Some studies have confirmed the neuroprotective effect of remote ischemic conditioning against stroke. Although numerous animal researches have shown that the neuroprotective effect of remote ischemic conditioning may...Some studies have confirmed the neuroprotective effect of remote ischemic conditioning against stroke. Although numerous animal researches have shown that the neuroprotective effect of remote ischemic conditioning may be related to neuroinflammation, cellular immunity, apoptosis, and autophagy, the exact underlying molecular mechanisms are unclear. This review summarizes the current status of different types of remote ischemic conditioning methods in animal and clinical studies and analyzes their commonalities and differences in neuroprotective mechanisms and signaling pathways. Remote ischemic conditioning has emerged as a potential therapeutic approach for improving stroke-induced brain injury owing to its simplicity, non-invasiveness, safety, and patient tolerability. Different forms of remote ischemic conditioning exhibit distinct intervention patterns, timing, and application range. Mechanistically, remote ischemic conditioning can exert neuroprotective effects by activating the Notch1/phosphatidylinositol 3-kinase/Akt signaling pathway, improving cerebral perfusion, suppressing neuroinflammation, inhibiting cell apoptosis, activating autophagy, and promoting neural regeneration. While remote ischemic conditioning has shown potential in improving stroke outcomes, its full clinical translation has not yet been achieved.展开更多
The minimal clinically important difference(MCID)represents a pivotal metric in bridging the gap between statistical significance and clinical relevance,addressing the direct impact of medical interventions from the p...The minimal clinically important difference(MCID)represents a pivotal metric in bridging the gap between statistical significance and clinical relevance,addressing the direct impact of medical interventions from the patient's perspective.This comprehensive review analyzes the evolution,applications,and challenges of MCID across medical specialties,emphasizing its necessity in ensuring that clinical outcomes not only demonstrate statistical significance but also offer genuine clinical utility that aligns with patient expectations and needs.We discuss the evolution of MCID since its inception in the 1980s,its current applications across various medical specialties,and the methodologies used in its calculation,highlighting both anchor-based and distribution-based approaches.Furthermore,the paper delves into the challenges associated with the application of MCID,such as methodological variability and the interpretation difficulties that arise in clinical settings.Recommendations for the future include standardizing MCID calculation methods,enhancing patient involvement in setting MCID thresholds,and extending research to incorporate diverse global perspectives.These steps are critical to refining the role of MCID in patient-centered healthcare,addressing existing gaps in methodology and interpretation,and ensuring that medical interventions lead to significant,patient-perceived improvements.展开更多
The general objective of our study was to describe the clinical and epidemiological aspects of anxiety disorders. This was a retrospective descriptive cross-sectional study, lasting 5 years, from January 01, 2019 to D...The general objective of our study was to describe the clinical and epidemiological aspects of anxiety disorders. This was a retrospective descriptive cross-sectional study, lasting 5 years, from January 01, 2019 to December 31, 2023, on 225 patients seen in consultation for anxiety disorders in the department. The prevalence of anxiety disorders was 2.5% in consultation. The 20 - 29 age group was the most represented at 33.3%. Females were slightly represented at 55.1%, with a sex ratio of 1.2. The secondary level was the most affected, accounting for 36.4% of cases. Insomnia was the most frequent reason for consultation, accounting for 71.1% of cases. A larger general population study would be necessary to better assess the extent of anxiety disorders in Guinea.展开更多
Machine learning(ML)is a type of artificial intelligence that assists computers in the acquisition of knowledge through data analysis,thus creating machines that can complete tasks otherwise requiring human intelligen...Machine learning(ML)is a type of artificial intelligence that assists computers in the acquisition of knowledge through data analysis,thus creating machines that can complete tasks otherwise requiring human intelligence.Among its various applications,it has proven groundbreaking in healthcare as well,both in clinical practice and research.In this editorial,we succinctly introduce ML applications and present a study,featured in the latest issue of the World Journal of Clinical Cases.The authors of this study conducted an analysis using both multiple linear regression(MLR)and ML methods to investigate the significant factors that may impact the estimated glomerular filtration rate in healthy women with and without non-alcoholic fatty liver disease(NAFLD).Their results implicated age as the most important determining factor in both groups,followed by lactic dehydrogenase,uric acid,forced expiratory volume in one second,and albumin.In addition,for the NAFLD-group,the 5th and 6th most important impact factors were thyroid-stimulating hormone and systolic blood pressure,as compared to plasma calcium and body fat for the NAFLD+group.However,the study's distinctive contribution lies in its adoption of ML methodologies,showcasing their superiority over traditional statistical approaches(herein MLR),thereby highlighting the potential of ML to represent an invaluable advanced adjunct tool in clinical practice and research.展开更多
The article"Secondary diabetes due to different etiologies:Four case reports"by Song et al,published in the World Journal of Clinical Cases,delves into the identi-fication of rare causes of secondary diabete...The article"Secondary diabetes due to different etiologies:Four case reports"by Song et al,published in the World Journal of Clinical Cases,delves into the identi-fication of rare causes of secondary diabetes and emphasizes the necessity for healthcare professionals to recognize these conditions.Failure to do so can result in treatment delays and compromised patient outcomes.The article discusses spe-cific types of diabetes,including maturity onset of diabetes in young,pancreas-related diseases,endocrinopathies,drug-induced diabetes,infections,and con-genital genetic syndromes associated with diabetes mellitus.Case summaries highlight how patients with secondary diabetes,stemming from conditions such as Williams-Beuren syndrome and pituitary adenoma,often exhibit distinct characteristics overlooked in clinical practice.The authors stress the importance of a holistic diagnostic approach and advocate for proactive management through early intervention,including genetic tests and antibody detection.Increased awa-reness and education are crucial for timely identification and proper management,ultimately improving patient well-being.These findings prompt a call to action for healthcare professionals to consider rare causes of secondary diabetes,facili-tating better glycemic control and overall patient care.展开更多
