How does the brain change in chronic migraine? Developing disease biomarkers

Cephalalgia ◽  
2020 ◽  
pp. 033310242097435
Author(s):  
Patricia Pozo-Rosich ◽  
Gianluca Coppola ◽  
Julio Pascual ◽  
Todd J Schwedt
Keyword(s):  
Chronic Migraine ◽  
Patient Outcomes ◽  
Improve Patient Care ◽  
Response To Treatment ◽  
Disease Biomarkers ◽  
Current State ◽  
Brain Structure And Function ◽  
Treatment Responses ◽  
And Function ◽  
Improve Patient

Background Validated chronic migraine biomarkers could improve diagnostic, prognostic, and predictive abilities for clinicians and researchers, as well as increase knowledge on migraine pathophysiology. Objective The objective of this narrative review is to summarise and interpret the published literature regarding the current state of development of chronic migraine biomarkers. Findings Data from functional and structural imaging, neurophysiological, and biochemical studies have been utilised towards the development of chronic migraine biomarkers. These biomarkers could contribute to chronic migraine classification/diagnosis, prognosticating patient outcomes, predicting response to treatment, and measuring treatment responses early after initiation. Results show promise for using measures of brain structure and function, evoked potentials, and sensory neuropeptide concentrations for the development of chronic migraine biomarkers, yet further optimisation and validation are still required. Conclusions Imaging, neurophysiological, and biochemical changes that occur with the progression from episodic to chronic migraine could be utilised for developing chronic migraine biomarkers that might assist with diagnosis, prognosticating individual patient outcomes, and predicting responses to migraine therapies. Ultimately, validated biomarkers could move us closer to being able to practice precision medicine in the field and thus improve patient care.

scholarly journals Immunotherapy in gastroesophageal cancers: Current state and future directions

2020 ◽  
pp. 107815522096353
Author(s):  
Hira Shaikh ◽  
Amir Kamran ◽  
Dulabh K Monga
Keyword(s):  
Patient Outcomes ◽  
Molecular Targeted Therapy ◽  
Treatment Options ◽  
Cell Cycle Checkpoints ◽  
Future Directions ◽  
Alternative Strategies ◽  
Current State ◽  
Dismal Prognosis ◽  
The World ◽  
Improve Patient

While gastroesophageal (GE) cancers are one of the most common cancers worldwide, unfortunately, the mortality remains high. Commonly used treatment options include surgical resection, chemotherapy, radiotherapy, and molecular targeted therapy, which improve survival only minimally; thus, affirming the dire need for exploring alternative strategies to improve patient outcomes. Immunotherapy, which has revolutionized the world of oncology, has somewhat lagged behind in GE malignancies. Tumor-associated microenvironment and regulatory T cells, alongside cell cycle checkpoints, have been proposed by various studies as the mediators of carcinogenesis in GE cancers. Thus, inhibition of each of these could serve as a possible target of treatment. While the approval of pembrolizumab has provided some hope, it is not enough to override the dismal prognosis that this disease confers. Herein, we discuss the prospects of immunotherapy in this variety of cancer.

scholarly journals Biomarkers of Stroke Recovery: Consensus-Based Core Recommendations from the Stroke Recovery and Rehabilitation Roundtable

2017 ◽  
Vol 31 (10-11) ◽  
pp. 864-876 ◽  
Author(s):  
Lara A. Boyd ◽  
Kathryn S. Hayward ◽  
Nick S. Ward ◽  
Cathy M. Stinear ◽  
Charlotte Rosso ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Recovery Process ◽  
Stroke Recovery ◽  
Design Studies ◽  
Current State ◽  
Brain Structure And Function ◽  
Clinical Questions ◽  
And Function ◽  
Patient Subgroups ◽  
Rehabilitation Strategy

