Main Cause Of Death Research Articles

Diabetic cardiomyopathy in rats was attenuated by endurance exercise through the inhibition of inflammation and apoptosis

Diabetic cardiomyopathy (DCM), as a ventricular dysfunction, is one of the main causes of death in diabetic patients. Former evidence revealed the beneficial effects of exercise on cardiovascular complications of diabetes. We aimed to investigate the effects of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on DCM. Male Wistar rats were divided into control, diabetic, metformin (300 mg/kg), HIIT, MICT, metformin + HIIT, and metformin + MICT diabetic groups. Serum biochemical, inflammatory, and oxidative stress indicators, gene expression of BCL2 and BAX, and histopathologic changes of cardiac tissue were assessed. Our analysis revealed an increase in fasting blood sugar (FBS), creatine kinase MB (CK-MB), lactate dehydrogenase (LDH), and aspartate aminotransferase (AST) in diabetes. Also, the superoxide dismutase (SOD) and catalase (CAT) activity, and the total thiol were decreased, in contrast, malondialdehyde (MDA) levels increased in the cardiac tissue of the diabetic group. All of these changes were significantly ameliorated in diabetic animals treated with exercise and metformin + exercise. The level of tumor necrosis factor-α (TNF-α) and Interleukin-1β (IL-1β), as well as the infiltration of inflammatory cells, were decreased in the heart of all exercise training groups. Up-regulation of BCL2 and down-regulation of BAX gene expressions were observed in the cardiac tissue of all exercise-treated groups. In conclusion, HIIT and MICT exercises are effective in preventing DCM development. Exercise training, besides improving oxidative stress and inflammation in cardiac tissue, alleviates cardiac damage by modulating the apoptotic gene expression in diabetic rats.

Trends in the incidence of certain socially significant diseases in the adults and children population of the Saratov region

Socially significant diseases are in the focus of world health care, because they affect a significant proportion of the able-bodied population and are the main causes of disability and death. The aim of the study was to carry out statistical analysis of the dynamics of morbidity of some socially significant diseases of the population of the Saratov region and comparative analysis of these data with similar indicators in the Russian Federation. Materials and methods. The statistical data published on the official site of the Federal State Statistics Service and the Russian Research Institute of Health of the Ministry of Health of Russia for the period from 2011 to 2021 were used. We built variation series and assessed the reliability of differences in relative indicators using Student’s t-criterion (p < 0.05 and t > 2). Results. Negative trends in the dynamics of primary and general morbidity of diseases characterized by high blood pressure, type 1 and 2 diabetes mellitus, and malignant neoplasms were recorded both in the region and in the Russian Federation. Conclusion. The obtained data regulate the necessity to conduct an in-depth study of the availability and quality of medical care for patients with socially significant diseases, as well as to develop measures to improve the provision of medical care for them.

The suppression of sepsis-induced kidney injury via the knockout of T lymphocytes

Patients with sepsis always have a high mortality rate, and acute kidney injury (AKI) is the main cause of death. It seems obvious that the immune response is involved in this process, but the specific mechanism is unknown, especially the pathogenic role of T cells and B cells needs to be further clarified. Acute kidney injury models induced by lipopolysaccharide were established using T-cell, B-cell, and T&B cell knockout mice to elucidate the role of immune cells in sepsis. Flow cytometry was used to validate the mouse models, and the pathology can confirm renal tubular injury. LPS-induced sepsis caused significant renal pathological damage, Second-generation gene sequencing showed T cells-associated pathway was enriched in sepsis. The renal tubular injury was significantly reduced in T cell and T&B cell knockout mice (BALB/c-nu, Rag1−/−), especially in BALB/c-nu mice, with a decrease in the secretion of inflammatory cytokines in the renal tissue after LPS injection. LPS injection did not produce the same effect after the knockout of B cells. We found that blocking T cells could alleviate inflammation and renal injury caused by sepsis, providing a promising strategy for controlling renal injury.

Enhancement of Radiation Sensitivity by Cathepsin L Suppression in Colon Carcinoma Cells.

