Precision Clinical Medicine最新文献

{"title":"Efficacy of early prone or lateral positioning in patients with severe COVID-19: a single-center prospective cohort.","authors":"Zhong Ni,&nbsp;Kaige Wang,&nbsp;Ting Wang,&nbsp;Yuenan Ni,&nbsp;Wei Huang,&nbsp;Ping Zhu,&nbsp;Tao Fan,&nbsp;Ye Wang,&nbsp;Bo Wang,&nbsp;Jun Deng,&nbsp;Zhicheng Qian,&nbsp;Jiasheng Liu,&nbsp;Wenhao Cai,&nbsp;Shanling Xu,&nbsp;Yu Du,&nbsp;Gang Wang,&nbsp;Zongan Liang,&nbsp;Weimin Li,&nbsp;Jianfei Luo,&nbsp;Fengming Luo,&nbsp;Dan Liu","doi":"10.1093/pcmedi/pbaa034","DOIUrl":"https://doi.org/10.1093/pcmedi/pbaa034","url":null,"abstract":"<p><strong>Background: </strong>Position intervention has been shown to improve oxygenation, but its role in non-invasively ventilated patients with severe COVID-19 has not been assessed. The objective of this study was to investigate the efficacy of early position intervention on non-invasively ventilated patients with severe COVID-19.</p><p><strong>Methods: </strong>This was a single-center, prospective observational study in consecutive patients with severe COVID-19 managed in a provisional ICU at Renmin Hospital of Wuhan University from 31 January to 15 February 2020. Patients with chest CT showing exudation or consolidation in bilateral peripheral and posterior parts of the lungs were included. Early position intervention (prone or lateral) was commenced for > 4 hours daily for 10 days in these patients, while others received standard care.</p><p><strong>Results: </strong>The baseline parameters were comparable between the position intervention group (<i>n</i> = 17) and the standard care group (<i>n</i> = 35). Position intervention was well-tolerated and increased cumulative adjusted mean difference of SpO₂/FiO₂ (409, 95% CI 86 to 733) and ROX index (26, 95% CI 9 to 43) with decreased Borg scale (-9, 95% CI -15 to -3) during the first 7 days. It also facilitated absorption of lung lesions and reduced the proportion of patients with high National Early Warning Score 2 (≥ 7) on days 7 and 14, with a trend toward faster clinical improvement. Virus shedding and length of hospital stay were comparable between the two groups.</p><p><strong>Conclusions: </strong>This study provides the first evidence for improved oxygenation and lung lesion absorption using early position intervention in non-invasively ventilated patients with severe COVID-19, and warrants further randomized trials.</p>","PeriodicalId":33608,"journal":{"name":"Precision Clinical Medicine","volume":" ","pages":"260-271"},"PeriodicalIF":5.3,"publicationDate":"2020-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/pcmedi/pbaa034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40693001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Future directions for screening and treatment in congenital hearing loss.","authors":"Ryan K Thorpe, Richard J H Smith","doi":"10.1093/pcmedi/pbaa025","DOIUrl":"10.1093/pcmedi/pbaa025","url":null,"abstract":"<p><p>Hearing loss is the most common neurosensory deficit. It results from a variety of heritable and acquired causes and is linked to multiple deleterious effects on a child's development that can be ameliorated by prompt identification and individualized therapies. Diagnosing hearing loss in newborns is challenging, especially in mild or progressive cases, and its management requires a multidisciplinary team of healthcare providers comprising audiologists, pediatricians, otolaryngologists, and genetic counselors. While physiologic newborn hearing screening has resulted in earlier diagnosis of hearing loss than ever before, a growing body of knowledge supports the concurrent implementation of genetic and cytomegalovirus testing to offset the limitations inherent to a singular screening modality. In this review, we discuss the contemporary role of screening for hearing loss in newborns as well as future directions in its diagnosis and treatment.</p>","PeriodicalId":33608,"journal":{"name":"Precision Clinical Medicine","volume":"3 3","pages":"175-186"},"PeriodicalIF":5.1,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/46/64/pbaa025.PMC7653508.