Search

Hospitals within the Veterans Affairs (VA) health care system exhibited growing use of observation care. It is unknown how this affected VA hospital performance since observation care is not included in acute inpatient measures. To examine changes in VA hospitalization outcomes and whether it was affected by shifting acute inpatient care to observation care. Longitudinal analysis of 986,355 acute hospitalizations and observation stays in 11 states 2011 to 2017. We estimated temporal changes in 30-day mortality, 30-day readmissions, costs, and length of stay (LOS) for all hospitalizations and 6 conditions in adjusted models. Changes in mortality and readmissions were compared including and excluding observation care. A 9% drop in acute hospitalizations was offset by a 157% increase in observation stays 2011 to 2017. A 30-day mortality decreased but readmissions did not when observation stays were included (all P

Prior research has identified frailty, comorbidity, and age as predictors of outcomes for patients with coronavirus disease 2019 (COVID-19), including mortality. However, it remains unclear how these factors play different roles in COVID-19 prognosis. This study focused on correlations between frailty, comorbidity and age, and their correlations to discharge outcome and length-of-stay in hospitalized patients with COVID-19. Clinical data was collected from 56 patients who were ≥50 years old and admitted from March 2020 to June 2020 primarily for COVID-19. Frailty Risk Score (FRS) and the Charlson Comorbidity Index (CCI) were used for assessment of frailty and comorbidity burden, respectively. Age had significant positive correlation with FRS and CCI (P

AbstractU.S. Veterans Affairs (VA) patients' multi-system use can create challenges for VA clinicians who are responsible for coordinating Veterans' use of non-VA care, including VA-purchased care ("Community Care") and Medicare.To examine the relationship between drive distance and time-key eligibility criteria for Community Care-and VA reliance (proportion of care received in VA versus Medicare and Community Care) among Veterans at high risk for hospitalization. We used prepolicy data to anticipate the impact of the 2014 Choice Act and 2018 Maintaining Internal Systems and Strengthening Integrated Outside Networks Act (MISSION Act), which expanded access to Community Care.Cross-sectional analysis using fractional logistic regressions to examine the relationship between a Veteran's reliance on VA for outpatient primary, mental health, and other specialty care and their drive distance/time to a VA facility.Thirteen thousand seven hundred three Veterans over the age of 65 years enrolled in VA and fee-for-service Medicare in federal fiscal year 2014 who were in the top 10th percentile for hospitalization risk.Key explanatory variables were patients' drive distance to VA > 40 miles (Choice Act criteria) and drive time to VA ≥ 30 minutes for primary and mental health care and ≥60 minutes for specialty care (MISSION Act criteria).Veterans at high risk for hospitalization with drive distance eligibility had increased odds of an outpatient specialty care visit taking place in VA when compared to Veterans who did not meet Choice Act eligibility criteria (odds ratio = 1.10, 95% confidence interval 1.05-1.15). However, drive time eligibility (MISSION Act criteria) was associated with significantly lower odds of an outpatient specialty care visit taking place in VA (odds ratio = 0.69, 95% confidence interval 0.67, 0.71). Neither drive distance nor drive time were associated with reliance for outpatient primary care or mental health care.VA patients who are at high risk for hospitalization may continue to rely on VA for outpatient primary care and mental health care despite access to outside services, but may increase use of outpatient specialty care in the community in the MISSION era, increasing demand for multi-system care coordination.

The elderly population experiences a decline in upper extremity range of motion (ROM), impairing activities of daily living. The primary mode of quantification is by goniometer measurement. In this cross-sectional observation study, we investigate a sensor-acquired reachable workspace for assessing shoulder ROM decline in an elderly population in comparison to traditional measurements. Sixty-one healthy subjects aged ≥ 65 years were included and compared to a cohort of 39 younger subjects, aged 20 to 64. A sensor acquired reachable workspace using a Kinect motion capture camera measured the maximum reaching ability of both arms while in a seated position, measured in m2 and normalized to arm length to calculate a novel score defined as a relative surface area. This score approximates range of motion in the upper extremity. This measurement was compared to goniometer measurements, including active ROM in shoulder flexion and abduction. Total RSA shows moderate to strong correlation between goniometer in flexion and abduction in the dominant arm (R = 0.790 and R = 0.650, P < .001, respectively) and moderate correlations for the nondominant arm (R = 0.622 and R = 0.615, P < .001). Compared to the younger cohort, the elderly population demonstrated significantly reduced total RSA in the dominant arm (meanelderly = 0.774, SD = 0.09; meanyounger = 0.830, SD = 0.07, P < .001), with significant reductions in the upper lateral quadrant in both arms (dominant: meanelderly = 0.225, SD = 0.04; meanyounger = 0.241, SD = 0.01; P < .001; nondominant: meanelderly = 0.213, SD = 0.03; meanyounger = 0.228, SD = 0.01; P = .004). The test-retest reliability was strong for both dominant and nondominant total RSA (ICC > 0.762). The reachable workspace demonstrates promise as a simple and quick tool for clinicians to assess detailed and quantitative active shoulder ROM decline in the elderly population.

AbstractThe peripheral immune system has a key pathophysiologic role in Frontotemporal degeneration (FTD). We sought a comprehensive transcriptome-wide evaluation of gene expression alterations unique to the peripheral immune system in FTD compared to healthy controls and amyotrophic lateral sclerosis.Nineteen subjects with FTD with 19 matched healthy controls and 9 subjects with amyotrophic lateral sclerosis underwent isolation of peripheral blood mononuclear cells (PBMCs) which then underwent bulk ribonucleic acid sequencing.There was increased expression in genes associated with CD19+ B-cells, CD4+ T-cells, and CD8+ T-cells in FTD participants compared to healthy controls. In contrast, there was decreased expression in CD33+ myeloid cells, CD14+ monocytes, BDCA4+ dendritic cells, and CD56+ natural killer cells in FTD and healthy controls. Additionally, there was decreased expression is seen in associated with 2 molecular processes: autophagy with phagosomes and lysosomes, and protein processing/export. Significantly downregulated in PBMCs of FTD subjects were genes involved in antigen processing and presentation as well as lysosomal lumen formation compared to healthy control PBMCs.Our findings that the immune signature based on gene expression in PBMCs of FTD participants favors adaptive immune cells compared to innate immune cells. And decreased expression in genes associated with phagosomes and lysosomes in PBMCs of FTD participants compared to healthy controls.

The aim of this study was to identify the combinations of chronic comorbidities associated with length of stay (LOS) among multimorbid medical inpatients.Multinational retrospective cohort of 126,828 medical inpatients with multimorbidity, defined as ≥2 chronic diseases (data collection: 2010-2011). We categorized the chronic diseases into comorbidities using the Clinical Classification Software. We described the 20 combinations of comorbidities with the strongest association with prolonged LOS, defined as longer than or equal to country-specific LOS, and reported the difference in median LOS for those combinations. We also assessed the association between the number of diseases or body systems involved and prolonged LOS.The strongest association with prolonged LOS (odds ratio [OR] 7.25, 95% confidence interval [CI] 6.64-7.91, P

Hypothyroidism and chronic kidney disease (CKD) are highly prevalent conditions with a potential mechanistic link. We sought to determine whether hypothyroidism is associated with CKD among a large diverse community-based cohort.A cross-sectional study was performed (January 1, 1990-December 31, 2017) within a large integrated health system. Individuals age ≥55 years of age with outpatient measurements of thyroid stimulating hormone (TSH) and ≥2 serum creatinine values were included. Hypothyroidism was defined as TSH >4 mIU/L and/or receipt of thyroid hormone replacement and further categorized as hypothyroid status: TSH >4 mcIU/mL and attenuated-hypothyroid status: TSH

To assess the intra-individual and inter-individuals biological variation and the effect of aging on lymphocyte T-cells subsets.We assessed lymphocyte phenotypes (CD3, CD4, and CD8 T-cells) in 89 HIV-1-infected and 88 uninfected white non-Hispanic men every 6 months, to examine the biological variation for those measurements, and the average change in lymphocyte phenotype over 34 years.The markers showed significant intra-individuality in HIV-infected and uninfected individuals with index of individuality of

Higher trait optimism and/or lower cynical hostility are associated with healthier behaviors and lower risk of morbidity and mortality, yet their association with health care utilization has been understudied. Whether these psychological attitudes are associated with breast cancer screening behavior is unknown. To assess the association of optimism and cynical hostility with screening mammography in older women and whether sociodemographic factors acted as mediators of these relationships, we used Women's Health Initiative (WHI) observational cohort survey data linked to Medicare claims. The sample includes WHI participants without history of breast cancer who were enrolled in Medicare Parts A and B for ≥2 years from 2005-2010, and who completed WHI baseline attitudinal questionnaires (n = 48,291). We used survival modeling to examine whether screening frequency varied by psychological attitudes (measured at study baseline) after adjusting for sociodemographic characteristics, health conditions, and healthcare-related variables. Psychological attitudes included trait optimism (Life Orientation Test-Revised) and cynical hostility (Cook Medley subscale), which were self-reported at study baseline. Sociodemographic, health conditions, and healthcare variables were self-reported at baseline and updated through 2005 as available. Contrary to our hypotheses, repeated events survival models showed that women with the lowest optimism scores (i.e., more pessimistic tendencies) received 5% more frequent screenings after complete covariate adjustment (p

