Epma Journal最新文献

{"title":"Cancer screening in hospitalized ischemic stroke patients: a multicenter study focused on multiparametric analysis to improve management of occult cancers","authors":"Jie Fang, Jielong Wu, Ganji Hong, Liangcheng Zheng, Lu Yu, Xiuping Liu, Pan Lin, Zhenzhen Yu, Dan Chen, Qing Lin, Chuya Jing, Qiuhong Zhang, Chen Wang, Jiedong Zhao, Xiaodong Yuan, Chunfang Wu, Zhaojie Zhang, Mingwei Guo, Junde Zhang, Jingjing Zheng, Aidi Lei, Tengkun Zhang, Quan Lan, Lingsheng Kong, Xinrui Wang, Zhanxiang Wang, Qilin Ma","doi":"10.1007/s13167-024-00354-8","DOIUrl":"https://doi.org/10.1007/s13167-024-00354-8","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background/aims</h3><p>The reciprocal promotion of cancer and stroke occurs due to changes in shared risk factors, such as metabolic pathways and molecular targets, creating a “vicious cycle.” Cancer plays a direct or indirect role in the pathogenesis of ischemic stroke (IS), along with the reactive medical approach used in the treatment and clinical management of IS patients, resulting in clinical challenges associated with occult cancer in these patients. The lack of reliable and simple tools hinders the effectiveness of the predictive, preventive, and personalized medicine (PPPM/3PM) approach. Therefore, we conducted a multicenter study that focused on multiparametric analysis to facilitate early diagnosis of occult cancer and personalized treatment for stroke associated with cancer.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Admission routine clinical examination indicators of IS patients were retrospectively collated from the electronic medical records. The training dataset comprised 136 IS patients with concurrent cancer, matched at a 1:1 ratio with a control group. The risk of occult cancer in IS patients was assessed through logistic regression and five alternative machine-learning models. Subsequently, select the model with the highest predictive efficacy to create a nomogram, which is a quantitative tool for predicting diagnosis in clinical practice. Internal validation employed a ten-fold cross-validation, while external validation involved 239 IS patients from six centers. Validation encompassed receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA), and comparison with models from prior research.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The ultimate prediction model was based on logistic regression and incorporated the following variables: regions of ischemic lesions, multiple vascular territories, hypertension, D-dimer, fibrinogen (FIB), and hemoglobin (Hb). The area under the ROC curve (AUC) for the nomogram was 0.871 in the training dataset and 0.834 in the external test dataset. Both calibration curves and DCA underscored the nomogram’s strong performance.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>The nomogram enables early occult cancer diagnosis in hospitalized IS patients and helps to accurately identify the cause of IS, while the promotion of IS stratification makes personalized treatment feasible. The online nomogram based on routine clinical examination indicators of IS patients offered a cost-effective platform for secondary care in the framework of PPPM.</p>","PeriodicalId":54292,"journal":{"name":"Epma Journal","volume":"31 1","pages":""},"PeriodicalIF":6.5,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139902286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated detection of nine infantile fundus diseases and conditions in retinal images using a deep learning system","authors":"Yaling Liu, Hai Xie, Xinyu Zhao, Jiannan Tang, Zhen Yu, Zhenquan Wu, Ruyin Tian, Yi Chen, Miaohong Chen, Dimitrios P. Ntentakis, Yueshanyi Du, Tingyi Chen, Yarou Hu, Sifan Zhang, Baiying Lei, Guoming Zhang","doi":"10.1007/s13167-024-00350-y","DOIUrl":"https://doi.org/10.1007/s13167-024-00350-y","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>We developed an Infant Retinal Intelligent Diagnosis System (IRIDS), an automated system to aid early diagnosis and monitoring of infantile fundus diseases and health conditions to satisfy urgent needs of ophthalmologists.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We developed IRIDS by combining convolutional neural networks and transformer structures, using a dataset of 7697 retinal images (1089 infants) from four hospitals. It identifies nine fundus diseases and conditions, namely, retinopathy of prematurity (ROP) (mild ROP, moderate ROP, and severe ROP), retinoblastoma (RB), retinitis pigmentosa (RP), Coats disease, coloboma of the choroid, congenital retinal fold (CRF), and normal. IRIDS also includes depth attention modules, ResNet-18 (Res-18), and Multi-Axis Vision Transformer (MaxViT). Performance was compared to that of ophthalmologists using 450 retinal images. The IRIDS employed a five-fold cross-validation approach to generate the classification results.