British journal of hospital medicine最新文献

{"title":"Gastrointestinal Manifestations of Systemic Sclerosis: Screening and Management to Improve Outcomes.","authors":"Amit Syal, Rishika Pasula, Kiana Mortezaei, Ioannis Panayiotou, Geeta Kumari, Chris Derk","doi":"10.31083/BJHM52377","DOIUrl":"https://doi.org/10.31083/BJHM52377","url":null,"abstract":"<p><p>Gastrointestinal (GI) involvement is among the most common and clinically important manifestations of systemic sclerosis (SSc), affecting up to 90% of patients and substantially contributing to morbidity and reduced quality of life. SSc-related GI disease results from microvascular injury, enteric nervous system dysfunction, and progressive smooth muscle atrophy with fibrosis, producing widespread dysmotility throughout the gastrointestinal tract. Clinical involvement can extend from the oral cavity to the anorectum, with esophageal dysfunction, gastroesophageal reflux disease (GERD), gastroparesis, small intestinal bacterial overgrowth (SIBO), and intestinal pseudo-obstruction among the major manifestations. Recent diagnostic advances, including high-resolution esophageal manometry (HRM), ambulatory pH-impedance monitoring, and improved imaging, have strengthened early detection and characterization of GI involvement. Treatment remains largely supportive and symptom-directed, including acid suppression, prokinetic therapy, nutritional optimization, and endoscopic or surgical management of complications. Growing evidence on the gut microbiome, immune-mediated mechanisms, and the gut-brain axis is expanding understanding of disease pathophysiology and may guide future targeted therapies. This review synthesizes current evidence on the epidemiology, pathophysiology, clinical manifestations, and management of gastrointestinal involvement in systemic sclerosis, emphasizing early recognition and multidisciplinary care. We conclude by outlining persistent management challenges and future directions to improve diagnostic precision, therapeutic development, and patient-centered outcomes.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 9","pages":"52377"},"PeriodicalIF":1.7,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079829","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 Surgery for Primary Hyperparathyroidism in 2026.","authors":"Shawn Thomas, Fausto F Palazzo","doi":"10.31083/BJHM57924","DOIUrl":"https://doi.org/10.31083/BJHM57924","url":null,"abstract":"<p><p>Primary hyperparathyroidism (PHPT) is the most common parathyroid disease and one of the most common endocrine disorders. It results from autonomous overproduction of parathyroid hormone, which in the classic form of the disease causes hypercalcaemia. The ready access to biochemical testing in high-income countries has moved the disease spectrum from a classic symptomatic presentation to a biochemical anomaly that is asymptomatic or minimally symptomatic. Untreated PHPT, however, remains associated with significant consequences. This review summarizes up-to-date concepts in the diagnosis, imaging, and surgical management of PHPT. The diagnosis of PHPT requires confirmation of hypercalcaemia with inappropriately elevated or unsuppressed parathyroid hormone levels, while excluding alternative causes. Parathyroidectomy remains the only definitive cure for PHPT, and the changing thresholds for intervention are discussed. Advances in pre-operative localization, including high-resolution ultrasonography, 99mTc-sestamibi (technetium-99m methoxyisobutylisonitrile), 4D-computed tomography, and fluorocholine positron emission tomography, have increased the number of patients with localised disease and therefore facilitated focused and minimally invasive surgical approaches. Intraoperative parathyroid hormone monitoring has also added a new dimension to intraoperative decision-making. However, the single biggest determinant of outcome in parathyroidectomy remains the practice volume and experience of the operating surgeon. It remains to be seen whether emerging technologies, including robotic surgery, thermal ablation, advanced molecular imaging, and artificial intelligence-assisted diagnosis and lesion localization, will further refine patient selection and improve treatment strategies in PHPT.