BMC Medicine最新文献

{"title":"Exploring DNA methylation, telomere length, mitochondrial DNA, and immune function in patients with Long-COVID.","authors":"Andrea Polli, Lode Godderis, Dries S Martens, Madhura Shekhar Patil, Jolien Hendrix, Arne Wyns, Jente Van Campenhout, Emma Richter, Lara Fanning, Olivia Vandekerckhove, Eveline Claeys, Wim Janssens, Natalie Lorent","doi":"10.1186/s12916-025-03881-x","DOIUrl":"10.1186/s12916-025-03881-x","url":null,"abstract":"<p><strong>Background: </strong>Long-COVID is defined as the persistency or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation. Common persistent symptoms are fatigue, sleep disturbances, post-exertional malaise (PEM), pain, and cognitive problems. Long-COVID is estimated to be present in about 65 million people. We aimed to explore clinical and biological factors that might contribute to Long-COVID.</p><p><strong>Methods: </strong>Prospective longitudinal cohort study including patients infected with SARS-CoV-2 between March 2020 and March 2022. Patients were assessed between 4 and 12 months after infection at the COVID follow-up clinic at UZ Leuven. We performed a comprehensive clinical assessment (including questionnaires and the 6-min walking test) and biological measures (global DNA methylation, telomere length, mitochondrial DNA copy number, inflammatory cytokines, and serological markers such as C-reactive protein, D-dimer, troponin T).</p><p><strong>Results: </strong>Of the 358 participants, 328 were hospitalised, of which 130 had severe symptoms requiring intensive care admission; 30 patients were ambulatory referrals. Based on their clinical presentation, we could identify 6 main clusters. One-hundred and twenty-seven patients (35.4%) belonged to at least one cluster. The bigger cluster included PEM, fatigue, sleep disturbances, and pain (n = 57). Troponin T and telomere shortening were the two main markers predicting Long-COVID and PEM-fatigue symptoms.</p><p><strong>Conclusions: </strong>Long-COVID is not just one entity. Different clinical presentations can be identified. Cardiac involvement (as measured by troponin T levels) and telomere shortening might be a relevant risk factor for developing PEM-fatigue symptoms and deserve further exploring.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"60"},"PeriodicalIF":7.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122150","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":"Implementation of a rapid host-protein diagnostic test for distinguishing bacterial and viral infections in adults presenting to urgent care centers: a pragmatic cohort study.","authors":"Boaz Kalmovich, Daniella Rahamim-Cohen, Ilan Yehoshua, Sara Kivity, Noam Orvieto, Shirley Shapiro Ben David","doi":"10.1186/s12916-025-03903-8","DOIUrl":"10.1186/s12916-025-03903-8","url":null,"abstract":"<p><strong>Background: </strong>Urgent care centers (UCCs) are a growing segment of healthcare with high rates of inappropriate antibiotic use. MeMed BV® (MMBV) is a blood test that differentiates bacterial from viral infections. Between April 2022 and March 2023, we introduced MMBV into routine care at ten UCCs. The primary objective was to assess MMBV's impact on antibiotic use; the secondary objective was to assess whether MMBV aided in patient management.</p><p><strong>Methods: </strong>A pragmatic prospective cohort study. Physicians who ordered MMBV reported electronically (in real-time) whether they intended to prescribe antibiotics before ordering the test and upon UCC discharge whether MMBV aided in patient management. Hospitalizations were recorded for 7 days post-UCC discharge.</p><p><strong>Results: </strong>During implementation, 3920 MMBV tests were ordered for adults (age ≥ 18) by 144 physicians. The study cohort had 59% female patients and the median age was 42 years (IQR 31-58). For the primary objective, 3262 cases were included. MMBV indicated 629/3262 (19.3%) cases of potentially unwarranted antibiotics, of which physicians avoided prescriptions in 397/629 (63.1%). MMBV indicated 405/3262 (12.4%) cases of potentially missed bacterial infections. Physicians prescribed antibiotics to 283/405 (69.9%). MMBV adherence was associated with fewer hospitalizations (7.8% vs. 30.3%, p < 0.001). For the secondary objective, 2901 cases were included. Physicians reported MMBV aided patient management in 2494/2901 (86.0%) cases and contributed to avoiding emergency department referrals in 595/2901 (20.5%).