BMC Medicine最新文献

{"title":"Lactobacillus ameliorates myocardial ischemia reperfusion injury by attenuating apoptosis, inflammation, oxidative stress, and ferroptosis.","authors":"Yan Liang, Lili Zhao, Xu Zhang, Shan Liu, Pengju Lu, Jingxian Wang, Liqun Chen, Yin Liu, Jing Gao","doi":"10.1186/s12916-025-04203-x","DOIUrl":"10.1186/s12916-025-04203-x","url":null,"abstract":"<p><strong>Background: </strong>Myocardial ischemia/reperfusion (I/R) injury is a significant complication following acute myocardial infarction (AMI) and lacks effective therapies. The involvement of gut microbiota in regulating ferroptosis during myocardial I/R injury has not been thoroughly explored. This study aimed to investigate the effect of Lactobacillus on myocardial I/R injury and explore its potential mechanisms.</p><p><strong>Methods: </strong>One hundred fifty eight patients with ST-elevation myocardial infarction (STEMI) were enrolled in our prospective observational study. The correlations between Lactobacillus levels and myocardial injury markers, inflammatory factors, oxidative stress, and ferroptosis were evaluated. Furthermore, 30 rats were treated with Lactobacillus or vehicle control for 4 weeks, followed by myocardial I/R surgery. The protective effects of Lactobacillus against I/R injury were assessed by quantifying myocardial apoptosis, inflammation, oxidative stress, and ferroptosis. In addition, the above results were verified in vitro. The signaling pathways were investigated through the knockdown and overexpression of sirtuin 1 (Sirt1) and nuclear factor erythroid 2-related factor 2 (Nrf2).</p><p><strong>Results: </strong>In clinical study, Lactobacillus levels were significantly negatively correlated with myocardial injury markers, inflammatory factors, and malondialdehyde (MDA), but positively correlated with glutathione (GSH). In rats, Lactobacillus decreased the levels of myocardial injury markers, reduced the size of the myocardial infarction area, ameliorated the disordered myocardial cell arrangement, and improved cardiac function. In both in vivo and in vitro studies, Lactobacillus inhibited cardiomyocyte apoptosis by upregulated B-cell lymphoma-2 (Bcl-2), downregulated Bcl-2 associated X (Bax), and caspase-3. Furthermore, Lactobacillus decreased inflammatory factors, MDA, reactive oxygen species (ROS) levels, and increased superoxide dismutase (SOD) activity. For ferroptosis, Lactobacillus upregulated the expression of glutathione peroxidase 4 (GPX4) and downregulated the expressions of acyl-CoA synthetase long-chain family member 4 (ACSL4) and transferrin receptor protein 1 (TfR1). Finally, knockdown and overexpression of Sirt1 and Nrf2 in vitro demonstrated that Lactobacillus exerted the effect by upregulating the Sirt1/Nrf2/HO-1 pathway.</p><p><strong>Conclusions: </strong>Our findings reveals that Lactobacillus protects against myocardial I/R injury by inhibiting apoptosis, inflammation, oxidative stress, and ferroptosis through the Sirt1/Nrf2/HO-1 signaling axis, suggesting a novel probiotic-based therapeutic potential for I/R injury.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"377"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12218948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538863","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":"Low-level viremia increases the risk of diabetes mellitus in people with HIV in China: a 7-year retrospective longitudinal cohort study.","authors":"Chunxing Tao, Liangjia Wei, Minn Thit Aung, Longyu Liao, Aidan Nong, Li Huang, Rongye Huang, Lijing Huang, Shuixia Wang, Xiaohuan Huang, Yanbing Yao, Li Ye, Hao Liang, Chuanyi Ning, Salma Gayed, Lijuan Bao, Bingyu Liang","doi":"10.1186/s12916-025-04166-z","DOIUrl":"10.1186/s12916-025-04166-z","url":null,"abstract":"<p><strong>Background: </strong>It is unclear whether low-level viremia (LV) during antiretroviral therapy (ART) increases the incidence of diabetes mellitus (DM). This study aims to assess the association between HIV viremia exposure during ART and DM using retrospective cohort data.</p><p><strong>Methods: </strong>People with HIV (PWH) who started ART in 2003 or later were identified from China's National Free ART Program database. Participants who had been on ART for ≥ 6 months without DM at enrollment were included in this study. Based on two consecutive viral load measurements after 6 months of ART, participants were categorized into three groups: viral suppression (VS), transient episode low-level viremia (blips), and persistent low-level viremia (LLV). Blips and LLV were collectively classified as the LV group. We analyzed the incidence of DM depending on viremia exposure using Cox proportional hazard models adjusted for age, sex, baseline viral load, CD4 count, ART initiation regimen, ART initiation period, and WHO HIV stage. Heterogeneous linear mixed models identified fasting blood glucose (FBG) trajectory patterns during the follow-up.