Clinical status

临床状态
  • 文章类型: Journal Article
    一个随机的,双盲,进行安慰剂对照临床试验以研究英夫利昔单抗的疗效,abatacept,和cenicriviroc治疗COVID-19住院患者。患者的临床状态每天以8点序数量表进行评估。通过考虑每位患者临床状态随时间的所有可能变化,我们评估了3种免疫调节剂功效的全部证据。我们证明,英夫利昔单抗在加入标准治疗时加速了临床状态的改善并减少了临床状态的恶化。也有证据表明abatacept的好处。没有证据表明cenicriviroc有好处。
    A randomized, double-blind, placebo-controlled clinical trial was conducted to investigate the efficacy of infliximab, abatacept, and cenicriviroc in treating patients hospitalized with COVID-19. The patient\'s clinical status was assessed daily on an 8-point ordinal scale. We evaluated the totality of evidence on the efficacy of the 3 immunomodulators by considering all possible changes in the clinical status of each patient over time. We demonstrated that infliximab accelerated improvement and reduced deterioration of clinical status when added to standard of care. There was also evidence for the benefit of abatacept. There was no evidence for the benefit of cenicriviroc.
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  • 文章类型: Journal Article
    近年来,研究人员专注于使用深度神经网络开发阿尔茨海默病(AD)进展的精确模型。通过分析时间序列数据来预测AD的进展是一种有前途的方法。
    这项研究的主要目的是通过整合多任务学习技术和分析相关医学数据来制定一种有效的方法来预测AD的进展。
    这项研究主要利用通过磁共振成像(MRI)获得的体积测量,认知评估的轨迹,和临床状态指标。该研究涵盖了2020年至2022年在北京接受检查的150名诊断为AD的患者,中国。采用多任务学习方法,使用MRI数据训练预测模型,认知评估的轨迹,和临床状态。在各个时间点进行相关性分析。
    在基线处,在预测任务之间观察到了稳健的相关性:体积MRI测量为0.75,认知评估的轨迹为0.62,临床状态为0.48。多任务学习框架的实施将缺失值的估算性能提高了12.7%,将预测精度提高了14.8%。
    我们的研究结果,表明多任务学习可以有效预测AD的进展。然而,重要的是要注意,由于数据集的限制和所检查的特定人群,该研究的普适性可能有限。这些结论代表了朝着更精确的诊断和治疗这种神经系统疾病迈出的重要一步。
    UNASSIGNED: In recent years, researchers have focused on developing precise models for the progression of Alzheimer\'s disease (AD) using deep neural networks. Forecasting the progression of AD through the analysis of time series data represents a promising approach.
    UNASSIGNED: The primary objective of this research is to formulate an effective methodology for forecasting the progression of AD through the integration of multi-task learning techniques and the analysis of pertinent medical data.
    UNASSIGNED: This study primarily utilized volumetric measurements obtained through magnetic resonance imaging (MRI), trajectories of cognitive assessments, and clinical status indicators. The research encompassed 150 patients diagnosed with AD who underwent examination between 2020 and 2022 in Beijing, China. A multi-task learning approach was employed to train forecasting models using MRI data, trajectories of cognitive assessments, and clinical status. Correlation analysis was conducted at various time points.
    UNASSIGNED: At the baseline, a robust correlation was observed among the forecasting tasks: 0.75 for volumetric MRI measurements, 0.62 for trajectories of cognitive assessment, and 0.48 for clinical status. The implementation of a multi-task learning framework enhanced performance by 12.7% for imputing missing values and 14.8% for prediction accuracy.
    UNASSIGNED: The findings of our study, indicate that multi-task learning can effectively predict the progression of AD. However, it is important to note that the study\'s generalizability may be limited due to the restricted dataset and the specific population under examination. These conclusions represent a significant stride toward more precise diagnosis and treatment of this neurological disorder.
