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Complex system in medicine

G Chowell, R Rothenberg
Infectious diseases continue to pose a significant public health burden despite the great progress achieved in their prevention and control over the last few decades. Our ability to disentangle the factors and mechanisms driving their propagation in space and time has dramatically advanced in recent years. The current era is rich in mathematical and computational tools and detailed geospatial information, including sociodemographic, geographic, and environmental data, which are essential to elucidate key drivers of infectious disease transmission from epidemiological and genetic data...
October 18, 2018: BMC Medicine
Sanjay Kalra, Gagan Priya, Yashdeep Gupta
Diabetes is a complex syndrome, with multiple pathophysiologic connections. While the vasculometabolic aspects are certainly important, current discourse tends to ignore the endocrine facets of diabetes. We propose the term 'glucocrinology', to define the study of medicine that relates to the relationship of glycaemia with the endocrine system. Glucocrinology includes in its ambit, endocrinopathies that may cause secondary diabetes, coexist with metabolic syndrome, precipitate hypoglycaemia, lead to refractory hyperglycaemia, or simply coexist with diabetes...
June 2018: JPMA. the Journal of the Pakistan Medical Association
Yun-Xia Luo, Xin-Yue Wang, Yu-Jie Huang, Shu-Huan Fang, Jun Wu, Yong-Bin Zhang, Tian-Qin Xiong, Cong Yang, Jian-Gang Shen, Chuan-Lan Sang, Qi Wang, Jian-Song Fang
Liver injury remains a significant global health problem and has a variety of causes, including oxidative stress (OS), inflammation, and apoptosis of liver cells. There is currently no curative therapy for this disorder. Sanwei Ganjiang Prescription (SWGJP), derived from traditional Chinese medicine (TCM), has shown its effectiveness in long-term liver damage therapy, although the underlying molecular mechanisms are still not fully understood. To explore the underlining mechanisms of action for SWGJP in liver injury from a holistic view, in the present study, a systems pharmacology approach was developed, which involved drug target identification and multilevel data integration analysis...
October 2018: Chinese Journal of Natural Medicines
Sarah Burm, Lisa Faden, Sandy DeLuca, Kathy Hibbert, Noureen Huda, Mark Goldszmidt
Today's hospitals are burdened with patients who have complex health needs. This is readily apparent in an inpatient internal medicine setting. While important elements of effective interprofessional collaboration have been identified and trialled across clinical settings, their promise continues to be elusive. One reason may be that caring for patients requires understanding the size and complexity of healthcare networks. For example, the non-human 'things' that healthcare providers work with and take for granted in their professional practice-patient beds, diagnostic imaging, accreditation standards, work schedules, hospital policies, team rounds-also play a role in how care is shaped...
October 15, 2018: Journal of Interprofessional Care
Rita K McCracken, Laura Fung, Anna K Stratis, Kimberley R Cottick, Sarah Dobson
PROBLEM ADDRESSED: Individuals with severe mental illness have an increased burden of physical comorbidities. Physical concerns of patients admitted to hospital for mental health reasons might be addressed by multiple specialists, leading to fragmented care and high costs to the system, when many of these concerns could be addressed by primary care. OBJECTIVE OF PROGRAM: The Family Doctor Outreach Clinic (FDOC) aims to provide rapid consultations for common concerns, to provide consultations for complex chronic disease and addictions, and to identify gaps in community care that contribute to patients' potential readmission to hospital...
October 2018: Canadian Family Physician Médecin de Famille Canadien
M H F Sakeena, Alexandra A Bennett, Andrew J McLachlan
BACKGROUND: Antimicrobial resistance (AMR) is a global challenge. Developing countries are more vulnerable to the consequences of AMR than developed nations because of complex issues pertaining to the nature their health care systems. Inappropriate antimicrobial drug use and the unrestricted availability of antimicrobial agents in community pharmacies in developing countries can contribute to emergence of resistant microbes. The aim of this systematic review is to explore the availability of antimicrobial agents without a doctor's prescription in developing countries and to investigate factors that contribute to inappropriate antimicrobial supply in developing countries...
