Early Detection Research Articles

Neutrophil-to-lymphocyte ratio associated with renal function in type 2 diabetic patients

BACKGROUND Type 2 diabetes mellitus (T2DM) is a leading risk factor for the development and progression of chronic kidney disease (CKD). However, an accurate and convenient marker for early detection and appropriate management of CKD in individuals with T2DM is limited. Recent studies have demonstrated a strong correlation between the neutrophil-to-lymphocyte ratio (NLR) and CKD. Nonetheless, the predictive value of NLR for renal damage in type 2 diabetic patients remains understudied. AIM To investigate the relationship between NLR and renal function in T2DM patients. METHODS This study included 1040 adults aged 65 or older with T2DM from Shanghai's Community Health Service Center. The total number of neutrophils and lymphocytes was detected, and NLR levels were calculated. CKD was defined as an estimated glomerular filtration rate ≤ 60 mL/min/1.73 m². Participants were divided into four groups based on NLR levels. The clinical data and biochemical characteristics were compared among groups. A multivariate logistic regression model was used to analyze the association between NLR levels and CKD. RESULTS Significant differences were found in terms of sex, serum creatinine, blood urea nitrogen, total cholesterol, and low-density lipoprotein cholesterol among patients with T2DM in different NLR groups (P < 0.0007). T2DM patients in the highest NLR quartile had a higher prevalence of CKD (P for trend = 0.0011). Multivariate logistic regression analysis indicated that a high NLR was an independent risk factor for CKD in T2DM patients even after adjustment for important clinical and pathological parameters (P = 0.0001, odds ratio = 1.41, 95% confidence intervals: 1.18-1.68). CONCLUSION An elevated NLR in patients with T2DM is associated with higher prevalence of CKD, suggesting that it could be a marker for the detection and evaluation of diabetic kidney disease.

Unveiling the spectrum of cardiac disease complicating pregnancy: A comprehensive exploration of maternal and fetal outcomes

Cardiac diseases pose a significant non-obstetrical threat to maternal well-being during pregnancy, contributing to nearly 10% of maternal mortality. The intersection of pregnancy and cardiac disease presents a complex scenario, affecting approximately 1-3% of pregnancies. Rheumatic heart disease (RHD) remains a prevalent issue in developing countries, while advancements in pediatric cardiology have increased survival rates for congenital heart disease. This exploration aims to comprehensively understand the impact of cardiac diseases on maternal and fetal outcomes during pregnancy.A prospective observational study conducted over 1 year and 6 months included 40 pregnant women with cardiovascular disease. Antenatal investigations, electrocardiogram, and echocardiography were performed. Maternal and fetal outcomes were assessed, and data were presented as descriptive statistics. The study revealed a 2.07% prevalence of cardiac disease in 1926 deliveries, with a mean age of 24±4 years. Cesarean section was the predominant mode of delivery (70%). Most cases had NYHA grade I disease (80%). Maternal outcomes were uneventful in 88%, and only 12% had ICU admission. Complications due to cardiac disease were observed in 17.5% of participants. Neonatal outcomes included NICU admission (25%), low birth weight (22.5%), and preterm birth (20%).Cardiovascular complications in pregnancy affect up to 4% of cases. The prevalence in this study aligns with existing literature. Rheumatic heart disease and congenital heart disease were predominant, consistent with global trends. Maternal and perinatal outcomes were favorable in NYHA grades I and II, emphasizing the importance of early intervention and healthcare accessibility.Cardiac disease is a substantial risk factor for maternal mortality during pregnancy. The study highlights the dual risk of balancing maternal well-being and fetal development. Prevalence, complications, and outcomes underscore the significance of pre-pregnancy counseling, early detection, and multidisciplinary management for optimal pregnancy outcomes.