BACKGROUND The adoption of telehealth services surged after the coronavirus disease 2019 pandemic,revolutionizing traditional healthcare delivery models.Amazon Clinic's recent nationwide launch marks a significant...BACKGROUND The adoption of telehealth services surged after the coronavirus disease 2019 pandemic,revolutionizing traditional healthcare delivery models.Amazon Clinic's recent nationwide launch marks a significant milestone in this trend.This study aims to offer a strengths,weaknesses,opportunities,and threats(SWOT)analysis of Amazon Clinic and compare its features with leading virtual healthcare platforms.AIM To evaluate Amazon Clinic's telehealth services through a SWOT analysis and compare its features with other leading virtual healthcare platforms.METHODS The initial search terms included were,amazon clinic odds ratio(OR)amwell OR Teladoc OR Walmart virtual health service OR CVS minute clinic OR CirrusMD OR brightside health,from 2000 to 2023.This search yielded 111 articles,from which duplicates were removed,and unrelated titles were filtered out.Eight articles were retained for a final review,including comparative studies,usability research,retrospective analyses,observational studies,and review articles.The data was organized and analyzed using Rayyan software and summarized in a table and PRISMA flowcharts.RESULTS The review included eight articles focusing on various aspects of telehealth.Comparative studies highlighted differences between Teladoc and traditional physician offices,noting lower diagnostic imaging orders and antibiotic prescriptions for Teladoc.User demographics for Teladoc showed younger,less engaged patients.Usability studies emphasized the importance of website design for telemedicine adoption.Tele-mental health platforms like Brightside showed superior outcomes in treating depression compared to traditional methods.Telemedicine for specialized fields like skin reconstruction demonstrated cost efficiency and reduced waiting times.The SWOT analysis identified Amazon Clinic's strengths,such as its vast consumer base and transparent pricing,and weaknesses like the lack of pediatric care.Opportunities included potential partnerships and service expansions,while threats involved competition and regulatory challenges.CONCLUSION Amazon Clinic's entry into the telehealth sector represents a significant development with various strengths and opportunities.However,it faces challenges from established healthcare providers and regulatory landscapes.The future success of Amazon Clinic will depend on strategic collaborations,addressing service gaps,and navigating competition and regulations.Telemedicine's impact will hinge on its ability to effectively leverage these opportunities and overcome inherent challenges in the ever-evolving healthcare landscape.展开更多
Introduction: Diabetes remains a real public health problem today, due to its associated morbidity and mortality. It induces numerous metabolic, biochemical, hematological, and immunological changes, responsible for m...Introduction: Diabetes remains a real public health problem today, due to its associated morbidity and mortality. It induces numerous metabolic, biochemical, hematological, and immunological changes, responsible for multiple complications. The objective of this study was to characterize clinically and biologically type 2 diabetic patients followed at the National Center for Diabetology and Arterial Hypertension of the Central Hospital of Yaoundé. Method: This prospective, cross-sectional, and analytical study took place from April 5 to July 31, 2023 (4 months) on 100 diabetic patients of both sexes (61 women and 39 men), aged from 31 to 88 years. Body Mass Index, systolic and diastolic blood pressure, and cardiac frequency were measured on each of the patients. Subsequently, blood was collected from the patients for the determination of the complete blood count, HBA1c, lipid profile, serum albumin, TNF-α, and IL-6 levels. The data were analyzed using SPSS 17.0 software. Results: The age average of our population was 56.99 ± 11.51 years, the population was primarily female (61%) and primarily between the ages of 55 and 88. 67% of respondents were married. 59% went to secondary school. 73% of them lived in urban areas. 30% were obese and 40% were overweight, with an average BMI of 28.75 kg/m2. 76% of patients took oral antidiabetic medications. HbA1c level average was 8.65%, with 60% having readings above 6.5%. Low hemoglobin and hypochromia were among the abnormalities of red blood cells observed. Lipid profiles revealed low HDL-cholesterol and high triglycerides and cholesterol. Elevated levels of TNF-α and IL-6 indicated inflammation and cardiovascular risk. Conclusion: These results indicate the necessity of focused diabetic care and management on diabetic patients attending the central hospital of Yaoundé, Cameroon.展开更多
Graphical abstracts(GAs)are emerging as a pivotal tool in medical literature,enhancing the dissemination and comprehension of complex clinical data through visual summaries.This editorial highlights the significant ad...Graphical abstracts(GAs)are emerging as a pivotal tool in medical literature,enhancing the dissemination and comprehension of complex clinical data through visual summaries.This editorial highlights the significant advantages of GAs,including improved clarity,increased reader engagement,and enhanced visibility of research findings.By transforming intricate scientific data into accessible visual formats,these abstracts facilitate quick and effective knowledge transfer,crucial in clinical decision-making and patient care.However,challenges such as potential data misrepresentation due to oversimplification,the skill gap in graphic design among researchers,and the lack of standardized creation guidelines pose barriers to their widespread adoption.Additionally,while software such as Adobe Illustrator,BioRender,and Canva are commonly employed to create these visuals,not all researchers may be proficient in their use.To address these issues,we recommend that academic journals establish clear guidelines and provide necessary design training to researchers.This proactive approach will ensure the creation of high-quality GAs,promote their standardization,and expand their use in clinical reporting,ultimately benefiting the medical community and improving healthcare outcomes.展开更多
Background: Clinical decision support tools provide suggestions to support healthcare providers and clinicians, as they attend to patients. Clinicians use these tools to rapidly consult the evidence at the point of ca...Background: Clinical decision support tools provide suggestions to support healthcare providers and clinicians, as they attend to patients. Clinicians use these tools to rapidly consult the evidence at the point of care, a practice which has been found to reduce the time patients spend in hospitals, promote the quality of care and improve healthcare outcomes. Such tools include Medscape, VisualDx, Clinical Key, DynaMed, BMJ Best Practice and UpToDate. However, use of such tools has not yet been fully embraced in low-resource settings such as Uganda. Objective: This paper intends to collate data on the use and uptake of one such tool, UpToDate, which was provided at no cost to five medical schools in Uganda. Methods: Free access to UpToDate was granted through the IP addresses of five medical schools in Uganda in collaboration with Better Evidence at The Global Health Delivery Project at Harvard and Brigham and Women’s Hospital and Wolters Kluwer Health. Following the donation, medical librarians in the respective institutions conducted training sessions and created awareness of the tool. Usage data was aggregated, based on logins and content views, presented and analyzed using Excel tables and graphs. Results: The data shows similar trends in increased usage over the period of August 2022 to August 2023 across the five medical schools. The most common topics viewed, mode of access (using either the computer or the mobile app), total usage by institution, ratio of uses to eligible users by institution and ratio of uses to students by institution are shared. Conclusion: The study revealed that the tool was used by various user categories across the institutions with similar steady improved usage over the year. These results can inform the librarians as they encourage their respective institutions to continue using the tool to support uptake of point-of-care tools in clinical practice.展开更多
