Postgraduate Medical Journal[JOURNAL]
Sun
200 papers
Genetic causality of circulating inflammatory proteins and plasma metabolites in coronary atherosclerosis.
Chen R, Shen D, Wu S … +2 more , Zhang Y, Ye S
Postgrad Med J · 2026 Feb · PMID 40920991 · Publisher ↗
BACKGROUND: Coronary atherosclerosis is a leading cause of cardiovascular disease and death worldwide. Despite progress in understanding its pathogenesis, the roles of circulating inflammatory proteins and plasma metabol...
BACKGROUND: Coronary atherosclerosis is a leading cause of cardiovascular disease and death worldwide. Despite progress in understanding its pathogenesis, the roles of circulating inflammatory proteins and plasma metabolites are complex and not fully elucidated. Existing Mendelian randomization (MR) studies often target isolated biomarkers, lacking comprehensive and mechanistic insights. This study uses MR to clarify the genetic causal relationships between circulating inflammatory proteins, plasma metabolites, and coronary atherosclerosis, and to explore potential mediation pathways. METHODS: Two-sample MR identified causal associations, while mediation analysis assessed whether plasma metabolites mediate the effects of inflammatory proteins on coronary atherosclerosis. Sensitivity analyses included Cochrane's Q test and MR-Egger intercept. RESULTS: Our analysis identified 11 circulating inflammatory proteins and 102 plasma metabolites associated with coronary atherosclerosis. Additionally, the genetic variants associated with elevated levels of eukaryotic translation initiation factor 4E-binding protein 1 (OR = 1.0590, 95% CI: 1.0050-1.1170) were found to increase the risk of coronary atherosclerosis through modulation of octadecanedioate and octadecanedioylcarnitine (C18-DC) levels, while leukemia inhibitory factor receptor (OR = 0.9400, 95% CI: 0.8890-0.9930)-associated variants reduced its risk through modulation of campesterol levels. Mediation analyses revealed that octadecanedioate levels (Mediated pro-portion = 18.5%), C18-DC levels (Mediated proportion = 21.6%) and campesterol levels (Mediated proportion = 26.7%) mediated these effects. CONCLUSIONS: This study provides new insights into the genetic and metabolic mechanisms underlying coronary atherosclerosis, extending beyond traditional biomarkers. The findings highlight potential therapeutic targets of coronary atherosclerosis and related metabolic disorders. Key messages What is already known on this topic: Coronary atherosclerosis, a leading cause of cardiovascular disease, has been linked to inflammatory proteins and plasma metabolites. However, the complexity of these relationships, particularly the genetic and metabolic mechanisms underlying the disease, remains poorly understood. Existing studies have largely focused on individual biomarkers and their associations with atherosclerosis, lacking comprehensive assessments and insights into potential mediation pathways. What this study adds: This study utilizes Mendelian randomization to identify genetic causal relationships between 11 circulating inflammatory proteins and 102 plasma metabolites with coronary atherosclerosis. It provides novel insights into the mediation roles of metabolites like octadecanedioate, C18-DC, and campesterol in the disease's progression. How this study might affect research, practice, or policy: By uncovering genetic and metabolic pathways involved in coronary atherosclerosis, this study lays the groundwork for future therapeutic interventions targeting these pathways. It highlights potential biomarkers and novel therapeutic targets, offering a new perspective on prevention and treatment strategies for coronary atherosclerosis and related metabolic disorders.
A retrospective study on Mohs micrographic surgery combined with adjuvant radiotherapy in the treatment of extramammary Paget's disease: analysis of 87 patients.
Zhang M, Gao X, Gao T … +4 more , Li H, Sheng X, Su M, Jia C
Postgrad Med J · 2026 Feb · PMID 40914962 · Publisher ↗
PURPOSE: This retrospective study assessed the effectiveness of Mohs micrographic surgery (MMS) combined with adjuvant radiotherapy for the treatment of extramammary Paget's disease (EMPD). METHODS: This retrospective st...
