N. Pedar. Georgia College and State University.
The city’s fortunes immediately took oﬀ best 525mg anacin pain treatment ibs, for it became the main supply center for the Amalﬁtan merchants purchase 525mg anacin pain treatment center colorado springs, whose own hinterland was insuﬃ- cient to feed them and whose port was inadequate to sustain traﬃc in the heavy goods theyexported from southern Italy to north Africa discount anacin 525 mg mastercard knee pain laser treatment. Norman pilgrims passing through southern Italy at the end of the tenth century had been asked to aid the city of Salerno in repelling an attack of Muslim invaders purchase anacin 525 mg with mastercard valley pain treatment center phoenix. Hired as mercenaries (by Christians as well as Muslims) during subsequent years, these Norman knights gradually became invaders themselves and bit by bit expanded their control over several southern Italian duchies. Their extended siege of Salerno in took its toll on the city, but Robert Guiscard immediately made it the capi- tal of the newly united Norman duchy of Apulia and Calabria. In , when the Normans consolidated most of the fragmented Norman duchies into a single kingdom, they moved their capital to Palermo, in Sicily, which they had seized from Muslim control. It had become an archepiscopal see in the mid-s, and so was of some importance for local ecclesiastical administration. The Lombards, a Germanic people who had immigrated into the area in the late sixth century, controlled the duchies of Benevento,Capua, and Salerno up through the eleventh century, and they remained numerically dominant in the population afterward. Therewere also enclaves of Greek-speaking commu- nities in southern Italy, and whole principalities (such as Gaeta, Naples, and Amalﬁ) continued to follow Byzantine (Roman) law throughout this period. In the far south, Byzantium had reconquered Calabria, Lucania, and Apulia in the ninth century, and these remained under loose Byzantine authority until the Normans began to wrench control away in . Contact with Byzantium remained frequent even after its political control faded, and individuals such as Archbishop Alfanus of Salerno are known to have traveled to Constanti- nople. Although there were no resident Muslim communities on the southern Italian mainland during the eleventh and twelfth centuries, commercial inter- change with Sicilian, North African, and other Muslim merchants throughout the period would have kept southern Italians aware of Muslim culture. All of these communities, of course, had their respective notions of how the genders should function and what rights and responsibilities they had. Most of the Normans who came were male, and they quickly intermarried with local Lombard women. Lombard women spent their whole lives under the guardian- ship (mundium) of a male: their father was their guardian until they married, Introduction then their husband, and then (if widowed) their adult sons, brothers, or other male relatives. Never- theless, even though wives technically retained their right over alienating this property (always, of course, with the permission of their guardian), charter evidence suggests that they more often merely consented to their husband’s actions than initiated such transactions themselves. Salernitan society has been characterized as having ‘‘an acute consciousness of nobility or aspirations to noble status,’’31 a sensitivity that manifests itself in Women’s Cosmetics as well as in the medical writings of other Salernitan practitioners. There may have always been some level of awareness among Christian women in southern Italy of the diﬀering cultural practices of Muslim women; a Muslim slave woman is listed as part of a Christian woman’s dowry in Bari in ,34 and it is likely that there were others. The Spanish Muslim historian Ibn Jubayr, who described his travels through the Mediterranean in –, noted with some surprise how eagerly Christian women in Palermo adopted the customs of local Muslim women: ‘‘The Christian women of this city follow the fashion of Muslim women, are ﬂuent in speech, wrap their cloaks about them, and are veiled. They go forth on this Feast Day [Christmas] dressed in robes of gold-embroidered silk, wrapped in elegant cloaks, concealed by coloured veils, and shod with gilt slippers. Indeed, the attribution of a certain cosmetic preparation to Muslim noblewomen suggests Christian women’s turning to this neighboring culture forany symbols that would help secure theirown class aspirations. Yet the exchanges between these cultures were as real as their mutual antagonisms. The recogni- tion by Christians that the Muslims had intellectual goods to oﬀer as valuable as their spices and perfumes is at the heart of what made Salernitan medicine unique. M In or early in , the Salernitan writer Alfanus reminisced that in his youth ‘‘Salerno then ﬂourished to such an extent in the art of medicine that no illness was able to settle there. At the time he made his claim, many other parts of southern Italy were richly supplied with practitioners; indeed, the neighboring city of Naples was particularly notable for its large number of lay healers. These features also con- tributed to the support of a population wealthy enough