Therapeutics And Clinical Risk Management[JOURNAL]
Sun
200 papers
Electroacupuncture as a Non-Pharmacological Intervention for Nicotine Dependence: Evidence from a Randomized Clinical Trial.
Lai Z, Fan Q, Lee AL … +3 more , Yao X, Dai R, Liang Y
Ther Clin Risk Manag · 2025 · PMID 41488199 · Full text
Nicotine dependence, a chronic addictive disorder characterized by high relapse rates, represents a significant global public health challenge. This study employed a randomized, single-blind, parallel-group controlled de...
Nicotine dependence, a chronic addictive disorder characterized by high relapse rates, represents a significant global public health challenge. This study employed a randomized, single-blind, parallel-group controlled design to systematically evaluate the efficacy and safety of electroacupuncture compared with varenicline in the treatment of nicotine dependence. The results demonstrated that electroacupuncture achieved significantly superior outcomes across multiple key outcome measures relative to varenicline: the electroacupuncture group exhibited a greater mean daily reduction in Fagerström Test for Nicotine Dependence (FTND) scores (-1.11 points/day vs -0.33 points/day, P < 0.001) and a higher rate of sustained improvement at the 3-month follow-up (84.4% vs 69.5%). With respect to the Heaviness of Smoking Index (HSI), the electroacupuncture group showed a more rapid and sustained decline (sustained rate: 81.7% vs 63.9%, P = 0.002). Moreover, electroacupuncture demonstrated significant advantages in alleviating nicotine withdrawal symptoms (sustained rate: 75.3% vs 52.8%, P = 0.026) and reducing daily cigarette consumption (79.0% vs 56.2%, P < 0.001). The potential mechanism may involve modulation of the mesolimbic dopamine system. These findings support electroacupuncture as a safe, effective, and sustainable non-pharmacological intervention for smoking cessation, particularly suitable for individuals with high nicotine dependence who are sensitive to adverse drug reactions or exhibit poor medication adherence, and suggest its potential role as a complementary or alternative strategy in clinical smoking cessation programs. Future research should further validate its long-term efficacy and investigate the neurobiological mechanisms underlying its effects on relapse prevention.
Free Skin Anterolateral Thigh Flap and Vacuum-Assisted Closure Therapy for Reconstruction of Snakebite-Induced Complex Hand Defects.
Nghĩa PT, Sơn TT, Thúy TTH … +2 more , Trọng NH, Nam ĐP
Ther Clin Risk Manag · 2025 · PMID 41477434 · Full text
INTRODUCTION: Cobra ( species) envenomation in tropical regions like Vietnam frequently leads to severe hand tissue necrosis, creating complex defects that challenge conventional reconstruction. This study evaluates a st...
INTRODUCTION: Cobra ( species) envenomation in tropical regions like Vietnam frequently leads to severe hand tissue necrosis, creating complex defects that challenge conventional reconstruction. This study evaluates a staged approach combining vacuum-assisted closure (VAC) therapy with free anterolateral thigh (ALT) flap for these challenging injuries. METHODS: Eleven patients with extensive hand defects involving skin and/or tendon due to cobra envenomation were included. Following surgical debridement, VAC therapy was applied to prepare the wound bed. Subsequently, definitive reconstruction was performed using tailored ALT flaps, which included fasciocutaneous or thinned configurations depending on defect complexity. Postoperative evaluation included flap viability, range of motion (ROM), and complication assessment. RESULTS: The mean duration of VAC therapy was 11.5 ± 4.2 days. Eleven ALT flaps with an average dimension of 14.5×7.0 cm were harvested. Flap thinning was performed in eight cases (72.7%), achieving a mean final thickness of 4.6 ± 1.3 mm. Eight flaps (72.7%) were used to cover defects spanning both digital and dorsal or palmar subunits. Over a mean follow-up of 15.3 months, patients with digital reconstruction achieved a functional ROM at the metacarpophalangeal joint, with 0° of extension and up to 60° of flexion. The main issue was flap bulkiness; no donor-site morbidity was observed. CONCLUSION: A staged approach combining VAC therapy for wound bed preparation and subsequent reconstruction with a free ALT flap is a safe and effective strategy for managing complex hand defects resulting from cobra bites. This method facilitates optimal wound conditions and provides versatile, well-vascularized tissue coverage, thereby promoting functional hand recovery.
Comparative Evaluation of 11 Prognostic Scores for Atrial Fibrillation Recurrence After Pulmonary Vein Isolation in Non-Paroxysmal AF: A Retrospective Comparative Analysis.
Guan LX, Chen XH, Xu Z … +2 more , Gong KZ, Zhang FL
Ther Clin Risk Manag · 2025 · PMID 41477433 · Full text
OBJECTIVE: Pulmonary vein isolation (PVI) remains the cornerstone of catheter ablation for atrial fibrillation (AF); however, a substantial proportion of patients with non-paroxysmal AF (non-PAF) experience recurrence fo...
