Therapeutics and Clinical Risk Management最新文献

{"title":"Efficacy of an Intelligent Closed-Loop Warming System in Preventing Perioperative Hypothermia and Improving Recovery in Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Trial.","authors":"Ruirong Chen, Yingjie Du, Xiongpeng He, Jinhan Fan, Yue Zhang, Yafan Bai, Min Liu, Wenjia Shen, Tiankuo Yu, Guyan Wang","doi":"10.2147/TCRM.S579479","DOIUrl":"10.2147/TCRM.S579479","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the efficacy of an intelligent closed-loop warming system compared with conventional warming methods in preventing perioperative hypothermia and improving postoperative recovery in patients undergoing video-assisted thoracoscopic surgery (VATS).</p><p><strong>Patients and methods: </strong>A total of 118 adult patients scheduled for elective VATS were randomly assigned to the conventional warming group (n = 59) or the intelligent closed-loop warming group (n = 59). Conventional warming management employed an underbody warming blanket, supplemented with blood and fluid warming when core temperature fell below 36.0°C. The intelligent closed-loop warming system utilized wireless sensors and an automated feedback-controlled warming unit to maintain core temperature between 36.5°C and 37.0°C. Core temperature was continuously monitored from anesthesia induction to post-anesthesia care unit (PACU) discharge. The primary outcome was the incidence of perioperative hypothermia (core temperature < 36.0°C). Secondary outcomes included mean and minimum intraoperative temperature, extubation time, PACU temperature, postoperative complications, length of hospital stay (HLOS), and hospitalization cost.</p><p><strong>Results: </strong>Perioperative hypothermia occurred in significantly fewer patients in the intelligent group than in the conventional group (25.4% vs. 76.3%, <i>p</i> < 0.001). The intelligent closed-loop warming system maintained higher mean (36.40 ±0.33°C vs. 35.96 ± 0.45°C, <i>p</i> < 0.001) and minimum (36.09 ± 0.35°C vs. 35.58 ± 0.58°C, <i>p</i> < 0.001) core temperatures. Extubation time was shorter (5.12 ± 2.31 min vs. 9.69 ± 8.27 min, <i>p</i> < 0.001), PACU temperature was higher (<i>p</i> = 0.001), postoperative fever incidence was lower (0% vs. 13.6%, <i>p</i> = 0.006), and HLOS was reduced (10.02 ± 3.87 vs. 11.63 ± 4.25 days, <i>p</i> = 0.034). No significant differences were observed in infection rate or hospitalization cost.</p><p><strong>Conclusion: </strong>The intelligent closed-loop warming system effectively prevents perioperative hypothermia and enhances postoperative recovery in VATS patients. It provides precise thermal regulation and better clinical outcomes, supporting its application in perioperative temperature management.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"579479"},"PeriodicalIF":2.6,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12994394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147481748","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":"Therapeutic Efficacy of Full-Endoscopic Unilateral Laminotomy with Bilateral Decompression for Degenerative Cervical Myelopathy: A Retrospective Cohort Study.","authors":"Wenhua Gong, Shuai Tang, Wenbo Wu, Hui Lu, Xuexiao Ma","doi":"10.2147/TCRM.S583348","DOIUrl":"10.2147/TCRM.S583348","url":null,"abstract":"<p><strong>Background: </strong>This study aims to evaluate the efficacy and potential advantages of full-endoscopic unilateral laminotomy with bilateral decompression (FE-ULBD) for degenerative cervical myelopathy (DCM) as a minimally invasive posterior decompression technique.</p><p><strong>Methods: </strong>We retrospectively reviewed 123 patients treated between January 2020 and January 2025. Procedures were selected based on predefined clinical/imaging indications and shared decision-making. FE-ULBD was primarily applied to 1-2-level posterior compression, whereas multilevel disease underwent laminoplasty or laminectomy with internal fixation. Patients were assigned to Group A (FE-ULBD, n=28), Group B (single-door laminoplasty, n=60), and Group C (laminectomy with internal fixation, n=35). Baseline characteristics, perioperative parameters (operative time, blood loss, length of stay), clinical outcomes (mJOA at multiple time points and modified MacNab criteria), and complications were compared among groups. In Group A, intervertebral height, C2-C7 Cobb angle, and dural sac cross-sectional area (DSCA) were evaluated pre- and postoperatively. Outcomes were assessed preoperatively, at 3 months postoperatively, and at final follow-up (mean 8.07 ± 2.24 months).