</p><p><strong>Results: </strong>During 26,097 person-years of follow-up, we observed 1297 cases of DM in 8731 participants, with a median follow-up of 2.4 years (IQR: 1.2, 4.5). Two distinct FBG trajectories, labeled \"Stable\" and \"Rapid increase,\" were identified. The LLV group had a significantly higher proportion of participants in the \"Rapid increase\" trajectory (OR: 2.53, p < 0.001). Both the blips (cHR: 1.40, p < 0.001) and LLV (cHR: 1.74, p < 0.001) groups were associated with a higher incidence of DM compared to the VS group. After propensity score matching, the LV group showed a higher DM risk (aHR: 1.27, p = 0.012). When restricted to the 35-49 age group, the risk of DM was even higher in both the LLV (aHR: 2.03, p = 0.017) and blips (aHR: 1.36, p = 0.027) groups compared to the VS group.</p><p><strong>Conclusions: </strong>Low-level viremia (LV) substantially increased the risk of diabetes mellitus (DM) among PWH, particularly in middle-aged individuals. Monitoring viral load and FBG is crucial to prevent DM development and improve life expectancy among ART patients.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"350"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12210907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538879","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":"Pediatric computed tomography scan and subsequent risk of malignancy: a nationwide population-based cohort study in Korea using National Cancer Institute dosimetry system for computed tomography (NCICT).","authors":"Sangsoo Han, Jaewan Soh, Sangun Nah, Kyungdo Han, Jin-Hyung Jung, Jiwon Park, YoonJoong Hwang, Choonsik Lee, Jae-Young Hong","doi":"10.1186/s12916-025-04235-3","DOIUrl":"10.1186/s12916-025-04235-3","url":null,"abstract":"<p><strong>Background: </strong>Computed tomography (CT) has advanced medical diagnostics by offering detailed anatomical imaging, but its use in children raises concerns due to higher radiation doses and increased vulnerability. This study enhances prior research by using organ-specific radiation dose calculations for a more precise cancer risk assessment, investigating the associations between pediatric cancers and radiation doses in a large population cohort.</p><p><strong>Methods: </strong>This nationwide cohort study analyzed National Health Insurance Service claims data from 2007 to 2015 with a focus on individuals < 20 years of age who underwent CT scans. We used the International Classification of Diseases Tenth Revision codes to identify an exposed cohort and excluded subjects with congenital anomalies or previous cancer diagnoses. The study had a 2-year lag period to minimize selection bias and reverse causation effects. We calculated the exposed organ dose for each organ during each CT scan using the national CT dose survey data and the National Cancer Institute for Computed Tomography (NCICT) dose calculator. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for cancer incidence according to organ-specific radiation dose.</p><p><strong>Results: </strong>From 2007 to 2015, 1,540,633 children underwent CT scans, with 1,380,896 being included in the final analysis. A significant dose-response relationship was observed: for every one standard deviation increase in organ-specific radiation dose, the overall cancer risk increased (HR 1.155, 95% CI: 1.139-1.171). Among solid malignancies, associations were observed for urinary cancer (HR 1.385, 95% CI: 1.291-1.486), thyroid cancer (HR 1.248, 95% CI: 1.218-1.278), brain cancer (HR 1.201, 95% CI: 1.177-1.225), and digestive system cancer (HR 1.285, 95% CI: 1.240-1.331). Hematologic malignancies, including leukemia (HR 1.074, 95% CI: 1.053-1.100) and other myeloid tumors (HR 1.087, 95% CI: 1.062-1.112), also showed increased risks.</p><p><strong>Conclusions: </strong>This study revealed a significant relationship between increased radiation doses during CT and the potential risk of various cancers in pediatric patients. Although CT is an invaluable diagnostic tool for which the risks are not high using the current diagnostic doses, a risk/benefit analysis is appropriate, especially for children.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"355"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12211530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538885","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":"Sex and gender considerations in randomized controlled trials in critical care nephrology: a meta-epidemiologic study.","authors":"Nuttha Lumlertgul, Anyarin Wannakittirat, Janice Y Kung, Nattachai Srisawat, David Collister, Emily J See, Neesh Pannu, Ravindra L Mehta, Danielle E Soranno, Marlies Ostermann, Sean M Bagshaw","doi":"10.1186/s12916-025-04202-y","DOIUrl":"10.1186/s12916-025-04202-y","url":null,"abstract":"<p><strong>Background: </strong>How sex and gender are considered in randomized controlled trials (RCTs) in critical care nephrology is unclear. We aimed to perform a meta-epidemiologic study to describe the representation, sex and gender reporting, and sex- and gender-based analyses (SGBA) in high-impact RCTs in critical care nephrology.