Search Results for: Innovativo test delle urine per una accuratezza diagnostica del cancro alla prostata

Objective
To predict the level at a specified time and design personalised dosing, we proposed a method (Method 1) for estimating coagulation factor VIII (FVIII) pharmacokinetic (PK) parameters using 4 levels within 48 hours after administering a test dose.

Design
A retrospective study based on virtual populations and real patients.

Setting
A comprehensive hospital in China.

Participants
Virtual populations generated by Monte Carlo simulations and retrospectively collected real patient data.

Methods
PK profiles of FVIII after dosing in the virtual populations were generated from a published population PK model coupled with Monte Carlo simulation. The simulated coagulation factor levels were considered as the reference (Cref). FVIII levels at six sampling points after dosing were estimated with Method 1 and the method proposed by Lisheng Cai (Method 2) and compared with Cref. PK data from three patients with severe haemophilia A were retrospectively collected to further validate the accuracy of the two methods.

Results
In the adult group, the maximum mean deviations for Methods 1 and 2 were 0.43% (±0.35%) and –36.31% (±6.67%), with corresponding maximum root mean square errors (RMSE) of 0.12% and 28.44%, respectively. For the paediatric group, the maximum mean deviations for Methods 1 and 2 were 0.13% (±0.25%) and –34.27% (±6.74%), with maximum RMSEs of 0.05% and 25.33%, respectively. In three actual patients, mean deviations using Method 1 were 0.32%, 1.34% and 0.24%. Mean deviations using Method 2 were 13.37%, –16.86% and 56.66%.

Conclusion
The proposed method for estimating FVIII PK parameters and levels demonstrates high accuracy and has the potential for precision dosing.

Objectives
To investigate the effects of uric-acid-lowering therapy with febuxostat in asymptomatic hyperuricaemic patients with heart failure.

Methods
In this retrospective cohort analysis, we included consecutive hospitalised patients with heart failure and concomitant asymptomatic hyperuricaemia in Yangzhong People’s Hospital from 1 April 2018 through 1 April 2022. Febuxostat was used to lower serum uric acid. The primary endpoint was defined as a composite of cardiovascular death, recurrent hospitalisation and emergency room visit for cardiovascular (CV) reasons. Additional endpoints included changes in echocardiography measures, Kansas City Cardiomyopathy Questionnaire (KCCQ) scores and 6-minute walk test (6MWT) distance from baseline to the most recent clinic visit. Cox analysis was used to determine HR between febuxostat and the control group after adjustment for age, sex, body mass index, serum creatinine, atrial fibrillation and coronary heart disease and the Kaplan-Meier curve was used to describe survival.

Results
979 patients were included in the final analysis (505 in the febuxostat group vs 474 in the control group). In a follow-up duration of 16±9 months, uric acid was significantly lower in the febuxostat group compared with the control group (p

Objectives
We aimed to explore the changes in oculomotor deficiencies during the follow-up of patients with multiple system atrophy (MSA) and Parkinson’s disease (PD), and to investigate the value of dynamic eye movement examination in their differential diagnosis.

Design
This was a cohort study conducted from 2017 to 2023.

Setting
The Movement Disorders Clinic at a tertiary hospital in Beijing, China.

Participants
56 patients with PD and 13 patients with MSA from an initial cohort of over 1100 with parkinsonism were included in the final longitudinal analysis.

Outcome measures
Multisystem evaluations were performed at baseline. Videonystagmography (VNG) was repeated to assess oculomotor dysfunction at baseline and during follow-up. Abnormalities in the fixation and gaze-holding test, without-fixation test, reflexive and memory-guided saccade tests, smooth pursuit test and optokinetic test were qualitatively and quantitatively recorded and statistically analysed.

Results
The median follow-up time of MSA (16 months) was significantly shorter than that of PD (27 months). In MSA, the incidence of abnormalities in fixation and gaze-holding tests (0% vs 30.8%, p=0.030), reflexive saccade tests (46.2% vs 84.6%, p=0.039, with slow saccades increasing from 7.7% to 46.2%, p=0.027) and smooth pursuit tests (38.5% vs 76.9%, p=0.047) increased significantly from baseline to the end of follow-up. In PD, no significant changes were revealed during follow-up.

Conclusions
MSA exhibited more rapid and prominent changes in fixation and gaze-holding tests, reflexive saccades and smooth pursuit tests than PD. Dynamic observation of oculomotor function may aid in the differential diagnosis of Parkinson’s syndrome.

