AIM:To assess and rank the efficacy of various nonsteroidal anti-inflammatory drugs(NSAIDs)in preventing postoperative macular edema(PME)after cataract surgery.METHODS:A comprehensive search was conducted across PubMe...AIM:To assess and rank the efficacy of various nonsteroidal anti-inflammatory drugs(NSAIDs)in preventing postoperative macular edema(PME)after cataract surgery.METHODS:A comprehensive search was conducted across PubMed,Embase,Cochrane Library,and Web of Science databases.Randomized controlled trials(RCTs)comparing different NSAIDs and control treatments for the prevention of PME were included.Data from the studies were synthesized using the“gemtc”package in R.Risk of bias was assessed with the Cochrane RoB 2 tool,and heterogeneity was evaluated using the global I2 statistic.Surface under the cumulative ranking curve(SUCRA)values were calculated for each treatment.RESULTS:Of 132 identified records,9 RCTs met the inclusion criteria.The Network Meta-analysis indicated that nepafenac had the highest efficacy in preventing PME,followed by artificial tear substitute,ketorolac,diclofenac,and bromfenac.The league table comparisons and rankograms corroborated these findings,with nepafenac consistently ranking highest.Heterogeneity analysis yielded high I2 values,indicating substantial variability across studies.CONCLUSION:This Network Meta-analysis suggests that nepafenac is the most effective NSAID for preventing PME following cataract surgery.Given the substantial heterogeneity observed,further high-quality RCTs are required to confirm these findings and explore the sources of variability.Clinicians should consider these results when selecting NSAIDs for PME prophylaxis in cataract surgery patients.展开更多
Background: The increasing use of non-steroidal anti-inflammatory drugs (NSAIDs) both on prescription and over the counter raises a major global health concern because of the risks associated with their use if no prop...Background: The increasing use of non-steroidal anti-inflammatory drugs (NSAIDs) both on prescription and over the counter raises a major global health concern because of the risks associated with their use if no proper guidance is given by the health care provider. This study assessed the roles of community pharmacists in screening and disseminating information about the risks associated with NSAID use in Zambia. Methodology: This was a national cross-sectional study in which a structured self-administered questionnaire was administered to 245 registered community pharmacists in Zambia. Stata/BE, version 15.1 (Stata Corporation, College Station, Texas, USA) and multivariate logistic regression model was used to determine factors associated with information dissemination about ADRs of NS-NSAIDs. Results: 231 of the 245 distributed questionnaires were returned giving a response rate of 94.3%. All (100%) participating community pharmacists claimed to have practiced dispensing NSAIDs. However, only 26 (11.0%) and 71 (30.8%) regularly screened for risk factor of selective COX-2 NSAIDS (SC2-NSAIDS) and non-selective NSAIDS (NS-NSAIDs) respectively. Information dissemination on adverse drug reactions (ADRs) of SC2-NSAIDS was regularly provided by only 22 (9.5%) of pharmacists while that of NS-NSAIDs was regularly provided by 49 (21.2%). In the multivariate logistic regression model, being the owner of a pharmacy (AOR: 5.4, CI: 1.84 - 16.4) was significantly associated with information dissemination about ADRs of NS-NSAIDs while an hour increase in the working hours per day (AOR: 0.9, CI: 0.64 - 0.95) was associated with less likelihood of information dissemination. Conclusion: Pharmacists working in community pharmacies in Zambia did not regularly screen and disseminate information about the risks associated with NSAID use. Therefore, pharmacists should be able to screen and monitor patients at risk and be aware of the majority of risk factors while dispensing NSAIDs to minimize the associated complications.展开更多
This editorial explores the impact of non-steroidal anti-inflammatory drugs(NSAIDs)on postoperative recovery in hand fracture patients,amidst shifting pain management strategies away from opioids due to their adverse ...This editorial explores the impact of non-steroidal anti-inflammatory drugs(NSAIDs)on postoperative recovery in hand fracture patients,amidst shifting pain management strategies away from opioids due to their adverse effects.With hand fractures being significantly common and postoperative pain management crucial for recovery,the potential of NSAIDs offers a non-addictive pain control alternative.However,the controversy over NSAIDs'effects on bone healing—stemming from their Cyclooxygenase-2 inhibition and associated risks of fracture non-union or delayed union—necessitates further investigation.Despite a comprehensive literature search,the study finds a lack of specific research on NSAIDs in postoperative hand fracture management,highlighting an urgent need for future studies to balance their benefits against possible risks.展开更多
Microneedles(MNs)have been extensively investigated for transdermal delivery of large-sized drugs,including proteins,nucleic acids,and even extracellular vesicles(EVs).However,for their sufficient skin penetration,con...Microneedles(MNs)have been extensively investigated for transdermal delivery of large-sized drugs,including proteins,nucleic acids,and even extracellular vesicles(EVs).However,for their sufficient skin penetration,conventional MNs employ long needles(≥600μm),leading to pain and skin irritation.Moreover,it is critical to stably apply MNs against complex skin surfaces for uniform nanoscale drug delivery.Herein,a dually amplified transdermal patch(MN@EV/SC)is developed as the stem cell-derived EV delivery platform by hierarchically integrating an octopusinspired suction cup(SC)with short MNs(≤300μm).While leveraging the suction effect to induce nanoscale deformation of the stratum corneum,MN@EV/SC minimizes skin damage and enhances the adhesion of MNs,allowing EV to penetrate deeper into the dermis.When MNs of various lengths are applied to mouse skin,the short MNs can elicit comparable corticosterone release to chemical adhesives,whereas long MNs induce a prompt stress response.MN@EV/SC can achieve a remarkable penetration depth(290μm)for EV,compared to that of MN alone(111μm).Consequently,MN@EV/SC facilitates the revitalization of fibroblasts and enhances collagen synthesis in middle-aged mice.Overall,MN@EV/SC exhibits the potential for skin regeneration by modulating the dermal microenvironment and ensuring patient comfort.展开更多
Due to the limited regeneration capacity of myocardial tissue after infarction,designing tissue engineering scaffolds are in demand.In the present study,electrospun nanofibrous scaffolds were made out of polyurethane,...Due to the limited regeneration capacity of myocardial tissue after infarction,designing tissue engineering scaffolds are in demand.In the present study,electrospun nanofibrous scaffolds were made out of polyurethane,collagen and gold nanoparticles with random and aligned nanofiber morphologies.The nanoparticles were green-synthesized using saffron extract.Nanoparticle characterizations with UV-Vis.spectroscopy and DLS illustrated theoretical and hydrodynamic diameters of around 7 and 13 nm,respectively,having zeta potential of−37 mV.SEM and TEM micrographs showed the morphology and diameters of obtained nanofibers.Also,further characterization were done by ATR-FTIR,XRD and TGA investigations and degradation studies.Contact angle measurements showed hydrophilic nature of the scaffolds(59±0.6°for aligned PU/Col/Au50 nanofibers compared to 120±2.6°for random PU nanofibers).Mechanical testing demonstrated appropriate tensile properties of the scaffolds for cardiac tissue engineering(Young’s modulus:1.53±0.07 MPa for aligned PU/Col/Au50 nanofibers compared to 0.4±0.05 MPa for random PU nanofibers).Finally,alamar blue assay revealed proper survival of the cells of HUVEC cell line on the prepared scaffolds,where the highest percentages were observed for random and aligned PU/Col/Au50 nanofibers.According to the findings,the fabricated PU/Col/AuNPs nanofibrous scaffolds could be considered as potential cardiac patches.展开更多