OBJECTIVE: Pulmonary vein isolation (PVI) remains the cornerstone of catheter ablation for atrial fibrillation (AF); however, a substantial proportion of patients with non-paroxysmal AF (non-PAF) experience recurrence following ablation. With numerous prognostic models available to predict recurrence, the aim of this study is to compare the predictive performance of multiple scoring systems in patients with non-PAF undergoing PVI as a standalone procedure. METHODS: A retrospective analysis was conducted involving 166 patients with non-PAF (22.3% female; mean age 60 ± 9 years) who underwent initial PVI alone. Clinical data, including transthoracic echocardiography and either cardiac computed tomography or transesophageal echocardiography, were collected. The evaluated prognostic scoring systems included APPLE, BASE-AF, CHEST, CAAP-AF, CHADS-VASc, CHADS, DR-FLASH, HATCH, MB-LATER, PATCH, and SCALE-CryoAF. RESULTS: Recurrence of AF following a 90-day blanking period was observed in 41 individuals (24.7%), including 24 (51.8%) in the cryo-balloon ablation (CBA) subgroup and 17 (48.2%) in the radiofrequency catheter ablation (RFCA) subgroup. Among the evaluated models, BASE-AF (AUC = 0.666, 95% CI: 0.572-0.759, = 0.001), MB-LATER (AUC = 0.734, 95% CI: 0.646-0.821, < 0.001), and SCALE-CryoAF (AUC = 0.702, 95% CI: 0.600-0.804, < 0.001) demonstrated superior prognostic performance for recurrence. After propensity score matching, MB-LATER (AUC = 0.734, 95% CI: 0.570-0.899, = 0.019) was identified as the most effective predictor of recurrence in the CBA subgroup, while BASE-AF (AUC = 0.758, 95% CI: 0.578-0.937, = 0.013) indicated superior predictive accuracy in the RFCA subgroup. CONCLUSION: The BASE-AF2, MB-LATER, and SCALE-CryoAF scoring systems demonstrated enhanced prognostic use for predicting AF recurrence following PVI alone in patients with non-PAF. MB-LATER exhibited superior performance in those treated with CBA, while BASE-AF2 was more predictive for those who underwent RFCA.
OPRM1 A118G Polymorphism and Ondansetron Efficacy for Postoperative Nausea and Vomiting in Laparoscopic Gynaecological Surgery: A Retrospective Cohort Study.
Zhao X, Yu Q, Yu G … +3 more , Liu C, Feng Z, Zhang W
Ther Clin Risk Manag · 2025 · PMID 41477432 · Full text
BACKGROUND: The OPRM1 A118G polymorphism has been implicated in modulating susceptibility to postoperative nausea and vomiting (PONV). Ondansetron, a 5-HT3 receptor antagonist, is widely utilized for PONV prophylaxis; ho...
BACKGROUND: The OPRM1 A118G polymorphism has been implicated in modulating susceptibility to postoperative nausea and vomiting (PONV). Ondansetron, a 5-HT3 receptor antagonist, is widely utilized for PONV prophylaxis; however, whether its efficacy is influenced by OPRM1 A118G polymorphism remains unclear. METHODS: We conducted a retrospective cohort study including patients undergoing laparoscopic gynecological surgery between January 2019 and December 2024; propensity score matching was used to adjust for confounders. OPRM1 A118G genotypes (AA, AG, GG) were analyzed through polymerase chain reaction and sequencing. PONV incidence and severity were assessed using the Visual Analog Scale (VAS) at various postoperative time points. RESULTS: The Ondansetron group had significantly lower PONV incidence within 2 hours (38.82% vs 56.98%, = 0.0174) and 2 ~ 24 hours (8.24% vs 19.77%, = 0.0300). The OPRM1 A118G polymorphism was associated with higher PONV risk, particularly in patients with the AG/GG genotypes in the control group. In the Ondansetron group, the association was significant only within 2 hours ( = 0.0460). CONCLUSION: The OPRM1 A118G polymorphism is associated with an increased risk of early PONV, particularly in patients with the G allele, which has been related to reduced μ-opioid receptor sensitivity and increased opioid requirements, thereby predisposing patients to a higher PONV risk. Ondansetron significantly reduces PONV incidence and severity, especially in patients with higher genetic susceptibility.
Eradication: Why Recurrence Risk Should Not Dictate Treatment Decisions.
Chen X, Wang Y, Dong Y … +3 more , Yang J, Xie B, Zhang D
Ther Clin Risk Manag · 2025 · PMID 41477431 · Full text
infection is unequivocally associated with the development and progression of various digestive diseases. Clinical guidelines recommend eradication therapy for all eligible patients without contraindications. However, re...
infection is unequivocally associated with the development and progression of various digestive diseases. Clinical guidelines recommend eradication therapy for all eligible patients without contraindications. However, reports of high recurrence rates in earlier studies have raised concerns among clinicians and patients regarding the necessity of treatment, which has, to some extent, hindered the timely implementation of eradication strategies. This article provides a systematic review of the issue of recurrence. A comprehensive analysis of literature retrieved from major databases such as PubMed, Web of Science, and Google Scholar, using keywords including "Helicobacter pylori", "recurrence", and "reinfection", indicates that the annual recurrence rate is significantly lower than previously thought, with modern epidemiological estimates ranging from 1.5% to 5.0%. The review further elucidates the underlying mechanisms of recurrence, identifies key modifiable risk factors, and highlights that optimizing eradication regimens and preventing intrafamilial transmission are central strategies for controlling recurrence. The conclusion emphasizes that concerns about recurrence should not preclude eradication therapy and offers a theoretical basis and practical directions for developing targeted prevention strategies in clinical practice.
