Postgraduate Medical Journal最新文献

{"title":"On reflection; a personal mildly dyslexic bramble.","authors":"Philip D Welsby","doi":"10.1093/postmj/qgaf116","DOIUrl":"https://doi.org/10.1093/postmj/qgaf116","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732940","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":"Retraction of: Volrustomig/Rilvegostomig related \"triple M\"-myasthenia gravis and overlap syndrome.","authors":"","doi":"10.1093/postmj/qgaf118","DOIUrl":"https://doi.org/10.1093/postmj/qgaf118","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732941","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":"Causal effects of one-carbon metabolism molecules on cancers risk: a Mendelian randomization study.","authors":"Xiao Li, Man Li, Simeng Gao, Jingru Han, Ping Liang","doi":"10.1093/postmj/qgaf114","DOIUrl":"https://doi.org/10.1093/postmj/qgaf114","url":null,"abstract":"<p><strong>Background: </strong>An association between the one-carbon metabolism molecules, such as vitamin B6 (VB6), vitamin B12 (VB12), folate and homocysteine (Hcy), and the incidence of various cancers risk has been reported in observational studies, but the causal relationship between one-carbon metabolism molecules and various cancers risk remains unclear. Our aim was to assess the causal effect of one-carbon metabolism molecules on various cancers risk using a two-sample Mendelian randomization (MR) approach.</p><p><strong>Methods: </strong>We performed two-sample MR to analyze associations between four one-carbon metabolism molecules and seven cancers in Europeans. Methods included IVW, weighted median, MR-Egger, MR-PRESSO, and outlier tests.</p><p><strong>Results: </strong>Hcy: Suggestive causal association with reduced GC risk (OR = 0.5427; P = .0217) and increased KC risk (OR = 1.3744; P = .0465). High Hcy levels linked to higher PCA (OR = 1.1038; P = .0496) and KC risk (OR = 1.5444; P = .0430), but lower GC risk (OR = 0.6487; P = .0499).Folate: Higher levels associated with increased CRC risk (OR = 1.2945; P = .0346) and reduced PCA risk (OR = 0.8330; P = .0486).VB12: Suggestive causal association with reduced BC (OR = 0.7421; P = .0203) and GC risk (OR = 0.4812; P = .0267). The causal associations of the above combinations were robust through the test of heterogeneity and pleiotropy.</p><p><strong>Conclusions: </strong>The large MR analysis indicated that one-carbon metabolism molecules may be causally associated with various cancers risk.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732939","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":"Confession of a primary care educator.","authors":"Masahiro J Morikawa","doi":"10.1093/postmj/qgaf117","DOIUrl":"https://doi.org/10.1093/postmj/qgaf117","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699258","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":"Fibrosis mechanisms in systemic sclerosis and new potential therapies.","authors":"Raffaele Barile, Cinzia Rotondo, Valeria Rella, Antonello Trotta, Francesco Paolo Cantatore, Addolorata Corrado","doi":"10.1093/postmj/qgae169","DOIUrl":"10.1093/postmj/qgae169","url":null,"abstract":"<p><p>Systemic sclerosis is a rare rheumatic disease characterized by immune cell activation, tissue fibrosis, and endothelial dysfunction. Extracellular matrix synthesis disorder causes widespread fibrosis, primarily in skin and internal organs. Various factors such as TGFβ, VEGF, Galectin-3, and signaling pathways like Wnt/β-catenin are involved in pathophysiological processes. Treatment lacks a unified approach but combines diverse modalities tailored to disease subtype and progression. Current therapeutic strategies include biologics, JAK inhibitors, and IL-6 pathway modulators. Monoclonal antibodies and hypomethylating agents demonstrate potential in fibrosis inhibition. This review focuses on emerging therapeutic evidence regarding drugs targeting collagen, cytokines, and cell surface molecules in systemic sclerosis, aiming to provide insight into potential innovative treatment strategies.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"680-689"},"PeriodicalIF":3.6,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829657","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":"A more precise interpretation of the potential value of artificial intelligence tools in medical education is needed.","authors":"Hongnan Ye","doi":"10.1093/postmj/qgaf024","DOIUrl":"10.1093/postmj/qgaf024","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"750-751"},"PeriodicalIF":3.6,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383269","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":"A case of euglycaemic diabetic ketoacidosis in a T2DM patient using Tirzepatide.","authors":"Natasha Chaudhury, Rohit Baslas, Kuljeet Bhamra","doi":"10.1093/postmj/qgaf079","DOIUrl":"10.1093/postmj/qgaf079","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"775-776"},"PeriodicalIF":3.6,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132536","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":"Rethinking polypharmacy: empowering junior doctors to tackle a chronic condition in modern practice.","authors":"Waseem Jerjes","doi":"10.1093/postmj/qgae198","DOIUrl":"https://doi.org/10.1093/postmj/qgae198","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":"101 1198","pages":"667-669"},"PeriodicalIF":3.6,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682957","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":"The