BMC Medicine最新文献

{"title":"Exploring the effect of pre-clinical Alzheimer's disease on blood pressure using Mendelian randomisation and parental dementia as an instrumental variable in UK Biobank.","authors":"Jennifer C Palmer, Emma Hart, Emma Anderson, Seth Love, Deborah A Lawlor","doi":"10.1186/s12916-025-04295-5","DOIUrl":"10.1186/s12916-025-04295-5","url":null,"abstract":"<p><strong>Background: </strong>Evidence suggests there may be a bidirectional relationship between high blood pressure (BP) and Alzheimer's disease (AD). It is hypothesised that this is due to cerebral changes during pre-clinical AD that cause elevation of systemic BP. We aimed to test this by exploring the effect of risk of pre-clinical AD on blood pressure.</p><p><strong>Methods: </strong>We used data from the UK Biobank, including adults without prevalent or incident (within first 5 years of follow-up) clinical AD (N = 501,420, mean age 56.6, SD 8 years). We used two instrumental variables, an age-weighted parental dementia instrument score and a participant genetic instrument score, that are vulnerable to differing biases, to instrument risk of pre-clinical AD (the exposure). We tested the association of both instrument scores with systolic BP (SBP), diastolic BP (DBP), and hypertension. Sensitivity analyses were undertaken to explore different biases.</p><p><strong>Results: </strong>Both the higher parental dementia instrument and participant genetic instrument score were associated with higher mean SBP (difference in mean SBP mmHg per 1SD higher score: 0.12, 95% CI 0.06 to 0.17, p < 0.0001, and 0.07, 95% CI 0.00 to 0.13, p=0.037, respectively) but not DBP. Sensitivity analyses were largely consistent with these findings.  CONCLUSIONS: Our findings provide preliminary evidence that pre-clinical AD increases SBP. Further research is required to determine whether this increase in SBP is due to increased cerebrovascular resistance as a result of pre-clinical AD. Obtaining a better understanding of the changing relationship with BP at different stages of AD may enable effective optimisation and targeting of therapies.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"483"},"PeriodicalIF":8.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882186","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":"Mental, physical, and respiratory health in people with tuberculosis in Southern Africa: a multi-country cohort analysis.","authors":"Nicolas Banholzer, Guy Muula, Fiona Mureithi, Denise Evans, Jacqueline Huwa, Idiovino Rafael, Cordelia Kunzekwenyika, Nelly Jinga, Amina Fernando, Agness Thawani, Remo Schmutz, Carolyn Bolton, Gunar Günther, Matthias Egger, Andreas D Haas, Annika C Sweetland, Marie Ballif, Lukas Fenner","doi":"10.1186/s12916-025-04321-6","DOIUrl":"10.1186/s12916-025-04321-6","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis (TB) affects people's quality of life (QoL). We prospectively monitored physical and mental health-related QoL over time in people with TB in the Southern African region with a high HIV and TB burden.</p><p><strong>Methods: </strong>Adults aged ≥ 15 years with pulmonary TB were enrolled in five cohorts in Malawi, Mozambique, South Africa, Zambia, and Zimbabwe from October 2022 to September 2024. We assessed six QoL outcomes using validated instruments at the start (baseline), end of treatment, and 6 months post-treatment: symptoms of depression (PHQ-9), mental and physical health (SF-12 mental, SF12-MC, SF-12 physical component, SF12-PC), physical fitness (6-Minute Walk Test, 6MWT; 1-min Sit-To-Stand Test, STST), and respiratory health (Saint-George-Respiratory-Questionnaire, SGRQ). Missing QoL scores were imputed with multivariate imputation by chained equations. We compared the proportion of participants with impaired QoL, defining impairment based on outcome-specific cut-off values. We also estimated changes in QoL scores and examined their associations with baseline characteristics using Bayesian multivariable regression models.