Lavage-Drainage Approach may Improve Spontaneous esophageal rupture Outcomes: Study

Researchers have found in a new study that the Lavage-Drainage method increased drainage efficiency, lowered inflammation, and improved prognosis in patients with Spontaneous oesophageal rupture. Despite these positive outcomes, the study’s limitations highlight the need for further multi-centre prospective research to refine the treatment and reduce associated costs.

Spontaneous esophageal rupture (SER) is a rare and severe emergency with high mortality, and the treatment algorithm remains controversial. This retrospective study analyzed SER cases that underwent VATS debridement and drainage in Jinling Hospital from January 2014 to July 2024. Patients were divided into Lavage-Drainage and Drainage groups based on whether they received a lavage tube cathetering through the esophageal fistula under gastroscope. Preoperative fluid resuscitation, thoracoscopic mediastinotomy, and thoracic debridement were performed. Post-operative management included fasting, enteral nutrition, anti-infective agents, and fluid and electrolyte balance maintenance. Monitoring indicators included vital signs, laboratory test results, postoperative complications, and other relevant factors. Results: A total of 24 patients were enrolled, with 11 in the Lavage-Drainage group and 13 in the Drainage group. The Lavage-Drainage group had lower 30-day mortality, fewer complications and adverse events, and a faster reduction in inflammatory factors, but a higher cost. There was no significant difference in the length of mechanical ventilation, hospital stay, and ICU stay. The Lavage-Drainage approach enhanced the drainage efficiency, reduced the inflammation level, and improved the prognosis of SER. However, this study has some limitations, and further multi-center prospective studies are needed to optimize the treatment and reduce costs.

Reference:

Huang, Z., Zhao, P., Qiu, B. et al. Effects of the lavage through fistula in treatment of spontaneous esophageal rupture by combined thoracoscopic and gastroscopic management. World J Emerg Surg 20, 51 (2025). https://doi.org/10.1186/s13017-025-00630-6

Keywords:

Lavage-Drainage, Approach, Improve, Spontaneous, esophageal, rupture, Outcomes, Study, Huang, Z., Zhao, P., Qiu, B, Boerhaave’s syndrome, Spontaneous rupture of the esophagus, Gastroscopy, Thoracoscopy, Video-assisted thoracoscopic surgery (VATS)

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Hyperprolactinemia Potentially Linked to Insulin Resistance and Metabolic Dysfunction in PCOS: Study

A new study published in the International Journal of Molecular Sciences showed that hyperprolactinemia may act as a pathophysiological link between obesity, insulin resistance, and impaired carbohydrate metabolism in PCOS patients. Elevated prolactin levels could serve as an additional marker of insulin resistance and potentially worsen it in affected women.

According to the diagnostic criteria used, the prevalence of polycystic ovarian syndrome (PCOS), the most prevalent endocrine condition among women of reproductive age, ranges from 5 to 20%. When two of the three criteria 9chronic anovulation, clinical or laboratory hyperandrogenism, and the existence of polycystic ovaries) are met, PCOS is diagnosed.

Moderate to severe insulin resistance is a hallmark of polycystic ovarian syndrome. In women with PCOS, obesity significantly alters the clinical and laboratory profile. Obesity increases the risk of overt diabetes mellitus in addition to decreasing fertility and worsening insulin resistance.

The prevalence of hyperprolactinemia in women with PCOS described in the literature varies greatly, ranging from less than 5% to more than 65%, due to the many variables that impact both PCOS and hyperprolactinemia. Due to prolactin’s lipogenic properties and impact on the metabolic profile, hyperprolactinemia in PCOS patients may further worsen the loss in insulin sensitivity. Thus, this study by Vesselina Yanachkova and team looked into the prolactin levels in the blood of women with PCOS and how they relate to prediabetes, obesity, and insulin resistance.

