ABSTRACT
The article explores the evolution of medical knowledge from its anatomical and functional foundations to the integration of advanced technological tools, focusing on the impact of artificial intelligence (AI) on the development of diagnostic competencies. Initially, medical training relied on direct observation and clinical judgment based on anatomical and surgical knowledge. Subsequently, the inclusion of physiology and pathology enabled a functional understanding of the human body, transforming diagnosis into a systematic skill supported by objective data such as laboratory tests and medical imaging. The integration of AI in recent decades has revolutionized this process, offering unprecedented capabilities to analyze complex clinical data. Tools such as machine learning algorithms and predictive systems have enhanced diagnostic precision, allowing for the identification of previously unnoticed patterns. This data-driven approach strengthens physicians' ability to correlate clinical symptoms and signs with specific pathological entities. However, the incorporation of AI presents challenges in medical education. Future physicians must combine learning traditional clinical foundations with mastering advanced technologies, all while maintaining an ethical and patient-centered approach. Furthermore, excessive reliance on technology and biases inherent in algorithms underscore the need to balance technological innovation with human clinical judgment. The article highlights that medical education must adapt to include critical competencies such as digital literacy, ethical reasoning, and critical thinking. AI-based simulators and educational platforms are playing a key role in preparing physicians for a more digitized clinical environment, while research remains essential to ensure transparency and fairness in these technologies.
El artículo explora la evolución del conocimiento médico desde sus bases anatómicas y funcionales hasta la integración de herramientas tecnológicas avanzadas, con un enfoque en el impacto de la inteligencia artificial (IA) en el desarrollo de competencias diagnósticas. En sus inicios, la formación médica dependía de la observación directa y el juicio clínico basado en el conocimiento anatómico y quirúrgico. Posteriormente, la inclusión de fisiología y patologías permitió una comprensión funcional del cuerpo humano, transformando el diagnóstico en una habilidad sistemática apoyada por datos objetivos como pruebas de laboratorio e imágenes médicas. La incorporación de la IA en las últimas décadas ha revolucionado este proceso, proporcionando capacidades sin precedentes para analizar datos clínicos complejos. Herramientas como algoritmos de aprendizaje automático y sistemas predictivos han elevado la precisión del diagnóstico, permitiendo identificar patrones que antes pasaban desapercibidos. Este enfoque basado en datos refuerza la capacidad del médico para correlacionar síntomas y signos clínicos con entidades patológicas específicas. Sin embargo, la integración de la IA plantea desafíos en la educación médica. Los futuros médicos deben combinar el aprendizaje de fundamentos clínicos tradicionales con el dominio de tecnologías avanzadas, todo ello mientras mantienen un enfoque ético y centrado en el paciente. Además, la dependencia excesiva en la tecnología y los sesgos inherentes a los algoritmos subrayan la necesidad de un equilibrio entre innovación tecnológica y juicio clínico humano. El artículo destaca que la formación médica debe adaptarse para incluir competencias críticas como alfabetización digital, razonamiento ético y pensamiento crítico. Los simuladores y plataformas educativas basadas en IA están desempeñando un papel clave en la preparación de los médicos para un entorno clínico más digitalizado, mientras que la investigación sigue siendo esencial para garantizar la transparencia y equidad de estas tecnologías.
Subject(s)
Humans , Artificial Intelligence/trends , Clinical Diagnosis , Health Sciences , Pathology/trends , Algorithms , Clinical Competence , Clinical Laboratory Techniques , Curriculum/trends , Delivery of Health Care , Education, Medical , Precision MedicineABSTRACT
El feocromocitoma es un tumor derivado de las células de la cresta neural con la capacidad de producir sustancias simpaticomiméticas y, por ende, un cuadro clínico particular. Causa menos del 1 % de los casos de hipertensión arterial sistémica y su incidencia se estima entre 0,4 y 0,6 casos por 100.000 personas cada año, con una supervivencia media de siete años. De todos los tumores sólidos, el feocromocitoma tiene un mayor componente genético, que puede heredarse hasta en el 40 % de los casos. Una vez diagnosticada la enfermedad, se debe definir el tratamiento y el pronóstico, en parte condicionados por las variantes genéticas asociadas, en especial RET, SDHx, VHL y NF1.Se presenta el caso de una mujer joven con dolor abdominal e hipertensión arterial sistémica, a quien se le diagnosticó feocromocitoma. Al secuenciar el exoma, se identificó una variante patogénica extremadamente rara y de reciente descubrimiento: SDHA: c.1A>C (p.Met1Leu). La paciente respondió adecuadamente al tratamiento quirúrgico y continuó en seguimiento sin recurrencias.El abordaje diagnóstico de los pacientes con feocromocitoma comienza con la sospecha clínica, seguida de la medición de determinados metabolitos en sangre y orina, y, finalmente, los estudios de imagenología. Los desarrollos tecnológicos actuales permiten la aplicación de la medicina de precisión en este campo. En este caso de feocromocitoma, se identificó un componente genético importante que no solo afecta al paciente, sino también, a sus familiares. La tamización adecuada del caso índice permite identificar mutaciones y caracterizar mejor la enfermedad.
