British journal of hospital medicine最新文献

Aims/Background The relationship between retinal fundus hemorrhage and the severity of coronary artery lesions remains unclear. This study aimed to explore the incidence of fundus hemorrhage in patients at high risk of coronary heart disease (CHD) and to examine its correlation with the SYNTAX score, a tool used to assess the complexity of coronary artery disease. Methods This retrospective study consecutively enrolled patients undergoing coronary angiography (CAG) at Beijing Anzhen Hospital Hospital from June 2019 to January 2020. Bilateral non-mydriatic fundus photography was performed to detect fundus hemorrhages. The SYNTAX score was calculated to quantify the severity of coronary artery lesions, and patients were divided into two groups: a high SYNTAX score (hSS) group (≥23 points) and a low SYNTAX score (lSS) group (≤22 points). Baseline demographic and clinical data were collected, along with relevant laboratory tests. Results A total of 878 patients were included in the study, with 177 in the hSS group and 701 in the lSS group. Fundus hemorrhage was observed in 91 patients (incidence: 10.36%, 95% confidence interval (CI): 8.35%-12.38%). The incidence of fundus hemorrhage was significantly higher in the hSS group compared to the lSS group (21.47% [38/177] vs. 7.56% [53/701], p < 0.001). Multivariate logistic regression analysis identified fundus hemorrhage, body mass index (BMI), and low-density lipoprotein cholesterol (LDL-C) as independent predictors of high SYNTAX scores. Conclusion Fundus hemorrhage is significantly associated with a higher SYNTAX score and may serve as a potential predictor of severe coronary artery lesions in clinical practice.

Aims/Background Patients receiving kidney transplant experience immunosuppression, which increases the risk of bacterial, viral, fungal, and parasitic infections. Q fever is a potentially fatal infectious disease that affects immunocompromised renal transplant recipients and has implications in terms of severe consequences for the donor's kidney. Case Presentation A patient with acute Q fever infection following kidney transplantation was admitted to the Tsinghua Changgung Hospital in Beijing, China, in March 2021. Next-generation sequencing (NGS) was used to diagnose Q fever in the patient. Based on the patient's blood test, we detected Rickettsia, the causative agent of Q fever and a zoonotic disease that can manifest in acute or chronic forms in humans. Comprehensive data on clinical symptoms, blood tests, chest computed tomography (CT), NGS, Immunoglobulin G (IgG) antibody titer, and therapeutic efficacy associated with Q fever infection following renal transplantation in this patient were gathered. Conclusion This is the first reported case of acute Q fever occurring in a Chinese renal transplant recipient detected using metagenomic NGS. This case underscores the need to consider acute Q fever as a possible differential diagnosis in kidney transplant recipients with fever of unknown origin.

Aims/Background Hypertension (HT) is a prevalent medical condition showing an increasing incidence rate in various populations over recent years. Long-term hypertension increases the risk of the occurrence of hypertensive nephropathy (HTN), which is also a health-threatening disorder. Given that very little is known about the pathogenesis of HTN, this study was designed to identify disease biomarkers, which enable early diagnosis of the disease, through the utilization of high-throughput untargeted metabolomics strategies. Methods The participants of this study were patients admitted to The Second Affiliated Hospital of Chengdu Medical College, Nuclear Industry 416 Hospital, who were randomly divided into three groups: Normal group (n = 11), HT group (n = 10), and HTN group (n = 12). Urine exosomes were extracted, purified, and subjected to untargeted metabolomics analysis. Differential metabolites and their significantly enriched Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were identified. The least absolute shrinkage and selection operator (LASSO) regression analysis was then employed to establish a diagnostic model for early-stage HTN. Finally, logistic regression and receiver operating characteristic (ROC) curve analysis were performed to identify biomarkers related to early HTN. Results Orthogonal partial least squares-discriminant analysis (OPLS-DA) revealed significant differences in the metabolic profiles of the three patient groups. Compared to subjects of the Normal group, the HT and HTN groups exhibited significantly upregulated and downregulated profiles of differential metabolites, respectively. LASSO regression analysis results indicated that 4-hydroxyphenylacetic acid, bilirubin, uracil, and iminodiacetic acid are potential biomarkers for HTN or HT. Conclusion With untargeted metabolomics analysis, we successfully identified differential metabolites in HTN. A further LASSO regression analysis revealed that four key metabolites, namely 4-hydroxyphenylacetic acid, bilirubin, uracil, and iminodiacetic acid, hold promise for the diagnosis of early-stage HTN.

Predictive algorithms have myriad potential clinical decision-making implications from prognostic counselling to improving clinical trial efficiency. Large observational (or "real world") cohorts are a common data source for the development and evaluation of such tools. There is significant optimism regarding the benefits and use cases for risk-based care, but there is a notable disparity between the volume of clinical prediction models published and implementation into healthcare systems that drive and realise patient benefit. Considering the perspective of a clinician or clinical researcher that may encounter clinical predictive algorithms in the near future as a user or developer, this editorial: (1) discusses the ways in which prediction models built using observational data could inform better clinical decisions; (2) summarises the main steps in producing a model with special focus on key appraisal factors; and (3) highlights recent work driving evolution in the ways that we should conceptualise, build and evaluate these tools.

Advanced life support certification has traditionally been the gold standard of resuscitation training for doctors and has been shown to improve outcomes from cardiac arrest. In 2021, Health Education England removed named courses from mandatory Foundational Programme competencies, which has resulted in capping of reimbursement and reduced access to courses. This represents a drop in educational standards which is particularly concerning when the medical school curriculum has been shown to deliver inconsistent, poor-quality resuscitation training. Here we review the benefits and negatives of life support training, looking at both junior and senior clinicians with differing educational requirements.

