Treatment Monitoring Research Articles

Severe Uncontrolled Asthma: A Longitudinal Retrospective Study Illustrating the Experience of the Pulmonology Clinic of Târgu-Mureș, Romania.

Introduction: Severe uncontrolled asthma (SUA) affects approximately 5% of asthma patients, leading to frequent exacerbations, reduced lung function, and lower quality of life. Recent biologic therapies target specific inflammatory pathways, offering new options for SUA. Objective: This study aimed to evaluate clinical characteristics, treatment outcomes, and biomarkers in patients with SUA treated with biologics (Omalizumab, Benralizumab, and Dupilumab) at our clinic. Material and Methods: A six-month retrospective longitudinal study was conducted on 28 patients aged 36-83 years with SUA. Patients were divided into three groups: Omalizumab (n = 4), Benralizumab (n = 18), and Dupilumab (n = 6). Lung function tests and biomarkers such as eosinophil and IgE levels were measured over 3-month periods (T0, T1, and T2). Asthma control was assessed using asthma control tests (ACT), and non-parametric statistical methods were applied. Results: The median patient age was 64 years, with 75% showing elevated eosinophil counts (>300 cells/µL). Benralizumab significantly improved lung function (p < 0.05) and ACT scores (p < 0.001), reducing eosinophil counts to zero (p < 0.001). Patients on Dupilumab and Omalizumab showed improved asthma control (p < 0.05) and reduced exacerbations, albeit to a lesser extent (p > 0.05). Conclusions: Biologics, particularly Benralizumab and Dupilumab, improved asthma control, lung function, and quality of life in SUA patients, with improved ACT scores and spirometry values. Some patients remained poorly controlled, emphasizing the need for personalized treatment and regular biomarker monitoring. Multidisciplinary management and lifestyle changes are critical for better outcomes in SUA.

Automatic 3-dimensional quantification of orthodontically induced root resorption in cone-beam computed tomography images based on deep learning

Orthodontically induced root resorption (OIRR) is a common and undesirable consequence of orthodontic treatment. Traditionally, studies employ manual methods to conduct 3-dimensional quantitative analysis of OIRR via cone-beam computed tomography (CBCT), which is often subjective and time-consuming. With advancements in computer technology, deep learning-based approaches have gained traction in medical image processing. This study presents a deep learning-based model for the fully automatic extraction of root volume information and the localization of root resorption from CBCT images. In this cross-sectional, retrospective study, 4534 teeth from 105 patients were used to train and validate an automatic model for OIRR quantification. The protocol encompassed several steps: preprocessing of CBCT images involving automatic tooth segmentation and conversion into point clouds, followed by segmentation of tooth crowns and roots via the Dynamic Graph Convolutional Neural Network. The root volume was subsequently calculated, and OIRR localization was performed. The intraclass correlation coefficient was employed to validate the consistency between the automatic model and manual measurements. The proposed method strongly correlated with manual measurements in terms of root volume and OIRR severity assessment. The intraclass correlation coefficient values for average volume measurements at each tooth position exceeded 0.95 (P<0.001), with the accuracy of different OIRR severity classifications surpassing 0.8. The proposed methodology provides automatic and reliable tools for OIRR assessment, offering potential improvements in orthodontic treatment planning and monitoring.

Primary pulmonary alveolar soft part sarcoma with ASPSCR1-TFE3 gene fusion: Case report and literature review.

Primary pulmonary alveolar soft part sarcoma (ASPS) is an extremely rare disease characterized by a specific genetic abnormality - the ASPSCR1-TFE3 gene fusion. This study presented a 27-year-old male patient who experienced persistent chest tightness for over 6 months. The computed tomography (CT) scan and enhanced CT scan revealed a mass in the medial segment of the right middle lobe of his lung. The patients then underwent further diagnosis. Pathological examination showed the tumor to be consisting of polygonal cells with abundant eosinophilic or transparent cytoplasm arranged in nests. Next-generation sequencing reported ASPSCR1-TFE3 gene fusion, confirming the final diagnosis of primary pulmonary ASPS. Regular follow-ups of 12 months showed no signs of tumor recurrence. The patients underwent the medial segment resection of the right middle lobe for treatment. A CT examination 3 months after the operation showed that the patient had improved. The last review showed no recurrence or metastasis. This case report highlights the importance of detailed diagnosis, prompt treatment, and close monitoring of patients with ASPS.

