This article discusses the manuscript recently published in the World Journal of Gastroenterology,which explores the application of deep learning models in decision-making processes via wireless capsule endoscopy.Inte...This article discusses the manuscript recently published in the World Journal of Gastroenterology,which explores the application of deep learning models in decision-making processes via wireless capsule endoscopy.Integrating artificial intelligence(AI)into gastrointestinal disease diagnosis represents a transformative step toward precision medicine,enhancing real-time accuracy in detecting multi-category lesions at earlier stages,including small bowel lesions and precancerous polyps,ultimately improving patient outcomes.However,the use of AI in clinical settings raises ethical considerations that extend beyond technological potential.Issues of patient privacy,data security,and potential diagnostic biases require careful attention.AI models must prioritize diverse and representative datasets to mitigate inequities and ensure diagnostic accuracy across populations.Furthermore,balancing AI with clinical expertise is crucial,positioning AI as a supportive tool rather than a replacement for physician judgment.Addressing these ethical challenges will support the responsible deployment of AI,through equitable contribution to patient-centered care.展开更多
The obesity epidemic continues to challenge global cardiovascular(CV)health,but not all obesity is equal.Emerging evidence underscores that distinct obesity phenotypes—particularly metabolically healthy vs unhealthy ...The obesity epidemic continues to challenge global cardiovascular(CV)health,but not all obesity is equal.Emerging evidence underscores that distinct obesity phenotypes—particularly metabolically healthy vs unhealthy profiles—confer differential CV risks.Recent large-scale studies have revealed that even metabol-ically healthy obesity(MHO)is associated with an increased risk of adverse CV events,particularly in the context of socioeconomic disadvantage.Central is the role of chronic low-grade inflammation,termed“metaflammation”,which can persist even in the absence of overt metabolic syndrome and is shaped by both gender and fat distribution.Epicardial and visceral adiposity contribute to this pro-inflammatory state and are strongly associated with conditions such as heart failure and atrial fibrillation.Notably,aging and hormonal changes,particularly in women,may destabilize MHO status,increasing CV vulnerability over time.This overview calls for a paradigm shift in cardiometabolic care,moving beyond anthropometric parameters toward a more refined assessment that incorporate inflammatory biomarkers,fat distribution and sex-specific factors.Recognizing these underlying biological and phenotypic differences enables more accurate CV risk stratification and supports the development of precision-based therapeutic strategies.Ultimately,understanding not just who is at risk,but why,is essential to improving prevention and outcomes across diverse populations facing the bur-den of obesity.展开更多
Atrial fibrillation(AF)is the most common arrhythmia in humans,affecting more than 40 million people worldwide.Radiofrequency catheter ablation(RFCA)was first introduced as a treatment for AF by Haïssaguerre M in...Atrial fibrillation(AF)is the most common arrhythmia in humans,affecting more than 40 million people worldwide.Radiofrequency catheter ablation(RFCA)was first introduced as a treatment for AF by Haïssaguerre M in the late 1990s.This procedure quickly became the treatment of choice,especially for symptomatic patients with AF refractory to medication.However,up to 45%of patients may experience AF recurrence within 12 months after RFCA.In this setting,AF recurrence is likely multifactorial,including atrial remodeling,local fibrosis or incomplete ablation due to failure in locating the trigger.Additionally,patients with obesity,sleep apnea,hypertension,or diabetes are at an increased risk of AF recurrence after RFCA.Inflammation is increasingly recognized as a potential key factor in AF recurrence and may arise both from the healing response of heart tissue post-ablation or from chronic low-grade inflammation,as observed in many risk factors.Here,we present an original study by Wang et al,which investigated the combination of the systemic immune-inflammation index-a marker developed to assess overall inflammatory status-and the APPLE score,designed to predict AF recurrence following RFCA.The study found that using both indicators together improved the accuracy of AF recurrence prediction.These findings underscore the significant role of inflammation in cardiovascular disease and demonstrated its impact on AF recurrence after RFCA.Further research is warranted to validate the combined use of these two scores in clinical settings for predicting AF recurrence following catheter ablation.展开更多
