Therapeutics And Clinical Risk Management[JOURNAL]
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200 papers
Inflammatory Burden Index Associated with Recurrence of Atrial Fibrillation After Radiofrequency Catheter Ablation.
Peng S, Li F, Jin M … +3 more , Zhang Y, Li H, Yin J
Ther Clin Risk Manag · 2025 · PMID 40395835 · Full text
BACKGROUND: Recurrence rates of atrial fibrillation (AF) remain high after radiofrequency catheter ablation (RFCA), and inflammation plays an important role in the process. Inflammatory burden index (IBI) as a new inflam...
BACKGROUND: Recurrence rates of atrial fibrillation (AF) remain high after radiofrequency catheter ablation (RFCA), and inflammation plays an important role in the process. Inflammatory burden index (IBI) as a new inflammatory marker has been found to be associated with worse prognosis in cardiovascular disease. But there are no studies on its role in predicting AF recurrence. The aim of this study was to assess the value of IBI in predicting recurrence of AF after RFCA. METHODS: This was a single-center retrospective observational study. Consecutive enrolment of PersAF who underwent first-time radiofrequency ablation between January 2021 and June 2024. Inflammatory Burden Index (IBI) was calculated as C-reactive protein (CRP) × neutrophil/lymphocyte (NLR). RESULTS: A total of 142 (27.2%) patients experienced recurrence after RFCA. Multivariate analysis showed that PersAF (OR = 1.599; 95% CI: 1.028 ~ 2.486, p = 0.018), CHADS-VASc score≥2 (OR = 1.769; 95% CI: 1.142 ~ 2.741, p = 0.011), LAD (OR = 1.098; 95% CI: 1.054 ~ 1.145, p < 0.001) and IBI (OR = 1.028; 95% CI: 1.007 ~ 1.050, p = 0.009), were independent predictors of recurrence. ROC analysis shows superiority of IBI (AUC=0.695, 95% CI: 0.647 ~ 0.743, p < 0.001) over CRP and NLR in predicting AF recurrence. When IBI was integrated into the traditional model (including PersAF, LAD and CHADS-VASc Score), the discrimination and reclassification accuracy for the recurrence were significantly improved. CONCLUSION: Inflammatory load index associated with the recurrence of AF after RFCA. Integration of IBI can improve the model about the recurrence of AF after RFCA.
Effect of Thoracic Paravertebral Block on Postoperative Pulmonary Complications After Video-Assisted Thoracoscopic Surgery: A Dual-Center Randomized Clinical Trial.
Zhu J, Wei B, Wu L … +7 more , Li H, Zhang Y, Lu J, Su S, Xi C, Liu W, Wang G
Ther Clin Risk Manag · 2025 · PMID 40390800 · Full text
PURPOSE: TPVB can provide effective postoperative analgesia in lung cancer patients undergoing video-assisted thoracoscopic surgery (VATS), which may enhance respiratory mechanics and postoperative expectoration, as well...
PURPOSE: TPVB can provide effective postoperative analgesia in lung cancer patients undergoing video-assisted thoracoscopic surgery (VATS), which may enhance respiratory mechanics and postoperative expectoration, as well as relieve inflammation and stress. These mechanisms may reduce the incidence of postoperative pulmonary complications (PPCs). This study explored whether TPVB reduces the risk of PPCs in patients undergoing VATS for lung cancer. PATIENTS AND METHODS: In this dual-center trial, patients who underwent VATS for lung cancer were randomly divided into the PV group (n = 151, general anesthesia [GA] and TPVB) and the C group (n = 151, GA only). The primary outcome was the incidence of a composite of PPCs within seven days postoperatively. RESULTS: The incidence of PPCs within seven days postoperatively was lower in the PV group (37.7%, 57/151) compared to the C group (49.0%, 74/151), with a risk ratio of 1.59 (95% CI: 1.00 to 2.50, =0.048). And within 8-30 days postoperatively, compared with that in the C group (33.1%, 50/151), the incidence of PPCs was lower in patients in the PV group (22.5%, 34/151), with a risk ratio of 1.70 (95% CI, 1.02 to 2.84, =0.040). There was a significant difference in the incidence of pneumonia between the PV group (11/151, 7.3%) and the C group (35/151, 23.3%; < 0.001), and the incidence of pneumothorax between the PV group (27/151, 17.9%) and the C group (45/151, 29.8%; = 0.015). CONCLUSION: Compared to GA alone, TPVB combined with GA reduces the incidence of PPCs within seven days postoperatively in patients undergoing VATS for lung cancer, and this beneficial effect can last up to 30 days after surgery. A possible mechanism is that TPVB reduces acute postoperative pain in patients.
Circulating-Water Mattress Enhances Thermal Comfort and Patient Satisfaction but Shows Non-Superiority in Temperature Maintenance in Ophthalmic Day-Case Surgery: A Randomized Controlled Trial.
Yan Y, Geng J, Xi C … +2 more , Cui X, Wang G
Ther Clin Risk Manag · 2025 · PMID 40390799 · Full text
PURPOSE: Perioperative hypothermia, a common complication of general anesthesia, is associated with adverse outcomes. While active warming methods are recommended, the effectiveness of circulating-water mattresses during...