Zero-Balance Ultrafiltration Reduces Postoperative Delirium After Cardiac Surgery with Cardiopulmonary Bypass: A Randomized Controlled Trial.
Lan X, Tang S, Lu J … +7 more , Tang G, Shao Y, Zhu Z, Zhou K, Xiong X, Chen D, Shi J
Ther Clin Risk Manag · 2025 · PMID 41459141 · Full text
PURPOSE: To assess the effects of conventional ultrafiltration and conventional plus zero-balanced ultrafiltration on delirium and cognition in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). METHO...
PURPOSE: To assess the effects of conventional ultrafiltration and conventional plus zero-balanced ultrafiltration on delirium and cognition in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). METHODS: A total of 116 adults who were scheduled for cardiac surgery with CPB were randomly assigned to the conventional ultrafiltration group or the conventional plus zero-balanced ultrafiltration group. CPB was managed with standard protocols. In the conventional ultrafiltration group, ultrafiltration began during the rewarming phase and was performed until the CPB was terminated. In another group, perfusionists conducted zero-balance ultrafiltration after aortic cross-clamping and began conventional ultrafiltration during the rewarming phase. The primary outcome was the incidence of postoperative delirium (POD) within 7 days; the secondary outcome was postoperative cognitive dysfunction (POCD) at 1 and 3 months. In addition, the patients' vital signs and postoperative complications at different points during the operation were also recorded. RESULTS: During the first 7 postoperative days, POD was observed in 12 patients in the zero-balance ultrafiltration group and 27 patients in the conventional ultrafiltration group (12/53 [22.64%] vs 27/53 [50.94%]; RR 0.45, 95% CI 0.25 to 0.78; = 0.005). At 1 month after surgery, POCD occurred in 12 patients in the zero-balance ultrafiltration group versus 18 patients in the conventional ultrafiltration group (12/53 [22.64%] vs 18/53 [33.96%]; RR = 0.67; 95% CI 0.36-1.24; P = 0.281). By 3 months postoperatively, postoperative cognitive dysfunction occurred in 4 patients in the zero-balance ultrafiltration group and 7 patients in the conventional ultrafiltration group (4/53 [7.55%] vs 7/53 [13.21%]; RR = 0.57; 95% CI 0.18-1.84; P = 0.524). CONCLUSION: In patients who underwent cardiac surgery with CPB, zero-balance ultrafiltration significantly reduced the incidence of delirium compared with conventional ultrafiltration alone within the first 7 postoperative days. In contrast, the incidence of cognitive dysfunction did not differ significantly between the two groups at 1 or 3 months postoperatively.
Clinical Efficacy of Endoscopy-Assisted Anterior Cervical Discectomy and Fusion for Single-Segment Cervical Spondylotic Myelopathy: A Retrospective, Propensity Score-Matched Study.
Li T, Ma J, Zhang H … +2 more , Jiang Q, Ding Y
Ther Clin Risk Manag · 2025 · PMID 41459140 · Full text
PURPOSE: Endoscopy-assisted anterior cervical discectomy and fusion (EA-ACDF), which integrates the advantages of conventional ACDF and spinal endoscopy, is an innovative technique for treating cervical spondylotic myelo...
PURPOSE: Endoscopy-assisted anterior cervical discectomy and fusion (EA-ACDF), which integrates the advantages of conventional ACDF and spinal endoscopy, is an innovative technique for treating cervical spondylotic myelopathy (CSM). We compared the clinical efficacy of EA-ACDF and ACDF for treating patients with single-segment CSM. METHODS: One-hundred and thirty-six CSM patients were retrospectively included from January 2021 to September 2023, of whom 61 underwent EA-ACDF and 75 underwent ACDF. Propensity score matching (PSM) was conducted to adjust for imbalances in covariates between groups. Then, clinical and imaging outcomes, perioperative data, and complications were compared. RESULTS: After matching, 108 patients were included and followed for 15-38 months. Compared to the ACDF group, the EA-ACDF group had less intraoperative bleeding volume, less drainage volume, and shorter postoperative hospital stays ( < 0.05). At 7 days and 3 months after the surgery, the visual analog scale (VAS), Japanese Orthopedic Association score (JOA), and neck disability index (NDI) improved more significantly in the EA-ACDF group ( < 0.05). Regarding imaging, intervertebral height index (IHI), C cervical lordosis (C CL), and C range of motion (C ROM) exhibited no statistical differences between the two groups ( > 0.05). The complication rates between the EA-ACDF (3.7%) and ACDF (14.8%) groups demonstrated statistical differences ( = 0.046). CONCLUSION: Both EA-ACDF and conventional ACDF for single-segment CSM provide satisfactory clinical efficacy. The EA-ACDF procedure provides a clearer surgical field, causes less trauma, allows faster recovery, and has the potential to reduce the risk of complications.
Prognostic Factors and Clinical Prediction Score for Progressive Respiratory Failure in Severe COVID-19 Pneumonia Patients Treated with Tocilizumab: A Multicenter Study.
Pongtarakulpanit N, Jayanama K, Phinyo P … +8 more , Naothavorn W, Nuprom S, Pitidhammabhorn D, Ngammisri P, Ngamjanyaporn P, Suthichatchawan V, Wicharit L, Thammavaranucupt K
Ther Clin Risk Manag · 2025 · PMID 41459139 · Full text
PURPOSE: A proportion of COVID-19 pneumonia patients develop respiratory failure despite tocilizumab administration. This retrospective cohort study aimed to identify prognostic factors associated with progressive respir...
