Therapeutics and Clinical Risk Management最新文献

{"title":"Retrospective Analysis of Prognostic Factors and Pregnancy Outcomes in Patients with Moderate-to-Severe Intrauterine Adhesions Following Hysteroscopic Adhesiolysis and Modified Intrauterine Stent Intervention.","authors":"Qiao Peng, Chao-Xia Cao, Yi-Nan Chen, Wei-Chu Liu, Rui-Kun Zhao, Quan-Jia Jiang, Qin Zhou","doi":"10.2147/TCRM.S511425","DOIUrl":"10.2147/TCRM.S511425","url":null,"abstract":"<p><strong>Objective: </strong>To assess the clinical prognosis and reproductive outcomes in individuals presenting with moderate-to-severe intrauterine adhesion (IUA) following the administration of hysteroscopic adhesiolysis (HA) in conjunction with modified intrauterine stents.</p><p><strong>Methods: </strong>A cohort comprising 156 individuals diagnosed with IUA (105 with moderate severity and 51 with severe severity) was enrolled. Subsequent to hysteroscopic intervention, all participants received intrauterine stent placement during the immediate postoperative phase. A comprehensive follow-up period of 2 years post-stent removal was instituted.</p><p><strong>Results: </strong>The occurrence of adhesion recurrence increased progressively, demonstrating a recurrence rate of 11.54% at hysteroscopic reevaluation administrated in 3 months after surgery and surging to 32.69% during the 2-year follow-up period. Comparative analysis indicated a statistically significant reduction in recurrence rates among patients with moderate IUA compared to severe IUA (P < 0.05). The median duration of stent placement was determined to be 4 months. Postoperatively, patients exhibited a cumulative pregnancy rate of 71.79%, with a live birth rate of 79.28%. Significantly, patients with moderate IUA exhibited a significantly elevated pregnancy rate in comparison to those with severe IUA (P = 0.004). Multifactorial logistic regression analysis revealed that the severity of IUA was an independent risk factor for recurrence risk. Furthermore, the severity of IUA and postoperative re-adhesion emerged as contributory factors to the infertility observed in these patients.</p><p><strong>Conclusion: </strong>The combination of HA with a modified intrauterine stent demonstrates efficacy in the treatment of IUA; however, outcomes remain suboptimal for cases characterized by severity. The prognostic assessment of patients and the suggested criteria for the removal of intrauterine stents, as delineated in the study, are considered both feasible and recommendable for clinical practice. Furthermore, conscientious and attentive management is imperative for the mitigation of adverse pregnancy such as early pregnancy loss in individuals afflicted with IUA during pregnancy.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"929-939"},"PeriodicalIF":2.8,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12191175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498022","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 Study on the Effect of STA Anesthesia Technique in the Extraction of Impacted Teeth in Dental Outpatients and Its Impact on Patient Anxiety Levels.","authors":"Jie Xu, Junsen Su, Guangfeng Liu, Wanggui Ying, Fang Yuan","doi":"10.2147/TCRM.S523718","DOIUrl":"10.2147/TCRM.S523718","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the effect of the Single Tooth Anesthesia (STA) technique in dental outpatient patients undergoing the extraction of impacted teeth and its impact on patient anxiety levels.</p><p><strong>Methods: </strong>This retrospective study included clinical data from 130 patients who underwent the extraction of a single mandibular impacted tooth in our dental outpatient department between April 2022 and June 2024. According to the anesthesia method, patients were divided into two groups: the Traditional Group (n = 65, receiving traditional local injection anesthesia) and the STA Group (n = 65, receiving Single Tooth Anesthesia). Parameters including intraoperative bleeding, duration of anesthesia, extent of anesthetic infiltration, blood pressure [systolic blood pressure (SBP), diastolic blood pressure (DBP)], heart rate (HR), pain [visual analog scale (VAS)], compliance (Frankl treatment compliance scale), tolerance (Houpt behavior scale), and anxiety level [modified dental anxiety scale (MDAS)] were compared between the two groups.