</p><p><strong>Results: </strong>Group A had significantly shorter operative time, reduced blood loss, and a shorter hospital stay compared to Groups B and C (all P<0.05). mJOA improved significantly from baseline in all groups at 3 months and at final follow-up (within-group P<0.05). No significant between-group differences were observed in absolute mJOA or ΔmJOA at either time point (all P>0.05). The excellent/good rate by modified MacNab criteria at final follow-up was 89.3% in Group A, 76.7% in Group B, and 77.1% in Group C (P>0.05). The overall complication rate was lower in Group A (P<0.05). In Group A, intervertebral height and C2-C7 Cobb angle showed no significant postoperative change, whereas DSCA increased significantly (P<0.05).</p><p><strong>Conclusion: </strong>In this retrospective cohort, FE-ULBD was associated with less perioperative morbidity and fewer complications while providing neurological recovery comparable to conventional posterior approaches in selected DCM patients.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"583348"},"PeriodicalIF":2.6,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Narrative Review of Remnant Cholesterol as an Independent Atherogenic Lipoprotein in Type 2 Diabetes: Pathophysiology and Clinical Implications.","authors":"Ramdhani M Natsir, Eli Halimah, Ajeng Diantini, Jutti Levita","doi":"10.2147/TCRM.S593168","DOIUrl":"10.2147/TCRM.S593168","url":null,"abstract":"<p><strong>Background: </strong>T2DM is characterized not only by chronic hyperglycemia but by a complex disturbance in triglyceride-rich lipoprotein (TRL) metabolism. Among the resulting lipid fractions, remnant cholesterol (RC) has emerged as a potentially independent atherogenic driver that persists despite optimal low-density lipoprotein cholesterol (LDL-C) control. Growing evidence suggests that RC integrates metabolic dysregulation, insulin resistance (IR), and inflammatory signaling, thereby contributing to the \"residual risk\" of vascular complications in DM.</p><p><strong>Objective: </strong>To evaluate whether RC functions as an independent atherogenic lipoprotein in T2DM and to assess its clinical implications for risk prediction and therapeutic targeting.</p><p><strong>Methods: </strong>This narrative review examined relevant cohort studies, genetic analyses, mechanistic experiments, and clinical trials published in the last decade with emphasis on RC definitions, measurement approaches, associations with macrovascular and microvascular outcomes, and therapeutic modulation.</p><p><strong>Results: </strong>RC elevation in T2DM reflects impaired TRL clearance driven by IR, hepatic VLDL overproduction, and adipose lipolysis. Across large cohorts, RC consistently predicts incident T2DM, major cardiovascular events, renal deterioration, and peripheral arterial disease independent of LDL-C, triglycerides, HbA1c, and inflammatory markers. RC trajectories and visit-to-visit variability further strengthen risk discrimination, suggesting that dynamic fluctuations reflect underlying metabolic instability. Thresholds associated with vascular injury vary across populations (≈0.56-0.80 mmol/L). Therapeutically, high-intensity statins, EPA-based therapy, and emerging APOC3/ANGPTL3 inhibitors lower RC to varying degrees, yet outcome trials targeting RC specifically remain scarce.</p><p><strong>Conclusion: </strong>RC represents a distinct atherogenic entity in T2DM. Its strong and independent associations with cardiovascular and renal events position it as a critical, yet underrecognized, contributor to diabetic vascular risk. Incorporating RC into routine risk assessment and exploring targeted interventions may bridge the persistent gap between LDL-C lowering and actual event reduction. Future studies should prioritize standardized measurement, mechanistic elucidation, and randomized trials directly testing whether lowering RC can modify clinical outcomes.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"593168"},"PeriodicalIF":2.6,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12967083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147378615","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":"Association Between Serum Vitamin D Levels and Metformin Efficacy in Obese Type 2 Diabetes Patients: A Retrospective Cohort Study Based on HbA1c Reduction.","authors":"Yimeng Wang, Hongli Liu, Yijia Li, Xiaoxue Wang, Chen He, Zhi Wei","doi":"10.2147/TCRM.S565034","DOIUrl":"10.2147/TCRM.S565034","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the association between baseline serum 25-hydroxyvitamin D [25(OH)D] levels and glycemic response to metformin monotherapy in obese adults with type 2 diabetes mellitus (T2DM).