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[MEDSCAPE]: 2017年最受关注的10项临床趋势
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The Top 10 Clinical Trends of 2017

Ryan Syrek, MA | December 21, 2017 | Contributor Information

Every week, we identify a top search term and consider what news, new study, or other factor caused an increase in popularity. We combine this information with an infographic about key information regarding a related condition to create the Clinical Trend of the Week. You may be surprised at what search terms were most popular this year! Here are the top 10 clinical trends for all of 2017.

Trend 10: PCOS

A study about the development of a serious associated condition and a new research analysis about an overall diagnostic approach resulted in this top search term in late September. A Danish study confirmed that women with polycystic ovary syndrome (PCOS) have a significantly increased risk of developing type 2 diabetes mellitus at a younger age. Women with PCOS were four times more likely to develop type 2 diabetes than controls; the type 2 diabetes event rate was also four times higher among women with PCOS.

Meanwhile, a research analysis published in the BMJ argues that a more thoughtful, deliberate approach to diagnosing PCOS is needed, because the current "one-size-fits-all" approach is potentially causing harm. The authors suggest that labeling women who fit broad diagnostic criteria at one stage in their life suggests to them that they will experience all associated metabolic and cardiovascular consequences, when not all types of PCOS are associated with those risks. The popularity of this search term suggests that healthcare providers are actively seeking more precise information to help guide patients with this potentially serious condition.

For more information on PCOS, read here.

Trend 9: Shingrix Vaccine

A newly approved vaccine designed to help older adults battle a painful disease resulted in a top search term in early November. The US Food and Drug Administration (FDA) approved GlaxoSmithKline's recombinant zoster vaccine (Shingrix) for the prevention of herpes zoster (shingles) in adults aged 50 years or older. The vaccine is given in two doses, with 2-6 months between doses, and is intended to generate a response that can overcome declining immunity associated with age.

In addition, the federal government's Advisory Committee on Immunization Practices narrowly voted to recommend Shingrix over a live, attenuated virus shingles vaccine in adults aged 50 years or older. Although the vote to recommend was 8 to 7, the group indicated the close margin was more of a response to Shingrix having been so recently approved than to confidence in the vaccine. With efficacy estimates of 97% in adults aged 60-69 years and 91% in those aged 70-79 years, optimism is high, as were searches for this top term.

For more information on shingles, read here.

Trend 8: Rheumatoid Arthritis

In late April, news about risk and a key drug denial resulted in a top search term. A study in Annals of Rheumatic Diseaseinvestigated the role of diet in the risk for rheumatoid arthritis (RA). The study of over 76,000 women, more than 1000 of whom had confirmed RA, evaluated the role of "healthy eating patterns" before a diagnosis of RA. A food-frequency questionnaire and multi-item semiquantitative instrument assessed whether dietary habits were healthy. The results showed that a healthier diet was associated with a significantly reduced risk for RA in women whose disease onset occurred at age 55 years or younger, particularly in women within that group who developed seropositive RA. Unsurprisingly, lower alcohol intake and lower red meat intake were most associated with reduced risk.

Meanwhile, baricitinib was rejected by the FDA for use in RA. The agency said that more information on safety and efficacy was needed before approval could be granted, which means a likely postponement until 2019 or later. As clinicians keep an eye on both of these developments, the term will remain a popular search.

For more information on RA, read here.

Trend 7: Appendicitis

Debate over a potential new approach to treating a relatively common condition was responsible for the top search in mid-August. A meta-analysis compared antibiotic therapy with surgical treatment in patients with uncomplicated appendicitis. This prompted a response from Dr Albert Lowenfels, who had many unresolved questions about the role of antibiotics in appendicitis and suggested that surgery will continue to be the "dominant treatment strategy." In turn, surgeon leaders of the Patient-Centered Outcomes Research Institute-funded trial Comparing Outcomes of Drugs and Appendectomy (CODA) responded by agreeing that appendectomy should be considered over antibiotics. However, those surgeons also encouraged patients and clinicians to remain "open-minded about the potential value of antibiotics while at the same time not offering antibiotics for appendicitis as part of usual practice." The CODA trial seeks to provide more information on this ongoing debate, and further studies on the issue are likely as well.

For more information on appendicitis, read here.

