The International Journal Of Risk & Safety In Medicine[JOURNAL]
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200 papers
Dental health as a determinant of operational readiness in military populations: Evidence from Ceuta (Spain).
Bel-Blesa A, Hernández-Donadeu M, Flores-Fraile J … +6 more , Gómez-Salgado J, El Khoury-Moreno L, Torrejón-Martínez J, Rosel-Gallardo E, Ribas-Pérez D, Castaño-Séiquer A
Medicine (Baltimore) · 2025 Dec · PMID 41398761 · Full text
The Spanish Armed Forces require optimal oral health to ensure operability during international missions. In a cross-sectional study with a sample of 691 military personnel, 17.66% were classified as temporarily unfit (N...
The Spanish Armed Forces require optimal oral health to ensure operability during international missions. In a cross-sectional study with a sample of 691 military personnel, 17.66% were classified as temporarily unfit (NAT), predominantly among enlisted ranks (21.7%). Employment status and smoking showed significant associations with NAT (P < .000), while gender, age, and alcohol consumption were not significant factors. The decayed, missing filled teeth index, particularly its decayed component, was strongly related to NAT (P = .000). Periodontal disease presence and the need for multiple dental treatments significantly increased NAT prevalence (P < .000). Use of dental floss correlated with higher fitness, whereas mouthwash use was associated with increased NAT (P < .05). These findings highlight the importance of prevention and risk factor control to maintain oral fitness and ensure military personnel effectiveness during deployments.
Comprehensive evaluation of current strategies in achalasia treatment: Insights from an umbrella review.
Letafatkar N, Habibi A, Mohammadyari F … +7 more , Joukar F, Nobakht S, Hosseini-Ghaziani SK, Keivanlou MH, Amini-Salehi E, Hassanipour S, Mansour-Ghanaei F
Medicine (Baltimore) · 2025 Dec · PMID 41366919 · Full text
BACKGROUND: Achalasia poses a considerable clinical challenge due to its complex pathophysiology and varied treatment responses. This umbrella review aims to consolidate current meta-analyses, providing a comprehensive e...
BACKGROUND: Achalasia poses a considerable clinical challenge due to its complex pathophysiology and varied treatment responses. This umbrella review aims to consolidate current meta-analyses, providing a comprehensive evaluation of treatment efficacy across various methodologies. By employing statistical analyses and concise quality assessment, we seek to standardize outcomes and effectively highlight the limitations inherent in existing research. METHODS: A comprehensive literature search was conducted across 5 international databases, including PubMed, Scopus, Web of Science, Embase, and the Cochrane Library, to identify relevant meta-analyses focused on achalasia treatments. Key parameters evaluated included clinical success rates, complications, operation times, and lengths of hospital stay. Statistical synthesis was employed to compare treatment effectiveness across studies. RESULTS: The initial search identified 1037 records, of which 23 meta-analysis studies were included in this study. This review suggests that peroral endoscopic myotomy (POEM) may be comparable to, or potentially more effective than, Heller myotomy in the short-term management of achalasia. However, this was not further supported in longer follow-up durations. While POEM offers advantages such as shorter hospital stays, the ability to perform longer myotomies, and reduced operative duration, it demonstrated a greater risk of gastroesophageal reflux. However, the existing data are insufficiently conclusive, underscoring the need for additional long-term, high-quality studies to validate these results. CONCLUSION: This review highlights the comparable efficacy and safety of POEM and Heller myotomy in the treatment of achalasia. The variability in study quality and the presence of methodological flaws in the conducted studies underlines the need for further long-term research, improved methodological rigor, and standardized treatment protocols to optimize patient management in achalasia.
Efficacy and safety of esketamine for "treatment resistant depression": registered report for a systematic review with an individual patient data meta-analysis of randomized, double-blind, placebo-controlled trials.
Naudet F, Pellen C, Fodor LA … +5 more , Gastaldon C, Barbui C, Turner EH, Le Pabic E, Cristea IA
BMC Med · 2025 Nov · PMID 41310599 · Full text
BACKGROUND: In 2019, the FDA and EMA approved intranasal esketamine for treatment-resistant depression (TRD). The current study re-evaluated its efficacy and safety. METHODS: This registered report presents a systematic...
BACKGROUND: In 2019, the FDA and EMA approved intranasal esketamine for treatment-resistant depression (TRD). The current study re-evaluated its efficacy and safety. METHODS: This registered report presents a systematic review and individual patient data (IPD) meta-analysis of double-blind, randomised, placebo-controlled trials (RCTs) assessing intranasal esketamine for TRD. Two reviewers independently screened studies from multiple databases and obtained IPD via the Yale Open Data Access Project. Two independent researchers selected studies and assessed risk of bias. The primary outcome was the Montgomery-Åsberg Depression Rating Scale (MADRS) score at ≥ 4 weeks in initiation trials, benchmarked against the 6.5-point clinical significance threshold used in the design of pivotal trials. Evidence certainty was rated using GRADE. Secondary outcomes included additional efficacy and safety endpoints. A two-step IPD meta-analysis was conducted, with separate analyses by trial phase (initiation vs. continuation) and treatment type (combination vs. monotherapy). A one-stage meta-analysis explored moderators (e.g. age and resistance level). RESULTS: We re-analysed IPD from 7 RCTs including 1505 patients. In five initiation trials of esketamine plus an antidepressant, esketamine reduced MADRS scores at 4 weeks (mean difference (MD) = - 2.94, 95% CI [- 5.39 to - 0.48]; GRADE: moderate certainty). A continuation trial showed reduced relapse risk (HR = 0.38 [0.26-0.57]), though FDA concerns about one centre could not be addressed due to data privacy restrictions. A monotherapy trial (aggregate data only) showed a larger effect (MD = - 6.32 [- 8.62 to - 4.03]), but there were concerns over selection bias and unblinding. Esketamine increased sedation (RR = 3.70 [2.02-6.78]), dissociation (RR = 2.36 [2.10-2.65]), and adverse events (IRR = 3.91 [2.37-6.45]), with no increase in serious adverse events (IRR = 1.35 [0.54-3.40]). No treatment effect moderation was found by age or resistance level, with most patients displaying low-stage TRD. CONCLUSIONS: Based on the IPD used for approval, esketamine in combination with an antidepressant showed an advantage over placebo that was statistically significant but small. The clinical relevance of this benefit is unclear, particularly given the risks of adverse events. STUDY REGISTRATION: PROSPERO: CRD42021290721.
