Musculoskeletal careMosab M Aldabbas, Tarushi Tanwar, Iram Iram, Zubia Veqar
BACKGROUND: Chronic neck pain is frequently associated with disturbed sleep, yet evidence on physiotherapy's impact on objective sleep parameters remains limited. To our knowledge, this study is the first to evaluate the effects of exercises, interferential current therapy (IFT) and myofascial release therapy on sleep quality and polysomnographic parameters in this population. METHODS: Thirty adult men with chronic neck pain and poor sleep were randomised (1:1) in a two-arm, assessor-blinded trial. Group 1 received therapeutic exercise plus interferential current therapy; Group 2 received the same plus myofascial release (MFR), 7 weeks. Outcomes included subjective sleep quality as a primary outcme, polysomnographic (PSG) architecture and pain as secondary outcomes. RESULTS: Sleep quality improved significantly in both groups (time effect p < 0.001), with greater overall improvement in Group 2 (group effect p = 0.003). For PSG parameters, both groups improved. Compared with exercise + IFT, adding MFR produced greater changes in PSG N1% and REM% (Time × Group interaction), while other PSG parameters showed similar improvements across groups. CONCLUSION: Physiotherapy significantly improved pain and sleep outcomes in patients with chronic neck pain. Exercise with IFT enhanced sleep continuity, while combining exercise with myofascial release further optimized sleep architecture, particularly N1% and REM%. These findings highlight the added value of multimodal physiotherapy for pain management and sleep improvement. TRIAL REGISTRATION: This clinical trial was registered at the Clinical Trials Registry of India under the registration number CTRI/2019/09/021028.
Musculoskeletal careJosé Ribeiro da Silva Neto, Lucas Henrique Caldas, Paula Gabrielly Oliveira Demes, Natalia Camargo Rodrigues Iosimuta, Ana Carolina Pereira Nunes Pinto, Areoli…
BACKGROUND: Exercise-based randomized controlled trials are essential for guiding the management of knee osteoarthritis, but their interpretability depends on transparent reporting of both intervention and comparator groups. The term usual care (UC) is frequently used as a comparator, yet its reporting quality remains unclear. OBJECTIVE: To evaluate the reporting completeness of UC comparator groups in randomized controlled trials (RCTs) of exercise-based interventions for knee osteoarthritis. METHODS: This systematic review included RCTs of exercise-based interventions for adults with knee osteoarthritis that used UC as a comparator. Searches were conducted in MEDLINE, EMBASE, CENTRAL, PEDro, CINAHL, and SPORTDiscus up to December 2024. Reporting completeness was assessed using the Template for Intervention Description and Replication (TIDieR) checklist and analysed using continuous and dichotomised approaches. RESULTS: Sixty-seven RCTs were included. Reporting completeness of UC interventions was consistently low. Median TIDieR scores (range 0-12) were higher for exercise interventions (4.0; IQR 3-5) than for UC comparators (1.0; IQR 1-2). Continuous analyses detected significant differences between groups, whereas dichotomised analyses did not. Only 22.3% of exercise-based interventions achieved high reporting completeness. No improvement was observed after publication of the TIDieR checklist, and no meaningful association was found between methodological quality and reporting completeness. CONCLUSIONS: Reporting of UC comparator groups in exercise-based RCTs for knee osteoarthritis is poor and has not improved over time. Although exercise interventions are better reported, overall completeness remains low, highlighting the need for improved reporting practices to support clearer interpretation of clinical trial evidence.
