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- 2019
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Tidskriftsartikel (refereegranskat)
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| 2. |
- Ahmad, Abrar, et al.
(författare)
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Precision Prognostics for Cardiovascular Disease in Type 2 Diabetes : A Systematic Review and Meta-analysis
- 2023
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- BACKGROUND: Precision medicine has the potential to improve cardiovascular disease (CVD) risk prediction in individuals with type 2 diabetes (T2D).METHODS: We conducted a systematic review and meta-analysis of longitudinal studies to identify potentially novel prognostic factors that could improve CVD risk prediction in T2D. Out of 9380 studies identified, 416 studies met inclusion criteria. Outcomes were reported for 321 biomarker studies, 48 genetic marker studies, and 47 risk score/model studies.Out of all evaluated biomarkers, only 13 showed improvement in prediction performance. Results of pooled meta-analyses, non-pooled analyses, and assessments of improvement in prediction performance and risk of bias, yielded the highest predictive utility for N-terminal pro b-type natriuretic peptide (NT-proBNP) (high-evidence), troponin-T (TnT) (moderate-evidence), triglyceride-glucose (TyG) index (moderate-evidence), Genetic Risk Score for Coronary Heart Disease (GRS-CHD) (moderate-evidence); moderate predictive utility for coronary computed tomography angiography (low-evidence), single-photon emission computed tomography (low-evidence), pulse wave velocity (moderate-evidence); and low predictive utility for C-reactive protein (moderate-evidence), coronary artery calcium score (low-evidence), galectin-3 (low-evidence), troponin-I (low-evidence), carotid plaque (low-evidence), and growth differentiation factor-15 (low-evidence). Risk scores showed modest discrimination on internal validation, with lower performance on external validation.CONCLUSIONS: Despite high interest in this topic, very few studies conducted rigorous analyses to demonstrate incremental predictive utility beyond established CVD risk factors for T2D. The most promising markers identified were NT-proBNP, TnT, TyG and GRS-CHD, with the highest strength of evidence for NT-proBNP. Further research is needed to determine their clinical utility in risk stratification and management of CVD in T2D.PLAIN LANGUAGE SUMMARY: Patients with T2D are at high risk for CVD but predicting who will experience a cardiac event is challenging. Current risk tools and prognostic factors, such as laboratory tests, may not accurately predict risk in different patient populations. There is a need for personalized risk prediction tools to identify patients more accurately so that CVD prevention can be targeted to those who need it most. This study examined novel biomarkers, genetic markers, and risk scores on the prediction of CVD in individuals with T2D. We found that four laboratory markers and a genetic risk score for CHD had high predictive utility beyond traditional CVD risk factors and that risk scores had modest predictive utility when tested in diverse populations, but more studies are needed to determine their usefulness in clinical practice. The highest strength of evidence was observed for NT-proBNP, a laboratory test currently used to monitor patients with heart failure but not currently used in clinical practice for the purpose of CVD prediction in T2D.
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| 3. |
- Ahmad, Abrar, et al.
