New Era In Medicine Research Articles

Our Genome's “Dark Matter” Is the Next Frontier in Molecular Diagnostics

The completion of the Human Genome Project in 2003 heralded a new era in medicine. Sequence variants causing aberrant protein function can now be identified and associated with specific disease states at unprecedented rates as sequencing technology continues to evolve. Numerous examples exist of how our growing understanding of the human genome has improved our ability to diagnose genetic diseases and facilitated the development of targeted therapeutics for the treatment of cancer and other pathogenic conditions. However, these success stories are the result of work that has focused primarily on the approximately 19000 protein-coding gene sequences, which constitute a minuscule 1%–2% of our genome. Often overlooked regions of the genome may be just as important in transforming medicine as we move further into the 21st century. In a recent article in Nature (1), Chi describes the substantial research efforts currently being devoted to exploring the remaining 99% of the genome—the “dark matter” responsible for controlling the expression of protein-coding genes. …

Anticancer Potential of Nutraceutical Formulations in MNU-induced Mammary Cancer in Sprague Dawley Rats.

Background:Nutraceuticals help in combating some of the major health problems of the century including cancer, and ‘nutraceutical formulations’ have led to the new era of medicine and health.Objective:To develop different nutraceutical formulations and to assess the anticancer potential of nutraceutical formulations in N-methyl-N-nitrosourea (MNU)-induced mammary cancer in Sprague Dawley rats.Materials and Methods:Different nutraceutical formulations were prepared using fine powders of amla, apple, garlic, onion, papaya, turmeric, and wheat grass with and without cow urine distillate. Total phenolic content, acute oral toxicity, and microbial load of nutraceutical formulations were assessed. The anticancer potential of nutraceutical formulations was evaluated against MNU-induced mammary cancer in female Sprague Dawley rats.Results:Improvement in total phenolic content was significant (P < 0.001) after self-fortification process. Toxicity studies showed that the nutraceutical formulations were safe to use in animals. Microbial load was within the limits. Significant longer tumor-free days (P < 0.01), lower tumor incidence (P < 0.01), lower tumor multiplicity (P < 0.05) and tumor burden (P < 0.01) were observed for nutraceutical formulation-treated groups.Conclusion:Combination of whole food-based nutraceuticals acted synergistically in the prevention of mammary cancer. Further, the process of fortification is novel and enhanced the anticancer potential of nutraceutical formulations.SUMMARYNutraceuticals help in combating some of the major health problems of the century including cancer, and ‘nutraceutical formulations’ have led to the new era of medicine and health. In this study, different nutraceutical formulations using fine powders of amla, apple, garlic, onion, papaya, turmeric, and wheat grass with and without cow urine distillate. Total phenolic content, acute oral toxicity, and microbial load of nutraceutical formulations were assessed. The anticancer potential of nutraceutical formulations was evaluated against MNU-induced mammary cancer in female Sprague Dawley rats. Improvement in total phenolic content was observed after self-fortification process. Toxicity studies showed that the nutraceutical formulations were safe to use in animals. Microbial load was within the limits. Longer tumor-free days, lower tumor incidence, lower tumor multiplicity and tumor burden were observed for nutraceutical formulation-treated groups. This suggests that combination of whole food-based nutraceuticals acted synergistically in the prevention of mammary cancer. Further, the process of fortification enhanced the anticancer potential of nutraceutical formulations.Abbreviations used: HMNU: N-methyl-N-nitrosourea, CAM: Complementary and Alternative Medicine, NF: Nutraceutical Formulation, SFNF: Self-Fortitfied Nutraceutical Formulation, NFCUD: Nutraceutical Formulation fortified with Cow Urine Disstillate, SFNFCUD: Self-Fortified Nutraceutical Formulation fortified with Cow Urine Disstillate, CPCSEA: Committee for the Purpose of Control and Supervision of Experiments on Animals, OECD: Organisation for Economic Co-operation and Development, TPC: Total Phenolic Content, ANOVA: Analysis of Variance, GAE: Gallic Acid Equivalent, cfu/g: Colony forming unit per g

Epigenetic therapy in a new era of medicine: creating and integrating molecular profiles of patients.

