Future Medical Treatment Research Articles

Advances of Epigenetic Biomarkers and Epigenome Editing for Early Diagnosis in Breast Cancer.

Epigenetic modifications are known to regulate cell phenotype during cancer progression, including breast cancer. Unlike genetic alterations, changes in the epigenome are reversible, thus potentially reversed by epi-drugs. Breast cancer, the most common cause of cancer death worldwide in women, encompasses multiple histopathological and molecular subtypes. Several lines of evidence demonstrated distortion of the epigenetic landscape in breast cancer. Interestingly, mammary cells isolated from breast cancer patients and cultured ex vivo maintained the tumorigenic phenotype and exhibited aberrant epigenetic modifications. Recent studies indicated that the therapeutic efficiency for breast cancer regimens has increased over time, resulting in reduced mortality. Future medical treatment for breast cancer patients, however, will likely depend upon a better understanding of epigenetic modifications. The present review aims to outline different epigenetic mechanisms including DNA methylation, histone modifications, and ncRNAs with their impact on breast cancer, as well as to discuss studies highlighting the central role of epigenetic mechanisms in breast cancer pathogenesis. We propose new research areas that may facilitate locus-specific epigenome editing as breast cancer therapeutics.

The perspectives of family caregivers of people with Alzheimer´s disease regarding advance care planning in China: a qualitative research

ObjectivesAdvance care planning (ACP) enables people to define goals and preferences for future medical treatment and care. Despite universal recognition of the importance of ACP for people with Alzheimer´s disease (AD) internationally, there is little support for its implementation in China. The viewpoint of family caregivers is crucial in making clinical decisions about AD. Therefore, it’s critical to understand the family caregivers’ perspectives on ACP in order to promote its practice among people with AD in China.MethodsSeventeen family caregivers of people with AD were purposively selected in three communities in Guangzhou. Semi-structured interviews were conducted to collect data and the data were analyzed using the thematic analysis.ResultsThree main themes were extracted: ①Attitudes toward ACP including positive and negative attitudes; ②Social pressure influencing ACP decision; ③Behavioral willingness of the implementation of ACP. ConclusionsAttitudes, social pressure, and behavioral willingness characterized the behavioral intentions of family caregivers of people with Alzheimer’s disease. It is recommended to strengthen efforts to publicity of advance care planning and promote legislation in China.

Electrochemical Detection of Carboplatin-Resistance in Ovarian Cancer

Epithelial ovarian cancer (EOC) has the highest mortality rate among gynecological cancers and affects patients on all continents. Primary treatments involve surgery and the administration of chemotherapeutics, such as carboplatin, which is listed by the World Health Organization as an essential medication for the treatment of human cancers. Unfortunately, due to high rates of drug resistance of EOC towards carboplatin, cancer relapse rates are devastating, and the mechanisms of chemoresistance to carboplatin have not been adequately identified. Consequently, there is a dire need for innovative strategies that are able to detect carboplatin resistance in cancer and to further our understanding of the fundamental nature of chemoresistance towards carboplatin.The presented work describes the thorough electrochemical characterization of carboplatin. The uptake of carboplatin by ovarian cancer cells was quantified by electrochemistry to better understand mechanisms of carboplatin chemoresistance. Scanning Electrochemical Microscopy studies demonstrate a differential behavior between drug-susceptible and drug-resistant ovarian cancer cells, in response to carboplatin exposure. Results emerging from this research might be important for future medical research, developing diagnostic and treatment strategies to combat chemoresistance.

Tailored Treatment Options for Cerebral Cavernous Malformations.

The diagnosis and treatment of cerebral cavernous malformations (CCMs), or cavernomas, continues to evolve as more data and treatment modalities become available. Intervention is necessary when a lesion causes symptomatic neurologic deficits, seizures, or has high risk of continued hemorrhage. Future medical treatment directions may specifically target the pathogenesis of these lesions. This review highlights the importance of individualized treatment plans based on specific CCM characteristics.

Non-genetically modified organism in vitro CRISPR/Cas9 gene editing of the lacZα gene: A 4.5h laboratory course for senior high-school students.

