BMC Medicine最新文献

{"title":"Differences in intention to receive clinician-collected and self-collected samples for HPV DNA testing and its determinants between heterosexual males and females in Hong Kong, China: findings of a territory-wide household survey.","authors":"Zixin Wang, Siyu Chen, Ngai Sze Wong, Annie Wai-Ling Cheung, Zoe Pui-Yee Tam, Sze Long Chung, Denise Pui-Chung Chan, Phoenix K H Mo, Eliza Lai-Yi Wong","doi":"10.1186/s12916-024-03788-z","DOIUrl":"10.1186/s12916-024-03788-z","url":null,"abstract":"<p><strong>Background: </strong>Human papillomavirus (HPV) infection is prevalent among people who are sexually active. This study aimed to compare the levels of behavioral intention to receive free clinician-collected and self-collected samples for HPV DNA testing and its determinants between heterosexual males and females in Hong Kong, China.</p><p><strong>Methods: </strong>This is a secondary analysis of a territory-wide survey conducted in Hong Kong between May 2021 and March 2022. Participants were sexually active adult Hong Kong residents who were able to communicate in English or Chinese. Invitation letters were mailed to residential addresses that were geographically randomly selected. All sexually active adult household members were invited to complete a self-administered online survey. Multivariate logistic regression analyses were fitted.</p><p><strong>Results: </strong>Out of 45,394 invitations, 1265 surveys were collected, and 487 heterosexual males and 741 females were included in the analysis. More females than heterosexual males intended to take up free clinician-collected samples for HPV DNA testing (76.7% versus 62.2%, p < 0.001). Similar proportion of heterosexual males and females intended to receive free self-collected samples for HPV DNA testing (67.8% versus 72.6%, p = 0.20). Perceived existing treatment could control sexually transmitted infections (STI) (treatment control), more concerned about STI (concern), perceived more benefits, cue to action (suggested by significant others), and self-efficacy related to HPV testing were associated with higher intention to receive clinician-collected samples for HPV testing in both groups. Heterosexual males who perceived more severe symptoms if contracted STI (identity), longer duration of STI (timeline), more negative effects of STI on their lives (consequences), more understanding of STI (coherence), and stronger negative emotions if contracted STI (emotions) also had higher behavioral intention to take up clinician-collected samples for HPV testing. In addition, perceived more benefits, cue to action, and self-efficacy related to self-collected samples for HPV DNA testing were associated with behavioral intention to take up such testing in both groups.</p><p><strong>Conclusions: </strong>HPV DNA testing was under-utilized in Hong Kong. Free self-collected samples for HPV testing were highly acceptable by both heterosexual males and females. Illness representation of STI and the Health Belief Model could explain intentions to take up HPV DNA testing.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"22 1","pages":"569"},"PeriodicalIF":7.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11613855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766231","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 fecal microbiota transplantation on patients with sporadic amyotrophic lateral sclerosis: a randomized, double-blind, placebo-controlled trial.","authors":"Renyi Feng, Qingyong Zhu, Ao Wang, Hanzhen Wang, Jiuqi Wang, Pei Chen, Rui Zhang, Dongxiao Liang, Junfang Teng, Mingming Ma, Xuebing Ding, Xuejing Wang","doi":"10.1186/s12916-024-03781-6","DOIUrl":"10.1186/s12916-024-03781-6","url":null,"abstract":"<p><strong>Background: </strong>Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disorder marked by the progressive loss of motor neurons. Recent insights into ALS pathogenesis underscore the pivotal role of the gut microbiome, prompting an investigation into the potential therapeutic impact of fecal microbiota transplantation (FMT) on sporadic ALS patients.</p><p><strong>Methods: </strong>Conducted as a double-blind, placebo-controlled, parallel-group, randomized clinical trial, the study enrolled 27 participants from October 2022 to April 2023. The participants were followed up for 6 months from February 2023 to October 2023, during in-person visits at baseline, week 15, week 23, and week 35. The participants, evenly randomized, received either healthy donor FMT (FMT, n = 14) or a mixture of 0.9% saline and food coloring (E150c) as sham transplantation (placebo, n = 13). The primary outcome measured the change in the ALS Functional Rating Scale-Revised (ALSFRS-R) total score from baseline to week 35. Secondary outcomes included changes in gastrointestinal and respiratory functions, muscle strength, autonomic function, cognition, quality of life, intestinal microbiome composition, and plasm neurofilament light chain protein (NFL). Efficacy and safety outcomes were assessed in the intention-to-treat population.