BMC Medicine最新文献

{"title":"Structural brain differences in school-aged children who are HIV-exposed uninfected.","authors":"Eve A Forster, Bilal Syed, Jennifer Bowes, Julia Young, Cassandra Kapoor, Matt Head, Jason P Lerch, Elka Miller, Jason Brophy, Ari Bitnun, Mary Lou Smith, Lena Serghides, Margot J Taylor, John G Sled","doi":"10.1186/s12916-025-04332-3","DOIUrl":"https://doi.org/10.1186/s12916-025-04332-3","url":null,"abstract":"<p><strong>Background: </strong>Antiretroviral therapy (ART) has dramatically reduced perinatal HIV transmission, leading to a growing population of children who are HIV-exposed but uninfected (CHEU). While the neuroanatomic developmental impacts of in utero HIV and ART exposure have been studied in young children, long-term effects on school-aged children are poorly understood, prompting this investigation.</p><p><strong>Methods: </strong>Fifty-eight CHEU and 38 children who are HIV-unexposed, uninfected (CHUU), 6-12 years old, were recruited through hospitals and community groups in Ontario, Canada. From T1-weighted magnetic resonance images, volume, cortical thickness, and gray-/white-matter tissue volume were extracted. Multiple linear regression models controlling for sex, age, household income, and total brain volume were fit to assess differences by in utero HIV exposure, with additional sex-stratified analyses to uncover sex-specific effects.</p><p><strong>Results: </strong>Compared with CHUU, CHEU showed total brain volumes that were significantly smaller by 49.7cm³ (95% CI [- 95.66, - 3.67]) and cortices thinner by 0.08 mm (95% CI [- 0.13, - 0.02]). In male CHEU, three regions displayed volumetric age-exposure interactions: the bilateral pars opercularis at 0.36 cm³/year (95% CI [0.10, 0.62]), left rolandic operculum at 0.22 cm³/year (95% CI [0.04, 0.39]) and left precentral gyrus at 0.71 cm³/year (95% CI [0.22, 1.21]), suggesting delayed maturation in those regions. Bilateral frontal lobe cortical thickness was reduced by 0.07 mm in CHEU (95% CI [- 0.14, - 0.006]), most pronounced in the left orbital middle frontal gyrus with a reduction of 0.20 mm among male CHEU (95% CI [- 0.32, - 0.07]). An age-exposure interaction of 0.06 cm³/year in bilateral amygdala volume (95% CI [- 0.11, - 0.01]) suggested reduced growth or altered developmental trajectory among CHEU, whereas male CHEU showed bilateral hippocampal volumes diminished by 0.21 cm³ (95% CI [- 0.40, - 0.01]).</p><p><strong>Conclusions: </strong>These findings suggest that in utero HIV and ART exposure have broad neuroanatomic developmental impacts, particularly in boys, with significant differences in brain regions critical for motor function, expressive language, memory, and emotion. These structural differences align with previously reported motor and language deficits and highlight the importance of early intervention and tailored support strategies for CHEU.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"496"},"PeriodicalIF":8.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943132","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":"Fecal microbiota transplantation for refractory chronic graft-versus-host disease after allogeneic hematopoietic cell transplantation: a pilot open-label, non-placebo-controlled study.","authors":"Kaibo Yang, Jing Du, Fen Huang, Yutian Si, Yingying Gu, Na Xu, Zhiping Fan, Rongtao Xue, Pu Wang, Xiang Yao, Hui Liu, Xiaofang Li, Jun Xu, Zhixiang Wang, Jing Sun, Ye Chen, Li Xuan, Qifa Liu","doi":"10.1186/s12916-025-04336-z","DOIUrl":"10.1186/s12916-025-04336-z","url":null,"abstract":"<p><strong>Background: </strong>Dysbiosis of the intestinal microbiota plays a crucial role in the initiation and development of graft-versus-host disease (GVHD). Fecal microbiota transplantation (FMT) has been reported to be effective for refractory acute GVHD; however, whether FMT is effective for refractory chronic GVHD (cGVHD) remains unknown.