Postgraduate Medical Journal最新文献

Background: Cardiovascular disease (CVD) is the leading global cause of mortality and imposes substantial health and economic burdens. However, the overall relationship between combined lifestyle factors and CVD incidence among Chinese adults remains poorly defined. This study aimed to explore the association between healthy lifestyle factors and CVD risk in a nationwide Chinese cohort.

Methods: We included 7349 participants from 2011-2012 and followed them until 2018. Lifestyle was assessed using seven factors (blood pressure, blood glucose, cholesterol, body mass index (BMI), tobacco exposure, physical activity, and sleep duration), and participants were categorized into three groups based on the number of ideal factors. Cox regression models were used to analyze data.

Results: Participants with intermediate and unfavorable lifestyles had 29.74% and 59.71% higher CVD risks, respectively, compared to those with favorable lifestyles. Former smokers, individuals with elevated blood glucose, higher BMI, and inadequate sleep duration also had increased CVD risks. Subgroup and sensitivity analyses showed consistent trends.

Conclusion: This nationwide cohort study highlights that healthy lifestyle practices are significantly associated with reduced CVD risk. Promoting healthy behaviors through public health strategies is crucial to mitigating CVD risk. Key messages What is already known on this topic: Modifiable lifestyle factors are established drivers of CVD, but composite lifestyle scores lacked nationally representative evidence in China's aging population before this study. What does this study add: Unhealthy lifestyles, including factors such as blood pressure, glucose levels, and BMI, significantly increased the risks of CVD and stroke in Chinese adults. Conditions like obesity, hyperglycemia, and poor sleep independently elevated these risks across all subgroups. How this study might affect research, practice, or policy: This study advocates multifactorial lifestyle interventions into public health policies, targeting high-risk populations, and prioritizing research on the scalability of these interventions.

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.

Background: Sarcopenia is an age-related progressive disease characterized by loss of muscle mass accompanied with low muscle strength and/or physical performance. The aim of the present study was to investigate the relationship between green tea intake and sarcopenia in a Chinese population of community-dwelling older adults.

Methods: A cross-sectional retrospective study with 2553 participants aged ≥65 years was performed. Appendicular skeletal muscle mass index (ASMI), grip strength, and gait speed were measured to assess sarcopenia. A quantitative questionnaire was used to obtain information of green tea consumption.

Results: Sarcopenia group had lower proportion of green tea consumers when compared to the non-sarcopenia group (21.6% vs. 28.1%, P = .001). Multivariate logistic regression analysis showed that green tea intake was associated with decreased risk of sarcopenia (OR = 0.695, 95% CI = 0.547-0.882, P = .003). Subgroup analysis demonstrated that the association of green tea intake with sarcopenia was significant in individuals who drank a small amount (<125 g/month) and weak tea. Moreover, green tea consumers had higher ASMI and faster gait speed than non-green tea consumers.

Conclusions: Our results suggest that green tea intake is associated with decreased risk of sarcopenia in a Chinese population of older adults, especially for those who prefer weak tea. Key messages What is already known on this topic: Although in vitro and in vivo studies have shown the protective effects of polyphenols on aging-related muscle loss and muscle dysfunction; however, the relationship between green tea consumption and the risk of sarcopenia remains unclear. What this study adds: Our findings demonstrate that green tea consumers had higher appendicular skeletal muscle mass index and faster gait speed than non-green tea consumers. Moreover, green tea consumption is associated with lower risk of sarcopenia in the older adults, especially for those who prefer weak tea. How this study might affect research, practice or policy: Our results suggest that drinking proper amount of green tea might be a health-promoting lifestyle for the prevention of sarcopenia in the older adults.

Purpose: The main objective of this study was to investigate the causal association between genetic susceptibility of lifestyle, psychosocial factors, socioeconomic status, and various spinal disorders by using bidirectional Mendelian randomization (MR).

Materials and methods: We used a bidirectional MR analysis to explore the association between 28 lifestyle, psychosocial factors, socioeconomic status, and a wide range of spinal disorders. We primarily adopted the inverse variance weighting method as the main effect estimate and used additional methods to evaluate the reliability of the results.

Results: Genetically predicted smoking and alcohol intake increased the risks of cervical spondylosis and intervertebral disc degenerative disease (IVDD). Longer education was associated with reduced risks of cervical spondylosis, IVDD, spinal stenosis, and spondylolisthesis/spondylolysis. Time spent watching TV increased the risks of cervical spondylosis, IVDD, and spinal stenosis. Sleeplessness elevated the risks of spinal stenosis and IVDD. Higher Townsend deprivation index was linked to cervical spondylosis and spondylolisthesis/spondylolysis, while neuroticism and higher household income increased IVDD risk. Depression was associated with cervical spondylosis. Sensitivity and reverse MR analyses supported robust and unidirectional causal relationships.

Conclusion: The results of the study emphasize the importance of addressing certain modifiable risk factors to reduce the burden of spinal diseases and improve the health status of the population. Key messages What is already known on this topic: Several retrospective and epidemiological studies have demonstrated associations between certain lifestyle, psychiatric, socioeconomic factors, and the risk of developing spinal disorders. However, there are no studies that have verified a positive causal relationship between these associations. What this study adds: This study employed a rigorous Mendelian randomization strategy to confirm and quantify the causal effects of known risk factors, thereby confirming the directionality of causality. How this study might affect research, practice, or policy: This study provides a scientific foundation for developing precise prevention strategies and public health policies targeting modifiable risk factors.

