Postgraduate medicine最新文献

Background: This study investigates obstetric outcomes and factors influencing preterm birth among Chinese-American and American Indian or Alaskan Native women to address the gap in knowledge and inform targeted interventions.

Methods: A retrospective cohort study was conducted using 2022 data from the National Vital Statistics System (NVSS), covering 50 U.S. states and the District of Columbia. The study included 40,983 Chinese-American and 35,648 AIAN women aged ≥18 years. Based on gestational age(GA), preterm birth was defined as extremely preterm birth (GA <27^6/7 weeks), very preterm birth (GA 28^0/7 to 31^6/7 weeks), moderately preterm birth (GA 32^0/7 to 33^6/7 weeks) and late preterm infants (GA 34^0/7 to 36^6/7 weeks). Bivariate analyses and multivariable logistic regression were used to estimate odds ratios (OR) and 95% confidence intervals (CIs) for preterm birth predictors.

Results: The preterm birth prevalence was 7.56% in Chinese-American women (5.86% late preterm) and 12.09% in AIAN women (8.98% late preterm). In both groups, preterm birth was associated with higher rates of adverse infant outcomes (low birth weight, NICU admission, surfactant therapy) and maternal complications. For Chinese-American women, significant risk factors included maternal age ≥35 years (OR = 1.23), weight gain <5.0 kg (OR = 1.67), chronic hypertension (OR = 3.18), gestational hypertension (OR = 2.58), previous preterm birth (OR = 3.96), infertility treatment (OR = 1.30), and multiple pregnancies (OR = 21.17); protective factors included higher education (e.g. master's degree: OR = 0.73), prenatal care (OR = 0.54), and weight gain ≥13.6 kg (OR = 0.52). For AIAN women, key risk factors included age ≥35 years (OR = 1.27), weight gain <5.0 kg (OR = 1.39), chronic hypertension (OR = 2.85), gestational hypertension (OR = 2.79), previous preterm birth (OR = 3.30), and multiple pregnancies (OR = 16.18); protective factors included prenatal care (OR = 0.37) and weight gain ≥13.6 kg (OR = 0.67).

Conclusions: Preterm birth disparities exist between Chinese-American and AIAN women, with shared and population-specific risk/protective factors. Routine practice should prioritize targeted monitoring for high-risk groups and promote prenatal care and optimal weight gain.

Objective: To evaluate the effect of lutikizumab intervention on patients with osteoarthritis (OA) and provide an evidence-based reference for the clinical application of lutikizumab intervention in patients with osteoarthritis.

Methods: Literature databases such as PubMed, Embase, web of science, and the Cochrane Library were searched to collect relevant data on randomized controlled trials (RCTs), clinical trials, and single/double arm non-randomized controlled trials studies of therapy interventions for patients with OA, and meta-analysis was performed using RevMan 5.4.

Results: A total of 6 randomized controlled studies were included, including 737 patients with osteoarthritis. Meta-analysis showed that compared with the control group, lutikizumab intervention had more gains, IL-α (0.3 mg/kg, Q2W, week2) (MD = -0.67, 95% CI [-1.25,-0.09]; Z = 2.26; p = 0.02), IL-1β (3 mg/kg,Q2W,week2) (MD = -0.58, 95% CI [-1.14, -0.02]; Z = 2.03; p = 0.04) and hsCRP (200 mg,Q2W,week8) (MD = -1.79, 95% CI [-2.09, -1.50]; Z = 11.80; p < 0.00001).

Conclusion: Reducing the OA process with lutikizumab provides a theoretical basis for further investigation of the function of lutikizumab in patients with OA.IL-1 is not only an inflammatory mediator in osteoarthritis, but also a key molecule connecting biomechanical abnormalities and tissue damage.IL-1 inhibitors precisely regulate the spatiotemporal expression of IL-1, and individualize the biomechanical intervention regimens or combination of multiple interventions to achieve optimal therapeutic effects.

Objectives: Hashimoto's thyroiditis (HT) is a T-cell mediated autoimmune disease characterized by the progressive destruction of thyroid gland. Hemoglobin-Albumin-Lymphocyte-Platelet (HALP) score and systemic inflammatory index (SII) are novel markers of inflammation. We aimed to compare HALP score and SII values of patients with HT to those in healthy control subjects in the present study.