Neuropsychopharmacologia Hungarica : a Magyar Pszichofarmakologiai Egyesulet lapja = official journal of the Hungarian Association of PsychopharmacologyAdrienne Incze
Bodily awareness has become a central therapeutic factor in psychodynamic and body-oriented psychotherapies, yet its clinical effects and theoretical status remain insufficiently integrated. This paper offers a clinically grounded account of bodily awareness work in Psychodynamic Movement and Dance Therapy (PMT), conceptualising the body as the primary medium of lived experience rather than as an object of intervention. Drawing on phenomenology, developmental psychoanalysis, and clinical theory, the paper argues that therapeutic change in PMT unfolds through prereflective, embodied processes that precede verbal reflection and symbolic articulation. To integrate these perspectives, it introduces the concept of the global mode of experience, defined as an amodal, prereflective organisation of experience in which bodily sensation and affective vitality are lived as an integrated whole. Rooted in Daniel Stern's work, this mode is understood as a stable, activatable capacity rather than a regressive state, with orientation to the reality of the here-and-now fundamentally preserved. The paper positions the global mode of experience as a clinically orienting framework for understanding both the therapeutic effects and the limitations of bodily awareness work, highlighting the importance of timing, containment, and indication in psychodynamic movement and dance therapy. (Neuropsychopharmacol Hung 2026; 28(3): 141-154)
Journal of the International Society of Sports NutritionClaire Buechel, Kate Pumpa, Naroa Etxebarria, Luke Ashton, Michelle Minehan
BACKGROUND: Resting Metabolic Rate (RMR) is measured in sport settings for health monitoring and nutrition planning; however, interpreting repeated measures requires an understanding of typical day-to-day variability under habitual, free-living conditions. This study quantified intra-individual variability in RMR among weight-stable strength-trained athletes, examined the impact of data processing approaches, and established protocol-specific least significant change (LSC) thresholds under ecological conditions. METHODS: A repeated-measures design was used to quantify intra-individual variability in RMR in 13 weight-stable strength-trained athletes (8 male, 5 female). RMR was measured on five consecutive mornings using the Parvo Medics TrueOne 2400 metabolic cart with a Hans Rudolph mouthpiece under standardized conditions. Breath-by-breath data were processed using multiple cleaning approaches to evaluate their impact on RMR estimates, with the most reliable method retained for analysis. Intra-individual variability was quantified and used to derive protocol-specific LSC thresholds. RESULTS: Session averaging produced the lowest intra-individual variability in RMR (CV: 3.4 ± 1.4%) compared with alternative data cleaning approaches. Mean RMR was 26.9 ± 1.4 and 29.1 ± 1.7 kcal·kgFFM-1·day-1 in males and females, respectively. The group-level LSC was 2.9 ± 1.2 kcal·kgFFM-1·day-1 (10.4 ± 4.2%), representing the magnitude of change required to exceed expected within-subject variability under the conditions of this protocol. Fat-free mass (FFM) was positively associated with both absolute RMR and day-to-day variability, whereas prior-day training load and protein intake showed no clear association with RMR variability. CONCLUSIONS: Notable intra-individual variability occurs in repeated RMR measurements in strength-trained athletes under applied conditions. Meaningful interpretation of change requires protocol-specific reliability estimates to distinguish true physiological change from expected day-to-day variation. Session averaging improves measurement consistency and is recommended for mouthpiece-based indirect calorimetry systems. RMR should be interpreted relative to individual and context-specific variability rather than universal thresholds.
The Libyan journal of medicineYuhang Yang, Ping Wang, Minshan Feng, Xunlu Yin, Aifeng Liu, Chengliang Zhong, Shengqiang Zhang, Futai Gong, Jian Liu, Zhiquan Wang, Bifeng Fu
BACKGROUND: Axial neck pain is a common manifestation of cervical degenerative disc disease (CDD). Rotation-traction manipulation (RTM) is widely used in China, but its comparative effectiveness and safety versus cervical traction remain uncertain. METHODS: In this prospective multicenter randomized controlled trial, 154 adults with CDD-related axial neck pain were randomized 1:1 to receive RTM (7 sessions over 2 weeks) or cervical traction (daily for 2 weeks). Outcomes were assessed at baseline, during treatment, and at 1 and 3 months after treatment. The primary outcome was pain intensity measured by the visual analogue scale (VAS); secondary outcomes were neck tenderness score (NTS) and cervical range of motion (ROM). Intention-to-treat analyses with multiple imputation were performed. RESULTS: All 154 randomized participants were included in the analyses, and 151 completed follow-up. Both groups showed significant improvement over time in VAS and ROM (both P < 0.001). Confirmatory mixed-effects analyses did not demonstrate significant between-group differences in VAS or ROM after adjustment for multiple comparisons. Exploratory analyses suggested that RTM provided faster improvement during the treatment phase and a small cumulative advantage in pain reduction, whereas cumulative ROM improvement did not differ significantly between groups. RTM was also associated with a faster reduction in neck tenderness severity. Adverse events were mild and infrequent, and no treatment-related radiographic deterioration was observed. CONCLUSIONS: Both RTM and cervical traction were associated with clinical improvement in patients with CDD-related axial neck pain. Confirmatory analyses did not demonstrate robust superiority of RTM for pain or cervical ROM, whereas exploratory analyses suggested faster early improvement and a small cumulative pain benefit with RTM. NTS findings should be interpreted cautiously because the tenderness score has not been formally validated. No serious adverse events were observed. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2400082667. Registered retrospectively on 4 April 2024.