Per l’uso innovativo dell’IA nella scoperta di farmaci e vaccini

Un traguardo storico per la formazione universitaria europea: si è concluso oggi il primo ciclo di MedTec School, l’innovativo corso di Laurea internazionale in Medicina e Chirurgia e Ingegneria Biomedica,…

Introduction
The prevalence of food allergies, particularly IgE-mediated allergies, is rising in developed countries, with cashew nut allergy emerging as a significant public health concern due to its potential for severe anaphylaxis and frequent association with atopic disorders. Cashew nuts are among the most common allergens in Europe and Australia, often involving cosensitisation with pistachios, hazelnuts and other allergens. Diagnosis relies on clinical history, measurement of specific IgE (sIgE) levels, skin prick tests (SPT) and oral food challenges (OFCs). Current management strategies focus on allergen avoidance and emergency interventions, whereas oral immunotherapy (OIT) represents a promising approach to desensitisation. Recent studies, including the NUT CRACKER trial, have reported high desensitisation rates with cashew OIT, although these are associated with a risk of adverse events. This study introduces a novel randomised controlled trial aimed at evaluating the efficacy and safety of cashew immunotherapy in children.

Methods and analysis
This randomised, open-label, parallel-group trial, with a 2:1 allocation ratio, will be conducted at the Department of Paediatric Pneumology and Allergology, Medical University of Warsaw, Poland. Thirty-nine children, aged 4–17 years, with confirmed IgE-mediated cashew allergy via open OFC will be enrolled. Participants in the experimental group will undergo OIT, which involves gradually increasing doses of cashew protein up to a maintenance dose of 1200 mg. The duration of OIT will range from 12 to 60 weeks, depending on individual baseline tolerance. The control group will receive standard management, including strict cashew avoidance and emergency response strategies to accidental exposure, for 1 year.
The primary endpoint is to determine the proportion of participants tolerating a 4043 mg dose of cashew protein at the study’s end in the OIT group compared with the control group. Secondary outcomes include evaluating the safety profile of OIT, assessing changes in laboratory markers such as sIgE and IgG4 levels for cashew and the major cashew allergen Ana o 3, analysing basophil activation test responses and measuring changes in SPT wheal diameter at baseline and study completion.

Ethics and dissemination
The study has been approved by the Ethics Committee of the Medical University of Warsaw (approval number: KB/267/2023). Study findings will be published in peer-reviewed journals and presented at international conferences.

Trial registration number
NCT06328504.

Discharge summaries are a form of communication between hospital-based and outpatient clinicians. In addition to providing an overview of the hospital course, discharge summaries frequently include information such as abnormal test results, necessary follow-up testing, and medication changes—critical information for ensuring safe continuity of care. Although discharge summaries are a recognized patient safety tool, they are also time-consuming to generate and contribute to the substantial administrative burden placed on clinicians—2 factors strongly associated with the national physician burnout crisis. Enter large language models (LLMs).

This diagnostic study assesses the accuracy of an investigational blood-based circulating tumor DNA test for detection of colorectal cancer in an asymptomatic average-risk population.

A compelling aspect of both medicine and poetry is how each incites us to articulate our perceptions through specific applications of expressive language. In medicine, words are firmly grounded upon what we directly observe; assumptions are discouraged, for concern that unconscious biases might lead to erroneous conclusions. In poetry, on the other hand, what we see is often just a touchstone for what we can infer, our imaginations unbounded by an idiom that senses as much as it describes. These two modes of comprehending are instructively contrasted in “The Morning After the Election.” We are at first dropped into a narrative about a father and a daughter, reckoning momentarily that the daughter “who had once been his son” and now living far away has been rejected by her family—until the poetically appreciated detail of “the mustache obscuring his lip quivered” as he describes her new imperilment leads us to a deeper inference instead that he must accept and love her. Additional surprising implications that further test objectivity follow, from the reference to another “perfect” son whose death during childbirth ended the patient’s marriage, which underscores how the speaker may have wrongly construed that the transgender child caused familial strife, to the oversimplified and also partly true (yet in retrospect not entirely so, and thus all the more poignant) reason for the patient’s clinic visit as solely “because his blood pressure is high.” Poetry, by transcending the ostensible and harkening to the intuited, allows us to more fully grasp the complexities of our patients’ experiences.

In JAMA Internal Medicine, Luchsinger et al describe the results of a prespecified secondary analysis of the GRADE clinical trial on cognitive performance. The GRADE trial randomized 3721 patients with type 2 diabetes using metformin at baseline to add either a long-acting insulin, a sulfonylurea, a glucagon-like peptide-1 (GLP-1) agonist, or a dipeptidyl peptidase-4 inhibitor. At 4 years following randomization, cognitive performance was not different between treatment groups across 3 validated cognitive tests. However, worsened glycemic control was associated with modestly lower cognitive test scores. These findings provide important data for clinicians, particularly in light of recent lay press and scientific enthusiasm about GLP-1 agonists for dementia prevention.