Background: Albumin-to-neutrophil-lymphocyte ratio (ANLR) is a novel composite biomarker integrating nutritional and inflammatory status. However, its prognostic value for mortality in the general population remains unclear. This study aimed to evaluate the predictive utility of ANLR for all-cause and cardiovascular mortality.

Methods: This study included 36 628 adults from the National Health and Nutrition Examination Survey 2003-2018. Mortality details were ascertained from the National Death Index. The relationship between ANLR and all-cause and cardiovascular mortality was verified using restricted cubic spline (RCS), weighted Cox proportional hazards model, subgroup analysis and time-dependent receiver operating characteristic curve (ROC).

Results: RCS analysis revealed an L-shaped ANLR-mortality relationship with an inflection point at 2.19. Below this threshold, each 0.1-unit ANLR increase was associated with 5.0% lower all-cause mortality (HR 0.95, 95% CI 0.94-0.96) and 6.0% lower cardiovascular mortality (HR 0.94, 95% CI 0.92-0.96). Participants were stratified into higher (> 1.23) and lower (≤ 1.23) ANLR groups. Weighted Cox proportional hazards models demonstrated that individuals with higher ANLR had a significantly reduced risk of all-cause (HR 0.57, 95% CI 0.53-0.62) and cardiovascular mortality (HR 0.55, 95% CI 0.47-0.65). Results were consistent across subgroups. Time-dependent ROC analysis confirmed moderate predictive ability over 1-7 years, with area under the curve values of 0.667-0.708 for all-cause and 0.690-0.703 for cardiovascular mortality.

Conclusion: Elevated ANLR is associated with reduced mortality risk, though non-linearly. Clinical attention to albumin supplementation and maintaining appropriate neutrophil-to-lymphocyte ratio levels may be warranted in high-risk populations.

Background: While triage systems focus on clinical acuity, patients at risk due to underlying vulnerabilities may be overlooked. Identifying specific vulnerability markers at triage could enhance early risk stratification. This study investigates the association between predefined vulnerability markers and adverse outcomes in emergency department patients, independently of triage level and presenting complaint.

Methods: Prospective study of an all-comer population presenting to the emergency department of a tertiary care hospital. The patients were attributed to one or more vulnerable groups at triage.

Results: Among the 4191 included patients, several vulnerability markers were associated with adverse outcomes after adjustment for age and sex. Patients with cognitive impairment had significantly higher odds of 30-day mortality [odds ratio (OR) 2.24; 95% confidence interval (CI), 1.08-4.32]. Intensive care unit admission was more likely in patients with immunosuppression (OR 4.13; 95% CI, 2.14-7.40), substance use disorder (OR 1.82; 95% CI, 1.03-3.02), and diabetes (OR 1.73; 95% CI, 1.07-2.71). Hospital admission was associated with cognitive impairment, immunosuppression, substance use disorder, diabetes, recent surgical intervention, and psychiatric comorbidities. In contrast, no significant associations with adverse outcomes were found for those with medical devices, acutely intoxicated patients, pregnancy, migrant status, or patients with recent trauma.

Conclusions: Certain vulnerability markers identifiable at triage are associated with specific adverse outcomes. These findings highlight the potential of pragmatic, early vulnerability assessment to improve risk stratification in the emergency department.

Background: As traditional lipid-lowering drugs, the role of statins in reducing the incidence of cholelithiasis remains controversial. The aim of this study is to utilize the single nucleotide polymorphisms (SNPs) related to the target of statins, HMGCR, to simulate the effect of statins and explore the causal relationship between statins and cholelithiasis.

Methods: Drug-targeted Mendelian randomization (MR) was first applied to study the causal relationship between the application of statins and the risk of cholelithiasis. Subsequently, we explored the causal relationship between other lipid-lowering drugs such as ezetimibe and PCSK9 inhibitors and the incidence of cholelithiasis. Thereafter two-sample MR analyses were conducted to examine the associations of lipids with the risk of cholelithiasis.

Results: The Low-Density Lipoprotein Cholesterol (LDL-C)-reducing SNPs near the HMGCR gene (rs10066707, rs12916, rs2006760, rs5909, and rs2303152), which mimic the effects of statins, were associated with a decreased risk of cholelithiasis (OR 0.445, 95% CI 0.339-0.585, P < 0.001). However, other lipid-lowering drugs such as ezetimibe and PCSK9 inhibitors, when reducing the same level of LDL-C, cannot reduce the incidence of cholelithiasis. Moreover, multivariable MR analyses showed that neither LDL-C nor High-Density Lipoprotein Cholesterol (HDL-C) had a significant impact on cholelithiasis risk.

Conclusion: These facts shows that statins are associated with a decreased risk of cholelithiasis, and this association is unlikely to be mediated by lipid-lowering effects. Further clinical trials and basic experimental validation is needed to validate their relationship and underlying mechanisms.

Cardiology remains one of the most competitive medical specialties in the UK. This article provides practical guidance for aspiring cardiologists preparing for Higher Specialty Training applications. It outlines strategies to maximize portfolio scores, prepare effectively for interviews and adapt to recent changes in the scoring framework. The guidance also simultaneously supports the development of core skills essential for a successful career in cardiology.