Probiotics in nonsurgical treatment of peri-implant diseases: A systematic review & meta-analysis.
AlRowis R, Albeshri S
Medicine (Baltimore) · 2025 Nov · PMID 41305830 · Full text
BACKGROUND: Peri-implant disease is an inflammatory condition that affects implant stability and quality of life. As nonsurgical treatments show limited efficacy, probiotics have been explored for their anti-inflammatory...
BACKGROUND: Peri-implant disease is an inflammatory condition that affects implant stability and quality of life. As nonsurgical treatments show limited efficacy, probiotics have been explored for their anti-inflammatory effects. This systematic review evaluated the efficacy, safety, and health-related quality of life outcomes of peri-implant diseases. METHODS: Databases were searched for randomized controlled trials (RCTs) and non-randomized studies (November 2024). The outcomes included bleeding on probing (BoP), probing depth, plaque index, and biomarkers. The protocol was registered with International Prospective Register of Systematic Reviews (CRD42024617103). The RoB in RCTs was assessed using the Cochrane Risk of Bias 2.0 tool, and non-RCTs using the RoB In Non-randomized Studies of Interventions tool. Evidence certainty was graded using the Grading of Recommendations, Assessment framework. RESULTS: Fourteen studies were included, and 10 RCTs (n = 391) were meta-analyzed. For peri-implant mucositis, probiotics reduced BoP at 3 months (mean difference [MD] -1.45; P = .002) and 6 months (MD -9.44; P = .0003) and improved plaque index at 3 months (MD -0.99; P = .001). No effects on probing depth or peri-implantitis were observed. Tumor necrosis factor-alpha levels improved, while interleukin levels remained unchanged. Microbial analysis revealed no major changes. Subgroup analyses showed greater effects in placebo-controlled versus active comparator studies. Health-related quality of life and long-term safety were not assessed. Evidence certainty ranged from moderate to very low. CONCLUSION: Probiotics may provide modest short-term benefits for peri-implant mucositis by reducing BoP and plaque accumulation. Current evidence is insufficient to support its use in peri-implantitis or to establish long-term safety and patient-centered outcomes. Further high-quality long-term trials are required.
The association between implant design, age, sex and the rate of major reoperation in patients undergoing primary total hip replacement: A retrospective study of UK National Joint Registry and Hospital Episodes Statistics data.
Lamb JN, Sayers A, Wilkinson JM … +2 more , Pandit H, Whitehouse MR
PLoS Med · 2025 Nov · PMID 41296797 · Full text
BACKGROUND: Implant revision is an operation with exchange of implants, and is used as a standard outcome after total hip replacement (THR), but may not fully represent the patient experience after a THR. Major reoperati...
BACKGROUND: Implant revision is an operation with exchange of implants, and is used as a standard outcome after total hip replacement (THR), but may not fully represent the patient experience after a THR. Major reoperation (hereafter referred to as 'reoperation') without revision of implants can also lead to increased patient morbidity and mortality, and most commonly occurs when the femur fractures around an implant (postoperative periprosthetic femoral fractures; POPFF) and is treated with fixation and the implant is left in place. Reliance on revision metrics that do not capture these reoperations has led to large-scale underreporting of reoperations in THR, and is likely to have affected implant performance estimates, which have guided national policy and implant selection. It is important to include these additional reoperations when estimating treatment success to guide innovation and clinical practice. We aimed to estimate the incidence of reoperation following primary THR. METHODS AND FINDINGS: We performed a large national cohort study on a mandatory, prospective database, the National Joint Registry, linked to Hospital Episode Statistics. All linkable primary THRs using recently available implants, with highest safety ratings between 01/01/2010 and 31/12/2020, were included. Major reoperation was defined as the first revision for any cause or fixation of POPFF and was identified using a combination of procedural and diagnosis codes. We identified 372,967 THRs representing 2,127,464 prostheses years at risk with a median follow-up time of 5.39 years (range 0 to 12.1 years). A total of 8,043 reoperations were identified that had been surgically treated by revision for any cause or fixation of POPFF. The incidence of reoperation was 3.78% (95% confidence interval [CI 3.70%, 3.86%]) per 1,000 prostheses years in comparison to 3.00% (95% CI [2.93%, 3.07%]) per 1,000 prostheses years when using conventional revision only outcomes. Cumulative incidence of major reoperation at 10 years was 3.1% (95% CI [3.0%, 3.1%]). Cumulative reoperation estimates were stratified by age and sex. In men aged 68 years and older, collared cementless stems performed better than cemented stems and in women aged 75 years and older, the relationship was reversed. Residual differences in patient characteristics may affect the accuracy of the estimates. CONCLUSIONS: Treatment failure after THR has been underrepresented by revision-only estimates. Major reoperation rates in older men were lowest with cementless collared stems, and in older women, reoperation rates were lowest with cemented polished taper stems made of stainless steel. These results prompt a review of the current implant guidance for hip replacements in older patients. LEVEL OF EVIDENCE: III (Retrospective cohort study).
