Postgraduate Medicine最新文献

The world has been living with another pandemic physical inactivity (PI) and sedentary behavior (SB) and of other nature for years. As social measures to prevent the spread of COVID-19 have been strengthened, the physical activity (PA) barrier has been hit and the PI/SB pandemic has been exacerbated, and in the current situation, triggered by its prolonged period, it is emerging as a problem to be considered in order to combat the PI/SB pandemic through PA and to maintain continuous physical and mental health. This review aims to summarize existing and recent studies on the effects of PA/SB on physical and mental health in preparation for the context of prolonged COVID-19 and provides an easy and fun way to motivate, access PA, and PA recommendations for maintaining physical and mental health. We performed search strategies on PubMed, Medline, Scopus, and Google Scholar databases, and used a literature review of the current available literature on the COVID-19 and the effects of PI, SB, and PA on physical and mental health. The clinical relevance of this review shows that integrating PA into daily life and reducing prolonged sitting time is an important strategy for continuing a healthy life physically and mentally. As a result, for those who have not yet incorporated exercise as part of their daily routine, fun and easy access to PA suggests that in the long run, may be an opportunity to implement newer habits. In addition, in an emergency such as the COVID-19 quarantine period or other pandemics, it is essential for one to maintain health through PA at home, and underscore the 'health message' of the current review that reducing SB, progressively increasing PA, and doing more PA regularly in the current context prolonged COVID-19 can bring significant benefits to long-term habits and physical and mental health.

Objective: The early detection of coronary artery disease (CAD) in diabetes mellitus is a major clinical difficulty. The purpose of this paper is to find out a convenient and economical index to help to screen for patients with CAD in diabetes mellitus.

Method: From January 2019 to December 2019, a total of 1028 patients hospitalized in the general department of our hospital have been enrolled in our cross-sectional study, of which 190 were diagnosed with CAD and 314 with diabetes. Differences of various factors between the CAD group and the non-CAD group were analyzed. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to evaluate the efficacy of each factor in predicting CAD. The correlation between calcium/magnesium (Ca/Mg) ratio and the prevalence of CAD in diabetic and non-diabetic people was compared, and the cutoff of Ca/Mg ratio to predict the risk of CAD in diabetic patients was calculated.

Results: Logistic regression analysis showed that serum high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, calcium, magnesium, Ca/Mg ratio, hypertension, diabetes, and smoking history were all associated with CAD. Among them, the AUC value of Ca/Mg ratio was the highest of 0.70. Furthermore, in diabetes patients, the AUC value of Ca/Mg ratio to predict the risk of CAD was 0.72, the cutoff was 2.55, the sensitivity was 77.1%, and the specificity was 53.7%. The prevalence rate of CAD was 18.5% below the cutoff, 46.9% higher than the cutoff, and the prevalence rate increased by 153.5%.

Conclusion: The Ca/Mg ratio is a good predictor of the risk of CAD in diabetes, higher than the cutoff, the prevalence rate was significantly increased.PLA IN LANGUAGE SUMMARYCAD brings great pain and burden to patient. However, CAD is asymptomatic in quiet a few cases of type 2 diabetes until myocardial infarction or sudden cardiac death occurs. In this study, we explored the association between CAD and various serum factor. We found that the Ca/Mg ratio is of excellent value in screening CAD, especially in diabetes. Moreover, we found that the cutoff of Ca/Mg ratio was 2.55 in diabetic population and the prevalence rate of CAD was 18.5% below the cutoff, 46.9% higher than the cutoff. The Ca/Mg ratio will provide good prediction of the risk of CAD and make early detection easier in diabetes.

Giant cell arteritis (GCA, also known as temporal arteritis) is classified as a vasculitis of large and medium sized vessels and can involve the cranial vessels as well as the aorta and great vessels. It is a systemic rheumatic disease that virtually never occurs in adults younger than 50 years of age. GCA is the most common idiopathic systemic vasculitis. Systemic symptoms are common and involvement of the muscular, extracranial branches off of the carotid arteries are what result in the classic manifestations of cranial GCA. The disease can also be generalized involving the aorta and its branches leading to aneurysms and stenosis of involved vessels. Glucocorticoids have been the longstanding treatment option for GCA but relatively recent studies have proven additional agents like Tocilizumab are effective steroid sparing agents. GCA is a disease that is of variable duration and length of treatment differs from patient to patient. This article will review the epidemiology, pathogenesis, clinical manifestations, work up and treatment options for GCA.

