British journal of hospital medicine最新文献

{"title":"Effect of Bortezomib Treatment in Multiple Myeloma on Blood Coagulation Function, Renal Function, Immune Function, and the NF-κB Pathway-Associated Indicators.","authors":"Jian Tao, Ling Wang, Zheyun Gu, Liyu Zhang","doi":"10.12968/hmed.2024.0701","DOIUrl":"10.12968/hmed.2024.0701","url":null,"abstract":"<p><p><b>Aims/Background</b> Multiple myeloma (MM) presents several underlying mechanisms of immune dysfunction. Advanced research on these mechanisms has introduced new drugs for MM into clinical practice. However, several challenges occur, particularly in cases of relapsed and refractory MM. In recent years, bortezomib has been recognized, for its anti-myeloma effect in both newly identified and refractory MM patients, but its mechanism of action on MM remains unexplored. Consequently, this study aims to explore the influence of bortezomib on coagulation function, renal function, immune function, and related indexes of nuclear transcription factor-κB (NF-κB) pathway in MM patients. <b>Methods</b> This retrospective study analyzed 120 MM patients admitted to the First People's Hospital of Nantong, China, between August 2018 and August 2023. Based on different treatment methods, patients were divided into a control group (thalidomide, cyclophosphamide, and dexamethasone (TCD), 58 cases) and an observation group (TCD regimen and bortezomib, 62 cases). The therapeutic efficacy of the drug was observed, and the levels of blood indexes, coagulation function indexes, NF-κB related indexes, renal function indexes and immunosuppressive factors were compared between the groups both before and after treatment. <b>Results</b> There were no significant differences in disease control rate (DCR) between the two groups (<i>p</i> > 0.05). After treatment, the objective response rate (ORR) and the hemoglobin levels were significantly higher in the observation group than in the control group, with lower M protein levels (<i>p</i> < 0.05). Furthermore, the prothrombin time (PT), the activated partial thromboplastin time (APTT), fibrinogen (FIB) values, <i>NF-κB</i> expression levels, β2-microglobulin (β2-MG) levels, blood urea nitrogen (BUN), serum creatinine (Scr), transforming growth factor-β (TGF-β), interleukin-6 (IL-6) and interleukin-17 (IL-17) levels were substantially decreased in the observation group compared to the control group (<i>p</i> < 0.001). Additionally, the progression-free survival rate was significantly higher in the observation group than in the control group (<i>p</i> < 0.001). However, no significant difference was observed in the overall survival (OS) rate between the two groups (<i>p</i> > 0.05). Moreover, the median progression-free survival (PFS) time was 11.95 months in the observation group and 9 months in the control group, while the median OS time was 11.7 months in the control group. <b>Conclusion</b> In summary, bortezomib treatment improves coagulation and renal function in MM patients. Furthermore, it helps reduce immune suppression, prolong survival time, and inhibit the NF-κB pathway activation.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 3","pages":"1-15"},"PeriodicalIF":1.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708602","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 Case of Left-Dominant Arrhythmogenic Cardiomyopathy Presenting with Cardiac Arrest.","authors":"Simran Piya, Alice Jackson, Caroline J Coats, Sabrina Nordin","doi":"10.12968/hmed.2024.0674","DOIUrl":"10.12968/hmed.2024.0674","url":null,"abstract":"<p><p>Arrhythmogenic cardiomyopathy (ACM) is a genetically inherited cardiomyopathy characterised by the fibro-fatty replacement of the myocardium. Patients can present with symptoms of arrhythmia or heart failure; it is a common cause of sudden cardiac arrest and death in young adults. Originally considered as right ventricular arrhythmogenic cardiomyopathy or dysplasia, this terminology has been updated to include left-dominant and biventricular phenotypes. We report a case of a 41-year-old man who presented with an out-of-hospital cardiac arrest due to ventricular arrhythmia as a first presentation. The patient underwent cardiac magnetic resonance imaging, which revealed severe left ventricular (LV) dysfunction with LV fibro-fatty infiltration and a ring-like subepicardial and mid-wall late gadolinium enhancement in the LV. Genetic sequencing identified a pathogenic desmoplakin gene variant. A diagnosis of left-dominant ACM (ALVC) was made based on his presentation, imaging, and genetic findings. Guideline-directed medical therapy with a beta-blocker and an angiotensin-converting enzyme inhibitor was initiated in the first instance. An implantable cardioverter-defibrillator was inserted for secondary prevention. This report highlights the presentation, current diagnostic criteria with a particular focus on ALVC, and the importance of the multimodality approach in the recognition and management of patients with ACM.