Pheochromocytoma is a tumor derived from neural crest cells able to produce sympathomimetic substances and, hence, a particular clinical picture. It is responsible for less than 1% of high blood pressure cases, with an estimated incidence between 0.4 and 0.6 cases per 100,000 people each year, and an average survival of seven years. Pheochromocytoma is a solid tumor with a high genetic component, as heritability can reach 40%. Once diagnosed, its treatment and prognosis are partly conditioned by the associated pathogenic variants that can be documented, especially those related to RET, SDHx, VHL, and NF1 genes.We present the case of a young woman with abdominal pain and high blood pressure, who was found to have a pheochromocytoma. Genetic testing detected a rare and recently discovered pathogenic variant: the SDHA:c.1A>C (p.Met1Leu). The patient responded adequately to the surgical treatment and continued the follow-up without documented recurrences.The diagnostic approach for pheochromocytoma patients must start with a clinical suspicion, followed by metabolite measurement in blood and urine, and finally, imaging. Currently, technology development allows precision medicine applicability. In this case of pheochromocytoma, recent developments in precision medicine resulted in the detection of associated genetic components involving the patient and her family. Adequate screening of the index patient is required for documenting pathogenic variants and better characterizing the disease.
Subject(s)
Humans , Paraganglioma , Pheochromocytoma , Neuroendocrine Tumors , Hypertension , Succinate Dehydrogenase , Precision Medicine , Multimodal ImagingABSTRACT
Lung cancer (LC) is the leading cause of death among patients with cancer both in worldwide and China. China accounts for 11.4% of the total number of cancer cases and 18.0% of the total number of cancer deaths in the world. Standardizing the diagnosis and treatment of LC is a key measure to improve the survival rate of LC patients and reduce the mortality rate. However, county hospitals generally face the problem of inaccessibility to advanced diagnostic and treatment technologies. Therefore, when developing quality control standards and clinical diagnosis and treatment specifications, it is necessary to combine the actual situation of county hospitals and formulate specific recommendations. The recommendations of treatment measures also need to consider the approval status of indications and whether it is included in the National Reimbursement Drug List (NRDL), to ensure the access to medicines. In order to solve the above problems, based on existing guidelines at home and abroad and the clinical work characteristics of county hospitals, the first clinical pathway in Chinese county for LC diagnosis and treatment (2023 edition) was compiled. This pathway elaborated on the imaging diagnosis, pathological diagnosis, molecular testing, and precision medicine based on histological-pathological types, tumor-node-metastasis (TNM) classification, and molecular classification, developed different diagnosis and treatment processes for different types of LC patients. Simultaneously, according to the actual work situation of county hospitals, the diagnosis and treatment recommendations in clinical scenarios are divided into basic strategies and optional strategies for elaboration. The basic strategies are the standards that county hospitals must meet, while the optional strategies provide more choices for hospitals, which are convenient for county doctors to put into clinical practice. All the recommended diagnostic and treatment plans strictly refer to existing guidelines and consensus, ensuring the scientificity.
