Disease Patients Research Articles

ANCA Kidney Risk Score Performance in a German Cohort of Patients with Histologically Confirmed ANCA-Associated Renal Vasculitis.

Predicting the outcome of ANCA-associated vasculitis (AAV) is a difficult task. One of the most promising prognostic scores, the ANCA Renal Risk Score (ARRS), has recently been updated and renamed to ANCA Kidney Risk Score (AKRiS). We wanted to test its performance in our population. 164 patients were included and categorized in subgroups analogous to that of both scores. Multivariable logistic regression analysis was applied to assess the risk of renal failure. Additionally, baseline data and outcome were compared between the subgroups of each score to retrieve useful clinical information. Stratified by AKRiS risk category, the proportions of patients who developed end-stage kidney disease (ESKD) at 36 months were 9.8%, 29.1%, 63.0%, and 83.3%, respectively (p < 0.001).Those belonging to the higher risk groups showed more pronounced proteinuria and anemia at diagnosis (p=0.001, p<0.001, respectively). Although our patients exhibited a more severe disease phenotype than those of AARS and AKRiS, both scores performed equally well: The Harrell´s C Index was similar (0.8381 vs. 0.8337). Beyond that, we found differences and similarities in the risk associations between the subgroups of both scores and disease activity or patient outcome, with some of them being described for the first time. For example, there was a higher risk of renal failure with anemia but not with C-reactive protein and the Birmingham Vasculitis Activity Score (BVAS) and an increased incidence of relapsing disease in the lower risk categories of ARRS. Here, we present the first external AKRiS validation confirming the improved ESKD prediction of the revised score in our cohort. Furthermore, we highlighted associations between risc score categories and patient mortality or vasculitis relapse.

The outcome of COVID-19 infection among Saudi oncology patients.

e23085 Background: Little data are available surrounding the outcomes and risk factors of COVID-19 in Saudi oncological patients. This study aims to elucidate the outcomes of COVID-19 infection among Saudi oncology patients and associated risk factors. Methods: We retrospectively reviewed the medical files of oncology patients who were diagnosed with COVID-19 at the King Faisal Specialist Hospital and Research Centre. The time from a positive PCR until death or last follow-up was calculated as COVID-specific survival. A p-value less than 0.05 was selected as the threshold for statistical significance. Results: 161 oncological patients were included in our analysis. The mean age was 53.83±15.81. 85 (52.8%) patients were female, 17 (10.6%) had a positive history of smoking, and 57 (35.4%) were obese. 70 (43.5%) patients had diabetes mellitus, 64 (39.8%) had hypertension, and 25 (15.5%) had dyslipidemia. The most common cancer in the group was breast cancer, which was present in 24 (14.9%), followed by non-Hodgkin lymphoma, colon cancer, and acute leukemia, respectively. 57 (35.4%) patients had no evidence of disease (NED) at presentation. Furthermore, 65 (40.4%) patients had received antineoplastic therapy within 30 days before infection. 25 (15.5%) patients had stage A COVID-19, 59 (36.6%) had stage B, 48 (29.8%) had stage C, and 29 (18%) had stage D. There was no difference between active and no NED patients in remission in regard to the stages of COVID-19 infection at presentation (p = 0.05). However, the stages of COVID were less severe in patients who received antineoplastic therapy (p = 0.02). 32 (19.9%) patients received tocilizumab during the acute phase of infection. Only 5 (3.1%) patients suffered COVID-specific death. Therefore, the median COVID-specific survival was not reached. Tocilizumab (p = 0.34), corticosteroids (p = 0.77), ACE inhibitors (p = 0.45) had no impact on COVID-specific death in our patient population. In patients who received steroid treatment, the duration of corticosteroid had no impact on survival (HR: 0.76, p = 0.39). Ventilation also had no impact on survival (p = 0.55). There was no difference between patients who received antineoplastic therapy within 30 days from infection and those who did not (p = 0.99). Finally, we noted no difference in survival between patients with active disease and NED patients (p = 0.17). Conclusions: COVID-related mortality is lower in Saudi oncology patients compared to other countries. Early management and admission of oncological patients may result in overall improved outcome. In line with some studies, antineoplastic therapy can reduce COVID-19 severity, possibly due to reduced ACE receptor expression.