Dabigatran-based versus warfarin-based triple antithrombotic regimen with a 1-month intensification after coronary stenting in patients with nonvalvular atrial fibrillation (COACH-AF PCI).
Liang M, Jin J, Zhao R … +28 more , Li H, Chen S, Liu L, Xu P, Wang W, Cheng X, Chen X, Tao L, Zhang Q, Yang M, Zeng C, Li L, Zheng Y, Chen H, Guo J, Zhong Z, Bi Y, Cheng B, Zhou Y, Wang H, Zhang Y, Qiu M, Zhang Q, Zhang P, Zhang J, Wang Z, Li Y, Han Y
BMC Med · 2025 Nov · PMID 41254594 · Full text
BACKGROUND: To assess the safety and efficacy of dabigatran-based triple antithrombotic (TAT) regimen in patients after percutaneous coronary intervention (PCI) with atrial fibrillation (AF). METHODS: A multicenter, open...
BACKGROUND: To assess the safety and efficacy of dabigatran-based triple antithrombotic (TAT) regimen in patients after percutaneous coronary intervention (PCI) with atrial fibrillation (AF). METHODS: A multicenter, open-label, randomized controlled trial across 50 Chinese hospitals enrolled nonvalvular AF patients after coronary stenting. Participants were randomly assigned to receive dabigatran (110 mg twice/daily) or warfarin-based TAT regimen (dabigatran or warfarin with aspirin and clopidogrel) for 1 month and then convert to dual antithrombotic therapy (dabigatran or warfarin with clopidogrel) for 6 months. The primary safety endpoint was the first occurrence of clinically relevant bleeding (BARC types 2-5). Secondary endpoints included net adverse clinical events (NACEs) and major or clinically relevant non-major bleeding (CRNB). And the efficacy endpoint was the major adverse cardiac and cerebral events (MACCEs). RESULTS: The study was terminated early due to COVID-19 impacting recruitment. A total of 540 patients were enrolled. BARC types 2-5 bleeding occurred in 8.0% and 4.3% of patients in warfarin and dabigatran groups, respectively (HR 0.54; 95% CI 0.26-1.09; P = 0.0861). And total bleeding events (BARC 1-5) were 20.5% and 9.4% (HR 0.44; 95% CI 0.27-0.70; P = 0.0005). Dabigatran showed a lower total bleeding risk than warfarin, with similar risks for BARC types 2-5 bleeding, NACEs, CRNB, major bleeding, and MACCEs. CONCLUSIONS: Among AF patients underwent PCI, the dabigatran-based TAT regimen did not significantly reduce the rate of BARC types 2-5 bleeding at 6 months compared with warfarin-based regimen, although the power of the study to find a difference was low due to early termination (COACH-PCI, NCT03536611, https://clinicaltrials.gov/show/NCT03536611 ).
Intrathoracic hemocoagulase Bothrops atrox injection efficacy in thoracoscopic lung cancer surgery.
Xie Y, Han J, Yang J … +4 more , Xiong W, Ye J, Yang A, Ruan Y
Medicine (Baltimore) · 2025 Nov · PMID 41239649 · Full text
Hemocoagulase Bothrops atrox (HBA) has been widely used to reduce perioperative bleeding in surgical procedures, while little is known about its specific efficacy and safety in video-assisted thoracoscopic surgery (VATS)...
Hemocoagulase Bothrops atrox (HBA) has been widely used to reduce perioperative bleeding in surgical procedures, while little is known about its specific efficacy and safety in video-assisted thoracoscopic surgery (VATS). This study aimed to evaluate the impact of intrathoracic HBA injection on perioperative outcomes and coagulation in patients undergoing VATS. We retrospectively included 388 patients who had lung cancer and received VATS. They were categorized into HBA (n = 51) and non-HBA (n = 337) groups. After 1:2 propensity score matching, 120 patients (45 HBA and 75 non-HBA) were included in final analysis. Multivariate analysis was performed to identify independent factors influencing postoperative thrombin time (TT). Before propensity score matching, the HBA group had significantly lower intraoperative bleeding volume, surgery duration, postoperative hospital stay, drainage volume, and drainage time compared to the non-HBA group (P < .001). Additionally, the HBA group had higher rates of comorbidities, more postoperative complications, and worse pre- and postoperative coagulation functions evaluated by international standardized ratio, activated partial thrombin time, prothrombin time, and fibrinogen level. After matching, the HBA group still demonstrated a higher TT (P = .006), shorter postoperative hospital stays (P = .001), and a lower drainage volume (P = .003) compared to non-HBA group. Multivariate analysis revealed that HBA (P = .009) and preoperative TT (P < .001) were independent risk factors for prolonged postoperative TT. Our study revealed that intrathoracic HBA injection in VATS may reduce postoperative hospital stay and drainage volume, albeit with prolonged TT. Monitoring coagulation function before and after surgery is necessary for patients receiving HBA during surgery.
Is less truly more? - reassessing antiretroviral efficacy - a safety analysis for HIV patients switching from triple to double regimens with integrase inhibitors: A systematic review and meta-analysis.
Jover F, Martínez-Sanz J, Antela A … +4 more , López-Cavanillas M, Viguera-Moreno M, González-Rodríguez P, Domingo P
Medicine (Baltimore) · 2025 Oct · PMID 41189136 · Full text
BACKGROUND: Antiretroviral therapy has marked a transformative advancement in the management of people living with human immunodeficiency virus type-1 (HIV-1) (PLWH), converting this disease into a manageable condition....
