Therapeutics And Clinical Risk Management[JOURNAL]
Sun
200 papers
Clinical Outcomes of Ilizarov Bone Transport for Distal Tibial Defects in Refractory Osteomyelitis: A Retrospective Study.
Alimujiang A, Jia Q, Guo J … +6 more , Zhang J, Wang X, Zhao M, Ouzhabayier M, Wang Y, Ma C
Ther Clin Risk Manag · 2025 · PMID 40984832 · Full text
BACKGROUND: Distal tibial defects following refractory osteomyelitis pose a significant orthopedic challenge, necessitating effective reconstruction. The Ilizarov bone transport technique is a potential treatment option,...
BACKGROUND: Distal tibial defects following refractory osteomyelitis pose a significant orthopedic challenge, necessitating effective reconstruction. The Ilizarov bone transport technique is a potential treatment option, but its clinical outcomes specifically for distal tibial infectious defects need further evaluation. METHODS: In this retrospective observational single-arm study, we analyzed the clinical data of 22 patients who had undergone multiple debridements for refractory distal tibial osteomyelitis (DTO) and had associated bone defects, and were subsequently treated with the Ilizarov bone transport technique. Following debridement surgery, bone transport treatment was administered. Regular X-ray examinations, rehabilitation guidance, and follow-up were conducted to assess infection control, bone healing, limb function recovery, and complications. Therapeutic effects were evaluated using the Association for the Study and Application of Methods of Ilizarov (ASAMI), Visual Analog Scale (VAS) score, Activities of Daily Living (ADL) score, and American Orthopaedic Foot & Ankle Society (AOFAS) score improvement. RESULTS: The mean follow-up was 29.32±20.92 months, with an average of 3.77±1.83 debridements. All bone defects healed, though 5 patients later required ankle arthrodesis. Complications included pin tract infection (n=10), axial deviation (n=3), ankle joint stiffness (n=2), non-union at the docking site (n=2), and delayed consolidation (n=2). At the last follow-up, ASAMI bone results: 15 excellent, 5 good, 2 poor (90.9% superiority rate). ASAMI functional results: 6 excellent, 14 good, 1 fair, 1 poor (90.9% superiority rate). VAS decreased from 4.86±0.83 to 0.5±0.66 (p<0.001). ADL improved from 80 (78.75-85) to 92.5 (90-95) (p<0.001). AOFAS score increased from 32 (25-38.25) to 82 (77-87.5) (p<0.001), with an 86.4% overall superiority rate. CONCLUSION: Bone transport post - debridement is a valuable salvage for reconstructing distal tibial defects post-refractory osteomyelitis, with high safety, healing rate, and good efficacy. However, further comparative studies are warranted to confirm its advantages over other treatments.
Combined Ruyi Zhenbao Pills-Baimai Ointment Therapy on Acute Ischemic Stroke: A Multi-Arm, Randomized, Double-Blind, Placebo Controlled Clinical Study.
Jiang Z, Qin X, Wu X … +8 more , Wang Z, Wang X, He L, Cuomu M, Mei Z, Hou H, Song H, Song J
Ther Clin Risk Manag · 2025 · PMID 40984831 · Full text
BACKGROUND: Ruyi Zhenbao Pills (RZPs) and Baimai Ointment (BMO), prescribed Tibetan formulations, have been confirmed as having a neuroprotective role in animal and cell models of stroke. However, the effects of RZPs and...
BACKGROUND: Ruyi Zhenbao Pills (RZPs) and Baimai Ointment (BMO), prescribed Tibetan formulations, have been confirmed as having a neuroprotective role in animal and cell models of stroke. However, the effects of RZPs and BMO in individuals with acute ischemic stroke (AIS) remain unclear. This is the first multicenter, large-sample, controlled trial to evaluate the therapeutic potential of traditional Tibetan medicine-specifically the RZP and BMO-in the treatment of AIS, thereby extending ethno-pharmacological evidence into modern stroke care. METHODS: A multi-arm, randomized, double-blind, placebo controlled clinical trial was conducted at 21 hospitals in China between December 2020 and September 2022. The inclusion criteria are as follows: individuals diagnosed as AIS, 18 to 75 years of age and within 14 days of AIS onset. Subjects were randomly assigned in a 1:1:1:1 ratio to RZPs+BMO, RZPs, BMO, or placebo. The primary outcome was change of Fugl-Meyer assessment (FMA) score from baseline to day 90. RESULTS: Four hundred and twenty-three participants were recruited and randomly allocated to the RZPs+BMO group (n=108), RZPs group (n=108), BMO group (n=99), or placebo group (n=108). The change from baseline to D90 in FMA score was 31.22 (SD 16.64) with RZPs+BMO, 29.25 (15.92) with RZPs, 29.88 (15.42) with BMO, and 19.20 (14.38) with placebo (RZPs+BMO group versus placebo group, < 0.001). CONCLUSION: Among Chinese patients suffering from AIS, combined RZPs and BMO therapy improved significantly the primary outcome of 90-day motor functions compared with placebo with acceptable safety, indicating that RZPs and BMO might be an effective therapeutic strategy in patients with AIS.
