1 103 144 A REHABILOMICS FRAMEWORK FOR PERSONALIZED AND TRANSLATIONAL REHABILITATION RESEARCH AND CARE FOR INDIVIDUALS WITH DISABILITIES: PERSPECTIVES AND CONSIDERATIONS FOR SPINAL CORD INJURY. DESPITE MANY PEOPLE HAVING SIMILAR CLINICAL PRESENTATION, DEMOGRAPHIC FACTORS, AND CLINICAL CARE, OUTCOME CAN DIFFER FOR THOSE SUSTAINING SIGNIFICANT INJURY SUCH AS SPINAL CORD INJURY (SCI) AND TRAUMATIC BRAIN INJURY (TBI). IN ADDITION TO TRADITIONAL DEMOGRAPHIC, SOCIAL, AND CLINICAL FACTORS, VARIABILITY ALSO MAY BE ATTRIBUTABLE TO INNATE (INCLUDING GENETIC, TRANSCRIPTOMIC PROTEOMIC, EPIGENETIC) BIOLOGICAL VARIATION THAT INDIVIDUALS BRING TO RECOVERY AND THEIR UNIQUE RESPONSE TO THEIR CARE AND ENVIRONMENT. TECHNOLOGIES COLLECTIVELY CALLED "-OMICS" ENABLE SIMULTANEOUS MEASUREMENT OF AN ENORMOUS NUMBER OF BIOMOLECULES THAT CAN CAPTURE MANY POTENTIAL BIOLOGICAL CONTRIBUTORS TO HETEROGENEITY OF INJURY/DISEASE COURSE AND OUTCOME. DUE TO THE NATURE OF INJURY AND COMPLEX DISEASE, AND ITS ASSOCIATIONS WITH IMPAIRMENT, DISABILITY, AND RECOVERY, REHABILITATION DOES NOT LEND ITSELF TO A SINGULAR "PROTOCOLIZED" PLAN OF THERAPY. YET, BY NATURE AND BY NECESSITY, REHABILITATION MEDICINE OPERATES AS A FUNCTIONAL MODEL OF "PERSONALIZED CARE". THUS, THE CHALLENGE FOR SUCCESSFUL PROGRAMS OF TRANSLATIONAL REHABILITATION CARE AND RESEARCH IS TO IDENTIFY VIABLE APPROACHES TO EXAMINE BROAD POPULATIONS, WITH VARIED IMPAIRMENTS AND FUNCTIONAL LIMITATIONS, AND TO IDENTIFY EFFECTIVE TREATMENT RESPONSES THAT INCORPORATE PERSONALIZED PROTOCOLS TO OPTIMIZE FUNCTIONAL RECOVERY. THE REHABILOMICS FRAMEWORK IS A TRANSLATIONAL MODEL THAT PROVIDES AN "-OMICS" OVERLAY TO THE SCIENTIFIC STUDY OF REHABILITATION PROCESSES AND MULTIDIMENSIONAL OUTCOMES. REHABILOMICS RESEARCH PROVIDES NOVEL OPPORTUNITIES TO EVALUATE THE NEUROBIOLOGY OF COMPLEX INJURY OR CHRONIC DISEASE AND CAN BE USED TO EXAMINE METHODS AND TREATMENTS FOR PERSON-CENTERED CARE AMONG POPULATIONS WITH DISABILITIES. EXEMPLARS FOR APPLICATION IN SCI AND OTHER NEUROREHABILITATION POPULATIONS ARE DISCUSSED. 2014 2 484 32 ARTICULAR CARTILAGE CHANGES IN MATURING ATHLETES: NEW TARGETS FOR JOINT REJUVENATION. CONTEXT: ARTICULAR CARTILAGE HAS A UNIQUE FUNCTIONAL ARCHITECTURE CAPABLE OF PROVIDING A LIFETIME OF PAIN-FREE JOINT MOTION. THIS TISSUE, HOWEVER, UNDERGOES SUBSTANTIAL AGE-RELATED PHYSIOLOGIC, MECHANICAL, BIOCHEMICAL, AND FUNCTIONAL CHANGES THAT REDUCE ITS ABILITY TO OVERCOME THE EFFECTS OF MECHANICAL STRESS AND INJURY. MANY FACTORS AFFECT JOINT FUNCTION IN THE MATURING ATHLETE-FROM CHONDROCYTE SURVIVAL AND METABOLISM TO STRUCTURAL COMPOSITION AND GENETIC/EPIGENETIC FACTORS GOVERNING CARTILAGE AND SYNOVIUM. AN EVALUATION OF AGE-RELATED CHANGES FOR JOINT HOMEOSTASIS AND RISK FOR OSTEOARTHRITIS IS IMPORTANT TO THE DEVELOPMENT OF NEW STRATEGIES TO REJUVENATE AGING JOINTS. OBJECTIVE: THIS REVIEW SUMMARIZES THE CURRENT LITERATURE ON THE BIOCHEMICAL, CELLULAR, AND PHYSIOLOGIC CHANGES OCCURRING IN AGING ARTICULAR CARTILAGE. DATA SOURCES: PUBMED (1969-2013) AND PUBLISHED BOOKS IN SPORTS HEALTH, CARTILAGE BIOLOGY, AND AGING. STUDY SELECTION: KEYWORDS INCLUDED AGING, ATHLETE, ARTICULAR CARTILAGE, EPIGENETICS, AND FUNCTIONAL PERFORMANCE WITH AGE. STUDY DESIGN: SYSTEMATIC REVIEW. LEVEL OF EVIDENCE: LEVEL 3. DATA EXTRACTION: TO BE INCLUDED, RESEARCH QUESTIONS ADDRESSED THE EFFECT OF AGE-RELATED CHANGES ON PERFORMANCE, ARTICULAR CARTILAGE BIOLOGY, MOLECULAR MECHANISM, AND MORPHOLOGY. RESULTS: THE MATURE ATHLETE FACES CHALLENGES IN MAINTAINING CARTILAGE HEALTH AND JOINT FUNCTION DUE TO AGE-RELATED CHANGES TO ARTICULAR CARTILAGE BIOLOGY, MORPHOLOGY, AND PHYSIOLOGY. THESE CHANGES INCLUDE CHONDROCYTE LOSS AND A DECLINE IN METABOLIC RESPONSE, ALTERATIONS TO MATRIX AND SYNOVIAL TISSUE COMPOSITION, AND DYSREGULATION OF REPARATIVE RESPONSES. CONCLUSION: ALTHOUGH PHYSICAL DECLINE HAS BEEN REGARDED AS A NORMAL PART OF AGING, MANY INDIVIDUALS MAINTAIN OVERALL FITNESS AND ENJOY TARGETED IMPROVEMENT TO THEIR ATHLETIC CAPACITY THROUGHOUT LIFE. HEALTHY ARTICULAR CARTILAGE AND JOINTS ARE NEEDED TO MAINTAIN ATHLETIC PERFORMANCE AND GENERAL ACTIVITIES. GENETIC AND POTENTIALLY REVERSIBLE EPIGENETIC FACTORS INFLUENCE CARTILAGE PHYSIOLOGY AND ITS RESPONSE TO MECHANICAL AND INJURIOUS STIMULI. IMPROVED UNDERSTANDINGS OF THE PHYSICAL AND MOLECULAR CHANGES TO ARTICULAR CARTILAGE WITH AGING ARE IMPORTANT TO DEVELOP SUCCESSFUL STRATEGIES FOR JOINT REJUVENATION. 