British journal of hospital medicine最新文献

{"title":"Becker Muscular Dystrophy and Nephrotic-Range Proteinuria: Chance or True Association?","authors":"Qunlan Yang, Yan Liu, Shaona Song, Wenhong Wang","doi":"10.12968/hmed.2024.0569","DOIUrl":"https://doi.org/10.12968/hmed.2024.0569","url":null,"abstract":"<p><p><b>Aims/Background</b> Improved life expectancy has led to an increased recognition of kidney dysfunction as a common complication in adults with Duchenne muscular dystrophy (DMD). However, data on renal impairment with Becker muscular dystrophy (BMD) especially in pediatric populations, and remains scarce. <b>Case Presentation</b> We present the case of a 5-year-old male with a two-month history of foamy urine. Laboratory investigations revealed nephrotic-range proteinuria and elevated serum creatine kinase (CK) levels. A subsequent muscle biopsy and genetic analysis confirmed the diagnosis of BMD. <b>Results</b> The patient accepted oral deflazacort for two months. Surprisingly, this targeted treatment at BMD not only led to a reduction in CK levels, but also resolved proteinuria during the two-year follow-up. <b>Conclusion</b> This clinical presentation of nephrotic-range proteinuria in pediatric BMD patients is novel and highlights a rare renal manifestation. Chronic kidney impairment in pediatric BMD warrants attention, and the role of kidney biopsy in characterizing DMD/BMD-associated nephropathy should be explored. Given the lifelong and heterogeneous nature of BMD, multicenter study and long-term follow-up are required to better understand the progression, underlying mechanisms, and clinical outcomes of renal complications in these patients.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 2","pages":"1-8"},"PeriodicalIF":1.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490822","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":"Predictive Value of Serum N-Terminal Pro-Brain Natriuretic Peptide, D-Dimer, Albumin Combined with T-Cell Subsets in Detecting Coronary Artery Damage in Children with Kawasaki Disease.","authors":"Yanfei Wang, Jing Xing, Hongbo Gao, Huanhuan Zhao, Mengjia Li, Zhenkui Liu","doi":"10.12968/hmed.2024.0630","DOIUrl":"https://doi.org/10.12968/hmed.2024.0630","url":null,"abstract":"<p><p><b>Aims/Background</b> Kawasaki disease (KD) is the common acute, self-limiting vasculitis in children, often affecting coronary arteries, which may lead to coronary artery dilation, stenosis, or in severe cases, myocardial infarction. This study aimed to identify new approaches for reducing or preventing coronary artery lesions (CAL) in KD patients by analyzing specific serological markers across various paediatric groups. <b>Methods</b> Clinical data were collected from 100 children diagnosed with Kawasaki disease (KD) admitted at First Affiliated Hospital of Hebei North University between May 2023 and June 2024. These children were divided into two groups based on coronary artery injury status: Occurrence group (n = 31) and Non-occurrence group (n = 69). Additionally, data from 100 children with acute upper respiratory tract infections (URTI) and 100 healthy children who underwent routine physical examination during the same period (Healthy group) were included for comparison. Serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), D-dimer (D-D), albumin (ALB), and T-cell subsets were measured and compared across groups to evaluate their clinical utility in diagnosing coronary artery damage in KD. <b>Results</b> NT-proBNP and D-D levels were highest in KD children with coronary artery injury and lowest in the healthy group, while ALB levels were lowest in KD children with coronary artery injury and highest in the healthy group, with statistically significant differences (<i>p</i> < 0.001). Analysis of T-cell subsets revealed that cluster of differentiation (CD)3⁺, CD4⁺, and CD4⁺/CD8⁺ levels were highest in the Healthy group, while CD8⁺ levels were highest in the Occurrence group, with statistically significant differences (<i>p</i> < 0.001). The combined diagnostic model demonstrated an area under the curve (AUC) value of 0.885 (95% CI: 0.829-0.941), showing higher specificity and AUC value compared to each marker individually. <b>Conclusion</b> The combination of serum NT-proBNP, D-D, ALB, and T-cell subsets offers valuable predictive insights for coronary artery damage in KD children and may serve as an auxiliary diagnostic tool.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 2","pages":"1-14"},"PeriodicalIF":1.