</p><p><strong>Results: </strong>A total of 27 randomized patients (47% women; mean age, 67.2 years), 24 participants completed the entire study. Notably, ALSFRS-R score changes exhibited no significant differences between FMT (6.1 [SD, 3.11]) and placebo (6.41[SD, 2.73]) groups from baseline to week 35. Secondary efficacy outcomes, encompassing respiratory function, muscle strength, autonomic function, cognition, quality of life, and plasm NFL, showed no significant differences. Nevertheless, the FMT group exhibited improvements in constipation, depression, and anxiety symptoms. FMT induced a shift in gut microbiome community composition, marked by increased abundance of Bifidobacterium, which persisted until week 15 (95% CI, 0.04 to 0.28; p = 0.01). Gastrointestinal adverse events were the primary manifestations of FMT-related side effects.</p><p><strong>Conclusions: </strong>In this clinical trial involving 27 sporadic ALS patients, FMT did not significantly slow the decline in ALSFRS-R score. Larger multicenter trials are needed to confirm the efficacy of FMT in sporadic ALS patients and to explore the underlying biological mechanisms.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry Identifier: ChiCTR 2200064504.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"22 1","pages":"566"},"PeriodicalIF":7.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766244","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":"Integration of non-randomized studies with randomized controlled trials in meta-analyses of clinical studies: a meta-epidemiological study on effect estimation of interventions.","authors":"Fan Mei, Minghong Yao, Yuning Wang, Jiayidaer Huan, Yu Ma, Guowei Li, Kang Zou, Ling Li, Xin Sun","doi":"10.1186/s12916-024-03778-1","DOIUrl":"10.1186/s12916-024-03778-1","url":null,"abstract":"<p><strong>Backgrounds: </strong>Syntheses of non-randomized studies of interventions (NRSIs) and randomized controlled trials (RCTs) are increasingly used in decision-making. This study aimed to summarize when NRSIs are included in evidence syntheses of RCTs, with a particular focus on the methodological issues associated with combining NRSIs and RCTs.</p><p><strong>Methods: </strong>We searched PubMed to identify clinical systematic reviews published between 9 December 2017 and 9 December 2022, randomly sampling reviews in a 1:1 ratio of Core and non-Core clinical journals. We included systematic reviews with RCTs and NRSIs for the same clinical question. Clinical scenarios for considering the inclusion of NRSIs in eligible studies were classified. We extracted the methodological characteristics of the included studies, assessed the concordance of estimates between RCTs and NRSIs, calculated the ratio of the relative effect estimate from NRSIs to that from RCTs, and evaluated the impact on the estimates of pooled estimates when NRSIs are included.</p><p><strong>Results: </strong>Two hundred twenty systematic reviews were included in the analysis. The clinical scenarios for including NRSIs were grouped into four main justifications: adverse outcomes (n = 140, 63.6%), long-term outcomes (n = 36, 16.4%), the applicability of RCT results to broader populations (n = 11, 5.0%), and other (n = 33, 15.0%). When conducting a meta-analysis, none of these reviews assessed the compatibility of the different types of evidence prior, 203 (92.3%) combined estimates from RCTs and NRSIs in the same meta-analysis. Of the 203 studies, 169 (76.8%) used crude estimates of NRSIs, and 28 (13.8%) combined RCTs and multiple types of NRSIs. Seventy-seven studies (35.5%) showed \"qualitative disagree\" between estimates from RCTs and NRSIs, and 101 studies (46.5%) found \"important difference\". The integration of NRSIs changed the qualitative direction of estimates from RCTs in 72 out of 200 studies (36.0%).</p><p><strong>Conclusions: </strong>Systematic reviews typically include NRSIs in the context of assessing adverse or long-term outcomes. The inclusion of NRSIs in a meta-analysis of RCTs has a substantial impact on effect estimates, but discrepancies between RCTs and NRSIs are often ignored. Our proposed recommendations will help researchers to consider carefully when and how to synthesis evidence from RCTs and NRSIs.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"22 1","pages":"571"},"PeriodicalIF":7.