BACKGROUND: Antiretroviral therapy has marked a transformative advancement in the management of people living with human immunodeficiency virus type-1 (HIV-1) (PLWH), converting this disease into a manageable condition. Triple-drug regimens have long been considered the gold standard for treatment. However, recent developments have focused on 2-drug regimens to mitigate the toxicities associated with polypharmacy while maintaining viral suppression and improving patient outcomes. Although the efficacy of treatment simplification is established, the impact on adverse events (AEs) remains unclear. METHODS: To evaluate the relative risk (RR) of developing drug-related AEs (DRAEs), DRAEs leading to treatment discontinuation (DRAEs-LD), and serious AEs, a systematic review and meta-analysis of available phase 3 and 4 clinical trials lasting at least 48 weeks and assessing treatment simplification to oral INSTIs in virologically suppressed PLWH were conducted. The study also evaluated the effects of early (ES) and late (LS) treatment regimen switches. RESULTS: Participants who switched to 2DR exhibited a significantly increased RR of developing DRAEs (RR = 6.92; confidence interval [CI]: 3.02-15.86, P < .001) and DRAES leading to discontinuation (DRAEs-LD) (RR = 4.41; 95% CI: 1.77-10.99; P = .001) compared to those who remained on 3DR/4DR, with no differences observed in the RR of developing serious AEs (RR = 1.06; 95% CI: 0.73-1.55; P = .76). CONCLUSION: Our findings indicate that there is still limited evidence to confirm that treatment simplification to oral INSTIs improves safety and tolerability profiles in the short-mid term. Our analyses emphasize the importance of evaluating symptom burden when considering therapy regimen switches in clinical practice.
Comparative efficacy and safety of different traditional Chinese medicine external therapies for polycystic ovary syndrome in women: A network meta-analysis.
Ye J, Guo H, Zeng Q … +4 more , Gan Z, Jin Q, Su H, Lin H
Medicine (Baltimore) · 2025 Oct · PMID 41137303 · Full text
BACKGROUND: Polycystic ovary syndrome (PCOS) is one of the most common endocrine diseases in women. In recent years, traditional Chinese medicine (TCM) treatment has had a positive effect on PCOS, and it is simple, conve...
BACKGROUND: Polycystic ovary syndrome (PCOS) is one of the most common endocrine diseases in women. In recent years, traditional Chinese medicine (TCM) treatment has had a positive effect on PCOS, and it is simple, convenient, and inexpensive. The purpose of this study was to compare the efficacy and safety of different external treatments in the treatment of PCOS using a network meta-analysis method. METHODS: The databases examined comprised Web of Science, Embase, PubMed, The Cochrane Library, China National Knowledge Infrastructure, VIP, Wanfang Data Knowledge Service Platform, and the China Biomedical Literature Database. Since the establishment of the database, randomized controlled trials related to TCM external treatment for PCOS have been screened. The literature was derived from follicle-stimulating hormone (FSH), luteinizing hormone (LH), LH/FSH ratios, body mass index, and testosterone, with detrimental impacts identified as the primary outcomes of the screening process. Odds ratio values with 95% confidence intervals and standardized mean difference values were used as performance measures to compare the effects of different interventions and rank them. The above data were statistically analyzed using STATA 17.0 software. RESULTS: Electroacupuncture has the highest cumulative probability of increasing FSH levels (surface under the cumulative ranking curve [SUCRA]: 86%) and is considered the best intervention to improve FSH in patients with PCOS. Regulating the conception-governor vessel had the highest cumulative probability of reducing LH levels (SUCRA: 76.6%), making it the best choice for improving LH in PCOS patients. Abdominal acupuncture has the highest cumulative probability (SUCRA: 58.6%) and is therefore the best intervention to improve LH/FSH in patients with PCOS. It also showed the best intervention effect with the highest cumulative probability of reducing testosterone levels (SUCRA: 98.2%). Acupuncture + medication had the highest cumulative probability of reducing body mass index (SUCRA: 98.2%) and was considered the most effective intervention. At the same time, abdominal acupuncture had the highest cumulative probability of adverse effects (SUCRA: 58.6%), indicating that it may be associated with adverse events. CONCLUSION: Different TCM external treatments benefit various PCOS-related indicators. Electroacupuncture, regulating conception-governor vessel, abdominal acupuncture, and acupuncture combined with drugs each excel in specific outcomes. However, abdominal acupuncture may carry a higher risk of adverse events.
Analysis of mortality rates from external causes from 2000 to 2020 in Brazil: A time-series.
de Souza AEB, Costa KTDS, de Morais TNB … +2 more , Oliveira AGRDC, de Andrade FB
Medicine (Baltimore) · 2025 Oct · PMID 41088687 · Full text
In the global context, mortality from external causes accounts for 10% of deaths, and 90% of them occur in developing countries, such as Brazil. Therefore, this study aimed to analyze the trends in mortality due to exter...
In the global context, mortality from external causes accounts for 10% of deaths, and 90% of them occur in developing countries, such as Brazil. Therefore, this study aimed to analyze the trends in mortality due to external causes in Brazil from 2000 to 2020. This is an ecological time-series study based on information collected through secondary data. The dependent variable was deaths from external causes, according to Chapter XX of the International Classification of Diseases. The study analyzes education, years, regions and resident population as independent variables. According to the results of this study, Brazil recorded 12% of total deaths in the country as being from external causes, with the highest number recorded in 2017. Regarding the analysis of education, the data showed that the highest mortality rates are in the population with 4 to 11 years of schooling, in addition to a notable tendency towards reduction or deceleration in the growth of mortality among the population with 1 to 3 years of education. This results may be related to the increase in deaths from traffic accidents and suicide among the middle and low socioeconomic status, which represent the areas of the population that have the most years of education. In light of the findings, there is a need to redirect public policies with a focus on prevention toward the most affected regions and the emerging risk profile, through actions targeting mental health, traffic safety, and firearm control.