PURPOSE: Perioperative hypothermia, a common complication of general anesthesia, is associated with adverse outcomes. While active warming methods are recommended, the effectiveness of circulating-water mattresses during ophthalmic surgeries remains understudied. This randomized controlled trial assessed whether a circulating-water mattress combined with a cotton quilt (Group W) was superior to a cotton quilt alone (Group C) in maintaining patient body temperature during ophthalmic day-case surgery. PATIENTS AND METHODS: Group W patients (n=39) used a preheated circulating-water mattress (38°C) on the operating table and were covered with a cotton quilt (from their entry to the operating room until they returned to the ward). Group C patients (n=38) lay on an unheated table and were covered with a cotton quilt. The axillary temperature in the surgical waiting area served as the baseline. Axillary temperature, ambient temperature, heart rate, and mean arterial pressure were documented at anesthesia induction (T), start of surgery (T), every 5 min for the first hour (T-T), and end of surgery (T). Satisfaction and thermal comfort scores were assessed at baseline in the waiting area, 5 min before anesthesia induction (t), 15 min after entering the post-anesthesia care unit (PACU) (t), and upon leaving the PACU (t). The primary outcome measure was the axillary temperature at T. RESULTS: At T, Group W had a higher axillary temperature than Group C (36.40±0.06°C vs 36.18±0.06°C, =0.011), with the mean difference 0.22°C, which did not exceed the predefined superiority threshold of 0.30°C, indicating that the warming effect in Group W was not superior to that in Group C. However, thermal comfort and satisfaction scores were significantly enhanced at t and t (<0.05). CONCLUSION: During ophthalmic day-case surgeries, a circulating-water mattress plus a cotton quilt was not superior, regarding their warming effect, but they significantly enhanced patients' thermal comfort and satisfaction.
Lessons Learned From Awake ECMO Approach in Covid-19-Related Acute Respiratory Distress Syndrome - a Scoping Review.
Sklienka P, Burša F, Frelich M … +8 more , Máca J, Romanová T, Vodička V, Straková H, Bílená M, Jor O, Neiser J, Tomášková H
Ther Clin Risk Manag · 2025 · PMID 40385980 · Full text
During the COVID-19 pandemic, specific COVID-19-related conditions renewed interest in the full-awake venovenous extracorporeal membrane oxygenation ( V-V ECMO) approach, in which ECMO is applied to awake, cooperative,...
During the COVID-19 pandemic, specific COVID-19-related conditions renewed interest in the full-awake venovenous extracorporeal membrane oxygenation ( V-V ECMO) approach, in which ECMO is applied to awake, cooperative, and non-intubated patients. This scoping review aims to provide a descriptive overview of V-V ECMO in patients with COVID-19-related acute respiratory distress syndrome (CARDS). We searched the PubMed, Web of Science, and Scopus databases using the keywords "awake ECMO" or "spontaneous breathing AND ECMO", combined with "COVID-19", "SARS-CoV-2" or "coronavirus", utilizing the Boolean operator "AND". The search included papers published from November 1, 2019, to December 31, 2024. Sixty-four papers were assessed for eligibility at the abstract level, and fourteen articles (seven small-sample cohort studies and seven case reports) comprising 95 patients were included in the final analysis. The most frequent reasons for preferring V-V ECMO over mechanical ventilation were barotrauma and patient refusal of intubation and mechanical ventilation. The V-V ECMO strategy was successful (ie, patients not intubated, disconnected from ECMO, and discharged from the hospital) in 36.4% of cases (cohort studies only). The incidence of defined severe adverse events (bleeding, thrombosis, cannula malposition, delirium, and progression of barotrauma) was considered low. The mortality rate for CARDS patients treated with V-V ECMO (including only patients from cohort studies) reached 33.0%, notably lower than the 48% reported for CARDS patients treated with V-V ECMO in the ELSO registry. Patients who were intubated due to worsening respiratory failure during V-V ECMO had significantly higher mortality. Infectious complications, sepsis, and multiorgan failure were the most frequent causes of death. However, significant heterogeneity in the definitions and reporting of management, ECMO-related complications, and outcomes was observed across the papers. Despite the heterogeneity of the data, V-V ECMO in CARDS patients can be considered a safe approach associated with a lower mortality rate than that reported in the overall V-V ECMO CARDS population.
Improved Tubeless Airway Management in JORRP Surgery: Comparative Analysis of Pre- and Post-THRIVE Implementation.
Lei G, Yang S, Wu L … +4 more , Yin Y, Xi C, Xiao Y, Wang G
Ther Clin Risk Manag · 2025 · PMID 40356688 · Full text
BACKGROUND: Juvenile-onset recurrent respiratory papillomatosis (JORRP) is a severe pediatric condition requiring frequent surgical interventions to maintain airway patency. Managing oxygenation during tubeless anesthesi...
BACKGROUND: Juvenile-onset recurrent respiratory papillomatosis (JORRP) is a severe pediatric condition requiring frequent surgical interventions to maintain airway patency. Managing oxygenation during tubeless anesthesia for these surgeries poses significant challenges. In 2021, our center introduced transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) as a novel method for airway management in JORRP surgeries. This study evaluated the impact of THRIVE on perioperative outcomes in pediatric JORRP surgeries. METHODS: This was a retrospective study of 122 pediatric JORRP surgical cases carried out at a tertiary center. Patients who underwent surgery prior to the implementation of THRIVE served as the control group (pre-THRIVE), while those treated after its introduction served as the intervention group (post-THRIVE), with 61 patients in each group. Perioperative data, including surgery and anesthesia parameters and extubation frequency were collected. RESULTS: A total of 122 patients were included. Baseline characteristics were comparable between groups. After the introduction of THRIVE, the median number of extubations significantly decreased from a median 3 in the pre-THRIVE group to 1 in the post-THRIVE group ( <0.001). Minimum intraoperative SpO levels were significantly higher in the post-THRIVE group (98% vs 85%, <0.001). Surgery duration was reduced from 41 minutes to 35.5 minutes ( =0.003), and anesthesia duration decreased from 67 minutes to 58.5 minutes ( =0.016). No significant differences were observed in PACU stay length or complications between the groups. CONCLUSION: The implementation of THRIVE in pediatric JORRP enhances intraoperative efficiency and safety. Further research is warranted to assess its long-term effect.