</p><p><strong>Conclusions: </strong>Implementing MMBV aided urgent care center physicians in their clinical decision-making and may have contributed to appropriate antibiotic use, better resource utilization, and patient management.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"63"},"PeriodicalIF":7.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122168","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":"Single-nucleotide polymorphisms in dizygotic twin ovine fetuses are associated with discordant responses to antenatal steroid therapy.","authors":"Erin L Fee, Haruo Usuda, Sean W D Carter, Hideyuki Ikeda, Tsukasa Takahashi, Yuki Takahashi, Yusaku Kumagai, Michael W Clarke, Demelza J Ireland, John P Newnham, Masatoshi Saito, Sebastian E Illanes, Binny Priya Sesurajan, Liang Shen, Mahesh A Choolani, Gokce Oguz, Adaikalavan Ramasamy, Sara Ritchie, Andrew Ritchie, Alan H Jobe, Matthew W Kemp","doi":"10.1186/s12916-025-03910-9","DOIUrl":"10.1186/s12916-025-03910-9","url":null,"abstract":"<p><strong>Background: </strong>Antenatal steroid (ANS) therapy is given to women at risk of preterm delivery to accelerate fetal lung maturation. However, the benefit of ANS therapy is variable and how maternal and fetal factors contribute to this observed variability is unknown. We aimed to test the degree of concordance in preterm lung function, and correlate this with genomic, transcriptomic, and pharmacokinetic variables in preterm dizygotic twin ovine fetuses.</p><p><strong>Methods: </strong>Thirty-one date-mated ewes carrying twin fetuses at 123 ± 1 days' gestation received maternal intramuscular injections of either (i) 1 × 0.25 mg/kg betamethasone phosphate and acetate (CS1, n = 11 twin pairs) or (ii) 2 × 0.25 mg/kg betamethasone phosphate and acetate, 24 h apart (CS2, n = 10 twin pairs) or (iii) 2 × saline, 24 h apart (negative control, n = 10 twin pairs). Fetuses were surgically delivered 24 h after their final treatment and ventilated for 30 min.</p><p><strong>Results: </strong>ANS-exposed female fetuses had lower arterial partial pressure of carbon dioxide (PaCO₂) values than male fetuses (76.5 ± 38.0 vs. 97.2 ± 42.5 mmHg), although the observed difference was not statistically significant (p = 0.1). Only 52% of ANS-treated twins were concordant for lung maturation responses. There was no difference in fetal lung tissue or plasma steroid concentrations within or between twin pairs. Genomic analysis identified 13 single-nucleotide polymorphisms (SNPs) statistically associated with ANS-responsiveness, including in the proto-oncogene MET and the transcription activator STAT1.</p><p><strong>Conclusions: </strong>Twin fetal responses and ANS tissue levels were comparable with those from singleton fetuses in earlier studies. Twin ovine fetuses thus benefit from ANS in a similar manner to singleton fetuses, and a larger dose of betamethasone is not required. Assuming no difference in input from the placental or maternal compartments, fetal lung responses to ANS therapy in dizygotic twin preterm lambs are dependent on the fetus itself. These data suggest a potential heritable role in determining ANS responsiveness.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"65"},"PeriodicalIF":7.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122178","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 accelerated phenotypic aging, genetic risk, and lifestyle with progression of type 2 diabetes: a prospective study using multi-state model.","authors":"Lulu Pan, Yahang Liu, Chen Huang, Yifang Huang, Ruilang Lin, Kecheng Wei, Ye Yao, Guoyou Qin, Yongfu Yu","doi":"10.1186/s12916-024-03832-y","DOIUrl":"10.1186/s12916-024-03832-y","url":null,"abstract":"<p><strong>Background: </strong>Aging is a major risk factor for type 2 diabetes (T2D), but individuals of the same chronological age may vary in their biological aging rate. The associations of Phenotypic Age Acceleration (PhenoAgeAccel), a new accelerated biological aging indicator based on clinical chemistry biomarkers, with the risk of dynamic progression remain unclear. We aimed to assess these associations and examine whether these associations varied by genetic risk and lifestyle.