Data on risk factors predicting rapid progression to end-stage renal disease (ESRD) or short-term kidney function decline (i.e., within 1 year) in chronic kidney disease (CKD) are rare but urgently needed to plan treatment. This study describes the association and predictive value of urinary uromodulin (uUMOD) for rapid progression of CKD.We assessed uUMOD, demographic/treatment parameters, estimated glomerular filtration rate (eGFR), and proteinuria in 230 CKD patients stage I-V. ESRD and 25% decline of eGFR was documented at the end of follow-up period and used as a composite endpoint. Association between logarithmic uUMOD and eGFR/proteinuria was calculated using linear regression analysis, adjusting for age, gender, and body mass index. We performed multivariable Cox proportional hazard regression analysis to evaluate the association of uUMOD with the composite endpoint. Therefore, patients were categorized into quartiles. The predictive value of uUMOD for the above outcomes was assessed using receiver-operating characteristic (ROC) curve analysis.Follow-up was 57.3 ± 18.7 weeks, baseline age was 60 (18;92) years, and eGFR was 38 (6;156) mL/min/1.73 m. Forty-seven (20.4%) patients reached the composite endpoint. uUMOD concentrations were directly associated with eGFR and inversely associated with proteinuria (β = 0.554 and β = -0.429, P

To analyze the short-term effects of air pollution on the hospitalization rates of individuals with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), stroke, and myocardial infarction (MI) after adjusting for confounding factors including weather, day of the week, holidays, and long-term trends in Jinan, China.Hospitalization information was extracted based on data from the primary class 3-A hospitals in Jinan from 2013 to 2015. The concentrations of PM2.5, PM10, SO2, NO2, and O3 were obtained from Jinan Environment Monitoring Center. The relative risk and 95% confidence intervals of AECOPD, stroke, and MI were estimated using generalized additive models with quasi-Poisson distribution in the mgcv package, using R software, version 1.0.136.The incremental increased concentrations of particulate pollutants including PM2.5 and PM10 were significantly associated with increased risk of hospitalization of AECOPD, stroke, and MI, and the adverse influences of PM2.5 on these diseases were generally stronger than that of PM10. The incremental increased concentrations of gaseous pollutants including SO2, NO2, and O3 were significantly associated with increased risk of hospitalization of stroke and MI in this population.Air pollution has significant adverse effects on hospitalization rates of individuals with AECOPD, stroke, and MI in Jinan, China.

Population aging generated changes in the epidemiological profile and culminated in a high frequency of diseases. The objective of this study was estimating the prevalence of multimorbidity and the associated variables in the elderly of an educational program in the Federal District of Brazil. This is a cross-sectional study with data collection carried out during the period from December 2022 to April 2023 by means of telephone calls. Multimorbidity was defined as a concomitant presence of 2 or more noncommunicable chronic diseases. One-hundred fifty individuals aged between 60 and 82 years old participated in the study. The median number of self-reported diseases was 2, ranging from 0 to 9. The estimated prevalence of multimorbidity was 69.3%, being higher among elderly individuals self-reporting their health as regular or bad/or very bad, having systemic arterial hypertension, diabetes mellitus, dyslipidaemia, hypothyroidism, overweight/obesity, and depression, including polypharmacy (P < .05). The high rate of multimorbidity and associated variables shows the importance of an integrated approach on health services focused on promoting health and preventing health impairment to favor the quality of life during aging., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

COVID-19 pandemic was accompanied by many healthcare-related issues. Concrete national data regarding the care performance of critical ill cases of COVID-19 does not exist in Korea. The current study aimed to describe the treatment outcome and healthcare resource utilization of critically ill COVID-19 patients. Our multicenter retrospective cohort study enrolled critically ill COVID-19 patients from 22 tertiary care hospitals in Korea. Inclusion criteria: (1) patients aged 19 years or older, (2) patients with laboratory-confirmed SARS-CoV-2 infection who received at least one of following initial treatments such as high-flow oxygen therapy (HFOT) or noninvasive ventilation (NIV) or invasive mechanical ventilation (IMV) or extracorporeal membrane oxygenation. During the study wave, a total of 1358 eligible participants were enrolled, with 21 institutions participating in the study. Among them, data from 1113 patients were available and analyzed. Of 921 (82.7%), 621 (55.8%) were supported by IMV. Of the 921 patients supported by HFOT or NIV, 438 (47.6%) recovered without IMV, 429 (46.6%) required IMV, and 54 died who DNR after NIV was applied. Prone position ventilation was administered to 163 (33.1%) patients with IMV and 25 (6.2%) patients with HFOT. Extracorporeal membrane oxygenation was administered to 128 (20.6%) patients treated with IMV. The overall mortality rate was 26.4%. In South Korea, mortality rates for patients with severe COVID-19 pneumonia have been shown substantial fatality, with the highest mortality rates observed in wave 3. The increased mortality rate in wave 3 could be associated with the rapid escalation of critically ill COVID-19 patients and the consequent saturation of intensive care unit capacities. Patients received NIV therapy and prone position ventilation more frequently in wave 3 as the number of cases increased., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

To investigate the value of circulating tumor cell (CTC) in cerebrospinal fluid (CSF) by Cyttel-Tech detection in patients with suspected leptomeningeal metastasis (LM) from malignant solid tumors. We collected CSF from 12 patients with suspected LM from malignant solid tumors at our hospital. Twelve milliliters (mL) of CSF were collected from each patient through the first lumbar puncture: 5 mL was for CTC detection by Cyttel-Tech method, 5 mL for CSF cytopathology examination, and 2 mL for cytology and biochemical analysis of the CSF. Additionally, all patients underwent cranial brain magnetic resonance imaging with both plain and contrast-enhanced scans. Among the 12 patients with suspected LM, CTC detection yielded a positivity rate of 11/12 (91.7%). The positivity rate for CSF cytopathology examination was 4/12 (33.3%). However, none of the patients showed positive findings on cranial brain magnetic resonance imaging with both plain and contrast-enhanced scans (0/12, 0%). The difference between CTC detection and cytopathology detection was statistically significant (P < .05). CTC detection may have a high positivity rate in diagnosing LM from malignant solid tumors. It potentially serves as a supplementary diagnostic method for patients with negative pathology results and be used for rapid and accurate adjunctive diagnosis of LM., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) are currently 2 major diagnostic biomarkers for gastric cancer (GC). The aims of study were to detect the expression of long intergenic nonprotein coding RNA 1133 (LINC01133), and to evaluate its diagnostic and prognostic value in GC. Furthermore, the clinical performance of the joint detection of LINC01133, CEA and CA19-9 was also evaluate in GC., Methods: The data were collected from 156 GC, 96 chronic superficial gastritis, 77 chronic atrophic gastritis patients and 89 healthy controls. LINC01133 expression was determined by quantitative real-time PCR. Receiver operating characteristics analysis was used to evaluate the diagnostic value of LINC01133, CEA, CA19-9 individually and jointly. Kaplan-Meier method and log-rank test were used to conduct survival comparison analysis. Cox regression was used to screen the independent prognostic factors for GC., Results: Serum LINC01133 expression was decreased in GC patients compared with chronic superficial gastritis, chronic atrophic gastritis and healthy controls, and had considerable diagnostic potential, and notably, the joint detection of LINC01133, CEA, and CA19-9 showed the highest diagnostic accuracy in distinguishing GC patients from healthy or gastritis patients. LINC01133 expression was associated with GC patients' CEA and CA19-9 levels, tumor size, differentiation, lymph node metastasis and tumor node metastasis stage. Low LINC01133 was associated with poor GC survival, and was an independent prognostic factor for GC., Conclusion: Decreased serum LINC01133 had considerable diagnostic potential, and the joint detection of LINC01133, CEA, and CA19-9 might be a more efficient diagnostic strategy for GC patients. Reduced LINC01133 served as a prognostic biomarker to predict poor GC survival., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Diabetic foot ulcers are characterized by disturbances in the epidermis and/or a portion of the dermis in patients with the disease. With over a million amputations performed annually, it has also emerged as one of the primary causes of lower limb amputation globally. To better understand the severity and anatomical distribution of ulcerated areas in patients with type II diabetes mellitus, this study aimed to identify the factors associated with diabetic foot ulcers (DFUs). This descriptive cross-sectional study was conducted at M Abdur Rahim Medical College Hospital in Dinajpur, Bangladesh, from July to September 2023. The study population was selected using a purposive sampling technique based on the patients' availability during their usual and regular treatment at MARMCH. Using a Bangla questionnaire data was obtained to evaluate the DFUs, in addition to measuring blood pressure and assessing the affected area's neurological function. The severity of the ulcer is calculated by using the Wagner grading system. Data was analyzed by using STATS v15 and chi-square was applied. A total of 113 DFU patients took part in this study. The mean age in years was 56 ± 12 (SD + mean) and the male proportion was greater (61.9%). Most of them (93.91%) were negligent about foot care and suffered from severe DFU (86.37%). The majority of respondents (57.94%) had a right foot ulcer, of which 94.50% had severe ulcers. Almost all ulcers were severe (86.14%) and measured <5 cm in diameter (69.71%). The results highlight the tremendous burden of DFUs, which can have serious consequences and substantial mental and economic effects on patients' healthcare systems., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Helicobacter pylori (H pylori) eradication is expected to effectively prevent gastric cancer (GC). However, GC cases may occur even longer than 10 years after H pylori eradication (L10AE). Moreover, the associated factors and characteristics are unknown. In this retrospective, single-center study conducted between 2017 and 2022, patients with GC diagnosed after H pylori eradication were enrolled and categorized into groups according to whether they were shorter than 10 years after H pylori eradication (S10AE) or L10AE. Patients were also categorized according to the depth of cancer invasion. Clinical data, pathological data, and risk factors were analyzed using logistic regression. Clinicopathological characteristics of GC diagnosed at L10AE and those invading the submucosal tissue or deeper (SMD) were investigated. In total, 202 cases of GC occurring after H pylori eradication were identified. Comparison of 158 S10AE and 44 L10AE GC cases revealed a significantly longer surveillance interval (SI) in L10AE cases (median: 2.0 vs 1.0 years, P = .01). Comparison of 150 intramucosal and 52 SMD GC cases revealed that L10AE GC cases were significantly more frequent amongst the SMD cases (18.0% vs 32.7%, P = .03). Pathologically, undifferentiated and mixed types were significantly more frequent in GC cases with SMD invasion (P < .001). Multivariate analysis revealed that L10AE was significantly related to GC cases with SMD invasion (odds ratio, 2.45; 95% confidence interval, 1.15-5.11; P = .019). SI was significantly longer in GC that developed at L10AE than at S10AE. In addition, GC with SMD invasion was more frequently detected in L10AE than in S10AE. Our data indicated that SI should not be groundlessly extended in patients at L10AE., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