Methods: Patients diagnosed with HT and healthy volunteers (as controls) were included in the study. The SII and HALP score were calculated using the following formulas: SII = (Platelet count×Neutrophil count)/Lymphocyte count. HALP score = (Hemoglobin×Serum Albumin×Lymphocyte count)/Platelet count. SII and HALP score of patients with HT and healthy controls were compared.

Results: Median SII of the patients with HT (510 (140-3646)) was significantly higher than that of the control subjects (422 (102-2173)) (p < 0.001). Median HALP score of the HT group (47 (7-149)) was significantly lower than that of the control group (54 (10-160)) (p < 0.001). The sensitivity and specificity of SII (when higher than 452%) in detecting HT were 61% and 62%, respectively (AUC: 0.64, p < 0.001, 95%CI: 0.61-0.67). A HALP score lower than 49.5% threshold had 64% sensitivity and 57% specificity in detecting HT (AUC: 0.61, p < 0.001, 95%CI: 0.57-0.64). In logistic regression analysis (considering age, gender, eGFR, TSH, CRP, ESR, BMI), a unit increase in SII increased the risk of HT by 0.3% (p < 0.001, OR: 1.003, 95%CI: 1.002-1.004). HALP score was also an independent risk factor for HT. A unit increase in HALP score decreased the risk of HT by 2% (p < 0.001, OR: 0.977, 95%CI: 0.968-0.985).

Conclusion: We recommend that, due to their inexpensive and easily assessable nature, SII and HALP score could serve as additional diagnostic tools in HT.

Objectives: This study evaluated the effectiveness and safety of maintenance therapy with capecitabine ± bevacizumab in Vietnamese patients with mCRC after disease control following first-line chemotherapy.

Methods: A retrospective cohort study was conducted at Vietnam National Cancer Hospital (March - May 2025). Eligible patients had mCRC, achieved response or stable disease after CAPOX plus bevacizumab, and received maintenance capecitabine alone or with bevacizumab. The primary endpoint was progression-free survival (PFS). Safety was assessed using CTCAE v5.0. Kaplan - Meier and Cox regression analyses were performed.

Results: Among 148 patients, 54 (36.5%) received capecitabine alone and 94 (63.5%) received bevacizumab - capecitabine. Baseline characteristics were balanced. Median PFS was 9.9 months (95% CI: 7.5-12.4) with bevacizumab - capecitabine vs. 5.8 months (95% CI: 4.3-7.4) with capecitabine alone (HR = 0.477, p = 0.001). Multivariable analysis showed that bevacizumab use (HR = 0.384, p = 0.001), achieving CR/PR after induction (HR = 0.416, p = 0.003), and absence of peritoneal metastases (HR = 1.758, p = 0.046) were independently associated with improved PFS. Both regimens were well tolerated, with no treatment-related deaths. The most common toxicity was hand - foot syndrome (27.7% vs. 25.9%). Hypertension and rare events (GI perforation, thrombosis) occurred only in the bevacizumab group but were infrequent. Grade 3-4 adverse events were uncommon and manageable.

Conclusions: In this first real-world study from Vietnam, maintenance therapy with bevacizumab plus capecitabine significantly improved PFS compared to capecitabine alone, with acceptable safety. These findings support the use of biologic-based maintenance strategies in appropriate patients and provide valuable evidence for guiding mCRC treatment in resource-constrained settings.

Background: Periprosthetic joint infection (PJI) is a severe complication of total joint arthroplasty (TJA), with traditional risk factors including diabetes and obesity. Emerging evidence suggests functional gastrointestinal disorders (FGIDs) may influence systemic inflammation and infection susceptibility. This study investigated whether preexisting FGIDs are independent risk factors for PJI.

Methods: A retrospective 1:1 matched case-control study analyzed 896 patients (448 PJI vs. 448 non-PJI) undergoing primary TJA (2013-2023). PJI was diagnosed using modified 2018 Musculoskeletal Infection Society criteria, and FGIDs (irritable bowel syndrome [IBS], functional diarrhea [FD], functional constipation [FC]) were classified per Rome IV criteria. Multivariable logistic regression identified PJI risk factors after adjusting for demographics, comorbidities, and surgical variables.