October 9, 2018: International Journal of Antimicrobial Agents
Xiaofeng Dai, Yi Mei, Jianqi Nie, Zhonghu Bai
Adoptive T cell immunotherapy, involving the reprogramming of immune cells to target specific cancer or virus-infected cells, has been recognized as a promising novel approach for the treatment of complex diseases. The impressive global momentum of this therapeutic approach has highlighted the urgent need for establishing it as an effective and standardized onco-therapeutic approach in a large manufacturing scale. However, given its heterogeneity and uncertainty in nature, adoptive T cell immunotherapy is associated with a high failure rate that restricts its manufacturing to a limited number of institutions worldwide...
October 11, 2018: Biotechnology Journal
Pingyuan Wang, Jia Zhou
Great success has been achieved in small molecule drug discovery programs, making extraordinary contributions for human health, especially in targeted therapy. Taking anticancer drug discovery as an example, small molecules traditionally inhibit the target protein enzyme activities and induce cancer cell apoptosis through the target binding. However, the target protein within tumor cells often recovers its activities, leading to acquired drug-resistance through the overexpression of the target protein or the generation of new mutations in the target protein [1]...
October 9, 2018: Current Topics in Medicinal Chemistry
Nicola Luigi Bragazzi, Andrea Aparo von Flüe, Ugo Luigi Aparo
We have reached the awareness that diseases, far from being simple altered health states, are characterized by intrinsic emerging and adaptive properties, requiring an interdisciplinary, global and systemic approach, oriented towards integration and coordination, rather than an atomic and disintegrated logic. A new approach is needed, "systems medicine", defined as an interdisciplinary field of study that looks at the systems of the human body as part of an integrated whole, incorporating biochemical, physiological, and environment interactions...
September 2018: Recenti Progressi in Medicina
Vritika Batura, Aleixo M Muise
PURPOSE OF REVIEW: To summarize the current understanding and recent advances on the genetic aetiology in the pathogenesis of very early onset inflammatory bowel disease (VEO-IBD). RECENT FINDINGS: IBD is a chronic disorder of the gastrointestinal tract whose manifestation is a result of complex interactions between genetics, environment, immune system and microbial flora. Over 230 IBD risk loci have been reported in genome wide association studies but the genetic contribution of the majority of these loci in the manifestation of IBD is very low...
October 6, 2018: Current Opinion in Allergy and Clinical Immunology
Hossam Hamdy
The complexity of medical education and healthcare systems is a 'wicked problem'. Change will be a continuous iteration between evaluation and revaluation. Medicine is a social science. It is about people, societies and human interaction and communication. Medical College of the future should be developed in the light of social constructivism theories. Students from year one, day one, should be embedded in the work environment. Academic Healthcare Systems will be the norm not the exceptional. The training of students will be in all healthcare related facilities in the community...
October 9, 2018: Medical Teacher
Heli M Parviainen, Heli Halava, Esa V J Leinonen, Elise Kosunen, Pasi-Heikki Rannisto
In Finland, the specialization programs in Medicine and Dentistry can be undertaken at all five university medical faculties in 50 specialization programs and in five programs for Dentistry. The specialist training requires 5 or 6 years (300-360 ECTS credits) of medical practice including 9 months of service in primary health care centers, theoretical substance specific education, management studies, and passing a national written exam. The renovation of the national curriculum for the specialization programs was implemented, first in 2008 and officially in August 2009, when theoretical multi-professional social, health management and leadership studies (10-30 ECTS credits) were added to the curriculum...
2018: Frontiers in Public Health
Claudio Dalvit, Anna Vulpetti
Ligand-based fluorine NMR screening has gained popularity in drug discovery projects during the past decade and has become a powerful methodology to produce high quality hits. Its high sensitivity to protein binding makes it particularly suitable for fragment screening allowing detection and binding strength measurement of very weak affinity ligands. The screening can be performed in direct or competition format and its versatility allows application to complex biological and chemical systems. As the potential of the methodology has now been recognized and successfully demonstrated in several relevant medicinal chemistry projects, is now an appropriate time to report the learned lessons and point the way to the future...
October 8, 2018: Journal of Medicinal Chemistry
Skander Mulder, Habib Hamidi, Matthias Kretzler, Wenjun Ju
Current therapeutic approaches are ineffective in many patients with established diabetic kidney disease (DKD), an epidemic affecting one in three patients with diabetes. Early identification of patients at high risk for progression and individualizing therapies have the potential to mitigate kidney complications due to diabetes. To achieve this, a better understanding of the complex pathophysiology of DKD is needed. A system biology approach integrating large-scale omic data is well suited to unravel the molecular mechanisms driving DKD and may offer new perspectives how to personalize therapy...
