Postgraduate Medical Journal最新文献

{"title":"London Major Trauma System: a review of an organised trauma system and the challenges it faces.","authors":"Matthew Edmunds","doi":"10.1093/postmj/qgae168","DOIUrl":"10.1093/postmj/qgae168","url":null,"abstract":"<p><p>London Major Trauma System (LMTS) was the first organised trauma system in the United Kingdom. It was created in 2010 in response to multiple reviews that suggested a large number of deaths from trauma may have been preventable. LMTS has all the features of a modern organised trauma system, including regionalisation, integration of care, transfer services, trauma teams, and a world leading research service. Since its introduction the benefits on mortality, morbidity, and other key metrics have been widely demonstrated. Despite its success, LMTS still faces a number of challenges; most notably from the ageing population, but also in ensuring equity of improvements across the entirety of the trauma network and throughout the whole patient journey. The very nature of LMTS being an inclusive and organised trauma system will help it in facing these challenges.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"591-595"},"PeriodicalIF":3.6,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829658","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":"Higher dietary zinc intake increases the risk of autoimmune thyroiditis.","authors":"Lijun Chen, Changjian Yan, Chunling Huang, Zhengrong Jiang, Ruhai Lin, Xiaohong Wu, Huibin Huang","doi":"10.1093/postmj/qgae202","DOIUrl":"10.1093/postmj/qgae202","url":null,"abstract":"<p><strong>Background: </strong>Autoimmune thyroiditis (AIT), encompassing Hashimoto's thyroiditis (HT), is a prevalent chronic autoimmune disorder characterized by lymphocytic infiltration and the presence of anti-thyroid antibodies. It is the primary cause of primary hypothyroidism and affects women more frequently than men. Nearly 95% of individuals with HT exhibit thyroid peroxidase antibodies or thyroglobulin antibodies. Dietary factors, including vitamins and trace elements such as zinc, play a significant role in thyroid health; yet, clinical guidelines lack explicit dietary recommendations for AIT.</p><p><strong>Methods: </strong>This study investigates the relationship between dietary zinc intake (Zinc) and AIT using data from the 2007-2008 National Health and Nutrition Examination Survey. A total of 5467 participants were analyzed, including 273 individuals with AIT and 5194 without AIT. Clinical characteristics, dietary Zinc, and other relevant variables were assessed. Multivariate logistic bidirectional stepwise regression analysis was conducted to identify independent risk factors for AIT, and a risk prediction model was developed.</p><p><strong>Results: </strong>The prevalence of AIT was 5%. Individuals with AIT were older, had a higher proportion of females, and showed elevated levels of various biomarkers, including zinc. Dietary Zinc was significantly higher in the AIT group (22.6 mg vs. 15.3 mg, P < .001). The regression analysis identified dietary Zinc, along with other factors, as an independent risk factor for AIT. The risk prediction model, including zinc, demonstrated a better performance (area under the curve = 0.8) compared to the model without zinc.</p><p><strong>Conclusion: </strong>The findings indicate that higher dietary Zinc is positively correlated with the risk of AIT and serves as an independent risk factor. Excessive Zinc may disrupt immune balance, potentially increasing the risk of autoimmune diseases. These results suggest that dietary Zinc should be carefully considered in the management of AIT, and further research is needed to explore the causal relationship and determine safe zinc consumption levels to avoid increasing the risk of autoimmune diseases.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"644-652"},"PeriodicalIF":3.6,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965687","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":"Exploring the pathophysiology of restless leg syndrome: focus on white matter structure and function.","authors":"Zairan Wang, Zhimin Li, Jingjing Wang, Jun Gao, Yongning Li","doi":"10.1093/postmj/qgae156","DOIUrl":"10.1093/postmj/qgae156","url":null,"abstract":"<p><strong>Background: </strong>Restless legs syndrome (RLS) is a sleep disorder characterized by an irresistible urge to move the legs, with pathogenesis involving genetic, environmental, and neurobiological factors. Recent advancements in imaging techniques have provided valuable insights into the pathophysiological mechanisms of RLS.