Orthostatic hypotension (OH) is a frequently undiagnosed condition, particularly affecting older adults and individuals with autonomic dysfunction. This comprehensive review offers a unique synthesis of current evidence on the aetiology, prevalence, diagnosis, and management of OH, integrating perspectives from neurology, cardiology, and geriatric medicine. It critically appraises the current limitations within clinical guidelines, highlighting the lack of standardised diagnostic protocols and the inadequate recognition of delayed OH and postural hypertension. Particular focus is given to the older population, proposing individualised diagnostic and therapeutic strategies to address their specific clinical vulnerabilities. By adopting a multidisciplinary, patient-centred framework, the review addresses the complexity of diagnosing and managing OH, emphasising both underutilised non-pharmacological interventions and the careful use of pharmacological therapies. It also calls for the urgent revision of national guidelines, including those by the National Institute for Health and Care Excellence, to align with contemporary evidence and improve clinical decision-making. Future research directions are proposed, particularly regarding symptomatic versus asymptomatic OH, the development of refined diagnostic tools, and the long-term impact of symptom control.
To explore the factors influencing sleep disorders in patients with polycystic ovary syndrome (PCOS) after ketogenic diet intervention and establish a predictive model.
Data of 220 PCOS patients undergoing ketogenic diet intervention at Beijing Shijitan Hospital, Capital Medical University, from January 2021 to December 2023 were retrospectively collected. Patients were randomly divided into the modelling group (132 patients) and the validation group (88 patients) in a 3:2 ratio. The modelling group was further divided into the sleep disorder group (56 patients) and the non-sleep disorder group (76 patients). Univariate and binary logistic regression analyses were conducted to determine the influencing factors of sleep disorders after administering a ketogenic diet intervention in patients with PCOS. The predictive model was constructed using SPSS, and analyses of receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA) were performed in the R language to evaluate the clinical practicality of the model.
In the modelling group, anxiety (odds ratio [OR] = 1.768, 95% confidence interval [CI]: 1.284–2.434, p < 0.001), depression (OR = 1.494, 95% CI: 1.193–1.872, p < 0.001), blood sugar status (impaired fasting glucose/tolerance) (OR = 5.278, 95% CI: 1.533–18.177, p = 0.008) and low-density lipoprotein cholesterol (LDL-c; OR = 1.619, 95% CI: 1.201–2.181, p = 0.002) were significant factors affecting sleep disorders. The prediction model incorporates these factors (X1–X4), and the model expression is Logit(P) = βConstant + (β1X1) + (β2X2) + (β3X3) + (β4X4). The calibration curve showed good agreement between predicted risks and actual risks. ROC analysis showed that the area under the curve was 0.9328 (95% CI: 0.892–0.954) for the modelling group and 0.8431 (95% CI: 0.777–0.899) for the validation group, both indicating that the model has high accuracy. DCA curves showed that the model has significant positive net benefits and good clinical utility.
Anxiety, depression, blood sugar status and LDL-c are key factors influencing sleep disorders in patients with PCOS after ketogenic diet intervention. A prediction model featuring high accuracy and remarkable clinical utility was successfully established.
Acute pesticide poisoning frequently results in secondary acute myocardial injury. Identifying predictive biomarkers, such as albumin-corrected anion gap (ACAG), is crucial for early intervention. This study aimed to explore the predictive value of ACAG for secondary acute myocardial injury in patients with acute pesticide poisoning.
A retrospective analysis was conducted on 205 patients with acute pesticide poisoning admitted between March 2017 and December 2024. Patients were classified into a myocardial injury group (n = 81) and a non-myocardial injury group (n = 124) based on the presence of secondary acute myocardial injury. Univariate and binary logistic regression analyses were employed to identify factors influencing secondary acute myocardial injury. Pearson or Spearman correlation analysis was used to analyze the correlation between variables, and receiver operating characteristic (ROC) curves were used to evaluate the predictive value of ACAG.
