Journal of clinical medicine research最新文献

{"title":"Opioid Free Total Intravenous Anesthesia With Dexmedetomidine-Esketamine-Lidocaine for Patients Undergoing Lumpectomy.","authors":"Xia Li Qian, Ping Li, Ya Jie Chen, Shi Qin Xu, Xian Wang, Shan Wu Feng","doi":"10.14740/jocmr5000","DOIUrl":"10.14740/jocmr5000","url":null,"abstract":"<p><strong>Background: </strong>The aim of the study was to evaluate the feasibility of the opioid-free anesthesia (OFA) technique with dexmedetomidine, esketamine, and lidocaine among patients diagnosed with benign breast mass and scheduled for lumpectomy.</p><p><strong>Methods: </strong>We enrolled 80 female patients who were aged from 18 to 60 years, graded with American Society of Anesthesiologists physical status I or II, diagnosed with benign breast mass, and scheduled for lumpectomy. These patients were randomly treated with OFA or opioid-based anesthesia (OBA). Dexmedetomidine-esketamine-lidocaine and sufentanil-remifentanil were administered in OFA and OBA group, respectively. We mainly compared the analgesic efficacy of OFA and OBA technique, as well as intraoperative hemodynamics, the quality of recovery, and satisfaction score of patients.</p><p><strong>Results: </strong>There was no significant difference between the two groups with regard to visual analogue scale (VAS) score at 2, 12, and 24 h after extubation. However, the time to first rescue analgesic was prolonged in OFA group than that in OFB group (6.18 ± 1.00 min vs. 7.40 ± 0.92 min, P = 0.000). Further, mean arterial pressure and heart rate at T0 (entering operating room), T1 (before anesthesia induction), T2 (immediately after intubation), T3, T4, and T5 (1, 5, and 10 min after surgical incision, respectively) were significantly higher in OFA group than that in OBA group. Incidence of hypotension and bradycardia was lower in OFA group. Consistently, fewer patients in OFA group consumed atropine (8% vs. 32%, P = 0.019) and ephedrine (5% vs. 38%, P = 0.001) compared to OBA group. Furthermore, patients in OFA group had a longer awakening time (7.14 ± 2.63 min vs. 4.54 ± 1.14 min, P = 0.000) and recovery time of orientation (11.76 ± 3.15 min vs. 6.92 ± 1.19 min, P = 0.000). Fewer patients in the OFA group experienced postoperative nausea and vomiting (PONV) (11% vs. 51%, P = 0.000) and consumed ondansetron (5% vs. 35%, P = 0.003) compared to OBA group. And patients in OFA group had a higher satisfaction score than those in OBA group (9 (8 - 9) vs. 7 (7 - 8), P = 0.000).</p><p><strong>Conclusion: </strong>For patients undergoing lumpectomy, OFA technique with dexmedetomidine-esketamine-lidocaine showed a better postoperative analgesic efficacy, a more stable hemodynamics, and a lower incidence of PONV. However, such advantage of OFA technique should be weighed against a longer awakening time and recovery time of orientation in clinical practice.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"15 8-9","pages":"415-422"},"PeriodicalIF":1.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e9/cb/jocmr-15-415.PMC10563822.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41224814","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":"Retrospective Study of IDegLira, a New Fixed-Ratio Combination, in Japanese Patients With Type 2 Diabetes Mellitus: Analysis of Background Factors Affecting Effectiveness After 6 Months of Treatment.","authors":"Hodaka Yamada,&nbsp;Jun Morimoto,&nbsp;Shunsuke Funazaki,&nbsp;Shiori Tonezawa,&nbsp;Asuka Takahashi,&nbsp;Masashi Yoshida,&nbsp;Shuichi Nagashima,&nbsp;Kazuo Hara","doi":"10.14740/jocmr4995","DOIUrl":"10.14740/jocmr4995","url":null,"abstract":"<p><strong>Background: </strong>The aim of the study was to provide real-world data on the effectiveness and safety of a new fixed-ratio combination, insulin degludec/liraglutide (IDegLira) injection in Japanese patients with type 2 diabetes mellitus (T2DM).</p><p><strong>Methods: </strong>The primary endpoint was the change in glycated hemoglobin (HbA1c) level 6 months after the introduction of IDegLira. We also examined the rate of achievement of target HbA1c 7% and the individualized HbA1c targets set for each patient. Baseline characteristics associated with the change in HbA1c were also assessed. Seventy-five patients with T2DM were included in the analysis.