Since the introduction of vision Transformers into the computer vision field,many vision tasks such as semantic segmentation tasks,have undergone radical changes.Although Transformer enhances the correlation of each l...Since the introduction of vision Transformers into the computer vision field,many vision tasks such as semantic segmentation tasks,have undergone radical changes.Although Transformer enhances the correlation of each local feature of an image object in the hidden space through the attention mechanism,it is difficult for a segmentation head to accomplish the mask prediction for dense embedding of multi-category and multi-local features.We present patch prototype vision Transformer(PPFormer),a Transformer architecture for semantic segmentation based on knowledge-embedded patch prototypes.1)The hierarchical Transformer encoder can generate multi-scale and multi-layered patch features including seamless patch projection to obtain information of multiscale patches,and feature-clustered self-attention to enhance the interplay of multi-layered visual information with implicit position encodes.2)PPFormer utilizes a non-parametric prototype decoder to extract region observations which represent significant parts of the objects by unlearnable patch prototypes and then calculate similarity between patch prototypes and pixel embeddings.The proposed contrasting patch prototype alignment module,which uses new patch prototypes to update prototype bank,effectively maintains class boundaries for prototypes.For different application scenarios,we have launched PPFormer-S,PPFormer-M and PPFormer-L by expanding the scale.Experimental results demonstrate that PPFormer can outperform fully convolutional networks(FCN)-and attention-based semantic segmentation models on the PASCAL VOC 2012,ADE20k,and Cityscapes datasets.展开更多
Software systems are vulnerable to security breaches as they expand in complexity and functionality.The confidentiality,integrity,and availability of data are gravely threatened by flaws in a system’s design,implemen...Software systems are vulnerable to security breaches as they expand in complexity and functionality.The confidentiality,integrity,and availability of data are gravely threatened by flaws in a system’s design,implementation,or configuration.To guarantee the durability&robustness of the software,vulnerability identification and fixation have become crucial areas of focus for developers,cybersecurity experts and industries.This paper presents a thorough multi-phase mathematical model for efficient patch management and vulnerability detection.To uniquely model these processes,the model incorporated the notion of the learning phenomenon in describing vulnerability fixation using a logistic learning function.Furthermore,the authors have used numerical methods to approximate the solution of the proposed framework where an analytical solution is difficult to attain.The suggested systematic architecture has been demonstrated through statistical analysis using patch datasets,which offers a solid basis for the research conclusions.According to computational research,learning dynamics improves security response and results in more effective vulnerability management.The suggested model offers a systematic approach to proactive vulnerability mitigation and has important uses in risk assessment,software maintenance,and cybersecurity.This study helps create more robust software systems by increasing patch management effectiveness,which benefits developers,cybersecurity experts,and sectors looking to reduce security threats in a growing digital world.展开更多
Adhesive patches offer an effective approach for wound closure,making them highly suitable for biomedical applications.However,conventional patches often face limitations such as dual-sided adhesion,lack of shape adap...Adhesive patches offer an effective approach for wound closure,making them highly suitable for biomedical applications.However,conventional patches often face limitations such as dual-sided adhesion,lack of shape adaptability,and limited maneuverability,which restrict their applications in deeper tissues.In this paper,we develop a magnetic patch robot(PatchBot),for targeted Janus adhesion with tissues.The PatchBot features a unique triple-layer structure,with adhesive,shape-morphing,and anti-adhesive layers,each fulfilling roles to support targeted attachment,enable shape transformation,and prevent unwanted adhesion to surrounding tissues.The Janus adhesion of the PatchBot was extensively demonstrated across a variety of tissues.A localized near-infrared(NIR)laser irradiation was used to induce programmable shape transformations.Magnetic actuation of the PatchBot for targeted adhesion was successfully demonstrated in ex vivo porcine stomach tissue.NIR light-activated shape-morphing and multimodal magnetic actuation significantly enhance its maneuverability and adaptability in confined in vivo environments while ensuring the structural integrity of the adhesive surface during deployment.This proof-of-concept study demonstrates the feasibility of using PatchBot for targeted wound adhesion,showing its potential for minimally invasive,precision therapies in complex in vivo environments.展开更多
This paper is a statistical survey of Southern Hemisphere cold and hot polar cap patches,in relation to the interplanetary magnetic field(IMF)and ionospheric convection geometry.A total of 11,946 patch events were ide...This paper is a statistical survey of Southern Hemisphere cold and hot polar cap patches,in relation to the interplanetary magnetic field(IMF)and ionospheric convection geometry.A total of 11,946 patch events were identified by Defense Meteorological Satellite Program(DMSP)F16 during the years 2011 to 2022.A temperature ratio of ion/electron temperature(T_(i)/T_(e))<0.68 is recommended to define a hot patch in the Southern Hemisphere,otherwise it is defined as a cold patch.The cold and hot patches have different dependencies on IMF clock angle,while their dependencies on IMF cone angle are similar.Both cold and hot patches appear most often on the duskside,and the distribution of cold patches gradually decreases from the dayside to the nightside,while hot patches have a higher occurrence rate near 14 and 21 magnetic local time(MLT).Moreover,we compared the key plasma characteristics of polar cap cold and hot patches in the Southern and Northern Hemispheres.The intensity of the duskside upward field-aligned current of patches in the Southern Hemisphere(SH)is stronger than that in the Northern Hemisphere(SH),which may be due to the discrepancy in conductivities between the two hemispheres,caused by the tilted dipole.In both hemispheres,the downward soft-electron energy flux of the dawnside patches is significantly greater than that of the duskside patches.展开更多
