Therapeutics and Clinical Risk Management最新文献

{"title":"Advanced Therapies in Elderly Patients With Inflammatory Bowel Disease: A Comparative Retrospective Cohort Study in Taiwan.","authors":"Shih-Hua Lin, Horng-Yih Chiu, Chia-Jung Kuo, Chien-Ming Chen, Ming-Yao Su, Ren-Chin Wu, Cheng-Tang Chiu, Chen-Wang Chang, Chen-Shuan Chung, Yu-Bin Pan, Puo-Hsien Le","doi":"10.2147/TCRM.S518405","DOIUrl":"https://doi.org/10.2147/TCRM.S518405","url":null,"abstract":"<p><strong>Purpose: </strong>Inflammatory Bowel Disease (IBD) predominantly affects younger individuals, but emerging data indicates a shift toward older populations. Elderly-onset IBD (diagnosed at 60 years or older) differs from younger-onset IBD, presenting with atypical symptoms and higher risks of infections and malignancies. However, drug persistence is underexplored in the elderly IBD group, warranting further investigation to optimize treatment strategies for this demographic.</p><p><strong>Patients and methods: </strong>This retrospective cohort study included IBD patients receiving advanced therapies at the Chang Gung IBD Center from October 2017 to September 2023. Patients were stratified into two groups: elderly-onset (≥60 years) and control (<60 years). We compared one-year persistence of advanced therapies, opportunistic infections, IBD-related admissions, complications, surgeries, and acute flare-ups between the groups. Specifically, we analyzed the one-year persistence of various advanced therapies within the elderly-onset cohort.</p><p><strong>Results: </strong>The study included 511 IBD patients, 107 of whom were elderly-onset. Elderly-onset patients had a higher body mass index, a higher proportion of ulcerative colitis, fewer smokers, and lower levels of white blood cells, hemoglobin, and albumin. Differences were noted in Montreal classifications and a higher use of Vedolizumab. Clinical outcomes, including steroid-free remission rates, one-year therapy persistence, infections, complications, surgeries, and flare-ups, were comparable between groups. In Crohn's disease (CD), Infliximab and Ustekinumab exhibited higher one-year persistence. Predictors of one-year therapy persistence included Montreal L1 (OR: 6.722; 95% CI: 1.296-34.852; P=0.023), Ustekinumab use (OR: 5.672; 95% CI: 1.138-28.267; P=0.034), and hemoglobin level (OR: 1.612; 95% CI: 1.210-2.147; P=0.001) with an optimal cutoff of 11.65 g/dL.</p><p><strong>Conclusion: </strong>Elderly-onset IBD patients display unique clinical characteristics and therapy persistence, particularly in CD, highlighting the necessity for customized therapeutic strategies.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"533-542"},"PeriodicalIF":2.8,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014545","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":"Feasibility and Outcomes of Vessel-Sparing Surgery for Soft Tissue Sarcoma of the Thigh Adjacent to Femoral Vessels.","authors":"Zheng-Ming Yang, Hao Qu, Ke-Yi Wang, Jia-Dan Wu, Bing Liu, Li-Bin Jin, Xin Huang, Nong Lin, Hui-Min Tao, Zhao-Ming Ye","doi":"10.2147/TCRM.S506754","DOIUrl":"https://doi.org/10.2147/TCRM.S506754","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to investigate the feasibility and oncological outcomes of vessel-sparing surgery for soft tissue sarcomas located near the femoral vessels in the thigh. A comparison was made with cases where the tumor was not adjacent to the femoral vessels, focusing on recurrence rates, survival prognosis, and the viability of vessel-sparing surgical techniques.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 211 cases. After well-differentiated liposarcoma were excluded from further analysis, 148 cases involved tumors not adjacent to the femoral vessels, while 22 cases were located near the vessels. Postoperative functional outcomes, survival rates, and local recurrence were evaluated. Due to the imbalance in case numbers between the two groups, propensity score matching was applied at a 1:1 ratio, after which the two datasets were compared and analyzed.</p><p><strong>Results: </strong>By the last follow-up, 40 had experienced recurrence, 35 patients had died, 15 were surviving with tumors, and 161 were living tumor-free. No statistically significant differences were found between the survival and recurrence-free survival curves for cases with sarcomas adjacent to the femoral vessels compared to those with tumors located elsewhere, both before and after propensity score matching. Tumor grade and size were identified as key factors influencing survival and recurrence outcomes in soft tissue sarcoma of the thigh.