RESUMEN
Use of digital health technologies (DHT) in chronic disease management is rising. We aim to evaluate the impact of DHT on clinical outcomes from randomized controlled trials (RCTs) of patients with heart failure (HF) and diabetes mellitus (DM). Electronic databases were searched for DHT RCTs in patients with HF and DM until February 2021. Patient characteristics and outcomes were analyzed. One published (N = 519) and 6 registered (N = 3423) eligible studies were identified, with one study exclusively including HF and DM patients. Median DHT monitoring was 12 months, with six studies using mobile platforms as their key exposure. Clinical outcomes included quality-of-life or self-care surveys (n = 1 each), physical activity metrics, changes in biomarkers, and other clinical endpoints (n = 3). Limited data exist on RCTs evaluating DHT in patients with concomitant HF and DM. Further work should define standardized clinical endpoints and platforms that can manage patients with multiple comorbidities.
Asunto(s)
Diabetes Mellitus , Insuficiencia Cardíaca , Humanos , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/terapia , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/terapia , Insuficiencia Cardíaca/epidemiología , Comorbilidad , Enfermedad Crónica , Calidad de VidaRESUMEN
PURPOSE: Drusen are hallmarks of age-related macular degeneration (AMD). Amyloid-beta 1-40 (Aß 1-40), a constituent of drusen, is known to stimulate inflammatory pathways in RPE; however, its effect in vivo is not known. The purpose of this study was to examine the effect of Aß 1-40 on cytokine expression and inflammasome activation relevant to AMD in an animal model. METHODS: Wild-type rats received intravitreal injections of Aß 1-40, and eyes were taken at days 1, 4, 14, and 49 postinjection. The RPE, neuroretina, and vitreous were analyzed for cytokine expression, inflammasome activation, and microglial response via RT-PCR, immunohistochemistry, and suspension array assay. Retinal cell loss was assessed via apoptotic markers and retinal thickness. RESULTS: Aß 1-40 stimulated upregulation of IL-6, TNF-α, IL-1ß, IL-18, caspase-1, NLRP3, and XAF1 genes in the RPE/choroid and the neuroretina. Increased IL-1ß and IL-6 immunoreactivity was found in retinal sections, and elevated levels of IL-1ß and IL-18 were found in the vitreous of Aß-injected eyes. Aß 1-40 induced a moderate increase in CD11b/c-reactive cells on day 1 postinjection only. No evidence of the proapoptotic XAF1 protein, p53, TUNEL immunoreactivity, or retinal thinning was observed. CONCLUSIONS: These results confirm earlier in vitro work and support the proinflammatory role of drusen component Aß 1-40 in the RPE and retina. Inflammasome activation may be responsible for this effect in vivo. This model is useful for understanding cellular triggers of inflammasome activation and proposed early inflammatory events in the outer retina associated with the etiology of AMD.