PURPOSE: This retrospective study assessed the effectiveness of Mohs micrographic surgery (MMS) combined with adjuvant radiotherapy for the treatment of extramammary Paget's disease (EMPD). METHODS: This retrospective study included 87 patients with pathologically confirmed EMPD and complete follow-up data who were treated at the Radiation Therapy Department of Peking University First Hospital between January 2012 and December 2021. The surgical approach for the primary lesion involved MMS, followed by postoperative radiotherapy with doses ranging from 50 to 60 Gy administered over 25-30 fractions. Lymph node dissection was performed on selected patients exhibiting clinical lymphatic metastasis. The primary endpoint of this study was the disease-specific survival (DSS) rate, while secondary endpoints included local recurrence-free survival (LRFS). Survival rates were calculated using the Kaplan-Meier method and statistically analyzed using the log-rank test. RESULTS: The study population comprised 78 men and 9 women. The median age was 65 years (range: 44-84). The median follow-up period was 71 months (range: 5-139). The 1-, 3-, 5-, and 10-year DSS rates were 99%, 95%, 92%, and 92%, respectively. The LRFS rates at 1, 3, 5, and 10 years were 100%, 100%, 97%, and 94%, respectively. The LNM rates at 1, 3, 5, and 10 years were 1.1%, 2.3%, 5.7%, and 5.7%, respectively. The DM rates at 1, 3, 5, and 10 years were 1.1%, 5.7%, 8.0%, and 9.2%, respectively. CONCLUSION: The combination of MMS and adjuvant radiotherapy offers excellent local control in the treatment of extramammary Paget's disease. Key messages What is already known on this topic: Surgical excision is the established primary treatment for extramammary Paget's Disease (EMPD). However, the role of adjuvant radiotherapy in improving outcomes was not definitively established. What this study adds: This study provides robust evidence that adjuvant radiotherapy combined with surgical excision significantly improves local disease control rates in EMPD compared to surgery alone. How this study might affect practice: These findings strongly support the integration of adjuvant radiotherapy into the standard management paradigm for EMPD, particularly for cases with risk factors for local recurrence.
Imaging surveillance after breast cancer: is it time for risk-stratification?
Bansal GJ, Agarwal H
Postgrad Med J · 2025 Sep · PMID 40905256 · Publisher ↗
Abstract loading — click title to view on PubMed.
Foundation allocation for underserved areas.
Hussain W, Alexander K, Isles C
Postgrad Med J · 2025 Sep · PMID 40905215 · Publisher ↗
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A new non-invasive detector for coronary microvascular dysfunction: exercise stress high-frequency QRS electrocardiogram.
Pan J, Liu M, Li D … +8 more , Wang S, Wang Z, Hua J, Kong X, Chen H, Ma Y, Hu H, Ma L
Postgrad Med J · 2026 Jan · PMID 40899985 · Publisher ↗
BACKGROUND: This study aimed to evaluate the diagnostic value of the exercise stress high-frequency QRS (HFQRS) electrocardiogram in coronary microvascular dysfunction. METHODS: We consecutively enrolled patients aged 20...
BACKGROUND: This study aimed to evaluate the diagnostic value of the exercise stress high-frequency QRS (HFQRS) electrocardiogram in coronary microvascular dysfunction. METHODS: We consecutively enrolled patients aged 20 years or older with chest pain between January 2022 and January 2024, all of them underwent HFQRS analysis and coronary angiography. The sensitivity, specificity, and positive predictive value of HFQRS for predicting coronary microcirculatory dysfunction were calculated using coronary angiography-based microvascular resistance (caIMR) ≥25.1 as the gold standard for determining coronary microcirculatory dysfunction. We used the area under the ROC curve (AUC) to evaluate the predictive accuracy of HFQRS and the diagnostic value of exercise HFQRS for coronary microvascular dysfunction (CMVD). RESULTS: A total of 139 patients were included. We found a moderate correlation between the caIMR values and the number of positive HFQRS leads. (R = 0.757, P < .001). Multifactorial logistic regression analysis showed that the number of positive leads on the HFQRS was an independent predictor of caIMR (9.17, CI 1.02-82.73, P = .048). The area under the ROC curve for the prediction of caIMR by the number of positive HFQRS leads was 0.81 (95% CI 0.73-0.89). The sensitivity, specificity, negative predictive value, and positive predictive value of HFQRS for the prediction of coronary microcirculatory dysfunction were 0.686, 0.971, 0.986, and 0.500, respectively. CONCLUSIONS: Our study found that exercise HFQRS is an important predictor of coronary microvascular disease, that there is a correlation between the number of positive exercise HFQRS leads and CMVD, and that exercise stress HFQRS is a noninvasive and reliable indicator for the diagnosis of CMVD.
Path to parenthood for medical residents and fellows: the impact of leave policies on parent trainees at Oregon Health and Science University.
Lenne E, Soller M, Lashen G … +4 more , Dukhovny S, Reimer A, Klawetter S, Carter E
Postgrad Med J · 2026 Jan · PMID 40891735 · Full text
BACKGROUND: Residents and fellows in graduate medical education (GME) programs across the USA often complete training during childbearing years, presenting challenges for pregnant and parenting trainees balancing work an...