The critical role of patient-reported outcome measures(PROMs)in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific research.PROMs encapsulate a pati...The critical role of patient-reported outcome measures(PROMs)in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific research.PROMs encapsulate a patient's health status directly from their perspective,encompassing various domains such as symptom severity,functional status,and overall quality of life.By integrating PROMs into routine clinical practice and research,healthcare providers can achieve a more nuanced understanding of patient experiences and tailor treatments accordingly.The deployment of PROMs supports dynamic patient-provider interactions,fostering better patient engagement and adherence to tre-atment plans.Moreover,PROMs are pivotal in clinical settings for monitoring disease progression and treatment efficacy,particularly in chronic and mental health conditions.However,challenges in implementing PROMs include data collection and management,integration into existing health systems,and acceptance by patients and providers.Overcoming these barriers necessitates technological advancements,policy development,and continuous education to enhance the acceptability and effectiveness of PROMs.The paper concludes with recommendations for future research and policy-making aimed at optimizing the use and impact of PROMs across healthcare settings.展开更多
Acute pancreatitis(AP) is not a disorder limited to a single organ,the pancreas,but often results in transient or sustained dysfunction,and even failure,of multiple organs,particularly as the disease progresses.^([1])...Acute pancreatitis(AP) is not a disorder limited to a single organ,the pancreas,but often results in transient or sustained dysfunction,and even failure,of multiple organs,particularly as the disease progresses.^([1]) Therefore,although AP is primarily a localized disease with systemic consequences in a subset of patients,its clinical manifestations extend beyond digestive system symptoms to encompass a variety of additional symptoms,particularly during disease progression from mild AP(MAP) to severe AP(SAP).展开更多
The destruction of the skin barrier and the presence of necrotic tissue in large burns increase the risk of multiple infections,often leading to sepsis,bacteremia,and other complications.Infective endocarditis(IE)is a...The destruction of the skin barrier and the presence of necrotic tissue in large burns increase the risk of multiple infections,often leading to sepsis,bacteremia,and other complications.Infective endocarditis(IE)is a severe manifestation of organ damage,and if conservative medical treatment fails to control the infection,irreversible pathological changes may occur,including valvular redundancy.展开更多
Arboviral diseases are viral infections transmitted to humans through the bites of arthropods,such as mosquitoes,often causing a variety of pathologies associated with high levels of morbidity and mortality.Over the p...Arboviral diseases are viral infections transmitted to humans through the bites of arthropods,such as mosquitoes,often causing a variety of pathologies associated with high levels of morbidity and mortality.Over the past decades,these infections have proven to be a significant challenge to health systems worldwide,particularly following the considerable geographic expansion of the dengue virus(DENV)and its most recent outbreak in Latin America as well as the difficult-tocontrol outbreaks of yellow fever virus(YFV),chikungunya virus(CHIKV),and Zika virus(ZIKV),leaving behind a substantial portion of the population with complications related to these infections.Currently,the world is experiencing a period of intense globalization,which,combined with global warming,directly contributes to wider dissemination of arbovirus vectors across the globe.Consequently,all continents remain on high alert for potential new outbreaks.Thus,this review aims to provide a comprehensive understanding of the pathogenesis of the four main arboviruses today(DENV,ZIKV,YFV,and CHIKV)discussing their viral characteristics,immune responses,and mechanisms of viral evasion,as well as important clinical aspects for patient management.This includes associated symptoms,laboratory tests,treatments,existing or developing vaccines and the main associated complications,thus integrating a broad historical,scientific and clinical approach.展开更多
Objective: This study focuses on the clinical observation of the impact of different treatment methods for gestational heart failure on delivery outcomes. Method: A total of 160 pregnant women with heart failure admit...Objective: This study focuses on the clinical observation of the impact of different treatment methods for gestational heart failure on delivery outcomes. Method: A total of 160 pregnant women with heart failure admitted to our hospital between October 2020 and October 2021 were selected as the study subjects. They were categorized based on delivery mode, delivery timing, heart failure control time, and cardiac function status. The delivery outcomes of the different groups were then compared. Result: In terms of delivery methods, the rate of neonatal asphyxia was higher following vaginal delivery than cesarean section. Regarding delivery timing, the neonatal mortality rate was lower for cesarean sections performed at 32-36 + 6 weeks compared to those conducted at 37-39 + 6 weeks. With respect to heart failure control time, the rates of neonatal asphyxia and pulmonary hyaline membrane disease were lower in the ≤ 48- hour group than in the > 48-hour group. From the perspective of cardiac function status, patients with cardiac function I- II exhibited relatively lower rates of neonatal asphyxia and perinatal mortality compared to those with cardiac function III-IV. The observed differences were statistically significant (P < 0.05). Conclusion: For patients with gestational heart failure, cesarean section is the recommended mode of delivery, with the optimal timing being between 32 and 36+6 weeks of pregnancy. During cesarean section, the timing of delivery should be carefully selected based on the mother’s cardiac function status.展开更多
Theoretical education and practical education are very important in clinical laboratory teaching.The teaching evaluation system is one of the important means to test the quality of course teaching.The traditional summ...Theoretical education and practical education are very important in clinical laboratory teaching.The teaching evaluation system is one of the important means to test the quality of course teaching.The traditional summative evaluation needs to be improved in terms of scientificity and impartiality,and its guiding effect on teaching reform is limited.Therefore,this paper proposes to apply formative evaluation to clinical laboratory teaching to remobilize students'learning enthusiasm and provide valuable guidance for the subsequent teaching reform,hoping to achieve the purpose of improving the quality of laboratory teaching.展开更多
