BMC Medicine最新文献

{"title":"The unwell patient with advanced chronic liver disease: when to use each score?","authors":"Oliver Moore, Wai-See Ma, Scott Read, Jacob George, Golo Ahlenstiel","doi":"10.1186/s12916-025-04185-w","DOIUrl":"10.1186/s12916-025-04185-w","url":null,"abstract":"<p><strong>Background: </strong>Prognostication in chronic liver disease and the implementation of appropriate scoring systems is difficult given the variety of clinical manifestations. It is important to understand the limitations of each scoring system as well as the context and patient group from which it was developed to allow appropriate application. This review seeks to explore the optimal clinical uses of different predictive scores developed for compensated and decompensated chronic liver disease, acute on chronic liver failure, and hepatocellular carcinoma. We will also review future areas of research for each score and current gaps in the literature.</p><p><strong>Main body: </strong>The Child-Pugh score is the pre-eminent prediction score for liver disease that was developed through empiric selection of relevant variables. It is useful for selection of patients for surgical resection of hepatocellular carcinoma but is inferior to other scores for other clinically relevant endpoints such as survival in acute decompensations. The Model for End-Stage Liver Disease (MELD) score and subsequent variants (MELD-Na, MELD 3.0) were developed to predict mortality following elective transjugular intrahepatic portosystemic shunt (TIPS) insertion. An alternative is the Frieberg Index of Post-TIPS Survival (FIPS) score, which has been externally validated for TIPS populations. Organ allocation for liver transplantation is also currently prioritised using the MELD score, with the MELD 3.0 reducing waitlist gender discrepancies. The Chronic Liver Failure Consortium (CLIF-C) acute decompensation (AD) and acute-on-chronic liver failure (ACLF) scores are used for predicting mortality in cirrhotic patients with acute decompensation of liver disease and acute-on-chronic liver failure, respectively. Both scores were developed from retrospective analyses of an observational European cohort with external validation. Understanding of ACLF presentation of advanced liver disease remains in the preliminary stages. Improving collective understanding is important to optimise prognostication. The albumin-bilirubin score is a non-invasive predictor of survival in patients with hepatocellular carcinoma. Incorporating artificial intelligence to personalise predictive algorithms may provide the most effective prognostication for all clinical phenotypes.</p><p><strong>Conclusion: </strong>We summarised key prognostic scores used in advanced liver disease and make recommendations for the optimal uses. Nuances in the development and implementation of each are discussed to help guide effective use.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"413"},"PeriodicalIF":7.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590457","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":"Do women need a change in dose of prescription drugs with onset of menopause? Time to find out.","authors":"Iris E C Sommer, Bodyl A Brand, Tanja R Zijp, Marian J E Mourits, Daan J Touw","doi":"10.1186/s12916-025-04253-1","DOIUrl":"10.1186/s12916-025-04253-1","url":null,"abstract":"","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"411"},"PeriodicalIF":7.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12236021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583158","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":"Mitigation of chemotherapy-induced gut dysbiosis and diarrhea by supplementation with heat-killed Bacteroides fragilis.","authors":"Xinwen Yan, Xinlong Lin, Jianhua Wu, Lijun Zheng, Yangyang Liu, Fang Wu, Ying Lin, Yishi Lu, Chongyang Huang, Binhai Shen, Hongbin Liu, Ruo Huang, Fengyi Hou, Qian Zhou, Mengyao Song, Ke Liu, Fangqing Zhu, Sheng Li, Yuqing Lin, Wei Wang, Ping Li, Wangjun Liao, Fachao Zhi","doi":"10.1186/s12916-025-04233-5","DOIUrl":"10.1186/s12916-025-04233-5","url":null,"abstract":"<p><strong>Background: </strong>The role of gut microbial dysbiosis in chemotherapy-induced diarrhea (CID) pathogenesis remains unclear in humans. This study investigates gut microbiota alterations in CID patients and evaluates the therapeutic potential of probiotic supplementation.