Opioids exert analgesic effects by agonizing opioid receptors and activating signaling pathways coupled to receptors such as G-protein and/or β-arrestin. Concomitant respiratory depression (RD) is a common clinical problem, and improvement of RD is usually achieved with specific antagonists such as naloxone; however, naloxone antagonizes opioid analgesia and may produce more unknown adverse effects. In recent years, researchers have used various methods to isolate opioid receptor-mediated analgesia and RD, with the aim of preserving opioid analgesia while attenuating RD. At present, the focus is mainly on the development of new opioids with weak respiratory inhibition or the use of non-opioid drugs to stimulate breathing. This review reports recent advances in novel opioid agents, such as mixed opioid receptor agonists, peripheral selective opioid receptor agonists, opioid receptor splice variant agonists, biased opioid receptor agonists, and allosteric modulators of opioid receptors, as well as in non-opioid agents, such as AMPA receptor modulators, 5-hydroxytryptamine receptor agonists, phosphodiesterase-4 inhibitors, and nicotinic acetylcholine receptor agonists.

To investigate the influence of health education based on the precede-proceed model (PPM) on the eradication rate and experience of Helicobacter pylori (H. pylori) infection. 200 patients with asymptomatic H. pylori infections were randomly assigned to a PPM group (n = 100) or a control group (n = 100) using the random number table method based on the time of their medical records. The control group received modified bismuth quadruple therapy (BQT), while the PPM group received modified BQT and health education based on the PPM. Completion rate, eradication rate, drug-related adverse events (AEs), discontinuation rate due to AEs, reexamination rate, recurrence rate, H. pylori knowledge scores, and satisfaction with medical experience were evaluated. The treatment completion rate was 96% vs. 84% (P<0.05), the reexamination rate was 93% vs. 79% (P<0.05), the eradication rate according to intention-to-treat (ITT) was 83% vs. 69% (P0.05) in the PPM and control groups, respectively. The recurrence rate was lower in the PPM group than in the control group (2.41% vs. 5.80%, P>0.05); the drug-related AEs were 14% vs. 16%(P>0.05), the discontinuation rate due to AEs was 14.3% vs. 37.5%(P>0.05) in the PPM and control groups, respectively. After treatment, the mean H. pylori knowledge scores were significantly higher in the PPM than in the control groups; the mean knowledge scores of the recurrent patients were significantly lower than those of the non-recurrent patients (P<0.001). Satisfaction with the medical experience was significantly higher in the PPM group than in the control group (P<0.001). Health education based on the PPM can effectively improve the completion rate of H. pylori eradication treatment, the eradication rate of the ITT analysis, the reexamination rate, and patient compliance, significantly improving patients’ knowledge of H. pylori and their experience.

Sleep deprivation (SD) has become a pervasive public health issue with significant ramifications for physiological and cognitive function. This review aims to provide a comprehensive synthesis of the detrimental health effects of SD, explore the underlying pathophysiological mechanisms, and evaluate current and emerging intervention strategies. We conducted a narrative review of the literature, synthesizing findings from epidemiological, clinical, and preclinical studies. The results indicate that SD profoundly disrupts the function of multiple organ systems, including the nervous, cardiovascular, respiratory, digestive, immune, and endocrine systems. At the mechanistic level, SD induces neuroinflammation, disrupts the intestinal barrier and gut microbiota, impairs hippocampal structure and function, and alters synaptic plasticity. Interventions span pharmacological approaches—from traditional central nervous system stimulants (e.g., caffeine, amphetamines, and modafinil) and sedative-hypnotics to novel therapies such as orexin receptor antagonists and gut microbiota modulators—and non-pharmacological strategies, including napping, physical therapies (e.g., transcranial magnetic stimulation, and light therapy), exercise, cognitive behavioral therapy, and dietary modifications. In conclusion, the evidence highlights the crucial role of adequate sleep in maintaining health. A multifaceted approach combining pharmacological and non-pharmacological interventions, tailored to individual and population-specific needs, holds the greatest promise for mitigating the adverse effects of SD. Future research should focus on personalized interventions and leverage advanced technologies to elucidate the pathogenesis of SD further and develop more effective countermeasures.

