Postgraduate Medical Journal最新文献

Prediabetes affects nearly one-third of adults in the United States and is increasingly recognized as a contributor to early chronic kidney disease (CKD). This review summarizes current evidence linking prediabetes with early kidney changes, including albuminuria, glomerular hyperfiltration, and mild renal impairment, as well as its association with increased cardiovascular risk. Large observational cohorts, such as the Chronic Renal Insufficiency Cohort, suggest an association between prediabetes and progression of proteinuria, although its independent contribution to advanced CKD remains variable. We review proposed mechanisms, including insulin resistance, low-grade hyperglycemia, altered tubulo-glomerular feedback mediated by sodium-glucose cotransporter 2 activity, inflammation, and endothelial dysfunction. Variability in diagnostic thresholds across major guidelines complicates risk stratification. Emerging biomarkers may facilitate earlier detection but require further validation. Early identification and guideline-directed lifestyle and pharmacological interventions may help mitigate CKD progression and related cardiovascular outcomes. These insights inform population-level screening, prevention, and decision-making.

Objective: To develop and internally validate a practical nomogram for predicting early respiratory failure in acute pesticide poisoning and to benchmark its performance against the National Early Warning Score (NEWS).

Methods: This retrospective cohort study included 205 acute pesticide poisoning patients admitted to a tertiary emergency department (ED) between November 2022 and April 2025. The primary outcome was respiratory failure or invasive ventilation within 48 h. Predictors were selected from initial assessment data (within 6 h) using least absolute shrinkage and selection operator regression to build a multivariable logistic model. Performance was assessed by discrimination [area under the curve (AUC)], calibration, and decision curve analysis, with specific comparison to NEWS using the DeLong test.

Results: Respiratory failure occurred in 55 (26.8%) patients. The final model comprised decreased level of consciousness (Glasgow Coma Scale < 15), organophosphate exposure, arterial pH, and serum creatinine. The nomogram demonstrated excellent discrimination (AUC 0.882; 95% confidence interval 0.829-0.934), statistically outperforming NEWS (AUC 0.789; P = .017). Calibration was robust (Hosmer-Lemeshow P = .503). A high-sensitivity screening threshold of 0.25 yielded a negative predictive value of 91.2%. Risk stratification effectively classified patients into low (<0.20; event rate 9.6%), intermediate (0.20-0.50; 28.2%), and high (>0.50; 78.0%) risk tiers.

Conclusions: This simple four-variable nomogram provides accurate early risk assessment for respiratory failure in acute pesticide poisoning, offering superior discrimination over standard NEWS. The proposed risk stratification framework can support ED triage decisions regarding monitoring intensity and critical care resource allocation. Key messages What is already known on this topic: Existing severity scores (e.g. PSS, NEWS) are either too complex for rapid triage or lack specificity for the toxicological and metabolic risks of acute pesticide poisoning. What this study adds: This study develops and internally validates a simple four-variable nomogram (decreased level of consciousness, organophosphate poisoning, arterial pH, serum creatinine) that predicts early respiratory failure with significantly better discrimination than the standard NEWS score. How this study might affect research, practice or policy: By providing a practical three-tier risk stratification framework, this bedside tool may support emergency physicians in optimizing monitoring intensity and critical care resource allocation, pending external validation.

Background: The relationship between metabolic syndrome (MetS) and colorectal cancer (CRC) remains incompletely understood, with chronic inflammation hypothesized as a potential mediator. This study aimed to investigate associations among MetS, systemic inflammation biomarkers, and CRC risk, while focusing on the mediating role of inflammation.

Methods: Using data from 335 544 participants in the UK Biobank, we assessed associations between MetS, CRC risk, and six systemic inflammation biomarkers [neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio, platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and inflammatory burden index (IBI)]. Fine and Gray's competing risk model, multivariable linear regression, and Cox proportional hazards models were employed. Causal mediation analysis was used to evaluate the mediating effects of inflammation biomarkers.

Results: MetS was associated with increased CRC risk (HR = 1.11, 95% CI = 1.03-1.20, P = .007), with central obesity and hyperglycemia showing the strongest associations. Five inflammation biomarkers (NLR, PLR, SII, SIRI, and IBI) were positively associated with both MetS and CRC risk. Mediation analysis revealed that these biomarkers partially mediated the MetS-CRC relationship, with IBI accounting for the largest mediating effects (16.6%).

Conclusion: This study confirms that both MetS and systemic inflammation contribute to increased CRC risk, with inflammation playing a significant mediating role. These findings provide novel insights into underlying mechanisms and highlight the potential of inflammation biomarkers, particularly IBI, for improving early CRC risk prediction in individuals with metabolic dysfunction. Key messages What is already known on this topic: Metabolic syndrome (MetS) is associated with an increased colorectal cancer (CRC) risk, but the biological pathway remains incompletely understood. Systemic low-grade inflammation has been proposed as a mediator, yet composite inflammation indices are underexplored. What this study adds: In 335 544 UK Biobank participants, MetS was associated with a higher risk of CRC (HR = 1.11, 95% CI 1.03-1.20). Five systemic inflammation biomarkers (NLR, PLR, SII, SIRI, and IBI) were associated with both MetS and CRC. Mediation analysis indicated partial mediation, with IBI contributing the largest proportion (16.6%). How this study might affect research, practice, or policy: Incorporating systemic inflammation indices, particularly IBI, may improve early risk stratification for CRC among individuals with MetS. These findings support the development of prevention strategies targeting low-grade inflammation, while guiding future mechanistic and translational research.