PURPOSE:Diaphragmatic weakness is a known cause of respiratory dysfunction in stroke. However, the role of extra-diaphragmatic muscles in this regard remains unclear. The aim of this study was to evaluate parasternal intercostal muscle thickness and asymmetry between the two sides in hemiparetic patients after stroke using ultrasonography and to provide exploratory and hypothesis-generating data regarding inspiratory muscle involvement and thoracic mechanical changes. METHODS:This prospective case-control study included 30 stroke patients and 30 healthy volunteers. Demographic data, parasternal intercostal muscle thickness measured by ultrasound, and pulmonary function test (PFT) results were recorded for all participants. RESULTS:Muscle thickness at both the end of expiration and the end of inspiration and thickening rates were found to be statistically significantly decreased on the paretic side compared with the non-paretic and dominant sides (p<0.050). No statistically significant difference was detected in terms of non-paretic and dominant muscle thickness and thickening rate (p>0.050). No statistically significant relationship was detected in the correlation analysis between paretic and non-paretic intercostal muscles of stroke patients and PFT parameters (p>0.050). CONCLUSION:Parasternal intercostal muscle thickness measurements show significant asymmetry between the two sides in hemiparetic patients after stroke. However, this asymmetry is not related to PFT and cannot be interpreted as a direct indicator of respiratory dysfunction. The findings may indicate localized inspiratory muscle involvement and thoracic mechanical changes.
PURPOSE:COVID-19 has a highly heterogeneous course, requiring objective tools for severity assessment. Chest CT quantifies parenchymal involvement, while laboratory biomarkers reflect systemic inflammatory, immunological, and metabolic responses. This study aimed to assess the associations between quantitative CT-derived measures of lung involvement and laboratory biomarkers in patients hospitalized with COVID-19. MATERIALS AND METHODS:We analyzed a multicenter prospective cohort of 555 adults hospitalized for COVID-19 who underwent baseline low-dose chest CT and laboratory testing within 24 h of admission. Lung involvement was assessed using the CT Severity Score (CTSS; 5-25) and quantitative measures (overall percentage involvement and inflammatory lesion volume). Associations were evaluated using Spearman correlations, and multivariable linear regression was performed for CTSS. RESULTS:CTSS correlated positively with CRP, LDH, ferritin, fibrinogen, and D-dimer, and negatively with lymphocyte percentage and serum albumin. The strongest association was for LDH (ρ = 0.68; p < 0.001). In multivariable analysis, LDH, glucose, creatinine, and lymphocyte percentage remained independently associated with CTSS, explaining ∼40% of its variance. Similar patterns were observed for overall percentage involvement and lesion volume. Lower lobes showed the greatest involvement and the strongest correlations with biomarkers. CONCLUSIONS:CT-derived severity metrics reflect systemic disease burden in hospitalized COVID-19 patients. Integrating quantitative CT measures with laboratory biomarkers may improve risk stratification and support clinical decision-making.
PURPOSE:Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), remains a major cause of morbidity and mortality. Data on the clinical relevance of concomitant DVT in patients with PE are limited. This study aimed to assess the prevalence, predictors, and in-hospital outcomes associated with concomitant DVT in PE. PATIENTS AND METHODS:This retrospective single-center cohort study included 576 consecutive patients hospitalized with confirmed PE between 2013 and 2022. Concomitant DVT, in-hospital mortality, length of hospital stay (LOS), and prior PE were evaluated. Clinical characteristics, laboratory parameters, and comorbidities were analyzed. Multivariable regression models were used to identify predictors of DVT and in-hospital mortality. RESULTS:The mean age of participants was 67.3 ± 16.2 years. Concomitant DVT was present in 56.9% of patients (n = 328), of whom 55.2% had asymptomatic DVT. Most patients had intermediate-risk PE (66.0%). In-hospital mortality was 6.4% (n = 37). Patients with DVT had a longer LOS than those without DVT (8 vs. 7 days, p < 0.003). Intermediate-risk PE was independently associated with increased odds of DVT, whereas unprovoked PE was associated with lower odds. Concomitant DVT was not an independent predictor of in-hospital mortality. Older age, chronic heart failure (CHF), and high-risk PE were independently associated with increased mortality. CONCLUSIONS:Concomitant DVT is common in patients with PE and is frequently asymptomatic. Although associated with longer hospitalization, it does not independently affect in-hospital mortality. Clinical severity remains the main determinant of short-term outcomes, and concomitant DVT appears to reflect disease presentation rather than prognosis.
