British medical bulletin最新文献

Introduction: This narrative review sets out to explore the current literature surrounding the mental health of serving personnel and veterans.

Sources of data: UK literature published in peer-reviewed scientific journals and publicly available UK Ministry of Defence reports.

Areas of agreement: Evidence suggests that common mental disorders are more prevalent in the UK serving and veteran personnel than in the general population. Risk factors include being female, adverse childhood events, combat exposure, and physical combat injury.

Areas of controversy: Post-traumatic stress disorder rates are broadly similar between UK serving personnel and the general population, though certain groups are at increased risk, such as veterans who deployed to Iraq/Afghanistan in combat roles.

Growing points: Understanding ways to maximize positive psychological outcomes, address poor sleep, and support those with combat injuries and chronic pain are key priorities for research/interventions. The prevalence of moral injury and military sexual trauma in the UK Armed Forces is currently unknown.

Areas timely for developing research: A longitudinal study following recruits including those who are part of the Lesbian, Gay, Bisexual, Transgender, Queer/Questioning or other sexualities and gender identities (LGBTQ+) community, or who have a neurodivergent condition, from entry to post-service would enhance our understanding of how serving in the Armed Forces impacts the mental health and wellbeing.

Background: Rehabilitation is a crucial component of comprehensive disease management and functional recovery. Despite advancements in surgical techniques for chronic lateral ankle instability (CLAI), there is still a lack of standardized, evidence-based rehabilitation protocols.

Source of data: After nine clinical questions were proposed by the guidance steering group, an independent search strategy was conducted for all clinical questions, encompassing the PubMed, MEDLINE, Web of Science, EMBASE, and Cochrane databases.

Areas of agreement: Rehabilitation is crucial to optimize surgical outcomes and patient recovery. An appropriate and well-structured rehabilitation plan can optimize a safe return to sports and daily activities.

Areas of controversy: Rehabilitation for surgical management of CLAI poses significant challenges, especially in the areas of preoperative preparation, control of postoperative swelling and pain, early-stage rehabilitation, advanced rehabilitation, and return to exercise.

Growing points: Given the lack of established guidelines for rehabilitation following surgical management of CLAI, this clinical practice guideline presents nine key recommendations aimed at addressing the existing controversies in this area. For CLAI patients undergoing surgery, preoperative rehabilitation should include exercise and education, followed by postoperative focus on pain and swelling management. Early rehabilitation emphasizes nonweight-bearing functional training, with gradual progression to weight-bearing exercises, dynamic balance, and strength training over the first 18 weeks. Regular follow-up visits are essential to monitor recovery and promote functional restoration.

Areas timely for developing research: In patients undergoing surgery for CLAI, there is a pressing need for comparative studies to assess the necessity of immobilization and to determine the optimal selection of braces.

Introduction: Knee osteoarthritis (OA) is a common degenerative joint condition and a major cause of disability in the general population.

Source of data: Recent published literature identified from PubMed, EMBASE, Google Scholar, and Scopus.

Areas of agreement: Orthobiological therapies try to regenerate articular cartilage and stop the progression of the degenerative lesion. Intra-articular injections of biological derivates have been increasingly used in the last decade.

Areas of controversy: The indications for the use of bone marrow aspirate concentrate (BMAC) are still unclear.

Growing points: We systematically reviewed the current literature on BMAC in the management of knee OA, giving an update on the current indications for the selection of the ideal patient and the preparations and efficacy of BMAC compared to other biological alternatives.

Areas timely for developing research: BMAC is a valuable source of mesenchymal stem cells, offering potential benefits in attenuating the inflammatory pathway associated with knee OA. Intra-articular injection of BMAC has shown effectiveness in clinical trials improving functional outcomes of knee OA patients. The superiority of BMAC over other orthobiological treatments cannot be assessed because of conflicting results.

Introduction: This article reviews the ethical issues surrounding obesity in public health and clinical contexts. We examine how obesity intersects with medical and social norms that raise questions of liberty, fairness, safety, and effectiveness or consequences.

