Communications medicine最新文献

Background: Adequate antenatal care (ANC) is often unrealised in sub-Saharan Africa (SSA). This is exemplified in the Cameroonian Anglophone Crisis, an ongoing armed civil conflict. Conflict intensity varies nationally, causing differential impacts on healthcare access. This study aimed to quantify the impact of the conflict's intensity on ANC use and identify its geographical variations.

Methods: We analysed live births from the 2011 and 2018 Cameroonian Demographic and Health Surveys and the 2022 Cameroonian Malaria Indicator Survey. Conflict intensity was measured as the proportion of Anglophone Crisis-related deaths occurring in each division, using Armed Conflict Location & Event Data Project (ACLED) data. Associations between conflict intensity and the proportion of live births attending at least one (ANC1) and at least four (ANC4) ANC visits were assessed using multiple linear regression and geographically weighted regression.

Results: Between 2011 and 2022, North West and South West Cameroon experienced ANC4 compliance declines. North West also experienced an ANC1 decline, but South West experienced an ANC1 increase. There is no evidence for an association between ANC1 and conflict intensity (p = 0.403). There is strong evidence for a negative association between conflict intensity and ANC4 (p = 0.007). A 1% increase in conflict intensity is associated with a 1.14% (95% CI: 0.326, 1.963) decrease in ANC4. There is strong evidence for spatial variation of this relationship (p < 0.001).

Conclusions: There is strong evidence to suggest that the Anglophone Crisis has adversely impacted ANC use, with varying magnitudes nationwide. Targeted solutions are crucial to mitigate its impacts on sustained ANC use.

Background: Cardiac arrhythmias are a major cause of morbidity and mortality increasing the risk of stroke, heart failure, and sudden cardiac death. Imageless electrocardiographic Imaging has emerged as an accessible non-invasive alternative for cardiac electrical mapping from body surface potentials. However, conventional electrocardiographic imaging is restricted to epicardial reconstructions, reducing its reliability in accurately identifying arrhythmias arising from deeper myocardial structures. We aim to overcome this limitation by reconstructing three-dimensional cardiac activity.

Methods: We introduce a volumetric formulation, which extends beyond epicardial potential estimation by solving an inverse source problem using Green's functions. This technique enables three-dimensional reconstructions of cardiac activation, improving arrhythmia localization in anatomically complex regions. We evaluate the method on simulated premature ventricular beats and on four patients representing clinical challenges, including a premature ventricular contraction from the right ventricular outflow tract, a left bundle branch block, a ventricular tachycardia, and a Wolff-Parkinson-White. We also assess performance on an open-source dataset for myocardial infarction estimation.

Results: Our results indicate that volumetric electrocardiographic imaging reconstructs three-dimensional activation and enhances the localization of arrhythmia origins, yielding a 59.3% reduction in geodesic error between the estimated and simulated origins compared to surface-only approaches. In patient cases, the recovered activation patterns are consistent with the clinical diagnoses.

Conclusions: Imageless volumetric electrocardiographic imaging enables non-invasive, accessible, three-dimensional mapping of cardiac activation, addressing a fundamental limitation of surface-restricted methods. This capability may support more accurate pre-procedural planning, may help guide ablation targets, and could refine selection and optimization of cardiac resynchronization therapy candidates.

Background: 25-hydroxyvitamin D₃ (25(OH)D₃) affects immune function, bone health, and reproduction. The precursor of 25(OH)D₃, vitamin D₃, is synthesized upon ultraviolet (UV) radiation exposure, the levels of which vary.

Methods: In a one-year observational study, we used multiple statistical approaches to examine 25(OH)D₃ metabolism and UV exposure in 217 healthy men (aged 30-50 years) not using vitamin D supplementation, living between Athens and the Arctic Circle. Complementary data were obtained from six consecutive crews of Antarctic expeditioners.

Results: We show that, while vitamin D₃ synthesis tracks UV exposure, resulting 25(OH)D₃ concentrations are strongly shaped by the kinetics of 25(OH)D₃ synthesis and degradation. Notably, the efficiency of 25(OH)D₃ synthesis is high at low vitamin D₃, but decreases markedly at higher vitamin D₃. This results in comparable summer 25(OH)D₃ maxima across European sites. Additionally, the kinetics of 25(OH)D₃ degradation induces rapid seasonal concentration shifts, yet also exerts a moderating effect by dampening both seasonal maximum and minimum 25(OH)D₃. Comparison of the seasonal patterns of plasma parameters and environmental parameters at European sites shows that vitamin D₃ follows the UV exposure pattern, while 25(OH)D₃ concentrations align with local temperature patterns. Antarctic data support the alignment between 25(OH)D concentrations and temperature.

Conclusions: The kinetics of 25(OH)D₃ synthesis and degradation modulate the effect of variable UV exposure on 25(OH)D₃ concentrations. This results in a regulated plasma signal reflecting local seasonal parameters. While absolute 25(OH)D₃ concentrations are commonly investigated, future studies should also examine their temporal dynamics as a biological signal.