Annals of medicineMeng Yuan, Si-Jin Lv, Meng-Ru Wu, Yu-Chen Lu, Min-Hao Zhang, Jian-Hua He
BACKGROUND: Postoperative pain after thoracic surgery remains common and challenging. Transcutaneous auricular vagus nerve stimulation (taVNS) is a noninvasive neuromodulation technique with potential analgesic effects. This study aimed to evaluate the efficacy and safety of taVNS for postoperative pain management in patients undergoing thoracoscopic partial lung resection. METHODS: Adults undergoing thoracoscopic partial lung resection were randomized to active or sham taVNS. The primary outcome was cough pain intensity at 48h post-surgery, assessed by Numeric Rating Scale (NRS). Secondary outcomes included cough pain at 24h and 72h, resting pain, moderate-to-severe pain incidence, opioid consumption, quality of recovery, postoperative pulmonary complications , chest tube duration, hospital stay, postoperative nausea/vomiting, and adverse events. RESULTS: Among 119 analyzed patients (active n = 60, sham n = 59), active taVNS reduced cough pain scores at 24h, 48h, and 72h postoperatively, as well as resting pain (p < 0.05). It also lowered the incidence of moderate-to-severe cough pain at 24h and 48h, reduced cumulative postoperative opioid use at 24h and 72h, and decreased rescue analgesia on postoperative day 3 (p < 0.05). Active taVNS was associated with a lower incidence of postoperative pneumothorax (p < 0.05). No serious adverse events occurred. CONCLUSION: Perioperative taVNS was associated with a modest analgesic benefit and reduced postoperative opioid requirements after thoracoscopic partial lung resection. The observed reduction in postoperative pneumothorax requires cautious interpretation, and further multicenter trials are needed to determine its clinical utility.
Brain research bulletinYi Gao, Weimin Li, Qi Ma, Xuechong Zhao, Qiujun Wang
Electroacupuncture (EA) has been identified as an effective intervention for mitigating postoperative cognitive dysfunction in the elderly; however, its underlying mechanisms remain inadequately understood. This study aimed to elucidate the neuroprotective effects of EA on anesthesia/surgery-induced cognitive impairment in aged rats through a combination of behavioral testing, RNA sequencing analysis, Golgi-Cox staining, dendritic spine analysis, Sholl analysis, immunofluorescence assays, and western blot analysis. The findings demonstrated that EA ameliorates anesthesia/surgery-induced cognitive decline by inhibiting hippocampal synaptic dysfunction, with a notable enrichment in the downregulation of IL-17A signaling and upregulation of ERK signaling. Furthermore, the study confirmed that an exogenous increase in IL-17A expression can induce hippocampal synaptic dysfunction and partially negate the neuroprotective effects of EA by inhibiting the expression of the ERK/CREB signaling pathway. In conclusion, EA attenuates anesthesia/surgery-induced cognitive impairment in aged rats by inhibiting IL-17A-mediated hippocampal synaptic dysfunction via the ERK/CREB signaling pathway.
INTRODUCTION: Postoperative nausea and vomiting (PONV) are common adverse events following gynecological laparoscopic surgery. This study aims to evaluate the efficacy of transcutaneous auricular vagus nerve stimulation in reducing the incidence of PONV within 24 h after gynecological laparoscopic surgery. METHODS AND ANALYSIS: This single-center, prospective, double-blinded, randomized and sham-controlled trial will enroll 200 patients scheduled for gynecological laparoscopic surgery. Participants will be randomized in a 1:1 ratio to either the taVNS group or the sham group. The taVNS group will receive electrical stimulation lasting for 30 min after anesthesia induction. Sham group will not provide stimulation. The primary endpoint is the incidence of PONV within the first 24 h after surgery. Secondary endpoints include the severity of PONV, the usage of rescue antiemetics and 5-point Likert satisfaction scale. Exploratory endpoints include consumption of opioids and heart rate variability within 24 h after surgery. DISCUSSION: The results of study will provide key evidence on the efficacy and safety of intraoperative taVNS for preventing PONV after gynecologic laparoscopic surgery.Trial registration: Chinese Clinical Trial Registry (registration No. ChiCTR2600120159; registered on March 10, 2026).