Continuous Inertial Alignment and Isolation of Spherical Microparticles and Nonspherical Flagellate Microalgae

Flagellate microalgae play an increasingly significant role in environmental management and biotechnology for valuable bioproducts, excellent photosynthetic capability, and autonomic movement. However, multiple flagellate microalgae practically live together in the ocean and lake areas, and they are susceptible to contamination as a result of improper operations. Enthused by these aspects, we develop a reliable inertial microfluidic method to overcome the influence of flagella movement and non-spherical shape on the alignment and isolation of target flagellate microalgae. Firstly, a computational model incorporating fluid-structure interaction was established to investigate influence of releasing position and shape parameters on the displacement and rotation of non-spherical microalgal cells and numerically studied the processes of shape- and size-based particle separation. Secondly, the movement of different-size particles under diverse flow rates in the channel was explored, and the capability of this method was validated by aligning and separating 10 μm and 20 μm polystyrene particles. Thirdly, this method was applied to align H. pluvialis and isolate Dunaliella salina from the mixed microalgal samples to explore the influence of flow rate on the alignment and isolation of flagellate microalgae. Fourthly, this method was engineered to select 20 μm polystyrene particles from three types of particles and isolate H. pluvialis from the mixture of multiple microalgae species. Finally, we leveraged this approach to realize separation of H. pluvialis and Synedra ulna to explore the performance of this method in shape-based cell separation, and we isolated Euglena from microalgal cell wastes, including dead cells, bacteria, and particles. This method has promising prospects to be a reliable tool to isolate target flagellate microalgae to address problematic issues in environmental monitoring, pharmaceutical synthesis, and chronic wound treatment for the advantage of good adaptability and reliability.

Vitiligo is associated with an increased risk of cardiovascular diseases: a large-scale, propensity-matched, US-based retrospective study

Vitiligo is an autoimmune disease, characterized by specific destruction of melanocytes. While associations with numerous comorbid conditions, which potentially increase the risk of cardiovascular diseases have been described, data on the risk for cardiovascular disease is inconclusive. To address this relevant knowledge gap, this study aims to identify the risk of cardiovascular disease in vitiligo. The US Collaborative Network was accessed using the TriNetX platform, allowing retrospective data retrieval from electronic health records (EHRs) from 57 US based health care organizations (HCOs). Patients with vitiligo and controls were identified by their respective ICD10 codes. Risk of onset of several cardiovascular diseases was determined in patients within 15 years after diagnoses. A total of 94 diagnoses with a prevalence of ≥1% in both cohorts, which consisted of 96,581 individuals per group after propensity-score-matching, were identified. Of those, 54 displayed an increased risk in vitiligo. None of the cardiovascular diseases investigated were associated with a decreased risk in patients with vitiligo. Specifically, cerebral infarction occurred in 1.3% of patients with vitiligo, and 1.0% in controls. This difference translated into a hazard ratio (HR) of 1.21 (95% confidence interval [CI] 1.11-1.32, padj<0.001). Venous thromboembolism was recorded in 1.34% of cases and 1.02% of controls without vitiligo, resulting in an increased HR of 1.27 (95% CI 1.171-1.38, padj<0.001). Further, major adverse cardiovascular events (MACE) as a composite endpoint was evaluated. The risk for MACE was increased following a vitiligo diagnosis (HR 1.28, 95% CI 1.22-1.35, padj<0.001), which persisted in both sensitivity analyses. Patients with vitiligo display an increased risk of onset of cardiovascular diseases as compared to healthy individuals. Thus, vitiligo might require more precise monitoring and systemic treatment. This research was supported by the Schleswig-Holstein Excellence-Chair Program from the State of Schleswig Holstein, by the Excellence Cluster Precision Medicine in Chronic Inflammation (DFG, EXC 2167), and by DFG Individual Grant LU 877/25-1.

