Postgraduate medicine最新文献

Background: Sepsis is a major health concern with high mortality, which is associated with immunosuppression. CD28, a co-stimulatory molecule on T lymphocytes, promotes T cell proliferation, survival, and cytokine production. CD4⁺CD28⁺ T cells play an important role in immune activation and regulation. This study aimed to determine whether CD4⁺CD28⁺ T lymphocytes were associated with 28-day mortality in patients with sepsis.

Methods: A retrospective analysis was performed in 80 adult patients with sepsis admitted to the department of intensive care unit. Peripheral blood CD4⁺CD28⁺ T cells were measured within 24 h of admission using flow cytometry. Independent predictors of 28-day mortality were identified using univariate and multivariate Cox regression analyses.

Results: In total, 80 patients with sepsis were included, of whom 15 (18.8%) died within 28 days. Most patients were older than 60 years (56/80, 70.0%) and male (52/80, 65.0%). The predominant sources of infection were the lung (47/80, 58.8%) and abdomen (28/80, 35.0%), with bacteria being the most common pathogens (68/80, 85.0%). Compared to non-survivors, survivors had lower Sequential Organ Failure Assessment (SOFA) scores, lower rates of septic shock and acute kidney injury (AKI), a higher proportion of CD4⁺CD28⁺ T cells > 75.9%, and a lower proportion of CD8⁺ CD28⁺ T cells ≤39.9%. Receiver operating characteristic analysis depicted that CD4⁺CD28⁺ T cells (cutoff value was 75.9%) showed an area under the curve of 0.732, a sensitivity of 66.67%, and a specificity of 80.00%. The Kaplan-Meier analysis demonstrated significantly better survival in patients with CD4⁺CD28⁺ T cells > 75.9% than in those with ≤75.9%. In univariate Cox regression analysis, SOFA score ≥6, septic shock, AKI, CD8⁺CD28⁺ T cells ≤39.9%, and CD4⁺CD28⁺ T cells ≤75.9% were associated with 28-day morality in patients with sepsis. Multivariate Cox analysis indicated that SOFA score ≥6, AKI, and CD4⁺CD28⁺ T cell ≤75.9% were independent risk factors for 28-day morality of sepsis patients.

Conclusion: A low percentage of CD4⁺CD28⁺ T lymphocytes (≤75.9%) is an independent risk factor for 28-day mortality in patients with sepsis.

Background: Although oxidative stress has been implicated in PE, findings on antioxidant and oxidative DNA damage markers remain inconsistent. This study aimed to assess the plasma levels of the antioxidant biomarkers sirtuin 1 (SIRT1) and superoxide dismutase 2 (SOD2), as well as the oxidative DNA damage marker 8-hydroxy-2'-deoxyguanosine (8-OHdG), and to evaluate their correlation with clinical parameters in cases of PE.

Methods: This case-control study included 25 women aged 20-45 years, divided into two groups: the PE group (n = 14) and the control group (n = 11). Plasma SIRT1, SOD2, and 8-OHdG concentrations were measured by enzyme-linked immunosorbent assay (ELISA). Pearson correlation coefficients were calculated to determine the relationships between plasma concentrations of these markers and specific clinical parameters in the PE group.

Results: Plasma levels of SIRT1 and SOD2 were significantly higher in the PE group compared to that in the control group, while no significant difference was observed in 8-OHdG. A significant positive correlation was observed between SIRT1 and both systolic and diastolic blood pressures in the PE group compared to that in the control group. In addition, a borderline significant positive association was observed between SOD2 and diastolic blood pressure in the PE group compared to that in the control group.

Conclusion: Increased levels of both plasma SIRT1 and SOD2, along with their positive correlation with blood pressure, suggest a potential role for oxidative stress and antioxidant response in the pathogenesis of PE.

