Complications Of Disease Research Articles

Enteric neuropathy in diabetes: Implications for gastrointestinal function

Diabetes, commonly known for its metabolic effects, also critically affects the enteric nervous system (ENS), which is essential in regulating gastrointestinal (GI) motility, secretion, and absorption. The development of diabetes-induced enteric neuropathy can lead to various GI dysfunctions, such as gastroparesis and irregular bowel habits, primarily due to disruptions in the function of neuronal and glial cells within the ENS, as well as oxidative stress and inflammation. This editorial explores the pathophysiological mechanisms underlying the development of enteric neuropathy in diabetic patients. Additionally, it discusses the latest advances in diagnostic approaches, emphasizing the need for early detection and intervention to mitigate GI complications in diabetic individuals. The editorial also reviews current and emerging therapeutic strategies, focusing on pharmacological treatments, dietary management, and potential neuromodulatory interventions. Ultimately, this editorial highlights the necessity of a multidisciplinary approach in managing enteric neuropathy in diabetes, aiming to enhance patient quality of life and address a frequently overlooked complication of this widespread disease.

Reply to the comments on "Coffee bean sign, steel pan sign and whirl sign in sigmoid volvulus".

We thank Prof. Atamanalp and colleagues for their interest and valuable comments on our article. The authors have highlighted important considerations in the diagnosis of sigmoid volvulus (SV). We would like to respond to their comments. Firstly, although we agree with their opinion that CT, MRI, and endoscopy are more reliable diagnostic tools than plain radiography, we still emphasize that diagnostic imaging for SV is initially based on plain radiography, as recommended by the WSES consensus guidelines. Since SV is the third most common cause of colonic obstruction worldwide, the accessibility of plain radiography is crucial. Among the many plain radiographic signs of SV, Levsky et al. reported that the most sensitive signs were absence of rectal gas, followed by inverted-U appearance and coffee bean sign. Understanding these signs may lead to early detection of SV and further CT evaluation for ischemia or perforation. Despite the high value of plain radiography, there is a global tend to use CT instead from the outset. Secondly, we agree with their opinion that endoscopy is not only a therapeutic, but also a diagnostic procedure to assess mucosal viability. In addition, we believe that endoscopy is also useful in ruling out other obstructive lesions, including colorectal neoplasia and complicated sigmoid diverticular disease. In the clinical setting, endoscopy is performed after the diagnosis of SV by plain radiography or CT and serves as the first line of decompression of SV when ischemia or perforation is not suspected. Finally, we congratulate Prof. Atamanalp and colleagues for their dedicated contribution to the large-scale SV studies in Eastern Anatolia, Turkey, where SV is endemic.

Network analysis combined with experimental assessment to explore the therapeutic mechanisms of New Shenqi Pills formula targeting mitochondria on senile diabetes mellitus