</p><p><strong>Conclusion: </strong>For soft tissue sarcoma of the thigh located adjacent to femoral vessels, vessel-sparing surgery involving vascular sheath removal demonstrates favorable outcomes. Tumor size greater than 10 cm and high pathological grade were significant predictors of survival and recurrence risk.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"553-564"},"PeriodicalIF":2.8,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024055","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 Epicardial Adipose Tissue and Contrast-Induced Acute Kidney Injury in Patients with ST-Segment Elevation Myocardial Infarction.","authors":"Baohe Zang, Weiwei Hu, Yali Chao, Dengji Wang","doi":"10.2147/TCRM.S518586","DOIUrl":"https://doi.org/10.2147/TCRM.S518586","url":null,"abstract":"<p><strong>Background: </strong>Epicardial adipose tissue (EAT) affects the kidneys by secreting various bioactive molecules. Contrast-induced acute kidney injury (CI-AKI) is a common complication after percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients. The relationship between EAT and CI-AKI remains unclear. This study aims to explore the relationship between EAT and the incidence of CI-AKI after PCI in STEMI patients.</p><p><strong>Methods: </strong>Patients diagnosed with STEMI were continuously included, all patients underwent PCI within 12 hours of onset. EAT volume was measured and obtained by chest CT. Logistic regression analysis was used to analyze possible risk factors for CI-AKI. Restricted cubic splines (RCS) were utilized to explore the dose-response relationship involving EAT and CI-AKI.</p><p><strong>Results: </strong>The incidence of CI-AKI was 8.9% (57/638). Compared with the Non-CI-AKI group, the EAT volume was significantly higher (<i>p</i><0.005). After adjusting for confounding factors, multivariate regression analysis showed FBG, NT-proBNP, LVEF, and EAT volume were the independent predictors for CI-AKI. RCS analysis indicated a linear dose-response relationship between EAT volume and CI-AKI. The integration of EAT volume could significantly improve ability of the model for CI-AKI (NRI 0.4071, 95% CI 0.231 ~ 0.583, <i>p</i> < 0.001; IDI 0.1356, 95% CI 0.091 ~ 0.180, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Higher EAT volume was an independent risk factor for CI-AKI in STEMI patients. Integration of EAT volume could significantly improve the risk model for CI-AKI.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"543-552"},"PeriodicalIF":2.8,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038951","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":"Comparative Analysis of a New Device-Assisted Mini-Incision Versus Conventional Surgery for Carpal Tunnel Syndrome: A Retrospective Study of 109 Cases.","authors":"Tianhao Guo, Chenfei Li, Dehu Tian, Ruijiao Gao, Kunlun Yu, Naichao Sun, Jing Yang, Jiangbo Bai","doi":"10.2147/TCRM.S514225","DOIUrl":"https://doi.org/10.2147/TCRM.S514225","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective cohort study.</p><p><strong>Objective: </strong>This study aimed to compare the effectiveness and safety of the new device-assisted mini-incision approach for carpal tunnel release (CTR) with the conventional method.</p><p><strong>Methods: </strong>A total of 109 patients diagnosed with primary carpal tunnel syndrome confirmed clinically were retrospectively included and divided into two groups based on the surgical approach: Group A (n=54) underwent surgery using a new device-assisted mini-incision, and Group B (n=55) received conventional surgery. Clinical outcomes, including pinch strength, grip strength, Visual Analog Scale (VAS) score, two-point discrimination (2-PD), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Boston Carpal Tunnel Questionnaire (BCTQ), were evaluated at 1, 3, and 6 months postoperatively. Additionally, operative time, incision length, wound pain, pillar pain, and the interval until return-to-work were compared between the two groups.