A Retrospective Machine Learning Analysis to Predict 3-Month Nonunion of Unstable Distal Clavicle Fracture Patients Treated with Open Reduction and Internal Fixation.
Ma C, Lu W, Liang L … +2 more , Huang K, Zou J
Ther Clin Risk Manag · 2025 · PMID 40352661 · Full text
BACKGROUND: This retrospective study aims to predict the risk of 3-month nonunion in patients with unstable distal clavicle fractures (UDCFs) treated with open reduction and internal fixation (ORIF) using machine learnin...
BACKGROUND: This retrospective study aims to predict the risk of 3-month nonunion in patients with unstable distal clavicle fractures (UDCFs) treated with open reduction and internal fixation (ORIF) using machine learning (ML) methods. ML was chosen over traditional statistical approaches because of its superior ability to capture complex nonlinear interactions and to handle imbalanced datasets. METHODS: We collected UDCFs patients at Nanjing Luhe People's Hospital (China) between January 2015 and May 2023. The unfavorable outcome was defined as 3-month nonunion, as represented by disappeared fracture line and continuous callus. Patients meeting inclusion criteria were randomly divided into training (70%) and testing (30%) sets. Five ML models (logistic regression, random forest classifier, extreme gradient boosting, multi-layer perceptron, and category boosting) were developed. Those models were selected based on univariate analysis and refined using the Least Absolute Shrinkage and Selection Operator (LASSO). Model performance was evaluated using AUROC, AUPRC, accuracy, sensitivity, specificity, F1 score, and calibration curves. RESULTS: A total of 248 patients were finally included into this study, and 76 (30.6%) of them had unfavorable outcomes. While all five models showed similar trends, the CatBoost model achieved the highest performance (AUROC = 0.863, AUPRC = 0.801) with consistent identification of the risk factors mentioned above. The SHAP values identified the CCD as the significant predictor for assessing the risk of 3-month nonunion in patients with UDCFs within the Chinese demographic. CONCLUSION: The refined model incorporated four readily accessible variables, wherein the CCD, HDL levels, and blood loss were associated with an elevated risk of nonunion. Conversely, the application of nerve blocks, including postoperative block, was correlated with a reduced risk. Our results suggest that ML, particularly the CatBoost model, can be integrated into clinical workflows to aid surgeons in optimizing intraoperative techniques and postoperative management to reduce nonunion rates.
Development and Validation of an Interpretable Machine Learning Model for Prediction of the Risk of Clinically Ineffective Reperfusion in Patients Following Thrombectomy for Ischemic Stroke.
Hu X, Qi D, Li S … +7 more , Ye S, Chen Y, Cao W, Du M, Zheng T, Li P, Fang Y
Ther Clin Risk Manag · 2025 · PMID 40336699 · Full text
BACKGROUND: Despite successful recanalization after thrombectomy in patients with acute ischemic stroke, poor prognosis often persists. This study aimed to investigate the factors contributing to clinically ineffective r...
BACKGROUND: Despite successful recanalization after thrombectomy in patients with acute ischemic stroke, poor prognosis often persists. This study aimed to investigate the factors contributing to clinically ineffective reperfusion (CIR), develop and validate a machine-learning model to predict CIR, and provide guidance for future clinical treatments. METHODS: We collected data from patients undergoing thrombectomy at Shanghai Fourth People's Hospital between December 2021 and June 2024. The clinical variables were compared between the clinically ineffective and effective recanalization groups using univariate analysis. Four machine learning models were developed: random forest (RF), support vector machine (SVM), decision tree (DT), and k-nearest neighbor (KNN). Model performance was evaluated using receiver operating characteristic (ROC) curves and heatmap visualization. The SHAP method rank the feature importance and provided interpretability for the final model. RESULTS: Among the four machine learning models, the RF model showed the best performance, with an area under the curve (AUC) of 0.96 (95% CI: 0.91-1.0), accuracy of 0.93, and specificity of 0.97 on the test dataset. The SHAP algorithm identified the number of endovascular thrombectomy (EVT) attempts as the key factor influencing CIR. Based on the RF model, a web-based calculator for CIR prediction is available at https://ineffectivereperfusion.shinyapps.io/calculate/. The final model included ten parameters: EVT attempts, diabetes mellitus, previous ischemic stroke, National Institutes of Health Stroke Scale (NIHSS score), preoperative infarction in the basal ganglia, baseline diastolic blood pressure, clot burden score (CBS)/basilar artery on computed tomography angiography (BATMAN) score, stroke cause, collateral grade, and MLS. CONCLUSION: We developed and validated the first interpretable machine learning model for CIR prediction after EVT, surpassing traditional methods. Our CIR risk prediction platform enables early intervention and personalized treatment. The number of EVT attempts has emerged as a key determinant, underscoring the need for optimized procedural timing to improve outcomes.
Risk Factors for Postoperative Infections in Severe Traumatic Brain Injury Patients Undergoing Emergency Craniotomy.
Zhang Z, Xu L, Xu S
Ther Clin Risk Manag · 2025 · PMID 40336698 · Full text
BACKGROUND AND AIM: Severe traumatic brain injury (TBI) patients undergoing emergency craniotomy are at high risk of postoperative infections. This study aims to identify the risk factors associated with these infections...
