Therapeutics and Clinical Risk Management最新文献

{"title":"Physical and Cognitive Impairments at ICU Discharge are Associated with High Long-Term Mortality in ICU Survivors with Solid Malignancies: A Retrospective Cohort Study.","authors":"Su Yeon Lee, Jin Won Huh, Sang-Bum Hong, Chae-Man Lim, Jee Hwan Ahn","doi":"10.2147/TCRM.S520206","DOIUrl":"10.2147/TCRM.S520206","url":null,"abstract":"<p><strong>Background: </strong>Many ICU survivors experience post-ICU physical, cognitive, or mental impairments. In ICU survivors with solid malignancies, post-ICU impairments can impede further cancer treatments and negatively impact their outcomes. This study aimed to investigate post-ICU mortalities and their risk factors at ICU discharge in ICU survivors with solid malignancies.</p><p><strong>Methods: </strong>In this retrospective cohort study, adult patients with solid malignancies who were unexpectedly admitted to the medical ICU of a tertiary hospital between 2016 and 2022 and survived to ICU discharge were included. Data at ICU discharge were collected from electronic medical records. In-hospital and 1-year mortality and their risk factors were analyzed.</p><p><strong>Results: </strong>Of the 708 ICU survivors, 25.1% died in the hospital, and 61% died within one year. At ICU discharge, 20.9% had delirium, 3.8% had coma, and 80.6% had impaired mobility. Respiratory support, including bilevel positive airway pressure (BiPAP), high-flow nasal cannula (HFNC), or other oxygen therapies was used in 88.7% of patients. Delirium (adjusted OR 1.73; 95% CI 1.04-2.87; p = 0.035), coma (adjusted OR 5.63; 95% CI 2.09-16.17; p < 0.001), limited mobility (adjusted OR 2.41; 95% CI 1.22-5.14; p = 0.015), and use of BiPAP (adjusted OR 21.63; 95% CI 5.36-99.57; p < 0.001) or HFNC (adjusted OR 7.08; 95% CI 2.45-23.99; p < 0.001) were independently associated with in-hospital mortality. One-year survival was significantly lower in patients with delirium (35%, p < 0.001), coma (26%, p < 0.001), limited mobility (37%, p = 0.003), or those receiving respiratory support at ICU discharge (35%, p < 0.001).</p><p><strong>Conclusion: </strong>A considerable portion of ICU survivors with solid malignancies died in the hospital or within one year after ICU discharge in our study. Cognitive, mobility, and pulmonary impairments at ICU discharge were significant risk factors for both in-hospital and long-term mortality.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"1121-1133"},"PeriodicalIF":2.8,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12296672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144733408","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 Neutrophil-to-Albumin Ratio as a Prognostic Indicator in Advanced Gastric Cancer Undergoing Radical Gastrectomy.","authors":"Huaping Ye, Rong Kang, Mao Chen, Si Zhang, Jinfeng Yang","doi":"10.2147/TCRM.S532863","DOIUrl":"10.2147/TCRM.S532863","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the prognostic significance of the preoperative neutrophil-to-albumin ratio (NAR) in patients with advanced gastric cancer undergoing radical gastrectomy.</p><p><strong>Methods: </strong>A retrospective analysis was conducted involving 526 patients diagnosed with locally advanced gastric adenocarcinoma who underwent radical gastrectomy between January 2017 and December 2019. Preoperative NAR values were calculated using neutrophil count and serum albumin levels obtained within 24 hours of admission. Patients were stratified into high-NAR and low-NAR groups using an optimal cut-off value determined by receiver operating characteristic analysis. Kaplan-Meier curves, univariate, and multivariate Cox regression analyses were used to evaluate overall survival and recurrence-free survival.</p><p><strong>Results: </strong>The optimal NAR cut-off value was identified as 2.8. Patients with high NAR exhibited significantly worse overall survival and recurrence-free survival compared to the low-NAR group. High NAR was significantly associated with advanced tumor stage, incomplete resection status, administration of chemotherapy and radiotherapy, and poor histological differentiation (all P < 0.0001). Multivariate analyses confirmed NAR as an independent prognostic factor for both overall survival (HR=2.67; 95% CI, 1.97-4.25; p = 0.002) and recurrence-free survival (HR=3.51; 95% CI, 1.58-5.26; p = 0.003).</p><p><strong>Conclusion: </strong>The preoperative neutrophil-to-albumin ratio is an independent and reliable prognostic biomarker for overall and recurrence-free survival in patients with advanced gastric cancer undergoing radical gastrectomy. Due to its accessibility, simplicity, and predictive value, the neutrophil-to-albumin ratio can effectively facilitate risk stratification, personalized clinical decision-making, and targeted interventions to improve patient outcomes.