Therapeutics and Clinical Risk Management最新文献

{"title":"Elevated MPV: A Key Indicator of Acute Anterior Circulation Stroke Prognosis in Mechanical Thrombectomy.","authors":"Shi-Yuan Tian, Min-Jie Yu, Kefu Mei, Bing Xu, Lian-Chen Xiao, Hong-Bin Wen, Fu-Rong Shang","doi":"10.2147/TCRM.S522253","DOIUrl":"10.2147/TCRM.S522253","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to investigate the relationship between admission platelet indices and 90-day clinical outcomes in patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy (MT).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 247 AIS patients with anterior circulation large vessel occlusion (LVO) treated with MT between July 2021 and April 2024. Platelet indices (PIs) were measured at admission. Participants were stratified into two groups based on 90-day modified Rankin Scale (mRS) outcomes. Multivariate regression analysis and receiver operating characteristic (ROC) curves were employed to evaluate relationships between admission platelet indices, clinical parameters, and functional outcomes.</p><p><strong>Results: </strong>Among 247 enrolled patients, those with unfavorable outcomes (mRS 3-6) exhibited significantly higher platelet distribution width (PDW) and Mean Platelet Volume (MPV) levels compared to the favorable outcome group (mRS 0-2). Elevated MPV remained an independent predictor of unfavorable outcomes after multivariate adjustment (OR=2.747, 95% CI: 1.791-4.216, <i>P</i><0.001). ROC analysis identified a MPV threshold >10.75 fL for predicting unfavorable prognosis, demonstrating 55.4% sensitivity and 81.2% specificity.</p><p><strong>Conclusion: </strong>PDW is associated with unfavorable 90-day outcomes in patients with acute anterior circulation LVO following MT, while elevated MPV may serve as a prognostic indicator for unfavorable functional outcomes in patients with acute anterior circulation LVO following MT.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"715-725"},"PeriodicalIF":2.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143573","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":"Corticosteroid Therapy for Diffuse Alveolar Hemorrhage with Respiratory Failure in Hematologic Malignancies: A Retrospective Cohort Study.","authors":"Jee Hwan Ahn, Kyung Mee Song, Jin Won Huh, Jung-Hee Lee, Sang-Bum Hong, Je-Hwan Lee, Chae-Man Lim, Kyoo-Hyung Lee, Younsuck Koh","doi":"10.2147/TCRM.S520299","DOIUrl":"10.2147/TCRM.S520299","url":null,"abstract":"<p><strong>Background: </strong>Although DAH in hematopoietic stem cell transplantation recipients is commonly treated with systemic corticosteroids, the efficacy of steroid therapy on DAH with respiratory failure in hematologic malignancy patients has not been studied. We aimed to investigate the effectiveness of steroid therapy in hematologic malignancy patients who developed DAH with respiratory failure and required treatment in the intensive care unit (ICU).</p><p><strong>Methods: </strong>Among DAH patients with leukemia, lymphoma, or multiple myeloma, those who were not admitted to the ICU were excluded. Included patients were classified into the steroid or control group according to steroid therapy. Patient data were retrospectively collected from electrical medical records. The primary outcome was ICU mortality.</p><p><strong>Results: </strong>A total of 44 patients (steroid group, n = 32; control group, n = 12) were included. At the DAH diagnosis, the steroid group was less likely to have a history of previously treated solid malignancy (3% vs 25%; <i>P</i> = 0.025) compared to the control group. ICU mortality in the steroid group was not significantly different from that in the control group (66% vs 67%; <i>P</i> = 0.948). Only in the steroid group, the ratio of arterial oxygen partial pressure to fractional inspired oxygen was significantly improved after 2 days from the DAH diagnosis (151 ± 64 vs 120 ± 38 mm Hg; <i>P</i> = 0.039).</p><p><strong>Conclusion: </strong>Hematologic malignancy patients who developed DAH with respiratory failure and were admitted to the ICU had high mortality, irrespective of steroid therapy.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"705-714"},"PeriodicalIF":2.8,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128723","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":"Circulating-Water Mattress Enhances Thermal Comfort and Patient Satisfaction but Shows Non-Superiority in Temperature Maintenance in Ophthalmic Day-Case Surgery: A Randomized Controlled Trial.","authors":"Yanhong Yan, Jiao Geng, Chunhua Xi, Xu Cui, Guyan Wang","doi":"10.2147/TCRM.S514218","DOIUrl":"10.2147/TCRM.S514218","url":null,"abstract":"<p><strong>Purpose: </strong>Perioperative hypothermia, a common complication of general anesthesia, is associated with adverse outcomes. While active warming methods are recommended, the effectiveness of circulating-water mattresses during ophthalmic surgeries remains understudied. This randomized controlled trial assessed whether a circulating-water mattress combined with a cotton quilt (Group W) was superior to a cotton quilt alone (Group C) in maintaining patient body temperature during ophthalmic day-case surgery.