Postgraduate Medical Journal最新文献

{"title":"Valproate induced obsessive-compulsive symptoms: unique side effect of a commonly used drug.","authors":"Pallavi Priyam, Payel Talukdar","doi":"10.1093/postmj/qgaf066","DOIUrl":"https://doi.org/10.1093/postmj/qgaf066","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045222","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":"Effectiveness of different music tempos in guiding cardiopulmonary resuscitation training.","authors":"Chen Lan, Hao Shen, Yang Li","doi":"10.1093/postmj/qgaf068","DOIUrl":"https://doi.org/10.1093/postmj/qgaf068","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to compare the effectiveness of different musical tempos on the quality of cardiopulmonary resuscitation (CPR).</p><p><strong>Methods: </strong>A total of 150 untrained intern doctors and nurses were randomly assigned to three groups: No Music (NM group), Slow tempo Music (AS group), and Fast tempo Music (BR group), with 50 participants in each group. Following the theoretical study of CPR, three groups of trainees were assessed. Trainees in the NM group performed CPR without any music, whereas the AS group practiced with the background music of \"All Star\" (104 bpm) and the BR group utilized \"Bad Romance\" (119 bpm) during their assessments. Outcome measures included overall compression scores, compression rate, compression depth, rate of adequate compression depth and rate of adequate chest recoil.</p><p><strong>Results: </strong>The overall compression score for the AS group was 86.0 (interquartile range [IQR] 59.0-93.0), which was significantly higher than the BR group's score of 57.0 (IQR 40.0-84.0) and the NM group's score of 54.0 (IQR 39.5-72.0) (P < .05). The AS group demonstrated significant differences in both compression rate and depth compared to the BR and NM groups (P < .05). However, there were no significant differences in the rate of adequate chest recoil among the three groups (P > .05).</p><p><strong>Conclusion: </strong>In CPR training for untrained medical students, using music with a tempo of 104 bpm enhances CPR effectiveness. However, it does not increase the rate of adequate chest recoil.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020701","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":"Roles of macrophages and monocytes in resistance to immunotherapy in breast cancers.","authors":"Siyuan Liu, Lihong Hu, Jiejie Hu, Chengdong Qin, Chuner Jiang, Yang Yu","doi":"10.1093/postmj/qgaf065","DOIUrl":"https://doi.org/10.1093/postmj/qgaf065","url":null,"abstract":"<p><strong>Background: </strong>Immunotherapy is increasingly integral to breast cancer treatment, yet a subset develops resistance, partly mediated by macrophages and monocytes in the tumor immune microenvironment. While macrophages play essential roles in phagocytosis and pathogen clearance, their dual role in breast cancer-acting as both barriers to therapy and potential therapeutic targets-complicates treatment efficacy.</p><p><strong>Strategy: </strong>Tumor-associated macrophages, polarized by tumor-derived signals, promote cancer progression and metastasis. Monocytes, subdivided into CD14+CD16- and CD14+CD16+ subsets, exhibit distinct functional profiles in cytokine secretion, antigen presentation, and migration. Modulating monocyte subset dynamics and functionality may enhance immunotherapy responsiveness.</p><p><strong>Conclusion: </strong>A multimodal strategy targeting macrophages, monocytes, and complementary immunotherapies offers promising avenues to overcome resistance. Further research into the heterogeneity and regulatory mechanisms of these cells is critical for developing optimized, safe immunotherapeutic protocols. This review underscores the necessity of combination immunotherapies to improve outcomes in breast cancer.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033346","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":"Varicose vein is associated with an increased risk of ischemic stroke: a population-based matched cohort study.","authors":"Feng-Renn Hsieh, Wei-Kai Lee, Sunny Ssu-Yu Chen, Cheuk-Kwan Sun, Wen-Bin Yeh, Yao-Min Hung, Fuu-Jen Tsai, Renin Chang, Li-Fei Pan","doi":"10.1093/postmj/qgaf063","DOIUrl":"https://doi.org/10.1093/postmj/qgaf063","url":null,"abstract":"<p><strong>Importance: </strong>The association between varicose veins (VVs) and stroke, and the influence of VV management on the risk of stroke remained unclear.