BMC Medicine最新文献

{"title":"Pharmacological pain management in patients with rheumatoid arthritis: a narrative literature review.","authors":"Natasha Cox, Christian D Mallen, Ian C Scott","doi":"10.1186/s12916-025-03870-0","DOIUrl":"10.1186/s12916-025-03870-0","url":null,"abstract":"<p><strong>Background: </strong>Pain is a major challenge for patients with rheumatoid arthritis (RA), with many people suffering chronic pain. Current RA management guidelines focus on assessing and reducing disease activity using disease-modifying anti-rheumatic drugs (DMARDs). Consequently, pain care is often suboptimal, with growing evidence that analgesics are widely prescribed to patients with RA, despite potential toxicities and limited evidence for efficacy. Our review provides an overview of pharmacological treatments for pain in patients with RA, summarising their efficacy and use.</p><p><strong>Findings: </strong>Thirteen systematic reviews of drug efficacy for pain in patients with RA were included in this review. These showed moderate- to high-quality evidence from clinical trials in more contemporary time-periods (mainly 1990s/2000s for synthetic DMARDs and post-2000 for biological/targeted synthetic DMARDs) that, in patients with active RA, short-term glucocorticoids and synthetic, biologic, and targeted synthetic DMARDs have efficacy at reducing pain intensity relative to placebo. In contrast, they showed low-quality evidence from trials in more historical time-periods (mainly in the 1960s-1990s for opioids and paracetamol) that (aside from naproxen) analgesics/neuromodulators provide any improvements in pain relative to placebo, and no supportive evidence for gabapentinoids, or long-term opioids. Despite this evidence base, 21 studies of analgesic prescribing in patients with RA consistently showed substantial and sustained prescribing of analgesics, particularly opioids, with approximately one quarter and > 40% of patients receiving chronic opioid prescriptions in each year in England and North America, respectively. Whilst NSAID prescribing had fallen over time across countries, gabapentinoid prescribing in England had risen from < 1% of patients in 2004 to approximately 10% in 2020. Prescribing levels varied substantially between individual clinicians and groups of patients.</p><p><strong>Conclusions: </strong>In patients with active RA, DMARDs have efficacy at reducing pain, supporting the role of treat-to-target strategies. Despite limited evidence that analgesics improve pain in patients with RA, these medicines are widely prescribed. The reasons for this are unclear. We consider that closing this evidence-to-practice gap requires qualitative research exploring the drivers of this practice, high-quality trials of analgesic efficacy in contemporary RA populations, alongside an increased focus on pain management (including pharmacological and non-pharmacological options) within RA guidelines.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"54"},"PeriodicalIF":7.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063793","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":"Economic loss attributable to premature deaths and morbidity among adolescents in India and its states.","authors":"G Anil Kumar, Anamika Pandey, Rakhi Dandona","doi":"10.1186/s12916-025-03895-5","DOIUrl":"10.1186/s12916-025-03895-5","url":null,"abstract":"<p><strong>Background: </strong>India's large youth population presents a significant opportunity to harness the demographic dividend. The disease burden in adolescents could be a hindrance for the future economy if not appropriately addressed.</p><p><strong>Methods: </strong>We utilised the data on the number of adolescent deaths and attributable years lived with disability (morbidity) in every state of India as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. We estimated the economic impact as the cost of lost output due to premature adolescent deaths and morbidity for every state of India in 2021, using an output-based method. The cost of lost output is reported in US Dollars (USD) and as a percentage of Gross Domestic Product (GDP) for all diseases/conditions together, and separately for communicable diseases (CDs), non-communicable diseases (NCDs), and injuries.</p><p><strong>Results: </strong>The lost output from premature deaths and morbidity attributable to adolescents was USD 9.87 (95% CI 9.04-10.71) and USD 28.13 (95% CI 20.53-37.71) billion respectively, in India in 2021. The total economic loss of USD 38.01 billion (95% CI 29.57-48.41) was 1.30% (1.01-1.65) of India's GDP. The total economic loss as a percentage of the state's GDP varied 3.42 times between the states in 2021, ranging from 2.43% in Bihar to 0.71% in Sikkim. The total economic loss due to CDs, NCDs, and injuries was estimated at 0.45%, 0.69% and 0.16% of India's GDP in 2021, with significant variations across the states.