Postgraduate Medical Journal最新文献

{"title":"Genetically predicted basal metabolic rate and infectious diseases: a Mendelian randomization study.","authors":"Zhanbin Li, Yicheng Ma, Qiuhui Xuan, Zhenyu Yao, Qiaoran Liu","doi":"10.1093/postmj/qgaf018","DOIUrl":"10.1093/postmj/qgaf018","url":null,"abstract":"<p><strong>Background: </strong>The causal relationship between basal metabolic rate (BMR) and infectious diseases remains elusive. This study aims to clarify this association.</p><p><strong>Methods: </strong>This study analyzed genome-wide association studies (GWASs) data from the UK Biobank and FinnGen cohorts to investigate the association between BMR and infectious diseases in European populations. Mendelian randomization (MR) analysis was initially employed, followed by multivariable Mendelian randomization (MVMR) to account for potential confounders. Mediation analysis further confirmed significant relationships. Sensitivity analyses were conducted to validate the study findings.</p><p><strong>Results: </strong>Using two sample MR, genetically predicted BMR was positively linked to skin and soft tissue infections (SSTIs) (OR: 1.31, 95% CI: 1.18-1.47, P < .001), osteomyelitis (OR: 1.95, 95% CI: 1.36-2.80, P < .001) (1.36 ± 2.80), all-cause infections (OR: 1.36, 95% CI: 1.26-1.48, P < .001) and sepsis (OR: 1.36, 95% CI: 1.23-1.51, P < .001). MVMR analysis confirmed BMR's direct causal effect on SSTIs, osteomyelitis, all-cause infections, and sepsis, except for BMI and other factors affecting osteomyelitis. Mediation analysis revealed VAT as a mediator in the linkage between BMR and SSTIs and all-cause infections. HbA1c mediated the path from BMR to osteomyelitis, while CRP and BMI exhibited mediation effects in the BMR-all-cause infections relationship.</p><p><strong>Conclusion: </strong>The study revealed a significant link between increased BMR and elevated risks of SSTIs, osteomyelitis, and bacterial infections, highlighting the intricate BMR-immune connection and its implications for disease control. Key message What is already known on this topic:  High BMR is positively correlated with COVID-19 and associated with proinflammatory and immunological activation, but the relationship between BMR and other infectious diseases remains largely unexplored. What this study adds:  Higher BMR significantly raises the risk of SSTIs, osteomyelitis, all-cause infections, and sepsis. VAT, HbA1c, CRP, and BMI may mediate the BMR-infection relationship. How this study might affect research, practice, or policy:  A higher BMR may be a valuable indicator associated with an increased risk for SSTIs, osteomyelitis, and sepsis. Modulating BMR might hold promise as a clinically relevant intervention to prevent specific infectious diseases.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"836-844"},"PeriodicalIF":2.7,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190282","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":"Transforming the NHS through AI-driven solutions: a new era of digital health.","authors":"Mohamed A Imam, Ahmed Elgebaly, Adam Zumla, Shyam Kolvekar, Rizwan Ahmed, Alimuddin Zumla","doi":"10.1093/postmj/qgaf023","DOIUrl":"10.1093/postmj/qgaf023","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"777-778"},"PeriodicalIF":2.7,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425964","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":"Academic pressure behind the suicide crisis of doctoral students at the Indian Institute of Technology: rethinking doctoral education policies.","authors":"Bo Gao","doi":"10.1093/postmj/qgaf030","DOIUrl":"10.1093/postmj/qgaf030","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"884-885"},"PeriodicalIF":2.7,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458968","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 reduction of medical resident duty hours for the benefit of patient safety.","authors":"Alison Hager","doi":"10.1093/postmj/qgaf014","DOIUrl":"10.1093/postmj/qgaf014","url":null,"abstract":"<p><p>Since the case of Libby Zion spurred the first duty hour restrictions placed upon medical residents, the impact of fatigue and the importance of duty hour restrictions have been hotly debated. This paper discusses the history of duty hour restrictions as well as the documented impact of fatigue both on the medical profession and other industries upon which the federal government has imposed hours restrictions due to the danger fatigue has been found to pose. It then takes this information and applies it to the American Medical Association's 'Code of Medical Ethics' to determine if residents can truly adhere to these principles and prioritize patient safety while working hours shaped by current duty hour limits.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"925-930"},"PeriodicalIF":2.7,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190284","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 Kafkaesque odyssey of securing study leave: a trainee's satirical take.","authors":"Ibraheem Alghamdi","doi":"10.1093/postmj/qgaf011","DOIUrl":"10.1093/postmj/qgaf011","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"880-881"},"PeriodicalIF":2.7,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391515","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 association between telomere length and female cancers: a two-sample Mendelian randomization study.","authors":"Yangyang Shi, He Huang, Rui Zhang, Ling Yin","doi":"10.1093/postmj/qgaf028","DOIUrl":"10.1093/postmj/qgaf028","url":null,"abstract":"<p><strong>Purpose: </strong>To explore the causal associations between genetically predicted telomere length and gynecologic and breast cancers.