Archives of Medical Research最新文献_第2页

Apparent Diffusion Coefficient Measurements. A Reliable Tool for the Diagnosis of Creutzfeldt-Jakob Disease 表观扩散系数测量。诊断克雅氏病的可靠工具

IF 4.7 3区医学 Q1 MEDICINE, RESEARCH & EXPERIMENTAL

Archives of Medical Research

Pub Date : 2024-10-21 DOI: 10.1016/j.arcmed.2024.103104

Marie Catherine Boll , Ignacio Muñoz-López , Graciela Cárdenas , Miguel Ángel Ramírez-García , María Guadalupe Nava-Galán , Petra Yescas-Gómez

Background and Purpose

Creutzfeldt-Jakob disease (CJD) is a rare, rapidly fatal neurodegenerative disorder. The gold standard test for a positive diagnosis of definite CJD is histopathological confirmation, usually post-mortem; however, an autopsy study is not always feasible in all health settings.

Materials and Methods

We performed a cross-sectional analysis of a retrospectively enrolled cohort of patients with suspected prion disease between 2008 and 2019. Only patients with complete medical histories who fulfilled a diagnostic checklist were enrolled. The magnetic resonance imaging (MRI) sequences (T2-FLAIR and DWI) were analyzed, and the apparent diffusion coefficients (ADCs) were calculated for five regions of interest (ROIs) in each cerebral hemisphere.

Results

In total, 72 MRI scans were post-processed. The series included 47 cases of CJD, including 25 genetic and 22 sporadic cases, in addition to 25 age-paired controls with non-prion encephalopathies. The neostriatum showed the most significant difference in ADC values (×10^–3 mm²/s) at 0.5946 in the left anterior putamen vs. 0.8644 in the control encephalopathies (p < 0.001; 95% confidence interval: 0.5751–0.6142 vs. 0.7812–0.9476), while the other ROIs also showed significant differences. The best cut-off value to differentiate CJD from other encephalopathies was identified as 0.65×10^–3 mm²/s, with no significant differences in this coefficient between sporadic and genetic cases.

Conclusions

Quantitative ADC measurements made in the basal ganglia seem to be the most useful ante-mortem diagnostic tool for differentiating CJD from non-prion encephalopathies when cerebrospinal fluid real-time quaking-induced conversion or other specific misfolded protein detection tests are inaccessible.

背景和目的：克雅氏病（CJD）是一种罕见的快速致死性神经退行性疾病。确诊克雅氏病的金标准检测方法是组织病理学确认，通常是在死后进行；然而，在所有医疗机构中，尸检研究并不总是可行的：我们对 2008 年至 2019 年期间回顾性入组的疑似朊病毒病患者进行了横断面分析。只有病史完整且符合诊断清单的患者才被纳入。对磁共振成像（MRI）序列（T2-FLAIR和DWI）进行了分析，并计算了每个大脑半球五个感兴趣区（ROI）的表观弥散系数（ADC）：共对 72 张磁共振成像扫描进行了后处理。该系列包括 47 例 CJD 病例，包括 25 例遗传性病例和 22 例散发性病例，以及 25 例年龄配对的非原发性脑病对照组病例。新纹状体的 ADC 值（×10-3 mm2/s）与对照组脑病的 ADC 值（×10-3 mm2/s）相比，差异最为显著，左侧前部丘脑的 ADC 值为 0.5946，对照组为 0.8644（P < 0.001；95% 置信区间：0.5751-0.6142 vs. 0.7812-0.9476），而其他 ROI 也有显著差异。区分CJD和其他脑病的最佳临界值为0.65×10-3 mm2/s，该系数在散发性病例和遗传性病例之间无明显差异：结论：在无法进行脑脊液实时震荡诱导转换或其他特异性错误折叠蛋白检测试验的情况下，基底节的定量 ADC 测量似乎是区分 CJD 和非先天性脑病的最有用的生前诊断工具。

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引用次数: 0

GNLY as a novel cis-eQTL and cis-pQTL mediated susceptibility gene in suppressing prostatitis. Mendelian randomization study GNLY 是抑制前列腺炎的顺式-eQTL 和顺式-pQTL 介导的新型易感基因。孟德尔随机化研究。

IF 4.7 3区医学 Q1 MEDICINE, RESEARCH & EXPERIMENTAL

Archives of Medical Research

Pub Date : 2024-10-21 DOI: 10.1016/j.arcmed.2024.103098

Yi Wang , Hao Ji , Guihua Chen , Jianhua Zhou , Dongliang Zhang , Xiang Wang

Background

Prostatitis is characterized by high prevalence, low cure rates, and frequent recurrences, and remains one of the most clinically challenging problems. Hence, in this article, we first integrated Mendelian randomization (MR) with expression quantitative trait loci (eQTL) and protein quantitative trait loci (pQTL) data to identify novel therapeutic targets and their potential metabolic mechanisms for prostatitis.

