BMC Medicine最新文献

{"title":"R-MINE-containing regimen in relapsed and refractory diffuse large B-cell lymphoma: a single-arm, multicenter phase II study.","authors":"Jin-Hua Liang, Xin-Yu Zhang, Lin-Tao Bi, Wei-Wei Qin, Li-Ping Su, Jie-Ban Liu, Jia-Zhu Wu, Hua Yin, Yi-Lin Kong, Hao-Rui Shen, Jian-Yong Li, Yue Li, Li Wang, Wei Xu","doi":"10.1186/s12916-026-05051-z","DOIUrl":"10.1186/s12916-026-05051-z","url":null,"abstract":"<p><strong>Background: </strong>Improving the prognosis of patients with relapsed or refractory diffuse large B-cell lymphoma (R/R DLBCL) remains an unmet need. This multicenter, phase II study (NCT05784987) aimed to assess the efficacy and safety of a mitoxantrone hydrochloride liposome (Lipo-MIT)-based rituximab with mitoxantrone/ifosfamide/mesna/etoposide (R-MINE)-containing regimen, in which conventional mitoxantrone was replaced with Lipo-MIT, with or without a targeted agent.</p><p><strong>Methods: </strong>Patients older than 18 years with histologically confirmed R/R DLBCL were enrolled. All enrolled patients received an R-MINE-containing regimen in 21-day cycles for up to four cycles. The addition of the targeted agent (X) was individualized according to prior treatment resistance and molecular subtype. The primary endpoint was objective response rate (ORR).</p><p><strong>Results: </strong>From March 27, 2023, to July 10, 2025, 60 patients were enrolled. Of the 55 efficacy-evaluable patients, the ORR was 76.4% (95% confidence interval [CI]: 63.0%-86.8%), and the complete response rate was 52.7% (95% CI: 38.8%-66.3%). With the median follow-up of 13.9 months, the median PFS was 17.5 months (95% CI: 10.8-24.2), and the estimated PFS rate at 1 year was 58.5%. The median OS was not reached, with an estimated 1-year OS rate of 84.0%. Late relapse after the last-line therapy was identified as the only independent predictor for ORR, with an ORR of 86.4%. Grade ≥ 3 treatment-related adverse events (TRAEs) occurred in 46.7% of patients, with neutropenia (33.3%) being the most common. No serious TRAEs or TRAE-related deaths occurred.</p><p><strong>Conclusions: </strong>The Lipo-MIT-based R-MINE-containing regimen showed encouraging efficacy and a manageable safety profile in R/R DLBCL, warranting further validation.</p><p><strong>Clinical trial registration: </strong>This trial is registered with ClinicalTrials.gov (NCT05784987). URL https//clinicaltrials.gov/study/NCT05784987.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418853","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":"Targeting ADGRG1 in cancer-associated adipocytes reprograms the immunosuppressive microenvironment and enhances immunotherapy responsiveness in triple-negative breast cancer models.","authors":"Ziling Zhou, Hanyi Zhong, Han Wang, Shoutang Wang, Nan Zhang, Zheng Wang, Renhong Huang, Kunwei Shen","doi":"10.1186/s12916-026-05049-7","DOIUrl":"10.1186/s12916-026-05049-7","url":null,"abstract":"<p><strong>Background: </strong>The adipocyte-rich microenvironment of the breast plays a crucial role in tumor progression, yet the functional heterogeneity of cancer-associated adipocytes (CAAs) and their specific mechanisms in driving immunosuppressive microenvironment and therapy resistance remain inadequately characterized.</p><p><strong>Methods: </strong>We performed an integrated analysis of single-nucleus RNA sequencing (snRNA-seq) data from human adipose tissue and bulk transcriptomic data from the TCGA-BRCA and METABRIC cohorts. A prognostic signature was developed based on transcriptional features of CAA subpopulations. Functional roles of the key gene ADGRG1 were investigated through in vitro co-culture systems and in vivo breast cancer models using genetic knockdown/overexpression and pharmacological inhibition.</p><p><strong>Results: </strong>snRNA-seq revealed a distinct CAA subpopulation enriched in aggressive contexts, labeled as HAD7. The HAD7-based signature stratified patients into high- and low-score groups, with the high-score group exhibiting poor survival and an immunosuppressive microenvironment. ADGRG1 was identified as a core driver. In vitro, ADGRG1 in CAAs promoted cancer cell migration, invasion, and epithelial mesenchymal transition. In vivo, adipocyte-specific ADGRG1 enhanced tumor growth, metastasis, and impaired anti-tumor immunity. Mechanistically, ADGRG1 activated a CXCL8-AKT/mTOR signaling axis. Crucially, pharmacological inhibition of ADGRG1 synergized with anti-PD-1 therapy, effectively suppressing tumor growth and metastasis by reversing immunosuppressive microenvironment.</p><p><strong>Conclusions: </strong>Our study identifies ADGRG1 as a master regulator of a pro-tumorigenic CAA subpopulation. Targeting the ADGRG1-CXCL8-AKT/mTOR axis represents a promising stromal-targeting strategy to overcome immunotherapy resistance in breast cancer.