The widespread use of cross-sectional imaging has increased the incidental detection of small renal masses (SRMs). In this context, overtreatment represents a major concern, particularly for lesions < 2 cm. Most evidence derives from retrospective registries, whereas prospective data remain limited. This multi-center, prospective, non-randomized clinical trial was conducted in five European centers between January 2015 and July 2021. Seventy-six patients aged > 50 years with asymptomatic, unilateral SRM < 2 cm were enrolled and followed under a structured prospective active surveillance (AS) protocol with periodic axial imaging. Active treatment was recommended according to predefined progression criteria or patient preference. The primary endpoint was event-free survival (EFS); secondary endpoints included treatment-free survival (TFS), overall survival (OS), and cancer-specific mortality (CSM). 69 patients were included in the analyses. After a median follow-up of 88 months, 8-year EFS and TFS were 66
Amyotrophic lateral sclerosis (ALS) is a progressive and debilitating neurodegenerative disease. Digital biomarkers derived from smartphone data can enable scalable, low-cost, remote, unobtrusive, and quantitative measurement of physical activity (PA). These biomarkers offer opportunities for quasi-continuous assessment of PA levels, which may provide new methods for monitoring ALS disease progression in real time. In this exploratory study, we analyzed data from 31 individuals with ALS (including 16 deaths) with up to 9 years of follow-up (median 3 years) to assess the impact of incorporating smartphone-derived PA measures into survival prediction models. We examine whether the strength of the statistical association with survival differs when PA is summarized as (i) a simple metric, such as the mean daily step count, vs. (ii) distributional representations of PA. The exploratory results suggest that the addition of PA variables defined via distributional representations improves the performance of the model, as reflected by higher C-score values (0.68 vs. 0.55, estimated as the median over bootstrap replicas B=1,000). A bootstrap-based hypothesis test shows statistically significant differences between the two models at the confidence level of 90%. These exploratory results indicate that the use of more advanced metrics to summarize PA time series can produce more accurate digital biomarkers to monitor the progression of ALS, although larger studies with larger sample sizes are required to confirm these findings.
AIMS:Uncontrolled blood pressure is a main issue in the management of hypertensive patients, while mobile health (mHealth) offers a new perspective. This study aimed to investigate the efficacy of an mHealth app-based intervention, the European Society of Hypertension (ESH) CARE, in the management of uncontrolled hypertensive patients. METHODS AND RESULTS:This was a two-arm randomized, controlled trial conducted among 107 hypertensive patients, with uncontrolled office (≥140/90 mmHg) and 24-h ambulatory blood pressure (≥130/80 mmHg). After antihypertensive drug treatment initiation or intensification, patients were 1:1 randomized to application assisted strategy (AAS) group or usual care group, with scheduled visits at 1 and 3 months. In ASS group there was a virtual visit, while in usual care group there was an office visit. At 6 months, there was a final visit assessment with office and ambulatory blood pressure (BP) measurement. The mean age of the total population (n = 107) was 52.9 ± 9.6 years, 50.5% were women, without any significant differences in the baseline characteristics. At 6 months, 50% in the usual care group and 78.2% in the AAS group (P = 0.002) achieved both systolic and diastolic ambulatory BP targets (<130/80 mmHg). Regarding office BP, there was a reduction of 19.9 ± 9.1/12.4 ± 7.7 mmHg in the usual care group and 25.1 ± 6.4/16.3 ± 6.3 mmHg in the AAS group, while regarding ambulatory BP, there was a reduction of 6.6 ± 9.2/3.3 ± 6.2 mmHg and 10.9 ± 9.1/6.4 ± 5.5 mmHg, respectively. CONCLUSION:Follow-up of hypertensive patients with the ESH Care App is feasible and contributes to a significantly better office and out-of-office BP control after 6 months.
The current classification criteria for antiphospholipid syndrome (APS) recommend testing for three assays, namely antibodies against cardiolipin (aCL) and β2 glycoprotein I (anti-β2GPI antibodies) plus lupus anticoagulant (LA). β2GPI-dependent antibodies are those mainly responsible for the positivity in the APS laboratory assays and for most of the pathogenic mechanisms involved in the syndrome. To overcome technical limitation of APS assays and identify a broader spectrum of patients, several tests have been assessed as additional laboratory tools: antibodies against domain I of β2GPI, aCL and anti-β2GPI IgA, antibodies against PT are among the most promising but still under evaluation. Other non-classification/diagnostic autoantibodies have been described in APS, some directly contributing to the clinical manifestations (antibodies against proteins involved in hemostasis, antiplatelet, and antiendothelial cell antibodies) and some others reflecting the ongoing systemic autoimmunity characteristic of the syndrome (antinuclear, antimitochondrial, antired cell, antithyroid antibodies, and antibodies against plasma lipoproteins).
This study aimed to provide preliminary information on the clinical usability of a set of Italian telephone-based cognitive screening (TBCS) tests in patients with neurodegenerative MCI and dementia. Eighty-one patients with MCI (N = 32) and dementia (N = 49) due to Alzheimer’s disease, frontotemporal lobar degeneration and Lewy body disease and 100 healthy controls (HCs) were administered a battery of TBCS tests assessing global cognition (Telephone Interview for Cognitive Status), executive functioning (Telephone-based Frontal Assessment Battery), verbal fluency (Telephone-based Phonemic and Semantic Verbal Fluency), working memory (Telephone-based Backward Digit Span) and language (Telephone Language Screener). For each test, we assessed their (1) applicability, (2) construct validity against in-person first- and second-level cognitive measures, (3) ecological validity against the Amsterdam IADL Questionnaire-Short Version (A-IADL-Q-SV), (4) capability to discriminate MCI and dementia patients from HCs and (5) to discriminate MCI from dementia. TBCS tests could be completed by the majority of patients (75–96
