Annals of medicine最新文献

Background: Rapid autonomic recovery after physical stress is a hallmark of cardiovascular health. While both yoga and conventional exercise modulate autonomic function, direct comparisons of their effect on post-exercise recovery are scarce. This study compared autonomic recovery in yoga practitioners versus those in aerobic or resistance training.

Methods: We conducted a cross-sectional study of 51 healthy adults (18-35 years) in three long-term training groups: Yoga (n = 17), Aerobic (n = 17), and Resistance (n = 17). Participants performed a 5-minute submaximal Harvard step test. Heart rate variability (HRV) was analyzed from electrocardiograms recorded at baseline and during a 10-minute post-exercise recovery.

Results: After adjusting for baseline differences, the Yoga group showed a more efficient autonomic recovery profile. ANCOVA revealed a significant group effect on vagal reactivation, as measured by High-Frequency (HF) power (p = 0.001). Post-hoc tests confirmed that the Yoga group's recovery was significantly greater than that of the Aerobic and Resistance groups. Similar significant effects favouring Yoga were found for pNN50, SDNN, LF power, and total power (all p < 0.05). No significant group differences were observed for pulse rate, blood pressure, or RMSSD recovery.

Conclusion: Regular yoga practice is associated with more efficient parasympathetic reactivation after physical exertion. This suggests yoga's integrative nature is associated with unique advantages for autonomic strength compared to conventional aerobic and strength training.

Background: Early spontaneous abortion (ESA) is recognized as the most common complication during pregnancy and is often linked to dysfunction in the trophoblast and placenta. Studies suggest that downregulation of trophoblast oestrogen-related receptor gamma (ESRRG) may play a significant role in the impairment of placental function. In light of these findings, we evaluated the impact of ESRRG on trophoblast and placental function in ESAs, aiming to uncover new targets for diagnosis and treatment.

Patients/materials and methods: Bioinformatics methods were used to analyse differentially expressed genes in the trophoblast of ESA patients and normal controls. ESA Patients and controls were recruited and the villus tissues were collected. Protein and mRNA levels were determined by western blot and qRT-PCR, respectively. Mitochondrial morphological changes in trophoblasts were observed via transmission electron microscopy. CCK8 and Transwell assays were conducted with ESRRG-knockdown HTR-8/SVneo cells. MitoSOX staining, JC-1 assays and ATP quantification were used to assess mitochondrial function in vitro. In addition, Esrrg was overexpressed in ICR female mice, and the number of embryos in the uterus was determined.

Results: The expression of ESRRG was significantly decreased in the placental villous tissue of ESA patients, accompanied by abnormal mitochondrial morphology and decreased ATP levels in trophoblast cells. Impaired proliferation, invasion, migration and tube formation abilities were observed in ESRRG-downregulated HTR-8/SVneo cells, as well as impaired mitochondrial function. ESRRG overexpression was associated with improved trophoblast functionality in a lipopolysaccharide-induced abortion model in ICR mice, leading to an increased number of retained embryos in the uterus.

Conclusion: In summary, this study revealed that ESRRG downregulation plays an important role in ESA, providing new targets for diagnosis and treatment.

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is associated with significant discomfort and necessitates adequate sedation. This study aims to determine the effect of dexmedetomidine nasal spray adjunct to propofol sedation for patients undergoing ERCP procedures.

Patients and methods: This randomized, double-blind, placebo-controlled trial will be conducted at a tertiary teaching hospital in eastern China. Approximately 15 min before sedation, 160 adult patients will be randomly assigned (1:1) to either the dexmedetomidine group (dexmedetomidine nasal spray; n = 80) or the control group (normal saline nasal spray; n = 80). Sedation will be achieved with a target-controlled infusion of propofol, titrated to Modified Observer's Assessment of Alertness/Sedation scores of 1 and 2. The primary endpoint is the total propofol consumption during sedation. Secondary endpoints include the composite incidence of hypotension and hypoxemia during the procedures and recovery; and fatigue scores 15 min after emergence from sedation. An independent Data and Safety Monitoring Committee will conduct an ongoing review of study implementation.

Discussion: We anticipate that preoperative dexmedetomidine nasal spray will decrease total propofol requirements, reduce sedation-related adverse events, and enhance recovery for patients undergoing ERCP.

Trial registration: Chinese Clinical Trial Registry (ChiCTR2400093656) on December 10, 2024.

Background: The testis is a male-specific organ that plays a central role in spermatogenesis and androgen secretion. Testicular ageing is a hallmark of male senescence. However, the underlying mechanisms, as well as strategies to prevent, delay, or reverse this process, remain incompletely understood.

Discussion: As a critical component of male ageing, testicular ageing has attracted broad scientific attention, with ongoing efforts to identify effective strategies to delay or prevent its onset, though therapeutic efficacy remains limited. In this review, we summarise the biological and clinical features of testicular ageing, discuss its underlying molecular and cellular mechanisms, and highlight emerging strategies aimed at mitigating age-related testicular dysfunction, with the goal of advancing understanding and improving therapeutic outcomes.

