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1.
Nutrients ; 16(11)2024 Jun 04.
Article in English | MEDLINE | ID: mdl-38892690

ABSTRACT

Dietary interventions represent an interesting alternative to pharmacological treatments for improving the quality of life (QoL) of subjects suffering from gastroesophageal reflux disease (GERD). This randomized, double-blind, placebo-controlled study aimed to evaluate the efficacy of a food supplement (FS) containing a probiotic strain, bioactive peptides, and vitamins in relieving heartburn/dyspeptic symptoms in subjects with mild-to-moderate GERD. Fifty-six adult participants were randomly assigned to receive the placebo or the active FS for 28 days. Subjects were asked to record daily the frequency and intensity of heartburn episodes and the intake of over- the-counter (OTC) medications. GERD-QoL and self-assessment questionnaires were also completed every two weeks and at the end of the treatment, respectively. FS was effective in achieving a progressive and significant reduction of heartburn frequency and severity, with an intergroup significant difference at the end of the treatment period. FS group also reported a reduction in the OTC medication intake, whereas placebo administration did not modify the OTC intake. Results from the QoL and self-assessment questionnaires showed that FS administration achieved a progressive and statistically significant intragroup and intergroup improvement in the QoL score and a higher positive response with respect to the placebo treatment.


Subject(s)
Dietary Supplements , Gastroesophageal Reflux , Lactobacillus acidophilus , Peptides , Probiotics , Quality of Life , Vitamins , Humans , Gastroesophageal Reflux/drug therapy , Male , Double-Blind Method , Female , Adult , Probiotics/administration & dosage , Probiotics/therapeutic use , Middle Aged , Vitamins/administration & dosage , Treatment Outcome , Peptides/administration & dosage , Peptides/therapeutic use , Heartburn/drug therapy , Surveys and Questionnaires , Severity of Illness Index
2.
Int J Chron Obstruct Pulmon Dis ; 19: 1315-1331, 2024.
Article in English | MEDLINE | ID: mdl-38895046

ABSTRACT

Purpose: Cigarette smoking is the most recognized risk factor of chronic obstructive pulmonary disease (COPD) in China. However, there are no studies analyzing the impact of different smoking behaviors on pulmonary function and pulmonary hypertension (PH) among Chinese male patients with COPD. Patients and Methods: Chinese male smokers with COPD performed pulmonary function tests. Clinical characteristics, smoking behavior features, spirometry and echocardiographic results were compared between the two groups stratified by initial smoking age (18 years old) or complicated PH. Results: The early-smoking group had more respiratory symptoms, more severe smoking behavior, worse pulmonary function with lower FEV1%pre (38.5% vs 70.2%) and FEV1/FVC% (47.5% vs 63.8%), and higher systolic pulmonary artery pressure (sPAP: 38.6 vs 33.9 mmHg) than the late-smoking group. Initiating smoking before adulthood was an independently contributing factor of ventilatory dysfunction and Global Initiative for Obstructive Lung Disease (GOLD) stage escalation. It also had a significant interaction with long smoking duration (≥30 years), characterized by markedly decreased lung volumes (VC%pre: 64.0% vs 84.5%), impaired diffusing capacity (DLCO%pre: 58.0% vs 76.8%) and severe emphysema (RV/TLC%pre: 145.2% vs 130.2%). COPD patients complicated with PH exhibited worse ventilatory function (FEV1%pre: 43.2% vs 56.2%), impaired diffusion capacity (DLCO%pre: 56.7% vs 77.1%) and decreased lung volume (VC%pre: 67.67% vs 75.38%). Both severe smoking behaviors and impaired pulmonary function had close correlations with sPAP. Conclusion: The early-smoking group exhibited predominantly ventilation dysfunction and had complex interactions with long smoking duration to further affect lung volume and diffusion capacity. Different smoking behaviors influenced variations of pulmonary dysfunction and comorbid PH in patients with COPD.


Subject(s)
Hypertension, Pulmonary , Lung , Pulmonary Disease, Chronic Obstructive , Smoking , Humans , Male , Pulmonary Disease, Chronic Obstructive/physiopathology , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/epidemiology , Middle Aged , Lung/physiopathology , China/epidemiology , Hypertension, Pulmonary/physiopathology , Hypertension, Pulmonary/epidemiology , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/etiology , Risk Factors , Aged , Forced Expiratory Volume , Smoking/adverse effects , Smoking/epidemiology , Vital Capacity , Spirometry , Pulmonary Diffusing Capacity , Time Factors , Severity of Illness Index , Smokers , Arterial Pressure , Pulmonary Artery/physiopathology , Cross-Sectional Studies , East Asian People
3.
Front Immunol ; 15: 1407768, 2024.
Article in English | MEDLINE | ID: mdl-38895111

