Therapeutics And Clinical Risk Management[JOURNAL]
Sun
200 papers
Impact of Onset-to-Needle Time on the Risk of Early Neurological Deterioration in Patients with Acute Ischemic Stroke Receiving Intravenous Thrombolysis.
Hu B, Hua J
Ther Clin Risk Manag · 2025 · PMID 40552125 · Full text
OBJECTIVE: This study aimed to investigate the influence of onset-to-needle time (ONT) on early neurological deterioration (END) in patients with acute ischemic stroke (AIS) undergoing intravenous thrombolysis. METHODS:...
OBJECTIVE: This study aimed to investigate the influence of onset-to-needle time (ONT) on early neurological deterioration (END) in patients with acute ischemic stroke (AIS) undergoing intravenous thrombolysis. METHODS: Patients with AIS receiving intravenous thrombolysis at The Fifth Hospital of Wuhan between March 2021 and December 2023 were enrolled. Patients were divided into an END group (n=104) and a non-END group (n=317) based on a National Institutes of Health Stroke Scale (NIHSS) score increase of ≥4 points within 24 hours. Baseline and clinical data were analyzed using univariate, multivariable logistic regression, and subgroup analyses. A logistic regression model was developed to predict END, and its performance was assessed using receiver operating characteristic (ROC) curves. RESULTS: Univariate analysis revealed significant differences between groups in age, total cholesterol, low-density lipoprotein cholesterol (LDL-C), lipoprotein-associated phospholipase A2 (Lp-PLA2), white blood cell count, activated partial thromboplastin time (APTT), pre-admission NIHSS score, and ONT (all P<0.05). Heart disease history, infarct location, and Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification also differed significantly (all P<0.05). Multivariable analysis identified age (Odds Ratio [OR]=1.098, 95% Confidence Interval [CI]: 1.031-1.169, P=0.003), LDL-C (OR=2.785, 95% CI: 1.360-5.710, P=0.005), Lp-PLA2 (OR=1.008, 95% CI: 1.001-1.015, P=0.045), complete anterior circulation infarction (vs lacunar; OR=8.050, 95% CI: 5.180-12.510, P=0.023), cardioembolic stroke (vs small vessel occlusion; OR=12.810, 95% CI: 8.420-19.530, P=0.002), and ONT (OR=1.015, 95% CI: 1.002-1.028, P=0.028) as independent risk factors for END. Subgroup analysis by admission NIHSS score showed that for moderate and severe strokes, each minute increase in ONT raised END risk by 1.5% (95% CI: 1.002-1.028, P=0.031) and 3.0% (95% CI: 1.009-1.052, P=0.005), respectively. CONCLUSION: Prolonged ONT is an independent risk factor for END in AIS patients, particularly those with moderate to severe strokes. Prompt thrombolysis is crucial for mitigating neurological decline.
AI-Assisted 3D Planning of CT Parameters for Personalized Femoral Prosthesis Selection in Total Hip Arthroplasty.
Yang TJ, Qian W
Ther Clin Risk Manag · 2025 · PMID 40547822 · Full text
OBJECTIVE: To investigate the efficacy of CT measurement parameters combined with AI-assisted 3D planning for personalized femoral prosthesis selection in total hip arthroplasty (THA). METHODS: A retrospective analysis w...
OBJECTIVE: To investigate the efficacy of CT measurement parameters combined with AI-assisted 3D planning for personalized femoral prosthesis selection in total hip arthroplasty (THA). METHODS: A retrospective analysis was conducted on clinical data from 247 patients with unilateral hip or knee joint disorders treated at Renmin Hospital of Hubei University of Medicine between April 2021 and February 2024. All patients underwent preoperative full-pelvis and bilateral full-length femoral CT scans. The raw CT data were imported into Mimics 19.0 software to reconstruct a three-dimensional (3D) model of the healthy femur. Using 3-matic Research 11.0 software, the femoral head rotation center was located, and parameters including femoral head diameter (FHD), femoral neck length (FNL), femoral neck-shaft angle (FNSA), femoral offset (FO), femoral neck anteversion angle (FNAA), tip-apex distance (TAD), and tip-apex angle (TAA) were measured. AI-assisted THA 3D planning system AIJOINT V1.0.0.0 software was used for preoperative planning and design, enabling personalized selection of femoral prostheses with varying neck-shaft angles and surgical simulation. Groups were compared by gender, age, and parameters. ROC curves evaluated prediction efficacy. RESULTS: Females exhibited smaller FHD, FNL, FO, TAD, TAA but larger FNSA/FNAA vs males (P<0.05). Patients >65 years had higher FO, TAD, TAA (P<0.05). TAD-TAA correlation was strong (r=0.954), while FNSA negatively correlated with TAD/TAA (r=-0.773/-0.701). ROC analysis demonstrated high predictive accuracy: TAD (AUC=0.891, sensitivity=91.7%, specificity=87.6%) and TAA (AUC=0.882, sensitivity=100%, specificity=88.8%). CONCLUSION: CT parameters (TAA, TAD, FNSA, FO) are interrelated and effective predictors for femoral prosthesis selection. Integration with AI-assisted planning optimizes personalized THA, reducing biomechanical mismatch risks.
The Application of Opacification-Development Ratio Based on CT Scan for Diagnosing Pediatric Chronic Rhinosinusitis.
Zhang J, Yang A, Chen T … +8 more , Cao Y, Lv Q, Xu Y, Liao Z, Chen X, Ye Z, Lai R, Hong H
Ther Clin Risk Manag · 2025 · PMID 40535561 · Full text
PURPOSE: To investigate the diagnostic potency of the opacification-development ratio (ODR) for pediatric chronic rhinosinusitis based on CT scanning. PATIENTS AND METHODS: Children aged 0-15 years who underwent nasal CT...