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11613474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766281","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 use and impact of surveillance-based technology initiatives in inpatient and acute mental health settings: a systematic review.","authors":"Jessica L Griffiths, Katherine R K Saunders, Una Foye, Anna Greenburgh, Ciara Regan, Ruth E Cooper, Rose Powell, Ellen Thomas, Geoff Brennan, Antonio Rojas-García, Brynmor Lloyd-Evans, Sonia Johnson, Alan Simpson","doi":"10.1186/s12916-024-03673-9","DOIUrl":"10.1186/s12916-024-03673-9","url":null,"abstract":"<p><strong>Background: </strong>The use of surveillance technologies is becoming increasingly common in inpatient mental health settings, commonly justified as efforts to improve safety and cost-effectiveness. However, their use has been questioned in light of limited research conducted and the sensitivities, ethical concerns and potential harms of surveillance. This systematic review aims to (1) map how surveillance technologies have been employed in inpatient mental health settings, (2) explore how they are experienced by patients, staff and carers and (3) examine evidence regarding their impact.</p><p><strong>Methods: </strong>We searched five academic databases (Embase, MEDLINE, PsycInfo, PubMed and Scopus), one grey literature database (HMIC) and two pre-print servers (medRxiv and PsyArXiv) to identify relevant papers published up to 19/09/2024. We also conducted backwards and forwards citation tracking and contacted experts to identify relevant literature. The Mixed Methods Appraisal Tool assessed quality. Data were synthesised narratively.</p><p><strong>Results: </strong>Thirty-two studies met the inclusion criteria. They reported on CCTV/video monitoring (n = 13), Vision-Based Patient Monitoring and Management (n = 9), body-worn cameras (n = 6), GPS electronic monitoring (n = 2) and wearable sensors (n = 2). Sixteen papers (50.0%) were low quality, five (15.6%) medium quality and eleven (34.4%) high quality. Nine studies (28.1%) declared a conflict of interest. Qualitative findings indicate patient, staff and carer views of surveillance technologies are mixed and complex. Quantitative findings regarding the impact of surveillance on outcomes such as self-harm, violence, aggression, care quality and cost-effectiveness were inconsistent or weak.</p><p><strong>Conclusions: </strong>There is currently insufficient evidence to suggest that surveillance technologies in inpatient mental health settings are achieving their intended outcomes, such as improving safety and reducing costs. The studies were generally of low methodological quality, lacked lived experience involvement, and a substantial proportion (28.1%) declared conflicts of interest. Further independent coproduced research is needed to more comprehensively evaluate the impact of surveillance technologies in inpatient settings. If they are to be implemented, all key stakeholders should be engaged in the development of policies, procedures and best practice guidance to regulate their use, prioritising patients' perspectives.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"22 1","pages":"564"},"PeriodicalIF":7.0,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11605989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754739","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":"Characterizing the pharmacological interaction of the antimalarial combination artefenomel-piperaquine in healthy volunteers with induced blood-stage Plasmodium falciparum to predict efficacy in patients with malaria.","authors":"Azrin N Abd-Rahman, Daniel Kaschek, Anne Kümmel, Rebecca Webster, Adam J Potter, Anand Odedra, Stephen D Woolley, Stacey Llewellyn, Lachlan Webb, Louise Marquart, Stephan Chalon, Myriam El Gaaloul, James S McCarthy, Jörg J Möhrle, Bridget E Barber","doi":"10.1186/s12916-024-03787-0","DOIUrl":"10.1186/s12916-024-03787-0","url":null,"abstract":"<p><strong>Background: </strong>The combination antimalarial artefenomel-piperaquine failed to achieve target efficacy in a phase 2b study in Africa and Vietnam. We retrospectively evaluated whether characterizing the pharmacological interaction of this antimalarial combination in a volunteer infection study (VIS) would have enabled prediction of the phase 2b study results.</p><p><strong>Methods: </strong>Twenty-four healthy adults enrolled over three consecutive cohorts were inoculated with Plasmodium falciparum-infected erythrocytes on day 0. Participants were randomized within each cohort to one of seven dose combination groups and administered a single oral dose of artefenomel-piperaquine on day 8. Participants received definitive antimalarial treatment with artemether-lumefantrine upon parasite regrowth or on day 42 ± 2. The general pharmacodynamic interaction (GPDI) model implemented in the Bliss Independence additivity criterion was developed to characterize the pharmacological interaction between artefenomel and piperaquine. Simulations based on the model were performed to predict the outcomes of the phase 2b combination study.