Purpose This study aimed to assess the performance of federated learning (FL) models and compare their performance with local and centralized models. Methods We conducted a systematic search of Ovid MEDLINE and PubMed from inception to June 10, 2025, to identify studies using patient data to train or validate FL algorithms and reporting at least one model performance outcome. Two reviewers independently screened articles and extracted data on study characteristics, FL frameworks and model training methodologies, and reported performance metrics. We summarized model performance using medians and interquartile ranges for federated, local, and centralized models. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Diagnostic Test Accuracy Studies was followed. Results Thirteen studies involving 247 sites and 158,435 samples were included, with eight studies contributing to this meta-analysis. Most FL models (85%) used the Federated Averaging (FedAvg) algorithm for parameter aggregation across sites. FL model performance metrics were compared with local and centralized models within each machine learning task in each study. FL showed notable gains over local models, improving the AUC by 8.2%, F1 score by 7.9%, sensitivity by 4.1%, PPV by 26.1%, and PRAUC by 1.6%. Compared with centralized models, FL showed modest losses of 4.1% in AUC, 9.9% in F1 score, 9.3% in sensitivity, and 2.8% in PRAUC. Conclusions FL outperformed local models and demonstrated comparable performance to centralized models while preserving data privacy. Standardized reporting and improved methodological transparency are needed to support its broader application in health research.
PURPOSE:The current study uses machine learning algorithms to predict the onset of cardiac arrhythmia in patients with implantable cardioverter-defibrillators (ICD). We aimed to check how far in advance the onset of arrhythmia can be predicted. MATERIALS AND METHODS:The input data consisted of 176 signals of R-R intervals from 28 patients with ICD, recorded both during a normal heartbeat and before the onset of arrhythmia. For every signal, we generated 42 descriptors with different signal analysis methods. Then, we identified relevant descriptors using the Boruta algorithm. Then, we used machine learning methods, such as Random Forest, AdaBoost, XGBoost, LASSO, and SVM, and focused on the best results obtained by Random Forest. Cross-validation was used to assess the accuracy of predictions. RESULTS:To check the nature of the signal, we trained the classifiers on the selected temporary windows. The best obtained AUC was 0.75. We have also presented risk groups. CONCLUSION:We found that the signal (information about arrhythmia) already appears for at least 1000 R-R intervals before the onset of arrhythmia and gets stronger with the decreasing time to the onset.
PURPOSE:Wilson disease (WD) is a rare disorder of copper metabolism, primarily affecting the liver and brain. While the toxic effects of copper are well established, the role of autoantibodies in the disease's pathophysiology remains poorly understood. This study aimed to evaluate the prevalence of liver-related autoantibodies in WD patients and their associations with clinical manifestations. MATERIALS AND METHODS:A total of 112 patients with confirmed WD and 88 healthy volunteers were enrolled. Autoantibodies against liver-related antigens were measured in serum samples taken at diagnosis and during follow-up examinations using standardized Line Blot assays. RESULTS:Liver-related autoantibodies were detected more frequently in WD patients (39.3% at diagnosis and 42.9% at follow-up) than in controls (10.2%; both P ≤ 0.0001 versus controls). In particular, the frequency of antibodies to filamentous actin was significantly higher in WD patients (21.4% at diagnosis and 22.3% at follow-up) compared with healthy controls (2.3%; both P ≤ 0.0001 versus controls). The frequency of autoantibodies remained stable during treatment, regardless of whether D-penicillamine or zinc sulphate was used. There was no significant relationship between the presence of autoantibodies and biochemical markers of liver injury. Autoantibodies were more frequent in female patients, but their presence did not correlate with clinical manifestations or disease severity. CONCLUSIONS:Liver-related autoantibodies were frequently observed in WD and appeared to be markers of immune dysregulation. Further research is needed to clarify the clinical significance of these antibodies and their potential use as biomarkers in the management of WD.
