Background Non-suicidal self-injury(NSSI)is a significant health concern among adolescents and young adults,often resulting from adverse childhood experiences(ACEs).Dissociation,post-traumatic symptoms and attachment ...Background Non-suicidal self-injury(NSSI)is a significant health concern among adolescents and young adults,often resulting from adverse childhood experiences(ACEs).Dissociation,post-traumatic symptoms and attachment style may have a role in shaping such associations.Aims This study aims to provide a unified model of the impact of ACEs on NSSI,exploring complex post-traumatic stress disorder(cPTSD)symptoms and dissociation as potential mediators and the role of the predominant attachment style in affecting such associations.Methods 1010 young individuals attending the last year of high school participated in this cross-sectional study.ACEs,cPTSD,dissociation and NSSI were evaluated using self-report questionnaires.We fitted a path model of NSSI,with ACEs as exogenous variables and cPTSD and dissociation as sequential mediators.Secure,fearful and preoccupied attachment styles were modelled as grouping variables.Results Our findings showed that dissociation mediated the impact of ACEs on NSSI in subjects with a fearful attachment style,as opposed to those with a preoccupied attachment for whom cPTSD symptoms mediated the ACEs-NSSI association.Conclusions Attachment styles moderate the relationship between ACEs and NSSI,with either dissociation or post-traumatic symptomatology mediating the impact of ACEs on NSSI,depending on the predominant attachment style.Our results highlight the importance of attachment as a pathway modifier in the relationships between different psychopathology dimensions,providing a useful framework to better conceptualise the ACEs-NSSI association.展开更多
AIM: To study the association between self-reported peptic ulcer and childhood adversities.METHODS: The Health and Social Support Study (HeS-Sup) population consisted of a stratif ied random sample drawn from the Finn...AIM: To study the association between self-reported peptic ulcer and childhood adversities.METHODS: The Health and Social Support Study (HeS-Sup) population consisted of a stratif ied random sample drawn from the Finnish Population Register in four age groups: 20-24, 30-34, 40-44 and 50-54. The survey was carried out by postal questionnaire during 1998, with a response rate of 40.0%. A follow-up questionnaire was sent during 2003 to all those who responded to the f irst. Altogether 19 626 individuals returned the follow-up questionnaire; a response rate of 75.8%. The subjects were asked whether a doctor had told them that they have or have had peptic ulcer. The analyses covered those who responded aff irmatively to both the baseline and the follow-up enquiries (n = 718). Those not re-porting a peptic ulcer in either of the two questionnaires (n = 17 677) were taken as controls. The subjects were further requested (through six questions) to think about their childhood adversities.RESULTS: The most common adversities mentioned were long-lasting financial difficulties in the family, serious conflicts in the family, and a family member seriously or chronically ill. All the adversities reported, except parental divorce, were more common among peptic ulcer patients than among controls (P values varied between < 0.001 and 0.003). Age- and sex-adjusted odds ratios (OR) of childhood adversities in the multivariate logistic analysis for self-reported pep-tic ulcer varied between 1.45 and 2.01. Adjusting for smoking, heavy drinking, stress and nonsteroidal anti-inflammatory drug use had no further influence (ORs between 1.22 and 1.73).CONCLUSION: Our findings suggest that childhood adversities maintain a connection with and have a predictive role in the development of peptic ulcer.展开更多
Background: It has been suggested that childhood events increase the risk of suffering from an eating disorder (ED) in adolescence or young adulthood. Our study here aimed at investigating whether there was an associa...Background: It has been suggested that childhood events increase the risk of suffering from an eating disorder (ED) in adolescence or young adulthood. Our study here aimed at investigating whether there was an association between stressful childhood events and eating disorders later in life. Methods: Our population-based study was a part of the HeSSup (The Health and Social Support) postal survey in 2003, a follow-up survey with a random sample of working-aged subjects drawn from the Finnish Population Register in 1998. Participants in this study reported having been suffering from ED (N = 374), while controls (N = 18,639) reported no history of eating disorder in the questionnaire both in 1998 and 2003. The questionnaire included six questions related to childhood adversities. Results: Each childhood stressor increased the risk of developing ED cumulatively (one adversity OR 1.7 versus all six OR 8.3). Intrafamiliar conflicts (OR 2.0), being afraid of a family member (OR 1.5) or long-term illnesses in the family (OR 1.4) increased the ED-risk statistical significantly. Conclusion: Children exposed to stress are more likely to suffer from eating disorders as adults than those not exposed.展开更多
Objective:Artemether is a semi-synthetic derivative of artemisinin and is widely used in the treatment of Plasmodium(P.)falciparum malaria.This study aimed to characterize the safety profile of artemether based on 15-...Objective:Artemether is a semi-synthetic derivative of artemisinin and is widely used in the treatment of Plasmodium(P.)falciparum malaria.This study aimed to characterize the safety profile of artemether based on 15-year data retrived from FDA adverse event reporting system(FAERS).Methods:This is a retrospective analysis on 15-year data of artemether-related adverse effects(AEs)retrieved from the FAERS.AEs were classified according to System Organ Class(SOC)and Preferred Terms(PT).Signal detection was performed using Reporting Odds Ratios(ROR),Proportional Reporting Ratios(PRR),and Empirical Bayes Geometric Mean(EBGM).Stratified analyses examined the impact of demographic factors such as sex,age,and time-to-onset.Temporal patterns and associated risk factors were also investigated.Results:Haemolytic anaemia and haemolysis emerged as the most frequently reported AEs,exhibiting significantly elevated RORs(males:ROR 381.36,95%CI 247.06-588.60;females:ROR 455.11,95%CI 286.43-723.12).Sex-specific differences were evident,with females showing a higher incidence of reproductive-related AEs,including spontaneous abortion and premature labour.Temporal trend analysis revealed that the majority of AEs occurred within the first 30 days after the initiation of artemether administration,indicating a rapid onset.The most affected SOCs were blood and lymphatic system disorders and hepatobiliary disorders.Conclusions:Artemether is associated with a notable frequency of early-onset AEs,particularly hematological and hepatobiliary disorders.The observed sex-specific vulnerability to reproductive AEs highlights the need for sex-conscious clinical approaches.Enhanced post-treatment monitoring and further investigations into the drug’s pharmacokinetics and mechanistic pathways are recommended.展开更多
Carbamazepine is an antiepileptic drug also used for neuropathic pain and mood stabilization.It is a strong enzyme inducer and autoinducer with multiple well-documented drug–drug interactions and adverse drug reactio...Carbamazepine is an antiepileptic drug also used for neuropathic pain and mood stabilization.It is a strong enzyme inducer and autoinducer with multiple well-documented drug–drug interactions and adverse drug reactions.Widely licensed and in use since the 1960s,carbamazepine has well-characterized pharmacological,pharmacogenetic,and safety profiles,and remains extensively used in neurology and psychiatry.In 2024,carbamazepine was recommended for inclusion in the World Health Organization list of essential medicines.Carbamazepine has a complex mode of action that includes neuronal stabilization,neuroprotection,neurotransmitter modulation,enhancement of autophagy,and anti-inflammatory effects.These make carbamazepine a good candidate for drug repurposing in oncology,genetic diseases,neurodegeneration,and systemic inflammation.Recent advances in precision medicine,genomics,and on/off-target drug repositioning have enabled the identification of new carbamazepinemolecular targets for novel applications in different therapeuticmodalities.This review highlights carbamazepine repurposing studies in cancers such as breast and colorectal,based on its mode of action.In addition,repurposing studies in genetic diseases such asmetaphyseal achondroplasia and Fragile-X,as well as in neurodegenerative conditions such as amyotrophic lateral sclerosis and Alzheimer's dementia,are discussed.The pharmacological mechanisms and drug repurposing pathways are critically summarized in order to provide insights into their therapeutic potential and proposed future directions.展开更多