Subject(s)
Humans , Lung Neoplasms/drug therapy , Critical Pathways , Precision Medicine , Diagnosis, Differential , ChinaABSTRACT
Lung cancer (LC) is the leading cause of death among patients with cancer both in worldwide and China. China accounts for 11.4% of the total number of cancer cases and 18.0% of the total number of cancer deaths in the world. Standardizing the diagnosis and treatment of LC is a key measure to improve the survival rate of LC patients and reduce the mortality rate. However, county hospitals generally face the problem of inaccessibility to advanced diagnostic and treatment technologies. Therefore, when developing quality control standards and clinical diagnosis and treatment specifications, it is necessary to combine the actual situation of county hospitals and formulate specific recommendations. The recommendations of treatment measures also need to consider the approval status of indications and whether it is included in the National Reimbursement Drug List (NRDL), to ensure the access to medicines. In order to solve the above problems, based on existing guidelines at home and abroad and the clinical work characteristics of county hospitals, the first clinical pathway in Chinese county for LC diagnosis and treatment (2023 edition) was compiled. This pathway elaborated on the imaging diagnosis, pathological diagnosis, molecular testing, and precision medicine based on histological-pathological types, tumor-node-metastasis (TNM) classification, and molecular classification, developed different diagnosis and treatment processes for different types of LC patients. Simultaneously, according to the actual work situation of county hospitals, the diagnosis and treatment recommendations in clinical scenarios are divided into basic strategies and optional strategies for elaboration. The basic strategies are the standards that county hospitals must meet, while the optional strategies provide more choices for hospitals, which are convenient for county doctors to put into clinical practice. All the recommended diagnostic and treatment plans strictly refer to existing guidelines and consensus, ensuring the scientificity.
Subject(s)
Humans , Lung Neoplasms/drug therapy , Critical Pathways , Precision Medicine , Diagnosis, Differential , ChinaABSTRACT
El cáncer seguirá siendo uno de los mayores desafíos para la salud pública a nivel local y mundial. Actualmente, en nuestro país, el cáncer es la principal causa de muerte. Gracias al enorme conocimiento acumulado en las últimas décadas sobre las bases celulares y moleculares del cáncer, se ha desarrollado la oncología de precisión, un enfoque que permite dirigir de manera cada vez más precisa el tratamiento farmacológico en función de los exámenes de diagnóstico. Para ello se utilizan tecnologías avanzadas, como la secuenciación de próxima generación. Es imprescindible implementar estas tecnologías en los sistemas sanitarios actuales y futuros para optimizar el arsenal de estrategias para el control del cáncer. En esta revisión, se discuten algunos alcances de la oncología de precisión, especialmente aplicada a tumores sólidos. Se aborda el estado del arte de los biomarcadores mínimos necesarios para el diagnóstico de este importante grupo de neoplasias, la situación local en cuanto a las capacidades tecnológicas instaladas en el territorio nacional ya sea con fines de investigación o diagnóstico, y el potencial impacto sanitario que tendría la aplicación de todo este conocimiento práctico al servicio de las personas con cáncer, tanto en el sector público como privado.
Cancer will remain one of the most significant challenges for public health, locally and globally. Currently, cancer is the leading cause of death in our country. Thanks to the enormous knowledge accumulated in recent decades on the cellular and molecular bases of cancer, precision oncology has been developed, an approach that allows for increasingly precise pharmacological treatment based on diagnostic tests. Advanced technologies such as next-generation sequencing are used for this purpose. It is essential to implement these technologies in current and future health systems to optimize the arsenal of strategies for cancer control. This review discusses some of the achievements of precision oncology, particularly applied to solid tumors. It addresses the state-of-the-art minimum biomarkers required for the diagnosis of this important group of neoplasms, the local situation regarding technological capabilities installed in the national territory, either for research or diagnosis, and the potential health impact of applying all this practical knowledge to serve people with cancer, both in the public and private sectors.
Subject(s)
Humans , Precision Medicine/methods , Neoplasms/diagnosis , Neoplasms/genetics , Biomarkers, Tumor/genetics , Chile , Molecular Diagnostic Techniques/methods , High-Throughput Nucleotide Sequencing/methods , Medical Oncology/methods , Medical Oncology/trendsABSTRACT
Organoids are three-dimensional cellular structures with self-organizing and self-differentiation capacities. They faithfully recapitulate structures and functions of in vivo organs as represented by functionality and microstructural definitions. Heterogeneity in in vitro disease modeling is one of the main reasons for anti-cancer therapy failures. Establishing a powerful model to represent tumor heterogeneity is crucial for elucidating tumor biology and developing effective therapeutic strategies. Tumor organoids can retain the original tumor heterogeneity and are commonly used to mimic the cancer microenvironment when co-cultured with fibroblasts and immune cells; therefore, considerable effort has been made recently to promote the use of this new technology from basic research to clinical studies in tumors. In combination with gene editing technology and microfluidic chip systems, engineered tumor organoids show promising abilities to recapitulate tumorigenesis and metastasis. In many studies, the responses of tumor organoids to various drugs have shown a positive correlation with patient responses. Owing to these consistent responses and personalized characteristics with patient data, tumor organoids show excellent potential for preclinical research. Here, we summarize the properties of different tumor models and review their current state and progress in tumor organoids. We further discuss the substantial challenges and prospects in the rapidly developing tumor organoid field.
