Pub Date : 2024-07-25DOI: 10.1038/s43856-024-00577-w
Farhan M. Asrar, Dana Bolles, Thu Jennifer Ngo-Anh
People with disabilities, including healthcare professionals, encounter many obstacles. The space sector is taking steps towards promoting equity, diversity, inclusion and accessibility, including developing the world’s first parastronaut program. Here, we propose that healthcare can learn from space in enhancing disability inclusion. Asrar et al. discuss the steps that the space sector is taking towards promoting equity, diversity, inclusion and accessibility, such as the world’s first parastronaut program. They propose that healthcare can learn from the space sector in enhancing disability inclusion and support for people, including healthcare workers, with disabilities.
{"title":"Healthcare can learn from space exploration to champion disability inclusion","authors":"Farhan M. Asrar, Dana Bolles, Thu Jennifer Ngo-Anh","doi":"10.1038/s43856-024-00577-w","DOIUrl":"10.1038/s43856-024-00577-w","url":null,"abstract":"People with disabilities, including healthcare professionals, encounter many obstacles. The space sector is taking steps towards promoting equity, diversity, inclusion and accessibility, including developing the world’s first parastronaut program. Here, we propose that healthcare can learn from space in enhancing disability inclusion. Asrar et al. discuss the steps that the space sector is taking towards promoting equity, diversity, inclusion and accessibility, such as the world’s first parastronaut program. They propose that healthcare can learn from the space sector in enhancing disability inclusion and support for people, including healthcare workers, with disabilities.","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":" ","pages":"1-3"},"PeriodicalIF":5.4,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11272785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-25DOI: 10.1038/s43856-024-00573-0
Jochen H. Weishaupt, Péter Körtvélyessy, Peggy Schumann, Ivan Valkadinov, Ute Weyen, Jasper Hesebeck-Brinckmann, Kanchi Weishaupt, Matthias Endres, Peter M. Andersen, Martin Regensburger, Marie Dreger, Jan C. Koch, Julian Conrad, Thomas Meyer
Since the antisense oligonucleotide tofersen has recently become available for the treatment of amyotrophic lateral sclerosis (ALS) caused by mutations in SOD1, determining the causality of the over 230 SOD1 variants has become even more important. The most common SOD1 variant worldwide is p.D91A (c.272A > C), whose causality for ALS is contested when in a heterozygous state. The reason is the high allele frequency of SOD1D91A in Europe, exceeding 1% in Finno-Scandinavia. We present the clinical disease course and serum neurofilament light chain (NfL) results of treating 11 patients either homo- or heterozygous for the SOD1D91A allele for up to 16 months with tofersen. Tofersen decreases serum neurofilament levels (sNFL), which are associated with the ALS progression rate, in the 6 ALS patients homozygous for SOD1D91A. We observe significantly lower sNfL levels in the 5 patients heterozygous for SOD1D91A. The results indicate that both mono- and bi-allelic SOD1D91A are causally relevant targets, with a possibly reduced effect size of SOD1D91Ahet. The finding is relevant for decision making regarding tofersen treatment, patient counseling and inclusion of SOD1D91A patients in drug trials. As far as we are aware, the approach is conceptually new since it provides evidence for the causality of an ALS variant based on a biomarker response to gene-specific treatment. Amyotrophic lateral sclerosis (ALS) is a disease that can be inherited which affects nerve cells in the brain and spinal cord. Changes within a gene called SOD1 that result in a mutation named p.D91A can lead to the development of ALS. People have two copies of the SOD1 gene. It has been unclear whether the presence of only one copy of p.D91A can cause ALS. We treated ALS patients with the p.D91A variant of SOD1 with a drug called tofersen. We found that a marker of disease progression was reduced in patients with one or two copies of the p.D91A mutation. This suggests that the presence of just one p.D91A variant of SOD1 contributes to disease development. This information could be used to improve treatment decisions for people with ALS. Weishaupt, Körtvélyessy, et al. investigate the role of a genetic variant in amyotrophic lateral sclerosis (ALS) causation. Reduction of serum neurofilament light chain levels upon treatment with the SOD1-specific drug tofersen indicates engagement of a relevant target and thus causality of the variant p.D91A in SOD1.
{"title":"Tofersen decreases neurofilament levels supporting the pathogenesis of the SOD1 p.D91A variant in amyotrophic lateral sclerosis patients","authors":"Jochen H. Weishaupt, Péter Körtvélyessy, Peggy Schumann, Ivan Valkadinov, Ute Weyen, Jasper Hesebeck-Brinckmann, Kanchi Weishaupt, Matthias Endres, Peter M. Andersen, Martin Regensburger, Marie Dreger, Jan C. Koch, Julian Conrad, Thomas Meyer","doi":"10.1038/s43856-024-00573-0","DOIUrl":"10.1038/s43856-024-00573-0","url":null,"abstract":"Since the antisense oligonucleotide tofersen has recently become available for the treatment of amyotrophic lateral sclerosis (ALS) caused by mutations in SOD1, determining the causality of the over 230 SOD1 variants has become even more important. The most common SOD1 variant worldwide is p.D91A (c.272A > C), whose causality for ALS is contested when in a heterozygous state. The reason is the high allele frequency of SOD1D91A in Europe, exceeding 1% in Finno-Scandinavia. We present the clinical disease course and serum neurofilament light chain (NfL) results of treating 11 patients either homo- or heterozygous for the SOD1D91A allele for up to 16 months with tofersen. Tofersen decreases serum neurofilament levels (sNFL), which are associated with the ALS progression rate, in the 6 ALS patients homozygous for SOD1D91A. We observe significantly lower sNfL levels in the 5 patients heterozygous for SOD1D91A. The results indicate that both mono- and bi-allelic SOD1D91A are causally relevant targets, with a possibly reduced effect size of SOD1D91Ahet. The finding is relevant for decision making regarding tofersen treatment, patient counseling and inclusion of SOD1D91A patients in drug trials. As far as we are aware, the approach is conceptually new since it provides evidence for the causality of an ALS variant based on a biomarker response to gene-specific treatment. Amyotrophic lateral sclerosis (ALS) is a disease that can be inherited which affects nerve cells in the brain and spinal cord. Changes within a gene called SOD1 that result in a mutation named p.D91A can lead to the development of ALS. People have two copies of the SOD1 gene. It has been unclear whether the presence of only one copy of p.D91A can cause ALS. We treated ALS patients with the p.D91A variant of SOD1 with a drug called tofersen. We found that a marker of disease progression was reduced in patients with one or two copies of the p.D91A mutation. This suggests that the presence of just one p.D91A variant of SOD1 