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"1107-1119"},"PeriodicalIF":2.8,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12285858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699622","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 Cost-Effectiveness of Two Artificial Liver Therapies in Early-Stage Hepatitis B Virus-Related Acute-on-Chronic Liver Failure: A Retrospective Cohort Study.","authors":"Jia Chen, Qiumin Luo, Lu Wang, Lihua Zheng, Yeqiong Zhang, Ying Liu, Liang Peng, Wenxiong Xu","doi":"10.2147/TCRM.S521406","DOIUrl":"10.2147/TCRM.S521406","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to compare the cost-effectiveness of the double plasma molecular adsorption system sequential low-volume plasma exchange (DPMAS+LPE) versus conventional plasma exchange (PE) in treating early-stage hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF).</p><p><strong>Patients and methods: </strong>A total of 215 early-stage HBV-ACLF patients were assigned to either DPMAS+LPE or conventional PE groups. After propensity score matching (1:1), 101 matched pairs were analyzed. We compared 30- and 90-day survival rates and direct medical costs from the healthcare payer's perspective. Cost-effectiveness analysis was performed with a willingness-to-pay (WTP) threshold of $12,681 and $38,043, equivalent to 1 and 3 times China's 2023 per capita GDP. Univariate and probabilistic sensitivity analyses (Bootstrap method) were used to assess parameter uncertainty.</p><p><strong>Results: </strong>Over the 90-day follow-up period, the DPMAS+LPE group had numerically higher survival rates compared to the PE group, but this difference was not statistically significant (91.04% vs 83.07%, Logrank: <i>P</i>=0.094). Compared to PE, DPMAS+LPE showed no economic benefit at 30 days. At 90 days, each 1% increase in the survival rate with DPMAS+LPE required an additional $3013.68 in medical costs, demonstrating cost-effectiveness. In the cirrhosis subgroup, the 90-day average total medical cost of the DPMAS+LPE group was lower than that of the PE group. At a WTP threshold of $12,681, the probability of DPMAS+LPE being cost-effective was 14% at 30 days and 75% at 90 days. At a WTP of $38,043, these probabilities increased to 45% and 90%, respectively. Univariate sensitivity analysis demonstrated that variations in the 90-day survival rates and costs for both groups still favored DPMAS+LPE within the 95% confidence interval. However, when the number of DPMAS+LPE treatments exceeded 4.4, it was no longer cost-effective.</p><p><strong>Conclusion: </strong>Compared to PE, DPMAS+LPE demonstrated cost-effectiveness at 90 days in early-stage HBV-ACLF patients, particularly those with cirrhosis. While DPMAS+LPE can be considered a suitable artificial liver therapy option for early-stage HBV-ACLF, careful consideration must be given to the number of treatments to ensure cost-effectiveness.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"1095-1105"},"PeriodicalIF":2.8,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12266066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650584","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":"Challenges in Traditional Chinese Medicine Clinical Trials: How to Balance Personalized Treatment and Standardized Research?","authors":"Yuyang Hu, Zhili Wang, Kaiwen Ni, Junchao Yang","doi":"10.2147/TCRM.S523279","DOIUrl":"10.2147/TCRM.S523279","url":null,"abstract":"<p><p>Randomized controlled trials (RCTs), as the highest level of evidence and the gold standard in clinical research, occupy a central position in modern medical research due to their stringent variable control and high internal validity. However, their vacuum-like research environment and standardized treatment approaches face significant challenges in traditional Chinese medicine (TCM), which emphasizes Treatment Tailored to Individual and Treatment Based on Syndrome Differentiation, focusing on personalized treatment according to a patient's constitution, age, gender, and lifestyle, and diagnosis based on specific syndromes. This approach lacks systematic modern clinical research and unified standards, conflicting with RCTs' standardized design, thus limiting TCM trials and posing serious challenges to its modernization and internationalization. This study systematically collected and categorized data on the registration status, study type, design, interventions and control measures, research objectives, primary outcome measures of registered trials by searching the ClinicalTrials.gov using TCM-related keywords. It reveals the current status and distribution patterns of TCM clinical registration trials. Evidence suggests that TCM clinical trials urgently need to seek a balance between standardized research and individualized treatment to address the limitations of RCTs in the