Postgraduate Medical Journal最新文献

{"title":"Mind of artificial intelligence and machine-a fact or fiction?","authors":"Souvik Dubey, Subhankar Chatterjee, Ritwik Ghosh, Samya Sengupta, Mahua Jana Dubey","doi":"10.1093/postmj/qgaf140","DOIUrl":"https://doi.org/10.1093/postmj/qgaf140","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144965988","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 and pathological features of 209 cases of pilomatricoma in children: a retrospective study.","authors":"Zishang Guo, Hailin Wang, Pengjie Wan, Huan He, Zhuo Chen, Dan Deng","doi":"10.1093/postmj/qgaf139","DOIUrl":"https://doi.org/10.1093/postmj/qgaf139","url":null,"abstract":"<p><strong>Background: </strong>Pilomatricoma, albeit benign, may have a potential impact on children's appearance and health. Clinical practice has revealed variations in the clinical manifestations, anatomical locations, and sizes of pilomatricoma among different pediatric patients. However, few studies have comprehensively summarized the correlations between these features and treatment efficacy, which is crucial for enhancing clinicians' understanding and diagnostic accuracy of the disease.</p><p><strong>Objectives: </strong>This study aimed to comprehensively analyze the clinical characteristics, ultrasonographic and pathological features, and treatment outcomes of pilomatricoma in Chinese pediatric patients at a single pediatric dermatology surgery center.</p><p><strong>Methods: </strong>A retrospective study was conducted on the medical histories of 209 Chinese children who underwent surgical excision with subsequent pathological confirmation of pilomatricoma at Shanghai Children's Medical Center between January 2023 and January 2024. We carried out a multidimensional analysis integrating clinical, ultrasonographic, and histopathological features.</p><p><strong>Results: </strong>Pilomatricoma exhibits distinct clinical, ultrasonographic, and pathological characteristics in children. Key findings included: (i) Female predominance in limb/trunk involvement (34.5% vs 17.3% in males, P ≤ .01); (ii) Head/neck localization decreasing with age; (iii) Characteristic ultrasonographic patterns (88.2% calcification detection rate); (iv) No recurrence following complete excision.</p><p><strong>Conclusions: </strong>Our findings demonstrate distinct gender-based anatomical distribution patterns and excellent surgical outcomes for pediatric pilomatricoma. The integration of high-frequency ultrasonography with clinical evaluation significantly enhances diagnostic accuracy, potentially reducing unnecessary interventions in this population. These findings provide critical references for clinicians regarding disease characteristics and diagnostic optimization. Key messages What is already known: Pilomatricoma is a benign hair matrix-derived tumor with diverse clinical presentations, often leading to misdiagnosis. Previous studies have reported its association with Wnt/β-catenin pathway mutations and a predilection for the head/neck region in children, but comprehensive analyses of gender-specific anatomical distribution and diagnostic optimization are lacking. What this study adds: This large pediatric cohort reveals gender differences in anatomical involvement (female predominance in limb/trunk lesions) and demonstrates that high-frequency ultrasonography (88.2% calcification detection) significantly improves preoperative diagnostic accuracy (71.3% vs. historical rates of 16%-43%). How this study might affect research, practice, or policy: The findings advocate for integrating ultrasonography into clinical workflows to reduce misdiagnosis and unnecessary i","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144965993","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":"Insights into modifiable risk factors of atrial fibrillation: a comprehensive Mendelian randomization study.","authors":"Xuexue Zhang, Xujie Wang, Wantong Zhang, Mengxuan Li, Qiuyan Li","doi":"10.1093/postmj/qgaf141","DOIUrl":"https://doi.org/10.1093/postmj/qgaf141","url":null,"abstract":"<p><strong>Background: </strong>Numerous observational studies suggest that modifiable risk factors contribute to the onset of atrial fibrillation (AF). This study aims to assess the causal relationship between 46 modifiable risk factors and AF.</p><p><strong>Methods: </strong>Univariable, multivariate, and mediation Mendelian randomization (MR) analyses were employed to examine the causal relationship between 46 modifiable risk factors and AF. Summary-level data from genome-wide association studies (GWAS) meta-analysis and FinnGen consortium were utilized for both discovery and replication. The combined results were analyzed using a fixed-effect model to confirm the robustness of the findings.