This study investigates the relationship between intraocular pressure (IOP), optical coherence tomography (OCT) parameters, and visual field (VF) outcomes in 'Green' patients-those with normal OCT findings but potential VF abnormalities. Understanding this relationship is crucial for improving early detection and management strategies for glaucoma, especially in patients who show functional loss despite normal structural findings on OCT. A cross-sectional study was conducted at Taipei City Hospital, Renai Branch, Taiwan, from July 1, 2015, to July 1, 2023. Participants were referred for suspected glaucoma and included based on normal OCT parameters ('green' coding) and completed VF tests. Patients with any ocular disease that could confound results were excluded. Logistic regression models were used to assess relationships between IOP, OCT parameters (rim area, disc area, retinal nerve fiber layer thickness, cup-to-disc ratios, and cup volume), and VF outcomes. Age, sex, and IOP status (normal or ocular hypertension) were also included in the analysis. All data were analyzed using Statistical Package for the Social Sciences version 23.0. Larger disc area was a significant predictor of VF abnormalities, with an adjusted OR of 3.72 (95% confidence interval [CI], 1.14-12.15). Neither normal IOP nor ocular hypertension significantly predicted VF loss (adjusted OR = 0.89; 95% CI, 0.27-2.96). Female sex was associated with a higher likelihood of VF abnormalities (adjusted OR = 5.68; 95% CI, 1.03-31.25). Other OCT parameters, including retinal nerve fiber layer thickness and cup-to-disc ratios, were not significantly associated with VF outcomes. Disc area plays a critical role in predicting VF abnormalities in "green" patients, suggesting the importance of integrating disc size into screening and monitoring protocols. These findings challenge the reliance on IOP alone for predicting VF loss and support the need for more comprehensive assessments. Future research should explore longitudinal studies to further assess the predictive value of disc area and investigate additional factors, such as vascular and biomechanical influences, that may contribute to VF deterioration in this population., Competing Interests: The authors have no funding and conflict of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Vitamin D deficiency has been proven to be associated with dyslipidemia. Additionally, the synthesis of vitamin D depends on cytochrome P450 2R1 (CYP2R1). However, the relationship between CYP2R1 polymorphisms and lipid metabolism has shown inconsistent results. A case-control study was conducted in a Han Chinese population, including 92 septic patients and 92 polytrauma patients. Based on serum lipid levels, 28 septic patients were further divided into a hyperlipidemia group, while 64 were placed in the control group; similarly, 34 polytrauma patients were categorized into a hyperlipidemia group and 58 into the control group. Genotyping of CYP2R1-rs10741657 was performed and serum lipid levels were measured. The Genotype-Tissue Expression project was used to assess expression quantitative trait loci for CYP2R1 mRNA expression and rs10741657. The genetic analyses revealed that the G-allele of CYP2R1-rs10741657 was significantly associated with an increased risk of hyperlipidemia in both sepsis (OR = 2.333, 95% CI: 1.227-4.436, P = .010) and polytrauma groups (OR = 4.000, 95% CI: 2.048-7.811, P < .001). Further analysis indicated that the rs10741657 mutation was mainly linked to higher serum high-density lipoprotein cholesterol levels in controls (P < .05). In functional analysis of rs10741657, the mutation was found to be associated with high CYP2R1 mRNA expression in whole blood from expression quantitative trait loci data (P = 3.53 × 10-9). In conclusion, the G-allele of CYP2R1-rs10741657 could elevate high-density lipoprotein cholesterol levels and protect against sepsis development., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

There is a paucity of research and evidence, regarding the effectiveness of applying bipolar pulsed radiofrequency (bPRF) in osteoarthritis of the knee. This study aimed to search for the impact of intra-articular bPRF (IA-bPRF) on pain, functionality, and quality of life in individuals with advanced knee osteoarthritis. A total of 35 patients experiencing knee pain were included in the study. IA-bPRF was applied at 42 °C temperature, 45 V, with a pulse-width of 20 ms and a frequency of 2 Hz for 3 cycles of 120 seconds. Pain severity was evaluated using the numeric rating scale. Assessment tools included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lequesne Algofunctional Index for knee. All measurements were made before the intervention, as well as 2 weeks and 6 months after application of IA-bPRF. Significant improvement was observed in numeric rating scale scores for walking pain from 8.57 ± 0.17 to 4.11 ± 0.35, total WOMAC scores decreased from 75.5 ± 2.71 to 36.7 ± 3.6 and Lequesne Algofunctional Index for knee scores decreased from 18.6 ± 0.70 to 10.4 ± 0.93 by the end of the sixth month (P < .01). WOMAC subgroups for pain, stiffness and functionality, were also significantly lower at the 2nd week and 6th month compared to pre-intervention scores (P < .01). No serious adverse events related to the procedure occurred. IA-bPRF use seems to be safe and effective in relieving pain among individuals with advanced knee osteoarthritis. As a result, with further research, we expect that IA-bPRF may be considered for inclusion in upcoming guidelines for the treatment of chronic pain related to osteoarthritis of the knee., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

The relationship between the alkaline phosphatase-to-albumin ratio (APAR) and mortality remains unclear. This research looked into the association between APAR levels and cause-specific mortality in US adults. A cohort of 7561 participants from National Health and Nutrition Examination Survey (2005-2016) was analyzed, with mortality outcomes collected from National Death Index records. Cox proportional hazards models and restricted cubic spline (RCS) analysis were utilized to determine hazard ratio (HR) and reveal the nonlinear relationship between APAR levels and mortality. Inflection points were calculated using a recursive algorithm. Followed for an average 99.41 months, a total of 1048 deaths occurred, including 200 cancer deaths and 348 cardiovascular disease-related deaths. Following multivariate adjustment, significant associations were observed between APAR levels and increased all-cause (HR 1.50, 95% CI 1.28-1.75, P < .001) and cardiovascular disease (HR 1.39, 95% CI 1.06-1.82, P = .018) mortality. Furthermore, nonlinear correlations between APAR levels and all-cause and cancer mortality were revealed, characterized by an L-shaped pattern, with mortality rates stabilizing at 1.289 and 2.167, respectively. Participants with APAR levels above the inflection point exhibited a 29.2% increase in all-cause mortality risk per unit increase in APAR levels (HR 1.292, 95% CI 1.217-1.372, P < .001), and a 38.3% increase in cancer mortality risk (HR 1.383, 95% CI 1.199-1.596, P < .001). This study demonstrated nonlinear associations between APAR levels and all-cause and cancer mortality. Thresholds of 1.289 and 2.167 might serve as potential targets for APAR to reduce all-cause and cancer mortality, respectively. Our findings suggest that APAR can be a valuable prognostic tool for clinical mortality risk assessments, helping to identify individuals at higher risk. Nevertheless, these findings necessitate validation through large-scale clinical trials for further substantiation., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

A recent randomized controlled clinical trial expanded the time window of intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS) beyond 4.5 hours by applying neuroimaging standards, enabling more patients to benefit from IVT. However, hemorrhagic transformation (HT) after IVT is still a major concern. We aimed to develop a nomogram to predict HT in AIS patients receiving IVT with extended time window. We aimed to develop a nomogram to predict HT in AIS patients receiving IVT with extended time window. Patients with AIS receiving IVT with extended time window from March 2017 to April 2023 were retrospectively reviewed. They were divided into the HT group and the non-HT group based on computed tomography. Logistic regression analysis was used to screen the predictive factors for HT. A nomogram was developed based on the predictive factors. The predictive accuracy of the nomogram was assessed by the area under the curve (AUC) of the receiver operating characteristic curve (ROC). A calibration plot was used to evaluate the calibration of the nomogram. A decision curve analysis (DCA) was used to test the clinical value. A total of 210 patients were enrolled, and 44 patients (21.0%) had HT. Onset to needle time (ONT) (OR = 1.002, 95% CI: 1.000-1.004, P = .016), atrial fibrillation (OR = 2.853, 95% CI: 1.072-7.594, P = .036), and baseline NIHSS (OR = 1.273, 95% CI: 1.159-1.399, P = .000) were predictive factors of HT. The AUC of the nomogram was 0.833 (95% CI: 0.7623-0.9041), with a sensitivity of 78.9% and specificity of 77.3%. The calibration curve indicates that predicted results of the nomogram were in good agreement with the actual observation results. The DCA showed the nomogram had good clinical applicability in predicting HT. We developed an easy-to-use nomogram to predict HT in AIS patients receiving IVT with extended time window. It could be a potential tool to stratify the risk of HT for patients beyond 4.5 hours of onset who may undergo IVT., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