Cost-effective analysis of enalapril, amlodipine, and enalapril plus amlodipine combination in newly diagnosed patients of hypertension: A pharmacoeconomic comparison of the antihypertensive efficacy of drugs

Hypertension (HTN) is a chronic condition with severe complications, so early detection and effective management are essential to prevent cardiovascular events and reduce the associated economic burden. This study aims to compare the cost-effectiveness of enalapril, amlodipine, and their combination in terms of blood pressure reduction, considering overall efficacy and economic implications. A prospective, observational cost-effectiveness analysis was conducted in 150 newly diagnosed hypertensive patients who were prescribed either enalapril (5 mg), amlodipine (5 mg), or enalapril plus amlodipine (2.5 mg each). The primary outcome was the difference in systolic and diastolic blood pressure between baseline and follow-up, as well as the evaluation of overall efficacy and cost. Based on the data, statistical analysis was carried out using ANOVA and post hoc Tukey tests for drug efficacy, and cost-effectiveness was compared using MS Excel. After 30 days, all treatments significantly reduced systolic and diastolic blood pressure (p = 0.0001). The combination therapy with a lower dose showed superior efficacy in blood pressure reduction and was most cost-effective, requiring less expense for a 1 mmHg reduction in blood pressure compared to individual drugs with a higher dose. Quality of life assessment favored low-dose combination therapy, with fewer reported adverse effects. The combinationof amlodipine and enalapril at a lower dose demonstrated superior cost-effectiveness, efficacy in blood pressure reduction, and a favorable impact on patients' quality of life compared to individual drugs at a higher dose. This suggests that combination therapy may be a preferred option in the management of hypertension, emphasizing the importance of considering both clinical and economic factors in treatment decisions.

Gallbladder metastasis of clear cell renal cell carcinoma: A case report and review of literature

Renal cell carcinoma (RCC) is the 3 most common malignancy in adults including both male and female. Clear cell RCC is the most common type of RCC, and it accounts for 70% of all cases. RCC is prone to get metastasize but its metastasis to gallbladder is quite rare. Various radiological modalities like ultrasound and CT scan can easily pick up gallbladder metastasis at an early stage. Along with our case report we will be review various articles published in literature and will be discussing various parameters of this rare occurrence also try to understand its pathogenesis. Early detection and appropriate treatment can improve the prognosis.

A Novel FSS Loaded Circular Slot Monopole Antenna for Microwave Breast Imaging Application

Breast cancer continues to be a major contributor to women's global mortality rates, emphasizing the need to explore alternative and supplementary early-stage detection techniques. This study delves into a circular slot monopole ultra-wideband (UWB) antenna equipped with a frequency-selective surface (CSMA-FSS) for early detection microwave imaging applications. To expand the impedance bandwidth of the traditional circular monopole antenna, a circular slit is introduced on a monopole structure. Additionally, a 10 × 10 unit cell FSS structure is integrated into the antenna as a far-field reflecting plane to enhance gain characteristics. The antenna, crafted with dimensions of 50 × 50 × 1.6 mm³ and a 1.6 mm thick FR4 substrate, operates across the ultra-wideband frequency spectrum, spanning from 3.1 GHz to 12 GHz, while consistently maintaining a reflection coefficient (S 11) value of – 10 dB or lower. Notably, the antenna showcases a gain of over 5 dBi across the entire 3.1 GHz to 12 GHz frequency range. The suggested antenna is ideal for microwave imaging applications due to its broad impedance bandwidth, impressive gain, and excellent directivity. Furthermore, it maintains a relatively uniform group delay, with a deviation of ±0.5 ns throughout the UWB band. In the time domain characteristics, the antenna exhibits excellent pulse handling capabilities and strong signal correlation, featuring an S 21 value of less than – 25 dB. The characteristics, observed in both the time and frequency domains, suggest that the proposed antenna holds significant potential for substantially enhancing breast cancer imaging system.

Ultrasound Patterns of Vitiligo at High Frequency and Ultra-High-Frequency.

