Therapeutics and Clinical Risk Management最新文献

{"title":"Dynamic Evolution Characteristics and Nursing Intervention Windows of Perioperative Deep Vein Thrombosis in Patients with Lower Extremity Traumatic Fractures: A Prospective Cohort Study.","authors":"Xuehua Hu, Yunying Wang, Yu Li, Hong Cao, Min He, Ying Li","doi":"10.2147/TCRM.S598379","DOIUrl":"10.2147/TCRM.S598379","url":null,"abstract":"<p><strong>Background and purpose: </strong>Deep vein thrombosis (DVT) is a major complication after lower extremity traumatic fractures. Current nursing assessment is largely postoperative-centered and may overlook risk evolution during the preoperative waiting period.</p><p><strong>Methods: </strong>In this prospective observational cohort study, 948 patients with lower extremity traumatic fractures were enrolled between January 2019 and January 2026. Serial color Doppler ultrasound examinations were performed at five timepoints: admission, preoperative, postoperative day 1, postoperative day 3, and discharge. Univariate and multivariate logistic regression analyses were used to identify predictors of preoperative DVT. A dynamic nomogram was developed and evaluated using receiver operating characteristic analysis, calibration, decision curve analysis, and SHAP-based interpretation.</p><p><strong>Results: </strong>The overall incidence of perioperative DVT was 32.9% (312/948). DVT showed a distinct \"twin-peak\" temporal pattern, with the highest incidence during the preoperative waiting period and a second peak on postoperative day 3. Thrombi also shifted from predominantly distal veins at admission to greater proximal involvement after surgery. Independent predictors of preoperative DVT were age >65 years, preoperative waiting time >3 days, D-dimer >1.85 mg/L, albumin <35 g/L, and time from injury to admission >12 h. The nomogram showed good discrimination (AUC 0.905, 95% CI 0.882-0.928), outperforming individual predictors such as D-dimer (AUC 0.796). Decision curve analysis demonstrated clinical net benefit, and SHAP analysis identified D-dimer and albumin as the most influential variables.</p><p><strong>Conclusion: </strong>Perioperative DVT after lower extremity fractures follows a dynamic pattern with a critical preoperative risk window. The proposed nomogram may support stage-specific nursing assessment and targeted interventions, particularly by reducing preoperative delay and optimizing nutritional status.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"598379"},"PeriodicalIF":2.6,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13100313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781763","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":"Comparison of Percutaneous Coronary Intervention Outcomes for in-Stent vs de Novo Chronic Total Occlusions: A Meta-Analysis.","authors":"Qiongya Mao, Lili Xie, Jun Wu","doi":"10.2147/TCRM.S576328","DOIUrl":"10.2147/TCRM.S576328","url":null,"abstract":"<p><strong>Background: </strong>Chronic coronary total occlusion (CTO) represents a formidable challenge in interventional cardiology, occurring either within previously implanted stents (in-stent CTO) or in non-stented native vessels (de novo CTO). We aimed to compare the outcomes of percutaneous coronary intervention (PCI) between patients with in-stent and de novo CTO through a systematic review and meta-analysis.</p><p><strong>Methods: </strong>PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar databases were searched for comparative studies published up to 20^th September 20, 2025. A meta-analysis was conducted to calculate the odds ratios (OR) using a random effects model.</p><p><strong>Results: </strong>Nineteen studies that compared 73,945 patients with in-stent CTO and 651,961 patients with de novo CTO were included. There was no statistically significant difference in technical success between the two groups (OR, 0.97; 95% CI, 0.87, 1.08; I²=0%; p=0.67). Pooled analysis of early outcomes demonstrated no statistically significant difference in the risk of all-cause mortality, major adverse cardiovascular events (MACE), myocardial infarction (MI), stent thrombosis, or tamponade between the two groups. We also noted no statistically significant differences in long-term all-cause or cardiac mortality between the two groups. However, a meta-analysis of long-term data indicated that patients with in-stent CTO have a statistically significantly increased risk of MACE, MI, and target vessel revascularization (TVR) compared to those with de novo CTO.</p><p><strong>Conclusion: </strong>Our results indicate that in-stent CTO-PCI has success rates similar to those of de novo CTO-PCI. There was no difference in short-term adverse outcomes between the two groups; however, patients undergoing in-stent CTO PCI had an increased risk of MACE and MI, mainly driven by the significantly increased need for TVR.