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 3","pages":"1-12"},"PeriodicalIF":1.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708637","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":"Advances in Immunotherapy and Targeted Therapy for Gastric Cancer: A Comprehensive Review.","authors":"Hui Yuan, Miao Bao, Minqiang Chen, Junhao Fu, Shian Yu","doi":"10.12968/hmed.2024.0759","DOIUrl":"10.12968/hmed.2024.0759","url":null,"abstract":"<p><p>Gastric cancer remains one of the most prevalent and lethal malignancies worldwide, characterized by poor survival rates, particularly in advanced stages. In recent years, a paradigm shift in gastric cancer treatment has been witnessed with the introduction of immunotherapy and targeted therapies. This review provides a detailed examination of current immunotherapeutic strategies, including adoptive cell therapy (ACT), immune checkpoint inhibitors (ICIs), and cancer vaccines. Additionally, it explores advancements in targeted therapies, focusing on the human epidermal growth factor receptor 2 (HER2) and vascular endothelial growth factor receptor (VEGFR) signaling pathways, as well as emerging targets such as claudin 18.2. Clinical trials investigating chimeric antigen receptor T-cell (CAR-T) therapy, T-cell receptor-engineered T-cell (TCR-T) therapy, and natural killer (NK) cell-based treatments have shown promise, particularly when combined with conventional chemotherapeutic regimens. However, challenges such as cytokine release syndrome, immune-related toxicities, and scalability issues remain significant. The combination of immunotherapy with targeted therapies represents a promising approach to enhance treatment outcomes. Future directions emphasize the need to overcome resistance mechanisms and refine treatment strategies to improve efficacy while reducing adverse effects. This review aims to elucidate the current landscape of immunotherapy and targeted therapy in gastric cancer and to explore their potential in shaping the future of clinical management for this devastating disease.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 3","pages":"1-24"},"PeriodicalIF":1.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708639","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":"Standardizing Best Practices: An Initiative Utilizing Surgical Ward Round Checklists to Enhance Patient Safety and Documentation in Our Trust.","authors":"Antonio Bozzi, Heraa Islam, Valentin Butnari, Nunzia Morricone, Sonia Franchini, Dixon Osilli, Ahmer Mansuri, Francesco Di Nubila, Robert Leonides Buhain","doi":"10.12968/hmed.2024.0559","DOIUrl":"10.12968/hmed.2024.0559","url":null,"abstract":"<p><p><b>Aims/Background</b> Comprehensive ward round documentation is crucial for ensuring effective communication and patient safety. Standardized checklists have been shown to improve documentation quality in various healthcare settings. This article presents the findings of a comprehensive audit consisting of two cycles, which incorporate feedback, bring about implications, and evaluate the impact of a standardized proforma on inpatient ward round documentation for General Surgery patients in a high-volume surgical unit. <b>Methods</b> Initially, a staff survey was conducted to identify deficiencies in ward round documentation, highlighting the need for a standardized proforma. To establish a baseline, a retrospective review of 45 ward round entries assessed five key areas: diagnosis, disease management, objective assessments, discharge planning, and documentation logistics. Subsequently, within a month of implementing the changes, 20 ward round entries were analyzed based on the same criteria during a second cycle. <b>Results</b> During Cycle 1, we found that 95.6% of the notes lacked information on Venous thromboembolism (VTE) prophylaxis, while nearly 88.9% were missing data on current issues, and 46.7% did not include pain scores. Additionally, we found that bowel function and fluid balance information were absent in 62.2% and 95.6% of ward round entries, respectively. Cycle 2 showed a significant improvement in terms of documentation for most of the items. Most of the variables were documented in all the reviewed proformas and others such as VTE prophylaxis and fluid balance showed a significant improvement being documented in 95% of the proformas. <b>Conclusion</b> Employing a standardized ward round proforma demonstrably improved documentation completeness across all safety parameters within our surgical unit. This enhanced focus on crucial safety discussions during ward rounds is expected to further elevate patient safety outcomes.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 3","pages":"1-11"},"PeriodicalIF":1.