Electronic health records with decision support systems for sharper diagnoses: bibliometric analysis

Clinical decision support systems (CDSS) and electronic health records (EHRs) are computer systems designed to assist decision-makers in making optimal and streamlined judgments on disease diagnosis, treatment, patient care, and health institution management. This study conducted descriptive and bibliometric evaluations of CDSS integrated with EHRs studies published in journals included in the Scopus database from 2007 to 2024. During the initial phase, the publications were distributed based on their publication year, nation, institution, journal, and citation numbers, as part of a descriptive analysis. During the second stage, the articles were subjected to bibliometric analysis, which involved doing common keyword analyses. The research yielded 409 papers about CDSS and EHRs. The United States has been identified as the country with the highest number of studies on this issue. The journal with the highest number of citations observed was Studies in Health Technology and Informatics. Furthermore, the text showcases visual representations of co-citations and cooperation between authors from different institutions and countries. This study aims to present a systematic framework for examining CDSS with EHRs to improve diagnosis and offer a comprehensive viewpoint to researchers and specialists in the field.

Melanoma immunotherapy longitudinal database: A comprehensive approach to capture oncological and toxicity data.

e23314 Background: Evaluating immunotherapy approaches is consistently performed in melanoma, a forefront cancer in immunotherapy responsiveness. Although immune checkpoint inhibitors (ICIs) showed the highest significant survival benefits in melanoma, 50% of patients experience recurrence/refractory disease, and ~59% develop grade 3/4 immune-related adverse events (irAEs). Thus, understanding the disease's natural history, exploring biomarkers of response/toxicity, and identifying the efficacy/safety of immunotherapy using real-world data is warranted. Methods: We established a centralized pro-/retrospective database on Research Electronic Data Capture (REDCap), encompassing patients' demographics/comorbidities, disease risk factors, clinicopathological parameters, genomic/immune profiling, treatment modalities, tumor outcomes, irAEs, and patients’ reported outcomes (PROs). Additionally, to streamline data collection and minimize the required time, effort, and cost for manual retrieval, we developed an automated pathway for data capture using MD Anderson Cancer Center (MDACC) electronic data capture (EDC) tools which pull clinical data from EPIC. Data quality will be validated by comparing it to manually retrieved data from an ongoing study of melanoma patients treated with ICIs in the adjuvant setting (NCT04990726). Results: A total of 4074 immunotherapy-treated melanoma patients were identified. We automatically captured demographics and laboratory values at predefined time points from REDCap, along with PROs using validated electronic self-reported questionnaires already built in REDCap. We also automatically captured family history, comorbidities, pathology data, and cancer treatments from the Data Management Initiative (DMI) validated software that automatically captures data from 12 various institutional sources that complement each other, including Radiation Oncology Database, the Biospecimen Information Management System,...etc. Moreover, genomic data were automatically pulled from the Molecular and Clinical Data Integration Platform for 1850 patients. Automated capture of tumor response and irAEs according to the Response Evaluation Criteria in Solid Tumors 1.1. and Common Terminology Criteria for Adverse Events version-5, respectively are currently ongoing and will be presented. Conclusions: Integrating EDC tools demonstrated accurate real-time data capture and minimized the manual retrieval burden. Our immunotherapy-treated melanoma patients’ cohort provides a comprehensive and a valuable resource for exploring the safety signals and efficacy of various immunotherapeutic approaches beyond clinical trials.

Blood metabolites–based MCTarg for multi-cancer screening and clinical diagnosis.

e15028 Background: Multi-cancer early detection (MCED) tests have emerged as promising tools for reducing cancer-related healthcare costs and mortality. As metabolome is closely linked to the phenotype of bio-individual, metabolomics analysis enables the high throughput investigating of the pathophysiological conditions. Based on metabolomics and machine learning, we developed the Multiple Cancer Target (MCTarg) analysis for multiple cancer screening and diagnosis by a single blood draw. Methods: A total of 1153 individuals (172 healthy participants, 623 patients with lung cancer, gastric cancer, and colorectal cancer, and 358 these organ-related benign disease patients) were enrolled from three independent clinical sites in China. Plasma samples were collected and measured by mass spectrometry (MS)-based platforms (LC-MS polar and lipid). MCTarg was developed with three machine learning modules for three scenarios (community screening for non-healthy individuals, clinical diagnosis for classifying malignant and benign diseases, and tracing tumor of origin). Results: MCTarg exhibited an Area Under the Curve (AUC) of 0.96 with 92.82% sensitivity at 80% specificity to differentiate the non-healthy individuals from healthy controls, and an AUC of 0.86 with 75.41% sensitivity at 79.66% specificity in discriminating multi-cancer from benign diseases. Notably, the classification accuracy for distinguishing between malignant and benign conditions in the colorectal organ was reached 90.74%, with a sensitivity of 83.87% and a specificity of 100%. Furthermore, the overall accuracy for detecting the cancer origin reached 84.78% with an average sensitivity and specificity of 78.08% and 90.7%, respectively. Conclusions: The outstanding results indicated that blood-metabolites-based MCTarg is poised to be a cost-effective, precise, and versatile tool for diagnosing multi-cancer and discriminating tumor of origin. Its potential applications encompass health checkups and supplementary diagnostic scenarios. More deadly cancer types will be extended and the performance of MCTarg will be validated by prospective and population-scale cohorts with longitudinal follow-up.