ABSTRACT

C-reactive protein (CRP) is an acute-phase protein produced by the liver in response to infection and during chronic inflammatory disorders. Systemic inflammation is a major driver of cirrhosis progression from the compensated to the decompensated stage. Previous studies have shown that pentameric CRP (pCRP) to be a weak predictor of disease severity and prognosis in patients with decompensated hepatitis B cirrhosis, with it being only helpful for identifying patients with a higher short-term risk of death under certain conditions. Accumulating evidence indicates that pCRP dissociates to and acts primarily as the monomeric conformation (mCRP) at inflammatory loci, suggesting that mCRP may be a potentially superior disease marker with higher specificity and relevance to pathogenesis. However, it is unknown whether mCRP and anti-mCRP autoantibodies are associated with disease severity, or progression in decompensated hepatitis B cirrhosis. In this study, we evaluated the serum levels of mCRP and anti-mCRP autoantibodies in patients with decompensated cirrhosis of hepatitis B and their association with disease severity and theoretical prognosis. The results showed that patients with high mCRP and anti-mCRP autoantibody levels had more severe liver damage and that coagulation function was worse in patients with high anti-mCRP autoantibodies. Analysis of the correlation between pCRP, mCRP and anti-mCRP autoantibody levels with Model for End-Stage Liver Disease (MELD), Albumin-Bilirubin (ALBI), and Child-Turcotte-Pugh (CTP) prognostic scores showed that mCRP was the most strongly correlated with MELD score, followed by anti-mCRP autoantibodies; conversely, pCRP was not significantly correlated with prognostic score. Therefore, mCRP and anti-mCRP autoantibodies may be more advantageous clinical indicators than pCRP for evaluating the pathological state of decompensated hepatitis B cirrhosis.


Subject(s)
Autoantibodies , Biomarkers , C-Reactive Protein , Liver Cirrhosis , Severity of Illness Index , Humans , C-Reactive Protein/analysis , C-Reactive Protein/metabolism , Female , Prognosis , Male , Liver Cirrhosis/immunology , Liver Cirrhosis/diagnosis , Liver Cirrhosis/blood , Liver Cirrhosis/etiology , Autoantibodies/blood , Autoantibodies/immunology , Middle Aged , Biomarkers/blood , Adult , Disease Progression , Hepatitis B/immunology , Hepatitis B/blood
4.
J Cell Mol Med ; 28(12): e18474, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38896027

ABSTRACT

Our previous study reckons that the impact of the rs1801133 variant of 5,10-methylenetetrahydrofolate reductase (MTHFR) on coronary artery disease (CAD) is possibly mediated by cardiometabolic disorder. This study is performed to verify this hypothesis. Four hundred and thirty CAD patients and 216 CAD-free individuals were enrolled in this case-control study. The rs1801133 variant was genotyped by PCR-RFLP. Severity of coronary lesions was evaluated by number of stenotic coronary vessels and extent of coronary stenosis. The rs1801133 T allele significantly increased homocysteine levels in patients with CAD and CAD-free individuals. Individuals with the T allele of rs1801133 had an increased risk of developing CAD. In contrast, individuals with the TT genotype of rs1801133 were at high risk of multiple vessel lesions. The carriers of CT genotype had higher levels of systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and high-sensitivity C-reactive protein (hs-CRP), and lower levels of apolipoprotein A1 (APOA1) than those with CC genotype in male patients with CAD. The receiver operating characteristic (ROC) curve and precision-recall (PR) curve indicated that hyperhomocysteinemia was sensitive to predict the severity of CAD. Multivariate logistic regression revealed that homocysteine, rs1801133, age, smoking, weight, body mass index (BMI), lipoprotein(a) [Lp(a)], and hs-CRP were independent risk factors for CAD. The increased risk of CAD and severity of coronary lesions associated with rs1801133 in the Chinese Han population were attributed, at least partly, to high homocysteine levels. Hyperhomocysteinemia had a high predictive value for severe CAD or multiple vessel lesions.


Subject(s)
Coronary Artery Disease , Homocysteine , Methylenetetrahydrofolate Reductase (NADPH2) , Polymorphism, Single Nucleotide , Humans , Homocysteine/blood , Male , Coronary Artery Disease/genetics , Coronary Artery Disease/blood , Coronary Artery Disease/pathology , Middle Aged , Female , Case-Control Studies , Methylenetetrahydrofolate Reductase (NADPH2)/genetics , Severity of Illness Index , Aged , Risk Factors , Genetic Predisposition to Disease , ROC Curve , Genotype , C-Reactive Protein/metabolism , C-Reactive Protein/genetics , Alleles , Apolipoprotein A-I/genetics , Apolipoprotein A-I/blood
7.
J Bras Nefrol ; 46(3): e20230066, 2024.
Article in English, Portuguese | MEDLINE | ID: mdl-38885435