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490840","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":"Ultrasound Radiomics for Preoperative Prediction of Cervical Lymph Node Metastasis in Medullary Thyroid Carcinoma.","authors":"Quanhong Lu, Xiaoxia Zhu, Manman Li, Weiwei Zhan, Feng Feng","doi":"10.12968/hmed.2024.0376","DOIUrl":"https://doi.org/10.12968/hmed.2024.0376","url":null,"abstract":"<p><p><b>Aims/Background</b> Medullary thyroid carcinoma (MTC) is a rare thyroid malignancy with a high mortality rate. Early detection of cervical lymph node metastasis (LNM) is critical for improving prognosis for patients with MTC. This study aimed to investigate the predictive utility of ultrasound-based radiomics for preoperative prediction of cervical LNM in MTC patients. <b>Methods</b> The clinical, ultrasound, and pathological information of 193 patients with MTC were retrospectively examined. Radiomics features were obtained from the ultrasound images using PyRadiomics. The selected patients were randomly divided into training (n = 135) and validation (n = 58) cohorts. In the training dataset, radiomics features were selected using the least absolute shrinkage and selection operator (LASSO) regression, and the univariate and multivariate logistic regression tests were employed to identify the clinical independent predictors of cervical LNM. Three models were created: radiomics, clinical, and combined models, with the latter presented as a nomogram. The area under the curve (AUC) was calculated to evaluate the models' predictive performance. The differences in AUCs between the combined and approach-specific models were compared using the DeLong test. The clinical usefulness of the models was evaluated using decision curve analysis (DCA). <b>Results</b> Nineteen radiomics features were chosen, and the AUCs of the developed radiomics model in the training and validation datasets were 0.881 and 0.859, respectively. Tumour diameter, calcitonin (Ctn) level, tumour margin, and sonographers' suspicion of cervical LNM based on ultrasound findings were clinical independent predictors for cervical LNM. The AUCs of the clinical model built using these predictors were 0.800 and 0.805 in the training and validation datasets, whereas the combined model had much-improved AUCs, measuring 0.925 for the training dataset and 0.918 for the validation test. The DeLong test indicated a significant AUC difference between the combined and clinical models (training dataset <i>p</i> < 0.001, validation dataset <i>p</i> = 0.027), but the difference between the combined and radiomics models was significant only in the training dataset (training dataset <i>p</i> = 0.021, validation dataset <i>p</i> = 0.066). Furthermore, based on the DCA results, the combined model features the largest clinical net benefit. <b>Conclusion</b> The nomogram, the combined model merging the ultrasound-based radiomics with clinical independent predictors, effectively predicts preoperative cervical LNM in MTC patients, outperforming the radiomics and clinical models.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 2","pages":"1-21"},"PeriodicalIF":1.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490675","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 and Validation of a Preoperative Prediction Model for Neoplastic Gallbladder Polyps.","authors":"Yanning Zhang, Jinyong Hao, Pengfei Wang, Shaoce Xu, Xiong Zhou, Jingzhe Wang, Xiaojun Huang","doi":"10.12968/hmed.2024.0800","DOIUrl":"https://doi.org/10.12968/hmed.2024.0800","url":null,"abstract":"<p><p><b>Aims/Background</b> The primary goal in evaluating gallbladder polypoid lesions (GPLs) is to identify neoplastic polyps (NP). Numerous studies have investigated risk factors for NP. This study aimed to develop a practical preoperative prediction model for NP using simple and easily accessible clinical variables. <b>Methods</b> We retrospectively analyzed clinical data from patients with GPLs who underwent cholecystectomy at Lanzhou University Second Hospital between January 2018 and September 2022. A total of 621 cases were included and randomly assigned into a training set (70%) and an internal validation set (30%). An external validation set was established using data from 117 patients treated at other centers between January and December 2023. Univariate logistic analyses were performed, followed by backward stepwise multivariate logistic regression analysis for variables with <i>p</i>< 0.2 to identify significant variables associated with NP. These predictors were included in the final logistic regression model and visualized as a nomogram model. The discrimination, calibration, and clinical utility of the model were evaluated. <b>Results</b> Age (odd ratio (OR) = 1.06, 95% CI = 1.03-1.09, <i>p</i>= 0.0001), polyp size (OR = 19.01, 95% CI = 6.48-55.79, <i>p</i> < 0.0001), polyp number (OR = 0.25, 95% CI = 0.12-0.56, <i>p</i> = 0.0006), gallbladder wall thickness (OR = 1.57, 95% CI = 1.02-2.41, <i>p</i>= 0.0385), and polyp echo characteristics (OR = 0.41, 95% CI = 0.19-0.85, <i>p</i> = 0.0169) were identified as independent influencing factors for NP. The area under the curve (AUC) of the nomogram model in the training, internal validation, and external validation sets were 0.886 (95% CI, 0.841-0.930), 0.836 (95% CI, 0.753-0.919), and 0.867 (95% CI, 0.743-0.978), respectively. Calibration curves for the three datasets showed Brier scores of 0.079, 0.092, and 0.070, all below 0.25, indicating good calibration. Decision curve analysis (DCA) and clinical impact curve (CIC) analysis suggested that a threshold probability of 0.6 provided the most significant clinical benefit. <b>Conclusion</b> This prediction model, incorporating easily accessible variables, demonstrated excellent performance in the identification of NP and contributed to clinical decision-making in GPL management.