Background: Cognitive resilience refers to an individual's capacity to cope with brain aging and pathology and to delay cognitive decline, whereas existing techniques such as functional magnetic resonance imaging capture only macroscopic features without linking them to neurophysiological mechanisms. Recent studies have shown that overexpression of the MST1 gene exacerbates Alzheimer's disease phenotypes by affecting neuronal activity and metabolism; however, its association with cognitive trajectories and imaging biomarkers remains to be further investigated.

Methods: Multimodal imaging data using information from 116 individuals with mild cognitive impairment was obtained from the ADNI database and participants from the HABS database. The correlation coefficient between glucose metabolism and neuronal low-frequency fluctuations was calculated, and residuals were derived from regression models of correlation coefficient with amyloid protein. Unsupervised clustering was then applied, and mediation analysis was conducted to investigate the mediating role of limbic orbital frontal cortex residuals in the association between MST1 gene expression and cognitive trajectories.

Results: Clustering identifies five groups with distinct cognitive trajectories: the high and low cognitive resilience groups exhibit slower dementia progression with lower MST1 expression, whereas the high and low cognitive vulnerability groups show faster dementia progression with higher MST1 expression. No significant differences are observed in glucose metabolism or amyloid protein levels across groups, while the limbic orbital frontal cortex residuals partially mediate the effect of MST1 gene expression on cognitive trajectories.

Conclusions: Residual biomarkers can track dementia progression and characterize MST1-related pathology, providing imaging markers for assessing cognitive resilience and monitoring disease at the molecular level.

Background: One third of patients with Escherichia coli bacteraemia develop a dysregulated inflammatory response (sepsis/septic shock). Our objective was to investigate whether specific microbiological determinants of E. coli are associated to presentation with sepsis/shock.

Methods: A matched case-control study was performed; 101 case-patients with E. coli bacteraemia presenting with sepsis (SEPSIS-3 criteria) and 101 control-patients with E. coli bacteraemia without sepsis were matched by service, sex, age, Charlson index, acquisition and source of the bacteraemia and empirical treatment. Whole genome sequencing of E. coli isolates was performed (Illumina MiSeq Inc.). Sequence type, serotype, fimH type, virulence factors, antibiotic resistance genes, plasmid replicons pathogenicity islands and prophages were determined. A multivariate model was built for presentation with sepsis/septic shock using conditional logistic regression. The predictive capacity on the observed data was measured with the area under the ROC curve (AUROC) with 95% confidence intervals (CI).

Results: Here we show that in the multivariate model (adjusted OR; 95% CI), the ST69 clone (7.53; 1.06-35.05) and pic gene (4.38; 1.53-12.54) are associated to presentation with sepsis/shock, while the genes papC (0.30; 0.12-0.74) and fdeC (0.18; 0.03-1.32) show a protective effect. The AUROC of this model is 0.81 (95% CI 0.74-0.87).

Conclusions: We identify E. coli bacterial factors associated with severe clinical presentation in patients with bacteraemia. Further studies would be needed to consider these factors as potential preventive or therapeutic targets.

Background: Early prediction of Alzheimer's disease is important for timely intervention and treatment. We examine whether machine learning on longitudinal electronic health record notes can improve early prediction of Alzheimer's disease.

Methods: From Veterans Health Administration records (2000 to 2022), we studied 61,537 individuals diagnosed with Alzheimer's disease and 234,105 without, aged 45-103 years, 98.4% were male. From clinical notes, we quantified the frequency of subjective cognitive decline and Alzheimer's disease-related keywords, and applied statistical machine learning models to assess their ability to predict future diagnosis.

Results: Here we show that Alzheimer's-related keywords (e.g., "concentration," "speaking"), occur more often in notes of individuals who later develop Alzheimer's disease than in controls. In the 15 years preceding diagnosis, cases demonstrate an exponential increase in keyword mentions (from 9.4 to 57.7 per year), whereas controls show a slower, linear increase (8.2 to 20.3). These trends are consistent across demographic subgroups. Random forest models using these keywords for prediction achieve an area under receiver operating characteristic curve from 0.577 at ten years before diagnosis to 0.861 one day before diagnosis, consistently outperforming models using only structured data.

Conclusions: Signs and symptoms of early Alzheimer's disease are reported in clinical notes many years before a clinical diagnosis is made and the frequency of these signs and symptoms, approximated by keywords, increases the closer one is to the diagnosis. A simple keyword-based approach can capture these signals and can help identify individuals at high risk of future Alzheimer's disease.

Background: The transcription factor Hypoxia-Inducible Factor 2α (HIF2α) plays a crucial role in cancer cell adaptation to hypoxic conditions, particularly in clear cell renal cell carcinoma, promoting tumor growth and angiogenesis. Targeting HIF2α through pharmacologic inhibition offers a promising therapeutic strategy for HIF2α-driven cancers.

