Postgraduate Medical Journal最新文献

{"title":"Insights into drug adverse reactions prediction through Mendelian randomization: a review.","authors":"Zhuanqing Huang, Hui Gong, Xuemin Sun, Wenqi Yi, Shiyang Liang, Sen Yang, Qi Sun, Xiaochuan Yan","doi":"10.1093/postmj/qgae203","DOIUrl":"10.1093/postmj/qgae203","url":null,"abstract":"<p><p>Adverse drug reactions pose a significant threat to patient safety and public health and often become apparent only after widespread clinical use. Mendelian randomization (MR) analysis is a valuable tool that can be used to infer causality by using genetic variants as instrumental variables, which can predict the occurrence of adverse drug reactions before they occur. Compared with traditional observational studies, MR Analysis can reduce the potential bias of confounding factors. This article reviews the principles of MR Analysis and its application in the prediction of adverse drug reactions, the challenges and future directions, and summarizes how to harness the power of this innovative epidemiological method to put us at the forefront of improving drug safety assessment and personalized medicine.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"933-943"},"PeriodicalIF":2.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067640","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 long working hours and poor cardiovascular health assessed by the American Heart Association's \"Life's essential 8\": findings from a nationally representative sample of Korean workers (2014-2021).","authors":"Seong-Uk Baek, Jin-Ha Yoon","doi":"10.1093/postmj/qgaf010","DOIUrl":"10.1093/postmj/qgaf010","url":null,"abstract":"<p><strong>Background: </strong>Long working hours represent a major public health concern. We explored the association between working hours and the American Heart Association's \"Life's Essential 8 (LE8).\"</p><p><strong>Methods: </strong>A nationwide sample comprising 21 062 Korean workers was analyzed. The LE8 scores (range 0-100) were calculated based on the following cardiovascular disease risk factors: diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipid levels, blood glucose levels, and blood pressure. Cardiovascular health (CVH) was categorized as low (LE8: 0-49), intermediate (LE8: 50-59), and high (LE8: 80-100). Linear regression and multinomial logistic regression models were used for statistical analyses.</p><p><strong>Results: </strong>The means of the LE8 scores for those working <35 h, 35-40 h, 41-48 h, 49-54 h, and ≥ 55 h per week were 69.4, 68.2, 66.8, 64.7, and 61.9, respectively. Among men, working 49-54 h per week [β: -1.43; 95% confidence interval (CI): -2.40, -0.45] and ≥55 h per week (β: -3.23; 95% CI: -4.11, -2.35) were associated with lower LE8 scores. Similarly, among women, working 49-54 h per week (β: -1.62; 95% CI: -2.72, -0.52) and ≥55 h per week (β: -2.88; 95% CI: -3.88, -1.88) had negative associations with LE8 scores. Working ≥55 h per week was associated with a 2.03-fold increase (95% CI: 1.53, 2.68) in the odds of low CVH among men and a 2.02-fold increase (95% CI: 1.37, 2.98) among women.</p><p><strong>Conclusion: </strong>Long working hours are associated with poor CVH, emphasizing the necessity of mitigating excessive working hours. Key message What is already known on this topic-The American Heart Association recently introduced \"Life Essential 8 (LE8),\" a metric assessing cardiovascular health. This study explored the association between long working hours and poor cardiovascular health among Korean adult workers. What this study adds-This study demonstrates that compared with working 35-40 h per week, working ˃48 h per week is associated with a reduced LE8 score. Specifically, working 49-54 h and ≥55 h per week are associated with increased odds of having poor cardiovascular health in both men and women, compared with working 35-40 h per week. Notably, long working hours showed a strong association with the health behavior factors of LE8. How this study might affect research, practice, or policy-This study suggests that promoting cardiovascular health based on the LE8 framework can be beneficial in mitigating the health burdens of long working hours.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"980-987"},"PeriodicalIF":2.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174630","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":"MVPA as the most influential factor for myocardial infarction through Bayesian Mendelian randomization among 11 behaviors.","authors":"Lei Pu, Peng Sun","doi":"10.1093/postmj/qgaf041","DOIUrl":"10.1093/postmj/qgaf041","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The causal associations between behavioral factors (BF) and myocardial infarction (MI), as well as the potential mediators and dose-response relationships, are incompletely clear. Therefore, this study aimed to evaluate the association of 11 BF with MI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used two-sample Mendelian randomization (2SMR) to investigate he associations between BF and MI and applied a two-sample multivariable MR approach based on Bayesian model averaging (MR-BMA) to prioritize the BF identified by 2SMR. For significant BF, we conducted extra conducted mediation analysis and restricted cubic spline (RCS) analysis to reveal potential mediating pathways and their dose-response relationships. Furthermore, we conducted replication analysis and meta-analysis to further support the results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 11 BF, 2SMR identified 3 BF that were significantly associated with MI. Among them, MR-BMA identified moderate to vigorous intensity physical activity (MVPA) (Marginal inclusion probability (MIP) = 0.77) as the most influential factor. A potential mechanism underlying the MVPA-MI association was waist-hip ratio (WHR, 7.26%). RCS analysis further revealed that an MVPA of 1094-2043 MET minutes/week was associated with the lowest risk of MI. Finally, replication analysis and meta-analysis further supported the 3 BF and identified an extra association between tea intake and MI risk (Meta: OR = 0.991, P = .003).