Methods

Prostatitis-related genetic data, eQTLs, pQTLs, and 1400 metabolites were downloaded from online databases. MR, or summary data-based MR (SMR) analyses were applied to assess the potential causal relationships between exposures and predicted outcomes. Sensitivity analysis was conducted using pleiotropy, heterogeneity, and leave-one-out analysis to evaluate the robustness of our results.

Results

Based on our results, we first identified and validated GNLY as a novel cis-eQTL and cis-pQTL-mediated susceptibility gene for reducing prostatitis risk in five independent datasets (one discovery dataset and four validation datasets) (all p <0.05). Meanwhile, we also found that the GNLY eQTL could increase the metabolite of sphingomyelin level (d18:0/20:0, d16:0/22:0) risks (p <0.05), and the metabolite of sphingomyelin level (d18:0/20:0, d16:0/22:0) could reduce the risk of prostatitis (p <0.05). According to the above-mentioned relationships, we finally revealed the potential metabolic mechanism of GNLY eQTL in suppressing prostatitis via regulating the metabolite of sphingomyelin level (d18:0/20:0, d16:0/22:0).

Conclusions

We successfully identified GNLY as a novel cis-eQTL and cis-pQTL-mediated susceptibility gene in suppressing prostatitis and its potential metabolic mechanism via regulating sphingomyelin (d18:0/20:0, d16:0/22:0) levels, providing a novel therapeutic target and paving the way for future GNLY-related studies in prostatitis.

背景：前列腺炎具有发病率高、治愈率低和复发频繁的特点，仍然是临床上最具挑战性的问题之一。因此，在本文中，我们首次将孟德尔随机化（MR）与表达定量性状位点（eQTL）和蛋白质定量性状位点（pQTL）数据整合在一起，以确定前列腺炎的新型治疗靶点及其潜在的代谢机制：方法：从在线数据库中下载与前列腺炎相关的遗传数据、eQTL、pQTL 和 1400 种代谢物。应用MR或基于数据摘要的MR（SMR）分析评估暴露与预测结果之间的潜在因果关系。为了评估结果的稳健性，我们采用了多向性分析、异质性分析和排除分析等方法进行了敏感性分析：基于我们的研究结果，我们首先在五个独立数据集（一个发现数据集和四个验证数据集）中发现并验证了GNLY是一个新型顺式-eQTL和顺式-pQTL介导的降低前列腺炎风险的易感基因（均为p 结论：我们成功地发现了GNLY是一个新型顺式-eQTL和顺式-pQTL介导的降低前列腺炎风险的易感基因：我们成功地发现了GNLY是一种新型的顺式-eQTL和顺式-pQTL介导的易感基因，它通过调节鞘磷脂（d18:0/20:0, d16:0/22:0）水平来抑制前列腺炎及其潜在的代谢机制，从而提供了一种新型的治疗靶点，并为今后GNLY在前列腺炎中的相关研究铺平了道路。

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引用次数: 0

Suicides in Czech Republic, Slovakia, Hungary, and Poland in 1990–2019: Epidemiological patterns and trends in European and Global context 1990-2019 年捷克共和国、斯洛伐克、匈牙利和波兰的自杀人数：欧洲和全球背景下的流行病学模式和趋势。

IF 4.7 3区医学 Q1 MEDICINE, RESEARCH & EXPERIMENTAL

Archives of Medical Research

Pub Date : 2024-10-19 DOI: 10.1016/j.arcmed.2024.103100

Alena Lochmannová , Marek Majdan , Miroslav Šafr

Background

Suicides are a major public health problem with serious consequences for societies.

Aim

To compare epidemiological patterns and trends of suicides in the Czech Republic, Slovakia, Hungary, and Poland in 1990–2019, and analyze them in the European and global context.

