British journal of hospital medicine最新文献

Cervical cancer remains a leading cause of cancer-related mortality among women worldwide, particularly in underdeveloped nations. Despite advances in standard therapies, patients with recurrent metastatic cervical cancer face a poor prognosis and limited treatment options. This study aims to evaluate the efficacy and safety of emerging therapeutic approaches in managing this challenging condition, including immunotherapy, targeted medicines, and chemotherapy. Our review of recent literature and clinical trials highlights the significant progress made in the systematic treatment of metastatic cervical cancer. While each treatment modality has its strengths and limitations, the collective data suggest a trend towards improved patient outcomes with the adoption of these novel therapies. However, the heterogeneity of patient responses underscores the need for personalised treatment strategies. In conclusion, improvements in medical technology and the adoption of tailored treatment approaches have led to promising advancements in the management of recurrent metastatic cervical cancer. To further enhance patient care, there is an urgent need for more extensive clinical trial data and the development of more efficient personalised treatment plans. This study aims to contribute to this effort by comprehensively analysing current therapeutic strategies and identifying areas for future research.

Aims/Background Perinatal obsessive-compulsive symptoms are significant predictors of increased postpartum anxiety, depression, and bipolar disorder. These symptoms have persistent adverse effects on both mothers and children. Currently, there are few reports in the literature on obsessive-compulsive disorder in elderly parturient women in China. This study primarily discusses the clinical characteristics of perinatal obsessive-compulsive symptoms in elderly parturient women and analyzes their influencing factors, aiming to provide references for clinical prevention and treatment. Methods This research employed a cross-sectional design, utilizing a convenience sampling method to select elderly parturients who delivered at Panjin Central Hospital from September 2022 to August 2023. The assessment instruments included a general data questionnaire, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the self-rating anxiety scale (SAS), the edinburgh postpartum depression scale (EPDS), and the sense of coherence scale (SOC-13). The relationship between the severity of obsessive-compulsive symptoms and negative emotions and psychological burden was examined through Pearson correlation analysis. Additionally, the influencing factors of perinatal obsessive-compulsive symptoms were analyzed using multivariate logistic regression. Results In this study, a total of 124 questionnaires were distributed, and 122 valid questionnaires were recovered, yielding an effective recovery rate of 98.39%. Among the 122 elderly parturients, 37 were positive for perinatal obsessive-compulsive disorder, accounting for 30.33% (37/122). Among the 37 elderly parturients with perinatal obsessive-compulsive symptoms, 64.86% had both obsessive-compulsive thoughts and behaviors, 21.62% had obsessive-compulsive thoughts as the main symptom (8/37), and 13.51% had obsessive-compulsive behaviors (5/37). Multivariate logistic regression analysis showed that pregnancy history, pregnancy complications, fetal health, SOC-13 score, SAS score, and EPDS score were independent risk factors for positive perinatal obsessive-compulsive symptoms (p < 0.05). Conclusion The incidence of perinatal obsessive-compulsive symptoms in elderly parturient women is high. Obsessive-compulsive thoughts primarily involve fears of injury and contamination, while obsessive-compulsive behaviors mainly consist of compulsive checking and cleaning. The occurrence of perinatal obsessive-compulsive disorder is associated with factors such as pregnancy and childbirth history, pregnancy complications, fetal health, negative emotions, and stress resistance.

With the rapid ageing of the population, the number of older adults with two or more chronic diseases is increasing. There are individual differences in health assessment, diagnosis, treatment, health management, and medication safety for older adults with chronic conditions and multiple morbidities. Managing these conditions poses increasingly complex challenges for the healthcare system. Developing effective community health management models specifically designed for older adults with multiple chronic diseases is crucial for improving their overall health. This study provides a comprehensive review of the progress in research on community health management models for older adults with multiple chronic diseases, aiming to offer valuable insights for health management in this population.

Huge advances in the medical treatment of ileocaecal Crohn's disease have occurred in the last 20 years. Consequently, surgery has become synonymous with treatment failure and is often only implemented when multiple medical interventions have been trialled. However, evidence that patients avoid surgery in the long term is questionable. When surgery occurs, the disease progresses. Surgery is more complex and outcomes such as complications and stoma formation are more common. Many studies suggest that, in terms of longer-term quality of life, earlier surgery may be superior. Specific clinical scenarios exist where this benefit is more obvious (fibrostenotic or fistulating disease) but even with disease limited to the lumen, benefits can be realised. Significant barriers exist to this mindset of earlier surgery. Such barriers can only be overcome with a vigorous multidisciplinary approach. This editorial describes the debate surrounding the concept of early bowel resection in these patients.