Efficacy and safety of naphlimostat mesylate versus sodium citrate in CRRT for EICU patients with coagulation dysfunction: A STROBE-compliant observational study.
Song B, Liu C, Fu K
Medicine (Baltimore) · 2025 Oct · PMID 41054083 · Full text
This study aimed to evaluate the safety of naphlimostat mesylate (NM) as an anticoagulant in vitro for emergency intensive care unit patients with coagulation dysfunction undergoing continuous renal replacement therapy (...
This study aimed to evaluate the safety of naphlimostat mesylate (NM) as an anticoagulant in vitro for emergency intensive care unit patients with coagulation dysfunction undergoing continuous renal replacement therapy (CRRT). Patients requiring CRRT and presenting with coagulation dysfunction, admitted to Dazhou Central Hospital's emergency intensive care unit in Sichuan Province between September 2021 and January 2023, were included. Patients were randomly assigned to either the NM group (experimental) or the sodium citrate group (control). Data on patient demographics, changes in coagulation factors, hemoglobin, platelets, inflammatory markers, and electrolytes during treatment were collected for both groups. A total of 89 patients participated, with 49 in the NM group and 40 in the sodium citrate group. Complete data were available for 39 patients in the NM group and 36 in the sodium citrate group. Data on filter usage, alterations in coagulation factors, hemoglobin, platelets, inflammatory markers, and electrolytes were collected throughout the treatment period. A total of 117 filters were used across both groups. The median filter duration was 25.5 (range 16.0-43.5) hours in the NM group and 28.5 (range 18.0-46.5) hours in the sodium citrate group. There was no statistically significant difference in daily filter usage between the groups (1.16 ± 0.76 vs 1.00 ± 0.55, P > .05). NM demonstrated comparable anticoagulant efficacy to sodium citrate. Posttreatment, there were no significant differences between groups in prothrombin time (PT) (35.95 ± 33.14 vs 23.71 ± 19.37), activated partial thromboplastin time (55.65 ± 20.82 vs 55.65 ± 20.82), international normalized ratio (3.05 ± 2.83 vs 4.91 ± 10.60), hemoglobin (82.10 ± 15.01 vs 93.10 ± 26.86), platelet count (66.70 ± 59.87 vs 70.10 ± 48.85), serum sodium (138.80 ± 5.92 vs 142.00 ± 3.59), serum potassium (4.00 ± 0.52 vs 3.96 ± 0.61), serum calcium (1.13 ± 0.19 vs 0.99 ± 0.28), white blood cell count (10.82 ± 5.81 vs 12.54 ± 6.32), and neutrophil count (8.73 ± 5.05 vs 10.89 ± 5.94) levels (all P > .05). NM is a safe and effective extracorporeal anticoagulant, demonstrating comparable anticoagulant efficacy to sodium citrate without increasing the risk of bleeding in patients with coagulation abnormalities undergoing CRRT.
Mapping the landscape of herpes zoster vaccine research: A bibliometric analysis.
Lu R, Bao S, Zhang J … +5 more , Yang Y, Wang Y, Zhou Y, Zhou P, Yuan X
Medicine (Baltimore) · 2025 Sep · PMID 40988174 · Full text
BACKGROUND: Although effective vaccines are available, herpes zoster (HZ) remains a considerable global health concern, particularly among the elderly. This study aimed to systematically map the research landscape and ev...
BACKGROUND: Although effective vaccines are available, herpes zoster (HZ) remains a considerable global health concern, particularly among the elderly. This study aimed to systematically map the research landscape and evolutionary trends in HZ vaccine development. METHODS: A comprehensive bibliometric analysis was conducted on 551 peer-reviewed publications from the Web of Science Core Collection database (retrieved before April 25, 2025). CiteSpace and VOSviewer were utilized to analyze research output, collaborations, and thematic evolution. RESULTS: The United States leads in research output and international collaboration, with Vaccine identified as the primary journal publishing HZ vaccine-related studies. Current research evaluates vaccine immunogenicity and efficacy across populations, elucidating protection mechanisms (with glycoprotein E as a key antigen), and addressing real-world challenges like vaccine hesitancy and strategy optimization for high-risk groups. The analysis indicates that recombinant subunit vaccines are currently the most established and widely recognized, with emerging mRNA and virus-like particle technologies. CONCLUSION: This analysis provides a holistic overview of HZ vaccine research, highlighting key trends and identifying critical gaps in long-term safety data and global vaccine equity. These findings are vital for informing future research and policy to enhance worldwide HZ prevention.
Efficacy and safety of bulleyaconitine A in the treatment of osteoarthritis: A systematic review and meta-analysis.
Xiao M, Huang XH, Ma FL
Medicine (Baltimore) · 2025 Sep · PMID 40958223 · Full text
BACKGROUND: This study evaluated the efficacy and safety of bulleyaconitine A in the treatment of osteoarthritis compared to non-bulleyaconitine A interventions. METHODS: We searched PubMed, Embase, Web of Science, Cochr...
