Chronic Disease Research Articles

Challenges and improvement strategies in the hospitalization of chronic multimorbid patients

BACKGROUND Addressing the growing challenge of hospitalizing chronic multimorbid patients, this study examines the strain these conditions impose on healthcare systems at a local level, focusing on a pilot program. Chronic diseases and complex patients require comprehensive management strategies to reduce healthcare burdens and improve patient outcomes. If proven effective, this pilot model has the potential to be replicated in other healthcare settings to enhance the management of chronic multimorbid patients. AIM To evaluate the effectiveness of the high complexity unit (HCU) in managing chronic multimorbid patients through a multidisciplinary care model and to compare it with standard hospital care. METHODS The study employed a descriptive longitudinal approach, analyzing data from the Basic Minimum Data Set (BMDS) to compare hospitalization variables among the HCU, the Internal Medicine Service, and other services at Antequera Hospital throughout 2022. The HCU, designed for patients with complex chronic conditions, integrates a patient-centered model emphasizing multidisciplinary care and continuity post-discharge. RESULTS The study employed a descriptive longitudinal approach, analyzing data from the BMDS to compare hospitalization variables among the HCU, the Internal Medicine Service, and other services at Antequera Hospital throughout 2022. The HCU, designed for patients with complex chronic conditions, integrates a patient-centered model emphasizing multidisciplinary care and continuity post-discharge. CONCLUSION This study demonstrates the effectiveness of the HCU in managing patients with complex chronic diseases through a multidisciplinary approach. The coordinated care provided by the HCU results in improved patient outcomes, reduced unnecessary hospitalizations, and better management of patient complexity. The superiority of the HCU compared to standard care is evident in key outcomes such as fewer readmissions and higher patient satisfaction, reinforcing its value as a model of care to be replicated.

Microplastic and nanoplastic exposure and risk of diabetes mellitus

The issue of plastic pollutants has become a growing concern. Both microplastics (MPs) (particle size < 5 mm) and nanoplastics (NPs) (particle size < 1 µm) can cause DNA damage, cytotoxicity, and oxidative stress in various organisms. The primary known impacts of microplastic/nanoplastic are observed in the liver and respiratory system, leading to hepatotoxicity and chronic obstructive pulmonary disease. Although research on the effects of MPs and NPs on diabetes is still in its early stages, there are potential concerns. This editorial highlights the risk to diabetics from co-exposure to contaminants and MPs/NPs, supported by evidence from animal studies and the various chemical compositions of MPs/NPs.

Efficacy and safety of first-line targeted synthetic DMARDs in rheumatoid arthritis patients with chronic kidney disease.

To evaluate the efficacy and safety of first-line targeted synthetic disease-modifying anti-rheumatic drugs (tsDMARDs) in patients with rheumatoid arthritis (RA) and chronic kidney disease (CKD). This retrospective cohort study included 216 patients with RA prescribed their first tsDMARDs at two hospitals between 2013 and 2022. Dose reduction and contraindication guidelines for tsDMARDs according to kidney function were followed. The patients were categorised by kidney function and tsDMARD modality. The primary outcome was the 24-month drug retention rate, and the secondary outcomes were changes in the Disease Activity Score 28-C-reactive protein (DAS28-CRP) level, prednisolone dosage, and reasons for discontinuation. The 24-month drug retention rates according to the estimated glomerular filtration rate (eGFR) (≥60, 30-60, or < 30 mL/min/1.73 m2) were as follows: all tsDMARDs (46.0, 44.1, 47.1%), tofacitinib (55.9, 53.3, 66.7%), baricitinib (64.2, 42.0%), and peficitinib (36.4, 44.1, 40.0%). Even in groups with lower kidney function, the drug retention rate was maintained (adjusted hazard ratio was 1.14 (95% confidence interval, 0.81-1.62), p= 0.45). Patients had a decreased DAS28-CRP (p< 0.01) and a reduced prednisolone dosage (p< 0.01) over the six-month period following tsDMARD initiation. The incidence of herpes zoster and deep vein thrombosis (DVT) was higher in the group with an eGFR <30 mL/min/1.73 m2, but not statistically significant. tsDMARDs have demonstrated efficacy and safety in patients with RA and CKD; however, clinicians should consider the potential for herpes zoster and DVT in patients with eGFR <30 mL/min/1.73 m2.