Background: Insulin resistance plays a pivotal role in developing left ventricular hypertrophy (LVH). Researchers have identified the estimated glucose disposal rate (eGDR) as a simple and cost-effective surrogate of insulin resistance. Our work aims to investigate the association between eGDR and the prevalent LVH and explore the incremental value of eGDR to detect prevalent LVH.

Methods: The present work enrolled 3839 subjects from a cross-sectional survey conducted between October 2019 to April 2020 in the rural areas of southeastern China. eGDR was calculated based on waist-to-hip circumference ratio, hypertension, and glycated hemoglobin.

Results: The prevalence of LVH was 17.30%. After adjusting demographic, anthropometric, laboratory, and medical history co-variates, each standard deviation increase of eGDR decreased a 29.6% risk of prevalent LVH. When dividing eGDR into quartiles, the top quartile had a 38.4% risk compared to the bottom quartile. Moreover, smooth curve fitting revealed that the association between eGDR and prevalent LVH was linear in the whole range of eGDR. Additionally, subgroup analysis demonstrated that our main finding was robust to age, sex, BMI, hypertension, and diabetes subgroups. Finally, ROC analysis exhibited a significant improvement by adding eGDR into LVH risk factors (0.780 vs. 0.803, P < 0.001), and category-free net reclassification index (0.702, P < 0.001) and integrated discrimination index (0.027, P < 0.001) also confirmed the improvement from eGDR to detect prevalent LVH.

Conclusion: Our analysis revealed a linear, robust association between eGDR and prevalent LVH and demonstrated the incremental value of eGDR to optimize the detection of prevalent LVH.

Objective: Association between neutrophil-to-lymphocyte ratio (NLR) on admission and poor prognosis in patients with acute heart failure (AHF) has been well established. However, the relationship between dynamic changes in NLR and in-hospital mortality in AHF patients has not been studied. Our purpose was to determine if an early change in NLR within the first week after AHF patients was admitted to intensive care unit (ICU) was associated with in-hospital mortality.

Methods: Data from the medical information mart for intensive care IV (the MIMIC-IV) database was analyzed. The effect of baseline NLR on in-hospital mortality in critical patients with AHF was evaluated utilizing smooth curve fitting and multivariable logistic regression analysis. Moreover, comparison of the dynamic change in NLR among survivors and non-survivors was performed using the generalized additive mixed model (GAMM).

Results: There were 1169 participants who took part in the present study, 986 of whom were in-hospital survivors and 183 of whom were in-hospital non-survivors. The smooth curve fitting revealed a positive relationship between baseline NLR and in-hospital mortality, and multivariable logistic regression analysis indicated that baseline NLR was an independent risk factor for in-hospital mortality (OR 1.04, 95% CI 1.02,1.07, P-value = 0.001). After adjusting for confounders, GAMM showed that the difference in NLR between survivors and non-survivors grew gradually during the first week after ICU admission, and the difference grew by an average of 0.51 per day (β = 0.51, 95% CI 0.45-0.56, P-value <0.001).

Conclusions: Baseline NLR was associated with poor prognosis in critical patients with AHF. Early rises in NLR were linked to higher in-hospital mortality, which suggests that keeping track of how NLR early changes might help identify short-term prognosis of critical patients with AHF.

Objective: Although there have been variations in the management of the patients with endometriosis, an important population of these women still require hospitalization . This study aimed to analyze the trends in hospital admissions associated with endometriosis from 1999 to 2019 in Spain.

Methods: An observational study of temporal trends was performed including women aged 15 to 54 years who were admitted to hospital for endometriosis in Spain from 1999 to 2019. Data on hospitalizations were drawn from the minimum basic data set. The data source used for the population was the continuous civil registry. The study variables were: age, year of admission, type of admission (elective/emergency), if there was surgical intervention during admission and length of hospital stay. Direct age-standardized admission rates were calculated using the 2013 European Standard Population differentiating between hospital admissions for elective surgery and any emergency admissions. Joinpoint regression models were fitted to estimate the annual percent change (APC).

Results: Admissions for elective surgery increased significantly, by 5.7% annually, until 2003, when they began to decrease slightly at different speeds until 2019. The mean APC for the entire study period was -0.88% (95%CI: -2.74; 1.02). There was a significant mean decrease of 4% in annual emergency admissions until 2012. Then, there was a significant average increase of 2% per year until 2019. Regarding the length of stay, there was a gradual decrease until 2012, after which slight, oscillating increases were apparent.