Methods

A trend analysis was conducted in Czech Republic, Slovakia, Hungary, Poland, in Western Europe and on global level for 1990–2019. All data were obtained from the Global Burden of Diseases study 2019. Numbers and age-standardized rates of deaths and Years of Life Lost (YLL) due to suicides were analyzed, stratified by sex and age (0–14 years old, 15–49 years old, 50–69 years old, 70+ years).

Results

In 2019, 759,028 suicides occurred globally, 17,408 (2.3%) in Central Europe. The proportion of males was substantially larger, compared to the global and Western European levels (E.g., 82 vs. 69% and 75%, respectively). The highest rates of suicide were in Hungary (19.7 per 100,000), lowest in Slovakia (12.8); the rate in Central Europe was higher than the global rate (15.2 vs. 9.8), and the rate in Western Europe (11.4). A steady decline of rates was observed in all countries, particularly in Hungary. In Czech Republic we found an increasing relative importance of suicides among people 70 years and older.

Conclusions

Death rates due to suicides have been declining in the analyzed countries, but some characteristics and trends when compared to global and regional estimates, such as substantially higher proportion of male suicides or high death rates among the elderly warrant specifically tailored preventative action coordinated by governments with community involvement.

背景：目的：比较 1990-2019 年捷克共和国、斯洛伐克、匈牙利和波兰的自杀流行病学模式和趋势，并在欧洲和全球背景下对其进行分析：对 1990-2019 年捷克共和国、斯洛伐克、匈牙利、波兰、西欧和全球的自杀趋势进行了分析。所有数据均来自 2019 年全球疾病负担研究。按照性别和年龄（0-14 岁、15-49 岁、50-69 岁、70 岁以上）进行分层，分析了自杀导致的死亡人数和年龄标准化比率以及生命损失年数（YLL）：2019年，全球共发生759028起自杀事件，中欧有17408起（2.3%）。与全球和西欧的水平相比，男性所占比例要大得多（例如，分别为82%和69%和75%）。匈牙利的自杀率最高（19.7/100,000），斯洛伐克最低（12.8）；中欧的自杀率高于全球（15.2 vs. 9.8）和西欧（11.4）。所有国家的发病率都在稳步下降，尤其是匈牙利。在捷克共和国，我们发现 70 岁及以上人群的自杀率相对较高：结论：在所分析的国家中，自杀死亡率一直在下降，但与全球和地区的估计相比，自杀的一些特点和趋势，如男性自杀比例大幅提高或老年人自杀死亡率高，需要政府在社区参与下协调采取专门的预防行动。

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引用次数: 0

Improving Efficiency in Healthcare: Lessons from Successful Health Policies in Chile 提高医疗保健效率：智利成功医疗政策的经验教训

IF 4.7 3区医学 Q1 MEDICINE, RESEARCH & EXPERIMENTAL

Archives of Medical Research

Pub Date : 2024-10-17 DOI: 10.1016/j.arcmed.2024.103105

Manuel A. Espinoza , Paula Zamorano , Carlos Zuñiga-San Martin , Carla Taramasco , Felipe Martinez , Sergio Becerra , Maria Jose Letelier , Nicolas Armijo

Background

Chile has made significant progress in recent decades in implementing policies to improve the efficiency of its health system with an impact on population health.

Aim

To present five case studies of successful policies whose impact has been documented.

Methods

Case study report.

Results

First, we present a summary of the evidence supporting the policy that is changing the Chilean care model from a problem-based to a patient-centered care model. Second, we show how tele-nephrology and advanced renal care units have demonstrated significant impact on chronic kidney disease in Chile. This internationally recognized successful Chilean policy is contributing to address one of the conditions that explains the highest financial burden on the health system. Third, we present recent evidence on the effectiveness of teleoncology care in Chile. Fourth, we highlight the most recent system of epidemiological surveillance implemented in Chile, the EPIVIGILA system, which was essential to support decisions throughout the pandemic. Finally, we underline the health benefit plans implemented in recent decades to improve access to services and financial protection.

Conclusions

Chile has successfully implemented policies in its health system that have an impact on efficiency and population health. These experiences can be replicated in countries facing similar challenges, using the Chilean experience as a benchmark.

