Clinical implications

临床意义
  • 文章类型: Journal Article
    The BRAFV600E mutation has been extensively studied in various cancers, but its role in breast lesions remains less understood. Immunohistochemistry (IHC) has emerged as a valuable tool for detecting BRAFV600E expression in breast tissue, aiding in diagnosis and prognosis. This comprehensive review examines the significance of BRAFV600E IHC in breast lesions, encompassing its frequency, association with clinicopathological features, and potential clinical implications. We summarize key findings, emphasizing their utility in diagnosis, prognosis prediction, and treatment response assessment. Additionally, we discuss implications for clinical practice, highlighting the need for integrating BRAFV600E IHC into diagnostic algorithms. Recommendations for future research include larger-scale studies to validate findings, optimize detection techniques, and explore therapeutic interventions targeting BRAFV600E in breast cancer. This review contributes to understanding the molecular landscape of breast lesions and informs clinical decision-making in their management.
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  • 文章类型: Journal Article
    本文就血管生成在乳腺癌进展和治疗中的关键作用作一综述。它涵盖了生物标志物,成像技术,治疗方法,抵抗机制,和临床意义。关键主题包括血管内皮生长因子,血管生成素,microRNA签名,循环内皮细胞作为生物标志物,随着磁共振成像,CT血管造影,超声波,和正电子发射断层扫描成像。靶向VEGF的治疗策略,酪氨酸激酶抑制剂,并讨论了血管生成与免疫治疗的交叉。解决了诸如抗性机制和个性化医疗方法等挑战。临床意义,预后价值,并强调了血管生成靶向治疗的未来方向。本文最后对理解血管生成的转化潜力进行了思考。
    This review explores the pivotal role of angiogenesis in breast cancer progression and treatment. It covers biomarkers, imaging techniques, therapeutic approaches, resistance mechanisms, and clinical implications. Key topics include Vascular Endothelial Growth Factors, angiopoietins, microRNA signatures, and circulating endothelial cells as biomarkers, along with Magnetic Resonance Imaging, Computed Tomography Angiography, Ultrasound, and Positron Emission Tomography for imaging. Therapeutic strategies targeting VEGF, tyrosine kinase inhibitors, and the intersection of angiogenesis with immunotherapy are discussed. Challenges such as resistance mechanisms and personalized medicine approaches are addressed. Clinical implications, prognostic value, and the future direction of angiogenesis-targeted therapies are highlighted. The article concludes with reflections on the transformative potential of understanding angiogenesis.
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  • 文章类型: Journal Article
    偏头痛,一种普遍的神经系统疾病,影响了约14.1%的全球人口,对女性的影响不成比例。这种使人衰弱的状况极大地损害了生活质量,生产力,并导致高昂的医疗费用,不仅对个人,而且对整个社会结构都提出了挑战。尽管我们对偏头痛病理生理学的理解有所进步,治疗选择仍然有限,需要对有效疗法进行持续研究。这篇综述深入研究了偏头痛管理的复杂性,检查遗传易感性的作用,环境影响,个性化治疗方法,合并症,现有急性和预防性治疗的疗效和安全性。它进一步探讨了偏头痛和紧张型头痛之间的连续性,并讨论了治疗各种偏头痛亚型的复杂性,包括有和没有光环的人。我们强调最近向三叉神经血管激活和血管活性物质释放的范式转变,如降钙素基因相关肽(CGRP),提供了新的治疗靶点。我们评估开创性的临床试验,药代动力学和药效学观点,安全,耐受性,以及CGRP单克隆抗体和gepant的实际应用。面对误诊等持续存在的治疗障碍,药物过度使用头痛,获得专科护理的机会有限,我们讨论了创新的CGRP针对性策略,长期疗效数据的高成本和稀缺,并建议为土耳其和发展中国家量身定制的全面解决方案。审查提供了战略建议,包括制定初级保健准则,建立专门的门诊诊所,向医生介绍新的治疗方法,提高全球对先进疗法的可及性,培养病人的教育。强调改变生活方式和整体方法的重要性,该综述强调了大众媒体和患者群体在传播关键健康信息和塑造偏头痛管理未来方面的潜力.