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"576328"},"PeriodicalIF":2.6,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781806","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 Anthracyclines Combined with Temozolomide Regimens for the Treatment of Advanced Leiomyosarcoma: A Retrospective Study.","authors":"Huijing Tan, Jianguo Zhou, Susheng Shi, Liming Jiang, Lijie Zuo, Aijiang Su, Huike Wang, Yuting Sun, Wenjuan Xuan, Yihebali Chi","doi":"10.2147/TCRM.S564176","DOIUrl":"10.2147/TCRM.S564176","url":null,"abstract":"<p><strong>Background: </strong>Leiomyosarcoma (LMS) is an aggressive soft tissue sarcoma with high rates of hematogenous metastasis and recurrent relapse, with a 5-year survival rate of 17.0%. This study evaluated the clinical efficacy of an anthracycline plus temozolomide (ATEM) regimen in advanced LMS and explored the feasibility of dynamic circulating tumor DNA (ctDNA) monitoring for early detection of disease progression.</p><p><strong>Methods: </strong>This retrospective study included patients with advanced LMS who received ATEM between September 2018 and December 2024. The efficacy, including complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD), objective response rate (ORR), and disease control rate (DCR), as well as safety, were assessed. The median progression-free survival (mPFS) and median overall survival (mOS) were calculated using Kaplan-Meier survival curves. A subset of patients treated with TEM-containing regimens between December 2023 and December 2024 underwent longitudinal ctDNA monitoring.</p><p><strong>Results: </strong>Forty-seven patients were included, with a median follow-up of 39.5 months. The mPFS was 12.0 months and mOS was 37.5 months. One patient achieved clinical CR, 9 achieved PR, 33 had SD and 4 experienced PD. The ORR was 21.3% (10/47), and DCR was 91.5% (43/47). The most common adverse events were leukopenia (42.6%), neutropenia (32.0%), and thrombocytopenia (14.9%). Grade 4 neutropenia occurred in three patients, including one case complicated by febrile neutropenia. All cases were managed successfully with supportive treatment. No treatment-related deaths were observed. In this pilot investigation of 7 patients, ctDNA levels consistently reflected clinical disease status and treatment response.</p><p><strong>Conclusion: </strong>ATEM regimen demonstrated promising efficacy in advanced LMS, with survival outcomes comparable to or better than in prior first-line treatments. ctDNA monitoring showed promise as a non-invasive biomarker for disease monitoring and treatment guidance. Prospective, multi-center studies are warranted to validate these findings.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"564176"},"PeriodicalIF":2.6,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730129","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":"qCON and qNOX-Guided Sedation Monitoring During Gastrointestinal Endoscopy: A Prospective Observational Preliminary Study.","authors":"Qin Liu, Dayuan Wei, Xiaoge Han, Wenjie Cheng, Xuanqi Yang, Su Min","doi":"10.2147/TCRM.S593667","DOIUrl":"10.2147/TCRM.S593667","url":null,"abstract":"<p><strong>Background: </strong>The depth of sedation during gastrointestinal endoscopy is predominantly assessed based on clinical experience due to the absence of a universally recognized objective standard. This study aimed to evaluate the utility of two novel electroencephalography-derived parameters, the quantitative consciousness index (qCON) and the quantitative nociception index (qNOX), for sedation and analgesia monitoring, and to determine the optimal qCON range correlated with optimal procedural stability.</p><p><strong>Methods: </strong>In this prospective observational study, a total of 220 patients scheduled for elective gastroscopy or colonoscopy were enrolled. All patients received propofol and sufentanil for sedation and analgesia according to routine clinical practice. Depth of anesthesia and nociceptive responses were continuously monitored using qCON and qNOX. Hemodynamic parameters, body movement, and coughing were recorded at predefined time points. The primary outcome was defined as optimal procedural stability, characterized by hemodynamic fluctuations within 10% of baseline combined with the absence of body movement or coughing.</p><p><strong>Results: </strong>A qCON range of 55-63 was observed to be associated with optimal procedural stability (95% confidence interval [CI]: 55.25-62.62 for gastroscopy; 55.25-62.52 for colonoscopy). A strong correlation between qCON and qNOX was observed (gastroscopy: qNOX = 0.78 × qCON + 26.1, <i>R²</i> = 0.714; colonoscopy: qNOX = 0.83 × qCON + 22.47, <i>R²</i> = 0.716; p < 0.001). The qNOX index demonstrated a more rapid response to noxious stimuli than qCON during recovery phases.</p><p><strong>Conclusion: </strong>The qCON index appears to provide an objective approach to assessing sedation depth in sedated gastrointestinal endoscopy. Our findings suggest that qCON values within the range of 55 to 63 are associated with optimal procedural stability as defined in this study. Combined monitoring with qCON and qNOX may provide complementary information to support a balanced approach to intra-procedural sedation management, thereby potentially enhancing the safety and overall quality of sedation management.