BACKGROUND: This study evaluated the efficacy and safety of bulleyaconitine A in the treatment of osteoarthritis compared to non-bulleyaconitine A interventions. METHODS: We searched PubMed, Embase, Web of Science, Cochrane Library, CBM, CNKI, VIP data, Wan Fang Data, ClinicalTrials.gov, the WHO International Clinical Trial Registry Platform (WHO ICTRP), and the Chinese Clinical Trial Registry (ChiCTR) from their inception to March 1, 2024, and selected relevant records based on inclusion criteria. Two independent reviewers screened the literature, extracted data, and assessed the risk of bias of the included studies. The meta-analysis was conducted using RevMan 5.3 software. RESULTS: The study included 5 randomized controlled trials with a total of 424 participants, which revealed that the efficacy rate and Visual Analog Scale score of bulleyaconitine A for treating osteoarthritis were comparable to those of conventional therapy. However, the knee joint function improvement in the experimental group exceeded that of the control group, and there was a reduced incidence of adverse events. CONCLUSION: Bulleyaconitine A is effective in the treatment of osteoarthritis and has few adverse events.
Clinical effectiveness analysis of transurethral vaporization prostatectomy for benign prostatic hyperplasia.
Cheng C, Wang L, Yang T … +3 more , Liao Y, Yan Y, Lu K
Medicine (Baltimore) · 2025 Aug · PMID 40760568 · Full text
This study compares the clinical effectiveness and safety of transurethral vaporization prostatectomy (TUVP) and traditional transurethral resection of the prostate (TURP) in the treatment of benign prostatic hyperplasia...
This study compares the clinical effectiveness and safety of transurethral vaporization prostatectomy (TUVP) and traditional transurethral resection of the prostate (TURP) in the treatment of benign prostatic hyperplasia (BPH), providing reference for clinical surgical selection. A total of 220 patients with BPH who were treated in our hospital from January 2022 to December 2024 were divided into an observation group (TUVP) and a control group (TURP), with 110 cases in each group. The surgical-related indicators (operative time, intraoperative blood loss, postoperative hospital stay, postoperative bladder irrigation time, and postoperative catheter indwelling time), urinary function indicators (maximum urinary flow rate Qmax, postvoid residual urine volume PVR, International Prostate Symptom Score (IPSS), and quality of life score (QoL), and postoperative complications were compared between the 2 groups. The observation group had significantly shorter operative time, postoperative hospital stay, postoperative bladder irrigation time, and postoperative catheter indwelling time than the control group (P < .05), and significantly less intraoperative blood loss (P < .001). Both groups showed significant improvements in Qmax, PVR, IPSS, and QoL at each postoperative time point compared to preoperatively (P < .001), but there were no significant differences between the 2 groups at each postoperative time point (P > .05). The total incidence of postoperative complications in the observation group was significantly lower than that in the control group (P = .033). TUVP has advantages in treating BPH, including shorter operative time, less intraoperative bleeding, faster postoperative recovery, and fewer complications, especially suitable for elderly and high-risk patients. Both surgical methods show similar effectiveness in improving urinary function, but TUVP has a better advantage in controlling postoperative complications. The appropriate surgical method should be chosen based on the specific conditions of the patient in clinical practice.
Application of blood flow restriction training in adolescents: A narrative review.
Chen ZL, Zhao TS, Ren SF … +4 more , Zhang SZ, Xu JL, Shen YQ, Huang LP
Medicine (Baltimore) · 2025 Jul · PMID 40696603 · Full text
Blood flow restriction training (BFRT) involves applying external compression to the limbs to restrict venous blood return during low-intensity exercise, thereby promoting improvements in muscle mass and strength. Origin...
Blood flow restriction training (BFRT) involves applying external compression to the limbs to restrict venous blood return during low-intensity exercise, thereby promoting improvements in muscle mass and strength. Originally developed decades ago, BFRT has gained renewed interest in recent years, with applications spanning rehabilitation medicine, aerospace, and general fitness. However, its use in adolescents remains limited and under-researched. This narrative review aims to summarize the current understanding of the effects, mechanisms, and practical applications of BFRT in adolescents, with a focus on muscle health, physical performance, and training safety. A comprehensive review of recent literature was conducted, focusing on BFRT-related physiological mechanisms, including metabolic stress, anabolic hormone responses, muscle fiber recruitment, protein synthesis regulation, myostatin suppression, and cell swelling. Relevant studies on adolescent populations were analyzed to evaluate the efficacy and safety of BFRT in this age group. BFRT appears to promote muscle hypertrophy, strength, endurance, and neuromuscular adaptations in adolescents, with reduced injury risk compared to high-load training. Individualized arterial occlusion pressure settings enhance both the safety and effectiveness of BFRT. Applications span general fitness, athletic performance enhancement, and injury rehabilitation. BFRT offers a promising, low-risk alternative to traditional resistance training for adolescents, supporting safe and effective physical development. Its integration into youth fitness and rehabilitation programs by educators, healthcare providers, and sports organizations may offer substantial benefits for adolescent health and performance.
Phosphodiesterase type 5 inhibitors combined with traditional Chinese medicine for diabetes mellitus-induced erectile dysfunction: A systematic review and meta-analysis.
Xiang L, Liu A, Tang W … +8 more , Sun B, Yang Y, Li Y, Chen S, Zhao J, Zhang W, Cai X, Tang X
Medicine (Baltimore) · 2025 Jul · PMID 40660517 · Full text
BACKGROUND: Diabetes mellitus-induced erectile dysfunction (DMED) involves complex pathophysiology, leading to suboptimal outcomes with phosphodiesterase type 5 inhibitors (PDE5I) alone. Combining PDE5I with traditional...
