Management Of Disease Research Articles

Exploitation of functionalized green nanomaterials for plant disease management.

A crucial determining factor in agricultural productivity is biotic stress. In addition, supply of quality food to the ever-increasing world's population has raised the food demand tremendously. Therefore, enhanced agricultural crop productivity is the only option to mitigate these concerns. It ultimately demanded the often and indiscriminate use of synthetic agrochemicals such as chemical fertilizers, pesticides, insecticides, herbicides, etc. for the management of various biotic stresses including a variety of plant pathogens. However, the food chain and biosphere are severely impacted due to the use of such harmful agrochemicals and their byproducts. Hence, it is need of hour to search for novel, effective and ecofriendly approaches for the management of biotic stresses in crop plants. Particularly, in plant disease management, efforts are being made to take advantage of newly emerged science i.e. nanotechnology for the creation of inorganic nanoparticles (NPs) such as metallic, oxide, sulphide, etc. through different routes and their application in plant disease management. Among these, green nanomaterials which are synthesized using environmentally friendly methods and materials reported to possess unique properties (such as high surface area, adjustable size and shape, and specific functionalities) making them ideal candidates for targeted disease control. Nanotechnology can stop crop losses by managing specific diseases from soil, plants, and hydroponic systems. This review mainly focuses on the application of biologically produced green NPs in the treatment of plant diseases caused due to bacteria, viruses, and fungi. The utilization of green synthesis of NPs in the creation of intelligent targeted pesticide and biomolecule control delivery systems, for disease management is considered environmentally friendly due to its pursuit of less hazardous, sustainable, and environmentally friendly methods.

Simulation-based Bone Marrow Aspiration and Trephine Biopsy Education for Medical Students: A Non-randomized Controlled Trial.

Introduction Despite the critical role of bone marrow aspiration and a trephine biopsy (BMAT) in the diagnosis and management of hematological diseases, research on effective teaching methods is limited. Medical students traditionally learn to perform BMAT through observation and replication, which poses a risk to patient safety. Therefore, we developed a novel BMAT simulator for undergraduate medical students using a simulation-based education program. Methods This program, designed for fourth- and fifth-year medical students at Okayama University Medical School, included pre-study materials and one hour of simulation training. Internists practicing hematology served as the controls. Before and after the simulation training, the students completed questionnaires regarding self-confidence, self-evaluation, interest, and knowledge. The procedures were evaluated objectively using a checklist at the end of the program. Results There were significant improvements in self-evaluation, self-confidence, interest, and knowledge acquisition after the simulation program (p≤0.001). The checklist revealed that the mean overall proficiency level of the students was 76.9%, which was significantly higher than that of internists (63.5%) (p≤0.01). Conclusion Our simulation-based education program using the novel BMAT simulator improved medical students' BMAT knowledge and skills.

Perspectives on progression of transboundary disease, one health and ecosystem health management in the Greater Mekong Subregion and beyond

Perspectives on progression of transboundary disease, one health and ecosystem health management in the Greater Mekong Subregion and beyond

Innovative approaches for coronary heart disease management: integrating biomedical sensors, deep learning, and stellate ganglion modulation.

Coronary heart disease (CHD) is a significant global health concern, necessitating continuous advancements in treatment modalities to improve patient outcomes. Traditional Chinese medicine (TCM) offers alternative therapeutic approaches, but integration with modern biomedical technologies remains relatively unexplored. This study aimed to assess the efficacy of a combined treatment approach for CHD, integrating traditional Chinese medicinal interventions with modern biomedical sensors and stellate ganglion modulation. The objective was to evaluate the impact of this combined treatment on symptom relief, clinical outcomes, hemorheological indicators, and inflammatory biomarkers. A randomized controlled trial was conducted on 117 CHD patients with phlegm-turbidity congestion and excessiveness type. Patients were divided into a combined treatment group (CTG) and a traditional Chinese medicinal group (CMG). The CTG group received a combination of herbal decoctions, thread-embedding therapy, and stellate ganglion modulation, while the CMG group only received traditional herbal decoctions. The CTG demonstrated superior outcomes compared to the CMG across multiple parameters. Significant reductions in TCM symptom scores, improved clinical effects, reduced angina manifestation, favorable changes in hemorheological indicators, and decreased serum inflammatory biomarkers were observed in the CTG post-intervention. The combination of traditional Chinese medicinal interventions with modern biomedical sensors and stellate ganglion modulation has shown promising results in improving symptoms, clinical outcomes, and inflammatory markers in CHD patients. This holistic approach enhances treatment efficacy and patient outcomes. Further research and advancements in sensor technology are needed to optimize this approach.