2014 3 1867 26 EMERGING GENE-EDITING MODALITIES FOR OSTEOARTHRITIS. OSTEOARTHRITIS (OA) IS A PATHOLOGICAL DEGENERATIVE CONDITION OF THE JOINTS THAT IS WIDELY PREVALENT WORLDWIDE, RESULTING IN SIGNIFICANT PAIN, DISABILITY, AND IMPAIRED QUALITY OF LIFE. THE DIVERSE ETIOLOGY AND PATHOGENESIS OF OA CAN EXPLAIN THE PAUCITY OF VIABLE PREVENTIVE AND DISEASE-MODIFYING STRATEGIES TO COUNTER IT. ADVANCES IN GENOME-EDITING TECHNIQUES MAY IMPROVE DISEASE-MODIFYING SOLUTIONS BY ADDRESSING INHERITED PREDISPOSING RISK FACTORS AND THE ACTIVITY OF INFLAMMATORY MODULATORS. RECENT PROGRESS ON TECHNOLOGIES SUCH AS CRISPR/CAS9 AND CELL-BASED GENOME-EDITING THERAPIES TARGETING THE GENETIC AND EPIGENETIC ALTERNATIONS IN OA OFFER PROMISING AVENUES FOR EARLY DIAGNOSIS AND THE DEVELOPMENT OF PERSONALIZED THERAPIES. THE PURPOSE OF THIS LITERATURE REVIEW WAS TO CONCISELY SUMMARIZE THE GENOME-EDITING OPTIONS AGAINST CHRONIC DEGENERATIVE JOINT CONDITIONS SUCH AS OA WITH A FOCUS ON THE MORE RECENTLY EMERGING MODALITIES, ESPECIALLY CRISPR/CAS9. FUTURE ADVANCEMENTS IN NOVEL GENOME-EDITING THERAPIES MAY IMPROVE THE EFFICACY OF SUCH TARGETED TREATMENTS. 2020 4 367 40 AMPLIFIED PAIN SYNDROMES IN CHILDREN: TREATMENT AND NEW INSIGHTS INTO DISEASE PATHOGENESIS. PURPOSE OF REVIEW: ALTHOUGH MANY DIAGNOSTIC TERMS ARE USED FOR PEDIATRIC CHRONIC PAIN, EVIDENCE SUGGESTS A COMMON THREAD OF SIGNAL AMPLIFICATION, LEADING TO THE UNIFYING TERM 'AMPLIFIED PAIN SYNDROMES'. ONGOING RESEARCH PROVIDES NEW INSIGHTS INTO BIOPSYCHOSOCIAL CONTRIBUTORS AND TREATMENTS FOR PEDIATRIC AMPLIFIED PAIN SYNDROMES. RECENT FINDINGS: BASIC SCIENCE INDICATES A COMPLEX INTERPLAY OF GENETIC, EPIGENETIC, NEUROCHEMICAL, ENDOCRINE, AND INFLAMMATORY CONTRIBUTORS, ALONG WITH ENVIRONMENTAL AND PSYCHOLOGICAL FACTORS. ALTHOUGH MEDICATIONS AND INTERVENTIONS REMAIN COMMON APPROACHES TO CHILDREN WITH CHRONIC PAIN, THEIR EVIDENCE IS LIMITED. PRELIMINARY EVIDENCE EXISTS FOR MINDFULNESS-BASED THERAPIES, YOGA, AND OTHER COMPLEMENTARY/ALTERNATIVE MEDICINE APPROACHES. THE STRONGEST EVIDENCE IS FOR EXERCISE-BASED AND COGNITIVE-BEHAVIORAL TREATMENTS, IN PARTICULAR, WHEN COMBINED IN A MULTIDISCIPLINARY FORMAT. INTENSIVE APPROACHES (PAIN REHABILITATION) HAVE THE POTENTIAL TO EFFECTIVELY AND EFFICIENTLY TREAT THOSE MOST DISABLED BY AMPLIFIED PAIN SYNDROMES, AND LEAD TO SUSTAINED IMPROVEMENT IN PAIN, FUNCTIONING, AND MEDICAL UTILIZATION. SUMMARY: ALTHOUGH UNDERSTANDING OF THE MECHANISMS UNDERLYING PEDIATRIC AMPLIFIED PAIN SYNDROMES EVOLVES, STANDARD OF CARE IS MULTIDISCIPLINARY EMPHASIZING EXERCISE THERAPY, COGNITIVE-BEHAVIORAL TREATMENT, AND SELF-REGULATION. TREATMENT SHOULD TARGET FULL RETURN TO PHYSICAL FUNCTION, WHICH LEADS TO SUBSEQUENT IMPROVEMENT OR RESOLUTION OF PAIN. MULTIDISCIPLINARY CARE CAN BE COORDINATED BY A RHEUMATOLOGIST OR OTHER PHYSICIAN WITH APPROPRIATE REFERRALS, OR THROUGH A MULTIDISCIPLINARY TEAM. 2014 5 3926 42 LITERATURE REVIEW AND METHODOLOGICAL CONSIDERATIONS FOR UNDERSTANDING CIRCULATING RISK BIOMARKERS FOLLOWING TRAUMA EXPOSURE. EXPOSURE TO TRAUMATIC EVENTS IS COMMON. WHILE MANY INDIVIDUALS RECOVER FOLLOWING TRAUMA EXPOSURE, A SUBSTANTIAL SUBSET DEVELOP ADVERSE POSTTRAUMATIC NEUROPSYCHIATRIC SEQUELAE (APNS) SUCH AS POSTTRAUMATIC STRESS, MAJOR DEPRESSION, AND REGIONAL OR WIDESPREAD CHRONIC MUSCULOSKELETAL PAIN. APNS CAUSE SUBSTANTIAL BURDEN TO THE INDIVIDUAL AND TO SOCIETY, CAUSING FUNCTIONAL IMPAIRMENT AND PHYSICAL DISABILITY, RISK FOR SUICIDE, LOST WORKDAYS, AND INCREASED HEALTH CARE COSTS. CONTEMPORARY TREATMENT IS LIMITED BY AN INABILITY TO IDENTIFY INDIVIDUALS AT HIGH RISK OF APNS IN THE IMMEDIATE AFTERMATH OF TRAUMA, AND AN INABILITY TO IDENTIFY OPTIMAL TREATMENTS FOR INDIVIDUAL PATIENTS. OUR PURPOSE IS TO PROVIDE A COMPREHENSIVE REVIEW DESCRIBING CANDIDATE BLOOD-BASED BIOMARKERS THAT MAY HELP TO IDENTIFY THOSE AT HIGH RISK OF APNS AND/OR GUIDE INDIVIDUAL INTERVENTION DECISION-MAKING. SUCH BLOOD-BASED BIOMARKERS INCLUDE CIRCULATING BIOLOGICAL FACTORS SUCH AS HORMONES, PROTEINS, IMMUNE MOLECULES, NEUROPEPTIDES, NEUROTRANSMITTERS, MRNA, AND NONCODING RNA EXPRESSION SIGNATURES, WHILE WE DO NOT REVIEW GENETIC AND EPIGENETIC BIOMARKERS DUE TO OTHER RECENT REVIEWS OF THIS TOPIC. THE CURRENT STATE OF THE LITERATURE ON CIRCULATING RISK BIOMARKERS OF APNS IS SUMMARIZED, AND KEY CONSIDERATIONS AND CHALLENGES FOR THEIR DISCOVERY AND TRANSLATION ARE DISCUSSED. WE ALSO DESCRIBE THE AURORA STUDY, A SPECIFIC EXAMPLE OF CURRENT SCIENTIFIC EFFORTS TO IDENTIFY SUCH CIRCULATING RISK BIOMARKERS AND THE LARGEST STUDY TO DATE FOCUSED ON IDENTIFYING RISK AND PROGNOSTIC FACTORS IN THE AFTERMATH OF TRAUMA EXPOSURE. 