</p><p><strong>Patients and methods: </strong>Group W patients (n=39) used a preheated circulating-water mattress (38°C) on the operating table and were covered with a cotton quilt (from their entry to the operating room until they returned to the ward). Group C patients (n=38) lay on an unheated table and were covered with a cotton quilt. The axillary temperature in the surgical waiting area served as the baseline. Axillary temperature, ambient temperature, heart rate, and mean arterial pressure were documented at anesthesia induction (T₀), start of surgery (T₁), every 5 min for the first hour (T₂-T₁₃), and end of surgery (T₁₄). Satisfaction and thermal comfort scores were assessed at baseline in the waiting area, 5 min before anesthesia induction (t₀), 15 min after entering the post-anesthesia care unit (PACU) (t₁), and upon leaving the PACU (t₂). The primary outcome measure was the axillary temperature at T₁₄.</p><p><strong>Results: </strong>At T₁₄, Group W had a higher axillary temperature than Group C (36.40±0.06°C vs 36.18±0.06°C, <i>P</i>=0.011), with the mean difference 0.22°C, which did not exceed the predefined superiority threshold of 0.30°C, indicating that the warming effect in Group W was not superior to that in Group C. However, thermal comfort and satisfaction scores were significantly enhanced at t₀ and t₁ (<i>P</i><0.05).</p><p><strong>Conclusion: </strong>During ophthalmic day-case surgeries, a circulating-water mattress plus a cotton quilt was not superior, regarding their warming effect, but they significantly enhanced patients' thermal comfort and satisfaction.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"669-680"},"PeriodicalIF":2.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12087790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101126","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":"Inflammatory Burden Index Associated with Recurrence of Atrial Fibrillation After Radiofrequency Catheter Ablation.","authors":"Siliang Peng, Feng Li, Mengchao Jin, You Zhang, Hui Li, Jiayu Yin","doi":"10.2147/TCRM.S518620","DOIUrl":"10.2147/TCRM.S518620","url":null,"abstract":"<p><strong>Background: </strong>Recurrence rates of atrial fibrillation (AF) remain high after radiofrequency catheter ablation (RFCA), and inflammation plays an important role in the process. Inflammatory burden index (IBI) as a new inflammatory marker has been found to be associated with worse prognosis in cardiovascular disease. But there are no studies on its role in predicting AF recurrence. The aim of this study was to assess the value of IBI in predicting recurrence of AF after RFCA.</p><p><strong>Methods: </strong>This was a single-center retrospective observational study. Consecutive enrolment of PersAF who underwent first-time radiofrequency ablation between January 2021 and June 2024. Inflammatory Burden Index (IBI) was calculated as C-reactive protein (CRP) × neutrophil/lymphocyte (NLR).</p><p><strong>Results: </strong>A total of 142 (27.2%) patients experienced recurrence after RFCA. Multivariate analysis showed that PersAF (OR = 1.599; 95% CI: 1.028 ~ 2.486, p = 0.018), CHA₂DS₂-VASc score≥2 (OR = 1.769; 95% CI: 1.142 ~ 2.741, p = 0.011), LAD (OR = 1.098; 95% CI: 1.054 ~ 1.145, p < 0.001) and IBI (OR = 1.028; 95% CI: 1.007 ~ 1.050, p = 0.009), were independent predictors of recurrence. ROC analysis shows superiority of IBI (AUC=0.695, 95% CI: 0.647 ~ 0.743, p < 0.001) over CRP and NLR in predicting AF recurrence. When IBI was integrated into the traditional model (including PersAF, LAD and CHA₂DS₂-VASc Score), the discrimination and reclassification accuracy for the recurrence were significantly improved.</p><p><strong>Conclusion: </strong>Inflammatory load index associated with the recurrence of AF after RFCA. Integration of IBI can improve the model about the recurrence of AF after RFCA.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"681-689"},"PeriodicalIF":2.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12091244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112012","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 Thoracic Paravertebral Block on Postoperative Pulmonary Complications After Video-Assisted Thoracoscopic Surgery: A Dual-Center Randomized Clinical Trial.","authors":"Jiayu Zhu, Biyu Wei, Lili Wu, He Li, Yi Zhang, Jinfeng Lu, Shaofei Su, Chunhua Xi, Wei Liu, Guyan Wang","doi":"10.2147/TCRM.S515093","DOIUrl":"10.2147/TCRM.S515093","url":null,"abstract":"<p><strong>Purpose: </strong>TPVB can provide effective postoperative analgesia in lung cancer patients undergoing video-assisted thoracoscopic surgery (VATS), which may enhance respiratory mechanics and postoperative expectoration, as well as relieve inflammation and stress. These mechanisms may reduce the incidence of postoperative pulmonary complications (PPCs). This study explored whether TPVB reduces the risk of PPCs in patients undergoing VATS for lung cancer.