PURPOSE:Allergic and asthma-related respiratory symptoms frequently co-occur in childhood and may reflect shared inflammatory mechanisms. However, population-based data on their overlap in Central and Eastern Europe remain limited. METHODS:We conducted a cross-sectional analysis of 1293 children aged 5-9 years from the Polish arm of the Global Asthma Network survey. Respiratory symptoms included wheeze, exercise-induced wheeze, and cough unrelated to infection. Allergic symptoms included nasal symptoms, itchy/watery eyes, and rash. Symptom-domain presence was defined as ≥1 symptom, and multi-symptom clustering as ≥2 symptoms per domain. Associations were assessed using χ2 tests and multivariable logistic regression adjusted for age, sex, and parental asthma. RESULTS:Respiratory symptom-domain presence was observed in 20.3% of children and allergic symptom-domain presence in 40.8%; 11.6% had both. Children with allergic symptoms were more likely to have respiratory symptoms (28.4% vs 14.8%, p < 0.001). Respiratory and allergic symptom domains were strongly associated in adjusted models (aOR 2.16, 95% CI 1.63-2.86). Using stricter ≥2 symptom definitions, the association increased markedly (respiratory clustering aOR 10.20; allergic clustering aOR 9.91; both p < 0.001). Parental asthma was associated with allergic symptoms (aOR 1.79, p = 0.002) and respiratory clustering (aOR 3.87, p = 0.002), but no significant interaction was observed. CONCLUSIONS:Respiratory and allergic symptoms commonly co-occur in children, particularly among those with higher symptom burden. Integrated assessment across symptom domains may improve recognition of children who could benefit from further primary care or specialist evaluation, particularly in the context of parental asthma.
This scientific review explores the intricate bidirectional relationship (crosstalk) between thyroid dysfunction and kidney dysfunction within the context of the intensive care unit (ICU). We discuss how critical illness and acute kidney injury (AKI) lead to thyroid dysregulation, specifically focusing on the high prevalence of non-thyroidal illness syndrome (NTIS) and low triiodothyronine (T3) levels in patients with renal impairment. Mechanisms such as altered deiodinase activity and selenium deficiency are highlighted. The article elucidates the impact of thyroid hormones on renal physiology: hypothyroidism is associated with reduced renal blood flow and glomerular filtration rate (GFR), potentially delaying AKI recovery, while hyperthyroidism induces glomerular hyperfiltration. Furthermore, we address the complexities introduced by renal replacement therapy (RRT), which can alter thyroid hormone kinetics. Recognizing this reciprocal interplay is crucial for intensivists to accurately interpret thyroid function tests and manage renal complications in critically ill patients.
PURPOSE:Thymomas are rare organotypic tumors frequently associated with immune-related paraneoplastic syndromes. The genetic alterations of thymomas are largely unknown and rely on general transcription factor I (GTF2I) and Harvey rat sarcoma (HRAS) mutations. Glutathione transferase omega-1-1 (GSTO1-1) is an atypical member of the glutathione transferase superfamily involved in regulating pro-survival and anti-apoptotic pathways. The association between GSTO1-1 polymorphisms and the increased risk of different types of cancer has been investigated, but no study has focused on thymomas to date. Therefore, we have investigated whether two major GSTO1-1 genetic variants, namely GSTO1∗A140D and GSTO1∗E155del polymorphisms, might represent a risk for thymoma development. PATIENTS AND METHODS:Genotyping was performed in 47 patients diagnosed with thymoma and myasthenia gravis by using a PCR-RFLP assay. RESULTS:The results of our study show no significant correlation between the two polymorphisms and thymoma histotype, stage, disease progression, and myasthenia gravis symptoms. A worse progression-free survival (PFS; 66.8 vs 236.6 months) was found, however, in patients bearing the homozygous GSTO1∗A140D polymorphism, suggesting a potential role for GSTO1-1 in thymoma. Indeed, enzymes with a regulatory function, such as GSTO1-1, could produce very different effects depending on both their activity and the relevance of their substrates in the risk/progression of a specific neoplasm. CONCLUSIONS:GSTO1∗A140D polymorphism deserves to be further explored as a possible risk factor associated with a worse PFS in thymoma. Specific targets of GSTO1-1 in thymomas need to be determined.