</p><p><strong>Methods: </strong>We searched the Web of Science Core Collection for critical care nephrology papers from 2000 to 2024. We included trials published in high-impact journals in general medicine, pediatrics, critical care, and nephrology. The main outcome was the proportion of female/woman participants enrolled and the association with trial characteristics, findings, and women authorship. We estimated the participation-to-prevalence ratio (PPR) to evaluate the representativeness of females within identified RCTs and selected case-mix and disease populations. Sex and gender reporting and SGBA were investigated.</p><p><strong>Results: </strong>A total of 117 RCTs, including 106,057 participants, were included. Sex (54.7%), gender (26.5%), both (2.6%), or none (16.2%) terminology were used for reporting. Male/female (82.1%), men/women (11.1%), both (4.3%), boys/girls (0.9%) and none (1.7%) were used as descriptors. Of the 115 RCTs with available sex/gender data, the median proportion of female/women participants was 35.4% (interquartile range (IQR) 31.2%-40.8%). Pediatric age group and process of care as an intervention were independently associated with the proportion of female/women participants. The median PPR was 0.89 (IQR 0.8-1.06), except in major surgery, for which PPR was 0.67 (IQR 0.29-0.73). Twelve (10.9%) and 49 (41.9%) studies used sex and/or gender as inclusion and exclusion criteria, respectively; 5 (4.3%) studies used sex/gender-stratified randomization; and 35 (29.9%) studies performed SGBA. RCTs with pregnancy, lactation, or women of childbearing age as exclusion criteria had a lower enrollment of female/women participants than RCTs that did not (33.6% vs. 36.8%, P = 0.04). Exclusion criteria of pregnancy, lactation, or childbearing age were considered strongly justified, potentially justified, and poorly justified in 36.1%, 14.9%, and 48.9%, respectively. There were no changes in the representation of females/women and SGBA across identified RCTs over the search range.</p><p><strong>Conclusions: </strong>Females/women are less frequently represented in critical care nephrology RCTs. Significant gaps exist in sex- and gender-specific eligibility criteria, reporting, and analysis.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"386"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12220064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538894","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":"Objective sleep quality in diverse older adults: a cross-sectional study on the importance of race and ethnicity and sex.","authors":"Clémence Cavaillès, Katie L Stone, Yue Leng, Carrie Peltz, Kristine Yaffe","doi":"10.1186/s12916-025-04204-w","DOIUrl":"10.1186/s12916-025-04204-w","url":null,"abstract":"<p><strong>Background: </strong>Research on sleep disparities across different sociodemographic groups is limited and often yields inconsistent findings. We aimed to examine differences in objective sleep measures by race and ethnicity, sex, and age within a diverse cohort of community-dwelling older adults.</p><p><strong>Methods: </strong>We analyzed cross-sectional data from 838 participants aged ≥ 50 years in the Dormir Study (2020-2024). Sleep metrics, including sleep duration, sleep efficiency, wake after sleep onset (WASO), and sleep fragmentation index (SFI), were derived from a minimum of four nights of wrist actigraphy (mean = 6.1 ± 0.7 nights). Race and ethnicity (Black; Mexican American (MA); Non-Hispanic White (NHW)), sex, and age (< 65; ≥ 65 years) were self-reported. We compared sleep metrics across sociodemographic groups and assessed their multivariable associations using linear, logistic, and multinomial regression models.</p><p><strong>Results: </strong>We studied 190 (22.7%) Black, 282 (33.6%) MA, and 366 (43.7%) NHW Dormir participants, with a mean age of 66.7 ± 8.4 years, and 64.8% women. Compared to NHW participants, Black and MA participants had shorter mean sleep duration (Black: 7.1 ± 1.2 h; MA: 7.1 ± 1.1 h; NHW: 7.5 ± 1.1 h; p < 0.0001), lower median sleep efficiency (Black: 87.2%; MA: 87.8%; NHW: 90.6%; p < 0.0001), longer median WASO (Black: 61.2 min; MA: 56.7 min; NHW: 44.4 min; p < 0.0001), and higher mean SFI (Black: 32.0 ± 11.0%; MA: 27.3 ± 9.7%; NHW: 24.0 ± 9.0%; p < 0.0001). Compared to men, women had longer mean sleep duration (women: 7.4 ± 1.1 h; men: 7.1 ± 1.2 h; p = 0.0004) and lower mean SFI (women: 25.9 ± 8.8%; men: 28.9 ± 12.1%; p = 0.0001). Older participants had longer mean sleep duration (old: 7.4 ± 1.1 h; young: 7.1 ± 1.1 h; p < 0.0001), higher median sleep efficiency (old: 89.8%; young: 87.7%; p < 0.0001), shorter median WASO (old: 48.5 min; young: 56.8 min; p < 0.0001), and lower mean SFI (old: 26.1 ± 10.2%; young: 28.1 ± 10.2%; p = 0.007). After adjusting for socioeconomic and behavioral factors, comorbidities, and sleep medications, findings were consistent except for age group comparisons in which differences were no longer significant.