QJM: An International Journal of Medicine最新文献

Introduction: Retinal vein occlusion (RVO) has shown a strong association with systemic cardiovascular risk factors and cardiovascular mortality, but some studies have also reported an increase in non-cardiovascular mortality in these patients.

Methods: A prospective case-control study was conducted between 2009 and 2019 at Marqués de Valdecilla University Hospital, involving 333 patients with a first episode of retinal vein occlusion (RVO) and 333 age- and sex-matched controls. Patients were referred to internal medicine after diagnosis based on clinical and angiographic criteria. Clinical data were collected using a standardized questionnaire, including cardiovascular risk factors such as hypertension, dyslipidemia, diabetes, smoking, alcohol use, and BMI. Median follow-up was 11 years. Overall, cardiovascular, and non-cardiovascular mortality were recorded in both groups. Cox regression identified variables linked to overall, cardiovascular, and non-cardiovascular mortality. All analyses were adjusted by individual`s age (at the mean point of the follow-up).

Results: A total of 666 participants (mean age 67.6 years, 52% men) were included (333 in the RVO group and 333 controls). At ≥ 5 years, mortality was 25% in the RVO group and 24% in controls, with no significant differences in age or sex of deceased individuals. RVO patients had significantly higher prevalence of hypertension (73%), dyslipidemia (66%), and diabetes (25%) compared to controls. No significant differences were found in smoking, alcohol use, or BMI. Most RVO cases (67%) involved the temporal branch; 31.5% were central RVO. RVO was associated with increased overall mortality (HR 1.98, p = 0.002) and non-cardiovascular mortality (HR 2.48, p = 0.007), but not cardiovascular mortality (HR 1.86, p = 0.11). No mortality differences were found between branch and central RVO types.

Conclusion: In our cohort the patients with RVO show increased mortality from non-cardiovascular causes, suggesting it may indicate broader systemic disease. This highlights the need for comprehensive medical evaluation and management beyond just cardiovascular risk.

Introduction: POEMS syndrome is a paraneoplastic condition characterized by peripheral neuropathy and monoclonal plasma cell dysfunction. additional major criteria include sclerotic bone lesions. Malignancies such Hodgkin lymphoma, metastatic prostate cancer, breast cancer, and Paget's disease frequently feature ivory vertebra.

Case report: A 21-year-old female exhibited symmetric onset of lower motor neuron weakness in both lower limbs, beginning distally and subsequently progressing to proximal involvement, accompanied by sensory loss during the past 8 months. The examination indicated skin hyperpigmentation, pallor, hepatomegaly, and papilledema. Nerve conduction shows axonal sensory-motor neuropathy, whereas bone marrow analysis reveals reactive marrow with 5% plasma cells and variable cellularity. Serum electrophoresis reveals an elevation of M protein in the gamma region. X-ray and MRI spine revealing sclerotic vertebra lesion of body of D11 vertebra, characteristics of ivory vertebra.

Conclusion: Ivory vertebra may be a feature of POEMS syndrome in appropriate clinical context. Ivory vertebra is usually associated with various malignancy conditions.

Background: Early identification of trauma-patients requiring emergency transfusion remains a critical challenge in prehospital critical care. Massive hemorrhage accounts for approximately 40% of trauma-related deaths and represents the most significant modifiable prognostic factor. Current assessment methods rely primarily on vital signs and physical examination, which have limited sensitivity for detecting compensated shock states.

Methods: We conducted a prospective, multicenter, derivation-validation study across three Spanish Emergency Medical Services systems from January 2021 through June 2025. Adult trauma patients (n = 853) meeting "Code 15" criteria were enrolled from 37 advanced life support units and 6 helicopter emergency medical services. Point-of-care testing was performed prehospitally using the epoc® Blood Analysis System. The primary outcome was emergency transfusion (packed red blood cells or massive transfusion protocol activation) within 24 hours.

Results: The derived Prehospital Transfusion Score (PTS) incorporates seven variables: mean blood pressure, Glasgow Coma Scale, pH, calcium, hemoglobin, base excess, and lactate. PTS demonstrated superior discrimination capacity with an area under the curve of 0.881 (95% CI: 0.836-0.925) for emergency transfusion and 0.946 (95% CI: 0.915-0.977) for massive transfusion, significantly outperforming six previously validated scoring systems (p < 0.001 for most comparisons).

Conclusion: The PTS provides a novel, multidimensional approach for early identification of trauma-patients requiring emergency transfusion by integrating sensitive biomarkers of tissue hypoperfusion, metabolic acidosis, and coagulopathy with traditional hemodynamic parameters. This scoring-system could enhance prehospital triage and facilitate timely activation of massive transfusion protocols.