</p><p><strong>Methods: </strong>We conducted a prospective cohort study that included 376,083 adults free of T2D and diabetes-related events at baseline in UK Biobank. PhenoAgeAccel > 0 and ≤ 0 were defined as biologically older and younger than chronological age. The outcomes of interest were incident T2D, diabetic complications, and mortality. Hazard ratios (HRs) with 95% confidence intervals (CIs) and population attributable fractions (PAFs) for these associations were calculated using multi-state model.</p><p><strong>Results: </strong>During a median follow-up of 13.7 years, 17,615 participants developed T2D, of whom, 4,524 subsequently developed complications, and 28,373 died. Being biologically older was associated with increased risks of transitions from baseline to T2D (HR 1.77, 95% CI 1.71-1.82; PAF 24.8 [95% CI 23.5-26.2]), from T2D to diabetic complications (1.10, 1.04-1.17; 4.4 [1.4-7.4]), from baseline to all-cause death (1.53, 1.49-1.57; 17.6 [16.6-18.6]), from T2D to all-cause death (1.14, 1.03-1.26; 7.4 [1.8-13.0]), and from diabetic complications to all-cause death (1.32, 1.15-1.51; 15.4 [7.5-23.2]) than being biologically younger. Additionally, participants with older biological age and high genetic risk had a higher risk of incident T2D (4.76,4.43-5.12;18.2 [17.5-19.0]) than those with younger biological age and low genetic risk. Compared with participants with younger biological age and healthy lifestyle, those with older biological age and unhealthy lifestyle had higher risks of transitions in the T2D trajectory, with HRs and PAFs ranging from 1.34 (1.16-1.55; 3.7 [1.8-5.6]) to 5.39 (5.01-5.79; 13.0 [12.4-13.6]).</p><p><strong>Conclusions: </strong>PhenoAgeAccel was consistently associated with an increased risk of all transitions in T2D progression. It has the potential to be combined with genetic risk to identify early T2D incidence risk and may guide interventions throughout T2D progression while tracking their effectiveness.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"62"},"PeriodicalIF":7.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122145","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":"Immune microenvironment spatial landscapes of tertiary lymphoid structures in gastric cancer.","authors":"Yi Xie, Haoxin Peng, Yajie Hu, Keren Jia, Jiajia Yuan, Dan Liu, Yanyan Li, Xujiao Feng, Jian Li, Xiaotian Zhang, Yu Sun, Lin Shen, Yang Chen","doi":"10.1186/s12916-025-03889-3","DOIUrl":"10.1186/s12916-025-03889-3","url":null,"abstract":"<p><strong>Background: </strong>Tertiary lymphoid structures (TLS) correlate with tumour prognosis and immunotherapy responses in gastric cancer (GC) studies. However, understanding the complex and diverse immune microenvironment within TLS requires comprehensive analysis.</p><p><strong>Methods: </strong>We examined the prognostic impact of TLS within the tumour core (TC) of 59 GC patients undergoing immunotherapy. Multispectral fluorescence imaging was employed to evaluate variations in immune cell infiltration across different TLS sites among 110 GC patients, by quantifying immune cell density and spatial characteristics. We also generated a single-cell transcriptomic atlas of TLS-positive (n = 4) and TLS-negative (n = 8) microenvironments and performed spatial transcriptomics (ST) analysis on two samples.</p><p><strong>Results: </strong>TLS presence in the TC significantly correlated with improved immune-related overall survival (P = 0.049). CD8⁺LAG-3^-PD-1⁺TIM-3^-, CD4⁺PD-L1⁺, and CD4⁺FoxP3^- T cell densities were significantly higher in the TLS within TC compared to tumour and stromal regions. Immune cells within TLS exhibited closer intercellular proximity than those outside TLS. Five key density and spatial characteristics of immune cells within TLS in the TC were selected to develop the Density and Spatial Score risk model. Single-cell RNA sequencing revealed strong intercellular interactions in the presence of TLS within the microenvironment. However, TLS-absent environment facilitated tumour cell interactions with immune cells through MIF- and galectin-dependent pathways, recruiting immunosuppressive cells. ST analysis confirmed that T and B cells co-localise within TLS, enhancing immune response activation compared to cancer nests and exerting a strong anti-tumour effect.