BACKGROUND Atrial fibrillation(AF)is a prevalent cardiac arrhythmia associated with significant morbidity and mortality,particularly in patients with concomitant renal dysfunction.Anticoagulation therapy reduces the r...BACKGROUND Atrial fibrillation(AF)is a prevalent cardiac arrhythmia associated with significant morbidity and mortality,particularly in patients with concomitant renal dysfunction.Anticoagulation therapy reduces the risk of thromboembolic complications in AF but presents challenges in patients with renal impairment due to altered pharmacokinetics and increased bleeding risk.AIM To support clinicians in navigating the complexities of anticoagulation in this high-risk population,ensuring optimal outcomes.METHODS The present review followed PRISMA guidelines.Data extraction was conducted using a standardized template that captured key study characteristics:Population demographics,renal function metrics,anticoagulant dosing strategies,and primary and secondary outcomes.For quality assessment,we employed the Cochrane Risk of Bias 2.0 tool for randomized controlled trials.Observational studies were appraised using the Newcastle-Ottawa Scale.RESULTS We analyze data from 16 studies to provide recommendations on optimal anticoagulation strategies,balancing thrombotic and bleeding risks.Current evidence supports the preferential use of apixaban in moderate chronic kidney disease and cautiously in end-stage renal disease,emphasizing the importance of individualized therapy.CONCLUSION The management of anticoagulation in AF patients with renal dysfunction is challenging but critical for reducing stroke risk.展开更多
BACKGROUND Listening to music has been shown to reduce pain and anxiety before,during,and after invasive coronary procedures.AIM To perform a systematic review and meta-analysis to explore the effect of therapeutic us...BACKGROUND Listening to music has been shown to reduce pain and anxiety before,during,and after invasive coronary procedures.AIM To perform a systematic review and meta-analysis to explore the effect of therapeutic use of music on both,perioperative and postoperative outcomes of invasive coronary procedures.METHODS An exhaustive literature search of 3 electronic databases(MEDLINE,Scopus,Cochrane CENTRAL)was conducted from inception until 10th December 2023.The results of our analyses are presented as standard mean difference(SMD)or weighted mean difference,with 95%CI and pooled using a random effects model.A P value<0.05 was considered significant in all cases.RESULTS From 21 studies,2141 participants were included in our analysis.The pooled analysis demonstrated that music listening significantly improves post-procedural pain(SMD=-0.78,95%CI:-1.34 to-0.23;P=0.006),anxiety(SMD=-0.86,95%CI:-1.43 to-0.29;P=0.003),heart rate[mean difference(MD)=-3.38,95%CI:-5.51 to-1.25;P=0.002],and systolic blood pressure(MD=-5.89,95%CI:-9.75 to-2.02;P=0.003).There was no significant improvement in diastolic blood pressure(MD=-3.22,95%CI:-6.58 to 0.14;P=0.06)or respiratory rate(MD=-0.97,95%CI:-1.98 to 0.03;P=0.06).CONCLUSION Music listening can be used in healthcare settings for patients undergoing invasive coronary procedures to reduce anxiety levels and improve their physiological parameters.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP)is a vital tool for diagnosing and treating biliary and pancreatic disorders,but its safety and efficacy are marred by preoperative gastric retention.Jia et al retro...Endoscopic retrograde cholangiopancreatography(ERCP)is a vital tool for diagnosing and treating biliary and pancreatic disorders,but its safety and efficacy are marred by preoperative gastric retention.Jia et al retrospectively analyzed 190 patients who underwent ERCP and found that gastrointestinal obstruction,jaundice,opioid use,female sex,and primary diseases were in-dependent predictors and risk factors of preoperative gastric retention.Based on these findings and comprehensive analysis,a proposed predictive model offers clinicians valuable tools to tailor preoperative strategies,improving the proce-dural safety and efficacy of ERCP.Despite having several limitations,like single-center design and limited generalizability,the study marks a significant advan-cement in optimizing ERCP outcomes through predictive analytics.Further research with larger populations and prospective designs is warranted to establish these findings.展开更多
BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SA...BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SAVR).However,the compara-tive safety and efficacy of these interventions remain subjects of ongoing investigation.AIM To compare the clinical outcomes and safety of TAVR vs SAVR in patients with severe symptomatic aortic stenosis.METHODS A systematic review and meta-analysis were conducted according to PRISMA guidelines.Randomized controlled trials(RCTs)comparing TAVR and SAVR were identified from databases including PubMed,Scopus,and Web of Science up to May 31,2024.Data were extracted on clinical outcomes,including mortality,procedural compli-cations,and post-procedure adverse events.Risk ratios(RRs)with 95%CIs were calculated using a random-effects model.RESULTS A total of 10 RCTs were included.TAVR demonstrated a significantly lower risk of acute kidney injury(RR:0.33;95%CI:0.25–0.44),major bleeding(RR:0.37;95%CI:0.30–0.46),and new-onset atrial fibrillation(RR:0.44;95%CI:0.34–0.57)compared to SAVR.However,TAVR was associated with higher risks of new permanent pacemaker implantation(RR:3.49;95%CI:2.77–4.39),major vascular complications(RR:2.47;95%CI:1.91–3.21),and paraval-vular leaks(RR:4.15;95%CI:3.14–5.48).Mortality at 30 days was comparable(RR:0.95;95%CI:0.78–1.15),but long-term mortality was slightly higher with TAVR in some analyses(RR:1.23;95%CI:1.01–1.49).Rates of stroke(RR:0.97;95%CI:0.81–1.17)and myocardial infarction(RR:0.91;95%CI:0.67–1.24)were similar between the groups.CONCLUSION TAVR offers a less invasive option with significant benefits in reducing acute kidney injury,major bleeding,and new-onset atrial fibrillation,making it particularly advantageous for high-risk surgical candidates.However,higher risks of permanent pacemaker implantation,vascular complications,and paravalvular leaks highlight the need for individualized patient selection and shared decision-making to optimize outcomes.展开更多