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Several baseline models achieved the following metrics: accuracy, precision, recall, F1-score (F1), kappa, and area under the receiver operating characteristic curve (AUC) with best values of 94.62% (95% CI, 94.34%-94.90%), 94.07% (95% CI, 93.32%-94.82%), 90.56% (95% CI, 88.64%-92.48%), 92.34% (95% CI, 91.87%-92.81%), 91.15% (95% CI, 90.37%-91.93%), and 99.08% (95% CI, 99.07%-99.09%), respectively. In comparison, IRIDS showed promising results compared to ophthalmologists, demonstrating an average accuracy, precision, recall, F1, kappa, and AUC of 96.45% (95% CI, 96.37%-96.53%), 95.86% (95% CI, 94.56%-97.16%), 94.37% (95% CI, 93.95%-94.79%), 95.03% (95% CI, 94.45%-95.61%), 94.43% (95% CI, 93.96%-94.90%), and 99.51% (95% CI, 99.51%-99.51%), respectively, in multi-label classification on the test dataset, utilizing the Res-18 and MaxViT models. These results suggest that, particularly in terms of AUC, IRIDS achieved performance that warrants further investigation for the detection of retinal abnormalities.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>IRIDS identifies nine infantile fundus diseases and conditions accurately. It may aid non-ophthalmologist personnel in underserved areas in infantile fundus disease screening. Thus, preventing severe complications. The IRIDS serves as an example of artificial intelligence integration into ophthalmology to achieve better outcomes in predictive, preventive, and personalized medicine (PPPM / 3PM) in the treatment of infantile fundus diseases.</p>","PeriodicalId":54292,"journal":{"name":"Epma Journal","volume":"69 1","pages":""},"PeriodicalIF":6.5,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139764659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty mediating the causality between leucocyte telomere length and mortality: a cohort study of 440,551 UK Biobank participants","authors":"Xuening Jian, Wenxin Sun, Jie Zhang, Qiaoyun Zhang, Xiaoni Meng, Huimin Lu, Deqiang Zheng, Lijuan Wu, Youxin Wang","doi":"10.1007/s13167-024-00355-7","DOIUrl":"https://doi.org/10.1007/s13167-024-00355-7","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>Previous studies reported leucocyte telomere length (LTL) and frailty were associated with mortality, but it remains unclear whether frailty serves as a mediator in the relationship between leucocyte telomere length and mortality risk. This study aimed to evaluate how measuring LTL and frailty can support early monitoring and prevention of risk of mortality from the prospective of predictive, preventive, and personalized medicine (PPPM/3PM).</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We included 440,551 participants from the UK Biobank between the baseline visit (2006–2010) and November 30, 2022. The time-dependent Cox proportional hazards model was conducted to assess the association between LTL and frailty index with the risk of mortality. Furthermore, we conducted causal mediation analyses to examine the extent to which frailty mediated the association between LTL and mortality.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>During a median follow-up of 13.74 years, each SD increase in LTL significantly decreased the risk of all-cause [hazard ratio (HR): 0.94, 95% confidence interval (CI): 0.93–0.95] and CVD-specific mortality (HR: 0.92, 95% CI: 0.90–0.95). The SD increase in FI elevated the risk of all-cause (HR: 1.35, 95% CI: 1.34–1.36), CVD-specific (HR: 1.47, 95% CI: 1.44–1.50), and cancer-specific mortality (HR: 1.22, 95% CI: 1.20–1.24). Frailty mediated approximately 10% of the association between LTL and all-cause and CVD-specific mortality.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Our results indicate that frailty mediates the effect of LTL on all-cause and CVD-specific mortality. There findings might be valuable to predict, prevent, and reduce mortality through primary prevention and healthcare in context of PPPM.