British journal of hospital medicine最新文献

{"title":"Advances in Immune Checkpoint Therapy in Hepatocellular Carcinoma.","authors":"Yamei Huang, Weiping Yu","doi":"10.12968/hmed.2024.0375","DOIUrl":"https://doi.org/10.12968/hmed.2024.0375","url":null,"abstract":"<p><p>The incidence and lethality of hepatocellular carcinoma (HCC) are increasing annually, and traditional treatments have been proven to be ineffective for patients with advanced stages of the disease. In recent years, immune checkpoint therapy has rapidly evolved, demonstrating promising results across a wide range of cancers and offering new hope for cancer treatment. However, the efficacy of immune checkpoint therapy in HCC varies greatly among individuals, with only a small proportion of HCC patients responding positively. A major cause of immune resistance and poor efficacy in HCC patients is immune evasion, which is often due to insufficient infiltration of immune cells. Understanding the mechanisms underlying immune evasion is crucial for enhancing the efficacy of immune therapies. In this review, we aim to summarize the mechanisms of immune evasion observed during immune checkpoint therapy and discuss future directions for this therapeutic approach. Our goal is to provide insights that could help overcome immune evasion, thereby improving the efficacy of immune therapies and extending patient survival time.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"85 9","pages":"1-21"},"PeriodicalIF":1.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342007","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":"Constructing a Nomogram for Predicting Pelvic Osteosarcoma: A Retrospective Study Based on the SEER Database and a Chinese Cohort.","authors":"Yefeng Xu, Qingying Yan, Jiewen Yang, Miao Cheng, Jialu Chen, Yongwei Yao, Yunxia Liu","doi":"10.12968/hmed.2024.0339","DOIUrl":"10.12968/hmed.2024.0339","url":null,"abstract":"<p><p><b>Aims/Background</b> Generally, pelvic osteosarcoma has a worse prognosis compared with limb osteosarcoma. This study aims to create and validate a new nomogram for predicting the prognosis of pelvic osteosarcoma. <b>Methods</b> Clinical data of 62 patients derived from the Surveillance, Epidemiology, and End Results (SEER) database and 31 Chinese patients diagnosed with pelvic osteosarcoma were gathered. Kaplan-Meier survival analysis was utilized to calculate the median survival time for all variables. Univariate and multivariate Cox regression models were employed to identify the prognostic factors of pelvic osteosarcoma. A nomogram was constructed using data gleaned from the SEER cohort and verified using the receiver operating characteristic (ROC) curve and calibration plot in the Chinese cohort. <b>Results</b> Kaplan-Meier analysis revealed that individuals of other races (Asians) (hazard ratio (HR) = 0.24, 95% confidence interval (CI): 0.1-0.57, <i>p</i> = 0.001), aged ≤51 years old (HR = 0.4, 95% CI: 0.22-0.73, <i>p</i> = 0.003), and with tumor size ≤160 mm (HR = 0.37, 95% CI: 0.2-0.71, <i>p</i> = 0.03) had better survival outcomes. Conversely, factors such as no primary surgery (HR = 3.6, 95% CI: 1.81-7.15, <i>p</i> < 0.001), lung metastasis (HR = 1.96, 95% CI: 1.17-3.28, <i>p</i> = 0.010), and radiotherapy (HR = 1.89, 95% CI: 1.10-3.25, <i>p</i> = 0.021) were associated with poorer survival. Multivariate Cox analysis indicated that lung metastasis (HR = 2.57, 95% CI: 1.29-5.13, <i>p</i> = 0.008), other races (Asians) (HR = 0.23, 95% CI: 0.07-0.75, <i>p</i> = 0.015), tumor size (HR = 0.28, 95% CI: 0.13-0.62, <i>p</i> = 0.001) and age (HR = 0.3, 95% CI: 0.16-0.59, <i>p</i> < 0.001) were independent prognostic factors for pelvic osteosarcoma. Univariate and multivariate Cox regression models identified three independent variables in the training cohort: age, lung metastasis, and tumor size. A predictive nomogram was developed based on the data from the SEER cohort and validated in the Chinese cohort. The areas under the curves (AUCs) that are used to predict 1-year, 2-year, and 3-year survival rates were 0.81 (95% CI: 0.68-0.94), 0.75 (95% CI: 0.63-0.86), and 0.80 (95% CI: 0.70-0.89) in the training cohort, and 0.67 (95% CI: 0.30-1.04), 0.66 (95% CI: 0.43-0.90) and 0.71 (95% CI: 0.50-0.93) in the validation cohort. <b>Conclusion</b> The predictive nomogram constructed in this study facilitates accurate and effective prediction of the overall survival of patients with pelvic osteosarcoma and helps enhance the clinical decision-making process.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"85 8","pages":"1-17"},"PeriodicalIF":1.