</p><p><strong>Results: </strong>There were no significant differences in the amount of bleeding, anesthesia duration, or infiltration range between the two groups (P > 0.05). In the Traditional Group, SBP at 3 minutes after anesthesia and post-extraction was significantly higher than before anesthesia (P < 0.05), whereas DBP and HR showed no significant changes (P > 0.05). In the STA Group, SBP, DBP, and HR remained stable across the three time points (P > 0.05). Compared with the Traditional Group, the STA Group showed significantly lower pain scores, reduced anxiety, and higher rates of treatment compliance and tolerance (P < 0.05).</p><p><strong>Conclusion: </strong>Within the limitations of this retrospective study, the STA anesthesia technique showed advantages over traditional local injection anesthesia in reducing pain and anxiety, while improving compliance and tolerance during impacted tooth extraction in dental outpatients.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"941-950"},"PeriodicalIF":2.8,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12191143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498071","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 Onset-to-Needle Time on the Risk of Early Neurological Deterioration in Patients with Acute Ischemic Stroke Receiving Intravenous Thrombolysis.","authors":"Bo Hu, Jiewei Hua","doi":"10.2147/TCRM.S515542","DOIUrl":"10.2147/TCRM.S515542","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the influence of onset-to-needle time (ONT) on early neurological deterioration (END) in patients with acute ischemic stroke (AIS) undergoing intravenous thrombolysis.</p><p><strong>Methods: </strong>Patients with AIS receiving intravenous thrombolysis at The Fifth Hospital of Wuhan between March 2021 and December 2023 were enrolled. Patients were divided into an END group (n=104) and a non-END group (n=317) based on a National Institutes of Health Stroke Scale (NIHSS) score increase of ≥4 points within 24 hours. Baseline and clinical data were analyzed using univariate, multivariable logistic regression, and subgroup analyses. A logistic regression model was developed to predict END, and its performance was assessed using receiver operating characteristic (ROC) curves.</p><p><strong>Results: </strong>Univariate analysis revealed significant differences between groups in age, total cholesterol, low-density lipoprotein cholesterol (LDL-C), lipoprotein-associated phospholipase A2 (Lp-PLA2), white blood cell count, activated partial thromboplastin time (APTT), pre-admission NIHSS score, and ONT (all P<0.05). Heart disease history, infarct location, and Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification also differed significantly (all P<0.05). Multivariable analysis identified age (Odds Ratio [OR]=1.098, 95% Confidence Interval [CI]: 1.031-1.169, P=0.003), LDL-C (OR=2.785, 95% CI: 1.360-5.710, P=0.005), Lp-PLA2 (OR=1.008, 95% CI: 1.001-1.015, P=0.045), complete anterior circulation infarction (vs lacunar; OR=8.050, 95% CI: 5.180-12.510, P=0.023), cardioembolic stroke (vs small vessel occlusion; OR=12.810, 95% CI: 8.420-19.530, P=0.002), and ONT (OR=1.015, 95% CI: 1.002-1.028, P=0.028) as independent risk factors for END. Subgroup analysis by admission NIHSS score showed that for moderate and severe strokes, each minute increase in ONT raised END risk by 1.5% (95% CI: 1.002-1.028, P=0.031) and 3.0% (95% CI: 1.009-1.052, P=0.005), respectively.</p><p><strong>Conclusion: </strong>Prolonged ONT is an independent risk factor for END in AIS patients, particularly those with moderate to severe strokes. Prompt thrombolysis is crucial for mitigating neurological decline.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"917-927"},"PeriodicalIF":2.8,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12184684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476755","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":"AI-Assisted 3D Planning of CT Parameters for Personalized Femoral Prosthesis Selection in Total Hip Arthroplasty.","authors":"Tian-Jiao Yang, Wei Qian","doi":"10.2147/TCRM.S521755","DOIUrl":"10.2147/TCRM.S521755","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the efficacy of CT measurement parameters combined with AI-assisted 3D planning for personalized femoral prosthesis selection in total hip arthroplasty (THA).