Poor nutritional status and suboptimal dietary patterns are strongly associated with adverse outcomes in patients with chronic heart failure (CHF), including increased mortality, reduced functional capacity, and a higher risk of hospitalization. This scientific statement from the Polish Society of Dietetics summarizes the current evidence and provides clinically oriented guidance on the role of nutrition in the management of CHF. It outlines the key components of nutritional care across the spectrum of CHF, including screening, assessment, dietary strategies, and supplementation. The main features of evidence-based nutritional management in CHF include: 1) routine nutritional screening using validated tools and structured assessment incorporating the GLIM criteria; 2) identification of malnutrition, cachexia, sarcopenia, and sarcopenic obesity; 3) individualized dietary management tailored to the HF phenotype and clinical status; 4) prioritization of dietary patterns rich in plant-based and minimally processed foods, with the Mediterranean diet as the dietary model supported by the strongest evidence; 5) avoidance of excessive sodium intake and unnecessary fluid restriction in stable patients; 6) ensuring adequate energy intake and protein intake to preserve lean body mass; and 7) targeted, rather than routine, use of micronutrient supplementation, with particular consideration of iron deficiency.
Background. Kidney transplantation is the optimal method of renal replacement therapy. The EQ-5D-5L is a widely used instrument for assessing health-related quality of life (HRQoL) across different populations. Objectives. This study aimed to assess HRQoL in kidney transplant recipients (KTRs) compared with the general population and to identify factors associated with impaired HRQoL. Materials and methods. A total of 156 KTRs (58 women and 98 men) participated in this prospective observational study. All participants completed the EQ-5D-5L questionnaire. Demographic and laboratory data were collected, and physical performance tests were performed. Statistical analyses were conducted using Statistica. Results. Of the 156 participants, 54 (34.62%) had an EQ-5D-5L health state of 11111, whereas 102 (65.38%) reported impairment in HRQoL in at least 1 domain. No significant differences in sex, age, orCharlson Comorbidity Index (CCI) were observed between the analyzed groups. Compared with Polish population reference values for the EQ-5D-5L, KTRs had similar HRQoL, with a median utility score of 0.970 [Q1-Q3:0.916-1.000]. In the multivariable Cox regression model, the EQ-5D-5L utility score independently predicted mortality in KTRs (hazard ratio (HR) = 0.007; 95% confidence interval (95% CI): 0.000-0.134; *p* = 0.001). The EuroQol Visual Analogue Scale (EQ VAS) score also independently predicted adverse outcomes (HR = 0.966; 95% CI: 0.935-0.997; p = 0.030). Conclusions. Assessment of HRQoL should be an integral component of the holistic management of KTRs. HRQoL assessment is associated with long-term outcomes in KTRs. Self-rated HRQoL measured on a 0-100 VAS may help identify patients at increased risk of adverse outcomes.
Background. Ischemic heart disease (IHD) remains a leading global cause of mortality. While reperfusion is essential for treating ischemic cardiomyopathy, it paradoxically induces myocardial ischemia/reperfusion (I/R) injurytargeting the microvascular endothelium. The link between autophagy and microvascular damage in myocardial I/R requires clarification. Objectives. This study aimed to identify autophagy-related biomarkers of myocardial I/R injury using integrated bioinformatics and experimental validation, characterize the associated molecular and immune features, and evaluate the role of Myc in cardiac microvascular endothelial injury. Materials and methods. Bioinformatics analysis of Gene Expression Omnibus (GEO) multi-chip datasets intersected autophagy-related genes (HADb) with differentially expressed genes (DEGs) to identify signature biomarkers using machine-learning algorithms. Diagnostic efficacy was validated using a nomogram. Mechanistic exploration through gene set enrichment analysis (GSEA) and immune profiling revealed I/R subtypes. Biomarker expression was externally validated in the GSE168610 dataset. Myocardial I/R models were assessed using echocardiography (cardiac function), Evans blue/TTC staining (infarction area), and ink perfusion (microvascular density). Hub gene expression was quantified using quantitative polymerase chain reaction (qPCR), western blot (WB), and immunohistochemistry (IHC). In vitro, c-Myc-knockout cardiac endothelial cells underwent hypoxia/reoxygenation (H/R), followed byanalysis of autophagy (WB), apoptosis (TUNEL), and autophagic vacuoles (transmission electron microscopy (TEM)). Results. Seven autophagy-related DEGs were identified and linked to muscle proliferation, protease activation, and oncogenesis. Four signature genes (Casp4, Cdkn1a, Myc, and Rgs19) were identified by 3 machine-learning algorithms, with diagnostic validation. In the development cohort, the AUCs ranged from 0.756 to 0.876. In the external-validation cohort, the AUC was 1.000 for Casp4, Myc, and Rgs19 and 0.875 for Cdkn1a. GSEA linked these genes to tricarboxylic acid cycle (TCA) dysregulation and immune infiltration. Unsupervised clustering identified 2 molecular subtypes. C1 exhibited higher expression of 6 of the 7 autophagy-related DEGs, whereas C2 showed higher proportions of mast cells and activated dendritic cells and enrichment of mitochondrial and energy-metabolism pathways. c-Myc knockout reduced endothelial apoptosis and autophagic injury. Conclusions. c-Myc emerged as a critical driver linking excessive autophagy to microvascular damage, providing a promising diagnostic and therapeutic target for reperfusion injury management.
Background. Tic disorders (TD) are common neuropsychiatric conditions in children, often accompanied by anxiety and depression. Understanding the associated risk factors and their relationship with TD severity is crucial for effective management. Objectives. This study investigated risk factors for TD in children and examined the relationship between anxiety, depression, and TD severity using the Screen for Child Anxiety Related Emotional Disorders (SCARED) and the Depression Self-Rating Scale for Children (DSRSC). Materials and methods. A prospective observational study was conducted in 113 children diagnosed with TD at our hospital between January 2021 and January 2024. Tic disorder severity was evaluated using the Yale Global Tic Severity Scale (YGTSS). Anxiety and depression were assessed using SCARED and DSRSC, respectively. Demographic and clinical characteristics, as well as comorbidities, were analyzed using IBM SPSS v. 25.0. Results. Children with TD had significantly higher rates of febrile seizures, family history of TD, recurrent respiratory infections, and comorbid attention-deficit/hyperactivity disorder (ADHD). Patients with TD exhibited elevated SCARED and DSRSC scores, which were significantly higher in moderate-to-severe cases than in mild cases. Yale Global Tic Severity Scale scores were positively correlated with both SCARED and DSRSC scores. Key risk factors associated with TD and with moderate-to-severe disease included a family history of TD, higher DSRSC scores, and higher SCARED scores. Conclusions. This study highlights a strong association between anxiety, depression, and TD severity, with higher SCARED and DSRSC scores observed in moderate-to-severe cases. A family history of TD, along with elevated anxiety and depression scores, were identified as significant associated factors. These findings underscore the importance of psychological assessment and tailored interventions for children with TD.
