Journal of clinical medicine research最新文献

{"title":"Endoscopic Versus Surgical Bariatric Interventions for Obesity: A Systematic Review and Network Meta-Analysis.","authors":"Mohammad Abdelmoaty, Abdulla Mohammad Abdulla Muhanna, Radwa Mohammed Mahmoud Attia, Adel Abdelwahed Ibrahim, Sarah Saeed Alqahtani, Hind Saeed Aseeri, Rawan Shaya Alqahtani, Bshar Jamal, Mohammad Alshehri, Ali Mohammed Alkasi, Nesreen Ali Ogran, Khaled Emad Elsayed Barakat, Ali Said Ali Metwaly","doi":"10.14740/jocmr6627","DOIUrl":"10.14740/jocmr6627","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic sleeve gastrectomy (LSG) is the gold standard surgical intervention for obesity; however, it is underutilized because of patient reluctance and perioperative risks. Endoscopic sleeve gastroplasty (ESG) is a promising, minimally invasive alternative; however, comprehensive data comparing its efficacy and safety with those of the broader spectrum of bariatric interventions remain fragmented. This study aimed to evaluate the comparative effectiveness and safety of endoscopic and surgical bariatric modalities through a systematic review and network meta-analysis (NMA).</p><p><strong>Methods: </strong>Major electronic databases (PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus) were searched from January 2010 to April 2026. Studies directly comparing endoscopic bariatric therapies (ESGs, intragastric balloons (IGBs)) with surgical interventions (LSG, laparoscopic greater curve plication (LGCP), and laparoscopic adjustable gastric banding (LAGB)) or lifestyle modifications (high-intensity diet and lifestyle therapy (HIDLT)) were included. The primary outcomes were the percentage total body weight loss (%TBWL) at 12 months and the incidence of serious adverse events (SAEs). Frequentist random-effects pairwise and NMAs were performed. The certainty of evidence was appraised using the GRADE framework.</p><p><strong>Results: </strong>Seventeen studies (including matched cohorts and large national registries) met the inclusion criteria. In direct pairwise analysis, LSG achieved significantly greater 12-month %TBWL than ESG (mean differences (MD): -10.53%; 95% confidence interval (CI), -14.10 to -6.97, P < 0.0001). There was no statistically significant difference in SAEs between the ESG and LSG (risk ratio, 1.30; 95% CI, 0.97-1.73; P = 0.076). In the NMA, with LSG as the reference, all interventions yielded inferior weight loss: LGCP (MD: -2.18%), ESG (-11.33%), LAGB (-15.81%), HIDLT (-17.63%), and IGB (-19.00%). The treatment hierarchy rankings (P-scores) identified LSG as the most effective intervention (0.988), followed by LGCP (0.812) and ESG (0.600). The IGB ranked the lowest (0.089). Local node splitting revealed no significant inconsistencies between direct and indirect evidence.</p><p><strong>Conclusions: </strong>LSG maintains definitive superiority in 12-month weight-loss efficacy. However, ESG has demonstrated robust clinical effectiveness, significantly outperforming legacy endoscopic devices (IGBs), and lifestyle interventions. Although data cannot confirm that ESG is as safe as LSG, it remains an anatomy-preserving option with a lower risk of reflux, making it an excellent alternative for patients averse to or ineligible for conventional bariatric surgery.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"18 8","pages":"542-555"},"PeriodicalIF":2.2,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13568731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957813","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":"Incidence and Predictors of Anticoagulant-Associated Bleeding in Patients With Venous Thromboembolism.","authors":"Tanapun Thamgrang, Pakkapol Thiwannarak, Pornpavee Siricharoenthai, Kannadit Prayongratana, Chonlada Laoruangroj, Panachai Silpsamrit, Rattapan Lamool","doi":"10.14740/jocmr6679","DOIUrl":"10.14740/jocmr6679","url":null,"abstract":"<p><strong>Background: </strong>Data on anticoagulant-associated bleeding among patients with venous thromboembolism (VTE) in Southeast Asia are limited. We aimed to determine the incidence and predictors of anticoagulant-associated bleeding and evaluate its association with mortality.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients with VTE treated with anticoagulants between January 2014 and June 2024. Clinically relevant bleeding (CRB) was defined according to the International Society on Thrombosis and Haemostasis criteria. Cumulative incidence was estimated using the Aalen-Johansen method with death as a competing event, and predictors were identified using Fine-Gray sub-distribution hazard models. The association between bleeding and all-cause mortality was evaluated using time-dependent Cox proportional hazards models.