1,720,980 research outputs found
Ultrasound unveiling: Decoding venous congestion in heart failure for precision management of fluid status
No full textThis editorial discusses the manuscript by Di Maria et al, published in the recent issue of the World Journal of Cardiology. We here focus on the still elusive pathophysiological mechanisms underlying cardio-renal syndrome (CRS), despite its high prevalence and the substantial worsening of both kidney function and heart failure. While the measure of right atrial pressure through right cardiac catheterization remains the most accurate albeit invasive and costly procedure, integrating bedside ultrasound into diagnostic protocols may substantially enhance the staging of venous congestion and guide therapeutic decisions. In particular, with the assessment of Doppler patterns across multiple venous districts, the Venous Excess Ultrasound (VExUS) score improves the management of fluid overload and provides insight into the underlying factors contributing to cardio-renal interactions. Integrating specific echocardiographic parameters, particularly those concerning the right heart, may thus improve the VExUS score sensitivity, offering perspective into the nuanced comprehension of cardio-renal dynamics. A multidisciplinary approach that consistently incorporates the use of ultrasound is emerging as a promising advance in the understanding and management of CRS
CAR T therapy from haematological malignancies to aging-related diseases: An ever-expanding universe
No full textBackground: Short but impactful, the two-decade story of gene editing allowed a significant breakthrough in the treatment of haematological malignancies. However, despite different generations of chimeric antigen receptor T (CAR T), such a successful therapy has not yet been replicated in solid tumours and non-oncological diseases. Methods: This narrative review discusses how CAR T therapy still faces challenges in overcoming the complexity of the solid tumour microenvironment and the concerns that its long-term activity raises about potential unknown and unpredictable consequences in non-oncological diseases. Results: In the most recent studies, the senolytic potential of CAR T is becoming an exciting field of research. Still, experimental but promising results indeed indicate the clearance of senescent cells as an effective strategy to improve exercise capacity and metabolic dysfunction in physiological ageing, with long-term therapeutic and preventive effects. However, an effective expansion of a CAR T population requires a lympho-depleting chemotherapy prior to infusion. While this procedure sounds reasonable for rescue therapy of oncological diseases, it poses genotoxic risks that may not be justified for non-malignant diseases. Those represent the leading gaps for applying CAR T therapy in non-oncological diseases. Conclusion: More is expected from current studies on the other classes of CAR cells now under investigation. Engineering NK cells and macrophages are candidates to improve cytotoxic and immunomodulating properties, potentially able to broaden application in solid tumours and non-oncological diseases. Finally, engineering autologous T cells in old individuals may generate biologically deteriorated CAR T clones with impaired function and unpredictable effects on cytokine release
Inflammatory biomarkers as cost-effective predictive tools in metabolic dysfunction-associated fatty liver disease
No full textQu and Li emphasize a fundamental aspect of metabolic dysfunction-associated fatty liver disease in their manuscript, focusing on the critical need for noninvasive diagnostic tools to improve risk stratification and predict the progression to severe liver complications. Affecting approximately 25% of the global population, metabolic dysfunction-associated fatty liver disease is the most common chronic liver condition, with higher prevalence among those with obesity. This letter stresses the importance of early diagnosis and intervention, especially given the rising incidence of obesity and metabolic syndrome. Research advancements provide insight into the potential of biomarkers (particularly inflammation-related) as predictive tools for disease progression and treatment response. This overview addresses pleiotropic biomarkers linked to chronic inflammation and cardiometabolic disorders, which may aid in risk stratification and treatment efficacy monitoring. Despite progress, significant knowledge gaps remain in the clinical application of these biomarkers, necessitating further research to establish standardized protocols and validate their utility in clinical practice. Understanding the complex interactions among these factors opens new avenues to enhance risk assessment, leading to better patient outcomes and addressing the public health burden of this worldwide condition
Navigating the autophagic landscape: Epigenetic modulation in gastrointestinal cancer
No full textThis editorial comments on the manuscript by Chang et al, focusing on the still elusive interplay between epigenetic regulation and autophagy in gastrointestinal diseases, particularly cancer. Autophagy, essential for cellular homeostasis, exhibits diverse functions ranging from cell survival to death, and is particularly implicated in physiological gastrointestinal cell functions. However, its role in pathological backgrounds remains intricate and context-dependent. Studies underscore the dual nature of autophagy in cancer, where its early suppressive effects in early stages are juxtaposed with its later promotion, contributing to chemoresistance. This discrepancy is attributed to the dysregulation of autophagy-related genes and their intricate involvement in cellular processes. Epigenetic modifications and regulations of gene expression, including non-coding RNAs (ncRNAs), emerge as critical players in exerting regulatory control over autophagy flux, influencing treatment responses and tumor progression. Targeting epigenetic mechanisms and improving strategies involving the inhibition or induction of autophagy through pharmacological or genetic means present potential avenues to sensitize tumor cells to chemotherapy. Additionally, nanocarrier-based delivery of ncRNAs offers innovative therapeutic approaches. Understanding the intricate interaction between autophagy and ncRNA regula-tion opens avenues for the development of targeted therapies, thereby improving the prognosis of gastrointestinal malignancies with poor outcomes
Artificial intelligence in gastroenterology: Ethical and diagnostic challenges in clinical practice
No full textThis article discusses the manuscript recently published in the World Journal of Gastroenterology, which explores the application of deep learning models in decision-making processes via wireless capsule endoscopy. Integrating artificial intelligence (AI) into gastrointestinal disease diagnosis represents a transformative step toward precision medicine, enhancing real-time accuracy in detecting multi-category lesions at earlier stages, including small bowel lesions and precancerous polyps, ultimately improving patient outcomes. However, the use of AI in clinical settings raises ethical considerations that extend beyond technological potential. Issues of patient privacy, data security, and potential diagnostic biases require careful attention. AI models must prioritize diverse and representative datasets to mitigate inequities and ensure diagnostic accuracy across populations. Furthermore, balancing AI with clinical expertise is crucial, positioning AI as a supportive tool rather than a replacement for physician judgment. Addressing these ethical challenges will support the responsible deployment of AI, through equitable contribution to patient-centered care