No statistically significant differences were observed between the two groups in terms of age, gender, body mass index (BMI), pesticide type, admission time, hemoglobin (Hb), white blood cell (WBC) count, platelet count (PLT), renal insufficiency, or admission heart rate (p > 0.05). The myocardial injury group had significantly higher anion gap (AG) and ACAG values, incidence of respiratory failure, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, and number of severe poisoning cases compared to the non-myocardial injury group (p < 0.05). Albumin levels were significantly lower in the myocardial injury group (p < 0.05). Correlation analysis revealed that ACAG was negatively correlated with albumin (r = –0.528, p < 0.05) and positively correlated with AG and APACHE II scores (r = 0.974, 0.365, p < 0.05). Respiratory failure was negatively correlated with albumin (r = –0.160, p < 0.05) and positively correlated with APACHE II scores (r = 0.206, p < 0.05). Severe poisoning showed a negative correlation with albumin (r = –0.217, p < 0.05) and positive correlations with ACAG and AG (r = 0.230, 0.199, p < 0.05). Binary logistic regression analysis showed that ACAG (odds ratio (OR) = 1.586, p < 0.001), respiratory failure (OR = 4.432, p = 0.001), APACHE II score (OR = 1.242, p < 0.001), and severe poisoning (OR = 3.472, p = 0.008) were significant influencing factors for secondary acute myocardial injury in patients with acute pesticide poisoning. ROC analysis results showed that ACAG had an area under the curve (AUC) of 0.859 (95% confidence interval [CI]: 0.809–0.909, p < 0.001), with a standard error of 0.025, a Youden index of 0.55, sensitivity of 59.26%, and specificity of 95.97%. Patients with ACAG ≤24.54 had significantly higher survival probability and better post-treatment cardiac function indicators than those with ACAG >24.54 (p < 0.05).
ACAG has strong predictive value for secondary acute myocardial injury in patients with acute pesticide poisoning. It is recommended that ACAG be routinely assessed upon admission in these patients.
Diabetes-related foot disease represents a growing burden on healthcare services. Peripheral arterial disease (PAD) is a contributing factor in over half of the cases, with treatment of severe PAD through revascularisation being crucial for limb salvage. The Society for Vascular Surgery Wound, Ischaemia, foot Infection (WIfI) classification system enhances diagnosis by providing a framework for identifying high-risk individuals needing intervention. Decision-making regarding which strategy of revascularisation (angioplasty or surgical bypass) is most suitable in these patients is complex, with decisions being primarily guided by the anatomical pattern of the disease, patient fitness, and availability of autologous vein. This review aims to provide a summary of the assessment and management of patients with diabetes-related foot disease and PAD, discussing the factors that influence patient selection for revascularisation. In general, short-segment disease is best treated by an endovascular-first approach, while long-segment occlusions are better managed with open surgery. Ultimately, individuals should be assessed and managed in conjunction with a multi-disciplinary team as part of a holistic management strategy.
Sepsis remains a challenging condition with high short-term mortality despite advances in intensive care, emphasizing the significance of early prognostic assessment in guiding treatment decisions. Inflammatory and nutritional-immune indices are well-established predictors of clinical outcomes in critically ill patients. This study aims to evaluate the prognostic significance of the systemic immune-inflammation index (SII) and the Naples Prognostic Score (NPS) in predicting 28-day survival outcomes among individuals diagnosed with sepsis. The study also aims to construct and assess a visual predictive tool—specifically, a nomogram—that incorporates both of these biomarkers.
This retrospective study analyzed clinical data recorded from patients with sepsis who were treated in the intensive care unit (ICU) of The People’s Hospital of Cangnan between January 2021 and December 2023. Applying pre-determined inclusion-exclusion criteria, 324 cases were ultimately included in the final analysis. Comprehensive baseline data, including clinical features and laboratory findings, were systematically retrieved from the electronic health record system. Mortality-associated markers were identified within 28 days using univariate analyses followed by multivariable logistic regression, with SII included as a continuous variable and NPS as a categorical variable. The predictive performance of SII and NPS, both individual and in combination, was assessed using receiver operating characteristic (ROC) curve. A predictive nomogram was developed, and the accuracy and clinical utility of the model were then evaluated using calibration plots and decision curve analysis (DCA).
The analysis revealed that higher SII values (p < 0.001) and NPS scores (≥2, p < 0.001) were closely associated with increased 28-day mortality. Multivariate logistic regression analysis identified SII (p < 0.001) and NPS (≥2, p < 0.001) as independent risk predictors. A predictive model was developed by combining both SII and NPS, demonstrating a superior area under the ROC curve [area under the curve (AUC): 0.846] compared to models utilizing either indicator alone. Furthermore, the nomogram that incorporated these two parameters exhibited high consistency between predicted probabilities and actual outcomes, while also demonstrating strong net clinical benefit in DCA.
SII and NPS are robust and independent predictors of short-term mortality in sepsis. The nomogram developed from these indicators offers a practical, data-driven approach to individualized risk prediction. This study highlights the clinical utility of integrating inflammatory and nutritional-immune indices in prognostic evaluation.