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  • 文章类型: Journal Article
    背景:住院COVID-19患者的治疗试验的当前终点仅捕获患者临床过程的一部分,并且统计能力和稳健性有限。
    方法:我们为临床状态的重复测量指定比例赔率模型,随着时间的推移,严重程度普遍降低。我们还指定了比例风险模型,用于临床状态改善或恶化的每个级别的时间,具有总体治疗效益的常见危险比。我们将这些方法应用于适应性COVID-19治疗试验。
    结果:对于remdesivir与安慰剂,共同比值比为1.48(95%置信区间(CI)=1.23-1.79;p<0.001),常见风险比为1.27(95%CI=1.09-1.47;p=0.002)。对于baricitinib+remdesivir与单独的remdesivir,普通比值比为1.32(95%CI=1.10-1.57;p=0.002),常见风险比为1.30(95%CI=1.13-1.49;p<0.001)。对于干扰素β-1a加雷德西韦与单独雷德西韦,普通比值比为0.95(95%CI=0.79-1.14;p=0.56),常见风险比为0.98(95%CI=0.85-1.12;p=0.74)。
    结论:所提出的方法全面表征了对住院COVID-19患者整个临床过程的治疗效果。
    BACKGROUND: The current endpoints for therapeutic trials of hospitalized COVID-19 patients capture only part of the clinical course of a patient and have limited statistical power and robustness.
    METHODS: We specify proportional odds models for repeated measures of clinical status, with a common odds ratio of lower severity over time. We also specify the proportional hazards model for time to each level of improvement or deterioration of clinical status, with a common hazard ratio for overall treatment benefit. We apply these methods to Adaptive COVID-19 Treatment Trials.
    RESULTS: For remdesivir versus placebo, the common odds ratio was 1.48 (95% confidence interval (CI) = 1.23-1.79; p < 0.001), and the common hazard ratio was 1.27 (95% CI = 1.09-1.47; p = 0.002). For baricitinib plus remdesivir versus remdesivir alone, the common odds ratio was 1.32 (95% CI = 1.10-1.57; p = 0.002), and the common hazard ratio was 1.30 (95% CI = 1.13-1.49; p < 0.001). For interferon beta-1a plus remdesivir versus remdesivir alone, the common odds ratio was 0.95 (95% CI = 0.79-1.14; p = 0.56), and the common hazard ratio was 0.98 (95% CI = 0.85-1.12; p = 0.74).
    CONCLUSIONS: The proposed methods comprehensively characterize the treatment effects on the entire clinical course of a hospitalized COVID-19 patient.
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  • 文章类型: Journal Article
    背景:自杀是全球范围内最可预防的死亡原因之一。STRONG研究的目的是通过心理社会功能的变化来评估自杀企图者中称为iFightDepression-SurVIVE(iFD-S)的特定干预措施(扩展安全计划干预措施)的有效性。作为次要结果,生活质量,认知表现,将考虑临床状态和神经影像学相关因素。
    目的:为了描述STRONG研究的基本原理和设计,生存研究的延伸,关于自杀未遂者预防的国家多中心队列研究。
    方法:STRONG研究是一项为期两年的临床试验。60名患者的总样本将被随机分配到两个组:一组将接受iFD-S和照常治疗(TAU)(n=30治疗组),而另一组将独家接受TAU(n=30对照组)。将有三个研究点:基线;3个月;和6个月的随访评估,所有这些都将包括对心理社会功能的评估者盲化评估,生活质量,临床状态,认知表现和神经影像学采集。
    结果:预计将获得关于iFD-S在自杀未遂患者中的疗效的数据。
    结论:结果将为IFD-S在改善心理社会功能方面的效果提供见解。生活质量,认知,和神经成像相关。
    NCT05655390。
    BACKGROUND: Suicide is one of the most largely preventable causes of death worldwide. The aim of the STRONG study is to assess the effectiveness of a specific intervention (an extended Safety Planning Intervention) called iFightDepression-SURVIVE (iFD-S) in suicidal attempters by changes in psychosocial functioning. As secondary outcomes, quality of life, cognitive performance, clinical state and neuroimaging correlates will be considered.
    OBJECTIVE: To describe the rationale and design of the STRONG study, an extension of the SURVIVE study, a national multicenter cohort about on prevention in suicidal attempters.