    Migraine, a prevalent neurological disorder, affects approximately 14.1% of the global population and disproportionately impacts females. This debilitating condition significantly compromises quality of life, productivity, and incurs high healthcare costs, presenting a challenge not only to individuals but to societal structures as a whole. Despite advances in our understanding of migraine pathophysiology, treatment options remain limited, necessitating ongoing research into effective therapies. This review delves into the complexity of migraine management, examining the roles of genetic predisposition, environmental influences, personalized treatment approaches, comorbidities, efficacy and safety of existing acute and preventive treatments. It further explores the continuum between migraine and tension-type headaches and discusses the intricacies of treating various migraine subtypes, including those with and without aura. We emphasize the recent paradigm shift toward trigeminovascular activation and the release of vasoactive substances, such as calcitonin gene-related peptide (CGRP), which offer novel therapeutic targets. We assess groundbreaking clinical trials, pharmacokinetic and pharmacodynamic perspectives, safety, tolerability, and the real-world application of CGRP monoclonal antibodies and gepants. In the face of persisting treatment barriers such as misdiagnosis, medication overuse headaches, and limited access to specialist care, we discuss innovative CGRP-targeted strategies, the high cost and scarcity of long-term efficacy data, and suggest comprehensive solutions tailored to Turkiye and developing countries. The review offers strategic recommendations including the formulation of primary care guidelines, establishment of specialized outpatient clinics, updating physicians on novel treatments, enhancing global accessibility to advanced therapies, and fostering patient education. Emphasizing the importance of lifestyle modifications and holistic approaches, the review underscores the potential of mass media and patient groups in disseminating critical health information and shaping the future of migraine management.
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  • 文章类型: Journal Article
    这篇综述强调了阿片类药物监测在临床实践中的重要性,并倡导了基于药物遗传学的个性化方法。除了有效控制疼痛,需要细致的监督来解决对副作用的担忧,特别是由于与阿片类药物危机相关的滥用和依赖。各种监测技术,随着药物遗传学的考虑,对于个性化治疗和优化疼痛缓解,同时减少滥用和成瘾风险至关重要。未来的前景揭示了机遇和挑战,随着分析技术的进步,有望提高监测效率。药物遗传学的整合有可能通过精确预测药物反应来改变疼痛管理。然而,诸如突出的药物遗传学测试和指南标准化等挑战仍然存在。合作努力对于将科学进步转化为患者护理的切实改善至关重要。需要标准化的协议和跨学科合作,以确保一致和基于证据的阿片类药物监测。未来的研究应该着眼于阿片类药物治疗的长期影响,以及遗传因素对个体反应的影响,帮助指导个性化治疗计划,减少不良事件。最后,通过在缓解疼痛和患者安全之间取得平衡,拥抱创新和协作可以提高慢性疼痛管理的护理标准。
    This review emphasises the importance of opioid monitoring in clinical practice and advocates for a personalised approach based on pharmacogenetics. Beyond effectively managing pain, meticulous oversight is required to address concerns about side effects, specially due to opioid-crisis-related abuse and dependence. Various monitoring techniques, along with pharmacogenetic considerations, are critical for personalising treatment and optimising pain relief while reducing misuse and addiction risks. Future perspectives reveal both opportunities and challenges, with advances in analytical technologies holding promise for increasing monitoring efficiency. The integration of pharmacogenetics has the potential to transform pain management by allowing for a precise prediction of drug responses. Nevertheless, challenges such as prominent pharmacogenetic testing and guideline standardisation persist. Collaborative efforts are critical for transforming scientific advances into tangible improvements in patient care. Standardised protocols and interdisciplinary collaboration are required to ensure consistent and evidence-based opioid monitoring. Future research should look into the long-term effects of opioid therapy, as well as the impact of genetic factors on individual responses, to help guide personalised treatment plans and reduce adverse events. Lastly, embracing innovation and collaboration can improve the standard of care in chronic pain management by striking a balance between pain relief and patient safety.