背景近几十年来，智利在实施提高卫生系统效率的政策方面取得了重大进展，并对人口健康产生了影响。目的介绍五项成功政策的案例研究，并记录其影响。方法案例研究报告。结果首先，我们总结了支持智利医疗模式从以问题为基础转变为以患者为中心的政策的证据。其次，我们展示了远程肾脏病学和先进的肾脏护理单元如何对智利的慢性肾脏病产生重大影响。智利的这一国际公认的成功政策有助于解决给卫生系统造成最高经济负担的疾病之一。第三，我们介绍了智利远程肿瘤治疗有效性的最新证据。第四，我们强调了智利最近实施的流行病学监测系统，即 EPIVIGILA 系统，该系统对整个大流行期间的决策支持至关重要。最后，我们强调了近几十年来实施的医疗福利计划，这些计划旨在改善服务的可及性和财务保护。以智利的经验为基准，面临类似挑战的国家可以借鉴这些经验。

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引用次数: 0

Low muscle mass in the internal medicine ward: Prevalence and survival implications 内科病房的低肌肉质量：发病率和对生存的影响

IF 4.7 3区医学 Q1 MEDICINE, RESEARCH & EXPERIMENTAL

Archives of Medical Research

Pub Date : 2024-10-15 DOI: 10.1016/j.arcmed.2024.103103

Luis Andrés González-Torres , Víctor Daniel Acuña-Rocha , Mario Herrera-Nuñez , Juan Manuel Millán-Alanís , Carlos de la Cruz-de la Cruz , Ricardo Humberto Z’ Cruz-López , Joel Isaí Alcalá-González , Juan Francisco Moreno-Hoyos-Abril , Julio Edgardo González-Aguirre

Background

Low muscle mass is common in hospitalized patients. It is associated with adverse clinical outcomes. Reported prevalence varies widely due to non-universally accepted diagnostic criteria and the heterogeneity of the populations studied. Non-surgical ill patients are underrepresented in the literature.

Aims

To estimate the prevalence of low muscle index and its impact on survival in patients admitted to an internal medicine unit.

Methods

We prospectively enrolled patients with abdominal CT scans on admission to the Internal Medicine ward. We assessed muscle mass index (L3MI) at the level of the L3 lumbar vertebra. The primary outcome was to estimate the prevalence of low muscle mass on admission. Secondary outcomes were to determine the relationship of low L3MI with hospital mortality, length of stay, nosocomial infections, and hospital readmission.

Results

One hundred and seven patients were included. The prevalence of low L3MI was 46.7%. An L3MI of 46.3 cm²/m² in men and 40.9 cm²/m² in women predicted death at one year with a sensitivity of 66% and a specificity of 78% (AUC = 0.62 [95% CI 0.38–0.86]) and 69 and 66% (AUC of 0.63 [95% IC 0.47–0.78]), respectively. In-hospital mortality, death at 60, 90, and 360 d, and hospital readmission were significantly higher in patients with low L3MI.

Conclusion

Almost half of the patients admitted to an internal medicine ward have low muscle mass index. The cutoff point of 40.9 cm²/m² in females and 46.3 cm²/m² in males predicts relevant clinical variables. We established the better L3MI cutoff value to predict 12-month mortality.

背景住院病人普遍存在肌肉质量低的问题。它与不良的临床结果有关。由于诊断标准未被普遍接受，且所研究的人群具有异质性，因此报告的发病率差异很大。目的估计内科病房住院病人低肌肉指数的患病率及其对生存的影响。方法我们前瞻性地招募了内科病房住院时接受腹部 CT 扫描的病人。我们评估了腰椎L3水平的肌肉质量指数（L3MI）。主要结果是估计入院时低肌肉质量的发生率。次要结果是确定低 L3MI 与住院死亡率、住院时间、院内感染和再次入院的关系。低 L3MI 患病率为 46.7%。男性 L3MI 为 46.3 cm2/m2，女性为 40.9 cm2/m2，预测一年后死亡的敏感性为 66%，特异性为 78%（AUC = 0.62 [95% CI 0.38-0.86]）；预测一年后死亡的敏感性为 69%，特异性为 66%（AUC 为 0.63 [95% IC 0.47-0.78]）。低 L3MI 患者的院内死亡率、60 d、90 d 和 360 d 死亡率以及再入院率均显著较高。女性 40.9 cm2/m2 和男性 46.3 cm2/m2 的临界点可预测相关的临床变量。我们确定了预测 12 个月死亡率的较佳 L3MI 临界值。

