QJM: An International Journal of Medicine最新文献

Background and aims: To establish an early and quick model for diagnosing infections in patients with acute-on-chronic liver disease (AoCLD).

Approach: This study analyzed 3,949 patients from two multicenter prospective cohorts of the Chinese Acute-on-Chronic Liver Failure (CATCH-LIFE) study. The dataset was randomly divided into training and validation cohorts in a 7:3 ratio. In the training cohort, logistic regression and least absolute shrinkage and selection operator regression analyses were used to identify predictive risk factors for infection in patients with AoCLD, and a simple nomogram was established. Two different cutoff values were determined to stratify infection risk in AoCLD patients.

Results: The developed diagnostic model included six variables: cirrhosis, ascites, neutrophil count (N), and total bilirubin, C-reactive protein (CRP), and blood sodium levels. The area under the receiver operating characteristic curve for the training and validation cohorts were 0.818 and 0.809, respectively, significantly higher than using CRP, procalcitonin, or N alone. Additionally, in the training cohort, we set a low cutoff value of 0.2028, resulting in a sensitivity of 80.15%, specificity of 68.25%, and a negative predictive value of 92.7% for rule-out diagnosis. A high cutoff value of 0.4045 resulting in a specificity of 90.1%, sensitivity of 52.7%, and a positive predictive value of 64% for rule-in diagnosis. These cutoff values were validated in the validation cohort.

Conclusions: We established a nomogram model to assist clinicians in diagnosing infections in patients with AoCLD, effectively improving the accuracy and timeliness of diagnosis.

Background: Variation in DNA is known to contribute to medication response, impacting both medicine effectiveness and incidence of adverse drug reactions (ADRs). However, clinical implementation of pharmacogenomics (PGx) has been slow, and the views of the public are not well understood.

Aim: To assess UK national public attitudes around pharmacogenetics.

Design and methods: The survey was co-designed with the Participant Panel at Genomics England and the data were collected by the National Centre for Social Research, using its nationally representative panel of UK adults. Multivariable logistic regression analyses were used to analyse relationships between selected survey reported variables, controlled for age and sex.

Results: The survey response rate was 58%. Two thousand seven hundred and nineteen responses were obtained. Most respondents (59%) had experienced either no benefit or a side effect. Forty-five per cent of respondents reported having experienced no benefit and 46% of respondents reported having experienced a side effect, with female respondents more likely to be in both groups (P < 0.0001). Despite variability in interindividual medicine response being well understood (89%), the involvement of DNA in predicting benefit or risk of a side effect is not (understood by 52% and 48%, respectively). Eighty-nine per cent would complete a PGx test, with 91% wanting direct access to this information. Eighty-five per cent of UK adults think that the NHS should offer PGx to those regularly taking many medicines. Respondents were not more worried overall about misuse of PGx data compared with other routine medical data. Experience with prescription medication impacted on views with those who were prescribed medication almost twice as likely to want a PGx test for any reason.

Conclusion: Most respondents reported experience with either a medication not working for them or ADRs. There was a high level of understanding of variable medication response but a relatively low level of awareness of the role genetics plays in that variability. Most respondents would want a PGx test, to have direct access to results, and think the NHS should offer this form of testing. Importantly, respondents were not more concerned about PGx data use than that of any other routinely generated medical data. Notably, this study highlights a relationship between individuals' experiences with prescription medications and their interest in PGx testing, underscoring the potential for personalized medicine to address public healthcare needs.

Background: Long COVID presents persistent neurological symptoms, including brain fog, with limited therapeutic options. Intravenous Laser Irradiation of Blood (ILIB) has been proposed as a potential intervention. This pilot study explores the efficacy of ILIB in alleviating brain fog symptoms and examines the underlying molecular mechanisms.

Aim: To evaluate the effectiveness of ILIB in improving cognitive function in long COVID patients with brain fog and to investigate the molecular pathways involved.

Design: A prospective, single-center pilot study involving six long COVID patients with brain fog who underwent ILIB therapy.

Methods: Patients received 30 ILIB sessions over eight weeks. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), and Athens Insomnia Scale (AIS) at baseline, post-treatment, and one-month follow-up. RNA sequencing and pathway enrichment analyses (KEGG, Gene Ontology) identified differentially expressed genes and molecular pathways influenced by ILIB.

Results: MoCA and AIS scores significantly improved post-ILIB, suggesting enhanced cognitive function and sleep quality. RNA sequencing revealed 141 upregulated and 130 downregulated genes. Upregulated pathways were associated with mitochondrial electron transport and oxidative phosphorylation, while immune response and inflammatory pathways were downregulated. Notably, the glutathione metabolism pathway was significantly altered, suggesting reduced oxidative stress.

Conclusions: ILIB shows potential in alleviating brain fog symptoms in long COVID patients, possibly through modulation of oxidative stress, mitochondrial function, and inflammation. However, larger randomized controlled trials are needed to confirm these findings and establish ILIB as a viable therapeutic option.

Background: Renal colic is one of the worst types of pain in acute renal colic caused by urinary calculi (ARCUC). We previously proved that acupuncture can alleviate the pain in ARCUC patients, but its effect on suspected ARCUC remains unclear.

Objective: The objective was to evaluate the effectiveness and safety of acupuncture in patients with suspected ARCUC.

Design: This prospective, double-blind, sham acupuncture-controlled, randomized clinical trial was conducted from July 2021 to June 2024 in an emergency department in China.

Methods: The patients immediately received acupuncture treatment or sham acupuncture treatment after randomization.The primary outcome was the response rate at 10 minutes (pain relief rate) after needle manipulation.The secondary outcomes included the response rates at 0, 5, 15, 20, and 30 minutes, trends in the NRS score over time, patient satisfaction, the analgesic injection rate at 30 minutes, the surgical intervention rate, the revisit rate, and the occurrence of adverse events.

Results: This trial enrolled 84 participants with suspected ARCUC patients, who immediately received acupuncture treatment or sham treatment after randomization. The pain response rates at 10 minutes were 64.3% and 16.7% in the acupuncture group and sham group, respectively, and the difference between the groups was 47.6% (95% CI, 29.3% to 66%; P < 0.01). The response rates of acupuncture were also significantly higher than those of sham acupuncture at 0, 5, 15, 20, and 30 minutes.

Conclusions: These results suggest that acupuncture could alleviate the pain in patients with suspected ARCUC safely.

Trial registration: Chinese Clinical Trial Registry: ChiCTR2100049069.