</p><p><strong>Results: </strong>At the 6-month follow-up, all patients in both groups had recovered. There were no significant differences between the two groups in postoperative pinch strength (<i>P</i> = 0.665), grip strength (<i>P</i> = 0.803), 2-point discrimination (2-PD) (<i>P</i> = 0.347), Visual Analogue Scale (VAS) score (<i>P</i> = 0.143), Disabilities of the Arm, Shoulder and Hand (DASH) score (<i>P</i> = 0.524), and Boston Carpal Tunnel Questionnaire (BCTQ) (SSS: <i>P</i> = 0.195; FSS: <i>P</i> = 0.103). Statistically significant differences were observed between the two groups in operation time (<i>P</i> < 0.001), incision length (<i>P</i> < 0.001), and return to work time (<i>P</i> < 0.001). Although at 6-month follow-up, there was no significant difference in the incidence of wound pain and pillar pain between the two groups. But the incidence of wound pain and pillar pain was lower in Group A (wound pain: 0%; pillar pain:0%) compared to Group B (wound pain: 5.5%; pillar pain:7.3%).</p><p><strong>Conclusion: </strong>The device-assisted mini-incision technique provided comparable functional results to the conventional approach, with reduced complications and smaller incisions, supporting its use as a viable alternative in appropriate cases.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"511-522"},"PeriodicalIF":2.8,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12034282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032860","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 of Diaphragmatic Mobility and Thickening Fraction with Postoperative Pulmonary Complications in Patients Undergoing Thoracic Surgery and Their Application in Prediction.","authors":"Abudushalamu Aisiaiti, Aiwuzaili Ajiaikebaier, Aini Maimaitiming, Qiang Geng, Bichen He, Jinhui Sun, Bing Zhang","doi":"10.2147/TCRM.S519646","DOIUrl":"https://doi.org/10.2147/TCRM.S519646","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the association of diaphragmatic mobility and thickening fraction with postoperative pulmonary complications (PPCs) in patients undergoing thoracic surgery and evaluate their values in predicting PPCs.</p><p><strong>Patients and methods: </strong>One hundred and nine consecutive patients undergoing thoracic surgery were prospectively enrolled. All patients underwent ultrasound measurements to obtain diaphragmatic mobility and thickening fraction. PPCs were systematically monitored and recorded from postoperative day 1 to 7. The binary logistic regression model was used to perform multivariate analysis, and the receiver operating characteristic (ROC) curve was used to evaluate predictive values.</p><p><strong>Results: </strong>PPCs occurred in 46 patients (42.2%). Multivariate analysis identified age, smoking, surgical sites, and mean diaphragmatic mobility and thickening fraction of operated side and nonoperated side as independent risk factors for PPCs. ROC curves revealed that the AUC of mean diaphragmatic mobility and thickening fraction for predicting PPCs in patients undergoing thoracic surgery was 0.722 [standard error (<i>SE</i>): 0.050, 95% confidence interval (<i>CI</i>): 0.623~0.821, <i>P</i><0.001] and 0.757 (<i>SE</i>: 0.050, 95% <i>CI</i>: 0.659~0.855, <i>P</i><0.001), respectively. The predictive model integrating age, smoking and surgical sites yielded an AUC of 0.810 (<i>SE</i>: 0.041, 95% <i>CI</i>: 0.728~0.891, <i>P</i><0.001), while the predictive model integrating age, smoking, surgical sites and mean diaphragmatic mobility or thickening fraction yielded an AUC of 0.849 (<i>SE</i>: 0.037, 95% <i>CI</i>: 0.777~0.922, <i>P</i><0.001) and 0.881 (<i>SE</i>: 0.033, 95% <i>CI</i>: 0.815~0.946, <i>P</i><0.001), respectively.</p><p><strong>Conclusion: </strong>Both diaphragmatic mobility and thickening fraction showed independent associations with PPCs following thoracic surgery, demonstrating moderate predictive values. The predictive models integrating age, smoking, surgical sites and diaphragmatic mobility or thickening fraction yielded high predictive values, suggesting significant clinical utility for risk stratification. Diaphragmatic mobility and thickening fraction offer a bedside, noninvasive, and cost-effective alternative for perioperative PPC prediction, particularly in resource-limited settings.