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on clinical data from 247 patients with unilateral hip or knee joint disorders treated at Renmin Hospital of Hubei University of Medicine between April 2021 and February 2024. All patients underwent preoperative full-pelvis and bilateral full-length femoral CT scans. The raw CT data were imported into Mimics 19.0 software to reconstruct a three-dimensional (3D) model of the healthy femur. Using 3-matic Research 11.0 software, the femoral head rotation center was located, and parameters including femoral head diameter (FHD), femoral neck length (FNL), femoral neck-shaft angle (FNSA), femoral offset (FO), femoral neck anteversion angle (FNAA), tip-apex distance (TAD), and tip-apex angle (TAA) were measured. AI-assisted THA 3D planning system AIJOINT V1.0.0.0 software was used for preoperative planning and design, enabling personalized selection of femoral prostheses with varying neck-shaft angles and surgical simulation. Groups were compared by gender, age, and parameters. ROC curves evaluated prediction efficacy.</p><p><strong>Results: </strong>Females exhibited smaller FHD, FNL, FO, TAD, TAA but larger FNSA/FNAA vs males (P<0.05). Patients >65 years had higher FO, TAD, TAA (P<0.05). TAD-TAA correlation was strong (r=0.954), while FNSA negatively correlated with TAD/TAA (r=-0.773/-0.701). ROC analysis demonstrated high predictive accuracy: TAD (AUC=0.891, sensitivity=91.7%, specificity=87.6%) and TAA (AUC=0.882, sensitivity=100%, specificity=88.8%).</p><p><strong>Conclusion: </strong>CT parameters (TAA, TAD, FNSA, FO) are interrelated and effective predictors for femoral prosthesis selection. Integration with AI-assisted planning optimizes personalized THA, reducing biomechanical mismatch risks.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"905-916"},"PeriodicalIF":2.8,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476754","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":"The Application of Opacification-Development Ratio Based on CT Scan for Diagnosing Pediatric Chronic Rhinosinusitis.","authors":"Jun Zhang, Anni Yang, Tengyu Chen, Yufeng Cao, Qiliang Lv, Yingxiang Xu, Zhenpeng Liao, Xianzhen Chen, Zhongkang Ye, Renjie Lai, Haiyu Hong","doi":"10.2147/TCRM.S520879","DOIUrl":"10.2147/TCRM.S520879","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the diagnostic potency of the opacification-development ratio (ODR) for pediatric chronic rhinosinusitis based on CT scanning.</p><p><strong>Patients and methods: </strong>Children aged 0-15 years who underwent nasal CT scanning from August 2011 through July 2021 were included in the research. The area under receiver operating characteristic curve (AUC) and predictive value were used to assess the diagnostic accuracy of the ODR and Lund-Mackay score based on CT scanning.</p><p><strong>Results: </strong>A total of 1820 patients (217 in the positive symptom group and 1603 in the negative symptom group) who underwent CT scanning were included in the study. A significant positive correlation was observed between the ODR and the Lund-Mackay score in all age groups. In children aged 0-15 years, the AUC of the ODR and the Lund-Mackay score were 0.7970 and 0.7719, respectively (p > 0.05). The optimal cut-off value for the ODR was 25.83, with a sensitivity of 57.14% and a specificity of 94.2%. In contrast, the optimal cut-off value for the Lund-Mackay score was 6.5, with a sensitivity of 6.5% and a specificity of 85.84%. Notably, the ODR score demonstrated significantly superior performance compared to the Lund-Mackay score in children aged 0-4 years (p < 0.001).</p><p><strong>Conclusion: </strong>In diagnosing pediatric chronic rhinosinusitis, the use of CT scans is associated with a higher rate of false positives when compared to clinical symptoms. The ODR score based on CT scanning is a valuable diagnostic tool for chronic rhinosinusitis in children aged 0-11, particularly those aged 0-4.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"895-904"},"PeriodicalIF":2.8,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326860","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 Antiviral Treatment on Survival in HBV-Related Intrahepatic Cholangiocarcinoma Patients After Hepatectomy: A 14-Year Retrospective Follow-Up Study Based on the Propensity Score Matching Method.","authors":"Zhiqiang Chen, Hui Zhang, Long Zhang, Guoyong Han, Yao Zhang, Jindao Wu, Xiangcheng Li, Xiaoxin Mu, Xuehao Wang","doi":"10.2147/TCRM.S520629","DOIUrl":"10.2147/TCRM.S520629","url":null,"abstract":"<p><strong>Purpose: </strong>Hepatitis B virus infection is one of the most common risk factors leading to the development of intrahepatic cholangiocarcinoma (ICC). This study aims to determine the impact of antiviral treatment (AVT) on the survival outcomes of ICC patients with hepatitis B virus infection.