BMC Medicine最新文献

{"title":"Efficacy of digital therapeutics for perioperative management in patients with lung cancer: a randomized controlled trial.","authors":"Jinming Xu, Heng Ni, Hanyu Zhan, Hongfan Yu, Zhongjie Lu, Jieping Zhang, Hongbo Meng, Lin Hang, Lin Mao, Xiaoying Xu, Xiaojian Ma, Qiongyin Wu, Wen Xu, Danyu Xiang, Yufang Zeng, Di Meng, Xiao Teng, Li Yu, Liping Zeng, Pengzhi Ni, Huiwen Miao, Shaozi Fu, Luming Wang, Zhehao He, Chong Zhang, Xiayi Lv, Heyun Xu, Yihua Wu, Wang Lv, Qiuling Shi, Jian Hu","doi":"10.1186/s12916-025-04012-2","DOIUrl":"https://doi.org/10.1186/s12916-025-04012-2","url":null,"abstract":"<p><strong>Background: </strong>Perioperative management and lung function recovery are vital for lung cancer patients. We conducted an open-label, single-center, noninferiority, randomized controlled trial in China to evaluate the efficacy of digital therapeutic (DTx)-assisted management vs. multidisciplinary management (MM) in the perioperative management of patients with lung cancer.</p><p><strong>Methods: </strong>From July 2022 to June 2023, 186 minimally invasive lung surgery patients were randomized, and 147 completed the study. The participants were randomly assigned a 1:1 ratio to receive DTx-assisted management (n = 72) or traditional MM (n = 75). The primary endpoint was the pulmonary function recovery rate measured by forced expiratory volume in the first second (FEV1%) 3 weeks after surgery, and the noninferiority margin was set to 4.8%. The secondary endpoints included hospital stay duration, 90-day unplanned readmission rate, symptom scores, patient management time, and patient satisfaction rate. Exploratory endpoints include factors influencing postoperative lung function recovery.</p><p><strong>Results: </strong>The lung function FEV1% recovery rate of the DTx group was not inferior to that of the MM group (87.18% ± 11.01% vs. 84.21% ± 11.75%). There were no significant differences between the two groups in terms of postoperative hospitalization duration or 90-day unplanned readmission rates. The patient management time in the DTx group was significantly shorter than that in the MM group (1.48 ± 3.22 min vs. 16.67 ± 6.41 min, P < 0.001). Patient symptom scores tended to decrease over time after discharge, and the 5 target symptoms included pain, coughing, shortness of breath, disturbed sleep, and fatigue. On the 7th day after discharge, the DTx group had a lower occurrence rate of the 5 target symptoms triggering the alert threshold compared to the MM group (P = 0.002). Patients with higher education levels achieved a better FEV1% recovery rate with DTx-assisted management (P = 0.021).</p><p><strong>Conclusions: </strong>Compared with the MM group, the DTx group achieved noninferior results in all evaluated clinically meaningful endpoints but was significantly more efficient in perioperative management, providing an alternative digitalized management mode for patients with lung cancer surgery.</p><p><strong>Trial registration: </strong>ChiCTR2200064723.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"186"},"PeriodicalIF":7.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742344","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":"Association of circulating metabolic biomarkers with risk of lung cancer: a population-based prospective cohort study.","authors":"Lan Wu, Jun Yang, Yu Chen, Jiahao Lin, Wenkai Huang, Mengmeng Li","doi":"10.1186/s12916-025-03993-4","DOIUrl":"10.1186/s12916-025-03993-4","url":null,"abstract":"<p><strong>Background: </strong>There is emerging evidence that metabolites might be associated with risk of lung cancer, but their relationships have not been fully characterized. We aimed to investigate the association between circulating metabolic biomarkers and lung cancer risk and the potential underlying pathways.</p><p><strong>Methods: </strong>Nuclear magnetic resonance metabolomic profiling was conducted on baseline plasma samples from 91,472 UK Biobank participants without cancer and pregnancy. Multivariate Cox regression models were employed to assess the hazard ratios (HRs) of 164 metabolic biomarkers (including metabolites and lipoprotein subfractions) and 9 metabolic biomarker principal components (PCs) for lung cancer, after adjusting for covariates and false discovery rate (FDR). Pathway analysis was conducted to investigate the potential metabolic pathways.