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引用次数: 0

COVID-19 policy response: Perspectives of key stakeholders in Mexico's health system and implications for resilience COVID-19 政策回应：墨西哥卫生系统主要利益攸关方的观点及其对复原力的影响

IF 4.7 3区医学 Q1 MEDICINE, RESEARCH & EXPERIMENTAL

Archives of Medical Research

Pub Date : 2024-10-15 DOI: 10.1016/j.arcmed.2024.103097

Lina Díaz-Castro , Christian Díaz de León-Castañeda , Galileo Pérez-Hernández , José Carlos Suárez-Herrera

Purpose

This study aims to analyze the perspectives of key stakeholders within Mexico's health system regarding the policy response to COVID-19 in 2020 to inform future policy formulation.

Methods

This qualitative study is based on a secondary data analysis (SDA) derived from a broader primary research on governance in Mexico during the COVID-19 pandemic. The analysis adopted a grounded theory approach to examine 15 semi-structured interviews with prominent figures in the health system between June and November 2020. The interviews were audio-recorded and analyzed through the lens of the Health Policy Triangle which includes context, key actors, and the Mexican health policy process. Moreover, the analysis was enriched by incorporating the framework outlined in the World Health Organization's COVID-19 Strategic Preparedness and Response Plan (SPRP).

Results

The findings indicate that key stakeholders perceived a centralized approach to policymaking with a strong emphasis on cross-sector communication, expert panels, equity-focused measures, accessibility to healthcare services (promoting portability), and improvements in the health information system.

Conclusion

Key stakeholders recognized the response to COVID-19 was complex, involving multiple dimensions and levels of action. The importance of preparedness and response in building health system resilience is emphasized. Recommendations include explicitly integrating resilience into national and local policy agendas, addressing systemic structural deficiencies, promoting equity in the pandemic response, improving risk governance, strengthening coordination mechanisms, ensuring supply chain resilience, improving personnel training, and enhancing local diagnostic capacity to better prepare for future public health emergencies.

本研究旨在分析墨西哥卫生系统内主要利益相关者对 2020 年 COVID-19 政策应对措施的看法，为未来政策制定提供参考。本定性研究基于一项二级数据分析 (SDA)，该分析源于对 COVID-19 大流行期间墨西哥治理情况的更广泛的一级研究。分析采用了基础理论方法，对 2020 年 6 月至 11 月期间与卫生系统知名人士进行的 15 次半结构化访谈进行了研究。对访谈进行了录音，并通过 "卫生政策三角"（包括背景、关键参与者和墨西哥卫生政策过程）的视角进行分析。结果研究结果表明，主要利益相关者认为政策制定应采用集中式方法，并着重强调跨部门沟通、专家小组、以公平为重点的措施、医疗保健服务的可及性（促进便携性）以及医疗信息系统的改进。强调了准备和应对工作在建设卫生系统复原力方面的重要性。建议包括将复原力明确纳入国家和地方政策议程、解决系统性结构缺陷、促进大流行应对措施的公平性、改善风险治理、加强协调机制、确保供应链复原力、改善人员培训以及提高地方诊断能力，以便更好地应对未来的公共卫生突发事件。

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引用次数: 0

Post COVID-19: Advancing medical laboratory service integration in nigeria and progress towards establishing integration guideline 后 COVID-19：推进尼日利亚医学实验室服务一体化以及在制定一体化准则方面取得的进展

IF 4.7 3区医学 Q1 MEDICINE, RESEARCH & EXPERIMENTAL

Archives of Medical Research

Pub Date : 2024-10-14 DOI: 10.1016/j.arcmed.2024.103094

Augustine Onyeaghala , Nkechi Nwoke , Kingsley Odiabara , Ughweroghene Kingston Omo-Emmanuel , Jibrin Kama , Bashir Mahmud , Charles Michael Etoroma , Gaius Mathew

Background

The Nigerian healthcare system, including medical laboratories, operates in a three-tiered structure across public and private sectors. Lessons from COVID-19 show the urgent need for a guideline to drive medical laboratory service integration.

Problem

Lack of operational guideline to drive the integration of laboratory services has resulted in siloed operations across different medical laboratories causing duplication of resources, coordination issues, and inefficiencies.

