British journal of hospital medicine最新文献

Aims/Background Coronary angiography is a widely used invasive approach for diagnosing coronary atherosclerotic heart disease (CHD). However, carotid ultrasound may predict CHD by assessing carotid atherosclerosis. Therefore, this study explores the predictive significance of carotid ultrasound parameters in accurately diagnosing coronary artery disease. Methods This retrospective analysis included 82 CHD patients who underwent carotid ultrasound scans at the Funan County Hospital of Traditional Chinese Medicine, China, between July 2021 and February 2024. Based on coronary angiography results, patients were divided into the CHD (n = 48) and non-CHD (n = 34) groups. Differences in clinical data, biochemical indicators, and carotid ultrasound parameters were evaluated between the two experimental groups. Furthermore, correlation analysis assessed the association between ultrasound parameters and CHD occurrence and severity. Additionally, multivariable logistic regression analyses were performed, followed by developing a CHD prediction nomogram model. Finally, the model's performance was evaluated through analyses of receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and calibration curves. Results The CHD group had higher body mass index (BMI), smoking history, diabetes, total cholesterol (TC), and triglycerides (TG) levels (p < 0.05). Furthermore, significantly higher intima-media thickness (IMT) and plaque score and lower plaque echogenicity grey scale median (GSM) were observed in the CHD group (p < 0.05). Pearson correlation showed a positive correlation between Gensini score and IMT, plaque score, and a negative association with plaque echogenicity GSM (p < 0.05). Spearman correlation revealed positive correlations between BMI, smoking history, diabetes, TG, TC, IMT, plaque score, and CHD diagnosis, and a negative correlation with plaque echogenicity GSM (p < 0.05). IMT and plaque score were identified as CHD risk factors and plaque echogenicity GSM as a protective factor (p < 0.05). The model based on carotid ultrasound parameters demonstrated high predictive performance for CHD, with an area under the curve (AUC) of 0.866 (95% confidence interval [CI]: 0.779-0.953). DCA and calibration curves supported the model's accuracy. Conclusion Carotid ultrasound parameters differ significantly between CHD and non-CHD patients. The developed model using these parameters effectively predicts CHD occurrence, providing a valuable diagnostic alternative for coronary angiography.

Aims/Background Psoriasis is a chronic inflammatory condition associated with an elevated risk of cardiovascular diseases including coronary artery disease (CAD). This study assessed coronary microvascular dysfunction (CMD) in psoriasis patients using echocardiographic coronary flow parameters, controlling for traditional cardiovascular risk factors and atherosclerosis, to fill gaps identified in previous research. Methods A comprehensive literature search was performed using multiple electronic databases for studies on echocardiographic coronary flow parameters in patients with psoriasis. The outcomes of interest included the coronary flow velocity reserve (CFVR), hyperemic diastolic peak flow velocity (DPFV), and baseline DPFV. Data were extracted and analyzed using RevMan 5.4 (Nordic Cochrane Center, Copenhagen, Denmark), with pooled standard mean differences (SMDs) and 95% confidence intervals (CIs) were calculated. Statistical significance was set at p < 0.05. Results Four studies involving 557 patients were included in this analysis. Pooled analysis revealed a significant reduction in CFVR in patients with psoriasis compared to controls (SMD: -0.71; 95% CI: -0.97, -0.45; p < 0.00001). Hyperemic DPFV was significantly reduced (SMD: -0.71; 95% CI: -1.30, -0.12; p = 0.02), whereas baseline DPFV showed no signficant difference (SMD: 0.20; 95% CI: -0.92, 1.32; p = 0.73). Conclusion Psoriasis was associated with reduced CFVR and hyperemic DPFV, suggesting early CMD. CFVR could aid in early CMD detection in psoriasis patients, informing cardiovascular risk management and potential anti-inflammatory treatment benefits. Systematic Review Registration PROSPERO: CRD42024574085.