PURPOSE:The associations between heart failure (HF) etiology in patients with HF with preserved ejection fraction (HFpEF), HF with mildly reduced ejection fraction (HFmrEF), HF with reduced ejection fraction (HFrEF) and all-cause mortality are inconsistent. We performed a comparative assessment of the different HF etiologies and their impact on the long-term prognosis. PATIENTS AND METHODS:Hospitalized patients and outpatients were enrolled in the HEart failuRe ObsErvational Study (HEROES), a prospective, multicenter cohort study. Patients were categorized according to HF etiology (ischemic, valvular, hypertensive, arrhythmic, and other) and HF subtype. Follow-up included all-cause mortality. RESULTS:Among included 1210 patients (26.5% HFpEF, 21.7% HFmrEF, 51.8% HFrEF, 41.2% ischemic, 11.6% hypertensive, 11.3% arrhythmic, 10.7% valvular, and 25.5% other etiologies), over a median follow-up of 14.7 months (interquartile range 11.6-18.4), 183 deaths (15.1%) were observed. Considering ischemic etiology as the reference, the adjusted hazard ratios (HRs) for all-cause mortality were: HFpEF - arrhythmic 1.00 [0.35-2.88], hypertensive 0.42 [0.14-1.30], valvular 0.54 [0.17-1.67], other 1.03 [0.25-4.29], P = 0.40; HFrEF - arrhythmic 0.76 [0.26-2.32], hypertensive 1.65 [0.60-4.65], valvular 0.80 [0.32-2.04], other 0.79 [0.47-1.35], P = 0.30. In HFmrEF, ischemic etiology conferred the best survival, with significantly higher risks for arrhythmic (aHR 5.30 [1.57-17.92]), hypertensive (4.33 [1.33-14.11]), and valvular (6.82 [1.95-23.82]) groups, P < 0.001. CONCLUSIONS:In our study, etiology exerts minimal independent influence on mortality in HFpEF and HFrEF, and HFmrEF exhibited marked divergence, with ischemic etiology conferring the best survival and significantly higher risks for arrhythmic, hypertensive, and valvular groups.
PURPOSE:Previous studies demonstrated that semicarbazide derivatives 1-(2-chlorophenylcarbonyl)-4-(2,4-dichlorophenyl)semicarbazide (AW8) and 1-(2-chlorophenylcarbonyl)-4-(3,4-dichlorophenyl)semicarbazide (AW12) possess promising physicochemical and anticancer properties. The present study aimed to evaluate their cytotoxicity, selectivity, and angiogenesis-modulating potential using in vitro models and zebrafish, together with an analysis of compound-induced biochemical changes. MATERIALS AND METHODS:The in vitro studies included MTT assay on selected cell lines and an assessment of changes in cell biochemistry using FTIR spectroscopy. Acute toxicity (FET test) and assessment of malformations and cardiotoxicity were also evaluated in a zebrafish model. Human Umbilical Vein Endothelial Cells (HUVEC) cell line and zebrafish Tg(fli1:EGFP) were used to evaluate angiogenesis. RESULTS:AW8 and AW12 exhibited a high safety index and were most selective toward the LN229 line, affecting both the cell cycle and necrosis/apoptosis. In zebrafish, toxicity, malformations, and cardiotoxicity occurred only at higher concentrations (AW12 LC50 = 6453.841; AW8 was not determined), with defects mainly in the yolk sac, pericardium, and spine. Only AW12 significantly influenced angiogenesis in vitro. Therefore, AW12 was selected for in vivo angiogenesis studies, in which >70% of larvae exposed at 4 hpf showed impaired development of dorsal longitudinal anastomotic vessels and intersegmental vessels at the highest doses. CONCLUSION:AW8 and AW12 exhibit selective anticancer activity, particularly against LN229 cells. While both affect apoptosis and necrosis, only AW12 modulates angiogenesis. Notably, AW8 showed a more favorable toxicity profile in vivo, supporting further development of these compounds as potential anticancer agents.