Aim

To highlight the development processes of medical laboratory service integration guideline and discuss its key provisions.

Method

The Medical Laboratory Services Division (MLSD), Federal Ministry of Health (FMoH) initiated the development of a national guideline for integrating medical laboratory services. Partnering with stakeholders and engaging two consultants, a technical workshop was facilitated in January 2024. The Consultants garnered the initial inputs stakeholders made at the five-day meeting. The inputs were collated and organized to produce the guideline. The guideline was circulated to participants and other stakeholders for review and feedback received was used to finalize the document. The MLSD with support from partners further held a three-day stakeholders’ meeting in May 2024 to validate the document before submitting it to the Health Minister for endorsement.

Result

The guideline sets standards for achieving medical laboratory services and systems integration across different medical laboratories. The contents of the guideline are enumerated and respective recommendations made under each element are highlighted.

Conclusion

The implementation of the guideline will help harmonize services, improve access to diagnostics, streamline processes, reduce redundancies, optimize resource utilization, enhance communication, data sharing, and pandemic preparedness.

背景尼日利亚的医疗保健系统（包括医学实验室）以三级结构在公共和私营部门运行。问题缺乏推动实验室服务整合的操作指南，导致不同医学实验室之间各自为政，造成资源重复、协调问题和效率低下。方法联邦卫生部医学实验室服务司（MLSD）着手制定整合医学实验室服务的国家指南。通过与利益相关方合作并聘请两名顾问，于 2024 年 1 月举办了一次技术研讨会。顾问收集了利益相关方在为期五天的会议上提出的初步意见。这些意见经过整理和组织后形成了该指南。该指南已分发给与会者和其他利益相关者审查，收到的反馈意见被用于文件的定稿。在合作伙伴的支持下，医学实验室发展部还于 2024 年 5 月举行了为期三天的利益相关者会议，以验证该文件，然后将其提交卫生部长批准。结论该指南的实施将有助于协调服务、改善诊断服务、简化流程、减少冗余、优化资源利用、加强沟通、数据共享和大流行病防备。

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引用次数: 0

Masseter Muscle Volume and Its Association with Sarcopenia and Muscle Determinants in Older Japanese Adults: the Bunkyo Health Study 日本老年人的肌肉量及其与肌肉疏松症和肌肉决定因素的关系：文化健康研究

IF 4.7 3区医学 Q1 MEDICINE, RESEARCH & EXPERIMENTAL

Archives of Medical Research

Pub Date : 2024-10-14 DOI: 10.1016/j.arcmed.2024.103095

Abulaiti Abudurezake , Saori Kakehi , Futaba Umemura , Hideyoshi Kaga , Yuki Someya , Hiroki Tabata , Yasuyo Yoshizawa , Hitoshi Naito , Tsubasa Tajima , Naoaki Ito , Hikaru Otsuka , Huicong Shi , Mari Sugimoto , Shota Sakamoto , Yukiko Muroga , Hidetaka Wakabayashi , Ryuzo Kawamori , Hirotaka Watada , Yoshifumi Tamura

Aim

Sarcopenia has been with a decrease in masseter muscle (MM) thickness in high-risk older populations. However, the relationship between sarcopenia and determinants of MM volume (MMV) in the general elderly population remains unclear.

Method

In a cross-sectional study of 1,484 older adults in Tokyo, we evaluated MMV using 3D MRI scanning, appendicular skeletal muscle mass (ASMM), handgrip strength, dietary intake, smoking, insulin-like growth factor 1 (IGF-1) levels, and the ACTN3 R577X polymorphism. Participants were divided into quintiles based on MMV (Q1–5).

Results

Participants in our study had a mean age of 73.0 ± 5.3 years and their MMV (Men: 35.3 ± 7.8 mL, Women: 25.0 ± 5.1 mL) was significantly higher in men than in women. A significant association between MMV and sarcopenia was observed, with the lowest quintile (Q1) showing a higher risk compared to the highest quintile (Q5) in both sexes. Body mass index (BMI) and age were independent determinants of ASMM in both sexes, whereas BMI, but interestingly not age, was a determinant of MMV. Moreover, IGF-1 was positively correlated with MMV in both sexes; smoking was negatively correlated with MMV in women. The ACTN3 577XX genotype was only associated with smaller MMV in men.

