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2 Minute Medicine Rewind July 27, 2025
1. Increases in serum 25 (OH) D concentration were nonlinearly associated with decreased all-cause, cardiovascular disease mortality, and cancer mortality, with protective effects no longer significant beyond certain thresholds.
Evidence Rating Level: 2 (Good)
There is a global prevalence of vitamin D insufficiency, with older adults at higher risk due to age-related declines in multiple body systems. This study aimed to quantify the prevalence of vitamin D deficiency and its relationship with all-cause and cause-specific mortality risk among middle-aged and older U.S. adults. This retrospective cohort study used data from the National Health and Nutrition Examination Survey (NHANES) 2001–2018 and included participants aged 40–70 years. Serum 25-hydroxy vitamin D [25(OH)D] concentrations were measured and categorized into four groups: severely deficient (<25.0 nmol/L), moderately deficient (25.0–49.9 nmol/L), insufficient (50.0–74.9 nmol/L), and sufficient (≥75.0 nmol/L). Among the 22,130 participants included in the analysis (mean [SD] age = 54.6 [8.9] years), the prevalence of vitamin D deficiency (≤50.00 nmol/L) was 33.59%, and insufficiency (≤75.00 nmol/L) was 71.74%. During a median follow-up of 103 months (interquartile range: 57–154 months), there were 2345 all-cause deaths, with 636 deaths related to cardiovascular disease (CVD) and 684 related to cancer. As 25(OH)D levels increased from < 25.00, 25.00–49.99, 50.00–74.99, to ≥ 75.00 nmol/L, the risk of all-cause mortality decreased, with adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of 1.00 (reference), 0.78 (0.65, 0.93), 0.59 (0.49,0.72), and 0.54 (0.44, 0.66), respectively. Similar trends were found for CVD mortality. For cancer mortality, only the insufficient and sufficient groups had lower mortality compared to the severely deficient group, with adjusted HR (95% CI) 0.62 (0.43–0.89) and 0.63 (0.42–0.92), respectively. A non-linear relationship was observed between 25 (OH) D concentration and mortality: increases in 25(OH)D were associated with reduced risks of all-cause, CVD, and cancer mortality when levels were below 54.80 nmol/L, 44.70 nmol/L, and 58.70 nmol/L, respectively; however, these associations were no longer significant once concentrations exceeded these thresholds. Overall, this study found that increases in serum 25 (OH) D concentration were nonlinearly associated with decreased all-cause, CVD, and cancer mortality, with protective effects no longer significant beyond specific thresholds. Maintaining an appropriate concentration of 25 (OH) D may be important in reducing mortality risk. Future studies are needed to investigate underlying mechanisms.
1. Compared to propofol, ciprofol had a better sedative effect, fewer adverse effects, and greater hemodynamic stability during general anesthesia induction in patients with obesity undergoing laparoscopic sleeve gastrectomy.