BACKGROUND AND AIM: Severe traumatic brain injury (TBI) patients undergoing emergency craniotomy are at high risk of postoperative infections. This study aims to identify the risk factors associated with these infections to improve patient outcomes. METHODS: A retrospective cohort study was conducted, including 312 severe TBI patients who underwent emergency craniotomy at Brain Hospital of Hunan Province between December 2019 and December 2021. Clinical data were collected, and both univariate and multivariate logistic regression analyses were performed to identify risk factors for postoperative infections. RESULTS: Among the 312 patients, 57 (18.3%) developed postoperative infections. Multivariate analysis identified several significant risk factors, including older age (OR=1.75, 95% CI: 1.23-2.49), prolonged surgery duration (OR=2.01, 95% CI: 1.38-2.92), presence of preoperative infection (OR=2.59, 95% CI: 1.64-4.09), and lower Glasgow Coma Scale (GCS) score on admission (OR=1.82, 95% CI: 1.21-2.74). CONCLUSION: Identifying patients at high risk for postoperative infections can help guide preventive measures and improve outcomes in severe TBI patients undergoing emergency craniotomy.
Impact of Relaxation and Music Intervention on Psychological and Gastrointestinal Health in Military Recruits: A Prospective Study.
Liu J, Liu T, Lu H … +6 more , Zhao X, Ma S, Song F, Qiao N, Cheng W, Qi X
Ther Clin Risk Manag · 2025 · PMID 40329986 · Full text
BACKGROUND AND AIMS: Gastrointestinal symptoms are closely associated with psychological problems, such as anxiety and depression. This prospective before-after study aimed to explore whether progressive muscular relaxat...
BACKGROUND AND AIMS: Gastrointestinal symptoms are closely associated with psychological problems, such as anxiety and depression. This prospective before-after study aimed to explore whether progressive muscular relaxation training combined with music intervention, which is potentially beneficial for psychological conditions, can improve gastrointestinal symptoms. METHODS: A total of 623 recruits' effective questionnaires before and after intervention were collected. They underwent progressive muscular relaxation training combined with music intervention for 4 weeks. They also completed the Self-Rating Depression Scale (SDS) and the Patient Health Questionnaire (PHQ-9) for assessment of depression, the Self-Rating Anxiety Scale (SAS) and the Generalized Anxiety Disorder-7 (GAD-7) for assessment of anxiety, the Gastrointestinal Symptom Rating Scale (GSRS) for assessment of gastrointestinal symptoms, and the Bristol Stool Form Scale (BSFS) for assessment of stool before and after interventions. Changes of psychological conditions and gastrointestinal symptoms were evaluated. RESULTS: The SDS (P<0.001), PHQ-9 (P<0.001), SAS (P<0.001), GAD-7 (P<0.001), and GSRS (P<0.001) scores were significantly decreased after intervention. The proportions of regurgitation (P<0.001), abdominal pain (P<0.001), dyspepsia (P<0.001), and constipation (P<0.001) evaluated by the GSRS were significantly decreased after intervention, but not diarrhea (P=0.601). The proportions of severe (P<0.001) and mild (P<0.001) constipation evaluated by the BSFS decreased after intervention, but those of severe (P=0.632) and mild (P<0.001) diarrhea evaluated by the BSFS increased. CONCLUSION: Short-term progressive muscular relaxation training in combination with music intervention is potentially effective for most gastrointestinal symptoms, but not for diarrhea, in recruits.
Assessment of the Impact of Dexmedetomidine on Myocardial Injury in TAVI Patients: A Retrospective Cohort Study Utilizing PSM-DID.
Song Y, Zhang J, Xu H … +4 more , Gui C, Cheng H, Chen Y, Wang S
Ther Clin Risk Manag · 2025 · PMID 40329985 · Full text
BACKGROUND: Transcatheter Aortic Valve Implantation (TAVI) is a minimally invasive procedure for treating severe aortic valve diseases but can lead to perioperative myocardial damage (PMD). Dexmedetomidine (DEX), an α2-a...
BACKGROUND: Transcatheter Aortic Valve Implantation (TAVI) is a minimally invasive procedure for treating severe aortic valve diseases but can lead to perioperative myocardial damage (PMD). Dexmedetomidine (DEX), an α2-adrenergic receptor agonist, has shown potential to reduce myocardial injury in other cardiac procedures. This effect is attributed to its anti-inflammatory properties, which help reduce the inflammatory response associated with myocardial damage, and its antioxidant properties, which combat oxidative stress that contributes to cell injury. But its effectiveness during TAVI remains unclear. OBJECTIVE: To assess the impact of DEX on myocardial injury in patients undergoing TAVI under general anesthesia. METHODS: A retrospective cohort study of 159 patients (after exclusions) who underwent TAVI from January 2022 to August 2024. Patients were divided into DEX and control groups. Primary outcomes were peak levels of cardiac troponin I and CK-MB within 48 hours postoperatively. Secondary outcomes included IL-6, PCT, and NT-proBNP levels. Propensity score matching (PSM) and Differences-in-Differences (DID) method were used for analysis. RESULTS: After PSM, the DEX group exhibited significantly lower peak values of troponin I (P < 0.001) and CK-MB (P < 0.001) compared to the control group, indicating reduced myocardial injury. No significant differences were observed in IL-6, PCT, and NT-proBNP levels between the groups. The DID analysis suggested a negative correlation between DEX use and major adverse postoperative events, highlighting DEX as a potential protective factor. CONCLUSION: Dexmedetomidine administration during TAVI was associated with reduced levels of myocardial injury markers, indicating a potential cardioprotective role. By reducing myocardial injury, DEX may contribute to improved perioperative outcomes, including a decreased risk of major adverse postoperative events. These results highlight the potential clinical utility of DEX in the perioperative management of TAVI patients, suggesting that its inclusion in anesthetic protocols could enhance patient care and recovery.