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708678","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":"Circulating Tumor DNA Predicts Conversion Therapy Response and Prognosis in Initially Unresectable Colorectal Liver-Limited Metastases: A Retrospective Study.","authors":"Bohan Han, Cailu Shen, Huabin Hu, Jianwei Zhang, Xiaoyu Xie, Qinli Mo, Yanhong Deng","doi":"10.12968/hmed.2024.0695","DOIUrl":"10.12968/hmed.2024.0695","url":null,"abstract":"<p><p><b>Aims/Background</b> Effective molecular biomarkers for predicting prognosis and guiding treatment in patients with initially unresectable colorectal liver metastases (CRLMs) undergoing conversion therapy are currently lacking. This study investigated the predictive value of circulating tumor DNA (ctDNA) conversion therapy outcomes in initially unresectable CRLMs. <b>Methods</b> A retrospective analysis was conducted on 81 patients with CRLMs treated at the Sixth Affiliated Hospital, Sun Yat-sen University from January 2017 to April 2021. The relationships between baseline and treatment ctDNA levels and clinical responses were evaluated using group comparisons based on data type. The impact of ctDNA on survival outcomes was analyzed through Cox regression survival analysis. <b>Results</b> Analysis of 81 patients with ctDNA-positive at baseline showed that patients in the ctDNA low-level group had a significantly longer median progression-free survival (mPFS) (<i>p</i> = 0.039). Among 45 patients who underwent ctDNA testing during systemic therapy, the proportion of patients in the ctDNA-negative group receiving local ablative treatment (LAT) was significantly higher (70.0% <i>vs</i> 26.7%, <i>p</i> = 0.006). Furthermore, 50% of patients in the ctDNA-negative group achieved no evidence of disease (NED) status, compared to 6.7% in the ctDNA-positive group (<i>p</i> = 0.004). Both mPFS and median overall survival (mOS) were significantly longer in ctDNA-negative patients compared to ctDNA-positive patients (<i>p</i> < 0.05). Of the 61 patients who underwent LAT, 37 received ctDNA testing at the same time as imaging assessment for NED. The proportion of patients with ctDNA clearance who achieved NED status was markedly higher than that of patients with ctDNA non-clearance (78.6% <i>vs</i> 33.3%, <i>p</i> = 0.036). Patients with ctDNA clearance demonstrated significantly improved mOS compared to those with ctDNA non-clearance (not reached <i>vs</i> 30.1 months, <i>p</i> = 0.036). <b>Conclusion</b> Dynamic changes in ctDNA levels can predict both long-term survival and the effectiveness of conversion therapy in patients with initially unresectable CRLMs.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 3","pages":"1-16"},"PeriodicalIF":1.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708350","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":"Impact of Fluticasone Propionate and Salmeterol Combined with Pulmonary Rehabilitation on Pulmonary Function, Exercise Tolerance, and Quality of Life in Elderly Patients with Stable Chronic Obstructive Pulmonary Disease.","authors":"Yong Yang","doi":"10.12968/hmed.2024.0708","DOIUrl":"10.12968/hmed.2024.0708","url":null,"abstract":"<p><p><b>Aims/Background</b> Chronic obstructive pulmonary disease (COPD) is a common respiratory disease characterized by persistent respiratory problems. COPD has become a major public health concern worldwide as the population ages. Therefore, we investigated the impact of fluticasone propionate and salmeterol inhalation combined with pulmonary rehabilitation on pulmonary function, exercise tolerance, and quality of life in elderly patients with stable COPD. <b>Methods</b> This retrospective study included 102 elderly patients with stable COPD who were treated between January 2021 and October 2023. Based on previous treatment regimens, patients were divided into a fluticasone propionate and salmeterol inhalation combined with a pulmonary rehabilitation group (n = 58) and a pulmonary rehabilitation alone group (n = 44). We collected baseline data upon admission and other relevant data after 3 months of follow-up. Furthermore, we evaluated pulmonary function [forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF)], inflammatory markers [interleukin-8 (IL-8), interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α), tumour necrosis factor-β (TNF-β)], exercise tolerance [6-minute walk test (6MWT)], and quality of life [COPD Assessment Test (CAT), and St. George's Respiratory Questionnaire (SGRQ)] between the two experimental groups. Additionally, the recurrence rate and adverse events during the 3-month follow-up were examined. <b>Results</b> Compared to baseline, FEV1, FVC, PEF, and 6MWT levels were significantly improved in both groups at the 3-month follow-up, with the combined treatment group performing better than the pulmonary rehabilitation alone group (<i>p</i> < 0.05). CAT and SGRQ scores decreased significantly, with the combined treatment group scoring lower than the pulmonary rehabilitation alone group (<i>p</i> < 0.05). Inflammatory markers, such as IL-8, IL-6, TNF-α, and TNF-β were significantly reduced in the combined treatment group and were lower than in the pulmonary rehabilitation alone group (<i>p</i> < 0.05). The recurrence rate in the combined treatment group was significantly lower than in the pulmonary rehabilitation alone group (<i>p</i> = 0.018), with no significant difference in the incidence of adverse events between the two groups (<i>p</i> > 0.05). <b>Conclusion</b> Fluticasone propionate and salmeterol inhalation combined with pulmonary rehabilitation can reduce recurrence rates, and improve pulmonary function, inflammatory status, and exercise tolerance, thereby significantly enhancing the quality of life for elderly patients with stable COPD.