British journal of hospital medicine最新文献

This review describes the evolution and enhanced diagnostic capabilities introduced by four-dimensional (4D) flow cardiac magnetic resonance (CMR) in cardiovascular imaging. It charts the historical advancements from echocardiography through to two-dimensional phase-contrast magnetic resonance imaging (2D-PC MRI), culminating in the adoption of 4D flow MRI. This technique affords exhaustive, time-resolved, three-dimensional visualisations of intracardiac and vascular blood flow, refining the accuracy of cardiovascular assessments over traditional methods, especially in complex anatomical settings. The review elaborates on the capacity of 4D flow MRI to offer unparalleled insights into flow dynamics, vessel wall interactions, and cardiac function, thereby enhancing disease detection, risk stratification, and therapeutic evaluations. It accentuates the impact of 4D flow MRI on modern cardiological practices, highlighting its pivotal role in advancing diagnostics and patient management in the context of diverse cardiovascular pathologies.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are antidiabetic agents that effectively lower blood glucose levels in patients with Type 2 Diabetes Mellitus (T2DM). Beyond their glycemic control properties, SGLT2 inhibitors have demonstrated significant cardiovascular benefits, including reductions in major adverse cardiovascular events. However, the limitations of the pivotal trials investigating these outcomes have not been fully explored. This letter aims to critically assess the major randomized clinical trials that evaluated the cardiovascular effects of SGLT2 inhibitors, highlighting both their strengths and limitations.

In a globalised world, patients may need to manage and track their health records with healthcare professionals anywhere and anytime with high data privacy and security. Blockchain technology (BcT) provides these necessities. This study aims to provide a general overview of the usability of BcT in healthcare applications. BcT has been adopted in many sectors, including healthcare. However, there is no unified record format among hospitals for tracking patients' medical histories. In BcT, recorded data cannot be modified without affecting the chain hash code. The blockchain creates a secure and public digital ledger. BcT can also ensure accurate and timely financial transactions by automating payment processes among providers, insurers, and patients through smart contracts. In conclusion, BcT plays a key role in the healthcare sector. It enables safer, cheaper, more dependable, and more effective pharmacotherapy by providing data security, traceability, and immutability.

Aims/Background Gastric cancer is the third leading cause of cancer-related death worldwide, which seriously affects the health of patients. Immunotherapy is a commonly used clinical treatment for gastric cancer, but the adverse events caused by it seriously affect the prognosis of patients. Therefore, it is necessary to control and manage the disease risk of patients during immunotherapy. To explore the effect of applying an intelligent management model based on electronic patient-reported outcome (ePRO) in patients with gastric cancer during immunotherapy. Methods The clinical data of 184 gastric cancer patients receiving immunotherapy in The Fourth Hospital of Hebei Medical University from September 2021 to September 2023 were retrospectively analyzed. Ninety patients receiving ePRO-based intelligent management were selected, and 85 patients were included in the observation group after excluding 5 patients. For the reference group, 94 patients receiving common case management were selected, with 90 patients being included after excluding 4 patients. After 6 months of follow-up, the nutritional status score, quality of life, treatment compliance and adverse events were compared between the two groups. Results No significant difference was detected in nutritional status and World Health Organization Quality of Life-BREF (WHOQOL-BREF) scores of the patients before discharge (p > 0.05). After 2 months of follow-up, compared with the reference group, the observation group had a higher proportion of patients in grade A and grade B, which was not statistically significant (p > 0.05), and significantly higher physiological and psychological scores (p < 0.001), but showed no meaningful differences in other fields (p > 0.05). After 4 months of follow-up, the nutritional status in the observation group was significantly improved (p < 0.05), and the subjects displayed higher WHOQOL-BREF scores (p < 0.05) than those in the reference group. No significant difference in the incidence of adverse events was detected (p > 0.05). After 6 months of follow-up, the treatment compliance of the observation group was 83.53%, which was significantly higher than that of the reference group (70.00%; p < 0.05). Conclusion The intelligent management model based on ePRO is conducive to improving the nutritional status of patients with gastric cancer during immunotherapy, as well as enhancing their quality of life and treatment compliance, making it worthy of clinical application.