BackgroundThe escalation of global population aging has accentuated the prominence of senile diabetes mellitus (SDM) as a consequential public health concern. Oxidative stress and chronic inflammatory cascades prevalent in individuals with senile diabetes significantly amplify disease progression and complication rates. Traditional Chinese Medicine (TCM) emerges as a pivotal player in enhancing blood sugar homeostasis and retarding complication onset in the clinical management of senile diabetes. Nonetheless, an evident research gap persists regarding the integration of TCM’s renal tonification pharmacological mechanisms with experimental validation within the realm of senile diabetes therapeutics.AimsThe objective of this study was to investigate the mechanisms of action of New Shenqi Pills (SQP) in the treatment of SDM and make an experimental assessment.MethodsNetwork analysis is used to evaluate target pathways related to SQP and SDM. Mitochondrial-related genes were obtained from the MitoCarta3.0 database and intersected with the common target genes of the disease and drugs, then constructing a protein-protein interaction (PPI) network making use of the GeneMANIA database. Representative compounds in the SQP were quantitatively measured using high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) to ensure quality control and quantitative analysis of the compounds. A type 2 diabetes mice (C57BL/6) model was used to investigate the pharmacodynamics of SQP. The glucose lowering efficacy of SQP was assessed through various metrics including body weight and fasting blood glucose (FBG). To elucidate the modulatory effects of SQP on pancreatic beta cell function, we measured oral glucose tolerance test (OGTT), insulin histochemical staining and tunel apoptosis detection, then assessed the insulin-mediated phosphoinositide 3-kinase (PI3K)/protein kinase A (Akt)/glycogen synthase kinase-3β (GSK-3β) pathway in diabetic mice via Western blotting. Additionally, we observe the structural changes of the nucleus, cytoplasmic granules and mitochondria of pancreatic islet β cells.ResultsIn this investigation, we identified a total of 1876 genes associated with senile diabetes, 278 targets of SQP, and 166 overlapping target genes, primarily enriched in pathways pertinent to oxidative stress response, peptide response, and oxygen level modulation. Moreover, an intersection analysis involving 1,136 human mitochondrial genes and comorbidity targets yielded 15 mitochondria-related therapeutic targets. Quality control assessments and quantitative analyses of SQP revealed the predominant presence of five compounds with elevated concentrations: Catalpol, Cinnamon Aldehyde, Rehmanthin D, Trigonelline, and Paeonol Phenol. Vivo experiments demonstrated notable findings. Relative to the control group, mice in the model group exhibited significant increases in body weight and fasting blood glucose levels, alongside decreased insulin secretion and heightened islet cell apoptosis. Moreover, β-cells nuclear condensation and mitochondrial cristae disappearance were observed, accompanied by reduced expression levels of p-GSK-3β protein in islet cells (p < 0.05 or p < 0.01). Conversely, treatment groups administered SQP and Rg displayed augmented expressions of the aforementioned protein markers (p < 0.05 or p < 0.01), alongside preserved mitochondrial cristae structure in islet β cells.ConclusionOur findings suggest that SQP can ameliorate diabetes by reducing islet cell apoptosis and resist oxidative stress. These insulin-mediated PI3K/AKT/GSK-3β pathway plays an important regulatory role in this process.

Cavitating Mesenteric Lymph Node Syndrome in a Patient with Celiac Disease: Differential Diagnosis Based on Radiological Findings

Mesenteric lymph node syndrome is a rare condition characterized by cystic or cavitating changes in mesenteric lymph nodes. It is commonly associated with celiac disease. We present a case of a 59-year-old woman with known celiac disease who presented with abdominal pain, abdominal swelling, and weight loss, ultimately diagnosed with mesenteric lymph node syndrome. This case highlights the importance of radiological findings when considering rare complications of celiac disease in the differential diagnosis.

Post-Diarrheal Acute Kidney Injury During an Epidemic in Monsoon – A Retrospective Study from a Tertiary Care Hospital

Background: Acute kidney injury (AKI) is a severe complication of acute diarrheal diseases; however, there is limited data on post-diarrheal AKI (PD-AKI) epidemiology and outcomes. This study aimed to investigate the clinicodemographic profile and outcomes of PD-AKI in our hospital. Materials and Methods: We retrospectively analyzed data from 93 patients admitted with PD-AKI during a diarrheal illness epidemic. Patients were stratified based on the Kidney Disease: Improving Global Outcomes (KDIGO) AKI stage and quick Sequential Organ Failure Assessment (qSOFA) score. Clinicodemographic data and outcomes were recorded and analyzed. Results: The mean age of the patients was 45.7 ± 11.9 years, with a majority being men (n = 55, 59%). All patients presented with watery diarrhea, 85% (n = 79) had vomiting, and 66% (n = 61) presented in shock. At presentation, 59% were oliguric, while 32% were anuric. KDIGO stage 3 AKI was observed in 71% (n = 66) of patients. Dialytic support was required in 29% (n = 27) of cases. The mortality rate was 6.5% (n = 6), mostly due to refractory shock, while the remaining patients recovered. Risk factor analysis demonstrated a higher qSOFA score, and peak serum creatinine levels were associated with an increased likelihood of requiring renal replacement therapy and delayed renal recovery. Conclusion: This study provides valuable insights into the clinicodemographic characteristics and outcomes of PD-AKI. The high prevalence of severe AKI emphasizes the importance of early recognition and appropriate management strategies for these patients.

Construction of Zwitterionic Coatings with Lubricating and Anti-Adhesive Properties for Invisible Aligner Applications.

