British journal of hospital medicine最新文献

Aims/Background Growth hormone (GH) supplementation contributes to improved reproductive and pregnancy outcomes in in vitro fertilization (IVF)-embryo transfer (ET) in polycystic ovary syndrome (PCOS) women. This study aimed to explore the effects of GH on the oxidative stress, ovarian reactivity, and pregnancy outcomes of IVF-ET in PCOS patients of different ages. Methods The clinical data of 342 women with PCOS undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) were collected for retrospective analysis. Based on age, patients were divided into three groups: <35 years (n = 118), 35-40 years (n = 120), and >40 years (n = 104). Each age group was further subdivided into a GH subgroup and a control subgroup, according to whether GH was supplemented during ovarian stimulation. Ovarian stimulation parameters and IVF/ICSI-ET outcomes were recorded. Levels of malondialdehyde (MDA) and superoxide dismutase (SOD) in both follicular fluid and serum were measured using commercial assay kits. Results In the 35-40 years group, the total number of oocytes retrieved, metaphase II (MII) oocytes, and ovarian sensitivity index (OSI) were significantly higher in the GH group compared to the control group (p = 0.012, 0.049, 0.006, respectively). In the >40 years group, the total number of oocytes retrieved and OSI were also significantly increased in the GH group compared to the control group (p = 0.001, 0.002, respectively). In the <35, 35-40, and >40 years groups, the serum SOD level on the trigger day was significantly higher in the GH groups than in the control groups (p = 0.004, 0.001, 0.012, respectively), while the serum MDA level was significantly lower (p = 0.032, 0.015, 0.004, respectively). In the 35-40 and >40 years groups, the fertilization rate was significantly higher in the GH subgroups compared to the control subgroups (p = 0.040, 0.001, respectively). A total of 43 ET cycles were cancelled, and 299 ET cycles were analyzed. In the 35-40 years group, the GH subgroup showed a significantly higher pregnancy rate compared to the control subgroup (p = 0.043); although the live birth rate was slightly higher, the difference was not statistically significant (p = 0.064). In the <35 years and >40 years groups, no significant differences were observed in pregnancy rate, miscarriage rate, or live birth rate between the GH and control subgroups (p > 0.05). Conclusion GH improves serum oxidative stress and ovarian reactivity in women with PCOS, and increases both the number of oocytes retrieved and the fertilization rate in those aged ≥35 years. Additionally, GH increases the pregnancy rate in PCOS patients aged 35-40 years, although it does not show a significant benefit in live birth rate.

Burns are a significant public health concern, with thousands in the UK requiring treatment annually. Burn assessment and management are complex and require a systematic approach. This study aims to provide an in-depth review of how to evaluate and treat burns to enhance clinical decision-making and ultimately improve patient outcomes. This study explores key aspects of a burn assessment, including key points in the history, examination findings and the classification of the burn depth and total body surface area. It also highlights the Emergency Management of Severe Burn (EMSB) approach and its significance in managing burns, as well as different fluid resuscitation formulas such as Parkland and biological engineering technology (BET). Wound care strategies, indications for surgical and specialist management and additional measurements needed for special burns are also discussed.

Chronic abdominal pain is a common presentation, and yet clinicians and patients often struggle with a suitable diagnostic label (naming the pain); how to avoid implying symptoms are all in the mind (framing the pain); how to avoid medical iatrogenesis for which patients are at risk (aggravating the pain) and finally what might be helpful rather than harmful in chronic pain rehabilitation (calming the pain). This article will review a diagnostic algorithm for the most appropriate name for the chronic pain; the importance of brain-gut axis and biopsychosocial framing of the pain; avoiding iatrogenic surgery and opioids that aggravate the pain and lastly the judicious use of gut-brain neuromodulators and psychotherapies to help with calming the pain. Future directions for research are highlighted. Despite the high clinical significance and prevalence of chronic abdominal pain presentations across both primary and secondary care, its diagnosis and management are marked by a general lack of confidence and unmet training needs, which this review attempts to address.

Aims/Background Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by synovial inflammation, pannus formation, and neovascularization. Reliable biomarkers for monitoring RA activity are needed to optimize treatment strategies. Periostin (POSTN) and vascular endothelial growth factor (VEGF) contribute to tissue remodeling and angiogenesis in various diseases, but their combined role and clinical significance in RA remain underexplored. This study aimed to evaluate serum POSTN and VEGF levels in RA patients and their correlation with disease activity. Methods Serum levels of POSTN and VEGF were quantified using enzyme-linked immunosorbent assay (ELISA) in 86 RA patients, 36 osteoarthritis (OA) patients, and 40 healthy volunteers (HV) enrolled between January 2022 and December 2024 at Jinhua Municipal Central Hospital. RA patients were categorized into active (Disease Activity Score-28 [DAS28] >2.6) and stable (DAS28 ≤2.6) subgroups. Serum POSTN and VEGF levels were compared across the three study groups and between RA activity subgroups. Correlations between these biomarkers and clinical/laboratory parameters, including DAS28, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR), were analyzed. Results Serum POSTN and VEGF levels were significantly higher in RA patients [(125.21 ± 35.17) ng/mL, (106.45 ± 29.54) pg/mL] compared to OA patients [(98.41 ± 30.09) ng/mL, (82.28 ± 23.18) pg/mL] and healthy controls [(75.86 ± 22.81) ng/mL, (71.24 ± 11.72) pg/mL] (all p < 0.001). Furthermore, POSTN and VEGF levels in the active RA group [(144.68 ± 29.98) ng/mL, (121.75 ± 27.49) pg/mL] were significantly higher than those in the inactive group [(100.62 ± 24.23) ng/mL, (87.33 ± 19.12) pg/mL] (all p < 0.001). Spearman's or Pearson's correlation analyses revealed a positive correlation between POSTN and VEGF in RA patients (r = 0.708, p < 0.001). Serum POSTN levels were positively correlated with DAS28, CRP, and ESR (r_DAS28 = 0.753, r_CRP = 0.623, r_ESR = 0.437, p < 0.001) so was VEGF (r_DAS28 = 0.720, r_CRP = 0.433, r_ESR = 0.623, all p < 0.001). Conclusion POSTN and VEGF levels are elevated in RA patients, correlate with disease activity markers, and may serve as complementary biomarkers for assessing RA activity.