</p><p><strong>Methods: </strong>To establish a paired cohort for longitudinal comparison and minimize confounding factors in assessing CID-related microbiota changes, strict inclusion/exclusion criteria were applied to gastrointestinal cancer patients. Fecal samples from eligible participants underwent shotgun metagenomic sequencing to comprehensively profile the gut microbiome composition and function. To evaluate probiotic efficacy and mechanisms, we utilized 6-8-week-old male BALB/c and C57BL/6 mice in established 5-FU- or CPT-11-induced CID models. Probiotic efficacy was assessed using primary (diarrhea severity) and secondary endpoints (body weight change, intestinal permeability). Mechanistic studies were conducted in murine models, complemented by IEC-6 cells and intestinal organoid experiments to elucidate microbiota-host interactions.</p><p><strong>Results: </strong>Analysis of paired fecal samples (pre- and post-chemotherapy) from 30 gastrointestinal cancer patients (n = 60) revealed chemotherapy-induced reduction of Bacteroides fragilis (B. f) via metagenomics sequencing, with baseline B. f relative abundance negatively correlating with CID severity (r =  - 0.93, p = 3.1e - 12). Building on these clinical observations, in 5-FU/CPT-11-induced CID murine models, oral gavage of heat-killed B. f (hk-B. f) outperformed live bacteria in diarrhea alleviation. Mechanistically, B. f-derived succinate exacerbated diarrhea, while its capsular polysaccharide (PSA) ameliorated mice diarrhea. This discovery explains the discrepant therapeutic effect between hk-B. f and live B. f. Fluorescence tracing confirmed hk-B. f transiently localized to the upper gastrointestinal tract without extraintestinal colonization. hk-B. f preserved epithelial integrity, mitochondrial function, and intestinal organoid development (higher budding count and larger organoid surface area). Moreover, hk-B. f upregulated the expression of BCL2 and downregulated the expression of BAX. Shifting the balance between BCL2 and BAX alleviates intestinal epithelial apoptosis. Caspase-3 inhibition or BCL2 silencing abrogated hk-B. f's anti-apoptotic effects in IEC-6 cells.</p><p><strong>Conclusions: </strong>Pathological process of CID can be partially explained by compositional alterations in the gut microbiota. Supplementation with hk-B. f reduces 5-FU-stimulated epithelial injury through mitochondrial apoptotic pathway in CID murine models. These preclinical findings suggest hk-B. f merits further investigation as a potential strategy for improving CID, pending clinical validation.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"408"},"PeriodicalIF":7.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12235877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583160","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":"Prognostic and predictive microRNA panels for heart failure patients with reduced or preserved ejection fraction: a meta-analysis of Kaplan-Meier-based individual patient data.","authors":"Reza Parvan, Victoria Becker, Milad Hosseinpour, Yousef Moradi, William E Louch, Alessandro Cataliotti, Yvan Devaux, Michael Frisk, Gustavo Jose Justo Silva","doi":"10.1186/s12916-025-04238-0","DOIUrl":"10.1186/s12916-025-04238-0","url":null,"abstract":"<p><strong>Background: </strong>Cardiac troponins and natriuretic peptides are benchmark biomarkers for heart failure (HF) with reduced ejection fraction (HFrEF) but have limited prognostic performance for HF patients with preserved ejection fraction (HFpEF). Non-coding RNA-based biomarkers represent an innovative approach to risk-stratify patients and might address the unmet need for minimally invasive prognostic and predictive tools for HF development and HF-related outcomes. Our aim is to investigate the prognostic performance and risk stratification potential of circulating panels of microRNAs (miRNAs) in HFrEF and HFpEF.</p><p><strong>Methods: </strong>A systematic search on PubMed, Web of Science, and Scopus databases was performed for studies reporting miRNAs as prognostic biomarkers in HF patients. A total of 22 studies pooling 5736 participants were included for quantitative analysis. KM-based individual patient data (IPD) analysis was performed in 12 studies (5064 participants).</p><p><strong>Results: </strong>KM-based IPD analysis in HFrEF allowed the identification of a panel of four miRNAs (miR-27a-3p, miR-129-5p, miR-145-5p, and miR-590-3p) predicting the risk of all-cause death with hazard ratio (HR) 4.26 [2.68-6.76]. MiR-122-5p and miR-423-5p predicted cardiovascular death of HFrEF patients (HR 3.61 [2.67-4.87]). In HFpEF, miR-19a-3p predicted all-cause death of HFpEF patients with HR 2.23 [1.16-4.27]. Moreover, a panel of eight miRNAs (miR-17-5p, miR-20a-5p, miR-21, miR-23, miR-27, miR-106b-5p, miR-210, and miR-221) showed significant association with HF incidence (HR 2.14 [1.81-2.53]).