</p><p><strong>Objective: </strong>To evaluate whether VVs are associated with an elevated risk of stroke and assess if interventions for VVs alter this risk.</p><p><strong>Design: </strong>From 1 January 2000 to 31 December 2015, adults with VVs were matched by propensity score with those without VVs. Patients with prior strokes were excluded. Follow-up continued until 31 December 2018.</p><p><strong>Outcomes: </strong>Relative hazards through comparing incidence rates of ischemic stroke (IS) and hemorrhagic stroke (HS) between the two groups using Cox proportional hazards models.</p><p><strong>Results: </strong>Comparison of the VV group (n = 23 238, mean [SD] age = 54.3 [15.6] years; 70% female) with the non-VV group (n = 92 952, mean [SD] age = 54.1 [15.7] years; 71% female) revealed a higher incidence rate of IS in the former than the latter (13.15 vs. 11.16 per 1000 person-years; 2555 vs. 8799 cases, respectively). The adjusted hazard ratio (aHR) for overall stroke in the VV group was 1.16 (95% CI = 1.11-1.21). Both females (aHR = 1.18 [95% CI = 1.11-1.25]) and males (aHR = 1.15 [95% CI = 1.07-1.24]) with VVs showed an increased IS risk. In patients aged ≥50, VVs were associated with a higher IS risk (aHR = 1.17 [95% CI = 1.12-1.23]). No significant correlation was found between VVs and HS. The association of VV management with a reduced risk of stroke (aHR = 0.82 [95% CI = 0.70-0.96]) was supported by sensitivity analyses.</p><p><strong>Conclusions: </strong>Adults with VVs showed an increased risk of IS but not HS. Key message What is already known on this topic.  Varicose veins (VVs) are linked to cardiovascular conditions, but their association with stroke risk and the impact of VV interventions remain unclear. What this study adds.  This study demonstrated that adults with VVs, especially those aged ≥50, have a higher ischemic stroke (IS) risk. VV interventions may reduce this risk. How this study might affect research, practice, or policy.  Stroke risk assessment and VV management should be considered in older patients to improve preventive care.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990917","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":"Clinical master of medicine students in China-focusing on their dilemma.","authors":"Jinming Zhang","doi":"10.1093/postmj/qgaf064","DOIUrl":"https://doi.org/10.1093/postmj/qgaf064","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053324","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":"Anticoagulation outcomes in cirrhotic patients with portal vein thrombosis: a tertiary center study.","authors":"Chengu Niu, Jing Zhang, Idoate-Domench Daniel-Jose, Teibel Zachary, Orakzai Abdullah, Purva Shah, Eltaher Basant, Devam Maity, Firoze A Abdullah, Nagesh Jadhav, Patrick I Okolo, Daglilar Ebubekir","doi":"10.1093/postmj/qgaf062","DOIUrl":"https://doi.org/10.1093/postmj/qgaf062","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Study purpose: &lt;/strong&gt;This study assesses the efficacy and safety of direct oral anticoagulants (DOACs) compared to traditional anticoagulants in managing portal vein thrombosis (PVT), aiming to address critical gaps in both research and clinical practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;We conducted a retrospective analysis at Rochester General Hospital from January 2011 to December 2023, involving 275 cirrhotic patients with PVT. The inclusion criteria included confirmed non-neoplastic PVT by imaging.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Analysis of 275 cirrhotic patients with PVT revealed no significant differences in age and gender between those treated with anticoagulants and those untreated. The mortality rate was significantly lower in the treated group (37.7%) compared to the untreated group (51.7%; P = 0.029). Gastrointestinal bleeding was slightly more prevalent in the treated group (60.7%) than in the untreated group (58.1%; P = 0.690), though not statistically significant. A significant reduction in intracranial hemorrhage was observed in the treated group (2.5% vs. 8.5% in the untreated group; P = 0.038). In a subgroup analysis comparing the outcomes and side effects of DOACs, Warfarin, and low molecular weight heparins (LMWH) in treated PVT patients, the DOAC group showed improved survival rates compared to traditional [vitamin K antagonists (VKA)/LMWH] treatment, a log-rank test indicated significant survival improvement (chi2 (1) = 8.27, P = 0.0040). DOACs demonstrated comparable mortality rates to VKAs (34.2% vs. 34.5%, P = 0.979) and a significant survival benefit over LMWH (33.3% vs. 60.0%, P = 0.030).