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2 Minute Medicine Rewind Aug 25, 2025
1. In sedated adults, lateral positioning compared with the supine position reduced the incidence and severity of hypoxaemia and lowered the need for airway rescue interventions.
Evidence Rating Level: 1 (Excellent)
Hypoxaemia, or low blood oxygen, is a critical complication that can result in adverse outcomes, such as arrhythmias, haemodynamic decompensation, hypoxic brain injury, and cardiac arrest. Hypoxaemia frequently occurs in sedated patients due to sedative-induced respiratory depression and upper airway obstruction. The conventional supine position has been widely reported to worsen the gravitational displacement of pharyngeal soft tissues, increasing the risk of airway obstruction. Lateral positioning can reduce these gravitational effects, but evidence supporting its use in clinical care remains limited. This study thus compared the effect of lateral vs supine positioning on the incidence of hypoxaemia in sedated patients. This prospective randomised controlled trial was conducted across 14 centres in China from July to November 2024. Participants (>18 years) undergoing general anaesthesia with intubation intraoperatively were included and randomized 1:1 to receive lateral positioning or supine positioning. Incidence of hypoxaemia was defined as peripheral oxygen saturation (SpO2) ≤90% for at least five seconds within the first 10 minutes after positioning. Of the 2143 patients analysed, 1073 were in the lateral group (mean [SD] age = 52.7 [14.9] years, women [%] = 567 [52.8]) and 1070 in the supine group (mean [SD] age = 53.5 [15.0] years, women [%] = 583 [54.5]). The incidence of hypoxaemia was lower in the lateral group compared with supine group (5.4% (58/1073) vs 15.0% (161/1070); adjusted risk ratio (aRR) 0.36, 95% confidence interval (CI) 0.27 to 0.49). Compared with patients in the supine group, patients in the lateral group required fewer airway rescue interventions (6.3% (68/1073) vs 13.8% (148/1070); aRR 0.46, 95% CI 0.34 to 0.61), had a lower incidence of severe hypoxaemia (0.7% (8/1073) vs 4.8% (51/1070); aRR 0.16, 95% CI 0.07 to 0.33), and had a higher mean lowest SpO2 level (96.9% vs 95.7%, absolute adjusted mean difference 1.20%, 95% CI 0.87% to 1.54%). Patients in the lateral group also had a shorter stay in the post-anaesthesia care unit (38.2 vs 40.5 minutes; absolute adjusted mean difference −2.22 minutes; 95% CI −3.63 to −0.80). Safety outcomes were similar in both groups, but tachycardia was less frequent in the lateral group (6.7% (72/1073) vs 10.4% (111/1070); aRR 0.65, 95% CI 0.48 to 0.87). Overall, this study found that lateral positioning decreased the incidence and severity of hypoxaemia compared with conventional supine positioning in sedated patients. Future studies should confirm these findings in more diverse populations to improve generalizability.
Breastfeeding, Prepubertal Adiposity, and Development of Precocious Puberty
1. Exclusive breastfeeding during the first 4 to 6 months was associated with a lower risk of central precocious puberty in both boys and girls, with prepubertal adiposity partially mediating this association.
Evidence Rating Level: 2 (Good)
The incidence of central precocious puberty (CPP) is increasing globally. Children experiencing precocious puberty are at an increased risk of health problems in adulthood, including diabetes, cardiovascular disease, and cancer. Childhood obesity is a key risk factor for precocious puberty. Early feeding practices during infancy influence the risk of childhood obesity, with breastfeeding providing a protective effect. Prepubertal obesity appears to affect pubertal development differently in boys and girls, although the underlying mechanisms remain unclear. This study thus examined the relationship between primary feeding type during the first 4 to 6 months of life and risk of CPP, and whether prepubertal adiposity mediates this association. The retrospective cohort study used data from the South Korean National Health Insurance Service Database between January 1, 2007, and December 31, 2020. Children who underwent routine health checkups at 4 to 6 months (examination 1) and 66 to 71 months (examination 7) were included. CPP was diagnosed when the peak luteinizing hormone level was >5.0 IU/L. Among 322,731 children included in the study (girls [%] = 187,499 [58.1]), 46.0% were exclusively breastfed, 34.9% were formula-fed, and 19.1% were mixed-fed. Compared with exclusively breastfed children, formula-fed children had the greatest risk of CPP in boys (adjusted hazard ratio (aHR), 1.16; 95% CI, 1.10-1.21) and girls (aHR, 1.60; 95% CI, 1.24-2.06), followed by mixed-fed boys (aHR, 1.14; 95% CI, 1.07-1.20) and girls (aHR, 1.45; 95% CI, 1.07-1.97). Prepubertal adiposity mediated 7.2% (bootstrap 95% CI, 4.5%-12.1%) of the association between formula feeding and CPP in boys and 17.8% (bootstrap 95% CI, 6.6%-30.0%) in girls. Overall, this study found that exclusive breastfeeding during the first 4 to 6 months was associated with a lower risk of CPP in both boys and girls, with prepubertal overweight or obesity partially mediating this association. These findings suggest that early-life nutrition is important in pubertal timing. Future longitudinal studies are needed to confirm these findings.
