Postgraduate Medical Journal最新文献

The rapid integration of generative artificial intelligence (AI) is transforming scientific writing and publishing, creating both unprecedented opportunities and critical ethical challenges. This article investigates how the use of AI tools affects research integrity, authorship accountability, and peer review processes in scientific publishing. Methodologically, the review synthesizes literature on current AI policies, detection tools, and empirical surveys of author and reviewer practices. Three key hypotheses are proposed for future empirical testing: (H1) mandatory AI disclosure improves the detection of fabricated content; (H2) AI-assisted language refinement enhances manuscript clarity without compromising originality; and (H3) undisclosed AI use by reviewers diminishes the depth of critique. The main findings indicate dominant reliance on descriptive studies, highlighting the need for hypothesis-driven, cross-disciplinary research frameworks and greater transparency to ensure that AI adoption fortifies the trustworthiness of scholarly communication.

Background: Edentulism is a common disease among the elderly. The relationship between sleep patterns and edentulism has not been fully explored.

Methods: This study utilized baseline and follow-up data from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2011 and 2015-participants aged 45 or above. The outcome variable was self-reported edentulism. Independent variables included nap duration, nighttime sleep duration, and sleep quality. The association between edentulism and sleep patterns was evaluated using multivariable logistic regression analysis. To further explore the potential non-linear relationship between nighttime sleep duration and the risk of edentulism, restricted cubic spline (RCS) regression was performed with nighttime sleep duration treated as a continuous variable. Subgroup analysis by gender and age, and introduce interaction terms into the Multivariable logistic regression analysis.

Results: 466 of the 9732 participants were edentulous. After adjusting for potential confounders, participants with short nighttime sleep duration had a 34.5% higher risk of edentulism than those with normal nighttime sleep duration (OR: 1.345; 95% CI:1.097-1.653). RCS regression demonstrates dose-response relationship. Subgroup analyses revealed a significant association between short nighttime sleep duration and edentulism in both men (OR: 3.89; 95% CI: 2.75-6.24) and women (OR: 4.25; 95% CI: 2.99-6.86), as well as in individuals aged ≥65 years (OR: 5.26; 95% CI: 3.25-10.72). Interaction analyses showed no significant interaction between nighttime sleep duration and gender or age.

Conclusion: Short nightly sleep duration may be closely connected to the prevalence of edentulism in people of middle age and older age.

Background: Latent Class Analysis (LCA) is an unsupervised clustering and analytical approach to identify subgroups of people with similar characteristics within a heterogenous population. We examined patterns of comorbidities in people with atrial fibrillation (AF) admitted to hospital using LCA and their relationship with 12-month mortality and length of hospitalisation.

Methods: We conducted a retrospective cohort study using hospital data from Flinders Medical Centre, a major tertiary public hospital in Southern Adelaide (South Australia), covering a period of 10 years (2009-2018). We explored the patterns of comorbidities using LCA and used Cox regression and logistic regression models to examine their association with 12-month mortality and length of hospitalisation.

Results: Three phenotypes were identified using LCA in 12 555 AF patients: phenotype 1 (lower comorbidity burden; n = 7689, 61%), phenotype 2 (higher comorbidity burden; n = 4120; 33%), and phenotype 3 (cerebrovascular, hypertensive disease, nervous system and non-specific abnormalities; n = 746, 6%). The hazard of death was significantly higher in phenotype 2 (adjusted hazard ratio (aHR) = 2.25, 95% CI = 2.01-2.50) and phenotype 3 (aHR = 1.69, 95%CI = 1.38-2.08) compared to phenotype 1. The odds of being hospitalized for ≥10 days (vs. <10 days) were significantly higher in phenotype 2 (adjusted odds ratio [aOR] = 8.53, 95%CI = 7.70-9.44) and phenotype 3 (aOR = 4.23, 95%CI = 3.56-5.04) compared to phenotype 1.

Conclusions: In this large cohort study in AF patients, LCA identified three comorbidity phenotypes with distinct associations with 12-month all-cause mortality and length of hospitalisation. Our findings suggest that phenotyping is valuable in identifying high-risk group of patients that may benefit from targeted intervention. Key messages What is already known on this topic? Previous studies have examined the impact of individual comorbidities in people with atrial fibrillation (AF), but there is limited data on how different combinations of comorbidity patterns occur in people with AF and their impact on health outcomes. What this study adds? Latent class analysis identified three comorbidity phenotypes with distinct associations with 12-month all-cause mortality and length of hospitalisation in people with AF. How this study might affect research, practice, or policy? Risk-stratified care management may help improve health outcomes of AF patients.

This paper provides a comprehensive overview of cardiopulmonary events associated with the occurrence, development, and treatment of tumours, serving as a valuable resource for the clinical management of cancer patients. It explores the complex relationship between the heart and lungs, collectively discussing the cardiopulmonary implications linked to tumours. Common risk factors that connect tumours with cardiac and pulmonary conditions are delineated, highlighting their direct and indirect correlations. Additionally, the paper addresses the cardiopulmonary disorders and symptoms resulting from tumour progression and their subsequent manifestations. The final section focuses on the cardiopulmonary repercussions of various tumour treatments, including chemotherapy, targeted therapy, radiation therapy, and immunotherapy, elaborating on their associated cardiopulmonary effects. Effective management of aggressive proliferative diseases, such as tumours, requires selecting appropriate treatment modalities that balance therapeutic efficacy with vigilant monitoring of cardiopulmonary function and thorough assessment of treatment outcomes and related side effects.

Objective: To review the role of high-sensitivity C-reactive protein (hsCRP) as a biomarker of inflammation in coronary atherosclerotic disease and its potential clinical applications.

