Postgraduate Medical Journal最新文献

{"title":"Pulsed-field ablation versus radiofrequency or cryoballoon thermal ablation in atrial fibrillation: a systematic review and meta-analysis.","authors":"Rasha Kaddoura, Dina Abushanab, Nidal Asaad","doi":"10.1093/postmj/qgaf049","DOIUrl":"https://doi.org/10.1093/postmj/qgaf049","url":null,"abstract":"<p><p>This review investigated efficacy and safety of pulsed-field ablation (PFA) in comparison with radiofrequency ablation (RFA), cryoballoon ablation (CBA), or both combined. The Odds ratio (OR) and mean difference (MD) with 95% confidence interval (95% CI) were computed. PFA allowed shorter procedure (MD -44.27 minutes, 95% CI: -63.61; -24.93) and left atrium (LA) dwell (MD -32.71 minutes (95% CI: -58.64; -6.78) times, but with longer fluoroscopy time than RFA (MD 8.54 minutes, 95% CI: 4.03; 13.04). Post-procedural complications rate was lower with PFA than CBA (OR 0.53, 95% CI: 0.35, 0.80). Atrial arrhythmias recurrence rate within one year of follow-up was lower with PFA than RFA (OR 0.68, 95% CI; 0.53; 0.87) and CBA (OR 0.69, 95% CI: 0.48; 0.97). PFA allowed shorter procedure and LA dwell times, as well as lower atrial arrhythmia recurrence than RFA and lower post-procedural complications and atrial arrhythmias recurrence rates than CBA.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insulin resistance: a paradoxical protector against low-grade prostate cancer? Findings from the REDUCE trial.","authors":"Rupak Desai, Akhil Jain","doi":"10.1093/postmj/qgaf047","DOIUrl":"https://doi.org/10.1093/postmj/qgaf047","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Volrustomig/Rilvegostomig related \"triple M\"-myasthenia gravis and overlap syndrome.","authors":"Tim Cooksley, Ryan Y S Keh, Jamie M J Weaver","doi":"10.1093/postmj/qgaf048","DOIUrl":"https://doi.org/10.1093/postmj/qgaf048","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of oral anticoagulants in patients with atrial fibrillation and acute myocardial infarction: a systematic review and meta-analysis.","authors":"Yi Zheng, Xinyu Zheng, George Bazoukis, Gary Tse, Tong Liu","doi":"10.1093/postmj/qgaf046","DOIUrl":"https://doi.org/10.1093/postmj/qgaf046","url":null,"abstract":"<p><strong>Background: </strong>The optimal antithrombotic therapy strategies for patients with atrial fibrillation (AF) and acute myocardial infarction (AMI) remain uncertain. We aimed to evaluate the efficacy and safety of oral anticoagulants (OAC) among patients with AF and AMI.</p><p><strong>Methods: </strong>PubMed, Embase, and Web of Science were searched from inception till 5 February 2025. The primary outcome was any stroke.</p><p><strong>Results: </strong>Eleven studies with 83 549 patients were included. OAC therapy was associated with lower risks of any stroke (odds ratio [OR]: 0.68; 95% confidence interval [CI]: 0.60-0.77; P < .001), ischemic stroke (OR: 0.64; 95% CI: 0.57-0.73; P < .001), and all-cause mortality (OR: 0.81; 95% CI: 0.74-0.89; P < .001). Additionally, OAC therapy was associated with a higher risk of any bleeding (OR: 1.24; 95% CI: 1.06-1.46; P = .009), but not for major bleeding (OR: 1.28; 95% CI: 0.87-1.90; P = .21).</p><p><strong>Conclusions: </strong>OAC therapy is effective for patients with AF and AMI, but should be administered cautiously in those at high bleeding risk.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of potential causal genes and drug targets in pulmonary hypertension based on transcriptomic analysis and Mendelian randomization.","authors":"Chengliang Liu, Fanliang Meng","doi":"10.1093/postmj/qgaf044","DOIUrl":"https://doi.org/10.1093/postmj/qgaf044","url":null,"abstract":"<p><strong>Purpose: </strong>Currently, there is no definitive treatment for pulmonary hypertension (PH). This study aims to utilize the GEO database and conduct Mendelian randomization (MR) analysis to identify new genetic targets for PH and investigate their potential pathogenic pathways and therapeutic drugs.</p><p><strong>Methods: </strong>We identified key genes by combining the findings from MR and bioinformatics analyses of GEO datasets. We performed enrichment analysis to explore the functional roles of these key genes. Then, we constructed protein-protein interaction (PPI) and miRNA-mRNA networks to identify interacting proteins and miRNAs. Drug prediction analysis was conducted to propose potential therapeutic drugs. Finally, we validated the results through the GEO dataset, RT-PCR, and western blot experiments.