(författare)
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Precision prognostics for cardiovascular disease in Type 2 diabetes : a systematic review and meta-analysis
- 2024
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Ingår i: Communications medicine. - 2730-664X. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Precision medicine has the potential to improve cardiovascular disease (CVD) risk prediction in individuals with Type 2 diabetes (T2D).METHODS: We conducted a systematic review and meta-analysis of longitudinal studies to identify potentially novel prognostic factors that may improve CVD risk prediction in T2D. Out of 9380 studies identified, 416 studies met inclusion criteria. Outcomes were reported for 321 biomarker studies, 48 genetic marker studies, and 47 risk score/model studies.RESULTS: Out of all evaluated biomarkers, only 13 showed improvement in prediction performance. Results of pooled meta-analyses, non-pooled analyses, and assessments of improvement in prediction performance and risk of bias, yielded the highest predictive utility for N-terminal pro b-type natriuretic peptide (NT-proBNP) (high-evidence), troponin-T (TnT) (moderate-evidence), triglyceride-glucose (TyG) index (moderate-evidence), Genetic Risk Score for Coronary Heart Disease (GRS-CHD) (moderate-evidence); moderate predictive utility for coronary computed tomography angiography (low-evidence), single-photon emission computed tomography (low-evidence), pulse wave velocity (moderate-evidence); and low predictive utility for C-reactive protein (moderate-evidence), coronary artery calcium score (low-evidence), galectin-3 (low-evidence), troponin-I (low-evidence), carotid plaque (low-evidence), and growth differentiation factor-15 (low-evidence). Risk scores showed modest discrimination, with lower performance in populations different from the original development cohort.CONCLUSIONS: Despite high interest in this topic, very few studies conducted rigorous analyses to demonstrate incremental predictive utility beyond established CVD risk factors for T2D. The most promising markers identified were NT-proBNP, TnT, TyG and GRS-CHD, with the highest strength of evidence for NT-proBNP. Further research is needed to determine their clinical utility in risk stratification and management of CVD in T2D.
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| 4. |
- Han, Hedong, et al.
(författare)
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Trends and Utilization of Inpatient Palliative Care Among Patients With Metastatic Bladder Cancer
- 2021
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Ingår i: Journal of Palliative Care. - : Sage Publications. - 0825-8597 .- 2369-5293. ; 36:2, s. 105-112
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To explore the trends and utilization of palliative care (PC) service among inpatients with metastatic bladder cancer (MBC).METHODS: A retrospective, cross-sectional analysis was performed using data from the 2003 to 2014 National Inpatient Sample. Palliative care was identified through International Classification of Diseases, Ninth Revision code V66.7. Demographics, comorbidities, hospital characteristics, tumor-related, and treatment-related factors were compared between patients with and without PC. Multivariable logistic regression was used to explore predictors of PC use.RESULTS: Among 131 852 patients with MBC, 13 224 (10.03%) received PC. Rate of PC increased from 2.49% in 2003 to 28.39% in 2014 (P < .0001). Similarly, rate of PC in decedents increased from 7.02% in 2003 to 54.86% in 2014 (P < .0001). Patients receiving PC were older, tendered to be white, had more comorbidities, and higher all-patient refined diagnosis-related group mortality risk. Predictors of PC included age (odds ratio [OR]: 1.02; 95% CI: 1.01-1.02; P < .0001), Medicaid (OR: 1.87; 95%.CI: 1.54-2.26; P < .0001), and private (OR: 1.61; 95% CI: 1.40-1.84; P < .0001) insurance, hospitals in the West (OR: 1.33; 95% CI: 1.10-1.61; P = .0032), and Mid-west (OR: 1.46; 95% CI: 1.22-1.75; P = .0032), major (OR: 1.32; 95% CI: 1.11-1.49; P < .0001), and extreme (OR: 2.37; 95% CI: 2.04-2.76; P < .0001) mortality risk. Chemotherapy and mechanical ventilation were related with lower odds of PC use. Palliative care predictors in the decedents were similar to those in overall patients with bladder cancer.CONCLUSIONS: Palliative care encounter in MBC shows an increasing trend. However, it still remains very low. Disparities in PC use covered age, insurance, and hospital characteristics among metastatic bladder cancer in the United States.
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| 5. |
- Tobias, Deirdre K, et al.