contributes to disease development. This information could be used to improve treatment decisions for people with ALS. Weishaupt, Körtvélyessy, et al. investigate the role of a genetic variant in amyotrophic lateral sclerosis (ALS) causation. Reduction of serum neurofilament light chain levels upon treatment with the SOD1-specific drug tofersen indicates engagement of a relevant target and thus causality of the variant p.D91A in SOD1.","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":" ","pages":"1-5"},"PeriodicalIF":5.4,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11272917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Artificial intelligence-based (AI) clinical decision support systems (CDSS) using unconventional data, like smartphone-acquired images, promise transformational opportunities for telehealth; including remote diagnosis. Although such solutions’ potential remains largely untapped, providers’ trust and understanding are vital for effective adoption. This study examines how different human–AI interaction paradigms affect clinicians’ responses to an emerging AI CDSS for streptococcal pharyngitis (strep throat) detection from smartphone throat images. In a randomized experiment, we tested explainable AI strategies using three AI-based CDSS prototypes for strep throat prediction. Participants received clinical vignettes via an online survey to predict the disease state and offer clinical recommendations. The first set included a validated CDSS prediction (Modified Centor Score) and the second introduced an explainable AI prototype randomly. We used linear models to assess explainable AI’s effect on clinicians’ accuracy, confirmatory testing rates, and perceived trust and understanding of the CDSS. The study, involving 121 telehealth providers, shows that compared to using the Centor Score, AI-based CDSS can improve clinicians’ predictions. Despite higher agreement with AI, participants report lower trust in its advice than in the Centor Score, leading to more requests for in-person confirmatory testing. Effectively integrating AI is crucial in the telehealth-based diagnosis of infectious diseases, given the implications of antibiotic over-prescriptions. We demonstrate that AI-based CDSS can improve the accuracy of remote strep throat screening yet underscores the necessity to enhance human–machine collaboration, particularly in trust and intelligibility. This ensures providers and patients can capitalize on AI interventions and smartphones for virtual healthcare. Strep pharyngitis, or strep throat, is a bacterial infection that can cause a sore throat. Artificial intelligence (AI) can use photos taken on a person’s phone to help diagnose strep throat, offering an additional way for doctors to screen patients during virtual appointments. However, it is currently unclear whether doctors will trust AI recommendations or how they might use them in decision-making. We surveyed clinicians about their use of an AI system for strep throat screening with smartphone images. We compared different ways of providing AI recommendations to standard medical guidelines. We found that all tested AI methods helped clinicians to identify strep throat cases. However, clinicians trusted AI less than their usual clinical guidelines, leading to more requests for follow-up in-person testing. Our results show how AI may improve the accuracy of pharyngitis assessment. Still, further research is needed to ensure doctors trust and collaborate with AI to improve remote healthcare. Gomez et al. develop an artificial intelligence-based clinical decision support tool that can
{"title":"Explainable AI decision support improves accuracy during telehealth strep throat screening","authors":"Catalina Gomez, Brittany-Lee Smith, Alisa Zayas, Mathias Unberath, Therese Canares","doi":"10.1038/s43856-024-00568-x","DOIUrl":"10.1038/s43856-024-00568-x","url":null,"abstract":"Artificial intelligence-based (AI) clinical decision support systems (CDSS) using unconventional data, like smartphone-acquired images, promise transformational opportunities for telehealth; including remote diagnosis. Although such solutions’ potential remains largely untapped, providers’ trust and understanding are vital for effective adoption. This study examines how different human–AI interaction paradigms affect clinicians’ responses to an emerging AI CDSS for streptococcal pharyngitis (strep throat) detection from smartphone throat images. In a randomized experiment, we tested explainable AI strategies using three AI-based CDSS prototypes for strep throat prediction. Participants received clinical vignettes via an online survey to predict the disease state and offer clinical recommendations. The first set included a validated CDSS prediction (Modified Centor Score) and the second introduced an explainable AI prototype randomly. We used linear models to assess explainable AI’s effect on clinicians’ accuracy, confirmatory testing rates, and perceived trust and understanding of the CDSS. The study, involving 121 telehealth providers, shows that compared to using the Centor Score, AI-based CDSS can improve clinicians’ predictions. Despite higher agreement with AI, participants report lower trust in its advice than in the Centor Score, leading to more requests for in-person confirmatory testing. Effectively integrating AI is crucial in the telehealth-based diagnosis of infectious diseases, given the implications of antibiotic over-prescriptions. We demonstrate that AI-based CDSS can improve the accuracy of remote strep throat screening yet underscores the necessity to enhance human–machine collaboration, particularly in trust and intelligibility. This ensures providers and patients can capitalize on AI interventions and smartphones for virtual healthcare. Strep pharyngitis, or strep throat, is a bacterial infection that can cause a sore throat. Artificial intelligence (AI) can use photos taken on a person’s phone to help diagnose strep throat, offering an additional way for doctors to screen patients during virtual appointments. However, it is currently unclear whether doctors will trust AI recommendations or how they might use them in decision-making. We surveyed clinicians about their use of an AI system for strep throat screening with smartphone images. We compared different ways of providing AI recommendations to standard medical guidelines. We found that all tested AI methods helped clinicians to identify strep throat cases. However, clinicians trusted AI less than their usual clinical guidelines, leading to more requests for follow-up in-person testing. Our results show how AI may improve the accuracy of pharyngitis assessment. Still, further research is needed to ensure doctors trust and collaborate with AI to improve remote healthcare. Gomez et al. develop an artificial intelligence-based clinical decision support tool that can","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":" ","pages":"1-11"},"PeriodicalIF":5.4,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11269612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-19DOI: 10.1038/s43856-024-00565-0