Despite a significant decline in colorectal cancer (CRC) incidence and mortality over the past several decades in the US, CRC remains the second leading cause of cancer deaths. Most of these deaths could be prevented if the 42% of Americans aged 45 to 75 years who are not up to date with screening would participate. There is strong evidence supporting screening with lower intestinal endoscopy (ie, colonoscopy or flexible sigmoidoscopy) or repeated rounds of occult blood–based stool screening tests. These screening tests are effective in detecting cancer at early, curable stages as well as preventing cancer through detection and removal of advanced precancerous lesions, including adenomas and serrated colorectal lesions. Despite public awareness campaigns, organized screening (eg, programmatic mailed stool-based tests), and patient decision aids and navigation, participation is suboptimal, and closing the screening gap remains elusive. This gap may result from reluctance to complete screening due to inconvenience, discomfort, embarrassment, aversion to handling stool, or fear of complications. The ideal CRC screening test would be noninvasive and acceptable to those being screened, be highly sensitive for both early cancer and advanced precancerous lesions, have excellent specificity, and be widely accessible. All of the currently available CRC screening test options fall short of this ideal in at least 1 way, limiting their effectiveness. Thus, there is an ongoing search for more agreeable screening test options.

This Viewpoint examines the use of blood-based biomarkers to test for Alzheimer disease and outlines why they should not be the first or only tool used in screening for cognitive impairment.

This Viewpoint examines the urinary nitrite test and questions its effectiveness and relevance in distinguishing between urinary tract infection and asymptomatic bacteriuria.

Introduction
Exercise training is recommended as a complementary treatment in postural orthostatic tachycardia syndrome (POTS) according to international guidelines. However, less is known regarding how exercise training could successfully be implemented in clinical practice in patients with POTS. Thus, in the current study, we aim to assess the effect of a 16-week tailored exercise training programme in POTS.

Methods and analysis
A total of 200 patients diagnosed with POTS will be recruited. The study will be conducted as a randomised cross-over study. POTS symptoms will be evaluated using the Malmö POTS Symptom Score, Orthostatic Hypotension Questionnaire and 36-item Short Form Health Survey. Haemodynamic parameters will be evaluated by orthostatic tests and maximum working capacity evaluated by bicycle exercise test. Symptoms, haemodynamic parameters and exercise capacity will be assessed before and after a 16-week training programme.

Ethics and dissemination
The study was approved by the Swedish ethical review authority (2022-03186-01) and all procedures will be performed in accordance with the Helsinki Declaration. Results will be made available to patients with POTS, healthcare professionals, the funders and other researchers in publicly available (open access) medical journals.

Trial registration details
NCT05554107, registered on 26 September 2022.

Objectives
The inflammatory response from acute infection may trigger cardiovascular events. We aimed to estimate associations between microbiologically confirmed urinary tract infections (UTIs) and first acute myocardial infarction (MI) and stroke.

Design
We used a self-controlled case series, with risk periods 1–7, 8–14, 15–28 and 29–90 days after UTI. Included individuals experienced the outcome and exposure of interest and acted as their own controls.

Setting
We used individually linked general practice, hospital admission and microbiology data for the population of Wales held by the Secure Anonymised Information Linkage databank.

Participants
Included individuals were Welsh residents aged over 30 years with a record of a hospital admission for MI or stroke (outcomes) and evidence of a microbiologically confirmed UTI (exposure) during the study period of 1 January 2010 to 31 December 2020.

Main outcome measures
The primary outcome was acute MI or stroke identified using the International Classification of Disease V.10 codes from inpatient diagnoses recorded in the Patient Episode Database for Wales. We used Poisson regression to estimate incidence rate ratios (IRRs) and 95% CIs for MI and stroke during predefined risk periods, compared with baseline periods.

Results
During the study period, 51 660 individuals had a hospital admission for MI, of whom 2320 (4.5%) had 3900 microbiologically confirmed UTIs, and 58 150 had a hospital admission for stroke, of whom 2840 (4.9%) had 4600 microbiologically confirmed UTIs. There were 120 MIs during risk periods and 2190 during baseline periods, with an increased risk of MI for 1–7 days following UTI (IRR 2.49, 95% CI (1.65 to 3.77)). There were 200 strokes during risk periods and 2640 during baseline periods, with an increased risk of stroke for 1–7 days following UTI (IRR 2.34, 95% CI (1.61 to 3.40)).

Conclusions
UTI may be a trigger for MI or stroke. Further work is needed to understand mechanisms and test interventions to reduce the risk of cardiovascular events among people with UTIs in primary care.