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 2","pages":"1-15"},"PeriodicalIF":1.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490826","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 Nafamostat Mesylate Combined with Continuous Renal Replacement Therapy on Clinical Outcomes, Immune Function, and Oxidative Stress Markers in Patients with Sepsis-Associated Acute Kidney Injury.","authors":"Mengai Miao, Zhile Chen","doi":"10.12968/hmed.2024.0615","DOIUrl":"https://doi.org/10.12968/hmed.2024.0615","url":null,"abstract":"<p><p><b>Aims/Background</b> Sepsis is a prevalent critical condition associated with acute kidney injury (AKI). Nafamostat mesylate (NM), a serine protease inhibitor, has anticoagulant and anti-inflammatory properties. This study aimed to investigate the effects of NM combined with continuous renal replacement therapy (CRRT) on clinical efficacy, immune function, and oxidative stress markers in patients with sepsis-associated acute kidney injury (SA-AKI). <b>Methods</b> A total of 98 patients diagnosed with SA-AKI and treated at The People's Hospital of Pingyang between January 2022 and January 2024 were included. Patients were divided into two groups based on their treatment regimen: a CRRT group (n = 48) and a NM+CRRT group (n = 50). Clinical outcomes, including length of stay in the intensive care unit (ICU) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, were analyzed. Changes in clinical efficacy, immune function, renal function, and oxidative stress markers were assessed before and after treatment. Adverse reactions were also compared between the groups. <b>Results</b> The total effective rate in the NM+CRRT group was significantly higher than in the CRRT group (<i>p</i> < 0.05). Patients in the NM+CRRT group had significantly shorter ICU stays and lower APACHE II scores compared to those in the CRRT group (<i>p</i> < 0.05). Baseline levels of renal function markers, serum creatinine (SCr), and blood urea nitrogen (BUN) were similar between the groups (<i>p</i> > 0.05). SCr and BUN levels improved significantly in the two groups post-treatment, with significant reductions observed in the NM+CRRT group (<i>p</i> < 0.05). Immune function markers, immunoglobulin G (IgG), and immunoglobulin A (IgA) showed no significant differences between groups at baseline (<i>p</i> > 0.05), but were significantly higher in the NM+CRRT group after treatment (<i>p</i> < 0.05). Oxidative stress markers, glutathione peroxidase (GSH-Px), and malondialdehyde (MDA) also showed no significant baseline differences (<i>p</i> > 0.05). After treatment, MDA levels decreased, and GSH-Px levels improved in the two groups, with more significant improvements in the NM+CRRT group. The incidence of adverse reactions was 26.00% in the NM+CRRT group and 16.67% in the CRRT group, with no statistically significant difference (<i>p</i> > 0.05). <b>Conclusion</b> NM combined with CRRT significantly enhances clinical efficacy, immune function, and renal function in patients with SA-AKI and reduces oxidative stress. The therapy demonstrates an acceptable safety profile and is suitable for clinical application.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 2","pages":"1-13"},"PeriodicalIF":1.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490836","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 Evolving Paradigm of Myocardial Infarction in the Era of Artificial Intelligence.","authors":"Maroua Dali, Cecilia Maria Elizabeth Bogle, Richard Gordon Bogle","doi":"10.12968/hmed.2024.0847","DOIUrl":"https://doi.org/10.12968/hmed.2024.0847","url":null,"abstract":"<p><p>The classification and treatment of myocardial infarction (MI) have evolved significantly over the past few decades, with the ST-segment elevation myocardial infarction (STEMI)/non-STEMI (NSTEMI) paradigm dominating clinical practice. While STEMI, identified by ST-segment elevation (STE) on electrocardiogram (ECG), has been the hallmark for urgent reperfusion therapy, this model misses a substantial number of patients with occlusive myocardial infarction (OMI) who do not exhibit STE. Recent evidence reveals that up to 25% of NSTEMI patients have OMI, leading to higher mortality due to delayed reperfusion. The emerging OMI/NOMI (Occlusive vs. Non-Occlusive MI) paradigm offers a more nuanced approach, incorporating advanced ECG interpretation and tools like point-of-care echocardiography and artificial intelligence (AI). AI has shown promise in detecting subtle ECG changes indicative of OMI, improving diagnostic accuracy and reducing misdiagnosis. This paradigm shift has important implications for clinical practice, calling for earlier identification of OMI and more inclusive treatment strategies to enhance patient outcomes.