Objective:To evaluate the intervention effect of childlike nursing combined with Chinese herbal patching on pediatric bronchopneumonia.Methods:1036 children with bronchopneumonia(one family member included for each ch...Objective:To evaluate the intervention effect of childlike nursing combined with Chinese herbal patching on pediatric bronchopneumonia.Methods:1036 children with bronchopneumonia(one family member included for each child)who were admitted to the hospital between January 2024 and June 2024 were selected and randomly divided into two groups using a random number table.The combined group received childlike nursing combined with Chinese herbal patching,while the control group received routine nursing.Symptom recovery time,treatment compliance,inflammatory factor levels,quality of life of the children,and family satisfaction were compared between the two groups.Results:The symptom recovery time in the combined group was shorter than that in the control group,treatment compliance was higher,inflammatory factor levels after intervention were lower,quality of life scores of the children were lower,and family satisfaction was higher(P<0.05).Conclusion:The implementation of childlike nursing combined with Chinese herbal patching for children with bronchopneumonia can shorten their symptom recovery time,significantly improve treatment compliance and quality of life,reduce inflammatory reactions,and achieve high satisfaction among family members.展开更多
Microneedle(MN)patches could be a promising treatment for diabetic foot ulcers that plague thousands of people worldwide.While reducing skin resistance or increasing driving force can accelerate the efficiency of tran...Microneedle(MN)patches could be a promising treatment for diabetic foot ulcers that plague thousands of people worldwide.While reducing skin resistance or increasing driving force can accelerate the efficiency of transdermal drug delivery with conventional MN patches,it can create toxic chemical residues or require the help of additional devices.Herein,a thermo-responsive microneedles patch(TMN)with high biocompatibility without additional equipment is proposed.The TMN consisted of a bilayer microneedles composed of sodium alginate(SA)-g-poly(N-isopropylacrylamide)layer(SA-g-PNIPAM)loaded with sucrose octasulfate sodium salt(SOS)and hyaluronic acid layer and a polycaprolactone/chitosan nanofiber membrane loading with tetracycline hydrochloride(TH)and SOS.PNIPAM accelerates drug release by extruding the drug through a volumetric phase transition in response to temperature changes,and TH and SOS promote wound healing by inhibiting bacterial growth and promoting vascular regeneration and epithelial formation.The results showed that the drug release of TMN was significantly faster,with the drug release rate of more than 80% in the 10th h,and the antibacterial rate of TMN could reach 800%.In addition,TMN had good biocompatibility and good healing effects in vivo,which may be helpful for the design of multifunctional dressings in the future.展开更多
To cater the need for real-time crack monitoring of infrastructural facilities,a CNN-regression model is proposed to directly estimate the crack properties from patches.RGB crack images and their corresponding masks o...To cater the need for real-time crack monitoring of infrastructural facilities,a CNN-regression model is proposed to directly estimate the crack properties from patches.RGB crack images and their corresponding masks obtained from a public dataset are cropped into patches of 256 square pixels that are classified with a pre-trained deep convolution neural network,the true positives are segmented,and crack properties are extracted using two different methods.The first method is primarily based on active contour models and level-set segmentation and the second method consists of the domain adaptation of a mathematical morphology-based method known as FIL-FINDER.A statistical test has been performed for the comparison of the stated methods and a database prepared with the more suitable method.An advanced convolution neural network-based multi-output regression model has been proposed which was trained with the prepared database and validated with the held-out dataset for the prediction of crack-length,crack-width,and width-uncertainty directly from input image patches.The pro-posed model has been tested on crack patches collected from different locations.Huber loss has been used to ensure the robustness of the proposed model selected from a set of 288 different variations of it.Additionally,an ablation study has been conducted on the top 3 models that demonstrated the influence of each network component on the pre-diction results.Finally,the best performing model HHc-X among the top 3 has been proposed that predicted crack properties which are in close agreement to the ground truths in the test data.展开更多
AIM: To investigate the effi cacy and safety of rabepra-zole under continuous non-steroidal anti-inflammatory drug (NSAID) administration for NSAID-induced ulcer in Japan. METHODS: Subjects comprised patients undergoi...AIM: To investigate the effi cacy and safety of rabepra-zole under continuous non-steroidal anti-inflammatory drug (NSAID) administration for NSAID-induced ulcer in Japan. METHODS: Subjects comprised patients undergoing NSAID treatment in whom upper gastrointestinal en-doscopy revealed an ulcerous lesion (open ulcer) with diameter ≥ 3 mm, who required continuous NSAID treatment. Endoscopies were performed at the start of treatment, during the treatment period, and at the conclusion (or discontinuation) of treatment. Findings were evaluated as size (maximum diameter) and stage based on the Sakita-Miwa classifi cation. An ulcer was regarded as cured when the "white coating" was seen to have disappeared under endoscopy. As criteria for evaluating safety, all medically untoward symptoms and signs (adverse events, laboratory abnormalities, accidental symptoms, etc.) occurring after the start of rabeprazole treatment were handled as adverse events.RESULTS: Endoscopic cure rate in 38 patients in the efficacy analysis (endoscopic evaluation) was 71.1% (27/38). Among those 38 patients, 35 had gastric ulcer with a cure rate of 71.4% (25/35), and 3 had duodenal ulcer with a cure rate of 66.7% (2/3). Three adverse drug reactions were reported from 64 patients in the safety analysis (interstitial pneumonia, low white blood cell count and pruritus); thus, the incidence rate for adverse drug reactions was 4.7% (3/64).CONCLUSION: The treatment efficacy of rabeprazole for NSAID-induced ulcer under continuous NSAID ad-ministration was confi rmed.展开更多
AIM: To critically appraise the published randomized, controlled trials on the prophylactic effectiveness of the non-steroidal anti-inflammatory drugs(NSAIDs), in reducing the risk of post-endoscopic retrograde cholan...AIM: To critically appraise the published randomized, controlled trials on the prophylactic effectiveness of the non-steroidal anti-inflammatory drugs(NSAIDs), in reducing the risk of post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis. METHODS: A systematic literature search(MEDLINE, Embase and the Cochrane Library, from inception of the databases until May 2015) was conducted to identify randomized, clinical trials investigating the role of NSAIDs in reducing the risk of post-ERCP pancreatitis. Random effects model of the meta-analysis was carried out, and results were presented as odds ratios(OR) with corresponding 95%CI.RESULTS: Thirteen randomized controlled trials on 3378 patients were included in the final meta-analysis. There were 1718 patients in the NSAIDs group and 1660 patients in non-NSAIDs group undergoing ERCP. The use of NSAIDs(through rectal route or intramuscular route) was associated with the reduced risk of post-ERCP pancreatitis [OR, 0.52(0.38-0.72), P = 0.0001]. The use of pre-procedure NSAIDs was effective in reducing approximately 48% incidence of post-ERCP pancreatitis, number needed to treat were 16 with absolute risk reduction of 0.05. But the risk of post-ERCP pancreattis was reduced by 55% if NSAIDs were administered after procedure. Similarly, diclofenac was more effective(55%) prophylactic agent compared to indomethacin(41%).CONCLUSION: NSAIDs seem to have clinically proven advantage of reducing the risk of post-ERCP pancreatitis.展开更多