PURPOSE:Adenosine monophosphate-activated protein kinase (AMPK) is a central regulator of cellular energy homeostasis that integrates metabolic stress signals arising from nutrient deprivation and other adverse conditions. Dysregulation of AMPK signaling is involved in malignancies, as cancer cells reprogram nutrient acquisition and metabolic pathways to meet heightened bioenergetic and biosynthetic demands. This review synthesizes recent advances in understanding AMPK's dual roles in tumor progression and suppression. METHODS:The literature was systematically searched in PubMed, Scopus, and Web of Science (mainly from 2010 to 2025) using relevant keywords. RESULTS:AMPK modulates oncogenic signaling via mTORC1, p53, and FOXO pathways in a context-dependent manner. AMPK serves a dual role, functioning primarily as a tumor suppressor in the early stages of carcinogenesis, while potentially promoting cancer cell survival in certain tumor conditions. AMPK can either inhibit or enhance cancer progression, depending on the specific cell type or condition. CONCLUSION:AMPK represents a promising therapeutic target for precision oncology through modulation of metabolic pathways.
Purpose This study evaluated the efficacy of a minimally invasive cervical procedure that combines percutaneous nucleoplasty, annuloplasty, and manual nucleotomy in patients with internal annular rupture or contained disc protrusion accompanied by cervicogenic symptoms. Patients and Methods Seventeen patients presenting with cervical radiculopathy and associated complaints - such as headache, vertigo/tinnitus, or facial numbness - underwent treatment with the Disc-FX Mini technique. A control group of 15 individuals with similar clinical and radiological findings received conservative therapy. Pain intensity and functional status were assessed using the Visual Analogue Scale (VAS) and the Neck Disability Index (NDI) at baseline and during follow-up. Psychological examination was performed to exclude any psychological background of ailments. Results In the treated group, the mean VAS scores dropped from 8.1 ± 1.2 at baseline to 1.6 ± 1.0 at one year, while the NDI scores improved from 29.8 ± 6.8 to 7.6 ± 2.3. The control group showed smaller improvement (VAS from 7.5 ± 1.4 to 3.9 ± 1.2; NDI from 26.0 ± 9.6 to 12.1 ± 6.1). Of 13 patients reporting persistent or recurrent headache in the treatment group, 9 reported relief of these symptoms. Vertigo and other atypical symptoms subsided or markedly decreased in most cases. Conclusions This combined percutaneous method may represent a safe and effective option for patients with cervicogenic symptoms who are unresponsive to conservative management. It potentially bridges the gap between ineffective conservative treatment and open surgery, particularly for patients with subtle imaging findings.
Purpose The profiles of house dust mite (HDM) sensitization may differ in various geographical regions, which could affect the course of allergic diseases. The identification of these discrepancies could help to introduce improved methods of HDM allergy management, more suited to the local needs. The study aimed to analyze the pattern of sensitization to Dermatophagoides pteronyssinus (DP) allergen components and allergens that may cross-react with the allergen components among Polish children and adults with suspicion of allergy. Methods The sensitization to DP allergens and homologous proteins was assessed in 17,821 Polish individuals suspected of allergy. The specific immunoglobulins E (sIgE) were detected with the ALEX2® test between 2019 and 2023 in various laboratories across the country. Results Almost 25% of the study participants had sIgE to any DP molecule (DP_m), and in this group, sIgE to Der p 2 was detected most frequently. The most common profile of sensitization was monosensitization to Der p 2. Polysensitization occurred in 61.3% of patients with sIgE to any DP_m. Among patients sensitized to Der p 23, 91.2% were co-sensitized to Der p 1 and/or Der p 2. The most common pattern of sensitization to tropomyosins included sIgE to all five proteins from the family. Conclusion Major DP_ms, in various combinations, most frequently cause sensitization in the study group. Tropomyosin is a panallergen with high cross-reactivity potential, which was proved by the sensitization profile to tropomyosins in our study group.