Effectiveness of Tralokinumab in Different Phenotypes of Atopic Dermatitis: A Real-World Study.

Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by pruritus and a relapsing course, affecting approximately 25% of children and 4-7% of adults. This study evaluated the efficacy, safety, and quality-of-life impact of tralokinumab, a humanized monoclonal antibody targeting interleukin-13 (IL-13), in treating moderate-to-severe AD in a real-world setting, with a focus on different AD phenotypes. An observational cohort of 30 adults treated with tralokinumab for ≥ 16weeks was analyzed. Clinical and demographic data were collected, and outcomes were assessed using the Eczema Area and Severity Index (EASI), Dermatology Life Quality Index (DLQI), and numeric rating scales (NRS) for pruritus and sleep disturbances. By week16, 60% achieved a 75% improvement inEASI (EASI75)and 31% reached a 90% improvement inEASI (EASI90), reflecting substantial clinical improvements. A ≥ 4-point reduction in pruritus NRS was observed in 63% of patients by week16, increasing to 70% by week32. Similarly, 75% achieved significant improvements in sleep disturbance NRS by week16, with sustained effects through week32. Subgroup analysis revealed superior clinical responses in patients with early-onset AD and atopic comorbidities. Lower total immunoglobulinE (IgE) levels at week16 correlated with better outcomes, suggesting total IgE as a potential biomarker. By week32, 70% of patients had a DLQI ≤ 5, indicating minimal quality-of-life impact. Additionally, 88% reached at least one therapeutic target, and 81% met composite endpoints combining clinician-assessed and patient-reported outcomes. The safety profile was consistent with clinical trials, with mild conjunctivitis and injection site reactions as the most common adverse events. These findings support tralokinumab as an effective and well-tolerated treatment, emphasizing the importance of phenotype-specific approaches in AD management.

Effect of adaptive statistical iterative reconstruction-V algorithm and deep learning image reconstruction algorithm on image quality and emphysema quantification in COPD patients under ultra-low-dose conditions.

To explore the effect of different reconstruction algorithms (ASIR-V and DLIR) on image quality and emphysema quantification in chronic obstructive pulmonary disease (COPD) patients under ultra-low-dose scanning conditions. This prospective study with patient consent included 62 COPD patients. Patients were examined by pulmonary function test (PFT), standard-dose CT (SDCT) and ultra-low-dose CT (ULDCT). SDCT images were reconstructed with filtered-back-projection (FBP), while ULDCT images were reconstructed using FBP, 30%ASIR-V, 60%ASIR-V, 90%ASIR-V, low-strength (DLIR-L), medium-strength (DLIR-M) and high-strength DLIR (DLIR-H) to form 8 image sets. Images were analyzed using a commercial computer aided diagnosis (CAD) software. Parameters such as image noise, lung volume (LV), emphysema index (EI), mean lung density (MLD), 15th percentile of lung density (PD15) were measured. Two radiologists evaluated tracheal and pulmonary artery image quality using a 5-point scale. Measurements were compared and the correlation between EI and PFT indices was analyzed. ULDCT used 0.46 ± 0.22mSv in radiation dose, 93.8% lower than SDCT (P < 0.001). There was no difference in LV and MLD among image groups (P > 0.05). ULDCT-ASIR-V90% and ULDCT-DLIR-M had similar image noise and EI and PD15 values to SDCT-FBP, and ULDCT-DLIR-M and ULDCT-DLIR-H had similar subjective scores to SDCT-FBP (all P > 0.05). ULDCT-DLIR-M provided the best correlation between EI and the FEV1/FVC and FEV1% indices in PFT, and the lowest deviations with SDCT-FBP in both EI and PD15. DLIR-M provides the best image quality and emphysema quantification for COPD patients in ULDCT. Ultra-low-dose CT scanning combined with DLIR-M reconstruction is comparable to standard dose images for quantitative analysis of emphysema and image quality.