Chronic kidney disease (CKD) is a global health concern strongly associated with cardiovascular disease (CVD) and high mortality rates. Glomerular filtration rate (GFR) abnormalities, such as glomerular hyperfiltration (GHF) and selective glomerular hypofiltration syndrome (SHS), although not traditionally included in the CKD framework, share chronic inflammation as a pivotal mechanism driving systemic complications and CVD progression. In recent decades, GHF has gained substantial importance due to the high cardiovascular (CV) risk and mortality observed in populations within the highest tertiles of GFR, as determined by both estimation formulas (estimated GFR (eGFR)) and clearance (Cl) of exogenous substances. It is frequently observed in conditions such as obesity, diabetes, and metabolic syndrome. This hyperfiltration state is linked to endothelial dysfunction and CKD progression, often presenting with albuminuria, an independent marker of oxidative stress and CVD. SHS, on the other hand, involves the selective hypofiltration of medium-sized molecules (e.g. cystatin C) (Cys C), leading to proteomic alterations and the retention of pro-inflammatory molecules. This dysregulation intensifies systemic inflammation, atherosclerosis, and endothelial dysfunction, emphasizing SHS's role in CVD pathogenesis. The accuracy of CKD diagnosis is challenged by variability in eGFR methods, with formulas based on Cys C and creatinine (Cr) providing superior predictive value as biomarkers of risk in CKD and for detecting GFR abnormalities like GHF and SHS. Early identification and targeted management of these classical and non-classical GFR alterations may reduce the CVD burden and improve outcomes, underscoring the need for consensus definitions and multidisciplinary approaches to expand the CKD paradigm.

Introduction: The effects of estrogen on arrhythmias are controversial. While animal studies suggest complex effects, the hypothesis that higher estrogen levels increase women's arrhythmia susceptibility has not yet been fully validated in human studies.

Case report: This case report describes a 30-year-old female patient who frequently experienced palpitations and was initially diagnosed with idiopathic ventricular arrhythmia. However, her symptoms were strongly correlated with her menstrual cycle. She experienced premature ventricular contractions (PVCs) 6 days before menstruation and 5 days before ovulation, which coincided with elevated estrogen levels. After other potential causes were ruled out, a diagnosis of hormone-induced PVCs was established. The patient was treated with a combination of estrogen and progestogen that not only alleviated her palpitations but also relieved her dysmenorrhea and menstrual irregularities. During a 5-month follow-up period, the patient reported no further palpitations.

Conclusion: This case provides clinical support of the hypothesis that elevated estrogen levels can increase vulnerability to ventricular arrhythmias in women. The influence of estrogen on arrhythmias may occur via a biphasic effect that potentially provides antiarrhythmic benefits during phases of low estrogen and increases the risk of arrhythmia during peak estrogen phases. Clinicians should consider hormone-related arrhythmias when young female patients present with palpitations that follow a cyclical pattern that is clearly linked to the menstrual cycle. Such cases warrant thorough history-taking and assessments of sex hormone levels. Hormonal regulation therapy could be an effective treatment strategy; however, its effectiveness and safety require careful evaluation.

Background: Intracranial atherosclerosis (ICAS) is a major cause of ischemic stroke. The longitudinal association of the estimated glomerular filtration rate (eGFR) with ICAS is unclear. This study aimed to investigate the association of cumulative eGFR burden with incident ICAS.

Methods: In this prospective cohort study, 4032 participants underwent baseline examinations in 2010-2011, 2012-2013, and 2014-2015 and were followed through 31 December 2021. Cumulative eGFR was calculated based on three consecutive measurements obtained from 2010 to 2015. The eGFR slope was estimated using a linear mixed-effects model with eGFR regressed on time from 2010 to 2015. The outcome was defined as the incident ICAS during 2016-2021.

Results: The median follow-up time was 3.96 years, during which 374 participants (9.28%) developed ICAS. In the fully adjusted model, single-time-point eGFR < 90 mL/min/1.73 m² (OR: 1.817, 95% CI: 1.343, 2.459), cumulative eGFR burden > 0 (OR: 1.366, 95% CI: 1.041, 1.791), eGFR slope < -10 mL/min/1.73 m²/year (OR: 2.086, 95% CI: 1.480, 2.944), and exposure duration of reduced kidney function > 3 to ≤ 6 years (OR: 1.867, 95% CI: 1.329, 2.622) were significantly associated with increased ICAS risk. Cumulative eGFR burden had a higher net reclassification improvement and integrated discrimination improvement than single-time-point eGFR for predicting ICAS.