Ali I. Mirza, Feng Zhu, Natalie Knox, Lucinda J. Black, Alison Daly, Christine Bonner, Gary Van Domselaar, Charles N. Bernstein, Ruth Ann Marrie, Janace Hart, E. Ann Yeh, Amit Bar-Or, Julia O’Mahony, Yinshan Zhao, William Hsiao, Brenda Banwell, Emmanuelle Waubant, Helen Tremlett
The interplay between diet and the gut microbiota in multiple sclerosis (MS) is poorly understood. We aimed to assess the interrelationship between diet, the gut microbiota, and MS. We conducted a case-control study including 95 participants (44 pediatric-onset MS cases, 51 unaffected controls) enrolled from the Canadian Pediatric Demyelinating Disease Network study. All had completed a food frequency questionnaire ≤21-years of age, and 59 also provided a stool sample. Here we show that a 1-point increase in a Mediterranean diet score is associated with 37% reduced MS odds (95%CI: 10%–53%). Higher fiber and iron intakes are also associated with reduced MS odds. Diet, not MS, explains inter-individual gut microbiota variation. Several gut microbes abundances are associated with both the Mediterranean diet score and having MS, and these microbes are potential mediators of the protective associations of a healthier diet. Our findings suggest that the potential interaction between diet and the gut microbiota is relevant in MS. Multiple sclerosis (MS) is a disease where the immune system attacks the protective covering of nerve cells in the brain. There may be a relationship between diet and bacteria within the gut and MS, however this is not well understood. We investigated how diet and gut bacteria are linked to MS in young people. We examined the diet and types of bacteria in stool samples from those with and without MS. We found that a diet richer in fiber and Mediterranean foods were less common in those with MS. This dietary pattern was linked to certain differences in the gut bacteria. These findings raise the possibility, but cannot prove, that what we eat may help prevent MS by influencing our gut bacteria. This research opens the door to further studies on how diet can impact MS through our gut bacteria. Mirza et al. assess the relationship between diet, the gut microbiota, and pediatric-onset multiple sclerosis. They observe that a higher Mediterranean diet score and nutrient intakes, such as fiber, are associated with a lower odds of having multiple sclerosis, and that the gut microbiota might mediate this protective relationship.
背景：人们对多发性硬化症（MS）中饮食与肠道微生物群之间的相互作用知之甚少。我们旨在评估饮食、肠道微生物群与多发性硬化症之间的相互关系：我们进行了一项病例对照研究，其中包括从加拿大儿科脱髓鞘疾病网络研究中招募的 95 名参与者（44 名儿科多发性硬化症病例，51 名未受影响的对照组）。所有21岁以下的参与者都填写了食物频率问卷，其中59人还提供了粪便样本：结果：我们在此表明，地中海饮食得分每增加 1 分，多发性硬化症的发病几率就会降低 37%（95%CI：10%-53%）。较高的纤维和铁摄入量也与多发性硬化症几率的降低有关。饮食而非 MS 可解释个体间肠道微生物群的差异。几种肠道微生物的丰度与地中海饮食评分和多发性硬化症都有关联，这些微生物是更健康饮食的保护性关联的潜在媒介：我们的研究结果表明，饮食与肠道微生物群之间的潜在相互作用与多发性硬化症有关。
{"title":"Mediterranean diet and associations with the gut microbiota and pediatric-onset multiple sclerosis using trivariate analysis","authors":"Ali I. Mirza, Feng Zhu, Natalie Knox, Lucinda J. Black, Alison Daly, Christine Bonner, Gary Van Domselaar, Charles N. Bernstein, Ruth Ann Marrie, Janace Hart, E. Ann Yeh, Amit Bar-Or, Julia O’Mahony, Yinshan Zhao, William Hsiao, Brenda Banwell, Emmanuelle Waubant, Helen Tremlett","doi":"10.1038/s43856-024-00565-0","DOIUrl":"10.1038/s43856-024-00565-0","url":null,"abstract":"The interplay between diet and the gut microbiota in multiple sclerosis (MS) is poorly understood. We aimed to assess the interrelationship between diet, the gut microbiota, and MS. We conducted a case-control study including 95 participants (44 pediatric-onset MS cases, 51 unaffected controls) enrolled from the Canadian Pediatric Demyelinating Disease Network study. All had completed a food frequency questionnaire ≤21-years of age, and 59 also provided a stool sample. Here we show that a 1-point increase in a Mediterranean diet score is associated with 37% reduced MS odds (95%CI: 10%–53%). Higher fiber and iron intakes are also associated with reduced MS odds. Diet, not MS, explains inter-individual gut microbiota variation. Several gut microbes abundances are associated with both the Mediterranean diet score and having MS, and these microbes are potential mediators of the protective associations of a healthier diet. Our findings suggest that the potential interaction between diet and the gut microbiota is relevant in MS. Multiple sclerosis (MS) is a disease where the immune system attacks the protective covering of nerve cells in the brain. There may be a relationship between diet and bacteria within the gut and MS, however this is not well understood. We investigated how diet and gut bacteria are linked to MS in young people. We examined the diet and types of bacteria in stool samples from those with and without MS. We found that a diet richer in fiber and Mediterranean foods were less common in those with MS. This dietary pattern was linked to certain differences in the gut bacteria. These findings raise the possibility, but cannot prove, that what we eat may help prevent MS by influencing our gut bacteria. This research opens the door to further studies on how diet can impact MS through our gut bacteria. Mirza et al. assess the relationship between diet, the gut microbiota, and pediatric-onset multiple sclerosis. They observe that a higher Mediterranean diet score and nutrient intakes, such as fiber, are associated with a lower odds of having multiple sclerosis, and that the gut microbiota might mediate this protective relationship.","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":" ","pages":"1-10"},"PeriodicalIF":5.4,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s43856-024-00565-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141728385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-18DOI: 10.1038/s43856-024-00559-y
David Lohr, Alena Kollmann, Maya Bille, Maxim Terekhov, Ibrahim Elabyad, Michael Hock, Steffen Baltes, Theresa Reiter, Florian Schnitter, Wolfgang Rudolf Bauer, Ulrich Hofmann, Laura Maria Schreiber
7 T cardiac magnetic resonance imaging (MRI) studies may enable higher precision in clinical metrics like cardiac function, ventricular mass, and more. Higher precision may allow early detection of functional impairment and early evaluation of treatment responses in clinical practice and pre-clinical studies. Methods: Seven female German Landrace pigs were scanned prior to and at three time points (3–4 days, 7–10 days, and ~60 days) post myocardial infarction using a whole body 7 T system and three radiofrequency (RF) coils developed and built in-house to accompany animal growth. Results: The combination of dedicated RF hardware and 7 T MRI enables a longitudinal study in a pig model of acute and chronic infarction, providing consistent blood tissue contrast and high signal-to-noise ratio (SNR) in measurements of cardiac function, as well as low coefficients of variation (CoV) for ejection fraction (CoVintra-observer: 2%, CoVinter-observer: 3.8%) and infarct size (CoVintra-observer: 8.4%, CoVinter-observer: 3.8%), despite drastic animal growth. Conclusions: Best results are achieved via manual