Non-steroidal anti-inflammatory drug （NSAID）-induced small bowel injury is a topic that deserves attention since the advent of capsule endoscopy and balloon enteroscopy. NSAID enteropathy is common and is mostly asy...Non-steroidal anti-inflammatory drug （NSAID）-induced small bowel injury is a topic that deserves attention since the advent of capsule endoscopy and balloon enteroscopy. NSAID enteropathy is common and is mostly asymptomatic. However, massive bleeding, stricture, or perforation may occur. The pathogenesis of small intestine injury by NSAIDs is complex and different from that of the upper gastrointestinal tract. No drug has yet been developed that can completely prevent or treat NSAID enteropathy. Therefore, a long-term randomized study in chronic NSAID users is needed.展开更多
The use of non-steroidal anti-inflammatory drugs(NSAIDs) is widespread worldwide thanks to their analgesic, anti-inflammatory and antipyretic effects. However, even more attention is placed upon the recurrence of dige...The use of non-steroidal anti-inflammatory drugs(NSAIDs) is widespread worldwide thanks to their analgesic, anti-inflammatory and antipyretic effects. However, even more attention is placed upon the recurrence of digestive system complications in the course of their use. Recent data suggests that the complications of the lower gastro-intestinal tract may be as frequent and severe as those of the upper tract. NSAIDs enteropathy is due to enterohepatic recycling of the drugs resulting in a prolonged and repeated exposure of the intestinal mucosa to the compound and its metabolites. Thus leading to so-called topical effects, which, in turn, lead to an impairment of the intestinal barrier. This process determines bacterial translocation and toxic substances of intestinal origin in the portal circulation, leading to an endotoxaemia. This condition could determine a liver inflammatory response and might promote the development of nonalcoholic steatohepatitis, mostly in patients with risk factors such as obesity, metabolic syndrome and a high fat diet, which may induce a small intestinal bacterial overgrowth and dysbiosis. This alteration of gut microbiota may contribute to nonalcoholic fatty liver disease and its related disorders in two ways: firstly causing a malfunction of the tight junctions that play a critical role in the increase of intestinal permeability, and then secondly leading to the development of insulin resistance, body weight gain, lipogenesis, fibrogenesis and hepatic oxidative stress.展开更多
Despite significant advances over the last decade, mucosal lesions of the small bowel are poorly detected by imaging studies such as CT scan, MRI-enteroclysis and contrast-enhanced abdominal ultrasound. Capsule endosc...Despite significant advances over the last decade, mucosal lesions of the small bowel are poorly detected by imaging studies such as CT scan, MRI-enteroclysis and contrast-enhanced abdominal ultrasound. Capsule endoscopy (CE) has dramatically changed the diagnostic approach to intestinal diseases. Moreover, the use of CE can be extended to include other conditions. However, it is diffi cult to assess the positive influence of CE on patient outcomes in conditions involving a small number of patients, or in critically ill and diff icult to examine patients. CE has the advantage of diagnosing intestinal lesions and of directing the use of double balloon enteroscopy (DBE) in order to obtain biopsy specimens. Moreover, CE allows repeated assessment in chronic conditions, especially to detect relapse of an infectious disease.展开更多
AIM: To determine whether aspirin or non-aspirin nonsteroidal anti-inflammatory drugs(NA-NSAIDs) prevent colorectal cancer(CRC) in patients with inflammatory bowel disease(IBD).METHODS: We performed a systematic revie...AIM: To determine whether aspirin or non-aspirin nonsteroidal anti-inflammatory drugs(NA-NSAIDs) prevent colorectal cancer(CRC) in patients with inflammatory bowel disease(IBD).METHODS: We performed a systematic review and meta-analysis. We searched for articles reporting the risk of CRC in patients with IBD related to aspirin or NANSAID use. Pooled odds ratios(OR) and 95%CIs were determined using a random-effects model. Publication bias was assessed using Funnel plots and Egger's test. Heterogeneity was assessed using Cochran's Q and the I2 statistic.RESULTS: Eight studies involving 14917 patients and 3 studies involving 1282 patients provided data on the risk of CRC in patients with IBD taking NA-NSAIDs and aspirin respectively. The pooled OR of developing CRC after exposure to NA-NSAIDs in patients with IBD was 0.80(95%CI: 0.39-1.21) and after exposure to aspirin it was 0.66(95%CI: 0.06-1.39). There was significant heterogeneity(I2 > 50%) between the studies. There was no change in the effect estimates on subgroup a na ly s e s o f t he po pulat io n s t udie d o r w he t he r adjustment or matching was performed.CONCLUSION: There is a lack of high quality evidence on this important clinical topic. From the available evidence NA-NSAID or aspirin use does not appear to be chemopreventative for CRC in patients with IBD.展开更多
Non-steroidal anti-inflammatory drugs (NSAIDs) constitute a family of drugs, which taken as a group, represents one of the most frequently prescribed around the world. Thus, not surprisingly NSAIDs, along with antiinf...Non-steroidal anti-inflammatory drugs (NSAIDs) constitute a family of drugs, which taken as a group, represents one of the most frequently prescribed around the world. Thus, not surprisingly NSAIDs, along with antiinfectious agents, list on the top for causes of DrugInduced Liver Injury (DILI). The incidence of liver disease induced by NSAIDs reported in clinical studies is fairly uniform ranging from 0.29/100 000 [95% confidence interval (CI): 0.17-051] to 9/100 000 (95% CI: 6-15). However, compared with these results, a higher risk of liver-related hospitalizations was reported (3-23 per 100 000 patients). NSAIDs exhibit a broad spectrum of liver damage ranging from asymptomatic, transient, hyper-transaminasemia to fulminant hepatic failure. However, under-reporting of asymptomatic, mild cases, as well as of those with transient liver-tests alteration, in conjunction with reports non-compliant with pharmacovigilance criteria to ascertain DILI and flawed epidemiological studies, jeopardize the chance to ascertain the actual risk of NSAIDs hepatotoxicity. Several NSAIDs, namely bromfenac, ibufenac and benoxaprofen, have been withdrawn from the market due to hepatotoxicity; others like nimesulide were never marketed in some countries and withdrawn in others. Indeed, the contro-versy concerning the actual risk of severe liver disease persists within NSAIDs research. The present work intends (1) to provide a critical analysis of the dissimilar results currently available in the literature concerning the epidemiology of NSAIDS hepatotoxicity; and (2) to review the risk of hepatotoxicity for each one of the most commonly employed compounds of the NSAIDs family, based on past and recently published data.展开更多
基金Supported by Natural Science Foundation of Chongqing(No.CSTB2024NSCQ-MSX0900No.CSTB2023NSCQ-MSX0593).
