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Annual Review of Medicine

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https://www.readbyqxmd.com/read/29261360/precision-medicine-functional-advancements
#1
Thomas Caskey
Precision medicine was conceptualized on the strength of genomic sequence analysis. High-throughput functional metrics have enhanced sequence interpretation and clinical precision. These technologies include metabolomics, magnetic resonance imaging, and I rhythm (cardiac monitoring), among others. These technologies are discussed and placed in clinical context for the medical specialties of internal medicine, pediatrics, obstetrics, and gynecology. Publications in these fields support the concept of a higher level of precision in identifying disease risk...
December 20, 2017: Annual Review of Medicine
https://www.readbyqxmd.com/read/29195057/novel-radiotherapy-techniques-for-breast-cancer
#2
Julie A Bradley, Nancy P Mendenhall
During the early decades of radiation therapy for breast cancer, local control of disease was documented consistently but, enigmatically, an anticipated impact on breast cancer survival was not observed, leading to confusion in our understanding of the natural history of breast cancer and radiation effects. Now, almost 90 years after its first use in breast cancer, technology developments in diagnostic imaging and radiation therapy have elucidated parts of this enigma. The data now available demonstrate a significant impact of radiation therapy on survival as well as disease control and treatment-related mortality, opening a doorway to understanding the powerful impact of radiation therapy on both breast cancer and critical organs...
December 1, 2017: Annual Review of Medicine
https://www.readbyqxmd.com/read/29144835/modern-systemic-therapy-for-metastatic-renal-cell-carcinoma-of-the-clear-cell-type
#3
Mamta Parikh, Primo N Lara
In the last 30 years, there have been many advances in the treatment of metastatic renal cell carcinoma of the clear cell type. Renal cell carcinoma has long been understood to have a component of immune mediation and has been responsive to immune-based therapies; in addition to early cytokine therapy, newer checkpoint inhibition therapies have also demonstrated activity. Molecular characterization of the genome of clear cell renal cell carcinoma enabled identification of the roles of angiogenesis and hypoxic stress...
November 16, 2017: Annual Review of Medicine
https://www.readbyqxmd.com/read/29120700/basket-studies-redefining-clinical-trials-in-the-era-of-genome-driven-oncology
#4
Jessica J Tao, Alison M Schram, David M Hyman
Understanding a tumor's detailed molecular profile has become increasingly necessary to deliver the standard of care for patients with advanced cancer. Innovations in both tumor genomic sequencing technology and the development of drugs that target molecular alterations have fueled recent gains in genome-driven oncology care. "Basket studies," or histology-agnostic clinical trials in genomically selected patients, represent one important research tool to continue making progress in this field. We review key aspects of genome-driven oncology care, including the purpose and utility of basket studies, biostatistical considerations in trial design, genomic knowledge-base development, and patient matching and enrollment models, which are critical for translating our genomic knowledge into clinically meaningful outcomes...
November 8, 2017: Annual Review of Medicine
https://www.readbyqxmd.com/read/29106805/innate-immunity-and-neurodegeneration
#5
Larisa I Labzin, Michael T Heneka, Eicke Latz
The innate immune system plays diverse roles in health and disease. It represents the first line of defense against infection and is involved in tissue repair, wound healing, and clearance of apoptotic cells and cellular debris. Excessive or nonresolving innate immune activation can lead to systemic or local inflammatory complications and cause or contribute to the development of inflammatory diseases. In the brain, microglia represent the key innate immune cells, which are involved in brain development, brain maturation, and homeostasis...
November 6, 2017: Annual Review of Medicine
https://www.readbyqxmd.com/read/29106804/targeting-rage-signaling-in-inflammatory-disease
#6
Barry I Hudson, Marc E Lippman
The receptor for advanced glycation end-products (RAGE) is a multiligand pattern recognition receptor implicated in diverse chronic inflammatory states. RAGE binds and mediates the cellular response to a range of damage-associated molecular pattern molecules (DAMPs) including AGEs, HMGB1, S100s, and DNA. RAGE can also act as an innate immune sensor of microbial pathogen-associated molecular pattern molecules (PAMPs) including bacterial endotoxin, respiratory viruses, and microbial DNA. RAGE is expressed at low levels under normal physiology, but it is highly upregulated under chronic inflammation because of the accumulation of various RAGE ligands...
November 6, 2017: Annual Review of Medicine
https://www.readbyqxmd.com/read/29099677/novel-latency-reversal-agents-for-hiv-1-cure
#7
Adam M Spivak, Vicente Planelles
Antiretroviral therapy (ART) has rendered HIV-1 infection a treatable illness; however, ART is not curative owing to the persistence of replication-competent, latent proviruses in long-lived restingTcells. Strategies that target these latently infected cells and allow immune recognition and clearance of this reservoir will be necessary to eradicate HIV-1 in infected individuals. This review describes current pharmacologic approaches to reactivate the latent reservoir so that infected cells can be recognized and targeted, with the ultimate goal of achieving an HIV-1 cure...
