Irreversible Condition Research Articles

Dual-3DM3AD: Mixed Transformer Based Semantic Segmentation and Triplet Pre-Processing for Early Multi-Class Alzheimer's Diagnosis.

Alzheimer's Disease (AD) is a widespread, chronic, irreversible, and degenerative condition, and its early detection during the prodromal stage is of utmost importance. Typically, AD studies rely on single data modalities, such as MRI or PET, for making predictions. Nevertheless, combining metabolic and structural data can offer a comprehensive perspective on AD staging analysis. To address this goal, this paper introduces an innovative multi-modal fusion-based approach named as Dual-3DM3-AD. This model is proposed for an accurate and early Alzheimer's diagnosis by considering both MRI and PET image scans. Initially, we pre-process both images in terms of noise reduction, skull stripping and 3D image conversion using Quaternion Non-local Means Denoising Algorithm (QNLM), Morphology function and Block Divider Model (BDM), respectively, which enhances the image quality. Furthermore, we have adapted Mixed-transformer with Furthered U-Net for performing semantic segmentation and minimizing complexity. Dual-3DM3-AD model is consisted of multi-scale feature extraction module for extracting appropriate features from both segmented images. The extracted features are then aggregated using Densely Connected Feature Aggregator Module (DCFAM) to utilize both features. Finally, a multi-head attention mechanism is adapted for feature dimensionality reduction, and then the softmax layer is applied for multi-class Alzheimer's diagnosis. The proposed Dual-3DM3-AD model is compared with several baseline approaches with the help of several performance metrics. The final results unveil that the proposed work achieves 98% of accuracy, 97.8% of sensitivity, 97.5% of specificity, 98.2% of f-measure, and better ROC curves, which outperforms other existing models in multi-class Alzheimer's diagnosis.

Bridging the Gap: Analyzing the Discrepancy Between Theoretical Knowledge and Clinical Implementation in Modern Caries Management in Existing Dental Education

Traditionally, caries has been addressed through surgical means, where the dentist utilizes rotary and hand instruments to eliminate the affected tooth tissue, creating a cavity that is subsequently filled with biomaterials for restoration purposes. This approach stems from the understanding of caries as an irreversible condition involving the destruction of hard tissues. However, recent evidence reveals caries to be a dynamic ailment characterized by alternating phases of demineralization and remineralization of hard tooth tissues. Contrary to the earlier perception, caries is now recognized as a dynamic disease with a fluctuating balance between factors that protect and promote tooth remineralization, as well as factors that contribute to tooth demineralization. Identified as caries risk factors and indicators, these pathological elements prompt a shift in perspective among cariologists towards managing caries through a medical model. In this medical model, caries is viewed as a multifactorial infectious disease caused by acidogenic bacteria present in the oral cavity. The recommended approach involves preventive strategies such as evaluating patients’ caries risk, regulating bacterial levels in saliva, employing various therapeutic agents, remineralizing incipient carious lesions and ultimately restoring cavitated lesions. These strategies not only emphasize prevention but also align with the principles of Minimal Intervention Dentistry (MID). Dental students studying in various dental institutions receive theoretical education on existing preventive caries management; however, the practical application of this knowledge is insufficient and requires emphasis through integration into the curriculum.

Detection and Removal of Aristolochic Acid in Natural Plants, Pharmaceuticals, and Environmental and Biological Samples: A Review.

Aristolochic acids (AAs) are a toxic substance present in certain natural plants. Direct human exposure to these plants containing AAs leads to a severe and irreversible condition known as aristolochic acid nephropathy (AAN). Additionally, AAs accumulation in the food chain through environmental mediators can trigger Balkan endemic nephropathy (BEN), an environmental variant of AAN. This paper presents a concise overview of the oncogenic pathways associated with AAs and explores the various routes of environmental exposure to AAs. The detection and removal of AAs in natural plants, drugs, and environmental and biological samples were classified and summarized, and the advantages and disadvantages of the various methods were analyzed. It is hoped that this review can provide effective insights into the detection and removal of AAs in the future.