Haplotype-based association mapping of genomic regions associated with Zymoseptoria tritici resistance using 217 diverse wheat genotypes

BackgroundSeptoria tritici blotch (STB) is considered to be one of the most destructive foliar wheat diseases and is caused by Zymoseptoria tritici. The yield losses are severe and in Northwestern Europe can reach up to 50%. The efficacy of fungicides is diminishing due to changes in the genetic structure of the pathogen. Therefore, resistance breeding is the most effective strategy of disease management. Recently, genome-wide association studies (GWAS) have become more popular due to their robustness in dissecting complex traits, including STB resistance in wheat. This was made possible by the use of large mapping populations and new sequencing technologies. High-resolution mapping benefits from historical recombination and greater allele numbers in GWAS.ResultsIn our study, 217 wheat genotypes of diverse origin were phenotyped against five Z. tritici isolates (IPO323, IPO88004, IPO92004, IPO86036 and St1-03) and genotyped on the DArTseq platform. In polytunnel tests two disease parameters were evaluated: the percentage of leaf area covered by necrotic lesions (NEC) and the percentage of leaf area covered by lesions bearing pycnidia (PYC). The disease escape parameters heading date (Hd) and plant height (Ht) were also measured. Pearson’s correlation showed a positive effect between disease parameters, providing additional information. The Structure analysis indicated four subpopulations which included from 28 (subpopulation 2) to 79 genotypes (subpopulation 3). All of the subpopulations showed a relatively high degree of admixture, which ranged from 60% of genotypes with less than 80% of proportions of the genome attributed to assigned subpopulation for group 2 to 85% for group 4. Haplotype-based GWAS analysis allowed us to identify 27 haploblocks (HBs) significantly associated with analysed traits with a p-value above the genome-wide significance threshold (5%, which was –log10(p) > 3.64) and spread across the wheat genome. The explained phenotypic variation of identified significant HBs ranged from 0.2% to 21.5%. The results of the analysis showed that four haplotypes (HTs) associated with disease parameters cause a reduction in the level of leaf coverage by necrosis and pycnidia, namely: Chr3A_HB98_HT2, Chr5B_HB47_HT1, Chr7B_HB36_HT1 and Chr5D_HB10_HT3.ConclusionsGWAS analysis enabled us to identify four significant chromosomal regions associated with a reduction in STB disease parameters. The list of valuable HBs and wheat varieties possessing them provides promising material for further molecular analysis of resistance loci and development of breeding programmes.

17α Hydroxylase/17,20 lyase deficiency: clinical features and genetic insights from a large Turkey cohort.

17α Hydroxylase/17,20 lyase deficiency (17OHD) is a rare form of congenital adrenal hyperplasia, typically diagnosed in late adolescence with symptoms of pubertal delay and hypertension. This study aimed to determine the clinical and laboratory characteristics of 17OHD cases and gather data on disease management. Data from 97 nationwide cases were analyzed using the CEDD-NET web system. Diagnostic, follow-up findings, and final heights of patients were evaluated. Mean age at admission was 13.54 ± 4.71 years, with delayed puberty as the most common complaint. Hypertension was detected in 65% at presentation; hypokalemia was present in 34%. Genetic analysis revealed Exon 1-6 homozygous deletion as the most frequent mutation, identified in 42 cases. Hydrocortisone replacement was universal; pubertal replacement was administered to 66 cases. Antihypertensive treatment was required in 57 (90%) patients. Thirty-seven cases reached final height, with an average SD of 0.015 in 46,XX and -1.43 in 46,XY. Thelarche and pubarche did not develop properly in some cases despite estradiol treatment. This study represents the largest cohort of pediatric cases of 17-hydroxylase deficiency (17OHD) documented in the literature. Hypertension and hypokalemia can serve as guiding indicators for early diagnosis.The final height is typically considered to be normal. The relationship between genotype and phenotype remains elusive. The initial genetic test for exon 1-6 deletions may be MLPA in our region.

