British journal of hospital medicine最新文献

Aims/Background Membranous nephropathy (MN) is categorized into primary and secondary forms based on its etiology, with autoimmune diseases significantly contributing to the secondary form. The phospholipase A2 receptor (PLA2R) antibody has been widely used as a specific marker for primary MN. However, explaining PLA2R positivity in MN patients who also exhibit typical features of Sjögren's syndrome (SS) is challenging. Case Presentation A 51-year-old male patient presented with acute systemic edema, hypertension, macroalbuminuria, and hypoproteinemia, confirming a diagnosis of nephrotic syndrome. Concurrently, SS, characterized by dry mouth and dry eye symptoms, positive specific antibodies, and positive labial gland biopsy results, was also confirmed. Renal pathology indicated MN (stage I-II) with moderate secondary chronic renal tubulointerstitial lesions. The cluster of differentiation 3 (CD3)+ and CD20+ immunostaining of renal tissue was consistent with renal interstitial damage associated with SS, and the clinical manifestations aligned with the typical presentation of renal tubular acidosis (RTA). PLA2R was negative in the serum but positive in the renal tissue. Conclusion SS is one of the autoimmune diseases associated with secondary membranous nephropathy, which has a low clinical incidence. In this particular case, the diagnosis of SS was confirmed, and the histopathological examination revealed typical tubulointerstitial lesions clinically accompanied by RTA. However, the specific antibody PLA2R, which is typically associated with primary MN, was positive in renal tissue. Additionally, IgG immunodeposition was not observed. Further investigation is warranted to ascertain whether the MN is secondary to SS.

Aims/Background Mentorship is crucial to research success, but a detailed assessment and evaluation of the different types of mentorship models in hospital medicine have not been conducted. We sought to identify and define research mentorship models in hospital medicine. We also assessed the effectiveness of each model for the identified studies that met this narrative review's criteria. Methods Narrative review of peer-reviewed, USA-published literature on hospital medicine research mentorship. Articles from 1996 to 2023 with selected search terms on hospitalists' mentorship in research were searched in PubMed, Scopus and Embase. Finalized articles obtained from the search were approved by the Society of Hospital Medicine's Research Committee. Results Ten articles published between 2008 and 2023 were identified and assessed by the Society of Hospital Medicine's Research Committee members. Three major research mentorship models were identified: (1) traditional mentor-mentee dyad, (2) peer mentorship, and (3) research coaching. Some hospital medicine groups combined mentorship models. All articles reported successful implementation with positive faculty receptivity and/or research output. However, the studies had small sample sizes and short evaluation periods. Conclusion Hospitalist research mentorship is essential to bolstering and enhancing research in hospital medicine. Further studies with larger samples, extended time frames, those conducted outside the USA, and frequent reassessments are urgently needed to determine the sustained effectiveness of any model.

Aims/Background Sepsis remains a major cause of mortality in intensive care units (ICUs) worldwide, with conventional treatments showing limited efficacy. Extracorporeal hemopurification (EH) techniques have emerged as promising adjunctive therapies. This study aims to explore the impact of EH techniques, including hemofiltration, hemoperfusion, hemodialysis, and hemosorption, on the clinical prognosis and immune function of patients with sepsis. Methods We searched relevant literature describing patients with a precise clinical diagnosis of sepsis, severe sepsis, or septic shock across various databases, including MEDLINE, AMED, Cochrane Library, Embase, PubMed, China National Knowledge Infrastructure (CNKI), Weipu, and Wanfang, published from January 2010 to October 2023. Both randomized controlled trials and observational studies were included to compare those receiving EH and conventional anti-infective treatment. Meta-analysis was performed using RevMan 5.3 software after two evaluators independently screened the literature, extracted information, and evaluated the methodological quality of the included studies. The primary outcome indicators included in-hospital mortality (IHM) and length of ICU stay (LOS-ICU). Furthermore, the changes in T-helper 1/T-helper 2 (Th1/Th2) levels were analyzed and expressed as relative risk (RR), odds ratio (OR), or mean difference (MD) with corresponding 95% confidence interval (CI) as appropriate for the type of outcome measure. Results This analysis included 30 studies (n = 2262) (1267 in the EH group and 995 in the conventional treatment group). We observed that EH treatment, such as hemopurification, hemofiltration, hemoperfusion, hemodialysis, and hemoadsorption, significantly reduced IHM in sepsis patients (RR = 0.75, 95% CI: 0.68-0.84, p < 0.00001). However, there was no significant impact on LOS-ICU (MD = -0.44, 95% CI: -2.29-1.41, p = 0.64). Subgroup analyses suggested that cytokine adsorption (OR = 0.69, p = 0.17) or polymyxin B blood perfusion (OR = 0.73, p = 0.06) did not reduce IHM in sepsis patients. Similarly, EH did not improve IHM in patients with septic acute renal failure (RR = 0.82, p = 0.27) and IHM in patients with burn-induced sepsis (RR = 0.59, p = 0.07). For sepsis patients with improved Th1/Th2 value of immune factor levels by EH, IHM was not significantly reduced (RR = 0.61, p = 0.08), and LOS-ICU also showed no significant difference (MD = 0.34, 95% CI: -5.92-6.60, p = 0.92). Conclusion For sepsis patients without relevant contraindications, EH holds promise as an adjunctive therapy, but the modulation of immune factor levels during treatment does not consistently influence the LOS-ICU.

