Postgraduate medicine最新文献

Purpose: This study investigates the relationships between melanocortin-4 receptor (MC4R) rs17782313 gene polymorphisms, low-fat diet, aerobic exercise, and the reduction in blood lipid levels in individuals with obesity.

Methods: A total of 240 adults living with obesity were enrolled to take part in a 12-week program that combined exercises with dietary interventions. Measurements taken included body weight, body mass index (BMI), plasma lipids, fasting insulin (FIN), and insulin resistance (Homeostasis Model Assessment, HOMA-IR). All participants underwent exercise intervention and genotyping.

Results: Our findings revealed significant interactions between genotype, sex, and diet in modulating lipid metabolism. Specifically, after the exercise intervention, the mean reduction in BMI in was: CC+CT with low-fat diet: -2.56 ± 1.98 kg/m²; CC+CT with regular diet: -1.00 ± 0.99 kg/m²; TT with low-fat diet: -1.89 ± 1.31 kg/m²; TT with regular diet: -0.85 ± 0.68 kg/m². Males with CC+CT genotypes exhibited significant improvements in low-density lipoprotein (LDL-C) (P<0.05) and insulin resistance (P<0.05) on a low-fat diet, while changes in high-density lipoprotein (HDL-C) were not significant (p > 0.05). Triglyceride (TG) reduction was most pronounced in males with CC+CT genotypes on a low-fat diet and regular diet(effect sizes:-0.75, p = 0.018), though genotype-diet interactions for TG reached statistical significance (p = 0.02). These males also showed a significant decrease in LDL-C between a low-fat diet with CC+CT genotypes and regular diet with TT genotypes (effect sizes -0.46, p = 0.008), though genotype-diet interactions for LDL-C on those two groups reached statistical significance (p = 0.01). However, this decrease was not significantly different from that in females with the CC+CT genotypes. Trends in FIN changes were similar to those in LDL-C between low-fat diet with CC+CT genotypes and regular diet with TT genotypes groups (effect sizes -12.88, P<0.001). Additionally, HOMA-IR scores reduction was most pronounced in males with CC+CT genotypes on a low-fat diet and regular diet (effect sizes-2.90, P<0.001).

Conclusion: The CC+CT genotype group, particularly males on a low-fat diet, showed robust improvements in TG, LDL-C, and insulin resistance markers. However, HDL-C responses were inconsistent across subgroups. Notably, males with the CC+CT allele exhibited the most pronounced benefits in LDL-C reduction and HOMA-IR improvement with a low-fat diet.

Background: Growth hormone (GH) reduces visceral adiposity, increases lean body mass, and improves the lipid profile in obese adults. However, high-dose GH regimens have been associated with frequent adverse effects. The efficacy and safety of low-dose GH treatment in obese individuals without GH deficiency remain unclear. This study aims to evaluate the effects of recombinant human growth hormone (rhGH) on body composition, lipid profile, glucose metabolism, and adverse events in this population.

Methods: A systematic review and meta-analysis were conducted in accordance with the PRISMA statement. PubMed, Cochrane Library, and EMBASE databases were systematically searched up to December 2024. Eligible studies included randomized controlled trials (RCTs) involving obese individuals without GH deficiency, with at least one endpoint related to body composition, lipid profile, or glucose metabolism. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO, #CRD42023464234).

Results: A total of 10 RCTs involving 420 participants were included. The mean age of participants ranged from 18 to 65 years, and treatment durations varied from 4 to 72 weeks. Low-dose rhGH therapy resulted in a significant reduction in visceral adipose tissue (SMD: -0.34, 95%CI: -0.57 to -0.12, p = 0.003) and a significant increase in thigh muscle area (MD: 6.33 cm², 95%CI: 1.72 to 10.95, p = 0.007) compared to placebo. Additionally, fasting glucose levels were modestly elevated (MD: 4.18 mg/dL, 95%CI: 0.68 to 7.67, p = 0.02). No serious adverse events were reported in association with low-dose rhGH treatment across the included studies.

Conclusions: Low-dose rhGH therapy significantly reduces visceral fat and enhances thigh muscle mass in obese individuals without GH deficiency. These findings suggest that low-dose rhGH may offer therapeutic potential for sarcopenic obesity, warranting further investigation in larger, longer-term studies.