Nurse led models of care for outpatient substance use disorder treatment: A scoping review.

To map key characteristics and describe nurse led models of care for the treatment of persons with substance use disorders (SUDs) in the outpatient setting. A scoping review. Conducted in accordance with the JBI methodology. The PRISMA-ScR checklist was used. Pubmed, CINAHL Complete (EBSCOhost), Cochrane Library, APA PsycNet and Scopus were searched from 1999 to May 2022 and updated on 28 November 2023. A handsearch and a grey literature search was conducted. Title and abstract screening was performed on 774 articles resulting in 88 articles for full text screening. Full text screening yielded 13 articles that met inclusion criteria. Existing nurse-led models of care for SUDS are scarce and limited in scope, with the majority focused on treating opioid use disorder. Additional research is needed to develop, test, and implement efficacious nurse-led models of care for the treatment and management of SUDs. Nurse led models of care have demonstrated their efficacy and quality in the management of other chronic diseases. As we move forward with innovative solutions for individuals with addiction, nurse led models of care can be a mechanism to deliver high quality, evidence-based care for SUDs. SUDs are chronic diseases that impact individuals, families, and communities. SUDs require a biopsychosocial approach to treatment. Globally, nurses are well positioned to provide high quality care to mitigate the impact of SUDs. This scoping review mapped the extant literature on nurse led models of care for substance use disorder treatment in the outpatient setting finding that additional research is needed to develop, test and implement evidence-based interventions to care for individuals, families, and communities experiencing SUDs. PRISMA checklist for scoping reviews. No patient or public contribution were part of this study. Open Science Framework accessible at: https://doi.org/10.17605/OSF.IO/NSW7V.

Effect of combined rapid access point-of-care intestinal ultrasound clinic on the management of inflammatory bowel disease

BackgroundIntestinal ultrasound (IUS), although less widely practiced in the UK, offers several advantages in inflammatory bowel disease (IBD), particularly with regard to the accessibility of the test and immediate availability...

Do functionality, strength, vascularization, inflammatory and biopsychosocial status improve by biopsychosocial model-based exercise in SSc?

This study aimed to investigation of the effects of the Cognitive Exercise Therapy Approach (Bilişsel Egzersiz Terapi Yaklaşımı-BETY), a supervised biopsychosocial model-based exercise intervention, on functionality, muscle strength, vascularization, anti-inflammatory and biopsychosocial status in Systemic Sclerosis (SSc) patients. Thirty-seven SSc patients were included. Twenty of them were recruited into the study group (SG) undergoing BETY group exercise sessions three times a week for three months and 17 were in the control group (CG) following a home exercise program. Assessments tools were the Modified Rodnan Skin Score (mRSS), Scleroderma Health Assessment Questionnaire (SHAQ), Modified Hand Mobility in Scleroderma (mHAMIS), Duruoz Hand Index (DHI), Six Minute Walk Test (6MWT), skeletal muscle strength measurements using an isokinetic dynamometer (Biodex System 3 Pro), Shear Wave Elastography (SWE), ELISA kits (for tumor necrosis factor-alpha, Interleukin-6, IL-10, serum irisin level), BETY-Biopsychosocial Questionnaire (BETY-BQ), Hospital Anxiety and Depression Scale (HADS), and Short Form-36 (SF-36). The SG demonstrated improvements in SHAQ, mHAMIS, 6MWT, BETY-BQ, HADS, and SF-36 values, excluding the DHI scores (p < 0.05). In contrast, CG showed worsening in SHAQ-general scleroderma symptoms and HADS scores compared to SG (p < 0.05). IL-10 and TNF-alpha increased in both groups, also various vascular parameters were significantly different changed in SG than CG (p < 0.05). Muscle strength values improved in the SG but decreased in the CG however this was statistically not significant (p > 0.05). BETY can be recommended as a nonpharmacologic approach to the disease management of SSc patients.

