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Challenges in Cardiovascular Risk Prediction and Stratifi cation in Women

Cardiovascular Innovations and Applications 2019年第B2期3卷 329-348页

作者： Sonia Henry,md Rachel Bond,md Stacey Rosen,md cindy grines,md Jennifer Mieres,md Northwell Health Department of CardiologyNorthshore University HospitalHofstra School of Medicine300 Community DriveManhassetNY 11030USA Northwell Health Department of CardiologyHofstra North Shore-LIJ School of MedicineLenox Hill Hospital110 E.59th StreetSuite 8ANew YorkNY 10022USA Northwell Health Department of CardiologyHofstra School of MedicineThe Katz Institute for Women’s Health1981 Marcus AvenueSuite E110Lake SuccessNY 11042USA Hofstra School of Medicine Northwell Health1979 Marcus Avenue Suite 236Lake SuccessNY 11042USA

There has been an appropriate focus,since the turn of the 21 st century,on sex-and gender-specifi c cardiovascular disease(CVD)as increasing evidence suggests that there are substantial differences in the risk factor profi le,social and environmental factors,clinical presentation,diagnosis,and treatment of ischemic heart disease in women compared with men.As a result of increased awareness,detection,and treatment of ischemic heart disease in women,there has been signifi cant reduction(greater than 30%)in cardiovascular mortality,and in 2013,more US men than US women died of CVD.Nevertheless,continued efforts are required as CVD remains the leading cause of cardiovascular morbidity and death of women in the Western world,and in women younger than 55 years there has been a rise in cardiovascular mortality.In this article,we review several of the contributing factors that continue to cause challenges in accurate risk prediction and risk stratifi cation in women.

关键词： sex and gender disparity risk prediction risk stratifi cation ischemic heart disease

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Recent advances in the translation of drug metabolism and pharmacokinetics science for drug discovery and development

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Acta Pharmaceutica Sinica B 2022年第6期12卷 2751-2777页

作者： Yurong Lai Xiaoyan Chu Li Di Wei Gao Yingying Guo Xingrong Liu Chuang Lu Jialin Mao Hong Shen Huaping Tang cindy Q.Xia Lei Zhang Xinxin Ding Drug Metabolism Gilead Sciences Inc.Foster CityCA 94404USA Department of Pharmacokinetics Pharmacodynamics and Drug MetabolismMerck&Co.Inc.KenilworthNJ 07033USA Pharmacokinetics Dynamics and MetabolismPﬁzer Worldwide Research and DevelopmentGrotonCT 06340USA Eli Lilly and Company IndianapolisIN 46221USA Drug Metabolism and Pharmacokinetics BiogenCambridgeMA 02142USA Drug Metabolism and Pharmacokinetics Accent TherapeuticsInc.LexingtonMA 02421USA Department of Drug Metabolism and Pharmacokinetics GenentechA Member of the Roche GroupSouth San FranciscoCA 94080USA Drug Metabolism and Pharmacokinetics Department Bristol-Myers Squibb CompanyPrincetonNJ 08540USA Bioanalysis and Biomarkers Glaxo Smith KlineKing of the PrussiaPA 19406USA Department of Drug Metabolism and Pharmacokinetics Takeda Pharmaceuticals International Co.CambridgeMA 02139USA Ofﬁce of Research and Standards Ofﬁce of Generic DrugsCDERFDASilver SpringMD 20993USA Department of Pharmacology and Toxicology College of PharmacyUniversity of ArizonaTucsonAZ 85721USA Current afﬁliation:Translational Medicine EMD Serono Research&Development InstituteInc.BillericaMA 01821USA Current afﬁliation:Drug Metabolism Gilead Sciences Inc.Foster CityCA 94404USA