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 3","pages":"1-13"},"PeriodicalIF":1.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708658","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":"International Experience in the Management of Pharmaceutical Expenditure: A Narrative Literature Review.","authors":"Vasileios Leivaditis, Christos Ntais, John Fanourgiakis, Francesk Mulita, Nikolaos Kontodimopoulos","doi":"10.12968/hmed.2024.0676","DOIUrl":"10.12968/hmed.2024.0676","url":null,"abstract":"<p><p>This narrative review examines global efforts to manage pharmaceutical expenditures across diverse economic settings, with the goal of identifying strategies that balance cost containment with equitable access to medications. The review highlights the impact of various policy measures on pharmaceutical pricing and spending trends in high-, middle-, and low-income countries. We conducted a comprehensive narrative literature review using PubMed, Scopus, and EconLit databases, applying no chronological or geographical restrictions. Articles were selected based on their relevance to pharmaceutical cost-containment strategies and their impact on medication access. Data extraction was performed independently by two independent reviewers, with a conflict-resolution protocol to ensure accuracy and minimize bias. The review identifies a range of policy interventions, including price regulation, reference pricing, and the promotion of generic drugs. While high-income countries have implemented sophisticated regulatory frameworks, lower-income countries often face challenges in aligning cost containment with healthcare access needs. The effectiveness of these strategies varies widely, underscoring the need for policies tailored to local healthcare and economic conditions. Effective management of pharmaceutical expenditures requires adaptable policy frameworks that consider local contexts and economic capacities. International collaboration and continuous policy evaluation are essential to developing sustainable strategies that enhance both cost efficiency and access to essential medicines.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 3","pages":"1-19"},"PeriodicalIF":1.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708661","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":"Role for MRI in Secondary Screening for Placenta Accreta.","authors":"Edward Golob, Kashif Burney, Tamal Datta, Sally Lewis, Jazmin Gajadhar, Ramesh Ganapathy","doi":"10.12968/hmed.2024.0528","DOIUrl":"10.12968/hmed.2024.0528","url":null,"abstract":"<p><p><b>Aims/Background</b> Rates of both placenta praevia and placenta accreta spectrum (PAS) are rising. There is significant morbidity associated with PAS and antenatal detection reduces morbidity at delivery. In the UK there is a move to centralise care of these cases in dedicated units. Incidental diagnosis is more common, in the absence of a regular screening program. In non-specialist hospitals, there is a need to consider adjunct confirmatory diagnostics prior to referral to specialist centres. This is important to ensure capacity management in specialist centres. Ultrasound (US) and Magnetic Resonance Imaging (MRI) have both been used to diagnose PAS with high levels of accuracy with experienced operators. The role of MRI as an adjunct with US has not been clearly defined but is often requested. <b>Methods</b> A retrospective analysis of all cases referred for MRI as a secondary modality after US to evaluate possible PAS. A total of 41 cases had MRI performed over 13 years with a trend of increasing demand over time. <b>Results</b> The series identified eleven cases of PAS. MRI demonstrated a high level of accuracy, similar to published literature (sensitivity 81.8%, Specificity 86.6%) and correctly reclassified 2 cases as PAS, which were considered normal on US. There were 2 cases of PAS which were missed by both US and MRI. <b>Conclusion</b> This series demonstrates increasing demand in our trust for MRI over the period of the study. The addition of MRI as a second test improved accuracy compared to ultrasound alone. MRI has a role in secondary screening for PAS in non-specialist units.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 3","pages":"1-10"},"PeriodicalIF":1.