文摘AIM:To assess and rank the efficacy of various nonsteroidal anti-inflammatory drugs(NSAIDs)in preventing postoperative macular edema(PME)after cataract surgery.METHODS:A comprehensive search was conducted across PubMed,Embase,Cochrane Library,and Web of Science databases.Randomized controlled trials(RCTs)comparing different NSAIDs and control treatments for the prevention of PME were included.Data from the studies were synthesized using the“gemtc”package in R.Risk of bias was assessed with the Cochrane RoB 2 tool,and heterogeneity was evaluated using the global I2 statistic.Surface under the cumulative ranking curve(SUCRA)values were calculated for each treatment.RESULTS:Of 132 identified records,9 RCTs met the inclusion criteria.The Network Meta-analysis indicated that nepafenac had the highest efficacy in preventing PME,followed by artificial tear substitute,ketorolac,diclofenac,and bromfenac.The league table comparisons and rankograms corroborated these findings,with nepafenac consistently ranking highest.Heterogeneity analysis yielded high I2 values,indicating substantial variability across studies.CONCLUSION:This Network Meta-analysis suggests that nepafenac is the most effective NSAID for preventing PME following cataract surgery.Given the substantial heterogeneity observed,further high-quality RCTs are required to confirm these findings and explore the sources of variability.Clinicians should consider these results when selecting NSAIDs for PME prophylaxis in cataract surgery patients.
文摘Background: The increasing use of non-steroidal anti-inflammatory drugs (NSAIDs) both on prescription and over the counter raises a major global health concern because of the risks associated with their use if no proper guidance is given by the health care provider. This study assessed the roles of community pharmacists in screening and disseminating information about the risks associated with NSAID use in Zambia. Methodology: This was a national cross-sectional study in which a structured self-administered questionnaire was administered to 245 registered community pharmacists in Zambia. Stata/BE, version 15.1 (Stata Corporation, College Station, Texas, USA) and multivariate logistic regression model was used to determine factors associated with information dissemination about ADRs of NS-NSAIDs. Results: 231 of the 245 distributed questionnaires were returned giving a response rate of 94.3%. All (100%) participating community pharmacists claimed to have practiced dispensing NSAIDs. However, only 26 (11.0%) and 71 (30.8%) regularly screened for risk factor of selective COX-2 NSAIDS (SC2-NSAIDS) and non-selective NSAIDS (NS-NSAIDs) respectively. Information dissemination on adverse drug reactions (ADRs) of SC2-NSAIDS was regularly provided by only 22 (9.5%) of pharmacists while that of NS-NSAIDs was regularly provided by 49 (21.2%). In the multivariate logistic regression model, being the owner of a pharmacy (AOR: 5.4, CI: 1.84 - 16.4) was significantly associated with information dissemination about ADRs of NS-NSAIDs while an hour increase in the working hours per day (AOR: 0.9, CI: 0.64 - 0.95) was associated with less likelihood of information dissemination. Conclusion: Pharmacists working in community pharmacies in Zambia did not regularly screen and disseminate information about the risks associated with NSAID use. Therefore, pharmacists should be able to screen and monitor patients at risk and be aware of the majority of risk factors while dispensing NSAIDs to minimize the associated complications.
文摘This editorial explores the impact of non-steroidal anti-inflammatory drugs(NSAIDs)on postoperative recovery in hand fracture patients,amidst shifting pain management strategies away from opioids due to their adverse effects.With hand fractures being significantly common and postoperative pain management crucial for recovery,the potential of NSAIDs offers a non-addictive pain control alternative.However,the controversy over NSAIDs'effects on bone healing—stemming from their Cyclooxygenase-2 inhibition and associated risks of fracture non-union or delayed union—necessitates further investigation.Despite a comprehensive literature search,the study finds a lack of specific research on NSAIDs in postoperative hand fracture management,highlighting an urgent need for future studies to balance their benefits against possible risks.
基金supported by National Research Foundation of Korea(NRF)grants funded by the Korean government(MSIT)(No.RS-2023-00256265,RS-2024-00352352,RS-2024-00405818)the Korean Fund for Regenerative Medicine(KFRM)grant funded by the Korea government(the Ministry of Science and ICT,the Ministry of Health&Welfare).(No.25A0102L1)support from the Market-led K-sensor technology program(RS-2022-00154781,Development of large-area wafer-level flexible/stretchable hybrid sensor platform technology for form factor-free highly integrated convergence sensor),funded By the Ministry of Trade,Industry&Energy(MOTIE,Korea).
文摘Microneedles(MNs)have been extensively investigated for transdermal delivery of large-sized drugs,including proteins,nucleic acids,and even extracellular vesicles(EVs).However,for their sufficient skin penetration,conventional MNs employ long needles(≥600μm),leading to pain and skin irritation.Moreover,it is critical to stably apply MNs against complex skin surfaces for uniform nanoscale drug delivery.Herein,a dually amplified transdermal patch(MN@EV/SC)is developed as the stem cell-derived EV delivery platform by hierarchically integrating an octopusinspired suction cup(SC)with short MNs(≤300μm).While leveraging the suction effect to induce nanoscale deformation of the stratum corneum,MN@EV/SC minimizes skin damage and enhances the adhesion of MNs,allowing EV to penetrate deeper into the dermis.When MNs of various lengths are applied to mouse skin,the short MNs can elicit comparable corticosterone release to chemical adhesives,whereas long MNs induce a prompt stress response.MN@EV/SC can achieve a remarkable penetration depth(290μm)for EV,compared to that of MN alone(111μm).Consequently,MN@EV/SC facilitates the revitalization of fibroblasts and enhances collagen synthesis in middle-aged mice.Overall,MN@EV/SC exhibits the potential for skin regeneration by modulating the dermal microenvironment and ensuring patient comfort.
基金supported by Shiraz University of Medical Sciences,Shiraz,Iran(grant No.:17780).
