Postgraduate Medical Journal最新文献

{"title":"Correlation between cathepsins and the likelihood of renal cancer: a Mendelian randomization study.","authors":"Tuo Peng, Tian Li, Caihua Zhang","doi":"10.1093/postmj/qgaf003","DOIUrl":"https://doi.org/10.1093/postmj/qgaf003","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have established a relationship between cathepsins and renal cancer. Nonetheless, the specific causal connection between the two factors continues to be ambiguous. The aim of this study is to evaluate the causal relationship between cathepsins and renal cancer via employing Mendelian randomization (MR).</p><p><strong>Methods: </strong>The summary data of genome-wide association study were used for univariable MR (UVMR), reverse MR, and multivariable MR (MVMR) analyses. The primary MR method used in this study was Inverse variance weighting.</p><p><strong>Results: </strong>UVMR analysis showed that cathepsin Z increased the overall risk of renal cancer and cathepsin F were observed increased the risk of clear cell renal cell carcinoma. Furthermore, the concentration of cathepsin S had a significant positive correlation with the risk of papillary renal cell carcinoma (pRCC), whereas that of cathepsin G was negatively correlated with the risk of pRCC. Reverse MR analysis showed that renal cancer reduced the concentration of cathepsin H. MVMR analysis showed that the concentration of cathepsin B had a significant positive correlation with overall risk of renal cancer and pRCC. In addition, a higher concentration of cathepsin S was significantly associated with an increased risk of pRCC.</p><p><strong>Conclusion: </strong>This study confirmed a direct link between cathepsins and the risk of renal cancer. Specifically, cathepsin S has a significant positive correlation with the risk of pRCC. The findings of our research could provide significant contributions to both fundamental and clinical investigations pertaining to renal cancer. Key message What is already known on this topic? - Previous studies have suggested the role of some cathepsins in renal cancer occurrence and progression. However, the causal link between different cathepsins and renal cancer is unknown. What this study adds? - Our Mendelian randomization (MR) study revealed that the effects of different cathepsins on the risk of renal cancer. Remarkably, both univariable MR and multivariable MR demonstrated that the levels of cathepsin S increases the risk of papillary renal cell carcinoma. How this study might affect research, practice or policy? - The findings offer novel insights into the relationship between cathepsins and renal cancer, which may have implications for the prevention and management of renal cancer.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010274","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":"Strategic tips to successfully undertake research: a comprehensive roadmap for medical trainees.","authors":"Isaac Oluwatobi Akefe, Victoria Aderonke Adegoke, Elijah Akefe","doi":"10.1093/postmj/qgaf001","DOIUrl":"https://doi.org/10.1093/postmj/qgaf001","url":null,"abstract":"<p><p>Engaging in research during medical training is crucial for fostering critical thinking, enhancing clinical skills, and deepening understanding of medical science. Despite its importance, the shortage of physician-scientists lingers with many trainees and junior doctors encountering challenges navigating the research process. Drawing on current literature, this article provides a comprehensive roadmap, categorising 12 actionable strategies into five themes, to help medical trainees overcome common obstacles and optimise their research experience. The strategies include early planning, research conduct and integrity, productivity and time management, collaboration and dissemination, and personal growth and development. By implementing these evidence-based recommendations, derived from current literature and expert insights, medical trainees can refine their research skills, produce high-quality outputs, and contribute meaningfully to the scientific community, ultimately enriching their medical training and future careers.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010307","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":"Pregnancy among thyroid cancer survivors: do thyroidectomy and radioactive iodine matter?","authors":"Chung-Jen Teng, Chiu-Mei Yeh, Chia-Jen Liu, Tzeng-Ji Chen, Nicole Huang, Yiing-Jenq Chou","doi":"10.1093/postmj/qgae197","DOIUrl":"https://doi.org/10.1093/postmj/qgae197","url":null,"abstract":"<p><strong>Background: </strong>Thyroid cancer primarily affects young women and raises concerns about future fertility due to treatments of thyroidectomy and radioactive iodine (RAI) therapy. This study investigated the effects of these treatments on pregnancy probability in young female patients post-diagnosis.</p><p><strong>Methods: </strong>A nationwide, population-based study using data from Taiwan's National Health Insurance Research Database (2000-2017) examined pregnancy likelihood in women ≤45 years with thyroid cancer. The effects of thyroidectomy and RAI therapy on pregnancy were analyzed using logistic regression and Cox proportional-hazards models.</p><p><strong>Results: </strong>In a cohort of 10 937 patients with thyroid cancer, 7022 (64.2%) underwent total thyroidectomy, with 718 receiving RAI treatment. The type of thyroidectomy and RAI treatment, even at doses exceeding 120 millicuries, did not reduce the likelihood of pregnancy. Age was identified as the most critical factor influencing pregnancy; women aged >30 years had a significantly lower likelihood of becoming pregnant than younger women did. Other factors associated with a reduced likelihood of pregnancy included comorbidity with diabetes (HR = 0.65, P = .002) and higher socioeconomic status (HR = 0.69, P = .085).</p><p><strong>Conclusions: </strong>Thyroidectomy and RAI therapy do not diminish pregnancy probability in young women with thyroid cancer. Age remains a crucial factor, with younger women more likely to conceive. These findings are critical for fertility counseling and treatment planning. Key message What is already known on this subjec?  Thyroid cancer primarily affects young women, and its standard treatments, including thyroidectomy and radioactive iodine (RAI) therapy, have raised concerns about their potential impact on fertility. Previous studies have shown that RAI treatment may temporarily affect ovarian function but typically does not have a significant long-term effect on fertility. What this study adds?  