</p><p><strong>Results: </strong>We included 1438 participants with a median follow-up of 344 days (interquartile range [IQR] 183-373). The median age was 39 years (IQR 30-50); 67% were male, and 39% living with HIV. At baseline, 49% had symptoms of depression, 73% had impaired mental health and 92% impaired physical health-related QoL, 68-74% had reduced physical fitness (68%: 6MWT, 74%: STST), and 78% impaired respiratory health. All QoL outcomes improved by the end of treatment, notably depressive symptoms (48% to 5%), mental health-related QoL (73% to 28%), and respiratory health (78% to 11%). Most QoL impairments continued to decrease post-treatment, especially physical and respiratory health; depressive symptoms remained below 5%. Across QoL domains and study visits, better outcomes were associated with age < 30 (83% probability), and worse outcomes with female gender (86%) and a prior TB history (89%). Living with HIV and alcohol drinking were associated with worse QoL only at baseline (88% and 87%).</p><p><strong>Conclusions: </strong>TB negatively impacts QoL across physical, mental, and social domains, including post-treatment. The study highlights the need for integrated mental and physical healthcare and rehabilitation during TB treatment and beyond, especially for high-risk populations, to address the long-term impact of TB on QoL.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"485"},"PeriodicalIF":8.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882126","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":"Longitudinal patterns of antidepressant and benzodiazepine use associated with injurious falls in older adults with depression: a retrospective cohort study.","authors":"Grace Hsin-Min Wang, Amie J Goodin, Rachel C Reise, Ronald I Shorr, Taewoo Park, Wei-Hsuan Lo-Ciganic","doi":"10.1186/s12916-025-04325-2","DOIUrl":"10.1186/s12916-025-04325-2","url":null,"abstract":"<p><strong>Background: </strong>Cross-sectional studies have shown that antidepressants (ADs) and benzodiazepines (BZDs) are commonly co-prescribed for depression, potentially increasing the risk of falls and related injuries (FRI) compared to monotherapies. However, little is known about the longitudinal dosing patterns (i.e., trajectory) of ADs and BZDs and their associated FRI risk.</p><p><strong>Methods: </strong>This retrospective cohort study used group-based multi-trajectory models to identify AD-BZD trajectories among older Medicare fee-for-service beneficiaries with depression initiating ADs with/without BZDs. We measured the standardized daily doses of AD and BZD within 84 days after AD initiation and categorized them into negligible, very-low, low, moderate, high, or very-high levels with a discontinuing, declining, increasing, or stable trend. Then, we assessed the subsequent 12-month FRI risk associated with each trajectory.</p><p><strong>Results: </strong>Among 102,750 eligible beneficiaries, the mean age was 75.5 years (SD = 7.5); 67.0% were female, 81.2% were White, and 4.9% experienced an FRI. We identified 12 distinct AD/BZD trajectories, of which 79,424 patients received AD monotherapy, and 23,326 patients received both ADs and BZDs. Compared with Group A (low discontinuing AD; 17.3% of the cohort; FRI crude incidence rate = 99.7/1000 person-year), trajectories with a higher dose or a longer duration of AD use were associated with an increased FRI risk, regardless of BZD use. The hazard ratios (HR) and 95% confidence intervals (CI) for Groups B (low declining AD; 31.0% of the cohort), C (moderate increasing AD; 23.5%), and D (high increasing AD; 5.4%) were 1.11 (1.04-1.19), 1.24 (1.16-1.32), and 1.29 (1.16-1.42), respectively. Combining ADs and BZDs at very-low doses or with declining trends did not significantly alter FRI risk compared to AD monotherapy. However, FRI risk increased when BZDs were used at low doses (either with stable or increasing trends). The HR and 95%CI for Groups J (moderate increasing AD/low stable BZD, 1.3%) and L (very-high increasing AD/low-dose increasing BZD) were 1.71 (1.41, 2.08) and 1.96 (1.53, 2.49), respectively.</p><p><strong>Conclusions: </strong>We observed a dose-response relationship between AD use and FRI risk, independent of BZD use, highlighting the importance of initiating ADs at the lowest effective dose and closely monitoring to prevent FRI.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"487"},"PeriodicalIF":8.