Subject(s)
Humans , Neoplasms/genetics , Organoids/pathology , Carcinogenesis , Models, Biological , Precision Medicine/methods , Tumor MicroenvironmentABSTRACT
Objective To explore the short-term efficacy of digitally-assisted traditional Chinese medicine manual reduction combined with 3D printed splint in the treatment of AO type-A distal radius fractures, and explore the quantification of traditional Chinese medicine manual reduction and personalized improvement of splinting. Methods The clinical data of 50 patients with AO type-A distal radius fractures, who received treatment at the outpatient department of Cangzhou Integrated Traditional Chinese and Western Medicine Hospital in Hebei Province, were retrospective analyzed. The patient cohort included 22 females and 28 males, with ages ranging from 25 to 75 years old. Among them, 27 cases presented with distal radius fractures on the left side, and 24 cases on the right side. The patients were categorized into two groups: treatment group (n=25) and control group(n=25). There were 13 males and 12 females in the treatment group, with an average age of (56.2±5.5) years old. Treatment approach for this group involved several steps. Initially, Mimics Research software was used to conduct comprehensive analysis of complete CT data from the affected limb, resulting in the creation of a three-dimensional model. Subsequently, 3D models of the bones and skin contours, stored as STL format files, were imported into the Materialise Magics 23.0 software for model processing and repair. This facilitated the simulation of reduction and recording of displacement data, effectively generating a "digital prescription" to guide and quantify traditional Chinese medicine manipulation procedures. Finally, a personalized 3D printed splint was applied for fixation treatment. There were 15 males and 10 females in the control group, with an average age of (53.32±5.28) years old. These patients were treated with manualreduction combined with traditional splinting. The clinical efficacy of the two groups was assessed in terms of fracture reduction quality, fracture healing time, Gartland-Werley wrist joint score and X-ray parameters (palminclination angle, ulnar deviation angle, radius height) at 6 weeks post-operatively. Results The treatment group exhibited a shorter duration for achieving clinical healing compared to the control group (P<0.05). Six weeks post-operatively, the treatment group demonstrated higher wrist joint function scores, and a higher proportion of excellent and good outcomes than the control group(P<0.05). The treatment group was superior to the control group in terms of imaging parameters 6 weeks post-operatively (P<0.05). Conclusion By quantifying skin contours through digital simulation prescription reduction, a personalized 3D printed splint is developed to effectively stabilize fractures, enhancing localized fixation while ensuring greater adherence, stability, and comfort. This innovative approach offers personalized treatment for AO type-A distal radius fractures and presents a novel, precise treatment strategy for consideration.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , East Asian People , Printing, Three-Dimensional , Retrospective Studies , Splints , Wrist Fractures/therapy , Medicine, Chinese Traditional/methods , Therapy, Computer-Assisted/methods , Manipulation, Orthopedic/methods , Tomography, X-Ray Computed , Precision Medicine/methodsABSTRACT
Messenger RNA (mRNA) has shown tremendous potential in disease prevention and therapy. The clinical application requires mRNA with enhanced stability and high translation efficiency, ensuring it not to be degraded by nucleases and targeting to specific tissues and cells. mRNA immunogenicity can be reduced by nucleotide modification, and translation efficiency can be enhanced by codon optimization. The 5´ capping structure and 3´ poly A increase mRNA stability, and the addition of 5' and 3' non-translational regions regulate mRNA translation initiation and protein production. Nanoparticle delivery system protects mRNA from degradation by ubiquitous nucleases, enhances mRNA concentration in circulation and assists it cytoplasmic entrance for the purpose of treatment and prevention. Here, we review the recent advances of mRNA technology, discuss the methods and principles to enhance mRNA stability and translation efficiency; summarize the requirements involved in designing mRNA delivery systems with the potential for industrial translation and biomedical application. Furthermore, we provide insights into future directions of mRNA therapeutics to meet the needs for personalized precision medicine.
