BMC Medicine最新文献

{"title":"Azithromycin in severe malaria bacterial co-infection in African children (TABS-PKPD): a phase II randomised controlled trial.","authors":"Roisin Connon, Peter Olupot-Olupot, Arthur M A Pistorius, William Okiror, Tonny Ssenyondo, Rita Muhindo, Sophie Uyoga, Ayub Mpoya, Thomas N Williams, Diana M Gibb, A Sarah Walker, Rob Ter Heine, Elizabeth C George, Kathryn Maitland","doi":"10.1186/s12916-024-03712-5","DOIUrl":"10.1186/s12916-024-03712-5","url":null,"abstract":"<p><strong>Background: </strong>African children with severe malaria are at increased risk of non-typhoidal salmonellae co-infection. Broad-spectrum antibiotics are recommended by guidelines but the optimal class and dose have not been established. We investigated the optimal dose of oral dispersible azithromycin and whether simple clinical criteria and point-of-care biomarkers could target antibiotics to those at greatest risk of bacterial co-infection.</p><p><strong>Methods: </strong>We conducted a phase I/II trial in Ugandan children with severe malaria comparing a 5-day course of azithromycin: 10, 15 and 20 mg/kg of azithromycin (prescribed by weight bands) spanning the dose-range effective for other salmonellae infection. We generated relevant pharmacokinetic (PK) data by sparse sampling during dosing intervals and investigated associations between azithromycin exposure and potential mechanisms (PK-pharmacodynamics) using change in C-reactive protein (CRP), a putative marker of sepsis, at 72 h (continuous) and microbiological cure (7-day) (binary), alone and as a composite with 7-day and 90-day survival. To assess whether clinical or biomarkers could identify those at risk of sepsis, a non-severe malaria control was concurrently enrolled.</p><p><strong>Results: </strong>Between January 2020 and January 2022, 105 cases were randomised azithromycin doses: 35 to 10 mg/kg, 35 to 15 mg/kg and 35 to 20 mg/kg. Fifty non-severe malaria controls were concurrently enrolled. CRP reduced in all arms by 72 h with a mean reduction of 65.8 mg/L (95% CI 57.1, 74.5) in the 10 mg/kg arm, 64.8 mg/L (95% CI 56.5, 73.1; p = 0.87) in the 20 mg/kg arm and a smaller reduction 51.2 mg/L (95% CI 42.9, 59.5; p = 0.02) in the 15 mg/kg arm. Microbiological cure alone outcome was not analysed as only one pathogen was found among cases. Three events contributed to the composite outcome of 7-day survival and microbiological cure, with no events in the 15 mg/kg arm. The odds ratio comparing 20 vs 10 mg/kg was 0.50 (95% CI 0.04, 5.79); p = 0.58. Due to the low number of pathogens identified, it was not possible to identify better methods for targeting antibiotics including both the cases and controls.</p><p><strong>Conclusions: </strong>We found no evidence for an association between systemic azithromycin exposure and reduction in CRP. Further work is needed to better identify children at highest risk from bacterial co-infection.</p><p><strong>Trial registration: </strong>ISRCTN49726849 (registered on 27th October 2017).</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"22 1","pages":"516"},"PeriodicalIF":7.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11542398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589671","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":"\"If government is saying the regulations are important, they should be putting in funding to back it up.\"- An in-depth analysis of local authority officers' perspectives of the Food (Promotion and Placement) (England) Regulations 2021.","authors":"Preeti Dhuria, Sarah Muir, Sarah Jenner, Emma Roe, Wendy Lawrence, Janis Baird, Christina Vogel","doi":"10.1186/s12916-024-03720-5","DOIUrl":"10.1186/s12916-024-03720-5","url":null,"abstract":"<p><strong>Background: </strong>As part of the UK government's obesity strategy, the Food (Promotion and Placement) (England) Regulations 2021 were implemented in October 2022 to restrict the prominent placement of products high in fat, sugar, or salt (HFSS) in most retail settings. Local authority (LA) officers have been tasked with enforcement of these regulations. This qualitative study examined the perspectives of LA officers including, trading standards, environmental health, and public health officers to understand enforcement approaches and requirements to optimise business compliance with the regulations.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted via MS Teams with a purposive sample of LA officers across England. Data were analysed using inductive thematic analysis.