BACKGROUND: Residents and fellows in graduate medical education (GME) programs across the USA often complete training during childbearing years, presenting challenges for pregnant and parenting trainees balancing work and family. Institutional policies must better support these trainees. Previous studies show supported trainees experience reduced burnout, better health, and improved patient outcomes. OBJECTIVE: This study assessed the experiences and unmet needs of pregnant and parenting GME trainees and presents their recommendations for improved support. METHODS: Using a sequential explanatory mixed-methods design, we examined the unmet needs and challenges of pregnant and parenting trainees, and their recommendations for improvement. We distributed a survey to all GME trainees across all specialties at Oregon Health and Science University (OHSU) in 2023. Ninety-eight out of 160 eligible participants completed the survey (~60% response rate). RESULTS: Despite existing policies, trainees at Oregon Health and Science University faced persistent challenges. We identified three themes and related recommendations from our analysis of quantitative and open-ended survey data: (1) Leave and coverage-barriers to adequate parental leave and inconsistent enforcement of GME policies; [2] Lactation-meeting breast/chest-feeding goals required immense effort due to limited resources; and [3] Health and childcare-existing policies negatively impacted fertility, childcare access, and mental health. Respondents recommended standardized, flexible leave policies; transparent processes for work adjustments and planning; improved access to private, well-equipped lactation spaces; and tailored mental health and wellness programs to support the perinatal period. CONCLUSIONS: Barriers persist for trainees starting families. Institutional leaders have actionable opportunities to improve equity and institutional support of parenting trainees. Key messages What is already known on this topic: GME trainees face significant challenges during childbearing years, including inconsistent parental leave policies, limited institutional support, and increased risk of stress and burnout, which negatively impact their health and patient-care outcomes. What this study adds: This study contributes trainees' recommendations for institutional reforms necessary to address persistent gaps in support for parenting trainees, such as insufficient parental leave, inadequate lactation accommodations, and barriers to mental health care. How this study might affect research, practice, or policy: Incorporating trainee perspectives is crucial to developing effective interventions. Institutions and national standards should prioritize equitable parental leave, flexible scheduling, and comprehensive supports to foster a culture that aligns with trainees' personal and professional goals. Research Questions How do Accreditation Council for Graduate Medical Education requirements and institutional policies reinforce or mitigate structural inequities that impact parent medical trainees? What systemic barriers and supports shape access to perinatal health and mental health resources for parent medical trainees? How might medical trainees' perspectives influence the development and implementation of Accreditation Council for Graduate Medical Education requirements and institutional policies that better support medical trainees ability to balance professional training and family responsibilities?
Machine learning models based on adipocyte fatty acid-binding protein help predict the chronic and lethal outcomes of patients with drug-induced liver injury.
Fu H, Song S, Zhao H … +9 more , Du B, Chen Y, Xiao Y, Zang X, Lai R, Mo R, Huang Y, Zhou T, Xie Q
Postgrad Med J · 2026 Jan · PMID 40888815 · Publisher ↗
PURPOSE: Some patients with drug-induced liver injury (DILI) would progress into chronicity or lethal. Although adipocyte fatty acid-binding protein (AFABP) is essential in liver diseases, its role in DILI is unknown. We...
PURPOSE: Some patients with drug-induced liver injury (DILI) would progress into chronicity or lethal. Although adipocyte fatty acid-binding protein (AFABP) is essential in liver diseases, its role in DILI is unknown. We aimed to investigate their association and construct predictive models for chronic/lethal DILI using machine learning. METHODS: DILI patients (n = 331) were enrolled and categorized into recovery (n = 213), chronicity (n = 89), or death/liver transplantation (LT) group (n = 29) based on 6-month follow-up. ELISA and immunohistochemistry were used to determine serum and hepatic AFABP levels, respectively. Patients were randomly divided into training (70%) and validation (30%) cohorts. Machine learning models were constructed for chronic and death/LT outcomes based on serum AFABP. Furthermore, the performance of previous models and constructed models were evaluated for predicting death/LT outcome. RESULTS: The AFABP level was associated with the progression of DILI patients, whatever in serum or liver. The Extreme Gradient Boosting model presented the best predictive performance for chronic DILI, with the AUROC of 0.87 (95%CI = 0.82-0.91) in training cohort and AUROC of 0.90 (95%CI = 0.82-0.95) in validation cohort. The logistic regression model presented the best predictive performance for death/LT outcome, with the AUROC of 0.90 (95%CI = 0.85-0.94) in training cohort and AUROC of 0.92 (95%CI = 0.83-0.96) in validation cohort. Furthermore, it showed better predictive performance for death/LT outcome than previous models. CONCLUSION: Serum AFABP level was associated with DILI progression, and machine learning models based on AFABP accurately predicted DILI outcomes, potentially assisting clinical management. Key messages What is already known on this topic: The chronic and lethal drug-induced liver injury (DILI) harms human health. Although adipocyte fatty acid-binding protein (AFABP) is essential in liver diseases, its role in DILI is unknown. We aimed to investigate their association and construct predictive models for chronic/lethal DILI using machine learning. What this study adds: The AFABP was associated with the progression of DILI patients, whatever in serum or liver. The Extreme Gradient Boosting model presented the best predictive performance for chronic DILI. The logistic regression model presented the best predictive performance for lethal DILI. Furthermore, it showed better predictive performance for lethal DILI than previous models. How this study might affect research, practice, or policy: We demonstrated that serum AFABP level was associated with the progression of DILI, and constructed accurate machine learning models to predict DILI outcomes based on serum AFABP, which could assist the clinical management of DILI patients.