ABSTRACT

INTRODUCTION: Blood pressure (BP) assessment affects the management of arterial hypertension (AH) in chronic kidney disease (CKD). CKD patients have specific patterns of BP behavior during ambulatory blood pressure monitoring (ABPM). OBJECTIVES: The aim of the current study was to evaluate the associations between progressive stages of CKD and changes in ABPM. METHODOLOGY: This is a cross-sectional study with 851 patients treated in outpatient clinics of a university hospital who underwent ABPM examination from January 2004 to February 2012 in order to assess the presence and control of AH. The outcomes considered were the ABPM parameters. The variable of interest was CKD staging. Confounding factors included age, sex, body mass index, smoking, cause of CKD, and use of antihypertensive drugs. RESULTS: Systolic BP (SBP) was associated with CKD stages 3b and 5, irrespective of confounding variables. Pulse pressure was only associated with stage 5. The SBP coefficient of variation was progressively associated with stages 3a, 4 and 5, while the diastolic blood pressure (DBP) coefficient of variation showed no association. SBP reduction was associated with stages 2, 4 and 5, and the decline in DBP with stages 4 and 5. Other ABPM parameters showed no association with CKD stages after adjustments. CONCLUSION: Advanced stages of CKD were associated with lower nocturnal dipping and greater variability in blood pressure.


Subject(s)
Blood Pressure Monitoring, Ambulatory , Hypertension , Renal Insufficiency, Chronic , Humans , Cross-Sectional Studies , Male , Female , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/physiopathology , Middle Aged , Hypertension/complications , Hypertension/physiopathology , Blood Pressure/physiology , Aged , Disease Progression , Adult , Severity of Illness Index
8.
RMD Open ; 10(2)2024 Jun 17.
Article in English | MEDLINE | ID: mdl-38886001

ABSTRACT

OBJECTIVES: To train, test and validate the performance of a convolutional neural network (CNN)-based approach for the automated assessment of bone erosions, osteitis and synovitis in hand MRI of patients with inflammatory arthritis. METHODS: Hand MRIs (coronal T1-weighted, T2-weighted fat-suppressed, T1-weighted fat-suppressed contrast-enhanced) of rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients from the rheumatology department of the Erlangen University Hospital were assessed by two expert rheumatologists using the Outcome Measures in Rheumatology-validated RA MRI Scoring System and PsA MRI Scoring System scores and were used to train, validate and test CNNs to automatically score erosions, osteitis and synovitis. Scoring performance was compared with human annotations in terms of macro-area under the receiver operating characteristic curve (AUC) and balanced accuracy using fivefold cross-validation. Validation was performed on an independent dataset of MRIs from a second patient cohort. RESULTS: In total, 211 MRIs from 112 patients (14 906 region of interests (ROIs)) were included for training/internal validation using cross-validation and 220 MRIs from 75 patients (11 040 ROIs) for external validation of the networks. The networks achieved high mean (SD) macro-AUC of 92%±1% for erosions, 91%±2% for osteitis and 85%±2% for synovitis. Compared with human annotation, CNNs achieved a high mean Spearman correlation for erosions (90±2%), osteitis (78±8%) and synovitis (69±7%), which remained consistent in the validation dataset. CONCLUSIONS: We developed a CNN-based automated scoring system that allowed a rapid grading of erosions, osteitis and synovitis with good diagnostic accuracy and using less MRI sequences compared with conventional scoring. This CNN-based approach may help develop standardised cost-efficient and time-efficient assessments of hand MRIs for patients with arthritis.


Subject(s)
Deep Learning , Magnetic Resonance Imaging , Osteitis , Synovitis , Humans , Osteitis/diagnostic imaging , Osteitis/etiology , Osteitis/diagnosis , Osteitis/pathology , Synovitis/diagnostic imaging , Synovitis/etiology , Synovitis/diagnosis , Magnetic Resonance Imaging/methods , Male , Female , Middle Aged , Arthritis, Rheumatoid/diagnostic imaging , Arthritis, Rheumatoid/complications , Hand/diagnostic imaging , Hand/pathology , Arthritis, Psoriatic/diagnostic imaging , Arthritis, Psoriatic/diagnosis , Adult , Aged , ROC Curve , Severity of Illness Index , Neural Networks, Computer
9.
BMC Emerg Med ; 24(1): 101, 2024 Jun 18.
Article in English | MEDLINE | ID: mdl-38886641

