Annals of medicine最新文献

Background: Anterior cruciate ligament (ACL) injury is one of the most common sports-related injuries, often resulting in not only mechanical instability but also long-term proprioceptive dysfunction. The ACL is richly innervated with mechanoreceptors that contribute to sensorimotor control. Injury-induced degeneration of these receptors leads to disrupted afferent signaling and maladaptive central nervous system (CNS) responses, which can compromise functional recovery and increase the risk of reinjury.

Objective: This review aims to summarize current knowledge on ACL-associated proprioception, including mechanoreceptor anatomy, injury-induced changes in neural signaling, and advances in evaluation and rehabilitation techniques. Emphasis is placed on the integration of peripheral and central mechanisms and their implications for clinical interventions.

Content: We detail the types and distribution of mechanoreceptors within the ACL and describe how their disruption alters joint position sense and kinesthesia. We further explore CNS neuroplasticity, such as cortical reorganization and bilateral sensorimotor changes. Traditional and emerging methods for proprioceptive assessment are critically evaluated. Finally, we discuss surgical and rehabilitative strategies-including remnant-preserving reconstruction, neuromuscular training, and neurofeedback-that target proprioceptive recovery through neuroplastic adaptation.

Conclusion: Restoration of proprioceptive integrity following ACL injury requires a multifaceted approach that addresses both peripheral mechanoreceptor preservation and central sensorimotor reorganization. Future research should focus on standardized assessments, long-term neurophysiological monitoring, and the integration of sensor-based technologies to support individualized, neuroplasticity-driven rehabilitation strategies.

Background: Postoperative nausea and vomiting (PONV) are significant perioperative challenges. This study evaluated the efficacy of perioperative esketamine in preventing PONV.

Materials and methods: We systematically searched Embase, PubMed, Web of Science, and the Cochrane Library from inception to August 2025 for randomized controlled trials investigating the effect of perioperative esketamine on PONV. The primary outcome was PONV incidence. Secondary outcomes included time to first flatus, postoperative pain degree, anxiety scores, agitation, anesthesia recovery time, and post-anesthesia care unit (PACU) stay duration. Data were analyzed using RevMan 5.4 and STATA 15.0 software. Sensitivity and subgroup analyses were performed to assess result stability and explore potential sources of heterogeneity.

Results: Thirty-eight randomized trials (3,425 patients) were included. Esketamine reduced the risk of nausea (RR=0.69, 95% CI: 0.53-0.90) and vomiting (RR=0.75, 95% CI: 0.57-0.98), shortened time to first flatus (SMD=-0.81, 95% CI: -1.48 to -0.15), and decreased rescue analgesic needs within 2 days (SMD=0.32, 95% CI: 0.2-0.5). However, it prolonged anesthesia recovery time (SMD=0.97, 95% CI: 0.28-1.67) and PACU stay (SMD=0.76, 95% CI: 0.27-1.26).

Conclusions: Perioperative esketamine may reduce PONV and aid gastrointestinal recovery, but its potential to delay anesthesia recovery and PACU discharge requires consideration. Further studies are needed to clarify its risk-benefit profile.

Date of first submission to prospero: 10 March 2024.

Date of the start of study screening against eligibility criteria: 21 March 2024.

Background: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) presents a significant clinical challenge in urology. Traditional pathophysiological models emphasize infection and local inflammation; however, the limited efficacy of conventional therapies suggests the involvement of deeper regulatory mechanisms.

Methods: This comprehensive review synthesizes evidence from the past five years regarding neuroendocrine pathways in CP/CPPS. We systematically analyzed literature from the PubMed, Web of Science, and CNKI databases, focusing on neuropeptide functions, hypothalamic-pituitary-adrenal (HPA) axis dysregulation, sympathetic nervous system (SNS) signaling, glial cell activation, and gut-prostate axis interactions.

Results: Neuroendocrine mechanisms significantly contribute to the pathophysiology of CP/CPPS through multiple pathways. Substance P and calcitonin gene-related peptide promote neurogenic inflammation, while B-type natriuretic peptide exhibits analgesic effects. Dysregulation of the HPA axis and sympathetic overactivation create stress-related imbalances. Central glial cell activation leads to central sensitization, and the emerging concept of the gut-prostate axis reveals bidirectional neuroendocrine-immune communication.

Conclusions: CP/CPPS is a systemic condition involving complex neuro-endocrine-immune interactions. Therapeutic strategies targeting neuroendocrine mechanisms-including neuropeptide receptor antagonists, glial cell inhibitors, and neuromodulation techniques-offer promising directions for precision medicine. Future research should focus on multi-omics approaches and neuroendocrine-based patient classification for individualized treatment.