</p><p><strong>Patients and methods: </strong>This single-center retrospective cohort study analyzed the electronic medical records (January 2021-December 2023) of obese T2DM patients initiating metformin monotherapy. Participants were stratified by baseline 25(OH)D levels: deficiency (<20 ng/mL, n = 256) or sufficiency (≥20 ng/mL, n = 171). Propensity score matching (1:1) balanced covariates (age, sex, BMI, HbA1c, diabetes duration, comorbidities, season), yielding 142 matched pairs (n = 284). The primary outcome was absolute HbA1c reduction (ΔHbA1c) at 3 months. Multivariable linear regression, subgroup, and sensitivity analyses were performed.</p><p><strong>Results: </strong>In the matched cohort, vitamin D-sufficient patients achieved a clinically meaningful and statistically significant greater HbA1c reduction versus vitamin D-deficient patients (mean difference: 0.34%; 95% CI: 0.16-0.52%; p < 0.001). Baseline 25(OH)D positively correlated with ΔHbA1c (r = 0.32, p < 0.001). Multivariable regression confirmed that vitamin D sufficiency independently predicted greater ΔHbA1c (adjusted β = 0.41%, 95% CI: 0.22-0.60%, p < 0.001). Subgroup analyses revealed enhanced effects in females (p-interaction = 0.018), patients >60 years (β = 0.49% vs ≤60 years 0.33%, p-interaction = 0.009), and baseline HbA1c ≥8.5% (β = 0.56% vs <8.5% 0.21%, p-interaction = 0.003). Adverse events were comparable between groups.</p><p><strong>Conclusion: </strong>Higher baseline vitamin D levels (≥20 ng/mL) are associated with significantly improved metformin efficacy in obese T2DM patients, particularly among females, older adults, and those with poorer glycemic control. Vitamin D status may serve as a predictive biomarker for metformin response.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"565034"},"PeriodicalIF":2.6,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12915425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146228880","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":"Effects of ICS + LABA Combination Therapy on Asthma Control: An Observational Study in Real-World Settings.","authors":"Ping Han, Lihua Wang","doi":"10.2147/TCRM.S547261","DOIUrl":"10.2147/TCRM.S547261","url":null,"abstract":"<p><strong>Background: </strong>Inhaled corticosteroids (ICS) combined with long-acting β2-agonists (LABAs) remain the cornerstone of maintenance therapy in persistent asthma. Although multiple trials have demonstrated short-term efficacy, there is a lack of comprehensive, long-term data on the impact of ICS/LABA therapy on asthma control, exacerbation frequency, and pulmonary function in real-world clinical settings. This study aims to fill this gap by evaluating the effects of ICS/LABA therapy over a 24-month period in a real-world cohort.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study involving 237 adult patients with moderate-to-severe persistent asthma treated at Wuhan Hankou Hospital between January 2021 and December 2023. Eligible participants had ≥12 months of documented ICS/LABA use. Patients were evaluated for asthma control using the Asthma Control Test (ACT), frequency of acute exacerbations requiring systemic corticosteroids, pulmonary function (FEV₁ % predicted), and adverse drug reactions. Data were collected at baseline, 12 months, and 24 months.</p><p><strong>Results: </strong>After 24 months, the proportion of patients achieving well-controlled asthma (ACT ≥20) increased significantly from 42.6% at baseline to 73.0% (P < 0.001). Mean FEV₁ improved from 72.1 ± 10.4% to 79.8 ± 11.2% predicted (P = 0.002). The annualized exacerbation rate declined from 2.1 ± 1.0 to 0.8 ± 0.6 episodes per patient (P < 0.001). Medication adherence, defined as ≥80% refill rate, was significantly associated with greater improvements in ACT and FEV₁. Reported side effects included oropharyngeal candidiasis (8.0%), dysphonia (5.1%), and tremors (3.8%), but no serious adverse events were documented.