1. Compared with drug therapy, catheter ablation improved cardiovascular prognosis in patients with atrial fibrillation (AF) and fewer than 3 nonmodifiable recurrence risk factors (NMRRFs), but not in those with 3 or more.
2. Catheter ablation reduced AF recurrence and improved quality of life, irrespective of NMRRF count.
Evidence Rating Level: 2 (Good)
Catheter ablation reduces symptoms of atrial fibrillation (AF) and AF recurrence. However, research on the effectiveness of catheter ablation in reducing major cardiovascular events among patients with varying nonmodifiable recurrence risk factors (NMRRFs) remains limited. This study thus examined the benefits of catheter ablation vs drug therapy in patients with varying numbers of NMRRFs. This study was a post hoc subanalysis of the multinational, multicenter, open-label Catheter Ablation vs Anti-Arrhythmic Drug Therapy for Atrial Fibrillation (CABANA) randomized clinical trial. The follow-up in the primary study was an average of >48 months. In CABANA trial, individuals with AF and at least 1 stroke risk factor were enrolled between November 2009 and April 2016 and followed for an average of >48 months. Participants were divided into 2 groups based on the number of NMRRFs they had (<3 or >3) and randomly assigned to receive either catheter ablation or drug therapy. The 4 NMRRFs considered were AF duration >1 year, persistent or long-standing persistent AF, age >65 years, and female sex. In the drug therapy group, patients started with rate-control medications and transitioned to rhythm-control drugs if rate-control was unsuccessful. The primary endpoint was death, disabling stroke, serious bleeding, or cardiac arrest. Of the 2185 participants included in the study (median [IQR] age = 67.0 [62.0-72.0] years, 1373 males [62.8%]), 1100 (50.3%) received catheter ablation and 1085 (49.7%) received drug therapy. Most patients (1469 [67.2%]) had <3 NMRRFs, while 716 (32.8%) had >3. Compared with the drug therapy group, the catheter ablation group had a reduced primary end point in patients with <3 NMRRFs (adjusted hazard ratio [AHR], 0.59 [95% CI, 0.41-0.86]), but not in those with >3. An interaction was observed between the primary end point and the NMRRF category (P = .003). Across all NMRRF groups, ablation did not reduce all-cause mortality, but reduced AF recurrence (<3 NMRRFs: AHR, 0.46 [95% CI, 0.40-0.52]; ≥3 NMRRFs: AHR, 0.58 [95% CI, 0.49-0.69]) and improved quality of life throughout follow-up for symptom frequency (<3 NMRRFs: −1.63 [95% CI, −2.18 to −1.07]; ≥3 NMRRFs: −1.15 [95% CI, −1.98 to −0.31]). Overall, this study found that catheter ablation compared with drug therapy improved cardiovascular prognosis in patients with AF and fewer than 3 NMRRFs. These findings support a more individualized approach to AF management by tailoring treatment decisions to patients’ risk profiles. Future studies should validate these results and investigate underlying mechanisms.
1. Among patients with melasma, microneedling with tranexamic acid was superior to microneedling with metformin or the control treatment in reducing melasma severity and improving patient satisfaction.