Aims/Background The drug treatment of recurrent respiratory tract infection caused by mycoplasma pneumonia (MP) has a complex background, involving the characteristics of pathogens, drug resistance, and multiple treatment methods. This study aimed to analyze the therapeutic effect of pulmicort respules and azithromycin on children with recurrent respiratory tract infection caused by MP. Methods The clinical data of 106 children with recurrent respiratory tract infection caused by MP diagnosed in Huoqiu First People's Hospital from July 2021 to July 2023 were retrospectively analyzed. Based on different therapeutic methods, 56 children treated with azithromycin were included in the reference group, and 50 children treated with pulmicort respules and azithromycin were included in the observation group. The disappearance time of clinical symptoms, levels of inflammatory factors, immunoglobulin levels, and complications in both groups were observed and compared. Results After treatment, the disappearance time of fever, cough, pulmonary rales, and expectoration was shorter in the observation group, compared with the reference group (p < 0.001). No significant difference was observed in levels of tumor necrosis factor-α (TNF-α), interleukin-2 (IL-2), or interleukin-6 (IL-6) between the two groups on the first day of admission (p > 0.05). After 1 week of treatment, the observation group had significantly higher levels of TNF-α, IL-2, and IL-6 compared with the reference group (p < 0.05). No significant difference was observed in levels of immunoglobulin G (IgG), immunoglobulin A (IgA) and immunoglobulin M (IgM) between the two groups on the first day of admission (p > 0.05). After 1 week of treatment, the observation group had significantly lower levels of IgG, IgA, and IgM than the reference group (p < 0.01). This study revealed that the incidence of complications in the observation group was 16.00%, which was significantly lower than the 37.50% in the reference group (p < 0.05). Conclusion In the short-term clinical treatment, the combination application of pulmicort respules and azithromycin can effectively improve the immune function of children with recurrent respiratory tract infection caused by MP and relieve their clinical symptoms.

Aims/Background Few hearing loss studies have been conducted in patients with progeria, and only the possibility of low-frequency conductive hearing loss has been mentioned. The primary objective of this study is to perform a comprehensive analysis of the clinical audiological characteristics of children with Hutchinson-Gilford progeria syndrome (HGPS), and the secondary objective is to analyse the causes of their hearing loss and what can be done to enable them to hear as well as possible. Methods Ten children with HGPS underwent impedance audiometry (tympanogram), otoacoustic emissions, and pure-tone audiometry tests. Otoscopic examination and imaging were also performed in the patients with abnormal hearing. Results Five patients had normal hearing, while the other five had varying degrees of hearing impairment manifesting as mild to moderate low-frequency or full-frequency conductive hearing loss. Otoscopic examination of those patients with abnormal hearing showed a narrowing of the external auditory canal, a thinning of the tympanic membrane, and a distorted cone of light. Further, computed tomography of one patient showed a poorly defined temporal bone morphology with scant pneumatization of the mastoid process. Conclusion Patients with HGPS differ from normally aging individuals with a predominant conductive pattern of hearing loss as opposed to sensorineural deafness, with more lower-frequency hearing impairment due to poor pneumatization of the mastoid process and the possible formation of osteophytes in the temporal bone.

