1  2378 105 EPIGENETIC REGULATION OF VASCULAR SMOOTH MUSCLE CELL PHENOTYPE SWITCHING IN ATHEROSCLEROTIC ARTERY REMODELING: A MINI-REVIEW. ATHEROSCLEROSIS IS A CHRONIC INFLAMMATORY DISEASE CHARACTERIZED BY EXTENSIVE REMODELING OF MEDIUM AND LARGE-SIZED ARTERIES. INWARD REMODELING (=LUMEN SHRINKAGE) OF THE VASCULAR WALLS IS THE UNDERLYING CAUSE FOR ISCHEMIA IN TARGET ORGANS. THEREFORE, INWARD REMODELING CAN BE CONSIDERED THE PREDOMINANT FEATURE OF ATHEROSCLEROTIC PATHOLOGY. OUTWARD REMODELING (=LUMEN ENLARGEMENT) IS A PHYSIOLOGICAL RESPONSE COMPENSATING FOR LUMEN SHRINKAGE CAUSED BY NEOINTIMAL HYPERPLASIA, BUT AS A PATHOLOGICAL RESPONSE TO CHANGES IN BLOOD FLOW, OUTWARD REMODELING LEADS TO SUBSTANTIAL ARTERIAL WALL THINNING. THINNED VASCULAR WALLS ARE PRONE TO RUPTURE, AND SUBSEQUENT THROMBUS FORMATION ACCOUNTS FOR THE MAJORITY OF ACUTE CARDIOVASCULAR EVENTS. PATHOLOGICAL REMODELING IS DRIVEN BY INFLAMMATORY CELLS WHICH INDUCE VASCULAR SMOOTH MUSCLE CELLS TO SWITCH FROM QUIESCENT TO A PROLIFERATIVE AND MIGRATORY PHENOTYPE. AFTER DECADES OF INTENSIVE RESEARCH, THE MOLECULAR MECHANISMS OF ARTERIAL REMODELING ARE STARTING TO UNFOLD. IN THIS MINI-REVIEW, WE SUMMARIZE THE CURRENT KNOWLEDGE OF THE EPIGENETIC AND TRANSCRIPTIONAL REGULATION OF VASCULAR SMOOTH MUSCLE CELL PHENOTYPE SWITCHING FROM THE CONTRACTILE TO THE SYNTHETIC PHENOTYPE INVOLVED IN ARTERIAL REMODELING AND DISCUSS POTENTIAL THERAPEUTIC OPTIONS.	2021	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
2  4651  28 NEUROPROGRESSION IN SCHIZOPHRENIA: PATHWAYS UNDERPINNING CLINICAL STAGING AND THERAPEUTIC COROLLARIES. OBJECTIVE: WHILST DOPAMINERGIC DYSFUNCTION REMAINS A NECESSARY COMPONENT INVOLVED IN THE PATHOGENESIS OF SCHIZOPHRENIA, OUR CURRENT PHARMACOLOGICAL ARMOURY OF DOPAMINE ANTAGONISTS DOES LITTLE TO CONTROL THE NEGATIVE SYMPTOMS OF SCHIZOPHRENIA. THIS SUGGESTS OTHER PATHOLOGICAL PROCESSES MUST BE IMPLICATED. THIS PAPER AIMS TO ELABORATE ON SUCH THEORIES. METHODS: DATA FOR THIS REVIEW WERE SOURCED FROM THE ELECTRONIC DATABASE PUBMED, AND WAS NOT LIMITED BY LANGUAGE OR DATE OF PUBLICATION. RESULTS: IT HAS BEEN SUGGESTED THAT MULTIPLE 'HITS' MAY BE REQUIRED TO UNVEIL THE CLINICAL SYNDROME IN SUSCEPTIBLE INDIVIDUALS. SUCH HITS POTENTIALLY FIRST OCCUR IN UTERO, LEADING TO NEURONAL DISRUPTION, EPIGENETIC CHANGES AND THE ESTABLISHMENT OF AN ABNORMAL INFLAMMATORY RESPONSE. THE DEVELOPMENT OF SCHIZOPHRENIA MAY THEREFORE POTENTIALLY BE VIEWED AS A NEUROPROGRESSIVE RESPONSE TO THESE EARLY STRESSORS, DRIVEN ON BY CHANGES IN TRYPTOPHAN CATABOLITE (TRYCAT) METABOLISM, REACTIVE OXYGEN SPECIES HANDLING AND N-METHYL D-ASPARTATE (NMDA) CIRCUITRY. GIVEN THE POTENTIAL FOR SUCH PROGRESSION OVER TIME, IT IS PRUDENT TO EXPLORE THE NEW TREATMENT STRATEGIES WHICH MAY BE IMPLEMENTED BEFORE SUCH CHANGES BECOME ESTABLISHED. CONCLUSIONS: OUTSIDE OF THE DOPAMINERGIC MODEL, THE POTENTIAL PATHOGENESIS OF SCHIZOPHRENIA HAS YET TO BE FULLY ELUCIDATED, BUT COMMON THEMES INCLUDE NEUROPIL SHRINKAGE, THE DEVELOPMENT OF ABNORMAL NEURONAL CIRCUITRY, AND A CHRONIC INFLAMMATORY STATE WHICH FURTHER DISRUPTS NEURONAL FUNCTION. WHILST SOME EARLY NON-DOPAMINERGIC TREATMENTS SHOW PROMISE, NONE HAVE YET TO BE FULLY STUDIED IN APPROPRIATELY STRUCTURED RANDOMIZED CONTROLLED TRIALS AND THEY REMAIN LITTLE MORE THAN POTENTIAL ATTRACTIVE TARGETS.	2014	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
