Therapeutics and Clinical Risk Management最新文献

{"title":"Introducing Angle B: A Novel Quantitative Approach for Sagittal Alignment Reduction in Atlanto-Axial Dislocation Surgery.","authors":"Shengyu Cui, Xinyu Wang, Kang Li, Hailong Feng, Zhenlei Liu, Fengzeng Jian, Kai Wang","doi":"10.2147/TCRM.S483075","DOIUrl":"https://doi.org/10.2147/TCRM.S483075","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to establish a quantitative relationship between cervical lordosis (CL) and the rotation angle of the axis for the surgical reduction of atlantoaxial dislocation (AAD) and to explore the potential applications of this relationship in preoperative planning and selection of surgical techniques.</p><p><strong>Methods: </strong>To construct the correlation between horizontal gaze and location of axis, we introduced the angle B, defined as the angle between the Frankfort horizontal line and the extension line of the posterior edge of the axis, and explored its application in surgical planning. We retrospectively analyzed imaging data from computed tomography of 23 AAD patients who had undergone posterior reduction and fixation. Theoretical equations were deduced through a series of angular transformations, and linear regression analysis was used to validate our findings.</p><p><strong>Results: </strong>Our results showed a strong linear relationship between the change in CL (ΔCL) and the change in B(ΔB) (y=-1.0402x, coefficient of determination R²=0.978, P<0.001), supporting our deduction that ΔCL=ΔB. Furthermore, we found that the rotation angle of the axis (angle D) was equal to ΔCL. By resolving the atlantoaxial interval into the vertical dimension (h) and horizontal dimension (d), we could calculate the maximum vertical and horizontal distance that the axis could move theoretically according to a patient's maximum ΔCL. This finding supports our theory that the introduction of angle B can provide more precise preoperative planning and surgical technique selection for patients with AAD.</p><p><strong>Conclusion: </strong>By introducing angle B and deducing the equation ΔB=ΔCL=D, we have provided an innovative tool for preoperative planning and surgical technique selection for patients with AAD. This equation not only helps surgeons achieve more precise and effective surgical reductions but also emphasizes the important role of angle B in surgical planning.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"789-797"},"PeriodicalIF":2.8,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772682","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":"Haemodynamic Changes in Adult Patients Transported in Emergency Medical Helicopters. A Systematic Review.","authors":"Alejandro Artero-García, Juan Gómez-Salgado, Francisco Javier Fernández-Carrasco, Juana María Vázquez-Lara, Juan Jesús García-Iglesias, Beatriz Mérida-Yáñez, Francisco Javier Muñoz-Vela, Luciano Rodríguez-Díaz","doi":"10.2147/TCRM.S488502","DOIUrl":"10.2147/TCRM.S488502","url":null,"abstract":"<p><strong>Objective: </strong>Patients transported by Helicopter Emergency Medical Services (HEMS) suffer a series of haemodynamic changes, mainly in terms of blood pressure, heart rate, and oxygen saturation, which worsen at different stages of the flight. The aim of this study was to identify haemodynamic changes in adult patients transported by the Helicopter Emergency Medical Service.</p><p><strong>Methods: </strong>A systematic review of studies published between January 2013 to April 2023 was conducted following the PRISMA 2020 guidelines criteria in the Pubmed, Scopus and Web of Science electronic databases. Methodological quality was assessed using the critical appraisal tool for non-randomised studies of the Joanna Briggs Institute (JBI). The followed protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) with code CRD4202222355798. Two independent reviewers read and extracted the information of the studies.</p><p><strong>Results: </strong>Eight studies were included in the review, which showed significant haemodynamic changes during transport by HEMS. All studies recorded readings at three points of the mission: pre-flight, in-flight, and post-flight. The greatest change in physiological variables is visible in oxygen saturation, during the in-flight phase, with a decrease in this value. Blood pressure mainly increased in various phases of the mission, especially in the in-flight phase. Heart rate also changed across the mission phases, mainly in the pre-flight and post-flight phases, increasing and decreasing during the flight.