Methods: An in silico docking study using 10,000 drug-like compounds was performed using the previously solved X-ray crystal structure of HIF2α. Select compounds predicted to bind to the Per-Arnt-Sim-A (PAS-A) and PAS-B domains of HIF2α were further evaluated for biological activity in clear cell renal cell carcinoma and normal kidney cell lines. Biochemical and cell-based assays were performed to define the mechanism of action for a lead compound.

Results: Here, we identify Compound-c2 as a selective HIF2α inhibitor that binds to the PAS-B domain of HIF2α. Notably, Compound-c2 disrupts the interaction between HIF2α and the molecular chaperone Hsp70, leading to proteasomal degradation of HIF2α and the induction of apoptosis in ccRCC.

Conclusions: The distinctive inhibitory mechanism of the HIF2α inhibitor identified here, Compound-c2, sets it apart from previous HIF2α antagonists. This positions Compound-c2 as a promising alternative with potential applications in addressing drug resistance, providing a unique approach to inhibit HIF2α-related processes.

Background: The clinical symptoms of obstructive sleep apnea (OSA) are poorly correlated with disease severity based on the apnea-hypopnea index (AHI). The cumulative duration of respiratory effort assessed by mandibular jaw movement monitoring with automated analysis (REMOV) may better capture the clinical burden of OSA. This cross-sectional study assessed the association between REMOV and patient-reported outcomes (PROs), including sleepiness, fatigue, and depression.

Methods: One thousand adults referred for suspected OSA underwent polysomnography, REMOV analysis, and PRO assessment using validated questionnaires. Relationships between REMOV, AHI, and PROs were examined using principal component analysis and regression models.

Results: Median REMOV values align with OSA severity (6.5%, 23.4%, 28.8%, and 42.8% of total sleep time at AHI values of <5, 5-15, 15- < 30, and ≥30 events/h, respectively). REMOV is significantly associated with sleepiness, fatigue, and depression. These associations are most evident in patients with an AHI ≤ 15 events/h. AHI is not significantly associated with any PROs.

Conclusions: These data suggest that REMOV may serve as a complementary metric in OSA, especially in patients with mild disease. Incorporating REMOV into OSA severity grading may improve the alignment between PROs and therapeutic decisions.

Background: Homologous recombination deficiency (HRD) impacts cancer treatment strategies, particularly effective utilization of PARP inhibitors. However, the variability of different HRD assays has hampered the selection of oncology patients who may benefit from these therapies. Our study aims to use the whole genome landscape to better define HRD in a pan-cancer cohort.

Methods: We employed a whole genome sequencing HRD classifier that includes genome-wide signatures associated with HRD to analyze 580 tumor/normal paired samples. The HRD phenotype was correlated with genomic variants in BRCA1/2 and other homologous recombination repair genes.

Results: In this paper we show that the HRD phenotype is identified in various cancers including breast (21%), pancreaticobiliary (20%), gynecological (17%), prostate (9%), upper gastrointestinal (GI) (2%), and other cancers (1%). HRD cases are not confined to BRCA1/2 mutations; 24% of HRD cases are BRCA1/2 wild-type. A diverse range of gene alterations involved in HRD are elucidated, including biallelic mutations in FANCF, XRCC2, and FANCC, and deleterious structural variants. In a subset of cases, the whole genome sequencing-based classifier offers more insights and a better correlation to treatment response when compared to other assays.

Conclusions: Although HRD is a biomarker used to determine which cancer patients would benefit from PARP inhibitors, a lack of harmonization of tests to determine HRD status makes it challenging to interpret their results. Our study highlights the use of comprehensive whole genome sequencing analysis to better predict HRD and elucidates genomic mechanisms associated with this phenotype.

Background: The gut microbiota influences breast cancer development through the estrobolome, a collection of bacterial genes involved in estrogen metabolism. While estrogen and the gut microbiota mutually affect each other, the long-term effects of oral endocrine therapy (ET) on the gut microbiota remain unclear. Furthermore, the relationship between gut microbiota profiles and breast cancer recurrence is not well understood. This study aims to investigate the long-term impact of oral ET on gut microbiota composition in disease-free and recurrent breast cancer patients.

Methods: We enrolled 48 participants divided into four groups: tamoxifen only (Tam), letrozole only (Let), chemotherapy plus letrozole without recurrence (CLet), and chemotherapy plus letrozole with recurrence (Recu). Fecal samples were collected for 16S rRNA sequencing. Blood samples for cell-free DNA (cfDNA) analysis and tissue samples for EndoPredict (EPclin) scoring.

Results: Here we show that long-term ET administration does not significantly alter overall gut microbial composition. However, patients with recurrence display lower α-diversity and higher abundances of Sutterella and Ruminococcus compared with non-recurrent patients. cfDNA profiles do not differ significantly between groups. Notably, high EPclin scores predict chemotherapy benefit, but recurrence still occurs in some cases. In such patients, gut microbial markers effectively distinguish recurrence and are associated with poorer progression-free survival, particularly in those with larger tumors.

Conclusions: This study provides the first human evidence with long-term ET administration to reveal that, besides genetic profiles, the gut microbiota is another critical factor that we should consider in the influence and prediction of breast cancer recurrence in the future.