Conclusion

Low MMV increased the risk of sarcopenia, particularly in men. BMI and age strongly influenced ASMM, while MMV was only weakly associated with BMI and not with age. Notably, IGF-1 level was positively associated with MMV only, and ACTN3 genotype was associated to reduced MMV only in men.

目的在高危老年人群中，肌肉疏松症会导致颌下肌肉（MM）厚度减少。方法在一项针对 1484 名东京老年人的横断面研究中，我们使用三维磁共振成像扫描评估了肌肉体积、骨骼肌质量（ASMM）、握力、饮食摄入量、吸烟、胰岛素样生长因子 1（IGF-1）水平和 ACTN3 R577X 多态性。结果我们研究的参与者平均年龄为（73.0 ± 5.3）岁，男性的MMV（男性：35.3 ± 7.8 mL，女性：25.0 ± 5.1 mL）明显高于女性。观察发现，MMV 与肌肉疏松症之间存在明显联系，在男女中，最低五分位数（Q1）与最高五分位数（Q5）相比风险更高。体重指数（BMI）和年龄是男女性肌肉萎缩症的独立决定因素，而体重指数则是肌肉萎缩症的决定因素，但有趣的是，体重指数与年龄无关。此外，IGF-1与男女的MMV呈正相关；吸烟与女性的MMV呈负相关。ACTN3 577XX 基因型只与男性较小的 MMV 有关。体重指数和年龄对 ASMM 有很大影响，而 MMV 与体重指数的关系较弱，与年龄的关系不大。值得注意的是，IGF-1 水平仅与 MMV 呈正相关，而 ACTN3 基因型仅与男性 MMV 减少相关。

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引用次数: 0

Kidney growth progression patterns in autosomal dominant polycystic kidney disease 常染色体显性多囊肾的肾脏发育模式

IF 4.7 3区医学 Q1 MEDICINE, RESEARCH & EXPERIMENTAL

Archives of Medical Research

Pub Date : 2024-10-10 DOI: 10.1016/j.arcmed.2024.103099

Aaron Pérez-Segovia , Gabriel Cojuc-Konigsberg , Estefania Reul-Linares , Elisa Naomi Hernández-Paredes , Mónica Chapa-Ibargüengoitia , Juan C. Ramírez-Sandoval

Background

Prognosis for autosomal dominant polycystic kidney disease (ADPKD), the main inherited cause of kidney failure, relies on estimating cystic growth using linear formulas derived from height-adjusted total kidney volume (Ht-TKV). However, nonlinear renal growth patterns may occur in typical ADPKD.

Aims

To determine kidney outcomes of subjects diagnosed with typical ADPKD exhibiting nonlinear, and unpredictable cystic growth during follow-up.

Methods

Retrospective cohort study. We categorized TKV changes in individuals with typical ADPKD according to observed kidney growth trajectories. Ht-TKV was calculated from consecutive CT or MRI using the ellipsoid method. We compared estimated glomerular filtration rate (eGFR) trajectories with linear mixed models.

Results

We included 83 individuals with ADPKD (67% women; age 47 ± 12 years; follow-up 5.2 years [IQR 2.8–9.0]). Three kidney growth patterns were observed: slow progression (24%, <3%/year linear increase), fast progression (39%, ≥3%/year linear increase), and atypical progression (37%, nonlinear growth). Adjusted ht-TKV change in mL/m/year was +1.4 (IQR –4.5 to +10.0), +40.3 (+16.9 to +89.3), and +32.8 (+15.9 to +85.9) for slow, fast, and atypical progressors, respectively (p < 0.001). Atypical progressors exhibited a significantly greater decline in eGFR in mL/min/m²/year (–7.9, 95% CI –6.5, –3.9) compared to slow (–0.5, 95% CI –3.1 to +0.5) and fast progressors (–3.4, 95% CI –7.9, –2.0; between-group p < 0.001). Atypical progressors had a higher proportion of acute complications, including hemorrhages, infections, and urolithiasis (84%), compared to slow (20%) and fast progressors (31%) (p < 0.001).

Conclusion

In typical ADPKD, nonlinear, abrupt, and unpredictable cyst growth occurs frequently, leading to a higher risk of acute complications and kidney function decline.