The computerized database of 157 women with PCOS diagnoses was used in a retrospective monocentric analysis. After OGTT, measurements were made of serum prolactin, BMI, the full glucose-insulin profile, and insulin resistance indicators. The BMI (p = 0.007), fasting glucose (p = 0.003), insulin levels (p < 0.001), and HOMA-IR (p < 0.001) of the women with hyperprolactinemia (40.8%) were all considerably higher.

Prolactin levels were considerably greater in PCOS women who were classified as overweight/obese (47.1%), insulin resistant (68.8%), having impaired fasting glycemia (28.7%), and prediabetic (36.3%) than in their respective counterparts. Therefore, among women with PCOS, greater prolactin levels were substantially linked to an increased risk of developing overweight/obesity, insulin resistance, and prediabetes.

Overall, the findings suggest that hyperprolactinemia may be a pathophysiological connection between PCOS patients’ obesity, insulin resistance, and abnormalities in their carbohydrate metabolism. In women with polycystic ovary syndrome, elevated prolactin levels might be an additional indicator of insulin resistance.

Source:

Yanachkova, V., & Stankova, T. (2025). Abnormally increased prolactin levels in women with polycystic ovarian syndrome are associated with risk of obesity, insulin resistance and prediabetes. International Journal of Molecular Sciences, 26(9). https://doi.org/10.3390/ijms26094239

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No increased risk of gynecological cancer with testosterone use after five years: Study

Transmasculine and gender-diverse individuals who use testosterone are not at increased risk of gynecological cancer in the first years of hormone therapy. This is evident from large-scale research by Amsterdam UMC, which was published today in eClinicalMedicine. The results provide important insights for healthcare providers and transmasculine and gender-diverse individuals who are considering starting hormone therapy.

Transmasculine and gender-diverse people are registered as women at birth, but do not feel male, non-binary or otherwise at home within the traditional image of being a woman. Many of them choose to use testosterone: a hormone therapy that induces physical changes that are more in line with their gender identity and/or expression.

Researchers at Amsterdam UMC followed 1955 young transmasculine and gender-diverse individuals, who used testosterone for an average of five years. They specifically investigated the risk of cancer of the uterus, ovaries, vagina and vulva during testosterone use.

Asra Vestering, researcher at Amsterdam UMC, explains: “We found no increased risk of these cancers compared to women from the general population. None of these cancers were diagnosed in the entire participant group. This is valuable information for both healthcare providers and transmasculine and gender-diverse people who are considering starting hormone therapy.”

It was also striking that in some of the participants the endometrium was still active, or that signs of ovulation were observed, despite the use of testosterone. Wouter van Vugt, co-researcher at Amsterdam UMC, explains: “This is not only relevant for long-term health, but also means that despite testosterone use, there is still a chance of pregnancy. That is why good gynaecological care and contraceptive care remains essential for this group, even after the start of hormone therapy.”

In recent years, gender registration legislation in the Netherlands has been relaxed, making surgical gender removal no longer a requirement to legally change gender. As a result, more and more transmasculine and gender-diverse people are choosing to start hormone therapy first, without undergoing sex removal surgery (immediately).

Although no definitive conclusions can yet be drawn about the effects of long-term testosterone use, these findings offer reassurance for individuals who have started or want to start testosterone use. Vestering emphasizes: “This research provides important knowledge for better information and guidance of transmasculine and gender-diverse people. At the same time, follow-up research into the effects of long-term testosterone use remains necessary, so that care can be further tailored to safety and quality of life.”

Reference:

Incidence of Gynaecological (Pre-)Malignancies and Endometrial Activity in Transmasculine and Gender Diverse Individuals Using Testosterone: A Retrospective, Single-Centre Cohort Study, eClinicalMedicine (2025).

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Antidepressant withdrawal symptoms more common among long-term users, reveals study

People who have been taking antidepressants for more than two years are substantially more likely to experience withdrawal symptoms compared to short-term users when they come off the medication, finds a new study led by UCL researchers.