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 2","pages":"1-7"},"PeriodicalIF":1.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490377","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":"Duty of Candour Following Avoidable Harm.","authors":"Prasanna Nemichandra de Silva","doi":"10.12968/hmed.2024.0758","DOIUrl":"https://doi.org/10.12968/hmed.2024.0758","url":null,"abstract":"<p><p>Duty of candour has emerged as the key expectation in health care at the ongoing judge-led statutory inquiries, including those conducted by Thirlwall and Lampard. Despite legal requirements in Health and Social Care legislation, backed up by the General Medical Council (GMC) and Nursing and Midwifery Council (NMC), both clinicians and National Health Service (NHS) managers have been reluctant to comply with this obligation. This article examines the pressures not to avoid transparency following avoidable harm, and suggests a more preventative approach through ongoing dialogue during care delivery including consulting on potential risks pre-treatment and providing feedback following interventions which have been less than successful.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 2","pages":"1-6"},"PeriodicalIF":1.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490827","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":"Efficacy of Triptorelin Combined with Recombinant Human Growth Hormone (rhGH) on Serum Sex Hormones, Bone Age, and Clinical Outcomes in Girls with Precocious Puberty.","authors":"Xiaofei Lao, Lihong Zhao, Xiaoqiang Zhu, Xinmei Yao, Huichao Chen","doi":"10.12968/hmed.2024.0587","DOIUrl":"https://doi.org/10.12968/hmed.2024.0587","url":null,"abstract":"<p><p><b>Aims/Background</b> Triptorelin effectively delays bone age progression in children with precocious puberty but may suppress pituitary growth hormone response, affecting growth hormone-binding protein secretion and overall growth rate. This study aimed to evaluate the efficacy and safety of triptorelin alone versus in combination with recombinant human growth hormone (rhGH) in treating girls with precocious puberty. <b>Methods</b> This retrospective study examined 82 girls with precocious puberty treated at The First People's Hospital of Tongxiang from January 2021 to June 2023. Patients treated with triptorelin alone were assigned to the control group (n = 42), while those treated with triptorelin combined with rhGH formed the study group (n = 40). Both groups received continuous treatment for one year. Outcomes, including efficacy and safety, were compared between the groups. <b>Results</b> Following treatment, height and body mass in the study group were significantly higher than those in the control group (<i>t</i> = 2.126, <i>p</i> = 0.037; <i>t</i> = 2.419, <i>p</i> = 0.018). The bone age/chronological age (BA/CA) ratio in the study group was significantly lower than that in the control group (<i>t</i> = 2.185, <i>p</i> = 0.032). Levels of estradiol (E₂), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) in the study group were also significantly reduced compared to the control group (<i>t</i> = 2.208, <i>p</i> = 0.030; <i>t</i> = 4.492, <i>p</i> < 0.001; <i>t</i> = 2.952, <i>p</i> = 0.004). Furthermore, left and right ovarian volumes and uterine volume were significantly lower in the study group than those in the control group (<i>t</i> = 2.740, <i>p</i> = 0.008; <i>t</i> = 2.936, <i>p</i> = 0.004; <i>t</i> = 2.520, <i>p</i> = 0.014). After one year, the effective treatment rate in the study group was higher than that in the control group (97.50% vs 80.95%, <i>p</i> < 0.05). No serious adverse reactions were observed in either group during the treatment period. <b>Conclusion</b> The combination of triptorelin and rhGH demonstrates a clear therapeutic in girls with precocious puberty, which effectively delays bone age growth, regulates sex hormone levels, and reduces ovarian and uterine volumes without severe adverse effects.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 2","pages":"1-12"},"PeriodicalIF":1.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490831","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 Individualized Comfort-Based Combined Anesthesia Protocol on Elderly Patients Undergoing Outpatient Oral Procedures.","authors":"Chen Cao, Dawei Hu, Jing Cao, Wenjing Zhu, Xiaotong Zhang, Chuxiong Pan","doi":"10.12968/hmed.2024.0778","DOIUrl":"https://doi.org/10.12968/hmed.2024.0778","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Aims/Background&lt;/b&gt; Anxiety, fear, and lack of confidence in surgical outcomes can lower the pain threshold of elderly patients. Developing individualized and comfortable anesthesia protocols is critical for optimizing outcomes in elderly patients undergoing oral procedures. This study aimed to investigate the impact of an individualized comfort anesthesia protocol on elderly patients with varying levels of dental anxiety undergoing complex tooth extraction. &lt;b&gt;Methods&lt;/b&gt; A