Clinical Medicine & Research最新文献

{"title":"\"Dialogue Between Franklin and the Gout\" Reexamined.","authors":"Mary Mikhael, Chokkalingam Siva","doi":"10.3121/cmr.2023.1833","DOIUrl":"10.3121/cmr.2023.1833","url":null,"abstract":"<p><p>Benjamin Franklin, one of the founding fathers of the United States, was not just a politician and a political philosopher but an inventor with a scientific temperament. He was overweight and likely suffered from the consequences of metabolic syndrome including gout. He woke up with a gout attack on October 22, 1780 and wrote the \"Dialogue Between Franklin and the Gout.\" His observations on the risk factors for gout are re-examined in the modern context 243 years later.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"21 4","pages":"196-200"},"PeriodicalIF":1.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139651889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating the Effect of Temperature Therapy on the Severity of Restless Legs Syndrome: Systematic Review and Meta-Analysis.","authors":"Mohammad Mehdi Mohammadi, Ali Akbar Vaisi Raygani","doi":"10.3121/cmr.2023.1824","DOIUrl":"10.3121/cmr.2023.1824","url":null,"abstract":"<p><p><b>Background:</b> Restless legs syndrome (RLS) is a sensorimotor disorder leading to disturbance of resting, discomfort, stress, and impaired daytime activity in the sufferers. The present systematic review and meta-analysis was conducted to determine the effect of temperature therapy on the severity of RLS.<b>Methods:</b> The electronic databases of Google Scholar, ProQuest, Scopus, PubMed, Web of Science, and State Inpatient Databases (SID) were searched from inception to August 2022. The Cochrane Collaboration's Risk of Bias Tool was used to check the quality of included studies. Meta-analysis was performed by calculating standardized mean differences (SMDs), using random effects model, and running Comprehensive Meta-Analysis (CMA) software version 2.<b>Results:</b> The included studies (n=6) comprised 177 participants, whose mean age was 49.85 years old. The results of the meta-analysis showed temperature therapy could reduce the severity of RLS (SMD=-1.520, 95% CI: -2.122 to -0.918). Regarding the source of heterogeneity, meta-regression results indicated the efficacy of the intervention in reducing the severity of RLS enhanced significantly by increasing the duration of the intervention in each session (β=-0.039, 95% CI -0.076 to -0.002, <i>P</i><0.001). The results also showed increasing the duration (β=-0.039, 95% CI -0.076 to -0.002, P<0.001) and the temperature of the intervention in each session (β=-0.016, 95% CI -0.028 to -0.003, <i>P</i><0.05) significantly enhanced the efficacy of the intervention in reducing the severity of RLS. The results also indicated that, among patients with underlying clinical conditions, the effectiveness of temperature therapy was higher in hemodialysis patients (β=-2.006, 95% CI -2.736 to -1.276, <i>P</i><0.05).<b>Conclusion:</b> The present study findings suggested temperature therapy could mildly reduce the severity of RLS symptoms. It was also found that the highest efficacy of this intervention could be achieved when the higher temperature was used in fewer treatment sessions in hemodialysis patients. Based on our findings, this intervention can be included in the care plan of patients with RLS considering the settings described to achieve the highest efficacy.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"21 4","pages":"216-225"},"PeriodicalIF":1.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139651893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meningitis in the Guise of Dementia: Lyme-Induced Normal Pressure Hydrocephalus.","authors":"Ryan Liu, Matheus Polly, Robert P Lennon, Alexis Reedy-Cooper","doi":"10.3121/cmr.2023.1829","DOIUrl":"10.3121/cmr.2023.1829","url":null,"abstract":"<p><p>While the cause of altered mentation in the elderly may be multifactorial, infectious etiologies may be missed. This case report aims to detail an account of a patient with dementia, found to have Lyme meningitis in the setting of a normal pressure hydrocephalus (NPH). The patient smelled of urine and presented with ambulatory dysfunction, fitting the \"wet, wacky, and wobbly\" triad of NPH while also having subjective chills and leukocytosis. Non-contrast brain CT scan showed dilated ventricles. Cerebrospinal fluid (CSF) studies suggested aseptic meningitis. Serum studies using a modified two-tiered algorithm confirmed the diagnosis of Lyme disease. Treatment of the underlying condition with a prolonged course of doxycycline improved symptoms and clinical course. Review of the literature on the association between Lyme meningitis and NPH reveals that few cases of Lyme-related NPH have been reported worldwide and further research into the pathophysiology, diagnostic approach, treatment modalities, and management of NPH secondary to Lyme meningitis may be warranted.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"21 4","pages":"226-229"},"PeriodicalIF":1.