Prognostic Impact of Tumor-Infiltrating Immune Cells on Efficacy of Neoadjuvant Chemotherapy in Patients with Advanced or Metastatic Ovarian Cancer: A Retrospective Study.

BACKGROUND Tumor-infiltrating immune cells (TIICs) are implicated in the survival of ovarian cancer (OVCA) patients, but their prognostic significance in advanced or metastatic OVCA patients treated with neoadjuvant chemotherapy (NCAT) has not been well documented, particularly in the Chinese population. MATERIAL AND METHODS A total of 31 advanced or metastatic OVCA patients who underwent NACT were included. The density and positive rate of tumor-infiltrating immune cells (TIICs) within cancer cell nests and in cancer stroma were explored. The correlations of pre- or post-NACT TIICs with the efficacy of NACT and the changes in TIIC subpopulation with NACT were examined. RESULTS Compared with patients with partial benefit from NACT, significantly decreased pre-NACT intratumoral CD68⁺CD163⁺ cells (P=0.0043) and increased pre-NACT intratumoral CD56⁺ cells (P=0.038) were observed in patients with benefit. The high level of pre-NACT intratumoral CD68⁺CD163⁻ M1 macrophage (P=0.075) and stromal CD3⁺PD-1⁺ cells (P=0.085) predicated improved progression-free survival, respectively. Increased post-NACT stromal CD68⁺CD163⁻ M1 macrophage (P=0.01), stromal CD8⁺ T cells (P=0.073), and stromal CD8⁺PD-1⁺ cells (P=0.072) were associated with benefit from NACT. Moreover, NACT increased intratumoral CD3⁺ (P=0.031), CD8+ (P=0.031), and CD3⁺CD8⁺ cells (P=0.031). CONCLUSIONS High intratumoral CD68⁺CD163⁻, intratumoral CD56⁺ cells, and stromal CD3⁺PD-1⁺ cells pre-NACT predicted good prognosis. Intratumoral CD3⁺, CD8⁺, and CD3⁺CD8⁺ cells were increased after NACT. Evaluation of immune profiles may help to identify patients who might benefit from NACT and allow us to further stratify advanced or metastatic OVCA patients treated with NACT for disease management.

Can vitamin supplementation improve quality of life and disease severity in patients with rheumatoid arthritis, or is physical activity enough?

Introduction: Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation and progressive joint destruction, significantly impacting quality of life. While conventional treatments focus on managing symptoms and slowing disease progression through pharmacological means, the potential role of complementary therapies like vitamin supplementation or increased physical activity has garnered increasing interest. Aim of the Study: This narrative review explores the existing literature on the efficacy and mechanisms of various vitamins in the management of RA. By synthesizing current research findings, we aim to provide a comprehensive overview of how vitamin supplementation might influence RA outcomes, offering insights into potential integrative approaches to enhance patient care. Methods and Materials: A thorough search was conducted using PubMed and Google Scholar, focusing on literature published in the past five years. Vitamins with potential impacts on RA progression were identified and paired with the term "Rheumatoid Arthritis" to collect data on their influence on the disease's incidence and management, as well as the mechanisms involved. Additionally, references from selected articles were reviewed and included in the analysis. This method ensured a comprehensive evaluation of the current evidence regarding vitamin supplementation in RA treatment. Similarly, studies on the impact of physical activity on RA were also reviewed. Results: The influence of physical activity on serum inflammatory markers in RA patients was limited. Vitamin D supplementation significantly reduced disease activity, alleviated pain, and mitigated methotrexate-related side effects, especially in patients with baseline vitamin D deficiency or lower serum levels. In contrast, other vitamins have not exhibited the same positive effects. These findings underscore the need for continued research to optimize the role of various vitamins in managing RA effectively.