move to 24/7 mechanical thrombectomy provision for ischaemic stroke: an observational study of the impact on referrals, activity, procedural efficacy, and safety at a supra-regional centre.","authors":"Alex Mortimer, Richard Flood, David Minks, Robert Crossley, James Wareham, Anthony Cox, Amit Goswami, James Dodd, Scott Grier, Aidan Marsh, Rose Bosnell","doi":"10.1093/postmj/qgae136","DOIUrl":"10.1093/postmj/qgae136","url":null,"abstract":"<p><strong>Background: </strong>Health systems are striving to improve delivery of mechanical thrombectomy (MT) for ischaemic stroke. With the move to 24/7 provision, we aimed to assess (1) the change in referral and procedural frequency and timing, (2) reasons referrals did not proceed to MT, and (3) nocturnal procedural efficacy and safety.</p><p><strong>Methods: </strong>This was an observational study comparing 12-month data for an extended daytime service (2021/2022, hours, 0800-2000) to that for a 12-month period delivering 24/7 cover (2023-2024). Nocturnal and daytime outcomes (rate of recanalisation using modified TICI scoring), extent of postprocedural infarction (using ASPECTS grading), rate of early neurological improvement (using 24-h NIHSS change), 90-day mortality, and complicating symptomatic intracranial haemorrhage (SICH) in the latter period were compared.</p><p><strong>Results: </strong>Both referrals (432 to 851) and procedural caseload (191 to 403) approximately doubled with the move to 24/7 cover; 36% of procedures occurred overnight (n = 145). The dominant reasons for referrals not proceeding to MT were a large core infarct (n = 144) or absence of a large vessel occlusion on baseline imaging (n = 140). There were no significant differences in successful recanalisation (TICI 2B/3: 85.5% vs 87.1%, P = .233), rates of postprocedural ASPECTS≥7 (74.9% vs 75.8%, P = .987), early neurological improvement (NIHSS reduction ≥30%: 43.4% vs 42.4%, P = .917), 90-day mortality (19.6% vs 18.6%, P = .896), or SICH (1.9% vs 4.1%, P = .214) obtained for daytime vs nighttime hours.</p><p><strong>Conclusion: </strong>24/7 MT provision has resulted in a rapid rise in the number of patients who may benefit from MT. This service can be provided with an acceptable safety profile during nighttime hours in a high-volume comprehensive UK centre.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"756-763"},"PeriodicalIF":3.6,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472939","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":"Contribution of nebulized budesonide before bronchoscopy, a prospective clinical study.","authors":"Guoxin Zhang, Hu Yu, Li Zhang, Xiaoyun Zhao","doi":"10.1093/postmj/qgae196","DOIUrl":"10.1093/postmj/qgae196","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluated the efficacy of adding budesonide to nebulized lidocaine in patients undergoing flexible bronchoscopy (FB) under topical anaesthesia.</p><p><strong>Study design: </strong>Patients aged ≥18 years, scheduled for FB under topical anaesthesia were randomized into two groups: the combination group received a pre-treatment of 2 ml 1 mg budesonide with 5 ml 2% lidocaine, whilst the lidocaine group received 5 ml 2% lidocaine with 2 ml saline solution, both administered via nebulization. Blood pressure (BP), heart rate, and percutaneous oxygen saturation were recorded before, during, and 10 min after FB. The Visual Analogue Scale (VAS) and Wong-Baker FACES Pain Rating Scale (FPS-R) were used to evaluate cough severity, discomfort, willingness to accept reoperation, and the operator's satisfaction with patient cooperation. In addition, the duration of the procedure, total lidocaine dosage instilled through the bronchoscope during the procedure, and types of procedures performed were documented.</p><p><strong>Results: </strong>Compared to the lidocaine group, the combination group showed lower maximum systolic and diastolic BP, higher minimum percutaneous oxygen saturation, and lower cough and discomfort severity scores. Operator's satisfaction, as measured via the VAS or FPS-R, was greater in the combination group, which also exhibited shorter procedure times and required lower lidocaine dosages. There were no significant differences between the groups in terms of willingness to accept reoperation or types of procedures performed.</p><p><strong>Conclusions: </strong>In patients undergoing FB with topical anaesthesia, pre-treatment with a combination of nebulized lidocaine and budesonide is more effective than nebulized lidocaine alone. Key message What is already known on this topic?  Flexible bronchoscopy (FB) with topical anaesthesia remains a common practice in many settings, although it can cause significant discomfort for patients. What this study adds?  Pre-treatment with a combination of nebulized budesonide and lidocaine was more effective and safer than nebulized lidocaine alone for improving patient tolerance during FB. How this study might affect research, practice, or policy?  In settings where conscious sedation is not feasible, the combined nebulization of lidocaine and budesonide may offer an optimized approach for FB, enhancing patient comfort and procedural efficiency.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"737-742"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010273","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}