Long-term users also tend to experience worse withdrawal symptoms, and for a longer period of time, than short-term users, and are less likely to be able to stop taking the drug when they attempt to do so, according to the findings published in Psychiatry Research.

The study’s lead author Dr Mark Horowitz, visiting clinical researcher at UCL Division of Psychiatry, said: “Our findings confirm what many researchers have long suspected, that the likelihood of experiencing withdrawal symptoms when coming off antidepressants is largely determined by duration of use.

“While coming off antidepressants can be easier for people who have only taken them for a short period of time, these drugs are commonly used for a long time. Half of those in the UK who take antidepressants have taken the medication for at least a year, and the majority of US antidepressants users have been taking them for over two years.”

The study was based on survey responses from 310 participants in England, who had been accessing NHS primary care therapy services, and who had at one point attempted to stop taking their prescribed antidepressant. Most participants – 62% – reported that antidepressants had been helpful to them.

Respondents were asked about an extensive list of potential withdrawal symptoms, and self-reported whether the symptoms were mild, moderate, or severe. Across the whole group, 79% reported at least one withdrawal symptom and 45% experienced symptoms they classified as moderate or severe (30% and 15%, respectively).

Across the entire group, 38% said they were unable to stop antidepressants when they tried to do so, rising to 79% among people who had been taking antidepressants for two years or more.

As some withdrawal symptoms (such as anxiety, worsened mood, agitation and fatigue) overlap with depression and anxiety symptoms and may represent relapse, the researchers also separated those out to find that 76% of respondents experienced at least one non-emotional withdrawal symptom such as dizziness, headache, vertigo, or nausea, while 43% experienced four or more non-emotional symptoms.

In analysis conducted by researchers in the UCL Division of Psychology & Language Sciences, the team found that how long someone had been on an antidepressant was the major determining factor for incidence, severity, and duration of withdrawal effects, and whether someone was able to stop taking the medication. The differences between short-term and long-term users were not explained by the severity of the underlying depression or anxiety disorder.

The researchers found that the odds of experiencing any withdrawal effects were 10 times greater for those who had been on antidepressants for more than two years, compared to those who had been taking them for less than six months.

Among people who had been taking antidepressants for two years of more, 64% reported moderate or severe withdrawal effects (25% reported severe effects), while among those who had been taking the medication for six months or less, the majority (73%) reported either no withdrawal effects or only mild symptoms, with only 7% experiencing severe withdrawal symptoms.

For long-term users, 30% reported withdrawal symptoms lasting more than three months, with 12% experiencing such symptoms for more than a year, while only 10.5% of short-term users experienced withdrawal symptoms for more than three months. For most short-term users, withdrawal symptoms resolved in under four weeks.

Dr Horowitz said: “This is one reason to use antidepressants for no longer than necessary – because doing so may make it harder to stop using them later on.”

The researchers say that one limitation of the study is that the survey response rate was less than one in five (18%). Respondents may have been more motivated to answer the survey if they experienced withdrawal symptoms, although the survey was not solely focused on withdrawal.

While the researchers asked whether people had been easing themselves off antidepressants slowly with a tapering technique, or quitting all at once, the results were inconclusive as not enough participants had been tapering for more than four weeks. The researchers say that as other studies have suggested that tapering is beneficial, further research is needed into how best to taper from antidepressants, and how it can mitigate withdrawal symptoms.

Senior author Professor Joanna Moncrieff (UCL Division of Psychiatry) said: “Withdrawal symptoms are commonly experienced by people coming off antidepressants, so we would advise that people who want to stop taking the medication should do so in consultation with an informed health professional.”

Reference:

Mark A. Horowitz, Joshua E.J. Buckman, Rob Saunders, Elisa Aguirre, James Davies, Joanna Moncrieff, Antidepressants withdrawal effects and duration of use: a survey of patients enrolled in primary care psychotherapy services, Psychiatry Research, 2025, https://doi.org/10.1016/j.psychres.2025.116497.