The most difficult clinical questions in stroke rehabilitation are “What is this patient’s potential for recovery?” and “What is the best rehabilitation strategy for this person, given her/his clinical profile?” Without answers to these questions, clinicians struggle to make decisions regarding the content and focus of therapy, and researchers design studies that inadvertently mix participants who have a high likelihood of responding with those who do not. Developing and implementing biomarkers that distinguish patient subgroups will help address these issues and unravel the factors important to the recovery process. The goal of the present paper is to provide a consensus statement regarding the current state of the evidence for stroke recovery biomarkers. Biomarkers of motor, somatosensory, cognitive and language domains across the recovery timeline post-stroke are considered; with focus on brain structure and function, and exclusion of blood markers and genetics. We provide evidence for biomarkers that are considered ready to be included in clinical trials, as well as others that are promising but not ready and so represent a developmental priority. We conclude with an example that illustrates the utility of biomarkers in recovery and rehabilitation research, demonstrating how the inclusion of a biomarker may enhance future clinical trials. In this way, we propose a way forward for when and where we can include biomarkers to advance the efficacy of the practice of, and research into, rehabilitation and recovery after stroke.

scholarly journals Biomarkers of stroke recovery: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable

2017 ◽  
Vol 12 (5) ◽  
pp. 480-493 ◽  
Author(s):  
Lara A Boyd ◽  
Kathryn S Hayward ◽  
Nick S Ward ◽  
Cathy M Stinear ◽  
Charlotte Rosso ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Recovery Process ◽  
Stroke Recovery ◽  
Design Studies ◽  
Current State ◽  
Brain Structure And Function ◽  
Clinical Questions ◽  
And Function ◽  
Patient Subgroups ◽  
Rehabilitation Strategy

The most difficult clinical questions in stroke rehabilitation are “What is this patient’s potential for recovery?” and “What is the best rehabilitation strategy for this person, given her/his clinical profile?” Without answers to these questions, clinicians struggle to make decisions regarding the content and focus of therapy, and researchers design studies that inadvertently mix participants who have a high likelihood of responding with those who do not. Developing and implementing biomarkers that distinguish patient subgroups will help address these issues and unravel the factors important to the recovery process. The goal of the present paper is to provide a consensus statement regarding the current state of the evidence for stroke recovery biomarkers. Biomarkers of motor, somatosensory, cognitive and language domains across the recovery timeline post-stroke are considered; with focus on brain structure and function, and exclusion of blood markers and genetics. We provide evidence for biomarkers that are considered ready to be included in clinical trials, as well as others that are promising but not ready and so represent a developmental priority. We conclude with an example that illustrates the utility of biomarkers in recovery and rehabilitation research, demonstrating how the inclusion of a biomarker may enhance future clinical trials. In this way, we propose a way forward for when and where we can include biomarkers to advance the efficacy of the practice of, and research into, rehabilitation and recovery after stroke.

scholarly journals REGENERATIVE REHABILITATION OF SKELETAL MUSCLES DAMAGES

2021 ◽  
Author(s):  
Alexandr S. Golota ◽  
Sergey G. Sherbak ◽  
Stanislav V. Makarenko ◽  
Andrey M. Sarana ◽  
Tatyana A. Kamilova
Keyword(s):  
Patient Outcomes ◽  
Skeletal Muscles ◽  
Genetic Basis ◽  
Molecular Genetic ◽  
Scientific Research ◽  
Expression Levels ◽  
Rehabilitation Programs ◽  
Current State ◽  
Molecular Genetic Basis ◽  
Improve Patient

The article is devoted to the analysis of the current state of regenerative and rehabilitative treatments of skeletal muscles, the possibilities of restoring the functioning of tissue lost due to aging, injuries or diseases. The study of the molecular genetic basis of mechanotransduction and mechanotherapy will allow the identification of genes and molecules, the expression levels of which can serve as biomarkers of the effectiveness of regenerative-rehabilitation measures. These mechanisms are potential therapeutic targets for stimulating of regeneration of skeletal muscles. The focus of the article is on the choice of an individual approach, both when conducting basic scientific research and developing rehabilitation programs. All this will significantly improve patient outcomes.