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;DOAC in treating PVT among patients with liver cirrhosis, demonstrating better significant survival rate when compared to traditional anticoagulation. Key message What is already known on this topic  Portal vein thrombosis (PVT) is significantly more prevalent in patients with liver cirrhosis compared to the general population, posing substantial management challenges. Previous studies have primarily focused on small cohorts and retrospective data, underscoring the need for robust, large-scale analyses to validate the efficacy and safety of direct oral anticoagulants (DOACs) versus traditional therapies. What this study adds  This study provides concrete evidence from a large cohort that DOACs not only offer a survival benefit over traditional anticoagulation therapies like Warfarin and LMWH in cirrhotic patients with PVT but also maintain comparable safety profiles. These findings bridge significant gaps in current research by comparing the outcomes of modern versus traditional anticoagulant approaches in a real-world setting. How this study might affect research, practice, or policy  The results advocate for the inclusion of DOACs in clinical guidelines for managing PVT in cirrhosis, potentially shifting clinical practice toward these agents. Furthermore, the detailed comparison a","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975960","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 novel indicator derived from heart sound energy map obtained by a wearable device can evaluate LV function.","authors":"Zhi-Jian Liu, Xiao-Hong Liu, Qing-Xue Zhang, Xiao-Hui Zhao, Xiu-Chang Li","doi":"10.1093/postmj/qgaf012","DOIUrl":"https://doi.org/10.1093/postmj/qgaf012","url":null,"abstract":"<p><strong>Background: </strong>Assessing cardiac function is important for early diagnosis, prognosis, and out-hospital follow-up for heart failure patients. It is especially crucial to identify a cost-effective and easily adaptable approach for evaluating cardiac function at home.</p><p><strong>Objective: </strong>Our purpose was to investigate whether some metrics derived from the heart sound energy map obtained by a wearable heart acquisition device could reflect the cardiac function.</p><p><strong>Methods: </strong>99 subjects were categorized into two groups based on whether their left ventricular ejection fraction was <50%. In the heart sound energy map mode, time intervals of energy intensity between 2100 and 2400 of the first heart sound was denoted as \"a,\" 1500-1800 as \"b,\" 1200-1500 as \"c,\" and 600-900 as \"d.\" The ratio of the time difference between adjacent energy intensity intervals and the high-energy interval was calculated, referred to as the Red index [(b-a)/a], Brn index [(c-b)/b], and Yel index [(d-c)/c], respectively.</p><p><strong>Results: </strong>Significant differences were observed in the Red index and Yel index between the two groups (P < .001 and P = 0.017, respectively). The Red and Yel indices showed a significant correlation with ejection fraction (EF) value (r = -0.50 and -0.27, P < .001 and P = .008, respectively). The intraclass correlation coefficient conformance test indicated that the intragroup correlation coefficients of the Red index with EF were 0.57. Receiver operating characteristic analysis revealed that the Red index exhibits strong diagnostic value for EF values <50% with an AUC of 0.86 (95% CI: 78% ~ 94%).</p><p><strong>Conclusions: </strong>The Red index, derived from the heart sound energy map, demonstrates a significant correlation with both the EF value and Tei index and can identify the reduction of left ventricular EF.