Drug metabolism and pharmacokinetics(DMPK) is an important branch of pharmaceutical sciences.The nature of ADME(absorption,distribution,metabolism,excretion) and PK(pharmacokinetics) inquiries during drug discovery and development has evolved in recent years from being largely descriptive to seeking a more quantitative and mechanistic understanding of the fate of drug candidates in biological systems.Tremendous progress has been made in the past decade,not only in the characterization of physiochemical properties of drugs that influence their ADME,target organ exposure,and toxicity,but also in the identification of design principles that can minimize drug-drug interaction(DDI) potentials and reduce the attritions.The importance of membrane transporters in drug disposition,efficacy,and safety,as well as the interplay with metabolic processes,has been increasingly recognized.Dramatic increases in investments on new modalities beyond traditional small and large molecule drugs,such as peptides,oligonucleotides,and antibody-drug conjugates,necessitated further innovations in bioanalytical and experimental tools for the characterization of their ADME properties.In this review,we highlight some of the most notable advances in the last decade,and provide future perspectives on potential major breakthroughs and innovations in the translation of DMPK science in various stages of drug discovery and development.

关键词： Drug discovery and development New drug application Biologics license application Pharmacokinetics ADME New modalities Model-informed drug development Micro-physiological systems

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Precision health: A nursing perspective

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International Journal of Nursing Sciences 2020年第1期7卷 5-12页

作者： Mei R.Fu Emma Kurnat-Thoma Angela Starkweather Wendy A.Henderson Ann K.Cashion Janet K.Williams Maria C.Katapodi Karin Reuter-Rice Kathleen T.Hickey Veronica Barcelona de Mendoza Kathleen Calzone Yvette P.Conley cindy M.Anderson Debra E.Lyon Michael T.Weaver Pamela K.Shiao Rose E.Constantino Shu-Fen Wung Marilyn J.Hammer Joachim G.Voss Bernice Coleman William F.Connell School of Nursing Boston CollegeChestnut HillMAUSA National Institute of Nursing Research National Institutes of HealthBethesdaMDUSA School of Nursing and Health Studies Georgetown UniversityWashingtonDCUSA School of Nursing University of ConnecticutStorrsCTUSA School of Nursing The University of IowaIowa CityIAUSA Nursing Science University of BaselBaselSwitzerland School of Nursing Duke UniversityDurhamNCUSA School of Nursing Columbia UniversityNew YorkNYUSA School of Nursing Yale UniversityOrangeCTUSA National Cancer Institute Center for Cancer ResearchGenetic BranchBethesdaMDUSA School of Nursing University of PittsburghPittsburghPAUSA College of Nursing The Ohio State UniversityOHUSA University of Florida Gainesville FLUSA Center for Biotechnology and Genomic Medicine Medical College of GeorgiaAugusta UniversityAugustaGAUSA College of Nursing The University of Arizona TucsonAZUSA Dana-Farber Cancer Institute 450 Brookline AvenueLW523BostonMAUSA Frances Payne Bolton School of Nursing Case Western Reserve UniversityClevelandOHUSA Nursing Research and Development Cedars-Sinai Medical CenterLos AngelesUSA

Precision health refers to personalized healthcare based on a person's unique genetic,genomic,or omic composition within the context of lifestyle,social,economic,cultural and environmental influences to help individuals achieve well-being and optimal health.Precision health utilizes big data sets that combine omics(i.***.genomic sequence,protein,metabolite,and microbiome information)with clinical information and health outcomes to optimize disease diagnosis,treatment and prevention specific to each patient.Successful implementation of precision health requires interprofessional collaboration,community outreach efforts,and coordination of care,a mission that nurses are well-positioned to lead.Despite the surge of interest and attention to precision health,most nurses are not well-versed in precision health or its implications for the nursing profession.Based on a critical analysis of literature and expert opinions,this paper provides an overview of precision health and the importance of engaging the nursing profession for its implementation.Other topics reviewed in this paper include big data and omics,information science,integration of family health history in precision health,and nursing omics research in symptom science.The paper concludes with recommendations for nurse leaders in research,education,clinical practice,nursing administration and policy settings for which to develop strategic plans to implement precision health.