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708667","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":"Stroke with White Matter Lesions: Potential Pathophysiology and Therapeutic Targets.","authors":"Xiwen Peng, Zhigang Mei, Zhenghua Luo, Jinwen Ge","doi":"10.12968/hmed.2024.0771","DOIUrl":"10.12968/hmed.2024.0771","url":null,"abstract":"<p><p>Stroke is one of the most common causes of morbidity and mortality among adults globally. Significant advancements have been made in elucidating its pathophysiology, with stroke categorized into pathological subtypes, such as ischemic stroke (IS) and hemorrhagic stroke. White matter lesions (WMLs) identified on magnetic resonance imaging rank as a hallmark of cerebral small vessel disease and are associated with vascular risk factors. They are linked to adverse outcomes like dementia, depression, and an increased risk of both first-ever and recurrent strokes, independent of other risk factors. Despite the evidence indicating the close link between WMLs and stroke, their underlying pathophysiological relationship remains unclear. This study aims to provide an overview of the current knowledge and recent advances in epidemiology, risk factors, and pathophysiological mechanisms of WMLs and stroke, focusing on their interconnection and emerging therapeutic targets.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 3","pages":"1-21"},"PeriodicalIF":1.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708680","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 Intestinal Flora Metabolites and Coronary Artery Vulnerable Plaque Characteristics in Coronary Heart Disease.","authors":"Xi You, Bo Gao","doi":"10.12968/hmed.2024.0772","DOIUrl":"10.12968/hmed.2024.0772","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Aims/Background&lt;/b&gt; The incidence of coronary heart disease (CHD) has been increasing annually. Patients with severe conditions may die from myocardial infarction, heart failure or malignant arrhythmia. Intestinal flora plays an important role in various metabolic processes, such as atherosclerosis, tumour formation, and inflammation. However, its direct role in promoting plaque vulnerability must be further explored and validated. Therefore, this study aims to explore the relationship between changes in intestinal flora, its metabolites in CHD patients and the vulnerability characteristics of coronary plaques. &lt;b&gt;Methods&lt;/b&gt; This study recruited 180 subjects, among these, 90 CHD patients diagnosed between January 2023 and January 2024 were selected as the CHD group and 90 healthy volunteers were selected as the control group following a principle of 1:1 ratio. The differences in intestinal flora composition, metabolite levels, and blood biochemical indexes were compared between the two study groups. Based on the coronary angiography (CAG) and intravascular ultrasound (IVUS) results, the CHD group was divided into two sub-groups for stratified comparative analysis: the stable plaque group (n = 49) and the vulnerable plaque group (n = 41). &lt;b&gt;Results&lt;/b&gt; The CHD group had reduced intestinal &lt;i&gt;Bifidobacteria&lt;/i&gt; and lactic acid bacteria counts and higher intestinal &lt;i&gt;Escherichia coli&lt;/i&gt; and &lt;i&gt;Enterococcus&lt;/i&gt; levels than the control group (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). Moreover, trimethylamine-N-oxide (TMAO) and phenylacetylglutamine (PAGln) levels were significantly higher in the CHD group compared to the control group (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). Similarly, the CHD group exhibited substantially elevated serum triglyceride (TG), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) levels compared to the control group. However, compared to the control group, the high-density lipoprotein cholesterol (HDL-C) levels were significantly lower in the CHD group (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). Furthermore, the serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum urea nitrogen (BUN), and serum creatinine (Scr) were comparable in the two experimental groups (&lt;i&gt;p&lt;/i&gt; &gt; 0.05). Similarly, intestinal &lt;i&gt;Bifidobacteria&lt;/i&gt;, lactic acid bacteria, &lt;i&gt;Escherichia&lt;/i&gt; &lt;i&gt;coli&lt;/i&gt;, and &lt;i&gt;Enterococcus&lt;/i&gt; compositions were comparable in CHD patients with vulnerable plaque and those with stable plaque (&lt;i&gt;p&lt;/i&gt; &gt; 0.05). Moreover, CHD patients with vulnerable plaque had elevated TMAO and PAGln levels than those with stable plaque (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). However, TG, TC, HDL-C, LDL-C, ALT, AST, BUN, and Scr levels were comparable between CHD patients with a vulnerable plaque and those with stable plaque (&lt;i&gt;p&lt;/i&gt; &gt; 0.05). Multivariate regression analysis showed that diabetes, elevated TMAO levels, and elevated PAGln levels were potential risk factors for coronary plaque vulnerability (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). &lt;b&gt;Conclusion&lt;/b&gt; In summary, CHD patient","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 3","pages":"1-13"},"PeriodicalIF":1.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708641","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}