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139651804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distance Matters: Investigating No-Shows in a Large Rural Provider Network.","authors":"Abdul Shour, Adedayo A Onitilo","doi":"10.3121/cmr.2023.1853","DOIUrl":"10.3121/cmr.2023.1853","url":null,"abstract":"<p><p><b>Background/Objective:</b> No-shows have a negative effect on healthcare outcomes. It is unclear, however, whether patients' distance from the clinic is associated with higher no-show rates. To fill this knowledge gap, we examined the relationship between patients' distance from the clinic and no-shows in a rural provider network.<b>Methods:</b> Data from Marshfield Clinic Health System's scheduling system, including 263,464 recent patient appointments in 2021 were analyzed. The outcome was no-shows, defined as when patients missed an appointment (categorized as yes/no). The exposure was the distance to the clinic, measured in miles as a straight-line distance from the clinic in the patient's zip code to the facility where the appointment was held (classified as <5 miles, 5-10, 10-20; >20, and used as continuous). Covariates were patient demographics, appointments, providers, and insurance status. Chi-square and logistic regression were used with p-values ≤.05 considered statistically significant.<b>Results:</b> The no-show rate was 8.0%. Patients who lived <5 miles (8.3%) and >20 miles (8.2%) from the clinic had higher no-show rates than those who lived between 10-20 miles (8.0%) and 5-10 miles (7.6%), at <i>P</i>=0.001. In the adjusted model, the odds of no-show were similar between patients who did not show and those who did (OR:1.00,95%CI:1.00-1.00). No-shows were more likely among male patients compared to females (OR:1.14,95%CI:1.11-1.18), Spanish compared to English speakers (OR:1.34,95%CI:1.20-1.50), prior no-show compared to no prior no-show (OR:4.42,95%CI:4.27-4.48), >4 weeks lead time compared to <1 day (OR:5.45,95%CI:4.98-5.97), and Medicaid compared to non-Medicaid patients (OR:1.56,95%CI:1.49-1.63).<b>Conclusion:</b> Our analysis showed patients who lived <5 miles and >20 miles from the clinic had higher no-show rates. The odds of a no-show were comparable between patients who showed up and those who did not. Male patients, Spanish-speaking patients, patients with a history of no-shows, and Medicaid beneficiaries were more likely to miss their appointments. Understanding the impact of these variables on no-show rates can assist healthcare providers in developing strategies to improve patient access and reduce no-show rates. These findings imply that rural patients may face a variety of barriers when seeking healthcare, necessitating a comprehensive approach to addressing this issue.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"21 4","pages":"177-191"},"PeriodicalIF":1.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139651892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Review of Interleukin-17 in Oral Lichen Planus: From Etiopathogenesis to Treatment.","authors":"Farzaneh Agha-Hosseini, Mahdieh-Sadat Moosavi, Hosna Bahrami","doi":"10.3121/cmr.2023.1822","DOIUrl":"10.3121/cmr.2023.1822","url":null,"abstract":"<p><p>Lichen planus (LP) is a chronic autoimmune disease of skin and mucous membranes. World Health Organization has announced oral lichen planus (OLP) as a premalignant lesion. The exact etiology of OLP remains unknown; however, different mechanisms may be involved in its immunopathogenesis. The upregulation of cytokines, chemokines, and adhesion molecules is consistent with a persistent and erratic immunological response to OLP-mediated antigens generated by oral keratinocytes and innate immune cells. These molecules attract T cells, and mast cells to the disease site and regulate complex interactions among cells that lead to death of keratinocytes, degradation of basement membrane, and chronicity of the disease. It is believed that CD8+ and CD4+ T helper 1 (Th1) cells are the main lymphocytes involved in this process, although recent evidence suggests implication of other T helper subgroups, such as Th23, Th17, and regulatory T cells (Tregs), proposing a more complex cellular immunity process to be involved in its pathogenesis. The emphasis of this research review is on the function of IL-17 in the pathophysiology of OLP and how current discoveries may point to future treatment strategies. This research protocol will follow Preferred Reporting Items for Systematic Reviews (PRISMA 2020) checklist. An electronic search was conducted in PubMed, Scopus, Google Scholar, Embase, and Cochrane databases for articles published from 1960 to June 2022. Based on the eligibility criteria, 21 articles were enrolled. In comparison to healthy controls, the findings of this review demonstrated greater expression of IL-17 and Th-17 in the blood, saliva, and tissues of OLP and LP patients. Additionally, there was a strong link between the relative levels of IL-17 and IL-23 expression. Treatment with monoclonal antibodies against Th-17/Tc-17, IL-12/IL-23, and IL-23 would result in significant long-term improvement of LP symptoms.