European journal of pharmaceutics and biopharmaceutics : official journal of Arbeitsgemeinschaft fur Pharmazeutische Verfahrenstechnik e.VXiaoyang Li, Xiaodan Wang, Yan Ming, Rongtao Li, Yun Yang, Jing Wang, Baiyu Chang, Qing Zhang, Jingling Tang, Jiaxin Liu, Hongyu Ji, Congcong Lin
Chronic wounds pose notable clinical challenges due to persistent infection, inflammation, and impaired tissue regeneration. We designed a multi-functional microneedle patch (MR-NPs-MNs) comprising chitosan-based microneedles encapsulating PLGA nanoparticles co-loaded with mupirocin and L-arginine. As a key component, L-arginine significantly enhances anti-inflammatory effects by reducing pro-inflammatory cytokines and effectively promotes tissue repair by regulating oxidative stress and facilitating angiogenesis. The PLGA nanoparticles MR-NPs exhibited stable physical properties (181.7 ± 5.875 nm particle size, 22.4 ± 0.529 mV zeta potential) and were incorporated into microneedles capable of withstanding 40.38 N compression. Notably, MR-NPs-MNs outperformed conventional mupirocin ointment, achieving a 99.82 ± 0.15% antibacterial rate (vs. 90.69 ± 1.11% for the ointment), superior biofilm inhibition (96.82 ± 0.83% and 77.8 ± 5.32%), and enhanced transdermal drug delivery. In vitro, MR-NPs-MNs increased NO production, reduced TNF-α, IL-6 and ROS levels, and promoted wound healing. In diabetic wound models, MR-NPs-MNs increased the healing rate by 1.54-fold, significantly reduced bacterial counts (P < 0.01) by day 9, and improved key healing parameters including collagen matrix reorganization, robust neovascularization, and functional tissue formation. With its biocompatible components, this system provides a potential local therapeutic platform for infected diabetic wound treatment.
Scandinavian journal of primary health careAstrid Maria Carolina Trulsson, Torsten Risør, Susanne Reventlow, Søren Thorgaard Skou, Anne Møller
BACKGROUND: Knee osteoarthritis (OA) is a prevalent condition and public health concern. Guidelines recommend non-surgical treatments - such as education, exercise and weight management - as core elements of OA management; however, uptake remains low. General practitioners (GPs) play a crucial role in delivery, yet little is known about how GPs navigate OA treatments in the Scandinavian context. AIM: To explore Danish GPs' perceptions and experiences of knee OA management, focusing on treatments and referral, and to identify key barriers and facilitators to delivering guideline-recommended treatments. METHODS: Twelve semi-structured online interviews were conducted with GPs and GP trainees. Participants were recruited through a combination of convenience and self-selection sampling. Data were analyzed inductively using thematic analysis. RESULTS: Four themes were identified: (1) knowledge and practice extend beyond guidelines, (2) non-surgical treatments are limited and inconsistently provided, (3) conceptual and relational tensions are negotiated and (4) fostering patient motivation is challenging. CONCLUSION: GPs displayed generally up-to-date knowledge of core non-surgical treatments, although familiarity with referral criteria was more variable. They held positive attitudes toward exercise and physiotherapy-led treatment, but experienced limited active dissemination of guidelines. Structural barriers, including fragmented pathways and uneven municipal services limited delivery of non-surgical treatments. Weight loss was viewed as effective in relieving joint pain but an unsustainable treatment focus, highlighting the need for a feasible, weight-inclusive approach to weight management. Strengthening cross-sector coordination, developing and implementing multidisciplinary OA services as well as clarifying where responsibility for fostering patient motivation should be placed, may enhance delivery of non-surgical care.