</p>","PeriodicalId":54292,"journal":{"name":"Epma Journal","volume":"124 1","pages":""},"PeriodicalIF":6.5,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139764646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive, preventive and personalised approach as a conceptual and technological innovation in primary and secondary care of inflammatory bowel disease benefiting affected individuals and populations","authors":"","doi":"10.1007/s13167-024-00351-x","DOIUrl":"https://doi.org/10.1007/s13167-024-00351-x","url":null,"abstract":"<h3>Abstract</h3> <p>Inflammatory bowel disease (IBD) is a global health burden which carries lifelong morbidity affecting all age groups in populations with the disease-specific peak of the age groups ranging between 15 and 35 years, which are of great economic importance for the society. An accelerating incidence of IBD is reported for newly industrialised countries, whereas stabilising incidence but increasing prevalence is typical for countries with a Westernised lifestyle, such as the European area and the USA. Although the aetiology of IBD is largely unknown, the interplay between the genetic, environmental, immunological, and microbial components is decisive for the disease manifestation, course, severity and individual outcomes. Contextually, the creation of an individualised patient profile is crucial for the cost-effective disease management in primary and secondary care of IBD. The proposed pathomechanisms include intestinal pathoflora and dysbiosis, chronic inflammation and mitochondrial impairments, amongst others, which collectively may reveal individual molecular signatures defining IBD subtypes and leading to clinical phenotypes, patient stratification and cost-effective protection against health-to-disease transition and treatments tailored to individualised patient profiles—all the pillars of an advanced 3PM approach. The paradigm change from reactive medical services to predictive diagnostics, cost-effective targeted prevention and treatments tailored to individualised patient profiles in overall IBD management holds a promise to meet patient needs in primary and secondary care, to increase the life-quality of affected individuals and to improve health economy in the area of IBD management. This article analyses current achievements and provides the roadmap for future developments in the area in the context of 3P medicine benefiting society at large.</p>","PeriodicalId":54292,"journal":{"name":"Epma Journal","volume":"68 1","pages":""},"PeriodicalIF":6.5,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139764651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The mediating effect of perceived stress on the relationship between big five personality traits and suboptimal health status in Chinese population: a nationwide survey in the framework of predictive, preventive, and personalized medicine","authors":"Qihua Guan, Hualei Dong, Zhihui Zhang, Zheng Guo, Zi Lin, Hui Niu, Yibo Wu, Haifeng Hou","doi":"10.1007/s13167-023-00349-x","DOIUrl":"https://doi.org/10.1007/s13167-023-00349-x","url":null,"abstract":"&lt;h3 data-test=\"abstract-sub-heading\"&gt;Background&lt;/h3&gt;&lt;p&gt;The effects of psychological factors on suboptimal health status (SHS) have been widely described; however, mechanisms behind the complex relationships among the Big Five personality traits and SHS are unclear. Identifying people with specific traits who are susceptible to SHS will help improve life quality and reduce the chronic disease burden under the framework of predictive, preventive, and personalized medicine (PPPM / 3PM). This study investigated the relationships among personality traits and SHS. It also explored whether perceived stress plays a mediating role in SHS development.&lt;/p&gt;&lt;h3 data-test=\"abstract-sub-heading\"&gt;Method&lt;/h3&gt;&lt;p&gt;A nationwide cross-sectional survey based on multistage random sampling was conducted in 148 cities in China between June 20 and August 31, 2022. Personality traits, perceived stress, and SHS were evaluated using the Big Five Inventory-10 (BFI-10), the 4-item Perceived Stress Scale (PSS-4), and the Short-Form Suboptimal Health Status Questionnaire (SHSQ-SF), respectively. Pearson’s correlation analysis was employed to examine the associations between personality traits, perceived stress, and SHS. Structural equation modeling (SEM) was used to discern the mediating role of perceived stress in the relationships among personality traits and SHS.