Treatment monitoring utilizing ctDNA-based molecular residual disease detection in early-stage endometrial cancer

Treatment monitoring utilizing ctDNA-based molecular residual disease detection in early-stage endometrial cancer

Detection of HBV pgRNA by catalytic hairpin assembly combined with two Kinds of immunochromatographic strips

Serum HBV pregenomic RNA (pgRNA), as an important marker of HBV replication activity, has significant potential in virological monitoring and efficacy evaluation. In this study, two highly sensitive HBV pgRNA detection platforms were developed based on catalytic hairpin assembly technology, combined with flow lateral immunochromatography and colloidal gold immunochromatography. The signal amplification achieved by CHA technology avoids the dependence of RT-qPCR on thermal cycling equipment. The experimental results showed that the minimum detection limit of CHA-LFIA was 1 pM, and the minimum detection limit of CHA-GICA was 10 pM. Both CHA-LFIA and CHA-GICA had good specificity and could effectively distinguish between target RNA and non-target sequences. The results of CHA-LFIA and CHA-GICA were highly consistent with those of RT-qPCR, and had the potential for clinical application. This study provides a simple, rapid and innovative solution for the detection of HBV pgRNA, which does not rely on expensive equipment, and can be used for the early diagnosis and treatment monitoring of HBV infection.

Bi-modal confirmation of liposome delivery to the brain after focused ultrasound-induced blood-brain barrier opening

Focused ultrasound-mediated opening of the blood-brain barrier offers a great opportunity to deliver therapeutics into hard-to-treat brain tumors such as glioblastoma multiforme or diffuse midline glioma. However, the potential of the technique to offer a time window for efficient nanomedicine delivery has not been thoroughly studied. Non-invasive and targeted delivery of large drug-loaded nanocarriers, such as liposomes, could offer a safe and scalable method of personalized therapy for the treatment of brain pathologies. Additionally, it is essential to monitor the safety and efficacy of such treatments, tracking drug delivery in real-time through quantitative medical imaging.In this study, liposomes were modified to have an MRI contrast agent (i.e., Gd) in both lipid membrane and core, while an infrared dye (i.e., CW800) was coupled to lipids introduced in the lipid bilayer for bimodal detection and treatment verification. Targeted delivery of 110nm-in-diameter liposomes to the brain was quantified using 9.4-T MRI and near infrared fluorescence imaging. The spatiotemporal distribution of liposomes in vivo was assessed up to 4 hours post treatment using T1 weighted MRI. In vivo MRI signal co-localized with NIRF signal from excised brains ex vivo. Passive acoustic detection during treatments revealed a correlation between acoustic signal and MRI contrast, providing a scalable metric for assessing clinical treatment efficacy in real-time. In conclusion, therapeutic ultrasound exposure can enhance delivery of large trackable nanoparticles into the brain, while enabling real-time treatment monitoring and verification.

Treatment monitoring utilizing ctDNA-based molecular residual disease detection in early-stage endometrial cancer

Treatment monitoring utilizing ctDNA-based molecular residual disease detection in early-stage endometrial cancer

Treatment monitoring utilizing ctDNA-based molecular residual disease detection in patients with recurrent endometrial cancer and recurrent platinum-resistant ovarian cancer

Treatment monitoring utilizing ctDNA-based molecular residual disease detection in patients with recurrent endometrial cancer and recurrent platinum-resistant ovarian cancer

Lessons learned from setting up a hospital-based national registry for venous thromboembolic disorders in India

