disease modeling

疾病建模
  • 文章类型: Journal Article
    尽管患者预后有所改善,儿科癌症仍然是儿童非意外死亡的主要原因.最近对儿科癌症患者的遗传分析表明,种系遗传易感性和癌症特异性体细胞驱动突变都具有重要作用。越来越多,有证据表明,起源癌细胞转化的发育时间点对于肿瘤身份和治疗反应至关重要.因此,未来的治疗发展将通过使用忠实地概括遗传背景的疾病模型来支持,细胞起源,和儿童癌症的脆弱性发展窗口。人类干细胞有可能将所有这些特征整合到儿科癌症模型中,同时作为快速遗传和药理测试的平台。在这次审查中,我们描述了人类干细胞是如何用于儿科癌症模型的,以及这些模型与其他儿科癌症模型模式的比较.
    今天,儿童癌症是儿童非意外死亡的主要原因.为了进一步改善结果,对于研究人员和临床医生来说,认识到小儿癌症与成人癌症的区别非常重要。遗传的癌症风险可能在儿科癌症风险中发挥更大的作用,和随后的肿瘤特异性获得性驱动突变启动肿瘤形成。然而,遗传和获得性突变之间存在实质性的相互作用,这支持同时考虑两者。生物技术的最新进展,改善了早期发育细胞和儿科癌细胞之间的匹配,尽管某些儿童中枢神经系统肿瘤的细胞来源仍然难以捉摸。越来越多,证据,特别是在小儿髓母细胞瘤中,证明了癌细胞起源转化的发育时间点对于肿瘤身份和治疗反应至关重要。因此,未来的治疗发展将通过使用忠实地概括遗传背景的疾病模型来支持,细胞起源,和儿科癌症的发育窗口。人类干细胞有可能将所有这些特征整合到儿科癌症模型中,同时作为快速遗传和药理测试的平台。在这次审查中,我们描述了如何使用人类干细胞来模拟儿科癌症,这些模型与其他儿科癌症模型相比,以及未来如何改进这些模型。
    Despite improvements in patient outcomes, pediatric cancer remains a leading cause of non-accidental death in children. Recent genetic analysis of patients with pediatric cancers indicates an important role for both germline genetic predisposition and cancer-specific somatic driver mutations. Increasingly, evidence demonstrates that the developmental timepoint at which the cancer cell-of-origin transforms is critical to tumor identity and therapeutic response. Therefore, future therapeutic development would be bolstered by the use of disease models that faithfully recapitulate the genetic context, cell-of-origin, and developmental window of vulnerability in pediatric cancers. Human stem cells have the potential to incorporate all of these characteristics into a pediatric cancer model, while serving as a platform for rapid genetic and pharmacological testing. In this review, we describe how human stem cells have been used to model pediatric cancers and how these models compare to other pediatric cancer model modalities.
    Today, pediatric cancer is a leading cause of non-accidental death in children. In order to further improve outcomes, it is important for researchers and clinicians alike to recognize how pediatric cancers are distinct from adult cancers. Inherited risk of cancer may play a greater role in pediatric cancer risk, and subsequent tumor-specific acquired driver mutations initiate tumor formation. However, there is substantial interaction between inherited and acquired mutations, which supports consideration of both simultaneously. Recent advancements in biotechnology, have improved matching between early cells of development and pediatric cancer cells, although cell-of-origin for certain pediatric central nervous system tumors remain elusive. Increasingly, evidence, particularly in pediatric medulloblastoma, demonstrates that the developmental timepoint at which the cancer cell-of-origin transforms is critical to tumor identity and therapeutic response. Therefore, future therapeutic development would be bolstered by the use of disease models that faithfully recapitulate the genetic context, cell-of-origin, and developmental window of pediatric cancers. Human stem cells have the potential to incorporate all of these characteristics into a pediatric cancer model, while serving as a platform for rapid genetic and pharmacological testing. In this review, we describe how human stem cells have been used to model pediatric cancers, how human these models compare to other pediatric cancer model modalities, and how these models can be improved in the future.
