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Knoblich C, Dunckelmann K, Krüger A, Küper T, Blatt T, Weise JM. N-acetyl-L-hydroxyproline - A potent skin anti-ageing active preventing advanced glycation end-product formation in vitro and ex vivo. Int J Cosmet Sci 2024; 46:297-306. [PMID: 38013225 DOI: 10.1111/ics.12930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/04/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE Advanced glycation end-products (AGEs) represent a large group of compounds generated by a non-enzymatic reaction between reducing sugars and amino groups. The formation and accumulation of AGEs in the skin lead to protein crosslinking, dermal stiffening and yellowing, which ultimately contribute to cutaneous ageing. Amino acids have been described to exhibit anti-glycation effects. The objective of this study was to understand the inhibitory role of the amino acid derivative N-acetyl-L-hydroxyproline (NAHP) as an anti-glycation active for human skin. METHODS A cell-free assay investigating the inhibition of glycation of serum albumin by NAHP was used to determine the capability of NAHP to decrease AGE formation. Also, by assessing the amount of the AGE N-(carboxymethyl)lysine (CML) the anti-glycation abilities of NAHP were investigated utilizing dot blot analysis. The improvement of cell-matrix interaction by NAHP was determined in vitro using a glycated fibroblast-populated collagen lattice (FPCL) dermis model. In skin biopsies, AGE autofluorescence was determined after treatment with NAHP and/or glucose ex vivo. RESULTS NAHP significantly and dose-dependently inhibited levels of AGEs, which were induced by the glycation of a protein solution. This decrease could be visualized by showing that the brownish appearance as well as the AGE-specific fluorescence of glucose-treated samples were reduced after the application of increasing amounts of NAHP. Also, CML formation was dose-dependently inhibited by NAHP. In FPCLs, the contractile capacity of fibroblasts was significantly disturbed after glycation. This could be prevented by the addition of NAHP. Compared to glyoxal-treated samples, the co-application of NAHP significantly decreased the diameter as well as the weight of glycated FPCLs. Ex vivo application of glucose to skin explants showed a higher AGE fluorescence signal compared to control explants. Co-treatment with NAHP and glucose decreased the level of AGE fluorescence in comparison to glucose-treated explants. CONCLUSION These data provide clear evidence that under glycation stress conditions treatment with NAHP inhibited AGE formation in vitro and ex vivo and prevented the loss of cellular contractile forces in a glycated dermis model. Thus, NAHP obviously provides a beneficial treatment option to counteract AGE-related changes in human skin such as dermal stiffening and yellowish skin appearance.
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Affiliation(s)
| | | | - Andrea Krüger
- Research and Development, Beiersdorf AG, Hamburg, Germany
| | - Thomas Küper
- Research and Development, Beiersdorf AG, Hamburg, Germany
| | - Thomas Blatt
- Research and Development, Beiersdorf AG, Hamburg, Germany
| | - Julia M Weise
- Research and Development, Beiersdorf AG, Hamburg, Germany
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Kim Y. Blood and Tissue Advanced Glycation End Products as Determinants of Cardiometabolic Disorders Focusing on Human Studies. Nutrients 2023; 15:nu15082002. [PMID: 37111220 PMCID: PMC10144557 DOI: 10.3390/nu15082002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
Cardiometabolic disorders are characterised by a cluster of interactive risk determinants such as increases in blood glucose, lipids and body weight, as well as elevated inflammation and oxidative stress and gut microbiome changes. These disorders are associated with onset of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). T2DM is strongly associated with CVD. Dietary advanced glycation end products (dAGEs) attributable from modern diets high in sugar and/or fat, highly processed foods and high heat-treated foods can contribute to metabolic etiologies of cardiometabolic disorders. This mini review aims to determine whether blood dAGEs levels and tissue dAGEs levels are determinants of the prevalence of cardiometabolic disorders through recent human studies. ELISA (enzyme-linked immunosorbent assay), high-performance liquid chromatography (HPLC), liquid chromatography-mass spectrometry (LC-MS) and gas chromatography-mass spectrometry (GC-MS) for blood dAGEs measurement and skin auto fluorescence (SAF) for skin AGEs measurement can be used. Recent human studies support that a diet high in AGEs can negatively influence glucose control, body weight, blood lipid levels and vascular health through the elevated oxidative stress, inflammation, blood pressure and endothelial dysfunction compared with a diet low in AGEs. Limited human studies suggested a diet high in AGEs could negatively alter gut microbiota. SAF could be considered as one of the predictors affecting risks for cardiometabolic disorders. More intervention studies are needed to determine how dAGEs are associated with the prevalence of cardiometabolic disorders through gut microbiota changes. Further human studies are conducted to find the association between CVD events, CVD mortality and total mortality through SAF measurement, and a consensus on whether tissue dAGEs act as a predictor of CVD is required.