to aﬀord the services of these increasingly sophisticated practitioners. Salerno’s growing reputation, in turn, attracted visitors from distant lands, including a signiﬁcant number of English people who themselves contributed to the further dissemination of Salernitan medicine. But it is only in the second quarter of the eleventh century, in the ﬁgure of a physician by the name of Gariopontus, that we ﬁnd the beginnings of the intellectual transformation that would not simply give shape to the distinctive teachings of Salernitan masters but would also serve as the foundation for medical instruction throughout all of western Europe for the next several centuries. Gariopontus, apparently frustrated with the disorga- nized and often indecipherable texts then circulating in southern Italy, decided to rework them into usable form. His resulting compilation, the Passionarius, would become a popular resource for physicians both near and far and initiate the ﬁrst teaching glosses and commentaries that marked the revival of medical pedagogy in early-twelfth-century Salerno. Sometime before the mid-s, Alfanus translated Nemesius of Emesa’s Greek On the Nature of Man into Latin; he also composed two medical works in his own right, at least one of which shows Byzantine inﬂuence. Constantine came from North Africa, perhaps from Tunis, and was thus a native speaker of Ara- bic. Constantine arrived in Salerno around the year but soon, at the recommendation of Alfanus, moved to the Benedic- tine Abbey of Monte Cassino, with which Alfanus had intimate ties. Constan- tine became a monk and spent the rest of his life in the rich, sheltered conﬁnes of the abbey, rendering his valuable cache of Arabic medical texts into Latin. He translated at least twenty works, including the better part of ‘Alī ibn al- ‘Abbās al-Majūsī’s Pantegni (a large textbook of general medicine) plus smaller, more specialized works on pharmaceutics, urines, diets, fevers, sexual inter- course, leprosy, and melancholy. Written by a physician from Qayrawān (in modern-day Tunisia) Introduction named Abū Ja‘far Aḥmad b. Its sixth book was devoted to diseases of the reproductive organs and the joints, and it was upon this that the author of the Salernitan Conditions of Women would draw most heavily. Beyond their length, they had introduced into Europe a rich but diﬃcult vocabulary, a wealth of new pharmaceuticals, and a host of philo- sophical concepts that would take medical thinkers years to fully assimilate. Yet ultimately, the availability of this sizable corpus of new medical texts would profoundly change the orientation of Salernitan medicine. The medical writings of twelfth-century Salerno fall into two distinct categories. Embodying the dictum that ‘‘medicine is divided into two parts: theory and practice,’’ twelfth-century Salernitan writings can be classiﬁed as either theoretical or practical. Salernitan medicine was distinguished by its em- phasis on what can properly be called a ‘‘philosophical medicine. A curriculum of basic medi- cal texts to be used for introductory instruction seems to have formed just after . Later to be called the Articella (The little art), this corpus initially comprised ﬁve texts, among which were Constantine’s translations of Ḥunayn ibn Isḥāq’s Isagoge (a short handbook that introduced the student to the most basic principles of medical theory) and the Hippocratic Aphorisms and Prog- nostics. Two additional works recently translated from Greek—Philaretus’s On Pulses and Theophilus’s On Urines—were also included. Gariopontus’s Pas- sionarius may have served as the ﬁrst text to be subjected to this kind of intense analysis, though at least by the second or third decade of the century extended commentaries were being composed on the Articella as well. The reintroduction of alphabeti- zation for pharmaceutical texts, for example, made it possible for Salernitan writers to absorb some small portion of the wealth of pharmacological lore that Constantine had rendered into Latin. The organizational beneﬁts that written discourse provided were equally evident in the Salernitan masters’ Practicae. These were veritable medical en- cyclopedias, usually arranged in head-to-toe order, encompassing all manner of diseases of the whole body. Copho in the ﬁrst half of the twelfth century, Johannes Platearius in the middle of the century, and Archimattheus, Bar- tholomeus, Petrus Musandinus, Johannes de Sancto Paulo, and Salernus in the latter half of the century all wrote their own compendia of cures. These practi- cae replicated the Arabic encyclopedias in including sections on women’s dis- eases (usually placed after diseases of the male genitalia), yet at the same time they showed considerable originality in devising their own therapeutic pro- grams. None of these male writers, however, broke new ground in his catego- rization of gynecological disease. Salernitan anatomical writers did de- vote considerable attention to the anatomy of the uterus and the ‘‘female tes- ticles’’; that these descriptions became increasingly more detailed over time owes not to inspection of women’s bodies, however, but to the assimilation of bits and pieces of anatomical and physiological lore from a variety of other written sources. Nicholaus, the author of the most important text on compound medicines, promised his readers that by dispensing the medicines described in his text, ‘‘they would have an abundance of money and be gloriﬁed by a multitude of friends.