</p><p><strong>Results: </strong>The 22 participants comprised 13 officers from Trading Standards, six from Environmental Health, and three from Public Health teams. The key messages include the following: (i) the regulations are complex and do not align with existing enforcement approaches, (ii) officers' professional background will result in variable enforcement practices, and (iii) compliance assessment is an arduous task. LAs are facing resource and workforce constraints and have to prioritise regulations addressing high health risks (e.g., allergens). Therefore, officers will mostly apply a light touch approach to enforcement, raising awareness and engaging with businesses rather than issuing notices. To develop a consistent enforcement approach across LAs, officers asked for (i) further leadership from central government in the form of funding, training, and tools to determine in-scope businesses and products, (ii) cross-departmental collaboration to raise the regulations' priority at local and regional levels, and (iii) greater consumer demand for healthier retail environments.</p><p><strong>Conclusion: </strong>It is crucial to address both structural challenges such as resource allocation, workforce, and prioritisation issues as well as the inherent complexity of the regulations to strengthen enforcement efforts. Our findings highlight the necessity of supporting enforcement activities at national and regional government levels to avoid potential false conclusions about ineffectiveness of regulations.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"22 1","pages":"514"},"PeriodicalIF":7.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11539601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589599","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":"Western diet promotes endometriotic lesion growth in mice and induces depletion of Akkermansia muciniphila in intestinal microbiota.","authors":"Guillaume Parpex, Benoît Chassaing, Mathilde Bourdon, Pietro Santulli, Ludivine Doridot, Marine Thomas, Frédéric Batteux, Sandrine Chouzenoux, Charles Chapron, Carole Nicco, Louis Marcellin","doi":"10.1186/s12916-024-03738-9","DOIUrl":"10.1186/s12916-024-03738-9","url":null,"abstract":"<p><strong>Background: </strong>Endometriosis, affecting 10% of women in their reproductive years, remains poorly understood. Both individual and environmental unexplained factors are implicated in this heterogenous condition. This study aims to examine the influence of a Western diet on endometriosis lesion development in mice and to uncover the mechanisms involved.</p><p><strong>Methods: </strong>Mice were fed either a control diet or a Western diet (high in fatty acids and low in fiber) for 4 weeks. Endometriosis was then surgically induced, and lesion development was monitored by ultrasound. After 7 weeks, the mice were sacrificed for analysis of lesion characteristics through RT-qPCR, immunohistochemistry, and flow cytometry. Additionally, the intestinal microbiota was assessed using 16S rRNA gene sequencing.</p><p><strong>Results: </strong>Mice on the Western diet developed lesions that were significantly twice as large compared to those on the control diet. These lesions exhibited greater fibrosis and proliferation, alongside enhanced macrophage activity and leptin pathway expression. Changes in the intestinal microbiota were significantly noted after endometriosis induction, regardless of diet. Notably, mice on the Western diet with the most substantial lesions showed a loss of Akkermansia Muciniphila in their intestinal microbiota.</p><p><strong>Conclusions: </strong>A Western diet significantly exacerbates lesion size in a mouse model of endometriosis, accompanied by metabolic and immune alterations. The onset of endometriosis also leads to substantial shifts in intestinal microbiota, suggesting a potential link between diet, intestinal health, and endometriosis development.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"22 1","pages":"513"},"PeriodicalIF":7.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11539706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581579","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":"METTL3 facilitates kidney injury through promoting IRF4-mediated plasma cell infiltration via an m6A-dependent manner in systemic lupus erythematosus.","authors":"Yu Liu, Xiaohua Wang, Mingcheng Huang, Ailing Luo, Shanshan Liu, Mansi Cai, Weinian Li, Shiwen Yuan, Zhihua Zheng, Xiaoping Liu, Chun Tang","doi":"10.1186/s12916-024-03735-y","DOIUrl":"10.1186/s12916-024-03735-y","url":null,"abstract":"<p><strong>Background: </strong>Systemic lupus erythematosus (SLE) is an autoimmune disease of unknown cause. N6-methyladenosine (m6A) is the most common mRNA modification and participates in various immune processes such as interferon production and immune cell regulation. However, the role of m6A in dysregulated immune response of SLE remains unknown.