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Affiliation(s)
- Yoona Kim
- Department of Food and Nutrition, Institute of Agriculture and Life Science, Gyeongsang National University, 501 Jinju-daero, Jinju 52828, Gyeongsangnam-do, Republic of Korea
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Giorgi D, Bastiani L, Morales MA, Pascali MA, Colantonio S, Coppini G. Cardio-metabolic risk modeling and assessment through sensor-based measurements. Int J Med Inform 2022; 165:104823. [PMID: 35763936 DOI: 10.1016/j.ijmedinf.2022.104823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/13/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Cardio-metabolic risk assessment in the general population is of paramount importance to reduce diseases burdened by high morbility and mortality. The present paper defines a strategy for out-of-hospital cardio-metabolic risk assessment, based on data acquired from contact-less sensors. METHODS We employ Structural Equation Modeling to identify latent clinical variables of cardio-metabolic risk, related to anthropometric, glycolipidic and vascular function factors. Then, we define a set of sensor-based measurements that correlate with the clinical latent variables. RESULTS Our measurements identify subjects with one or more risk factors in a population of 68 healthy volunteers from the EU-funded SEMEOTICONS project with accuracy 82.4%, sensitivity 82.5%, and specificity 82.1%. CONCLUSIONS Our preliminary results strengthen the role of self-monitoring systems for cardio-metabolic risk prevention.
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Affiliation(s)
- Daniela Giorgi
- CNR Institute of Information Science and Technologies, Via G. Moruzzi 1, Pisa 56124, Italy.
| | - Luca Bastiani
- CNR Institute of Clinical Physiology, Via G. Moruzzi 1, Pisa 56124, Italy.
| | | | | | - Sara Colantonio
- CNR Institute of Information Science and Technologies, Via G. Moruzzi 1, Pisa 56124, Italy.
| | - Giuseppe Coppini
- CNR Institute of Information Science and Technologies, Via G. Moruzzi 1, Pisa 56124, Italy.
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Filošević Vujnović A, Jović K, Pištan E, Andretić Waldowski R. Influence of Dopamine on Fluorescent Advanced Glycation End Products Formation Using Drosophila melanogaster. Biomolecules 2021; 11:biom11030453. [PMID: 33803017 PMCID: PMC8002736 DOI: 10.3390/biom11030453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/09/2021] [Accepted: 03/13/2021] [Indexed: 01/14/2023] Open
Abstract
Non-enzymatic glycation and covalent modification of proteins leads to Advanced Glycation End products (AGEs). AGEs are biomarkers of aging and neurodegenerative disease, and can be induced by impaired neuronal signaling. The objective of this study was to investigate if manipulation of dopamine (DA) in vitro using the model protein, bovine serum albumin (BSA), and in vivo using the model organism Drosophila melanogaster, influences fluorescent AGEs (fAGEs) formation as an indicator of dopamine-induced oxidation events. DA inhibited fAGEs-BSA synthesis in vitro, suggesting an anti-oxidative effect, which was not observed when flies were fed DA. Feeding flies cocaine and methamphetamine led to increased fAGEs formation. Mutants lacking the dopaminergic transporter or the D1-type showed further elevation of fAGEs accumulation, indicating that the long-term perturbation in DA function leads to higher production of fAGEs. To confirm that DA has oxidative properties in vivo, we fed flies antioxidant quercetin (QUE) together with methamphetamine. QUE significantly decreased methamphetamine-induced fAGEs formation suggesting that the perturbation of DA function in vivo leads to increased oxidation. These findings present arguments for the use of fAGEs as a biomarker of DA-associated neurodegenerative changes and for assessment of antioxidant interventions such as QUE treatment.