The inefficiency of photocatalytic overall water splitting is well documented and has been extensively studied.However,a crucial aspect of this process,the side reaction,has often been overlooked.In this study,we inve...The inefficiency of photocatalytic overall water splitting is well documented and has been extensively studied.However,a crucial aspect of this process,the side reaction,has often been overlooked.In this study,we investigate the impact of side reactions on photocatalytic overall water splitting by monitoring factors such as dissolved oxygen,reactive oxygen species,and hydrogen peroxide.Further insights into the side reaction are obtained through the introduction of a platinum cocatalyst.Our findings reveal that dissolved oxygen significantly contributes to the side reaction by promoting the production of hydrogen peroxide.This byproduct is generated at the expense of electrons needed for the hydrogen evolution reaction,thereby reducing the overall efficiency of photocatalytic water splitting.This article aims to provide guidance on future research directions in the field of water splitting,with a particular emphasis on photocatalysis.展开更多
BACKGROUND Renal complications of diabetes mellitus pose a significant public health challenge,contributing to substantial morbidity and mortality globally.Understanding temporal trends and regional disparities in mor...BACKGROUND Renal complications of diabetes mellitus pose a significant public health challenge,contributing to substantial morbidity and mortality globally.Understanding temporal trends and regional disparities in mortality related to diabetic nephropathy is crucial for guiding targeted interventions and policy decisions.AIM To display the trends and disparities of diabetic nephropathy related mortality.METHODS A retrospective analysis was conducted using death certificate data from the center for disease control and prevention(CDC)wide-ranging online data for epidemiologic research analysis(WONDER)database,spanning from 1999 to 2020,to investigate mortality related to renal complications of diabetes in adults aged 35 or above.Age-adjusted mortality rate(AAMR)per 100000 persons and annual percent change(APC)were computed,with stratification by year,sex,race/ethnicity,and geographic region.RESULTS Between 1999 and 2020,a total of 525804 deaths occurred among adults aged 35 to 85+years due to renal-related issues associated with diabetes.AAMR for renal-related deaths in adult diabetic patients showed a consistent increase from 1.6 in 1999 to 34.9 in 2020(average APC[AAPC]:17.23;95%confidence interval[CI]:13.35-28.79).Throughout the study period,men consistently had higher AAMR(overall AAMR for men:17.8;95%CI:17.7-17.9).In 1999,the AAMR for men was 1.8,increasing to 44.2 by 2020(AAPC:17.54;95%CI:13.09-29.53),while for women,it was 1.6 in 1999 and rose to 27.6 by 2020(AAPC:15.55;95%CI:13.35-21.10).American Indian/Alaska Native adults exhibited the highest overall AAMR(36.1;95%CI:35.2-36.9),followed by Black/African American(25.5;95%CI:25.3-25.7).The highest mortality was observed in the Western(AAMR:16.6;95%CI:16.5-16.7),followed by the Midwestern region(AAMR:14.4;95%CI:14.314.4).Significant variations in AAMR were observed among different states,with Oklahoma recording the highest(21.2)and Connecticut the lowest(7).The CDC WONDER database could potentially have omissions or inaccuracies.It does not provide data outside of the available variables.Furthermore,dataset after 2020 was not included in this study.CONCLUSION Our findings highlight an alarming rise in mortality related to renal complications of diabetes among United States adults over the past two decades,with concerning disparities across demographic and geographic factors.These results underscore the urgent need for targeted interventions,policies,and protocols to address the growing burden of diabetic nephropathy and substantially reduce mortality rates in the United States.This will help improve the overall health outcome in the United States by identifying communities at risk and implementing tailored assistance to them.展开更多
Introduction:Infections are the most feared complication of transrectal prostate biopsies,along with growing concerns of antibiotic resistance.Our institution transitioned to a transperineal approach without use of pe...Introduction:Infections are the most feared complication of transrectal prostate biopsies,along with growing concerns of antibiotic resistance.Our institution transitioned to a transperineal approach without use of perioperative antibiotics or bowel preparations.We aimed to compare the safety outcomes associated with transperineal and transrectal prostate biopsy techniques.Materials and Methods:A retrospective analysis of patients who underwent transrectal and transperineal prostate biopsies at our institution from 2019–2022 was performed.Results:We identified 319 patients—174 transrectal and 145 transperineal.8 patients who had transperineal biopsy(5.5%)received peri-operative antibiotics,compared to 100%with transrectal biopsy.35.86%of transperineal patients received a bowel preparation,compared to 100%in the transrectal group.44.14%and 49.43%of patients received a prior prostate biopsy in the transperineal and transrectal groups,respectively.Patients in the transperineal biopsy group had zero infectious complications,1 ER visit,and zero 30-day readmissions.This is compared to 9 infectious complications(5.17%,p=0.005),8 ER visits(4.60%,p=0.036),and 730-day readmissions(4.02%,p=0.015)in the transrectal group.Conclusions:In a single institution series,patients undergoing transperineal biopsy had fewer infectious complications compared to those undergoing transrectal biopsy.Despite only a small percentage of patients receiving perioperative antibiotics and a majority of patients not receiving a bowel preparation in the transperineal group,there were zero infectious complications or 30-day readmissions.With greater infectious complications with transrectal biopsy and growing antibiotic resistance,we underline the safety of transperineal prostate biopsy which can largely be done without perioperative antibiotics or a bowel preparation.展开更多