Literary Adaptation in Film: A Boon or a Bane? A Study in Paulo Coelho’s Veronika Decides to Die

This paper focuses on the movie adaptations of literary work. It is about the advantages and disadvantages of converting a novel into a movie. Some of the advantages are visual storytelling, entertainment value, wide audience reach, and collaborative creativity. Disadvantages are time constraints, loss of depth, changes in adaptation, and commercial pressures. In this novel, the protagonist tries to commit suicide by swallowing sleeping pills. Veronika is fed up with her monotonous life and she finds no meaning in her life. Veronika is saved and admitted to a mental institution called Villete. Dr. Igor is the director of the institution who is trying to write a thesis on vitriol poisoning. He believes that vitriol poisoning is the reason for anxiety and depression. He decides to use Veronika for his research. He lies to her that she suffers from a irreversible heart condition and she would die within a week. This awareness creates a change in Veronica’s personality. She starts to do things she likes and it creates a desire in her to overcome her suicidal thoughts.

A DEEP LEARNING FRAMEWORK-BASED EXERCISE ASSESSMENT FOR REHABILITATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Chronic obstructive pulmonary disease (COPD), which has a high prevalence and mortality rate, is an irreversible condition marked by airflow restriction with different degrees of reversible damage. Notably, there is no cure for COPD, whose treatment primarily relies on rehabilitation exercises to improve airflow limitation. In this paper, a vision-based rehabilitation exercise efficacy prediction system is proposed to assess the efficacy of rehabilitation training for COPD patients. A camera was utilized to capture rehabilitation training videos of COPD patients, and we also collected various physical indicators. In addition, we used clustering algorithm to divide patients with different rehabilitation effects for subsequent progression analysis. Our model achieved a classification of rehabilitation progress accuracy of 90.6%, making it possible to effectively obtain favorable rehabilitation training results without physician supervision. It was meaningful for helping COPD patients get effective feedback when training alone.

Decrement Evoked Potential (DEEP) Mapping of the Atria: Unmasking Atrial Fibrillation Substrate.

Atrial myopathy may underlie the progression of atrial fibrillation (AF) from a treatable disease to an irreversible condition with poor ablation outcomes. Electrophysiological methods to unmask areas prone to re-entry initiation could be key to defining latent atrial myopathy. Consecutive patients referred for AF ablation were prospectively included at four institutions. Decrement evoked potential mapping (DEEP) was performed in eight left atrial sites and five right atrial sites, from two different pacing locations (endocardially from the left atrial appendage, epicardially from the proximal coronary sinus). The electrograms (EGMs) during S1 600 ms drive and after an extra stimulus (S2 at+30 ms above atrial refractoriness) were studied at each location and assessed for decremental properties. Follow-up was 12 months. Seventy-four patients were included and 85% had persistent AF. A total of 17,614 EGMs were individually analysed and measured. Nine percent of the EGMs showed DEEP properties (local delay of >10 ms after S2) with a mean decrement of 33±26 ms. DEEPs were more frequent in the left atrium than the right atrium (9.4% vs 8.0%; p<0.001) and more prevalent in persistent AF patients than paroxysmal AF patients (9.8% vs 4.6% p=0.001). Atrial DEEPs were more frequently unmasked in normal bipolar voltage areas and by epicardial pacing than endocardial pacing (9.6% vs 8.4%, respectively; p=0.004). Within the left atrium, the roof had the highest prevalence of DEEP EGMs. DEEP mapping of both atria is useful for highlighting areas with a tendency for unidirectional block and re-entry initiation. Those areas are more easily unmasked by epicardial pacing from the coronary sinus and more prevalent in persistent AF patients than in paroxysmal AF patients.