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 9","pages":"57924"},"PeriodicalIF":1.7,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079801","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":"Ending Sexual Misconduct in the NHS-Lessons Learned From Surgery.","authors":"Ester Mikova, Laura Hamilton","doi":"10.31083/BJHM55815","DOIUrl":"https://doi.org/10.31083/BJHM55815","url":null,"abstract":"","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 9","pages":"55815"},"PeriodicalIF":1.7,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079649","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":"Diagnostic Value of Serum HE4, TFF3, and CA72-4 for Gastric Cancer Stratified by <i>Helicobacter pylori</i> Infection Status.","authors":"Muyong Wang, Mengke Xu","doi":"10.31083/BJHM52019","DOIUrl":"https://doi.org/10.31083/BJHM52019","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aims/background: &lt;/strong&gt;Gastric cancer remains a leading cause of cancer-related mortality worldwide. &lt;i&gt;Helicobacter pylori&lt;/i&gt; (Hp) infection is a major risk factor, but the diagnostic performance of serum biomarkers may vary according to Hp infection status. This study aimed to evaluate the diagnostic value of serum human epididymis protein 4 (HE4), trefoil factor 3 (TFF3), and carbohydrate antigen 72-4 (CA72-4), individually and in combination, for gastric cancer stratified by Hp infection status using a propensity score-matched retrospective case-control design.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective study was conducted at Jinshazhou Hospital of Guangzhou University of Chinese Medicine, from January 2022 to December 2025. Propensity score matching (1:1 nearest neighbor matching, caliper 0.1) was performed to balance age, sex, body mass index (BMI), smoking history, alcohol consumption history, chronic kidney disease, chronic liver disease, and Hp infection status between groups. After matching, 268 gastric cancer patients and 268 healthy controls were included. Serum levels of HE4, TFF3, and CA72-4 were measured. Between-group comparisons of each marker, stratified by Hp status, were performed. Logistic regression was used to construct combined diagnostic models, and receiver operating characteristic (ROC) curve analysis was performed to evaluate the area under the curve (AUC).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;After matching, all covariates achieved good balance with standardized mean differences &lt;0.1. In the total population, serum levels of HE4, TFF3, and CA72-4 were significantly higher in the gastric cancer group than in the control group (all &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Multivariate logistic regression identified all three markers as independent risk factors for gastric cancer (HE4: odds ratio [OR] = 1.05, 95% confidence interval [CI]: 1.03-1.06; TFF3: OR = 1.19, 95% CI: 1.13-1.26; CA72-4: OR = 1.46, 95% CI: 1.34-1.62; all &lt;i&gt;p&lt;/i&gt; &lt; 0.001). The combined model yielded an AUC of 0.899 (0.872-0.925) in the total population, significantly superior to any single marker (all &lt;i&gt;p&lt;/i&gt; &lt; 0.001). After stratification by Hp status, the AUC of TFF3 was significantly higher in Hp-positive individuals than in Hp-negative individuals (&lt;i&gt;p&lt;/i&gt; &lt; 0.001); no significant differences were observed for HE4 or CA72-4 between the two strata (&lt;i&gt;p&lt;/i&gt; &gt; 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The diagnostic value of serum HE4, TFF3, and CA72-4 for gastric cancer varies according to Hp infection status. In Hp-positive patients, TFF3 demonstrates significantly higher diagnostic performance compared with Hp-negative individuals. HE4 and CA72-4 demonstrate stable performance across Hp strata, with no statistically significant differences observed. The combined detection of these biomarkers demonstrates favorable diagnostic performance regardless of Hp status. These findings suggest that Hp status-stratified testing provides an auxiliary strateg","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 9","pages":"52019"},"PeriodicalIF":1.7,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079653","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 Paradigm Shift of Acute Pulmonary Embolism Management From an Old Classification System to a Novel A-E Approach From 2026 American Heart Association Guideline.","authors":"Kawser Ahmed, Mohammed Shahid Elachola, Jehan Mahmud Aurangzeb","doi":"10.31083/BJHM54655","DOIUrl":"https://doi.org/10.31083/BJHM54655","url":null,"abstract":"","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 9","pages":"54655"},"PeriodicalIF":1.7,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079567","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":"Spontaneous Intracerebral Haemorrhage: A Practical Guide to Diagnosis and Management.","authors":"Sumanjit K Gill, Dermot H Mallon, David J Werring","doi":"10.31083/BJHM50492","DOIUrl":"https://doi.org/10.31083/BJHM50492","url":null,"abstract":"<p><p>We present a topical review intended to update on the pathophysiology, investigation and management of intracerebral haemorrhage (ICH). Recent advances in the field have refined our knowledge of managing ICH and, when implemented, can significantly improve patient outcomes. The aim of this article is to describe the common causes of acute ICH that might be encountered in accident and emergency departments or hyperacute stroke units, and to discuss investigation and management. Reading this article will give the reader confidence in establishing the diagnosis of ICH, starting the investigation pathway and instigating evidence-based acute management to significantly improve outcomes across the United Kingdom. We have included case vignettes with neuroradiology expert opinion on imaging of more commonly found aetiologies of intracerebral haemorrhage. Neurosurgical management is also discussed in addition to medical management, with the limits to knowledge elucidated.