1 4724 128 NONINVASIVE MULTIMODAL METHODS TO DIFFERENTIATE INFLAMED VS FIBROTIC STRICTURES IN PATIENTS WITH CROHN'S DISEASE. FIBROTIC STRICTURES OCCUR IN 30% OF PATIENTS WITH CROHN'S DISEASE (CD). HOWEVER, THERE ARE NO THERAPEUTIC AGENTS THAT PREVENT OR REVERSE FIBROTIC STRICTURES. STRICTURES ARE TREATED BY ENDOSCOPIC DILATATION PROCEDURES AND SURGICAL PROCEDURES, BUT THERE ARE HIGH RATES OF RECURRENCE. TWO ANTIFIBROTIC AGENTS (NINTEDANIB AND PIRFENIDONE) RECENTLY WERE APPROVED FOR THE TREATMENT OF IDIOPATHIC PULMONARY FIBROSIS AND INHIBITORS OF RHO-ASSOCIATED PROTEIN KINASES 1 AND 2 REVERSED FIBROSIS IN MICE WITH CHRONIC INTESTINAL INFLAMMATION. CROSS-SECTIONAL IMAGING TECHNIQUES, SUCH AS MAGNETIC RESONANCE (MR) ENTEROGRAPHY, COMPUTED TOMOGRAPHY ENTEROGRAPHY, AND BOWEL ULTRASOUND, ARE USED TO ASSESS SMALL-BOWEL AND CD-RELATED COMPLICATIONS, INCLUDING STRICTURES. IT IS IMPORTANT TO BE ABLE TO DETERMINE THE DEGREE OF INFLAMMATION AND FIBROSIS IN STRICTURES TO SELECT THE BEST THERAPY; THIS CAN BE A CHALLENGE BECAUSE INFLAMMATION AND FIBROSIS CO-EXIST TO VARYING DEGREES IN A DAMAGED BOWEL SEGMENT. DELAYED GADOLINIUM ENHANCEMENT, MAGNETIZATION TRANSFER MR IMAGING, AND ULTRASOUND ELASTOGRAPHY SEEM TO BE PROMISING TOOLS FOR ASSESSING FIBROSIS IN PATIENTS WITH CD. WE REVIEW NONINVASIVE TECHNIQUES FOR FIBROSIS ASSESSMENT, INCLUDING ANALYSES OF GENETIC, EPIGENETIC, AND PROTEIN MARKERS. WE DISCUSS THE POTENTIAL OF IMAGING TECHNIQUES SUCH AS DIFFUSION-WEIGHTED AND MAGNETIZATION TRANSFER MR IMAGING, STRAIN ELASTOGRAPHY, SHEAR-WAVE IMAGING, AND POSITRON EMISSION TOMOGRAPHY TO GUIDE THERAPEUTIC DECISIONS FOR PATIENTS WITH STRICTURING CD. 2019 2 5025 30 PERSONALIZED MANAGEMENT OF CARDIOVASCULAR DISORDERS. PERSONALIZED MANAGEMENT OF CARDIOVASCULAR DISORDERS (CVD), ALSO REFERRED TO AS PERSONALIZED OR PRECISION CARDIOLOGY IN ACCORDANCE WITH GENERAL PRINCIPLES OF PERSONALIZED MEDICINE, IS SELECTION OF THE BEST TREATMENT FOR AN INDIVIDUAL PATIENT. IT INVOLVES THE INTEGRATION OF VARIOUS "OMICS" TECHNOLOGIES SUCH AS GENOMICS AND PROTEOMICS AS WELL AS OTHER NEW TECHNOLOGIES SUCH AS NANOBIOTECHNOLOGY. MOLECULAR DIAGNOSTICS AND BIOMARKERS ARE IMPORTANT FOR LINKING DIAGNOSIS WITH THERAPY AND MONITORING THERAPY. BECAUSE CVD INVOLVE PERTURBATIONS OF LARGE COMPLEX BIOLOGICAL NETWORKS, A SYSTEMS BIOLOGY APPROACH TO CVD RISK STRATIFICATION MAY BE USED FOR IMPROVING RISK-ESTIMATING ALGORITHMS, AND MODELING OF PERSONALIZED BENEFIT OF TREATMENT MAY BE HELPFUL FOR GUIDING THE CHOICE OF INTERVENTION. BIOINFORMATICS TOOLS ARE HELPFUL IN ANALYZING AND INTEGRATING LARGE AMOUNTS OF DATA FROM VARIOUS SOURCES. PERSONALIZED THERAPY IS CONSIDERED DURING DRUG DEVELOPMENT, INCLUDING METHODS OF TARGETED DRUG DELIVERY AND CLINICAL TRIALS. INDIVIDUALIZED RECOMMENDATIONS CONSIDER MULTIPLE FACTORS - GENETIC AS WELL AS EPIGENETIC - FOR PATIENTS' RISK OF HEART DISEASE. EXAMPLES OF PERSONALIZED TREATMENT ARE THOSE OF CHRONIC MYOCARDIAL ISCHEMIA, HEART FAILURE, AND HYPERTENSION. SIMILAR APPROACHES CAN BE USED FOR THE MANAGEMENT OF ATRIAL FIBRILLATION AND HYPERCHOLESTEROLEMIA, AS WELL AS THE USE OF ANTICOAGULANTS. PERSONALIZED MANAGEMENT INCLUDES PHARMACOTHERAPY, SURGERY, LIFESTYLE MODIFICATIONS, AND COMBINATIONS THEREOF. FURTHER PROGRESS IN UNDERSTANDING THE PATHOMECHANISM OF COMPLEX CARDIOVASCULAR DISEASES AND IDENTIFICATION OF CAUSATIVE FACTORS AT THE INDIVIDUAL PATIENT LEVEL WILL PROVIDE OPPORTUNITIES FOR THE DEVELOPMENT OF PERSONALIZED CARDIOLOGY. APPLICATION OF PRINCIPLES OF PERSONALIZED MEDICINE WILL IMPROVE THE CARE OF THE PATIENTS WITH CVD. 2017 3 1200 23 CORTICOTROPIN RELEASING HORMONE AND IMAGING, RETHINKING THE STRESS AXIS. THE STRESS SYSTEM PROVIDES INTEGRATION OF BOTH NEUROCHEMICAL AND SOMATIC PHYSIOLOGIC FUNCTIONS WITHIN ORGANISMS AS AN ADAPTIVE MECHANISM TO CHANGING ENVIRONMENTAL CONDITIONS THROUGHOUT EVOLUTION. IN MAMMALS AND PRIMATES THE COMPLEXITY