</p><p><strong>Conclusion: </strong>Patients transported by helicopter undergo haemodynamic changes during the different stages of evacuation (pre-flight, in-flight, and post-flight). However, there is a need for further studies on helicopter transport of patients due to the paucity of publications on this topic.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"775-787"},"PeriodicalIF":2.8,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740564","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":"Leveraging 3D Convolutional Neural Networks for Accurate Recognition and Localization of Ankle Fractures.","authors":"Hua Wang, Jichong Ying, Jianlei Liu, Tianming Yu, Dichao Huang","doi":"10.2147/TCRM.S483907","DOIUrl":"10.2147/TCRM.S483907","url":null,"abstract":"<p><strong>Background: </strong>Ankle fractures are common injuries with substantial implications for patient mobility and quality of life. Traditional imaging methods, while standard, have limitations in detecting subtle fractures and distinguishing them from complex bone structures. The advent of 3D Convolutional Neural Networks (3D-CNNs) offers a promising avenue for enhancing the accuracy and reliability of ankle fracture diagnoses.</p><p><strong>Methods: </strong>In this study, we acquired 1453 high-resolution CT scans and processed them through three distinct 3D-CNN models: 3D-Mobilenet, 3D-Resnet101, and 3D-EfficientNetB7. Our approach involved meticulous preprocessing of images, including normalization and resampling, followed by a systematic comparative evaluation of the models based on accuracy, Area Under the Curve (AUC), and recall metrics. Additionally, the integration of Gradient-weighted Class Activation Mapping (Grad-CAM) provided visual interpretability of the models' predictive focus points.</p><p><strong>Results: </strong>The 3D-EfficientNetB7 model outperformed the other models, achieving an accuracy of 0.91 and an AUC of 0.94 after 20 training epochs. It demonstrated particularly effective in the accurate detection and localization of subtle and complex fractures. Grad-CAM visualizations confirmed the model's focus on clinically relevant areas, aligning with expert assessments and enhancing trust in automated diagnostics. Spatial localization techniques were pivotal in improving interpretability, offering clear visual guidance for pinpointing fracture sites.</p><p><strong>Conclusion: </strong>Our findings highlight the effectiveness of the 3D-EfficientNetB7 model in diagnosing ankle fractures, supported by robust performance metrics and enhanced visualization tools.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"761-773"},"PeriodicalIF":2.8,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11585985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711106","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 Permissive Hypercapnia on Postoperative Early Plasma Neurofilament Light Chain in Elderly Patients Undergoing Laparoscopic Surgery: A Prospective, Randomized Controlled Trial.","authors":"Ya-Zhi Xi, Xue-Lian Wei, Lei Xie, Xiao-Yu Jia, Zhen-Ping Li, Qing-He Zhou","doi":"10.2147/TCRM.S492456","DOIUrl":"10.2147/TCRM.S492456","url":null,"abstract":"<p><strong>Background: </strong>The effects of intraoperative permissive hypercapnia (<i>P</i>aCO₂ of 45-55 mmHg) on the central nervous system remain unclear. Neurofilament light chain (NfL, a protein found in the axons and nerve fibers of neurons) has been associated with central nervous system disorders. This study investigated the effect of intraoperative permissive hypercapnia on plasma NfL concentration 1 day postoperatively, and in turn on the central nervous system, during laparoscopic surgery.