A Comprehensive Analysis of Noise-Induced Hearing Loss and Its Ayurvedic Insight

Noise-induced hearing loss (NIHL) is a growing global health concern, primarily attributed to our increasingly noisy environments. This comprehensive analysis delves into the multifaceted aspects of NIHL while exploring potential insights from Ayurveda, an ancient Indian system of medicine. NIHL results from prolonged exposure to loud noise levels, causing damage to the delicate structures of the inner ear. It is a gradual and irreversible condition that affects millions of people worldwide, impacting their quality of life and overall health. Traditional approaches to NIHL management primarily focus on hearing aids and protective measures. However, this analysis seeks to integrate Ayurvedic principles and treatments to offer a holistic perspective on NIHL prevention and management. Ayurveda, with its holistic approach to health, considers the interplay of physical, mental, and environmental factors. In Ayurveda, hearing loss can be linked to imbalances in the doshas (Vata, Pitta, and Kapha) and the accumulation of toxins in the body. By addressing these imbalances through dietary modifications, lifestyle changes, and herbal remedies, Ayurveda may offer valuable insights into preventing and managing NIHL. The analysis highlights the importance of noise awareness, emphasizing the need for public health campaigns and workplace regulations to reduce noise exposure. Additionally, it explores Ayurvedic herbs and therapies known for their potential in mitigating the effects of NIHL, such as Ashwagandha (Withania somnifera) and Panchakarma detoxification procedures. Furthermore, the study discusses the role of yoga and meditation in stress management, as chronic stress can exacerbate NIHL. Ayurvedic practices like Pranayama (breathing exercises) and Shirodhara (oil therapy for the head) may promote relaxation and reduce stress, contributing to overall hearing health. In conclusion, this analysis offers a comprehensive overview of NIHL, including its causes, symptoms, and conventional management strategies. By incorporating Ayurvedic insights, we explore a holistic approach to NIHL prevention and management, acknowledging the potential benefits of Ayurveda in promoting hearing health. Further research and collaboration between traditional and modern healthcare systems are essential to harness the full potential of Ayurveda in addressing the global issue of NIHL.

Deep learning methods to detect Alzheimer's disease from MRI: A systematic review

AbstractAlzheimer's disease (AD) is a progressive and irreversible neurodegenerative condition in the brain that affects memory, thinking, and behaviour. To overcome this problem, which according to the World Health Organization, is on the rise, creating strategies is essential to identify and predict the disease in its early stages before clinical manifestation. In addition to cognitive and mental tests, neuroimaging is promising in this field, especially in assessing brain matter loss. Therefore, computer‐aided diagnosis systems have been imposed as fundamental tools to help imaging technicians as the diagnosis becomes less subjective and time‐consuming. Thus, machine learning and deep learning (DL) techniques have come into play. In recent years, articles addressing the topic of Alzheimer's diagnosis through DL models are increasingly popular, with an exponential increase from year to year with increasingly higher accuracy values. However, the disease classification remains a challenging and progressing issue, not only in distinguishing between healthy controls and AD patients but mainly in differentiating intermediate stages such as mild cognitive impairment. Therefore, there is a need to develop more valuable and innovative techniques. This article presents an up‐to‐date systematic review of deep models to detect AD and its intermediate phase by evaluating magnetic resonance images. The DL models chosen by different authors are analysed, as well as their approaches regarding the used dataset and the data pre‐processing and analysis techniques.

Detection and diagnosis of age-related macular degeneration using recurrent neural network with cloud architecture and internet of things

Age-Related Macular Degeneration is a progressive, irreversible eye condition that causes vision loss and impairs quality of life. The lost potential of the optic nerve cannot be regained, but a patient with Age-Related Macular Degeneration must have early diagnosis and treatment in order to prevent visual loss. The diagnosis of Age-Related Macular Degeneration is based on visual field loss tests, a patient’s medical history, intraocular pressure, and a physical fundus evaluation. Age-Related Macular Degeneration must be diagnosed early in order to avoid irreparable structural damage and vision loss. The objective of the proposed study is to develop a new optimization-driven strategy-based recurrent neural network using the Internet of Things for the identification of age-related macular degeneration. The Recurrent Neural Network (RNN) classifier is trained using the Particle Swarm Optimization (PSO) technique included into the RNN-IoMT. Initially, the input picture is sent through pre-processing in order to remove noise and artefacts. The generated preprocessed picture is simultaneously sent to optical disc detection and blood vessel detection. In addition, picture level characteristics are extracted from the image that has been preprocessed. Finally, the image-level, optic disc-level, and blood vessel-level features are retrieved and compiled into a feature vector. The acquired feature vector is fed into the RNN classifier, with the suggested PSO used to train the RNN for Age-Related Macular Degeneration detection via the Internet of Medical Things. The suggested PSO+RNN exhibits better performance with enhanced precision of 97.194%, sensitivity of 97.184%, and specificity of 97.2044%, respectively.