Subject(s)
RNA, Messenger/genetics , Cytoplasm , Nanoparticles , Precision MedicineABSTRACT
Prostate cancer (PCa) is a pernicious tumor with high heterogeneity, which creates a conundrum for making a precise diagnosis and choosing an optimal treatment approach. Multiparametric magnetic resonance imaging (mp-MRI) with anatomical and functional sequences has evolved as a routine and significant paradigm for the detection and characterization of PCa. Moreover, using radiomics to extract quantitative data has emerged as a promising field due to the rapid growth of artificial intelligence (AI) and image data processing. Radiomics acquires novel imaging biomarkers by extracting imaging signatures and establishes models for precise evaluation. Radiomics models provide a reliable and noninvasive alternative to aid in precision medicine, demonstrating advantages over traditional models based on clinicopathological parameters. The purpose of this review is to provide an overview of related studies of radiomics in PCa, specifically around the development and validation of radiomics models using MRI-derived image features. The current landscape of the literature, focusing mainly on PCa detection, aggressiveness, and prognosis evaluation, is reviewed and summarized. Rather than studies that exclusively focus on image biomarker identification and method optimization, models with high potential for universal clinical implementation are identified. Furthermore, we delve deeper into the critical concerns that can be addressed by different models and the obstacles that may arise in a clinical scenario. This review will encourage researchers to design models based on actual clinical needs, as well as assist urologists in gaining a better understanding of the promising results yielded by radiomics.
Subject(s)
Male , Humans , Artificial Intelligence , Magnetic Resonance Imaging/methods , Prostatic Neoplasms/diagnostic imaging , Image Processing, Computer-Assisted/methods , Precision Medicine , Retrospective StudiesABSTRACT
Acute kidney injury (AKI) is caused by a variety of diseases, which leads to acute renal function decline, azotemia, water and electrolyte disorders and acid-base balance disorders. Metabolomics is a research method that can quantitatively analyze all metabolites in an organism and find the relative relationship between metabolites and physiological and pathological changes. In recent years, several metabolites screened based on metabolomics have been proposed as potential biomarkers to assess the early development and prognosis of AKI and for the discovery of unknown potential therapeutic targets. Based on metabolomics, this paper reviews the risk prediction, early diagnosis, disease monitoring, prognosis assessment and the application of corresponding drugs for AKI, so as to provide reference for precision medicine.
Subject(s)
Humans , Acute Kidney Injury/metabolism , Metabolomics , Prognosis , Biomarkers , Precision MedicineABSTRACT
Sepsis is a life-threatening organ dysfunction caused by dysregulated host responses to infection. Despite significant advances in anti-infective, immunomodulatory, and organ function support technologies, the precise and targeted management of sepsis remains a challenge due to its high heterogeneity. Studies have identified disturbed tryptophan (TRP) metabolism as a common mechanism in multiple diseases, which is involved in both immune regulation and the development of multi-organ damages. The rise of research on intestinal microflora has further highlighted the critical role of microflora-regulated TRP metabolism in pathogen-host interactions and the "cross-talk" among multi-organs, making it a potential key target for precision medicine in sepsis. This article reviews TRP metabolism, the regulation of TRP metabolism by the intestinal microflora, and the characteristics of TRP metabolism in sepsis, providing clues for further clinical targeting of TRP metabolism for precision medicine in sepsis.
Subject(s)
Humans , Gastrointestinal Microbiome/physiology , Tryptophan/metabolism , Precision Medicine , SepsisABSTRACT
@#Precision medicine is a form of medicine that utilizes information about a person’s own genes to prevent, diagnose, or treat disease. In trophoblastic disease, precision medicine is important for accurate diagnosis, risk stratification, prognostication, and management. Immunohistochemistry, particularly p57kip2, has become an important ancillary procedure for the accurate identification of complete hydatidiform mole (HM). Molecular genotyping, on the other hand, is now considered the gold standard for the accurate classification of HM. Both tests are important for prognostication and the determination of the appropriate follow‑up plan. For gestational trophoblastic neoplasia, immunohistochemical markers can confirm the histologic diagnosis of its various types. Molecular genotyping differentiates gestational from nongestational tumors with overlapping histology and allows for precise identification of the index or causative pregnancy of a choriocarcinoma.
