scholarly journals Precision Medicine in Interventional Cardiology

2020 ◽  
Vol 15 ◽  
Author(s):  
Thijmen W Hokken ◽  
Joana M Ribeiro ◽  
Peter P De Jaegere ◽  
Nicolas M Van Mieghem
Keyword(s):  
Precision Medicine ◽  
Therapeutic Option ◽  
Computational Modelling ◽  
Interventional Cardiology ◽  
Individual Therapy ◽  
Psychosocial Characteristics ◽  
Personal Variables ◽  
Test Treatments ◽  
The Individual ◽  
Genetic Biomarker

Precision medicine has recently become widely advocated. It revolves around the individual patient, taking into account genetic, biomarker, phenotypic or psychosocial characteristics and uses biological, mechanical and/or personal variables to optimise individual therapy. In silico testing, such as the Virtual Physiological Human project, is being promoted to predict risk and to test treatments and medical devices. It combines artificial intelligence and computational modelling to select the best therapeutic option for the individual patient.

scholarly journals Treatable traits: toward precision medicine of chronic airway diseases

2016 ◽  
Vol 47 (2) ◽  
pp. 410-419 ◽  
Author(s):  
Alvar Agusti ◽  
Elisabeth Bel ◽  
Mike Thomas ◽  
Claus Vogelmeier ◽  
Guy Brusselle ◽  
...  
Keyword(s):  
Precision Medicine ◽  
Social Impact ◽  
Chronic Obstructive ◽  
Biological Mechanisms ◽  
Psychosocial Characteristics ◽  
Obstructive Pulmonary Disease ◽  
Airway Diseases ◽  
Clinical Presentations ◽  
Genetic Biomarker ◽  
Chronic Airway

Asthma and chronic obstructive pulmonary disease (COPD) are two prevalent chronic airway diseases that have a high personal and social impact. They likely represent a continuum of different diseases that may share biological mechanisms (i.e. endotypes), and present similar clinical, functional, imaging and/or biological features that can be observed (i.e. phenotypes) which require individualised treatment. Precision medicine is defined as “treatments targeted to the needs of individual patients on the basis of genetic, biomarker, phenotypic, or psychosocial characteristics that distinguish a given patient from other patients with similar clinical presentations”. In this Perspective, we propose a precision medicine strategy for chronic airway diseases in general, and asthma and COPD in particular.

Precision medicine in oncology – On a journey from dreams to reality

2018 ◽  
Vol 3 (1) ◽  
pp. 15
Author(s):  
Alpa Nimesh Patel ◽  
Mit Shah
Keyword(s):  
Precision Medicine ◽  
Clinical Presentation ◽  
Precision Oncology ◽  
Psychosocial Characteristics ◽  
The Status ◽  
To Come ◽  
The Right ◽  
Next Generation Sequencing Ngs ◽  
Genetic Biomarker ◽  
Generation Sequencing

Precision medicine is defined as treatments targeted to the needs of individual patients on the basis of genetic, biomarker, phenotypic, or psychosocial characteristics that distinguish a given patient from another patient with similar clinical presentation. Precision Oncology is an innovation at the cusp of blooming. We reviewed the status of precision oncology today, and discuss the flaws, mainly in next-generation sequencing (NGS) and the design of clinical trials thus far. Precision oncology although paints a glossy imagery, the reality is laden with inherent flaws, lack of guided research and a generalisability for the clinical market. The scenario in India is similar. It remains to be seen, if Precision Oncology is able to withstand the scrutiny likely to come its way, and if it can appeal largely to a complex socioeconomic market as India. We conclude that precision oncology is not far from an exponential boom, provided the right questions are asked, and answers derived.

THE SCIENCE OF JUDICIAL PSYCHOLOGY

2019 ◽  
Vol 12 (2) ◽  
pp. 78-87
Author(s):  
Petru TĂRCHILĂ
Keyword(s):  
Criminal Behavior ◽  
Cultural Context ◽  
Scientific Explanation ◽  
Preventive Measures ◽  
Psychosocial Characteristics ◽  
Legal Norms ◽  
Behavioral Profile ◽  
The Individual ◽  
Determining Factor ◽  
Determinant Factor