Background:Low relative sit-to-stand(STS)power has emerged as a critical predictor of adverse health outcomes,such as frailty and disability,in older adults.However,its impact on falls,fractures,hospitalizations,and a...Background:Low relative sit-to-stand(STS)power has emerged as a critical predictor of adverse health outcomes,such as frailty and disability,in older adults.However,its impact on falls,fractures,hospitalizations,and all-cause mortality remains unclear.Therefore,this longitudinal study aimed to investigate the potential associations between low relative STS power and these adverse health outcomes in older adults.Methods:A total of 1876 older adults(aged≥65 years,56.4%women)were included from the Toledo Study for Healthy Aging.Relative STS power was assessed using the 30-s STS test and the Alcazar equation.Participants were categorized as having low relative STS power based on previously established cut-off points(2.53 W/kg for men and 2.01 W/kg for women).Falls and fractures(hip and all-type)within the previous year were recorded.Hospitalizations and all-cause mortality were obtained during a follow-up of 6.8±3.1 years(mean±SD;median=7.8 years;interquartile range:3.9-10.1 years)and 9.7±3.5 years(median=10.9 years;interquartile range:8.2-12.5 years),respectively.Generalized linear mixed models,binary logistic regression,and proportional hazards regression adjusted for age,educational level,and comorbidities were used.Results:In men,low relative STS power was significantly associated with an increased likelihood of history of falls(odds ratio(OR)=1.73,95%confidence interval(95%CI):1.08-2.75,p=0.022)and all-type fractures(OR=1.86,95%CI:1.21-2.84,p=0.004)in the previous year.In women,low relative STS power was associated with a higher probability of hip fractures within the previous year(OR=3.25,95%CI:1.07-9.86,p=0.038).Low relative STS power predicted hospitalizations in women(hazard ratio(HR)=1.29,95%CI:1.06-1.58,p=0.012)and longer hospital stays in both men(p=0.020)and women(p=0.033).Low relative STS power significantly increased all-cause mortality in both men(HR=1.57,95%CI:1.26-1.97,p<0.001)and women(HR=2.04,95%CI:1.51-2.74,p<0.001).Conclusion:Low relative STS power was associated with history of hip fractures in women,whereas in men it was associated with history of falls and all-type fractures.Low relative STS power predicted hospitalizations in women but not in men.In both men and women,low relative STS power was associated with longer hospital stays and increased risk of all-cause mortality.展开更多
This study aimed to elucidate the clinical features and temporal patterns of drug-induced lupus(DIL)associated with the stilbene amine antiepileptic drugs carbamazepine and oxcarbazepine.A comprehensive systematic rev...This study aimed to elucidate the clinical features and temporal patterns of drug-induced lupus(DIL)associated with the stilbene amine antiepileptic drugs carbamazepine and oxcarbazepine.A comprehensive systematic review was conducted using multiple literature databases.Both domestic and international case reports of DIL linked to these agents were screened and analyzed.A total of 22 eligible cases were identified,comprising 19 cases related to carbamazepine and three to oxcarbazepine.Analysis revealed a mean patient age of 32.50±16.08 years,with a marked female predominance(72.73%,16/22).The latency period,the duration between drug initiation and the onset of DIL,was notably prolonged and variable,averaging 56.93±75.57 months.Clinically,DIL presented as a multi-system disorder,with hematologic abnormalities(e.g.,thrombocytopenia,anemia,and leukopenia)observed in 68.18%of cases,musculoskeletal symptoms(arthritis or joint pain)in 59.09%,and cutaneous involvement(rash or photosensitivity)in 54.55%.Following drug discontinuation and,in some instances,glucocorticoid therapy,clinical improvement was observed to varying degrees.Notably,31.82%of patients experienced complete symptom resolution within 7 d.Given the insidious onset and multi-organ involvement of DIL,our findings underscored the importance of heightened clinical vigilance and routine monitoring protocols during antiepileptic drug therapy.This study highlighted the need for a dynamic risk-benefit assessment in the clinical use of antiepileptic drugs and provides valuable insights for the management of rare but serious neurological adverse reactions.展开更多
Delivery carriers serve as a highly efficient approach for precision nutrition and medicine;however,artificial delivery carriers are prone to triggering the immune response and have the disadvantages of poor stability...Delivery carriers serve as a highly efficient approach for precision nutrition and medicine;however,artificial delivery carriers are prone to triggering the immune response and have the disadvantages of poor stability and low bioavailability.Extracellular vesicles(EVs),nucleus-free biological particles composed of phospholipid bilayers secreted by living cells,are a new generation of targeted delivery carriers.In recent years,an increasing number of species have been reported to contain EVs.Among them,food-derived extracellular vesicles(FDEVs)show outstanding comprehensive properties.FDEVs are considered to have great application potential due to their wide range of sources,high yields,absence of human pathogenic pathogens,and ethical concerns.In this review,the preparation,nomenclature,physicochemical characteristics,and preservation methods of FDEVs are discussed,as well as their potential protein markers,bioactivities,and applications as novel targeted delivery carriers of FDEVs from animals,plants,and microorganisms.We also summarized the adverse consequences of FDEVs in current studies,and put forward the problems and challenges in the process of FDEVs research and commercialization.In short,the importance of FDEVs has been highlighted,and FDEVs have good application prospects as a new class of targeted delivery carriers.The current problems should be paid attention to and actively solved.展开更多
Objective:To analyze the efficacy of allergen subcutaneous injection immunotherapy in patients with allergic rhinitis.Methods:Fifty patients with allergic rhinitis admitted from May 2023 to May 2025 were selected as s...Objective:To analyze the efficacy of allergen subcutaneous injection immunotherapy in patients with allergic rhinitis.Methods:Fifty patients with allergic rhinitis admitted from May 2023 to May 2025 were selected as study subjects and randomly divided into a control group and an observation group,with 25 patients in each group.The control group was treated with budesonide nasal spray,while the observation group received allergen subcutaneous injection immunotherapy in addition to the control treatment.The treatment efficacy,adverse reactions,symptom improvement time,and immune indicators were compared between the two groups.Results:The observation group showed a higher disease treatment efficacy than the control group(p<0.05);the incidence of adverse reactions in the observation group was not statistically significant compared to the control group(p>0.05);the observation group had a shorter symptom improvement time for nasal obstruction,rhinorrhea,and sneezing than the control group(p<0.05);before treatment,there was no statistical significance in immune indicators between the two groups(p>0.05);after treatment,CD3+and CD4/CD8+in the observation group were higher than those in the control group(p<0.05).Conclusion:Allergen subcutaneous injection immunotherapy in patients with allergic rhinitis can improve disease treatment efficacy,alleviate clinical symptoms,and enhance immune function.This therapy is safe and has clinical application value.展开更多
Objective:To characterize placental morphologic features in Moroccan women with adverse outcomes,across different clinical contexts,based on the Amsterdam consensus classification.Methods:A prospective analysis was co...Objective:To characterize placental morphologic features in Moroccan women with adverse outcomes,across different clinical contexts,based on the Amsterdam consensus classification.Methods:A prospective analysis was conducted on placentas with umbilical cords collected fresh between March 1,2024 and July 15,2024 from women with adverse pregnancy outcomes.Clinical data(age,parity,gravidity,complications)were retrieved.Macroscopic parameters(weight,dimensions,cord insertion,membranes,lesions)were assessed,followed by systematic sampling.Tissue was processed by standard histology(formalin fixation,paraffin embedding,hematoxylin and eosin staining),and lesions were classified per Amsterdam criteria.Results:16 placentas from patients with adverse pregnancy outcomes were included.The median maternal age was 30 years.Adverse conditions included placental abruption(50%),intrauterine growth restriction(IUGR,38%),intrauterine fetal death(IUFD,31%),pre-eclampsia/eclampsia(19%),premature rupture of membranes(13%),and oligohydramnios(13%).Several placentas were associated with more than one adverse condition.Histopathology revealed maternal vascular malperfusion lesions in 94%,particularly in pre-eclampsia,IUGR,and IUFD.Fetal vascular malperfusion was found in 88%,mainly in IUGR and IUFD.Inflammatory lesions,dominated by acute maternal and fetal responses stage 3(necrotizing chorioamnionitis and funisitis),were primarily linked to IUFD.Conclusions:Placental examination enhances understanding of the pathophysiology underlying adverse pregnancy outcomes,supports diagnostic confirmation,and guides preventive strategies for recurrence.This study highlights the prevalence of maternal vascular malperfusion in Moroccan women and emphasizes the importance of systematic placental histopathology in obstetric care.展开更多
