Postgraduate Medical Journal最新文献

{"title":"Comprehensive multi-omics approach reveals potential therapeutic targets and agents for osteoarthritis.","authors":"Qingxia Gao, Dawei Yao, Zuozhen Yin, Gongchang Yu, Bin Shi, Jiaying Wang","doi":"10.1093/postmj/qgae176","DOIUrl":"10.1093/postmj/qgae176","url":null,"abstract":"<p><strong>Background: </strong>The mechanisms underlying osteoarthritis (OA) remain unclear, and effective treatments are lacking. This study aims to identify OA-related genes and explore their potential in drug repositioning for OA treatment.</p><p><strong>Methods: </strong>Transcriptome-wide association studies (TWAS) were performed using genome-wide association studies summary data and expression quantitative trait loci data from the Genotype-Tissue Expression project. Differentially expressed genes between OA patients and healthy controls were identified using four datasets from the Gene Expression Omnibus database. Gene ontology and pathway enrichment analyses identified potential hub genes associated with OA. A network-based drug repositioning approach was applied to discover potential therapeutic drugs for OA.</p><p><strong>Results: </strong>Through TWAS and mRNA expression profiling, 7 and 167 OA-related genes were identified, respectively. From these, 128 OA-related genes were selected based on common biological processes. Using the maximal clique centrality algorithm, 10 core-related genes (JUN, VEGFA, FN1, CD44, PTGS2, STAT1, MAP 2K7, GRB2, EP300, and PXN) were identified for network-based drug repositioning. Consequently, 24 drugs were identified based on 128 OA-related genes and 23 drugs based on 10 core OA-related genes. Some identified drugs, such as dexamethasone, menadione, and hyaluronic acid, have been previously reported for OA and/or rheumatoid arthritis treatment. Network analysis also indicated that spironolactone, lovastatin, and atorvastatin may have potential in OA treatment.</p><p><strong>Conclusion: </strong>This study identified potential OA-related genes and explored their roles in drug repositioning, suggesting the repurposing of existing drugs and the development of new therapeutic options for OA patients. Key message What is already known on this topic The exact pathogenesis of osteoarthritis (OA) remains unclear, and currently, there are no approved drugs that can prevent, halt, or inhibit the progression of OA. What this study adds We identified 128 OA-related genes and 10 core-related genes based on common biological processes revealed by TWAS and mRNA expression profiling. Using these genes, we discovered potential drugs for OA through the Network-based drug repositioning method. How this study might affect research, practice, or policy This study provides recommendations for repositioning existing drugs and developing new treatment options for patients with OA.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"464-474"},"PeriodicalIF":3.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814137","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":"Disentangling preventive effects of differential exercise types on tension-type headache: a component network meta-analysis of randomized controlled trials.","authors":"Qing-Feng Tao, Can Hua, Di Qin, Chao-Rong Xie, Yun-Zhou Shi, Min Chen, Hui Zheng","doi":"10.1093/postmj/qgaf055","DOIUrl":"https://doi.org/10.1093/postmj/qgaf055","url":null,"abstract":"<p><strong>Background: </strong>The effectiveness of exercise for tension-type headache (TTH) is unclear because of the complexity of exercise regimens-usually the combination of different types of exercise. We aimed to estimate the effectiveness of exercise for TTH and to test the incremental effect of each type of exercise by component network meta-analysis (CNMA).</p><p><strong>Methods: </strong>We searched Ovid Medline, Embase, and the Cochrane Library from database inception to 25 December 2023, and a supplementary search was conducted on 10 February 2025. We included randomized controlled trials of exercise, including aerobic, resistance, and stretching exercise, in adults with TTH. The primary outcome was headache frequency, and secondary outcomes were headache intensity and medication use.</p><p><strong>Results: </strong>Twelve trials with 759 participants were included. There were no significant differences between exercise and usual care in reducing headache frequency at the end of treatment with very low certainty evidence (mean difference [MD] -2.30, 95% [confidence interval] CI -8.86 to 4.26), while CNMA suggested that resistance exercise significantly reduced headache frequency (incremental mean difference [iMD] -6.00, 95% CI -9.10 to -2.90) and stretching exercise increased headache frequency (iMD 4.60, 95% CI 1.20 to 8.00). Exercise was better than usual care in reducing headache intensity (MD -2.29, 95% CI -3.23 to -1.34); the CNMA suggested that no single type of exercise had the greatest effect.