Postgraduate Medical Journal最新文献

{"title":"Effect of remote ischemic conditioning on albuminuria in adults with diabetes mellitus (ricadime): a parallel group, double blind, sham controlled, randomized clinical trial.","authors":"Nishanth Dev, Garima Kumar, Gaurav Singh, Jhuma Sankar","doi":"10.1093/postmj/qgag040","DOIUrl":"https://doi.org/10.1093/postmj/qgag040","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetic kidney disease (DKD), a chronic microvascular complication is leading cause of End Stage Kidney disease (ESKD). Reduction of ≥30% urinary albumin is recommended to slow ESKD progression. Remote Ischemic conditioning (RIC) induces brief episodes of ischemia and reperfusion and has protective effect on various organs. The current study aims to explore the effects of RIC on albuminuria reduction in adults with type-2 Diabetes Mellitus.</p><p><strong>Materials and methods: </strong>In this double blind, sham controlled, Randomized Clinical Trial, we assigned 40 normotensive Diabetic adults with moderate and severely increased albuminuria to RIC group (n = 20) or Sham group (n = 20) weekly for 8 weeks. Primary outcome was reduction in albuminuria at the end of 8 weeks. Secondary outcomes were changes in serum creatinine, e-Glomerular Filtration Rate (eGFR), and HbA1c levels.</p><p><strong>Results: </strong>The reduction in albuminuria at the end of 8 weeks was 37.9% [Median (IQR): -7.5, 43.9] in the RIC group while it increased by 1.10% (-5.6, 15.2) in the Sham group (P = 0.015). Significant reduction was noted in serum creatinine in RIC group from 1 to 0.83 mg/dl as compared to increase in Sham group from 0.97 to 1.1 mg/dl (P = 0.0004). The mean eGFR in the RIC group improved from 85 to 99 (ml/min/1.73m2) P = 0.0001). No significant change was detected in HbA1C levels. Mild pain was the only adverse effect noted in 10% in the RIC group and none in the Sham group.</p><p><strong>Conclusion: </strong>Among adults with DKD, treatment with RIC significantly reduced albuminuria and serum creatinine while improving the eGFR (CTRI/2024/09/074453).</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chest pain, troponin, and electrocardiogram: rethinking how we diagnose myocardial ischemia.","authors":"Maria Giulia Bellicini","doi":"10.1093/postmj/qgaf179","DOIUrl":"https://doi.org/10.1093/postmj/qgaf179","url":null,"abstract":"<p><p>Chest pain remains one of the most common reasons for emergency department visits and cardiology consultations worldwide. Although structured diagnostic algorithms, such as the European Society of Cardiology, endorsed 0 h/1 h approach, have greatly improved the triage of suspected myocardial infarction, they are designed to be applied only after the clinician has determined that the presenting symptoms may be cardiac in origin. This article focuses on that crucial pre-algorithmic step: helping clinicians recognize which symptom presentations truly warrant consideration for myocardial ischemia. By clarifying how clinical features such as symptom duration, electrocardiogram changes, and troponin kinetics relate to pathophysiology, we aim to support the early identification of potentially ischemic chest pain, before structured pathways are applied. Rather than offering an alternative to current algorithms, this work seeks to enhance their precision and applicability by reinforcing the clinical reasoning required to use them appropriately.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imagine what we can do together: visual art as a catalyst for strengthening connections across the inpatient team.","authors":"Sam Woodworth, Lisa Abia-Smith, Elizabeth Lahti","doi":"10.1093/postmj/qgaf236","DOIUrl":"https://doi.org/10.1093/postmj/qgaf236","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: The impact of community-based Tai Chi exercise on intrinsic capacity improvement in the elderly: a meta-analysis of randomized controlled trials.","authors":"","doi":"10.1093/postmj/qgag061","DOIUrl":"https://doi.org/10.1093/postmj/qgag061","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147819803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The potential role for GLP-1 receptor agonists in cancer survivorship: a narrative review.","authors":"George Hatzis, Audrey McKennitt, Ben S Gerber, Ryann M Quinn, Jung Ae Lee","doi":"10.1093/postmj/qgag044","DOIUrl":"https://doi.org/10.1093/postmj/qgag044","url":null,"abstract":"<p><strong>Introduction: </strong>Cancer survivors face a high burden of comorbidities which negatively influence long-term outcomes. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may augment these outcomes, but their role in this population remains understudied.</p><p><strong>Methods: </strong>We conducted a literature review of randomized controlled trials, observational studies, retrospective cohort studies, pre-clinical trials, and reviews related to GLP-1 RAs and cancer survivors.