segmentation. We define state-of-the-art procedures for large animal studies at 7 T. In magnetic resonance imaging (MRI), scanners use magnets to generate detailed images of structures in the body, such as the heart. Stronger magnets can produce stronger magnetic fields, which can be leveraged for better image quality and developing new methods for disease diagnosis. In clinical practice, such systems using strong magnets are not yet used for imaging of the heart and some safety aspects remain challenging. We apply such an imaging approach in pigs, in which heart structure and function are similar to humans. We focus on the most important clinical imaging aspects following a heart attack, namely heart function and scar detection. We demonstrate that the high magnetic strength system enabled consistent image quality and accuracy. These findings may help to guide future developments in MRI of the heart, for example in patients who have had a heart attack. Lohr et al. demonstrate that 7 T cardiac MRI in conjunction with dedicated radiofrequency hardware enables high precision imaging of cardiac function and scar size in a large animal model of acute and chronic myocardial infarction. High precision is achieved based on consistent blood tissue contrast and SNR in measurements of cardiac function.
背景：7 T 心脏磁共振成像（MRI）研究可提高心功能、心室质量等临床指标的精确度。更高的精确度可在临床实践和临床前研究中早期发现功能障碍并早期评估治疗反应：方法：在心肌梗塞发生前和发生后的三个时间点（3-4 天、7-10 天和约 60 天），使用内部开发和制造的全身 7 T 系统和三个射频线圈对七只雌性德国兰德猪进行扫描，以伴随动物的生长：专用射频硬件和 7 T MRI 的结合实现了猪急性和慢性心肌梗塞模型的纵向研究，在测量心脏功能时提供了一致的血液组织对比度和高信噪比 (SNR)，以及射血分数（CoVintra-observer：2%，CoVinter-observer：3.8%）和梗塞大小（CoVintra-observer：8.4%，CoVinter-observer：3.8%）的低变异系数 (CoV)，尽管动物急剧长大：结论：手动分割可获得最佳效果。我们为 7 T 下的大型动物研究定义了最先进的程序。
{"title":"Precision imaging of cardiac function and scar size in acute and chronic porcine myocardial infarction using ultrahigh-field MRI","authors":"David Lohr, Alena Kollmann, Maya Bille, Maxim Terekhov, Ibrahim Elabyad, Michael Hock, Steffen Baltes, Theresa Reiter, Florian Schnitter, Wolfgang Rudolf Bauer, Ulrich Hofmann, Laura Maria Schreiber","doi":"10.1038/s43856-024-00559-y","DOIUrl":"10.1038/s43856-024-00559-y","url":null,"abstract":"7 T cardiac magnetic resonance imaging (MRI) studies may enable higher precision in clinical metrics like cardiac function, ventricular mass, and more. Higher precision may allow early detection of functional impairment and early evaluation of treatment responses in clinical practice and pre-clinical studies. Methods: Seven female German Landrace pigs were scanned prior to and at three time points (3–4 days, 7–10 days, and ~60 days) post myocardial infarction using a whole body 7 T system and three radiofrequency (RF) coils developed and built in-house to accompany animal growth. Results: The combination of dedicated RF hardware and 7 T MRI enables a longitudinal study in a pig model of acute and chronic infarction, providing consistent blood tissue contrast and high signal-to-noise ratio (SNR) in measurements of cardiac function, as well as low coefficients of variation (CoV) for ejection fraction (CoVintra-observer: 2%, CoVinter-observer: 3.8%) and infarct size (CoVintra-observer: 8.4%, CoVinter-observer: 3.8%), despite drastic animal growth. Conclusions: Best results are achieved via manual segmentation. We define state-of-the-art procedures for large animal studies at 7 T. In magnetic resonance imaging (MRI), scanners use magnets to generate detailed images of structures in the body, such as the heart. Stronger magnets can produce stronger magnetic fields, which can be leveraged for better image quality and developing new methods for disease diagnosis. In clinical practice, such systems using strong magnets are not yet used for imaging of the heart and some safety aspects remain challenging. We apply such an imaging approach in pigs, in which heart structure and function are similar to humans. We focus on the most important clinical imaging aspects following a heart attack, namely heart function and scar detection. We demonstrate that the high magnetic strength system enabled consistent image quality and accuracy. These findings may help to guide future developments in MRI of the heart, for example in patients who have had a heart attack. Lohr et al. demonstrate that 7 T cardiac MRI in conjunction with dedicated radiofrequency hardware enables high precision imaging of cardiac function and scar size in a large animal model of acute and chronic myocardial infarction. High precision is achieved based on consistent blood tissue contrast and SNR in measurements of cardiac function.","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":" ","pages":"1-17"},"PeriodicalIF":5.4,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s43856-024-00559-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141725193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-18DOI: 10.1038/s43856-024-00556-1
Rochelle N. Naylor, Kashyap A. Patel, Jarno L. T. Kettunen, Jonna M. E. Männistö, Julie Støy, Jacques Beltrand, Michel Polak, ADA/EASD PMDI, Tina Vilsbøll, Siri A. W. Greeley, Andrew T. Hattersley, Tiinamaija Tuomi
Beta-cell monogenic forms of diabetes have strong support for precision medicine. We systematically analyzed evidence for precision treatments for GCK-related hyperglycemia, HNF1A-, HNF4A- and HNF1B-diabetes, and mitochondrial diabetes (MD) due to m.3243 A > G variant, 6q24-transient neonatal diabetes mellitus (TND) and SLC19A2-diabetes. The search of PubMed, MEDLINE, and Embase for individual and group level data for glycemic outcomes using inclusion (English, original articles written after 1992) and exclusion (VUS, multiple diabetes types, absent/aggregated treatment effect measures) criteria. The risk of bias was assessed using NHLBI study-quality assessment tools. Data extracted from Covidence were summarized and presented as descriptive statistics in tables and text. There are 146 studies included, with only six being experimental studies. For GCK-related hyperglycemia, the six studies (35 individuals) assessing therapy discontinuation show no HbA1c deterioration. A randomized trial (18 individuals per group) shows that sulfonylureas (SU) were more effective in HNF1A-diabetes than in type 2 diabetes. Cohort and case studies support SU’s effectiveness in lowering HbA1c. Two cross-over trials (each with 15–16 individuals) suggest glinides and GLP-1 receptor agonists might be used in place of SU. Evidence for HNF4A-diabetes is limited. Most reported patients with HNF1B-diabetes (N = 293) and MD (N = 233) are on insulin without treatment studies. Limited data support oral agents after relapse in 6q24-TND and for thiamine improving glycemic control and reducing/eliminating insulin requirement in SLC19A2-diabetes. There is limited evidence, and with moderate or serious risk of bias, to guide monogenic diabetes treatment. Further evidence is needed to examine the optimum treatment in monogenic subtypes. Monogenic diabetes is a type of diabetes caused by changes in genes that affect how the body makes or responds to insulin. Precision medicine (where knowledge of the gene change directs the selection of treatment) is available for some forms of monogenic diabetes. This study evaluated the published literature for several forms of monogenic diabetes to assess the level of evidence supporting specific precision treatments. Among the 146 small studies that we reviewed, only six compared different treatments. However, we found evidence supporting oral medications for some types of monogenic diabetes, and evidence that treatment is not needed for one particular type. Based on our results, we provide treatment recommendations for certain forms of monogenic diabetes and identify future directions for research to help us optimize precision medicine in monogenic diabetes. Naylor et al. systematically review the efficacy of treatments for beta-cell monogenic diabetes. Limited evidence from the mostly non-randomized, small studies supports no treatment in glucokinase-related hyperglycemia and sulfonylureas for HNF1A-diabetes; further evidence is needed on