A Motorcycle Paramedic Increases the Survival Rate of Patients after OHCA.

Background and Objectives: Despite advancements in modern medicine, the survival rate of patients after out-of-hospital cardiac arrest (OHCA) remains low. The proportion of OHCA patients who could be saved under ideal circumstances is unknown. A significant portion of patients experience cardiac arrest due to irreversible conditions. The survival of patients with reversible causes depends on the prompt initiation of basic life support (BLS) and early defibrillation. In order to increase the chances of survival, the motorcycle paramedic (MP) project was implemented in Ljubljana in 2003. The MP is equipped with an AED. In the case of OHCA with a shockable rhythm, he performs defibrillation before the arrival of the emergency medical team (EMT). The aim of this study was to evaluate whether the MP, by reducing response times to OHCA patients, increases the survival and outcome of these patients compared to the EMT. Materials and Methods: A retrospective analysis of OHCA cases within the area covered by Ljubljana Emergency Medical Service (EMS) was conducted for the period from January 2003 to December 2022. Instances where the MP arrived at the scene before the EMT were considered MP interventions and classified as the MP group; all other interventions were classified as the EMT group. Results: Between January 2003 and December 2022, the EMT performed resuscitation on 3352 patients. In 316 cases, the MP was simultaneously activated and arrived at the scene before the EMT. The response time in the MP group was shorter compared to the EMT group (7.7 ± 4.1 min vs. 9.9 ± 6.5 min, p < 0.001). In 16 patients, return of spontaneous circulation (ROSC) was achieved before the arrival of the EMT. The MP group had a higher ROSC rate, a larger proportion of patients were discharged from the hospital and there were more patients with a good neurological outcome compared to the EMT group (44.3% vs. 36.9%, p = 0.009; 18.7% vs. 13.0%, p = 0.005; 15.9% vs. 10.6%, p = 0.004, respectively). Conclusion: This study has demonstrated that the implementation of the MP into the EMS in Ljubljana has resulted in shorter response times, an increased survival rate and improved neurological outcome for OHCA patients.

Advances in the design, generation, and application of tissue-engineered myocardial equivalents.

Due to the limited regenerative ability of cardiomyocytes, the disabling irreversible condition of myocardial failure can only be treated with conservative and temporary therapeutic approaches, not able to repair the damage directly, or with organ transplantation. Among the regenerative strategies, intramyocardial cell injection or intravascular cell infusion should attenuate damage to the myocardium and reduce the risk of heart failure. However, these cell delivery-based therapies suffer from significant drawbacks and have a low success rate. Indeed, cardiac tissue engineering efforts are directed to repair, replace, and regenerate native myocardial tissue function. In a regenerative strategy, biomaterials and biomimetic stimuli play a key role in promoting cell adhesion, proliferation, differentiation, and neo-tissue formation. Thus, appropriate biochemical and biophysical cues should be combined with scaffolds emulating extracellular matrix in order to support cell growth and prompt favorable cardiac microenvironment and tissue regeneration. In this review, we provide an overview of recent developments that occurred in the biomimetic design and fabrication of cardiac scaffolds and patches. Furthermore, we sift in vitro and in situ strategies in several preclinical and clinical applications. Finally, we evaluate the possible use of bioengineered cardiac tissue equivalents as in vitro models for disease studies and drug tests.

Venous congestion affects neuromuscular changes in pigs in terms of muscle electrical activity and muscle stiffness.

Early detection of venous congestion (VC)-related diseases such as deep vein thrombosis (DVT) is important to prevent irreversible or serious pathological conditions. However, the current way of diagnosing DVT is only possible after recognizing advanced DVT symptoms such as swelling, pain, and tightness in affected extremities, which may be due to the lack of information on neuromechanical changes following VC. Thus, the goal of this study was to investigate acute neuromechanical changes in muscle electrical activity and muscle stiffness when VC was induced. The eight pigs were selected and the change of muscle stiffness from the acceleration and muscle activity in terms of integral electromyography (IEMG) was investigated in three VC stages. Consequently, we discovered a significant increase in the change in muscle stiffness and IEMG from the baseline to the VC stages (p < 0.05). Our results and approach can enable early detection of pathological conditions associated with VC, which can be a basis for further developing early diagnostic tools for detecting VC-related diseases.