Left Bundle Branch Area Pacing Improves Left Atrial Outcomes in Pacemaker-Dependent Patients: A Prospective Cohort Study Using Speckle Tracking and Three-Dimensional Echocardiography.
Mei Y, Han R, Cheng L … +4 more , Wang Z, He Y, Liu W, Wu Y
Ther Clin Risk Manag · 2025 · PMID 40969185 · Full text
PURPOSE: Evidence that left bundle branch area pacing (LBBAP) is more effective than conventional right ventricular (RV) pacing in enhancing left atrial (LA) outcomes is lacking. The aim of this study was to investigate...
PURPOSE: Evidence that left bundle branch area pacing (LBBAP) is more effective than conventional right ventricular (RV) pacing in enhancing left atrial (LA) outcomes is lacking. The aim of this study was to investigate LA outcomes using 2-dimensional speckle tracking echocardiography (2D-STE) and real-time 3-dimensional echocardiography (RT-3DE) at 6-months of follow-up in patients that received LBBAP, RV septal pacing (RVSP), or RV apical pacing (RVAP). METHODS: A total of 90 patients with normal left ventricular ejection fraction (LVEF) underwent dual-chamber pacemaker implantation for bradycardia at Beijing Anzhen Hospital between January 2021 and July 2021. Patients were divided into three groups based on the pacing site: LBBAP, RVSP, or RVAP. RESULTS: There were no significant differences in baseline characteristics and echocardiographic findings among patients that received LBBAP, RVSP, or RVAP. At 6-months of follow-up, left atrial volume index (LAVI), LA reservoir strain (LASr), LA contractile strain (LASct), global longitudinal strain (GLS), global circumferential strain (GCS), and synchronization parameters (Tmsv-16SD, Tmsv-12SD, Tmsv-6SD, longitudinal Tε-dif, circumferential Tε-dif) were significantly improved in patients that received LBBAP, while they had significantly worsened with RVSP and RVAP. Compared to baseline, at 6-months of follow-up, patients that received LBBAP had significantly improved LASr (28.17±10.12% vs 35.4±17.17%, =0.024), LASct (-12.03±2.15% vs -17.53±7.37%, =0.045), E/e' ratio(12.61±3.8 vs 10.85±3.75,P=0.014) and LVEF (65.74±7.90% vs 68.81±5.92%, =0.023). The 6-minute walking distance significantly increased at 6-months of follow-up compared to baseline in all patients, but the increase was most prominent for LBBAP (403.00±98.46 m vs. 469.34±59.32m, =0.015). LBBAP was associated with a lower risk of new-onset atrial fibrillation. CONCLUSION: In pacemaker-dependent patients, LBBAP achieved better LA strain, LV strain, and LV synchronization than RVSP or RVAP at 6-months of follow-up.
Low-Dose Sulfamethoxazole-Trimethoprim Could Prevent Pneumonia in Kidney Transplant Recipients: A Retrospective, Observational Study.
Wang R, Wu X, Xie X … +3 more , Wei C, Wu J, Ma K
Ther Clin Risk Manag · 2025 · PMID 40937146 · Full text
OBJECTIVE: Emerging evidence suggests that low doses of sulfamethoxazole-trimethoprim (TMP-SMX) may offer protection against pneumonia (PJP) in kidney transplant recipients. However, cases of PJP following the withdrawa...
OBJECTIVE: Emerging evidence suggests that low doses of sulfamethoxazole-trimethoprim (TMP-SMX) may offer protection against pneumonia (PJP) in kidney transplant recipients. However, cases of PJP following the withdrawal of prophylaxis have been documented. This study aimed to investigate the relationship between the occurrence of PJP and different regimes of low-dose TMP-SMX prophylaxis. METHODS: This retrospective observational study was conducted in the First Affiliated Hospital of Zhejiang University in China. Recipients diagnosed with PJP were included, and four controls were matched for each case based on transplantation time, age, and sex. Multivariate conditional logistic regression was employed to compare the odds of PJP occurrence among different TMP-SMX regimens. RESULTS: From January 1, 2017, to December 31, 2020, 1763 patients underwent kidney transplantation at our center. Thirty-one patients developed PJP post-transplantation, and 124 patients without PJP were included as controls. One patient developed PJP during the prophylaxis period, and the others occurred after TMP-SMX discontinuation, resulting in a PJP incidence rate of 1.36% over the follow-up period. Compared to controls, the PJP group received a significantly lower cumulative TMP-SMX dose (median: 57 single-strength dose [SSD] tablets 100 tablets; ) and had a shorter prophylaxis duration (median: 6.00 months 10.00 months; ). They also exhibited higher CMV infection rates (29.0% vs 4.8%, < 0.001), elevated serum creatinine levels at discharge (174.80μmol/L vs 134.58 μmol/L, = 0.018), and reduced CD 4 cell counts (354.12/L vs 542.58/L, = 0.05). Multivariate analysis revealed that a higher cumulative TMP-SMX dose was significantly associated with a lower risk of PJP ( = 0.005). Subgroup analysis indicated that at least 6 months of TMP-SMX prophylaxis is necessary for PJP prevention in recipients on quarter-strength daily (SMX/TMP 100/20 mg, = 0.022) or half-single strength daily (SMX/TMP 200/40 to 400/80 mg, = 0.005) regimens. CONCLUSION: An adequate prophylactic duration of either quarter-strength daily TMP-SMX or half-single strength daily TMP-SMX may protect kidney transplant recipients from PJP.