</p><p><strong>Results: </strong>After the initiation of IDegLira, HbA1c decreased significantly from baseline with a change of -1.81% (baseline 9.61% and at 6 months 7.80%; P < 0.001). At baseline, the achievement rate of 7% HbA1c was 2.67% (n = 2), which increased to 36.0% (n = 27) after 6 months of IDegLira introduction (P < 0.05). The attainment rate of individualized HbA1c targets, which were set considering each patient's characteristics, improved from 2.67% (n = 2) to 49.3% (n = 37) (P < 0.001). Regardless of sex, body mass index, estimated glomerular filtration rate, duration of diabetes, or history of glucagon-like peptide-1 receptor agonist use, IDegLira significantly reduced HbA1c, but a higher C-peptide index was associated with a greater reduction in HbA1c.</p><p><strong>Conclusion: </strong>In this study, initiation of IDegLira in a real-world clinical setting was beneficial in lowering HbA1c in Japanese T2DM patients with inadequate glycemic control with existing therapy.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"15 8-9","pages":"406-414"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f1/e6/jocmr-15-406.PMC10563818.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41224815","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":"Computer-Aided Pulmonary Fibrosis Detection Leveraging an Advanced Artificial Intelligence Triage and Notification Software.","authors":"Kavitha C Selvan, Angad Kalra, Joshua Reicher, Michael Muelly, Ayodeji Adegunsoye","doi":"10.14740/jocmr5020","DOIUrl":"10.14740/jocmr5020","url":null,"abstract":"<p><strong>Background: </strong>Improvement in recognition and referral of pulmonary fibrosis (PF) is vital to improving patient outcomes within interstitial lung disease. We determined the performance metrics and processing time of an artificial intelligence triage and notification software, ScreenDx-LungFibrosis™, developed to improve detection of PF.</p><p><strong>Methods: </strong>ScreenDx-LungFibrosis™ was applied to chest computed tomography (CT) scans from multisource data. Device output (+/- PF) was compared to clinical diagnosis (+/- PF), and diagnostic performance was evaluated. Primary endpoints included device sensitivity and specificity > 80% and processing time < 4.5 min.</p><p><strong>Results: </strong>Of 3,018 patients included, PF was present in 22.9%. ScreenDx-LungFibrosis™ detected PF with a sensitivity and specificity of 91.3% (95% confidence interval (CI): 89.0-93.3%) and 95.1% (95% CI: 94.2-96.0%), respectively. Mean processing time was 27.6 s (95% CI: 26.0 - 29.1 s).</p><p><strong>Conclusions: </strong>ScreenDx-LungFibrosis™ accurately and reliably identified PF with a rapid per-case processing time, underscoring its potential for transformative improvement in PF outcomes when routinely applied to chest CTs.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"15 8-9","pages":"423-429"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7f/92/jocmr-15-423.PMC10563821.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41224812","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":"Exploration of Clinical Characteristics and Drug Treatment of Inflammatory Bowel Disease Complicated with Autoimmune Diseases","authors":"Jiawei Guo","doi":"10.32629/jcmr.v4i3.1260","DOIUrl":"https://doi.org/10.32629/jcmr.v4i3.1260","url":null,"abstract":"Objective: To analyze the clinical characteristics and drug treatment outcomes of inflammatory bowel disease (IBD) complicated with autoimmune diseases. Methods: A total of 200 patients with IBD and autoimmune diseases were selected as the observation group from January 2022 to June 2023. In addition, 200 patients with simple IBD during the same period were selected as the control group. The general and clinical data of the two groups of patients were collected and analyzed to compare their clinical characteristics and drug treatment outcomes. Results: ① There were no significant