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  • 文章类型: Journal Article
    股骨远端骨折带来了巨大的骨科挑战,需要进行全面的流行病学探索,解剖学,分类,诊断,和治疗策略。这篇综述彻底分析了股骨远端骨折周围的多方面问题。它深入研究了定义和流行病学,在入射角上发光,年龄分布,和相关的危险因素。彻底检查股骨远端的解剖结构,包括韧带和肌腱,根据AO基金会/骨科创伤协会(AO/OTA)系统,为理解骨折模式和随后的分类奠定了基础。诊断考虑包括体格检查和各种成像方式,强调迅速和准确评估的关键重要性。关于治疗方案的广泛讨论包括非手术管理,包括铸造和牵引,外科手术干预,如切开复位和内固定,髓内钉,和外固定。临床实践的意义强调了基于骨折特征的定制方法以优化患者预后的必要性。然而,这次审查还强调了需要进一步调查的领域,包括探索预测性生物标志物,先进的外科技术,和创新的康复方案。来自不同人群的长期结果和生活质量评估的见解为加强股骨远端骨折的综合管理提供了有希望的途径。这些领域的持续研究可以完善治疗策略,并提高应对这种复杂骨科疾病的个人的护理标准。
    Distal femur fractures present a substantial orthopedic challenge, necessitating a comprehensive exploration spanning epidemiology, anatomy, classification, diagnosis, and treatment strategies. This review thoroughly analyzes the multifaceted aspects surrounding distal femur fractures. It delves into the definition and epidemiology, shedding light on the incidence, age distribution, and associated risk factors. An exhaustive examination of the distal femur\'s anatomy, encompassing ligaments and tendons, establishes the groundwork for understanding fracture patterns and subsequent classification according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) system. Diagnostic considerations encompass physical examination and various imaging modalities, emphasizing the critical importance of prompt and accurate assessment. The extensive discussion on treatment options ranges from non-surgical management, including casting and traction, to surgical interventions, such as open reduction and internal fixation, intramedullary nailing, and external fixation. The implications for clinical practice underscore the necessity for tailored approaches based on fracture characteristics to optimize patient outcomes. However, this review also emphasizes areas necessitating further investigation, including exploring predictive biomarkers, advanced surgical techniques, and innovative rehabilitation protocols. Insights from long-term outcomes and quality-of-life assessments in diverse populations offer promising avenues for enhancing the comprehensive management of distal femur fractures. Continuous research in these areas can refine treatment strategies and elevate the standard of care for individuals grappling with this intricate orthopedic condition.
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  • 文章类型: Journal Article
    成纤维细胞生长因子受体2(FGFR2)基因是研究最广泛的基因之一,具有许多已知的突变与几种人类疾病有关。包括致癌的。大多数FGFR2疾病相关基因突变是错义突变,导致FGFR2蛋白和下游分子途径的组成型激活。FGFR2激酶结构域的许多三级结构在野生型和突变形式以及受体的失活和活化状态中是公开可用的。目前的文献表明分子制动抑制ATP结合A环采用活化状态。突变减轻了刹车,触发活性和非活性状态之间的变构变化。然而,现有的分析依赖于静态结构,没有考虑到内在的结构动力学。在这项研究中,我们利用FGFR2酪氨酸激酶域的实验解析结构和机器学习来捕获内在的结构动力学,将其与功能区域和疾病类型相关联,并用预测的变体结构丰富它,目前没有实验解析的结构。我们的发现证明了机器学习的结构动力学特征在揭示突变对FGFR2中(dys)功能和紊乱的影响方面的价值。
    The fibroblast growth factor receptor 2 (FGFR2) gene is one of the most extensively studied genes with many known mutations implicated in several human disorders, including oncogenic ones. Most FGFR2 disease-associated gene mutations are missense mutations that result in constitutive activation of the FGFR2 protein and downstream molecular pathways. Many tertiary structures of the FGFR2 kinase domain are publicly available in the wildtype and mutated forms and in the inactive and activated state of the receptor. The current literature suggests a molecular brake inhibiting the ATP-binding A loop from adopting the activated state. Mutations relieve this brake, triggering allosteric changes between active and inactive states. However, the existing analysis relies on static structures and fails to account for the intrinsic structural dynamics. In this study, we utilize experimentally resolved structures of the FGFR2 tyrosine kinase domain and machine learning to capture the intrinsic structural dynamics, correlate it with functional regions and disease types, and enrich it with predicted structures of variants with currently no experimentally resolved structures. Our findings demonstrate the value of machine learning-enabled characterizations of structure dynamics in revealing the impact of mutations on (dys)function and disorder in FGFR2.
