Expert opinion on medical diagnostics最新文献

Introduction: Personalized medicine based on tumor characteristics is transforming the management of lung cancer. This review provides an overview of clinically approved strategies to personalize treatment for lung cancer as well as evolving strategies in various stages of clinical development.

Areas covered: Selecting therapy based on various tumor characteristics such as histology and presence of specific molecular alterations will be covered. This review will not only discuss the role of targeted agents in personalizing care for lung cancer but also the strategies to personalize traditional chemotherapeutic agents.

Expert opinion: Advances in genomic medicine to identify key genetic alterations with subsequent development of matching targeted agents are rapidly changing the management of lung cancer. Being able to target key driver molecular aberrations is certainly exciting and clinically meaningful, but only for a limited period of time. Intra- and intertumoral heterogeneity is a major contributor to therapy resistance, a substantial roadblock to durable response. Better understanding of resistance mechanism is at least as important as identifying new targetable genetic changes to effectively advance personalized therapy for lung cancer. Finally, optimization of biopsy specimens and rigorous validation steps to ensure reliability of diagnostic methods would be critical in moving forward.

Introduction: Thyroid cancer is the most common endocrine cancer in the USA and its incidence is increasing worldwide. Thyroid fine-needle aspiration biopsy (FNA) and cytologic analysis is the most cost-effective approach to distinguish between malignant and benign thyroid nodules. However, up to 30% of thyroid FNA biopsy results are inconclusive.

Areas covered: In this article, the authors provide an update on the current status and emerging approaches for improving thyroid cancer diagnosis. This review covers imaging, genetic and genomic approaches being used or in development to help distinguish between malignant and benign thyroid nodules.

Expert opinion: There has been considerable progress in improving thyroid cancer diagnosis. The molecular markers analysis to avoid diagnostic surgeries seems to be promising. However, the clinical utility and accuracy of some markers reported in this review are not conclusive and need to be validated as clinical diagnostic tool.

Introduction: One sober consequence of the current epidemic of diabetes mellitus is that an increasing number of people world-wide will partially or completely lose their sight to diabetic retinopathy. Clinically, the sight-threatening complications of diabetes are diagnosed and treated based on visible retinal lesions (e.g., dot-blot hemorrhages or retinal neovascularization). However, such anatomical microvascular lesions are slow to respond with treatment. Thus, there remains an urgent need for imaging biomarkers that are abnormal before retinal lesions are visibly apparent and are responsive to treatment.

Areas covered: Here, the development of new MRI methods, such as manganese-enhanced MRI, for evaluating early diabetes-evoked retinal pathophysiology, and its usefulness in guiding new treatments for diabetic retinopathy are reviewed.

Expert opinion: In diabetic retinopathy, not all important diagnostic and prognostic needs are well served by optical methods. In the absence of gross anatomy changes, critical times when drug intervention is most likely to be successful at reducing vision loss are missed by most light-based methods and thus provide little help in guiding diagnosis and treatment. For example, before clinical symptoms, is there an optimal time to intervene with drug therapy? Is a drug reaching its target? How does one assess optimal drug dose, schedule, and routes? How well do current experimental models mimic the clinical condition? As discussed herein, MRI is as an analytical tool for addressing these unmet needs. Future clinical applications of MRI can be envisioned such as in clinical trials to assess drug treatment efficacy, or as an adjunct approach to refine or clarify a difficult clinical case. New MRI-generated hypotheses about the pathogenesis of diabetic retinopathy and its treatment are discussed. In the coming years, a substantial growth in the development and application of MRI is expected to address relevant question in both the basic sciences and in the clinic.

Introduction: Acute bacterial meningitis (ABM) is a life-threatening infectious disease requiring prompt antimicrobial therapy. ABM must be differentiated from systemic disorders with CNS manifestations that may mimic ABM. ABM should also be differentiated from acute meningoencephalitis (AME) and acute viral encephalitis (AVE). Nonviral causes of AME are treatable. Among the causes of AVE, Herpes simplex encephalitis (HSE) is treatable. This article reviews the clinical diagnostic approach to ABM, AME and AVE.

Areas covered: The differential diagnostic (DDx) approach to ABM, AME and AVE is based on clinical and laboratory findings. A specific pathogen diagnosis is based on serum/cerebrospinal fluid (CSF) tests. This overview presents the diagnostic approach to ABM, AME and AVE in normal hosts (excluding brain abscesses and chronic CNS infections).

Expert opinion: It is time critical to diagnose ABM and begin empiric antimicrobial therapy based on the known/most likely pathogen. The diagnosis of ABM depends on clinical features and the CSF profile. The CSF Gram stain and CSF lactic acid (LA) levels provide the most rapid, reliable and cost-effective tests to diagnose ABM. CSF LA levels are also the best way to diagnose partially treated acute bacterial meningitis (PTABM). In those cases of AME/AVE due to viruses with a CSF profile mimicking ABM, for example, HSE, unelevated CSF LA levels rapidly/reliably rule out ABM as a diagnostic possibility.

Introduction: Over 75,000 people in the United States were diagnosed with melanoma in 2012. The incidence of melanoma continues to increase over time and early detection is currently the most promising strategy to decrease melanoma-related morbidity and mortality. Currently, most physicians perform skin cancer screenings with the unaided eye. However, the FDA recently approved, MelaFind, a multispectral objective computer vision system to assist dermatologists in making more accurate biopsy decisions to facilitate early melanoma diagnosis.

Areas covered: This review covers the sensitivity and specificity, limitations and clinical role of MelaFind and other devices available or under development to aid in the detection of melanoma.

Expert opinion: Physician screening with the aid of MelaFind device may improve detection of early melanoma and potentially reduce melanoma morbidity and mortality, if used widely. The strength of MelaFind is its high sensitivity, acceptable specificity, ease of use and objective output. Thus it has potential to improve biopsy decisions made by both dermatologists and less experienced clinicians. Currently, the use of MelaFind is not reimbursed by insurance and the cost, which is paid directly by the patient, will likely limit its use.

Introduction: Acute heart failure (AHF) is the leading cause of hospitalization in patients over 65 years, representing a heterogenic syndrome and a major burden, as it is associated with elevated health expenditures and high rates of mortality and readmission.

Areas covered: This article provides a review of individual markers for risk stratification, including clinical, cardiorenal, hemodynamic, neurohormonal and cardiac biomarkers. In addition, aspects as complementary value, monitoring, risk models and events prediction are analyzed.

Expert opinion: In clinical practice, risk stratification of AHF is complex and relies on the integration of bedside evaluation and laboratory biomarkers. Measures of congestion and perfusion, renal function, natriuretic peptides and cardiac troponins have become standard risk markers of death and/or readmission. However, there are numerous research findings that do not translate into an improved clinical management of individuals and a reduction of health costs. Research on this field needs to be redirected in a prospective manner in order to evaluate risk models in the emergency department. This would allow safe identification of patients at lower risk - who could be transferred and managed in out-patient facilities - as well as those biomarkers that, by reflecting pathophysiological routes, could be used as a guide to related therapeutics for improving outcomes. In addition, the identification of specific markers and models closely related with the risk of recurrent AHF is mandatory. Consequently, it is the time for clinicians working in networks to assume a leading role in translating risk assessment in AHF into clinical practice.

The 'real time' capability of ultrasound (US) allows dynamic assessment of joint and tendon movements, which can often aid in the detection of structural abnormalities. The simultaneous use of arthroscopy (AS) and US is therefore a logical progression. Here the results of a series of 11 patients with different rheumatic diseases in whom a combined use of US and AS was adopted are reported.