Purpose The impact of body weight on wound healing is well established in obesity but remains an unexplored aspect in normal-weight organisms. The extensive data we gathered using murine wound models provided a unique opportunity to address this question by retrospective data analysis. Materials/methods Wound closure data were obtained in two models: a 2-mm ear pinna punch and a 6-mm dorsal skin excision, in 8-10-weeks-old BALB/c strain females, exclusively from control experiments in which animals received vehicle alone. The analyses included 132 mice examined in the ear pinna and 58 in the dorsal skin models, with weights ranging from 15.6 to 25.9 g, with a mean of approximately 20 g at the beginning of the experiments. Results Linear regression models revealed inverse and statistically significant correlations between body weight and wound closure in the ear pinna (R=-0.185, slope=0.0209, p =2.52E-03) and dorsal skin (R=-0.266, slope=0.0260, p=4.08E-03). The correlations were consistent with significant differences in mean wound closure between extreme quartiles in the ear pinna (62.6% vs. 53.6%, p=5.79E-03) and the dorsal skin model (81.4% vs 68.4%, p =1.40E-03). Conclusions Our retrospective study provides a methodological clue that body weight should be included in wound healing experiment designs and data interpretation. The finding delineates a promising research model for skin wound healing and tissue regeneration research. Such a model could involve omics comparisons between animals with lower and higher body weights to identify molecular signatures of improved wound healing within physiological norms, as well as molecular factors promoting tissue regeneration.
Purpose This study aimed to determine a correlation between baseline sodium levels, laboratory test results, and clinical condition as well as the association between sodium level changes during treatment and prognosis of patients with COVID-19. Materials and methods Our retrospective analysis included 1,673 patients hospitalized due to COVID-19 at the Temporary Hospital in Pyrzowice. The patients were treated in accordance with the hospital’s treatment protocol, including standard fluid therapy regimen adjusted to oxygen support. The analysis considered data on comorbidities, laboratory tests results, blood gas analysis and computed tomography. The endpoints were the need for treatment in the intensive care unit, length of hospital stay, in-hospital mortality, and long-term mortality. Results Abnormal sodium levels were found in 35.7% (597) of patients. This correlated with comorbidities and abnormal laboratory test results. Baseline sodium imbalance correlated with longer hospitalization and increased in-hospital and long-term mortality rates. Significant sodium level changes (≥6 mmol/L) were observed in 148 patients which correlated with higher in-hospital and long-term mortality rates. Conclusions Baseline sodium imbalances and significant sodium level changes during treatment are associated with worse prognosis of COVID-19. According to our best knowledge there are no prospective randomized studies which would compare different fluid strategies in COVID-19 patients. Further prospective studies comparing different fluid therapy strategies and different compositions of fluids should be conducted.
PURPOSE:Kidney damage is a significant concern in type 1 (T1DM) and type 2 (T2DM) diabetes mellitus, with diagnoses of chronic kidney disease (CKD) based on glomerular filtration rate and albumin excretion. An early marker for kidney damage is needed, and extracellular vesicles (EVs) show promise in this area. These nanostructures facilitate the transport of proteins, lipids, and nucleic acids between cells and undergo structural changes that can indicate the presence of disease. MATERIALS AND METHODS:Our study employed time-of-flight secondary ion mass spectrometry (ToF-SIMS) to analyse lipid content in urinary EVs (uEVs) from 29 individuals with well-controlled T1DM (15 years duration, HbA1c ∼7%) and 16 healthy controls. uEVs were analysed using tunable resistive pulse sensing (TRPS) to determine size, concentration, and zeta potential, and by ToF-SIMS in both positive and negative ion modes to profile lipid- and amino acid-related ions. RESULTS:T1DM uEVs exhibited a more negative zeta potential (-27.65 ± 1.51 mV vs -18.43 ± 0.87 mV) and higher particle concentration ((7.1 ± 0.7) × 1011 vs (6.4 ± 0.9) × 1010 particles/mL), while mean particle diameters were similar between groups. TOF-SIMS showed broadly comparable class-level proportions of lipids and amino acids; however, several individual lipid ions, including diacylglycerols, sphingolipids and selected fatty acids, displayed measurable differences. Amino-acid-related ions showed minor variations without major shifts in overall composition. CONCLUSIONS:These findings suggest that uEVs may reflect pathological processes in individuals with T1DM without CKD. However, further research is necessary to confirm whether uEVs can be markers for CKD.