The CRISPR/Cas9 system opens new horizons (M. Adli, Nat Commun, 2018) regarding genetic modifications of living organisms but also as an in vitro tool in laboratory protocols. Therefore, it boosts possibilities in research and future medical treatments. As the controversial claim of genomically edited babies by He Jiankui (Cyranoski D., Nature, 2019) demonstrates, the new gene editing potentials entail ethical discussions. A public or social discussion presupposes not only a theoretical knowledge or understanding of the system, but also profits from direct laboratory experiences showing how easy these techniques can be applied. Introducing numerous students and classes into these emerging techniques in a modern biology classroom depends on a suitable course concept, which fits legal and organizational requirements at the same time. Therefore, we implemented an appropriate hands-on laboratory course for senior high-school students, lasting just 4.5h. Particularly with regard to European regulations concerning the handling of genetically modified organisms, the constructs and protocols avoid the transfer of Cas9 DNA. This normally mandatory transfer was replaced by in vitro gene-editing. This leads to Cas9 induced gene knock-outs due to frame shifts and/or the excision of DNA fragments in common Escherichia coli (E. coli) plasmids, such as pUC19. This gene knock-out concept covers various steps: In vitro plasmid editing with Cas9, ligation and transformation of E. coli cells with the modified plasmid DNA and finally the spread plating of transformed E. coli cells in order to analyze colonies after overnight incubation. The successful excision of DNA fragments by in vitro Cas9 treatment was determined by subsequent gel electrophoresis.

Advance Care Planning-further development of the patient advance directive : What the specialist in internal medicine must know

Trotz der zur Verfügung stehenden Vorsorgeinstrumente Patientenverfügung, Vorsorgevollmacht und Betreuungsverfügung ist der Behandlungswille des Patienten in der konkreten Situation oft nicht in handlungsleitender Weise bekannt. Ziele des systemisch angelegten Konzepts „Behandlung im Voraus Planen“ – advance care planning, sind die Ermittlung, Dokumentation und Umsetzung des Behandlungswillens des Patienten für den Fall, dass er selbst nicht (mehr) rechtsverbindlich über seine Behandlung entscheiden kann. Auf der individuellen Ebene unterstützt ein speziell geschulter Gesprächsbegleiter zunächst bei der Formulierung der Einstellungen zu Leben, schwerer Erkrankung und Sterben. Darauf aufbauend können die Behandlungswünsche für verschiedene medizinische Situationen besprochen und z. B. in einer Patientenverfügung dokumentiert werden. Hierzu gehören der Notfall, die Situation im Krankenhaus bei unklarer Dauer der Einwilligungsunfähigkeit und die Situation bei dauerhaftem Verlust der Einwilligungsfähigkeit. Durch achtsame, nichtdirektive Gesprächsführung im Sinne einer gemeinsamen Entscheidungsfindung („shared decision making“) wird der Vorausplanende befähigt, gut informiert und reflektiert zu entscheiden („informed consent“). Die an den zukünftigen Behandlungsentscheidungen beteiligten Personen, insbesondere der zukünftige Vertreter, werden möglichst frühzeitig einbezogen. Die institutionelle und regionale Implementierung des Konzepts fördert die Umsetzung des auf diese Weise ermittelten und wirksam dokumentierten Patientenwillens in der gesamten Versorgungskette. Durch den neuen § 132 g SGB V, der den Einrichtungen der stationären Altenhilfe und der Eingliederungshilfe ermöglicht, Behandlung im Voraus Planen zulasten der GKV anzubieten, ist eine zunehmende Verbreitung des Konzepts zu erwarten.Zusatzmaterial onlineDie Online-Version dieses Beitrags (10.1007/s00108-022-01333-9) enthält die Muster-Patientenverfügungen der DiV-BVP „Einstellung zu Leben, schwere Krankheit und Sterben“ und „Ärztliche Anordnung für den Notfall“ (© Deutsche interprofessionelle Vereinigung Behandlung im Voraus Planen e.V. (DiV-BVP), Frankfurt am Main, www.div-bvp.de).

A nonlinear dynamic factor model of health and medical treatment.