</p><p><strong>Trial registration: </strong>This study was registered at ClinicalTrials.gov (Registration Number: NCT06604156) on April 11, 2024.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"593667"},"PeriodicalIF":2.6,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781844","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":"Effect of Dexmedetomidine Combined with Esketamine on Postoperative Fatigue in Patients Undergoing Total Laparoscopic Hysterectomy: A Single-Center Randomized Double-Blinded Controlled Trial.","authors":"Lei Wu, Yuhui Wang, Yuxin Chai, Zhuang Qiu, Jingwen Yin, Baoshuang Zhang, Guanglei Wang","doi":"10.2147/TCRM.S575704","DOIUrl":"10.2147/TCRM.S575704","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this experiment is to study the impact of dexmedetomidine combined with esketamine on postoperative fatigue in patients who undergo total laparoscopic hysterectomy.</p><p><strong>Patients and methods: </strong>A total of 176 patients who received elective total laparoscopic hysterectomy were included in the study and divided into four groups: control group (Group C), dexmedetomidine group (Group D), esketamine group (Group E), and dexmedetomidine combined with esketamine group (Group DE). Group D received dexmedetomidine intervention, Group E received esketamine intervention, and Group DE received the combined intervention of dexmedetomidine and esketamine. The primary outcome was the 10-item Identity-Consequence Fatigue Scale (ICFS-10) scores, which were assessed before surgery and on postoperative days 3, 5, 7, and 30. Secondary outcomes included postoperative Visual Analog Scale (VAS) scores, Pittsburgh Sleep Quality Index (PSQI) scores, extubation time, first postoperative ambulation time, first postoperative flatus time, and nausea and vomiting incidence among four groups.</p><p><strong>Results: </strong>Compared with Group C, Groups D, E, and DE had lower scores on ICFS-10 and PSQI on postoperative days 3, 5, and 7, as well as lower movement VAS scores at the postoperative 24 and 48 hours (<i>p<</i>0.05). A lower fatigue incidence was also observed in Group DE on postoperative days 3, 5, and 7. Group DE showed a reduced rate of adverse events (vasoactive drug administration, postoperative nausea and vomiting, and requirement for rescue analgesia) compared with Group C (<i>p<</i>0.05). No intergroup differences in ICFS-10 scores or fatigue incidence were found on postoperative day 30 (<i>p></i>0.05).</p><p><strong>Conclusion: </strong>For patients undergoing total laparoscopic hysterectomy, the combined use of dexmedetomidine and esketamine enhances early postoperative fatigue levels and lowers the incidence of fatigue. However, this combination has no significant effect on fatigue on postoperative day 30.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"575704"},"PeriodicalIF":2.6,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781778","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":"Artificial Intelligence in the Diagnosis and Management of Pulmonary Tuberculosis: A Review of Current Applications and Future Perspectives.","authors":"Yangyu Ou, Qi Zhang, Cheng Meng, Xingshun Zhou, Mengyao Na, Zhenni Yu, Wenhui Ma, Cong Huang","doi":"10.2147/TCRM.S596651","DOIUrl":"10.2147/TCRM.S596651","url":null,"abstract":"<p><p>Pulmonary tuberculosis (PTB) remains a major global public health challenge, with traditional diagnostic and management approaches plagued by diagnostic delays, time-consuming drug resistance testing, and subjective efficacy assessment. Artificial intelligence (AI) has emerged as a revolutionary solution for these bottlenecks. This review comprehensively summarizes AI's current applications in PTB care: deep learning models enable automated detection, segmentation and activity differentiation of PTB lesions on chest X-ray/CT with performance comparable to or exceeding human experts (sensitivity >90% for X-ray detection); AI-driven whole-genome sequence analysis rapidly predicts anti-TB drug resistance, shortening testing time from weeks to days; multimodal AI models also show potential in dynamic treatment response monitoring and individualized outcome prediction. However, AI's clinical translation is hindered by data quality/bias, poor model generalizability, low algorithm interpretability, and regulatory/ethical issues. Future priorities include multimodal data fusion, federated learning, prospective clinical validation, and developing lightweight AI models for resource-limited settings. Interdisciplinary collaboration is critical to transform AI from a research tool into a safe, reliable and equitable clinical assistant for PTB care.