Subject(s)
Gestational Trophoblastic Disease , Hydatidiform Mole , Precision MedicineABSTRACT
Hepatocellular carcinoma (HCC) is the most common type of primary hepatocellular carcinoma (PHC). Early diagnosis of HCC remains the key to improve the prognosis. In recent years, with the promotion of the concept of precision medicine and more in-depth analysis of the biological mechanism underlying HCC, new diagnostic methods, including emerging serum markers, liquid biopsies, molecular diagnosis, and advances in imaging (novel contrast agents and radiomics), have emerged one after another. Herein, we reviewed and analyzed scientific advances in the early diagnosis of HCC and discussed their application and shortcomings. This review aimed to provide a reference for scientific research and clinical practice of HCC.
Subject(s)
Humans , Carcinoma, Hepatocellular/pathology , Liver Neoplasms/pathology , Prognosis , Early Diagnosis , Precision MedicineABSTRACT
The aging society has led to a substantial increase in the number of clinical comorbidities. To meet the needs of comorbidity treatment, polypharmacy is widely used in clinical practice. However, polypharmacy has drawbacks such as treatment conflict. Same treatment of different diseases refers to treating different diseases with same treatment. Therefore, the principle of same treatment of different diseases can alleviate the problems caused by polypharmacy. Under the research background of precision medicine, it becomes possible to explore the mechanism of same treatment of different diseases and achieve its clinical application. However, drugs successfully developed in the past have revealed shortcomings in clinical use. To better interpret the mechanism of precision medicine for same treatment of different diseases, under the multi-dimensional attributes including dynamic space and time, omics was performed, and a new strategy of tensor decomposition was proposed. With the characteristics of complete data, tensor decomposition is advantageous in data mining and can fully grasp the connotation of precision treatment of different diseases with same treatment under dynamic spatiotemporal changes. This method is used for drug repositioning in some biocomputations. By taking advantage of the dimensionality reduction of tensor decomposition and integrating the dual influences of time and space, this study achieved accurate target prediction of same treatment of different diseases at each stage, and discovered the mechanism of precision medicine of same treatment for different diseases, providing scientific support for precision prescription and treatment of different diseases with same treatment in clinical practice. This study thus conducted preliminary exploration of the pharmacological mechanism of precision Chinese medicine treatment.
Subject(s)
Humans , Data Mining , Medicine, East Asian Traditional , Precision MedicineABSTRACT
Genome-guided oncology refers to a new treatment concept that transcends histological classification and pathological ty-ping and uses drugs according to the genetic characteristics of tumors. New drug development technology and clinical trial design based on this concept provide new ideas for the clinical application of precision oncology. The multi-component and multi-target characteristics of Chinese medicine provide rich resources for the development of tumor-targeting drugs from natural products, and the design of the master protocol trial aiming at the characteristics of precision oncology supports the rapid clinical screening of effective tumor-targeting drugs. The emergence of the synthetic lethality strategy breaks through the bottleneck that the drug can only target the oncogene but cannot do anything to the tumor suppressor gene with the loss-of-function mutation in the past. With the rapid development of high-throughput sequencing technology, the cost of sequencing is also decreasing. For the development of tumor-targeting drugs, how to keep up with the update speed of target information is a difficult problem of concern. Based on the integration of innovative ideas and me-thods of precision oncology, network pharmacology, and synthetic lethality strategy on synthetic lethal interaction network of antitumor Chinese medicine compatibility formula design, and the combination of improvement of innovative clinical trial methods, such as master protocol trial, basket trial, and umbrella trial, unique advantages of Chinese medicine are expected to be exerted beyond the antibody-based drugs and small molecule-based drugs and corresponding targeted drugs are potentially developed for clinical application.