Conclusion: In this cohort study, single-time-point eGFR, cumulative eGFR burden, eGFR slope, and exposure duration of reduced kidney function were all associated with increased risk of ICAS. Notably, cumulative eGFR burden, which captures both the duration and magnitude of kidney function decline, demonstrated superior predictive value compared with single-time-point eGFR for identifying individuals at risk of ICAS.

Hemophagocytic lymphohistiocytosis (HLH) is an increasingly recognized disorder of immune hyperactivity that often leads to multiorgan failure and death. In adults, HLH is usually triggered by infection, malignancy, or an autoimmune/autoinflammatory disorder that precipitates a destructive cytokine storm. Treatment aims to deescalate the hyperimmunity by treating the triggers while interfering with the immune pathways that cause the morbidity. We summarize what is known about this devastating disorder while adding insights gleaned from our review of the literature coupled with our own experiences. For example, we recognized that 1) more than one trigger may coexist in the same patient, 2) there is a predilection for HLH in lymphoma patients, particularly in the presence of Epstein-Barr virus infection, 3) aspartate transaminase elevation exceeds that of alanine transaminase, and 4) encephalopathy is underrecognized. These and other observations may assist the readers in identifying HLH, distinguishing its clinical presentation from that of its triggers, and thoroughly assessing all possible triggers rather than anchoring on the first diagnosed.

Background: Non-dilated left ventricular cardiomyopathy (NDLVC) is a distinct entity characterized by impaired left ventricular ejection fraction despite normal chamber dimensions. While it may represent an earlier or less fibrotic stage of non-ischemic cardiomyopathy compared to dilated-cardiomyopathy (DCM), its clinical and structural characterization remains incomplete.

Objectives: This study aimed to compare left atrial (LA) phasic strain parameters between patients with NDLVC and those with DCM, all with similarly reduced ejection fractions. Additionally, the relationship between LA function and exercise capacity was assessed using the 6-minute walk test (6MWT).

Methods: In this prospective, observational study, 83 patients with non-ischemic systolic dysfunction were enrolled(NDLVC:n = 51; DCM:n = 32). All underwent comprehensive transthoracic echocardiography, including LA strain analysis (reservoir, conduit, contractile phases) using speckletracking imaging. Functional capacity was evaluated via 6MWT.

Results: Patients with NDLVC exhibited significantly higher LA reservoir and conduit strain values than those with DCM. Among all echocardiographic parameters, LA conduit strain showed the strongest correlation with 6MWT distance (r = 0.42, p = 0.002) and was the only independent predictor of functional capacity in multivariable analysis.

Conclusions: LA conduit strain is a promising noninvasive parameter for identifying functional and structural differences between NDLVC and DCM. Its strong association with exercise capacity and ability to differentiate phenotypes may support its integration into clinical assessment and follow up,particularly in clarifying structural and functional differences in non-ischemic remodeling patterns. These findings suggest that preserved LA conduit function in NDLVC may reflect a less hemodynamically burdened atrial profile, which is consistent with better clinical performance and functional capacity.

Objectives: This exploratory study evaluated the feasibility of solely virtually recruiting patients with symptoms suggestive of acute rhinosinusitis (ARS) and whether a questionnaire-based study on disease history, use of over-the-counter (OTC) medications and symptom burden in ARS can provide plausible and meaningful results.

Methods: The study was advertised via Google Ads and on social media (Facebook, Instagram, and TikTok). Its questionnaire contained 20 questions regarding disease history and use of OTC medicinal products such as BNO 1016 (Sinupret® extract). Symptomatic burden and disease impact were evaluated by patient-reported outcome measures (PROMs), i.e. the major symptom score in a patient-assessed form (MSS_PAT) and bothersomeness of symptoms on a numerical rating scale (NRS). A subgroup of participants also completed the Sino-Nasal Outcome Test-20 German Adapted Version (SNOT-20 GAV). Analyses on correlation of PROMs and parameters that influence outcomes of PROMs were performed after the study.