{"title":"Precision treatment of beta-cell monogenic diabetes: a systematic review","authors":"Rochelle N. Naylor, Kashyap A. Patel, Jarno L. T. Kettunen, Jonna M. E. Männistö, Julie Støy, Jacques Beltrand, Michel Polak, ADA/EASD PMDI, Tina Vilsbøll, Siri A. W. Greeley, Andrew T. Hattersley, Tiinamaija Tuomi","doi":"10.1038/s43856-024-00556-1","DOIUrl":"10.1038/s43856-024-00556-1","url":null,"abstract":"Beta-cell monogenic forms of diabetes have strong support for precision medicine. We systematically analyzed evidence for precision treatments for GCK-related hyperglycemia, HNF1A-, HNF4A- and HNF1B-diabetes, and mitochondrial diabetes (MD) due to m.3243 A > G variant, 6q24-transient neonatal diabetes mellitus (TND) and SLC19A2-diabetes. The search of PubMed, MEDLINE, and Embase for individual and group level data for glycemic outcomes using inclusion (English, original articles written after 1992) and exclusion (VUS, multiple diabetes types, absent/aggregated treatment effect measures) criteria. The risk of bias was assessed using NHLBI study-quality assessment tools. Data extracted from Covidence were summarized and presented as descriptive statistics in tables and text. There are 146 studies included, with only six being experimental studies. For GCK-related hyperglycemia, the six studies (35 individuals) assessing therapy discontinuation show no HbA1c deterioration. A randomized trial (18 individuals per group) shows that sulfonylureas (SU) were more effective in HNF1A-diabetes than in type 2 diabetes. Cohort and case studies support SU’s effectiveness in lowering HbA1c. Two cross-over trials (each with 15–16 individuals) suggest glinides and GLP-1 receptor agonists might be used in place of SU. Evidence for HNF4A-diabetes is limited. Most reported patients with HNF1B-diabetes (N = 293) and MD (N = 233) are on insulin without treatment studies. Limited data support oral agents after relapse in 6q24-TND and for thiamine improving glycemic control and reducing/eliminating insulin requirement in SLC19A2-diabetes. There is limited evidence, and with moderate or serious risk of bias, to guide monogenic diabetes treatment. Further evidence is needed to examine the optimum treatment in monogenic subtypes. Monogenic diabetes is a type of diabetes caused by changes in genes that affect how the body makes or responds to insulin. Precision medicine (where knowledge of the gene change directs the selection of treatment) is available for some forms of monogenic diabetes. This study evaluated the published literature for several forms of monogenic diabetes to assess the level of evidence supporting specific precision treatments. Among the 146 small studies that we reviewed, only six compared different treatments. However, we found evidence supporting oral medications for some types of monogenic diabetes, and evidence that treatment is not needed for one particular type. Based on our results, we provide treatment recommendations for certain forms of monogenic diabetes and identify future directions for research to help us optimize precision medicine in monogenic diabetes. Naylor et al. systematically review the efficacy of treatments for beta-cell monogenic diabetes. Limited evidence from the mostly non-randomized, small studies supports no treatment in glucokinase-related hyperglycemia and sulfonylureas for HNF1A-diabetes; further evidence is needed on ","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":" ","pages":"1-17"},"PeriodicalIF":5.4,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s43856-024-00556-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141725194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-16DOI: 10.1038/s43856-024-00560-5
Elena Sena, Frank Tacke, Quentin M. Anstee, Nicholas Di Prospero, Mette Skalshøi- Kjær, Sergio Muñoz-Martínez, Jesús Rivera-Esteban, Alba Jiménez-Masip, Jesús M. Bañales, María Martínez-Gómez, Franz Koenig, Joan Genescà, Vlad Ratziu, Juan M. Pericàs
The EU Patient-cEntric clinicAl tRial pLatforms (EU-PEARL) project (IMI2-853966) aimed to develop tools to establish integrated research platforms (IRP) for conducting adaptive-design trials in various diseases, including metabolic-dysfunction associated steatohepatitis (MASH). One essential component of a successful MASH IRP is a robust and reliable Clinical Research Network (CRN). Herein, we outline the required elements and anticipated steps to set-up such a CRN. We identified European clinical research sites that could potentially serve as the foundation for MASH IRP and a CRN. A survey was sent to sites to assess their interest in joining a CRN, their familiarity with platform trials, and their capacity to participate in a future MASH IRP. A total of 141 investigators were invited to participate in the survey, and 40% responded. More than half of the answers (52%) identify MASH with advanced fibrosis (F3-4) as the subpopulation with the greatest unmet need. Regarding the difficulty in identifying candidates for trials, 65% find it is moderately difficult and 30% very difficult. Most respondents (94%) believe that a platform trial could offer substantial benefits to patients. Nearly all researchers express interest in participating in a platform trial (78%), with 22% indicating their interest would be contingent on initial industry funding. While preliminary, our findings on responding sites are encouraging for the potential establishment of a CRN for a MASH IRP. However, funding schemes and sustainability strategies to provide proof-of-platform in MASH seem key in the short-term scenario. Metabolic dysfunction-associated steatohepatitis (MASH) occurs when the liver becomes damaged due to the build up of fat, which is often related to obesity and diabetes. There is a lack of effective drug treatments for MASH, so strategies to strengthen clinical research in this area are needed. Here, we survey key European experts on MASH to assess their interest in joining a network of MASH researchers and their interest in participating in a new type of clinical trial called a platform trial, where multiple drugs can be tested simultaneously. Researchers largely agree that these are promising approaches to boost drug development in the field, although have concerns regarding funding and sustainability strategies. Our findings may inform the creation of a network of MASH researchers capable of running a platform trial, which in turn may speed up research into treatments for MASH. Sena et al. survey European clinical research sites that could potentially serve as the foundation for a MASH integrated research platform and clinical research network. Respondents generally believe that a MASH platform trial could benefit patients and are interested in participating, though securing industry funding is identified as a priority.