</p><p><strong>Results: </strong>Among 46 modifiable risk factors, both the discovery dataset and the combined results confirmed that alcohol consumption, smoke consumption, job involves heavy manual or physical work, sleep apnea syndrome, trunk fat mass, body fat percentage, whole body fat mass, waist circumference, body mass index, basal metabolic rate, poor health status, diastolic blood pressure, systolic blood pressure, glycosylated hemoglobin type A1C (HbA1C), lipoprotein A, serum uric acid, coronary artery disease, myocardial infarction, heart failure, hypertension, hyperthyroidism, and negative emotions increased the risk of AF (P < .05 and false discovery rate-adjusted P < .05). Conversely, college or university degree, impedance of whole body, and heart rate were associated with a decreased risk of AF (P < .05 and false discovery rate-adjusted P < .05). Multivariate MR identified sleep apnea syndrome, basal metabolic rate, diastolic blood pressure, systolic blood pressure, HbA1C, lipoprotein A, serum uric acid, coronary artery disease, myocardial infarction, heart failure, and hypertension as risk factors for AF.</p><p><strong>Conclusion: </strong>Our findings offer new and comprehensive evidence demonstrating the confirmed causal effects of various risk factors on AF among Europeans. Larger-scale GWAS will be necessary to further validate these causal associations in the future.Highlights Our study investigated the causal association between 46 modifiable risk factors and AF under a two-sample MR framework. This comprehensive MR study confirmed that alcohol consumption, smoke consumption, job involves heavy manual or physical work, sleep apnea syndrome, trunk fat mass, body fat percentage, whole body fat mass, waist circumference, body mass index, basal metabolic rate, poor health status, diastolic blood pressure, systolic blood pressure, HbA1C, lipoprotein A, serum uric acid, coronary artery disease, myocardial infarction, heart failure, hypertension, hyperthyroidism, negative emotions, college or university degree, impedance of whole body, and heart rate contribute causally to the onset and development of AF. No significant association was found between lipid levels and AF. Key messages What is already known on this topic: Previous studies have","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966029","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 weight of words: teaching junior doctors to reframe harmful labels.","authors":"Waseem Jerjes","doi":"10.1093/postmj/qgaf143","DOIUrl":"https://doi.org/10.1093/postmj/qgaf143","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966074","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":"Temperature effect on scrub typhus incidence in South Korea: the projection for climate change.","authors":"Donghee Seo, Yoon-Jung Choi, Yun-Chul Hong","doi":"10.1093/postmj/qgaf110","DOIUrl":"https://doi.org/10.1093/postmj/qgaf110","url":null,"abstract":"<p><strong>Objective: </strong>The influence of climate change on infectious disease dynamics is a subject of interest, but it demands robust scientific evidence. This study explores the short-term and long-term relationships between meteorological factors and the incidence of scrub typhus (ST) in South Korea.</p><p><strong>Methods: </strong>From 2001 to 2018, data on meteorological conditions and weekly ST cases were sourced from national databases. A generalized additive model was used to visualize the relationship, while a generalized linear model was applied to measure the association's strength. Mean annual temperature change was used as a proxy for climate change in long-term analysis. Despite the small sample size, generalized and mixed-effect models were employed to minimize geographical effects.</p><p><strong>Results: </strong>The number of ST cases was linearly related to the mean temperature 13 weeks prior, above a threshold temperature of 13.3-18.5°C. A 0.1°C increase in mean temperature was associated with a 25% increase in ST cases (OR 1.25, 95% CI: 1.21, 1.29). In line with the short-term trend, the annual incidence of ST increased by 33% (OR 1.33, 95% CI: 1.26, 1.41) for every 0.1°C increase in annual mean temperature compared to the previous 30 years.</p><p><strong>Conclusions: </strong>Higher mean temperatures during summer were associated with the increased ST cases in the following autumn. Annual mean temperature increases compared to 30 years ago were also associated with higher annual incidence of ST. These findings suggest that global warming has influenced the incidence of ST.