In the 17 th century, Antonie von Leeuwenhoek revolutionized microbiology with the advent of the microscope. Today we are in a similar revolution for cancer and genetics with the development of sequencing technology as “molecular microscopes” to peer into cells and catalog their genetic and epigenetic changes. We now have the capabilities to study diseases like cancer and how tumors evolve via single-cell sequencing and dynamics (1,2). Sequencing has gone far to transform the way we understand and view the central dogma of biology (3). While the central dogma of molecular biology is still a guiding framework for understanding disease (DNA to RNA to protein), we are beginning to understand the panoply of regulatory levers and mechanisms that guide—and even deviate—from such an orderly progression of molecular relationships, especially in the context of diseases like cancer.

Pharmacogenomics to achieve precision medicine

The term precision medicine was thrust into the national lexicon in early 2015 with the launch of the Precision Medicine Initiative by President Obama in his State of the Union Address. The mission of this National Institutes of Health (NIH) program is “to enable a new era of medicine through research, technology, and policies that empower patients, researchers, and providers to work together toward development of individualized care.”1 Precision medicine promises a greater appreciation of variability within populations—accounting for factors such as genetics, age, comorbidities, medications, lifestyle, and environment—to select a patient’s personalized treatment. It is not a novel idea but rather a renewed focus on personalizing healthcare versus a one-size-fits-all approach. The main driver is rapidly advancing “-omics” technology as well as the gains in knowledge it has enabled through research. The cost for whole genome sequencing, for example, has plummeted over 50,000-fold after the mapping of the human genome was completed in 2003.2

Tissue Engineering: Toward a New Era of Medicine.

The goal of tissue engineering is to mitigate the critical shortage of donor organs via in vitro fabrication of functional biological structures. Tissue engineering is one of the most prominent examples of interdisciplinary fields, where scientists with different backgrounds work together to boost the quality of life by addressing critical health issues. Many different fields, such as developmental and molecular biology, as well as technologies, such as micro- and nanotechnologies and additive manufacturing, have been integral for advancing the field of tissue engineering. Over the past 20 years, spectacular advancements have been achieved to harness nature's ability to cure diseased tissues and organs. Patients have received laboratory-grown tissues and organs made out of their own cells, thus eliminating the risk of rejection. However, challenges remain when addressing more complex solid organs such as the heart, liver, and kidney. Herein, we review recent accomplishments as well as challenges that must be addressed in the field of tissue engineering and provide a perspective regarding strategies in further development.

The Missing Link: Connection Is the Key to Resilience in Medical Education.

Awareness of the risks of burnout, depression, learner mistreatment, and suboptimal learning environments is increasing in academic medicine. A growing wellness and resilience movement has emerged in response to these disturbing trends; however, efforts to address threats to physician resilience have often emphasized strategies to improve life outside of work, with less attention paid to the role of belonging and connection at work. In this Commentary the authors propose that connection to colleagues, patients, and profession is fundamental to medical learners' resilience, highlighting "social resilience" as a key factor in overall well-being. They outline three specific forces that drive disconnection in medical education: the impact of shift work, the impact of the electronic medical record, and the impact of "work-life balance." Finally, the authors propose ways to overcome these forces in order to build meaningful connection and enhanced resilience in a new era of medicine.

Precision medicine: what’s all the fuss about?

Precision medicine is now recognized globally as a major new era in medicine. It is being driven by advances in genomics and other ‘omics’ but also by the desire on the part of both health systems and governments to offer more targeted and cost-effective care. However, it faces a number of challenges, from the economics of developing more expensive companion diagnostics to the need to educate patients and the public on the advantages for them. New models of both R&D and care delivery are needed to capture the scientific, clinical and economic benefits of precision medicine.