High Modified 5 Factor Frailty Index is Associated With Worse PROMs and Decreased Return to Activities After 1 or 2 Level MI-TLIF.

Retrospective cohort study. Frailty is defined as a state of minimal "physiologic reserve." The modified 5 factor frailty index (mFI-5) is a recently proposed metric for assessing frailty and has been previously studied as a predictor of morbidity and mortality. However, its utility in predicting postoperative patient reported outcomes (PROMs) and return to activities remains understudied. This is a retrospective cohort study of patients undergoing 1 or 2 level minimally invasive transforaminal lumbar interbody fusion queried from a prospectively maintained multi-surgeon registry. Comorbidities including hypertension, congestive heart failure, diabetes, chronic obstructive pulmonary disease, and functional status were utilized to calculate the mFI-5. Patients were separated into 3 cohorts, "non-frail," "moderately frail" or "severely frail" based on their mFI-5. Patient outcomes were compared between the cohorts. 392 patients were included of which 227 patients were non-frail, 134 were moderately frail, and 31 were severely frail. Frail patients had longer operative time (P = 0.002), greater estimated blood loss (P = 0.038). Despite similar preoperative PROMs, at a longer term follow up, frail patients also had worse PROM scores for ODI (P = 0.009), VAS-back (P = 0.028), and VAS-leg (P = 0.004). Frail patients had worse preoperative (P = 0.017) and postoperative (P < 0.001) SF-12 PCS. At 1-year, frail patients had lower rates of fusion (P = 0.002). Frail patients also demonstrated lower rates of returning to work (P = 0.018), returning to driving (P = 0.027), and discontinuation of narcotics (P = 0.004). Frail patients as measured by the mFI-5 index demonstrated worse postoperative outcomes following 1 or 2 level MI-TLIF. Careful patient selection and preoperative optimization may be especially important in frail patients.

Urgical Challenges In Managing Haemodialysis Arteriovenous Fistula Complications In Tertiary Care Centre: Our Approach.

Arteriovenous (AV) fistula creation is the most common surgical procedure for providing vascular access for haemodialysis in patients with chronic kidney disease (CKD). The functioning of fistula dictates the quality of dialysis and the longevity of patients. The most common circumstances that require surgical takedown of AV fistula are thrombosis and rupture. While some patients undergo elective AV fistula takedown post renal transplantation or for cosmesis, majority of patients presenting with life-threatening rupture require emergency surgery for AV fistula takedown with or without maintaining arterial continuity. This study aims to compile our experience with surgical management of various AF fistula complications. This is a retrospective study of 29 patients who underwent Arteriovenous Fistula takedown in our institute over a period of 3years from May 2021 to May 2024. The most common cause of fistula takedown in our setup was rupture (n=25, 86.21%). AV fistula takedown was done in all cases (n=29, 100%). Arterial ligation was done in all infected cases (n=22, 75.86%) whereas in non-infected cases arterial continuity was maintained by repair or interposition venous graft. There was no aneurysm or psedoaneurysm formation or limb ischaemia in a follow up period ranging from 1month to 3 years. Erroneous ways of cannulation and lack of awareness of fistula care were the prime cause of AV fistula complications. Early detection and presentation to healthcare setup could offer a better prognosis for limb salvage in the long term and decrease the incidence of morbidity and mortality.

Crafting emotional narratives: autoethnography as a tool for reflexive inquiry in healthcare codesign practice during COVID-19

ABSTRACT Autoethnography can be used in design to deepen the reflexive analysis of the participants but also of the researchers, especially in sensible fieldwork. This article analyzes the emotional journey of two researchers in a healthcare co-design context, specifically Chronic Kidney Disease (CKD). Our research aimed to understand patient experiences with home dialysis and other techniques, while the COVID-19 pandemic (2021 to 2023) required innovative adjustments due to restricted fieldwork. Our mixed-methods approach integrated co-design, research/creation, social innovation by design, and sensory ethnography. We examine how emotional dimensions in autoethnographic research shaped our methodological choices, using a narrative emotional journey as a tool. The practice of narrative tools during and after the fieldwork is analysed as a contribution to autoethnography in design research. Our analysis highlights the relevance of structuring autoethnography around the researcher’s narrative emotional journey, communication practices, and co-design media materiality, to reveal how project conditions influenced methodology. This approach underscored the performative nature of design material culture in fostering relationships with participants. Our findings offer both an autoethnographic tool and a tripartite framework for reflexive analysis, offering insights for research in constrained and sensitive contexts.