Invisible aligners have been widely used in orthodontic treatment but still present issues with plaque formation and oral mucosa abrasion, which can lead to complicated oral diseases. To address these issues, hydrophilic poly(sulfobetaine methacrylate) (polySBMA) coatings with lubricating, antifouling, and anti-adhesive properties have been developed on the aligner materials (i.e., polyethylene terephthalate glycol, PETG) via a simple and feasible glycidyl methacrylate (GMA)-assisted coating strategy. Poly(GMA-co-SBMA) was grafted onto the aminated PETG surface via the ring-opening reaction of GMA (i.e., "grafting to" approach to obtain G-co-S coating), or a polySBMA layer was formed on the GMA-grafted PETG surface via free radical polymerization (i.e., "grafting from" approach to obtain G-g-S coating). The G-co-S and G-g-S coatings significantly reduced the friction coefficient of PETG surface. Protein adsorption, bacterial adhesion, and biofilm formation on the G-co-S- and G-g-S-coated surfaces were significantly inhibited. The performance of the coatings remained stable after storage in air or artificial saliva for 2 weeks. Both coatings demonstrated good biocompatibility in vitro and did not cause irritation to the oral mucosa of rats in vivo over 2 weeks. This study proposed a promising strategy for the development of invisible aligners with improved performance, which is beneficial for oral health treatment. This article is protected by copyright. All rights reserved.

Safety and efficacy of unilateral focused ultrasound pallidotomy on motor complications in Parkinson's disease (PD): a systematic review and meta-analysis.

To systematically review and conduct a meta-analysis to evaluate the safety and efficacy of the unilateral focused ultrasound (FUS) pallidotomy on motor complications in Parkinson's disease (PD) patients. A comprehensive search strategy was implemented through August 15, 2023, and updated on February 13, 2024, across six databases, identifying studies relevant to unilateral focused ultrasound pallidotomy and PD. Eligibility criteria included observational studies, clinical trials, and case series reporting on the impact of the intervention on motor complications in PD patients. The screening and data extraction were done by two independent reviewers. Risk of bias assessment utilized appropriate tools for different study designs. Statistical analysis involved narrative synthesis and meta-analysis. Subgroup analyses and leave-one-out analyses were performed. Five studies were included in our study, involving 112 PD patients undergoing FUS pallidotomy. UPDRS-II analysis revealed a significant improvement from baseline (mean difference (MD): -3.205, 95% CI: -4.501, -1.909, P < 0.001). UPDRS-III overall change was significant (MD: -10.177, 95% CI: [-12.748, -7.606], P < 0.001). UPDRS-IV showed a significant change from baseline (MD: -5.069, 95% CI: [-5.915, -4.224], P < 0.001). UDysRS demonstrated a significant overall improvement (MD: -18.895, 95% CI: [-26.973, -10.818], P < 0.001). The effect of FUS pallidotomy on motor complications in PD patients was effective, with a significant decrease in the UPDRS and UDysRS, reflecting improvement. The incidence of adverse events (headaches, pin-site pain, difficulty walking, and sonication-related head pain) of the FUS pallidotomy was not statistically significant, indicating its safety.

TL1A Promotes Fibrogenesis in Colonic Fibroblasts via the TGF-β1/Smad3 Signaling Pathway.