American journal of health promotion : AJHPKhansaa Abdullah, Elizabeth Ablah, Vicki Collie-Akers, Laurie P Whitsel
ContextPhysical inactivity is a major contributor to chronic disease, disability, and premature mortality in the United States and is associated with substantial healthcare expenditures. Although regular physical activity improves health outcomes, individuals with chronic conditions often require structured supervision to exercise safely and effectively. Building upon this context, the objective of this review is to synthesize evidence on the clinical, psychosocial, and economic impacts of supervised exercise interventions (SEIs) and to examine policy and implementation factors influencing their adoption. To achieve this objective, a structured literature review was conducted, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework.Eligibility CriteriaStudies published in English between 2010 and 2024 that involved adults aged 18 years or older and evaluated supervised exercise interventions with reported clinical, psychosocial, economic, or policy-related outcomes were included.Study SelectionPubMed, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched using predefined keywords. Reference lists of relevant studies were also reviewed to identify additional eligible articles.Main Outcome MeasuresClinical outcomes (eg, mortality, aerobic capacity, HbA1c), psychosocial outcomes (eg, adherence, depression, quality of life), and economic and policy outcomes (eg, cost-effectiveness, reimbursement).ResultsTwenty studies met the inclusion criteria. Across cardiovascular, metabolic, oncologic, pulmonary, and geriatric populations, SEIs were associated with improved clinical outcomes, including reduced rehospitalization and mortality, enhanced aerobic capacity, improved glycemic control, and reductions in fatigue and depressive symptoms. SEIs were cost-effective across disease categories, with several studies reporting healthcare cost savings within 1 year. However, disparities in referral and participation persisted among racial and ethnic minorities, rural populations, and individuals with lower socioeconomic status.ConclusionSEIs are effective and scalable strategies for managing chronic diseases and preventing secondary complications. Evidence indicates that supervised exercise improves clinical, psychosocial, and economic outcomes across diverse populations. Expanding reimbursement and strengthening integration within health systems will be critical to improving equitable access to SEIs.
BACKGROUND: Transcutaneous auricular vagus nerve stimulation (taVNS) provides targeted modulation of the autonomic nervous system and descending pain pathways, exerting analgesic potential. However, high-quality evidence remains insufficient to determine whether taVNS can effectively replace opioids in sedation regimens for same-session bidirectional endoscopy while maintaining the quality of early postoperative recovery. DISCUSSION: This study is a single-center, prospective, randomized, double-blind, placebo-controlled, three-arm non-inferiority trial. A total of 181 patients scheduled for painless same-session bidirectional endoscopy will be enrolled and randomly assigned using dynamic block randomization to one of three groups: Group S (sufentanil 0.1 µg/kg plus sham taVNS), Group T (normal saline plus active taVNS), and Group P (normal saline plus sham taVNS). All participants will receive ciprofol for sedation induction and maintenance. The primary outcome will be the quality of recovery at 24 h postoperatively, assessed using the 15-item Quality of Recovery scale (QoR-15), with a predefined non-inferiority margin (δ) of 6 points, which corresponds to the minimal clinically important difference of the QoR-15 scale. Secondary outcomes will include perioperative adverse events (pre-, intra-, and postoperative, including taVNS-related events), QoR-15 score at 1 h postoperatively, procedural and recovery efficiency indices, sedative dosage, and patient and endoscopist satisfaction scores. Blinding effectiveness will be assessed in all participants, and statistical analyses will follow the modified intention-to-treat principle. CONCLUSION: This study protocol will rigorously assess the effectiveness and safety of taVNS as an alternative to opioid analgesics for sedation during same-session bidirectional endoscopy using, to our knowledge, the first three-arm design.Trial registration: Chinese Clinical Trial Registry (ChiCTR2600117962).