Hospital-Based Simulation

2020 ◽  
Vol 39 (1) ◽  
pp. 83-103
Author(s):  
J. Cedar Wang ◽  
Lori Podlinski
Keyword(s):  
Patient Outcomes ◽  
Simulation Training ◽  
Training Methods ◽  
In Situ Simulation ◽  
Staffing Ratios ◽  
Current State ◽  
Medical Emergencies ◽  
Low Incidence ◽  
Hospital Staffing ◽  
Improve Patient

This chapter discusses the current state of hospital-based simulation, including the unprecedented events of 2020's global COVID-19 pandemic. Hospital-based simulation training requires a new approach. The realities of social distancing and the operational demands of hospital staffing ratios warrant creative adaptations of traditional simulation training methods. Hospitals used simulation to improve patient outcomes by training healthcare staff and students through telesimulation, and tested systems and equipment using in situ simulation (ISS). Latent safety threats (LSTs) were identified and corrected to improve patient outcomes. Hospital-based simulation has been incorporated into newly licensed registered nurses (NLRNs) residency programs to prepare them for competent practice. Simulations are also used for preparing staff for low-incidence, high-risk medical emergencies or disasters, such as active shooter events. Hospital-based simulation training adds value to healthcare systems, but requires more evidence of its quantitative and qualitative impacts.

scholarly journals Does Sex Bias Play a Role for Dissatisfied Patients With Hypothyroidism?

2018 ◽  
Vol 2 (8) ◽  
pp. 970-973 ◽  
Author(s):  
Elizabeth A McAninch ◽  
Jennifer S Glueck ◽  
Antonio C Bianco
Keyword(s):  
Patient Outcomes ◽  
Thyroid Disease ◽  
Thyroid Diseases ◽  
Sex Bias ◽  
Diagnosis And Management ◽  
Men 2 ◽  
Current State ◽  
Pregnancy And Postpartum ◽  
Improve Patient

Abstract The current state of the diagnosis and management of thyroid disease cannot be separated from the larger context of women’s health for the following reasons: (1) the disproportionate incidence and prevalence of functional and structural thyroid diseases among women vs men; (2) the role of thyroid health on fertility, pregnancy, and postpartum; and (3) the challenge posed in managing the nonspecific symptoms of functional thyroid disease in the context of menopause. Here, we explore the hypothesis that sex bias has played a role in the management of thyroid diseases historically and has extended into the modern medical era. Once knowledge gaps that may have resulted from sex bias are recognized, we can strive to overcome this bias and develop better treatments to improve patient outcomes universally.

scholarly journals Artificial intelligence-guided tissue analysis combined with immune infiltrate assessment predicts stage III colon cancer outcomes in PETACC08 study

Gut ◽  
2019 ◽  
Vol 69 (4) ◽  
pp. 681-690 ◽  
Author(s):  
Cynthia Reichling ◽  
Julien Taieb ◽  
Valentin Derangere ◽  
Quentin Klopfenstein ◽  
Karine Le Malicot ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Colon Cancer ◽  
Patient Outcomes ◽  
Improve Patient Care ◽  
Stage Iii ◽  
Free Survival ◽  
Relapse Risk ◽  
Stage Iii Colon Cancer ◽  
Healthy Mucosa ◽  
Improve Patient

ObjectiveDiagnostic tests, such as Immunoscore, predict prognosis in patients with colon cancer. However, additional prognostic markers could be detected on pathological slides using artificial intelligence tools.DesignWe have developed a software to detect colon tumour, healthy mucosa, stroma and immune cells on CD3 and CD8 stained slides. The lymphocyte density and surface area were quantified automatically in the tumour core (TC) and invasive margin (IM). Using a LASSO algorithm, DGMate (DiGital tuMor pArameTErs), we detected digital parameters within the tumour cells related to patient outcomes.ResultsWithin the dataset of 1018 patients, we observed that a poorer relapse-free survival (RFS) was associated with high IM stromal area (HR 5.65; 95% CI 2.34 to 13.67; p<0.0001) and high DGMate (HR 2.72; 95% CI 1.92 to 3.85; p<0.001). Higher CD3+ TC, CD3+ IM and CD8+ TC densities were significantly associated with a longer RFS. Analysis of variance showed that CD3+ TC yielded a similar prognostic value to the classical CD3/CD8 Immunoscore (p=0.44). A combination of the IM stromal area, DGMate and CD3, designated ‘DGMuneS’, outperformed Immunoscore when used in estimating patients’ prognosis (C-index=0.601 vs 0.578, p=0.04) and was independently associated with patient outcomes following Cox multivariate analysis. A predictive nomogram based on DGMuneS and clinical variables identified a group of patients with less than 10% relapse risk and another group with a 50% relapse risk.ConclusionThese findings suggest that artificial intelligence can potentially improve patient care by assisting pathologists in better defining stage III colon cancer patients’ prognosis.