2020 6 5224 36 PRIORITIZED RESEARCH FOR THE PREVENTION, TREATMENT, AND REVERSAL OF CHRONIC DISEASE: RECOMMENDATIONS FROM THE LIFESTYLE MEDICINE RESEARCH SUMMIT. DECLINING LIFE EXPECTANCY AND INCREASING ALL-CAUSE MORTALITY IN THE UNITED STATES HAVE BEEN ASSOCIATED WITH UNHEALTHY BEHAVIORS, SOCIOECOLOGICAL FACTORS, AND PREVENTABLE DISEASE. A GROWING BODY OF BASIC SCIENCE, CLINICAL RESEARCH, AND POPULATION HEALTH EVIDENCE POINTS TO THE BENEFITS OF HEALTHY BEHAVIORS, ENVIRONMENTS AND POLICIES TO MAINTAIN HEALTH AND PREVENT, TREAT, AND REVERSE THE ROOT CAUSES OF COMMON CHRONIC DISEASES. SIMILARLY, INNOVATIONS IN RESEARCH METHODOLOGIES, STANDARDS OF EVIDENCE, EMERGENCE OF UNIQUE STUDY COHORTS, AND BREAKTHROUGHS IN DATA ANALYTICS AND MODELING CREATE NEW POSSIBILITIES FOR PRODUCING BIOMEDICAL KNOWLEDGE AND CLINICAL TRANSLATION. TO UNDERSTAND THESE ADVANCES AND INFORM FUTURE DIRECTIONS RESEARCH, THE LIFESTYLE MEDICINE RESEARCH SUMMIT WAS CONVENED AT THE UNIVERSITY OF PITTSBURGH ON DECEMBER 4-5, 2019. THE SUMMIT'S GOAL WAS TO REVIEW CURRENT STATUS AND DEFINE RESEARCH PRIORITIES IN THE SIX CORE AREAS OF LIFESTYLE MEDICINE: PLANT-PREDOMINANT NUTRITION, PHYSICAL ACTIVITY, SLEEP, STRESS, ADDICTIVE BEHAVIORS, AND POSITIVE PSYCHOLOGY/SOCIAL CONNECTION. FORTY INVITED SUBJECT MATTER EXPERTS (1) REVIEWED EXISTING KNOWLEDGE AND GAPS RELATING LIFESTYLE BEHAVIORS TO COMMON CHRONIC DISEASES, SUCH AS CARDIOVASCULAR DISEASE, DIABETES, MANY CANCERS, INFLAMMATORY- AND IMMUNE-RELATED DISORDERS AND OTHER CONDITIONS; AND (2) DISCUSSED THE POTENTIAL FOR APPLYING CUTTING-EDGE MOLECULAR, CELLULAR, EPIGENETIC AND EMERGING SCIENCE KNOWLEDGE AND COMPUTATIONAL METHODOLOGIES, RESEARCH DESIGNS, AND STUDY COHORTS TO ACCELERATE CLINICAL APPLICATIONS ACROSS ALL SIX DOMAINS OF LIFESTYLE MEDICINE. NOTABLY, FEDERAL HEALTH AGENCIES, SUCH AS THE DEPARTMENT OF DEFENSE AND VETERANS ADMINISTRATION HAVE BEGUN TO ADOPT "WHOLE-PERSON HEALTH AND PERFORMANCE" MODELS THAT ADDRESS THESE LIFESTYLE AND ENVIRONMENTAL ROOT CAUSES OF CHRONIC DISEASE AND ASSOCIATED MORBIDITY, MORTALITY, AND COST. RECOMMENDATIONS STRONGLY SUPPORT LEVERAGING EMERGING RESEARCH METHODOLOGIES, SYSTEMS BIOLOGY, AND COMPUTATIONAL MODELING IN ORDER TO ACCELERATE EFFECTIVE CLINICAL AND POPULATION SOLUTIONS TO IMPROVE HEALTH AND REDUCE SOCIETAL COSTS. NEW AND ALTERNATIVE HIERARCHIES OF EVIDENCE ARE ALSO BE NEEDED IN ORDER TO ASSESS THE QUALITY OF EVIDENCE AND DEVELOP EVIDENCE-BASED GUIDELINES ON LIFESTYLE MEDICINE. CHILDREN AND UNDERSERVED POPULATIONS WERE IDENTIFIED AS PRIORITIZED GROUPS TO STUDY. THE COVID-19 PANDEMIC, WHICH DISPROPORTIONATELY IMPACTS PEOPLE WITH CHRONIC DISEASES THAT ARE AMENABLE TO EFFECTIVE LIFESTYLE MEDICINE INTERVENTIONS, MAKES THE SUMMIT'S FINDINGS AND RECOMMENDATIONS FOR FUTURE RESEARCH PARTICULARLY TIMELY AND RELEVANT. 2020 7 1047 29 CLINICAL EFFECT AND BIOLOGICAL MECHANISM OF EXERCISE FOR RHEUMATOID ARTHRITIS: A MINI REVIEW. RHEUMATOID ARTHRITIS (RA) IS A COMMON SYSTEMATIC, CHRONIC INFLAMMATORY, AUTOIMMUNE, AND POLYARTICULAR DISEASE, CAUSING A RANGE OF CLINICAL MANIFESTATIONS, INCLUDING JOINT SWELLING, REDNESS, PAIN, STIFFNESS, FATIGUE, DECREASED QUALITY OF LIFE, PROGRESSIVE DISABILITY, CARDIOVASCULAR PROBLEMS, AND OTHER COMORBIDITIES. STRONG EVIDENCE HAS SHOWN THAT EXERCISE IS EFFECTIVE FOR RA TREATMENT IN VARIOUS CLINICAL DOMAINS. EXERCISE TRAINING FOR RELATIVELY LONGER PERIODS (E.G., >/= 12 WEEKS) CAN DECREASE DISEASE ACTIVITY OF RA. HOWEVER, THE MECHANISM UNDERLYING THE EFFECTIVENESS OF EXERCISE IN REDUCING RA DISEASE ACTIVITY REMAINS UNCLEAR. THIS REVIEW FIRST SUMMARIZES AND HIGHLIGHTS THE EFFECTIVENESS OF EXERCISE IN RA TREATMENT. THEN, WE INTEGRATE CURRENT EVIDENCE AND PROPOSE BIOLOGICAL MECHANISMS RESPONSIBLE FOR THE POTENTIAL EFFECTS OF EXERCISE ON IMMUNE CELLS AND IMMUNITY, INFLAMMATORY RESPONSE, MATRIX METALLOPROTEINASES, OXIDATIVE STRESS, AND EPIGENETIC REGULATION. HOWEVER, A LARGE BODY OF EVIDENCE WAS OBTAINED FROM THE NON-RA POPULATIONS. FUTURE STUDIES ARE NEEDED TO FURTHER EXAMINE THE PROPOSED BIOLOGICAL MECHANISMS RESPONSIBLE FOR THE EFFECTIVENESS OF EXERCISE IN DECREASING DISEASE ACTIVITY IN RA POPULATIONS. SUCH KNOWLEDGE WILL CONTRIBUTE TO THE BASIC SCIENCE AND STRENGTHEN THE SCIENTIFIC BASIS OF THE PRESCRIPTION OF EXERCISE THERAPY FOR RA IN THE CLINICAL ROUTINE. 