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  • 文章类型: Journal Article
    目标:女性,年龄小和紧张的生活事件是已知的功能性神经系统疾病(FND)的诱发因素。医疗保健行业的就业也被认为是一个诱发因素。我们着手进行大规模的病例对照研究,以估计FND患者在医疗保健行业的就业率。
    方法:我们纳入了200例确诊为FND的连续患者,2016年10月1日至2019年8月1日期间转诊到我们在瑞士伯尔尼大学医院的诊所。此外,我们纳入了一个由200名确诊神经系统疾病患者组成的对照组,年龄和性别相匹配,在同一时期看到的。主要终点是比较两组之间医疗保健专业人员的患病率。我们还描述了FND队列中的临床表现和伴随的精神病诊断。
    结果:女性占主导地位(70%),参与者的平均年龄为37岁。FND患者中医疗保健专业人员的比例为18%(33/186),明显高于对照组,其中为10.6%(17/189;p=0.019,95%置信区间比值比1.168-4.074)。这两个队列中的大多数医疗保健专业人员都是护士(FND患者中有21/33,控件中的10/17)。在FND患者中,140(70%)有运动症状,65(32.5%)有伴随的精神病诊断。
    结论:这项病例对照研究证实,FND患者在医疗保健行业的就业率更高,提示FND的两种潜在机制:暴露于有关神经症状的模型/特定知识或与压力相关的专业因素。这需要对潜在机制和预防进行进一步研究。
    Female gender, younger age and stressful life events are known predisposing factors for functional neurological disorders (FNDs). Employment in a healthcare profession has also been suggested to be a predisposing factor. We set out to conduct a large-scale case-control study to estimate the rate employment in a healthcare profession among people with FND.
    We included 200 consecutive patients with a confirmed diagnosis of FND, referred to our clinic at University Hospital Bern Switzerland between October 1, 2016, and August 1, 2019. In addition, we included a control group of 200 patients with a confirmed neurological disorder, matched for age and gender, seen during the same period. The primary endpoint was to compare the prevalence of healthcare professionals between the groups. We also describe the clinical manifestations and concomitant psychiatric diagnoses in the FND cohort.
    Female gender was predominant (70%), and the participants\' mean age was 37 years. The proportion of healthcare professionals in the FND patients was 18% (33/186), which was significantly higher than in the control group, in which it was 10.6% (17/189; p = 0.019, 95% confidence interval odds ratio 1.168-4.074). Most healthcare professionals in both cohorts were nurses (21/33 among FND patients, 10/17 among controls). Among FND patients, 140 (70%) had motor symptoms and 65 (32.5%) had a concomitant psychiatric diagnosis.
    This case-control study confirmed a higher rate of employment in healthcare professions in patients with FND, suggesting two potential mechanisms of FND: exposure to models/specific knowledge about neurological symptoms or stress-related professional factors. This warrants further studies on underlying mechanisms and prevention.
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  • 文章类型: Journal Article
    目前,从早期到晚期临床试验,肿瘤学中的药物流失率很高。计算方法的最新进展,尤其是因果人工智能,和丰富的临床基因组数据库的可用性使得有可能模拟癌症药物方案在不同患者人群中的疗效,这可以为临床试验设计提供信息和改进。这里,我们回顾了计算机模拟试验和因果AI的当前和潜在用途,以提高传统临床试验的疗效和安全性.我们得出的结论是,在使用因果人工智能方法的模拟试验中,可以模拟控制和功效臂,告知患者招募和方案滴定,更好地实现对精准医学至关重要的亚组分析。
    Pharmaceutical agents in oncology currently have high attrition rates from early to late phase clinical trials. Recent advances in computational methods, notably causal artificial intelligence, and availability of rich clinico-genomic databases have made it possible to simulate the efficacy of cancer drug protocols in diverse patient populations, which could inform and improve clinical trial design. Here, we review the current and potential use of in silico trials and causal AI to increase the efficacy and safety of traditional clinical trials. We conclude that in silico trials using causal AI approaches can simulate control and efficacy arms, inform patient recruitment and regimen titrations, and better enable subgroup analyses critical for precision medicine.