Factors Associated with Sickle Cell Crisis Among Sickle Cell Disease Patients Aged ≤15 Years in Three Kenyan Health Facilities

In view of the dearth of definitive therapeutic measures for sickle cell disease (SCD) and its associated crises, the resulting financial burden on parents and caregivers, coupled with psychological distress, social stigma, and other far-reaching consequences, remains incalculable. This research assessed the determinants of sickle cell crises among individuals with SCD aged 15 years and below, focusing on three healthcare facilities in Nairobi County. Using a descriptive cross-sectional design, the study aimed to establish the correlation between SCD crises and various variables in this specific age group within the selected health facilities. Structured interviewer-administered questionnaires, featuring both open-ended and dichotomous questions, were meticulously validated, optimized, and employed to gather pertinent data from the participants. The findings revealed that a majority of SCD patients below 15 years in sampled hospitals were female (52.85%), and the highest incidence of SCD occurred in the age range of 0-5 years (46.63%). Educational attainment among patients predominantly peaked at the primary school level (65.80%), with a minimal 7.77% reaching a secondary school level. Moreover, female caregivers (92.23%) were prevalent among those responsible for SCD patients aged 15 years and below. Primary caregivers, aged between 26- 30 years (37.82%) and 31-35 years (26.42%) were predominately married (75.13%) and engaged in agricultural activities (63.73%). This study revealed that out of the sampled SCD patients under 15 years old, a staggering 83.94% experienced crises related to their sickle cell disease, manifesting as abdominal pains for nearly 70 %, joint discomfort for over 72.22%, acute chest pain occurring approximately 25 %, with bone ache accounting about 32 %. Multiple logistic regression analysis demonstrated that female gender, the age group of 6-10 years, and frequent hospital visits (more than twice a month) significantly increased the log odds for severe SCD crises. Therefore, this study underscores the impact of patient and caregiver factors on the severity of SCD and its crises. Modifying these factors appropriately holds the potential to enhance the prognosis and wellbeing of both patients and caregivers, and strategic interventions must be devised to improve adherence to treatment protocols for SCD patients aged 15 years and below, thereby enhancing prognosis and overall quality of life.

Global Prevalence of Anxiety, Depression, and Stress Among Patients with Skin Diseases: A Systematic Review and Meta-analysis.

The changes in human lifestyle over the past few decades have impacted the prevalence of skin diseases within different societies. Skin diseases may result in various physical and mental disorders. The most common mental disorders observed among the patients are stress, anxiety, and depression. This study aims to investigate the global prevalence of anxiety, depression, and stress in patients with skin diseases. In this Systematic Review and Meta-Analysis study, the PubMed, Scopus, Science Direct, Embase, Web of science, and Google Scholar repositories were searched without a lower time limit. Heterogeneity among the identified studies was examined using the I2 index, and accordingly random effects model was adopted for analysis. Data analysis was conducted within the Comprehensive Meta-Analysis software (v. 2). In total, 113 studies were included for the final analysis. The overall pooled prevalence of stress, depression, and anxiety in skin disease patients was found to be 39.4%, 27.2% and 28.8%, respectively. Among patients with psoriasis, acne, vitiligo or atopic dermatitis diseases, the highest number of patients suffering from stress was related to patients with acne (75.7%). The highest prevalence of depression, and anxiety was reported in patients with vitiligo (38.3%) and acne (36.5%), respectively. Considering the high prevalence of mental disorders among patients with skin diseases and recognising the impacts of mental health challenges on patients' well-being, the findings of this study provide valuable insights for identifying specific populations that require targeted interventions for the diagnosis, treatment, and prevention of mental illnesses. Accordingly, healthcare policymakers should incorporate psychological treatment and support measures as integral components of comprehensive care strategies for patients with skin diseases.