This editorial comments on the manuscript by Chang et al,focusing on the still elusive interplay between epigenetic regulation and autophagy in gastrointestinal diseases,particularly cancer.Autophagy,essential for cel...This editorial comments on the manuscript by Chang et al,focusing on the still elusive interplay between epigenetic regulation and autophagy in gastrointestinal diseases,particularly cancer.Autophagy,essential for cellular homeostasis,exhibits diverse functions ranging from cell survival to death,and is particularly implicated in physiological gastrointestinal cell functions.However,its role in pathological backgrounds remains intricate and context-dependent.Studies underscore the dual nature of autophagy in cancer,where its early suppressive effects in early stages are juxtaposed with its later promotion,contributing to chemoresistance.This discrepancy is attributed to the dysregulation of autophagy-related genes and their intricate involvement in cellular processes.Epigenetic modifications and regulations of gene expression,including non-coding RNAs(ncRNAs),emerge as critical players in exerting regulatory control over autophagy flux,influencing treatment responses and tumor progression.Targeting epigenetic mechanisms and improving strategies involving the inhibition or induction of autophagy through pharmacological or genetic means present potential avenues to sensitize tumor cells to chemotherapy.Additionally,nanocarrier-based delivery of ncRNAs offers innovative therapeutic approaches.Understanding the intricate interaction between autophagy and ncRNA regula-tion opens avenues for the development of targeted therapies,thereby improving the prognosis of gastrointestinal malignancies with poor outcomes.展开更多
This editorial discusses the manuscript by Di Maria et al,published in the recent issue of the World Journal of Cardiology.We here focus on the still elusive pathophysiological mechanisms underlying cardio-renal syndr...This editorial discusses the manuscript by Di Maria et al,published in the recent issue of the World Journal of Cardiology.We here focus on the still elusive pathophysiological mechanisms underlying cardio-renal syndrome(CRS),despite its high prevalence and the substantial worsening of both kidney function and heart failure.While the measure of right atrial pressure through right cardiac catheterization remains the most accurate albeit invasive and costly procedure,integrating bedside ultrasound into diagnostic protocols may substantially enhance the staging of venous congestion and guide therapeutic decisions.In particular,with the assessment of Doppler patterns across multiple venous districts,the Venous Excess Ultrasound(VExUS)score improves the management of fluid overload and provides insight into the underlying factors contributing to cardio-renal interactions.Integrating specific echocardiographic parameters,particularly those concerning the right heart,may thus improve the VExUS score sensitivity,offering perspective into the nuanced comprehension of cardio-renal dynamics.A multidisciplinary approach that consistently incorporates the use of ultrasound is emerging as a promising advance in the understanding and management of CRS.展开更多
This editorial,comments on the article by Spartalis et al published in the recent issue of the World Journal of Cardiology.We here provide an outlook on potential ethical concerns related to the future application of ...This editorial,comments on the article by Spartalis et al published in the recent issue of the World Journal of Cardiology.We here provide an outlook on potential ethical concerns related to the future application of gene therapy in the field of inherited arrhythmias.As monogenic diseases with no or few therapeutic options available through standard care,inherited arrhythmias are ideal candidates to gene therapy in their treatment.Patients with inherited arrhythmias typically have a poor quality of life,especially young people engaged in agonistic sports.While genome editing for treatment of inherited arrhythmias still has theoretical application,advances in CRISPR/Cas9 technology now allows the generation of knock-in animal models of the disease.However,clinical translation is somehow expected soon and this make consistent discussing about ethical concerns related to gene editing in inherited arrhythmias.Genomic off-target activity is a known technical issue,but its relationship with ethnical and individual genetical diversity raises concerns about an equitable accessibility.Meanwhile,the costeffectiveness may further limit an equal distribution of gene therapies.The economic burden of gene therapies on healthcare systems is is increasingly recognized as a pressing concern.A growing body of studies are reporting uncertainty in payback periods with intuitive short-term effects for insurance-based healthcare systems,but potential concerns for universal healthcare systems in the long term as well.Altogether,those aspects strongly indicate a need of regulatory entities to manage those issues.展开更多