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  • 文章类型: Journal Article
    冠状病毒病-19(COVID-19)大流行的爆发对这种疾病的行为产生了很多猜测。已经提出的一些问题可以通过基于高性能计算(HPC)和机器学习技术的计算建模来解决。参考模型以前使用这样的技术来模拟糖尿病。参考模型现在用于回答关于COVID-19的几个问题,同时改变传统的易感感染恢复(SIR)模型方法。这种适应使我们能够回答诸如每次相遇的传输概率之类的问题,疾病持续时间,和死亡率。参考模型使用来自52个州和地区的美国感染和死亡率数据,结合人类相互作用的多个假设,计算最佳拟合参数,这些参数解释了给定假设和2020年4月至2020年6月的累积数据的疾病行为。这是一份初步报告,旨在证明可能使用基于计算能力的计算模型来帮助理解疾病特征。该基础结构可以积累来自多个贡献者的模型和假设。
    The outbreak of the coronavirus disease-19 (COVID-19) pandemic has created much speculation on the behavior of the disease. Some of the questions that have been asked can be addressed by computational modeling based on the use of high-performance computing (HPC) and machine learning techniques.  The Reference Model previously used such techniques to model diabetes. The Reference Model is now used to answer a few questions on COVID-19, while changing the traditional susceptible-infected-recovered (SIR) model approach. This adaptation allows us to answer questions such as the probability of transmission per encounter, disease duration, and mortality rate. The Reference Model uses data on US infection and mortality from 52 states and territories combining multiple assumptions of human interactions to compute the best fitting parameters that explain the disease behavior for given assumptions and accumulated data from April 2020 to June 2020. This is a preliminary report aimed at demonstrating the possible use of computational models based on computing power to aid comprehension of disease characteristics. This infrastructure can accumulate models and assumptions from multiple contributors.
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  • 文章类型: Journal Article
    从受影响的胚泡或从患者来源的体细胞产生的人多能干细胞(PSC)是用于疾病建模和药物发现的新兴平台。脆性X综合征(FXS),遗传性智力残疾的主要原因,是在胚胎干细胞和诱导的PCSs中建模的首批疾病之一,并且可以作为在人类疾病研究中利用人类PSC的示例性病例。在过去的十年里,FXS-PSC已用于解决关于FXS的病理生理学的基本问题。在这篇综述中,我们总结了FXS-PSC的生成方法,讨论它们与现有建模系统相比的优缺点,并描述它们在FXS发病机制研究和靶向治疗开发中的应用。
    Human pluripotent stem cells (PSCs) generated from affected blastocysts or from patient-derived somatic cells are an emerging platform for disease modeling and drug discovery. Fragile X syndrome (FXS), the leading cause of inherited intellectual disability, was one of the first disorders modeled in both embryonic stem cells and induced PCSs and can serve as an exemplary case for the utilization of human PSCs in the study of human diseases. Over the past decade, FXS-PSCs have been used to address the fundamental questions regarding the pathophysiology of FXS. In this review we summarize the methodologies for generation of FXS-PSCs, discuss their advantages and disadvantages compared with existing modeling systems and describe their utilization in the study of FXS pathogenesis and in the development of targeted treatment.
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  • 文章类型: Journal Article
    在“基本生殖数”下分组的各种阈值数量经常被混淆,但代表了估计流行病传播潜力的不同方法,并满足不同的建模需求。这里,我们对比了应用于随机隔室模型的几种常见的繁殖度量,并引入了一种新的数量,称为“经验调整的繁殖数”,具有几个优点。其中包括:比常见的替代方案更完整地使用基本的隔室动力学,用作潜在的诊断工具来检测强度过程不足的存在和原因,以及对疾病传播提供及时反馈的能力。探讨了传统繁殖措施与我们的方法之间的概念联系,并在仿真下检查了我们方法的行为。开发了两个说明性示例:首先,我们方法的单位置应用是使用1995年刚果民主共和国埃博拉疫情的数据和传统的随机SEIR模型建立的.第二,在西非持续爆发的埃博拉疫情的背景下,探索了这种技术的空间表述,特别强调在模型选择中的潜在用途,诊断,以及由此产生的估计和预测应用。两种分析都放在新开发的传统SEIR建模方法的空间模拟的背景下。
    The various thresholding quantities grouped under the \"Basic Reproductive Number\" umbrella are often confused, but represent distinct approaches to estimating epidemic spread potential, and address different modeling needs. Here, we contrast several common reproduction measures applied to stochastic compartmental models, and introduce a new quantity dubbed the \"empirically adjusted reproductive number\" with several advantages. These include: more complete use of the underlying compartmental dynamics than common alternatives, use as a potential diagnostic tool to detect the presence and causes of intensity process underfitting, and the ability to provide timely feedback on disease spread. Conceptual connections between traditional reproduction measures and our approach are explored, and the behavior of our method is examined under simulation. Two illustrative examples are developed: First, the single location applications of our method are established using data from the 1995 Ebola outbreak in the Democratic Republic of the Congo and a traditional stochastic SEIR model. Second, a spatial formulation of this technique is explored in the context of the ongoing Ebola outbreak in West Africa with particular emphasis on potential use in model selection, diagnosis, and the resulting applications to estimation and prediction. Both analyses are placed in the context of a newly developed spatial analogue of the traditional SEIR modeling approach.
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