Evidence Rating Level: 1 (Excellent)
Obesity results in pathophysiological changes that can increase anesthetic risk during bariatric surgery, including laparoscopic sleeve gastrectomy (LSG), making the choice of safe and effective anesthetic agents critical. Propofol is commonly used for anesthesia induction and maintenance, but can lead to injection pain, circulatory and respiratory depression, and in rare cases propofol infusion syndrome, resulting in multiple organ failure and death. Ciprofol is a newer intravenous anesthetic that has shown potential advantages such as high potency and low respiratory and circulatory depression post-injection; however, limited research exists for ciprofol’s clinical use in patients with obesity. This study thus compared the efficacy and safety of ciprofol versus propofol in inducing general anesthesia in patients with obesity undergoing LSG. This was a randomized, double-blind, controlled study conducted at a hospital in Chengdu, China between January and June 2023. Adults aged 19 − 65 years with a body mass index (BMI) ≥35 kg/m2 scheduled for LSG were included and randomly assigned 1:1 into one of two groups: ciprofol (0.5 mg/kg) and propofol (2.5 mg/kg) groups. A total of 212 participants were included in this study with 106 in each group (ciprofol group: mean [SD] age = 31.45 [7.85], female [%] = 69 [65.09]; propofol group: mean [SD] age = 32.65 [7.33], female [%] = 76 [71.70]). Both ciprofol and propofol groups achieved a 100% success rate of anesthesia induction, with no significant difference between groups. Compared to the propofol group, the ciprofol group had a longer time to successful induction onset (39.38 ± 8.57 s vs. 36.74 ± 6.82 s, P = 0.014) and to eyelash reflex disappearance (40.36 ± 8.59 s vs. 37.77 ± 6.84 s). Incidence of adverse events was lower in the ciprofol group than in the propofol group (25.47% vs. 89.62%, P = 0.000). Moreover, the ciprofol group had a lower incidence of hypotension compared to propofol (14.15% vs. 37.74%, P < 0.001), and more patients maintained appropriate sedation depth (86.80% vs. 72.64%, P = 0.010, 40 ≤ bispectral index ≤ 60 within 10 min of intravenous administration). Overall, this study found ciprofol to have a better sedative, fewer adverse effects, and greater hemodynamic stability compared to propofol during general anesthesia induction in patients with obesity undergoing LSG. Future clinical trials are needed to confirm these findings.
Psychological and Physical Health of a Preterm Birth Cohort at Age 35 Years
1. U.S. adults born preterm have increased internalizing mental health problems, blood pressure, triglycerides, and body fat distribution, along with lower high-density lipoprotein cholesterol and bone density at age 35 compared with their full-term peers.
Evidence Rating Level: 2 (Good)
Preterm birth can have lifelong consequences, with research showing that adults born preterm face a higher risk of various chronic conditions, including diabetes, heart failure, and ischemic heart disease. Given that much of the current research on individuals born preterm comes from international studies of homogeneous populations, there is a need to study health outcomes in a more diverse, U.S.-born cohort. This study thus aimed to examine how early-life medical risk from preterm birth is associated with psychological and physiological health in adulthood. This study analyzed data from the Rhode Island Cohort of Adults Born Preterm (RHODE) Study cohort, the longest continuously running US study of individuals born preterm, using data from the tenth follow-up conducted between March 2020 and March 2024. This prospective cohort included preterm infants recruited from a Level III neonatal intensive care unit (NICU) in New England between 1985 and 1989, along with a control group of healthy full-term infants. Cumulative medical risk was indexed across multiple follow-up assessments. In total, 158 preterm and 55 full-term–born adults (mean [SD] age = 35.0 [1.3] years, female [%] = 107 [50.2];17 Black [8.0%], 9 Hispanic [4.2%], 186 White [87.3%]) were included in the analysis. Higher birth-childhood medical risk severity was associated with increased adulthood internalizing problems (β [standard error (SE)], 0.85 [0.33]; P = .01), higher systolic blood pressure (β [SE], 7.15 [2.47]; P = .004), lower high-density lipoprotein (good) cholesterol (β [SE], −13.07 [4.4]; P = .003), higher triglycerides (β [SE], 53.97 [24.6]; P = .03), higher android-to-gynoid fat ratio, indicating more central fat accumulation (β [SE], 0.22 [0.08]; P = .006), and lower bone density (β [SE], −1.14 [0.40]; P = .004). Overall, this study found that US adults born preterm with higher early life medical risk had increased mental health disorders, cardiometabolic issues, and body composition differences at age 35 compared with their full-term peers. Evidence-based clinical screening guidelines may be needed for adults born preterm to support early intervention and preventative care.
1. In a retrospective cohort study of adults included in the National Health and Nutrition Examination Survey (NHANES), obesity was associated with increased odds of gallstones.
2. The inflammatory markers white blood cell count (WBC), neutrophil count (NEU), and C-reactive protein (CRP) partially mediated this relationship.