Intestinal fibrosis is a refractory complication of inflammatory bowel disease (IBD). Tumor necrosis factor ligand-related molecule-1A (TL1A) is important for IBD-related intestinal fibrosis in a dextran sodium sulfate (DSS)-induced experimental colitis model. This study aimed to explore the effects of TL1A on human colonic fibroblasts. A trinitrobenzene sulfonic acid (TNBS)-induced experimental colitis model of LCK-CD2-TL1A-GFP transgenic (Tg) or wild-type (WT) mice was established to determine the effect and mechanism of TL1A on intestinal fibrosis. The human colonic fibroblast CCD-18Co cell line was treated concurrently with TL1A and human peripheral blood mononuclear cell (PBMC) supernatant. The proliferation and activation of CCD-18Co cells were detected by BrdU assays, flow cytometry, immunocytochemistry and Western blotting. Collagen metabolism was tested by Western blotting and real-time quantitative polymerase chain reaction (RT-qPCR). The level of collagen metabolism in the TNBS+ethyl alcohol (EtOH)/Tg group was greater than that in the TNBS+EtOH/WT group. Transforming growth factor-β1 (TGF-β1) and p-Smad3 in the TNBS+EtOH/Tg group were upregulated as compared with those in the TNBS+EtOH/WT group. The proliferation of CCD-18Co cells was promoted by the addition of human PBMC supernatant supplemented with 20 ng/mL TL1A, and the addition of human PBMC supernatant and TL1A increased CCD-18Co proliferation by 24.4% at 24 h. TL1A promoted cell activation and increased the levels of COL1A2, COL3A1, and TIMP-1 in CCD-18Co cells. Treatment of CCD-18Co cells with TL1A increased the expression of TGF-β1 and p-Smad3. TL1A promotes TGF-β1-mediated intestinal fibroblast activation, proliferation, and collagen deposition and is likely related to an increase in the TGF-β1/Smad3 signaling pathway.

A Nationwide Analysis of the Impact of Cardiopulmonary Anomalies on Cleft Palate Surgical Outcomes.

To increase awareness and improve perioperative care of patients with cleft palate (CP) and coexisting cardiopulmonary anomalies. Retrospective cohort. Multi-center. Patients who underwent surgical repair of CP between 2012-2020 identified in the American College of Surgeons National Surgical Quality Improvement Program Pediatric Data File. Chi-squared analysis and Student's t-test were implemented to make associations between congenital heart disease (CHD) and congenital pulmonary disease (CPD) and postoperative complications. Multiple logistic regression was performed to identify associations between CP and CHD/CPD while controlling for age, gender, and ASA class. C2 values were used to assess the logistic regressions, with a significance level of 0.05 indicating statistical significance. Length of stay (LOS), perioperative complications (readmission, reoperation, reintubation, wound dehiscence, cerebrovascular accidents, and mortality). 9 96 181 patients were identified in the database, 17 786 of whom were determined to have CP, of whom 16.0% had congenital heart defects (CHD) and 13.2% had congenital pulmonary defects (CPD). Patients with CHD and CPD were at a significantly greater risk of increased LOS and all but one operative complication rate (wound dehiscence) relative to patients with CP without a history of CHD and CPD. This study suggests that congenital cardiopulmonary disease is associated with increased adverse outcomes in the setting of CP repair. Thus, heightened clinical suspicion for coexisting congenital anomalies in the presence of CP should prompt referring providers to perform a comprehensive and multidisciplinary evaluation to ensure cardiopulmonary optimization prior to surgical intervention.

Isolation and characterization of Chlamydia felis and its pathogenesis in cats

Feline upper respiratory tract disease (URTD) is a common but complicated disease that occurs in domestic cats, worldwide. 396 cats in Guangxi Province, China were screened for URTD-associated pathogens from March 2022 to August 2023. Mycoplasma felis was found to be the most prevalent infectious agent with a positivity rate of 24.75 %, followed by feline calicivirus (FCV), Chlamydia felis, feline herpesvirus 1 (FHV-1) and feline influenza A virus (FeIAV) with rates of 15.91, 11.62, 5.56 and 1.52 %, respectively. In particular, C. felis and M. felis were found in 13 of 55 co-infected cats. Of the 46 C. felis-positive samples, one strain, named as GXNN36, was successfully isolated using chicken embryos and it was characterized both in vivo and in vitro. For the cat studies, both high- and low-dose challenged groups showed severe conjunctivitis, accompanied by transient fever and respiratory symptoms. C. felis replicated well in turbinate, trachea and lung tissues with high copy numbers and the infection subsequently spread to the livers, spleens, pancreas, kidneys, hearts and intestines. These findings will help our understanding of the role of C. felis in feline URTD and provide a valuable model to evaluate the efficacy of vaccines and therapeutic remedies in the future.