</p><p><strong>Patients and methods: </strong>This retrospective study included ICC patients who had HBV infection and underwent hepatectomy from May 2009 to June 2023 at a single medical center. Patients' baseline characteristics were analyzed, and the 14-year follow-up data were investigated using Kaplan-Meier curves and multivariable Cox proportional hazards regression models. The propensity score matching method was performed to balance the baseline differences between the AVT group and the non-AVT group.</p><p><strong>Results: </strong>A total of 229 patients were finally enrolled in the analysis. In the total cohort, 81 patients were classified into the AVT group and 148 patients into the non-AVT group. Kaplan-Meier curves showed that the AVT group exhibited prolonged overall survival and recurrence-free survival compared to the non-AVT group. Cox proportional hazards regression models revealed that AVT was an independent prognostic factor for both overall survival (HR 0.453, 95% CI: 0.280-0.732) and recurrence-free survival (HR 0.659, 95% CI: 0.436-0.997). A 1:1 nearest-neighbor matching algorithm was adopted, and 64 pairs of AVT and non-AVT patients were included in the propensity score matching cohort. Multivariable survival analyses confirmed AVT as a significant predictor for a favorable overall survival (HR 0.277, 95% CI: 0.147-0.519), but no statistical significance for recurrence-free survival was observed between the AVT group and the non-AVT group after propensity score matching.</p><p><strong>Conclusion: </strong>We analyzed the long-term follow-up data for ICC patients with hepatitis B virus infection who underwent hepatectomy. Notably, AVT exhibited a beneficial impact on overall survival for these postoperative ICC patients. However, our findings indicated no statistically significant effect of AVT on recurrence-free survival.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"869-884"},"PeriodicalIF":2.8,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12168928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310470","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":"Construction and Validation of Risk Scoring Model for Inadequate Bowel Preparation in Elderly Patients Undergoing Colonoscopy.","authors":"Yun Xu, Shan Ou, Xiu Yuan, Jie Yao, Tianwen Yang","doi":"10.2147/TCRM.S503389","DOIUrl":"10.2147/TCRM.S503389","url":null,"abstract":"<p><strong>Objective: </strong>To establish a prediction model for the risk of inadequate bowel preparation for colonoscopy in the elderly, and to validate the model to test its prediction effect.</p><p><strong>Methods: </strong>A total 927 patients who underwent colonoscopy in the First Affiliated Hospital to Chongqing Medical and Pharmaceutical College from January to December 2023 were selected as the modeling group, and were divided into the success group (839 patients) and failure group (88 patients) according to whether or not inadequate bowel preparation occurred, and then a logistic regression prediction model was established and transformed into a risk scoring system. The area under the ROC curve and the Hosmer-Lemeshow test were used for model differentiation and calibration, respectively, and the 10-fold cross-validation method was used for internal validation of the model. A total of 548 patients who underwent colonoscopy in our hospital from January to June 2024 were selected for external validation of the model.</p><p><strong>Results: </strong>Logistic regression analysis showed that age ≥65 years, diabetes mellitus, exercise habits, Bristol stool characterization scale, frailty, and ambulatory functional status were independent factors influencing the inadequate bowel preparation for colonoscopy in the elderly. The area under the ROC curve for the modeling group was 0.806, and the Hosmer-Lemeshow test showed p=0.870. The area under the ROC curve of the validation group was (0.785±0.090). The area under the ROC curve of the validation group was 0.824, and the Hosmer-Lemeshow test showed <i>P</i>=0.907, with a sensitivity of 73.13%, a specificity of 80.70%, and a Jordon's index of 0.538.