British journal of hospital medicine最新文献

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.

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 The association between rheumatic immune diseases and polycystic ovary syndrome (PCOS) remains elusive. The purpose of this study was to investigate the causal relationship between rheumatic immune diseases and the risk of PCOS through a two-sample Mendelian randomization (MR) analysis. Methods In the assessment of exposure variables, we chose systemic lupus erythematosus (SLE), polymyositis (PM), and rheumatoid arthritis (RA) as representative rheumatic immune diseases, while PCOS was designated as the outcome of interest. All data utilized in this investigation were obtained from the Medical Research Council Integrative Epidemiology Unit (MRC-IEU) database. A two-sample MR analysis was conducted using summary statistics for both the exposure and outcome variables, which were gathered from the genome-wide association study (GWAS) datasets. Single nucleotide polymorphisms (SNPs) significantly associated with rheumatic diseases were selected as instrumental variables (IVs) to estimate the causal effects on PCOS. The final results were analyzed using five MR analysis methods, namely MR-Egger, inverse variance weighted (IVW), weighted median (WM), simple mode, and weighted mode. Causal estimation of MR was primarily obtained using the IVW method. Sensitivity analyses were also conducted to evaluate pleiotropy and heterogeneity. Results In this two-sample MR analysis, a total of 1,000,246 participants were included. Among them, there were 647 cases of SLE, 44 cases of PM, 5539 cases of RA, and 797 cases of PCOS. The IVW approach indicated a causal relationship between RA and an increased risk of PCOS (odds ratio [OR] = 1.069, 95% confidence interval [CI] = 1.007-1.134, p = 0.041). The MR-Egger intercept and Cochran's Q test (p > 0.005) further verified the stability of the MR results. However, no significant correlation was observed between the other two rheumatic immune diseases (PM and SLE) and the risk of developing PCOS (both p > 0.05). Conclusion This study suggests a potential causal association between RA and PCOS, while SLE and PM do not exhibit a causal association with PCOS, enhancing our comprehension of the etiological factors of PCOS and shedding light on prevention strategies for the disease. Additional research is required to elucidate the underlying biological mechanisms by which RA contributes to the progression of PCOS.

Aims/Background Pulmonary arterial hypertension (PAH) is a significant contributor to increased overall and cardiovascular mortality in peritoneal dialysis (PD) patients. Cardiopulmonary exercise testing (CPET) is an accurate method for measuring cardiorespiratory fitness (CRF) during both submaximal and peak exercise. Previous studies have demonstrated a strong correlation among CRF and increased cardiovascular and overall mortality rates. However, no literature currently reports the predictive value of CPET parameters for PAH occurrence in PD patients. This study primarily aims to analyze the risk factors for PAH in PD patients, assess the predictive value of CPET parameters, and provide a reference for the clinical prevention and management of PAH. Methods The clinical data of 121 PD patients who underwent CPET were retrospectively collected at Xuzhou Medical University Affiliated Hospital. Based on the event of PAH, patients were divided into two groups: a PAH group (n = 39) and a non-PAH group (n = 82). Clinical data, laboratory results, ultrasound findings, and CPET parameters were compared between the groups. Multifactorial logistic regression analysis was performed to identify the risk factors for PAH. The predictive value of CPET parameters was evaluated by calculating the area under the receiver operating characteristic (ROC) curve (AUC) using ROC curve analysis. Results White blood cell count (WBC) was an independent risk factor for PAH in PD patients (p < 0.05). VO₂peak (peak oxygen uptake), VO₂AT (anaerobic threshold oxygen uptake), METspeak (peak metabolic equivalents), WRpeak (peak power load) were identified as protective factors for PAH in PD patients (p < 0.05). ROC curve analysis showed that the AUC values for predicting PAH in PD patients using VO₂peak, VO₂AT, METspeak, and WRpeak were 0.675, 0.651, 0.719, and 0.689, respectively, with METspeak demonstrating the highest AUC for prediction. Conclusion The occurrence of PAH in PD patients is associated with WBC, VO₂peak, VO₂AT, METspeak, and WRpeak. Additionally, CPET parameters exhibit predictive value for PAH, with METspeak showing the highest AUC for prediction.

Antimicrobial therapy is essential to modern healthcare practice. However, years of injudicious use has contributed to the development of population and individual level harm from antimicrobial resistance. The frail elderly are particularly at risk from infection as well as antimicrobial adverse effects due to multimorbidity, polypharmacy and declining physiological reserve. Diagnosis and management decision making may be challenging in this vulnerable group due to subtle or absent symptoms and signs. Antimicrobial stewardship is the systematic approach to safe and effective use of antimicrobials to optimise outcomes, minimise harm and preserve future therapies. Herein, we consider the significance and importance of antimicrobial stewardship in the frail elderly and suggest ten steps to assist clinicians in the recognition, investigation and management of infection in this group.

Aims/Background Chlamydia psittaci is an obligate intracellular bacterium that primarily infects birds, but can cause respiratory infections in humans. Clinical evidence supporting the use of omadacycline for the treatment of Chlamydia psittaci pneumonia remains limited; therefore, this study aimed to evaluate the potential of omadacycline in treating Chlamydia psittaci pneumonia by analyzing the patients' clinical outcomes and the drug safety profile. Methods We retrospectively reviewed the medical records of 15 patients with Chlamydia psittaci pneumonia treated at the First Affiliated Hospital, Zhejiang University School of Medicine between January and December 2023. Following diagnosis with the aid of metagenomic next-generation sequencing, the patients received omadacycline for treatment, and their clinical outcomes and laboratory marker profiles were monitored to assess the treatment efficacy and safety. Results Significant improvements were observed in clinical symptoms and laboratory markers, including C-reactive protein (p < 0.001), procalcitonin (p = 0.001), neutrophil percentage (p < 0.001), and the SpO₂/FiO₂ ratio (p < 0.001), after treatment with omadacycline. A 100% cure rate was reported within 28 days of treatment initiation, with gastrointestinal disturbances being the most common side effect. Conclusion Omadacycline shows promise in treating Chlamydia psittaci pneumonia and is well tolerated by the users. However, further controlled trials involving larger samples are required to confirm the efficacy and safety of the drug.