</p><p><strong>Conclusion: </strong>Resistance exercise could be considered an effective and accessible treatment for patients with TTH. But our study was limited by heterogeneity and inconsistency of results, and more studies are warranted.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009065","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":"Clinical characteristics and survival outcomes of long-term responders for advanced nonsmall cell lung cancer patients with first-line PD-1/PD-L1 inhibitors: a multicenter retrospective study.","authors":"Zhijuan Du, Xiangwei Ge, Yao Li, Yuhui Qin, Hao Fan, Yahui Lv, Xiangyu Du, Zhefeng Liu","doi":"10.1093/postmj/qgaf045","DOIUrl":"https://doi.org/10.1093/postmj/qgaf045","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Immunotherapy has shown long-term benefits in advanced nonsmall cell lung cancer patients. However, the clinical characteristics, prognosis, and selection of appropriate therapies for long-term responders (LTR) to first-line programmed cell death protein-1/programmed cell death ligand-1 (PD-L1) inhibitors remain undetermined.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;About 413 advanced nonsmall cell lung cancer patients were included from 1 June 2015 to 31 August 2021. It examined clinicopathologic data, overall survival distributions, and treatment strategies involving immune checkpoint inhibitors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the patients, 213 (51.6%) were LTRs. PD-L1 expression ≥50% was observed in 39.1% of LTR patients, higher than in non-LTR patients (21.7%). After propensity score matching, Cox univariable analysis revealed pathological type (hazard ratio [HR] 0.563; 95% confidence interval [CI]: 0.391-0.811; P = .002), bone metastasis (HR 1.820; 95% CI: 1.278-2.590; P = .001), and liver metastasis (HR 2.220; 95% CI: 1.291-3.817; P = .004) as significant predictors of LTR. The pathological type (HR 0.641; 95% CI: 0.441-0.932; P = .020), bone metastasis (HR 1.593; 95% CI: 1.106-2.293; P = .012), and liver metastasis (HR 1.820; 95% CI: 1.046-3.165; P = .034) were significant predictors of LTR in Cox multivariable analysis. Significant difference showed in overall survival (P &lt; .0001) for Pembrolizumab-chemotherapy of lung squamous cell carcinoma in LTR group compared with Sintilimab-chemotherapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Nonsquamous cell carcinoma, bone metastasis, and liver metastasis were significant predictors of LTR. LTR patients showed a higher proportion of PD-L1 expression. Compared to Sintilimab-chemotherapy, Pembrolizumab-chemotherapy may be more promising for long-term survival of lung squamous cell carcinoma patients. Key messages What is already known on this topic - Immunotherapy (IO) has demonstrated long-term survival benefits in advanced nonsmall cell lung cancer (NSCLC). However, the clinical characteristics, prognosis, and optimal treatment strategies for long-term responders (LTR) to first-line programmed cell death protein-1/programmed cell death ligand-1 inhibitors remain unclear, necessitating further investigation. What this study adds - This study identifies nonsquamous cell carcinoma, absence of bone metastasis, and absence of liver metastasis as significant predictors of LTR in NSCLC patients. LTR patients exhibit a higher proportion of programmed cell death ligand-1 expression (≥50%). Additionally, Pembrolizumab-chemotherapy shows superior overall survival outcomes for LTR with lung squamous cell carcinoma compared to Sintilimab-chemotherapy. How this study might affect research, practice, or policy - These findings provide critical insights for patient stratification and therapy optimization in NSCLC. The identification of predictive factors and superior therapeutic combina","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990910","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":"Risk factors for post-stroke epilepsy and seizures among stroke survivors: a qualitative aggregate analysis of more than 82 000 cases.","authors":"Heping Cai, Zaibang Feng, Rui Guo, Kangkang Mei, Huiying Chen, Yanhui Liu, Wenyi Ruan, Jing Chen, Zubing Mei","doi":"10.1093/postmj/qgaf054","DOIUrl":"https://doi.org/10.1093/postmj/qgaf054","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Post-stroke seizures and epilepsy can affect patients' quality of life, increase mortality in stroke patients, affect patient outcomes, and are associated with higher medical expenditures. However, little is known about the risk factors that influence the onset post-stroke seizures and epilepsy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;We aimed to summarize and assess the credibility of evidence of potential risk factors for seizures and epilepsy after stroke.