AND SOPHISTICATION OF THESE SYSTEMS HAVE SURPASSED OTHER SPECIES IN TRIAGING NEUROCHEMICAL AND PHYSIOLOGIC SIGNALING TO MAXIMIZE CHANCES OF SURVIVAL. CORTICOTROPIN RELEASING HORMONE (CRH) AND ITS RELATED PEPTIDES AND RECEPTORS HAVE BEEN IDENTIFIED OVER THE LAST THREE DECADES AND ARE FUNDAMENTAL MOLECULAR INITIATORS OF THE STRESS RESPONSE. THEY ARE CRUCIAL IN THE TOP DOWN REGULATORY CASCADE OVER A MYRIAD OF NEUROCHEMICAL, NEUROENDOCRINE AND SYMPATHETIC NERVOUS SYSTEM EVENTS. FROM NEUROSCIENCE, WE'VE SEEN THAT STRESS ACTIVATION IMPACTS BEHAVIOR, ENDOCRINE AND SOMATIC PHYSIOLOGY AND INFLUENCES NEUROCHEMICAL EVENTS THAT ONE CAN CAPTURE IN REAL TIME WITH CURRENT IMAGING TECHNOLOGIES. TO DELINEATE THESE EFFECTS ONE CAN DEMONSTRATE HOW THE CRH NEURONAL NETWORKS INFILTRATE CRITICAL COGNITIVE, EMOTIVE AND AUTONOMIC REGIONS OF THE CENTRAL NERVOUS SYSTEM (CNS) WITH SOMATIC EFFECTS. ABUNDANT PRECLINICAL AND CLINICAL STUDIES SHOW INTER-REGULATORY ACTIONS OF CRH WITH MULTIPLE NEUROTRANSMITTERS/PEPTIDES. STRESS, BOTH ACUTE AND CHRONIC HAS EPIGENETIC EFFECTS WHICH MAGNIFY GENETIC SUSCEPTIBILITIES TO ALTER NEUROCHEMISTRY; STRESS SYSTEM ACTIVATION CAN ADD CRITICAL VARIABLES IN DESIGN AND INTERPRETATION OF BASIC AND CLINICAL NEUROSCIENCE AND RELATED RESEARCH. THIS REVIEW WILL ATTEMPT TO PROVIDE AN OVERVIEW OF THE SPECTRUM OF KNOWN FUNCTIONS AND SPECULATIVE ACTIONS OF CRH AND STRESS RESPONSES IN LIGHT OF IMAGING TECHNOLOGY AND ITS INTERPRETATION. METABOLIC AND NEURORECEPTOR POSITRON EMISSION/SINGLE PHOTON TOMOGRAPHY (PET/SPECT), FUNCTIONAL MAGNETIC RESONANCE IMAGING (FMRI), ANATOMIC MRI, DIFFUSION TENSOR IMAGING (DTI), AND PROTON MAGNETIC RESONANCE SPECTROSCOPY (PMRS) ARE TECHNOLOGIES THAT CAN DELINEATE BASIC MECHANISMS OF NEUROPHYSIOLOGY AND PHARMACOLOGY. STRESS MODULATES THE MYRIAD OF NEUROCHEMICAL AND NETWORKS WITHIN AND CONTROLLED THROUGH THE CENTRAL AND PERIPHERAL NERVOUS SYSTEM AND THE EFFECTS OF STRESS ACTIVATION ON IMAGING WILL BE HIGHLIGHTED. 2015 4 728 34 CAN WE IDENTIFY PATIENTS WITH HIGH RISK OF OSTEOARTHRITIS PROGRESSION WHO WILL RESPOND TO TREATMENT? A FOCUS ON BIOMARKERS AND FRAILTY. OSTEOARTHRITIS (OA), A DISEASE AFFECTING DIFFERENT PATIENT PHENOTYPES, APPEARS AS AN OPTIMAL CANDIDATE FOR PERSONALIZED HEALTHCARE. THE AIM OF THE DISCUSSIONS OF THE EUROPEAN SOCIETY FOR CLINICAL AND ECONOMIC ASPECTS OF OSTEOPOROSIS AND OSTEOARTHRITIS (ESCEO) WORKING GROUP WAS TO EXPLORE THE VALUE OF MARKERS OF DIFFERENT SOURCES IN DEFINING DIFFERENT PHENOTYPES OF PATIENTS WITH OA. THE ESCEO ORGANIZED A SERIES OF MEETINGS TO EXPLORE THE POSSIBILITY OF IDENTIFYING PATIENTS WHO WOULD MOST BENEFIT FROM TREATMENT FOR OA, ON THE BASIS OF RECENT DATA AND EXPERT OPINION. IN THE FIRST MEETING, PATIENT PHENOTYPES WERE IDENTIFIED ACCORDING TO THE NUMBER OF AFFECTED JOINTS, BIOMECHANICAL FACTORS, AND THE PRESENCE OF LESIONS IN THE SUBCHONDRAL BONE. IN THE SECOND MEETING, SUMMARIZED IN THE PRESENT ARTICLE, THE WORKING GROUP EXPLORED OTHER MARKERS INVOLVED IN OA. PROFILES OF PATIENTS MAY BE DEFINED ACCORDING TO THEIR LEVEL OF PAIN, FUNCTIONAL LIMITATION, AND PRESENCE OF COEXISTENT CHRONIC CONDITIONS INCLUDING FRAILTY STATUS. A CONSIDERABLE AMOUNT OF DATA SUGGESTS THAT MAGNETIC RESONANCE IMAGING MAY ALSO ASSIST IN DELINEATING DIFFERENT PHENOTYPES OF PATIENTS WITH OA. AMONG MULTIPLE BIOCHEMICAL BIOMARKERS IDENTIFIED, NONE IS SUFFICIENTLY VALIDATED AND RECOGNIZED TO IDENTIFY PATIENTS WHO SHOULD BE TREATED. CONSIDERABLE EFFORTS ARE ALSO BEING MADE TO IDENTIFY GENETIC AND EPIGENETIC FACTORS INVOLVED IN OA, BUT RESULTS ARE STILL LIMITED. THE MANY POTENTIAL BIOMARKERS THAT COULD BE USED AS POTENTIAL STRATIFIERS ARE PROMISING, BUT MORE RESEARCH IS NEEDED TO CHARACTERIZE AND QUALIFY THE EXISTING BIOMARKERS AND TO IDENTIFY NEW CANDIDATES. 