</p><p><strong>Methods: </strong>PBMCs from SLE patients were collected to compare the m6A modification profile by methylated RNA immunoprecipitation sequencing (MeRIP-seq). Interferon regulatory factor 4 (IRF4) was identified by combination with MeRIP-seq and RNA-Seq. IRF4 and methyltransferase 3 (METTL3) were detected using qRT-PCR and WB. Clinical significance of IRF4 in SLE patients was explored subsequently. IRF4 expression in B cell subsets of female MRL/lpr mice was detected by flow cytometry. Adeno-associated viruses (AAV) including AAV9-METTL3-OE and/or AAV9-IRF4-sh were treated with female MRL/lpr mice. Autoantibody levels and kidney injury were tested by ELISA, pathological staining, and immunofluorescence. m6A level of IRF4 was detected by MeRIP-qPCR. The downstream effectors of IRF4 contributing to renal pathology were explored by RNA-seq and verified by qRT-PCR.</p><p><strong>Results: </strong>m6A methylation features were obviously aberrant in SLE patients, and IRF4 was the upregulated gene modified by m6A. METTL3 and IRF4 expressions were elevated in SLE patients and kidney of MRL/lpr mice. Clinical analysis indicated that SLE patients with high IRF4 level were more prone to kidney damage. IRF4 expression was especially increased in plasma cells of MRL/lpr mice. METTL3 induced renal IRF4 expression, plasma creatinine, ANA and urine ALB levels, IgG and C3 deposition, and renal damage and plasma cell infiltration were aggravated in MRL/lpr mice. However, IRF4 depletion could partially reduce METTL3-induced kidney damage. Meanwhile, m6A level of IRF4 elevated with METTL3 overexpression. Also, the expression of Cxcl1, Bcl3, and Fos mRNA were significantly reduced after knockdown of IRF4, which were mainly involved in TNF signaling pathway.</p><p><strong>Conclusions: </strong>Our study confirmed that upregulated METTL3 promoting IRF4 expression in an m6A-dependent manner, thus causing plasma cell infiltration-mediated kidney damage of SLE. This provides new evidence for the role of m6A in SLE kidney injury.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"22 1","pages":"511"},"PeriodicalIF":7.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11539763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581482","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":"Identification of sensitive periods of weight status transition over the lifespan in Chinese population.","authors":"Chaonan Gao, Xin Meng, Wei Liu, Qianjin Qi, Yinkun Yan","doi":"10.1186/s12916-024-03721-4","DOIUrl":"10.1186/s12916-024-03721-4","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of high body mass index (BMI) is increasing in both children and adults worldwide. However, it is unclear whether vulnerabilities to maintenance and transition of weight status vary throughout the lifespan.</p><p><strong>Objective: </strong>We aimed to characterize dynamic transitions of weight statuses across different life stages and to identify the sensitive periods for maintenance, onset, and resolution of obesity.</p><p><strong>Methods: </strong>This longitudinal study included a total of 23,179 participants aged 6-80 years with 95,994 BMI measurements from the China Health and Nutrition Survey 1989-2015. To examine the heterogeneity in transitions of weight statuses across different life stages, we divided participants into 8 sub-cohorts based on baseline ages by 10-year intervals, i.e., 6-10 years, 11-20 years, 21-30 years, 31-40 years, 41-50 years, 51-60 years, 61-70 years, and 71-80 years. We estimated the probabilities of transitioning between weight statuses at a given follow-up year by baseline age using generalized linear mixed-effects models.</p><p><strong>Results: </strong>The predicted prevalence of obesity decreased from 6 years, bottomed at around 20 years, increased thereafter, peaked at around 55 years, and then decreased gradually. In general, participants with underweight had lower probabilities of maintaining the same status compared to those with normal weight, overweight, or obesity for all age groups. For 10-year follow-up, individuals aged 21-30 years had the highest probabilities of transitioning from normal weight to obesity and transitioning from overweight to obesity compared to those in other age groups. Individuals aged 6-20 years had the highest probabilities of transitioning from obesity to normal weight and transitioning from overweight to normal weight. Individuals in all adult age groups had higher probabilities of maintaining obesity status than children and adolescents.</p><p><strong>Conclusions: </strong>Young adulthood is the most sensitive period for obesity onset, whereas childhood and adolescence are the most sensitive periods for obesity resolution. The findings suggest the heterogeneity of susceptibilities to weight status transitions across different life stages and highlight the importance of the development of age-appropriate approaches for the prevention and intervention of obesity.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"22 1","pages":"507"},"PeriodicalIF":7.