背景：常染色体显性多囊肾病（ADPKD）是导致肾衰竭的主要遗传性疾病，其预后依赖于根据身高调整肾脏总体积（Ht-TKV）得出的线性公式来估计囊肿的生长情况。然而，在典型的 ADPKD 中可能会出现非线性的肾脏生长模式。目的：确定被诊断为典型 ADPKD 的受试者在随访期间表现出非线性和不可预测的囊性生长的肾脏预后：方法：回顾性队列研究。我们根据观察到的肾脏生长轨迹对典型 ADPKD 患者的 TKV 变化进行了分类。Ht-TKV采用椭圆体法从连续CT或MRI中计算得出。我们用线性混合模型比较了估计的肾小球滤过率（eGFR）轨迹：我们纳入了 83 名 ADPKD 患者（67% 为女性；年龄 47 ± 12 岁；随访 5.2 年 [IQR 2.8-9.0]）。观察到三种肾脏生长模式：进展缓慢（24%，结论：在典型的 ADPKD 患者中，非肾脏生长模式的肾脏生长速度较慢：在典型的 ADPKD 中，非线性、突发性和不可预测的囊肿生长经常发生，导致急性并发症和肾功能下降的风险较高。

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引用次数: 0

Theranostics advances in the treatment and diagnosis of neurological and neurosurgical diseases Theranostics 推进了神经和神经外科疾病的治疗和诊断。

IF 4.7 3区医学 Q1 MEDICINE, RESEARCH & EXPERIMENTAL

Archives of Medical Research

Pub Date : 2024-10-05 DOI: 10.1016/j.arcmed.2024.103085

Wireko Andrew Awuah , Arjun Ahluwalia , Joecelyn Kirani Tan , Vivek Sanker , Sakshi Roy , Adam Ben-Jaafar , Devansh Mitesh Shah , Pearl Ohenewaa Tenkorang , Nicholas Aderinto , Toufik Abdul-Rahman , Oday Atallah , Athanasios Alexiou

Theranostics represents a significant advance in the fields of neurology and neurosurgery, offering innovative approaches that combine the diagnosis and treatment of various neurological disorders. This innovation serves as a cornerstone of personalized medicine, where therapeutic strategies are closely integrated with diagnostic tools to enable precise and targeted interventions. Primary research results emphasize the profound impact of theranostics in Neuro Oncol. In this context, it has provided valuable insights into the complexity of the tumor microenvironment and mechanisms of resistance. In addition, in the field of neurodegenerative diseases (NDs), theranostics has facilitated the identification of distinct disease subtypes and novel therapeutic targets. It has also unravelled the intricate pathophysiology underlying conditions such as cerebrovascular disease (CVD) and epilepsy, setting the stage for more refined treatment approaches. As theranostics continues to evolve through ongoing research and refinement, its goals include further advancing the field of precision medicine, developing practical biomarkers for clinical use, and opening doors to new therapeutic opportunities. Nevertheless, the integration of these approaches into clinical settings presents challenges, including ethical considerations, the need for advanced data interpretation, standardization of procedures, and ensuring cost-effectiveness. Despite these obstacles, the promise of theranostics to significantly improve patient outcomes in the fields of neurology and neurosurgery remains a source of optimism for the future of healthcare.

Theranostics 代表着神经内科和神经外科领域的一大进步，它提供了结合诊断和治疗各种神经系统疾病的创新方法。这一创新是个性化医疗的基石，将治疗策略与诊断工具紧密结合，实现了精确和有针对性的干预。主要研究成果强调了治疗学在神经肿瘤领域的深远影响。在这方面，它为了解肿瘤微环境的复杂性和抗药性机制提供了宝贵的见解。此外，在神经退行性疾病（NDs）领域，治疗技术有助于确定不同的疾病亚型和新的治疗靶点。它还揭示了脑血管疾病（CVD）和癫痫等疾病背后错综复杂的病理生理学，为更精细的治疗方法奠定了基础。随着治疗学通过不断的研究和完善而持续发展，其目标包括进一步推进精准医疗领域的发展、开发临床使用的实用生物标记物，以及为新的治疗机会打开大门。然而，将这些方法整合到临床环境中也面临着挑战，包括伦理方面的考虑、对高级数据解读的需求、程序的标准化以及确保成本效益。尽管存在这些障碍，但治疗学有望在神经内科和神经外科领域显著改善患者的治疗效果，这仍然是未来医疗保健的乐观源泉。

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引用次数: 0