Clinical Efficacy of Microplasma Radiofrequency in Treating Post-Traumatic Pigmentary Deposition: A VISIA Quantitative Analysis.
Xu Y, Yin Y, Yang ZQ … +3 more , Li J, Guo LN, Ma C
Ther Clin Risk Manag · 2025 · PMID 40322637 · Full text
OBJECTIVE: To observe the clinical efficacy of microplasma radiofrequency in treating post-traumatic pigmentary deposition using VISIA quantitative analysis, an innovative approach not previously emphasized in microplasm...
OBJECTIVE: To observe the clinical efficacy of microplasma radiofrequency in treating post-traumatic pigmentary deposition using VISIA quantitative analysis, an innovative approach not previously emphasized in microplasma radiofrequency studies. METHODS: Twenty patients with post-traumatic pigmentary deposition, treated at Cangzhou Central Hospital between July 2022 and December 2022, were selected. Pigmented areas were divided into four regions (A: control; B, C, D: treated with increasing energy parameters). Adverse effects (erythema, edema, micro-crusts, pruritus) were monitored at 2, 4, and 6 weeks post-treatment using CTCAE v5.0 criteria. Pigmentary deposition scores and VISIA parameters (spots, ultraviolet spots, red areas, brown spots) were evaluated. RESULTS: At 2, 4, and 6 weeks, Groups B, C, D showed significant reductions in pigment scores and VISIA parameters vs Group A (P < 0.05), with Group D (highest energy) achieving maximal improvement. Transient mild-moderate erythema (60-100%), edema (40-80%), and micro-crusts (20-60%) occurred in treated groups, resolving spontaneously within 14 days; no severe adverse events were observed. CONCLUSION: Microplasma radiofrequency significantly improves post-traumatic pigmentary deposition, with energy-dependent efficacy. Despite transient side effects at higher energies, its favorable safety profile supports clinical adoption. VISIA quantitative analysis provides robust objective evaluation, advancing standardization in pigment management.
Higher Neutrophil-Percentage-to-Albumin Ratio Was Associated with Poor Outcome in Endovascular Thrombectomy Patients.
Xu M, Zhai Q, Wei B … +5 more , Chen S, E Y, Huang Z, Qi J, Xu Y
Ther Clin Risk Manag · 2025 · PMID 40308268 · Full text
BACKGROUND AND PURPOSE: The neutrophil percentage-to-albumin ratio (NPAR) is connected with all-cause mortality and stroke-related pneumonia. The purpose of this study was to assess the diagnostic efficacy of NPAR in pre...
BACKGROUND AND PURPOSE: The neutrophil percentage-to-albumin ratio (NPAR) is connected with all-cause mortality and stroke-related pneumonia. The purpose of this study was to assess the diagnostic efficacy of NPAR in predicting functional outcomes at 90 days after endovascular thrombectomy (EVT). METHODS: We retrospective analyzed consecutive patients who underwent EVT at Nanjing First Hospital from October 2019 to June 2024. NPAR was defined as the percentage of neutrophils divided by the albumin levels. An unfavorable outcome was indicated by a modified Rankin Scale score of 3-6 at 90 days. Multivariable logistic regression models were utilized to investigate the association between NPAR and functional outcomes after EVT treatment. RESULTS: A total of 713 patients (mean age, 70.5 ± 11.9 years; 430 males) were finally enrolled for analysis. Among these, 357 (50.1%) patients exhibited unfavorable outcomes at 90 days. Multivariate regression analysis indicated that elevated NPAR levels at admission were independently associated with poor outcome (adjusted odds ratio: 6.921; 95% confidence interval, 4.216-11.363; 0.001) in ischemic stroke patients undergoing EVT. Furthermore, the restricted cubic spline observed a positive and nonlinear association between the NPAR and poor outcome at 90 days ( for linearity=0.001). CONCLUSION: This study indicated that higher NPAR levels were associated an increased risk of poor outcome at 90 days in patients treated with EVT, suggesting that NPAR could serve as a viable prognostic biomarker for ischemic stroke after EVT.
Chronic Khat Chewing Induced High-Grade Hemorrhoidal Disease and Post-Operative Bleeding in Yemen.
Al-Kubati WR
Ther Clin Risk Manag · 2025 · PMID 40303315 · Full text
BACKGROUND: Khat contains alkaloids, tannins, and flavonoids with physiological and pathological effects. In Yemen, anorectal diseases, including hemorrhoids, are prevalent, and hemorrhoidectomy is frequently performed....
BACKGROUND: Khat contains alkaloids, tannins, and flavonoids with physiological and pathological effects. In Yemen, anorectal diseases, including hemorrhoids, are prevalent, and hemorrhoidectomy is frequently performed. PURPOSE: This study evaluates the relationship between chronic khat chewing and high-grade hemorrhoidal disease, as well as post-operative complications such as bleeding and pain. PATIENTS AND METHODS: This prospective cross-sectional study included 1,896 patients aged 16-85 years, meeting the inclusion criteria were included and followed for three months. PATIENTS WERE DIVIDED INTO TWO GROUPS: Chronic khat chewers (n=1,492) and non-khat chewers (n=404) Data included khat habits, clinical assessments, digital rectal exams, anoproctoscopy, intraoperative findings, and post-operative outcomes. RESULTS: Chronic khat chewing was strongly associated with thrombosed grade IV hemorrhoidal disease. Among khat chewers, 90% had hemorrhoids, with 75% requiring hemorrhoidectomy or hemorrhoidopexy, compared to 25% in non-chewers, where half underwent hemorrhoidopexy. The odds ratio (OR) for hemorrhoids in khat chewers was 27.04. Gender-specific analysis showed a six-fold higher OR for hemorrhoids in khat-chewing females versus non-chewing females. Post-operative complications, including bleeding and severe pain, were significantly higher in male khat chewers (p < 0.05), while no significant differences were observed in females. CONCLUSION: Chronic khat chewing is strongly associated with high-grade hemorrhoidal disease and increased post-operative complications. Mechanisms include chronic constipation, increased anal sphincter tone, and prolonged sitting. These findings highlight the need for public health strategies to reduce khat use and tailored clinical approaches to improve outcomes. Future research should focus on establishing causality, identifying confounders, dose-response relationships, and exploring gender-specific management strategies that target both mechanical and pharmacological factors to optimize surgical care and long-term outcomes.