Judicial psychology is the science that analyzes and tries to understand the criminal phenomenon in general and its determinant factor in particular, by the complexity of factors that generate it and by the diversity of its forms of manifestation. Although the determining factor of criminal behavior is always subjective being generated by the psychic of the offender, this aspect must be correlated with the context in which it manifests itself: social, economic, cultural context etc. Judicial psychology investigates the behavior of the individual in all its aspects, seeking a scientific explanation of the mechanisms and factors enhancing criminal favors, thus enabling the identification of the preventive measures to be taken to reduce the categories of offenses. It studies the psycho-behavioral profile of the offender, identifying the causes that determined its behavior in order to take preventive measures.The domain of judicial psychology is mainly deviance, conduct that departs from the moral or legal norms that are dominant in a given culture. The object of judicial psychology is the criminal act, correlated with the psychosocial characteristics of the participants in the judicial action (offender, victim, witness, investigator, magistrate, lawyer, civil party, educator, etc.). The science of judicial psychology also analyzes how these characteristics appear and manifest themselves in concrete and special conditions of their interaction in three phases of the criminal act: the pre-criminal phase, the actual criminal phase and the post-criminal phase.

scholarly journals Radical Hemithoracic Radiotherapy Induces Systemic Metabolomics Changes That Are Associated with the Clinical Outcome of Malignant Pleural Mesothelioma Patients

Cancers ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 508
Author(s):  
Emanuela Di Gregorio ◽  
Gianmaria Miolo ◽  
Asia Saorin ◽  
Elena Muraro ◽  
Michela Cangemi ◽  
...  
Keyword(s):  
Amino Acids ◽  
Overall Survival ◽  
Clinical Outcome ◽  
Malignant Pleural Mesothelioma ◽  
Therapeutic Option ◽  
Enrichment Analysis ◽  
Metabolic Effects ◽  
Pleural Mesothelioma ◽  
Polyamine Biosynthesis ◽  
The Individual

Radical hemithoracic radiotherapy (RHRT) represents an advanced therapeutic option able to improve overall survival of malignant pleural mesothelioma patients. This study aims to investigate the systemic effects of this radiotherapy modality on the serum metabolome and their potential implications in determining the individual clinical outcome. Nineteen patients undergoing RHRT at the dose of 50 Gy in 25 fractions were enrolled. Serum targeted metabolomics profiles were investigated at baseline and the end of radiotherapy by liquid chromatography and tandem mass spectrometry. Univariate and multivariate OPLS-DA analyses were applied to study the serum metabolomics changes induced by RHRT while PLS regression analysis to evaluate the association between such changes and overall survival. RHRT was found to affect almost all investigated metabolites classes, in particular, the amino acids citrulline and taurine, the C14, C18:1 and C18:2 acyl-carnitines as well as the unsaturated long chain phosphatidylcholines PC ae 42:5, PC ae 44:5 and PC ae 44:6 were significantly decreased. The enrichment analysis showed arginine metabolism and the polyamine biosynthesis as the most perturbed pathways. Moreover, specific metabolic changes encompassing the amino acids and acyl-carnitines resulted in association with the clinical outcome accounting for about 60% of the interpatients overall survival variability. This study highlighted that RHRT can induce profound systemic metabolic effects some of which may have a significant prognostic value. The integration of metabolomics in the clinical assessment of the malignant pleural mesothelioma could be useful to better identify the patients who can achieve the best benefit from the RHRT treatment.

P2Y12 inhibitors in neuroendovascular surgery: An opportunity for precision medicine

2021 ◽  
pp. 159101992199139
Author(s):  
Axel Rosengart ◽  
Malie K Collins ◽  
Philipp Hendrix ◽  
Ryley Uber ◽  
Melissa Sartori ◽  
...  
Keyword(s):  
Adverse Events ◽  
Precision Medicine ◽  
Point Of Care ◽  
Indirect Evidence ◽  
Cost Benefit ◽  
Interventional Cardiology ◽  
Platelet Inhibition ◽  
Response Monitoring ◽  
P2y12 Inhibitor ◽  
P2y12 Inhibitors

Introduction Dual antiplatelet therapy (DAPT), primarily the combination of aspirin with a P2Y12 inhibitor, in patients undergoing intravascular stent or flow diverter placement remains the primary strategy to reduce device-related thromboembolic complications. However, selection, timing, and dosing of DAPT is critical and can be challenging given the existing significant inter- and intraindividual response variations to P2Y12 inhibitors. Methods Assessment of indexed, peer-reviewed literature from 2000 to 2020 in interventional cardiology and neuroendovascular therapeutics with critical, peer-reviewed appraisal and extraction of evidence and strategies to utilize DAPT in cardio- and neurovascular patients with endoluminal devices. Results Both geno- and phenotyping for DAPT are rapidly and conveniently available as point-of-care testing at a favorable cost-benefit ratio. Furthermore, systematic inclusion of a quantifying clinical risk score combined with an operator-linked, technical risk assessment for potential adverse events allows a more precise and individualized approach to new P2Y12 inhibitor therapy. Conclusions The latest evidence, primarily obtained from cardiovascular intervention trials, supports that combining patient pharmacogenetics with drug response monitoring, as part of an individually tailored, precision medicine approach, is both predictive and cost-effective in achieving and maintaining individual target platelet inhibition levels. Indirect evidence supports that this gain in optimizing drug responses translates to reducing main adverse events and overall treatment costs in patients undergoing DAPT after intracranial stent or flow diverting treatment.

