BMC Medicine最新文献

{"title":"Association between pre-pregnancy maternal stress and small for gestational age: a population-based retrospective cohort study.","authors":"Manman Chen, Qiongjie Zhou, Yuanyuan Li, Qu Lu, Anying Bai, Fangyi Ruan, Yandan Liu, Yu Jiang, Xiaotian Li","doi":"10.1186/s12916-024-03837-7","DOIUrl":"https://doi.org/10.1186/s12916-024-03837-7","url":null,"abstract":"<p><strong>Background: </strong>Maternal stress is a potential factor affecting fetal growth, but it is unknown whether it directly affects fetal growth restriction. This study aims to investigate the association between pre-pregnancy maternal stress with small for gestational age (SGA).</p><p><strong>Methods: </strong>This study used a population-based retrospective cohort analysis to examine the association between pre-pregnancy maternal stress and SGA in offspring. Data were extracted from the National Preconception Health Care Project (NPHCP), conducted between 2010 and 2012, which encompassed preconception health-related information from 572,989 individuals across various regions in China. Logistic regression models were used to assess the associations between pre-pregnancy maternal stress variables and the risk of SGA. In addition, Synthetic Minority Over-sampling Technique (SMOTE) and Propensity Scores (PS) methods were used to enhance the model's ability to the associations between pre-pregnancy maternal stress and SGA.</p><p><strong>Results: </strong>Pre-pregnancy maternal stress was significantly associated with an increased the risk of SGA in offspring (OR 1.35, 95% CI 1.20 to 1.51, P < 0.001). Stress related to life and economic factors notably increased the risk of SGA across different socio-economic conditions, whereas stress related to friends did not show a statistically significant association (P > 0.05). Specially, individuals with lower socio-economic status that characterized by below high school education levels (OR = 1.45, 95% CI: 1.23 to 1.70), farmer occupation (OR = 1.33, 95% CI: 1.15 to 1.55, P = 0.002), rural residence (OR = 1.38, 95% CI: 1.22 to 1.56, P < 0.001), and younger age (under 35 years: OR = 1.35, 95% CI: 1.20 to 1.52, P < 0.001) were more susceptible to pre-pregnancy maternal stress, increasing their risk of SGA.</p><p><strong>Conclusions: </strong>Pre-pregnancy maternal stress was positively associated with an increased risk of SGA in offspring. Individuals with lower socio-economic status were more likely to experience pre-pregnancy maternal stress related to life and economic factors, which in turn contributed to a higher risk of SGA.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"7"},"PeriodicalIF":7.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930516","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":"Multimorbidity latent classes in relation to 11-year mortality, risk factors and health-related quality of life in Malaysia: a prospective health and demographic surveillance system study.","authors":"Michelle M C Tan, Charlotte Hanlon, Graciela Muniz-Terrera, Tatiana Benaglia, Roshidi Ismail, Devi Mohan, Ann Breeze Joseph Konkoth, Daniel Reidpath, Pedro José M Rebello Pinho, Pascale Allotey, Zaid Kassim, Matthew Prina, Tin Tin Su","doi":"10.1186/s12916-024-03796-z","DOIUrl":"https://doi.org/10.1186/s12916-024-03796-z","url":null,"abstract":"<p><strong>Background: </strong>We aimed to identify specific multimorbidity latent classes among multi-ethnic community-dwelling adults aged ≥ 18 years in Malaysia. We further explored the risk factors associated with these patterns and examined the relationships between the multimorbidity patterns and 11-year all-cause mortality risk, as well as health-related quality of life (HRQoL).</p><p><strong>Methods: </strong>Using data from 18,101 individuals (aged 18-97 years) from the baseline Census 2012, Health Round 2013, and Verbal Autopsies 2012-2023 of the South East Asia Community Observatory (SEACO) health and demographic surveillance system, latent class analysis was performed on 13 chronic health conditions to identify statistically and clinically meaningful groups. Multinomial logistic regression and Cox proportional hazards regression models were conducted to investigate the adjusted association of multimorbidity patterns with the risk factors and mortality, respectively. HRQoL was analyzed by linear contrasts in conjunction with ANCOVA adjusted for baseline confounders.