2022 8 966 45 CHRONIC NEUROLOGICAL DISORDERS: GENETIC AND EPIGENETIC MARKERS FOR MONITORING OF PHARMACOTHERAPY. INTRODUCTION: CHRONIC NEUROLOGICAL DISEASES ARE A MAJOR CAUSE OF MORTALITY AND MORBIDITY IN THE WORLD. WITH INCREASING LIFE EXPECTANCY IN THE DEVELOPING WORLD, THE INCIDENCE AND PREVALENCE OF THESE DISEASES ARE PREDICTED TO RISE EVEN FURTHER. THIS HAS ALSO CONTRIBUTED TO AN INCREASE IN DISABILITY-ADJUSTED LIFE YEARS (DALYS) FOR NONCOMMUNICABLE DISEASES. TREATMENT FOR SUCH DISEASES ALSO POSES A CHALLENGE WITH MULTIPLE GENETIC AND EPIGENETIC FACTORS LEADING TO A VARIED OUTCOME. PERSONALIZATION OF TREATMENT IS ONE WAY THAT TREATMENT OUTCOME/PROGNOSIS OF DISEASE CAN BE IMPROVED, AND PHARMACOGENOMICS PLAYS A SIGNIFICANT ROLE IN THIS CONTEXT. METHODOLOGY: THIS ARTICLE REVIEWED THE EVIDENCE PERTAINING TO THE ASSOCIATION OF GENETIC AND EPIGENETIC MARKERS WITH MAJOR NEUROLOGICAL DISORDERS LIKE MULTIPLE SCLEROSIS (MS), ALZHEIMER'S DISEASE (AD), AND PARKINSON'S DISEASE (PD), WHICH ARE A MAJOR SOURCE OF BURDEN AMONG NEUROLOGICAL DISORDERS. TYPES OF STUDIES INCLUDED ARE PEER-REVIEWED ORIGINAL RESEARCH ARTICLES FROM THE PUBMED DATABASE (1999-2018). RESULTS: THIS STUDY COMPILED DATA REGARDING SPECIFIC GENETIC AND EPIGENETIC MARKERS WITH A SIGNIFICANT CORRELATION BETWEEN THE CLINICAL DIAGNOSIS OF THE DISEASE AND PROGNOSIS OF THERAPY FROM 65 STUDIES. IN A SINGLE PLATFORM, THIS REVIEW HIGHLIGHTS THE CLUES TO SOME VITAL QUESTIONS, SUCH AS WHY INTERFERON BETA (IFN-BETA) THERAPY FAILS TO IMPROVE SYMPTOMS IN ALL MS PATIENTS? WHY CHOLINESTERASE INHIBITORS FAIL TO IMPROVE COGNITIVE IMPAIRMENT IN A SUBSET OF PEOPLE SUFFERING FROM AD? OR WHY SOME INDIVIDUALS ON LEVODOPA (L-DOPA) FOR PD SUFFER FROM SIDE-EFFECTS RANGING FROM DYSKINESIA TO HALLUCINATION WHILE OTHERS DO NOT? CONCLUSION: THIS ARTICLE SUMMARIZES THE GENETIC AND EPIGENETIC FACTORS THAT MAY EITHER REQUIRE MONITORING OR HELP IN DECIDING FUTURE PHARMACOTHERAPY IN A PATIENT SUFFERING FROM MS, AD, AND PD. AS THE HEALTH CARE SYSTEM DEVELOPS AND REACHES NEWER HEIGHTS, WE EXPECT MORE AND MORE OF THESE BIOMARKERS TO BE USED AS PHARMACOTHERAPEUTIC OUTCOME INDICATORS. 2021 9 5372 34 RECENT ADVANCES IN UNDERSTANDING THE PATHOGENESIS OF RHEUMATOID ARTHRITIS: NEW TREATMENT STRATEGIES. RHEUMATOID ARTHRITIS (RA) IS CONSIDERED A CHRONIC SYSTEMIC, MULTI-FACTORIAL, INFLAMMATORY, AND PROGRESSIVE AUTOIMMUNE DISEASE AFFECTING MANY PEOPLE WORLDWIDE. WHILE PATIENTS SHOW VERY INDIVIDUAL COURSES OF DISEASE, WITH RA FOCUSING ON THE MUSCULOSKELETAL SYSTEM, JOINTS ARE OFTEN SEVERELY AFFECTED, LEADING TO LOCAL INFLAMMATION, CARTILAGE DESTRUCTION, AND BONE EROSION. TO PREVENT JOINT DAMAGE AND PHYSICAL DISABILITY AS ONE OF MANY SYMPTOMS OF RA, EARLY DIAGNOSIS IS CRITICAL. AUTO-ANTIBODIES PLAY A PIVOTAL CLINICAL ROLE IN PATIENTS WITH SYSTEMIC RA. AS BIOMARKERS, THEY COULD HELP TO MAKE A MORE EFFICIENT DIAGNOSIS, PROGNOSIS, AND TREATMENT DECISION. BESIDES AUTO-ANTIBODIES, SEVERAL OTHER FACTORS ARE INVOLVED IN THE PROGRESSION OF RA, SUCH AS EPIGENETIC ALTERATIONS, POST-TRANSLATIONAL MODIFICATIONS, GLYCOSYLATION, AUTOPHAGY, AND T-CELLS. UNDERSTANDING THE INTERPLAY BETWEEN THESE FACTORS WOULD CONTRIBUTE TO A DEEPER INSIGHT INTO THE CAUSES, MECHANISMS, PROGRESSION, AND TREATMENT OF THE DISEASE. IN THIS REVIEW, THE LATEST RA RESEARCH FINDINGS ARE DISCUSSED TO BETTER UNDERSTAND THE PATHOGENESIS, AND FINALLY, TREATMENT STRATEGIES FOR RA THERAPY ARE PRESENTED, INCLUDING BOTH CONVENTIONAL APPROACHES AND NEW METHODS THAT HAVE BEEN DEVELOPED IN RECENT YEARS OR ARE CURRENTLY UNDER INVESTIGATION. 2021 10 734 43 CANCER HEALTHCARE DISPARITIES AMONG AFRICAN AMERICANS IN THE UNITED STATES. A NEED EXISTS TO EXAMINE RACIAL DISPARITIES IN THE HEALTHCARE ARENA AND THE IMPACT ON PATIENTS WITH CANCER. DESPITE ONGOING EFFORTS TO INCREASE EQUITY IN PRIMARY HEALTHCARE ACCESS, RACIAL AND SOCIOECONOMIC DISPARITIES PERSIST, THUS CONTRIBUTING TO DISPROPORTIONATE TREATMENT OUTCOMES AND SURVIVORSHIP AMONG MINORITY AND LOW-INCOME PATIENTS. SUCH DISPARITIES HAVE BEEN REVEALED IN TREATMENT COHORTS OF PATIENTS WITH MULTIPLE FORMS OF CANCER, INCLUDING BREAST, CERVICAL, OVARIAN, ENDOMETRIAL, PROSTATE, LUNG, COLORECTAL, GASTROINTESTINAL, AND HEPATOCELLULAR, AND HAVE BEEN ATTRIBUTED TO A RANGE OF CO-OCCURRING BEHAVIORAL, SOCIAL DETERMINANTS OF HEALTH, UNDERLYING GENETIC FACTORS, AS WELL AS ACCESS TO EDUCATIONAL OPPORTUNITIES THAT LIMIT THE QUALITY OF INFORMED HEALTHCARE. THESE VARIOUS INTERRELATED FACTORS WIDEN CANCER HEALTHCARE DISPARITIES SYNERGISTICALLY THROUGHOUT UNDERSERVED COMMUNITIES, AND THEIR INFLUENCE HAS BEEN AMPLIFIED BY THE CORONAVIRUS DISEASE 2019 (COVID-19) PANDEMIC. FUNDAMENTALLY, A LACK OF BASIC AND CLINICAL RESEARCH EXISTS THAT FAILS TO ADEQUATELY REFLECT DIVERSITY AND MINORITY INVOLVEMENT IN DRUG DEVELOPMENT. ALTHOUGH OVERCOMING THE OBSTACLES RESPONSIBLE FOR CHRONIC TREATMENT