Trend 6: Chronic Fatigue Syndrome

An investigation into the origins of a sometimes controversial condition was responsible for the top search term in the last week of January. A new study suggests that blockage of a metabolic enzyme could be responsible for the symptoms experienced in myalgic encephalomyelitis/chronic fatigue syndrome. The findings suggest that a reduction in the amino acids that fuel oxidative metabolism could result in a shortage of energy in muscles and a build-up of lactate. This may have major implications for understanding and treating a challenging condition, leading to the popularity of this top term.

For more information on chronic fatigue syndrome, read here.

Trend 5: Vitiligo

A potentially promising treatment for a fairly common condition was responsible for this top search term in late July. Vitiligo, which has a prevalence rate of 1%-2%, is notoriously difficult to treat. This is why the potential use of Janus kinase inhibitors represents an exciting development. A proof-of-concept study found that twice-daily topical ruxolitinib 1.5% cream was associated with a 23% overall improvement in Vitiligo Area Scoring Index totals. The scores were most improved for facial vitiligo, and side effects were mild. The next step is randomized, placebo-controlled clinical trials that will help quantify the efficacy and clarify the safety. Further news is no doubt eagerly awaited by patients with vitiligo and those who treat them.

For more information on vitiligo, read here.

Trend 4: Pancreatic Cancer

A complex connection with another condition resulted in this top search term from mid-February. A European study of more than 550,000 patients with type 2 diabetes found that receiving glucagon-like peptide-1 receptor agonists, or insulin mimetics, was associated with an increased risk of developing pancreatic cancer. However, the findings also suggest that the risk diminished rapidly after diagnosis. In addition, "reverse causation" is a possibility, because asymptomatic pancreatic cancer that initially caused diabetes before progression to a symptomatic state may be at work. Given this complicated association, it's no wonder that the top search term, "pancreatic cancer," was followed by "diabetes" in terms of popularity in mid-February.

For more information on pancreatic cancer, read here.

Trend 3: Parkinson's Disease

A trio of studies were responsible for the top search term the first week of September. First, a retrospective, case/control analysisfound that patients with Parkinson's disease have a nearly fourfold increased risk of having preexisting melanoma and that those with melanoma have a similar risk of developing Parkinson's disease. Although the study's authors did not strongly recommend screening for all such patients, they did recommend that physicians counsel patients with melanoma about the risk for Parkinson's disease and vice versa.

A separate study compared specialist care for Parkinson's disease using virtual house calls with traditional in-office visits. The findings showed increased patient satisfaction and preference for the virtual house calls, with a significant benefit of reduced time and burden of travel.

Finally, a randomized, double-blind, placebo-controlled trial suggested that the type 2 diabetes drug exenatide may potentially have disease-modifying effects in patients with Parkinson's disease. The study found that the medication was associated with improved off-medication motor scores, with benefits persisting for several weeks after discontinuation of the drug. From a significant newly documented association with another serious condition to potential new ways to provide care and treatment, this search term had many reasons for its popularity.

For more information on Parkinson's disease, read here.

Trend 2: Magnesium Deficiency

Speculation on the death of a beloved celebrity resulted in the top clinical trend for early 2017. Carrie Fisher—an outspoken mental health advocate, author, and actress—died a few days after becoming suddenly unresponsive while on an airplane. Although nothing is certain, Dr George D. Lundberg suggested the possibility that chronic magnesium deficiency may have been the cause of her untimely death. He described how low magnesium levels can trigger various cardiac rhythm abnormalities, including fatal ones.

Dr Lundberg explained that regardless of whether magnesium deficiency ultimately contributed to Fisher's death, it is a serious and commonly overlooked medical condition that deserves more consideration. Hopefully, the fact that magnesium deficiency is one of the top searches in 2017 is a sign that clinicians are doing just that.

For more information on magnesium deficiency, read here.

Trend 1: Viral Encephalitis

Several pieces of news from around the world combined to influence 2017's top search term. Initially, a study examined the impactof Nepal's efforts to vaccinate against Japanese encephalitis. The analysis found that the impact was even stronger than first thought, as the incidence rate of the virus dropped 78%, with an estimated 3011 cases prevented.

Meanwhile, a teen in Sacramento, California died of an invasive form of encephalitis. Her death was unexpected, because her diagnosis was originally accompanied by a positive prognosis until massive organ failure set in days later.

Finally, a study that screened inhibitors of Japanese encephalitis approved by the FDA identified five drugs, most notably calcium inhibitors, that blocked viral replication. Although this condition may not be on the minds of most healthcare professionals, the various items of interest resulted in this 2017's top search term.

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