Unveiling the role of cathepsins in depression: a Mendelian randomization study.
Zhuo G, Chen W, Xu F … +6 more , Zhu X, Zhang J, Su M, Fu Y, Chen X, Wu L
Postgrad Med J · 2026 Feb · PMID 40887099 · Publisher ↗
OBJECTIVE: Depression is a prevalent psychological disorder involving complex pathogenesis mechanisms. Cathepsins may play a significant role in the pathogenesis of depression, yet the exact impact of cathepsins on the r...
OBJECTIVE: Depression is a prevalent psychological disorder involving complex pathogenesis mechanisms. Cathepsins may play a significant role in the pathogenesis of depression, yet the exact impact of cathepsins on the risk of developing depression remains unclear. The objective of this research was to examine the cause-and-effect link between cathepsins and the susceptibility to depression through the application of Mendelian randomization (MR) techniques. METHODS: Univariate MR, bidirectional MR, and multivariable MR were employed to study this causal relationship. Additionally, horizontal pleiotropy, heterogeneity, and sensitivity assessments were performed on the results obtained from MR. RESULTS: The univariate MR analysis indicated that elevated levels of cathepsin S increase the risk of depression. Conversely, the reverse MR analysis showed no causal relationship between depression, serving as an exposure dataset, and nine types of cathepsins. The multivariable MR analysis, based on nine types of cathepsins, revealed that increased expression levels of cathepsin S and F are associated with an increased risk of depression. CONCLUSION: A positive causal relationship has been identified between cathepsin S and cathepsin F and the risk of depression. Consequently, individuals exhibiting elevated levels of cathepsin S and F should be vigilant regarding their mental health to mitigate the potential risk of developing depression in the future. Key message What is already known on this topic Depression is a prevalent psychological disorder involving complex pathogenesis mechanisms. Cathepsins may play a significant role in the pathogenesis of depression, yet the exact impact of cathepsins on the risk of developing depression remains unclear. What this study adds This study presents the inaugural univariate and multivariate Mendelian randomization analysis examining the association between cathepsins and depression, identifying a positive causal relationship between cathepsins S and F and the risk of developing depression. How this study might affect research, practice, or policy Individuals exhibiting elevated levels of cathepsin S and F should prioritize monitoring their mental health to mitigate the potential risk of developing depression in the future.
Mind of artificial intelligence and machine-a fact or fiction?
Dubey S, Chatterjee S, Ghosh R … +2 more , Sengupta S, Dubey MJ
Postgrad Med J · 2025 Aug · PMID 40886116 · Publisher ↗
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Clinical and pathological features of 209 cases of pilomatricoma in children: a retrospective study.
Guo Z, Wang H, Wan P … +3 more , He H, Chen Z, Deng D
Postgrad Med J · 2025 Dec · PMID 40886114 · Publisher ↗
BACKGROUND: Pilomatricoma, albeit benign, may have a potential impact on children's appearance and health. Clinical practice has revealed variations in the clinical manifestations, anatomical locations, and sizes of pilo...
BACKGROUND: Pilomatricoma, albeit benign, may have a potential impact on children's appearance and health. Clinical practice has revealed variations in the clinical manifestations, anatomical locations, and sizes of pilomatricoma among different pediatric patients. However, few studies have comprehensively summarized the correlations between these features and treatment efficacy, which is crucial for enhancing clinicians' understanding and diagnostic accuracy of the disease. OBJECTIVES: This study aimed to comprehensively analyze the clinical characteristics, ultrasonographic and pathological features, and treatment outcomes of pilomatricoma in Chinese pediatric patients at a single pediatric dermatology surgery center. METHODS: A retrospective study was conducted on the medical histories of 209 Chinese children who underwent surgical excision with subsequent pathological confirmation of pilomatricoma at Shanghai Children's Medical Center between January 2023 and January 2024. We carried out a multidimensional analysis integrating clinical, ultrasonographic, and histopathological features. RESULTS: Pilomatricoma exhibits distinct clinical, ultrasonographic, and pathological characteristics in children. Key findings included: (i) Female predominance in limb/trunk involvement (34.5% vs 17.3% in males, P ≤ .01); (ii) Head/neck localization decreasing with age; (iii) Characteristic ultrasonographic patterns (88.2% calcification detection rate); (iv) No recurrence following complete excision. CONCLUSIONS: Our findings demonstrate distinct gender-based anatomical distribution patterns and excellent surgical outcomes for pediatric pilomatricoma. The integration of high-frequency ultrasonography with clinical evaluation significantly enhances diagnostic accuracy, potentially reducing unnecessary interventions in this population. These findings provide critical references for clinicians regarding disease characteristics and diagnostic optimization. Key messages What is already known: Pilomatricoma is a benign hair matrix-derived tumor with diverse clinical presentations, often leading to misdiagnosis. Previous studies have reported its association with Wnt/β-catenin pathway mutations and a predilection for the head/neck region in children, but comprehensive analyses of gender-specific anatomical distribution and diagnostic optimization are lacking. What this study adds: This large pediatric cohort reveals gender differences in anatomical involvement (female predominance in limb/trunk lesions) and demonstrates that high-frequency ultrasonography (88.2% calcification detection) significantly improves preoperative diagnostic accuracy (71.3% vs. historical rates of 16%-43%). How this study might affect research, practice, or policy: The findings advocate for integrating ultrasonography into clinical workflows to reduce misdiagnosis and unnecessary interventions. Gender-specific patterns may prompt research into hormonal influences on tumor pathogenesis. Surgical excision remains definitive, with no recurrence, reinforcing its role as first-line therapy.