Cancer is one of the main causes of death globally. Radiotherapy/Radiation therapy (RT) is one of the most common and effective cancer treatments. RT utilizes high-energy radiation to damage the DNA of cancer cells, leading to their death or impairing their proliferation. However, radiation resistance remains a significant challenge in cancer treatment, limiting its efficacy. Emerging evidence suggests that cathepsin L (cath L) contributes to radiation resistance through multiple mechanisms. In this study, we investigated the role of cath L, a member of the cysteine cathepsins (caths) in radiation sensitivity, and the potential reduction in radiation resistance by using the specific cath L inhibitor (Z-FY(tBu)DMK) or by knocking out cath L with CRISPR/Cas9 in colon carcinoma cells (caco-2). Cells were treated with different doses of radiation (2, 4, 6, 8, and 10), dose rate 3 Gy/min. In addition, the study conducted protein expression analysis by western blot and immunofluorescence assay, cytotoxicity MTT, and apoptosis assays. The results demonstrated that cath L was upregulated in response to radiation treatment, compared to non-irradiated cells. In addition, inhibiting or knocking out cath L led to increased radiosensitivity in contrast to the negative control group. This may indicate a reduced ability of cancer cells to recover from radiation-induced DNA damage, resulting in enhanced cell death. These findings highlight the possibility of targeting cath L as a therapeutic strategy to enhance the effectiveness of RT. Further studies are needed to elucidate the underlying molecular mechanisms and to assess the translational implications of cath L knockout in clinical settings. Ultimately, these findings may contribute to the development of novel treatment approaches for improving outcomes of RT in cancer patients.

Physiological characteristics of IRR 400 series rubber clones (Hevea brasiliensis Muell. Arg.) under drought stress

Background Drought stress is one of the main causes of plant death. Strategies for plants survival are morphological adaptations, specific signaling pathways, and tolerance mechanisms. Rubber plantations have many uses, such as foreign exchange sources, job sources, forest revitalization, and a source of alternative wood for building materials and furniture. The rubber plant’s response to drought stress is a complex biological process. A tolerant rubber clone in a dry area is the right approach. The present study aimed to identify drought tolerant traits in order to select or identify drought-tolerant clones at juvenile stage. Methods The first factor examined for this work was clones (IRR 425, IRR 428, IRR 429, IRR 434, IRR 440, RRIC 100, and BPM 24) and the second factor was water content (30%, 60%, and 90%). The study was arranged on a factorial randomized block design and repeated three times. Characteristics observed were total sugar (µM), proline (mg/L), chlorophyll a, b, total (µg/mL), hydrogen peroxidase (µmol/g), ascorbate peroxidase (unit/mg), superoxide dismutase (unit/mg), and peroxide dismutase (unit/mg). Results The tolerance ability of the IRR 400 series rubber clones to drought stress was determined by observing the characteristics of sugar total and proline. The concentration of total sugar and proline were higher when the plant was treated with a lower water content. The selected clones tolerant to drought stress are RR 425 and IR 434 with high total sugar content and proline. Other characteristics, namely chlorophyll a, b, and total, as well as hydrogen peroxidase, ascorbate peroxidase, super oxide dismutase, peroxide dismutase, cannot be used as selection characteristics for this study. Conclusions This drought study of IRR 400 clones with varying water content percentages illustrated that the total sugar and proline characteristics could be used to distinguish tolerance levels from other observed characteristics.

Knockdown of Slfn5 alleviates lipopolysaccharide-induced pneumonia by regulating Janus kinase/signal transduction and activator of transcription pathway.