DISPARITIES IS A FORMIDABLE TASK, PROMISING MEANS OF ACHIEVING MORE UNIFORM QUALITY HEALTHCARE ARE BECOMING MORE CLEARLY ELUCIDATED. TO REDUCE DISEASE PROGRESSION, INCREASE OVERALL SURVIVAL, AND IMPROVE THE HEALTH OF VULNERABLE POPULATIONS, IT IS NECESSARY TO IDENTIFY AND FULLY DISCLOSE ENVIRONMENTAL, BIOLOGICAL, AND ANCESTRAL FACTORS THAT IMPACT THE RISK FOR CANCER; HEAL HISTORICAL FRACTURES WITHIN COMMUNITIES; AND INCREASE PARTICIPATION OF RACIAL AND ETHNIC MINORITIES IN SCREENING EFFORTS AND RESEARCH STUDIES. THIS REQUIRES DEVELOPING A SYSTEM OF JUSTICE AND TRUST BASED ON SPECIFIC, SOLUTION-ORIENTED GRASSROOTS COMMUNITY EFFORTS WORKING IN TANDEM WITH MEDICAL AND PHARMACEUTICAL LEADERS. BY FULLY EXPLORING AND PINPOINTING THE UNDERLYING CAUSES OF HEALTHCARE DISPARITIES, IT SHOULD BE POSSIBLE TO DEFINE STRATEGIES AND INTERVENTIONS MOST LIKELY TO TRANSFORM CANCER CARE. THE ULTIMATE GOAL IS UNDERSTANDING INDIVIDUAL, CULTURAL, AND BIOLOGICAL VULNERABILITIES, INCLUDING ENVIRONMENTAL AND EPIGENETIC LIABILITIES, TO OPTIMIZE CANCER PREVENTION, DIAGNOSIS, AND TREATMENT. 2022 11 6822 38 [GENDER MEDICINE. SEX- AND GENDER-SPECIFIC ASPECTS OF CLINICAL MEDICINE]. GENDER MEDICINE STUDIES SEX- AND GENDER-BASED DIFFERENCES IN THE DEVELOPMENT AND PREVENTION OF DISEASES, THE AWARENESS AND PRESENTATION OF SYMPTOMS, AND THE EFFECTIVENESS OF THERAPY. GENDER MEDICINE IS PART OF PERSONALIZED MEDICINE, CONSIDERING DIFFERENCES IN BIOLOGICAL AND PSYCHOSOCIAL FACTORS INDIVIDUALLY. THERE ARE DIFFERENCES IN GENES, CHROMOSOMES, HORMONES, AND METABOLISM AS WELL AS DIFFERENCES IN CULTURE, ENVIRONMENT, AND SOCIETY. LIFELONG INTERACTIONS BETWEEN PHYSICAL AND PSYCHOSOCIAL FACTORS WILL INFLUENCE THE HEALTH AND ILL-HEALTH OF MEN AND WOMEN IN DIFFERENT WAYS. EPIGENETIC MODIFICATIONS PROVIDE EVIDENCE OF THE IMPACT OF ENVIRONMENT AND LIFESTYLE DURING VULNERABLE PHASES ON BIOLOGICAL PROCESSES, EFFECTING FUTURE GENERATIONS. MATERNAL LIFESTYLE AND ENVIRONMENTAL FACTORS DURING PREGNANCY CAN IMPACT THE HEALTH OF OFFSPRING IN LATER LIFE ALREADY IN UTERO IN A SEX-SPECIFIC WAY. PAIN, STRESS, AND COPING STYLES DIFFER BETWEEN MEN AND WOMEN. WOMEN EXPERIENCE MORE DRAMATIC PHYSICAL CHANGES DURING THEIR LIFETIME, WHICH ARE ASSOCIATED WITH SPECIFIC BURDENS AND PSYCHOSOCIAL ALTERATIONS. WOMEN WITH MULTIPLE ROLES AND RESPONSIBILITIES SUFFERING FROM STRESS DEVELOP DEPRESSION MORE FREQUENTLY. HOWEVER, MEN ARE OFTEN NOT DIAGNOSED AND TREATED APPROPRIATELY IN CASES OF DEPRESSION OR OSTEOPOROSIS, DISEASES THAT ARE TYPICALLY CONSIDERED "FEMALE." THERE ARE PROMINENT DIFFERENCES BETWEEN MEN AND WOMEN IN MEDICINE REGARDING THE IMMUNE SYSTEM, INFLAMMATION, AND NONCOMMUNICABLE DISEASES SUCH AS OBESITY, TYPE 2 DIABETES, HYPERTENSION, AND CARDIOVASCULAR DISEASE. WOMEN EXPERIENCE MORE OFTEN AUTOIMMUNE DISEASES AND SUFFER MORE FREQUENTLY FROM (CHRONIC) PAIN, NEURODEGENERATIVE CHANGES, AND FUNCTIONAL DISABILITIES. MEN HAVE SHORTER LIFE EXPECTANCY BUT RELATIVELY MORE HEALTHY YEARS OF LIFE, WHICH IS IN GREATER PART ASCRIBED TO PSYCHOSOCIAL DETERMINANTS. STATE-OF-THE-ART CLINICAL MEDICINE COMPRISES INDIVIDUAL RISK FACTORS BASED ON SEX- AND GENDER-SENSITIVE HEALTH PROGRAMS IN ORDER TO IMPROVE THE HEALTH-RELATED QUALITY OF LIFE FOR MEN AND WOMEN. 2014 12 29 38 A BIOPSYCHOSOCIAL OVERVIEW OF THE OPIOID CRISIS: CONSIDERING NUTRITION AND GASTROINTESTINAL HEALTH. THE OPIOID CRISIS HAS REACHED EPIDEMIC PROPORTIONS IN THE UNITED STATES WITH RISING OVERDOSE DEATH RATES. IDENTIFYING THE UNDERLYING FACTORS THAT CONTRIBUTE TO ADDICTION VULNERABILITY MAY LEAD TO MORE EFFECTIVE PREVENTION STRATEGIES. SUPPLY SIDE ENVIRONMENTAL FACTORS ARE A MAJOR CONTRIBUTING COMPONENT. PSYCHOSOCIAL FACTORS SUCH AS STRESS, TRAUMA, AND ADVERSE CHILDHOOD EXPERIENCES HAVE BEEN LINKED TO EMOTIONAL PAIN LEADING TO SELF-MEDICATION. GENETIC AND EPIGENETIC FACTORS ASSOCIATED WITH BRAIN REWARD PATHWAYS AND IMPULSIVITY ARE KNOWN PREDICTORS OF ADDICTION VULNERABILITY. THIS REVIEW ATTEMPTS TO PRESENT A BIOPSYCHOSOCIAL APPROACH THAT CONNECTS VARIOUS SOCIAL AND BIOLOGICAL THEORIES RELATED TO THE ADDICTION CRISIS. THE EMERGING ROLE OF NUTRITION THERAPY WITH AN EMPHASIS ON GASTROINTESTINAL HEALTH IN THE TREATMENT OF OPIOID USE DISORDER IS PRESENTED. THE BIOPSYCHOSOCIAL MODEL INTEGRATES CONCEPTS FROM SEVERAL DISCIPLINES, EMPHASIZING MULTICAUSALITY RATHER THAN A REDUCTIONIST APPROACH. POTENTIAL SOLUTIONS AT MULTIPLE LEVELS ARE PRESENTED, CONSIDERING INDIVIDUAL AS WELL AS POPULATION HEALTH. THIS SINGLE COHESIVE FRAMEWORK IS BASED ON THE INTERDEPENDENCY OF THE ENTIRE SYSTEM, IDENTIFYING RISK AND PROTECTIVE FACTORS THAT MAY INFLUENCE SUBSTANCE-SEEKING BEHAVIOR. NUTRITION SHOULD BE INCLUDED AS ONE FACET OF A MULTIDISCIPLINARY APPROACH TOWARD IMPROVED RECOVERY OUTCOMES. CROSS-DISCIPLINARY COLLABORATIVE EFFORTS, NEW IDEAS, AND FISCAL RESOURCES WILL BE CRITICAL TO ADDRESS THE EPIDEMIC. 