International Journal of Clinical Practice

Objective. To investigate the potential association between nonalcoholic fatty liver disease (NAFLD) and colon polyps in Taiwan. Methods. We utilized 2006–2015 claims data of the Taiwan National Health Insurance Program as a data source. A case-control study was conducted, involving individuals 20 years or older with and without colon polyps. Cases comprised individuals diagnosed with colon polyps, identified through diagnosis codes. Controls were selected from individuals without colon polyps, matched to cases based on sex, age, and comorbidities. NAFLD was identified based on diagnosis codes. The logistic regression model with odds ratio (OR) and 95% confidence interval (CI) was employed to assess the association between NAFLD and colon polyps. Results. The study included 16,890 cases with colon polyps and 67,560 matched controls without colon polyps. The mean age was 57 years old and about 61% of study subjects were males. Among cases with colon polyps, 1.0% had a diagnosis of NAFLD, whereas only 0.4% exhibited NAFLD in the control group. After adjustment for confounding variables, a multivariable logistic regression model revealed a statistically significant association between NAFLD and colon polyps, with an odds ratio of 2.32 (95% CI = 1.91–2.82). Conclusion. This case-control study suggests a positive association between NAFLD and colon polyps. These results contribute to our understanding of the potential links between NAFLD and gastrointestinal health.

Background. The escalating utilization of gastroscopy in young individuals necessitates an in-depth examination of its diagnostic yield and outcomes in this population. This study aims to investigate and compare various aspects of gastroscopy between young and older adults, shedding light on age-related differences in indications, endoscopic findings, histologic outcomes, and clinically significant findings (CSFs). Methods. A retrospective, large cohort study spanning five years, focused on consecutive patients undergoing gastroscopy. We analyzed age subgroups, specifically categorizing patients into those aged 30 and below, 30–39, 40–49, and a control group aged 50 and above. The investigation aimed to compare various aspects of gastroscopy outcomes among these distinct age categories. Indication-based analyses were conducted to assess the yield and outcomes in these subgroups, focusing on CSFs and the number needed to investigate (NNTI). Results. A total of 1313 young patients aged 16–49 and 3396 controls aged 50 and above were included. Among the young patients, unspecified epigastric pain and dyspepsia emerged as a prevalent indication, accounting for 41.5% of cases. Endoscopic findings revealed a significantly higher diagnosis rate of gastritis than controls (48.2% vs. 35.7%; ). Histologic analysis demonstrated a substantially elevated rate of H. pylori-associated gastritis in the young (41.1% vs. 29%; ). Notably, although significantly lower than older controls, precancerous lesions were detected in 7.5% of young patients. CSFs’ diagnosis rate displayed a clear age-dependent increase. Particularly, gastroscopy for upper gastrointestinal bleeding and iron deficiency anemia were associated with higher CSF rates across all young-age subgroups. In multivariate analysis, age and indications of upper gastrointestinal bleeding and iron deficiency anemia were predictors of CSFs’ detection in young patients. Conclusion. This study comprehensively delineates various facets of gastroscopy in the young population, elucidating age and indication-specific patterns in endoscopic and histologic findings, and clinically significant outcomes.

This study delves into the therapeutic potential of β-hydroxybutyrate (BHB) in clear cell renal cell carcinoma (ccRCC), a cancer known for its complex pathogenesis and resistance to conventional treatments. The research specifically explores the impact of BHB on cell viability, autophagy induction, and lipid metabolism in Caki-1 cells. The findings reveal that BHB significantly reduces ccRCC cell viability, particularly under low-glucose conditions. The combination of glucose and BHB treatment activates autophagy pathways, as evidenced by increased expression of autophagy-related genes (Beclin-1, LC3IIβ, and ATG5) and decreased expression of P62 after 48 and 72 hours. Moreover, the combined therapy enhances lipid metabolism, as indicated by elevated expression of PGC-1α and UCP-1, along with upregulation of ACSL3 and CPT1A, which are associated with lipid droplet formation and facilitate lipid breakdown within cells. The study concludes that BHB holds promise as a therapeutic agent for ccRCC, targeting abnormal lipid metabolism, inducing autophagy-mediated cell death, and promoting fat browning. The results suggest potential avenues for precision-guided nutritional therapies in ccRCC treatment, highlighting the innovative role of BHB in addressing the challenges posed by this cancer.