</p><p><strong>Methods: </strong>To investigate the efficacy and safety of FMT for refractory cGVHD and the underlying mechanism, 12 patients with refractory cGVHD received FMT via colonoscopy, and the response was evaluated at 12 weeks after FMT.</p><p><strong>Results: </strong>Among the 12 patients who underwent FMT, 1 patient achieved a complete response, and 5 patients achieved a partial response. Patients with refractory cGVHD presented lower α diversity and higher abundance of Escherichia-Shigella and Enterobacteriaceae. FMT increased gut microbial diversity, increased the abundance of short-chain fatty acid (SCFA)-producing bacteria, and decreased the abundance of Escherichia-Shigella and Enterobacteriaceae in responder patients. Moreover, it increased SCFA levels in fecal samples from the responder group and promoted the expansion of peripheral CD4⁺CD127^- regulatory T (Treg) cells. Colon pathological examination revealed that CD4⁺ T and CD19⁺ B cell infiltration decreased and that CD4⁺ Treg infiltration increased after FMT.</p><p><strong>Conclusions: </strong>The results of the present study suggest that FMT is feasible and deserves further investigation for use in patients with refractory cGVHD.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT06938165).</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"498"},"PeriodicalIF":8.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The causal effects of remnant cholesterol on increased risk of cardiovascular diseases in East Asians.","authors":"Chenhao Lin, Haolong Wen, Mengyao Yu, Qingxia Huang, Qi Wang, Jinran Lin, Wenjun Yang, Jennifer Ming Jen Wong, Mingfeng Xia, Huiru Tang, Li Jin, Sijia Wang, Xiaofeng Wang, Yuxiang Dai, Guo-Chong Chen, Yan Zheng","doi":"10.1186/s12916-025-04329-y","DOIUrl":"https://doi.org/10.1186/s12916-025-04329-y","url":null,"abstract":"<p><strong>Background: </strong>Remnant cholesterol (RC) has been implicated in cardiovascular diseases (CVDs) in populations of European ancestry, yet its causal role remains underexplored in populations of East Asian ancestry, which are underrepresented in genetic studies. We sought to investigate the causal association between circulating RC levels and CVD risk in East Asian populations.</p><p><strong>Methods: </strong>We first conducted observational analyses of RC and multiple CVD outcomes in Chinese populations. We then conducted genome-wide association studies (GWAS) of RC in 14,939 Chinese individuals and assessed its causal associations with CVD risk using two-sample Mendelian randomization (MR) with Biobank Japan data. Replication analyses in European ancestry populations utilized summary statistics from the UK Biobank and FinnGen.</p><p><strong>Results: </strong>Circulating RC levels were significantly associated with multiple CVD outcomes in Chinese individuals. Our GWAS identified seven significant loci associated with circulating RC levels in the Chinese population. In the MR analyses, we found that genetically predicted higher RC levels were significantly associated with increased risks of aortic aneurysm (odds ratio per standard deviation increase, 1.82; 95% CI, 1.53-2.17; P = 1.17 × 10^-11) and ischemic heart diseases, such as myocardial infarction (1.22, 1.13-1.32; P = 1.81 × 10^-7) and stable angina pectoris (1.17, 1.11-1.23; P = 1.18 × 10^-8). Notably, these associations persisted after adjustment for total cholesterol, low-density and high-density lipoprotein cholesterols, Apolipoprotein A1 and Apolipoprotein B, respectively. Replication in European ancestry populations confirmed consistent causal effects for aortic aneurysm and ischemic heart diseases. A suggestive East Asian-specific association was identified between genetically predicted higher RC levels and an increased risk of peripheral artery disease, whereas a suggestive association with a higher risk of atrial flutter/fibrillation and ventricular arrhythmia was only observed in populations of European ancestry.