Postgraduate Medical Journal最新文献

Background: The incidence of peripheral nerve injury has increased annually and it has become a common traumatic disease in clinical practice.

Methods: Netrin-1 is a crucial extracellular matrix protein that plays a significant role in nerve development and regeneration, and is involved in the construction of a local neurological injury regional regeneration and repair microenvironment to support axon and myelin repair growth.

Results: Recent studies have highlighted its important roles in the repair of peripheral nerve injuries.

Conclusion: This review clarifies how Netrin-1 in fluences neuronal survival, promotes axonal regeneration, and modulates neuro-inflammation.

Background: This study aimed to evaluate the diagnostic value of the exercise stress high-frequency QRS (HFQRS) electrocardiogram in coronary microvascular dysfunction.

Methods: We consecutively enrolled patients aged 20 years or older with chest pain between January 2022 and January 2024, all of them underwent HFQRS analysis and coronary angiography. The sensitivity, specificity, and positive predictive value of HFQRS for predicting coronary microcirculatory dysfunction were calculated using coronary angiography-based microvascular resistance (caIMR) ≥25.1 as the gold standard for determining coronary microcirculatory dysfunction. We used the area under the ROC curve (AUC) to evaluate the predictive accuracy of HFQRS and the diagnostic value of exercise HFQRS for coronary microvascular dysfunction (CMVD).

Results: A total of 139 patients were included. We found a moderate correlation between the caIMR values and the number of positive HFQRS leads. (R = 0.757, P < .001). Multifactorial logistic regression analysis showed that the number of positive leads on the HFQRS was an independent predictor of caIMR (9.17, CI 1.02-82.73, P = .048). The area under the ROC curve for the prediction of caIMR by the number of positive HFQRS leads was 0.81 (95% CI 0.73-0.89). The sensitivity, specificity, negative predictive value, and positive predictive value of HFQRS for the prediction of coronary microcirculatory dysfunction were 0.686, 0.971, 0.986, and 0.500, respectively.

Conclusions: Our study found that exercise HFQRS is an important predictor of coronary microvascular disease, that there is a correlation between the number of positive exercise HFQRS leads and CMVD, and that exercise stress HFQRS is a noninvasive and reliable indicator for the diagnosis of CMVD.

Purpose: The aim was to evaluate the association between homocysteine levels and arterial stiffness in the adult population.

Methods: Scopus, Web of Science, and PubMed databases were searched from their inception to November 30, 2024. The DerSimonian and Laird method was used to calculate pooled odds ratio (OR) estimates and 95% confidence intervals (95% CIs) of the associations between homocysteine levels (plasma and serum homocysteine) and arterial stiffness in the adult population.

Results: Finally, 17 studies were included in the systematic review, and 16 studies were included in the meta-analysis, and included a total of 31 049 subjects. Our findings provide evidence supporting the associations between plasma homocysteine levels and arterial stiffness (OR: 2.06; 95% CI: 1.50, 2.82) and between serum homocysteine levels and arterial stiffness (OR: 1.76; 95% CI: 1.17, 2.65) in the adult population.

Conclusion: For each μmol/L unit increase in homocysteine levels, the risk of arterial stiffness increased by 106% for plasma homocysteine and by 76% for serum homocysteine. These findings are of clinical importance for understanding the underlying mechanisms involved in vascular dysfunction to establish preventive strategies in the cardiovascular setting.

Recent advancements in cancer therapy have led to the emergence of innovative approaches that offer new hope to patients. This review provides a comprehensive overview of the latest cutting-edge technologies and strategies in cancer treatment, including clinically approved therapies and experimental modalities in preclinical or early clinical development, with a focus on their potential to improve patient outcomes. We examined next-generation therapies, including personalized immunotherapies, targeted molecular treatments, gene editing approaches, and artificial intelligence-driven strategies. By evaluating the current landscape of these therapies, we highlighted their benefits, limitations, and future directions. The integration of these advanced modalities into clinical practice holds promise for enhancing their efficacy, reducing side effects, and ultimately transforming cancer care.

Objective: To review evidence from randomized trials assessing the effects of preoperative double-dose oral carbohydrates in patients undergoing elective digestive system surgery.

Methods: China Biomedical Literature Database, the Cochrane Library, Ovid Technologies, PubMed, Web of Science, Wanfang, China Science and Technology Journal Database and China National Knowledge Infrastructure were searched from inception to March 2024, with Revman5.4 for analysis.

Results: Fifteen trials involving 1354 patients showed that compared with the preoperative fasting or placebo group, double-dose carbohydrates improved insulin levels [mean difference (MD) = -4.14; 95%CI = -5.50, -2.78; P < .00001] and reduced insulin resistance (MD = -1.02; 95%CI = -1.48, -0.57; P < .0001). Perioperative hunger, thirst, nausea, vomiting, and PONV were mitigated, though no significant variations on blood glucose level (MD = -0.17; 95%CI = -0.45, 0.11; P = .24).

Conclusion: Preoperative double-dose oral carbohydrates may be a safe and feasible approach for digestive system surgery.

Background: The association of body fat distribution markers with cardiovascular (CV) outcomes is not established among older adults.