Therapeutic Potential of Lumbrokinase in Acute Ischemic Stroke: A Meta-Analysis of Efficacy and Safety.
Wiyarta E, Hidayat R, Kurniawan M … +5 more , Saputro BIL, Maharani IL, Rampengan DDCH, Tanudharma LC, Tjandrawinata RR
Ther Clin Risk Manag · 2025 · PMID 40933244 · Full text
BACKGROUND: Acute ischemic stroke (AIS) requires rapid treatment. Although alteplase is a standard thrombolytic therapy, its limited availability in low-resource settings presents a challenge. Lumbrokinase, a fibrinolyti...
BACKGROUND: Acute ischemic stroke (AIS) requires rapid treatment. Although alteplase is a standard thrombolytic therapy, its limited availability in low-resource settings presents a challenge. Lumbrokinase, a fibrinolytic enzyme isolated from earthworms, has been proposed as an adjunct treatment option. This meta-analysis evaluated efficacy and safety in addition to supportive care. METHODS: A systematic review of randomized controlled trials (RCTs) was conducted using multiple databases through July 2024 following PRISMA guidelines. The risk of bias was assessed using RoB 2.0, and evidence quality was graded using GRADE. Publication bias was evaluated using funnel plots. Meta-analyses employed a random-effects model and reported odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals. Primary outcomes included the Barthel Index and NIHSS scores, and secondary outcomes included adverse events and laboratory results. RESULTS: A total of 35 RCTs published between 2010 and 2024 were included. Compared with supportive care alone, lumbrokinase adjunct therapy significantly improved Barthel Index scores (MD = 15.17; 95% CI: 14.60 to 15.74) and reduced NIHSS scores (MD = -2.01; 95% CI: -2.06 to -1.97). Safety analyses revealed no significant increase in adverse events including gastrointestinal discomfort (OR = 1.00; 95% CI: 0.32 to 3.16) and GI bleeding (OR = 1.42; 95% CI: 0.55 to 3.67). Laboratory assessments indicated improvements in aPTT (MD = 1.93; 95% CI: 1.58 to 2.28), platelet aggregation rate (MD = -205.86; 95% CI, -206.77 to -204.96), and D-dimer levels (MD = -0.04; 95% CI: -0.05 to -0.03). CONCLUSION: Lumbrokinase may safely improve stroke outcomes; however, limited evidence warrants cautious use and further high-quality trials.
Efficacy and Clinical Significance of Postoperative Transcutaneous Electrical Acupoint Stimulation [Response to Letter].
Zhou Z, Yang X, Shi M … +4 more , Huang L, Wu D, Yang H, Zhang X
Ther Clin Risk Manag · 2025 · PMID 40922978 · Full text
Abstract loading — click title to view on PubMed.
Evaluating the Efficacy of High-Intensity Focused Electromagnetic (HIFEM) Therapy for Postprostatectomy Incontinence in Men.
Tosun H, Akinsal EC, Bas U … +3 more , Sonmez G, Baydilli N, Demirci D
Ther Clin Risk Manag · 2025 · PMID 40909763 · Full text
PURPOSE: Urinary incontinence (UI) is a common complication after radical prostatectomy (RP), adversely affecting patients' quality of life. This study aimed to evaluate the efficacy and safety of high-intensity focused...
PURPOSE: Urinary incontinence (UI) is a common complication after radical prostatectomy (RP), adversely affecting patients' quality of life. This study aimed to evaluate the efficacy and safety of high-intensity focused electromagnetic (HIFEM) therapy as a non-invasive treatment for post-prostatectomy UI. PATIENTS AND METHODS: Twenty-seven men (mean age ± SD: 67.9 ± 3.4 years) with persistent UI after RP underwent six HIFEM sessions (28 min, twice weekly) using the BTL EMSELLA chair. Outcomes were assessed after the sixth session and at one-month follow-up. Primary endpoints were changes in International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scores and daily pad use. RESULTS: Baseline mean ICIQ-SF score was 10.58 ± 4.15. This decreased to 5.43 ± 3.85 after treatment and to 4.16 ± 3.97 at one month, representing improvements of 53.1% and 60.6%, respectively (both p < 0.005). Daily pad use declined from baseline to 1.45 ± 1.54 after treatment and 1.13 ± 1.81 at follow-up (both p < 0.001). No adverse events were reported. CONCLUSION: HIFEM therapy significantly improved UI severity and reduced pad dependence in men with post-prostatectomy incontinence, with effects sustained for at least one month and no observed side effects. These findings support HIFEM as a safe, non-invasive treatment option warranting further study in larger, long-term trials.