ABSTRACT

BACKGROUNDS: Acute Appendicitis (AA) is one of the most common surgical emergencies worldwide. This study aims to investigate the predictive performances of 6 different Machine Learning (ML) algorithms for simple and complicated AA. METHODS: Data regarding operated AA patients between 2012 and 2022 were analyzed retrospectively. Based on operative findings, patients were evaluated under two groups: perforated AA and none-perforated AA. The features that showed statistical significance (p < 0.05) in both univariate and multivariate analysis were included in the prediction models as input features. Five different error metrics and the area under the receiver operating characteristic curve (AUC) were used for model comparison. RESULTS: A total number of 1132 patients were included in the study. Patients were divided into training (932 samples), testing (100 samples), and validation (100 samples) sets. Age, gender, neutrophil count, lymphocyte count, Neutrophil to Lymphocyte ratio, total bilirubin, C-Reactive Protein (CRP), Appendix Diameter, and PeriAppendicular Liquid Collection (PALC) were significantly different between the two groups. In the multivariate analysis, age, CRP, and PALC continued to show a significant difference in the perforated AA group. According to univariate and multivariate analysis, two data sets were used in the prediction model. K-Nearest Neighbors and Logistic Regression algorithms achieved the best prediction performance in the validation group with an accuracy of 96%. CONCLUSION: The results showed that using only three input features (age, CRP, and PALC), the severity of AA can be predicted with high accuracy. The developed prediction model can be useful in clinical practice.


Subject(s)
Appendicitis , Machine Learning , Severity of Illness Index , Humans , Appendicitis/diagnosis , Female , Male , Retrospective Studies , Adult , Middle Aged , C-Reactive Protein/analysis , ROC Curve , Algorithms , Adolescent , Acute Disease , Young Adult , Aged
10.
Ital J Pediatr ; 50(1): 116, 2024 Jun 18.
Article in English | MEDLINE | ID: mdl-38886797

ABSTRACT

BACKGROUND: Anemia is a common complication of tuberculosis (TB), and there is evidence that its prevalence is higher in patients with TB. Although TB is very important in epidemiology, careful investigation of TB-related anemia in children has not been carried out systematically. This study aimed to describe the details of anemia in children with TB and its association with clinical characteristics and the severity of inflammation. METHODS: In this retrospective study, we explored Hb levels in 103 children with pulmonary TB (PTB) and they were divided into anemic or non-anemic groups. Logistics regression analysis was used to study the associations between anemia and demographic characteristics. Spearman correlations analysis was performed to analyse the associations between the biochemical parameters and hemoglobin levels in blood. RESULTS: The prevalence of anemia in children with TB was 37.9% (48.7% showed microcytic hypochromic anemia, and 5.1% showed normal cell anemia). Compared with the anemia (n = 39) group, the non-anemic group (n = 64) had longer fever duration and increased respiratory rate (P < 0.05). In logistic regression analysis, anemia was associated with lower levels of Alb and higher levels of WBC, CRP, LDH, and ESR (P < 0.05). Spearman correlations analysis showed a significant negative correlation between hemoglobin (Hb) levels and inflammatory markers. After one month of antitubercular therapy (ATT), the Hb levels of 76.9% children returned to normal. CONCLUSIONS: Anemia is common among children with TB at diagnosis. The majority of children with TB-related anemia are mild to moderate microcytic hypochromic anemia. There is a strong correlation between the severity of anemia and the inflammation induced by TB. This suggests that anemia is a biomarker of the severity of TB in clinical practice among children.


Subject(s)
Anemia , Inflammation , Severity of Illness Index , Humans , Retrospective Studies , Male , Female , Anemia/etiology , Anemia/blood , Anemia/epidemiology , Child , Child, Preschool , Tuberculosis, Pulmonary/complications , Tuberculosis, Pulmonary/blood , Prevalence , Infant
11.
Acta Derm Venereol ; 104: adv40127, 2024 Jun 17.
Article in English | MEDLINE | ID: mdl-38887031

ABSTRACT

Heat application is known to activate transient receptor potential (TRP) channels, which play a crucial role in sensory perception, including itch. In this study, the effect of a 5-s, 49°C heat application on itch intensity in atopic dermatitis (AD) patients was evaluated. The study comprised 2 parts: a controlled trial investigating the impact of brief heat treatment on mechanically induced itch, and a real-life study of AD patients experiencing itch attacks. A significant and immediate reduction in itch sensations following heat application was shown, with effects enduring over time. This response, however, showed notable individual variability, underscoring the potential of personalized approaches in AD treatment. Repeated applications of heat showed no habituation effect, suggesting its viability as a non-pharmacological, patient-tailored option for managing itch in AD. Further research in larger cohorts is warranted to refine treatment protocols and deepen understanding of the mechanisms involved.


Subject(s)
Dermatitis, Atopic , Hot Temperature , Pruritus , Humans , Dermatitis, Atopic/therapy , Dermatitis, Atopic/physiopathology , Dermatitis, Atopic/complications , Pruritus/therapy , Pruritus/physiopathology , Pruritus/etiology , Female , Male , Adult , Young Adult , Middle Aged , Treatment Outcome , Time Factors , Severity of Illness Index , Adolescent
12.
CNS Neurosci Ther ; 30(6): e14797, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38887169