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"501-509"},"PeriodicalIF":2.8,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995844","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":"Study on the Combined Application of Occlusal Splint and Intra-Articular Injection of Hyaluronic Acid in the Treatment of Non-Reducible Anterior Disc Displacement of the Temporomandibular Joint.","authors":"Ke Bi, Gang Cheng, Xiuyin Wu, Zhijun Lv","doi":"10.2147/TCRM.S518989","DOIUrl":"https://doi.org/10.2147/TCRM.S518989","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effect of combining intra-articular injection of hyaluronic acid (HA) with occlusal splint therapy in the treatment of non-reducible anterior disc displacement of the temporomandibular joint (ADDWoR).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on the clinical data of 62 patients with ADDWoR admitted to our hospital from April 2023 to June 2024. According to the treatment method received, patients were divided into a control group (n=31, treated with occlusal splints) and an observation group (n=31, treated with occlusal splints combined with intra-articular injection of HA). The clinical treatment effects, pain levels (Visual Analog Scale [VAS]), temporomandibular joint dysfunction (Friction Temporomandibular Joint Dysfunction Index [CMI]), mandibular movement function (maximum mouth opening [MMO], left lateral excursion [LLE], right lateral excursion [RLE], protrusive movement [PM]), clinical aesthetic indicators (condylar height, joint space width), and adverse reactions were compared between the two groups.</p><p><strong>Results: </strong>(1) Clinical Efficacy: The observation group had a higher total effective rate (90.32% vs 67.74%, P < 0.05). (2) Pain & Dysfunction: Both groups showed significant improvement in VAS and CMI scores over time, with the observation group exhibiting greater reductions (P < 0.05). (3) Mandibular Function & Aesthetic Indicators: The observation group had greater improvements in MMO, LLE, RLE, PM, condylar height, and joint space width (P < 0.05). (4) Adverse Reactions: No significant difference in adverse reaction rates (P > 0.05).</p><p><strong>Conclusion: </strong>The combination of intra-articular injection of HA with occlusal splint therapy can further improve the treatment outcomes for ADDWoR patients, alleviate pain, improve temporomandibular joint dysfunction and mandibular movement function, promote aesthetic recovery, and does not increase the risk of adverse reactions.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"523-532"},"PeriodicalIF":2.8,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028056","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":"Chronic Khat Chewing Induced High-Grade Hemorrhoidal Disease and Post-Operative Bleeding in Yemen.","authors":"Waheeb Radman Al-Kubati","doi":"10.2147/TCRM.S498067","DOIUrl":"https://doi.org/10.2147/TCRM.S498067","url":null,"abstract":"<p><strong>Background: </strong>Khat contains alkaloids, tannins, and flavonoids with physiological and pathological effects. In Yemen, anorectal diseases, including hemorrhoids, are prevalent, and hemorrhoidectomy is frequently performed.</p><p><strong>Purpose: </strong>This study evaluates the relationship between chronic khat chewing and high-grade hemorrhoidal disease, as well as post-operative complications such as bleeding and pain.</p><p><strong>Patients and methods: </strong>This prospective cross-sectional study included 1,896 patients aged 16-85 years, meeting the inclusion criteria were included and followed for three months.</p><p><strong>Patients were divided into two groups: </strong>Chronic khat chewers (n=1,492) and non-khat chewers (n=404) Data included khat habits, clinical assessments, digital rectal exams, anoproctoscopy, intraoperative findings, and post-operative outcomes.</p><p><strong>Results: </strong>Chronic khat chewing was strongly associated with thrombosed grade IV hemorrhoidal disease. Among khat chewers, 90% had hemorrhoids, with 75% requiring hemorrhoidectomy or hemorrhoidopexy, compared to 25% in non-chewers, where half underwent hemorrhoidopexy. The odds ratio (OR) for hemorrhoids in khat chewers was 27.04. Gender-specific analysis showed a six-fold higher OR for hemorrhoids in khat-chewing females versus non-chewing females. Post-operative complications, including bleeding and severe pain, were significantly higher in male khat chewers (p < 0.05), while no significant differences were observed in females.