In recent years, the incidence of pneumonia has been increasing, which is the main cause of death and morbidity of children and the elderly in the world. Slfn5 is implicated in multiple cancers, and Slfn5 promotes epithelial-mesenchymal transition and metastasis in lung cancer. However, the influences of Slfn5 in pneumonia have not yet been completely cleared. Herein, we aimed to explore the underlying effects and regulatory mechanisms of Slfn5 in lipopolysaccharide (LPS)-induced pneumonia in mice and A549 cells. Mice were intratracheally administered 5 mg/kg LPS to construct pneumonia model. In vitro, A549 cells were treated with 10 µg/mL LPS to construct cellular pneumonia model. Slfn5 expression was detected using immunohistochemistry and western blotting. Haematoxylin and eosin staining, TUNEL (terminal deoxynucleotidyl transferasemediated deoxyuridine triphosphate‑biotin nick end‑labelling), and western blotting were performed to assess pathological injury and inflammation. MTT [3(4,5‑dimethyl‑2‑thiazolyl)‑2,5‑diphenyl‑2‑H‑tetrazolium bromide], flow cytometry, and enzyme-linked immunosorbent assay analysis were performed to analyze cell viability, apoptosis, and inflammation. Gene set enrichment analysis was performed to explore the mechanism of Slfn5 in pneumonia. Slfn5 expression was upregulated in LPS-induced pneumonia in mice and A549 cells. In mice, knockdown of Slfn5 weakened LPS-induced lung injury and inflammation and decreased the expression of p-JAK2, p-JAK3, and p-STAT3. In LPS-stimulated A549 cells, downregulation of Slfn5 expression increased and Slfn5 overexpression decreased cell viability. Downregulation of Slfn5 expression decreased and Slfn5 overexpression increased cell apoptosis, inflammation and the expression of p-JAK2, p-JAK3, and p-STAT3. AG490, an inhibitor of the JAK/STAT pathway, reversed the damaging effects of Slfn5 overexpression. In the LPS-induced pneumonia model, Slfn5 knockdown alleviated LPS-induced lung injury by regulating the JAK/STAT pathway.

Construction and Validation of a Novel Nomogram for Predicting the Risk of Metastasis in a Luminal B Type Invasive Ductal Carcinoma Population.

Postoperative distant metastasis is the main cause of death in breast cancer patients. We aimed to construct a nomogram to predict the risk of metastasis of luminal B type invasive ductal carcinoma. We applied the data of 364 luminal B type breast cancer patients between 2008 and 2013. Patients were categorized into modeling group and validation group randomly (1:1). The breast cancer metastasis nomogram was developed from the logistic regression model using clinicopathological variables. The area under the receiver-operating characteristic curve (AUC) was calculated in modeling group and validation group to evaluate the predictive accuracy of the nomogram. The multivariate logistic regression analysis showed that tumor size, No. of the positive level 1 axillary lymph nodes, human epidermal growth factor receptor 2 (HER2) status and Ki67 index were the independent predictors of the breast cancer metastasis. The AUC values of the modeling group and the validation group were 0.855 and 0.818, respectively. The nomogram had a well-fitted calibration curve. The positive and negative predictive values were 49.3% and 92.7% in the modeling group, and 47.9% and 91.0% in the validation group. Patients who had a score of 60 or more were thought to have a high risk of breast cancer metastasis. The nomogram has a great predictive accuracy of predicting the risk of breast cancer metastasis. If patients had a score of 60 or more, necessary measures, like more standard treatment methods and higher treatment adherence of patients, are needed to take to lower the risk of metastasis and improve the prognosis.

Recommendations for the primary prevention of atherosclerotic cardiovascular disease in primary care: study protocol for a systematic guideline review

IntroductionAtherosclerotic cardiovascular disease (ASCVD) was the main cause of death in Germany in 2021, with major risk factors (ie, hypertension, diabetes, dyslipidaemia, obesity and certain lifestyle factors) being highly prevalent....

Using infrared cameras in drones to detect bleeding events

BackgroundHemorrhage is one of the main causes of death in trauma. Critical bleeding in patients needs to be detected as soon as possible to save the patient. Drones are gaining increasing importance in emergency services and can support rescue forces in accident scenarios such as a mass casualty incident.MethodsIn this study, a simulated pelvic hemorrhage was detected using a drone from 7 m above the ground over a time span of 30 s.ResultsThe results allow a good detection of the pelvic hemorrhage. Nevertheless, the simulated blood cools down quickly. After 30 s, there was no significant temperature difference compared to the rest of the body. At this point, further assessment is only possible via the RGB image.ConclusionThe findings suggest that bleeding from an open and continuously bleeding wound would most likely be detectable using the drone’s thermal imaging camera, even over a longer period of time.