Quantitative assessments of the relationship between health and medical treatment are of great importance to policy makers. To overcome endogeneity problems we formulate and estimate a tractable dynamic factor model where observed health outcomes are driven by the individual's latent health. The dynamics of latent health reflects both exogenous health deterioration and endogenous health investments. Our model allows us to investigate the effect of medical treatment on current health, as well as on future medical treatment and health outcomes. We estimate the model by maximum simulated likelihood and minimum distance methods using a rich longitudinal data set from Italy obtained by merging a number of administrative archives. These data contain detailed information on medical drug purchase, hospitalization, and mortality for a representative sample of elderly hypertensive patients. Our findings show that the observed autocorrelation in medical treatment reflects both permanent and time-varying observed and unobserved heterogeneity. They also show that medical drug purchase significantly maintains future health levels and prevents transitions to worse health. This suggests that policies aimed at increasing the awareness and the compliance of hypertensive patients help reduce cardiovascular risks and consequent hospitalization and mortality.

WHAT ELEMENTS CONTRIBUTE TO IMPROVING BRAIN CANCER TREATMENTS?

Brian cancer is a serious disease that has recently been discovered in an increasing number of people. It isnt a simple problem to solve, and it involves several procedures to overcome it. Brain cancer is also the 10th biggest cause of mortality for both men and women, according to Cancer.Net. In the coming years, it is also expected that 18,600 persons (10,500 men and 8,100 women) will die from primary malignant brain and CNS tumors. Moreover, people with a malignant brain or CNS tumor have a 36 percent 5-year survival rate. Although there are numerous therapies for brain cancer, such as chemotherapy and radiation, the death rate remains high, and those treatments arent the most comfortable. As a result, complementary therapies and other supplements are utilized to promote the health and well-being of brain cancer patients. Workout, diet, acupuncture, aromatherapy, talking therapy, and music are some of the various treatments discussed in this article. The primary goal of this article is to learn more about the aspects that can help improve and enhance the success of brain cancer treatment. Furthermore, to investigate and research the advantages of each aspect, as well as how it might be used in future medical treatments.

Health Care Planning for the Final Phase of Life - an Advance Care Planning Concept in Germany

Health Care Planning for the Final Phase of Life - an Advance Care Planning Concept in Germany Abstract. The international concept of Advance Care Planning (ACP) is a systematic and qualified communication process for people who want to talk about possible disease scenarios and their wishes for medical, nursing, psychosocial and spiritual care, and treatment for those scenarios, in the presence of their relatives and therapists. In Germany, section 132 g on health care planning for the last phase of life was stipulated in the Social Security Code Book (Sozialgesetzbuch) V as an insurance benefit of statutory health insurance funds (Gesetzliche Krankenversicherung) for certain patient groups, which reflects the ACP concept. An ACP concept that is geared towards the structures of the healthcare system in Germany has become known nationwide as "Behandlung im Voraus Planen" (BVP). As part of the BVP conversations, the individual wishes for future medical, nursing, and psychosocial treatments are recorded and discussed according to the principle of shared decision-making with residents of senior citizens' facilities or with disabled people in cantres for integration assistance. These wishes can be recorded in detail in a document such as an advance directive. Specially trained persons from the medical and non-medical professional groups - such as nurses, social workers, curative educator therapists - can hold these BVP conversations. For this purpose, further training which follows a predefined core curriculum of the GKV-Spitzenverband must be successfully completed.

Performance of CsI (Tl) photodiode with optic fiber wire for Gamma-rays and X-rays detection

In this paper, we explored the feasibility study of using the optic fiber wire to be a light transmitter for crystal scintillation material in the radiation measurement. The high-density material; thallium doped cesium iodide CsI (Tl) are widely used as converters for Gamma-rays and X-rays into visible light. Optic fibers are applied in the various applications such nuclear facilities, future fusion installations, medical treatment and diagnostic premises etc. The major advantages to be considered in optic fibers for radiation detection because their characteristics such as: capacities to work under electromagnetic fields; possibility to carry the wavelength signals; small size and low mass including possibility to monitor parameters from the sites far away from the controller. In this work, the cylindrical crystal CsI (Tl) material was connected with the single-clad optic scintillating fiber which transmitted the light signal to photodiode. Gamma-rays and X-rays sources had been investigated the measurement. The optic scintillating fibers have a good response with Cs-137 gamma radiation source at 662 keV. X-ray radiation that was generated from the X-ray tube was determined with the different operating voltages. The obtained results show this device can measure the X-ray radiation with energy range from 39 to 309 keV. CsI (TI) photodiode detector with optic fiber wire can be applied to measure gamma radiation and X-ray radiation as well as being able to the further work in the nuclear and radiation fields.

