIF":2.8,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12042835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016185","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":"Advanced Therapies in Elderly Patients With Inflammatory Bowel Disease: A Comparative Retrospective Cohort Study in Taiwan.","authors":"Shih-Hua Lin, Horng-Yih Chiu, Chia-Jung Kuo, Chien-Ming Chen, Ming-Yao Su, Ren-Chin Wu, Cheng-Tang Chiu, Chen-Wang Chang, Chen-Shuan Chung, Yu-Bin Pan, Puo-Hsien Le","doi":"10.2147/TCRM.S518405","DOIUrl":"https://doi.org/10.2147/TCRM.S518405","url":null,"abstract":"<p><strong>Purpose: </strong>Inflammatory Bowel Disease (IBD) predominantly affects younger individuals, but emerging data indicates a shift toward older populations. Elderly-onset IBD (diagnosed at 60 years or older) differs from younger-onset IBD, presenting with atypical symptoms and higher risks of infections and malignancies. However, drug persistence is underexplored in the elderly IBD group, warranting further investigation to optimize treatment strategies for this demographic.</p><p><strong>Patients and methods: </strong>This retrospective cohort study included IBD patients receiving advanced therapies at the Chang Gung IBD Center from October 2017 to September 2023. Patients were stratified into two groups: elderly-onset (≥60 years) and control (<60 years). We compared one-year persistence of advanced therapies, opportunistic infections, IBD-related admissions, complications, surgeries, and acute flare-ups between the groups. Specifically, we analyzed the one-year persistence of various advanced therapies within the elderly-onset cohort.</p><p><strong>Results: </strong>The study included 511 IBD patients, 107 of whom were elderly-onset. Elderly-onset patients had a higher body mass index, a higher proportion of ulcerative colitis, fewer smokers, and lower levels of white blood cells, hemoglobin, and albumin. Differences were noted in Montreal classifications and a higher use of Vedolizumab. Clinical outcomes, including steroid-free remission rates, one-year therapy persistence, infections, complications, surgeries, and flare-ups, were comparable between groups. In Crohn's disease (CD), Infliximab and Ustekinumab exhibited higher one-year persistence. Predictors of one-year therapy persistence included Montreal L1 (OR: 6.722; 95% CI: 1.296-34.852; P=0.023), Ustekinumab use (OR: 5.672; 95% CI: 1.138-28.267; P=0.034), and hemoglobin level (OR: 1.612; 95% CI: 1.210-2.147; P=0.001) with an optimal cutoff of 11.65 g/dL.</p><p><strong>Conclusion: </strong>Elderly-onset IBD patients display unique clinical characteristics and therapy persistence, particularly in CD, highlighting the necessity for customized therapeutic strategies.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"533-542"},"PeriodicalIF":2.8,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014545","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 and Outcomes of Vessel-Sparing Surgery for Soft Tissue Sarcoma of the Thigh Adjacent to Femoral Vessels.","authors":"Zheng-Ming Yang, Hao Qu, Ke-Yi Wang, Jia-Dan Wu, Bing Liu, Li-Bin Jin, Xin Huang, Nong Lin, Hui-Min Tao, Zhao-Ming Ye","doi":"10.2147/TCRM.S506754","DOIUrl":"https://doi.org/10.2147/TCRM.S506754","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to investigate the feasibility and oncological outcomes of vessel-sparing surgery for soft tissue sarcomas located near the femoral vessels in the thigh. A comparison was made with cases where the tumor was not adjacent to the femoral vessels, focusing on recurrence rates, survival prognosis, and the viability of vessel-sparing surgical techniques.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 211 cases. After well-differentiated liposarcoma were excluded from further analysis, 148 cases involved tumors not adjacent to the femoral vessels, while 22 cases were located near the vessels. Postoperative functional outcomes, survival rates, and local recurrence were evaluated. Due to the imbalance in case numbers between the two groups, propensity score matching was applied at a 1:1 ratio, after which the two datasets were compared and analyzed.</p><p><strong>Results: </strong>By the last follow-up, 40 had experienced recurrence, 35 patients had died, 15 were surviving with tumors, and 161 were living tumor-free. No statistically significant differences were found between the survival and recurrence-free survival curves for cases with sarcomas adjacent to the femoral vessels compared to those with tumors located elsewhere, both before and after propensity score matching. Tumor grade and size were identified as key factors influencing survival and recurrence outcomes in soft tissue sarcoma of the thigh.</p><p><strong>Conclusion: </strong>For soft tissue sarcoma of the thigh located adjacent to femoral vessels, vessel-sparing surgery involving vascular sheath removal demonstrates favorable outcomes. Tumor size greater than 10 cm and high pathological grade were significant predictors of survival and recurrence risk.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"553-564"},"PeriodicalIF":2.8,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024055","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}