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882125","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":"Dynamic OGTT-derived C-peptide trajectories for metabolic heterogeneity and adverse pregnancy outcomes in gestational diabetes mellitus: a nested case‒control study.","authors":"Xinyue Wang, Zhangya He, Jing Ji, Simin Zhang, Jinglin Li, Jiahui Zhang, Wenlu Yu, Hexiang Yang, Zhen Han, Yang Mi, Xiaoqin Luo","doi":"10.1186/s12916-025-04281-x","DOIUrl":"10.1186/s12916-025-04281-x","url":null,"abstract":"<p><strong>Background: </strong>Existing diagnostic criteria for gestational diabetes mellitus (GDM) rely solely on glucose thresholds, which are insufficient to capture metabolic heterogeneity. We aimed to evaluate the role of C-peptide measured during the oral glucose tolerance test (OGTT) in assisting the development of stratified treatment strategies and predicting the risk of adverse pregnancy outcomes.</p><p><strong>Methods: </strong>This nested case-control study conducted within the Xi'an Longitudinal Mother-Child Cohort included 1014 pregnant women with GDM and 1014 without GDM (non-GDM) who delivered singleton live-born infants between January 1, 2017, and December 31, 2018. C-peptide levels were measured at three intervals during the OGTT. Latent class trajectory modeling was used to identify distinct C-peptide trajectories, and logistic regression was used to assess their associations with adverse fetal and maternal outcomes.</p><p><strong>Results: </strong>Two principal C-peptide trajectories were identified in GDM despite similar glucose profiles. GDM Class 1 (771, 76.04%) presented a delayed 120-min C-peptide peak and poorer beta-cell secretion, whereas GDM Class 2 (243, 23.96%) presented a sharp 60-min peak followed by a decline and significantly increased insulin resistance, with greater risks of delivering large for gestational age (LGA) (adjusted odds ratio (aOR), 1.52; 95% confidence interval (CI), 1.07-2.15) and macrosomia (aOR, 1.83; 95% CI, 1.13-2.97). Surprisingly, 21.7% (220) of the non-GDM group had a high C-peptide response associated with elevated preeclampsia risk (aOR, 2.91; 95% CI, 1.25-6.74).</p><p><strong>Conclusions: </strong>Dynamic OGTT-derived C-peptide trajectories revealed clinically significant metabolic subgroups of GDM that were obscured by glucose-only diagnostics, with the predominantly insulin-resistant Class being at higher risk of fetal overgrowth.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"482"},"PeriodicalIF":8.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882184","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":"\"Have you considered that it could be burnout?\"-psychologization and stigmatization of self-reported long COVID or post-COVID-19 vaccination syndrome.","authors":"Ronja Büchner, Christian Sander, Stephanie Schindler, Martin Walter, Carmen Scheibenbogen, Georg Schomerus","doi":"10.1186/s12916-025-04335-0","DOIUrl":"10.1186/s12916-025-04335-0","url":null,"abstract":"<p><strong>Background: </strong>People reporting long COVID (LC) or post-COVID-19 vaccination syndrome (PCVS) not only suffer from their symptoms but also from stigmatization. Despite ample account and characterization of stigma experiences so far, its mechanisms and consequences on health outcomes, and particularly the role of \"psychologization\" remain unclear.</p><p><strong>Methods: </strong>In a cross-sectional observational study, we examined a large convenience sample of adults who report having LC or PCVS. We translated and adapted the \"Long Covid Stigma Scale\" to measure stigmatization. We measured generally perceived and personally experienced psychologization with newly developed scales/items. Outcome measures included disclosure concerns, loss of trust in medicine, life satisfaction, depression, anxiety, self-esteem, and loneliness. We calculated overall prevalences of stigma and psychologization and their correlations with the outcomes. Using mediation analysis with SEM, we tested the hypothesis that psychologization of LC and PCVS syndromes causes harm by increasing stigmatization.</p><p><strong>Results: </strong>Altogether, N = 2053 individuals (68% reporting LC, 32% reporting PCVS) were included in the analyses. The overall prevalences of stigma experiences were high: 83% of those reporting LC and 90% of those reporting PCVS experienced stigma. Prevalences of perceived psychologization (LC: 87%, PCVS: 91%) and experienced psychologization (LC: 82%, PCVS: 87%) were similarly high. Both stigmatization and psychologization were positively correlated with disclosure concerns, loss of trust in medicine, depression, anxiety, and loneliness as well as negatively correlated with life satisfaction and self-esteem. Mediation analysis indicated that stigmatization mediated a relevant proportion of the relationship between psychologization and negative outcomes.