ABSTRACT Introduction: Health registries are instrumental in tracking trends in the number of people with diseases, monitoring treatment options, and assessing health outcomes. This research examines the challenges of establishing and maintaining a venous thromboembolism (VTE) registry in the Indian context. Methods: A mixed-method approach with purposive sampling was conducted to capture the challenges faced by individuals playing key roles in the establishment and operation of the national registry on VTE. This study focused on 10 questions related to technological infrastructure, resource optimization, data collection and management, coordination and collaboration, regulatory compliance, and political influences and were documented using a semi-structured questionnaire and telephonic interviews. Results: Technological, recruitment, and follow-up challenges were prominently highlighted with issues related to data entry, system glitches, changes to the data entry forms, and potential participant reluctance. Conclusion: Findings from this study highlight the multifaceted challenges experienced during the establishment of a national registry on VTE. By integrating insights from our findings into suggestions, this discussion reflects the specific challenges faced by the research project and offers evidence-based strategies for mitigating these challenges.

Changes in Donor-Derived Cell-Free DNA Before and After Rejection and De Novo DSA Detection in Primary and Repeat Kidney Transplant Recipients.

Serial monitoring of dd-cfDNA and change from baseline can provide meaningful information beyond absolute thresholds. We describe dd-cfDNA trajectories from the baseline before and after acute rejection (AR) and de novo donor-specific antibodies (dnDSA) detection in kidney transplant recipients (KTRs). We included KTR from 02/2019 to 03/2022 with serial dd-cfDNA. The primary analysis compared the time-varying change in dd-cfDNA from baseline in KTR first AR on biopsy [AR] to patients with no-AR on biopsy [no-AR]. 151 KTR were analyzed (AR=56 KTR, no-AR=95 KTRs). In the AR group, dd-cfDNA rose ahead of diagnosis: median rise from baseline was 75% at -3 months, 32% at -2 months, and 325% at -1 month before biopsy. At the time of biopsy, the median rise in dd-cfDNA from baseline was 291% (IQR [interquartile range] 88%-1081%) in AR and 17% (IQR 0%- 194%) in no-AR (p<0.0001). Following treatment, dd-cfDNA values fell in the AR group with a median change from baseline of 94.7% at +1 month, 10.5% at +2 months, and 0% at +3 months. These trajectories were not observed in the no-AR group. Similarly, there were no significant differences in eGFR (estimated glomerular filtration rate) trajectories between the two groups. The median change from baseline to dnDSA detection was 141% (IQR 112%-574%). In KTRs with persistent rejection, median dd-cfDNA was 0.95% (IQR 0.44-1.8) compared to 0.19% (IQR 0.12-0.31) in subjects with no rejection on follow-up (p<0.001). The significant changes from baseline observed before and after AR show how serial monitoring enhances dd-cfDNA utility and allows for earlier identification of evolving injury and monitoring treatment response.

Preliminary Study of Radionuclide-Labeled MerTK-Targeting PET Imaging Agents for the Diagnosis of Melanoma.

MerTK PET imaging holds potential as a promising approach for assessing tumor aggressiveness and monitoring treatment response. In this study, we synthesized a series of 18F- and 68Ga-labeled tracers derived from MerTK inhibitors for detection of MerTK expression. Among the synthesized agents, the dimeric compounds [68Ga]10 and [68Ga]12 demonstrated good in vivo and in vitro stability, high affinities to the MerTK receptor, and good MerTK-targeting specificity. Notably, [68Ga]10 exhibited a tumor uptake of 2.6 ± 0.2%ID/g at 1 h p. i. in B16F10 tumor-bearing mice, nearly tripling the uptake of its monomeric counterpart [68Ga]3. A similar enhancement was observed with [68Ga]12 compared to its monomeric analog [68Ga]6. Additionally, [18F]14 achieved a tumor uptake of 7.6 ± 0.5%ID/g at 2 h p. i., outperforming the previously reported [18F]15. Biodistribution analysis further validated the results, highlighting their potential for clinical investigation.