Conclusion: There was a reduction of hospital admissions for elective surgery to treat endometriosis from 2003 to 2019 in Spain but emergency hospitalizations due to endometriosis have been growing since 2012. The mean length of hospital decreased for the study period.

Objectives: To evaluate extraperitoneal cesarean section as a routine elective surgery.

Methods: In this retrospective study, 461 primiparas were divided into the extraperitoneal and transperitoneal cesarean section groups according to the operation type in a random, but non-blinded, manner. The outcome measures were intraoperative blood loss, operation duration, postoperative gas passage time, postoperative pain, postoperative complications, and neonatal indicators.

Results: The operation duration of the extraperitoneal cesarean section group was significantly lower than that of the transperitoneal cesarean section group (P < 0.05). Compared to the transperitoneal cesarean section group, the extraperitoneal cesarean section group had neonates with higher birth weights and fewer neonatal transfers (P < 0.05). There was no difference in other maternal surgical or neonatal complications between the two groups.

Conclusion: While extraperitoneal cesarean section can be safely performed as a routine procedure in the surgical delivery of primiparas, it must be performed by well-trained surgeons. In view of its advantages, it is worth being promoted in senior general hospitals as a routine choice.Abbreviations: CS: Cesarean section; ECS: Extraperitoneal; TCS: Transperitoneal; VAS: Visual analogue scale.

Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) compromise a rare group of necrotizing small to medium vessel vasculitides that constitute three distinct disorders: granulomatosis with polyangiitis (GPA) (formerly known as Wegener's granulomatosis), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA) (formerly known as Churg-Strauss syndrome). AAV is characterized by the usual presence of circulating autoantibodies to the neutrophil proteins leukocyte proteinase 3 (PR3-ANCA) or myeloperoxidase (MPO-ANCA). These antibodies can activate neutrophils and the complement system resulting in vessel wall inflammation and damage. The clinical presentation of AAV varies from non-severe (non-life threatening) to severe often with potentially life-threatening multi-organ involvement. Early recognition and diagnosis are crucial. In the past two decades, advances in understanding the pathophysiology of AAV have led to development of new treatments and resulted in significant improvement in general outcomes and survival rates. This narrative review will focus on GPA and MPA. We will highlight clinical manifestations, diagnosis, disease monitoring, and treatment strategies in patients with AAV.

People with type 2 diabetes (T2D) have a higher risk of cardiovascular (CV) disease (CVD) than those without. This increased risk begins with pre-diabetes, potentially 7-10 years before T2D is diagnosed. Selecting medication for patients with T2D should focus on reducing the risk of CVD and established CVD. Within the last decade, several antihyperglycemic agents with proven CV benefit have been approved for the treatment of hyperglycemia and for the prevention of primary and secondary CV events, including glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors. T2D treatment guidelines recommend that an antihyperglycemic agent with proven CV benefit should be used after metformin in patients with high risk of or established CVD, regardless of glycated hemoglobin levels. Despite the availability of antihyperglycemic agents with proven CV benefit, and guidelines on when to use them, less than one in four patients with T2D and CVD receive this type of therapy. These findings suggest a potential gap between current recommendations and clinical practice. This article reviews the approved agents with CV indications, with a focus on injectable GLP-1RAs, and their place in the T2D treatment paradigm according to current guidelines. We aim to provide primary healthcare providers with in-depth information on subsets of patients who would benefit from this type of therapy and when it should be initiated, taking into consideration safety and tolerability and other disease factors. An individualized treatment approach is increasingly recommended in the management of T2D, employing a shared decision-making strategy between patients and healthcare professionals.

Takayasu's arteritis is a rare, chronic, large vessel vasculitis which affects the aorta and its large branches. Early diagnosis is important to prevent serious end organ damage, including to stroke and ischemic heart disease. Studies have demonstrated treatment response with methotrexate, azathioprine, and tumor necrosis factor (TNF) inhibitors. This article aims to describe to the reader key features of Takayasu's arteritis and highlights updated evidence in the diagnosis and management of these patients. We also review the 2021 ACR guidelines for Takayasu's arteritis and correlate them to the updated evidence discussed throughout the review. An extensive literature search was conducted via PUBMED, including the words 'Takayasu's diagnostic criteria,' 'Takayasu's treatment,' 'Takayasu's diagnosis,' 'Takayasu's imaging', and 'Takayasu's diagnostic criteria.' Search was filtered to include clinical trials, randomized controlled trials, systematic reviews, and meta-analyses. Articles in the English language or with English translation and published by the date of 20 December 2021 were included.