Background. Anastrozole has been approved for treatment of hormone receptor-positive advanced or metastatic breast cancer by FDA. This study was to assess Anastrozole-related adverse events (AEs) of real-world through data mining of the US Food and drug administration adverse event reporting system (FAERS). Methods. Four different disproportionality analyses, including the reporting odds ratio (ROR), the proportional reporting ratio (PRR), the Bayesian confidence propagation neural network (BCPNN) and the multiitem gamma Poisson shrinker (MGPS) algorithms were employed to quantify the signals of Anastrozole-associated AEs. Results. A total 25 system organ class (SOCs) and 300 significant disproportionality Preferred Terms (PTs) were found in this study. The top 5 most significant SOCs were Eye disorders, renal and urinary disorders, respiratory, thoracic and mediastinal disorders, investigations, and cardiac disorders. Unexpected significant AEs was vitreoretinal traction syndrome (ROR = 1108.22, PRR = 1103.98, IC025 = 9.51, EBGM05 = 389.98), nitrituria (ROR = 3561.82, PRR = 3557.28, IC025 = 10.38, EBGM05 = 318.83) and human epidermal growth factor receptor negative (ROR = 675.04, PRR = 674.01, IC025 = 9, EBGM05 = 204.57). Conclusion. The Unexpected significant AEs associated with anastrozole were identified in this study, warrants urgent clarification through additional prospective studies.

Objective. Although the association between chronic kidney disease (CKD) and osteoporotic fractures is well established, data on CKD combined with hip fracture (HF) are scarce and controversial. We aimed to assess in patients with HF the prevalence of CKD, its impact on hospital mortality and length of stay (LOS) and to determine the prognostic value of CKD to predict hospital outcomes. Methods. Prospectively collected clinical data were analysed in 3623 consecutive HF patients aged ≥65 years (mean age 83.4 ± 7.50 [standard deviation] years; 74.4% females). Results. CKD among older patients with HF is highly prevalent (39.9%), has different clinical characteristics, a 2.5-fold higher mortality rate, and 40% greater risk of prolonged LOS. The strongest risk for a poor outcome was advanced age (>80 years). The risk of death substantially increases in combination with chronic disorders, especially coronary artery disease, anaemia, hyperparathyroidism, and atrial fibrillation; models based only on three variables—CKD stage, age >80, and presence of a specific chronic condition—predicted in-hospital death with good discrimination capability (AUC ≥ 0.700) and reasonable accuracy, the number needed to predict ranged between 5.7 and 14.5. Only 12% of HF patients received osteoporotic drugs prefracture. Conclusion. In HF patients with CKD, the risk of adverse outcomes largely increases in parallel with worsening kidney function and, especially, in combination with comorbidities; models based on three admission variables predict a fatal outcome. Assessment of renal function is essential to preventing osteoporotic fractures.

Background. In order to prevent the recurrence and progression of intermediate- and high-risk non-muscle invasive bladder cancer (NMIBC) after transurethral resection of bladder tumor (TURBT), various bladder instillation therapies have been developed in recent years. Among these, device-assisted Hyperthermic Intravesical Chemotherapy (HIVEC) has received a great deal of attention. Objective. To identify the efficacy and safety of HIVEC, we conducted this meta-analysis. Methods. We identified relevant articles from PubMed, Embase, and Cochrane Library databases. All published randomized controlled trials (RCTs) describing the role of bladder instillation for the treatment of intermediate- and high-risk NMIBC were involved. Outcomes included 1–3 years Recurrence-Free Survival (RFS), 1–3 years Progression-Free Survival (PFS), 5 years Overall Survival (OS), Adverse Events (AEs), and relevant subgroup analyses. Result. Our study involved a total of 10 RCTs and 1360 patients. In subgroup analysis, we found that compared to MMC instillation, HIVEC decreased the 1–3 years RFS (OR = 0.51; ) while not increasing the incidence of AEs (OR = 0.86; ). Compared with BCG instillation, HIVEC reduced the incidence of serious AEs (OR = 0.21; ) while bringing the same efficacy (OR = 0.78; ). Conclusion. HIVEC combined the advantages of efficacy and safety compared with the two recommended instillation modalities. As a potential alternative therapy, its widespread clinical effect remains to be further evaluated.