PURPOSE: To investigate the diagnostic potency of the opacification-development ratio (ODR) for pediatric chronic rhinosinusitis based on CT scanning. PATIENTS AND METHODS: Children aged 0-15 years who underwent nasal CT scanning from August 2011 through July 2021 were included in the research. The area under receiver operating characteristic curve (AUC) and predictive value were used to assess the diagnostic accuracy of the ODR and Lund-Mackay score based on CT scanning. RESULTS: A total of 1820 patients (217 in the positive symptom group and 1603 in the negative symptom group) who underwent CT scanning were included in the study. A significant positive correlation was observed between the ODR and the Lund-Mackay score in all age groups. In children aged 0-15 years, the AUC of the ODR and the Lund-Mackay score were 0.7970 and 0.7719, respectively (p > 0.05). The optimal cut-off value for the ODR was 25.83, with a sensitivity of 57.14% and a specificity of 94.2%. In contrast, the optimal cut-off value for the Lund-Mackay score was 6.5, with a sensitivity of 6.5% and a specificity of 85.84%. Notably, the ODR score demonstrated significantly superior performance compared to the Lund-Mackay score in children aged 0-4 years (p < 0.001). CONCLUSION: In diagnosing pediatric chronic rhinosinusitis, the use of CT scans is associated with a higher rate of false positives when compared to clinical symptoms. The ODR score based on CT scanning is a valuable diagnostic tool for chronic rhinosinusitis in children aged 0-11, particularly those aged 0-4.
Construction and Validation of Risk Scoring Model for Inadequate Bowel Preparation in Elderly Patients Undergoing Colonoscopy.
Xu Y, Ou S, Yuan X … +2 more , Yao J, Yang T
Ther Clin Risk Manag · 2025 · PMID 40525121 · Full text
OBJECTIVE: To establish a prediction model for the risk of inadequate bowel preparation for colonoscopy in the elderly, and to validate the model to test its prediction effect. METHODS: A total 927 patients who underwent...
OBJECTIVE: To establish a prediction model for the risk of inadequate bowel preparation for colonoscopy in the elderly, and to validate the model to test its prediction effect. METHODS: A total 927 patients who underwent colonoscopy in the First Affiliated Hospital to Chongqing Medical and Pharmaceutical College from January to December 2023 were selected as the modeling group, and were divided into the success group (839 patients) and failure group (88 patients) according to whether or not inadequate bowel preparation occurred, and then a logistic regression prediction model was established and transformed into a risk scoring system. The area under the ROC curve and the Hosmer-Lemeshow test were used for model differentiation and calibration, respectively, and the 10-fold cross-validation method was used for internal validation of the model. A total of 548 patients who underwent colonoscopy in our hospital from January to June 2024 were selected for external validation of the model. RESULTS: Logistic regression analysis showed that age ≥65 years, diabetes mellitus, exercise habits, Bristol stool characterization scale, frailty, and ambulatory functional status were independent factors influencing the inadequate bowel preparation for colonoscopy in the elderly. The area under the ROC curve for the modeling group was 0.806, and the Hosmer-Lemeshow test showed p=0.870. The area under the ROC curve of the validation group was (0.785±0.090). The area under the ROC curve of the validation group was 0.824, and the Hosmer-Lemeshow test showed =0.907, with a sensitivity of 73.13%, a specificity of 80.70%, and a Jordon's index of 0.538. CONCLUSION: The predictive model of the risk of inadequate bowel preparation for colonoscopy in elderly people can predict the risk of inadequate bowel preparation in elderly people, and can be used as a tool for clinical caregivers to screen the high-risk group of inadequate bowel preparation in the elderly.
Impact of Antiviral Treatment on Survival in HBV-Related Intrahepatic Cholangiocarcinoma Patients After Hepatectomy: A 14-Year Retrospective Follow-Up Study Based on the Propensity Score Matching Method.
Chen Z, Zhang H, Zhang L … +6 more , Han G, Zhang Y, Wu J, Li X, Mu X, Wang X
Ther Clin Risk Manag · 2025 · PMID 40525120 · Full text
PURPOSE: Hepatitis B virus infection is one of the most common risk factors leading to the development of intrahepatic cholangiocarcinoma (ICC). This study aims to determine the impact of antiviral treatment (AVT) on the...
PURPOSE: Hepatitis B virus infection is one of the most common risk factors leading to the development of intrahepatic cholangiocarcinoma (ICC). This study aims to determine the impact of antiviral treatment (AVT) on the survival outcomes of ICC patients with hepatitis B virus infection. PATIENTS AND METHODS: This retrospective study included ICC patients who had HBV infection and underwent hepatectomy from May 2009 to June 2023 at a single medical center. Patients' baseline characteristics were analyzed, and the 14-year follow-up data were investigated using Kaplan-Meier curves and multivariable Cox proportional hazards regression models. The propensity score matching method was performed to balance the baseline differences between the AVT group and the non-AVT group. RESULTS: A total of 229 patients were finally enrolled in the analysis. In the total cohort, 81 patients were classified into the AVT group and 148 patients into the non-AVT group. Kaplan-Meier curves showed that the AVT group exhibited prolonged overall survival and recurrence-free survival compared to the non-AVT group. Cox proportional hazards regression models revealed that AVT was an independent prognostic factor for both overall survival (HR 0.453, 95% CI: 0.280-0.732) and recurrence-free survival (HR 0.659, 95% CI: 0.436-0.997). A 1:1 nearest-neighbor matching algorithm was adopted, and 64 pairs of AVT and non-AVT patients were included in the propensity score matching cohort. Multivariable survival analyses confirmed AVT as a significant predictor for a favorable overall survival (HR 0.277, 95% CI: 0.147-0.519), but no statistical significance for recurrence-free survival was observed between the AVT group and the non-AVT group after propensity score matching. CONCLUSION: We analyzed the long-term follow-up data for ICC patients with hepatitis B virus infection who underwent hepatectomy. Notably, AVT exhibited a beneficial impact on overall survival for these postoperative ICC patients. However, our findings indicated no statistically significant effect of AVT on recurrence-free survival.