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Atacicept Significantly Reduces Proteinuria in IgA Nephropathy: Phase 3 Trial Results

Researchers have found in phase 3 ORIGIN 3 trial that investigational dual BAFF/APRIL inhibitor atacicept significantly reduced proteinuria in patients with immunoglobulin A nephropathy (IgAN). The randomized, double-blind, placebo-controlled study involved 431 patients receiving either atacicept 150 mg or placebo weekly via subcutaneous injection.

The primary outcome measured was the change in 24-hour urine protein-to-creatinine ratio (UPCR) at 36 weeks, demonstrating notable improvement with atacicept treatment.

Participants treated with atacicept achieved a 46% reduction from baseline in proteinuria as measured by 24-hour urine protein-to-creatinine ratio (UPCR), with a statistically significant and clinically meaningful 42% reduction in UPCR compared to placebo (p<0.0001) at week 36. For other prespecified endpoints, atacicept treatment also demonstrated results that were consistent with or better than those previously observed in the ORIGIN Phase 2b trial. The safety profile of atacicept in this analysis was favorable, and comparable to placebo. Vera plans to share these results with the FDA in the coming weeks, and full results will be submitted to the American Society of Nephrology Kidney Week.

“ORIGIN 3 is the first Phase 3 clinical trial in IgAN to demonstrate this magnitude of UPCR reduction compared to placebo at week 36. These results convincingly demonstrate the impact of atacicept to reduce proteinuria,” said Richard Lafayette, M.D., F.A.C.P., Professor of Medicine, Nephrology and Director of the Glomerular Disease Center at Stanford University Medical Center, and a primary investigator for both ORIGIN 2b and ORIGIN 3.

“If approved, we believe that atacicept has the potential to advance the standard of care in IgAN as the first dual BAFF/APRIL inhibitor. We currently plan to submit a BLA for atacicept in IgAN to the FDA in the fourth quarter of this year, which may allow for US approval and commercial launch in 2026. We are grateful to the study participants, their families and caregivers, the study investigators and staff, our research partners, and the Vera team for their ongoing commitment and dedication to this important research,” said Marshall Fordyce, M.D., Founder and CEO of Vera Therapeutics. “Vera aspires to evolve the practice of kidney medicine with the hope that, one day, patients may no longer face a future of dialysis or transplantation. Vera is poised for potential commercial launch of atacicept in 2026 and to pursue development in additional indications in other autoimmune kidney diseases and beyond.”

“Patients with IgA nephropathy, as well as their families and care partners, suffer from clinical uncertainty and the horrible outcome of kidney failure. In addition to clinical signs and symptoms, IgAN has a devastating impact on quality of life and mental wellbeing. I’m thrilled with the progress that is being made in developing new treatments for patients,” said Bonnie Schneider, Director and Cofounder of the IgA Nephropathy Foundation.

ORIGIN 3 is an ongoing global, multicenter, randomized, double-blind, placebo-controlled Phase 3 trial of 431 adults with IgA nephropathy. Participants were randomized 1:1 to atacicept 150 mg, self-administered at home via once weekly subcutaneous injection, or placebo. The primary efficacy endpoint was the change in 24-hour UPCR compared to placebo at the 36-week interim analysis. The trial continues in a placebo-controlled blinded manner to evaluate the change in kidney function over two years as measured by eGFR and is expected to complete in 2027.

About Atacicept

Atacicept is an investigational recombinant fusion protein that contains the soluble transmembrane activator and calcium-modulating cyclophilin ligand interactor (TACI) receptor that binds to the cytokines B-cell activating factor (BAFF) and A PRoliferation-Inducing Ligand (APRIL). These cytokines are members of the tumor necrosis factor family that promote B-cell survival and autoantibody production associated with certain autoimmune diseases, including IgAN, other autoimmune kidney diseases and lupus nephritis.