</p><p><strong>Conclusion: </strong>The predictive model of the risk of inadequate bowel preparation for colonoscopy in elderly people can predict the risk of inadequate bowel preparation in elderly people, and can be used as a tool for clinical caregivers to screen the high-risk group of inadequate bowel preparation in the elderly.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"885-894"},"PeriodicalIF":2.8,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12168974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310469","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":"Muscular and Renal Safety of Ticagrelor with High-Intensity Statins: Retrospective Cohort Findings.","authors":"Abdullah S Alshammari, Amer A Shalwala, Mohammed A Alnuhait, Abdulfattah Y Alhazmi, Refal E Fagieha, Nura Bin Hallabi, Eyad A Alandijani, Mansour A Aloufi, Mudhhi S Alharbi, Reem S Alzahrani, Emad M Elkholy, Mahmoud E Elrggal, Abdulmalik S Alotaibi","doi":"10.2147/TCRM.S515732","DOIUrl":"10.2147/TCRM.S515732","url":null,"abstract":"<p><strong>Introduction: </strong>Ticagrelor is a widely used antiplatelet agent approved in over 70 countries, including the European Union and the United States, for reducing thrombotic events in patients with acute coronary syndromes (ACS). In clinical practice, combining ticagrelor with high-intensity statins is considered standard therapy for ACS. However, recent pharmacodynamic studies and case reports suggest potential drug-drug interactions that may increase the risk of adverse events, particularly muscular and renal complications. This study aimed to evaluate these risks in a real-world clinical setting in Saudi Arabia.</p><p><strong>Methods: </strong>This retrospective observational cohort study was conducted at the Makkah Cardiology Center, Saudi Arabia. The study included adult patients (n = 577) who were prescribed high-intensity statins, with or without concurrent ticagrelor. The primary outcomes were the incidence of statin-associated muscular complications-defined as myalgia, myopathy, myositis, or rhabdomyolysis-and acute kidney injury (AKI). Clinical data were extracted from the hospital information system, and statistical comparisons were conducted between patients receiving statin monotherapy and those receiving combination therapy.</p><p><strong>Results: </strong>The cohort consisted predominantly of male patients (74.5%). Muscle-related complications were significantly more common in the group receiving both ticagrelor and statins (20.2%) compared to the statin-only group (10.5%) (P = 0.001). Among comorbid conditions, hypertension was the only factor significantly associated with a higher incidence of muscle-related complications. Although a trend toward increased AKI incidence was observed in the combination therapy group, this difference did not reach statistical significance.</p><p><strong>Conclusion: </strong>This study highlights potential safety concerns related to the co-administration of ticagrelor and high-intensity statins, particularly the increased risk of muscle-related complications. While the findings on AKI were inconclusive, the results support the need for cautious use of this combination and call for larger prospective studies to further evaluate its safety profile and optimize treatment strategies.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"861-867"},"PeriodicalIF":2.8,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12161285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286571","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":"Preoperative Prognostic Nutritional Index as a Useful Tool for Predicting Postoperative Delirium in Elderly Patients with Degenerative Lumbar Diseases.","authors":"Jinlei Zhou, Jing Tang, Shanggao Xie, Haiyu Shao, Chen Xia, Yazeng Huang, Tingxiao Zhao","doi":"10.2147/TCRM.S520912","DOIUrl":"10.2147/TCRM.S520912","url":null,"abstract":"<p><strong>Purpose: </strong>The high incidence of postoperative delirium (POD) among patients undergoing lumbar spine surgery presents a significant barrier to achieving enhanced postoperative recovery. Accordingly, a thorough understanding and precise identification of common risk factors for POD in this surgical context are crucial to mitigating its occurrence and facilitating improved recovery outcomes. This study is the first to assess the predictive value of the Prognostic Nutritional Index (PNI) for POD in elderly patients undergoing transforaminal lumbar interbody fusion (TLIF) for degenerative lumbar spine disease.