Visualization of Global Disease Burden for the Optimization of Patient Management and Treatment

Abstract

BackgroundThe assessment and treatment of complex disorders is challenged by the multiple domains and instruments used to evaluate clinical outcome. With the large number of assessment tools typically used in complex disorders comes the challenge of obtaining an integrative view of disease status to further evaluate treatment outcome both at the individual level and at the group level. Radar plots appear as an attractive visual tool to display multivariate data on a two-dimensional graphical illustration. Here, we describe the use of radar plots for the visualization of disease characteristics applied in the context of tinnitus, a complex and heterogeneous condition, the treatment of which has shown mixed success.MethodsData from two different cohorts, the Swedish Tinnitus Outreach Project (STOP) and the Tinnitus Research Initiative (TRI) database, were used. STOP is a population-based cohort where cross-sectional data from 1,223 non-tinnitus and 933 tinnitus subjects were analyzed. By contrast, the TRI contained data from 571 patients who underwent various treatments and whose Clinical Global Impression (CGI) score was accessible to infer treatment outcome. In the latter, 34,560 permutations were tested to evaluate whether a particular ordering of the instruments could reflect better the treatment outcome measured with the CGI.ResultsRadar plots confirmed that tinnitus subtypes such as occasional and chronic tinnitus from the STOP cohort could be strikingly different, and helped appreciate a gender bias in tinnitus severity. Radar plots with greater surface areas were consistent with greater burden, and enabled a rapid appreciation of the global distress associated with tinnitus in patients categorized according to tinnitus severity. Permutations in the arrangement of instruments allowed to identify a configuration with minimal variance and maximized surface difference between CGI groups from the TRI database, thus affording a means of optimally evaluating the outcomes in individual patients.ConclusionWe anticipate such a tool to become a starting point for more sophisticated measures in clinical outcomes, applicable not only in the context of tinnitus but also in other complex diseases where the integration of multiple variables is needed for a comprehensive evaluation of treatment response.

Galectin-3 in M2 Macrophages Plays a Protective Role in Resolution of Neuropathology in Brain Parasitic Infection by Regulating Neutrophil Turnover

“…However, it remains to be determined the consequence as well as the mechanisms involved in the increased accumulation of M2 macrophages in the CNS of parasite-infected Galectin-3 Ϫ/Ϫ mice. In this regard, it has been suggested that galectins, including galectin-3, can play a role in immune cell trafficking (Sperandio et al, 2009;Ge et al, 2013;Jia et al, 2013). However, our results showed that adoptively transferred galectin-3-sufficient as well as -deficient M2 macrophages accumulated in the CNS of both WT and Galectin-3 Ϫ/Ϫ mice with similar frequency.…”

“…Here we observed that the parasite-infected Galectin-3 Ϫ/Ϫ mice, despite showing the presence of an increased number of M2 macrophages in the CNS compared with their WT counterparts, exhibit severe neurological signs and are highly susceptible to the infection. In the CNS of Galectin-3 Ϫ/Ϫ mice, perhaps the observed elevated amount of the chemokines, including CCL2, which are known to involve in trafficking of monocytes/ macrophages (Ransohoff et al, 2003;Shi and Pamer, 2011), facilitates the increased influx of M2 cells. This indicated to us that the protective function, but not the development, of M2 cells is dependent on galectin-3.…”

Association of Genetic vs Environmental Factors in Swedish Adoptees With Clinically Significant Tinnitus

“…Familial aggregation studies, including influence on spouses, may help complement the present study; however, one should consider that different mechanisms of development of severe tinnitus may occur between men and women, as recently suggested. 13 …”

Genetics of Tinnitus: Time to Biobank Phantom Sounds

“…With tinnitus being a condition with highly unmet clinical needs ( Cederroth et al, 2013 ), the recent identification of a high heritability opens door to exciting research. Since it is more than likely that tinnitus is a polygenic trait and it will require the study of several thousand samples, audiologists and ENT doctors should optimize their phenotyping strategies for instance by using high frequency audiometry and multivariate questionnaire data ( Muller et al, 2016 ; Schlee et al, 2017 ), initiate incentives to allocate a specific ICD-code for bilateral tinnitus, and start biobanking samples ( Lopez-Escamez et al, 2016 ). Regarding the latter, since it is not custom for an ENT clinic to collect samples for DNA biobanking, guidelines should emerge to promote good practice ( Fuller et al, 2017 ) and enable the creation of a large consortium to join efforts to decipher the genetic basis of tinnitus.…”