October 2018: Diabetes, Obesity & Metabolism
Sin Man Lam, Raoxu Wang, Huan Miao, Bowen Li, Guanghou Shui
Development of rapid metabolomic methods poised for pathway discovery is expected to facilitate the identification of therapeutic candidates in the metabolomic approach to translational medicine. Using sphingolipid homeostasis as a prototype, we present herein an integrated method to facilitate a fast interrogation of altered sphingolipid (and phospholipid) metabolism associated with perturbed endolysosomal functions in mammalian systems. Constructed upon high performance liquid chromatography coupled to mass spectrometry, this method allows semi-quantitative measurements of more than 300 individual species within 20 min...
December 11, 2018: Analytica Chimica Acta
Iman Tavassoly, Joseph Goldfarb, Ravi Iyengar
Systems biology is an integrative discipline connecting the molecular components within a single biological scale and also among different scales (e.g. cells, tissues and organ systems) to physiological functions and organismal phenotypes through quantitative reasoning, computational models and high-throughput experimental technologies. Systems biology uses a wide range of quantitative experimental and computational methodologies to decode information flow from genes, proteins and other subcellular components of signaling, regulatory and functional pathways to control cell, tissue, organ and organismal level functions...
October 4, 2018: Essays in Biochemistry
Y Kazakov, M Khodos, M Vidrevich, K Brainina
The complexity of biological objects and the rapid change in their composition after sampling, the variety of compounds of different chemical nature, possessing oxidative and antioxidant properties, make the task of its estimating extremely nontrivial and important for food, nutrients and human health characterization. The paper discusses the use of potentiometry in determining integral antioxidant/oxidant activity mainly of biological fluids and human skin. The source of information is the electrode potential shift that occurs when the analyzed object is inserted in the solution of the mediator system or when the mediator system is exposed to human skin...
October 4, 2018: Critical Reviews in Analytical Chemistry
Xue Gao, Phillipa McSwiney, Andrew Court, Aaron Wiggins, Susan M Sawyer
PURPOSE: There are only a few reports of adolescents with somatic disorders (SDs) whose symptoms are sufficiently severe to require hospital admission. The aim of this study was to describe the symptom profile, health service utilization, and outcome of adolescents with SDs admitted to a tertiary children's hospital. METHODS: A retrospective cohort study of all adolescents admitted to the Adolescent Medicine Unit of a tertiary children's hospital was undertaken from July 2013 to June 2014...
September 29, 2018: Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine
James P K Armstrong, Jennifer L Puetzer, Andrea Serio, Anne Géraldine Guex, Michaella Kapnisi, Alexandre Breant, Yifan Zong, Valentine Assal, Stacey C Skaalure, Oisín King, Tara Murty, Christoph Meinert, Amanda C Franklin, Philip G Bassindale, Madeleine K Nichols, Cesare M Terracciano, Dietmar W Hutmacher, Bruce W Drinkwater, Travis J Klein, Adam W Perriman, Molly M Stevens
Tissue engineering has offered unique opportunities for disease modeling and regenerative medicine; however, the success of these strategies is dependent on faithful reproduction of native cellular organization. Here, it is reported that ultrasound standing waves can be used to organize myoblast populations in material systems for the engineering of aligned muscle tissue constructs. Patterned muscle engineered using type I collagen hydrogels exhibits significant anisotropy in tensile strength, and under mechanical constraint, produced microscale alignment on a cell and fiber level...
September 12, 2018: Advanced Materials
Daniela P Vasconcelos, Artur P Águas, Mário A Barbosa, Pablo Pelegrín, Judite N Barbosa
The development of new biomaterials to be used in tissue engineering applications is creating new solutions for a range of healthcare problems. The trend in biomaterials research has shifted from biocompatible "immune-evasive" biomaterials to "immune-interactive" materials that modulate the inflammatory response supporting implant integration as well as improving healing and tissue regeneration. Inflammasomes are large intracellular multiprotein complexes that are key players in host defence during innate immune responses and assemble after recognition of pathogens or danger signals...
September 28, 2018: Acta Biomaterialia
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