Objective: To evaluate the preventive effect of shoulder dystocia midwifery techniques combined with predictive nursing on shoulder dystocia. Methods: A total of 82 high-risk pregnant women with shoulder dystocia admi...Objective: To evaluate the preventive effect of shoulder dystocia midwifery techniques combined with predictive nursing on shoulder dystocia. Methods: A total of 82 high-risk pregnant women with shoulder dystocia admitted for childbirth from January 2022 to January 2025 were selected and equally divided using a random number table. The experimental group received shoulder dystocia midwifery techniques combined with predictive nursing, while the reference group received routine midwifery care. Indicators such as the preventive effect on shoulder dystocia were compared between the two groups. Results: The incidence of shoulder dystocia in the experimental group was lower than that in the reference group, the duration of labor was shorter, the amount of intra-partum bleeding was less, the incidence of adverse delivery outcomes was lower, and the score for fear of childbirth after intervention was lower than that in the reference group (p < 0.05). Conclusion: Implementing shoulder dystocia midwifery techniques combined with predictive nursing for high-risk pregnant women with shoulder dystocia can prevent shoulder dystocia and other adverse delivery outcomes, shorten the duration of labor, reduce intra-partum bleeding, and alleviate pregnant women’s fear of childbirth, demonstrating high nursing value.展开更多
Background In patients with coronary artery disease,age is of known significance in predicting outcomes.Data on clinical outcomes in patients≥85 years undergoing percutaneous coronary intervention(PCI)remain scarce.T...Background In patients with coronary artery disease,age is of known significance in predicting outcomes.Data on clinical outcomes in patients≥85 years undergoing percutaneous coronary intervention(PCI)remain scarce.The study aim was to determine clinical characteristics,risk of adverse cardiovascular events,and mortality in patients aged≥85 years compared to those aged<85 undergoing PCI.Methods In this retrospective study,data were obtained from the nationwide Netherlands Heart Registration on patients undergoing PCI between January 1st,2017 and January 1st,2021.The primary endpoint was all-cause mortality at long-term followup.Results A total of 155,683 patients underwent PCI,of which 100,209(64.4%)acute coronary syndrome cases.Compared to patients aged<85 years,patients aged≥85 were more often female and showed a higher number of cardiovascular comorbidities,including impaired left ventricle ejection fraction and reduced kidney function.Mortality at short-term and long-term follow-up were significantly higher in those aged≥85(P<0.001).Patients aged≥85 were more likely to have a myocardial infarction within 30 days following the index intervention(0.9%vs.0.7%;P=0.024),though they less often underwent revascularization at longterm follow-up compared to patients aged<85(P<0.001).Conclusions The elderly(≥85 years)patient requiring PCI carries an extensive cardiovascular risk profile,translating in significant risk of recurrent cardiovascular events and increased mortality rate.Clinicians should carefully weigh perceived risks and potential benefits in the individual patient,considering the patients’age,cardiovascular risk profile,and associated risk of morbidity and mortality.展开更多
Objective:To identify the root causes of typical adverse drug events through the lens of patient experiences proposing novel strategies to mitigate preventable harm.Methods:A qualitative case study leveraging in-depth...Objective:To identify the root causes of typical adverse drug events through the lens of patient experiences proposing novel strategies to mitigate preventable harm.Methods:A qualitative case study leveraging in-depth interviews with patients and families,anchored by Interactive Patient Par ticipation Theory,to analyze 4 high-severity adverse drug events(ADE)cases.Cases were purposively sampled from 8 communities in China's National Adverse Event Monitor Center(2018-2023).Semi-structured interviews explored patient perspectives,with data analyzed via thematic coding and triangulation against clinical records.Results:Five interconnected themes emerged:(1)erosion of trust,(2)communication breakdowns,(3)information asymmetry,(4)environmental inadequacies,and(5)technological alienation.Notably,75% of participants had≤high school education,and 50% used≥7 medications daily,compounding ADE risks.Conclusions:We considered elements mentioned by theory,exploring trust,communication,information,and suppor t as the root causes.In addition,we added“adaptability to new technology”as an impor tant and necessary component.It is impor tant and necessary to analyze typical adverse drug events from the perspectives of patients.展开更多
Background:The purpose of this study was to analyze and classify adverse drug events(ADEs)related to ceftazidime/avibactam reported in the Food and Drug Administration Adverse Event Reporting System(FAERS)database and...Background:The purpose of this study was to analyze and classify adverse drug events(ADEs)related to ceftazidime/avibactam reported in the Food and Drug Administration Adverse Event Reporting System(FAERS)database and to evaluate their potential safety signals since the drug’s market introduction.Methods:This analysis systematically extracted and filtered FAERS data for ceftazidime/avibactam from its market launch in 2015 to the last quarter of 2024,utilizing the Medical Dictionary for Regulatory Activities(MedDRA)terminology for ADE recoding.The analysis employed the reporting odds ratio(ROR)method to assess the strength of ADE signals and to identify significant diseases associated with infections,the hepatobiliary system,the urinary system,and the nervous system.Results:A review of 540 adverse reaction reports revealed significant signals of adverse effects related to infections,hepatobiliary disorders,urinary system issues,and neurological impairments,including pathogen resistance,liver and kidney function impairment,encephalopathy,thrombocytopenia,and toxic epidermal necrolysis.However,these issues require further clinical attention.Conclusion:Ceftazidime/avibactam is associated with a range of adverse reactions,necessitating enhanced clinical monitoring,particularly in patients with underlying liver or kidney dysfunction.Continuous risk assessment and vigilant monitoring are critical for its clinical use.However,this study is limited by inherent reporting biases and confounders associated with the spontaneous reporting database(FAERS).Future research should validate these signals through prospective cohort and mechanistic studies and explore personalized risk management strategies for high-risk populations.展开更多
Deep brain stimulation(DBS)is an established therapeutic intervention for people with Parkinson’s disease(PwPD)and is increasingly being utilized for other neurological disorders.Although effective in alleviating mot...Deep brain stimulation(DBS)is an established therapeutic intervention for people with Parkinson’s disease(PwPD)and is increasingly being utilized for other neurological disorders.Although effective in alleviating motor symptoms and reducing medication requirements,DBS has undergone minimal conceptual evolution and still relies on continuous high-frequency electrical stimulation.In Parkinson’s disease(PD),this persistent stimulation may cause adverse effects,including dysarthria,stimulation-induced dyskinesia,impulsivity,and mood alterations.Additionally,the continuous energy demand of current DBS systems accelerates battery depletion,necessitating more frequent battery charging or battery replacement surgeries,increasing risks,burden,and costs.Basic neuroscience research has long demonstrated that exogenous electrical stimulation can induce persistent changes to synaptic connections,known as long-term plasticity.展开更多