</p><p><strong>Conclusion: </strong>Chronic khat chewing is strongly associated with high-grade hemorrhoidal disease and increased post-operative complications. Mechanisms include chronic constipation, increased anal sphincter tone, and prolonged sitting. These findings highlight the need for public health strategies to reduce khat use and tailored clinical approaches to improve outcomes. Future research should focus on establishing causality, identifying confounders, dose-response relationships, and exploring gender-specific management strategies that target both mechanical and pharmacological factors to optimize surgical care and long-term outcomes.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"489-499"},"PeriodicalIF":2.8,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12038854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987183","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":"Posterior Pericardial Window and a Single Pleural Drain: A Dual Defence Against Post-CABG Pericardial Effusion and Atrial Fibrillation.","authors":"Redoy Ranjan, Stamatis Kapetanakis, Venkatachalam Chandrasekaran, Riyaz A Kaba, Aziz U Momin","doi":"10.2147/TCRM.S521874","DOIUrl":"https://doi.org/10.2147/TCRM.S521874","url":null,"abstract":"<p><strong>Background: </strong>Postoperative new atrial fibrillation (POAF) commonly occurs after coronary artery bypass graft (CABG) and is often associated with postoperative pericardial effusion. We aimed to investigate the effectiveness of a posterior pericardial window (PPW) with a single left pleural drain in reducing post-CABG pericardial effusion and atrial fibrillation without mediastinal chest drains.</p><p><strong>Methods: </strong>This descriptive observational study evaluated age and sex-adjusted isolated elective on-pump CABG patients into two groups: PPW with only left pleural chest drains and control (routine multiple mediastinal and pleural chest drains. We performed continuous telemonitoring for 96 hours after surgery to assess heart rhythm, followed by daily electrocardiograms. Bedside echocardiography was conducted on postoperative day 4 to check for pericardial effusion.</p><p><strong>Results: </strong>This study evaluated age and sex-adjusted 250 CABG patients, with male predominance (80%) and identical comorbidities between study groups. We found similar age (61.5 ±7.5 vs 62.6 ±6.2, P =0.40) and male sex (86.9% vs 74.8%, P =0.13) between the PPW and control groups. Additionally, the sociodemographic and intraoperative variables were the same across the study groups (P >0.05). The occurrence of >1cm pericardial effusions (0.8% vs 14.1%, P <0.001) and postoperative AF (6.9% vs 19.3%, P =0.002) occurrence was significantly lower in the PPW compared to the control group.</p><p><strong>Conclusion: </strong>Despite similar clinical and operative profiles, a posterior pericardial window with a single left pleural drain effectively reduces pericardial effusion and the incidence of postoperative AF following CABG surgery.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"481-487"},"PeriodicalIF":2.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12009033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049383","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 Association Between Preoperative Triglyceride Glucose Index and Postoperative Adverse Cardiovascular Events in Non-Cardiac Surgery: A Single-Center Study From China.","authors":"Jiandong Hao, Li Qu, Yang Yang, Yun Sun, Guiping Xu","doi":"10.2147/TCRM.S518077","DOIUrl":"https://doi.org/10.2147/TCRM.S518077","url":null,"abstract":"<p><strong>Background: </strong>The incidence of postoperative adverse cardiovascular events (PACE) in non-cardiac surgery has significantly increased, severely affecting surgical outcomes and patient prognosis. This study investigates the relationship between preoperative triglyceride-glucose (TyG) index and PACE in patients who underwent non-cardiac surgery.</p><p><strong>Methods: </strong>We conducted a single-center retrospective study, including adult patients (age ≥18 years) who underwent non-cardiac surgery. Univariate and multivariate logistic regression analyses assessed the relationship between the TyG index and PACE. Nonlinear correlations were investigated using restricted cubic splines (RCS). Additionally, subgroup analysis was performed to evaluate the relationship between the TyG index and PACE in different subsamples.