Aims/Background Clear cell renal cell carcinoma (ccRCC) is a common and aggressive form of kidney cancer, where early diagnosis is crucial for improving prognosis and treatment outcomes. Radiomics, which utilizes machine learning techniques, presents a promising approach in medical imaging for the early detection and characterization of such conditions. This study aims to explore the clinical utility of a machine-learning-based radiomics model in the early diagnosis of ccRCC. Methods Case data and abdominal computed tomography (CT) tumour images of patients with ccRCC were obtained from The Cancer Imaging Archive (TCIA) database. The dataset included 31 cases in the training set (19 males and 12 females, with an average age of 58.1 years) and 13 cases in the validation set (8 males and 5 females, with an average age of 69.6 years). The volume of interest (VOI) was manually delineated, slice by slice, along the tumour's edge in cross-sectional images of ccRCC. Radiomics features were extracted from each region of interest (ROI) using the "PyRadiomics" plug-in in 3D Slicer software (version 5.1.0, Massachusetts Institute of Technology and Brigham and Women's Hospital, Boston, MA, USA). Feature selection was performed using Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis, followed by 10-fold cross-validation. The selected radiomics features were then used to construct prediction models based on two different supervised machine learning algorithms: logistic regression and random forest. The diagnostic performance of these models was evaluated using receiver operating characteristic (ROC) curves and calibration curves. Finally, clinical data were integrated with the radiomics features to enhance the prediction model. Results A total of 44 radiomics features were ultimately selected to establish the prediction model based on the training set results. Among the two machine learning models, the logistic regression model demonstrated superior diagnostic performance. An evaluation of model establishment, considering both individual radiomics features (DifferenceVariance, JointEnergy.1, JointEntropy.2, MeanAbsoluteDeviation.7, SmallAreaHighGrayLevelEmphasis.7) and clinical data, indicated that the logistic regression model was stable and exhibited strong diagnostic performance, good calibration, and clinical applicability in patients with ccRCC. When clinical data were combined with radiomics features in the model, the area under the curve (AUC) reached 0.969, with an optimal threshold of -2.290, and sensitivity and specificity values of 89.3% and 95.2%, respectively. The calibration curve also confirmed that the logistic regression model had high calibration accuracy and greater clinical application value. Conclusion This machine-learning-based radiomics prediction model demonstrated significant value in the early diagnosis of clear cell renal cell carcinoma (ccRCC).

Aims/Background Pregnancy can affect various bodily functions, including metabolism, cardiovascular function, and eyesight. Pathological ocular changes observed during pregnancy are linked to the development of pregnancy-specific conditions, such as preeclampsia/eclampsia and gestational diabetes. This study aims to analyze clinical data disease history and maternal characteristics collected during pregnancy, to determine ocular parameters and develop a risk prediction model for adverse ocular outcomes. Methods We retrospectively analyzed the medical records of 760 pregnant women (1520 eyes) from September 2020 to September 2022 at The Third Affiliated Hospital of Guangzhou Medical University. We identified maternal variables that could influence adverse ocular outcomes, including maternal age, pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), eclampsia, pre-eclampsia, uterine disease, fetal abnormalities, in vitro fertilization with embryo transfer, hypoproteinemia, and major comorbidities during pregnancy. Univariate and multivariate logistic regression analyses were conducted to evaluate the effects of these independent predictors on adverse ocular outcomes. Additionally, receiver operating characteristic (ROC) curve analysis was performed to determine the cut-off probability with for optimal sensitivity and specificity. Results Eclampsia, pre-eclampsia, GDM, a history of chronic hypertension, and hypoproteinemia were identified as independent predictors of adverse ocular outcomes during pregnancy (p < 0.05). Maternal age, PIH, intrauterine growth retardation (IUGR), obesity, and pregnancy with immunoglobulin A nephropathy were predictors of moderate and severe retinal arteriole sclerosis during pregnancy (p < 0.05). Additionally, hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome were predictors of retinal hemorrhage and exudate during pregnancy (p < 0.05). The area under the ROC curve for adverse ocular outcomes were 0.75 and 0.74, respectively. Conclusion Our predictive model effectively forecasts adverse ocular outcomes during pregnancy, incorporating risk factors such as maternal age, eclampsia and pre-eclampsia, GDM, obesity, a history of chronic hypertension, hypoproteinemia, IUGR, pregnancy with immunoglobulin A nephropathy, and HELLP syndrome.