The aim was to investigate the independent risk factors for postoperative recurrence of lumbar disc herniation treated by percutaneous intervertebral laminectomy, and to establish a nomogram prediction model accordingly. Data on patients with lumbar disc herniation were collected from January 2018 to December 2023 in our hospital, and single-factor and multifactorial logistic regression analyses were used to determine the independent risk factors for postoperative recurrence of lumbar disc herniation and establish the corresponding nomogram. The receiver operating characteristic curves were plotted the area under the curve was calculated, and the calibration curves and decision curves were plotted to evaluate the model performance. A total of 644 patients with lumbar disc herniation were included in the study, and 61 patients had a postoperative recurrence, with a recurrence rate of 9.5%. After univariate and multivariate logistic regression model analysis, a total of 7 variables were identified as independent risk factors for postoperative recurrence of lumbar disc herniation: age > 60 years (OR, 3.709; 95% CI, 1.284-10.714), type of nucleus pulposus protrusion as herniation (OR, 7.342; 95% CI, 1.500-35.929), nucleus pulposus degeneration grade III-V (OR, 4.068; 95% CI, 1.214-13.627), operative segment L4-L5 (OR, 5.060; 95% CI, 1.659-15.431), incomplete intraoperative medullary removal (OR, 5.355; 95% CI, 2.017-14.220), and broken fibrous ring (OR, 5.229; 95% CI, 1.235-22.142), and postoperative high-intensity activity (OR, 5.096; 95% CI, 1.420-17.669). The nomogram constructed in this study for postoperative recurrence of lumbar disc herniation treated by percutaneous intervertebral foramenoscopy has good predictive accuracy, which helps orthopedic surgeons to intervene in advance in patients at high risk of postoperative recurrence of lumbar disc herniation treated by percutaneous intervertebral foramenoscopy., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Extracorporeal shock wave therapy (ESWT) has emerged as a contemporary modality in physiotherapy, demonstrating efficacy in addressing musculoskeletal disorders. Despite its potential, the clinical efficacy of ESWT in the context of cervical spondylosis remains understudied, with a dearth of robust empirical evidence. To bridge this gap, the present study was designed to evaluate the therapeutic impact of focused ESWT (fESWT) on pain alleviation and functional improvement in individuals afflicted with cervical spondylosis., Method: A multicenter, randomized controlled clinical study was conducted, collecting data from 5 clinical studies on the treatment of cervical spondylosis with fESWT from June 2021 to March 2024. The inclusion criteria were patients diagnosed with cervical spondylosis, aged 20 to 70, without severe underlying diseases such as heart disease, hypertension, diabetes, etc. The exclusion criteria included pregnant women, nursing women, patients with bleeding tendencies, or those with cardiac pacemakers. The control group underwent a sham fESWT, while the experimental group received fESWT administered via the Duolith SD1 Tower device. The main observation indicators included the Visual Analogue Scale (VAS) for pain scoring, Neck Disability Index (NDI) scoring, cervical range of motion (ROM) scoring, and the Short Form-36 (SF-36) quality of life survey scoring., Results: A total of 320 subjects were included in the study, with 160 in the experimental group and 160 in the control group. Post-treatment, the VAS and NDI scores in the experimental group were significantly lower than those in the control group (P < .05), while the cervical range of motion (ROM) and SF-36 scores were significantly higher than in the control group (P < .05). The overall treatment efficacy rate in the experimental group exceeded 90%, markedly higher than the approximately 70% rate in the control group (P < .05). There was no significant difference in the incidence of adverse reactions between the 2 groups., Conclusion: The fESWT has shown promising therapeutic effects in the treatment of cervical spondylosis. It effectively reduces patient pain, improves cervical function, and enhances the quality of life, making it worthy of clinical promotion and application., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

This study was intended to determine whether rapid rehabilitation nursing can enhance postoperative rehabilitation and life quality for breast cancer (BC) patients. One hundred seventy-two patients with BC treated in our hospital from March 2020 to September 2022 were included in this retrospective study and divided into the observation group (n = 86) and control group (n = 86) based on the different nursing methods that they received. The control group accepted routine nursing care, and the observation group accepted rapid rehabilitation nursing intervention. The amount of intraoperative blood loss, anesthesia awake time, postoperative drainage tube removal time, postoperative time of getting out of bed, length of hospital stays, incidence of postoperative complications, and postoperative recovery rate of affected limb, Barthel index and quality of life instruments for cancer patients: breast cancer (QLICP-BR) of BC patients were analyzed. The amount of intraoperative bleeding in the observation group was less, and the difference was statistically significant (P < .05). The awake time of anesthesia, the time of pulling out the drainage tube after operation, the time of getting out of bed after operation and the time of hospitalization in the observation group were significant shorter (P < .05). The incidence of postoperative complications in the observation group was notably lower (P < .05). The excellent and good rate of postoperative rehabilitation of the affected limbs in the observation group was notably higher (P < .05). Before nursing, there exhibited no notable difference in the scores of Barthel index (P > .05). After 10 days of nursing, the score of Barthel index in the observation group was notably higher (P < .05). After 10 days of nursing, the QLICP-BR score of the observation group was significant higher (P < .05). Rapid rehabilitation nursing is beneficial to reduce the intraoperative blood loss of BC patients, shorten the recovery time of anesthesia, promote the excellent and good rate of rehabilitation of affected limbs, and improve the quality of life., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Empirical antibiotic prescription guidelines were developed at the University Medical Center Ho Chi Minh City in 2020, which included recommendations for the use of antibiotics to treat diabetic foot infections (DFIs). This study investigated the treatment outcomes when implementing empirical antibiotic guidelines. This retrospective study included 120 inpatients with DFIs at the Department of Endocrinology, University Medical Center Ho Chi Minh City. This study had 2 periods (before and after implementation of hospital antibiotic guidelines): Period 1 from July 2019 to June 2020 and Period 2 from July 2021 to June 2022, with 60 random patients in each period. Treatment outcomes were assessed as follows: improvement (defined as the absence of fever and a white blood cell count within the normal range) at 72 hours and 7 days; duration of hospitalization; and clinical status at hospital discharge. After implementing empirical antibiotic guidelines, a greater proportion of improvement in the first 7 days of hospitalization (75.0% vs 56.7%, P = .03), and a shorter median duration of hospitalization (12.5 days vs 15.0 days, P = .02) were observed in patients with DFIs. All the patients showed improvement at the time of hospital discharge. The study findings revealed the encouraging effects of implementing empirical antibiotic prescription guidelines for DFI treatment., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Clonal hematopoiesis (CH), which is characterized by variants of hematopoietic stem cells, increases the risk of subsequent myeloid neoplasms (MNs). This study aimed to investigate the prevalence and characteristics of CH variants in breast cancer (BC) patients treated with cytotoxic therapy (CT), focusing on those who developed MNs after cytotoxic therapy (MN-pCT). We retrospectively analyzed 107 BC patients from a biobank and sequenced peripheral blood and bone marrow samples from 31 CH-associated genes at 2 time points. We analyzed changes in CH for paired samples: T0 to T1 (before and after CT) and T1 to T2 (after CT vs greater CT exposure). Additionally, we compared CH variants in patients with and without MN-pCT. 29% of patients harbored CH variants that were restricted to 8 genes and DNMT3A was the most frequent variant. Among 54 patients with paired samples (T1 to T2), the variant allele frequency (VAF) of CH variants significantly increased after greater CT exposure (P = .02). However, there were no significant changes in VAF before and after CT. Five of the 9 patients who developed MN-pCT harbored CH variants. TP53 was the most frequently mutated gene, but it did not significantly affect MN-pCT risk compared to patients without CH variants. Although the presence of CH did not directly predict MN-pCT development in patients with BC, CT induced changes in CH genes. Further studies are required to determine the role of specific CH variants in the risk of MN-pCT and their potential as predictive biomarkers., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

The increasing use of electric scooters (e-scooters) has been accompanied by an increase in the number of traumas. Noncompliance with regulations and the effectiveness of legal measures remain subjects of ongoing debate. This study aimed to investigate the demographic characteristics of patients with e-scooter-related orthopedic injuries, temporal distribution of trauma, and patterns of these injuries. We retrospectively evaluated 534 patients with e-scooter-related injuries who were referred to the Department of Orthopedics and Traumatology between January 2020 and October 2023. Variables such as patient sex, age, time of trauma, type of hospital transfer, mechanism of trauma, injury location and type, accompanying head trauma in extremity injuries, and treatment approach were recorded. Temporal analysis was performed by hour, day, month, season, and weekday versus weekend. The majority of patients were male (80.0%), with injuries most common in the 25 to 39 age group (33.7%). Trauma was frequent in the summer (45.7%), especially in July (16.5%), with most hospital visits occurring on Fridays (18.2%) and weekends (32.2%). Blunt soft tissue injuries (47.3%) and fractures (42.4%) were prevalent, particularly in the elbow (18.4%), wrist (16.9%), and knees (14.3%). A total of 247 fractures were identified, with the radial head (17.0%) and distal radius (10.9%) being the most common fractures. Fracture rates have increased in 2022 and 2023 compared to those in previous years. While 86.0% of patients received nonsurgical treatment, 14.0% underwent surgery, with a rise in surgical cases in 2022 and 2023. Elbow (19.0%), knee (16.7%), and wrist (16.7%) were the most frequent surgical sites. The increasing use of e-scooters among young people has increased trauma cases, with a growing proportion of fractures over time. The higher incidence of injuries, particularly in the elbow and knee joints, underscores the importance of protective equipment. Therefore, additional legal regulations can help to prevent such injuries., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