</p><p><strong>Conclusions: </strong>People reporting LC or PCVS are subject to stigmatization and psychologization. From a patient perspective, psychologization appears to be an important driver of stigmatization and negative outcomes.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"488"},"PeriodicalIF":8.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882183","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":"Bridges to treatment satisfaction: the roles of trauma, social support, race and ethnicity among perinatal women receiving behavioural activation therapy.","authors":"Maya Zaidan, Andrea S Lawson, Nicole Andrejek, Kate Walsh, Cindy-Lee Dennis, Samantha Meltzer-Brody, Richard K Silver, Alison M Stuebe, Simone N Vigod, Daisy R Singla","doi":"10.1186/s12916-025-04272-y","DOIUrl":"https://doi.org/10.1186/s12916-025-04272-y","url":null,"abstract":"<p><strong>Background: </strong>High treatment satisfaction is related to improved treatment adherence and outcomes in psychotherapy research. Satisfaction with psychotherapy treatment among racially and ethnically diverse perinatal populations with post-traumatic stress (PTS) remains understudied. The aims of this study are to examine the relations between PTS symptoms, perceived social support, and race and ethnicity, and treatment satisfaction among perinatal women receiving behavioural activation (BA) psychotherapy.</p><p><strong>Methods: </strong>This is a mixed-methods study of the Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) trial-a large, multi-site, non-inferiority trial for perinatal women with depressive and anxiety symptoms (NCT04153864). A two-sample t-test compared baseline PTS symptoms, social support, and treatment satisfaction between participants from white and racial and ethnic minority groups. Hierarchical multiple linear regression examined whether PTS symptoms, perceived social support, race and ethnicity predicted treatment satisfaction. Content analysis of open-ended responses explored facilitators and modifications for improving treatment satisfaction across PTS symptom severity and race and ethnicity.</p><p><strong>Results: </strong>Of 1230 women, 1119 (90.98%) had ≥ 1 BA session. Compared to their white counterparts, baseline PTS symptom severity was higher (t(1087) = - 4.98; p < 0.001; 95% CI = - 2.23, - 0.97), and social support lower (t(1087) = 8.05; p < 0.001; 95% CI = 0.43, 0.71) among racial and ethnic minority women. Lower baseline PTS symptom severity (β = - 0.009; 95% CI = - 0.016, - 0.002) and higher perceived social support (β = 0.042; 95% CI = 0.013, 0.072) were associated with higher post-treatment satisfaction across the sample. Descriptive analysis revealed no differences in treatment satisfaction across race and ethnicity; treatment satisfaction was higher for racial and ethnic minority women when social support was added to the regression model (β = 0.077; 95% CI = 0.005, 0.149). Content analysis (n = 807) revealed no differences by PTS symptoms severity or race and ethnicity across reported facilitators and modifications. BA as a treatment modality (n = 446, 55.27%) was a key facilitator; modifications included more sessions (n = 202, 25.03%).</p><p><strong>Conclusions: </strong>PTS symptom severity and social support predict treatment satisfaction among racially and ethnically diverse perinatal populations and should be considered when delivering psychotherapy.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT04153864. Registered on November 6, 2019.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"489"},"PeriodicalIF":8.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943379","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":"Innovative approaches to combat antibiotic resistance: integrating CRISPR/Cas9 and nanoparticles against biofilm-driven infections.","authors":"Abolfazl Saffari Natanzi, Mohsen Poudineh, Elham Karimi, Azad Khaledi, Hamed Haddad Kashani","doi":"10.1186/s12916-025-04323-4","DOIUrl":"10.1186/s12916-025-04323-4","url":null,"abstract":"<p><p>The increasing prevalence of antibiotic-resistant bacterial infections is a major global health concern, with biofilms playing a key role in bacterial persistence and resistance. Biofilms provide a protective matrix that limits antibiotic penetration, enhances horizontal gene transfer, and enables bacterial survival in hostile environments. Conventional antimicrobial therapies are often ineffective against