{"title":"Needs assessment for creation of a platform trial network in metabolic-dysfunction associated steatohepatitis","authors":"Elena Sena, Frank Tacke, Quentin M. Anstee, Nicholas Di Prospero, Mette Skalshøi- Kjær, Sergio Muñoz-Martínez, Jesús Rivera-Esteban, Alba Jiménez-Masip, Jesús M. Bañales, María Martínez-Gómez, Franz Koenig, Joan Genescà, Vlad Ratziu, Juan M. Pericàs","doi":"10.1038/s43856-024-00560-5","DOIUrl":"10.1038/s43856-024-00560-5","url":null,"abstract":"The EU Patient-cEntric clinicAl tRial pLatforms (EU-PEARL) project (IMI2-853966) aimed to develop tools to establish integrated research platforms (IRP) for conducting adaptive-design trials in various diseases, including metabolic-dysfunction associated steatohepatitis (MASH). One essential component of a successful MASH IRP is a robust and reliable Clinical Research Network (CRN). Herein, we outline the required elements and anticipated steps to set-up such a CRN. We identified European clinical research sites that could potentially serve as the foundation for MASH IRP and a CRN. A survey was sent to sites to assess their interest in joining a CRN, their familiarity with platform trials, and their capacity to participate in a future MASH IRP. A total of 141 investigators were invited to participate in the survey, and 40% responded. More than half of the answers (52%) identify MASH with advanced fibrosis (F3-4) as the subpopulation with the greatest unmet need. Regarding the difficulty in identifying candidates for trials, 65% find it is moderately difficult and 30% very difficult. Most respondents (94%) believe that a platform trial could offer substantial benefits to patients. Nearly all researchers express interest in participating in a platform trial (78%), with 22% indicating their interest would be contingent on initial industry funding. While preliminary, our findings on responding sites are encouraging for the potential establishment of a CRN for a MASH IRP. However, funding schemes and sustainability strategies to provide proof-of-platform in MASH seem key in the short-term scenario. Metabolic dysfunction-associated steatohepatitis (MASH) occurs when the liver becomes damaged due to the build up of fat, which is often related to obesity and diabetes. There is a lack of effective drug treatments for MASH, so strategies to strengthen clinical research in this area are needed. Here, we survey key European experts on MASH to assess their interest in joining a network of MASH researchers and their interest in participating in a new type of clinical trial called a platform trial, where multiple drugs can be tested simultaneously. Researchers largely agree that these are promising approaches to boost drug development in the field, although have concerns regarding funding and sustainability strategies. Our findings may inform the creation of a network of MASH researchers capable of running a platform trial, which in turn may speed up research into treatments for MASH. Sena et al. survey European clinical research sites that could potentially serve as the foundation for a MASH integrated research platform and clinical research network. Respondents generally believe that a MASH platform trial could benefit patients and are interested in participating, though securing industry funding is identified as a priority.","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":" ","pages":"1-8"},"PeriodicalIF":5.4,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s43856-024-00560-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141629422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-15DOI: 10.1038/s43856-024-00570-3
Leighton M. Watson, Michael J. Plank, Bridget A. Armstrong, Joanne R. Chapman, Joanne Hewitt, Helen Morris, Alvaro Orsi, Michael Bunce, Christl A. Donnelly, Nicholas Steyn
Timely and informed public health responses to infectious diseases such as COVID-19 necessitate reliable information about infection dynamics. The case ascertainment rate (CAR), the proportion of infections that are reported as cases, is typically much less than one and varies with testing practices and behaviours, making reported cases unreliable as the sole source of data. The concentration of viral RNA in wastewater samples provides an alternate measure of infection prevalence that is not affected by clinical testing, healthcare-seeking behaviour or access to care. We construct a state-space model with observed data of levels of SARS-CoV-2 in wastewater and reported case incidence and estimate the hidden states of the effective reproduction number, R, and CAR using sequential Monte Carlo methods. We analyse data from 1 January 2022 to 31 March 2023 from Aotearoa New Zealand. Our model estimates that R peaks at 2.76 (95% CrI 2.20, 3.83) around 18 February 2022 and the CAR peaks around 12 March 2022. We calculate that New Zealand’s second Omicron wave in July 2022 is similar in size to the first, despite fewer reported cases. We estimate that the CAR in the BA.5 Omicron wave in July 2022 is approximately 50% lower than in the BA.1/BA.2 Omicron wave in March 2022. Estimating R, CAR, and cumulative number of infections provides useful information for planning public health responses and understanding the state of immunity in the population. This model is a useful disease surveillance tool, improving situational awareness of infectious disease dynamics in real-time. To make informed public health decisions about infectious diseases, it is important to understand the number of infections in the community. Reported cases, however, underestimate the number of infections and the degree of underestimation likely changes with time. Wastewater data provides an alternative data source that does not depend on testing practices. Here, we combined wastewater observations of SARS-CoV-2 with reported cases to estimate the reproduction number (how quickly infections are increasing or decreasing) and the case ascertainment rate (the fraction of infections reported as cases). We apply the model to Aotearoa New Zealand and demonstrate that the second wave of infections in July 2022 had approximately the same number of infections as the first wave in March 2022 despite reported cases being 50% lower. Watson et. al construct a state-space model to assess disease transmission from virus concentration data in wastewater. Using data from New Zealand they estimate infection and relative case ascertainment rates during several waves of infection with the omicron SARS-CoV-2 variant.