Fusarium Tropical Race 4 in Latin America and the Caribbean: status and global research advances towards disease management

Fusarium wilt of banana (FWB), caused by the soil-borne fungus Fusarium oxysporum f. sp. cubense (Foc), poses an undeniable threat to global banana production. This disease has intensified in recent years, with the tropical race 4 (TR4) strain spreading rapidly. Since 2018, the number of affected countries has increased from 16 to 23, presenting a significant challenge to researchers, producers, and National Plant Protection Organizations (NPPOs) worldwide. The potential impact of TR4 in Latin America and the Caribbean (LAC) is particularly concerning. This region boasts seven of the top ten banana-exporting countries, and bananas and plantains are crucial for food security and income generation. In Colombia, where TR4 was detected in 2019, the disease has already spread from La Guajira to Magdalena, and it is currently affecting 20 large commercial export farms. In Peru, the disease was detected in 2021 and although still restricted to the northern region, flood irrigation and heavy rains associated with the Yaku cyclone, boosted pathogen spread, and more than 400 small organic banana farmers are currently affected. In Venezuela, TR4 detection occurred in 2023, with plantations across three states and five municipalities now affected. Worryingly, TR4 has also been confirmed in plantains, a staple food in the region. Current national responses in LAC primarily rely on preventive and reactive measures: preventing initial incursions and containing outbreaks to avoid further spread. However, the disease’s relentless progression suggests that its eventual presence in all banana-producing areas is likely. Therefore, exploring alternative management approaches beyond pathogen exclusion becomes crucial, both in affected and disease-free regions. This paper examines the current spread of TR4, focusing on epidemiological aspects and recent research-based management options. Key epidemiological features were highlighted, drawing practical examples from various scales (plots to landscapes) and utilizing experiences from LAC’s fight against TR4. The paper also reviews field-tested approaches in biosecurity, biological control, resistant varieties, soil health, and integrated disease management, acknowledging the specific challenges faced by smallholder settings. In each section research initiatives were analyzed, identifying gaps, and proposing directions to minimize TR4 impact and accelerate the development of sustainable solutions for managing this devastating disease.

The use of diffusion tensor imaging in spinal pathology: a comprehensive literature review.

We reviewed the available literature systematically without meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. To evaluate contemporary literature on use of spinal diffusion tensor imaging(sDTI) in spinal pathology. sDTI reveals the location and functional state of critical long tracts and is a potentially useful adjunct in disease management. Studies were included if they presented or discussed data from investigative or therapeutic procedures involving sDTI on human subjects in the setting of surgically amenable spinal pathology. Studies were excluded if they were (1) restricted to computational models investigating parameters using data not obtained clinically, (2) about cranial DTI methods, (3) about spinal pathology data not related to surgical management, (4) discussions or overviews of methods/techniques with minimal inclusion of objective experimental or clinical data. Degenerative pathologies of interest were restricted to either cervical myelopathy (22/29,75.9%) or lumbar spondylosis 7/29,24.1%). Mass-occupying lesions included intradural pathology and discussed preoperative (7/9,77.8%) and intraoperative imaging(2/9,22.2%) as an adjunct to surgery 22.2%. Traumatic pathology focused on spinal cord injury prognosis and severity grading. sDTI seems useful in surgical decision making and outcome measurements and in establishing clinical prognoses over a wide range of surgical pathologies. Further research is warranted with longer follow-up and larger population sizes in a prospective and controlled protocol.

Sustainable aquaculture over the last 30 years: An analysis of the scientific literature by the Text Mining approach

AbstractA literature search approach (using Scopus®, Elsevier© database) was established to identify peer‐reviewed articles published in English between 1960 and 2023 dealing with ‘sustainable aquaculture’ and focusing on specific aquaculture practices (aquaponics, integrated multi‐trophic aquaculture, biofloc and recirculating aquaculture systems). Text Mining combined with Topic Analysis was utilized to extract information from the text data of the papers identified. After an appropriate screening procedure, 1111 articles were selected. The analysis showed a gradual increase in sustainable aquaculture publications over time, peaking at more than 200 publications in 2023. The first articles on biofloc, integrated multi‐trophic aquaculture and recirculating aquaculture systems as alternative aquaculture practices began to appear in 2010, while studies in aquaponics have only been published since 2015. Most publications (40%) came from Asia, in line with the leadership of this continent in aquaculture. European also showed considerable interest in sustainable aquaculture practices, with Italy (leader in publications), Portugal and Germany researchers contributing with 111 papers on the subject in the past 30 years. This study identified the main research topics on the subject and observed how these have evolved. The papers analysed dealt mainly with optimization of aquatic life, genetic in aquaculture and disease management. The topic of protein replacement in feed was also important, with the term ‘diet’ the most frequently utilized in papers. The subjects identified could serve as valuable primary data source, offering opportunities for deeper examination, such as systematic reviews on research topics or geographic regions.