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  • 文章类型: Journal Article
    心肌缺血再灌注损伤(MIRI)在心肌梗死(MI)的再灌注程序中仍然是一个挑战。早期血运重建是减轻心肌损伤的金标准,最近的见解阐明了再灌注的矛盾作用,引起称为缺血再灌注损伤的现象。这篇全面的综述深入探讨了MIRI涉及的复杂的病理生理途径,特别关注内皮的关键作用。除了阐明分子的复杂性,我们探讨了与MIRI相关的各种临床表现,强调其对最终梗死面积有实质性贡献的潜力,高达50%。我们进一步浏览当前的预防方法,并强调旨在抵消这一现象的破坏性影响的有希望的新兴战略。通过综合现有知识并提供对不断发展的预防性干预措施的观点,这篇综述为从事MIRI动态领域的临床医生和研究人员提供了宝贵的资源。
    Myocardial ischemia-reperfusion injury (MIRI) remains a challenge in the context of reperfusion procedures for myocardial infarction (MI). While early revascularization stands as the gold standard for mitigating myocardial injury, recent insights have illuminated the paradoxical role of reperfusion, giving rise to the phenomenon known as ischemia-reperfusion injury. This comprehensive review delves into the intricate pathophysiological pathways involved in MIRI, placing a particular focus on the pivotal role of endothelium. Beyond elucidating the molecular intricacies, we explore the diverse clinical manifestations associated with MIRI, underscoring its potential to contribute substantially to the final infarct size, up to 50%. We further navigate through current preventive approaches and highlight promising emerging strategies designed to counteract the devastating effects of the phenomenon. By synthesizing current knowledge and offering a perspective on evolving preventive interventions, this review serves as a valuable resource for clinicians and researchers engaged in the dynamic field of MIRI.
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  • 文章类型: Journal Article
    这篇综述探讨了维生素K激活孕烷X受体(PXR)对人体健康的可能临床影响。PXR,最初被认为是肝脏异种生物代谢的主要调节因子,作为影响肠道稳态的关键调节剂,炎症,氧化应激,和自噬。维生素K对PXR的激活强调了其作为具有不同临床意义的有效内源性和局部激动剂的作用。最近的研究表明,维生素K介导的激活PXR突出了这种维生素的潜力,在解决病理生理条件通过促进肝脏解毒,强化肠道屏障完整性,控制促炎和凋亡途径。维生素K激活PXR提供了与癌细胞存活的复杂关联,特别是在结直肠癌和肝癌中,为潜在的新治疗策略提供新的见解。了解维生素K激活PXR的临床意义与健康结果的分子机制,进一步为复杂疾病提供个性化治疗方法。
    This review explores the likely clinical impact of Pregnane X Receptor (PXR) activation by vitamin K on human health. PXR, initially recognized as a master regulator of xenobiotic metabolism in liver, emerges as a key regulator influencing intestinal homeostasis, inflammation, oxidative stress, and autophagy. The activation of PXR by vitamin K highlights its role as a potent endogenous and local agonist with diverse clinical implications. Recent research suggests that the vitamin K-mediated activation of PXR highlights this vitamin\'s potential in addressing pathophysiological conditions by promoting hepatic detoxification, fortifying gut barrier integrity, and controlling pro-inflammatory and apoptotic pathways. PXR activation by vitamin K provides an intricate association with cancer cell survival, particularly in colorectal and liver cancers, to provide new insights into potential novel therapeutic strategies. Understanding the clinical implications of PXR activation by vitamin K bridges molecular mechanisms with health outcomes, further offering personalized therapeutic approaches for complex diseases.