Clinical inertia(CI)is common in clinical practice.Sexual health issues are common in society,and CI is ubiquitous in sexual medicine practice.CI influences all aspects of healthcare,including prevention,diagnosis,and...Clinical inertia(CI)is common in clinical practice.Sexual health issues are common in society,and CI is ubiquitous in sexual medicine practice.CI influences all aspects of healthcare,including prevention,diagnosis,and treatment.In this short review,we briefly describe the various aspects of CI in sexual medicine practice and ways to tackle them.展开更多
BACKGROUND Hepatitis B-associated cirrhosis is an important disease burden in China.However,there is a lack of effective predictors in clinical practice to drive delivery and enable early treatment to delay disease pr...BACKGROUND Hepatitis B-associated cirrhosis is an important disease burden in China.However,there is a lack of effective predictors in clinical practice to drive delivery and enable early treatment to delay disease progression.AIM To analyzing the clinical characteristics of patients with hepatitis and cirrhosis,the nomogram model was established and validated.METHODS The clinical data of 1070 patients with hepatitis B who were treated in our hospital from October 2015 to July 2022 were collected.In a 7:3 ratio,749 cases were divided into training cohorts and 321 cases were divided into validation cohorts.In addition,the training cohort and validation cohort were further divided into hepatitis group and hepatitis B-related cirrhosis group based on whether the patient progressed to cirrhosis.Binary logistic regression was used to analyze the influencing factors of hepatitis progression to cirrhosis.A roadmap prediction model was established,and the predictive effect of the model was evaluated by patientsubject receiver operating characteristic curve(ROC),and the effectiveness of the model was evaluated by decision curve analysis.RESULTS Binary logistic regression analysis was performed using hepatitis B-related cirrhosis=1 and hepatitis=0 as dependent variables,and univariate analysis of serological indicators was used as covariates.The results showed that glutamic oxaloacetate aminotransferase/glutamate acetone aminotransferase levels,prothrombin time activity,and hepatitis B e antigen levels were all contributing factors to the progression of hepatitis to cirrhosis.The area under the ROC curve was 0.693[95%confidence interval(CI):0.631 to 0.756]for the training cohort and 0.675(95%CI:0.561 to 0.790)for the validation cohort.In addition,the decision analysis curves of the prediction models of both the training cohort and the validation cohort confirmed the effectiveness of the nomogram prediction model.CONCLUSION Three independent factors influencing the progression to cirrhosis in patients with hepatitis B were identified.The construction of a nomogram prediction model from hepatitis to cirrhosis has high application value as a tool for predicting the occurrence of liver cirrhosis in hepatitis B patients.展开更多
BACKGROUND Cytomegalovirus(CMV)prophylaxis with valganciclovir and ganciclovir is associated with elevated neutropenia and leukopenia risk in kidney transplant recipients,although the impact of these events on healthc...BACKGROUND Cytomegalovirus(CMV)prophylaxis with valganciclovir and ganciclovir is associated with elevated neutropenia and leukopenia risk in kidney transplant recipients,although the impact of these events on healthcare resource utilization(HCRU)and clinical outcomes is unclear.AIM To quantify clinical events and HCRU associated with neutropenia and leukope-nia among adults receiving valganciclovir and/or ganciclovir post-kidney trans-plantation.METHODS Adult kidney transplant recipients receiving valganciclovir and/or ganciclovir prophylaxis were identified in the TriNetX database from 2012 to 2021.Patient characteristics were evaluated in the 1-year period pre-first transplant.HCRU and adjusted event rates per person-year were evaluated in follow-up year 1 and years 2-5 after first kidney transplantation among cohorts with vs without neutropenia and/or leukopenia.RESULTS Of 15398 identified patients,the average age was 52.39 years and 58.70%were male.Patients with neutropenia and/or leukopenia had greater risk of clinical events for CMV-related events,opportunistic infections,use of granulocyte colony stimulating factor,and hospitalizations(relative risk>1 in year 1 and years 2-5).Patients with vs without neutropenia and/or leukopenia had higher HCRU in year 1 and years 2-5 post kidney transplantation,including the mean number of inpatient admissions(year 1:3.47 vs 2.76;years 2-5:2.70 vs 2.29)and outpatient visits(48.97 vs 34.42;31.73 vs 15.59,respectively),as well as the mean number of labs(1654.55 vs 1182.27;622.37 vs 327.89).CONCLUSION Adults receiving valganciclovir and/or ganciclovir prophylaxis post-kidney transplantation had greater risk of neutropenia and/or leukopenia,which were associated with higher clinical event rates and HCRU up to 5 years post-transplantation.These findings suggest the need for alternative prophylaxis options with lower myelosup-pressive effects to improve patient outcomes.展开更多
Exosomes(Exos)are extracellular vesicles secreted by cells and serve as crucial mediators of intercellular communication.They play a pivotal role in the pathogenesis and progression of various diseases and offer promi...Exosomes(Exos)are extracellular vesicles secreted by cells and serve as crucial mediators of intercellular communication.They play a pivotal role in the pathogenesis and progression of various diseases and offer promising avenues for therapeutic interventions.Exos derived from mesenchymal stem cells(MSCs)have significant immunomodulatory properties.They effectively regulate immune responses by modulating both innate and adaptive immunity.These Exos can inhibit excessive inflammatory responses and promote tissue repair.Moreover,they participate in antigen presentation,which is essential for activating immune responses.The cargo of these Exos,including ligands,proteins,and microRNAs,can suppress T cell activity or enhance the population of immunosuppressive cells to dampen the immune response.By inhibiting lymphocyte proliferation,acting on macrophages,and increasing the population of regulatory T cells,these Exos contribute to maintaining immune and metabolic homeostasis.Furthermore,they can activate immune-related signaling pathways or serve as vehicles to deliver microRNAs and other bioactive substances to target tumor cells,which holds potential for immunotherapy applications.Given the immense therapeutic potential of MSC-derived Exos,this review comprehensively explores their mechanisms of immune regulation and therapeutic applications in areas such as infection control,tumor suppression,and autoimmune disease management.This article aims to provide valuable insights into the mechanisms behind the actions of MSC-derived Exos,offering theoretical references for their future clinical utilization as cell-free drug preparations.展开更多