November 3, 2017: Annual Review of Medicine
https://www.readbyqxmd.com/read/29099676/molecular-and-genomic-determinants-of-response-to-immune-checkpoint-inhibition-in-cancer
#8
Russell W Jenkins, Rohit Thummalapalli, Jacob Carter, Israel CaƱadas, David A Barbie
Molecularly targeted therapy and immunotherapy have dramatically changed the landscape of available treatment options for patients with advanced cancer. Improved understanding of the molecular and genomic features of cancers over the last decade has led to the development of successful targeted therapies and the field of precision cancer medicine. As a result of these advances, patients whose tumors harbor select molecular alterations are eligible for treatment with targeted therapies active against the unique molecular aberration...
November 3, 2017: Annual Review of Medicine
https://www.readbyqxmd.com/read/29095667/pcsk9-inhibitors-mechanisms-of-action-metabolic-effects-and-clinical-outcomes
#9
Connie N Hess, Cecilia C Low Wang, William R Hiatt
Atherosclerotic cardiovascular disease (ASCVD) is associated with significant morbidity and mortality worldwide. Increased serum levels of lowdensity lipoprotein cholesterol (LDL-C) are an independent risk factor for ASCVD, and clinical trial data have shown that lowering LDL-C generally reduces cardiovascular risk. Until recently, 3-hydroxy-3-methylglutarylcoenzyme A (HMG-CoA) reductase inhibitors (statins) have been the main therapy for lowering LDL-C. However, some statin-treated patients have persistently elevated residual cardiovascular risk due to inadequate lowering of LDL-C levels or non-LDL-related dyslipidemia...
November 2, 2017: Annual Review of Medicine
https://www.readbyqxmd.com/read/29029586/use-and-misuse-of-opioids-in-chronic-pain
#10
Nora Volkow, Helene Benveniste, A Thomas McLellan
The prescribing of opioid analgesics for pain management-particularly for management of chronic noncancer pain (CNCP)-has increased more than fourfold in the United States since the mid-1990s. Yet there is mounting evidence that opioids have only limited effectiveness in the management of CNCP, and the increased availability of prescribed opioids has contributed to upsurges in opioid-related addiction cases and overdose deaths. These concerns have led to critical revisiting and modification of prior pain management practices (e...
October 13, 2017: Annual Review of Medicine
https://www.readbyqxmd.com/read/29029585/refinement-of-the-affordable-care-act-a-progressive-perspective
#11
Olveen Carrasquillo, Michael Mueller
The Affordable Care Act (ACA) was the most significant expansion of health coverage since Medicare and Medicaid were enacted. The law resulted in approximately 13-20 million uninsured persons gaining coverage. Despite these gains, the ACA has numerous shortcomings. For progressives, the ACA was a unique opportunity to provide access to high-quality, comprehensive, equitable health coverage to all persons living in the United States. Using this perspective as our framework, in this review we highlight some of the limitations of the ACA and potential areas for refinement...
October 13, 2017: Annual Review of Medicine
https://www.readbyqxmd.com/read/29029584/evidence-for-genetic-risk-contributing-to-long-term-adverse-treatment-effects-in-childhood-cancer-survivors
#12
Maria Monica Gramatges, Smita Bhatia
Survivors of childhood cancer are at increased risk for therapy-related morbidities and mortality. Although the demographic and clinical factors predicting the risk for long-term effects of cancer therapy are well known, the impact of genetic risk for specific late effects is less clearly defined. Here, we review the extant literature and recent research describing genetic modifiers to risk for the more common late effects of childhood cancer therapy. Results of this research support the need for clinical trials that attempt to further refine risk prediction by incorporating genetic testing into existing algorithms that are primarily based on clinical and demographic factors...
October 13, 2017: Annual Review of Medicine
https://www.readbyqxmd.com/read/29029583/new-generation-high-potency-and-designer-antibodies-role-in-hiv-1-treatment
#13
Lucio Gama, Richard A Koup
Broadly neutralizing antibodies (bNAbs) have been evaluated as promising agents in the fight against infectious diseases. HIV-1-specific bNAbs, in particular, have been tested in both preventive and therapeutic modalities. Multiple bNAbs have been isolated, characterized, and assessed in vitro and in vivo, but no single antibody appears to possess the breadth and potency that may be needed if it is to be used in the treatment of HIV-1 infection. With the technological advances of the past decades, novel and more effective bNAbs have been identified or engineered for higher neutralizing potency, greater breadth, and increased serum half-life...