2019 13 6760 35 WORKGROUP ON NAPA'S SCIENTIFIC AGENDA FOR A NATIONAL INITIATIVE ON ALZHEIMER'S DISEASE. THIS REPORT OUTLINES A GOAL-DIRECTED SCIENTIFIC AGENDA FOR A NATIONAL INITIATIVE TO OVERCOME THE ALZHEIMER'S DISEASE (AD) CRISIS. THE STATEMENT, WHICH REFLECTS THE COLLECTIVE VIEWS AND RECOMMENDATIONS OF LEADERS IN AD RESEARCH, IS INTENDED TO AID THE IMPLEMENTATION OF THE NATIONAL ALZHEIMER'S PROJECT ACT (NAPA)'S NATIONAL PLAN TO DEFEAT AD. THE PRIMARY PUBLIC POLICY AIMS OF THIS 10-YEAR SCIENTIFIC AGENDA ARE TO DISCOVER, VALIDATE, AND DEVELOP: (1) A BROAD RANGE OF TECHNOLOGIES, TOOLS AND ALGORITHMS FOR EARLY DETECTION OF PEOPLE WITH SYMPTOMATIC AD, AND ASYMPTOMATIC INDIVIDUALS AT ELEVATED RISK FOR AD AND OTHER DEMENTIAS; AND (2) A WIDE RANGE OF INTERVENTIONS TO PRESERVE AND/OR RESTORE HEALTH AND NORMAL NEURAL FUNCTION, AIMING TO MAINTAIN INDEPENDENT FUNCTIONING FOR AS LONG AS POSSIBLE. THE LONG-TERM SCIENTIFIC PUBLIC HEALTH OBJECTIVES OF THIS COMPREHENSIVE PLAN ARE TO: (1) REDUCE THE NUMBER OF PEOPLE WITH CHRONIC DISABLING SYMPTOMS WHO WILL REQUIRE PROLONGED CARE AND, EVENTUALLY, REDUCE THE NUMBER OF ASYMPTOMATIC PEOPLE AT ELEVATED RISK FOR AD/DEMENTIA; (2) DELAY THE ONSET OF CHRONIC DISABILITY FOR PEOPLE WITH AD AND OTHER DEGENERATIVE BRAIN DISORDERS; AND (3) LOWER THE COST AND BURDEN OF CARE. THE PLAN CALLS FOR SIGNIFICANT EXPANSION OF RESEARCH PROGRAMS TO IDENTIFY AND VALIDATE THE CAUSE(S) AND PATHOGENESIS OF AD, GENETIC AND EPIGENETIC FACTORS THAT CONTRIBUTE TO AD RISK, THERAPEUTIC TARGETS THAT AFFECT DISEASE PROGRESSION, SURROGATE BIOMARKERS OF AD PATHOBIOLOGY, AND TECHNOLOGIES FOR EARLY DETECTION OF AD. 2012 14 5161 39 PRECISION AND PERSONALIZED MEDICINE: HOW GENOMIC APPROACH IMPROVES THE MANAGEMENT OF CARDIOVASCULAR AND NEURODEGENERATIVE DISEASE. LIFE EXPECTANCY HAS GRADUALLY GROWN OVER THE LAST CENTURY. THIS HAS DEEPLY AFFECTED HEALTHCARE COSTS, SINCE THE GROWTH OF AN AGING POPULATION IS CORRELATED TO THE INCREASING BURDEN OF CHRONIC DISEASES. THIS REPRESENTS THE INTERESTING CHALLENGE OF HOW TO MANAGE PATIENTS WITH CHRONIC DISEASES IN ORDER TO IMPROVE HEALTH CARE BUDGETS. EFFECTIVE PRIMARY PREVENTION COULD REPRESENT A PROMISING ROUTE. TO THIS END, PRECISION, TOGETHER WITH PERSONALIZED MEDICINE, ARE USEFUL INSTRUMENTS IN ORDER TO INVESTIGATE PATHOLOGICAL PROCESSES BEFORE THE APPEARANCE OF CLINICAL SYMPTOMS AND TO GUIDE PHYSICIANS TO CHOOSE A TARGETED THERAPY TO MANAGE THE PATIENT. CARDIOVASCULAR AND NEURODEGENERATIVE DISEASES REPRESENT SUITABLE MODELS FOR TAKING FULL ADVANTAGE OF PRECISION MEDICINE TECHNOLOGIES APPLIED TO ALL STAGES OF DISEASE DEVELOPMENT. THE AVAILABILITY OF HIGH TECHNOLOGY INCORPORATING ARTIFICIAL INTELLIGENCE AND ADVANCEMENT PROGRESS MADE IN THE FIELD OF BIOMEDICAL RESEARCH HAVE BEEN SUBSTANTIAL TO UNDERSTAND HOW GENES, EPIGENETIC MODIFICATIONS, AGING, NUTRITION, DRUGS, MICROBIOME AND OTHER ENVIRONMENTAL FACTORS CAN IMPACT HEALTH AND CHRONIC DISORDERS. THE AIM OF THE PRESENT REVIEW IS TO ADDRESS HOW PRECISION AND PERSONALIZED MEDICINE CAN BRING GREATER CLARITY TO THE CLINICAL AND BIOLOGICAL COMPLEXITY OF THESE TYPES OF DISORDERS ASSOCIATED WITH HIGH MORTALITY, INVOLVING TREMENDOUS HEALTH CARE COSTS, BY DESCRIBING IN DETAIL THE METHODS THAT CAN BE APPLIED. THIS MIGHT OFFER PRECIOUS TOOLS FOR PREVENTIVE STRATEGIES AND POSSIBLE CLUES ON THE EVOLUTION OF THE DISEASE AND COULD HELP IN PREDICTING MORBIDITY, MORTALITY AND DETECTING CHRONIC DISEASE INDICATORS MUCH EARLIER IN THE DISEASE COURSE. THIS, OF COURSE, WILL HAVE A MAJOR EFFECT ON BOTH IMPROVING THE QUALITY OF CARE AND QUALITY OF LIFE OF THE PATIENTS AND REDUCING TIME EFFORTS AND HEALTHCARE COSTS. 