</p><p><strong>Conclusions: </strong>Strengthening the Indian Adolescent Health Strategy to address the diseases/ conditions contributing most to the total economic loss is needed to facilitate substantial avoidance of the high economic losses attributable to adolescent premature deaths and morbidity in India.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"51"},"PeriodicalIF":7.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057963","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":"Long COVID and its risk factors in migrants: a nationwide register study from Sweden.","authors":"Agneta Cederström, George Frederick Mkoma, Thomas Benfield, Charles Agyemang, Marie Nørredam, Mikael Rostila","doi":"10.1186/s12916-025-03900-x","DOIUrl":"10.1186/s12916-025-03900-x","url":null,"abstract":"<p><strong>Background: </strong>Many studies have found more severe COVID-19 outcomes in migrants and ethnic minorities throughout the COVID-19 pandemic, while recent evidence also suggests higher risk of longer-term consequences. We studied the risk of a long COVID diagnosis among adult residents in Sweden, dependent on country of birth and accounting for known risk factors for long COVID.</p><p><strong>Methods: </strong>We used linked Swedish administrative registers between March 1, 2020 and April 1, 2023, to estimate the risk of a long COVID diagnosis in the adult population that had a confirmed COVID-19 infection. Poisson regressions were used to calculate incidence rate ratios (IRR) of long COVID by country/region of birth. The contribution of sex, preexisting health status, disease severity, vaccination status, and socioeconomic factors to differences in long COVID diagnosis by country/region of birth were further investigated.</p><p><strong>Results: </strong>Of the 1,869,188 persons diagnosed with COVID-19 that were included, 7539 had received a long COVID diagnosis. Compared with residents born in Sweden, we found higher risks of long COVID among migrants from East Europe (IRR: 1.44 CI: 1.29-1.60), Finland (IRR: 1.36 CI: 1.15-1.61), South Asia (IRR: 1.28 CI: 1.03-1.59), Other Asia (IRR: 1.35 CI: 1.13-1.62), Other Africa (IRR: 1.48 CI: 1.17-1.87), and the Middle East (IRR: 1.43 CI: 1.27-1.63) in models adjusted for age and sex. We discovered that disease severity, i.e., whether the person was hospitalized (IRR: 18.6 CI: 17.3-20.0) or treated in an intensive care unit (IRR: 120.5 CI: 111.7-129.8), primarily contributed to the higher risk of long COVID found in migrants while the contribution of vaccinations and social conditions were moderate. Preexisting health problems did not contribute to the increased risk of long COVID in migrants.</p><p><strong>Conclusions: </strong>The greater exposure and impact of the COVID-19 virus among migrants also affected longer-term consequences. Disease severity was the most important risk factor for long COVID in migrants. The findings emphasize the need for targeted health interventions for migrant communities during an infectious disease pandemic, such as strategic vaccination campaigns and extending social insurance schemes, focusing on reducing disease severity to mitigate the longer-term health consequences of an infection.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"53"},"PeriodicalIF":7.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057899","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":"Habitual sleep duration, healthy eating, and digestive system cancer mortality.","authors":"Diana A Nôga, Elisa M S Meth, André P Pacheco, Jonathan Cedernaes, Pei Xue, Christian Benedict","doi":"10.1186/s12916-025-03882-w","DOIUrl":"10.1186/s12916-025-03882-w","url":null,"abstract":"<p><strong>Background: </strong>Lifestyle choices, such as dietary patterns and sleep duration, significantly impact the health of the digestive system and may influence the risk of mortality from digestive system cancer.</p><p><strong>Methods: </strong>This study aimed to examine the associations between sleep duration, dietary habits, and mortality from digestive system cancers. The analysis included 406,584 participants from the UK Biobank cohort (54.1% women; age range: 38-73 years), with sleep duration classified as short (≤ 6 h, 24.2%), normal (7-8 h, 68.4%), and long (≥ 9 h, 7.4%). Healthy eating habits were defined as a daily intake of at least 25 g of fibre, seven portions of fruits and vegetables, and fewer than four servings of meat per week. These dietary factors were combined into a score ranging from 0 (least healthy) to 3 (healthiest). Cox proportional hazards regression analyses were conducted, with a median follow-up period of 12.6 years, ending on September 30, 2021.