Versatility of Caenorhabditis elegans as a Model Organism for Evaluating Foodborne Neurotoxins and Food Bioactive Compounds in Nutritional Neuroscience.

Epidemiological evidence has shown that the regular ingestion of vegetables and fruits is associated with reduced risk of developing chronic diseases. The introduction of the 3Rs (replacement, reduction, and refinement) principle into animal experiments has led to the use of valid, cost-effective, and efficient alternative and complementary invertebrate animal models which are simpler and lower in the phylogenetic hierarchy. Caenorhabditis elegans (C. elegans), a nematode with a much simpler anatomy and physiology compared to mammals, share similarities with humans at the cellular and molecular levels, thus making it a valid model organism in neurotoxicology. This review explores the versatility of C. elegans in elucidating the neuroprotective mechanisms elicited by food bioactive compounds against neurotoxic effects of food- and environmental-related contaminants. Several signaling pathways linked to the molecular basis of neuroprotection exerted by bioactive compounds in chemically induced or transgenic C. elegans models of neurodegenerative diseases are also discussed. Specifically, the modulatory effects of bioactive compounds on the DAF-16/FoxO and SKN-1/Nrf2 signaling pathways, stress resistance- and autophagy-related genes, and antioxidant defense enzyme activities were highlighted. Altogether, C. elegans represent a valuable model in nutritional neuroscience for the identification of promising neuroprotective agents and neurotherapeutic targets which could help in overcoming the limitations of current therapeutic agents for neurotoxicity and neurodegenerative diseases.

The Management of Chronic Kidney Disease not Requiring Renal Replacement Therapy in General Practice.

Chronic kidney disease (CKD) is common in the German adult population, with a prevalence of 10%. This guideline, updated on the basis of current scientific evidence, contains recommendations for the management of CKD in general practice. The updated guideline is based on a review and assessment of source guidelines and systematic reviews concerning individual questions. The recommendations were agreed upon in a moderated two-stage nominal group process by the mandate holders of the participating specialist societies, along with patient representatives. The risk of progression to renal failure requiring renal replacement therapy should be assessed with a risk score. Assessing this risk and determining the indication for treatment with SGLT2 inhibitors both require measurement of the urinary albumin-to-creatinine ratio. Pharmacotherapy is not recommended for asymptomatic hyperuricemia. An initial ultrasonographic examination of the kidneys and urogenital system is now recommended for all patients. The vaccination recommendations that differ for people with CKD have been integrated into the guideline. The risk assessment of CKD and the treatment options have been expanded. The updated guideline can improve primary care for patients with CKD and the selection of patients for interdisciplinary care.

Immune Cell Characteristics and Infections Associated with Chronic Obstructive Pulmonary Disease (COPD), Asthma, and Interstitial Lung Disease (ILD): A Mendelian Randomization Studies.

