BMC Medicine最新文献

{"title":"Placental insulin-mTOR and stress-inflammatory signaling patterns are associated with childhood adiposity.","authors":"Ellen C Francis, Kristen E Boyle, Lauren E Gyllenhammer, Dana Dabelea, Thomas Jansson, Wei Perng","doi":"10.1186/s12916-026-04896-8","DOIUrl":"https://doi.org/10.1186/s12916-026-04896-8","url":null,"abstract":"<p><strong>Background: </strong>Placental signaling pathways regulate nutrient transport and fetal growth, with potential long-term consequences for offspring metabolic health. Most prior human studies have focused on individual placental markers, limiting insight into the role of coordinated activity across multiple pathways in relation to offspring outcomes. Our objective was to identify patterns across placental nutrient signaling pathways and assess whether the latent placental signaling patterns were associated with early childhood adiposity, and secondarily, explore associations of adiposity-associated patterns with metabolic biomarkers.</p><p><strong>Methods: </strong>Among 108 mother-child pairs from the Healthy Start cohort, we quantified 33 placental signaling proteins and their phosphorylated-to-total protein ratios involved in nutrient sensing, insulin/growth factor signaling, stress/inflammation, and mitochondrial biogenesis using Simple Western assays of term placental villus tissue. We applied unsupervised methods to identify latent patterns and LASSO regression was used to select patterns associated with %fat mass at age 4. Multivariable linear regression was used to estimate associations adjusting for offspring age, sex, and maternal pre-pregnancy BMI. These same models were used in exploratory analysis of fasting levels of adiponectin, leptin, insulin, glucose, and lipids at age 4.</p><p><strong>Results: </strong>We identified two placental signaling patterns associated with %fat mass. The insulin-mTOR-energy sensing pattern was associated with lower childhood %fat mass (β = -2.46, 95% CI - 4.84, - 0.09) and adiponectin, and the stress-inflammatory MAPK pattern was associated with higher %fat mass (β = 1.28, 95% CI 0.05, 2.51), leptin, and triglycerides; however, the FDR p-values ranged from 0.06 to 0.13.</p><p><strong>Conclusion: </strong>Two placental signaling patterns were associated with childhood %fat mass and metabolic markers. These findings indicate that capturing placental activity across several signaling pathways may yield insights into early origins of adiposity and metabolic health.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic predisposition for depression, psychosocial and behavioural factors and premenstrual symptoms: a cross-sectional study among young women in China.","authors":"Yu Zhao, Qing Pan, Min Chen, Yanan Zhang, Grace W K Ho, Yifei Lin, Huan Song, Jin Huang, Yuchen Li, Donghao Lu","doi":"10.1186/s12916-026-04913-w","DOIUrl":"https://doi.org/10.1186/s12916-026-04913-w","url":null,"abstract":"<p><strong>Background: </strong>Premenstrual disorders (PMDs) affect approximately one in three women of reproductive age and have a substantial impact on daily functioning and mental health. Given the challenges observed in diagnosis and clinical management, understanding whether genetic predisposition and readily assessable factors jointly mark greater symptom burden may help inform future risk-stratified monitoring and assessment.</p><p><strong>Methods: </strong>After excluding 424 participants with missing data, we conducted a cross-sectional study of 1528 female college students from the Care of Premenstrual Emotion (COPE) cohort in China. Premenstrual symptoms and probable PMD cases were assessed with the Calendar of Premenstrual Experiences. Four psychosocial and behavioural factors, including alcohol consumption, psychological resilience, adverse childhood experiences (ACEs), and body mass index (BMI), were recorded through electronic questionnaires. The polygenic risk score (PRS) of depression was derived from trans-ancestry genome-wide association study (GWAS) summary statistics. The associations and interactions of the PRS for depression and psychosocial and behavioural factors with premenstrual symptoms and probable PMD cases were examined.</p><p><strong>Results: </strong>The average age of the participants was 20.1 ± 1.59 years. Positive associations were observed between the depression PRS, alcohol consumption, low psychological resilience, ACEs, and premenstrual symptoms; additionally, positive associations between low psychological resilience, ACEs, and probable PMDs were observed. The psychosocial and behavioural factor score was associated with more severe premenstrual symptoms (β = 0.49, 95% CI: 0.35-0.62, P < 0.001) and higher odds of probable PMDs (OR = 1.97, 95% CI: 1.42-2.73, P < 0.001). Specifically, compared with participants with low depression PRS and no adverse psychosocial-behavioural factors, participants with high depression PRS and alcohol consumption (β = 0.32, 95% CI: 0.14-0.51, P = 0.001), low psychological resilience (β = 0.54, 95% CI: 0.33-0.75, P < 0.001) or ACEs (β = 0.26, 95% CI: 0.08-0.43, P = 0.003) exhibited more severe premenstrual symptoms; moreover, participants with high depression PRS and ≥ 2 psychosocial-behavioural factor scores demonstrated the greatest burden of premenstrual symptoms (β = 0.59, 95% CI: 0.37-0.81, P < 0.001) and higher odds of probable PMDs (OR = 1.79, 95% CI: 1.05-3.11, P = 0.035).