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  • 文章类型: Journal Article
    皮肤鳞状细胞癌(cSCC)是一种常见且可能致命的皮肤癌,对公众健康构成重大威胁,患病率高。皮肤表面暴露于紫外线辐射会增加cSCC的风险,尤其是那些患有遗传性综合征的患者,如皮肤干燥和大疱性表皮松解症。因此,了解cSCC的分子发病机制对于开发在cSCC中有效的个性化治疗方法至关重要。本文对cSCC发病机制的现有知识进行了全面概述,强调失调的信号通路和分子谱分析的重要性。与传统疗法相关的几个限制和挑战,然而,被识别,强调需要新的治疗策略。本文进一步讨论了分子靶标和治疗方法,即,表皮生长因子受体抑制剂,hedgehog通路抑制剂,和PI3K/AKT/mTOR通路抑制剂,以及新兴的分子靶标和治疗剂。该手稿探讨了分子靶向治疗的抗性机制,并提出了克服它们的方法,包括组合策略,合理的设计,和优化。评估分子靶向治疗的临床意义和患者预后,包括反应率和生存结果。分子靶向治疗中不良事件和毒性的管理至关重要,需要仔细监测和控制。本文进一步讨论了该领域未来的治疗进展和研究方向,以及与常规疗法相关的困难和限制。
    Cutaneous Squamous Cell Carcinoma (cSCC) is a common and potentially fatal type of skin cancer that poses a significant threat to public health and has a high prevalence rate. Exposure to ultraviolet radiation on the skin surface increases the risk of cSCC, especially in those with genetic syndromes like xerodermapigmentosum and epidermolysis bullosa. Therefore, understanding the molecular pathogenesis of cSCC is critical for developing personalized treatment approaches that are effective in cSCC. This article provides a comprehensive overview of current knowledge of cSCC pathogenesis, emphasizing dysregulated signaling pathways and the significance of molecular profiling. Several limitations and challenges associated with conventional therapies, however, are identified, stressing the need for novel therapeutic strategies. The article further discusses molecular targets and therapeutic approaches, i.e., epidermal growth factor receptor inhibitors, hedgehog pathway inhibitors, and PI3K/AKT/mTOR pathway inhibitors, as well as emerging molecular targets and therapeutic agents. The manuscript explores resistance mechanisms to molecularly targeted therapies and proposes methods to overcome them, including combination strategies, rational design, and optimization. The clinical implications and patient outcomes of molecular-targeted treatments are assessed, including response rates and survival outcomes. The management of adverse events and toxicities in molecular-targeted therapies is crucial and requires careful monitoring and control. The paper further discusses future directions for therapeutic advancement and research in this area, as well as the difficulties and constraints associated with conventional therapies.
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  • 文章类型: Case Reports
    人体血管系统表现出显著的解剖变异性,与常规动脉分支模式的偏差偶尔会遇到。在这些变化中,非典型分叉因其罕见发生和潜在的临床意义而引起关注。这项研究调查了肱动脉尸体解剖过程中罕见的高分叉解剖变异。它强调了理解已建立的血管解剖结构中的这种变化及其临床意义的相关性。上肢解剖的详细发现,揭示了40岁男性尸体的高度分叉,被呈现。该报告突出了独特的解剖学变化,包括一条肤浅的道路。结论强调了这种高度分叉的稀有性及其对医疗程序的潜在影响。它强调了医疗保健专业人员意识到并为这种解剖学变化做好准备以实现最佳患者护理的重要性。为了管理影响循环系统的医疗操作过程中的潜在困难,并最终提高患者的治疗效果,有必要理解这些偏差。
    The human vascular system exhibits a remarkable degree of anatomical variability, with deviations from conventional arterial branching patterns occasionally encountered. Among these variations, the atypical bifurcation has drawn attention for its infrequent occurrence and potential clinical implications. This study investigates the rare anatomical variation of high bifurcation seen during cadaver dissection in the brachial artery. It emphasizes the relevance of understanding such variations in established vascular anatomy and their clinical implications. Detailed findings from the dissection of the upper limbs, which reveal a high bifurcation in a 40-year-old male cadaver, are presented. The report highlights unique anatomical variations, including a superficial path. The conclusion underscores the rarity of this high bifurcation and its potential impact on medical procedures. It stresses the importance of healthcare professionals being aware of and prepared for such anatomical variations for optimal patient care. In order to manage potential difficulties during medical operations affecting the circulatory system and eventually enhance patient outcomes, it is necessary to understand these deviations.
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