TCM field, like implementation difficulties and the neglect of individual differences. To address this, the paper proposes an innovative research framework centered on pragmatic RCTs, highlighting randomization based on patient preferences to gather real-world evidence. Additionally, it suggests constructing a multidimensional core information set for standardized diagnosis of TCM syndromes by integrating disease and syndrome data to enhance diagnostic scientificity and increase the credibility and international acceptance of TCM clinical trials. The introduction of this framework effectively integrates the traditional characteristics of TCM with modern scientific methods, providing essential theoretical support and innovative solutions for the design and implementation of TCM clinical research, thereby enhancing TCM's role in global health.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"1085-1094"},"PeriodicalIF":2.8,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12262083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643618","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 Effect of Repairing the Integrity of the Calcaneofibular Ligament During Calcaneal Fracture Surgery on Postoperative Ankle Joint Function.","authors":"Zhenfeng Huang, Mengni Chen, Zhiwei Ye","doi":"10.2147/TCRM.S521627","DOIUrl":"10.2147/TCRM.S521627","url":null,"abstract":"<p><strong>Background: </strong>Calcaneal fracture is a common fracture in clinical practice. Open reduction and internal fixation of the calcaneal plate inevitably require cutting or damaging the calcaneofibulartibial fibrous ligament (CFL) beneath the sheath of the fibular muscle tendon. Hence, calcaneal fractures are mainly treated through the lateral L-shaped extension approach. However, there is still controversy over whether the integrity of CFL can be repaired during surgery. Thus, we aimed to explore the effect of repairing CFL during calcaneal fracture surgery on postoperative ankle joint function.</p><p><strong>Methods: </strong>In this retrospective study, we analyzed the clinical data of 84 patients with Sanders type II and III calcaneal fractures admitted to Wuhan Fourth Hospital from March 2021 to May 2023. According to whether CFL was repaired during surgery, the patients were divided into a repair group (n=44) and non-repair group (n=40). These patients underwent surgery by the same surgeon. The perioperative conditions between the two groups were compared. After a one-year follow-up, the rates of excellent ankle function and incidence of complications was also compared.</p><p><strong>Results: </strong>The duration of surgery and hospitalization in the repair group was longer than that in the non-repair group, and the intraoperative blood loss was greater than that in the non-repair group (<i>P</i><0.05). After surgery, the excellent and good rate of ankle function in the repair group (90.91%) was higher than that in the non-repair group (67.50%) (<i>P</i><0.05). The incidence of complications in the repair group (9.09%) was not significantly higher than that in the non-repair group (7.50%) (<i>P</i>>0.05).</p><p><strong>Conclusion: </strong>Although preserving CFL integrity during calcaneal fracture surgery increases the duration of surgery and hospitalization, the postoperative recovery of range of motion is good, the rate of excellent ankle function is significantly improved, and there is no significant increase in complications.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"1059-1067"},"PeriodicalIF":2.8,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643620","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":"Establishment and Verification of Risk Prediction Model for Adverse Outcomes After Hip Arthroplasty in Elderly Patients.","authors":"Jie Ding, Guoli Sun, Yifei Ren, Jiajia Xu, Qingqing Hu, Jun Luo, Zhaowen Wu, Ting Chu","doi":"10.2147/TCRM.S523040","DOIUrl":"10.2147/TCRM.S523040","url":null,"abstract":"<p><strong>Background: </strong>Adverse outcomes after hip arthroplasty in elderly patients are frequently observed; however, most existing studies concentrate on single complications. Comprehensive predictive models for a wider range of adverse outcomes remain insufficient. This study explores this issue and proposes new approaches for clinical practice.</p><p><strong>Purpose: </strong>This study aimed to construct and verify risk prediction model for adverse outcomes after hip arthroplasty in elderly patients.</p><p><strong>Patients and methods: </strong>The TRIPOD checklist was followed to guide the reporting of this study. Data from 620 subjects who underwent hip arthroplasty at a tertiary A-level hospital from January 1, 2021 to December 31, 2023 were used for the modelling group. Additionally, 264 post-hip arthroplasty patients admitted to the orthopaedic department of another tertiary A-level hospital from January 1, 2024 to December 31, 2024 were selected as the validation group. Risk prediction models were constructed by logistic regression, plotted in column line graphs and evaluated for their predictive effectiveness.