Alzheimer's disease is a common neurodegenerative disorder in older adults.Despite its prevalence,its pathogenesis remains unclea r.In addition to the most widely accepted causes,which in clude excessive amyloid-b...Alzheimer's disease is a common neurodegenerative disorder in older adults.Despite its prevalence,its pathogenesis remains unclea r.In addition to the most widely accepted causes,which in clude excessive amyloid-beta aggregation,tau hyperphosphorylation,and deficiency of the neurotransmitter acetylcholine,numerous studies have shown that the dopaminergic system is also closely associated with the occurrence and development of this condition.Dopamine is a crucial catecholaminergic neurotransmitter in the human body.Dopamine-associated treatments,such as drugs that target dopamine receptor D and dopamine analogs,can improve cognitive function and alleviate psychiatric symptoms as well as ameliorate other clinical manifestations.Howeve r,therapeutics targeting the dopaminergic system are associated with various adverse reactions,such as addiction and exacerbation of cognitive impairment.This review summarizes the role of the dopaminergic system in the pathology of Alzheimer's disease,focusing on currently available dopamine-based therapies for this disorder and the common side effects associated with dopamine-related drugs.The aim of this review is to provide insights into the potential connections between the dopaminergic system and Alzheimer's disease,thus helping to clarify the mechanisms underlying the condition and exploring more effective therapeutic options.展开更多
BACKGROUND Propofol has been widely used in bidirectional gastrointestinal endoscopy sedation;however,it frequently leads to cardiovascular adverse events and respiratory depression.Propofol target-controlled infusion...BACKGROUND Propofol has been widely used in bidirectional gastrointestinal endoscopy sedation;however,it frequently leads to cardiovascular adverse events and respiratory depression.Propofol target-controlled infusion(TCI)can provide safe sedation but may require higher dosages of propofol.On the contrary,etomidate offers hemodynamic stability.AIM To evaluate the effect of different dose etomidate added to propofol TCI sedation during same-visit bidirectional endoscopy.METHODS A total of 330 patients from Fujian Provincial Hospital were randomly divided into three groups:P,0.1EP,and 0.15EP.Patients in the P group received propofol TCI only,with an initial effect-site concentration of the propofol TCI system of 3.0 mg/mL.Patients in the 0.1EP and 0.15EP groups received 0.1 and 0.15 mg/kg etomidate intravenous injection,respectively,followed by propofol TCI.RESULTS Patients in the 0.15EP group had higher mean blood pressure after induction than the other groups(P group:78 mmHg,0.1EP group:82 mmHg,0.15EP group:88 mmHg;P<0.05).Total doses of propofol consumption significantly decreased in the 0.15EP group compared with that in the other groups(P group:260.6 mg,0.1EP group:228.1 mg,0.15EP group:201.2 mg;P<0.05).The induction time was longer in the P group than in the other groups(P group:1.9±0.7 minutes,0.1EP group:1.2±0.4 minutes,0.15EP group:1.1±0.3 minutes;P<0.01).The recovery time was shorter in the 0.15EP group than in the other groups(P group:4.8±2.1 minutes,0.1EP group:4.5±1.6 minutes,0.15EP group:3.9±1.4 minutes;P<0.01).The incidence of hypotension(P group:36.4%,0.1EP group:29.1%,0.15EP group:11.8%;P<0.01)and injection pain was lower in the 0.15EP group than in the other groups(P<0.05).Furthermore,the incidence of respiratory depression was lower in the 0.15EP group than in the P group(P<0.05).Additionally,the satisfaction of the patient,endoscopist,and anesthesiologist was higher in the 0.15EP group than in the other groups(P<0.05).CONCLUSION Our findings suggest that 0.15 mg/kg etomidate plus propofol TCI can significantly reduce propofol consumption,which is followed by fewer cardiovascular adverse events and respiratory depression,along with higher patient,endoscopist,and anesthesiologist satisfaction.展开更多
Geological analysis,despite being a long-term method for identifying adverse geology in tunnels,has significant limitations due to its reliance on empirical analysis.The quantitative aspects of geochemical anomalies a...Geological analysis,despite being a long-term method for identifying adverse geology in tunnels,has significant limitations due to its reliance on empirical analysis.The quantitative aspects of geochemical anomalies associated with adverse geology provide a novel strategy for addressing these limitations.However,statistical methods for identifying geochemical anomalies are insufficient for tunnel engineering.In contrast,data mining techniques such as machine learning have demonstrated greater efficacy when applied to geological data.Herein,a method for identifying adverse geology using machine learning of geochemical anomalies is proposed.The method was identified geochemical anomalies in tunnel that were not identified by statistical methods.We by employing robust factor analysis and self-organizing maps to reduce the dimensionality of geochemical data and extract the anomaly elements combination(AEC).Using the AEC sample data,we trained an isolation forest model to identify the multi-element anomalies,successfully.We analyzed the adverse geological features based the multi-element anomalies.This study,therefore,extends the traditional approach of geological analysis in tunnels and demonstrates that machine learning is an effective tool for intelligent geological analysis.Correspondingly,the research offers new insights regarding the adverse geology and the prevention of hazards during the construction of tunnels and underground engineering projects.展开更多
BACKGROUND The CAR-OLT score predicts major adverse cardiovascular events 1 year after liver transplant(LT).AIM To test the hypothesis that the CAR-OLT score may help avoid cardiac stress tests in LT candidates.METHOD...BACKGROUND The CAR-OLT score predicts major adverse cardiovascular events 1 year after liver transplant(LT).AIM To test the hypothesis that the CAR-OLT score may help avoid cardiac stress tests in LT candidates.METHODS This retrospective single-center cohort study included all adult patients undergoing elective evaluation for first cadaveric donor orthotopic LT for liver cirrhosis with or without hepatocellular carcinoma at Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricerca e Cura a Carattere Scientifico in Rome,Italy.Cardiac contraindications for LT listing were defined after a center-specific cardiac workup,which included cardiac stress tests for most patients.The diagnostic accuracy of the CAR-OLT score was evaluated using the area under the receiver operating characteristic(AUROC)method.RESULTS A total of 342 LT candidates were evaluated between 2015 and 2019,with a moderate cardiovascular risk profile(37%diabetes,34%hypertension,22%obesity).Of these,80(23%)candidates underwent coronary angiography.Twenty-one(6%)candidates were given cardiac contraindications to LT listing,48%of which were due to coronary artery disease.The CAR-OLT score predicted cardiac contraindications to LT listing with an AUROC of 0.81.The optimal cut-off for sensitivity was a CAR-OLT score≤23,which showed a 99%negative predictive value for cardiac contraindications to LT listing.A total of 84(25%)LT candidates with a CAR-OLT score≤23 underwent 87 non-invasive cardiac tests and 13 coronary angiographies pre-listing,with estimated costs of approximately 48000€.The estimated savings per patient was€574.70 for the Italian National Health System.CONCLUSION A CAR-OLT score≤23 can identify LT candidates who can be safely listed without the need for cardiac stress tests,providing time and cost savings.These findings require external validation.展开更多
BACKGROUND Diabetic foot ulcers(DFUs)are a significant challenge in diabetic care,and the efficacy of negative pressure wound therapy(NPWT)in treating them remains a subject of continuous investigation.AIM To provide ...BACKGROUND Diabetic foot ulcers(DFUs)are a significant challenge in diabetic care,and the efficacy of negative pressure wound therapy(NPWT)in treating them remains a subject of continuous investigation.AIM To provide a comprehensive meta-analysis of the role of NPWT in the manage-ment of DFUs.METHODS A systematic review was performed based on Preferred Reporting Items for Sys-tematic Reviews and Meta-Analyses guidelines,searching databases like PubMed,Embase,Web of Science,and the Cochrane Library.Randomized clinical trials(RCTs)were included to compare NPWT to other dressings for DFUs.Outcomes measured were wound healing time and rate,granulation tissue formation time,amputation rate,and adverse events.Study quality was evaluated using Coch-rane's risk of bias tool.Analyses utilizedχ2,I2,fixed or random-effects models via Stata v17.RESULTS Of the 1101 identified articles,9 RCTs were selected for meta-analysis.Studies spanned from 2005 to 2020 and originated from countries including the United States,Chile,Pakistan,Italy,India,and Germany.Meta-analysis demonstrated a significant improvement in wound healing rate[risk ratio(RR)=1.46,95%CI:1.22-1.76,P<0.01]and a reduction in amputation rate(RR=0.69,95%CI:0.50-0.96,P=0.006)with NPWT.Furthermore,the time for granulation tissue formation was significantly reduced by an average of 19.54 days.However,the incidence of adverse events did not significantly differ between NPWT and control treatments.CONCLUSION NPWT significantly improves wound healing rates and reduces amputation rates in DFUs.It also hastens the formation of granulation tissue.However,the therapy does not significantly alter the risk of adverse events compared to alternate treatments.展开更多
基金supported by #NEXTGENERATIONEU(NGEU)and funded by the Ministry of University and Research(MUR),National Recovery and Resilience Plan(NRRP),project MNESYS(PE0000006)-(DN.155311.10.2022)supported by Sapienza Grant 2021(RM12117A60BDF685).
