Expert review of molecular diagnostics
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Expert Rev. Mol. Diagn. · Sep 2020
ReviewThe diagnostic methods in the COVID-19 pandemic, today and in the future.
The emergence of anovel coronavirus identified in patients with unknown cause of acute respiratory disease in Wuhan, China at the end of 2019 has caused aglobal outbreak. The causative coronavirus was later named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease caused by SARS-CoV-2 was named as Coronavirus Disease-2019 (COVID-19). As of 10 August 2020, more than 19,718,030 confirmed cases and 728,013 deaths have been reported. COVID-19 is spread via respiratory droplets which are inhaled into the lungs. ⋯ In this pandemic, rapid and accurate identification of COVID-19 patients are critical to break the chain of infection in the community. RT-PCR provides a rapid and reliable identification of SARS-CoV-2 infection. In the future, molecular diagnostics will still be the gold standard and next-generation sequencing can help us to understand more on the pathogenesis and detect novel mutations. It is believed that more sophisticated detection methods will be introduced to detect SARS-CoV-2 as earliest as possible.
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Expert Rev. Mol. Diagn. · Oct 2018
ReviewCirculating tumor cells as biomarkers in head and neck cancer: recent advances and future outlook.
Assessment of circulating tumor cells (CTCs) in peripheral blood from solid cancer patients including head and neck squamous cell carcinoma (HNSCC) has proven useful for detection of subclinical disease that otherwise remains invisible for current staging techniques. Based on large cohort studies, diagnostic tests for enumeration of CTCs have been developed, which can be used for tumor staging, prognosis, treatment monitoring, and post-treatment surveillance. Areas covered: Here, we briefly summarize the history of CTC discovery. ⋯ We also discuss potential clinical applications of CTC detection for personalized treatment strategies. Expert commentary: Recent technical advances in the platforms for enrichment, detection, and comprehensive molecular characterization of CTC represent a great opportunity to improve our understanding in the biology of CTCs and will allow to expand the clinical utility of CTCs in HNSCC. Especially, HNSCC patients with recurrent/metastatic disease associated dismal prognosis and little improvement in treatment outcome over the past decade might benefit in the future from incorporation of CTC assays in clinical management.
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Expert Rev. Mol. Diagn. · Jul 2018
ReviewMolecular and point-of-care diagnostics for Ebola and new threats: National POCT policy and guidelines will stop epidemics.
US hospitals that admitted Ebola virus disease (EVD) patients mitigated risk by using point-or-care testing (POCT) for critical support in isolation units. Success proved unequivocally the need for POCT. Additionally, molecular diagnostics have been used to help stop new outbreaks, and even handheld diagnostic solutions are emerging. ⋯ New graphics illustrate POC error mitigation/risk reduction, a framework for national POCT policy and guidelines, modular adaptations for country-specific solutions, and a logic diagram for future progress embedding artificial intelligence. Expert commentary: The USA is still not prepared for highly infectious diseases. Key is lack of community rapid response and resilience, which must be enhanced not via mechanisms distant, but instead by molecular diagnostics directly at critical points of need.
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Expert Rev. Mol. Diagn. · Oct 2017
ReviewAn update on biomarkers for kinase inhibitor response in non-small-cell lung cancer.
The discovery of activating genetic and their use as predictive biomarkers for targeted therapy, such as tyrosine kinase inhibitors (TKIs), has changed the treatment paradigm of non-small cell lung cancer (NSCLC). As a result, epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) TKIs have become the standard first-line treatment. Since then, other kinds of targetable oncogenic alterations have been identified in NSCLC. ⋯ Expert commentary: Although targeted therapies dramatically improve the outcome of patients with NSCLC harboring specific oncogenic alterations, molecular and clinical resistance almost invariably develops. New TKIs specifically active in molecular subgroups of NSCLC or the resistance setting have now been developed. The development of additional TKIs and rational combinations may further improve outcomes of NSCLC.
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Expert Rev. Mol. Diagn. · Jun 2017
ReviewOverview of procalcitonin assays and procalcitonin-guided protocols for the management of patients with infections and sepsis.
Procalcitonin is a surrogate infection blood marker whose levels help estimate the likelihood of bacterial infections and correlate with their resolution. Recent trials have revealed the benefits of inclusion of procalcitonin in antibiotic stewardship protocols for initiation and discontinuation of antimicrobial therapy. Areas covered: Procalcitonin-guided antibiotic stewardship protocols have shown appreciable reductions in antibiotic use and duration of therapy in respiratory infections, sepsis, and other infections, with positive effects on clinical outcomes. ⋯ The authors provide an overview of the strengths and limitations of currently available procalcitonin assays and antibiotic therapy algorithms incorporating procalcitonin currently used in different clinical settings and in patients with different underlying infections. Expert commentary: Use of sensitive procalcitonin measurements in clinical algorithms can reduce antimicrobial overuse, decreasing the risk of side effects and controlling emerging bacterial multi-resistance. Before use in clinical practice, it is important to carefully assess the quality of novel PCT assays and rigorously evaluate them in target patient populations across clinically relevant cut-off ranges.