Associations between socioeconomic status and cardiovascular Diabetes Research and Clinical Practice order 525 mg anacin visa pain medication for dogs over the counter, 2000 generic anacin 525 mg otc sacroiliac joint pain treatment exercises, 48:37–42 cheap 525 mg anacin with mastercard pain treatment center of illinois. Health Policy and Planning purchase anacin 525 mg amex knee pain treatment by injection, 2005, care for coronary heart disease related and not related to 20:41–49. Organization European Ofﬁce for Investment for Health and Canberra, Australian Institute of Health and Welfare/Centre for Development, 2005. Canberra, Australian Journal of Health, Population and Nutrition, 2001, 19:291–300. The economic costs associated with physical inactivity and obesity in Canada: an update. This part of the report provides a summary of the evidence, and explains how interventions for both the whole population and individuals can be combined when designing and implementing a chronic disease prevention and control strategy. They address the causes rather than the consequences of chronic diseases and are central to attempts to prevent the emergence of future epidemics. Small reductions in the exposure of the population to risk factors such as tobacco » Rapid health gains use, unhealthy diet and physical can be achieved with inactivity lead to population-level comprehensive and reductions in cholesterol, blood integrated action pressure, blood glucose and body » In this way, many weight. More fundamentally, countries and regions interventions are also required have already successfully to address the underlying deter- curbed chronic diseases minants of chronic disease, as described in Part Two. Interventions for individuals focus on people who are at high risk and those with estab- lished chronic disease. These interventions reduce the risk of developing chronic disease, reduce complications, and im- prove quality of life. A strategy to achieve rapid results Population-wide and individual approaches are complementary. They should be combined as part of a comprehensive strategy that serves the needs of the entire population and has an impact at the individual, community and national levels. Comprehensive approaches should also be integrated: covering all the major risk factors and cutting across speciﬁc diseases. Risk factor reduction can lead to surprisingly rapid health gains, at both population and individual levels. This can be observed through national trends (in Finland and Poland, for example, as described on page 93), sub-national epidemiological data and clinical trials. In the case of tobacco control, the impact of proactive policies and programmes is almost immediate. The implementation of tobacco-free policies leads to quick decreases in tobacco use, rates of cardiovascular disease, and hospitalizations from myocardial infarction. Improving diet and physical activity can prevent type 2 diabetes among those at high risk in a very short space of time. Lowering a person’s serum cholesterol concentration results in quick and substantial protec- tion from heart disease. Beneﬁts are related to age: a 10% reduction in serum cholesterol in men aged 40 can result in a 50% reduction in heart disease, while at age 70 there is on average a 20% reduction. Beneﬁts can be realized quickly – after two years – with full beneﬁts coming after ﬁve years (4). While Australia, Canada, the United Kingdom and the United States, for example, have achieved steady declines in heart disease death rates, the rates in other countries, such as Brazil and the Rus- sian Federation, have remained the same or increased (see ﬁgure below). Initial reductions occurred partly as a result of the diffusion of health-related information to the general population. These approaches have been used to reduce chronic disease death rates in many countries, demonstrating the feasibility of achieving more widespread success. Vegetable fat and oil consumption disease among young and middle-aged men elimination of blinding trachoma by increased (primarily in the form of rape- and women. This success has resulted from seed and soybean oil products), while political and economic changes in 1991, a combination of high-level political animal fat consumption, mainly butter, this trend sharply reversed. These trends were associated between 20 and 44 years, the decline in death munity participation in prevention with the removal of price subsidies on rates averaged 10% annually, while in those and control efforts. Other factors contribut- Trachoma is a chronic disease with rate of decline was 6. This was one of ing to the decline include increased fruit an infectious origin that results in the most dramatic rates of decline ever seen consumption and decreased tobacco use irreversible blindness if untreated. Improvements in medi- was common in Morocco in the 1970s since occurred in other countries in eastern cal treatment contributed little, if at all, to and 1980s. This was largely a result of widespread and heavy tobacco