</p><p><strong>Results: </strong>The joint analysis utilizing GEO databases and MR analysis identified two key genes, ITGA2B and TSPAN9 that exhibited significance across both analytical methods. The enrichment analysis indicated that the key genes were involved in critical biological functions and pathways, including cell adhesion, platelet activation, and the PI3K-Akt signaling pathway. The PPI and miRNA-mRNA networks further highlighted the significance of the key genes in PH. Drug prediction analysis revealed the potential of the key genes as therapeutic targets. The RT-PCR and western blot experiments validated the above findings.</p><p><strong>Conclusion: </strong>By integrating bioinformatics and MR analysis, we found that ITGA2B and TSPAN9 have a causal relationship with PH. Our findings offer new insights into the molecular mechanism and potential treatment targets of PH, establishing a basis for future research and clinical applications.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing chikungunya vaccine equity: a Global Health imperative.","authors":"Amira M Taha, Cameron J Sabet, Dang Nguyen, Alfonso J Rodriguez-Morales","doi":"10.1093/postmj/qgaf036","DOIUrl":"https://doi.org/10.1093/postmj/qgaf036","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One step forwards, two steps back: changes to Specialised Foundation Programme recruitment in England are counterproductive.","authors":"Andrew MacPhie, Adam Mallis, Callum Weston, Man Hei Marcus Kam","doi":"10.1093/postmj/qgaf040","DOIUrl":"https://doi.org/10.1093/postmj/qgaf040","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of mindfulness and sleep quality on self-efficacy of clinical decision making among resident physicians: an observational study.","authors":"Mira M Abu-Elenin, Reham M Mounir, Walaa M Shehata","doi":"10.1093/postmj/qgaf031","DOIUrl":"https://doi.org/10.1093/postmj/qgaf031","url":null,"abstract":"<p><strong>Background: </strong>Mindfulness and sleep quality implicate the mental well-being of physicians; whose job demands high cognitive performance.</p><p><strong>Aim: </strong>This study aimed to measure the effect of sleep quality and mindfulness on residents to make timely proper clinical decisions.</p><p><strong>Methods: </strong>A cross-section study recruited 200 residents at Tanta University hospitals, in Egypt. Sleep quality was assessed using the Sleep Quality Scale, Mindfulness was measured by the Mindful Attention Awareness Scale, and clinical self-decision efficacy was determined by the Decision Self-efficacy Scale.</p><p><strong>Results: </strong>The study revealed that 22.5% of respondents had poor quality and 46.5% had low decision self-efficacy. A statistically significant high score of mindfulness was observed between residents of non-surgical specialties (3.1 ± 0.7). High capability of clinical decisions efficiently was statistically signficant and proportionally correlated with increased mindfulness scale (r = 0.4, P = 0.002). Lower self-efficacy was significantly associated with taking >3-night shifts/week and reduced break duration.</p><p><strong>Conclusion: </strong>There is remarkable low to moderate self-efficacy for clinical decision-making capability among the studied resident physicians, underpinned by the degree of mindfulness and hospital environmental factors.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between body roundness index and stroke incidence among middle-aged and older adults in China: a longitudinal analysis of the CHARLS data.","authors":"Lanqing Peng, Zhiguo Wen, Cong Xia, Yawei Sun, Yifan Zhang","doi":"10.1093/postmj/qgaf043","DOIUrl":"https://doi.org/10.1093/postmj/qgaf043","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between body roundness index (BRI) and stroke risk in middle-aged and elderly Chinese population.</p><p><strong>Methods: </strong>This retrospective cohort study utilized data from the China Health and Retirement Longitudinal Study (CHARLS), including participants aged ≥45 years. BRI was the exposure variable, and stroke incidence was the outcome. Weighted Cox regression models analyzed the association and evaluated the threshold effect of BRI on stroke risk.</p><p><strong>Results: </strong>Among 7651 participants, 519 stroke cases were identified. A one-unit increase in BRI was associated with a 15.8% elevated stroke risk [hazard ratio (HR) = 1.158, 95% confidence interval (CI): 1.158-1.159, P < 0.00001]. Quartile analysis revealed that the highest BRI quartile group had an 80.3% increased stroke risk compared to the lowest quartile (HR = 1.803, 95%CI: 1.800-1.806, P < 0.00001). A threshold effect was observed: when BRI was <5.94, a 1-unit increase was associated with an 18% increased stroke risk (HR = 1.18, 95%CI: 1.08-1.29, P = 0.0002). However, when BRI was >5.94, a 1-unit increase was associated with a non-significant 13% decreased risk (HR = 0.87, 95%CI: 0.68-1.12, P = 0.2944).