PURPOSE: A proportion of COVID-19 pneumonia patients develop respiratory failure despite tocilizumab administration. This retrospective cohort study aimed to identify prognostic factors associated with progressive respiratory failure within 14 days among patients with severe COVID-19 pneumonia treated with Tocilizumab and to describe treatment outcomes. PATIENTS AND METHODS: Patients with severe COVID-19 pneumonia were assessed, and their demographic, clinical, laboratory data, and prior treatment were collected on the day of tocilizumab administration. A multivariable Cox proportional hazard model was employed to identify prognostic factors. RESULTS: Of the 109 patients, 32 (29.4%) progressed to respiratory failure. We identified the following independent prognostic factors for progressive respiratory failure: pulse oximetry saturation to fraction of inspired oxygen ratio (SpO/FiO) ≤ 160 (HR 2.97, 95% CI 1.41-6.23, P = 0.004), estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m (HR 3.21, 95% CI 1.23-8.39, P = 0.017), and serum potassium ≤ 4 mmol/L (HR 2.82, 95% CI 1.38-5.80, P = 0.005). A predictive model based on these factors effectively stratified the risk of progressive respiratory failure (area under the curve = 0.72, 95% CI 0.63-0.80). Patients experiencing progressive respiratory failure had poor clinical outcomes, with a mortality rate of 62.5%, compared to 0.0% in the non-respiratory failure group (p < 0.001). CONCLUSION: In severe COVID-19 pneumonia patients treated with Tocilizumab, low SpO/FiO ratio, low eGFR, and relatively low serum potassium were independent predictors for progressive respiratory failure. This simple clinical score may help identify high-risk patients early, though external validation is required before routine implementation.
Comparative Effectiveness of Propofol-Sufentanil vs Propofol-Fentanyl in Elderly Patients Undergoing Transurethral Resection of the Prostate.
Dong T, Lei S, Ding G
Ther Clin Risk Manag · 2025 · PMID 41459138 · Full text
OBJECTIVE: The aim of this study is to compare the anesthetic effect and cognitive function impact of propofol-sufentanil (PS) versus propofol-fentanyl (PF) in elderly patients undergoing transurethral resection of the p...
OBJECTIVE: The aim of this study is to compare the anesthetic effect and cognitive function impact of propofol-sufentanil (PS) versus propofol-fentanyl (PF) in elderly patients undergoing transurethral resection of the prostate (TURP) under general anesthesia (GA). METHODS: This is a retrospective cohort study conducted in First People's Hospital of Yongkang City. They included 98 patients aged 65 and above who underwent TURP under GA between October 2023 and March 2025. 49 patients who received PS were matched with a cohort of propofol-fentanyl (PF) in a 1:1 ratio. Compare the hemodynamic parameters (heart rate (HR) and mean arterial pressure (MAP)) of two groups at 30 minutes before anesthesia induction (T0), after anesthesia completion (T1), at the time of skin incision (T2), at the end of surgery (T3), at the postanesthesia care unit (PACU) (T4), 15 minutes after PACU arrival (T5), and 30 minutes after PACU arrival (T6). Compare two perioperative indicators (anesthesia onset time, postoperative awakening time, and extubation time). Compare the pain visual analogue scale (VAS) scores of two groups at three, 12, and 24 hours after surgery. And the Montreal Cognitive Assessment Scale (MoCA) was used to evaluate the number of patients with cognitive impairment at six, 24, and 72 hours after surgery in two groups. Compare the incidence of adverse reactions within 72 hours after surgery between two groups. RESULTS: Compared with the PF group, the PS group had more stable hemodynamics during T2-T5 (<0.05); VAS scores were lower at 12 and 24 hours postoperatively (<0.05); The anesthesia onset time, postoperative awakening time, and extubation time of the PS group were significantly shorter than those of the PF group (<0.05); The incidence of cognitive dysfunction was lower at six and 24 hours after surgery (<0.05). However, there was no significant difference in the incidence of various complications between the two groups (>0.05). CONCLUSION: PS is more effective for TURP anesthesia and has a better protective effect on early postoperative cognitive function.
Rehabilitation Combined with Coagulation Tests for the Prevention of DVT in Patients After Hypertensive Intracerebral Hemorrhage Surgery.
Kong L, Yao S
Ther Clin Risk Manag · 2025 · PMID 41445676 · Full text
OBJECTIVE: To evaluate the efficacy of ultra-early rehabilitation combined with coagulation monitoring in preventing deep vein thrombosis (DVT) in patients following surgical intervention for hypertensive intracerebral h...