</p><p><strong>Results: </strong>We first delineate the GLP-1 RA mechanisms of action in glycemic control, inflammation, cardiovascular protection, neuroprotection, nephroprotection, and cancer proliferation. Then, we highlight the potential clinical benefits that these drugs could have in cancer survivors based on available studies, including metabolism, cardiovascular risk, lymphedema and mortality. Finally, we address ongoing safety concerns for GLP-1 RAs, particularly focusing on their potential use in cancer survivors.</p><p><strong>Discussion: </strong>Given the limited evidence to date, further research is needed to evaluate the long-term benefits and safety of GLP-1 RA use in cancer survivors.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical education in sub-Saharan Africa: challenges and prospects using the first private medical university in Nigeria as a case-study.","authors":"Akaninyene E Ubom, Peter O Odili, Abdulrahman Sambo, Nestor Inimgba, Smith Jaja, John I Ikimalo","doi":"10.1093/postmj/qgag051","DOIUrl":"https://doi.org/10.1093/postmj/qgag051","url":null,"abstract":"<p><p>Medical education has a significant role in reducing the health inequities and physician shortages in sub-Saharan Africa (SSA). There has been an expansion in medical education in SSA since the early 1900s, with >168 medical schools in the region. This expansion, has, however, been fraught with a myriad of challenges, chief amongst which include massive emigration of medical doctors, poor funding of healthcare and education, and adoption of traditional Western medical curriculum. Emigration creates significant shortages of clinicians and medical faculty, putting extra pressure and strain on the remaining clinicians and faculty, and driving even more emigration. Poor funding translates to poor remuneration, which is the greatest 'push factor' for emigration. Poor remuneration, service conditions and welfare, drive industrial/strike actions in medical schools, prolonging duration of medical training and graduation from medical schools. Western-style medical education can also be a 'push factor' factor for emigration upon graduation. To address the widening inequities in access to and quality of healthcare and physician shortages in SSA, private sector investment in medical education must be encouraged, as well as improved funding of healthcare and education by national governments, and the adoption of community-based medical education and problem-based learning with medical curricula that are tailored to local needs and peculiarities. This review article discusses the challenges and prospects of medical education in SSA using PAMO University of Medical Sciences, the first private medical university in Nigeria, as a case-study.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dysregulation of PIWI-interacting RNA-63049 (piRNA-63049) is associated with increased risk of post-menopausal osteoporosis in Chinese population via regulating the Wnt signaling pathway.","authors":"Yu Cong, Xing Zhou, Nirong Bao, Peng He","doi":"10.1093/postmj/qgae138","DOIUrl":"https://doi.org/10.1093/postmj/qgae138","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;This study investigates the association between PIWI-interacting RNA-63049 (piRNA-63049) and the risk of post-menopausal osteoporosis in a Chinese population. It explores piRNA-63049's role in modulating the Wnt signaling pathway, which is crucial for bone health, particularly in the context of estrogen deficiency-induced osteoporosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We enrolled 216 participants divided into three groups: healthy control participants as the osteoporosis(-)fracture(-) group, osteoporosis patients without fractures as the osteoporosis(+)fracture(-) group, and osteoporosis patients with fractures as the osteoporosis(+)fracture(+) group. T-scores at both spine and hip were compared. The expression of piRNA-63049 and its impact on the Wnt/β-catenin signaling pathway were examined using polymerase chain reaction analysis and luciferase assays.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Compared with other candidate piRNAs, piRNA-63049 exhibited significantly higher expression levels in patients with osteoporosis, while being highest in osteoporosis patients with fractures. T-scores of the osteoporosis(+)fracture(+) were also the lowest among all groups, which indicated worse bone health compared with the osteoporosis(+)fracture(-) group. Luciferase assays confirmed the molecular interactions between piRNA-63049 and the Wnt2b mRNA and β-catenin mRNA, both being crucial components of the Wnt signaling pathway. Overexpression of piRNA-63049 resulted in the downregulation of several key genes involved in bone metabolism, further elucidating its critical role in osteogenesis and bone health. Moreover, key genes of bone metabolism including LRP5, LRP6, OCN, OPN, and ALP were also regulated by the overexpression of piRNA-63049.