Feasibility and Outcomes of Vessel-Sparing Surgery for Soft Tissue Sarcoma of the Thigh Adjacent to Femoral Vessels.
Yang ZM, Qu H, Wang KY … +7 more , Wu JD, Liu B, Jin LB, Huang X, Lin N, Tao HM, Ye ZM
Ther Clin Risk Manag · 2025 · PMID 40303314 · Full text
OBJECTIVE: This study aims to investigate the feasibility and oncological outcomes of vessel-sparing surgery for soft tissue sarcomas located near the femoral vessels in the thigh. A comparison was made with cases where...
OBJECTIVE: This study aims to investigate the feasibility and oncological outcomes of vessel-sparing surgery for soft tissue sarcomas located near the femoral vessels in the thigh. A comparison was made with cases where the tumor was not adjacent to the femoral vessels, focusing on recurrence rates, survival prognosis, and the viability of vessel-sparing surgical techniques. METHODS: A retrospective analysis was conducted on 211 cases. After well-differentiated liposarcoma were excluded from further analysis, 148 cases involved tumors not adjacent to the femoral vessels, while 22 cases were located near the vessels. Postoperative functional outcomes, survival rates, and local recurrence were evaluated. Due to the imbalance in case numbers between the two groups, propensity score matching was applied at a 1:1 ratio, after which the two datasets were compared and analyzed. RESULTS: By the last follow-up, 40 had experienced recurrence, 35 patients had died, 15 were surviving with tumors, and 161 were living tumor-free. No statistically significant differences were found between the survival and recurrence-free survival curves for cases with sarcomas adjacent to the femoral vessels compared to those with tumors located elsewhere, both before and after propensity score matching. Tumor grade and size were identified as key factors influencing survival and recurrence outcomes in soft tissue sarcoma of the thigh. CONCLUSION: For soft tissue sarcoma of the thigh located adjacent to femoral vessels, vessel-sparing surgery involving vascular sheath removal demonstrates favorable outcomes. Tumor size greater than 10 cm and high pathological grade were significant predictors of survival and recurrence risk.
Advanced Therapies in Elderly Patients With Inflammatory Bowel Disease: A Comparative Retrospective Cohort Study in Taiwan.
Lin SH, Chiu HY, Kuo CJ … +8 more , Chen CM, Su MY, Wu RC, Chiu CT, Chang CW, Chung CS, Pan YB, Le PH
Ther Clin Risk Manag · 2025 · PMID 40303313 · Full text
PURPOSE: Inflammatory Bowel Disease (IBD) predominantly affects younger individuals, but emerging data indicates a shift toward older populations. Elderly-onset IBD (diagnosed at 60 years or older) differs from younger-o...
PURPOSE: Inflammatory Bowel Disease (IBD) predominantly affects younger individuals, but emerging data indicates a shift toward older populations. Elderly-onset IBD (diagnosed at 60 years or older) differs from younger-onset IBD, presenting with atypical symptoms and higher risks of infections and malignancies. However, drug persistence is underexplored in the elderly IBD group, warranting further investigation to optimize treatment strategies for this demographic. PATIENTS AND METHODS: This retrospective cohort study included IBD patients receiving advanced therapies at the Chang Gung IBD Center from October 2017 to September 2023. Patients were stratified into two groups: elderly-onset (≥60 years) and control (<60 years). We compared one-year persistence of advanced therapies, opportunistic infections, IBD-related admissions, complications, surgeries, and acute flare-ups between the groups. Specifically, we analyzed the one-year persistence of various advanced therapies within the elderly-onset cohort. RESULTS: The study included 511 IBD patients, 107 of whom were elderly-onset. Elderly-onset patients had a higher body mass index, a higher proportion of ulcerative colitis, fewer smokers, and lower levels of white blood cells, hemoglobin, and albumin. Differences were noted in Montreal classifications and a higher use of Vedolizumab. Clinical outcomes, including steroid-free remission rates, one-year therapy persistence, infections, complications, surgeries, and flare-ups, were comparable between groups. In Crohn's disease (CD), Infliximab and Ustekinumab exhibited higher one-year persistence. Predictors of one-year therapy persistence included Montreal L1 (OR: 6.722; 95% CI: 1.296-34.852; P=0.023), Ustekinumab use (OR: 5.672; 95% CI: 1.138-28.267; P=0.034), and hemoglobin level (OR: 1.612; 95% CI: 1.210-2.147; P=0.001) with an optimal cutoff of 11.65 g/dL. CONCLUSION: Elderly-onset IBD patients display unique clinical characteristics and therapy persistence, particularly in CD, highlighting the necessity for customized therapeutic strategies.
Association Between Epicardial Adipose Tissue and Contrast-Induced Acute Kidney Injury in Patients with ST-Segment Elevation Myocardial Infarction.