Value of Liberal Arts education in the Era of Precision Medicine

The Precision Medicine Initiative (PMI) aims to treat and prevent disease by accounting for individual variability in genes, environment, and lifestyle for each person. The initiative announced by President Obama aims to build the PMI Cohort Program that will compile a national research cohort of one million or more U.S. participants. Through technical advances in research capability for high throughput screening of genes/gene products, data sharing technology and informed consent policies that empowers patients, the PMI will usher in a new era of medicine in which researchers, providers and patients work together to develop individualized care. Paramount to successful delivery of this initiative will require trust and participation of the public and scientists being able to share data and protect the rights of the public. It is our contention that liberal arts colleges can fully participate in PMI by: 1. Taking advantage of open source and cloud platforms to access and analyze data obtained from both basic and clinical sciences; and 2. Providing an intellectually diverse student body to survey opinions and knowledge of modern genomic technologies in order to identify areas of public distrust and issues with informed consent arising from the implementation of these technologies. Furthermore, the curriculum at liberal arts colleges will enable deep discussion and exploration of moral, ethical, legal and scientific aspects of large scale initiatives such as PMI.

A Patient-Designed Do-It-Yourself Mobile Technology System for Diabetes: Promise and Challenges for a New Era in Medicine.

The US health care system has typically embraced a top-down model of health production, in which large-scale organizations, such as pharmaceutical or medical device companies or academic health centers, produce the tools and technologies for improving health. The underlying assumption is that physicians, researchers, and industry professionals are health experts rather than the patients. However, in 2014, the Nightscout Project, an innovative do-it-yourself mobile technology system for type 1 diabetes, was created by patients for patients and was rapidly scaled to a US and global population within a relatively short period. This bottom-up, patient-driven approach to health production has important lessons for a new era of medicine powered by patient engagement, mobile technology, cloud computing, and social media. This Viewpoint describes the Nightscout Project, including the challenges it poses for the current health care system, and the opportunities yielded from this new form of health production

Precision Medicine: The new era in medicine

Precision Medicine: The new era in medicine

Towards a new era in medicine: therapeutic genome editing.

Genome editing is the process of precisely modifying the nucleotide sequence of the genome. It has provided a powerful approach to research questions but, with the development of a new set of tools, it is now possible to achieve frequencies of genome editing that are high enough to be useful therapeutically. Genome editing is being developed to treat not only monogenic diseases but also infectious diseases and diseases that have both a genetic and an environmental component.

Treatment of Hepatic Epithelioid Hemangioendothelioma: Finding Uses for Thalidomide in a New Era of Medicine.

Hepatic epithelioid hemangioendothelioma (HEH) is extremely rare, occurring in 1 to 2 per 100,000, with chemotherapy options not well defined. Our case involved a 49-year-old female who had hepatic masses and metastasis to the lungs with a liver biopsy revealing HEH. After developing a rash from sorafenib, thalidomide was started with the progression of disease stabilized. Resection is only an option in 10% of the cases; therefore, chemotherapy is the only line of treatment. Newer chemotherapy alternatives are targeting angiogenesis via the vascular endothelial growth factor. Thalidomide was first used as an antiemetic, but, sadly, soon linked to phocomelia birth defects. Given the mechanism of action against angiogenesis, thalidomide has a valid role in vascular tumors. In conclusion, the use of thalidomide as chemotherapy is novel and promising, especially in the setting of a rare vascular liver tumor such as HEH.

Science and art in the 21st century: on a way toward the unification.

Science and art in the 21st century: on a way toward the unification.

Novel wireless devices for cardiac monitoring.

The digital revolution and the rapid development of smartphones, mobile connectivity, and social networking have changed the way we live. The average American is constantly connected via high bandwidth to a vast network of data and sophisticated digital platforms, with >90% of American adults owning a cell phone and 55% having a smartphone.1 The digital revolution has transformed virtually every industry and every facet of our personal lives but has been conspicuously absent from the world of medicine. Physicians and healthcare networks have been slow to adopt electronic medical records and to integrate medical data with the ubiquitous mobile device. Recently, however, novel devices for wireless monitoring have emerged and begun to be integrated with the care of the cardiac patient. We believe that the evolution of these wireless cardiac monitoring devices will mark a new era in medicine and a transition from population-level health care to individualized medicine in which suitable patients are equipped with advanced biosensors that, in turn, have their data processed through sophisticated algorithms to predict events before they occur. This review is meant to be a comprehensive overview of the novel wireless cardiac monitoring devices that are available, as well as the technologies that are currently under development and poised to revolutionize the way we practice cardiology. A comprehensive list of a number of devices that are currently available or under development is given in the Table for reference. View this table: Table. Comprehensive Overview of Existing Wireless Cardiac Monitoring Devices Cardiac arrhythmias such as atrial fibrillation are common and can be associated with adverse outcomes such as embolic stroke. Less common but more malignant rhythm disorders such as ventricular tachycardia can herald sudden cardiac death.2 The identification and management of arrhythmias in the patient with palpitations, syncope, a history of arrhythmia, or high risk for sudden …

