Assessing respiratory function in spinal muscular atrophy (SMA) is challenging due to the effort-dependent nature of traditional spirometry. While respiratory oscillometry offers a passive alternative, its clinical utility in predicting clinical status remains underexplored. This study evaluates the efficacy of integrating spirometric and respiratory oscillometric indices through machine learning (ML) to predict ambulatory status and the requirement for bilevel positive airway pressure (BiPAP) in SMA patients. We retrospectively analyzed forty-five patients with a genetically confirmed diagnosis of SMA. To address data imbalance, we utilized the SMOTETomek technique and validated Random Forest models through leave-one-out cross-validation. SHAP (SHapley Additive exPlanations) analysis was used to interpret the contribution of individual physiological markers. In univariate logistic regression, forced vital capacity (FVC), peak expiratory flow (PEF), and forced expiratory flow at 75
Bronchiectasis has traditionally been characterized as a neutrophil-driven disease, yet emerging evidence suggested inflammatory heterogeneities. The prognostic significance of elevated serum immunoglobulin E (IgE) in patients without peripheral eosinophilia remains unclear. We conducted a multicenter prospective cohort study between 2017 and 2020 across 16 institutions in Taiwan. Individuals with bronchiectasis but without allergic bronchopulmonary aspergillosis were included. Patients were stratified by baseline absolute eosinophil count (cutoff 300 /uL) and serum IgE level (≤ 100, 100–500, > 500 IU/mL). The primary endpoint was severe exacerbations resulting in hospitalization at one year. Secondary endpoints included all-cause mortality, distribution of sputum pathogen, imaging pattern, and lung function. A total of 579 individuals were enrolled. Nontuberculous mycobacteria (10.7
BackgroundThe ongoing Russian-Ukrainian conflict has led to the large-scale displacement of over one million Ukrainian citizens, predominantly women and children, seeking protection in Poland. This necessitates a rigorous investigation into the factors associated with psychological conditions and adaptive coping mechanisms employed by this vulnerable population.MethodsThis quantitative, online survey study comprised a sample of N = 290 adult participants (91.7% female, mean age 43.6 years). Due to the small number of male participants (n = 24, 8.3%), gender was not included as a variable in the analyses. Participants were recruited through social workers and psychologists working in Collective Accommodation Centers, and Integration Centers in Poland for Ukrainian refugees. Depression, Anxiety, and Stress symptoms were assessed using the DASS-21, psychological wellbeing with the PERMA-Profiler, and coping with stress strategies using the Brief-COPE.ResultsAnalysis revealed significantly elevated psychological distress among Ukrainian refugees in Poland. Multivariate regression models identified independent predictors of mental health, wellbeing and coping with stress. Older age, partnered status, and skills-matched employment are key predictors of depression. Higher education and partnered status are negative predictors of anxiety, and older age is a negative predictor of stress. Skills-matched employment emerged as a predictor of wellbeing, though only 23.5% of this highly educated sample held such positions. Access to information, receipt of psychological assistance, and current employment are predictors of problem-focused coping, while psychological assistance is a predictor of emotion-focused coping. Avoidant coping showed no significant model fit.ConclusionThe findings underscore the critical need for comprehensive, evidence-based mental health interventions and accessible psychosocial support for Ukrainian refugees. The results indicate the modifiable post-migration factors important for refugee adaptation. Policy priorities should include early mental health screening targeting younger adults and unpartnered individuals, facilitation of skills-matched employment, provision of clear information about legal rights and available services, and culturally sensitive interventions that promote adaptive coping mechanisms.
Purpose:Chronic obstructive pulmonary disease (COPD) and its comorbidities impose substantial economic burdens on healthcare systems, but evidence remains scarce in Asian countries where patients exhibit distinct clinical and inflammatory phenotypes, as well as policy and health system differences. This study aimed to estimate direct medical costs of COPD multimorbidity, comparing to non-COPD patients in Singapore, and identify high-cost users. Patients and Methods:Using Singapore's health administrative data (2012-2019), we created a propensity score-matched COPD and non-COPD cohort and applied generalised linear models to estimate all-cause, index disease- and comorbidity-attributable costs. All costs were measured in patient-years (PYs) in 2023 Singaporean dollars (SGD$1=US$0.76=₤0.60=€0.69). Patient characteristics and comorbidity prevalence were compared across patients incurring top 10%, 11%-50%, and bottom 50% of average annualised costs. Results:The study included 18,866 patients from each group (83% males, 17% females). Average annual direct medical costs were significantly higher among COPD patients ($5,290.9/PY; 95% confidence interval [CI]: 5,242.9-5,350.1) than non-COPD patients ($1,110.4/PY; 95% CI: 1,085.9-1,135.9). 33.8% of total costs were COPD-attributable, with major contributions from other respiratory (15.0%), circulatory (14.9%), metabolic (7.8%), and digestive (4.7%) diseases. From 2012 to 2019, hospitalisation costs declined (-$59.0/year), while primary care (polyclinic) costs increased sharply (+$148.8/year). Indian patients comprised 67% of the top 10th cost percentile and experienced frequent hospitalisations (≥2/year). Conclusion:In Singapore's multi-ethnic Asian context, COPD patients incurred substantial multimorbidity costs, particularly from respiratory, circulatory, and metabolic diseases, underscoring distinct Asian multimorbidity patterns and highlighting the need for integrated, multimorbidity-focused care models. Disproportionately high costs among Indian patients and low female prevalence warrant further investigation.
Resveratrol (RSV; 3,5,4'-trihydroxy-trans-stilbene) is a natural polyphenolic compound with notable antioxidant, anti-inflammatory, and immunomodulatory properties. It has been investigated for therapeutic applications in cardiovascular disease, cancer, and neurodegenerative disorders. This review emphasizes the potential of RSV in oncology and neuroprotection, synthesizing evidence from systematic database searches and experimental studies. Despite promising biological activities, RSV is limited by poor stability, low aqueous solubility, rapid metabolism, and restricted bioavailability, necessitating improved delivery strategies such as nanoencapsulation, nanocrystals, prodrugs, and structural analogues. Mechanistically, RSV exerts anticancer and neuroprotective effects through modulation of p53, STAT3, NF-κB, and mitochondrial-mediated apoptosis. Its antioxidant actions involve regulation of reactive oxygen species (ROS), activation of NRF2, AMPK signaling, and SIRT1. RSV and related antioxidants act on multiple molecular pathways, including TP53, β-catenin, STAT3, NF-κB, NRF2-AMPK, PI3K/AKT, and SIRT1, to regulate inflammation and cell death. The balance between oxidative and antioxidative processes is critical for therapeutic efficacy. Notably, RSV-induced ROS-mediated cell death, particularly in the context of TP53 mutations, represents a promising target for future interventions. Overall, RSV demonstrates multi-target potential for cancer and neurodegenerative disease therapy, though optimization of its pharmacological profile remains essential.