{"title":"Jointly estimating epidemiological dynamics of Covid-19 from case and wastewater data in Aotearoa New Zealand","authors":"Leighton M. Watson, Michael J. Plank, Bridget A. Armstrong, Joanne R. Chapman, Joanne Hewitt, Helen Morris, Alvaro Orsi, Michael Bunce, Christl A. Donnelly, Nicholas Steyn","doi":"10.1038/s43856-024-00570-3","DOIUrl":"10.1038/s43856-024-00570-3","url":null,"abstract":"Timely and informed public health responses to infectious diseases such as COVID-19 necessitate reliable information about infection dynamics. The case ascertainment rate (CAR), the proportion of infections that are reported as cases, is typically much less than one and varies with testing practices and behaviours, making reported cases unreliable as the sole source of data. The concentration of viral RNA in wastewater samples provides an alternate measure of infection prevalence that is not affected by clinical testing, healthcare-seeking behaviour or access to care. We construct a state-space model with observed data of levels of SARS-CoV-2 in wastewater and reported case incidence and estimate the hidden states of the effective reproduction number, R, and CAR using sequential Monte Carlo methods. We analyse data from 1 January 2022 to 31 March 2023 from Aotearoa New Zealand. Our model estimates that R peaks at 2.76 (95% CrI 2.20, 3.83) around 18 February 2022 and the CAR peaks around 12 March 2022. We calculate that New Zealand’s second Omicron wave in July 2022 is similar in size to the first, despite fewer reported cases. We estimate that the CAR in the BA.5 Omicron wave in July 2022 is approximately 50% lower than in the BA.1/BA.2 Omicron wave in March 2022. Estimating R, CAR, and cumulative number of infections provides useful information for planning public health responses and understanding the state of immunity in the population. This model is a useful disease surveillance tool, improving situational awareness of infectious disease dynamics in real-time. To make informed public health decisions about infectious diseases, it is important to understand the number of infections in the community. Reported cases, however, underestimate the number of infections and the degree of underestimation likely changes with time. Wastewater data provides an alternative data source that does not depend on testing practices. Here, we combined wastewater observations of SARS-CoV-2 with reported cases to estimate the reproduction number (how quickly infections are increasing or decreasing) and the case ascertainment rate (the fraction of infections reported as cases). We apply the model to Aotearoa New Zealand and demonstrate that the second wave of infections in July 2022 had approximately the same number of infections as the first wave in March 2022 despite reported cases being 50% lower. Watson et. al construct a state-space model to assess disease transmission from virus concentration data in wastewater. Using data from New Zealand they estimate infection and relative case ascertainment rates during several waves of infection with the omicron SARS-CoV-2 variant.","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":" ","pages":"1-9"},"PeriodicalIF":5.4,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s43856-024-00570-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-13DOI: 10.1038/s43856-024-00569-w
César Higgins Tejera, Erin B. Ware, Margaret T. Hicken, Lindsay C. Kobayashi, Herong Wang, Freida Blostein, Matthew Zawistowski, Bhramar Mukherjee, Kelly M. Bakulski
Exposure to systemic racism is linked to increased dementia burden. To assess systemic inflammation as a potential pathway linking exposure to racism and dementia disparities, we investigated the mediating role of C-reactive protein (CRP), a systemic inflammation marker, and the moderating role of the racialization process in incident dementia. In the US Health and Retirement Study (n = 6,908), serum CRP was measured at baseline (2006, 2008 waves). Incident dementia was classified by cognitive tests over a six-year follow-up. Self-reported racialized categories were a proxy for exposure to the racialization process. We decomposed racialized disparities in dementia incidence (non-Hispanic Black and/or Hispanic vs. non-Hispanic white) into 1) the mediated effect of CRP, 2) the moderated portion attributable to the interaction between racialized group membership and CRP, and 3) the controlled direct effect (other pathways through which racism operates). The 6-year cumulative incidence of dementia is 12%. Among minoritized participants (i.e., non-Hispanic Black and/or Hispanic), high CRP levels ( ≥ 75th percentile or 4.73μg/mL) are associated with 1.26 (95%CI: 0.98, 1.62) times greater risk of incident dementia than low CRP ( < 4.73μg/mL). Decomposition analysis comparing minoritized versus non-Hispanic white participants shows that the mediating effect of CRP accounts for 3% (95% CI: 0%, 6%) of the racial disparity, while the interaction effect between minoritized group status and high CRP accounts for 14% (95% CI: 1%, 27%) of the disparity. Findings are robust to potential violations of causal mediation assumptions. Minoritized group membership modifies the relationship between systemic inflammation and incident dementia. Higher levels of inflammation in blood are linked to greater dementia risk in older adults. Non-Hispanic Black and Hispanic Americans have higher inflammation levels compared to non-Hispanic white Americans. We conducted a study to examine whether high levels of inflammation could explain differences in dementia risk among these racial groups. We found that differences in inflammation levels in non-Hispanic Black or Hispanic adults modestly explain their higher risk of dementia compared to non-Hispanic white adults. These findings suggest that interventions aimed at reducing high levels of inflammation in minoritized US adults could ameliorate racial differences in dementia risk. Higgins Tejera et al. employ mediation-interaction decomposition analyses in a large population study to demonstrate how the racialization process and systemic inflammation interact to explain racial disparities in dementia risk. They propose a causal framework to integrate biological pathways in the study of racial disparities in health.