Objective: Given the paucity of systematic research on self-circumcision, this study aims to synthesize existing case data to highlight its risks and inform preventive measures.

Methods: We summarized the case data on academic websites and reports from news media as well as items from online shopping platforms, and analyzed the prevalence, motivations, methods, and complications of self-circumcision.

Results: We found that self-circumcision is an under-researched subject in the medical community. Its most common motivations include economic factors, cultural and religious beliefs, fear of medical environment, and social and psychological factors. Some of the most commonly reported complications include bleeding and hematomas, infection, skin necrosis and tissue damage, urethral damage, penile deformities, and psychological effects. Some circumcision products on e-commerce platforms contain exaggerated, misleading, and false claims.

Conclusions: Self-circumcision represents a dangerous and largely unregulated practice with potentially severe medical and psychological consequences.

Background: In patients with alcohol-associated liver disease (ALD), heavy and prolonged alcohol consumption can trigger acute-on-chronic liver failure (ACLF), a condition associated with high early mortality and significant clinical challenges. Early identification of patients at risk is critical for improving outcomes.

Aims: We conducted a retrospective observational study of patients diagnosed with ALD between January 2000 and December 2024 to develop a predictive model for ACLF.

Methods: Key clinical indicators were selected using LASSO-regularized logistic regression (LR). The final LR model was visualized as a nomogram and compared with four additional machine learning algorithms. Model performance was evaluated using ten-fold cross-validation and area under the curve (AUC), while feature importance was assessed with Shapley Additive exPlanations values.

Results: Among 210 patients with ALD, LASSO identified four independent predictors of ACLF: total bilirubin (TBIL), folate, vitamin B12 (VitB12) and the difference from the normal value of prothrombin time (ΔPT). The LR model achieved an AUC of 0.970, indicating excellent predictive accuracy.

Conclusion: We developed a robust clinical prediction model combining LR and machine learning approaches. TBIL, folate, VitB12 and ΔPT are key prognostic markers that may enable early risk stratification and timely intervention, potentially reducing ACLF incidence in ALD patients.

Background: The aim of the study was to assess the relationship between the physical activity and medical knowledge of adult residents of the Silesian Voivodeship.

Methods: 1,638 (100%) adult residents of the Silesian Voivodeship were analyzed. The group was divided as follows: Group A - people not related to medical professions, Group B - people practicing medical professions: doctors, midwives, nurses/nurses, paramedics, pharmacists, laboratory diagnosticians, Group C - the entire study group. The research method used was an original survey questionnaire containing questions about physical activity and socio-demographic data, supplemented with a standardized International Physical Activity Questionnaire (IPAQ). For the purposes of the study, the respondents' general medical knowledge was checked.

Conclusions: The physical activity of the surveyed inhabitants of the Silesian Voivodeship was slightly better in the group of people performing medical professions compared to people not related to them, however, in both groups it was insufficient and required improvement. A higher level of general medical knowledge among the surveyed residents of the Silesian Voivodeship was not associated with the level of physical activity in the respondents, neither in terms of regularity nor intensity.

Purpose: Adenomyosis (AM) with dysmenorrhea (AMD) is a global public health concern that may involve abnormal brain function and heightened vulnerability to anxiety and depression. This study aimed to investigate static and dynamic regional homogeneity (sReHo and dReHo) alterations in AMD and their associations with clinical symptoms.

Methods: Fifty-two patients with AMD and 52 age- and education-matched healthy controls (HCs) underwent resting-state functional magnetic resonance imaging (rs-MRI). sReHo and dReHo maps were generated and compared using two-sample t-tests (voxel-level p < 0.01; cluster-level, Gaussian random field corrected p < 0.05), with age, education and head motion as covariates. Effect sizes (Cohen's d) were calculated for significant clusters. Partial correlation analyses assessed relationships between regional homogeneity (ReHo) alterations and clinical measures, controlling for medication use, menstrual phase and psychiatric history.

Results: Compared with HCs, AMD patients showed significantly increased sReHo and dReHo in the right fusiform gyrus (FFG; d = 0.84, p < 0.001) and decreased values in the bilateral supramarginal gyri (SMG; d = -0.73, p < 0.001). Additional regiongs exhibiting abnormal dReHo were included the bilateral angular gyri, right hippocampus, right cerebellum (lobule 4_5) , left middle frontal gyrus (MFG) and multiple subdivisions of the inferior frontal gyrus. Importantly, ReHo in the right FFG positively correlated with pain severity (visual analogue scale (VAS): r = 0.539-0.797, p < 0.001) and anxiety (Hamilton Anxiety Scale (HAMA): r = 0.442, p = 0.001). Abnormalities in the right hippocampus and cerebellum were also significantly associated with anxiety and depression scores (r = 0.555-0.861, all p < 0.001).