2015 5 1392 31 DIAGNOSTIC APPROACH TO PULMONARY HYPERTENSION IN PREMATURE NEONATES. BRONCHOPULMONARY DYSPLASIA (BPD) IS A FORM OF CHRONIC LUNG DISEASE IN PREMATURE INFANTS FOLLOWING RESPIRATORY DISTRESS AT BIRTH. WITH INCREASING SURVIVAL OF EXTREMELY LOW BIRTH WEIGHT INFANTS, ALVEOLAR SIMPLIFICATION IS THE DEFINING LUNG CHARACTERISTIC OF INFANTS WITH BPD, AND ALONG WITH PULMONARY HYPERTENSION, INCREASINGLY CONTRIBUTES TO BOTH RESPIRATORY MORBIDITY AND MORTALITY IN THESE INFANTS. GROWTH RESTRICTED INFANTS, INFANTS BORN TO MOTHERS WITH OLIGOHYDRAMNIOS OR FOLLOWING PROLONGED PRETERM RUPTURE OF MEMBRANES ARE AT PARTICULAR RISK FOR EARLY ONSET PULMONARY HYPERTENSION. ALTERED VASCULAR AND ALVEOLAR GROWTH PARTICULARLY IN CANALICULAR AND EARLY SACCULAR STAGES OF LUNG DEVELOPMENT FOLLOWING MECHANICAL VENTILATION AND OXYGEN THERAPY, RESULTS IN DEVELOPMENTAL LUNG ARREST LEADING TO BPD WITH PULMONARY HYPERTENSION (PH). EARLY RECOGNITION OF PH IN INFANTS WITH RISK FACTORS IS IMPORTANT FOR OPTIMAL MANAGEMENT OF THESE INFANTS. SCREENING TOOLS FOR EARLY DIAGNOSIS OF PH ARE EVOLVING; HOWEVER, ECHOCARDIOGRAPHY IS THE MAINSTAY FOR NON-INVASIVE DIAGNOSIS OF PH IN INFANTS. CARDIAC COMPUTED TOMOGRAPHY (CT) AND MAGNETIC RESONANCE ARE BEING USED AS IMAGING MODALITIES, HOWEVER THEIR ROLE IN IMPROVING OUTCOMES IN THESE PATIENTS IS UNCERTAIN. FOLLOW-UP OF INFANTS AT RISK FOR PH WILL HELP NOT ONLY IN EARLY DIAGNOSIS, BUT ALSO IN APPROPRIATE MANAGEMENT OF THESE INFANTS. AGGRESSIVE MANAGEMENT OF LUNG DISEASE, AVOIDANCE OF HYPOXEMIC EPISODES, AND OPTIMAL NUTRITION DETERMINE THE PROGRESSION OF PH, AS EPIGENETIC FACTORS MAY HAVE SIGNIFICANT EFFECTS, PARTICULARLY IN GROWTH-RESTRICTED INFANTS. INFANTS WITH DIAGNOSIS OF PH ARE MANAGED WITH PULMONARY VASODILATORS AND THOSE RESISTANT TO THERAPY NEED TO BE WORKED UP FOR THE PRESENCE OF CARDIO-VASCULAR ANOMALIES. THE MANAGEMENT OF INFANTS AND TODDLERS WITH PH, ESPECIALLY FOLLOWING PREMATURE BIRTH IS AN EMERGING FIELD. NONETHELESS, COMBINATION THERAPIES IN A MULTI-DISCIPLINARY SETTING IMPROVES OUTCOMES FOR THESE INFANTS. 2017 6 5792 30 STAGING IN BIPOLAR DISORDER: FROM THEORETICAL FRAMEWORK TO CLINICAL UTILITY. ILLNESS STAGING IS WIDELY UTILIZED IN SEVERAL MEDICAL DISCIPLINES TO HELP PREDICT COURSE OR PROGNOSIS, AND OPTIMIZE TREATMENT. STAGING MODELS IN PSYCHIATRY IN GENERAL, AND BIPOLAR DISORDER IN PARTICULAR, DEPEND ON THE PREMISE THAT PSYCHOPATHOLOGY MOVES ALONG A PREDICTABLE PATH: AN AT-RISK OR LATENCY STAGE, A PRODROME PROGRESSING TO A FIRST CLINICAL THRESHOLD EPISODE, AND ONE OR MORE RECURRENCES WITH THE POTENTIAL TO REVERT OR PROGRESS TO LATE OR END-STAGE MANIFESTATIONS. THE UTILITY AND VALIDITY OF A STAGING MODEL FOR BIPOLAR DISORDER DEPEND ON ITS LINKING TO CLINICAL OUTCOME, TREATMENT RESPONSE AND NEUROBIOLOGICAL MEASURES. THESE INCLUDE PROGRESSIVE BIOCHEMICAL, NEUROIMAGING AND COGNITIVE CHANGES, AND POTENTIALLY STAGE-SPECIFIC DIFFERENCES IN RESPONSE TO PHARMACOLOGICAL AND PSYCHOSOCIAL TREATMENTS. MECHANISTICALLY, STAGING MODELS IMPLY THE PRESENCE OF AN ACTIVE DISEASE PROCESS THAT, IF NOT REMEDIATED, CAN LEAD TO NEUROPROGRESSION, A MORE MALIGNANT DISEASE COURSE AND FUNCTIONAL DETERIORATION. BIOLOGICAL ELEMENTS THOUGHT TO BE OPERATIVE IN BIPOLAR DISORDER INCLUDE A GENETIC DIATHESIS, PHYSICAL AND PSYCHIC TRAUMA, EPIGENETIC CHANGES, ALTERED NEUROGENESIS AND APOPTOSIS, MITOCHONDRIAL DYSFUNCTION, INFLAMMATION, AND OXIDATIVE STRESS. MANY AVAILABLE AGENTS, SUCH AS LITHIUM, HAVE EFFECTS ON THESE TARGETS. STAGING MODELS ALSO SUGGEST THE UTILITY OF STAGE-SPECIFIC TREATMENT APPROACHES THAT MAY NOT ONLY TARGET SYMPTOM REDUCTION, BUT ALSO IMPEDE ILLNESS NEUROPROGRESSION. THESE TREATMENT APPROACHES RANGE FROM PREVENTION FOR AT-RISK INDIVIDUALS, TO EARLY INTERVENTION STRATEGIES FOR PRODROMAL AND NEWLY DIAGNOSED INDIVIDUALS, COMPLEX COMBINATION THERAPY FOR RAPIDLY RECURRENT ILLNESS, AND PALLIATIVE-TYPE APPROACHES FOR THOSE AT CHRONIC, LATE STAGES OF ILLNESS. THERE IS HOPE THAT PROMPT INITIATION OF POTENTIALLY DISEASE MODIFYING THERAPIES MAY PRECLUDE OR ATTENUATE THE COGNITIVE AND STRUCTURAL CHANGES SEEN IN THE LATER STAGES OF BIPOLAR DISORDER. THE AIMS OF THIS PAPER ARE TO: A) EXPLORE THE CURRENT LEVEL OF EVIDENCE SUPPORTING THE DESCRIPTIVE STAGING OF THE SYNDROMAL PATTERN OF BIPOLAR DISORDER; B) DESCRIBE PRELIMINARY ATTEMPTS AT VALIDATION; C) MAKE RECOMMENDATIONS FOR THE DIRECTION OF FURTHER STUDIES; AND D) PROVIDE A DISTILLATION OF THE POTENTIAL CLINICAL IMPLICATIONS OF STAGING IN BIPOLAR DISORDER WITHIN A BROADER TRANSDIAGNOSTIC FRAMEWORK. 