OBJECTIVE: To evaluate the efficacy of ultra-early rehabilitation combined with coagulation monitoring in preventing deep vein thrombosis (DVT) in patients following surgical intervention for hypertensive intracerebral hemorrhage (HICH). METHODS: A retrospective cohort study was conducted involving 126 HICH patients treated at the Neurosurgery ICU of The Affiliated Hospital of Xuzhou Medical University and the Rehabilitation Department of Xuzhou Central Hospital between January 2023 and December 2024. Participants were stratified into an experimental group (ultra-early rehabilitation with daily coagulation testing, n=63) and a control group (conventional care, n=63) based on the management protocol they received during their hospitalization. Hemodynamic parameters, muscle strength, and coagulation markers were assessed at baseline (T0: pre-intervention), T1 (postoperative day 1), T7 (postoperative day 7), and T14 (postoperative day 14). RESULTS: Baseline characteristics demonstrated comparability between groups (P>0.05). The experimental group exhibited superior muscle strength recovery in both upper and lower extremities, with statistically significant differences emerging at T14 (P<0.05). Coagulation parameters including fibrinogen (FIB), fibrinogen degradation products (FDP), D-dimer, thrombin-antithrombin III complex (TAT), plasmin-antiplasmin complex (PIC), and thrombomodulin (TM) demonstrated progressive decline in the experimental cohort. At T7, FIB, FDP, and D-dimer levels were significantly lower in the experimental group compared to controls (P<0.05), with more pronounced reductions observed at T14. TAT, PIC, and TM similarly demonstrated substantial decreases at T14 (P<0.01). DVT incidence was significantly reduced in the experimental group (12.70% vs 31.75%, P<0.05). CONCLUSION: Ultra-early rehabilitation guided by systematic coagulation monitoring appears to be associated with favorable modulation of hemostatic markers (FIB, FDP, D-dimer, TAT, PIC, TM) and enhanced muscle strength recovery following HICH surgery. This integrated approach may effectively reduce postoperative DVT incidence, offering a promising strategy for thromboprophylaxis management.
Hepatic Safety of Febuxostat and Allopurinol in Gout Patients: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Dewi C, Puspita F, Insani WN … +3 more , Sinuraya RK, Puspitasari IM, Zakiyah N
Ther Clin Risk Manag · 2025 · PMID 41439039 · Full text
PURPOSE: This study aimed to conduct an updated systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the hepatic safety of febuxostat and allopurinol in gout patients. Subgroup analyses w...
PURPOSE: This study aimed to conduct an updated systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the hepatic safety of febuxostat and allopurinol in gout patients. Subgroup analyses were conducted based on age, dosage, and treatment duration. METHODS: This study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Published studies were reviewed in PubMed, The Cochrane Library, and Scopus. The Cochrane Risk of Bias (RoB) 2 tool was used to assess the quality of the included studies. Risk ratios (RR) were estimated using binary outcomes of fixed effect model and were reported with corresponding 95% confidence intervals (CI). This study is registered on PROSPERO with number CRD42024611074. RESULTS: Out of 703 publications from the databases, a total of 15 studies met the inclusion criteria. The RR meta-analysis of the included studies was calculated using binary outcomes and a fixed effect model based on available hepatic safety events. We identified 5 RCTs with some concerns regarding the risk of bias, and 10 RCTs with a low risk of bias. Overall, hepatic safety outcomes were comparable between febuxostat and allopurinol, including across subgroups by age, dosage, and treatment duration. Febuxostat showed no significant difference in hepatic risk compared to allopurinol, with RRs of 1.03 (95% CI: 0.78-1.36) for overall liver function abnormalities, 1.03 (95% CI: 0.66-1.61) for investigator-defined liver abnormalities, and 1.21 (95% CI: 0.96-2.74) for hepatobiliary disorders. CONCLUSION: This updated systematic review and meta-analysis found no difference in hepatic safety profiles between febuxostat and allopurinol in patients with gout across age categories, dosage levels, or treatment durations. Further research is warranted to address the limitations of sample sizes and the overall moderate quality of existing evidence.
Modulating Metabolic Health and Physiological Functions: Advances in Dietary Interventions Targeting Gut Microbiota.
Rabbani SA, El-Tanani M, Janić M … +6 more , Janež A, Tanani YE, Hajeer E, Matalka MI, Rizzo M, Kumar R
Ther Clin Risk Manag · 2025 · PMID 41426235 · Full text
The human gut possesses a highly complex and metabolically functional microbial community. This microbial ecosystem, often termed a "super-organism", plays a critical function in regulating the host's metabolic processes...
The human gut possesses a highly complex and metabolically functional microbial community. This microbial ecosystem, often termed a "super-organism", plays a critical function in regulating the host's metabolic processes, including gut motility, energy absorption, appetite, glucose and lipid metabolism, as well as hepatic fat storage. These metabolic functions of the gut microbiota (GM) play a central role in maintaining host homeostasis and overall metabolic health. This review synthesizes findings from recent clinical and preclinical studies, focusing on the interactions between gut microbiota, metabolic functions, and dietary interventions, to provide an evidence-based overview of current knowledge and future perspectives. Evidence was compiled through a narrative review of studies indexed in PubMed, Scopus, Web of Science, and Google Scholar using prespecified keywords related to gut microbiota, metabolic syndrome, diet, and dysbiosis.Recent advancements in nutritional science and microbiology have highlighted the substantial relation between the GM and multiple pathological conditions, including metabolic syndrome (MetS). A plethora of studies predict that disruptions in the GM, known as dysbiosis, may influence the progression of diabetes, obesity, and cardiovascular diseases (CVDs). Notably, elucidating the contributions of the GM in the pathogenesis of MetS could offer promising avenues for therapeutic interventions. Herein, we review the physiological and metabolic functions of the GM and its connection to MetS pathogenesis, while also highlighting the potential molecular mechanisms underlying these observed associations. Furthermore, we discuss the influence of different dietary approaches on MetS and the impact of nutritional therapeutic strategies to support the development of beneficial gut bacteria and alleviate dysbiosis. By integrating insights from both clinical and preclinical research, this study provides a comprehensive overview of how GM modulation can support metabolic health. The possibility of tailoring nutritional interventions based on individual microbiota profiles represents a promising frontier for personalized and effective approaches to improve metabolic health.