The weight of words: teaching junior doctors to reframe harmful labels.
Jerjes W
Postgrad Med J · 2026 Feb · PMID 40886113 · Publisher ↗
Abstract loading — click title to view on PubMed.
Insights into modifiable risk factors of atrial fibrillation: a comprehensive Mendelian randomization study.
Zhang X, Wang X, Zhang W … +2 more , Li M, Li Q
Postgrad Med J · 2026 Jan · PMID 40886111 · Publisher ↗
BACKGROUND: Numerous observational studies suggest that modifiable risk factors contribute to the onset of atrial fibrillation (AF). This study aims to assess the causal relationship between 46 modifiable risk factors an...
BACKGROUND: Numerous observational studies suggest that modifiable risk factors contribute to the onset of atrial fibrillation (AF). This study aims to assess the causal relationship between 46 modifiable risk factors and AF. METHODS: Univariable, multivariate, and mediation Mendelian randomization (MR) analyses were employed to examine the causal relationship between 46 modifiable risk factors and AF. Summary-level data from genome-wide association studies (GWAS) meta-analysis and FinnGen consortium were utilized for both discovery and replication. The combined results were analyzed using a fixed-effect model to confirm the robustness of the findings. RESULTS: Among 46 modifiable risk factors, both the discovery dataset and the combined results confirmed that alcohol consumption, smoke consumption, job involves heavy manual or physical work, sleep apnea syndrome, trunk fat mass, body fat percentage, whole body fat mass, waist circumference, body mass index, basal metabolic rate, poor health status, diastolic blood pressure, systolic blood pressure, glycosylated hemoglobin type A1C (HbA1C), lipoprotein A, serum uric acid, coronary artery disease, myocardial infarction, heart failure, hypertension, hyperthyroidism, and negative emotions increased the risk of AF (P < .05 and false discovery rate-adjusted P < .05). Conversely, college or university degree, impedance of whole body, and heart rate were associated with a decreased risk of AF (P < .05 and false discovery rate-adjusted P < .05). Multivariate MR identified sleep apnea syndrome, basal metabolic rate, diastolic blood pressure, systolic blood pressure, HbA1C, lipoprotein A, serum uric acid, coronary artery disease, myocardial infarction, heart failure, and hypertension as risk factors for AF. CONCLUSION: Our findings offer new and comprehensive evidence demonstrating the confirmed causal effects of various risk factors on AF among Europeans. Larger-scale GWAS will be necessary to further validate these causal associations in the future.Highlights Our study investigated the causal association between 46 modifiable risk factors and AF under a two-sample MR framework. This comprehensive MR study confirmed that alcohol consumption, smoke consumption, job involves heavy manual or physical work, sleep apnea syndrome, trunk fat mass, body fat percentage, whole body fat mass, waist circumference, body mass index, basal metabolic rate, poor health status, diastolic blood pressure, systolic blood pressure, HbA1C, lipoprotein A, serum uric acid, coronary artery disease, myocardial infarction, heart failure, hypertension, hyperthyroidism, negative emotions, college or university degree, impedance of whole body, and heart rate contribute causally to the onset and development of AF. No significant association was found between lipid levels and AF. Key messages What is already known on this topic: Previous studies have identified several risk factors associated with AF, yet the precise causal relationships between these factors and the development of AF remain unclear, highlighting the need for further research. What this study adds: This study systematically evaluates the causal association of 46 modifiable risk factors with AF by combining data from two independent GWAS datasets. How this study might affect research, practice, or policy: The discovery of AF-related risk factors provides valuable knowledge for early identification and intervention strategies for AF patients.
Temperature effect on scrub typhus incidence in South Korea: the projection for climate change.
Seo D, Choi YJ, Hong YC
Postgrad Med J · 2025 Aug · PMID 40878852 · Publisher ↗
OBJECTIVE: The influence of climate change on infectious disease dynamics is a subject of interest, but it demands robust scientific evidence. This study explores the short-term and long-term relationships between meteor...