</p><p><strong>Conclusions: </strong>Our findings establish RC as an independent causal CVD risk factor in East Asian ancestry individuals and highlight population-specific differences in CVD risk profiles, emphasizing the need for ethnicity-tailored prevention strategies.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"495"},"PeriodicalIF":8.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term oncological outcomes of indocyanine green fluorescence imaging-guided laparoscopic lymphadenectomy for gastric cancer: 5-year outcomes from the FUGES-012 randomized clinical trial.","authors":"Qing Zhong, Dong Wu, Zhi-Yu Liu, Zhi-Xin Shang-Guan, Ze-Ning Huang, Zhi-Quan Zhang, Tao-Yuan Qiu, Jun-Yu Chen, Yi-Ming Jiang, Guang-Tan Lin, Yi-Hui Tang, Ping Li, Jian-Wei Xie, Jian-Xian Lin, Chao-Hui Zheng, Qi-Yue Chen, Chang-Ming Huang","doi":"10.1186/s12916-025-04334-1","DOIUrl":"10.1186/s12916-025-04334-1","url":null,"abstract":"<p><strong>Background: </strong>The clinical use of indocyanine green (ICG) in laparoscopic radical gastrectomy for gastric cancer remains at an exploratory stage.</p><p><strong>Methods: </strong>Participants with resectable gastric adenocarcinoma were randomly allocated in a 1:1 ratio. The primary outcome is the number of retrieved lymph nodes (LNs) and has been reported. Herein, we report the 5-year overall survival (OS) rate, 5-year disease-free survival (DFS) rate, and related recurrence patterns.</p><p><strong>Results: </strong>Total 258 patients (ICG group, 129; non-ICG group, 129) were included in the final per-protocol analysis. The 5-year OS and DFS rate of the ICG group were superior to those of the non-ICG group (all log-rank P < 0.05). After a 5-year follow-up, the ICG group had a considerably lower cumulative recurrence rate (26/129, 20.2%) than the non-ICG group (44/129, 34.1%) (Gray's test P = 0.011), with a risk difference of - 0.140. Stratified by recurrence types, the ICG group exhibited a notably lower cumulative incidence of locoregional recurrence in comparison to the non-ICG group (ICG vs. non-ICG: 1.6% vs. 7.8%; risk difference = - 0.062; Gray's test P = 0.019). Dynamic analysis revealed that, in comparison to the ICG group, the non-ICG group had an earlier peak time and higher peak hazard of overall recurrence (ICG vs. non-ICG: peak time: 13.9 vs. 13.1 months; peak hazard: 0.0065 vs. 0.0138). Furthermore, landmark analysis indicated that the early recurrence (within 2 years) rate in the non-ICG group was 26.8%, which was significantly higher than the 13.1% in the ICG group (P = 0.006).</p><p><strong>Conclusions: </strong>ICG-guided lymphadenectomy not only significantly improved the 5-year OS and DFS but also noticeably reduced the cumulative incidence of early recurrence. These findings support the routine use of ICG fluorescence-guided lymphadenectomy in laparoscopic radical gastrectomy.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, NCT03050879.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"497"},"PeriodicalIF":8.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical activity, air pollution, and incident long-term conditions: a prospective cohort study.","authors":"Minshan Huang, Jonathan R Olsen, Stewart G Trost, Carlos Celis-Morales, Jill P Pell, Frederick K Ho","doi":"10.1186/s12916-025-04338-x","DOIUrl":"https://doi.org/10.1186/s12916-025-04338-x","url":null,"abstract":"<p><strong>Background: </strong>Physical activity (PA) is consistently associated with lower risk of long-term conditions. Preliminary evidence suggested the associations could be modified by air pollution. This study aims to examine whether air pollution levels modify the associations of PA with all-cause mortality and incident cancer, major adverse cardiovascular events (MACE), type 2 diabetes, and chronic obstructive pulmonary disease (COPD).