Sternum-sparing multivessel coronary surgery as a routine procedure: Midterm results of total coronary revascularization via left anterior thoracotomy

ObjectiveA sternum-sparing approach of minimally invasive total coronary revascularization via left anterior thoracotomy demonstrated promising early outcomes in unselected patients with coronary artery multivessel disease. Follow-up data are still missing. MethodsFrom November 2019 to September 2023, coronary artery bypass grafting via left anterior minithoracotomy on cardiopulmonary bypass and cardioplegic cardiac arrest was performed as a routine procedure in 392 consecutive, nonemergency patients (345 men; 67.0 ± 9.9 years; range, 32-88 years). All patients had multivessel coronary artery disease (77.6% 3-vessel-disease, 22.4% 2-vessel-disease, and 32.9% left main stenosis). Patients at old age (older than a 80 years, 12.5%), with severe left ventricular dysfunction (ejection fraction <30%, 7.9%), diabetes mellitus (34.9%), massive obesity (body mass index > 35, 8.9%), and chronic lung disease (17.1%) were included. Mean European System for Cardiac Operative Risk Evaluation II score was 2.9 ± 2.8. Mean midterm follow-up (100%) was 15.2 ± 10.7 months (range, 0.1-39.5 months). ResultsLeft internal thoracic artery (99.0%), radial artery (70.4%), and saphenous vein grafts (57.4%) were used, and 70.4% of patients received at least 2 arterial grafts. A total of 3.0 ± 0.8 anastomoses (range, 2-5 anastomoses) per patient were performed to revascularize the territories of left anterior descending (98.7%), circumflex (91.6%), and right coronary (70.9%) artery. Complete anatomical revascularization was achieved in 95.1%. At follow-up, all-cause-mortality, myocardial infarction, repeat revascularization, and stroke was 3.1%, 1.5%, 5.4%, and 0.7%, respectively. Overall major adverse cardiac and cerebrovascular events rate was 8.7%. ConclusionsThis is the first report of midterm follow-up after routine sternum-sparing total coronary revascularization via left anterior thoracotomy for multivessel coronary artery disease with a high rate of multiple arterial grafting and complete anatomical revascularization. Outcome was favorable and similar to that of contemporary conventional coronary artery bypass grafting.

Bilateral superficial cervical plexus block as sole anesthesia for parathyroid surgeries in chronic kidney disease patients

Bilateral superficial cervical plexus block as sole anesthesia for parathyroid surgeries in chronic kidney disease patients

Examination of genomic profile of true single circulating tumor cells (sCTC) from hepatocellular carcinoma and its effect on mutational features.

e15039 Background: Hepatocellular carcinoma (HCC) is the fifth leading cause of cancer-related deaths worldwide. Despite numerous NGS studies unveiling diverse mutational patterns through tissue biopsies, the absence of tissue for biopsy and distinct biomarkers complicates both diagnosis and treatment. The utilization of sCTC genomics holds promise in furnishing clinically relevant and actionable insights to tailor personalized diagnostics and therapy for HCC. We present a comparative analysis of sCTC and paired ctDNA obtained from primary HCC patients for better Tx possibilities. Methods: Genomic profile from 24 sCTCs/CTC clusters (19 sCTCs, 79%; 5 CTC clusters, 21 %) revealed distinct mutational patterns compared to paired ctDNA. Live sCTCs/CTC clusters were isolated from peripheral blood of treatment naïve 12 Hepatobiliary Cancer with advanced and metastatic disease patients using OncoRadar technology. Whole genomes from sCTCs/CTC clusters were amplified, target enriched with hybridization capture using a comprehensive 1080 gene panel-OncoIndx to obtain sequencing libraries, and sequenced on Illumina NextSeq2000 platform in paired end mode (depth 500x). The raw sequence alignment and variant calling was performed using iCare software. Paired ctDNA samples were sequenced the same way, except at the depth of 5500x. Results: Pathogenic (P)/likely pathogenic (LP) variants were detected from all sCTCs, while ctDNA was negative for 40% samples. sCTCs showed at least twice as many P variants compared to paired ctDNA. ATM (50%), PIK3CA (42%), ARID1A /1B (42%), TP53/RB1 (34%), and IDH1 (34%) were among the most frequently mutated genes, while 42% sCTCs showed amplified CCND1/2 variants. In comparison, paired ctDNA had no distinct mutational pattern. Genomic profile of sCTC showed concordance with paired ctDNA for at least one gene mutation when compared at patient level. At pathway level, all sCTCs were mutated for at least one HRR pathway component, while 60% sCTCs had at least one mutation in receptor tyrosine kinase (RTK) pathway (FGFR1, ERBB, ALK, ROS1). sCTC population showed a strong cooccurrence of HRR mutation and epigenetic regulatory pathway mutations (OR =4, CI=0.4-60). At individual mutation level, 30 % concordance was observed in sCTC population, suggesting high mutational heterogeneity. Besides actionable targets, 50% sCTC were enriched with resistance conferring variants such as STK11, NF1, STAT5B, and RB1. Conclusions: The genomic profile of sCTCs in primary HCC pts revealed a complex mutational landscape, offering complementarity to ctDNA for clinical insights. sCTCs exhibited more actionable targets and greater heterogeneity compared to paired ctDNA, making sCTC genomics valuable for pts ineligible for tissue biopsy or lacking clinically relevant information from ctDNA.