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581465","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":"Twenty-year trend in the prevalence of increased cardiometabolic risk, measured by abdominal obesity, among Spanish children and adolescents across body mass index categories.","authors":"Helmut Schröder, Charlotte Juton, Michael I Goran, Julia Wärnberg, Maddi Osés, Marcela Gonzalez-Gross, Narcis Gusi, Susana Aznar, Elena Marín-Cascales, Miguel González-Valeiro, Estefanía Herrera-Ramos, Nicolás Terrados, Josep A Tur, Marta Segú, Montserrat Fitó, Lourdes Ribas-Barba, Inmaculada Bautista-Castaño, Luis Peña-Quintana, Paula Berruezo, Juan Carlos Benavente-Marín, Idoia Labayen, Augusto G Zapico, Jesús Sánchez-Gómez, Fabio Jiménez-Zazo, Pedro E Alcaraz, Marta Sevilla-Sanchez, Susana Pulgar, Cristina Bouzas, Lluis Serra-Majem, Santiago F Gómez","doi":"10.1186/s12916-024-03719-y","DOIUrl":"10.1186/s12916-024-03719-y","url":null,"abstract":"<p><strong>Background: </strong>Identifying children and adolescents with cardiometabolic risk at an early stage is crucial for effective treatment and prevention. From a practical perspective, this could be accomplished by assessing the presence of abdominal obesity, which serves as a surrogate indicator of increased cardiometabolic risk and is easy to measure. However, the assessment of abdominal obesity via waist circumference has not yet become a standard procedure in pediatric healthcare. The present study aimed to analyze the secular trends in increased cardiometabolic risk, as indicated by waist circumference among Spanish children and adolescents.</p><p><strong>Methods: </strong>This study included 4861 children and adolescents aged 8 to 16 years from two nationwide representative cross-sectional surveys, the EnKid study and the PASOS study, conducted in 1998-2000 and 2019-2020, respectively. Anthropometric variables were measured in both surveys by trained personnel. Three different waist-to-height (WHtR) cutoffs were used to define abdominal obesity as criteria for cardiometabolic risk. BMI categories were defined according to the IOTF and WHO growth charts.</p><p><strong>Results: </strong>Abdominal obesity [waist to height ratio (cm/cm) > 0.49] significantly increased from 40.7 to 56.1% and 93.8 to 97.2% in participants with overweight and obesity, respectively, between 1998-2000 and 2019-2020 (p < 0.05). Logistic regression analysis, adjusted for sex and age, revealed that the odds of being at increased cardiometabolic risk in 2019-2020 was 1.99 (95% CI 1.48-2.67) in participants with overweight in comparison with 1998-2000. The effect size was comparable among the three WHtR criteria for abdominal obesity or the BMI categories according to IOTF and WHO boundaries.</p><p><strong>Conclusions: </strong>The prevalence of Spanish children with increased cardiometabolic risk, identified by abdominal obesity, significantly increased among those with overweight during the last two decades. This finding underlines the need of including the measurement of waist circumference as a standard procedure in pediatric practice.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"22 1","pages":"509"},"PeriodicalIF":7.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11539305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581557","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":"BMI trajectories from birth to young adulthood associate with distinct cardiometabolic profiles.","authors":"Gang Wang, Dang Wei, Simon Kebede Merid, Sandra Ekström, Susanna Klevebro, Natalia Hernandez-Pacheco, Sophia Björkander, Petter Ljungman, Inger Kull, Jochen M Schwenk, Anna Bergström, Erik Melén","doi":"10.1186/s12916-024-03741-0","DOIUrl":"10.1186/s12916-024-03741-0","url":null,"abstract":"<p><strong>Background: </strong>Numerous studies have investigated links between body mass index (BMI) trajectories and cardiovascular risk, yet discrepancies in BMI measurement duration and timing of the cardiovascular-related outcome evaluation have led to inconsistent findings.</p><p><strong>Methods: </strong>We included participants from the Swedish birth cohort (BAMSE) and applied latent class mixture modeling to identify BMI trajectories using data of multiple BMI measures (≥ 4 times) from birth until 24-year follow-up (n = 3204). Subsequently, we analyzed the associations of BMI trajectories with lipids (n = 1974), blood pressure (n = 2022), HbA1c (n = 941), and blood leukocytes (n = 1973) using linear regression. We also investigated the circulating levels of 92 inflammation-related proteins (n = 1866) across BMI trajectories.</p><p><strong>Results: </strong>Six distinct BMI groups were identified, denoted as increasing-persistent high (n = 74; 2.3%), high-accelerated increasing (n = 209; 6.5%), increasing-accelerated resolving (n = 142; 4.4%), normal-above normal (n = 721; 22.5%), stable normal (n = 1608; 50.2%), and decreasing-persistent low (n = 450; 14.1%) BMI groups. The increasing-persistent high and high-accelerated increasing BMI groups had higher levels of total cholesterol [mean difference (95% confidence intervals): 0.30 (0.04-0.56) and 0.16 (0.02-0.31) mmol/L], triglyceride, low-density lipoprotein, hemoglobin A1C [3.61 (2.17-5.54) and 1.18 (0.40-1.98) mmol/mol], and low-density lipoprotein/high-density lipoprotein ratios, but a lower level of high-density lipoprotein than the stable normal BMI group. These two groups also had higher leukocyte cell counts and higher circulating levels of 28 inflammation-related proteins. No increased cardiometabolic markers were observed in the increasing-accelerated resolving BMI group.