Relationship between cardiac output, heart rate and microcirculation in patients with multiorgan dysfunction syndrome

Multiple organ dysfunction syndrome (MODS) is one of the main causes of death in intensive care units. There is evidence that microcirculation in sepsis and coronary shock is regulated separately from hemodynamics. This study investigates the relationship between heart rate (HR), cardiac output (CO) and microcirculation in patients with MODS. This is apartial analysis of the "MODIFY study" (Reducing Elevated Heart Rate in Patients With Multiple Organ Dysfunction Syndrome [MODS] by Ivabradine). During the period 05/2010-09/2011, the microcirculation of 46patients with septic and coronary MODS was measured using the sidestream dark field technique on the day of inclusion and 96 h later. Patients were randomized into acontrol and ivabradine treatment group. Overall, there is arelevant improvement in microcirculation over time small perfused vessels, SPV [%] on day0, d0:56.5 ± 34.2/d4:73.2 ± 22.1 (p = 0.03); perfused vessel density, PVDsmall [1/mm2] d0:7.5 ± 5.0/d4:9.8 ± 3.4 (p = 0.04); proportion of perfused vessels, PPVsmall [%] d0:51.6 ± 31.6/d4:66.7 ± 21.8 (p = 0.04); microcirculatory flow index, MFI d0:1.7 ± 1.0/d4:2.2 ± 0.7 (p = 0.05). Administration of ivabradine shows no effect. In patients with coronary MODS, there is arelevant correlation between microcirculatory parameters and cardiac output (SPV [%]: r = 0.98, p = 0.004). Patients with coronary MODS show better microcirculation values at high heart rates (> 100 bpm), while patients with septic MODS show an opposite relationship. The results indicate that in critically ill patients, depending on the genesis of the MODS, there are different relationships between HF or CO values, on the one hand, and the parameters of the microcirculation, on the other.

Detection of heart pathology using deep learning methods

<span lang="EN-US">In the directions of modern medicine, a new area of processing and analysis of visual data is actively developing - a radio municipality - a computer technology that allows you to deeply analyze medical images, such as computed tomography (CT), magnetic resonance imaging (MRI), chest radiography (CXR), electrocardiography and electrocardiography. This approach allows us to extract quantitative texture signs from signals and distinguish informative features to describe the heart's pathology, providing a personified approach to diagnosis and treatment. Cardiovascular diseases (SVD) are one of the main causes of death in the world, and early detection is crucial for timely intervention and improvement of results. This experiment aims to increase the accuracy of deep learning algorithms to determine cardiovascular diseases. To achieve the goal, the methods of deep learning were considered used to analyze cardiograms. To solve the tasks set in the work, 50 patients were used who are classified by three indicators, 13 anomalous, 24 nonbeat, and 1 healthy parameter, which is taken from the MIT-BIH Arrhythmia database.</span>

The Impact of Screening and Surgery on Life Expectancy in Breast Cancer - A Mathematical Model Case Study in the European Union.

Background: In the last 20 years in European Union states, the life expectancy did not change much. In the period 2012-2021 the average life expectancy remained almost constant at 82 years. Breast cancer represents the main cause of death by cancer in women The purpose of this research is to identify o identify and measure the influence of some medical interventions and procedures related to breast cancer on life expectancy. In our article, the target group is the feminine population from 27 EU countries. Methodology: For the analysis several indicators provided by Eurostat were considered: life expectancy for female population as a dependent variable and breast cancer screenings, surgical operations and procedures performed in hospitals (partial and total excision) were used as independent variables. The research used a mathematical model (regression panel) for 27 EU countries, for a 10 year period, to evaluate the impact of each independent variable on the life expectancy in EU as a whole. Results: From a statistical point of view, screening has a significant effect on life expectancy. On the other hand, surgical interventions have a role in the overall medical process and positively influence life expectancy. The panel model has shown that partial interventions contribute less than screening procedures to increase life expectancy. Conclusion: The development of mathematical models in health care is useful in the process of improving health care quality. In our days, the measurement and quantification of some medical methods is particularly difficult due to so many variables and observations. In these difficult circumstances, the mathematical models could bring some clarifications and structure.

Function and prognosis analysis of nucleolus protein DCAF13 in breast cancer.