use, high- external partners. In response to local concerns, a large-scale provision of surgical services to stop the pro- community-based intervention was organized, involving consumers, schools, and gression of blindness, health promotion and social and health services. It included legislation banning tobacco advertising, environmental measures to prevent infection, the introduction of low-fat dairy and vegetable oil products, changes in farmers’ and treatment with antibiotics in trachoma- payment schemes (linking payment for milk to protein rather than fat content), and endemic areas. As a result, in the last 10 years more than Death rates from heart disease in men have been reduced by at least 65%, and 80 000 people have had progression of blind- lung cancer death rates in men have also fallen. Greatly reduced cardiovascular ness prevented through surgery; more than and cancer mortality has led to greater life expectancy – approximately seven 700 000 people were treated with antibiotics; years for men and six years for women (7). Vil- 200 lages have also received support for the 100 development of income-generating activities, with some of the revenue supporting health 0 promotion and health service provision for 1950 1960 1970 1980 1990 2000 2010 Year children and the elderly. In 2003, at the age of 50, he was diagnosed with diabetes following his yearly medical check-up. He had been developing a programme which enables children with diabetes to exercise safely. More than ever, Milton is convinced that awareness is crucial to maintaining health and avoiding complications. Milton now believes that being diagnosed with diabetes is the best thing that ever happened to him as he feels deeply that he’s making a difference through his actions. The chapter out- risk factors can lead to lines the evidence showing that a large reduction of the chronic diseases can be prevent- burden of chronic diseases ed and controlled using available » Population-wide knowledge. Moreover, it shows approaches form the that the solutions are not only central strategy for effective but can be highly cost- preventing chronic effective even in settings with few disease epidemics, but resources. Historically, laws have played a crucial role also suitable for resource- in some of the greatest achievements in public health such constrained settings as environmental control laws, seat-belt laws, warnings on cigarette packs and other tobacco control measures, and water ﬂuoridation to reduce dental caries. Review of effective interventions Current laws relating to chronic disease have proved to be an effec- tive and central component of comprehensive prevention and control strategies. Legislation and regulations could be used control tobacco use include: more effectively to reduce the burden of chronic disease, and to protect » prohibition of tobacco advertis- the rights of people with a chronic disease. Interven- tions are grouped into three broad categories: very cost-effective, cost-effective or cost- ineffective. In 1999, the Philippines introduced major changes in tobacco control policies which have contributed to positive changes. Singapore’s smoking rate decreased The Philippines Clear Air Act of 1999 identiﬁed cigarette smoke as a pol- from an overall prevalence rate of lutant and instituted smoke-free indoor air laws. The national law allows 23% in 1977 to 20% in 1984, and to designated smoking areas in restaurants and other indoor areas, but some the lowest level ever, 14%, in 1987. This increase stimulated a to be smoke-free, improved training for students and teachers, and levied review of the situation and of the penalties for smoking. Consolidation The Tobacco Regulatory Act of 2003 seeks to increase public education of the Smoking (Control of Adver- measures, ban all tobacco advertising, strengthen warning labels on tobacco tisements and Sale of Tobacco) Act products, and prohibit sales to minors. Evidence of the success of this legislation in combination with other amendments to health warnings to interventions can be seen in the signiﬁcant drop in the number of students make them more conspicuous and who reported being current cigarette smokers or using other tobacco prod- bold, extension of the prohibition ucts over the period 2000–2003. The percentage of students who had never of smoking to all air-conditioned smoked but were likely to initiate smoking in the next year also decreased, offices, and continuing educa- from 27% in 2000 to 14% in 2003. Among adolescent boys, the percentage tion programmes and progressive of current tobacco smokers declined by around a third, from 33% in 2000 increases in taxation, contributed to 22% in 2003. Among adolescent girls, the decline was similar, from 13% to a second drop in rates, to 17% in 97 in 2000 to 9% in 2003 (8).