</p><p><strong>Conclusions: </strong>A comprehensive meta-analysis of KM-based IPD enabled the identification of unique miRNA panels predicting the incidence and severity of HFrEF and HFpEF, supporting the clinical usefulness of miRNA profiling for tailored healthcare and risk stratification in HF patients. Nonetheless, more rigorously designed longitudinal studies are needed to validate the clinical application of miRNAs as prognostic and predictive biomarkers.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"409"},"PeriodicalIF":7.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12235814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583162","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":"Multi-dimensional sleep health and dementia risk: a prospective study in the UK Biobank.","authors":"Tianyi Huang, May A Beydoun, Sina Kianersi, Susan Redline, Lenore J Launer","doi":"10.1186/s12916-025-04251-3","DOIUrl":"10.1186/s12916-025-04251-3","url":null,"abstract":"<p><strong>Background: </strong>The intricate interplay of various sleep characteristics may influence dementia risk through different pathogenic pathways. However, few studies have examined multi-dimensional sleep health in relation to dementia risk or explored potential etiologic heterogeneity by dementia subtypes.</p><p><strong>Methods: </strong>Our study included 313,248 UK Biobank participants aged ≥ 50 years who were dementia-free in 2006-2010. Incident dementia was identified using validated algorithms through primary care, hospital admissions, or death records through 2022. Multi-dimensional sleep health was evaluated based on seven self-reported sleep-related factors and assessed in two ways: (1) using an a priori sleep health score (SHS) ranging from 0 to 7, with higher scores indicating healthier sleep, and (2) through data-driven sleep health patterns identified by latent class analysis. We used Cox proportional hazards models to estimate the associations between multi-dimensional sleep health and risk of all-cause dementia, vascular dementia (VaD), and Alzheimer's disease (AD).</p><p><strong>Results: </strong>There were 7458 incident all-cause dementia cases (1636 VaD, 3376 AD) after 4,165,352 person-years of follow-up. After adjusting for potential confounders, the hazard ratio (95% CI) comparing participants with SHS of 0-2 (worst sleep) vs 6-7 (best sleep) was 1.76 (1.52, 2.05) for all-cause dementia (p-trend < 0.0001), 2.13 (1.61, 2.83) for VaD (p-trend < 0.0001), and 1.55 (1.22, 1.97) for AD (p-trend < 0.57). We identified six multi-dimensional sleep health patterns, including relatively healthy sleep, insomnia with short sleep duration, non-restorative sleep with evening chronotype, insomnia with non-restorative sleep, snoring with daytime sleepiness and napping, and severely disturbed sleep with multiple symptoms and daytime impairment. Compared with the healthy sleep pattern, all other five sleep patterns were significantly associated with 8-85% higher all-cause dementia risk and 11-148% higher VaD risk, whereas only the severely disturbed sleep pattern was associated with 56% higher AD risk (95% CI: 1.21, 2.01).</p><p><strong>Conclusions: </strong>Poor multi-dimensional sleep health, either assessed by a simple SHS or characterized by sleep clusters, was associated with higher incident dementia risk. There is substantial heterogeneity in multi-dimensional sleep health patterns and their associations with different dementia outcomes. Understanding the specific sleep health profiles associated with dementia risk may help to identify high-risk populations and inform more targeted interventions.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"410"},"PeriodicalIF":7.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12235804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583161","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":"Vagus nerve stimulation inhibits pyroptosis and improves outcome of cerebral ischemic stroke by upregulating osteopontin (SPP1) to disturb ASC oligomerization.","authors":"Jun Wen, Hao Tang, Ling Wang, Qinghuan Yang, Yong Zhao, Yu Ren, Ting Qin, Xuemei Li, Jianfeng Xu, Gongwei Jia, Qin Yang","doi":"10.1186/s12916-025-04242-4","DOIUrl":"10.1186/s12916-025-04242-4","url":null,"abstract":"<p><strong>Background: </strong>Vagus nerve stimulation (VNS) brings new hope for handling stroke. Our previous study confirmed that VNS could reduce neuronal pyroptosis and improve stroke prognosis. However, how VNS suppresses pyroptosis remains poorly understood. Osteopontin (OPN,SPP1) plays a neuroprotective role. Therefore, this study aims to determine whether vagus nerve stimulation (VNS) inhibits pyroptosis and promotes recovery from cerebral ischemic injury through osteopontin (OPN), and to elucidate the mechanisms by which OPN regulates pyroptosis.