BMC Medicine最新文献

{"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":"Associations and mediators of estimated sodium intake with cardiovascular mortality: data based on a national population cohort.","authors":"Yuan Tian, Chunying Lin, Hui Zhong, Chaoqun Wu, Yi Wu, Bowang Chen, Xiaoyan Zhang, Xueke Bai, Yang Yang, Yanping Wang, Libo Hou, Jianlan Cui, Wei Xu, Lijuan Song, Hao Yang, Wenyan He, Yan Zhang, Weili Zhang, Haibo Zhang, Xi Li, Shengshou Hu","doi":"10.1186/s12916-025-04206-8","DOIUrl":"10.1186/s12916-025-04206-8","url":null,"abstract":"<p><strong>Background: </strong>The current research on the association of sodium excretion with health outcomes is inconclusive, despite its linear relationship with blood pressure. Moreover, there is a lack of evidence regarding sodium intake. This study aims to estimate sodium intake, examine its associations with mortality, and explore potential factors that may mediate these associations.</p><p><strong>Methods: </strong>Based on a nationwide community-based population cohort in China that covered 215 counties from 31 provinces, we collected fasting morning urine from 270,991 participants aged 35-75 years during Dec 2015 and Dec 2019. We calculated 24-h urinary sodium excretion using the Kawasaki formula, and estimated daily sodium intake by adjusting for sweat excretion based on a model with ambient temperature. We fitted Cox regression models to examine its independent hazard ratios (HR) and 95% confidence intervals (CI) on mortality, and assessed the causal mediation effects of metabolic factors.</p><p><strong>Results: </strong>Among the included participants with an average age of 56 years, the mean of estimated daily sodium intake was 222.9 ± 71.0 mmol. Sodium intake was lower in elderly and women, but higher in participants living in the north or rural areas (P < 0.001 for both). In participants without antihypertensive treatment, blood pressure was positively related to sodium intake (4.14/1.58 mmHg per 100 mmol/day, P < 0.001). Compared with participants in the quintile 3 of sodium intake (i.e., 200.8-235.1 mmol/day), those in the quintile 1 (i.e., < 163.5 mmol/day) had an adjusted HR of 1.17 (95% CI: 1.05-1.30) for cardiovascular mortality, after adjusting for demographic, socioeconomic, behavioural, and clinical characteristics, as well as urinary potassium, with heart rate (29.4%) and blood glucose (18.5%) as major significant mediators. In the meantime, participants in the quintile 5 (i.e., > 278.8 mmol/day) had an adjusted HR of 1.18 (95% CI: 1.05-1.32), with systolic blood pressure (24.6%) and body mass index (2.4%) playing substantial mediating effects.</p><p><strong>Conclusions: </strong>Both high and low sodium intake are associated with increased cardiovascular mortality. The lowest risk is observed at an estimated sodium intake of 200.8-235.1 mmol/day (equivalent to 4.6-5.4 g/day). Mediation analysis suggests that blood pressure, heart rate and glycaemic disorders could be plausible explanations for this U-shaped association.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"392"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12220591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538776","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":"Brain state dynamics and working memory in patients with schizophrenia and unaffected siblings.","authors":"Feiwen Wang, Jie Yang, Jun Yang, Peng Cheng, Wenjian Tan, Danqing Huang, Maoxing Zhong, Xiawei Liu, Weiqing Huang, Zhening Liu, Lena Palaniyappan","doi":"10.1186/s12916-025-04216-6","DOIUrl":"10.1186/s12916-025-04216-6","url":null,"abstract":"<p><strong>Background: </strong>Working memory (WM) deficits are a key feature of schizophrenia and are also seen in unaffected siblings. These deficits might arise  from disrupted transitions from one brain state to another. Using a robust algorithm called the Bayesian Switching Dynamical System (BSDS), we studied hidden brain states and their transitions during a WM task in people with schizophrenia.</p><p><strong>Methods: </strong>We used BSDS to identify brain states based on regions of interest (ROIs) within the default mode network and the frontoparietal network in 161 patients with schizophrenia, 37 unaffected siblings, and 96 healthy controls during N-back (0, 2, and resting fixation) tasks. We estimated group differences in the properties of brain states and studied the influence of WM performance and clinical characteristics on them using General Linear Models.</p><p><strong>Results: </strong>We identified 4 brain states underlying the WM task: high-demand, low-demand, fixation, and non-dominant states. Compared with controls and siblings, patients showed reduced occupancy and lifetime of high-demand state during the \"2-back,\" reduced lifetime of low-demand state during the \"0-back,\" but increased occupancy and lifetime of fixation state during both task periods. Aberrant high-demand state mediated the association between WM performance and negative symptoms. Compared with controls and patients, siblings showed increased occupancy of high-demand and reduced fixation state during the resting fixation condition; this putative compensatory process correlated with better WM performance.</p><p><strong>Conclusions: </strong>Latent brain states of intrinsic connectivity that represent internal mental processes affect WM performance, influencing the expression of negative symptoms in schizophrenia and cognitive resilience in unaffected siblings.