Muscular and Renal Safety of Ticagrelor with High-Intensity Statins: Retrospective Cohort Findings.
Alshammari AS, Shalwala AA, Alnuhait MA … +10 more , Alhazmi AY, Fagieha RE, Hallabi NB, Alandijani EA, Aloufi MA, Alharbi MS, Alzahrani RS, Elkholy EM, Elrggal ME, Alotaibi AS
Ther Clin Risk Manag · 2025 · PMID 40510620 · Full text
INTRODUCTION: Ticagrelor is a widely used antiplatelet agent approved in over 70 countries, including the European Union and the United States, for reducing thrombotic events in patients with acute coronary syndromes (AC...
INTRODUCTION: Ticagrelor is a widely used antiplatelet agent approved in over 70 countries, including the European Union and the United States, for reducing thrombotic events in patients with acute coronary syndromes (ACS). In clinical practice, combining ticagrelor with high-intensity statins is considered standard therapy for ACS. However, recent pharmacodynamic studies and case reports suggest potential drug-drug interactions that may increase the risk of adverse events, particularly muscular and renal complications. This study aimed to evaluate these risks in a real-world clinical setting in Saudi Arabia. METHODS: This retrospective observational cohort study was conducted at the Makkah Cardiology Center, Saudi Arabia. The study included adult patients (n = 577) who were prescribed high-intensity statins, with or without concurrent ticagrelor. The primary outcomes were the incidence of statin-associated muscular complications-defined as myalgia, myopathy, myositis, or rhabdomyolysis-and acute kidney injury (AKI). Clinical data were extracted from the hospital information system, and statistical comparisons were conducted between patients receiving statin monotherapy and those receiving combination therapy. RESULTS: The cohort consisted predominantly of male patients (74.5%). Muscle-related complications were significantly more common in the group receiving both ticagrelor and statins (20.2%) compared to the statin-only group (10.5%) (P = 0.001). Among comorbid conditions, hypertension was the only factor significantly associated with a higher incidence of muscle-related complications. Although a trend toward increased AKI incidence was observed in the combination therapy group, this difference did not reach statistical significance. CONCLUSION: This study highlights potential safety concerns related to the co-administration of ticagrelor and high-intensity statins, particularly the increased risk of muscle-related complications. While the findings on AKI were inconclusive, the results support the need for cautious use of this combination and call for larger prospective studies to further evaluate its safety profile and optimize treatment strategies.
Preoperative Prognostic Nutritional Index as a Useful Tool for Predicting Postoperative Delirium in Elderly Patients with Degenerative Lumbar Diseases.
Zhou J, Tang J, Xie S … +4 more , Shao H, Xia C, Huang Y, Zhao T
Ther Clin Risk Manag · 2025 · PMID 40503213 · Full text
PURPOSE: The high incidence of postoperative delirium (POD) among patients undergoing lumbar spine surgery presents a significant barrier to achieving enhanced postoperative recovery. Accordingly, a thorough understandin...
PURPOSE: The high incidence of postoperative delirium (POD) among patients undergoing lumbar spine surgery presents a significant barrier to achieving enhanced postoperative recovery. Accordingly, a thorough understanding and precise identification of common risk factors for POD in this surgical context are crucial to mitigating its occurrence and facilitating improved recovery outcomes. This study is the first to assess the predictive value of the Prognostic Nutritional Index (PNI) for POD in elderly patients undergoing transforaminal lumbar interbody fusion (TLIF) for degenerative lumbar spine disease. METHODS: We conducted a retrospective analysis of the outcomes of TLIF surgery in elderly patients with degenerative lumbar spine disease between 2020 and 2024. The diagnosis of POD was based on postoperative medical records during hospitalization, using the Confusion Assessment Method. The PNI was calculated based on preoperative serum albumin levels and total lymphocyte counts. Multivariate logistic regression analysis was performed to evaluate the relationship between preoperative PNI scores and the occurrence of POD. Finally, the optimal PNI cut-off point for predicting POD was determined using the receiver operating characteristic curve. RESULTS: POD was observed in 61 of 370 patients, with PNI being significantly lower in the delirium group. The mean PNI values were 43.02±3.44 in the non-delirium group and 48.53±3.72 in the delirium group. Multivariate logistic regression analysis revealed that low PNI (OR: 0.743; 95% CI: 0.597-0.924; p = 0.008), low serum albumin levels (OR: 0.759; 95% CI: 0.584-0.987; p = 0.040), and advanced age (OR: 1.096; 95% CI: 1.030-1.166; p = 0.004) were independent predictors of POD following TLIF. The area under the curve (AUC) for PNI on the receiver operating characteristic curve was 0.864±0.025. The cutoff value for PNI, determined using the Youden index, was 45.825, with a sensitivity of 82.0% and a specificity of 74.4%. CONCLUSION: The preoperative use of PNI holds promise as a valuable tool for assessing the risk of POD in elderly patients undergoing TLIF.
Enhanced Recovery After Surgery (ERAS) Rehabilitation Protocols Significantly Improve Postoperative Pain and Recovery in Ankle Fracture Surgery.