</p><p><strong>Conclusions: </strong>Our findings demonstrate significant variations in objective sleep measures across sociodemographic groups, with non-White participants and men experiencing poorer sleep quality. These disparities may contribute to health inequalities, emphasizing the need for targeted interventions to support at-risk populations.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"391"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12219036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538884","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":"Multisensory BCI promotes motor recovery via high-order network-mediated interhemispheric integration in chronic stroke.","authors":"Rongrong Lu, Zhen Pang, Tianhao Gao, Zhijie He, Yiqian Hu, Jie Zhuang, Qin Zhang, Zhengrun Gao","doi":"10.1186/s12916-025-04214-8","DOIUrl":"10.1186/s12916-025-04214-8","url":null,"abstract":"<p><strong>Background: </strong>Chronic stroke patients often experience persistent motor impairments, and current rehabilitation therapies rarely achieve substantial functional recovery. Sensory feedback during movement plays a pivotal role in driving neuroplasticity. This study introduces a novel multi-modal sensory feedback brain-computer interface (Multi-FDBK-BCI) system that integrates proprioceptive, tactile, and visual stimuli into motor imagery-based training. We aimed to explore the potential therapeutic efficacy and elucidate its neural mechanisms underlying motor recovery.</p><p><strong>Methods: </strong>Thirty-nine chronic stroke patients were randomized to either the Multi-FDBK-BCI group (n = 20) or the conventional motor imagery therapy group (n = 19). Motor recovery was assessed using the Fugl-Meyer Assessment (primary outcome), Motor Status Scale, Action Research Arm Test, and surface electromyography. Functional MRI was used to examine brain activation patterns during upper limb tasks, while Granger causality analysis and machine learning evaluated inter-regional connectivity changes and their predictive value for recovery.</p><p><strong>Results: </strong>Multi-FDBK-BCI training led to significantly greater motor recovery compared to conventional therapy. Functional MRI revealed enhanced activation of high-order transmodal networks-including the default mode, dorsal/ventral attention, and frontoparietal networks-during paralyzed limb movement, with activation strength positively correlated with motor improvement. Granger causality analysis identified a distinct information flow pattern: signals from the lesioned motor cortex were relayed through transmodal networks to the intact motor cortex, promoting interhemispheric communication. These functional connectivity changes not only supported motor recovery but also served as robust predictors of therapeutic outcomes.</p><p><strong>Conclusions: </strong>Our findings highlight the Multi-FDBK-BCI system as a promising strategy for chronic stroke rehabilitation, leveraging activity-dependent neuroplasticity within high-order transmodal networks. This multi-modal approach holds significant potential for patients with limited recovery options and sheds new light on the neural drivers of motor restoration, warranting further investigation in clinical neurorehabilitation.</p><p><strong>Trial registration: </strong>All data used in the present study were obtained from a research trial registered with the ClinicalTrials.gov database (ChiCTR-ONC-17010739, registered 26 February 2017, starting from 10 January 2017).</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"380"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12220625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538883","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 sociodemographic factors and comorbidity with non-receipt of medications for secondary prevention: a cohort study of 12,204 myocardial infarction survivors.","authors":"Ike Dhiah Rochmawati, Jocelyn M Friday, Daniel Ang, Tran Q B Tran, Clea du Toit, Alan Stevenson, Jim Lewsey, Daniel Mackay, Ruth Dundas, Bhautesh Jani, S Vittal Katikireddi, Christian Delles, Sandosh Padmanabhan, Carlos Celis-Morales, Paul Welsh, Frederick K Ho, Jill P Pell","doi":"10.1186/s12916-025-04160-5","DOIUrl":"10.1186/s12916-025-04160-5","url":null,"abstract":"<p><strong>Background: </strong>Clinical guidelines recommend use of (1) antiplatelet, (2) lipid-lowering, and (3) beta blocker medication, and (4) angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEi/ARB) for secondary prevention following myocardial infarction (MI). This study examines whether sociodemographic factors and comorbidity were associated with receipt of guideline-recommended medication, and whether receipt was associated with all-cause mortality.