British journal of hospital medicine最新文献

{"title":"Iron in Chronic Kidney Disease and End-Stage Kidney Disease-Current Trends and Future Direction.","authors":"Thomas McDonnell, Philip A Kalra","doi":"10.12968/hmed.2024.0619","DOIUrl":"10.12968/hmed.2024.0619","url":null,"abstract":"<p><p>Anaemia is a frequent and serious complication in chronic kidney disease (CKD), affecting both non-dialysis-dependent (NDD) and dialysis-dependent (DD) patients. While erythropoietin (EPO) deficiency is the primary cause, iron deficiency (ID) also plays a crucial role. ID in CKD can be classified as either absolute, resulting from blood loss, or functional, driven by inflammation and elevated hepcidin levels, which trap iron in macrophages and hepatocytes, preventing its use in erythropoiesis. Elevated hepcidin also reduces dietary iron absorption in the gut, making oral iron supplements ineffective, particularly in advanced CKD. This review summarises the available intravenous (IV) iron formulations, discusses diagnostic definitions and treatment thresholds for ID in NDD and DD CKD, and explores potential future therapeutic directions.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 2","pages":"1-19"},"PeriodicalIF":1.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490837","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":"Managing your Palliative Patient.","authors":"Nicholas Herodotou","doi":"10.12968/hmed.2024.0579","DOIUrl":"10.12968/hmed.2024.0579","url":null,"abstract":"<p><p>Palliative Care is the symptom management of any patient who has an irreversible, progressive, life-limiting condition and is not solely cancer patients. It aims to enhance quality of life, utilizing a holistic, multidisciplinary approach. Good symptom management of palliative patients is what every clinician should be able to deliver. This short article addresses the practical management of how to commence strong opioids, palliative surgical interventions, palliative emergencies and lastly, when do you stop treating a patient who is clinically deteriorating.</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":"143490838","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":"Recent Advances in the Diagnosis and Management of Pulmonary Arterial Hypertension.","authors":"Eamon Mullen, Brian McCullagh, Sean Gaine, Syed Rehan Quadery","doi":"10.12968/hmed.2024.0635","DOIUrl":"10.12968/hmed.2024.0635","url":null,"abstract":"<p><p>Pulmonary arterial hypertension (PAH) is a rare, progressive, debilitating and life shortening condition characterized by raised pulmonary arterial pressures. PAH includes a group of conditions sharing similar pathophysiology, clinical features and response to therapy. The commonest sub-groups of PAH include idiopathic pulmonary arterial hypertension (IPAH), and PAH associated with connective tissue disease. Recently published international guidelines emphasize the need for disease awareness and early referral to expert centres in suspected cases. Following diagnosis and careful risk stratification, combination therapy is recommended using drugs targeting the nitric oxide, endothelin and prostacyclin signaling pathways. Promising new therapies are on the horizon, however, the survival remains disappointing with a median survival of 7 years. In this review, we focus on the diagnostic evaluation, risk stratification, available treatment options and future directions in PAH.</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":"143490458","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":"Combining Circulating Tumour DNA with Clinical Pathological Risk Factors for Developing Peritoneal Metastasis Prediction Model in Patients with Colorectal Cancer.","authors":"Bohan Han, Huabin Hu, Jianwei Zhang, Xiaoyu Xie, Yanhong Deng","doi":"10.12968/hmed.2024.0704","DOIUrl":"10.12968/hmed.2024.0704","url":null,"abstract":"<p><p><b>Aims/Background</b> Peritoneal metastasis in colorectal cancer (CRC) indicates a poor prognosis for patients. Circulating tumour DNA (ctDNA) effectively predicts recurrence and metastasis. Therefore, this study aims to construct a predictive model for peritoneal metastasis by integrating ctDNA with clinicopathological factors in stage I-III CRC patients. <b>Methods</b> We conducted a retrospective analysis of 299 CRC patients who underwent ctDNA detection at The Sixth Affiliated Hospital, Sun Yat-sen University between January 2010 and December 2022. Patients were randomly divided into training (n = 209) and validation (n = 90) sets in a 7:3 ratio using a random number table method. The least absolute shrinkage and selection operator (LASSO) regression model optimized feature selection, and multivariable logistic regression constructed the predictive model. <b>Results</b> Among the study cohort, 59 patients were ctDNA-positive. Postoperative ctDNA positivity was associated with an 8.522-fold increased risk of peritoneal metastasis (<i>p</i> < 0.001, odds ratio (OR) 8.522, 95% confidence interval (CI) 4.371-16.615). The model included preoperative carbohydrate antigen 125 (CA-125), pathological lymph node staging, perineural invasion, and ctDNA levels, achieving an area under the curve (AUC) of 0.808 (95% CI 0.727-0.888) in the training set and 0.784 (95% CI 0.658-0.910) in the validation set. <b>Conclusion</b> This model can accurately identify high-risk patients for peritoneal metastasis in postoperative CRC, facilitating early detection and timely intervention.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 2","pages":"1-18"},"PeriodicalIF":1.