Breast cancer is one of the main causes of death among women. RNA binding proteins (RBPs) play a crucial role in the progression of breast cancer, with increasingly detailed understanding of RBP functional molecular mechanisms in breast cancer, the functional research of RBPs may help elucidate the potential mechanisms of tumor occurrence, development, invasion, metastasis and prognosis. DDB1- and CUL4-associated factor 13 (DCAF13) is an RBPs has been identified as a substrate receptor for the CUL4-DDB1 E3 ligase complex. Its expression is related to the prognosis of certain cancer. We tried to explore both co-expressed network and biological functions of DCAF13 in breast cancer. The Cancer Genome Atlas (TCGA) database was used to analyze the different expression of DCAF13 messenger RNA (mRNA) between normal breast tissue and breast carcinoma tissue, and the clinical data about 960 samples were downloaded from the cBio Cancer Genomics Portal (cBioPortal). The expression level of DCAF13, co-expression network, and survival were analyzed. Those with a fold change ≥1 and FDR <0.05 were considered to have statistical significance. Unsupervised clustering of differentially expressed RBPs was performed based on log2-transformed FPKM values using the "pheatmap" package in R. Genes with a Spearman score >0.55 were regarded as moderately co-expressed genes. The Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) database was used to construct a co-expression network. Meanwhile, the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) databases were used to identify the biological process cluster and pathway cluster, respectively. Compared with normal breast tissue, DCAF13 mRNA expression was significantly increased in breast cancer tissue (P<0.01). The Database for Annotation, Visualization and Integrated Discovery (DAVID) was used to identify the functions of the co-expressed network. These genes were mainly enriched in mitosis, nuclear division, metabolic process, recombination, replication and repair of DNA, double-strand break repair, posttranscriptional regulation of gene expression, regulation of cell cycle, division and proliferation, regulation of protein stability and also participation in in regulation of poly(A) RNA binding, mRNA binding, tRNA binding, adenosine triphosphate (ATP) binding. KEGG pathway analysis revealed that the genes were mainly enriched in cell cycle, oocyte meiosis and oxidative phosphorylation. According to survival analysis, upregulation of DCAF13 mRNA was significant for overall survival (OS) (P=0.0163). DCAF13 is up-regulated in breast cancer, the OS of patients with DCAF13 up-regulation was obviously reduced. DCAF13 was used as a diagnostic marker and therapeutic target for breast cancer. By building a co-expression network of DCAF13 and conducting bioinformatics analysis, it is possible to find the biomarker to evaluate patient prognosis. This finding provides a new target in mechanism and cell research of breast cancer.

Experience of mothers with a history of preeclampsia in pregnancy

Pre-eclampsia is a disease that can occur in pregnancy, and is one of the causes of death in large numbers in childbirth. One indicator of a country's health status is the low maternal mortality rate, where preeclampsia is one of the main causes of maternal death. Objective this Scoping Review is to review and map research on mother's life experience with a history of preeclampsia in pregnancy. Scoping Review it uses framework PRISMA-ScR with search of articles through relevant databases Pubmed, ScienceDirect, and Willey then do Critical Appraisal use The Joanna Briggs Institute (JBI). Based on the search results of the selected 921 articles, there were 10 articles that met the inclusion criteria, and then the review process was continued to identify keywords that resulted in 3 themes, namely Mother's Experience with a history of preeclampsia in pregnancy Impacts related to preeclampsia in pregnant women and Outlook Society believes that preeclampsia is a disorder of evil spirits. History of preeclampsia in pregnancy still really need attention from families and health workers, especially from the aspect of vigilance for the symptoms that are felt and the importance of information about preeclampsia in pregnancy.

Effect of Regional Anesthesia on Oncological Outcomes (Meta-Analysis)