Effect of Anisotropic Brain Conductivity on Patient-Specific Volume of Tissue Activation in Deep Brain Stimulation for Parkinson Disease.

Deep brain stimulation (DBS) modeling can improve surgical targeting by quantifying the spatial extent of stimulation relative to subcortical structures of interest. A certain degree of model complexity is required to obtain accurate predictions, particularly complexity regarding electrical properties of the tissue around DBS electrodes. In this study, the effect of anisotropy on the volume of tissue activation (VTA) was evaluated in an individualized manner. Tissue activation models incorporating patient-specific tissue conductivity were built for 40 Parkinson disease patients who had received bilateral subthalamic nucleus (STN) DBS. To assess the impact of local changes in tissue anisotropy, one VTA was computed at each electrode contact using identical stimulation parameters. For comparison, VTAs were also computed assuming isotropic tissue conductivity. Stimulation location was considered by classifying the anisotropic VTAs relative to the STN. VTAs were characterized based on volume, spread in three directions, sphericity, and Dice coefficient. Incorporating anisotropy generated significantly larger and less spherical VTAs overall. However, its effect on VTA size and shape was variable and more nuanced at the individual patient and implantation levels. Dorsal VTAs had significantly higher sphericity than ventral VTAs, suggesting more isotropic behavior. Contrastingly, lateral and posterior VTAs had significantly larger and smaller lateral-medial spreads, respectively. Volume and spread correlated negatively with sphericity. The influence of anisotropy on VTA predictions is important to consider, and varies across patients and stimulation location. This study highlights the importance of considering individualized factors in DBS modeling to accurately characterize the VTA.

Oncologic outpatient specialty palliative care referral utilization: A single institution quality improvement project.

e23205 Background: ASCO recommends that late-stage and/or recurrent disease patients with a prognosis of 6-24 months receive specialty palliative care within eight weeks of diagnosis. Prior studies suggest only 30% of eligible patients are referred to outpatient palliative care. Little is known about existing referral patterns to direct quality improvement initiatives. Our aim was to characterize outpatient palliative care referral sources, timeliness, and completion rates across our cancer center. More broadly, this investigation may serve as a model for outpatient palliative care utilization improvement at other cancer centers. Methods: A single institution retrospective quality improvement study was conducted of patients in the seven oncology subspecialties with the most palliative care referrals from 2019 – 2022. Data collected included demographics, referral source, and utilization metrics. Outcomes were rate of referral completion and time from referral to first palliative care visit, hospice enrollment, and/or death. Descriptive statistics were performed. Results: 1671 outpatient specialty palliative care referrals were placed. 57% were initiated by medical oncologists, 21% by inpatient palliative care consulting service at hospital discharge, and 14% by surgical oncology. 27% of referred patients did not schedule an appointment. Gynecologic and breast cancer patients had the highest rates of being scheduled. Median time from referral to appointment was 20 days (interquartile range 9 – 30 days). Reasons patients did not utilize palliative care included transition to hospice (41%), lack of interest (41%), or death prior to visit (7%). 79% of patients seen by palliative care who died were enrolled in hospice. Median time from palliative care referral to hospice enrollment was 66 days (IQR 22 – 164 days), and median time from hospice enrollment to death was 13 days (IQR 5 – 31 days). Conclusions: In a single institution self-evaluation, most patients referred to outpatient specialty palliative care completed referral within thirty days. Within the context of this institution, relevant goals for quality improvement interventions include increasing palliative care referrals among surgical oncologists and shifting palliative care referrals earlier in the disease course and prior to need for inpatient hospital admission. Understanding the elements of the creation of our palliative care referral database and relevant data tracking may serve as a method for other institutions to target interventions that may improve uptake of outpatient palliative care referrals at cancer centers more broadly.