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418819","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":"Development and validation of a novel multimodal deep neural network model based on CBC digit parameters and scattergrams for rapid hematolymphoid malignancy classification: a multicenter cohort study.","authors":"Hongyan Liao, Siyuan Chen, Qiang Meng, Mingxia Tang, Shuyi Hou, Jie Zhao, Yan Liu, Qin Zheng","doi":"10.1186/s12916-026-05036-y","DOIUrl":"10.1186/s12916-026-05036-y","url":null,"abstract":"<p><strong>Background: </strong>Rapid screening of hematolymphoid malignancies (HMs) by complete blood cell count (CBC) is crucial for choosing the next appropriate workup and initiating timely treatment for critical cases such as acute promyelocytic leukemia. Commonly presented as leukocytosis and abnormal differential, HMs could be misdiagnosed with diverse etiologies including reactive status of bacterial or viral infection, which also require early diagnosis and treatment to prevent severity, such as sepsis. Conventional workflow based on morphology review for HM screening remains time-consuming, labor-intensive, expertise-dependent and subjective. This study aimed to develop and validate an interpretable and cost-effective artificial intelligence (AI)-assisted model, to enable rapid and accurate prediction of HMs mixed with acute bacterial and viral infection, thus informing proper further workup and timely treatment.</p><p><strong>Methods: </strong>We retrospectively collected a multicenter dataset containing 4996 CBC records from patients presented with leukocytosis and finally diagnosed of either diseases from six prevalent HMs and acute bacterial and/or acute viral infection for model development and validation. This eight-nomial classification model, on a multimodal basis, integrates the digit parameters and its matching WBC differential scattergram from a single CBC test via a convolutional fusion deep neural network, and was compared with the digit- and scattergram-based unimodal model, as well as the current CBC review rules for performance evaluation.</p><p><strong>Results: </strong>The multimodal mDNN-cHM outperformed either unimodal model, as is demonstrated by metrics including precision, recall, F1-score and accuracy (all p < 0.05). The model showed striking diagnostic accuracy in both internal and external validations (the area under the ROC curve [AUC-ROC] all above 0.95, ranging from 0.98-1.00 internally and 0.95-1.00 externally). Further, mDNN-cHM demonstrated a higher prediction rate than the flag prompt by the current CBC review rules.</p><p><strong>Conclusions: </strong>Our study presents a proof-of-concept AI classifier for HMs in a real-time manner, which potentially maximizes the diagnostic value of the low-cost and widely-accessible CBC within 0.5 h after sample receipt. The framework also underscores the potential of interpretable AI in accelerating early disease diagnosis, mitigating human error and enlightening clinical decision-making via CBC, which complements and enhances standard-of-care diagnostics, particularly for urgent and high-risk diseases including leukemia/lymphoma and acute infection.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13440036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410345","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":"Establishing an efficacy hierarchy for breakthrough cancer pain management: a network meta-analysis of rapid-onset fentanyl formulations and morphine.","authors":"Po-Hung Tsao, Cho-Hao Lee, Jia-Hong Chen, Ching-Liang Ho, Hong-Jie Jhou, Po-Huang Chen","doi":"10.1186/s12916-026-04993-8","DOIUrl":"10.1186/s12916-026-04993-8","url":null,"abstract":"<p><strong>Background: </strong>Breakthrough cancer pain (BTP) is a common and debilitating condition affecting most patients with advanced malignancy. While multiple rapid-onset opioid formulations are available, a lack of comprehensive comparative evidence has hindered evidence-based treatment selection. We conducted a network meta-analysis (NMA) to evaluate the relative efficacy of all available formulations and characterize their temporal analgesic profiles for BTP management.</p><p><strong>Methods: </strong>We performed a systematic search of PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) evaluating rapid-onset fentanyl formulations (intranasal fentanyl spray [INFS], fentanyl buccal tablet [FBT], fentanyl pectin nasal spray [FPNS], fentanyl sublingual tablet [FST], fentanyl buccal soluble film [FBSF], and oral transmucosal fentanyl citrate [OTFC]) and morphine preparations (oral morphine sulfate immediate release [MSIR] and subcutaneous morphine [SCM]) for BTP in adults. The primary outcome was the standardized mean difference (SMD) in pain intensity difference (PID) at 10, 15, 30, and 60 min post-administration. A frequentist random-effects NMA was conducted for each time point, and treatments were ranked using P-scores, a frequentist metric ranging from 0 to 1 that reflects the probability of a treatment being superior to competitors (higher values indicate better ranking; distinct from p-values for statistical significance).