</p><p><strong>Conclusion: </strong>BRI is significantly and positively associated with stroke risk in middle-aged and elderly Chinese population, with a threshold effect observed. BRI may serve as a valuable marker for stroke prediction and prevention, particularly at lower levels. Further research is needed to investigate BRI's applicability in diverse populations and its potential in developing stroke prevention strategies. Key message What is already known on this topic.  Stroke remains a leading cause of death and disability, particularly in China, emerging body shape indices warrant investigation as cardiovascular predictors, extending beyond the cross-sectional associations documented in previous studies. What this study adds.  In this first longitudinal study of Chinese adults aged 45 and older, we identified four distinct BRI trajectory patterns over a 10-year follow-up, revealing that consistently high and rapidly increasing trajectories were associated with elevated stroke risk, with notable gender differences. How this study might affect research, practice, or policy.  Our findings support BRI trajectory monitoring as a valuable stroke risk assessment tool, emphasizing the importance of gender-specific prevention strategies, stable body shape maintenance, and early intervention for unfavorable patterns.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetically predicted effects of COVID-19 on 2272 traits: exploring through a phenome-wide Mendelian randomization study.","authors":"Junyu Zhou, Yi Ge, Jing Yu, Yu Zhang","doi":"10.1093/postmj/qgaf037","DOIUrl":"https://doi.org/10.1093/postmj/qgaf037","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic has significantly impacted global health, making it essential to understand its genetic effects on various traits.</p><p><strong>Method: </strong>Leveraging the extensive FinnGen dataset comprising 500 000 individuals, we performed a Mendelian randomization (MR) phenome-wide association study. COVID-19-related phenotypes obtained from the COVID-19 Host Genetics Initiative GWAS (release 7). We employed four distinct approaches, including MR-Egger, weighted median, random-effect inverse variance weighted (IVW), and weighted mode, to conduct the MR analysis.</p><p><strong>Results: </strong>Two hundred fifty-five potential causal effects of COVID-19 were observed for a diverse range of outcomes using the IVW method, including cardiovascular disorders, respiratory conditions, autoimmune diseases, and metabolic disorders. Apart from a few that can be classified as \"other traits,\" the majority of the traits are disease-related traits. We have also identified 31 traits, wherein all four distinct MR analyses yielded a P-value of less than 0.05. Only one trait remained statistically significant after multiple testing correction using the conservative Bonferroni threshold (P < 2.2E-5).</p><p><strong>Conclusions: </strong>This phenome-wide MR study provides valuable insights into the genetically predicted effects of COVID-19 on a comprehensive range of traits. The identified associations contribute to our understanding of the complex interplay between the impact of the post-COVID-19 era on healthcare and may have implications for the development of targeted therapeutic strategies and public health interventions. Key messages What is already known on this topic - COVID-19 has a high mortality rate, and patients often have many sequelae, including myocarditis, acute respiratory distress syndrome, and neurological and hematologic complications. What this study adds Most of the current relevant studies lack large-scale phenotype-group ranging Mendelian randomization (MR) studies on the outcome of COVID-19 due to their small sample sizes. Therefore, this study performed a full phenotypic group MR analysis in the FinnGen dataset to investigate the relationship between COVID-19 and thousands of outcome variables. How this study might affect research, practice or policy- The study identified a set of traits that are strongly associated with genetic susceptibility to the long-term effects of COVID-19.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}