</p><p><strong>Conclusion: </strong>Continuous use of inhaled corticosteroids in combination with long-acting β-agonists was associated with sustained improvements in asthma control, enhanced lung function, and a reduction in the frequency of exacerbations. These findings support the continued use of ICS/LABA therapy as an effective and safe strategy for long-term asthma management in clinical practice.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"547261"},"PeriodicalIF":2.6,"publicationDate":"2026-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13016119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147521895","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 Comprehensive Treatment of Hashimoto's Thyroiditis with Traditional Chinese Medicine from the Perspective of Modern Medicine.","authors":"Jing Zhang, Guiling Huang","doi":"10.2147/TCRM.S575059","DOIUrl":"10.2147/TCRM.S575059","url":null,"abstract":"<p><p>Hashimoto's thyroiditis (HT) is a common autoimmune disorder characterized by the presence of thyroid-specific autoantibodies and lymphocytic infiltration within the thyroid gland. Although its etiology is multifactorial and complex-encompassing genetic susceptibility, environmental influences, and epigenetic modifications-HT primarily presents as primary hypothyroidism. Conventional management predominantly involves hormone replacement therapy; however, Traditional Chinese Medicine (TCM) has demonstrated promising efficacy and safety in the treatment of HT. This review critically examines the application of TCM in HT management, contextualized within contemporary understandings of the disease's pathophysiology. TCM exerts therapeutic effects through multiple mechanisms, including immunomodulation, attenuation of oxidative stress, and inhibition of thyroid cell apoptosis. Clinical studies indicate that TCM interventions, such as herbal formulations and acupuncture, can effectively enhance thyroid function, decrease autoantibody levels, and improve patients' quality of life. The integration of TCM with standard Western medical treatments offers a valuable complementary strategy for HT, addressing both symptomatic relief and underlying immune dysregulation. Nonetheless, there remains a need for large-scale, multicenter randomized controlled trials to establish standardized treatment protocols and to confirm the long-term safety and efficacy of TCM approaches. Overall, TCM represents a promising adjunctive therapeutic option for HT, expanding the range of treatment modalities beyond conventional hormone replacement. Future investigations should aim to elucidate the molecular mechanisms underlying TCM's effects and to optimize therapeutic regimens to maximize clinical benefits.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"575059"},"PeriodicalIF":2.6,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13029525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575316","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":"ECG-Guided Antiarrhythmic Therapy in Acute Coronary Syndrome: A Multidimensional Assessment of Biomarkers, Cardiac Function, and Quality of Life.","authors":"Xiaolong Li, Xianfeng Liu, Ming Jing, Chengwu Yang, Haoxiang Luo, Long Li","doi":"10.2147/TCRM.S583212","DOIUrl":"10.2147/TCRM.S583212","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of electrocardiogram (ECG)-guided antiarrhythmic strategy on serum biomarkers, cardiac function, and quality of life in patients with acute coronary syndrome (ACS) and arrhythmias.</p><p><strong>Methods: </strong>This prospective observational cohort enrolled 80 ACS patients with arrhythmias managed via a monitor-alert-response-titration pathway (observation group) during January-December 2024. Propensity score-matched controls (n = 80) received conventional experience-based antiarrhythmic therapy. Comparisons included in-hospital antiarrhythmic interventions, arrhythmia control, adverse events, and myocardial injury/stress biomarkers (NT-proBNP, hs-cTnI, hs-cTnT, hs-CRP) at T0 (baseline), T1 (2-day), and T2 (7-day). Cardiac function (LVEF, LVEDD, LVEDVI, E/e') and patient-reported outcomes [Seattle Angina Questionnaire (SAQ), 6-minute walk test (6MWT)] were assessed at T0, T3 (1-month), and T4 (6-month). Major adverse cardiovascular events (MACE) were recorded over 6 months.