Aims/Background Primary hypercholesterolemia (PHC) is a major risk factor for atherosclerotic cardiovascular disease (ASCVD). Although the fact that statins effectively lower low-density lipoprotein cholesterol (LDL-C) levels, some patients fail to achieve target LDL-C levels and continue to have a high risk of cardiovascular disease. This study aims to evaluate the clinical efficacy and safety of ezetimibe combined with rosuvastatin in patients with PHC. Methods This study retrospectively examined 101 patients with PHC who received statins at the cardiology department of Jilin Province FAW General Hospital, between 2021 and 2024. Patients were divided into the observation (ezetimibe combined with rosuvastatin, n = 45) and control (rosuvastatin, n = 66) groups in accordance with their treatment regimens. Data were sourced from the hospital's electronic health records system, and statistical analysis was performed by using SPSS 25.0 software (IBM Corporation, Armonk, NY, USA). Results Baseline characteristics were similar between the two groups. After 12 weeks of treatment, the reduction in LDL-C levels in the observation group (-0.373 [-0.427, -0.348]) was greater than that in the control group (-0.240 [-0.318, -0.222], p < 0.001). The percentage changes in total cholesterol (TC), triglyceride (TG), and high-density lipoprotein cholesterol (HDL-C) levels were significantly better in the observation group (TC: -0.230 [-0.302, -0.144], TG: -0.292 [-0.333, -0.237], and HDL-C: 0.081 [0.067, 0.111]) than in the control group (TC: -0.127 [-0.158, -0.119], TG: -0.082 [-0.101, -0.067], and HDL-C: 0.000 [-0.163, 0.133] with p < 0.001, p < 0.001, and p = 0.011, respectively). Regarding drug safety, the incidence of adverse events was comparable between the two groups (11.10% vs. 12.10%, p = 0.871). Conclusion The combination of ezetimibe and rosuvastatin demonstrates superior lipid-lowering efficacy and good safety in patients with PHC inadequately controlled by statin therapy, providing an effective alternative treatment option. Further large-scale, multicenter randomized controlled trials are warranted to confirm its long-term efficacy and safety.

Aims/Background Fetal growth restriction (FGR) is a common clinical disorder in pregnant women. Inflammation and endoplasmic reticulum stress play an important role in the occurrence and development of FGR. The purpose of this study was to explore the expression and significance of endoplasmic reticulum stress and inflammatory response indicators in the serum of pregnant women with FGR. Methods The data of pregnant women admitted to Changzhou Maternal and Child Health Care Hospital from January 2020 to June 2023 were collected and analyzed by propensity score matching (PSM). Pregnant women with FGR were included in the observation group (n = 65), whereas healthy pregnant women admitted to the hospital during the same period were included in the control group (n = 65). Enzyme-linked immunosorbent assay (ELISA) was used to detect the serum levels of inflammatory markers such as tumor necrosis factor alpha (TNF-α), interleukin-1β (IL-1β) and interleukin-6 (IL-6) in all the pregnant women recruited in this study. The serum levels of glucose regulatory protein 78 (GRP78) and C/EBP homologous protein (CHOP), which are characteristic indicators of endoplasmic reticulum stress, in the two groups of pregnant women, were also detected and analyzed. A range of parameters concerning fetal growth and development indicators, such as fetal head circumference, abdominal circumference and fetal development index, of the two groups of study subjects were recorded and compared. Analyze the correlation between inflammatory response indicators and endoplasmic reticulum stress factors in pregnant women with FGR and fetal growth and development indicators. Results The serum levels of TNF-α, IL-1β and IL-6 in the observation group were significantly higher than those in the control group (p < 0.001). The serum levels of GRP78 and CHOP in the observation group were significantly higher than those in the control group (p < 0.001). The levels of GRP78 and CHOP in pregnant women with FGR were negatively correlated with fetal head circumference, abdominal circumference, and fetal growth and development index (p < 0.05). Conclusion The serum levels of inflammatory markers such as TNF-α, IL-1β and IL-6 in pregnant women with FGR were abnormally elevated, indicating severe inflammatory response. In addition, endoplasmic reticulum stress was observed in pregnant women with FGR, marked by significantly elevated levels of GRP78 and CHOP. The levels of TNF-α, IL-1β, IL-6, GRP78 and CHOP were negatively correlated with fetal head circumference, abdominal circumference and fetal growth and development index, implying their impacts on the occurrence and development of FGR.