Aims/Background Patients with recurrent or/and metastatic nasopharyngeal carcinoma (NPC) have a notably low survival rate. Our primary objective in this study is to establish a comprehensive nomogram model based on clinical factors, semantic features, and multi-parameter magnetic resonance imaging (MRI) radiomic features, and to predict the risk of mortality in patients with progressive NPC following intensity-modulated radiation therapy. Methods A retrospective study, including 110 patients with recurrent or/and metastatic NPC who underwent treatment at the Zhejiang Cancer Hospital between June 2012 and December 2016, was conducted. Comprehensive reviews of clinical and pre-treatment MRI data were undertaken. Patients were categorized into two groups based on their mortality status within a 5 year-frame: the non-death group (54 cases) and the death group (56 cases). Radiomic features were extracted from patients' MRIs and the best feature set was selected. Each patient was assigned a radiomic score (Rad-Score). A combined model was constructed using multivariate binary logistic regression, incorporating Rad-Score, semantic features, and clinical data. Receiver operating characteristic (ROC) curves and calibration plots were generated to evaluate the predictive performance of the radiomic feature model, the clinical-semantic feature model, and the combined model for predicting death risk in patients with progressive NPC. A nomogram based on the combined model was constructed. Results Gender, invasion of the carotid sheath by the primary tumour, tumour volume, and progression time showed statistically significant differences between the two groups (p < 0.05). There were statistically significant differences between the three models in the death and non-death groups (p < 0.001). The area under the curve (AUC) value for the radiomic feature model was 0.861 (95% confidence interval [CI]: 0.783-0.920), while the AUC value for the clinical-semantic feature model was 0.797 (95% CI: 0.709-0.868). The combined model demonstrated the highest efficacy for predicting death risk in NPC patients, with an AUC value of 0.904 (95% CI: 0.832-0.952), accuracy of 0.818, sensitivity of 0.857, specificity of 0.870, negative predictive value of 0.778, and positive predictive value of 0.857. Conclusion The combined model incorporating clinical features, semantic features and multi-parameter MRI radiomic features is a highly valuable tool for predicting death risk in patients with progressive NPC, providing a quantitative approach to aiding in early clinical intervention and treatment.

Rather than the absence of any harm, it is the expectation of an overall benefit of a medical treatment that is the foundation of the implicit doctor-patient contract. In the context of an expectation of efficacy, powerful cognitive biases can blind clinicians to obvious signs that a treatment is not helping, or may even be harming their patients. With examples from medical history and current clinical controversies, this paper examines how systematic psychological biases can distort not just individual decision making, but perceptions of the evidence base upon which clinical decisions are built. These distortions can perpetuate harmful practices in medicine long after the objective evidence points in a different direction. By becoming aware of these biases and the way they shape perceptions of the evidence base, doctors can reduce the negative impact they may have on the patients in their care.

Aims/Background The effects of the coronavirus disease 2019 (COVID-19) pandemic on surgical specialities have been devastating, with more than 1.5 million operations cancelled in 2020, leading to reduced training opportunities and morale. We investigated the impact of COVID-19 pandemic on UK medical students' interest in pursuing a career in cardiothoracic surgery (CTS) and their perceptions of the field, including perceived challenges and opportunities. Methods This study is a comparative cross-sectional study design aiming to assess if there were changes in perceptions amongst UK medical students before and after COVID-19. We distributed the same online survey to all UK medical schools via social media outlets before COVID-19 in 2018 and after in 2022. The Chi-square test was used to analyze differences, with a significance level set a p < 0.05. Results Overall, career intentions of survey respondents towards CTS did not change between 2018 and 2022. However, students' perceptions towards CTS became more negative (p = 0.033). In 2018, for instance, 37% of survey respondents had neutral or negative perceptions of CTS which increased to 59% in 2022. This result was statistically significant, indicating the negative impact of COVID-19 on UK medical students' perceptions of CTS. Conclusion Overall, the effects of COVID-19 did not have a significant impact on medical student interest in a career in CTS. However, negative perceptions associated with a career in CTS persist. A new era of remote, hybrid career events and student modules in CTS could encourage greater interest.

Neisseria sicca is commonly found in oral flora and is usually deemed harmless. Neisseria sicca is very rarely associated with infective endocarditis and has a high mortality rate with it. We present a case of infective endocarditis in a 57-year-old male who presented with fever, lethargy, and reduced mobility and was admitted to an acute medical unit of a UK district general hospital. Serial blood cultures grew Neisseria sicca and transoesophageal echocardiography confirmed vegetation on the aortic valve. As per microbiology advice, his antibiotic treatment was adjusted to oral ciprofloxacin and intravenous ceftriaxone for 6 weeks given this organism's sensitivity. The cardiology team arranged outpatient appointments for long-term follow-ups. Involving acute medicine, microbiology, and cardiology teams as part of a multidisciplinary team (MDT) led to good clinical outcomes and patients remained alive and well on follow-ups. So far only 27 cases have been documented and we think our work would increase insights into management strategies for this condition particularly the utilization of the MDT approach.