To detect ultrasonographic anatomical alterations in all the skin layers in patients with vitiligo. A prospective observational color Doppler ultrasound study was performed in nonsegmental face and/or neck vitiligo patients without a history of previous treatments. Two sites, a lesional area and a contralateral clinically healthy region, were ultrasonographically studied and compared in the same patient. All cases were studied in high-frequency (24 MHz) and ultra-high-frequency (70 MHz) ultrasound devices with the highest axial spatial resolution available in the market. Demographic data of the sample, ultrasound grayscale, and color Doppler features were recorded and analyzed. Ten patients met the study criteria (60% females; mean age 49 years). All cases presented ultrasonographic undulation of the epidermis in the affected zones vs 50% in the healthy control regions, being more prominent in the vitiligo areas. Eighty percent demonstrated intense hypoechoic thin plaques in the upper dermis (subepidermal). All vitiligo areas presented thickening and hypoechogenicity of the regional hair follicles and/or pilosebaceous units. Ninety percent showed prominent sebaceous glands, and 20% demonstrated a hypoechoic cap surrounding the sebaceous glands in the lesional areas. Dermal hypervascularity was detected in 100% of the affected regions and 40% of the clinically healthy areas. Ultrasound can identify subclinical inflammatory cutaneous patterns in the epidermis, dermis, hair follicles, pilosebaceous units, and sebaceous glands in vitiligo. This noninvasive information can support early detection, monitoring, and research, including the clinical trials of drugs used to manage this devastating disease.

Diagnostik der Meta-bolischen Dysfunktion- assoziierten Steato- hepatitis (MASH)

This 2nd part of the review on the diagnosis and care of patients with of patients with metabolically associated steatohepatitis (MASH) addresses the challenges the challenges and recommendations in consideration of the current S2k guidelines. The diagnostic algorithm focusses on on a screening procedure for the early detection of MASH, with general practitioners are key players. In the event of elevated liver values or an abnormal Fatty Liver index, further examinations and, if necessary, referral to a specialist are are planned. Particularly for risk groups such as people with type 2 diabetes, obesity obesity or metabolic syndrome, early identification is essential, to be able to take preventive action. Comprehensive metabolic diagnostics is a is a prerequisite for preventing the progression of the disease. However, the care situation in the diagnosis of MASH is characterised by a number of characterised by a number of limitations, including the limited use of the of the screening algorithm and the challenges involved in making a definitive diagnosis by means of liver biopsy. The discrepancy between the diagnosed number of MASH cases diagnosed and the presumed prevalence indicates a significant significant number of undiagnosed cases, which ultimately also leads to therapeutic deficit

빗속의 사람 그림 검사(PITR) 반응에 대한 대학생의 우울, 불안, 부정정서에 관한 연구

Objectives This study aims to identify the responses shown in the picture test and negative psychological aspects such as depression, anxiety, and negative emotions by using both the subjective responses shown in the People-in-the-Rain Picture Test(PITR), a projective test, and a multiple-choice self-report test. Methods The target was college students attending K University in Region P. 146 copies were distributed and 125 copies were collected. Of these, the data from 108 people, excluding 17 who responded insincerely, was analyzed. The collected data were subjected to frequency analysis, reliability analysis, descriptive statistics, and correlation analysis using the SPSS statics 26.0 program. An independent sample t-test was conducted to confirm gender differences in variables, and a simple regression analysis was conducted to determine the effect of the PITR re-sponse on depression, anxiety, and negative emotions. An independent samples t-test was conducted to confirm the differences in responses to the PITR according to the upper and lower levels of the average emotional score. Results First, as a result of checking the correlation between variables, the ‘stress’ response did not have a stat-istically significant relationship with depression, anxiety, and negative emotions in the PITR response, and the ‘coping resources’ response did not have a statistically significant relationship with depression, it was found to be negatively correlated with anxiety and negative emotions, and the ‘coping ability’ response was also found to be negatively correlated with depression, anxiety, and negative emotions. Second, differences in variables according to gender were confirmed in the ‘coping resources’ response and the ‘coping ability’ response among the PITR responses. Third, PITR response was found to affect depression, anxiety, and negative emotions. Fourth, as a re-sult of checking whether there was a difference in the response to the PITR depending on the average score of depression, anxiety, and negative emotions, it was found that there was no difference in the response to the PITR according to depression, the differences in responses to the PITR according to anxiety and negative emotions were verified to have statistically significant differences in both ‘coping ability’ responses. Conclusions Through the results of this study, it was confirmed that negative psychological aspects such as de-pression, anxiety, and negative emotions can vary depending on how one copes with the stress rather than the stress itself, and that the response to the PITR differs depending on gender in terms of coping with stress. It was confirmed that there was a difference. In addition, we were able to understand that depression, anxiety, and neg-ative emotions are different psychological characteristics, and it was confirmed that coping abilities vary accordingly. The significance of this study is that it provided evidence for early detection, appropriate treatment, and prevention education for college students with mental health difficulties.

