Inflammation as a cause of acute myocardial infarction in patients with myeloproliferative neoplasm

Myeloproliferative neoplasms(MPN)are a group of diseases characterized by the clonal proliferation of hematopoietic progenitor or stem cells.They are clinically classifiable into four main diseases:chronic myeloid leukemia,essential thrombocythemia,polycythemia vera,and primary myelofibrosis.These pathologies are closely related to cardio-and cerebrovascular diseases due to the increased risk of arterial thrombosis,the most common underlying cause of acute myocardial infarction.Recent evidence shows that the classical Virchow triad(hypercoagulability,blood stasis,endothelial injury)might offer an explanation for such association.Indeed,patients with MPN might have a higher number and more reactive circulating platelets and leukocytes,a tendency toward blood stasis because of a high number of circulating red blood cells,endothelial injury or overactivation as a consequence of sustained inflammation caused by the neoplastic clonal cell.These abnormal cancer cells,especially when associated with the JAK2V617F mutation,tend to proliferate and secrete several inflammatory cytokines.This sustains a pro-inflammatory state throughout the body.The direct consequence is the induction of a pro-thrombotic state that acts as a determinant in favoring both venous and arterial thrombus formation.Clinically,MPN patients need to be carefully evaluated to be treated not only with cytoreductive treatments but also with cardiovascular protective strategies.

Inflammatory biomarkers as cost-effective predictive tools in metabolic dysfunction-associated fatty liver disease

Qu and Li emphasize a fundamental aspect of metabolic dysfunction-associated fatty liver disease in their manuscript,focusing on the critical need for noninvasive diagnostic tools to improve risk stratification and predict the progression to severe liver complications.Affecting approximately 25%of the global population,metabolic dysfunction-associated fatty liver disease is the most common chronic liver condition,with higher prevalence among those with obesity.This letter stresses the importance of early diagnosis and intervention,especially given the rising incidence of obesity and metabolic syndrome.Research advancements provide insight into the potential of biomarkers(particularly inflammationrelated)as predictive tools for disease progression and treatment response.This overview addresses pleiotropic biomarkers linked to chronic inflammation and cardiometabolic disorders,which may aid in risk stratification and treatment efficacy monitoring.Despite progress,significant knowledge gaps remain in the clinical application of these biomarkers,necessitating further research to establish standardized protocols and validate their utility in clinical practice.Understanding the complex interactions among these factors opens new avenues to enhance risk assessment,leading to better patient outcomes and addressing the public health burden of this worldwide condition.

T-cells in myocardial infarction:Culprit instigators or mere effectors?

Immune system activation and dysfunction characterize the early phase of reperfusion after a myocardial infarction(MI). Despite initially neglected, adaptive immunity has been recently showed to play an important role in this setting. In fact, the immune system can recognize sequestered antigens released by the necrotic tissue, initiating a deleterious autoimmune vicious circle leading to worse outcome. In their recent work, Angelini et al shed the light on a new feature of post-MI which involves two "old players" of post-ischemic myocardial injury: CD31 and matrix metalloproteinase(MMP)-9. Specifically, the authors showed that an enhancement of MMP-9 release could determine the cleavage of inhibitory CD31 from CD4+ T-cells surface in patients with Acute Coronary Syndromes(ACS). These findings open the room for new studies investigating the role of MMP9 in other pathological processes associated with a reduction of CD31 functionality, such as plaque instability and rupture. Of interest, in the case of a causative role for CD31 shedding in ACS would be confirmed, there might be a potential role for the administration of CD31 protein or analogue compounds to blunt post-ischemic cardiac inflammation and improve ACS outcome.

Coronary stenting:A matter of revascularization

In the last few decades, the recommended treatment for coronary artery disease has been dramatically improved by percutaneous coronary intervention(PCI) and the use of balloon catheters, bare metal stents(BMSs), and drug-eluting stents(DESs). Catheter balloons were burdened by acute vessel occlusion or target-lesion restenosis. BMSs greatly reduced those problems holding up the vessel structure, but showed high rates of instent re-stenosis, which is characterized by neo-intimal hyperplasia and vessel remodeling leading to a renarrowing of the vessel diameter. This challenge was overtaken by first-generation DESs, which reduced restenosis rates to nearly 5%, but demonstrated delayed arterial healing and risk for late in-stent thrombosis, with inflammatory cells playing a pivotal role. Finally, new-generation DESs, characterized by innovations in design, metal composition, surface polymers, and antiproliferative drugs, finally reduced the risk for stent thrombosis and greatly improved revascularization outcomes. New advances include bioresorbable stents potentially changing the future of revascularization techniques as the concept bases upon the degradation of the stent scaffold to inert particles after its function expired, thus theoretically eliminating risks linked with both stent thrombosis and re-stenosis. Talking about DESs also dictates to consider dual antiplatelet therapy(DAPT), which is a fundamental moment in view of the good outcome duration, but also deals with bleeding complications. The better management of patients undergoing PCI should include the use of DESs and a DAPT finely tailored in consideration of the potentially developing bleeding risk in accordance with the indications from last updated guidelines.

Artificial intelligence in gastroenterology:Ethical and diagnostic challenges in clinical practice

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.