3    50  19 A DEEP LEARNING MODEL FOR EARLY RISK PREDICTION OF HEART FAILURE WITH PRESERVED EJECTION FRACTION BY DNA METHYLATION PROFILES COMBINED WITH CLINICAL FEATURES. BACKGROUND: HEART FAILURE WITH PRESERVED EJECTION FRACTION (HFPEF), AFFECTED COLLECTIVELY BY GENETIC AND ENVIRONMENTAL FACTORS, IS THE COMMON SUBTYPE OF CHRONIC HEART FAILURE. ALTHOUGH THE AVAILABLE RISK ASSESSMENT METHODS FOR HFPEF HAVE ACHIEVED SOME PROGRESS, THEY WERE BASED ON CLINICAL OR GENETIC FEATURES ALONE. HERE, WE HAVE DEVELOPED A DEEP LEARNING FRAMEWORK, HFMERISK, USING BOTH 5 CLINICAL FEATURES AND 25 DNA METHYLATION LOCI TO PREDICT THE EARLY RISK OF HFPEF IN THE FRAMINGHAM HEART STUDY COHORT. RESULTS: THE FRAMEWORK INCORPORATES LEAST ABSOLUTE SHRINKAGE AND SELECTION OPERATOR AND EXTREME GRADIENT BOOSTING-BASED FEATURE SELECTION, AS WELL AS A FACTORIZATION-MACHINE BASED NEURAL NETWORK-BASED RECOMMENDER SYSTEM. MODEL DISCRIMINATION AND CALIBRATION WERE ASSESSED USING THE AUC AND HOSMER-LEMESHOW TEST. HFMERISK, INCLUDING 25 CPGS AND 5 CLINICAL FEATURES, HAVE ACHIEVED THE AUC OF 0.90 (95% CONFIDENCE INTERVAL 0.88-0.92) AND HOSMER-LEMESHOW STATISTIC WAS 6.17 (P = 0.632), WHICH OUTPERFORMED MODELS WITH CLINICAL CHARACTERISTICS OR DNA METHYLATION LEVELS ALONE, PUBLISHED CHRONIC HEART FAILURE RISK PREDICTION MODELS AND OTHER BENCHMARK MACHINE LEARNING MODELS. OUT OF THEM, THE DNA METHYLATION LEVELS OF TWO CPGS WERE SIGNIFICANTLY CORRELATED WITH THE PAIRED TRANSCRIPTOME LEVELS (R < -0.3, P < 0.05). BESIDES, DNA METHYLATION LOCUS IN HFMERISK WERE ASSOCIATED WITH INTERCELLULAR SIGNALING AND INTERACTION, AMINO ACID METABOLISM, TRANSPORT AND ACTIVATION AND THE CLINICAL VARIABLES WERE ALL RELATED WITH THE MECHANISM OF OCCURRENCE OF HFPEF. TOGETHER, THESE FINDINGS GIVE NEW EVIDENCE INTO THE HFMERISK MODEL. CONCLUSION: OUR STUDY PROPOSES AN EARLY RISK ASSESSMENT FRAMEWORK FOR HFPEF INTEGRATING BOTH CLINICAL AND EPIGENETIC FEATURES, PROVIDING A PROMISING PATH FOR CLINICAL DECISION MAKING.	2022	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
4  6843  20 [MEDICAL APPLICATIONS OF GENOME DISCOVERY]. THE DISCOVERY OF THE COMPLETE BASE SEQUENCE OF HUMAN GENOME UNVEILS SEVERAL PERSPECTIVES TO UNDERSTAND HUMAN DISEASES AND DEVELOP NEW THERAPIES. HUMAN GENOME CONTAINS APPROXIMATELY 39,000 GENES OF WHICH 26,000 CODE SPECIFIC PROTEINS THAT HAVE BEEN IDENTIFIED. THERE ARE APPROXIMATELY 1,500 DISEASES WITH IDENTIFIED MOLECULAR DISTURBANCES. GENES CAN MODIFY SIGNS AND SYMPTOMS OF COMMON DISEASES. THUS, THERE ARE NO PURE MONOGENIC DISEASES. CHRONIC DISEASES OF ADULTS ARE COMPLEX AND DEPENDENT ON MULTIPLE FACTORS. SEVERAL GENES THAT PREDISPOSE TO CHRONIC DEGENERATIVE DISEASES HAVE BEEN IDENTIFIED. THIS IS REVEALING THE COMPLEX NATURE AND THE INTERACTION OF THESE AILMENTS WITH THE ENVIRONMENT. THE DISCOVERY OF BACTERIAL AND VIRAL GENOMIC SEQUENCES WILL ALLOW THE MANUFACTURING OF NEW VACCINES AND SPECIFIC MOLECULAR ANTIMICROBIALS. THE NEW PHARMACOGENOMICS WILL DEVISE TREATMENTS FOR EACH SUBJECT ACCORDING TO HER SPECIFIC GENOMIC PROFILE. THE NEW APPLICATIONS OF GENOMIC TECHNOLOGY IS CREATING NEW PARADIGMS IN BIOMEDICAL RESEARCH SUCH AS FUNCTIONAL GENOMICS, PROTEONOMICS, EPIGENETIC REGULATION. GENE DIAGNOSIS AND THERAPY WILL CONSIDERABLY IMPROVE THE FUTURE OF MEDICINE.	2001	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