</p><p><strong>Results: </strong>For a dose of 800 mg artefenomel administered with 640 mg, 960 mg, or 1440 mg piperaquine, the simulated adequate parasitological response at day 28 (APR₂₈), incorporating actual patient pharmacokinetic (PK) data from the phase 2b trial, was 69.4%, 63.9%, and 74.8%, respectively. These results closely matched the observed APR₂₈ in the phase 2b trial of 67.0%, 65.5%, and 75.4%, respectively.</p><p><strong>Conclusions: </strong>These results indicate that VIS offer an efficient means for informing antimalarial combination trials conducted in the field, potentially expediting clinical development.</p><p><strong>Trial registration: </strong>This study was registered on ClinicalTrials.gov on 11 May 2018 with registration number NCT03542149.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"22 1","pages":"563"},"PeriodicalIF":7.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11603672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749967","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":"Exploring the link between dietary patterns and gastric adenocarcinoma in Brazil: a mediation analysis.","authors":"Alex Richard Costa Silva, Gianfranco Alicandro, Valdete Regina Guandalini, Patrícia Paula da Fonseca Grili, Paulo Pimentel Assumpção, Mônica Santiago Barbosa, Rosane Oliveira de Sant'Ana, Felipe José Fernández Coimbra, Maria Paula Curado","doi":"10.1186/s12916-024-03785-2","DOIUrl":"10.1186/s12916-024-03785-2","url":null,"abstract":"<p><strong>Background: </strong>The causal pathway between different dietary patterns (DPs) and gastric adenocarcinoma (GA) remains largely unexplored. The study aimed to identify DPs and evaluate how selected nutrients mediate the relationship between DPs and GA.</p><p><strong>Methods: </strong>This multicenter case-control study in Brazil involved 1751 participants (600 cases, 377 endoscopic controls, and 774 hospital controls). DPs were identified through exploratory factor analysis. A counterfactual-based mediation analysis was performed to decompose the total effect of DPs on GA into direct and indirect effects mediated by saturated fatty acids, added sugars, total fiber, and sodium intakes. Effects were expressed as ORs and 95% CIs.</p><p><strong>Results: </strong>Two DPs were identified-\"unhealthy dietary pattern\" (UDP) and \"healthy dietary pattern\" (HDP), which were associated with an increased and decreased risk of GA, respectively. Added sugars partly mediated the association between UDP and GA (percentage mediated between 7.3 and 21.7%), while sodium intake mediated most of the association between HDP and GA (percentage mediated between 52.4 and 100%). No significant mediating effects were detected for saturated fatty acids and total fiber.</p><p><strong>Conclusions: </strong>This study contributes innovative insights into the DPs-GA relationships, highlighting the significant mediating roles of sodium and added sugars, offering valuable information for preventive strategies and public health interventions targeting GA.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"22 1","pages":"562"},"PeriodicalIF":7.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11603788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750001","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":"Chronic disease diagnoses and health service use among people who died of illicit drug toxicity in British Columbia, Canada.","authors":"Heather Palis, Kevin Hu, Andrew Tu, Frank Scheuermeyer, John A Staples, Jessica Moe, Beth Haywood, Roshni Desai, Chloé G Xavier, Jessica C Xavier, Alexis Crabtree, Amanda Slaunwhite","doi":"10.1186/s12916-024-03646-y","DOIUrl":"10.1186/s12916-024-03646-y","url":null,"abstract":"<p><strong>Background: </strong>Illicit drug toxicity (i.e., overdose) is the leading cause of death in British Columbia (BC) for people aged 10-59. Stimulants are increasingly detected among drug toxicity deaths. As stimulant use and detection in deaths rises, it is important to understand how people who die of stimulant toxicity differ from people who die of opioid toxicity.</p><p><strong>Methods: </strong>BC Coroners Service records were retrieved for all people who died of unintentional illicit drug toxicity (accidental or undetermined) between January 1, 2015, and December 31, 2019, whose coroner investigation had concluded and who had an opioid and/or stimulant detected in post-mortem toxicology and identified by the coroner as relevant to the death (N = 3788). BC Chronic Disease Registry definitions were used to identify people with chronic disease. Multinomial regression models were used to examine the relationship between chronic disease diagnoses and drug toxicity death type.