Irritable Bowel Syndrome with Constipation (IBS-C) is a functional gastrointestinal disorder characterised by abdominal pain, bloating, and altered bowel habits. Emerging research highlights the role of colonic microbiota in its pathophysiology, with IBS-C patients often exhibiting dysbiosis marked by reduced beneficial bacteria (Bifidobacterium, Lactobacillus) and increased inflammatory microbes (Enterobacteriaceae, Escherichia coli). Dysbiosis in IBS-C leads to reduced short-chain fatty acid production, impaired gut motility, and altered serotonin signalling, affecting peristalsis and sensitivity. It also increases intestinal permeability, inflammation, and gut-brain axis interactions, worsening pain and gastrointestinal dysfunction. These alterations impact gut motility, serotonin metabolism, and gut-brain axis signalling, contributing to IBS-C symptoms. Despite growing evidence, inconsistencies in study findings highlight the need for standardised research methods. Future studies should focus on long-term microbiota dynamics, targeted therapies, and personalised treatment strategies to improve symptom management and clinical outcomes. This review systematically summarises the changes in gut microbiota connected to IBS-C and provides a reference for future personalised treatment strategies.

Dementia poses major challenges to healthcare worldwide. Traditional diagnostics rely on lengthy assessments, and access to specialist clinicians is limited. Large language models (LLMs), like Generative Pre-trained Transformer 4 (GPT-4) present new avenues for enhancing dementia diagnosis and care through advanced language processing. Whilst research into their applications is in its infancy, LLMs can harness vast datasets and powerful algorithms, with significant potential to enhance diagnostic accuracy in dementia, monitor symptom progression, and provide personalised care recommendations. While dementia serves as the primary example, the ethical and practical considerations discussed are applicable to the wider use of LLMs across different areas of medicine. This review explores the prospect of LLMs transforming dementia management and addresses the ethical and practical considerations involved.

Aims/Background Acute myeloid leukemia (AML) is a hematologic malignancy that often requires prolonged hospitalization and intensive treatment, leading to substantial psychological distress and impaired quality of life (QoL). The positive psychology-based PERMA (positive emotion, engagement, relationships, meaning, and accomplishment) model encompasses five dimensions and has demonstrated benefits in various chronic diseases, though evidence in AML remains limited. This study aims to investigate the effects of PERMA model-based nursing on psychological well-being and QoL in hospitalized AML patients. Methods We conducted a single-center, retrospective case-control study of 555 AML inpatients admitted between March 2022 and March 2025. Patients received either PERMA model-based nursing (PERMA group) or conventional nursing (control group). Propensity score matching (PSM; 1:1; caliper = 0.2) was applied to balance baseline characteristics, resulting in 242 matched patients (121 per group). Psychological status was assessed using the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS), and QoL was evaluated using the Chinese version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ‑C30). Results After matching, baseline characteristics were comparable across the two groups. In the control group, SAS scores increased significantly (p = 0.001) while SDS scores showed a slight decrease. Scores of global health status-quality of life (GHS-QoL), physical functioning (PF), emotional functioning (EF), and social functioning (SF) declined markedly (all p < 0.001); nausea/vomiting (NV) and appetite loss (AP) increased, diarrhea (DI) decreased, and financial difficulties (FI) increased significantly. In the PERMA group, SAS and SDS scores decreased significantly (both p < 0.001), PF declined (p < 0.001), role functioning (RF) improved (p = 0.024), while fatigue (FA), NV, AP, and FI all increased significantly. At discharge, the PERMA group recorded significantly lower SAS and SDS scores and higher GHS-QoL, EF, and SF scores than the control group (p < 0.01). Conclusion PERMA model-based nursing significantly alleviated anxiety and depression and improved key QoL domains in hospitalized AML patients. This structured, low-cost intervention is feasible in clinical practice and merits further validation in multicenter prospective studies.

This paper reviews the literature available regarding the reliability, validity and clinical utility of a schizophrenia diagnosis. Schizophrenia is a complex and typically chronic mental illness, with diagnosis being based on symptoms, not unlike many psychiatric illnesses. The reliability, validity and utility of the diagnosis of schizophrenia have been debated, often controversially, and sometimes challenged with misinformation. The reliability of schizophrenia diagnoses is excellent when a structured interview is used, but can be poor in routine clinical practice. The diagnosis of schizophrenia is hindered by the lack of objective diagnostic tests, however, the concept has face and predictive validity, with progress in genetics and neuroimaging providing some biological and concurrent validity. It is clear that the diagnosis has high clinical utility globally, similar to many psychiatric and medical conditions. Overall, schizophrenia is comparable to medical diagnoses made clinically, in that the diagnosis enables evidence-based treatment and improves patient outcomes.