Hypoxemia and respiratory failure are common among critically ill patients, and high-flow nasal cannula (HFNC) therapy has been increasingly utilized as a non-invasive respiratory support modality. However, a subset of patients eventually requires mechanical ventilation (MV), and predicting this transition remains challenging. This study aimed to develop and validate nomograms that predict the risk of MV among patients undergoing HFNC therapy.
A retrospective cohort study was conducted using the publicly available Multiparameter Intelligent Monitoring in Intensive Care IV version 2.0 (MIMIC-IV v2.0) database to identify adult intensive care unit (ICU) patients who received HFNC oxygen therapy for 24 hours or longer. Patients who had undergone MV before HFNC initiation were excluded. Key clinical variables, including demographic data and illness severity scores, were extracted. A multivariable logistic regression model was employed to identify independent predictors of subsequent MV, and a nomogram was constructed based on these predictors. The cohort was randomly divided into training (70%) and validation (30%) sets. Model performance was evaluated using the area under the curve (AUC), calibration plots, the Hosmer–Lemeshow goodness-of-fit test, and decision curve analysis (DCA).
Among 4069 patients included in the final analysis, 1332 (32.7%) transitioned from HFNC to MV. Multivariable analysis identified body weight, Sepsis-3 status, urine output score, the ratio of the partial pressure of oxygen in arterial blood (PaO2) to the fraction of inspired oxygen (PaO2/FiO2 ratio), Pulmonary Score, Glasgow Coma Scale (GCS), and creatinine as independent predictors of MV. The constructed nomogram demonstrated AUC values of 0.659 in the training cohort and 0.656 in the validation cohort. Calibration curves and Hosmer–Lemeshow tests indicated good model calibration, while DCA confirmed its clinical utility within low-to-moderate risk thresholds (≤0.4).
We developed and validated a nomogram to predict the likelihood of MV requirement in patients receiving HFNC therapy. The nomogram may serve as a practical clinical tool to assist physicians in determining whether to continue HFNC therapy or initiate MV in clinically ill patients.
Prevalent societal narratives, terminology, and imagery regarding body weight, obesity, diet, and physical activity reinforce weight stigma, and lead to adverse health and social consequences for individuals throughout their lifespan and body weight continuum. This study analyzed hotspots, frontiers, collaboration mapping, themes, and emerging topics in research on non-stigmatizing language in obesity and weight management (RnSLO).
A bibliometric analysis was performed using VOSviewer and Bibliometrix, with data extracted from the Scopus database. The study examined 480 documents (1953–2024) using co-citation analysis, co-occurrence network mapping, and thematic evolution analysis. H-, G-, and M-index metrics were used to assess research impact, while thematic clustering and keyword analysis identified key focus areas. Descriptive statistical analysis was applied to assess publication trends, regional contributions, and institutional collaborations.
Research output and citation peaks indicate a growing academic focus on RnSLO. North America, particularly the United States and Canada, led contributions, followed by Europe, Asia, and Oceania. Key institutions, including Harvard Medical School and Johns Hopkins University, were at the forefront of this research. Collaborative networks and international co-authorships were crucial in advancing the field. Finally, major research themes included obesity management, health communication, and diabetes care, highlighting the domain’s interdisciplinary nature.
This study provides the first comprehensive bibliometric analysis of RnSLO research, revealing key trends, influential institutions, and collaborative networks. It highlights the growing shift toward inclusive health communication, emphasizing the need for policy interventions to promote non-stigmatizing language in healthcare settings. These insights can inform future clinical practices, public health strategies, and policymaking, thereby ensuring more equitable and patient-centered obesity management.
Heart failure with preserved ejection fraction (HFpEF) poses therapeutic challenges, especially among the elderly. Dapagliflozin, a sodium-glucose cotransporter 2 inhibitor, has potential benefits beyond glucose regulation, including possible cardioprotective effects. This study evaluates the efficacy and safety of dapagliflozin in patients over 75 years old with HFpEF.
This retrospective cohort study included 215 patients over 75 years old with HFpEF, divided into a standard treatment group (known as routine group, n = 105) and a dapagliflozin plus standard treatment group (known as dapagliflozin group, n = 110). Key assessments included Kansas City Cardiomyopathy Questionnaire (KCCQ) scores, Six-Minute Walk Test (6MWT), echocardiographic parameters, adverse events, and biochemical markers such as N-terminal pro-B-type natriuretic peptide (NT-proBNP) and B-type natriuretic peptide (BNP), alongside patients’ satisfaction with the treatment administered.