</p><p><strong>Objective: </strong>To synthesize recent research on white matter fiber alterations in RLS and their role in disease pathology.</p><p><strong>Materials and methods: </strong>This review synthesized recent research on RLS, focusing on neuroimaging findings, particularly white matter fiber alterations, and their implications for disease mechanisms. Studies involving structural and functional MRI were analyzed.</p><p><strong>Results: </strong>Imaging studies suggested that RLS was associated with white matter integrity changes, affecting areas linked to sensory and motor control. These alterations may reflect disruptions in central nervous system pathways regulating movement.</p><p><strong>Conclusion: </strong>White matter changes provide valuable insights into the pathophysiology of RLS, enhancing our understanding of the disorder and potentially guiding future therapeutic strategies.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"596-602"},"PeriodicalIF":3.6,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695762","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":"Effect of abnormal placental cord insertion on hemodynamic change of umbilical cord in a tertiary center: a prospective cohort study.","authors":"Xiu-Qin Wu, Ying Miao, Xiao-Feng Yang, Yong-Qiang Hong, Liang-Cheng Wang, Wei-Hsiu Chiu","doi":"10.1093/postmj/qgae193","DOIUrl":"10.1093/postmj/qgae193","url":null,"abstract":"<p><strong>Background: </strong>Our study aims to evaluate the umbilical vein (UV) hemodynamic change in the prenatal cohort of pregnancies diagnosed with abnormal placental cord insertion (aPCI).</p><p><strong>Methods: </strong>From January 2022 to December 2022, the fetal umbilical cord insertion site was sonographically examined in singleton fetuses, and umbilical cord blood flow was calculated. The umbilical artery and UV Doppler flow indexes were assessed in cases of normal and abnormal cord insertion.</p><p><strong>Results: </strong>Among 570 singleton fetuses between 18 + 0 and 40 + 6 weeks of gestation in the final study, the umbilical vein blood flow (UVBF) in the 3 groups of normal umbilical cord insertions, marginal umbilical cord insertions, and velamentous umbilical cord insertions was 145.39 ml/min, 146.18 ml/min, and 93.96 ml/min, respectively. UVBF was significantly lower in the velamentous cord insertion (VCI) group than in the other groups (P < 0.05). Compared with the normal cord insertions group, lower birth weight (2820 ± 527 g vs. 3144 ± 577 g, P < 0.05), delivery at an earlier gestational age (38.0 ± 1.55 weeks vs. 38.8 ± 2.34 weeks, P < 0.05), higher bicarbonate (25.08 ± 1.72 mmol/L vs. 22.66 ± 4.05 mmol/L, P < 0.05), and higher standard base excess (-1.14 ± 1.50 mmol/L vs. -3.30 ± 3.22 mmol/L, P < 0.05) were found in the VCI group.</p><p><strong>Conclusions: </strong>We observed lower UVBF volume with aPCI. Hence, we propose UVBF analysis to evaluate fetal aPCI according to UV hemodynamics as an advisory in prenatal care. This would be useful and improve obstetricians' clinical explanation about the potential prenatal consequences so that parents can opt for future prenatal care during pregnancy.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"627-635"},"PeriodicalIF":3.6,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142966464","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":"Exploring the feasibility of using artificial intelligence to simulate the placebo arm of randomized clinical trials.","authors":"Nitesh Gautam, Abdelrahman Elhusseiny, Munthir Mansour, Jawahar L Mehta, Olaf S Andersen, Yifan Peng, Subhi J Al'Aref","doi":"10.1093/postmj/qgaf095","DOIUrl":"https://doi.org/10.1093/postmj/qgaf095","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512411","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":"Correction to: Pulsed-field ablation versus radiofrequency or cryoballoon thermal ablation in atrial fibrillation: a systematic review and meta-analysis.","authors":"","doi":"10.1093/postmj/qgaf091","DOIUrl":"https://doi.org/10.1093/postmj/qgaf091","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249285","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":"Correction to: Revisiting the diagnostic and prognostic significance of high-frequency QRS analysis in cardiovascular diseases: a comprehensive