</p><p><strong>Results: </strong>Among 395 patients (mean age, 60.7 ± 16.2 years; 65.3% female), 43.5% had cancer-associated thrombosis. Low-molecular-weight heparin was the most commonly prescribed initial anticoagulant (39.0%), followed by warfarin (32.7%) and direct oral anticoagulants (25.1%), of which apixaban was the most frequently used (12.7%). During a median follow-up of 0.88 years, 60 patients (15.2%) developed CRB. The 1-year cumulative incidence of CRB was 14.89% (95% confidence interval (CI), 11.09-19.23). Independent predictors of CRB included concomitant antiplatelet therapy (adjusted sub-distribution hazard ratio (aSHR), 3.48; 95% CI, 1.76-6.90), Eastern Cooperative Oncology Group performance status ≥ 2 (aSHR, 3.05; 95% CI, 1.34-6.94), body mass index (BMI) < 20 kg/m² (aSHR, 2.50; 95% CI, 1.36-4.61), and age ≥ 65 years (aSHR, 1.97; 95% CI, 1.12-3.45). Both clinically relevant non-major bleeding (adjusted hazard ratio (aHR), 3.72; 95% CI, 1.55-8.92) and major bleeding (aHR, 5.62; 95% CI, 2.91-10.85) were independently associated with increased all-cause mortality.</p><p><strong>Conclusions: </strong>Anticoagulant-associated bleeding is common among Thai patients with VTE and is associated with an increased risk of all-cause mortality. Patients with advanced age, poor performance status, low BMI, or concomitant antiplatelet therapy may benefit from closer monitoring during anticoagulant treatment.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"18 8","pages":"585-598"},"PeriodicalIF":2.2,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13568748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957748","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":"Comparative Effectiveness of Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections on Glycemic Control in Pediatric Type 1 Diabetes: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis.","authors":"Zeinh Hussein Fardan, Alam Eldin Musa Mustafa, Niemat Mohammed Tahir Ali, Youssef A Alqahtani, Marwa Hussein Said Ahmad Alhag, Leen A Aburas, Mai Mazen Alzayer, Khulud Musallam Salem Alsulami, Lama Atef, Ali Said Ali Metwaly","doi":"10.14740/jocmr6560","DOIUrl":"10.14740/jocmr6560","url":null,"abstract":"<p><strong>Background: </strong>Intensive insulin therapy is crucial for mitigating complications in pediatric type 1 diabetes mellitus (T1DM). This study aimed to evaluate the impact of continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI) on glycemic control and safety in pediatric patients.</p><p><strong>Methods: </strong>A systematic search of PubMed/MEDLINE, Embase, and Cochrane Central was conducted for randomized controlled trials (RCTs) published up to 2026. Data were synthesized using random-effects meta-analysis to calculate mean differences (MD) for hemoglobin A1c (HbA1c) and risk ratios (RR) for adverse events. Trial sequential analysis (TSA) was employed to assess the sufficiency of evidence. Certainty of evidence was graded using the Grades of Recommendations Assessment, Development, and Evaluation (GRADE) approach.</p><p><strong>Results: </strong>Fourteen RCTs involving 659 participants were included. CSII was associated with a modest reduction in HbA1c compared to MDI (MD -0.36%; 95% confidence interval (CI), -0.80 to 0.08), although this did not reach statistical significance in the primary analysis (P = 0.098). However, sensitivity analysis excluding one large pragmatic trial revealed a significant benefit for CSII (MD -0.27%, P < 0.0001). No significant differences were found in the risks of severe hypoglycemia (RR = 0.83) or diabetic ketoacidosis (RR = 1.40). TSA indicated that the required information size for a definitive conclusion on HbA1c has not yet been met.</p><p><strong>Conclusions: </strong>CSII may offer a modest glycemic advantage over MDI in pediatric T1DM without increasing safety risks; however, current randomized evidence is insufficient to universally recommend one modality over the other. Treatment choice should be personalized. Although the proportion of patients using automated insulin delivery (AID) is rising rapidly, CSII retains practical and cost advantages; future research should focus on modern AID systems.