Stromal-like Cells Are Found in Peripheral Blood of Inflammatory Bowel Disease Patients and Correlate with Immune Activation State.

Recent studies have identified a critical role for stromal-immune cell interactions in immunity and immune tolerance. Transcriptomic profiling has implicated stromal cells in immune-mediated disorders including the two common forms of inflammatory bowel disease (IBD), Crohn's disease (CD) and ulcerative colitis (UC). Stromal-immune interactions may edify inflammatory state and the development of IBD-related complications such as fibrosis; yet the lack of protein markers has hampered studying stromal-immune perturbation. In this study, we designed a 40-color spectral flow cytometry assay to characterize hematopoietic and nonhematopoietic cells in intestinal biopsies and matched blood samples from patients with CD or UC. We identified circulating stromal-like cells that are significantly more abundant in IBD blood samples than in healthy controls. Those cells expressed podoplanin (PDPN), a commonly used marker for fibroblasts, and they were associated with activated and memory T and B cells, and altered NK cell, monocyte, and macrophage populations. PDPN+ cells in the blood correlated with PDPN+ cells in the colon. Principal component analysis distinctly separated healthy blood samples from IBD blood samples, with stromal-like cells and B cell subtypes dominating the IBD signature; Pearson correlation detected an association between PDPN+ stromal-like cells and B cell populations in IBD blood and gut biopsies. These observations suggest that PDPN+ cells in the blood may serve as a biomarker of IBD. Understanding the relationship between stromal cells and immune cells in the intestine and the blood may provide a window into disease pathogenesis and insight into therapeutic targets for IBD.

Controversy on the CONVINCE study findings: the PRO take.

The CONVINCE study, recently published in the New England Journal of Medicine, reveals a groundbreaking 23% reduction in the relative risk of all-cause mortality among end-stage kidney patients undergoing high convective volume hemodiafiltration. This significant finding challenges the conventional use of high-flux hemodialysis and offers hope for improving outcomes in chronic kidney disease patients. While some controversies surround the study's findings, including concerns about generalizability and the causes of death, it is essential to acknowledge the study's design and its main outcomes. The CONVINCE study, part of the HORIZON 2020 project, enrolled 1360 patients and demonstrated the superiority of hemodiafiltration in reducing all-cause mortality overall, as well as in specific patient subgroups (elderly, short vintage, non-diabetic, and those without cardiac issues). Interestingly, it was shown that hemodiafiltration had a protective effect against infection, including COVID-19. Future research will address sustainability, dose scaling effects, identification of subgroups especially likely to benefit and cost-effectiveness. However, for now, the findings strongly support a broader adoption of hemodiafiltration in renal replacement therapy, marking a significant advancement in the field.

Malnutrition as a potential predictor of mortality in chronic kidney disease patients on dialysis: A systematic review and meta-analysis

Background & AimsMalnutrition, a significant problem in patients with chronic kidney disease (CKD), is linked to lower health-related quality of life, longer and more frequent hospital admissions, worse functional capacity, and higher levels of morbidity. However, the extent of its impact on mortality is poorly elucidated. This systematic review and meta-analysis aimed to investigate the impact of malnutrition on mortality among CKD patients on dialysis. MethodsThis meta-analysis was designed and performed in accordance with the PRISMA guidelines (CRD42023394584). A systematic electronic literature search was conducted in PubMed, ScienceDirect, and Embase to identify relevant cohort studies. The studies that reported nutritional status and its impact on mortality in patients were considered for analysis. The generic inverse variance method was used to pool the hazard ratio effect estimates by employing a random effects model. The Newcastle-Ottawa scale was used for the quality assessment. The statistical analysis was performed by utilizing RevMan and CMA 2.0. ResultsA total of 29 studies that comprised 11063 patients on dialysis whose nutritional status was evaluated were eligible for quantitative analysis. Based on a comparison between the "malnutrition" category and the reference "normal nutrition status" category, the results showed that the overall pooled hazard risk (HR) for mortality was (HR 1.49, 95% CI: 1.36–1.64, p<0.0001). According to the subgroup analysis, the hemodialysis subgroup had greater mortality hazards (HR 1.53; 95% CI 1.38–1.70, p<0.0001), compared to the peritoneal dialysis subgroup (HR 1.26; 95% CI 1.15–1.37, p<0.00001). Additionally, the overall incidence of mortality was explored but the authors were unable to combine the results due to limitations with the data. ConclusionThe findings conclude that malnutrition is a strong predictor of mortality among patients on dialysis, with the hemodialysis subgroup having a higher mortality hazard compared to the peritoneal dialysis subgroup. The results of this study will advocate for early nutritional evaluation and timely dietary interventions to halt the progression of CKD and death.