</p><p><strong>Methods: </strong>Acute ischemic stroke (AIS) patients and healthy controls were recruited. The middle cerebral artery ischemia-reperfusion (MCAO/R) model of rats in vivo, the oxygen-glucose deprivation and reperfusion (OGD/R) and lipopolysaccharide (LPS) + adenosine triphosphate (ATP) models of microglia in vitro were established. Gene analysis of GEO public dataset (GSE61616), analysis of proteomics, western blotting, Co-immunoprecipitation (Co-IP) analysis, immunofluorescence staining, ELISA, TTC staining, TUNEL staining, transmission electron microscopy (TEM), scanning electron microscopy (SEM) and neurological function score were used to examinate expressions or concentrations of osteopontin, pyroptosis-related molecules, OPN-ASC interaction, infarct volume, neurological function, cell membrane pore, respectively.</p><p><strong>Results: </strong>In MCAO/R rats and AIS patients, osteopontin levels were elevated. Intranasally administered recombinant osteopontin (rOPN) and VNS reduced pyroptosis and improved neurological deficits. VNS upregulated osteopontin expression in MCAO/R rats and AIS patients. Small interfering OPN RNA (siOPN) reversed effects of VNS on pyroptosis and outcome of MCAO/R injury in rats. The binding energy of OPN and ASC was -11.7 kcal/mol. LPS + ATP enhanced OPN-ASC interaction, and rOPN interfered with ASC oligomerization. Conditioned medium of microglia treated with rOPN reversed LPS + ATP-induced neruonal injury. Collectively, OPN may serve as a potential mediator through which VNS inhibits pyroptosis and improves the outcome of ischemic stroke, thereby representing a promising therapeutic target for stroke treatment.</p><p><strong>Conclusions: </strong>These findings suggest that VNS alleviates pyroptosis and improves the outcome of cerebral ischemic stroke by upregulating osteopontin (OPN), which interferes with ASC oligomerization.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"407"},"PeriodicalIF":7.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12235890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583163","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":"Phase 1 trial of HR070803 (an Irinotecan liposome) in combination with 5-fluorouracil, leucovorin, and oxaliplatin for untreated advanced or metastatic pancreatic ductal adenocarcinoma.","authors":"Qiang Xu, Xue Zhao, Xianze Wang, Ruizhe Zhu, Yuejuan Cheng, Tao Xia, Heshui Wu, He Tian, Yuping Sun, Mingjun Zhang, Chuntao Gao, Deliang Fu, Xiaojie Wu, Tongsen Zheng, Xiaoyu Yin, Yili Chen, Xiaobing Chen, Zhihua Li, Rufu Chen, Xue Yang, Huan Wang, Quanren Wang, Xiaohong Han, Wenming Wu","doi":"10.1186/s12916-025-04234-4","DOIUrl":"10.1186/s12916-025-04234-4","url":null,"abstract":"<p><strong>Background: </strong>This study assessed the safety, preliminary antitumor activity, and pharmacokinetics of HR070803 (a novel liposomal irinotecan) in combination with 5-FU/LV and oxaliplatin for treatment-naive patients with unresectable locally advanced or metastatic pancreatic ductal adenocarcinoma (PDAC).</p><p><strong>Methods: </strong>This multicenter, open-label, single-arm, dose-escalation phase 1 study recruited treatment-naive patients aged 18-70 years with unresectable locally advanced or metastatic PDAC. Treatment doses were escalated from 40/60 (HR070803 40 mg/m² plus 5-FU/LV and oxaliplatin 60 mg/m²) to 60/60 and 60/85. The primary endpoints were maximum tolerated dose (MTD) and the recommended phase 2 dose (RP2D). Secondary endpoints included safety, preliminary antitumor activity, and pharmacokinetics.</p><p><strong>Results: </strong>A total of 41 patients were enrolled, including 6, 17, and 18 patients in the 40/60, 60/60, and 60/85 group, respectively. Only one patient in the 60/60 group experienced dose-limiting toxicities of grade 3 increased alanine aminotransferase and grade 3 increased aspartate aminotransferase, and the MTD was not reached. Adverse events of grade ≥ 3 were reported in 31 (75.6%) patients, with the most common being decreased neutrophil count and increased gamma-glutamyltransferase. No treatment discontinuation occurred owing to adverse events, and there were no treatment-related deaths. The overall response (complete or partial response) rate was 29.3% in the total population. Pharmacokinetic results demonstrated prolonged circulation and slow release of free irinotecan.