</p><p><strong>Methods: </strong>A cohort study was conducted on West of Scotland patients aged 53 years or above who were discharged from hospital alive after an incident MI between 2014 and 2022. Receipt of guideline-directed therapy was defined as relevant medications dispensed within 3 months of discharge. Age, sex, area-deprivation, care/nursing home residence, year of incident MI, and pre-existing conditions were included as predictors of non-receipt and covariates in the analysis of the association between non-receipt and death.</p><p><strong>Results: </strong>Among 12,204 MI survivors, 7898 (64.72%) received all four classes of recommended medications. Non-receipt increased over the study period and was more likely in women, older people, more deprived people, care/nursing home residents, or those with preexisting atrial fibrillation, chronic kidney disease, liver diseases, chronic obstructive pulmonary disease, or psychosis; and was less likely in those who had prior revascularisation. Non-receipt was associated with higher mortality (HR 1.15, 95% CI 1.05-1.26) after adjusting for sociodemographic factors and preexisting conditions. Excess mortality due to area deprivation and care/nursing home residence could be partly explained by non-receipt of ACEi/ARB (9.4% for deprivation; 40.7% for care/nursing home residence) and lipid lowering medication (39.7% for care/nursing home residence).</p><p><strong>Conclusions: </strong>Recommended secondary prevention medications were less likely to be received by women, those deprived, living in care/nursing homes, and with comorbid conditions. Equivalising appropriate ACEi/ARB use for secondary prevention could slightly reduce socioeconomic inequality of cardiovascular mortality.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"381"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12219715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538775","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":"Sympathetic reactivity to physiological stress is associated with expanded cardiac extracellular volume in humans.","authors":"Hazel C Blythe, Zoe H Adams, Katrina A Hope, Richard P Baker, Melanie J Hezzell, M Saadeh Suleiman, Ana Paula Abdala Sheikh, Nathan Manghat, Konstantina Mitrousi, Angus K Nightingale, Emma C Hart","doi":"10.1186/s12916-025-04197-6","DOIUrl":"10.1186/s12916-025-04197-6","url":null,"abstract":"<p><strong>Background: </strong>Expanded extracellular volume (ECV) is an early marker of myocardial interstitial fibrosis in patients with hypertension. Animal studies suggest that surges in sympathetic nerve activity (SNA) might contribute more to the development of interstitial fibrosis than the resting level of SNA. The aim of this study was to investigate whether resting SNA or greater SNA reactivity to a stressor may be associated with expanded ECV in humans across a range of blood pressures.</p><p><strong>Methods: </strong>This was a cross-sectional study in 19 individuals with varying levels of ambulatory systolic blood pressure (111-153 mmHg, 48 ± 13 years, 26.5 ± 2.6 kg/m², n = 10 diagnosed with hypertension and n = 9 normotensive controls). Beat-to-beat non-invasive blood pressure (Finometer), heart rate (3-lead ECG) and muscle SNA (MSNA; peroneal microneurography) were recorded simultaneously during baseline, and throughout a cold pressor test (physiological stress), with hand immersion in 3-4 °C water. LV chamber size, wall thickness and ECV were assessed using cardiac magnetic resonance imaging.</p><p><strong>Results: </strong>Resting MSNA was not associated with cardiac ECV (B coefficient = - 0.07, 95% CI (- 0.24-0.10), P = 0.549), but SNA reactivity to the cold pressor test was a predictor of ECV independent of daytime systolic blood pressure (B coefficient = 0.12, 95% CI (0.05-0.20), P = 0.007). We determined associations between ECV and MSNA variables using liner regressions, with ECV as the dependent variable.</p><p><strong>Conclusions: </strong>Our findings show that SNA responses to physiological stress were predictive of ECV, whereas resting SNA was not, independent of the level of blood pressure. Thus, surges in SNA during stress might be more important in cardiac remodelling than overall resting levels of SNA. Further studies should test this hypothesis in larger cohorts.