</p><p><strong>Methods: </strong>A total of 414,644 UK Biobank participants were included in the analyses. PA was self-reported and objectively measured using accelerometers. PA was self-reported with IPAQ and objectively measured using accelerometers. Annual PM_2.5, PM₁₀, and NO air pollutant concentrations in 2010 were measured using a European land use regression model. Cox proportional hazard models were used to examine the associations of PA and air pollution with health outcomes. Multiplicative and additive interactions were estimated.</p><p><strong>Results: </strong>During the study period from 2006 to 2022, 31,765 (7.7%) died, 70,299 (17.0%) had incident cancer, 25,130 (8.5%) had type 2 diabetes, 33,284 (8.0%) had MACE, and 18,844 (4.5%) had COPD. Lower PA was associated with higher risk of all health outcomes. Higher concentration of PM_2.5 was associated with all outcomes except for cancer. The associations of self-reported PA with mortality and cancer were stronger in areas with higher air pollution with significant additive and multiplicative interactions. There was no evidence of moderation for objectively measured PA.</p><p><strong>Conclusions: </strong>In the UK, air pollution should not be a factor inhibiting the promotion of PA.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"491"},"PeriodicalIF":8.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943038","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":"Basophil-derived exosomes exacerbate systemic lupus erythematosus by regulating B-cell proliferation via miR-24550.","authors":"Jiaxuan Chen, Shuzhen Liao, Jiaqi Lun, Xing Lu, Bitang Huang, Xiaoxian Liu, Xiaowei Xu, Lawei Yang, Fengbiao Guo, Liuyong You, Haiyan Xiao, Hua-Feng Liu, Qingjun Pan","doi":"10.1186/s12916-025-04324-3","DOIUrl":"https://doi.org/10.1186/s12916-025-04324-3","url":null,"abstract":"<p><strong>Background: </strong>Systemic lupus erythematosus (SLE) is a complex autoimmune disease where B-cell proliferation and activation play a pivotal role in pathogenesis. While the role of basophils in SLE is recognized, the impact of basophil-derived exosomes on B-cell proliferation and activation has not been thoroughly investigated.</p><p><strong>Methods: </strong>Exosomes from human basophils in both resting and activated states were isolated and characterized. These exosomes were then co-cultured with B cells to assess their effects on B-cell survival and proliferation. To investigate the in vivo roles, a Pristane-induced lupus model in Mcpt8^{flox/flox CAGGCre-}^ERTM mice was utilized. The Pristane-Mcpt8^{flox/flox, CAGGCre-ERTM} mice were analyzed for basophil-derived exosome accumulation in the spleen and kidneys, and the effects on immune cell proliferation and plasma cell-plasmablast balance were assessed. Transcriptomic analysis was conducted on basophil-derived exosomes to identify key non-coding RNAs. Lupus mice were humanized by transplanting peripheral blood mononuclear cells (PBMCs) from patients with SLE into immunodeficient mice to evaluate the effects of intervening miR-24550 in B cells.</p><p><strong>Results: </strong>Activated basophil-derived exosomes were found to enhance B-cell survival and proliferation in patients with SLE. In the lupus mouse model, basophil-derived exosomes accumulated primarily in the spleen and kidneys, inducing excessive immune cell proliferation and disrupting the plasma cell-plasmablast balance, which worsened kidney damage. Transcriptomic analysis revealed key non-coding RNAs within basophil-derived exosomes. Activated basophil-derived exosomes were internalized by B cells, releasing miR-24550, which promoted B-cell proliferation. In humanized SLE mice, inhibiting miR-24550 in B cells reduced immune hyperactivation and improved renal function, similar to the effects of inhibiting basophil-derived exosomes release in Pristane-Mcpt8^{flox/flox, CAGGCre-ERTM} mice. Ultimately, basophil-derived exosomal miR-24550 promotes B-cell proliferation and activation by targeting Krüppel-like factor 5 (KLF5), which exacerbates SLE progression.