</p><p><strong>Results: </strong>The factors included in the prediction model were age, malignancy history, surgical procedure, albumin, prothrombin time, ASA grade, operation duration, and changeover surgery status. Hosmer-Lemeshow test, <i>χ2</i>=5.418, <i>p</i>=0.712, the area under the receiver operating characteristic curve (AUC) was 0.902. The Youden index is 0.668, with a sensitivity of 0.84 and a specificity of 0.828. The correct practical application rate was 83.33%.</p><p><strong>Conclusion: </strong>The risk prediction model constructed in this study demonstrates favourable predictive performance and can serve as a reference for healthcare professionals in predicting the risk of adverse outcomes after hip arthroplasty in elderly patients.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"1047-1058"},"PeriodicalIF":2.8,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638163","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":"Exploring the Complementary Role of Traditional Chinese Medicine in Enhancing Percutaneous Coronary Intervention Outcomes: Mechanisms, Benefits, and Future Research Directions.","authors":"Sidao Zheng, Jun Guo, Qi Wang","doi":"10.2147/TCRM.S511630","DOIUrl":"10.2147/TCRM.S511630","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous coronary intervention (PCI) is a cornerstone treatment for coronary artery disease (CAD), yet opportunities remain to improve clinical outcomes, symptom management, and long-term prognosis. Traditional Chinese Medicine (TCM), with its multi-target and multi-pathway mechanisms, offers a promising complementary approach to enhance PCI efficacy.</p><p><strong>Methods: </strong>A systematic search was conducted in PubMed and Web of Science using the terms: (\"Percutaneous Coronary Intervention\" AND \"Traditional Chinese Medicine\") and (\"Percutaneous Coronary Intervention\" AND \"Chinese Herbal Drugs\"). Randomized controlled trials (RCTs) with ≥100 participants were included to evaluate TCM's clinical efficacy in PCI. Pharmacological studies were also reviewed to explore underlying mechanisms.</p><p><strong>Results: </strong>A review of 20 RCTs showed that TCM plays multiple roles in CAD treatment during PCI. Specific interventions such as Danhong Injection, Tongxinluo Capsule, and Shenzhu Guanxin Granule were found to alleviate angina symptoms, restore cardiac function, reduce cardiac biomarkers, prevent no-reflow/slow-flow phenomena, inhibit in-stent restenosis, and improve prognosis while reducing complications. Mechanistically, TCM exerts its effects through antiplatelet action, anti-inflammation, inhibition of smooth muscle proliferation, vasodilation, microcirculation improvement, and endothelial protection.</p><p><strong>Conclusion: </strong>This systematic review highlights the complementary benefits of TCM in PCI for CAD patients. Effective interventions such as Danhong Injection and Tongxinluo Capsule contribute to symptom relief, cardiac function restoration, restenosis inhibition, and prognosis improvement. These benefits are linked to TCM's multi-target mechanisms, including anti-inflammatory and antiplatelet effects. Future high-quality studies are needed to further validate these findings and refine clinical applications.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"1069-1083"},"PeriodicalIF":2.8,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643619","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":"Erratum: Impact of Hypertension and Antihypertensive Treatment on COVID-19 Severity: A Retrospective Observational Study in Ternopil Region, Ukraine [Corrigendum].","authors":"","doi":"10.2147/TCRM.S551276","DOIUrl":"https://doi.org/10.2147/TCRM.S551276","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.2147/TCRM.S527151.].</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"1045-1046"},"PeriodicalIF":2.8,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12256059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627133","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":"Endovascular Treatment in Stroke Patients of Working Age: A Multicenter Observational Study of Real-World Outcomes.","authors":"Yongting Zhou, Mohammad Mofatteh, Zijie Zheng, Feng Liu, Sijie Zhou, Jicai Ma, Zile Yan, Yuzheng Lai, Weijiang Li, Weiying Chen, Mohamad Abdalkader, Robert W Regenhardt, Xiangmin Liu","doi":"10.2147/TCRM.S508295","DOIUrl":"10.2147/TCRM.S508295","url":null,"abstract":"<p><strong>Purpose: </strong>The prevalence of acute ischemic stroke (AIS) is increasing among people of working age, posing socioeconomic and healthcare challenges. Inability to return to work can have significant negative consequences and contribute to the economic burden of stroke. Endovascular treatment (EVT) has been established as the standard of care for large vessel occlusion AIS patients. In this study, we aimed to identify factors predicting favorable outcome among working age AIS patients undergoing EVT.