Comprehensive Multimodal Prehabilitation for Lung Cancer: A Systematic Review of Randomized Controlled Trials.
Mania K, Pieczynska A, Hojan K
Ther Clin Risk Manag · 2025 · PMID 41426234 · Full text
INTRODUCTION: Surgical resection is a cornerstone of curative treatment for early-stage lung cancer. Multimodal prehabilitation, a comprehensive, patient-centered program integrating physical exercise, nutritional status...
INTRODUCTION: Surgical resection is a cornerstone of curative treatment for early-stage lung cancer. Multimodal prehabilitation, a comprehensive, patient-centered program integrating physical exercise, nutritional status, and psychological support, has emerged as a promising approach to enhance patients' physiological and psychological resilience prior to surgery. While multimodal prehabilitation is valuable for optimizing patients' tolerance of oncological treatment, there is a scarcity of studies incorporating multimodal interventions, likely due to the absence of clear guidelines for lung cancer patients. This systematic review aimed to assess the comprehensiveness and effectiveness of prehabilitation activities for lung cancer patients undergoing thoracic surgery. EVIDENCE ACQUISITION: A systematic literature search was conducted according to PRISMA guidelines. The search was performed in PubMed, Google Scholar, PEDro, and Cochrane Library, with additional publications identified from reference lists. The search was completed on February 27, 2024. Studies published between 2019 and 2024 were included to capture the most recent evidence. The study was registered in PROSPERO (registration number CRD42024499622). EVIDENCE SYNTHESIS: Out of 1233 identified studies, 10 randomized controlled trials were included. Prehabilitation programs varied in duration and setting. Only three studies (Liu et al, 2020; Yao et al, 2022; Ferreira et al, 2021) employed a comprehensive multimodal approach integrating physical exercise, psychological care, and nutrition interventions. Prehabilitation was associated with improved exercise capacity (eg, increased 6MWT distance), reduced postoperative complications, and potential benefits for quality of life and psychological well-being. However, the impact on length of stay and cognitive function remains unclear. CONCLUSION: This review highlights a significant gap in the implementation of comprehensive multimodal prehabilitation for lung cancer patients. While physical exercise is widely adopted, psychological and nutritional components are often overlooked. Further research is needed to establish clear guidelines and elucidate the full benefits of a comprehensive multimodal prehabilitation approach, particularly regarding its impact on mental health, quality of life, and long-term outcomes in lung cancer patients.
Incidence of and Risk Factors for Laryngopharyngeal Reflux in Patients Undergoing Modified Electroconvulsive Therapy: A Prospective Observational Study.
Mo X, Li X, Zheng T … +3 more , Hu J, Chen C, Zhou S
Ther Clin Risk Manag · 2025 · PMID 41409686 · Full text
BACKGROUND: Laryngopharyngeal reflux (LPR) is among the most common complications associated with modified electroconvulsive therapy (MECT). The purpose of this study was to assess the prevalence of LPR among patients un...
BACKGROUND: Laryngopharyngeal reflux (LPR) is among the most common complications associated with modified electroconvulsive therapy (MECT). The purpose of this study was to assess the prevalence of LPR among patients undergoing MECT and to identify risk factors for LPR within this population. METHODS: This observational prospective study enrolled 107 consecutive patients who underwent MECT at the Third Affiliated Hospital of Sun Yat-sen University. Data regarding potential risk factors for LPR in patients undergoing MECT were collected. The salivary pepsin test was used to diagnose LPR. RESULTS: The incidence of LPR was 39.3% in this study. On univariate analysis, height ( = 0.040), history of acid regurgitation ( = 0.19), number of MECT session number ( = 0.014), succinylcholine dose ( = 0.032), and oral secretion volume ( = 0.01) were significantly associated with LPR. Outcomes from the multivariate analysis are shown as odds ratio (OR [95% confidence interval (CI)]), >3 MECT sessions (3.02 [1.20-7.58]), history of acid regurgitation (3.90 [1.20-12.70]), succinylcholine dose > 50 mg (2.54 [1.04-6.22]), oral secretion volume > 3 mL (3.66 [1.50-8.97]) were significantly and independently associated with the development of LPR. CONCLUSION: A history of acid regurgitation, >3 MECT sessions, succinylcholine dose > 50 mg, oral secretion volume > 3 mL was significantly associated with an increased risk of LPR in patients undergoing MECT.
NLR and PLR as Adjunctive Markers of MRI-Derived Vertebral Bone Quality in a Preoperative Lumbar Cohort.
Ma L, Liu Y, Qin Y … +4 more , Liu Y, Yu H, Ma Z, Nan C
Ther Clin Risk Manag · 2025 · PMID 41404173 · Full text
BACKGROUND: MRI-derived vertebral bone quality (VBQ) rises with marrow fat and denotes poorer bone integrity. We examined whether simple inflammatory ratios-neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR)...