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"21 4","pages":"201-215"},"PeriodicalIF":1.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139651890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HLH and TET2 Mutation Presenting after First Cycle of CLL Treatment.","authors":"Allison J Geiger, Demet Gokalp Yasar, Kajal V Sitwala","doi":"10.3121/cmr.2023.1804","DOIUrl":"10.3121/cmr.2023.1804","url":null,"abstract":"<p><p>Here we report development of hemophagocytic lymphohistiocytosis (HLH), along with unmasking of a TET2-mutated myeloid neoplasm, after initial doses of bendamustine and rituximab for longstanding chronic lymphocytic leukemia (CLL). After many years of CLL showing minimally progressive lymphocytosis, the patient's white blood cell count began to decline in parallel with neutrophil count, hemoglobin, and platelet count. Bone marrow biopsy showed partial CLL involvement; bendamustine+rituximab therapy was augmented with granulocyte colony-stimulating factor (g-CSF) and romiplostim to mitigate worsening pancytopenia, without response. Laboratory evaluation revealed a pattern supportive of the clinical impression of HLH, while bone marrow biopsy showed persistent CLL, new reticulin fibrosis, megakaryocytic proliferation, and 32% mutated TET2, but no compelling morphologic evidence of hemophagocytosis. The patient recovered with dexamethasone and g-CSF support.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"21 3","pages":"155-158"},"PeriodicalIF":1.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10659132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138177569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Link Between COVID-19 and Alzheimer Disease Through Neuroinflammation.","authors":"Ali Nouraeinejad","doi":"10.3121/cmr.2023.1841","DOIUrl":"10.3121/cmr.2023.1841","url":null,"abstract":"levels have been linked to defective memory performance. 17 Therefore, the elevated levels of IL-1 reported in COVID-19 patients can cause cognitive impairment, resulting in the progression of Alzheimer disease.","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"21 3","pages":"119-121"},"PeriodicalIF":1.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10659131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138177573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparative Analysis of Perioperative Complications in Octogenarians and Patients under 60 Years of Age after Primary Cemented Total Knee Arthroplasty.","authors":"Julian Koettnitz, Jan Isbeih, Christian D Peterlein, Filippo Migliorini, Christian Götze","doi":"10.3121/cmr.2023.1810","DOIUrl":"10.3121/cmr.2023.1810","url":null,"abstract":"<p><p><b>Introduction:</b> Knee arthroplasty is exposed to demographic changes as patients age. An analysis of risk factors for surgical treatment decisions in patients over 80 years old is crucial. This study compared perioperative complications between groups of patients undergoing primary knee arthroplasty, under 60 years old and over 80 years old.<b>Materials and Methods:</b> For this retrospective study, data from 400 patients with primary cemented bi- and unicondylar total knee endoprosthesis during inpatient stay from 2017 to 2018 were analyzed. Patients aged 61-79 years (257) were excluded. An analysis of the remaining 143 patients was performed. The incidence of surgery-related and systemic complications (eg, urinary tract infections, electrolyte imbalances, and cases of pneumonia), the blood supply and C-reactive protein (CRP) as well as hemoglobin progression were compared across both age groups. Furthermore, a correlation between prevalent diseases and systemic complications were investigated. Statistical analysis was performed using IBM SPSS (Armonk, US).<b>Results:</b> Data analyses showed a significant difference in the occurrence of systemic complications and blood transfusion between the age groups (<i>P</i> = 0.001, phi = 0.44; phi= 0.55, <i>P</i> = 0.001). Surgical complications did not differ significantly between the age groups. Age-typical pre-existing conditions, especially arterial hypertension (<i>P</i> = 0.003), showed a significant association with the occurrence of systemic complications. In addition, high postoperative CRP values in elderly patients revealed an association to systemic complications (<i>P</i> = 0.008).<b>Discussion and Conclusion:</b> The study shows that primary cemented knee arthroplasty is a safe procedure without an increased incidence of surgical complications, even in elderly patients. The increased incidence of internal complications in octogenarians, in turn, should receive more attention in the perioperative course. The interdisciplinary preoperative optimization of pre-existing conditions and drug therapy, as well as close interdisciplinary assessments of elderly patients, should be ensured.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"21 3","pages":"136-143"},"PeriodicalIF":1.