OBJECTIVE: The influence of climate change on infectious disease dynamics is a subject of interest, but it demands robust scientific evidence. This study explores the short-term and long-term relationships between meteorological factors and the incidence of scrub typhus (ST) in South Korea. METHODS: From 2001 to 2018, data on meteorological conditions and weekly ST cases were sourced from national databases. A generalized additive model was used to visualize the relationship, while a generalized linear model was applied to measure the association's strength. Mean annual temperature change was used as a proxy for climate change in long-term analysis. Despite the small sample size, generalized and mixed-effect models were employed to minimize geographical effects. RESULTS: The number of ST cases was linearly related to the mean temperature 13 weeks prior, above a threshold temperature of 13.3-18.5°C. A 0.1°C increase in mean temperature was associated with a 25% increase in ST cases (OR 1.25, 95% CI: 1.21, 1.29). In line with the short-term trend, the annual incidence of ST increased by 33% (OR 1.33, 95% CI: 1.26, 1.41) for every 0.1°C increase in annual mean temperature compared to the previous 30 years. CONCLUSIONS: Higher mean temperatures during summer were associated with the increased ST cases in the following autumn. Annual mean temperature increases compared to 30 years ago were also associated with higher annual incidence of ST. These findings suggest that global warming has influenced the incidence of ST.
Perceived prevalence, risk factors, and reported management of delirium in critically ill emergency patients: a survey of physicians in China.
Shang W, Zheng K, Du L … +6 more , Zhang H, Yang R, Chen F, Liu W, Yan X, Ma Q
Postgrad Med J · 2025 Dec · PMID 40874709 · Publisher ↗
PURPOSE: To investigate Chinese emergency physicians' perceptions of prevalence, associated risk factors, and reported management practices for delirium in critically ill emergency department (ED) patients. METHODS: A cr...
PURPOSE: To investigate Chinese emergency physicians' perceptions of prevalence, associated risk factors, and reported management practices for delirium in critically ill emergency department (ED) patients. METHODS: A cross-sectional survey of 402 physicians from EDs across 18 Chinese provinces. RESULTS: Physician-estimated delirium prevalence varied widely (median: 15%; interquartile range: 10%-30%), with most perceiving higher incidence during night shifts. Key perceived risk factors included metabolic disorders, pre-existing cognitive impairment, shock, and severe infections. Clinical judgment was the most common assessment method; structured screening tools were reportedly used infrequently. Pharmacological interventions were the preferred management approach for most respondents. CONCLUSIONS: This survey highlights Chinese emergency physicians' varied perceptions of delirium prevalence and reliance on clinical judgment over standardized assessment. Findings suggest a need for enhanced training in standardized screening, greater emphasis on non-pharmacological interventions, and fostering interprofessional collaboration to improve care for ED patients with or at risk of delirium. Key messages What is already known on this topic: Delirium is a serious acute neurocognitive syndrome with high Intensive Care Unit prevalence (31.8%-70%) and significant adverse outcomes. Emergency department delirium remains under recognized despite 6%-38% prevalence in older adults. International guidelines recommend non-pharmacological interventions as first-line management. What this study adds: This survey provides the first assessment of Chinese emergency physicians' delirium perceptions in critically ill patients. Key findings reveal predominant reliance on clinical judgment rather than validated tools and a preference for pharmacological interventions, particularly benzodiazepines, which conflicts with international guidelines. Substantial variation exists in perceived prevalence estimates. How this study might affect research, practice, or policy: Findings inform targeted educational initiatives for Chinese emergency departments, emphasizing the need for standardized screening training and non-pharmacological intervention promotion. Future research should prioritize objective epidemiological studies to validate perceived prevalence rates and evaluate protocol implementation.
Physician's concerns and patient's concerns: never the twain shall meet?
Schattner A
Postgrad Med J · 2025 Aug · PMID 40862341 · Publisher ↗
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Risk factors of severe adverse in-hospital outcomes in adults hospitalized for parainfluenza infections: a territory-wide study.
Kwok WC, To KKW, Leung ISH … +6 more , Wong CK, Ho JCM, Lam DCL, Ip MSM, Ngai SM, Yap DYH
Postgrad Med J · 2026 Jan · PMID 40856417 · Publisher ↗
BACKGROUND: While parainfluenza virus infections are common, there is relatively little data on the impact and risk factors of parainfluenza virus infection on severe in-hospital outcomes. METHODS: This territory-wide re...