</p><p><strong>Conclusions: </strong>If confirmed in prospective studies, a combined profile of genetic predisposition and psychosocial and behavioural factors may help identify young women who warrant closer evaluation for PMDs, and may inform future prevention-oriented studies focused on actionable exposures.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smartphone-based lightweight AI system for real-time multiple anterior segment disease screening: development and real-world validation.","authors":"Yuwen Liu, Changsheng Xu, Shinan Wu, Yuqian Wang, Wenying Guan, Shaopan Wang, Xiang Lin, Qi Zhang, Zhaolin Liu, Qiuping Liu, Junhua Fan, Huping Wu, Ying Li, Hui Zhang, Wenjin Zou, Jiaoyue Hu, Zhiming Luo, Zuguo Liu","doi":"10.1186/s12916-026-04905-w","DOIUrl":"https://doi.org/10.1186/s12916-026-04905-w","url":null,"abstract":"<p><strong>Background: </strong>Anterior segment diseases are a major global cause of preventable blindness, especially in regions with limited access to specialized ophthalmic care. Diagnosis typically requires slit-lamp biomicroscopy, creating a significant access bottleneck in primary care and rural settings. Existing AI solutions often lack the efficiency and generalizability necessary for widespread mobile deployment and primarily focus on individual conditions, failing to meet the demand for scalable, multi-disease screening platforms.</p><p><strong>Methods: </strong>We developed the Intelligent Detection System (IDS), a smartphone-compatible AI platform for real-time, automated, multi-disease screening of anterior segment diseases. The core model, Eye-YOLO, is a novel, lightweight deep learning model optimized for standard smartphone images. IDS integrates image quality assessment and urgency classification. The model was rigorously trained on a large, heterogeneous multi-center dataset of 24,671 images (comprising 17,853 slit-lamp and 6,818 smartphone images) collected from three tertiary hospitals in China. IDS was prospectively deployed and validated via a widely accessible WeChat Mini Program for community screening.</p><p><strong>Results: </strong>Eye-YOLO achieved a mean average precision of 0.816 with an exceptionally compact architecture (2.77 million parameters and 7.3G FLOPs), enabling real-time inference at 131 FPS on mobile devices. In controlled testing, IDS demonstrated high diagnostic performance (93.50% accuracy; AUC = 0.9837) with consistent performance across multiple smartphone brands (AUC > 0.95). Crucially, with AI assistance, junior ophthalmologists achieved an accuracy of 93.79% (AUC 0.8984), compared with 95.79% for senior experts. In real-world external validation via the WeChat Mini Program, IDS achieved 98.25% accuracy.</p><p><strong>Conclusions: </strong>IDS provides a highly efficient, robust, and globally scalable framework for multi-disease anterior segment screening using ubiquitous smartphone technology. Its deployment through a widely accessible mobile platform offers a promising public health solution that facilitates early detection and triage, with the potential to improve access to ophthalmic care between specialized centers and primary care settings.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry: ChiCTR2200060808.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Waist circumference and grip strength and their joint relations to type 2 diabetes incidence in UK Biobank.","authors":"Johanna Wirler, Michael J Stein, Hansjörg Baurecht, Patricia Bohmann, Heinz Freisling, Claas Lendt, Anja M Sedlmeier, Michael F Leitzmann","doi":"10.1186/s12916-026-04907-8","DOIUrl":"https://doi.org/10.1186/s12916-026-04907-8","url":null,"abstract":"<p><strong>Background: </strong>Waist circumference and grip strength are each associated with type 2 diabetes (T2D) risk, but their joint associations have been less well studied.</p><p><strong>Methods: </strong>We examined the separate and joint associations of waist circumference and grip strength with incident T2D among 483,578 adults aged 40-69 years (55% women) without T2D at baseline (2006-2010) from UK Biobank. Waist circumference was measured by trained staff and categorized using World Health Organization thresholds. Grip strength was assessed using a hydraulic dynamometer and categorized into age- and sex-specific tertiles. Incident T2D was ascertained through linkage to hospital inpatient records until 2022. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression, adjusting for sociodemographic, lifestyle, and clinical covariates.</p><p><strong>Results: </strong>During 13.0 years of follow-up (6.3 million person-years), 30,240 participants (6.3%) developed T2D. Compared to individuals with low waist circumference (men: ≤ 94 cm, women: ≤ 80 cm), HRs were 2.11 (95% CI 2.03-2.19) for those with intermediate (men: 95-102 cm, women: 81-88 cm) and 5.48 (95% CI 5.30-5.66) for those with high waist circumference (men: > 102 cm, women: > 88 cm). Compared to individuals with high grip strength, HRs were 1.08 (95% CI 1.05-1.11) for those with intermediate and 1.35 (95% CI 1.32-1.39) for those with low grip strength. Joint analyses showed the highest risk among participants with the combination of high waist circumference and low grip strength (HR 7.68, 95% CI 7.22-8.17) compared to individuals with the combination of low waist circumference and high grip strength. Associations between waist circumference and T2D were stronger in women, whereas associations with grip strength were stronger in men. Both patterns were more pronounced among younger adults.</p><p><strong>Conclusions: </strong>Waist circumference and grip strength were separately and jointly associated with T2D risk. The combination of high waist circumference and low grip strength conferred the greatest risk. Joint assessment of waist circumference and grip strength identifies individuals at particularly elevated risk and may inform preventive strategies, though formal evaluation of incremental predictive utility is needed.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"24 1","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obesity-derived metabolites modulate anti-tumor immunity in the tumor microenvironment: from mechanisms to clinical applications.","authors":"Yihang Cai, Junyi Jin, Yihui Wang, Dongchen Han, Xinmiao Yu, Feng Jin, Mu Li, Yang Li, Xiaoying Li","doi":"10.1186/s12916-026-04898-6","DOIUrl":"https://doi.org/10.1186/s12916-026-04898-6","url":null,"abstract":"<p><p>The tumor microenvironment (TME) is increasingly understood as a metabolically dynamic ecosystem in which local metabolite availability, composition, and trafficking shape immune cell fitness and therapeutic responsiveness. Against the backdrop of the global obesity epidemic, obesity-associated systemic metabolic dysregulation has been implicated in tumor initiation and progression and may also influence the immune contexture and treatment responsiveness of tumors. This Review examines how obesity-derived systemic metabolites may modulate anti-tumor immunity and influence cancer immunotherapy, with particular emphasis on pathways involved in metabolic reprogramming and TME remodeling. We further discuss intervention strategies spanning (i) upstream metabolite generation, (ii) systemic-to-local trafficking into the TME, and (iii) direct functional antagonism within the TME. However, the available evidence remains heterogeneous across metabolite classes, tumor types, and experimental contexts, and this heterogeneity is likely to contribute to divergent immunotherapeutic phenotypes, including obesity-associated heterogeneity in immune checkpoint blockade (ICB) responsiveness. By integrating these layers into a source-to-sink framework, we highlight translationally relevant directions for understanding how systemic metabolites may reshape the metabolic niche of the TME and for informing more precise, context-aware, and safety-conscious metabolite-directed strategies in cancer immunotherapy.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nourishing future generations: the critical role of healthy school lunches and strategic food procurement.","authors":"Aurora Perez-Cornago, Carmen Piernas","doi":"10.1186/s12916-026-04708-z","DOIUrl":"https://doi.org/10.1186/s12916-026-04708-z","url":null,"abstract":"","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"24 1","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal B-vitamin status modifies the risk of congenital heart disease in offspring associated with prenatal persistent organic pollutants exposure.","authors":"Sainan Li, Hai Lin, Chengrong Wang, Chen Yang, Qianhui Cheng, Jufen Liu, Yali Zhang, Lei Jin, Zhiwen Li, Aiguo Ren, Linlin Wang","doi":"10.1186/s12916-026-04900-1","DOIUrl":"https://doi.org/10.1186/s12916-026-04900-1","url":null,"abstract":"<p><strong>Background: </strong>No epidemiological studies have systematically evaluated the associations between prenatal exposure to organophosphate esters and polychlorinated biphenyls and the risk of congenital heart disease (CHD) in offspring. Moreover, the potential modifying role of maternal B-vitamin status in persistent organic pollutants (POPs)-CHD associations has not been examined. We therefore investigated the cardiotoxic effects of prenatal POPs exposure and evaluated effect modification by maternal B-vitamin levels.