文摘Background Non-suicidal self-injury(NSSI)is a significant health concern among adolescents and young adults,often resulting from adverse childhood experiences(ACEs).Dissociation,post-traumatic symptoms and attachment style may have a role in shaping such associations.Aims This study aims to provide a unified model of the impact of ACEs on NSSI,exploring complex post-traumatic stress disorder(cPTSD)symptoms and dissociation as potential mediators and the role of the predominant attachment style in affecting such associations.Methods 1010 young individuals attending the last year of high school participated in this cross-sectional study.ACEs,cPTSD,dissociation and NSSI were evaluated using self-report questionnaires.We fitted a path model of NSSI,with ACEs as exogenous variables and cPTSD and dissociation as sequential mediators.Secure,fearful and preoccupied attachment styles were modelled as grouping variables.Results Our findings showed that dissociation mediated the impact of ACEs on NSSI in subjects with a fearful attachment style,as opposed to those with a preoccupied attachment for whom cPTSD symptoms mediated the ACEs-NSSI association.Conclusions Attachment styles moderate the relationship between ACEs and NSSI,with either dissociation or post-traumatic symptomatology mediating the impact of ACEs on NSSI,depending on the predominant attachment style.Our results highlight the importance of attachment as a pathway modifier in the relationships between different psychopathology dimensions,providing a useful framework to better conceptualise the ACEs-NSSI association.
文摘AIM: To study the association between self-reported peptic ulcer and childhood adversities.METHODS: The Health and Social Support Study (HeS-Sup) population consisted of a stratif ied random sample drawn from the Finnish Population Register in four age groups: 20-24, 30-34, 40-44 and 50-54. The survey was carried out by postal questionnaire during 1998, with a response rate of 40.0%. A follow-up questionnaire was sent during 2003 to all those who responded to the f irst. Altogether 19 626 individuals returned the follow-up questionnaire; a response rate of 75.8%. The subjects were asked whether a doctor had told them that they have or have had peptic ulcer. The analyses covered those who responded aff irmatively to both the baseline and the follow-up enquiries (n = 718). Those not re-porting a peptic ulcer in either of the two questionnaires (n = 17 677) were taken as controls. The subjects were further requested (through six questions) to think about their childhood adversities.RESULTS: The most common adversities mentioned were long-lasting financial difficulties in the family, serious conflicts in the family, and a family member seriously or chronically ill. All the adversities reported, except parental divorce, were more common among peptic ulcer patients than among controls (P values varied between < 0.001 and 0.003). Age- and sex-adjusted odds ratios (OR) of childhood adversities in the multivariate logistic analysis for self-reported pep-tic ulcer varied between 1.45 and 2.01. Adjusting for smoking, heavy drinking, stress and nonsteroidal anti-inflammatory drug use had no further influence (ORs between 1.22 and 1.73).CONCLUSION: Our findings suggest that childhood adversities maintain a connection with and have a predictive role in the development of peptic ulcer.
基金Centre for General Practice,Pirkanmaa Hospital District has supported the work financially.
文摘Background: It has been suggested that childhood events increase the risk of suffering from an eating disorder (ED) in adolescence or young adulthood. Our study here aimed at investigating whether there was an association between stressful childhood events and eating disorders later in life. Methods: Our population-based study was a part of the HeSSup (The Health and Social Support) postal survey in 2003, a follow-up survey with a random sample of working-aged subjects drawn from the Finnish Population Register in 1998. Participants in this study reported having been suffering from ED (N = 374), while controls (N = 18,639) reported no history of eating disorder in the questionnaire both in 1998 and 2003. The questionnaire included six questions related to childhood adversities. Results: Each childhood stressor increased the risk of developing ED cumulatively (one adversity OR 1.7 versus all six OR 8.3). Intrafamiliar conflicts (OR 2.0), being afraid of a family member (OR 1.5) or long-term illnesses in the family (OR 1.4) increased the ED-risk statistical significantly. Conclusion: Children exposed to stress are more likely to suffer from eating disorders as adults than those not exposed.
文摘Objective:Artemether is a semi-synthetic derivative of artemisinin and is widely used in the treatment of Plasmodium(P.)falciparum malaria.This study aimed to characterize the safety profile of artemether based on 15-year data retrived from FDA adverse event reporting system(FAERS).Methods:This is a retrospective analysis on 15-year data of artemether-related adverse effects(AEs)retrieved from the FAERS.AEs were classified according to System Organ Class(SOC)and Preferred Terms(PT).Signal detection was performed using Reporting Odds Ratios(ROR),Proportional Reporting Ratios(PRR),and Empirical Bayes Geometric Mean(EBGM).Stratified analyses examined the impact of demographic factors such as sex,age,and time-to-onset.Temporal patterns and associated risk factors were also investigated.Results:Haemolytic anaemia and haemolysis emerged as the most frequently reported AEs,exhibiting significantly elevated RORs(males:ROR 381.36,95%CI 247.06-588.60;females:ROR 455.11,95%CI 286.43-723.12).Sex-specific differences were evident,with females showing a higher incidence of reproductive-related AEs,including spontaneous abortion and premature labour.Temporal trend analysis revealed that the majority of AEs occurred within the first 30 days after the initiation of artemether administration,indicating a rapid onset.The most affected SOCs were blood and lymphatic system disorders and hepatobiliary disorders.Conclusions:Artemether is associated with a notable frequency of early-onset AEs,particularly hematological and hepatobiliary disorders.The observed sex-specific vulnerability to reproductive AEs highlights the need for sex-conscious clinical approaches.Enhanced post-treatment monitoring and further investigations into the drug’s pharmacokinetics and mechanistic pathways are recommended.
文摘Carbamazepine is an antiepileptic drug also used for neuropathic pain and mood stabilization.It is a strong enzyme inducer and autoinducer with multiple well-documented drug–drug interactions and adverse drug reactions.Widely licensed and in use since the 1960s,carbamazepine has well-characterized pharmacological,pharmacogenetic,and safety profiles,and remains extensively used in neurology and psychiatry.In 2024,carbamazepine was recommended for inclusion in the World Health Organization list of essential medicines.Carbamazepine has a complex mode of action that includes neuronal stabilization,neuroprotection,neurotransmitter modulation,enhancement of autophagy,and anti-inflammatory effects.These make carbamazepine a good candidate for drug repurposing in oncology,genetic diseases,neurodegeneration,and systemic inflammation.Recent advances in precision medicine,genomics,and on/off-target drug repositioning have enabled the identification of new carbamazepinemolecular targets for novel applications in different therapeuticmodalities.This review highlights carbamazepine repurposing studies in cancers such as breast and colorectal,based on its mode of action.In addition,repurposing studies in genetic diseases such asmetaphyseal achondroplasia and Fragile-X,as well as in neurodegenerative conditions such as amyotrophic lateral sclerosis and Alzheimer's dementia,are discussed.The pharmacological mechanisms and drug repurposing pathways are critically summarized in order to provide insights into their therapeutic potential and proposed future directions.