retrospective analysis was conducted on 210 elderly patients who underwent complex tooth extractions at the Comfort Oral Treatment VIP Center and Oral Surgery Department of Beijing Stomatological Hospital, Capital Medical University, between December 2022 and May 2024. Patients were categorized into three groups based on Corah's Dental Anxiety Scale: mild dental anxiety (Group G1, 72 cases), moderate dental anxiety (Group G2, 72 cases), and severe dental anxiety (Group G3, 66 cases). Corresponding anesthesia regimens were administered: 0.06 mg/kg, 0.08 mg/kg + 0.03 μg/kg/time, and 0.06 mg/kg + 0.05 μg/kg/time, respectively. Mean arterial pressure (MAP), bispectral index (BIS), and heart rate (HR) were measured at sedation onset (T1), after local anesthesia injection (T2), and at the end of tooth extraction (T3). Sedation onset time, recovery time, discharge time, and adverse reactions were also recorded. &lt;b&gt;Results&lt;/b&gt; Repeated measures analysis of variance (ANOVA) revealed significant difference in BIS within groups over time (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), with notable group-by-time interactions (&lt;i&gt;p&lt;/i&gt; &lt; 0.001) and significant within-group effects (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). For MAP, there was a significant within-group effect (&lt;i&gt;p&lt;/i&gt; &lt; 0.001) and group-by-time effect (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), while the time effect was not statistically significant (&lt;i&gt;p&lt;/i&gt; = 0.302). HR demonstrated a significant within-group effect (&lt;i&gt;p&lt;/i&gt; &lt; 0.001) but no significant time effects (&lt;i&gt;p&lt;/i&gt; = 0.278) and marginally non-significant group-by-time interactions (&lt;i&gt;p&lt;/i&gt; = 0.052). Compared with Group G3, Groups G1 and G2 exhibited shorter sedation onset, recovery times, and discharge times (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). Additionally, Group G3 had longer sedation onset and recovery times compared to Group G2 (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). No significant difference in discharge times was observed between Groups G1 and G2 (&lt;i&gt;p&lt;/i&gt; &gt; 0.05). Among the adverse reactions, bradycardia and drowsiness were significantly more frequent in specific groups (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). &lt;b&gt;Conclusion&lt;/b&gt; An individualized comfort-based anesthesia protocol tailored to the levels of anxiety, fear, and anticipated pain effectively provides optimal sedative and anesthetic outcomes for elderly patients undergoing complex tooth extractions in outpatient settings. This approach exhibits significant benefits in sedation onset, recovery, and discharge times while minimizing adverse reactions, making it a practical and effective option for clinical application","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 2","pages":"1-14"},"PeriodicalIF":1.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490835","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":"Efficacy of Intravitreal Anti-VEGF Agents in Neovascular Age-Related Macular Degeneration Patients with or without Polypoidal Choroidal Vasculopathy: A Meta-Analysis.","authors":"Luyao Wang, Shiyu Liu, Tingting He, Chun Liu, Junguo Duan","doi":"10.12968/hmed.2024.0673","DOIUrl":"https://doi.org/10.12968/hmed.2024.0673","url":null,"abstract":"<p><p><b>Aims/Background</b> The classification of polypoidal choroidal vasculopathy (PCV) as a subtype of neovascular age-related macular degeneration (nAMD) remained an ongoing controversy. This meta-analysis examines the efficacy of intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents in nAMD patients with or without PCV. <b>Methods</b> A systematic search was conducted in four databases, including PubMed, EMBASE, MEDLINE, and Cochrane Library, from their inception to 1 July 2023. The outcome measure was the change in best-corrected visual acuity (BCVA) and center retinal thickness (CRT) from the baseline to different follow-up durations. Furthermore, sensitivity analysis was performed when significant heterogeneity was detected. <b>Results</b> This meta-analysis included sixteen studies involving 6679 patients, comprising 5070 non-PCV and 1609 PCV cases. The findings revealed that the improvement in BCVA at 6-month follow-up (mean difference (MD) = 0.05; 95% confidence interval (CI), 0.02 to 0.07; <i>p</i> = 0.0001) and the reduction in CRT at 3-month follow-up duration (MD = 10.29; 95% CI, 0.93 to 19.66; <i>p</i> = 0.03) were significantly greater in the PCV group compared to the non-PCV group. <b>Conclusion</b> This meta-analysis indicates that PCV may exhibit better short-term efficacy in response to anti-VEGF therapy than non-PCV. <b>Systematic Review Registration</b> PROSPERO (CRD42023445591).</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 2","pages":"1-22"},"PeriodicalIF":1.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490830","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}