DPP: A Novel Disease Progression Prediction Method for Ginkgo Leaf Disease Based on Image Sequences

Ginkgo leaf disease poses a grave threat to Ginkgo biloba. The current management of Ginkgo leaf disease lacks precision guidance and intelligent technologies. To provide precision guidance for disease management and to evaluate the effectiveness of the implemented measures, the present study proposes a novel disease progression prediction (DPP) method for Ginkgo leaf blight with a multi-level feature translation architecture and enhanced spatiotemporal attention module (eSTA). The proposed DPP method is capable of capturing key spatiotemporal dependencies of disease symptoms at various feature levels. Experiments demonstrated that the DPP method achieves state-of-the-art prediction performance in disease progression prediction. Compared to the top-performing spatiotemporal predictive learning method (SimVP + TAU), our method significantly reduced the mean absolute error (MAE) by 19.95% and the mean square error (MSE) by 25.35%. Moreover, it achieved a higher structure similarity index measure (SSIM) of 0.970 and superior peak signal-to-noise ratio (PSNR) of 37.746 dB. The proposed method can accurately forecast the progression of Ginkgo leaf blight to a large extent, which is expected to provide valuable insights for precision and intelligent disease management. Additionally, this study presents a novel perspective for the extensive research on plant disease prediction.

Erythropoietic protoporphyrias: Pathogenesis, diagnosis and management.

The erythropoietic protoporphyrias consist of three ultra-rare genetic disorders of the erythroid heme biosynthesis, including erythropoietic protoporphyria (EPP1), X-linked protoporphyria (XLEPP) and CLPX-protoporphyria (EPP2), which all lead to the accumulation of protoporphyrin IX (PPIX) in erythrocytes. Affected patients usually present from early childhood with episodes of severe phototoxic pain in the skin exposed to visible light. The quantification of PPIX in erythrocytes with a metal-free PPIX ≥3 times the upper limit of normal confirms the diagnosis. Protoporphyria-related complications include liver failure, gallstones, mild anaemia and vitamin D deficiency with reduced bone mineral density. The management is focused on preventing phototoxic reactions and treating the complications. Vitamin D should be supplemented, and DEXA scans in adults should be considered. In EPP1, even in cases of biochemically determined iron deficiency, supplementation of iron may stimulate PPIX production, resulting in an increase in photosensitivity and the risk of cholestatic liver disease. However, for patients with XLEPP, iron supplementation can reduce PPIX levels, phototoxicity and liver damage. Because of its rarity, there is little data on the management of EPP-related liver disease. As a first measure, any hepatotoxins should be eliminated. Depending on the severity of the liver disease, phlebotomies, exchange transfusions and ultimately liver transplantation with subsequent haematopoietic stem cell transplantation (HSCT) are therapeutic options, whereby multidisciplinary management including porphyria experts is mandatory. Afamelanotide, an alpha-melanocyte-stimulating hormone analogue, is currently the only approved specific treatment that increases pain-free sunlight exposure and quality of life.

Detection of pathogenic bacteria and biomarkers in lung specimens from cystic fibrosis patients

Diagnosing lung infections is often challenging because of the lack of a high-quality specimen from the diseased lung. Since persons with cystic fibrosis are subject to chronic lung infection, there is frequently a need for a lung specimen. In this small, proof of principle study, we determined that PneumoniaCheckTM, a non-invasive device that captures coughed droplets from the lung on a filter, might help meet this need. We obtained 10 PneumoniaCheckTM coughed specimens and 2 sputum specimens from adult CF patients hospitalized with an exacerbation of their illness. We detected amylase (upper respiratory tract) with an enzymatic assay, surfactant A (lower respiratory tract) with an immunoassay, pathogenic bacteria by PCR, and markers of inflammation by a Luminex multiplex immunoassay. The amylase and surfactant A levels suggested that 9/10 coughed specimens were from lower respiratory tract with minimal upper respiratory contamination. The PCR assays detected pathogenic bacteria in 7 of 9 specimens and multiplex Luminex assay detected a variety of cytokines or chemokines. These data indicate that the PneumoniaCheckTM coughed specimens can capture good quality lower respiratory tract specimens that have the potential to help in diagnosis, management and understanding of CF exacerbations and other lung disease.