During retrograde autologous priming (RAP), some patients develop hypotension and hemodynamic instability, which impedes the procedure. This study aimed to demonstrate the effects of RAP on transfusion requirements and the development of hemodynamic instability. Overall, 443 patients who were operated upon for coronary artery bypass surgery (CABG) between January 2017 and December 2022 were enrolled and examined, including 162 who underwent RAP (RAP group) and 281 who did not (non-RAP group). Further, data regarding demographic characteristics, preoperative and intraoperative characteristics, and postoperative outcomes of both groups were analyzed. The demographic characteristics and intraoperative data were similar between both groups. Meanwhile, the amount of intraoperative and postoperative blood transfusion and postoperative drainage was lower in the RAP group than in the non-RAP group (P = .001 and .001, respectively). The length of intensive care unit (ICU) stay was shorter in the RAP group, whereas the length of overall hospital stay was the same in both groups. In 17% of the RAP patients, the procedure was terminated following hemodynamic instability. Further, regression analysis revealed body surface area (BSA) and baseline central venous pressure (CVP) as risk factors for the development of hemodynamic instability. In the receiver operating characteristic (ROC) curve analysis, the cutoff values for BSA and CVP were found to be 1.73 (sensitivity = 84.2%, specificity = 80.3%, the area under the ROC curve [AUC] = 0.905) and 4.5 (sensitivity = 97.7%, specificity = 99.7%, AUC = 0.994), respectively. Our finding suggest that RAP is associated with a reduction in the requirement in blood transfusion during both intra-and postoperative periods, as well as a decrease in postoperative drainage. Additionally, the risk of hemodynamic instability during RAP appears to be minimal in patients with a body surface area (BSA) >1.73 and a baseline CVP exceeding 4.5., Competing Interests: The author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

This study investigates the efficacy and safety of transurethral prostate laser resection (HoLEP) with preservation of the urethral mucosa from the bladder neck to the tip of the prostate for the treatment of benign prostatic hyperplasia (BPH). A retrospective study was conducted on 208 patients with BPH treated at our hospital. In the control group, the urethral mucosa from the bladder neck to the tip of the prostate was not retained during surgery to ensure maximum removal of possible diseased tissue. The urethral mucosa was preserved in the observation group, which was finely separated to avoid injury, in order to protect urinary control function to the greatest extent and reduce postoperative complications. The surgical-related indicators, urinary function, sexual function, quality of life (QOL), and occurrence of postoperative complications were compared between the 2 groups of patients. After the procedure, both groups of patients experienced an increase in maximum flow rate and a decrease in residual urine volume (P < .05). The observation group showed a higher immediate postoperative urinary continence rate of 98.23% compared to 85.26% in the control group (P < .05). After the procedure, both groups of patients exhibited a significant increase in International index of erectile function-5 scores (P < .05). The retrograde ejaculation rates were compared between the 2 groups of patients before the procedure (P > .05). After the procedure, the occurrence rate of retrograde ejaculation decreased in both groups of patients, with the observation group being lower than the control group (P < .05). The International prostate symptom score (IPSS) scores and QOL scores were compared between the 2 groups of patients before and after the procedure (P > .05). After the procedure, both groups of patients showed a decrease in IPSS scores and QOL scores compared to before the procedure (P < .05). The occurrence of complications such as urethral injury, urinary incontinence, urinary retention, and postoperative bleeding was compared between the 2 groups of patients (P > .05). The efficacy and safety of performing HoLEP treatment for BPH patients with preservation of the urethral mucosa from the bladder neck to the tip of the prostate are comparable to those without preservation. However, it can improve immediate urinary continence rate and reduce retrograde ejaculation rate., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

This retrospective cohort study aimed to examine changes in coronary blood flow before and after post-dilation following primary percutaneous coronary intervention (PPCI) in patients with ST-segment elevation myocardial infarction (STEMI). 419 eligible patients who underwent PPCI due to STEMI between January 2019 and September 2023 were enrolled. The corrected thrombolysis in myocardial infarction frame count (CTFC), final quantitative coronary angiography, and the incidence of no-reflow and slow-flow during different procedure moments were assayed. The changes in coronary blood flow before and after post-dilation in the post-dilation group were analyzed. Among the 419 patients enrolled, 259 patients underwent post-dilation. The post-dilation procedure was more frequently performed in patients with calcium plaque present, longer stents, bigger-diameter stents, and overlapping stents. The incidence of final no-reflow and slow-flow in the post-dilation group was not significantly higher than that observed in the non-post-dilation group. In contrast post-dilation patients had significantly increased CTFC values by 3.54 ± 10.54 frames (P < .001) and the rate of no-reflow/slow-flow increased on average by 114% (P < .001) in comparison to patients not undergoing post-dilation. The receiver operating characteristic curve showed that if post-dilation was performed in patients when their after-stent CTFC was smaller than 23.25, no-reflow/slow-flow was less likely to occur (63.5% sensitivity, 88.8% specificity, [AUC]: 0.817, 95% CI: 0.749-0.886, P < .001). Post-dilation exacerbates the coronary blood flow and increases the incidence of no-reflow/slow-flow during PPCI for STEMI patients, except where after-stend CTFC values were <23.25., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Following improved accessibility to medical services, the phenomenon of polypharmacy in elderly patients with comorbidity has been increasing globally. Polypharmacy patients are prone to drug interactions, adverse drug reactions, and even the risk of death etc. Therefore, there is an urgent need to fully understand the current status and characteristics of drug use in elderly patients with chronic diseases, focusing on polypharmacy factors to ensure that medications for elderly patients are effective and safe. To collect and analyze the characteristics of the current drug use situation in elderly patients with chronic diseases in Chongqing and further explore the influencing factors for polypharmacy, providing references for formulating more effective and safe medication regimens for elderly patients. Most elderly patients affected with chronic diseases in Chongqing were willing to go to hospitals or pharmacies to buy medicines. However, they were not familiar with their disease conditions and drug-related adverse reactions and could not be regularly followed up or monitored. The number of diseases, medications, and adverse drug reactions increased with the increasing age of elderly patients. The problem of irrational use of drugs in elderly patients with chronic diseases was relatively prominent, especially the use of traditional Chinese medicines. The medication situation in elderly patients with chronic diseases was not optimistic, and the problem of polypharmacy was relatively prominent. Further large-scale studies are needed to provide a certain reference for improving the current status of drug use in elderly patients., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Metabolic syndrome is a major public health problem worldwide and an independent predictor of cardiovascular disease in patients with type 2 diabetes (T2DM). This study aimed to determine the prevalence of metabolic syndrome and its individual components among Jordanian patients with T2DM. A cross-sectional design was conducted among T2DM patients at the National Center for Diabetes, Endocrinology and Genetics in Jordan. Data were collected using a structured questionnaire and clinical data extracted from medical records. The National Cholesterol Education Program-Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) diagnostic criteria were used to define metabolic syndrome. Among 1017 participants aged between 22 and 90 years, the overall prevalence of IDF defined metabolic syndrome was 84.2% (72.5% and 96.2% among males and females, respectively). Using ATP III criteria, overall prevalence was 79.1% (77.4% and 80.8% among males and females, respectively). Advancing age, female gender, nonadherence to a diet regimen, sedentary lifestyle or insufficient physical activity, and duration of diabetes ≥10 years were significantly associated with increased odds of metabolic syndrome, regardless of the definition used. Current smoking status and family history of cardiovascular diseases were significantly associated with increased likelihood of ATP III defined metabolic syndrome. The prevalence of metabolic syndrome among Jordanian patients with T2DM is extremely high. The main modifiable risk factors of metabolic syndrome among these patients include nonadherence to a diet regimen, insufficient physical activity, being overweight/obese and smoking. It is recommended that healthcare providers counsel patients on the importance of maintaining physical activity, smoking cessation, and adherence to a diet regimen., Competing Interests: The authors have no funding and conflict of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