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Our study suggested that the dysregulation of piRNA-63049 is associated with the increased risk of post-menopausal osteoporosis and fractures in the Chinese population by modulating the Wnt/β-catenin signaling pathway. Key messages What is already known on this topic: Post-menopausal osteoporosis was recognized for its significant bone loss and increased fracture risk, largely due to estrogen deficiency disrupting bone remodeling. The Wnt signaling pathway was identified as a key regulator in bone metabolism, with its dysregulation linked to osteoporosis. However, the specific role of piRNA-63049 was not well understood, which requested further research into its regulatory functions and its connection to osteoporosis in the Chinese population. What this study adds: This study reveals that piRNA-63049 is significantly upregulated in post-menopausal osteoporosis patients, particularly in those with fractures, and demonstrates a direct molecular interaction between piRNA-63049 and the Wnt/β-catenin signaling pathway. How this study might affect research, practice, or policy: The study's findings have implications for developing targeted therapies for osteoporosis, as piRNA","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the effect of a culturally adapted and personalized digital CBT-I app in insomnia patients with mild-to-moderate OSA: a secondary analysis of a randomized controlled trial.","authors":"Cheng Zhang, Yuxuan Liu, Xiaoming Guo, Yane Shen, Jing Ma","doi":"10.1093/postmj/qgaf203","DOIUrl":"10.1093/postmj/qgaf203","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the effectiveness of a culturally adapted, interactive, and personalized digital cognitive behavioral therapy (CBT-I) for individuals with co-morbid insomnia and sleep apnea (COMISA), and to compare the treatment outcomes with those of insomnia alone.</p><p><strong>Methods: </strong>This secondary analysis utilized data from a prior randomized controlled trial. The efficacy of digital CBT-I (dCBT-I) on insomnia severity and mental health was assessed in both COMISA and insomnia-only groups at postintervention and at 1-, 3-, and 6-month follow-ups.</p><p><strong>Results: </strong>Among 38 insomnia participants who completed the dCBT-I, 20 underwent sleep studies (4 males, 16 females; mean age 52.3 ± 13.0 years). Seven were diagnosed as mild-to-moderate obstructive sleep apnea (COMISA), and 13 did not (insomnia alone). Compared with baseline, the insomnia severity index scores significantly decreased at postintervention and the 1-, 3-, and 6-month follow-ups in both the COMISA and insomnia alone groups (P < .05), with large effect sizes (Cohen's d > 1.0). No significant differences were observed between the two groups in insomnia severity index scores at baseline, postintervention, and at 1-, 3-, and 6-month follow-ups (P > .05). Mixed-effects models indicated no significant group × time interaction on insomnia severity index scores (P > .05). Wake time after sleep onset, sleep efficiency of the sleep diaries, and health questionnaire (PHQ-9) scores also improved significantly postintervention and at follow-up in both groups.</p><p><strong>Conclusions: </strong>This self-guided, culturally adapted, and personalized dCBT-I effectively improved insomnia severity, sleep quality, and depressive symptoms among individuals with COMISA. While treatment effects were comparable between COMISA and insomnia-alone groups, the observed numerical differences may reflect limited statistical power. Larger studies are warranted to determine whether individuals with comorbid obstructive sleep apnea respond differently to dCBT-I. Key messages What is already known on this topic: Cognitive behavioral therapy for insomnia may improve outcomes in patients with comorbid insomnia and sleep apnea. What this study adds: This study shows that an interactive, personalized, and culturally adapted digital cognitive behavioral therapy for insomnia program is also effective for comorbid insomnia and sleep apnea patients. How this study might affect research, practice, or policy: These findings support broader implementation of tailored digital cognitive behavioral therapy for insomnia in the treatment of comorbid insomnia and sleep apnea.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"446-453"},"PeriodicalIF":2.7,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145637955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of lipid and blood glucose profiles and their association with short-term progression of carotid plaque among middle-aged adults.","authors":"Xinghe Sun, Junping Kang, Hui Lv, Chaoqun Wu, Xiaohui Liu","doi":"10.1093/postmj/qgaf185","DOIUrl":"10.1093/postmj/qgaf185","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The progression of carotid atherosclerotic plaques is a significant predictor of cardiovascular events; however, there is a paucity of comparative analyses regarding metabolic biomarkers that can forecast short-term carotid plaque progression in middle-aged adults.