Research progress of ZIC5 for tumor metastasis.

The zinc finger protein of the cerebellum (ZIC) family comprises five members (ZIC1-5), homologous with the odd-paired (OPA) gene in Drosophila melanogila. These transcription factors contain five Cys2His zinc finger domains, constituting one of the most abundant transcription factor families in human cells. ZIC proteins significantly contribute to transcriptional regulation and chromatin remodeling. As a member of the ZIC family, ZIC5 is essential for animal growth and development. Numerous studies have investigated the connection between ZIC proteins and cancer as well as tumor metastases in recent years. Many studies have found that within tumor tissues, the transcription and translation processes increase the expression of ZIC5 which is linked to tumor aggressiveness. This review aims to provide an objective summary of the impact of ZIC5 on tumor metastasis and consider the potential application of ZIC5 targets in both tumor therapy and the early detection of cancer.

Physiologic validation of the compensatory reserve metric obtained from pulse oximetry: A step towards advanced medical monitoring on the battlefield.

The Compensatory Reserve Metric (CRM) provides a time sensitive indicator of hemodynamic decompensation. However, its in-field utility is limited due to the size and cost-intensive nature of standard vital sign monitors or photoplethysmographic volume-clamp (PPGVC) devices used to measure arterial waveforms. In this regard, photoplethysmographic measurements obtained from pulse oximetry (PPGPO) may serve as a useful, portable alternative. This study aimed to validate CRM values obtained using PPGPO. Forty-nine healthy adults (25 females) underwent a graded lower body negative pressure (LBNP) protocol to simulate hemorrhage. Arterial waveforms were sampled using PPGPO and PPGVC. The CRM was calculated using a one-dimensional convolutional neural network. Cardiac output and stroke volume were measured using PPGVC. A brachial artery catheter was used to measure intraarterial pressure. A 3-lead ECG was used to measure heart rate. Fixed-effect linear mixed models with repeated measures were used to examine the association between CRM values and physiologic variables. Log-rank analyses were used to examine differences in shock determination during LBNP between monitored hemodynamic parameters. The median LBNP stage reached was 70 mmHg (Range: 45-100 mmHg). Relative to baseline, at tolerance there was a 47±12% reduction in stroke volume, 64±27% increase in heart rate, and 21±7% reduction in systolic blood pressure (P<0.001 for all). CRM values obtained with both PPGPO and PPGVC were associated with changes in heart rate (P<0.001), stroke volume (P<0.001), and pulse pressure (P<0.001). Furthermore, they provided an earlier detection of hemodynamic shock relative to the traditional metrics of shock index (P<0.001 for both), systolic blood pressure (P<0.001 for both), and heart rate (P=0.001 for both). The CRM obtained from PPGPO provides a valid, time-sensitized prediction of hemodynamic decompensation, opening the door to provide military medical personnel noninvasive in-field advanced capability for early detection of hemorrhage and imminent onset of shock. Diagnostic Tests or Criteria, Level IV.

Assessing Regurgitation Severity, Adverse Remodeling, and Fibrosis with CMR in Primary Mitral Regurgitation.

This review offers an evidence-based analysis of established and emerging cardiovascular magnetic resonance (CMR) techniques used to assess the severity of primary mitral regurgitation (MR), identify adverse cardiac remodeling and its prognostic effect. The aim is to provide different insights regarding clinical decision-making and enhance the clinical outcomes of patients with MR. Cardiac remodeling and myocardial replacement fibrosis are observed frequently in the presence of substantial LV volume overload, particularly in cases with severe primary MR. CMR serves as a useful diagnostic imaging modality in assessing mitral regurgitation severity, early detection of cardiac remodeling, myocardial dysfunction, and myocardial fibrosis, enabling timely intervention before irreversible damage ensues. Incorporating myocardial remodeling in terms of left ventricular (LV) dilatation and myocardial fibrosis with quantitative MR severity assessment by CMR may assist in defining optimal timing of intervention.