</p><p><strong>Results: </strong>During a median follow-up of 11.0 years, 702 participants developed lung cancer. A total of 109 metabolic biomarkers (30 metabolites and 79 lipoprotein subfractions) were associated with the risk of lung cancer. Glycoprotein acetyls demonstrated a positive association with lung cancer risk [HR = 1.13 (95%CI: 1.04, 1.22)]. Negative associations with lung cancer were found for albumin [0.78 (95%CI: 0.72, 0.83)], acetate [0.91 (95%CI: 0.85, 0.97)], valine [0.90 (95%CI: 0.83, 0.98)], alanine [0.88 (95%CI: 0.82, 0.95)], glucose [0.91 (95%CI: 0.85, 0.99)], citrate [0.91 (95%CI: 0.85, 0.99)], omega-3 fatty acids [0.83 (95%CI: 0.77, 0.90)], linoleic acid [0.83 (95%CI: 0.77, 0.89)], etc. Nine PCs represented over 90% of the total variances, and among those with statistically significant estimates, PC1 [0.85 (95%CI: 0.80, 0.92)], PC2 [0.88 (95%CI: 0.82, 0.95)], and PC9 [0.87 (95%CI: 0.80, 0.93)] were negatively associated with lung cancer risk, whereas PC7 [1.08 (95%CI: 1.00, 1.16)] and PC8 [1.16 (95%CI: 1.08, 1.26)] showed positive associations with lung cancer risk. The pathway analysis showed that the \"linoleic acid metabolism\" was statistically significant after the FDR adjustment (p value 0.0496).</p><p><strong>Conclusions: </strong>Glycoprotein acetyls had a positive association with lung cancer risk while other metabolites and lipoprotein subfractions showed negative associations. Certain metabolites and lipoprotein subfractions might be independent risk factors for lung cancer. Our findings shed new light on the etiology of lung cancer and might aid the selection of high-risk individuals for lung cancer screening.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"176"},"PeriodicalIF":7.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717956","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":"Exploring the interaction effects of subclinical hypothyroidism and major depressive disorder on brain networks.","authors":"Shuai Zhao, Jindan Wu, Xiaomei Liu, Yishan Du, Xiaoqin Wang, Yi Xia, Hao Sun, Haowen Zou, Xumiao Wang, Zhilu Chen, Rui Yan, Hao Tang, Qing Lu, Zhijian Yao","doi":"10.1186/s12916-025-03995-2","DOIUrl":"10.1186/s12916-025-03995-2","url":null,"abstract":"<p><strong>Background: </strong>Major depressive disorder (MDD) often presents alongside physical illnesses, such as a high incidence of subclinical hypothyroidism (SHypo) in patients, highlighting the common occurrence of these comorbidities. Recent research has indicated that the presence of comorbid SHypo in individuals diagnosed with MDD may result in notable alterations in both brain structure and function. This study aimed was to investigate the neurological mechanisms underlying this co-occurrence using a data-driven approach to analyze brain activity patterns.</p><p><strong>Methods: </strong>Twenty-nine patients diagnosed with MDD without any comorbid conditions (nSHypo-MDD) were included in the study, along with 29 MDD patients who also had SHypo (SHypo-MDD), 26 patients with SHypo only, and 29 healthy individuals as controls (HCs). Each participant received resting-state functional magnetic resonance imaging scans and underwent neuropsychological evaluations.</p><p><strong>Results: </strong>We found significantly altered functional connectivity (FC) within the resting-state networks (RSNs) of the ventral and dorsal sensorimotor network (VSMN and DSMN) and occipital pole visual network (PVN) (p < 0.05, FDR corrected). A vital interaction effect between SHypo and MDD was detected in the PVN, showing that SHypo-MDD patients had higher FC values in the left cuneus than nSHypo-MDD patients. Serum-free triiodothyronine (FT3) levels in SHypo-MDD patients demonstrated an inverse relationship with FC values of the right supplementary motor area (SMA.R) (r = - 0.563, p = 0.003). Furthermore, the FC values in the left cuneus are positively associated with the Digit Symbol Substitution Test (DSST) scores (r = 0.507, p = 0.008).</p><p><strong>Conclusions: </strong>Our study reveals significant FC changes in SHypo-MDD patients, particularly in the PVN, VSMN, and DSMN, suggesting compensatory mechanisms that mitigate cognitive deficits and highlighting the need for integrated management of SHypo and MDD to improve cognitive outcomes.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"177"},"PeriodicalIF":7.