Research progress of organic small probes sensitive to tumor microenvironment

The development, metastasis, and spread of malignant tumors are closely associated with the inherent properties of tumor cells. These tumors often exhibit low pH, low polarity, high viscosity, and hypoxia. Understanding these characteristics is essential for early cancer detection and monitoring treatment effectiveness. Small molecule fluorescent probes have emerged as powerful tools for real-time localization, dynamic detection, and visualization of tumors. In this paper, we review recent progress in the use of these probes to study tumor biology, focusing on their design strategies, response mechanisms, and preclinical applications for detecting pH, viscosity, polarity, and hypoxia.

Assessing Pain Levels Using Bioelectrical Impedance in Low Back Pain Patients: Clinical Performance Evaluation.

Musculoskeletal pain is one of the leading causes of years lived with disability worldwide and has a negative impact on daily life and quality of life. The purpose of this study was to analyze the electrical characteristics of back pain by measuring and calculating bioelectrical impedance variables (R, Z, PA) in 85 subjects (45 in the Healthy group and 40 in the LBP group). Additionally, impedance measurements were conducted on 20 subjects (10 in the Young group and 10 in the Older group) to assess the impact of aging. Bioelectrical impedance parameter values were higher in cases of back pain, and correlation analysis showed that there was a statistically significant difference between the Healthy and LBP groups (p < 0.05). A positive correlation was found between impedance parameters and pain related indices (ODI, RMDQ, VAS) (mean R, Z, PA: 0.68, 0.54, 0.75), with BMI positively correlating only with PA (0.493). Diagnostic accuracy for detecting back pain exceeded 95% (R, Z, PA: 0.984, 0.984, 0.963). Results indicated that aging did not significantly affect impedance values. The bioelectrical impedance measurement device used in this study, with its simultaneous diagnostic and therapeutic capabilities, proved useful for real-time pain diagnosis and treatment monitoring, highlighting its potential clinical utility.

Unveiling the dynamics of circulating tumor cells in colorectal cancer: from biology to clinical applications.

This review delves into the pivotal role of circulating tumor cells (CTCs) in colorectal cancer (CRC) metastasis, focusing on their biological properties, interactions with the immune system, advanced detection techniques, and clinical implications. We explored how metastasis-competent CTCs evade immune surveillance and proliferate, utilizing cutting-edge detection and isolation technologies, such as microfluidic devices and immunological assays, to enhance sensitivity and specificity. The review highlights the significant impact of CTC interactions with immune cells on tumor progression and patient outcomes. It discusses the application of these findings in clinical settings, including non-invasive liquid biopsies for early diagnosis, prognosis, and treatment monitoring. Despite advancements, challenges remain, such as the need for standardized methods to consistently capture and analyze CTCs. Addressing these challenges through further molecular and cellular research on CTCs could lead to improved interventions and outcomes for CRC patients, underscoring the importance of unraveling the complex dynamics of CTCs in cancer progression.

Multichannel Sensor Array Design for Minimizing Detector Complexity and Power Consumption in Ionoacoustic Proton Beam Tomography

Ionoacoustic tomography exploits the acoustic signal generated by the fast energy deposition along the path of pulsed particle beams to reconstruct with sub-mm precision the dose deposition, with promising envisioned applications in hadron therapy treatment monitoring. State-of-the-art ionoacoustic detectors mainly rely on single-channel sensors and time-of-flight measurements to provide 1D localization of the maximum dose deposition at the so-called Bragg peak. This work investigates the design challenges of multichannel sensors for ionoacoustic tomography in terms of their ability to accurately reconstruct the dose deposition of a 200 MeV clinical proton beam, highlighting the impact of the number of channels in the array and their directivity. A complete acoustic model of the sensors and environment has been developed and used to find an optimum tradeoff between accuracy, evaluated numerically through the gamma index, and hardware complexity due to higher channel numbers, thus minimizing the system-level power consumption of the detector.

Automation and innovation in home hemodialysis machines.