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"367"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12220307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538897","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":"Temporal multimorbidity patterns and cluster identification: a longitudinal analysis of administrative data.","authors":"Jennifer K Ferris, Brandon Wagar, Alex Choi, Jonathan Simkin, Hind Sbihi, Kari Harder, Kate Smolina","doi":"10.1186/s12916-025-04184-x","DOIUrl":"10.1186/s12916-025-04184-x","url":null,"abstract":"<p><strong>Background: </strong>Multimorbidity is analytically and clinically complex, involving multiple interactions between diseases each with unique implications for health. Identifying disease co-occurrence patterns at the population level could aid in disease prevention, management, and care delivery.</p><p><strong>Methods: </strong>Here, we analyzed multimorbidity patterns using linked administrative data from a longitudinal cohort of 1,347,820 individuals with multimorbidity over 20 years in British Columbia, Canada. A directed network-based approach was used to assess disease patterns in multimorbidity by frequency (prevalence) and non-random association (lift). We applied a community detection algorithm to identify multimorbidity disease clusters.</p><p><strong>Results: </strong>Mood and anxiety disorders and hypertension were the most common disease predecessors in prevalence networks, with differences between age groups. Lift networks revealed non-random disease associations. Some indicate potential etiological disease relationships (e.g., breast cancer preceding heart disease in young women), shared risk profiles (e.g., chronic obstructive pulmonary disease and lung cancer), or overlapping disease constructs (e.g., Parkinsonism and dementia). Disease clusters often centered around a single disease as a common predecessor or consequence, representing potential multimorbidity profiles, which may be relevant for patient subgrouping or management.</p><p><strong>Conclusions: </strong>Insights from these analyses can complement traditional chronic disease surveillance methods, flagging disease patterns for further interrogation into their impacts on function, mortality, and health service utilization.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"370"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12219922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538898","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":"Cost-effectiveness of self-sampling and enhanced strategies for HPV prevention among men who have sex with men in China: a modeling study.","authors":"Zhen-Hao Wu, Yu-Jing An, Zhen-Xing Chu, Xin-Ru Li, An-Yang Hou, Yong-Jun Jiang, Qing-Hai Hu","doi":"10.1186/s12916-025-04131-w","DOIUrl":"10.1186/s12916-025-04131-w","url":null,"abstract":"<p><strong>Background: </strong>Human papillomavirus (HPV) testing on self-collected samples (self-sampling) can address the challenges with facility-sampling among men who have sex with men (MSM). However, its cost-effectiveness and effective combination with vaccination must be evaluated, particularly in the absence of national HPV vaccination immunization programs among men.</p><p><strong>Methods: </strong>We constructed a decision-analytic Markov model to assess the cost-effectiveness of the status quo, HPV self-sampling at different intervals, vaccination alone, and HPV self-sampling-vaccination combination based on the incremental cost-effectiveness ratio (ICER), from a healthcare system perspective. Univariate and probabilistic sensitivity analyses were conducted to evaluate the robustness of the proposed model.</p><p><strong>Results: </strong>A lifetime cost-effectiveness analysis on a hypothetical cohort comprising 100,000 MSM aged 12 years at baseline projected that combining screening and vaccination generated incremental costs of US$49,638-219,213 million while accruing 189,881-271,564 quality-adjusted life-years (QALYs) compared with the status quo. Incorporating HPV self-sampling significantly improved the cost-effectiveness of traditional interventions. Remarkably, combining annual HPV self-sampling with nine-valent vaccination proved the most cost-effective at a willingness-to-pay (WTP) threshold three times the Chinese per-capita gross domestic product (GDP). This strategy yielded an ICER of $775 per QALY compared to the status quo and was 55.7% possible to be cost-effective with a WTP threshold three times the per-capita GDP, outperforming other strategies.</p><p><strong>Conclusions: </strong>Implementing annual HPV self-sampling along with nine-valent vaccination is projected to be the most cost-effective among MSM in China. Reducing the costs of HPV self-sampling and vaccination is crucial for guaranteeing that future initiatives produce favorable economic outcomes. These findings provide valuable guidance for formulating policies on HPV prevention among MSM in China.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"362"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12217994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538781","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}