The ORIGIN Phase 2b clinical trial of atacicept in IgAN met its primary and key secondary endpoints, with statistically significant and clinically meaningful proteinuria reductions and stabilization of eGFR versus placebo through 36 weeks. The safety profile during the randomized period was comparable between atacicept and placebo. Through 96 weeks, atacicept demonstrated further improvements in Gd-IgA1, hematuria, and proteinuria, as well as stabilization of eGFR reflecting a profile consistent with that of the general population without IgAN.

Atacicept has received FDA Breakthrough Therapy Designation for the treatment of IgAN, which reflects the FDA’s determination that, based on an assessment of data from the ORIGIN Phase 2b clinical trial, atacicept may demonstrate substantial improvement on a clinically significant endpoint over available therapies for patients with IgAN. Vera believes atacicept is positioned for best-in-class potential, targeting B cells to reduce autoantibodies and having been administered to more than 1,500 patients in clinical trials across different indications.

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Tau PET Positivity Linked to Higher Risk of Alzheimer’s Progression: JAMA

Researchers have found in a large study that among cognitively unimpaired individuals there was a notable number of positive tau PET scans. When combined with Aβ PET positivity, tau PET positivity was strongly associated with increased risk of clinical progression in both preclinical and symptomatic stages of Alzheimer’s disease (AD). The study highlights tau PET’s potential as a valuable biomarker for staging Alzheimer’s disease pathology.

Tau positron emission tomography (PET) allows in vivo detection of neurofibrillary tangles, a core neuropathologic feature of Alzheimer disease (AD).

A study was done to provide estimates of the frequency of tau PET positivity and its associated risk of clinical outcomes. Longitudinal study using data pooled from 21 cohorts, comprising a convenience sample of 6514 participants from 13 countries, collected between January 2013 and June 2024. Cognitively unimpaired individuals and patients with a clinical diagnosis of mild cognitive impairment (MCI), AD dementia, or other neurodegenerative disorders were included. Tau PET with flortaucipir F 18, amyloid-β (Aβ) PET, and clinical examinations. Tau PET scans were visually rated as positive according to a US Food and Drug Administration– and European Medicines Agency–approved method, designed to indicate the presence of advanced neurofibrillary tangle pathology (Braak stages V-VI). Results Among the 6514 participants (mean age, 69.5 years; 50.5% female), median follow-up time ranged from 1.5 to 4.0 years. Of 3487 cognitively unimpaired participants, 349 (9.8%) were tau PET positive; the estimated frequency of tau PET positivity was less than 1% in those aged younger than 50 years, and increased from 3% (95% CI, 2%-4%) at 60 years to 19% (95% CI, 16%-24%) at 90 years. Tau PET positivity frequency estimates increased across MCI and AD dementia clinical diagnoses (43% [95% CI, 41%-46%] and 79% [95% CI, 77%-82%] at 75 years, respectively). Most tau PET–positive individuals (92%) were also Aβ PET positive. Cognitively unimpaired participants who were positive for both Aβ PET and tau PET had a higher absolute risk of progression to MCI or dementia over the following 5 years (57% [95% CI, 45%-71%]) compared with both Aβ PET–positive/tau PET–negative (17% [95% CI, 13%-22%]) and Aβ PET–negative/tau PET–negative (6% [95% CI, 5%-8%]) individuals. Among participants with MCI at the time of the tau PET scan, an Aβ PET–positive/tau PET–positive profile was associated with a 5-year absolute risk of progression to dementia of 70% (95% CI, 59%-81%). In a large convenience sample, a positive tau PET scan occurred at a nonnegligible rate among cognitively unimpaired individuals, and the combination of Aβ PET positivity and tau PET positivity was associated with a high risk of clinical progression in both preclinical and symptomatic stages of AD. These findings underscore the potential of tau PET as a biomarker for staging AD pathology.