Conclusions: AMD is characterized by altered intrinsic brain activity in pain- and emotion-related regions, supporting a central mechanism underlying chronic pain and affective symptoms. These findings provide neuroimaging evidence for AMD-related brain dysfunction. Longitudinal studies with larger cohorts and hormonal control are warranted to confirm these results and clarify causal relationships.

Background: Coronary small-vessel disease (SVD) remains challenging for percutaneous coronary intervention (PCI) because small lumens magnify restenosis and ischemic risk. Multiple devices are available, yet their comparative performance is uncertain. This study evaluated and ranked PCI strategies for SVD.

Methods: A systematic review and network meta-analysis was conducted in accordance with PRISMA. PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar were searched from inception to 15 August 2025. Eligible studies were English-language randomized controlled trials enrolling adults with angiographic SVD defined as reference vessel diameter ≤3.0 mm, comparing PCI strategies, and reporting target lesion revascularization (TLR), binary restenosis (BR), or myocardial infarction (MI). A frequentist random-effects network meta-analysis generated odds ratios (ORs) with 95% confidence intervals (CIs) and treatment rankings using the surface under the cumulative ranking curve (SUCRA).

Results: Thirty-nine trials including 14,503 patients met the criteria. For TLR (37 studies; 11,980 patients), the highest SUCRA values were observed with sirolimus-eluting stents (SES 90.1%), zotarolimus-eluting stents (ZES 83.9%), and everolimus-eluting stents (EES 82.2%). For BR (32; 6,468), SES, ZES, and paclitaxel-coated balloons (DCB-PTX) ranked highest (95.0%, 80.0%, and 78.3%). For MI (37; 11,602), SES, DCB-PTX, and ZES ranked highest (79.0%, 78.7%, and 68.5%). Representative effects showed SES reduced TLR versus bare-metal stents (BMS) (OR, 0.25; 95% CI, 0.15-0.43) and MI versus BMS (OR, 0.41; 95% CI, 0.21-0.79). Conventional approaches such as BMS, plain old balloon angioplasty (POBA), and gold-plated balloon angioplasty (GPBA) ranked lowest across outcomes.

Conclusion: SES provides the most consistent clinical benefit for coronary SVD. ZES, EES, and DCB-PTX are effective alternatives in selected settings, whereas BMS, POBA, and GPBA are less effective. These findings offer comparative evidence to guide device selection in SVD.

Background: The increasing prevalence of non-tuberculous mycobacteria pulmonary disease (NTM PD) is a burden to public health. Successful management of NTM PD critically depends on accurate species identification and reliable drug susceptibility testing to guide appropriate antibiotic therapy. Emerging molecular technologies offer rapid diagnostic solutions compared to conventional methods, but their performance varies. This study aims to provide a comprehensive evaluation of current molecular techniques for NTM identification and to present a global antibiotic resistance profile.

Methods: A systematic literature search was conducted in PubMed and Web of Science for studies published between 2005 and 2024. Studies applying molecular methods for NTM identification and resistance detection in humans were included. Data on study characteristics, diagnostic methods, sample types, sample sizes, identification sensitivity, and drug susceptibility results were extracted. Meta-analysis was performed using R with the meta4diag package. The quality of included studies was assessed using the QUADAS-2 tool.

Results: The analysis included 49 studies on NTM identification and 33 studies on antibiotic resistance. For species identification, all evaluated molecular technologies (MALDI-TOF MS, PCR-based methods, Sequencing, DNA chip, and DNA strip) demonstrated high pooled sensitivities (>0.92). Subgroup analysis revealed that sample type significantly affected performance for MALDI-TOF MS. Preliminary analysis of antibiotic resistance rates revealed varying patterns. For slowly growing mycobacteria, a significantly high Ethambutol resistance rate was observed in M. avium (69.20%). Among rapidly growing mycobacteria, resistance to Imipenem was notable (54.22%), and Clarithromycin resistance varied significantly within the Mycobacterium abscessus complex.

Conclusion: Emerging molecular technologies have revolutionized the methodology for NTM identification with excellent performance. However, their performance can be influenced by sample type, particularly for MALDI-TOF MS. The alarming and heterogeneous antibiotic resistance patterns also highlight the critical need for rapid and accurate species identification and drug susceptibility testing to inform effective therapeutic strategies. Key messagesMolecular technologies demonstrate high accuracy for NTM identification.Antibiotic resistance is a serious concern with variations among NTM species and subspecies.Rapid and accurate species identification and drug susceptibility testing are crucial for guiding effective clinical management of NTM PD.