BACKGROUND: While parainfluenza virus infections are common, there is relatively little data on the impact and risk factors of parainfluenza virus infection on severe in-hospital outcomes. METHODS: This territory-wide retrospective study elucidated the risk factors for serious in-hospital outcomes among patients hospitalized due to parainfluenza infection. Data were retrieved from the Clinical Data Analysis and Reporting System managed by the Hospital Authority, Hong Kong, from 1 January 2016 to 30 June 2023. The main outcomes of interest were: (i) death during hospitalization; (ii) severe respiratory failure requiring invasive or non-invasive mechanical ventilation; (iii) secondary bacterial pneumonia; (iv) acute kidney injury. RESULTS: 2058 adult patients were hospitalized due to parainfluenza virus infection during the study period. 87 (4.2%) patients died during the index admission, 467 (22.7%) patients developed severe respiratory failure, 1355 (65.8%) patients developed secondary bacterial pneumonia, and 625 (30.3%) patients developed acute kidney injury. Risk factors for severe in-hospital outcomes included underlying cardiopulmonary and kidney diseases (especially those receiving renal replacement therapy) and advanced age. CONCLUSIONS: Important risk factors for severe in-hospital outcomes among patients with parainfluenza infections include underlying age ≥65 years, cardio-pulmonary and kidney diseases. These at-risk patients may benefit from future vaccines and antiviral drugs. Key messages What is already known on this topic: Severe in-hospital outcomes among adult patients with parainfluenza infections are common What this study adds: The risk factors for severe in-hospital outcomes include underlying age ≥ 65 years, cardio-pulmonary, and kidney diseases How this study might affect research, practice, or policy: These at-risk patients may benefit from future vaccines and antiviral drugs.
Health literacy mediates the association of education levels with engagement in leisure-time physical activity and muscle-strengthening exercise: a population-based study of Korea.
Baek SU, Yoon JH
Postgrad Med J · 2026 Jan · PMID 40856399 · Publisher ↗
BACKGROUND: Health literacy is recognized as a major determinant of wellbeing. We examined how health literacy links the association of educational level with participation in leisure-time physical activity (LTPA) and mu...
BACKGROUND: Health literacy is recognized as a major determinant of wellbeing. We examined how health literacy links the association of educational level with participation in leisure-time physical activity (LTPA) and muscle-strengthening exercise (MSE). METHODS: We analyzed a nationwide sample of 5248 adults. Education attainment was grouped into four groups: elementary school, middle school, high school, and college. Health literacy was assessed using the Health Literacy Index for the Community (HLIC). The Global Physical Activity Questionnaire was also employed, with engagement in ≥150 min of moderate-to-vigorous LTPA per week and MSE ≥ twice weekly defined as meeting recommended levels. Counterfactual-based mediation analyses were conducted to estimate the natural indirect effects (NIE), presented as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: Among the participants, 20.5% and 25.2% met the recommended LTPA and MSE levels, respectively. Compared with those with an education attainment of elementary school or below, ORs (95% CI) for the NIE of education level on LTPA, mediated through the HLIC, were 1.06 (1.02-1.09) for middle school, 1.10 (1.04-1.15) for high school, and 1.14 (1.06-1.21) for college or above, accounting for 65.8%, 19.5%, and 16.4% of the total effects, respectively. For MSE, the ORs (95% CI) of the NIE were 1.06 (1.03-1.10) for middle school, 1.12 (1.07-1.17) for high school, and 1.16 (1.10-1.24) for college or above, accounting for 31.8%, 27.1%, and 24.8% of the total effects. CONCLUSION: Health literacy may serve as a key mechanism contributing to disparities in physical activity across different educational levels. Key messages What is already known on this topic: Health literacy has garnered considerable public health interest as a key determinant of health disparities. Although previous studies have reported that health literacy is positively associated with engagement in physical activity, research on its mediating role in the association between educational attainment and leisure-time physical activity (LTPA) and muscle-strengthening exercise (MSE) is scarce in the literature. What this study adds: This study demonstrated that health literacy mediates a meaningful proportion of the link between high educational attainment and engagement in the recommended levels of LTPA or MSE. This suggests that health literacy can be an important factor underlying disparities in physical activity across varying education levels. How this study might affect research, practice, or policy: Our findings suggest that proactive policy interventions are required to enhance health literacy among individuals with low educational levels and to promote physical activity.
Empowering the next generation: integrating artificial intelligence education into medical training.
Tan JA, Ng IKS, Hong A … +2 more , Teo DB, Tan LF
Postgrad Med J · 2026 Jan · PMID 40851220 · Publisher ↗
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Impact of comorbidity patterns on mortality and length of stay in hospitalized patients with atrial fibrillation: a cohort study.
Ng HS, Woodman R, Mangoni AA
Postgrad Med J · 2025 Dec · PMID 40834110 · Publisher ↗
BACKGROUND: Latent Class Analysis (LCA) is an unsupervised clustering and analytical approach to identify subgroups of people with similar characteristics within a heterogenous population. We examined patterns of comorbi...