Reference:

Moscoso A, Heeman F, Raghavan S, et al. Frequency and Clinical Outcomes Associated With Tau Positron Emission Tomography Positivity. JAMA. Published online June 16, 2025. doi:10.1001/jama.2025.7817

Keywords:

Tau, PET, Positivity, Linked, Higher Risk, Alzheimer’s , Progression, JAMA , Moscoso A, Heeman F, Raghavan S

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Women who work nightshifts are more likely to have asthma, suggests study

Women who work night shifts are more likely to suffer with moderate or severe asthma compared to women who work in the daytime, according to a study published in ERJ Open Research.

The research, which included more than 270,000 people, found no such link between asthma and working nightshifts in men.

The study was by Dr Robert Maidstone from the University of Manchester, UK, and colleagues. He said: “Asthma disproportionately affects women. Women generally have more severe asthma, and higher rate of hospitalisation and death from asthma compared to men.

“In our previous research we found a higher risk of moderate or severe asthma in nightshift workers, so we wanted to see whether there were further differences between the sexes.”

The researchers used data from the UK Biobank. They included a total of 274,541 working people and found that 5.3% of these had asthma, with 1.9% suffering with moderate or severe asthma (meaning they were taking an asthma preventer inhaler and at least one other asthma treatment, such as an oral steroid). They categorised these people according to whether they worked only during the day, only nightshifts, or a combination of the two.

Their analysis revealed that, overall, women who work shifts are more likely to have asthma. Women who only work nightshifts are around 50% more likely to suffer with moderate or severe asthma compared to women who only work in the daytime.

The risk of asthma in men did not alter according to whether they worked days or nights.

Dr Maidstone said: “This is the first study to evaluate sex differences in the relationship between shift work and asthma. We found that permanent night shift-workers had higher odds of moderate-severe asthma when compared to corresponding day workers.

“This type of research cannot explain why shift work and asthma are linked; however, it could be because shift work disrupts the body clock, including the levels of male and female sex hormones. High testosterone has previously been shown to be protective against asthma, and so lower testosterone in women could play a role. Alternatively, men and women work different types of shift jobs, and this could be a factor.”

In postmenopausal women, the risk of moderate or severe asthma was almost doubled in night workers, compared to day workers, in those not taking hormone replacement therapy (HRT).

Dr Maidstone added: “Our results suggest that HRT might be protective against asthma for nightshift workers, however further research is needed to test this hypothesis in prospective studies and randomised controlled trials.”

The researchers plan to study whether sex hormones play a role in the relationship between shift work and asthma by using data from the UK Biobank and from Our Future Health, a new health research programme in the UK population.

Professor Florence Schleich from the European Respiratory Society’s expert group on airway diseases, asthma, COPD and chronic cough, based at the University of Liège, Belgium, and was not involved in the research. She said: “Asthma is a common, long- term condition that affects millions of people worldwide. We know that women are more likely to have asthma, to have worse asthma and more likely to die from asthma, but we do not fully understand why.

“This research suggests that working nightshifts could be a risk factor for asthma in women, but not in men. The majority of workers will not have an easy option of switching their shift pattern, so we need further research to verify and understand this link and find out what could be done to reduce the risk for women who work shifts.”

Reference:

Robert J. Maidstone, Increased risk of asthma in female night shift workers, ERJ Open Research, https://doi.org/10.1183/23120541.00137-2025 

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Patients, doctors and pharma companies set out plans to improve mental health diagnosis

An international group of psychiatrists, patient associations, and pharmaceutical companies has unveiled plans to systematically include objective biological tests in the diagnosis of psychiatric conditions. This Precision Psychiatry Roadmap, which may radically change the practice of psychiatry, is published in the journal Molecular Psychiatry.

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Heading soccer balls can cause changes in the brain even without concussion or symptoms

Heading a soccer ball alters the brain, new research spearheaded by the University of Sydney has found, despite having no immediate impact on cognition.

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Positive life outlook may protect against middle-aged memory loss, 16-year study suggests

Higher levels of well-being may help reduce the risk of memory loss in middle age, suggests new research, which tracked more than 10,000 over 50-year-olds across a 16-year span.

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