</p><p><strong>Results: </strong>Seventeen RCTs involving 1,463 patients were included. Intranasal fentanyl spray (INFS) was consistently the most effective treatment across all time points, demonstrating statistically significant pain relief within 10 min (SMD: 0.85; 95% CI: 0.59-1.10) and showing its peak effect at 15 min (SMD: 1.05; 95% CI: 0.67-1.42). Fentanyl buccal tablet (FBT) consistently ranked as the second most effective agent. In contrast, immediate-release oral morphine (MSIR) did not achieve statistical superiority over placebo until the 30-minute mark (SMD: 0.20; 95% CI: 0.01-0.39; p = 0.036), confirming a comparatively delayed onset of action.</p><p><strong>Conclusions: </strong>This analysis provides evidence for a relative efficacy hierarchy among rapid-onset opioids for BTP. INFS demonstrated the most rapid and sustained analgesia across all evaluated time points, while FBT consistently ranked second. The delayed onset of MSIR warrants consideration when selecting agents for rapid pain relief. Treatment selection should integrate these efficacy data with safety profiles, route feasibility, and patient-specific factors.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410420","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":"Opioid-specific risk of respiratory depression in non-cancer pain: a retrospective cohort study.","authors":"Carlos Raul Ramirez Medina, Mark Lunt, William G Dixon, Meghna Jani","doi":"10.1186/s12916-026-04972-z","DOIUrl":"10.1186/s12916-026-04972-z","url":null,"abstract":"<p><strong>Background: </strong>Opioids are associated with serious adverse outcomes, including premature death. Respiratory depression is among the most severe opioid-related events, yet data on its incidence in non-cancer pain remain limited. Pharmacological differences suggest varying respiratory risks across opioid drugs. This study evaluated the comparative risk of respiratory depression by opioid drug and dose, and the impact of concomitant gabapentinoids and benzodiazepines in hospitalised patients with non-cancer pain.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using electronic health records from a large tertiary hospital in Northwest England. Adult inpatients (≥ 18 years) receiving opioids for non-cancer pain were included. Opioid exposure was defined from drug administration records. Respiratory depression was identified using National Early Warning Scores or naloxone administration. Incidence rates were estimated by time-varying opioid exposure, opioid drug, and daily morphine milligram equivalent (MME). Associations with incident respiratory depression were examined using a Cox regression adjusted for confounders. Effect modifiers including co-administration of gabapentinoids or benzodiazepines were assessed for their impact on respiratory depression risk, in addition to opioids.</p><p><strong>Results: </strong>Among 32,909 inpatients, fentanyl (HR: 3.36, 95% CI 2.70-4.18), combination opioids (HR: 2.74, 95% CI 2.38-3.15), oxycodone (HR: 2.10, 95% CI 1.74-2.54), and morphine (HR: 1.84, 95% CI 1.59-2.12) were associated with a significantly higher risk compared with codeine. Relative to morphine, fentanyl (HR: 1.85, 95% CI 1.50-2.27) and combination opioids (HR: 1.49, 95% CI 1.32-1.69) remained associated with higher risk. Concomitant opioid-gabapentinoid use was associated with an increased risk compared to opioid use alone (HR: 1.73; 95% CI: 1.53-1.96). Doses ≥ 120 MME/day doubled the risk compared with < 50 MME/day (HR: 2.06, 95% CI 1.81-2.35), with evidence of increased risk at lower doses (31-60 MME/day) when examined using narrower dose categories.</p><p><strong>Conclusions: </strong>Our study highlights the increased risk of respiratory depression associated with specific opioid drugs, particularly fentanyl and combination opioids, compared with codeine or morphine. Even moderate doses (31 to 60 MME/day) were associated with an increased risk, while co-prescription of gabapentinoids with opioids was associated with a higher risk compared with opioids alone.