Vitamin D deficiency has been indicated as a pandemicemerging public health problem. In addition to the well-known role on calcium-phosphorus homeostasis in thebone, vitamin D-mediated processes have been recentlyinve...Vitamin D deficiency has been indicated as a pandemicemerging public health problem. In addition to the well-known role on calcium-phosphorus homeostasis in thebone, vitamin D-mediated processes have been recentlyinvestigated on other diseases, such as infections, can-cer and cardiovascular diseases. Recently, both the dis-covery of paracrine actions of vitamin D(recognized as"local vitamin D system") and the link of vitamin D with renin-angiotensin-aldosterone system and the fibroblast growth factor 23/klotho pathways highlighted its ac-tive cardiovascular activity. Focusing on hypertension, this review summarizes the more recent experimental evidence involving the vitamin D system and deficiency in the cardiovascular pathophysiology. In particular, we updated the vascular synthesis/catabolism of vitamin D and its complex interactions between the various endocrine networks involved in the regulation of blood pressure in humans. On the other hand, the conflicting results emerged from the comparison between obser-vational and interventional studies emphasize the frag-mentary nature of our knowledge in the field of vitamin D and hypertension, strongly suggesting the need of further researches in this field.展开更多
We present the case of a 74 year old woman suffering from severe mitral valve incompetence and rapid atrial fibrillation. After an appropriate vitamin K antagonist(VKA) therapy, the patient underwent mitral valve repl...We present the case of a 74 year old woman suffering from severe mitral valve incompetence and rapid atrial fibrillation. After an appropriate vitamin K antagonist(VKA) therapy, the patient underwent mitral valve replacement by bioprosthesis. Then, the patient was rehospitalized for jaundice. Suspecting hepatotoxicity, VKA was discontinued and fondaparinux was started. During this treatment, the patient developed a symptomatic atrial thrombus. After exclusion of a hepatic disease, VKA was re-established with hemodynamic and liver enzymes normalization and atrial thrombus resolution. Caution has to be used when considering fondaparinux as an alternative strategy to VKA in patients with multiple thrombotic risk factors.展开更多
文摘This article discusses the manuscript recently published in the World Journal of Gastroenterology,which explores the application of deep learning models in decision-making processes via wireless capsule endoscopy.Integrating artificial intelligence(AI)into gastrointestinal disease diagnosis represents a transformative step toward precision medicine,enhancing real-time accuracy in detecting multi-category lesions at earlier stages,including small bowel lesions and precancerous polyps,ultimately improving patient outcomes.However,the use of AI in clinical settings raises ethical considerations that extend beyond technological potential.Issues of patient privacy,data security,and potential diagnostic biases require careful attention.AI models must prioritize diverse and representative datasets to mitigate inequities and ensure diagnostic accuracy across populations.Furthermore,balancing AI with clinical expertise is crucial,positioning AI as a supportive tool rather than a replacement for physician judgment.Addressing these ethical challenges will support the responsible deployment of AI,through equitable contribution to patient-centered care.
文摘The obesity epidemic continues to challenge global cardiovascular(CV)health,but not all obesity is equal.Emerging evidence underscores that distinct obesity phenotypes—particularly metabolically healthy vs unhealthy profiles—confer differential CV risks.Recent large-scale studies have revealed that even metabol-ically healthy obesity(MHO)is associated with an increased risk of adverse CV events,particularly in the context of socioeconomic disadvantage.Central is the role of chronic low-grade inflammation,termed“metaflammation”,which can persist even in the absence of overt metabolic syndrome and is shaped by both gender and fat distribution.Epicardial and visceral adiposity contribute to this pro-inflammatory state and are strongly associated with conditions such as heart failure and atrial fibrillation.Notably,aging and hormonal changes,particularly in women,may destabilize MHO status,increasing CV vulnerability over time.This overview calls for a paradigm shift in cardiometabolic care,moving beyond anthropometric parameters toward a more refined assessment that incorporate inflammatory biomarkers,fat distribution and sex-specific factors.Recognizing these underlying biological and phenotypic differences enables more accurate CV risk stratification and supports the development of precision-based therapeutic strategies.Ultimately,understanding not just who is at risk,but why,is essential to improving prevention and outcomes across diverse populations facing the bur-den of obesity.