</p><p><strong>Methods: </strong>A multicenter case-control study was conducted in China from 2016 to 2021, including 425 participants. Thirty POPs and seven plasma B vitamins were quantified using high-resolution mass spectrometry. Single-exposure associations were examined by logistic regression, while multipollutant effects were assessed through Bayesian kernel machine regression (BKMR) and Weighted Quantile Sum (WQS) models. Potential effect modification by B vitamins was systematically evaluated.</p><p><strong>Results: </strong>Prenatal exposure to p-cresyl diphenyl phosphate was associated with an increased risk of CHD (odds ratio [OR] = 1.36, 95% confidence interval [CI]: 1.08, 1.71). Mixture analyses consistently showed an increasing trend in CHD risk with higher exposure to the POPs mixture, with the WQS model yielding a statistically significant association (OR = 1.20, 95% CI: 1.03, 1.40). Higher concentrations of pyridoxamine, pyridoxal, and vitamin B12 were inversely associated with CHD risk, and mixture analyses using both BKMR and WQS regression further demonstrated a significant negative association between the overall B-vitamin mixture and CHD risk. In the interaction analysis, B vitamins significantly modified the association between prenatal POPs exposure and CHD risk (OR = 0.14, 95% CI: 0.04, 0.52).</p><p><strong>Conclusions: </strong>This study provides the first population evidence that prenatal POPs exposure is associated with increased CHD risk and adequate maternal B-vitamin levels may attenuate the developmental cardiotoxicity of emerging flame retardants, highlighting the importance of maternal nutritional status in modifying environmental risk factors for CHD.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipid levels and risk-stratified management gaps of dyslipidemia in China.","authors":"Long Zhang, Xu Liu, Fangfang Fan, Mei Zhang, Zhihao Liu, Zuoyi Zhou, Yaokun Liu, Tieci Yi, Yuxi Li, Shengcong Liu, Haoyu Weng, Yixue Zhao, Leyi Wang, Yangyang Sun, Chao Zhai, Jingwei Bian, Junguo Jin, Rujie Zheng, Jia Jia, Yan Chen, Luya Wang, Yanwen Qin, Hu Ding, Zhenyan Fu, Maigeng Zhou, Shuduo Zhou, Yan Zhang, Jianping Li","doi":"10.1186/s12916-026-04904-x","DOIUrl":"https://doi.org/10.1186/s12916-026-04904-x","url":null,"abstract":"<p><strong>Background: </strong>Dyslipidemia remains a major modifiable contributor to China's cardiovascular disease (CVD) burden, yet large-scale evidence on risk-stratified management gaps is lacking.</p><p><strong>Methods: </strong>In this nationwide study across 1,785 hospitals in 28 Chinese provinces, 604,250 outpatients with dyslipidemia were enrolled. We analyzed lipid levels, quantified control rate among treated population and rates of requiring lipid-lowering therapy (LLT) among untreated population across regions, socioeconomic status, and demographic groups.</p><p><strong>Results: </strong>Total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels were higher among females, middle-aged individuals, and individuals with obesity. LDL-C levels were also higher among urban residents, while TC showed no significant urban-rural difference. Triglyceride (TG) levels were higher in males, middle-aged individuals, individuals with obesity, and rural residents. Among treated population, LDL-C/non-HDL-C control rates reached 95% in low-risk, 70-90% in moderate-risk, 40-50% in high-risk, and 5-15% in very-high-risk groups. Among untreated population, rates of requiring LLT reached about 20% in the low-risk group and over 70% in moderate- and high-risk groups. After adjusting for covariates, males, older individuals, smokers, patients with hypertension or type 2 diabetes mellitus, as well as those in rural and low-gross-domestic-product areas were associated with lower lipid control rates and higher treatment needs.</p><p><strong>Conclusions: </strong>Our findings highlight the urgent need for risk-stratified lipid management in primary care, improved access to LLT, and policies addressing regional and socioeconomic disparities to enhance lipid control and reduce CVD burden in China. Lessons from China can inform global strategies to improve lipid management and reduce the CVD burden.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a real-time automatic quality control system for magnetically controlled capsule gastroscopy: a multicenter randomized controlled trial.","authors":"Xiaoya Wang, Dawei Shen, Yusha Zhao, Jiaqi Xing, Jing Liu, Ruchen Zhou, Chongmei Yang, Chengxia Liu, Xingbin Ma, Jian Ge, Hao Zhang, Wenjin Yuan, Hang Zhang, Yu Ma, Ping Hu, Xiuli Zuo, Yanqing Li, Zhen Li","doi":"10.1186/s12916-026-04901-0","DOIUrl":"https://doi.org/10.1186/s12916-026-04901-0","url":null,"abstract":"<p><strong>Background: </strong>Quality control can reduce variations in operators' performance conducting magnetically controlled capsule gastroscopy (MCCG). However, an optimal method for quality control in routine MCCG procedures is still lacking. This study aimed to develop an automatic quality control system (AQCS) and assess its effectiveness in a clinical trial.