Already in 2011 safe 525mg anacin back pain treatment yahoo answers, a European Commission conference on the subject highlighted the role of molecular diagnostics in helping healthcare professionals identify which patients were most likely to respond to specific interventions buy 525 mg anacin otc pain treatment doctors. New diagnostic technology was making it possible to match patients with the most appropriate treatments purchase anacin 525mg amex neck pain treatment options. Since then diagnostics have become more sophisticated anacin 525 mg with mastercard shoulder pain treatment guidelines, and a revolution in information technology has made it possible for researchers to collect, store and analyse ever-larger quantities of data that are relevant to patient care. On 1-2 June 2016, the European Commission held a second conference on personalised medicine, this time to discuss a broader policy perspective. Putting the patient at the center of healthcare will require innovation in the way medicines are developed and healthcare systems are structured to deliver care. Under this new paradigm, the patient ceases to be the subject of research or treatment and instead becomes an active partner. This will require a big adjustment amongst all participants in the healthcare system. But the potential rewards can be significant: better healthcare at more affordable prices. They will use their own funding rules and policy processes to contribute to the overall goals of the consortium. As highlighted by the Commissioner, the focus of this consortium will be to make Europe a global leader in personalised medicine, define the research challenges and develop the science and drive innovation. Ruxandra Draghia-Akli, Director of the Health Directorate, Directorate-General for Research and Innovation, gave an overview of the subject. While there are other ways to describe patient-centric healthcare, such as stratified medicine and precision medicine, the Commission has elected to use the term personalised medicine. According to this definition, personalised medicine “…refers to a medical model using characterisation of individuals’ phenotypes and genotypes (eg molecular profiling, medical imaging, lifestyle data) for tailoring the right therapeutic strategy for the right person at the right time, and/or to determine the predisposition to disease and/or to deliver timely and targeted prevention. The Commission was an early mover in the field, already in 2011 it looked at the role of the ‘omics’ disciplines in helping understand the causes of disease. Robert-Jan Smits, Director-General for Research and Innovation, said that personalised medicine goes beyond the scope of pharmaceuticals to include other industries. It promises to make healthcare smarter and proactive and it is in line with the Commission’s priorities of supporting cutting edge research, driving innovation and creating new markets and jobs. It will rely on the ability of participants to integrate data from multiple sources and use this information to improve health without affecting patient confidentiality. He noted that inequalities still exist within healthcare systems at a national level. Personalised medicine is an opportunity to look at new ways of delivering healthcare, assessing healthcare technologies and monitoring regulatory systems to make sure that they are keeping up with innovation. It is an approach to healthcare that presents an opportunity to bring people together to work on big issues of common interest. There are opportunities for industry to develop new business models based on the widespread use of digital technologies. Personalised medicine also goes hand-in-hand with the development of 2 The Council conclusions on personalised medicine for patients can be consulted on the web page: http://eur- lex. While the regulatory aspects of some of the new technologies are being addressed, there remains the issue of the cost of personalised medicine. Roberto Viola, Director-General for Communications Networks, Content and Technology, addressed the issue of data. For example, computing power needs to be increased, with the possibility of creating a European science cloud. The Directorate-General for Communications Networks, Content and Technology plays various roles in the personalised medicine initiative; considering activities in e-Health, Big data and High Performance Computing. The regulatory aspects are equally important: such as data flows, cybersecurity and data exchanges. Using breast cancer as an example, he said molecular analysis has shown that there is not one, but several types of the disease. Yet will these new treatments help a woman with cancer who also lives in a deprived area and may also be suffering from obesity and diabetes? Personalised medicine may be a way of closing the gap between clinical medicine and the other aspects of real life that affect human health. These differences can be captured in data, but patients must consent to provide this data. Another question is whether it will be possible to produce a better quality of care at a reduced cost. This will require a shift from a system that reacts to disease to one that seeks to prevent disease. Patient-reported outcome statistics will make it possible to establish which interventions are necessary and which are not. Anders Olauson, Honorary President of the European Patients’ Forum, ended the session with a call for patient empowerment. This entails giving patients access to information that will enable them to work with doctors in the management of their own healthcare. Personalised medicine puts the patient at the centre of healthcare decision-making. She illustrated this with an example of a woman whose