文摘Atrial fibrillation(AF)is the most common arrhythmia in humans,affecting more than 40 million people worldwide.Radiofrequency catheter ablation(RFCA)was first introduced as a treatment for AF by Haïssaguerre M in the late 1990s.This procedure quickly became the treatment of choice,especially for symptomatic patients with AF refractory to medication.However,up to 45%of patients may experience AF recurrence within 12 months after RFCA.In this setting,AF recurrence is likely multifactorial,including atrial remodeling,local fibrosis or incomplete ablation due to failure in locating the trigger.Additionally,patients with obesity,sleep apnea,hypertension,or diabetes are at an increased risk of AF recurrence after RFCA.Inflammation is increasingly recognized as a potential key factor in AF recurrence and may arise both from the healing response of heart tissue post-ablation or from chronic low-grade inflammation,as observed in many risk factors.Here,we present an original study by Wang et al,which investigated the combination of the systemic immune-inflammation index-a marker developed to assess overall inflammatory status-and the APPLE score,designed to predict AF recurrence following RFCA.The study found that using both indicators together improved the accuracy of AF recurrence prediction.These findings underscore the significant role of inflammation in cardiovascular disease and demonstrated its impact on AF recurrence after RFCA.Further research is warranted to validate the combined use of these two scores in clinical settings for predicting AF recurrence following catheter ablation.
文摘This editorial comments on the manuscript by Chang et al,focusing on the still elusive interplay between epigenetic regulation and autophagy in gastrointestinal diseases,particularly cancer.Autophagy,essential for cellular homeostasis,exhibits diverse functions ranging from cell survival to death,and is particularly implicated in physiological gastrointestinal cell functions.However,its role in pathological backgrounds remains intricate and context-dependent.Studies underscore the dual nature of autophagy in cancer,where its early suppressive effects in early stages are juxtaposed with its later promotion,contributing to chemoresistance.This discrepancy is attributed to the dysregulation of autophagy-related genes and their intricate involvement in cellular processes.Epigenetic modifications and regulations of gene expression,including non-coding RNAs(ncRNAs),emerge as critical players in exerting regulatory control over autophagy flux,influencing treatment responses and tumor progression.Targeting epigenetic mechanisms and improving strategies involving the inhibition or induction of autophagy through pharmacological or genetic means present potential avenues to sensitize tumor cells to chemotherapy.Additionally,nanocarrier-based delivery of ncRNAs offers innovative therapeutic approaches.Understanding the intricate interaction between autophagy and ncRNA regula-tion opens avenues for the development of targeted therapies,thereby improving the prognosis of gastrointestinal malignancies with poor outcomes.
文摘This editorial discusses the manuscript by Di Maria et al,published in the recent issue of the World Journal of Cardiology.We here focus on the still elusive pathophysiological mechanisms underlying cardio-renal syndrome(CRS),despite its high prevalence and the substantial worsening of both kidney function and heart failure.While the measure of right atrial pressure through right cardiac catheterization remains the most accurate albeit invasive and costly procedure,integrating bedside ultrasound into diagnostic protocols may substantially enhance the staging of venous congestion and guide therapeutic decisions.In particular,with the assessment of Doppler patterns across multiple venous districts,the Venous Excess Ultrasound(VExUS)score improves the management of fluid overload and provides insight into the underlying factors contributing to cardio-renal interactions.Integrating specific echocardiographic parameters,particularly those concerning the right heart,may thus improve the VExUS score sensitivity,offering perspective into the nuanced comprehension of cardio-renal dynamics.A multidisciplinary approach that consistently incorporates the use of ultrasound is emerging as a promising advance in the understanding and management of CRS.