Yang Q, Yang H, Zhao J … +1 more , Ren L
Ther Clin Risk Manag · 2025 · PMID 40497243 · Full text
BACKGROUND: Enhanced Recovery After Surgery (ERAS) principles have gained widespread recognition for optimizing recovery across various surgical specialties. Effective management of postoperative pain plays a pivotal rol...
BACKGROUND: Enhanced Recovery After Surgery (ERAS) principles have gained widespread recognition for optimizing recovery across various surgical specialties. Effective management of postoperative pain plays a pivotal role in facilitating early rehabilitation and enhancing patient outcomes, particularly in ankle fracture surgery. This study investigated the effectiveness of rehabilitation therapies rooted in ERAS protocols in alleviating postoperative wound pain and improving recovery for patients undergoing ankle fracture surgery. METHODS: A total of 376 patients who underwent ankle fracture surgery between December 2022 and December 2023 were included in this retrospective analysis. Of these, 190 patients received ERAS-guided rehabilitation, while 186 underwent standard rehabilitation care. The ERAS program encompassed tailored interventions such as multimodal pain control, prompt mobilization, and personalized physical therapy regimens. Pain intensity was evaluated using the Visual Analog Scale (VAS) at 24 hours, 48 hours, and 7 days postoperatively. Additional metrics, including the duration of hospital stay, complication rates, and patient satisfaction, were also assessed. RESULTS: Patients in the ERAS group experienced significantly lower VAS scores than the standard care group at 24 hours (4.2 ± 1.1 vs 5.6 ± 1.4, P<0.001), 48 hours (3.1 ± 0.9 vs 4.4 ± 1.2, P<0.001), and 7 days post-surgery (2.0 ± 0.7 vs 3.1 ± 0.9, P<0.001). Furthermore, those receiving ERAS care had a shorter average hospital stay (5.1 ± 1.6 days vs 6.7 ± 2.1 days, P<0.001) and reported higher levels of satisfaction (92.1% vs 78.4%, P<0.001). However, there were no statistically significant differences in overall complication rates between the two groups (3.7% vs 4.3%, P=0.712). CONCLUSION: Rehabilitation therapies incorporating ERAS principles demonstrate substantial benefits in reducing postoperative wound pain and expediting recovery in ankle fracture surgery patients. These findings underscore the value of integrating ERAS-driven protocols into clinical practice to enhance patient experiences and postoperative outcomes.
Application of Perioperative Nursing Based on Enhanced Recovery After Surgery (ERAS) Principles in Patients Undergoing Total Knee Arthroplasty.
Huang J, Wu G, Li X
Ther Clin Risk Manag · 2025 · PMID 40469199 · Full text
BACKGROUND: Enhanced Recovery After Surgery (ERAS) principles have gained widespread adoption in perioperative care to optimize recovery and reduce complications. Total knee arthroplasty (TKA) patients benefit significan...
BACKGROUND: Enhanced Recovery After Surgery (ERAS) principles have gained widespread adoption in perioperative care to optimize recovery and reduce complications. Total knee arthroplasty (TKA) patients benefit significantly from ERAS-guided strategies, which minimize surgical stress and accelerate postoperative recovery. This study evaluates the application of perioperative nursing care based on ERAS principles and its impact on TKA patients. METHODS: A retrospective analysis was conducted on prospectively maintained data of 312 patients who underwent TKA between January 2023 and December 2023. Of these, 158 patients received perioperative nursing care based on ERAS principles, while 154 received standard nursing care. The ERAS-based perioperative nursing protocol included preoperative education, intraoperative fluid optimization, postoperative pain management, and early mobilization strategies. Clinical data, including postoperative complications, length of hospital stay, and patient satisfaction, were collected and compared between the two groups using statistical methods. RESULTS: Patients in the ERAS-based nursing group exhibited significantly better outcomes compared to the standard care group. Postoperative complications, such as deep vein thrombosis and infections, were reduced (4.4% vs 11.7%, P<0.05), and the average length of hospital stay was shorter (5.6 ± 1.8 days vs 8.3 ± 2.4 days, P<0.001). Patient satisfaction scores were notably higher in the ERAS group (94.3% vs 78.6%, P<0.001). Multivariate analysis identified perioperative nursing based on ERAS principles as an independent factor for improved recovery. CONCLUSION: Perioperative nursing care guided by ERAS principles significantly improves clinical outcomes in TKA patients, reducing complications and hospital stay while enhancing patient satisfaction. This study supports the broader implementation of ERAS protocols in perioperative nursing to optimize surgical care outcomes.
Effect of Low-Dose Esketamine Combined with Propofol on Postoperative Fatigue in Colonoscopy: A Randomized Clinical Trial.
Sun X, Du Q, Liang Y … +4 more , Tang L, Wei Q, Guo P, Liu X
Ther Clin Risk Manag · 2025 · PMID 40463767 · Full text
PURPOSE: Postoperative fatigue (POF) is a common occurrence following colonoscopy, primarily attributed to bowel preparation and endoscopic probe stimulation, and is associated with worse postoperative outcomes. Esketami...