ABSTRACT

BACKGROUND: In absence of drug therapy options, standard treatment for spinocerebellar ataxia consists of symptomatic physiotherapy and speech therapy. New therapeutic options are urgently needed. Transcranial magnetic stimulation is a promising therapeutic option, but applicability is limited by lengthy duration of stimulation protocols. METHODS: In this randomized sham controlled clinical trial, patients were assigned to verum (n = 15) or sham (n = 18) cerebellar transcranial magnetic stimulation. To yield best possible treatment effects, both intervention groups received intensified physiotherapy for the duration of the study. RESULTS: Ataxia severity was reduced by 1.6 points on the Scale for assessment and Rating of Ataxia among patients in the verum group (p < 0.001). Clinical improvement was significantly larger in the verum group, compared to the sham group (p < 0.01). The treatment effect was mainly carried by improved appendicular coordination. Patients in the verum group also significantly improved in the 8 Meter Walk Test (p < 0.05) and PATA rate (p < 0.01). CONCLUSIONS: Cerebellar rTMS ameliorates ataxia severity in patient with spinocerebellar ataxia. Condensing treatment duration to only 5 days without reduction of treatment effects facilitates applicability and therefore broadens availability to larger patient populations.


Subject(s)
Cerebellum , Physical Therapy Modalities , Spinocerebellar Ataxias , Transcranial Magnetic Stimulation , Humans , Spinocerebellar Ataxias/therapy , Male , Female , Transcranial Magnetic Stimulation/methods , Middle Aged , Adult , Treatment Outcome , Combined Modality Therapy/methods , Aged , Severity of Illness Index
13.
Front Public Health ; 12: 1399470, 2024.
Article in English | MEDLINE | ID: mdl-38887257

ABSTRACT

Objective: Pneumonia is a common and serious infectious disease that affects the older adult population. Severe pneumonia can lead to high mortality and morbidity in this group. Therefore, it is important to identify the risk factors and develop a prediction model for severe pneumonia in older adult patients. Method: In this study, we collected data from 1,000 older adult patients who were diagnosed with pneumonia and admitted to the intensive care unit (ICU) in a tertiary hospital. We used logistic regression and machine learning methods to analyze the risk factors and construct a prediction model for severe pneumonia in older adult patients. We evaluated the performance of the model using accuracy, sensitivity, specificity, area under the receiver operating characteristic curve (AUC), and calibration plot. Result: We found that age, comorbidities, vital signs, laboratory tests, and radiological findings were associated with severe pneumonia in older adult patients. The prediction model had an accuracy of 0.85, a sensitivity of 0.80, a specificity of 0.88, and an AUC of 0.90. The calibration plot showed good agreement between the predicted and observed probabilities of severe pneumonia. Conclusion: The prediction model can help clinicians to stratify the risk of severe pneumonia in older adult patients and provide timely and appropriate interventions.


Subject(s)
Intensive Care Units , Pneumonia , Humans , Aged , Female , Risk Factors , Male , Aged, 80 and over , Logistic Models , ROC Curve , Severity of Illness Index , Machine Learning , Risk Assessment/methods , Comorbidity , Age Factors , Tertiary Care Centers
14.
Front Immunol ; 15: 1408406, 2024.
Article in English | MEDLINE | ID: mdl-38887291

ABSTRACT

Introduction: Acute respiratory distress syndrome (ARDS) is a major cause of death among critically ill patients in intensive care settings, underscoring the need to identify biomarkers capable of predicting ARDS patient clinical status and prognosis at an early time point. This study specifically sought to explore the utility and clinical relevance of TM9SF1 as a biomarker for the early prediction of disease severity and prognostic outcomes in patients with ARDS. Methods: This study enrolled 123 patients with severe ARDS and 116 patients with non-severe ARDS for whom follow-up information was available. The mRNA levels of TM9SF1 and cytokines in peripheral blood mononuclear cells from these patients were evaluated by qPCR. The predictive performance of TM9SF1 and other clinical indicators was evaluated using received operating characteristic (ROC) curves. A predictive nomogram was developed based on TM9SF1 expression and evaluated for its ability in the early prediction of severe disease and mortality in patients with ARDS. Results: TM9SF1 mRNA expression was found to be significantly increased in patients with severe ARDS relative to those with non-severe disease or healthy controls. ARDS severity increased in correspondence with the level of TM9SF1 expression (odds ratio [OR] = 2.43, 95% confidence interval [CI] = 2.15-3.72, P = 0.005), and high TM9SF1 levels were associated with a greater risk of mortality (hazard ratio [HR] = 2.27, 95% CI = 2.20-4.39, P = 0.001). ROC curves demonstrated that relative to other clinical indicators, TM9SF1 offered superior performance in the prediction of ARDS severity and mortality. A novel nomogram incorporating TM9SF1 expression together with age, D-dimer levels, and C-reactive protein (CRP) levels was developed and was used to predict ARDS severity (AUC = 0.887, 95% CI = 0.715-0.943). A separate model incorporating TM9SF1 expression, age, neutrophil-lymphocyte ratio (NLR), and D-dimer levels (C-index = 0.890, 95% CI = 0.627-0.957) was also developed for predicting mortality. Conclusion: Increases in ARDS severity and patient mortality were observed with rising levels of TM9SF1 expression. TM9SF1 may thus offer utility as a novel biomarker for the early prediction of ARDS patient disease status and clinical outcomes.