5  6410  24 THE SIGNATURE OF HBV-RELATED LIVER DISEASE IN PERIPHERAL BLOOD MONONUCLEAR CELL DNA METHYLATION. BACKGROUND: HEPATITIS B VIRUS (HBV)-RELATED LIVER DISEASE INDUCES LIVER DAMAGE BY HEPATIC IMMUNE AND INFLAMMATORY RESPONSE. THE ASSOCIATION BETWEEN ABERRANT PERIPHERAL BLOOD MONONUCLEAR CELL (PBMC) DNA METHYLATION AND PROGRESSION OF LIVER DISEASE AND FIBROSIS REMAINS UNCLEAR. RESULTS: HERE WE APPLIED INFINIUM 450 K BEADCHIP INVESTIGATING PBMC GENOME-WIDE METHYLATION PROFILING OF 48 HBV-RELATED LIVER DISEASE PATIENTS INCLUDING 24 CHRONIC HEPATITIS B (CHB), 14 COMPENSATED LIVER CIRRHOSIS (LC), AND 10 DECOMPENSATED LIVER CIRRHOSIS (DLC). IN TOTAL, THERE WERE 7888 DIFFERENTIALLY METHYLATED CPG SITES (36.06% HYPERMETHYLATION, 63.94% HYPOMETHYLATION) CORRELATE WITH LIVER DISEASE PROGRESSION. LC WAS DIFFICULT TO BE DIAGNOSED, INTERMEDIATING BETWEEN CHB AND DLC. WE USED LEAST ABSOLUTE SHRINKAGE AND SELECTION OPERATOR (LASSO)-LOGISTIC REGRESSION METHOD TO PERFORM A LC PREDICTIVE MODEL. THE PREDICTED PROBABILITY (P) OF HAVING LC WAS ESTIMATED BY THE COMBINED MODEL: P = 1/(1 - E(-X)), WHERE X = 11.52 - 2.82 X (IF AST WITHIN THE NORMAL RANGE - 0.19 X (PERCENT METHYLATION OF CG05650055) - 0.21 X (PERCENT METHYLATION OF CG17149911 ). PYROSEQUENCING VALIDATION AND CONFUSION MATRIX ANALYSIS WAS USED FOR INTERNAL TESTING, AREA UNDER RECEIVER OPERATING CHARACTERISTIC CURVE (AUROC) OF MODEL WAS 0.917 (95% CI, 0.80-0.977). ON THE FIBROSIS PROGRESS, THERE WERE 1705 GENES IN LC COMPARED WITH CHB, WHOSE DIFFERENTIALLY METHYLATED CPG SITES LOADING WITHIN THE "PROMOTER" REGIONS (INCLUDING TSS1500, TSS200, 5'UTR, AND THE 1ST EXON OF GENES) SUBJECT INTO THE ENRICHMENT ANALYSIS USING INGENUITY PATHWAY ANALYSIS (IPA). THERE WERE 113 ENRICHED IMMUNE-RELATED PATHWAYS INDICATED THAT HBV-RELATED LIVER FIBROSIS PROGRESSION CAUSED EPIGENETIC REPROGRAMMING OF THE IMMUNE AND INFLAMMATORY RESPONSE. CONCLUSIONS: THESE DATA SUPPORT IDEA THAT DEVELOPMENT OF HBV-RELATED CHRONIC LIVER DISEASE IS LINKED WITH ROBUST AND BROAD ALTERATION OF METHYLATION IN PERIPHERAL IMMUNE SYSTEM. CPG METHYLATION SITES SERVE AS RELEVANT BIOMARKER CANDIDATES TO MONITOR AND DIAGNOSE LC, PROVIDING NEW INSIGHT INTO THE IMMUNE MECHANISMS UNDERSTANDING THE PROGRESSION OF HBV-RELATED LIVER FIBROSIS AND CIRRHOSIS.	2020	
                                                                                                                                                                        
6   310  25 ALCOHOL AND NMDA RECEPTOR: CURRENT RESEARCH AND FUTURE DIRECTION. THE BRAIN IS ONE OF THE MAJOR TARGETS OF ALCOHOL ACTIONS. MOST OF THE EXCITATORY SYNAPTIC TRANSMISSION IN THE CENTRAL NERVOUS SYSTEM IS MEDIATED BY N-METHYL-D-ASPARTATE (NMDA) RECEPTORS. HOWEVER, ONE OF THE MOST DEVASTATING EFFECTS OF ALCOHOL LEADS TO BRAIN SHRINKAGE, LOSS OF NERVE CELLS AT SPECIFIC REGIONS THROUGH A MECHANISM INVOLVING EXCITOTOXICITY, OXIDATIVE STRESS. EARLIER STUDIES HAVE INDICATED THAT CHRONIC EXPOSURE TO ETHANOL BOTH IN VIVO AND IN VITRO, INCREASES NR1 AND NR2B GENE EXPRESSION