A separated type cathode photoelectrochemical aptasensor for thrombin detection based on novel organic polymer heterojunction photoelectric material

In this work, poly(5-formylindole)/poly(3,4-ethylenedioxythiophene) (P5FIn/PEDOT) organic polymer heterojunction was firstly prepared and utilized as a novel photocathode material to construct a separated type cathode photoelectrochemical (STC-PEC) aptasensor for ultrasensitive and selective detection of thrombin (TB). Specifically, P5FIn/PEDOT heterojunction and TB aptamers in this PEC sensor were modified on different ITO electrodes to make the photoexcitation and biological recognition process separately. P5FIn/PEDOT heterojunction was prepared by simple two-step electrochemical polymerization and exhibited a strong photocurrent signal owing to the synergistic effect between P5FIn and PEDOT. This photocathode need not to be replaced in the PEC measurement improving the reproducibility. This construction strategy of the proposed sensor avoided the mutual interference between photoexcitation process and biological detection process, and effectively improved the sensitivity, reproducibility and stability of this PEC sensor. The proposed STC-PEC aptasensor had a detection range of 0.000100 nM–10.0 nM with a detection limit of 0.0410 pM, also showing an excellent applicability in the detection of TB in real human serum samples. This STC-PEC aptasensor not only has a good potential application in future clinical medical diagnosis and disease treatment but also provides new ideas for the development of PEC sensors.

Diagnostic utility of next-generation sequencing-based panel testing in 543 patients with suspected skeletal dysplasia

BackgroundSkeletal dysplasia is typically diagnosed using a combination of radiographic imaging, clinical examinations, and molecular testing. Identifying a molecular diagnosis for an individual with a skeletal dysplasia can lead to improved clinical care, guide future medical management and treatment, and inform assessment of risk for familial recurrence. The molecular diagnostic utility of multi-gene panel testing using next-generation sequencing (NGS) has not yet been characterized for an unselected population of individuals with suspected skeletal dysplasia. In this study, we retrospectively reviewed patient reports to assess the diagnostic yield, reported variant characteristics, impact of copy number variation, and performance in prenatal diagnostics of panel tests for variants in genes associated with skeletal dysplasia and growth disorders.ResultsClinical reports of consecutive patients with a clinical indication of suspected skeletal dysplasia who underwent panel testing were examined. The 543 patients included in the study submitted samples for diagnostic genetic testing with an indication of suspected skeletal dysplasia or growth disorder and received one of three nested panel tests. A molecular diagnosis was established in 42.0% of patients (n = 228/543). Diagnostic variants were identified in 71 genes, nearly half of which (n = 35, 49.3%) contributed uniquely to a molecular diagnosis for a single patient in this cohort. Diagnostic yield was significantly higher among fetal samples (59.0%, n = 52/88) than postnatal samples (38.7%, n = 176/455; z = 3.55, p < 0.001). Diagnostic variants in fetal cases were identified across 18 genes. Thirteen diagnostic CNVs were reported, representing 5.7% of diagnostic findings and ranging in size from 241-bp to whole chromosome aneuploidy. Additionally, 11.4% (36/315) of non-diagnostic patient reports had suspicious variants of unknown significance (VUS), in which additional family studies that provide segregation data and/or functional characterization may result in reclassification to likely pathogenic.ConclusionsThese findings demonstrate the utility of panel testing for individuals with a suspected skeletal dysplasia or growth disorder, with a particularly high diagnostic yield seen in prenatal cases. Pursuing comprehensive panel testing with high-resolution CNV analysis can provide a diagnostic benefit, given the considerable phenotype overlap amongst skeletal dysplasia conditions.

Biomolecule Release from Alginate Composite Hydrogels Triggered by Logically Processed Signals.