&lt;/p&gt;&lt;h3 data-test=\"abstract-sub-heading\"&gt;Result&lt;/h3&gt;&lt;p&gt;A total of 22,897 participants were enrolled in this study, among whom the prevalence of SHS was 52.9%. SHS was negatively correlated with three trait dimensions (i.e., extraversion, agreeableness, and conscientiousness) but positively correlated with neuroticism. Meanwhile, stress was negatively correlated with extraversion, agreeableness, conscientiousness, and openness, whereas it was positively correlated with neuroticism. The SEM results showed that, when adjusting for covariates (i.e., gender, age, BMI, educational level, current residence, marital status, and occupational status), higher agreeableness (&lt;i&gt;β&lt;/i&gt; = − 0.049, &lt;i&gt;P&lt;/i&gt; &lt; 0.001) and conscientiousness (&lt;i&gt;β&lt;/i&gt; = − 0.103, &lt;i&gt;P&lt;/i&gt; &lt; 0.001) led to lower SHS prevalence, higher neuroticism (&lt;i&gt;β&lt;/i&gt; = 0.130, &lt;i&gt;P&lt;/i&gt; &lt; 0.001), and openness (&lt;i&gt;β&lt;/i&gt; = 0.026, &lt;i&gt;P&lt;/i&gt; &lt; 0.001) caused SHS to be more prevalent. Perceived stress played a partial mediating role in the relationships among personality traits and SHS, respectively, contributing 41.3%, 35.9%, and 32.5% to the total effects of agreeableness, conscientiousness, and neuroticism on SHS. Additionally, the mediating impact of stress was significant even though extraversion had no direct effect on SHS.&lt;/p&gt;&lt;h3 data-test=\"abstract-sub-heading\"&gt;Conclusion&lt;/h3&gt;&lt;p&gt;This study revealed a high prevalence of SHS in Chinese residents. Personality traits significantly influenced SHS rates, which perceived stress tended to mediate. From a PPPM perspective, early screening and targeted intervention for people with neuroticism (as well as stress allevi","PeriodicalId":54292,"journal":{"name":"Epma Journal","volume":"24 1","pages":""},"PeriodicalIF":6.5,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138572346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nitroproteomics is instrumental for stratification and targeted treatments of astrocytoma patients: expert recommendations for advanced 3PM approach with improved individual outcomes","authors":"Wenshuang Jia, Xiaoxia Gong, Zhen Ye, Na Li, Xianquan Zhan","doi":"10.1007/s13167-023-00348-y","DOIUrl":"https://doi.org/10.1007/s13167-023-00348-y","url":null,"abstract":"<p>Protein tyrosine nitration is a selectively and reversible important post-translational modification, which is closely related to oxidative stress. Astrocytoma is the most common neuroepithelial tumor with heterogeneity and complexity. In the past, the diagnosis of astrocytoma was based on the histological and clinical features, and the treatment methods were nothing more than surgery-assisted radiotherapy and chemotherapy. Obviously, traditional methods short falls an effective treatment for astrocytoma. In late 2021, the World Health Organization (WHO) adopted molecular biomarkers in the comprehensive diagnosis of astrocytoma, such as IDH-mutant and DNA methylation, which enabled the risk stratification, classification, and clinical prognosis prediction of astrocytoma to be more correct. Protein tyrosine nitration is closely related to the pathogenesis of astrocytoma. We hypothesize that nitroproteome is significantly different in astrocytoma relative to controls, which leads to establishment of nitroprotein biomarkers for patient stratification, diagnostics, and prediction of disease stages and severity grade, targeted prevention in secondary care, treatment algorithms tailored to individualized patient profile in the framework of predictive, preventive, and personalized medicine (PPPM; 3P medicine). Nitroproteomics based on gel electrophoresis and tandem mass spectrometry is an effective tool to identify the nitroproteins and effective biomarkers in human astrocytomas, clarifying the biological roles of oxidative/nitrative stress in the pathophysiology of astrocytomas, functional characteristics of nitroproteins in astrocytomas, nitration-mediated signal pathway network, and early diagnosis and treatment of astrocytomas. The results finds that these nitroproteins are enriched in mitotic cell components, which are related to transcription regulation, signal transduction, controlling subcellular organelle events, cell perception, maintaining cell homeostasis, and immune activity. Eleven statistically significant signal pathways are identified in astrocytoma, including remodeling of epithelial adherens junctions, germ cell-sertoli cell junction signaling, 14-3-3-mediated signaling, phagosome maturation, gap junction signaling, axonal guidance signaling, assembly of RNA polymerase III complex, and TREM1 signaling. Furthermore, protein tyrosine nitration is closely associated with the therapeutic effects of protein drugs, and molecular mechanism and drug targets of cancer. It provides valuable data for studying the protein nitration biomarkers, molecular mechanisms, and therapeutic targets of astrocytoma towards PPPM (3P medicine) practice.