</p><p><strong>Patients and methods: </strong>We analyzed data from 309 patients from five comprehensive stroke centers between 2019 and 2023. All patients were working age (18<59) with symptoms onset of within 24 hours. Modified thrombolysis in cerebral infarction (mTICI) score of 2b-3 was considered as successful recanalization. We used 3-months mRS post-EVT to evaluate the outcome; mRS of 0-2 was defined as favorable outcome, whereas mRS of 3-6 was considered unfavorable outcome.</p><p><strong>Results: </strong>The unfavorable outcome group consisted of 150 patients, and 159 patients were in the favorable outcome group. More people in the unfavorable outcome group had diabetes (29.33% vs 15.72%, p=0.004) and hypertension (61.33% vs 40.88, p<0.001). A multivariable regression analysis demonstrated that several factors, including successful recanalization (odds ratio (OR) 5.298, 95% confidence interval (CI) 1.735-16.174, p=0.003), pre-EVT NIHSS (OR 0.892, 95% CI 0.852-0.934, p=0.000), baseline Alberta stroke program early CT score (ASPECTS) (OR 1.609, 95% CI 1.274-2.032, p=0.000), hypertension (OR 0.477, 95% CI 0.270-0.845, p=0.011), diabetes mellitus (OR 0.413, 95% CI 0.208-0.820, p=0.011), and symptomatic intracerebral hemorrhage (sICH) (OR 0.045, 95% CI 0.006-0.359, p=0.003) can predict the outcome of patients undergoing EVT.</p><p><strong>Conclusion: </strong>Favorable outcome of working age patients with AIS undergoing EVT can be predicted using multiple factors, including hypertension, diabetes mellitus, successful recanalization, pre-EVT NIHSS, baseline ASPECTS, and sICH.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"1009-1019"},"PeriodicalIF":2.8,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601692","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 Effect of Minimal-Dose S-Ketamine Administration Post-Surgery on Opioids Consumption and Functional Rehabilitation Exercises in Patients Undergoing Minimally Invasive Radical Resection of Esophageal Cancer.","authors":"Jue Xie, Fangming Shen, Xingming Wang, Juan Yao, Lingzhen Zhou, Luxin Huang, Jie Sun","doi":"10.2147/TCRM.S527262","DOIUrl":"10.2147/TCRM.S527262","url":null,"abstract":"<p><strong>Study objective: </strong>To examine the impact of minimal-dose S-ketamine on postoperative analgesia in patients undergoing minimally invasive radical resection for esophageal cancer, with a focus on reducing opioid consumption, enhancing analgesic quality, and facilitating postoperative recovery.</p><p><strong>Methods: </strong>A total of 216 patients undergoing minimally invasive radical resection of esophageal cancer under general anesthesia were randomly assigned into two groups (S-ketamine and control group), receiving intravenous S-ketamine (0.015 mg/kg/h) or an equal volume of saline for 48 h postoperatively. The primary outcome was cumulative oxycodone consumption in the first 48 h postoperatively. Secondary outcomes included functional activity score (FAS) after one bolus administration, numerical rating scale (NRS) pain scores at rest and when coughing, cumulative oxycodone consumption in different time periods, incidence of postoperative nausea and vomiting (PONV), level of sedation (LOS) score, time to first postoperative flatulence, postoperative delirium, activities of daily living assessed by BI (Barthel Index) and so on.</p><p><strong>Main results: </strong>The postoperative opioid consumption within 48 hours in S-ketamine group was significantly lower than those in placebo group (<i>P</i> < 0.001), and the difference between the two groups was 40% (mean: 44.5 mg vs 74.8 mg). FAS after one bolus administration and BI in the S-ketamine group were notably superior to those in the control group (<i>P</i> < 0.001). There were Statistical differences between the two groups in the NRS scores at rest at postoperative hour 48 (<i>P</i> = 0.001) and the NRS scores when coughing at postoperative hour 12 (<i>P</i> = 0.011) with mean differences of -0.3 and 0.4, respectively.</p><p><strong>Conclusion: </strong>Minimal-dose S-ketamine for managing acute postoperative pain in patients undergoing radical resection for esophageal cancer led to a 40% reduction in opioid consumption and promoted rehabilitation.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"1033-1044"},"PeriodicalIF":2.8,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12241663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609587","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}