BACKGROUND Clinical pathways(CPs)are structured guidelines introduced to improve healthcare quality and efficiency.In South Korea,CPs for Korean medicine have been developed since 2016 under the 3rd Comprehensive Plan...BACKGROUND Clinical pathways(CPs)are structured guidelines introduced to improve healthcare quality and efficiency.In South Korea,CPs for Korean medicine have been developed since 2016 under the 3rd Comprehensive Plan for Korean Medicine Promotion,with limited studies on their clinical application.Neck and shoulder pain are common conditions frequently treated at Korean medicine clinics,often by patients dissatisfied with conventional treatments.The demand for Korean medicine treatments for neck and shoulder pain is on the rise.AIM To evaluate the clinical applicability and effectiveness of Korean medicine CPs for neck pain and shoulder pain in public healthcare institutions in South Korea.METHODS We collected and analyzed data from patients aged 19 years and older who visited the outpatient clinic of the Department of Korean Medicine at the National Medical Center in Korea from March 1,2023 to August 31,2023.CP completion rates,along with patient satisfaction,clinical outcomes,and economic outcomes between the CP-implemented and non-CP groups were assessed.RESULTS The CP completion rates were 93.3%for neck pain and 96.8%for shoulder pain.Patient satisfaction scores showed an improvement of 17.7%for neck pain and 18.0%for shoulder pain in the CP-implemented group compared to the non-CP group.For neck pain,significant improvements were observed in the numerical rating scale(NRS)and the neck disability index,while for shoulder pain,only the University of California-Los Angeles shoulder rating scale showed notable progress,with no substantial change in NRS scores.CONCLUSION This study partially confirms the clinical applicability and effectiveness of the Korean medicine CPs for neck pain and shoulder pain.Further research is required to enhance and validate these findings.展开更多
基金supported partly by the National Natural Science Foundation of China,No.82071332the Chongqing Natural Science Foundation Joint Fund for Innovation and Development,No.CSTB2023NSCQ-LZX0041 (both to ZG)。
文摘Some studies have confirmed the neuroprotective effect of remote ischemic conditioning against stroke. Although numerous animal researches have shown that the neuroprotective effect of remote ischemic conditioning may be related to neuroinflammation, cellular immunity, apoptosis, and autophagy, the exact underlying molecular mechanisms are unclear. This review summarizes the current status of different types of remote ischemic conditioning methods in animal and clinical studies and analyzes their commonalities and differences in neuroprotective mechanisms and signaling pathways. Remote ischemic conditioning has emerged as a potential therapeutic approach for improving stroke-induced brain injury owing to its simplicity, non-invasiveness, safety, and patient tolerability. Different forms of remote ischemic conditioning exhibit distinct intervention patterns, timing, and application range. Mechanistically, remote ischemic conditioning can exert neuroprotective effects by activating the Notch1/phosphatidylinositol 3-kinase/Akt signaling pathway, improving cerebral perfusion, suppressing neuroinflammation, inhibiting cell apoptosis, activating autophagy, and promoting neural regeneration. While remote ischemic conditioning has shown potential in improving stroke outcomes, its full clinical translation has not yet been achieved.
文摘The minimal clinically important difference(MCID)represents a pivotal metric in bridging the gap between statistical significance and clinical relevance,addressing the direct impact of medical interventions from the patient's perspective.This comprehensive review analyzes the evolution,applications,and challenges of MCID across medical specialties,emphasizing its necessity in ensuring that clinical outcomes not only demonstrate statistical significance but also offer genuine clinical utility that aligns with patient expectations and needs.We discuss the evolution of MCID since its inception in the 1980s,its current applications across various medical specialties,and the methodologies used in its calculation,highlighting both anchor-based and distribution-based approaches.Furthermore,the paper delves into the challenges associated with the application of MCID,such as methodological variability and the interpretation difficulties that arise in clinical settings.Recommendations for the future include standardizing MCID calculation methods,enhancing patient involvement in setting MCID thresholds,and extending research to incorporate diverse global perspectives.These steps are critical to refining the role of MCID in patient-centered healthcare,addressing existing gaps in methodology and interpretation,and ensuring that medical interventions lead to significant,patient-perceived improvements.
文摘The general objective of our study was to describe the clinical and epidemiological aspects of anxiety disorders. This was a retrospective descriptive cross-sectional study, lasting 5 years, from January 01, 2019 to December 31, 2023, on 225 patients seen in consultation for anxiety disorders in the department. The prevalence of anxiety disorders was 2.5% in consultation. The 20 - 29 age group was the most represented at 33.3%. Females were slightly represented at 55.1%, with a sex ratio of 1.2. The secondary level was the most affected, accounting for 36.4% of cases. Insomnia was the most frequent reason for consultation, accounting for 71.1% of cases. A larger general population study would be necessary to better assess the extent of anxiety disorders in Guinea.
文摘Machine learning(ML)is a type of artificial intelligence that assists computers in the acquisition of knowledge through data analysis,thus creating machines that can complete tasks otherwise requiring human intelligence.Among its various applications,it has proven groundbreaking in healthcare as well,both in clinical practice and research.In this editorial,we succinctly introduce ML applications and present a study,featured in the latest issue of the World Journal of Clinical Cases.The authors of this study conducted an analysis using both multiple linear regression(MLR)and ML methods to investigate the significant factors that may impact the estimated glomerular filtration rate in healthy women with and without non-alcoholic fatty liver disease(NAFLD).Their results implicated age as the most important determining factor in both groups,followed by lactic dehydrogenase,uric acid,forced expiratory volume in one second,and albumin.In addition,for the NAFLD-group,the 5th and 6th most important impact factors were thyroid-stimulating hormone and systolic blood pressure,as compared to plasma calcium and body fat for the NAFLD+group.However,the study's distinctive contribution lies in its adoption of ML methodologies,showcasing their superiority over traditional statistical approaches(herein MLR),thereby highlighting the potential of ML to represent an invaluable advanced adjunct tool in clinical practice and research.
文摘The article"Secondary diabetes due to different etiologies:Four case reports"by Song et al,published in the World Journal of Clinical Cases,delves into the identi-fication of rare causes of secondary diabetes and emphasizes the necessity for healthcare professionals to recognize these conditions.Failure to do so can result in treatment delays and compromised patient outcomes.The article discusses spe-cific types of diabetes,including maturity onset of diabetes in young,pancreas-related diseases,endocrinopathies,drug-induced diabetes,infections,and con-genital genetic syndromes associated with diabetes mellitus.Case summaries highlight how patients with secondary diabetes,stemming from conditions such as Williams-Beuren syndrome and pituitary adenoma,often exhibit distinct characteristics overlooked in clinical practice.The authors stress the importance of a holistic diagnostic approach and advocate for proactive management through early intervention,including genetic tests and antibody detection.Increased awa-reness and education are crucial for timely identification and proper management,ultimately improving patient well-being.These findings prompt a call to action for healthcare professionals to consider rare causes of secondary diabetes,facili-tating better glycemic control and overall patient care.