Aims/Background Epidemiological studies indicate that the involvement of the immune system in the pathogenesis of infections associated with chronic obstructive pulmonary disease (COPD), asthma, and interstitial lung disease (ILD) remains unclear. This study aims to assess the potential causal link between infections associated with COPD, asthma, or ILD and immune system function. Methods We conducted a two-sample Mendelian randomization analysis using publicly available genome-wide association study (GWAS) datasets. The causal relationship between immune cell signaling and susceptibility to infections related to COPD, asthma, and ILD was evaluated using inverse variance weighting (IVW), Mendelian randomization (MR)-Egger regression, weighted median, weighted mode, and simple mode approaches. To concurrently assess the causal impact of immune cell signaling on infection susceptibility associated with COPD, asthma, and ILD, a reverse Mendelian randomization analysis was also conducted. Results Genetic predisposition to elevated counts of circulating blood cells and their subpopulations demonstrated significant causal associations with a higher risk of COPD/asthma/ILD-related infections, as determined by IVW analysis. Specifically, genetically predicted increases in white blood cell count (odds ratio (OR) 1.08 [95% confidence interval (CI): 1.04-1.11], p < 0.00001), neutrophil count (OR: 1.06 [95% CI: 1.02-1.10], p = 0.00190), lymphocyte count (OR: 1.04 [95% CI: 1.01-1.07], p = 0.01515), monocyte count (OR: 1.03 [95% CI: 1.01-1.06], p = 0.00440), and eosinophil count (OR: 1.07 [95% CI: 1.04-1.10], p = 0.00001) were causally correlated with an increased risk of these respiratory infections. Notably, four immunophenotypes were significantly associated with the risk of COPD/asthma/ILD-related infections: Human Leukocyte Antigen (HLA) DR+ NK% NK (OR: 0.98 [95% CI: 0.97-0.99], p = 0.0004), CD66b on CD66b++ myeloid cell (OR: 0.98 [95% CI: 0.97-0.99], p = 0.0007), HLA DR on CD14+ monocyte (OR: 1.03 [95% CI: 1.01-1.04], p = 0.0002), and HLA DR on CD33- HLA DR+ (OR: 1.03 [95% CI: 1.02-1.05], p < 0.00001). The causal effect of COPD/asthma/ILD-related infections on Immunoglobulin D (IgD) expression in IgD+ CD38br and transitional B cells was estimated to be 0.64 (95% CI: 0.49-0.83, p = 0.00091) and 0.70 (95% CI: 0.54-0.91, p = 0.00727), respectively. Additionally, COPD/asthma/ILD-related infections demonstrated a significant causal effect on several B cell and T cell subpopulations: IgD+ CD38- % B cells, IgD+ CD38- AC, CD4+ CD8dim AC, IgD+ CD38- % lymphocyte, and TD CD4+ AC, with the OR 1.54 (95% CI: 1.19-2.00, p = 0.00113), 1.56 (95% CI: 1.16-2.10, p = 0.00340), 1.60 (95% CI: 1.15-2.22, p = 0.00478), 1.47 (95% CI: 1.12-1.92, p = 0.00483) and 1.63 (95% CI: 1.14-2.34, p = 0.00725), respectively. Conclusion Our study reveals a causal association between altered circulating blood cell counts and specific immunophenotypes with the susceptibility to respiratory infections related to COPD, asthma, and ILD.

CT angiography of acute aortic syndrome in patients with chronic kidney disease.

The term acute aortic syndrome (AAS) refers to a range of different entities, including dissection, intramural haematoma and penetrating atherosclerotic ulcer. Patients with chronic renal disease and particularly those with dominant polycystic kidney disease are susceptible to this pathology, given the underlying renal arteriopathy and hypertension. Imaging plays a crucial role in diagnosing, grading and guiding management of these patients, with computed tomography angiography (CTA) being on the frontline. Albeit of overlapping of imaging findings between these conditions, specific imaging characteristics help discriminate and guide treatment. Given the nephrotoxic contrast agent involved, tailored CTA protocols or alternative imaging modalities such as MRI or US are necessary in this patient population. This review article discusses the main imaging findings of entities found in the spectrum of AAS, as well as the appropriate use and protocol of imaging modalities, focusing on the appropriate use of nephrotoxic contrast agents, the preservation of renal function and maintenance of optimal diagnostic accuracy.

The Kidney-Immune-Brain Axis: The Role of Inflammation in the Pathogenesis and Treatment of Stroke in Chronic Kidney Disease.