Advance Care Planning in Taiwan

Taiwan has been promoting the concept of palliative care since 1983. In the 2021 global quality of death index, Taiwan ranked third. Regarding the development of patient autonomy, there are two phases. The first phase was the passage of the Hospice Palliative Care Act in 2000, which respects the personal choices of terminally ill patients, including the decision to refuse cardiopulmonary resuscitation and to withhold or withdraw life-sustaining treatment. The second phase was the passage of the Patient Right to Autonomy Act in 2015, which expanded the scope of application beyond terminally ill patients to include four other severe and irreversible conditions, while providing clearer explanations on life-sustaining treatment and artificial nutrition. Taiwan's legislation regarding the respect for patient autonomy has become increasingly comprehensive. However, there is still room for improvement in its practical implementation.

Automated Myocardial Infarction Screening Using Morphology-Based Electrocardiogram Biomarkers.

Ischemic heart disease (IHD), a critical and dreadful cardiovascular disease, is a leading cause of death globally. The steady progress of IHD leads to an irreversible condition called myocardial infarction (MI). The detection of MI can be done by observing the altered electrocardiogram (ECG) characteristics. Often, automated ECG analysis is preferred in place of visual inspection to reduce time and ensure reliable detection even when the recording quality is not very good. This paper presents an automated approach to classify recent MI, past MI, and normal sinus rhythm (NSR) classes based on the morphological features of the ECG. In clinical practice, a standard 12-lead ECG setup is typically employed to identify MI. However, acquiring a 12-lead ECG is not always convenient. Hence, in this study, we have explored the possibility of using a minimal number of ECG leads by deriving the augmented limb leads using leads I and II. A well-known and widely used ensemble machine learning tool, the random forest (RF) classifier is trained using features extracted from the derived augmented limb leads and their combinations. An RF classifier built using features extracted from all limb leads has outperformed classifiers built on combinations of them with five-fold cross-validation training accuracy of 97.9 (±0.008) % and testing accuracy of 98 %.Clinical relevance- As high sensitivity is reported in identifying recent MI and past MI classes, the proposed approach is suitable for preventative healthcare applications since it is less likely that subjects with recent or past MI will be misclassified. Due to its low computational complexity, better interpretability, and comparable performance to the state-of-the-art results, the proposed approach can be employed in clinical and cardiac health screening applications. It also has the potential to be employed in remote monitoring with mobile and wearable devices because it is built on features extracted from only lead I and II ECG recordings.

Assessment of awareness regarding Chronic Kidney Disease and Chronic Hepatitis among people visiting a Tertiary Care Hospital

Objective: To assess the level of knowledge, regarding chronic kidney disease (CKD) and chronic hepatitis in high risk groups of people Study design: Cross-sectional study Place and Duration: The study was carried out at Ziauddin Hospital, Karachi over a period of 8 months from 19th November 2021 till 19th July 2022. Methodology: A total of 300 patients were interviewed verbally on a questionnaire translated into Urdu. Results: Regarding CKD, only 13% of the participants knew that it is a long term and irreversible condition, with only 6% of them being aware that it can also be asymptomatic in initial stages. Only 5% of them knew that disease management revolves around reducing its progression and complications. 33% of the patients knew about hepatitis B or C, out of which 26% had knowledge that it can progress to chronic hepatitis. Only 21% knew that the infection is lifelong and incurable. Almost 80% of the respondents were not aware regarding the different routes of transmission, the symptoms or the complications. Conclusion: The research identified dismally low level of awareness up to 80-90%, regarding awareness aspects of two very common health conditions. Thus, it is imperative to design religiously and culturally acceptable public health strategies to increase awareness for earlier detection of both CKD and CLD for better health outcomes and therefore to reduce the economic burden of our country. Key words: Chronic Kidney Disease, Chronic Hepatitis, Knowledge, Perception, Strategies, Healthcare. How to Cite This: Mahmud M, Baqai K, Anwar M. Assessment of awareness regarding Chronic Kidney Disease and Chronic Hepatitis among people visiting a Tertiary Care Hospital. Isra Med J. 2022;14(4):143-147. DOI: https://doi.org/10.55282/imj.oa1341

Palliative care and end of life care in decompensated cirrhosis.