</p><p><strong>Conclusions: </strong>TLS presence facilitates frequent cell-to-cell communication, forming an active immune microenvironment, highlighting the prognostic value of TLS.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"59"},"PeriodicalIF":7.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122155","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":"Visceral adipose tissue area and proportion provide distinct reflections of cardiometabolic outcomes in weight loss; pooled analysis of MRI-assessed CENTRAL and DIRECT PLUS dietary randomized controlled trials.","authors":"Hadar Klein, Hila Zelicha, Anat Yaskolka Meir, Ehud Rinott, Gal Tsaban, Alon Kaplan, Yoash Chassidim, Yftach Gepner, Matthias Blüher, Uta Ceglarek, Berend Isermann, Michael Stumvoll, Ilan Shelef, Lu Qi, Jun Li, Frank B Hu, Meir J Stampfer, Iris Shai","doi":"10.1186/s12916-025-03891-9","DOIUrl":"10.1186/s12916-025-03891-9","url":null,"abstract":"<p><strong>Background: </strong>Visceral adipose tissue (VAT) is well established as a pathogenic fat depot, whereas superficial subcutaneous adipose tissue (SAT) is associated with either an improved or neutral cardiovascular state. However, it is unclear to what extent VAT area (VATcm²) and its proportion of total abdominal adipose tissue (VAT%) are distinguished in predicting cardiometabolic status and clinical outcomes during weight loss.</p><p><strong>Methods: </strong>We integrated magnetic resonance imaging (MRI) measurements of VAT, deep-SAT, and superficial-SAT from two 18-month lifestyle weight loss clinical trials, CENTRAL and DIRECT PLUS (n = 572).</p><p><strong>Results: </strong>At baseline, the mean VATcm² was 144.8cm² and VAT% = 28.2%; over 18 months, participants lost 28cm² VATcm² (- 22.5%), and 1.3 VAT% units. Baseline VATcm² and VAT% were similarly associated with metabolic syndrome, hypertension, and diabetes status, while VAT% better classified hypertriglyceridemia. Conversely, higher VATcm² was associated with elevated high-sensitivity C-reactive protein (hsCRP), while VAT% was not. After 18 months of lifestyle intervention, both VATcm² and VAT% loss were significantly associated with decreased triglycerides, HbA1c, ferritin, and liver enzymes, and increased HDL-c levels beyond weight loss (FDR < 0.05). Only VATcm² loss was correlated with decreased HOMA-IR, chemerin, and leptin levels.</p><p><strong>Conclusions: </strong>MRI follow-up of 572 participants over 18 months of weight loss intervention suggests that although increased VATcm² and VAT% exhibit similar clinical manifestations, it might be preferable to examine VAT% when exploring lipid status, while VATcm² may better reflect inflammatory and glycemic states.</p><p><strong>Trial registration: </strong>CENTRAL (Clinical-trials-identifier: NCT01530724); DIRECT PLUS (Clinical-trials-identifier: NCT03020186).</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"57"},"PeriodicalIF":7.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122180","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":"Moments that matter: childhood pain treatment shapes pain for life-we can do better every time in every child.","authors":"Rebeccah Slater, Suellen Walker, Christopher Eccleston, Carlo Bellieni, Tanvi Hirekodi, Ricardo Carbajal, Lucinda Smart, William Laughey, Maria M Cobo, Stefan Friedrichsdorf","doi":"10.1186/s12916-025-03869-7","DOIUrl":"10.1186/s12916-025-03869-7","url":null,"abstract":"<p><strong>Background: </strong>Needle procedures, such as vaccinations, blood draws, and intravenous cannulation, are the most frequent source of childhood pain, causing fear and reducing the uptake of medical procedures. Every child has the right to expect pain relief, and we have evidence-based tools to reduce needle procedure-related pain. Therefore, the lack of analgesic provision for needle pain is not justified. We argue that better informed and motivated healthcare professionals and families can advocate for appropriate pain relief in every child, every time.