British medical bulletin最新文献

Background: Despite significant advances in tissue engineering and regenerative medicine, articular cartilage repair remains a major clinical challenge. Conventional pharmacological and surgical interventions are largely ineffective in promoting durable tissue regeneration or halting progressive cartilage degradation.

Sources of data: This review integrates evidence from recent peer-reviewed literature focusing on nanotechnology-based drug delivery, stem cell-based therapy, and biomimetic scaffold design for cartilage tissue engineering.

Areas of agreement: There is a broad consensus that current standard treatments fail to restore native cartilage structure and function. The literature supports the view that integrating nanomedicine with tissue engineering strategies can enhance chondrogenic outcomes. In particular, nanocarriers enable targeted and controlled delivery of bioactive molecules, while synthetic extracellular matrix-mimicking scaffolds provide essential structural and biochemical cues for chondrogenesis.

Areas of controversy: Key unresolved issues include identifying the optimal stem cell source, the long-term safety and biodegradability of nanomaterials, and the scalability of engineered constructs for clinical use. The immunogenicity of advanced biomaterials and the regulatory challenges associated with their clinical translation remain subjects of debate.

Growing points: Recent studies demonstrate the feasibility of integrating nanocarriers within three-dimensional biomimetic scaffolds to better replicate the native cartilage microenvironment. Advances in biofabrication techniques and in situ delivery systems are enabling the development of more physiologically relevant and functional cartilage models.

Areas timely for developing research: Future research should prioritize in vivo validation of bio-activated scaffolds, comprehensive assessment of long-term functional outcomes, and strategies to facilitate clinical translation of combined nanocarrier-scaffold platforms. Further investigation into both patient-specific and off-the-shelf regenerative approaches is essential to overcome current translational barriers.

Background: In chronic lateral ankle instability (CLAI) and irreparable anterior talofibular ligament (ATFL), reconstruction procedures are commonly advocated. All-inside arthroscopic capsular plication may be a viable alternative for CLAI in patients with an unrepairable ATFL.

Source of data: A retrospective study was conducted between 2016 and 2021 on 92 consecutive CLAI patients with arthroscopically confirmed unrepairable ATFL who underwent all-inside arthroscopic surgery. Patients were divided into two groups: in the reconstruction group (n = 40), an autologous gracilis tendon was used to reconstruct the lateral ligament complex; in the plication group (n = 52), the lateral ankle capsule was plicated using a double-loaded suture anchor.

Areas of agreement: Restoring lateral ankle stability is the optimal goal in the management of CLAI.

Areas of controversy: The reliability of all-inside arthroscopic capsular plication for CLAI with an irreparable ATFL compared with reconstruction procedures remains uncertain.

Growing points: Over 2 years of follow-up, the plication group achieved superior American Orthopedic Foot and Ankle Society scores at 3 months and 1 year, and higher Karlsson Ankle Functional scores at 1 and 2 years, whereas the reconstruction group demonstrated better anterior talar translation scores; ankle joint position sense was comparable between groups.

Areas timely for developing research: Biomechanical comparisons between the two procedures are urgently needed.

Introduction: Outdoor running gait analysis using wearable sensors requires establishing minimum step requirements for reliable parameter measurement.

Sources of data: Fourteen trained runners completed 10-minute trials at critical speed. RunScribe™ captured kinetic/kinematic data at 500 Hz. Convergence analysis determined minimum steps when cumulative means stabilized within ±2% for ≥10 consecutive steps.

Areas of agreement: Most parameters achieved excellent reliability (ICC > 0.900). Metabolic parameters (V̇O₂: 108 ± 32 steps) and step rate (124 ± 36 steps) converged fastest, while kinematic variables required moderate sampling (stride length: 152 ± 48 steps; contact time: 198 ± 52 steps).

Areas of controversy: Complex biomechanical metrics showed substantial variability: leg stiffness (kleg: 342 ± 78 steps; kvert: 298 ± 71 steps) and gait variability (246 ± 12 steps) required substantially more data, challenging brief field assessment feasibility.

Growing points: This study establishes parameter-specific sampling protocols for outdoor gait analysis, demonstrating that different measurement domains require tailored data collection strategies to optimize ecological validity.

Areas timely for developing research: Future research should examine how speed, terrain, and environmental conditions affect sampling requirements. Adaptive protocols and machine learning approaches offer promising opportunities for optimizing data collection efficiency.

Background: Surgical intervention remains a cornerstone to restore function after acute Achilles tendon rupture (AATR), but evidence-based guidelines for surgical management are limited.

Sources of data: A steering committee of 40 orthopedic surgeons identified nine key clinical questions on the surgical management of AATR. A systematic search of PubMed, MEDLINE, Web of Science, Cochrane Library, and EMBASE was conducted for studies published since 1980.