AND THEIR POLYPEPTIDE LEVELS. THE EFFECT OF ALCOHOL AND MOLECULAR CHANGES ON THE REGULATORY PROCESS, WHICH MODULATES NMDAR FUNCTIONS INCLUDING FACTORS ALTERING TRANSCRIPTION, TRANSLATION, POST-TRANSLATIONAL MODIFICATIONS, AND PROTEIN EXPRESSION, AS WELL AS THOSE INFLUENCING THEIR INTERACTIONS WITH DIFFERENT REGULATORY PROTEINS (DOWNSTREAM EFFECTORS) ARE INCESSANTLY INCREASING AT THE CELLULAR LEVEL. FURTHER, I DISCUSS THE VARIOUS GENETICALLY ALTERED MICE APPROACHES THAT HAVE BEEN USED TO STUDY NMDA RECEPTOR SUBUNITS AND THEIR FUNCTIONAL IMPLICATION. IN A RECENT COUNTABLE REVIEW, EPIGENETIC DIMENSION (I.E., HISTONE MODIFICATION-INDUCED CHROMATIN REMODELING AND DNA METHYLATION, IN THE PROCESS OF ALCOHOL RELATED NEUROADAPTATION) IS ONE OF THE KEY MOLECULAR MECHANISMS IN ALCOHOL MEDIATED NMDAR ALTERATION. HERE, I PROVIDE A RECOUNT ON WHAT HAS ALREADY BEEN ACHIEVED, CURRENT TRENDS AND HOW THE FUTURE RESEARCH/STUDIES OF THE NMDA RECEPTOR MIGHT LEAD TO EVEN GREATER ENGAGEMENT WITH MANY POSSIBLE NEW INSIGHTS INTO THE NEUROBIOLOGY AND TREATMENT OF ALCOHOLISM.	2013	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
7  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	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
8  5792  27 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	

9  4911  12 PAIN IMAGING: FUTURE APPLICATIONS TO INTEGRATIVE CLINICAL AND BASIC NEUROBIOLOGY. WE HAVE ENTERED A NEW ERA IN UNDERSTANDING CNS CIRCUITRY INVOLVED IN ACUTE AND CHRONIC PAIN. THE ABILITY TO OBJECTIVELY MEASURE A PAIN OR ANALGESIC STATE OF THE BRAIN USING NON-INVASIVE METHODS THAT DEFINE NEURAL ACTIVATION PROVIDES THE POSSIBILITY FOR TOP-DOWN APPROACHES TO DRUG DISCOVERY. THESE BRAIN MAPS REPRESENT THE SPECIFIC BRAIN STATE. IN THE FUTURE, CORRELATIONS WITH SUCH STATES AND BEHAVIORAL, GENETIC, EPIGENETIC OR OTHER CHEMICAL MARKERS MAY HELP DEFINE SPECIFIC DIAGNOSTIC TOOLS AND NOVEL APPROACHES TO DRUG DISCOVERY.	2003	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
10  6392  21 THE ROLE OF THE GUT MICROBIOTA IN SCHIZOPHRENIA: CURRENT AND FUTURE PERSPECTIVES. OBJECTIVES: SCHIZOPHRENIA IS A POORLY UNDERSTOOD CHRONIC DISEASE. ITS PATHOPHYSIOLOGY IS COMPLEX, DYNAMIC, AND LINKED TO EPIGENETIC MECHANISMS AND MICROBIOTA INVOLVEMENT. NOWADAYS, CORRELATING SCHIZOPHRENIA WITH THE ENVIRONMENT MAKES SENSE OWING TO ITS MULTIDIMENSIONAL IMPLICATIONS: TEMPORAL AND SPATIAL VARIABILITY. MICROBIOTA INVOLVEMENT AND EPIGENETIC MECHANISMS ARE FACTORS THAT ARE CURRENTLY BEING CONSIDERED TO BETTER UNDERSTAND ANOTHER DIMENSION OF SCHIZOPHRENIA. METHODS: THIS REVIEW SUMMARISES AND DISCUSSES CURRENTLY AVAILABLE INFORMATION, FOCUSSING ON THE MICROBIOTA, EPIGENETIC MECHANISMS, TECHNOLOGICAL APPROACHES AIMED AT PERFORMING EXHAUSTIVE ANALYSES OF THE MICROBIOTA, AND PSYCHOTHERAPIES, TO ESTABLISH FUTURE PERSPECTIVES. RESULTS: THE CONNECTION BETWEEN THE MICROBIOTA, EPIGENETIC MECHANISMS AND TECHNOLOGICAL DEVELOPMENTS ALLOWS FOR FORMULATING NEW APPROACHES OBJECTIVELY ORIENTED TOWARDS THE DEVELOPMENT OF ALTERNATIVE PSYCHOTHERAPIES THAT MAY HELP TREAT SCHIZOPHRENIA. CONCLUSIONS: IN THIS REVIEW, THE GUT MICROBIOTA AND EPIGENETIC MECHANISMS WERE CONSIDERED AS KEY REGULATORS, REVEALING A POTENTIAL NEW AETIOLOGY OF SCHIZOPHRENIA. LIKEWISE, CONTINUOUS TECHNOLOGICAL ADVANCES (E.G. CULTUROMICS), AIMED AT THE MICROBIOTA-GUT-BRAIN AXIS GENERATE NEW EVIDENCE ON THIS CONCEPT.	2018	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