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Qualitative synthesis in random-effects model and evidence appraisal using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Pubmed, Embase, and the Cochrane Library were searched from inception to March 31, 2023. Random-effects models were used to estimate the pooled crude or adjusted relative risks (RRs) with 95% confidence intervals (CIs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We screened 51 991 citations, selecting 15 publications with 82 829 stroke survivors encompassing 6970 seizures and epilepsy events. Risk factors assessed included patient demographic factors, stroke characteristics, medical pre-existing history, and other clinical factors. Independent risk factors identified from pooled analyses included imaging indicators of cortical location (RR, 1.62; 95% CI, 1.23-2.12), cortical involvement (RR, 3.34; 95% CI, 1.67-6.66), early seizure (RR, 4.84; 95% CI, 2.16-10.85), and stroke severity (Scandinavian Stroke Scale [SSS]-score: &lt;30 vs. &gt;30. RR, 5.45; 95% CI, 2.42-12.24). Based on the quality of the evidence or GRADE criteria, there was high (Class I) to very low (Class IV) confidence in the pooled effect estimates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This meta-analysis identifies several risk factors for post-stroke seizures and epilepsy among stroke survivors. The findings enhance clinical awareness for early identification of high-risk individuals and may guide interventions to improve outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Registration: &lt;/strong&gt;PROSPERO (CRD42023434348). Key Messages What is already known on this topic  Post-stroke seizures and epilepsy are common neurological complications of stroke, significantly affecting survivors' quality of life and clinical outcomes. Although several studies have suggested potential risk factors, including stroke severity, cortical involvement, and early seizures, no comprehensive systematic review or meta-analysis has previously been conducted to summarize and appraise the strength of evidence for these factors. What this study adds  This study provides the first comprehensive synthesis of evidence, identifying significant risk factors for post-stroke epilepsy and seizures among stroke survivors. Key findings include that cortical involvement, imaging indicators of cortical location, early seizures, and stroke severity are associated with increased risk. The study also evaluates the strength of evidence for each factor using GRADE criteria","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045219","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":"Publication for sale: the rise of academies catering to medical students.","authors":"Hamrish Kumar Rajakumar, Umashri Sundararaju","doi":"10.1093/postmj/qgaf059","DOIUrl":"https://doi.org/10.1093/postmj/qgaf059","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976040","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":"Dopaminergic medications as a preventive for myopia: insights derived from pediatric patients diagnosed with attention deficit hyperactivity disorder.","authors":"Yu-Te Huang, Jhih-Yi Lu, Peng-Tai Tien, Yih-Dih Cheng, Heng-Jun Lin, Yow-Wen Hsieh, Fuu-Jen Tsai, Lei Wan, Hui-Ju Lin","doi":"10.1093/postmj/qgaf051","DOIUrl":"https://doi.org/10.1093/postmj/qgaf051","url":null,"abstract":"<p><strong>Background/objectives: </strong>This study investigated the impact of dopaminergic medications on myopia progression by comparing myopia susceptibility in ADHD patients treated with dopaminergic agents to those untreated. A non-ADHD cohort was also established to assess myopia risk compared to individuals with ADHD.</p><p><strong>Subjects/methods: </strong>This population-based cohort study used Taiwan National Health Insurance data (2009-2020), stratifying participants by ADHD status. Myopia was identified using ICD-10 diagnostic codes, while ADHD-related drug usage (methylphenidate, atomoxetine, clonidine) was analyzed. Cox regression models compared hazard ratios (HRs) for myopia, with cumulative incidence curves generated via the Kaplan-Meier method.</p><p><strong>Results: </strong>Adjusting for sex, age, comorbidities, and follow-up time, the untreated ADHD cohort had a 1.22-fold higher myopia risk (95% CI: 1.21-1.24) compared to the non-ADHD cohort. In contrast, ADHD patients receiving treatment showed a 39% reduced myopia risk (adjusted HR (aHR): 0.61; 95% CI: 0.59-0.62). An increased number of ADHD-related medications correlated with a notable myopia risk reduction: one drug (aHR: 0.50; 95% CI: 0.49-0.51) and two drugs (aHR: 0.28; 95% CI: 0.26-0.31).