review.","authors":"","doi":"10.1093/postmj/qgaf092","DOIUrl":"https://doi.org/10.1093/postmj/qgaf092","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249286","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 burden of some of the most common zoonoses in primary care: a population-based study in Italy.","authors":"Francesco Lapi, Ettore Marconi, Ezio Ferroglio, Iacopo Cricelli, Alessandro Rossi, Claudio Cricelli","doi":"10.1093/postmj/qgaf086","DOIUrl":"https://doi.org/10.1093/postmj/qgaf086","url":null,"abstract":"<p><strong>Background: </strong>Preventing and managing zoonoses mandate the combined efforts of physicians, veterinarians, and environmental and social scientists. The systematic recording of zoonoses in humans is rarely carried out through dedicated surveillance systems, and there is a need to boost awareness among general practitioners about these diseases. Companion animals, especially dogs and cats which constitute a reservoir for zoonotic infective agents, are frequently present in Italian families. We therefore conducted an assessment of the burden of certain zoonoses in primary care settings in Italy.</p><p><strong>Methods: </strong>Using an Italian primary care database, we identified the active population aged 15 years or older in the database on 31 December 2022, the study index date. We calculated the lifetime prevalence of zoonoses transmissible by domestic animals through different vectors. These estimates were stratified by the presence of immunodeficiencies and the level of frailty in older adults.</p><p><strong>Results: </strong>The most common zoonosis was Lyme disease (4.7 per 10 000) followed by rickettsioses (3 per 10 000). Leishmania and Bartonella-related infections showed prevalence lower than 1 out of 10 000. Those with a positive history of immunodeficiencies showed greater occurrence of zoonoses (7.60 vs. 5.05 per 10 000). The proportion of zoonoses increased according to frailty level, from 14.73 to 18.62 per 10 000 moving from fit to severe frailty.</p><p><strong>Conclusions: </strong>These findings suggest that improved surveillance and greater awareness among healthcare providers should support general practitioner-veterinarian interactions to minimize zoonosis transmission, especially for immunodeficient and frail older patients. Main messagesDogs and cats, which are frequently found in Italian families, constitute a reservoir of zoonotic infective agents.Zoonoses in humans are rarely systematically recorded using surveillance systems and there are no dedicated surveillance systems in Italy for zoonotic diseases, especially for primary care.The most common zoonoses in Italian primary care settings were Lyme disease and rickettsioses.The proportion of zoonoses increased with frailty levels in older adults and was almost double in those with immunodeficiencies relative to the general population.Enhancing knowledge and establishing dedicated monitoring systems within primary healthcare, as well as interdisciplinary collaboration between general practitioners and veterinarians, are essential for the prevention and control of zoonotic diseases.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249287","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":"When judgment and initiative fail: dilemmas in frontal lobe lesions.","authors":"Marianna E Kapsetaki","doi":"10.1093/postmj/qgaf088","DOIUrl":"https://doi.org/10.1093/postmj/qgaf088","url":null,"abstract":"<p><p>A key part of neurosurgery is decision-making; not only by the neurosurgeons but also by the patients. The patient needs to decide: shall I do the operation? Now or later? With which doctor? At which medical center? In which country? But what if the exact condition that needs an operation causes you problems with making decisions, such as a frontal lobe lesion? Your decision-making capacity may need to go to others [1]. But what if those others may not act in your best interest? What if your decisions carry weight not just for you, but for someone else who depends on you, e.g. as a caregiver, parent, or guardian?</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209236","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":"Long-term anticoagulation in cancer patients with low- risk pulmonary embolism.","authors":"Nishma Dhand, Akhil Jain","doi":"10.1093/postmj/qgaf089","DOIUrl":"https://doi.org/10.1093/postmj/qgaf089","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216651","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}