Inflammation is recognized as an important component of atherosclerosis resulting in an increased risk of myocardial infarction and stroke. Studies, conducted as early as the 1960s, involving drugs targeting different pathways of inflammation linked to cardiovascular (CV) disease have produced inconsistent results. Drugs such as the statins with mechanisms of action beyond an anti-inflammatory effect have clear benefit in reducing CV risk. Other drugs such as the broad-spectrum anti-inflammatory agents (corticosteroids, lipoprotein-associated phospholipase A2 inhibitors, methotrexate) have been found to have no benefit in reducing CV risk. More specific anti-inflammatory agents which target the NLRP3 inflammasome, interleukin (IL)-1β and/or IL-6, and high-sensitivity C-reactive protein have been associated with therapeutic benefit. Despite favorable outcome data and FDA-approval for one of these agents (colchicine), a recent study has created uncertainty concerning the routine use of this agent for CV risk reduction. Multiple studies with a variety of anti-cytokine related agents are on-going in efforts to further reduce residual CV risk. Compared to other common CV risk factors such as hypertension and dyslipidemia, our understanding and management of inflammation is poorly understood. Due to the complexities of the inflammatory process, targeted approaches that can markedly reduce inflammatory markers are likely needed to demonstrate clinically relevant reductions in major adverse cardiovascular events.

Objective: To describe the sociodemographic and clinical characteristics of Middle Eastern patients with atrial fibrillation (AF) and a history of prior ischemic stroke/systemic embolism (SSE) and compare the risk of adverse events between AF patients with and without prior SSE from the Middle East.

Methods: The study population was recruited from the JoFib study, a multicenter, nationwide, prospective registry of patients with AF from the Middle East. Patients were categorized into two study groups according to the history of prior SSE.

Results: The current study population consisted of 2003 AF patients divided into two groups: a prior SSE group of 318 (15.9%) patients and a no prior SSE group of 1685 (84.1%). Patients with prior SSE were older than those without prior SSE (45.3% vs. 30.4%, < 0.001). Compared to the no prior SSE group, patients with prior SSE were less symptomatic (61.3% vs. 72.8%, p < 0.001), had a higher prevalence of diabetes (49.1% vs. 42.4%, p = 0.03) and dyslipidemia (51.9% vs. 43.6%, p = 0.007), and were less commonly obese (34.0% vs. 42.2%, p = 0.009). Rhythm-control strategies were less frequently pursued in patients with prior SSE compared to the no prior SSE group (16.0% vs. 22.0%, p = 0.02). Antithrombotic medications were used more frequently by the prior SSE group, including anticoagulants (89.0% vs. 80.7%, p < 0.001) and antiplatelets (48.4% vs. 37.6%, p < 0.001). Compared to the no prior SSE group, the prior SSE group was at greater risk of all-cause death (aHR 1.64, 95% CI 1.21-2.22), cardiovascular death (adjusted sub-hazard ratio [aSHR], 95% CI: 1.50, 1.04-2.16), non-cardiovascular death (1.76, 1.00-3.08), and SSE (3.05, 1.83-5.07). History of prior SSE did not significantly alter the risk of major bleeding (0.67, 0.27-1.65) or CRNMB (AOR 0.79, 95% CI 0.47-1.33).

Conclusion: A F patients with prior SSE are at higher risk of adverse events compared to patients without prior SSE.

Objective: Frailty is becoming more widely acknowledged as a critical factor that impacts the quality of life and health outcomes of patients with chronic conditions, including those who have experienced a stroke. This study aims to analyze the determinants of frailty in a prospective cohort of chronic stroke patients undergoing rehabilitation via relevant clinical, functional, and quality-of-life measures.

Methods: In this prospective study, 124 chronic stroke patients (mean age: 63.3 years, SD = 10.5) were assessed for frailty using the Edmonton Frailty Scale (EFS). Variables included age, stroke severity indices, functional status, and quality of life. Descriptive and inferential analyses was performed.