Zang B, Hu W, Chao Y … +1 more , Wang D
Ther Clin Risk Manag · 2025 · PMID 40297064 · Full text
BACKGROUND: Epicardial adipose tissue (EAT) affects the kidneys by secreting various bioactive molecules. Contrast-induced acute kidney injury (CI-AKI) is a common complication after percutaneous coronary intervention (P...
BACKGROUND: Epicardial adipose tissue (EAT) affects the kidneys by secreting various bioactive molecules. Contrast-induced acute kidney injury (CI-AKI) is a common complication after percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients. The relationship between EAT and CI-AKI remains unclear. This study aims to explore the relationship between EAT and the incidence of CI-AKI after PCI in STEMI patients. METHODS: Patients diagnosed with STEMI were continuously included, all patients underwent PCI within 12 hours of onset. EAT volume was measured and obtained by chest CT. Logistic regression analysis was used to analyze possible risk factors for CI-AKI. Restricted cubic splines (RCS) were utilized to explore the dose-response relationship involving EAT and CI-AKI. RESULTS: The incidence of CI-AKI was 8.9% (57/638). Compared with the Non-CI-AKI group, the EAT volume was significantly higher (<0.005). After adjusting for confounding factors, multivariate regression analysis showed FBG, NT-proBNP, LVEF, and EAT volume were the independent predictors for CI-AKI. RCS analysis indicated a linear dose-response relationship between EAT volume and CI-AKI. The integration of EAT volume could significantly improve ability of the model for CI-AKI (NRI 0.4071, 95% CI 0.231 ~ 0.583, < 0.001; IDI 0.1356, 95% CI 0.091 ~ 0.180, < 0.001). CONCLUSION: Higher EAT volume was an independent risk factor for CI-AKI in STEMI patients. Integration of EAT volume could significantly improve the risk model for CI-AKI.
Study on the Combined Application of Occlusal Splint and Intra-Articular Injection of Hyaluronic Acid in the Treatment of Non-Reducible Anterior Disc Displacement of the Temporomandibular Joint.
Bi K, Cheng G, Wu X … +1 more , Lv Z
Ther Clin Risk Manag · 2025 · PMID 40297063 · Full text
OBJECTIVE: To investigate the effect of combining intra-articular injection of hyaluronic acid (HA) with occlusal splint therapy in the treatment of non-reducible anterior disc displacement of the temporomandibular joint...
OBJECTIVE: To investigate the effect of combining intra-articular injection of hyaluronic acid (HA) with occlusal splint therapy in the treatment of non-reducible anterior disc displacement of the temporomandibular joint (ADDWoR). METHODS: A retrospective analysis was conducted on the clinical data of 62 patients with ADDWoR admitted to our hospital from April 2023 to June 2024. According to the treatment method received, patients were divided into a control group (n=31, treated with occlusal splints) and an observation group (n=31, treated with occlusal splints combined with intra-articular injection of HA). The clinical treatment effects, pain levels (Visual Analog Scale [VAS]), temporomandibular joint dysfunction (Friction Temporomandibular Joint Dysfunction Index [CMI]), mandibular movement function (maximum mouth opening [MMO], left lateral excursion [LLE], right lateral excursion [RLE], protrusive movement [PM]), clinical aesthetic indicators (condylar height, joint space width), and adverse reactions were compared between the two groups. RESULTS: (1) Clinical Efficacy: The observation group had a higher total effective rate (90.32% vs 67.74%, P < 0.05). (2) Pain & Dysfunction: Both groups showed significant improvement in VAS and CMI scores over time, with the observation group exhibiting greater reductions (P < 0.05). (3) Mandibular Function & Aesthetic Indicators: The observation group had greater improvements in MMO, LLE, RLE, PM, condylar height, and joint space width (P < 0.05). (4) Adverse Reactions: No significant difference in adverse reaction rates (P > 0.05). CONCLUSION: The combination of intra-articular injection of HA with occlusal splint therapy can further improve the treatment outcomes for ADDWoR patients, alleviate pain, improve temporomandibular joint dysfunction and mandibular movement function, promote aesthetic recovery, and does not increase the risk of adverse reactions.
Association of Diaphragmatic Mobility and Thickening Fraction with Postoperative Pulmonary Complications in Patients Undergoing Thoracic Surgery and Their Application in Prediction.
Aisiaiti A, Ajiaikebaier A, Maimaitiming A … +4 more , Geng Q, He B, Sun J, Zhang B
Ther Clin Risk Manag · 2025 · PMID 40297062 · Full text
PURPOSE: To investigate the association of diaphragmatic mobility and thickening fraction with postoperative pulmonary complications (PPCs) in patients undergoing thoracic surgery and evaluate their values in predicting...