文摘This editorial,comments on the article by Spartalis et al published in the recent issue of the World Journal of Cardiology.We here provide an outlook on potential ethical concerns related to the future application of gene therapy in the field of inherited arrhythmias.As monogenic diseases with no or few therapeutic options available through standard care,inherited arrhythmias are ideal candidates to gene therapy in their treatment.Patients with inherited arrhythmias typically have a poor quality of life,especially young people engaged in agonistic sports.While genome editing for treatment of inherited arrhythmias still has theoretical application,advances in CRISPR/Cas9 technology now allows the generation of knock-in animal models of the disease.However,clinical translation is somehow expected soon and this make consistent discussing about ethical concerns related to gene editing in inherited arrhythmias.Genomic off-target activity is a known technical issue,but its relationship with ethnical and individual genetical diversity raises concerns about an equitable accessibility.Meanwhile,the costeffectiveness may further limit an equal distribution of gene therapies.The economic burden of gene therapies on healthcare systems is is increasingly recognized as a pressing concern.A growing body of studies are reporting uncertainty in payback periods with intuitive short-term effects for insurance-based healthcare systems,but potential concerns for universal healthcare systems in the long term as well.Altogether,those aspects strongly indicate a need of regulatory entities to manage those issues.
基金Supported by European Commission(FP7-INNOVATION I HEALTH-F2-2013-602114Athero-B-Cell:Targeting and exploiting B cell function for treatment in cardiovascular disease)to Dr.F Mach+3 种基金Swiss National Science Foundation Grants to Dr.F Mach,No.#310030_118245Swiss National Science Foundation Grants to Dr.N Vuilleumier,No.#310030_140736and Swiss National Science Foundation Grants to Dr.F Montecucco,No.#32003B_134963/1the Novartis Foundation and the Foundation"Gustave and Simone Prévot"to Dr.F Montecucco
文摘Vitamin D deficiency has been indicated as a pandemicemerging public health problem. In addition to the well-known role on calcium-phosphorus homeostasis in thebone, vitamin D-mediated processes have been recentlyinvestigated on other diseases, such as infections, can-cer and cardiovascular diseases. Recently, both the dis-covery of paracrine actions of vitamin D(recognized as"local vitamin D system") and the link of vitamin D with renin-angiotensin-aldosterone system and the fibroblast growth factor 23/klotho pathways highlighted its ac-tive cardiovascular activity. Focusing on hypertension, this review summarizes the more recent experimental evidence involving the vitamin D system and deficiency in the cardiovascular pathophysiology. In particular, we updated the vascular synthesis/catabolism of vitamin D and its complex interactions between the various endocrine networks involved in the regulation of blood pressure in humans. On the other hand, the conflicting results emerged from the comparison between obser-vational and interventional studies emphasize the frag-mentary nature of our knowledge in the field of vitamin D and hypertension, strongly suggesting the need of further researches in this field.
基金Supported by Swiss National Science Foundation,No.310030_118245 and No.32003B_134963/1
文摘We present the case of a 74 year old woman suffering from severe mitral valve incompetence and rapid atrial fibrillation. After an appropriate vitamin K antagonist(VKA) therapy, the patient underwent mitral valve replacement by bioprosthesis. Then, the patient was rehospitalized for jaundice. Suspecting hepatotoxicity, VKA was discontinued and fondaparinux was started. During this treatment, the patient developed a symptomatic atrial thrombus. After exclusion of a hepatic disease, VKA was re-established with hemodynamic and liver enzymes normalization and atrial thrombus resolution. Caution has to be used when considering fondaparinux as an alternative strategy to VKA in patients with multiple thrombotic risk factors.