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Affiliation(s)
| | - Katarina Jović
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7XH, UK;
| | | | - Rozi Andretić Waldowski
- Department of Biotechnology, University of Rijeka, 51000 Rijeka, Croatia;
- Correspondence: ; Tel.: +385-51-584-553
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Lee J, Jeong ET, Lim JM, Park SG. Development of the facial glycation imaging system for in situ human face skin glycation index measurement. J Cosmet Dermatol 2021; 20:2963-2968. [PMID: 33522691 PMCID: PMC8451778 DOI: 10.1111/jocd.13943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 01/30/2023]
Abstract
Background The accumulation of advanced glycation end products has been proposed as a causative agent of skin aging, but there are no conventional devices for quantifying advanced glycation end‐product accumulation in facial skin. Aims This study aimed to develop a convenient and accurate in situ advanced glycation end‐product measurement system for the human face. Methods We developed a facial glycation imaging system, which consisted of illumination (white light‐emitting diode, ultraviolet light‐emitting diode) and image acquisition modules to capture face images. Advanced glycation end product–related autofluorescence and total skin reflectance were calculated to obtain the skin glycation index using an image analysis algorithm. Correlations between the skin glycation index and facial skin elasticity and age were examined in 36 healthy Korean women. Results The facial glycation imaging system was validated against a volar forearm skin autofluorescence measurement device, that is, the AGE Reader mu, with forearm skin glycation index (R = 0.64, P < .01). Cheek elasticity was negatively correlated with cheek skin glycation index (R = −0.56, R = −0.57, and R = −0.61, P < .01 for R2, R5, and R7, respectively). Age was significantly correlated with forearm skin glycation index (R = 0.44, P < .01) and cheek skin glycation index (R = 0.48, P < .01). Conclusion We successfully developed a novel in situ facial skin glycation index measurement device. Our convenient and accurate system enables in situ skin glycation index monitoring for skin aging studies such as those on anti‐glycation cosmetics.
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Affiliation(s)
- Jinyong Lee
- LG Household & Health Care, LG Science Park, Seoul, Korea
| | - Eui Taek Jeong
- LG Household & Health Care, LG Science Park, Seoul, Korea
| | - Jun-Man Lim
- LG Household & Health Care, LG Science Park, Seoul, Korea
| | - Sun Gyoo Park
- LG Household & Health Care, LG Science Park, Seoul, Korea
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Zharkikh E, Dremin V, Zherebtsov E, Dunaev A, Meglinski I. Biophotonics methods for functional monitoring of complications of diabetes mellitus. J Biophotonics 2020; 13:e202000203. [PMID: 32654427 DOI: 10.1002/jbio.202000203] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 06/11/2023]
Abstract
The prevalence of diabetes complications is a significant public health problem with a considerable economic cost. Thus, the timely diagnosis of complications and prevention of their development will contribute to increasing the length and quality of patient life, and reducing the economic costs of their treatment. This article aims to review the current state-of-the-art biophotonics technologies used to identify the complications of diabetes mellitus and assess the quality of their treatment. Additionally, these technologies assess the structural and functional properties of biological tissues, and they include capillaroscopy, laser Doppler flowmetry and hyperspectral imaging, laser speckle contrast imaging, diffuse reflectance spectroscopy and imaging, fluorescence spectroscopy and imaging, optical coherence tomography, optoacoustic imaging and confocal microscopy. Recent advances in the field of optical noninvasive diagnosis suggest a wider introduction of biophotonics technologies into clinical practice and, in particular, in diabetes care units.