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"24 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403630","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":"Microglia-mediated synaptic pruning in neural circuit remodeling: multidimensional control in homeostasis and neuropathology.","authors":"Zheng Liu, Wu-Lan Ao, Ai-Di Luo, Si-Qi Guan, Ji Wang, Chang-Yin Yu, Zu-Cai Xu, Ping Xu, Hao Huang","doi":"10.1186/s12916-026-05016-2","DOIUrl":"10.1186/s12916-026-05016-2","url":null,"abstract":"<p><strong>Background: </strong>Microglia, the resident immune cells of the central nervous system, are key regulators of synaptic plasticity and neural circuit homeostasis.</p><p><strong>Main body: </strong>This review summarizes the mechanisms by which microglia shape synaptic structure and function, including dynamic synaptic interactions, selective pruning, epigenetic regulation, extracellular matrix remodeling, metabolic adaptation, and communication with other glial cells. Under physiological conditions, these processes support circuit refinement, synaptic stability, and cognition, which are modulated by circadian rhythms and the microbiota-gut-brain axis. In Alzheimer's disease, schizophrenia, and related disorders, microglial dysfunction can shift synaptic pruning from a controlled homeostatic process to pathological synapse loss. Excessive complement-mediated pruning, disrupted excitation-inhibition balance, neuroinflammation, and metabolic dysregulation may jointly impair synaptic integrity and circuit function.</p><p><strong>Conclusion: </strong>This review highlights microglial heterogeneity, state transitions, and targeted modulation as important directions for understanding synaptic remodeling and developing therapeutic strategies for neurological diseases.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410397","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":"Sex of surgeons and team composition and patients' length of stay after surgery: evidence from inpatient claims data in China.","authors":"Chi Shen, Yan Zhuang, Shamma Adeeb Alam, Xianhua Zai","doi":"10.1186/s12916-026-05053-x","DOIUrl":"10.1186/s12916-026-05053-x","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;High-income country evidence suggests female physicians may achieve equal or better patient outcomes, but little is known about how surgeon sex and care-team gender composition affect postoperative recovery in low- and middle-income countries (LMICs). Hospital length of stay after surgery (LOSAS) is a key indicator of recovery efficiency and resource use. We assessed whether surgeon sex and team sex composition are associated with LOSAS in a large LMIC dataset.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We analyzed administrative data on 602,608 surgical inpatient admissions from all general hospitals in a western Chinese province (January-December 2023). Records were linked with workforce data to identify surgeon sex and team characteristics. Poisson models estimated associations between surgeon sex, team sex composition, and LOSAS, adjusting for patient- and surgeon-level factors, surgery-type and hospital-month fixed effects, enabling comparisons for identical procedures in the same hospital and month. Post-hoc analyses estimated predicted LOSAS in days.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Within the sample, 48.4% (N = 363,659) of patients were female. Among the total surgeon population (N = 11,994), 58.7% (N = 7,042) were female. Patients treated by female surgeons had significantly shorter LOSAS relative to those treated by male surgeons in the overall sample (coefficient = -0.017; SE 0.008). These results remained robust across complex scenarios, including emergency department admissions and cases involving multiple surgeries within a single admission. Furthermore, procedures performed by female surgeons assisted by female first assistants had significantly shorter LOSAS (4.73 days) compared to male-male and female-male teams (5.04 days for both pairings). Younger female surgeons (born 1996-2005) had shorter LOSAS (4.50 days), relative to male counterparts (5.13 days).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this LMIC setting, female surgeons are associated with shorter LOSAS, even when accounting for case complexity. However, team sex composition and generational differences are influential factors. Our findings suggest shorter LOSAS in female-led teams, specifically those with a female surgeon and a female first assistant, as well as among younger female cohorts. Supporting integration of female surgeons and providing opportunities for female-led teams may therefore enhance recovery efficiency. These results highlight the clinical value of increasing female representation in the surgical workforce. 