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This prospective cohort study included adults without initial carotid abnormalities who underwent serial carotid ultrasounds and metabolic profiling. A total of 11 blood lipid and glucose profiles were examined. Carotid artery plaque progression was defined as the emergence of new plaques within a 2-year period. The association between each metabolic indicator and the outcome was analyzed using Pearson correlation, restricted cubic splines, multivariable logistic regression, and receiver operating characteristic curves. The five indicators with the strongest associations were identified, and a logistic regression model, adjusted for covariates, was utilized to assess the impact of the coexistence of risk factors on the progression of carotid atherosclerosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 7703 individuals were included in the study, among which 9.52% (n = 733) developed new carotid plaques over the 2-year period. The elevated total cholesterol to high-density lipoprotein cholesterol (HDL-C) ratio [odds ratio (OR) = 1.38, 95% confidence interval (CI) 1.28-1.49], low-density lipoprotein cholesterol to HDL-C ratio (OR = 1.66, 95% CI 1.49-1.85), and triglyceride-glucose index (OR = 1.34, 95% CI 1.17-1.53) demonstrated the strongest correlations with plaque progression. Cumulative risk factor analysis indicated that individuals with five or more risk factors faced a 3-fold increased risk (OR = 3.02, 95% CI 2.28-4.01) relative to those with no risk factors. Subgroup analyses confirmed the robustness of the total cholesterol/HDL-C ratio across various metabolic subgroups, while the triglyceride-glucose index diminished in hypertensive and obese populations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Both traditional lipid ratios, particularly the total cholesterol/HDL-C ratio, and indices of insulin resistance, such as triglyceride-glucose index, are significant risk factors of carotid plaque progression. A dose-response relationship was observed between the accumulation of identified risk factors and the progression of carotid atherosclerotic plaques. Therefore, risk stratification in health screenings should prioritize these biomarkers to improve early detection and prevention strategies for atherosclerosis. Key messages What is already known on this topic: Existing evidence has established associations between various individual lipid parameters [e.g. low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglycerides (TG)] and glucose metabolism markers with the presence of carotid atherosclerosis. Furthermore, composite ratios like TC/high-density lipoprotein cholesterol (HDL-C) and the triglyceride-gluco","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"409-419"},"PeriodicalIF":2.7,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145506437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of preoperative double-dose oral carbohydrates in patients undergoing elective digestive system surgery: a systematic review and meta-analysis.","authors":"He Xiating, Cheng Shenting, Wang Xuewei, Huang Hui, Zhao Lishuang","doi":"10.1093/postmj/qgaf129","DOIUrl":"10.1093/postmj/qgaf129","url":null,"abstract":"<p><strong>Objective: </strong>To review evidence from randomized trials assessing the effects of preoperative double-dose oral carbohydrates in patients undergoing elective digestive system surgery.</p><p><strong>Methods: </strong>China Biomedical Literature Database, the Cochrane Library, Ovid Technologies, PubMed, Web of Science, Wanfang, China Science and Technology Journal Database and China National Knowledge Infrastructure were searched from inception to March 2024, with Revman5.4 for analysis.</p><p><strong>Results: </strong>Fifteen trials involving 1354 patients showed that compared with the preoperative fasting or placebo group, double-dose carbohydrates improved insulin levels [mean difference (MD) = -4.14; 95%CI = -5.50, -2.78; P < .00001] and reduced insulin resistance (MD = -1.02; 95%CI = -1.48, -0.57; P < .0001). Perioperative hunger, thirst, nausea, vomiting, and PONV were mitigated, though no significant variations on blood glucose level (MD = -0.17; 95%CI = -0.45, 0.11; P = .24).</p><p><strong>Conclusion: </strong>Preoperative double-dose oral carbohydrates may be a safe and feasible approach for digestive system surgery.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"400-408"},"PeriodicalIF":2.7,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}