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"596651"},"PeriodicalIF":2.6,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13050177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623753","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":"Real-World Evidence on Statin Use for Traumatic Brain Injury Associated Degenerative Neurological Disorders.","authors":"Yu-Hui Lin, I-Ju Tsai, Yu-Ang Chang, Ching-Hui Huang, Chia-Chu Chang","doi":"10.2147/TCRM.S591742","DOIUrl":"10.2147/TCRM.S591742","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) is a major risk factor for subsequent neurodegenerative disorders. Emerging evidence suggests that statins may mitigate neuroinflammation and lipid dysregulation after TBI. This study aimed to evaluate the association between statin use and the risk of post-TBI degenerative neurological disorders in a global, real-world population.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the TriNetX global research network and a 1:1 propensity score matching procedure to balance demographic, clinical, and medication covariates. Patients with the first TBI diagnosis from 2000 onward were included. Individuals with continuous statin use every year from 1 year before to 5 years after the index date were classified as the statin treated group, whereas those with no statin prescriptions during the same period were categorized as the untreated group. Patients younger than 18 years and those with pre-index dementia, stroke, or CNS infection were excluded. A 1:1 propensity score matching procedure was applied to balance demographic, clinical, and medication covariates. Cox proportional hazards models estimated hazard ratios (HRs) for vascular dementia, non-vascular dementia, stroke, depression, and Parkinson's disease during the 5-year follow-up.</p><p><strong>Results: </strong>After matching, 21,427 patients were included in each group. Statin-treated patients demonstrated higher risks of all neurologic outcomes compared with untreated individuals, including vascular dementia (HR 2.47; 95% CI, 1.83-3.34), non-vascular dementia (HR 1.45; 95% CI, 1.30-1.61), stroke (HR 1.80; 95% CI, 1.70-1.89), depression (HR 1.91; 95% CI, 1.79-2.04), and Parkinson's disease (HR 1.63; 95% CI, 1.34-1.98). Subgroup analyses showed consistent risk elevations across sex and age categories.</p><p><strong>Conclusion: </strong>The current Real-World data do not provide evidence supporting the use of statins primarily for neuroprotection after TBI. These findings underscore the importance of pursuing alternative therapeutic strategies that directly target TBI-associated neurodegenerative mechanisms.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"591742"},"PeriodicalIF":2.6,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13034796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594922","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 Portal Vein Thrombosis Grading Predicts Post-Transplant Thrombosis and Survival.","authors":"Yan Liu, Jin-Sheng Tian, Ya-Nan Wang, Zeng-Rong Wang, Jing Cao, Zhi-Yong Shi","doi":"10.2147/TCRM.S565328","DOIUrl":"10.2147/TCRM.S565328","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have suggested an association between preoperative portal vein thrombosis (PVT) and post-transplant PVT occurrence, but comprehensive evidence evaluating the impact of thrombosis severity grading remains limited.</p><p><strong>Objective: </strong>To investigate the influence of preoperative PVT grading on cumulative PVT occurrence time and survival outcomes following liver transplantation.</p><p><strong>Methods: </strong>This retrospective cohort study consecutively enrolled patients undergoing deceased donor liver transplantation between April 2020 and October 2023. All patients underwent dual-modality imaging assessment (Doppler ultrasound combined with contrast-enhanced CT/MRI) for PVT grading according to the Yerdel classification. A standardized anticoagulation protocol was implemented postoperatively. Statistical analyses included Kaplan-Meier curves for cumulative incidence, Fine-Gray competing risk models adjusting for death as a competing event, multivariable Cox regression analysis, and comprehensive sensitivity analyses.</p><p><strong>Results: </strong>Among 126 enrolled patients, the preoperative PVT grading distribution showed significant differences in cumulative post-transplant PVT risk (Grade 0: 14.3%, Grade I: 52.4%, Grade II: 71.4%, Grade III: 85.7%, p<0.001). Fine-Gray competing risk analysis confirmed grading as an independent predictor after adjusting for death (subdistribution hazard ratio [sHR] for Grade III vs Grade 0: 6.24, 95% CI: 3.81-10.21, p<0.001). The combined predictive model incorporating PVT grading, donor factors, and ALBI score achieved superior discrimination (1-year AUC: 0.876; 2-year AUC: 0.843) compared to binary PVT assessment alone (1-year AUC: 0.739, p<0.001). Tertile-based risk stratification revealed significant differences in 3-year survival rates (high-risk: 76.2%, intermediate-risk: 88.1%, low-risk: 95.2%, p<0.001).