</p><p><strong>Methods: </strong>This Mendelian randomization study used data from genome-wide association studies on telomere length and breast (BC), cervical cancer, endometrial (EC), and ovarian (OC) cancers. The primary analysis was performed using the inverse variance weighted (IVW) method, with confirmation using the weighted median, weighted mode, and MR-Egger methods. Heterogeneity was detected using Cochran's Q-test, horizontal pleiotropy using MR-Egger regression, outliers using MR-PRESSO, and discordant single-nucleotide polymorphisms using the leave-one-out method.</p><p><strong>Results: </strong>The genetic prediction results indicated causal associations between the risk of telomere length and EC [IVW; OR = 1.29, 95% confidence interval (95%CI): 1.05-1.59, P = .02], leukocyte telomere length and EC (IVW; OR = 1.23, 95%CI: 1.01-1.51, P = .04), telomere length and OC (IVW; OR = 1.27, 95%CI: 1.01-1.60, P = .04), telomere length and BC (IVW; OR = 1.12, 95%CI: 1.01-1.23, P = .03), and leukocyte telomere length and BC (IVW; OR = 1.12, 95%CI: 1.02-1.24, P = .02). Cochran's Q-test revealed heterogeneity for telomere length and BC (P < .001), leukocyte telomere length and BC (P < .001), and B-cell telomere length and BC (P = .012). The MR-Egger regression results suggest that the analyses of telomere length and BC (P = .014) and leukocyte telomere length and BC (P = .044) were influenced by horizontal pleiotropy. The MR-PRESSO analysis indicated the presence of outliers in the analyses of telomere length and BC and leukocyte telomere length and breast cancer. After removing the outliers, the statistical significance remained.</p><p><strong>Conclusion: </strong>This MR study suggests a causal association between telomere length and BC, EC, and OC, warranting additional study. Key message What is already known on this topic?  Previous research has indicated an association between telomere length and the risk of various cancers, including breast and gynecologic cancers. However, the causal relationship remained unclear, necessitating further exploration to establish whether telomere length could be a modifiable risk factor for these cancers. What this study adds?  This study provides robust evidence of a causal relationship between genetically predicted telomere length and an increased risk of breast cancer, endometrial cancer, and ovarian cancer, with specific odds ratios indicating a significant association. It highlights that both leukocyte and overall telomere length are important factors in cancer risk. How this study might affect research, practice, or policy?  The findings could inform future research into telomere length as a biomarker for cancer risk, promote investigations into telomere-targeting interventions, and influence guidelines on screening and preventive strategies for at-risk popula","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"863-872"},"PeriodicalIF":2.7,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441770","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":"Can you(th) afford healthcare? The case of financial microtoxicity.","authors":"Christos Tsagkaris, Islam Kourampi, Kyriaki Apergi","doi":"10.1093/postmj/qgaf029","DOIUrl":"10.1093/postmj/qgaf029","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"882-883"},"PeriodicalIF":2.7,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458984","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 impact of traumatic brain injury on visual processing: a neuro-ophthalmological perspective.","authors":"Hajar Nasir Tukur, Olivier Uwishema, Dalal Sheikhah, Hatice Akbay, Tarek Emir Chehab, Jack Wellington","doi":"10.1093/postmj/qgae188","DOIUrl":"10.1093/postmj/qgae188","url":null,"abstract":"<p><strong>Introduction: </strong>Traumatic brain injury (TBI) is a critical global health issue characterized by perturbance in cerebral function attributed to mechanical force. TBI often precipitates significant visual impairment that negatively impacts the patients' quality of life. This review examines the effects of TBI on visual function from a neuro-ophthalmological perspective, focusing on the assessment, diagnostics, and management of associated sequelae.</p><p><strong>Methods: </strong>A comprehensive literature review was conducted using PubMed/MEDLINE, ScienceDirect, and Google Scholar to garner and collate relevant data.</p><p><strong>Results: </strong>TBI may result in visual field defects, ocular motor dysfunction, insufficiency of accommodation, and photosensitivity. Early detection remains a profound challenge, partly due to a dearth of standardized protocols for evaluating visual impairment. Diagnostic methodologies include visual field testing, ocular motility assessments, and fundus photography, while rehabilitation approaches encompass vision therapy and low-vision rehabilitation.</p><p><strong>Conclusion: </strong>Establishing hospital-based multidisciplinary teams is essential for effectively addressing TBI-related visual impairment. Future research should prioritize evidence-based treatment protocols and explore diverse vision rehabilitation strategies through large-scale studies.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"886-894"},"PeriodicalIF":2.7,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896874","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":"Machine-learning models to predict serious adverse hospitalization events after ACS.","authors":"Hui Gao, Xuanze Liu, Dongyuan Sun, Xue Liu, Yasong Wang, Zhiqiang Zhang, Yaling Han, Xiaozeng Wang","doi":"10.1093/postmj/qgae180","DOIUrl":"10.1093/postmj/qgae180","url":null,"abstract":"<p><strong>Objective: </strong>We developed a risk stratification model to predict serious adverse hospitalization events (mortality, cardiac shock, cardiac arrest) (SAHE) after acute coronary syndrome (ACS) based on machine-learning models and logistic regression model.