Areas of agreement: Surgical management represents a reliable option to manage patients who suffered AATR. A well-designed operative strategy is essential to facilitate early recovery and achieve optimal functional outcomes.

Areas of controversy: The surgical management of AATR remains challenging, particularly with respect to defining surgical indications, determining the optimal timing of intervention, selecting the most appropriate patient positioning, choosing between open and minimally invasive techniques, deciding on the role of primary augmentation, and establishing evidence-based postoperative rehabilitation protocols.

Growing points: In the absence of established guidelines for the surgical management of AATR, this evidence-based clinical practice guideline provides nine key recommendations designed to address current controversies in the field.

Areas timely for developing research: Further studies are warranted to evaluate emerging strategies such as nutraceuticals, biomaterials, cellular therapies, bioprinting, gene therapy, and anti-inflammatory agents, as no single approach has yet been validated as the optimal method to accelerate or enhance recovery following AATR.

Introduction: Angiogenesis plays a pivotal role in cutaneous wound healing by restoring vascular supply to regenerating tissues. Mesenchymal stem cell-derived exosomes (MSC-exosomes) are emerging as potent acellular mediators of angiogenesis, thanks to their cargo of bioactive molecules and immunomodulatory effects.

Sources of data: This review synthesizes recent findings from in vivo and in vitro studies, including preclinical models of diabetic wounds, ischemic injuries, and burn healing. It draws upon peer-reviewed articles published in biomedical journals, with a focus on the mechanisms and efficacy of MSC-exosomes.

Areas of agreement: MSC-derived exosomes enhance endothelial cell proliferation, migration, and tube formation. Their ability to activate pro-angiogenic signaling pathways, such as Wnt/β-catenin, AKT/eNOS, and angiopoietin/TIE2, is widely accepted. Additionally, their low immunogenicity, enhanced stability, and potential for bioengineered delivery systems are recognized advantages over other angiogenic therapies.

Areas of controversy: Challenges persist regarding the standardization of exosome isolation, characterization, and large-scale production. Debate also exists about their long-term safety and therapeutic consistency across MSC sources.

Growing points: Incorporation of MSC-exosomes into hydrogels and scaffolds offers promising controlled delivery systems that enhance angiogenic efficacy. Preconditioning MSCs (e.g. with hypoxia or pharmacological agents) further improves the pro-angiogenic potency of exosomes.

Areas timely for developing research: Future efforts should prioritize clinical translation by developing GMP-compliant production protocols, optimizing delivery strategies, and conducting rigorous clinical trials to assess safety, dosing, and therapeutic efficacy across diverse wound types.

Background: Evidence highlights the potential of human-dog relationships to support the health and wellbeing of patients, caregivers, and healthcare professionals. This review examines the application and impact of dog-assisted interventions (DAIs) in healthcare contexts.

Sources of data: A narrative review of research from 2009 to 2025 was conducted utilizing multidisciplinary databases, including, PubMed, MEDLINE, APA PsycINFO, Academic Search Complete, ProQuest One Business, and Scopus.

Areas of agreement: DAIs have been shown to reduce loneliness, depression, low mood, and anxiety in hospitalized patients; lessen pain perception and improve perceptions of healthcare in children; and reduce burnout, stress, and anxiety among healthcare professionals.

Areas of controversy: The increasing use of DAIs in healthcare points to potential benefits, but more high-quality research is required. Research has generally overlooked differing attitudes toward dogs in clinical settings and given little consideration to the animals' own health, welfare, and ethical treatment.

Growing points: DAIs may be beneficial, even when brief, with potential to reduce anxiety and strain and enhance job satisfaction, restoration, and reflective practice among healthcare professionals.

Areas timely for developing research: Future research should establish causal relationships, recruit balanced samples, incorporate biometric, psychological, and social measures and critically evaluate existing dog visitation programs.

Background: The accurate and safe assessment of physiological parameters, such as the highest oxygen consumption (V̇O2peak) and the lactate threshold (LT), plays a crucial role in optimizing training intensity and monitoring long-term progress, ensuring the safety of the trainees.

Sources of data: Data were obtained during tests performed by 28 recreationally active young adults with varying levels and types of training. These individuals underwent a modified incremental Åstrand protocol for a treadmill test to exhaustion, during which their V̇O2peak and lactate threshold (Onset of Blood Lactate Accumulation method) were directly assessed.

Areas of agreement: Tests to exhaustion are considered valid methods for directly measuring V̇O2peak and determining LT. However, the direct assessment of V̇O2peak and LT requires specific equipment and raises various practical issues.

Areas of controversy: Indirect methods for estimating of V̇O2peak and lactate threshold are simpler to use, but these methods are often difficult to generalize or have a high margin of error from the many variables that can affect a subject's V̇O2peak and lactate threshold.