The dapagliflozin group showed significant improvements in KCCQ Overall Summary Score (72.48 ± 12.49 vs 68.59 ± 13.11, p = 0.027) and 6MWT distance (358.47 ± 28.62 m vs 311.69 ± 30.26 m, p < 0.001) compared to the routine group. NT-proBNP and BNP levels showed significantly greater reductions in the dapagliflozin group (p = 0.046 and p = 0.039, respectively). Echocardiographic parameters indicated favorable cardiac remodeling. Incidence of adverse events was similar between groups, with no increase in serious renal or metabolic events in the dapagliflozin group. Dapagliflozin significantly improves patients’ satisfaction in elderly patients with HFpEF (p = 0.041).
Dapagliflozin administration in HFpEF patients over 75 years significantly enhances cardiac function and exercise capacity, as well as improves quality of life markers, without notable safety concerns.
Non-small cell lung cancer (NSCLC) accounts for approximately 80–85% of all lung cancers, and lymph node metastasis is a key determinant of patient prognosis, often leading to poorer clinical outcomes. Although immune checkpoint inhibitors (ICIs) have transformed the therapeutic landscape of advanced NSCLC, their specific efficacy in patients with lymph node metastases remains unclear. This study aimed to evaluate the efficacy and safety of ICI monotherapy versus chemotherapy in previously treated, unresectable NSCLC patients with lymph node metastasis.
A retrospective analysis was performed on patients with unresectable, previously treated NSCLC with lymph node metastasis who received treatment at Xi’an International Medical Center Hospital between April 2019 and October 2022. Following 1:1 propensity score matching (PSM), 112 patients were included in the final analysis, comprising 56 in the ICI group (treated with pembrolizumab) and 56 in the chemotherapy group (treated with docetaxel). The primary endpoint was objective response rate (ORR), while secondary endpoints included disease control rate (DCR), overall survival (OS), and safety.
The ICI group demonstrated a significantly higher ORR compared with the chemotherapy group (50.0% vs. 26.8%, p = 0.012). No significant difference in DCR was observed between the groups (p = 0.057). Kaplan-Meier analysis revealed significantly longer OS in the ICI group (p = 0.009). Multivariate analysis indicated a high risk of death in the chemotherapy group compared to the ICI group (hazard ratio [HR] = 1.796; 95% confidence interval [CI]: 1.112–2.900; p = 0.017). In terms of safety, leukopenia occurred more frequently in the chemotherapy group (p = 0.039), while immune-related adverse events (irAEs), including hypothyroidism (p = 0.027) and rash (p = 0.008), were more common in the ICI group.
In previously treated patients with unresectable NSCLC and lymph node metastasis, real-world evidence from this study suggests that pembrolizumab monotherapy offers superior efficacy and survival benefits compared with docetaxel chemotherapy. Moreover, the two therapies display distinct safety profiles, with ICI therapy associated with fewer severe hematologic toxicities.
This study explores the attitudes and barriers faced by UK orthopaedic trainees regarding less than full time (LTFT) training. LTFT training has become more accessible since 2022, yet surgical trainees have been slower to adopt it compared to other specialties.
A cross-sectional, questionnaire-based study was carried out via a 16-item online questionnaire which was distributed to aspiring orthopaedic surgeons registering for an orthopaedic themed teaching programme.
216 respondents met the inclusion criteria. The study found that 42% of respondents would consider LTFT training, with higher interest among female trainees. Key barriers identified included extended training duration, financial concerns, potential decline in surgical skills, and negative perceptions from colleagues.
The research highlights the need for clearer guidance, better support, and a cultural shift within orthopaedic departments to address these barriers. Initiating education and awareness programmes for senior staff and providing comprehensive information to trainees are essential steps to fostering a more inclusive and supportive environment for LTFT training in orthopaedic surgery.
Young and middle-aged patients undergoing maintenance hemodialysis (MHD) experience significant physical impairment and psychological stress, resulting in reduced levels of subjective well-being. Therefore, this study aimed to assess the subjective well-being of this population and to identify its influencing factors, thereby informing the clinical development of targeted nursing strategies.
Clinical data were collected from 220 young and middle-aged MHD patients at the Blood Purification Center of the Second Affiliated Hospital, Zhejiang University School of Medicine between April 2024 and April 2025. General demographic and clinical characteristics, along with scores from relevant assessment scales, were collected. The factors influencing subjective well-being were analyzed in this patient cohort.