2017 7 250 31 ADVANCED GLYCATION END PRODUCTS (AGES): BIOCHEMISTRY, SIGNALING, ANALYTICAL METHODS, AND EPIGENETIC EFFECTS. THE ADVANCED GLYCATION END PRODUCTS (AGES) ARE ORGANIC MOLECULES FORMED IN ANY LIVING ORGANISMS WITH A GREAT VARIETY OF STRUCTURAL AND FUNCTIONAL PROPERTIES. THEY ARE CONSIDERED ORGANIC MARKERS OF THE GLYCATION PROCESS. DUE TO THEIR GREAT HETEROGENEITY, THERE IS NO SPECIFIC TEST FOR THEIR OPERATIONAL MEASUREMENT. IN THIS REVIEW, WE HAVE UPDATED THE MOST COMMON CHROMATOGRAPHIC, COLORIMETRIC, SPECTROSCOPIC, MASS SPECTROMETRIC, AND SEROLOGICAL METHODS, TYPICALLY USED FOR THE DETERMINATION OF AGES IN BIOLOGICAL SAMPLES. WE HAVE DESCRIBED THEIR SIGNALING AND SIGNAL TRANSDUCTION MECHANISMS AND CELL EPIGENETIC EFFECTS. ALTHOUGH MASS SPECTROMETRIC ANALYSIS IS NOT WIDESPREAD IN THE DETECTION OF AGES AT THE CLINICAL LEVEL, THIS TECHNIQUE IS HIGHLY PROMISING FOR THE EARLY DIAGNOSIS AND THERAPEUTICS OF DISEASES CAUSED BY AGES. PROTOCOLS ARE AVAILABLE FOR HIGH-RESOLUTION MASS SPECTROMETRY OF GLYCATED PROTEINS ALTHOUGH THEY ARE CHARACTERIZED BY COMPLEX MACHINE MANAGEMENT. SIMPLER PROCEDURES ARE AVAILABLE ALTHOUGH MUCH LESS PRECISE THAN MASS SPECTROMETRY. AMONG THEM, IMMUNOCHEMICAL TESTS ARE VERY COMMON SINCE THEY ARE ABLE TO DETECT AGES IN A SIMPLE AND IMMEDIATE WAY. IN THESE YEARS, NEW METHODOLOGIES HAVE BEEN DEVELOPED USING AN IN VIVO NOVEL AND NONINVASIVE SPECTROSCOPIC METHODS. THESE METHODS ARE BASED ON THE MEASUREMENT OF AUTOFLUORESCENCE OF AGES. ANOTHER METHOD CONSISTS OF DETECTING AGES IN THE HUMAN SKIN TO DETECT CHRONIC EXPOSURE, WITHOUT THE INCONVENIENCE OF INVASIVE METHODS. THE AIM OF THIS REVIEW IS TO COMPARE THE DIFFERENT APPROACHES OF MEASURING AGES AT A CLINICAL PERSPECTIVE DUE TO THEIR STRICT ASSOCIATION WITH OXIDATIVE STRESS AND INFLAMMATION. 2020 8 3559 29 IMPACT OF CHRONIC CONDITIONS AND DEMENTIA IN RURAL WEST TEXAS: A HEALTHY AGING STUDY. ALZHEIMER'S DISEASE (AD) IS A DEVASTATING ILLNESS IN ELDERLY INDIVIDUALS, THAT CURRENTLY HAS NO KNOWN CURE. CAUSAL GENETIC FACTORS ONLY ACCOUNT FOR 1-2% OF AD PATIENTS. HOWEVER, OTHER CAUSAL FACTORS ARE STILL UNKNOWN FOR A MAJORITY OF AD PATIENTS. CURRENTLY, MULTIPLE FACTORS ARE IMPLICATED IN LATE-ONSET AD, INCLUDING UNHEALTHY DIET, PHYSICAL INACTIVITY, TRAUMATIC BRAIN INJURY, CHRONIC CONDITIONS, EPIGENETIC FACTORS, AND ENVIRONMENTAL EXPOSURES. ALTHOUGH CLINICAL SYMPTOMS OF DEMENTIA ARE COMMON TO ALL RACES AND ETHNIC GROUPS, CONDITIONS THAT LEAD TO DEMENTIA ARE DIFFERENT IN TERMS OF LIFESTYLE, GENETIC PROFILE, AND SOCIO-ECONOMIC CONDITIONS. INCREASING EVIDENCE ALSO SUGGESTS THAT SOME ELDERLY INDIVIDUALS AGE WITHOUT COGNITIVE IMPAIRMENTS IN THEIR 60-90S AS SEEN IN RURAL WEST TEXAS, WHILE SOME INDIVIDUALS PROGRESS WITH CHRONIC CONDITIONS AND COGNITIVE IMPAIRMENTS INTO THEIR 60S. TO UNDERSTAND THESE DISCRIMINATIONS, WE ASSESSED CURRENT LITERATURE ON DEMOGRAPHIC FEATURES OF HEALTH IN RURAL WEST TEXAS. THIS PAPER ALSO OUTLINES OUR INITIATED CLINICAL STUDY WITH A PURPOSE OF UNDERSTANDING THE FACTORS THAT ALLOW SOME INDIVIDUALS TO LIVE WITHOUT COGNITIVE IMPAIRMENTS AT THE AGE OF 60-90 YEARS, WHEREAS OTHERS DEVELOP DEFICITS IN COGNITIVE FUNCTION AROUND OR ABOVE 60 YEARS. OUR ONGOING STUDY HOPES TO DETERMINE THE FACTORS THAT DELAY AGING IN SOME INDIVIDUALS BY INVESTIGATING VARIOUS ASPECTS INCLUDING GENETICS, EPIGENETICS, ETHNICITY, BIOLOGY, CULTURE, AND LIFESTYLE. THIS WILL BE ACHIEVED BY GATHERING INFORMATION ABOUT PARTICIPANTS' ETHNOGRAPHIC PROFILES, COGNITIVE ASSESSMENTS, BLOOD-PROFILES, BRAIN SCANS, AND BLOOD-BASED GENOMIC ANALYSES IN RELATION TO LIFESTYLE. THE OUTCOMES OF OUR STUDY WILL PROVIDE INSIGHTS INTO HEALTHY AGING IN RURAL WEST TEXAS. 