文摘BACKGROUND The adoption of telehealth services surged after the coronavirus disease 2019 pandemic,revolutionizing traditional healthcare delivery models.Amazon Clinic's recent nationwide launch marks a significant milestone in this trend.This study aims to offer a strengths,weaknesses,opportunities,and threats(SWOT)analysis of Amazon Clinic and compare its features with leading virtual healthcare platforms.AIM To evaluate Amazon Clinic's telehealth services through a SWOT analysis and compare its features with other leading virtual healthcare platforms.METHODS The initial search terms included were,amazon clinic odds ratio(OR)amwell OR Teladoc OR Walmart virtual health service OR CVS minute clinic OR CirrusMD OR brightside health,from 2000 to 2023.This search yielded 111 articles,from which duplicates were removed,and unrelated titles were filtered out.Eight articles were retained for a final review,including comparative studies,usability research,retrospective analyses,observational studies,and review articles.The data was organized and analyzed using Rayyan software and summarized in a table and PRISMA flowcharts.RESULTS The review included eight articles focusing on various aspects of telehealth.Comparative studies highlighted differences between Teladoc and traditional physician offices,noting lower diagnostic imaging orders and antibiotic prescriptions for Teladoc.User demographics for Teladoc showed younger,less engaged patients.Usability studies emphasized the importance of website design for telemedicine adoption.Tele-mental health platforms like Brightside showed superior outcomes in treating depression compared to traditional methods.Telemedicine for specialized fields like skin reconstruction demonstrated cost efficiency and reduced waiting times.The SWOT analysis identified Amazon Clinic's strengths,such as its vast consumer base and transparent pricing,and weaknesses like the lack of pediatric care.Opportunities included potential partnerships and service expansions,while threats involved competition and regulatory challenges.CONCLUSION Amazon Clinic's entry into the telehealth sector represents a significant development with various strengths and opportunities.However,it faces challenges from established healthcare providers and regulatory landscapes.The future success of Amazon Clinic will depend on strategic collaborations,addressing service gaps,and navigating competition and regulations.Telemedicine's impact will hinge on its ability to effectively leverage these opportunities and overcome inherent challenges in the ever-evolving healthcare landscape.
文摘Introduction: Diabetes remains a real public health problem today, due to its associated morbidity and mortality. It induces numerous metabolic, biochemical, hematological, and immunological changes, responsible for multiple complications. The objective of this study was to characterize clinically and biologically type 2 diabetic patients followed at the National Center for Diabetology and Arterial Hypertension of the Central Hospital of Yaoundé. Method: This prospective, cross-sectional, and analytical study took place from April 5 to July 31, 2023 (4 months) on 100 diabetic patients of both sexes (61 women and 39 men), aged from 31 to 88 years. Body Mass Index, systolic and diastolic blood pressure, and cardiac frequency were measured on each of the patients. Subsequently, blood was collected from the patients for the determination of the complete blood count, HBA1c, lipid profile, serum albumin, TNF-α, and IL-6 levels. The data were analyzed using SPSS 17.0 software. Results: The age average of our population was 56.99 ± 11.51 years, the population was primarily female (61%) and primarily between the ages of 55 and 88. 67% of respondents were married. 59% went to secondary school. 73% of them lived in urban areas. 30% were obese and 40% were overweight, with an average BMI of 28.75 kg/m2. 76% of patients took oral antidiabetic medications. HbA1c level average was 8.65%, with 60% having readings above 6.5%. Low hemoglobin and hypochromia were among the abnormalities of red blood cells observed. Lipid profiles revealed low HDL-cholesterol and high triglycerides and cholesterol. Elevated levels of TNF-α and IL-6 indicated inflammation and cardiovascular risk. Conclusion: These results indicate the necessity of focused diabetic care and management on diabetic patients attending the central hospital of Yaoundé, Cameroon.
文摘Graphical abstracts(GAs)are emerging as a pivotal tool in medical literature,enhancing the dissemination and comprehension of complex clinical data through visual summaries.This editorial highlights the significant advantages of GAs,including improved clarity,increased reader engagement,and enhanced visibility of research findings.By transforming intricate scientific data into accessible visual formats,these abstracts facilitate quick and effective knowledge transfer,crucial in clinical decision-making and patient care.However,challenges such as potential data misrepresentation due to oversimplification,the skill gap in graphic design among researchers,and the lack of standardized creation guidelines pose barriers to their widespread adoption.Additionally,while software such as Adobe Illustrator,BioRender,and Canva are commonly employed to create these visuals,not all researchers may be proficient in their use.To address these issues,we recommend that academic journals establish clear guidelines and provide necessary design training to researchers.This proactive approach will ensure the creation of high-quality GAs,promote their standardization,and expand their use in clinical reporting,ultimately benefiting the medical community and improving healthcare outcomes.
文摘Background: Clinical decision support tools provide suggestions to support healthcare providers and clinicians, as they attend to patients. Clinicians use these tools to rapidly consult the evidence at the point of care, a practice which has been found to reduce the time patients spend in hospitals, promote the quality of care and improve healthcare outcomes. Such tools include Medscape, VisualDx, Clinical Key, DynaMed, BMJ Best Practice and UpToDate. However, use of such tools has not yet been fully embraced in low-resource settings such as Uganda. Objective: This paper intends to collate data on the use and uptake of one such tool, UpToDate, which was provided at no cost to five medical schools in Uganda. Methods: Free access to UpToDate was granted through the IP addresses of five medical schools in Uganda in collaboration with Better Evidence at The Global Health Delivery Project at Harvard and Brigham and Women’s Hospital and Wolters Kluwer Health. Following the donation, medical librarians in the respective institutions conducted training sessions and created awareness of the tool. Usage data was aggregated, based on logins and content views, presented and analyzed using Excel tables and graphs. Results: The data shows similar trends in increased usage over the period of August 2022 to August 2023 across the five medical schools. The most common topics viewed, mode of access (using either the computer or the mobile app), total usage by institution, ratio of uses to eligible users by institution and ratio of uses to students by institution are shared. Conclusion: The study revealed that the tool was used by various user categories across the institutions with similar steady improved usage over the year. These results can inform the librarians as they encourage their respective institutions to continue using the tool to support uptake of point-of-care tools in clinical practice.