</p><p><strong>Results: </strong>16,066 patients were studied, among which 1505 cases (9.37%) developed PACE, with a median TyG index of 8.61 (8.22, 9.07). Using the lowest quartile of the TyG index as a reference, the fully adjusted (ORs) (95% CIs) for PACE in the second, third, and fourth quartiles of the TyG index were 1.78 (1.49~2.11), 2.16 (1.81~2.59), and 2.30 (1.88~2.83), respectively. After adjusting for all confounding factors, we found that patients with the highest TyG index had a 68% increased risk of PACE (OR 1.68, 95% CI 1.50~1.90). The results of the subgroup analysis were similar to those of the primary analysis. The RCS model suggests a linear positive correlation between the TyG index and the risk of PACE occurrence. (P for overall < 0.001, P for nonlinear = 0.547).</p><p><strong>Conclusion: </strong>This cohort study indicates that preoperative TyG index is linearly and positively correlated with an increased incidence of PACE in the non-cardiac surgery population. This finding suggests that intensifying the evaluation of the TyG index may provide a more convenient and effective tool for identifying individuals at risk of PACE during non-cardiac surgeries.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"467-479"},"PeriodicalIF":2.8,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12005211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015934","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 of Prognostic Nutritional Index with Post-Discharge Bleeding After Percutaneous Coronary Intervention in ACS Patients on DAPT.","authors":"Nasima Mohamed Elkenany, Zia Ul Sabah, Nadia Ahmed Agiba, Hanaa Kamel Elmahdy, Eman Aziz Yousef Elsherbiny, Salwa Rashad Aly Said, Eman Mostafa Nassef, Ahmed Mohamed Ewis Alhawy, Marwan Sayed Mohamed Ahmed, Ashraf Mohammed Said Elsharkawy, Amr Mahmoud Mohamed Hussein, Abeer Ahmed Elmalah","doi":"10.2147/TCRM.S496656","DOIUrl":"https://doi.org/10.2147/TCRM.S496656","url":null,"abstract":"<p><strong>Purpose: </strong>Malnutrition increases bleeding risk by reducing thrombogenicity, impairing platelet aggregation, prolonging bleeding time, and promoting systemic inflammation, which affects vascular permeability and angiogenesis. The Prognostic Nutritional Index (PNI), calculated from serum albumin and lymphocyte count, reflects both nutritional and inflammatory status. This study aimed to assess PNI's association with bleeding risk in acute coronary syndrome (ACS) patients on dual antiplatelet therapy (DAPT).</p><p><strong>Patients and methods: </strong>This prospective, single-center observational cohort study enrolled 1843 patients presenting with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). ROC analysis determined 42.7 as the optimal PNI cut-off value for risk stratification. Participants were stratified into distinct groups based on Prognostic Nutritional Index (PNI) cut-off values, a composite marker derived from serum albumin levels and peripheral lymphocyte counts, reflecting both nutritional and inflammatory status. Patients were prospectively followed for 12 months post-discharge to assess the occurrence of actionable bleeding events, with the aim of evaluating the association between PNI and post-PCI bleeding risk.</p><p><strong>Results: </strong>The study cohort had a mean age of 66.4, with 65.16% male. After PCI, 98.04% were on DAPT. Patients were divided into Group I (PNI ≥ 42.7, n = 1290) and Group II (PNI < 42.7, n = 553). During follow-up, 5.58% of patients experienced actionable bleeding, with 3.5% in Group I and 10.3% in Group II (p < 0.0001). Multivariable Cox regression analysis revealed that PNI < 42.7 was a significant independent predictor of bleeding (HR: 1.7; 95% CI: 1.1-2.5; p < 0.003).</p><p><strong>Conclusion: </strong>Baseline PNI is an independent predictor of post-discharge bleeding in ACS patients on DAPT after PCI, suggesting it could be a valuable tool for risk stratification of bleeding in these patients.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"455-466"},"PeriodicalIF":2.8,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11995920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014548","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}