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"18 8","pages":"567-584"},"PeriodicalIF":2.2,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13568733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957760","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":"Blood Count-Based Inflammatory Indices Do Not Improve Prediction of Acute Kidney Injury in Cardiogenic Shock.","authors":"Jackson Rajendran, Shubhangi Sharma, Franklyn Vega Batista, Anshu Sutihar, Sharon Paul, Song Peng Ang, Saria Qaiser, Cristina Rodriguez, Madison Laezzo, Jose Iglesias","doi":"10.14740/jocmr6666","DOIUrl":"10.14740/jocmr6666","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is common in cardiogenic shock and is associated with poor outcomes. Whether routinely available inflammatory indices add useful information for AKI risk stratification in this population remains unclear.</p><p><strong>Methods: </strong>We performed a retrospective multicenter cohort study using the eICU Collaborative Research Database. Adult intensive care unit (ICU) patients with cardiogenic shock were included if laboratory components required to calculate inflammatory indices were available. All indices were derived from a single set of laboratory values obtained on ICU admission rather than from serial measurements. AKI was defined using creatinine-based Kidney Disease: Improving Global Outcomes criteria and renal replacement therapy status. We evaluated neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, monocyte to lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index, aggregate index of systemic inflammation, and neutrophil percentage to albumin ratio. Missing covariate data were handled using multiple imputation. Multivariable logistic regression, false discovery rate correction, elastic-net analysis, calibration, and decision-curve analysis were used to assess associations and incremental discrimination.</p><p><strong>Results: </strong>The final cohort included 419 patients, of whom 273 (65.1%) developed AKI. Baseline creatinine was the strongest variable associated with AKI in the primary multivariable model. Chronic kidney disease was associated with AKI when creatinine and blood urea nitrogen were excluded. Inflammatory indices were not independently associated with AKI after multivariable adjustment and false discovery rate correction. The base clinical model had modest discrimination, which improved after adding renal laboratory variables. Adding inflammatory indices provided little to no meaningful incremental discrimination, and inflammatory indices were not consistently retained in elastic-net models.</p><p><strong>Conclusion: </strong>In this multicenter ICU cohort of patients with cardiogenic shock, AKI was associated mainly with baseline renal dysfunction and illness severity. Routine inflammatory indices did not provide meaningful incremental discrimination beyond established clinical and renal variables for AKI during ICU hospitalization. These findings apply to blood count-derived indices and do not exclude a contribution of inflammation to AKI in cardiogenic shock.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"18 8","pages":"528-541"},"PeriodicalIF":2.2,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13568768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957695","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":"Clinical Significance of Cardio-Ankle Vascular Index in Stage A/B Heart Failure Patients With Type 2 Diabetes Mellitus.","authors":"Takashi Hitsumoto","doi":"10.14740/jocmr6680","DOIUrl":"10.14740/jocmr6680","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is a medical condition with a poor prognosis; therefore, it is important to consider treatment strategies from the pre-onset stage, i.e., at stage A/B HF. However, in addition to type 2 diabetes mellitus (T2DM) being a risk factor for HF, it has also been reported that the prognosis of HF is worse among patients with T2DM than among those without it. This cross-sectional study aimed to clarify the clinical significance of the cardio-ankle vascular index (CAVI), an indicator of arterial stiffness, in stage A/B HF patients with T2DM.</p><p><strong>Methods: </strong>In total, 292 stage A/B HF patients (113 men and 179 women) with T2DM were enrolled, and the relationships between CAVI and various clinical parameters were evaluated. Furthermore, cut-off values of CAVI and brain natriuretic peptide (BNP) for distinguishing between stage A HF and stage B HF were determined using a receiver operating characteristic curve, and these two markers were employed in combination to distinguish stage A HF from stage B HF.