文摘The critical role of patient-reported outcome measures(PROMs)in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific research.PROMs encapsulate a patient's health status directly from their perspective,encompassing various domains such as symptom severity,functional status,and overall quality of life.By integrating PROMs into routine clinical practice and research,healthcare providers can achieve a more nuanced understanding of patient experiences and tailor treatments accordingly.The deployment of PROMs supports dynamic patient-provider interactions,fostering better patient engagement and adherence to tre-atment plans.Moreover,PROMs are pivotal in clinical settings for monitoring disease progression and treatment efficacy,particularly in chronic and mental health conditions.However,challenges in implementing PROMs include data collection and management,integration into existing health systems,and acceptance by patients and providers.Overcoming these barriers necessitates technological advancements,policy development,and continuous education to enhance the acceptability and effectiveness of PROMs.The paper concludes with recommendations for future research and policy-making aimed at optimizing the use and impact of PROMs across healthcare settings.
基金Science and Technology Planning Project of Xi’an,China (No. 22YXYJ0111, to LFP)。
文摘Acute pancreatitis(AP) is not a disorder limited to a single organ,the pancreas,but often results in transient or sustained dysfunction,and even failure,of multiple organs,particularly as the disease progresses.^([1]) Therefore,although AP is primarily a localized disease with systemic consequences in a subset of patients,its clinical manifestations extend beyond digestive system symptoms to encompass a variety of additional symptoms,particularly during disease progression from mild AP(MAP) to severe AP(SAP).
文摘The destruction of the skin barrier and the presence of necrotic tissue in large burns increase the risk of multiple infections,often leading to sepsis,bacteremia,and other complications.Infective endocarditis(IE)is a severe manifestation of organ damage,and if conservative medical treatment fails to control the infection,irreversible pathological changes may occur,including valvular redundancy.
基金Supported by the Permanecer Program(part of the actions of the Office of Affirmative Actions)Education and Diversity of the Dean of Student Assistance at the Federal University of Bahia(UFBA)and CNPq Research Productivity Fellow.
文摘Arboviral diseases are viral infections transmitted to humans through the bites of arthropods,such as mosquitoes,often causing a variety of pathologies associated with high levels of morbidity and mortality.Over the past decades,these infections have proven to be a significant challenge to health systems worldwide,particularly following the considerable geographic expansion of the dengue virus(DENV)and its most recent outbreak in Latin America as well as the difficult-tocontrol outbreaks of yellow fever virus(YFV),chikungunya virus(CHIKV),and Zika virus(ZIKV),leaving behind a substantial portion of the population with complications related to these infections.Currently,the world is experiencing a period of intense globalization,which,combined with global warming,directly contributes to wider dissemination of arbovirus vectors across the globe.Consequently,all continents remain on high alert for potential new outbreaks.Thus,this review aims to provide a comprehensive understanding of the pathogenesis of the four main arboviruses today(DENV,ZIKV,YFV,and CHIKV)discussing their viral characteristics,immune responses,and mechanisms of viral evasion,as well as important clinical aspects for patient management.This includes associated symptoms,laboratory tests,treatments,existing or developing vaccines and the main associated complications,thus integrating a broad historical,scientific and clinical approach.
文摘Objective: This study focuses on the clinical observation of the impact of different treatment methods for gestational heart failure on delivery outcomes. Method: A total of 160 pregnant women with heart failure admitted to our hospital between October 2020 and October 2021 were selected as the study subjects. They were categorized based on delivery mode, delivery timing, heart failure control time, and cardiac function status. The delivery outcomes of the different groups were then compared. Result: In terms of delivery methods, the rate of neonatal asphyxia was higher following vaginal delivery than cesarean section. Regarding delivery timing, the neonatal mortality rate was lower for cesarean sections performed at 32-36 + 6 weeks compared to those conducted at 37-39 + 6 weeks. With respect to heart failure control time, the rates of neonatal asphyxia and pulmonary hyaline membrane disease were lower in the ≤ 48- hour group than in the > 48-hour group. From the perspective of cardiac function status, patients with cardiac function I- II exhibited relatively lower rates of neonatal asphyxia and perinatal mortality compared to those with cardiac function III-IV. The observed differences were statistically significant (P < 0.05). Conclusion: For patients with gestational heart failure, cesarean section is the recommended mode of delivery, with the optimal timing being between 32 and 36+6 weeks of pregnancy. During cesarean section, the timing of delivery should be carefully selected based on the mother’s cardiac function status.
文摘Theoretical education and practical education are very important in clinical laboratory teaching.The teaching evaluation system is one of the important means to test the quality of course teaching.The traditional summative evaluation needs to be improved in terms of scientificity and impartiality,and its guiding effect on teaching reform is limited.Therefore,this paper proposes to apply formative evaluation to clinical laboratory teaching to remobilize students'learning enthusiasm and provide valuable guidance for the subsequent teaching reform,hoping to achieve the purpose of improving the quality of laboratory teaching.
文摘Clinical inertia(CI)is common in clinical practice.Sexual health issues are common in society,and CI is ubiquitous in sexual medicine practice.CI influences all aspects of healthcare,including prevention,diagnosis,and treatment.In this short review,we briefly describe the various aspects of CI in sexual medicine practice and ways to tackle them.
基金Supported by the“Climbing Program”Construction Project“High Peak Project”Department of Major Infectious Disease Prevention and Control.