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 8","pages":"50492"},"PeriodicalIF":1.7,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886242","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":"Development of a LASSO Regression-Based Nomogram to Predict Post-Neoadjuvant Chemotherapy Infection Risk in Lung Cancer Patients.","authors":"Lijie Zhou, Xuejia Chen, Juanli Zeng, Jun Cao, Jiangchuan Chen, Jianmin Li, Huan Yang","doi":"10.31083/BJHM57260","DOIUrl":"https://doi.org/10.31083/BJHM57260","url":null,"abstract":"<p><strong>Aims/background: </strong>Post-chemotherapy infection is a major cause of treatment failure in lung cancer (LC) patients undergoing neoadjuvant chemotherapy (NAC). This study aimed to identify risk factors for post-NAC infection using the Least Absolute Shrinkage and Selection Operator (LASSO) regression and to develop and validate a corresponding risk prediction model.</p><p><strong>Methods: </strong>Clinical data from 144 LC patients who underwent NAC at Hunan Provincial People's Hospital between January 2021 and December 2024 were retrospectively analysed. Patients were stratified into a non-infection group (<i>n</i> = 81) and an infection group (<i>n</i> = 63) based on the occurrence of infection. LASSO-logistic regression was used to identify risk factors for post-chemotherapy infection. A risk prediction nomogram was subsequently constructed and validated based on these factors.</p><p><strong>Results: </strong>The optimal LASSO model was selected at lambda.1se (λ = 0.074), which retained 9 of the 15 candidate predictors. Eastern Cooperative Oncology Group Performance Status (ECOG-PS) ≥2, recent invasive procedures/catheterization, and Nutritional Risk Screening 2002 (NRS-2002) score ≥3 were identified as significant risk factors for post-chemotherapy infection, while a high cluster of differentiation 4-positive (CD4⁺) count served as a protective factor (<i>p</i> < 0.05). A nomogram incorporating these variables was subsequently developed. Internal validation using the bootstrap method (1000 iterations) demonstrated a good predictive performance with an area under the curve (AUC) of 0.831 (95% confidence interval [CI]: 0.761-0.901, <i>p</i> < 0.001), sensitivity of 76.2%, and specificity of 79.0% at the optimal cutoff. The calibration curve demonstrated good agreement between predicted and observed outcomes. Decision curve analysis (DCA) confirmed the clinical utility of the nomogram by showing a positive net benefit across a wide range of threshold probabilities.</p><p><strong>Conclusion: </strong>The LASSO-derived nomogram integrates key variables (ECOG-PS ≥2, invasive procedures/catheterization, NRS-2002 score ≥3, and CD4⁺ level) to enable individualised prediction of post-NAC infection risk in LC patients. Targeted interventions addressing these risk factors, together with maintenance of protective factors, may help reduce infection rates and improve treatment outcomes, providing a scientific basis for infection prevention and management.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 8","pages":"57260"},"PeriodicalIF":1.7,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886482","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":"Dietary Considerations and Nutritional Strategies to Enhance Recovery After Cardiac Surgery: A Comprehensive Review.","authors":"Vasileios Leivaditis, Francesk Mulita, Efstratios Koletsis, Vasiliki Androutsopoulou, Nikolaos G Baikoussis, Sofoklis Mitsos, Athanasios Papatriantafyllou, Periklis Tomos, Manfred Dahm","doi":"10.31083/BJHM57290","DOIUrl":"https://doi.org/10.31083/BJHM57290","url":null,"abstract":"<p><p>The metabolic and inflammatory burden of cardiac surgery results in increased protein catabolism, elevated energy expenditure and thereby a consequent increased risk of postoperative complications. Therefore, it is imperative to optimise nutritional status preoperatively and postoperatively to ameliorate these effects on wound healing, immune function, and recovery of the myocardium, in addition to other clinical outcomes. Despite its benefits, structured perioperative nutritional care is rarely undertaken. In this narrative review, we will summarise contemporary literature (2017-2026) and international guideline recommendations to outline phase-specific nutritional strategies for patients undergoing cardiac surgery. In the early postoperative period, early initiation of enteral nutrition, adequate protein provision (1.2-2.0 g/kg/day), and careful fluid and glycaemic management are critical to attenuate catabolic stress and reduce complications. During hospital recovery and discharge