A study of asymptpmatic hypoglycemia in at risk newborn babies admitted at a tertiary care hospital

: Babies often have blood glucose levels that are 70% of their mothers at birth. Within an hour, it reaches its lowest point, which can be as low as 20 to 25 mg/dl. All healthy newborns experience this low point and have lower than average blood glucose levels. These are just temporary, and they gradually increase in the first few days of a newborn's life. : To determine the proportion of asymptomatic hypoglycemia in at risk newborn babies. To study plasma sugar level at various time, point during first 48hr of life and the effect of risk factor associated with asymptomatic hypoglycemia. : A Hospital-based longitudinal observational study was conducted among 303 patients at Department of Pediatrics of tertiary care Hospital during June 2021 – July 2021. : Total 159 were males and 154 were females. Among the study participants, 203(83%) cases were from Urban area, while 50(17%) were from Rural area. No. of 114(37.6%) babies had asymptomatic hypoglycemia, identified by routine screening. In total various risk factors was found in which among 29% cases had LGA, 41% had preterm and 30% had weight less than 2 kg. : Screening of at risk newborn helps in the early detection of asymptomatic hypoglycemia which will help in the prevention of adverse neurodevelopmental outcome. Routine screening helped to decrease morbidity and mortality due to hypoglycemia. The first 24 hours of life is a crucial part, at - risk babies are more prone to hypoglycemia hence routine screening is recommended in high-risk babies.

Janus Membrane-Based Wearable pH Sensor with Sweat Absorption, Gas Permeability, and Self-Adhesiveness.

Wearable biomedical sensors have enabled noninvasive and continuous physiological monitoring for daily health management and early detection of chronic diseases. Among biomedical sensors, wearable pH sensors attracted significant interest, as pH influences most biological reactions. However, conformable pH sensors that have sweat absorption ability, are self-adhesive to the skin, and are gas permeable remain largely unexplored. In this study, we present a pioneering approach to this problem by developing a Janus membrane-based pH sensor with self-adhesiveness on the skin. The sensor is composed of a hydrophobic polyurethane-polydimethylsiloxane porous hundreds nanometer-thick substrate and a hydrophilic poly(vinyl alcohol)-poly(acrylic acid) porous nanofiber layer. This Janus membrane exhibits a thickness of around 10 μm, providing a conformable adhesion to the skin. The simultaneous realization of solution absorption, gas permeability, and self-adhesiveness makes it suitable for long-term continuous monitoring without compromising the comfort of the wearer. The pH sensor was tested successfully for continuous monitoring for 7.5 h, demonstrating its potential for stable analysis of skin health conditions. The Janus membrane-based pH sensor holds significant promise for comprehensive skin health monitoring and wearable biomedical applications.

Exploring breast cancer screening fear through a psychosocial lens.

Breast cancer screening is crucial for early detection and treatment. Yet, underutilization persists due to various psychosocial factors. This manuscript delves into the multifaceted fears that hinder screening adherence. The literature provides a framework categorizing breast cancer screening fears into generalized cancer fear, fear of screening components, and fear of screening outcomes. In this review, we explore fear of screening components (concerns regarding radiation, discomfort, and pain) and fear of screening outcomes (disability and mortality apprehension, treatment fears, obligation anxiety, and financial concerns) as undesirable, and potentially addressable, aspects of breast cancer screening fear. False-positive results exacerbate these anxieties, prolonging distress and impacting patients' lives beyond the screening process. Addressing these concerns requires reframing current screening approaches to prioritize patient comfort, cultural sensitivity, and accessibility. To address current psychosocial challenges in breast cancer screening, this manuscript advocates for modifying breast cancer screening methods to improve adherence and patient well-being.