Determining Effect of Postoperative Transcutaneous Electrical Acupoint Stimulation on Recovery Quality After Gynecological Laparoscopic Surgery [Letter].
Huang ZB, Lin YB, Xue FS
Ther Clin Risk Manag · 2025 · PMID 40904942 · Full text
Abstract loading — click title to view on PubMed.
Knowledge, Attitude, and Practice of Nurses in Preventing Complications in Patients with Nephrotic Syndrome: A Cross-Sectional Study.
Wang N, Deng X, Zhang T … +2 more , Tao Y, Feng Q
Ther Clin Risk Manag · 2025 · PMID 40894522 · Full text
BACKGROUND AND AIM: Nephrotic syndrome (NS) is frequently accompanied by serious complications such as edema-related infections, thromboembolism, and acute kidney injury, which can significantly impact prognosis. Nurses...
BACKGROUND AND AIM: Nephrotic syndrome (NS) is frequently accompanied by serious complications such as edema-related infections, thromboembolism, and acute kidney injury, which can significantly impact prognosis. Nurses are essential in early identification, patient education, and implementation of preventive measures. This study explores the knowledge, attitude, and practice (KAP) levels of nurses concerning complication prevention in nephrotic syndrome and identifies relevant influencing factors. METHODS: A cross-sectional survey was conducted from January to December 2023 across Ruijin Hospital affiliated with Shanghai Jiao Tong University School of Medicine and Shanghai Baoshan Medical Emergency Center in China, targeting nurses working in nephrology-related units. A total of 246 valid responses were obtained using a structured and pre-validated KAP questionnaire. The instrument included domains assessing factual understanding, behavioral attitudes, and routine clinical practices. Data were analyzed using descriptive statistics, Pearson's correlation, and logistic regression to determine relationships between demographic variables and KAP outcomes. RESULTS: The mean knowledge score among respondents was 5.12±2.67, attitude score was 18.76±5.02, and practice score was 30.45±11.07. Correlational analysis revealed significant positive associations between knowledge and practice (r = 0.421, p < 0.001), and between attitude and practice (r = 0.336, p = 0.015). Regression analysis identified prior nephrology education, years of clinical experience, and academic qualifications as independent predictors of higher practice scores. CONCLUSION: While nurses generally hold positive attitudes towards complication prevention in nephrotic syndrome (NS), there are significant gaps in their knowledge and inconsistencies in the application of preventive practices. These findings emphasize the need for targeted training programs to enhance nurses' practical competencies in managing NS complications. By improving nurses' knowledge and clinical practices, especially in early detection and prevention, patient outcomes can be significantly improved, leading to more effective management of NS-related complications.
Erratum: Impact of Isotretinoin on Blood Lipids and Liver Enzymes: A Retrospective Cohort Study in Saudi Arabia [Corrigendum].
Ther Clin Risk Manag · 2025 · PMID 40861378 · Full text
[This corrects the article DOI: 10.2147/TCRM.S466113.].
[This corrects the article DOI: 10.2147/TCRM.S466113.].
Neoadjuvant Therapy for Organ Preservation in Locally Advanced Rectal Cancer: A Review.
Qiu L, Li J
Ther Clin Risk Manag · 2025 · PMID 40861377 · Full text
Preoperative chemoradiotherapy (CRT) and sphincter-preserving total mesorectal excision (TME) effectively control tumor growth in locally advanced rectal cancer (LARC). However, associated complications can impair the qu...
Preoperative chemoradiotherapy (CRT) and sphincter-preserving total mesorectal excision (TME) effectively control tumor growth in locally advanced rectal cancer (LARC). However, associated complications can impair the quality of life (QoL) of the patients. Neoadjuvant therapies, such as consolidation neoadjuvant therapy and total neoadjuvant therapy (TNT), can improve tumor regression, potentially achieving a complete response and allowing organ preservation. Emerging clinical data suggest that these approaches can promote long-term cancer control in patients with LARC.
The Predictive Value of the Combination of Serum RBP4, ALP, IL-1β for Postoperative Recurrence of Intrahepatic Bile Duct Stones.
Tang W, Kang X, Zhou C … +1 more , Chen C
Ther Clin Risk Manag · 2025 · PMID 40837286 · Full text
OBJECTIVE: To investigate the predictive value of serum retinol-binding protein (RBP4), alkaline phosphatase (ALP), and interleukin (IL)-1β for postoperative recurrence of intrahepatic bile duct stones (IBDS). METHODS: T...
