Annals of medicine最新文献

Objective: Acute type A aortic dissection (ATAAD) is a devastating cardiovascular disease with extraordinary morbidity and mortality. Prolonged mechanical ventilation (PMV) is a common complication following ATAAD surgery, leading to adverse outcomes. This study aimed to investigate the correlation between mechanical ventilation time (MVT) and prognosis and to devise a nomogram for predicting PMV after ATAAD surgery.

Methods: This retrospective study enrolled 1049 ATAAD patients from 2011 to 2019. Subgroups were divided into < 12 h, 12 h to < 24 h, 24 h to < 48 h, 48 h to < 72 h, and ≥ 72 h according to MVT. Clinical characteristics and outcomes were compared among the groups. Using multivariable logistic regression analyses, we investigated the relationship between each stratification of MVT and mortality. A nomogram was constructed based on the refined multivariable logistic regression model for predicting PMV.

Results: The total mortality was 11.8% (124/1049). The results showed that the groups with MVT 48 h to < 72 h and ≥ 72 h had significantly higher operative mortality compared to other MVT categories. Multivariate logistic regression analysis showed that MVT ≥72 h was significantly associated with higher short-term mortality. Thus, a nomogram was presented to elucidate the association between PMV (MVT ≥72 h) and risk factors including advanced age, preoperative cerebral ischemia, ascending aorta replacement, concomitant coronary artery bypass grafting (CABG), longer cardiopulmonary bypass (CPB), and large-volume intraoperative fresh frozen plasma (FFP) transfusion. The nomogram exhibited strong predictive performance upon validation.

Conclusions: Safely extubating patients within 72 h after ATAAD surgery is crucial for achieving favorable outcomes. The developed and validated nomogram provides a valuable tool for predicting PMV and optimizing postoperative care to improve patient prognosis. This novel nomogram has the potential to guide clinical decision-making and resource allocation in the management of ATAAD patients.

Background: The prognosis of trauma patients is highly dependent on early medical diagnosis. By constructing a nomogram model, the risk of adverse outcomes can be displayed intuitively and individually, which has important clinical implications for medical diagnosis.

Objective: To develop and evaluate models for predicting patients with adverse outcomes of trauma that can be used in different data availability settings in China.

Methods: This was a retrospective prognostic study using data from 8 public tertiary hospitals in China from 2018. The data were randomly divided into a development set and a validation set. Simple, improved and extended models predicting adverse outcomes were developed, with adverse outcomes defined as in-hospital death or ICU transfer, and patient clinical characteristics, vital signs, diagnoses, and laboratory test values as predictors. The results of the models were presented in the form of nomograms, and performance was evaluated using area under the receiver operating characteristic curve (ROC-AUC), precision-recall (PR) curves (PR-AUC), Hosmer-Lemeshow goodness-of-fit test, calibration curve, and decision curve analysis (DCA).

Results: Our final dataset consisted of 18,629 patients (40.2% female, mean age of 52.3), 1,089 (5.85%) of whom resulted in adverse outcomes. In the external validation set, three models achieved ROC-AUC of 0.872, 0.881, and 0.903, and a PR-AUC of 0.339, 0.337, and 0.403, respectively. In terms of the calibration curves and DCA, the models also performed well.

Conclusions: This prognostic study found that three prediction models and nomograms including the patient clinical characteristics, vital signs, diagnoses, and laboratory test values can support clinicians in more accurately identifying patients who are at risk of adverse outcomes in different settings based on data availability.

Background: Opioid overdoses have continued to increase at higher rates among Black Americans compared to people from other racial groups. Despite demonstrated effectiveness of MOUD in reducing risk of opioid overdose, Black Americans face decreased access to and uptake of MOUD. The current study aimed to examine the knowledge, perceptions, and experiences with MOUD among a sample of Black adults who use prescription opioids nonmedically in order to inform tailored efforts to improve MOUD uptake.

Methods: Data were derived from a larger study assessing cultural and structural influences on drug use and drug treatment among people who use prescription opioids nonmedically. Semi-structured qualitative interviews were conducted with 34 Black men and women across four generational cohorts: born 1955-1969; 1970-1979; 1980-1994; and 1995-2001. Participant responses were analyzed using thematic analysis.

Results: Nearly half of participants (44.1%) reported no knowledge or experience with MOUD. Among participants who had any knowledge about MOUD, four major themes regarding their perceptions emerged: MOUD Helps with Recovery; Not Needed for Level of Drug Use; Side Effects and Withdrawal; Equivalence with Illicit Drug Use. The majority reported negative perceptions of MOUD (52.6%), and the youngest cohort (born 1995-2001) had a higher proportion of negative perceptions (80%) relative to other age cohorts (born 1980-1994: 50%; 1970-1979: 75%; 1955-1969: 16.6%).

