Therapeutics and Clinical Risk Management最新文献

{"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}

{"title":"Application of Perioperative Nursing Based on Enhanced Recovery After Surgery (ERAS) Principles in Patients Undergoing Total Knee Arthroplasty.","authors":"Juan Huang, Guoqing Wu, Xiaohong Li","doi":"10.2147/TCRM.S515992","DOIUrl":"10.2147/TCRM.S515992","url":null,"abstract":"<p><strong>Background: </strong>Enhanced Recovery After Surgery (ERAS) principles have gained widespread adoption in perioperative care to optimize recovery and reduce complications. Total knee arthroplasty (TKA) patients benefit significantly from ERAS-guided strategies, which minimize surgical stress and accelerate postoperative recovery. This study evaluates the application of perioperative nursing care based on ERAS principles and its impact on TKA patients.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on prospectively maintained data of 312 patients who underwent TKA between January 2023 and December 2023. Of these, 158 patients received perioperative nursing care based on ERAS principles, while 154 received standard nursing care. The ERAS-based perioperative nursing protocol included preoperative education, intraoperative fluid optimization, postoperative pain management, and early mobilization strategies. Clinical data, including postoperative complications, length of hospital stay, and patient satisfaction, were collected and compared between the two groups using statistical methods.</p><p><strong>Results: </strong>Patients in the ERAS-based nursing group exhibited significantly better outcomes compared to the standard care group. Postoperative complications, such as deep vein thrombosis and infections, were reduced (4.4% vs 11.7%, P<0.05), and the average length of hospital stay was shorter (5.6 ± 1.8 days vs 8.3 ± 2.4 days, P<0.001). Patient satisfaction scores were notably higher in the ERAS group (94.3% vs 78.6%, P<0.001). Multivariate analysis identified perioperative nursing based on ERAS principles as an independent factor for improved recovery.</p><p><strong>Conclusion: </strong>Perioperative nursing care guided by ERAS principles significantly improves clinical outcomes in TKA patients, reducing complications and hospital stay while enhancing patient satisfaction. This study supports the broader implementation of ERAS protocols in perioperative nursing to optimize surgical care outcomes.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"829-839"},"PeriodicalIF":2.8,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226719","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 Value of Continuous Fascia Iliaca Compartment Block in Perioperative Management of Elderly Patients with Intertrochanteric Fracture: A Propensity Score-Matched Retrospective Study.","authors":"Guoqiang Xu, Yuqing Deng, Hua Gao, Baojun Wang, Gang Wang, Ji Ma","doi":"10.2147/TCRM.S523883","DOIUrl":"10.2147/TCRM.S523883","url":null,"abstract":"<p><strong>Background: </strong>Hip fractures in elderly patients represent a significant healthcare challenge, with substantial morbidity and mortality rates. This study investigated the efficacy of continuous fascia iliaca compartment block (CFICB) in perioperative management.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on elderly patients (≥65 years) with intertrochanteric fractures treated between January 2020 and December 2023. Eligible patients were initially divided into CFICB (n=46) and routine analgesia (RA, n=64) groups. Propensity score matching with a caliper width of 0.21 was performed, yielding 40 patients in each group for final analysis. Matching variables included age, gender, BMI, and ASA score. Primary outcomes were Visual Analog Scale pain scores, cognitive function assessed through a two-tier protocol (Montreal Cognitive Assessment [MoCA©] screening followed by confirmatory Mini-Mental State Examination-2 [MMSE-2Ⓡ] for positive screens), and functional recovery evaluated using the Harris Hip Score.</p><p><strong>Results: </strong>The CFICB group showed significantly lower VAS scores during the early postoperative period (≤ 72h). This was most notable at 24 hours postoperatively (2.43 ± 0.72 vs 3.45 ± 0.87, <i>P</i> < 0.001). Postoperative cognitive dysfunction rates were significantly lower in the CFICB group. The differences were evident at 6h (10% vs 30%, <i>P</i> = 0.025), 24h (15% vs 35%, P = 0.039), and 72h (5% vs 20%, P = 0.043). Multivariable analysis identified CFICB as an independent protective factor against postoperative cognitive dysfunction (adjusted OR = 0.41, 95% CI: 0.26-0.65, P < 0.001). Harris Hip Scores at one month postoperatively were significantly higher in the CFICB group (78.56 ± 8.12 vs 72.39 ± 7.65, P = 0.008). Complication rates were comparable between groups (22.5% vs 17.5%, <i>P</i> = 0.576).</p><p><strong>Conclusion: </strong>CFICB effectively improves postoperative pain management, reduces cognitive dysfunction incidence, and enhances early functional recovery in elderly patients with intertrochanteric fractures, while maintaining a favorable safety profile.