The mean General Well-Being (GWB) scale score among these patients was 62.44 ± 3.12. Statistically significant differences were observed across education level, per capita monthly family income, self-care ability, self-management ability, symptom distress, financial burden to the family, and social support (p < 0.05). Multiple linear regression analysis indicated that education, per capita monthly family income, self-care ability, self-management ability, symptom distress, financial burden on the family, and social support were significant predictors of subjective well-being among young and middle-aged MHD patients (p < 0.05).
The subjective well-being of young and middle-aged MHD patients remains at a moderate level and is influenced by factors such as education level, per capita monthly family income, self-care ability, self-management ability, symptom distress, financial burden on the family, and social support. Nursing care interventions should be designed and implemented based on these factors to improve the overall well-being of this patient group.
Gastrointestinal duplication cysts are rare congenital anomalies that are often discovered incidentally. Although asymptomatic cases may not require immediate intervention, optimal management remains controversial, particularly due to concerns regarding malignant potential. This report aims to highlight the diagnostic role of contrast-enhanced endoscopic ultrasound (CE-EUS) and discuss management strategies for asymptomatic gastrointestinal duplication cysts.
A 54-year-old woman was found to have an asymptomatic subepithelial lesion during a routine oesophagogastroduodenoscopy (OGD). Further evaluation with endoscopic ultrasound (EUS) demonstrated a characteristic “gut signature sign”. Subsequent contrast-enhanced EUS revealed enhancement limited to the cyst wall, supporting the diagnosis of a duplication cyst. The patient remained asymptomatic throughout the evaluation period.
Over two years of follow-up, serial EUS examinations demonstrated no significant changes in the size or characteristics of the lesion. No clinical symptoms developed, and no features suggestive of malignant transformation were identified.
This case illustrates the utility of CE-EUS as a safe and effective diagnostic alternative to EUS-guided fine needle biopsy for gastrointestinal duplication cysts. The findings support a conservative management approach with careful EUS surveillance for asymptomatic lesions, reserving surgical intervention for symptomatic cases. A tailored strategy based on clinical presentation and lesion characteristics may optimize patient outcomes.
Severe hypocalcemia (SH) is a common and serious complication after parathyroidectomy (PTX) in patients with secondary hyperparathyroidism (SHPT). However, accurately predicting high-risk patients remains challenging. This study aimed to develop and validate a linear predictive model to identify these patients preoperatively.
From January 2013 to May 2025, 755 total parathyroidectomy (TPTX) or TPTX with autotransplantation (TPTX-AT) were performed by a single surgical team at the 960th Hospital of the PLA Joint Logistics Support Force. After applying inclusion and exclusion criteria, 685 patients were enrolled and randomly divided (7:3) into training and validation cohorts. Variables associated with serum calcium levels on the first postoperative day (POD1 Ca) were identified through linear regression analysis in the training cohort. Model validity was assessed using ten-fold and leave-one-out cross-validation. Bland-Altman plots and paired t-tests evaluated agreement within groups. Model performance in the validation cohort was measured using bias, precision, and accuracy metrics.
Significant predictors of POD1 Ca included TPTX-AT (β [95% confidence interval (CI)]: –0.055 [–0.119, –0.001]), parathyroid hormone (PTH) (–0.078 [–0.115, –0.041], ng/mL), C-terminal cross-linked telopeptide of type I collagen (CTX) (–0.147 [–0.198, –0.096], μg/L), preoperative serum calcium (0.626 [0.516, 0.736], mmol/L), and alkaline phosphatase (ALP) (–0.018 [–0.024, –0.012], μkat/L). Bland-Altman analysis showed good agreement in the validation cohort (bias <0.001, 95% limits of agreement [LoA]: –0.507, 0.566).
The nomogram provides an accurate, individualized prediction of postoperative hypocalcemia risk after parathyroidectomy, supporting tailored clinical management of SHPT patients.
This review presents an outline of the state of the knowledge on the prevention and diagnosis of cervical cancers over the last decade. Screening and prevention methods are considered, such as cervical self-sampling, Human Papillomavirus (HPV) vaccination and the use of digital technologies and artificial intelligence (AI) in diagnostics and screening, as are some success stories. However, despite the successes stemming from the UK and Europe–such as that no new cases of cervical cancer have been detected in a cohort of Scottish women vaccinated against HPV between 12–13 years old–cervical screening rates are falling and social, cultural and economic barriers to HPV vaccination uptake remain. There are several clear pathways that could reduce not only incidence rates of cervical cancer, but also non-cervical HPV related cancers such as oropharyngeal and anal cancers.
