Precision Clinical Medicine最新文献

{"title":"Long-term spaceflight and the cardiovascular system.","authors":"Nicholas A Vernice,&nbsp;Cem Meydan,&nbsp;Ebrahim Afshinnekoo,&nbsp;Christopher E Mason","doi":"10.1093/pcmedi/pbaa022","DOIUrl":"https://doi.org/10.1093/pcmedi/pbaa022","url":null,"abstract":"<p><p>While early investigations into the physiological effects of spaceflight suggest the body's ability to reversibly adapt, the corresponding effects of long-term spaceflight (>6 months) are much less conclusive. Prolonged exposure to microgravity and radiation yields profound effects on the cardiovascular system, including a massive cephalad fluid translocation and altered arterial pressure, which attenuate blood pressure regulatory mechanisms and increase cardiac output. Also, central venous pressure decreases as a result of the loss of venous compression. The stimulation of baroreceptors by the cephalad shift results in an approximately 10%-15% reduction in plasma volume, with fluid translocating from the vascular lumen to the interstitium. Despite possible increases in cardiac workload, myocyte atrophy and notable, yet unexplained, alterations in hematocrit have been observed. Atrophy is postulated to result from shunting of protein synthesis from the endoplasmic reticulum to the mitochondria via mortalin-mediated action. While data are scarce regarding their causative agents, arrhythmias have been frequently reported, albeit sublethal, during both Russian and American expeditions, with QT interval prolongation observed in long, but not short duration, spaceflight. Exposure of the heart to the proton and heavy ion radiation of deep space has also been shown to result in coronary artery degeneration, aortic stiffness, carotid intima thickening via collagen-mediated action, accelerated atherosclerosis, and induction of a pro-inflammatory state. Upon return, long-term spaceflight frequently results in orthostatic intolerance and altered sympathetic responses, which can prove hazardous should any rapid mobilization or evacuation be required, and indicates that these cardiac risks should be especially monitored for future missions.</p>","PeriodicalId":33608,"journal":{"name":"Precision Clinical Medicine","volume":"3 4","pages":"284-291"},"PeriodicalIF":5.3,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/pcmedi/pbaa022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38775507","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":"Vegetarian diets, circulating miRNA expression and healthspan in subjects living in the Blue Zone.","authors":"Tiantian Liu,&nbsp;Nicole M Gatto,&nbsp;Zhong Chen,&nbsp;Hongyu Qiu,&nbsp;Grace Lee,&nbsp;Penelope Duerksen-Hughes,&nbsp;Gary Fraser,&nbsp;Charles Wang","doi":"10.1093/pcmedi/pbaa037","DOIUrl":"https://doi.org/10.1093/pcmedi/pbaa037","url":null,"abstract":"<p><p>A long-term vegetarian diet plays a role in the longevity and maintenance of the healthspan, but the underlying mechanisms for these observations are largely unknown. Particularly, it is not known whether a long-term vegetarian dietary pattern may affect the circulating miRNA expression in such a way as to modulate the healthspan. The Adventist Health Study-2 (AHS-2) cohort includes a large number of older adults who primarily follow vegetarian dietary patterns and reside in Loma Linda, California, one of five \"Blue Zones\" in the world in which a higher proportion of the population enjoys a longer than average lifespan. We performed miRNA-seq in 96 subjects selected from the AHS-2 cohort with different dietary patterns. We identified several differentially expressed miRNAs between vegetarians and non-vegetarians, which are involved in immune response and cytokine signaling, cell growth and proliferation as well as age-related diseases such as cardiovascular diseases and neurodegenerative diseases. Overall, our study showed that a vegetarian diet modulates aging-associated circulating miRNAs in a sex-dependent manner of differential expression for certain miRNAs, which may be related in a beneficial manner to the healthspan. Further investigation is needed to validate these miRNAs as potential biomarkers for diet-modulated longevity in humans.</p>","PeriodicalId":33608,"journal":{"name":"Precision Clinical Medicine","volume":"3 4","pages":"245-259"},"PeriodicalIF":5.3,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/pcmedi/pbaa037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38775506","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":"Bilateral simultaneous primary acute angle-closure glaucoma","authors":"Charlotte L. Zhang, Wico Lai, Ian Ziyar, L. Lau, Jie Xu","doi":"10.1093/pcmedi/pbaa035","DOIUrl":"https://doi.org/10.1093/pcmedi/pbaa035","url":null,"abstract":"Dear Editor, Acute primary angle-closure glaucoma (PACG) is an important cause of blindness in East Asia.1 It is estimated that the overall prevalence of PACG will increase from 1.44% to 2.01% from 2020 to 2050.2 Acute PACG is typically related to increased high intraocular pressure (IOP), with symptoms including red eye, blurred vision, nausea, vomiting, and headache. Delay in timely IOPlowering treatment can result in permanent optic nerve damage and vision loss.3 Axial hyperopia is the main ocular risk factor for development of primary closure of the anterior chamber angle, while its systemic risk factors include older age, east Asian ethnic origin, and female sex.4 Although generally deemed to be a bilateral condition, PACG often occurs unilaterally, and bilateral simultaneous onset is very rare. For patients with unilateral onset, even if the effect of treatment is not satisfactory, relatively good outcomes can be achieved by carrying out early intervention on the fellow eye. However, for bilateral cases, the condition is usually severe and often comes with a poor prognosis. Therefore, appropriate preventive measures are critical. Here, we present a case of bilateral simultaneous acute PACG related to hyperopia. A 58-year-old Chinese woman presented with intermittent headaches, nausea, vomiting, and acute pain in both eyes for 1 month, which had worsened recently. The patient reported no history of taking anticholinergic and sympathomimetic drugs, nor was any other cause identified. The vital signs included a body temperature of 37.4◦C, blood pressure 150/96 mmHg, and a pulse 90 beats/min. Visual acuities were CF in 50 cm in both eyes and IOP was 51 and 53 mmHg in the right and left eye, respectively. Slit lamp examination revealed conjunctiva hyperemia, corneal edema, mid-dilated pupils, and shallow anterior chambers peripherally and centrally (Fig. 1). Fundus examination had a hazy view. B-scan ultrasonography demonstrated that retinas were attached in both eyes. Initial treatments included systemic acetazolamide 250 mg twice a day, pilocarpine 2% four times a day, brinzolamide 1.0% twice-a-day, and fixed-combination eye drops containing timolol maleate 0.5% and brimonidine tartrate 0.2% twice-a-day. A few hours later, the IOPs reduced to 28 OD and 32 OS mmHg respectively. The patient underwent a laser peripheral iridotomy and was sent home with prednisolone acetate eye drops to be applied four times a day, acetazolamide 500 mg every","PeriodicalId":33608,"journal":{"name":"Precision Clinical Medicine","volume":"2 1","pages":"297 - 300"},"PeriodicalIF":5.3,"publicationDate":"2020-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78610984","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":"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}