Cancer literacy differences of basic knowledge, prevention, early detection, treatment and recovery: a cross-sectional study of urban and rural residents in Northeast China

Cancer literacy differences of basic knowledge, prevention, early detection, treatment and recovery: a cross-sectional study of urban and rural residents in Northeast China

Early source control of infection in patients seen in the emergency department: a systematic review

The term source (or focus) control encompasses all those physical measures that can be used to reduce the inoculum and modify those factors in the infectious medium that promote microbial growth or foreign antimicrobial defenses of the host. The main objective of this systematic review (SR) is to know and compare whether early detection and control of the focus (in less than 6 hours) in adult patients treated in the ED for severe infection or sepsis, compared to not controlling the focus or delayed focus control (more than 12 hours) is more effective and safer (improves clinical evolution, mortality, complications, hospital stay or need for ICU admission). A systematic review is carried out following the PRISMA regulations in the databases of PubMed, Web of Science, EMBASE, Lilacs, Cochrane, Epistemonikos, Tripdatabase and ClinicalTrials.gov from January 2000 to December 31, 2023 without language restrictions and using a combination of MESH terms: "Source Control", "Early" "Infection OR Bacterial Infection OR Sepsis", "Emergencies OR Emergency OR Emergency Department" and "Adults". Observational cohort studies were included. No meta-analysis techniques were performed, but results were compared narratively. A total of 1,658 articles were identified, of which 2 that met the inclusion criteria and were classified as high quality were finally analyzed. The included studies represent a total of 2,404 patients with 678 cases in which an intervention was performed to control the focus (28.20%). In the first study, 28-day mortality was lower in patients who underwent an intervention to control the focus (12.3% vs. 22.5%; P <0.001), with an adjusted HR of 0.538 (95% CI: 0.389-0.744; P<0.001). In the second, it was demonstrated that the time elapsed from when the patient was evaluated for the first time and was hemodynamically stabilized, until the start of surgery was associated with his survival at 60 days with an OR of 0.31 (95% CI: 0.19-0.45; P <0.0001). In fact, for each hour of delay an adjusted OR of 0.29 (95% CI: 0.16-0.47; P<0.0001) is established. So if the intervention is performed before 2 hours at 60 days, 98% of the patients are still alive, if it is performed between 2-4 hours it is reduced to 78%, if it is between 4-6 hours it drops to 55%, but if it is done for more than 6 hours there will be no survivors at 60 days. This review shows that source control carried out after the evaluation of patients attending the ED reduces short-term mortality (30-60 days) and that it would be advisable to implement any required source control intervention as soon as possible, ideally early (within 6 hours).

Prostate cancer screening-current overview

The harm-to-benefit ratio of prostate cancer (PCa) screening remains controversial mainly due to the unfavorable test characteristics of prostate-specific antigen (PSA) as ascreening test. In this nonsystematic review, we present acurrent overview of the body of evidence on prostate cancer screening with afocus on the role of magnetic resonance imaging (MRI) of the prostate. Evidence generated in large randomized controlled trials showed that PSA-based screening significantly decreases cancer-specific mortality. The main obstacle in developing and implementing PCa screening strategies is the resulting overdiagnosis and as aconsequence overtreatment of indolent cancers. Opportunistic screening is characterized by an adverse benefit-to-harm ratio and should, therefore, not be recommended. The German Statutory Early Detection Program for prostate cancer, which consists of adigital rectal examination (DRE) as astand-alone screening test, is not evidence-based, neither specific nor sensitive enough and results in unnecessary diagnostics. The European Commission recently urged member states to develop population-based and organized risk-adapted PSA-based screening programs, which are currently tested in the ongoing German PROBASE trial. Finetuning of the diagnostic pathway following PSA-testing seems key to improve its positive and negative predictive value and thereby making PCa screening more accurate. Incorporation of prostatic MRI into screening strategies leads to more accurate diagnosis of clinically significant prostate cancer, while diagnosis of indolent cancers is reduced. In the future, molecular liquid-based biomarkers have the potential to complement or even replace PSA in PCa screening and further personalize screening strategies. Active surveillance as an alternative to immediate radical therapy of demographically increasing PCa diagnoses can potentially further improve the benefit-to-harm ratio of organized screening. Early detection of PCa should be organized on apopulation level into personalized and evidence-based screening strategies. Multiparametric MRI of the prostate may play akey role in this setting.

Prostate cancer biomarkers: from early diagnosis to precision treatment.