BACKGROUND: MRI-derived vertebral bone quality (VBQ) rises with marrow fat and denotes poorer bone integrity. We examined whether simple inflammatory ratios-neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR)-relate to VBQ in degenerative lumbar disease. METHODS: We retrospectively studied 200 patients aged ≥50 years who underwent surgery between January 2022 and January 2024. VBQ was calculated on mid-sagittal T1-weighted MRI using vertebral and cerebrospinal-fluid regions of interest. Associations were tested with Spearman correlations and multivariable linear regression adjusting for age, sex, smoking, diabetes, and body mass index (BMI). RESULTS: Among 200 patients (mean age = 64.8 ± 8.7 years), those with higher VBQ values (indicating poorer bone quality) were older and had higher NLR and PLR (all p<0.001). VBQ showed significant positive correlations with age ( = 0.650), NLR ( = 0.534), and PLR ( = 0.452) (all p<0.001). In multivariable regression, age, NLR, and PLR remained independently associated with higher VBQ, whereas BMI, sex, smoking, and diabetes were not significant (adjusted R=0.520; all VIF≤2.26). Standardized effect sizes indicated moderate independent contributions (β_std = 0.151 for NLR; β_std = 0.303 for PLR), corresponding to roughly 0.020-unit and 0.075-unit increases in VBQ per 1-unit NLR and 50-unit PLR increments, respectively. CONCLUSION: Preoperative NLR and PLR were independently associated with higher MRI-derived VBQ and may aid imaging-based risk stratification; prospective validation with calibrated thresholds is needed.
Perioperative Blood Pressure Optimization to Improve Outcomes in Orthopedic Patients: A Clinical Review.
Yang YF, Ma X, Ahmad MA … +5 more , Lee P, Qin Y, Ji FH, Sudhan N, Peng K
Ther Clin Risk Manag · 2025 · PMID 41395206 · Full text
Perioperative blood pressure fluctuations significantly contribute to postoperative complications in orthopedic surgery, particularly among high-risk patients. This clinical review synthesizes current evidence on individ...
Perioperative blood pressure fluctuations significantly contribute to postoperative complications in orthopedic surgery, particularly among high-risk patients. This clinical review synthesizes current evidence on individualized blood pressure management across the perioperative continuum, highlighting procedure-specific risks such as bone cement implantation syndrome, tourniquet-induced hemodynamic changes, and cerebral hypoperfusion in the beach-chair position. Special considerations for vulnerable populations, including frail elderly and anticoagulated patients, are discussed to balance bleeding and thrombotic risks. Maintaining mean arterial pressure within 10-20% of baseline through tailored anesthesia, goal-directed fluid therapy, and continuous monitoring is associated with improved outcomes. A multidisciplinary, risk-stratified approach is recommended to reduce perioperative morbidity and improve postoperative outcomes. Future research should validate personalized blood pressure targets and explore the role of advanced hemodynamic monitoring in enhancing patient safety.
Anatomical Foundations and Clinical Utility of Personalized Free Ilioinguinal Zone Flap for Hand Skin and Soft Tissue Defect Reconstruction.
Zhang H, Luo QJ, Ding MC … +1 more , Qi JW
Ther Clin Risk Manag · 2025 · PMID 41367890 · Full text
OBJECTIVE: This study aims to explore the anatomical foundations and clinical utility of personalized free ilioinguinal zone flaps for reconstructing skin and soft tissue defects in the hand. METHODS: Anatomical evaluati...
OBJECTIVE: This study aims to explore the anatomical foundations and clinical utility of personalized free ilioinguinal zone flaps for reconstructing skin and soft tissue defects in the hand. METHODS: Anatomical evaluations of the superficial circumflex iliac and the superficial epigastric arteries and veins were performed on 10 cadavers within the inguinal region. Forty-two patients received flap transplants from January 2017 to December 2022 to repair hand tissue defects. Flap areas ranged from 4.0 cm × 6.0 cm to 11.0 cm × 23.0 cm, with arterial anastomosis ensuring vascular connection to recipient sites. Donor sites were directly sutured for closure and healing. RESULTS: The arteries, sourced from the femoral artery, were consistently identified in all cadavers, with a common trunk found in 70% of cases. Of the 42 transplants, 40 successfully survived, showing a high efficacy rate. Complications included two vascular crises; one was successfully managed, and one led to necrosis. Post-operative observations included soft flap texture, mild bloating, sensory recovery from S2 to S3, and minimal scarring at the donor site. CONCLUSION: The personalized free ilioinguinal zone flap is highly effective for repairing hand skin and soft tissue defects, offering advantages like direct donor site closure and reliable vascularity. This method shows great promise in enhancing outcomes in reconstructive hand surgery.
Lung Cancer Diagnosis and Prognostic Monitoring Through Cell-Free RNA via Liquid Biopsy.
Pan Y, Jiang C, Ye M … +2 more , Li D, Wang J
Ther Clin Risk Manag · 2025 · PMID 41367889 · Full text
Lung cancer remains a leading cause of cancer-related mortality worldwide, largely due to challenges in its early detection and effective management. Despite advances in treatment modalities, the complex nature of lung c...