文摘BACKGROUND Hepatitis B-associated cirrhosis is an important disease burden in China.However,there is a lack of effective predictors in clinical practice to drive delivery and enable early treatment to delay disease progression.AIM To analyzing the clinical characteristics of patients with hepatitis and cirrhosis,the nomogram model was established and validated.METHODS The clinical data of 1070 patients with hepatitis B who were treated in our hospital from October 2015 to July 2022 were collected.In a 7:3 ratio,749 cases were divided into training cohorts and 321 cases were divided into validation cohorts.In addition,the training cohort and validation cohort were further divided into hepatitis group and hepatitis B-related cirrhosis group based on whether the patient progressed to cirrhosis.Binary logistic regression was used to analyze the influencing factors of hepatitis progression to cirrhosis.A roadmap prediction model was established,and the predictive effect of the model was evaluated by patientsubject receiver operating characteristic curve(ROC),and the effectiveness of the model was evaluated by decision curve analysis.RESULTS Binary logistic regression analysis was performed using hepatitis B-related cirrhosis=1 and hepatitis=0 as dependent variables,and univariate analysis of serological indicators was used as covariates.The results showed that glutamic oxaloacetate aminotransferase/glutamate acetone aminotransferase levels,prothrombin time activity,and hepatitis B e antigen levels were all contributing factors to the progression of hepatitis to cirrhosis.The area under the ROC curve was 0.693[95%confidence interval(CI):0.631 to 0.756]for the training cohort and 0.675(95%CI:0.561 to 0.790)for the validation cohort.In addition,the decision analysis curves of the prediction models of both the training cohort and the validation cohort confirmed the effectiveness of the nomogram prediction model.CONCLUSION Three independent factors influencing the progression to cirrhosis in patients with hepatitis B were identified.The construction of a nomogram prediction model from hepatitis to cirrhosis has high application value as a tool for predicting the occurrence of liver cirrhosis in hepatitis B patients.
文摘BACKGROUND Cytomegalovirus(CMV)prophylaxis with valganciclovir and ganciclovir is associated with elevated neutropenia and leukopenia risk in kidney transplant recipients,although the impact of these events on healthcare resource utilization(HCRU)and clinical outcomes is unclear.AIM To quantify clinical events and HCRU associated with neutropenia and leukope-nia among adults receiving valganciclovir and/or ganciclovir post-kidney trans-plantation.METHODS Adult kidney transplant recipients receiving valganciclovir and/or ganciclovir prophylaxis were identified in the TriNetX database from 2012 to 2021.Patient characteristics were evaluated in the 1-year period pre-first transplant.HCRU and adjusted event rates per person-year were evaluated in follow-up year 1 and years 2-5 after first kidney transplantation among cohorts with vs without neutropenia and/or leukopenia.RESULTS Of 15398 identified patients,the average age was 52.39 years and 58.70%were male.Patients with neutropenia and/or leukopenia had greater risk of clinical events for CMV-related events,opportunistic infections,use of granulocyte colony stimulating factor,and hospitalizations(relative risk>1 in year 1 and years 2-5).Patients with vs without neutropenia and/or leukopenia had higher HCRU in year 1 and years 2-5 post kidney transplantation,including the mean number of inpatient admissions(year 1:3.47 vs 2.76;years 2-5:2.70 vs 2.29)and outpatient visits(48.97 vs 34.42;31.73 vs 15.59,respectively),as well as the mean number of labs(1654.55 vs 1182.27;622.37 vs 327.89).CONCLUSION Adults receiving valganciclovir and/or ganciclovir prophylaxis post-kidney transplantation had greater risk of neutropenia and/or leukopenia,which were associated with higher clinical event rates and HCRU up to 5 years post-transplantation.These findings suggest the need for alternative prophylaxis options with lower myelosup-pressive effects to improve patient outcomes.
基金Supported by the National Natural Science Foundation of China,No.82072537the General Project of Hunan Natural Science Foundation,No.2022JJ30412 and No.2021JJ30464.
文摘Exosomes(Exos)are extracellular vesicles secreted by cells and serve as crucial mediators of intercellular communication.They play a pivotal role in the pathogenesis and progression of various diseases and offer promising avenues for therapeutic interventions.Exos derived from mesenchymal stem cells(MSCs)have significant immunomodulatory properties.They effectively regulate immune responses by modulating both innate and adaptive immunity.These Exos can inhibit excessive inflammatory responses and promote tissue repair.Moreover,they participate in antigen presentation,which is essential for activating immune responses.The cargo of these Exos,including ligands,proteins,and microRNAs,can suppress T cell activity or enhance the population of immunosuppressive cells to dampen the immune response.By inhibiting lymphocyte proliferation,acting on macrophages,and increasing the population of regulatory T cells,these Exos contribute to maintaining immune and metabolic homeostasis.Furthermore,they can activate immune-related signaling pathways or serve as vehicles to deliver microRNAs and other bioactive substances to target tumor cells,which holds potential for immunotherapy applications.Given the immense therapeutic potential of MSC-derived Exos,this review comprehensively explores their mechanisms of immune regulation and therapeutic applications in areas such as infection control,tumor suppression,and autoimmune disease management.This article aims to provide valuable insights into the mechanisms behind the actions of MSC-derived Exos,offering theoretical references for their future clinical utilization as cell-free drug preparations.
基金approved by the National Medical Center Institutional Review Board(approval No.NRC-2023-10-109).
文摘BACKGROUND Clinical pathways(CPs)are structured guidelines introduced to improve healthcare quality and efficiency.In South Korea,CPs for Korean medicine have been developed since 2016 under the 3rd Comprehensive Plan for Korean Medicine Promotion,with limited studies on their clinical application.Neck and shoulder pain are common conditions frequently treated at Korean medicine clinics,often by patients dissatisfied with conventional treatments.The demand for Korean medicine treatments for neck and shoulder pain is on the rise.AIM To evaluate the clinical applicability and effectiveness of Korean medicine CPs for neck pain and shoulder pain in public healthcare institutions in South Korea.METHODS We collected and analyzed data from patients aged 19 years and older who visited the outpatient clinic of the Department of Korean Medicine at the National Medical Center in Korea from March 1,2023 to August 31,2023.CP completion rates,along with patient satisfaction,clinical outcomes,and economic outcomes between the CP-implemented and non-CP groups were assessed.RESULTS The CP completion rates were 93.3%for neck pain and 96.8%for shoulder pain.Patient satisfaction scores showed an improvement of 17.7%for neck pain and 18.0%for shoulder pain in the CP-implemented group compared to the non-CP group.For neck pain,significant improvements were observed in the numerical rating scale(NRS)and the neck disability index,while for shoulder pain,only the University of California-Los Angeles shoulder rating scale showed notable progress,with no substantial change in NRS scores.CONCLUSION This study partially confirms the clinical applicability and effectiveness of the Korean medicine CPs for neck pain and shoulder pain.Further research is required to enhance and validate these findings.