2022 9 5787 27 SPUTUM ANALYSIS: NON-INVASIVE EARLY LUNG CANCER DETECTION. LUNG CANCER IS THE LEADING CAUSE OF CANCER-RELATED DEATHS OVER THE WORLD, CHARACTERIZED BY A VERY HIGH MORTALITY RATE. MOLECULAR TECHNIQUE DEVELOPMENT TRIES TO FOCUS ON EARLY DETECTION OF CANCERS BY STUDYING MOLECULAR ALTERATIONS THAT CHARACTERIZE CANCER CELLS. WORLDWIDE LUNG CANCER RESEARCH HAS FOCUSED ON AN EVER-INCREASING NUMBER OF MOLECULAR ELEMENTS OF CARCINOGENESIS AT GENETIC, EPIGENETIC AND PROTEIN LEVELS. THE NON-INVASIVENESS IS THE CHARACTERISTIC THAT ALL CLINICAL TRIALS ON CANCER DETECTION SHOULD HAVE. ABNORMAL CHEST IMAGING AND/OR NON-SPECIFIC SYMPTOMS ARE INITIAL SIGNALS OF LUNG CANCER THAT APPEAR IN AN ADVANCED STAGE OF DISEASE. THIS FACT REPRESENTS THE CAUSE OF THE LOW 5-YEAR SURVIVAL RATE: OVER 90% OF PATIENTS DYING WITHIN 5 YEARS OF DIAGNOSIS. SINCE SMOKERS HAVE HIGHER QUANTITY OF SPUTUM CONTAINING EXFOLIATED CELLS FROM THE BRONCHIAL TREE, AND THE SPUTUM REPRESENTS THE MOST EASILY ACCESSIBLE BIOLOGICAL FLUID AND ITS COLLECTION IS NON-INVASIVE, ANALYSIS OF THIS SAMPLE REPRESENTS A GOOD AREA OF RESEARCH IN EARLY LUNG CANCER DIAGNOSIS. CONTINUED CIGARETTE SMOKING IS THE CAUSE OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD), WITH AN ESTIMATED ATTRIBUTABLE RISK FACTOR EXCEEDING 80% IN SMOKING AFFECTED INDIVIDUALS. LUNG CANCER IS FOUND IN 40-70% OF PATIENTS WITH COPD, PARTICULARLY IN SEVERE DISEASE, AND IT IS A COMMON CAUSE OF DEATH IN THESE PATIENTS. A LARGE PROSPECTIVE TRIAL OF ALMOST HALF A MILLION NON-SMOKERS SHOWED AS LUNG CANCER IS ALSO COMMON IN PATIENTS WITH COPD WHO HAVE NEVER SMOKED. THIS REVIEW DESCRIBES ISSUES RELATED TO EARLY LUNG CANCER SCREENING USING NON-INVASIVE METHODS. 2013 10 103 28 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 11 5175 20 PREDICTORS OF BIOLOGICAL AGE: THE IMPLICATIONS FOR WELLNESS AND AGING RESEARCH. AS HEALTHSPAN AND LIFESPAN RESEARCH BREAKTHROUGHS HAVE BECOME MORE COMMONPLACE, THE NEED FOR VALID, PRACTICAL MARKERS OF BIOLOGICAL AGE IS BECOMING INCREASINGLY PARAMOUNT. THE ACCESSIBILITY AND AFFORDABILITY OF BIOLOGICAL AGE PREDICTORS THAT CAN REVEAL INFORMATION ABOUT MORTALITY AND MORBIDITY RISK, AS WELL AS REMAINING YEARS OF LIFE, HAS PROFOUND CLINICAL AND RESEARCH IMPLICATIONS. IN THIS REVIEW, WE EXAMINE 5 GROUPS OF AGING BIOMARKERS CAPABLE OF PROVIDING ACCURATE BIOLOGICAL AGE ESTIMATIONS. THE UNIQUE CAPABILITIES OF THESE BIOMARKERS HAVE FAR REACHING IMPLICATIONS FOR THE TESTING OF BOTH PHARMACEUTICAL AND NON-PHARMACEUTICAL INTERVENTIONS DESIGNED TO SLOW OR REVERSE BIOLOGICAL AGING. ADDITIONALLY, THE ENHANCED VALIDITY AND AVAILABILITY OF THESE TOOLS MAY HAVE INCREASINGLY RELEVANT CLINICAL VALUE. THE AUTHORS OF THIS REVIEW EXPLORE THOSE IMPLICATIONS, WITH AN EMPHASIS ON LIFESTYLE MODIFICATION RESEARCH, AND PROVIDE AN OVERVIEW OF THE CURRENT EVIDENCE REGARDING 5 BIOLOGICAL AGE PREDICTOR CATEGORIES: TELOMERE LENGTH, COMPOSITE BIOMARKERS, DNA METHYLATION "EPIGENETIC CLOCKS," TRANSCRIPTIONAL PREDICTORS OF BIOLOGICAL AGE, AND FUNCTIONAL AGE PREDICTORS. 