scholarly journals The Use of Genotoxicity Endpoints as Biomarkers of Low Dose Radiation Exposure in Interventional Cardiology

2021 ◽  
Vol 9 ◽  
Author(s):  
Martha Habibi ◽  
Panagiotis K. Karyofyllis ◽  
Aggeliki Nikolakopoulou ◽  
Panagiotis Papagiannis ◽  
Pantelis Karaiskos ◽  
...  
Keyword(s):  
Risk Estimation ◽  
Biological Effects ◽  
Interventional Cardiology ◽  
Mean Values ◽  
Individual Level ◽  
Cardiac Procedures ◽  
Before And After ◽  
Radiation Induced ◽  
The Individual ◽  
Almost All

The effect of the reportedly low ionizing radiation doses, such as those very often delivered to patients in interventional cardiology, remains ambiguous. As interventional cardiac procedures may have a significant impact on total collective effective dose, there are radiation protection concerns for patients and physicians regarding potential late health effects. Given that very low doses (<100 mSv) are expected to be delivered during these procedures, the purpose of this study was to assess the potency and suitability of current genotoxicity biomarkers to detect and quantitate biological effects essential for risk estimation in interventional cardiology. Specifically, the biomarkers γ-H2AX foci, dicentric chromosomes, and micronuclei, which underpin radiation-induced DNA damage, were studied in blood lymphocytes of 25 adult patients before and after interventional cardiac procedures. Even though the mean values of all patients as a group for all three endpoints tested show increased yields relative to baseline following medical exposure, our results demonstrate that only the γ-H2AX biomarker enables detection of statistically significant differences at the individual level (p < 0.001) for almost all patients (91%). Furthermore, 24 h after exposure, residual γ-H2AX foci were still detectable in irradiated lymphocytes. Their decline was found to vary significantly among the individuals and the repair kinetics of γ-H2AX foci was found to range from 25 to 95.6% of their maximum values obtained.

scholarly journals Contrasting Medical and Legal Standards of Evidence: A Precision Medicine Case Study

2016 ◽  
Vol 44 (1) ◽  
pp. 194-204 ◽  
Author(s):  
Gary E. Marchant ◽  
Kathryn Scheckel ◽  
Doug Campos-Outcalt
Keyword(s):  
Precision Medicine ◽  
New Technologies ◽  
Clinical Care ◽  
Large Body ◽  
Standard Of Care ◽  
Genetic Profile ◽  
Legal Standards ◽  
Standards Of Evidence ◽  
The Individual

As the health care system transitions to a precision medicine approach that tailors clinical care to the genetic profile of the individual patient, there is a potential tension between the clinical uptake of new technologies by providers and the legal system's expectation of the standard of care in applying such technologies. We examine this tension by comparing the type of evidence that physicians and courts are likely to rely on in determining a duty to recommend pharmacogenetic testing of patients prescribed the oral anti-coagulant drug warfarin. There is a large body of inconsistent evidence and factors for and against such testing, but physicians and courts are likely to weigh this evidence differently. The potential implications for medical malpractice risk are evaluated and discussed.

scholarly journals Assessment of the Exposure of Turkey Farmers to Antimicrobial Resistance Associated with Working Practices

2019 ◽  
Vol 6 (1) ◽  
pp. 13
Author(s):  
Giorgio Franceschini ◽  
Marta Bottino ◽  
Ilary Millet ◽  
Elisa Martello ◽  
Francesca Zaltron ◽  
...  
Keyword(s):  
Direct Contact ◽  
Failure Modes ◽  
Individual Therapy ◽  
Human Consumption ◽  
Structured Interviews ◽  
Public And Private ◽  
Effect Analysis ◽  
Extended Spectrum Beta Lactamase ◽  
Working Practices ◽  
The Individual