2020 15 4167 34 MEDICINE AND PHLEBOLYMPHOLOGY: TIME TO CHANGE? BIOMEDICAL SCIENCE IS UNDERGOING A REAPPRAISAL OF ITS SCIENTIFIC ADVANCEMENT PROCESS AND OF THE RELATED HEALTHCARE MANAGEMENT. PROGRESS IN MEDICINE SHOULD COMBINE IMPROVEMENTS OF KNOWLEDGE, EFFICACY, AND SAFETY OF DIAGNOSTIC/THERAPEUTIC PROCEDURES, WITH ADEQUATE COST-EFFECTIVENESS PROFILES. THIS NARRATIVE REVIEW IS AIMED AT ASSESSING IN MEDICINE, MORE SPECIFICALLY IN PHLEBOLOGY AND LYMPHOLOGY: (A) SCIENTIFIC LITERATURE POSSIBLE BIASES, (B) THE LEVEL OF EVIDENCE, COMPREHENSIVENESS, AND COST-EFFECTIVENESS OF THE MAIN THERAPEUTIC OPTIONS, AND (C) THE POSSIBLE CONTRIBUTION OF INTEGRATIVE AND TRANSLATIONAL MEDICINE. CURRENT MEDICAL RESEARCH MAY HAVE COGNITIVE BIASES, OR INDUSTRY-TIED INFLUENCES, WHICH IMPACTS CLINICAL PRACTICE. SOME REDUCTIONISM, WITH AN INCREASING USE OF DRUGS AND TECHNOLOGY, OFTEN NEGLECTING THE UNDERSTANDING AND CARE OF THE ROOT CAUSATIVE PATHWAYS OF THE DISEASES, IS AFFECTING BIOMEDICAL SCIENCE AS WELL. AGING BRINGS A RELEVANT BURDEN OF CHRONIC DEGENERATIVE DISEASES AND DISABILITIES, WITH RELEVANT SOCIO-ECONOMIC REPERCUSSIONS; THUS, A MAJOR ATTENTION TO COST-EFFECTIVENESS AND APPROPRIATENESS OF HEALTHCARE IS WARRANTED. IN THIS SCENARIO, COSTLY AND INNOVATIVE BUT RELATIVELY VALIDATED THERAPIES MAY TEND TO BE ADOPTED IN VENOUS AND LYMPHATIC DISEASES, SUCH AS VARICOSE VEINS, LEG VENOUS ULCER, POST-THROMBOTIC SYNDROME, PELVIC CONGESTION SYNDROME, AND LYMPHEDEMA. CONVERSELY, A MORE COMPREHENSIVE APPROACH TO THE BASIC PATHOPHYSIOLOGY OF CHRONIC VENOUS AND LYMPHATIC INSUFFICIENCY AND THE INCLUSION OF PHARMACOECONOMICS ANALYSES WOULD BENEFIT OVERALL PATIENTS' MANAGEMENT. ERRONEOUS LIFESTYLE AND NUTRITION, TOGETHER WITH CHRONIC STRESS-INDUCED SYNDROMES, SIGNIFICANTLY INFLUENCE CHRONIC DEGENERATIVE PHLEBO-LYMPHATIC DISEASES. THE MAIN ACTIVE EPIGENETIC SOCIO-BIOLOGIC FACTORS ARE OBESITY, DYSFUNCTIONS OF MUSCULO-RESPIRATORY-VASCULAR PUMPS, PRO-INFLAMMATORY NUTRITION, HYPERACTIVATION OF STRESS AXIS, AND SEDENTARISM. AN OVERALL CRITICAL VIEW OF THE SCIENTIFIC EVIDENCE AND INNOVATIONS IN PHEBOLYMPHOLOGY COULD BE OF HELP TO IMPROVE EFFICACY, SAFETY, AND SUSTAINABILITY OF CURRENT PRACTICE. TRANSLATIONAL AND INTEGRATIVE MEDICINE MAY CONTRIBUTE TO A PATIENT-CENTERED APPROACH. CONVERSELY, REDUCTIONISM, EMINENCE/REIMBURSEMENT-BASED DECISIONAL PROCESSES, PATIENTS' LACK OF EDUCATION, INDUSTRY-INFLUENCED SCIENCE, AND PHYSICIAN'S IMPROVABLE AWARENESS, MAY COMPROMISE EFFICACY, SAFETY, APPROPRIATENESS, AND COST-EFFECTIVENESS OF FUTURE DIAGNOSTIC AND THERAPEUTIC PATTERNS OF PHLEBOLOGY AND LYMPHOLOGY. 2020 16 380 37 AN EPIGENETIC PERSPECTIVE ON LIFESTYLE MEDICINE FOR DEPRESSION: IMPLICATIONS FOR PRIMARY CARE PRACTICE. DEPRESSION IS THE MOST COMMON PRESENTING MENTAL HEALTH DISORDER IN PRIMARY CARE. IT IS ALSO A MAJOR CONTRIBUTOR TO SOMATIC COMPLAINTS, WORSENING OF CHRONIC MEDICAL CONDITIONS, POOR QUALITY OF LIFE, AND SUICIDE. CURRENT PHARMACOLOGIC AND PSYCHOTHERAPEUTIC APPROACHES AVERT LESS THAN HALF OF DEPRESSION'S CUMULATIVE BURDEN ON SOCIETY. HOWEVER, THERE IS A GROWING BODY OF RESEARCH DESCRIBING BOTH HOW MALADAPTIVE LIFESTYLE CHOICES CONTRIBUTE TO THE DEVELOPMENT AND WORSENING OF DEPRESSION AND HOW LIFESTYLE-ORIENTED MEDICAL INTERVENTIONS CAN REDUCE THE INCIDENCE AND SEVERITY OF DEPRESSION. THIS RESEARCH, LARGELY DERIVED FROM AN EMERGING FIELD CALLED EPIGENETICS, ELUCIDATES THE INTERACTIONS BETWEEN OUR LIFESTYLE CHOICES AND THOSE EPIGENETIC FACTORS WHICH MEDIATE OUR TENDENCIES TOWARD EITHER HEALTH, OR THE ONSET, IF NOT WORSENING OF DISEASE. THE PRESENT REVIEW HIGHLIGHTS HOW LIFESTYLE CHOICES INVOLVING DIET, PHYSICAL ACTIVITY, SLEEP, SOCIAL RELATIONSHIPS, AND STRESS INFLUENCE EPIGENETIC PROCESSES POSITIVELY OR NEGATIVELY, AND THEREBY PLAY A SIGNIFICANT ROLE IN DETERMINING WHETHER ONE DOES OR DOES NOT SUFFER FROM DEPRESSION. THE AUTHORS PROPOSE THAT MEDICAL TRAINING PROGRAMS CONSIDER AND ADOPT LIFESTYLE MEDICINE ORIENTED INSTRUCTIONAL INITIATIVES THAT WILL ENABLE TOMORROW'S PRIMARY CARE PROVIDERS TO MORE EFFECTIVELY IDENTIFY AND THERAPEUTICALLY INTERVENE IN THE MALADAPTIVE CHOICES CONTRIBUTING TO THEIR PATIENTS' DEPRESSION. 2022 17 6282 40 THE POTENTIAL IMPACT OF SOCIAL GENOMICS ON WOUND HEALING. SIGNIFICANCE: HUMAN SKIN WOUNDS CARRY AN IMMENSE EPIDEMIOLOGIC AND FINANCIAL BURDEN, AND THEIR IMPACT WILL CONTINUE TO GROW WITH AN AGING POPULATION AND RISING INCIDENCE OF COMORBID CONDITIONS KNOWN TO AFFECT WOUND HEALING. TO COMPREHENSIVELY ADDRESS THIS GROWING CLINICAL ISSUE, PHYSICIANS SHOULD ALSO BE AWARE OF HOW CONDITIONS OF THE HUMAN SOCIAL ENVIRONMENT MAY AFFECT WOUND HEALING. HERE WE PROVIDE A REVIEW OF THE EMERGING FIELD OF SOCIAL GENOMICS AND ITS POTENTIAL IMPACT ON THE WOUND HEALING. RECENT ADVANCES: MULTIPLE STUDIES USING HUMAN AND ANIMAL MODELS HAVE CORRELATED SOCIAL INFLUENCES AND THEIR CONTRIBUTING EFFECTS TO ACUTE AND CHRONIC STRESS WITH DELAYS IN WOUND HEALING. FURTHERMORE, OBSERVATIONS BETWEEN NONGENETIC FACTORS SUCH AS NUTRITION, SOCIOECONOMIC, AND EDUCATIONAL STATUS HAVE ALSO SHOWN TO HAVE A DIRECT OR INDIRECT IMPACT ON CLINICAL OUTCOMES OF WOUND HEALING. CRITICAL ISSUES: NUTRITION, FINANCIAL