</p><p><strong>Results: </strong>3949 participants died from cancer of the digestive system. Both short and long sleep duration were associated with an increased risk of mortality from cancer of the digestive system (1.09 (1.01-1.18) and 1.14 (1.03-1.27), respectively). Additionally, a diet score ≥ 1 was linked to a lower cancer risk (0.72-0.91 (0.59-0.96)). Adjusting for smoking, type 2 diabetes, and body mass index (BMI) status eliminated the association between sleep duration and digestive cancer mortality. The association between healthy dietary patterns and the risk of digestive system cancer mortality did not vary by sleep duration.</p><p><strong>Conclusions: </strong>Aberrant sleep durations may increase the risk of mortality from digestive system cancer, potentially through smoking, higher BMI, and type 2 diabetes. However, aberrant sleep durations do not seem to reduce the protective effects of a healthy dietary pattern.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"44"},"PeriodicalIF":7.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045689","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":"Persistent effect of salt reduction in schoolchildren and their families: 1-year follow-up after an application-based cluster randomized controlled trial.","authors":"Yuan Li, Puhong Zhang, Feng J He, Rong Luo, Jing Song, Changqiong Wang, Fengge Chen, Wei Zhao, Yuhong Zhao, Hang Chen, Tianyong Wu, Xiaoyan Wang, Hui Zhou, Zhi Han, Jie Zhang","doi":"10.1186/s12916-025-03868-8","DOIUrl":"10.1186/s12916-025-03868-8","url":null,"abstract":"<p><strong>Background: </strong>A 12-month cluster randomized controlled trial (RCT) demonstrated the effectiveness of an application-based education program in reducing the salt intake and systolic blood pressure (SBP) of schoolchildren's adult family members. This study aimed to assess whether the effect at 12 months persisted at 24 months.</p><p><strong>Methods: </strong>Fifty-four schools were randomly assigned to either the intervention or control group. All participants (594 children in grade 3 and 1188 of their adult family members) who completed the baseline survey were contacted again 12 months after the trial. The primary outcome was the difference in salt intake change between the intervention and control groups at 24 months versus baseline and 12 months, measured by the mean two consecutive 24-h urinary sodium excretions. The secondary outcome was the difference in the change of blood pressure and salt-related Knowledge, Attitude, Practice (KAP) score.</p><p><strong>Results: </strong>The difference in salt intake change in adults between the intervention and control groups after adjusting for confounding factors was - 0.38 g/day at 24 months versus baseline (95% CI - 0.81 to 0.05, p = 0.09), following the - 0.83 g/day (95% CI - 1.25 to - 0.41, p < 0.001) at 12 months. The adjusted difference in SBP change was - 2.19 mm Hg (95% CI - 3.63 to - 0.76, p = 0.003) at 24 months versus baseline, following the - 1.80 mm Hg (95% CI - 3.19 to - 0.40, p = 0.01) at 12 months. The intervention group had a higher KAP score than the control group both at 12 months and at 24 months versus baseline. No significant changes were found in children.</p><p><strong>Conclusions: </strong>The effect of the education program on adults' salt intake faded, but the SBP lowering effect and the improvement of KAP score remained 12 months after the completion of the RCT. Continuous efforts are needed to maintain the salt reduction effects in real-world settings.</p><p><strong>Trial registration: </strong>ChiCTR1800017553. Registered on August 3, 2018.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"41"},"PeriodicalIF":7.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045018","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":"Changes in the critical nutrient content of packaged foods and beverages after the full implementation of the Chilean Food Labelling and Advertising Law: a repeated cross-sectional study.","authors":"Natalia Rebolledo, Pedro Ferrer-Rosende, Marcela Reyes, Lindsey Smith Taillie, Camila Corvalán","doi":"10.1186/s12916-025-03878-6","DOIUrl":"10.1186/s12916-025-03878-6","url":null,"abstract":"<p><strong>Background: </strong>Chile's Food Labelling Law was implemented in three phases with increasingly stricter limits. After initial implementation, sugars and sodium decreased in packaged foods, with no significant changes for saturated fats. It is unclear whether full implementation is linked with further reformulation or if producers reversed changes due to consumers' preferences. This study examines changes in the proportion of \"high in\" products and the nutrient content of packaged foods during the Law's three phases.