Postgraduate Medical Journal最新文献

Patients with chronic coronary syndromes deserve high attention and tailored management for the effective reduction of the residual cardiovascular risk. Long-term secondary prevention strategies are the key to reaching this goal and mitigating the overall cardiovascular burden. Four pillars should be the cornerstones of the management of patients with chronic coronary syndromes: lifestyle interventions, cardiac rehabilitation, risk factor control and achievement of treatment targets, and guideline-directed medical therapy. These interventions should be personalized to achieve prevention and treatment goals in order to improve prognosis and health-related quality of life. Herein, we present a state-of-the-art review on the comprehensive cardiovascular risk assessment and secondary prevention among patients with chronic coronary syndromes. In addition, we provide practical guidance for the management of this patient population in complex clinical scenarios and specific groups, including those with heart failure, older adults, sex-specific considerations, high bleeding risk, atrial fibrillation, and chronic kidney disease.

Physicians rely on clinical judgment and patients look for it. However, clinical judgment is infrequently discussed in the literature, and is often perceived as an intuitive art, that is likely to be replaced by technology and artificial intelligence. This review offers a reconceptualization of the role of clinical judgment in current medical practice and research, informed by the extensive knowledge that has accumulated in psychosomatic medicine. Clinical judgment consists of three phases: collecting clinical information; interpretation and clinical reasoning; decision making. Interviewing is the primary method for gathering data. Clinical reasoning involves bringing together relevant information and formulating hypotheses, which result in decisions and therapeutic acts. Clinimetrics, the science of clinical measurements, facilitates physician's reasoning and organization of data. Improving the features of clinical judgment is likely to yield a highly effective precision medicine.

Background: Parkinson's disease (PD) is regarded as the second most common neurodegenerative disease. Accumulating evidence suggested an emerging effect of the dysregulation of the gut-brain axis in the neurodegenerative disease pathogenesis, mediated particularly by microbiota-derived metabolites in PD. The aryl hydrocarbon receptor (AHR) is of great importance in regulating central nervous system inflammation by sensing microbiota-derived metabolites.

Strategy: AHR is a transcription factor activated by ligands, which can be activated locally or remotely by endogenous microbial metabolites. AHR signaling suppressed inflammation by activating anti-inflammatory and immunosuppressive responses, promoting intestinal host-microbiome homeostasis. The pathogenesis of PD is related to the activation of microglia and the occurrence of neuroinflammation. There is increasing attention that alterations in the intestinal flora and decreased AHR activity were closely associated with PD.

Conclusion: The AHR-gut microbiota axis garnered increasing attention in PD research. In this review, we synthesize current clinical and preclinical evidence linking the AHR-gut microbiota axis to PD pathogenesis, and we highlight that pharmacological targeting of this pathway represents an emerging therapeutic strategy for PD.

Background: With global population aging, the decline in intrinsic capacity-crucial for health and independence of older adults-has become a major concern.

Objective: With global population aging, the decline in intrinsic capacity-crucial for health and independence of older adults-has become a major concern. To evaluate the effects of community-based Tai Chi on intrinsic capacity in elderly populations.

Methods: A meta-analysis of 26 randomized controlled trials (RCTs) including 3275 participants aged ≥60 years was conducted. Intervention durations ranged from 6 to 72 weeks. Outcomes assessed included activities of daily living, cognitive function, motor function, and depressive symptoms. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated.

Results: Tai Chi interventions significantly improved activities of daily living (SMD = 1.11), cognitive function (SMD = 0.44), motor function (SMD = -0.50), and depressive symptoms (SMD = -0.79). The intervention was consistently effective across various program lengths and settings.

Conclusion: Community-based Tai Chi is a low-cost, low-risk intervention that enhances intrinsic capacity, particularly motor, cognitive, and psychological domains, in older adults. It should be considered in managing age-related decline. Further large-scale, long-term RCTs are warranted to confirm these findings and clarify underlying mechanisms. Key message What is already known on this topic: Decline in intrinsic capacity threatens independence and well-being in older adults. Tai Chi has been reported to improve balance, cognition, and mood, but evidence on its overall effect across multiple domains of intrinsic capacity has been inconsistent. What this study adds: This meta-analysis of 26 RCTs demonstrates that community-based Tai Chi significantly improves activities of daily living, cognitive function, motor function, and depressive symptoms in elderly populations. How this study might affect research, practice or policy: Findings support the integration of Tai Chi into community-based aging programs as a safe, low-cost strategy to preserve intrinsic capacity. Future large-scale, long-term studies could refine protocols and inform public health policy on healthy aging.

Treatment of Graves' disease (GD) is complex and controversial. Conventional therapy of GD includes antithyroid drugs (ATDs), surgery, and radio-iodine therapy (RIT) and each has limitations. ATDs are associated with high rates of relapse and side effects. Definitive therapies result in permanent hypothyroidism and increased risk of Graves' ophthalmopathy. With advancements in the understanding of precise autoimmune mechanisms causing GD, novel therapies targeting immune pathways are in the pipeline of development. Newer drugs switch off a part of the immune system that is causing the disease, leaving the rest of the immune system still functioning. Though newer drugs seem to be efficacious, they may elicit higher incidence of infection and other side effects. Other concerns with newer drugs are that they may not be able to cure the disease, do not achieve adequate effectiveness in all patients, and may not achieve remission in all patients. Therefore, additional newer drugs will be needed in future.

Opioid-induced constipation (OIC), a prevalent form of opioid-induced bowel dysfunction, significantly affects patients with chronic pain, both with and without cancer, who rely on opioid analgesics. OIC reduces opioid effectiveness, impairs quality of life and is frequently underdiagnosed and inadequately managed. A comprehensive literature search of MEDLINE and EMBASE (2000-April 2025) was conducted using terms such as opioid-induced constipation, epidemiology, pathophysiology, treatment, and guidelines. Relevant studies, meta-analyses, and consensus statements were analysed to synthesize mechanistic insights and practical recommendations. This review clarifies OIC's pathophysiology, clinical evaluation, and evidence-based management strategies to guide practicing clinicians. OIC arises from opioids binding to mu-opioid receptors in the gastrointestinal tract, leading to slowed intestinal motility, reduced mucosal secretions, and increased sphincter tone, which collectively cause constipation and related symptoms. Clinicians should proactively educate patients about OIC risks at the start of opioid therapy or during dose escalation. Initial management includes prescribing over-the-counter laxatives, such as stimulant or osmotic agents, tailored to patient needs and tolerances. Regular follow-up, utilizing validated tools like the Bowel Function Index, is crucial to monitor symptom severity and adjust therapies as needed. If initial treatments fail, peripherally acting mu-opioid receptor antagonists are effective second-line options, yet they remain underutilized due to access barriers and low clinician awareness. Unlike prior reviews that primarily address pharmacologic mechanisms, this review integrates mechanistic insights with pragmatic clinical guidance, emphasizing evidence-based implementation strategies and global prescribing disparities to enhance real-world management of OIC.