2021 12 4363 31 MIRNA AS MARKERS FOR THE DIAGNOSTIC SCREENING OF COLON CANCER. EARLY SCREENING FOR COLON CANCER (CC) ALLOWS FOR EARLY STAGE DIAGNOSIS OF THE MALIGNANCY AND POTENTIALLY REDUCES DISEASE MORTALITY AS THE CANCER IS MOST LIKELY CURABLE AT ITS EARLIEST STAGES. EARLY DETECTION WOULD BE DESIRABLE IF ACCURATE, PRACTICAL AND COST-EFFECTIVE DIAGNOSTIC MEASURES FOR THIS CANCER WERE AVAILABLE. MORTALITY AND MORBIDITY FROM CC REPRESENT A MAJOR HEALTH PROBLEM INVOLVING A MALIGNANT DISEASE THAT IS THEORETICALLY PREVENTABLE THROUGH SCREENING. CURRENT SCREENING METHODS (E.G., THE CONVENIENT AND INEXPENSIVE IMMUNOLOGICAL FECAL OCCULT BLOOD TEST, FOBTI, OBTAINED FROM PATIENTS' MEDICAL RECORDS) EITHER LACK SENSITIVITY AND REQUIRE DIETARY RESTRICTION, WHICH IMPEDES COMPLIANCE AND USE; ARE COSTLY (E.G., COLONOSCOPY), WHICH DECREASES COMPLIANCE; OR COULD RESULT IN MORTALITY. IN COMPARISON WITH THE FOBT TEST, A NON-INVASIVE SENSITIVE SCREEN FOR WHICH THERE IS NO REQUIREMENT FOR DIETARY RESTRICTION WOULD BE A MORE CONVENIENT TEST. COLORECTAL CANCER IS THE ONLY CANCER FOR WHICH COLONOSCOPY IS RECOMMENDED AS A SCREENING METHOD. ALTHOUGH COLONOSCOPY IS A RELIABLE SCREENING TOOL, THE INVASIVE NATURE, ABDOMINAL PAIN, POTENTIAL COMPLICATIONS AND HIGH COST HAVE HAMPERED THE APPLICATION OF THIS PROCEDURE WORLDWIDE. A SCREENING APPROACH USING THE STABLE MIRNA MOLECULES, WHICH ARE RELATIVELY NON-DEGRADABLE WHEN EXTRACTED FROM NON-INVASIVE STOOL AND SEMI-INVASIVE BLOOD SAMPLES BY COMMERCIALLY AVAILABLE KITS AND MANIPULATED THEREAFTER, WOULD BE PREFERABLE TO A TRANSCRIPTOMIC MRNA-, A MUTATION DNA-, AN EPIGENETIC- OR A PROTEOMIC-BASED TEST. THE APPROACH USES REVERSE TRANSCRIPTASE, MODIFIED REAL-TIME QUANTITATIVE PCR. ALTHOUGH EXOSOMAL RNA WOULD BE MISSED, USING A RESTRICTED EXTRACTION OF TOTAL RNA FROM STOOL OR BLOOD, A PARALLEL TEST COULD ALSO BE CARRIED OUT ON RNA OBTAINED FROM STOOL OR PLASMA SAMPLES, AND APPROPRIATE CORRECTIONS FOR EXSOSOMAL LOSS CAN BE MADE FOR ACCURATE AND QUANTITATIVE TEST RESULT. EVENTUALLY, A CHIP CAN BE DEVELOPED TO FACILITATE DIAGNOSIS, AS HAS BEEN DONE FOR THE QUANTIFICATION OF GENETICALLY MODIFIED ORGANISMS IN FOODS. THE GOLD STANDARD TO WHICH THE MOLECULAR MIRNA TEST IS COMPARED IS COLONOSCOPY, WHICH CAN BE OBTAINED FROM PATIENTS' MEDICAL RECORDS. IF PERFORMANCE CRITERIA ARE MET, AS DETAILED HEREIN, A MIRNA TEST IN HUMAN STOOL OR BLOOD SAMPLES BASED ON HIGH-THROUGHPUT AUTOMATED TECHNOLOGIES AND QUANTITATIVE EXPRESSION MEASUREMENTS COMMONLY USED IN THE DIAGNOSTIC CLINICAL LABORATORY SHOULD BE ADVANCED TO THE CLINICAL SETTING, WHICH WILL MAKE A SIGNIFICANT IMPACT ON CC PREVENTION. 2014 13 30 29 A BRIEF LOOK AT HASHIMOTO'S DISEASE, ADRENAL INCIDENTALOMAS, OBESITY AND INSULIN RESISTANCE-COULD ENDOCRINE DISRUPTORS BE THE OTHER SIDE OF THE SAME COIN? HASHIMOTO'S DISEASE (HD) IS THE MOST COMMON CAUSE OF HYPOTHYROIDISM IN DEVELOPED COUNTRIES. THE EXACT PATHOMECHANISM BEHIND IT HAS NOT BEEN CLEARLY ESTABLISHED; HOWEVER, AN INTERPLAY OF GENETIC SUSCEPTIBILITY, ENVIRONMENTAL TRIGGERS (INCLUDING DIET) AND EPIGENETIC FACTORS SEEMS TO BE INVOLVED. AMONG THE LATTER, INCREASINGLY MORE ATTENTION HAS BEEN PAID TO SOME HORMONALLY ACTIVE SUBSTANCES, KNOWN AS ENDOCRINE DISRUPTORS, WHICH ARE COMMONLY USED WORLDWIDE. HD HAS BECOME A CONDITION WIDELY REPORTED IN THE MEDIA, ACTING AS A CULPRIT FOR INEXPLICABLE WEIGHT GAIN, CHRONIC FATIGUE OR WEAKNESS. NEVERTHELESS, THE RECOGNITION OF HD IS UNDENIABLY INCREASING AND REPRESENTS A MAJOR PUBLIC HEALTH BURDEN. AT THE SAME TIME, IMPROVING ACCESS TO IMAGING TESTS HAS INCREASED THE NUMBER OF INCIDENTALLY DIAGNOSED ADRENAL TUMORS. ABOVE ALL, THE WIDESPREAD USE OF CHEST COMPUTED TOMOGRAPHY (CT) DUE TO THE COVID-19 PANDEMIC HAS CONTRIBUTED TO FREQUENT INCIDENTAL DETECTION OF ADRENAL LESIONS. FORTUNATELY, A VAST MAJORITY OF THESE FINDINGS ARE ASYMPTOMATIC BENIGN TUMORS WITH NO EXCESSIVE HORMONAL ACTIVITY, AND THEREFORE, THEY ARE DEFINED AS ADRENAL INCIDENTALOMAS (AIS). INTERESTINGLY, RECENT STUDIES HAVE INDICATED THAT PATIENTS WITH AIS ARE MORE PRONE TO OBESITY AND INSULIN RESISTANCE. ALTHOUGH MUTUAL RELATIONSHIPS BETWEEN THE THYROID AND THE ADRENAL GLANDS HAVE BEEN STUDIED WIDELY, STILL, LITTLE IS KNOWN ABOUT THE POSSIBLE PATHOPHYSIOLOGICAL ASSOCIATIONS BETWEEN THYROID AUTOIMMUNITY AND THE OCCURRENCE OF ADRENAL INCIDENTALOMAS. THIS ARTICLE PRESENTS A BRIEF REVIEW OF THE COMMON ENDOCRINE DISORDERS WITH A SPECIAL FOCUS ON THE FREQUENTLY COEXISTING INSULIN RESISTANCE AND/OR OBESITY. FURTHERMORE, IN RESPONSE TO THE RECENT GROWING INTEREST IN ENDOCRINE DISRUPTORS, WITH THEIR TRANSGENERATIONAL EPIGENETIC EFFECTS THAT INFLUENCE HORMONAL SYSTEM FUNCTION, A CONCISE OVERVIEW OF THE TOPIC HAS ALSO BEEN INCLUDED. 