Cardiovascular diseases such as stroke are a major cause of morbidity and mortality for patients with chronic kidney disease (CKD). The underlying mechanisms connecting CKD and cardiovascular disease are yet to be fully elucidated, but inflammation is proposed to play an important role based on genetic association studies, studies of inflammatory biomarkers, and clinical trials of anti-inflammatory drug targets. There are multiple sources of both endogenous and exogenous inflammation in CKD, including increased production and decreased clearance of proinflammatory cytokines, oxidative stress, metabolic acidosis, chronic and recurrent infections, dialysis access, changes in adipose tissue metabolism, and disruptions in intestinal microbiota. This review focuses on the mechanisms of inflammation in CKD, dialysis and associated therapies, its proposed impact on stroke pathogenesis and prognosis, and the potential role of anti-inflammatory agents in the prevention and treatment of stroke in patients with CKD.

A STRONG call for intensive oral heart failure therapy in acute heart failure patients.

Heart failure (HF), a chronic and progressive disease, is increasing in prevalence worldwide and is associated with increased hospitalizations and death. Despite notable improvements in medical therapy for HF, patients are still at risk of future negative outcomes. Current guidelines recommend four classes of medication for treating patients with HF, deemed guideline-directed medical therapy (GDMT). The use and adherence of these GDMTs serve as a major predictor of outcomes in those with chronic HF; however, implementation of therapy remains poor, despite substantial evidence of benefit. The acute hospitalization for HF and the subsequent vulnerable period serve as important milestones for adequate disease modification, and implementing a strategy for aggressive medical therapy can improve HF outcomes. Current guidelines also recommend that follow-up withmultidisciplinary chronic disease management specific to HF be provided to those living with heart failure, which is essential for improving readmissions and mortality. This follow-up, although important by itself, serves as an important avenue for disease modification through medication titration, and implementing such structured follow-up is essential for further population-wide improvements in HF mortality. In this context, the STRONG-HF trial investigators developed an implementation trial providing evidence for the rapid inpatient initiation and subsequent titration of HF GDMT, demonstrating the importance of implementation strategies in the care of HF patients. In this narrative review, we review the evidence base for treating patients with HF, highlight deficits in our current real-world experience, and provide support for trial evidence like STRONG-HF in the global fight to reduce the burden of HF.

Feasibility of self-investment in a medically tailored meals program by a large health enterprise: Cleveland Clinic experience.

Background: Medically tailored meals (MTMs) are personalized meals designed to meet the therapeutic needs of patients with chronic diseases. Most MTM programs rely on philanthropic support, and the optimal parameters for these programs are not well-defined. Aim: To assess the feasibility of an MTM program developed by a major healthcare institution using internal investments and an online platform for meal ordering. Methods: Single-arm prospective cohort feasibility MTM project implemented between August 2021 and June 2022. Each participant received 14 frozen meals per week over 3 months via a courier system. Participants answered several questionnaires and healthcare utilization was abstracted from electronic medical records up to 6 months post-intervention. Results: Sixty participants were enrolled. Emergency department (ED) visits and inpatient days significantly decreased in the 180 days post-intervention compared to the 180 days pre-intervention (ED visits: 1.2 vs 1.7, P = 0.005; inpatient days: 3.2 vs 5.1, P = 0.02). Participants saved an average of $12,046 in healthcare costs. Despite challenges with implementation, including upfront costs and sustainability, client and service outcomes were highly favorable. Patients were overwhelmingly satisfied with the program, although there was no quantitative improvement in global mental health (GMH) or global physical health (GPH) scores. Conclusion: MTM programs run by healthcare institutions can enhance patient satisfaction, reduce hospital visits, and lower healthcare costs, particularly for vulnerable populations. Providing healthy, frozen meals over an extended period is feasible, though it requires significant initial investment. Large healthcare institutions should consider implementing such programs to prioritize primary prevention in the US healthcare system.

Associations of Global Burden of Diseases study-derived dietary scores with mortality and chronic disease risk: a comprehensive analysis from the prospective NutriNet-Santé study.