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104523","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":"Should We Defund the National Health Service?","authors":"Andrew Thomson","doi":"10.12968/hmed.2024.0140","DOIUrl":"https://doi.org/10.12968/hmed.2024.0140","url":null,"abstract":"<p><p>Despite record investment in Scotland's National Health Service, ever-increasing numbers of people remain in hospital despite being clinically fit for discharge. This paper curiously explores two of the whole-system problems ensuring discharges are delayed and argues that greater investment in, and contractual changes to, social care commissioning is required to support more people to live their best lives in their own homes. A more creative perspective is required to ensure better outcomes for the population.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"85 8","pages":"1-5"},"PeriodicalIF":1.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104542","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 Effect of Personalized Adjustable Mandibular Advancement Device on Obstructive Sleep Apnea.","authors":"Wei Wang, Jian Pang, Yi-Xue Zhang, Yi-Meng Mo, Jiao Zhang, Zhen-Hui Wei","doi":"10.12968/hmed.2024.0189","DOIUrl":"10.12968/hmed.2024.0189","url":null,"abstract":"<p><p><b>Aims/Background:</b> Mandibular advancement devices are effective in treating mild or moderate obstructive sleep apnea (OSA), but such devices that are commonly used in clinical settings require further improvement. In this study, we evaluated the clinical effects of personalized adjustable mandibular advancement devices on mild or moderate OSA. <b>Methods:</b> Forty patients with mild or moderate OSA were randomly divided into experimental (personalized adjustable device) and control (traditional device) groups. Side effects, including increased salivation, dry mouth, muscle aches, and temporomandibular joint discomfort, were assessed. Respiratory markers during sleep, including the apnea-hypopnea index, mean blood oxygen saturation, lowest blood oxygen saturation and maximum apnea time, were evaluated using polysomnography. The upper airway cross-sectional area and temporomandibular joint morphology and motion trajectory were evaluated using cone beam computed tomography. <b>Results:</b> Side effects were significantly lower in the experimental group than in the control group. Respiratory marker levels were significantly restored post-treatment. Soft palate- and tongue-pharyngeal cross-sectional areas were significantly increased in both groups, but temporomandibular joint morphology or motion trajectory remained unchanged. <b>Conclusion:</b> The personalized adjustable mandibular advancement devices may reduce side effects and are effective in treating patients with OSA. <b>Clinical Trial Registration:</b> The study was registered and approved by the Chinese Clinical Trial Registry (ChiCTR2400080306). https://www.chictr.org.cn/showproj.html?proj=206538.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"85 8","pages":"1-17"},"PeriodicalIF":1.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104521","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":"Data Infrastructure for Improvement in Perioperative Medicine: Experience at a London Tertiary Hospital.","authors":"Daniel Bendel, Teresa Wong, James Bedford, Peter M Odor","doi":"10.12968/hmed.2024.0128","DOIUrl":"https://doi.org/10.12968/hmed.2024.0128","url":null,"abstract":"<p><p>Adoption of electronic health record systems offers an opportunity to collate massive volumes of complex information about patient care. Healthcare data can inform performance management, enable predictive analytics and enhance strategic decision making. A data-driven approach to improving patient care is vital to address the growing burden of morbidity and mortality associated with major surgery. We describe our methodology for transforming and utilising process of care data in an electronic health record system to develop a registry for quality improvement purposes in patients undergoing major surgery at a single UK hospital. We highlight development of our data-driven vision, technical aspects of processing raw data into metrics relevant to clinical decision making, alongside challenges encountered. Finally, we outline how our data infrastructure supports clinical governance, quality improvement and research. In sharing our experiences, we hope to enable others to embed and access the transformative clinical insights that healthcare data can yield.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"85 8","pages":"1-12"},"PeriodicalIF":1.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104524","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":"Parathyroid Hormone Related Protein Mediated Hypercalcaemia Due to Metastatic Squamous Cell Carcinoma Originating from Pilonidal Disease: A Case Report.","authors":"Annalisa Montebello, Martina Grech, Nicoletta Maniscalco, David Pisani","doi":"10.12968/hmed.2024.0171","DOIUrl":"10.12968/hmed.2024.0171","url":null,"abstract":"<p><p>A 56-year-old male presented with a longstanding, gradually enlarging, painful, skin lesion over the natal cleft. This was initially thought to be a pilonidal abscess but, following multiple surgeries, he was diagnosed with Stage IVb squamous cell carcinoma of the natal cleft skin with bilateral inguinal lymph node metastases and subcutaneous metastatic deposits. Complete surgical cure was not possible. He underwent radiotherapy, cisplatin chemotherapy and cemiplimab immunotherapy to control his disease. His course was complicated by severe humoral hypercalcaemia of malignancy (HHM) resistant to medical therapy. His disease progressed, and he developed widespread metastases. He was thus transferred to palliative care with pain control being the major priority. He died within a year of diagnosis.