</p><p><strong>Results: </strong>The observation group demonstrated higher β-blocker utilization, guideline adherence, and drug adjustment rates (<i>P</i> < 0.05). Arrhythmia control was superior in the observation group at T2 (93.75% vs 82.50%, <i>P</i> < 0.05). More pronounced reductions in all biomarkers were observed in the observation group at T1 and T2 (<i>P</i> < 0.05). Greater improvements in LVEF, LVEDD, LVEDVI, E/e', SAQ scores, and 6MWT distance were sustained in the observation group at T3 and T4 (<i>P</i> < 0.05). The 6-month MACE rate was lower in the observation group (13.75% vs 32.50%, <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>ECG-guided antiarrhythmic therapy improves pharmacotherapy quality and arrhythmia control, accelerating myocardial injury and stress attenuation. This strategy approach enhances cardiac recovery, reverse remodeling, functional capacity, and quality of life, ultimately reducing long-term cardiovascular risk.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"583212"},"PeriodicalIF":2.6,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13021552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575371","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 and Procedural Predictive Model for Pneumothorax Risk After CT-Guided Lung Biopsy.","authors":"Yongchao Qin, Zhenyu Zhao, Lele Zhang, Xiaonan Shao, Qianyun Wang","doi":"10.2147/TCRM.S579698","DOIUrl":"10.2147/TCRM.S579698","url":null,"abstract":"<p><strong>Purpose: </strong>To develop and validate a model integrating clinical/imaging and procedural variables to predict pneumothorax after CT-guided percutaneous lung nodule biopsy.</p><p><strong>Methods: </strong>We retrospectively enrolled 395 patients and split them 7:3 into training (n=276) and validation (n=119) cohorts. Variables with P < 0.15 in group comparisons (combined with clinical relevance) were selected as candidates and analyzed using age- and sex-adjusted univariable logistic regression. Two prespecified logistic models were fitted: a baseline model (clinical/imaging variables only) and a full model (baseline plus procedural variables). Discrimination, calibration, and clinical utility were assessed using ROC curves, calibration plots, and decision curve analysis (DCA).</p><p><strong>Results: </strong>Pneumothorax occurred in 22.1% (training) and 22.7% (validation). The baseline model contained BMI and emphysema grade; the full model additionally included patient position (prone or lateral vs supine) and the number of needle adjustments. In training, the full model outperformed the baseline (AUC 0.722 vs 0.630; P=0.018). In validation, AUC was 0.720 vs 0.670 (P=0.307), but the difference did not reach statistical significance. Sensitivity was higher with the full model (0.667 vs 0.593). Both models showed good calibration; the full model was closer to the ideal line across predicted probabilities of 0.1-0.5. DCA indicated greater net benefit for the full model across most threshold probabilities.</p><p><strong>Conclusion: </strong>A model combining clinical/imaging and procedural characteristics may facilitate peri-operative risk communication and support peri-procedural risk management for CT-guided lung nodule biopsy.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"579698"},"PeriodicalIF":2.6,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13021554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575293","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 Efficacy of Levocarnitine-Alprostadil Combination Therapy on Indicators of Renal Function, Oxidant-Antioxidant Balance, and Systemic Inflammation in Patients with End-Stage Diabetic Nephropathy.","authors":"Li Cheng, Sheng Wan, Yonglong Min, Can Tu, Dongdong Mao, Quan Wang, Shuai Fu, Fei Xiong","doi":"10.2147/TCRM.S553649","DOIUrl":"10.2147/TCRM.S553649","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effects of combined Levocarnitine and Alprostadil therapy on renal function, oxidant-antioxidant balance, and systemic inflammation in patients with end-stage diabetic nephropathy (ESDN).</p><p><strong>Methods: </strong>This retrospective study included 104 ESDN patients admitted to our hospital between April 2021 and April 2023 who met all inclusion criteria. All patients were on maintenance hemodialysis for chronic kidney failure due to ESDN. Based on the treatment regimen received, patients were divided into two groups: the control (n=51) received intravenous Alprostadil (20 μg/day) for 30 days in addition to standard care, and the observation group (n=53) received additional intravenous Levocarnitine (1.0 g/day) for 30 days. Clinical efficacy, renal function parameters [blood urea nitrogen (BUN), cystatin C (Cys-C), 24-hour urinary protein (24 h Upro)], oxidative stress markers [malondialdehyde (MDA), superoxide dismutase (SOD), reactive oxygen species (ROS)], inflammatory factors [C-reactive protein (CRP), interleukin-1β (IL-1β), interleukin-6 (IL-6)], and adverse reactions were compared between groups.