BACKGROUND Laparoscopic nephrectomy is a preferred surgical approach due to its minimally invasive nature and faster recovery times.However,effective management of postoperative pain remains a significant challenge.Se...BACKGROUND Laparoscopic nephrectomy is a preferred surgical approach due to its minimally invasive nature and faster recovery times.However,effective management of postoperative pain remains a significant challenge.Several traditional methods,including opioid-based analgesia,are commonly used but are associated with side effects such as nausea,vomiting,sedation,and delayed recovery.In recent years,the erector spinae plane block(ESPB)has gained attention as an ultrasoundguided regional anesthesia technique offering promising results in various surgical procedures by reducing opioid requirements and enhancing patient comfort.AIM To evaluate the efficacy and safety of ESPB in comparison to conventional pain management strategies in patients undergoing laparoscopic nephrectomy.METHODS Following PRISMA guidelines,we searched PubMed,EMBASE,Web of Science,and the Cochrane Register for randomized controlled trials(RCTs)comparing ESPB with control for laparoscopic nephrectomy.The Cochrane Risk of Bias tool was employed for quality assessment.The primary outcome was total patient-controlled analgesia(PCA)consumption.Secondary outcomes included hospital discharge time and the incidence of postoperative nausea and vomiting.A random-effects meta-analysis was conducted to calculate pooled mean differences(MD)and odds ratios(OR)with 95%CIs.RESULTS Nine RCTs involving a total of 643 patients(ESPB group=320;control group=323)were included in the analysis.ESPB significantly reduced PCA opioid consumption compared to controls(MD:-14.24,95%CI:-20.66 to-7.83,P<0.0001).Subgroup analysis showed reduced PCA use with ESPB vs morphine(MD:-8.78,95%CI:-15.34 to-2.22,P=0.009),and a non-significant effect compared to other analgesics(MD:-48.26,95%CI:-143.60 to 47.09).No statistically significant differences were observed in discharge time or the incidence of nausea and vomiting.CONCLUSION ESPB demonstrates the potential of reducing PCA in laparoscopic nephrectomy patients;however,its impact on secondary outcomes remains inconclusive.Large-scale RCTs are needed to confirm ESPB's benefits and explore long-term effects.展开更多
BACKGROUND The heterogeneous group of disorders called peripheral vascular diseases(PVDs)occurs outside the heart and brain tissue to cause ischemia and severe health complications.Diagnosis accuracy is essential in s...BACKGROUND The heterogeneous group of disorders called peripheral vascular diseases(PVDs)occurs outside the heart and brain tissue to cause ischemia and severe health complications.Diagnosis accuracy is essential in starting appropriate patient management at the proper time.Modern medicine considers skin biopsies crucial diagnostic tools that yield histopathological and molecular evidence for examining PVD-related microvascular changes.AIM To evaluate skin biopsy applications in PVD diagnostics through artistic analysis of technical processes and examination of pathological and innovative molecular indicators.METHODS A systematic review of randomized controlled trials and original studies about skin biopsy utility in PVD diagnosis used PubMed,Scopus,and EMBASE search platforms.The reviewed studies met specific entry requirements,while all case reports and review articles remained excluded.RESULTS A total of 22 studies suited the research criteria that were evaluated.Researchers emphasized the value of skin biopsies for identifying inflammatory from non-inflammatory PVDs.At the same time,they detect systemic sclerosis and diabetic vasculopathy abnormalities of micro-vessels and identify endothelial dysfunction through measurements of vascular endothelial growth factor and intercellular adhesion molecule-1 and endothelial nitric oxide synthase markers.Skin biopsies require further improvement because they cause patient discomfort and produce variable diagnostic results that specialists must interpret.CONCLUSION Skin biopsies enable essential diagnostic findings about PVD and improve patient detection.The development of standardized biopsy procedures and molecular diagnosis techniques should be studied to advance PVD diagnoses in clinical practice.展开更多
BACKGROUND Prolonged immobility during intensive care unit(ICU)admission has been a cause of muscle atrophy and worsening functional outcomes with longer recovery times.Prior research has demonstrated that mobilizatio...BACKGROUND Prolonged immobility during intensive care unit(ICU)admission has been a cause of muscle atrophy and worsening functional outcomes with longer recovery times.Prior research has demonstrated that mobilization within a week of ICU admission potentially benefits physical function in critically ill patients.AIM To evaluate the effects of initiating mobilization within 72 hours of ICU admission in critically ill patients through an updated systematic review and meta-analysis.METHODS A systematic search was performed through MEDLINE,Scopus,and Cochrane Library from inception until September 2024 for randomized controlled trials(RCTs)comparing early mobilization(EM)with usual or conventional care in critically ill adult patients.Primary outcomes included length of ICU(days)and ventilation duration(days).Secondary outcomes included muscle strength,functional status,adverse events,all-cause mortality,and quality of life(QOL).A random effects meta-analysis was performed for pooled effect estimates and to derive risk ratios(RR)and corresponding 95%confidence intervals(CI).RESULTS Out of 3487 results,16 RCTs were included with a population of 2385 patients(1195 receiving EM and 1190 with usual care.)A significant reduction