1) WHAT IS ALREADY KNOWN ON THIS TOPIC: Studies from high-income countries have found that female physicians frequently achieve outcomes equal to or better than their male counterparts in measures such as mortality, readmission, and patient satisfaction. However, the bulk of this work focuses on general medicine rather than operative surgical care, and there is only very limited evidence on how surgeon sex, or the gender composi","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13352664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410373","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":"Fragmented employment inclusion and lifespan health outcomes for autistic adults: systemic barriers and implications in China.","authors":"Xi Wang, Xiaoli Guo","doi":"10.1186/s12916-026-05052-y","DOIUrl":"10.1186/s12916-026-05052-y","url":null,"abstract":"<p><strong>Background: </strong>Employment is a core social determinant of long-term health, well-being, and social inclusion across the autism lifespan, yet autistic adults face severe, globally pervasive employment inequities. Existing research has disproportionately focused on childhood diagnosis and intervention, with limited exploration of systemic barriers to substantive employment inclusion for autistic adults, particularly in non-Western family-led welfare contexts amid state welfare retrenchment. This study addresses this gap by examining how multi-stakeholder goal misalignment shapes fragmented employment inclusion for autistic adults and its implications for health equity.</p><p><strong>Methods: </strong>This study integrates Job Fit Theory and Regulatory Focus Theory to conduct an exploratory qualitative analysis, using maximum variation sampling to recruit 37 key stakeholders (parents, parents-led organizations, pre-employment training institutions, and employers) across four Chinese cities (Beijing, Guangzhou, Xi'an, and Changchun). Data were collected through 48 semi-structured interviews and long-term participant observation of sheltered workshops and cross-sector negotiation meetings, with thematic analysis applied for data coding. Autistic adults were not directly interviewed in this study because we focused on key interest-holders who directly shape their employment trajectories and daily work experiences.</p><p><strong>Results: </strong>Core findings reveal three critical forms of fragmented inclusion: parents' collective prevention orientations narrow skill-demand matching to behavioral compliance, isolating autistic adults from mainstream labor markets; employers' promotion-prevention conflicts result in symbolic hiring (\"paid absence\"-a practice where employers keep autistic adults on the payroll and pay them salaries but do not require them to attend work or perform meaningful tasks), maintaining formal employment status while undermining substantive inclusion; and these dynamics form a \"proxy-driven fragmented inclusion paradox,\" trapping job fit in a low-equilibrium state where short-term employment stability perpetuates capability deprivation.</p><p><strong>Conclusions: </strong>This study reveals how policies redistribute regulatory labor to families, exacerbating health inequities for autistic adults. These findings point toward a normative ethical framework that balances protection and autonomy and underscore that employment policies must empower autistic adults as active agents in their own employment trajectories. The findings offer critical insights for global autism employment policy and health equity practice for autistic adults.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403650","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":"Complex affect dynamics offer limited incremental value for cross-sectional prediction of psychological and behavioural variables in cross-validated models.","authors":"Yinuo Shu, Priscila Thalenberg Levi, Jeggan Tiego, Toby Constable, James C Pang, Bree Hartshorn, Jessica Kwee, Kate Fortune, Mark Bellgrove, Alex Fornito","doi":"10.1186/s12916-026-04936-3","DOIUrl":"10.1186/s12916-026-04936-3","url":null,"abstract":"<p><strong>Background: </strong>There is growing interest in the use of end-of-day dairies (EODD) as a means for quantifying how individuals' affective experiences fluctuate over time, and how such dynamics relate to mental health variables. A plethora of methods exist for precisely quantifying these affect dynamics, but recent work pooling data from multiple studies has suggested that most of the variance in outcome measures of depression, borderline symptoms, and life satisfaction is captured by simple measures, such as the mean (M) and standard deviation (SD) of affect ratings over time. Ever-more sophisticated approaches for measuring affect dynamics may offer little value for understanding mental health. Here, we examined a broad array of mental health variables and affect dynamic measures within a single cohort to comprehensively evaluate whether EODD-derived measures of affect dynamics are associated with specific psychopathological experiences.