PURPOSE: Postoperative fatigue (POF) is a common occurrence following colonoscopy, primarily attributed to bowel preparation and endoscopic probe stimulation, and is associated with worse postoperative outcomes. Esketamine, an antidepressant anesthetic, has shown the potential to enhance postoperative recovery through various mechanisms. We hypothesized that the low-dose esketamine could alleviate POF in outpatients undergoing colonoscopy. METHODS: 200 participants scheduled for painless colonoscopy were enrolled, with 151 patients included in the primary endpoint analysis. Patients were randomly received 0.15 mg/kg esketamine or 0.1 μg/kg sufentanil before anesthesia induction. The primary outcome was the incidence of POF, assessed using the Identity-Consequence Fatigue Scale-10 (ICFS-10) scores at 30 min after colonoscopy. Secondary outcomes included ICFS-10 scores at baseline and 1 day post-colonoscopy, time to discharge and patients' satisfaction. RESULTS: The incidence of POF was significantly lower in the esketamine group (Group E) compared to the sufentanil group (Group S) (28% vs 44%, = 0.036). There were no significant differences in ICFS-10 scores between the two groups at baseline and 1 day post-colonoscopy. However, discharge time was significantly shorter in Group E than in Group S (25 min vs 30 min, = 0.001). In Group E, there was improved hemodynamic stability and greater patients' satisfaction. CONCLUSION: The administration of esketamine significantly reduced the incidence of POF and shortened discharge time in patients undergoing colonoscopy. A regimen of 0.15 mg/kg esketamine combined with propofol proved to be an effective anesthesia strategy for painless colonoscopy.
Clinical Value of Continuous Fascia Iliaca Compartment Block in Perioperative Management of Elderly Patients with Intertrochanteric Fracture: A Propensity Score-Matched Retrospective Study.
Xu G, Deng Y, Gao H … +3 more , Wang B, Wang G, Ma J
Ther Clin Risk Manag · 2025 · PMID 40463766 · Full text
BACKGROUND: Hip fractures in elderly patients represent a significant healthcare challenge, with substantial morbidity and mortality rates. This study investigated the efficacy of continuous fascia iliaca compartment blo...
BACKGROUND: Hip fractures in elderly patients represent a significant healthcare challenge, with substantial morbidity and mortality rates. This study investigated the efficacy of continuous fascia iliaca compartment block (CFICB) in perioperative management. METHODS: A retrospective analysis was conducted on elderly patients (≥65 years) with intertrochanteric fractures treated between January 2020 and December 2023. Eligible patients were initially divided into CFICB (n=46) and routine analgesia (RA, n=64) groups. Propensity score matching with a caliper width of 0.21 was performed, yielding 40 patients in each group for final analysis. Matching variables included age, gender, BMI, and ASA score. Primary outcomes were Visual Analog Scale pain scores, cognitive function assessed through a two-tier protocol (Montreal Cognitive Assessment [MoCA©] screening followed by confirmatory Mini-Mental State Examination-2 [MMSE-2Ⓡ] for positive screens), and functional recovery evaluated using the Harris Hip Score. RESULTS: The CFICB group showed significantly lower VAS scores during the early postoperative period (≤ 72h). This was most notable at 24 hours postoperatively (2.43 ± 0.72 vs 3.45 ± 0.87, < 0.001). Postoperative cognitive dysfunction rates were significantly lower in the CFICB group. The differences were evident at 6h (10% vs 30%, = 0.025), 24h (15% vs 35%, P = 0.039), and 72h (5% vs 20%, P = 0.043). Multivariable analysis identified CFICB as an independent protective factor against postoperative cognitive dysfunction (adjusted OR = 0.41, 95% CI: 0.26-0.65, P < 0.001). Harris Hip Scores at one month postoperatively were significantly higher in the CFICB group (78.56 ± 8.12 vs 72.39 ± 7.65, P = 0.008). Complication rates were comparable between groups (22.5% vs 17.5%, = 0.576). CONCLUSION: CFICB effectively improves postoperative pain management, reduces cognitive dysfunction incidence, and enhances early functional recovery in elderly patients with intertrochanteric fractures, while maintaining a favorable safety profile.
Cerebrovascular Autoregulation-Based Optimal Mean Arterial Pressure During Prostate Surgery - A Secondary Analysis of a Prospective Cohort Study.
Mewes C, Wei P, Yang Y … +6 more , Kainz E, Kahl U, Beck S, Graefen M, Zöllner C, Fischer M
Ther Clin Risk Manag · 2025 · PMID 40453324 · Full text
PURPOSE: Cerebrovascular autoregulation (CVA) is a homoeostatic regulatory function to maintain constant cerebral blood flow (CBF) despite changes in systemic blood pressure. The CVA-based optimal mean arterial pressure...
PURPOSE: Cerebrovascular autoregulation (CVA) is a homoeostatic regulatory function to maintain constant cerebral blood flow (CBF) despite changes in systemic blood pressure. The CVA-based optimal mean arterial pressure (MAPopt) refers to the MAP level at which the CVA mechanism reaches its lowest degree of pressure passiveness, allowing for optimal autoregulation. This study aimed to determine MAPopt by analyzing existing CVA data from patients undergoing non-cardiac surgery. METHODS: This single-center investigation is a secondary analysis of prospectively recorded CVA data of patients undergoing oncologic prostate surgery. Intraoperative CVA was assessed using the cerebral oxygenation index (COx) derived from the simultaneous measurement of MAP and regional cerebral oxygen saturation (rSO). Patient-specific MAPopt values were calculated using a second-order polynomial formula, in which the MAP related to the lowest COx was considered to be the intraoperative MAPopt. RESULTS: A total of 180 patients were enrolled into the study. The average age was 63 years, 83.9% of patients had no or mild systemic disease. MAPopt determination was feasible in 128 patients, while 52 patients exhibited no U-shaped correlation between MAP and COx. The average intraoperative MAPopt was 81.7 mmHg ranging from 60.2 to 101.4 mmHg. The mean duration of intraoperative CVA measurement was 178 min. CONCLUSION: This study demonstrates a wide range of individual intraoperative MAPopt values and underscores that CVA-based MAPopt during non-cardiac surgery may differ from commonly accepted intraoperative MAP thresholds in clinical practice (ie 65 mmHg).