Complementary therapies in medicineXin Liu, Xiaona He, Yuyue Yang, Jiayan Chen, Jun Xiong, Wei Gao
OBJECTIVE: This review evaluates the effects of wearable device-telemonitored Baduanjin on exercise tolerance and cardiac function in patients with chronic heart failure (CHF). METHODS: A comprehensive literature search was performed in PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database and Chinese Biomedical Literature Database (CBM) from their inception to 1 January 2026. The search aimed to identify randomised controlled trials investigating Baduanjin for CHF that explicitly used wearable devices. Study screening, data extraction and Cochrane RoB 2.0 bias assessment were performed independently by two reviewers with discrepancies were resolved by a third. Given significant clinical heterogeneity across the included studies, a narrative synthesis of the findings was conducted, supported by tabulated presentation of outcome data. RESULTS: Three randomized controlled trials involving 248 participants were included. Individual studies reported that wearable device-telemonitored Baduanjin was associated with improvements in several clinical outcomes in patients with CHF. Reported benefits included increased 6-minute walking distance (568.58 m vs. 367.47 m, P < 0.05), higher peak oxygen uptake (19.00 vs. 17.00 ml/[kg·min], P < 0.001) and improved left ventricular ejection fraction (52.60% vs. 45.28% and 42.79%, P < 0.05). Improvements were also observed in quality of life, depression symptoms, cardiovascular readmission in the intervention group of individual studies. No exercise-related adverse events were reported. CONCLUSION: Current evidence suggests that wearable device-telemonitored Baduanjin may potentially improve key outcomes in patients with chronic heart failure, However, these findings are based on a narrative synthesis of individual studies and should therefore be interpreted cautiously. Further high-quality, standardised randomised controlled trials are urgently needed.
BACKGROUND: In contemporary sports science, athletes and coaches continuously explore strategies to reduce training load and injury risk while increasing muscular strength and sport-specific performance. This meta-analysis evaluated the effects of blood flow restriction training (BFRT) combined with resistance training (RT) on lower-limb muscle strength and sport-specific performance in athletes. METHODS: Relevant randomized controlled trials (RCTs) were systematically searched across major databases (e.g. PubMed, Web of Science, Cochrane, CNKI, Wanfang Data, and Embase) from inception until November 2024. Two independent reviewers carefully assessed the studies. Data analysis was carried out using RevMan 5.4 software, which included heterogeneity testing, meta-analysis, subgroup analysis, and assessment of publication bias. RESULTS: Ten RCTs (181 athletes; 91 in the BFRT and RT group, 90 in the control group) were included. Outcomes determined BFRT combined with RT yielded notable enhancements in lower-limb muscle strength (SMD = 1.09, 95% CI [0.52, 1.66], p < 0.05) and muscle hypertrophy (MD = 1.09, 95% CI [0.10, 2.09], p < 0.05) compared to control training. However, no significant improvement in sport-specific performance was found (SMD = 0.11, 95% CI [-0.18, 0.40], p = 0.46). Substantial heterogeneity was observed for strength outcomes (I2 = 75%), whereas low heterogeneity was observed for sport-specific performance and hypertrophy outcomes (I2 = 0%). No evidence of significant publication bias was detected. CONCLUSION: BFRT combined with RT appears to provide effective augmentation of lower-limb muscle strength and hypertrophy in athletes compared to RT or conventional training alone. It may be prudent to integrate this approach systematically into training cycles to optimize physiological muscle stimulation and training outcomes, despite not directly improving sport-specific performance.
Although electroacupuncture (EA) yields favorable clinical outcomes for vascular dementia (VD), its mechanisms remain poorly understood. This study aimed to investigate the protective effects of EA on VD by regulating growth hormone (GH). A rat VD model was induced by multiple microinfarction (MMI). EA was applied at Baihui (GV20) and Shenting (GV24), and its effects on cognitive function and synaptic lesions were assessed. Hippocampal synaptic morphology and synaptic protein expression, as well as GH level were detected using transmission electron microscopy and biochemical methods. Finally, GH and PGC-1α agonists were used for mechanistic validation. Our results showed that MMI rats presented severe cognitive deficits and synaptic dysfunction relative to sham rats, and EA successfully alleviated these abnormalities. The expression of GH-related and mitochondrial proteins in the hippocampus continuously decreased on D7, D14 and D21 post-modeling, and EA significantly prevented such reductions. EA also increased hippocampal GH level and repaired damaged mitochondria in VD rats. Of note, GH receptor and PGC-1α agonists exerted similar beneficial effects as EA, validating the proposed mechanism. Collectively, EA at GV20 and GV24 increases hippocampal GH levels, rescues mitochondrial and synaptic dysfunction in VD rats, and possesses great potential for clinical application.