</p><p><strong>Methods: </strong>A total of 314 adults (97 males; aged 18-45 years) first completed a 2-hour online questionnaire comprising a comprehensive battery of psychometrically validated instruments assessing personality traits, mental health symptoms, life satisfaction, and various psychological factors, and subsequently completed 28 days of EODD assessments (M_{interval days} = 21.4 days, SD_{interval days} = 31.0 days), including once-daily ratings on the Positive and Negative Affect Schedule (PANAS-10) and daily measures of stress, sleep, and alcohol use. We calculated 16 established affect dynamics measures (M, SD, relative SD, mean-squared successive differences, autoregression, intraclass correlation, and Gini coefficient for positive affect (PA) and negative affect (NA), as well as emotion network density and PA-NA correlation) in addition to six additional measures derived using dynamic network analyses of participant responses (promiscuity and flexibility for the entire network, PA, and NA). Predictive power was assessed using cross-validated linear regression models predicting 117 variables spanning five cross-sectional psychometric questionnaires and EODD-based longitudinal behavioral measures. We compared models that included each complex measure against baseline models using only M or M + SD scores quantifying PA and NA.</p><p><strong>Results: </strong>Across all 117 variables, no complex affect dynamics measures improved cross-validated R² by more than 5.3 % beyond the M and SD of PA and NA.</p><p><strong>Conclusions: </strong>Elaborate measures of affect dynamics, as indexed by the PANAS-10, offer minimal incremental explanatory power in predicting psychopathology beyond basic summary statistics of daily affect. These findings question the added value of increasingly complex measures of affect dynamics for predicting standard psychological and behavioral variables.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403663","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":"Migraine and risk of adverse obstetric outcomes: a matched cohort study of English linked electronic health records.","authors":"Katherine Phillips, Megha Singh, Siang Ing Lee, Nadia Sarween, Kelly-Ann Eastwood, Arturo Gonzalez-Izquierdo, Benjamin Wakerley, Lakshrieni Nishshanka, Neil Cockburn, Francesca L Crowe, Krishnarajah Nirantharakumar","doi":"10.1186/s12916-026-04991-w","DOIUrl":"10.1186/s12916-026-04991-w","url":null,"abstract":"<p><strong>Background: </strong>Existing literature suggests a link between migraine and various adverse pregnancy outcomes, but findings remain inconsistent. This study aimed to evaluate the association between pre-pregnancy migraine and obstetric outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study used linked electronic health records from Clinical Practice Research Datalink (CPRD) GOLD and Hospital Episode Statistics (HES) maternity data. We included women aged 15-50 years in England with singleton deliveries between 2000 and 2019. Deliveries from women with a recorded migraine diagnosis before pregnancy were matched 1:1 by maternal age to those without migraine. Logistic regression models, adjusted for demographic and clinical factors, were used to examine associations with preterm birth, low birth weight, small for gestational age (SGA), mode of delivery, and stillbirth.</p><p><strong>Results: </strong>The cohort included 428,217 deliveries from 317,016 women, comprising 46,560 (10.9%) migraine-exposed deliveries and an equal number of matched controls. No significant association was found between pre-pregnancy migraine and preterm birth (aOR 1.04(0.99-1.09)), although migraine appeared to have a protective effect against very preterm birth (aOR 0.83(0.73-0.95)). Pre-pregnancy migraine was associated with increased odds of iatrogenic preterm birth (aOR 1.10, 95% CI: 1.04-1.18), but not spontaneous preterm birth (aOR 0.97, 95% CI: 0.91-1.03). Migraine was associated with a significant increase in the odds of pre-eclampsia (aOR 1.17 (95% CI 1.07-1.27)). There were no notable associations with low birth weight (1500-2500 g) (aOR 1.02, 95% CI: 0.95-1.09), very low (1000-1500 g) or extremely low birth weight (< 1000 g), SGA (aOR 0.96, 95% CI: 0.89-1.03), or stillbirth (aOR 1.00, 95% CI: 0.81-1.24). No significant association was seen between migraine and elective caesarean section (aOR 1.04, 95% CI: 0.99-1.09).</p><p><strong>Conclusion: </strong>Pre-pregnancy migraine was associated with increased odds of iatrogenic preterm birth and pre-eclampsia. Associations with other outcomes were small and uncertain. Further research is needed to understand the mechanisms underlying these findings and their clinical relevance.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403578","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}