Methods: A narrative review of key clinical trials, meta-analyses, and guideline recommendations was performed to evaluate the association between hsCRP levels, cardiovascular risk, and therapeutic interventions.

Results: Elevated hsCRP levels are associated with increased risk of coronary events, both in primary and secondary prevention settings. Statins, independent of their lipid-lowering effects, significantly reduce hsCRP levels and associated cardiovascular events. Anti-inflammatory agents such as canakinumab and colchicine also demonstrate benefit in reducing major adverse cardiovascular events, while newer agents like bempedoic acid show promising hsCRP-lowering effects. Current guidelines recommend selective hsCRP use for risk stratification, particularly in intermediate-risk patients.

Conclusion: hsCRP is a valuable biomarker reflecting residual inflammatory risk in coronary atherosclerosis. Incorporating hsCRP into routine clinical practice may enhance cardiovascular risk stratification and guide therapeutic decisions.

Categories: Cardiology, Internal medicine.

Purpose: This single-centre retrospective audit evaluates the accuracy of nurse-documented vital signs and aggregated New Zealand's early warning scores (NZEWS) in high-acuity inpatients, and the proportion who appropriately received medical emergency team (MET) callouts.

Methods: Eligible patients admitted to general medicine and surgery services in the first 2 days of each month starting January 2022 and ending August 2022 and February 2023, respectively, had every documented vital sign and NZEWS entered into a database until 100 patients with an NZEWS of 6 or greater in the first 24 hours of the admission, or 10 patients with MET callouts per service were identified. We examined NZEWS calculations and their association with MET callout activation. An agreement analysis examined discrepancies between nurse-calculated and audit-calculated NZEWS.

Results: Of 491 screened admissions, 63 (12.8%) fulfilled criteria for inclusion and a total of 20 (4.1%) patients had at least 1 MET callout, of 23 who fulfilled MET criteria. Correct calculation and documentation occurred in three quarters (75.8%) of all NZEWS audited. Approximately half (46.8%) of the 47 individual NZEWS instances mandating MET activation resulted in a MET callout and only one in eight (12.8%) had a documented and accurately calculated NZEWS. The mean difference between nurse and audit-calculated NZEWS was -0.19 (nurse minus audit-calculated, with 95% confidence intervals of -0.28 to -0.09) with limits of agreement -3.64 to 3.26.

Conclusions: When dependent on manual processes, NZEWS documentation, calculation, and MET activation is suboptimal. Automation of NZEWS and MET callouts requires prioritization.

Background: An association between the one-carbon metabolism molecules, such as vitamin B6 (VB6), vitamin B12 (VB12), folate and homocysteine (Hcy), and the incidence of various cancers risk has been reported in observational studies, but the causal relationship between one-carbon metabolism molecules and various cancers risk remains unclear. Our aim was to assess the causal effect of one-carbon metabolism molecules on various cancers risk using a two-sample Mendelian randomization (MR) approach.

Methods: We performed two-sample MR to analyze associations between four one-carbon metabolism molecules and seven cancers in Europeans. Methods included IVW, weighted median, MR-Egger, MR-PRESSO, and outlier tests.

Results: Hcy: Suggestive causal association with reduced GC risk (OR = 0.5427; P = .0217) and increased KC risk (OR = 1.3744; P = .0465). High Hcy levels linked to higher PCA (OR = 1.1038; P = .0496) and KC risk (OR = 1.5444; P = .0430), but lower GC risk (OR = 0.6487; P = .0499).Folate: Higher levels associated with increased CRC risk (OR = 1.2945; P = .0346) and reduced PCA risk (OR = 0.8330; P = .0486).VB12: Suggestive causal association with reduced BC (OR = 0.7421; P = .0203) and GC risk (OR = 0.4812; P = .0267). The causal associations of the above combinations were robust through the test of heterogeneity and pleiotropy.

Conclusions: The large MR analysis indicated that one-carbon metabolism molecules may be causally associated with various cancers risk.

Background: Cardiovascular disease (CVD) is the leading global cause of mortality and imposes substantial health and economic burdens. However, the overall relationship between combined lifestyle factors and CVD incidence among Chinese adults remains poorly defined. This study aimed to explore the association between healthy lifestyle factors and CVD risk in a nationwide Chinese cohort.

Methods: We included 7349 participants from 2011-2012 and followed them until 2018. Lifestyle was assessed using seven factors (blood pressure, blood glucose, cholesterol, body mass index (BMI), tobacco exposure, physical activity, and sleep duration), and participants were categorized into three groups based on the number of ideal factors. Cox regression models were used to analyze data.

Results: Participants with intermediate and unfavorable lifestyles had 29.74% and 59.71% higher CVD risks, respectively, compared to those with favorable lifestyles. Former smokers, individuals with elevated blood glucose, higher BMI, and inadequate sleep duration also had increased CVD risks. Subgroup and sensitivity analyses showed consistent trends.

Conclusion: This nationwide cohort study highlights that healthy lifestyle practices are significantly associated with reduced CVD risk. Promoting healthy behaviors through public health strategies is crucial to mitigating CVD risk. Key messages What is already known on this topic: Modifiable lifestyle factors are established drivers of CVD, but composite lifestyle scores lacked nationally representative evidence in China's aging population before this study. What does this study add: Unhealthy lifestyles, including factors such as blood pressure, glucose levels, and BMI, significantly increased the risks of CVD and stroke in Chinese adults. Conditions like obesity, hyperglycemia, and poor sleep independently elevated these risks across all subgroups. How this study might affect research, practice, or policy: This study advocates multifactorial lifestyle interventions into public health policies, targeting high-risk populations, and prioritizing research on the scalability of these interventions.