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38618794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent advancements in PARP inhibitors-based targeted cancer therapy.","authors":"Ping Zhou,&nbsp;Justin Wang,&nbsp;Daniel Mishail,&nbsp;Cun-Yu Wang","doi":"10.1093/pcmedi/pbaa030","DOIUrl":"https://doi.org/10.1093/pcmedi/pbaa030","url":null,"abstract":"<p><p>Poly(ADP-ribose) polymerase inhibitors (PARPi) are a new class of agents with unparalleled clinical achievement for driving synthetic lethality in BRCA-deficient cancers. Recent FDA approval of PARPi has motivated clinical trials centered around the optimization of PARPi-associated therapies in a variety of BRCA-deficient cancers. This review highlights recent advancements in understanding the molecular mechanisms of PARP 'trapping' and synthetic lethality. Particular attention is placed on the potential extension of PARPi therapies from BRCA-deficient patients to populations with other homologous recombination-deficient backgrounds, and common characteristics of PARPi and non-homologous end-joining have been elucidated. The synergistic antitumor effect of combining PARPi with various immune checkpoint blockades has been explored to evaluate the potential of combination therapy in attaining greater therapeutic outcome. This has shed light onto the differing classifications of PARPi as well as the factors that result in altered PARPi activity. Lastly, acquired chemoresistance is a crucial issue for clinical application of PARPi. The molecular mechanisms underlying PARPi resistance and potential overcoming strategies are discussed.</p>","PeriodicalId":33608,"journal":{"name":"Precision Clinical Medicine","volume":"3 3","pages":"187-201"},"PeriodicalIF":5.3,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/pcmedi/pbaa030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38429051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calling for a united action to defeat COVID-19.","authors":"Madison Overby, Qinqin Pu, Xiawei Wei, Min Wu","doi":"10.1093/pcmedi/pbaa027","DOIUrl":"10.1093/pcmedi/pbaa027","url":null,"abstract":"<p><p>The widespread and lingering pandemic of COVID-19 is partly due to disjointed international countermeasures and policies enforced by different countries. We have been witnessing disparity in policies and measures in different countries and regions: some are in much better control than others. To effectively deal with this and future devastating pandemics, we as human beings must work together to coordinate a concerted, cooperative international policy to reduce or possibly avoid unnecessary health crises, and life and economic losses.</p>","PeriodicalId":33608,"journal":{"name":"Precision Clinical Medicine","volume":"3 3","pages":"235-239"},"PeriodicalIF":5.1,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7454840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38624382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent advances of deep learning in psychiatric disorders","authors":"Lu Chen, C. Xia, Huaiqiang Sun","doi":"10.1093/pcmedi/pbaa029","DOIUrl":"https://doi.org/10.1093/pcmedi/pbaa029","url":null,"abstract":"ABSTRACT Deep learning (DL) is a recently proposed subset of machine learning methods that has gained extensive attention in the academic world, breaking benchmark records in areas such as visual recognition and natural language processing. Different from conventional machine learning algorithm, DL is able to learn useful representations and features directly from raw data through hierarchical nonlinear transformations. Because of its ability to detect abstract and complex patterns, DL has been used in neuroimaging studies of psychiatric disorders, which are characterized by subtle and diffuse alterations. Here, we provide a brief review of recent advances and associated challenges in neuroimaging studies of DL applied to psychiatric disorders. The results of these studies indicate that DL could be a powerful tool in assisting the diagnosis of psychiatric diseases. We conclude our review by clarifying the main promises and challenges of DL application in psychiatric disorders, and possible directions for future research.","PeriodicalId":33608,"journal":{"name":"Precision Clinical Medicine","volume":"35 1","pages":"202 - 213"},"PeriodicalIF":5.3,"publicationDate":"2020-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91380846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Host/genetic factors associated with COVID-19 call for precision medicine.","authors":"Alain R Thierry","doi":"10.1093/pcmedi/pbaa026","DOIUrl":"https://doi.org/10.1093/pcmedi/pbaa026","url":null,"abstract":"<p><p>If the current rate of infection are to be better managed, and future waves of infection kept at bay, it is absolutely necessary that the conditions and mechanisms of exposure to Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) be better understood, as well as the downstream severe or lethal clinical complications. While the identification of notable comorbidities has now helped to define broad risk groups, the idiosyncratic responses of individual