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Of the 11 BF, MVPA was the most influential factor independently associated with the reduced risk of MI, with WHR mediating this association. At least 39 minutes of MVPA per day is recommended to reduce the risk of MI. In addition, tea intake is a potential protective factor for MI that warrants further investigation. Key messages What is already known on this topic?  Previous studies have shown an association between behavioral factors and the risk of myocardial infarction (MI). However, the exact causal relationship, which behavioral factors is most influential for MI, and the potential dose-response relationship are incompletely clear. Mendelian randomization can provide genetic evidence of causal associations and reveal the underlying mechanisms. What this study adds?  This study provides novel genetic evidence that smoking initiation, leisure sedentary time, and moderate to vigorous intensity physical activity (MVPA) are associated with MI. MVPA is the most influential factor. Only MVPA is independently associated with MI, and waist-to-hip ratio mediated the association. In addition, we found that at least 39 minutes of MVPA per day resulted in the greatest reduction in MI. Finally, we also found a potential protective effect of tea drinking on MI. How this study might affect research, practice, or policy?  This study suggests that MVPA is independently associated with MI. In addition, this provides a basis for clinical exercise intervention. Final","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"1049-1056"},"PeriodicalIF":2.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649997","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":"Comparison of one-handed face mask ventilation techniques on the simulation model: EO technique and EC technique.","authors":"Lan Xiao, Weijun Fang, Cheng Jiang, Hang Ke, Zongze Zhang, Hao Zou","doi":"10.1093/postmj/qgaf019","DOIUrl":"10.1093/postmj/qgaf019","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the efficacy of two one-handed face mask ventilation techniques. Secondarily, we also assessed the effect of hand size on the performance of both these techniques.</p><p><strong>Methods: </strong>Eighty subjects were randomized into the EO group and the EC group. After receiving face mask ventilation training, they carried out one-handed mask ventilation on a simulation model according to the order of EO technique-EC technique or EC technique-EO technique, and they performed each face mask ventilation technique for five consecutive ventilations. The primary outcomes were the time of the first chest undulation and the total number of chest undulations in the five operations. A questionnaire evaluated the subjects' feelings of simplicity and comfort regarding the two techniques.</p><p><strong>Results: </strong>Compared with the EC technique, the first success time was significantly shorter with the EO technique (17.69 ± 11.32 seconds vs 8.39 ± 8.08 seconds, P < 0.001), and the EO technique produced an improved successful ventilation rate (50.00% ± 33.89% vs 77.00% ± 28.84%, P < 0.001). For the EC technique, the first success time and successful ventilation rate of male subjects were better than those of female subjects (P < 0.05), whereas the first success time and successful ventilation rate in males and females did not significantly differ from each other for the EO technique (P > 0.5). Most subjects reported that the EO technique was simpler and more comfortable than the EC technique.</p><p><strong>Conclusion: </strong>On the simulation model, compared to the one-handed EC face mask ventilation technique, the EO technique is more conducive to the learning and mastery of novices and small-handed operators.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"997-1002"},"PeriodicalIF":2.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374003","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":"Emergency department evaluation of early warning scores in predicting mortality in febrile neutropenia patients.","authors":"Mehmet H Ağırağaç, Mahmut Yaman, Mustafa Içer, Zuhat Urakçı, Cahfer Güloğlu","doi":"10.1093/postmj/qgaf156","DOIUrl":"https://doi.org/10.1093/postmj/qgaf156","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;To compare the ability of five risk-stratification tools-the Multinational Association for Supportive Care in Cancer (MASCC) index, Clinical Index of Stable Febrile Neutropenia (CISNE), National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), and Quick Sequential Organ Failure Assessment (qSOFA)-to predict in-hospital mortality among adults presenting to the emergency department (ED) with febrile neutropenia (FN).