11   367  26 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	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
12  3021  23 GENETICS AND EPIGENETICS OF PRIMARY SJOGREN SYNDROME: IMPLICATIONS FOR FUTURE THERAPIES. IN PRIMARY SJOGREN SYNDROME (PSS), CHRONIC INFLAMMATION OF EXOCRINE GLANDS RESULTS IN TISSUE DESTRUCTION AND SICCA SYMPTOMS, PRIMARILY OF THE MOUTH AND EYES. FATIGUE, ARTHRALGIA AND MYALGIA ARE ALSO COMMON SYMPTOMS, WHEREAS EXTRAGLANDULAR MANIFESTATIONS THAT INVOLVE THE RESPIRATORY, NERVOUS AND VASCULAR SYSTEMS OCCUR IN A SUBSET OF PATIENTS. THE DISEASE PREDOMINANTLY AFFECTS WOMEN, WITH AN ESTIMATED FEMALE TO MALE RATIO OF 14 TO 1. THE AETIOLOGY OF PSS, HOWEVER, REMAINS INCOMPLETELY UNDERSTOOD, AND EFFECTIVE TREATMENT IS LACKING. LARGE-SCALE GENETIC AND EPIGENETIC INVESTIGATIONS HAVE REVEALED ASSOCIATIONS BETWEEN PSS AND GENES IN BOTH INNATE AND ADAPTIVE IMMUNE PATHWAYS. THE GENETIC VARIANTS MEDIATE CONTEXT-DEPENDENT EFFECTS, AND BOTH SEX AND ENVIRONMENTAL FACTORS CAN INFLUENCE THE OUTCOME. AS SUCH, GENETIC AND EPIGENETIC STUDIES CAN PROVIDE INSIGHT INTO THE DYSREGULATED MOLECULAR MECHANISMS, WHICH IN TURN MIGHT REVEAL NEW THERAPEUTIC POSSIBILITIES. THIS REVIEW DISCUSSES THE GENETIC AND EPIGENETIC FEATURES THAT HAVE BEEN ROBUSTLY CONNECTED WITH PSS, PUTTING THEM INTO THE CONTEXT OF CELLULAR FUNCTION, CARRIER SEX AND ENVIRONMENTAL CHALLENGES. IN ALL, THE OBSERVATIONS POINT TO SEVERAL NOVEL OPPORTUNITIES FOR EARLY DETECTION, TREATMENT DEVELOPMENT AND THE PATHWAY TOWARDS PERSONALIZED MEDICINE.	2023	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
13   391  26 AN INTRODUCTION TO THE MATHEMATICAL MODELING IN THE STUDY OF CANCER SYSTEMS BIOLOGY. BACKGROUND: FREQUENTLY OCCURRING IN CANCER ARE THE ABERRANT ALTERATIONS OF REGULATORY ONCO-METABOLITES, VARIOUS ONCOGENES/EPIGENETIC STOCHASTICITY, AND SUPPRESSOR GENES, AS WELL AS THE DEFICIENT MISMATCH REPAIR MECHANISM, CHRONIC INFLAMMATION, OR THOSE DEVIATIONS BELONGING TO THE OTHER CANCER CHARACTERISTICS. HOW THESE ABERRATIONS THAT EVOLVE OVERTIME DETERMINE THE GLOBAL PHENOTYPE OF MALIGNANT TUMORS REMAINS TO BE COMPLETELY UNDERSTOOD. DYNAMIC ANALYSIS MAY HAVE POTENTIAL TO REVEAL THE MECHANISM OF CARCINOGENESIS AND CAN OFFER NEW THERAPEUTIC INTERVENTION. AIMS: WE INTRODUCE SIMPLIFIED MATHEMATICAL TOOLS TO MODEL SERIAL QUANTITATIVE DATA OF CANCER BIOMARKERS. WE ALSO HIGHLIGHT AN INTRODUCTORY OVERVIEW OF MATHEMATICAL TOOLS AND MODELS AS THEY APPLY FROM THE VIEWPOINT OF KNOWN CANCER FEATURES. METHODS: MATHEMATICAL MODELING OF POTENTIALLY ACTIONABLE GENOMIC PRODUCTS AND HOW THEY PROCEED OVERTIME DURING TUMORIGENESIS ARE EXPLORED. THIS REPORT IS INTENDED TO BE INSTINCTIVE WITHOUT BEING OVERLY TECHNICAL. RESULTS: TO DATE, MANY MATHEMATICAL MODELS OF THE COMMON FEATURES OF CANCER HAVE BEEN DEVELOPED. HOWEVER, THE DYNAMIC OF INTEGRATED HETEROGENEOUS PROCESSES AND THEIR CROSS TALKS RELATED TO CARCINOGENESIS REMAINS TO BE RESOLVED. CONCLUSIONS: IN CANCER RESEARCH, OUTLINING MATHEMATICAL MODELING OF EXPERIMENTALLY OBTAINED DATA SNAPSHOTS OF MOLECULAR