BMC Medicine最新文献

{"title":"Associations of pretreatment emotional distress with adherence to therapy for patients with locally advanced rectal cancer: a post hoc analysis of the Chinese FOWARC phase 3 randomized clinical trial.","authors":"Lishuo Shi, Jianwei Zhang, Yanhong Deng","doi":"10.1186/s12916-025-04128-5","DOIUrl":"10.1186/s12916-025-04128-5","url":null,"abstract":"<p><strong>Background: </strong>Non-adherence in advanced rectal cancer therapy is common and severely impairs clinical outcomes. Although behavioral research suggests emotional factors influence adherence, limited evidence links pretreatment emotional distress (PED) to treatment adherence in rectal cancer patients.</p><p><strong>Methods: </strong>This post hoc analysis of a phase 3 randomized clinical trial was conducted from June 9, 2010, to February 15, 2015, involving 219 patients (assigned to receive neoadjuvant therapy with fluorouracil plus radiotherapy [group A, 67 patients], modified fluorouracil, leucovorin, and oxaliplatin [mFOLFOX6] plus radiotherapy [group B, 66 patients], or mFOLFOX6 alone [group C, 86 patients] followed by TME resection and postoperative adjuvant chemotherapy) with locally advanced rectal cancer from the main center. The PED of patients was measured through the emotional dimension items in the Quality of Life Questionnaire-Core Questionnaire (QLQ-C30). The primary outcome was adherence to therapy, with non-adherence defined as patients in groups A and B receiving fewer than ten cycles of chemotherapy or less than 37 Gy of radiotherapy, and patients in group C receiving fewer than ten cycles of chemotherapy. Multivariable logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for adherence by PED levels. Additionally, the structural equation model (SEM) was utilized to analyze the impact pathways of PED on adherence.</p><p><strong>Results: </strong>Among the 219 patients (142 men; mean age, 53.4 years) who completed the QLQ-C30 scale, 27.8% (61/219) demonstrated non-adherence to the treatment regimen. Multivariable analyses showed that each 1-point increase in PED score raised non-adherence risk by 4.37 times (OR: 4.37, 95% CI: 1.92-9.96, P < 0.001). The SEM analysis revealed that PED score was positively correlated with the risk of non-adherence (standardized regression coefficients [β] = 0.25, 95% CI: 0.11 to 0.28), while economic burden was positively correlated with PED (β = 0.17, 95% CI: 0.11 to 0.28), and could indirectly affect adherence through PED (β = 0.04, 95% CI: 0.01 to 0.09).</p><p><strong>Conclusions: </strong>Higher levels of pretreatment emotional distress were associated with an increased risk of treatment non-adherence, thereby highlighting the potential significance of addressing emotional distress in cancer management.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT01211210.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"293"},"PeriodicalIF":7.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118908","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":"The portfolio dietary pattern and risk of cardiovascular disease mortality during 1988-2019 in US adults: a prospective cohort study.","authors":"Meaghan E Kavanagh, Andreea Zurbau, Andrea J Glenn, Julianah O Oguntala, Robert G Josse, Vasanti S Malik, Laura Chiavaroli, Simin Liu, Cyril W C Kendall, David J A Jenkins, John L Sievenpiper","doi":"10.1186/s12916-025-04067-1","DOIUrl":"10.1186/s12916-025-04067-1","url":null,"abstract":"<p><strong>Background: </strong>The Portfolio Diet, a dietary pattern of cholesterol-lowering foods, has been shown to reduce cardiovascular disease (CVD) risk factors in clinical trials and lower CVD risk in observational cohorts of mainly white men and women. However, evidence on mortality outcomes in diverse populations is limited.</p><p><strong>Objective: </strong>To examine the association of the Portfolio dietary pattern with CVD mortality in a racially diverse cohort.</p><p><strong>Methods: </strong>A total of 14,835 US adults from the National Health and Nutrition Examination Survey, NHANES (1988-1994), were included. Diet was assessed by a 24-h dietary recall which was supplemented with a food frequency questionnaire at baseline using the Portfolio Diet Score (PDS), with positive points for nuts, plant protein, viscous fiber, phytosterols, and plant monounsaturated fatty acid sources, and negative points for foods high in saturated fat and cholesterol (range, 6-30 points). The primary outcome was CVD mortality. Other mortality outcomes included coronary heart disease (CHD), stroke, and all-cause mortality.