Results: During 8 weeks in winter/spring 2024, 2889 people wanted to participate in the study, 2032 (70.3%) participants over the age of 16 and with a history of ARS were finally included. There was a great willingness to participate and complete the study, as 93.7% of eligible starters also completed the study. The majority of included participants were female (83.7%) and between 25 and 54 years old (52.6%). PROMs were well accepted by participants and provided plausible results (mean MSS_PAT: 8.3 score points; NRS in 86.6% rated with at least 5; mean SNOT-20 GAV: 45.5 score points). Moreover, PROM scores correlated with each other, indicating their validity for assessing ARS disease burden and impact also in a real-world setting.

Conclusion: This feasibility study showed that it appears indeed possible to generate real-world data (RWD) in ARS in a solely virtual setting. We are planning a larger prospective virtual RWD study as the next step to gain deeper insights into the treatment course of ARS.

Objective: This research investigates the prevalence of thyroid nodules and their association with anxiety and depression disorders in Eastern China. It also investigates the potential factors influencing this relationship, focusing on demographics and thyroid function.

Methods: As part of the SPECT-China project, a cross-sectional survey was conducted with 5497 participants from both urban and rural regions in Shanghai, Zhejiang, and Jiangxi provinces. Participants received thyroid ultrasonography and laboratory tests for thyroid function, while their mental health was evaluated using the Zung Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS). Data analysis employed descriptive statistics, Student's T-test, Chi-square test, and logistic regression.

Results: The study found a high prevalence of TNs (57.5%) among participants, with a higher incidence in females, older individuals, and those with lower education levels. Anxiety and depression disorders were diagnosed in 4.8% and 5.2% of participants, respectively, with higher rates in females and older individuals. Logistic regression analysis, controlling for age and gender, showed no significant link between TNs and anxiety or depression disorders in the general population. However, a significant association was observed in females. No significant correlation was identified between thyroid function (as measured by TSH levels) and the presence of TNs or mental disorders.

Conclusion: Thyroid nodules are prevalent in Eastern China, particularly among females, older individuals, and those with lower education. TNs show a significant correlation with anxiety and depression disorders in females, although not in the general population. This study emphasizes the significance of examining gender differences in the link between thyroid nodules and mental health, and calls for additional research in this domain.

Objective: Arteriovenous graft (AVG) infection is a severe and potentially life-threatening complication that frequently leads to graft dysfunction in patients undergoing maintenance hemodialysis (MHD). However, antimicrobial resistance are becoming increasingly common.This study investigated the efficacy of linezolid in treating graft infections and to compare the effectiveness and safety of linezolid against teicoplanin among MHD patients.

Method: This retrospective cohort study was conducted at a single center. A total of 53 cases of AVG infections occurring between June 2016 and June 2023 were included in this study. The AVG infections were divided into two groups: the control group (teicoplanin 200 mg/day iv) and the linezolid group (600 mg/day iv). The antimicrobial treatment period for AVG infection depended on whether the symptoms completely disappeared.Clinical data, operative records, duration of hospital stays, and costs were collected from the Hospital Information System (HIS) and analyzed between the two groups.

Results: Out of the 53 patients, 30 (56.6%) were women, and their median age was 64 years. The most common clinical presentations of graft infection were purulent drainage, abscesses, pain, and swelling. Among the 53 patients, 9 (17.0%) had positive blood or wound cultures. Gram-positive cocci were the most common organisms identified. The proportion of salvaged grafts in the linezolid group was significantly higher (24 out of 28) compared to the control group (15 out of 25) (p = 0.034). The duration of hospital stays was shorter for patients in the linezolid group compared to the control group (9.6 ± 1.0 versus 16.1 ± 1.9, p = 0.012). Additionally, the average cost in the linezolid group was significantly lower than that in the control group (CNY 15,050 ± 1,611 versus 23,920 ± 4,097, p = 0.039).

Conclusions: Linezolid was found to effectively control most cases of AVG infections, resulting in shorter hospital stays and significantly reducing the clinical burden on MHD patients especially when the blood or wound cultures were negative.