Evidence Rating Level: 2 (Good)
The mechanisms underlying the relationship between obesity and gallstones are unclear. Some studies have suggested that inflammatory factors may mediate the relationship between obesity and gallstones, but evidence is lacking. This study thus examined the relationship between obesity and gallstones and the mediating role of inflammatory factors. This retrospective cohort study analyzed data from the National Health and Nutrition Examination Survey (NHANES) collected between 2017 and 2020 and included adults aged >20 years. The study population was divided into four groups: “Obesity with Gallstones,” “Gallstones without Obesity,” “Obesity without Gallstones,” and “Neither Gallstones nor Obesity.” The presence of gallstones was self-reported, and obesity was defined as a BMI ≥ 30kg/m2. Inflammatory markers included white blood cell count (WBC), neutrophil count (NEU), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), and the systemic immune inflammation index (SII). In total, 7978 were included in the study, of which 517 were in the “Gallstone with obesity” group (mean [SD] age = 56.11 (15.36); female [%] = 401 [77.6]). Obesity was associated with an increased odds of gallstones (adjusted odds Ratio (OR) = 1.86; 95% CI, 1.57–2.22). Inflammatory markers, such as WBC (adjusted OR = 1.61; 95% CI, 1.22–2.11), NEU (adjusted OR = 1.46; 95% CI, 1.17–1.81), and CRP (adjusted OR = 1.18; 95% CI, 1.10–1.28), were also associated with increased odds of gallstones. After adjusting for confounders, WBC, NEU, and CRP mediated the relationship between obesity and gallstones by 3.91%, 3.76%, and 12.48%, respectively. Subgroup analysis found only WBC and NEU to mediate effects in individuals 41–60 years, while PLR had a negative association in those over 60. Among females, no mediating effects were found after adjustments. Overall, this study found obesity to increase the risk of gallstones, with some inflammatory markers partially mediating this relationship. Reducing inflammation may help lower the risk of gallstone formation associated with obesity. Future studies are needed to confirm these findings.
1. Higher red cell distribution width to albumin ratio (RAR) values were associated nonlinearly with a higher mortality risk.
2. The predictive power of RAR alone was moderate but increased when combined with Sequential Organ Failure Assessment (SOFA) scores.
Evidence Rating Level: 2 (Good)
Current scoring systems, such as the Sequential Organ Failure Assessment (SOFA), can help predict intensive care unit (ICU) mortality but are often complex and require multiple clinical inputs. Simpler prognostic markers are needed to complement existing tools to improve risk stratification. Red cell distribution width (RDW)-to-albumin ratio (RAR) is a novel composite marker with emerging evidence as a potential predictor of mortality across patients with diseases. However, its role in predicting mortality in the diverse ICU population remains unclear. This study thus examined the role of RAR as a predictor of mortality in ICU patients. This retrospective cohort study used data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and included ICU patients aged 18-90 who were admitted between 2008 and 2022. The primary outcome was all-cause mortality within 28 days after ICU admission. In total, 24,568 ICU patients were included in the study (median [IQR] age = 66 [54-76] years; females [%] = 10,484 [42.67]). Higher RAR values were nonlinearly associated with a higher 28-day mortality risk (adjusted HR = 1.06, 95% CI 1.05–1.07, P < 0.001) and a significant nonlinear relationship (P < 0.001), with a sharp increase in mortality risk observed when RAR values exceeded approximately 5.0 (P for nonlinearity < 0.001). The predictive power of RAR for 28-day mortality was moderate (area under the curve (AUC) = 0.66, 95% CI 0.65–0.67) but improved when combined with SOFA scores (AUC = 0.74, 95% CI 0.72–0.76). Overall, this study found RAR alone has moderate predictive ability for mortality but increases prognostic accuracy when combined with SOFA scores, highlighting RAR’s potential as an adjunct to mortality risk assessment in the ICU setting. Future studies are needed to validate these findings across diverse populations.
Image: PD
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