</p><p><strong>Methods: </strong>This cohort study is based on the CCC-ACS project. The primary efficacy outcomes were SAHE. Clinical prediction models were established based on five machine-learning (XGBoost, RF, MLP, KNN, and stacking model) and logistic regression models.</p><p><strong>Results: </strong>Among the 112 363 patients in the study, age (55-65 years: OR: 1.392; 95%CI: 1.212-1.600; 65-75 years: OR: 1.878; 95%CI: 1.647-2.144; ≥75 year: OR: 2.976; 95%CI: 2.615-3.393), history of diabetes mellitus (OR: 1.188; 95%CI: 1.083-1.302), history of renal failure (OR: 1.645; 95%CI: 1.311-2.044), heart rate (60-100 beats/min: OR: 0.468; 95%CI: 0.409-0.536; ≥100 beats/min: OR: 0.540; 95%CI: 0.454-0.643), shock index (0.4-0.8: OR: 1.796; 95%CI: 1.440-2.264; ≥0.8: OR: 5.883; 95%CI: 4.619-7.561), KILLIP (II: OR: 1.171; 95%CI: 1.048-1.306; III: OR: 1.696; 95%CI: 1.469-1.952; IV: OR: 7.811; 95%CI: 7.023-8.684), and cardiac arrest at admission (OR: 12.507; 95%CI: 10.757-14.530) were independent predictors of severe adverse hospitalization events for ACS patients. In several machine-learning models, RF (AUC: 0.817; 95%CI: 0.808-0.826) and XGBoost (AUC: 0.816; 95%CI: 0.807-0.825) also showed good discrimination in the training set, which ranked the first two positions. They also presented good accuracy and the best clinical benefits in the decision curve analysis. In addition, logistic regression was able to discriminate the SAHE (AUC: 0.816; 95%CI: 0.807-0.825) and performed the best prediction accuracy (0.822; 95%CI: 0.822-0.822) compared to several machine-learning models. Model calibration and decision curve analysis showed these prediction models have similar predictive performance. Based on these findings, we developed two CCC-ACS In-hospital Major Adverse Events Risk Scores and its online calculator. One is based on machine-learning model (https://ccc-acs-sae-3-xcnjsvoccusjwkfhfthh44.streamlit.app/), and another is based on logistic regression model (https://ccc-acs-sae-logistic-9te57ylnq3kazkeuyc7dub.streamlit.app/), offering a validated tool to predict survival for patients with ACS during hospitalization.</p><p><strong>Conclusions: </strong>Machine-learning-based approaches for identifying predictors of SAHE after an ACS were feasible and practical. Based on this, we developed two online risk prediction websites for clinicians' decision-making. The CCC-ACS-MSAE score showed accurate discriminative capabilities for predicting severe adverse hospitalization events and might help guide clinical decision-making. Key messages: Three research questions and three bullet points What is already known on this topic? Observational studies have identified risk factors for in-hospital death i","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"895-914"},"PeriodicalIF":2.7,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557807","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 laparoscopic cholecystectomy on plasma levels of EETs, arachidonic acids derived lipid mediators.","authors":"İsmail Sarı, Hacı Bolat, Esma Özmen, Burcu Köse, Durmuş Ayan","doi":"10.1093/postmj/qgae175","DOIUrl":"10.1093/postmj/qgae175","url":null,"abstract":"<p><strong>Background: </strong>Epoxyeicosatrienoic acids (EETs) are closely associated with lipoprotein metabolism, and changes in lipid profiles potentially affect their levels and functions. Given the alterations in lipid metabolism after cholecystectomy, this study aimed to investigate the levels of four EET regioisomers (free and esterified) and lipid profiles in patients with cholelithiasis after laparoscopic cholecystectomy (LC) and explore correlations between these parameters.</p><p><strong>Methods: </strong>This prospective study involved 40 patients with symptomatic cholelithiasis who underwent LC. Plasma EETs and serum total cholesterol, triglyceride, high-density lipoprotein (HDL), very low-density lipoprotein, low-density lipoprotein, and body mass index (BMI) values were determined preoperatively and after 6 months of LC.</p><p><strong>Results: </strong>After LC, triglyceride and very low-density lipoprotein levels increased while TC decreased. BMI values increased significantly after the operation. Despite plasma EET levels decreasing remarkably after surgery, this change did not reach statistical significance. A significant correlation was observed between preoperative levels of 8,9- and 11,12-EET and pre-and post-operative HDL. There was a significant negative correlation between the EET levels measured before and after surgery and the change in BMI values.</p><p><strong>Conclusions: </strong>In this study, we observed significant changes in lipid profile 6 months after LC. While HDL, low-density lipoprotein, and EET levels showed a decreasing trend post-surgery, this change was not statistically significant. This trend and their significant correlations may indicate a complex relationship between HDL and EET metabolism. In addition, the negative correlation between EET levels and BMI changes highlights the need for further research to elucidate the metabolic impact and weight regulation of EETs after LC.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"828-835"},"PeriodicalIF":2.7,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067638","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}