    METHODS: The STRONG study is a two-year clinical trial. A total sample of 60 patients will be randomly allocated to two arms: a group will receive a iFD-S and treatment as usual (TAU) (n=30 treatment group), while another group will exclusively receive TAU (n=30 control group). There will be three study points: baseline; 3-month; and 6-month follow-up assessments, all of which will include rater-blinded evaluation of psychosocial functioning, quality of life, clinical state, cognitive performance and neuroimaging acquisition.
    RESULTS: It is expected to obtain data on the efficacy of iFD-S in patients who have committed a suicide attempt.
    CONCLUSIONS: Results will provide insight into the effectiveness of IFD-S in suicidal attempters with respect to improvements in psychosocial functioning, quality of life, cognition, and neuroimaging correlates.
    UNASSIGNED: NCT05655390.
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  • 文章类型: Journal Article
    p.Asn1303Lys(N1303K)是CFTR基因的常见错义变异体,引起囊性纤维化(CF)。在这项研究中,我们最初评估了CFTR调节剂对N1303K-CFTR功能恢复的影响,使用来自四名表达N1303K变体的CF患者的肠道类器官。Forskolin在类器官中诱导的肿胀测定提供了有关VX-770VX-661VX-445(ElexacaftorTezacaftorIvacaftor,ETI)关于N1303K-CFTR功能恢复以及关于不鼓励N1303K/I类患者的VX-770VX-809(IvacaftorLumacaftor)或VX-770VX-661(IvacaftorTezacaftor)治疗的处方。然后,对一名N1303K/I类基因型患者的例子进行了全面评估,以检查ETI对N1303K-CFTR功能恢复的影响,使用体外患者的肠道类器官,体外肠电流测量(ICM)方法和评估靶向治疗前后的临床状态。所有获得的结果彼此一致,并且已经证明了ETI对于N1303K变体的有效性。ETI对N1303K/I类器官中毛喉素诱导的肿胀产生了显着的积极作用,表明CFTR蛋白的功能改善;ICM证明ETI治疗在治疗三个月后恢复了肠上皮的CFTR功能,患者的临床状况和肺功能得到改善,增加了他的身体质量指数(BMI),减少了肺部致病菌群的多样性,令人惊讶的是,没有改善汗液测试结果。
    p.Asn1303Lys (N1303K) is a common missense variant of the CFTR gene, causing cystic fibrosis (CF). In this study, we initially evaluated the influence of CFTR modulators on the restoration of N1303K-CFTR function using intestinal organoids derived from four CF patients expressing the N1303K variant. The forskolin-induced swelling assay in organoids offered valuable insights about the beneficial effects of VX-770 + VX-661 + VX-445 (Elexacaftor + Tezacaftor + Ivacaftor, ETI) on N1303K-CFTR function restoration and about discouraging the prescription of VX-770 + VX-809 (Ivacaftor + Lumacaftor) or VX-770 + VX-661 (Ivacaftor + Tezacaftor) therapy for N1303K/class I patients. Then, a comprehensive assessment was conducted on an example of one patient with the N1303K/class I genotype to examine the ETI effect on the restoration of N1303K-CFTR function using in vitro the patient\'s intestinal organoids, ex vivo the intestinal current measurements (ICM) method and assessment of the clinical status before and after targeted therapy. All obtained results are consistent with each other and have proven the effectiveness of ETI for the N1303K variant. ETI produced a significant positive effect on forskolin-induced swelling in N1303K/class I organoids indicating functional improvement of the CFTR protein; ICM demonstrated that ETI therapy restored CFTR function in the intestinal epithelium after three months of treatment, and the patient improved his clinical status and lung function, increased his body mass index (BMI) and reduced the lung pathogenic flora diversity, surprisingly without improving the sweat test results.