Conclusions: Testicular ageing is a defining feature of male senescence, marked by progressive structural deterioration and declining steroidogenic and spermatogenic capacity. Although lifestyle, pharmacological, and stem-cell-based interventions show promise, their clinical applicability remains limited. A deeper mechanistic understanding and well-designed, large-scale prospective studies are essential to establish effective strategies for delaying or preventing testicular ageing.

Background: Tuberculosis infection (TBI) is a significant cause of bronchiectasis (BE). Identifying risk factors for radiological BE (RBE) could enhance the early detection of high-risk individuals following TB infection. This study aimed to develop and validate a novel Inflammation-Nutrition Risk Score (INRS) and a corresponding nomogram model to predict the risk of RBE after TBI.

Patients and methods: We enrolled 2,210 post-TBI patients from two medical centres. Data from 1,825 patients at Wuhan Jinyintan Hospital were used to develop the INRS and the RBE nomogram. An independent cohort of 385 patients from Wuhan Union Hospital served as an external validation set.

Results: The INRS was derived from four parameters: PNI, HALP score, Lg(SII) and CAR. Multivariate analysis identified the following independent risk factors for RBE: age ≥60 years (OR = 1.19, p = 0.030), current smoking (OR = 1.71, p = 0.009), COPD (OR = 3.13, p < 0.001), RDW-CV ≥12.8% (OR = 1.09, p = 0.005), ALB <35.5 g/L (OR = 1.04, p = 0.003) and INRS ≥1.86 (OR = 5.04, p < 0.001). The RBE nomogram model demonstrated strong discriminatory power, accuracy and clinical utility across the development, internal validation and external validation cohorts.

Conclusion: In post-TBI patients, the INRS represents a novel predictive biomarker for RBE. The INRS-based nomogram is a clinically applicable and efficient tool for risk stratification and guiding follow-up management to prevent RBE progression.

Background: While dexamethasone is proven to enhance single-shot erector spinae plane block (ESPB), its role as an adjuvant in continuous ESPB catheters is unclear. This randomised controlled trial evaluated whether adding dexamethasone to ropivacaine improves analgesia after video-assisted thoracoscopic surgery (VATS).

Methods: 85 patients undergoing VATS with continuous ESPB were randomised to receive postoperative infusion of either 0.2% ropivacaine(C-ESPB group) or ropivacaine with 10 mg dexamethasone(D + C-ESPB group). The primary outcome was resting pain visual analog scale (VAS)at 12 h postoperatively, while secondary outcomes included QoR-15 scores, tramadol consumption, time to first analgesic requirement, postoperative adverse events, 3-month incidence of chronic pain, catheter-related complications, pain intensity at other times, and hospital stay.

Results: The D + C-ESPB group had significantly lower resting pain at 12 h [2.56 (1.03) vs 3.24 (1.21), mean difference -0.680, p = 0.006]; and lower coughing pain at 12 h [4.60 (1.48) vs 5.69 (1.35), mean difference 1.086, p < 0.001], with analgesic superiority sustained through 72 h. Quality of Recovery-15 scores were higher at 12 h [124.70 (12.48) vs 117.26 (12.24); mean difference -7.436, p = 0.007] and 48 h [141.60 (5.51) vs 138.98 (6.64); mean difference -2.628, p = 0.050]; Total tramadol consumption over 72 h was markedly reduce [0 (0,100) vs 100 (75,100), z = -3.807, p < 0.001], and hospital stay was shorter [Mean (SD) 6.09 (1.34) d vs 6.93 (1.55)d, p < 0.001]. The intervention did not, however, alter the 3-month incidence of chronic postsurgical pain (31% vs 34%, p = 0.756).

Conclusion: Dexamethasone significantly enhances the analgesic efficacy of continuous ESPB, improving early pain control, recovery quality, and opioid-sparing after VATS, but does not reduce the incidence of chronic persistent surgical pain.

Background: Many factors can influence the occurrence of postoperative pulmonary complications (PPCs) in the perioperative period, but it is unclear whether chronic high-altitude exposure (CHAE) affects the occurrence of PPCs.

Methods: This retrospective study included 235,128 surgical patients aged 18 years and older from January 2013 to December 2022. The occurrence of PPCs, such as pneumonia, atelectasis, and respiratory failure, was determined based on the admission and discharge diagnoses. To reduce the confounding effects caused by imbalances in demographic and clinical characteristics at baseline, we employed a 1:1 propensity score matching (PSM) to match the CHAE and non chronically high-altitude exposed (NCHAE) patients. Statistical analyses were conducted from January 1, 2025, to March 1, 2025.

Results: A total of 235,128 cases were included, with 11,075 (4.7%) patients experiencing PPCs. There were 8,565 patients with CHAE, of whom 484 (5.7%) developed PPCs. In contrast, there were 226,562 patients NCHAE, with 10,591 (4.7%) experiencing PPCs. After 1:1 PSM, 8,564 CHAE were matched with 8,564 NCHAE. In the CHAE group, 484 (5.7%) experienced PPCs, while 394 (4.6%) in the NCHAE group shoewd a statistically significant difference (p = 0.002). Adjusted multivariable conditional logistic regression analysis indicated that CHAE increased the incidence of PPCs (odds ratio [OR], 1.25; 95% CI, 1.02-1.53). Furthermore, the length of hospitalization and postoperative hospitalization duration of patients in the CHAE group were longer than those in the NCHAE group.