The Global Burden of Diseases (GBD) network has proposed theoretical minimum risk exposure level (TMREL) for leading risk factors associated with diet that minimize the risk of morbimortality from chronic diseases. TMREL can be applied to develop follow-up or evaluation indicators in individual studies. The validity of these scores can be tested by assessing associations with health outcomes in prospective cohorts. In this study conducted within the NutriNet-Santé cohort, four dietary scores (TMREL-Risk Score, TMREL-Probability of adequacy, TMREL-standardized distance, and TMREL dietary score) using different scoring methods were developed, with higher scores reflecting less healthy diets. Associations of these scores with the risk of type 2 diabetes, cancer, cardiovascular diseases (CVD) and mortality were estimated using multivariable Cox proportional hazards models, adjusted for a wide range of covariates. Counterfactual and marginal structural models were used to infer causality. Analyses were conducted in a sample of up to103,324 participants ((78.3% women, mean age of 43.6 years old (y) (SD = 14.6)), followed for a median of 8.47 (IQR = 14.7) years (2009-2024). The association with dietary scores (for 1SD-increase) varied in magnitude for each health outcome. For mortality, HR varied from 1.12 (95%CI = 1.07-1.18, ) to 1.18 (95%CI = 1.12-1.24) for TMREL-Stdis and TMREL-DI, for overall cancer from 1.07 (95%CI = 1.03-1.12) to 1.09 (1.04-1.13) for TMREL-RS and TMREL-PA, for CVD from 1.07 (95%CI = 1.00-1.16) to 1.12 (95%CI = 1.04-1.20) for TMREL-PA and TMREL-RS, and for type 2 diabetes from 1.33 (95%CI = 1.23-1.43) to 1.47 (95%CI = 1.36-1.59) for TMREL-DI and TMREL-PA. Marginal structural Cox models strengthened all associations compared to classical analyses. Standardized survival curves showed clear associations, especially for the risk of cancer and type 2 diabetes. Dietary scores based on GBD TMREL can serve as key indicators for characterizing diet quality in relation to long-term health, and using different scoring systems helped evaluate the robustness of these associations.

A review of cutting-edge biomarkers for diagnosing coronary artery disease.

Chronic coronary artery disease (CAD) remains a significant global healthcare burden. Current risk assessment methods have notable limitations in early detection and risk stratification. Hence, there is an urgent need for innovative biomarkers that facilitate the premature CAD diagnosis, ultimately leading to reduction in associated morbidity and mortality rates. This review comprehensively examines recent advances in emerging biomarkers for CAD detection. Our analysis delves into various aspects of these biomarkers such as their mechanisms of action, roles in the pathophysiology of the disease, and different measurement techniques employed in clinical practice. Comparative assessment of biomarker performance between CAD patients and control groups was also presented relying on their sensitivity, specificity, and area under the curve at specific cutoff points. In this regard, prominent biomarkers including Tenascin-C, IL-37, PTX3, transthyretin, soluble interleukin-6 receptor α, and miR-15a are identified as having high diagnostic potential for chronic CAD that indeed showcase promising performance metrics. These findings underscore the role of novel biomarkers in enhancing CAD risk stratification and improving patient outcomes through early intervention. However, the pursuit of an ideal and inclusive biomarker continues due to the multifaceted nature of CAD. Future randomized controlled trials are essential to bridge the gap between research findings and clinical practice in order to augment the practical application of these biomarkers in routine healthcare settings.

Relationship of perfluoroalkyl chemicals with chronic obstructive pulmonary disease: A cross-sectional study.