differences in gender, age, lesion location, and clinical type between the two groups (P > 0.05). However, the two groups differed significantly in terms of disease duration, severity of the condition, and extraintestinal symptoms (P < 0.05). ② There was no significant difference in the use of microbial preparations between the two groups (P > 0.05). The observation group had a higher usage rate of steroids compared to the control group, while the usage rate of aminosalicylate suppositories was lower in the observation group than in the control group (P < 0.05). ③ There was no significant difference in treatment efficacy between the two groups (P > 0.05). Conclusion: Patients with IBD complicated by autoimmune diseases have longer disease duration, more severe conditions, and more extraintestinal symptoms compared to those with simple IBD. The usage rate of steroids is higher, while the usage rate of aminosalicylate suppositories is lower in the treatment plan for the former group. Nevertheless, the overall effectiveness is comparable to that of patients with simple IBD, and the overall prognosis is relatively favorable.","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135354365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of ABC (Hemoglobin A1c, Blood Pressure and Low-Density Lipoprotein Cholesterol) Goal Achievement With Chronic Kidney Disease in Type 2 Diabetic Patients With Preserved Kidney Function.","authors":"Satomi Minato, Akiko Takenouchi, Kaori Kitaoka, Mika Takeuchi, Ayaka Tsuboi, Miki Kurata, Keisuke Fukuo, Tsutomu Kazumi","doi":"10.14740/jocmr4001","DOIUrl":"10.14740/jocmr4001","url":null,"abstract":"<p><strong>Background: </strong>We investigated cross-sectional and prospective associations of ABC (hemoglobin A1c (HbA1c), blood pressure and low-density lipoprotein cholesterol) goal attainment with chronic kidney disease. Cross-sectional association with carotid intima-media thickness (IMT) was evaluated as well.</p><p><strong>Methods: </strong>Prevalence of low estimated glomerular filtration rate (eGFR < 60 mL/min/1.73 m²) and albuminuria (urinary albumin-to-creatinine ratio (ACR) ≥ 30 mg/g) were assessed at baseline and after a median follow-up of 6.0 years in 168 patients with type 2 diabetes with preserved kidney function (aged 62.3 years, 53.6% men). Carotid IMT was measured at baseline only.</p><p><strong>Results: </strong>At baseline, 47 (28.0%), 45 (26.8%), 63 (37.5%) and 13 (7.7%) patients achieved triple-goal, dual-goal, single-goal and no-goal, respectively. Achieving more ABC targets was associated with lower log ACR (P < 0.01), lower percentage of albuminuria (P = 0.02), and lower carotid IMT (P < 0.01) at baseline. Over 6.0 years, eGFR decreased from 76 ± 16 to 67 ± 18 mL/min/1.73 m² (P < 0.01) whereas ACR levels did not change. There were 32 patients with incident reduced eGFR, eight with GFR stage progression, 15 with progression of albuminuric stages and five with doubling of ACR within the microalbuminuric range. Achieving more ABC targets decreased the percentage of deterioration of GFR stages (30.8%, 28.6%, 24.4% and 14.9%, respectively, P = 0.01). Achieving two or more (8.9% and 8.5%, respectively) compared with one or less ABC targets (15.4% and 15.9%, respectively) was associated with less deterioration of albuminuria (P < 0.001). Although achieving more ABC targets was associated with lower annual decline in eGFR, the difference was not significant.</p><p><strong>Conclusions: </strong>ABC goal achievement has shown cross-sectional and prospective associations with deterioration of chronic kidney disease in type 2 diabetic patients with preserved kidney function. Cross-sectional association with carotid IMT has been demonstrated as well. Reaching more ABC treatment targets may be important for preventing adverse renal outcomes.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"11 12","pages":"818-824"},"PeriodicalIF":1.6,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/50/c6/jocmr-11-818.PMC6879039.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49687105","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}