</p><p><strong>Results: </strong>During 22 years of follow-up, 2300 CVD deaths, including 1887 CHD deaths, 413 stroke deaths, and 6238 all-cause deaths were documented. Greater adherence was inversely associated with risk factors including blood lipids, glycemia, and inflammation. Treated as a continuous variable, an increase in PDS by 8 points was associated with a 12% (hazard ratio 0.88 [95% confidence intervals:0.78, 0.99]), 14% (0.86 [0.78, 0.96]), and 12% (0.88 [0.82, 0.95]) lower risk of CVD, CHD, and all-cause mortality after adjustments for known CVD risk factors. Comparing the highest to lowest tertiles of the PDS, higher PDS was associated with 16% (0.84 [0.73, 0.98]), 18% (0.82 [0.72, 0.95]) and 14% (0.86 [0.78, 0.96]) lower risk of CVD, CHD, and all-cause mortality, respectively. As part of exploratory analyses, an interaction between PDS and race/ethnicity was observed, emphasizing the necessity of future research involving underserved groups.</p><p><strong>Conclusions: </strong>Among a national cohort of racially diverse adults in the US, greater adherence to the Portfolio dietary pattern was inversely and prospectively associated with CVD, CHD, and all-cause mortality.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"287"},"PeriodicalIF":7.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109512","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":"Marburg virus disease in Rwanda: an observational study of the first 10 days of outbreak response, clinical interventions, and outcomes.","authors":"Gashaija Absolomon, Canita R Brent, Emmanuel C Nyabyenda, Kelly Mwiza, Piero Irakiza, Zuki Chiwandire, Caroline Mudereri, Nathalie Umutoni, Sabine Musange, Eric Seruyange, Felix K Rubuga, Theogene Twagiramugabe, Sanctus Musafiri, Edson Rwagasore, Jeanine Condo","doi":"10.1186/s12916-025-04123-w","DOIUrl":"10.1186/s12916-025-04123-w","url":null,"abstract":"<p><strong>Background: </strong>Marburg virus disease (MVD) is a highly fatal hemorrhagic fever with fatality rates between 33 and 88% in sub-Saharan Africa. Rwanda reported its first MVD outbreak on September 27, 2024. This study assessed Rwanda's response to its first MVD outbreak, focusing on identifying critical success factors and areas for improvement during the initial 10 days after outbreak declaration.</p><p><strong>Methods: </strong>This observational study analyzed publicly available data from daily screenings and outbreak reports provided by the Rwanda Ministry of Health and Rwanda Biomedical Center between September 27 and October 7, 2024. The study examined confirmed cases, deaths, testing rates, and recoveries, including healthcare response measures. Data was collected from checkpoints and passenger screening at entry points, with information aggregated into Rwanda's Health System.</p><p><strong>Results: </strong>By October 7, 2024, Rwanda reported 56 confirmed MVD cases, including 12 deaths and 8 recoveries. Daily screening began on October 3rd, and by October 7th, 2387 individuals were tested, with a positivity rate of 2.3%. Healthcare workers accounted for over 70% of confirmed cases. No new deaths were reported from October 4 (day 7) until October 7th (day 10), though the first 2-3 days after outbreak declaration were critical, with 6 deaths occurring during this period. Rwanda's response included increased testing, early detection, intensive care management, experimental therapeutics (monoclonal antibodies and remdesivir), and comprehensive contact tracing.</p><p><strong>Conclusions: </strong>Analysis of the first 10 days of Rwanda's MVD outbreak provides valuable insights into effective outbreak response, highlighting the importance of early interventions, healthcare worker protection, enhanced testing, and international collaboration. Early detection and intensive management of cases, including advanced critical care and strong laboratory infrastructure, are essential to reduce early mortality. These findings emphasize the need to strengthen healthcare systems by establishing rapid preparedness and response mechanisms before outbreaks occur and fostering international partnerships to enhance outbreak management and control.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"292"},"PeriodicalIF":7.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109726","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":"Optimising digital advance care planning implementation in palliative and end-of-life care: a multi-phase mixed-methods national research programme and recommendations.","authors":"Matthew J Allsop, Jacqueline Birtwistle, Michael I Bennett, Andy Bradshaw, Paul Carder, Catherine J Evans, Robbie Foy, Ciara Heavin, Barbara Hibbert, Pablo Millares Martin, Sam D Relton, Suzanne H Richards, Maureen Twiddy, Katherine E Sleeman","doi":"10.1186/s12916-025-04114-x","DOIUrl":"10.1186/s12916-025-04114-x","url":null,"abstract":"<p><strong>Background: </strong>Digital advance care planning (DACP) is increasingly used globally for patients with life-limiting conditions to support real-time documentation and the sharing of preferences for care. There has been low engagement with DACP systems, with patients often having information about their care preferences documented late in their illness trajectory or not at all. To optimise implementation, the Optimal Care research programme sought to understand DACP system use from multiple perspectives to guide their development and evaluation.