{"title":"The mediating role of systemic inflammation and moderating role of racialization in disparities in incident dementia","authors":"César Higgins Tejera, Erin B. Ware, Margaret T. Hicken, Lindsay C. Kobayashi, Herong Wang, Freida Blostein, Matthew Zawistowski, Bhramar Mukherjee, Kelly M. Bakulski","doi":"10.1038/s43856-024-00569-w","DOIUrl":"10.1038/s43856-024-00569-w","url":null,"abstract":"Exposure to systemic racism is linked to increased dementia burden. To assess systemic inflammation as a potential pathway linking exposure to racism and dementia disparities, we investigated the mediating role of C-reactive protein (CRP), a systemic inflammation marker, and the moderating role of the racialization process in incident dementia. In the US Health and Retirement Study (n = 6,908), serum CRP was measured at baseline (2006, 2008 waves). Incident dementia was classified by cognitive tests over a six-year follow-up. Self-reported racialized categories were a proxy for exposure to the racialization process. We decomposed racialized disparities in dementia incidence (non-Hispanic Black and/or Hispanic vs. non-Hispanic white) into 1) the mediated effect of CRP, 2) the moderated portion attributable to the interaction between racialized group membership and CRP, and 3) the controlled direct effect (other pathways through which racism operates). The 6-year cumulative incidence of dementia is 12%. Among minoritized participants (i.e., non-Hispanic Black and/or Hispanic), high CRP levels ( ≥ 75th percentile or 4.73μg/mL) are associated with 1.26 (95%CI: 0.98, 1.62) times greater risk of incident dementia than low CRP ( < 4.73μg/mL). Decomposition analysis comparing minoritized versus non-Hispanic white participants shows that the mediating effect of CRP accounts for 3% (95% CI: 0%, 6%) of the racial disparity, while the interaction effect between minoritized group status and high CRP accounts for 14% (95% CI: 1%, 27%) of the disparity. Findings are robust to potential violations of causal mediation assumptions. Minoritized group membership modifies the relationship between systemic inflammation and incident dementia. Higher levels of inflammation in blood are linked to greater dementia risk in older adults. Non-Hispanic Black and Hispanic Americans have higher inflammation levels compared to non-Hispanic white Americans. We conducted a study to examine whether high levels of inflammation could explain differences in dementia risk among these racial groups. We found that differences in inflammation levels in non-Hispanic Black or Hispanic adults modestly explain their higher risk of dementia compared to non-Hispanic white adults. These findings suggest that interventions aimed at reducing high levels of inflammation in minoritized US adults could ameliorate racial differences in dementia risk. Higgins Tejera et al. employ mediation-interaction decomposition analyses in a large population study to demonstrate how the racialization process and systemic inflammation interact to explain racial disparities in dementia risk. They propose a causal framework to integrate biological pathways in the study of racial disparities in health.","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":" ","pages":"1-14"},"PeriodicalIF":5.4,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11246521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141604604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-12DOI: 10.1038/s43856-024-00555-2
Mohamed Elgendi, Fridolin Haugg, Richard Ribon Fletcher, John Allen, Hangsik Shin, Aymen Alian, Carlo Menon
Photoplethysmography (PPG) is a non-invasive optical technique that measures changes in blood volume in the microvascular tissue bed of the body. While it shows potential as a clinical tool for blood pressure (BP) assessment and hypertension management, several sources of error can affect its performance. One such source is the PPG-based algorithm, which can lead to measurement bias and inaccuracy. Here, we review seven widely used measures to assess PPG-based algorithm performance and recommend implementing standardized error evaluation steps in their development. This standardization can reduce bias and improve the reliability and accuracy of PPG-based BP estimation, leading to better health outcomes for patients managing hypertension. Elgendi et al. discuss pros and cons of seven measures to assess photoplethysmography-based algorithm performance for blood pressure estimation. They highlight the need for standardized error evaluation to enhance accuracy and reliability in hypertension management and make recommendations to achieve this goal.
{"title":"Recommendations for evaluating photoplethysmography-based algorithms for blood pressure assessment","authors":"Mohamed Elgendi, Fridolin Haugg, Richard Ribon Fletcher, John Allen, Hangsik Shin, Aymen Alian, Carlo Menon","doi":"10.1038/s43856-024-00555-2","DOIUrl":"10.1038/s43856-024-00555-2","url":null,"abstract":"Photoplethysmography (PPG) is a non-invasive optical technique that measures changes in blood volume in the microvascular tissue bed of the body. While it shows potential as a clinical tool for blood pressure (BP) assessment and hypertension management, several sources of error can affect its performance. One such source is the PPG-based algorithm, which can lead to measurement bias and inaccuracy. Here, we review seven widely used measures to assess PPG-based algorithm performance and recommend implementing standardized error evaluation steps in their development. This standardization can reduce bias and improve the reliability and accuracy of PPG-based BP estimation, leading to better health outcomes for patients managing hypertension. Elgendi et al. discuss pros and cons of seven measures to assess photoplethysmography-based algorithm performance for blood pressure estimation. They highlight the need for standardized error evaluation to enhance accuracy and reliability in hypertension management and make recommendations to achieve this goal.","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":" ","pages":"1-7"},"PeriodicalIF":5.4,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s43856-024-00555-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141602332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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