</p>","PeriodicalId":54292,"journal":{"name":"Epma Journal","volume":"111 1","pages":""},"PeriodicalIF":6.5,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138580750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impacts of a multipurpose outpatient hospital pharmacy in the framework of 3P medicine","authors":"Lara González Freire, Ana Belen Veiga Villaverde, Ana Ballester Vieitez, Rosario Olivera Fernández, Carlos Crespo-Diz","doi":"10.1007/s13167-023-00346-0","DOIUrl":"https://doi.org/10.1007/s13167-023-00346-0","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Challenge in the framework of Predictive, Preventive and Personalised Medicine</h3><p>In recent years, we have been witnessing a change in the performance of hospital pharmacists, aimed at increasing their participation in the pharmacotherapeutic process of patients. The drug cycle, characterised as multidisciplinary, is very complex. It is essential for the multidisciplinary team to have a broad vision of the medication system in order to guarantee safety and quality.</p><p>Considering the challenges of current healthcare systems and paradigm shift from reactive to predictive medicine, a new professional environment should be created to promote the implementation of Predictive, Preventive and Personalised Medicine in healthcare.</p><h3 data-test=\"abstract-sub-heading\">Objectives and study design</h3><p>To optimise care times in multipurpose outpatient hospital both in the preparation of ready-to-use medications and in the dispensing of medications for home treatment.</p><p>To increase the confidence and value of hospital pharmacists in the process of patient and family care.</p><p>The design of the study was carried out by the following:</p><p>-Coordinating the schedules of the multi-pathology day hospital with the software and records of Medication Preparation in the pharmacy service.</p><p>-Opening a Pharmacy Outpatient Clinic associated with the multi-pathology day hospital.</p><p>-Planning and scheduling patient treatments.</p><h3 data-test=\"abstract-sub-heading\">Achievements</h3><p>With the implementation of this programme, the visibility of hospital pharmacists in the multidisciplinary team was increased.</p><p>This Pharmacy Outpatient Clinic allowed the coordination of the pharmaceutical care process in the day hospital.</p><p>This project increased the credibility of the Pharmacy Service in the improvement of the integral process of the medicine.</p><h3 data-test=\"abstract-sub-heading\">Conclusions and expert recommendations</h3><h3 data-test=\"abstract-sub-heading\">Predictive approach</h3><p>The presence of pharmacists in the multi-pathology day hospital has a predictive approach. A change is made in the workflow that allows to generate a speed of intervention by acting before prescribing, dispensing and administering the treatment to the patient.</p><h3 data-test=\"abstract-sub-heading\">Targeted prevention</h3><p>The presence of pharmacists in the multipurpose day hospital unit and their collaboration with other professionals and the patient bring about a selective prevention that decreases the possibility of medication errors occurring.</p><h3 data-test=\"abstract-sub-heading\">Personalisation of medical services</h3><p>With the individualised dispensing of treatments, a step forward is taken in the <i>personalisation of medical services</i>, which avoids medication errors in labelling and administration and improves safety in the overall medication circuit in the hospital.</p>","PeriodicalId":54292,"journal":{"name":"Epma Journal","volume":"44 7","pages":""},"PeriodicalIF":6.5,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138518966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes, glycemic control and arterial stiffness: a real-world cohort study in the context of predictive, preventive, and personalized medicine","authors":"Cancan Cui, Te Zhang, Yitian Qi, Jiaqi Chu, Haikun Xu, Chen Sun, Zhenming Zhang, Xingang Wang, Siqi Yue, Xiaoping Kang, Ling Fang","doi":"10.1007/s13167-023-00347-z","DOIUrl":"https://doi.org/10.1007/s13167-023-00347-z","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Arterial stiffness is a major contributor to morbidity and mortality worldwide. Although several metabolic markers associated with arterial stiffness have been developed, there is limited data regarding whether glycemic control modifies the association between diabetes and arterial stiffness. For these reasons, identification of traits around diabetes will directly contribute to arterial stiffness and atherosclerosis management in the context of predictive, preventive, and personalized medicine (PPPM). Thus, this study aimed to explore the relationship of diabetes and glycemic control status with arterial stiffness in a real-world setting.