Metastatic processes remain the main cause of deaths in oncology. Methods of anesthesia, in particular regional anesthesia, are considered as potential modulators of the immune response and metastatic spread. The ambiguity of the available data on the effect of regional and general anesthesia on metastatic spread is partly due to the fact that general anesthetic in combined anesthesia is quite often not taken into account, and this, in turn, masks the possible influence of regional anesthesia.The purpose of this meta-analysis was to make a comparative assessment of the effect of general anesthesia and general anesthesia in combination with regional anesthesia on the relapse-free and overall survival of cancer patients after surgery.Materials and methods. We analyzed 8 randomized controlled trials involving 1822 patients and comparing the groups of cancer patients who were operated either under general anesthesia (total intravenous (TIVA) or inhalation (IA)), or general anesthesia in combination with regional anesthesia (TIVA+RA or IA+RA, respectively). Trial using combinations of inhaled and intravenous anesthetics was excluded from the analysis for a more accurate assessment of the effect of regional anesthesia. The study complies with the recommendations of the Cochrane Community and PRISMA standards. The protocol was registered on the INPLASY platform. We used PubMed, Google Scholar and CENTRAL databases. We used a subgroup analysis and GRADE tool to assess the quality of evidence.Results. There were no statistically significant differences in relapse-free and overall survival when comparing different anesthesia methods. For a relapse-free survival, comparing TIVA vs TIVA+RA resulted in no significant difference : OR=1.20 [95% CI 0.92-1.55]; when IA vs IA+RA were compared, OR=1.10 [95% CI 0.94-1.29]. Similar results were obtained for overall survival.Conclusion. Based on the meta-analysis results, regional anesthesia had no effect on relapse-free and overall survival in oncosurgery patients.

Circulating Biomarkers for Monitoring Chemotherapy-Induced Cardiotoxicity in Children.

Most commonly diagnosed cancer pathologies in the pediatric population comprise leukemias and cancers of the nervous system. The percentage of cancer survivors increased from approximatively 50% to 80% thanks to improvements in medical treatments and the introduction of new chemotherapies. However, as a consequence, heart disease has become the main cause of death in the children due to the cardiotoxicity induced by chemotherapy treatments. The use of different cardiovascular biomarkers, complementing data obtained from electrocardiogram, echocardiography cardiac imaging, and evaluation of clinical symptoms, is considered a routine in clinical diagnosis, prognosis, risk stratification, and differential diagnosis. Cardiac troponin and natriuretic peptides are the best-validated biomarkers broadly accepted in clinical practice for the diagnosis of acute coronary syndrome and heart failure, although many other biomarkers are used and several potential markers are currently under study and possibly will play a more prominent role in the future. Several studies have shown how the measurement of cardiac troponin (cTn) can be used for the early detection of heart damage in oncological patients treated with potentially cardiotoxic chemotherapeutic drugs. The advent of high sensitive methods (hs-cTnI or hs-cTnT) further improved the effectiveness of risk stratification and monitoring during treatment cycles.

Education of TB Cadres About Health Promotion of The Lung TB Program Using Vidio and Digital Liefate Media

Background: TB is the main cause of death by infectious agents and is one of the 10 causes of death from all diseases . Indonesia is currently in third place in contributing to tuberculosis cases in the world after India and China. Every year there are 582,000 new cases, of which 259,970 are BTA positive pulmonary tuberculosis. The number of TB patient discoveries in Indonesia in the last 5 years has fluctuated, recorded in 2017 at 446,732, in 2018 it increased to 570,289 and in 2019 it was 543,874, in 2020 there were 393,323 cases and in 2021 it decreased to 385,295 cases . with a Case Detection Rate (CDR) figure of 47%. Jambi Province's TB program achievement nationally is in the bottom 31st place, namely 26% (Jambi Health Office, 2022)&#x0D; Method: This research is a type of quantitative research using a pre-experimental design method, type one group pretest-posttest design, which is a research activity that provides an initial test (pretest) before being given treatment, after being given treatment, then giving a final test (posttest). This research was carried out on 50 cadres in the working area of the Putri Ayu Community Health Center, Jambi City.&#x0D; Result: The average knowledge score before training was 57.4 and after training it increased to 75.2 . The results of educational activities for cadres in the working area of the P Utri Ayu Community Health Center show a level of success with indications of a positive response from cadres by showing increased knowledge through pre and posttest methods during training . From the results of the pretest and posttest through the T-test measurement for paired samples, a significance value or p value of 0.000 (p &lt; 0.005) was obtained.&#x0D; Conclusion: there is a significant difference between the knowledge scores of health cadres before and after participating in the training