(författare)
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Second international consensus report on gaps and opportunities for the clinical translation of precision diabetes medicine
- 2023
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Ingår i: Nature Medicine. - 1546-170X. ; 29:10, s. 2438-2457
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Forskningsöversikt (refereegranskat)abstract
- Precision medicine is part of the logical evolution of contemporary evidence-based medicine that seeks to reduce errors and optimize outcomes when making medical decisions and health recommendations. Diabetes affects hundreds of millions of people worldwide, many of whom will develop life-threatening complications and die prematurely. Precision medicine can potentially address this enormous problem by accounting for heterogeneity in the etiology, clinical presentation and pathogenesis of common forms of diabetes and risks of complications. This second international consensus report on precision diabetes medicine summarizes the findings from a systematic evidence review across the key pillars of precision medicine (prevention, diagnosis, treatment, prognosis) in four recognized forms of diabetes (monogenic, gestational, type 1, type 2). These reviews address key questions about the translation of precision medicine research into practice. Although not complete, owing to the vast literature on this topic, they revealed opportunities for the immediate or near-term clinical implementation of precision diabetes medicine; furthermore, we expose important gaps in knowledge, focusing on the need to obtain new clinically relevant evidence. Gaps include the need for common standards for clinical readiness, including consideration of cost-effectiveness, health equity, predictive accuracy, liability and accessibility. Key milestones are outlined for the broad clinical implementation of precision diabetes medicine.
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| 6. |
- Zhou, Feifei, et al.
(författare)
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ENSO weakens the co-variability between the spring persistent rains and Asian summer monsoon: Evidences from tree-ring data in southeastern China
- 2024
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Ingår i: Journal of Hydrology. - 0022-1694. ; 634
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Tidskriftsartikel (refereegranskat)abstract
- The Spring Persistent Rains (SPR) and the Asian Summer Monsoon (ASM) are the two dominant rainfall systems in East Asia, providing together a majority of annual rainfall in southeastern China (SEC). Since observational data in SEC were mostly unavailable until the 1950s, proxy records that are capable of capturing the SPR and ASM variations are required to examine the long-term co-variability patterns between them. Tree-ring earlywood and latewood δ18O records in SEC were found to respond to relative humidity (RH) during the SPR and ASM seasons, respectively, allowing us, for the first time, to reconstruct the RH changes of SPR and ASM back to 1801. The two reconstructions can explain 44.9 % and 42.3 % of the instrumental variance. We observed a long-lasting wet epoch in the 1920s–60s for both the SPR and ASM, caused by a peak in the land–ocean thermal contrast. The El Niño-Southern Oscillation (ENSO) and the Intertropical Convergence Zone (ITCZ) were found to be the two leading tropical systems that modulated the SPR and ASM co-variability. During a period with weakened ENSO variance, the RH of SPR and ASM showed in-phase changes driven by the ITCZ. However, when the ENSO variance became strengthened, the co-variability collapsed since the ENSO can offset the influence of the ITCZ via teleconnections.
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| 7. |
- Zhou, Feifei, et al.
(författare)
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Summer heat induced the decline of Pinus taiwanensis forests at its southern limit in humid Subtropical China
- 2024
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Ingår i: Agricultural and Forest Meteorology. - 0168-1923. ; 350
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Tidskriftsartikel (refereegranskat)abstract
- Warming-induced aridity has caused forest decline and mortality for many sites with water-limiting conditions. However, equatorward rear-edge Pinus taiwanensis trees at the Daiyun Mountains in humid subtropical China are also suffering die-backs and decline, but the roles played by heat or drought stress still remain unclear. Here, we compared the tree-ring radial width, anatomical features, stable carbon isotope (δ13C) and intrinsic water use efficiency (iWUE) between die-back and healthy trees to elucidate potential causes driving the decline. Die-back trees showed sustained growth reductions and produced tracheids with thinner cell walls over the recent decade, indicative of reduced carbon assimilation. The climate response pattern and Vaganov-Shashkin (V-S) model indicated the critical role of summer (June-August) temperature in recent growth decline. Long-term higher wood δ13C and iWUE within die-back trees indicated that actual growth decline already started several decades earlier. This conservative growth strategy was at the cost of low efficiency of photosynthesis due to chronic stomatal closure. When the lethal heatwaves arrived, these weakened trees were not able to access sufficient carbonhydrates to maintain metabolism, causing a distinct decline and mortality. We concluded that recent decline in Pinus taiwanensis trees was mainly caused by long-term carbon starvation.
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