RESUMO
Amyotrophic lateral sclerosis is a fatal neurodegenerative disease, associated with the degeneration of both upper and lower motor neurons of the motor cortex, brainstem and spinal cord. Death in most patients results from respiratory failure within 3-4 years from symptom onset. However, due to disease heterogeneity some individuals survive only months from symptom onset while others live for several years. Identifying specific biomarkers that aid in establishing disease prognosis, particularly in terms of predicting disease progression, will help our understanding of amyotrophic lateral sclerosis pathophysiology and could be used to monitor a patient's response to drugs and therapeutic agents. Transcriptomic profiling technologies are continually evolving, enabling us to identify key gene changes in biological processes associated with disease. MicroRNAs are small non-coding RNAs typically associated with regulating gene expression, by degrading mRNA or reducing levels of gene expression. Being able to associate gene expression changes with corresponding microRNA changes would help to distinguish a more complex biomarker signature enabling us to address key challenges associated with complex diseases such as amyotrophic lateral sclerosis. The present study aimed to investigate the transcriptomic profile (mRNA and microRNA) of lymphoblastoid cell lines from amyotrophic lateral sclerosis patients to identify key signatures that are distinguishable in those patients who suffered a short disease duration (<12 months) (n = 22) compared with those that had a longer disease duration (>6 years) (n = 20). Transcriptional profiling of microRNA-mRNA interactions from lymphoblastoid cell lines in amyotrophic lateral sclerosis patients revealed differential expression of genes involved in cell cycle, DNA damage and RNA processing in patients with longer survival from disease onset compared with those with short survival. Understanding these particular microRNA-mRNA interactions and the pathways in which they are involved may help to distinguish potential therapeutic targets that could exert neuroprotective effects to prolong the life expectancy of amyotrophic lateral sclerosis patients.
RESUMO
Artificial intelligence (AI) tools are increasingly being used within healthcare for various purposes, including helping patients to adhere to drug regimens. The aim of this narrative review was to describe: (1) studies on AI tools that can be used to measure and increase medication adherence in patients with non-communicable diseases (NCDs); (2) the benefits of using AI for these purposes; (3) challenges of the use of AI in healthcare; and (4) priorities for future research. We discuss the current AI technologies, including mobile phone applications, reminder systems, tools for patient empowerment, instruments that can be used in integrated care, and machine learning. The use of AI may be key to understanding the complex interplay of factors that underly medication non-adherence in NCD patients. AI-assisted interventions aiming to improve communication between patients and physicians, monitor drug consumption, empower patients, and ultimately, increase adherence levels may lead to better clinical outcomes and increase the quality of life of NCD patients. However, the use of AI in healthcare is challenged by numerous factors; the characteristics of users can impact the effectiveness of an AI tool, which may lead to further inequalities in healthcare, and there may be concerns that it could depersonalize medicine. The success and widespread use of AI technologies will depend on data storage capacity, processing power, and other infrastructure capacities within healthcare systems. Research is needed to evaluate the effectiveness of AI solutions in different patient groups and establish the barriers to widespread adoption, especially in light of the COVID-19 pandemic, which has led to a rapid increase in the use and development of digital health technologies.
RESUMO
Weber C ankle fractures are unstable ankle fractures occurring above the syndesmosis. These fractures are often managed operatively, although a small population of patients are still selected for nonoperative management. This study primarily aimed to summarize the current evidence on functional outcomes for Weber C patients managed operatively and nonoperatively. Evidence on secondary outcomes such as complications and radiographic outcomes were also reviewed. This systematic search was conducted according to PRISMA guidelines. A literature search was conducted using the EMBASE, Medline, and Central databases. A total of 26 studies were included in the final analysis. All papers studied the management of Weber C fractures using open reduction and internal fixation (ORIF). Three main functional outcome scores were identified: American Orthopedic Foot and Ankle Society score, Olerud-Molander Ankle Score, and Foot and Ankle Outcome Score. Only 1 study compared operative and conservative management, which showed similar outcomes for either option (median Olerud-Molander Ankle Score 95 [range 20 to 95] vs 100 [70 to 100], respectively). Complications associated with operative management included infection, wound dehiscence, implant failure, and malunion or nonunion. The mean rate of syndesmosis malreduction was 18.2%. This study showed that operative management, regardless of the method of ORIF used, as well as nonoperative management resulted in good functional outcomes, indicating that patient selection for either method is important. However, there is limited evidence on the complications and radiographic outcomes associated with nonoperative management. We recommend further studies to compare all ORIF methods with conservative management and examine the complications associated with nonoperative management.
