Aiming at Strategies for a Complex Problem of Medical Nonadherence

The deteriorating health of the population and the increasing prevalence of chronic diseases are global problems whose causes are multifactorial and complex. The Western lifestyle does not promote healthy living, and the consequences are most devastating when social inequalities, together with the economic and population explosion of recent decades, are considered. The expansion of poor nutritional habits, obesity, sedentarism, and hypertension are increasingly contributing to the development of a cardiovascular disease epidemic. Recent data on the rates of compliance with lifestyle modification and adherence to prescribed medication are alarming. Over 50% of patients, on average, decide to abandon the treatment prescribed, and the objectives to improve their habits (quit smoking, lose weight, or engage in physical activity) are met by an equal or lower percentage. Beyond the impact it has on individual health, it carries a huge economic cost, as it is associated with a failure in achieving therapeutic goals, higher rate of hospitalization, and death. Improving communication between doctors and patients, the active involvement of other health professionals, and the development of combination drug formulations (polypill) are potential strategies for improving adherence and reducing costs.     

Targeting and Recanalization after Embolization with Calibrated Resorbable Microspheres versus Hand-cut Gelatin Sponge Particles in a Porcine Kidney Model

PurposeTo report on polyethylene glycol hydrogel-based resorbable embolization microspheres (REM) that were synthesized to resorb in < 24 hours, before inflammation and vascular remodeling, to achieve a complete arterial recanalization and to compare targeting and recanalization of REM of 300–500 µm, 500–700 µm, and 700–900 µm with hand-cut gelatin sponge particles (GSP).Materials and MethodsEight pigs underwent polar renal artery embolization with REM or GSP. Angiograms were obtained before embolization and 10 minutes and 7 days after embolization before pigs were sacrificed to determine the occlusion level, the percentage of occlusion, and the recanalization rate for each product. The distribution of embolic material was assessed in pathology, and infarction rate of the kidneys was measured.ResultsREM of 300–500 µm occluded more distal vessels than REM of 500–700 µm and 700–900 µm. At day 7, the recanalization rate was complete for the larger REM, whereas it was about 60% for the two smaller sizes. REM were completely degraded, with no residual material or inflammation. GSP occluded more proximal arteries than REM of 700–900 µm, were partly degraded at day 7, and were accompanied by a foreign body reaction in proximal and distal arteries. GSP recanalized at 79%. The infarction rate was higher with the two smaller sizes of REM and with GSP than with the largest REM.ConclusionsREM of different sizes targeted different occlusion levels in kidney arteries. GSP provided an extended occlusion level without actual targeting. Regardless of embolic material used, angiographic recanalization of renal arteries depended on the extent of necrosis. REM of 700–900 µm demonstrated the lowest infarction rate and the best recanalization rate.     

The influence of differently polarised microwave radiation on chromatin in human cells

Purpose: To determine the possible biological effects of differently polarised microwave radiation on the chromatin state in human cells.

Materials and methods: Isolated human buccal epithelium cells were irradiated by microwaves of frequency f = 35 GHz and surface power density E = 30 μW/cm². The state of chromatin in human cells was determined by methods of light and electron microscopy. The state of cell membranes was evaluated by the method of vital indigo carmine staining.

Results: The microwave-induced condensation of chromatin in human cells is revealed. Degree of microwave-induced condensation depends on the state of polarisation of electromagnetic wave: In some cases left circularly polarised waves induce less effect than linearly polarised radiation. The linearly polarised electromagnetic waves induce cell membrane damage revealed by increase of cell staining. The data obtained are discussed in connection with mechanisms of biological effects of electromagnetic fields.

Conclusion: The data obtained in this work demonstrate important biological effects of monochromatic microwave irradiation at 35 GHz. Low-level microwave irradiation induces chromatin condensation in human cells and damages of cell membranes.     

Blood-based risk stratification for pre-malignant and symptomatic plasma cell neoplasms to improve patient management

Standard risk stratification (sRisk) guides clinical management in monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma (SMM) and multiple myeloma (MM). Nonetheless, clinical results are considerably heterogeneous among patients with similar risk status. Blood and bone marrow samples from 276 MGUS, 56 SMM and 242 MM in regular clinical practice were analyzed at diagnosis by flow cytometry. Higher levels of aberrant circulating plasma cells (cPC) (> 0.0035% of leukocytes), combined with albumin, beta2-microglobuline and lactate-dehydrogenase levels, offered minimally-invasive risk stratification (RcPC) with results comparable to sRisk. RcPC and sRisk 10-year progression-free-survival (10y-PFS) rates were: 93.8% vs. 95.1% for low-risk, 78.4% vs. 81.7% for intermediate-risk and 50.0% vs. 47.8% for high-risk MGUS; 58.3% vs. 57.8% low-risk, 44.4% vs. 45.8% intermediate-risk and 8.9% vs. 15.0% high-risk SMM; and 44.4% vs. 44.4% low-risk, 36.1% vs. 36.8% intermediate-risk, and 13.3% vs. 16.2% high-risk MM. Circulating-PC > 0.0035% vs. cPC<0.0035% was an independent prognostic factor for PFS (HR=4.389, P=1.2×10^-15, Harrell C-statistic =0.7705±0.0190) and over-all survival (OS, HR=4.286, 2.3×10^-9, Harrell C-statistic =0.8225±0.0197) that complemented sRisk in patients with low-sRisk (10y-PFS rates 48.1% vs. 87.3%, P=1.2×10^-8) and intermediate-sRisk (10y-PFS rates 28.9% vs. 74.1%, P=8.6×10^-12). Patients with high cPCs values are associated with higher proliferation and lower apoptosis rates of PC. Circulating-PC > 0.0035% identified MGUS, SMM and MM patients at higher risk of progression or death and predicted a cohort of patients that after relapse from stringent complete response showed shorter OS. These patients could benefit from early consolidation therapy, tandem ASCT or intensive maintenance.     

Global cardiovascular health: urgent need for an intersectoral approach

Cardiovascular disease (CVD) is the leading cause of mortality worldwide, with more than 80% of CVD deaths occurring in low- and middle-income countries (LMICs). There have been several calls for action to address the global burden of CVD, but there remains insufficient investment in and implementation of CVD prevention and disease management efforts in LMICs. To catalyze the action needed to control global CVD, the Institute of Medicine recently produced a report, Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health. This paper presents a commentary of the Institute of Medicine's report, focusing specifically on the intersectoral nature of intervention approaches required to promote global cardiovascular health. We describe 3 primary domains of intervention to control global CVD: 1) policy approaches; 2) health communication programs; and 3) healthcare delivery interventions. We argue that the intersectoral nature of global CVD interventions should ideally occur at 2 levels: first, all 3 domains of intervention must be activated and engaged simultaneously, rather than only 1 domain at a time; and second, within each domain, a synergistic combination of interventions must be implemented. A diversity of public and private sector actors, representing multiple sectors such as health, agriculture, urban planning, transportation, finance, broadcasting, education, and the food and pharmaceutical industries, will be required to collaborate for policies, programs, and interventions to be optimally aligned. Improved control of global CVD is eminently possible but requires an intersectoral approach involving a diversity of actors and stakeholders.