</p><p><strong>Patients and methods: </strong>In this dual-center trial, patients who underwent VATS for lung cancer were randomly divided into the PV group (n = 151, general anesthesia [GA] and TPVB) and the C group (n = 151, GA only). The primary outcome was the incidence of a composite of PPCs within seven days postoperatively.</p><p><strong>Results: </strong>The incidence of PPCs within seven days postoperatively was lower in the PV group (37.7%, 57/151) compared to the C group (49.0%, 74/151), with a risk ratio of 1.59 (95% CI: 1.00 to 2.50, <i>P</i>=0.048). And within 8-30 days postoperatively, compared with that in the C group (33.1%, 50/151), the incidence of PPCs was lower in patients in the PV group (22.5%, 34/151), with a risk ratio of 1.70 (95% CI, 1.02 to 2.84, <i>P</i>=0.040). There was a significant difference in the incidence of pneumonia between the PV group (11/151, 7.3%) and the C group (35/151, 23.3%; <i>P</i> < 0.001), and the incidence of pneumothorax between the PV group (27/151, 17.9%) and the C group (45/151, 29.8%; <i>P</i> = 0.015).</p><p><strong>Conclusion: </strong>Compared to GA alone, TPVB combined with GA reduces the incidence of PPCs within seven days postoperatively in patients undergoing VATS for lung cancer, and this beneficial effect can last up to 30 days after surgery. A possible mechanism is that TPVB reduces acute postoperative pain in patients.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"691-703"},"PeriodicalIF":2.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12087603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101153","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":"Lessons Learned From Awake ECMO Approach in Covid-19-Related Acute Respiratory Distress Syndrome - a Scoping Review.","authors":"Peter Sklienka, Filip Burša, Michal Frelich, Jan Máca, Tereza Romanová, Vojtěch Vodička, Hana Straková, Markéta Bílená, Ondřej Jor, Jan Neiser, Hana Tomášková","doi":"10.2147/TCRM.S507120","DOIUrl":"10.2147/TCRM.S507120","url":null,"abstract":"<p><p>During the COVID-19 pandemic, specific COVID-19-related conditions renewed interest in the full-awake venovenous extracorporeal membrane oxygenation ( <i>^fa</i> V-V ECMO) approach, in which ECMO is applied to awake, cooperative, and non-intubated patients. This scoping review aims to provide a descriptive overview of <i>^fa</i> V-V ECMO in patients with COVID-19-related acute respiratory distress syndrome (CARDS). We searched the PubMed, Web of Science, and Scopus databases using the keywords \"awake ECMO\" or \"spontaneous breathing AND ECMO\", combined with \"COVID-19\", \"SARS-CoV-2\" or \"coronavirus\", utilizing the Boolean operator \"AND\". The search included papers published from November 1, 2019, to December 31, 2024. Sixty-four papers were assessed for eligibility at the abstract level, and fourteen articles (seven small-sample cohort studies and seven case reports) comprising 95 patients were included in the final analysis. The most frequent reasons for preferring <i>^fa</i> V-V ECMO over mechanical ventilation were barotrauma and patient refusal of intubation and mechanical ventilation. The <i>^fa</i> V-V ECMO strategy was successful (ie, patients not intubated, disconnected from ECMO, and discharged from the hospital) in 36.4% of cases (cohort studies only). The incidence of defined severe adverse events (bleeding, thrombosis, cannula malposition, delirium, and progression of barotrauma) was considered low. The mortality rate for CARDS patients treated with <i>^fa</i> V-V ECMO (including only patients from cohort studies) reached 33.0%, notably lower than the 48% reported for CARDS patients treated with V-V ECMO in the ELSO registry. Patients who were intubated due to worsening respiratory failure during <i>^fa</i> V-V ECMO had significantly higher mortality. Infectious complications, sepsis, and multiorgan failure were the most frequent causes of death. However, significant heterogeneity in the definitions and reporting of management, ECMO-related complications, and outcomes was observed across the papers. Despite the heterogeneity of the data, <i>^fa</i> V-V ECMO in CARDS patients can be considered a safe approach associated with a lower mortality rate than that reported in the overall V-V ECMO CARDS population.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"655-668"},"PeriodicalIF":2.