文摘Due to the limited regeneration capacity of myocardial tissue after infarction,designing tissue engineering scaffolds are in demand.In the present study,electrospun nanofibrous scaffolds were made out of polyurethane,collagen and gold nanoparticles with random and aligned nanofiber morphologies.The nanoparticles were green-synthesized using saffron extract.Nanoparticle characterizations with UV-Vis.spectroscopy and DLS illustrated theoretical and hydrodynamic diameters of around 7 and 13 nm,respectively,having zeta potential of−37 mV.SEM and TEM micrographs showed the morphology and diameters of obtained nanofibers.Also,further characterization were done by ATR-FTIR,XRD and TGA investigations and degradation studies.Contact angle measurements showed hydrophilic nature of the scaffolds(59±0.6°for aligned PU/Col/Au50 nanofibers compared to 120±2.6°for random PU nanofibers).Mechanical testing demonstrated appropriate tensile properties of the scaffolds for cardiac tissue engineering(Young’s modulus:1.53±0.07 MPa for aligned PU/Col/Au50 nanofibers compared to 0.4±0.05 MPa for random PU nanofibers).Finally,alamar blue assay revealed proper survival of the cells of HUVEC cell line on the prepared scaffolds,where the highest percentages were observed for random and aligned PU/Col/Au50 nanofibers.According to the findings,the fabricated PU/Col/AuNPs nanofibrous scaffolds could be considered as potential cardiac patches.
基金supported in part by the Gansu Haizhi Characteristic Demonstration Project(No.GSHZTS2022-2).
文摘Since the introduction of vision Transformers into the computer vision field,many vision tasks such as semantic segmentation tasks,have undergone radical changes.Although Transformer enhances the correlation of each local feature of an image object in the hidden space through the attention mechanism,it is difficult for a segmentation head to accomplish the mask prediction for dense embedding of multi-category and multi-local features.We present patch prototype vision Transformer(PPFormer),a Transformer architecture for semantic segmentation based on knowledge-embedded patch prototypes.1)The hierarchical Transformer encoder can generate multi-scale and multi-layered patch features including seamless patch projection to obtain information of multiscale patches,and feature-clustered self-attention to enhance the interplay of multi-layered visual information with implicit position encodes.2)PPFormer utilizes a non-parametric prototype decoder to extract region observations which represent significant parts of the objects by unlearnable patch prototypes and then calculate similarity between patch prototypes and pixel embeddings.The proposed contrasting patch prototype alignment module,which uses new patch prototypes to update prototype bank,effectively maintains class boundaries for prototypes.For different application scenarios,we have launched PPFormer-S,PPFormer-M and PPFormer-L by expanding the scale.Experimental results demonstrate that PPFormer can outperform fully convolutional networks(FCN)-and attention-based semantic segmentation models on the PASCAL VOC 2012,ADE20k,and Cityscapes datasets.
基金supported by grants received by the first author and third author from the Institute of Eminence,Delhi University,Delhi,India,as part of the Faculty Research Program via Ref.No./IoE/2024-25/12/FRP.
文摘Software systems are vulnerable to security breaches as they expand in complexity and functionality.The confidentiality,integrity,and availability of data are gravely threatened by flaws in a system’s design,implementation,or configuration.To guarantee the durability&robustness of the software,vulnerability identification and fixation have become crucial areas of focus for developers,cybersecurity experts and industries.This paper presents a thorough multi-phase mathematical model for efficient patch management and vulnerability detection.To uniquely model these processes,the model incorporated the notion of the learning phenomenon in describing vulnerability fixation using a logistic learning function.Furthermore,the authors have used numerical methods to approximate the solution of the proposed framework where an analytical solution is difficult to attain.The suggested systematic architecture has been demonstrated through statistical analysis using patch datasets,which offers a solid basis for the research conclusions.According to computational research,learning dynamics improves security response and results in more effective vulnerability management.The suggested model offers a systematic approach to proactive vulnerability mitigation and has important uses in risk assessment,software maintenance,and cybersecurity.This study helps create more robust software systems by increasing patch management effectiveness,which benefits developers,cybersecurity experts,and sectors looking to reduce security threats in a growing digital world.
基金supported by the National Key Technologies R&D Program of China(Grant No.2023YFC2415900)the National Natural Science Foundation of China(Grant Nos.62373182 and 52405619)+2 种基金the China Postdoctoral Science Foundation(Grant No.2024M751300)supported by the Shenzhen Science and Technology Program(Grant No.JCYJ20241202125417024)Guangdong Basic and Applied Basic Research Foundation(Grant No.2024A1515011915).
文摘Adhesive patches offer an effective approach for wound closure,making them highly suitable for biomedical applications.However,conventional patches often face limitations such as dual-sided adhesion,lack of shape adaptability,and limited maneuverability,which restrict their applications in deeper tissues.In this paper,we develop a magnetic patch robot(PatchBot),for targeted Janus adhesion with tissues.The PatchBot features a unique triple-layer structure,with adhesive,shape-morphing,and anti-adhesive layers,each fulfilling roles to support targeted attachment,enable shape transformation,and prevent unwanted adhesion to surrounding tissues.The Janus adhesion of the PatchBot was extensively demonstrated across a variety of tissues.A localized near-infrared(NIR)laser irradiation was used to induce programmable shape transformations.Magnetic actuation of the PatchBot for targeted adhesion was successfully demonstrated in ex vivo porcine stomach tissue.NIR light-activated shape-morphing and multimodal magnetic actuation significantly enhance its maneuverability and adaptability in confined in vivo environments while ensuring the structural integrity of the adhesive surface during deployment.This proof-of-concept study demonstrates the feasibility of using PatchBot for targeted wound adhesion,showing its potential for minimally invasive,precision therapies in complex in vivo environments.
基金supported by the National Natural Science Foundation of China(Grants 42325404,42120104003,42204164,42474219 and U22A2006)the Chinese Meridian Project,the International Partnership Program of Chinese Academy of Sciences(Grant 183311KYSB20200003)+7 种基金Shandong Provincial Natural Science Foundation(Grants ZR2022QD077,ZR2022MD034)the Stable-Support Scientific Project of China Research Institute of Radiowave Propagation(Grant A132312191)the foundation of the National Key Laboratory of Electromagnetic Environment(Grant 6142403180204)the Chongqing Natural Science Foundation(Grants cstc2021ycjh-bgzxm0072,CSTB2023NSCQ-LZX0082)National Program on Key Basic Research Project(Grant 2022173-SD-1)The work in Norway is supported by the Research Council of Norway Grant 326039Work at UCLA has been supported by NSF grant AGS-2055192This research was supported by the International Space Science Institute(ISSI)in Bern and Beijing,through ISSI International Team project#511(Multi-Scale Magnetosphere-Ionosphere-Thermosphere Interaction).