Results: Univariate analysis revealed significantly higher FC prevalence in PJI cases (14.3% vs. 8.3%, p = 0.0043), while IBS and FD showed no association. Multivariate analysis confirmed FC as an independent PJI risk factor (odds ratio [OR] = 1.844, 95% confidence interval [CI]:1.199-2.872, p = 0.0059), alongside diabetes (OR = 1.714, 95%CI:1.116-2.661, p = 0.0148), and surgery duration >2 hours (OR = 2.220, 95%CI:1.242-4.125, p = 0.0088). Perioperative antibiotic usage reduced PJI risk (OR = 0.405, 95%CI:0.232-0.686, p = 0.0010).

Conclusion: Functional constipation was identified as a novel independent risk factor for PJI, alongside established metabolic comorbidities and prolonged surgery. These findings underscore the gut-joint axis in PJI pathogenesis and advocate integrating FGID screening into preoperative risk stratification. Antibiotic prophylaxis remains critical for minimizing infection risk in TJA patients.

Background: Microvascular dysfunction (MD) is advocated as one of the main pathogenic mechanisms of Takotsubo syndrome (TTS). Several studies investigated MD in TTS using different techniques; however, no systematic review of these data is currently available.

Methods: We searched the main scientific database (Embase, Medline, Scopus, PubMed) for articles written in English language using the following keywords: ('takotsubo' OR 'broken heart' OR 'apical ballooning' OR 'stress cardiomyopathy') AND ('microvascular'). Case reports: studies not performed in human subjects or investigating microvascular function in organs other than the heart were excluded.

Results: 35 studies matched the inclusion criteria. Microvascular function was assessed by standard coronary angiography-derived indexes (n = 17), invasive measurement (n = 10, index of microcirculatory resistance (IMR) in n = 7), echocardiography (n = 5), nuclear medicine (n = 3), and cardiac magnetic resonance imaging (CMR) in n = 2, with some studies applying more than 1 technique. When established cutoff values were used, MD prevalence largely varied (35% to 100%). Although comprehensive clinical correlates were scarcely reported, MD was consistently associated with higher systolic impairment. Blood-based inflammatory biomarkers analysis was performed in one study only, providing inconclusive results. Clinical outcomes associated with MD were reported in four studies including higher rates of major cardiovascular events and long-term mortality.

Conclusions: MD in TTS has a variable prevalence. It is absent in a relevant proportion of the cases, making it questionable as it should be considered a pre-requisite for disease onset. The presence and extent of MD in TTS is a promising prognostic marker; no data in humans currently confirm its role as a therapeutic target.

Objectives: Heart failure (HF) with reduced (HFrEF) or mildly reduced ejection fraction (HFmrEF) frequently coexists with atrial fibrillation (AF), leading to worse prognosis and greater therapeutic complexity. Although beta-blockers (BBs) are a cornerstone of HF treatment, their benefit in patients with AF remains unclear.

Methods: We analyzed 1088 patients with stable chronic HF and left ventricular ejection fraction < 50% enrolled in the multicentre FAR NHL registry. Patients were stratified by the presence of AF and achieved BB dose: low ( < 25%), medium (25-49%), or high (≥50% of target). The primary endpoint was a composite of all-cause mortality, hospitalization for acute HF, left ventricular assist device (LVAD) implantation, or heart transplantation.

Results: AF was present in 379 patients (34.5%). BBs were prescribed to 94% of patients, but only 17% achieved high-dose therapy. The event rate was higher in AF patients (28.0%) than in those without AF (20.5%, p = 0.005). High BB dose was independently associated with a lower risk of the primary endpoint (HR 0.62, 95% CI 0.48-0.80; p < 0.001), consistently across both rhythm group.

Conclusion: Higher BB doses were associated with improved outcomes in patients with chronic HF, regardless of AF status. These real-world data support up-titration of BBs as a key component in optimized guideline-directed therapy, even in patients with coexisting AF.