</p><p><strong>Conclusions: </strong>Basophil-derived exosomal miR-24550 promotes B-cell proliferation and activation by targeting KLF5, thereby exacerbating SLE progression. This study presents a novel strategy for SLE prevention and treatment.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"490"},"PeriodicalIF":8.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943376","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":"Circulating proteins and metabolites panel for noninvasive preoperative diagnosis of epithelial ovarian cancer.","authors":"Yan Jia, Li Yuan, Weijia Wen, Linna Chen, Xueyuan Zhao, Qiong Wu, Yan Liao, Caixia Shao, Chaoyun Pan, Chunyu Zhang, Shuzhong Yao","doi":"10.1186/s12916-025-04341-2","DOIUrl":"https://doi.org/10.1186/s12916-025-04341-2","url":null,"abstract":"<p><strong>Background: </strong>Existing biomarkers for epithelial ovarian cancer (EOC) have demonstrated limited sensitivity and specificity. This study aimed to investigate plasma protein and metabolite characteristics of EOC and identify novel biomarker candidates for noninvasive diagnosis and differential diagnosis.</p><p><strong>Methods: </strong>In this prospective diagnostic cohort study, plasma was preoperatively collected from 536 consecutive patients presenting with imaging-suspected adnexal masses, uterine fibroids, or pelvic organ prolapse. After exclusions, the final cohort comprised 251 participants: EOC (n = 97), borderline ovarian tumors (n = 38), benign ovarian tumors (n = 54), and healthy controls (n = 62). Proteomic and metabolomic profiling was performed. A machine learning model was trained on a training cohort (34 EOC patients and 62 non-OC individuals [borderline, benign, and healthy controls]) to distinguish EOC from other groups. The model was validated in two independent cohorts: validation cohort 1 (n = 25) and validation cohort 2 (n = 130) using targeted proteomics and untargeted metabolomics. External transcriptomic datasets (TCGA-OV, GTEx bulk RNA-seq; GSE180661 scRNA-seq) were leveraged to validate TDO2 upregulation in ovarian cancer tissues, particularly in fibroblasts. This TDO2 upregulation were experimentally confirmed through quantitative PCR, immunohistochemistry, and immunofluorescence using clinical specimens.</p><p><strong>Results: </strong>We identified significant protein alterations in EOC patients' plasma, implicating dysregulated metabolic and PI3K-Akt signaling pathways. Metabolite analysis further revealed aberrant sphingolipid metabolism, steroid hormone biosynthesis, and tryptophan metabolism in EOC patients' plasma. A diagnostic panel comprising 4 proteins (LRG1, ITIH3, PDIA4, and PON1) and 3 metabolites (kynurenine, indole, and 3-hydroxybutyrate) achieved an AUC of 0.975 (95% CI 0.943-0.997) with 95.2% sensitivity and 91.2% specificity in the training cohort. Critically, the model demonstrated robust generalizability in two independent validation cohorts: validation cohort 1 (AUC = 0.962, 95% CI 0.878-1.000) and validation cohort 2 (AUC = 0.965, 95% CI 0.921-0.995). Furthermore, fibroblasts with high expression of tryptophan 2,3-dioxygenase are contributing factors to elevated levels of kynurenine.</p><p><strong>Conclusions: </strong>Our findings provide novel insights into the EOC metabolic and protein landscape. We developed and validated a plasma classifier demonstrating high sensitivity and specificity, which effectively distinguishes EOC patients from non-OC individuals. This classifier could enhance preoperative diagnostic accuracy and aid in differential diagnosis.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"492"},"PeriodicalIF":8.