to home, emphasis should shift towards caloric adequacy, micronutrient optimisation-particularly vitamins C and D, zinc, and iron-and management of medication-related gastrointestinal effects. In the long-term phase, adoption of cardioprotective dietary patterns such as the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets supports secondary prevention and cardiovascular risk reduction. Elderly patients who are sarcopenic, individuals with diabetes mellitus or chronic kidney disease (CKD), overweight individuals and people on anticoagulation warrant special consideration. Integrating nutritional assessment and intervention into Enhanced Recovery After Cardiac Surgery (ERACS) pathways may help improve recovery trajectories and reduce morbidity. Further high-quality research should be conducted to define procedure-specific and individualised nutritional protocols in the cardiac surgical population.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 8","pages":"57290"},"PeriodicalIF":1.7,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886500","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":"Chronic Cough in Children: What to Do and When to Refer?","authors":"Lowri Williams, Rossa Brugha","doi":"10.31083/BJHM57291","DOIUrl":"10.31083/BJHM57291","url":null,"abstract":"<p><p>Cough is one of the leading causes for children and their families to seek medical advice, and it may be difficult for clinicians to determine the underlying cause. Cough is a pulmonary defence mechanism and may be acute, recurrent or defined as chronic if lasting beyond 4 weeks. Further differentiating a chronic cough into wet or dry may aid clinicians in establishing the possible cause. This article provides a framework for the assessment of chronic cough in children, signposts to the latest guidelines, explains when and how to further investigate chronic cases and considers when to refer to a tertiary respiratory service.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 8","pages":"57291"},"PeriodicalIF":1.7,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886499","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":"Predicting Coronary Artery Stenosis Severity in Coronary Heart Disease: A Combined Model of Triglyceride-Glucose Index and Carotid Ultrasound Radiomics.","authors":"Haotian Hu, Runyu Zhu, Dian Shen, Aoyi Zhang, Wenshu Hu, Xinyi Li, Chang Zhou","doi":"10.31083/BJHM49951","DOIUrl":"https://doi.org/10.31083/BJHM49951","url":null,"abstract":"<p><strong>Aims/background: </strong>Precise evaluation of coronary lesion severity is pivotal for the clinical management of coronary heart disease (CHD). However, because the invasive coronary angiography (ICA) method, which is considered the gold standard for diagnosis, is relatively invasive, it is not widely used in early risk stratification. This study evaluated the performance of a predictive model based on a combined triglyceride-glucose (TyG) index and ultrasound radiomics characteristics of carotid plaques for evaluating coronary artery lesion severity in patients with CHD.</p><p><strong>Methods: </strong>From January 2020 to October 2024, 381 CHD patients were diagnosed by ICA at Yichang Central People's Hospital. Radiomics features were extracted from manually divided regions of interest (ROIs) in carotid plaque ultrasound images. A two-stage feature selection was carried out to identify the essential features, and then logistic regression was employed to construct a radiomics score (Rad score). Clinical data, such as the TyG index, were also included in the construction of the combined prediction model, and the predictive performance of this model was evaluated on both the training and test sets.</p><p><strong>Results: </strong>Multivariate logistic regression shows that the TyG index (odds ratio [OR] = 3.82, 95% confidence interval [CI]: 2.13-6.84), sex (OR = 1.80, 95% CI: 1.08-3.00), and hypertension status (OR = 1.81, 95% CI: 1.14-2.87) are all independent predictors of coronary lesion severity. Based on 17 essential radiomics features, the Rad score model reached an area under the curve (AUC) of 0.673 (95% CI: 0.613-0.734) for the training set and an AUC of 0.686 (95% CI: 0.567-0.806) for the test set. The combined model including sex, TyG index, hypertension status, and Rad score performed better, with AUC values of 0.823 (95% CI: 0.777-0.870) for the training set and 0.730 (95% CI: 0.616-0.844) for the test set.</p><p><strong>Conclusion: </strong>The combined model of the TyG index and ultrasound radiomics features for carotid plaques can be used to predict the severity of coronary artery lesions in patients with CHD. Non-invasively, it can be used to assess the risk of coronary artery disease and tailor a plan for other treatment options.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 8","pages":"49951"},"PeriodicalIF":1.7,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886648","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}