Developing a wearable device for upper extremity tremors

Objective: This project aims to develop a wearable device to suppress both the essential and resting tremor and investigate its effectiveness. Materials and Methods: This study details the development and assessment of a wearable device for upper extremity tremors. The wearable device underwent a comprehensive design and a prototype was produced with a 3D-printer. To refine the functionality of the prototype, a motor that mimics tremor was attached to a 3D-printed prototype. Then, the printed prototype was applied to the hand model, and tested its effectiveness for tremor suppressing. The wearable device was further investigated on patients with essential tremor and Parkinson`s disease seeking treatment at Neurology Clinics. We recorded the tremor data and processed and visualized the recorded data by using the MatLab (version R2021a, MathWorks Inc., USA) software. Results: The wearable device effectively decreased the tremors both during the simulation phase and the patient testing phase. The data from the wearable device revealed a notable decrease in the amplitude of the tremor. This decrease signifies an achievement of tremor suppression. Conclusion: The prototype of the wearable device signifies a remarkable efficacy in tremor supression. It holds promise for being a potential solution to alleviate the tremor symptoms of essential tremor and Parkinson`s disease patients.

Differences in Cardiac Troponin T Composition in Myocardial Infarction and End-Stage Renal Disease Patients: A Blood Tube Effect?

Cardiac troponin T (cTnT) is key in diagnosing myocardial infarction (MI) but is also elevated in end-stage renal disease (ESRD) patients. Specific larger cTnT proteoforms were identified for the acute phase of MI, while in serum of ESRD patients solely small cTnT fragments were found. However, others allocated this to a pre-analytic effect due to abundant thrombin generation in serum. Therefore, we investigated the effect of various anticoagulation methods on cTnT composition and concentration and compared the cTnT composition of MI and ESRD patients. The agreement of cTnT concentrations between simultaneously collected serum, lithium-heparin (LH) plasma, and ethylenediaminetetraacetic acid (EDTA) plasma was studied using the high-sensitivity (hs-)cTnT immunoassay. cTnT proteoform composition was investigated in a standardized time-dependent manner through spike experiments and in simultaneously collected blood matrixes of MI and ESRD patients. Excellent hs-cTnT concentration agreements were observed across all blood matrixes (slopes > 0.98; 95% CI, 0.96-1.04). Time-dependent degradation (40 kDa intact:29 kDa fragment:15 to 18 kDa fragments) was found in LH plasma and EDTA plasma, and serum in ratios (%) of 90:10:0, 0:5:95, and 0:0:100, respectively (48 h after blood collection). Moreover, gel filtration chromatography (GFC) profiles illustrated mainly larger cTnT proteoforms in MI patients, while in ESRD patients mainly 15 to 18 kDa fragments were found for all matrices. The extent of cTnT degradation in vitro is dependent on the (anti)coagulation method, without impacting hs-cTnT concentrations. Furthermore, mainly larger cTnT proteoforms were present in MI patients, while in ESRD patients mainly small 15 to 18 kDa cTnT fragments were found. These insights are essential when developing a novel hs-cTnT assay targeting larger cTnT proteoforms.