patients can generate unexpected clinical deterioration that is difficult to predict from initial clinical features. Thus, physicians caring for patients with COVID-19 face clinical dilemmas on a daily basis. The ability to decipher individual predispositions to SARS-CoV-2 infection or severe illness, in light of variations in host immunological and inflammatory responses, in particular as a result of genetic variations, would be of great benefit in infection management. To this end, this work associates the description of COVID-19 clinical complications, comorbidities, sequelae, and environmental and genetic factors. We also give examples of underlying genomic susceptibility to COVID-19, especially with regard to the newly reported link between the disease and the unbalanced formation of neutrophil extracellular traps. As a consequence, we propose that the host/genetic factors associated with COVID-19 call for precision medicine in its treatment. This is to our knowledge the first article describing elements towards precision medicine for patients with COVID-19.</p>","PeriodicalId":33608,"journal":{"name":"Precision Clinical Medicine","volume":" ","pages":"228-234"},"PeriodicalIF":5.3,"publicationDate":"2020-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/pcmedi/pbaa026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40692996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personnel protection strategy for healthcare workers in Wuhan during the COVID-19 epidemic.","authors":"Fan Fan Hou,&nbsp;Fuling Zhou,&nbsp;Xin Xu,&nbsp;Daowen Wang,&nbsp;Gang Xu,&nbsp;Tao Jiang,&nbsp;Sheng Nie,&nbsp;Xiaoyan Wu,&nbsp;Chanjun Ren,&nbsp;Guangyu Wang,&nbsp;Johnson Yiu-Nam Lau,&nbsp;Xinghuan Wang,&nbsp;Kang Zhang","doi":"10.1093/pcmedi/pbaa024","DOIUrl":"https://doi.org/10.1093/pcmedi/pbaa024","url":null,"abstract":"<p><strong>Objective: </strong>To identify the effectiveness of a personnel protection strategy in protection of healthcare workers from SARS-CoV-2 infection.</p><p><strong>Design: </strong>During the COVID-19 pandemic, 943 healthcare staff sent from Guangzhou to Wuhan to care for patients with suspected/confirmed COVID-19 received infection precaution training before their mission and were equipped with Level 2/3 personal protective equipment (PPE), in accordance with guidelines from the National Health Commission of China. We conducted a serological survey on the cumulative attack rate of SARS-CoV-2 among the healthcare workers sent to Wuhan and compared the seropositive rate to that in local healthcare workers from Wuhan and Jingzhou.</p><p><strong>Results: </strong>Serial tests for SARS-CoV-2 RNA and tests for SARS-CoV-2 immunoglobulin M and G after the 6-8 week mission revealed a zero cumulative attack rate. Among the local healthcare workers in Wuhan and Jingzhou of Hubei Province, 2.5% (113 out of 4495) and 0.32% (10 out of 3091) had RT-PCR confirmed COVID-19, respectively. The seropositivity for SARS-CoV-2 antibodies (IgG, IgM, or both IgG/IgM positive) was 3.4% (53 out of 1571) in local healthcare workers from Wuhan with Level 2/3 PPE working in isolation areas and 5.4% (126 out of 2336) in healthcare staff with Level 1 PPE working in non-isolation medical areas, respectively.</p><p><strong>Conclusions and relevance: </strong>Our study confirmed that adequate training/PPE can protect medical personnel against SARS-CoV-2.</p>","PeriodicalId":33608,"journal":{"name":"Precision Clinical Medicine","volume":" ","pages":"169-174"},"PeriodicalIF":5.3,"publicationDate":"2020-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/pcmedi/pbaa024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40718703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whole-exome sequencing in a patient with synchronous triple primary malignancies involving lung cancer: a case report","authors":"Dan Li, M. Yu, P. Zhou, Jie Yang, Yongsheng Wang","doi":"10.1093/pcmedi/pbaa019","DOIUrl":"https://doi.org/10.1093/pcmedi/pbaa019","url":null,"abstract":"Abstract The incidence of multiple primary malignancies (MPMs) has been increasing rapidly in recent years, however, the genetic pathogenesis is largely unknown on account of rare cases, especially for those patients who are diagnosed with three or more tumors. Under these circumstances, whole-exome sequencing (WES) may help to provide more comprehensive genomic information and guidance to proper therapeutic strategies. Here, we presented a rare case of a 66-year-old Chinese male patient who was diagnosed with synchronous triple primary malignancies: esophageal squamous cell carcinoma (ESCC), lung adenocarcinoma (LA), and hepatocellular carcinoma (HCC). Tumors were surgically removed within 3 months. WES was performed when the patient suffered from cancer recurrence and tumor-specific neoantigens were predicted. Each tumor displayed a distinct somatic mutation profile, providing direct evidence of independent origins. No shared driver gene mutation or neoantigen was detected among the three tumors. Two germline alterations of cancer susceptibility genes—SPINK1 c.194 + 2T>C and JAK3 c.425G>A were identified. This case is the first report of synchronous primary triple cancers covering the esophagus, lung, and liver. Our findings highlight the complexities of MPMs that even when under identical germline genetic backgrounds, the occurrence of MPMs can be a random event and driven by distinct somatic gene mutations. Synchronous multiple primary cancers that originated from different organs may not have common therapeutic gene targets, and it can be difficult to find a treatment to cover all the tumors.","PeriodicalId":33608,"journal":{"name":"Precision Clinical Medicine","volume":"73 1","pages":"306 - 310"},"PeriodicalIF":5.3,"publicationDate":"2020-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83565510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can the personalized medicine approach contribute in controlling tuberculosis in general and India in particular?","authors":"Nikhat Khan, Aparup Das","doi":"10.1093/pcmedi/pbaa021","DOIUrl":"https://doi.org/10.1093/pcmedi/pbaa021","url":null,"abstract":"Abstract Poor drug compliance and drug-resistant Mycobacterium tuberculosis are the two principal obstacles in controlling tuberculosis (TB) in endemic regions including India, which has contributed the most to global TB burden. We argue here that a personalized medicine approach, to start with the N-acetyl transferase-2–isoniazid (NAT2–INH) model, could be a step forward in dealing with both these limitations in controlling TB in India.","PeriodicalId":33608,"journal":{"name":"Precision Clinical Medicine","volume":"39 1","pages":"240 - 243"},"PeriodicalIF":5.3,"publicationDate":"2020-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86229615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved gastrointestinal health for irritable bowel syndrome with metagenome-guided interventions.","authors":"Cem Meydan,&nbsp;Ebrahim Afshinnekoo,&nbsp;Nate Rickard,&nbsp;Guy Daniels,&nbsp;Laura Kunces,&nbsp;Theresa Hardy,&nbsp;Loukia Lili,&nbsp;Sarah Pesce,&nbsp;Paul Jacobson,&nbsp;Christopher E Mason,&nbsp;Joel Dudley,&nbsp;Bodi Zhang","doi":"10.1093/pcmedi/pbaa013","DOIUrl":"https://doi.org/10.1093/pcmedi/pbaa013","url":null,"abstract":"<p><p>Irritable bowel syndrome (IBS) is the most prevalent functional gastrointestinal disorder worldwide, and the most common reason for referral to gastroenterology clinics. However, the pathophysiology is still not fully understood and consequently current management guidelines are very symptom-specific, leading to mixed results. Here we present a study of 88 individuals with IBS who had baseline sequencing of their gut microbiome (stool samples), received targeted interventions that included dietary, supplement, prebiotic/probiotic, and lifestyle recommendations for a 30-day period, and a follow-up sequencing of their gut microbiome. The study's objectives were to demonstrate unique metagenomic signatures across the IBS phenotypes and to validate whether metagenomic-guided interventions could lead to improvement of symptom scores in individuals with IBS. Enrolled subjects also completed a baseline and post-intervention questionnaire that assessed their symptom scores. The average symptom score of an individual with IBS at baseline was 160 and at the endpoint of the study the average symptom score of the cohort was 100.9. The mixed IBS subtype showed the most significant reduction in symptom scores across the different subtypes (average decrease by 102 points, <i>P</i> = 0.005). The metagenomics analysis reveals shifts in the microbiome post-intervention that have been cross-validated with the literature as being associated with improvement of IBS symptoms. Given the complex nature of IBS, further studies with larger sample sizes, more targeted analyses, and a broader population cohort are needed to explore these results further.</p>","PeriodicalId":33608,"journal":{"name":"Precision Clinical Medicine","volume":"3 2","pages":"136-146"},"PeriodicalIF":5.3,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/pcmedi/pbaa013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38170632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}