</p><p><strong>Observations: </strong>Engaging communication campaigns are needed to educate our healthcare professionals. Evidence-based modalities such as topical anaesthesia, sucrose or breastfeeding, comfort positioning, and age-appropriate distractions should be available for every child during needle procedures. However, high-quality information is not enough to change behaviour-healthcare professionals need to be motivated, encouraged, and inspired. Parents and carers should be empowered to advocate for their children and be aware that their child has the right to receive pain relief during these procedures. CONCLUSIONS AND RELEVANCE: This is a call to action-we need collaboration between academics, healthcare professionals, industry and charities, to expedite behavioural change and parental advocacy through high-quality communication strategies. Effective pain management in infants and children can play a crucial role in promoting the uptake of vaccinations and medical procedures and can influence future attitudes to pain.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"64"},"PeriodicalIF":7.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122171","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":"Exploration of treatment burden through examination of workload and patient capacity during transition onto kidney replacement therapy: a systematic review of qualitative research.","authors":"Catrin Jones, Ross Cairns, Heather Walker, Silje Welsh, Benjamin Edgar, Karen Stevenson, Bhautesh D Jani, Patrick B Mark, David Kingsmore, Katie I Gallacher","doi":"10.1186/s12916-025-03904-7","DOIUrl":"10.1186/s12916-025-03904-7","url":null,"abstract":"<p><strong>Background: </strong>Patients with advanced chronic kidney disease requiring initiation of kidney replacement therapy (KRT) are frequently asked to enact complex management plans. Treatment burden has been defined as the effect of healthcare workload and the capacity a person has to manage this workload has on wellbeing. The aim of this review is to examine the experience of healthcare workload and the factors that affect capacity to meet that workload for people transitioning onto KRT for the first time, using a framework synthesis of published literature informed by normalisation process theory (NPT) and theory of patient capacity (TPC).</p><p><strong>Methods: </strong>Medline, Scopus and CINAHL were systematically searched with manual citation and reference searching. Studies were included if meeting the criteria of adults aged 18 or over transitioning for the first time onto any modality of KRT (haemodialysis, peritoneal dialysis or kidney transplantation), using qualitative methodologies to describe any aspect of experiences of healthcare workload or any factors that affect capacity to manage workload were included. Abstracts and full papers were independently screened by two reviewers and data extraction and quality appraisal were also independently conducted by two reviewers. Qualitative data were analysed using framework synthesis informed by NPT and TPC.</p><p><strong>Results: </strong>A total of 24,380 studies were screened, 406 full texts were reviewed and 18 studies were included. There were four broad categories of workload described: making sense of KRT, working out what to do and how to do it, meeting the challenges of KRT, and reflecting on work done. Patient capacity influenced the experience of all types of workload and the treatment burden generated by the work.</p><p><strong>Conclusions: </strong>Transitioning onto KRT is a period of very high healthcare workload and potentially high treatment burden. The relationship between healthcare workload and capacity to handle workload is complex, multifactorial and changes over time. By better understanding workload, capacity and burden during transition, we can develop better ways of measuring these important aspects of care and develop interventions to reduce treatment burden in those transitioning onto KRT.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"61"},"PeriodicalIF":7.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122148","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":"Global cervical cancer elimination: quantifying the status, progress, and gaps.","authors":"Liangru Zhou, Yi Li, Hongyun Wang, Ruixi Qin, Zhen Han, Ruifeng Li","doi":"10.1186/s12916-025-03897-3","DOIUrl":"10.1186/s12916-025-03897-3","url":null,"abstract":"<p><strong>Background: </strong>To address the public health concern of cervical cancer (CC), 194 countries committed to eliminate it at the initiative of the World Health Organization (WHO). We summarised quantitative results concerning CC elimination across these countries, including the progress in implementing three prevention levels (human papillomavirus [HPV] vaccination, CC screening, and treatment for patients with CC) and achievement of interim Global Strategy for Cervical Cancer Elimination targets.