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717992","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":"Therapeutic hypothermia in patients with acute myocardial infarction complicated by out-of-hospital cardiac arrest.","authors":"Oh-Hyun Lee, Seok-Jae Heo, Moon-Hyun Kim, Je-Wook Park, SungA Bae, Minkwan Kim, Ji Woong Roh, Yongcheol Kim, Eui Im, In Hyun Jung, Deok-Kyu Cho","doi":"10.1186/s12916-025-03997-0","DOIUrl":"10.1186/s12916-025-03997-0","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of data regarding outcomes of therapeutic hypothermia in patients with acute myocardial infarction (AMI) complicated by out-of-hospital cardiac arrest (OHCA). This study aimed to evaluate the effect of therapeutic hypothermia on clinical outcomes in comatose patients after percutaneous coronary intervention (PCI) for AMI following OHCA.</p><p><strong>Methods: </strong>Using a prospective nationwide registry from 2016 to 2021, we selected 2925 patients with AMI who underwent emergency PCI among 182,508 OHCA cases. These patients were divided into groups receiving hypothermia treatment (n = 624) and those not receiving hypothermia treatment (n = 2301). The primary endpoint was in-hospital mortality, and secondary endpoints were mortality rate at 24 h and neurological outcomes at discharge.</p><p><strong>Results: </strong>The hypothermia group showed a significantly lower rate of in-hospital mortality than the non-hypothermia group (odds ratio [OR] 0.71; 95% confidence interval [CI], 0.59-0.85; P < 0.001). However, there was no significant difference in neurological outcomes at discharge between the two groups. Furthermore, quartile analysis of door-to-cooling (DtC) time, defined as the time from hospital arrival to initiation of hypothermia, demonstrated that a shorter DtC time was associated with a decreased risk of mortality and poor neurological outcomes (mortality: adjusted OR, 0.40; 95% CI, 0.30-0.54; P < 0.001; poor neurological outcome: adjusted OR, 0.59; 95% CI, 0.45-0.77; P < 0.001 for quartile 1 versus quartile 4).</p><p><strong>Conclusions: </strong>Therapeutic hypothermia reduced the rate of in-hospital mortality in patients with AMI complicated by OHCA. Moreover, early initiation of hypothermia demonstrated a reduction in mortality and poor neurological outcomes.</p><p><strong>Pre-registered clinical trial number: </strong>URL: http://clinicaltrials.gov . Unique identifier: NCT05724914. In this large, government-controlled, nationwide, prospective real-world registry with AMI and complicated by OHCA, we demonstrated therapeutic hypothermia reduced the rate of in-hospital mortality, but it did not improve neurological outcomes at discharge. Our findings also showed that early initiation of hypothermia was significantly associated with reduced in-hospital mortality and poor neurological outcomes. The findings of this study suggest that therapeutic hypothermia reduces in-hospital mortality in patients with AMI complicated by OHCA. Early application of hypothermia should be considered as a potential means of improving neurological outcomes in patients with AMI-OHCA undergoing emergency PCI.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"179"},"PeriodicalIF":7.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718023","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":"Sensitive diagnosis of paucibacillary tuberculosis with targeted next-generation sequencing: a molecular diagnostic study.","authors":"Yu Chen, Lichao Fan, Zhong Ren, Yanhong Yu, Jiao Sun, Miaoran Wang, Chang Liu, Ying Zhang, Shuihua Lu, Xuhui Liu, Zhen Huang","doi":"10.1186/s12916-025-03996-1","DOIUrl":"10.1186/s12916-025-03996-1","url":null,"abstract":"<p><strong>Background: </strong>Targeted next-generation sequencing (tNGS) enables high-performance tuberculosis (TB) diagnosis and drug resistance prediction directly from clinical samples. However, its applicability to paucibacillary TB, including pediatric TB and extrapulmonary TB (EPTB), has been less explored. We aimed to evaluate the performance of tNGS in these challenging TB presentations.</p><p><strong>Methods: </strong>We prospectively and consecutively enrolled children (< 18 years) with suspected TB and adults with suspected EPTB. All participants underwent a comprehensive clinical examination, laboratory tests, and tNGS analysis. The diagnostic performance of tNGS was evaluated against composite reference standards, while resistance prediction capabilities were assessed with GeneXpert MTB/RIF and phenotypic drug susceptibility testing.