Natural products and drug discovery and development: A history of success and continuing promise for the future

For millennia, Nature, especially plants, has provided a source of medicines for the treatment of a wide spectrum of diseases. The isolation of plant-derived bioactive compounds, such as colchicine, morphine, and quinine in the early 1800 s, introduced a new era in medicine with the later development of pure commercial products, including morphine and the semi-synthetic drug, aspirin. The next milestone was the report by Fleming in 1929 of the serendipitous discovery of penicillin from Penicillium notatum, ushering in the 'Golden Age of Antibiotics' (1940 s-1970 s), and leading to the discovery of many other antibacterial antibiotics, including the cephalosporins, tetracyclines, aminoglycosides, glycopeptides, lipopeptides and macrocyclic compounds, as well as antifungal and antiparisitic agents. Microbes also provided models for the development of the anticholesterolemic class of drugs (statins), and a broad range of antitumor antibiotics, while plants yielded novel anticancer drugs. The intensive investigation of the marine environment began in the 1970 s, leading to the isolation of a plethora of novel, bioactive chemotypes. The first marine-derived drug, Ziconotide, based on ω-conotoxin MVIIA from the venom of Conus magus, was approved in 2005 for the treatment of chronic pain. Since then, several marine-derived anticancer agents have been approved, and a number are in clinical trials. The largely untapped potential of terrestrial flora and the marine environment, the expanding study of microbial diversity, including extremophiles and symbiotic microbes, and the fast developing field of microbial genomics, hold immense promise for the discovery and development of novel drugs and drug leads.

Biomedical Acoustics: Making a quantum leap in medicine

At the dawn of a new era in medicine, the future of biomedical acoustics is bright. In the last century, we witnessed the introduction of ultrasound contrast agents, lithotripsy, and the visualization of ultrasound images in three dimensions. Currently, scientists are developing acoustic-based techniques for opening the blood–brain barrier transiently in order to treat brain tumors and neurological diseases. Additionally, researchers are developing echogenic liposomes and microbubbles for targeted ultrasound image enhancement and drug and gene delivery. Further excitement has been generated by the advances made with focused ultrasound to ablate or mechanically erode solid tumors in a noninvasive and site-specific manner. As technology and protocols continue to evolve, biomedical acoustics will have a dramatic impact on the diagnosis and treatment of debilitating diseases, thus improving patient care and quality of life.