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094915","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":"Improved Tubeless Airway Management in JORRP Surgery: Comparative Analysis of Pre- and Post-THRIVE Implementation.","authors":"Guiyu Lei, Siliu Yang, Lili Wu, Yue Yin, Chunhua Xi, Yang Xiao, Guyan Wang","doi":"10.2147/TCRM.S513941","DOIUrl":"https://doi.org/10.2147/TCRM.S513941","url":null,"abstract":"<p><strong>Background: </strong>Juvenile-onset recurrent respiratory papillomatosis (JORRP) is a severe pediatric condition requiring frequent surgical interventions to maintain airway patency. Managing oxygenation during tubeless anesthesia for these surgeries poses significant challenges. In 2021, our center introduced transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) as a novel method for airway management in JORRP surgeries. This study evaluated the impact of THRIVE on perioperative outcomes in pediatric JORRP surgeries.</p><p><strong>Methods: </strong>This was a retrospective study of 122 pediatric JORRP surgical cases carried out at a tertiary center. Patients who underwent surgery prior to the implementation of THRIVE served as the control group (pre-THRIVE), while those treated after its introduction served as the intervention group (post-THRIVE), with 61 patients in each group. Perioperative data, including surgery and anesthesia parameters and extubation frequency were collected.</p><p><strong>Results: </strong>A total of 122 patients were included. Baseline characteristics were comparable between groups. After the introduction of THRIVE, the median number of extubations significantly decreased from a median 3 in the pre-THRIVE group to 1 in the post-THRIVE group (<i>P</i> <0.001). Minimum intraoperative SpO₂ levels were significantly higher in the post-THRIVE group (98% vs 85%, <i>P</i> <0.001). Surgery duration was reduced from 41 minutes to 35.5 minutes (<i>P</i> =0.003), and anesthesia duration decreased from 67 minutes to 58.5 minutes (<i>P</i> =0.016). No significant differences were observed in PACU stay length or complications between the groups.</p><p><strong>Conclusion: </strong>The implementation of THRIVE in pediatric JORRP enhances intraoperative efficiency and safety. Further research is warranted to assess its long-term effect.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"647-654"},"PeriodicalIF":2.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12068389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016194","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 Retrospective Machine Learning Analysis to Predict 3-Month Nonunion of Unstable Distal Clavicle Fracture Patients Treated with Open Reduction and Internal Fixation.","authors":"Changke Ma, Wei Lu, Limei Liang, Kaizong Huang, Jianjun Zou","doi":"10.2147/TCRM.S518774","DOIUrl":"https://doi.org/10.2147/TCRM.S518774","url":null,"abstract":"<p><strong>Background: </strong>This retrospective study aims to predict the risk of 3-month nonunion in patients with unstable distal clavicle fractures (UDCFs) treated with open reduction and internal fixation (ORIF) using machine learning (ML) methods. ML was chosen over traditional statistical approaches because of its superior ability to capture complex nonlinear interactions and to handle imbalanced datasets.</p><p><strong>Methods: </strong>We collected UDCFs patients at Nanjing Luhe People's Hospital (China) between January 2015 and May 2023. The unfavorable outcome was defined as 3-month nonunion, as represented by disappeared fracture line and continuous callus. Patients meeting inclusion criteria were randomly divided into training (70%) and testing (30%) sets. Five ML models (logistic regression, random forest classifier, extreme gradient boosting, multi-layer perceptron, and category boosting) were developed. Those models were selected based on univariate analysis and refined using the Least Absolute Shrinkage and Selection Operator (LASSO). Model performance was evaluated using AUROC, AUPRC, accuracy, sensitivity, specificity, F1 score, and calibration curves.</p><p><strong>Results: </strong>A total of 248 patients were finally included into this study, and 76 (30.6%) of them had unfavorable outcomes. While all five models showed similar trends, the CatBoost model achieved the highest performance (AUROC = 0.863, AUPRC = 0.801) with consistent identification of the risk factors mentioned above. The SHAP values identified the CCD as the significant predictor for assessing the risk of 3-month nonunion in patients with UDCFs within the Chinese demographic.</p><p><strong>Conclusion: </strong>The refined model incorporated four readily accessible variables, wherein the CCD, HDL levels, and blood loss were associated with an elevated risk of nonunion. Conversely, the application of nerve blocks, including postoperative block, was correlated with a reduced risk. Our results suggest that ML, particularly the CatBoost model, can be integrated into clinical workflows to aid surgeons in optimizing intraoperative techniques and postoperative management to reduce nonunion rates.