</p><p><strong>Conclusions: </strong>HR070803 plus 5-FU/LV and oxaliplatin demonstrated an acceptable toxicity, good antitumor activity, and favorable pharmacokinetic profile as a first-line treatment for patients with unresectable locally advanced or metastatic PDAC. Based on the comprehensive data obtained during the dose escalation and dose expansion stages, HR070803 60 mg/m² plus 5-FU/LV and oxaliplatin 85 mg/m² was chosen as the RP2D.</p><p><strong>Trial registration: </strong>Clinical trials.gov NCT04796948; registered March 15, 2021.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"402"},"PeriodicalIF":7.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574832","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":"Molecular Mechanisms and Clinical Divergences in HPV-Positive Cervical vs. Oropharyngeal Cancers: A Critical Narrative Review.","authors":"Canio Martinelli, Alfredo Ercoli, Silvana Parisi, Giuseppe Iatì, Stefano Pergolizzi, Luigi Alfano, Francesca Pentimalli, Michelino De Laurentiis, Antonio Giordano, Salvatore Cortellino","doi":"10.1186/s12916-025-04247-z","DOIUrl":"10.1186/s12916-025-04247-z","url":null,"abstract":"<p><p>Human papillomavirus (HPV) plays a pivotal role in the development of both cervical squamous cell carcinoma (CSCC) and oropharyngeal squamous cell carcinoma (OPSCC). However, these two cancers exhibit markedly different clinical behaviors. While HPV-positive OPSCC is distinguished by its heightened radiosensitivity, enabling effective treatment de-escalation and reduced toxicity, HPV-positive CSCC shows no such advantage, requiring aggressive therapeutic approaches similar to HPV-negative cases. This critical narrative review explores the limited molecular drivers currently known and the potential mechanisms underlying the divergent clinical responses of HPV-positive OPSCC and CSCC. Here, we discuss the role of HPV E6 and E7 oncoproteins in disrupting key tumor suppressor pathways, the impact of HPV DNA integration into the host genome, and the resulting genomic instability. By comparing the molecular mechanisms of these cancers, we aim to provide a comprehensive understanding of how these processes contribute to their distinct radiosensitivities and clinical outcomes. This review further highlights the gaps in the current research and proposes areas for future investigation, particularly in tailoring personalized treatment strategies for HPV-driven cancers. Understanding the differences in the molecular pathways that influence radiosensitivity in HPV-related cancers will not only enhance treatment strategies but also lead to improved patient outcomes and reduced treatment-associated toxicity.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"405"},"PeriodicalIF":7.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574831","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":"Predictors and outcomes associated with prolonged hospital length of stay in intracerebral hemorrhage: a multicenter prospective cohort study in China.","authors":"Zhuangzhuang Zhang, Jieyu Li, Wenzhe Wang, Haowei Wang, Junlong Shu, Haiqiang Jin, Peng Sun, Craig S Anderson, Zhaoxia Wang, Yining Huang, Weiping Sun","doi":"10.1186/s12916-025-04241-5","DOIUrl":"10.1186/s12916-025-04241-5","url":null,"abstract":"<p><strong>Background: </strong>Research on factors influencing prolonged length of stay (LOS) and its impact on prognosis in intracerebral hemorrhage (ICH) patients is limited. This study aimed to identify clinical predictors associated with prolonged LOS and to explore the potential impact of prolonged LOS on the prognosis of patients with mild to moderate ICH.</p><p><strong>Methods: </strong>The study included mild to moderate ICH patients from the China Quality Evaluation of Stroke Care and Treatment (QUEST) database. Prolonged LOS was defined as a hospitalization exceeding 14 days. Sociodemographic characteristics, medical histories, stroke severity, in-hospital treatments, complications, discharge destination, and hospital characteristics were compared between the prolonged and normal LOS groups to screen for the potential predictors of extending LOS after ICH. The outcomes were the proportions of poor outcome at 3 months and 12 months after stroke onset. Poor outcome was defined as an mRS score of 3-5 or death.