in the length of ICU stays[mean difference(MD)=-1.02,95%CI:-1.96 to-0.09;P=0.03;I2=60%]and ventilation duration(MD=-1.07,95%CI:-1.91 to-0.23,P=0.01;I2=57%)was observed in the EM group compared to usual care.EM significantly improved muscle strength[standard MD(SMD)=0.47,95%CI:0.18-0.75,P=0.001;I2=79%]and functional status(SMD=0.70,95%CI:0.40-1.00,P<0.00001;I2=81%)in ICU patients.No statistically significant difference was observed in adverse events(RR=1.72,95%CI:1.01-2.94,P=0.05;I2=31%),all-cause mortality(RR=1.10,95%CI:0.79-1.53,P=0.57;I2=30%),and QOL(SMD=0.04,95%CI:-0.07-0.15,P=0.50;I2=9%)between the two groups.CONCLUSION Initiating mobilization within 72 hours of ICU admission is associated with improved functional outcomes and reduced ICU length of stay and ventilation duration.These findings indicate that EM may be a safe option for ICU patients,contributing to lower recovery times and healthcare costs.Further extensive research is required to validate the long-term effects on survival and QOL.展开更多
BACKGROUND Optical coherence tomography(OCT)offers detailed cross-sectional imaging during percutaneous coronary intervention(PCI),aiding in anatomically complex coronary lesions.Despite its advantages,evidence on the...BACKGROUND Optical coherence tomography(OCT)offers detailed cross-sectional imaging during percutaneous coronary intervention(PCI),aiding in anatomically complex coronary lesions.Despite its advantages,evidence on the clinical effectiveness of OCT-guided PCI remains limited.Major databases were systematically searched for randomized controlled trials(RCTs)comparing OCT-guided and angiography-guided PCI in complex lesions.Primary outcomes included major adverse cardiovascular events(MACE)and target vessel failure(TVF);secondary outcomes included mortality,myocardial infarction(MI),and other procedural outcomes.A random-effects model was used to pool risk ratio(RR),with 95%CI.Statistical analysis was conducted in R software(v4.4.1),with significance set at P<0.05.RESULTS Five RCTs(5737 patients)showed OCT-guided PCI significantly reduced MACE(RR:0.63,95%CI:0.52-0.77,P<0.01),TVF(RR:0.68,95%CI:0.56-0.83,P<0.01),all-cause(RR:0.58,95%CI:0.38-0.87,P<0.01)and cardiac mortality(RR:0.43,95%CI:0.24-0.76,P<0.01),target-lesion revascularization(RR:0.53,95%CI:0.33-0.84,P<0.01),stent thrombosis(RR:0.52,95%CI:0.31-0.86,P=0.01),and target-vessel MI(RR:0.64,95%CI:0.42-0.97,P=0.04)vs angiography-guided PCI.Periprocedural MI,any revascularization,target-vessel revascularization,and contrast-associated kidney injury were similar between groups.CONCLUSION OCT-guided PCI improves outcomes in complex lesions by reducing MACE,TVF,mortality,stent thrombosis,and target-vessel MI.These findings highlight the need for further large-scale RCTs to confirm its benefits.展开更多
Increased mortality rates in chronic obstructive pulmonary disease(COPD)patients with heart failure(HF)are believed to be driven by various factors,including disparities in access to healthcare services and shifting d...Increased mortality rates in chronic obstructive pulmonary disease(COPD)patients with heart failure(HF)are believed to be driven by various factors,including disparities in access to healthcare services and shifting dynamics of the population characteristics.In this study,we examined the racial and ethnic disparities in the clinical outcomes of HF in COPD patients in the United States,analyzing data from the Nationwide Inpatient Sample database.The database was searched retrospectively from 2016 to 2022 to identify COPD and HF patients by International Classification of Diseases-10 codes.A total of 2445545 individuals were included of which 76%were Whites,16%were Blacks,5%Hispanics and 3%others.Whites were significantly older than other populations(P<0.001),and a significantly higher proportion of Blacks were females compared to other racial groups.Regarding clinical outcomes,Black COPD patients with HF had the lowest mortality rates while it was similar between Whites and Hispanics(P<0.001).Compared to Whites,the adjusted odds ratio was significantly lower for Blacks,0.797[95%confidence interval(CI):0.783-0.812;P<0.001]and Hispanics,0.956(95%CI:0.932-0.981;P=0.001).Other racial groups had significantly higher mortality compared to Whites,with an adjusted odds ratio of 1.131(95%CI:1.099-1.164;P<0.001).Individuals from other racial groups had significantly longer hospital stay,and hospitalization cost adjusted for inflation.Cardiac arrest was the strongest predictor(P<0.001)for in-hospital mortality in all racial groups.展开更多
BACKGROUND Atrial fibrillation(AF)associated with chronic kidney disease(CKD)is a prevalent condition in the United States,significantly impacting global morbidity and mortality.Understanding temporal patterns in AF-r...BACKGROUND Atrial fibrillation(AF)associated with chronic kidney disease(CKD)is a prevalent condition in the United States,significantly impacting global morbidity and mortality.Understanding temporal patterns in AF-related mortality among CKD patients is crucial for effective clinical and public health strategies.AIM To investigate AF-CKD comorbidity and mortality on the national level.METHODS Death certificates from the Centers for Disease Control Wide-Ranging Online Data for Epidemiologic Research database spanning 2011-2020 were analyzed to investigate AF-related CKD mortality in adults aged 35 to 85 or more years.Age-adjusted mortality rates(AAMRs)per 100000 persons and annual percent change(APC)were calculated,stratified by year,sex,race/ethnicity,and geographic region.RESULTS A total of 110733 deaths occurred among adults(aged 35-85 or more years)related to AF associated with CKD in the United States.Overall AAMR declined from 8.1 in 2011 to 5.5 in 2014(APC:-14.89;95%confidence interval(CI):-30.44 to-4.06),followed by an increase to 10.3 in 2020(APC:9.91;95%CI:6.1-19.62).Men had higher AAMRs than women(men:7.6,95%CI:7.6-7.7).Non-Hispanic White adults had the highest AAMR(7.8),followed by non-Hispanic Black(5).States in the top 90th percentile had approximately four times higher AAMRs than those in the lower 10th percentile.AAMR also varied by region(Midwest:7.6,West:6.7,Northeast:6.3,South:5.6),with nonmetropolitan areas exhibiting higher AF-associated CKD mortality.CONCLUSION Temporal trends in AF-related mortality among CKD patients showed fluctuations over the study period,with notable disparities across demographic and geographic factors.Targeted interventions are warranted to mitigate the burden of AF associated with CKD and reduce mortality rates in the United States.展开更多