biofilm-associated infections, necessitating the development of novel therapeutic strategies. The CRISPR/Cas9 gene-editing system has emerged as a revolutionary tool for precision genome modification, offering targeted disruption of antibiotic resistance genes, quorum sensing pathways, and biofilm-regulating factors. However, the clinical application of CRISPR-based antibacterials faces significant challenges, particularly in efficient delivery and stability within bacterial populations. Nanoparticles (NPs) present an innovative solution, serving as effective carriers for CRISPR/Cas9 components while exhibiting intrinsic antibacterial properties. Nanoparticles can enhance CRISPR delivery by improving cellular uptake, increasing target specificity, and ensuring controlled release within biofilm environments. Recent advances have demonstrated that liposomal CRISPR-Cas9 formulations can reduce Pseudomonas aeruginosa biofilm biomass by over 90% in vitro, while gold nanoparticle carriers enhance editing efficiency up to 3.5-fold compared to non-carrier systems. These hybrid platforms also enable co-delivery with antibiotics, producing synergistic antibacterial effects and superior biofilm disruption. Additionally, they can facilitate co-delivery of antibiotics or antimicrobial peptides, further enhancing therapeutic efficacy. This review explores the synergistic integration of CRISPR/Cas9 and nanoparticles in combating biofilm-associated antibiotic resistance. We discuss the mechanisms of action, recent advancements, and current challenges in translating this approach into clinical practice. While CRISPR-nanoparticle hybrid systems hold immense potential for next-generation precision antimicrobial therapies, further research is required to optimize delivery platforms, minimize off-target effects, and assess long-term safety. Understanding and overcoming these challenges will be critical for developing effective biofilm-targeted antibacterial strategies.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"486"},"PeriodicalIF":8.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882187","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":"Accuracy of NT-proBNP for predicting mortality amongst patients with ischemic stroke: a systematic review and meta-analysis.","authors":"Jun Ran, Yun Liu, Hao Ma, Yu Zhang","doi":"10.1186/s12916-025-04299-1","DOIUrl":"10.1186/s12916-025-04299-1","url":null,"abstract":"<p><strong>Background: </strong>Ischemic stroke remains one of the leading causes of morbidity and mortality worldwide. NT-proBNP is emerging as a promising biomarker for risk stratification in acute ischemic stroke. This review aimed to assess its prognostic accuracy for mortality in this patient population.</p><p><strong>Methods: </strong>We conducted a comprehensive literature search across databases (PubMed, Embase, Web of Science, Scopus and Cochrane Library), retrieving 4832 records. Following duplicate removal and full-text screening, 11 prospective observational studies meeting the inclusion criteria were included. Data on study characteristics, risk of bias, and diagnostic performance (sensitivity, specificity, likelihood ratios, diagnostic odds ratio, and area under the ROC curve [AUROC]) were extracted and pooled using a bivariate random-effects model.</p><p><strong>Results: </strong>The 11 studies included 2994 patients (12.19% mortality). Pooled prognostic performance of NT-proBNP for mortality showed a sensitivity of 0.83 (95% CI, 0.73-0.89) and specificity of 0.77 (95% CI, 0.67-0.84), with an area under the receiver operating characteristic curve (AUROC) of 0.87 (95% CI, 0.84-0.90). In subgroup analyses, NT-proBNP demonstrated a sensitivity of 0.84 and specificity of 0.70 (AUROC = 0.86) for predicting in-hospital mortality (5 studies), and sensitivity of 0.81 and specificity of 0.87 (AUROC = 0.91) for predicting 3-month mortality (4 studies). The positive likelihood ratio was 3.5, and the negative likelihood ratio was 0.23, corresponding to a diagnostic odds ratio of 16.</p><p><strong>Conclusions: </strong>NT-proBNP demonstrates moderate to high accuracy for predicting mortality in acute ischemic stroke, supporting its potential role in clinical risk stratification. Further standardized, multicenter research is warranted to confirm optimal threshold values and to evaluate its impact on patient management.