Results: The majority (81.5%) of patients had ischemic strokes. Frail patients were older (mean age: 64.6 vs. 55.2 years, p < 0.005), had more severe strokes (modified Rankin scale (mRS) 3.87 vs. 2.53, p < 0.005; National Institutes of Health Stroke Scale (NIHSS) 6.08 vs. 3.47, p < 0.005), greater functional impairment (Barthel Index 52.9 vs. 80.6, p < 0.005), and lower quality of life (2.78 vs. 4.02, p < 0.005). Logistic regression showed that advanced age and lower self-efficacy significantly predicted frailty (age: OR = 1.1, 95% CI: 1.01-1.21; Stroke Self-Efficacy Questionnaire (SSEQ): OR = 0.72, 95% CI: 0.55-0.95). The ROC analysis demonstrated that age had an AUC of 0.742 (95% CI: 0.65-0.86, p < 0.001), whereas the AUC for SSEQ was 0.924 (95% CI: 0.86-0.96, p < 0.001).

Conclusions: In patients with chronic stroke, frailty, as measured with the EFS, is best predicted by age and by the stroke-related impaired self-efficacy. Interestingly, the latter is a stronger frailty predictor, especially in younger patients. These findings indicate that both physiological and disease-related functional declines contribute to the development of frailty. However, additional longitudinal studies are necessary to validate the causal association and to account for potential confounding factors like depression or social support.

Background: Recent studies have indicated that the pretreatment lactate dehydrogenase (LDH)-to-albumin ratio (LAR) serves as a comprehensive prognostic biomarker. However, no comprehensive meta-analysis that assesses its prognostic role in various malignancies has been conducted. This study aimed to summarize the current evidence on the prognostic value of the LAR in patients with malignancies.

Method: A systematic literature search was conducted before 1 October 2024 in six databases. Quantitative analysis with random-effect meta-analysis was employed for generating the pooled estimates of survival outcomes (overall, progression-free, disease-free, and relapse-free survivals [OS, PFS, DFS, and RFS, respectively]).

Results: A meta-analysis of 19 retrospective studies encompassing 11,088 patients with cancer demonstrated the significant association between a high LAR and poorer OS (hazard ratio [HR] = 1.67 [1.37-2.05], I² = 84%). Patients with solid tumors exhibited a significantly higher risk of poorer OS and PFS (HR = 1.73 [1.44-2.06], I² = 84%; HR = 1.43 [1.11-1.84], I² = 75%). Subgroup analysis revealed that digestive system tumors were associated with an increased risk of poor OS (HR = 2.15), including oral cancer (HR = 5.14), esophageal carcinoma (HR = 1.85), hepatocellular carcinoma (HR = 1.90), and colorectal cancer (HR = 2.12). Furthermore, nasopharyngeal carcinoma was associated with poorer OS and PFS (HR = 1.62 [1.36-1.92]; HR = 1.60 [1.20-2.14], I² < 50%).

Conclusion: This study demonstrated the significant association between an elevated pretreatment LAR and poorer survival outcomes in malignancies, particularly in solid and digestive system tumors. These findings support the LAR as a potential prognostic biomarker, warranting further validation in diverse populations with standardized cutoff values.

Introduction: Childhood and adolescence are critical stages during which mental health disorders may develop and profoundly impact individuals and families in the future. Understanding the prevalence and distribution of these disorders is crucial for public health policies and interventions. This analysis aims to summarize current evidence of the prevalence and geographic distribution of mental health disorders among children and adolescents to inform the development of effective psychopharmacological treatments.

Methods: The data were systematically gathered from the most commonly used databases worldwide, including PubMed, PsycINFO, EMBASE, PSYNDEX, MEDLINE, and the Global Burden of Disease (GBD), as well as from current literature to ensure comprehensive coverage. The studies using standardized assessment procedures and recognized diagnostic standards (i.e. DSM, DC, SDQ) were included in the final analysis.

Findings: Our findings indicated that the prevalence of mental health disorders in children and adolescents is higher than previously reported and varies widely across the regions. The analysis underlines the imperative for extensive, culturally attuned research and fortifies the call for global cooperation to surmount the challenges posed by these mental health disorders. It accentuates the need to appreciate the intricate interplay of cultural, socioeconomic, and healthcare factors to improve mental healthcare infrastructure and endorse equitable care access worldwide.

Conclusion: The pursuit of evidence-based public health policies and pharmacotherapy is deemed crucial for improving the prevention and management of mental illnesses in children and adolescents.