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A single-center retrospective cross-sectional review included all FN visits to a tertiary ED (1 January 2018-31 December 2021). FN was defined as fever ≥38°C with an absolute neutrophil count &lt;1000 cells/μL. After exclusions, 90 encounters were analyzed. Demographics, vital signs, laboratory data, and calculated scores were compared between survivors and non-survivors. Receiver-operating-characteristic curves and areas under the curve (AUC) determined prognostic performance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Median age was 59 years (interquartile range 40-68); 68.9% were male. Fifteen patients died (16.6%). All five scores discriminated mortality (P &lt; 0.001). NEWS showed the highest AUC (0.851; 73.3% sensitivity, 78.7% specificity at cut-off 5.5), followed by MEWS (0.839), qSOFA (0.829), MASCC (0.816), and CISNE (0.798).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Physiology-based early warning scores, particularly NEWS and MEWS, outperformed oncology-specific indices for early mortality prediction in FN patients in the ED. Incorporating these rapid scores alongside MASCC or CISNE could enhance triage accuracy, inform disposition and ultimately improve outcomes. Key messages What is already known on this topic?  Febrile neutropenia (FN) is a life-threatening oncologic emergency requiring rapid risk stratification in the emergency department. Multinational Association for Supportive Care in Cancer (MASCC) and Clinical Index of Stable Febrile Neutropenia (CISNE) are commonly used oncology-specific tools for risk assessment, but their performance in acute emergency department (ED) settings is variable. General early warning scores like National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), and Quick Sequential Organ Failure Assessment (qSOFA) have been validated for sepsis but less frequently applied to febrile neutropenic patients. What this study adds?  This study is among the few to directly compare MASCC, CISNE, NEWS, MEWS, and qSOFA in predicting in-hospital mortality in FN patients in the ED. NEWS and MEWS demonstrated the highest area under the curve values and more balanced sensitivity-specificity ratios, outperforming oncology-specific scores. Vital sign-based scores, calculated rapidly at presentation, offer strong prognostic value for early identification of high-risk FN patients. How this study might affect research, practice, or policy?  Supports the integration of physiologic early warning scores (NEWS and MEWS) into FN triage protocols i","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092478","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":"Wisdom, mythology, and the prefrontal cortex: a neurocognitive interpretation of Athena's birth.","authors":"Muzaffer Ece Hakan Şahin, Tayfun Hakan","doi":"10.1093/postmj/qgaf155","DOIUrl":"https://doi.org/10.1093/postmj/qgaf155","url":null,"abstract":"<p><strong>Background: </strong>The myth of Athena's birth from Zeus' forehead presents a symbolic narrative that resonates with modern neuroscientific perspectives. The prefrontal cortex, crucial for decision-making, foresight, and moral reasoning, aligns intriguingly with the ancient attribution of wisdom to the head. This study aims to explore the convergence of mythology, philosophy, visual art, and neuroscience in order to examine whether ancient cultural narratives implicitly localized wisdom in the brain.</p><p><strong>Methods: </strong>A multidisciplinary approach was employed, drawing on classical texts, iconographic traditions, and contemporary neurobiological models of wisdom.Comparative analysis was used to identify symbolic parallels between mythological representations and neurocognitive functions.</p><p><strong>Results: </strong>The cranial emergence of Athena can be interpreted as a cultural archetype that anticipates the modern understanding of higher-order cognition. Artistic depictions reinforce this correspondence by emphasizing the head as the seat of wisdom. Despite the risk of anachronism, the recurrence of this imagery across centuries suggests that myth may encode latent insights into brain function.</p><p><strong>Conclusions: </strong>The case of Athena's birth highlights how mythological narratives can serve as proto-scientific frameworks for understanding human cognition. Integrating insights from mythology and neuroscience may enrich both historical interpretation and contemporary discussions on the nature of wisdom.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092473","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: Exploring the feasibility of using artificial intelligence to simulate the placebo arm of randomized clinical trials.","authors":"","doi":"10.1093/postmj/qgaf158","DOIUrl":"https://doi.org/10.1093/postmj/qgaf158","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092462","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: Genetically predicted effects of COVID-19 on 2272 traits: exploring through a phenome-wide Mendelian randomization study.","authors":"","doi":"10.1093/postmj/qgaf159","DOIUrl":"https://doi.org/10.1093/postmj/qgaf159","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092465","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":"Acute tubular injury following a single dose of tirzepatide in a patient with diabetic kidney disease: a cautionary case.","authors":"Subrahmanian Sathiavageesan, Vivek Sundaram, Anila Abraham","doi":"10.1093/postmj/qgaf153","DOIUrl":"https://doi.org/10.1093/postmj/qgaf153","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086084","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":"Doctors are encouraged to undertake research-but the system makes it far too difficult.","authors":"Harrison Charles Duell, Mary Shifona Kumarasingam","doi":"10.1093/postmj/qgaf152","DOIUrl":"https://doi.org/10.1093/postmj/qgaf152","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024068","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}