Positive Collaboration in Rehabilitation Nursing Enhances Fall Efficacy and Confidence in Elderly Patients with Cerebral Infarction.
Luo F, Xu W, Xu Y … +2 more , Lou L, Xu C
Ther Clin Risk Manag · 2025 · PMID 40453323 · Full text
BACKGROUND: Cerebral infarction is a prevalent disabling condition among the elderly, often leading to limb dysfunction and psychological challenges that significantly impair quality of life. Traditional nursing approach...
BACKGROUND: Cerebral infarction is a prevalent disabling condition among the elderly, often leading to limb dysfunction and psychological challenges that significantly impair quality of life. Traditional nursing approaches have primarily focused on physical rehabilitation; however, growing evidence highlights the importance of psychological factors-such as emotional well-being and rehabilitation confidence-in influencing recovery outcomes. Positive collaboration in rehabilitation nursing, which involves coordinated efforts among patients, healthcare providers, and family members, has emerged as a holistic approach to enhance both physical and psychological recovery. OBJECTIVE: To analyze the effects of positive collaboration concept rehabilitation nursing on elderly patients with cerebral infarction, focusing on fall efficacy and rehabilitation confidence. METHODS: A retrospective analysis was conducted on clinical data from 106 elderly patients with cerebral infarction, admitted from October 2022 to April 2024. Patients were divided into a control group (n=53, receiving routine care) and an observation group (n=53, receiving positive collaboration rehabilitation nursing). Neurological function (NIHSS), negative emotions (SAS, SDS), fall efficacy (MFES), activities of daily living (ADL), quality of life (SS-QOL), rehabilitation confidence (CaSM), and nursing satisfaction (NSNS) were compared between the two groups. RESULTS: The observation group showed significantly lower NIHSS scores at 2 weeks and 1 month post-intervention (P<0.05). Both groups demonstrated reduced SAS and SDS scores, with the observation group showing greater improvement (P<0.05). A higher proportion of patients in the observation group (56.60%) showed excellent fall efficacy compared to the control group (37.74%) (P<0.05). The observation group also had greater improvements in ADL, SS-QOL, and rehabilitation confidence, with higher patient satisfaction (90.57% vs 71.70%, P<0.05). CONCLUSION: Positive collaboration rehabilitation nursing significantly improves neurological function, emotional well-being, fall efficacy, and quality of life in elderly patients with cerebral infarction. This approach increases patient and family satisfaction, highlighting the potential benefits of integrating collaborative care into clinical practice.
Long-Term Benefits of N-Butylphthalide in Preventing Ischemic Stroke Recurrence: A 12-Month Prospective Study.
Liu W, Shao Y, Liu J … +5 more , Hao J, Lu Y, Yang L, Wang J, Ning X
Ther Clin Risk Manag · 2025 · PMID 40453322 · Full text
PURPOSE: This study evaluated the effects of 12 months of NBP treatment on stroke recurrence and examined the influence of age and gender on its efficacy. METHODS: A prospective cohort of 1109 patients with non-cardioemb...
PURPOSE: This study evaluated the effects of 12 months of NBP treatment on stroke recurrence and examined the influence of age and gender on its efficacy. METHODS: A prospective cohort of 1109 patients with non-cardioembolic ischemic stroke (IS) within six months was divided into NBP (n = 538) and control (n = 571) groups. The NBP group received NBP plus standard treatment, while the control group received standard treatment alone. Primary outcomes were recurrent ischemic and hemorrhagic stroke over 12 months. Secondary outcomes included functional status (modified Rankin Scale, m-RS) and all-cause mortality. RESULTS: NBP reduced recurrent IS by 39% compared to controls (RR:0.61,95% CI:0.40-0.93, P=0.022) and total stroke events by 39.6% (RR:0.60,95% CI:0.40-0.91,P=0.016). Protective effects were more significant in males (RR:0.52,95% CI:0.30-0.91, P=0.021 vs RR:0.53,95% CI:0.40-0.91,P=0.021) and in patients under 70 years (P<0.05). Functional outcomes (modified Rankin Scale and Barthel index) and all-cause mortality did not differ significantly between groups (all P>0.05). CONCLUSION: NBP significantly reduces stroke recurrence and overall vascular events, especially in males and younger patients. While it does not improve functional outcomes or mortality, NBP demonstrates substantial preventive value for recurrent strokes.
The Role of Integrated Nursing Interventions in Traumatic Brain Injury Management in the Emergency Department: A Retrospective Study.
Zhou Y, Zhou L, Chen X
Ther Clin Risk Manag · 2025 · PMID 40453321 · Full text
BACKGROUND: Traumatic brain injury (TBI) is a leading cause of both disability and death, frequently necessitating treatment in emergency departments (ED). Integrated nursing interventions are critical in the management...