OBJECTIVE: To investigate the predictive value of serum retinol-binding protein (RBP4), alkaline phosphatase (ALP), and interleukin (IL)-1β for postoperative recurrence of intrahepatic bile duct stones (IBDS). METHODS: This retrospective study included 320 patients with intrahepatic bile duct stones (IBDS) admitted to our hospital from May 2020 to May 2022, all of whom underwent laparoscopic choledocholithotomy combined with choledochoscopy. Patients were divided into a recurrence group and a non-recurrence group based on their postoperative status. Serum levels of RBP4 and IL-1β were measured by ELISA; liver function indicators including ALP were analyzed using a biochemical analyzer; levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were also detected by ELISA; toll-like receptor 4 (TLR4) and thyroid-stimulating hormone (TSH) were measured by radioimmunoassay.Pearson correlation analysis was performed to assess the relationships between serum RBP4, ALP, IL-1β and laboratory indicators. Multivariate logistic regression analysis was used to identify factors influencing postoperative recurrence of IBDS. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of serum RBP4, ALP, and IL-1β for IBDS recurrence after surgery. RESULTS: The levels of serum RBP4, ALP, IL-1β, TNF-α, TLR4, and TSH in the recurrence group were significantly higher than those in the non-recurrence group (P < 0.05). Pearson correlation analysis showed that serum RBP4, ALP, and IL-1β were all positively correlated with TNF-α, TLR4, and TSH (P < 0.05). Multivariate logistic regression analysis identified RBP4, ALP, IL-1β, TNF-α, TLR4, and TSH as independent risk factors for postoperative recurrence of IBDS (P < 0.05).According to ROC curve analysis showed that the area under the curve (AUC) for serum RBP4 in predicting postoperative recurrence of IBDS was 0.844, for serum ALP was 0.822, and for serum IL-1β was 0.732. The combined detection of RBP4, ALP, and IL-1β yielded an AUC of 0.892, which was superior to the predictive performance of each marker alone (Z = 2.654, Z = 2.668, Z = 2.650; all P < 0.05). CONCLUSION: Serum levels of RBP4, ALP, and IL-1β are significantly elevated in patients with IBDS, and their combined detection can enhance the predictive value for postoperative recurrence of IBDS.
Causal Associations of the Alterations in Peripheral Blood Immune Cell Characteristics on the Incidence of Osteoporosis: A Bidirectional Mendelian Randomization Study.
Yin Q, Li K, Chen R … +6 more , Li X, Lo WLA, Yu Q, Ding M, Zhang S, Wang C
Ther Clin Risk Manag · 2025 · PMID 40831655 · Full text
PURPOSE: Osteoporosis is closely related to specific immune cell, yet the causal mechanism has not been clarified. Previous studies mostly adopted traditional unidirectional Mendelian randomization (MR) for analysis, fai...
PURPOSE: Osteoporosis is closely related to specific immune cell, yet the causal mechanism has not been clarified. Previous studies mostly adopted traditional unidirectional Mendelian randomization (MR) for analysis, failing to fully clarify their relationship. This study is the first to analyze the bidirectional causal relationship between the characteristics of peripheral immune cells and the risk of osteoporosis. METHODS: A bilateral two-sample MR was performed, with immune cells serving as instrumental variables and the incidence of osteoporosis as the outcome. We used five algorithms to evaluate the causal relationship between immune cells and the incidence of osteoporosis (inverse-variance weighted [IVW], MR-Egger, simple mode, weight median, and weight mode). The Cochran Q and leave-one-out tests were used to evaluate heterogeneity and stability, and the MR-Egger intercept test was used to evaluate horizontal pleiotropy. RESULTS: The eosinophil percentage of granulocytes (odds ratio [OR] = 1.25, 95% confidence interval [CI] = 1.08-1.44, P = 0.002), eosinophil percentage of white cells (OR = 1.17, 95% CI = 1.02-1.35, P = 0.027), and sum eosinophil basophil counts (OR = 1.16, 95% CI = 1.02-1.32, P = 0.027) had positive causal associations with the incidence of osteoporosis. The lymphocyte counts (OR = 0.83, 95% CI = 0.71-0.97, P = 0.016), neutrophil percentage of granulocytes (OR = 0.78, 95% CI = 0.67-0.90, P < 0.001) played negative effect on osteoporosis. The reverse direction showed that osteoporosis had no causal effect on the characteristics of the immune cells. Non-significant heterogeneity and horizontal pleiotropy indicated the results were robust. CONCLUSION: This study identified a unidirectional causal link between five immune cell traits and osteoporosis, providing new insights into osteoporosis pathogenesis and potential targeted immunotherapy.
Factors Influencing Prolonged Hospital Stay in Surgically Treated Children and Adolescents with Left-to-Right Shunt Congenital Heart Disease: Evidence From a Hospital in Southern China.
Huang L, Zhang Y, Jiang S
Ther Clin Risk Manag · 2025 · PMID 40822700 · Full text
BACKGROUND: Congenital heart disease(CHD) is a congenital malformation caused by abnormal development of the heart and large blood vessels, and left-to-right shunt CHD is a relatively common type. Surgical treatment has...