</p><p><strong>Results: </strong>Of the 3788 deaths, 11.1% (N = 422) had stimulants but not opioids deemed relevant to the cause of death (stimulant group), 26.8% (N = 1014) had opioids but not stimulants deemed relevant (opioid group), and 62.1% (N = 2352) had both opioids and stimulants deemed relevant (opioid/stimulant group). People with ischemic heart disease (1.80 (1.14-2.85)) and people with heart failure (2.29 (1.25-4.20)) had approximately twice the odds of being in the stimulant group as compared to the opioid group.</p><p><strong>Conclusions: </strong>Findings suggest that people with heart disease who use illicit stimulants face an elevated risk of drug toxicity death. Future research should explore this association and should identify opportunities for targeted interventions to reduce drug toxicity deaths among people with medical comorbidities.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"22 1","pages":"479"},"PeriodicalIF":7.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726214","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":"Colorectal cancer screening using a multi-locus blood-based assay targeting circulating tumor DNA methylation: a cross-sectional study in an average-risk population.","authors":"Baohua Wang, Yunzhi Zhang, Jun Liu, Bin Deng, Qing Li, Hongmei Liu, Yi Sui, Ning Wang, Qin Xiao, Wei Liu, Yan Chen, Yongsheng Li, Haipeng Jia, Qilong Yuan, Cuiping Wang, Wenjun Pan, Fan Li, Huimin Yang, Yongfeng Wang, Yanbing Ding, Daoliang Xu, Rui Liu, Jing-Yuan Fang, Jing Wu","doi":"10.1186/s12916-024-03777-2","DOIUrl":"10.1186/s12916-024-03777-2","url":null,"abstract":"<p><strong>Background: </strong>Effective screening for colorectal cancer (CRC) enables earlier diagnosis and intervention to improve patient survival.</p><p><strong>Methods: </strong>In this study, we prospectively conducted a blood-based CRC screening program for community residents in Hanjiang District, Yangzhou City, and evaluated the screening efficacy of a blood-based multi-locus DNA methylation assay (ColonAiQ). The ColonAiQ-positive rate and colonoscopy participation rate of the population, detection rate of intestinal lesions, and positive predictive value (PPV) of CRC and advanced adenoma (AA) were calculated, and the associated factors were explored.</p><p><strong>Results: </strong>A total of 105,285 participants were enrolled from January 2021 to December 2022, all of whom completed the ColonAiQ assay, yielding a positive rate of 6.42% (6759/105,285). The colonoscopy compliance rate was 48.56% (3282/6759). Intestinal lesions were detected in 1773 individuals (54.02%), including 63 cases of CRCs (predominately early-stage), 1195 adenomas (441 cases of AAs), 327 polyps, and 188 other benign lesions. CRC patients exhibited higher ColonAiQ scores and more positive loci compared to healthy individuals. The PPVs were 1.92% for CRC and 13.44% for AA. Among participants, 66,121 (62.8%) completed questionnaires graded by the Asia-Pacific Colorectal Screening score, with 12,139 (18.36%) classified in the high-risk tier. High-risk participants had a higher ColonAiQ-positive rate (11.07%) and PPVs for CRC (3.46%) and AA (22.18%). Factors associated with increased detection rates for CRC and AA included male gender, older age, a history of alcohol consumption, and prior polyps.</p><p><strong>Conclusions: </strong>Our study demonstrated that ColonAiQ assay effectively identifies high-risk population. These findings strongly suggest that the ColonAiQ assay represents a promising strategy for the early detection of CRC and AA in individuals at average risk.</p><p><strong>Trial registration: </strong>Registered at ClinicalTrials.gov (NCT05336539).</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"22 1","pages":"560"},"PeriodicalIF":7.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738446","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":"Even moderate liver fat accumulation below conventional fatty liver cutoffs is linked to multiple metabolomic alterations and gestational dysglycemia in Asian women of reproductive age.","authors":"Priti Mishra, Suresh Anand Sadananthan, Jadegoud Yaligar, Kok Hian Tan, Yap Seng Chong, Peter D Gluckman, Keith M Godfrey, Marielle V Fortier, Johan G Eriksson, Jerry Kok Yen Chan, Shiao-Yng Chan, Dennis Wang, S Sendhil Velan, Navin Michael","doi":"10.1186/s12916-024-03779-0","DOIUrl":"10.1186/s12916-024-03779-0","url":null,"abstract":"<p><strong>Background: </strong>It is not clear if conventional liver fat cutoff of 5.56% weight which has been used for identifying fatty liver in western populations is also applicable for Asians. In Asian women of reproductive age, we evaluate the optimum metabolic syndrome (MetS)-linked liver fat cutoff, the specific metabolomic alterations apparent at this cutoff, as well as prospective associations of preconception liver fat levels with gestational dysglycemia.