Purpose This publication aims to provide an overview of the challenges involved in establishing connections between national and international research teams and biobanks for the purposes of sample collection, preservation, and data analysis, using the Stomach Cancer Pooling (StoP) project as a case study. Materials and methods The StoP project illustrates collaboration in gastric cancer risk factor analysis. Internationally, the project integrates 33 research teams from 15 countries and associated biobanks to support the collection, preservation, and analysis of samples for epidemiological and genetic studies. Within Latvia, project activities involved the systematic collection of epidemiological, clinical, and biological data across multiple institutions. Latvian contributions were integrated into the broader StoP consortium to support comprehensive analyses. Results The collaborative effort has strengthened local biobanking infrastructure by expanding prospective data collection, updating standard operating procedures, and harmonizing retrospective datasets. It enhanced multi-institutional collaboration nationally and internationally. Key challenges were identified in data collection, harmonization, storage, funding, and sustainability. The StoP project working group has produced over forty scientific publications, with Latvian data contributing to five studies on smoking, Helicobacter pylori infection, sex-based differences, and proton pump inhibitor use. Current efforts focus on genome-wide association studies using collected biological specimens and epidemiological data. Conclusions The methods from the StoP project can be replicated across other institutions by focusing on robust ethical frameworks and data-sharing agreements. Effective cross-institutional collaboration further supports these efforts. Together, these practices increase public trust and enhance the scalability of such initiatives globally.
Purpose Fingertip-based photoplethysmographic (PPG) devices offer a noninvasive method for at-home atrial fibrillation (AF) screening. In this study, we evaluated the accuracy of a fingertip pulse oximeter enhanced with a supervised artificial intelligence (AI) algorithm in diagnosing AF in a real-world setting. Materials and methods This prospective, multicenter study included 401 individuals who underwent concurrent assessment using an AI-enhanced fingertip pulse oximeter and standard 12-lead electrocardiography (ECG), with expert-interpreted ECG serving as the diagnostic reference standard. The oximeter measured pulse rate, oxygen saturation, perfusion index (PI; a PPG-derived indicator of peripheral perfusion), and PPG waveforms, which were analyzed with an embedded AI module to classify heart rhythm as “normal,” “irregular,” or “possible AF.” Results When benchmarked against expert-interpreted ECG, the AI-enhanced pulse oximeter demonstrated high diagnostic performance for AF detection, with a sensitivity of 96.7%, specificity of 90.5%, positive predictive value of 91.9%, and negative predictive value of 96.1%. AF detection rates derived from the AI-enhanced pulse oximeter were consistent with those identified by computer-read 12-lead ECG (55.4% vs. 52.6%, p = 0.436). Diagnostic performance remained high across all clinical subgroups, with a minor decrease observed among individuals with a perfusion index value of ≤1%. No severe device-related adverse events were reported. Conclusions The portable, site-less design of this fingertip-based PPG device incorporating an AI algorithm supports its scalability for remote, real-time rhythm monitoring and population-level AF screening.
PURPOSE:The incidence of bone marrow metastases is a rarely described manifestation of metastatic breast cancer (BC). MATERIAL AND METHODS:Clinical, laboratory and histopathological data were retrospectively analyzed in 50 women with histopathologically confirmed BC metastasis. RESULTS:The median age was 68.3 years, and 60% of patients had an ECOG performance status of 0-1. Most cases were BC of no special type (n = 47; 94%), primary in 70% (n = 35). The luminal Human Epidermal Growth Factor Receptor 2 (HER2) - was the predominant biological subtype (n = 35; 70%). The most common indications for trephine biopsy were anemia and thrombocytopenia. Synchronous bone metastases occurred in most patients. Biological type 4conversion was seen in 16 cases (32%) and included luminal converting into triple negative BC (n = 6; 37.5%) and luminal HER2+ into luminal HER2- BC (n = 3; 18.75%). The median of overall survival (OS) was 9.2 months (95% CI: 6.3 - 14.9). High lactate dehydrogenase level (p = 0.023) and thrombocytopenia (p < 0.001) correlated with a shorter median OS. In multivariate analysis, low levels of platelets correlated with a lower median OS (p < 0.001). A positive correlation occurred between lymphocytes (p < 0.001), monocytes (p < 0.001) and the percentage of bone marrow infiltration. Higher neutrophil-to-lymphocyte ratio was associated with shorter survival (p = 0.02). CONCLUSIONS:Bone marrow metastases indicate a poor prognosis. The high rate of receptor conversion highlights the importance of re-evaluating tumor biology after BC progression which may increase the scope of systemic treatment options and improve the prognosis.