Sources of data: PubMed, Cochrane Library, and Google Scholar.

Areas of agreement: We identify three main areas of agreement that are pertinent to ethical analysis of obesity: stigma is considered harmful, there needs to be a more-than personal responsibility approach, and a general acceptance of a global rise in body weight.

Areas of controversy: There are many areas of controversy, we limit our focus to four: conflicts of interest in the creation of guidelines and policies, mortality rates, whether weight is a meaningful proxy for health, and how to treat childhood obesity.

Areas timely for developing research: Post-genomic explanations, such as exposure to endocrine disrupting toxins, and development of epigenomics and microbiomics in the form of personalized nutrition are two developing areas we identify.

Introduction: The complex phenomenon of the athlete's heart (AH) describes the chronic physiological structural and functional adaptation secondary to repeated exposure of an acute exercise stimulus.

Sources of data: This narrative review is based on published evidence.

Areas of agreement: Highly trained athletic individuals frequently display cardiac parameters which are suggestive of an AH and can exceed the traditional 'normal' limits.

Area of controversy: The physiological processes underpinning the extent of cardiac adaption and how this is closely linked to exercise type, but also sex, ethnicity, and body size.

Growing points: Since its seminal description by Morganroth and colleagues in 1975, our understanding of the AH has evolved in tandem with improvements in cardiac imaging techniques alongside the exploration of more diverse athletic populations. This narrative review aims to provide a balanced discussion of the multi-factorial nature of structure and function of the AH with specific reference to the unique physiological exercise stimuli.

Areas timely for developing research: Despite great interest in cardiac adaptations across a broad spectrum of athletic populations, future research designs should consider the use of new and novel imaging techniques to enhance our understanding of the acute cardiovascular responses which ultimately mediates such adaptations, especially in athletic populations underrepresented in the literature.

Purpose: The present prospective comparative study included patients with acute Achilles tendon rupture (ATR) who underwent percutaneous repair with one knot compared to percutaneous repair with two knots.

Methods: All patients underwent the procedure under local anesthesia. A total of 29 patients underwent percutaneous repair with two knots (Group A), and 33 patients underwent percutaneous repair with one knot (Group B). All patients were treated by a single surgeon between 2019 and 2021 and were followed prospectively for 24 months.

Results: Patients' characteristics at baseline were similar between the two groups, except for age [38.0(15.0) vs 32.0(15.0) years, P = 0.028]. The procedure took longer for the two knots technique [19.0(4.0) vs 13.0(3.0) min, P < 0.001]. The Achilles tendon total rupture score was not different between the two techniques (90.7 ± 3.26 vs 90.5 ± 2.18, P = 0.737), as was the elongation of the gastrosoleus-Achilles tendon complex measured by the Achilles tendon resting angle [-1.0(2.0) vs - 1.0(2.0), P < 0.380]. The calf circumference of the injured and non-injured leg did not differ between the groups. Plantarflexion strength of the operated leg was significantly weaker than the non-operated leg in both groups. The European Foot and Ankle Society and patient reported outcome measures score by Piedade et al. scores were not statistically significant different between the two groups. No patient experienced a re-rupture, a venous thrombo-embolism episode, or injury to the sural nerve.

Conclusion: The modified technique offered similar objective and subjective outcome measures, in addition to reduced operative time.

Introduction: Surgical treatment of pelvic girdle pain (PGP) involves arthrodesis of sacroiliac (SI) and pubic symphysis joints. Fusion of pubic symphysis involves the implantation of an autologous iliac crest tricortical graft harvested from the iliac crest. The objective was to assess the safety of a novel synthetic graft substitute (b.Bone) for iliac crest reconstruction and to evaluate the results of PGP surgical treatment.

Sources of data: Consecutive participants undergoing pelvic fusion and requiring iliac crest reconstruction were enrolled and followed-up for 12 months in a prospective first-in-human clinical investigation. Adverse events were documented, and health-related quality of life was evaluated using EuroQol-5D-5L questionnaire. Iliac crest defect healing was evaluated by the Modified Lane and Sandhu radiological scoring system. In addition, relevant published peer-reviewed scientific articles identified from PubMed.