</p><p><strong>Results: </strong>CAVI was significantly associated with various parameters in this study. Among them, multiple regression analyses indicated that 11 explanatory factors (calf circumference, renin-angiotensin system inhibitors use, E/e' ratio, skin autofluorescence, subendocardial viability ratio, glucagon-like peptide-1 receptor agonists use, age, decreased estimated glomerular filtration rate, coronary artery disease, stage B HF, and sodium-glucose cotransporter 2 inhibitors use) were selected as independent variables for CAVI as the dependent variable (R² = 0.663). However, CAVI and BNP thresholds for distinguishing stage A HF from stage B HF using the receiver operating characteristic curve were 9.0 and 34.0 pg/mL, respectively. In addition, compared to patients with low CAVI (≤ 9.0) and low BNP (≤ 34.0 pg/mL), those with high levels of both factors (CAVI > 9.0, BNP > 34.0 pg/mL) showed a 9.72-fold higher odds ratio (95% confidence interval: 3.24-19.92, P < 0.001).</p><p><strong>Conclusion: </strong>CAVI is significantly associated with early-stage HF in T2DM patients. Combining CAVI and BNP may provide a useful screening tool for subclinical HF risk stratification, although further prospective studies are required to elucidate causal relationships.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"18 8","pages":"556-566"},"PeriodicalIF":2.2,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13568742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957682","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":"Application Progress of Machine Learning in Prognostic Prediction of Percutaneous Coronary Intervention: A Systematic Review.","authors":"Jian Chen, Lu Huan Shen, Peng Fei Xia, Ke Qiang Xu","doi":"10.14740/jocmr6638","DOIUrl":"10.14740/jocmr6638","url":null,"abstract":"<p><p>Percutaneous coronary intervention (PCI) has become a cornerstone treatment for coronary artery disease; however, accurate prognostic prediction remains a significant clinical challenge. Machine learning technologies demonstrate tremendous potential in PCI prognostic prediction by analyzing vast amounts of clinical data and identifying complex nonlinear relationships among variables. This article systematically reviews recent advances in machine learning applications for PCI prognostic prediction, encompassing predictive targets including in-hospital mortality, major adverse cardiovascular events, bleeding complications, and long-term survival. Algorithms such as random forest, support vector machines, neural networks, and deep learning have demonstrated superior predictive performance compared to traditional risk scoring systems across multiple studies. Deep learning approaches exhibit particular advantages in processing multimodal data. Nevertheless, significant challenges remain regarding model interpretability, external validation, and clinical implementation. Future research should prioritize the development of explainable artificial intelligence systems, the conduct of multicenter validation studies, and the establishment of regulatory frameworks for clinical deployment.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"18 8","pages":"515-527"},"PeriodicalIF":2.2,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13568772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957685","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":"Disease-Modifying Therapies for Transthyretin Amyloid Cardiomyopathy: Current Evidence and Emerging Strategies.","authors":"Meet Popatbhai Kachhadia, Amrit Gautam, Sarah Meadows, Smit R Kotadiya, Roshani Aryal, Hasan Ilyas, Juber D Shaikh, Gurnoor Gill, Samarth Shah, Jay Patel, Harshal A Sanghvi","doi":"10.14740/jocmr6603","DOIUrl":"10.14740/jocmr6603","url":null,"abstract":"<p><p>Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive and life-threatening condition caused by extracellular deposition of misfolded transthyretin protein in cardiac tissue. Once considered rare and universally fatal, ATTR-CM has emerged as an increasingly recognized cause of heart failure, particularly among older adults. Recent therapeutic advances have transformed the management landscape from purely symptomatic care to disease-modifying interventions targeting multiple pathogenic mechanisms. This narrative review synthesizes current evidence on pharmacologic strategies for ATTR-CM, including transthyretin stabilizers such as tafamidis and acoramidis, gene-silencing therapies including patisiran, vutrisiran, and eplontersen, fibril disruptors, and emerging amyloid-depleting monoclonal antibodies and gene-editing approaches. We examine pivotal trial data demonstrating improvements in survival, functional capacity, and quality of life, alongside ongoing challenges related to safety, cost, and equitable access. The convergence of early diagnosis through improved imaging and biomarker strategies with targeted therapeutics has substantially changed the outlook for patients with a previously untreatable disease. Future directions emphasize combination therapies, biomarker-guided treatment selection, and precision medicine approaches tailored to disease genotype and phenotype.