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of follow-up reexamination on the long-term prognosis of patients with acute coronary syndrome undergoing coronary angiography.","authors":"Chao Wang, Lina Cui, Xianqin Ma, Meng Sun, Yulin Wang, Fuhong Dong, Chen Zhao, Xueqin Tian, Yini Wang, Haihong Zhang, Tianhui Cao, Xinyu Hou, Jian Wu, Sining Hu, Jiannan Dai, Duolao Wang, Haibo Jia, Bo Yu","doi":"10.1186/s12916-025-04346-x","DOIUrl":"https://doi.org/10.1186/s12916-025-04346-x","url":null,"abstract":"<p><strong>Background: </strong>Patients with acute coronary syndrome (ACS) remain at high risk for recurrent adverse cardiovascular events after discharge. Patient adherence to secondary prevention is poor. This study proposes a follow-up center-based secondary prevention program to assess whether a structured cardiologist-led follow-up and reexamination protocol influences ACS patient prognosis.</p><p><strong>Methods: </strong>A total of 9,534 ACS patients undergoing coronary angiography were retrospectively included and divided into a reexamination group (n = 6,804) and a non-reexamination group (n = 2,730) according to whether they were reexamined within one year or not. The patients were followed up after discharge for 3 years, and clinical outcomes were recorded. The primary outcome was cardiac death.</p><p><strong>Results: </strong>Reexamination within 12 months was significantly associated with a reduced risk of cardiac death (adjusted hazard ratio [aHR], 0.58; 95% confidence interval [CI], 0.44-0.75) at 3 years after ACS. Among patients who underwent reexamination, the risk of cardiac death was 50% lower (aHR, 0.50; 95% CI, 0.35-0.70) and 63% lower (aHR, 0.37; 95% CI, 0.20-0.67) in the high-frequency (more than or equal to 2 times within one year) and long-term (continued reexamination after the first year of follow-up) reexamination groups, respectively. Similar results were observed after propensity score matching analysis.</p><p><strong>Conclusions: </strong>Participation in a structured follow-up and reexamination programme significantly reduces the risk of cardiac death among ACS survivors. Establishing a follow-up center could be of great significance in improving patient prognoses.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"494"},"PeriodicalIF":8.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943084","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":"Incident arrhythmias in relation to ventilatory parameters and pulmonary disease: evidence from two prospective cohort studies.","authors":"Yun-Jiu Cheng, Li-Ping Qu, Yi-Jian Liao, Si-Long Lu, Mei-Ping Lin, Qian He, Jin-Bo Fu, Jun-Chi Li, Wen-Juan Duan, Li-Juan Liu","doi":"10.1186/s12916-025-04345-y","DOIUrl":"https://doi.org/10.1186/s12916-025-04345-y","url":null,"abstract":"<p><strong>Background: </strong>Emerging epidemiological evidence implicates pulmonary dysfunction in cardiovascular pathogenesis, yet its arrhythmogenic potential remains poorly defined.</p><p><strong>Objectives: </strong>We aimed to assess the link between ventilatory parameters, pulmonary disease phenotypes and risk of incident arrhythmias across diverse populations.</p><p><strong>Methods: </strong>We analyzed data from 17,684 adults in two prospective cohort studies-the Atherosclerosis Risk in Communities (ARIC; n = 12,929) and Cardiovascular Health Study (CHS; n = 4,755). Adjudicated arrhythmia diagnoses (atrial fibrillation/flutter [AF/AFL], ventricular arrhythmias [VAs], high-grade atrioventricular [AV] block, and premature atrial/ventricular complexes [PAC/PVC]) were identified via hospitalization records and mortality data. Multivariable-adjusted Cox proportional hazards models quantified associations between forced expiratory volume in 1 s (FEV1%) predicted and forced vital capacity (FVC%) predicted quartiles with arrhythmia risk, adjusting for traditional cardiovascular risk factors.</p><p><strong>Results: </strong>Over a median follow-up of 12.6 years, impaired FEV1% and FVC% corresponded to a graded increase in arrhythmia risk. Compared to the highest quartile, the lowest FEV1% predicted quartile had elevated hazards for any arrhythmias (HR 1.32, 95% CI 1.23-1.42), AF/AFL (HR 1.68, 1.52-1.85), VAs (HR 1.55, 1.29-1.86), high-grade AV block (HR 1.37, 1.08-1.73), and PAC/PVC (HR 1.42, 1.20-1.69). Similar trends were observed for FVC% predicted quartiles. These associations remained consistent in never-smoking individuals and across cohorts. Obstructive spirometry pattern was associated with the strongest arrhythmia risk, while restrictive ventilatory patterns showed relatively lower risk elevations. No association was observed with sick sinus syndrome.