Conclusions: This retrospective study suggests an association between CHAE and PPCs within 30 days after surgery. However, the undefined exposure duration highlight the need for prospective studies to definitively establish causality.

Background: The treatment strategy for intestinal non-Hodgkin lymphoma (NHL) and the role of surgery warrant reevaluation.

Methods: This study analyzed clinical data from a cohort of 12,047 patients diagnosed with intestinal NHL, extracted from the Korean National Health Insurance System database between 2002 and 2021.

Results: Among these patients, 3,566 (29.6%) were categorized into the surgery group, while 8,481 (70.4%) were included in the nonsurgery group. Surgery was independently associated with both prolonged overall survival (OS) and a favorable prognosis in multivariate analysis (Hazard Ratio [HR] = 0.645, 95% Confidence Interval [CI] = 0.598-0.695, p <.001). The median OS was longer in patients who underwent lymph node dissection during surgery than in patients who did not undergo lymph node dissection (10-year OS with lymph node dissection 63.17% vs. surgery without lymph node dissection 54.78%, p < .001).

Conclusions: To our knowledge, this is the first Korean population-based nationwide study to describe the clinical impact of surgery on the OS of patients with intestinal NHL. A prospective randomized study evaluating strategies to improve the survival of intestinal NHL patients is needed.

Purpose: There remains a lack of epidemiological data and evidence regarding risk factors for intracranial arterial dissection (IAD) worldwide, making it difficult to make a more timely and accurate clinical diagnosis. We aimed to identify risk factors, clinical and imaging features of spontaneous IAD (sIAD) using a case-control design.

Methods: We collected data on sIAD patients admitted to Tongji Hospital in Wuhan, China from June 2017 to June 2024. Non-IAD ischemic stroke (IS) and non-IAD intracerebral hemorrhage (ICH) patients served as control groups. Logistic regression models analyzed the three data sets, with results expressed as odds ratio (OR) and 95% confidence interval (CI).

Results: After screening, 71 patients with sIAD, 84 patients with non-IAD IS and 102 patients with non-IAD ICH were included in this study. The findings showed that the participants with diabetes had a lower likelihood of sIAD than non-IAD IS (OR = 0.145, 95%CI = 0.030-0.702). Compared with non-IAD ICH patients, individuals with sIAD had lower systolic blood pressure on admission (OR = 0.941, 95%CI = 0.900-0.983) and less likely to be young (OR = 0.911, 95%CI = 0.855-0.970). Serological data showed that compared with non-IAD ICH patients, elevated triglyceride (OR = 0.326, 95%CI = 0.179-0.594) were associated with the reduced likelihood of sIAD, whereas the opposite was true for uric acid levels (OR = 1.007, 95%CI = 1.000-1.014). In imaging, sIAD patients showed the largest number of arterial lumen dilatation, followed by stenosis with dilatation.

Conclusions: Diabetes may be associated with a reduced likelihood of sIAD. Differences in serologic markers may help in the differential diagnosis of sIAD from other cerebrovascular events.

Background: Micro/nanoplastics (MNP) have emerged as ubiquitous environmental contaminants with demonstrated bioaccumulation potential in organisms through multiple exposure pathways, posing substantial health risks globally. While mounting evidence indicates that MNP exposure adversely affects various organ systems including the nervous, reproductive, and digestive systems, the specific mechanisms underlying MNP-induced thyrotoxicity remain enigmatic.

Methods: 4-week-old male C57BL/6 mice were administered microplastics (MP, 5 μm) or nanoplastics (NP, 50 nm) via intragastric gavage at 30 mg/kg for 4 and 8 weeks. The thyroid architecture and endocrine function were evaluated by histological staining and thyroid hormones ELISA kit. The expression of apoptosis indicators (BCL2, BAX, CASPASE3), inflammatory factors (IL-1β, IL-18, TNF-α) and pyroptosis related-proteins (NLRP3, CASPASE1 and GSDMD), as well as the activity of NF-κB signaling were determined by immunofluorescence.

Results: We found that MNP exposure induces significant thyrotoxicity characterized by disrupted thyroid follicular architecture, comprised endocrine function, heightened apoptosis, and excessive inflammatory cytokines production, with NP exhibiting a more pronounced effect than MP. Mechanistically, MNP exposure stimulated thyroid follicular cell pyroptosis by upregulation of key pyroptotic mediators including NLRP3, CASPASE1, and GSDMD, driven by NF-κB signaling pathway activation.

Conclusion: Collectively, these findings provide novel mechanistic insights into MNP-induced thyroid toxicity and highlight the critical role of follicular cell pyroptosis, contributing to our understanding of the adverse health consequences associated with environmental plastic pollution.