BACKGROUND: Diabetes mellitus-induced erectile dysfunction (DMED) involves complex pathophysiology, leading to suboptimal outcomes with phosphodiesterase type 5 inhibitors (PDE5I) alone. Combining PDE5I with traditional Chinese medicine (TCM) may enhance therapeutic efficacy, but evidence synthesis is lacking. Therefore, this systematic review and meta-analysis aims to compare the efficacy and safety of PDE5I combined with TCM versus PDE5I monotherapy in DMED management. METHODS: We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines (PROSPERO: CRD42021240608). Six databases (PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure Database, Wanfang, and VIP Science Technology Periodical Database) were searched up to May 10, 2024. Randomized controlled trials (RCTs) evaluating PDE5I + TCM versus PDE5I alone in DMED patients with International Index of Erectile Function-5 (IIEF-5) ≤ 21 were included. Data extraction, risk of bias assessment (Cochrane tool), and meta-analysis (RevMan 5.3) were performed using fixed/random-effects models. Outcomes included clinical efficacy, IIEF-5 scores, TCM syndrome scores, and adverse events. RESULTS: Twelve RCTs (1070 participants) were included. PDE5I + TCM significantly improved clinical efficacy (relative risk = 2.86, 95% confidence interval [CI] [2.13, 3.84], P < .001) compared to PDE5I alone. Subgroup analysis showed higher IIEF-5 scores for tadalafil + TCM (standardized mean difference [SMD] = 1.07, 95% CI [0.85, 1.30], P < .001) and sildenafil + TCM (SMD = 1.38, 95% CI [1.11, 1.65], P < .001). TCM syndrome scores decreased significantly with combination therapy (tadalafil + TCM: SMD = -3.43, 95% CI [-3.93, -2.94]; sildenafil + TCM: SMD = -1.40, 95% CI [-1.77, -1.03]). Adverse event rates (dizziness, gastrointestinal effects, flushing) did not differ between groups (all P > .05). CONCLUSION: This study demonstrates that PDE5I combined with TCM demonstrates superior efficacy in improving erectile function and TCM symptom profiles in DMED patients, without increasing adverse events. However, limitations such as variability in TCM formulations and treatment durations across studies, as well as unclear blinding protocols in some trials, may introduce heterogeneity and affect the generalizability of these findings. Further high-quality RCTs are needed to validate optimal regimens and long-term outcomes.
Risk thresholds for soft versus hard cardiovascular disease outcome models for initiating statin therapy among Chinese adults: a cost-utility analysis.
Sun Z, Zhang H, Ding Y … +16 more , Yu C, Sun D, Pang Y, Pei P, Yang L, Chen Y, Du H, Huang D, Yang X, Barnard M, Clarke R, Chen J, Chen Z, Li L, Lv J, China Kadoorie Biobank Collaborative Group
BMC Med · 2025 Jul · PMID 40598486 · Full text
BACKGROUND: Current guidelines for atherosclerotic cardiovascular disease (ASCVD) primary prevention mostly recommend risk scores that predict risk of non-fatal myocardial infarction, fatal ischemic heart disease (IHD),...
BACKGROUND: Current guidelines for atherosclerotic cardiovascular disease (ASCVD) primary prevention mostly recommend risk scores that predict risk of non-fatal myocardial infarction, fatal ischemic heart disease (IHD), and fatal or non-fatal ischemic stroke (hard outcomes), ignoring the burden from other non-fatal IHD outcomes. We explored the optimal risk thresholds for statin initiation using non-laboratory-based soft and hard ASCVD outcome models and compared the cost-utility of such models in the Chinese population. METHODS: We constructed Markov cohort models to estimate the incidence of ASCVD events, costs, and quality-adjusted life years (QALYs) over a lifetime from a social perspective. The simulation cohort was constructed using data from the China Kadoorie Biobank (CKB). Input data included cost, utility, statin efficacy, and other parameters were derived from published literature. We used CKB-ASCVD models to predict 10-year risk and different risk thresholds to guide statin initiation. The incremental cost-effectiveness ratio (ICER) was estimated as cost per QALY gained. Sensitivity analyses were performed to explore the uncertainty in the models. RESULTS: The optimal risk threshold was 18% for the soft ASCVD model and 10% for the hard ASCVD model, with ICERs of $7013.48/QALY and $6540.71/QALY, respectively. The optimal thresholds were robust in stratified analyses by region and sex, and one-way sensitivity analyses over a wide range of input parameters. Probabilistic sensitivity analyses showed that these optimal thresholds had around 70% chance of being cost-effective. When analyzed by age group, above optimal thresholds were cost-effective in adults aged 30-59 years but not in those aged 60-75 years. The threshold strategies based on soft ASCVD model were mostly cost-saving compared with those based on hard models to treat the same proportions of the population. CONCLUSIONS: The risk threshold of 18% for soft ASCVD model and 10% for hard ASCVD model have acceptable cost-utility profiles in the Chinese population. The soft ASCVD model is more cost-effective than the hard model and should be used as a screening tool for ASCVD primary prevention.
Effectiveness of acupotomy combined with nerve block therapy for cervical radiculopathy: A systematic review and meta-analysis.
Choi HK, Lee SH, Lee JH … +6 more , Choi S, Park S, Lim YS, Kim HJ, Kim YI, Park TY
Medicine (Baltimore) · 2025 Jun · PMID 40527792 · Full text
BACKGROUND: This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of combining acupotomy with nerve block therapy (NBT) for cervical radiculopathy (CR) compared to NBT alone. METHODS: A...