</p><p><strong>Conclusion: </strong>Preoperative PVT grading represents a crucial predictor of cumulative PVT risk and survival differences after liver transplantation. Implementation of dual-modality imaging assessment and risk-stratified anticoagulation protocols may optimize post-transplant outcomes.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"565328"},"PeriodicalIF":2.6,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13033272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582498","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":"From Tradition to Future: Pathophysiological Mechanisms and Clinical Research Progress in the Treatment of Hypothyroidism with Traditional Chinese Medicine--A Narrative Review.","authors":"Lei Piao, Jian Ma, Na Zhao, Chunyan Liu, Yongqing Hou, Tehasi Wang","doi":"10.2147/TCRM.S581042","DOIUrl":"10.2147/TCRM.S581042","url":null,"abstract":"<p><p>Hypothyroidism, a prevalent endocrine disorder primarily resulting from inadequate thyroid hormone secretion, is commonly attributed to etiologies, such as Hashimoto's thyroiditis and iodine deficiency. Currently, levothyroxine (LT4) replacement therapy is the standard treatment in Western medicine. However, suboptimal therapeutic responses in certain patients have motivated the investigation of alternative interventions. In recent years, TCM, particularly the integrative approach of combining acupuncture with herbal medicine, has demonstrated promising potential in the management of hypothyroidism. Through a systematic review of 12 randomized controlled trials (RCTs) onTCM for hypothyroidism conducted in the past decade, this article found that TCM exerts therapeutic effects by regulating immune function, improving thyroid antibody levels, and modulating metabolic status. Commonly used herbs include Astragalus membranaceus (Huangqi), Codonopsis pilosula (Dangshen), and Rehmannia glutinosa (Shudihuang), whose mechanisms of action involve key signaling pathways such as MAPK and PI3K-AKT.Acupuncture and moxibustion therapies target specific acupoints (e.g. Guanyuan and Zusanli) to improve thyroid function by regulating apoptosis and the associated signaling cascades. Multiple randomized controlled trials have demonstrated that the combination of acupuncture and herbal medicine not only significantly ameliorates clinical symptoms, but also modulates serum concentrations of TSH, T3, and T4, thereby enhancing treatment efficacy. Nonetheless, current research is limited by factors such as small sample sizes, insufficient long-term follow-up, and a lack of comprehensive mechanistic studies. Future investigations employing large-scale, multi-center, high-quality clinical trials are warranted to further substantiate the efficacy and safety of these integrative therapeutic modalities.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"581042"},"PeriodicalIF":2.6,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13015334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147521860","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 Therapeutic Role of Biologics in Chronic Rhinosinusitis with Nasal Polyps (CRSwNP): A Review of the Current Evidence.","authors":"Wenjing Chen, Yanhui Wen, Jing Wang, Xun Meng, Long Su, Yaling Wu","doi":"10.2147/TCRM.S586959","DOIUrl":"10.2147/TCRM.S586959","url":null,"abstract":"<p><p>Chronic rhinosinusitis with nasal polyps (CRSwNP) is a complex inflammatory condition that is primarily categorized as either Type 2 (T2) or non-T2. The T2 inflammatory pathway plays a pivotal role in the pathogenesis of T2 CRSwNP. A significant proportion of patients do not respond to systemic glucocorticoid regimens or repeated surgical interventions, which severely impacts their long-term quality of life and presents a therapeutic challenge. Recent studies confirm that biologics are an effective treatment for severe or refractory CRSwNP. This review systematically collates the latest advances in biological therapies for CRSwNP by conducting extensive searches of the PubMed, Embase, and Cochrane Library databases from the inception of these databases up to October 2025. The review focuses on elucidating the pathological mechanisms of CRSwNP and the classification and target mechanisms of biologics. It also examines the current research landscape regarding variability in biologics efficacy. Substantial clinical evidence indicates that these biologics can effectively alleviate symptoms of sinusitis, reduce turbinate volume, and improve patients' quality of life. They also demonstrate potential in improving comorbid conditions, offering novel therapeutic options for severe or refractory CRSwNP. However, challenges remain in identifying biomarkers and selecting suitable biologics, requiring further research to enable personalized treatment strategies.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"586959"},"PeriodicalIF":2.6,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13005648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499675","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}