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"18 7","pages":"421-436"},"PeriodicalIF":2.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148709190","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":"Pulse Index Continuous Cardiac Output-Guided Hemodynamic Therapy in Living Donor Kidney Transplantation: A Prospective Cohort Study.","authors":"Van Dung Le, Huu Tu Nguyen, Quang Thuy Luu, Minh Hoang Thach, Thi Thuy Trang Tran, Van Dong Pham, Francis Zamora, Gary Ta-Wei Yu, Viet Hoang Dinh","doi":"10.14740/jocmr6632","DOIUrl":"10.14740/jocmr6632","url":null,"abstract":"<p><strong>Background: </strong>Central venous pressure (CVP)-guided fluid therapy remains common during kidney transplantation, although CVP is a static marker with limited ability to predict fluid responsiveness. This prospective observational cohort study evaluated whether pulse index continuous cardiac output-guided goal-directed hemodynamic therapy (GDHT), using dynamic and volumetric hemodynamic variables, was associated with improved early graft function compared with conventional CVP-guided management in living donor kidney transplantation.</p><p><strong>Methods: </strong>Eighty living donor kidney transplant recipients at Cho Ray Hospital, Vietnam, were enrolled between May 2024 and December 2025. Patients were managed according to the institutional anesthetic monitoring protocol in use at the time of surgery: CVP-guided fluid therapy (group C, n = 40) or PiCCO-guided GDHT (group P, n = 40). The PiCCO protocol incorporated stroke volume variation, pulse pressure variation, cardiac index, global end-diastolic volume index, systemic vascular resistance index, and extravascular lung water index. Outcomes included intraoperative fluid volume, vasopressor use, postoperative urine output, serum creatinine through postoperative day 7, delayed graft function, and postoperative complications.</p><p><strong>Results: </strong>Baseline recipient, donor, and operative characteristics were comparable between groups, with the exception of cold ischemia time, which was longer in group P. Total intraoperative fluid volume was lower in group P than in group C (2,656 ± 480 mL vs. 3,097 ± 555 mL; P = 0.001), and vasopressor use was numerically lower but not statistically significant (12.5% vs. 27.5%; Fisher's exact P = 0.161). First-hour postoperative urine output was higher in group P (1,235 ± 162 mL vs. 1,010 ± 315 mL; P < 0.001). Serum creatinine was similar on postoperative day 1 but was significantly lower in group P on day 3 (1.3 (0.8-1.8) mg/dL vs. 1.6 (1.4-1.9) mg/dL; P = 0.036); the difference on day 7 was not statistically significant (1.1 (0.7-1.4) mg/dL vs. 1.3 (1.1-2.1) mg/dL; P = 0.16). No patient in either group developed delayed graft function within 7 days. Extravascular lung water index remained within the reference range during surgery, and no patient developed clinical pulmonary edema.</p><p><strong>Conclusions: </strong>In this prospective cohort, PiCCO-guided GDHT was associated with lower intraoperative fluid administration, numerically lower vasopressor use, and faster early recovery of graft function after living donor kidney transplantation. These findings support further evaluation of multiparameter hemodynamic monitoring as an individualized perioperative strategy in kidney transplantation.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"18 7","pages":"456-464"},"PeriodicalIF":2.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148709228","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":"Predicting Risk of Postoperative Pneumonia by a Nomogram in Elderly Patients After Hip Fracture Surgery.","authors":"Toshihiro Higashikawa, Kenji Shigemoto, Shintarou Iwai, Haruki Takigawa, Masahiro Hangyou, Tsugiyasu Kanda, Takeshi Horii, Masashi Okuro, Takeshi Sawaguchi","doi":"10.14740/jocmr6514","DOIUrl":"10.14740/jocmr6514","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to develop a nomogram, a visual prediction model to predict the risk of postoperative pneumonia (POP) in elderly patients after hip fracture surgery.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 711 patients aged 65 and over who underwent surgery for hip fractures. A logistic regression analysis with a nomogram was used to identify independent risk factors for POP.