Discussion: Findings indicate a significant knowledge gap and clear points of intervention for improving MOUD uptake. Interventions to improve communication of health information in ways that are culturally relevant and tailored by age group can be used in conjunction with efforts to improve MOUD access among Black individuals who use opioids nonmedically.

Background: Despite the widespread administration of coronavirus disease 2019 (COVID-19) vaccines, the impact on patients with asymptomatic to mild illness remains unclear. Here, we aimed to assess the efficacy of various vaccine doses and types on the duration of isolation duration and discharge rates, the viral shedding duration, and negative rates in asymptomatic to mild COVID-19 patients.

Methods: We included adult patients at the Fangcang isolation centres in Pazhou or Yongning between November and December 2022. We analysed data on basic demographics, admission details, laboratory indicators and vaccination information.

Results: A total of 6560 infected patients were included (3584 from Pazhou and 2976 from Yongning). Of these, 90.6% received inactivated vaccines, 3.66% received recombinant SARS-CoV-2 spike protein subunit vaccines and 0.91% received adenovirus vaccines. Among the 6173 vaccinated individuals, 71.9% received a booster dose. By day 9, the isolation rate reached 50% among vaccinated patients. On day 7.5, the positive rate among vaccinated individuals reached 50%.

Conclusions: Full vaccination was effective, with heterologous vaccines showing greater efficacy than inactivated vaccines alone. However, there was no significant difference in the vaccine protective effect 12 months after vaccination.

The diagnosis of amyotrophic lateral sclerosis (ALS) is based on evidence of upper and lower motor neuron degeneration in the bulbar, cervical, thoracic, and lumbar regions in a patient with progressive motor weakness, in the absence of differential diagnosis. Despite these well-defined criteria, ALS can be difficult to diagnose, given the wide variety of clinical phenotypes. Indeed, the central or peripheral location of the disease varies with a spectrum ranging from predominantly central to exclusively peripheral, symptoms can be extensive or limited to the limbs, bulbar area or respiratory muscles, and the duration of the disease may range from a few months to several decades. In the absence of a specific test, the diagnostic strategy relies on clinical, electrophysiological, biological and radiological investigations to confirm the disease and exclude ALS mimics. The main challenge is to establish a diagnosis based on robust clinical and paraclinical evidence without delaying treatment initiation by increasing the number of additional tests. This approach requires a thorough knowledge of the phenotypes of ALS and its main differential diagnoses.

Introduction: This study intended to evaluate the medium-term effectiveness of a community-based medical education (CBME) program and to determine the program's influence on the application rates of regional-quota students seeking to become residents in Tamba, Japan.

Materials and methods: We conducted a cohort study of regional-quota students. Exposure factors included (1) experience compared to no experience of CBME in the Tamba area; (2) CBME experience compared to no experience in Tamba in the senior years (4-6 years of medical school) and experience in the junior years (1-3 years of medical school); and (3) experience in the senior years compared with those in the junior years. Outcome measures were applications to become a medical resident and actually becoming a medical resident at the Hyogo Prefectural Tamba Medical Center.

Results: Of 94 participants, 58 (61.7%) were male and 37 students (39.4%) had previous CBME experience in the Tamba area. In applying to become a resident at the Hyogo Prefectural Tamba Medical Center, students who had experienced CBME in the Tamba area in their senior years had significantly higher adjusted risk ratios compared to those who experienced it in their junior years. Regarding applications to become a resident, students who had experienced CBME in the Tamba area in their senior years had a significantly higher adjusted risk ratio than students who had not experienced CBME and students who had experienced CBME in their junior years.

Conclusions: There was a statistically significant application rate for residency programs among medical students who participated in the CBME program in their senior years compared with those who did not. This is the first study to confirm the medium-term effects of CBME after several years in short-term CBME programs of three days and two nights.

Background: Previous research has strongly supported the utility of spaced learning in enhancing memory, but its effectiveness in complex surgical procedures has largely been unexplored. The main objective of this study was to evaluate whether, in comparison to concentrated learning, spaced learning improves the short-term acquisition and long-term retention of cosmetic suturing skills as outcomes of surgical resident training courses.

Methods: This randomized controlled trial was conducted from February 2023 to June 2023. Surgical residents were recruited from a teaching hospital in Guangzhou, China. The participants were randomly assigned at a 1:1 ratio to either the spaced training group (40 min of training followed by a 20-minute break) or the concentrated training group (3 h of continuous training), in which they received one-on-one training for cosmetic suturing skills. The short-term acquisition and long-term retention outcomes were evaluated by three independent raters using an objective scoring scale to assess the participants' cosmetic suturing skills before the training (pretraining test), within one hour after the training (posttraining test), and three months after the completion of the training (follow-up test). The score for each participant was calculated as the average of three independent scores.