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978996","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":"Impacts of viral respiratory infections on segments of fatal out-of-hospital cardiac arrests.","authors":"Jo-Jo Hai, Di Liu, Kathy Leung, Eric Lau, Sai-Chak Lai, Chin-Pang Chan, Chiu-Sun Yue, Lok-Yan Tam, Yuet-Wong Cheng, Wai-Ling Poon, Ngai-Yin Chan, Chu-Pak Lau, Joseph-Tszkei Wu, Hung-Fat Tse","doi":"10.1093/postmj/qgaf057","DOIUrl":"https://doi.org/10.1093/postmj/qgaf057","url":null,"abstract":"<p><strong>Purpose of the study: </strong>Viral respiratory infections have been linked to fatal out-of-hospital cardiac arrest (OHCA), yet the specific causes remain unclear, and the impact of individual viral infections is often confounded by local meteorological and environmental factors. This study aimed to investigate the independent effects of prevalent viral respiratory infections on the risk and causes of fatal OHCA in different age groups.</p><p><strong>Study design: </strong>We conducted negative binomial regression analyses to investigate the association between influenza, respiratory syncytial virus (RSV), and coronavirus disease 2019 (COVID-19) infections, along with temperature, extreme weather alerts, and the air quality health index, with age- and cause-specific fatal out-of-hospital cardiac arrest (OHCA) from the 2nd week of 2014 to the 17th week of 2020. The analysis covered three etiological categories (cardiovascular, respiratory, and non-cardiovascular non-respiratory) across three age groups (≤ 64 years, 65-84 years, ≥ 85 years) in Hong Kong.</p><p><strong>Results: </strong>During this period, there were 41 548 fatal OHCA cases in Hong Kong. Influenza was consistently associated with fatal OHCA across all etiologies and age groups, significantly impacting cardiovascular and non-cardiovascular non-respiratory causes more than respiratory causes (110.9, 66.8, and 17.4 per 1 million persons, respectively). Reduced healthcare-seeking behaviors during the COVID-19 pandemic was linked to increased fatal OHCA across all ages and etiologies, except for respiratory causes. RSV showed no association with fatal OHCA in our population.</p><p><strong>Conclusions: </strong>Influenza is a significant independent risk factor for fatal OHCA across variouscauses and age groups, particularly affecting cardiovascular and non-cardiovascular non-respiratory outcomes.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013149","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":"Recruiting and retaining doctors-a wicked problem needing complex solutions.","authors":"Jo-Anne Johnson, Sanjiv Ahluwalia","doi":"10.1093/postmj/qgaf058","DOIUrl":"https://doi.org/10.1093/postmj/qgaf058","url":null,"abstract":"<p><p>Recruiting and retaining healthcare professionals, particularly doctors, remains a critical challenge for the National Health Service (NHS), exacerbated by an ageing population, geographical disparities, and persistent workforce shortages. Traditional linear solutions fail to address the complexity of these interconnected issues, necessitating a multidimensional approach rooted in complexity science. This article frames the recruitment and retention of doctors as a wicked problem, characterized by interdependencies, dynamic interactions, and context-specific nuances. Using the Anglia Ruskin University School of Medicine in Essex as a case study, we explore a locally contextualized strategy within the national 'train, retain, reform' framework. Initiatives include the innovative Medical Degree Doctor Apprenticeship, targeted outreach programmes, and collaboration with NHS England to prioritize local foundation training posts for graduates. These strategies are designed to address workforce disparities in socioeconomically disadvantaged regions whilst fostering local retention. Our findings highlight the need for adaptive, non-linear solutions that integrate national policies with local innovations to address workforce inequalities effectively. We argue that sustainable improvements require distributed control, interdependent systemic interventions, and stakeholder collaboration. This approach not only addresses local recruitment challenges but also contributes to reducing health inequalities, emphasizing the importance of local agency within a national framework.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041597","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":"Creativity in medicine during times of uncertainty.","authors":"Caitlin Linscheid, Gillian Luevano, Lindsay Nordwald","doi":"10.1093/postmj/qgaf060","DOIUrl":"https://doi.org/10.1093/postmj/qgaf060","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041780","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}