Aims/Background Lung cancer (LC) remains one of the most common malignant tumours worldwide, and assessment of its progression is important for ensuring better prognostic outcomes for patients. This study was designed to explore the prognostic role of certain indices, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and prognostic nutritional index (PNI) in patients with LC, to help clinics to better determine the prognosis of patients with LC, and to allow them to intervene in a timely manner. Methods A retrospective analysis of 116 initially diagnosed patients with LC in China from 2018 to 2020 was conducted. The counts of neutrophils (NEU), lymphocytes (LYM), and monocytes (MON), as well as albumin levels, were obtained from laboratory databases. The PNI was calculated using a specific formula. The progression-free survival (PFS) curves were plotted using the Kaplan-Meier method, and the Log-rank test was used to compare survival among different groups. The potential prognostic role of these indicators was assessed with univariate and multivariate regression analysis. Results Multivariate Cox regression demonstrated that the PNI (hazard ratio (HR): 0.513, 95% confidence interval (CI): 0.288-0.917, p = 0.024), NLR (HR: 2.038, 95% CI: 1.128-3.682, p = 0.018), and tumour type (small cell lung cancer vs. non-small cell lung cancer) (HR: 2.145, 95% CI: 1.308-3.520, p = 0.003) were significantly associated with PFS. The median PFS for patients with low and high PNI was 10 and 11.5 months, respectively. Conclusion The NLR, PLR, and PNI are all significantly associated with the prognostic survival of LC patients.

Polypharmacy is common among older people and is associated with multiple adverse outcomes. Assessing whether it is appropriate or inappropriate for an individual is more informative than relying on a simple pill count. Modern medicine is based on single disease guidelines that promote prescribing but tend not to have deprescribing criteria. Barriers to deprescribing promote the accumulation of medicines over time. Clinical trial data have limitations due to the selected populations recruited. Some evidence suggests older people with multi-morbidity may benefit less and people with frailty are at increased risk of harm. Prescribing can be inappropriate if it is not evidence-based, harm is likely to exceed the benefit, includes hazardous medications or combinations of medicines, the patient experiences therapeutic burden, there is reduced adherence or prescribing cascades. Medicines optimisation aims to improve prescribing quality for an individual patient and may include deprescribing. It is a complex process that includes shared decision-making, careful follow-up, and communication of any resulting prescription changes.

Aims/Background In the treatment of patients with cervical cancer, lymph node metastasis (LNM) is an important indicator for stratified treatment and prognosis of cervical cancer. This study aimed to develop and validate a multimodal model based on contrast-enhanced multiphase computed tomography (CT) images and clinical variables to accurately predict LNM in patients with cervical cancer. Methods This study included 233 multiphase contrast-enhanced CT images of patients with pathologically confirmed cervical malignancies treated at the Affiliated Dongyang Hospital of Wenzhou Medical University. A three-dimensional MedicalNet pre-trained model was used to extract features. Minimum redundancy-maximum correlation, and least absolute shrinkage and selection operator regression were used to screen the features that were ultimately combined with clinical candidate predictors to build the prediction model. The area under the curve (AUC) was used to assess the predictive efficacy of the model. Results The results indicate that the deep transfer learning model exhibited high diagnostic performance within the internal validation set, with an AUC of 0.82, accuracy of 0.88, sensitivity of 0.83, and specificity of 0.89. Conclusion We constructed a comprehensive, multiparameter model based on the concept of deep transfer learning, by pre-training the model with contrast-enhanced multiphase CT images and an array of clinical variables, for predicting LNM in patients with cervical cancer, which could aid the clinical stratification of these patients via a noninvasive manner.