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Data of participants from Beijing Xiaotangshan Examination Center (BXEC) with at least two surveys between 2008 and 2019 were used. Cumulative hazards were presented by inverse probability of treatment weighted (IPTW) Kaplan-Meier curves. Cox models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI). Arterial stiffness was defined as brachial-ankle pulse wave velocity (baPWV) ≥1400 cm/s.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Of 5837 participants, the mean baseline age was 46.5±9.3 years, including 3791 (64.9%) males. During a median follow-up of 4.0 years, 1928 (33.0%) cases of incident arterial stiffness were observed. People with diabetes at baseline had a 48.4% (HR: 1.484, 95% CI: 1.250–1.761) excessive risk of arterial stiffness. Adherence to good glycemic control attenuated the relationship between diabetes and arterial stiffness (HR: 1.264, 95% CI: 0.950–1.681); while uncontrolled diabetes was associated with the highest risk of arterial stiffness (HR: 1.629, 95% CI: 1.323–2.005). Results were consistent using IPTW algorithm and multiple imputed data.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Our study quantified that diabetes status is closely associated with an increased risk of arterial stiffness and supported that adherence to good glycemic control could attenuate the adverse effect of diabetes on arterial stiffness. Therefore, glucose monitoring and control is a cost-effective strategy for the predictive diagnostics, targeted prevention, patient stratification, and personalization of medical services in early vascular damages and arterial stiffness.</p>","PeriodicalId":54292,"journal":{"name":"Epma Journal","volume":"164 ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138518925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The predictive, preventive, and personalized medicine of insomnia: gut microbiota and inflammation","authors":"Hao-Wen Chen, Rui Zhou, Bi-Fei Cao, Kuan Liu, Qi Zhong, Yi-Ning Huang, Hua-Min Liu, Jin-Qing Zhao, Xian-Bo Wu","doi":"10.1007/s13167-023-00345-1","DOIUrl":"https://doi.org/10.1007/s13167-023-00345-1","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>The human gut microbiota (GM) has been recognized as a significant factor in the development of insomnia, primarily through inflammatory pathways, making it a promising target for therapeutic interventions. Considering the principles of primary prediction, targeted prevention, and personalized treatment medicine (PPPM), identifying specific gut microbiota associated with insomnia and exploring the underlying mechanisms comprehensively are crucial steps towards achieving primary prediction, targeted prevention, and personalized treatment of insomnia.</p><h3 data-test=\"abstract-sub-heading\">Working hypothesis and methodology</h3><p>We hypothesized that alterations in the composition of specific GM could induce insomnia through an inflammatory response, which postulates the existence of a GM-inflammation-insomnia pathway. Mendelian randomization (MR) analyses were employed to examine this pathway and explore the mediative effects of inflammation. We utilized genetic proxies representing GM, insomnia, and inflammatory indicators (including 41 circulating cytokines and C-reactive protein (CRP)), specifically identified from European ancestry. The primary method used to identify insomnia-related GM and examine the medicative effect of inflammation was the inverse variance weighted method, supplemented by the MR-Egger and weighted median methods. Our findings have the potential to identify individuals at risk of insomnia through screening for GM imbalances, leading to the development of targeted prevention and personalized treatment strategies for the condition.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Nine genera and three circulating cytokines were identified to be associated with insomnia; only the associations of <i>Clostridium</i> (<i>innocuum</i> group) and β-NGF on insomnia remained significant after the FDR test, OR = 1.08 (95% CI = 1.04–1.12, <i>P</i> = 1.45 × 10⁻⁴, <i>q</i> = 0.02) and OR = 1.06 (95% CI = 1.02–1.10, <i>P</i> = 1.06 × 10⁻³, <i>q</i> = 0.04), respectively. CRP was associated with an increased risk of insomnia, OR = 1.05 (95% CI = 1.01–1.10, <i>P</i> = 6.42 × 10⁻³). CRP mediated the association of <i>Coprococcus</i> 1, <i>Holdemania</i>, and <i>Rikenellaceae</i> (<i>RC9gut</i> group) with insomnia. No heterogeneity or pleiotropy were detected.