Subject(s)
Biomarkers , Respiratory Distress Syndrome , Severity of Illness Index , Humans , Respiratory Distress Syndrome/mortality , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/blood , Respiratory Distress Syndrome/genetics , Male , Female , Middle Aged , Prognosis , Aged , Adult , ROC Curve , Cytokines/blood , Cytokines/metabolism
15.
Circ Cardiovasc Imaging ; 17(6): e016635, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38889213

ABSTRACT

BACKGROUND: Despite recent guideline recommendations, quantitative perfusion (QP) estimates of myocardial blood flow from cardiac magnetic resonance (CMR) have only been sparsely validated. Furthermore, the additional diagnostic value of utilizing QP in addition to the traditional visual expert interpretation of stress-perfusion CMR remains unknown. The aim was to investigate the correlation between myocardial blood flow measurements estimated by CMR, positron emission tomography, and invasive coronary thermodilution. The second aim is to investigate the diagnostic performance of CMR-QP to identify obstructive coronary artery disease (CAD). METHODS: Prospectively enrolled symptomatic patients with >50% diameter stenosis on computed tomography angiography underwent dual-bolus CMR and positron emission tomography with rest and adenosine-stress myocardial blood flow measurements. Subsequently, an invasive coronary angiography (ICA) with fractional flow reserve and thermodilution-based coronary flow reserve was performed. Obstructive CAD was defined as both anatomically severe (>70% diameter stenosis on quantitative coronary angiography) or hemodynamically obstructive (ICA with fractional flow reserve ≤0.80). RESULTS: About 359 patients completed all investigations. Myocardial blood flow and reserve measurements correlated weakly between estimates from CMR-QP, positron emission tomography, and ICA-coronary flow reserve (r<0.40 for all comparisons). In the diagnosis of anatomically severe CAD, the interpretation of CMR-QP by an expert reader improved the sensitivity in comparison to visual analysis alone (82% versus 88% [P=0.03]) without compromising specificity (77% versus 74% [P=0.28]). In the diagnosis of hemodynamically obstructive CAD, the accuracy was only moderate for a visual expert read and remained unchanged when additional CMR-QP measurements were interpreted. CONCLUSIONS: CMR-QP correlates weakly to myocardial blood flow measurements by other modalities but improves diagnosis of anatomically severe CAD. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03481712.


Subject(s)
Coronary Angiography , Coronary Stenosis , Fractional Flow Reserve, Myocardial , Myocardial Perfusion Imaging , Positron-Emission Tomography , Thermodilution , Humans , Male , Female , Coronary Stenosis/physiopathology , Coronary Stenosis/diagnostic imaging , Middle Aged , Prospective Studies , Aged , Fractional Flow Reserve, Myocardial/physiology , Positron-Emission Tomography/methods , Coronary Angiography/methods , Myocardial Perfusion Imaging/methods , Predictive Value of Tests , Reproducibility of Results , Coronary Circulation/physiology , Severity of Illness Index , Blood Flow Velocity , Computed Tomography Angiography , Coronary Vessels/physiopathology , Coronary Vessels/diagnostic imaging
16.
Circ Cardiovasc Imaging ; 17(6): e016274, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38889214

ABSTRACT

BACKGROUND: This study aimed to develop and validate a computed tomography angiography based machine learning model that uses plaque composition data and degree of carotid stenosis to detect symptomatic carotid plaques in patients with carotid atherosclerosis. METHODS: The machine learning based model was trained using degree of stenosis and the volumes of 13 computed tomography angiography derived intracarotid plaque subcomponents (eg, lipid, intraplaque hemorrhage, calcium) to identify plaques associated with cerebrovascular events. The model was internally validated through repeated 10-fold cross-validation and tested on a dedicated testing cohort according to discrimination and calibration. RESULTS: This retrospective, single-center study evaluated computed tomography angiography scans of 268 patients with both symptomatic and asymptomatic carotid atherosclerosis (163 for the derivation set and 106 for the testing set) performed between March 2013 and October 2019. The area-under-receiver-operating characteristics curve by machine learning on the testing cohort (0.89) was significantly higher than the areas under the curve of traditional logit analysis based on the degree of stenosis (0.51, P<0.001), presence of intraplaque hemorrhage (0.69, P<0.001), and plaque composition (0.78, P<0.001), respectively. Comparable performance was obtained on internal validation. The identified plaque components and associated cutoff values that were significantly associated with a higher likelihood of symptomatic status after adjustment were the ratio of intraplaque hemorrhage to lipid volume (≥50%, 38.5 [10.1-205.1]; odds ratio, 95% CI) and percentage of intraplaque hemorrhage volume (≥10%, 18.5 [5.7-69.4]; odds ratio, 95% CI). CONCLUSIONS: This study presented an interpretable machine learning model that accurately identifies symptomatic carotid plaques using computed tomography angiography derived plaque composition features, aiding clinical decision-making.