Evidence Rating Level: 2 (Good)
Melasma is an acquired hyperpigmentation disorder most commonly affecting women. Its chronicity and high recurrence rate make it difficult to treat. Microneedling has emerged as a promising technique to improve transdermal delivery and efficacy of topical agents by enabling deeper skin penetration. Tranexamic acid (TXA), a synthetic antifibrinolytic agent, has demonstrated clinical efficacy in the treatment of melasma, while metformin, an antidiabetic agent, has more recently emerged as a novel therapeutic option. This study compared the therapeutic efficacy and safety of microneedling with topical metformin versus microneedling with topical TXA in melasma patients. This randomized, prospective, parallel-group clinical trial included female patients aged 20-50 years with facial melasma. Participants were randomized 1:1:1 into one of three groups: metformin group: microneedling + topical metformin solution, TXA group: microneedling + topical TXA solution, control group: topical modified Kligman’s formula (hydroquinone 4%, tretinoin 0.05%, mometasone 0.1%) once daily. Metformin and TXA groups underwent four biweekly sessions for 8 weeks, whereas the control group applied Kligman’s formula daily for 8 weeks. The study included 45 participants, with 15 in each group (mean [SD] ages: metformin group = 36.33 [8.1] years; TXA group = 35.73 [9.41] years, control group = 37.07 [10.11] years). After 8 weeks of treatment, all groups showed significant reductions in the modified Melasma Area and Severity Index (mMASI), with the greatest reduction in the TXA group (mean [SD] 45.28% [9.29%]), followed by the control group (38.21% [12.11%]) and metformin group (22.11% [16.13%]) (p < 0.001 between groups). Satisfaction scores were highest in the TXA group, with 33.3% reporting marked improvement (≥ 75% improvement), compared to 0% in the metformin group and 20% in the control group (p = 0.001 between groups). All groups experienced minimal adverse events, with no serious side effects. Overall, this study found that microneedling with TXA was superior to microneedling with metformin or to Kligman’s regimen in reducing melasma severity and improving patient satisfaction. These findings suggest that microneedling is a safe and effective adjunct for transdermal delivery in melasma management. Future longitudinal studies in larger cohorts are needed to validate study findings.
1. Higher peak expiratory flow was associated with a lower probability and lower risk of headache in middle-aged and older adults.
Evidence Rating Level: 2 (Good)
Headache is a common symptom of patients with chronic lung disease (CLD). Peak expiratory flow (PEF) is the maximum instantaneous flow rate during forced expiration in a forced vital capacity maneuver and serves as an important measure of lung function. The relationship between lung function and headache risk is unclear. This study thus investigated the association between lung function and headache risk through cross-sectional and longitudinal analyses. This study analyzed data from the China Health and Retirement Longitudinal Study (CHARLS) collected between 2015 to 2020, comprising community-dwelling residents > 45 years across 28 provinces in China. The longitudinal component included participants with no history of headache diagnosis in the 2015 cross-sectional survey, who were followed up until 2020. The ratio of actual PEF values to predicted values (PEF% predicted) was used and split into quartiles: Q1 (< 66.0%), Q2 (66.0%–84.1%), Q3 (84.2%–101.5%), and Q4 (≥ 101.6%). In total, 10,917 participants (51.4 % aged >60 years, 43.9% male) were included in the cross-sectional analysis, with 1648 in the headache group and 9269 in the non-headache group. Higher PEF% predicted was associated with a lower probability of headache (P < 0.05). Compared with the Q1 group, participants in the Q4 group had a lower probability of experiencing headaches (adjusted odds ratio (aOR) = 0.81, 95% CI 0.68–0.96). The longitudinal analysis included 2,428 (46.7%) participants newly diagnosed with headaches by the end of the follow-up period. Higher PEF% predicted was associated with a lower risk of headache (p < 0.05). Compared with the Q1 group, the Q4 group had a lower risk of headache (adjusted hazard ratio (aHR) = 0.80, 95% CI 0.72–0.91). Overall, this study found that a higher PEF% predicted was a protective factor for the occurrence of headache among a middle-aged and elderly population in China. Improving levels of PEF may be important in preventing headaches. Future studies are needed to validate these findings using other indicators of lung function.
Image: PD
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