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966048","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":"Perceived prevalence, risk factors, and reported management of delirium in critically ill emergency patients: a survey of physicians in China.","authors":"Wen Shang, Kang Zheng, Lanfang Du, Hua Zhang, Rongjia Yang, Fengying Chen, Wencao Liu, Xianliang Yan, Qingbian Ma","doi":"10.1093/postmj/qgaf136","DOIUrl":"https://doi.org/10.1093/postmj/qgaf136","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate Chinese emergency physicians' perceptions of prevalence, associated risk factors, and reported management practices for delirium in critically ill emergency department (ED) patients.</p><p><strong>Methods: </strong>A cross-sectional survey of 402 physicians from EDs across 18 Chinese provinces.</p><p><strong>Results: </strong>Physician-estimated delirium prevalence varied widely (median: 15%; interquartile range: 10%-30%), with most perceiving higher incidence during night shifts. Key perceived risk factors included metabolic disorders, pre-existing cognitive impairment, shock, and severe infections. Clinical judgment was the most common assessment method; structured screening tools were reportedly used infrequently. Pharmacological interventions were the preferred management approach for most respondents.</p><p><strong>Conclusions: </strong>This survey highlights Chinese emergency physicians' varied perceptions of delirium prevalence and reliance on clinical judgment over standardized assessment. Findings suggest a need for enhanced training in standardized screening, greater emphasis on non-pharmacological interventions, and fostering interprofessional collaboration to improve care for ED patients with or at risk of delirium. Key messages What is already known on this topic: Delirium is a serious acute neurocognitive syndrome with high Intensive Care Unit prevalence (31.8%-70%) and significant adverse outcomes. Emergency department delirium remains under recognized despite 6%-38% prevalence in older adults. International guidelines recommend non-pharmacological interventions as first-line management. What this study adds: This survey provides the first assessment of Chinese emergency physicians' delirium perceptions in critically ill patients. Key findings reveal predominant reliance on clinical judgment rather than validated tools and a preference for pharmacological interventions, particularly benzodiazepines, which conflicts with international guidelines. Substantial variation exists in perceived prevalence estimates. How this study might affect research, practice, or policy: Findings inform targeted educational initiatives for Chinese emergency departments, emphasizing the need for standardized screening training and non-pharmacological intervention promotion. Future research should prioritize objective epidemiological studies to validate perceived prevalence rates and evaluate protocol implementation.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144965983","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":"Physician's concerns and patient's concerns: never the twain shall meet?","authors":"Ami Schattner","doi":"10.1093/postmj/qgaf134","DOIUrl":"https://doi.org/10.1093/postmj/qgaf134","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966021","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":"Risk factors of severe adverse in-hospital outcomes in adults hospitalized for parainfluenza infections: a territory-wide study.","authors":"Wang Chun Kwok, Kelvin Kai Wang To, Isaac Sze Him Leung, Chun Ka Wong, James Chung Man Ho, David Chi Leung Lam, Mary Sau Man Ip, Shuk Man Ngai, Desmond Yat Hin Yap","doi":"10.1093/postmj/qgaf127","DOIUrl":"https://doi.org/10.1093/postmj/qgaf127","url":null,"abstract":"<p><strong>Background: </strong>While parainfluenza virus infections are common, there is relatively little data on the impact and risk factors of parainfluenza virus infection on severe in-hospital outcomes.</p><p><strong>Methods: </strong>This territory-wide retrospective study elucidated the risk factors for serious in-hospital outcomes among patients hospitalized due to parainfluenza infection. Data were retrieved from the Clinical Data Analysis and Reporting System managed by the Hospital Authority, Hong Kong, from 1 January 2016 to 30 June 2023. The main outcomes of interest were: (i) death during hospitalization; (ii) severe respiratory failure requiring invasive or non-invasive mechanical ventilation; (iii) secondary bacterial pneumonia; (iv) acute kidney injury.</p><p><strong>Results: </strong>2058 adult patients were hospitalized due to parainfluenza virus infection during the study period. 