</p><p><strong>Methods: </strong>This repeated cross-sectional study included the best-selling packaged foods and beverages during 2015-2020. We analyzed the proportion of products classified as \"high in\" critical nutrients using the final phase cutoffs and examined changes in the content of calories, sugars, sodium, and saturated fats in the three phases. To assess the changes in proportions, we used Firth's bias-reduced logistic regression models and the Cochran-Armitage test for trends. Quantile regression was used to evaluate changes in nutrient content.</p><p><strong>Results: </strong>The proportion of \"high in\" products decreased from 70.8 to 52.5% after the final phase (p < 0.001). The proportion of \"high in\" sugars products decreased across all sweet food and beverage groups (p < 0.001), except for candies (- 4.5 percentage points (pp), p = 0.09). The largest reductions occurred in sweet spreads and breakfast cereals (- 44.3 and - 40.4 pp, respectively, p < 0.001). For the proportion of \"high in\" sodium, reductions occurred in all savory food groups (p < 0.001), except cheeses and ready-to-eat meals (p < 0.24), with the largest decreases in savory baked products and non-sausage meat products (- 40.4 and - 38.9 pp, respectively, p < 0.001). Reductions in \"high in\" saturated fats and energy were less consistent, with the largest decreases in nuts and snacks and savory spreads (- 22.2 and - 20.0 pp, respectively, p < 0.001) and savory baked products and breakfast cereals (- 32.8 and - 25.7 pp, respectively, p < 0.001), respectively. After full implementation, most sweet categories showed left shifts in sugars distribution, except for candies. Similarly, most savory categories showed left shifts for sodium, except savory spreads and ready-to-eat meals. Changes increased as regulation limits tightened (p for trend < 0.001).</p><p><strong>Conclusions: </strong>After fully implementing Chile's law, the proportion of \"high in\" products and the content of critical nutrients decreased in all food and beverage categories. The largest changes occurred for sodium in savory foods and sugars in sweet foods/beverages. Stricter regulatory limits were associated with decreases in critical nutrient content over time.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"46"},"PeriodicalIF":7.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051603","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":"Effect of enhanced recovery after surgery on older patients undergoing transvaginal pelvic floor reconstruction surgery: a randomised controlled trial.","authors":"Xuezhu Huang, Sisi Deng, Xiaofeng Lei, Shentao Lu, Ling Dai, Chunyan She","doi":"10.1186/s12916-025-03880-y","DOIUrl":"10.1186/s12916-025-03880-y","url":null,"abstract":"<p><strong>Background: </strong>Prospective trial evidence is lacking regarding the application of enhanced recovery after surgery (ERAS) in transvaginal pelvic floor reconstruction surgery among older patients. Our study aimed to investigate whether implementing the ERAS protocol could enhance post-operative recovery in this patient population.</p><p><strong>Methods: </strong>Older patients undergoing elective transvaginal pelvic floor reconstruction surgery were randomly assigned to either the ERAS group or the conventional group. The primary outcome was post-operative length of stay (LOS). The secondary outcomes encompassed other post-operative recovery metrics, post-operative pain within 30 days, the occurrence of complications, the peri-operative blood test and cognitive function.</p><p><strong>Results: </strong>A cohort of 100 patients was enrolled. Implementation of the ERAS protocol significantly reduced the duration of post-operative LOS (74.00 (69.00, 96.00) vs. 65.00 (59.00, 78.25) h, P < 0.01). Additionally, the ERAS protocol significantly reduced the duration of the first oral intake post-operatively (5.00 (2.50, 7.00) vs. 3.00 (2.00, 4.00) h, P = 0.01), and reduced rest and movement-related pain within 48 h post-operatively, effects that persisted through the 7-day follow-up period. It also shortened the duration of post-operative laryngeal mask airway support and promoted opioid-sparing. Moreover, the incidence and severity of post-operative nausea and vomiting (PONV) were significantly lower in the ERAS group compared to the conventional group at 12 h post-operatively.