</p><p><strong>Results: </strong>Four distinct multimorbidity latent classes were identified: (1) relatively healthy (n = 10,640); (2) cardiometabolic diseases (n = 2428); (3) musculoskeletal, mobility and sensory disorders (n = 2391); and (4) complex multimorbidity (a group with more severe multimorbidity with combined profiles of classes 2 and 3) (n = 699). Significant variations in associations between socio-demographic characteristics and multimorbidity patterns were discovered, including age, sex, ethnicity, education level, marital status, household monthly income and employment status. The complex multimorbidity group had the lowest HRQoL across all domains compared to other groups (p < 0.001), including physical health, psychological, social relationships and environment. This group also exhibited the highest mortality risk over 11 years even after adjustment of confounders (age, sex, ethnicity, education and employment status), with a hazard of death of 1.83 (95% CI 1.44-2.33), followed by the cardiometabolic group (HR 1.42, 95% CI 1.18-1.70) and the musculoskeletal, mobility and sensory disorders group (HR 1.29, 95% CI 1.04-1.59).</p><p><strong>Conclusions: </strong>Our study advances the understanding of the complexity of multimorbidity and its implications for health outcomes and healthcare delivery. The findings suggest the need for integrated healthcare approaches that account for the clusters of multiple conditions and prioritize the complex multimorbidity cohort. Further longitudinal studies are warranted to explore the underlying mechanisms and evolution of multimorbidity patterns.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"5"},"PeriodicalIF":7.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930495","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":"Future atherosclerotic cardiovascular disease in systemic lupus erythematosus based on CSTAR (XXVIII): the effect of different antiphospholipid antibodies isotypes.","authors":"Can Huang, Yufang Ding, Zhen Chen, Lijun Wu, Wei Wei, Cheng Zhao, Min Yang, Shudian Lin, Qian Wang, Xinping Tian, Jiuliang Zhao, Mengtao Li, Xiaofeng Zeng","doi":"10.1186/s12916-024-03843-9","DOIUrl":"https://doi.org/10.1186/s12916-024-03843-9","url":null,"abstract":"<p><strong>Background: </strong>Patients with systemic lupus erythematosus (SLE) suffered from an increasing risk of cardiovascular diseases. In this multi-center prospective study, we aimed to determine the association between antiphospholipid antibodies (aPLs) and future atherosclerotic cardiovascular disease (ASCVD) in SLE.</p><p><strong>Methods: </strong>In total, 1573 SLE patients were recruited based on the Chinese SLE Treatment and Research group (CSTAR) registry. aPLs profile, including anticardiolipin antibodies (aCL) IgG/IgM, anti-β2 glycoprotein I antibodies (aβ2GPI) IgG/IgM, and lupus anticoagulant (LA), were measured in each center. Future ASCVD events were defined as new-onset myocardial infarction, stroke, artery revascularization, or cardiovascular death.</p><p><strong>Results: </strong>Among the 1573 SLE patients, 525 (33.4%) had positive aPLs. LA had the highest prevalence (324 [20.6%]), followed by aCL IgG (249 [15.8%]), aβ2GPI IgG (199 [12.7%]). 116 (7.37%) patients developed ASCVD during the mean follow-up of 4.51 ± 2.32 years and 92 patients were aPLs positive. In univariate Cox regression analysis, both aPLs (HR = 7.81, 95% CI 5.00-12.24, p < 0.001) and traditional risk factors of cardiovascular disease were associated with future ASCVD events. In multiple Cox regression analysis, aCL IgG (HR = 1.95, 95% CI 1.25-3.00, p = 0.003), aCL IgM (HR = 1.83, 95% CI 1.03-3.20, p = 0.039), and LA (HR = 5.13, 95% CI 3.23-8.20, p < 0.001) positivity remained associated with ASCVD; traditional risk factors for ASCVD, including smoking, gender, age and hypertension, also play an independent role in SLE patients. More importantly, Aspirin can reduce ASCVD risk in SLE patients with positive aPLs (HR = 0.57 95% CI, 0.25-0.93, P = 0.026).</p><p><strong>Conclusions: </strong>SLE patients with positive aPLs, especially positive aCL IgG/IgM and LA, warrant more care and surveillance of future ASCVD events during follow-up. Aspirin may have a protective effect on future ASCVD.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"8"},"PeriodicalIF":7.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930527","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":"Investigating the causal effects of childhood and adulthood adiposity on later life mental health outcome: a Mendelian randomization study.","authors":"Sweta Pathak, Tom G Richardson, Eleanor Sanderson, Bjørn Olav Åsvold, Laxmi Bhatta, Ben M Brumpton","doi":"10.1186/s12916-024-03765-6","DOIUrl":"https://doi.org/10.1186/s12916-024-03765-6","url":null,"abstract":"<p><strong>Background: </strong>Obesity particularly during childhood is considered a global public health crisis and has been linked with later life health consequences including mental health. However, there is lack of causal understanding if childhood body size has a direct effect on mental health or has an indirect effect after accounting for adulthood body size.