</p><p><strong>Methods: </strong>Between 2020 and 2023, our mixed-methods research programme sought an understanding of DACP implementation from multiple perspectives, including (i) national online survey of end-of-life care commissioning leads in England; (ii) online survey of community and hospital-based health and care professionals in two geographical regions; (iii) semi-structured interviews with a sample of survey respondents; (iv) focus groups and interviews with patients with life-limiting illness and their carers and (v) regional and national Theory of Change workshops. Findings were organised by five phases of a conceptual model of DACP generated during the programme and further categorised using the Non-adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework.</p><p><strong>Results: </strong>A total of 788 stakeholders participated. Twenty evidence-based recommendations were distilled from data collected across the research programme to guide the implementation of DACP in routine care. Considerations are provided across the five phases of DACP implementation (system design, recognition of clinical need for DACP, documentation processes, health and care professional engagement with DACP and DACP evaluation). Recommendations prioritise a focus on end-user needs and experiences, alongside highlighting the requisite need for DACP systems to support information exchange across settings involved in the care of people with life-limiting conditions.</p><p><strong>Conclusions: </strong>As currently designed and implemented, DACP systems may be falling short of their potential and are not working as intended for patients, carers and health and care professionals. The application of the recommendations should ensure consideration of the wider ecosystem in which DACP is being implemented, prioritising end-user experiences. Future research should prioritise developing approaches that target health and care professional DACP system engagement, alongside developing and evaluating patient and carer access to DACP systems.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"291"},"PeriodicalIF":7.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109498","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":"Physical disability and psychological distress before and after a diagnosis of cancer: evidence on multiple cancer types from a large Australian cohort study, compared to people without a cancer diagnosis.","authors":"Yuehan Zhang, Joanne Thandrayen, Kay Soga, Marianne Weber, Bogda Koczwara, Rebekah Laidsaar-Powell, Chloe Yi Shing Lim, Grace Joshy, Emily Banks","doi":"10.1186/s12916-025-04111-0","DOIUrl":"10.1186/s12916-025-04111-0","url":null,"abstract":"<p><strong>Background: </strong>Although most people with cancer now survive long-term, evidence on long-term person-centred outcomes in survivors is limited, particularly relative to people without cancer. We quantified changes in physical and psychological outcomes among adults aged ≥ 45 years from pre- to post-cancer-diagnosis, for multiple cancer types and compared to changes in people without cancer.</p><p><strong>Methods: </strong>Questionnaire data from the Australian population-based 45 and Up Study were linked to cancer registrations, hospitalisations and deaths; those without cancer at baseline (2006-2009) and participating in a follow-up survey (by 2015) were included (n = 142,682). Generalised linear models quantified changes in physical functioning (MOS-PF score, range = 0-100) and psychological distress (Kessler-10 score, range = 10-50) between surveys in people diagnosed and not diagnosed with cancer between surveys, adjusting for confounding factors.</p><p><strong>Results: </strong>Overall, 9313 individuals had incident cancer (12.2/1000 person-years; median follow-up = 5.2 years). Among those without cancer, 30.0% had moderate or severe physical functioning limitations at baseline, increasing to 40.6% at follow-up; corresponding figures were 35.2% and 52.3%, respectively, in participants with incident cancer. Around 80% of those with and without incident cancer had low psychological distress at baseline and follow-up. Compared to those without cancer, cancer survivors had greater average physical functioning declines (mean-score: 77.5 versus 82.9 at follow-up; mean-change: - 8.31 versus - 4.71; adjusted-difference - 2.55 (95%CI = - 2.97-2.13)) and slightly greater increases in psychological distress (mean-score: 13.6 versus 13.5 at follow-up; mean-change: 0.24 versus - 0.04; adjusted-difference 0.21 (95%CI = 0.12-0.31)). Physical outcomes varied by cancer type with greater deterioration with multiple myeloma, lung cancer and leukaemia and lesser declines with breast, colorectal and prostate cancers. Greater deterioration in physical and psychological outcomes were observed in cancer survivors with more advanced disease at diagnosis and recent cancer treatment at follow-up; psychological outcomes in those not receiving recent treatment did not differ from cancer-free participants.