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"633-645"},"PeriodicalIF":2.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049352","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":"Development and Validation of an Interpretable Machine Learning Model for Prediction of the Risk of Clinically Ineffective Reperfusion in Patients Following Thrombectomy for Ischemic Stroke.","authors":"Xiaolong Hu, Dayong Qi, Suya Li, Shifei Ye, Yue Chen, Wei Cao, Meng Du, Tianheng Zheng, Peng Li, Yibin Fang","doi":"10.2147/TCRM.S520362","DOIUrl":"https://doi.org/10.2147/TCRM.S520362","url":null,"abstract":"<p><strong>Background: </strong>Despite successful recanalization after thrombectomy in patients with acute ischemic stroke, poor prognosis often persists. This study aimed to investigate the factors contributing to clinically ineffective reperfusion (CIR), develop and validate a machine-learning model to predict CIR, and provide guidance for future clinical treatments.</p><p><strong>Methods: </strong>We collected data from patients undergoing thrombectomy at Shanghai Fourth People's Hospital between December 2021 and June 2024. The clinical variables were compared between the clinically ineffective and effective recanalization groups using univariate analysis. Four machine learning models were developed: random forest (RF), support vector machine (SVM), decision tree (DT), and k-nearest neighbor (KNN). Model performance was evaluated using receiver operating characteristic (ROC) curves and heatmap visualization. The SHAP method rank the feature importance and provided interpretability for the final model.</p><p><strong>Results: </strong>Among the four machine learning models, the RF model showed the best performance, with an area under the curve (AUC) of 0.96 (95% CI: 0.91-1.0), accuracy of 0.93, and specificity of 0.97 on the test dataset. The SHAP algorithm identified the number of endovascular thrombectomy (EVT) attempts as the key factor influencing CIR. Based on the RF model, a web-based calculator for CIR prediction is available at https://ineffectivereperfusion.shinyapps.io/calculate/. The final model included ten parameters: EVT attempts, diabetes mellitus, previous ischemic stroke, National Institutes of Health Stroke Scale (NIHSS score), preoperative infarction in the basal ganglia, baseline diastolic blood pressure, clot burden score (CBS)/basilar artery on computed tomography angiography (BATMAN) score, stroke cause, collateral grade, and MLS.</p><p><strong>Conclusion: </strong>We developed and validated the first interpretable machine learning model for CIR prediction after EVT, surpassing traditional methods. Our CIR risk prediction platform enables early intervention and personalized treatment. The number of EVT attempts has emerged as a key determinant, underscoring the need for optimized procedural timing to improve outcomes.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"621-631"},"PeriodicalIF":2.8,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035880","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":"Risk Factors for Postoperative Infections in Severe Traumatic Brain Injury Patients Undergoing Emergency Craniotomy.","authors":"Zhiyu Zhang, Lin Xu, Sheng Xu","doi":"10.2147/TCRM.S512780","DOIUrl":"https://doi.org/10.2147/TCRM.S512780","url":null,"abstract":"<p><strong>Background and aim: </strong>Severe traumatic brain injury (TBI) patients undergoing emergency craniotomy are at high risk of postoperative infections. This study aims to identify the risk factors associated with these infections to improve patient outcomes.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted, including 312 severe TBI patients who underwent emergency craniotomy at Brain Hospital of Hunan Province between December 2019 and December 2021. Clinical data were collected, and both univariate and multivariate logistic regression analyses were performed to identify risk factors for postoperative infections.</p><p><strong>Results: </strong>Among the 312 patients, 57 (18.3%) developed postoperative infections. Multivariate analysis identified several significant risk factors, including older age (OR=1.75, 95% CI: 1.23-2.49), prolonged surgery duration (OR=2.01, 95% CI: 1.38-2.92), presence of preoperative infection (OR=2.59, 95% CI: 1.64-4.09), and lower Glasgow Coma Scale (GCS) score on admission (OR=1.82, 95% CI: 1.21-2.74).</p><p><strong>Conclusion: </strong>Identifying patients at high risk for postoperative infections can help guide preventive measures and improve outcomes in severe TBI patients undergoing emergency craniotomy.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"609-619"},"PeriodicalIF":2.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024068","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}