Chronic heart failure (HF) is a complex clinical syndrome and a major cause of morbidity and mortality, which affects more than 64 million people worldwide. HF is associated with decreased life expectancy and is characterised by increased hospitalisations, which increase in frequency and severity as the disease progresses. Patients with advanced HF experience a poorer health status and quality of life. Advanced HF increases the risk of premature death (80% of patients die within 5 years), as well as increasing symptoms, psychosocial and spiritual burden. The trajectory of the disease is unpredictable and person-specific, influenced by a multitude of factors including age of diagnosis, ethnicity, gender, comorbidity and socioeconomic status. In advanced HF, symptom management, psychosocial support and assistance with advanced care planning are important aspects of delivering holistic care. Dyspnoea, fatigue, pain, depression, anxiety, insomnia and worsening cognitive function are frequently seen in these patients. The symptoms experienced by the patient can be caused by the HF itself, comorbidities and treatment side effects, which all require careful consideration. While many aspects of palliative care are universal, HF patients have unique needs, challenges, and opportunities. Palliative care is much less likely to be offered to patients with HF than to those with other diagnoses. In this article, we explore the rationale for improving patient access and the key opportunities and challenges for delivering high-quality palliative care in this group.
Obliterative bronchiolitis (OB) is a chronic, progressively obstructive lung disease characterized by fixed airflow limitation and a high burden of malnutrition. At present, whether a personalized regimen combining nutritional support with respiratory training could improve obliterative bronchiolitis patient outcomes remains unclear. Thus, this study aimed to explore the clinical efficacy of a comprehensive intervention combining nutritional support with respiratory training in OB patients, with a particular focus on assessing their pulmonary function.
A retrospective analysis was conducted on 101 patients with OB who received treatment in The Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital) from January 2022 to March 2025. According to the type of intervention, the subjects were divided into the experimental group (56 cases, receiving comprehensive intervention) and the control group (45 cases, receiving nutritional support only). Propensity score matching was used to balance the baseline data at a 1:1 ratio, and 44 pairs of patients were successfully matched. Pre- and post-intervention data on pulmonary function indicators, nutritional indicators, oxidative stress and inflammatory indicators, as well as quality of life and symptom indicators of the included patients, were compared. Multiple linear regression analysis was performed to determine the independent factors affecting the changes in pulmonary function indicators before and after the intervention.
Regarding the nutritional status, the experimental group exhibited significant post-intervention improvement only in the Nutritional Risk Screening 2002 (NRS-2002) score when compared with the pre-intervention score (p < 0.05). After the intervention, the forced expiratory volume in the first second (FEV1; p = 0.002) and forced vital capacity (FVC; p < 0.001) in the experimental group were significantly higher than those in the control group, while the malondialdehyde (p < 0.001), C-reactive protein (p = 0.005) and procalcitonin (p < 0.001) in the experimental group were significantly lower than those in the control group. The number of patients with modified British Medical Research Council (mMRC) dyspnea scale score <2 in the experimental group was significantly higher than that in the control group (p = 0.006), and the improvements in 6-minute walk distance (6MWD) and World Health Organization Quality of Life-Brief (WHOQOL-BREF) version scores were greater in the experimental group than in the control group. In addition, multiple linear regression analysis showed that compared with nutritional support alone, the comprehensive intervention was independently associated with greater improvements in FEV1 (p = 0.002) and FVC (p = 0.001) but had no independent effect on improvements of FEV1/FVC (p = 0.556).
Comprehensive intervention combining nutritional support with respiratory training effectively improves the pulmonary function, oxidative stress, inflammatory status, quality of life, and respiratory symptoms in OB patients, with outcomes superior to those achieved with nutritional support alone.
Idiopathic pulmonary fibrosis (IPF) is the prototypical fibrosing interstitial lung disease, characterised by its unrelenting progressive course and poor prognosis. The incidence of IPF is rising and is becoming a major public health concern. Debilitating dyspnoea and respiratory failure results. Death occurs on average 3–5 years from the time of diagnosis. Clearer understanding of the pathobiology of the condition continues to advance and although we may now better understand disease mechanisms, our therapeutic approach remains limited. In the UK, only two treatments are licensed for IPF, and both can only slow the process down. An ideal silver bullet would halt and ideally reverse established fibrosis. New therapies are showing promise; however, lung transplant remains the only treatment that can substantially increase both duration and quality of life. Here we will provide a comprehensive overview of IPF to summarise definitions, epidemiology, mechanisms, diagnostics, and management.