Methods: 939 adults from the Glucose Intolerance, Obesity, and Hypertension study, were followed for a mean follow-up of 13 years (IQR 8). Nine fat-distribution markers were evaluated for their association with ischemic changes on ECG, and mortality. Multivariable regression models were used, and their performance was assessed using receiver operating characteristic (ROC) curves and net reclassification improvement (NRI) analysis.

Results: Mean baseline age was 72.3 ± 7 years and 471 (49%) were females. Upper quintiles (Q4-5) of weight-adjusted waist index (WWI) were associated with 1.8 (95%CI: 1.1-2.9, P = .01) greater odds for ischemic ECG changes. During follow-up, 466 (48.4%) participants died, 179 (38.4%) from CV causes. The WWI was the strongest predictor of both all-cause (HR = 1.4, 95%CI: 1.1-1.7, P = .002) and CV mortality (HR = 1.7, 95%CI: 1.2-2.3, P = .0031). ROC analysis showed better predictive ability for WWI (AUC = 0.442, 95%CI: 0.4-0.5, P = .003), and NRI analysis revealed that WWI outperformed other markers, correctly reclassifying 36% (95%CI: 0. 2-0.5, P = .01) and 32% (95%CI: 0.1-0.5, P < .001) of participants for all-cause and CV mortality respectively, compared with Body mass index (BMI)-based model.

Conclusions: WWI showed the strongest association with mortality and should be considered the preferred marker for identifying abnormal fat distribution, potentially replacing BMI. Key messages What is already known on this topic: Body mass index (BMI) correlates poorly with visceral fat yet data on which body fat distribution markers is the strongest predictor of cardiovascular (CV) morbidity and mortality is lacking among older adults. What this study adds: Weight adjusted waist index (WWI) was the strongest predictor of ischemic ECG changes, all-cause and CV mortality, outperforming BMI. How this study might affect research, practice or policy: WWI should be considered the preferred marker for identifying abnormal fat distribution, screening individuals at risk and guide medical intervention for weight reduction, potentially replacing BMI.

A systematic review and meta-analysis of real-world studies on tirzepatide is essential to strengthen evidence of its effectiveness in improving glycated hemoglobin (HbA1c) and body weight in patients with type 2 diabetes. 13 real-world studies (N = 89 296; duration 3-18 months) with moderate to serious bias revealed a mean HbA1c reduction of 0.91% (95% confidence interval [CI]: -1.04 to -0.79), weight loss of 9.7 kg (95% CI: -14.05 to -5.35), and body mass index decrease of 2.09 kg/m2 (95% CI: -3.27 to -0.92). Overall, 64% of tirzepatide users reached HbA1c <7%. Furthermore, tirzepatide lowered HbA1c (mean difference [MD] -0.38%; 95% CI: -0.44 to -0.33) and body weight (MD -6.27 kg; 95% CI: -9.22 to -0.33) more than the control. 47%, 23%, 9%, and 4% of tirzepatide users lost ≥5%, ≥10%, ≥15%, and ≥ 20% of their baseline weight, respectively. Tirzepatide's effects on HbA1c and weight in observational studies support clinical trial findings.

Introduction: In 2024, the UK Foundation Programme Office introduced Preference Informed Allocation (PIA) to replace the Educational Performance Measure and Situational Judgement Test (SJT) for allocating Foundation Year 1 (FY1) posts. This study evaluates FY1 doctors' perceptions of PIA's fairness and effectiveness.

Methods: A nationwide survey was distributed to FY1 doctors following induction (n = 9702 eligible). Perceptions on PIA fairness, SJT removal, and Specialised Foundation Programme (SFP) allocation were collected using a five-point Likert scale (1 = strongly disagree, 5 = strongly agree). Quantitative data were analysed using non-parametric statistics, and free-text responses were examined using reflexive thematic analysis.

Results: A total of 1340 FY1s responded (13.8%), representing graduates from 56 medical schools. Overall, 75.2% received their first-choice foundation school, and 91.5% were placed within their top five. Most respondents disagreed that PIA was equitable (median 2 [IQR 1-3]) or should be used for SFP allocation (median 2 [IQR 1-3]), but agreed they were pleased not to have taken the SJT [median 4 (IQR 3-5)]. UK trained graduates and younger, white respondents viewed PIA less favourably than international, older, and minority-ethnic graduates. Thematic analysis emphasized loss of perceived control, calls for greater transparency, and preferences for merit-based or hybrid allocation models.

Conclusions: While PIA maintained high first-choice placements, concerns about fairness were prominent, particularly among UK graduates. Many respondents favoured reintroducing merit-based components. Continued evaluation is needed to ensure a fair, transparent, and acceptable allocation process for future graduates. Key messages What is already known on this topic: The UK Foundation Programme Office replaced performance-based allocation with preference informed allocation (PIA) in 2024, aiming to improve fairness, reduce stress, and align placements with applicant preferences. However, graduate perceptions of this change have not been fully explored. What this study adds: Most respondents disagreed that PIA was a fair allocation system and opposed its use for the specialized foundation programme, particularly younger, white, and UK graduates. Many expressed preferences for reintroducing merit-based elements, such as a standardized clinical examination. How this study might affect research, practice, or policy: The findings highlight the need for ongoing evaluation of the PIA system to ensure fairness, transparency, and acceptability among medical graduates, and may help inform future postgraduate allocation reforms.