Alginate composite hydrogels that exhibit highly sensitive stimuli-responsive behavior were used for signal-stimulated release of pre-loaded insulin. The alginate pores, particularly located at the periphery, were blocked by interpenetration of polyvinyl alcohol (PVA) cross-linked with 1,3-benzenediboronic acid (IPN), thus, significantly reducing uncontrolled leakage of the entrapped biomolecules. The beads were loaded with insulin and various enzymes mimicking different Boolean logic gates (AND, OR, NOR, IMP, INHIB). The enzymes were activated with biologically relevant input signals applied in four logic combinations: 0,0; 1,0; 0,1; 1,1, having the production of H2 O2 as the result of the biocatalytic reactions. The "successful" combination of the input signals leading to the H2 O2 production was different for different logic gates, following the corresponding truth tables of the logic gates. When H2 O2 was produced, boronate ester bonds were oxidized and the IPN was irreversibly degraded, thus re-opening the original pores of the hydrogel. This process allowed release of insulin from the alginate beads. The smart soft material that we have developed tackled well-known limitations of these systems and it may prove valuable in future medical diagnostics or treatments.

​Ethno-veterinary Treatment of Livestock and Poultry by Ethnic Community of Dhemaji District, Assam, India

Background: Livestock and poultry are considered as one of the source of income for the rural household which need proper care for their livelihood. To safeguard the livestock and poultry from various health related problems, ethno-veterinary practices, the indigenous healing system is the cheapest and easily available natural resources around them. Traditional animal health care practices are mostly from their experiences or passed on from one to another verbally. Methods: The present study was carried in randomly selected villages of Dhemaji district. Field study was conducted from September 2020 - April 2021, among the small household local inhabitant of the selected areas who mostly depend on the livestock and poultry farming for socio-economic development, by performing personal interview, semi-structured questionnaire, group discussion and free consultation was conducted with the local peoples. Result: The study recorded about 36 plant species having medicinal value belonging to 34 genus and 31 families, which are used for treating 22 ailments in livestock. Leaves, stems, fruits, bulb, roots, seeds, rhizomes, bark and peel of plant species are used in treating different ailments of livestock. Leaves (48%) are mostly used in preparing medicine among the other plant parts. Proper documentation of the old practice of ethno-veterinary provides information of the various medicinal plants available around us which are on the verge of extinction due to the negligence by the younger generation and emphasises sustainable use of these resources in our ecosystem. Ethno-Veterinary gives a scope for the pharmaceutical field to discover the bioactive compound present in the plant species for future scientific medical treatment.

SY24-2 Advance care planning through collaboration between physicians and nurses: Discussions to identify and advocate the intangible value of patients

A survey conducted in 2019 at Kyoto University hospital revealed that about 90% of advanced lung cancer patients had thought or tried to think about their goals and preferences for future medical treatment and care, but they were not allowed to have the opportunity to discuss their wish with their health care providers. It is essential that patients receive support for advanced care planning (ACP) from health care professionals at the appropriate time so that they can live their lives with peace of mind and reasonable prospects. However, it has been reported that clinicians, as well as patients and their families, face a variety of barriers when it comes to ACP. In this presentation, strategies for physician-nurse collaboration and tools that can be utilized for end-of-life discussions are discussed to overcome these challenges. The irreplaceable and important values of patients are often invisible to them and drift unnoticed in their daily lives. In the course of ACP discussions with patients with serious illnesses, when patients are supported to reflect on their values, verbalize them and share them with their families and health care providers, they are more likely to find ways to maintain and improve their well-being. The role of the health care provider in placing the intangible value at the forefront will be mentioned.

Advance care planning in multiple sclerosis: reflections of a palliative care physician

Multiple sclerosis (MS) has a long illness trajectory punctuated by serious acute events, with a later stage that is often accompanied by cognitive impairment. There is ample time for advance care planning (ACP) discussions. While there is much to be learned about the optimal way to approach ACP for people living with MS, it is possible to approach these discussions sensitively at all stages of the condition. However, as such voluntary discussions currently lie outside usual practice, people living with MS are denied the opportunities to consider the effect future medical treatments may have on their quality and length of life. How can clinicians assist in planning for a ‘good life’ and a ‘good death’?

Optimizing radiotherapy plans for cancer treatment with Tensor Networks

We present a novel application of Tensor Network methods in cancer treatment as a potential tool to solve the dose optimization problem in radiotherapy. In particular, the intensity-modulated radiation therapy technique—that allows treating irregular and inhomogeneous tumors while reducing the radiation toxicity on healthy organs—is based on the optimization problem of the beamlets intensities that shall result in a maximal delivery of the therapy dose to cancer while avoiding the organs at risk of being damaged by the radiation. The resulting optimization problem is expressed as a cost function to be optimized. Here, we map the cost function into an Ising-like Hamiltonian, describing a system of long-range interacting qubits. Finally, we solve the dose optimization problem by finding the ground-state of the Hamiltonian using a Tree Tensor Network algorithm. In particular, we present an anatomical scenario exemplifying a prostate cancer treatment. A similar approach can be applied to future hybrid classical–quantum algorithms, paving the way for the use of quantum technologies in future medical treatments.