</p><p><strong>Results: </strong>A total of 85 children and 228 adults were enrolled. In children, tNGS showed a sensitivity of 74% (95% CI, 61-84%) and a specificity of 97% (95% CI, 84-100%) for microbiologically and clinically confirmed TB, whereas in adults with microbiologically and clinically confirmed EPTB, it demonstrated 77% sensitivity (95% CI, 68-83%) and 98% specificity (95% CI, 94-100%). For drug resistance prediction, tNGS exhibited variable sensitivity, peaking at 88% for rifampicin (95% CI, 47-100%) and bottoming out at 38% for streptomycin (95% CI, 9-76%), alongside a consistently acceptable specificity ranging from 89% (95% CI, 76-96%) to 100% (95% CI, 93-100%).</p><p><strong>Conclusions: </strong>tNGS is a potentially promising test that enables rapid and sensitive diagnosis of TB in children and individuals with extrapulmonary TB. However, the variability in its accuracy for predicting drug resistance in these populations needs to be validated and addressed before its clinical application.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"178"},"PeriodicalIF":7.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718003","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":"A comparative study of shoulder replacement outcomes using linked national registry and hospital data from England and Denmark.","authors":"Epaminondas Markos Valsamis, Josefine Beck Larsen, Theis M Thillemann, Stephen E Gwilym, Gary S Collins, Inger Mechlenburg, Jonathan L Rees","doi":"10.1186/s12916-025-04003-3","DOIUrl":"10.1186/s12916-025-04003-3","url":null,"abstract":"<p><strong>Background: </strong>The incidence of shoulder replacement surgery continues to rise internationally. The aim of this study was to compare revision surgery, reoperations and serious adverse events after shoulder replacement surgery in England and Denmark.</p><p><strong>Methods: </strong>Linked National Joint Registry and NHS Hospital Episode Statistics of England, and linked Danish Shoulder Arthroplasty Registry and Danish National Patient Registry data were available from 1 April 2012 to 31 December 2020. All primary shoulder replacements in adult patients were included. Revision surgery, reoperations and serious adverse events were compared between the two countries, and stratified by procedure type and surgical indication. The risk of revision and serious adverse events were adjusted for age, sex and comorbidities, using flexible parametric survival models and logistic regression models, respectively.</p><p><strong>Results: </strong>A total of 41,471 and 9,268 primary shoulder replacement procedures were analysed from England and Denmark, respectively. The mean patient age in Denmark was 70.6 years (SD 10.1) and in England 72.6 years (SD 9.9). Danish patients had a lower risk of serious adverse events (4.5%) compared to patients in England (5.6%), but a slightly higher risk of re-operations by 1 year (Denmark 2.3% [95% CI 2.0% to 2.6%], England 1.7% [95% CI 1.6% to 1.8%]). There was a slightly lower risk of revision joint replacement surgery by 8 years in Denmark (5.1% [95% CI 4.5% to 5.8%]) compared to England (5.7% [95% CI 5.4% to 6.1%]). The reverse total shoulder replacement had a higher revision rate in Denmark, but the anatomical total shoulder replacement and humeral hemiarthroplasty had lower revision rates. Denmark had a considerably higher revision rate for patients having surgery for acute trauma. These results remained the same after adjusting for age, sex, and the Charlson Comorbidity Index.</p><p><strong>Conclusions: </strong>While there was variation in the demographics of patients having shoulder replacement surgery in England and Denmark, differences in serious adverse events and revision rates were observed despite case-mix adjustment. Some of this variation might be attributed to the differences seen in the use of different procedures for different surgical indications between the two countries.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"180"},"PeriodicalIF":7.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717949","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":"Cancer incidence inconsistency between UK Biobank participants and the population: a prospective cohort study.","authors":"Chenxi Li, Gillian S Dite, Tuong L Nguyen, John L Hopper, Shuai Li","doi":"10.1186/s12916-025-03998-z","DOIUrl":"10.1186/s12916-025-03998-z","url":null,"abstract":"<p><strong>Background: </strong>While the UK Biobank has been widely used for cancer research, its representativeness of the population in terms of cancer incidence has not been thoroughly investigated.