Postgraduate Medical Journal最新文献

Introduction: The association between maternal hemoglobin in the first trimester (1st TRI) and the risk of neonatal congenital heart disease (CHD) remains unclear.

Methods: A case-control study was conducted involving 102 CHD neonates and 408 controls. Iron-deficiency anemia in the first trimester (1st TRI) was characterized by a hemoglobin level below 110 mg/L, in the absence of hemoglobinopathies such as thalassemias and sickle cell anemia like thalassemia or sickle cell anemia. We utilized logistic regression models to assess the association between maternal hemoglobin/iron-deficiency anemia in 1st TRI and the risk of neonatal CHD.

Results: Neonate born to mothers with iron-deficiency anemia in 1st TRI increased risks of CHD and patent ductus arteriosus compared to those in neonates born to mothers without anemia in 1st TRI (OR = 3.544, 95%CI = 1.428, 8.795; OR = 6.990, 95%CI = 1.248, 39.157, respectively). Pregnant women in the lowest hemoglobin quartile (Q1) in 1st TRI had a significantly higher risk compared to Q4 (OR = 5.365, 95% CI: 2.232-12.896). There was a dose-response relationship between lower maternal hemoglobin in 1st TRI and the increased risk of neonate CHD (P for trend < .001). The probabilities of neonates developing CHD increased as the maternal hemoglobin concentrations in 1st TRI decreased (rs = -0.614, 95% CI: -0.673, -0.555, P < .05).

Conclusion: Maternal iron-deficiency anemia in 1st TRI increased the risk of CHD in neonates. Maternal hemoglobin in 1st TRI may be a practical risk marker of neonatal CHD. Key message What is already known on this topic-Previous studies have suggested that maternal anemia may influence fetal development, but the association between first-trimester maternal hemoglobin levels and the risk of neonatal CHD has remained unclear. What this study adds-This study demonstrates that maternal iron-deficiency anemia in the first trimester is significantly associated with an increased risk of neonatal CHD, particularly PDA, and that lower maternal hemoglobin levels are positively associated with higher CHD risk. How this study might affect research, practice or policy-These findings highlight the importance of early screening and management of maternal iron-deficiency anemia, suggesting that maternal hemoglobin in the first trimester could serve as a potential risk marker for neonatal CHD, informing prenatal care strategies and public health policies.

Purpose: To investigate Chinese emergency physicians' perceptions of prevalence, associated risk factors, and reported management practices for delirium in critically ill emergency department (ED) patients.

Methods: A cross-sectional survey of 402 physicians from EDs across 18 Chinese provinces.

Results: Physician-estimated delirium prevalence varied widely (median: 15%; interquartile range: 10%-30%), with most perceiving higher incidence during night shifts. Key perceived risk factors included metabolic disorders, pre-existing cognitive impairment, shock, and severe infections. Clinical judgment was the most common assessment method; structured screening tools were reportedly used infrequently. Pharmacological interventions were the preferred management approach for most respondents.

Conclusions: This survey highlights Chinese emergency physicians' varied perceptions of delirium prevalence and reliance on clinical judgment over standardized assessment. Findings suggest a need for enhanced training in standardized screening, greater emphasis on non-pharmacological interventions, and fostering interprofessional collaboration to improve care for ED patients with or at risk of delirium. Key messages What is already known on this topic: Delirium is a serious acute neurocognitive syndrome with high Intensive Care Unit prevalence (31.8%-70%) and significant adverse outcomes. Emergency department delirium remains under recognized despite 6%-38% prevalence in older adults. International guidelines recommend non-pharmacological interventions as first-line management. What this study adds: This survey provides the first assessment of Chinese emergency physicians' delirium perceptions in critically ill patients. Key findings reveal predominant reliance on clinical judgment rather than validated tools and a preference for pharmacological interventions, particularly benzodiazepines, which conflicts with international guidelines. Substantial variation exists in perceived prevalence estimates. How this study might affect research, practice, or policy: Findings inform targeted educational initiatives for Chinese emergency departments, emphasizing the need for standardized screening training and non-pharmacological intervention promotion. Future research should prioritize objective epidemiological studies to validate perceived prevalence rates and evaluate protocol implementation.

Background: Regional anesthetic techniques are applied in cardiac surgery to improve postoperative pain and accelerate recovery. Pecto-intercostal fascial block (PIFB) combined with rectus sheath block (RSB) has been proved to provide ideal analgesia for cardiac surgery, but the effects of combing regional anesthetic techniques on postoperative recovery are uncertain.

Methods: This is a prospective and randomized controlled trial at Fuwai Hospital from 1 June 2024 to 3 July 2024. Eighty patients undergoing elective cardiac surgery via cardiopulmonary bypass were randomized at a 1:1 ratio to be allocated in the intervention group (PIFB combined with RSB) or control group (without regional blocks). The primary outcome was the global score of the 15-item quality of recovery (QoR-15) questionnaire at 24 h after surgery. Secondary outcomes included QoR-15 at 72 h, postoperative pain scores, time to extubation, length of stay, medical expenses in hospital and postoperative morbidities.