SPECIES MAY PROVIDE INSIGHTS INTO A BETTER UNDERSTANDING OF THE MULTIPLE BIOCHEMICAL CIRCUITS. RECENT DISCOVERIES HAVE PROVIDED SUPPORT FOR THE EXISTENCE OF COMPLEX CANCER PROGRESSION IN DYNAMICS THAT SPAN FROM A SIMPLE 1-DIMENSIONAL DETERMINISTIC SYSTEM TO A STOCHASTIC (IE, PROBABILISTIC) OR TO AN OSCILLATORY AND MULTISTABLE NETWORKS. FURTHER RESEARCH IN MATHEMATICAL MODELING OF CANCER PROGRESSION, BASED ON THE EVOLVING MOLECULAR KINETICS (TIME SERIES), COULD INFORM A SPECIFIC AND A PREDICTIVE BEHAVIOR ABOUT THE GLOBAL SYSTEMS BIOLOGY OF VULNERABLE TUMOR CELLS IN THEIR EARLIER STAGES OF ONCOGENESIS. ON THIS FOOTING, NEW PREVENTIVE MEASURES AND ANTICANCER THERAPY COULD THEN BE CONSTRUCTED.	2018	
                                                                                                                                                                                                                                                                                                          
14   958  26 CHRONIC MYELOMONOCYTIC LEUKEMIA - A REVIEW. INTRODUCTION: CHRONIC MYELOMONOCYTIC LEUKEMIA (CMML) IS A CLONAL MYELOID NEOPLASM, DENOTED BY OVERLAPPING MYELODYSPLASTIC AND MYELOPROLIFERATIVE FEATURES, WITH POOR OVERALL SURVIVAL AND HIGH TRANSFORMATION RATE TO ACUTE MYELOID LEUKEMIA. AREAS COVERED: THIS REVIEW, FOLLOWING A THOROUGH MEDLINE SEARCH OF PERTINENT PUBLISHED LITERATURE, DISCUSSES THE DIAGNOSTIC CRITERIA, THE PATHOGENESIS, AND THE COMPLEX GENETIC LANDSCAPE OF THE DISEASE. PROGNOSTICATION, RESPONSE CRITERIA, THERAPEUTIC MANAGEMENT OF PATIENTS, EFFICACY OF ESTABLISHED AND NOVEL TREATMENT MODALITIES ARE THOROUGHLY REVIEWED. EXPERT OPINION: CYTOGENETIC ABNORMALITIES AND MUTATIONS IN GENES INVOLVED IN EPIGENETIC AND TRANSCRIPTIONAL REGULATION, AND CELL-SIGNALING ARE ABUNDANT IN CMML AND IMPLICATED IN ITS COMPLEX PATHOGENESIS. AS PRESENCE OF THESE MUTATIONS CARRY A PROGNOSTIC IMPACT, THEY ARE INCREASINGLY INCORPORATED IN RISK-STRATIFICATION SCHEMES. NOVEL RESPONSE CRITERIA HAVE BEEN PROPOSED, CONSIDERING THE UNIQUE FEATURES OF THE DISEASE. ALTHOUGH ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION REMAINS THE ONLY TREATMENT WITH CURATIVE INTENT, IT IS RESERVED FOR A MINORITY OF PATIENTS; THEREFORE, THERE IS AN UNMET NEED FOR OPTIMIZING TREATMENT MODALITIES, SUCH AS HYPOMETHYLATING AGENTS, AND INTRODUCING NOVEL AGENTS, WHICH COULD SUBSTANTIALLY IMPROVE SURVIVAL AND QUALITY OF LIFE OF CMML PATIENTS. CLINICAL TRIALS DEDICATED SPECIFICALLY TO CMML ARE NEEDED TO EXPLORE THE EFFICACY AND SAFETY OF NOVEL TREATMENT MODALITIES.	2021	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
15  3881  25 KETOGENIC DIETS AND THE NERVOUS SYSTEM: A SCOPING REVIEW OF NEUROLOGICAL OUTCOMES FROM NUTRITIONAL KETOSIS IN ANIMAL STUDIES. OBJECTIVES: KETOGENIC DIETS HAVE REPORTED EFFICACY FOR NEUROLOGICAL DYSFUNCTIONS; HOWEVER, THERE ARE LIMITED PUBLISHED HUMAN CLINICAL TRIALS ELUCIDATING THE MECHANISMS BY WHICH NUTRITIONAL KETOSIS PRODUCES THERAPEUTIC EFFECTS. THE PURPOSE OF THIS PRESENT STUDY WAS TO INVESTIGATE ANIMAL MODELS THAT REPORT VARIATIONS IN NERVOUS SYSTEM FUNCTION BY CHANGING FROM A STANDARD ANIMAL DIET TO A KETOGENIC DIET, SYNTHESISE THESE INTO BROAD THEMES, AND COMPARE THESE WITH MECHANISMS REPORTED AS