BACKGROUND: This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of combining acupotomy with nerve block therapy (NBT) for cervical radiculopathy (CR) compared to NBT alone. METHODS: A comprehensive search was conducted across multiple databases to identify randomized controlled trials (RCTs) investigating the combined use of acupotomy and NBT for CR. Studies were assessed for risk of bias using the Cochrane Risk of Bias 2 tool. Data were synthesized through meta-analysis where applicable. RESULTS: Four RCTs with a total of 540 patients were included. Meta-analysis showed that the combination of acupotomy and NBT significantly improved the total effective rate compared to NBT alone (risk ratio 1.16, 95% confidence interval 1.08-1.24, P < .0001). However, no significant pain reduction was observed based on the pain visual analog scale (SMD - 2.55, 95% confidence interval -5.32 to 0.22, P = .07), and there was substantial heterogeneity among the included studies (I² = 99%). The overall risk of bias was high, and safety data were limited, with only one study reporting adverse events. CONCLUSION: The findings suggest that acupotomy combined with NBT may enhance treatment effectiveness for CR, particularly in terms of overall therapeutic response. However, due to the high risk of bias, study heterogeneity, and insufficient safety reporting, further well-designed, large-scale RCTs with long-term follow-ups are needed to establish robust clinical evidence.
Effectiveness of continuous intravenous insulin infusion in hypertriglyceridemia-induced acute pancreatitis of varying severity: A longitudinal study.
Le TQ, Le HTT, Tran NTT … +2 more , Nguyen NN, Tran TT
Medicine (Baltimore) · 2025 May · PMID 40441219 · Full text
Among causes of acute pancreatitis, hypertriglyceridemia has gained increasing recognition, with a higher prevalence in Asian populations. Intravenous insulin infusion is the primary treatment for hypertriglyceridemia-in...
Among causes of acute pancreatitis, hypertriglyceridemia has gained increasing recognition, with a higher prevalence in Asian populations. Intravenous insulin infusion is the primary treatment for hypertriglyceridemia-induced acute pancreatitis (HTGP). However, the effectiveness and safety of insulin therapy may vary depending on baseline triglyceride levels and individual insulin resistance. Additionally, the necessity of rapid triglyceride reduction to prevent disease progression remains unclear. This study aims to assess the efficacy and safety of insulin infusion in HTGP patients with varying triglyceride levels and evaluate its impact on disease progression. This prospective study enrolled 54 patients aged 18 years or older diagnosed with HTGP and treated with insulin infusion between October 2022 and June 2023. Diagnosis and severity classification followed the 2012 revised Atlanta criteria. Patients received continuous intravenous insulin following a standardized protocol. Patients were stratified into 2 groups based on median baseline triglyceride levels: high (<25.455 mmol/L) and extremely high (≥25.455 mmol/L). Triglyceride levels were measured at baseline and at 12, 24, 48, and 72 hours posttreatment, along with other biochemical and clinical parameters. Differences in mean change from baseline and other indices between the 2 groups were compared and the association between triglyceride reduction and disease progression was assessed. Statistical significance was set at P < .05. A total of 54 patients (mean age: 48 ± 10 years, 88.9% male) were included in the study. Baseline characteristics, including age, body mass index, and history of diabetes, pancreatitis, gallstones, and alcohol consumption, were similar between the high and extremely high triglyceride groups (all P > .05). Triglyceride levels decreased significantly in both groups, with a greater reduction observed in the extremely high group at all time points. A greater triglyceride reduction within the first 12 hours was significantly associated with a lower risk of worsening pancreatitis (odds ratio 0.642, 95% confidence interval 0.347-0.892, P = .049). Continuous intravenous insulin infusion is a safe and effective treatment for reducing triglyceride levels in HTGP. Early triglyceride reduction, particularly within the first 24 hours, plays a crucial role in preventing disease deterioration.
The positive role of Chinese herbal medicine as an adjunctive therapy for refractory gastroesophageal reflux disease: A systematic review and network meta-analysis.
Zhang R, Yang Z, Pan X … +6 more , Liu Y, Huang Q, Song Z, Yao Q, Li D, Zhang Y
Medicine (Baltimore) · 2025 May · PMID 40419902 · Full text
BACKGROUND: Proton pump inhibitors are currently the primary treatment option for refractory gastroesophageal reflux disease (rGERD), yet they have limitations, including poor efficacy and potential adverse events. Chine...
BACKGROUND: Proton pump inhibitors are currently the primary treatment option for refractory gastroesophageal reflux disease (rGERD), yet they have limitations, including poor efficacy and potential adverse events. Chinese herbal medicine (CHM) may offer an effective and safe adjunctive therapy. METHODS: This network meta-analysis investigate the adjunctive therapeutic effect and safety of CHM on rGERD. Randomized controlled trials (RCTs) of CHM combined with conventional Western medicine in the treatment of rGERD added to 8 online databases from its inception to January 2024 were systematically searched. Review Manager 5.3 and and Stata 14.0 software were used to conduct pairwise meta-analysis and network meta-analysis of RCTs that met the inclusion criteria. In addition, the methodological quality of RCTs was analyzed using the Cochrane Collaboration Risk of Bias ROB 2.0 assessment tool. This study was registered in PROSPERO (International Prospective Register of Systematic Reviews) (CRD42024532264). RESULTS: This study included a total of 19 RCTs, comparing 16 CHMs. Pairwise meta-analysis indicated that CHM combined with conventional Western medicine outperformed the latter in terms of overall clinical efficacy, recurrence rate, and symptom improvement. Network meta-analysis suggested that Shugan Jieyu Capsule may significantly enhance overall clinical efficacy, while Buzhongyiqi Granules may significantly reduce the recurrence rate, Sanji Powders may significantly improve symptoms of acid reflux, Shugan Jieyu Capsule may significantly improve symptoms of heartburn, and Shugan Jianpi Hewei Decoction may significantly improve symptoms of esophageal chest pain, Qingweishu Granules may significantly improve the frequency scale for the symptoms of GERD score. No serious adverse events were reported in any of the RCTs. CONCLUSION: The findings of this study indicate that CHM offers a positive adjunctive therapeutic benefit for rGERD; however, it is imperative to enhance the quality of future RCTs to validate these preliminary findings.
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