</p><p><strong>Conclusions: </strong>On average, cancer survivors experienced greater declines in physical wellbeing than people without cancer and minimal differences in psychological distress. Those not receiving recent cancer treatment and those with many common cancer types had physical and psychological outcomes comparable to people without cancer. Additional targeted support may particularly benefit those receiving treatment, with specific cancer types, and advanced disease.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"290"},"PeriodicalIF":7.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101386","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":"Unveiling lipoprotein subfractions signature in high-FNPO PCOS: implications for PCOM diagnosis and risk assessment using advanced machine learning models.","authors":"Xueqi Yan, Ziyi Yang, Hui Zhao, Gengchen Feng, Shumin Li, Yimeng Li, Yu Sun, Jinlong Ma, Han Zhao, Xueying Gao, Shigang Zhao","doi":"10.1186/s12916-025-04120-z","DOIUrl":"10.1186/s12916-025-04120-z","url":null,"abstract":"<p><strong>Background: </strong>Polycystic ovary syndrome (PCOS) is a common reproductive and metabolic disorder in the reproductive-age women. The international evidence-based guideline for the assessment and management of PCOS 2023 now suggests raising the follicle number per ovary (FNPO) threshold from 12 to 20 to define its key feature, polycystic ovarian morphology (PCOM). However, understanding of low- and high-FNPO PCOS cases defined in this cutoff is very limited. Given that the measures of lipoprotein subfractions are the biomarkers of several common diseases, this study aims to explore clinical characteristics and lipoprotein subfractions in low- and high-FNPO PCOS, and develop a diagnostic model.</p><p><strong>Methods: </strong>A total of 1918 women including 792 low- and 182 high-FNPO PCOS cases, met the international evidence-based guideline 2023, and 944 controls were collected for clinical data analysis. Plasma samples of 66 low-FNPO and 24 high-FNPO PCOS cases and 22 controls matched with BMI and age were utilized for the measurement of 112 lipoprotein subfractions by nuclear magnetic resonance spectroscopy. Partial least squares discriminant analysis (PLS-DA) and logistic regression analysis were used to identify key lipoprotein subfractions. Ten machine learning algorithms and recursive feature elimination with logistic regression were used to construct the effective model to predict PCOM based on the new guideline. Models were validated with bootstrap resampling.</p><p><strong>Results: </strong>High-FNPO PCOS cases presented worse lipid parameters compared with low-FNPO cases and controls. Based on the results of PLS-DA and logistic regression analysis, seven key lipoprotein subfractions were selected, including V2TG, V3TG, V4TG, V2CH, V3CH, V3PL, and V4PL. The addition of them into the anti-Müllerian hormone (AMH) models for predicting high-FNPO PCOS resulted in a significantly improved model performance (AUC increased from 0.750 to 0.874). Even if the only V3TG was added into the AMH model, the AUC increased to 0.807.</p><p><strong>Conclusions: </strong>Lipid metabolism, particularly seven key lipoprotein subfractions, has been identified as a major risk factor for high-FNPO PCOS cases. Among these, V3TG subfraction warrants special attention, both from the perspective of disease risk and precision diagnosis. Due to the lack of effective external validation at this stage, validation of larger sample sizes is necessary before generalizing the application.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"289"},"PeriodicalIF":7.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101387","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":"Outcomes and cost-effectiveness of an integrated holistic care package on persons affected by podoconiosis, lymphatic filariasis and leprosy and community members in north-western Ethiopia: an implementation research study.","authors":"Oumer Ali, Awoke Mihretu, Natalia Hounsome, Vasso Anagnostopoulou, Stephen A Bremner, Mersha Kinfe, Asrat Mengiste, Maya Semrau, Abebaw Fekadu, Gail Davey","doi":"10.1186/s12916-025-04108-9","DOIUrl":"10.1186/s12916-025-04108-9","url":null,"abstract":"<p><strong>Background: </strong>Most studies on integration of neglected tropical disease programmes have focused on mass drug administration or environmental measures rather than Disease Management, Disability and Inclusion (DMDI). The study reported here explored integration of a DMDI care package across three disabling, stigmatising neglected tropical diseases (podoconiosis, lymphatic filariasis and leprosy), across physical and mental health, and into the state health system.