</p><p><strong>Methods: </strong>We conducted a prospective cohort study of 466,163 UK Biobank participants who were cancer-free at recruitment. Standardised incidence ratios (SIRs) were calculated for all cancers combined and for 25 cancers, by comparing incidences for the participants with the UK national incidences. Variations in SIR by age, sex and deprivation measures were investigated.</p><p><strong>Results: </strong>Over a median follow-up period of 12 years, 47,535 participants had a cancer diagnosis. The SIR for all cancers combined was 0.90 (95% CI: 0.89, 0.91). The SIR increased with age and deprivation (P = 10^-9). The SIRs of 17 cancers differed from 1 (Bonferroni-adjusted P < 0.05): for prostate cancer and melanoma the SIRs were 1.2 and for the other 15 cancers the SIRs ranged from 0.43 to 0.93. The SIRs of 13 cancers differed by deprivation: the greater the deprivation, the lower the SIRs for prostate cancer and melanoma, and the higher the SIRs for the other 11 cancers.</p><p><strong>Conclusions: </strong>The overall cancer incidence was 10% lower for the UK Biobank participants compared with the population, with most cancers having a lower incidence that increased with deprivation. Irrespective of their causes, the inconsistencies could bias UK Biobank research results related to absolute cancer risks, such as the development and/or validation of cancer risk models and penetrance estimates for cancer susceptibility genes.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"181"},"PeriodicalIF":7.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717959","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":"Diagnosis of celiac disease on a gluten-free diet: a multicenter prospective quasi-experimental clinical study.","authors":"Sara Gómez-Aguililla, Sergio Farrais, Natalia López-Palacios, Beatriz Arau, Carla Senosiain, María Corzo, Nora Fernandez-Jimenez, Ángela Ruiz-Carnicer, Fernando Fernández-Bañares, Bárbara P González-García, Eva Tristán, Ana Montero-Calle, María Garranzo-Asensio, Isabel Casado, Mar Pujals, Juana María Hernández, Jorge Infante-Menéndez, Garbiñe Roy, Carolina Sousa, Concepción Núñez","doi":"10.1186/s12916-025-04008-y","DOIUrl":"10.1186/s12916-025-04008-y","url":null,"abstract":"<p><strong>Background: </strong>Diagnosing celiac disease (CD) in individuals adhering to a gluten-free diet (GFD) presents significant challenges. Current guidelines recommend a gluten challenge (GC) lasting at least 6-8 weeks, which has several limitations. Our aim was to compare four approaches previously proposed for diagnosing CD on a GFD: IL-2 serum levels, gut-homing CD8⁺ T cells, % TCRγδ⁺ intraepithelial lymphocytes (IELs), and UBE2L3 gene expression. Additionally, we evaluated the CD8⁺ T-cell-based method with a 3-day GC against the standard GC protocol.</p><p><strong>Methods: </strong>We conducted a multicenter prospective quasi-experimental clinical study. Two subsets of individuals were considered: (1) 20 patients with CD previously diagnosed and 15 non-CD controls, to evaluate the first aim; (2) 41 individuals with uncertain diagnosis who were on a GFD and required GC following current clinical guidelines, to assess the second aim. All participants underwent a 3-day GC (10 g gluten/day).</p><p><strong>Results: </strong>Among CD patients and non-CD controls, the sensitivity and specificity of IL-2, gut-homing CD8⁺ T cells, and UBE2L3 were 82.4% and 83.3%, 88.2% and 100%, and 52.9% and 100%, respectively. The percentage of TCRγδ⁺ IELs showed 88.2% sensitivity. In the uncertain diagnosis group, a CD8⁺ T-cell positive response was observed in 8 of the 41 subjects.</p><p><strong>Conclusions: </strong>The percentage of TCRγδ⁺ IELs and the analysis of IL-2 levels and gut-homing CD8⁺ T cells are promising diagnostic methods for CD on a GFD. Notably, our results suggest that the CD8⁺ T-cell assay may provide a consistent and reliable alternative to the extended GC, eliminating the need for invasive procedures to obtain duodenal samples and prolonged gluten ingestion. However, further research with larger cohorts are necessary to validate these findings and establish their definitive clinical utility.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"182"},"PeriodicalIF":7.