Insights into beige phenotype and immune cell dynamics of human epicardial adipose tissue
No full textReimagining risk stratification: Dipeptidyl peptidase 3 in the new era of cardiovascular biomarkers
No full textThe rapid evolution of cardiovascular (CV) research demands innovative strategies to enhance risk stratification, diagnosis, and management. While traditional biomarkers, such as natriuretic peptides and troponins, remain essential, they often fall short due to suboptimal sensitivity and specificity, particularly in complex or early-stage cases. Emerging biomarkers are central to advancing personalized medicine by enabling earlier, more accurate detection of CV diseases and enhancing predictive algorithms, including those powered by artificial intelligence and machine learning. Among these novel biomarkers, dipeptidyl peptidase 3 (DPP3) has recently garnered attention as a highly specific indicator of cardiogenic shock, offering both prognostic value and therapeutic target potential. Released during cellular stress, circulating DPP3 (cDPP3) plays a mechanistic role in myocardial depression and blood pressure regulation, positioning it as a compelling candidate for inclusion in multi-marker panels. Its integration into predictive models could further refine therapeutic decision-making and patient stratification in acute cardiac care. This editorial discusses the clinical value of incorporating cDPP3 into CV biomarker research and advocates its inclusion in next-generation predictive algorithms and real-time decision-support tools. Continued exploration of such biomarkers may enable tailored interventions and improve outcomes in complex CV cases
The role of artificial intelligence in cardiovascular research: Fear less and live bolder
No full textBackground: Artificial intelligence (AI) has captured the attention of everyone, including cardiovascular (CV) clinicians and scientists. Moving beyond philosophical debates, modern cardiology cannot overlook AI's growing influence but must actively explore its potential applications in clinical practice and research methodology. Methods and results: AI offers exciting possibilities for advancing CV medicine by uncovering disease heterogeneity, integrating complex multimodal data, and enhancing treatment strategies. In this review, we discuss the innovative applications of AI in cardiac electrophysiology, imaging, angiography, biomarkers, and genomic data, as well as emerging tools like face recognition and speech analysis. Furthermore, we focus on the expanding role of machine learning (ML) in predicting CV risk and outcomes, outlining a roadmap for the implementation of AI in CV care delivery. While the future of AI holds great promise, technical limitations and ethical challenges remain significant barriers to its widespread clinical adoption. Conclusions: Addressing these issues through the development of high-quality standards and involving key stakeholders will be essential for AI to transform cardiovascular care safely and effectively
Sepsis in elderly patients: the role of neutrophils in pathophysiology and therapy
No full textSepsis is among the most important causes of mortality, particularly within the elderly population. Sepsis prevalence is on the rise due to different factors, including increasing average population age and the concomitant rise in the prevalence of frailty and chronic morbidities. Recent investigations have unveiled a "trimodal" trajectory for sepsis-related mortality, with the ultimate zenith occurring from 60 to 90 days until several years after the original insult. This prolonged temporal course ostensibly emanates from the sustained perturbation of immune responses, persevering beyond the phase of clinical convalescence. This phenomenon is particularly associated with the aging immune system, characterized by a broad dysregulation commonly known as "inflammaging." Inflammaging associates with a chronic low-grade activation of the innate immune system preventing an appropriate response to infective agents. Notably, during the initial phases of sepsis, neutrophils-essential in combating pathogens-may exhibit compromised activity. Paradoxically, an overly zealous neutrophilic reaction has been observed to underlie multi-organ dysfunction during the later stages of sepsis. Given this scenario, discovering treatments that can enhance neutrophil activity during the early phases of sepsis while curbing their overactivity in the later phases could prove beneficial in fighting pathogens and reducing the detrimental effects caused by an overactive immune system. This narrative review delves into the potential key role of neutrophils in the pathological process of sepsis, focusing on how the aging process impacts their functions, and highlighting possible targets for developing immune-modulatory therapies. Additionally, the review includes tables that outline the principal potential targets for immunomodulating agents
Is metabolically healthy obesity shaped by inflammation, gender differences, and fat distribution?
No full textThe obesity epidemic continues to challenge global cardiovascular (CV) health, but not all obesity is equal. Emerging evidence underscores that distinct obesity phenotypes—particularly metabolically healthy vs unhealthy profiles—confer differential CV risks. Recent large-scale studies have revealed that even metabolically healthy obesity (MHO) is associated with an increased risk of adverse CV events, particularly in the context of socioeconomic disadvantage. Central is the role of chronic low-grade inflammation, termed “metaflammation”, which can persist even in the absence of overt metabolic syndrome and is shaped by both gender and fat distribution. Epicardial and visceral adiposity contribute to this pro-inflammatory state and are strongly associated with conditions such as heart failure and atrial fibrillation. Notably, aging and hormonal changes, particularly in women, may destabilize MHO status, increasing CV vulnerability over time. This overview calls for a paradigm shift in cardiometabolic care, moving beyond anthropometric parameters toward a more refined assessment that incorporate inflammatory biomarkers, fat distribution and sex-specific factors. Recognizing these underlying biological and phenotypic differences enables more accurate CV risk stratification and supports the development of precision-based therapeutic strategies. Ultimately, understanding not just who is at risk, but why, is essential to improving prevention and outcomes across diverse populations facing the burden of obesity
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