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10659135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138177567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis of Irritable Bowel Syndrome: Primary Care Physicians Compared with Gastroenterologists.","authors":"Genevieve Pareki, Amy Wozniak, Ayokunle Temidayo Abegunde","doi":"10.3121/cmr.2023.1817","DOIUrl":"10.3121/cmr.2023.1817","url":null,"abstract":"<p><p><b>Objective:</b> To examine disparities between primary care provider (PCP) and gastroenterologist diagnosis and management of irritable bowel syndrome (IBS).<b>Design:</b> Retrospective cross-sectional study.<b>Setting:</b> A 547-bed quaternary-care hospital within the Loyola University Healthcare System.<b>Participants:</b> 1000 patients aged 18-65 with an ICD-10 diagnosis of IBS<b>Methods:</b> We randomly selected 1000 patients aged 18 to 65 years within the Loyola University Healthcare System's electronic medical record with an ICD-10 diagnosis of IBS. Physician notes and diagnostic results were reviewed for documentation of symptoms fulfilling Rome IV criteria and resolution of symptoms. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of primary diagnoses assigned by PCPs and gastroenterologists were assessed along with number of diagnostic tests ordered.<b>Results:</b> The mean age (SD) was 45 (12) years, and 76.9% were female. Sensitivity of an IBS diagnosis by a PCP was 77.6% (95% CI 73.3-81.9), compared with 60.1% (95% CI 54.7-65.6) for a gastroenterologist. Specificity of an IBS diagnosis by a PCP was 27.5% (95% CI 23.5-31.5), compared with 71.1% (95% CI 64.6-77.5) for a gastroenterologist diagnosis of IBS. A gastroenterologist diagnosis of IBS carried a high PPV (77.3%, 95% CI 72.0-82.6) compared with 44.6% (95% CI 40.7-48.5) for a PCP. Of 180 patients with outcome data, 69.4% had resolution of symptoms at follow-up.<b>Conclusion:</b> The sensitivity of gastroenterologist diagnosis of IBS closely matches the sensitivity of Rome IV criteria in validation studies. The high specificity and PPV of gastroenterologists suggest more cautious diagnosis by gastroenterologists, with PCPs more likely to assign a diagnosis of IBS incorrectly or without sufficient documentation of symptoms fulfilling Rome IV criteria. Reported resolution rates suggest primary care management of IBS is appropriate, but PCPs may benefit from gastroenterologist consultation and diagnostic guidelines for greater specificity in diagnosing IBS.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"21 3","pages":"129-135"},"PeriodicalIF":1.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10659134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138177568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Transjugular Intrahepatic Portosystemic Shunt and Gastric Coronary Vein Embolization for Variceal Bleeding in Cirrhotic Portal Hypertension.","authors":"Gauri Mukhiya, Xinwei Han, Dechao Jiao, Yonghua Bi, Gaurab Pokhrel, Zaoqu Liu, Zhaonan Li, Yongfu He","doi":"10.3121/cmr.2023.1796","DOIUrl":"10.3121/cmr.2023.1796","url":null,"abstract":"<p><p><b>Purpose:</b> To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with gastric coronary vein embolization (GCVE) for cirrhotic portal hypertensive variceal bleeding and compare outcomes of first-line with second-line treatment, coil with glue, and single-covered with double stents.<b>Methods:</b> Fifteen patients received TIPS plus GCVE as the first-line treatment for secondary prophylaxis of variceal bleeding, and 45 received it as second-line treatment. Preoperative and postoperative quantitative variables were compared using a paired t test. The incidence of survival rate, re-bleeding, hepatic encephalopathy, and shunt dysfunction were analyzed using the Kaplan-Meier method.<b>Results:</b> The portal venous pressure was significantly decreased from 39.0 ± 5.0 mm Hg to 22.5 ± 4.4 mm Hg (<i>P</i>≤0.001) after TIPS treatment. After 1, 3, 6, 12, 18, and 24 months re-bleeding rates were 1.6%, 3.3%, 6.6%, 13.3%, 0%, and 0%, respectively. Shunt dysfunction rates were 5%, 0%, 10%, 16.6%, 1.6%, and 5%, respectively. Hepatic encephalopathy rates were 3.3%, 1.6%, 3.3%, 6.6%, 0%, and 0%, respectively. And survival rates were 100%, 100%, 100%, 96.6%, 93.3%, and 88.3% respectively. In comparative analysis, statistically significant differences were seen in re-bleeding between the first-line and second-line treatment groups (26.6% vs 24.4%, log-rank <i>P</i>=0.012), and survival rates between single-covered and double stent (3.7% vs 16.1%, log-rang (<i>P</i>=0.043).<b>Conclusion:</b> The results suggest that TIPS combined with GCVE is effective and safer in the treatment of cirrhotic portal hypertensive variceal bleeding. The use of TIP plus GCVE as first-line treatment, may be preferable for high-risk re-bleeding, and more than 25 mm Hg portal venous pressure with repeated variceal bleeding. However, the sample size was small. Therefore, large, randomized, controlled, multidisciplinary center studies are needed for further evaluation.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"21 3","pages":"144-154"},"PeriodicalIF":1.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10659130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138177571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}