</p><p><strong>Results: </strong>The cumulative treatment effectiveness (defined as the sum of patients with \"markedly effective\" and \"effective\" outcomes) was significantly higher in the observation group (92.45%) compared to the control group (78.43%, P<0.05). Post-treatment, the observation group demonstrated significantly greater improvements in all parameters: lower BUN (4.35±1.06 vs 5.29±1.12 mmol/L), Cys-C (1.21±0.34 vs 1.75±0.46 mg/L), 24 h Upro (66.79±18.37 vs 75.17±19.54 mg/24h), MDA (3.54±0.89 vs 4.63±1.08 nmol/mL), ROS (371.34±46.32 vs 417.53±48.16 U/mL), CRP (5.02±0.83 vs 6.63±0.94 mg/L), IL-1β (11.04±2.38 vs 13.61±2.67 pg/mL), and IL-6 (12.78±3.51 vs 16.84±4.53 pg/mL), alongside higher SOD (88.17±9.34 vs 72.49±8.71 U/mL) (P<0.05). Adverse reaction incidence showed no significant difference (16.98% vs 13.73%, P>0.05).</p><p><strong>Conclusion: </strong>In ESDN patients, the combination of Levocarnitine and Alprostadil demonstrates superior cumulative treatment effectiveness over Alprostadil monotherapy in improving renal function, reducing oxidative stress, and attenuating inflammation, without increasing the incidence of adverse reactions.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"553649"},"PeriodicalIF":2.6,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147514919","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 Individualized Positive End-Expiratory Pressure Guided by Driving Pressure on Postoperative Atelectasis Assessed by Lung Ultrasound in Laparoscopic Surgery Patients: A Randomized Controlled Trial.","authors":"Yi Zhang, Jiayu Zhu, Chunhua Xi, Shaofei Su, Yafan Bai, Yue Zhang, Wenjia Shen, Guyan Wang","doi":"10.2147/TCRM.S564979","DOIUrl":"10.2147/TCRM.S564979","url":null,"abstract":"<p><strong>Purpose: </strong>Pulmonary atelectasis frequently develops during laparoscopic procedures under general anesthesia, often leading to postoperative pulmonary complications (PPCs). Given the connection between high driving pressure and these complications, this study employed ultrasonography to assess whether individualized positive end-expiratory pressure (PEEP) titration by minimum driving pressure reduces postoperative atelectasis.</p><p><strong>Patients and methods: </strong>Adult patients with medium-to-high-risk PPCs who were scheduled for laparoscopic procedures were allocated to receive either a fixed PEEP of 5 cmH₂O (Group C) or minimum driving pressure-guided individualized PEEP (Group D). The primary outcome was the lung ultrasound score (LUS) on postoperative day 1, and LUSs at other postoperative time points were also recorded. The secondary outcomes were occurrence of atelectasis evaluated by ultrasonography and occurrence of PPCs within 7 days postoperatively.</p><p><strong>Results: </strong>A total of 106 participants were assigned randomly, with 102 included in the final analysis. Individualized PEEP resulted in better intraoperative respiratory mechanics. Compared with Group C, Group D demonstrated a more substantial decrease in the LUS on postoperative day 1 (4[3-6] vs 6[5-8], <i>P</i> < 0.001), and this benefit persisted until postoperative day 3. Moreover, the occurrence of atelectasis evaluated by ultrasonography in Group D was considerably lower than that in Group C at 15 min after extubation (58.8% vs 80.4%, <i>P</i> = 0.018), and this advantage persisted until postoperative day 2. Compared with Group C, Group D experienced fewer PPCs within 7 days after surgery (13.7% vs 31.4%, <i>P</i> = 0.033), whereas other postoperative recovery indicators were not significantly different.</p><p><strong>Conclusion: </strong>In adult patients undergoing laparoscopic surgery, compared with a fixed PEEP of 5 cmH₂O, the driving pressure-guided individualized PEEP strategy improved postoperative LUSs and reduced incidences of early postoperative atelectasis assessed by ultrasound. Furthermore, it was associated with fewer PPCs and lower rates of atelectasis in the first 7 postoperative days.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"564979"},"PeriodicalIF":2.6,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13007958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147514891","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}