PREDICTING CHRONIC DISEASES IN HIGHLY POLLUTED INDUSTRIAL ENVIRONMENTS USING MACHINE LEARNING

ABSTRACT: Environmental pollution is a risk factor for chronic diseases (CD), which today are identified as the main cause of death in the world, 80% in low- and middle-income countries, in people of all ages. Given that industrial areas maintain a high rate of air pollution, their inhabitants are considered highly vulnerable, such is the case of the Metropolitan Area of Tula Hgo., in Mexico. At the request of the World Health Organization to integrate vulnerable populations to the quality of life through innovative strategies, the present study aims to build prediction models for CD of higher frequency in the area, to support predictive diagnosis through machine learning algorithms, recognized for their high performance in health areas. Based on the CRISP-DM methodology, requirements, characteristics and data behavior were analyzed, exhaustive cleaning and minmax scaler normalization were performed, the models were trained and validated with 80% - 20% of records, dropout and early stopping were applied to combat overtraining. The comparative analysis between 9 built models demonstrated the best performance of 3 of them, one for each EC; the Artificial Neural Network (ANN) for respiratory diseases and Random Forest (RF) for diabetes and high blood pressure. Its results of accuracy, precision, sensitivity, specificity and F1-score were 99%, 99%, 100%, 99% and 99.49% respectively for ANN, the RF model for diabetes obtained 98%, 100%, 97%, 100% and 98.7% and for arterial hypertension 95%, 97%, 94, 97% and 95.47%, these models were integrated into a graphical interface. The proposal constitutes a high-precision technological strategy for prevention and early diagnosis of CD in industrial areas, aimed at reducing mortality and improving the quality of life of the inhabitants.

Safety and effects of a home-based Tai Chi exercise rehabilitation program in patients with chronic heart failure: study protocol for a randomized controlled trial

IntroductionChronic heart failure (CHF), as the final stage of the progression of many cardiovascular disorders, is one of the main causes of hospitalization and death in the elderly and has a substantial impact on patients' quality of life (QOL). Exercise-based cardiac rehabilitation (CR) has been shown to considerably enhance QOL and prognosis. Given the barriers to center-based CR faced by most developing countries in the form of expensive instruments, the development of home-based CR is necessary. Tai Chi, as an instrument-free exercise, has been shown to be successful in treating elderly CHF individuals. Fu Yang, as one of the academic concept of Traditional Chinese Medicine (TCM), believes that the fundamental pathogenesis of CHF is the gradual decline of Yang, and emphasizes the restoration of Yang physiological function in the treatment process. Therefore, we develope a home-based Tai Chi exercise rehabilitation program called Fu Yang Tai Chi (FYTC) for elderly CHF patients by combining the Fu Yang Theory of TCM with the CR theory. The objective of this study is to evaluate the effectiveness, acceptability, and safety of the program.Methods and analysisWe suggest conducting a parallel randomized controlled clinical trial with open label. Eighty CHF elderly participants will be randomly assigned in a 1:1 ratio to the FYTC rehabilitation program group or the moderate-intensity aerobic walking control group. Eligible participants will engage in either three sessions weekly of FYTC or walking exercise for 12 weeks. The primary outcome is the relative change in 6 min walk distance (6MWD). The secondary outcomes are the plasma levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), QOL, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), self-rating anxiety scale (SAS) and depression scale (SDS), exercise skills, and noninvasive hemodynamic monitoring. Throughout the trial, adverse events will be recorded for safety evaluation. Researchers who are blinded to the treatment allocation will analyze the data.Ethics and disseminationThis research was authorized by the Guang'anmen Hospital Ethics Committee of the Chinese Academy of Medical Sciences (2022-141-KY). Our findings will be shared online and in academic conferences as well as in peer-reviewed journals. Trial registration numberChiCTR2200063511.