Subject(s)
Carotid Artery Diseases , Computed Tomography Angiography , Machine Learning , Plaque, Atherosclerotic , Humans , Computed Tomography Angiography/methods , Male , Female , Retrospective Studies , Plaque, Atherosclerotic/diagnostic imaging , Aged , Middle Aged , Carotid Artery Diseases/diagnostic imaging , Carotid Artery Diseases/complications , Carotid Stenosis/diagnostic imaging , Carotid Stenosis/complications , Predictive Value of Tests , Reproducibility of Results , Carotid Arteries/diagnostic imaging , Severity of Illness Index
17.
Circ Cardiovasc Imaging ; 17(6): e016372, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38889215

ABSTRACT

BACKGROUND: Aortic valve calcification (AVC), Lp(a) [lipoprotein(a)], and low-density lipoprotein cholesterol (LDL-C) are associated with severe aortic stenosis (AS). We aimed to determine which of these risk factors were most strongly associated with the risk of incident severe AS. METHODS: A total of 6792 participants from the MESA study (Multi-Ethnic Study of Atherosclerosis) had computed tomography-quantified AVC, Lp(a), and LDL-C values at MESA visit 1 (2000-2002). We calculated the absolute event rate of incident adjudicated severe AS per 1000 person-years and performed multivariable adjusted Cox proportional hazards regression. RESULTS: The mean age was 62 years old, and 47% were women. Over a median 16.7-year follow-up, the rate of incident severe AS increased exponentially with higher AVC, regardless of Lp(a) or LDL-C values. Participants with AVC=0 had a very low rate of severe AS even with elevated Lp(a) ≥50 mg/dL (<0.1/1000 person-years) or LDL-C ≥130 mg/dL (0.1/1000 person-years). AVC >0 was strongly associated with severe AS when Lp(a) <50 mg/dL hazard ratio (HR) of 33.8 (95% CI, 16.4-70.0) or ≥50 mg/dL HR of 61.5 (95% CI, 7.7-494.2) and when LDL-C <130 mg/dL HR of 31.1 (95% CI, 14.4-67.1) or ≥130 mg/dL HR of 50.2 (95% CI, 13.2-191.9). CONCLUSIONS: AVC better identifies people at high risk for severe AS compared with Lp(a) or LDL-C, and people with AVC=0 have a very low long-term rate of severe AS regardless of Lp(a) or LDL-C level. These results suggest AVC should be the preferred prognostic risk marker to identify patients at high risk for severe AS, which may help inform participant selection for future trials testing novel strategies to prevent severe AS.


Subject(s)
Aortic Valve Stenosis , Aortic Valve , Biomarkers , Calcinosis , Cholesterol, LDL , Lipoprotein(a) , Severity of Illness Index , Humans , Aortic Valve Stenosis/blood , Aortic Valve Stenosis/diagnosis , Aortic Valve Stenosis/epidemiology , Aortic Valve Stenosis/diagnostic imaging , Female , Lipoprotein(a)/blood , Male , Middle Aged , Cholesterol, LDL/blood , Aortic Valve/diagnostic imaging , Aortic Valve/pathology , Calcinosis/blood , Calcinosis/diagnostic imaging , Calcinosis/diagnosis , Calcinosis/epidemiology , Calcinosis/ethnology , Aged , Biomarkers/blood , Risk Factors , Risk Assessment , Incidence , United States/epidemiology , Aged, 80 and over , Predictive Value of Tests , Time Factors , Prospective Studies , Proportional Hazards Models , Tomography, X-Ray Computed , Prognosis
18.
Ultrasound Q ; 40(3)2024 Sep 01.
Article in English | MEDLINE | ID: mdl-38889400

ABSTRACT

METHODS: Twenty-three peer-reviewed articles on HRI measurements published between 2018 through 2023 were reviewed, and 11 were selected based on common subjects. The search terms included "hepatorenal index," "HRI," "HRI ultrasound," "hepatorenal ultrasound index," and "HRI ultrasound measurement."Three common subject areas were identified in the literature and synthesized down to 11 articles. The common subjects identified were HRI technique, HRI limitations, and HRI diagnostic accuracy. The matrix provided a quick overview of the general information in each piece, aiding in the paper's overall organization. Thirteen articles were rejected as not relevant or out of date. The research question leading this review was, "What does the literature say about the value of HRI in determining moderate to severe hepatic steatosis?" RESULTS: The literature revealed that HRI could be valuable in determining moderate to severe hepatic steatosis. HRI could not accurately determine normal or mild steatosis and has several limitations. CONCLUSIONS: HRI is a more objective method for determining the degree of hepatic steatosis compared with traditional B-mode ultrasound scoring and does not require additional or specialized equipment. Many studies excluded patients with various liver diseases, which may not make HRI a practical tool for clinical usefulness. Further studies should be conducted with larger patient cohorts, a greater degree of hepatic steatosis, and determine specific standardized cutoff values.