</p><p><strong>Methods: </strong>This investigation was a prospective, single-blind randomized controlled trial. Eighty-four individuals aged above 60 years were randomly allocated to either the normocapnia group with an <i>P</i>aCO₂ of 35-45 mmHg (n=42) or the hypercapnia group with a <i>P</i>aCO₂ of 45-55 mmHg (n=42). The primary outcome was the 1-day postoperative plasma NfL concentration. Secondary outcomes included the area under the curve (AUC) values for <i>P</i>aCO₂ and regional cerebral oxygen saturation (rSO₂). The Mann-Whitney <i>U</i>-test was mainly used to analyze the outcomes.</p><p><strong>Results: </strong>The final analysis included 38 and 40 patients in the normocapnia and hypercapnia groups, respectively. There was no statistically significant difference observed between the groups regarding the preoperative and 1-day postoperative plasma NfL concentration (14.0 [11.1, 19.9] vs 16.3 [9.06, 19.9] pg/mL, <i>P</i>>0.05; 23.4 [16.8, 32.3] vs 21.5 [15.6, 29.9] pg/mL, <i>P</i>>0.05, respectively). However, in both groups, the postoperative plasma concentration of NfL showed a significant increase when compared with the preoperative levels (both <i>P</i> < 0.001). The AUCs of <i>P</i>aCO₂ and rSO₂ from the beginning to the end of the pneumoperitoneum were significantly higher in the hypercapnia group compared with the normocapnia group (both <i>P<</i>0.05).</p><p><strong>Conclusion: </strong>Our results indicate that intraoperative permissive hypercapnia targeting a <i>P</i>aCO₂ of 45-55 mmHg does not significantly influence postoperative early plasma NfL elevation levels in elderly patients undergoing laparoscopic surgery. During general anesthesia, intraoperative permissive hypercapnia might not significantly impact the central nervous system.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"749-759"},"PeriodicalIF":2.8,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11576572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682861","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":"Medications Associated with Geriatric Syndromes and Prescribing Patterns: The Impact of Excessive Polypharmacy in Older Adult Patients.","authors":"Ahmad Al-Azayzih, Walid Al-Qerem, Sayer Al-Azzam, Karem H Alzoubi, Feras Jirjees, Khalid Al-Kubaisi, Zelal Kharaba, Suhaib Muflih, Roaa J Kanaan, Ayah H Abandeh","doi":"10.2147/TCRM.S493095","DOIUrl":"10.2147/TCRM.S493095","url":null,"abstract":"<p><strong>Aims of the study: </strong>To assess the prescribing patterns of medications associated with geriatric syndromes (MAGS) in older adult patients with multiple comorbidities and to identify factors that may increase the risk of MAGS prescribing in the same population.</p><p><strong>Methodology: </strong>This study involved a retrospective analysis of the electronic medical records of older adult patients (≥ 65 years) who visited outpatient clinics at King Abdullah University Hospital (KAUH) in Jordan between January 1, 2019, and June 1, 2024. The collected data included patient demographics, medical history, and medications, focusing on those associated with geriatric syndromes. Descriptive and logistic regression statistical analyses were performed using SPSS with the significance level set at p < 0.05.</p><p><strong>Results: </strong>The study included 1087 older adult patients (52.7% female), with a median age of 71 years. The common conditions existed were peptic ulcer disease (57.1%), hypertension (54.65%), and uncomplicated diabetes (50%). Polypharmacy was presented in 94.8% of total patients number, with 41.6% experiencing excessive polypharmacy. Antihypertensives (78.4%), non-opioid analgesics (56.5%), and antidiabetics (51.8%) were the most frequently prescribed MAGS, which frequently resulted in falls (96%), urinary incontinence (87.6%), and depression (87.3%). Patients with excessive polypharmacy had significantly higher MAGS scores than those with moderate or mild polypharmacy (95% CI: -2.230 to -1.770 and -3.322 to -2.678, respectively, P < 0.001).</p><p><strong>Conclusion: </strong>The findings demonstrate a high prevalence of excessive polypharmacy among older adult patients, significantly contributing to the elevated prescription level of medications associated with geriatric syndrome occurrence, particularly falls, urinary incontinence, and depression.