</p><p><strong>Methods: </strong>Two-sample Mendelian randomization (MR) was performed to estimate the total effect and direct effect (accounting for adulthood body size) of childhood body size on anxiety and depression. We used summary statistics from a genome-wide association study (GWAS) of UK Biobank (n = 453,169) and large-scale consortia of anxiety (Million Veteran Program) and depression (Psychiatric Genomics Consortium) (n = 175,163 and n = 173,005, respectively).</p><p><strong>Results: </strong>Univariable MR did not indicate genetically predicted effects of childhood body size with later life anxiety (beta = - 0.05, 95% CI = - 0.13, 0.02) and depression (OR = 1.06, 95% CI = 0.94, 1.20). However, using multivariable MR, we observed that the higher body size in childhood reduced the risk of later life anxiety (beta = - 0.19, 95% CI = - 0.29, - 0.08) and depression (OR = 0.83, 95% CI = 0.71, 0.97) upon accounting for the effect of adulthood body size. Both univariable and multivariable MR indicated that higher body size in adulthood increased the risk of later life anxiety and depression.</p><p><strong>Conclusions: </strong>Higher body size in adulthood may increase the risk of anxiety and depression, independent of childhood higher body size. In contrast, higher childhood body size does not appear to be a risk factor for later life anxiety and depression.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"4"},"PeriodicalIF":7.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930457","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":"Effect of intravenous urokinase vs best medicine treatment on functional outcome for patients with acute minor stroke (TRUST): a randomized controlled trial.","authors":"Yongli Tao, Yuan Gao, Lu Zhao, Yafang Xu, Chenyang Jiang, Kai Liu, Hui Fang, Lulu Pei, Xin Wang, Rui Zhang, Jun Wu, Jing Yang, Xinsheng Han, Hongling Guo, Baoguo Xue, Jinlou Li, Yuqian Liu, Hongqiu Gu, Kejin Du, Xin Cheng, Qiang Dong, Duolao Wang, Ferdinando S Buonanno, MingMing Ning, Yuming Xu, Bo Song","doi":"10.1186/s12916-024-03820-2","DOIUrl":"https://doi.org/10.1186/s12916-024-03820-2","url":null,"abstract":"<p><strong>Background: </strong>The benefits of intravenous thrombolysis in patients with acute minor stroke remain controversial. For the aim of providing a better therapeutic strategy, high-quality trials are required to validate the efficacy of thrombolytic medicine other than intravenous recombinant tissue plasminogen and tenecteplase. In the trial, we evaluate the efficacy and safety of urokinase (UK) in acute minor stroke.</p><p><strong>Methods: </strong>This multicenter, open-label, blinded-endpoint, randomized controlled clinical trial enrolled patients with minor stroke within 6 h of symptom onset, with a NIHSS score ≤ 5. The trial was conducted at 25 hospitals in China between October 2020 and February 2023. Eligible patients were randomized to the UK group (1,000,000 U) or the best medicine treatment group. The responsible investigator recommended and implemented the best medicine treatment based on guidelines. The primary endpoint was an excellent functional outcome, defined as a modified Rankin scale (mRS) score of 0-1 at 90 days. The primary safety outcome was symptomatic intracranial hemorrhage (sICH) within 36 h.</p><p><strong>Results: </strong>A total of 999 patients were enrolled in the trial, the median age was 64 years, 371 (36.9%) were women; the median (IQR) NIHSS score was 3 (2-4). At 90 days, the primary endpoint was observed in 427 patients (84.9%) in the UK group and 425 patients (85.7%) in the control group (adjusted risk ratio [RR] 1.00, 95% CI 0.96-1.05, p = 0.87). A total of 3 patients in the UK-treated (0.6%) group experienced sICH compared to 1 patient (0.2%) in the control group (RR 1.83, 95% CI 0.16-20.27, p = 0.62).</p><p><strong>Conclusions: </strong>For patients with acute minor stroke treated within 6 h of symptom onset, UK intravenous thrombolysis treatment was not found to be beneficial in terms of excellent functional outcome at 90 days, whereas it was safe.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT04420351.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"6"},"PeriodicalIF":7.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930520","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":"Non-small cell lung cancer in ever-smokers vs never-smokers.","authors":"Jeremy R Burt, Naim Qaqish, Greg Stoddard, Amani Jridi, Parker Sage Anderson, Lacey Woods, Anna Newman, Malorie R Carter, Reham Ellessy, Jordan Chamberlin, Ismail Kabakus","doi":"10.1186/s12916-024-03844-8","DOIUrl":"https://doi.org/10.1186/s12916-024-03844-8","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer is a leading cause of cancer-related mortality. Non-small cell lung cancer (NSCLC) comprises 85% of cases with rising incidence among never-smokers (NS). This study seeks to compare clinical, imaging, pathology, and outcomes between NS and ever-smokers (S) NSCLC patients to identify significant differences if any.