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  • 文章类型: Journal Article
    结直肠癌(CRC)是全球第三大最常见的癌症,转移性CRC是一种致命疾病。受CRC影响的组织显示了几种分子标记,可以用作新的策略来创建治疗该疾病的新方法。肝脏和腹膜是转移最频繁发生的地方。一旦肿瘤转移到肝脏,腹膜癌通常被认为是疾病的最后阶段。然而,近50%的腹膜癌CRC患者没有肝转移.必须开发新的诊断和治疗方法,因为该疾病在晚期阶段对目前的治疗选择反应不佳,并且需要在早期阶段进行准确诊断。在纳米技术中可能会发现许多独特而惊人的纳米材料,这些材料有望用于诊断和治疗。许多纳米材料和纳米配方,包括碳纳米管,树枝状聚合物,脂质体,二氧化硅纳米颗粒,金纳米粒子,金属有机框架,核壳聚合物纳米配方,和纳米乳液系统,其中,可用于CRC的靶向抗癌药物递送和诊断目的。与纳米医学结合的Theranostic方法已被提出作为改进CRC检测和治疗的革命性方法。这篇综述强调了最近的研究,潜力,以及用于检测和治疗CRC的纳米平台开发的挑战。
    Colorectal cancer (CRC) is the third most common cancer worldwide, and metastatic CRC is a fatal disease. The CRC-affected tissues show several molecular markers that could be used as a fresh strategy to create newer methods of treating the condition. The liver and the peritoneum are where metastasis occurs most frequently. Once the tumor has metastasized to the liver, peritoneal carcinomatosis is frequently regarded as the disease\'s final stage. However, nearly 50% of CRC patients with peritoneal carcinomatosis do not have liver metastases. New diagnostic and therapeutic approaches must be developed due to the disease\'s poor response to present treatment choices in advanced stages and the necessity of an accurate diagnosis in the early stages. Many unique and amazing nanomaterials with promise for both diagnosis and treatment may be found in nanotechnology. Numerous nanomaterials and nanoformulations, including carbon nanotubes, dendrimers, liposomes, silica nanoparticles, gold nanoparticles, metal-organic frameworks, core-shell polymeric nano-formulations, and nano-emulsion systems, among others, can be used for targeted anticancer drug delivery and diagnostic purposes in CRC. Theranostic approaches combined with nanomedicine have been proposed as a revolutionary approach to improve CRC detection and treatment. This review highlights recent studies, potential, and challenges for the development of nanoplatforms for the detection and treatment of CRC.
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  • 文章类型: Journal Article
    物质使用障碍(SUD)是在全球范围内急剧加剧的主要精神疾病之一。由于治疗选择有限,它变得势不可挡。成瘾障碍的复杂性是理解疾病病理生理学的主要障碍。因此,通过基础研究揭示大脑的复杂性,鉴定新的信号通路,发现新的药物靶点,尖端技术的进步将有助于控制这种疾病。此外,通过治疗性抗体和疫苗等免疫治疗措施控制SUD的希望很大。疫苗在消除小儿麻痹症等许多疾病方面发挥了重要作用,麻疹,还有天花.Further,疫苗控制了许多疾病,如霍乱,登革热,白喉,b型流感嗜血杆菌(Hib),人乳头瘤病毒,流感,日本脑炎,等。最近,COVID-19在许多国家通过疫苗接种得到控制。目前,不断努力开发针对尼古丁的疫苗,可卡因,吗啡,甲基苯丙胺,和海洛因。针对SUD的抗体治疗是需要认真关注的另一个重要领域。抗体对白喉等许多严重疾病有很大的帮助,狂犬病,克罗恩病,哮喘,类风湿性关节炎,和膀胱癌。由于其在癌症治疗中的成功率,抗体治疗获得了巨大的动力。此外,由于具有长半衰期的高效人源化抗体的产生,在抗体治疗方面取得了巨大的进步。抗体疗法的优势在于其即时结果。本文的重点是讨论SUDs的药物靶点及其相关机制。重要的是,我们还讨论了消除药物依赖的预防措施的范围。
    Substance Use Disorder (SUD) is one of the major mental illnesses that is terrifically intensifying worldwide. It is becoming overwhelming due to limited options for treatment. The complexity of addiction disorders is the main impediment to understanding the pathophysiology of the illness. Hence, unveiling the complexity of the brain through basic research, identification of novel signaling pathways, the discovery of new drug targets, and advancement in cutting-edge technologies will help control this disorder. Additionally, there is a great hope of controlling the SUDs through immunotherapeutic measures like therapeutic antibodies and vaccines. Vaccines have played a cardinal role in eliminating many diseases like polio, measles, and smallpox. Further, vaccines have controlled many diseases like cholera, dengue, diphtheria, Haemophilus influenza type b (Hib), human papillomavirus, influenza, Japanese encephalitis, etc. Recently, COVID-19 was controlled in many countries by vaccination. Currently, continuous effort is done to develop vaccines against nicotine, cocaine, morphine, methamphetamine, and heroin. Antibody therapy against SUDs is another important area where serious attention is required. Antibodies have contributed substantially against many serious diseases like diphtheria, rabies, Crohn\'s disease, asthma, rheumatoid arthritis, and bladder cancer. Antibody therapy is gaining immense momentum due to its success rate in cancer treatment. Furthermore, enormous advancement has been made in antibody therapy due to the generation of high-efficiency humanized antibodies with a long half-life. The advantage of antibody therapy is its instant outcome. This article\'s main highlight is discussing the drug targets of SUDs and their associated mechanisms. Importantly, we have also discussed the scope of prophylactic measures to eliminate drug dependence.