Areas of agreement: The EQ-5D-5L scores improved steadily reaching the highest point at 365 days. By 365 days complete healing of the bone defect was observed.

Areas of controversy: The management of PGP remains challenging with mixed results reported in the literature.

Growing points: While there is lack of consensus on how to manage PGP, the present study shows improved outcomes at one year following surgery. The synthetic b.Bone scaffold is a safe option with good healing outcomes for iliac crest defect reconstruction.

Areas timely for developing research: Although b.Bone synthetic scaffold found to be safe, further studies reporting on surgical treatment of PGP are required to confirm the findings in comparative trials.

Background: Utilizing Artificial Intelligence (AI) in clinical settings may offer significant benefits. A roadblock to the responsible implementation of medical AI is the remaining uncertainty regarding requirements for AI users at the bedside. An overview of the academic literature on human requirements for the adequate use of AI in clinical settings is therefore of significant value.

Sources of data: A systematic review of the potential implications of medical AI for the required competencies of physicians as mentioned in the academic literature.

Areas of agreement: Our findings emphasize the importance of physicians' critical human skills, alongside the growing demand for technical and digital competencies.

Areas of controversy: Concrete guidance on physicians' required competencies in AI-assisted clinical settings remains ambiguous and requires further clarification and specification. Dissensus remains over whether physicians are adequately equipped to use and monitor AI in clinical settings in terms of competencies, skills and expertise, issues of ownership regarding normative guidance, and training of physicians' skills.

Growing points: Our review offers a basis for subsequent further research and normative analysis on the responsible use of AI in clinical settings.

Areas timely for developing research: Future research should clearly outline (i) how physicians must be(come) competent in working with AI in clinical settings, (ii) who or what should take ownership of embedding these competencies in a normative and regulatory framework, (iii) investigate conditions for achieving a reasonable amount of trust in AI, and (iv) assess the connection between trust and efficiency in patient care.

Introduction: Anterior cruciate ligament (ACL) injuries in children and adolescents with open physes are common.

Areas of agreement: Evidence of ACL reconstruction using allografts in children with open physes is limited.

Areas of controversy: Whether the outcomes of ACL allograft reconstruction in children and adolescents with open physes are superior to autograft ACL reconstruction is unclear, with contrasting evidence.

Source of data: In October 2024, the Web of Science, PubMed, and Embase were accessed with no additional filters. Only clinical investigations evaluating ACL reconstruction in children or adolescents with open physes were eligible. Only studies reporting a minimum length of 24 months of follow-up were included.

Areas timely for developing research: Children who undergo allograft ACL reconstruction demonstrate similar functional outcomes to those who undergo autograft ACL reconstruction. Although allografts allow a faster return to sport, the greater laxity, the reduced activity level, and the higher failure and reoperation rates make their use dubious as a first-choice option for ACL reconstruction in skeletally immature patients.

Background: Osteoporosis (OP) is a metabolic bone disease producing reduction in bone mass with consequent bone fragility. Circular ribonucleic acid (CircRNA) is a form of RNA that forms a loop structure rather than a linear one. CircRNA can be used for therapeutic purposes, including molecular targets or to test new therapies.

Sources of data: A systematic search of different databases to July 2024 was performed to define the role of circRNA in OP therapy. Seventeen suitable studies were identified.

Areas of agreement: CircRNAs may be useful in studying metabolic processes in OP and identify possible therapeutic targets and new drug therapies.

Areas of controversy: The metabolic processes involved in OP are regulated by many genes and cytokines that can be targeted by CircRNAs. However, it is not easy to predict whether the in vitro responses of the studied CircRNAs and their interaction with drugs are also applicable in vivo.

Growing points: Metabolic processes can be affected by gene dysregulation of CircRNAs on various growth factors. Areas timely for developing research: Despite the predictability of CircRNA pharmacological response in vitro, such pharmacological response cannot be expected to be replicated in vivo.

Data availability: The data that support the findings of this study are available from the corresponding author.