</p><p><strong>Methods: </strong>Retrospective cohort study of 155 NSCLC patients (88 S and 67 NS). The main predictor was smoking. Clinical, imaging, and pathology findings were evaluated at initial biopsy for staging. The primary outcome was all-cause mortality, and the secondary outcome was 12-month progression-free survival.</p><p><strong>Results: </strong>Imaging: NS and S had similar nodule size (0.81), calcification (> 0.99), and invasion of adjacent structures (> 0.99) (p values). NS slightly trended to more commonly involve the RLL vs S the RUL (p = 0.11). NS had higher numbers of extrathoracic metastases at initial biopsy for staging (p = 0.055).</p><p><strong>Pathology: </strong>NS more commonly had adenocarcinoma compared to S, who had equal numbers of adenocarcinoma and squamous cell carcinoma (p = 0.001). Rates of lymphovascular and pleural invasion were similar (p = 0.84 and 0.28). Initial staging: NS were more often initially diagnosed with stage IV disease (p = 0.046), positive nodal disease (p = 0.002), and metastatic disease (p = 0.004).</p><p><strong>Outcomes: </strong>S had a non-significant trend toward worse 12-month progression-free survival (rate ratio = 1.31, p = 0.31; HR = 1.33, p = 0.28). NS and S had similar 1-year all-cause mortality (HR = 1.06, p = 0.90). S had nearly double the risk of all-cause mortality in 5 years (HR = 1.73, p = 0.056) and 10 years (HR = 1.77, p = 0.02). Median survival was 6.6 years for NS and 3.9 years for S, with NS surviving 2.7 years longer on average (p = 0.045).</p><p><strong>Conclusions: </strong>CT nodule features were similar in NS and S. NS more often had metastatic adenopathy, distant metastases, and stage IV disease at initial biopsy. Despite similar 12-month progression-free survival and 1-year all-cause mortality, S had nearly double the risk of mortality in the first 5 and 10 years post-diagnosis.</p><p><strong>Trial registration: </strong>Retrospectively registered.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"3"},"PeriodicalIF":7.0,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930500","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":"A meta-analysis and systematic review of myocardial infarction-induced cardiomyocyte proliferation in adult mouse heart.","authors":"Ya Liu, Lingyan Liu, Pengcheng Zhuang, Jiamin Zou, Xiaokang Chen, Hao Wu, Bingjun Lu, Wei Eric Wang","doi":"10.1186/s12916-024-03822-0","DOIUrl":"10.1186/s12916-024-03822-0","url":null,"abstract":"<p><strong>Background: </strong>The proliferation capacity of adult cardiomyocytes is very limited in the normal adult mammalian heart. Previous studies implied that cardiomyocyte proliferation increases after injury stimulation, but the result is controversial partly due to different methodologies. We aim to evaluate whether myocardial infarction (MI) stimulates cardiomyocyte proliferation in adult mice.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted through PubMed/Medline, Embase, and Web of Science databases from 1 January 2000 to 21 December 2023. The SYRCLE's Risk of Bias tool for animal experiments was used to evaluate the quality of the literature by two independent reviewers. Twenty-six studies with cell cycle indicators (Ki67⁺, PH3⁺, BrdU/EdU⁺, and AurkB⁺) to evaluate cycling cardiomyocytes were collected for a meta-analysis. Another 10 studies with genetic reporter/tracing systems to evaluate cardiomyocyte proliferation were collected for a systematic review.</p><p><strong>Results: </strong>Evaluating cardiomyocyte proliferation by immunostaining of the cell cycle indicators on heart tissue, the meta-analysis showed that differences of Ki67⁺, PH3⁺, and BrdU/EdU⁺ cycling cardiomyocytes between MI and Sham groups were not statistically significant. In the post-MI heart, the percentages of PH3⁺, BrdU/EdU⁺, and AurkB⁺ cardiomyocytes were not significantly different between the infarct border zone and remote zone. The percentage of Ki67⁺ cardiomyocytes in the infarct border zone was statistically higher than that in the remote zone. Most of the studies (6 out of 10) using genetic reporter/tracing mouse systems showed that the difference in cardiomyocyte proliferation between MI and Sham groups was not statistically significant. Among the other 4 studies, at least 3 studies could not demonstrate that MI stimulates bona fide cardiomyocyte proliferation because of methodological shortages.