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"741-748"},"PeriodicalIF":2.8,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11531279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569708","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":"Three Artificial Liver Models of Treatment of Acute-on-Chronic Liver Failure.","authors":"Yanping Xiang, Renhua Li, Jia Cai, Qian Jiang","doi":"10.2147/TCRM.S485620","DOIUrl":"10.2147/TCRM.S485620","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to investigate clinical efficacy, safety and short-term prognosis of plasma exchange (PE), plasma perfusion combining PE (PP+PE), dual-plasma molecular adsorption system combining PE (DPMAS+PE) in treating acute-on-chronic liver failure (ACLF).</p><p><strong>Methods: </strong>Two hundred and fourteen ACLF patients admitted to our hospital were included and divided into PE (n = 72), PP+PE (n = 75), DPMAS+PE group (n = 67). Laboratory indexes and MELD scores were collected, and clinical efficacy was compared. Patients' adverse reactions during and 24-h after treatment were collected, and safety was compared. Survival status of patients was followed-up within 90 days, and prognosis was analyzed.</p><p><strong>Results: </strong>PE, PP+PE and DPMAS+PE significantly reduce TBiL, DBiL, ALT, AST, SA, PT, INR, PCT and CRP levels, and increase PA and PTA levels, compared with pre-treatments (<i>P</i> < 0.05). WBC and SCR levels in DPMAS+PE group decreased significantly post-treatment (<i>P</i> < 0.05). Na⁺ and Cl^- levels in PE and PP+PE group decreased significantly post-treatment (<i>P</i> < 0.05). Total adverse reaction incidence in PE, PP+PE, DPMAS+PE group were 38.89%, 22.70%, 17.90%, respectively, with significant differences among three groups (<i>P</i> < 0.05). Ninety-day mortality rates of patients in PE, PP+PE, DPMAS+PE group were 41.67%, 34.67%, 20.90%, respectively, with significant differences among three groups (<i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>PE, PP+PE and DPMAS+PE three artificial liver treatment modes can effectively improve liver, kidney and coagulation function of ACLF patients. DPMAS+PE demonstrated better ability to remove endotoxin and inflammatory mediators, showed advantages in reducing ACLF patient mortality within 90 days, and had the least impact on electrolyte post-treatment. Therefore, DPMAS+PE can be used as a better choice for clinical treatment.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"731-740"},"PeriodicalIF":2.8,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547611","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 Utility of Speckle Tracking Echocardiographic Parameters in Predicting Atrial Fibrillation Recurrence After Catheter Ablation in Patients with Non-Valvular Atrial Fibrillation.","authors":"Decai Zeng, Linyan Li, Shuai Chang, Xiaofeng Zhang, Yanfen Zhong, Yongzhi Cai, Tongtong Huang, Ji Wu","doi":"10.2147/TCRM.S486056","DOIUrl":"10.2147/TCRM.S486056","url":null,"abstract":"<p><strong>Background: </strong>Despite the efficacy of catheter ablation (CA) as a treatment for non-valvular atrial fibrillation (NVAF), many patients still experience atrial fibrillation (AF) recurrence after CA. This study aimed to evaluate the predictive value of speckle tracking echocardiographic (STE) parameters for AF recurrence post-ablation.</p><p><strong>Methods: </strong>A total of 380 NVAF patients treated with CA at the First Affiliated Hospital of Guangxi Medical University from January 2020 to March 2023 were prospectively recruited. The mean age was 59.4 ± 10.8 years, and 72.1% were male, including 150 patients (39.5%) with persistent AF and 230 patients (60.5%) with paroxysmal AF. STE was used to evaluate baseline left atrial (LA) function before CA within 48h. Over a median follow-up of 9 (interquartile range, 4-17) months, AF recurrence occurred in 132 patients (34.7%).</p><p><strong>Results: </strong>The recurrence group showed lower left ventricular ejection fraction, LA reservoir strain (LASr), and conduit strain (LAScd), but higher LA stiffness than non- recurrence group (all <i>P</i> < 0.05). Multivariable Cox regression identified LA stiffness and LASr as independent risk factors. Time-dependent ROC analysis showed that LA stiffness (AUC 0.768, 95% CI 0.705-0.831) and LASr (AUC 0.755, 95% CI 0.691-0.820) were better at predicting 1-year AF recurrence than other risk factors. For 2-year AF recurrence post-catheter ablation, LA stiffness (AUC 0.866, 95% CI 0.804-0.928) and LASr (AUC 0.860, 95% CI 0.800-0.920) also demonstrated superior predictive performance. Kaplan-Meier curves showed a significant difference in AF recurrence rate for patients with LA stiffness > 0.55 and LASr ≤ 24.3% (Log rank <i>P</i> < 0.01).