文摘BACKGROUND Atrial fibrillation(AF)is a prevalent cardiac arrhythmia associated with significant morbidity and mortality,particularly in patients with concomitant renal dysfunction.Anticoagulation therapy reduces the risk of thromboembolic complications in AF but presents challenges in patients with renal impairment due to altered pharmacokinetics and increased bleeding risk.AIM To support clinicians in navigating the complexities of anticoagulation in this high-risk population,ensuring optimal outcomes.METHODS The present review followed PRISMA guidelines.Data extraction was conducted using a standardized template that captured key study characteristics:Population demographics,renal function metrics,anticoagulant dosing strategies,and primary and secondary outcomes.For quality assessment,we employed the Cochrane Risk of Bias 2.0 tool for randomized controlled trials.Observational studies were appraised using the Newcastle-Ottawa Scale.RESULTS We analyze data from 16 studies to provide recommendations on optimal anticoagulation strategies,balancing thrombotic and bleeding risks.Current evidence supports the preferential use of apixaban in moderate chronic kidney disease and cautiously in end-stage renal disease,emphasizing the importance of individualized therapy.CONCLUSION The management of anticoagulation in AF patients with renal dysfunction is challenging but critical for reducing stroke risk.
文摘BACKGROUND Listening to music has been shown to reduce pain and anxiety before,during,and after invasive coronary procedures.AIM To perform a systematic review and meta-analysis to explore the effect of therapeutic use of music on both,perioperative and postoperative outcomes of invasive coronary procedures.METHODS An exhaustive literature search of 3 electronic databases(MEDLINE,Scopus,Cochrane CENTRAL)was conducted from inception until 10th December 2023.The results of our analyses are presented as standard mean difference(SMD)or weighted mean difference,with 95%CI and pooled using a random effects model.A P value<0.05 was considered significant in all cases.RESULTS From 21 studies,2141 participants were included in our analysis.The pooled analysis demonstrated that music listening significantly improves post-procedural pain(SMD=-0.78,95%CI:-1.34 to-0.23;P=0.006),anxiety(SMD=-0.86,95%CI:-1.43 to-0.29;P=0.003),heart rate[mean difference(MD)=-3.38,95%CI:-5.51 to-1.25;P=0.002],and systolic blood pressure(MD=-5.89,95%CI:-9.75 to-2.02;P=0.003).There was no significant improvement in diastolic blood pressure(MD=-3.22,95%CI:-6.58 to 0.14;P=0.06)or respiratory rate(MD=-0.97,95%CI:-1.98 to 0.03;P=0.06).CONCLUSION Music listening can be used in healthcare settings for patients undergoing invasive coronary procedures to reduce anxiety levels and improve their physiological parameters.
文摘Endoscopic retrograde cholangiopancreatography(ERCP)is a vital tool for diagnosing and treating biliary and pancreatic disorders,but its safety and efficacy are marred by preoperative gastric retention.Jia et al retrospectively analyzed 190 patients who underwent ERCP and found that gastrointestinal obstruction,jaundice,opioid use,female sex,and primary diseases were in-dependent predictors and risk factors of preoperative gastric retention.Based on these findings and comprehensive analysis,a proposed predictive model offers clinicians valuable tools to tailor preoperative strategies,improving the proce-dural safety and efficacy of ERCP.Despite having several limitations,like single-center design and limited generalizability,the study marks a significant advan-cement in optimizing ERCP outcomes through predictive analytics.Further research with larger populations and prospective designs is warranted to establish these findings.
文摘BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SAVR).However,the compara-tive safety and efficacy of these interventions remain subjects of ongoing investigation.AIM To compare the clinical outcomes and safety of TAVR vs SAVR in patients with severe symptomatic aortic stenosis.METHODS A systematic review and meta-analysis were conducted according to PRISMA guidelines.Randomized controlled trials(RCTs)comparing TAVR and SAVR were identified from databases including PubMed,Scopus,and Web of Science up to May 31,2024.Data were extracted on clinical outcomes,including mortality,procedural compli-cations,and post-procedure adverse events.Risk ratios(RRs)with 95%CIs were calculated using a random-effects model.RESULTS A total of 10 RCTs were included.TAVR demonstrated a significantly lower risk of acute kidney injury(RR:0.33;95%CI:0.25–0.44),major bleeding(RR:0.37;95%CI:0.30–0.46),and new-onset atrial fibrillation(RR:0.44;95%CI:0.34–0.57)compared to SAVR.However,TAVR was associated with higher risks of new permanent pacemaker implantation(RR:3.49;95%CI:2.77–4.39),major vascular complications(RR:2.47;95%CI:1.91–3.21),and paraval-vular leaks(RR:4.15;95%CI:3.14–5.48).Mortality at 30 days was comparable(RR:0.95;95%CI:0.78–1.15),but long-term mortality was slightly higher with TAVR in some analyses(RR:1.23;95%CI:1.01–1.49).Rates of stroke(RR:0.97;95%CI:0.81–1.17)and myocardial infarction(RR:0.91;95%CI:0.67–1.24)were similar between the groups.CONCLUSION TAVR offers a less invasive option with significant benefits in reducing acute kidney injury,major bleeding,and new-onset atrial fibrillation,making it particularly advantageous for high-risk surgical candidates.However,higher risks of permanent pacemaker implantation,vascular complications,and paravalvular leaks highlight the need for individualized patient selection and shared decision-making to optimize outcomes.