BACKGROUND: Congenital heart disease(CHD) is a congenital malformation caused by abnormal development of the heart and large blood vessels, and left-to-right shunt CHD is a relatively common type. Surgical treatment has the problem of prolonged hospital stay in CHD patients. It is of great significance to explore the influencing factors of prolonged hospital stay after surgery therapy for children and adolescents with left-to-right shunt CHD. METHODS: A total of 463 children and adolescents with left-to-right shunt CHD who received surgery therapy were retrospectively analyzed. Medical records (gender, CHD types, echocardiography, invasive mechanical ventilation, blood transfusion, tracheal intubation, intraoperative blood loss, and length of hospital stay) were collected. The threshold for prolonged hospital stay was defined based on the third quartile (75th percentile) of length of hospital stay in all patients. The relationship between clinical features and prolonged hospital stay was analyzed. RESULTS: The mean length of hospital stay was 13.00 (7.00, 18.00) days, there were 330 (71.3%) patients with non-prolonged hospital stay (<18.0 days) and 133 (28.7%) with prolonged stay (≥18.0 days). There were statistically significant differences in the distributions of types of CHD (χ=67.959, <0.001), severity of mitral insufficiency (χ=14.171, =0.002) and pulmonary hypertension (χ=49.611, <0.001), and the proportion of treated with invasive mechanical ventilation (χ=104.657, <0.001), blood transfusion (χ=117.649, <0.001), and tracheal intubation (χ=67.752, <0.001) between CHD patients with prolonged and non-prolonged hospital stay. Multivariate logistic regression analysis showed that male (odds ratio(OR): 2.137, 95% confidence interval(CI): 1.278-3.574, =0.004), compound types CHD (OR: 2.021, 95% CI: 1.178-3.469, =0.011), pulmonary hypertension (OR: 3.179, 95% CI: 1.537-6.572, =0.002), invasive mechanical ventilation (OR: 4.069, 95% CI: 1.567-10.564, =0.004), and blood transfusion (OR: 5.128, 95% CI: 2.421-10.862, <0.001) were independently associated with prolonged hospital stay. CONCLUSION: Male, compound types CHD, pulmonary hypertension, invasive mechanical ventilation, and blood transfusion were independently associated with prolonged hospital stay in CHD patients. It provides valuable information to guide the hospitalization management of CHD.
The Relationship Between the Time Until Penile Fracture Repair and Post-Operative Erectile Dysfunction.
Bıçak Y, Dede O
Ther Clin Risk Manag · 2025 · PMID 40822699 · Full text
AIM: Although penile fracture is a rare condition, the damage it may cause afterwards is challenging for patients. We aimed to investigate the relationship between late presentation to the hospital and the frequency of e...
AIM: Although penile fracture is a rare condition, the damage it may cause afterwards is challenging for patients. We aimed to investigate the relationship between late presentation to the hospital and the frequency of erectile dysfunction (ED) in patients with penile fractures. METHODS: In our cross-sectional, retrospective study, the frequency and severity of ED were calculated according to the International Index of Erectile Function (IIEF) scoring in patients with penile fracture admitted to Dicle University Hospital in the inter-operative period between the event and the operation and the subsequent controls. The relationship between these two conditions was analysed. RESULTS: Forty-six patients who met the inclusion criteria were included in our study. The mean age was 37 (28-46) years. The mean preoperative IIEF was 25 (20-28), and the mean postoperative IIEF was 21.3 (15-27). The mean event-operation time was 9 (6-15) hours. The rate of sexual intercourse was 50%, trauma was 30%, development after masturbation was 11%, and other causes were 9%. CONCLUSION: Penile fracture is a real urological emergency, and as urologists, we need to intervene as early as possible in patients experiencing this condition. We found that patients who presented to the hospital more than 12.5 hours after penile fracture had a significantly higher risk of developing ED or worsening ED in the subsequent period.
The Impact of Continuous Cardiac Rehabilitation on the Psychological and Physiological Prognosis of Patients with Heart Failure-A Retrospective Study.
Yan LH, Ge Y, Wang F … +2 more , Zhu YL, Lu L
Ther Clin Risk Manag · 2025 · PMID 40801040 · Full text
OBJECTIVE: This study aimed to assess the impact of continued cardiac rehabilitation on cardiac function, psychological well-being, and prognostic outcomes in patients diagnosed with heart failure and improved ejection f...
OBJECTIVE: This study aimed to assess the impact of continued cardiac rehabilitation on cardiac function, psychological well-being, and prognostic outcomes in patients diagnosed with heart failure and improved ejection fraction (HFimpEF). METHODS: This study adopted a retrospective design, and a total of 150 patients with HFimpEF who experienced reduced ejection fraction after the first acute myocardial infarction were included. All patients underwent emergency percutaneous coronary intervention (PCI). Participants were categorized into a control group (n = 70) or an observation group (n = 80) based on their participation in ongoing cardiac rehabilitation. The follow-up period extended for one year. Comparative analyses were conducted to assess differences between the two groups in baseline characteristics, cardiac function, anxiety and depression scores, and the incidence of cardiovascular events. RESULTS: No statistically significant differences were observed between the groups in terms of sex, age, past medical history, blood lipid levels, blood glucose levels, or renal function. Similarly, pre-treatment assessments of cardiac function, six-minute walk test results, Self-Rating Anxiety Scale (SAS) scores, Self-Rating Depression Scale (SDS) scores, or the incidence of cardiovascular events showed no significant differences. Compared to the control group, the observation group demonstrated significantly better cardiac function and six-minute walk test performance, along with significantly lower SAS and SDS scores. Furthermore, the incidence of heart failure and rehospitalization was significantly lower in the observation group than in the control group. CONCLUSION: Sustained cardiac rehabilitation in patients with HFimpEF was associated with significant improvements in cardiac function, enhanced six-minute walk test performance, reduced anxiety and depression levels, and a lower incidence of heart failure and rehospitalization. These findings highlight the key role of sustained cardiac rehabilitation in improving clinical outcomes for patients with HFimpEF.