</p><p><strong>Conclusions: </strong>Reduced pulmonary function suggested independent associations with incident arrhythmias across supraventricular, ventricular, and conduction system pathologies in two historical cohorts. These findings suggest that spirometric indices could potentially represent novel independent indicators for arrhythmia development worthy of further validation in contemporary settings,, with associations distinct from conventional cardiometabolic risk factors.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"493"},"PeriodicalIF":8.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of discontinuing antipsychotic medications on the risk of hospitalization in long-term care: a machine learning-based analysis.","authors":"Mikko Nuutinen, Riikka-Leena Leskelä, Daniela Fialova, Ira Haavisto, Harriet Finne-Soveri, Jokke Häsä, Johanna Edgren, Hein van Hout, Daniel E da Cunha Leme, John P Hirdes, Graziano Onder, Rosa Liperoti","doi":"10.1186/s12916-025-04304-7","DOIUrl":"10.1186/s12916-025-04304-7","url":null,"abstract":"<p><strong>Background: </strong>Antipsychotic medications are frequently prescribed to older residents of long-term care facilities (LTCFs) despite their limited efficacy and considerable safety risks. While discontinuation of these drugs might help reduce their associated morbidity, the impact of stopping antipsychotics on the risk of hospitalization has not been studied yet. The study aimed at estimating the effect of antipsychotic discontinuation on the risk of hospitalization in older LTCF residents and at identifying relevant factors influencing such effect.</p><p><strong>Methods: </strong>For this registry-based retrospective cohort study, data from a cohort of older LTCF residents in Finland from the years 2014 to 2018 was analyzed. Data sources were the Resident Assessment Instrument for Long-Term Care (RAI-LTC) based comprehensive geriatric assessments and the Finnish Care Register for Health Care. For the initial cohort, 5467 users of antipsychotic medications with at least four assessments, each conducted 6 months apart, were selected. Residents were defined either as discontinuing, if antipsychotics were prescribed at the first two assessments but not at the last two, or as chronic users, if antipsychotics were prescribed at all four assessments. Causal machine learning (ML) methods including double machine learning (DML), double robust (DR), X-learner, and causal forest (CF) were applied to estimate the effect of antipsychotic discontinuation on the risk of hospitalization and to identify factors influencing such effect. The follow-up time was 1 year. The methods of SHAP values (SHapley Additive exPlanations), partial dependence plots (PDP), and surrogate models were used for model interpretation.</p><p><strong>Results: </strong>Nearly 43% of residents in the study discontinued antipsychotic medications. Antipsychotic discontinuation lowered the probability of hospitalization of about 12% (average treatment effect, ATE). The individual treatment effect (ITE) estimations ranged from - 30% to + 1%. The use of restraints, age, and functional impairment were relevant variables in all ITE models in influencing the predicted ITE.</p><p><strong>Conclusions: </strong>Antipsychotic discontinuation may decrease the likelihood of hospitalization among older LTCF residents, benefiting most users of these drugs. Promoting antipsychotic discontinuation may prevent hospitalizations and reduce morbidity and mortality in long-term care.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"484"},"PeriodicalIF":8.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882185","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}