This retrospective study aimed to investigate differences in clinical characteristics between different antibody phenotypes in patients with dermatomyositis (DM). Two hundred and ninety-three patients with DM were included in this study from September 2018 to September 2023. We collected basic clinical data from the patients, using statistical methods to analyze the clinical characteristics, and used survival analysis and COX regression to assess the prognosis of the patients. In the 293 patients, the antibody distribution was as follows: antibody negative (50, 20.3%), anti-melanoma differentiation-associated gene 5 (MDA5) antibody (104, 42.3%), anti-transcription intermediary factor γ (TIF-γ) antibody (41, 16.7%), anti-complex nucleosome remodeling histone deacetylase (Mi2) antibody (28, 11.4%), anti-nuclear matrix protein 2 (NXP2) antibody (19, 7.7%), anti-small ubiquitin-like modifier activating enzyme (SAE) antibody (4, 1.6%). Interstitial pneumonia (P < .001), lung infection (P < .001), respiratory symptoms (P < .001), arthralgia (P < .001), and fever (P < .001) were more likely to be seen in patients with anti-MDA5 antibody. Malignancy (P < .001) and V-sign (P = .017) were more likely to occur in anti-TIF1-γ antibody positive patients. Anti-NXP2 antibody-positive patients showed more symptoms of muscle involvement, such as myasthenia (P = .002), myalgia (P = .003) and dysphagia (P = .001). In the analysis of prognosis, age at onset (hazard ratio = 1.096, 95% CI: 1.064-1.129, P < .001), fever (hazard ratio = 2.449, 95% CI: 1.183-5.066, P = .016), γ-glutamyl transferase level (hazard ratio = 1.005, 95% CI: 1.002-1.008, P < .001), eosinophil level (hazard ratio = 0.000, 95% CI: 0.000-0.324, P = .024), and complement 3 (C3) level (hazard ratio = 0.115, 95% CI: 0.023-0.575, P = .008) had a statistically significant effect on survival time. The clinical features of DM are associated with myositis-specific antibodies. At the same time, advanced age, fever, elevated γ-glutamyl transferase levels, and reduced C3 and eosinophil levels may be associated with poor prognosis in patients with DM. These data may provide useful information for clinical management of patients with DM., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Surgical resection is the cornerstone of treatment for locally advanced gastric cancer (LAGC). Hence, downstaging of the tumor with neoadjuvant therapy is critical for R0 resection and prolongs the overall survival. Data from related studies are lacking, and the literature is scarce. Therefore, a single arm-study was performed on PD-1 inhibitor and apatinib plus S-1 and oxaliplatin as neoadjuvant chemotherapy for patients with LAGC. The findings are expected to serve as a reference for neoadjuvant therapy for LAGC. We assessed 130 LAGC patients using PD-1 inhibitor, apatinib plus S-1, and oxaliplatin as neoadjuvant chemotherapy from January 2021 to October 2022. A total of 104 patients received gastric transcatheter chemoembolization (GTC). The primary endpoint was the rate of clinical complete response, pathological complete response, and safety, while the secondary endpoints were the R0 resection rate and objective response rate of the disease and the disease control rate. A total of 130 patients completed the clinical assessment, of which 6 patients (4.6%) achieved clinical complete response, 87 patients (66.9%) achieved partial response, 30 patients (23.0%) achieved stable disease, and 7 patients (5.5%) experienced progressive disease. The overall response rate was 71.5% (93/130), and the disease control rate was 94.5% (123/130). A remarkable downstaging effect was observed in this study. Downstaging of the T stage and N stage was achieved in 71.5% and 80% of the patients, respectively, which translated into a high R0 resection rate. The findings revealed that 125 patients underwent R0 resection, and the R0 resection rate was 96.1%. According to the observed results, 21.6% of the patients achieved pathological complete response after neoadjuvant chemotherapy. Gastric transcatheter chemoembolization in the first cycle of neoadjuvant therapy was beneficial for tumor regression (P < .001). All adverse events were relieved and disappeared after symptomatic treatment, and no grade 4 adverse events were noted. PD-1 inhibitor and apatinib plus S-1 and oxaliplatin are safe and effective as neoadjuvant treatment of LAGC. Gastric transcatheter chemoembolization is useful for tumor regression during neoadjuvant therapy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

This study aimed to discuss the clinical value of health education using an animated video for postoperative patients with digital subtraction angiography (DSA)-guided implantable venous access ports. Retrospective study. Based on expert consensus and clinical experience, we created an animated video presenting postoperative health education for patients to watch after infusion port implantation and uploaded it to a multimedia room. A total of 93 patients who underwent DSA-guided implantable venous access port placement at our hospital from March to June 2022 and from July to October 2022 were selected. Forty-six patients who received traditional oral and written education from March to June 2022 were selected as the control group. Forty-seven patients who received animated video-assisted health education from July to October 2022 were selected as the experimental group. The time spent on health education and patients' awareness of the educational content were compared between the 2 groups. The time spent on health education in the experimental group was 3.51 ± 0.62 minutes, which was less than that of the control group, 6.76 ± 1.14 minutes (t = 17.07, P < .001). Patients' awareness of educational content in the experimental group was 8.62 ± 1.26 points, which was significantly better than the control group's 7.26 ± 1.63 points (t = -4.490, P < .001). Animated video-assisted health education can enable patients to gain a better understanding of educational content in a shorter time. Moreover, it can improve nurses' interventional efficiency. Therefore, this health education method is worthy of clinical promotion., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Cardiovascular disease has become to the main cause of death in the patients with end-stage renal disease (ESRD), and anemia is associated with increased cardiovascular morbidity and mortality in these patients. This study aimed to explore the impact of anemia on myocardial fibrosis using T1 mapping technique in patients with ESRD. A total of 128 subjects including 98 ESRD patients (65 with anemia, 33 without anemia) and 30 normal controls were enrolled. All subjects were underwent cardiovascular magnetic resonance to obtain cardiac cine and T1 mapping images. As potential markers of fibrosis, native T1 values and global longitudinal strain derived by feature-tracking technique were compared. Differences between 3 groups were analyzed using one-way analysis of variance. Associations between variables were assessed by Pearson and Spearman correlation coefficient appropriately. An independent association was identified by the multiple stepwise linear regression analysis. Intraclass correlation was applied to assess observer variability. In all ESRD patients, native T1 values were significantly longer than those of normal controls (global T1, 1357 ± 42 ms vs 1275 ± 48 ms, P < .001). Global T1 value in ESRD patients with anemia was significantly higher (1375 ± 36 ms) compared to that in ESRD patients without anemia (1322 ± 25 ms) and normal controls (1275 ± 48 ms), respectively (all P < .001). Global T1 correlated with hemoglobin negatively (R= -0.499, P < .001). Multiple stepwise linear regression analysis presented the anemia is independently associated with global T1 (R = 0.607, P < .001). Global longitudinal strain was remarkably reduced in ESRD patients with anemia in comparison to those without anemia (P < .001). Diffuse myocardial fibrosis could be detected by native T1 mapping in ESRD patients with long-term anemia. Anemia is an important factor in myocardial fibrosis in ESRD patients, and the evaluation of myocardial involvement is worth considering for clinical management., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

This research seeks to examine the correlation between the triglyceride-glucose index and the hazard of all-cause and cardiovascular death in individuals with cardiovascular disease (CVD). By evaluating the index, we can better anticipate and assess the risk and prognosis of CVD patients, and provide precise and individualized guidance for clinical treatment and management. Demographic and clinical data of 2185 CVD patients from 10 cycles of the National Health and Nutrition Examination Survey database from 1999 to 2018 were extracted for analysis. Employed the 3-level quantile method to group data, and a multivariate Cox proportional hazard model along with subgroup analysis to study the correlation between index and both mortalities. Additionally, restricted cubic spline examination was employed to assess the correlation, aiming to enhance the comprehension of their interrelation. Over the course of an average post-observation duration of 89.5 months involving 2185 CVD individuals, 607 patients suffered from all-cause mortality and 313 patients suffered from CVD-related mortality. An inverted U-shaped correlation was identified through restricted cubic spline analysis. During the multivariate COX regression analysis, it was found that individuals in the T2 and T3 had a dramatically lower hazard of both mortalities as opposed to those in the T1. The results were overall consistent across subgroup analyses according to age, gender, race, body mass index, diabetes, and hypertension, the interaction between these characteristics and the index was not remarkable (P > .05). Studies conducted on CVD individuals in the US have revealed a U-shaped correlation between triglyceride-glucose index and hazard of both all-cause and CVD-related death. However, further investigations are required to examine the particular function of index in forecasting the prognosis of CVD individuals. This will be helpful in accurately evaluating the risk and prognosis of CVD patients, and ultimately in developing more precise and personalized treatment and management strategies., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

The presence of patients who leave without being seen (LWBS) by a physician in the emergency department (ED) is an essential indicator of the accessibility and quality of healthcare delivery. A high LWBS rate implies low patient satisfaction. This study aims to analyze the prevalence and characteristics of LWBS patients in Türkiye and their ED readmission rate within 3 days. This retrospective, single-center, observational study was conducted in the ED of a Turkish tertiary university hospital. It looked at patients who left without being evaluated by a physician admitted to the ED between June 01, 2021, and June 01, 2023. Data on age, gender, residential area, health insurance status, ED readmission within 3 days, complaints, and hospitalization were obtained through the hospital's electronic record system. The prevalence of LWBS patients was 0.43%. Only 0.6% (n = 5) of LWBS patients had no health insurance. About 12.8% (n = 99) of them were 65 years and older. About 10.2% (n = 79) of LWBS patients were readmitted to the ED within 72 hours. The most common reason for readmission was musculoskeletal system complaints. Statistically, ED readmission was significantly more common in older adults (P = .05). Older LWBS patients are more likely hospitalized upon return visits to the ED (P = .014). LWBS patients are both a result and a consequence of ED crowding. A zero LWBS rate is crucial for older adults' health as they may fall victim to an invisible accident while avoiding ED traffic. Prioritizing older adults and reorganizing waiting areas can reduce ED crowding and cost burden due to delayed treatments., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