Risk Factors for Sigmoid Colonic Anastomosis: A Comparative and Cross-Sectional Analysis.
Talih T, Sonmez G, Sozuer EM … +7 more , Tombul ST, Kulturoglu MO, Islam DG, Akyıldız HY, Demirtas A, Karaagac M, Dal F
Ther Clin Risk Manag · 2025 · PMID 40786138 · Full text
OBJECTIVE: To evaluate the anastomotic leakage (AL) rates in cancerous and non-cancerous intestinal anastomoses and analyze the general risk factors for AL. METHODS: The primary endpoint of this study is to investigate w...
OBJECTIVE: To evaluate the anastomotic leakage (AL) rates in cancerous and non-cancerous intestinal anastomoses and analyze the general risk factors for AL. METHODS: The primary endpoint of this study is to investigate whether there is a difference in terms of AL between patients who underwent sigmoid colon resection + colorectal anastomosis due to primary colon cancer (Group 1) and patients with a completely healthy colorectal region who underwent sigmoid colon resection + colorectal anastomosis for use in the orthotopic bladder during radical cystoprostatectomy (Group 2). The secondary endpoint, considering all the patients, is to evaluate and investigate the risk factors affecting the AL rates. RESULTS: A total of 178 patients, including 63 (35.4%) patients in Group 1 and 115 (64.6%) patients in Group 2, were included in the study. The mean age of all patients was 61.7 ± 9.9 years, and there was no statistical difference between the mean ages of the groups (62.8 ± 11.3 vs 60.7 ± 6.1, p = 0.106, respectively). Thirty-six (20.2%) of the patients were female, and 142 (79.8%) were male. There was no significant difference between the groups in terms of AL in the postoperative period. Postoperative AL was seen in three patients (4.8%) and six patients (5.2%) in Group 1 and Group 2, respectively (p = 0.642). According to univariate and multiple logistic regression analysis, the risk of AL increased in patients with comorbidities, in the presence of previous abdominal surgery, in patients with high neutrophil-to-lymphocyte ratio, and patients with postoperative ileus (p values are 0.042, 0.010, 0.029 and 0.048, respectively). CONCLUSION: Our data suggest that anastomosis due to colon cancer resection does not increase the risk of AL compared with healthy bowel anastomoses. In addition, some clinical factors have been found to compromise anastomotic safety and are risk factors for AL. In addition, some clinical factors have been found to endanger anastomotic safety and are risk factors for AL.
Medicinal Plants for Chemotherapy-Induced Nausea and Vomiting: A Systematic Review of Antiemetic, Chemosensitizing, and Immunomodulatory Mechanisms.
Sun X, Nie F, Sun J … +2 more , Zhang J, Wang Y
Ther Clin Risk Manag · 2025 · PMID 40771488 · Full text
BACKGROUND: Chemotherapy-induced nausea and vomiting (CINV) is a major burden for cancer patients, often poorly managed by conventional antiemetics, prompting exploration of medicinal plant therapies for better supportiv...
BACKGROUND: Chemotherapy-induced nausea and vomiting (CINV) is a major burden for cancer patients, often poorly managed by conventional antiemetics, prompting exploration of medicinal plant therapies for better supportive care. OBJECTIVE: This systematic review critically evaluates medicinal plants for CINV, detailing bioactive compounds, diverse antiemetic mechanisms, and promising chemosensitizing and immunomodulatory properties. METHODS: A comprehensive literature search and critical analysis of studies investigating medicinal plants for CINV were performed. KEY FINDINGS: This review synthesizes evidence for 22 botanicals. Ginger (gingerols, shogaols) acts via 5-hydroxytryptamine 3 (5-HT₃) receptor antagonism and substance P/neurokinin-1 (NK-1) inhibition, and offers chemosensitization by downregulating P-glycoprotein. Cannabis (THC, CBD) modulates the endocannabinoid system and 5-HT₃ receptors for CINV relief and may enhance chemotherapy sensitivity. Mint (menthol, menthone) relaxes gastrointestinal smooth muscle and offers anti-inflammatory benefits. Chamomile (apigenin) has antispasmodic/anxiolytic effects; its apigenin also sensitizes cancer cells to chemotherapy. Turmeric (curcumin) acts on neurotransmitter systems, offers potent anti-inflammatory/antioxidant effects, and boosts chemosensitivity via NF-κB/P-gp modulation. Plants like , lemon, fennel, and licorice show varied mechanisms (gastrointestinal regulation, anti-inflammatory, neurotransmitter modulation). Many botanicals show chemosensitizing (inhibiting efflux pumps, promoting apoptosis) and immunomodulatory (affecting cytokines, immune cells) properties. Synergistic plant combinations (eg, ginger with P. ternata or turmeric) are noted for enhanced efficacy and safety. CONCLUSION: Medicinal plants offer a compelling, multi-targeted approach for CINV management, with potential beyond symptomatic relief via their antiemetic, chemosensitizing, and immunomodulatory actions. Rigorous clinical trials are needed to integrate these botanicals into evidence-based supportive cancer care.