文摘This paper is a statistical survey of Southern Hemisphere cold and hot polar cap patches,in relation to the interplanetary magnetic field(IMF)and ionospheric convection geometry.A total of 11,946 patch events were identified by Defense Meteorological Satellite Program(DMSP)F16 during the years 2011 to 2022.A temperature ratio of ion/electron temperature(T_(i)/T_(e))<0.68 is recommended to define a hot patch in the Southern Hemisphere,otherwise it is defined as a cold patch.The cold and hot patches have different dependencies on IMF clock angle,while their dependencies on IMF cone angle are similar.Both cold and hot patches appear most often on the duskside,and the distribution of cold patches gradually decreases from the dayside to the nightside,while hot patches have a higher occurrence rate near 14 and 21 magnetic local time(MLT).Moreover,we compared the key plasma characteristics of polar cap cold and hot patches in the Southern and Northern Hemispheres.The intensity of the duskside upward field-aligned current of patches in the Southern Hemisphere(SH)is stronger than that in the Northern Hemisphere(SH),which may be due to the discrepancy in conductivities between the two hemispheres,caused by the tilted dipole.In both hemispheres,the downward soft-electron energy flux of the dawnside patches is significantly greater than that of the duskside patches.
文摘Objective:To evaluate the intervention effect of childlike nursing combined with Chinese herbal patching on pediatric bronchopneumonia.Methods:1036 children with bronchopneumonia(one family member included for each child)who were admitted to the hospital between January 2024 and June 2024 were selected and randomly divided into two groups using a random number table.The combined group received childlike nursing combined with Chinese herbal patching,while the control group received routine nursing.Symptom recovery time,treatment compliance,inflammatory factor levels,quality of life of the children,and family satisfaction were compared between the two groups.Results:The symptom recovery time in the combined group was shorter than that in the control group,treatment compliance was higher,inflammatory factor levels after intervention were lower,quality of life scores of the children were lower,and family satisfaction was higher(P<0.05).Conclusion:The implementation of childlike nursing combined with Chinese herbal patching for children with bronchopneumonia can shorten their symptom recovery time,significantly improve treatment compliance and quality of life,reduce inflammatory reactions,and achieve high satisfaction among family members.
基金supported by the Joint Funds of National Natural Science Foundation of China(No.U22A20162)the Natural Science Foundation of Hebei Province of China(No.C2021202002)+1 种基金the National Natural Science Foundation of China(No.52271245),the Natural Science Foundation of Tianjin(No.21JCQNJC01280)the financial support from the Danish Council for Independent Research(9040-00219B),European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement ENSIGN(Project ID:101086226),L4DNANO(Project ID:101086227).
文摘Microneedle(MN)patches could be a promising treatment for diabetic foot ulcers that plague thousands of people worldwide.While reducing skin resistance or increasing driving force can accelerate the efficiency of transdermal drug delivery with conventional MN patches,it can create toxic chemical residues or require the help of additional devices.Herein,a thermo-responsive microneedles patch(TMN)with high biocompatibility without additional equipment is proposed.The TMN consisted of a bilayer microneedles composed of sodium alginate(SA)-g-poly(N-isopropylacrylamide)layer(SA-g-PNIPAM)loaded with sucrose octasulfate sodium salt(SOS)and hyaluronic acid layer and a polycaprolactone/chitosan nanofiber membrane loading with tetracycline hydrochloride(TH)and SOS.PNIPAM accelerates drug release by extruding the drug through a volumetric phase transition in response to temperature changes,and TH and SOS promote wound healing by inhibiting bacterial growth and promoting vascular regeneration and epithelial formation.The results showed that the drug release of TMN was significantly faster,with the drug release rate of more than 80% in the 10th h,and the antibacterial rate of TMN could reach 800%.In addition,TMN had good biocompatibility and good healing effects in vivo,which may be helpful for the design of multifunctional dressings in the future.
文摘To cater the need for real-time crack monitoring of infrastructural facilities,a CNN-regression model is proposed to directly estimate the crack properties from patches.RGB crack images and their corresponding masks obtained from a public dataset are cropped into patches of 256 square pixels that are classified with a pre-trained deep convolution neural network,the true positives are segmented,and crack properties are extracted using two different methods.The first method is primarily based on active contour models and level-set segmentation and the second method consists of the domain adaptation of a mathematical morphology-based method known as FIL-FINDER.A statistical test has been performed for the comparison of the stated methods and a database prepared with the more suitable method.An advanced convolution neural network-based multi-output regression model has been proposed which was trained with the prepared database and validated with the held-out dataset for the prediction of crack-length,crack-width,and width-uncertainty directly from input image patches.The pro-posed model has been tested on crack patches collected from different locations.Huber loss has been used to ensure the robustness of the proposed model selected from a set of 288 different variations of it.Additionally,an ablation study has been conducted on the top 3 models that demonstrated the influence of each network component on the pre-diction results.Finally,the best performing model HHc-X among the top 3 has been proposed that predicted crack properties which are in close agreement to the ground truths in the test data.
文摘AIM: To investigate the effi cacy and safety of rabepra-zole under continuous non-steroidal anti-inflammatory drug (NSAID) administration for NSAID-induced ulcer in Japan. METHODS: Subjects comprised patients undergoing NSAID treatment in whom upper gastrointestinal en-doscopy revealed an ulcerous lesion (open ulcer) with diameter ≥ 3 mm, who required continuous NSAID treatment. Endoscopies were performed at the start of treatment, during the treatment period, and at the conclusion (or discontinuation) of treatment. Findings were evaluated as size (maximum diameter) and stage based on the Sakita-Miwa classifi cation. An ulcer was regarded as cured when the "white coating" was seen to have disappeared under endoscopy. As criteria for evaluating safety, all medically untoward symptoms and signs (adverse events, laboratory abnormalities, accidental symptoms, etc.) occurring after the start of rabeprazole treatment were handled as adverse events.RESULTS: Endoscopic cure rate in 38 patients in the efficacy analysis (endoscopic evaluation) was 71.1% (27/38). Among those 38 patients, 35 had gastric ulcer with a cure rate of 71.4% (25/35), and 3 had duodenal ulcer with a cure rate of 66.7% (2/3). Three adverse drug reactions were reported from 64 patients in the safety analysis (interstitial pneumonia, low white blood cell count and pruritus); thus, the incidence rate for adverse drug reactions was 4.7% (3/64).CONCLUSION: The treatment efficacy of rabeprazole for NSAID-induced ulcer under continuous NSAID ad-ministration was confi rmed.