Palliative care and end of life care in decompensated cirrhosis.

P-086 Prevalence and clinical factors associated with biochemical hypogonadism in infertile men with non-obstructive azoospermia: a single-center cohort study including 761 patients

Abstract Study question What is the prevalence, and which factors are associated with hypogonadism in infertile men with non-obstructive azoospermia (NOA)? Summary answer The prevalence of biochemical hypogonadism among NOA males is significant. The condition is associated with testicular volume, estradiol levels, paternal age, and testicular histopathology results. What is known already NOA is a severe and irreversible condition that accounts for approximately 60% of azoospermia cases, primarily associated with intrinsic testicular deficiencies of various causes. NOA men can present signs of hypogonadism, associated or not with elevated circulating FSH levels; however, the exact prevalence is ill-reported. There is also a lack of data on the clinical factors associated with hypogonadism. We, therefore, estimated the prevalence of biochemical hypogonadism using real-world data and investigated its relationship with clinical factors. Study design, size, duration An observational cohort study was conducted, including 767 consecutive NOA patients with primary spermatogenic failure seeking fertility treatment at a University-affiliated tertiary center for male reproductive health between January 2014 and September 2021. Biochemical hypogonadism was defined as total testosterone (T) levels &amp;lt;350 ng/dL, measured by chemiluminescence immunoassay from a venous sample, collected in the morning, from 8:00 to 10:00 am, and confirmed on a second analysis at least one week apart. Participants/materials, setting, methods All included patients (age range: 23-55 years) had complete clinical, hormonal, genetic, seminal, and histopathology data and were naïve concerning previous sperm retrieval attempts. Patients with NOA due to hypogonadotropic hypogonadism and those using hormonal therapy were excluded. Prevalence rates were computed by Goodman’s method. The relationship between clinical factors and hypogonadism was assessed by logistic regression analysis. We also assessed the frequency of patients with high and within-range FSH levels in the cohort. Main results and the role of chance NOA patients with biochemical hypogonadism represented 80.3% (95% confidence interval [CI] 77.3–43.7) of the studied population. The median (interquartile range [IQR]) of T and FSH levels in hypogonadal men were 276 ng/dL (233.0-303 ng/dL) and 12.3 IU/L (8.9-18.2). Among them, hypergonadotropic (FSH&amp;gt;12 IU/L) and normogonadotropic (within-range FSH levels 1.5-12.0 IU/L) patients were 52.1% (95% CI 48.1-56.0) and 47.8% (43.9-51.8) of studied individuals, respectively. Logistic regression analyses revealed that testicular volume (p &amp;lt; 0.0001) and estradiol levels (p = 0.0005) had a significant inverse relationship with hypogonadism, whereas paternal age (p = 0.02) showed a positive relationship. Moreover, testicular histopathology was a relevant predictor (p = 0.003), with an inverse relationship between hypogonadism and germ cell maturation arrest and a positive relationship between hypogonadism and hypospermatogenesis or Sertoli cell-only. Using these variables, a model constructed to predict hypogonadism had an area under the ROC curve of 0.72. Limitations, reasons for caution Limitations include possible unmeasured confounding factors and the intra- and inter-assay electrochemiluminescence method variability. Another limitation is that the study center is a referral facility for azoospermic patients; thus, hypogonadism prevalence rates reported herein might not represent that of the general population of NOA males attending general fertility centers. Wider implications of the findings Efforts are needed to provide adequate care for this population due to its association with poor quality of life. Moreover, as recent evidence has suggested that hormonal therapy to boost T production might increase sperm retrieval success rates, studies investigating hormonal therapy in such patients may be warranted. Trial registration number Not applicable