</p><p><strong>Methods: </strong>We conducted this pre-post study, the third phase of an implementation research project, in two predominantly rural districts in north-west Ethiopia in 2021. We assessed physical and mental health outcomes on 192 affected persons and 817 community members at baseline and 6 months after initiation of the integrated care package, implemented by nurses and health officers. Key outcomes measured were disability (using WHODAS-2.0), depression (Patient Health Questionnaire-9), discrimination (Discrimination and Stigma Scale), internalised stigma (Internalized Stigma Related to Lymphoedema), quality of life (Dermatology Life Quality Index) and social support (Oslo-3 Social Support Scale). Mixed effects linear regression models were used to estimate change in outcomes between baseline and 6 months after initiation of the care package. We also evaluated implementation feasibility and conducted cost-effectiveness analysis.</p><p><strong>Results: </strong>Among 221 patients, improvements were observed in foot (- 2.3 cm; 95% CI: - 2.2, - 1.8) and leg circumference (- 1.8 cm; - 2.0, - 1.7) and acute attacks (6.2; 0.0, 6.6); these were statistically significant at the 5% level. Reductions were seen in disability scores (- 6.5; - 7.6, - 5.5), depression (- 5.3; - 6.6, - 4.6), discrimination (- 3.3; - 4.2, - 2.3), internalised stigma (- 3.7; - 4.6, - 2.8), quality of life (- 4.0; - 4.8, - 3.2), and alcohol use (- 1.6; - 2.4, - 0.8). No notable changes were found in the presence of wounds or moss, or perceived social support. Across 817 community members, there was strong evidence that knowledge improved, and stigmatising attitudes and social distance reduced. The intervention was cost-effective in reducing depression and disability and improving health-related quality of life and feasible to implement.</p><p><strong>Conclusion: </strong>The integrated intervention is feasible and cost-effective even in remote areas and appears ideal for scale-up to other endemic regions in Ethiopia and other countries.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"284"},"PeriodicalIF":7.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12077021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978378","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":"Higher adherence to the EAT-Lancet reference diet is inversely associated with mortality in a UK population of cancer survivors.","authors":"Nena Karavasiloglou, Alysha S Thompson, Giulia Pestoni, Flurina Suter, Keren Papier, Aedín Cassidy, Tilman Kühn, Sabine Rohrmann","doi":"10.1186/s12916-025-04106-x","DOIUrl":"10.1186/s12916-025-04106-x","url":null,"abstract":"<p><strong>Background: </strong>Significant advancements in treatment and care, as well as early detection, have contributed to an increase in cancer survival rates. Recently, the EAT-Lancet Commission on Food, Planet, Health proposed the \"planetary health diet\" but to date, no study has investigated the potential associations between adherence to the EAT-Lancet reference diet and mortality in cancer survivors. To determine whether higher adherence to the EAT-Lancet reference diet is associated with lower risk for all-cause, cancer, and cardiovascular mortality in cancer survivors.</p><p><strong>Methods: </strong>Data from the prospective UK Biobank study were used. Information from UK Biobank's Touchscreen questionnaire was used to develop a score reflecting adherence to the EAT-Lancet reference diet. Cox proportional hazards regression was used to assess the association of the EAT-Lancet reference diet score with all-cause, cancer, and cardiovascular mortality in cancer survivors.</p><p><strong>Results: </strong>Within 25,348 cancer survivors, better adherence to the EAT-Lancet reference diet was inversely related to all-cause mortality (hazard ratio (HR): 0.97, 95% confidence interval (CI): 0.95-0.99), 1 unit increase) and cancer mortality (HR: 0.98, 95% CI: 0.96-1.00), while mostly null associations were observed for major cardiovascular mortality (HR: 0.99, 95% CI: 0.95-1.03).</p><p><strong>Conclusions: </strong>Our findings suggest the adoption of the EAT-Lancet reference diet is associated with lower all-cause and cancer-specific mortality among cancer survivors.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"286"},"PeriodicalIF":7.