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"476"},"PeriodicalIF":8.3,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858912","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":"CircRNAs: functions and emerging roles in cancer and immunotherapy.","authors":"Yan Wang, Yanru Cui, Xin Li, Su-Han Jin, Haitao Wang, Udo S Gaipl, Hu Ma, Shixiang Wang, Jian-Guo Zhou","doi":"10.1186/s12916-025-04306-5","DOIUrl":"10.1186/s12916-025-04306-5","url":null,"abstract":"<p><strong>Background: </strong>Circular RNAs (circRNAs) are emerging as promising tools in cancer and immunotherapy, with unique characteristics that offer potential therapeutic applications.</p><p><strong>Main body: </strong>This review outlines the discovery, biogenesis, and mechanisms of circRNAs, emphasizing their roles in cancer and immune regulation. CircRNAs modulate immune responses by acting as miRNA sponges, binding RNA-binding proteins, or serving as translation templates. These interactions influence T cells, NK cells, macrophages, and immune checkpoints. The review also explores circRNAs' roles in different cancers, focusing on target identification, immune effects, and mechanisms of action. Additionally, it examines circRNA-based therapies, including vaccines, CAR-T cell therapy, and database applications.</p><p><strong>Conclusion: </strong>Despite their potential, technical hurdles must be overcome to advance circRNAs' clinical use in cancer immunotherapy. Future research should focus on addressing these challenges to fully realize the therapeutic potential of circRNAs.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"477"},"PeriodicalIF":8.3,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858914","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":"Trends and disparities in health status and health care in the United States during COVID-19 pandemic.","authors":"Zhiyuan Wu, Frank Qian, Siyu Zou, Xinye Zou, Ruolin Zhang, Xiuhua Guo, Haibin Li","doi":"10.1186/s12916-025-04315-4","DOIUrl":"10.1186/s12916-025-04315-4","url":null,"abstract":"<p><strong>Background: </strong>Concerns exist over a possible worsening of disparities in health status and health care access across racial/ethnic and income groups during the COVID-19 pandemic. We aimed to characterize trends in racial/ethnic and income differences in self-reported measures of health status and health care access among US adults.</p><p><strong>Methods: </strong>This serial cross-sectional nationally representative study included adults (age ≥ 18 years) participating in the National Health Interview Survey (NHIS) from 2019 to 2022. Self-reported health status (poor or fair health status, functional limitation, clinician-diagnosed depression or anxiety disorders) and health care access and affordability were collected.</p><p><strong>Results: </strong>Our analysis included 107,230 adults (mean [SE] age, 48.1 [0.1] years, 51.6% women), of whom 6.1% were Asian, 12.1% were Black, 17.3% were Latino/Hispanic, and 64.5% were White. Black individuals with low income had the highest prevalence of poor or fair health status (30.9% [95% CI, 27.8%-34.3%] in 2019 and 28.4% [95% CI, 25.1% to 32.0%] in 2022), and these racial/ethnic gaps did not change significantly, irrespective of income levels. The prevalence of clinician-diagnosed depression or anxiety disorders increased from 2019 to 2022 for all racial/ethnic groups, especially for Whites (from 32.6% [95% CI, 30.8%-34.4%] to 38.2% [95% CI, 36.4% to 40.1%], P < 0.001). There was no significant change in functional limitations during the pandemic. Latino/Hispanic individuals with low income had the highest estimated prevalence of limited health care access from 2019 to 2022. Health insurance access and affordability significantly improved for White individuals with low income from 2019 to 2022 (P < 0.001), but not for other racial/ethnic groups. Racial/ethnic gaps in health care access and affordability did not change significantly, irrespective of income levels.</p><p><strong>Conclusions: </strong>In a serial cross-sectional survey study of US adults during the COVID-19 pandemic, prevalence of clinician-diagnosed depression or anxiety disorders significantly increased. Racial and ethnic differences in health status and health care access either persisted or widened over time.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"478"},"PeriodicalIF":8.3,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858918","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}