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"376"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12220267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538777","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":"Cross-national differences in the association between estimated cardiorespiratory fitness and depressive symptoms among older adults: findings from three nationwide cohort studies.","authors":"Xue He, Cong Li, GuangYao Hua, Yan Wang, Lijun Zhang, Chingyu Cheng, Jinghua Jiao, Honghua Yu, Xiaohong Yang, Lei Liu","doi":"10.1186/s12916-025-04175-y","DOIUrl":"10.1186/s12916-025-04175-y","url":null,"abstract":"<p><strong>Background: </strong>Cardiorespiratory fitness (CRF) is a modifiable risk factor for chronic diseases, but its association with depressive symptoms remains unclear, particularly across different populations. We aimed to investigate the link between estimated CRF (eCRF) and incident depressive symptoms among individuals over 50 years old, and to explore potential cross-country variations in this association.</p><p><strong>Methods: </strong>Data were retrieved from three national cohorts: the Health and Retirement Study (HRS, United States), the English Longitudinal Study of Ageing (ELSA, England), and the China Health and Retirement Longitudinal Study (CHARLS, China). eCRF was estimated using sex-specific algorithms and categorized into low (quintiles 1), moderate (quintiles 2-3), and high (quintiles 4-5) levels. Depressive symptoms were measured using the 8-item Center for Epidemiological Studies Depression Scale (CESD-8) (cutoff ≥ 3) in HRS and ELSA, and the 10-item version (CESD-10) (cutoff ≥ 10) in CHARLS. Cox proportional hazard models estimated hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for potential confounders.</p><p><strong>Results: </strong>This study included 13,680 participants (4195 from HRS, 5421 from ELSA, and 4064 from CHARLS) with median follow-ups of 9.78, 12.11, and 5.73 years, respectively. Depressive symptoms incidence was 22.79% in HRS, 22.15% in ELSA, and 40.58% in CHARLS. Per 1-SD increase in eCRF was associated with 9% lower risk of depressive symptoms in HRS (HR = 0.91; 95% CI, 0.87-0.96), 8% lower in ELSA (HR = 0.92; 95% CI, 0.87-0.97), but 6% higher in CHARLS (HR = 1.06; 95% CI, 1.01-1.16). Compared with the low eCRF level group, high eCRF level was associated with decreased risk of depressive symptoms in HRS (HR = 0.69; 95% CI, 0.55-0.85) and ELSA (HR = 0.62; 95% CI, 0.48-0.79), but increased risk in CHARLS (HR = 1.27; 95% CI, 1.01-1.61). Subgroup analyses revealed that the associations were modified by smoking status (HRS), by gender and presence of diabetes (ELSA), and by the presence of hypertension (CHARLS) (P for interaction < 0.05).</p><p><strong>Conclusions: </strong>A higher level of eCRF was associated with reduced depressive symptoms risk in the US (HRS) and England (ELSA) older adults but with increased risk in China (CHARLS), emphasizing the need for nation-specific public health strategies.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"363"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12220467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538841","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":"Disability in mitochondrial aerobic metabolism and Mg²⁺ transport: linking biomarkers and mechanisms of ischemic heart disease to diesel particulate matter exposure.","authors":"Ze Zhang, Gan Miao, Juan Ma, Ziyuan Li, Chuer Zheng, Jian Ding, Hao Yin, Xiangcheng Cui, Shoujie Dai, Rifat Zubair Ahmed, Yong Niu, Shanfa Yu, Xiaoting Jin, Yuxin Zheng","doi":"10.1186/s12916-025-04212-w","DOIUrl":"10.1186/s12916-025-04212-w","url":null,"abstract":"<p><strong>Background: </strong>Ischemic heart disease (IHD) is a major cardiovascular health concern. In addition to metabolic and behavioral risks, diesel particulate matter (DPM), with a widely exposed population, is an important external environmental risk factor for IHD. However, the effect biomarkers used to diagnose DPM-caused IHD and underlying mechanisms remain unknown. We investigated the biomarkers and underlying mechanisms of DPM in relation to myocardial hypoxia injury.</p><p><strong>Methods: </strong>This study applied a unique population of diesel engine testers with stable DPM exposure. Electrocardiogram examination, echocardiogram examination, serum levels of myocardial enzymes, and 6-min walking test were used for the myocardial risks assessment. A mouse model exposed to occupational environmental DPM dose and in vitro models of DPM-induced myocardial hypoxia injury were used for assessment of mitochondrial aerobic metabolism via the oxygraph-2k system, western blotting, and kits. Ion fluorescence probes, ion supplements, and mitochondrial RNA splicing protein 2 (Mrs2) overexpression transfection were used in further investigations and verifications of the mechanism of mitochondrial Mg²⁺ deficiency.</p><p><strong>Results: </strong>We identified compromised myocardial mitochondrial aerobic metabolism as a precursor biomarker for the cardiac risk of myocardial hypertrophy and hypoxia injury in DPM exposure. DPM induce mitochondrial Mg²⁺ deficiency of cardiomyocytes, which in turn disrupt the mitochondrial aerobic metabolism processes, including the tricarboxylic acid cycle, oxidative phosphorylation, and ATP synthesis. Mg²⁺ deficiency is mediated by the disruption of Mg²⁺ transport proteins, such as DPM-enhanced hyperubiquitination and degradation of Mrs2, a protein responsible for mitochondrial Mg²⁺ uptake.</p><p><strong>Conclusions: </strong>Our findings show that compromised mitochondrial aerobic metabolism, associated with Mg²⁺ deficiency, serves as a critical biomarker for DPM-induced IHD and represents a promising investigative avenue for intervention.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"379"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12218838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538844","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":"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":"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":8.3,"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":"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}