</p><p><strong>Conclusions: </strong>Implementation of the ERAS protocol can expedite post-operative recovery in older patients undergoing transvaginal pelvic floor reconstruction surgery, achieve opioid-sparing, alleviate pain post-operatively, and decrease the incidence of complications.</p><p><strong>Trial registration: </strong>This study was retrospectively registered with the Chinese Clinical Trial Registry (registration number: ChiCTR2400084608). The date of first registration was 21/05/2024.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"43"},"PeriodicalIF":7.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045687","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":"Which factors influence the transition towards a healthy and sustainable food environment in Dutch hospitals? A qualitative view from stakeholders.","authors":"Joline J Wierda, Femke van Nassau, Sanne K Djojosoeparto, Maartje P Poelman","doi":"10.1186/s12916-025-03872-y","DOIUrl":"10.1186/s12916-025-03872-y","url":null,"abstract":"<p><strong>Background: </strong>Hospitals fulfill an important exemplary role in promoting health and well-being. It is therefore crucial to have a supportive food environment that stimulates healthy and sustainable food choices of patients, staff, and visitors. This qualitative study aimed to identify factors influencing the implementation of long-lasting actions to enhance the healthiness and sustainability of the food environment in the hospital setting in the Netherlands, from the perspective of different stakeholders.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted in hospitals realizing a healthy and sustainable food environment. Verbatim transcripts were thematically analyzed, guided by the Consolidated Framework for Implementation Research. Data were organized and interpreted per theme as well as stakeholder group.</p><p><strong>Results: </strong>In three hospitals, 29 semi-structured interviews were conducted with 30 stakeholders from a wide spectrum of stakeholder groups (i.e., facility professionals, healthcare professionals, project coordinators, and board of directors). Identified themes and subthemes were: 1 the outer setting, with momentum for change, government-established policies and guidelines, collaboration and networks outside the hospital, and caterers' and suppliers' food offerings, interests, and contracts; 2 the innovation domain, with familiarity and compliance with the TEH program; 3 support at all levels, achieving organizational buy-in with communication as a strategy, and end user interests; 4 the inner setting, with key priority in policy and having a vision, available resources, infrastructure within the hospital, ambassadors, and gradual process with continuous effort; and 5 the individual domain with personal drive.</p><p><strong>Conclusions: </strong>The results revealed an interplay of perceived factors that influence the enhancement of a healthy and sustainable food environment and underscored the importance of addressing various facilitators and barriers across multiple domains within and outside the hospital setting. To ensure successful integration of a healthy and sustainable food environment in hospitals, throughout the entire organization it is crucial to engage diverse stakeholders at all levels and address their barriers with tailored implementation strategies. We suggest verification of our findings in more hospitals.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"45"},"PeriodicalIF":7.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051591","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":"Obstructive sleep apnea and structural and functional brain alterations: a brain-wide investigation from clinical association to genetic causality.","authors":"Kang Wu, Qiming Gan, Yuhong Pi, Yanjuan Wu, Wenjin Zou, Xiaofen Su, Sun Zhang, Xinni Wang, Xinchun Li, Nuofu Zhang","doi":"10.1186/s12916-025-03876-8","DOIUrl":"10.1186/s12916-025-03876-8","url":null,"abstract":"<p><strong>Background: </strong>Obstructive sleep apnea (OSA) is linked to brain alterations, but the specific regions affected and the causal associations between these changes remain unclear.</p><p><strong>Methods: </strong>We studied 20 pairs of age-, sex-, BMI-, and education- matched OSA patients and healthy controls using multimodal magnetic resonance imaging (MRI) from August 2019 to February 2020. Additionally, large-scale Mendelian randomization analyses were performed using genome-wide association study (GWAS) data on OSA and 3935 brain imaging-derived phenotypes (IDPs), assessed in up to 33,224 individuals between December 2023 and March 2024, to explore potential genetic causality between OSA and alterations in whole brain structure and function.