</p><p><strong>Conclusions: </strong>Untreated ADHD in children is linked to a higher myopia risk than both non-ADHD individuals and treated ADHD patients. Dopaminergic treatments may provide a therapeutic avenue for mitigating myopia progression by enhancing dopamine signaling pathways. Key messages What is already known on this topic  Dopamine release in the retina inhibits myopia progression, and ADHD is linked to dopaminergic dysfunction. ADHD treatments like methylphenidate enhance dopamine signaling, but their effect on myopia risk has not been thoroughly studied. What this study adds  This study shows that untreated ADHD children have a higher risk of myopia, while dopaminergic treatments significantly reduce this risk. The use of multiple ADHD medications further strengthens the protective effect. How this study might affect research, practice or policy  These findings suggest that ADHD treatments may serve as a new approach for myopia prevention, encouraging cross-field research and consideration of systemic therapies for managing comorbid conditions.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027760","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":"Opportunities and challenges for young physicians in the era of artificial intelligence: current status and future perspectives.","authors":"Bo Gao","doi":"10.1093/postmj/qgaf052","DOIUrl":"https://doi.org/10.1093/postmj/qgaf052","url":null,"abstract":"<p><p>Artificial Intelligence (AI) has witnessed rapid evolution in recent years and is gradually integrated into healthcare systems worldwide. For young physicians, navigating this landscape requires a delicate balance. They must weigh the potential benefits offered by AI-driven innovations against the intricate demands of patient care, ethical imperatives, and the evolving nature of their professional roles. This concise review aims to spotlight the key opportunities and challenges that young physicians encounter in this digital age. Additionally, practical recommendations are provided to guide young physicians in integrating AI knowledge seamlessly into their clinical practice. Finally, this review concludes with forward-looking suggestions,including incorporating AI training into medical education curricula and formulating policy initiatives. The overarching goal is to optimize the role of young physicians within the dynamic and evolving digital healthcare environment, ensuring they are well-equipped to leverage AI for the betterment of patient care.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029645","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":"Citation rat race-an academic malignancy.","authors":"Kaushik Bhattacharya","doi":"10.1093/postmj/qgaf053","DOIUrl":"https://doi.org/10.1093/postmj/qgaf053","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035368","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 improvement of functional dyspepsia symptoms after Helicobacter pylori eradication: caused by an unrecognized change in duodenal microbiota?","authors":"Rujun Ai, Guozhong Ji, Bota Cui","doi":"10.1093/postmj/qgaf050","DOIUrl":"https://doi.org/10.1093/postmj/qgaf050","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020860","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":"Pulsed-field ablation versus radiofrequency or cryoballoon thermal ablation in atrial fibrillation: a systematic review and meta-analysis.","authors":"Rasha Kaddoura, Dina Abushanab, Nidal Asaad","doi":"10.1093/postmj/qgaf049","DOIUrl":"https://doi.org/10.1093/postmj/qgaf049","url":null,"abstract":"<p><p>This review investigated efficacy and safety of pulsed-field ablation (PFA) in comparison with radiofrequency ablation (RFA), cryoballoon ablation (CBA), or both combined. The Odds ratio (OR) and mean difference (MD) with 95% confidence interval (95% CI) were computed. PFA allowed shorter procedure (MD -44.27 minutes, 95% CI: -63.61; -24.93) and left atrium (LA) dwell (MD -32.71 minutes (95% CI: -58.64; -6.78) times, but with longer fluoroscopy time than RFA (MD 8.54 minutes, 95% CI: 4.03; 13.04). Post-procedural complications rate was lower with PFA than CBA (OR 0.53, 95% CI: 0.35, 0.80). Atrial arrhythmias recurrence rate within one year of follow-up was lower with PFA than RFA (OR 0.68, 95% CI; 0.53; 0.87) and CBA (OR 0.69, 95% CI: 0.48; 0.97). PFA allowed shorter procedure and LA dwell times, as well as lower atrial arrhythmia recurrence than RFA and lower post-procedural complications and atrial arrhythmias recurrence rates than CBA.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804097","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}