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Affiliation(s)
- Elena Zharkikh
- Research & Development Center of Biomedical Photonics, Orel State University, Orel, Russia
| | - Viktor Dremin
- Research & Development Center of Biomedical Photonics, Orel State University, Orel, Russia
- School of Engineering and Applied Science, Aston University, Birmingham, UK
| | - Evgeny Zherebtsov
- Research & Development Center of Biomedical Photonics, Orel State University, Orel, Russia
- Optoelectronics and Measurement Techniques unit, University of Oulu, Oulu, Finland
| | - Andrey Dunaev
- Research & Development Center of Biomedical Photonics, Orel State University, Orel, Russia
| | - Igor Meglinski
- School of Engineering and Applied Science, Aston University, Birmingham, UK
- Optoelectronics and Measurement Techniques unit, University of Oulu, Oulu, Finland
- Interdisciplinary Laboratory of Biophotonics, National Research Tomsk State University, Tomsk, Russia
- Institute of Engineering Physics for Biomedicine (PhysBio), National Research Nuclear University-MEPhI, Moscow, Russia
- School of Life and Health Sciences, Aston University, Birmingham, UK
- Department of Histology, Cytology and Embryology, Institute of Clinical Medicine N.V. Sklifosovsky, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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Jiang R, Wu H, Yang J, Jiang H, Du M, Vai M, Pun S, Gao Y. Automatic Range Adjustment of the Fluorescence Immunochromatographic Assay Based on Image Processing. Sensors (Basel) 2019; 20:E209. [PMID: 31905939 DOI: 10.3390/s20010209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 12/20/2019] [Accepted: 12/25/2019] [Indexed: 12/27/2022]
Abstract
As an emerging technology, fluorescence immunochromatographic assay (FICA) has the advantages of high sensitivity, strong stability and specificity, which is widely used in the fields of medical testing, food safety and environmental monitoring. The FICA reader based on image processing meets the needs of point-of-care testing because of its simple operation, portability and fast detection speed. However, the image gray level of common image sensors limits the detection range of the FICA reader, and high-precision image sensors are expensive, which is not conducive to the popularization of the instrument. In this paper, FICA strips' image was collected using a common complementary metal oxide semiconductor (CMOS) image sensor and a range adjustment mechanism was established to automatically adjust the exposure time of the CMOS image sensor to achieve the effect of range expansion. The detection sensitivity showed a onefold increase, and the upper detection limit showed a twofold increase after the proposed method was implemented. In addition, in the experiments of linearity and accuracy, the fitting degree (R2) of the fitted curves both reached 0.999. Therefore, the automatic range adjustment method can obviously improve the detection range of the FICA reader based on image processing.
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Asha Madhavan A, Juneja S, Sen P, Ghosh Moulick R, Bhattacharya J. Gold Nanoparticle-Based Detection of Low Molecular Weight AGEs from In Vitro Glycated Haemoglobin A0 Samples. Nanoscale Res Lett 2018; 13:390. [PMID: 30511188 PMCID: PMC6277258 DOI: 10.1186/s11671-018-2812-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/19/2018] [Indexed: 06/09/2023]
Abstract
Protein glycation is a major biochemical event that takes place in the plasma of diabetic patients due to increased sugar levels. Extensive glycation leads to the formation of advanced glycation end products (AGEs) that is well known for having detrimental effects on diabetic patients. In the current work, we have glycated the physiologically important protein Haemoglobin A0 in vitro to study AGE formation and activity by using them as a template for gold nanoparticle (GNPs) synthesis. It was found that the surface plasmon resonance of synthesised GNPs showed high correlation with the extent of glycation. On fractionation, the glycated Haemoglobin A0 segregated into two distinct population of products, one consisting of proteinaceous, cross-linked larger fragments of Haemoglobin A0 and a second population of non-proteinaceous low molecular weight AGEs. Only low molecular weight AGEs contributed to synthesis of GNPs upon using the fractions as a template, substantiating the principle of proposed GNP-based assay. Owing to its physiological importance, AGEs can be used as a diagnostic means for diabetes and its associated complications. In this study, we have employed the high reactivity of AGEs for the development of a GNP-based novel colorimetric sensor to enable their detection. Our proposed GNP-based sensing could have high clinical significance in detecting diabetes and its associated complexities.
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Affiliation(s)
- A. Asha Madhavan
- School of Biotechnology, Jawaharlal Nehru University, New Mehrauli Road, New Delhi, 110067 India
| | - S. Juneja
- School of Biotechnology, Jawaharlal Nehru University, New Mehrauli Road, New Delhi, 110067 India
| | - P. Sen
- School of Physical Sciences, Jawaharlal Nehru University, New Mehrauli Road, New Delhi, 110067 India
| | - R. Ghosh Moulick
- Amity Institute of Integrative sciences and Health, Amity University Gurgaon, Manesar, Haryana 122413 India
| | - J. Bhattacharya
- School of Biotechnology, Jawaharlal Nehru University, New Mehrauli Road, New Delhi, 110067 India
