Coronary Microvascular Dysfunction in Asymptomatic Patients with Severe Psoriasis

Disease Modification in Psoriasis: Future Prospects for Long-Term Remission

A subset of patients with moderate-to-severe psoriasis show long-term remission after drug withdrawal lasting well beyond several half-life times of the drug, particularly following effective treatment with modern biologics such as interleukin-23 inhibitors. Furthermore, evidence suggests that the development of comorbidities, including psoriatic arthritis, a key comorbidity causing irreversible damage, can be prevented or delayed in a subgroup of patients with psoriasis receiving these therapies. This implies that psoriasis treatments may alter the underlying disease mechanisms in some individuals, extending beyond their direct pharmacological effects. However, this concept of disease modification remains controversial, as predicting the natural clinical course of an individual patient with psoriasis is challenging, and typically, no permanent clinically detectable changes occur in psoriatic skin inflammation. This article aims to provide an overview of the current evidence on disease modification in psoriasis and discusses clinical and molecular markers that could be used to predict or monitor disease modification in psoriasis.

Development and validation of an AMR-based predictive model for post-PCI upper gastrointestinal bleeding in NSTEMI patients

Background

Upper gastrointestinal bleeding (UGIB) is a common complication in patients with non-ST-segment elevation myocardial infarction (NSTEMI) after percutaneous coronary intervention (PCI), and the aim of our study is to construct a nomogram for predicting the occurrence of UGIB within 1 year after PCI in NSTEMI patients.

Methods

In this study, 784 patients with NSTEMI after PCI in the Affiliated Hospital of Xuzhou Medical University between September 1, 2017 and August 31, 2019 were included as the training group, and 336 patients from the East Affiliated Hospital of Xuzhou Medical University were included as the external validation group. Classical regression methods were combined with a machine learning model to identify the independent risk factors. These factors based on multivariate logistic regression analysis were then utilized to develop a nomogram. The performance of the nomogram was evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis (DCA).

Results

The nomogram consisted of six independent predictors, including HASBLED, triglyceride glucose index, alcohol drinking, red blood cell count, use of proton pump inhibitor, and angiographic microvascular resistance of culprit vessel. Training and validation groups accurately predicted the occurrence of UGIB (AUC, 0.936 and 0.910). The calibration curves showed that the nomogram agreed with the actual observations and the DCA also demonstrated that the nomogram was applicable in the clinic.

Conclusion

We developed a simple and effective nomogram for predicting the occurrence of UGIB within 1 year in NSTEMI patients after PCI based on angiographic microvascular resistance.

Endothelial dysfunction and risk factors for atherosclerosis in psoriatic arthritis: overview and comparison with rheumatoid arthritis

Endothelial dysfunction (ED) is defined as an impairment in the vasodilatory, anti-thrombotic, and anti-inflammatory properties of the cells that make up the lining of blood vessels. ED is considered a key step in the development of atherosclerotic cardiovascular disease. The association between ED and systemic inflammatory diseases is well established. However, the prevalence and clinical significance of ED in psoriatic arthritis (PsA) have been investigated to a lesser extent. This review aims to explore the link between ED and PsA, including ED in macro- and microcirculation, as well as risk factors for its occurrence in PsA and its relationship with atherosclerosis in PsA. Furthermore, the ED in PsA was compared with that of rheumatoid arthritis (RA). Regarding ED in the microcirculation, the coronary flow reserve was found to be significantly reduced in individuals with PsA. The relationship between PsA and macrovascular ED is more pronounced, along with more advanced atherosclerosis detected in patients with PsA. These results are consistent with those obtained in RA studies. On the other hand, arterial stiffness and signs of vascular remodeling were found more frequently in RA than in PsA, with the potential role of efficient anti-TNF treatment in patients with PsA and psoriasis explaining this finding. The impact of ED on cardiovascular diseases and the burden of this risk caused independently by PsA have not yet been precisely established, however, this group of patients requires special attention with regard to cardiovascular events.

Improved microvascular imaging with optical coherence tomography using 3D neural networks and a channel attention mechanism

Skin microvasculature is vital for human cardiovascular health and thermoregulation, but its imaging and analysis presents significant challenges. Statistical methods such as speckle decorrelation in optical coherence tomography angiography (OCTA) often require multiple co-located B-scans, leading to lengthy acquisitions prone to motion artefacts. Deep learning has shown promise in enhancing accuracy and reducing measurement time by leveraging local information. However, both statistical and deep learning methods typically focus solely on processing individual 2D B-scans, neglecting contextual information from neighbouring B-scans. This limitation compromises spatial context and disregards the 3D features within tissue, potentially affecting OCTA image accuracy. In this study, we propose a novel approach utilising 3D convolutional neural networks (CNNs) to address this limitation. By considering the 3D spatial context, these 3D CNNs mitigate information loss, preserving fine details and boundaries in OCTA images. Our method reduces the required number of B-scans while enhancing accuracy, thereby increasing clinical applicability. This advancement holds promise for improving clinical practices and understanding skin microvascular dynamics crucial for cardiovascular health and thermoregulation.