基金supported by Centro de Investigaci on Biom edica en Red Fragilidad y Envejecimiento Saludable(CIBERFES)(Grant Nos.CB16/10/00477,CB16/10/00456,and CB16/10/00464)Plan Propio de Investigaci on of the University of Castilla-La Mancha,and Fondo Europeo de Desarrollo Regional(FEDER)funds from the European Union(Grant No.2022-GRIN-34296)+3 种基金further funded by grants from the Instituto de Salud Carlos III(Grant Nos.PI031558,PI07/90637,PI07/90306,RD 06/0013,and PI18/00972)the Government of Castilla-La Mancha(Grant Nos.03031 and SBPLY/19/180501/000312)Red EXERNETRED DE EJERCICIO FISICO Y SALUD:RED2022-134800T from the Spanish Ministry of Innovation and Sciencesupported by a research grant from the University of Castilla-La Mancha(Programa Investigo,Grant No.2024INVGO-12359)。
文摘Background:Low relative sit-to-stand(STS)power has emerged as a critical predictor of adverse health outcomes,such as frailty and disability,in older adults.However,its impact on falls,fractures,hospitalizations,and all-cause mortality remains unclear.Therefore,this longitudinal study aimed to investigate the potential associations between low relative STS power and these adverse health outcomes in older adults.Methods:A total of 1876 older adults(aged≥65 years,56.4%women)were included from the Toledo Study for Healthy Aging.Relative STS power was assessed using the 30-s STS test and the Alcazar equation.Participants were categorized as having low relative STS power based on previously established cut-off points(2.53 W/kg for men and 2.01 W/kg for women).Falls and fractures(hip and all-type)within the previous year were recorded.Hospitalizations and all-cause mortality were obtained during a follow-up of 6.8±3.1 years(mean±SD;median=7.8 years;interquartile range:3.9-10.1 years)and 9.7±3.5 years(median=10.9 years;interquartile range:8.2-12.5 years),respectively.Generalized linear mixed models,binary logistic regression,and proportional hazards regression adjusted for age,educational level,and comorbidities were used.Results:In men,low relative STS power was significantly associated with an increased likelihood of history of falls(odds ratio(OR)=1.73,95%confidence interval(95%CI):1.08-2.75,p=0.022)and all-type fractures(OR=1.86,95%CI:1.21-2.84,p=0.004)in the previous year.In women,low relative STS power was associated with a higher probability of hip fractures within the previous year(OR=3.25,95%CI:1.07-9.86,p=0.038).Low relative STS power predicted hospitalizations in women(hazard ratio(HR)=1.29,95%CI:1.06-1.58,p=0.012)and longer hospital stays in both men(p=0.020)and women(p=0.033).Low relative STS power significantly increased all-cause mortality in both men(HR=1.57,95%CI:1.26-1.97,p<0.001)and women(HR=2.04,95%CI:1.51-2.74,p<0.001).Conclusion:Low relative STS power was associated with history of hip fractures in women,whereas in men it was associated with history of falls and all-type fractures.Low relative STS power predicted hospitalizations in women but not in men.In both men and women,low relative STS power was associated with longer hospital stays and increased risk of all-cause mortality.
基金Clinical Pharmacy of National TCM Superior Specialties of the National Administration of Traditional Chinese MedicineDocument No.Guozhongyiyaozheng Han[2024]No.90。
文摘This study aimed to elucidate the clinical features and temporal patterns of drug-induced lupus(DIL)associated with the stilbene amine antiepileptic drugs carbamazepine and oxcarbazepine.A comprehensive systematic review was conducted using multiple literature databases.Both domestic and international case reports of DIL linked to these agents were screened and analyzed.A total of 22 eligible cases were identified,comprising 19 cases related to carbamazepine and three to oxcarbazepine.Analysis revealed a mean patient age of 32.50±16.08 years,with a marked female predominance(72.73%,16/22).The latency period,the duration between drug initiation and the onset of DIL,was notably prolonged and variable,averaging 56.93±75.57 months.Clinically,DIL presented as a multi-system disorder,with hematologic abnormalities(e.g.,thrombocytopenia,anemia,and leukopenia)observed in 68.18%of cases,musculoskeletal symptoms(arthritis or joint pain)in 59.09%,and cutaneous involvement(rash or photosensitivity)in 54.55%.Following drug discontinuation and,in some instances,glucocorticoid therapy,clinical improvement was observed to varying degrees.Notably,31.82%of patients experienced complete symptom resolution within 7 d.Given the insidious onset and multi-organ involvement of DIL,our findings underscored the importance of heightened clinical vigilance and routine monitoring protocols during antiepileptic drug therapy.This study highlighted the need for a dynamic risk-benefit assessment in the clinical use of antiepileptic drugs and provides valuable insights for the management of rare but serious neurological adverse reactions.
基金supported by the National Natural Science Foundation of China(82373277).
文摘Delivery carriers serve as a highly efficient approach for precision nutrition and medicine;however,artificial delivery carriers are prone to triggering the immune response and have the disadvantages of poor stability and low bioavailability.Extracellular vesicles(EVs),nucleus-free biological particles composed of phospholipid bilayers secreted by living cells,are a new generation of targeted delivery carriers.In recent years,an increasing number of species have been reported to contain EVs.Among them,food-derived extracellular vesicles(FDEVs)show outstanding comprehensive properties.FDEVs are considered to have great application potential due to their wide range of sources,high yields,absence of human pathogenic pathogens,and ethical concerns.In this review,the preparation,nomenclature,physicochemical characteristics,and preservation methods of FDEVs are discussed,as well as their potential protein markers,bioactivities,and applications as novel targeted delivery carriers of FDEVs from animals,plants,and microorganisms.We also summarized the adverse consequences of FDEVs in current studies,and put forward the problems and challenges in the process of FDEVs research and commercialization.In short,the importance of FDEVs has been highlighted,and FDEVs have good application prospects as a new class of targeted delivery carriers.The current problems should be paid attention to and actively solved.
文摘Objective:To analyze the efficacy of allergen subcutaneous injection immunotherapy in patients with allergic rhinitis.Methods:Fifty patients with allergic rhinitis admitted from May 2023 to May 2025 were selected as study subjects and randomly divided into a control group and an observation group,with 25 patients in each group.The control group was treated with budesonide nasal spray,while the observation group received allergen subcutaneous injection immunotherapy in addition to the control treatment.The treatment efficacy,adverse reactions,symptom improvement time,and immune indicators were compared between the two groups.Results:The observation group showed a higher disease treatment efficacy than the control group(p<0.05);the incidence of adverse reactions in the observation group was not statistically significant compared to the control group(p>0.05);the observation group had a shorter symptom improvement time for nasal obstruction,rhinorrhea,and sneezing than the control group(p<0.05);before treatment,there was no statistical significance in immune indicators between the two groups(p>0.05);after treatment,CD3+and CD4/CD8+in the observation group were higher than those in the control group(p<0.05).Conclusion:Allergen subcutaneous injection immunotherapy in patients with allergic rhinitis can improve disease treatment efficacy,alleviate clinical symptoms,and enhance immune function.This therapy is safe and has clinical application value.