</p><p><strong>Methods: </strong>Data were obtained from the International Agency for Research on Cancer, WHO, United Nations International Children's Emergency Fund, and country responses to the WHO National Capacity Survey on Non-Communicable Diseases. This retrospective analysis examined data from 194 countries and regions, stratified by national income (high-income countries (HICs) vs low- and middle-income countries (LMICs)) and geographic location (continents such as Europe, Asia, and North America). A quantitative assessment evaluated global progress in primary, secondary, and tertiary CC prevention.</p><p><strong>Results: </strong>By 2020, four countries had achieved Target 1 (90% of girls fully vaccinated against HPV by age 15). A total of 115 countries (51 (44.35%) HICs and 64 (55.65%) LMICs)) included HPV vaccination in their national immunisation programs. As of 2021, 133 countries (50 (37.59%) HICs and 83 (62.41%) LMICs)) implemented CC screening programs. Most of these were in Europe (41, 30.83%), Asia (32, 24.06%), and North America (20, 15.04%). Additionally, 126 countries (44 (34.92%) HICs and 82 (65.08%) LMICs)) had published national guidelines on CC management. These countries were primarily in Asia (32, 25.40%) and Europe (32, 25.40%). Furthermore, 69 countries provided palliative care under both scenarios. The 10 countries with the highest annual opioid consumption (excluding methadone) for CC, in oral morphine equivalence per capita (2017), were all HICs.</p><p><strong>Conclusions: </strong>Major inequalities persist in CC vaccination and screening across 194 countries, and access to these services is limited in most LMICs. Focusing on vulnerable populations with lower incomes and regions with stunted economic growth may help alleviate inequity and accelerate CC elimination. We also found that tertiary prevention was achieved in most LMICs, but the indicator-reported annual opioid consumption in oral morphine equivalents indirectly illustrates the under-utilisation of cancer treatment services.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"67"},"PeriodicalIF":7.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122152","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":"Positive hepatitis B surface antigen leads to a decrease in ovarian reserve in infertile patients receiving first in vitro fertilization treatment.","authors":"Yutao Li, Xuejiao Wang, Ye Jiang, Qun Lv, Yi Zhang, Yu Wang","doi":"10.1186/s12916-025-03905-6","DOIUrl":"10.1186/s12916-025-03905-6","url":null,"abstract":"<p><strong>Background: </strong>This study assessed the impact of chronic hepatitis B virus (HBV) infection on ovarian reserve in women.</p><p><strong>Methods: </strong>We analyzed data from 38,861 infertile women undergoing their first in vitro fertilization (IVF) treatment (2016-2022), including 1574 HBsAg-positive cases. A control group of 1574 HBsAg-negative women was matched by age and body mass index (BMI). Comparison of clinical characteristics, antral follicle count (AFC), follicle-stimulating hormone (FSH), luteinizing hormone (LH)/FSH ratio, anti-Müllerian hormone (AMH), gonadotropins (Gn) days, total Gn dosage, number of retrieved oocytes, number of mature metaphase II (MII) oocytes, and the proportion of patients with diminished ovarian reserve (DOR; AMH < 1.1 ng/ml) between two groups.</p><p><strong>Results: </strong>HBsAg-positive women showed lower basal AFC and AMH, higher basal FSH, received more Gn, and had fewer retrieved and MII oocytes than HBsAg-negative women. No significant differences in ovarian reserve or stimulation outcomes were found between e antigen-positive and e antigen-negative HBV-infected groups. DOR was less prevalent in HBsAg-negative women, and logistic regression indicated a higher DOR risk with HBV infection.</p><p><strong>Conclusions: </strong>HBsAg positivity significantly impairs ovarian reserve in women, but e antigen status does not notably affect it among HBV-infected individuals.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"58"},"PeriodicalIF":7.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122174","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}