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"85 8","pages":"1-7"},"PeriodicalIF":1.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104538","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":"Investigation and Analysis of the Current Status of Health-Related Quality of Life in Adolescents with Hemophilia in Hubei Province.","authors":"Xiuli Qin, Ai Zhang, Xin Zhao, Ting Zhou, Zhili Xia, Genzhen Yu","doi":"10.12968/hmed.2024.0199","DOIUrl":"https://doi.org/10.12968/hmed.2024.0199","url":null,"abstract":"<p><p><b>Aims/Background</b> Reliable health-related quality of life data are critical in developing countries, in order to advocate for government agencies to develop national hemophilia care programmes. This study aims to explore the current status and influencing factors of health-related quality of life among adolescents with hemophilia in Hubei Province, so as to provide empirical data for professionals. <b>Methods</b> A total of 84 children with hemophilia aged 8 to 18, who were registered in Tongji Hemophilia Treatment Center and Hubei Hemophilia Home, were selected using a cluster sampling method. The \"General Situation Questionnaire of Hemophiliac Adolescents\", designed by Tongji Hemophilia Treatment Center, and \"the Chinese version of Canadian hemophilia outcomes-kid's life assessment tool (CHO-KLAT)\", were used for this study conducted from June 1, 2022 to December 30, 2022. <b>Results</b> 82 completed questionnaires were included. The average age of the 82 adolescents was 13.04 ± 3.29 years and all were males. Among them, 67 were hemophilia A and 15 were hemophilia B. 61 cases were severe type, 19 were moderate type and 2 cases were mild type. The average total score of the CHO-KLAT for adolescents with hemophilia in Hubei Province was 49.49, which was lower than their counterparts in developed countries. The statistically significant influencing factors included residence, annual family income, and disease type. <b>Conclusion</b> This study provides empirical data support for the health management of adolescents with hemophilia, highlighting the importance of improving medical resource access, transfusion convenience, and psychological support in enhancing the quality of life for this group. The results emphasize the need for healthcare systems and policymakers to take specific measures to address these factors to improve the treatment and care conditions for adolescents with hemophilia.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"85 8","pages":"1-12"},"PeriodicalIF":1.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104535","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 Value of Bedside Ultrasound Evaluation of Intravenous Ultrasound Grading System Combined with TyG Index in Predicting Acute Renal Injury in Patients with Acute Hyperlipidemic Pancreatitis.","authors":"Lingling He, Tinglong Huang, Long Xie","doi":"10.12968/hmed.2024.0283","DOIUrl":"https://doi.org/10.12968/hmed.2024.0283","url":null,"abstract":"<p><p><b>Aims/Background</b> Bedside ultrasound evaluation of venous excess ultrasound (VExUS) combined with the triglyceride-glucose (TyG) index plays an important role in predicting acute kidney injury (AKI) in patients with acute hyperlipidemic pancreatitis. VExUS can effectively evaluate the degree of venous congestion, while the TyG index is valuable in predicting severe pancreatitis. The combination of these two methods is expected to provide a more accurate AKI risk assessment tool for clinical practice. This study explores the value of combining bedside ultrasound evaluation using the VExUS grading system with the TyG index in predicting acute renal damage in patients with acute hyperlipidemic pancreatitis. <b>Methods</b> From January 2021 to December 2023, 110 patients with acute hyperlipidemic pancreatitis were selected. The patients were divided into two groups based on whether they were complicated with acute kidney injury (AKI): the AKI group (n = 23) and the non-AKI group (n = 87). The general data of the two groups were compared, and the risk factors for AKI in patients with acute hyperlipidemic pancreatitis were analyzed using multivariate logistic regression. The predictive value was assessed using receiver operating characteristic curve (ROC) analysis. <b>Results</b> There were no statistically significant differences in age, gender, outcome, triglyceride (TG), total