Multidimensional assessment of social cognition using non-immersive virtual reality in dementia with Lewy bodies and Alzheimer’s disease: an exploratory study

ABSTRACT Introduction Few studies have focused on social cognition in dementia with Lewy bodies (DLB), even though some brain structures being well known as underlying social cognitive processes are directly impacted in this disease. Furthermore, social cognition processes have been mostly studied independently using evaluations with poor ecological validity. We aimed at studying the ability of a new naturalistic and multidimensional social cognition task to reveal impairments in DLB patients. We chose to compare the profile of these patients with that of Alzheimer’s disease (AD) patients, for which social cognition is better preserved. Method Fifteen patients (DLB: n = 7; AD: n = 8) and 28 healthy controls underwent the REALSoCog task. They encountered several social situations (e.g. control versus transgressions) in a non-immersive virtual city environment allowing the assessment of moral cognition, cognitive and affective theory of mind (ToM), emotional empathy and behavioral intentions. Results The main results showed (i) a lower ability to detect transgressions in DLB patients, particularly conventional ones, whereas moral cognition seemed better preserved in AD patients; (ii) a cognitive ToM impairment in both DLB and AD patients, while affective ToM is impaired only in DLB patients; (iii) a decreased emotional empathy specifically observed in DLB patients; (iv) more inappropriate behavioral intentions, mainly in DLB patients, but also in some AD patients. Conclusions This study suggests the feasibility and potential interest of the REALSoCog task in revealing social cognition deficits, particularly for DLB patients by showing different social patterns as compared to AD patients. These results offer interesting clinical perspectives to develop more naturalistic tasks in such populations and for clinical differential diagnosis. Limitations and future perspectives are discussed.

MondoA and AKI and AKI-to-CKD Transition.

Elderly individuals and chronic kidney disease (CKD) patients are at a higher risk of acute kidney injury (AKI). The transcription factor MondoA is downregulated in the kidneys of aged or AKI patients; however, its roles in AKI development and the AKI-to-CKD transition remain unknown. We investigated the expression of MondoA in human kidney biopsy samples, ischemia-reperfusion (I/R)-injured mouse kidneys, and cultured proximal tubular epithelial cells under hypoxia/reoxygenation. The role of MondoA during the initial and recovery phases after I/R injury was evaluated using proximal tubule-specific MondoA knockout mice and MondoA-deficient proximal tubular epithelial cells. Furthermore, we explored the involvement of Rubicon and transcription factor EB (TFEB), both of which are downstream factors of MondoA. MONDOA expression was decreased in the renal tubules of CKD patients. In mouse kidneys, MondoA expression was decreased under ischemia, while its expression was increased during reperfusion. Genetic ablation of MondoA in proximal tubular epithelial cells inhibited autophagy and increased vulnerability to AKI through increased expression of Rubicon. Ablation of Rubicon in MondoA-deficient I/R-injured kidneys activated autophagy and protected mitochondrial function. MondoA ablation during the recovery phase after I/R aggravated kidney injury through downregulation of the TFEB-PGC1α axis. Pharmacological upregulation of TFEB contributed to maintaining mitochondrial biogenesis and increased PGC1α transcription. Our findings demonstrate that MondoA protected against vulnerability to AKI by maintaining autophagy and subsequently supporting mitochondrial function to prevent progression to CKD.

Bone turnover prediction in patients with chronic kidney disease (CKD) undergoing hemodialysis using shortened dynamic 18F-NaF PET/CT Ki–Patlak

This study investigated whether Ki–Patlak derived from a shortened scan time for dynamic 18F-NaF PET/CT in chronic kidney disease (CKD) patients undergoing hemodialysis can provide predictive accuracy comparable to that obtained from a longer scan. Twenty-seven patients on chronic hemodialysis, involving a total of 42 scans between December 2021 and August 2023 were recruited. Dynamic 18F-NaF PET/CT scans, lasting 60–90 min, were immediately acquired post-injection, covering the mid-twelfth thoracic vertebra to the pelvis region. Ki–Patlak analysis was performed on bone time–activity curves at 15, 30, 45, 60, and 90 min in the lumbar spine (L1–L4) and both anterior iliac crests. Spearman’s rank correlation (rs) and interclass correlation coefficient were used to assess the correlation and agreement of Ki–Patlak between shortened and standard scan times. Bone-specific alkaline phosphatase (BsAP) and tartrate-resistant acid phosphatase isoform 5b (TRAP5b) were tested for their correlation with individual Ki–Patlak. Strong correlations and good agreement were observed between Ki–Patlak values from shortened 30-min scans and longer 60–90-min scans in both lumbar spine (rs = 0.858, p < 0.001) and anterior iliac crest regions (rs = 0.850, p < 0.001). The correlation between BsAP and Ki–Patlak in the anterior iliac crests was weak and statistically insignificant. This finding suggests that a proposed shortened dynamic 18F-NaF PET/CT scan is effective in assessing bone metabolic flux in CKD patients undergoing hemodialysis, offering a non-invasive alternative approach for bone turnover prediction.