This study aimed to develop and validate a clinical risk model based on clinical factors to predict prognosis in patients with wake-up stroke (WUS) after multimodal magnetic resonance imaging combined with recombinant tissue plasminogen activator intravenous thrombolysis. The study enrolled 263 patients with WUS, who were divided into the training (n = 162) and validation cohorts (n = 101). In the training cohort, patients were stratified based on modified Rankin Scale (mRS) score at 90 days after thrombolysis, with mRS ≤ 2 indicating a good prognosis (n = 117), and mRS > 2 indicating a poor prognosis (n = 45). Multivariate regression analyses were employed to identify independent risk factors and develop clinical risk models. The performance and stability of the clinical risk model were evaluated using receiver operating characteristic analysis and Hosmer-Lemeshow test. The clinical risk nomogram was constructed based on this model, and evaluated using decision curve analyses. Patients with poor prognosis showed a higher proportion of hyperlipidemia and diabetes and showed a higher levels of National Institute of Health Stroke Scale (NIHSS) at admission, NIHSS at 24 hours, triglyceride, and total cholesterol. Diabetes (odds ratio [OR] = 3.823), hyperlipidemia (OR = 7.361), NIHSS at admission (OR = 5.399), NIHSS at 24 hours (OR = 2.869), triglyceride (OR = 13.790), and total cholesterol (OR = 9.719) were independent predictors of poor prognosis in patients with WUS. Hosmer-Lemeshow test showed that the clinical risk model had a good fit in the training (χ2 = 19.573, P = .726) and validation cohorts (χ2 = 19.573, P = .726). The clinical risk model had an area under the curve value of 0.929 (95% confidence interval, 0.886-0.978) in the training cohort and 0.948 (0.906-0.989) in the validation cohort. The decision curve analysis indicated clinical risk nomogram has application value. The clinical risk model can effectively predict WUS prognosis outcomes., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Diverticular disease is a common condition that has numerous complications. Understanding the impact of diabetes mellitus (DM) on these complications, especially diverticulitis, is crucial for optimizing patient care. This study aimed to determine the relationship between type II DM and the complications of colonic diverticulitis. A retrospective cohort study was conducted on 158 patients complaining of diverticulitis at Asir Central Hospital, Abha, Saudi Arabia, between January 2013 and December 2023. Data on gender, age, and chronic diseases, especially DM, were collected. Data retrieved regarding diverticulitis included the involved segment, complications, Hinchey classification, and management. We classified the patients into groups A for nondiabetics and B for diabetics. We analyzed the data using descriptive statistics, chi-square tests, t tests, and analysis of variance. Diabetic patients were significantly older than their nondiabetic counterparts. Diabetic patients showed a significantly higher complication rate (62.5%) and a higher degree of Hinchey classification compared to nondiabetic patients (43.7%). Furthermore, in comparison to individuals without diabetes, they were hospitalized for a considerably extended period (8.06 ± 7.38 days vs 5.26 ± 5.90 days, respectively). In addition, surgical intervention was observed to be considerably more common in patients with diabetes (46.9%) than in those without diabetes (16.5%). The study showed that DM adversely affected patients with diverticulitis. A greater incidence of complications and a higher category of Hinchey classification were associated with DM compared to nondiabetics. Additionally, diabetics underwent more surgical interventions and had longer hospital stays. Diabetics with diverticulitis require particular care to prevent severe complications., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Patients with dialysis are at high risk of reoperation after lumbar spinal fusion surgery. However, the risk of reoperation after short-segment (≤2 fusion levels) lumbar spinal fusion surgery in this patient group has not been completely investigated. This study aimed to compare the risk of reoperation after short-segment lumbar spinal fusion surgery between patients with dialysis and matched controls without dialysis. We retrospectively evaluated 85 patients who underwent short-segment lumbar spinal fusion surgery at a single institution. Based on the current dialysis treatment, patients were divided into the non-dialysis and dialysis groups. We compared the patients' characteristics, surgical data, pre- and postoperative radiographic measurements, locomotive functional levels in activities of daily living (ADL), rate of whole reoperation, and cause-specific incidence of reoperation such as adjacent segmental disease (ASD) and implant failure between the non-dialysis and dialysis groups. Then, these variables were compared after adjusting for age, sex, and body mass index (BMI) via a propensity-score-matched analysis. In total, 68 patients in the non-dialysis group and 17 patients in the dialysis group were included in this study. The dialysis group was significantly younger and had a lower postoperative ADL status than the non-dialysis group. Moreover, the dialysis group had a significantly higher rate of whole reoperation (8.8% vs 41.2%, P = .003), reoperation due to ASD (4.4% vs 23.5%, P = .027), and reoperation due to implant failure (0.8% vs 11.8%, P = .038) than in the non-dialysis group. Based on a propensity-score-matched analysis, the dialysis group had a significantly higher rate reoperation rate after short-segment lumbar spinal fusion surgery than the non-dialysis group (0.0% vs 58.3%, P = .005). The current study firstly clarified that patients with dialysis are at significantly high risk of reoperation even after short-segment lumbar spinal fusion surgery., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

To investigate the clinical characteristics, treatment methods, and factors influencing the prognosis of patients with severe pneumonia complicated by Acute Respiratory Distress Syndrome (ARDS), aiming to provide references for clinical decision-making and improve patient outcomes. A retrospective analysis was conducted on 118 patients with severe pneumonia complicated by ARDS treated at our hospital from June 2018 to December 2022. Based on treatment outcomes, patients were divided into a death group (n = 75) and a survival group (n = 43). General data and clinical laboratory indicators, including blood urea nitrogen, serum creatinine, C-reactive protein, procalcitonin, arterial partial pressure of oxygen, and arterial partial pressure of carbon dioxide, were collected and compared between the 2 groups to identify independent factors affecting prognosis. Among the 118 patients, the mortality rate was 63.56%. Patients in the death group had a significantly higher average age (57.15 ± 13.38 years) and a higher proportion of severe ARDS (66.67%) compared to the survival group (40.02 ± 11.41 years, 30.23%, P < .001). The death group had significantly lower white blood cell counts (8.10 ± 1.64 × 109/L), oxygenation index (19.82 ± 2.29), and duration of mechanical ventilation (7.79 ± 2.11 days) compared to the Survival group (8.92 ± 1.22 × 109/L, 13.42 ± 1.82, 12.23 ± 3.05 days, P < .05). Conversely, the death group had significantly higher levels of blood urea nitrogen (6.87 ± 1.80 mmol/L), C-reactive protein (130.55 ± 50.28 mg/L), procalcitonin (5.50 ± 2.11 ng/mL), arterial partial pressure of carbon dioxide (41.12 ± 5.56 mm Hg), and a higher proportion of viral infections (48.00%) compared to the survival group (5.90 ± 1.72 mmol/L, 101.77 ± 55.56 mg/L, 3.98 ± 1.15 ng/mL, 35.59 ± 6.22 mm Hg, 27.91%, P < .05). Logistic regression analysis revealed that age (odds ratios [OR] = 1.990, 95% confidence interval [CI]: 1.306-3.033, P < .001), oxygenation index (OR = 1.426, 95% CI: 1.123-1.649, P < .001), and duration of mechanical ventilation (OR = 0.694, 95% CI: 0.557-0.864, P < .001) were independent factors influencing patient prognosis. This indicates that an increase in age and a decrease in oxygenation index are associated with a significantly higher risk of mortality, while shorter mechanical ventilation duration is related to poorer prognosis. Advanced age, lower oxygenation index, and shorter duration of mechanical ventilation are unfavorable prognostic factors in patients with severe pneumonia complicated by ARDS. These findings aid clinicians in identifying high-risk patients, optimizing treatment plans, and improving patient prognosis., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Study the treatment of poststroke depression and insomnia using varied repetitive transcranial magnetic stimulation (rTMS) frequencies alongside paroxetine. Aim to enhance rTMS effectiveness for depression, insomnia, neurological impairment, and daily living skills., Methods: Ninety poststroke depression (PSD) patients were randomly divided into a low-frequency group (low-frequency rTMS + enteric-coated paroxetine), a high-frequency group (high-frequency rTMS + enteric-coated paroxetine), and a control group (sham stimulation + enteric-coated paroxetine). The treatment was administered 5 times a week for a total of 2 weeks. Before treatment, at the end of the 2-week treatment, and at the end of the 6-week follow-up, the 3 groups of patients were assessed using the Hamilton Depression Rating Scale (HAMD), Pittsburgh Sleep Quality Index (PSQI), National Institutes of Health Stroke Scale (NIHSS), and Modified Barthel Index (MBI). The mean differences of scores measured at different frequencies and at different times were analyzed by repeated measure one-way analysis of variance., Results: The interaction between different frequency and score before and after treatment was significant. HAMD, PSQI, and NIHSS scores of the 3 groups after 2 weeks of treatment and 6 weeks of follow-up were significantly lower than before treatment, while MBI scores were opposite. The main effect of treatment scores in different frequency groups showed that HAMD, NIHSS, and MBI scores were not significantly different among the 3 groups before treatment. The HAMD, PSQI, and NIHSS scores of the low frequency group and the high frequency group were significantly lower than those of the control group after treatment, and the MBI scores were the opposite, except that there was no significant difference in HAMD-17 scores among the 3 groups at the 6-week follow-up. Among them, HAMD score in high-frequency group was significantly lower than that in low-frequency group, and PSQI score was significantly higher than that in low-frequency group., Conclusion: Low-frequency rTMS combined with medication has a better therapeutic effect on the insomnia symptoms of PSD, while high-frequency rTMS combined with medication has a more pronounced therapeutic effect on the depressive symptoms of PSD. Both high-frequency and low-frequency rTMS have an improving effect on neurofunctional deficits and activities of daily living., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