Risk Factors for Pleural Reaction in CT-Guided Percutaneous Lung Nodule Localization: A Single-Center Retrospective Study.
Zhou N, Feng N, Jiao Z … +3 more , Shi X, Wang T, Zhao G
Ther Clin Risk Manag · 2025 · PMID 40726730 · Full text
BACKGROUND: Pleural reaction (PR) frequently occurs during computed tomography (CT) -guided lung puncture procedures, and its development is influenced by various factors. This study aims to identify the risk factors ass...
BACKGROUND: Pleural reaction (PR) frequently occurs during computed tomography (CT) -guided lung puncture procedures, and its development is influenced by various factors. This study aims to identify the risk factors associated with PR in CT-guided percutaneous lung nodule localization (CT-PLNL) procedures. METHODS: This retrospective study included 467 patients who underwent video-assisted thoracic surgery (VATS) at Nanjing Drum Tower Hospital between January 2022 and December 2023, all of whom had received CT-PLNL. Clinical data, including medical records, imaging findings, and laboratory results, were collected. Univariate analysis and Least Absolute Shrinkage and Selection Operator (LASSO) regression identified independent risk factors for PR. Binary logistic regression was performed to further analyze these factors. Receiver Operating Characteristic (ROC) curves were plotted to assess model performance, and Bootstrap validation evaluated discriminative ability. Calibration curves and decision curve analysis (DCA) were conducted to compare predicted versus actual probabilities and assess clinical applicability. RESULTS: The incidence of PR was 5.35% (25/467). Significant variables from univariate analysis and LASSO regression were analyzed by logistic regression. Age, intrapulmonary needle path adjustment, inadequate anesthesia, and a history of diabetes were identified as independent risk factors for PR. ROC curves showed Area Under the Curve (AUC) values indicating excellent discriminative ability. Calibration curves showed appropriate fit, and DCA demonstrated high clinical applicability. CONCLUSION: Younger age groups, intraprocedural needle adjustments, inadequate anesthesia, and diabetes were independent risk factors for PR after CT-PLNL. Optimizing anesthesia, avoiding unnecessary needle manipulations, and perioperative glucose monitoring in diabetic patients may mitigate PR risks and enhance procedural safety.
Efficacy of Transcutaneous Electrical Acupoint Stimulation Applied During the Post-Anesthesia Recovery Period in Improving Postoperative Recovery Quality After Gynecological Laparoscopic Surgery: A Randomized Controlled Trial.
Zhou Z, Yang X, Shi M … +4 more , Huang L, Wu D, Yang H, Zhang X
Ther Clin Risk Manag · 2025 · PMID 40726729 · Full text
PURPOSE: Transcutaneous electrical acupoint stimulation (TEAS) has emerged as a promising non-pharmacological intervention to enhance postoperative recovery. However, its application during the post-anesthesia recovery p...
PURPOSE: Transcutaneous electrical acupoint stimulation (TEAS) has emerged as a promising non-pharmacological intervention to enhance postoperative recovery. However, its application during the post-anesthesia recovery period remains underexplored. This study investigated the impact of TEAS during the post-anesthesia recovery period on postoperative recovery quality in patients undergoing laparoscopic gynecological surgery. PATIENTS AND METHODS: In this single-center, randomized, double-blinded, sham-controlled trial, 100 patients undergoing elective gynecological laparoscopic surgery were randomly allocated to receive either TEAS or sham stimulation at bilateral Hegu (LI4), Neiguan (PC6), Zusanli (ST36), and Sanyinjiao (SP6) acupoints for 30 minutes during the post-anesthesia recovery period in the post-anesthesia care unit (PACU). The primary outcome was the Quality of Recovery-15 (QoR-15) score assessed on postoperative days (POD) 1, 2, and 3. Secondary outcomes included pain, postoperative nausea and vomiting (PONV), recovery times, and adverse events. RESULTS: Ninety-seven patients completed the study, with 48 in the TEAS group and 49 in the Sham group. The TEAS group exhibited significantly higher QoR-15 scores on POD 1 compared to the Sham group, with improvements in emotional state, physical comfort, and pain dimensions. On POD 2, the TEAS group had significantly higher pain dimension scores. The TEAS group also reported lower resting VAS scores on POD 1 and lower exercise VAS scores on POD 1 and 2. The incidence of PONV was lower on POD 1, with fewer patients requiring rescue antiemetics. Additionally, the TEAS group experienced shorter times to first flatus and ambulation. Adverse events were comparable between the groups, with no local skin irritation noted in the TEAS group. CONCLUSION: TEAS applied during the post-anesthesia recovery period significantly improves early postoperative recovery quality, reduces pain and PONV, and accelerates functional recovery in patients undergoing gynecological laparoscopic surgery.
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