医学的未来场景是现实的吗?

R. Mazaheri Nezhad Fard
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Numerous ideas are available although they are mostly raw and need supporting activities to become applicable. On the other hand, the lack of sufficient resources such as funds, scientists, and training programs has slowed down the process. Personalized medicine (i.e., AKA personal medicine, precision medicine, stratified medicine, and P4) is considered as one of the most important novelties in medicine (1). Since the mid-90s and by marketing next-generation sequencing (NGS) platforms, significant steps have been taken in mapping the human genome. The huge body of data from such studies clarifies hidden gene functions that were previously unknown (2). Furthermore, other cell function fields such as transcriptome and metabolome help better understand cell metabolism. Recent developments in NGS (3rd and 4th generation sequencings) have decreased the total cost and the required time while increasing accuracy and efficiency. 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Microbiology, physiology epidemiology, and particularly bioinformatics can be listed among these sciences. Bioinformatics can help analyze and visualize raw data, thus the information is ready to be summarized by the physicians although this discipline is still developing. Another pitfall of developing personalized medicine refers to the lack of medical consultants in general practices. Considering that personalized medicine is a multidisciplinary field of science, the diagnosis process should be progressed based on suggestions from various medical specialists. Although this scenario does not match the current scenario in medical centers, it seems necessary for further efficient diagnosis. A major reason for this idea is directly linked to highlighted axes between body organs mostly due to their microbial populations. 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引用次数: 0

摘要

许多年前,有人问我关于医学的未来和这个领域的创新。尽管近几十年来医学预测已经成为现实,但至少在未来几年,整体情况似乎是不可避免的。事实上,这个问题显然让我想起了科幻小说。这种类型的预测通常被高估了。总的来说,现代医学或正统医学在过去的几个世纪里一直很受欢迎。传统医学以前使用了几千年,后来被现代医学所取代。然而,这些医学知识宝库都不包括提高公共卫生、降低成本和增加患者救济的完美熟练程度。因此,医疗机构关注建立新的协议,以提高目前的医疗环境。有许多想法是可用的,尽管它们大多是原始的,需要支持活动才能应用。另一方面,缺乏足够的资源,如资金、科学家和培训计划,减缓了这一进程。个性化医疗(即个人医疗、精准医疗、分层医疗和P4)被认为是医学中最重要的新奇事物之一(1)。自90年代中期以来,通过营销下一代测序(NGS)平台,在绘制人类基因组图谱方面取得了重大进展。来自此类研究的大量数据阐明了以前未知的隐藏基因功能(2)。此外,转录组和代谢组等其他细胞功能领域有助于更好地了解细胞代谢。NGS(第三代和第四代测序)的最新发展降低了总成本和所需时间,同时提高了准确性和效率。然而,技术上的限制,如相对较少数量的测序仪和专业操作人员,削弱了它的多重优势。NGS的另一个重大医学进步是微生物组研究。微生物组(或微生物群)包括大多数人类和动物体细胞(3)。换句话说,它约占体细胞的900%。目前,微生物群在人体器官中的各种基本规律作用被描述。此外,人体器官之间还存在必要轴,与它们的微生物组含量和微生物代谢物有关。这些轴的一些例子包括肠-脑、肠-肝和肝-脑轴。考虑到每个人的微生物组都是特定的,对不同的人(包括健康的人和病人)进行分析是必要的,基因组分析也是必要的。此外,其他跨学科的科学对于分析结果的成功使用是必不可少的。微生物学、生理学、流行病学,尤其是生物信息学,都属于这些学科。生物信息学可以帮助分析和可视化原始数据,因此这些信息可以被医生总结,尽管这一学科仍在发展中。发展个体化医疗的另一个陷阱是在一般实践中缺乏医疗顾问。考虑到个性化医疗是一个多学科的科学领域,诊断过程应该根据不同医学专家的建议来推进。虽然这种情况与目前医疗中心的情况不相符,但为了进一步有效诊断,这似乎是必要的。这个想法的一个主要原因是与身体器官之间的突出轴直接相关,主要是由于它们的微生物种群。可能的专家委员会组合包括一名全科医生、一名内科专家、一名医学专家(根据患者的症状或涉及的器官)、一名微生物学家和一名遗传学家。这个想法可以避免患者重复访问医疗中心/办公室,从而降低治疗成本。普及个性化医疗的其他先决条件包括微阵列分析和微芯片植入跟踪器。幸运的是,进展阿维森纳临床微生物学和感染杂志
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Are Futuristic Scenarios for Medicine Realistic?
Many years ago, I was literarily asked about the future of medicine and innovations in this field. Although medical predictions have come to reality in recent decades, the whole picture seems inevitable at least for upcoming years. Indeed, this issue apparently reminded me of the science-fiction genre. Predictions in this genre are usually overestimated. In general, modern medicine or orthodox medicine has been popular for the last few centuries. Traditional medicine was previously used for millenniums, which was later replaced by modern medicine. However, none of these medical knowledge treasures included perfect proficiencies for enhancing public health, decreasing the costs, and increasing patient relief. Therefore, medical bodies have concerns about establishing novel protocols in order to elevate current medical settings. Numerous ideas are available although they are mostly raw and need supporting activities to become applicable. On the other hand, the lack of sufficient resources such as funds, scientists, and training programs has slowed down the process. Personalized medicine (i.e., AKA personal medicine, precision medicine, stratified medicine, and P4) is considered as one of the most important novelties in medicine (1). Since the mid-90s and by marketing next-generation sequencing (NGS) platforms, significant steps have been taken in mapping the human genome. The huge body of data from such studies clarifies hidden gene functions that were previously unknown (2). Furthermore, other cell function fields such as transcriptome and metabolome help better understand cell metabolism. Recent developments in NGS (3rd and 4th generation sequencings) have decreased the total cost and the required time while increasing accuracy and efficiency. However, technical limitations such as relatively small numbers of sequencers and expert operators have faded its multiple advantages. Another great medical advancement by NGS belongs to microbiome studies. Microbiome (alternatively microbiota) includes a majority of human and animal body cells (3). In other words, this accounts for approximately 900% of somatic cells. Nowadays, various fundamental regularity roles in body organs are described for microbiota. Moreover, essential axes are demonstrated between body organs, associating to their microbiome contents and microbial metabolites. Some examples of these axes include gut-brain, gut-liver, and liver-brain axes. Given that the microbiome of every person is specific to that person, its analysis for different people (both healthies and patients) is necessary as is genome analysis. Additionally, other interdisciplinary sciences are essential for the successful use of analysis results. Microbiology, physiology epidemiology, and particularly bioinformatics can be listed among these sciences. Bioinformatics can help analyze and visualize raw data, thus the information is ready to be summarized by the physicians although this discipline is still developing. Another pitfall of developing personalized medicine refers to the lack of medical consultants in general practices. Considering that personalized medicine is a multidisciplinary field of science, the diagnosis process should be progressed based on suggestions from various medical specialists. Although this scenario does not match the current scenario in medical centers, it seems necessary for further efficient diagnosis. A major reason for this idea is directly linked to highlighted axes between body organs mostly due to their microbial populations. A possible expert board combination includes a general practitioner, an internal medicine specialist, a medical specialist (based on the patient’s symptoms or the involved organ), a microbiologist, and a geneticist. This idea can avoid repetitive visits of medical centers/offices by patients and hence decrease treatment costs. Other prerequisites for popularizing personalized medicine include microarray analysis and microchip implant trackers. Fortunately, advancements Avicenna Journal of Clinical Microbiology and Infection
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