Diagnostic and Prognostic Circulating MicroRNA in Acute Stroke: A Systematic and Bioinformatic Analysis of Current Evidence / 대한뇌졸중학회지

Background@#and Purpose Stroke is the second leading cause of death and disability worldwide and its diagnosis, and assessment of prognosis, remains challenging. There is a need for improved diagnostic and prognostic biomarkers. MicroRNAs (miRNAs) play important roles in the post-transcriptional regulation of gene expression and their secretion and remarkable stability in biofluids highlights their potential as sensitive biomarkers in the diagnosis and prognosis of acute stroke. @*Methods@#We carried out a systematic review to assess current evidence supporting the potential of miRNAs to act as unique diagnostic and prognostic biomarkers in blood samples collected from patients suffering acute stroke within 24 hours of symptoms onset. @*Results@#We identified 22 studies eligible for inclusion with 33 dysregulated miRNAs having diagnostic potential in the acute phase of the disease. We identified miR-16, miR-126, and miR-335 as having the highest sensitivity as diagnostic and prognostic biomarkers in acute ischaemic stroke and present original bioinformatic and pathway enrichment analysis of putative miRNA–target interactions. @*Conclusions@#miRNAs represent unique biomarkers which have a promising future in stroke diagnosis and prognosis. However, there is a need for more standardized and consistent methodology for the accurate interpretation and translation of miRNAs as novel specific and sensitive biomarkers into clinical practice.

Diagnostic and Prognostic Circulating MicroRNA in Acute Stroke: A Systematic and Bioinformatic Analysis of Current Evidence / 대한뇌졸중학회지

Background@#and Purpose Stroke is the second leading cause of death and disability worldwide and its diagnosis, and assessment of prognosis, remains challenging. There is a need for improved diagnostic and prognostic biomarkers. MicroRNAs (miRNAs) play important roles in the post-transcriptional regulation of gene expression and their secretion and remarkable stability in biofluids highlights their potential as sensitive biomarkers in the diagnosis and prognosis of acute stroke. @*Methods@#We carried out a systematic review to assess current evidence supporting the potential of miRNAs to act as unique diagnostic and prognostic biomarkers in blood samples collected from patients suffering acute stroke within 24 hours of symptoms onset. @*Results@#We identified 22 studies eligible for inclusion with 33 dysregulated miRNAs having diagnostic potential in the acute phase of the disease. We identified miR-16, miR-126, and miR-335 as having the highest sensitivity as diagnostic and prognostic biomarkers in acute ischaemic stroke and present original bioinformatic and pathway enrichment analysis of putative miRNA–target interactions. @*Conclusions@#miRNAs represent unique biomarkers which have a promising future in stroke diagnosis and prognosis. However, there is a need for more standardized and consistent methodology for the accurate interpretation and translation of miRNAs as novel specific and sensitive biomarkers into clinical practice.

Diabetes-Related Cardiac Dysfunction

The proposal that diabetes plays a role in the development of heart failure is supported by the increased risk associated with this disease, even after correcting for all other known risk factors. However, the precise mechanisms contributing to the condition referred to as diabetic cardiomyopathy have remained elusive, as does defining the disease itself. Decades of study have defined numerous potential factors that each contribute to disease susceptibility, progression, and severity. Many recent detailed reviews have been published on mechanisms involving insulin resistance, dysregulation of microRNAs, and increased reactive oxygen species, as well as causes including both modifiable and non-modifiable risk factors. As such, the focus of the current review is to highlight aspects of each of these topics and to provide specific examples of recent advances in each area.

Austere, remote and disaster medicine-keeping everybody safe

Medical care in resource-limited environments [[austere] settings] can occur in the context of a disaster, wilderness, or a tactical field operation. Regardless of the type of environment, there are common organizational themes in most successful humanitarian missions that occur in harsh environmental conditions, be they natural, or man-made. These principles prioritize the initiation and execution of any given deployment in austere or remote settings, diverging from priorities that would occur in a situation where the medical structure is intact and operating well. Attention to these priorities not only helps providers with delivering medical care to the needy during a period of resource limitations, they also can keep a provider, teams, the public, and a patient safe during, and after a deployment

Implementation of integrated vector management for disease vector control in the Eastern Mediterranean: where are we and where are we going?

Integrated vector management [IVM] is an acknowledged strategy of choice for the prevention and control of vector-borne diseases. The paper describes and documents the progress countries of the World Health Organization [WHO] Eastern Mediterranean Region have made in endorsing and translating the strategy into action at the national level. These include increased political commitment; strengthened intersectoral coordination and partnership; strengthened capacity in entomology and vector control; and scaling up of vector control interventions through universal access. These efforts, however, are compromised by inappropriate institutional arrangements in some countries; weak national capacities to address management of pesticides; development and spread of vector resistance to insecticides, including to pyrethroids; and the expansion of emerging and re-emerging vector-borne diseases. With WHO leadership and support from partners, countries continue to address these challenges head-on

Assessement of sleep disordered breathing in neuromuscular disease patients by heart rate variability

Respiratory failure develops in neuromuscular disorders when the load on the respiratory pump exceeds its capacity. Innitially, the respiratory pump may function satisfactorily during wakefulness but may fail during sleep. Causing non-obstructive sleep hypoventilation [NOSH] prior to the development of respiratory failure. Episodes of NOSH are associated with autonomic disturbances. Heart rate variability [HRV] is a measure of autonomic regulation of cardiac function. The high frequency [HF] band of the HRV frequency spectrum reflects vagal tone, while low frequency [LF] reflects mainly sympathetic activity. This study was undertaken to show the role of HRV in screening for NOSH. Ten normal subjects [age 27-66 years, M:F ratio 6:4] and ten patients [age 37-67 years, M:F ratio 3:7] with neuromuscular disease and [NOSH] participated in this study. All subjects underwent overnight full polysomnography including ECG recording [sampling rate=100 Hz]. Sequential segments of 256 seconds were extracted and analysed using power spectral analysis. From these segments, spectral power in the LF band [0.002-0.15 Hz] and HF band [0.15-0.4Hz], and LF/HF ratio were calculated. In normal sleep, uninterrupted NREM sleep stage 2-4 was associated with a decreased LF and LF/HF ratio and an increased HF as compared to the wake and REM sleep. During NOSH, HF remained the same, LF increased to 127% [118-137] and LF/HF increased to 133% [124-143%] [mean change per 10 seconds apnoea segment [95% confidence interval], p<0.01], suggesting an immediate sympathoactivation. HRV reflects autonomic activity in different sleep stages and can be used to screen for NOSH