Background: This study evaluates the safety and efficacy of cold snare polypectomy (CSP) and hot snare polypectomy endoscopic mucosal resection (HSP-EMR) for small sessile colorectal polyps in the elderly population. Methods: Patients with small sessile colorectal polyps were randomized to either CSP or HSP-EMR, including 80 patients in the observation group (CSP) and 125 patients in the control group (HSP-EMR). General data, titanium clip utilization rates, complete resection rates, immediate bleeding rates, specimen recovery rates, incidence of delayed bleeding, perforation rates, and incidence of abdominal discomfort were compared between the 2 groups. Results: There were no significant differences in the distribution of general data (age, gender, location, morphology, and pathological type) or underlying diseases (hypertension and diabetes) between the 2 groups ( P > .05). There were no significant differences in the complete resection rate, specimen recovery rate, or delayed bleeding rate between the 2 groups ( P > .05). The utilization rate of titanium clips and the incidence of abdominal discomfort in the observation group were significantly lower than those in the control group. The immediate bleeding rate was higher in the observation group than that in the control group. The difference between the 2 groups was statistically significant ( P < .05). No perforation occurred in either of the groups. Group discussion was conducted according to whether postoperative complications occurred. Univariate and binary logistic regression analysis was used to analyze the risk factors of postoperative complications. The average polyp diameter, body mass index and surgical method were independent risk factors for postoperative complications ( P < .05). Conclusion: CSP and HSP-EMR are safe and efficacy in the treatment of small sessile colorectal polyps in elderly people. For overweight and obese people with large polyps, HSP-EMR patients should be closely observed for postoperative complications.

Background: This study aimed to investigate the feasibility of inducing mental fatigue (MF) through nap deprivation, based on monitoring heart rate variability (HRV), cognitive performance, and subjective fatigue levels. Additionally, the intervention effect of caffeine oral tablets (COT) on MF was evaluated. Methods: This was an open-label, non-randomized, single-sequence crossover pilot study. The caffeine content in COT was quantified using high-performance liquid chromatography (HPLC). Ten healthy volunteers who habitually took naps were enrolled. Participants underwent nap deprivation to induce MF. Various parameters were collected at different time points, including the Karolinska Sleepiness Scale (KSS), Attention Network Task (ANT), and HRV metrics. Changes in each parameter before and after COT intervention were analyzed. Results: Following nap deprivation, there was a significant increase in KSS scores for the control group compared to baseline measurements taken after 2 h of sleep deprivation ( P < 0.01). No significant changes were observed in ANT performance; however, HRV exhibited variations influenced by circadian rhythms—showing increased volatility in time-domain parameters and differing trends in frequency-domain parameters without statistical significance. After administration of low-dose COT to experimental participants, KSS scores did not significantly rise; conversely, correct response rates (CR) on ANT improved significantly ( P < 0.05), alongside notable changes in both time-domain and frequency-domain HRV parameters ( P < 0.05). Conclusions: In this pilot study, the alignment between subjective and objective indices suggests that low-dose COT is associated with favorable changes in the MF state of volunteers following sleep deprivation. However, due to the small sample size and open-label design, these findings should be considered preliminary and warrant confirmation in larger, randomized controlled trials.

Background: To systematically evaluate the effectiveness of regular coffee intake in the prevention or treatment of COVID-19 infection, and to explore its possible mechanism of action using computer molecular docking technology. Methods: We searched for relevant ClinicalTrials.gov, Cochrane Library, PubMed, Web of Science, Embase, and China Biomedicine, Wanfang, CNKI, VIP databases to summarize studies on the effectiveness of coffee in preventing or treating COVID-19. The search period lasted until August 1, 2024. The 2 researchers screened the literature and data using Rev Man 5.4 software (the Cochrane Collaboration, 2020) for data analysis and used Schrodinger 2018-1 software to explore possible mechanisms of action. Results: A total 5 studies with 39,290 participants were included. The results showed that compared with the control group that drank less or no coffee, the experimental group that drank more than 1 cup of coffee per day had significantly higher benefit rates (RD = 0.17, 95% confidence intervals [CI] = 0.08–0.27, P = .0005), including lower infection rates and improved recovery rates from COVID-19 (RD = 0.24, 95% CI = 0.13–0.35), P < .0001). Molecular docking showed that CGA and caffeine present in coffee could combine with key amino acid residues of ACE2 or 3CL proteins to form hydrogen bonds. Conclusions: Regular consumption of coffee may have certain preventive or therapeutic effects on COVID-19, and the mechanism of action may be that CGA or/caffeine in coffee may be related to the formation of hydrogen bonds by key amino acid residues such as ARG273/HIE345 of ACE2 and CYS145 of 3CL. Owing to the limited number and quality of the included studies, the effect evaluation needs to be further confirmed using clinical randomized controlled trials. The exact mechanism of action requires further verification at the molecular level, both inside and outside cells.