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Berkhout-Byrne N, Kallenberg MH, Gaasbeek A, Rabelink TJ, Hammer S, van Buchem MA, van Osch MJ, Kroft LJM, Boom H, Mooijaart SP, van Buren M. The Cognitive decline in Older Patients with End stage renal disease (COPE) study - rationale and design. Curr Med Res Opin 2017; 33:2057-2064. [PMID: 28604116 DOI: 10.1080/03007995.2017.1341404] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Older patients with end stage renal disease (ESRD) are at increased risk for cognitive decline, but detailed studies of the magnitude of cognitive decline on dialysis or comprehensive conservative management (CCM) are lacking and the underlying pathophysiological mechanisms have poorly been studied. OBJECTIVES To describe the rationale and design of the COPE study. Study objectives are as follows. Firstly, to examine the severity of cognitive impairment in older patients reaching ESRD before dialysis and the rate of decline after dialysis or CCM initiation. Secondly, to study the association of blood biomarkers for microvascular damage and MRI derived measurements of small vessel disease with the rate of cognitive decline. Thirdly, to examine to what extent cardiac function is related to brain structure and perfusion in patients reaching ESRD. Finally, to study the association of cognitive and functional capacity with quality of life in pre-dialysis patients, as well as after dialysis or CCM initiation. STUDY DESIGN AND METHODS The COPE study is a prospective, multicenter cohort study in the Netherlands, including prevalent and incident pre-dialysis patients ≥65 years old with eGFR ≤20 ml/min/1.73 m2, awaiting either dialysis or CCM initiation. At baseline extensive data is collected including a comprehensive geriatric assessment and laboratory tests. Brain and cardiac MRI for analysis of structural and functional abnormalities are performed at baseline and repeated following therapy change. All other measurements are repeated annually during four years of follow up, including an extra evaluation six months after initiation of dialysis. CONCLUSIONS Knowledge of the magnitude of cognitive decline and its underlying pathophysiological mechanism, as well as its impact on functionality and quality of life can eventually help to postulate an algorithm for well balanced decision making in treatment strategies in older patients reaching ESRD. CLINICAL TRIAL REGISTRATION The COPE study is registered on www.ccmo.nl (number: NL46389.058.13).
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Affiliation(s)
- Noeleen Berkhout-Byrne
- a Department of Nephrology , Leiden University Medical Center , Leiden , The Netherlands
| | - Marije H Kallenberg
- a Department of Nephrology , Leiden University Medical Center , Leiden , The Netherlands
- b Department of Gerontology and Geriatrics , Leiden University Medical Center , Leiden , The Netherlands
| | - André Gaasbeek
- a Department of Nephrology , Leiden University Medical Center , Leiden , The Netherlands
| | - Ton J Rabelink
- a Department of Nephrology , Leiden University Medical Center , Leiden , The Netherlands
| | - Sebastiaan Hammer
- c Department of Radiology , Leiden University Medical Center , Leiden , The Netherlands
- d Department of Radiology , HAGA Hospital , The Hague , The Netherlands
| | - Mark A van Buchem
- c Department of Radiology , Leiden University Medical Center , Leiden , The Netherlands
| | - Matthias J van Osch
- c Department of Radiology , Leiden University Medical Center , Leiden , The Netherlands
| | - Lucia J M Kroft
- c Department of Radiology , Leiden University Medical Center , Leiden , The Netherlands
| | - Henk Boom
- e Department of Nephrology , Reinier de Graaf Group , Delft , The Netherlands
| | - Simon P Mooijaart
- b Department of Gerontology and Geriatrics , Leiden University Medical Center , Leiden , The Netherlands
- f Institute for Evidence-based Medicine in Old Age (IEMO) , Leiden , The Netherlands
| | - Marjolijn van Buren
- a Department of Nephrology , Leiden University Medical Center , Leiden , The Netherlands
- g Department of Nephrology , HAGA Hospital , The Hague , The Netherlands
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Coppini G, Colantonio S. Self-monitoring systems for personalised health-care and lifestyle surveillance. Comput Biol Med 2017; 88:161-162. [PMID: 28735153 DOI: 10.1016/j.compbiomed.2017.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 07/16/2017] [Indexed: 01/12/2023]
Abstract
The quality of life and individual well-being are universally recognised as key factors in disease prevention. In particular, lifestyle interventions are effective tools for reducing the risk and incidence of major illnesses, such as cardiovascular diseases and metabolic disorders. On the other hand, patient role is progressively shifting from being a passive recipient of care towards being a co-producer of her/his health. In this frame, novel devices and systems able to help individuals in self-evaluation are expected to play a crucial role. In this special issue we focus on innovative methodologies and technologies devoted to individual self-assessment, oriented both to healthy people to maintain their well-being, and to diseased persons to improve their care.
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Affiliation(s)
- Giuseppe Coppini
- Italian National Research Council (CNR), Institute of Clinical Physiology, Pisa, Italy.
| | - Sara Colantonio
- Italian National Research Council (CNR), Institute of Information Science and Technologies, Pisa, Italy.
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