Anaemia is a frequent and serious complication in chronic kidney disease (CKD), affecting both non-dialysis-dependent (NDD) and dialysis-dependent (DD) patients. While erythropoietin (EPO) deficiency is the primary cause, iron deficiency (ID) also plays a crucial role. ID in CKD can be classified as either absolute, resulting from blood loss, or functional, driven by inflammation and elevated hepcidin levels, which trap iron in macrophages and hepatocytes, preventing its use in erythropoiesis. Elevated hepcidin also reduces dietary iron absorption in the gut, making oral iron supplements ineffective, particularly in advanced CKD. This review summarises the available intravenous (IV) iron formulations, discusses diagnostic definitions and treatment thresholds for ID in NDD and DD CKD, and explores potential future therapeutic directions.

Pulmonary arterial hypertension (PAH) is a rare, progressive, debilitating and life shortening condition characterized by raised pulmonary arterial pressures. PAH includes a group of conditions sharing similar pathophysiology, clinical features and response to therapy. The commonest sub-groups of PAH include idiopathic pulmonary arterial hypertension (IPAH), and PAH associated with connective tissue disease. Recently published international guidelines emphasize the need for disease awareness and early referral to expert centres in suspected cases. Following diagnosis and careful risk stratification, combination therapy is recommended using drugs targeting the nitric oxide, endothelin and prostacyclin signaling pathways. Promising new therapies are on the horizon, however, the survival remains disappointing with a median survival of 7 years. In this review, we focus on the diagnostic evaluation, risk stratification, available treatment options and future directions in PAH.

Aims/Background The relationship between dysregulated branched-chain amino acid (BCAA) and inflammatory bowel disease (IBD) is not fully understood. This study applied a bidirectional, two-sample Mendelian randomization (MR) approach to explore the potential causal relationship between circulating BCAA levels and IBD. Methods Genome-wide association studies (GWAS) data on total BCAA levels, comprising leucine, valine, and isoleucine, were utilized. Data on IBD and its subtypes were sourced from the FinnGen study. The primary analytical method was the inverse-variance weighted (IVW) MR. To determine the direct causal effect of BCAA levels on IBD risk while accounting for confounders, we employed multivariable Mendelian randomization (MVMR). Results IVW analysis revealed a positive correlation between circulating total BCAA levels, including valine, leucine, and isoleucine, and an increased risk of Crohn's disease (CD). No causal link was detected between BCAA levels and overall IBD or ulcerative colitis (UC). In the MVMR analysis, adjusting for common risk factors further validated a direct causal effect of elevated BCAA levels on CD risk. Conclusion Our findings suggest that elevated circulating BCAA levels are associated with an increased risk of CD. Further research is warranted to explore the potential implications of these findings for CD risk management.

Aims/Background Peritoneal metastasis in colorectal cancer (CRC) indicates a poor prognosis for patients. Circulating tumour DNA (ctDNA) effectively predicts recurrence and metastasis. Therefore, this study aims to construct a predictive model for peritoneal metastasis by integrating ctDNA with clinicopathological factors in stage I-III CRC patients. Methods We conducted a retrospective analysis of 299 CRC patients who underwent ctDNA detection at The Sixth Affiliated Hospital, Sun Yat-sen University between January 2010 and December 2022. Patients were randomly divided into training (n = 209) and validation (n = 90) sets in a 7:3 ratio using a random number table method. The least absolute shrinkage and selection operator (LASSO) regression model optimized feature selection, and multivariable logistic regression constructed the predictive model. Results Among the study cohort, 59 patients were ctDNA-positive. Postoperative ctDNA positivity was associated with an 8.522-fold increased risk of peritoneal metastasis (p < 0.001, odds ratio (OR) 8.522, 95% confidence interval (CI) 4.371-16.615). The model included preoperative carbohydrate antigen 125 (CA-125), pathological lymph node staging, perineural invasion, and ctDNA levels, achieving an area under the curve (AUC) of 0.808 (95% CI 0.727-0.888) in the training set and 0.784 (95% CI 0.658-0.910) in the validation set. Conclusion This model can accurately identify high-risk patients for peritoneal metastasis in postoperative CRC, facilitating early detection and timely intervention.