Estimating the Economic Burden of Type 2 Diabetes Among the Elderly in Tehran Province

Background: The prevalence of non-communicable diseases such as diabetes tends to rise with age, peaking among the elderly population. Objectives: This study aimed to estimate the economic burden of type 2 diabetes mellitus (T2DM) among the elderly in Tehran province. Methods: This research employs a descriptive-analytical approach, focusing on T2DM patients who attended the specialized diabetes clinic of Tehran province in 2019. A total of 1256 cases were included in the study. Data collection involved reviewing hospital records and accessing information from the accounting department. Data analysis was conducted using Excel software. Results: The economic burden of T2DM amounted to 432,471,301,510 Rials. Among this, 230,841,323,930 Rials (53.3%) were attributed to the costs of diagnosis and treatment, while 180,365,897,580 Rials (41.7%) were associated with treating disease complications. Additionally, 9,043,200,000 Rials (2%) accounted for non-medical direct costs (NMDC), and 12,220,880 Rials (0.3%) were attributed to NMDC due to complications. Conclusions: Given the substantial financial burden incurred by elderly T2DM patients and the constraints on healthcare resources, it is imperative to prioritize preventive and therapeutic measures for this demographic. Comprehensive efforts are needed to mitigate the costs and consequences of this disease within the healthcare system.

ОПЫТ ЛЕЧЕНИЯ ПАЦИЕНТОВ СО СВИЩАМИ ОБОДОЧНОЙ КИШКИ ДИВЕРТИКУЛЯРНОГО ПРОИСХОЖДЕНИЯ

Abstract. Introduction. In the 21st century, a massive increase was noted in the incidence of diverticular disease (DD) by more than 10 times with an increase in the frequency of its complications ranging from 5 to 25%. According to the literature, the colon fistulation frequency is 5-30%, over a half of such formations being colovesical fistulas. The problem of surgical approaches to the purulent-inflammatory complications of DD is far from being resolved. Despite the fact that diverticular disease is a benign pathology, inflammatory process often creates serious technical difficulties in surgery due to the violation of the anatomical relationship of the intestine with the surrounding organs, while surgeries often affect several organs with a high infection risk. Aim. Analysis of the results of the treatment of patients with diverticular colon fistulas in a specialized department of a multidisciplinary hospital. Materials and Methods. Treatment outcomes were analyzed retrospectively in 347 patients with diverticular colon disease complications for the period from 2013 to 2022. The study included 17 patients with diverticular fistulas: 14 (82.4%) patients with internal (intestinal-urinary (13) and intestinal-vaginal (1)) fistulas and 3 (17.6%) with external ones. Results and Discussion. The therapeutic and diagnostic algorithm for diverticular fistulas required a wide range of diagnostic methods and a multidisciplinary approach. Surgery remains the single treatment option for this pathology. The choice of the surgical procedure depended on the inflammatory process severity, its spread to the surrounding abdominal organs, and the largest diverticula accumulation in the gut. In the group of patients with intestinal-urinary fistulas, the resection was not limited to the removal of the colon segment only. In 9 (52.9%) cases, it was expanded to the anterior rectum resection due to the inflammation transition to its upper ampullary region. We are supporters of the one-stage surgical procedures with forming the primary anastomosis in patients with diverticular fistulas. We give preference to the Sigal-Ramazanov invagination anastomosis that allows avoiding the anastomosis due to creating a duplicate of the intestinal wall hiding the anastomosis zone. The paper identifies probable predictors of complicating diverticular disease with fistulation. Conclusions. Choosing the optimal treatment option for patients with diverticular disease complications is a difficult problem. It is better to operate on them in the coloproctology departments of multidisciplinary hospitals with the established good interaction among the members of a multidisciplinary team.

MST1 knockdown inhibits osteoarthritis progression through Parkin-mediated mitophagy and Nrf2/NF-κB signalling pathway.

Osteoarthritis (OA) is a complicated disease that involves apoptosis and mitophagy. MST1 is a pro-apoptotic factor. Hence, decreasing its expression plays an anti-apoptotic effect. This study aims to investigate the protective effect of MST1 inhibition on OA and the underlying processes. Immunofluorescence (IF) was used to detect MST1 expression in cartilage tissue. Western Blot, ELISA and IF were used to analyse the expression of inflammation, extracellular matrix (ECM) degradation, apoptosis and mitophagy-associated proteins. MST1 expression in chondrocytes was inhibited using siRNA and shRNA invitro and invivo. Haematoxylin-Eosin, Safranin O-Fast Green and alcian blue staining were used to evaluate the therapeutic effect of inhibiting MST1. This study discovered that the expression of MST1 was higher in OA patients. Inhibition of MST1 reduced inflammation, ECM degradation and apoptosis and enhanced mitophagy invitro. MST1 inhibition slows OA progression invivo. Inhibiting MST1 suppressed apoptosis, inflammation and ECM degradation via promoting Parkin-mediated mitophagy and the Nrf2-NF-κB axis. The results suggest that MST1 is a possible therapeutic target for the treatment of osteoarthritis as its inhibition delays the progression of OA through the Nrf2-NF-κB axis and mitophagy.