BACKGROUND: Latent Class Analysis (LCA) is an unsupervised clustering and analytical approach to identify subgroups of people with similar characteristics within a heterogenous population. We examined patterns of comorbidities in people with atrial fibrillation (AF) admitted to hospital using LCA and their relationship with 12-month mortality and length of hospitalisation. METHODS: We conducted a retrospective cohort study using hospital data from Flinders Medical Centre, a major tertiary public hospital in Southern Adelaide (South Australia), covering a period of 10 years (2009-2018). We explored the patterns of comorbidities using LCA and used Cox regression and logistic regression models to examine their association with 12-month mortality and length of hospitalisation. RESULTS: Three phenotypes were identified using LCA in 12 555 AF patients: phenotype 1 (lower comorbidity burden; n = 7689, 61%), phenotype 2 (higher comorbidity burden; n = 4120; 33%), and phenotype 3 (cerebrovascular, hypertensive disease, nervous system and non-specific abnormalities; n = 746, 6%). The hazard of death was significantly higher in phenotype 2 (adjusted hazard ratio (aHR) = 2.25, 95% CI = 2.01-2.50) and phenotype 3 (aHR = 1.69, 95%CI = 1.38-2.08) compared to phenotype 1. The odds of being hospitalized for ≥10 days (vs. <10 days) were significantly higher in phenotype 2 (adjusted odds ratio [aOR] = 8.53, 95%CI = 7.70-9.44) and phenotype 3 (aOR = 4.23, 95%CI = 3.56-5.04) compared to phenotype 1. CONCLUSIONS: In this large cohort study in AF patients, LCA identified three comorbidity phenotypes with distinct associations with 12-month all-cause mortality and length of hospitalisation. Our findings suggest that phenotyping is valuable in identifying high-risk group of patients that may benefit from targeted intervention. Key messages What is already known on this topic? Previous studies have examined the impact of individual comorbidities in people with atrial fibrillation (AF), but there is limited data on how different combinations of comorbidity patterns occur in people with AF and their impact on health outcomes. What this study adds? Latent class analysis identified three comorbidity phenotypes with distinct associations with 12-month all-cause mortality and length of hospitalisation in people with AF. How this study might affect research, practice, or policy? Risk-stratified care management may help improve health outcomes of AF patients.
Potential circadian rhythm-related pathogenic genes in coronary artery disease: a Mendelian randomization study.
Zhang H, Zhao Z, Shi W … +7 more , Niu G, Feng D, Wang M, Zhou Z, Li Z, Zhao J, Wu Y
Postgrad Med J · 2026 Jan · PMID 40833086 · Publisher ↗
PURPOSE: Coronary artery disease (CAD) is a leading cause of cardiovascular morbidity and mortality worldwide. Recent studies suggest disruptions in circadian rhythms may contribute to CAD, but the underlying mechanisms...
PURPOSE: Coronary artery disease (CAD) is a leading cause of cardiovascular morbidity and mortality worldwide. Recent studies suggest disruptions in circadian rhythms may contribute to CAD, but the underlying mechanisms remain unclear. This study employs summary-data-based Mendelian randomization to explore the roles of circadian rhythm genes in CAD and their clinical implications. METHODS: We retrieved circadian rhythm-related genes from the GeneCards database and utilized genome-wide association study summary data for CAD from the IEU database, further validated with FinnGen and UK Biobank datasets. We integrated expression quantitative trait loci (eQTL), methylation quantitative trait loci (mQTL), and protein abundance quantitative trait loci (pQTL) data to assess causal associations with CAD. Colocalization analysis confirmed that the signals originated from the same genetic variants. RESULTS: Our analyses identified 49 mQTLs, 11 eQTLs, and one pQTL causally associated with CAD. Integration of mQTL and eQTL data revealed 13 methylation sites and eight key genes, particularly RASD1 (OR = 0.777, 95% CI: 0.672-0.898) and SREBF1 (OR = 0.893, 95% CI: 0.844-0.946). The DNA methylation level at site cg20122488 was negatively correlated with RASD1 expression, while eQTL data for SREBF1 indicated a regulatory relationship with CAD risk. CONCLUSIONS: This study emphasizes the significant roles of circadian rhythm genes RASD1 and SREBF1 in CAD pathogenesis. Findings suggest therapeutic potential for these genes, warranting further research to validate their functions and inform preventive and treatment strategies. Key messages What is already known Coronary artery disease (CAD) is a leading global cause of cardiovascular mortality, with circadian rhythm disruptions increasingly implicated in its pathogenesis, though causal genetic mechanisms remain unclear. What this study adds This Mendelian randomization study identifies 13 methylation sites and eight key circadian-related genes (e.g. RASD1, SREBF1) with causal links to CAD, revealing specific epigenetic and transcriptional regulatory effects on disease risk. How this study might affect research, practice, or policy The findings highlight circadian rhythm genes as potential therapeutic targets, offering novel insights for CAD prevention strategies and guiding future research into circadian-based interventions.
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