</p><p><strong>Conclusions: </strong>Participants with persistently high or accelerated increasing BMI trajectories from birth to young adulthood have elevated levels of cardiometabolic risk markers at young adulthood than those with stable normal BMI. However, a raised BMI in childhood may not be inherently harmful to cardiometabolic health, provided it does not persist into adulthood.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"22 1","pages":"510"},"PeriodicalIF":7.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11539615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581458","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":"How does surgery influence female sexuality in patients with endometriosis compared to those with other benign gynecological conditions?","authors":"Alexandra Perricos, Manuela Gstoettner, Sahra Iklil, Florian Heinzl, Lejla Sandrieser, Jana Heine, Heinrich Husslein, Lorenz Kuessel, Christine Bekos, René Wenzl","doi":"10.1186/s12916-024-03733-0","DOIUrl":"10.1186/s12916-024-03733-0","url":null,"abstract":"<p><strong>Background: </strong>Endometriosis is a chronic, estrogen-dependent, benign condition, affecting 10-15% of women of reproductive age. It is associated with a prevalence of sexual dysfunction that is nearly twice as high as that seen in women with other benign gynecological conditions. Our study aimed to assess the effect of surgical intervention on sexual function, as measured by the FSFI (Female Sexual Function Index) score, in women with endometriosis compared to those with other benign gynecological conditions, both before and after surgery.</p><p><strong>Methods: </strong>A comparative analysis was conducted at the Medical University of Vienna from 2015 to 2020. The study included patients suspected of having endometriosis, fibroids, adnexal cysts, and/or infertility. Based on findings during surgery, patients were categorized into two groups: those with endometriosis (n = 64) and control patients (n = 38). All participants completed the FSFI questionnaire before surgery and again 8 to 18 weeks after the operation.</p><p><strong>Results: </strong>No significant differences were observed in the preoperative FSFI scores between the endometriosis patients and the control group. Similarly, no significant differences were found between the two groups in postoperative scores. However, in women diagnosed with endometriosis, surgical removal of endometriotic lesions significantly increased their full-scale FSFI score, and resulted in a significant improvement in the areas \"desire\" and \"satisfaction\". Improvements were noted in all other areas as well, though they were not statistically significant.</p><p><strong>Conclusions: </strong>Our research indicates that the surgical removal of endometriotic lesions can lead to an improvement in sexual function, as measured by the FSFI, within 8 to 18 weeks post-surgery. This improvement was not observed in the control group, which underwent surgery for other benign gynecological issues.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"22 1","pages":"508"},"PeriodicalIF":7.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581464","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":"General health and social outcomes 50 years after exposure to antenatal betamethasone: follow-up of a randomised controlled trial.","authors":"Anthony G B Walters, Greg D Gamble, Caroline A Crowther, Stuart R Dalziel, Carl L Eagleton, Christopher J D McKinlay, Barry J Milne, Jane E Harding","doi":"10.1186/s12916-024-03732-1","DOIUrl":"10.1186/s12916-024-03732-1","url":null,"abstract":"<p><strong>Background: </strong>Antenatal corticosteroids are recommended for women at risk of preterm birth from 24 to 34 weeks' gestation as they reduce neonatal morbidity and mortality, but evidence regarding their long-term effects on offspring is limited. This study assessed general health and social outcomes 50 years after antenatal exposure to corticosteroids.