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  • 文章类型: Randomized Controlled Trial
    对COVID-19研究的初步见解令人失望,这表明有必要加大寻找替代策略的力度。在这方面,有人提出瑜伽的辅助潜力可以提高COVID-19管理方面的护理标准的有效性。我们测试了瑜伽干预的远程模型是否可以帮助轻中度COVID-19住院患者在补充护理标准时更好的临床管理。
    这是一项在NarayanaHrudyalaya进行的随机对照试验,班加罗尔,印度,2021年5月31日至7月22日纳入的轻中度COVID-19感染住院患者。患者(n=225)以1:1的比例随机分配[辅助远程瑜伽(n=113)或标准护理]。辅助瑜伽组在随机分组后4小时内接受远程模式干预,直到14天,以及标准护理。主要结果是随机分组后第14天的临床状态,用七类序数量表进行评估。次要结果集包括第7天的COVID结果量表评分,第28天的临床状态随访和全因死亡率,在医院的日子,随机化后第5天病毒载量变化,以循环阈值(Ct)表示,以及第14天的炎症标志物和感知压力评分。
    与单独的护理标准相比,辅助远程瑜伽组在第14天的7分序数量表上得分较高的比例几率为~1.8(OR=1.83,95%CI,1.11~3.03).在第5天,与单独的标准护理相比,辅助瑜伽组的CRP(P=0.001)和LDH水平(P=0.029)显着降低。还观察到CRP降低是瑜伽诱导的临床结果改善的潜在介质。第28天全因死亡率的Kaplan-Meier估计为0.26的校正风险比(HR)(95%CI,0.05-1.30)。
    在第14天观察到的COVID-19患者的临床状态改善了1.8倍,辅助使用远程瑜伽证明了其在医院环境中作为补充治疗的用途。
    The initial insights from the studies on COVID-19 had been disappointing, indicating the necessity of an aggravated search for alternative strategies. In this regard, the adjunct potential of yoga has been proposed for enhancing the effectiveness of the standard of care with respect to COVID-19 management. We tested whether a telemodel of yoga intervention could aid in better clinical management for hospitalized patients with mild-to-moderate COVID-19 when complemented with the standard of care.
    This was a randomized controlled trial conducted at the Narayana Hrudyalaya, Bengaluru, India, on hospitalized patients with mild-to-moderate COVID-19 infection enrolled between 31 May and 22 July 2021. The patients (n = 225) were randomized in a 1:1 ratio [adjunct tele-yoga (n = 113) or standard of care]. The adjunct yoga group received intervention in tele-mode within 4-h post-randomization until 14 days along with the standard of care. The primary outcome was the clinical status on day 14 post-randomization, assessed with a seven-category ordinal scale. The secondary outcome set included scores on the COVID Outcomes Scale on day 7, follow-up for clinical status and all-cause mortality on day 28, post-randomization, duration of days at the hospital, 5th-day changes post-randomization for viral load expressed as cyclic threshold (Ct), and inflammatory markers and perceived stress scores on day 14.