</p><p><strong>Methods: </strong>We developed the AQCS using convolutional neural network (CNN) models to monitor inspection completeness, evaluate gastric cleanliness, and identify suspicious lesions. Then, patients were prospectively randomized to undergo routine MCCG with or without AQCS assistance. The primary outcome was the blind spot rate in the AQCS and control groups.</p><p><strong>Results: </strong>The CNN model demonstrated specificity of 98.27-99.30% and sensitivity of 76.33-96.35% in gastric site identification. Between August 27, 2021, and July 28, 2022, a total of 200 patients were randomized, with 98 and 96 patients analyzed in the AQCS and control groups, respectively. Compared to the control group, the AQCS group achieved lower blind spot rates (median: 0.00% vs. 16.67%, P < 0.01), higher lesion detection rates (75.51% vs. 60.42%, P = 0.02), and comparable gastric examination time (28.63 min vs. 27.58 min, P = 0.48). Additionally, AQCS showed high consistency with expert evaluations in cleanliness assessment (Kappa = 0.95, P < 0.01). No serious adverse events occurred in either group.</p><p><strong>Conclusions: </strong>AQCS significantly reduced the blind spot rate during MCCG procedures. It could be a powerful assistant tool to mitigate operator skill variability and enhance the overall quality of routine MCCG examinations.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier NCT04954677.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medicine price and affordability in China and selected ASEAN countries: a cross-country comparison with forward-looking implications for regional pooled procurement.","authors":"Zhuangqi Li, Shuting Zhang, Qian Xu, Bao Liu","doi":"10.1186/s12916-026-04886-w","DOIUrl":"https://doi.org/10.1186/s12916-026-04886-w","url":null,"abstract":"<p><strong>Background: </strong>The China-ASEAN regional medical procurement platform was launched in early 2025. However, the scope and operational mechanisms of the platform remain unclear. This study aims to assess medicine prices and affordability in China and ASEAN countries, explore potential implementation challenges of the platform, provide policy suggestions.</p><p><strong>Methods: </strong>We selected commonly used medicines from four ATC categories (alimentary tract and metabolism, cardiovascular system, anti-infective for systemic use, nervous system). Prices were standardized to WHO defined-daily-dose (DDD) prices and converted into median price ratio (MPR) using Management Sciences for Health (MSH) international reference prices (IRP). All prices data were collected from official public sources and converted to US dollars using the official 2024 annual average exchange rate. Affordability was estimated the number of days' statutory gross daily minimum wages required to purchase one DDD, with wage data obtained from the International Labor Organization (ILO). Descriptive statistics were performed.</p><p><strong>Results: </strong>A total of 68 medicines were included, with 68, 68, 60, and 59 available in China, Thailand, Indonesia, and the Philippines, respectively. Median MPRs were 0.88 (IQR:0.46-3.49), 0.97 (IQR:0.50-2.20), 1.69 (IQR:0.77-3.16), 1.86(IQR:0.72-5.03), respectively, and 45.6%, 45.6%, 61.7%, and 67.8% of medicines were priced above the IRPs. Prices varied widely across and within countries. For cardiovascular medicines, median MPRs exceeded the IRPs in China 1.72(IQR:0.53-6.30), Indonesia 1.79(IQR:0.78-2.80), the Philippines 2.85(IQR:1.31-6.43), while Thailand achieved a lower price of 0.78(IQR:0.31-1.37). The overall affordability was higher in China, Indonesia and Thailand, where one DDD of medicine required less than 6% of a day's wage, with median values of 4.8% (IQR:2.5%-19.3%), 5.1% (IQR:2.3%-9.6%), and 3.6% (IQR:1.8%-8.1%), respectively, compared with 14.0% (IQR:5.4%-37.7%) in the Philippines. Sensitivity analysis excluding extreme affordability values yielded similar results.</p><p><strong>Conclusions: </strong>Our findings suggest that understanding cross-country disparities in medicine prices and affordability may help inform the design of future regional purchasing strategies. Realizing the benefits of such joint procurement will require strong political commitment to establish a legal framework, enhance price transparency, harmonize regulations, and strengthen supply chains to ensure the platform's effectiveness and sustainability.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147810795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}