Smartphone-based digital phenotyping for dry eye toward P4 medicine: a crowdsourced cross-sectional study

Multidimensional integrative data analysis of digital phenotyping is crucial for elucidating the pathologies of multifactorial and heterogeneous diseases, such as the dry eye (DE). This crowdsourced cross-sectional study explored a novel smartphone-based digital phenotyping strategy to stratify and visualize the heterogenous DE symptoms into distinct subgroups. Multidimensional integrative data were collected from 3,593 participants between November 2016 and September 2019. Dimension reduction via Uniform Manifold Approximation and Projection stratified the collected data into seven clusters of symptomatic DE. Symptom profiles and risk factors in each cluster were identified by hierarchical heatmaps and multivariate logistic regressions. Stratified DE subgroups were visualized by chord diagrams, co-occurrence networks, and Circos plot analyses to improve interpretability. Maximum blink interval was reduced in clusters 1, 2, and 5 compared to non-symptomatic DE. Clusters 1 and 5 had severe DE symptoms. A data-driven multidimensional analysis with digital phenotyping may establish predictive, preventive, personalized, and participatory medicine.

Interactions Networks for Primary Heart Sarcomas

Personalized medicine incorporates genetic information into medical practice so as to optimize the management of chronic diseases. In rare diseases, such as heart cancer (incidence 0.0017–0.33%), this may be elusive. Ninety-five percent of the cases are due to secondary involvementwith the neoplasm originating in the lungs, breasts, kidney, blood, or skin. The clinical manifestations of heart tumors (benign or malignant) include heart failure, hypertension, and cardiac arrhythmias of varying severity, frequently resulting in blood vessel emboli, including strokes. This study aims to explain the pathophysiology and contribute to a P4 medicine model for use by cardiologists, pathologists, and oncologists. We created six gene/protein heart-related and tumor-related targets high-confidence interactomes, which unfold the main pathways that may lead to cardiac diseases (heart failure, hypertension, coronary artery disease, arrhythmias), i.e., the sympathetic nervous system, the renin-angiotensin-aldosterone axis and the endothelin pathway, and excludes others, such as the K oxidase or cytochrome P450 pathways. We concluded that heart cancer patients could be affected by beta-adrenergic blockers, ACE inhibitors, QT-prolonging antiarrhythmic drugs, antibiotics, and antipsychotics. Interactomes may elucidate unknown pathways, adding to patient/survivor wellness during/after chemo- and/or radio-therapy.

P4 medicine as a tool for stimulating healthy lifestyle and the basis of teaching prevention to students of general medicine and pediatrics

This article focuses on approaches to implementing the principles of P4 medicine, specifically, stimulating prevention-based thinking among students of faculties of general medicine and pediatrics. Below, we describe a pilot approach to teaching hygiene that was implemented at the Department of General Hygiene (Kazan State Medical University). Considering the gnoseological role of empathy, we designed an interactive workbook for students taking a course in Hygiene. The workbook allows the student to engage in empathic interactions and discourse about the studied subject with the teacher and peers. After the course, the students were surveyed; their degree of engagement in the learning process and their expectations were evaluated. The respondents rated their interest in Hygiene before starting the course as 5.6 and 5.7 points on the 10-point scale (for the traditional and innovative courses, respectively). During the course, the score increased to 5.8 and 8.6 points for the traditional and innovative courses, respectively. Our pilot project demonstrates the need for reviewing the strategy of teaching hygiene and prevention-related disciplines at clinical faculties and including the principles of P4 medicine in the medical curriculum, thus allowing the student to effectively perform their professional duties in primary healthcare.

Healthy Ageing and Vaccines: Application of the P4 Medicine Concept to Immunizations

In today’s tormented world, it appears useful to take advantage of communication channels to promote life-course immunization and affirm its major role in healthy ageing. Instead of developing the argument of chronological age, we demonstrate the life-course principle here based on the P4 medicine concept. Are vaccines “preventive, personalized, predictive, and participatory?” Based on detailed analysis of research findings, we successively demonstrate the seminal role of vaccines on preventable infectious diseases, post-sepsis functional decline, non-communicable diseases (cardio-neuro-vascular, respiratory, and renal diseases), community protection, antimicrobial resistance, and perhaps even old-age dementia. Healthy ageing and the promotion of immunization are closely dependent on health literacy and provision of information by skilled health-care professionals. However, personal autonomy and individual freedom are influenced by psycho-cognitive hurdles (cultural approaches, beliefs, emotions, and behaviours), the opinions of the public/family/friends, and the increasing role of social media, which challenges scientific evidence. A similar phenomenon exists when dealing with the issue of healthy ageing, whose success depends greatly on life-course immunization.