Epilepsy is a serious neurological condition that can affect individuals of all ages. Treatment is far from perfect, and roughly 30% of patients can experience seizures that are resistant to antiseizure medications. Interestingly, the cannabis plant, specifically the phytocannabinoids, cannabidiol and delta-9-tetrahydrocannabinol, has been shown to possess anticonvulsant properties and are effective in the treatment of seizures. The clinical evidence base for cannabis for epileptic conditions has been growing in the last few decades with studies aiming to establish the clinical efficacy and safety profile of the plant. Despite the advancements that are being made, clinicians and medical regulatory bodies are still reluctant for epilepsy patients to use cannabis. Thus, it is essential that individuals are educated about the therapeutic properties of cannabis and the clinical evidence base to help patients gain access to cannabis medicines.

Aims/Background Peripheral neuropathy (PN) is a common and debilitating complication in patients with multiple myeloma (MM), which results from both disease-related mechanisms and treatment-induced neurotoxicity. Despite its clinical significance, comprehensive investigations assessing PN risk in MM, along with examining demographic, clinical, nutritional, and inflammatory factors, remain limited. Therefore, this study aimed to investigate independent risk predictors associated with PN in MM patients using univariate and multivariate logistic regression analysis, thereby enhancing clinical risk management and improving treatment outcomes. Methods This retrospective observational study included 161 MM patients who were treated at Ganzhou People's Hospital between February 2020 and February 2024. Study participants were divided into the PN (n = 45) and non-PN (n = 116) groups. PN diagnosis was conducted based on new neurological signs and symptoms post-treatment, confirmed through abnormal sensory, motor, autonomic, or nerve conduction assessments. Baseline characteristics, including demographic information, clinical features, and laboratory parameters, were compared between the two groups using Mann-Whitney U and Chi-square tests. Univariate logistic regression analysis evaluated potential parameters associated with PN. Furthermore, a multivariate logistic model was used to assess independent risk predictors. Finally, model performance was evaluated via receiver operating characteristic (ROC) curve analysis. Results This study analyzed 161 patients, of whom 45 (27.95%) developed PN. Patients in the PN group were significantly older, and had higher body mass index (BMI), increased immunoglobulin G (IgG) and interleukin-6 (IL-6) levels, and increased diabetes prevalence than the non-PN group. However, they exhibited lower hemoglobin (Hb) and serum 25-hydroxyvitamin D [25(OH)D] levels (p < 0.05). Multivariate logistic regression analysis identified older age (odds ratio [OR] = 1.49, 95% confidence interval [CI]: 1.07-2.08), higher BMI (OR = 2.05, 95% CI: 1.01-4.17), reduced 25(OH)D levels (OR = 0.54, 95% CI: 0.29-0.97), elevated IgG (OR = 1.64, 95% CI: 1.12-2.41), and increased IL-6 (OR = 2.07, 95% CI: 1.10-3.88) as independent PN predictor. The model showed excellent discrimination capability (area under the curve [AUC] = 0.998, 95% CI: 0.996-1.000, p < 0.001). Conclusion This study identified older age, higher BMI, vitamin D deficiency, elevated IgG, and increased IL-6 levels as independent risk predictors for PN. Assessing these parameters in the early stages facilitates the identification of high-risk patients, allowing for targeted preventive strategies and personalized nursing interventions in MM patients which can reduce PN incidence and enhance overall clinical outcomes.

Metacarpal fractures are one of the most common types of upper extremity fractures. During fracture, the balanced force couple of the hand flexors and extensors is disrupted, allowing shortening, angulation and rotation of the metacarpal shaft. Malunion is the most common complication, though it can largely be treated conservatively. When malunion leads to significant functional deficit surgical approaches must be explored to restore the biomechanics of the hand to allow functional return. This review article aims to explore the current concepts in surgical management of malunited metacarpal shaft fractures to ensure the latest advances are available to the hand surgeons of today.

Aims/Background In rheumatoid arthritis (RA) patients, malnutrition and sarcopenia are commonly associated with poor prognosis. The prognostic nutritional index (PNI), which includes serum albumin levels and lymphocyte counts, reflects the nutritional and inflammatory status of the patient. Therefore, this study aims to assess the relationship between PNI and sarcopenia in RA and examine its role as a diagnostic tool. Methods This retrospective study analysed data from 178 RA patients hospitalised at Affiliated Jinhua Hospital, Zhejiang University School of Medicine, between June 2023 and June 2025. Sarcopenia was diagnosed following the 2019 Asian Working Group for Sarcopenia (AWGS) criteria. Demographic, clinical, and laboratory data were collected, and PNI was calculated. Univariate and multivariate logistic regression analyses were performed to examine the association between PNI and sarcopenia, and receiver operating characteristic (ROC) curves were used to evaluate its diagnostic performance. Results Out of the total 178, 56 (31.5%) patients were diagnosed with sarcopenia. Multivariate regression analysis indicated lower PNI as an independent risk factor for sarcopenia (odds ratio [OR] = 0.88, 95% confidence interval [CI]: 0.80-0.97, p = 0.007), indicating that each 1-point increase in PNI was associated with a 12% decrease in risk. Older age (OR = 1.07), longer RA disease duration (OR = 1.50), and higher C-reactive protein (CRP) (OR = 1.06) were also independent risk factors. A prediction model combining age, PNI, disease duration, and CRP showed excellent discriminatory ability for sarcopenia, with an area under the curve (AUC) of 0.92 (95% CI: 0.87-0.97, p < 0.001), a sensitivity of 95.1%, and a specificity of 80.4%. Conclusion PNI is a simple, cost-effective measure that integrates nutritional (albumin) and inflammatory (lymphocyte) markers, facilitating early identification of RA patients at higher risk for sarcopenia and providing a basis for timely intervention.