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of the outcomes of TLIF surgery in elderly patients with degenerative lumbar spine disease between 2020 and 2024. The diagnosis of POD was based on postoperative medical records during hospitalization, using the Confusion Assessment Method. The PNI was calculated based on preoperative serum albumin levels and total lymphocyte counts. Multivariate logistic regression analysis was performed to evaluate the relationship between preoperative PNI scores and the occurrence of POD. Finally, the optimal PNI cut-off point for predicting POD was determined using the receiver operating characteristic curve.</p><p><strong>Results: </strong>POD was observed in 61 of 370 patients, with PNI being significantly lower in the delirium group. The mean PNI values were 43.02±3.44 in the non-delirium group and 48.53±3.72 in the delirium group. Multivariate logistic regression analysis revealed that low PNI (OR: 0.743; 95% CI: 0.597-0.924; p = 0.008), low serum albumin levels (OR: 0.759; 95% CI: 0.584-0.987; p = 0.040), and advanced age (OR: 1.096; 95% CI: 1.030-1.166; p = 0.004) were independent predictors of POD following TLIF. The area under the curve (AUC) for PNI on the receiver operating characteristic curve was 0.864±0.025. The cutoff value for PNI, determined using the Youden index, was 45.825, with a sensitivity of 82.0% and a specificity of 74.4%.</p><p><strong>Conclusion: </strong>The preoperative use of PNI holds promise as a valuable tool for assessing the risk of POD in elderly patients undergoing TLIF.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"851-859"},"PeriodicalIF":2.8,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275970","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":"Enhanced Recovery After Surgery (ERAS) Rehabilitation Protocols Significantly Improve Postoperative Pain and Recovery in Ankle Fracture Surgery.","authors":"Qian Yang, Huan Yang, JunYan Zhao, Lei Ren","doi":"10.2147/TCRM.S517790","DOIUrl":"10.2147/TCRM.S517790","url":null,"abstract":"<p><strong>Background: </strong>Enhanced Recovery After Surgery (ERAS) principles have gained widespread recognition for optimizing recovery across various surgical specialties. Effective management of postoperative pain plays a pivotal role in facilitating early rehabilitation and enhancing patient outcomes, particularly in ankle fracture surgery. This study investigated the effectiveness of rehabilitation therapies rooted in ERAS protocols in alleviating postoperative wound pain and improving recovery for patients undergoing ankle fracture surgery.</p><p><strong>Methods: </strong>A total of 376 patients who underwent ankle fracture surgery between December 2022 and December 2023 were included in this retrospective analysis. Of these, 190 patients received ERAS-guided rehabilitation, while 186 underwent standard rehabilitation care. The ERAS program encompassed tailored interventions such as multimodal pain control, prompt mobilization, and personalized physical therapy regimens. Pain intensity was evaluated using the Visual Analog Scale (VAS) at 24 hours, 48 hours, and 7 days postoperatively. Additional metrics, including the duration of hospital stay, complication rates, and patient satisfaction, were also assessed.</p><p><strong>Results: </strong>Patients in the ERAS group experienced significantly lower VAS scores than the standard care group at 24 hours (4.2 ± 1.1 vs 5.6 ± 1.4, P<0.001), 48 hours (3.1 ± 0.9 vs 4.4 ± 1.2, P<0.001), and 7 days post-surgery (2.0 ± 0.7 vs 3.1 ± 0.9, P<0.001). Furthermore, those receiving ERAS care had a shorter average hospital stay (5.1 ± 1.6 days vs 6.7 ± 2.1 days, P<0.001) and reported higher levels of satisfaction (92.1% vs 78.4%, P<0.001). However, there were no statistically significant differences in overall complication rates between the two groups (3.7% vs 4.3%, P=0.712).</p><p><strong>Conclusion: </strong>Rehabilitation therapies incorporating ERAS principles demonstrate substantial benefits in reducing postoperative wound pain and expediting recovery in ankle fracture surgery patients. These findings underscore the value of integrating ERAS-driven protocols into clinical practice to enhance patient experiences and postoperative outcomes.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"841-850"},"PeriodicalIF":2.8,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267276","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}