Subject(s)
Fatty Liver , Liver , Ultrasonography , Humans , Ultrasonography/methods , Fatty Liver/diagnostic imaging , Liver/diagnostic imaging , Kidney/diagnostic imaging , Severity of Illness Index , Reproducibility of Results
19.
BMC Infect Dis ; 24(1): 597, 2024 Jun 18.
Article in English | MEDLINE | ID: mdl-38890575

ABSTRACT

BACKGROUND: There is an urgent need for therapeutic strategies for inpatients with severe or critical COVID-19. The evaluation of the clinical benefits of nirmatrelvir and ritonavir (Nmr/r) for these patients beyond five days of symptom onset is insufficient. METHODS: A new propensity score-matched cohort was constructed by using multicenter data from 6695 adult inpatients with COVID-19 from December 2022 to February 2023 in China after the epidemic control measures were lifted across the country. The severity of disease of the inpatients was based on the tenth trial edition of the Guidelines on the Diagnosis and Treatment of COVID-19 in China. The symptom onset of 1870 enrolled severe or critical inpatients was beyond five days, and they received either Nmr/r plus standard treatment or only standard care. The ratio of patients whose SOFA score improved more than 2 points, crucial respiratory endpoints, changes in inflammatory markers, safety on the seventh day following the initiation of Nmr/r treatment, and length of hospital stay were evaluated. RESULTS: In the Nmr/r group, on Day 7, the number of patients with an improvement in SOFA score ≥ 2 was much greater than that in the standard treatment group (P = 0.024) without a significant decrease in glomerular filtration rate (P = 0.815). Additionally, the rate of new intubation was lower (P = 0.004) and the no intubation days were higher (P = 0.003) in the first 7 days in the Nmr/r group. Other clinical benefits were limited. CONCLUSIONS: Our study may provide new insight that inpatients with severe or critical COVID-19 beyond five days of symptom onset benefit from Nmr/r. Future studies, particularly randomized controlled trials, are necessary to verify the above findings.


Subject(s)
COVID-19 Drug Treatment , Propensity Score , Ritonavir , SARS-CoV-2 , Humans , Ritonavir/therapeutic use , Male , Middle Aged , Female , Retrospective Studies , Aged , China , Antiviral Agents/therapeutic use , Adult , Severity of Illness Index , COVID-19 , Length of Stay/statistics & numerical data , Inpatients , Treatment Outcome
20.
BMC Psychiatry ; 24(1): 450, 2024 Jun 18.
Article in English | MEDLINE | ID: mdl-38890629

ABSTRACT

BACKGROUND: Bipolar Disorder is one of the most incapacitating diseases among young persons, leading to cognitive and functional impairment and raised mortality, particularly death by suicide. Managing a manic episode and developing new and more effective treatment modalities requires sensitive and reliable instruments. This study aims to translate the English version of the YMRS questionnaire into Kinyarwanda, adapt it to the Rwandan context, and assess its validity. METHODS: The original English version of The Young Mania Rating Scale questionnaire was translated into Kinyarwanda. The translation process followed a standardized approach, including back-translation, cross-cultural adaptation, and final adjustments. A total of 130 inpatients with bipolar disorder in a manic episode from CARAES Ndera Teaching Hospital were included. The descriptive statistics and test-retest correlations were carried out, as well as the CFA for validation and Rasch-analysis. RESULTS: The Rwandese version of The Young mania rating scale had an adequate internal consistency (Cronbach's alpha = 0.90). Item 11 provided the lowest standardized loading in both ratings (0.51 and 0.55). The second lowest loading involved the highly correlated item pairs 5 & 9, with item 5 loading 0.51 in rating 1 and item 9 loading 0.57 in rating 2. The remaining loadings ranged from 0.59 to 0.79. This relatively narrow range indicated that a fit to a Rasch model was plausible if excluding item 11. CONCLUSION: The findings demonstrate that the translated YMRS, the R-YMRS, can be used as a reliable and valid instrument for assessing mania in the Rwandese population in clinical and research settings. However, the results supported using an unweighted total score of 32 and removing items 5, 9, and 11. Studies on this revised scale with an added interview guide for less-trained clinical staff are recommended.


Subject(s)
Bipolar Disorder , Psychiatric Status Rating Scales , Psychometrics , Humans , Female , Male , Adult , Bipolar Disorder/diagnosis , Bipolar Disorder/psychology , Psychiatric Status Rating Scales/standards , Reproducibility of Results , Mania/diagnosis , Young Adult , Severity of Illness Index , Surveys and Questionnaires/standards , Translations , Adolescent
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