Aims/Background Intrahepatic cholestasis of pregnancy (ICP) is associated with adverse perinatal outcomes, yet the correlation between ICP and the neutrophil-to-lymphocyte ratio (NLR) remains unclear. This study aims to investigate the diagnostic value of NLR in ICP. Methods In this retrospective case-control study, 113 patients with ICP treated in Beilun District People's Hospital from January 2020 to December 2022 were recruited and categorized as the ICP group, and 209 healthy pregnant women treated during the same period were selected as the control group. The levels of NLR and mean platelet volume (MPV) were compared between the two groups. The NLR of patients with different ICP severity were compared. Logistic regression model was used to analyze the relationship between relevant indicators and ICP. The capability of NLR in predicting ICP was evaluated using receiver operating characteristic (ROC) curves. Results There were significant differences in age, neutrophil count, lymphocyte count, platelet count, MPV, alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), NLR, and serum total bile acid (sTBA) among all groups (p < 0.05). The NLR in the severe ICP group was significantly higher than that in the mild ICP group (p < 0.05). Logistic regression analysis showed that MPV (odds ratio [OR] = 1.247) and NLR (OR = 1.885) were independent factors influencing the occurrence of ICP (p < 0.05). ROC curve analysis showed that the area under the curve (AUC) for both mild ICP and severe ICP was 0.679 and 0.869, respectively, substantiating the diagnostic value of NLR. Conclusion NLR can be used as an auxiliary indicator in the diagnosis of ICP and has important clinical value in predicting adverse pregnancy outcomes in ICP patients.

Aims/Background Deep venous thrombosis (DVT) represents a significant postoperative complication after artificial femoral head replacement, with the incidence increasing proportionally with patient age. This study aimed to evaluate the effect of early postoperative use of intermittent pneumatic compression devices (IPC), followed by the combined use of low molecular weight heparin (LMWH) after 48 hours, for the prevention of postoperative lower limb DVT in elderly patients undergoing hip arthroplasty. Methods The retrospective study included 100 elderly patients who underwent unilateral femoral head replacement. The control group (n = 55) received combined LMWH initiated 12 hours postoperatively, while the observation group (n = 45) started combined LMWH 48 hours postoperatively. Changes in coagulation parameters, perioperative complications, and the incidence of postoperative lower limb DVT were compared between the two groups. Results Coagulation parameters showed significant changes post-intervention in both groups, with no statistically significant inter-group differences observed post-intervention (p > 0.05). The incidence of postoperative lower limb DVT did not differ significantly between the two groups (p > 0.05). However, the observation group demonstrated significantly lower postoperative blood loss, incidence of periwound hematoma, and transfusion rates compared to the control group (p < 0.05). Conclusion The sequential application of IPC in the early postoperative period, followed by combined LMWH administration after 48 hours, demonstrates comparable efficacy in preventing lower limb DVT formation in elderly patients undergoing hip arthroplasty when compared to the initiation of combined LMWH starting 12 hours postoperatively. In addition, this approach significantly reduces the risk of postoperative bleeding and exhibits a high safety profile.

Patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM) face considerable cardiorenal morbidity and mortality despite existing therapies. Recent clinical trials demonstrate the efficacy of finerenone, a novel non-steroidal mineralocorticoid receptor antagonist, in reducing adverse renal and cardiovascular outcomes. This editorial briefly reviews the evidence and its implications for clinical practice, advocating the use of finerenone in these high-risk patients in combination with currently established treatment agents.

Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are commonly prescribed in diabetes mellitus and increasingly for cardiorenal protection. They carry the risk of euglycaemic diabetic ketoacidosis (eDKA). Guidelines around the perioperative handling of these medications are limited and some evidence suggests that withholding them can lead to more surgical complications and poorer glycaemic control. This article gives an overview of arguments for and against withholding SGLT-2 inhibitors in the perioperative period.

Aims/Background A novel exercise protocol for cardiac rehabilitation aerobic (CRA) has been developed by Hebei Sport University, demonstrating efficacy in patients with coronary heart disease (CHD). The objective of this study was to evaluate the impact of CRA on precise cardiac rehabilitation (CR) for CHD patients presenting with stable angina pectoris. Methods The study cohort comprised patients with stable angina who were categorized into three groups: the CRA group (n = 35), the power bicycles (PB) group (n = 34), and the control group (n = 43). In addition to standard treatment, the CRA group underwent a 12-week CRA-based CR intervention, while the PB group participated in a similar program centered on PB exercise, and the control group received only standard treatment. Results At the end of the 12-week intervention, significant differences were observed among the groups in several physiological parameters, including systolic blood pressure (SBP), fasting blood glucose (FBG), triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), Glycated Haemoglobin (Hb-A1c), peak oxygen uptake (Peak VO₂), anaerobic threshold (AT), and Peak VO₂/heart rate (HR) (p < 0.05). Both the CRA and PB groups showed significant reductions in SBP, FBG, TG, TC, LDL, and Hb-A1c compared to the control group (p < 0.05). Additionally, both groups exhibited significant improvements in Peak VO₂, AT, and Peak VO₂/HR (p < 0.05). Intra-group analysis revealed that the CRA group showed significant improvements from baseline to post-intervention in SBP, diastolic blood pressure (DBP), FBG, TG, TC, high-density lipoprotein (HDL), LDL, Hb-A1c, Peak VO₂, AT, and Peak VO₂/HR (p < 0.05). Similarly, the PB group demonstrated significant improvements across these parameters (p < 0.05). Conclusion Both CRA and PB exercises are safe and effective for achieving precise CR in patients with CHD. A 12-week CRA intervention, conducted three times per week for 30 minutes per session, significantly improves cardiopulmonary function and biochemical makers in patients with stable angina. These improvements are comparable to those achieved through PB exercise in precise CR.