Aims/Background During the coronavirus disease 2019 (COVID-19) pandemic, the COVID-19 surveillance staff members experienced an increased risk for musculoskeletal disorders. Thus, it is necessary to further investigate the causal factors stemming from COVID-19 surveillance work, especially nucleic acid testing, and establish their relationship with work-related musculoskeletal disorders (WMSDs) by building upon the previous research. This study aimed to determine the prevalence of WMSDs and the major risks faced by the COVID-19 surveillance staff members. Methods This cross-sectional study was conducted in May 2022. The Quick Exposure Check (QEC), Nordic Musculoskeletal Questionnaire (NMQ), and Maslach Burnout Inventory (MBI) were used to evaluate ergonomic factors, musculoskeletal symptoms and pressure among 131 COVID-19 surveillance staff members in four hospitals in South-central Henan Province. Additionally, data regarding the coping strategies adopted by the respondents for lowing the risk of developing WMSDs were collected using a self-report questionnaire. Results The QEC results showed that the back, neck, and should/arm of the COVID-19 surveillance staff members bore high ergonomic loads, while the wrist suffered a medium load. The neck (75.6%), shoulder (66.4%), upper back (58%), and wrist (55.7%) were at higher risk for musculoskeletal disorder. Most of the respondents claimed a low sense of achievement (124, 94.7%) and slightly less than half of them had endured emotional exhaustion at work (61, 46.6%). Prolonged period of maintaining the same posture at work, awkward bending or twisting of back side, task repetition and so on were the perceived job risk factors precipitating WMSDs among the participants in this study. The top three coping strategies for lowering the risk of WMSDs included adjusting the plinth/bed height (49.6%), utilizing different parts of the body at work (47.3%), and taking short breaks when required (33.6%). Conclusion Prolonged large-scale nucleic acid detection can aggravate the musculoskeletal injuries of the neck, shoulder, upper back, and wrist in COVID-19 surveillance staff members. Prevention measures for musculoskeletal injuries factors must be in place to deter such incidence at work.

Aims/Background Rheumatoid arthritis (RA) is an inflammatory autoimmune disease and N-acetylcysteine (NAC) is considered a potential therapeutic agent for RA due to strong antioxidant and anti-inflammatory properties. Therefore, this systematic review and meta-analysis aimed to evaluate the efficacy of NAC as an adjuvant therapy for RA. Methods A systematic search was conducted across five databases from inception to 1 August 2024, including CINAHL, Cochrane Library, EMBASE, PubMed, and Web of Science. The Cochrane risk-of-bias tool for randomized trials was used to assess the quality of the included studies. Sensitivity analysis was performed when significant heterogeneity was identified. Results Four studies involving 204 patients were included in our meta-analysis. The results indicated that NAC alleviated disease activity in RA patients (Disease Activity Score 28-erythrocyte sedimentation rate (DAS28-ESR): mean difference (MD) = 0.54). Additionally, NAC reduced inflammatory markers (erythrocyte sedimentation rate (ESR): MD = 3.00). However, the beneficial effects of NAC on oxidative stress in RA patients were not observed. Conclusion This meta-analysis demonstrated the efficacy of NAC in reducing inflammatory markers, improving joint tenderness, and swelling in patients with RA.

Aims/Background Hyperuricemia is a metabolic disorder characterized by elevated levels of uric acid in the blood. If left untreated, hyperuricemia can progress to gout, which manifests as acute arthritic attacks, and may also lead to uric acid nephrolithiasis and other renal conditions. This widespread condition poses significant risks to human health and quality of life. This study retrospectively evaluated the effectiveness and safety of using benzbromarone in combination with sodium bicarbonate tablets for the treatment of gout associated with hyperuricemia. Methods The study reviewed the electronic medical records (EMR) of 150 patients with gout and hyperuricemia who were admitted to our hospital between May 2018 and December 2023. These patients were divided into two groups: a control group and a research group. The control group received oral sodium bicarbonate tablets, while the research group was treated with oral benzbromarone tablets in addition to sodium bicarbonate tablets. The study compared the treatment outcomes and adverse reactions between the two groups, as well as assessed changes in blood-related indicators, the number of tophi, pain levels, and quality of life before and after treatment. Results The research group demonstrated a higher total effective rate compared to the control group (p < 0.05). Post-treatment, the research group exhibited significantly lower levels of serum uric acid (UA), serum creatinine (Scr), and urea (p < 0.05). Additionally, this group had fewer tophi and lower visual analog scale (VAS) scores compared to the control group (p < 0.05). Quality of life scores were also significantly higher in the research group (p < 0.05). No statistically significant difference was found in the incidence of adverse drug reactions between the two groups (p > 0.05). Conclusion The combination of benzbromarone and sodium bicarbonate tablets is highly effective in treating gout associated with hyperuricemia. This treatment not only reduces uric acid levels and the number of tophi but also enhances renal function, alleviates pain, and improves the overall quality of life for patients.