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957424","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":"Phenotypic and genotypic characteristics of macrolide, lacosamide, and streptogramin resistance in clinically resistant Streptococci and their correlation with reduced biocide susceptibility.","authors":"Safaa A Abdel-Karim, Fathy M Serry, Eman M Elmasry, Wael A H Hegazy","doi":"10.1186/s12916-025-04097-9","DOIUrl":"10.1186/s12916-025-04097-9","url":null,"abstract":"<p><strong>Background: </strong>Gram-positive Streptococci is a huge group of different species that are classified based on its hemolytic effect besides the C-substance in the cell wall. This study focuses on the investigation of the prevalence and genetic basis of resistance to macrolides, lincosamides, and streptogramins (MLS) in α- and β-hemolytic Streptococci.</p><p><strong>Methods: </strong>Streptococcal isolates were identified and their resistance was assessed to MLS antibiotics through phenotypic analysis and genotypic screening of resistance genes. Isolates were also tested for susceptibility to antiseptics/disinfectants. The correlation between high MLS antibiotic resistance and reduced susceptibility to biocides was assessed. Efflux pump activity in the most resistant isolates (to both MLS antibiotics and biocides) was investigated.</p><p><strong>Results: </strong>The susceptibility testing indicates an increasing resistance to MLS, particularly macrolides (erythromycin, azithromycin, and clarithromycin) and lincomycin. By screening the resistance, the most predominant phenotype is the constitutive (cMLS) one, while the erm genes, particularly ermB, are the most detected genotype. Furthermore, the esterase-encoding gene ereA is widely distributed in the streptococcal isolates. By evaluating the minimum inhibitory concentrations (MICs) to different biocides, there was a strong relation between the increased MIC values to both MLS antibiotics and tested biocides. This can be attributed mainly to the transferable ermB gene and the enhanced bacterial efflux.</p><p><strong>Conclusions: </strong>A significant correlation exists between reduced biocide susceptibility and resistance to MLS antibiotics. Elevated efflux pump activity in MLS-resistant isolates suggests efflux mechanisms may contribute to dual resistance to antibiotics and biocides. However, cross-resistance is primarily driven by the horizontally transferable ermB gene, which confers resistance by targeting the 50S ribosomal subunit.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"281"},"PeriodicalIF":7.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062331","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":"Major depressive disorder recognition based on electronic handwriting recorded in psychological tasks.","authors":"Chong Li, Kunxue Zhang, Qunxing Lin, Shan Huang, Wanying Cheng, Yueshiyuan Lei, Xinyu Zhao, Jiubo Zhao","doi":"10.1186/s12916-025-04101-2","DOIUrl":"10.1186/s12916-025-04101-2","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to determine whether handwriting patterns are altered in individuals experiencing depressive episodes. Additionally, we developed a model for the recognition of major depressive disorder (MDD) based on electronic handwriting in psychological tasks.</p><p><strong>Methods: </strong>A total of 130 patients and 117 healthy controls completed 21 psychology-related handwriting tasks. The electronic tablet recorded several handwriting characteristics, including horizontal and vertical coordinates, nib pressure and speed, and inclination angle. The statistical indicators for each handwriting characteristic were calculated. Statistical analyses, including differential analysis, were performed to identify predictors of depression. Furthermore, logistic regression and machine learning models were developed to discriminate MDD.</p><p><strong>Results: </strong>The study included 130 patients with onset depression (mean (standard deviation (SD)) age, 20.42 (5.21)) and 117 healthy controls (mean (SD) age, 20.54 (2.60)). The t-test and logistics analysis results indicated that depressed patients exhibited a higher minimum of handwriting pressure, an elevated median of handwriting speed, and greater pen tip jitter. The LightGBM machine learning model exhibited satisfactory performance, with a cross-validated area under the receiver operating curve of mean 0.90 (SD, 0.01). The analysis of variance revealed that the negative question-answer task model exhibited superior performance compared to the neutral and positive task models.</p><p><strong>Conclusions: </strong>The present study indicates that depressed patients exhibit modal handwriting changes and developed a cost-effective, rapid, and valid model for identifying MDD. This finding established a strong foundation for developing multimodal recognition models in the future.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"282"},"PeriodicalIF":7.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12077001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962756","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}