British journal of hospital medicine最新文献

Aims/Background Triptorelin effectively delays bone age progression in children with precocious puberty but may suppress pituitary growth hormone response, affecting growth hormone-binding protein secretion and overall growth rate. This study aimed to evaluate the efficacy and safety of triptorelin alone versus in combination with recombinant human growth hormone (rhGH) in treating girls with precocious puberty. Methods This retrospective study examined 82 girls with precocious puberty treated at The First People's Hospital of Tongxiang from January 2021 to June 2023. Patients treated with triptorelin alone were assigned to the control group (n = 42), while those treated with triptorelin combined with rhGH formed the study group (n = 40). Both groups received continuous treatment for one year. Outcomes, including efficacy and safety, were compared between the groups. Results Following treatment, height and body mass in the study group were significantly higher than those in the control group (t = 2.126, p = 0.037; t = 2.419, p = 0.018). The bone age/chronological age (BA/CA) ratio in the study group was significantly lower than that in the control group (t = 2.185, p = 0.032). Levels of estradiol (E₂), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) in the study group were also significantly reduced compared to the control group (t = 2.208, p = 0.030; t = 4.492, p < 0.001; t = 2.952, p = 0.004). Furthermore, left and right ovarian volumes and uterine volume were significantly lower in the study group than those in the control group (t = 2.740, p = 0.008; t = 2.936, p = 0.004; t = 2.520, p = 0.014). After one year, the effective treatment rate in the study group was higher than that in the control group (97.50% vs 80.95%, p < 0.05). No serious adverse reactions were observed in either group during the treatment period. Conclusion The combination of triptorelin and rhGH demonstrates a clear therapeutic in girls with precocious puberty, which effectively delays bone age growth, regulates sex hormone levels, and reduces ovarian and uterine volumes without severe adverse effects.

Aims/Background The classification of polypoidal choroidal vasculopathy (PCV) as a subtype of neovascular age-related macular degeneration (nAMD) remained an ongoing controversy. This meta-analysis examines the efficacy of intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents in nAMD patients with or without PCV. Methods A systematic search was conducted in four databases, including PubMed, EMBASE, MEDLINE, and Cochrane Library, from their inception to 1 July 2023. The outcome measure was the change in best-corrected visual acuity (BCVA) and center retinal thickness (CRT) from the baseline to different follow-up durations. Furthermore, sensitivity analysis was performed when significant heterogeneity was detected. Results This meta-analysis included sixteen studies involving 6679 patients, comprising 5070 non-PCV and 1609 PCV cases. The findings revealed that the improvement in BCVA at 6-month follow-up (mean difference (MD) = 0.05; 95% confidence interval (CI), 0.02 to 0.07; p = 0.0001) and the reduction in CRT at 3-month follow-up duration (MD = 10.29; 95% CI, 0.93 to 19.66; p = 0.03) were significantly greater in the PCV group compared to the non-PCV group. Conclusion This meta-analysis indicates that PCV may exhibit better short-term efficacy in response to anti-VEGF therapy than non-PCV. Systematic Review Registration PROSPERO (CRD42023445591).

Non-alcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease and is linked to metabolic syndrome components such as insulin resistance and obesity. In 2020, the term "metabolic dysfunction-associated fatty liver disease (MAFLD)" was introduced, incorporating metabolic risk factors and including patients with other liver conditions. However, concerns about the term "fatty" led to the proposal of the term "metabolic dysfunction-associated steatotic liver disease (MASLD)", which refined diagnostic criteria but excluded patients with significant alcohol consumption or liver comorbidities. Although MASLD improves NAFLD in some respects, its exclusion of comorbid conditions may hinder comprehensive care for metabolic dysregulation. A proposed solution is "combinatorial MASLD", which would better address patients with liver comorbidities. Further studies are necessary to determine the most appropriate nomenclature for clinical practice.