基金supported by the National Key Research and Development Program of China(No.2022YFB3803600)the National Natural Science Foundation of China(Nos.22202187,22361142704,22238009,U24A2071,and 52272290)+4 种基金the National Postdoctoral Program for Innovative Talents(No.BX2021275)the Natural Science Foundation of Hubei Province of China(No.2022CFA001)the Project funded by China Postdoctoral Science Foundation(No.2022M712957)the Postdoctoral Funding Program of Hubei Province.Chuanbiao Bie and Bicheng Zhu would like to thank the China Scholarship Council(CSC)for its financial supportsupport from Australian Research Council Discovery Early Career Award(No.DE220100429).
文摘The inefficiency of photocatalytic overall water splitting is well documented and has been extensively studied.However,a crucial aspect of this process,the side reaction,has often been overlooked.In this study,we investigate the impact of side reactions on photocatalytic overall water splitting by monitoring factors such as dissolved oxygen,reactive oxygen species,and hydrogen peroxide.Further insights into the side reaction are obtained through the introduction of a platinum cocatalyst.Our findings reveal that dissolved oxygen significantly contributes to the side reaction by promoting the production of hydrogen peroxide.This byproduct is generated at the expense of electrons needed for the hydrogen evolution reaction,thereby reducing the overall efficiency of photocatalytic water splitting.This article aims to provide guidance on future research directions in the field of water splitting,with a particular emphasis on photocatalysis.
文摘BACKGROUND Renal complications of diabetes mellitus pose a significant public health challenge,contributing to substantial morbidity and mortality globally.Understanding temporal trends and regional disparities in mortality related to diabetic nephropathy is crucial for guiding targeted interventions and policy decisions.AIM To display the trends and disparities of diabetic nephropathy related mortality.METHODS A retrospective analysis was conducted using death certificate data from the center for disease control and prevention(CDC)wide-ranging online data for epidemiologic research analysis(WONDER)database,spanning from 1999 to 2020,to investigate mortality related to renal complications of diabetes in adults aged 35 or above.Age-adjusted mortality rate(AAMR)per 100000 persons and annual percent change(APC)were computed,with stratification by year,sex,race/ethnicity,and geographic region.RESULTS Between 1999 and 2020,a total of 525804 deaths occurred among adults aged 35 to 85+years due to renal-related issues associated with diabetes.AAMR for renal-related deaths in adult diabetic patients showed a consistent increase from 1.6 in 1999 to 34.9 in 2020(average APC[AAPC]:17.23;95%confidence interval[CI]:13.35-28.79).Throughout the study period,men consistently had higher AAMR(overall AAMR for men:17.8;95%CI:17.7-17.9).In 1999,the AAMR for men was 1.8,increasing to 44.2 by 2020(AAPC:17.54;95%CI:13.09-29.53),while for women,it was 1.6 in 1999 and rose to 27.6 by 2020(AAPC:15.55;95%CI:13.35-21.10).American Indian/Alaska Native adults exhibited the highest overall AAMR(36.1;95%CI:35.2-36.9),followed by Black/African American(25.5;95%CI:25.3-25.7).The highest mortality was observed in the Western(AAMR:16.6;95%CI:16.5-16.7),followed by the Midwestern region(AAMR:14.4;95%CI:14.314.4).Significant variations in AAMR were observed among different states,with Oklahoma recording the highest(21.2)and Connecticut the lowest(7).The CDC WONDER database could potentially have omissions or inaccuracies.It does not provide data outside of the available variables.Furthermore,dataset after 2020 was not included in this study.CONCLUSION Our findings highlight an alarming rise in mortality related to renal complications of diabetes among United States adults over the past two decades,with concerning disparities across demographic and geographic factors.These results underscore the urgent need for targeted interventions,policies,and protocols to address the growing burden of diabetic nephropathy and substantially reduce mortality rates in the United States.This will help improve the overall health outcome in the United States by identifying communities at risk and implementing tailored assistance to them.
基金the Cancer Institute of New Jersey is supported by a grant from the National Cancer Institute:P30CA072720Arnav Srivastava is supported by a training grant from the National Cancer Institute:T32CA180984.
文摘Introduction:Infections are the most feared complication of transrectal prostate biopsies,along with growing concerns of antibiotic resistance.Our institution transitioned to a transperineal approach without use of perioperative antibiotics or bowel preparations.We aimed to compare the safety outcomes associated with transperineal and transrectal prostate biopsy techniques.Materials and Methods:A retrospective analysis of patients who underwent transrectal and transperineal prostate biopsies at our institution from 2019–2022 was performed.Results:We identified 319 patients—174 transrectal and 145 transperineal.8 patients who had transperineal biopsy(5.5%)received peri-operative antibiotics,compared to 100%with transrectal biopsy.35.86%of transperineal patients received a bowel preparation,compared to 100%in the transrectal group.44.14%and 49.43%of patients received a prior prostate biopsy in the transperineal and transrectal groups,respectively.Patients in the transperineal biopsy group had zero infectious complications,1 ER visit,and zero 30-day readmissions.This is compared to 9 infectious complications(5.17%,p=0.005),8 ER visits(4.60%,p=0.036),and 730-day readmissions(4.02%,p=0.015)in the transrectal group.Conclusions:In a single institution series,patients undergoing transperineal biopsy had fewer infectious complications compared to those undergoing transrectal biopsy.Despite only a small percentage of patients receiving perioperative antibiotics and a majority of patients not receiving a bowel preparation in the transperineal group,there were zero infectious complications or 30-day readmissions.With greater infectious complications with transrectal biopsy and growing antibiotic resistance,we underline the safety of transperineal prostate biopsy which can largely be done without perioperative antibiotics or a bowel preparation.