2023 14 1737 32 EARLY DETECTION OF ACCELERATED AGING AND CELLULAR DECLINE (AACD): A CONSENSUS STATEMENT. THE CELLULAR HALLMARKS OF ACCELERATED AGING AND THEIR CLINICAL EXPRESSION MAY BE GROUPED USING THE TERMS 'ACCELERATED AGING AND CELLULAR DECLINE' (AACD) AND/OR 'AGE-ASSOCIATED CELLULAR DECLINE'. THIS CONSTRUCT IS DESIGNED TO CAPTURE THE BIOLOGICAL BACKGROUND PREDISPOSING THE DEVELOPMENT OF AGE-RELATED CONDITIONS. BY CLASSIFYING RISK FACTORS, EARLY INDICATORS, AND CLINICAL DIFFERENTIATORS OF AACD THROUGH EXPERT CONSENSUS, THIS STUDY AIMED TO IDENTIFY THE SIGNS, SYMPTOMS, AND MARKERS INDICATIVE OF AACD. IN DOING SO, THIS WORK PAVES THE WAY FOR FUTURE IMPLEMENTATION OF THE AACD CONCEPT IN THE CLINICAL AND RESEARCH SETTINGS. AN INTERDISCIPLINARY PANEL OF EXPERTS WITH CLINICAL AND RESEARCH EXPERTISE WAS SELECTED TO PARTICIPATE IN A VIRTUAL WORKSHOP TO DISCUSS AACD. A MODIFIED NOMINAL GROUP TECHNIQUE WAS USED TO ESTABLISH CONSENSUS AMONG THE GROUP. AN EXTENDED GROUP OF INTERNATIONAL EXPERTS CRITICALLY REVIEWED AN EARLY DRAFT OF THE MANUSCRIPT, AND THEIR FEEDBACK WAS THEN INCORPORATED INTO THE MODEL. EXPERTS IDENTIFIED 13 FACTORS PREDISPOSING TO OR CLINICALLY MANIFESTING AACD. AMONG THESE, CHRONIC DISEASES, OBESITY, AND UNFAVORABLE GENETIC BACKGROUND WERE CONSIDERED AS THE MOST IMPORTANT. THERE WAS A CONSENSUS THAT A GRADUAL AND NONSPECIFIC DEVELOPMENT OFTEN CHARACTERIZES AACD, MAKING ITS CLINICAL DETECTION POTENTIALLY CHALLENGING. IN ADDITION, SIGNS AND SYMPTOMS MIGHT HAVE MULTIFACTORIAL CAUSES AND OVERLAPPING ORIGINS, SUCH AS GENETIC AND EPIGENETIC PREDISPOSITIONS. AS A RESULT, AN INITIAL CHECKLIST WAS OUTLINED, LISTING CLINICAL FACTORS OF SPECIAL RELEVANCE (E.G., FATIGUE, LOW QUALITY OF SLEEP, AND LOW MOOD) TO REPRESENT EARLY MANIFESTATIONS OF THE ORGANISM'S EXHAUSTION, WHICH ARE ALSO FREQUENTLY NEGLECTED IN THE CLINICAL SETTING. DIFFERENTIATING AACD FROM OTHER CONDITIONS IS ESSENTIAL. THE USE OF A COMBINATION OF BIOMARKERS WAS PROPOSED AS A VIABLE METHOD IN A TWO-STEP PROCESS OF DIFFERENTIATION: 1) IDENTIFICATION OF EARLY AACD CLINICAL INDICATORS, FOLLOWED BY 2) SYMPTOM AND BIOMARKER CONFIRMATION WITH A FOCUS ON SYSTEM DOMAINS (TO BE POTENTIALLY TARGETED BY FUTURE SPECIFIC INTERVENTIONS). ALTHOUGH THE AACD CONSTRUCT IS NOT YET READY FOR ROUTINE USE IN CLINICAL PRACTICE, ITS OPERATIONALIZATION MAY SUPPORT THE EARLY IDENTIFICATION OF AGE-RELATED CONDITIONS (WHEN THIS MIGHT STILL BE AMENABLE TO REVERSION) AND ALSO ENCOURAGE PREVENTATIVE INTERVENTIONS. FURTHER INVESTIGATION IS NEEDED TO ESTABLISH SPECIFIC BIOMARKERS THAT CONFIRM INDEPENDENT RISK FACTORS FOR AACD AND PROVIDE A MORE DEFINITIVE STRUCTURE TO THE CONCEPT OF AACD (AND AGE-ASSOCIATED CELLULAR DECLINE). 2021 15 734 26 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 16 5039 30 PHARMACOGENETICS OF CHRONIC PAIN MANAGEMENT. OBJECTIVE: THE EXPERIENCE OF CHRONIC PAIN IS ONE OF THE COMMONEST REASONS INDIVIDUALS SEEK MEDICAL ATTENTION, MAKING THE MANAGEMENT OF CHRONIC PAIN A MAJOR ISSUE IN CLINICAL PRACTICE. DRUG METABOLISM AND RESPONSES ARE AFFECTED BY MANY FACTORS, WITH GENETIC VARIATIONS OFFERING ONLY A PARTIAL EXPLANATION OF AN INDIVIDUAL'S RESPONSE. THERE IS A PAUCITY OF EVIDENCE FOR THE BENEFITS OF PHARMACOGENETIC TESTING IN THE CONTEXT OF PAIN MANAGEMENT. DESIGN AND METHODS: WE REVIEWED THE LITERATURE BETWEEN 2000 AND 2013, AND REFERENCES CITED THEREIN, USING VARIOUS KEYWORDS RELATED TO PAIN MANAGEMENT, PHARMACOLOGY AND PHARMACOGENETICS. RESULTS: OPIOIDS CONTINUE TO BE THE MAINSTAY OF CHRONIC PAIN MANAGEMENT. SEVERAL NON-OPIOID