Prostate cancer (PCa) is the second most prevalent cancer in men. In 2020, approximately 1,414,259 new cases were reported that accounted for 3,75,324 deaths (Sung et al. in CA 71:209-249, 2021). PCa is often asymptomatic at early stages; hence, routine screening and monitoring based on reliable biomarkers is crucial for early detection and assessment of cancer progression. Early diagnosis of disease is key step in reducing PCa-induced mortality. Biomarkers such as PSA have played vital role in reducing recent PCa deaths. Recent research has identified many other biomarkers and also refined PSA-based tests for non-invasive diagnosis of PCa in patients. Despite progress in screening methods, an important issue that influences treatment is heterogeneity of the cancer in different individuals, necessitating personalized treatment. Currently, focus is to identify biomarkers that can accurately diagnose PCa at early stage, indicate the stage of the disease, metastatic nature and chances of survival based on individual patient profile (Fig.1). Fig.1 Graphical abstract.

Salivary metabolites are promising noninvasive biomarkers of drug-induced liver injury

BACKGROUND Drug-induced liver injury (DILI) is one of the most common adverse events of medication use, and its incidence is increasing. However, early detection of DILI is a crucial challenge due to a lack of biomarkers and noninvasive tests. AIM To identify salivary metabolic biomarkers of DILI for the future development of noninvasive diagnostic tools. METHODS Saliva samples from 31 DILI patients and 35 healthy controls (HCs) were subjected to untargeted metabolomics using ultrahigh-pressure liquid chromatography coupled with tandem mass spectrometry. Subsequent analyses, including partial least squares-discriminant analysis modeling, t tests and weighted metabolite coexpression network analysis (WMCNA), were conducted to identify key differentially expressed metabolites (DEMs) and metabolite sets. Furthermore, we utilized least absolute shrinkage and selection operato and random fores analyses for biomarker prediction. The use of each metabolite and metabolite set to detect DILI was evaluated with area under the receiver operating characteristic curves. RESULTS We found 247 differentially expressed salivary metabolites between the DILI group and the HC group. Using WMCNA, we identified a set of 8 DEMs closely related to liver injury for further prediction testing. Interestingly, the distinct separation of DILI patients and HCs was achieved with five metabolites, namely, 12-hydroxydodecanoic acid, 3-hydroxydecanoic acid, tetradecanedioic acid, hypoxanthine, and inosine (area under the curve: 0.733-1). CONCLUSION Salivary metabolomics revealed previously unreported metabolic alterations and diagnostic biomarkers in the saliva of DILI patients. Our study may provide a potentially feasible and noninvasive diagnostic method for DILI, but further validation is needed.

Unveiling the retinal secrets of neuromyelitis optica spectrum disorder

BackgroundVascular alterations are now recognized as important contributors to the pathophysiology of neuromyelitis optica spectrum disorder (NMOSD). This study aimed to use optical coherence tomography (OCT) and OCT-angiography (OCTA) to assess alterations in the retinal structure and microvasculature in patients with NMOSD, so we can understand pathophysiology of NMOSD, implicating this on disease activity, visual outcome and management on the future.MethodsA case–control study was conducted on 40 NMOSD patients with (NMOSD + ON) and without (NMOSD – ON) history of optic neuritis and 36 healthy subjects. The following data were assessed in NMOSD patients: clinical history, EDSS, and visual function testing. Both groups underwent spectral domain (SD)-OCT and OCTA.ResultsIn this study, NMOSD + ON patients had a statistically significant reduction in all SD-OCT parameters compared to healthy control. Regarding OCTA, there was a significant reduction in radial peripapillary capillary density (RPCD) in NMOSD + ON (P-value < 0.001) and some sectors of NMOSD–ON compared to healthy control. NMOSD + ON patients had significant differences in RPCD compared to those without (P-value < 0.001).ConclusionsHere we show that the advance of this study is that retinal microvascular alterations have been noticed in NMOSD–ON eyes, indicating that subclinical primary retinal vasculopathy and disease activity may occur in NMOSD before onset of ON and retinal atrophy. This may have implications on early detection of disease activity, early interference in management and prognostic tool to visual outcome in following the patients.