</p><p><strong>Methods: </strong>We assessed 424 adult offspring of women who participated in the first randomised, double-blind, placebo-controlled trial of antenatal betamethasone for the prevention of neonatal respiratory distress syndrome. The first 717 mothers received two intramuscular injections of betamethasone (6 mg betamethasone sodium phosphate and 6 mg betamethasone acetate) or placebo given 24 h apart and the subsequent 398 received two injections of double dose betamethasone (12 mg betamethasone sodium phosphate and 12 mg betamethasone acetate) or equivalent volume of placebo. Follow-up included a health questionnaire and consent for access to administrative data sources. Outcome categories included mental health (depression, anxiety, bipolar affective disorder, schizophrenia and treatment or hospital admission for any mental health disorder), general health (chronic kidney disease, cancer diagnosis, bone fracture, oral health, allergies, functional difficulties and physical activity) and social outcomes (educational attainment, employment and criminal convictions). Investigators remained blinded to treatment allocation. Analyses were adjusted for gestational age at entry, sex and clustering.</p><p><strong>Results: </strong>We assessed 424 adult offspring (46% of survivors; mean [SD] age 49.3 [1.0] years; 212 [50%] female). There was no difference in mental health, general health and social outcomes between those exposed to betamethasone and those exposed to placebo, with the exception that osteoporotic site fracture in adulthood was more likely to have occurred in the betamethasone group compared with placebo (adjusted relative risk 1.57, 95% CI 1.00, 2.48, p = 0.05). No dose-effect relationship was evident and there was no difference in the proportion with at least one fracture. Follow-up rate and lack of in-person assessments were the main limitations.</p><p><strong>Conclusions: </strong>There is no evidence that antenatal corticosteroids have clinically important effects on general health and social outcomes up to 50 years of age.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"22 1","pages":"505"},"PeriodicalIF":7.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11533403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575337","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":"Mortality from external causes in late adolescence and early adulthood by gestational age and sex: a population-based cohort study in four Nordic countries.","authors":"Josephine Funck Bilsteen, Signe Opdahl, Anna Pulakka, Per Ivar Finseth, Weiyao Yin, Kristine Pape, Jorun Schei, Johanna Metsälä, Anne-Marie Nybo Andersen, Sven Sandin, Eero Kajantie, Kari Risnes","doi":"10.1186/s12916-024-03731-2","DOIUrl":"10.1186/s12916-024-03731-2","url":null,"abstract":"<p><strong>Background: </strong>External causes of death, such as accidents, substance use, and suicide, contribute substantially to mortality during adolescence and early adulthood and show marked sex differences. Individuals born preterm are at increased risk of mental disorders, and impaired cognitive and executive functions, potentially increasing their vulnerability to death from external causes. We investigated sex-specific associations between gestational age at birth and mortality from external causes during late adolescence and early adulthood.</p><p><strong>Methods: </strong>Individual level data from national health registries in Denmark (1978-2001), Finland (1987-2003), Norway (1967-2002), and Sweden (1974-2001) were linked to form nationwide cohorts. In total, 6,924,697 participants were followed from age 15 years to a maximum of 50 years in 2016-2018. Gestational age was categorized as \"very/moderately preterm\" (23-33 weeks), \"late preterm\" (34-36 weeks), \"early term\" (37-38 weeks), \"full term\" (39-41 weeks), and \"post term\" (42-44 weeks). Outcomes were mortality from external causes overall and from the largest subgroups transport accidents, suicide, and drugs or alcohol. We estimated sex-specific hazard ratios (HRs), with full term as the reference, and pooled each country's estimates in meta-analyses.</p><p><strong>Results: </strong>Across gestational ages mortality was higher for males than females. Individuals born very/moderately preterm had higher mortality from external causes, with HRs 1.11 (95% confidence interval [CI] 0.99-1.24) for males and 1.55 (95% CI 1.28-1.88) for females. Corresponding estimates for late preterm born were 1.11 (95% CI 1.04-1.18) and 1.15 (95% CI 1.02-1.29), respectively. Those born very/moderately preterm had higher mortality from transport accidents, but precision was low. For females, suicide mortality was higher following very/moderately preterm birth (HR 1.76, 95% CI 1.34-2.32), but not for males. Mortality from drugs or alcohol was higher in very/moderately and late preterm born males (HRs 1.23 [95% CI 0.99-1.53] and 1.29 [95% CI 1.16-1.45], respectively) and females (HRs 1.53 [95% CI 0.97-2.41] and 1.35 [95% CI 1.07-1.71], respectively, with some heterogeneity across countries).</p><p><strong>Conclusions: </strong>Mortality from external causes overall was higher in preterm than full term born among both males and females. A clear sex difference was seen for suicide, where preterm birth was a risk factor in females, but not in males.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"22 1","pages":"506"},"PeriodicalIF":7.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575344","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}