Complementary therapies in medicineHongliang Wang, Shiwei Chen, Wenling Gou, Jian Huang, Xue Han
BACKGROUND: Physical exercise has received increasing attention as a complementary approach for managing post-traumatic stress disorder (PTSD). Nevertheless, evidence regarding its effectiveness across different exercise modalities and populations remains mixed. This systematic review and meta-analysis synthesizes findings to assess the impact of structured exercise programs on PTSD symptom severity and to explore potential moderators. METHODS: Searches of PubMed, Embase, Web of Science, the Cochrane Library, and EBSCOhost-SportDiscus were conducted from inception to 27 September 2025. We included randomized controlled trials in which participants receiving an exercise intervention were compared with those receiving usual care or a control condition without structured physical activity. Subgroup analyses were conducted based on exercise type, participant characteristics, and outcome measures. In addition, a random-effects meta-regression was used to examine whether the total supervised training duration influenced treatment efficacy. RESULTS: Sixteen randomized controlled trials involving 663 participants met the inclusion criteria. Pooled findings indicated that exercise interventions were associated with a significant reduction in PTSD symptoms (Hedges' g = -0.49, 95% CI -0.76 to -0.22). Subgroup analyses suggested that yoga-based interventions and studies involving military populations showed larger effect sizes; however, differences between subgroups were not statistically significant. Training duration did not significantly moderate the treatment outcome. CONCLUSIONS: This review provides evidence that physical exercise can effectively reduce PTSD symptoms. Beneficial effects were observed across different exercise modalities and populations, although no statistically significant subgroup differences were identified. These findings support structured exercise as a promising and scalable component of PTSD treatment strategies.
Stress (Amsterdam, Netherlands)Margherita Barbetti, Luca Carnevali, Andrea Sgoifo
Chronic stress exposure contributes to the onset and maintenance of a wide range of mental and physical disorders. Non-invasive modulation of vagal pathways has received increasing attention as a potential strategy for the prevention and treatment of stress-related conditions, given the central role of the vagus nerve in brain-body communication. By stimulating auricular vagal afferents, transcutaneous auricular vagal nerve stimulation (taVNS) is proposed to engage stress regulatory circuits, with downstream effects that may modulate stress-related physiology. Consistent with this mechanistic rationale, preclinical rodent research has begun investigating the effectiveness of taVNS as a non-invasive approach to mitigate stress-related outcomes. The aim of this narrative review is to summarize this emerging preclinical evidence, focusing on potential mechanisms involving central neural circuits implicated in stress regulation, as well as downstream autonomic function, inflammatory signaling pathways, and gut microbiota composition. Collectively, available studies support taVNS as a multi-system modulator of stress responses acting through interconnected neural, autonomic, immune, and gut-brain pathways. However, preclinical taVNS research remains at an early stage. Major unresolved challenges include the lack of standardized stimulation parameters and insufficient consideration of biological sex as a critical experimental variable. Addressing these limitations will be essential to improve reproducibility and strengthen translational relevance.
Life sciencesDiego Gomes de Melo, Camila Oliveira Ramos, Vivian Cristina da Cruz Rodrigues, Gustavo José de Sá Pereira, Rafael Dos Santos Brícola, Dennys Esper Corrêa Cintr…
Adipose tissue plays a central role in systemic metabolic regulation, and impairments in lipid turnover are a hallmark of obesity associated adipose dysfunction. Lipolytic activation depends on perilipin-1 (PLIN1) phosphorylation, which enables the release of α/β-hydrolase domain-containing-5 (ABHD5), a key co-activator of adipose triglyceride lipase (ATGL). Obesity disrupts this regulatory axis, reducing ABHD5 expression and favoring a lipogenic and monounsaturated fatty acid (MUFA) enriched environment driven in part by increased stearoyl-CoA desaturase-1 (SCD1). These contribute to adipocyte hypertrophy, impaired lipid mobilization, and dysfunctional extracellular matrix. This study investigated whether a brief strength training protocol following fourteen weeks of induction on a high-fat diet containing 35% fat could restore the lipolytic machinery and rebalance lipid metabolism in the mesenteric adipose tissue of obese Swiss mice. Seven days of strength training at 70% of loading capacity increased ABHD5 gene expression (p = 0,0012) and protein content (p = 0,0003), accompanied by elevations in pHSL and pPLIN1 (p = 0,0062 and p = 0,0002), indicating lipolytic activation. Exercise reduced mass and adipocyte size, and demonstrated that obesity increased MUFA abundance (p = 0,0039). Correlation revealed that SCD1 showed a positive association with sedentarism, these gene as central determinant of lipid composition in mesenteric adipose tissue. Additionally, strength training decreases MMP2 and increases MMP9 activity (p = 0,002 and p = 0,0001), a pattern consistent with adaptive structural reorganization rather than fibrotic progression. Collectively, these findings indicate that short-term strength training is a non-pharmacological strategy to counteract mesenteric adipose dysfunction by restoring lipolytic balance and improving lipid metabolic profiles before mass loss and changes in eating behavior occur.