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Our study highlights the role of specific GM alterations in the development of insomnia and provides insights into the mediating effects of inflammation. Targeting these specific GM alterations presents a promising avenue for advancing the transition from reactive medicine to PPPM in managing insomnia, potentially leading to significant clinical benefits.</p>","PeriodicalId":54292,"journal":{"name":"Epma Journal","volume":"143 2 1","pages":""},"PeriodicalIF":6.5,"publicationDate":"2023-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138518893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence to improve ischemia prediction in Rubidium Positron Emission Tomography—a validation study","authors":"Simon M. Frey, Adam Bakula, Andrew Tsirkin, Vasily Vasilchenko, Peter Ruff, Caroline Oehri, Melissa Fee Amrein, Gabrielle Huré, Klara Rumora, Ibrahim Schäfer, Federico Caobelli, Philip Haaf, Christian E. Mueller, Bjoern Andrew Remppis, Hans-Peter Brunner-La Rocca, Michael J. Zellweger","doi":"10.1007/s13167-023-00341-5","DOIUrl":"https://doi.org/10.1007/s13167-023-00341-5","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Patients are referred to functional coronary artery disease (CAD) testing based on their pre-test probability (PTP) to search for myocardial ischemia. The recommended prediction tools incorporate three variables (symptoms, age, sex) and are easy to use, but have a limited diagnostic accuracy. Hence, a substantial proportion of non-invasive functional tests reveal no myocardial ischemia, leading to unnecessary radiation exposure and costs. Therefore, preselection of patients before ischemia testing needs to be improved using a more predictive and personalised approach.</p><h3 data-test=\"abstract-sub-heading\">Aims</h3><p>Using multiple variables (symptoms, vitals, ECG, biomarkers), artificial intelligence–based tools can provide a detailed and individualised profile of each patient. This could improve PTP assessment and provide a more personalised diagnostic approach in the framework of predictive, preventive and personalised medicine (PPPM).</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Consecutive patients (<i>n</i> = 2417) referred for Rubidium-82 positron emission tomography were evaluated. PTP was calculated using the ESC 2013/2019 and ACC 2012/2021 guidelines, and a memetic pattern–based algorithm (MPA) was applied incorporating symptoms, vitals, ECG and biomarkers. Five PTP categories from very low to very high PTP were defined (i.e., &lt; 5%, 5–15%, 15–50%, 50–85%, &gt; 85%). Ischemia was defined as summed difference score (SDS) ≥ 2.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Ischemia was present in 37.1%. The MPA model was most accurate to predict ischemia (AUC: 0.758, <i>p</i> &lt; 0.001 compared to ESC 2013, 0.661; ESC 2019, 0.673; ACC 2012, 0.585; ACC 2021, 0.667). Using the &lt; 5% threshold, the MPA’s sensitivity and negative predictive value to rule out ischemia were 99.1% and 96.4%, respectively. The model allocated patients more evenly across PTP categories, reduced the proportion of patients in the intermediate (15–85%) range by 29% (ACC 2012)–51% (ESC 2019), and was the only tool to correctly predict ischemia prevalence in the very low PTP category.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>The MPA model enhanced ischemia testing according to the PPPM framework:</p><ol>\u0000<li>\u0000<span>1)</span>\u0000<p>The MPA model improved individual prediction of ischemia significantly and could safely exclude ischemia based on readily available variables without advanced testing (“predictive”).</p>\u0000</li>\u0000<li>\u0000<span>2)</span>\u0000<p>It reduced the proportion of patients in the intermediate PTP range. Therefore, it could be used as a gatekeeper to prevent patients from further unnecessary downstream testing, radiation exposure and costs (“preventive”).</p>\u0000</li>\u0000<li>\u0000<span>3)</span>\u0000<p>Consequently, the MPA model could transform ischemia testing towards a more personalised diagnostic algorithm (“personalised”).</p>\u0000</li>\u0000</ol>","PeriodicalId":54292,"journal":{"name":"Epma Journal","volume":"45 ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138518905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}