文摘Objective:To characterize placental morphologic features in Moroccan women with adverse outcomes,across different clinical contexts,based on the Amsterdam consensus classification.Methods:A prospective analysis was conducted on placentas with umbilical cords collected fresh between March 1,2024 and July 15,2024 from women with adverse pregnancy outcomes.Clinical data(age,parity,gravidity,complications)were retrieved.Macroscopic parameters(weight,dimensions,cord insertion,membranes,lesions)were assessed,followed by systematic sampling.Tissue was processed by standard histology(formalin fixation,paraffin embedding,hematoxylin and eosin staining),and lesions were classified per Amsterdam criteria.Results:16 placentas from patients with adverse pregnancy outcomes were included.The median maternal age was 30 years.Adverse conditions included placental abruption(50%),intrauterine growth restriction(IUGR,38%),intrauterine fetal death(IUFD,31%),pre-eclampsia/eclampsia(19%),premature rupture of membranes(13%),and oligohydramnios(13%).Several placentas were associated with more than one adverse condition.Histopathology revealed maternal vascular malperfusion lesions in 94%,particularly in pre-eclampsia,IUGR,and IUFD.Fetal vascular malperfusion was found in 88%,mainly in IUGR and IUFD.Inflammatory lesions,dominated by acute maternal and fetal responses stage 3(necrotizing chorioamnionitis and funisitis),were primarily linked to IUFD.Conclusions:Placental examination enhances understanding of the pathophysiology underlying adverse pregnancy outcomes,supports diagnostic confirmation,and guides preventive strategies for recurrence.This study highlights the prevalence of maternal vascular malperfusion in Moroccan women and emphasizes the importance of systematic placental histopathology in obstetric care.
文摘Objective: To evaluate the preventive effect of shoulder dystocia midwifery techniques combined with predictive nursing on shoulder dystocia. Methods: A total of 82 high-risk pregnant women with shoulder dystocia admitted for childbirth from January 2022 to January 2025 were selected and equally divided using a random number table. The experimental group received shoulder dystocia midwifery techniques combined with predictive nursing, while the reference group received routine midwifery care. Indicators such as the preventive effect on shoulder dystocia were compared between the two groups. Results: The incidence of shoulder dystocia in the experimental group was lower than that in the reference group, the duration of labor was shorter, the amount of intra-partum bleeding was less, the incidence of adverse delivery outcomes was lower, and the score for fear of childbirth after intervention was lower than that in the reference group (p < 0.05). Conclusion: Implementing shoulder dystocia midwifery techniques combined with predictive nursing for high-risk pregnant women with shoulder dystocia can prevent shoulder dystocia and other adverse delivery outcomes, shorten the duration of labor, reduce intra-partum bleeding, and alleviate pregnant women’s fear of childbirth, demonstrating high nursing value.
文摘Background In patients with coronary artery disease,age is of known significance in predicting outcomes.Data on clinical outcomes in patients≥85 years undergoing percutaneous coronary intervention(PCI)remain scarce.The study aim was to determine clinical characteristics,risk of adverse cardiovascular events,and mortality in patients aged≥85 years compared to those aged<85 undergoing PCI.Methods In this retrospective study,data were obtained from the nationwide Netherlands Heart Registration on patients undergoing PCI between January 1st,2017 and January 1st,2021.The primary endpoint was all-cause mortality at long-term followup.Results A total of 155,683 patients underwent PCI,of which 100,209(64.4%)acute coronary syndrome cases.Compared to patients aged<85 years,patients aged≥85 were more often female and showed a higher number of cardiovascular comorbidities,including impaired left ventricle ejection fraction and reduced kidney function.Mortality at short-term and long-term follow-up were significantly higher in those aged≥85(P<0.001).Patients aged≥85 were more likely to have a myocardial infarction within 30 days following the index intervention(0.9%vs.0.7%;P=0.024),though they less often underwent revascularization at longterm follow-up compared to patients aged<85(P<0.001).Conclusions The elderly(≥85 years)patient requiring PCI carries an extensive cardiovascular risk profile,translating in significant risk of recurrent cardiovascular events and increased mortality rate.Clinicians should carefully weigh perceived risks and potential benefits in the individual patient,considering the patients’age,cardiovascular risk profile,and associated risk of morbidity and mortality.
基金supported by the Science and Technology Fund Project of Guizhou Health Commission(gzwkj2025-163)。
文摘Objective:To identify the root causes of typical adverse drug events through the lens of patient experiences proposing novel strategies to mitigate preventable harm.Methods:A qualitative case study leveraging in-depth interviews with patients and families,anchored by Interactive Patient Par ticipation Theory,to analyze 4 high-severity adverse drug events(ADE)cases.Cases were purposively sampled from 8 communities in China's National Adverse Event Monitor Center(2018-2023).Semi-structured interviews explored patient perspectives,with data analyzed via thematic coding and triangulation against clinical records.Results:Five interconnected themes emerged:(1)erosion of trust,(2)communication breakdowns,(3)information asymmetry,(4)environmental inadequacies,and(5)technological alienation.Notably,75% of participants had≤high school education,and 50% used≥7 medications daily,compounding ADE risks.Conclusions:We considered elements mentioned by theory,exploring trust,communication,information,and suppor t as the root causes.In addition,we added“adaptability to new technology”as an impor tant and necessary component.It is impor tant and necessary to analyze typical adverse drug events from the perspectives of patients.
基金Intramural Project of The First Affiliated Hospital of Guangxi University of Chinese Medicine(2018QN008).
文摘Background:The purpose of this study was to analyze and classify adverse drug events(ADEs)related to ceftazidime/avibactam reported in the Food and Drug Administration Adverse Event Reporting System(FAERS)database and to evaluate their potential safety signals since the drug’s market introduction.Methods:This analysis systematically extracted and filtered FAERS data for ceftazidime/avibactam from its market launch in 2015 to the last quarter of 2024,utilizing the Medical Dictionary for Regulatory Activities(MedDRA)terminology for ADE recoding.The analysis employed the reporting odds ratio(ROR)method to assess the strength of ADE signals and to identify significant diseases associated with infections,the hepatobiliary system,the urinary system,and the nervous system.Results:A review of 540 adverse reaction reports revealed significant signals of adverse effects related to infections,hepatobiliary disorders,urinary system issues,and neurological impairments,including pathogen resistance,liver and kidney function impairment,encephalopathy,thrombocytopenia,and toxic epidermal necrolysis.However,these issues require further clinical attention.Conclusion:Ceftazidime/avibactam is associated with a range of adverse reactions,necessitating enhanced clinical monitoring,particularly in patients with underlying liver or kidney dysfunction.Continuous risk assessment and vigilant monitoring are critical for its clinical use.However,this study is limited by inherent reporting biases and confounders associated with the spontaneous reporting database(FAERS).Future research should validate these signals through prospective cohort and mechanistic studies and explore personalized risk management strategies for high-risk populations.
文摘Deep brain stimulation(DBS)is an established therapeutic intervention for people with Parkinson’s disease(PwPD)and is increasingly being utilized for other neurological disorders.Although effective in alleviating motor symptoms and reducing medication requirements,DBS has undergone minimal conceptual evolution and still relies on continuous high-frequency electrical stimulation.In Parkinson’s disease(PD),this persistent stimulation may cause adverse effects,including dysarthria,stimulation-induced dyskinesia,impulsivity,and mood alterations.Additionally,the continuous energy demand of current DBS systems accelerates battery depletion,necessitating more frequent battery charging or battery replacement surgeries,increasing risks,burden,and costs.Basic neuroscience research has long demonstrated that exogenous electrical stimulation can induce persistent changes to synaptic connections,known as long-term plasticity.
文摘Alzheimer's disease is a common neurodegenerative disorder in older adults.Despite its prevalence,its pathogenesis remains unclea r.In addition to the most widely accepted causes,which in clude excessive amyloid-beta aggregation,tau hyperphosphorylation,and deficiency of the neurotransmitter acetylcholine,numerous studies have shown that the dopaminergic system is also closely associated with the occurrence and development of this condition.Dopamine is a crucial catecholaminergic neurotransmitter in the human body.Dopamine-associated treatments,such as drugs that target dopamine receptor D and dopamine analogs,can improve cognitive function and alleviate psychiatric symptoms as well as ameliorate other clinical manifestations.Howeve r,therapeutics targeting the dopaminergic system are associated with various adverse reactions,such as addiction and exacerbation of cognitive impairment.This review summarizes the role of the dopaminergic system in the pathology of Alzheimer's disease,focusing on currently available dopamine-based therapies for this disorder and the common side effects associated with dopamine-related drugs.The aim of this review is to provide insights into the potential connections between the dopaminergic system and Alzheimer's disease,thus helping to clarify the mechanisms underlying the condition and exploring more effective therapeutic options.