BACKGROUND: Traumatic brain injury (TBI) is a leading cause of both disability and death, frequently necessitating treatment in emergency departments (ED). Integrated nursing interventions are critical in the management of TBI patients, but limited research has been conducted to evaluate their effectiveness in this setting. The aim of this article is to investigate and evaluate the impact of integrated nursing interventions on the management of TBI patients in the ED. METHOD: A retrospective study was conducted among 216 patients with TBI who came to the ED between January 2022 and December 2022, of whom 120 were treated with nursing interventions and 96 were not treated with nursing interventions. The integrated interventions included rapid triage, continuous monitoring of neurological status, early rehabilitation involvement, patient and family education, and interdisciplinary care coordination. The medical records were reviewed to assess the utilization of nursing interventions and analyze the impact of these interventions on the short-term and long-term prognosis of TBI patients. Patient demographics, clinical characteristics, and outcomes were analyzed using descriptive statistics and logistic regression analysis. RESULT: Among the 216 TBI patients, 96 (44.4%) received nursing interventions as part of their ED care. These patients had significantly lower rates of adverse events such as intracranial hemorrhage (3.3% vs 12.5%, P=0.018) and hospital stays (7 ± 2 days vs 10 ± 4 days, P<0.001). Logistic regression analysis showed that nursing interventions were significantly associated with a decreased risk of adverse events (OR=0.25, 95% CI=0.10-0.63, P=0.003). CONCLUSION: Integrated nursing interventions are essential in the care of TBI patients in the emergency department. Early detection, swift treatment, continuous monitoring, assessment, and education for both patients and their families can enhance recovery and minimize the likelihood of complications. Implementation of nursing interventions should be encouraged in EDs to improve the quality of TBI care. Further studies are needed to investigate the optimal strategies and cost-effectiveness of nursing interventions in TBI management in the ED.
Comparative Sedative Effects of Esketamine and Dexmedetomidine Versus Dexmedetomidine Alone in Patients Undergoing Spinal Tumor Surgery.
Lin C, Yuan L, Shi J … +3 more , Kong L, Luo N, Wang J
Ther Clin Risk Manag · 2025 · PMID 40433631 · Full text
OBJECTIVE: Esketamine and dexmedetomidine are commonly used sedatives in surgery, which can result in minimal respiratory depression and analgesic activity. This study investigated the sedative effect of esketamine combi...
OBJECTIVE: Esketamine and dexmedetomidine are commonly used sedatives in surgery, which can result in minimal respiratory depression and analgesic activity. This study investigated the sedative effect of esketamine combined with dexmedetomidine on patients undergoing spinal tumor (ST) surgery. METHODS: We did a retrospective analysis at the Anesthesiology Department of Ningbo City's the sixth Hospital. They studied 75 ST surgery patients who got esketamine in combination with dexmedetomidine (Group ED) between April 2022 and June 2024. In a 1:1 cohort, compare these individuals to those who only received dexmedetomidine at the same time period (Group D). The primary outcome is perioperative hemodynamic status. The secondary outcomes were pain intensity, intraoperative neurophysiological monitoring (IONM), and the occurrence of adverse responses. RESULTS: Compared with group E, the group ED had lower mean arterial pressure (MAP), heart rate (HR), and visual-analogue scale (VAS) scores after the start of surgery (all P<0.05). There was no significant difference in the waiting time for perioperative motor evoked potential (MEP) and the intensity of the first induced MEP current between the two groups (all P>0.05); The Group ED first induced MEP amplitude, somatosensory evoked potential (SEP) amplitude, and MEP amplitude greater than the Group D, while SEP latency and MEP latency were smaller than the Group D (all P<0.05). There was no significant difference in the incidence of perioperative adverse events between the two groups (P>0.05). CONCLUSION: Compared with dexmedetomidine alone, the combination of esketamine and dexmedetomidine during ST surgery can demonstrated superior sedation and pain control without increasing adverse event risk, making it a viable alternative for ST surgery anesthesia.
Comparative Outcomes of Apical Induction Versus Pulp Revascularization in Young Permanent Anterior Teeth with Traumatic Pulp Necrosis.
Cheng G, Wu X, Li W … +1 more , Lv Z
Ther Clin Risk Manag · 2025 · PMID 40421432 · Full text
OBJECTIVE: This study aims to evaluate and analyze the clinical application of pulp revascularization surgery in young permanent anterior teeth with pulp necrosis caused by trauma. METHODS: This study selected 40 cases o...
OBJECTIVE: This study aims to evaluate and analyze the clinical application of pulp revascularization surgery in young permanent anterior teeth with pulp necrosis caused by trauma. METHODS: This study selected 40 cases of young permanent anterior teeth with pulp necrosis caused by trauma, treated at our hospital between August 2018 and December 2022. All patients met the complete inclusion criteria and were divided into a study group and a control group based on treatment methods. The study group received pulp revascularization surgery, and the control group received apical induction surgery. There were 20 patients in each group. Comparative observation indicators included clinical treatment outcomes, clinical-related indicators, pain levels, and patient family satisfaction. RESULTS: The treatment outcomes in the study group were significantly better than those in the control group (P < 0.05). The crown-to-root ratio in the study group was lower than that in the control group, and the root canal wall thickness was higher in the study group, with all P < 0.05. The pain level grading in the study group was significantly lower than that in the control group (P < 0.05). Satisfaction indicators for both patients and their families were significantly higher in the study group compared to the control group, with all P < 0.05. CONCLUSION: Pulp revascularization surgery shows great potential in the clinical application for young permanent anterior teeth with pulp necrosis caused by trauma. It can effectively improve the treatment outcomes, clinical indicators, and alleviate pain, while significantly enhancing patient satisfaction. With continuous research and practice, this advanced treatment method is expected to provide a better oral health experience for patients and promote the development of the dental field.
Relationship Between Timing of PCSK9 Inhibitor Monoclonal Antibody Initiation and Clinical Outcomes in Patients with Prior Cardiovascular Events.
Sidelnikov E, Kalich BA, Miglins ML … +4 more , Multani JK, Tuly R, Hawkins K, Baber U
Ther Clin Risk Manag · 2025 · PMID 40417171 · Full text
PURPOSE: Timing of initiation of proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) monoclonal antibody (mAb) therapy and its impact on cardiovascular outcomes is unknown. The aim was to identify any associ...