</p><p><strong>Conclusion: </strong>Evaluation of LA function using STE assists in stratifying the risk of AF recurrence in NVAF patients and guiding follow-up management. LASr and LA stiffness are independent predictors of AF recurrence following CA in NVAF patients, and potentially outperforming other morphological parameters.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"719-729"},"PeriodicalIF":2.8,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11463183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393557","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":"Potentially Risk Factors for New Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting: A Retrospective Cohort Study.","authors":"Aiwen Wang, Zhuo Yuan, Xingpeng Bu, Shuzhen Bi, Yadong Cheng, Huanzhen Chen","doi":"10.2147/TCRM.S473886","DOIUrl":"https://doi.org/10.2147/TCRM.S473886","url":null,"abstract":"<p><strong>Objective: </strong>Our study evaluated the risk factors for new postoperative atrial fibrillation (POAF) by analyzing the data collected from patients who underwent first coronary artery bypass grafting (CABG).</p><p><strong>Methods: </strong>Our study retrospectively collected data from January 2021 to December 2023 at Changzhi People's Hospital. The perioperative period data were collected, and logistic regression was used to analyze the independent predictors of the occurrence of POAF after CABG and the related predictive values of risk factors were analyzed by using the subjects' work characteristic curve (ROC).</p><p><strong>Results: </strong>A total of 169 patients were included, and there are 45 patients in the POAF group, with an incidence of 26.6%, and 124 in the non-POAF group. The POAF group was significantly higher than the non-POAF group in terms of age (69.2±8.8 years vs 62.3±9.3 years) and preoperative LAD (42.7±7.2mm vs 36.8±5.5mm), and the difference was significant (P<0.05). Preoperative HDL-C in the POAF group were lower than non-POAF group (1.0±0.5 mmol/l vs 1.4±0.7 mmol/l, P<0.05). The logistic regression analysis revealed a significant correlation between age, LAD, HDL-C and the occurrence of POAF (P<0.05). According to the ROC curve analysis, age >64.5 years, LAD >41mm, and HDL-C <0.9 mmol/l were the cut-off values for predicting the occurrence of POAF (AUC1=0.733; AUC2=0.741; AUC3=0.647, P < 0.05). The combined age + LAD + HDL-C (AUC = 0.755; P < 0.05) had a higher diagnostic value and high sensitivity.</p><p><strong>Conclusion: </strong>The age, LAD, and HDL-C are independent risk factors for the POAF after CABG, and clinicians should assess these risk factors as much as possible when managing patients in the perioperative period and make corresponding measures to prevent the development of POAF.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"711-718"},"PeriodicalIF":2.8,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11456735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393556","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":"Analysis of Influencing Factors and Construction of Predictive Model for Persistent Cough After Lung Cancer Resection Under Thoracoscopy.","authors":"Jingling Lan, Xia Lin, Li Liu","doi":"10.2147/TCRM.S464307","DOIUrl":"10.2147/TCRM.S464307","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to explore the influencing factors of cough after pulmonary resection (CAP) after thoracoscopic lung resection in lung cancer patients and to develop a predictive model.</p><p><strong>Methods: </strong>A total of 374 lung cancer patients who underwent lung resection in our hospital from March 2020 to October 2023 were randomly divided into a modeling group (n=262) and a validation group (n=112). Based on the occurrence of CAP in the modeling group, the patients were divided into a CAP group (n=85) and a non-CAP group (n=177). Multivariate Logistic regression analysis was used to identify the influencing factors of CAP in lung cancer patients. A nomogram model for predicting the risk of CAP was constructed using R4.3.1. The consistency of the model's predictions was evaluated, and a clinical decision curve (DCA) was drawn to assess the clinical utility of the nomogram. The predictive performance of the model was evaluated using ROC curves and the Hosmer-Lemeshow test.