</p><p><strong>Results: </strong>Out of the studied patients, 26 (3.7%) developed POP after surgery. Independent risk factors for POP included age, gender, body mass index (BMI), serum albumin levels, change in inflow E and mitral e' annular velocities (E/e'), severity of fracture (fractured) and administration of diuretics. The results of both univariate and multivariate logistic regression analyses revealed that age, gender, serum albumin levels and diuretics showed significant increase in odds ratio, whereas no significant differences were found in BMI, E/e' and fractured in odds ratios in POP patients. The area under the curve (AUC) of the nomogram model was 0.838, indicating discriminative ability.</p><p><strong>Conclusions: </strong>The nomogram developed in this study predicted the risk of POP in elderly patients with hip fractures. Using this model in clinical practice could allow for appropriate preventive measures to be taken for high-risk patients, potentially reducing the incidence of POP and improving patient outcomes.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"18 7","pages":"465-471"},"PeriodicalIF":2.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148709198","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":"Development and Validation of an XGBoost-Based Machine Learning Model With Nomogram for Predicting Diabetic Peripheral Neuropathy Risk in Type 2 Diabetes Patients.","authors":"Ning Yao, Ke Ke Zhang","doi":"10.14740/jocmr6642","DOIUrl":"10.14740/jocmr6642","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The study aimed to develop risk stratification models for diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus (T2DM) using multiple machine learning algorithms, identify the optimal model, and visualize it through a nomogram, thereby providing a clinical decision-support tool for the early identification of high-risk individuals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective analysis was conducted on 180 inpatients diagnosed with T2DM at the Endocrinology Department of our hospital from January 2021 to September 2024, including 88 patients with DPN (48.9%) and 92 patients without DPN (51.1%). All enrolled participants were randomly divided into a training cohort (n = 126) and an internal validation cohort (n = 54) at a 7:3 stratified ratio. Collected clinical variables covered demographic profiles (age, gender, diabetes duration), anthropometric indicators (body mass index (BMI)), and multiple laboratory biomarkers. Five predictive algorithms were adopted for model construction, namely logistic regression (LR), random forest (RF), extreme gradient boosting (XGBoost), support vector machine (SVM), and decision tree (DT). Model predictive efficacy was comprehensively assessed using receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA), and SHapley Additive exPlanations (SHAP) interpretability analysis. A visual nomogram was finally developed based on the best-performing model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Multivariate regression analysis screened out six independent predictive factors for DPN occurrence, including diabetes duration, glycated hemoglobin (HbA1c), microalbuminuria (MAU), low-density lipoprotein cholesterol (LDL-C), neutrophil percentage (NEUT%), and BMI (all P &lt; 0.05). Among all established models, the XGBoost algorithm yielded the best predictive outcomes in internal validation, with an area under the curve (AUC) of 0.903 (95% confidence interval (CI): 0.816-0.986), accuracy of 85.2%, sensitivity of 84.6%, and specificity of 85.7%. Its predictive efficacy was numerically superior to that of RF (AUC = 0.808), LR (AUC = 0.838), SVM (AUC = 0.884), and DT (AUC = 0.814). SHAP analysis further identified diabetes duration, HbA1c, and MAU as the most influential predictors for DPN risk. The nomogram established based on these core variables achieved a validation AUC of 0.85, with favorable calibration efficiency (Hosmer-Lemeshow P = 0.512) and positive net clinical benefit across a wide range of threshold probabilities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The XGBoost-based model shows favorable preliminary performance for cross-sectional DPN risk stratification in T2DM patients based on internal hold-out validation, outperforming traditional statistical approaches. Combined with SHAP interpretability and nomogram visualization, this model provides an exploratory clinical tool for early identification of potential high-risk individuals,","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"18 7","pages":"472-488"},"PeriodicalIF":2.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148709208","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}