Perfluoroalkyl chemicals are one of the most stable substances in industry and have become ubiquitous contaminants owing to their persistence in the environment. This study enrolled 1,953 participants aged ≥40years old using data from the National Health and Nutrition Examination Survey (NHANES). We selected four perfluoroalkyl chemicals with a detection frequency of more than 80%, including perfluorohexane sulfonic acid (PFHxS), perfluorononanoic acid (PFNA), perfluorooctanoic acid (PFOA), and perfluorooctane sulfonic acid (PFOS). Multivariate logistic regression was performed to determine the relationship of serum perfluoroalkyl chemicals with COPD and airflow limitation. We evaluated the interaction between perfluoroalkyl chemicals and lung function using multivariate linear regression analyses. Our results showed that the prevalence of COPD was not significantly related to serum PFHxS, PFNA, PFOA, and PFOS. Airflow limitation was positively linked with serum PFHxS, PFOA, and PFOS. However, these significant differences were not robust after adjustment of all confounders of interest. Serum PFHxS, PFOA, and PFOS were all positively related to the forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF). However, only PFOA remained significantly linked with the FEV1 and FVC after covariate adjustment. These results indicated that there was no significant interaction between exposure to perfluoroalkyl chemicals and the prevalence of COPD. Higher levels of serum PFOA appeared to be related to higher measures of FEV1 and FVC.

Analysis of choroidal markers of activity in pachychoroid disease spectrum.

To detect choroidal markers of disease activity in eyes with chronic active unilateral pachychoroid disease spectrum (PDS) compared to the non-active contralateral eyes, based on multimodal imaging and particularly indocyanine green angiography (ICGA). An observational retrospective case-control study. The study evaluated individuals diagnosed with chronic active unilateral PDS (group 1) by comparing the eyes with the non-active fellow eyes (group 2). Imaging was performed using fundus photographs, ICGA, and spectral-domain optical coherence tomography (SD-OCT). Choroidal thickness, choroidal vascular density, choroidal vasodilation, choroidal vascular leakage, and choroidal meridian breakdown were evaluated. Of the 90 patients with chronic PDS with ICGA at our database, 27 Caucasians (mean age: 55.9 years) were identified with active unilateral PDS. Group 1 showed a higher prevalence of the following parameters compared to Group 2: choroidal meridian breakdown (81.5% vs. 25.9%; p < 0.001), choroidal vasodilation (88.9% vs. 48.1%; p < 0.001), greater subfoveal choroidal thickness (420 ± 79.8μm vs. 346 ± 78.5μm; p = 0.002), ICGA choroidal vascular leakage (96.3% vs. 29.6%; p < 0.001), and choroidal hyperpermeability (100% vs. 29.6%; p < 0.001), with a nonsignificant increase in choroidal vascular density (55.4%±13.4 vs. 49.3%±13.5 in the contralateral eye; p = 0.167). Choroidal meridian breakdown, thicker choroid, choroidal vasodilation, and ICGA choroidal vascular leakage are potential posterior choroidal markers of disease activity in PDS.

Dihydrotanshinone I Attenuates Diet-Induced Nonalcoholic Fatty Liver Disease via Up-Regulation of IRG1.

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, but effective therapeutic drugs are still lacking. Dihydrotanshinone I (DHTS), a natural product isolated from Salvia miltiorrhiza, has been shown to have ameliorative effects on NAFLD. The aim of this study was to investigate the hepatoprotective effect of DHTS on NAFLD and its mechanism. A model of NAFLD and DHTS treatment was established using a Western diet to observe the effect of DHTS on NAFLD, which were detected by immunohistochemical, immunofluorescence, and other experiments. The mechanism was further explored by constructing immune responsive gene 1 (IRG1) knockout mice, RNA sequence, and molecular docking. The results revealed that DHTS significantly improved diet-induced metabolic disorders in mice, notably alleviating liver inflammation, oxidative stress, and fibrosis. Further analysis revealed that the intervention of DHTS was associated with the activation of IRG1. Subsequent experiments confirmed that IRG1 gene deletion reversed the above protective effects of DHTS in NAFLD. Mechanistically, DHTS enhanced the antioxidant nuclear factor-erythroid 2-related factor 2 (Nrf2) pathway through IRG1/itaconate and blocked the oxidative stress response in the liver. In addition, DHTS also inhibited the activation of NACHT-, leucine-rich repeat (LRR)-, and pyrin domain (PYD)-containing protein 3 (NLRP3) inflammasome via IRG1/itaconate, blocking the inflammatory amplification effect in the liver. The study suggests that DHTS may be a potential drug for the treatment of NAFLD, which exerts protective regulatory effects mainly through the IRG1/itaconate molecular pathway.