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717963","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":"Gut virome and its implications in the pathogenesis and therapeutics of inflammatory bowel disease.","authors":"Yushan Wu, Rui Cheng, Hao Lin, Lili Li, Yongbin Jia, Anna Philips, Tao Zuo, Hu Zhang","doi":"10.1186/s12916-025-04016-y","DOIUrl":"10.1186/s12916-025-04016-y","url":null,"abstract":"<p><p>Inflammatory bowel disease (IBD) refers to chronic, recurrent inflammatory intestinal disorders, primarily including Crohn's disease (CD) and Ulcerative colitis (UC). Numerous studies have elucidated the importance of the gut microbiome in IBD. Recently, numerous studies have focused on the gut virome, an intriguing and enigmatic aspect of the gut microbiome. Alterations in the composition of phages, eukaryotic viruses, and human endogenous retroviruses that occur in IBD suggest potential involvement of the gut virome in IBD. Nevertheless, the mechanisms by which it maintains intestinal homeostasis and interacts with diseases are only beginning to be understood. Here, we thoroughly reviewed the composition of the gut virome in both healthy individuals and IBD patients, emphasizing the key viruses implicated in the onset and progression of IBD. Furthermore, the complex connections between the gut virome and the intestinal barrier, immunity, and gut microbiome were dissected to advance the interpretation of IBD pathogenesis. The updated discussion of the evidence regarding the gut virome will advance our knowledge in gut virome and chronic gastrointestinal diseases. Targeting the gut virome is a promising avenue for IBD treatment in future.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"183"},"PeriodicalIF":7.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717996","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":"Language complexity of patient-physician chat communication on hypertension control: results of the cluster-randomised PIA study.","authors":"Simon-Konstantin Thiem, Lucas Küppers, Benjamin Aretz, Arezoo Bozorgmehr, Arian Karimzadeh, Frauke Leupold, Birgitta Weltermann","doi":"10.1186/s12916-025-04006-0","DOIUrl":"10.1186/s12916-025-04006-0","url":null,"abstract":"<p><strong>Background: </strong>High language complexity impairs patients' understanding and medical outcomes. While messengers accelerate communication, the language complexity of chats between patients and providers is poorly studied. This study analyses language complexity and communication characteristics of chat data from the PIA study, which significantly improved blood pressure control after 6 to 12 months.</p><p><strong>Methods: </strong>The cluster-randomised controlled PIA study enrolled 848 hypertension patients (412 intervention, 436 control) from 64 German general practices. The PIA technology enabled a secured communication of blood pressure readings, medication plans and messages. The chats were analysed regarding frequency, length, response time and content. Language complexity was measured using the Flesch index with seven levels from 'hard' to 'very simple'. The study is registered in the German Clinical Trials Register (DRKS00012680).</p><p><strong>Results: </strong>In total, 4231 messages were sent between 24 general practitioners and 363 patients of the intervention arm between 09/20 and 09/21: 22% messages (n = 941) were automated (new medication plan or prescription available), while 78% were non-automated (n = 3290), with 41.1% of these messages originating from patients and 58.9% from practices. The average chat dialogue lasted 176.8 days (SD 9.8). Patients' messages had a mean of 22.6 words (SD 22.6) compared to 16.8 (SD 19.4) by practices. Most messages (88.92%) from practices and 51.9% from patients addressed medication or treatments. Simple or very simple language was used in 90.5% of the messages both by patients and by physicians regardless of sociodemographic characteristics. BP improved with increased frequency of messages (p < 0.001).</p><p><strong>Conclusions: </strong>This communication showed a remarkably low language complexity by physicians and patients and better control with more messages. The results support the use of digital communication for topics such as chronic hypertension care.</p><p><strong>Trial registration: </strong>German Clinical Trials Register, DRKS00012680. Registered May 10th, 2019, https://www.drks.de/drks_web/setLocale_EN.do .</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"174"},"PeriodicalIF":7.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699694","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}