</p><p><strong>Results: </strong>In the cohort study, OSA patients exhibited significantly lower fractional amplitude of low-frequency fluctuation and regional homogeneity in the right posterior cerebellar lobe and bilateral superior and middle frontal gyrus, while showing higher levels in the left occipital lobe and left posterior central gyrus. Decreased fractional anisotropy (FA) but increased apparent diffusion coefficient (ADC) was shown in the bilateral superior longitudinal fasciculus. According to the results of Affiliation file 2: table s6, it is the ADC value of right superior longitudinal fasciculus was shown a positive correlation with the lowest oxygen saturation. In the Mendelian randomization analyses, the area of left inferior temporal sulcus (OR: 0.89; 95% CI: 0.82-0.96), rfMRI connectivity ICA100 edge 893 (OR: 0.88; 95% CI: 0.82-0.96), ICA100 edge 951 (OR: 0.89; 95% CI: 0.82-0.97), and ICA100 edge 1213 (OR: 0.89; 95% CI: 0.82-0.96) were significantly decreased in OSA. Conversely, mean thickness of G-front-inf-Triangul in right hemisphere (OR: 1.14; 95% CI: 1.05-1.23), mean orientation dispersion index in right tapetum (OR: 1.13; 95% CI: 1.04-1.23), and rfMRI connectivity ICA100 edge 258 (OR: 1.13; 95% CI: 1.04-1.22) showed opposite results.</p><p><strong>Conclusions: </strong>Nerve fiber damage and imbalances in neuronal activity across multiple brain regions caused by hypoxia, particularly the frontal lobe, underlie the structural and the functional connectivity impairments in OSA.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"42"},"PeriodicalIF":7.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045690","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":"Childhood body size, adulthood adiposity, underlying mechanisms, and risk of incident hypertension: a prospective cohort study of 180,527 participants.","authors":"Shujing Ma, Xue Liu, Ruilang Lin, Ye Yao, Min Zhao, Yongfu Yu, Costan G Magnussen, Bo Xi","doi":"10.1186/s12916-025-03884-8","DOIUrl":"10.1186/s12916-025-03884-8","url":null,"abstract":"<p><strong>Background: </strong>Mechanisms underlying the association of life-course adiposity with incident hypertension in adulthood have not been comprehensively investigated. In this study, we aimed to investigate the potential biochemical and metabolomic mechanisms underlying the association between adiposity and incident hypertension.</p><p><strong>Methods: </strong>A total of 180,527 participants from the UK Biobank aged 37 to 73 years were included. Associations of childhood body size or adulthood adiposity status as well as child-adult weight status change with incident adulthood hypertension were estimated by multivariate Cox proportional regression models.</p><p><strong>Results: </strong>Participants with childhood thinner body size and adulthood obesity had the highest risk of incident hypertension (hazard ratio, HR = 3.09, 95% CI = 2.88-3.32) compared with those with \"average → normal\" pattern, followed by those with \"average → obese\" pattern (HR = 2.45, 95% CI = 2.31-2.61) and \"plumper → obese\" pattern (HR = 2.82, 95% CI = 2.62-3.02). Of note, those with \"plumper → normal\" pattern (HR = 1.11, 95% CI = 1.00-1.23) and \"thinner → normal\" pattern (HR = 1.17, 95% CI = 1.10-1.24) had the second and third lowest risk of incident hypertension. Adulthood overweight (mediation proportion: 58.7%, 95% CI: 40.4-74.8%) or obesity (mediation proportion = 46.7%, 95% CI: 29.4-64.9%) largely mediated the association between childhood plumper body size and hypertension. The association between adiposity and hypertension was mediated by biochemical indices (e.g., liver function, immunometabolism) and metabolites (e.g., alanine aminotransferase, apolipoprotein A) (mediation proportions ranging from 3.2 to 23.4%).</p><p><strong>Conclusions: </strong>Thinner or plumper body size in childhood increases the risk of incident adulthood hypertension, and adulthood adiposity partly mediated this association, suggesting the importance of maintaining normal weight across the life course. Several biochemical indices and metabolites mediated these associations providing clues to underlying biological mechanisms.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"47"},"PeriodicalIF":7.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051633","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}