British journal of hospital medicine最新文献

Aims/Background The purpose of this study is to investigate the risk factors for gestational diabetes mellitus (GDM) during pregnancy and its impact on neonatal birth outcomes. Methods A total of 2010 cases of mothers with GDM who underwent routine prenatal examinations and delivered at The Fourth Hospital of Shijiazhuang from June 2021 to April 2022, and their newborns were selected as the GDM group. For comparison, 2087 cases of mothers with normal glucose tolerance (NGT) and their newborns during the same period were selected as the NGT group. Birth outcomes of both groups were compared. Results Pregnant women in the GDM group exhibited significantly higher proportions of advanced age, higher body mass index (BMI), and irregular dietary habits compared to the NGT group (p < 0.05). Conversely, the GDM group had significantly lower proportions of nutrient supplementation and prenatal exercise compared to the NGT group (p < 0.05). The incidences of macrosomia, neonatal hypoglycemia, hyperbilirubinemia, and acute respiratory distress syndrome (ARDS) were significantly higher in the GDM group compared to the NGT group (p < 0.05 for all). Among GDM women with adverse outcomes, significant differences were observed in pre-pregnancy BMI, insufficient or excessive weight gain during pregnancy, and poor glycemic control during pregnancy compared to those without adverse outcomes (p < 0.05 for all). Poor glycemic control during pregnancy, pre-pregnancy BMI, and inadequate or excessive weight gain were significant factors influencing adverse pregnancy outcomes in GDM patients (p < 0.05). Conclusion The risk factors for GDM include advanced maternal age, being underweight, overweight, or obese prior to pregnancy, irregular eating habits, dietary nutritional deficiencies, and lack of prenatal exercise. The incidence of adverse pregnancy outcomes is higher in GDM patients compared to those without GDM. Poor glycemic control during pregnancy and higher pre-pregnancy BMI are significant factors that contribute to negative outcomes for both GDM patients and their newborns.

Aims/Background Atraumatic splenic rupture is a very rare and potentially life-threatening event usually associated with underlying pathological conditions. Splenic rupture in infectious mononucleosis occurs only in 0.1%-0.5% of patients. The aim of the present study was to publish a case report of the atraumatic splenic rupture and to present a mini-review of the international literature. Case Presentation A 30-year-old man of mixed races (Caucasian and African) diagnosed with acute cholecystitis was referred by a rural doctor to a secondary district hospital. His past medical and family history was unremarkable. He did not report any allergies. On arrival, his vital signs were stable. However, laboratory examinations demonstrated: white blood cells 26 × 10³/μL (4-11), neutrophils 38.8% (35%-72%), lymphocytes 58% (20%-45%), red blood cells 3.59 M/μL (0-0.6), haemoglobin 10.9 g/dL (13.5-17.5), haematocrit 33.4% (40%-54%), platelets 11.5 fL (6.5-11), prothrombin time 13.2 s (9.4-12.5), glucose 70 mg/dL (74-107), sodium 135 mmol/L (137-146), calcium 7.6 mg/dL (8.8-106), serum glutamic-oxaloacetic transaminase 426 U/L (10-45), serum glutamate pyruvate transaminase 530 U/L (7-45), gamma glutamyl transferase 151 U/L (7-49), total albumins 5.3 g/dL (6.6-8.3), C-reactive protein 235 mg/L (<5), and Epstein-Barr virus 15.50 S/CO (0-1.0). In addition, computed tomography determined hepatosplenomegaly, haemoperitoneum, and spleen rupture. Physical examination revealed abdominal rigidity, left shoulder tip pain, shortened capillary refill time, and neck lymphadenopathy. Results The patient underwent expeditious total splenectomy, postoperative period was uneventful and he was discharged on the sixth postoperative day. He was scheduled to undergo the post-splenectomy vaccinations and regular follow-ups with his general practitioner abroad. Conclusion In patients without a history of trauma, spontaneous splenic rupture should be considered in the differential diagnosis if patients have complaints of abdominal and left shoulder tip pain, and laboratory results indicate low haemoglobin and haematocrit levels.

Aims/Background Neonatal respiratory distress syndrome (NRDS) is characterized by progressive aggravation and rapid progression of respiratory distress, with a high incidence rate among premature infants. If left untreated, NRDS results in a poor prognosis. In recent years, various respiratory support modalities have received extensive attention in clinical practice. The therapeutic effect of different respiratory support modes on NRDS has gradually become the focus of clinical research. The aim of this study was to explore the therapeutic effects of nasal bi-level positive airway pressure (nBiPAP) and nasal synchronized intermittent mandatory ventilation (nSIMV) on NRDS. Methods This study retrospectively analyzed the clinical data of 157 newborns with NRDS in the Mudanjiang Medical University Affiliated Second Hospital from January 2021 to December 2023, finally including 153 cases after excluding 4 cases with missing clinical data. According to the non-invasive ventilation method, these newborns were categorized into a nBiPAP group (receiving nBiPAP treatment, n = 77) and an nSIMV group (receiving nSIMV treatment, n = 76). The blood gas indices, using time of ventilator, hospitalization time, therapeutic effects, and incidence of complications were compared between the two groups. Results The PaCO₂, PaO₂, and pH levels in the nBiPAP group were basically consistent with those in the nSIMV group before and after treatment (p > 0.05). The use time of ventilator, hospitalization time, and therapeutic effects in the nBiPAP group were similar to those in the nSIMV group (p > 0.05). Additionally, both groups demonstrated no significant difference in the incidence of complications such as intraventricular hemorrhage, apnea, necrotizing enterocolitis, and feeding intolerance (p > 0.05). The incidence rates of ventilator-associated lung injury and neonatal bronchopulmonary dysplasia in the nBiPAP group were lower than those in the nSIMV group, with a significant difference (p < 0.05). Conclusion Both nBiPAP and nSIMV have shown good effects in treating NRDS, with nBiPAP showing a significant advantage in reducing the incidence rates of complications such as ventilator-associated lung injury and neonatal bronchopulmonary dysplasia.

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).