Results: The study included 23 surgical residents, 12 in the spaced training group and 11 in the concentrated training group. The pretraining test revealed no significant difference between the groups. However, in the post-training test, the spaced training group achieved a significantly higher total score than did the concentrated training group (74.06 ± 5.87 vs. 63.43 ± 10.73, p = 0.0070). Specifically, the suture technique scores were 28.46 ± 1.78 and 22.85 ± 3.75, respectively, which were significantly different (p = 0.0002). During the long-term follow-up test, the spaced training group consistently outperformed the concentrated training group by having significantly higher total (75.60 ± 4.78 vs. 60.68 ± 10.40, p = 0.0001), suture quality (32.26 ± 4.01 vs. 26.23 ± 4.16, p = 0.0019), suture technique (28.68 ± 2.63 vs. 22.18 ± 3.94, p = 0.0001), and suturing time scores (14.67 ± 1.15 vs. 12.27 ± 6.07, p = 0.0460).

Conclusions: Incorporating the principles of spaced learning into the instructional process of obtaining cosmetic suture skills for surgical residents not only significantly enhances short-term skill improvement but also contributes to the long-term retention of training outcomes.

Chronic active Epstein-Barr virus (CAEBV) infection of the T-cell or Natural killer (NK)-cell type, systemic form (systemic CAEBV or sCAEBV) was defined by the WHO in 2017 as an EBV-related lymphoproliferative disorder and is listed as an EBV-positive T-cell and NK-cell proliferation. The clinical manifestations and prognoses are heterogeneous. This makes systemic CAEBV indistinguishable from other EBV-positive T-cell and NK-cell proliferations. Early diagnosis of systemic CAEBV and early hematopoietic stem cell transplantation can improve patient prognosis. At present, the diagnosis of systemic CAEBV relies mainly on age, clinical manifestations, and cell lineage, incurring missed diagnosis, misdiagnosis, long diagnosis time, and inability to identify high-risk systemic CAEBV early. The diagnostic methods for systemic CAEBV are complicated and lack systematic description. The recent development of diagnostic procedures, including molecular biological and immunological techniques such as flow cytometry, has provided us with the ability to better understand the proliferation of other EBV-positive T cells and NK cells, but there is no definitive review of their value in diagnosing systemic CAEBV. This article summarizes the recent progress in systemic CAEBV differential diagnosis and the prospects of flow cytometry.

Objective: Pulmonary hypertension (PH) is a life-threatening disease, especially in paediatric population. Symptoms of paediatric PH are non-specific. Accurate detection of paediatric PH is helpful for early treatment and mortality reduction. Therefore, we assessed the overall performance of brain natriuretic peptide (BNP) and N-terminal brain natriuretic peptide (NT-proBNP) for diagnosing PH in paediatric population.

Methods: PubMed, Web of Science, Cochrane Library and Embase databases were screened since their respective inceptions until August 2023. A bivariate random model and a hierarchical summary receiver operating characteristic model were used together to evaluate and summarize the overall performance of BNP and NT-proBNP for diagnosing paediatric PH.

Results: Eighteen studies using BNP/NT-proBNP were assessed, comprising 1127 samples. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and area under the curve (AUROC) of BNP/NT-proBNP were separately as 0.81, 0.87, 6.33, 0.21, 29.50 and 0.91, suggesting a good diagnostic performance of BNP/NT-proBNP for detecting PH in paediatric population. For BNP, the pooled sensitivity, specificity, PLR, NLR, DOR and AUROC were 0.83, 0.89, 7.76, 0.19, 40.90 and 0.93, indicating the diagnostic accuracy of BNP for paediatric PH patients was good. For NT-proBNP, the pooled sensitivity, specificity, PLR, NLR, DOR and AUROC were 0.81, 0.86, 5.59, 0.22, 24.96 and 0.90, showing that NT-proBNP could provide a good value for detecting paediatric PH.

Conclusions: Both BNP and NT-proBNP are good markers for differentiating paediatric PH patients from non-PH individuals.

Background: The neutrophil to high-density lipoprotein cholesterol ratio (NHR) is independently associated with the severity of various diseases. However, its association with acute biliary pancreatitis (ABP) remains unknown.

Methods: This study included 1335 eligible patients diagnosed with ABP from April 2016 to December 2022. Patients were divided into low- and high-NHR level groups using an optimal cut-off value determined utilizing Youden's index. Multivariate logistic regression analysis was used to investigate the correlation between NHR and ABP severity. Multivariate analysis-based limited restricted cubic spline (RCS) method was used to evaluate the nonlinear relationship between NHR and the risk of developing moderate or severe ABP.

Results: In this study, multivariate logistic regression analysis indicated an independent association between NHR and ABP severity (p < .001). The RCS analysis showed a linear correlation between NHR and the risk of developing moderate or severe ABP (P for non-linearity > 0.05), and increased NHR was found to be independently associated with a more severe form of the disease.

Conclusions: Our study suggests that NHR is a simple and practical independent indicator of disease severity, serving as a potential novel predictor for patients with ABP.