This study compares the accuracy of SRK/T and Barrett Universal II intraocular lens (IOL) measurement formulas for cataract phacoemulsification combined with intraocular lens implantation in angle-closure glaucoma (ACG) patients. Prospective serial case studies were conducted. A total of 146 patients (146 eyes) with ACG complicated with cataract who underwent cataract surgery with atrial angle closure ≤180° were observed. All the patients were divided into 2 groups according to different intraocular lens calculation formula, with 73 cases in each group (73 eyes). SRK/T intraocular lens calculation formula was used in group A, and Barrett intraocular lens calculation formula was used in group B. The visual acuity, the best corrected visual acuity, intraocular pressure and central anterior chamber depth were significantly improved in 146 eyes 3 months after operation, and the differences were statistically significant. There was statistically significant difference in postoperative spherical equivalent (SE) between the 2 groups (t = 2.147, P = .033), and there was statistically significant difference in preoperative expected refraction between group A and postoperative SE (t = 4.221, P < .001). There was no significant difference between preoperative expected diopter and postoperative SE in group B (t = 1.857, P = .065). The difference in absolute predicted error between the 2 groups was statistically significant (t = 4.929, P < .001). Axis length was negatively correlated with SRK/T formula and Barrett Universal II formula absolute refractive error value (ME) (group A: r = -0.740, P < .001; group B: r = -0.532, P < .001), there was A significant negative correlation between absolute refractive error value and anterior chamber depth in both groups (group A: r = -0.382, P = .001; group B: r = -0.358, P = .002). The cataract phacoemulsification combined with intraocular lens implantation is safe and effective for ACG patients with cataract. For such patients, the Barrett Universal II intraocular lens measurement formula may be more accurate after surgery., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

We aimed to assess the worldwide burden of ischemic stroke (IS) associated with high body mass index (BMI) using data from the Global Burden of Disease 2019. This study examined the impact of high BMI on IS-related age-standardized death rates (ASDR) and disability-adjusted life years (DALYs). Estimated annual percentage changes (EAPC) is estimated annual percentage change. Trends were assessed using EAPCs. Over the past 3 decades, there has been a declining trend in the global burden of IS associated with high BMI, especially in Western Europe (EAPC = -3.09 for DALYs) and high-income Asia Pacific (EAPC = -4.6 for ASDR). However, certain developing regions, notably Southeast Asia, have experienced significant increases in ASDR (EAPC = 3.7) and age-standardized DALY rates (EAPC = 3.64). The most substantial increase in burden was observed in Southeast Asia for both males (EAPC = 3.85) and females (EAPC = 3.53). Importantly, the burden was most pronounced in regions with low to middle sociodemographic index. The rising disease burden linked to high BMI is largely due to insufficient medical infrastructure and ineffective public health policies in the region. Urgent action is needed from decision-makers to improve these areas and implement effective interventions. This study reveals a consistent global decline in IS related to high BMI, with a more significant burden observed in males under the age of 65, particularly in Southeast Asia, where increases in IS associated with high BMI are notable. Public health officials and global policymakers need timely and reliable quantitative data. This information is essential for implementing effective behavioral interventions, such as monitoring diet and physical activity, to address identified risk factors and reduce the burden of high BMI., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

To explore the value of ultrasound in volume assessment during the perioperative period of single-shot spinal anesthesia for total hip arthroplasty. A total of 100 patients undergoing elective surgery under spinal anesthesia at our hospital from January 2022 to January 2024 were selected. Transthoracic echocardiography was used to measure the diameter of the abdominal aorta (Ao) before anesthesia (T1), 10 minutes after anesthesia (T2), and 30 minutes after anesthesia (T3). The inferior vena cava collapsibility index (IVC-CI) and the ratio of IVCe to Ao (IVCe/Ao) were calculated. A volume load test was performed 10 minutes after anesthesia. Based on the increase in stroke volume (ΔSV) after the volume load test, patients were divided into a volume-responsive group (ΔSV ≥ 15%) and a volume-nonresponsive group (ΔSV < 15%). The reliability of inferior vena cava parameters in predicting hypotension after spinal anesthesia and the value in predicting volume responsiveness postanesthesia were evaluated using ROC curves. A total of 100 patients were enrolled, 18 were withdrawn, and a total of 82 patients were included. After the volume load test, the parameters of the volume response group and the volume nonresponse group were basically consistent, and the difference was not statistically significant (P > .05). The SV of volume reaction group was significantly higher than that of volume no reaction group (P < .05). The incidence of hypotension in the volume response group was higher than that in the non-volume response group (51.28% vs 11.63%, χ2 = 15.174, P < .01). The AUC for volume reactivity prediction using IVCe, IVCi, IVC-CI, and IVCe/Ao were 0.62, 0.71, 0.70, and 0.72, respectively. IVCi, IVC-CI, and IVCe/Ao were significant predictors of volume reactivity (P < .05). The AUC predicting persistent hypotension after spinal anesthesia using IVCe, IVCi, IVC-CI, and IVCe/Ao were 0.78, 0.79, 0.70, and 0.84, respectively. IVCe, IVCi, IVC-CI, and IVCe/Ao can predict volume reactivity before anesthesia. IVCi, IVC-CI, and IVCe/Ao predicted persistent hypotension in patients with spinal anesthesia after anesthesia, and IVCe/Ao showed the best predictive effect. Thus, IVCe/Ao is a reliable parameter for predicting persistent hypotension and assessing volumetric reactivity., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

This study evaluates the diagnostic accuracy of ultrashort echo time (UTE)-MRI for detecting pulmonary nodules and image quality. A total of 46 patients at our hospital underwent unenhanced computed tomography (CT) and UTE-MRI. The image quality and number of nodules detected using CT were used as the gold standards. Three diagnostic radiologists independently recorded the image quality (visibility and sharpness of normal anatomical structures) of the CT and UTE images and the number of pulmonary nodules detected. The diagnostic accuracy, subjective image quality, and consistency between observations were statistically analyzed. Among 46 patients, 36 (78.2%) had pulmonary nodules on CT images, whereas 10 patients (21.7%) had no pulmonary nodules. A total of 48 lung nodules were detected, 3 of which were ground-glass opacities. UTE-MRI revealed 46 lung nodules. Compared with CT, the sensitivity of all MRI readers for detecting lung lesions was 95.8%, and the 3-observer agreement was nearly perfect (P < .001, Kendall Wa [Kender Harmonious Coefficient] = 0.913). The overall image quality score of the observers was high, ranging from good to excellent, and the consistency of the subjective UTE-MRI image quality was good (Kendall Wa = 0.877, P < .001). For tracheal display, the subsegment of the bronchus was displayed, and the wall of the tube was clearly displayed. The difference in the Wa values between the observers was 0.804 (P < .001), indicating strong consistency. For blood vessels, subsegment blood vessels could also be displayed with clear walls and uniform signals (Kendal Wa = 0.823, P < .001), indicating strong consistency. Compared to CT, UTE-MRI can detect pulmonary nodules with a high detection rate, relatively good image quality, and strong consistency between observers. The development of UTE-MRI can provide a novel imaging method for the detection and follow-up of pulmonary nodules and diagnosis of pneumonia by reducing ionizing radiation., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Rationale: Patients with chronic immune diseases, such as idiopathic thrombocytopenic purpura (ITP), should be alert for Guillain-Barre/acute transverse myelitis (GBS/ATM) overlap syndrome after infection with coronavirus disease 2019 (COVID-19)., Patient Concerns: A 65-year-old male with an ITP history, who presented with limb numbness and weakness, urinary retention, right peripheral facial paralysis, and diplopia 2 weeks after being diagnosed with COVID-19., Diagnosis: GBS/ATM overlap syndrome secondary to COVID-19., Interventions: Five days intravenous immune globulin, methylprednisolone (500 mg) was added for treatment. He was discharged with medicine and continued to take Methylprednisolone tablets (60 mg/d), Eltrombopag olamine (25 mg 1/d), Mecobalamine tablets, vitamin B1, and rehabilitation treatment outside the hospital., Outcomes: The patient significantly improved after initial treatment, he returned to normal life after 8 weeks. Five months later, he was infected with COVID-19 for the second time, exhibiting only symptoms of upper respiratory tract infection and no other discomfort., Lessons: COVID-19 infection can lead to secondary myelitis and GBS, and GBS/ATM overlap syndrome is rare, but patients are significantly better after immunization and hormone therapy., Competing Interests: The authors declare that they have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: A quasi-experimental study was conducted to investigate the clinical efficacy and outcomes of calcitriol combined with bisphosphonates in the treatment of postmenopausal osteoporosis (OP)., Methods: A total of 152 patients with postmenopausal OP from March 2019 to June 2021 were enrolled. The patients who received calcitriol treatment were adopted as the control group, and the patients treated with calcitriol combined with bisphosphonates were considered as the intervention group. The treatment effects of patients were compared, and the pain degree of the joints of the patients was evaluated by Visual Analogue Scale/Score (VAS), the Barthel Index score was used to evaluate the daily living ability of patients, the hand and Oswestry Disability Index (ODI) were used to evaluate the dysfunction before and after treatment, and the bone metabolism indexes, immune cytokines and bone mineral density were detected before and after treatment, and the incidence of adverse reactions was calculated., Results: Regarding the therapeutic effects, the intervention group indicated an effective rate of 96.05% while the effective rate was 84.21% in the control group. The total effective rate of treatment in the intervention group was higher than the control group. The VAS, ODI scores, and bone metabolism indexes of the intervention group were significantly lower than the control group at 1, 2, and 3 months after treatment. The Barthel Index scores and bone mineral density of the intervention group were higher than the control group at 1, 2, and 3 months after treatment. The improvement of immune cytokines in the intervention group was significantly better than the control group (P < .05). One patient in the intervention group developed dizziness and 1 patient developed chills, with an adverse reaction rate of 2.63%, while in the control group, 2 patients had fever, and 2 patients developed chills, with an adverse reaction rate of 5.26% (P > .05)., Conclusion: Calcitriol combined with bisphosphonates has a significant clinical effect in the treatment of postmenopausal OP, which can significantly relieve bone pain in postmenopausal OP patients, enhance abnormal bone metabolism and immune function, and promote bone mineral density and daily living ability., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)