BASED THERAPIES, SUCH AS TREATMENT WITH CANNABINOIDS, GENE THERAPY AND EPIGENETIC-BASED APPROACHES ARE NOW AVAILABLE FOR THESE PATIENTS. ADJUVANT THERAPIES WITH ANTIDEPRESSANTS, BENZODIAZEPINES OR ANTICONVULSANTS CAN ALSO BE USEFUL IN MANAGING PAIN. CURRENTLY, LABORATORY MONITORING OF PAIN MANAGEMENT PATIENTS, IF PERFORMED, IS LARGELY THROUGH URINE DRUG MEASUREMENTS. CONCLUSIONS: DRUG HALF-LIFE CALCULATIONS CAN BE USED AS FUNCTIONAL MARKERS OF THE CUMULATIVE EFFECT OF PHARMACOGENETICS AND DRUG-DRUG INTERACTIONS. ASSESSMENT OF HALF-LIFE AND THERAPEUTIC EFFECTS MAY BE MORE USEFUL THAN GENETIC TESTING IN PREVENTING ADVERSE DRUG REACTIONS TO PAIN MEDICATIONS, WHILE ENSURING EFFECTIVE ANALGESIA. DEFINITIVE, MASS SPECTROMETRY-BASED METHODS, CAPABLE OF MEASURING PARENT DRUG AND METABOLITE LEVELS, ARE THE MOST USEFUL ASSAYS FOR THIS PURPOSE. URINE DRUG MEASUREMENTS DO NOT NECESSARILY CORRELATE WITH SERUM DRUG CONCENTRATIONS OR THERAPEUTIC EFFECTS. THEREFORE, THEY ARE LIMITED IN THEIR USE IN MONITORING EFFICACY AND TOXICITY. 2014 17 5161 27 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 18 1314 28 DELINEATING CONDITIONS AND SUBTYPES IN CHRONIC PAIN USING NEUROIMAGING. DIFFERENTIATING SUBTYPES OF CHRONIC PAIN STILL REMAINS A CHALLENGE-BOTH FROM A SUBJECTIVE AND OBJECTIVE POINT OF VIEW. PERSONALIZED MEDICINE IS THE CURRENT GOAL OF MODERN MEDICAL CARE AND IS LIMITED BY THE SUBJECTIVE NATURE OF PATIENT SELF-REPORTING OF SYMPTOMS AND BEHAVIORAL EVALUATION. PHYSIOLOGY-FOCUSED TECHNIQUES SUCH AS GENOME AND EPIGENETIC ANALYSES INFORM THE DELINEATION OF PAIN GROUPS; HOWEVER, EXCEPT UNDER RARE CIRCUMSTANCES, THEY HAVE DILUTED EFFECTS THAT AGAIN, SHARE A COMMON RELIANCE ON BEHAVIORAL EVALUATION. THE APPLICATION OF STRUCTURAL NEUROIMAGING TOWARDS DISTINGUISHING PAIN SUBTYPES IS A GROWING FIELD AND MAY INFORM PAIN-GROUP CLASSIFICATION THROUGH THE ANALYSIS OF BRAIN REGIONS SHOWING HYPERTROPHIC AND ATROPHIC CHANGES IN THE PRESENCE OF PAIN. ANALYTICAL TECHNIQUES SUCH AS MACHINE-LEARNING CLASSIFIERS HAVE THE CAPACITY TO PROCESS LARGE VOLUMES OF DATA AND DELINEATE DIAGNOSTICALLY RELEVANT INFORMATION FROM NEUROIMAGING ANALYSIS. THE ISSUE OF DEFINING A "BRAIN TYPE" IS AN EMERGING FIELD AIMED AT INTERPRETING OBSERVED BRAIN CHANGES AND DELINEATING THEIR CLINICAL IDENTITY/SIGNIFICANCE. IN THIS REVIEW, 2 CHRONIC PAIN CONDITIONS (MIGRAINE AND IRRITABLE BOWEL SYNDROME) WITH SIMILAR CLINICAL PHENOTYPES ARE COMPARED IN TERMS OF THEIR STRUCTURAL NEUROIMAGING FINDINGS. INDEPENDENT INVESTIGATIONS ARE COMPARED WITH FINDINGS FROM APPLICATION OF MACHINE-LEARNING ALGORITHMS. FINDINGS ARE DISCUSSED IN TERMS OF DIFFERENTIATING PATIENT SUBGROUPS USING NEUROIMAGING DATA IN PATIENTS WITH CHRONIC PAIN AND HOW THEY MAY BE APPLIED TOWARDS DEFINING A PERSONALIZED PAIN SIGNATURE THAT HELPS SEGREGATE PATIENT SUBGROUPS (EG, MIGRAINE WITH AND WITHOUT AURA, WITH OR WITHOUT NAUSEA; IRRITABLE BOWEL SYNDROME VS OTHER FUNCTIONAL GASTROINTESTINAL DISORDERS). 2019 19 367 25 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 20 1037 12 CLASSIFICATION AND DIAGNOSIS OF TEMPOROMANDIBULAR DISORDERS AND TEMPOROMANDIBULAR DISORDER PAIN. DESIGNING CLASSIFICATION SYSTEMS AND DEVELOPING DIAGNOSTIC CRITERIA FOR TEMPOROMANDIBULAR DISORDERS IS DIFFICULT. AN APPRECIATION OF THE UTILITY AND APPLICABILITY OF THESE ENTITIES REQUIRES AN UNDERSTANDING OF THE IMPORTANCE OF EACH, THE DIFFERENCES BETWEEN THE TWO, AND HOW THEY MAY BE OPTIMALLY OPERATIONALIZED FOR BOTH CLINICAL AND RESEARCH ACTIVITIES IN LIGHT OF THEIR INHERENT ADVANTAGES AND LIMITATIONS. IN ADDITION, CONSIDERATION FOR ADOPTING NEWER APPROACHES, SUCH AS FOLLOWING ONTOLOGICAL AND PRECISION-BASED MEDICINE PRINCIPLES, ACCOUNTING FOR GENETICS/EPIGENETIC AND NEUROBIOLOGICAL FACTORS, AND THE INCLUSION OF BIOMARKERS WILL POTENTIALLY RESULT IN MORE THOROUGH AND COMPREHENSIVE CLASSIFICATION SYSTEMS AND DIAGNOSTIC CRITERIA. 2023