Psychiatric disorders are often accompanied by complex comorbidities. Even non-psychiatric medical professionals are increasingly encountering patients with mental disorders during routine clinical practice. This study assessed post-training mental health knowledge and additional training needs across grassroots medical workers who had recently undergone systematic training, aiming to provide empirical evidence for building the capacity of mental health professionals.
This study surveyed 503 medical staff from various levels and types of medical institutions in Tongxiang city, China, who had undergone systematic mental health training. Data regarding baseline characteristics and mental health-related knowledge were obtained 1–2 days after training completion using two questionnaire types: the “Questionnaire on Medical Staff’s Awareness of Mental Health Issues” and the “Questionnaire on Training Needs of Medical Staff”. The Kruskal-Wallis (K-W) test was used to compare the demand for psychiatric services and total psychiatric knowledge scores among primary care medical staff with different job positions, specialties, professional titles, and years of service.
The mean mental health knowledge score among 503 grassroots medical workers was 53.22 ± 17.44 out of the total 70 points. Regarding mental health service training content, over 80% of the respondents reported knowledge and skills items as “urgently needed” or “needed”, with some items exceeding 90%. Short-term training workshops were the preferred delivery approach, with centralized on-site lectures or distance education as the favored formats. High demand was reported for theoretical knowledge sessions, simulated case-based discussions, simulation exercises, and internship practice; the preferred training duration was half a working day per session. The leading motivations for participating in training were job requirements, personal professional development needs, and skill enhancement, whereas the main barriers to participating in training were workload or scheduling conflicts. Multiple factors were found to affect training effectiveness, including training time, format, and content. Significant differences were observed in the proportion of mental health service needs regarding primary job positions, specialties, professional titles, and years of service (p < 0.05). Total mental health knowledge scores also varied by primary job position, years of service, and prior participation in mental health work (p < 0.05).
Grassroots medical workers demonstrated a foundational level of mental health knowledge following recent systematic training, with significant inter-individual variation. Demand for mental health service training was generally high, with job requirements and personal capacity enhancement as the primary drivers, while time constraints and insufficient course practicality of the modules were the main barriers. It is recommended to develop and implement corresponding strategies to address these challenges and enhance grassroots medical workers’ mastery of mental health knowledge.
Sedation plays a crucial role in gastrointestinal endoscopy, balancing patient comfort and procedural safety. With the increasing complexity of gastrointestinal endoscopic procedures, comes the inherent risk of sedation-related complications. This review, based on the 2024 British Society of Gastroenterology (BSG) guidelines, outlines updated strategies to address the increasingly diverse clinical needs. This review article focuses on case studies to highlight key recommendations for different patient groups. Case analyses highlight unique sedation considerations for patients with comorbidities such as obstructive sleep apnoea (OSA), cardiac dysrhythmia, and chronic kidney disease, emphasizing the need for thorough pre-procedural assessment and individualized sedation plans. Special considerations for the choice of sedation in pregnant and breastfeeding patients are explored. In emergency endoscopies, particularly for upper gastrointestinal bleeding, close collaboration with anaesthetics is essential to determine sedation choice, airway management, and the ceiling of care. The review also examines the need for deep sedation in complex or combined procedures such as endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP), advocating for resource investment to support safe and effective sedation practices.
Multiple myeloma is a haematological malignancy of plasma cells, typically characterised by a monoclonal immunoglobulin protein detectable in the blood. Myeloma requires treatment when it affects specific end-organs, including lytic bone disease. The accurate detection of bone disease is therefore crucial in the diagnosis and management of myeloma, and advanced imaging with whole-body magnetic resonance imaging or positron emission tomography is now recommended as the standard of care. For patients with non-secretory myeloma and those with extramedullary disease, imaging is the only way to monitor response to treatment and to detect relapse. Whilst there are challenges in delivering advanced imaging modalities to patients with myeloma, the clinical and financial advantages mean that improving access should be a priority. This review discusses the importance of advanced imaging in the management of myeloma across its disease course, and outlines current barriers and potential future directions in this rapidly evolving field.