关键词： Nurses Genomics Omics Precision medicine Precision health

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颅内出血患者抗栓药逆转指南美国神经重症监护学会和美国重症医学会对医疗卫生专业人员的声明

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国际脑血管病杂志 2016年第11期24卷 961-985页

作者： Jennifer A. Frontera John J. Lewin Ⅲ Alejandro A. Rabinstein Imo P. Aisiku Anne W. Alexandrov Aaron M. Cook Gregory J. del Zoppo Monisha A. Kumar Ellinor I. B. Peerschke Michael F. Stiefel Jeanne S Teitelbaum Katja E. Wartenberg cindy L. Zerfoss 杨一萍谢丽丽宁小金季宇腾柯开富 From the Cerebrovascular Center Neurological Institute Cleveland Clinic and Case Western Reserve University 9500 Euclid Ave. S80 Cleveland OH44195 USA The Departments of Pharmacy and Anesthesiology & Critical Care Medicine The Johns Hopkins Hospital and Johns Hopkins University School of Medicine Baltimore MD USA The Department of Neurology Mayo Clinic Rochester MN USA Harvard Medical School Brigham and Women's Hospital Boston MA USA The University of Tennessee Health Science Center Memphis TN USA Department of Pharmacy Practice & Science (UK College of Pharmacy) University of Kentucky Lexington KY USA The Departments of Medicine (Hematology) and Neurology University of Washington School of Medicine Seattle WA USA The Departments of Neurology Neurosurgery Anesthesiology & Critical Care Perelman School of Medicine Hospital of the University of Pennsylvania Philadelphia PA USA The Department of Laboratory Medicine and Pathology Memorial Sloan Kettering Cancer Center and Weill Comell Medical School New York NY USA The Department of Neurosurgery Westchester Medical Center New York Medical College Valhalla NY USA Hepital du Sacre-Coeur and University of Montreal and Montreal Neurological Institute and McGill University Montreal Quebec Canada Klinik fur Neurologie Martin-Luther-Universitat Halle-Wittenberg Halle Germany The Neuroscience and Neurosurgery Departments Centra Lynchburg General Hospital Lvnchburg VA. USA 南通大学附属医院神经内科 226001

背景抗栓药的使用，包括抗凝药、抗血小板药和溶栓药，在过去10年中日益增多并且预计将继续上升。虽然抗栓药相关性颅内出血可能是灾难性的，但快速逆转凝血功能障碍可能有助于限制血肿增大和改善转归。方法美国神经重症监护学会联合美... 详细信息

背景抗栓药的使用，包括抗凝药、抗血小板药和溶栓药，在过去10年中日益增多并且预计将继续上升。虽然抗栓药相关性颅内出血可能是灾难性的，但快速逆转凝血功能障碍可能有助于限制血肿增大和改善转归。方法美国神经重症监护学会联合美国重症医学会组建了一个国际性多机构委员会，涉及的专业领域包括神经重症监护、神经内科、神经外科、卒中、血液学、血液病理学、急诊医学、药学、护理和指南制定，目的是进行文献评价并制定一份循证实践指南。该委员会进行了正式的文献检索，并对符合标准的研究进行了评价。结果利用GRADE方法学，委员会提出了在颅内出血情况下逆转维生素K拮抗药、直接Xa因子拮抗药、直接凝血酶抑制药、普通肝素、低分子肝素、类肝素、戊多糖、溶栓药和抗血小板药的推荐意见。结论该指南提供了及时和循证的抗栓药逆转策略以协助临床医生治疗抗栓药相关性颅内出血。

关键词：抗凝药抗血小板药抗栓药颅内出血脑出血脑实质出血蛛网膜下腔出血硬膜下出血逆转解药维生素K拮抗药华法林香豆素直接凝血酶抑制药达比加群 Xa因子抑制药阿哌沙班利伐沙班依杜沙班低分子肝素肝素类肝素戊多糖磺达肝素 TPA rtPA 阿替普酶溶栓药纤溶酶原激活物阿司匹林氯吡格雷凝血酶原复合物新鲜冰冻血浆重组因子Ⅶa 鱼精蛋白血小板去氨加压素冷沉淀指南 GRADE标准

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