BURDEN, SOCIOECONOMIC AND EDUCATION STATUS, AND ACUTE AND CHRONIC STRESS ARE VARIABLES THAT HAVE EITHER DIRECT (EPIGENETIC) OR INDIRECT IMPACT ON WOUND HEALING AND PATIENTS' QUALITY OF LIFE. WOUND CARE IS COSTLY AND REMAINS A CHALLENGE PLACING ECONOMIC BURDEN ON PATIENTS. FURTHERMORE, POOR CLINICAL OUTCOMES AND COMPLICATIONS INCLUDING LOSS OF MOBILITY AND DISABILITY MAY LEAD TO JOB LOSS, FURTHER CONTRIBUTING TO SOCIOECONOMIC RELATED STRESS. THUS, THE ECONOMIC BURDEN AND INADEQUATE WOUND HEALING ARE INTERTWINED, MAKING EACH OTHER WORSE. FUTURE DIRECTIONS: ALTHOUGH SOME EVIDENCE REGARDING THE SPECIFIC CHANGES IN GENETIC PATHWAYS IMPARTED BY CONDITIONS OF THE SOCIAL ENVIRONMENT EXISTS, FURTHER STUDIES ARE WARRANTED TO IDENTIFY POTENTIAL MECHANISMS, INTERVENTIONS, AND PREVENTION APPROACHES. 2020 18 4685 27 NEW TARGETS AND STRATEGIES FOR RHEUMATOID ARTHRITIS: FROM SIGNAL TRANSDUCTION TO EPIGENETIC ASPECT. RHEUMATOID ARTHRITIS (RA) IS A CHRONIC AUTOIMMUNE DISEASE THAT CAN LEAD TO JOINT DAMAGE AND EVEN PERMANENT DISABILITY, SERIOUSLY AFFECTING PATIENTS' QUALITY OF LIFE. AT PRESENT, THE COMPLETE CURE FOR RA IS NOT ACHIEVABLE, ONLY TO RELIEVE THE SYMPTOMS TO REDUCE THE PAIN OF PATIENTS. FACTORS SUCH AS ENVIRONMENT, GENES, AND SEX CAN INDUCE RA. PRESENTLY, NON-STEROIDAL ANTI-INFLAMMATORY DRUGS, DRMADS, AND GLUCOCORTICOIDS ARE COMMONLY USED IN TREATING RA. IN RECENT YEARS, SOME BIOLOGICAL AGENTS HAVE ALSO BEEN APPLIED IN CLINICAL PRACTICE, BUT MOST HAVE SIDE EFFECTS. THEREFORE, FINDING NEW MECHANISMS AND TARGETS FOR TREATING RA IS NECESSARY. THIS REVIEW SUMMARIZES SOME POTENTIAL TARGETS DISCOVERED FROM THE PERSPECTIVE OF EPIGENETICS AND RA MECHANISMS. 2023 19 264 25 ADVANCING ASTHMA CARE: THE GLASS IS ONLY HALF FULL! OVER THE PAST 20 YEARS, THERE HAS BEEN A CONCERTED EFFORT IN THE UNITED STATES TO REDUCE MORBIDITY RELATED TO CHRONIC DISEASE, INCLUDING ASTHMA. ATTENTION WAS INITIALLY DIRECTED TOWARD ASTHMA IN RESPONSE TO THE RECOGNITION THAT ASTHMA MORTALITY WAS INCREASING AND THAT THE BURDEN OF DISEASE WAS SIGNIFICANT. THESE EFFORTS TO ADDRESS ASTHMA MORTALITY LED TO MANY NEW INITIATIVES TO DEVELOP CLINICAL PRACTICE GUIDELINES, IMPLEMENT THE ASTHMA GUIDELINES INTO CLINICAL PRACTICE, CONDUCT RESEARCH TO FILL THE GAPS IN THE GUIDELINES, AND CONTINUOUSLY REVISE THE ASTHMA GUIDELINES AS MORE INFORMATION BECAME AVAILABLE. AN ASSESSMENT OF OUR PROGRESS SHOWS SIGNIFICANT ACCOMPLISHMENTS IN RELATION TO REDUCING ASTHMA MORTALITY AND HOSPITALIZATIONS. CONSEQUENTLY, WE ARE NOW AT A CROSSROADS IN ASTHMA CARE. ALTHOUGH WE HAVE RECOGNIZED SOME REMARKABLE ACCOMPLISHMENTS IN REDUCING ASTHMA MORTALITY AND MORBIDITY, THE AVAILABILITY OF NEW TOOLS TO MONITOR DISEASE ACTIVITY, INCLUDING BIOMARKERS AND EPIGENETIC MARKERS, ALONG WITH INFORMATION TECHNOLOGY SYSTEMS TO MONITOR ASTHMA CONTROL HOLD SOME PROMISE IN IDENTIFYING GAPS IN DISEASE MANAGEMENT. THESE ADVANCES SHOULD PROMPT THE EVOLUTION OF NEW STRATEGIES AND NEW TREATMENTS TO FURTHER REDUCE DISEASE BURDEN. IT NOW BECOMES IMPERATIVE TO CONTINUE A FOCUS ON WAYS TO FURTHER REDUCE THE BURDEN OF ASTHMA AND PREVENT ITS ONSET. 2011 20 4776 25 NUTRACEUTICAL ACTIVITY IN OSTEOARTHRITIS BIOLOGY: A FOCUS ON THE NUTRIGENOMIC ROLE. OSTEOARTHRITIS (OA) IS A DISEASE ASSOCIATED TO AGE OR CONDITIONS THAT PRECIPITATE AGING OF ARTICULAR CARTILAGE, A POST-MITOTIC TISSUE THAT REMAINS FUNCTIONAL UNTIL THE FAILURE OF MAJOR HOMEOSTATIC MECHANISMS. OA SEVERELY IMPACTS THE NATIONAL HEALTH SYSTEM COSTS AND PATIENTS' QUALITY OF LIFE BECAUSE OF PAIN AND DISABILITY. IT IS A WHOLE-JOINT DISEASE SUSTAINED BY INFLAMMATORY AND OXIDATIVE SIGNALING PATHWAYS AND MARKED EPIGENETIC CHANGES RESPONSIBLE FOR CATABOLISM OF THE CARTILAGE EXTRACELLULAR MATRIX. OA USUALLY PROGRESSES UNTIL ITS SEVERITY REQUIRES JOINT ARTHROPLASTY. TO DELAY THIS PROGRESSION AND TO IMPROVE SYMPTOMS, A WIDE RANGE OF NATURALLY DERIVED COMPOUNDS HAVE BEEN PROPOSED AND ARE SUMMARIZED IN THIS REVIEW. PRECLINICAL IN VITRO AND IN VIVO STUDIES HAVE PROVIDED PROOF OF PRINCIPLE THAT MANY OF THESE NUTRACEUTICALS ARE ABLE TO EXERT PLEIOTROPIC AND SYNERGISTIC EFFECTS AND EFFECTIVELY COUNTERACT OA PATHOGENESIS BY EXERTING BOTH ANTI-INFLAMMATORY AND ANTIOXIDANT ACTIVITIES AND BY TUNING MAJOR OA-RELATED SIGNALING PATHWAYS. THE LATTER ARE THE BASIS FOR THE NUTRIGENOMIC ROLE PLAYED BY SOME OF THESE COMPOUNDS, GIVEN THE MARKED CHANGES IN THE TRANSCRIPTOME, MIRNOME, AND METHYLOME. ONGOING AND FUTURE CLINICAL TRIALS WILL HOPEFULLY CONFIRM THE DISEASE-MODIFYING ABILITY OF THESE BIOACTIVE MOLECULES IN OA PATIENTS. 2020