Myocarditis, an inflammatory condition of the myocardium, can present with a spectrum of clinical manifestations, ranging from mild symptoms to cardiogenic shock or death. While endomyocardial biopsy (EMB) remains the gold standard for diagnosis, its invasive nature and limited sensitivity have shifted focus toward non-invasive imaging, particularly cardiovascular magnetic resonance (CMR) imaging. CMR has emerged as a cornerstone in diagnosing myocarditis, offering high sensitivity and specificity through advanced tissue characterisation and functional assessment. Key CMR techniques include T1 and T2 mapping, which allow quantitative evaluation of myocardial injury, oedema, and fibrosis, alongside late gadolinium enhancement (LGE), which identifies predominantly necrosis and scar tissue. The revised 2018 Lake Louise Criteria have further standardised the diagnostic approach with integration of mapping for enhanced accuracy. However, emerging technologies, such as radiomics with machine learning techniques, show promise in improving diagnostic precision, risk stratification, and prognostication. This review explores the pathophysiology, clinical manifestations, and underlying causes of myocarditis, with a particular emphasis on the role of imaging modalities. It highlights the central importance of CMR in the diagnosis and management of myocarditis, while also underscoring the need for ongoing innovation and advancements to enhance patient outcomes.
The optimal regimens of third-line treatments for advanced gastric cancer have yet to be identified. This study aimed to evaluate the therapeutic efficacy of different third-line treatment regimens and to identify prognostic factors affecting patient outcomes following third-line therapy. Additionally, it sought to evaluate treatment-related adverse events and economic costs associated with different regimens, thereby providing a theoretical basis to guide the selection of third-line treatment regimens.
In this real-world retrospective study, data were collected from patients diagnosed with advanced gastric cancer who fulfilled predetermined inclusion criteria. Survival outcomes between different groups were compared using Kaplan–Meier survival curves and the log-rank test. Cox proportional hazards regression analysis was employed to identify prognostic factors of patients with advanced gastric cancer after receiving third-line treatment.
A total of 145 patients were included and divided into three groups: 45 patients in the chemotherapy-alone group, 58 patients in the immunotherapy/targeted therapy group, and 42 patients in the chemotherapy + immunotherapy/targeted therapy group. Survival analysis revealed a median survival time (MST) of 7.7 months (95% confidence interval [CI]: 6.8–8.5) for the overall cohort, while the chemotherapy + immunotherapy/targeted therapy group demonstrated the longest MST (MST: 10.5 months; 95% CI: 8.9–12.1), followed by the immunotherapy/targeted therapy group (MST: 8.5 months; 95% CI: 7.1–9.9). Regression analysis showed that a history of gastric surgery was an independent prognostic factor (hazard ratio [HR] = 0.639; 95% CI: 0.431–0.948; p = 0.026) for gastric cancer patients following third-line treatment. Regarding adverse events, the chemotherapy + immunotherapy/targeted therapy group exhibited the highest incidence (90.5%), followed by the chemotherapy-alone group (75.6%). Cost analysis showed that the chemotherapy + immunotherapy/targeted therapy group incurred the highest overall cost, and both total treatment costs and anti-tumor drug-related costs were positively correlated with patient survival (r2 = 0.2656 and 0.3081, respectively).
Patients receiving third-line chemotherapy combined with immune or targeted therapy achieve the longest MST; however, this regimen is also associated with a higher incidence of adverse events and overall treatment costs.
Acute kidney injury (AKI) affects up to 20% of hospitalised patients and is associated with significant morbidity, mortality, and healthcare burden. Despite national guidelines, variability in recognition and management persists. This review bridges the UK Kidney Association (UKKA) AKI Summit recommendations with real-world National Health Service (NHS) clinical practice, summarising 24 key recommendations into core principles and translating them into practical guidance for clinicians across emergency, ward-based, critical care, and geriatric settings. Emphasis is placed on early identification, fluid and medication management, escalation to specialist teams, and discharge planning. We highlight implementation tools, including e-alert systems, care bundles, and standardised referral pathways. Finally, the article discusses barriers to consistent AKI care and proposes system-wide strategies to support education, coordination, and long-term follow-up. This practical review offers a setting-specific roadmap to improve patient outcomes and promote consistent, proactive care across the AKI continuum.
The integration of electronic consent (e-consent) into anaesthetic practice has accelerated since the Coronavirus Disease 2019 (COVID-19) pandemic, offering new opportunities to enhance patient autonomy, documentation fidelity, and clinical efficiency. This review examines the clinical, legal, and ethical dimensions of e-consent, situating it within the statutory and common law frameworks, such as the Mental Capacity Act 2005 and the principles established in Montgomery v Lanarkshire Health Board. It further interrogates the challenges posed by digital exclusion, cybersecurity vulnerabilities, and the environmental implications of transitioning to digital platforms. The emerging role of artificial intelligence in tailoring and strengthening consent processes is explored, while highlighting the imperative to preserve ethical integrity and legal validity.