    As compared with the standard of care alone, the proportional odds of having a higher score on the 7-point ordinal scale on day 14 were ~1.8 for the adjunct tele-yoga group (OR = 1.83, 95% CI, 1.11-3.03). On day 5, there were significant reductions in CRP (P = 0.001) and LDH levels (P = 0.029) in the adjunct yoga group compared to the standard of care alone. CRP reduction was also observed as a potential mediator for the yoga-induced improvement of clinical outcomes. The Kaplan-Meier estimate of all-cause mortality on day 28 was the adjusted hazard ratio (HR) of 0.26 (95% CI, 0.05-1.30).
    The observed 1.8-fold improvement in the clinical status on day 14 of patients of COVID-19 with adjunct use of tele-yoga contests its use as a complementary treatment in hospital settings.
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  • 文章类型: Editorial
    暂无摘要。
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  • 文章类型: Journal Article
    内脏利什曼病(VL)是所有利什曼病中最致命的疾病,是仅次于疟疾的第二大最常见的寄生虫疾病,仍然,被归类为被忽视的热带病(NTD)。根据世界卫生组织的最新研究,>20种利什曼原虫每年传播0.7-100万新的利什曼病病例。VL是由属引起的,利什曼尼亚多诺瓦尼(LD),每年影响全球5万至9万人。缺乏新药开发,增加耐药性,即使使用两性霉素B(AmB)的一线治疗,毒性和高成本,需要治疗VL的新配方。此外,缺乏疫苗,允许研究人员开发基于纳米模拟的AmB以改善分娩。AmB的限制是其肾和肝毒性,这迫使开发昂贵的脂质体AmB(AmBisome)纳米制剂。AmBisome的成功激发并吸引了广泛的AmB纳米制剂,固体脂质,脂质体/胶束,金属,巨噬细胞受体靶向纳米颗粒(NP),甚至具有复杂的基于碳/量子点的AmBnano递送系统。值得注意的是,由于摄取增加,基于NP的AmB递送显示出增加的功效,NP和AmB的靶向递送和协同影响。在这次审查中,我们已经讨论了利什曼病的不同形式及其目前的治疗方案。的发现,AmB的作用机制,进一步讨论了AmB的临床状况以及AmBisome对VL治疗的抗真菌剂(AmB-脱氧胆酸盐)的改善作用.最后,讨论了各种AmB纳米制剂的发展及其优于传统化疗给药的优势.
    Visceral leishmaniasis (VL) is the most lethal of all leishmaniasis diseasesand the second most common parasiticdisease after malaria and,still, categorized as a neglected tropical disease (NTD). According to the latest WHO study, >20 Leishmania species spread 0.7-1.0 million new cases of leishmaniasis each year. VL is caused by the genus, Leishmania donovani (LD), which affects between 50,000 and 90,000 people worldwide each year. Lack of new drug development, increasing drug resistance, toxicity and high cost even with the first line of treatmentof Amphotericin B (AmB), demands new formulation for treatment of VLFurther the lack of a vaccine, allowedthe researchers to develop nanofomulation-based AmB for improved delivery. The limitation of AmB is its kidney and liver toxicity which forced the development of costly liposomal AmB (AmBisome) nanoformulation. Success of AmBisome have inspired and attracted a wide range of AmB nanoformulations ranging from polymeric, solid lipid, liposomal/micellar, metallic, macrophage receptor-targetednanoparticles (NP) and even with sophisticated carbon/quantum dot-based AmBnano delivery systems. Notably, NP-based AmB delivery has shown increased efficacy due to increased uptake, on-target delivery and synergistic impact of NP and AmB. In this review, we have discussed the different forms of leishmaniasis disease and their current treatment options with limitations. The discovery, mechanism of action of AmB, clinical status of AmB and improvement with AmBisome over fungizone (AmB-deoxycholate)for VL treatment was further discussed. At last, the development of various AmB nanoformulation was discussed along with its adavantages over traditional chemotherapy-based delivery.
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