P4-medicine in the resort spa treatment of patients after acute circulatory disorders

The formation of the basis for personalized medicine of the future should be based on the prognostic and preventive principles of medicine. The article presents an overview of the information on the method and application of the CME (complex medical expert) analysis. The features of the method, the object domain of its application, its task and methodology are described. The scheme of the options used to increase the efficiency of the method is of interest. The strengths and the shortcomings of the CME analysis noted by experts in the field of its application are given. Results. The authors propose an innovative technology for using the CME model to develop personalized forecasting, preservation, development, and management of health. The advantages of the technology and the urgency of its application are revealed. The new technology is based on the provisions of the development of the theory of the essential adaptation. To ensure the health state, the level of functioning of body systems must be consistent with the optimality, namely with the response norms, which determine the individual phenotype. In the process of the organism adaptation to the conditions of the external environment, the central nervous system and the significant body system (the system with the maximum response norm), which determine the specific and nonspecific responses of the organism, respectively, will be especially active (it is a known fact). Discussion. Dominant systems can actively involve other body systems in the adaptation process by the principle of interaction with them, increasing or decreasing their activity. Taking into account the direction of interaction (inhibition, toning), this fact becomes important for understanding the pathogenesis of diseases, their targeted prevention, and treatment. A comprehensive record of the mechanisms of the formation of a specific and nonspecific reaction is used with the aim of identifying and effectively preventing functional disorders in the body. The CME technology of personalized forecasting, preservation, development and health management eliminates the main drawbacks of CME analysis. On the other hand, the CME analysis technology helps to expand the range of its application, depending on the opportunities and threats of the environment. Conclusion. The presented approach will make it possible to optimally use the human potential to maintain a high quality of life and active longevity.

Patent Landscape of Automated Systems for Personalized Health Management (ASHM): Features, Shortcomings, and Implications for Developing an Optimal ASHM

The current struggle of national health care systems against global epidemic of non-communicable diseases (NCD) is both clinically ineffective and cost ineffective. On the other hand, rapid development of systems biology, P4 medicine and new digital and communication technologies are good prerequisites for creating an affordable and scalable automated system for personalized health management (ASHM). The current practice of ASHM is better represented in patent literature (36 relevant documents found in Google Patents and USPTO) than in scientific papers (17 documents found in PubMed and Google Scholar). However, only a small fraction of publications disclose a complete self-sufficient system. Problems that authors of ASHM aim to address, methodological approaches, and the most important technical solutions are reviewed and discussed along with shortcomings and limitations. Technical solutions for ASHM currently commercialized or described in literature generally fail to enable practicable, scalable and affordable automated and individualized screening, monitoring, prevention and correction of human health conditions. They also fail to provide a decision support system to patients that would help effectively prevent major NCD and their complications, be accessible and cost effective, consider individual lifestyle factors and involve patients in management of their individual health. Based on analysis of the literature, models of health and care, we propose conceptual framework for developing an ASHM that would be free from the mentioned problems.

Molecular Pathology: A Paradigm Shift towards Precision Medicine

Healthcare system is experiencing a paradigm shift to precision medicine. Genotypic–phenotypic affiliation has been found to be a fundamental percept in biology after the completion of Human Genome project. The first era of precision medicine is now split into groups and subgroups, making it a meaningful strategy concurrently throughout the clinical phases of drug designing and development. It likewise recommends healthcare reshaping that suggests disease perceptivity or remedial treatment. Thus, translational genomics addresses bench to bedside approach to achieve P4 medicine (personalized, predictive, preventive, and participatory), i.e., early disease diagnosis and specifically designed treating plans instead of one size fits all1.