Results: The QoR-15 global score at 24 h after cardiac surgery was 122.35 ± 6.71 in the intervention group vs 115.30 ± 5.90 in the control group (P < .001). The proportion of patients experiencing better quality of recovery (Qor-15 ≥ 118) was higher in the intervention group (77.5% vs 55%, P = .033). Postoperative pain scores were 1.90 ± 0.18 in the intervention group compared to 2.95 ± 0.99 in the control group (P = .027) at 24 h. Time to extubation was earlier in the intervention group (274.40 ± 98.36 vs 741.28 ± 93.82 min, P < .001). There were no statistically differences in Qor-15 at 72 h and other recovery outcomes.

Conclusion: The administration of PIFB combined with RSB could improve quality of recovery and relieve postoperative pain for patients following cardiac surgery. Key message What is already known on this topic Previous studies have demonstrated that ultrasound-guided nerve blocks effectively reduce postoperative pain in cardiac surgery patients. However, whether these techniques further enhance overall postoperative recovery remained unclear. What this study adds This trial revealed that ultrasound-guided nerve blocks improved postoperative QoR-15 scores, and combined regional techniques further improved recovery without compromising analgesia. How this study might affect research, practice, or policy The findings support applying combined nerve blocks into enhanced recovery protocols for cardiac surgery, offering evidence to optimize postoperative analgesia strategies.

Aim: To investigate the relationship between the Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score and prognosis in patients with acute ischemic stroke (AIS).

Methods: This retrospective, cross-sectional, observational, single-center study enrolled 1128 patients with AIS who presented to the emergency department and were hospitalized between June 2019 and December 2021. The HALP score was calculated as follows: hemoglobin (g/L) × albumin (g/L) × lymphocytes (/L)/platelets (/L). Demographics, clinical characteristics, and HALP scores were compared between survivors and nonsurvivors to identify factors associated with in-hospital mortality.

Results: The HALP scores for nonsurvivors and survivors were 13.9 [7.2-25.9] and 36.4 [22.8-52.8], respectively. Compared to the survivors, the HALP score was significantly lower in nonsurvivor patients.

Conclusions: The HALP score has prognostic value in patients with AIS. Patients with lower HALP scores at admission are at higher risk for prolonged hospital stay, need for intensive care, and mortality, suggesting that a low score may be predictive of poor prognosis in patients with AIS. The cut-off value for predicting mortality was 21.5. Key messages What is already known on this topic: Acute ischemic stroke (AIS) is a leading cause of death and disability worldwide, and accurate early prognostic markers are essential for guiding clinical decisions. Nutritional and inflammatory parameters such as hemoglobin, albumin, lymphocyte, and platelet counts have individually been associated with stroke prognosis. The HALP score-originally validated in cancer and critical illness-has recently emerged as a composite marker reflecting inflammation and nutritional status. However, data on its prognostic value in AIS patients remain limited and inconsistent. What this study adds: This study demonstrates that the HALP score on admission is an independent predictor of in-hospital mortality in AIS patients. A specific cut-off value of 21.5 was identified, below which the risk of death, intensive care unit (ICU) admission, and prolonged hospital stay significantly increased. The HALP score also showed good discriminative ability (Area under the curve (AUC)  = 0.781) in predicting adverse outcomes. How this study might affect research, practice or policy: The HALP score, calculated using routine and inexpensive laboratory parameters, may serve as a practical bedside tool for early risk stratification in AIS. Its use could help clinicians identify high-risk patients at triage and prioritize monitoring or interventions. Future prospective studies could support its integration into prognostic models or emergency care pathways for stroke.

Background: Thyroid nodules are a widespread disease in endocrine system. While ultrasound is the preferred non-invasive examination, it still has some limitations. The study aims to evaluate the correlation between the location of thyroid nodules and pathological diagnosis of thyroid cancer (TC).

Methods: We retrospectively reviewed data from medical records of patients with thyroid nodules who underwent thyroidectomy from 2018 to 2024. A total of 1307 patients with confirmed benign or malignant thyroid nodules were included.

Results: Nodules located in the lower part of left/right thyroid lobe had a higher frequency of malignancy (41.2%) compared to the isthmus (5.4%). A logistic regression model uncovered that the location of thyroid nodules was a significant risk factor for the diagnosis of TC (P = .044), both the upper [P = .040, odds ratio (OR) = 2.009] and the middle (P = .020, OR = 1.702) nodules in left/right lobe were distinctly malignant compared those in the lower. Adjusted by age, maximum nodule size, and aspect ratio, nodules in the middle part still had higher malignancy than the lower lobe (P = .046, OR = 1.630). We also evaluated the correlation between the location and capsular invasion. Compared with nodules in the lower part, non-lower nodules had a greater likelihood of invading the capsule, indicating a poorer prognosis for TC patients.

Conclusions: Our study showed that the location of thyroid nodules is an independent risk factor in determining TC. Nodules located in the lower part of the left/right lobe are considered as having the lower risk of malignancy and capsular invasion.