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490824","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":"Causal Relationship between Branched-Chain Amino Acids and Inflammatory Bowel Disease: A Bidirectional and Multivariable Mendelian Randomization Study.","authors":"Jiaying Zhou, Fengting Zhu, Leimin Sun","doi":"10.12968/hmed.2024.0722","DOIUrl":"10.12968/hmed.2024.0722","url":null,"abstract":"<p><p><b>Aims/Background</b> The relationship between dysregulated branched-chain amino acid (BCAA) and inflammatory bowel disease (IBD) is not fully understood. This study applied a bidirectional, two-sample Mendelian randomization (MR) approach to explore the potential causal relationship between circulating BCAA levels and IBD. <b>Methods</b> Genome-wide association studies (GWAS) data on total BCAA levels, comprising leucine, valine, and isoleucine, were utilized. Data on IBD and its subtypes were sourced from the FinnGen study. The primary analytical method was the inverse-variance weighted (IVW) MR. To determine the direct causal effect of BCAA levels on IBD risk while accounting for confounders, we employed multivariable Mendelian randomization (MVMR). <b>Results</b> IVW analysis revealed a positive correlation between circulating total BCAA levels, including valine, leucine, and isoleucine, and an increased risk of Crohn's disease (CD). No causal link was detected between BCAA levels and overall IBD or ulcerative colitis (UC). In the MVMR analysis, adjusting for common risk factors further validated a direct causal effect of elevated BCAA levels on CD risk. <b>Conclusion</b> Our findings suggest that elevated circulating BCAA levels are associated with an increased risk of CD. Further research is warranted to explore the potential implications of these findings for CD risk management.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 2","pages":"1-17"},"PeriodicalIF":1.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490823","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 Dapagliflozin in the Treatment of Type 2 Diabetes Mellitus Complicated by Coronary Heart Disease: A Meta-Analysis.","authors":"Wenchao Ma, Kun Wang, Leina Sun, Fangcheng Su","doi":"10.12968/hmed.2024.0336","DOIUrl":"10.12968/hmed.2024.0336","url":null,"abstract":"<p><p><b>Aims/Background</b> Dapagliflozin is a sodium-glucose cotransporter inhibitor that functions to lower blood sugar by promoting glucose excretion. We conducted a meta-analysis to assess the therapeutic efficacy of dapagliflozin in patients with type 2 diabetes mellitus complicated by coronary heart disease. The objective of this analysis is to provide additional clarity on dapagliflozin's effectiveness in this specific patient population. <b>Methods</b> A systematic review of the literature was performed by searching China National Knowledge Infrastructure (CNKI), Wanfang, Wip Chinese Science, Technology Journals, China Biomedicine, Pubmed, Web of Science, and Cochrane Library. Related literature regarding the effectiveness of dapagliflozin, published since the inception of databases until October 2023, was searched and selected. Subsequent to the screening process, the Jadad scale was used to assess the quality of the gathered literature. The NoteExpress3.2 software (Beijing Aegean Music Technology Co., Ltd., Beijing, China) was utilized to manage the literature. Statistical analysis was conducted using RevMan5.4.1 software (The Cochrane Collaboration, London, UK). The <i>p</i>-value of the Q test determined the heterogeneity of the studies, guiding the choice between fixed or random effect models for establishing the combined effect. Forest plots were used to visualize dapagliflozin's efficacy in treating patients with type 2 diabetes mellitus and coronary heart disease. A funnel plot was plotted to assess potential publication bias. <b>Results</b> Twenty-three studies were eligible for inclusion in this meta-analysis. The results revealed that dapagliflozin has better clinical efficacy (odds ratio [OR] = 3.88, 95% confidence interval [CI] 2.59 to 5.82), left ventricular ejection fraction (LVEF) (OR = 5.43, 95% CI 4.02 to 6.84). The values of left ventricular end-diastolic diameter (LVEDD) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were lower in the experimental group (OR: -4.03 and -84.65, 95% CI -5.08 to -2.98 and -127.05 to -42.25, respectively). In addition, further analysis showed that the experimental group experienced a lower incidence of adverse reactions (OR = 0.30, 95% CI 0.16 to 0.57). <b>Conclusion</b> Dapagliflozin is more effective in controlling type 2 diabetes mellitus complicated by coronary heart disease.</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":"143490829","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":"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":"What is the Future of Diagnostics in Heart Failure?","authors":"Aimee McCoubrey, Ross T Campbell","doi":"10.12968/hmed.2024.0797","DOIUrl":"10.12968/hmed.2024.0797","url":null,"abstract":"<p><p>Heart failure (HF) is a common and malignant condition. Disease-modifying therapies are available, with early diagnosis being crucial as these therapies modify risk within weeks of commencement. A higher proportion of patients are now being diagnosed with HF during a hospital admission, rather than in the community, with an associated poorer prognosis. There is a need to reduce the time spent to diagnosis and treatment in the community. Advances in the diagnostic tools deployed in HF diagnostics, in particular the use of artificial intelligence, hold promise to deliver this.</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":"143490679","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":"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":"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":"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":"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}