scholarly journals Peritoneal Membrane Injury and Peritoneal Dialysis

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Shaan Chugh ◽  
Sultan Chaudhry ◽  
Timothy Ryan ◽  
Peter J. Margetts
Keyword(s):  
Peritoneal Dialysis ◽  
Patient Outcomes ◽  
Structure And Function ◽  
Peritoneal Membrane ◽  
Membrane Injury ◽  
Common Life ◽  
Membrane Structure And Function ◽  
And Function ◽  
Technique Failure ◽  
Improve Patient

For patients with chronic renal failure, peritoneal dialysis (PD) is a common, life sustaining form of renal replacement therapy that is used worldwide. Exposure to nonbiocompatible dialysate, inflammation, and uremia induces longitudinal changes in the peritoneal membrane. Application of molecular biology techniques has led to advances in our understanding of the mechanism of injury of the peritoneal membrane. This understanding will allow for the development of strategies to preserve the peritoneal membrane structure and function. This may decrease the occurrence of PD technique failure and improve patient outcomes of morbidity and mortality.

scholarly journals Applications of MRI Connectomics

2021 ◽  
Author(s):  
Jessica S. Damoiseaux ◽  
Andre Altmann ◽  
Jonas Richiardi ◽  
Sepideh Sadaghiani
Keyword(s):  
Clinical Research ◽  
Brain Connectivity ◽  
Current Status ◽  
Disease Biomarkers ◽  
Brain Structure And Function ◽  
And Function ◽  
And Behavior ◽  
The Impact ◽  
Behavior And Cognition ◽  
Brain Connectomics

Structural and functional brain connectomics are considered a basis for an individual's behavior and cognition. Therefore, deviations from typical connectivity patterns may indicate disease processes, and can potentially serve as disease biomarkers. To date, the direct clinical application of brain connectivity measures for diagnostics or treatment is limited. Nonetheless, the extant literature on fundamental and clinical research applications reveals important advances in our understanding of typical and atypical brain structure and function. In this chapter we discuss the current status of the field regarding: (1) the impact of the connectome on cognitive processes and behavior, (2) the connectome across the lifespan, and (3) clinical research applications of connectomics. In addition, we highlight some limitations of connectomics for research and clinical translation.

scholarly journals Regenerative Rehabilitation for Bone Tissue Damage

2021 ◽  
Vol 3 (1) ◽  
pp. 48-62
Author(s):  
Alexander S. Golota ◽  
Stanislav V. Makarenko ◽  
Sergey G. Sсherbak ◽  
Tatyana A. Kamilova
Keyword(s):  
Patient Outcomes ◽  
Tissue Damage ◽  
Genetic Basis ◽  
Special Section ◽  
Molecular Genetic ◽  
Rehabilitation Programs ◽  
Current State ◽  
Molecular Genetic Basis ◽  
Rehabilitation Measures ◽  
Improve Patient

The article is devoted to the analysis of the current state of regenerative and rehabilitative treatments in orthopedics, the possibilities of restoring of bone lost due to injuries or diseases. An overview of the main methods and approaches to enable effective regenerative and rehabilitation measures is given. The study of the molecular genetic basis of mechanotransduction and mechanotherapy will allow the identification of genes and molecules, the expression levels of which can serve as biomarkers of the effectiveness of regenerative-rehabilitation measures. These mechanisms are potential therapeutic targets for stimulating of regeneration of bones. A special section is devoted to the study of the characteristics of cellular technologies in the treatment of injuries and diseases of these tissues. The focus of the article is on the choice of an individual approach, both when conducting basic scientific research and developing rehabilitation programs. All this will significantly improve patient outcomes.

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