</p><p><strong>Results: </strong>Multivariate Logistic regression analysis showed that smoking history (OR=6.285, 95% CI: 3.031-13.036), preoperative respiratory function training (OR=20.293, 95% CI: 7.518-54.779), surgical scope (OR=20.667, 95% CI: 7.734-55.228), and peribronchial lymph node dissection (OR=5.883, 95% CI: 2.829-12.235) were significant influencing factors of CAP in lung cancer patients (P<0.05). ROC curves indicated good discriminatory power of the model, and the Hosmer-Lemeshow test showed a high degree of agreement between predicted and actual probabilities. The DCA curve revealed that the nomogram model had high clinical value when the high-risk threshold was between 0.08 and 0.98.</p><p><strong>Conclusion: </strong>The nomogram model based on smoking history, preoperative respiratory function training, surgical scope, and peribronchial lymph node dissection has high predictive performance for CAP in lung cancer patients. It is useful for clinical prediction, guiding preoperative preparation, and postoperative care.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"701-709"},"PeriodicalIF":2.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11453154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381594","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 Dexmedetomidine on Hemodynamics, Plasma Catecholamine Levels, and Delirium Incidence Among Intubated Patients in the ICU--A Randomized Controlled Trial.","authors":"Li Qiao, Zheng Wang, Jian Shen, Xiaohui Xing, Hongxun Yuan","doi":"10.2147/TCRM.S471229","DOIUrl":"10.2147/TCRM.S471229","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the impact of various sedative medications on hemodynamics and plasma levels of epinephrine (E) and norepinephrine (NE) in mechanically ventilated patients postoperatively in the intensive care unit (ICU).</p><p><strong>Methods: </strong>Ninety-seven patients admitted to the ICU undergoing postoperative mechanical ventilation with tracheal intubation and continuous analgesic sedation following general anesthesia were randomly assigned to either the observation group (dexmedetomidine) (n = 49) or the control group (propofol) (n = 48) in this randomized controlled trial. Upon transfer to the ICU, vital signs (heart rate [HR], respiratory rate [RR], mean arterial pressure [MAP]) were recorded prior to the initiation of the sedation treatment (T0), at one-hour post sedation (T1) and two hours following tracheal extubation (T2), plasma levels of epinephrine (E) and norepinephrine (NE) were measured at these time points. The incidence of delirium was recorded in both groups.</p><p><strong>Results: </strong>MAP between the two groups at both T0 and T1 At T2 plasma NE and HR were found to be lower in the observation group compared to the control group (<i>P</i> < 0.001). Among the patients receiving antihypertensive medication in the ICU, NE levels were significantly lower in the observation group compared to the control group (<i>P = 0.019</i>) Among the patients not receiving antihypertensive medication, both NE (P < <i>0.001</i>) and MAP (P = <i>0.001</i>) levels were lower in the observation group compared to the control group. The incidence of delirium in the observation group (dexmedetomidine) was not significantly different from that in the control group (propofol).</p><p><strong>Conclusion: </strong>With dexmedetomidine sedation, blood pressure fluctuated less, plasma catecholamine levels were lower, and sympathetic inhibition was stronger in patients before and after extubation. However, it did not significantly reduce the incidence of postoperative delirium.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"689-700"},"PeriodicalIF":2.8,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11451452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381595","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}