The objective of the present study was the identification of farming practices in the production of turkeys for human consumption, and their ranking in terms of the occupational probability of exposure to antimicrobial resistant (AMR) bacteria, for farm workers. We gathered evidence and data from scientific literature, on risk factors for AMR in farmers, and on the prevalence of those hazards across farming phases. We administered semi-structured interviews to public and private veterinarians in Northern Italy, to obtain detailed information on turkey farming phases, and on working practices. Data were then integrated into a semi-quantitative Failure Modes and Effect Analysis (FMEA). Those working practices, which are characterized by direct contact with numerous animals, and which are carried out frequently, with rare use of personal protection devices resulted as associated with the greatest probability of exposure to AMR. For methicillin resistant Staphylococcus aureus (MRSA), these included vaccination and administration of any individual therapy, and removal and milling of litter, given the exposure of farmers to high dust level. Indeed, levels of occupational exposure to MRSA are enhanced by its transmission routes, which include direct contact with animal, as well as airborne transmission. Level of exposure to extended spectrum beta lactamase (ESBL) is more strictly associated with direct contact and the oral-fecal route. Consequently, exposure to ESBL resulted and associated with the routinely tipping over of poults turned on their back, and with the individual administration of therapies.

scholarly journals Lipid Mediators in Critically Ill Patients: A Step Towards Precision Medicine

2020 ◽  
Vol 11 ◽  
Author(s):  
Luca Cioccari ◽  
Nora Luethi ◽  
Mojgan Masoodi
Keyword(s):  
Immune Response ◽  
Fatty Acid ◽  
Critical Illness ◽  
Precision Medicine ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Lipid Mediators ◽  
Research Management ◽  
Inflammatory Status ◽  
The Individual

A dysregulated response to systemic inflammation is a common pathophysiological feature of most conditions encountered in the intensive care unit (ICU). Recent evidence indicates that a dysregulated inflammatory response is involved in the pathogenesis of various ICU-related disorders associated with high mortality, including sepsis, acute respiratory distress syndrome, cerebral and myocardial ischemia, and acute kidney injury. Moreover, persistent or non-resolving inflammation may lead to the syndrome of persistent critical illness, characterized by acquired immunosuppression, catabolism and poor long-term functional outcomes. Despite decades of research, management of many disorders in the ICU is mostly supportive, and current therapeutic strategies often do not take into account the heterogeneity of the patient population, underlying chronic conditions, nor the individual state of the immune response. Fatty acid-derived lipid mediators are recognized as key players in the generation and resolution of inflammation, and their signature provides specific information on patients’ inflammatory status and immune response. Lipidomics is increasingly recognized as a powerful tool to assess lipid metabolism and the interaction between metabolic changes and the immune system via profiling lipid mediators in clinical studies. Within the concept of precision medicine, understanding and characterizing the individual immune response may allow for better stratification of critically ill patients as well as identification of diagnostic and prognostic biomarkers. In this review, we provide an overview of the role of fatty acid-derived lipid mediators as endogenous regulators of the inflammatory, anti-inflammatory and pro-resolving response and future directions for use of clinical lipidomics to identify lipid mediators as diagnostic and prognostic markers in critical illness.

scholarly journals Current Concepts in Pharmacometabolomics, Biomarker Discovery, and Precision Medicine

Metabolites ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. 129 ◽  
Author(s):  
Richard D. Beger ◽  
Michael A Schmidt ◽  
Rima Kaddurah-Daouk
Keyword(s):  
Clinical Trials ◽  
Drug Treatment ◽  
Precision Medicine ◽  
Metabolic Profile ◽  
Biomarker Discovery ◽  
Response To Treatment ◽  
Individual Response ◽  
Patient Response ◽  
Drug Mechanism ◽  
The Individual

Pharmacometabolomics (PMx) studies use information contained in metabolic profiles (or metabolome) to inform about how a subject will respond to drug treatment. Genome, gut microbiome, sex, nutrition, age, stress, health status, and other factors can impact the metabolic profile of an individual. Some of these factors are known to influence the individual response to pharmaceutical compounds. An individual’s metabolic profile has been referred to as his or her “metabotype.” As such, metabolomic profiles obtained prior to, during, or after drug treatment could provide insights about drug mechanism of action and variation of response to treatment. Furthermore, there are several types of PMx studies that are used to discover and inform patterns associated with varied drug responses (i.e., responders vs. non-responders; slow or fast metabolizers). The PMx efforts could simultaneously provide information related to an individual’s pharmacokinetic response during clinical trials and be used to predict patient response to drugs making pharmacometabolomic clinical research valuable for precision medicine. PMx biomarkers can also be discovered and validated during FDA clinical trials. Using biomarkers during medical development is described in US Law under the 21st Century Cures Act. Information on how to submit biomarkers to the FDA and their context of use is defined herein.

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