This nationwide population-based study found that neither total nor partial thyroidectomy, nor RAI treatment, adversely affects the likelihood of pregnancy in young women with thyroid cancer. Age was identified as the most significant factor influencing pregnancy, with younger women having a higher probability of becoming pregnant after treatment. How this study might affect research, practice, or policy?  Clinicians should recognize that age, rather than the type of thyroidectomy or RAI treatment, is the most critical factor influencing fertility in young women with thyroid cancer. This insight can guide personalized fertility counseling and treatment planning to optimize outcomes.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953783","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":"https://doi.org/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":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-10","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":"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":"https://doi.org/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":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-10","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":"Revisiting Ronald Ross: inspiration for pioneering research in resource-limited settings.","authors":"Rupak Chatterjee, Atanu Chandra, Sugata Dasgupta","doi":"10.1093/postmj/qgae199","DOIUrl":"https://doi.org/10.1093/postmj/qgae199","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953784","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 trimethoprim-sulfamethoxazole goes rogue.","authors":"Tina H Dao, Christopher D Jackson","doi":"10.1093/postmj/qgae192","DOIUrl":"https://doi.org/10.1093/postmj/qgae192","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953786","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 diabetes mellitus and fetal and maternal outcomes during and after pregnancy-a nationwide study.","authors":"Binita Neupane, Sunita Karki, Monica Sharma, Umer Farooq","doi":"10.1093/postmj/qgae191","DOIUrl":"https://doi.org/10.1093/postmj/qgae191","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetes Mellitus (DM) affects both the mother and fetus during and after pregnancy. Multiple studies have shown the prognostic impact of DM on maternal and fetal outcomes, but studies at the national level are limited. Therefore, we aimed to conduct this nationwide study.</p><p><strong>Materials and methods: </strong>This retrospective study used a Nationwide Inpatient Sample 2020 (NIS) using International Classification of Diseases (ICD-10) codes for adult pregnant patients. STATA version MP14.2 was used mainly for analysis. We used Fischer's exact test to compare proportions, the student's t-test to compare continuous variables, and multivariate regression analysis to calculate the adjusted odds ratio.</p><p><strong>Results: </strong>The total number of pregnant patients included in the study was 3 436 671; 36 350 (1.05%) had DM. Patients with DM had longer hospital lengths of stay than non-diabetic patients (3.93 days vs. 2.5 days, P < .01). Other significant outcomes were higher cost of hospital stay ($37 079 vs. $23 371, P < .01), preeclampsia (7.17% vs. 2.02%, P < .01), intrauterine fetal death (0.63% vs. 0.13%, P < .01), stillbirth (2.89% vs. 0.75%, P < .01), gestational hypertension (7.07% vs. 3.07%, P < .01) and preterm labor (5.8% vs. 1.94%, P < .01). There were no differences in the two groups regarding pre-existing hypertension, abortion, large for gestational age, eclampsia, placenta previa, abruptio placenta, postpartum anemia, prolonged labor, intrapartum, and postpartum hemorrhage. We conducted a trend analysis from 2016 to 2020 for mortality, length of stay, total charges, and significant maternal and fetal outcomes.</p><p><strong>Conclusion: </strong>DM is associated with greater maternal and fetal adverse outcomes, resource utilization, and length of stay.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953781","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":"Abortion in evolution, caesarean scar pregnancy, and cervical ectopic: discerning the triplets on ultrasound.","authors":"Akaninyene Eseme Ubom, Engelbert Hanzal, Petra Kohlberger","doi":"10.1093/postmj/qgae189","DOIUrl":"https://doi.org/10.1093/postmj/qgae189","url":null,"abstract":"<p><strong>Background: </strong>On the second day of my clinical observership in the Obgyn Department of the Vienna University Hospital, I saw a suspected case of caesarean scar pregnancy on follow-up, with one of my very senior professors, in the gynaecology outpatient clinic.</p><p><strong>Methods: </strong>The 29-year-old multigravida with a previous caesarean section had earlier presented to the emergency room with vaginal bleeding at 7 weeks of gestation.</p><p><strong>Results: </strong>Ultrasound scan revealed a non-viable low-lying gestational sac located near the caesarean section scar, with a myometrial thickness of 0.96 cm. There was minimal vascular flow during the Doppler interrogation. Her quantitative serum beta-human chorionic gonadotropin was 687 IU/l at presentation. This had dropped to 344 IU/l after 48 h, with a further drop to 39 IU/l after a week. Repeat ultrasound scan 1 week after revealed an empty uterus with no visible gestational sac, and vaginal bleeding had resolved. My professor made a final diagnosis of a spontaneous complete abortion.</p><p><strong>Conclusions: </strong>On reflection, this experience further reinforced the diagnostic dilemma that many clinical conditions can present, the need for a high index of suspicion in diagnosing and differentiating clinical conditions that present similar features, as well as the need for younger clinicians to leverage the better knowledge and experience of more senior colleagues to unknot knotty clinical dilemmas.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896867","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":"Navigating UK internal medicine training applications: 10 essential tips.","authors":"Sara Khalid, Thomas Heather, Victoria Palin, Oliver I Brown, Michael Drozd","doi":"10.1093/postmj/qgae190","DOIUrl":"https://doi.org/10.1093/postmj/qgae190","url":null,"abstract":"<p><p>Internal medicine training applications in the UK have become increasingly competitive. This article provides ten tips for optimizing internal medicine training applications covering portfolio development, teaching experience, project selection, and interview preparation. We outline strategies for maximizing application scores through efficient resource allocation, effective project selection, and structured interview preparation. These tips are designed to help candidates navigate the competitive selection process while developing skills valuable for their future medical careers.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896869","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}