Annals of medicineYung-Fong Tsai, Yu Chang, Sheng-Dean Luo, Amina M Illias, Shao-Chun Wu
BACKGROUND: To evaluate whether warm intranasal saline irrigation (38-40 °C) during functional endoscopic sinus surgery (FESS) is associated with reduced intraoperative bleeding compared with standard cold irrigation (18-21 °C). METHODS: We performed a single-centre retrospective cohort study of consecutive FESS procedures under inhalational general anaesthesia (January 2017-December 2022). After exclusions, 1,990 cases were eligible. One-to-one propensity score matching (age, sex, ASA class, and type of inhaled anaesthetic) yielded 409 warm and 409 cold cases. Primary outcomes were estimated blood loss and blood loss >50 mL. Secondary outcomes included anaesthesia duration, intraoperative medication requirements, and lowest recorded temperature. Multivariable logistic regression adjusted for BIS monitoring utilisation, intravenous fluid rate, and intraoperative antihypertensive medication use. RESULTS: Median blood loss was 50 mL (IQR 50-50) with warm irrigation versus 50 mL (IQR 50-100) with cold irrigation (p = 0.001). Blood loss >50 mL occurred in 18.6% versus 32.0%, respectively (p < 0.001). Warm irrigation remained independently associated with lower odds of blood loss >50 mL (adjusted OR 0.45, 95% CI 0.31-0.66; p < 0.001). BIS monitoring was also protective (adjusted OR 0.57, 95% CI 0.37-0.87; p = 0.009). Warm irrigation was associated with shorter anaesthesia duration (median 2.82 vs 3.38 h; p < 0.001) and a slightly higher nadir temperature (35.6 vs 35.5 °C; p = 0.007). CONCLUSIONS: Warm intranasal saline irrigation at 38-40 °C was associated with fewer clinically significant bleeding events during routine FESS and may represent a simple, low-cost adjunct to perioperative haemostatic management.
Sleep medicineAlexis C Shindhelm, Alan R Tesson, Emily A Commesso, Shakthi Unnithan, Russel R Kahmke, Matthew D Ellison, Hussein R Al-Khalidi, Stephen V Gliske, Rodney A Rad…
Obstructive sleep apnea (OSA) severity varies by sleep position and sex; however, it is unknown whether these factors affect hypoglossal nerve stimulation (HGNS) treatment effectiveness. Thus, this study evaluates HGNS control of OSA by sleep position and sex. To enhance real-world clinical applicability of results and address concerns regarding appropriate postoperative sleep study criteria to evaluate HGNS outcomes, our study also proposes and utilizes a standardized HGNS titration study scoring protocol to assess apnea-hypopnea index (AHI). A retrospective cohort of adult patients underwent device implantation at a tertiary care center between January 2018 and June 2021. Outcome measures included response rate by sleep position and sex using Sher criteria (reduction of AHI ≥50% to < 20/hr) and AHI normalization (<5/hr). Of 181 patients implanted, 113 patients met inclusion criteria. Patients were primarily older (median 65.0 years), overweight (BMI 30.0), white (91.2%) males (67.3%) with severe OSA (AHI 32.0/hr). HGNS success by Sher criteria and AHI normalization were 77.0% and 54.1%, respectively, in lateral sleep compared to 52.9% and 23.5% in supine sleep. Females attained a greater supine AHI reduction (p < 0.04, Wilcoxon rank-sum test) and success by both response criteria (both p < 0.03, chi-square tests of independence). Subgroup analyses using fixed-voltage home sleep apnea tests were underpowered and limited by low counts. Thus, HGNS more effectively controlled OSA in lateral sleep and for females, suggesting clinically meaningful differences by sleep position and sex that may help inform clinical decision making for patients with similar demographics.