In this review, we discuss the timeline of innovation and technologic development in home hemodialysis (HHD) in the United States and the legislative approvals that accompanied them. The most recently FDA-approved home hemodialysis devices provide features that include on-demand and batch dialysate generation, access disconnect for venous needle dislodgement, touchscreen interface with visual and auditory prompts and animations, drop-in sterilized cartridges with prestrung tubing, hot water disinfection of tubing allowing extended-use, dialysate flow rates as high as 500 ml/min, as well as remote treatment monitoring capabilities. Furthermore, wearable/portable dialysis devices are currently under development to simplify dialysis delivery to patients with end-stage kidney disease. Home hemodialysis devices providing longitudinal hemodialysis across different clinical settings, virtual reality headsets for more personalized training, automated patient support, as well as wearable device development and innovations give hope for a future where home hemodialysis is more accessible and seamless.

Radiomics in precision medicine for colorectal cancer: a bibliometric analysis (2013–2023)

BackgroundThe incidence and mortality of colorectal cancer (CRC) have been rising steadily. Early diagnosis and precise treatment are essential for improving patient survival outcomes. Over the past decade, the integration of artificial intelligence (AI) and medical imaging technologies has positioned radiomics as a critical area of research in the diagnosis, treatment, and prognosis of CRC.MethodsWe conducted a comprehensive review of CRC-related radiomics literature published between 1 January 2013 and 31 December 2023 using the Web of Science Core Collection database. Bibliometric tools such as Bibliometrix, VOSviewer, and CiteSpace were employed to perform an in-depth bibliometric analysis.ResultsOur search yielded 1,226 publications, revealing a consistent annual growth in CRC radiomics research, with a significant rise after 2019. China led in publication volume (406 papers), followed by the United States (263 papers), whereas the United States dominated in citation numbers. Notable institutions included General Electric, Harvard University, University of London, Maastricht University, and the Chinese Academy of Sciences. Prominent researchers in this field are Tian J from the Chinese Academy of Sciences, with the highest publication count, and Ganeshan B from the University of London, with the most citations. Journals leading in publication and citation counts are Frontiers in Oncology and Radiology. Keyword and citation analysis identified deep learning, texture analysis, rectal cancer, image analysis, and management as prevailing research themes. Additionally, recent trends indicate the growing importance of AI and multi-omics integration, with a focus on improving precision medicine applications in CRC. Emerging keywords such as deep learning and AI have shown rapid growth in citation bursts over the past 3 years, reflecting a shift toward more advanced technological applications.ConclusionsRadiomics plays a crucial role in the clinical management of CRC, providing valuable insights for precision medicine. It significantly contributes to predicting molecular biomarkers, assessing tumor aggressiveness, and monitoring treatment efficacy. Future research should prioritize advancing AI algorithms, enhancing multi-omics data integration, and further expanding radiomics applications in CRC precision medicine.

Implementation of Measurement-Based Care in Mental Health Service Settings for Youth: A Systematic Review.

Measurement-Based Care (MBC) is the systematic use of patient-reported data to inform care decisions and monitor treatment progress. MBC has been shown to improve patient outcomes across medical and mental health treatment settings for adults and youth. While many studies have examined the use of MBC in specific care settings, few have focused on the implementation of MBC among youth populations or across care settings. While a review has shown that use of MBC benefits youth, no published reviews exist that summarize the successful strategies and barriers to implementation models across studies in youth service settings. To address these gaps, the present systematic review (N = 25 studies) focuses on the implementation of MBC across four youth service settings, including outpatient mental health centers, medical centers/pediatric clinics, schools, and clinical psychology training clinics. Results suggest that few studies employ consistent implementation models or strategies to guide efforts. Further, there is significant overlap in the successful strategies employed as well as the barriers to implementation of MBC across youth service settings, at the client, clinician, and organizational levels. Broadly, the authors recommend on the basis of findings that future implementation work in youth service settings: incorporate comprehensive training in the use of MBC for clinicians; incorporate stakeholder feedback into the implementation process for initial and sustained use; employ digital measurement feedback systems to deliver MBC that allow for real-time feedback and continuous technical support; and employ a health equity lens in implementation efforts to help address disparities in access to and use of MBC so that all youth and families may benefit from this evidence-based practice.