PURPOSE: Timing of initiation of proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) monoclonal antibody (mAb) therapy and its impact on cardiovascular outcomes is unknown. The aim was to identify any association between timing of PCSK9i mAb initiation after a major adverse cardiovascular event (MACE) and the rate of subsequent MACE. PATIENT AND METHODS: A retrospective cohort study of adult patients in the United States with a MACE (myocardial infarction, stroke, unstable angina, or coronary revascularization) from January 1, 2017 to February 28, 2022 was conducted using administrative claims databases (index date = first observed MACE during this period). Patients were required to have ≥360 days of data visibility prior to (baseline period) and for ≥30 days after the index date (minimum, variable follow up period), and ≥1 prescription claim for PCSK9i mAb therapy on or after the index date. Subsequent MACE rates, time from index MACE to PCSK9i mAb initiation, and time to subsequent MACE were reported. RESULTS: A total of 58,997 patients with ≥1 MACE were identified (mean age = 64 years; 58% male; median follow up=1,241 days). Over half of the patients did not initiate a PCSK9i mAb in the first year after the index MACE. Overall, 35% (n = 20,465) had ≥1 subsequent MACE. Compared to the period between index MACE and prior to PCSK9i mAb initiation, rates of subsequent MACE after PCSK9i mAb initiation were reduced in a time-dependent manner by 70% among patients who initiated PCSK9i mAb therapy within 30 days, 78% (31-90 days), 76% (91-180 days), 65% (181-360 days), and 42% (>360 days) after the index MACE. Those who initiated PCSK9i mAb within 30 days of the index MACE had longer median time to the first subsequent MACE (111 days) compared to patients who initiated at later times. CONCLUSION: This study provides evidence that earlier initiation of PCSK9i mAb therapy after a MACE appeared to be associated with longer time to a subsequent MACE. Patients without timely treatment are left at an unnecessarily elevated risk of further MACE.
Elevated MPV: A Key Indicator of Acute Anterior Circulation Stroke Prognosis in Mechanical Thrombectomy.
Tian SY, Yu MJ, Mei K … +4 more , Xu B, Xiao LC, Wen HB, Shang FR
Ther Clin Risk Manag · 2025 · PMID 40417170 · Full text
OBJECTIVE: The aim of this study is to investigate the relationship between admission platelet indices and 90-day clinical outcomes in patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy (MT). ME...
OBJECTIVE: The aim of this study is to investigate the relationship between admission platelet indices and 90-day clinical outcomes in patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy (MT). METHODS: A retrospective analysis was conducted on 247 AIS patients with anterior circulation large vessel occlusion (LVO) treated with MT between July 2021 and April 2024. Platelet indices (PIs) were measured at admission. Participants were stratified into two groups based on 90-day modified Rankin Scale (mRS) outcomes. Multivariate regression analysis and receiver operating characteristic (ROC) curves were employed to evaluate relationships between admission platelet indices, clinical parameters, and functional outcomes. RESULTS: Among 247 enrolled patients, those with unfavorable outcomes (mRS 3-6) exhibited significantly higher platelet distribution width (PDW) and Mean Platelet Volume (MPV) levels compared to the favorable outcome group (mRS 0-2). Elevated MPV remained an independent predictor of unfavorable outcomes after multivariate adjustment (OR=2.747, 95% CI: 1.791-4.216, <0.001). ROC analysis identified a MPV threshold >10.75 fL for predicting unfavorable prognosis, demonstrating 55.4% sensitivity and 81.2% specificity. CONCLUSION: PDW is associated with unfavorable 90-day outcomes in patients with acute anterior circulation LVO following MT, while elevated MPV may serve as a prognostic indicator for unfavorable functional outcomes in patients with acute anterior circulation LVO following MT.
Corticosteroid Therapy for Diffuse Alveolar Hemorrhage with Respiratory Failure in Hematologic Malignancies: A Retrospective Cohort Study.
Ahn JH, Song KM, Huh JW … +6 more , Lee JH, Hong SB, Lee JH, Lim CM, Lee KH, Koh Y
Ther Clin Risk Manag · 2025 · PMID 40405916 · Full text
BACKGROUND: Although DAH in hematopoietic stem cell transplantation recipients is commonly treated with systemic corticosteroids, the efficacy of steroid therapy on DAH with respiratory failure in hematologic malignancy...
BACKGROUND: Although DAH in hematopoietic stem cell transplantation recipients is commonly treated with systemic corticosteroids, the efficacy of steroid therapy on DAH with respiratory failure in hematologic malignancy patients has not been studied. We aimed to investigate the effectiveness of steroid therapy in hematologic malignancy patients who developed DAH with respiratory failure and required treatment in the intensive care unit (ICU). METHODS: Among DAH patients with leukemia, lymphoma, or multiple myeloma, those who were not admitted to the ICU were excluded. Included patients were classified into the steroid or control group according to steroid therapy. Patient data were retrospectively collected from electrical medical records. The primary outcome was ICU mortality. RESULTS: A total of 44 patients (steroid group, n = 32; control group, n = 12) were included. At the DAH diagnosis, the steroid group was less likely to have a history of previously treated solid malignancy (3% vs 25%; = 0.025) compared to the control group. ICU mortality in the steroid group was not significantly different from that in the control group (66% vs 67%; = 0.948). Only in the steroid group, the ratio of arterial oxygen partial pressure to fractional inspired oxygen was significantly improved after 2 days from the DAH diagnosis (151 ± 64 vs 120 ± 38 mm Hg; = 0.039). CONCLUSION: Hematologic malignancy patients who developed DAH with respiratory failure and were admitted to the ICU had high mortality, irrespective of steroid therapy.
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