Nursing Intervention to Prevent and Manage Delirium in Critically Ill Patients: A Scoping Review.

Delirium is an acute neuropsychiatric syndrome of multifactorial etiology with a high incidence in people admitted to intensive care units. In addition to reversible impairment of cognitive processes, it may be associated with changes in thinking and perception. If, in the past, it was considered an expected complication of severe disease, nowadays, delirium is associated with a poor short-term and long-term prognosis. Knowing that its prevention and early identification can reduce morbidity, mortality, and health costs, it is vital to investigate nursing interventions focused on delirium in critically ill patients. This study aimed to identify nursing interventions in the prevention and management of delirium in critically ill adults. The method used to answer the research question was a scoping review. The literature search was performed in the Medline (via PubMed), CINAHL (via EBSCOhost), Scopus, Web of Science, and JBI databases. The final sample included 15 articles. Several categories of non-pharmacological interventions were identified, addressing the modifiable risk factors that contribute to the development of delirium, and for which nurses have a privileged position in their minimization. No drug agent can, by itself, prevent or treat delirium. However, psychoactive drugs are justified to control hyperactive behaviors through cautious use. Early diagnosis, prevention, or treatment can reduce symptoms and improve the individual's quality of life. Therefore, nursing professionals must ensure harmonious coordination between non-pharmacological and pharmacological strategies.

Use of Fludrocortisone for Hyperkalemia in Chronic Kidney Disease Not Yet on Dialysis.

Hyperkalemia is a frequent and potentially lethal complication of chronic kidney disease (CKD). We retrospectively examined the potassium-lowering effect of oral fludrocortisone and its adverse effects in hyperkalemic CKD patients not yet on dialysis. Thirty-three patients (23 men and 10 women, ages 69±14 years) were included. To control hyperkalemia at the outpatient clinic, twenty-one patients (Group 1) received fludrocortisone (0.05-0.1 mg/day) without changes in angiotensin II receptor blockers (ARBs) and calcium polystyrene sulfonate (CPS), while twelve patients (Group 2) were treated with fludrocortisone in addition to stopping ARBs and/or adding low-dose CPS. Fludrocortisone was administered for a median of 169 days (interquartile range, 47-445). At the first follow-up after fludrocortisone administration, serum potassium dropped from 6.14±0.32 mEq/L to 4.52±1.06 mEq/L (p<0.001) in Group 1 and from 6.37±0.35 mEq/L to 4.08±0.74 mEq/L (p<0.01) in Group 2. Ten patients in Group 1 and five patients in Group 2 measured serum potassium levels at four outpatient visits before and after fludrocortisone administration, respectively. The frequency of serum potassium ≥6.0 mEq/L decreased from 19/40 (48%) to 2/40 (5%) (p<0.001) in Group 1 and from 11/20 (55%) to 0/20 (0%) (p<0.001) in Group 2. Eleven patients experienced sodium retention-related problems after fludrocortisone administration: 7 with worsening leg edema, 2 with pleural effusions, and 2 with pulmonary edema. In pre-dialysis CKD patients, fludrocortisone at low doses effectively reduced serum potassium levels; however, sodium retention was a common adverse effect.