Aims/Background Femoral neck fractures in elderly patients carry a high risk of developing deep vein thrombosis (DVT) due to prolonged immobilization and surgical intervention. This study examines the effectiveness of combining intermittent pneumatic compression (IPC) with low-molecular-weight heparin (LMWH) for preventing DVT in elderly patients following femoral neck fracture surgery. Methods A total of 150 elderly patients with femoral neck fractures, admitted between January 2022 and January 2024, were retrospectively selected, and their clinical data were analyzed. Based on the treatment methods, the patients were divided into a control group (n = 71) and a study group (n = 79). The control group received LMWH treatment, while the study group received a combination of LMWH and IPC. The incidence of DVT, surgical outcomes, hip joint function, coagulation function indicators, hemodynamic indicators, and serum pro-inflammatory factors were compared between the two groups. Results The results showed that the incidence of DVT in the study group was lower than in the control group (p = 0.017). There were no significant differences between the two groups in terms of intraoperative blood loss, postoperative drainage volume, or Harris scores (p > 0.05). After the intervention, the study group demonstrated higher levels of average velocity (Va), peak blood flow velocity (Vp), and blood flow (BF) compared to the control group (p < 0.05). Additionally, the activated partial thromboplastin time (APTT) and prothrombin time (PT) were longer, while the D-dimer (D-D) level was lower in the study group (p < 0.05). The study group also exhibited lower levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-8 (IL-8) (p < 0.05). Conclusion The results indicate that combining IPC with LMWH effectively reduces the incidence of postoperative DVT in elderly patients with femoral neck fractures, improves venous blood flow in the lower limbs, reduces vascular inflammation, and ensures safety.

Lung cancer is a leading cause of death globally with high mortality and morbidity. Patients are often diagnosed at an advanced stage. Metformin has become a primary medication used in the clinical management of type 2 diabetes mellitus (T2DM) due to its relative safety, low cost, and effectiveness, mainly exerting its hypoglycemic effect by inhibiting hepatic gluconeogenesis and insulin resistance. Research data indicate that metformin extends the distant metastasis-free survival (DMFS) and progression-free survival (PFS) of diabetic patients with lung cancer, improving overall survival rates. Metformin lowers the risk of tumour development through various mechanisms, including the adenosine 5'-monophosphate-activated protein kinase/liver kinase B1/mechanistic target of rapamycin (AMPK/LKB1/mTOR) pathway, insulin-like growth factor-1 receptor pathway, apoptosis, and autophagy. However, research findings are not entirely consistent. This article reviews the research progress of metformin in terms of lung cancer treatment within the past few years, aiming to provide a more comprehensive understanding of how metformin exerts its anti-cancer impact and how it can be clinically applied, as well as provide new insights for lung cancer treatment.

Aims/Background Both membranous nephropathy (MN) and immunoglobulin A nephropathy (IgAN) are immune complex-mediated glomerular diseases, but the concurrent occurrence of these two conditions in the same patient is not common, a phenomenon that is currently not supported by clinical data in terms of treatment and prognosis. This study explores the clinical and pathological characteristics, as well as the treatment outcomes, of patients affected by MN and IgAN simultaneously. Methods The clinical data, pathological features, and diagnostic and therapeutic information of seven cases of MN complicated by IgAN, treated between December 2015 and December 2022, were retrospectively analyzed. Results Among the seven cases, there were two male and five female patients, with an average age of 57.3 ± 9.2 years. All patients presented with clinical manifestations of proteinuria and edema upon admission, with an average 24-hour urine protein of 3716.6 ± 1519.4 mg/24 h. Phospholipase A2 receptor (PLA2R) expression was detected in all seven cases, and nephrotic syndrome was clinically diagnosed in five cases. Additionally, all seven cases showed microscopic hematuria, with intermittent gross hematuria in two cases. All seven patients included in this study underwent renal biopsy. After disease staging, the patients had MN stages I-III and IgAN stages II-III. Pathological findings revealed abnormal glomerular basement membrane (GBM) and diffuse immunoglobulin G (IgG) deposition in the subepithelial space, predominantly of the IgG4 subtype. Simultaneously, there was diffuse mesangial zone deposition of immunoglobulin A (IgA) to varying degrees, co-localization of complement component C3 and IgA, and mesangial cell proliferation. Treatment strategies included angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) in combination with steroids or immunosuppressive therapies such as tacrolimus, cyclophosphamide, and rituximab. After 2-6 months of treatment, all patients achieved complete remission with a favourable prognosis. Conclusion MN accompanied by IgAN tends to occur more frequently in middle-aged and elderly individuals, with a relatively low incidence. The latent feature of the comorbidities manifests as a form of IgAN superimposed on the background of MN. Utilizing ACEI or ARB in combination with steroids or various immunosuppressive therapies represents a potentially effective treatment strategy.