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"817-827"},"PeriodicalIF":2.8,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12132637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216931","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 Low-Dose Esketamine Combined with Propofol on Postoperative Fatigue in Colonoscopy: A Randomized Clinical Trial.","authors":"Xuemei Sun, Qiuling Du, Yongjie Liang, Lili Tang, Qingfeng Wei, Peipei Guo, Xuesheng Liu","doi":"10.2147/TCRM.S521961","DOIUrl":"10.2147/TCRM.S521961","url":null,"abstract":"<p><strong>Purpose: </strong>Postoperative fatigue (POF) is a common occurrence following colonoscopy, primarily attributed to bowel preparation and endoscopic probe stimulation, and is associated with worse postoperative outcomes. Esketamine, an antidepressant anesthetic, has shown the potential to enhance postoperative recovery through various mechanisms. We hypothesized that the low-dose esketamine could alleviate POF in outpatients undergoing colonoscopy.</p><p><strong>Methods: </strong>200 participants scheduled for painless colonoscopy were enrolled, with 151 patients included in the primary endpoint analysis. Patients were randomly received 0.15 mg/kg esketamine or 0.1 μg/kg sufentanil before anesthesia induction. The primary outcome was the incidence of POF, assessed using the Identity-Consequence Fatigue Scale-10 (ICFS-10) scores at 30 min after colonoscopy. Secondary outcomes included ICFS-10 scores at baseline and 1 day post-colonoscopy, time to discharge and patients' satisfaction.</p><p><strong>Results: </strong>The incidence of POF was significantly lower in the esketamine group (Group E) compared to the sufentanil group (Group S) (28% vs 44%, <i>P</i> = 0.036). There were no significant differences in ICFS-10 scores between the two groups at baseline and 1 day post-colonoscopy. However, discharge time was significantly shorter in Group E than in Group S (25 min vs 30 min, <i>P</i> = 0.001). In Group E, there was improved hemodynamic stability and greater patients' satisfaction.</p><p><strong>Conclusion: </strong>The administration of esketamine significantly reduced the incidence of POF and shortened discharge time in patients undergoing colonoscopy. A regimen of 0.15 mg/kg esketamine combined with propofol proved to be an effective anesthesia strategy for painless colonoscopy.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"807-816"},"PeriodicalIF":2.8,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216941","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":"Cerebrovascular Autoregulation-Based Optimal Mean Arterial Pressure During Prostate Surgery - A Secondary Analysis of a Prospective Cohort Study.","authors":"Caspar Mewes, Peipei Wei, Yi Yang, Elena Kainz, Ursula Kahl, Stefanie Beck, Markus Graefen, Christian Zöllner, Marlene Fischer","doi":"10.2147/TCRM.S505676","DOIUrl":"10.2147/TCRM.S505676","url":null,"abstract":"<p><strong>Purpose: </strong>Cerebrovascular autoregulation (CVA) is a homoeostatic regulatory function to maintain constant cerebral blood flow (CBF) despite changes in systemic blood pressure. The CVA-based optimal mean arterial pressure (MAPopt) refers to the MAP level at which the CVA mechanism reaches its lowest degree of pressure passiveness, allowing for optimal autoregulation. This study aimed to determine MAPopt by analyzing existing CVA data from patients undergoing non-cardiac surgery.</p><p><strong>Methods: </strong>This single-center investigation is a secondary analysis of prospectively recorded CVA data of patients undergoing oncologic prostate surgery. Intraoperative CVA was assessed using the cerebral oxygenation index (COx) derived from the simultaneous measurement of MAP and regional cerebral oxygen saturation (rSO₂). Patient-specific MAPopt values were calculated using a second-order polynomial formula, in which the MAP related to the lowest COx was considered to be the intraoperative MAPopt.</p><p><strong>Results: </strong>A total of 180 patients were enrolled into the study. The average age was 63 years, 83.9% of patients had no or mild systemic disease. MAPopt determination was feasible in 128 patients, while 52 patients exhibited no U-shaped correlation between MAP and COx. The average intraoperative MAPopt was 81.7 mmHg ranging from 60.2 to 101.4 mmHg. The mean duration of intraoperative CVA measurement was 178 min.</p><p><strong>Conclusion: </strong>This study demonstrates a wide range of individual intraoperative MAPopt values and underscores that CVA-based MAPopt during non-cardiac surgery may differ from commonly accepted intraoperative MAP thresholds in clinical practice (ie 65 mmHg).</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"757-767"},"PeriodicalIF":2.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12126105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200055","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}