87 (4.2%) patients died during the index admission, 467 (22.7%) patients developed severe respiratory failure, 1355 (65.8%) patients developed secondary bacterial pneumonia, and 625 (30.3%) patients developed acute kidney injury. Risk factors for severe in-hospital outcomes included underlying cardiopulmonary and kidney diseases (especially those receiving renal replacement therapy) and advanced age.</p><p><strong>Conclusions: </strong>Important risk factors for severe in-hospital outcomes among patients with parainfluenza infections include underlying age ≥65 years, cardio-pulmonary and kidney diseases. These at-risk patients may benefit from future vaccines and antiviral drugs. Key messages What is already known on this topic: Severe in-hospital outcomes among adult patients with parainfluenza infections are common What this study adds: The risk factors for severe in-hospital outcomes include underlying age ≥ 65 years, cardio-pulmonary, and kidney diseases How this study might affect research, practice, or policy: These at-risk patients may benefit from future vaccines and antiviral drugs.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966062","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":"Health literacy mediates the association of education levels with engagement in leisure-time physical activity and muscle-strengthening exercise: a population-based study of Korea.","authors":"Seong-Uk Baek, Jin-Ha Yoon","doi":"10.1093/postmj/qgaf138","DOIUrl":"https://doi.org/10.1093/postmj/qgaf138","url":null,"abstract":"<p><strong>Background: </strong>Health literacy is recognized as a major determinant of wellbeing. We examined how health literacy links the association of educational level with participation in leisure-time physical activity (LTPA) and muscle-strengthening exercise (MSE).</p><p><strong>Methods: </strong>We analyzed a nationwide sample of 5248 adults. Education attainment was grouped into four groups: elementary school, middle school, high school, and college. Health literacy was assessed using the Health Literacy Index for the Community (HLIC). The Global Physical Activity Questionnaire was also employed, with engagement in ≥150 min of moderate-to-vigorous LTPA per week and MSE ≥ twice weekly defined as meeting recommended levels. Counterfactual-based mediation analyses were conducted to estimate the natural indirect effects (NIE), presented as odds ratios (ORs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Among the participants, 20.5% and 25.2% met the recommended LTPA and MSE levels, respectively. Compared with those with an education attainment of elementary school or below, ORs (95% CI) for the NIE of education level on LTPA, mediated through the HLIC, were 1.06 (1.02-1.09) for middle school, 1.10 (1.04-1.15) for high school, and 1.14 (1.06-1.21) for college or above, accounting for 65.8%, 19.5%, and 16.4% of the total effects, respectively. For MSE, the ORs (95% CI) of the NIE were 1.06 (1.03-1.10) for middle school, 1.12 (1.07-1.17) for high school, and 1.16 (1.10-1.24) for college or above, accounting for 31.8%, 27.1%, and 24.8% of the total effects.</p><p><strong>Conclusion: </strong>Health literacy may serve as a key mechanism contributing to disparities in physical activity across different educational levels. Key messages What is already known on this topic: Health literacy has garnered considerable public health interest as a key determinant of health disparities. Although previous studies have reported that health literacy is positively associated with engagement in physical activity, research on its mediating role in the association between educational attainment and leisure-time physical activity (LTPA) and muscle-strengthening exercise (MSE) is scarce in the literature. What this study adds: This study demonstrated that health literacy mediates a meaningful proportion of the link between high educational attainment and engagement in the recommended levels of LTPA or MSE. This suggests that health literacy can be an important factor underlying disparities in physical activity across varying education levels. How this study might affect research, practice, or policy: Our findings suggest that proactive policy interventions are required to enhance health literacy among individuals with low educational levels and to promote physical activity.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144965985","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":"Empowering the next generation: integrating artificial intelligence education into medical training.","authors":"Justina Angel Tan, Isaac K S Ng, Anjin Hong, Desmond B Teo, Li Feng Tan","doi":"10.1093/postmj/qgaf144","DOIUrl":"https://doi.org/10.1093/postmj/qgaf144","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966020","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}