</p><p><strong>Results: </strong>A total of 1055 mild to moderate ICH patients were enrolled in the study, with 281 (26.6%) exhibiting a LOS of 14 days or less, and 774 (73.4%) exceeding 14 days. The multivariable logistic regression analysis identified several independent predictors of prolonged LOS including younger age, higher annual household income, possession of medical insurance, a history of antithrombotic medication use, infection complication during hospitalization, and hospital regions. Unadjusted analyses showed there were no significant differences in the risk of poor outcome between the prolonged and normal LOS groups at 3 and 12 months after ICH (OR 0.89, 95% CI 0.67-1.17, P = 0.404; OR 0.82, 95% CI 0.61-1.09, P = 0.165). The adjusted models and the sensitivity analysis using propensity score matching and subgroup analysis produced the similar results.</p><p><strong>Conclusions: </strong>Various factors contributed to prolonged LOS in mild to moderate ICH patients, including younger age, higher annual household income, possession of medical insurance, a history of antithrombotic medication use, the occurrence of infections during hospitalization, and the hospital regions. A prolonged LOS exceeding 14 days was not associated with a better functional outcome for mild to moderate ICH patients at 3 and 12 months.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"404"},"PeriodicalIF":7.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574833","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":"Chronic care provision in general practices and association with patient level outcomes: a nationwide cohort study.","authors":"Anders Prior, Claus Høstrup Vestergaard, Nynne Bech Utoft, Peter Vedsted, Susan M Smith, Mogens Vestergaard, Morten Fenger-Grøn","doi":"10.1186/s12916-025-04239-z","DOIUrl":"10.1186/s12916-025-04239-z","url":null,"abstract":"<p><strong>Background: </strong>General practice provides long-term care for most people living with long-term conditions, but the impact of generic chronic care provision on patient outcomes has not been examined on a national level. We aimed to investigate whether the provision of chronic care services in general practice is associated with potentially inappropriate medications (PIMs) and potentially preventable hospitalisations in listed patients.</p><p><strong>Methods: </strong>Nationwide cohort study using linked health registry data covering 4.42 million patients (18 + years) listed with general practices in Denmark in 2019 (n = 1769). The exposure was the patient's practice listing. Practices were grouped evenly into low, medium, or high level of service provision (chronic care consultations, chronic care procedures, and daytime consultations) after adjustment for patient case-mix and multimorbidity. Sub-group analyses were based on list size, morbidity load, deprivation score, and urbanisation. The outcomes at patient level were number of patient days with PIMs (modified STOPP-START criteria) and number of potentially preventable hospitalisations.</p><p><strong>Results: </strong>In practices providing high levels of chronic care consultations, the listed patients had a 1.2% lower risk of PIMs compared to the medium-level group (incidence rate ratio [IRR] 0.988, 95% confidence interval [CI] 0.977 to 0.999, corresponding to 3600 fewer patient years of PIMs per year) and an IRR of 0.964 (95% CI 0.927 to 1.002) for potentially preventable hospitalisations. In practices providing high levels of chronic care procedures, patients had a 1.7% lower risk of PIMs (IRR 0.983, 95% CI 0.972 to 0.993, 5500 fewer patient years of PIMs) and an 8.6% lower risk of potentially preventable hospitalisations (IRR 0.914, 95% CI 0.879 to 0.950, 3700 fewer potentially preventable hospitalisations per year). High levels of daytime consultations were associated with higher risk of PIMs, but not with potentially preventable hospitalisations. We found an inverse dose-response relationship between chronic care provision and adverse outcomes. The findings were stable between different practice characteristics and patient populations.</p><p><strong>Conclusions: </strong>Patients experienced fewer potentially inappropriate medications and potentially preventable hospitalisations if listed at a general practice with high chronic care provision, regardless of other practice characteristics.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"403"},"PeriodicalIF":7.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574830","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}