cholesterol, low-density lipoprotein (LDL) levels at admission, blood nutrition at discharge, creatinine (CREA) at discharge, underlying diseases, start time of enteral nutrition, complications, length of stay, Intensive Care Unit (ICU) days, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, blood glucose level, blood amylase level, CREA, blood urine nitrogen (BUN), blood purification treatment (<i>p</i> > 0.05). However, there were significant differences (<i>p</i> < 0.05) between the TyG index and the VExUS score, with variables including the TyG index and the VExUS score (included in the logistic regression analysis as variables), and AKI (AKI = 1, non-AKI = 0) as dependent variables. Multiple logistic regression results showed that the TyG index and VExUS score were independent predictors of AKI in patients with acute hyperlipidemia pancreatitis (<i>p</i> < 0.05). The standard error, sensitivity and specificity of the TyG index, VExUS score and combined model for predicting AKI in these patients were 0.064, 73.91 and 87.45; 0.036, 78.16 and 95.65; 0.010, 100.00 and 95.65, respectively (<i>p</i> < 0.05). <b>Conclusion</b> The VExUS score combined with the TyG index is highly valuable in predicting AKI in patients with acute hyperlipidemic pancreatitis.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"85 8","pages":"1-11"},"PeriodicalIF":1.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104544","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":"Discharge Against Medical Advice: The Causes, Consequences and Possible Corrective Measures.","authors":"Akshay Gaur, Elizabeth Gilham, Laura Machin, David Warriner","doi":"10.12968/hmed.2024.0231","DOIUrl":"https://doi.org/10.12968/hmed.2024.0231","url":null,"abstract":"<p><p>Patients who discharge themselves against medical advice comprise 1%-2% of hospital admissions. Discharge against medical advice (DAMA) is defined as when a hospitalised patient chooses to leave the hospital before the treating medical team recommends discharge. The act of DAMA impacts on both the patient, the staff and their ongoing care. Specifically, this means that the patient's medical problems maybe inadequately assessed or treated. Patients who decide to DAMA tend to be young males, from a lower socioeconomic background and with a history of mental health or substance misuse disorder. DAMA has an associated increased risk of morbidity and mortality. In this review of studies across Western healthcare settings, specifically adult medical inpatients, we will review the evidence and seek to address the causes, consequences and possible corrective measures in this common scenario.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"85 8","pages":"1-14"},"PeriodicalIF":1.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104527","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":"Enhancing the Diagnostic Accuracy of Sacroiliitis: A Machine Learning Approach Applied to Computed Tomography Imaging.","authors":"Qingsong Fu, Xueru Yuan, Xinyou Han, Weibin Wang, Jiakai Zhang, Xinhua Yuan","doi":"10.12968/hmed.2024.0228","DOIUrl":"https://doi.org/10.12968/hmed.2024.0228","url":null,"abstract":"<p><p><b>Aims/Background</b> Sacroiliitis is a challenging condition to diagnose accurately due to the subtle nature of its presentation in imaging studies. This study aims to improve the diagnostic accuracy of sacroiliitis by applying advanced machine learning techniques to computed tomography (CT) images. <b>Methods</b> We employed five convolutional neural network (CNN) models-Visual Geometry Group 16-layer Network (VGG16), ResNet101, DenseNet, Inception-v4, and ResNeXt-50-to analyze a dataset of 830 CT images, including both sacroiliitis and non-sacroiliitis cases. Each model's performance was evaluated using metrics such as accuracy, precision, recall, F1 score, Receiver Operating Characteristic (ROC), and Area Under the Curve (AUC). The interpretability of the models' decisions was enhanced using Gradient-weighted Class Activation Mapping (Grad-CAM) visualization. <b>Results</b> The ResNeXt-50 and Inception-v4 models demonstrated superior performance, achieving the highest accuracy and F1 scores among the tested models. Grad-CAM visualizations offered insights into the decision-making processes, highlighting the models' focus on relevant anatomical features critical for accurate diagnosis. <b>Conclusion</b> The use of CNN models, particularly ResNeXt-50 and Inception-v4, significantly improves the diagnosis of sacroiliitis from CT images. These models not only provide high diagnostic accuracy but also offer transparency in their decision-making processes, aiding clinicians in understanding and trusting Artificial Intelligence (AI)-driven diagnostics.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"85 8","pages":"1-13"},"PeriodicalIF":1.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104531","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}