Associations between lipoprotein(a), oxidized phospholipids, and extracoronary vascular disease

The roles of lipoprotein(a) [Lp(a)] and related oxidized phospholipids (OxPLs) in the development and progression of coronary disease is known, but their influence on extracoronary vascular disease is not well-established. We sought to evaluate associations between Lp(a), OxPL apolipoprotein B (OxPL-apoB), and apolipoprotein(a) (OxPL-apo(a)) with angiographic extracoronary vascular disease and incident major adverse limb events (MALEs). Four hundred forty-six participants who underwent coronary and/or peripheral angiography were followed up for a median of 3.7 years. Lp(a) and OxPLs were measured before angiography. Elevated Lp(a) was defined as ≥150 nmol/L. Elevated OxPL-apoB and OxPL-apo(a) were defined as greater than or equal to the 75th percentile (OxPL-apoB ≥8.2 nmol/L and OxPL-apo(a) ≥35.8 nmol/L, respectively). Elevated Lp(a) had a stronger association with the presence of extracoronary vascular disease compared to OxPLs and was minimally improved with the addition of OxPLs in multivariable models. Compared to participants with normal Lp(a) and OxPL concentrations, participants with elevated Lp(a) levels were twice as likely to experience a MALE (odds ratio: 2.14, 95% confidence interval: 1.03, 4.44), and the strength of the association as well as the C statistic of 0.82 was largely unchanged with the addition of OxPL-apoB and OxPL-apo(a). Elevated Lp(a) and OxPLs are risk factors for progression and complications of extracoronary vascular disease. However, the addition of OxPLs to Lp(a) does not provide additional information about risk of extracoronary vascular disease. Therefore, Lp(a) alone captures the risk profile of Lp(a), OxPL-apoB, and OxPL-apo(a) in the development and progression of atherosclerotic plaque in peripheral arteries. These results lay a foundation in support of studying Lp(a) lowering medications and their effect on limb-related complications.

Chemotherapy Care Companion: Enhancing cancer care through digital remote monitoring.

1636 Background: Oncology patients often encounter preventable acute issues prompting the need for proactive monitoring and management. To manage disease and therapy complications, Ochsner Health developed Chemotherapy Care Companion (CCC) for remote monitoring of treatment patients. This abstract highlights the feasibility of digital remote monitoring (DRM) in managing oncologic patient care, while increasing patient satisfaction and reducing patient events and healthcare costs. Methods: Starting in January 2021, patients initiating an oral or intravenous cancer treatment with an active Ochsner portal account and smartphone became eligible. Providers can manually enroll patients via an order set and receive enrollment reminders within the Epic electronic medical record (EMR). Patients receive a digital WiFi-enabled monitoring scale, blood pressure cuff, and ear thermometer, at no cost. Patients are reminded via phone alerts to take vitals at 9am and 3pm, along with a daily questionnaire. The data is transmitted wirelessly to the EMR, where abnormal vital signs or questionnaire responses trigger escalations sent to an Epic in-basket pool. During clinic hours, advanced practice providers (APPs) review and intervene, utilizing embedded urgent care slots for same-day access. In August 2022, a patient satisfaction survey comprising of nine questions was distributed to all enrolled patients. Results: A retrospective analysis was conducted from September 2022 to August 2023 including 722 participants, 7,360 escalations and 668 interventions. Patient compliance reached 62%, defined as submitting at least 50% of daily vitals. The most common interventions were related to hypertension, hypotension, weight changes, and questionnaire responses. Regarding questionnaire responses, diarrhea, pain, fever, and dizziness were the mostly frequently triaged. Data analytics revealed that CCC led to a 5.9% decrease in emergency room visits, a 41.7% decrease in the rate of inpatient hospital admissions, and a 32.3% improvement in the inpatient length of stay compared to non-enrolled patients. Extrapolating this data across 5,500 oncology patients within our hospital system, CCC could prevent 172 ER visits, 914 inpatient hospital admissions and 2,006 hospital days. The survey (131 responses) revealed high satisfaction with CCC: over 80% felt a sense of security, 90% were overall satisfied, and more than 90% would recommend CCC. Conclusions: Findings highlight the value of integrating DRM in cancer care, showcasing its ability to reduce healthcare costs and optimize resource utilization while enhancing patient care and satisfaction. Moreover, the study underscores the high patient satisfaction and engagement with DRM, bolstering its feasibility and acceptance in oncology care. Further investigation is warranted to explore the financial benefits for hospitals, insurance companies, and pharmaceutical companies.