aunt had a gene mutation which was predictive of cancer. After genetic counselling, the woman asked to be tested and discovered that she too was positive and had a risk of developing cancer. This points to a new model for care where the patient is engaged in researching aspects of his or her own health. Diagnosed with lymphoma in 2005, Peter Kapitein is a founder of the patient advocacy group Inspire2Live. Based in the Netherlands, Inspire2Live has about 34 members who are living with cancer. They meet with clinicians, scientists and business people to identify parts of the cancer healthcare system that could be improved. The group supports a fundraising event each year where cyclists bike up and down Alpe d’Huez in the French Alps six times in one day. They are: engage people with different perspectives; search for the root cause of a problem; think on a big scale, and remain independent. Rudi Westendorp of the Center for Healthy Aging, University of Copenhagen, spoke about the relevance of personalised medicine to ageing. Prof Westendorp is author of the book, Growing Older Without Feeling Old: on Vitality and Ageing. He said that elderly citizens are concerned about disease but also about the quality of their lives. Members of the cooperative can decide to share their data with doctors or participate in medical research. This is one initiative to bring healthcare companies together to help the end-user, Prof Westendorp said. Jan Geissler, Director of the European Patients’ Academy on Therapeutic Innovation, told the meeting that patients need to be involved early in the clinical development of new medicines. A cancer patient for 15 years, Mr Geissler has many advocacy roles including as a co-founder of a global network of leukaemia patients. He said patients should be involved in the design of clinical studies, not just the final stages of these trials. The European Medicines Agency has set an example by involving patients in some of their committees. These social values include what interventions are appropriate for patients at the end of their lives.
Within the non-small cell lung cancer category anacin 525 mg line pain treatment winnipeg, there are again several different tumour types cheap 525mg anacin with mastercard joint and pain treatment center fresno. Lung and breast cancers are only two examples generic anacin 525 mg visa abdominal pain treatment guidelines, because it is possible to recognise several entities within the same tumour type for many other cancers cheap 525mg anacin otc advanced pain treatment center union sc. Lung Cancer – Not One Disease: Histological (Tissue) and Molecular Subtypes of Lung Cancer. On the right side, a pie chart showing the percentage distribution of molecular subsets of lung adenocarcinoma. Personalisation Requires Humanisation of Medicine We don’t have the defnitive solution for all cancers yet, but it is very important for patients and patient organisations to understand a few issues. It will be very hard, for example, to start talking Medicine Task Force to patients about the evaluation of 255 genes that may be altered in a tumour that metastasises to the brain; we need to begin seeing through the eyes of our patients. So personalisation starts with an individual relationship on the part of the physician and the medical team who are taking care of the patient. Personalisation also depends on a multidisciplinary approach; we need a range of experts, because we need the medical oncologist, the surgeon and the expertise of the molecular pathologist, who should be part of the team in a more effective, integrated way than before. We don’t need the pathology report alone; we need to interact with all professionals, including nurses, who are dealing with the patient. This, to me, will create a lot of problems in terms of organisation of care and in terms of cost, but it is the only way to bring together knowledge on the biology and pathology of tumours for effective treatment in every single patient. We now understand that some genes contribute signifcantly to making us resistant to illness, while other genes may make us more susceptible to specifc diseases. In our chromosomes there are also instructions to make drugs work, or fail, or to produce side effects. Cancer occurs when the switches inside our genes that control cell growth do not work. For example, if a growth gene is supposed to be turned off, in cancer it is turned on. Knowing that oncogenes are the key, there can be no doubt that gene-based prevention and therapy will be crucial in winning the war on cancer. Now, things are changing and advances in technology and the results of the Human Genome Project* have enabled researchers to identify the molecular features of each single tumour. Researchers have found that there is a wide heterogeneity among apparently similar tumours. Each person has about 25 000 genes, which are stored in the nucleus, the vital centre of every cell. If an alteration occurs in the gene, the instructions on how to build the protein will be wrong and therefore the message will not be delivered correctly. This phenomenon means that the tumour can survive and reproduce itself mainly because this alteration is present. It is therefore intuitive that giving a drug that