文摘BACKGROUND Laparoscopic nephrectomy is a preferred surgical approach due to its minimally invasive nature and faster recovery times.However,effective management of postoperative pain remains a significant challenge.Several traditional methods,including opioid-based analgesia,are commonly used but are associated with side effects such as nausea,vomiting,sedation,and delayed recovery.In recent years,the erector spinae plane block(ESPB)has gained attention as an ultrasoundguided regional anesthesia technique offering promising results in various surgical procedures by reducing opioid requirements and enhancing patient comfort.AIM To evaluate the efficacy and safety of ESPB in comparison to conventional pain management strategies in patients undergoing laparoscopic nephrectomy.METHODS Following PRISMA guidelines,we searched PubMed,EMBASE,Web of Science,and the Cochrane Register for randomized controlled trials(RCTs)comparing ESPB with control for laparoscopic nephrectomy.The Cochrane Risk of Bias tool was employed for quality assessment.The primary outcome was total patient-controlled analgesia(PCA)consumption.Secondary outcomes included hospital discharge time and the incidence of postoperative nausea and vomiting.A random-effects meta-analysis was conducted to calculate pooled mean differences(MD)and odds ratios(OR)with 95%CIs.RESULTS Nine RCTs involving a total of 643 patients(ESPB group=320;control group=323)were included in the analysis.ESPB significantly reduced PCA opioid consumption compared to controls(MD:-14.24,95%CI:-20.66 to-7.83,P<0.0001).Subgroup analysis showed reduced PCA use with ESPB vs morphine(MD:-8.78,95%CI:-15.34 to-2.22,P=0.009),and a non-significant effect compared to other analgesics(MD:-48.26,95%CI:-143.60 to 47.09).No statistically significant differences were observed in discharge time or the incidence of nausea and vomiting.CONCLUSION ESPB demonstrates the potential of reducing PCA in laparoscopic nephrectomy patients;however,its impact on secondary outcomes remains inconclusive.Large-scale RCTs are needed to confirm ESPB's benefits and explore long-term effects.
文摘BACKGROUND The heterogeneous group of disorders called peripheral vascular diseases(PVDs)occurs outside the heart and brain tissue to cause ischemia and severe health complications.Diagnosis accuracy is essential in starting appropriate patient management at the proper time.Modern medicine considers skin biopsies crucial diagnostic tools that yield histopathological and molecular evidence for examining PVD-related microvascular changes.AIM To evaluate skin biopsy applications in PVD diagnostics through artistic analysis of technical processes and examination of pathological and innovative molecular indicators.METHODS A systematic review of randomized controlled trials and original studies about skin biopsy utility in PVD diagnosis used PubMed,Scopus,and EMBASE search platforms.The reviewed studies met specific entry requirements,while all case reports and review articles remained excluded.RESULTS A total of 22 studies suited the research criteria that were evaluated.Researchers emphasized the value of skin biopsies for identifying inflammatory from non-inflammatory PVDs.At the same time,they detect systemic sclerosis and diabetic vasculopathy abnormalities of micro-vessels and identify endothelial dysfunction through measurements of vascular endothelial growth factor and intercellular adhesion molecule-1 and endothelial nitric oxide synthase markers.Skin biopsies require further improvement because they cause patient discomfort and produce variable diagnostic results that specialists must interpret.CONCLUSION Skin biopsies enable essential diagnostic findings about PVD and improve patient detection.The development of standardized biopsy procedures and molecular diagnosis techniques should be studied to advance PVD diagnoses in clinical practice.
文摘BACKGROUND Prolonged immobility during intensive care unit(ICU)admission has been a cause of muscle atrophy and worsening functional outcomes with longer recovery times.Prior research has demonstrated that mobilization within a week of ICU admission potentially benefits physical function in critically ill patients.AIM To evaluate the effects of initiating mobilization within 72 hours of ICU admission in critically ill patients through an updated systematic review and meta-analysis.METHODS A systematic search was performed through MEDLINE,Scopus,and Cochrane Library from inception until September 2024 for randomized controlled trials(RCTs)comparing early mobilization(EM)with usual or conventional care in critically ill adult patients.Primary outcomes included length of ICU(days)and ventilation duration(days).Secondary outcomes included muscle strength,functional status,adverse events,all-cause mortality,and quality of life(QOL).A random effects meta-analysis was performed for pooled effect estimates and to derive risk ratios(RR)and corresponding 95%confidence intervals(CI).RESULTS Out of 3487 results,16 RCTs were included with a population of 2385 patients(1195 receiving EM and 1190 with usual care.)A significant reduction in the length of ICU stays[mean difference(MD)=-1.02,95%CI:-1.96 to-0.09;P=0.03;I2=60%]and ventilation duration(MD=-1.07,95%CI:-1.91 to-0.23,P=0.01;I2=57%)was observed in the EM group compared to usual care.EM significantly improved muscle strength[standard MD(SMD)=0.47,95%CI:0.18-0.75,P=0.001;I2=79%]and functional status(SMD=0.70,95%CI:0.40-1.00,P<0.00001;I2=81%)in ICU patients.No statistically significant difference was observed in adverse events(RR=1.72,95%CI:1.01-2.94,P=0.05;I2=31%),all-cause mortality(RR=1.10,95%CI:0.79-1.53,P=0.57;I2=30%),and QOL(SMD=0.04,95%CI:-0.07-0.15,P=0.50;I2=9%)between the two groups.CONCLUSION Initiating mobilization within 72 hours of ICU admission is associated with improved functional outcomes and reduced ICU length of stay and ventilation duration.These findings indicate that EM may be a safe option for ICU patients,contributing to lower recovery times and healthcare costs.Further extensive research is required to validate the long-term effects on survival and QOL.