TARGETS IN PAIN NEUROSCIENCE TO INFORM HUMAN CHRONIC PAIN TRIALS. METHODS: AN ELECTRONIC SEARCH OF SEVEN DATABASES WAS CONDUCTED IN JULY 2020. TWO INDEPENDENT REVIEWERS SCREENED STUDIES FOR ELIGIBILITY, AND DESCRIPTIVE OUTCOMES RELATING TO NERVOUS SYSTEM FUNCTION WERE EXTRACTED FOR A THEMATIC ANALYSIS, THEN SYNTHESISED INTO BROAD THEMES. RESULTS: IN TOTAL, 170 STUDIES FROM EIGHTEEN DIFFERENT DISEASE MODELS WERE IDENTIFIED AND GROUPED INTO FOURTEEN BROAD THEMES: ALTERATIONS IN CELLULAR ENERGETICS AND METABOLISM, BIOCHEMICAL, CORTICAL EXCITABILITY, EPIGENETIC REGULATION, MITOCHONDRIAL FUNCTION, NEUROINFLAMMATION, NEUROPLASTICITY, NEUROPROTECTION, NEUROTRANSMITTER FUNCTION, NOCICEPTION, REDOX BALANCE, SIGNALLING PATHWAYS, SYNAPTIC TRANSMISSION AND VASCULAR SUPPLY. DISCUSSION: THE MECHANISMS PRESENTED CENTRED AROUND THE REDUCTION OF INFLAMMATION AND OXIDATIVE STRESS AS WELL AS A REDUCTION IN NERVOUS SYSTEM EXCITABILITY. GIVEN THE MULTIPLE POTENTIAL MECHANISMS PRESENTED, IT IS LIKELY THAT MANY OF THESE ARE INVOLVED SYNERGISTICALLY AND UNDERGO ADAPTIVE PROCESSES WITHIN THE HUMAN BODY, AND CONTROLLED ANIMAL MODELS THAT LIMIT THE INVESTIGATION TO A PARTICULAR PATHWAY IN ISOLATION MAY REACH DIFFERING CONCLUSIONS. ATTENTION IS REQUIRED WHEN TRANSLATING THIS INFORMATION TO HUMAN CHRONIC PAIN POPULATIONS OWING TO THE LIMITATIONS OUTLINED FROM THE ANIMAL RESEARCH.	2022	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
16  5372  19 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	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
17  3399  22 HOW CAN GENETICS AND EPIGENETICS HELP THE NEPHROLOGIST IMPROVE THE DIAGNOSIS AND TREATMENT OF CHRONIC KIDNEY DISEASE PATIENTS? DISCOVERY OF NOVEL IMPROVED TOOLS FOR DIAGNOSIS, PREVENTION AND THERAPY OF CHRONIC KIDNEY DISEASE (CKD) IS AN IMPORTANT TASK FOR THE NEPHROLOGY COMMUNITY AND IT IS LIKELY THAT SCIENTIFIC BREAKTHROUGHS, TO A LARGE EXTENT, WILL BE BASED ON GENOMICS. THE RAPID GROWTH OF THE NUMBER OF GENOME-WIDE ASSOCIATION STUDIES, MAJOR ADVANCES IN DNA SEQUENCING AND OMICS PROFILING, AND ACCELERATING BIOMEDICAL RESEARCH EFFORTS IN THIS AREA HAVE GREATLY EXPANDED THE KNOWLEDGE BASE NEEDED FOR APPLIED GENOMICS. HOWEVER, TRANSLATING AND IMPLEMENTING GENOTYPE-PHENOTYPE DATA INTO GENE-BASED MEDICINE IN CKD POPULATIONS IS STILL IN AN EARLY PHASE AND WILL REQUIRE CONTINUOUS RESEARCH EFFORTS WITH INTEGRATED APPROACHES AND INTENSIFIED INVESTIGATIONS THAT FOCUS ON THE BIOLOGICAL PATHWAYS, WHICH CAUSATIVELY LINK A GENETIC VARIANT WITH THE DISEASE PHENOTYPE. IN THIS ARTICLE, WE REVIEW SOME CURRENT STRATEGIES TO UNRAVEL THESE TRANSLATIONAL GAPS AS WELL AS PROSPECTS FOR THE IMPLEMENTATION OF GENETIC AND EPIGENETIC METHODS INTO NOVEL CLINICAL PRACTICE.	2014	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
18  4845  23 ONE YEAR IN REVIEW 2020: PATHOGENESIS OF RHEUMATOID ARTHRITIS. RHEUMATOID ARTHRITIS (RA) IS A CHRONIC INFLAMMATORY AUTOIMMUNE DISEASE INFLUENCED BY BOTH GENETIC, EPIGENETIC AND ENVIRONMENTAL FACTORS. THE DISCOVERY OF NEW GENE POLYMORPHISMS AND THEIR ASSOCIATION WITH DISEASE SUSCEPTIBILITY HAVE ADDED NEW ELEMENTS TO BETTER CLARIFY RA PATHOGENESIS. IN THE LAST YEAR, IMPORTANT ELEMENTS HAVE BEEN ADDED TO THE CURRENT KNOWLEDGE OF MECHANISMS REGULATING INNATE AND ADAPTIVE IMMUNITY IN RA, LEADING TO DISCOVERING NEW TARGETS FOR THE DEVELOPMENT OF DISEASE-MODIFYING THERAPIES. THUS, IN THIS REVIEW WE SUMMARISE THE NEW INSIGHTS RESULTING FROM A LITERATURE RESEARCH DATA PUBLISHED IN THE LAST YEAR.	2020	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