PURPOSE: To investigate the association of diaphragmatic mobility and thickening fraction with postoperative pulmonary complications (PPCs) in patients undergoing thoracic surgery and evaluate their values in predicting PPCs. PATIENTS AND METHODS: One hundred and nine consecutive patients undergoing thoracic surgery were prospectively enrolled. All patients underwent ultrasound measurements to obtain diaphragmatic mobility and thickening fraction. PPCs were systematically monitored and recorded from postoperative day 1 to 7. The binary logistic regression model was used to perform multivariate analysis, and the receiver operating characteristic (ROC) curve was used to evaluate predictive values. RESULTS: PPCs occurred in 46 patients (42.2%). Multivariate analysis identified age, smoking, surgical sites, and mean diaphragmatic mobility and thickening fraction of operated side and nonoperated side as independent risk factors for PPCs. ROC curves revealed that the AUC of mean diaphragmatic mobility and thickening fraction for predicting PPCs in patients undergoing thoracic surgery was 0.722 [standard error (): 0.050, 95% confidence interval (): 0.623~0.821, <0.001] and 0.757 (: 0.050, 95% : 0.659~0.855, <0.001), respectively. The predictive model integrating age, smoking and surgical sites yielded an AUC of 0.810 (: 0.041, 95% : 0.728~0.891, <0.001), while the predictive model integrating age, smoking, surgical sites and mean diaphragmatic mobility or thickening fraction yielded an AUC of 0.849 (: 0.037, 95% : 0.777~0.922, <0.001) and 0.881 (: 0.033, 95% : 0.815~0.946, <0.001), respectively. CONCLUSION: Both diaphragmatic mobility and thickening fraction showed independent associations with PPCs following thoracic surgery, demonstrating moderate predictive values. The predictive models integrating age, smoking, surgical sites and diaphragmatic mobility or thickening fraction yielded high predictive values, suggesting significant clinical utility for risk stratification. Diaphragmatic mobility and thickening fraction offer a bedside, noninvasive, and cost-effective alternative for perioperative PPC prediction, particularly in resource-limited settings.
Comparative Analysis of a New Device-Assisted Mini-Incision Versus Conventional Surgery for Carpal Tunnel Syndrome: A Retrospective Study of 109 Cases.
Guo T, Li C, Tian D … +5 more , Gao R, Yu K, Sun N, Yang J, Bai J
Ther Clin Risk Manag · 2025 · PMID 40290858 · Full text
STUDY DESIGN: A retrospective cohort study. OBJECTIVE: This study aimed to compare the effectiveness and safety of the new device-assisted mini-incision approach for carpal tunnel release (CTR) with the conventional meth...
STUDY DESIGN: A retrospective cohort study. OBJECTIVE: This study aimed to compare the effectiveness and safety of the new device-assisted mini-incision approach for carpal tunnel release (CTR) with the conventional method. METHODS: A total of 109 patients diagnosed with primary carpal tunnel syndrome confirmed clinically were retrospectively included and divided into two groups based on the surgical approach: Group A (n=54) underwent surgery using a new device-assisted mini-incision, and Group B (n=55) received conventional surgery. Clinical outcomes, including pinch strength, grip strength, Visual Analog Scale (VAS) score, two-point discrimination (2-PD), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Boston Carpal Tunnel Questionnaire (BCTQ), were evaluated at 1, 3, and 6 months postoperatively. Additionally, operative time, incision length, wound pain, pillar pain, and the interval until return-to-work were compared between the two groups. RESULTS: At the 6-month follow-up, all patients in both groups had recovered. There were no significant differences between the two groups in postoperative pinch strength ( = 0.665), grip strength ( = 0.803), 2-point discrimination (2-PD) ( = 0.347), Visual Analogue Scale (VAS) score ( = 0.143), Disabilities of the Arm, Shoulder and Hand (DASH) score ( = 0.524), and Boston Carpal Tunnel Questionnaire (BCTQ) (SSS: = 0.195; FSS: = 0.103). Statistically significant differences were observed between the two groups in operation time ( < 0.001), incision length ( < 0.001), and return to work time ( < 0.001). Although at 6-month follow-up, there was no significant difference in the incidence of wound pain and pillar pain between the two groups. But the incidence of wound pain and pillar pain was lower in Group A (wound pain: 0%; pillar pain:0%) compared to Group B (wound pain: 5.5%; pillar pain:7.3%). CONCLUSION: The device-assisted mini-incision technique provided comparable functional results to the conventional approach, with reduced complications and smaller incisions, supporting its use as a viable alternative in appropriate cases.
Posterior Pericardial Window and a Single Pleural Drain: A Dual Defence Against Post-CABG Pericardial Effusion and Atrial Fibrillation.
Ranjan R, Kapetanakis S, Chandrasekaran V … +2 more , Kaba RA, Momin AU
Ther Clin Risk Manag · 2025 · PMID 40255667 · Full text
BACKGROUND: Postoperative new atrial fibrillation (POAF) commonly occurs after coronary artery bypass graft (CABG) and is often associated with postoperative pericardial effusion. We aimed to investigate the effectivenes...
BACKGROUND: Postoperative new atrial fibrillation (POAF) commonly occurs after coronary artery bypass graft (CABG) and is often associated with postoperative pericardial effusion. We aimed to investigate the effectiveness of a posterior pericardial window (PPW) with a single left pleural drain in reducing post-CABG pericardial effusion and atrial fibrillation without mediastinal chest drains. METHODS: This descriptive observational study evaluated age and sex-adjusted isolated elective on-pump CABG patients into two groups: PPW with only left pleural chest drains and control (routine multiple mediastinal and pleural chest drains. We performed continuous telemonitoring for 96 hours after surgery to assess heart rhythm, followed by daily electrocardiograms. Bedside echocardiography was conducted on postoperative day 4 to check for pericardial effusion. RESULTS: This study evaluated age and sex-adjusted 250 CABG patients, with male predominance (80%) and identical comorbidities between study groups. We found similar age (61.5 ±7.5 vs 62.6 ±6.2, P =0.40) and male sex (86.9% vs 74.8%, P =0.13) between the PPW and control groups. Additionally, the sociodemographic and intraoperative variables were the same across the study groups (P >0.05). The occurrence of >1cm pericardial effusions (0.8% vs 14.1%, P <0.001) and postoperative AF (6.9% vs 19.3%, P =0.002) occurrence was significantly lower in the PPW compared to the control group. CONCLUSION: Despite similar clinical and operative profiles, a posterior pericardial window with a single left pleural drain effectively reduces pericardial effusion and the incidence of postoperative AF following CABG surgery.
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