文摘BACKGROUND Optical coherence tomography(OCT)offers detailed cross-sectional imaging during percutaneous coronary intervention(PCI),aiding in anatomically complex coronary lesions.Despite its advantages,evidence on the clinical effectiveness of OCT-guided PCI remains limited.Major databases were systematically searched for randomized controlled trials(RCTs)comparing OCT-guided and angiography-guided PCI in complex lesions.Primary outcomes included major adverse cardiovascular events(MACE)and target vessel failure(TVF);secondary outcomes included mortality,myocardial infarction(MI),and other procedural outcomes.A random-effects model was used to pool risk ratio(RR),with 95%CI.Statistical analysis was conducted in R software(v4.4.1),with significance set at P<0.05.RESULTS Five RCTs(5737 patients)showed OCT-guided PCI significantly reduced MACE(RR:0.63,95%CI:0.52-0.77,P<0.01),TVF(RR:0.68,95%CI:0.56-0.83,P<0.01),all-cause(RR:0.58,95%CI:0.38-0.87,P<0.01)and cardiac mortality(RR:0.43,95%CI:0.24-0.76,P<0.01),target-lesion revascularization(RR:0.53,95%CI:0.33-0.84,P<0.01),stent thrombosis(RR:0.52,95%CI:0.31-0.86,P=0.01),and target-vessel MI(RR:0.64,95%CI:0.42-0.97,P=0.04)vs angiography-guided PCI.Periprocedural MI,any revascularization,target-vessel revascularization,and contrast-associated kidney injury were similar between groups.CONCLUSION OCT-guided PCI improves outcomes in complex lesions by reducing MACE,TVF,mortality,stent thrombosis,and target-vessel MI.These findings highlight the need for further large-scale RCTs to confirm its benefits.
文摘Increased mortality rates in chronic obstructive pulmonary disease(COPD)patients with heart failure(HF)are believed to be driven by various factors,including disparities in access to healthcare services and shifting dynamics of the population characteristics.In this study,we examined the racial and ethnic disparities in the clinical outcomes of HF in COPD patients in the United States,analyzing data from the Nationwide Inpatient Sample database.The database was searched retrospectively from 2016 to 2022 to identify COPD and HF patients by International Classification of Diseases-10 codes.A total of 2445545 individuals were included of which 76%were Whites,16%were Blacks,5%Hispanics and 3%others.Whites were significantly older than other populations(P<0.001),and a significantly higher proportion of Blacks were females compared to other racial groups.Regarding clinical outcomes,Black COPD patients with HF had the lowest mortality rates while it was similar between Whites and Hispanics(P<0.001).Compared to Whites,the adjusted odds ratio was significantly lower for Blacks,0.797[95%confidence interval(CI):0.783-0.812;P<0.001]and Hispanics,0.956(95%CI:0.932-0.981;P=0.001).Other racial groups had significantly higher mortality compared to Whites,with an adjusted odds ratio of 1.131(95%CI:1.099-1.164;P<0.001).Individuals from other racial groups had significantly longer hospital stay,and hospitalization cost adjusted for inflation.Cardiac arrest was the strongest predictor(P<0.001)for in-hospital mortality in all racial groups.
文摘BACKGROUND Atrial fibrillation(AF)associated with chronic kidney disease(CKD)is a prevalent condition in the United States,significantly impacting global morbidity and mortality.Understanding temporal patterns in AF-related mortality among CKD patients is crucial for effective clinical and public health strategies.AIM To investigate AF-CKD comorbidity and mortality on the national level.METHODS Death certificates from the Centers for Disease Control Wide-Ranging Online Data for Epidemiologic Research database spanning 2011-2020 were analyzed to investigate AF-related CKD mortality in adults aged 35 to 85 or more years.Age-adjusted mortality rates(AAMRs)per 100000 persons and annual percent change(APC)were calculated,stratified by year,sex,race/ethnicity,and geographic region.RESULTS A total of 110733 deaths occurred among adults(aged 35-85 or more years)related to AF associated with CKD in the United States.Overall AAMR declined from 8.1 in 2011 to 5.5 in 2014(APC:-14.89;95%confidence interval(CI):-30.44 to-4.06),followed by an increase to 10.3 in 2020(APC:9.91;95%CI:6.1-19.62).Men had higher AAMRs than women(men:7.6,95%CI:7.6-7.7).Non-Hispanic White adults had the highest AAMR(7.8),followed by non-Hispanic Black(5).States in the top 90th percentile had approximately four times higher AAMRs than those in the lower 10th percentile.AAMR also varied by region(Midwest:7.6,West:6.7,Northeast:6.3,South:5.6),with nonmetropolitan areas exhibiting higher AF-associated CKD mortality.CONCLUSION Temporal trends in AF-related mortality among CKD patients showed fluctuations over the study period,with notable disparities across demographic and geographic factors.Targeted interventions are warranted to mitigate the burden of AF associated with CKD and reduce mortality rates in the United States.