Growing points: These results enable estimation of V̇O2peak and LT in apparently healthy young adults engaged in regular physical activity, regardless of their specific training backgrounds.

Areas timely for developing research: Future research should focus on developing more precise field-based methods for estimating V̇O2peak and lactate threshold, with lactate threshold presenting particular challenges due to the need for blood sampling equipment.

Background: Our study explored how religious ritual engagement during Ramadan intermittent fasting (RIF) shaped athletes' performance perceptions and adaptive strategies in Tunisian professional football. We compared players who fasted only (G-FNRP) with those who also engaged in additional religious rituals (G-FRP).

Sources of data: Semi-structured interviews were conducted with 24 professional footballers from Tunisia's League 2, divided into G-FRP (n = 10), who combined fasting with additional rituals such as Tarawih, Tahajjud, and Khatm al-Qur'an, and G-FNRP (n = 14), who observed fasting only. Data were analyzed through a reflexive thematic approach, using manual coding and Excel matrices to organize and interpret these players' reported experiences.

Areas of agreement: Participants in the G-FRP group perceived religious rituals as a means of improving their spiritual awareness, resilience, and discipline, which they associated with a greater ability to cope with competition-related stress.

Areas of controversy: In contrast, participants in the G-FNRP group did not establish a direct link between rituals and performance but rather emphasized perceptions of fatigue, sociocultural pressures, and reduced psychological resources such as motivation.

Growing points: We have shown that RIF-related religious rituals could be identity and motivational resources that influence how athletes perceive their ability to cope with performance demands. Understanding these dynamics can help to develop personalized strategies from an inclusive health and human perspective in sport.

Areas timely for developing research: Further research should extend to different sports, contexts, populations, and religious ways of fasting.

Background: Adipose tissue secretes bioactive substances, adipokines, which affect cardiovascular health. The secretion of adinopectines is associated with decreases in metabolic and cardiovascular diseases risk-factors such as obesity and type 2 diabetes. High-intensity interval training (HIIT) exerts beneficial effects on cardiometabolic health, but its effect on adipokines is unclear.

Sources of data: This systematic review and meta-analysis, aimed to report the effects of HIIT on adiponectin levels in overweight and obese individuals, was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search was conducted in Web of Science, PubMed, ScienceDirect, and Google Scholar. The quality of the articles was evaluated using the Downs and Black checklist.

Areas of agreement: HIIT training generally did not affect adiponectin levels in overweight and obese individuals. Most likely, this effect can result from the lack of weight loss of the subjects in some studies.

Areas of controversy: One notable constraint within the scope of these investigations pertains to the relatively modest sample sizes employed. Consequently, future research endeavours should employ larger cohorts to enhance the generalizability of findings.

Growing points: HIIT focused on weight loss and fat percentage may effectively enhance the impact of HIIT on adiponectin levels.

Areas timely for developing research: Future research should implement rigorous dietary controls to isolate the independent effects of HIIT on adiponectin modulation.

Prospero registration: CRD42024580266.

Background: The benefits of strength training in cyclists are still a topic of debate. The aim of this study was to compare the effects of strength training performed in the gym with specific strength training performed on the bike in young off-road cyclists.

Sources of data: Nineteen participants were divided into the following two groups: (i) the group A performed 12 weeks of endurance training combined with two sessions/week of strength training in the gym; (ii) the group B performed 12 weeks of endurance training combined with two sessions/week of specific strength training on the bike. Incremental test, 30 s Wingate test, and countermovement jump test were conducted at pre (T0) and post (T1) training programs.

Areas of agreement: The findings are in line with previous research showing that heavy strength training in cyclists has significant improvements in some aerobic and anaerobic performance outcomes. Indeed, our results showed that in the group A, the Mean Power Output (MPO) of the 30 s Wingate test increased significantly between T0 and T1 (P = .002). In the group B, no significant differences were found in the MPO of the 30 s Wingate test between T0 and T1 (P = .276). In the group A, the Maximum Power Achieved (MPA) increased significantly between T0 and T1 (P < .001). In the group B, no significant differences were found in the MPA between T0 and T1 (P = .889).

Areas of controversy: Strength training in the gym for cyclists has not been widely investigated, and, in fact, the literature shows conflicting results on the topic, with some research groups highlighting the importance of sport-specific strength training. In this way, in both groups, no significant differences in the vertical jump height between T0 and T1 (P = .331 and P = .184, for groups A and B, respectively) were detected. However, the small sample size and the numerical heterogeneity between males and females in the recruited sample do not allow to generalize findings.

Growing points: As the group of cyclists who performed strength training in the gym showed significant improvements, this study suggests integrating heavy strength sessions in the gym into the usual endurance training program.

Areas timely for developing research: Further studies should investigate the effectiveness of strength training in the gym both in all off-road cycling categories as well as in other cycling specialities.