Subject(s)
Humans , Neoplasms/genetics , Medicine, Chinese Traditional , Precision Medicine/methods , Medical Oncology , Antineoplastic Agents/therapeutic useABSTRACT
The diagnosis and treatment of chronic refractory wounds on body surface has always been full of challenges, and it also poses a huge burden on medical care and society. High-throughput sequencing combined with omics analysis can reveal potential mechanisms of chronic wound formation, and identify potential biomarkers related to diagnosis, prognosis, and screening of chronic wound. Combined with multiple levels of omics analysis, the detailed molecular mechanism of chronic wound development can be further explored and understood, so as to provide clues for the formulation of personalized treatment methods and lay a solid foundation for the precision medicine of chronic wounds. Therefore, this review addresses the recent progress of various omics analyses in chronic refractory wounds on body surface.
Subject(s)
Precision Medicine/methods , BiomarkersABSTRACT
ensaio clínico de pacientes únicos (ECPU/ensaio n-de-1) consiste na observação sistemática de condutas terapêuticas adotadas para otimizar o restabelecimento da saúde em um único paciente, com múltiplos cruzamentos ao longo do tratamento, podendo ter adicionalmente propósito de pesquisa clínica. Foi proposto há décadas e tem sido mais utilizado nas áreas de psicologia clínica, recebendo maior atenção em estudos médicos nos últimos anos. Embora seja considerado como o tipo de estudo com maior força para tomada de decisões terapêuticas, ainda são escassas as publicações sobre o seu emprego em medicina. Este artigo aborda as possibilidades dos ECPUs na avaliação dos resultados clínicos da homeopatia, explorando seus aspectos metodológicos, éticos e educacionais característicos em comparação aos ensaios clínicos randomizados tradicionais. Em pesquisa clínica, diferentemente dos ensaios convencionais, os ECPUs permitem a participação mais direta do paciente na escolha dos procedimentos e acompanhamento dos resultados, com possibilidade de alterações imediatas e sem que seja necessária sua exclusão do estudo, além de implicações de ordem econômica, política e ética. Podem ser utilizados no teste de medicamentos usados de modo off label, sem as restrições impostas à inclusão de pacientes vulneráveis nos estudos clínicos habituais, com excessiva artificialização no delineamento experimental. Poderiam ser ainda adotados nas diversas fases de teste clínico dos medicamentos, reduzindo a exposição de grande número de participantes aos riscos da pesquisa e baixa margem de extrapolação clínica dos resultados ao conjunto da população. Em homeopatia, podem ajudar a aprimorar o conhecimento dos medicamentos já em uso ou a melhor detectar os efeitos de novas substâncias testadas em ensaios patogenéticos homeopáticos. Em função do seu propósito principal de otimização do tratamento individual e do alinhamento com os princípios éticos da autonomia e beneficência associados à prática da medicina centrada-no-paciente ou de precisão - podem ser desenvolvidos em conjunto com o paciente e familiares, sem a obrigatoriedade de aprovação prévia por Comissões de Ética Médica ou Comitês de Ética em Pesquisa.
The single-patient clinical trial (n-of-1 trial) is primarily designed to systematically observe outcomes from different therapeutic options to optimize the restoration of health in a single patient, with multiple crossovers throughout the treatment. They may additionally have a clinical research purpose. They have been proposed for decades and were mostly used in clinical psychology, receiving greater attention in medical studies in recent years. Although it is considered the type of study with the greatest strength for therapeutic decision-making, there are still few publications with its application in medicine. This article discusses the possibilities of single-patient clinical trials in assessing homeopathy outcomes, exploring their characteristic methodological, educational and ethical aspects compared to traditional randomized clinical trials. In clinical research, unlike conventional trials, single-patient clinical trials allow for more direct patient participation in choosing procedures and monitoring results, with the possibility of immediate changes without the need for their exclusion from the study, in addition to economic, political and ethical implications. They can be used in testing off-label drugs without the restrictions imposed on the inclusion of vulnerable patients in usual clinical studies, with excessive artificiality in the experimental design. They could also be adopted in the various clinical trial phases of drugs, reducing the exposure of many participants to the risks of research and low margin of clinical extrapolation of the results to the entire population. In homeopathy, they can help refine the knowledge of medications already in use or better detect the effects of new substances tested in homeopathic pathogenetic trials. Due to their purpose of optimizing individual treatment and alignment with the principles of patient-centered or precision medicine they can be developed jointly with the patient and her family without the mandatory prior approval by Medical Ethics Committees or Research Ethics Committees.