</p><p><strong>Methods: </strong>Liver fat (measured by magnetic resonance spectroscopy), MetS, and nuclear magnetic resonance (NMR)-based plasma metabolomic profiles were assessed in 382 Asian women, who were planning to conceive. Ninety-eight women went on to become pregnant and received an oral glucose tolerance test at week 26 of gestation.</p><p><strong>Results: </strong>The optimum liver fat cutoff for diagnosing MetS was 2.07%weight. Preconception liver fat was categorized into Low (liver fat < 2.07%), Moderate (2.07% ≤ liver fat < 5.56%), and High (liver fat ≥ 5.56%) groups. Individual MetS traits showed worsening trends, going from Low to Moderate to High groups. Multiple plasma metabolomic alterations, previously linked to incident type 2 diabetes (T2D), were already evident in the Moderate group (adjusted for ethnicity, age, parity, educational attainment, and BMI). Both a cross-sectional multi-metabolite score for incident T2D and mid-gestational glucose area under the curve showed increasing trends, going from Low to Moderate to High groups (p < 0.001 for both). Gestational diabetes incidence was 2-fold (p = 0.23) and 7-fold (p < 0.001) higher in the Moderate and High groups relative to the Low group.</p><p><strong>Conclusions: </strong>In Asian women of reproductive age, moderate liver fat accumulation below the conventional fatty liver cutoff was not metabolically benign and was linked to gestational dysglycemia. The newly derived cutoff can aid in screening individuals before adverse metabolic phenotypes have consolidated, which provides a longer window for preventive strategies.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"22 1","pages":"561"},"PeriodicalIF":7.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738447","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":"Exacerbated ischemic brain damage in type 2 diabetes via methylglyoxal-mediated miR-148a-3p decline.","authors":"Zhenguo Yang, Cheng Huang, Wenhui Huang, Chao Yan, Xueyi Wen, Di Hu, Hesong Xie, Kejing He, Chi Kwan Tsang, Keshen Li","doi":"10.1186/s12916-024-03768-3","DOIUrl":"10.1186/s12916-024-03768-3","url":null,"abstract":"<p><strong>Background: </strong>Although microvascular dysfunction is a widespread phenomenon in type 2 diabetes (T2D) and is recognized as a main cause of T2D-aggravated ischemic stroke injury, the underlying mechanisms by which T2D-mediated exacerbation of cerebral damage after ischemic stroke is still largely uncharacterized. Here, we found that methylglyoxal-mediated miR-148a-3p decline can trigger blood-brain barrier dysfunction, thereby exacerbating cerebrovascular injury in diabetic stroke.</p><p><strong>Methods: </strong>Using T2D models generated with streptozotocin plus a high-fat diet or db/db mice, and then inducing focal ischemic stroke through middle cerebral artery occlusion and reperfusion (MCAO/R), we established a diabetic stroke mouse model. RNA-sequencing was applied to identify the differentially expressed miRNAs in peri-cerebral infarction of diabetic stroke mice. RT-qPCR confirmed the potential miRNA in the plasma of ischemic stroke patients with or without T2D. Fluorescence in situ hybridization was used to image the localization of the miRNA. Brain pathology was analyzed using magnetic resonance imaging, laser-Doppler flowmetry, and transmission electron microscope in diabetic stroke mice. Immunofluorescence and immunoblotting were performed to elucidate the molecular mechanisms.</p><p><strong>Results: </strong>miR-148a-3p level was downregulated in the peri-infarct cortex of stroke mice and this downregulation was even more enhanced in diabetic stroke mice. A similar decrease in miR-148a-3p expression was also confirmed in the plasma of ischemic stroke patients with T2D compared to patients with ischemic stroke only. This miR-148a-3p downregulation intensified the severity of BBB damage, infarct size, and neurological function impairment caused by stroke. Notably, the reduction in miR-148a-3p levels was primarily triggered by methylglyoxal, a toxic byproduct of glucose metabolism commonly associated with T2D. Furthermore, methylglyoxal somewhat replicated the influence of T2D in exacerbating BBB damage and increasing infarct size caused by ischemia. Mechanistically, we found that downregulation of miR-148a-3p de-repressed SMAD2 and activated matrix metalloproteinase 9 signaling pathway, promoting blood-brain barrier impairment, and exacerbating the cerebral ischemic injury.</p><p><strong>Conclusions: </strong>Blood-brain barrier damage caused by methylglyoxal-mediated miR-148a-3p downregulation may provide a novel target for the therapeutic intervention for the treatment of stroke patients with diabetes.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"22 1","pages":"557"},"PeriodicalIF":7.0,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726218","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}