19  6576  27 TREATMENT OF PRIMARY SJOGREN SYNDROME. PRIMARY SJOGREN SYNDROME (PSS) IS A PROGRESSIVE AUTOIMMUNE DISEASE CHARACTERIZED BY SICCA AND SYSTEMIC MANIFESTATIONS. IN THIS REVIEW, WE SUMMARIZE THE AVAILABLE DATA ON TOPICAL AND SYSTEMIC MEDICATIONS, ACCORDING TO CLINICAL SIGNS AND DISEASE ACTIVITY, AND WE DESCRIBE THE ONGOING STUDIES USING BIOLOGIC DRUGS IN THE TREATMENT OF PSS. EXPANDING KNOWLEDGE ABOUT THE EPIDEMIOLOGY, CLASSIFICATION CRITERIA, SYSTEMIC ACTIVITY SCORING (ESSDAI) AND PATIENT-REPORTED OUTCOMES (ESSPRI) IS DRIVING ACTIVE RESEARCH. TREATMENT DECISIONS ARE BASED ON THE EVALUATION OF SYMPTOMS AND EXTRAGLANDULAR MANIFESTATIONS. SYMPTOMATIC TREATMENT IS USUALLY APPROPRIATE, WHEREAS SYSTEMIC TREATMENT IS RESERVED FOR SYSTEMIC MANIFESTATIONS. SICCA IS MANAGED BY EDUCATION, ENVIRONMENT MODIFICATION, ELIMINATION OF CONTINGENT OFFENDING DRUGS, ARTIFICIAL TEARS, SECRETAGOGUES AND TREATMENTS FOR COMPLICATIONS. MILD SYSTEMIC SIGNS SUCH AS FATIGUE ARE TREATED BY EXERCISE. PAIN CAN REQUIRE SHORT-TERM MODERATE-DOSE GLUCOCORTICOID THERAPY AND, IN SOME CASES, DISEASE-MODIFYING DRUGS. SEVERE AND ACUTE SYSTEMIC MANIFESTATIONS INDICATE TREATMENT WITH GLUCOCORTICOIDS AND/OR IMMUNOSUPPRESSANT DRUGS. THE ROLE FOR BIOLOGIC AGENTS IS PROMISING, BUT NO DOUBLE-BLIND RANDOMIZED CONTROLLED TRIALS (RCTS) PROVING THE EFFICACY OF THESE DRUGS ARE AVAILABLE. TARGETS FOR NEW TREATMENTS DIRECTED AGAINST THE IMMUNOPATHOLOGICAL MECHANISMS OF PSS INCLUDE EPITHELIAL CELLS, T CELLS, B-CELL OVERACTIVITY, THE INTERFERON SIGNATURE, PROINFLAMMATORY CYTOKINES, ECTOPIC GERMINAL CENTRE FORMATION, CHEMOKINES INVOLVED IN LYMPHOID CELL HOMING, AND EPIGENETIC MODIFICATIONS.	2016	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
20   963  22 CHRONIC MYELOMONOCYTIC LEUKEMIA: INSIGHTS INTO BIOLOGY, PROGNOSTIC FACTORS, AND TREATMENT. PURPOSE OF REVIEW: CHRONIC MYELOMONOCYTIC LEUKEMIA (CMML) IS A CLONAL HEMATOLOGICAL MALIGNANCY CHARACTERIZED BY BOTH DYSPLASTIC AND PROLIFERATIVE FEATURES, WITH AN INHERENT RISK FOR LEUKEMIC TRANSFORMATION. WITH THE HELP OF THIS REVIEW, WE AIM TO SUMMARIZE KEY CONCEPTS WITH REGARDS TO CMML BIOLOGY, DIAGNOSIS, RISK STRATIFICATION, AND THERAPEUTICS. RECENT FINDINGS: BASED ON RECENT STUDIES, CMML IS HALLMARKED BY A RELATIVELY LOW GENETIC COMPLEXITY, WHICH CONTRASTS WITH A COMPELLING PHENOTYPICAL HETEROGENEITY, LARGELY DRIVEN BY EPIGENETIC MECHANISMS. RECENT ADVANCES IN THE CHARACTERIZATION OF CMML BIOLOGY HAS LED TO AN IMPROVEMENT IN RISK-STRATIFICATION, BY MEANS OF INCORPORATING PROGNOSTICALLY RELEVANT GENE MUTATIONS. THIS, HOWEVER, HAS NOT SIGNIFICANTLY IMPACTED AVAILABLE THERAPIES AND OUTCOMES CONTINUE TO REMAIN POOR. ADVANCES IN CMML BIOLOGY HAVE BETTER EXPLAINED THE PHENOTYPIC HETEROGENEITY, WHILE CONTINUING TO DEFINE THE GENETIC AND EPIGENETIC LANDSCAPE. IN SPITE OF RECENT ADVANCES, LIMITED EFFECTIVE THERAPIES EXIST AND DEVELOPING RATIONALLY DERIVED THERAPEUTIC APPROACHES IS MUCH NEEDED.	2019