</p><p><strong>Conclusions: </strong>MI injury increases Ki67⁺ cycling adult mouse cardiomyocytes in infarct border zone. Very little overwhelming evidence shows that MI stimulates bona fide proliferation in the adult heart.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"22 1","pages":"603"},"PeriodicalIF":7.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11686908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906600","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":"Impaired pulmonary function increases the risk of gout: evidence from a large cohort study in the UK Biobank.","authors":"Zijian Kang, Jianzheng Zhang, Chen Zhu, Ying Zhu, Hanlei Jiang, Qiang Tong, Sheng-Ming Dai","doi":"10.1186/s12916-024-03836-8","DOIUrl":"10.1186/s12916-024-03836-8","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary function is increasingly recognized as a key factor in metabolic diseases. However, its link to gout risk remains unclear. The study aimed to investigate the relationship between pulmonary function and the risk of developing gout and the underlying biological mechanisms.</p><p><strong>Methods: </strong>Our study included 420,002 participants with complete pulmonary function data from the UK Biobank. Logistic regression was used to evaluate gout prevalence among individuals with different pulmonary function statuses. Propensity score matching (PSM) created balanced groups, while Cox regression gauged the risk association between reduced lung capacity and gout compared with normal function. Mendelian randomization (MR) analysis was used to verify causal associations. Non-linear correlations were assessed with restricted cubic spline (RCS) analysis, and mediation analysis was used to explore the role of blood biomarkers. Mediation analyses were used to investigate the potential mediating role of biomarkers in the association.</p><p><strong>Results: </strong>Cross-sectional analysis revealed a higher prevalence of gout in individuals with preserved ratio of impaired spirometry (PRISm) of 6.31% and chronic obstructive pulmonary disease (COPD) of 6.26% than in those with normal pulmonary function (3.45%). After adjustment for covariates, both PRISm (odds ratio [OR] 1.24, 95% confidence interval [CI] 1.17-1.31) and COPD (OR 1.14, 95% CI 1.07-1.22) were significantly associated with gout. Longitudinal analysis confirmed that impaired pulmonary function significantly increased the risk of developing gout (hazard ratio [HR] 1.32, 95% CI 1.24-1.40). MR further revealed a potential causal effect of decreased pulmonary function on an increased risk of gout. Subgroup analysis revealed significant interactions between impaired pulmonary function and several factors, including body mass index (BMI), levels of physical activity, and diabetes status, in their associations with the risk of gout. RCS analysis showed a nonlinear relationship between pulmonary function indicators and gout incidence, characterized by an inverse S-shaped curve. Mediation analysis revealed that urate levels (49.1% mediation proportion), C-reactive protein (CRP) levels (6.62%), monocyte counts (1.33%), and neutrophil counts (4.85%) significantly mediated the relationship between pulmonary function and the risk of gout.</p><p><strong>Conclusions: </strong>Our study revealed a significant association between impaired pulmonary function and an increased risk of developing gout. The association might be partially mediated by biomarkers including urate levels, inflammatory markers, and immune cell counts.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"22 1","pages":"606"},"PeriodicalIF":7.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11686989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906604","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":"Assessment of the efficacy of palliative sedation in advanced cancer patients by evaluating discomfort levels: a prospective, international, multicenter observational study.","authors":"Maaike Rijpstra, Kris Vissers, Alazne Belar, Michael Van der Elst, Séverine Marie Surges, Claudio Adile, Rocío Rojí, Yasmine Grassi, Ewald Bronkhorst, Sebastiano Mercadante, Lukas Radbruch, Johan Menten, Carlos Centeno, Evelien Kuip, Jeroen Hasselaar","doi":"10.1186/s12916-024-03829-7","DOIUrl":"10.1186/s12916-024-03829-7","url":null,"abstract":"<p><strong>Background: </strong>Palliative sedation involves the intentional proportional lowering of the level of consciousness in patients with life-limiting disease who are experiencing refractory suffering. The efficacy of palliative sedation needs to be monitored to ensure patient comfort. The aim of this study was to evaluate the efficacy using discomfort levels combined with sedation/agitation levels.