文摘BACKGROUND Propofol has been widely used in bidirectional gastrointestinal endoscopy sedation;however,it frequently leads to cardiovascular adverse events and respiratory depression.Propofol target-controlled infusion(TCI)can provide safe sedation but may require higher dosages of propofol.On the contrary,etomidate offers hemodynamic stability.AIM To evaluate the effect of different dose etomidate added to propofol TCI sedation during same-visit bidirectional endoscopy.METHODS A total of 330 patients from Fujian Provincial Hospital were randomly divided into three groups:P,0.1EP,and 0.15EP.Patients in the P group received propofol TCI only,with an initial effect-site concentration of the propofol TCI system of 3.0 mg/mL.Patients in the 0.1EP and 0.15EP groups received 0.1 and 0.15 mg/kg etomidate intravenous injection,respectively,followed by propofol TCI.RESULTS Patients in the 0.15EP group had higher mean blood pressure after induction than the other groups(P group:78 mmHg,0.1EP group:82 mmHg,0.15EP group:88 mmHg;P<0.05).Total doses of propofol consumption significantly decreased in the 0.15EP group compared with that in the other groups(P group:260.6 mg,0.1EP group:228.1 mg,0.15EP group:201.2 mg;P<0.05).The induction time was longer in the P group than in the other groups(P group:1.9±0.7 minutes,0.1EP group:1.2±0.4 minutes,0.15EP group:1.1±0.3 minutes;P<0.01).The recovery time was shorter in the 0.15EP group than in the other groups(P group:4.8±2.1 minutes,0.1EP group:4.5±1.6 minutes,0.15EP group:3.9±1.4 minutes;P<0.01).The incidence of hypotension(P group:36.4%,0.1EP group:29.1%,0.15EP group:11.8%;P<0.01)and injection pain was lower in the 0.15EP group than in the other groups(P<0.05).Furthermore,the incidence of respiratory depression was lower in the 0.15EP group than in the P group(P<0.05).Additionally,the satisfaction of the patient,endoscopist,and anesthesiologist was higher in the 0.15EP group than in the other groups(P<0.05).CONCLUSION Our findings suggest that 0.15 mg/kg etomidate plus propofol TCI can significantly reduce propofol consumption,which is followed by fewer cardiovascular adverse events and respiratory depression,along with higher patient,endoscopist,and anesthesiologist satisfaction.
基金the support from the National Natural Science Foundation of China(Nos.52279103,52379103)the Natural Science Foundation of Shandong Province(No.ZR2023YQ049)。
文摘Geological analysis,despite being a long-term method for identifying adverse geology in tunnels,has significant limitations due to its reliance on empirical analysis.The quantitative aspects of geochemical anomalies associated with adverse geology provide a novel strategy for addressing these limitations.However,statistical methods for identifying geochemical anomalies are insufficient for tunnel engineering.In contrast,data mining techniques such as machine learning have demonstrated greater efficacy when applied to geological data.Herein,a method for identifying adverse geology using machine learning of geochemical anomalies is proposed.The method was identified geochemical anomalies in tunnel that were not identified by statistical methods.We by employing robust factor analysis and self-organizing maps to reduce the dimensionality of geochemical data and extract the anomaly elements combination(AEC).Using the AEC sample data,we trained an isolation forest model to identify the multi-element anomalies,successfully.We analyzed the adverse geological features based the multi-element anomalies.This study,therefore,extends the traditional approach of geological analysis in tunnels and demonstrates that machine learning is an effective tool for intelligent geological analysis.Correspondingly,the research offers new insights regarding the adverse geology and the prevention of hazards during the construction of tunnels and underground engineering projects.
文摘BACKGROUND The CAR-OLT score predicts major adverse cardiovascular events 1 year after liver transplant(LT).AIM To test the hypothesis that the CAR-OLT score may help avoid cardiac stress tests in LT candidates.METHODS This retrospective single-center cohort study included all adult patients undergoing elective evaluation for first cadaveric donor orthotopic LT for liver cirrhosis with or without hepatocellular carcinoma at Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricerca e Cura a Carattere Scientifico in Rome,Italy.Cardiac contraindications for LT listing were defined after a center-specific cardiac workup,which included cardiac stress tests for most patients.The diagnostic accuracy of the CAR-OLT score was evaluated using the area under the receiver operating characteristic(AUROC)method.RESULTS A total of 342 LT candidates were evaluated between 2015 and 2019,with a moderate cardiovascular risk profile(37%diabetes,34%hypertension,22%obesity).Of these,80(23%)candidates underwent coronary angiography.Twenty-one(6%)candidates were given cardiac contraindications to LT listing,48%of which were due to coronary artery disease.The CAR-OLT score predicted cardiac contraindications to LT listing with an AUROC of 0.81.The optimal cut-off for sensitivity was a CAR-OLT score≤23,which showed a 99%negative predictive value for cardiac contraindications to LT listing.A total of 84(25%)LT candidates with a CAR-OLT score≤23 underwent 87 non-invasive cardiac tests and 13 coronary angiographies pre-listing,with estimated costs of approximately 48000€.The estimated savings per patient was€574.70 for the Italian National Health System.CONCLUSION A CAR-OLT score≤23 can identify LT candidates who can be safely listed without the need for cardiac stress tests,providing time and cost savings.These findings require external validation.
基金Supported by the National Natural Science Foundation of China,No.82202454 and No.81873934the Wang Zhengguo Trauma Medicine Fund(Growth Factor Revival Plan)No.SZYZ-TR-09+1 种基金the Shandong Provincial Natural Science Foundation Youth Fund,No.ZR2020QH168the Jinan Science and Technology Plan Project,No.202225065。
文摘BACKGROUND Diabetic foot ulcers(DFUs)are a significant challenge in diabetic care,and the efficacy of negative pressure wound therapy(NPWT)in treating them remains a subject of continuous investigation.AIM To provide a comprehensive meta-analysis of the role of NPWT in the manage-ment of DFUs.METHODS A systematic review was performed based on Preferred Reporting Items for Sys-tematic Reviews and Meta-Analyses guidelines,searching databases like PubMed,Embase,Web of Science,and the Cochrane Library.Randomized clinical trials(RCTs)were included to compare NPWT to other dressings for DFUs.Outcomes measured were wound healing time and rate,granulation tissue formation time,amputation rate,and adverse events.Study quality was evaluated using Coch-rane's risk of bias tool.Analyses utilizedχ2,I2,fixed or random-effects models via Stata v17.RESULTS Of the 1101 identified articles,9 RCTs were selected for meta-analysis.Studies spanned from 2005 to 2020 and originated from countries including the United States,Chile,Pakistan,Italy,India,and Germany.Meta-analysis demonstrated a significant improvement in wound healing rate[risk ratio(RR)=1.46,95%CI:1.22-1.76,P<0.01]and a reduction in amputation rate(RR=0.69,95%CI:0.50-0.96,P=0.006)with NPWT.Furthermore,the time for granulation tissue formation was significantly reduced by an average of 19.54 days.However,the incidence of adverse events did not significantly differ between NPWT and control treatments.CONCLUSION NPWT significantly improves wound healing rates and reduces amputation rates in DFUs.It also hastens the formation of granulation tissue.However,the therapy does not significantly alter the risk of adverse events compared to alternate treatments.