GGATB-LSTM: Grouping and Global Attention-based Time-aware Bidirectional LSTM Medical Treatment Behavior Prediction

In China, with the continuous development of national health insurance policies, more and more people have joined the health insurance. How to accurately predict patients future medical treatment behavior becomes a hotspot issue. The biggest challenge in this issue is how to improve the prediction performance by modeling health insurance data with high-dimensional time characteristics. At present, most of the research is to solve this issue by using Recurrent Neural Networks (RNNs) to construct an overall prediction model for the medical visit sequences. However, RNNs can not effectively solve the long-term dependence, and RNNs ignores the importance of time interval of the medical visit sequence. Additionally, the global model may lose some important content to different groups. In order to solve these problems, we propose a Grouping and Global Attention based Time-aware Bidirectional Long Short-Term Memory (GGATB-LSTM) model to achieve medical treatment behavior prediction. The model first constructs a heterogeneous information network based on health insurance data, and uses a tensor CANDECOMP/PARAFAC decomposition method to achieve similarity grouping. In terms of group prediction, a global attention and time factor are introduced to extend the bidirectional LSTM. Finally, the proposed model is evaluated by using real dataset, and conclude that GGATB-LSTM is better than other methods.

Perceptions of involvement in advance care planning and emotional functioning in patients with advanced cancer

PurposeAdvance Care Planning (ACP) is positively associated with the quality of care, but its impact on emotional functioning is ambiguous. This study investigated the association between perceptions of ACP involvement and emotional functioning in patients with advanced cancer.MethodsThis study analyzed baseline data of 1,001 patients of the eQuiPe study, a prospective, longitudinal, multicenter, observational study on quality of care and quality of life in patients with advanced cancer in the Netherlands. Patients with metastatic solid cancer were asked to participate between November 2017 and January 2020. Patients’ perceptions of ACP involvement were measured by three self-administered statements. Emotional functioning was measured by the EORTC-QLQ-C30. A linear multivariable regression analysis was performed while taking gender, age, migrant background, education, marital status, and symptom burden into account.ResultsThe majority of patients (87%) reported that they were as much involved as they wanted to be in decisions about their future medical treatment and care. Most patients felt that their relatives (81%) and physicians (75%) were familiar with their preferences for future medical treatment and care. A positive association was found between patients’ perceptions of ACP involvement and their emotional functioning (b=0.162, p<0.001, 95%CI[0.095;0.229]) while controlling for relevant confounders.ConclusionsPerceptions of involvement in ACP are positively associated with emotional functioning in patients with advanced cancer. Future studies are needed to further investigate the effect of ACP on emotional functioning.Trial registration numberNTR6584 Date of registration: 30 June 2017Implications for Cancer SurvivorsPatients’ emotional functioning might improve from routine discussions regarding goals of future care. Therefore, integration of ACP into palliative might be promising.

‘Our legal responsibility…to intervene on behalf of the child’: Recognising public responsibilities for the medical treatment of children

This article argues for recognition of public responsibilities to protect the welfare of children with respect to decisions affecting their health and medical treatment. As the quote in the title of this article, from David Plank, the Director of Social Services responsible for bringing the case of Baby Alexandra before the courts, identifies, early cases concerning children’s medical treatment were brought by local authorities to determine responsibilities to protect the welfare of children. In cases such as Re B (1981), Re J (1990) and Re W (1992), the court was asked not only to determine the child’s best interests but also to clarify the duties of the local authority, Trust, court and child’s parents to the child. The respective duties established apply to all involved in cases brought before the courts on the question of a child’s future medical treatment, whether or not the child is in the care of the state. Recent cases concerning the medical treatment of seriously ill children have involved claims of parental authority to determine the care of their child. To the contrary, this article argues that court involvement is required when parents are disagreed with the child’s treating doctors over the child’s medical treatment because of public as well as parental and professional responsibilities for the welfare of all children.