Advances in COVID-19 and Cancer Research

The global health crisis caused by COVID-19 has radically changed the management of several diseases [...]

Chinese herbal compound preparation Qing-Xin-Jie-Yu granules for intermediate coronary lesions in patients with stable coronary artery disease: Study protocol for a multicenter, randomized, double-blind, placebo-controlled trial.

Despite the available secondary preventive treatments, the management of stable coronary artery disease (SCAD) remains challenging. Intermediate coronary lesion (ICL), defined as luminal stenosis between 50% and 70%, is a key stage of SCAD. However, existing therapeutic strategies are limitated in delaying plaque progression and associated with various adverse effects and economic burdens. Qing-Xin-Jie-Yu Granules (QXJYG) with proven anti-platelet, anti-inflammatory, and lipid-lowering effects may compensate for the drawbacks of current treatments and can be tested as a complementary therapy. Therefore, this study aims to investigate the efficacy and safety of QXJYG in treating ICL, with a particular focus on its impact on myocardial ischemia and plaque progression. This is a multicenter, randomized, double-blind, placebo-controlled trial. A total of 120 participants with ICL will be randomly assigned to two groups in a 1:1 ratio. In addition to basic medications, the intervention group will receive QXJYG, while the control group will receive a placebo for over 6 months, followed by a 12-month follow-up. The primary efficacy outcome is computed tomography-derived fractional flow reserve. The secondary outcomes include the degree of coronary stenosis, coronary artery calcification score, Gensini score, Seattle Angina Questionnaire score, high-sensitivity C-reactive protein, matrix metalloproteinase-9, blood lipids, and carotid artery ultrasound parameters. Major adverse cardiovascular events are recorded as endpoints. The safety outcomes include composite events of bleeding, laboratory test results, and adverse events. Clinical visits are scheduled at baseline, every 2 months during the treatment, and after a 12-month follow-up. This trial is anticipated to yield reliable results to verify the efficacy and safety of QXJYG in the treatment of ICL, which will provide novel insights to help address the prevailing therapeutic dilemma of ICL, thereby facilitating for the management of SCAD. Chinese Clinical Trial Registry, ChiCTR2200059262. Registered on April 27, 2022.

Achieving consensus on the key elements of a nurse-led multidisciplinary chronic heart failure service in Thailand: An e-Delphi study.

To describe the outcomes of an e(electronic)-Delphi survey used to achieve consensus on the essential elements that should be included in a multidisciplinary, nurse-led service for patients with chronic heart failure (CHF). The study design was based on a three-round e-Delphi survey. A series of three survey rounds were used to gather expert opinions and achieve consensus on the key elements that should be included in a CHF disease management program from a sample of healthcare professionals and organizational leaders with expertise in existing CHF services. Consensus for each item was defined as at least 90% agreement. There were 20 participants (18 healthcare professionals and 2 organizational leaders) in round-1, 22 (20 healthcare professionals and 2 organizational leaders) in round-2, and 17 (15 healthcare professionals and 2 organizational leaders) in round-3. Fifteen participants attended a final online meeting (13 healthcare professionals and 2 organizational leaders). Consensus was obtained on five essential components: (i) consumer education, (ii) treatment optimization using a multidisciplinary approach, (iii) discharge planning, (iv) provision of supportive community care and (v) mechanisms to respond to early symptoms of decompensated CHF. Participants focused on mechanisms to improve treatment effectiveness, patient and family knowledge, communication between healthcare providers and supportive care in the community. The proposed model of care may be useful to other health service providers who are designing or adapting CHF models of care for the South-East Asian environment. This research provides a solid basis for using a Delphi method to resolve the challenges and issues of transferring global model-based recommendations in CHF knowledge. The Delphi method proved successful as an important step in developing a culturally acceptable model of chronic care that meets the goals of local healthcare providers.