Lung cancer remains a leading cause of cancer-related mortality worldwide, largely due to challenges in its early detection and effective management. Despite advances in treatment modalities, the complex nature of lung cancer, characterized by its molecular heterogeneity and resistance mechanisms, underscores the need for innovative approaches. Cell-free RNA (cfRNA) has emerged as a promising biomarker with significant clinical applications in lung cancer diagnosis, monitoring, and precision medicine. We explore key themes including the utility of cfRNA in early detection, differentiation between benign and malignant lung nodules, molecular subtyping, and real-time therapeutic monitoring. Advances in liquid biopsy technologies, particularly non-invasive cfRNA analysis, provide dynamic means of tracking tumor evolution. cfRNA biomarkers such as miRNA, long non-coding RNAs, and circular RNAs offer unique insights into tumor biology, paving the way for personalized treatment strategies. Further, we discuss the application of cutting-edge technologies such as AI-driven analytics, next-generation sequencing, and multi-omics integration, which are enhancing the clinical utility of cfRNA in identifying treatment resistance and improving outcomes in immunotherapy, targeted therapy, and chemotherapy. The review addresses significant challenges facing cfRNA applications, including pre-analytical variability, technical limitations in detection methods, economic constraints, and the lack of standardization in clinical protocols. Through multidisciplinary collaborations and standardized methodologies, significant progress can be made toward integrating cfRNA into routine clinical practice. Emphasis is placed on future research directions, which include validating cfRNA biomarkers across diverse populations, streamlining workflows, and addressing scalability issues for real-world applications. This comprehensive exploration positions cfRNA at the forefront of innovations in lung cancer management, offering a pathway for improved diagnostic accuracy and individualized care.
Application of a Personalized Nursing Pathway for Infection Prevention in Hospitalized Leukemia Patients: A Single-Center Retrospective Cohort Study.
Lin J, Guo Q, Zhuang P … +3 more , Xie X, Zheng R, Chen X
Ther Clin Risk Manag · 2025 · PMID 41367888 · Full text
OBJECTIVE: To evaluate the effectiveness of a personalized nursing pathway in reducing hospital-acquired infections among leukemia patients during hospitalization through a single-center retrospective analysis. METHODS:...
OBJECTIVE: To evaluate the effectiveness of a personalized nursing pathway in reducing hospital-acquired infections among leukemia patients during hospitalization through a single-center retrospective analysis. METHODS: This study retrospectively reviewed the clinical records of 291 adult leukemia patients admitted to the Hematology Department of The First Hospital of Putian between January 2018 and December 2022. Patients were divided into two groups based on nursing intervention models: the control group (n = 138) received standard nursing care, while the intervention group (n = 153) was managed using a personalized nursing pathway, which included individualized infection risk assessment, dynamic nursing goals, targeted hygiene protocols, and real-time multidisciplinary coordination. Primary outcomes included infection incidence, infection-related readmission, antibiotic use duration, and length of hospital stay. Secondary outcomes included patient satisfaction and nursing compliance rates. RESULTS: The incidence of hospital-acquired infections was significantly lower in the intervention group compared to the control group (12.4% vs 24.6%, p < 0.01). The average duration of antibiotic therapy was reduced by 2.6 days (p = 0.015), and hospital stay was shortened by 3.2 days on average (p = 0.022). Patient satisfaction with nursing care improved notably (92.8% vs 78.3%, p < 0.01), and nursing compliance to infection control protocols increased to 95.6% in the intervention group. CONCLUSION: A personalized nursing pathway significantly reduces the risk of infection among hospitalized leukemia patients and enhances the efficiency and quality of nursing care. This model offers a feasible, effective approach for infection prevention in high-risk hematology wards and warrants further prospective validation.
Early Phase Thrombolysis and Functional Outcome for Acute Ischemic Stroke Treated with Endovascular Thrombectomy After Intravenous Thrombolysis.
Sun S, Yuan K, Huang H … +5 more , Xie M, Huo S, Deng K, Liu R, Liu X
Ther Clin Risk Manag · 2025 · PMID 41355977 · Full text
BACKGROUND: The efficacy of intravenous thrombolysis (IVT) in treating acute ischemic stroke (AIS) has shown a rapid decline with time; however, the impact of this trend on IVT prior to endovascular thrombectomy (EVT) re...
BACKGROUND: The efficacy of intravenous thrombolysis (IVT) in treating acute ischemic stroke (AIS) has shown a rapid decline with time; however, the impact of this trend on IVT prior to endovascular thrombectomy (EVT) remains uncertain. METHODS: This study retrospectively analyzed patients from multicenter trials who received EVT after IVT in the anterior circulation. The endpoints included unfavorable outcomes (defined as a 90-day modified Rankin Scale score of 3-6) and hemorrhagic complications. Patients were stratified into two groups based on onset-to-needle time (ONT), with a 2-hour threshold. ONT was defined as the interval from the first observed stroke symptoms (or the last known well state) to the initiation of IVT. Multivariate logistic regression and propensity score matching (PSM) were used to compare outcomes. RESULTS: Among the 176 patients following PSM (with a median age of 67.5 years and 60.8% being female), the median ONT was 120 minutes (85 minutes vs 176 minutes in early and late phase group), with 88 patients in each group. Multivariate analysis revealed that late phase IVT (ONT > 2 hours) was significantly associated with unfavorable outcomes (odds ratio [OR] = 2.213; 95% confidence interval [CI] = 1.078-4.646; = 0.032). No significant differences were observed in mortality and hemorrhagic complications between the groups. Subgroup analysis revealed no significant disparities among the predefined subgroups. CONCLUSION: Early phase IVT (ONT ≤ 2 hours) before EVT was linked to reduced unfavorable outcomes for AIS. No significant differences were observed among predefined subgroups.
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