</p><p><strong>Methods: </strong>In this prospective observational study, adult patients with advanced malignancies were recruited from hospice units, palliative care units, and hospital wards in five European countries. Health care professionals used proxy observations of discomfort levels (Discomfort Scale-Dementia of Alzheimer Type, range 0-27) and sedation/agitation levels (Richmond Agitation-Sedation Scale modified for palliative care inpatients), range - 5 to + 4) to evaluate the efficacy of palliative sedation.</p><p><strong>Results: </strong>In 78 participants, discomfort levels were monitored during palliative sedation. The mean discomfort score before start was 9.4 points (95% CI 8.3-10.5), which showed a significant decrease of 6.0 points (95% CI 4.8-7.1) after start of sedation for the total sedation period. In the multivariable analysis, no significant factors influencing baseline discomfort levels were identified. The discomfort and depth of sedation scores were found to be positively correlated, with an r of 0.72 (95% CI 0.61-0.82). The internal consistency of the discomfort scale was good (0.83), but the \"Noisy breathing\" item was less informative of the total discomfort score.</p><p><strong>Conclusions: </strong>The efficacy of palliative sedation can be evaluated by measuring discomfort levels combined with sedation/agitation levels. The measurement of discomfort levels might provide a more specific and detailed evaluation of adequate sedation.</p><p><strong>Trial registration: </strong>This study is registered at ClinicalTrials.gov since January 22, 2021, registration number: NCT04719702.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"22 1","pages":"608"},"PeriodicalIF":7.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11689561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909119","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":"Intensified conditioning containing decitabine versus standard myeloablative conditioning for adult patients with KMT2A-rearranged leukemia: a multicenter retrospective study.","authors":"Zhongli Hu, Zinan Feng, Shiqi Liu, Hai He, Ying Dong, Zhiping Fan, Yiqing Li, Fen Huang, Na Xu, Can Liu, Yunxin Zeng, Ping Zhu, Ren Lin, Hua Jin, Xiong Zhang, Ruijuan Sun, Qifa Liu, Li Xuan","doi":"10.1186/s12916-024-03830-0","DOIUrl":"10.1186/s12916-024-03830-0","url":null,"abstract":"<p><strong>Background: </strong>Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is recommended for patients with KMT2A-rearranged (KMT2A-r) leukemia whereas relapse remains high. We aimed to determine whether intensified conditioning containing decitabine (Dec) could reduce relapse compared with standard myeloablative conditioning in adult patients with KMT2A-r leukemia.</p><p><strong>Methods: </strong>We performed a multicenter retrospective study at seven institutions in China. Eligible patients were aged 14 years or older at transplantation, had a diagnosis of KMT2A-r leukemia, and underwent the first allo-HSCT. Standard myeloablative conditioning regimens (standard group) included BuCy (busulfan 3.2 mg/kg/day on days -7 to -4; cyclophosphamide 60 mg/kg/day on days -3 to -2) and TBI-Cy (total body irradiation 4.5 Gy/day on days -5 to -4; Cy 60 mg/kg/day on days -3 to -2). Intensified conditioning regimens containing Dec (intensified group) consisted of Dec-BuCy (Dec 20 mg/m²/day on days -14 to -10; the same dose of BuCy) and Dec-TBI-Cy (Dec 20 mg/m²/day on days -10 to -6; the same dose of TBI-Cy).</p><p><strong>Results: </strong>Between April 2009 and December 2019, 218 patients were included in this study, of whom 105 were in the intensified group and 113 were in the standard group. The 3-year cumulative incidence of relapse was 17.6% and 34.5%, overall survival was 71.3% and 61.0%, disease-free survival was 70.1% and 56.0%, and non-relapse mortality was 12.3% and 9.5% in the intensified and standard groups, respectively (P = 0.001; P = 0.034; P = 0.005; P = 0.629). Subgroup analysis showed that the relapse rate of intensified conditioning was lower than that of standard conditioning in multiple subgroups, including different leukemia types, disease status at transplantation, high-risk cytogenetics and Bu-based regimens. There was no difference in regimen-related toxicity, engraftment, or graft-versus-host disease between the intensified and standard groups.</p><p><strong>Conclusions: </strong>These results suggest that intensified conditioning containing Dec might be a better strategy than standard myeloablative conditioning for adult patients with KMT2A-r leukemia undergoing allo-HSCT.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"22 1","pages":"605"},"PeriodicalIF":7.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906605","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}