Aims/Background Systemic lupus erythematosus (SLE) is a complex autoimmune disorder characterised by an unpredictable disease course and multifaceted clinical presentations. Recent studies have highlighted the potential role of interleukin-33 (IL-33) in autoimmune diseases, but its exact relationship with SLE remains unclear. Therefore, to investigate the role of serum IL-33 levels as a biomarker, we evaluated its correlation with disease activity and organ damage in SLE patients. Methods This retrospective analysis included 120 SLE patients from the Department of Rheumatology and Immunology, The Fourth Affiliated Hospital of Soochow University between January 2018 and December 2022. For comparative analysis, we recruited 60 healthy controls. Correlations between IL-33 levels and disease metrics were evaluated, and subgroup analyses were performed to explore specific clinical associations. Results Our findings revealed that SLE patients had significantly higher serum IL-33 levels than the control group (258.7 ± 103.5 pg/mL vs 78.3 ± 32.6 pg/mL, p < 0.001). Furthermore, IL-33 levels showed a significant association with both disease activity (Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)) (r = 0.68, p < 0.001) and cumulative organ damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR DI)) scores (r = 0.45, p < 0.01). Notably, patients with active disease (SLEDAI ≥6) exhibited substantially elevated IL-33 levels (p < 0.001). Patients with organ damage (SLICC/ACR DI ≥1) demonstrated significantly higher IL-33 levels than those without organ damage (289.6 ± 95.3 pg/mL vs 234.1 ± 86.2 pg/mL, p = 0.001), and those with renal involvement showed higher IL-33 levels (p < 0.01). Receiver operating characteristic (ROC) curve analysis revealed better diagnostic potential of serum IL-33 levels for SLE (area under the curve (AUC) = 0.892, 95% confidence interval (CI): 0.845-0.939, sensitivity = 84.2%, specificity = 82.7%) and for identifying active disease (AUC = 0.816, 95% CI: 0.752-0.880, sensitivity = 77.8%, specificity = 75.0%). Conclusion Our findings suggest that serum IL-33 may serve as a promising biomarker for comprehensive SLE assessment, offering new avenues for monitoring disease progression and guiding therapeutic strategies.

Aims/Background Sentinel lymph nodes (SLNs) are an important prognostic factor for breast cancer patients, but traditional axillary lymph node dissection methods have many complications, while sentinel lymph node biopsy has been developed as a better method. This study aimed to evaluate the efficiency of combining contrast-enhanced ultrasound (CEUS) with methylene blue for identifying SLNs in early-stage breast cancer patients. Methods This retrospective study included clinical data from 163 female patients with lymph node-negative and T1-2 early breast cancer admitted to China-Japan Friendship Hospital between August 2022 and November 2023. All patients received a periareolar injection of SonoVue followed by ultrasonography to identify SLNs. The methylene blue was used to detect SLNs during the surgery, and the patients underwent sentinel lymph node biopsy. We compared the methylene blue method with combined CEUS and methylene blue to identify the number of SLNs per patient. Furthermore, these two methods were compared to determine the number of SLNs and the number of SLNs positive in 34 SLNs positive patients. Results This study included 163 patients with tumor (T)1-2 node (N)0-3 metastasis (M)0. The identification rate of SLNs was 100% for CEUS. We detected 376 SLNs using a combined CEUS and methylene blue method, with a median of 2 (1, 5). Furthermore, methylene blue identified 627 SLNs, with a median of 3 (1, 12). However, CEUS detected a significantly lower number of SLNs than those identified by methylene blue (p < 0.001). Additionally, metastasis frequency was substantially higher for the combined CEUS and methylene blue method (66.3%, 53/80) compared to methylene blue approach alone (39.5%, 58/147) (p < 0.001). Conclusion Combining CEUS with methylene blue is expected to improve the accuracy of axillary staging in breast cancer patients while reducing surgical trauma and postoperative complications.

Aims/Background Pacemakers are essential devices for patients with cardiac rhythm abnormalities. However, the occurrence of arrhythmias after pacemaker implantation remains a clinical challenge. This study aimed to identify and analyze the factors that influence the occurrence of arrhythmias following pacemaker implantation to improve patient outcomes. Methods Clinical data of patients who received pacemaker implantation treatment in the Affiliated Hospital of Chengdu University from January 2021 to December 2022 were retrospectively analyzed. A total of 137 patients were followed up for 12 months and then divided into two groups based on the occurrence of arrhythmias post-implantation: the occurrence group (n = 40) and the non-occurrence group (n = 97). General data, including gender, age, cardiac function indexes, and preoperative anxiety, were collected and compared. Binary logistic regression was used to analyze the influencing factors of arrhythmia occurrence, while Spearman correlation analysis was employed to examine the correlation between cardiac function indexes and arrhythmia occurrence. Results Significant differences were found in age, history of hypertension, preoperative anxiety score, preoperative depression score, preoperative left ventricular end-diastolic diameter (LVEDD), and preoperative left ventricular ejection fraction (LVEF) between the two groups (p < 0.05). There was a positive correlation between arrhythmias occurrence and preoperative LVEDD and LVEF (r = 0.270, 0.329; p < 0.01). Age, history of hypertension, preoperative anxiety score, preoperative depression score, preoperative LVEDD, and preoperative LVEF were identified as risk factors for arrhythmias (odds ratio [OR]) = 2.507, 2.479, 3.012, 2.432, 3.614, 4.525; all p < 0.05). Conclusion Age, history of hypertension, preoperative anxiety score, preoperative depression score, preoperative LVEF, and preoperative LVEDD are important influencing factors for arrhythmias occurrence, which are correlated with preoperative cardiac function indexes. Thus, preoperative observation utilizing these factors can provide a reference for screening high-risk groups.

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.