Primary Care and the Ethics of Integrating Genomic Medicine

Objectives: To explore the practical barriers to, and implications of, incorporating genomic technologies in the primary care setting. In evaluating the primary care mission and anticipated role of genomic medicine in conversation with one another, I discuss the ways in which the primary care philosophy problematizes innovations afforded to clinical medicine through whole genome sequencing. I discuss these themes in relation to the evaluation frameworks that must precede full integration, specifically the Analytic validity, Clinical validity, Clinical Utility and Ethical, legal social considerations (ACCE) model. Finally, my analysis will consider the added ethical nuances for integrating genomic medicine in the wake of new standards for healthcare delivery in the U.S.Methods: I review the literature concerning 1) models for evaluating the applicability of emerging genomic technologies in the primary care setting, namely the ACCE model proposed by the Center for Disease Control, and 2) anticipated changes to primary care delivery through proposed healthcare legislation.Results: Three main facets of primary care delivery problematize full integration of genomic medicine in clinical practice. They include: primary care providers' propensity to maintain therapeutic relationships with patients over the lifecourse, acuity to community health patterns, and gaps in genetic/genomic-specific knowledge among practicing clinicians. Implementation of genomic medicine requires that technologies be adaptable to the heterogeneity of the primary care clinic, in both the diverse populations it serves and broad spectrum of resource availability.Conclusions: The rapid pace at which genomic technology has fundamentally altered the direction of medical research scene is extraordinary to say the least. The potential benefits for incorporating these innovations depict a clinical landscape that predicts and prevents disease before it manifests, and cares for patients using treatments that are tailored to their own genetic person. The primary care arena presents unique challenges to the evaluation, diffusion and translation of genomic technologies. Yet the same aspects that present limitations also reinforce the reasons why the primary care setting is a critical forum in which to operationalize genomic medicine in practice. With so much dialogue generated around ushering in a new era of medicine, it is unclear whether this is celebrating the novelty of the genomic revolution, or the reinvigoration of a longstanding clinical tradition in patient-centered primary care.

Clinicians' expectations for gene-driven cancer therapy.

A new era of medicine is rapidly approaching, which will change not only pathological diagnosis but also medical decision-making. This paper raises the question of how well prepared doctors are to address the new issues that will soon confront them. The human genome has been completely sequenced and general understanding about cancer biology has increased enormously with understanding that unregulated gene function and complicated changes in signal pathways are related to uncontrolled cell growth. Thus, gene-driven therapy involving alterations to genes are recognized to present new therapy options. This advance will necessitate major changes to the decision-making aspect of physicians. This article focuses on defining the pertinent changes and addressing what they mean for practicing physicians.

Preimplantation Genetic Testing

The application of genetic technologies to the field of reproductive medicine has ushered in a new era of medicine that is likely to greatly expand in the coming years. Concurrent with an in vitro fertilization (IVF) cycle, it is now possible to obtain a cellular biopsy from a developing embryo and genetically evaluate this sample with increasing sophistication and detail. Information obtained from this analyzed sample may then guide which embryos are selected for uterine transfer. Applications for this technology are currently being employed to avoid the propagation of certain genetically based diseases and to increase the efficiency of assisted reproductive technologies in general. The way such technologies are implemented, however, has caused a continuous and ever evolving debate among reproductive medicine physicians and geneticists. This article will define the current uses of preimplantation genetic testing and discuss the benefits and limitations of this technology.

You want me to write a business plan? Capital budgeting fundamentals for the plastic surgeon

As we enter the new era of medicine in which cost becomes as important as outcomes, clinicians struggling to treat patients frequently find themselves in uncharted territory. Gone are the days in which a new technology or treatment will be embraced by hospital administrators simply because a surgeon makes a cogent argument that it will raise the quality of care delivered at the institution. Administrators want to know how much the intervention will cost, whether it is revenue positive or, at the very least, revenue neutral, and what the long-term implications will be on the global budget. Think of administrators as investors: they want to know if there is value in the investment. The yearly process of allocating funds in the hospital falls under the umbrella of capital budgeting. Regardless of whether we agree with the direction of things, there is certain advantage to being able to ‘talk the talk’. Understanding the calculations behind capital budgeting enables a clinician to do just that. Imagine, if you will, a struggling telecommunications company. Money is tight. Shareholders are demanding; they want return on investment. All decisions must be considered in the context of their ability to generate revenue. Managers need money to invest in projects in their respective departments. The engineers want money for research and development, the marketing division wants money for promotion and the HR department wants money for new hires. The CEO must decide what investments are most likely to generate revenue moving forward. To attract investment, departmental managers make arguments using a universal business tool: the business plan. They typically base their business plan on one of two capital budgeting calculations: net present value (NPV) or the internal rate of return (IRR). The hospital is no different, with one exception: the goal is savings, not profit. Treatments change rapidly when evidence emerges favouring one modality over another. The rapid integration of BRAF inhibitors into the melanoma treatment armamentarium is a good example. Costly interventions will emerge that drain funds; money saved can be re-allocated, enabling programs to evolve with the dynamism of treatment.