Post-Exchange Transfusion Hematocrit in Sickle Cell Disease and Vaso-occlusive Complications

Post-Exchange Transfusion Hematocrit in Sickle Cell Disease and Vaso-occlusive Complications

Potential therapeutic natural compounds for the treatment of Alzheimer's disease

BackgroundAlzheimer's disease (AD) is a complicated neurodegenerative disease with cognitive impairment occurring in the older people, in which extracellular accumulation of β-amyloid and intracellular aggregation of hyperphosphorylated tau are regarded as the prevailing theories. However, the exact AD mechanism has not been determined. Moreover, there is no effective treatment available in phase III trials to eradicate AD, which is imperative to explore novel treatments. PurposeA number of up-to-date pre-clinical studies on cognitive impairment is beneficial to clarify the pathology of AD. This review recapitulates several advances in AD pathobiology and discusses the neuroprotective effects of natural compounds, such as phenolic compounds, natural polysaccharides and oligosaccharides, peptide, and lipids, underscoring the therapeutic potential for AD. MethodsElectronic databases involving PubMed, Web of Science, and Google Scholar were searched up to October 2023. Articles were conducted using the keywords like Alzheimer's disease, pathogenic mechanisms, natural compounds, and neuroprotection. ResultThis review summarized several AD pathologies and the neuroprotective effects of natural compounds such as natural polysaccharides and oligosaccharides, peptide, and lipids. ConclusionWe have discussed the pathogenic mechanisms of AD and the effect natural products on neurodegenerative diseases particularly in treating AD. Specifically, we investigated the molecular pathways and links between natural compounds and Alzheimer's disease such as through NF-κB, Nrf2, and mTOR pathway. Further investigation is necessary in exploring the bioactivity and effectiveness of natural compounds in clinical trials, which may provide a promising treatment for AD patients.

Impact of acute ischemic stroke on mortality in gastrointestinal malignancies: A nationwide analysis.

e16372 Background: Acute ischemic stroke, marked by a sudden loss of brain blood supply, carries potential life-threatening consequences. The impact on individuals with pre-existing gastrointestinal (GI) malignancies, coupled with ensuing complex medical complications affecting morbidity and mortality, remains inadequately understood. This study aims to assess the influence of acute ischemic stroke on in-hospital mortality in GI cancer patients in the United States. Methods: This retrospective analysis utilized the 2016-2020 National Inpatient Survey (NIS) database. Adults aged 18 and above with esophageal, gastric, colon, cholangiocarcinoma, hepatocellular carcinoma, and pancreatic cancers were identified using the International Classification of Disease-10 (ICD-10) code. The cohort was stratified into patients with and without acute ischemic stroke. Hospital mortality was analyzed using STATA 18, adjusted for age, gender, race, insurance, Charlson’s index, baseline hospital characteristics, and comorbidities. Multivariate logistic regression analysis was performed, with all P values ≤ 0.05 considered statistically significant. Results: Among 2,133,465 adults with GI malignancies, 28,394 were hospitalized with acute ischemic stroke. Patients with acute ischemic stroke were older (mean age 71.19 vs. 67.01 years; P &lt; 0.001), more likely to be male (55.47%, P = 0.002), Caucasian (67.96%, P &lt; 0.001), from urban teaching hospitals (76.83%, P = 0.011), and had Medicare insurance (70.50%, P &lt; 0.001). Acute ischemic stroke was most associated with pancreatic cancer (39.81%), colon cancer (30.13%), and esophageal cancer (9.86%). Within the cohort of patients with acute ischemic stroke, esophageal cancer patients had the highest mortality rates of 20%. After adjusting for potential confounders, patients with colon cancer, esophageal cancer, gastric cancer, pancreatic cancer, cholangiocarcinoma, and hepatocellular carcinoma had significantly higher odds of in-hospital mortality of 2.91, 2.50, 2.31, 2.22, 1.65, and 1.51, respectively. Conclusions: This study reveals an association between outcomes in hospitalized GI cancer patients and acute ischemic stroke, leading to increased mortality despite adjusting for potential confounders. The impact of anticancer therapies on the vascular system may influence the risk and severity of ischemic events. Further studies are needed to develop tailored prevention, diagnosis, and management strategies to reduce disease complications and the overall healthcare burden of cerebrovascular events.