Transplant Outcomes for Acute Myeloid Leukemia or Myelodysplastic Syndromes Secondary to Acquired Aplastic Anemia or Paroxysmal Nocturnal Hemoglobinuria: A Report from the EBMT Severe Aplastic Anemia Working Party

Introduction Clonal evolution into myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML) is the most concerning late event among non-transplanted acquired aplastic anemia (AA) or paroxysmal nocturnal hemoglobinuria (PNH) patients, occurring in nearly 10% of cases. MDS/AML secondary to AA differ from primary MDS/AML, presenting with higher risk cytogenetics and poorer prognosis, usually involving abnormalities in chromosome 7 (Gurnari C. et al., JCO 2023). The survival is poor, and the only curative treatment is allogeneic hematopoietic stem cell transplantation (HSCT). We present the HSCT outcomes of secondary MDS/AML following AA/PNH. Methods We have extracted data from the EBMT database for patients with AA or PNH diagnosed after 2010, who later presented a clonal evolution into AML, MDS, or isolated cytogenetic abnormality insufficient for MDS diagnosis according to WHO 2016 classification, who have undergone HSCT after the clonal evolution diagnosis. We have excluded AA/PNH patients with HSCT before clonal evolution, inherited bone marrow failure syndromes, and non-transplanted patients. Our primary objective was to describe the overall survival (OS). The secondary aims were transplant outcomes according to clonal evolution category and conditioning regimen intensity. Results: We have studied 278 patients from 114 different EBMT centers, 250 patients diagnosed with AA, and 28 with classical PNH. The median age at AA/PNH diagnosis was 34.7 (20.5-51.7) years. At first evolution, 153 (56.5%) patients had a diagnosis of MDS, 45 (16.6%) AML, and 73 (26.9%) isolated abnormal cytogenetics insufficient for a diagnosis of MDS (missing data for 7 patients). The median interval from AA/PNH diagnosis to clonal evolution was 30.1 (8.1-67) and 39.8 (21.5-82.6) months for MDS and AML, respectively. The interval from clonal evolution to HSCT was 5 (3-10.2) and 3.4 (2.3-5.1) months for MDS and AML, respectively. We present transplant characteristics in Table 1. With a median follow-up of 5 (4.3 - 5.9) years, the 5-year overall survival (OS) was 65% for the entire cohort. A subgroup analysis did not find a significant 5-year OS difference among groups: 73, 62, and 60% for isolated cytogenetic abnormality, MDS, and AML, respectively (p=0.3, Figure 1). The main causes of death were transplant-related toxicities (66.7% and 75% for isolated cytogenetic abnormality and MDS, respectively) and relapse or progression for AML (43.8%). AML patients relapsed more frequently than MDS patients by 5 years [cumulative incidences of 22 (9-35) vs. 10% (4-17) for AML and MDS (p=0.046), respectively]. The 5-year non-relapse mortality (NRM) was 19 (7-31) and 28% (19-36) for AML and MDS patients, respectively (p=0.3). When stratifying by conditioning regimen intensity, the 5-year NRM was 34% (19-40) for myeloablative (MAC) vs. 18% (9-26) for reduced-intensity (RIC, p=0.025), with similar incidence of relapse in both groups (4 vs 10% for MAC and RIC, respectively, p=0.2). AML patients were more prone to have presented acute graft-versus-host disease (GvHD) by day+100 than MDS or isolated cytogenetic abnormality patients (cumulative incidences of 36, 26, and 14% respectively, p=0.022). Likewise, AML patients had more chronic GvHD (43, 28, and 12% respectively, p=0.008). Graft-failure, GvHD, relapse-free survival (GGRFS) was 71 (61-82), 60 (51-68), and 45% (29-60) for isolated abnormality, MDS, and AML, respectively (p=0.026). Discussion This study is the largest cohort of transplanted patients with secondary MDS/AML following AA/PNH. The major limitations of our study are its retrospective nature, non-adjusted analyses, and missing data on complete cytogenetics. We found a 5-year OS higher than 60% for MDS/AML compared to 45% in the previously published EBMT study (Hussein A. et al., BBMT 2014) and did not find a survival difference between AML and MDS. Interestingly, the main cause of death for MDS patients was HSCT complications. Furthermore, MAC was also associated with a higher NRM. Clinicians should indicate HSCT with discretion for post-AA/PNH MDS or isolated cytogenetic abnormality, considering the transplant toxicity, especially with MAC, and the risk of primary disease progression. For patients with AML and a high risk of relapse, early tapering of immunosuppressive agents and post-transplant maintenance, such as hypomethylating agents and donor lymphocyte infusion, should be considered.