文摘AIM: To critically appraise the published randomized, controlled trials on the prophylactic effectiveness of the non-steroidal anti-inflammatory drugs(NSAIDs), in reducing the risk of post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis. METHODS: A systematic literature search(MEDLINE, Embase and the Cochrane Library, from inception of the databases until May 2015) was conducted to identify randomized, clinical trials investigating the role of NSAIDs in reducing the risk of post-ERCP pancreatitis. Random effects model of the meta-analysis was carried out, and results were presented as odds ratios(OR) with corresponding 95%CI.RESULTS: Thirteen randomized controlled trials on 3378 patients were included in the final meta-analysis. There were 1718 patients in the NSAIDs group and 1660 patients in non-NSAIDs group undergoing ERCP. The use of NSAIDs(through rectal route or intramuscular route) was associated with the reduced risk of post-ERCP pancreatitis [OR, 0.52(0.38-0.72), P = 0.0001]. The use of pre-procedure NSAIDs was effective in reducing approximately 48% incidence of post-ERCP pancreatitis, number needed to treat were 16 with absolute risk reduction of 0.05. But the risk of post-ERCP pancreattis was reduced by 55% if NSAIDs were administered after procedure. Similarly, diclofenac was more effective(55%) prophylactic agent compared to indomethacin(41%).CONCLUSION: NSAIDs seem to have clinically proven advantage of reducing the risk of post-ERCP pancreatitis.
文摘Non-steroidal anti-inflammatory drug （NSAID）-induced small bowel injury is a topic that deserves attention since the advent of capsule endoscopy and balloon enteroscopy. NSAID enteropathy is common and is mostly asymptomatic. However, massive bleeding, stricture, or perforation may occur. The pathogenesis of small intestine injury by NSAIDs is complex and different from that of the upper gastrointestinal tract. No drug has yet been developed that can completely prevent or treat NSAID enteropathy. Therefore, a long-term randomized study in chronic NSAID users is needed.
文摘The use of non-steroidal anti-inflammatory drugs(NSAIDs) is widespread worldwide thanks to their analgesic, anti-inflammatory and antipyretic effects. However, even more attention is placed upon the recurrence of digestive system complications in the course of their use. Recent data suggests that the complications of the lower gastro-intestinal tract may be as frequent and severe as those of the upper tract. NSAIDs enteropathy is due to enterohepatic recycling of the drugs resulting in a prolonged and repeated exposure of the intestinal mucosa to the compound and its metabolites. Thus leading to so-called topical effects, which, in turn, lead to an impairment of the intestinal barrier. This process determines bacterial translocation and toxic substances of intestinal origin in the portal circulation, leading to an endotoxaemia. This condition could determine a liver inflammatory response and might promote the development of nonalcoholic steatohepatitis, mostly in patients with risk factors such as obesity, metabolic syndrome and a high fat diet, which may induce a small intestinal bacterial overgrowth and dysbiosis. This alteration of gut microbiota may contribute to nonalcoholic fatty liver disease and its related disorders in two ways: firstly causing a malfunction of the tight junctions that play a critical role in the increase of intestinal permeability, and then secondly leading to the development of insulin resistance, body weight gain, lipogenesis, fibrogenesis and hepatic oxidative stress.
文摘Despite significant advances over the last decade, mucosal lesions of the small bowel are poorly detected by imaging studies such as CT scan, MRI-enteroclysis and contrast-enhanced abdominal ultrasound. Capsule endoscopy (CE) has dramatically changed the diagnostic approach to intestinal diseases. Moreover, the use of CE can be extended to include other conditions. However, it is diffi cult to assess the positive influence of CE on patient outcomes in conditions involving a small number of patients, or in critically ill and diff icult to examine patients. CE has the advantage of diagnosing intestinal lesions and of directing the use of double balloon enteroscopy (DBE) in order to obtain biopsy specimens. Moreover, CE allows repeated assessment in chronic conditions, especially to detect relapse of an infectious disease.
文摘AIM: To determine whether aspirin or non-aspirin nonsteroidal anti-inflammatory drugs(NA-NSAIDs) prevent colorectal cancer(CRC) in patients with inflammatory bowel disease(IBD).METHODS: We performed a systematic review and meta-analysis. We searched for articles reporting the risk of CRC in patients with IBD related to aspirin or NANSAID use. Pooled odds ratios(OR) and 95%CIs were determined using a random-effects model. Publication bias was assessed using Funnel plots and Egger's test. Heterogeneity was assessed using Cochran's Q and the I2 statistic.RESULTS: Eight studies involving 14917 patients and 3 studies involving 1282 patients provided data on the risk of CRC in patients with IBD taking NA-NSAIDs and aspirin respectively. The pooled OR of developing CRC after exposure to NA-NSAIDs in patients with IBD was 0.80(95%CI: 0.39-1.21) and after exposure to aspirin it was 0.66(95%CI: 0.06-1.39). There was significant heterogeneity(I2 > 50%) between the studies. There was no change in the effect estimates on subgroup a na ly s e s o f t he po pulat io n s t udie d o r w he t he r adjustment or matching was performed.CONCLUSION: There is a lack of high quality evidence on this important clinical topic. From the available evidence NA-NSAID or aspirin use does not appear to be chemopreventative for CRC in patients with IBD.
文摘Non-steroidal anti-inflammatory drugs (NSAIDs) constitute a family of drugs, which taken as a group, represents one of the most frequently prescribed around the world. Thus, not surprisingly NSAIDs, along with antiinfectious agents, list on the top for causes of DrugInduced Liver Injury (DILI). The incidence of liver disease induced by NSAIDs reported in clinical studies is fairly uniform ranging from 0.29/100 000 [95% confidence interval (CI): 0.17-051] to 9/100 000 (95% CI: 6-15). However, compared with these results, a higher risk of liver-related hospitalizations was reported (3-23 per 100 000 patients). NSAIDs exhibit a broad spectrum of liver damage ranging from asymptomatic, transient, hyper-transaminasemia to fulminant hepatic failure. However, under-reporting of asymptomatic, mild cases, as well as of those with transient liver-tests alteration, in conjunction with reports non-compliant with pharmacovigilance criteria to ascertain DILI and flawed epidemiological studies, jeopardize the chance to ascertain the actual risk of NSAIDs hepatotoxicity. Several NSAIDs, namely bromfenac, ibufenac and benoxaprofen, have been withdrawn from the market due to hepatotoxicity; others like nimesulide were never marketed in some countries and withdrawn in others. Indeed, the contro-versy concerning the actual risk of severe liver disease persists within NSAIDs research. The present work intends (1) to provide a critical analysis of the dissimilar results currently available in the literature concerning the epidemiology of NSAIDS hepatotoxicity; and (2) to review the risk of hepatotoxicity for each one of the most commonly employed compounds of the NSAIDs family, based on past and recently published data.