October 13, 2017: Annual Review of Medicine
https://www.readbyqxmd.com/read/29029582/new-concepts-in-the-treatment-of-malignant-pleural-mesothelioma
#14
Ori Wald, David J Sugarbaker
Malignant pleural mesothelioma (MPM) is a highly aggressive and generally incurable cancer. Current anti-MPM chemotherapy-based treatments are only marginally effective, and long-term survival remains an unmet goal. Nonetheless, in selected cases, personalized surgery-based multimodality treatments (MMT) have been shown to significantly extend survival. The design of MMT and selection of patients are challenging, and optimal results require accurate presurgical diagnosis, staging, and risk stratification. Further, meticulous surgical techniques and advanced radiation protocols must be applied...
October 13, 2017: Annual Review of Medicine
https://www.readbyqxmd.com/read/28877002/lymphedema-pathogenesis-and-novel-therapies
#15
Joseph H Dayan, Catherine L Ly, Raghu P Kataru, Babak J Mehrara
Lymphedema affects up to 1 in 6 patients who undergo treatment for a solid tumor in the United States. Its prevalence has increased as more effective oncologic therapies have improved patient survival, but there remains no definitive cure. Recent research has elucidated new details in the pathogenesis of the disease and has demonstrated that it is fundamentally an immunologic progress that ultimately results in inflammation, fibroadipose deposition, impaired lymphangiogenesis, and dysfunctional lymphatic pumping...
September 6, 2017: Annual Review of Medicine
https://www.readbyqxmd.com/read/28846489/zika-chikungunya-and-other-emerging-vector-borne-viral-diseases
#16
Scott C Weaver, Caroline Charlier, Nikos Vasilakis, Marc Lecuit
Arthropod-borne viruses (arboviruses) have a long history of emerging to infect humans, but during recent decades, they have been spreading more widely and affecting larger populations. This is due to several factors, including increased air travel and uncontrolled mosquito vector populations. Emergence can involve simple spillover from enzootic (wildlife) cycles, as in the case of West Nile virus accompanying geographic expansion into the Americas; secondary amplification in domesticated animals, as seen with Japanese encephalitis, Venezuelan equine encephalitis, and Rift Valley fever viruses; and urbanization, in which humans become the amplification hosts and peridomestic mosquitoes, mainly Aedes aegypti, mediate human-to-human transmission...
August 28, 2017: Annual Review of Medicine
https://www.readbyqxmd.com/read/28846488/circulating-tumor-dna-measurement-and-clinical-utility
#17
Joshua Donaldson, Ben Ho Park
Circulating tumor DNA (ctDNA) is a component of the "naked" DNA found in blood. It can be isolated from plasma and represents combined genetic material from the primary tumor and metastases. Quantitative and qualitative information about a cancer, including mutations, can be derived using digital polymerase chain reaction and other technologies. This "liquid biopsy" is quicker and more easily repeated than tissue biopsy, yields real-time information about the cancer, and may suggest therapeutic options. All stages of cancer therapy have the ability to benefit from ctDNA, starting with screening for cancer before it is clinically apparent...
August 28, 2017: Annual Review of Medicine
https://www.readbyqxmd.com/read/28841383/refinement-of-the-affordable-care-act
#18
Vivian Ho
Regardless of what legislation the federal government adopts to address health insurance coverage for nonelderly Americans, private insurance will likely play a major role. This article begins by listing some of the major reasons critics dislike the Affordable Care Act, then discusses the validity of these concerns from an economics perspective. Criticisms of the ACA include the increased role of government in healthcare, the ACA's implicit income redistribution, and concern about high and rising insurance premiums...
August 25, 2017: Annual Review of Medicine
https://www.readbyqxmd.com/read/28813232/understanding-peripartum-cardiomyopathy
#19
Zoltan Arany
Peripartum cardiomyopathy (PPCM) is the unexplained loss of maternal cardiac systolic function in the period surrounding parturition. PPCM affects women worldwide and is a leading cause of maternal mortality. The cause of PPCM has remained elusive until recently. We review here the epidemiology of PPCM, recent findings that strongly indicate hormonal and genetic contributions to the development of PPCM, and implications for the management of women with PPCM. Expected final online publication date for the Annual Review of Medicine Volume 69 is January 29, 2018...
August 16, 2017: Annual Review of Medicine
https://www.readbyqxmd.com/read/28806148/atrial-fibrillation-ablation
#20
Rakesh Latchamsetty, Fred Morady
The prevalence of atrial fibrillation (AF) has risen significantly over the past two decades. Catheter ablation is an increasingly utilized treatment strategy and has evolved significantly over the same time period. Successful ablation improves patient symptoms, reduces stroke risk, and can preserve or improve cardiac function. Recurrences following ablation can occur, particularly in patients with persistent AF. Procedural efficacy can best be improved through continued advancements in ablation technology and strategy, better understanding of the mechanisms of AF initiation and perpetuation, and rigorous integration of ablation into a multidisciplinary AF management approach...
August 14, 2017: Annual Review of Medicine
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