targets these specifc alterations is fundamental in fghting the war against cancer. To explain briefy, it means that we have to deeply analyse each tumour of every patient in order to identify those genetic characteristics that make the tumour able to survive. As a result, we can choose the appropriate drugs to target the specifc alterations. The clearest examples of this process are in melanoma, lung cancer and breast cancer. When oncologists identify these mutations in a patient’s tumour, they may observe that the lesion disappears a few weeks after treatment. Unfortunately, oncogene addiction is not the only process underlying carcinogenesis* and tumour growth. The tumour environment and so-called “epigenetic” alterations* play an important role in rendering the fght against cancer more and more challenging. Despite the enormous recent advances, a specifc alteration has not been identifed in all cancers. The hope is that the possibility of sequencing the full genome – which means every gene – will give us new insights and therefore new drugs for our patients. This means that a particular mutation is conferring susceptibility to that person to develop a particular type of cancer during his/her life. Mutations that are not germline are called somatic mutations*, which are acquired mutations and are found generally only in the tumour. The move from blockbuster or empirical medicine* towards personalised medicine is a stepwise process. We are currently on the second step of stratifed medicine and moving up the stairs towards personalised medicine. Personalised Medicine and Pathology Will molecular pathology evolve from pathology? You need to give a name to a tumour, and a pathologist is the professional who gives a name to tumours. The variety of cancers is broad; when we say “sarcoma”, “carcinoma”, or “lymphoma”, we actually say nothing, because we have hundreds and hundreds of diseases within these categories that need to be recognised. We always thought that the problem was how genes become altered in the cancer cell, but actually it is even more complex than that and also involves the way genes direct how they are read; it is the fow of information that comes from genes to the making of their proteins which is as important as the aberration of the genome. Question from Selma Schimmel: “What do European patients really need to know, and learn and understand, regarding their own role in advancing molecular pathology, considering the importance that tissue analysis potentially plays in tailoring therapy? We need tissue because all of the information that we need is sitting in the tissue, in the biopsy samples. We are facing obstacles currently because the whole issue of tissue sampling has been regulated under the umbrella of privacy, which is of course important. Defending your rights as a human being is a key issue, but we should also try to focus a little bit on the necessity to use that tissue. Of course, we need to have rules, but the approach we are currently facing is basically preventing clinical research and translational research under the excuse of protecting our privacy as human beings, and this is an increasing obstacle. We as researchers, as molecular geneticists, as pathologists, are really looking into a future in which it is becoming increasingly diffcult to try to answer the basic question of cancer genomics. With the new therapeutic approach and the use of targeted therapy, molecular testing is gaining a very relevant role. It should be the doctor who explains to the patient the reason why molecular testing is performed; the doctor has to explain that molecular testing will fnd whether there is some tumour characteristic which can be targeted with one of these therapies, in order to determine if maybe the patient is the right Women Against Lung Cancer candidate to receive targeted therapy and perhaps to beneft from it. This can be important also to empower the patient in treatment decisions, but it is important that he/she knows that not every patient may be a candidate for receiving targeted therapy and to understand why this is the case. Chemotherapy In the past, the most important part of the treatment of many cancers was chemotherapy, due to the systemic nature of most of the disease and the potential of malignant cells to spread to other parts of the body early in the course of the disease. Today, in the era of targeted therapy, chemotherapy still remains the cornerstone of treatment for the majority of malignant diseases. The mechanism that underlies chemotherapy is based on killing cells that divide rapidly. Unfortunately, chemotherapy also harms healthy cells that divide rapidly under normal circumstances: cells in the bone marrow, digestive tract and hair follicles. This effect on healthy cells results in the most common side effects of chemotherapy: myelosuppression (decreased production of blood cells, hence also immunosuppression), mucositis (infammation of the lining of the digestive tract) and alopecia (hair loss). In the past, one of the major problems with chemotherapy was acute nausea and vomiting. However, nowadays several powerful anti-nausea agents are available and this problem has become more manageable.
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