The value of pre-symptomatic genetic risk assessment for age-related macular degeneration: the Moran AMD Genetic Testing Assessment (MAGENTA) study—a study protocol for a randomized controlled trial

BackgroundAge-related macular degeneration (AMD) is an irreversible blinding eye condition with complex genetic and environmental etiologies. Genetic testing for AMD for previously identified multiple-risk single nucleotide polymorphisms can help determine an individual’s future susceptibility. However, such testing has been discouraged until evidence shows that providing such information to symptomatic or pre-symptomatic individuals will alter their disease course. Therefore, we designed this study to investigate whether knowledge of AMD risk could stimulate the adoption of a healthier lifestyle that could lower the incidence of AMD later in life. We hypothesize that pre-symptomatic individuals informed of a high genetic risk of AMD are more likely to make quantifiable, positive lifestyle changes relative to participants informed of lower genetic risk or randomized to deferred disclosure of genetic testing results.MethodsThe Moran AMD Genetic Testing Assessment (MAGENTA) study is a phase 2, single-center, prospective, double-masked, randomized controlled trial conducted at the John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Participants are randomized by a 3:1 allocation ratio to immediate and deferred disclosure groups and followed for 12 months. Skin, ocular, and serum carotenoid status, as well as nutritional and social surveys, are assessed at study visits. Skin carotenoid assessment is by resonance Raman spectroscopy and reflectance spectroscopy, ocular carotenoids are measured with Heidelberg Spectralis autofluorescence imaging and fluorescence lifetime imaging ophthalmoscopy (FLIO), and serum carotenoids are quantified using high-performance liquid chromatography. The primary outcome evaluates changes in skin carotenoid status in response to genetic risk disclosure. The secondary outcomes examine changes in ocular and serum carotenoid status in response to genetic risk disclosure. Also, we will correlate AMD genetic risk with baseline ocular and systemic carotenoid status and FLIO.DiscussionMAGENTA will provide much-needed evidence on whether pre-symptomatic testing for AMD risk can lead to quantifiable long-term changes in behavior and lifestyle associated with a lower incidence of AMD later in life. Findings from the MAGENTA trial will facilitate the design of a future larger, longer-term, multicenter phase 3 trial that could feature subgroup analysis, expanded measures of lifestyle modification, and potential active nutritional interventions.Trial registrationClinicalTrials.gov NCT05265624. Registered on March 3, 2022.

Nanomedicine in the Management of Alzheimer's Disease: State-of-the-Art.

Alzheimer's disease (AD) is a deadly, progressive, and irreversible brain condition that impairs cognitive abilities. Globally, it affects 32.6 million individuals, and if no viable therapies are available by 2050, that figure might rise to 139 million. The current course of treatment enhances cognitive abilities and temporarily relieves symptoms, but it does not halt or slow the disease's development. Additionally, treatments are primarily offered in conventional oral dosage forms, and conventional oral treatments lack brain specialization and cause adverse effects, resulting in poor patient compliance. A potential nanotechnology-based strategy can improve the bioavailability and specificity of the drug targeting in the brain. Furthermore, this review extensively summarizes the applications of nanomedicines for the effective delivery of drugs used in the management of AD. In addition, the clinical progress of nanomedicines in AD is also discussed, and the challenges facing the clinical development of nanomedicines are addressed in this article.

Stabilization of vulnerable plaque in the ACS patient: evidence from HUYGENS studies.

The introduction of PCSK9 inhibitors in addition to statin therapy allowed better control of LDL-C plasma levels with a subsequent reduction of cardiovascular events. Human atherosclerosis has been previously considered an irreversible condition; studies firstly based on angiography imaging and secondly with intra-coronary imaging-mainly IVUS based-have demonstrated that lipid-lowering therapy based on statins can stabilize and even reduce atherosclerotic burden of coronary circulation. While plaque stabilization and/or reduction with PCSK9 inhibitors have already been demonstrated in the GLAGOV study, the HUYGENS study showed a positive effect not only on atherosclerotic burden but also on plaque phenotype, with an increased FCT, decrease in maximum lipid arch, and reduction of macrophages infiltration. Further studies need to assess the clinical impact of the reduction of plaques displaying high-risk features with PCSK9 inhibitors.